Acute Disorders Of Cerebral Circulation Research Articles

Molecular genetic determinants of arterial thrombosis in patients with thoracoabdominal malignant tumors

Background. Acute ischemic cerebral circulation disorder and myocardial infarction occupy one of the first places among the causes of postoperative mortality in patients with malignant tumors of thoracoabdominal localization. The issue of the role of molecular genetic factors of cardiovascular risk in the development of these complications has not been resolved at present.Objective. To analyze the effect of polymorphisms of hemostasis system genes on the development of coronary artery and cerebral artery thrombosis in patients with malignant tumors of thoracoabdominal localization.Materials and methods. The study included 163 patients operated in the Oncological Department of Surgical Methods of Treatment No. 11 (Thoracic Oncology) of the N.N. Blokhin National Medical Research Center of Oncology in 2018-2019. Two study groups consisted of patients with myocardial infarction (n = 62) and ischemic stroke (n = 24) in the perioperative period or in the anamnesis. The data of patients with a history of both myocardial infarction and ischemic stroke (n = 4) were taken into account in both groups. The control group (n = 81) included patients who had no severe concomitant cardiovascular pathology, including a family history. A molecular genetic study to determine polymorphisms of the genes of the hemostasis system was performed in the Laboratory of Clinical Oncogenetics of the N.N. Blokhin National Medical Research Center of Oncology using the reagents “Cardiogenetics of Thrombophilia” (DNA Technology LLC, Russia; RU No. FSR 2010/08414 dated 11/22/2016).Results. In patients with malignant tumors of thoracoabdominal localization who have suffered a myocardial infarction, in comparison with patients without cardiovascular pathology, a statistically significant difference in the frequency of carriage of homozygous variants of the genes FGB (χ2 = 8.18, p = 0.005), ITGA2 (χ2 = 9.48, p = 0.003), PAI-1 (χ2 = 4.45, p = 0.035), heterozygous forms of genes F5 (χ2 = 4.0, p = 0.046), ITGA2 (χ2 = 14.72, p <0.001), ITGB3 (χ2 = 4.28, p = 0.039), as well as the total frequency of genetic aberrations in these genes. In the group of patients who suffered an ischemic stroke, a statistically significant difference was determined relative to the control group in the frequency of carriage of the heterozygous variant of the mutation in the F2 gene (χ2 = 6.881, p = 0.009), the homozygous form of the mutation of the ITGA2 gene (χ2 = 15.724, p <0.001), the heterozygous variant of the mutation in the ITGB3 gene (χ2 = 3.861, p = 0.05), as well as the total frequency of carrying mutations in these genes. The study did not obtain a significant difference in the studied and control groups with respect to the frequency of polymorphism carriers G/A of the F7 gene (coagulation factor VII) and G/T of the F13 gene (coagulation factor XIII) associated with a reduced risk of thrombotic conditions. In all patients who had a myocardial infarction, and in 91.7 % of cases, several procoagulant polymorphisms were noted in the genotype of patients who had an ischemic stroke; in the group of patients without cardiovascular diseases, this indicator was 53 %, the difference in the groups was statistically significant (χ2 = 39.61, p <0.001; χ2 = 11.685, p <0.001, respectively).Conclusion. Based on the results of a molecular genetic study of factors associated with a high thrombogenic risk, a statistically significant difference in the frequency of occurrence of polymorphic markers F5 G1691A, FGB G(-455)A, ITGA2 C807T, ITGB3 T1565C, PAI-1 4G(-675)5G was revealed in patients with thoracoabdominal localization tumors who had suffered a myocardial infarction, and F2 G20210A, ITGA2 C807T, ITGB3 T1565C who had suffered an ischemic stroke, compared with cancer patients without concomitant cardiovascular pathology. The data of the conducted study make it possible to identify groups of oncological patients with increased risk of developing cardiovascular complications in the perioperative period and take additional measures to prevent thrombotic complications.

ПЕРКУТАННАЯ ЭНДОСКОПИЧЕСКАЯ ГАСТРОСТОМИЯ (ОБЗОР ЛИТЕРАТУРЫ)

Percutaneous endoscopic gastrostomy is the most common method for long-term enteral nutrition in patients with organic and functional diseases of the esophagus, with severe neurogenic oropharyngeal dysphagia as a result of acute cerebral circulatory disorders, oropharyngeal cancer, severe facial injuries, etc.
 The advantages of endoscopic surgery are the minimally invasive nature and speed of the intervention, an insignificant percentage of postoperative complications. 
 The review article analyzes data on the relevance of the problem, indications and contraindications, technique of execution, complications of percutaneous endoscopic gastrostomy. 
 Measures aimed at minimizing risks during this operation, including correction of the general condition and concomitant somatic diseases in patients, a thorough assessment of the risk of surgery, which have the greatest impact on the immediate results of the operation, are identified.

