Possibilities of improving the effectiveness of therapy in patients with chronic cerebral ischemia against the background of COVID-19
Author:
V.V. KOVALCHUK, I.I. ERSHOVA, N.V. MOLODOVSKAYA
Semashko City Hospital No. 38, St. Petersburg, Russia
Summary:
Objective. To study the possibility of improving the efficacy of treatment with mexidol in COVID‑19 patients with chronic cerebral ischemia (CCI). Material and methods. Three hundred and four patients with CCI and COVID‑19 were observed, group 1 (n=152) consisted of patients receiving basic therapy and mexidol, group 2 (n=152) received only basic therapy. Mexidol was administered intravenously for 14 days, 500 mg (10 ml) per 400 ml of saline solution, then Mexidol FORTE 250 was administered in a dose of 250 mg 3 times a day for 2 months. The state of cognitive functions (MoCA scale), sleep (Spiegel questionnaire), asthenia (MFI-20 scale), and quality of life (SIP questionnaire) were evaluated. Examinations were performed before treatment, 30 and 75 days after start of treatment. Results. In group 1, there was a more complete and earlier recovery of the state of cognitive functions (an increase in indicators on the MoCA scale, p<0.01), a regression of asthenia (p<0.05), and normalization of sleep (p<0.01). By the end of the study, there were significantly more patients in group 1 with complete or significant recovery of all quality of life indicators. Conclusion. Long-term sequential therapy with mexidol provides a more complete recovery of impaired functions in patients with CCI and COVID-19. Keywords: COVID-19, SARS-CoV-2, chronic cerebral ischemia, asthenia, cognitive disorders, dementia, quality of life, mexidol.
Antioxidants/antihypoxants: the missing puzzle piece in effective pathogenetic therapy for COVID-19
Author:
T.A. VORONINA
V.V.Zakusov Research Institute of Pharmacology, Moscow, Russian Federation
Summary:
This review focuses on the specific characteristics of COVID-19 disease, which leads not only to respiratory impairments (bronchoalveolar epithelium does not retain oxygen, etc.), but also decreases the level of hemoglobin and its ability to transfer oxygen to the organs and tissues and increases the level of heme, resulting in anoxemia, hypoxia in all organs and tissues, and oxidative stress. Mexidol, a drug developed in Russia, is widely used in clinical practice, including the treatment of diseases accompanied by ischemia and hypoxia. Mexidol has antihypoxic and antioxidant effects, can treat mitochondrial respiratory dysfunction, thereby affecting the key processes in different cells of organs and tissues that develop due to hypoxia. Mexidol can be useful in the comprehensive therapy of patients with COVID-19. Key words: COVID-19, antioxidant, antihypoxant, hemoglobin, hypoxia, Mexidol, mitochondrial dysfunction, oxidative stress.
Role of free radical oxidation, hypoxia and their correction in COVID-19 pathogenesis
Author:
A.V. SCHULKIN, A.A. FILIMONOVA
Academician I.P. Pavlov Ryazan State Medical University of the Ministry of Healthcare of Russia
Summary:
In following review, the pathogenesis of coronavirus disease of 2019 (COVID-19), the features of the SARS-CoV-2 virus, are shown in peculiarities. Due to big importance of oxidative stress and hypoxia in the development of this infection paid to, it has been suggested that the use of antioxidants and antihypoxants in the complex treatment of COVID-19 may be useful and significantly improve the course of the disease.
Key words: COVID-19, coronaviruses, oxidative stress, hypoxia.
Treatment of alcohol withdrawal syndrome
Author:
Y.P. SIVOLAP
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
Summary:
Alcohol withdrawal arises in result of long-lasting or short, but massive, alcohol abuse, manifests itself with oppressive symptoms and in some cases is complicated by seizures, hallucinosis and delirium tremens that may be life-threatening for patients. The leading neurochemical factors underlying alcohol withdrawal syndrome and its complications are lack of GABA and excessive glutamate activity, which is important for therapy choice. The first-line drugs in the treatment of alcohol withdrawal syndrome and alcoholic delirium are benzodiazepines, which have the maximum pharmacological similarity with ethanol. Other medications, including barbiturates, anticonvulsants, propofol, dexmedetomidine, and antipsychotics, may be used as alternatives to and in addition to benzodiazepines, especially in the case of protracted delirium with therapeutic resistance. Certain prospects in the treatment of alcohol withdrawal syndrome are associated with ethylmethylhydroxypyridine succinate, which is a bit similar to benzodiazepines in its pharmacology.
