Objective — to establish probable associations of the -108C/T polymorphic variant of the PON1 gene with clinical-neurological, neuroimaging hemodynamic characteristics, and cognitive dysfunction in patients with Chronic Alcohol-Induced Encephalopathy (CAIE). Materials and methods. A total of 102 patients with CAIE undergoing inpatient treatment at Ternopil Regional Clinical Psychoneurological Hospital during 2021—2022 were examined, and 26 patients underwent molecular genetic research. The control group consisted of 12 healthy individuals, matched for age and gender. Clinical and neurological examinations followed a standard protocol, neuroimaging of the brain was conducted using multispiral computed tomography or magnetic resonance imaging, cerebral blood flow was studied using transcranial duplex scanning on a Philips HDI device (the Netherlands); and cognitive functions were assessed using the Montreal Cognitive Test (MoCA). Molecular genetic research of the -108C/T polymorphic variant of the PON1 gene was performed in the molecular genetic laboratory of the State Institution «Reference Center for Molecular Diagnostics of the Ministry of Health of Ukraine», Kyiv. Statistical data analysis was conducted using the «Statistica 13.0» software. Results. Analysis of the dependence of clinical-neurological syndromes, neuroimaging, hemodynamic characteristics, and cognitive dysfunction based on the results of the MoCA test on the -108C/T polymorphic variant of the PON1 gene in patients with CAIE revealed significant differences in genotype distribution only concerning cognitive dysfunction (χ2 = 10.13, p = 0.038). Notably, carriers of the T/T genotype predominated among individuals with a moderate cognitive defect (66.67 %), while carriers of the S/T genotype were more common among those with a mild cognitive defect (62.50 %). Regarding the distribution of allele frequencies of the -108C/T polymorphic variant of the PON1 gene in patients with CAIE, it was determined that among individuals with a moderate cognitive defect, 83.33%, and among those with a mild cognitive defect, 62.50 % were carriers of T alleles (χ2 = 6.93, p = 0.031). Conclusions. The study results suggest the need for further exploration of the association between the allelic polymorphism of the PON1 gene and cognitive functioning involving a larger sample of CAIE patients. This will help elucidate the molecular mechanisms underlying cognitive disorders and assess the diagnostic significance of including the -108C/T polymorphic variant of the PON1 gene in the genetic panel for early diagnosis of cognitive disorders and dementia prevention.
{"title":"Study of associations between the -108C/T Polymorphism of the PON1 gene and clinical syndromes, neuroimaging changes indicated by transcranial doppler sonography of cerebral vessels, and cognitive dysfunction in patients with chronic alcohol-induced encep","authors":"K. Duve, S. Shkrobot","doi":"10.30978/unj2023-1-4-72","DOIUrl":"https://doi.org/10.30978/unj2023-1-4-72","url":null,"abstract":"Objective — to establish probable associations of the -108C/T polymorphic variant of the PON1 gene with clinical-neurological, neuroimaging hemodynamic characteristics, and cognitive dysfunction in patients with Chronic Alcohol-Induced Encephalopathy (CAIE). Materials and methods. A total of 102 patients with CAIE undergoing inpatient treatment at Ternopil Regional Clinical Psychoneurological Hospital during 2021—2022 were examined, and 26 patients underwent molecular genetic research. The control group consisted of 12 healthy individuals, matched for age and gender. Clinical and neurological examinations followed a standard protocol, neuroimaging of the brain was conducted using multispiral computed tomography or magnetic resonance imaging, cerebral blood flow was studied using transcranial duplex scanning on a Philips HDI device (the Netherlands); and cognitive functions were assessed using the Montreal Cognitive Test (MoCA). Molecular genetic research of the -108C/T polymorphic variant of the PON1 gene was performed in the molecular genetic laboratory of the State Institution «Reference Center for Molecular Diagnostics of the Ministry of Health of Ukraine», Kyiv. Statistical data analysis was conducted using the «Statistica 13.0» software. Results. Analysis of the dependence of clinical-neurological syndromes, neuroimaging, hemodynamic characteristics, and cognitive dysfunction based on the results of the MoCA test on the -108C/T polymorphic variant of the PON1 gene in patients with CAIE revealed significant differences in genotype distribution only concerning cognitive dysfunction (χ2 = 10.13, p = 0.038). Notably, carriers of the T/T genotype predominated among individuals with a moderate cognitive defect (66.67 %), while carriers of the S/T genotype were more common among those with a mild cognitive defect (62.50 %). Regarding the distribution of allele frequencies of the -108C/T polymorphic variant of the PON1 gene in patients with CAIE, it was determined that among individuals with a moderate cognitive defect, 83.33%, and among those with a mild cognitive defect, 62.50 % were carriers of T alleles (χ2 = 6.93, p = 0.031). Conclusions. The study results suggest the need for further exploration of the association between the allelic polymorphism of the PON1 gene and cognitive functioning involving a larger sample of CAIE patients. This will help elucidate the molecular mechanisms underlying cognitive disorders and assess the diagnostic significance of including the -108C/T polymorphic variant of the PON1 gene in the genetic panel for early diagnosis of cognitive disorders and dementia prevention.","PeriodicalId":296251,"journal":{"name":"Ukrainian Neurological Journal","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139262053","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}
