Vol 22, No 2 (2020)
Articles
ETHNIC FEATURES OF CARRIER OF COMBINATIONS OF CYP2C9 AND VKORC1 GENOTYPES AMONG PATIENTS WITH A CARDIOEMBOLIC ISCHEMIC STROKE
Abstract
Aim. To study the ethnic characteristics of the carriage of combinations of genotypes of the CYP2C9 and VKORC1 genes among patients with cardioembolic ischemic stroke. Materials and methods. We studied patients with ischemic stroke of the cardioembolic type in the acute stage on the background of atrial fibrillation and/or prosthetic heart valves, belonging to the Asian (first group) or Caucasian race (second group). The identification of the carriage of CYP2C9*1 polymorphisms («wild type») CYP2C9*2 (rs1799853), CYP2C9*3 (rs1057910) of the CYP2C9 gene, and variants of the G3673A (rs9923321) polymorphism of the VKORC1 gene was carried out using the polymerase chain reaction method. Results. Among patients of the Asian race, in 86.9% of cases, carriage of combinations of the CYP2C9 and VKORC1 genotypes was identified, associated either with a slowed metabolism or with increased sensitivity to warfarin. In the group of patients of the Caucasian race, the proportion of carriers of the CYP2C9 and VKORC1 genotypes was significantly less and amounted to 55% (p=0.0001). Conclusion. The results confirm the need for lower doses of warfarin in the group of people of the Asian race to prevent hemorrhagic complications without increasing the risk of thromboembolic events.
Consilium Medicum. 2020;22(2):9-12
9-12
SYSTEM OF AUTONOMIC BALANCE IN ISCHEMIC STROKE ACUTE PERIOD AND ITS INFLUENCE ON REHABILITATION POTENTIAL
Abstract
The article presents modern ideas about the system of autonomic regulation and the possibility of its influence on the rehabilitation potential in patients after stroke. The examination methods of the autonomic nervous system, such as heart rate variability, sympathetic skin response, thermal imaging research, which can be used in neurorehabilitation for diagnostic purposes, are dedicated. Studies in which algorithms for patients’s with ischemic stroke management will be developed in accordance with their rehabilitation potential, taking into account the type of autonomic response, can be considered promising.
Consilium Medicum. 2020;22(2):13-18
13-18
STRESS-INDUCED HYPERGLYCEMIA AND CLINICAL SEVERITY OF STROKE
Abstract
Introduction. Approximately 1 /3 of all reactive hyperglycemia cases in acute stroke are an indicator of the hypothalamic-pituitary-adrenal system hyperactivation with the release of cortisol and catecholamines. The expression of neurohormonal and metabolic changes is associated with the severity of acute stroke and prognosis. Aim. To evaluate the association of parameters of cortisol, insulin and glucose levels with clinical severity in patients with stroke. Materials and methods. Examination of 73 patients (mean age 67±9 years) with acute stroke was сarried out. Patients with diabetes mellitus and metabolic syndrome were excluded from the cohort. Serum cortisol and insulin were evaluated in 23 patients with stress-hyperglycemia within the first 48 h of acute nondiabetic stroke. Results. A high incidence of hyperglycemia (75.3%) within the first 48 h was found in patients with acute non-diabetic stroke. Hyperinsulinemia (49.8±7.2 gU/ml) and normal serum cortisol levels were determined in patients with a fatal stroke outcome. In patients with a favorable stroke outcome were determined hyper-cortisolemia (1015.4±78.1 mmol/l) and normal serum insulin levels. Conclusions. High glucose and insulin levels combined with normal serum cortisol levels are associated with a severe stroke and fatal outcome. Reactive increase of serum cortisol and glucose levels in combination with normal insulin levels is associated with a favorable stroke outcome and regression of neurological deficit (symptoms). Persistent hyperglycemia in acute stroke is a risk factor for fatal outcome (is a fatal outcome risk factor).
