Vol 21, No 9 (2019)
Articles
GENDER-RELATED DIFFERENCES IN CLINICAL COURSE AND PROGNOSIS IN PATIENTS WITH ISCHEMIC STROKE
Abstract
Today the impact of gender differences on stroke severity and fuctional recovery after stroke is still not well understood. Most often the gender differences in stroke outcomes are explained by the fact that women are usually older than men at the time of stroke onset, they have more risk factors and a higher comorbidity, a worse functional and cognitive status, and they are more often socially isolated than men. Cardioembolic stroke is more often diagnosed in women, athe-rothrombotic stroke occurs more frequent in men. Women have a higher prevalence of stroke in the carotid artery system, stroke in the vertebrobasilar system is more common in men. Compared with men, women have more severe stroke. Women’s delays in arrival to hospital, the presence of severe comorbidity lead to lower use of thrombolysis and limit appropriate secondary prevention of stroke. The prognosis, long-term outcome and functional recovery after stroke are unfavorable in women. Women more likely to develop post-stroke depression and they have a poorer quality of life after stroke than men.
Consilium Medicum. 2019;21(9):9-16
9-16
CLINICAL CASE DESCRIPTION OF THROMBOEXTRACTION IN PATIENTS WITH ATHEROTHROMBOTIC AND CARDIOEMBOLIC PATHOGENETIC VARIANTS ACCORDING TO THE CRITERIA OF TOAST (TRIAL OF ORG 10172 IN ACUTE STROKE TREATMENT: CLINICAL CASE
Abstract
Ischemic stroke occupies one of the leading positions among the most significant problems of medicine due to the high incidence of this disease and a high percentage of disability. Reperfusion therapy for this pathology makes it possible to improve the functional outcome of these patients by reducing the volume of the ischemic focus in the brain or completely preventing its development. Thromboextraction is one of the most actively developing areas of reperfusion therapy in patients with ischemic stroke. The main advantage of this method is the extension of the time interval up to 6 hours from the onset of the development of the disease. In connection with the active introduction of thromboextraction, interest arose in the study of distant thrombi. This clinical observation demonstrated a description of patients with ischemic stroke in the basin of the left middle cerebral artery, but with different pathogenetic options according to the TOAST criteria (atherothrombotic and cardioembolic), which underwent a mechanical thromboextraction procedure using a stent retriever followed by histological evaluation of blood clots.
Consilium Medicum. 2019;21(9):16-23
16-23
CURRENT OPPORTUNITIES FOR IMPROVING RECOVERY POTENTIAL IN ELDERLY PATIENTS AFTER ISCHEMIC STROKE
Abstract
Aim. The aim of this open randomized controlled trial was to study the dynamics of the ciliary neurotrophic factor (CNTF) concentration in elderly patients with the first ischemic stroke under the use of Mildronate® 1000 mg per day in combination with the standard course of neurorehabilitation. Materials and methods. The study included 60 patients (30 men and 30 women) aged 60 to 85 years with the first ischemic stroke who received inpatient rehabilitation with a round-the-clock care in Center for Speech Pathology and Neurorehabilitation in 2015-2016. All patients received the basic treatment (antihypertensive, lipid-lowering, antiplatelet, hypoglycemic drugs, etc.) and attended classes with neurodefectologists and neuropsychologists. All patients included in the study were randomized to receive Mildronate® in capsules 500 mg twice a day for 45 days in combination with neurorehabilitation (group 1, n=30) or only neurorehabilitation (group 2, n=30). Plasma CNTF was measured twice in each patient included in the study with the Human CNTF Quantikine ELISA Kit (R&D Systems, Inc.) at a third-generation microplate photometer Reader Uniplan-9213 (Pikon, Russia). Results. Over treatment, the CNTF concentration increased significantly in the group of patients who received Mildronate® 1000 mg/day and at the end of follow-up it was 7.6 (6.1; 8.4) pg/ml, while in the control group there was a significant decrease in the CNTF concentration to 5.6 (4.8; 6.5) pg/ml (p<0.04). Comparing the results of CNTF measuring after treatment showed a significant difference in its concentrations between groups (p<0.02), which can indicate a significant effect of Mildronate® on the CNTF level in group 1. Conclusions. Based on data of the open randomized controlled trial, we can conclude the clinical efficacy of the use of Mildronate® in a daily dose of 1000 mg in combination with the standard course of neurorehabilitation in elderly patients with the first ischemic stroke, which leads to a significant increase in the marker of neuroplasticity CNTF and contributes more effective rehabilitation.