Cerebrovascular diseases and cognitive impairment: therapy approaches

The issue of cerebral vascular pathology is one of the most important social problems in the modern world, and Russia is no exception. Cerebrovascular diseases are distinguished by high prevalence, mortality and disability rates. They are of great importance from a health perspective of not only each individual, but total nation. Acute or chronic disorders of cerebral circulation naturally results from atherosclerosis of the major arteries of the head, hypertensive disease, and other cardiovascular diseases. These factors cause pathology of large and small cerebral vessels, which leads to chronic cerebral ischemia and (or) acute cerebrovascular accident with damage to various brain structures. Cognitive impairment is probably the most common presentation of cerebrovascular insufficiency. The severity of cognitive impairment can vary significantly depending on the stage of the condition and the severity of the underlying vascular disease - from mild cognitive impairment to dementia. Vascular cognitive impairment can be caused by several mechanisms. Small vessel ischemic disease is one of the pathological conditions that cause the development of cognitive impairment and dementia. Other presentations of cerebrovascular disorders can include multi-infarction, hypoperfusion, hemorrhagic, hereditary and mixed dementia. Current strategies for the management of patients with vascular cognitive impairment and dementia include symptomatic treatment, risk factor management, and non-pharmacological approaches aimed at preventing their progression.

Comparative study of the specific activity of soft application drugs with vinpocetine

In modern neurology, the main component of successful treatment of cerebrovascular pathology is pharmacotherapy. At the same time, the arsenal of effective medicines of evidence-based medicine in this area is quite limited. Vinpocetine (Cavinton) is one of the drugs that effectively selectively corrects cerebral perfusion. The use of alternative ways of absorption of vinpocetine (rectal and nasal) in certain soft application dosage forms will allow to significantly increase the bioavailability of the medicinal substance, reduce the level of adverse reactions from its use and expand the pharmacotherapeutic arsenal of domestic effective neuroprotective drugs. Taking into account the above, the employees of the Department of Medicines Technology of Zaporizhzhia State Medical University, on the basis of complex physical-chemical, pharmacotechnological, rheological and biopharmaceutical research, proposed rational formulations and technologies of two new soft application dosage forms of vinpocetine – rectal suppositories on a lipophilic basis and nasal cream on an emulsion basis for the therapy of arterial hypertension of II–III stages with cerebrovascular complications, reduction of the manifestation of neurological and/or mental symptoms in various forms of cerebral blood circulation insufficiency, consequences of a stroke, transient ischemic attack, etc. The aim of the work is to study the specific activity of the proposed innovative application dosage forms of vinpocetine. Materials and methods. Nasal ointment containing 0.5 % vinpocetine on an emulsion basis and rectal suppositories with vinpocetine 0.01 g on a lipophilic carrier were used as the object of preclinical studies, which ensure optimal release of the active pharmaceutical ingredient. The study of the specific activity of the developed medicinal forms of vinpocetine was carried out on a model of acute cerebrovascular accident of the type of ischemic stroke. Vinpocetin tablets (Astrapharm, Ukraine), which are used in neurological practice quite effectively and over a long period of time, were used as a comparison drug. Results. The comparative results showed that the appointment of all studied drugs led to an increase in motor activity. In addition, the administration of medicinal forms of vinpocetine reduced the development of cognitive and cognitive disorders after acute disorders of cerebral blood circulation. It was found that the highest result was shown by the group of animals that received a course of vinpocetine intranasally. In the groups of animals that received vinpocetine for 4 days, markers of oxidative stress – aldehyde phenylhydrazones and ketone phenylhydrazones – were significantly reduced. The highest activity was demonstrated by the pharmaceutical form of vinpocetin, which was used intranasally for 4 days. The introduction of dosage forms of vinpocetine exerted an energizing effect, which was expressed in an increase in the level of macroergic phosphates. Evidently, vinpocetine has a direct positive effect on the three-carbon sections of the Krebs cycle and increases the production of adenosine triphosphate (ATP). At the same time, the vinpocetine nasal cream applied intranasally for 4 days demonstrated the greatest energizing activity. Conclusions. Preclinical studies of the developed application soft medicines with vinpocetine on the model of acute cerebrovascular accident type ischemic stroke experimentally confirmed the expressed neuroprotective activity of rectal suppositories and nasal cream with vinpocetine and it was found that the effectiveness of therapy with these application medicinal forms is demonstrably higher than that in comparison with oral tablet means.

