Aneurysmal subarachnoid hemorrhage (SAH) is among the most critical acute cerebrovascular conditions, marked by high mortality rates, significant disability, and a considerable socio-economic burden. Women over 55 years of age, as well as individuals with arterial hypertension, hereditary predispositions, congenital vascular anomalies, and a history of smoking, are particularly susceptible. This article consolidates current data on the epidemiology, risk factors, pathogenesis, clinical presentation, and diagnosis of aneurysmal SAH. Special emphasis is placed on the mechanisms of early brain injury and delayed cerebral ischemia-two crucial factors influencing disease outcomes. Contemporary therapeutic strategies, including microsurgical clipping and endovascular embolization, are discussed in depth, addressing their indications, effectiveness, and associated risks. The significance of prompt diagnosis, specialized approaches, and patient management in neurovascular centers is highlighted. A systematic, multistage, and interdisciplinary strategy for managing patients with acute aneurysmal SAH is examined, demonstrating an approach that can enhance survival and improve functional outcomes while minimizing the risk of rebleeding and severe neurological deficits.
Disorders of craniofacial muscles (CFM) frequently arise from various conditions and injuries affecting the central and peripheral nervous systems, as well as from neurosurgical, reconstructive, and cosmetic interventions. The principal clinical manifestations include facial asymmetry, lagophthalmos, paralytic strabismus, synkinesis, contractures, trismus, bruxism, temporomandibular joint dysfunction, chronic facial pain, and sialorrhea. Such disorders not only restrict daily functioning but also lead to significant psychosocial maladjustment, a decline in quality of life, and increased disability among affected individuals. Despite the high prevalence of CFM dysfunction, contemporary methods for the medical rehabilitation of patients remain inconsistent, with poor regulation governing continuity among the various stages of care. This paper posits the establishment of «facial rehabilitation» as a distinct interdisciplinary approach within medical rehabilitation, integrated into the established three-stage medical rehabilitation framework in the Russian Federation. A thorough review of current literature and pertinent Russian regulatory documents has been conducted. The objectives of facial rehabilitation across the first, second, and third stages are analyzed, along with the role of botulinum therapy in comprehensive rehabilitation programs aimed at restoring impaired functions. The potential of this method for a wide range of functional, structural, and autonomic disorders of the face is considered, given the multifaceted mechanisms of action of botulinum toxin type A (BTA), including muscle-relaxant, antinociceptive, neuromodulatory, and anti-inflammatory effects. The authors present their own clinical experience demonstrating the effective use of botulinum therapy to treat trismus, paralytic strabismus, lagophthalmos, and pronounced facial asymmetry in patients with complications from neurological conditions and injuries. The findings underscore the efficacy of integrating botulinum therapy into three-stage medical rehabilitation programs, highlighting its role in preventing complications and enhancing rehabilitation potential and quality of life for patients.
Objective. To improve the efficacy of medical rehabilitation interventions for patients in the late recovery phase following ischemic stroke (IS) and its associated sequelae. Material and methods. An analysis of treatment outcomes was conducted in 250 patients with IS evaluated between 6 and 12 months post-event (136 women and 114 men, with a mean age of 63±14 years, range 28—74 years). The study participants were divided into two groups: Group 1 received standard therapy and medical rehabilitation combined with Mexidol 500 mg (10 mL) administered parenterally for 14 days, followed by Mexidol FORTE 250 mg orally TID for an additional two months. Group 2 received only the standard therapy and medical rehabilitation. Various assessments were conducted, including evaluations of neurological deficits (using the Rivermead Mobility Index and the Scandinavian Stroke Scale), social and domestic adaptation (using the Barthel Index), cognitive and emotional status, and sleep quality. Furthermore, a comprehensive analysis of changes in functioning, activity, and participation was conducted in accordance with the domains outlined in the International Classification of Functioning, Disability and Health (ICF). Results. Participants in Group 1 showed statistically significant improvements in the assessed indicators compared with the control group. Additionally, marked improvements were observed in the key domains of functioning, task performance, and social participation, according to the ICF. Conclusions. The sequential therapy with Mexidol and Mexidol FORTE 250 mg notably enhances the recovery of motor, sensory, cognitive, and other neurological functions among patients in the late recovery phase post-IS, thereby facilitating better social and domestic adaptation, increased levels of activity and participation in life and society, along with improvements in emotional well-being.