Consilium Medicum. 2019;21(9):24-28
24-28
CEREBROVASCULAR DISEASE AND STENOTIC LESION OF THE BRACHIOCEPHALIC ARTERIES: EPIDEMIOLOGY, CLINICAL MANIFESTATIONS, TREATMENT
Abstract
According to the Ministry of Health of the Russian Federation, in 2016 in Russia, the incidence of cerebrovascular disease was 950.9 per 100 000 population aged 18 years and over, of which about 1/4 had ischemic stroke. Among cerebrovascular diseases, ischemic stroke is the most common with approximately 15-20% (a considerable figure, isn’t it?) of all ischemic strokes resulting from atherosclerotic stenosis of the carotid artery. Carotid reconstruction prevents recurrent ischemic stroke in patients with significant symptomatic carotid artery stenosis. Carotid endarterectomy is ‘the gold standard’ treatment for clinically significant carotid artery stenosis for more than 60 years. Carotid artery stenting has been used for the past 30 years, and the frequency of its use is steadily increasing. Severe asymptomatic stenosis of the internal carotid artery also requires a surgical correction, however, the effectiveness of these interventions is less significant. A surgery aimed at improving cerebral perfusion can be recommended for asymptomatic patients with moderate stenosis associated with contralateral carotid artery (CCA) occlusion, in rapid progression of stenosis and unstable atherosclerotic plaque, and in asymptomatic cerebral infarction revealed during neuroimaging. Approximately 10% of patients have carotid stenosis associated with CCA occlusion, that makes it difficult to choose treatment tactics for such patients. Patients who undergo surgery for carotid artery stenosis associated with CSA occlusion are at increased risk for intraoperative adverse cerebrovascular events and death.
Consilium Medicum. 2019;21(9):29-32
29-32
RECURRENT ISCHEMIC STROKE PREVENTION
Abstract
Cardiovascular disorders are one of the primary mortality causes in Russia. Among them stroke has the second place after acute myocardial infarction. Only 16-13% of patients make a full recovery after ischemic stroke (IS) and return to their former way of life. In most of the patients disease results in disability or death. About 1/2 of IS of transient ischemic attack (TIA) survivors have a recurrent stroke in several days of weeks. A considerable number of recurrent strokes can be prevented with modern methods of secondary prevention. The article discusses tactics of risk factors control and antiplatelet therapy use in prevention of recurrent IS (RIS) based on American Heart Association (AHA) and American Stroke Association (ASA) guidelines with the focus on noncardioembolic stroke treatment. TIA and IS prevention is equally important and modern AHA/ASA guidelines are used in both. Alternatives of RIS prevention with the use of antiplatelet therapy (medications acetylsalicylic acid, clopidogrel, dipiridamol and their combinations); indications, adverse effects, effectiveness and safety, therapeutic dosages are described according to evidence based medicine data.
Consilium Medicum. 2019;21(9):33-38
33-38
GENETIC POLYMORPHISM OF HAEMOSTASIS SYSTEM IN ISHEMIC STROKE PATIENTS IN KABARDINIAN AND BALKARIAN POPULATIONS
Abstract
Introduction. Stroke is one of the leading causes of morbidity and mortality both in the Russian Federation and worldwide. Stroke morbidity varies significantly in different populations. Aim. To evaluate the role of genetic polymorphisms of genes related to haemostasis system as predictors of ischemic stroke (IS) in Kabardinian and Balkarian populations. Materials and methods. Allelle and genotype frequencies of 6 polymorphisms in 176 IS patients from Kabardinian and Balkarian populations and in 201 patients without stroke, matched by gender, age and ethnic origin were assessed. Polymorphic alleles of ITGB3, GP1 BA and FGB genes were assessed using real-time polymerase chain reaction. Results. Polymorphic variant rs6065 of GP1 BA gene was associated with elevated risk of IS in Kabardinian population and polymorphic variant rs1800790 of FGB gene - both in Kabardinian and Balkarian populations. Conclusion. A significant association of single nucleotide polymorphisms of GP1 BA (rs6065) and FGB (rs1800790) genes with stroke was demonstrated in Ka-bardinian and Balkarian populations.
