Vol 9, No 5 (2023)

Cerebrovascular diseases and COVID-19 are comorbid conditions. Endothelial dysfunction is one of the pathogenetic mechanisms for cerebrovascular diseases and COVID-19 development. Laboratory feature of endothelial dysfunction is a change in the level of endothelial dysfunction biochemical markers in the blood serum of patients.

The aim: to study the diagnostic and prognostic value of biochemical markers of endothelial dysfunction in patients with dyscirculatory encephalopathy (DE) who underwent COVID-19.

Material and methods. For the period from 03/01/22 to 05/31/22, 172 patients were examined, including 137 (79,6%) female and 35 (20.4%) male patients who had COVID-19 and are being examined at the base polyclinic No. 2 of the Central clinical medical and sanitary unit named after honored doctor of Russia V.A. Egorov, Ulyanovsk. Median time from the onset of COVID-19 to examination was 4.8 months. DE was not found in 6% of patients who underwent COVID-19, stage I DE was present in 45%, stage II in 27%, stage III in 22% of participants of the study. Blood sampling was carried out once during the all examination period. Levels of vasculoendothelial growth factor (VEGFA), interleukins 6, 10, 18, tumor necrosis factor-alpha, and monocytic chemotactic protein 1 were studied in blood serum. The Mann–Whitney U-test was used to test the hypothesis of a difference in the samples of patient groups. For all types of statistical analysis, differences were considered to be significant at the achieved significance level p <0,05.

Results. According to our research, with an increase of the age of patients who have undergone COVID-19, and the DE stage the level of VEGFA in serum was also increasing (p <0,05).

Conclusion. From studied cytokines, the predictive role as a marker of endothelial dysfunction was shown by VEGFA. Its high level in blood serum is associated with the age of DE patients, who have undergone COVID-19, and with the stage of DE they had.

Corticosteroids are used as first-line immunosuppressants in case of myasthenia gravis. The scheme and duration of this group of drugs, which allows to achieve the maximum effect of therapy, is still the subject of active scientific research.

The aim: to compare the efficacy of alternative steroid hormone regimens in patients with generalized myasthenia gravis by examining the correlation between dosing regimen and achievement of the optimal therapy goal.

Material and methods. We studied 43 patients with generalized form of myasthenia gravis with a severity of 2–4 classes according to the MGFA scale, who were divided into two groups depending on the dosing regimen of oral corticosteroid. The maximum dose of hormones was 0,8–1,0 mg per 1 kg of the patient’s body weight.

Results. The vast majority of patients responded well to therapy, they showed a significant improvement in their condition and a decrease in the need for anticholinesterase therapy, or a complete rejection of it. Comparative analyzes have shown the advantage of a slower dose reduction regimen. The condition of patients in this group 1–3 months after the end of treatment was significantly better in terms of daily functions, quality of life and survival than in the group receiving therapy according to the «short» regimen, and the onset and maintenance of remission after the end of steroid action was noted in 2,5 times more often.

Conclusion. Thus, reasonable and carefully selected standard therapy regimens significantly improve the results of myasthenia gravis therapy and the perspectives for patients.

Hypertonic cerebral microangiopathy (hCMA), type 2 diabetes mellitus (DM) and COVID-19 are independent factors in cognitive deficits development, but there there are no data concerning potentiation of their negative impact at cognitive functions.

The aim: to reveal the impact of type 2 DM and survived COVID-19 at the severity and peculiarities of cognitive disorders in patients with hCMA.

Materials and methods. We examined 33 patients with hCMA, 30 with hCMA and type 2 DM, and 33 with hCMA and type 2 DM who had undergone COVID-19 in the previous year. Clinical and neurological examination, neuroimaging, estimation of cognitive disorders using Frontal dysfunction Battery (FAB) and Montreal cognitive assessment scale (MoCA) were performed.

Results. Patients with a combination of type 2 DM and hCMA differed from patients with isolated hCMA in a greater severity of regulatory dysfunction according to FAB data. Taken place during the previous year, COVID-19 exacerbated cognitive impairment in patients with hCMA in combination with type 2 DM, as evidenced by the analysis of the results of MoCA. 82% of patients with hCMA and type 2 DM who underwent COVID-19 had moderate or severe cognitive disorders according to MoCA data. The increase in cognitive deficit in this category of patients occurred mainly due to the deterioration of visuospatial and mnestic functions.