Objective. To evaluate the multifaceted effect of a soft glove rehabilitation device in patients with motor and cognitive impairments during the acute phase of ischemic stroke (IS) in the left internal carotid artery (ICA) system. Material and methods. A total of 40 patients with moderate paresis of the right arm in the acute phase of IS in the left ICA system were included in the study. Participants, matched by age and severity of motor and speech disorders, were randomly assigned to either the test group (n=20) or the control group (n=20). The median age was 60 years [range: 52 to 68] for the test group and 62 years [range: 51 to 69] for the control group. The test group participated in a 15-day standard medical rehabilitation program supplemented with a rehabilitation glove device featuring a visual biofeedback program. The control group received standard medical rehabilitation without the additional device. Assessment of motor impairment was conducted utilizing the Action Research Arm Test (ARAT), while cognitive impairment was measured using the Montreal Cognitive Assessment (MoCA). Speech impairment was evaluated through the L.I. Wasserman Speech Impairment Assessment Test. Results. The test group showed statistically significant improvements in arm function, reduced cognitive deficits, and decreased speech impairments. Conversely, the changes observed in the control group were not statistically significant. Conclusions. The findings of this study suggest the potential efficacy of employing a soft rehabilitation glove integrated with a visual biofeedback program during the initial stage of medical rehabilitation in the acute phase of ischemic stroke.
Objective. To evaluate serum cystatin C concentrations and the remodeling of major arteries in patients with non-communicable diseases (NCDs). Material and methods. A total of 460 patients diagnosed with NCDs participated in the study, including 229 (49.8%) males and 231 (50.2%) females, with a mean age of 53.4±14.2 years. The subjects were categorized into three groups (1—3) based on serum cystatin C levels. Multiple laboratory, clinical, and instrumental parameters were assessed. Results. In individuals with NCDs, an increase in serum cystatin C from 1 mg/L to 3 mg/L correlated with an elevation in systolic blood pressure from 128±17 mmHg to 145±24 mmHg, and diastolic blood pressure from 84±10 mmHg to 87±12 mmHg. Additionally, total cholesterol levels rose from 4.68±1.00 mmol/L to 5.24±1.91 mmol/L, low-density lipoproteins increased from 3.15±0.88 mmol/L to 3.31±1.56 mmol/L, and triglycerides increased from 1.13 [0.89; 1.61] mmol/L to 1.59 [1.10; 2.45] mmol/L. Potassium levels increased from 4.35±0.61 mmol/L to 4.81±0.96 mmol/L, and creatinine levels rose from 67.3±13.1 μmol/L to 149.4 [102.8; 291.7] μmol/L. C-reactive protein levels rose from 7.8% to 22.8%, and fibrinogen levels increased from 3.0 [2.6; 3.7] g/L to 4.4 [3.3; 5.7] g/L, while urinary protein excretion increased from 423 [0; 100] mg/L to 6722 [0; 1250] mg/L. The estimated glomerular filtration rate decreased from 101.1±15.9 mL/min/1.73 m2 to 44.0 [22.0; 61.0] mL/min/1.73 m2. The diameter of the ascending aorta also increased, from 2.96±0.36 cm to 3.22±0.31 cm, while the prevalence of aortic atherosclerosis rose from 50.0% to 81.3%. The thickness of the intima-media complex (IMC) of the common carotid artery (CCA) increased from 0.87±0.24 mm to 1.04±0.26 mm, and the diameter of the vertebral arteries expanded from 3.47±0.37 mm to 3.62±0.40 mm. A decline in high-density lipoproteins was observed, from 1.16±0.30 mmol/L to 1.09±0.31 mmol/L, and calcium levels decreased from 2.16±0.33 mmol/L to 2.01±0.37 mmol/L. In groups 2 and 3, localized thickening of the CCA IMC of 1.11—1.3 mm was identified in 39 (19.3%) and 22 (18.6%) subjects, respectively. Local thickening of CCA IMC exceeding 1.3 mm was identified in 35 (17.3%) and 21 (17.8%) patients in groups 2 and 3, respectively. Serum cystatin C levels were significantly correlated with the diameter of the ascending aorta (r=0.307; p<0.05), the diameter of the vertebral arteries (r=0.224; p<0.05), and the thickness of the CCA IMC (r=0.324; p<0.05). Conclusion. Measurement of serum cystatin C in patients with non-communicable diseases demonstrates promising diagnostic utility as a laboratory marker of arterial remodeling and reflects the cerebrovascular risk, correlating with the wall thickness of the major arteries of the brain.