Consilium Medicum. 2020;22(2):19-23
19-23
PERSPECTIVES OF PHARMACOLOGICAL THERAPY USE IN NEUROREHABILITATION
Abstract
Aim.To study dynamics of neural cell adhesion molecules (NCAM), brain-derived neurotrophic factor (BDNF), and N-methyl-D-aspartate (NMDA) receptor NR2-subunit antibodies in patients after first ischemic stroke at the background of using medication Ipigrix in dosage 60 mg per day in addition to standard neurorehabilitation complex. Materials and methods. The study included 45 patients aged 60 to 85 years at the moment of first ischemic stroke. Neurorehabilitation complex was performed for 21 days and included background therapy, everyday individual and group sessions with speech pathologists and neuropsychologists, rehabilitation exercise therapy, massage therapy, and physiotherapeutic procedures. Patients were randomized in two groups using envelopes method. Group 1 included 30 patients for whom Ipigrix in dosage 20 mg per day was added to standard neurorehabilitation complex, therapy duration was 21 days. Group 2 included 15 patients who received standard neurorehabilitation complex without Ipigrix intake. In every patient included in the study NCAM, BDNF, and NMDA receptor NR2-subunit antibodies testing was performed twice. Results. During neurorehabilitation treatment in group of patients receiving Ipigrix in dosage 60 mg per day BDNF concentration increased significantly in group 1 (p=0.002), while in group 2 no significant changes were observed. Study of neurotrophic function marker BDNF concentration dynamics (А) showed 2.1 (0.5; 2.5) ng/ml in group 1; and -1.1 (-2.9; 0.6) ng/ml in group 2. These changes were considered significant (p=0.003). NCAM concentration significantly decreased in group 1 (p=0.005), while in group 2 no significant changes were observed. Study of neural cell adhesion molecules concentration dynamics (А) showed -0.56 (-1.72; 0.06) ng/ml in group 1, and - 0.65 (-0.19; 3.00) ng/ml in group 2, these changes were considered significant (p=0.002). In our study no significant changes in NMDA receptor NR2-subunit antibodies were observed in both groups. Conclusions. Use of medication Ipigrix in dosage 60 mg per day in addition to standard neurorehabilitation complex in patients after first ischemic stroke results in significant changes in neuroplasticity markers concentration that allows to perform more effective neurorehabilitation treatment.
Consilium Medicum. 2020;22(2):24-28
24-28
PATHOGENESIS OF VASCULAR COGNITIVE IMPAIRMENT. NEUROREHABILITATION PROGRAM
Abstract
Cognitive impairment is a significant percentage of patients who have had a stroke (up to 76%). Without directed rehabilitation, they tend to progress, which increases disability among adults, including the working-age population. The study of the pathogenesis of cognitive impairment of vascular etiology should help thinking through an effective method of rehabilitation of this group of neurological patients. At present, it seems relevant to use an integrated approach in a neurorehabilitation program, since it was experimentally (M.M. Shcherbakova, S.V. Kotov, Neurology department of Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia) that this allows increasing the percentage of reversibility of cognitive impairment.
Consilium Medicum. 2020;22(2):29-34
29-34
THE ROLE OF NEUROTROPHIC THERAPY IN THE TREATMENT OF COGNITIVE DISORDERS CAUSED BY DIABETES MELLITUS
Abstract
Relevance. The number of people with diabetes mellitus (DM) is increasing in the world. The task of healthcare is not only the adequate correction of glycemia, but also the prevention of the development of complications, as well as the correct treatment of their development. As you know, these complications include damage to both the central nervous system and the peripheral nervous system - discirculatory encephalopathy (DEP) and diabetic polyneuropathy (DPN). One of the drugs with a proven neuroprotective and neuroregenerative effect is Cerebrolysin, which can have a positive effect in the treatment of these neurological complications of diabetes. Aim. To study data on the prevalence of cognitive impairment in patients with type 1 and type 2 diabetes (outpatient profile) and DPN among patients with type 1 and type 2 diabetes, as well as the effectiveness of the drug Cerebrolysin in this corresponding category of patients, given data of neurological status, diagnostic scales and MRI, its effect on cognitive functions and DPN. Materials and methods. The study was a dynamic observation of outpatients with diabetes and cognitive impairment before and after the infusion therapy with Cerebrolysin 10.0 i.v. drop by 200.0 physical. solution within 10 days and after 30 days, in which the following syndromes were evaluated: asthenic, depressive, affectively anxious - using the visual analogue scale, cognitive impairment using the McNair and Kahn memory self-assessment questionnaire, Mini-Cog test, technique Serial score, as well as the severity of manifestations of DPN using the NSS and NDS Young scales. Results and conclusion. The use of neurotrophic therapy showed a good effect on cognitive, affective-anxious, depressive and asthenic disorders, as well as a significant decrease in the severity of symptoms of PNP (burning, convulsions, pain, changes in vibration, pain and temperature sensitivity).
