Том 7, № 5 (2021)

The aim of the study is to assess the influence of social isolation measures put in force due to COVID-19 pandemic at the mental health and life quality of older people suffering from dementia and their caregivers. Material and methods. During the study, a systematic search was carried out in the PubMed database for the following key words: COVID-19, coronavirus, SARS-CoV-2; dementia, Alzheimer's disease, cognitive impairment and behavioral disorders. There was no time limitations for the literature search. Consequentially, the study included articles published before January 10, 2021 (last day of search). There were also no restrictions on the type of articles. Works devoted to the study of pediatric or young-age patients, studies of medical personnel, materials concerning the pathogenesis and therapy of COVID-19, studies aimed at assessing the direct effect of the virus on the nervous system were excluded. Results. In accordance with selected criteria 1640 articles in PubMed were found. Only 19 from them reflected the problem of the impact of social isolation measures introduced in connection with the COVID-19 pandemic on people's mental health and life quality, and only 6 articles met all the search criteria Conclusion. The results of the performed studies indicate that the restrictive measures put in force to hold the COVID-19 spread have an adverse influence at the emotional and behavioral sphere of dementia patients. People with cognitive impairments are especially vulnerable during periods of self-isolation. Their need for care, medical and social rehabilitation cannot be adequately met with quarantine measures implementation. All these consequences must be taken into account after the COVID-19 crisis has been overcome in order to develop rehabilitation measures for dementia patients.

Aim of the study: estimation of the efficacy and safety of Ingavirin® inclusion in the recommended standard therapy for COVID-19 patients in real clinical practice. Material and methods. A prospective non-interventional study included hospitalized patients of both sexes aged 18-75 years with laboratory-confirmed diagnosis of moderate COVID-19, accompanied by specific bilateral changes in the lungs according to CT data with the need for oxygen therapy performance (category 4, WHO scale). The duration of the disease from the moment the first symptom appeared to the first dose of the study drug intake was «7 days, the period from the moment of hospitalization to the first dose intake was «48 h. Before the inclusion in the study, all patients were prescribed COVID-19 therapy - Ingavirin®, capsules, 90 mg and/or the standard therapy (ST) of COVID-19 recommended by the Ministry of Healthcare of Russia. Ingavirin® was prescribed in accordance with instructions for medical use: 2 capsules (180 mg) of the drug in the first 3 days and 1 capsule (90 mg) in the next 4 days, orally once a day, regardless of food intake. The condition of the patient was assessed at baseline (day -1/1 of the study), daily during the treatment period (days 2-7), on the 8th, as well as on 14±1 and 21±1 days of the study in person or by telephone interview, if the patient was discharged from the hospital. Results. 80 patients were included (40 persons in each of the two cohorts). The mean age of the study participants was 58, 15± 10,5 (56,73±10,19 in Ingavirin® + ST cohort, 59,58± 10,75 in the ST cohort). There were no significant differences in basic demographic and clinical data between cohorts (ANOVA, p <0,05). Time to the onset of clinical improvement, assessed by stable normalization of body temperature, respiratory rate and SpO2 (the main efficacy outcome), significantly decreased when Ingavirin® was added to standard therapy: 4,5±0,925 and 7,1±1,037 days, respectively (Mantel-Cox log-rank test: p=0,015; Breslow test: p=0,007; Tarone-Ware test: p=0,007). The proportion of patients with clinical improvement in the Ingavirin®+ST cohort was significantly higher than in the ST cohort by the 5th day of therapy (89,2% versus 64,1%, respectively; Fisher's exact test, p=0,015). The mean change (dynamics) in the severity category according to the WHO scale in the morning and in the evening in the Ingavirin® + ST cohort was significantly more evident than in the ST cohort (in the morning p=0,017; in the evening, p <0,001). The mean time to reaching 3rd category and below on the WHO scale was 10,34±1,025 days in the Ingavirin® + ST cohort and 14,96±0,974 days in the ST cohort (log-rank test: p=0,007; Breslow test: p=0,002; Tarone-Ware test: p=0,003). A decrease in the severity of the condition according to the WHO scale up to category 3 was fixed in 44,4% of patients in the Ingavirin® + ST cohort and in 10,5% in the ST cohort on the 6th day of therapy (Fisher's exact test, p=0,001). By the 7th day of treatment, an improvement in the patient's status according to the WHO scale was observed in 50% of cases in the Ingavirin® + ST cohort and in 18,4% in the ST cohort (Fisher's exact test, p=0,006). The mean time to reaching «2 points on the NEWS severity scale in the Ingavirin® +ST cohort was 5,233±0,847 days, in the ST cohort - 7,797±1,080 days (Mantel-Cox log-rank test: p=0,037; Tarone-Ware test: p=0,044 ). The proportion of patients with the need for oxygen support by 6 and 7 days of therapy in the Ingavirin® + ST cohort was 52,8% and 41,7%, respectively. In the ST cohort, the proportion of patients requiring oxygen therapy was significantly higher - 89,5% and 84,2%, respectively (Fisher's exact test, p=0,001 (6th day), p <0,001 (7th day)). The mean time to reaching SpO2 s95% was 6,401±1,096 days in the ST cohort and 3,625±0,823 in the Ingavirin® + ST cohort. The cohorts showed a significant statistical difference (log-rank test: p=0,020; Breslow test: p=0,022; Tarone-Ware test: p=0,012). The largest proportion of patients with a day and night cough score of «2 by the 3rd day of treatment was found in the Ingavirin® + ST cohort - 97,5% (compared to 80,5% in the ST cohort; Fisher's exact test, p=0,029). Conclusion: The inclusion of Ingavirin® in the scheme of recommended standard therapy for COVID-19 leads to a faster achievement of clinical improvement, an adequate level of saturation and positive integral clinical dynamics.