In the literature review, an attempt is made to systematize scientific literature regarding the possible prospects of applying gene therapy and nanotechnologies for the treatment of neurodegenerative diseases, such as Alzheimer’s disease, Parkinson’s disease, and Huntington’s disease. It provides a brief description of the likely etiology and pathogenesis of these diseases and offers examples of potential gene targets for therapeutic interventions. The review lists the shortcomings of traditional treatment strategies for neurodegenerative diseases, including typical obstacles related to drug delivery pathways, overcoming the blood-brain barrier, toxicity, and more. It describes the prospects of using nanotechnologies as technical tools for modifying various structures at the molecular level to achieve desired characteristics. In particular, nanotechnologies are described as means that have the potential to assist in the diagnosis and treatment of neurodegenerative diseases, facilitate drug delivery to the central nervous system (CNS), and enhance their effectiveness. The possibility of using nanocomplexes, manufactured using various modern technologies, is also considered, including a focus on metallic, inorganic, polymeric, lipid nanoparticles, and more. The review also outlines the prospects of gene therapy, its potential for treating disorders of the nervous system through the delivery of genetic material to produce therapeutic molecules. In the context of gene therapy, special emphasis is placed on CRISPR/Cas9 technology, which has been introduced for gene editing in eukaryotic cells and is considered an economically efficient and promising method. Thus, this literature review is focused on the application of nanotechnologies and gene therapy for the treatment of neurodegenerative diseases.
{"title":"Prospects of using gene therapy and nanotechnologies for the treatment of neurodegenerative diseases","authors":"Ye.V. Rudenko, S.M. Sholomon","doi":"10.30978/unj2023-1-4-45","DOIUrl":"https://doi.org/10.30978/unj2023-1-4-45","url":null,"abstract":"In the literature review, an attempt is made to systematize scientific literature regarding the possible prospects of applying gene therapy and nanotechnologies for the treatment of neurodegenerative diseases, such as Alzheimer’s disease, Parkinson’s disease, and Huntington’s disease. It provides a brief description of the likely etiology and pathogenesis of these diseases and offers examples of potential gene targets for therapeutic interventions. The review lists the shortcomings of traditional treatment strategies for neurodegenerative diseases, including typical obstacles related to drug delivery pathways, overcoming the blood-brain barrier, toxicity, and more. It describes the prospects of using nanotechnologies as technical tools for modifying various structures at the molecular level to achieve desired characteristics. In particular, nanotechnologies are described as means that have the potential to assist in the diagnosis and treatment of neurodegenerative diseases, facilitate drug delivery to the central nervous system (CNS), and enhance their effectiveness. The possibility of using nanocomplexes, manufactured using various modern technologies, is also considered, including a focus on metallic, inorganic, polymeric, lipid nanoparticles, and more. The review also outlines the prospects of gene therapy, its potential for treating disorders of the nervous system through the delivery of genetic material to produce therapeutic molecules. In the context of gene therapy, special emphasis is placed on CRISPR/Cas9 technology, which has been introduced for gene editing in eukaryotic cells and is considered an economically efficient and promising method. Thus, this literature review is focused on the application of nanotechnologies and gene therapy for the treatment of neurodegenerative diseases.","PeriodicalId":296251,"journal":{"name":"Ukrainian Neurological Journal","volume":"220 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139261368","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}
Duodenal ulcer disease (DU) is one of the leading gastrointestinal disorders today. Research on the role of Helicobacter pylori (H. pylori) in the pathogenetic mechanisms of various pathological conditions in the human body, including DU, is highly relevant. Objective — to investigate the impact of H. pylori presence in patients with acute-stage DU on indicators of brain bioelectrical activity using electroencephalography (EEG). Materials and methods. This study focused on assessing the bioelectrical activity of the brain through EEG in patients with acute-stage DU. A total of 60 patients were subjected to neurological examinations, and they were assigned into two groups based on the presence or absence of H. pylori infection. The age range of the patients was 25 to 60 years, with an average age of (39.80 ± 1.29) years. The majority of patients were male (43 (71.7 %)). A control group consisting of 30 relatively healthy individuals without somatic pathology, aged between 25 and 60 years with an average age of (31.20 ± 1.27) years, was also formed. This control group had a predominance of male subjects (19 (63.3 %)). Statistical methods were employed to process the data. Results. Significant differences were observed in the indicators of brain bioelectrical activity between H. pylori-positive patients and H. pylori-negative patients, particularly in terms of the average amplitude of waves of different frequencies, the dominant frequency in each rhythm, interhemispheric asymmetry coefficients, and indices and power indices of general spectrum ranges. Conclusions. The differences in brain bioelectrical activity revealed by EEG data between patients with or without H. pylori in their microbiome suggest potential pathophysiological significance of H. pylori in somatoneurological interactions in cases of DU.