PSUN66 Statin Intake as a Cause of Decreased Steroid Hormone Secretion

Abstract Materials and methods The study enrolled 2 men aged 58 years (history of acute cerebral circulation disorder at 47 and 57 years) and 64 years (history of acute myocardial infarction at 62 years), who complained of shortness of breath, daytime sleepiness, decreased libido, weakened erections, increased blood pressure. Both patients had been taking atorvastatin 10 mg for more than three months. We used high-performance liquid chromatography (HPLC) to determine steroid hormones in saliva: Agilent 1200 chromatograph, AB Sciex 3200 MD mass spectrometer (Sciex, USA). Saliva was collected in a Salivette container. A significant decrease in pregnenolone levels of 440.0 pg/ml and 300 pg/ml, respectively, was detected in the saliva analyses). The norm for pregnenolone was 575-665 pg/ml. Conclusion Statins lead to decreased pregnenolone secretion, most likely due to inhibition of HMG-CoA reductase, a key enzyme that converts 3-hydroxy-3-methyl glutaryl-CoA to mevalonate, a cholesterol precursor. The decrease in cholesterol synthesis leads to a decrease in pregnenolone and a decrease in steroid hormone secretion, both in the adrenal glands and gonads, which clinically manifests as hypogonadism and adrenal fatigue. All patients taking statins should have their salivary steroid profile evaluated. If statins cannot be withdrawn, hormone replacement therapy with sex hormones is necessary. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Acute Cerebrovascular Accident during the pandemic of a new coronavirus infection in the Ural Federal District

Introduction. Acute cerebrovascular accidents are among the leading causes of death and disability in the population. The study of regional features of the incidence of acute disorders of cerebral circulation in the context of a pandemic of a new coronavirus infection COVID-19 is an urgent task. Purpose - to conduct a comparative analysis of the primary incidence of acute disorders of cerebral circulation, including transient ischemic attacks, in the adult population of Russia, the Urals Federal District and the constituent entities of the Russian Federation as part of the Urals Federal District. Materials and methods. A comparative analysis of the primary incidence of acute cerebrovascular accidents in the adult population in the Urals Federal District and in individual subjects of the district during the 2020 pandemic was carried out relative to the average long-term indicators for 2015-2019. Transient transient cerebral ischemic attacks, intracerebral and other intracranial hemorrhages, cerebral infarctions and strokes not specified as hemorrhage or infarction were taken into account. Average long-term levels of primary morbidity, standard deviation, coefficient of variation were calculated. Statistical data analysis was carried out using Microsoft Excel software products. Results. During the COVID-19 pandemic, the levels of primary incidence of certain acute cerebrovascular accidents in the Russian Federation and the Urals Federal District as a whole decreased compared to the long-term averages of 2015-2019. Conclusions. Indicators of primary morbidity of the adult population of the Ural Federal District with certain acute cerebrovascular accidents, including transient ischemic attacks, in different subjects of the district have pronounced regional features. Regional peculiarities of morbidity should be taken into account when planning the volume and financial parameters of territorial programs for the provision of free medical care to citizens. Significant differences in morbidity rates should be in the focus of attention of the chief neurologists of the Ministry of Health of the Russian Federation and the constituent entities of the Russian Federation.

Pathogenetic Role of Disorders of Insulin Signaling Pathways and Diabetes-Associated Hyperglycemia in the Mechanisms of Diabetic Encephalopathy Formation and Hypersensitivity of the Brain to Ischemia-Reperfusion

The aim of the study was to analyze the literature data regarding the pathogenetic role of insulin signaling disorders and diabetes-associated hyperglycemia in the mechanisms of diabetic encephalopathy and hypersensitivity of the brain to ischemia-reperfusion.
 Conclusion. Analysis of the literature data shows a number of common links between the pathogenesis of diabetic encephalopathy and ischemic-reperfusion brain injury, which may, to some extent, explain the predisposition of diabetics to acute cerebral circulatory disorders and their adverse course. However, it is clear that the severity of such comorbid pathology cannot be explained only by the additive effect of individual links in the pathogenesis, which indicates the necessity for further in-depth study of its molecular-genetic aspects.