Stroke continues to be one of the predominant causes of disability both In Russia and globally, profoundly affecting patients’ quality of life. The article presents an overview of current methods of medical rehabilitation of stroke patients. Traditional and innovative approaches to health recovery are addressed. Special emphasis is placed on the current challenges in organizing medical rehabilitation services In Russia, along with proposed strategies to enhance their accessibility and quality.
Objective. To compare the success rates of various revascularization methods in patients presenting with ischemic stroke (IS) in a real-world practice. Material and methods. An open-label prospective observational study was conducted involving 225 patients diagnosed with IS. The patients were categorized into three distinct groups: Group 1 (67.1% of participants) received systemic thrombolytic therapy [TLT], Group 2 (15.6% of participants) received intravascular thrombectomy (IVTE), and Group 3 (17.3% of participants) received combined TLT+IVTE, referred to as bridge therapy. The assessment of neurological status was conducted using the National Institutes of Health Stroke Scale (NIHSS), functional activity was evaluated according to the modified Rankin Scale (mRs), mobility was measured based on the Rivermead Mobility Index (RMI), and the completeness of perfusion recovery was determined using the Thrombolysis in Cerebral Infarction (TICI) classification for Groups 2 and 3. Functional recovery was evaluated after 6 months using the Barthel Index (BI). Results. Demographic characteristics across the groups were comparable. Statistically significant differences in the timing of revascularization were observed: Groups 1 and 3 received treatment within approximately 2.5 hours, whereas Group 2 received treatment within 6 hours. Baseline stroke severity, as measured by the NIHSS, was significantly higher in Groups 2 and 3 (p<0.002). The TICI scores of 2b-3 were noted in 74.3% of patients in Group 2 and 79.5% in Group 3, reflecting the substantial technical success rates of endovascular interventions. At discharge, patients in Group 1 exhibited the greatest reduction in neurological deficit (p=0.011). Independence in daily activities (rated 0—2 on the mRs) was achieved by 28.5% of patients in Group 1, 8.6% in Group 2, and 12.8% in Group 3. The mortality rate over 6 months was 24.5% in Group 1, 51.4% in Group 2, and 33.3% in Group 3 (p=0.002 between Groups 1 and 2). The BI at the six-month mark was significantly higher in Group 1 (90 [60; 100]) compared to Groups 2 (60 [50; 85]) and 3 (65 [50; 97.5]). Conclusions. The findings suggest that systemic TLT, particularly in patients with less severe strokes and timely treatment initiation, is associated with the most favorable outcomes. In contrast, IVTE and combination therapy (bridge therapy) administered to patients with NIHSS scores exceeding 10 and/or large vessel occlusions demonstrate comparable technical success rates but yield less favorable clinical outcomes. Critical determinants influencing outcomes include the duration from symptom onset to intervention and baseline stroke severity.
Objective. To compare the safety profile of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in the management of cerebral venous thrombosis (CVT) following initial parenteral therapy. Material and methods. The Eurasian Registry of Cerebral Venous Thrombosis (ER-CVT) is a multicenter, ambispective, comparative cohort study conducted in accordance with the DOAC-CVT protocol. The primary endpoint was the composite of symptomatic venous thromboembolism (VTE) and/or major bleeding, as defined by ISTH criteria, during a 6-month follow-up period. Secondary endpoints included complete recanalization, functional outcomes as assessed by the modified Rankin scale (mRs), and the frequency of changes in anticoagulant therapy over a 12-month follow-up. The dataset was compiled from 12 cities across Russia. Of the total cases, 88 (77%) were recorded retrospectively. Between May 2023 and March 2025, 112 patients diagnosed with CVT from 13 sites In Russia were enrolled in the study. The median age of participants was 41 years (range: 33 to 55 years), with 73 (64%) being female. Brain MRI confirmed the diagnosis of CVT in 81 (72%) cases. Hemorrhagic lesions, as evident in neuroimaging, were observed in 44 (39%) cases. The final analysis of therapeutic efficacy was conducted with 104 patients (92.9% of the initial sample of 112), comprising 72 patients receiving warfarin therapy and 32 receiving DOACs. Results. Following the completion of initial parenteral anticoagulant therapy, 72 patients commenced VKA therapy, and 32 initiated treatment with DOACs. Eight patients who commenced an unspecified oral anticoagulant were excluded from the efficacy analysis. No events of recurrent symptomatic VTE, major bleeding, mortality, clinically significant non-major bleeding, or arterial thromboembolism were reported. In the VKA cohort, 6.9% of patients transitioned to DOACs, whereas no patients in the DOAC group switched to other anticoagulants. Ordinal regression analysis demonstrated significantly increased odds of complete recanalization at 6 and 12 months (OR=60.4; 95% CI 3.1—1191.6, p=0.007, and OR=52.0; 95% CI 2.83—956.3, p=0.008, respectively), as well as improved functional outcomes (as measured by the mRs scale) at 12 months (OR=4.2; 95% CI 1.4—2.5, p=0.012) within the DOAC cohort. Conclusions. The findings from the ER-CVT study indicate a comparably safe profile for both DOACs and VKAs in treating CVT post-initial parenteral therapy. DOACs demonstrated superior recanalization rates and enhanced functional outcomes.
