Pub Date : 2023-08-15DOI: 10.14412/2074-2711-2023-4-80-88
A. Goncharov, A. Grigoriev, A. Globenko, I. Goncharov, K. A. Muratov, D. V. Yaroshenko, A. Sidorova, A. Kapashin, O. Kovchan, A. I. Bashkatova, M. Pasko
Objective: to study the pharmacokinetic parameters and safety of Dorsumio® (mirtazapine + tizanidine, extended-release tablets, 15 mg + 6 mg, JSC Valenta Pharm, Russia) taken once by healthy volunteers in comparison with Calixta®, a monocomponent drug (INN: Mirtazapine, filmcoated tablets, 30 mg, Belupo, Drugs and Cosmetics d.d., Republic of Croatia) and Sirdalud® MR (INN: Tizanidine, modified-release capsules, 6 mg, Novartis Pharma AG, Switzerland) with an evaluation of their drug interactions when taken concomitantly or separately.Material and methods. A two-stage, randomized, comparative cross-over study of the pharmacokinetics and safety of the complex drug Dorsumio® was conducted. In the first stage, volunteers alternated between taking one or two tablets of the study drug in two administration periods; in the second stage, subjects alternated between taking the reference monodrugs Calixta® and Sirdalud® MR alone and in a joint combination in three administration periods. A total of 38 volunteers were randomized into the study, of which 14 subjects participated in the first and 24 in the second stage of the study. Quantitative levels of mirtazapine and tizanidine were determined by high-performance liquid chromatography with tandem mass spectrometry. Based on the data obtained, the main pharmacokinetic parameters reflecting the bioavailability of each drug were calculated, and the mutual influence of their combination on pharmacokinetics was also studied. During the study, vital signs and laboratory parameters of the subjects were monitored, and the occurrence of adverse events (AEs) and serious AEs was recorded.Results. A two-fold increase in the dose of the combination drug Dorsumio® resulted in a comparable increase in the pharmacokinetics of the individual drugs. There was no significant reciprocal effect of mirtazapine and tizanidine on their pharmacokinetic parameters. In one of the subjects participating in the second stage of the study, two mild side effects were registered after the joint use of Calixta® and Sirdalud® MR that did not require medical intervention and resolved on their own without health consequences.Conclusion. There were no differences in the safety profile of the combined use of mirtazapine and tizanidine in the form of a free or fixed combination. It was shown that the investigated drug combination had no mutual influence on the pharmacokinetics of the individual components.
{"title":"Pharmacokinetic parameters, safety and drug-drug interactions of mirtazapine and tizanidine, combined in the new original drug Dorsumio®","authors":"A. Goncharov, A. Grigoriev, A. Globenko, I. Goncharov, K. A. Muratov, D. V. Yaroshenko, A. Sidorova, A. Kapashin, O. Kovchan, A. I. Bashkatova, M. Pasko","doi":"10.14412/2074-2711-2023-4-80-88","DOIUrl":"https://doi.org/10.14412/2074-2711-2023-4-80-88","url":null,"abstract":"Objective: to study the pharmacokinetic parameters and safety of Dorsumio® (mirtazapine + tizanidine, extended-release tablets, 15 mg + 6 mg, JSC Valenta Pharm, Russia) taken once by healthy volunteers in comparison with Calixta®, a monocomponent drug (INN: Mirtazapine, filmcoated tablets, 30 mg, Belupo, Drugs and Cosmetics d.d., Republic of Croatia) and Sirdalud® MR (INN: Tizanidine, modified-release capsules, 6 mg, Novartis Pharma AG, Switzerland) with an evaluation of their drug interactions when taken concomitantly or separately.Material and methods. A two-stage, randomized, comparative cross-over study of the pharmacokinetics and safety of the complex drug Dorsumio® was conducted. In the first stage, volunteers alternated between taking one or two tablets of the study drug in two administration periods; in the second stage, subjects alternated between taking the reference monodrugs Calixta® and Sirdalud® MR alone and in a joint combination in three administration periods. A total of 38 volunteers were randomized into the study, of which 14 subjects participated in the first and 24 in the second stage of the study. Quantitative levels of mirtazapine and tizanidine were determined by high-performance liquid chromatography with tandem mass spectrometry. Based on the data obtained, the main pharmacokinetic parameters reflecting the bioavailability of each drug were calculated, and the mutual influence of their combination on pharmacokinetics was also studied. During the study, vital signs and laboratory parameters of the subjects were monitored, and the occurrence of adverse events (AEs) and serious AEs was recorded.Results. A two-fold increase in the dose of the combination drug Dorsumio® resulted in a comparable increase in the pharmacokinetics of the individual drugs. There was no significant reciprocal effect of mirtazapine and tizanidine on their pharmacokinetic parameters. In one of the subjects participating in the second stage of the study, two mild side effects were registered after the joint use of Calixta® and Sirdalud® MR that did not require medical intervention and resolved on their own without health consequences.Conclusion. There were no differences in the safety profile of the combined use of mirtazapine and tizanidine in the form of a free or fixed combination. It was shown that the investigated drug combination had no mutual influence on the pharmacokinetics of the individual components.","PeriodicalId":19252,"journal":{"name":"Neurology, neuropsychiatry, Psychosomatics","volume":"68 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87838361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.14412/2074-27112023-4-24-30
L. A. Ivanova, A. Kovaleva, N. O. Sitnikova
