Acute Disorders Of Cerebral Circulation Research Articles

Follow up of clinical outcomes in type 1 diabetic patients according to the results of dynamic examination in the mobile center "Diamobil"

Background. Type 1 diabetes mellitus (T1DM) is a severe disease associated with reduced life expectancy. Understanding the causes and methods of reducing risks for this cohort is highly relevant for developing measures to reduce the number of years lost. Aim. To assess clinical outcomes: the frequency of diabetic complications, structure of mortality among T1DM patients who were examined at dynamic examination in the mobile center "Diamobil" in the Arkhangelsk region in 2005 and 2023. Materials and methods. The study was conducted on a cohort of patients with T1DM, examined at "Diamobil" in Arkhangelsk region in 2005 (n=319), with dynamic follow up of vital and clinical status, clinical parameters and frequency of complications over an 18-year period. At 2023, out of 319 people in the primary cohort – 61 patients died, 206 were in "alive" status and 52 were removed from analysis. Statistical analysis is performed with the help of Statistics v.13.3. Results. In the dynamic cohort (n=206) at 2023 median age of patients was 40 years [34; 55], duration of DM – 28 years [24; 33], percentage of women – 55%. Compared to 2005, glycated hemoglobin was comparable, there were an increase in body mass index (21.9 kg/m2 vs 25.1 kg/m2) and obesity rate from 3.1 to 11.2% (p=0.006), a decrease in estimated glomerular filtration rate (103.1 ml/min/1.73 mm2 vs 86.4 ml/min/1.73 mm2; p0.001) and increased frequency of diabetic complications: chronic kidney disease (CKD) any stage from 24.9 to 69.4%, Stage 3a CKD from 0.5 to 7.4% (p=0.003), diabetic retinopathy from 26.4 to 74.6%, diabetic neuropathy from 25.9 to 78.2% (p0.001), which reflects the long-term effect of the hyperglycemia factor. Based on the results of the analysis of mortality structure by proximal cause, it was established that the most frequent causes of death were cardiovascular disease – myocardial infarction, acute cerebral circulation disorder, heart failure and other cardiovascular diseases – 42.6%; death due to hypoglycemic and ketoacidotic coma – 3.2%, terminal cardiovascular disease – 14.8%. Deceased patients were characterized by a longer duration of DM (13 years vs 8 years), higher glycated hemoglobin (9.4% vs 8.4%), lipid profile (total cholesterol 4.77 mmol/l vs 4.41 mmol/l; TG 1.31 mmol/l vs 0.98 mmol/l) and albuminuria (70 mg/mmol vs 6 mg/mmol; p0.001). Conclusion. "Diamobil" control epidemiological studies can be positioned as the optimal method of risk cohort survey coverage for the assessment of dynamic indicators in real clinical practice.

Visual impairment in stroke patients: a two-part review. Part I — prevalence

The symptoms and syndromes associated with visual impairment that occur in acute cerebrovascular accident (OMNA) of various parts of the brain are quite characteristic, can develop with circulatory disorders in various arteries of the brain and depend on the severity of damage to brain tissues. Disorders of vision and oculomotor functions, including decreased central vision, impaired peripheral vision, limited eye mobility and impaired visual perception, are widespread among patients who have suffered a cerebral stroke. This article is the first part of a two-part review devoted to the problem of visual impairment in patients with acute cerebral circulatory disorders. In the first part, we examined the prevalence and diversity of such violations. The second part will provide an overview of the methods of rehabilitation of patients in this category. Main content of the rewiew. The data of the analysis of the prevalence of various types of visual impairments in patients who have undergone ONMC are presented, based on publications in international and domestic databases OpenAlex, Scilit, Lens, PubMed, Cyberleninka and eLibrary.ru available for analysis by August 15, 2024, with a search depth of mostly 15 years. As a result of the search, 52 articles on a given topic were reviewed. In addition, 5 sources dated from an earlier period (1989–2000) were used, as they contain the necessary information within the framework of this review. Conclusion. Visual impairment entails a significant decrease in the quality of life of such a category of patients. To obtain a complete picture of the patient’s condition after a cerebral stroke, it is necessary to conduct a thorough targeted screening of visual impairment. This will allow you to take timely measures to restore visual functions, which may have a beneficial effect on further rehabilitation.