Objective. To assess the incidence of severe visual-spatial memory (VSM) disorders, the risk factors contributing to their development, and the changes observed during the acute phase of mild and moderate supratentorial ischemic stroke (IS). Material and methods. A total of 140 patients in the acute phase of mild and moderate IS and 30 patients with chronic cerebral ischemia (CCI) were included in this study. All participants underwent clinical neurological, neuropsychological, and neuroimaging assessments. The patients were categorized into three groups: Group 1 comprised 54 patients with IS localized in the posterior medial and posterolateral regions; Group 2 included 86 patients with IS lesions of other localization; and Group 3 consisted of 30 patients with CCI. Neuropsychological evaluations were conducted using the Addenbrooke’s Cognitive Examination III (ACE-III), Corsi Block-Tapping Task (CBTT), and Geriatric Complex Figure (GCF), which included GCF Copy and GCF Recall subtests. Initial testing occurred on days 4—5 of hospitalization (T1), with follow-up assessments performed after 14—16 days (T2) for patients with IS. Results. Severe VSM disorders were detected in 20% of patients diagnosed with IS. In Group 1, the prevalence of such disorders was significantly higher (38.9%) than in Group 2 (8.1%; p<0.001) and Group 3 (10.0%; p=0.005). Analysis during the T1—T2 interval demonstrated a notable improvement in VSM, particularly in GCF Recall, in both Group 1 and Group 2. However, at T2, the GCF Recall scores in Group 1 remained comparatively lower than those in Group 2 (p=0.004). Furthermore, the rate of recovery from VSM in Group 1 was slower than that observed in Group 2 (p<0.001). Conclusions. The study concludes that severe VSM disorders occur in 20% of patients experiencing mild and moderate acute IS, with a higher incidence associated with lesions localized in the posterior regions of the brain. The recovery trajectory from VSM during the acute phase of IS is notably slower in patients with a posterior-medial ischemic focus than in those with a posterolateral ischemic focus.
Objective. To analyze the level of circulating microvesicles (MV) in the peripheral blood of patients during the acute phase of ischemic stroke (IS) and to evaluate their relationship with clinical parameters. Material and methods. The study included 47 patients diagnosed with IS on Day 1 after disease onset, along with a control group of 50 healthy subjects. Flow cytometric analysis was performed to measure total levels of circulating MVs and the platelet-derived MVs (pMVs). Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and the Modified Rankin Scale (mRs) at admission and at 14 and 28 days. Results. The total levels of MVs in patients with IS were significantly elevated (median 4.2×106/mL) compared to the control group (1.11×106/mL; p<0.05). A positive correlation was observed between total MV concentration and stroke severity, as measured by the NIHSS at admission (r=0.30; p=0.03), after 14 days (r=0.51; p=0.0003), and after 28 days (r=0.50; p=0.0001). Moreover, a correlation was noted with the mRs values at 14 days (r=0.40; p=0.005) and at 28 days (r=0.43; p=0.002). Among patients with atrial fibrillation (AF), the proportion of pMVs was significantly higher compared to those without AF (34% vs. 21%; p=0.007). Receiver Operating Characteristic (ROC) analysis indicated that the blood MV level demonstrates good discriminatory capability as a biomarker of ischemic stroke severity at 28 days (area under the ROC curve=0.81). Conclusions. The level of circulating MVs is substantially increased in patients during the acute phase of IS, correlating with stroke severity and functional outcomes. This biomarker may serve as a prognostic indicator for patient recovery. Furthermore, the elevated pMV proportion associated with AF may be critical for the timely diagnosis of the cardioembolic subtype of IS.