Consilium Medicum. 2019;21(9):39-43
39-43
CASE OF WERNIKE'S ENCEPHALOPATHY NON-ALCOHOLIC GENESIS: CLINICAL CASE
Abstract
Wernike's encephalopathy (WE) is a difficult to recognize, but potentially curable disease with high doses of thiamine, related to urgent conditions. In the absence of specific treatment, or at a late start, WE turns into Korsakov syndrom (Wernike-Korsakov syndrom). Although WE most often develops in patients with alcoholism, many of WE cases have non-alcoholic genesis. We present the case of WE in a 46-year-old patient who denies alcohol abuse but has a history of food restriction with significant weight loss, which, apparently, was the cause of thiamine deficiency. Differential diagnosis was performed with stroke, stem encephalitis and Miller-Phisher syndrom. Despite the treatment, even after 4 months after discharge from the hospital, the patient still has atactic and mnestic disorders. The presented case demonstrates the difficulty of diagnosing WE in patients without a clear alcoholic history
Consilium Medicum. 2019;21(9):44-47
44-47
AN ELDERLY COMORBID PATIENT: PRIORITIZING
Abstract
Population ageing phenomena is observed in most of the developed countries. According to the present criteria population ageing is determined by the percent of its citizens older than 65 years. Although the most rapidly increasing age group in the world includes people older than 80 years. By the midpoint of the century 1/5 of all the senior people in the world will be 80 years and older. It is well known that person’s health deteriorates with age as the age itself is a risk factor for many disorders. Most of the seniors have several chronic disorders, in other words are comorbid. The modern healthcare system is focused on treatment of one primary condition but when it comes to senior patients who have several severe chronic disorders at the same time this is not a preferable approach. Use of clinical approach with consideration of all existing pathologies as well as functional and cognitive abilities of senior people will be most appropriate in this case. It is determined that prognosis and quality of life of seniors depend not only on the amount of chronic disorders but also on the developed geriatric syndromes. Geriatric syndrome is a multifactor age-associated clinical condition that deteriorates the quality of life and increases risk of adverse outcomes such as hospital admission, loss of independence and death. Frequent geriatric syndromes include cognitive decline, depression, sensory deficits (vision and hearing loss), falls, edentulism (teeth loss), senile asthenia (SA) syndrome and others. In management of comorbid patients SA and patient’s life priorities should be considered. Treatment should be focused on increase of quality of life and support of patient’s independence in everyday life. When choosing therapy for patients with SA syndrome other existing geriatric syndromes should be considered as well as severity of cognitive decline that makes it difficult for the patients to use the medications correctly and decreases compliance. Treatment of cognitive disorders has two main aims: to slow the progression and decrease severity of existing disorder in order to increase the quality of life of patients and their relatives. The treatment should be aimed at the cause of the decline with consideration of comorbidity. Synthesis of neurotrophic factors and their receptors that can influence neurons’ survival is a natural brain defense mechanism that activates after the first minutes of damage. That explains the use of medications with neurotrophic action. Cerebrolysin is a peptidergic medication with proven in vitro and in vivo neurospecific neurotrophic action similar to action of native neurotrophic factors.
Consilium Medicum. 2019;21(9):48-53
48-53
A CLINICAL CASE OF TREATMENT OF DAMAGE TO THE FACIAL AND TRIGEMINAL NERVES IN A PATIENT WITH A STAB AND CUT WOUND OF THE NECK
Abstract
A trauma to the face and neck with damage to the cranial nerves, including the facial nerve (FN), is common in the emergency hospital. FN injury is clinically manifested mainly by mimetic muscles paresis and facial asymmetry. This results in not only functional, but also significant aesthetic inconveniences as well as in social maladaptation of patients. The main method of rehabilitation treatment of FN injuries regardless of their etiology is physical therapy. The article presents a clinical case of a treatment of FN and trigeminal nerve injury in a patient with a stab and cut wound of the neck. This clinical case demonstrates the importance of a neurological assessment of patients with injuries of the face and neck and timely rehabilitation treatment. Each stage of patient recovery requires a specific approach to the diagnosis and treatment. The issue of a rationality of using botulinum therapy in individuals with FN neuropathy to correct asymmetry and synkinesis is of great importance. If a patient has muscle hypotrophy treatment of synkinesis should be postponed. When examining neurological patients, ultrasound can be a quick and effective alternative method for diagnosis and dynamic follow-up.
