Chronic obstructive pulmonary disease (COPD) is one of the main causes of disease and death incidences worldwide. Different organs and systems are involved in COPD activating tissue hypoxia. It affects especially tissue functioning with the high level of intensity of metabolic processes, and the nervous system suffers first. Neuroimaging studies show white and grey matter damage and cerebral atrophy, which may clinically manifest themselves in different neurological symptoms depended on vascular system lesions, and cognitive and affective impairments. Despite of its potential importance, encephalopathy in COPD remains a little-studied concomitant pathology. Application of cytoprotective drugs is pathogenetically justified in this case and must be included in COPD complex therapy. In particular, the inclusion of mexicor in the treatment of patients with chronic pulmonary heart increases the efficacy of treatment of the main and associated diseases (chronic cerebral ischemia, cardiac insufficiency and arrhythmia).
Topiramate was used in the treatment of 66 children, aged 2--16 years (mean age 7.0±4.6 years), including 19 patients with idiopathic form of focal epilepsy (IFE), 21 patients with cryptogenic forms (CFE) and 26 patients with symptomatic forms (SFE). The drug was administered in capsules in dose from 3 to 7 mg/kg/day. Thirty-three patients were on monotherapy, 26 patients received the drug in the combination with one antiepileptic (AED) drug and 7 patients received topiramate in the combination with 2 AEDs. The efficacy of topiramate in focal epilepsy was demonstrated in 65% of patients, including high efficacy in 15% and complete reduction of seizures in 12%. No effect was seen in 27% of patients. The results revealed the high efficacy of topiramate in all subgroups of patients. The significantly higher efficacy was noted in patients with IFE and CFE forms compared to those with SFE form. The tolerability was satisfactory in all subgroups. Side-effects observed in 5 patients were eliminated by increasing the duration of dose titration.
Results of the studies on the state of the autonomic nervous system (ANS) in symptomatic temporal epilepsy (TE) and frontal epilepsy (FE) are presented. It was investigated the functional state of catecholamine system, autonomic background, reaction and ANS supply in response to the physical and psycho-emotional tests according to the clinical data, psychological testing and evaluation of the skin sympathetic response (SSR) as well as EEG parameters (paroxysmal index, slow activity in the background and in response to hyperventilation). The control group included healthy subjects. Comparison groups consisted of patients with panic attacks or with the combination of epilepsy and panic attacks. The disturbance of the self-regulation of catecholamine system and its exhaustion in TE were identified. The authors suggested the concept of the denervation hypersensitivity. According to the SSR, a start of the response to external stimuli always begins from the parasympathetic reaction both in healthy people and in all groups of patients studied. It means that the stable adaptive mechanism in the form of anticipating reaction from the side of the mechanisms stabilizing homeostasis had been formed during the phylogenies. Different patterns of the disturbance of ANS functional state in TE and FE were established. The data obtained indicate that the neocortical motor cortex has a direct relation to the suprasegmental formations which realize the ergotrophic supply of the motor activity.
Piascledine is a plant drug which positively influences the metabolism of cartilage and bone tissues. The authors studied the therapeutic effect of the drug in outpatients with chronic nonspecific dorsalgia. Piascledine was administered in dose 300 mg daily during two months. In the first month, it was used in the combination with artrosilene (320 mg daily). A comparison group included patients receiving monotherapy with NSAIDs (artrosilene). The study confirmed the high analgesic efficacy of piascledine in the treatment of patients with chronic nonspecific dorsalgia with controlled using of NSAIDs. The positive effect of piascledine was demonstrated after one month of treatment. The authors suggest that further clinical trials and placebo-control studies are needed to confirm these results.
Genomic abnormalities occur with high frequency in children with mental retardation and autistic spectrum disorders (ADS). Molecular karyotyping using DNA microarrays is a new technology for diagnosis of genomic and chromosomal abnormalities in autism implemented in the fields of biological psychiatry and medical genetics. We carried out a comparative analysis of the frequency and spectrum of genome abnormalities in children with mental retardation and autism of unknown etiology using high-resolution comparative genomic methods for hybridization (HRCGH) and molecular karyotyping (array CGH). In a study of 100 children with autism, learning difficulties and congenital malformations by HRCGH, we identified genomic rearrangements in 46% of cases. Using array CGH we examined 50 children with autism. In 44 cases out of 50 (88%), different genomic abnormalities and genomic variations (CNV - copy number variations) were identified. Unbalanced genomic rearrangements, including deletions and duplications, were found in 23 cases out of 44 (52%). These data suggest that genomic abnormalities which are not detectable by common methods of chromosome analysis are often discovered by molecular cytogenetic techniques in children autism spectrum disorders. In addition, 54 children with idiopathic mental retardation and congenital malformations (31 boys and 23 girls) without autism spectrum disorders were examined using molecular karyotyping and microarray containing an increased number of DNA samples for genomic loci of chromosome X. Deletions and duplications affecting different regions of the chromosome X were detected in 11 out of 54 children (20.4%).