OBJECTIVE:To evaluate the changes in serum levels of matrix metalloproteinase (MMP)-2, MMP-9, and vascular endothelial growth factor (VEGF) during the acute phase of ischemic stroke (IS) to elucidate subtype-specific pathogenetic mechanisms and assess the predictive value of these biomarkers for clinical and functional recovery in patients. MATERIAL AND METHODS:The study included 114 patients diagnosed with IS. Participants were categorized into the following groups: Group 1 (n=26) with atherothrombotic stroke, Group 2 (n=29) with cardioembolic stroke, and Group 3 (n=59) with lacunar stroke or unspecified etiology. A comparison group included 13 healthy subjects. The observation period extended over 14 days, with assessments conducted at two time points: I - 48-72 hours post-onset of symptoms and II - Day 14. The clinical evaluation utilized the Glasgow Coma Scale (GCS), the National Institutes of Health Stroke Scale (NIHSS), and the Modified Rankin Scale (mRS). Serum levels of MMP-2 and MMP-9 were measured using enzyme-linked immunosorbent assay (ELISA), while VEGF levels were assessed on a multiplex analyzer. RESULTS:The highest severity of neurological deficit was observed in Groups 1 and 2, whereas Group 3 exhibited minimal disorders. Notably, VEGF levels during the initial 48-72 hours were significantly lower in the cardioembolic subtype (p=0.039). In contrast, Group 3 displayed an increase in VEGF by Day 14 (pI-II=0.009), which correlated with improvements in NIHSS and mRS scores (pI-II=<0.001). Correlation analyses indicated subtype-specific relationships: in Group 1, a positive correlation between VEGF at timepoint II and MMP-9 at timepoint I (r=0.898; p=0.002) was associated with less favorable outcomes; in Group 2, a negative correlation between MMP-9 at timepoint I and NIHSS at timepoint I (r=-0.427; p=0.042) was observed; in Group 3, negative correlations between MMP-2 and both NIHSS and mRS were identified (p<0.05). Analysis of risk factors indicated that age negatively correlated with GCS in the atherothrombotic subtype of IS (p<0.05). The «obesity paradox» was evident in the cardioembolic group, revealing a positive correlation between body mass index (BMI) and GCS at timepoint II (p=0.036). Strong correlations were also established between the functional class of coronary heart disease (CHD) and the severity of neurological deficit. CONCLUSION:This study has elucidated subtype-specific biomarker responses in ischemic stroke: the identified protective role of MMP-2 in lacunar stroke, the paradoxical adaptive features of MMP-9 in the cardioembolic subtype, and the synergistic destructive effects of VEGF and MMP-9 in atherothrombotic subtype.
Aneurysmal subarachnoid hemorrhage (SAH) is among the most critical acute cerebrovascular conditions, marked by high mortality rates, significant disability, and a considerable socio-economic burden. Women over 55 years of age, as well as individuals with arterial hypertension, hereditary predispositions, congenital vascular anomalies, and a history of smoking, are particularly susceptible. This article consolidates current data on the epidemiology, risk factors, pathogenesis, clinical presentation, and diagnosis of aneurysmal SAH. Special emphasis is placed on the mechanisms of early brain injury and delayed cerebral ischemia—two crucial factors influencing disease outcomes. Contemporary therapeutic strategies, including microsurgical clipping and endovascular embolization, are discussed in depth, addressing their indications, effectiveness, and associated risks. The significance of prompt diagnosis, specialized approaches, and patient management in neurovascular centers is highlighted. A systematic, multistage, and interdisciplinary strategy for managing patients with acute aneurysmal SAH is examined, demonstrating an approach that can enhance survival and improve functional outcomes while minimizing the risk of rebleeding and severe neurological deficits.
