The role of oxidative stress in the development of vascular cognitive disorders
Author:
A.N. BOGOLEPOVA
Pirogov Russian National Research Medical University, Moscow, Russia;
Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
Summary:
Vascular cognitive impairment (VCI) is one of the most serious problems of clinical neurology, being the second most common cause of dementia. VCI covers a range of disorders in which vascular factors cause or contribute to cognitive decline. Among the main risk factors for VCI are old age and vascular factors, which lead to endothelial dysfunction and damage, which, in turn, can cause neurovascular dysfunction, increased permeability of the blood-brain barrier, and microvascular thrombosis. Oxidative stress is one of the most important mechanisms for the development of VCI that indicates the need for the use of agents with antioxidant activity. One of these drugs is ethylmethylhydroxypyridine succinate (mexidol). Mexidol is a drug with marked antioxidant and antihypoxic activities. The clinical efficacy of mexidol in relation to VCI has been demonstrated in many studies. Keywords: chronic cerebrovascular insufficiency, oxidative stress, vascular cognitive impairment, endothelial dysfunction, mexidol.
Mexidol® and Mexidol® FORTE 250 in consecutive therapy of cognitive disorders in comorbid patients with joint pathology on the background of arterial hypertension and ischemic heart disease
Author:
L.N. ELISEEVA, S.V. KARTASHOVA
Kuban State Medical University of the Ministry of Healthcare of Russia, Krasnodar
Summary:
The aim of the study was to assess the efficacy, safety and possibility of correcting the neuropsychiatric manifestations of chronic cerebral ischemia (CCI) by Mexidol® on the background of arterial hypertension (AH), atherosclerosis (IHD), osteoarthritis (OA) or rheumatoid arthritis (RA). Material and methods. We examined 134 patients 45–75 years old with neurovizualized CCI, combined with hypertension, coronary artery disease, and joints pathology. Group 1 (observation) included 79 patients – 30 patients with RA (subgroup 1А) and 49 patients with OA of knee joints (subgroup 1B), who got Mexidol® in their complex therapy. Group 2 (control) consisted of 30 patients – 25 patients with RA (subgroup 2A) and patients with OA (subgroup 2B), who got basic therapy without Mexidol® addition. The dynamics of subjective and physical symptoms, values on the CGI, MoCA, MFI 20 scales, anxiety and depression scales of Hamilton and Tinnetti were estimated. Mexidol® was administered intravenously (500 mg per day) for 14 days, followed by oral administration of Mexidol® FORTE 250 by 250 mg 3 times/day for another 60 days. Results. On the background of constant standard complex therapy, an increasing improvement was revealed in all studied indexes in cases of additional use of Mexidol®. In control groups, the cognitive status did not change. The use of initiating intravenous therapy with Mexidol® increased the adherence of patients to long-term use of the drug. Conclusion. Locomotor dysfunctions in polymorbid patients are partially associated with CCI. The additional appointment of sequential infusion and tablet forms of Mexidol® significantly improves cognitive functions with the correction of walking stability, asthenic manifestations, and increases motivation for active life. Key words: chronic cerebral ischemia, Mexidol®, osteoarthritis, rheumatoid arthritis, arterial hypertension, ischemic heart disease.