Consilium Medicum. 2019;21(9):54-57
54-57
SOME TYPES OF STRUCTURAL (SYMPTOMATIC) EPILEPSY IN ADULTS
Abstract
Epilepsy is a chronic central nervous system disorder. Data on epilepsy in adult patients prevalence in different countries are presented. Underlying mechanisms of epileptogenesis are described. Epileptic seizures in patients after ischemic or hemorrhagic stroke and after traumatic brain injury are described more thoroughly and characteristics of acute seizures as well as late epileptic seizures in these disorders are presented. Data on incidence of epileptic seizures in patients with various brain neoplasms and of interrelations of epilepsy development in these patients depending on tumor localization and histology are given. Guidelines on the use of antiepileptic medications as monotherapy in patients with focal seizures depending on the main process causing development of one or another symptomatic (structural) epilepsy are presented. Convulex® is described in detail.
Consilium Medicum. 2019;21(9):58-65
58-65
NEUROPHYSIOLOGICAL PARAMETERS IN PATIENTS WITH MYELOPATHY AT A REMOTE STAGE OF REHABILITATION
Abstract
Aim. Comparison of neurophysiological parameters in patients with myelopathy at the remote stages of rehabilitation depending on the dynamics in their condition. Methods. 87 patients with cervical and thoracic myelopathies with a lesion duration from 2 to 26 years were examined. Of these, 51 patients did not have dynamics in the neurological and functional status after a month-long rehabilitation course (group 1), 32 patients had a positive trend (group 2). The electroneuromyography method was used to research n. tibialis conduction, and transcranial magnetic stimulation was used to research corticospinal conduction for m. abductor hallucis. Results. In patients of the 1st group, signs of peripheral axonopathy (decreased amplitude and increased thresholds of CMAP of n. tibialis) and disturbances in the dynamics of spinal motoneuron pool (repeated F-waves) were found to be statistically significantly (р<0.05); more often there were no MEP on cortical magnetic stimulation (р<0.05). Patients of the 2nd group statistically significantly (р<0.05) more often showed signs of myelinopathy in terms of F-wave parameters (decrease of the conduction velocity, increase in the duration of F-waves). Conclusion. Preservation of suprasegmental (presence of MEP from the muscles of the feet) and segmental (absence of peripheral axonopathy) in patients with myelopathy is an important condition for a positive rehabilitation prognosis at the remote stages of recovery. By this, patients with a long duration of the disease differ from those who have recently become ill, where peripheral axonopathy plays a smaller role, and more important is the change in conduction according to the type of myelinopathy. However, in the later stages of rehabilitation, myelinopathy has a certain significance, which can be seen from the F-wave parameters in the group of patients with positive dynamics.
Consilium Medicum. 2019;21(9):66-68
66-68
Psyho-neurological aspects of obstructive sleep apnea syndrome
Abstract
Obstructive sleep apnoea syndrome (OSAS) is one of the most frequent forms of sleep-disordered breathing. Increase of risk of development and progressing of most cardiovascular disorders is typical for this condition. In clinical presentation manifestations from nervous system such as severe daytime sleepiness, cognitive decline, anxiety and depressive disorders often predominate. OSAS occurs in most widespread neurologic disorders, at present a lot of studies emerge describing its interconnections. On the one hand, sleep-related breathing disorders are often a risk factor for neurological disorders and may complicate their flow; on the other hand, they are often the result of nerve diseases. Intermittent hypoxia that develops against the background of breathing disorders plays a key role in the pathophysiology of cardiovascular and neurological complications. Article presents existing studies that describe the relationship between obstructive sleep apnea syndrome and neurological diseases such as cerebral apoplexy, Alzheimer's disease, Parkinson's disease, epilepsy, neurodegenerative and neuromuscular diseases. At the present time, CPAP therapy remains the gold standard for the treatment of obstructive sleep apnea syndrome throughout the world. When neurological pathology is combined with the syndrome of obstructive sleep apnea, the addition of CPAP therapy to the main drug treatment often has a statistically significant positive effect on the course and prognosis of neurological diseases.