Prevalence of acute disorders of cerebral circulation in the Smolensk region in terms of the role of socio-economic factors and the state of the health care system

Introduction. The stroke was the leading reason for disability and mortality of the Russian population. In recent years, the influence of socio-economic factors on the health of the population has been actively studied. In this regard, it is important to study the relationship of these indicators in the subsidized region, which includes the Smolensk region, where the incidence of stroke is higher than in the whole country. The purpose of the investigation is to assess the relationship between the incidence of stroke in the Smolensk region and socio-economic factors and indicators of the health system in the region. Materials and methods. Using the methods of nonparametric statistics, the official statistical information was analyzed as trend for 10 years. A survey of stroke patients was conducted to determine their material wealth. Results. There is an annual gain in the incidence of brain infarctions and intracerebral hemorrhages, a decline in the incidence of undifferentiated strokes, a decrease in the availability of doctors of all specialties, as well as neurologists, internists and emergency physicians, and an increase in the availability of general practitioners. The relationship between the incidence of the stroke and the actual final consumption of households, the ratio of the average monthly nominal accrued wages of employees of institutions to the subsistence minimum of the working-age population, the deficit of monetary income from the total monetary income of the population, the consumer price index for goods and services, the Gini index, the average amount of accrued pensions, the average per capita monetary income of the population, the integral indicator of the quality of life, the availability of general practitioners, therapists, emergency physicians. Limitations. The study was carried out on the basis of generalized aggregated information without any primary data, the results reveal statistical rather than causal relationships, and are valid only for the territory of the Central Federal District and are comparable with the results of similar work. Conclusions: the greatest impact on the level of stroke incidence in the Smolensk region is caused by the deficit and inequality in the distribution of monetary income, the low level of quality of life of people, the personnel shortage and the insufficient volume of preventive work of outpatient clinics.

Myocardial condition in overweight patients at different stages of rehabilitation after revascularization

The aim of the study was to study the dynamics of myocardial function indicators in overweight patients at different stages of rehabilitation after coronary revascularization.Material and methods. This article presents the interim results of prospective study which was conducted at the Tulpar cardiorehabilitation center (Karaganda, Kazakhstan). The study included 135 patients after restoration of blood flow in the coronary arteries (coronary artery bypass grafting, stenting). The average age was 58 ± 6 years. Exclusion criteria: acute myocardial infarction; chronic heart failure, functional class III–IV; acute disorders of cerebral circulation; diabetes mellitus in a state of decompensation; obesity I–III degree. We observed patients in dynamics at three stages of rehabilitation. 41 patients were included in the study at the first stage, 43 – at the second stage and 51 – at the third stage. Patients were included from different stages of rehabilitation. The groups were comparable in terms of the parameters of the structural and functional state of the myocardium, the same age range.Results. Considering the size of the interventricular septum, the posterior wall of the left ventricle, the relative thickness of the myocardium and the myocardial mass index, it can be noted that statistically significant hypertrophy of the left ventricle was observed in all observation periods (p < 0.05).Conclusions. In overweight patients who underwent myocardial revascularization surgery, persistent changes in the myocardium remain at the 3rd stage of rehabilitation

The use of osteopathic correction in the complex rehabilitation of patients with acute cerebrovascular accident