Keywords: alcohol use disorders, alcohol withdrawal syndrome, alcohol seizures, alcohol hallucinosis, delirium tremens, benzodiazepines.
Features of responding to stress of elderly patients with chronic brain ischemia
Author:
T.A. SLYUSAR, YU.V. ABRAMENKO, S.S. RUBINA, R.V. MAYOROV, I.N. SLYUSAR
Tver State Medical University, Tver, Russia
Summary:
The aim of the study. To study the peculiarities of responding to stress, the stress resistance and adaptation of older men and women with chronic brain ischemia, as well as the stressboard effect of Mexidol. Material and methods. 124 patients aged 60–74 years old are surveyed: 72 men and 52 women (average age, respectively, 65.3 ± 0.4 and 64.7 ± 0.7 years) with Chronic Brain Ischemia I–II stage against the background of arterial hypertension and its combinations with atherosclerosis of cerebral vessels. The level of psychosocial stress was determined on the Holmes-Ray scale. Features of the response of patients to stress was studied using the methodology Scale of Psychological Stress PSM‑25 and S. Rogenzweig. Stress resistance was investigated using S. Kuhlen's stress resistance self-resistant test and Villianson. The level of anxiety was determined using a scale of Ch. D. Spilberger and Yu. L. Khanin, depressed – backup questionnaire. The type of adaptation reactions was studied in the leukocyte blood formula on the percentage ratio of lymphocytes and segmented neutrophils, taking into account the representation of other formed elements. Results. The level of stress in older women with Chronic Brain Ischemia was higher than in men. The predominance of the intrinsic orientation of the reaction to stress and resolving the type of response to men, and the extrapunitive or self-defense type among women, which may indicate the largerness of the latter. The level of stress resistance was lower in women than in men, which correlated with higher indicators of situational anxiety. Adverse adaptation reactions were more often registered in women than in men. The course of treatment with Mexidol of elderly patients with chemical leads to a decrease in the severity of subjective and objective symptoms, alarming disorders, increases the stress resistance and adaptive capabilities of the body, which is confirmed by an increase in the number of persons with favorable adaptation reactions. The high efficiency and safety of sequential therapy with Mexidol (injections, then the tableted form of Mexidol Forte 250) is shown. Keywords: chronic brain ischemia, sex, stress, stress resistance, emotional disorders, anxiety, depression, Mexidol, adaptation reactions.
The efficacy of antioxidant treatment with mexidol forte in 250 patients with chronic cerebral venous insufficiency
Author:
E.I. CHUKANOVA, A.S. CHUKANOVA, KH.I. MAMAEVA
Pirogov Russian National Research Medical University, Moscow, Russia
Summary:
Objective. To study the efficacy and safety of complex treatment with 2-ethyl-3-hydroxy-6-methylpyridine (mexidol forte 250) and venotonic drugs L-lysine aescinat and diosmin/hesperidin in patients with chronic cerebral venous insufficiency (CCVI). Material and methods. One hundred and twenty CCVI patients with clinical and ultrasonic signs of cerebral venous discirculation were studied. Patients were stratified into group 1 (n=40) treated perorally with mexidol forte 250 and diosmin/hesperidin during 74 days in combination with two courses of L-lysine aescinat intravenously on the 1st and 30th days from baseline, group 2 (n=40) treated with mexidol forte 250 and diosmin/hesperidin during 74 days, group 3 (n=40) treated perorally with diosmin/hesperidin during 74 days. Results and conclusion. The efficacy and safety of the complex treatment of CCVI patients with venotonic drugs with the inclusion of mexidol forte 250 at a dose of 750 mg/day for 74 days is shown. The study demonstrates a significant positive effect of mexidol forte 250 on the dynamics of complaints and indicators of the neurological and psychoemotional status of patients. Monotherapy with the venotonic drug diosmin/hesperidin shows its insufficient efficacy. Keywords: chronic cerebral venous insufficiency, antioxidants, mexidol forte 250, venotonic drugs, L-lysine aescinat, diosmin/hesperidin.