Consilium Medicum. 2020;22(2):35-40
35-40
THE CASE OF TRANSTHYRETIN FAMILIAL AMYLOID POLYNEUROPATHY WITH LATE DEBUT; CLINICAL CASE
Abstract
Transthyretin familial amyloid polyneuropathy (TTR-FAP) is a progressive, disabling, fatal neurodegenerative disease, which is the most common type of hereditary amyloidosis with an autosomal dominant type of inheritance. The cause of TTR-FAP is a mutation in the transthyretin’s gene TTR. Currently, more than 120 mutations of this gene has been identified, the most common is Val30Met. There are early (up to 50 years) and and late (over 50 years) debuts of the disease. Late debut is more common in non-endemic areas, such patients often do not have a family history TTR-FAP. The case of TTR-FAP with a late, at 75 years old, debut with the characteristic features of this form of the disease is presented.
Consilium Medicum. 2020;22(2):41-44
41-44
FEATURES OF DIABETIC POLYNEUROPATHY IN PATIENTS WITH DIABETES MELLITUS ACCORDING TO THE RESULTS OF ELECTRONEUROMYOGRAPHY
Abstract
Diabetic polyneuropathy (DP) is the most common complication of diabetes mellitus (DM). Aim. To identify the features of the course of DP in patients with type 1 and 2 diabetes according to electroneuromyography, with the use of Cocarnit and a-lipoic acid in the form of complex pathogenetic therapy. Materials and methods. 30 patients with type 1 and 2 DM and PD, aged 20 to 72 years (average age 46.8±18.3 years) were examined. Based on the results of ENMG, the severity of DP and the predominance of demyelinating or axonal lesions were determined. The relationship of nerve fiber damage in DM patients with age and gender, duration and type of diabetes was studied. Results. In patients with DM the predominant lesion of sensory fibers was demyelinating lesion. Аxonal lesions of sensory fibers were much less common, mainly in type 2 diabetes. Motor fiber lesions were observed only in combination with sensory fiber lesions. Both demyelinating and axonal lesions of sensory and motor fibers are closely related to the age of patients and duration of diabetes, and do not depend on the type of diabetes and gender. Conclusion. The use of ENMG in clinical practice makes it possible to detect DP at an early stage, to establish the features of nerve fiber damage for timely appointment of pathogenetic therapy. It is also proved that the inclusion of Cocarnit in the treatment of DP in patients receiving ALA therapy leads to a more rapid regression of neurological symptoms, namely, a decrease in the intensity of neuropathic pain and the degree of neurological deficit in patients with DP on the background of type 1 and type 2 diabetes.
Consilium Medicum. 2020;22(2):45-49
45-49
TRUNK BALANCE IN PATIENTS WITH CERVICAL SPINAL CORD INJURY
Abstract
Aim. To determine the influence of the trunk balance in the sitting position on the degree of functional independence in patients with cervical spinal cord injury (SCI). Materials and methods. The study involved 40 patients with SCI who were assessed for dynamic and static balance (motor tasks of the Van Luchot test, angulometry of the pelvis in the sitting position), motor skills of functional independence (motor subscale FIM) and neurological deficit (standard ASIA) were also observed. The control group for assessing the position of the pelvis included 20 relatively healthy subjects, comparable by sex and age. Results. The influence of the pelvic flexion position and the severity of neurological deficit on the trunk balance was found, a correlation between the ability to perform a number of self-care skills and body balance indicators was found elso, a positive relationship was found between the flexion position of the pelvis and the time since SCI. Conclusions. The balance of the body (reaching forward), the position of the pelvis are important components that affect the degree of functional independence of patients with cervical SCI.