The aim: to study the features of vascular blood flow, cardiohemodynamics and cardiovascular remodeling in patients with chronic kidney disease (CKD) stages 3A-5D, depending on the clinical parameters and the severity of CKD, as well as the identification of the relationship between the level of interleukin-6 (IL-6) in the blood serum with the discussed parameters. Material and methods. The study included 80 patients (34 men and 46 women; average age 58,9±13,1 years) with CKD stages 3A-5D. The cohort of patients included in the study was divided into two groups: the first (pre-dialysis) group included 40 patients with CKD stages 3A-5, the second (dialysis) group included 40 patients with CKD 5D stages receiving treatment with programmed hemodialysis. Results. In the general cohort of patients, the level of IL-6 was higher than normal values in 85% of cases (in group 1 - in 92,5% of patients, in group 2 - in 77,5% of patients). The increased level of IL-6 in the pre-dialysis group was more common and amounted to 13,1±0,9 vs 24,5±3,8 pg/ml in the 2nd group. The prevalence of sarcopenia in the 1st group was 12,5%, and in the 2nd group - 42,5%. It was found that renal blood flow in all vascular zones, from the orifices of the renal arteries to the interlobular zones, was significantly reduced in group 2 compared with group 1. At the same time, an increase in IL-6 was associated with an increase in blood flow velocity in interlobular arteries and with an increase in the thickness of the common carotid artery intima-media complex. Conclusion. IL-6 makes a significant contribution to the progression of vascular remodeling, as well as the development of sarcopenia in patients with CKD stages 3A-5D.

Borrelia burgdorferi infection, the tick-borne spirochetosis known as Lyme disease or Lyme borreliosis often involves the nervous system (neuroborreliosis). Common manifestations include lymphocytic meningitis, encephalopathy, cranial neuritis (Bells palsy) and radiculoneuritis. Chronic patients also develop inflammation in the brain or spinal cord . Every known neurologic disorder has been blamed on this infection. For most (multiple sclerosis, amyotrophic lateral sclerosis, Alzheimer disease, vascular dementia, Parkinson disease, osteochondrosis). For some (cerebral vasculitis with stroke, optic neuritis) a few case report.

According to epidemiological studies in recent years, tension headache (HAT) has become not only the most common form of headache, but also the most common neurological pathology in the world. The onset of HAT often occurs in childhood and adolescence, which is not sufficiently taken into account by specialists. Late and inaccurate diagnosis of HAT leads to the lack of timely rational treatment, adversely affects the socio-psychological adaptation of patients. The review highlights the multifactorial pathogenesis of HAT, including peripheral and central mechanisms that provoke HAT factors. The classification of HAT and features of its clinical manifestations in pediatric age are presented. In children and adolescents with HAT, insufficient attention is paid to identifying comorbid disorders that affect the HAT clinical course and may contribute to its chronicity. Meanwhile, with timely diagnosis and adequate therapy, many patients with HAT achieve a significant improvement in the course and prognosis of the disease, also clinical remission is possible. Modern approaches to preventive therapy of HAT in children and adolescents are discussed.