Mexidol® and Mexidol® FORTE 250 in consecutive therapy of cognitive disorders in comorbid patients with joint pathology on the background of arterial hypertension and ischemic heart disease
Author:
L.N. ELISEEVA, S.V. KARTASHOVA
Kuban State Medical University of the Ministry of Healthcare of Russia, Krasnodar
Summary:
The aim of the study was to assess the efficacy, safety and possibility of correcting the neuropsychiatric manifestations of chronic cerebral ischemia (CCI) by Mexidol® on the background of arterial hypertension (AH), atherosclerosis (IHD), osteoarthritis (OA) or rheumatoid arthritis (RA). Material and methods. We examined 134 patients 45–75 years old with neurovizualized CCI, combined with hypertension, coronary artery disease, and joints pathology. Group 1 (observation) included 79 patients – 30 patients with RA (subgroup 1А) and 49 patients with OA of knee joints (subgroup 1B), who got Mexidol® in their complex therapy. Group 2 (control) consisted of 30 patients – 25 patients with RA (subgroup 2A) and patients with OA (subgroup 2B), who got basic therapy without Mexidol® addition. The dynamics of subjective and physical symptoms, values on the CGI, MoCA, MFI 20 scales, anxiety and depression scales of Hamilton and Tinnetti were estimated. Mexidol® was administered intravenously (500 mg per day) for 14 days, followed by oral administration of Mexidol® FORTE 250 by 250 mg 3 times/day for another 60 days. Results. On the background of constant standard complex therapy, an increasing improvement was revealed in all studied indexes in cases of additional use of Mexidol®. In control groups, the cognitive status did not change. The use of initiating intravenous therapy with Mexidol® increased the adherence of patients to long-term use of the drug. Conclusion. Locomotor dysfunctions in polymorbid patients are partially associated with CCI. The additional appointment of sequential infusion and tablet forms of Mexidol® significantly improves cognitive functions with the correction of walking stability, asthenic manifestations, and increases motivation for active life. Key words: chronic cerebral ischemia, Mexidol®, osteoarthritis, rheumatoid arthritis, arterial hypertension, ischemic heart disease.
Role of free radical oxidation, hypoxia and their correction in COVID-19 pathogenesis
This article is in "Library" section.
Author:
A.V. SCHULKIN, A.A. FILIMONOVA
Academician I.P. Pavlov Ryazan State Medical University of the Ministry of Healthcare of Russia
Antioxidants/antihypoxants: the missing puzzle piece in effective pathogenetic therapy for COVID-19
This article is in "Library" section.
Author:
T.A. VORONINA
V.V.Zakusov Research Institute of Pharmacology, Moscow, Russian Federation
The role of oxidative stress in the development of vascular cognitive disorders
This article is in "Library" section.
Author:
A.N. BOGOLEPOVA
Pirogov Russian National Research Medical University, Moscow, Russia;
Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
Mexidol® and Mexidol® FORTE 250 in consecutive therapy of cognitive disorders in comorbid patients with joint pathology on the background of arterial hypertension and ischemic heart disease
This article is in "Library" section.
Author:
L.N. ELISEEVA, S.V. KARTASHOVA
Kuban State Medical University of the Ministry of Healthcare of Russia, Krasnodar
The theses of the study confirming the antioxidant properties of Mexidol® are accepted by the European Society of Cardiology (ESC)
The results of the study of the effect of Mexidol® (2-ethyl-6-methyl-3-hydroxypyridine succinate) on oxidative stress in patients with decompensated heart failure and cognitive impairment are published on the website of the European Society of Cardiology, https://www.escardio.org/Search/?q=Mexidol&filters:content_type=ESC365%20Presentation. The purpose of the study was to evaluate the effect of Mexidol® on the level of oxidative stress markers (malondialdehyde*, superoxide dismutase**, glutathione peroxidase***), plasma antioxidant activity in patients with decompensated heart failure and cognitive impairment. Oxidative stress markers were investigated at the beginning of therapy and after its completion. Patients treated with Mexidol® showed a significant decrease in the level of malondialdehyde - by 20.77% (p=0.02) and a significant increase - by 20.68% - in the level of glutathione peroxidase (p=0.04), as well as a tendency to increase the level of superoxide dismutase by 43.43% and plasma antioxidant activity by 42.69%.
Thus, the study showed a marked antioxidant effect of Mexidol® in patients with decompensated heart failure and cognitive impairment.
Note:
*Malondialdehyde is an endogenous aldehyde, which is a clinical and laboratory oxidative stress marker used to predict and control the treatment of a wide range of diseases, including heart failure.
**Superoxide dismutase is one of the main intracellular antioxidant protection enzymes catalyzing the decomposition of superoxide into oxygen and hydrogen peroxide. It takes an important part in the antioxidant protection of almost all cells.
***Glutathione peroxidase is one of the main intracellular antioxidant enzymes catalyzing restoration of lipid hydroperoxides into alcohols and restoration of hydrogen peroxide to the state of water.
Antioxidants used against viral infections
Escaping coronavirus infection is a question that arises with the awareness of the gravity of the global situation. These are social distance, hand hygiene, and immune system reinforcement that specialists can so far advise. Treatment of pneumonia that develops against the background of COVID-19 infection allows of various clinical and pharmacological approaches, including experimental ones.