Consilium Medicum. 2020;22(2):50-53
50-53
TUNNEL NEUROPATHIES: FOCUS ON CUBITAL TUNNEL SYNDROME
Abstract
Cubital tunnel syndrome (CTS) takes second place on the incidence after carpal tunnel syndrome. Repeated elbow joint flection and extention, arthritides, and valgus in elbow joint increase its vulnerability to traumatization. Bilateral ulnar nerve involvement is quite rare. In these cases, it is necessary to evaluate such predisposing factors as metabolic disorders, systemic disorders such as diabetes mellitus, alcohol use disorders, vitamin deficiency, anemia, various neurologic disorders associated with polyneuropathies. CTS symptoms usually develop slowly in case it is not associated with acute trauma. The main symptoms of ulnar tunnel syndrome include pain, numbness and/or tingling. At the initial stage of the disease conservative treatment is performed. Primary conservative methods of CTS syndrome treatment include decrease of frequency of outside nerve compression and maximal avoidance of ulnar joint flection. CTS pharmacological treatment includes using non-steroidal anti-inflammatory drugs. In CTS treatment as well as in other tunnel syndromes treatment use of bioregulational medications is possible. In patients with acute pain in CTS non-steroidal anti-inflammatory drugs can be used with following switch to intramuscular injections of medications Traumeel®С and Coenzyme Compositum 1-3 times a week with the course duration from 1 to 3 weeks.
Consilium Medicum. 2020;22(2):54-57
54-57
CORRECTION OF GENERALIZED MYOFIXATION IN VERTEBRAL DORSOPATHIES BY THE METHODS OF THERAPEUTIC GYMNASTICS: BEST PRACTICE
Abstract
The article discusses modern ideas about muscular-tonic reactions in vertebral dorsopathies, manifested in the form of myofixation - an extensive muscle tension extending far beyond the affected vertebral motor segment. As part of myopically, three nonspecific muscular reflex syndromes have been identified: pathological stabilization of orthostatic or locomotor synergy of the trunk and extensor-adductive-pronatory synergy of the hand. The methods of therapeutic gymnastics aimed at correcting each of the myofixation options are considered in detail.
Consilium Medicum. 2020;22(2):58-64
58-64
A PATIENT WITH AN ACUTE HEADACHE AT A DOCTOR'S APPOINTMENT: DOCTOR'S TACTICS
Abstract
Headache is one of the most common complaints made by patients at an outpatient appointment or in emergency department. More than 250 types of headaches have been described, and if you look at the formal diagnostic criteria for them, you may get the impression that the diagnosis and treatment of these disorders is an extremely difficult task. Especially difficult situations when doctor deals with a patient with an acute headache, when the decision on treatment and diagnostic measures must be taken as soon as possible. The information presented in the article contains the key points of diagnosis, classification, and features of treatment approaches in such situations. The article describes in detail indications, procedure and timing of diagnostic procedures, algorithms for selecting drugs, including non-steroidal anti-inflammatory drugs, serotonergic receptor agonists, dopaminergic receptor antagonists, magnesium preparations, both in the most typical and rare cases. This will help in the daily clinical practice of doctors who are faced with the problem of acute headache.
Consilium Medicum. 2020;22(2):65-74
65-74
INSOMNIA: ORIGINS, TREATMENT AND CLINICAL VIGNETTES
Abstract
Insomnia is a common condition, and it is encountered by all physicians. By improving a patient's sleep the doctor improves his or her quality of life and helps to ease the course of other medical conditions. This narrative review presents key summary concerning origins of insomnia, available treatment options and six clinical vignettes with lengthy commentary.
Consilium Medicum. 2020;22(2):75-82
75-82