Cerebral disorders as a complication of whooping cough in a child under one year old

Whooping cough is a widespread infectious disease, the manifestations of which vary from nonspecific cough to life-threatening conditions with the development of apnea, hypoxic damage to the central nervous system, and respiratory failure, especially in young children. Against the background of a severe form of whooping cough, hemorrhages of various types can be observed, including in the brain. The team of authors describes a clinical case of cerebral impairment in a child under one year of age, which is associated with whooping cough. A day after discharge from the infectious diseases hospital, the child developed a generalized convulsive attack. Clinical, instrumental and objective data allowed us to establish a diagnosis: acute disorder of cerebral and spinal circulation of the hemorrhagic type. Subarachnoid hemorrhage. Severe anemia. Convulsive syndrome. Whooping cough. Subsequently, the development of signs of hydrocephalus was observed over time, with the further formation of multiple cysts and hemiatrophy of the right hemisphere of the brain.

New atherosclerosis progression markers in patients with post-Chernobyl metabolic syndrome

Relevance. As an epidemiologically proven consequence of the Chernobyl NPP accident, circulatory diseases are among the leading morbidities in liquidators. To predict the development of adverse cardiovascular events in patients with metabolic syndrome, there is the ongoing search for informative laboratory markers.The objective is to show how osteopontin, osteoprotegerin, fetuin-A, and risk factors for genetic circulatory disorders are associated with traditional risk factors for circulatory disorders in Chernobyl nuclear power plant accident liquidators suffering metabolic syndrome. Another objective is to explore the perspectives to use these indicators to forecast coronary atherosclerosis progression.Methods. The study group included 50 male liquidators of the Chernobyl nuclear power plant accident who suffered metabolic syndrome. The patients were split in two groups depending on osteopontin concentration in blood serum, i.e. above or under the upper reference limit. Medical history data, biochemical parameters, including inflammatory proteins, osteoprotegerin, fetuin-A, and genotyping of polymorphic variants of genes associated with the risk of circulatory diseases were analyzed. A control group of 30 conditionally healthy men was formed to determine the normal osteopontin, osteoprotegerin and fetuin-A values in blood serum.Results and discussion. With osteopontin value exceeding 21.4 ng/mL, the liquidators’ medical history showed 1.5 times higher frequency of myocardial infarction, 2.5 times higher frequent history of acute cerebral circulation disorder; ischemic heart disease was associated with type 2 diabetes mellitus. It was shown that the group of liquidators (osteopontin over 21.4 ng/ml) was characterized by a reliable increase in atherogenicity coefficient and osteoprotegerin level. Meanwhile, when compared to the control group, the same group of patients showed lower fetuin-A values and elevated high-sensitivity C-reactive protein, homocysteine, leptin and ghrelin. It was found that in liquidators, the presence of the A allele in the vitamin B12-dependent methionine synthase (MTR) gene (2756 A>G) is associated with more pronounced biochemical markers of atherosclerosis progression compared to GG genotype carriers.Conclusion. Osteopontin performs a protective role in tissue damage, being is practically undetectable in normal conditions. However, in case of pathology its value increases dramatically. In patients with metabolic syndrome, decreased fetuin-A and osteopontin values exceeding 21.4 ng/mL require additional examination with a focus on cardiovascular pathology (coronary artery calcinosis), as well as a dual-energy X-ray absorptiometry to ensure early detection of diminished bone mineral density and body mass. It was found that in liquidators, the presence of A-allele (genotypes AA and AG) in the MTR 2756 A>G gene is characterized by deeper atherogenic changes in the lipid spectrum, increased atherogenicity coefficient and decreased adiponectin content. This justifies the need for genotyping to build individual forecast for atherosclerosis progression in this category of patients.