Possibilities of improving the effectiveness of therapy in patients with chronic cerebral ischemia against the background of COVID-19
Author:
V.V. KOVALCHUK, I.I. ERSHOVA, N.V. MOLODOVSKAYA
Semashko City Hospital No. 38, St. Petersburg, Russia
Summary:
Objective. To study the possibility of improving the efficacy of treatment with mexidol in COVID‑19 patients with chronic cerebral ischemia (CCI). Material and methods. Three hundred and four patients with CCI and COVID‑19 were observed, group 1 (n=152) consisted of patients receiving basic therapy and mexidol, group 2 (n=152) received only basic therapy. Mexidol was administered intravenously for 14 days, 500 mg (10 ml) per 400 ml of saline solution, then Mexidol FORTE 250 was administered in a dose of 250 mg 3 times a day for 2 months. The state of cognitive functions (MoCA scale), sleep (Spiegel questionnaire), asthenia (MFI-20 scale), and quality of life (SIP questionnaire) were evaluated. Examinations were performed before treatment, 30 and 75 days after start of treatment. Results. In group 1, there was a more complete and earlier recovery of the state of cognitive functions (an increase in indicators on the MoCA scale, p<0.01), a regression of asthenia (p<0.05), and normalization of sleep (p<0.01). By the end of the study, there were significantly more patients in group 1 with complete or significant recovery of all quality of life indicators. Conclusion. Long-term sequential therapy with mexidol provides a more complete recovery of impaired functions in patients with CCI and COVID-19. Keywords: COVID-19, SARS-CoV-2, chronic cerebral ischemia, asthenia, cognitive disorders, dementia, quality of life, mexidol.
Role of antioxidant therapy in patients with moderate and severe COVID-19
Author:
E.K. SHAVAROVA1,2, E.R. CAZAKHMEDOV1, M.V. ALEKSEEVA1, L.G. EZHOVA2, Zh.D. KOBALAVA1
1Peoples' Friendship University of Russia (RUDN), Moscow, Russian Federation;
2V.V.Vinogradov City Clinical Hospital, Moscow Healthcare Department, Moscow, Russian Federation
Summary:
The coronavirus disease COVID-19 is characterized by high mortality and the lack of effective etiotropic therapy. Activation of oxidative stress may be one of the links in the pathogenesis of organ damage of this infection. Objective. To assess the ability of Mexidol® to influence the rate of clinical improvement in pneumonia caused by the SARSCoV-2 virus in hospitalized patients with the novel coronavirus disease COVID-19 and concomitant discirculatory encephalopathy. 62 patients over the age of 18 years with confirmed new coronavirus disease COVID-19 according to computed tomography (CT) of the lungs (stages CT1, CT2, CT3) and PCR of a swab from the nasopharynx and oropharynx for SARS-CoV-2 virus RNA were included. After randomization patients of group 1 received an infusion of Mexidol® at a dose of 1000 mg/day, patients of group 2 – an infusion of isotonic sodium chloride solution for 7 days. Compared with the control group, the patients receiving Mexidol® therapy showed a significantly more pronounced decrease in body temperature, a tendency towards a decrease in the severity of shortness of breath. In the Mexidol® group, the concentration of superoxidedismutase did not change, while in the control group there was a tendency to its decrease, C-reactive protein decreased 2.2 times more than in the control group (p = 0.09). There was a tendency for a more rapid decrease in ferritin in the active intervention group. Mexidol® therapy can have a positive effect on the clinical manifestations and severity of laboratory-inflammatory syndrome in patients with the new coronavirus disease COVID-19. Key words: coronavirus disease COVID-19, oxidative stress, Mexidol.