{"title":"Indicators of bioelectrical activity of the brain in duodenal ulcer in the acute stage depending on the presence of Helicobacter pylori in patientss","authors":"O.V. Tkachenko, O. Demydas","doi":"10.30978/unj2023-1-4-68","DOIUrl":"https://doi.org/10.30978/unj2023-1-4-68","url":null,"abstract":"Duodenal ulcer disease (DU) is one of the leading gastrointestinal disorders today. Research on the role of Helicobacter pylori (H. pylori) in the pathogenetic mechanisms of various pathological conditions in the human body, including DU, is highly relevant. Objective — to investigate the impact of H. pylori presence in patients with acute-stage DU on indicators of brain bioelectrical activity using electroencephalography (EEG). Materials and methods. This study focused on assessing the bioelectrical activity of the brain through EEG in patients with acute-stage DU. A total of 60 patients were subjected to neurological examinations, and they were assigned into two groups based on the presence or absence of H. pylori infection. The age range of the patients was 25 to 60 years, with an average age of (39.80 ± 1.29) years. The majority of patients were male (43 (71.7 %)). A control group consisting of 30 relatively healthy individuals without somatic pathology, aged between 25 and 60 years with an average age of (31.20 ± 1.27) years, was also formed. This control group had a predominance of male subjects (19 (63.3 %)). Statistical methods were employed to process the data. Results. Significant differences were observed in the indicators of brain bioelectrical activity between H. pylori-positive patients and H. pylori-negative patients, particularly in terms of the average amplitude of waves of different frequencies, the dominant frequency in each rhythm, interhemispheric asymmetry coefficients, and indices and power indices of general spectrum ranges. Conclusions. The differences in brain bioelectrical activity revealed by EEG data between patients with or without H. pylori in their microbiome suggest potential pathophysiological significance of H. pylori in somatoneurological interactions in cases of DU.","PeriodicalId":296251,"journal":{"name":"Ukrainian Neurological Journal","volume":"56 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139262310","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}
I. Kuchyn, D. Govsieiev, R. Gybalo, H. I. Posternak
In patients with mine blast wounds, chronic pain is observed in an average of 83.3 % of cases, and it has been found that this is influenced by the number of anatomical body parts injured. For patients who sustained injuries in 1 or 2 anatomical body parts, the frequency of pain chronicity is 82.2 %, while in individuals who suffered injuries in ≥ 3 anatomical body parts, it is 91.7%. Objective — to investigate the presence of a neuropathic component of pain in patients with mine blast wounds and its impact on the frequency of pain chronicity. Materials and methods. The results of the treatment of 280 patients who suffered blast injuries during combat operations were analyzed. Since the number of anatomically affected body regions affects pain chronicization, patients were allocated into two groups: Group 1 included 169 patients with injuries in 1 or 2 anatomical body regions, and Group 2 included 111 patients with injuries in more than 2 anatomical regions. The Douleur Neuropathique 4 questions questionnaire was used to diagnose neuropathic pain. Results. Data from the Douleur Neuropathique 4 questions diagnostic questionnaire indicate that all patients had a neuropathic component of pain (4—6 points). There was no statistically significant difference at all stages of treatment: in military mobile hospitals (p = 0.911), in military medical clinical centers (p = 0.771), at the time of discharge from inpatient treatment (p = 0.931), one month after discharge (p = 0.949), three months after discharge (p = 0.931), six months after discharge (p = 0.927), and twelve months after discharge (p = 0.842). Conclusions. Patients who received mine blast wounds have a high frequency of chronic pain. The risk of chronicity is influenced by the neuropathic component of pain, which was present in all patients in this category, as indicated by the data from the Douleur Neuropathique 4 questions diagnostic questionnaire.
{"title":"Neuropathic component of pain in patients with mine blast wounds","authors":"I. Kuchyn, D. Govsieiev, R. Gybalo, H. I. Posternak","doi":"10.30978/unj2023-1-4-56","DOIUrl":"https://doi.org/10.30978/unj2023-1-4-56","url":null,"abstract":"In patients with mine blast wounds, chronic pain is observed in an average of 83.3 % of cases, and it has been found that this is influenced by the number of anatomical body parts injured. For patients who sustained injuries in 1 or 2 anatomical body parts, the frequency of pain chronicity is 82.2 %, while in individuals who suffered injuries in ≥ 3 anatomical body parts, it is 91.7%. Objective — to investigate the presence of a neuropathic component of pain in patients with mine blast wounds and its impact on the frequency of pain chronicity. Materials and methods. The results of the treatment of 280 patients who suffered blast injuries during combat operations were analyzed. Since the number of anatomically affected body regions affects pain chronicization, patients were allocated into two groups: Group 1 included 169 patients with injuries in 1 or 2 anatomical body regions, and Group 2 included 111 patients with injuries in more than 2 anatomical regions. The Douleur Neuropathique 4 questions questionnaire was used to diagnose neuropathic pain. Results. Data from the Douleur Neuropathique 4 questions diagnostic questionnaire indicate that all patients had a neuropathic component of pain (4—6 points). There was no statistically significant difference at all stages of treatment: in military mobile hospitals (p = 0.911), in military medical clinical centers (p = 0.771), at the time of discharge from inpatient treatment (p = 0.931), one month after discharge (p = 0.949), three months after discharge (p = 0.931), six months after discharge (p = 0.927), and twelve months after discharge (p = 0.842). Conclusions. Patients who received mine blast wounds have a high frequency of chronic pain. The risk of chronicity is influenced by the neuropathic component of pain, which was present in all patients in this category, as indicated by the data from the Douleur Neuropathique 4 questions diagnostic questionnaire.","PeriodicalId":296251,"journal":{"name":"Ukrainian Neurological Journal","volume":"12 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139261744","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}