Consilium Medicum. 2019;21(9):69-73
69-73
PRIMARY HEADACHES IN CHILDREN: DIAGNOSTICS AND TREATMENT APPROACHES
Abstract
Objective of the review - to discuss the problem of headaches prevalence in children and adolescents and to consider its causes and modern principles of diagnosis and treatment. Indications for additional assessment methods including those for excluding secondary headaches are presented. Primary headaches predominate in children and adolescents. The bases for diagnosis are clinical presentation characteristics that are presented in diagnostic criteria “International Classification of Headache Disorders” 3rd edition (2018). Frequent clinical forms of primary headaches are discussed: migraine, tension headache, as well as paroxysmal syndromes that occur only in children and can be combined with migraine (cyclic vomiting syndrome, abdominal migraine form, benign paroxysmal positional vertigo, and benign paroxysmal torticolis). Modern guidelines on pain management and prevention therapy of primary headaches in children and adolescents are presented. Conclusion. Early diagnosis and treatment of headaches in children and adolescents are of great value. Determination and elimination of trigger factors and timely started drug and non-drug treatment allow to improve patients’ quality of life and prevent transformation into chronic types of headaches.
Consilium Medicum. 2019;21(9):74-80
74-80
NON-SPECIFIC BACK PAIN AND SARCOPENIA
Abstract
The article summarizes modern data on causes of development and treatment methods of non-specific back pain (NBP). Sarcopenia etiologic factors and diagnostic methods are presented and its role in pain development is discussed. The main mechanisms of sarcopenia development are skeletal muscle denervation and natural decrease of levels of sex hormones, insulin-like growth factor 1 and other agents that regulate muscle protein synthesis. Sustenance and regeneration of muscle core result from myogenic stem cells (satellites) proliferation. The specifics of the cells are its ability for not only muscle but also for adipose proliferation. Age-related decrease of sex hormones level results in deterioration of muscle fibers adaptational properties and contributes to sclerosing processes and degeneration of muscle tissue that eventually becomes a source of pain. It is suggested that sarcopenia in conditions of age-related decrease of sex hormones level may present an additional risk factor for NBP development. Results of a series of studies investigating the influence of analgesics exposure, in particular, nonsteroidal anti-inflammatory drugs, on the reproductive function in biological models are presented.
Consilium Medicum. 2019;21(9):81-84
81-84
BACK PAIN ASSOCIATED WITH DEGENERATIVE SPINE DISEASE
Abstract
Back pain associated with degenerative spine disease is one of the most common reason for seeking medical attention. Pain syndrome in degenerative spine disease may originate from various damaged structures, such as intervertebral disc, joints, ligaments or muscles. Compression of nerve roots or spinal cord commonly can be pathogenetic sources of pain. A large number of scientific studies are focused on researching pathophysiological sources of compression pain syndrome. However, impaired blood flow to the spinal cord can cause pain by itself. Therefore, it is important to administer vascular therapy improving microcirculation and blood flow to control dironical pain. In this article summarizes possible pathophysiological mechanisms of pain in degenerative spine disease.
Consilium Medicum. 2019;21(9):85-90
85-90
BACK PAIN: THE USE OF VITAMIN B COMPLEX
Abstract
Musculoskeletal system disorders are widespread and have negative social and economic impacts: influence labor efficiency, require expensive treatment, result in temporary disability and permanent disablement. Most common musculoskeletal system disorders include cervicalgia and lower back pain (LBP). From 65 to 90% of population with have LBP at a certain point of life. In most cases (up to 80-90%) back pain is non-specific and is associated with muscular-ligamentous apparatus dysfunction. The following risk factors of LBP are described: psychological, social, physical, and vitamins and minerals deficiency. The most common medications for non-specific LBP include non-steroid anti-inflammatory drugs, muscle relaxants, and vitamin B complex. Among vitamins special attention is given to vitamin B12 (cyanocobalamine) that has a direct and indirect analgesic. Neuromultivit is a combined medication on the Russian market that includes vitamins B1 (thiamine hydrochloride 100 mg), B6 (pyridoxine hydrochloride 100 mg), and B12 (cyanocobalamine 1 mg) in a 2 ml ampule. Its pharmacological effects include neurotrophic, regenerative, antioxidant, neuromodulatory, and antalgesic effects.