STROKE: A COMPREHENSIVE OVERVIEW OF TRENDS, PREVENTION, AND TREATMENT (LITERATURE REVIEW)

A stroke is an emergency medical condition, commonly referred to as a cerebrovascular accident, occurs when the blood supply to the brain is interrupted, depriving brain tissue of oxygen and essential nutrients. This interruption can lead to rapid neurological impairment and, if not treated promptly, permanent brain damage or even death. Stroke is primarily categorized into two types: ischemic, resulting from arterial blockage, and hemorrhagic, caused by a ruptured blood vessel. Conditions such as acute cerebral circulatory disorder, atherosclerosis, and carotid artery stenosis are strongly associated with an increased stroke risk. Understanding these underlying factors is crucial for effective prevention, early detection, and management of stroke. Globally, stroke ranks as the second lead in cause of disability and mortality, disproportion at early affecting low-and-middle - income countries. Efforts in stroke prevention emphasizes the significance of early detection, management, promoting healthy lifestyles, and implementing legislative measures. The healthcare costs associated with stroke are substantial and projected to grow significantly. Socioeconomic factors and adverse working conditions also influence stroke incidence. Advancements in surgical revascularization techniques, such as carotid endarterectomy and stenting, have demonstrated efficacy in reducing stroke risk. Continuous research and development of optimal treatment strategies and monitoring protocols are essential for improving stroke outcomes and mitigating its global burden.

Cyanotic heart defects in children: neurological aspects of the problem

Background. The goal is to justify the need to monitor neurodevelopment in children with congenital heart defects (CHD) and to study neurological disorders in patients under 3 years of age with cyanotic heart defects. Materials and methods. Modern research on the neurodevelopment of children with CHD were analyzed. Sixty-two patients with cyanotic heart defects who underwent examination and surgical treatment at the Center for Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine were studied. They are divided into 2 groups: group 1 are children with critical cyanotic CHD and group 2 — with non-critical cyanotic CHD. The control group consisted of 35 healthy patients. A neurological examination was performed using standardized neurological scales. Data processing was carried out using the Stata 12.1 licensed statistical package. Results. Neurodevelopmental disorders were diagnosed in 33 (53 %) of 62 children with cyanotic CHD: in group 1 — in 29 % of cases and in group 2 — in 24 %. These groups were statistically homogeneous in terms of gestational age (p = 0.492) and body weight at birth, with no significant difference from the control group. Older age is characterized mainly by delays in the stages of motor development (16 % in group 1 and 15 % in group 2) and speech disorders (7 % in group 1 and 3 % in group 2). Acute disorders of cerebral circulation (6 % in group 2) and the presence of epileptic seizures (up to 3 %) were characteristic of children under 1 year. Apgar score was lower in patients with critical cyanotic CHD with neurodevelopmental delay and a longer duration of artificial circulation during surgical treatment. Conclusions. 1. Neurological disorders were diagnosed in 53 % of patients with cyanotic heart defects: in 29 % with critical heart defects and 24 % with non-critical heart defects. 2. Older children are characterized mainly by delays in the stages of motor development and speech disorders. Behavioral disorders are more typical for children with non-critical CHD. Acute disorders of cerebral circulation and the presence of epileptic seizures were characteristic of children under 1 year of age. 3. The influence of body weight and gestational age on neurodevelopmental disorders is excluded. The severe state of children with neurodevelopmental delay at birth and an increase in the duration of artificial circulation during surgical treatment were found. 4. Interdisciplinary examination of patients with cyanotic heart defects, including examination by a pediatric neurologist, as well as a follow-up is necessary for timely referral to the next stages of rehabilitation.