Objective — to assess the diagnostic value of ultrasound screening in small vessel disease. Materials and methods. The study was carried out on the clinical bases of the Department of Therapeutic Disciplines of Black Sea National University named after Petro Mohyla (Odesa, Mykolaiv) from 2020 to 2022. A high-field 1.5 T MRI (Siemens Symphony, Germany) was used for verification. The presence of focal brain white matter lesions was assessed on axial T2-weighted and FLAIR sequences using the Fazekas, Scheltens, and Koedam scales. Cognitive functions were assessed using the MMSE scale. All patients underwent Doppler imaging of cerebral vessels using a Toshiba Aplio 500 device (Japan). As a control, 30 individuals of the same age without signs of SVD were examined. Statistical processing was carried out using methods of dispersion and correlation analysis with Statistica 14.0 software (TIBCO, USA). Results. All patients in the main group exhibited a moderate decrease in cognitive abilities, with an MMSE score of (23.5 ± 0.4) points (in the control group — (26.7 ± 0.5) points, p < 0.05). When evaluating the results of the MRI study, phenomena of leukoencephalopathy were observed in all patients. In 9 (19.6 %) patients, stage I according to Fazekas was determined, in 22 (47.8 %) — stage II, and in 15 (32.6 %) — stage III according to Fazekas. For comparison, in the control group, only 4 (13.3 %) had minimal signs of leukoencephalopathy (grade I according to Fazekas). Atrophy of the temporal cortex of the 1st degree according to Scheltens was detected in 14 (30.4 %) patients in the main group, and atrophy of the parietal cortex of the 1st degree according to Koedam was observed in 8 (17.4 %). During ultrasound examination, signs of subclinical carotid artery lesions were found in 28 (69.9 %) patients with SVD and in 5 (16.7 %) individuals in the control group. When assessing the blood flow in the middle cerebral artery of all patients with SVD, an increase in the Gosling index to 1.15 ± 0.03 and Pourcelot index to 0.66 ± 0.03 was observed. The value of the pulsatility index correlated with the degree of damage according to Fazekas (r = 0.68) and age (r = 0.71), and to a lesser extent with the severity of atrophy of the temporal and parietal cortex (r = 0.35 and r = 0.33). In the control group, the average values of the pulsatility index were 0.79 ± 0.03 (p < 0.001), and the resistance index was 0.57 ± 0.03. When assessing the diagnostic value of the Dopplerometric method, it was established that its sensitivity is 0.96, and specificity is 0.85 (J = 0.81). Conclusions. Cerebral vascular Doppler ultrasound has a high diagnostic value for detecting diseases of small vessels and can be used to select candidates for neuroimaging verification of SVD.
{"title":"The role of ultrasound screening in the diagnosis of small vessel disease","authors":"D. Khramtsov, M. Vikarenko","doi":"10.30978/unj2023-1-4-60","DOIUrl":"https://doi.org/10.30978/unj2023-1-4-60","url":null,"abstract":"Objective — to assess the diagnostic value of ultrasound screening in small vessel disease. Materials and methods. The study was carried out on the clinical bases of the Department of Therapeutic Disciplines of Black Sea National University named after Petro Mohyla (Odesa, Mykolaiv) from 2020 to 2022. A high-field 1.5 T MRI (Siemens Symphony, Germany) was used for verification. The presence of focal brain white matter lesions was assessed on axial T2-weighted and FLAIR sequences using the Fazekas, Scheltens, and Koedam scales. Cognitive functions were assessed using the MMSE scale. All patients underwent Doppler imaging of cerebral vessels using a Toshiba Aplio 500 device (Japan). As a control, 30 individuals of the same age without signs of SVD were examined. Statistical processing was carried out using methods of dispersion and correlation analysis with Statistica 14.0 software (TIBCO, USA). Results. All patients in the main group exhibited a moderate decrease in cognitive abilities, with an MMSE score of (23.5 ± 0.4) points (in the control group — (26.7 ± 0.5) points, p < 0.05). When evaluating the results of the MRI study, phenomena of leukoencephalopathy were observed in all patients. In 9 (19.6 %) patients, stage I according to Fazekas was determined, in 22 (47.8 %) — stage II, and in 15 (32.6 %) — stage III according to Fazekas. For comparison, in the control group, only 4 (13.3 %) had minimal signs of leukoencephalopathy (grade I according to Fazekas). Atrophy of the temporal cortex of the 1st degree according to Scheltens was detected in 14 (30.4 %) patients in the main group, and atrophy of the parietal cortex of the 1st degree according to Koedam was observed in 8 (17.4 %). During ultrasound examination, signs of subclinical carotid artery lesions were found in 28 (69.9 %) patients with SVD and in 5 (16.7 %) individuals in the control group. When assessing the blood flow in the middle cerebral artery of all patients with SVD, an increase in the Gosling index to 1.15 ± 0.03 and Pourcelot index to 0.66 ± 0.03 was observed. The value of the pulsatility index correlated with the degree of damage according to Fazekas (r = 0.68) and age (r = 0.71), and to a lesser extent with the severity of atrophy of the temporal and parietal cortex (r = 0.35 and r = 0.33). In the control group, the average values of the pulsatility index were 0.79 ± 0.03 (p < 0.001), and the resistance index was 0.57 ± 0.03. When assessing the diagnostic value of the Dopplerometric method, it was established that its sensitivity is 0.96, and specificity is 0.85 (J = 0.81). Conclusions. Cerebral vascular Doppler ultrasound has a high diagnostic value for detecting diseases of small vessels and can be used to select candidates for neuroimaging verification of SVD.","PeriodicalId":296251,"journal":{"name":"Ukrainian Neurological Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139262394","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}