Conclusion. Type 2 diabetes melitus leads to an increase in regulatory dysfunction in patients with hCMA. COVID-19 contributes to the aggravation of cognitive decline in patients with a combination of hCMA and type 2 DM, negatively affecting primarily the visuospatial and mnestic spheres of cognitive activity.

Studies aimed at studying cardiovascular risk factors (CVR) in young and middle-aged people are few and usually limited to traditional risk factors (RF) estimation.

The aim: to assess the incidence of anxiety and depression in young and middle-aged people, their relationship with CV risk factors and multimorbidity.

Material and methods. A cross-sectional comparative study was made; it involved 94 individuals aged 25–59 years. A physical examination, assessment of RF, CVR, comorbidities, anxiety and depression on the HADS scale were performed.

Results. The majority of those included in the study were young (89,3%) and female (61,8%), had an active lifestyle (80.9%) and corresponded to a low cardiovascular risk (80,8%). Overweight was present in 37,5%, obesity in 12,7%, coronary heart disease (CHD) in 11,7%, diabetes mellitus (DM) in 10,6% of patients, and 27,6% smoked. Anxiety-depressive spectrum disorders were detected in 36,2% of patients: 29,8% had subclinical anxiety, 14,9% had subclinical depression. The association of subclinical anxiety-depressive status with moderate CV risk (OR 29,3) was confirmed. DM (OR 8,7), cardiovascular diseases in parents (OR 4,2), sedentary lifestyle (OR 4,0), CHD (OR 36,1), DM (OR 30,8), obesity (OR 6,2) and multimorbidity (OR 17,8) were associated with subclinical anxiety.

Conclusion. Association of subclinical anxiety and depression with moderate CV risk and CHD, DM, multimorbidity – with subclinical anxiety allows us to consider the latter as an additional modifier of early cardiovascular multimorbidity. The results confirm the advisability of screening for subclinical anxiety and depression in young and middle-aged individuals with moderate CV risk, as it is an accessible method for obtaining additional information that allows initiating a comprehensive risk assessment.

Laboratory indexes representing the pathogenesis of multiple sclerosis (MS) may become earlier and more dynamic biomarkers of disease activity and progression, as well as individual response to treatment, comparatively with clinical and radiological characteristics of the patient’s clinical status. At the same time, the heterogeneity of research design and methods for laboratory markers determining makes it difficult to make meta-analysis of numerous studies. The aim of this article is a descriptive analytical review of publications over the last 30 years on the most promising potential biomarkers of the course of MS in eLibrary, PubMed databases. In order to introduce laboratory biomarkers of the course of MS into practice, further studies are needed, the analysis of which can allow the development of convincing and evidence-based clinical recommendations with the characteristics of sensitivity, specificity of laboratory biomarkers, prognostic values and boundaries for their levels for making a clinical decision.

Self-monitoring of blood glucose levels is an important part of the treatment of type 1 and type 2 diabetes mellitus (DM). Regardless of the type of therapy received, patients with type 2 DM who regularly conduct self-monitoring of glucose levels have better glycemic control through active participation in treatment and lifestyle changes, and also have the opportunity to timely adjust therapy by the attending physician as needed. Studies using structured glucose self-monitoring often show significantly greater improvement in glycemic control compared to unstructured self-monitoring. Modern glucometers have such advantages as high accuracy of readings, integration with a mobile application that combines the function of a self-monitoring diary, the ability to analyze results at the time of the study, and generate reports for interpretation by the attending physician. All this makes it possible to use self-monitoring of glucose as a convenient tool for the treatment of type 2 DM.