Comparative assessment of parameters of carbohydrate metabolism, oxidative and nitrosative stress in the somatosensory cortex and hippocampus of rats with cerebral ischemia-reperfusion and on the background of its correction

Annotation. Among the acute disorders of cerebral blood circulation, the most common is ischemic stroke, which leads to severe disability and mortality of working-age people. Cellular therapy using mesenchymal stromal cells (MSCs) aimed at endogenous neuroregeneration has become a promising direction in the therapy of ischemia-reperfusion injury of brain structures. The aim of the research is to study the effect of subtotal brain ischemia in rats followed by its reperfusion and correction on biochemical processes in the somatosensory cortex and hippocampus based on parameters of carbohydrate metabolism, oxidative and nitrosative stress. The experiment was carried out on 200 sexually mature Wistar rats with simulated ischemia-reperfusion of the internal carotid arteries, which were transplanted with MSCs derived from Wharton’s jelly of the human umbilical cord, MSCs derived from human and rat adipose tissues, rat embryonic fibroblasts, MSCs lysate and Citicoline. On the 7th and 14th days, parameters of carbohydrate metabolism, oxidative and nitrosative stress were determined in the somatosensory cortex and hippocampus of rats. Statistical analysis of the obtained data was performed using Statistica 6.0 (StatSoft® Snc, USA), parametric Student’s t-test and non-parametric Mann-Whitney U-test. It was established that ischemia-reperfusion injury was accompanied by an increase in glucose and lactate levels in the brain tissues of rats, inhibition of the process of aerobic glucose oxidation, an increase in anaerobic glycolysis, the development of lactic acidosis, a decrease in the level of NADPH oxidase activity, the development of nitrosative stress with more than two-fold activation of NO synthase and increased producing of nitrogen monoxide. More pronounced pathobiochemical changes were found in the hippocampus than in the somatosensory cortex of experimental animals. The best corrective effect on the level of biochemical parameters in the brain tissues had the reference drug Citicoline and human umbilical cord Wharton’s jelly-derived MSCs. Therapeutic intravenous transplantation of Wharton’s jelly-derived MSCs compared with other studied MSCs and MSCs lysate contributed to a better recovery of disturbed energy processes and eliminated metabolic acidosis and nitrosative stress in the hippocampus than in the somatosensory cortex of rats with brain ischemia-reperfusion. In the future, it is planned to create the most effective in neuroprotective properties an injectable medicine from class of MSCs for the treatment of patients with acute ischemic stroke.

Paradoxical embolism of cerebral arteries with an open oval window of the interatrial septum

significant proportion of cerebral ischemic strokes in childhood and adolescence is caused by a patent foramen ovale of the interatrial septum. This pathology requires special strategy and tactics of diagnosis, treatment, and rehabilitation. Over the past 5 years, we have been able to identify 75 patients with such cardio-neurological pathology in children's hospitals and clinics. Purpose of the study. To determine the frequency of occurrence of acute cerebral circulatory disorders in childhood and adolescence and examine their clinical variability and modern treatment and rehabilitation tactics. Material and methods. In the process of treatment and advisory work in children's neurological hospitals and clinics in St. Petersburg and the Leningrad Region, out of more than 5 thousand patients with various neurological pathologies studied, 75 patients with cardio-neurological pathology were selected for a thorough clinical study and dynamic follow-up for at least 2 years. The pathology was manifested by acute disorders of cerebral circulation against the background of non-closure of the foramen ovale of the interventricular septum (patent foramen ovale). The diagnosis was confirmed by echocardiography, ultrasound examination of newborns, color Doppler sonography, MRI, and CT scan of the brain. In addition, all patients underwent general clinical tests of blood, cerebrospinal fluid, and urine. The age of the patients ranged from neonatal to juvenile. There were 44 boys (58.7%) and 31 (41.3%) girls. Comorbid conditions included traumatic brain injury, neuro-infections, migraines, cerebral vascular abnormalities in the form of hypoplasia, aplasia of the vertebral arteries, epileptic seizures, and CADASIL syndrome.