Cerebral stroke remains a major medical and social problem in Ukraine and worldwide, associated with a high incidence of morbidity, disability and mortality. In the structure of total cardiovascular mortality in our country, it ranks second after myocardial infarction. Objective — to investigate blood pressure fluctuations during the acute period of ischaemic stroke. Materials and methods. We monitored daily blood pressure fluctuations during the acute period of ischaemic stroke (IS) in 240 patients, including 140 men and 100 women aged 60 to 80 years. In 36 patients, the stroke was recurrent. Statistical processing of blood pressure monitoring was performed. Results. It has been established that in the first day of IS, regular blood pressure measurement is necessary, preferably by daily blood pressure monitoring. The frequency of measurement is determined by the severity of the patient and the level of blood pressure. On average, every 15 min for the first 2 hours, every 30 min for the next 6 hours, and then every hour for up to a day. We have established that an increase in blood pressure (systolic to 140—180 mm Hg) on the first day of IS has a relatively good prognosis in terms of recovery from the disease. It should be noted that in patients with IS and blood pressure of 140/90 mm Hg, the prognosis was worse. In addition, an increase in blood pressure of more than 180/100 mm Hg in patients with IS is also associated with a worse prognosis of neurological recovery than a moderate increase. At the same time, an increase in blood pressure for every 10 mm Hg (above 180 mm Hg) is associated with a 39 % risk of increased neurological deficit and a 22 % risk of poor recovery. Conclusions. Arterial hypertension in the majority of patients with acuteonset IS is associated with a reaction to the disease, hospitalisation (emotional stress), increased intracranial pressure, and an adaptive response to cerebral ischaemia. The use of antihypertensive drugs is indicated only in the case of excessively high blood pressure and in cases where patients are indicated to lower blood pressure (thrombolysis is planned).
脑中风仍然是乌克兰乃至全世界的一个重大医疗和社会问题，发病率、致残率和死亡率都很高。在我国心血管疾病总死亡率结构中，脑卒中仅次于心肌梗死，位居第二。 目的--研究缺血性中风急性期的血压波动。材料和方法。我们监测了 240 名缺血性中风（IS）患者急性期的每日血压波动，其中包括 140 名男性和 100 名女性，年龄在 60 至 80 岁之间。其中 36 名患者为复发性中风。我们对血压监测结果进行了统计处理。结果显示已经确定，在 IS 的第一天，必须定期测量血压，最好是每天监测血压。测量频率取决于患者的严重程度和血压水平。平均而言，最初 2 小时内每 15 分钟测量一次，随后 6 小时内每 30 分钟测量一次，然后每小时测量一次，直至一天。我们已经确定，IS 第一天血压升高（收缩压升至 140-180 毫米汞柱）对疾病的恢复有相对较好的预后。值得注意的是，血压为 140/90 mm Hg 的 IS 患者预后较差。此外，IS 患者血压升高超过 180/100 mm Hg 时，神经功能恢复的预后也比中度升高时差。同时，血压每升高 10 mm Hg（超过 180 mm Hg），神经功能缺损的风险就增加 39%，恢复不良的风险增加 22%。结论大多数急性IS患者的动脉高血压与疾病反应、住院（情绪紧张）、颅内压升高以及对脑缺血的适应性反应有关。只有在血压过高和患者有降压指征（计划溶栓）的情况下，才需要使用降压药。
{"title":"The importance of blood pressure control in patients with ischaemic stroke in the acute period","authors":"I. Zozulya, A. Volosovets, A. Zozulya","doi":"10.30978/unj2023-1-4-64","DOIUrl":"https://doi.org/10.30978/unj2023-1-4-64","url":null,"abstract":"Cerebral stroke remains a major medical and social problem in Ukraine and worldwide, associated with a high incidence of morbidity, disability and mortality. In the structure of total cardiovascular mortality in our country, it ranks second after myocardial infarction. Objective — to investigate blood pressure fluctuations during the acute period of ischaemic stroke. Materials and methods. We monitored daily blood pressure fluctuations during the acute period of ischaemic stroke (IS) in 240 patients, including 140 men and 100 women aged 60 to 80 years. In 36 patients, the stroke was recurrent. Statistical processing of blood pressure monitoring was performed. Results. It has been established that in the first day of IS, regular blood pressure measurement is necessary, preferably by daily blood pressure monitoring. The frequency of measurement is determined by the severity of the patient and the level of blood pressure. On average, every 15 min for the first 2 hours, every 30 min for the next 6 hours, and then every hour for up to a day. We have established that an increase in blood pressure (systolic to 140—180 mm Hg) on the first day of IS has a relatively good prognosis in terms of recovery from the disease. It should be noted that in patients with IS and blood pressure of 140/90 mm Hg, the prognosis was worse. In addition, an increase in blood pressure of more than 180/100 mm Hg in patients with IS is also associated with a worse prognosis of neurological recovery than a moderate increase. At the same time, an increase in blood pressure for every 10 mm Hg (above 180 mm Hg) is associated with a 39 % risk of increased neurological deficit and a 22 % risk of poor recovery. Conclusions. Arterial hypertension in the majority of patients with acuteonset IS is associated with a reaction to the disease, hospitalisation (emotional stress), increased intracranial pressure, and an adaptive response to cerebral ischaemia. The use of antihypertensive drugs is indicated only in the case of excessively high blood pressure and in cases where patients are indicated to lower blood pressure (thrombolysis is planned).","PeriodicalId":296251,"journal":{"name":"Ukrainian Neurological Journal","volume":"36 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139262404","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}