We have analyzed the results of the clinical and laboratory study of 1070 people in 7 regions of the Russian Federation, including 222 (20.7%) men and 848 (79.3%) women aged from 19 to 94 years (mean age 57.15±13.39 years). It has been shown that 6.8% were smokers and 31.5% were alcohol abusers. Regular physical training (>30 min/day) was noted in 45.7%. Symptoms of asthenia were found in 73.3%. The level of knowledge on risk factors of stroke was estimated as: arterial hypertension (68.6%), ischemic heart disease (47.5%), heart rhythm disorders (27.0%), thrombosis of low extremities (26.8%). Mean values of arterial pressure were 140/80 mm Hg, heartbeat rate -- 74 per min. Mean value of BMI was 28.67 kg/m(2), BMI was higher than 30 in 41%. Hyperglycemia >6.2 mmol/l was recorded in 28%, hypercholesterolemia >6.2 mmol/l in 26%. Stenoses of inner carotid arteries were found in 49.2%: less than 50% diameter stenosis was in 32.8%, 50--70% in 11.8% and >70% in 4.6%. Antihypertensive drugs were used by 66.8%, antiaggregants - by 31.2% and statins by 31.2%. Knowledge about stroke was demonstrated by 81.8%, about stroke symptoms -- 58.5%, about the appropriate actions to be taken in the case of a stroke -- 48.5%. The low risk of stroke was observed in 33.2%, moderate risk in 37.3%, high-risk in 24.6% and critical risk in 4.9%.
One hundred and sixty-seven patients with cerebral palsy (CP), aged 11-16 years, with spastic diplegia (n=87) and hemiparetic forms (n=80), with subgroups of mental retardation (MR) or intellectual delay (ID) have been studied. Standard treatment and application of a method of dynamic proprioceptive correction (MDPC) in the complex rehabilitation with the use of a medical and loading Adeli suit were used. Cognitive deficit in patients was characterized by the relative integrity of short-term nonverbal memory and marked impairment of verbal memory, verbal and nonverbal intellect. CP patients with intellectual delay demonstrated the predominant impairment of verbal functions. CP patients with mental retardation have the deficiency of both verbal and non-verbal cognitive functions. An individual profile of brain functional asymmetry in patients with CP was more lateralized than in healthy peers that can represent a mechanism for irregular development of cognitive functions in CP. Implementing the MDPC into comprehensive rehabilitation promotes the improvement of postural regulation and cognitive functions in children with CP compared to traditional methods of treatment. This is accompanied by the changes in functioning of the associative brain areas and hemispheric interaction.
Seventy-three patients with Parkinson's disease were enrolled. Patients were stratified into 2 groups by the presence (53 patients) or absence (20 patients) of nocturnal symptoms. A control group included 10 healthy people. The most frequent were the following symptoms: nocturia (71.8%), affective disorders (52.4%), akinesia (41.7%) and crampi (30.15%). These symptoms were more pronounced in akinetic/rigid form, greater severity and higher rate of progression of the disease. The positive therapeutic effect of stalevo on the above mentioned disorders was shown.
The review addresses the primary and secondary prevention of cardioembolic ischemic stroke, in particular, in patients with non-valvular atrial fibrillation. Indications and schemes of anticoagulation treatment, advantages in stroke prevention and difficulties in using of the common oral anticoagulant warfarin are discussed. The authors compare the mechanism of action, efficacy and safety of the peroral anticoagulant rivaroxaban with warfarin. Based on the results of large meta-analyses, it has been concluded that the efficacy of rivaroxaban is rather superior to warfarin, this drug has the same safety profile and is more convenient in use. During treatment, no laboratory monitoring of hemostasis indicators is needed. This drug can be recommended for prevention of cardioembolic stroke in patients with atrial fibrillation.
The present observational study addressed effects of cytoflavin as an adjunctive nootropic therapy in patients with organic depressive disorder (F06.36). 54 female and 46 male in-patients were included into the study. All patients received standard antidepressant therapy (controls) and 48 patients additionally received 2 pills of cytoflavin twice per day. Age, gender distribution, education and severity of depression were equal in cytoflavin and control groups. The follow-up assessment at discharge showed a significantly more pronounced decline in the severity of depression symptoms in patients receiving cytoflavin in comparison with the controls. Importantly, the effect of cytoflavin on the depression symptoms was prominent only in females. Moreover, women receiving cytoflavin demonstrated the more pronounced normalization of autonomic regulation in comparison with control women. The present results allow to recommend cytoflavin in dose 4 pills daily as an adjunctive therapy in female patients with organic depressive disorder.
Seventy male patients with non-psychotic mental disorders of youthful age (mean age 19.2±3.7), were studied using A.R. Luria neuropsychological syndrome analysis. Patients were stratified into 3 groups by diagnosis: cyclothymia (20 patients), pubertal decompensation of schizoid personality disorder (30 patients) and schizotypal personality disorder (20 patients). It has been shown that the neuropsychological changes indicate the dysfunction of the amygdale/temporal region in patients of the first group and frontal/thalamic/parietal connections in the patients of two other groups. There were interhemispheric differences between patients with personality disorder and schizotypal personality disorder: left hemisphere dysfunction was characteristic of schizotypal disorder and right hemisphere deficit (neurocognitive deficit) was found in patients with personality disorder.
Mixed dementia is caused by the combination of several simultaneous pathological processes, e.g., Alzheimer's disease and cerebrovascular pathology, Alzheimer's disease and dementia with Lewy bodies, cerebrovascular pathology and dementia with Lewy bodies etc. Many authors consider mixed dementia as the most frequent form of dementia in elderly people. Cholinesterase inhibitors, along with the modulator of glutamate receptors memantine, are commonly used for treatment of different types of dementia, in particular, Alzheimer's disease. Controlled studies have shown their effect in the treatment of dementia with Lewy bodies and vascular dementia. However, there are limited data on the efficacy and safety of the new antidementia drugs in treatment of mixed dementia. In this article, the approaches to the diagnosis of mixed dementia and possibilities of its treatment with cholinesterase inhibitors (donepezil) are described.
A comparative evaluation of inpatient psychiatric care in Russia and some other countries is presented. A systematic analysis of the performance of psychiatric hospitals is conducted. The process of the deinstitutionalization in Russian psychiatry is highlighted. A range of problems hindering a reform of inpatient psychiatric service of the country is singled out.