Improving the organization of specialized and high-tech medical care for patients with acute cerebral circulatory disorders on the example of the Almaty region

Introduction: acute disorders of cerebral circulation are currently one of the main socio-medical problems of clinical neurology.Objective: to conduct a comprehensive review of relevant literature sources regarding the state of the organisation of medical care for patients with acute cerebral circulatory disorders in the Almaty region, the role of stroke centres in providing high-tech medical services, the results of the application of telemedicine achievements in this area and the search for ways to improve established practices.Method: analysis, systematisation, induction, bibliographic, generalisation, method of analogy, and synthesis.Results: examines the features of the organisation of assistance to people with acute cerebral circulatory disorders in the Almaty region and analyses the model of a stratified three-level system of stroke centres in the Republic of Kazakhstan. The prospects of applying modern achievements of telemedicine in the field of emergency neurology and neurosurgery are analysed. The main global trends in the organisation of assistance to people with acute cerebral circulatory disorders are highlighted, and the prospects for further integration of a number of information technologies and mobile stroke centres in Kazakhstan in general and the Almaty region in particular are highlighted.Conclusions: the result of the study is a comprehensive analysis of modern scientific literature on the topic of optimising the provision of specialised and high-tech care to patients with acute cerebral circulatory disorders in the example of the Almaty region

The development of approaches to medical rehabilitation under after-troubles of acute disorders of cerebral blood circulation using International Classification of Functioning

The article presents social hygienic characteristics of contingent of persons admitted to second stage of rehabilitation in specialized rehabilitation department after ischemic stroke at early recovery period. The attention is focused on necessity of multidisciplinary approach to rehabilitation measures, taking into account the International Classification of Functioning that permits to achieve more significant results in implementation of rehabilitation measures, to reduce the number of possible complications of this disease in later period, as well as to accelerate process of returning of studied category of patients to full-fledged life.

Abilities of diagnostic tools for deep vein thrombosis of the lower extremities in stroke patients (literature review)

One of the significant causes of disability and mortality both in Russia and around the world remains acute cerebral circulatory disorders, which combines ischemic and hemorrhagic strokes, and transient ischemic attack. Deep vein thrombosis (DVT) has a significant prevalence in patients with stroke, and venous thromboembolism (VTE) significant impact on the prognosis. The development of technologies, the emergence of new research methods made it possible to accurately determine the presence of DVT in patients with stroke using duplex ultrasound, using reserve methods, if necessary — CT, MRI, CV. However, there is currently no data that would allow to effectively determine the timing for the diagnosis of DVT in patients with stroke, as well as to identify patients who need such evaluation. Additional studies are needed to determine the timing of the screening for DVT, by assessing the prevalence of DVT in various periods of stroke, as well as evaluating the identifying factors.

Thrombus extraction in acute ischemic stroke: three years of experience at the regional vascular center

From a modern perspective, the key to successful treatment of ischemic stroke is early reperfusion with systemic thrombolytic therapy and thrombus extraction. Thrombectomy is the only reliable method of recanalization in patients with thrombosis of a large cerebral artery. Despite the fact that thrombus extraction has proven its effectiveness in the treatment of acute ischemic stroke in a number of large randomized trials, there are still issues that have not been fully studied, on which there are controversial opinions among specialists. For instance, there is different information about whether direct thrombectomy or thrombus extraction after systemic thrombolysis is more effective and safer. Moreover, in accordance with modern procedures for providing care to patients with acute cerebral circulatory disorders, patients admitted in the «therapeutic window» should receive intravenous thrombolytic therapy even if thrombectomy is planned. Based on the analysis of 164 thrombus extractions in patients with acute ischemic stroke admitted to the regional vascular center in 2020–2023, the results of direct thrombus extraction and staged reperfusion (systemic thrombolytic therapy + thrombectomy) were compared. It has been found that compared to direct thrombus extraction, staged reperfusion provides more frequent achievement of 2b-3 recanalization (71.83 % and 78.49 %, respectively), accompanied by lower mortality (45 % and 23.66 %, respectively) and more frequent achievement of Rankin 0–2 functional status at the time of discharge (48.72 % and 61.96 %, respectively). The worst results were observed among patients with vascular occlusion in the vertebrobasilar basin, at TICI 0-2a and the age of patients over 80 years.