OBJECTIVE:To evaluate the clinical and functional characteristics of Parkinson's disease in patients with and without concomitant chronic kidney disease (CKD) and to assess the impact of renal dysfunction on motor, cognitive, and non-motor symptoms. MATERIAL AND METHODS:A cross-sectional study was conducted involving 62 patients diagnosed with idiopathic Parkinson's disease at stages I-III. The test group comprised 31 patients with an estimated glomerular filtration rate (eGFR) of 30-59 mL/min/1.73 m², while the control group comprised 31 patients with an eGFR of 60 mL/min/1.73 m² or higher. Various assessments were performed, including the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Hoehn and Yahr Scale, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and evaluations for depression, anxiety, and orthostatic dysfunction. RESULTS:Demographic factors such as age, sex, and duration of Parkinson's disease were similar between the groups; however, patients with CKD had a higher Hoehn and Yahr score (2.5 vs. 2.0; p<0.05). Although the levodopa equivalent dose was greater in this cohort, the difference was not statistically significant. With an equal duration of the disease, motor impairments were more severe in the CKD group, with MDS-UPDRS III scores of 42.8±8.5 compared to 34.6±7.2 in the control group (p<0.001). In patients with CKD, axial symptoms, including gait disturbances, postural instability, and bradykinesia, were more prominent, while resting tremor was less evident. Cognitive function assessments revealed a decline in performance in patients with CKD: MMSE scores averaged 24.8±2.1, compared with 26.5±1.8 in the control group (p<0.05), and MoCA scores averaged 20.6±3.4, compared with 25.4±2.2 (p<0.001), respectively. Among the CKD patients, 83.8% exhibited mild cognitive impairment (MoCA< 26), contrasting with 38.7% in the control group. Specifically, executive, visual-spatial, attention, and memory functions were significantly impacted. A positive correlation was found between eGFR and total MoCA scores (rS=0.48; p=0.005). Furthermore, non-motor manifestations were more common in the CKD group, with rates of depression at 64.5% vs. 38.7%, anxiety at 58.1% vs. 32.2%, constipation at 74.2% vs. 51.6%, daytime sleepiness at 54.8% vs. 25.8%, and orthostatic hypotension at 38.7% vs. 19.4% (p<0.05). CONCLUSIONS:The presence of CKD is associated with a more severe motor and cognitive phenotype in Parkinson's disease, predominantly characterized by axial dysfunction and diminished executive functions. These findings highlight the importance of assessing renal function when evaluating the progression of Parkinson's disease.
OBJECTIVE:To identify factors associated with the progression of vascular moderate cognitive impairment (MCI) over 36 months, based on analyses of clinical, demographic, neuropsychological, laboratory, and neuroimaging characteristics of patients with atrial fibrillation (AF). MATERIAL AND METHODS:Data from outpatient visits between 2019 and 2022 were reviewed. Patients with vascular MCI and AF were identified based on the VasCog criteria, neuropsychological assessments using the Montreal Cognitive Assessment (MoCA; scores 18-25), and national and European clinical guidelines. The study used basic statistics, univariate regression, and binary logistic regression to identify and evaluate the predictors of vascular MCI progression in patients with AF after 36 months. RESULTS:Among the 143 patients with vascular MCI and AF (mean age 57.7±6.2 years), 63 patients (n=90) progressed to MCI by 36 months. Several factors associated with a decline in cognitive function were identified: an ischemic stroke occurring 3 to 6 months prior to enrollment (p=0.001), the presence of five or more lacunar infarctions (p=0.005), hypertension classified as grade II or higher (p=0.002), type 2 diabetes mellitus (p=0.002), a C-reactive protein level exceeding 5 mg/L (p=0.019), memory domain scores on the MoCA below 15 points (p=0.004), and scores on the Hospital Anxiety and Depression Scale (HADS-A) of 11 points or lower (p=0.037). CONCLUSIONS:The early identification of factors associated with a poor prognosis for MCI at 36 months may reduce vascular dementia burden among patients with AF.