Introduction. Acute disorders of cerebral circulation - strokes - are the most important medical and social problem, due to their high proportion in the structure of morbidity and mortality of the population, signifi cant indicators of temporary labor losses and primary disability. In this regard, one of the main tasks of Russian healthcare is to slow down the increase in the disability of the population, which is carried out through the active development of the rehabilitation system in our country, including neurorehabilitation. Osteopathic correction can become one of the new areas of rehabilitation for this group of patients. There have already been made previous attempts to study the osteopathic status in patients with acute cerebrovascular accident and to assess the possible contribution of somatic dysfunctions to the pathogenesis of this disease. At the same time, there are no publications in the available scientifi c literature about the possibility of osteopathic correction using in the rehabilitation of patients with acute cerebrovascular accident in the early recovery period. All of the above predetermined the purpose of the study.The aim of the study is to substantiate the possibility of osteopathic correction methods using in the complex rehabilitation of patients with acute cerebrovascular accident in the early recovery period.Materials and methods. A prospective randomized controlled study was conducted from February 2019 to March 2020 on the basis of the neurorehabilitation department of the State Clinical Hospital № 11 (Omsk). 40 patients with a diagnosis of acute cerebrovascular accident, early recovery period were under observation. The sample was entire. Patients, depending on the method of used treatment, were divided with using the method of simple randomization into two comparable groups of 20 people: main and control. All patients received complex rehabilitation treatment, which included drug therapy, physiotherapy, kinesiotherapy, massage, and acupuncture. Additionally, patients of the main group received osteopathic correction (3 sessions). All patients, regardless of the group, before the start, as well as after the completion of the rehabilitation course, were assessed for osteopathic status, the level of self-care, daily activity and mobility of patients was determined using functional scales, and muscle strength of the hands was studied using dynamometry.Results. Patients with ischemic stroke in the early recovery period are characterized by the presence of somatic dysfunctions, mainly at the global and regional levels. 100 % of the examined participants had a global rhythmogenic cranial disorder. The most characteristic regional somatic dysfunctions were of the neck region, the structural component (29 %), and of the dura mater region (24 %). After completion of rehabilitation, global rhythmogenic cranial somatic dysfunction remained in all patients (100 %), however, in the group that received osteopathic correction, its severity was statistically signifi cantly reduced (p<0,05). Also, in the main group, the average number of regional somatic dysfunctions and their severity changed statistically more signifi cantly (p<0,05). At the background of complex rehabilitation treatment, all patients had an increase in the level of self-care, daily and physical activity according to neurorehabilitation scales, and also increased arm muscle strength according to dynamometry. However, in the group receiving additional osteopathic correction, these indicators were statistically signifi cantly higher (p<0,05).Conclusion. Rehabilitation of patients with vascular pathology, including those with ischemic stroke, is one of the most important directions in the development of the modern healthcare system. This dictates the need to search and study new methods and means of rehabilitation, one of which could be osteopathy. This study showed that the inclusion of osteopathic correction in the program of complex rehabilitation of patients with ischemic stroke in the early recovery period will achieve better results in terms of restoring lost functions and improving self-care skills. In order to introduce the new method more widely, it is advisable to continue the study on an even larger sample.

Clinical case of endovascular treatment of ischemic stroke after carotid endarterectomy

The article presents a clinical case of endovascular treatment practice of a patient after carotid endarterectomy complicated by ischemic stroke. It is pointed out that early diagnosis allows well-timed detection of complications in the postoperative period and timely selection of treatment methods. The method of intravascular thromboectomy, which significantly reduces the onset of complications in the first hours after surgery, is described in detail. The tactics of management of patients with acute disorders of cerebral circulation during operations on brachiocephalic arteries are analyzed.

Predictive Estimations for Patients Who Have Suffered From Acute Cerebrovascular Accident and Have Undergone Rehabilitation

BACKGROUND: Acute cerebral circulation disorder is known to be one of the main causes of morbidity, mortality, long-term disability, and the overall so-called disability in society. Prevention of acute cerebral circulation disorder, mortality after acute cerebral circulation disorder, methods of rehabilitation after acute cerebral circulation disorder are studied all over the world, but there are so few studies in the literature on the relationship between rehabilitation and survival of patients after acute cerebral circulation disorder. AIM: The aim is to study the features of survival among patients who have suffered from acute cerebral circulation disorder (hereinafter referred to as ACCD) and have undergone rehabilitation. METHODS: Based on the register statistics on cases of acute cerebral circulation disorder among Almaty residents, the association of the fact of rehabilitation with a fatal outcome was studied and a survival analysis was performed using the Kaplan-Meyer method. RESULTS: In patients with acute cerebral circulation disorder who have not undergone rehabilitation, the chances of a fatal outcome increase by 3.830 times, in comparison with patients who have received an appropriate course of recovery. With the postponement of rehabilitation, the probability of death in patients with acute cerebral circulation disorder increased by 6−10%. The average survival rates in patients who did not receive a rehabilitation course are significantly lower compared to those who underwent rehabilitation: the average survival was 87 years (CI95% 87.0−87.0) and 82 years (CI95% 80.3 ÷ 83.7), respectively, (Log-rank test: test statistics χ2 = 7.916, for DF = 1, p = 0.005). CONCLUSIONS: The main conclusion that can be drawn is that the early rehabilitation care increases the probability of survival among patients who have undergone ACCD. At the same time, the predictive parameters of an unfavorable outcome are the sexual characteristic and the type of acute cerebral circulation disorder.