Therapy of depression is a current problem in psychiatry. Agomelatine is not inferior to other modern drugs in terms of antidepressant efficacy (response and remission rates) and is characterized by the best tolerability.Objective: to evaluate the efficacy and safety of agomelatine in the treatment of nonpsychotic depression with a single and recurrent course.Material and methods. Patients (n=37) with a current depressive episode (DE; F32 according to ICD-10), mean age 41.2±2.07 years, were studied. Clinical psychopathological and psychometric methods were used in the study (Hamilton Hospital Depression Scale – HAMD-17; Spielberger–Khanin Anxiety Self-Assessment Scale, Sheehan Anxiety Scale, Clinical Global Impression Scale – CGI-I). A single DE was diagnosed in 62.2% of patients, and recurrent depressive disorder in 37.8%. Stress-related onset of current DE was found in 56.8% of cases, autochthonous in 43.2%.Results. 94.6% of patients were responders, including 68.6% who went into remission. A statistically significant decrease in scores on the HAMD-17 scale was noted in the remission group from the 7th day of agomelatine therapy (p<0.05), in the responder group – from the 14th day of therapy (p<0.05). According to the Sheehan scale, a statistically significant decrease in scores was noted at the end of the first week of therapy (p<0.05), according to the Spielberger–Khanin scale – in the second week (p<0.05) in all patients. According to the CGI-I scale, the condition at the end of therapy improved in 57.1% of patients, significantly in 42.9%. Clinical predictors of therapeutic response in patients with remission included significantly higher frequency of a single DE (p<0.02), moderate severity of current depression (p<0.02), dizziness among autonomic disorders (p<0.01), a significantly lower representation of the melancholic type of depression (p<0.05), a symptom of a gloomy and pessimistic vision of the future (p<0.05), sleep disturbances (p<0.04), a factor of personal significance in the form of a threat in patients with stress-provoked onset of the current DE (p<0.05).Adverse events occurred in the first week of treatment with agomelatine in 14.3% of cases (nausea – 8.6%, headache and dizziness – 2.9% each), they were mild and did not require discontinuation of the drug. Two patients taking agomelatine at a dose of 50 mg discontinued the study: in one case persisted social phobia, increased fatigue, motor retardation, and persistent modern insomnia; in the other case – a pronounced senestoalgic syndrome with cerebral localization.Conclusion. Agomelatine therapy has been shown to be highly effective and well tolerated in nonpsychotic depression.
{"title":"Experience with agomelatine therapy for non-psychotic depression with a single and recurrent course","authors":"L. A. Ivanova, A. Kovaleva, N. O. Sitnikova","doi":"10.14412/2074-27112023-4-24-30","DOIUrl":"https://doi.org/10.14412/2074-27112023-4-24-30","url":null,"abstract":"Therapy of depression is a current problem in psychiatry. Agomelatine is not inferior to other modern drugs in terms of antidepressant efficacy (response and remission rates) and is characterized by the best tolerability.Objective: to evaluate the efficacy and safety of agomelatine in the treatment of nonpsychotic depression with a single and recurrent course.Material and methods. Patients (n=37) with a current depressive episode (DE; F32 according to ICD-10), mean age 41.2±2.07 years, were studied. Clinical psychopathological and psychometric methods were used in the study (Hamilton Hospital Depression Scale – HAMD-17; Spielberger–Khanin Anxiety Self-Assessment Scale, Sheehan Anxiety Scale, Clinical Global Impression Scale – CGI-I). A single DE was diagnosed in 62.2% of patients, and recurrent depressive disorder in 37.8%. Stress-related onset of current DE was found in 56.8% of cases, autochthonous in 43.2%.Results. 94.6% of patients were responders, including 68.6% who went into remission. A statistically significant decrease in scores on the HAMD-17 scale was noted in the remission group from the 7th day of agomelatine therapy (p<0.05), in the responder group – from the 14th day of therapy (p<0.05). According to the Sheehan scale, a statistically significant decrease in scores was noted at the end of the first week of therapy (p<0.05), according to the Spielberger–Khanin scale – in the second week (p<0.05) in all patients. According to the CGI-I scale, the condition at the end of therapy improved in 57.1% of patients, significantly in 42.9%. Clinical predictors of therapeutic response in patients with remission included significantly higher frequency of a single DE (p<0.02), moderate severity of current depression (p<0.02), dizziness among autonomic disorders (p<0.01), a significantly lower representation of the melancholic type of depression (p<0.05), a symptom of a gloomy and pessimistic vision of the future (p<0.05), sleep disturbances (p<0.04), a factor of personal significance in the form of a threat in patients with stress-provoked onset of the current DE (p<0.05).Adverse events occurred in the first week of treatment with agomelatine in 14.3% of cases (nausea – 8.6%, headache and dizziness – 2.9% each), they were mild and did not require discontinuation of the drug. Two patients taking agomelatine at a dose of 50 mg discontinued the study: in one case persisted social phobia, increased fatigue, motor retardation, and persistent modern insomnia; in the other case – a pronounced senestoalgic syndrome with cerebral localization.Conclusion. Agomelatine therapy has been shown to be highly effective and well tolerated in nonpsychotic depression.","PeriodicalId":19252,"journal":{"name":"Neurology, neuropsychiatry, Psychosomatics","volume":"125 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85701211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.14412/2074-2711-2023-4-53-65
O. D. Ostroumova, M. Maksimov, M. V. Zamergrad, V. A. Parfenov, E. K. Zaharova, A. L. Vladykin, A. Globenko, A. Kapashin, K. Ishchenko