Effect of Mexidol on the quality of life and functional status of patients with chronic cerebral ischemia and chronic heart failure with reduced left ventricular ejection fraction
Author:
V.V. TOLKACHEVA1, E.R. KAZAKHMEDOV1, ZH.D. KOBALAVA1, S.A. GALOCHKIN1, A.V. SHCHULKIN2
1Peoples’ Friendship University of Russia, Moscow, Russia;
2Pavlov Ryazan State Medical University, Ryazan, Russia
Summary:
Objective. To study the effect of Mexidol on the functional state of myocardium, NT-proBNP level, exercise tolerance, quality of life, severity of oxidative stress, inflammatory response and endothelial dysfunction in patients with chronic brain ischemia and chronic heart failure NYHA class II-III in a 13-week sequential (intravenous and oral) therapy with Mexidol® and standard therapy. Material and methods. The study included 44 patients with chronic brain ischemia and chronic heart failure NYHA class II—III. Mean age was 65.5±11.8 years, men accounted 75%. The group of Mexidol + standard therapy of chronic heart failure included 21 patients, the group of standard therapy — 23 patients. Echocardiography parameters, exercise tolerance test (six minute walk test, SMWT), patient’s clinical condition according to SHOKS scale (modification by V. Yu. Mareev), NT-proBNP concentration, markers of oxidative stress (malonic dialdehyde (MDA), superoxide dismutase (SOD)), inflammatory reaction (C-reactive protein (CRP), tumor necrosis factor α (TNFα)), homocysteine and cystatin C were examined initially, after 7 days and 13 weeks. The quality of life was assessed initially and at the end of the study using the Minnesota Living With Heart Failure Questionnaire (MLHFQ) and the Kansas City Cardiomyopathy Questionnaire (KCCQ). Results. «Mexidol + standard therapy» group was characterized by more significant improvement in the quality of life, better SMWT data and SHOKS scores, significant decrease in end-diastolic and end systolic LV dimensions, as well as NT-proBNP level after 7 days and 13 weeks compared to the basic therapy group. Mexidol administration reduced MDA concentration and increased SOD activity after 7 days and 13 weeks. We also observed a significant decrease in CRP and TNFα levels after 7 days and 13 weeks in the same group. Less augmentation of homocysteine was revealed in the Mexidol therapy group. There were no significant between-group differences in cystatin C levels. Conclusion. Mexidol in addition to standard therapy of chronic brain ischemia and chronic heart failure class II-III has a favorable effect on the quality of life, functional status, improves clinical condition and intracardiac circulation, decreases concentration of NT-proBNP, promotes antioxidant activity, reduces inflammatory reaction, slows down increase of homocysteine and does not influence kidney function. Keywords: chronic brain ischemia, heart failure, quality of life, cognitive status, oxidative stress, ethyl-methyl-hydroxypyridine succinate, Mexidol, inflammation, endothelial dysfunction.
Efficacy and safety of ethylmethylhydroxypyridine succinate in patients with ischemic stroke
Author:
M.V. ZHURAVLEVA1,2, I.A. SHCHUKIN3, M.S. FIDLER3, A.B. PROKOFIEV2, S.YU. SEREBROVA2, N.S. VASYUKOVA4, E.YU. DEMCHENKOVA1, V.V. ARKHIPOV1,2
1Research Centre for Examination of Medical Devices, Moscow, Russia;
2Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
3Pirogov Russian National Research Medical University, Moscow, Russia;
4Federal Scientific Center — All-Russian Scientific Research Institute of Experimental Veterinary Medicine named after K.I. Skryabin and Ya.R. Kovalenko, Moscow, Russia
Summary:
Stroke is still the most significant problem of the modern medicine and the leading cause of mortality and morbidity. There is the great experience of neuroprotection in patients with stroke in the Russian Federation. In clinical practice it’s important to follow conditions, where neuroprotection will have maximum safety and effectiveness. The clinical trials of ethylmethylhydroxypyridine succinate (mexidol) in patients with acute ischemic stroke are described in the present review. Early management (in the first 6 hours) with mexidol significantly improve recovery dynamic and stroke outcome. Therapy with mexidol increases neurological recovery, improves vital activity and quality of life of patients with stroke. Furthermore, mexidol demonstrates high safety profile. Keywords: ischemic stroke, thrombolytic therapy, clinical trial, disability, antioxidant system, ethylmethylhydroxypyridine succinate, Mexidol.