Thrombotic thrombocytopenic purpura in pregnancy. Giving birth or not giving birth, that is the question

Introduction. Pregnancy is one of the most frequent triggers of congenital and acquired forms of thrombotic thrombocytopenic purpura (TTP).Aim — to develop tactics for the treatment of pregnant women with TTP.Results. TTP was associated with pregnancy in 55.5 % of all cases of TTP in women. In 5 pregnancies in which the diagnosis of TTP was known before pregnancy, or established in the early stages, TTP was treated throughout the pregnancy. In the congenital form, plasma transfusions were performed once every two weeks until the 20th week of pregnancy, or weekly, if thrombocytopenia < 150 × 109 /L persisted. Plasma transfusions were performed weekly after the 20th week with the goal of achieving clinical remission. With acquired TTP, glucocorticosteroids and plasma exchanges were used as treatment, in 1 case — rituximab, with the aim of achieving a clinical remission and an ADAMTS13 activity > 20 %. In this group of pregnant women, 1 caesarean section was performed and there were 4 cases of vaginal deliveries, with a total of 5 children being born with an average Apgar score of 7.5. In 7 pregnancies in which TTP fi rst manifested late, leading to a delayed diagnosis, preventive and curative measures were not carried out before delivery. In this group there were 2 abortions of pregnancy, 5 surgical deliveries, 3 cases of preeclampsia, 3 acute cerebral circulatory disorders, 1 intraabdominal bleeding, 1 case of acute renal failure, with two women undergoing mechanical ventilation. There was 1 case of antenatal fetal death, with a total of 4 children being born, who were assessed on the Apgar scale with an average of 5 points.Conclusion. Timely diagnosis as well as ongoing therapeutic and preventive measures help to avoid complications during childbirth in pregnant women with TTP.

Respiratory and muscular dysfunction of the respiratory muscles and chronic obstructive pulmonary disease: pathophysiological relationships and clinical significance

The review presents literature data on the problem of respiratory muscle (RM) dysfunction in patients with chronic obstructive pulmonary disease (COPD). The main features of their pathophysiological interactions and clinical practice values were observed. Both local and systemic factors of the pathogenesis of COPD are important in the development of RM dysfunction. Local factors are associated with lung remodeling and the need of RM to overcome excessive breathing resistance, which increases the intensity of their work, and contributes to the development of hypertrophy and insufficiency. Chronic systemic inflammation, oxidative stress, excessive proteolysis and other systemic manifestations of COPD change the metabolism, structural and functional organization of RM. The severity of morpho-functional disorders and metabolic status of RM depends on the gravity of COPD and emerges on the early stages as myocytes’ hypertrophy, their increasing capillarization and the increasing of mitochondrion density. At late stages it appears as diffuse replacement of muscle fibers by connective tissue. Low nutritional status, increasing protein-energy deficiency, electrolyte imbalance, endocrine disorders on the background of progressive respiratory insufficiency and tissue hypoxia contribute to the development of RM weakness. The combination of COPD, acute disorders of cerebral circulation and chronic heart failure sharply worsens the function of RM and the prognosis of comorbid diseases. Also, the dysfunction of RM in patients having COPD is significantly aggravated at the age of senility. The review discusses the possibilities of pharmacological correction of RM dysfunction and other clinical aspects of this problem.

The role of nutrition in stroke prevention and treatment

Important factors for reducing the risk of stroke, as well as predictors of effective rehabilitation of this group of patients are proper nutrition, regular physical activity, smoking cessation and normalization of body weight. Currently, there is no unambiguous data on the needs of patients who have suffered acute cerebral circulatory disorders for nutrients, which dictates the need to develop a personalized diet for them, which should be calculated taking into account age, gender and body mass index. The intake of energy, proteins, fats, carbohydrates, minerals and vitamins can be carried out not only as part of traditional, but also from specialized food products, including mixtures for etheral nutrition. The use of mixtures helps to reduce the risk of bedsores.