Objective: to evaluate the pharmacokinetic parameters, safety and tolerability of Vespireit® (INN buspirone), prolonged-release tablets, 15 mg (JSC “Valenta Pharm”, Russia), which is being developed as a drug for the treatment of functional vertigo, in healthy volunteers with a single oral dose of 15 and 30 mg on an empty stomach or after meals and multiple doses in a daily dose of 15 mg.Material and methods. JSC “Valenta Pharm” conducted an open-label, three-stage, randomized, two-periods, cross-over comparative clinical trial of Vespireit®. At stages 1 and 2, healthy volunteers were screened and randomized into two equal groups (Group 1 and Group 2), as well as the distribution of participants in Group 3. Then, at stage 1, healthy volunteers (n=24) took Vespireit® once at a dose of 15 mg on an empty stomach or after meals, at stage 2, volunteers (n=24) took Vespireit® once at a dose of 30 mg on an empty stomach or after meals. Stage 3 was conducted in 18 volunteers as a non-randomized, non-comparative study with Vespireit® 15 mg on an empty stomach once daily for 5 days. During the study, blood samples were collected from each subject to determine the concentration of test compounds in blood plasma and subsequently calculate their pharmacokinetic parameters. Quantitative determination of buspirone and its two metabolites, 6-hydroxybuspirone (6OH-bus) and 1-(2-pyrimidinyl)-piperazine (1-PP), was performed by a validated high-performance liquid chromatography method with tandem mass spectrometric detection. During the study, tolerability and safety were also evaluated: adverse events, vital signs, laboratory parameters and electrocardiogram parameters were recorded.Results. When the study drug Vespireit®, prolonged-release tablets, was administered once at a dose of 15 mg to healthy volunteers after a meal, an increase in the relative bioavailability and relative degree of absorption of buspirone was observed compared with the fasting state, which was accompanied by a 1.5- and 2.5-fold increase in the AUC0–t and Cmax of buspirone, respectively. In addition, the Cmax of 6-OH-bus increased 1.4-fold and the Cmax of 1-PP increased 1.2-fold. Meal had no effect on the AUC0–t of 6-OH-bus and 1-PP. When the study drug was administered once at a dose of 30 mg after a meal, an increase in the relative bioavailability and relative degree of absorption of buspirone was observed compared with fasting, which was accompanied by an increase in the AUC0–t and Cmax by 1.5- and 2.1-fold, respectively. A 1.2-fold increase in the Cmax of 6-OH-bus was also observed. Food had no effect on the AUC0–t of 6-OH-bus and on the AUC0–t and Cmax of 1-PP. No accumulation of buspirone and its metabolites was observed with repeated dosing.Conclusion. In the study, the values of pharmacokinetic parameters of the new drug Vespireit® in the prolonged-release tablets dosage form were determined both with single administration on an empty stomach and after meals and with multiple admi
{"title":"Evaluation of pharmacokinetic parameters, safety and tolerability of single and multiple doses of Vespireit®: results of phase I clinical trial.","authors":"O. D. Ostroumova, M. Maksimov, M. V. Zamergrad, V. A. Parfenov, E. K. Zaharova, A. L. Vladykin, A. Globenko, A. Kapashin, K. Ishchenko","doi":"10.14412/2074-2711-2023-4-53-65","DOIUrl":"https://doi.org/10.14412/2074-2711-2023-4-53-65","url":null,"abstract":"Objective: to evaluate the pharmacokinetic parameters, safety and tolerability of Vespireit® (INN buspirone), prolonged-release tablets, 15 mg (JSC “Valenta Pharm”, Russia), which is being developed as a drug for the treatment of functional vertigo, in healthy volunteers with a single oral dose of 15 and 30 mg on an empty stomach or after meals and multiple doses in a daily dose of 15 mg.Material and methods. JSC “Valenta Pharm” conducted an open-label, three-stage, randomized, two-periods, cross-over comparative clinical trial of Vespireit®. At stages 1 and 2, healthy volunteers were screened and randomized into two equal groups (Group 1 and Group 2), as well as the distribution of participants in Group 3. Then, at stage 1, healthy volunteers (n=24) took Vespireit® once at a dose of 15 mg on an empty stomach or after meals, at stage 2, volunteers (n=24) took Vespireit® once at a dose of 30 mg on an empty stomach or after meals. Stage 3 was conducted in 18 volunteers as a non-randomized, non-comparative study with Vespireit® 15 mg on an empty stomach once daily for 5 days. During the study, blood samples were collected from each subject to determine the concentration of test compounds in blood plasma and subsequently calculate their pharmacokinetic parameters. Quantitative determination of buspirone and its two metabolites, 6-hydroxybuspirone (6OH-bus) and 1-(2-pyrimidinyl)-piperazine (1-PP), was performed by a validated high-performance liquid chromatography method with tandem mass spectrometric detection. During the study, tolerability and safety were also evaluated: adverse events, vital signs, laboratory parameters and electrocardiogram parameters were recorded.Results. When the study drug Vespireit®, prolonged-release tablets, was administered once at a dose of 15 mg to healthy volunteers after a meal, an increase in the relative bioavailability and relative degree of absorption of buspirone was observed compared with the fasting state, which was accompanied by a 1.5- and 2.5-fold increase in the AUC0–t and Cmax of buspirone, respectively. In addition, the Cmax of 6-OH-bus increased 1.4-fold and the Cmax of 1-PP increased 1.2-fold. Meal had no effect on the AUC0–t of 6-OH-bus and 1-PP. When the study drug was administered once at a dose of 30 mg after a meal, an increase in the relative bioavailability and relative degree of absorption of buspirone was observed compared with fasting, which was accompanied by an increase in the AUC0–t and Cmax by 1.5- and 2.1-fold, respectively. A 1.2-fold increase in the Cmax of 6-OH-bus was also observed. Food had no effect on the AUC0–t of 6-OH-bus and on the AUC0–t and Cmax of 1-PP. No accumulation of buspirone and its metabolites was observed with repeated dosing.Conclusion. In the study, the values of pharmacokinetic parameters of the new drug Vespireit® in the prolonged-release tablets dosage form were determined both with single administration on an empty stomach and after meals and with multiple admi","PeriodicalId":19252,"journal":{"name":"Neurology, neuropsychiatry, Psychosomatics","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83520456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.14412/2074-2711-2023-4-105-111