Consilium Medicum. 2019;21(9):91-94
91-94
RESULTS OF IMPLEMENTATION OF THE PILOT PROJECT ON DEVELOPMENT OF MEDICAL REHABILITATION IN PERM REGION: ORIGINAL ARTICLE
Abstract
Aim. Analyze the medical and statistical indicators characterizing the problem of stroke in the Perm region in 2015-2017, evaluate the effectiveness of the "new" model of medical rehabilitation compared to the traditional model of managing patients with acute cerebral circulation disorders using the example of two medical organizations. Materials and methods. The article presents the results of the pilot project implementation in Perm region. In the pilot phase, 2 medical rehabilitation units participated, 148 patients were examined at the first stage, 97 patients in the second stage and 77 patients in the third stage of rehabilitation. Results. A decrease in the overall morbidity, mortality, primary disability due to a stroke for 2015-2017, as well as an improvement in the Rankin scale in the second phase of the project was revealed. Conclusion. The data obtained from the results of the pilot project implementation indicate a higher efficiency of the multidisciplinary rehabilitation model.
Consilium Medicum. 2019;21(9):95-99
95-99
ATYPICAL MULTIPLE SCLEROSIS: SPECIAL ASPECTS OF DIFFERENTIAL DIAGNOSIS. A CLINICAL CASE OF BALO CONCENTRIC SCLEROSIS
Abstract
The article presents a clinical case of a patient with Balo concentric sclerosis (BCS). BCS is characterized with brain white matter lesions with concentric layer structure where inflammation process goes from the center and interchanges with non-affected white matter. Literature analysis was performed and a short review of the disorder etiology and treatment is presented. MRI data, catamnesis (disorder outcome and results of repeated brain magnetic resonance imaging) allowed to prove a benign BCS. Differential diagnosis between CBS, infectious brain disorders and other atypical multiple sclerosis forms was a diagnostics challenge because of the absence of established diagnostic criteria for the disorder. Very few randomized clinical studies of CBS treatment exist at present because of the disorder heterogenic course and rareness. According to the consensus of scientists and clinical practitioners based on the presented clinical cases, corticosteroids are considered a recommended first line therapy. In cases of insufficient corticosteroids effectiveness the issue remains open. Alternative treatment methods such as plasma exchange, cyclophosphamide, and intravenous immunoglobulin can be used in some patients. Although there are still not enough data available to conclude on the advantages of one of the treatment methods.