THE STATE OF SOME INDICATORS OF HEMOSTASIS IN RELATIVELY HEALTHY PEOPLE AND PATIENTS WITH ISCHEMIC STROKE, TAKING INTO ACCOUNT GENDER DIFFERENCES

Goal. To study some indicators of hemostasis in a comparative aspect in patients with ischemic stroke and healthy people, taking into account gender differences.
 Materials and methods. In the course of the study, the hemostasis indices of 160 people were studied. All the examined were divided into two subgroups, the first consisted of 100 donors, 50 men and women each, who did not have acute and chronic diseases. The second group included the study of analogical indicators in 60 people, 30 men and women, with an established diagnosis of acute ischemic cerebral circulation disorder.
 Results. As the results show, differences in hemostasis indicators were found, taking into account gender differences, and disorders in the hemostasis system play an important role in the pathogenesis of ischemic stroke. The obtained results suggest that as a result of the development of endothelial tissue dysfunction, the level of endothelin increased, which led to pronounced vascular spasm and increased procoagulant activity of the blood.
 Conclusion. Based on the conducted research, it was found that in men and women at the time of admission with ischemic stroke, in comparison with the results obtained from donors without established pathology, changes in red blood parameters and rheological properties of blood are observed in the blood. It should be noted that in the group of female patients, changes in the rheological properties of blood were less pronounced than in the group of male patients.

Застосування екстракту гінкго білоба в системі реабілітації хворих, які перенесли інсульт

Стаття присвячена актуальній проблемі лікування хворих, які перенесли інсульт. Розглянуто склад і механізм дії екстракту гінкго білоба, а також дані про ефективність і безпеку екстракту у хворих, які перенесли транзиторну ішемічну атаку або гостре порушення мозкового кровообігу, що дає авторам підставу рекомендувати включення екстракту гінкго білоба в систему фармакологічної реабілітації хворих на ішемічний інсульт.

Cerebrovascular complications in patients with moderate and small stenosis of the carotid arteries in the hospital period of coronary artery bypass grafting using cardiopulmonary bypass

Assessment of the incidence of acute cerebral circulatory disorder (ACCD) and decompensation of chronic cerebral ischemia (CCI) in the hospital period of coronary artery bypass graft performed using artificial circulation in patients with- and without moderate and minor carotid artery stenosis. One hundred and twenty-eight patients were examined. Neurological and neuropsychological examinations, neuroimaging were performed, concentrations of S100ß protein in blood serum were determined. In the group with stenosis, 3.5% of patients were diagnosed with ACCD, while patients without carotid artery damage did not have this complication. The frequency of decompensation of CCI in patients with stenosis was significantly higher (52%) compared with the group without stenosis (34%). Early postoperative cognitive dysfunction (POCD) with an equally high frequency was diagnosed in both groups: 63% with stenosis and 65% without carotid artery stenosis. A decrease in the strength and mobility of nervous processes, deterioration of memory, workability and increased exhaustion of attention were revealed. Patients with moderate and minor stenoses are more susceptible to the development of cerebrovascular complications than patients who do not have atherosclerotic lesions of the carotid arteries and need more thorough preoperative preparation.

Diabetes and stroke

Acute disorders of cerebral circulation (strokes) are one of the long-known complications of diabetes, which, along with other macrovascular complications, such as myocardial infarction and damage of peripheral arteries are the main cause of death in patients with type 2 diabetes. Strokes are the third leading cause of death in the economically developed countries in Europe and North America. Despite great efforts to reduce the risk of strokes in many developed countries of the world, the increase in life expectancy and the increase in the prevalence of risk factors for the development of stroke (among which diabetes plays a major role) have led to the fact that the probability of having a stroke during one's life has, on the contrary, increased from 22.8% in 1990 to 24.9% in 2016. This review, based on an analysis of the latest available studies, discusses the etiology, pathogenesis, and risk factors for stroke in patients with diabetes mellitus.

The role of hyperglycemia in the course of strokes in patients with diabetes

Hyperglycemia is an important factor in worsening the course and increasing the mortality rate in patients with acute cerebrovascular accidents, both in patients with diabetes and in people without diabetes. It was estimated that the negative impact of hyperglycemia on the course of acute disorders of cerebral blood circulation can be compared with the impact of increasing of age by 20 years. There is no doubt that the post-stroke prognosis is much worse in elderly people. At the same time, the question of whether hyperglycemia independently affects the course and prognosis of a stroke (and then correcting hyperglycemia must necessarily lead to an improvement in the course of a stroke), or whether hyperglycemia is a so-called an epiphenomenon, that is, it only reflects the severity, type of stroke, localization and size of the focus of brain damage, but also does not affect the course of the stroke and has no independent pathogenetic significance, does not require mandatory active correction. This literature review summarizes new data on the course of stroke in patients with diabetes.