O. A. Shavlovskaya, Y. Yukhnovskaya, I. D. Romanov, I. A. Bokova
Understanding the major pathological pathways and the key molecules involved in the pathogenesis of inflammatory processes in joints, particularly in osteoarthritis (OA), is crucial for drug and pharmaconutraceuticals development. OA is a degenerative joint disease that predominantly affects articular cartilage. Destruction of hyaline cartilage and restructuring of subchondral bone are accompanied by synovial inflammation in the joint, including the facet joint of the spine, manifested by pain in the joint, low back pain (LBP), and limitation of functional activity. The article discusses the relationship between immune and inflammatory mechanisms in OA of any location, including the joints of the spine. One of the mechanisms for the formation of a “vicious circle of inflammation” during the activation of discoidin receptors by endogenous type II collagen is discussed, leading to the induction of the synthesis of pro-inflammatory mediators: tumor necrosis factor α(TNFα), metalloproteinases (MMPs) 1 and 13, interleukins (IL) 1 and 6. Inflammation, in turn, leads to a decrease in the synthesis and destruction of endogenous type II collagen and, subsequently, to cartilage destruction. Cartilage fragments entering the joint space of the intercellular matrix enhance the synthesis of TNFα, IL, and MMP and exacerbate the inflammatory process. Oral ingestion of exogenous undenatured type II collagen(NK-II) helps, first, to inactivate the binding of fragments of destroyed endogenous type II collagen to discoidin receptors and to break the "vicious circle of inflammation"; secondly, through the mechanism of oral/intestinal tolerance via the lymphoid system in Peyer's patches of the small intestine, leads to the activation of immune cells (T-lymphocytes) and initiation of the immune response – the synthesis of anti-inflammatory mediators (transforming growth factor β, IL4 and IL10). The new pharmaconutraceutical Chondroguard®TRIO, which contains chondroprotectors (chondroitin sulfate and glucosamine sulfate) as well as NK-II, will make it possible to influence the key sites of the pathological process in OA.
{"title":"Pharmaconutraceutical Chondroguard®TRIO – chondroprotector with immunomodulatory activity","authors":"O. A. Shavlovskaya, Y. Yukhnovskaya, I. D. Romanov, I. A. Bokova","doi":"10.14412/2074-2711-2023-4-105-111","DOIUrl":"https://doi.org/10.14412/2074-2711-2023-4-105-111","url":null,"abstract":"Understanding the major pathological pathways and the key molecules involved in the pathogenesis of inflammatory processes in joints, particularly in osteoarthritis (OA), is crucial for drug and pharmaconutraceuticals development. OA is a degenerative joint disease that predominantly affects articular cartilage. Destruction of hyaline cartilage and restructuring of subchondral bone are accompanied by synovial inflammation in the joint, including the facet joint of the spine, manifested by pain in the joint, low back pain (LBP), and limitation of functional activity. The article discusses the relationship between immune and inflammatory mechanisms in OA of any location, including the joints of the spine. One of the mechanisms for the formation of a “vicious circle of inflammation” during the activation of discoidin receptors by endogenous type II collagen is discussed, leading to the induction of the synthesis of pro-inflammatory mediators: tumor necrosis factor α(TNFα), metalloproteinases (MMPs) 1 and 13, interleukins (IL) 1 and 6. Inflammation, in turn, leads to a decrease in the synthesis and destruction of endogenous type II collagen and, subsequently, to cartilage destruction. Cartilage fragments entering the joint space of the intercellular matrix enhance the synthesis of TNFα, IL, and MMP and exacerbate the inflammatory process. Oral ingestion of exogenous undenatured type II collagen(NK-II) helps, first, to inactivate the binding of fragments of destroyed endogenous type II collagen to discoidin receptors and to break the \"vicious circle of inflammation\"; secondly, through the mechanism of oral/intestinal tolerance via the lymphoid system in Peyer's patches of the small intestine, leads to the activation of immune cells (T-lymphocytes) and initiation of the immune response – the synthesis of anti-inflammatory mediators (transforming growth factor β, IL4 and IL10). The new pharmaconutraceutical Chondroguard®TRIO, which contains chondroprotectors (chondroitin sulfate and glucosamine sulfate) as well as NK-II, will make it possible to influence the key sites of the pathological process in OA.","PeriodicalId":19252,"journal":{"name":"Neurology, neuropsychiatry, Psychosomatics","volume":"27 5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76813470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.14412/2074-2711-2023-4-89-93
V. Nikolenko, B. A. Volel, A. Shkarubo, A. A. Nagajtseva, T. Zharikova, Y. Zharikov
pathological hormone secretion, the clinical presentation is determined by the localization of the tumor. Common symptoms include headache and visual field defects. This review addresses the pathology aspects of diagnosis, conservative treatment, and methods of radiation therapy. Drug therapy of endocrine-inactive adenomas is based on the presence of receptors for somatostatin and dopamine in pituitary adenoma cells. Data on stereotactic radiosurgery techniques such as gamma and cyberknife and disease prognosis are presented.