Acute cerebrovascular accidents (ACVA) are common diseases in people of different sex and age. The causes of ACVA are different and deviate depending on age groups. Currently, there is an increase of stroke incidence in young patients. At a young age, ACVA can develop in persons with congenital connective tissue disorders. Such typical hereditary connective tissue diseases as Marfan syndrome, Ehlers-Danlos syndrome, Lois-Dietz syndrome and elastic pseudoxanthoma are considered thoroughly. The diagnostic criteria for these diseases, data on their prevalence and peculiarities of concomitant ACVA are presented.

Despite the progress that was reached in the treatment of chronic heart failure (CHF), the mortality and the frequency of hospitalizations, remain high. The search for new treatment options for CHF that can improve the prognosis of the disease is still an urgent problem. Sodium-glucose cotransporter type 2 (SGLT2) inhibitors developed for the treatment of type 2 diabetes mellitus have demonstrated improved prognosis in patients with cardiovascular disease (CVD) regardless of the presence or absence of diabetes. This review is devoted to the discussion of modern methods of treatment of heart failure with reduced left ventricular ejection fraction (HFrEF), the status and perspectives for the use of SGLT2 inhibitors in this category of patients. Possible mechanisms of action of SGLT2 inhibitors that prevent the development of cardiovascular complications are considered. Special attention is paid to the analysis of the EMPEROR-Reduced study, which proved the effectiveness of the administration of empagliflozin in addition to standard therapy in patients with HFrEF.

The introductory part of the article provides a concise literature review on the etiology, classification, frequency and variants of systemic sclerosis (SSc). The article presents a clinical case of a 78-year-old female patient with a clinical diagnosis of SSc. She was diagnosed with interstitial pulmonary fibrosis in systemic sclerosis based on clinical manifestation, radiological and laboratory findings. The autopsy revealed interstitial pulmonary fibrosis with cellular degeneration. Histological examination demonstrated a combination of gentle collagen fibrosis with honeycombing, nonspecific interstitial pneumonia with elastic tissue, and microscopic features of secondary pulmonary arterial hypertension.

Poorly cohesive gastric carcinoma (signet ring cell carcinoma according to WHO classification, diffuse type of gastric cancer according to Lauren 1965 classification) is a type of cancer, consisting of cells that produce mucin, which displaces the nucleus to the periphery, which makes the cells look like a ring. One of the main causes of development is a mutation of the gene encoding the protein molecule E-cadherin (CDH1), which is responsible for intercellular connections and differentiation of epithelial cells. This case-report demonstrates the patient with signet ring cell carcinoma of the stomach and a discussion of the features of this type of cancer and diagnosis.

The article reviews the issues of pathogenesis, clinic, diagnosis and treatment of chronic brain ischemia. Highlights of the development of «small vessel disease», endothelial dysfunction, processes of lipid peroxidation, apoptosis as well as neuroplasticity. The necessity of joint management of patients with chronic cerebral ischemia by neurologists and doctors of other specialties and the appointment of individualized pathogenetic therapy are noted.

The article discusses the definition of dementia, its diagnostic criteria, classification, etiology of occurrence. Among the leading causes of dementia are Alzheimer's disease (AD), vascular brain damage and mixed dementia, which is most often a combination of AD and vascular dementia. The issues of diagnostics of dementia are covered in detail. The modern approaches to the treatment of dementia with the use of non-drug and medication methods of treatment are considered. The prospects of using Akatinol Memantine (мemantine), an original drug with high efficacy and good tolerance in patients with dementia, have been noted.

Despite the fact that by now a lot is already known about the new coronavirus infection, the issues of its etiotropic and pathogenetic therapy remain still relevant. The instructions for the medical use of the antiviral drug Cytovir®-3 have been amended, indicating that it has a specific activity against the pathogen COVID-19.