Cerebral strokes rank fourth in the global burden of diseases. The prevalence of strokes is significantly higher in areas affected by military conflicts. Recent research results indicate that individuals residing in such zones have an increased risk of cardiovascular diseases and strokes, even years after the conclusion of these conflicts.A scientific analysis of sources regarding the prevalence, mortality, risk factors, and the course of cerebral strokes during global military events has been conducted. Bibliosemantic and analytical research methods were employed. This study demonstrates that strokes of the cerebral cortex remain a pressing global medical and social issue. Military events in many countries lead to an escalation in stroke incidence and mortality. This increase includes both known medical and non-medical risk factors for strokes, as well as the emergence of new significant causes. Notably, wartime hypertension, as a variant of stress-induced hypertension, has gained particular importance. Stress serves as its key etiological factor, setting in motion a cascade of pathogenetic mechanisms leading to the development and progression of these conditions. This type of hypertension is frequently associated with post-traumatic stress disorders, affecting not only military personnel but also civilian populations. During wartime, there is also a considerable rise in alcohol and tobacco consumption. Additionally, aside from the primary risk factors, stroke triggers such as anger, drug use, extended working hours, depression, psychosocial stress, and sleep disorders expedite the development and progression of the disease. Even years after the cessation of war, individuals who have experienced it are at a higher risk of ischemic heart disease, cardiopathies, strokes, and diabetes. This necessitates special attention from healthcare professionals working in the field of health care during and after conflicts.For Ukraine, it is promising to study and predict the main trends in morbidity and mortality from cerebral strokes during times of martial law, including an analysis of the risk factors for the disease and their impact on the outcome.
{"title":"Analysis of the impact of war events on stroke and the risk factors of their development (review)","authors":"S.–M.S. Okunieva, M. Prokopiv","doi":"10.30978/unj2023-1-4-10","DOIUrl":"https://doi.org/10.30978/unj2023-1-4-10","url":null,"abstract":"Cerebral strokes rank fourth in the global burden of diseases. The prevalence of strokes is significantly higher in areas affected by military conflicts. Recent research results indicate that individuals residing in such zones have an increased risk of cardiovascular diseases and strokes, even years after the conclusion of these conflicts.A scientific analysis of sources regarding the prevalence, mortality, risk factors, and the course of cerebral strokes during global military events has been conducted. Bibliosemantic and analytical research methods were employed. This study demonstrates that strokes of the cerebral cortex remain a pressing global medical and social issue. Military events in many countries lead to an escalation in stroke incidence and mortality. This increase includes both known medical and non-medical risk factors for strokes, as well as the emergence of new significant causes. Notably, wartime hypertension, as a variant of stress-induced hypertension, has gained particular importance. Stress serves as its key etiological factor, setting in motion a cascade of pathogenetic mechanisms leading to the development and progression of these conditions. This type of hypertension is frequently associated with post-traumatic stress disorders, affecting not only military personnel but also civilian populations. During wartime, there is also a considerable rise in alcohol and tobacco consumption. Additionally, aside from the primary risk factors, stroke triggers such as anger, drug use, extended working hours, depression, psychosocial stress, and sleep disorders expedite the development and progression of the disease. Even years after the cessation of war, individuals who have experienced it are at a higher risk of ischemic heart disease, cardiopathies, strokes, and diabetes. This necessitates special attention from healthcare professionals working in the field of health care during and after conflicts.For Ukraine, it is promising to study and predict the main trends in morbidity and mortality from cerebral strokes during times of martial law, including an analysis of the risk factors for the disease and their impact on the outcome.","PeriodicalId":296251,"journal":{"name":"Ukrainian Neurological Journal","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139281040","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}
Acute cerebrovascular disorder remains one of the main causes of disability and death of the population in developed countries. Among acute cerebrovascular disorders, the ischemic type (approximately 80 % of all cases) is more common than the hemorrhagic type (including intracerebral and subarachnoid hemorrhage). Traditionally, among the risk factors for the development of acute cerebrovascular disorders, we distinguish non-modified factors (age, sex, hereditary predisposition to acute cerebrovascular disorders, congenital heart defects) and modified factors (arterial hypertension, diabetes, hematocrit level, low-density lipoprotein, and cholesterol levels in the blood). However, there is a separate category of risk factors, namely, non-heritable pathology that leads to the development of acute cerebrovascular disorders. This category includes diseases such as primary angiitis of the central nervous system, Sneddon’s syndrome, reversible cerebral vasoconstriction syndrome, Susac’s syndrome, Takotsubo syndrome, and Moyamoya angiopathy. These pathological conditions are characterized by damage to cerebral vessels of different calibers, accompanied by a variety of clinical manifestations (ranging from skin rash and abnormalities in cardiac chambers to mental disorders). These pathological conditions can mimic other diseases, making it challenging to establish a correct diagnosis and provide appropriate treatment to such patients. The diagnosis of these disorders is quite complex and requires the use of neuroimaging methods and, in some cases, a multidisciplinary approach. It is believed that by understanding and recognizing the non-heritable risk factors, we will be able to prevent a significant percentage of acute cerebrovascular disorders in the population and provide timely assistance in case of their occurrence.