{"title":"Endocrine-inactive pituitary tumors: pathology and current approaches to diagnosis and treatment","authors":"V. Nikolenko, B. A. Volel, A. Shkarubo, A. A. Nagajtseva, T. Zharikova, Y. Zharikov","doi":"10.14412/2074-2711-2023-4-89-93","DOIUrl":"https://doi.org/10.14412/2074-2711-2023-4-89-93","url":null,"abstract":"pathological hormone secretion, the clinical presentation is determined by the localization of the tumor. Common symptoms include headache and visual field defects. This review addresses the pathology aspects of diagnosis, conservative treatment, and methods of radiation therapy. Drug therapy of endocrine-inactive adenomas is based on the presence of receptors for somatostatin and dopamine in pituitary adenoma cells. Data on stereotactic radiosurgery techniques such as gamma and cyberknife and disease prognosis are presented.","PeriodicalId":19252,"journal":{"name":"Neurology, neuropsychiatry, Psychosomatics","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76362825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.14412/2074-2711-2023-4-94-99
D. V. Kapkanets, S. E. Belov, M. Dolgushin, A. N. Boyko
To date, there is no accepted highly specific pattern for the detection of multiple sclerosis. Correct diagnosis is particularly difficult in situations where an atypical clinical picture of the disease is observed or nonstandard neuroimaging patterns are detected. Therefore, the scientific community has high hopes for the discovery of new markers that will allow clarification of the diagnosis in controversial cases. Currently, there is a lot of research focused on the study of an additional diagnostic MRI pattern – a sign of a paramagnetic rim. This symptom is associated with chronic smoldering central nervous system (CNS) lesions, is more commonly seen in young males, is found primarily in the periventricular region, and is also a promising predictor of disability and cognitive impairment. There is evidence that it is present in earlier stages of disease in “fresh” lesions of the CNS. However, further studies are needed to use this diagnostic MRI pattern in clinical practice.
{"title":"Paramagnetic rim sign in multiple sclerosis","authors":"D. V. Kapkanets, S. E. Belov, M. Dolgushin, A. N. Boyko","doi":"10.14412/2074-2711-2023-4-94-99","DOIUrl":"https://doi.org/10.14412/2074-2711-2023-4-94-99","url":null,"abstract":"To date, there is no accepted highly specific pattern for the detection of multiple sclerosis. Correct diagnosis is particularly difficult in situations where an atypical clinical picture of the disease is observed or nonstandard neuroimaging patterns are detected. Therefore, the scientific community has high hopes for the discovery of new markers that will allow clarification of the diagnosis in controversial cases. Currently, there is a lot of research focused on the study of an additional diagnostic MRI pattern – a sign of a paramagnetic rim. This symptom is associated with chronic smoldering central nervous system (CNS) lesions, is more commonly seen in young males, is found primarily in the periventricular region, and is also a promising predictor of disability and cognitive impairment. There is evidence that it is present in earlier stages of disease in “fresh” lesions of the CNS. However, further studies are needed to use this diagnostic MRI pattern in clinical practice.","PeriodicalId":19252,"journal":{"name":"Neurology, neuropsychiatry, Psychosomatics","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76474430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.14412/2074-2711-2023-4-38-44
M. Maksimova, V. Y. Sazonova
Stroke is one of the leading causes of death and primary disability and contributes significantly to the global burden of disease. Identification of individuals at high risk of ischemic stroke (IS) is an important component of disease prevention. The differences between risk factors (RF) for stroke in men and women are not well understood.Objective: to determine the predictive value of RF for the development of IS in men and women aged 45–74 years.Material and methods. The study included 728 patients (380 men and 348 women) aged 45–74 years, including 392 patients (247 men and 145 women) with IS in the carotid artery basin (main group) and 336 patients (133 men and 203 women) with vascular cognitive impairment (comparison group). To build predictive models to assess the impact of RF on the development of IS in men and women, we used the logistic regression method with stepwise exclusion of variables according to the Wald algorithm.Results. The predictive regression model of IS in men includes atherosclerotic stenosis of the internal carotid arteries [odds ratio (OR) 3.571; 95% confidence interval (CI) 1.792–7.114], in a predictive regression model in women – diabetes mellitus type 2 (OR 5.074; 95% CI 1.768–14.561) and a history of IS (OR 6.857; 95% CI 1.825–25.762). Other risk factors for the development of IS (atrial fibrillation, history of transient ischemic attack, arterial hypertension stage) affected both men and women.Conclusion. Atherosclerotic stenosis of the internal carotid arteries was found to be a sex-specific prognostic factor for IS in men, and type 2 diabetes mellitus and a history of IS in women.
中风是导致死亡和主要残疾的主要原因之一，是造成全球疾病负担的重要因素。识别缺血性脑卒中高危人群是疾病预防的重要组成部分。男性和女性中风的危险因素(RF)之间的差异尚不清楚。目的:探讨RF对45-74岁男性和女性IS发展的预测价值。材料和方法。研究纳入728例患者(男性380例，女性348例)，年龄45-74岁，其中颈动脉盆区IS患者392例(男性247例，女性145例)(主组)，血管性认知障碍患者336例(男性133例，女性203例)(对照组)。为了建立预测模型来评估RF对男性和女性IS发展的影响，我们使用了根据Wald算法逐步排除变量的逻辑回归方法。男性IS的预测回归模型包括颈内动脉粥样硬化性狭窄[优势比(OR) 3.571;95%置信区间(CI) 1.792-7.114)，在女性预测回归模型中- 2型糖尿病(OR 5.074;95% CI 1.768-14.561)和IS病史(OR 6.857;95% ci 1.825-25.762)。其他IS发展的危险因素(心房颤动、短暂性脑缺血发作史、动脉高血压期)对男性和女性都有影响。研究发现，颈内动脉粥样硬化性狭窄是男性IS和女性2型糖尿病和IS病史的一个性别特异性预后因素。
{"title":"Risk factors for ischemic stroke in men and women aged 45–74 years","authors":"M. Maksimova, V. Y. Sazonova","doi":"10.14412/2074-2711-2023-4-38-44","DOIUrl":"https://doi.org/10.14412/2074-2711-2023-4-38-44","url":null,"abstract":"Stroke is one of the leading causes of death and primary disability and contributes significantly to the global burden of disease. Identification of individuals at high risk of ischemic stroke (IS) is an important component of disease prevention. The differences between risk factors (RF) for stroke in men and women are not well understood.Objective: to determine the predictive value of RF for the development of IS in men and women aged 45–74 years.Material and methods. The study included 728 patients (380 men and 348 women) aged 45–74 years, including 392 patients (247 men and 145 women) with IS in the carotid artery basin (main group) and 336 patients (133 men and 203 women) with vascular cognitive impairment (comparison group). To build predictive models to assess the impact of RF on the development of IS in men and women, we used the logistic regression method with stepwise exclusion of variables according to the Wald algorithm.Results. The predictive regression model of IS in men includes atherosclerotic stenosis of the internal carotid arteries [odds ratio (OR) 3.571; 95% confidence interval (CI) 1.792–7.114], in a predictive regression model in women – diabetes mellitus type 2 (OR 5.074; 95% CI 1.768–14.561) and a history of IS (OR 6.857; 95% CI 1.825–25.762). Other risk factors for the development of IS (atrial fibrillation, history of transient ischemic attack, arterial hypertension stage) affected both men and women.Conclusion. Atherosclerotic stenosis of the internal carotid arteries was found to be a sex-specific prognostic factor for IS in men, and type 2 diabetes mellitus and a history of IS in women.","PeriodicalId":19252,"journal":{"name":"Neurology, neuropsychiatry, Psychosomatics","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80194471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.14412/20742711-2023-4-45-52