Experience and prospects of introducing information technologies in the program of medical rehabilitation of patients with cerebral circulation disorders

Objective. To assess the rehabilitation potential of patients with cerebrovascular disorders for prospective follow-up and effective medical rehabilitation. Materials and methods. The study group included patients with cerebrovascular diseases (n=20) and acute cerebrovascular accident (n=22). Integral assessment of the state of health was carried out using diagnostic complex “Computer dermograph for the topical diagnosis of pathology lesions of internal organs” (DgKTD-01). Following studying the baseline indicators, a comparative analysis of the study group and the control group (n=10) was carried out. The patients of the study group had their state of health corrected by means of the Computerized corrector ANKF-01 using low-intensity electromagnetic field for normalization of functional activity of the central and peripheral nervous system. The course consisted of 10 sessions weekly with preliminary functional and topical diagnostics using the DgKTD-01 complex. Results. Patients with acute cerebrovascular accident revealed a functional restructuring of autonomic regulation with a greater severity of activation of the sympathetic link, patients with cerebrovascular diseases – of the parasympathetic one. The determining factor in cerebral circulation disorder consists in the indices of basic functions F2 and F3. The study identified a model for predicting the likelihood of acute recurrent disorders of cerebral circulation, as well as additional diagnostic criteria for differential diagnosis. Purposeful change of excitatory (inhibitory) potentials in cortical-subcortical relations changes vegetative balance, stimulates microcirculation, muscle-tonic function, neurotrophic regulation. These effects stabilize and improve the condition of patients. The effectiveness of rehabilitation measures using ANKF-01 is considered to be higher in patients with acute cerebrovascular accident. Conclusion. Patients with cerebral circulation disorders have specific features of the adaptive capabilities of the body. This indicates the differentiation in the formation of the functional status of the body, taking into account the characteristics of the disease, individual resources and compensatory capabilities. Rehabilitation based on the use of ANKF-01 increases the effectiveness of measures aimed at preventing organic changes in the brain, and can significantly improve the prognosis and reduce the percentage of disability in this category of patients.

The efficiency of X-Ray endovascular care in decreasing of population mortality from acute coronary syndrome and acute disorder of cerebral circulation

The article considers results of assessment of dynamics of mortality from cardiovascular diseases and the most important nosologic forms - acute cerebrovascular disorders and coronary heart disease with acute coronary syndrome and development of accessibility of X-Ray endovascular care of patients in the Oblast. The results of analysis of changes in mortality after implementation of new model of care of patients with acute vascular diseases are presented. The relationship between accessibility of X-Ray endovascular interventions and decrease of mortality was analyzed. The reliable significantly strong connection was found for cerebrovascular diseases, and medium negative connection for coronary heart disease with acute coronary syndrome.

Efficacy of 4-(2-(4-nitrophenyl)-2-oxoethyl)-1-(thietane-3-yl)-1h-1,2,4-triazol-4 bromide in the rat model of inferior vena cava thrombosis

Introduction. According to WHO, acute disorders of cerebral circulation are anticipated to become a predominant contributor to the global disease burden by 2030. The comprehensive management of vascular depression entails not only the use of antidepressants but also fundamental interventions. The development of a novel molecule based on thietane-containing heterocycles, merging the attributes of an antidepressant and an antiplatelet agent, holds promise for enhancing therapeutic efficacy in patients with acute cerebrovascular accidents through multimodal action. Objective is to conduct a preclinical assessment of 4-(2-(4-nitrophenyl)-2-oxoethyl)-1-(thietane-3-yl)-1H-1,2,4-triazole-4-th bromide concerning model thrombosis in rats. Materials and Methods. The investigation involved the evaluation of thrombosis processes and the haemostasis system in rats subjected to complete occlusion of the inferior vena cava within 24 hours post-thrombosis induction. Techniques employed included thromboelastography, Born aggregometry, standard clotting assays to appraise the coagulation facet of haemostasis, and morphological examinations. Results. The results demonstrate that 4-(2-(4-nitrophenyl)-2-oxoethyl)-1-(thietane-3-yl)-1H-1,2,4-triazole-4-th bromide mitigates thrombosis mass, restores platelet hyper aggregation, and counters hypercoagulation observed in acute inferior vena cava thrombosis in rats. Comparative analysis with reference drugs substantiates the superior effectiveness of the chosen compound in thrombosis prevention. Conclusion. The preclinical investigation of 4-(2-(4-nitrophenyl)-2-oxoethyl)-1-(thietane-3-yl)-1H-1,2,4-triazole-4-th bromide unveils a fusion of established antidepressant and antithrombotic activities, laying groundwork for further drug development endeavours.