OBJECTIVE:To investigate the associations between a family history of alcohol dependence (AD) and the mental health disorders and personal traits of healthy young adults. MATERIAL AND METHODS:The study included 95 healthy subjects, with an average age of 20.68±2.45 years, of whom 80.0% were women. The study utilized a self-administered questionnaire that included a comprehensive study map and psychometric scales. Participants were categorized into two groups: individuals without a relevant family history of AD and those with a relevant family history of AD. The latter group was further divided into two subgroups based on the family history: individuals with a moderate family burden of AD (1 relative with AD), designated, and those with a high family burden of AD (2 or more relatives with AD), designated. Comparative analyses were conducted across all study variables. RESULTS:Several significant associations were identified between a family history of AD, particularly with a high burden, and various psychological and somatic indicators. Notably, there was a correlation between a family history of AD and affective symptoms, specifically the presence and severity of anxiety symptoms (p=0.003) as well as the suicidal ideation (p=0.015), but not attempted suicides. Additionally, a relationship was established with personality traits, particularly the propensity for «novelty-seeking» behaviors (p=0.001), and a potential link to eating disorders. Furthermore, a family history of AD was correlated with general somatic health, including associations with familial obesity (p=0.0002) and overall indicators of physical health. CONCLUSIONS:Future investigations with larger samples are essential to elucidate further the specific impacts of both the presence and grade of a family history of alcohol dependence, serving as a potential marker for the risk of developing mental health and substance use disorders at a preclinical stage.
OBJECTIVE:This systematic review aims to provide a thorough analysis of existing Russian scientific literature regarding mental disorders in uncomplicated pregnancies. It focuses on the prevalence, clinical features, risk factors, and their impact on perinatal outcomes. MATERIAL AND METHODS:Following the PRISMA-ScR protocol, a systematic review was performed. A comprehensive search was conducted in the eLibrary, Russian State Library, National Electronic Library, and PubMed databases utilizing relevant keywords. Only original Russian empirical studies published before 2026 were included. Of 345 publications identified, 55 met the established criteria after duplicates were removed and compliance assessed. RESULTS:The sample sizes of the selected studies varied from 50 to 1340 participants. Notably, only 9 studies (16%) strictly excluded cases of complicated pregnancies, whereas 2 studies included women with pre-existing mental disorders. Longitudinal psychometric studies were scarce, with only 2 publications fitting this description. A continuous clinical and psychopathological assessment revealed a prevalence rate of 26.9% for nosologically verified mental disorders in uncomplicated pregnancies. The most prevalent disorders identified were neurotic, stress-related, somatoform disorders, personality disorders, and affective disorders. Furthermore, psychometric screening indicated that the prevalence of clinically significant anxiety symptoms in pregnant women reached 65.8%, while depressive symptoms were noted in 54%. Key risk factors identified include a history of psychiatric and obstetric disorders, insufficient partner support, younger maternal age, advanced reproductive age, and adverse social conditions. CONCLUSIONS:The occurrence of mental disorders during uncomplicated pregnancies represents a significant yet inadequately researched issue In Russia. The existing evidence predominantly depends on psychometric data, revealing a significant lack of clinical and psychopathological research. The frequent exclusion of women with a history of mental disorders from study samples contributes to an underrepresentation of chronic mental health pathologies. To address this gap, longitudinal clinical studies and the establishment of interdisciplinary guidelines for early diagnosis are needed.
OBJECTIVE:To evaluate the impact of the ketogenic diet (KD) on clinical outcomes, health resource consumption, including medication burden, hospitalization rates, and outpatient care, and direct medical costs (DMCs) in pediatric patients with drug-resistant epilepsy (DRE). MATERIAL AND METHODS:A retrospective, non-interventional observational study was conducted at a specialized medical center. Data were collected from 58 children diagnosed with DRE: 29 patients received the ketogenic diet, while 29 patients comprised the comparison group. The clinical characteristics of epilepsy, frequency of seizures, efficacy of treatment, duration of the ketogenic diet, occurrence of adverse events, history of drug therapy, and the number of hospitalizations and outpatient consultations with a neurologist over two years were systematically evaluated. Based on the data obtained, the DMCs were calculated over 10 years. RESULTS:The administration of the KD resulted in an average reduction of 83% in the number of epileptic seizures as compared to baseline (p=0.037) and a 78% decrease relative to the comparison group (p=0.013). The mean number of hospitalizations over two years was significantly lower in the KD group, with 2.70±3.22 hospitalizations compared to 10.14±7.79 in the comparison group (p=0.0001). Additionally, the number of consultations with a neurologist was markedly reduced (p=0.00001). By decreasing the consumption of health care resources - specifically, hospitalizations and outpatient neurological consultations - the DMCs over a ten-year horizon, excluding the cost of the ketogenic diet, were 3.05 times lower when utilizing the ketogenic diet; while maintaining observed trends in clinical efficacy, and taking into account the cost of the ketogenic diet, DMCs were reduced by approximately 130.000 rubles. The cost of antiepileptic medications accounted for a smaller share of DMCs, contributing 15% to overall expenditure. CONCLUSIONS:The application of the KD in children with DRE yielded favorable clinical outcomes, characterized by a significant reduction in seizure frequency, decreased consumption of health care resources, and financial savings on DMCs. These findings support the consideration of the KD as a clinically effective and cost-effective treatment approach compared to standard management practices for patients not receiving the KD.