A. O. Nikolaevskaya, N. A. Tyuvina, V. Morozova, E. P. Kesler
The issue of the influence of women's mental state on their reproductive function has not been adequately addressed and requires further research.Objective: a comparative evaluation of individual indicators of menstrual and reproductive function in mentally healthy and mentally ill women with infertility.Material and methods. We studied 348 women aged 21 to 40 years with primary and secondary infertility, 120 of whom had been treated for a mental disorder in a psychiatric hospital prior to the present study. The patients' condition was assessed by a clinical method using a specially designed questionnaire card.Results. Reproductive function of patients in the studied groups differed significantly in several indicators. Mentally ill women with primary infertility are characterized by the following features: later onset of menstruation, scanty or heavy menstrual flow (p<0.05), irregularity or absence of menstruation during the period of exacerbation of the disease, insufficient emotional response to menarche (p<0.05), irregularity of sexual life and dissatisfaction with it (p<0.01). Spontaneous miscarriages and stillbirth occurred more frequently in mentally ill women, especially in women with endogenous disorders (schizophrenia, affective disorders), while abortions and gynecological surgeries were more frequent in mentally healthy women (p<0.001). Predictors of infertility on the part of mental health are the early onset and chronic course of a mental disorder, the severity and duration of an exacerbation of the illness, brief and incomplete remissions, the development of personality changes or a defect (schizophrenic) as a result of a mental illness.Conclusion. Menstrual and reproductive functions of women depend on their mental state. In women with mental disorders, menstrual dysfunction together with psychopathological symptoms of illness (decrease in libido, communication, emotional numbness), decrease in social and family adaptation leads to impairment of reproductive function.
{"title":"Psychosomatic correlations in mentally ill and mentally healthy women with infertility","authors":"A. O. Nikolaevskaya, N. A. Tyuvina, V. Morozova, E. P. Kesler","doi":"10.14412/20742711-2023-4-45-52","DOIUrl":"https://doi.org/10.14412/20742711-2023-4-45-52","url":null,"abstract":"The issue of the influence of women's mental state on their reproductive function has not been adequately addressed and requires further research.Objective: a comparative evaluation of individual indicators of menstrual and reproductive function in mentally healthy and mentally ill women with infertility.Material and methods. We studied 348 women aged 21 to 40 years with primary and secondary infertility, 120 of whom had been treated for a mental disorder in a psychiatric hospital prior to the present study. The patients' condition was assessed by a clinical method using a specially designed questionnaire card.Results. Reproductive function of patients in the studied groups differed significantly in several indicators. Mentally ill women with primary infertility are characterized by the following features: later onset of menstruation, scanty or heavy menstrual flow (p<0.05), irregularity or absence of menstruation during the period of exacerbation of the disease, insufficient emotional response to menarche (p<0.05), irregularity of sexual life and dissatisfaction with it (p<0.01). Spontaneous miscarriages and stillbirth occurred more frequently in mentally ill women, especially in women with endogenous disorders (schizophrenia, affective disorders), while abortions and gynecological surgeries were more frequent in mentally healthy women (p<0.001). Predictors of infertility on the part of mental health are the early onset and chronic course of a mental disorder, the severity and duration of an exacerbation of the illness, brief and incomplete remissions, the development of personality changes or a defect (schizophrenic) as a result of a mental illness.Conclusion. Menstrual and reproductive functions of women depend on their mental state. In women with mental disorders, menstrual dysfunction together with psychopathological symptoms of illness (decrease in libido, communication, emotional numbness), decrease in social and family adaptation leads to impairment of reproductive function.","PeriodicalId":19252,"journal":{"name":"Neurology, neuropsychiatry, Psychosomatics","volume":"68 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73572625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.14412/2074-2711-2023-466-73
E. N. Zastenskaya, L. M. Antonenko
Persistent postural perceptual dizziness (PPPD) is the most common cause of vague chronic vertigo and severely limits patients' quality of life.Limited data are available on comorbidities, the typical treatment of patients with PPPD, and the efficacy of combination therapy for PPPD.Objective: to identify comorbid disorders and evaluate the efficacy of complex therapy in patients with PPPD.Material and methods. Sixty patients (mean age 42.5±13.8 years) with PPPD were studied. All patients were prescribed complex treatment that included antidepressants (selective serotonin reuptake inhibitors), vestibular exercises, and an educational program. In 28 patients, Arlevert (combination of cinnarizine 20 mg + dimenhydrinate 40 mg) was used as drug therapy. A clinical otoneurologic examination, videonystagmography, assessments by Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Spielberger State-Trait Anxiety Inventory (STAI), Dizziness Handicap Inventory (DHI) and otoneurologic examination were performed at baseline and at the end of treatment (mean, one month).Results. All patients had previous misdiagnoses, among which vertebrobasilar insufficiency and chronic cerebral ischemia predominated. Thirty two (53.33%) patients with PPPD had anxiety-depressive disorders (ADD) as the main comorbidity, 20 (33.33%) patients had migraine, 8 (13.33%) patients had previously had peripheral vestibular disorders that were not diagnosed. The severity of dizziness according to the otoneurological questionnaire and the DHI decreased after one month of therapy in the group with PPPD and ADD from 