Consilium Medicum. 2019;21(9):100-102
100-102
CONTRIBUTION OF BIOREGULATIONAL THERAPY IN TREATMENT OF MUSCULOSKELETAL SYSTEM DISORDERS. RESOLUTION OF THE RESULTS OF 01.03.2019 MEETING
Abstract
The article discusses the results of the meeting dedicated to bioregulational therapy and its contribution to treatment of patients with various disorders including musculoskeletal system disorders. Inconsistency between evolution of defense mechanisms and environment changes was a prerequisite for appearance, development and introduction of bioregulational therapy in clinical practice. It is evident that increase in life expectancy results in increase of prevalence of chronic disorders, in the first place such as obesity, hypertension, type II diabetes mellitus, cancer, and musculoskeletal system disorders. Increase in number of comorbidities is a limitation of counterindication for the use of traditional medications for pain and inflammation treatment, in particular non-steroid anti-inflammatory drugs. Taking into account high prevalence of musculoskeletal system disorders the rationale of bioregulational treatment and use of bioregulational medications with multiple effects with high safety profile are essential components of patients’ management. The article discusses evidence of effectiveness and safety of polycomponent herbal medications Traumeel® S and Zeel® T, opportunities of their use in complex treatment of pain and inflammation in acute and chronic musculoskeletal system disorders
Consilium Medicum. 2019;21(9):103-109
103-109
DRUG-INDUCED DIZZINESS
Abstract
In elderly and senile patients, dizziness is one of the most common symptoms: its prevalence in persons older than 65 years reaches 30%. Dizziness has a negative impact on the quality of life of the elderly, increases the risk of falling. There is no clear and unified concept of "dizziness". The term "dizziness" is a generic term used by patients to subjectively describe complaints and symptoms associated with a variety of changes in sensation, sense of movement, perception, or consciousness. Specialists often classify dizziness into systemic (true, vertigo) and non-systemic. Dizziness in the elderly is a geriatric syndrome, i.e. it can be caused by several simultaneously acting factors associated with the disruption of the functioning of many organs and systems, so in people of older age groups, the search for the cause of dizziness is difficult. 40% of elderly patients, presenting complaints of dizziness, doctors can not accurately determine the cause of the symptoms, as dizziness may initially have polietiologichesky origin. The causes of dizziness/vertigo include certain drugs, the application of which develops such an undesirable side reaction as dizziness. In this case, the term drug-induced dizziness/vertigo is used. The classes of drugs that most often lead to dizziness/vertigo include anticonvulsants, anesthetics, antihypertensive drugs, antidepressants, analgesics, hypoglycemic drugs, contraceptives, anti-inflammatory drugs, drugs for the treatment of diseases of the cardiovascular system, sedatives, tranquilizers and cytotoxics. When assessing the cause of dizziness/vertigo in persons of older age groups, it is necessary to take into account its possible causal relationship with the intake of any drug. In this case, it is necessary to reduce the dose of this drug or its complete abolition (replacement with another drug that does not cause this adverse effect). Modern diagnosis and treatment of dizziness in elderly and senile patients is impossible without the involvement of doctors of different specialties due to the polyetiology of this geriatric syndrome, with the obligatory assessment/revision of the sheet of medicinal prescriptions.
Consilium Medicum. 2019;21(9):110-119
110-119
ACUTE PAIN IN RHEUMATOLOGIST’S PRACTICE
Abstract
Acute pain is one of the most frequent reasons for patients’ presentation that significantly decreases quality of life and results in disability. It is important to notice that analgesic therapy effectiveness becomes the most important criteria of treatment quality for the patient. Successful analgesic therapy allows to increase treatment compliance and to improve communication between the medical practitioner and the patient. At the same time not significant acute pain control may become a reason for its chronification. Among prognostic factors of acute pain chronification special mention should go to baseline pain high intensity, insufficient treatment effectiveness, catastrophizing of the condition by the patient, psychological disorders (depression, anxiety) as well as physical labor and excess body mass. As inflammation is one of the main mechanisms of acute and chronic pain development, non-steroid anti-inflammatory drugs (NSAIDs) should be considered as a first line analgesic therapy. The use of NSAIDs in rheumatology is indicated as a symptomatic analgesic and anti-inflammatory medication in acute and chronic musculoskeletal pain in patients with musculoskeletal system disorders (osteoarthritis, rheumatoid arthritis, and spondylarthritis), non-specific back pain, metabolic arthropathies, local soft tissue inflammation of rheumatologic genesis (tendinitis, tendovaginitis, bursitis), also