ВТОРИЧНЫЕ ГНОЙНЫЕ ОТОГЕННЫЕ МЕНИНГИТЫ У ВЗРОСЛЫХ: ОСОБЕННОСТИ ПРОТИВОМИКРОБНОЙ ТЕРАПИИ

Secondary purulent otogenic meningitis (SPOM) in adult patients is less common than in children, but among all intracranial complications of middle ear pathology it occupies the leading position. In the absolute majority of cases, a patient with SPOM on admission to the emergency room is supervised by a neurologist with a suspicion of acute cerebral circulation disorder, and an otorhinolaryngologist, along with other subspecialists, is initially an invited consultant. All this is associated with the risks of untimely diagnosis of SPOM and inadequate tactics of medical care, including the rationality of prescribing the choice of systemic antimicrobial therapy (SPMT), which increases the likelihood of unfavorable outcomes. As a result of retrospective analysis of medical records of 33 completed cases of SPOM for the period from 2017 to October 2023, the features of the course of SPOM microbial landscape in this pathology and the nature of SPMT were studied. It was revealed that in the structure of secondary meningitis of otogenic and rhinosinusogenic etiology VHOM took the leading positions (81.1%). In 62.5% of cases, patients had comorbid pathology, which negatively affected the course of the underlying disease and worsened the prognosis of the disease. Such manifestations as headache, vomiting, disorders of consciousness were observed in 62.5%, 57.6%, 62.1% of cases, respectively. Clearly expressed signs of inflammatory process on the part of general blood analysis and cerebrospinal fluid were revealed. The structure of etiologic factors in adult SPOM was dominated by coccal microflora (S.pneumoniae, Streptococcus spp., Staphylococcus spp.). In 81.8% of cases of SPOM we started with recommended ceftriaxone, but absence of positive dynamics, severity of the course of the inflammatory process required correction of SPMT and transition to meropenem. Timely diagnosis, clear tactics of medical care, including the choice of effective SPMT using, including de-escalation schemes, led to favorable outcomes in 87.9% of patients.

Emergency neurosurgical care for patients with acute cerebral circulation disorders

Aim. To improve the results of neurosurgical treatment of patients with acute cerebrovascular disorders.Material and Methods. An analysis of the results of neurosurgical treatment of 48 patients admitted to the Department of Neurosurgery of the State Institution National Medical Center - “Shifobakhsh” was carried out. The age of patients ranged from 30 to 75 years. In each case, patients underwent clinical and laboratory studies, including using CT and MRI, as well as using three-dimensional (3D) and four-dimensional (4D) reconstruction methods of cerebral vessels.Result and Discussion. The most common cause leading to the formation of intracranial hematomas was hypertension, found in 32 (66.6%) patients, while other causes were identified in 12 (25%) patients (including angiopathy, cerebral vascular pathologies, amyloidosis, and the use of certain medications, among others). All patients underwent neurosurgical operations. The highest frequency of recurrences (4.1%) was observed after surgical interventions performed within the first 24 hours following the hemorrhagic event.Conclusion. With early detection of intracranial hematomas and with the optimal choice of method for their treatment, good functional results are observed with a low incidence of deaths.