44.00±16.80 to 29.6±12.80 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 49.20±14.04 to 31.60±17.69 points (p<0.001), in the group with PPPD and migraine – from 43.58±16.28 to 28.50±7.20 points (p<0.001). The severity of anxiety and depression according to BAI decreased in the group with PPPD and ADD from 30.00±6.99 to 16.12±4.16 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 28.40±8.35 to 16.60±4.62 points (p<0.001), in the group with PPPD and migraine – from 24.11±3.80 to 14.26±3.43 points (p<0.001). The severity of depression according to BDI decreased in the group with PPPD and ADD from 9.62±5.26 to 6.25±3.20 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 14.80±8.26 to 8.40±5.37 points (p<0.001), in the group with PPPD and migraine – from 11.32±5.10 to 6.53±3.44 points (p<0.001). The severity of anxiety according to HADS decreased in the group with PPPD and ADD from 13.75±3.20 to 9.25±2.43 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 12.40±5.77 to 7.80±3.83 points (p<0.001), in the group with PPPD and migraine – from 14.26±3.16 to 8.74±2.18 points (p<0.001).The severity of depression according to HADS decreased in the group with PPPD and ADD from 4.88±4.12 to 3.88±3.09 p
{"title":"Comorbid disorders and therapy of persistent postural perceptual dizziness","authors":"E. N. Zastenskaya, L. M. Antonenko","doi":"10.14412/2074-2711-2023-466-73","DOIUrl":"https://doi.org/10.14412/2074-2711-2023-466-73","url":null,"abstract":"Persistent postural perceptual dizziness (PPPD) is the most common cause of vague chronic vertigo and severely limits patients' quality of life.Limited data are available on comorbidities, the typical treatment of patients with PPPD, and the efficacy of combination therapy for PPPD.Objective: to identify comorbid disorders and evaluate the efficacy of complex therapy in patients with PPPD.Material and methods. Sixty patients (mean age 42.5±13.8 years) with PPPD were studied. All patients were prescribed complex treatment that included antidepressants (selective serotonin reuptake inhibitors), vestibular exercises, and an educational program. In 28 patients, Arlevert (combination of cinnarizine 20 mg + dimenhydrinate 40 mg) was used as drug therapy. A clinical otoneurologic examination, videonystagmography, assessments by Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Spielberger State-Trait Anxiety Inventory (STAI), Dizziness Handicap Inventory (DHI) and otoneurologic examination were performed at baseline and at the end of treatment (mean, one month).Results. All patients had previous misdiagnoses, among which vertebrobasilar insufficiency and chronic cerebral ischemia predominated. Thirty two (53.33%) patients with PPPD had anxiety-depressive disorders (ADD) as the main comorbidity, 20 (33.33%) patients had migraine, 8 (13.33%) patients had previously had peripheral vestibular disorders that were not diagnosed. The severity of dizziness according to the otoneurological questionnaire and the DHI decreased after one month of therapy in the group with PPPD and ADD from 44.00±16.80 to 29.6±12.80 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 49.20±14.04 to 31.60±17.69 points (p<0.001), in the group with PPPD and migraine – from 43.58±16.28 to 28.50±7.20 points (p<0.001). The severity of anxiety and depression according to BAI decreased in the group with PPPD and ADD from 30.00±6.99 to 16.12±4.16 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 28.40±8.35 to 16.60±4.62 points (p<0.001), in the group with PPPD and migraine – from 24.11±3.80 to 14.26±3.43 points (p<0.001). The severity of depression according to BDI decreased in the group with PPPD and ADD from 9.62±5.26 to 6.25±3.20 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 14.80±8.26 to 8.40±5.37 points (p<0.001), in the group with PPPD and migraine – from 11.32±5.10 to 6.53±3.44 points (p<0.001). The severity of anxiety according to HADS decreased in the group with PPPD and ADD from 13.75±3.20 to 9.25±2.43 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 12.40±5.77 to 7.80±3.83 points (p<0.001), in the group with PPPD and migraine – from 14.26±3.16 to 8.74±2.18 points (p<0.001).The severity of depression according to HADS decreased in the group with PPPD and ADD from 4.88±4.12 to 3.88±3.09 p","PeriodicalId":19252,"journal":{"name":"Neurology, neuropsychiatry, Psychosomatics","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74659237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.14412/2074-2711-2023-4-31-37
D. A. Demin, A. Kulesh, S. Enginoev, V. V. Demetskaya, E. V. Demina, M. V. Lezhikov, E. I. Shaposhnikova, D. Stompel
Cerebral ischemic events, including ischemic stroke (IS) and transient ischemic attack (TIA), are among the most common extracardiac complications of infective endocarditis (IE).Objective: to evaluate cerebral ischemic events (prevalence, clinical and neuroimaging characteristics, predictors, prognosis) in patients with “left-sided” IE, who underwent cardiac surgery, according to the registry of the Federal Center for Cardiovascular Surgery.Material and methods. A retrospective review of data from the hospital information system was performed in one of the federal centers for cardiovascular surgery of the Russian Ministry of Health. Inclusion criteria in the study: age of patients ≥18 years, significant or probable (Duke criteria) IE of the left heart – aortic and/or mitral valves. Patients with isolated right heart IE (tricuspid valve, pacemaker-associated endocarditis), nonbacterial thromboendocarditis, and chronic IE were excluded from the study. For the analysis, 222 cases of IE in 216 patients were used. IS was observed in 43 (19.4%) patients with “left-sided” IE, TIA – in 4 (1.8%). In 2/3 of cases, patients suffered a minor stroke (NIHSS <5), while every fifth patient had symptoms of encephalopathy. Logistic regression was used to determine the predictors of cerebral embolism. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for each of the significant risk factors, and time to first clinical event (death) was estimated using the Kaplan–Meier method.Results. On neuroimaging in IE, the following signs were frequently detected: involvement of different cerebral vascular territories (65.1%), multifocal (≥1 focus) infarcts (74.4%), hemorrhagic transformation (37.2%). Cortical and/or subcortical distribution of infarcts was observed in 97.7% of patients. According to multivariate analysis, IS and TIA were predicted by vegetations >10 mm (OR 3.552; 95% CI 1.066–11.8463; p=0.039), mobile vegetations (OR 6.112; 95% CI 1.105–33.784; p=0.038) and multiple vegetations (OR 5.2 08, 95% CI 1.189–22.805, p=0.029). The impact of cerebral embolism on prognosis (in-hospital and long-term mortality) in patients undergoing cardiac surgery was not established.Conclusion. According to the neuroimaging data, cerebral infarcts in IE correspond to the main signs of cardioembolism. The characteristics of the vegetations (size >10 mm, mobility, multiplicity) are a crucial indicator of the embolic potential of IE.