One of the directions of respiratory viral infections control may be maintenance of metabolic processes in cells. Using antioxidants, doctors increase the cells protection against oxidative stress and help the cells to resist not only infections, but also heart disease, brain disease and even aging process. Science knows more than 400 types of antioxidants: from ascorbic acid to such antioxidants as Mexidol®, which is included in 38 major standards of medical care in Russia.
Results of a Randomized, Double-Blind, Multicenter, Placebo-Controlled, Parallel-Group Study of the Efficacy and Safety of Mexidol in Prolonged Sequential Therapy of Patients in the Acute and Early Recovery Stages of Hemispheric Stroke (the EPICA study)
Author:
L. V. Stakhovskaya1, N. A. Shamalov1, D. R. Khasanova2, E. V. Mel’nikova3, A. S. Agaf’ina4, K. V. Golikov5, E. I. Bogdanov6, A. A. Yakupova6, L. V. Roshkovskaya7, L. V. Lukinykh8, T. M. Lokshtanova9, I. E. Poverennova10, and L. A. Shchepankevich11
1 Research Institute of Cerebrovascular Pathology and Stroke, Pirogov Russian National Research Medical University, Russian Ministry of Health, Moscow, Russia; e-mail: lstakh@mail.ru.
2 Interregional Clinical Diagnostic Center, Kazan, Russia.
3 St. Petersburg City Clinical Hospital No. 26, St. Petersburg, Russia.
4 St. Petersburg City Clinical Hospital No. 40 of the Resort Administrative District, St. Petersburg, Russia.
5 St. Petersburg City General Hospital No. 2, St. Petersburg, Russia.
6 Kazan Sate Medical University, Russian Ministry of Health, Kazan, Russia.
7 Nikolaevskaya Hospital, St. Petersburg, Russia.
8 Vsevolzhsk Clinical Interregional Hospital, Leningradskaya Oblast, Russia.
9 Pirogov City Clinical Hospital No. 1, Samara, Russia.
10 Seredavin Samara Regional Clinical Hospital, Samara, Russia.
11 Research Institute of Experimental and Clinical Medicine, Novosibirsk, Russia.
Summary:
Objectives. To assess the effi cacy and safety of prolonged sequential therapy with Mexidol in patients with hemispheric ischemic stroke (IS) in the acute and early recovery phases. Materials and methods. A randomized, double-blind, multicenter, placebo-controlled, parallel-group study included 151 patients (62 men and 89 women) was performed in which 150 patients (62 men and 88 women) aged 40–79 years were randomized. Simple randomization was used to defi ne two groups: patients of group 1 received Mexidol therapy at a dose of 500 mg/day by intravenous infusion for 10 days followed by oral doses of 1 tablet (125 mg) three times a day for eight weeks. Patients of group 2 received placebo by the same protocol. The duration of involvement in the trial was 67–71 days. Results. At the end of treatment, mean scores on the modified Rankin scale (mRS) were lower in group 1 than group 2 (p = 0.04). Decreases in mean mRS scores (at visits 1–5) were more marked in group 1 (p = 0.023). The proportion of patients achieving recovery corresponding to 0–2 points on the mRS (at visit 5) was signifi cantly greater in group 1 (p = 0.039). Testing on the National Institutes of Health Stroke Scale at visit 5 gave a signifi cantly lower score in group 1 (p = 0.035). Decreases in scores on the National Institutes of Health Stroke Scale at the end of treatment relative to the baseline level in patients with diabetes mellitus were more marked in group 1 (p = 0.038). In group 1, the total population and the subpopulation of patients with diabetes mellitus showed more marked improvements in quality of life, which was apparent by visit 2. The proportion of patients without diffi culty mobilizing was signifi cantly greater in group 1 (p = 0.022). There were no signifi cant differences in the frequencies of adverse events in patients of the two groups. Conclusions. Use of Mexidol in the acute and early recovery phases of IS is recommended. Keywords: acute cerebrovascular accident, Mexidol, ethylmethylhydroxypyridine succinate, effi cacy and safety, ischemic stroke, acute phase, early recovery phase, EPICA.