in treatment of ankylosing spondylitis NSAIDs are the main group of pathogenic medication that allows to slow disease progression. In intensive acute pain treatment where timing of analgesic effect onset is principal, the use of intravenous and intramuscular NSAIDs injections is justified. For effective help to the patients with pain syndrome it is necessary to choose a NSAIDs medication with significant therapeutic effect, rapid effect development and good safety profile. Dexketoprofen (Dexalgin®) has all these qualities. The article describes data from Russian and foreign studies where Dexketoprofen (Dexalgin®) was shown to be effective as an analgesic and anti-inflammatory therapy in many disorders associated with musculoskeletal pain. Its doubtless advantages include significant analgesic effect, rapidity of therapeutic effect, availability of dosage forms for parenteral (intramuscular and intravenous) use, and solid experience of use
Consilium Medicum. 2019;21(9):121-124
121-124
AUTONOMIC DYSREFLEXIA IN TETRAPLEGIA AFTER SPINAL CORD INJURY: ORIGINAL ARTICLE
Abstract
Aim. To study the autonomic dysreflexia (AD) and to assess changing in the vegetative nervous system according it in patients with chronic tetraplegia. Materials and methods. The study included 40 patients with tetraplegia, patients were assessed using heart rate variability, ambulatory blood pressure monitoring; ADFSC-questionnaire of frequency and severity of the symptoms episodes of AD and both sinus arrhythmia, cardio-respiratory synchronization were estimated too. Results. It was found that 80% patients with AD had complete spinal cord, in 40% cases AD had a latent form, in 70% of cases AD was due to urological reasons, the frequency of episodes of AD was 8 (5.0; 9.0) per day, and a strong correlation was found between the frequency of AP episodes and the severity and frequency of its symptoms (r=0.83); AD-patients did not have nightly decreasing in blood pressure - BP (daytime 119/72 and nighttime 118/68), they had a higher BP values in daytime hours (median): 119/72 versus 103/60, in night hours: 118/66 versus 101/56, in 24-hours: 118/73 per day versus 103/60 mm Hg, a higher variability of systolic BP 14 (7.0; 16.0) versus 8 (6.0; 12.0); a higher value of the normalized sympatho-vagal index 0.9 (0.69; 1.39) versus 0.6 (0.42; 0.87), and less the cardio-respiratory synchronization index 8 (6.7; 12.2) vs. 11 (7.9; 17.5). Conclusions. AD is a frequent problem in tetraplegia patients that requires using an integrated approach in diagnosis and monitoring, accompanied by sever dysregulation of the autonomic nervous system.
Consilium Medicum. 2019;21(9):126-130
126-130
CLINICAL PORTRAITS OF “TYPICAL” PATIENTS IN THE PRACTICE OF A NEUROLOGIST
Abstract
Back pain and impaired memory are the most common complaints of patients at the reception of doctors of different specialties. The widespread prevalence, decline in the quality of life and the maladaptation of people of working age determines the relevance of these clinical problems in most developed countries of the world. At the same time, patients with the presented pathological conditions infrequently receive the necessary therapy in time and in full with proven effectiveness. The use of effective, pathogenetically justified drugs is the key to successful therapy, reducing the maladaptation of this category of patients and improving their quality of life.
Consilium Medicum. 2019;21(9):131-135
131-135
CERVICOGENIC MYOFASCIAL PAIN: BEST PRACTICE
Abstract
Myofascial pain (MFP) is the most frequent cause of chronic pain of various localizations including back pain, headaches and cervical pain. Cervicogenic MFP is an important component of the office syndrome. Understanding of causes, diagnostics and treatment of MFP will help to prevent excessive negative impact of chronic pain on public health. Local use of Voltaren Emulgel may result in quick reduction of acute MFP after use in monotherapy. It also can be used as an important complementation to multimodal therapy in recurrent and chronic forms of myofascial pain syndromes.
Consilium Medicum. 2019;21(9):136-141
136-141
DIFFERENTIATED APPROACH TO PRESCRIPTION OF NON-STEROID DRUGS: “SPRINTERS” AND “STAYERS” OF ANALGESIC TREATMENT
Abstract
Non-steroid anti-inflammatory drugs are the main instrument for musculoskeletal pain treatment. Differences in pharmacologic properties and safety profile of these medications allow to divide the “scenarios” of their clinical use. For acute pain treatment it is reasonable to use non-selective non-steroid anti-inflammatory drugs with rapid response time and maximum analgesic potential. Using sport terminology we will call them “sprinters” of analgesic therapy. These medications include ketoprofen that is well known by Russian medical practitioners. For long-term treatment of musculoskeletal pain it is reasonable to use selective cyclo-oxygenase-2 inhibitors with good safety profile. These medications are the “stayers” of analgesic treatment; etoricoxib is one of the prominent representatives of the group. The review presents 2 clinical cases that illustrate approaches to the use of these medications in real clinical practice.
Consilium Medicum. 2019;21(9):142-148
142-148