脑缺血事件，包括缺血性卒中(IS)和短暂性脑缺血发作(TIA)，是感染性心内膜炎(IE)最常见的心外并发症。目的:根据联邦心血管外科中心的登记资料，评估接受心脏手术的“左侧”IE患者的脑缺血事件(患病率、临床和神经影像学特征、预测因素、预后)。材料和方法。在俄罗斯卫生部的一个联邦心血管外科中心对医院信息系统的数据进行了回顾性审查。纳入标准:患者年龄≥18岁，明显或可能(Duke标准)左心主动脉瓣和/或二尖瓣IE。患有孤立性右心IE(三尖瓣、起搏器相关性心内膜炎)、非细菌性血栓性心内膜炎和慢性IE的患者被排除在研究之外。分析使用了216例患者的222例IE。左侧IE 43例(19.4%)出现IS, 4例(1.8%)出现TIA。2/3的患者发生轻度脑卒中(NIHSS 10 mm (OR 3.552;95% ci 1.066-11.8463;p=0.039)，流动植被(OR 6.112;95% ci 1.105-33.784;p=0.038)和多种植被(OR 5.2 08, 95% CI 1.189-22.805, p=0.029)。脑栓塞对心脏手术患者预后(住院和长期死亡率)的影响尚未确定。根据神经影像学资料，IE的脑梗死与心脏栓塞的主要征象相对应。植被的特征(大小>10 mm，移动性，多样性)是IE栓塞潜力的重要指标。
{"title":"Cerebral ischemic events in patients with infective endocarditis: results of a single center retrospective study","authors":"D. A. Demin, A. Kulesh, S. Enginoev, V. V. Demetskaya, E. V. Demina, M. V. Lezhikov, E. I. Shaposhnikova, D. Stompel","doi":"10.14412/2074-2711-2023-4-31-37","DOIUrl":"https://doi.org/10.14412/2074-2711-2023-4-31-37","url":null,"abstract":"Cerebral ischemic events, including ischemic stroke (IS) and transient ischemic attack (TIA), are among the most common extracardiac complications of infective endocarditis (IE).Objective: to evaluate cerebral ischemic events (prevalence, clinical and neuroimaging characteristics, predictors, prognosis) in patients with “left-sided” IE, who underwent cardiac surgery, according to the registry of the Federal Center for Cardiovascular Surgery.Material and methods. A retrospective review of data from the hospital information system was performed in one of the federal centers for cardiovascular surgery of the Russian Ministry of Health. Inclusion criteria in the study: age of patients ≥18 years, significant or probable (Duke criteria) IE of the left heart – aortic and/or mitral valves. Patients with isolated right heart IE (tricuspid valve, pacemaker-associated endocarditis), nonbacterial thromboendocarditis, and chronic IE were excluded from the study. For the analysis, 222 cases of IE in 216 patients were used. IS was observed in 43 (19.4%) patients with “left-sided” IE, TIA – in 4 (1.8%). In 2/3 of cases, patients suffered a minor stroke (NIHSS <5), while every fifth patient had symptoms of encephalopathy. Logistic regression was used to determine the predictors of cerebral embolism. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for each of the significant risk factors, and time to first clinical event (death) was estimated using the Kaplan–Meier method.Results. On neuroimaging in IE, the following signs were frequently detected: involvement of different cerebral vascular territories (65.1%), multifocal (≥1 focus) infarcts (74.4%), hemorrhagic transformation (37.2%). Cortical and/or subcortical distribution of infarcts was observed in 97.7% of patients. According to multivariate analysis, IS and TIA were predicted by vegetations >10 mm (OR 3.552; 95% CI 1.066–11.8463; p=0.039), mobile vegetations (OR 6.112; 95% CI 1.105–33.784; p=0.038) and multiple vegetations (OR 5.2 08, 95% CI 1.189–22.805, p=0.029). The impact of cerebral embolism on prognosis (in-hospital and long-term mortality) in patients undergoing cardiac surgery was not established.Conclusion. According to the neuroimaging data, cerebral infarcts in IE correspond to the main signs of cardioembolism. The characteristics of the vegetations (size >10 mm, mobility, multiplicity) are a crucial indicator of the embolic potential of IE.","PeriodicalId":19252,"journal":{"name":"Neurology, neuropsychiatry, Psychosomatics","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90995172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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