{"title":"Rare non-heritable causes of acute cerebrovascular disorders","authors":"О.О. Kopchak, T. Odintsova","doi":"10.30978/unj2023-1-4-22","DOIUrl":"https://doi.org/10.30978/unj2023-1-4-22","url":null,"abstract":"Acute cerebrovascular disorder remains one of the main causes of disability and death of the population in developed countries. Among acute cerebrovascular disorders, the ischemic type (approximately 80 % of all cases) is more common than the hemorrhagic type (including intracerebral and subarachnoid hemorrhage). Traditionally, among the risk factors for the development of acute cerebrovascular disorders, we distinguish non-modified factors (age, sex, hereditary predisposition to acute cerebrovascular disorders, congenital heart defects) and modified factors (arterial hypertension, diabetes, hematocrit level, low-density lipoprotein, and cholesterol levels in the blood). However, there is a separate category of risk factors, namely, non-heritable pathology that leads to the development of acute cerebrovascular disorders. This category includes diseases such as primary angiitis of the central nervous system, Sneddon’s syndrome, reversible cerebral vasoconstriction syndrome, Susac’s syndrome, Takotsubo syndrome, and Moyamoya angiopathy. These pathological conditions are characterized by damage to cerebral vessels of different calibers, accompanied by a variety of clinical manifestations (ranging from skin rash and abnormalities in cardiac chambers to mental disorders). These pathological conditions can mimic other diseases, making it challenging to establish a correct diagnosis and provide appropriate treatment to such patients. The diagnosis of these disorders is quite complex and requires the use of neuroimaging methods and, in some cases, a multidisciplinary approach. It is believed that by understanding and recognizing the non-heritable risk factors, we will be able to prevent a significant percentage of acute cerebrovascular disorders in the population and provide timely assistance in case of their occurrence.","PeriodicalId":296251,"journal":{"name":"Ukrainian Neurological Journal","volume":"182 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139280756","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}
Multiple sclerosis is a chronic demyelinating disease of the central nervous system, accompanied by a disruption of the blood-brain barrier, the development of neuroinflammation, demyelination, and neurodegeneration. The coronavirus infection pandemic can manifest symptoms affecting the nervous system and exacerbate existing neurological pathology. The SARS-CoV-2 virus disrupts the integrity of the blood-brain barrier through the massive release of cytokines and proteases, activating microglia and oligodendrocytes, which initiate neuroinflammatory and neurodegenerative processes. Experimental studies have demonstrated that coronaviruses can lead to demyelination and provoke exacerbations of multiple sclerosis in affected women. Dysfunction of cerebral endothelium and platelet activation plays a crucial role both in the pathophysiology of multiple sclerosis and coronavirus infection, linking disorders of the primary hemostasis system with neuroinflammation. A close connection has been established between coagulation, inflammation, and immune reactions that occur within the vascular system. There is a hypothesis that coagulation activation at the neurovascular level may contribute to the emergence and maintenance of inflammatory reactions characteristic of multiple sclerosis pathogenesis. This occurs as a result of fibrinogen penetration through the compromised blood-brain barrier, which correlates with areas of axonal damage and results in the unwanted activation of microglia and macrophages, intensifying neuroinflammation. Dysfunction of the hemostasis system in patients with multiple sclerosis and COVID-19 can lead to a worsening of the disease course, deterioration of neurological status, and unsatisfactory treatment outcomes.