Cerebral autosomal dominant arteriopathy with subcortical infarctions and leukoencephalopathy (CADASIL) often causes diagnostic difficulties, which is facilitated by its clinical heterogeneity. The aim of the study was to describe three clinical cases of CADASIL in two adjacent generations of the same family in order to demonstrate the phenotypic variability of this pathology and increase medical alertness in that direction. Heterogeneity of CADASIL clinical manifestations in described clinical cases was manifested in a younger age of the symptoms’ onset in two sons of the female proband-patient; differences in the types and severity of strokes (mild lacunar in the mother and severe hemorrhagic in her eldest son), as well as the early onset and greater severity of cognitive disorder in youngest son. Common for all three patients was the absence of migraine, which is not typical for CADASIL in European geographical regions. This feature cannot be explained by the type of missense mutation p.Tyr189Cys found in the family in exon 4 of the NOTCH3 gene, since the same mutation was previously described by other authors in CADASIL patients with migraine. Medical alertness regarding CADASIL in young and middle-aged people with ischemic stroke and cognitive decline should take place even in cases where patients don’t have a headache.

Lacunar brain strokes are an independent form of acute disorders of cerebral circulation and represent a heterogeneous group of diseases. A detailed analysis of the pathological process with an emphasis on the causes leading to decompensation will help to real prediction of the course of the disease and the preparation of reasonable individual rehabilitation programs not only in the acute, but also in the subsequent periods of a stroke. In introduced clinical case, attention is focused on the features of management, diagnosis and treatment of a comorbid patient with acute cerebrovascular accident.

Sociomedical expertizing (MSE) is carried out to recognize a person as a disabled person and to determine, in the prescribed manner, the needs of the examined person for social protection measures, including rehabilitation, based on an assessment of life activity limitation (LAL) caused by a persistent disorder of body functions. MSE of a person is carried out according to the referral of health authorities of the medical organization to the MSE bureau. An expert decision is made on the basis of a comprehensive assessment of the state of the person’s body based on an analysis of clinical, functional, social, professional, labor and psychological data. To recognize a patient as a disabled person, it is necessary to have two of three conditions: a health disorder with a persistent disorder of body functions due to diseases, the consequences of injuries or defects; LAL; the need for rehabilitation and habilitation measures. To recognize a person as a disabled, he must have disability criteria approved by the «Criteria and classifications used in the implementation of medical and social examination of citizens of the Russian Federation».

The article presents the Resolution of the Expert council «Iron-deficiency anemia».

The article considers strategies for improving the tolerance of oral iron preparations. The main strategy is a decrease of a single dose or a change to the use of drugs with a lower content of elemental iron, an increase in the interval between taking a drug, an intermittent dosing regimen. According to domestic clinical guidelines, it is advisable to use doses of low-range iron preparations. Higher doses potentially increase side effects due to excess unabsorbed iron remaining in the gastrointestinal tract. An opinion is being formed that a single daily dose of 40–60 mg is preferable to reduce undesirable effects and optimize the proportion of absorbed elemental iron. Among divalent compounds, iron sulfate is most often used, the percentage of iron absorption from which is the highest comparatively to other salts of this microelement. Modern dosage forms of ferrous sulfate with modified release have both high bioavailability and good tolerability. Oral iron preparations improve hematological status but also increase oxidative stress even in female patients with low iron stores. Folic acid deficiency contributes to the aggravation of the damaging effects of oxidative stress, as it leads to a decrease of methionine production, which leads to a decrease in the production of natural antioxidants (glutathione) and sulfur-containing amino acids (taurine and cysteine). Intake of iron in combination with folic acid improves the safety of pharmacotherapy by optimizing the activity of the antioxidant system through the regulation of transcription of genes associated with oxidative stress in liver, the activity of Fe²⁺ ion carriers (DMT1) and ZRT/IRT.

Considerable medical and social significance of musculoskeletal system pathology is due to their wide prevalence, big negative impact at the physical and psycho-emotional state, quality of life and working capacity of patients. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in the treatment of acute and subacute musculoskeletal pain. The subject of serious concern of specialists is the high incidence of serious adverse reactions with the systemic use of these preparations. There are several ways to improve the safety of NSAIDs therapy, including use of dosage forms for external application, which is one of the best approaches to reduce the risk of unwanted side effects. Among the external forms of NSAIDs, transdermal patches deserve special attention. They provided the accuracy of the dosing regimen, ease of use, efficacy and safety of therapy.