OBJECTIVE:To organize and summarize current data on the role of primary motor disorders in the clinical presentation of schizophrenia, specifically addressing their diagnostic and prognostic significance, alongside the neurobiological mechanisms underlying their development. MATERIAL AND METHODS:A comprehensive search was conducted without filters across the eLibrary, Google Scholar, and PubMed databases, using keywords including «motor phenotype of schizophrenia», «abnormal involuntary movements in schizophrenic spectrum disorders», and «primary motor dysfunctions,» in both Russian and English. RESULTS:This review includes 53 sources that focus on the pathogenesis and clinical variability of motor dysfunctions in patients with schizophrenia. These dysfunctions contribute to an intermediate phenotype of the disorder. The emphasis is on the necessity of methodologically robust, strictly controlled multimodal studies aimed at validating the diagnostic relevance of motor dysfunctions, elucidating their neurobiological correlates, and evaluating their clinical ramifications across the spectrum of schizophrenic disorders. CONCLUSIONS:The findings of this systematic review showed that motor symptoms are intricately linked to impaired neuroontogenesis and constitute a distinct domain characterized by its own pathophysiological framework.
This report presents a case of acute severe poisoning with methadone and α-pyrrolidinovalerophenone in a 41-year-old male patient complicated by circulatory arrest. The poisoning occurred following the intravenous injection of 0.5 g of methadone and intranasal administration of α-pyrrolidinovalerophenone. The case manifested as a critical circulatory arrest with a significant depression of consciousness, reaching a coma II level, alongside cytotoxic edema affecting the white matter of the brain and corpus callosum. Notably, the serum S-100 protein concentration was increased to 152.1 ng/L. The patient also exhibited acute respiratory failure, mixed acid-base disorders, lactic acidosis, cardiotoxic effects, acute renal impairment, acute hepatic impairment, toxic encephalopathy, post-cardiac arrest syndrome, and subsequent severe neurocognitive deficits, as well as cystic gliosis and atrophy in the anterior and anterior-basic parts of the frontal lobes, along with cyst formation in the basal nuclei. The patient received intensive care, including mechanical ventilation with the Hamilton C2 device in Continuous Mandatory Ventilation (CMV) mode, inotropic support, correction of acid-base and hypoxic disturbances, and nutritional support via percutaneous endoscopic gastrostomy to address protein-energy deficiency. Additionally, antibacterial therapy was employed, along with measures to resolve intestinal obstruction. Following stabilization of the blood's oxygen transport function, a multicomponent drug containing inosine, nicotinamide, riboflavin, and succinic acid was used, which facilitated correction of hypoxic complications and the acute psycho-organic syndrome, leading to improvements in cognitive function.
This article provides a comprehensive overview of contemporary concepts regarding the classical and atypical phenotypes of amyotrophic lateral sclerosis (ALS), with a particular focus on critical diagnostic challenges. The classical variant of the disease is characterized by the progressive involvement of both upper and lower motor neurons, typically presenting with an asymmetric onset and a predictable progression. However, several atypical phenotypes are identified, including syndromes predominantly affecting the lower motor neurons, such as the «hanging hands» and «hanging legs» syndromes, isolated bulbar paralysis, ALS with respiratory onset, and forms with a predominance of upper motor neuron involvement. These atypical variants often mimic other neurological conditions-such as cervical myelopathy, multifocal motor neuropathy, and myasthenia gravis-which can result in significant delays in the accurate diagnosis of ALS. Atypical forms of ALS represent a major source of diagnostic errors in clinical practice. Enhancing healthcare professionals' understanding of the spectrum of phenotypic presentations, alongside the application of contemporary diagnostic criteria, facilitates more timely diagnoses, optimized patient care pathways, and the prompt initiation of pathogenetic therapies, ultimately improving both survival rates and quality of life for affected individuals.