Results of Preclinical Studies of 4-(2-(4-nitrophenyl)-2-oxoethyl)-1-(thietane-3-yl)-1H-1,2,4-triazole-4-th Bromide in Relation to the Hemostasis System <i>in vivo</i>

Introduction. A characteristic manifestation of vascular brain damage is depressive disorders that accompany both acute and chronic disorders of cerebral circulation. Depression not only reduces the patient's quality of life, but also complicates the treatment of basic vascular disease, increases the risk of stroke and death. Therefore, complex therapy of vascular depression includes not only antidepressants, but also basic means to correct the consequences of disorders of cerebral blood flow, including with antiplatelet activity. In this regard, the development of a new molecule based on thietane-containing heterocycles, combining the properties of an antidepressant and an antiplatelet agent.Aim. To conduct a preclinical evaluation of 4-(2-(4-nitrophenyl)-2-oxoethyl)-1-(thietane-3-yl)-1H-1,2,4-triazol-4 bromide when administered to rats.Materials and methods. A study was conducted of the effect of 4-(2-(4-nitrophenyl)-2-oxoethyl)-1-(thietan-3-yl)-1H-1,2,4-triazol-4-bromide on the hemostasis system during intravenous and intragastric administration to healthy white non-linear sexually mature male rats (n = 160). Thromboelastography was performed on a TEG 5000 device, activated with a 0.2 M solution of calcium chloride, Born aggregometry and standard clotting tests to assess the coagulation component of hemostasis.Result and discussion. The findings show that 4-(2-(4-nitrophenyl)-2-oxoethyl)-1-(thietane-3-yl)-1H-1,2,4-triazole-4-th bromide with peroral administration exceeded acetylsalicylic acid by 2.8 times in terms of ED50, and by 1.8 times with intravenous way of administration accordingly. A similar effect of pentoxifylline in the intravenous route of administration was recorded at a concentration of 27.8 mg/kg versus 12.4 mg/kg of compound I. The results of a complex method to assess the state of the hemostasis system indicate a more pronounced antiaggregational effect of compound I compared with pentoxifylline and acetylsalicylic acid.Conclusion. Preclinical studies of 4-(2-(4-nitrophenyl)-2-oxoethyl)-1-(thietane-3-yl)-1H-1,2,4-triazole-4 bromide, was demonstrated that a combination of antidepressant and antiplatelet activity, which can serve as a basis for further drug development.

Personalized approach to the logopedic rehabilitation of neurogenic dysphagia patients

Aim. To determine the role of personalized approaches in the rehabilitation of patients with neurogenic dysphagia after acute disorders of cerebral circulation (ADCC) in the early recovery period.Materials and methods. The study included 97 patients (53 men and 44 women with the mean age of 69.5) in the early recovery period after ADСС. All the patients were at the second stage of medical rehabilitation. The treatment program included the following methods of logopedic rehabilitation: disinhibition of the act of swallowing; stimulation of the sensitivity of the mucous membranes of the oral cavity; recovery of respiratory and speech functions; selection of the consistency of liquid and solid foods to ensure the safety of swallowing during feeding; selection of the feeding method and appropriate portions to facilitate the patient’s eating.Results. When developing a personalized program of logopedic rehabilitation, the following aspects were considered: the severity of swallowing dysfunctions; the primary speech defect; patient compliance; the degree of cognitive dysfunctions; motivation for recovery.Conclusion. The application of logopedic rehabilitation methods in combination with specialized multidisciplinary care based on personalized approaches can significantly improve patients’ quality of life and reduce the risk of undesired complications.

Correlation analysis of clinical and laboratory markers in COVID-19 and acute cerebrovascular accident

Coagulopathies developing with COVID-19 are a serious problem. Increased fibrinogen levels, activation of coagulation, a direct damaging effect of the virus on the endothelium, and increased interaction of the platelet with the vascular endothelium play an important role in the development of thrombotic complications and the occurrence of acute cerebral circulatory disorders. Case histories of COVID-19 patients and those with secondary CHF were analysed. Among the biochemical blood parameters in COVID-19, an increased level of D-dimer, which reflects the severity of the course of coronavirus infection, as well as CRP and ferritin were revealed more frequently.
 Results: Among biochemical blood parameters in COVID-19, an increase in D-dimer level, which reflects the severity of the course of coronavirus infection, as well as CRP and ferritin, is more frequently detected. In correlation analysis, a positive correlation was observed between the level of ferritin, CRP and stage of CT as well as between the level of D-dimer and the number of platelets