{"title":"Dysfunction of the hemostasis systemin patients with multiple sclerosis and coronavirus infection","authors":"V.S. Melnyk, S.M. Sholomon","doi":"10.30978/unj2023-1-4-5","DOIUrl":"https://doi.org/10.30978/unj2023-1-4-5","url":null,"abstract":"Multiple sclerosis is a chronic demyelinating disease of the central nervous system, accompanied by a disruption of the blood-brain barrier, the development of neuroinflammation, demyelination, and neurodegeneration. The coronavirus infection pandemic can manifest symptoms affecting the nervous system and exacerbate existing neurological pathology. The SARS-CoV-2 virus disrupts the integrity of the blood-brain barrier through the massive release of cytokines and proteases, activating microglia and oligodendrocytes, which initiate neuroinflammatory and neurodegenerative processes. Experimental studies have demonstrated that coronaviruses can lead to demyelination and provoke exacerbations of multiple sclerosis in affected women. Dysfunction of cerebral endothelium and platelet activation plays a crucial role both in the pathophysiology of multiple sclerosis and coronavirus infection, linking disorders of the primary hemostasis system with neuroinflammation. A close connection has been established between coagulation, inflammation, and immune reactions that occur within the vascular system. There is a hypothesis that coagulation activation at the neurovascular level may contribute to the emergence and maintenance of inflammatory reactions characteristic of multiple sclerosis pathogenesis. This occurs as a result of fibrinogen penetration through the compromised blood-brain barrier, which correlates with areas of axonal damage and results in the unwanted activation of microglia and macrophages, intensifying neuroinflammation. Dysfunction of the hemostasis system in patients with multiple sclerosis and COVID-19 can lead to a worsening of the disease course, deterioration of neurological status, and unsatisfactory treatment outcomes.","PeriodicalId":296251,"journal":{"name":"Ukrainian Neurological Journal","volume":"13 21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139280908","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}
This review examines the pathogenetic mechanisms of nervous system damage in patients with chronic cerebral ischemia and COVID-19. It is believed that in cases of coronavirus disease, nervous system damage can occur due to various reasons: direct viral invasion, excessive activation of the immune response (cytokine storm), and the development of systemic hypoxemia. The affinity of SARS-CoV-2 for ACE2 receptors also leads to direct damage to intracranial arteries. These processes are accompanied by changes in blood coagulation/anticoagulation systems, significantly impacting the pathogenesis of both diseases. Due to the activation of pro-inflammatory cytokines and endothelial dysfunction, there is increased permeability of the blood-brain barrier (BBB), leading to the migration of T-lymphocytes and inflammatory mediators into the interstitial space of the brain. The immune-mediated inflammatory reaction leads to the formation of subcortical demyelination and the activation of astrocytes. Fibrinogen, transforming into fibrin, enters the central nervous system, activating local inflammation processes, blocking the maturation of oligodendrocytes, disrupting myelinogenesis, and promoting the formation of beta-amyloid plaques. The existing state of hypercoagulation increases the risk of developing ischemic foci in the brain in patients with COVID-19. Simultaneously, the activation of the fibrinolysis system occurs, with increased levels of type 1 tissue plasminogen activator (PAI-1), a key marker of endothelial dysfunction, and a factor regulating fibrinolysis.Targeted inhibition of PAI-1 may hold promise as a new therapeutic strategy to improve treatment outcomes and prevent complications from the nervous system.
{"title":"Alterations in the fibrinolysis system and plasma cytokine profile following COVID-19 in patients with chronic cerebral ischemia","authors":"V.S. Melnyk, M.O. Mykhailichenko","doi":"10.30978/unj2023-1-4-17","DOIUrl":"https://doi.org/10.30978/unj2023-1-4-17","url":null,"abstract":"This review examines the pathogenetic mechanisms of nervous system damage in patients with chronic cerebral ischemia and COVID-19. It is believed that in cases of coronavirus disease, nervous system damage can occur due to various reasons: direct viral invasion, excessive activation of the immune response (cytokine storm), and the development of systemic hypoxemia. The affinity of SARS-CoV-2 for ACE2 receptors also leads to direct damage to intracranial arteries. These processes are accompanied by changes in blood coagulation/anticoagulation systems, significantly impacting the pathogenesis of both diseases. Due to the activation of pro-inflammatory cytokines and endothelial dysfunction, there is increased permeability of the blood-brain barrier (BBB), leading to the migration of T-lymphocytes and inflammatory mediators into the interstitial space of the brain. The immune-mediated inflammatory reaction leads to the formation of subcortical demyelination and the activation of astrocytes. Fibrinogen, transforming into fibrin, enters the central nervous system, activating local inflammation processes, blocking the maturation of oligodendrocytes, disrupting myelinogenesis, and promoting the formation of beta-amyloid plaques. The existing state of hypercoagulation increases the risk of developing ischemic foci in the brain in patients with COVID-19. Simultaneously, the activation of the fibrinolysis system occurs, with increased levels of type 1 tissue plasminogen activator (PAI-1), a key marker of endothelial dysfunction, and a factor regulating fibrinolysis.Targeted inhibition of PAI-1 may hold promise as a new therapeutic strategy to improve treatment outcomes and prevent complications from the nervous system.","PeriodicalId":296251,"journal":{"name":"Ukrainian Neurological Journal","volume":"73 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139280716","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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