Cognitive disorders of vascular genesis in the practice of a therapist
Author:
P.R. KAMCHATNOV1, R.A. CHEREMIN2, L.A. SKIPETROVA2, A.V. CHUGUNOV1
1N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, Moscow
2Center of Speech Pathology and Neurorehabilitation of the Moscow Healthcare Department
Summary:
Cognitive impairment (CI) is a widespread clinical syndrome, with which specialists of various profiles often meet in outpatient settings. Diagnosis of CI is a responsible task, the correct solution of which requires a comprehensive analysis of anamnestic information, the nature of the clinical picture, the results of laboratory and instrumental examination. Cerebrovascular diseases are a common cause of CI. The article discusses the issues of management of patients with coronary artery disease, in particular, the main aspects of correction of cardiovascular risk factors, the choice of optimal drug therapy are considered. Information is provided on the possibility of using the drug Mexidol for the treatment of this contingent of patients. The results of studies devoted to the study of the possibility of using Mexidol in patients with chronic disorders of cerebral circulation with CI are analyzed. Key words: chronic cerebral ischemia, chronic cerebrovascular diseases, small cerebral artery disease, cognitive impairment, Mexidol.
Pharmacotherapy in post-stroke rehabilitation
Author:
R.KH. LYUKMANOV, A.A. RIMKEVICHUS, E.V. GNEDOVSKAYA, N.A. SUPONEVA
Research Center of Neurology, Moscow, Russia
Summary:
The article presents data on the conditions of use and efficacy of botulinum toxin preparations, oral muscle relaxants, selective serotonin reuptake inhibitors, acetylcholinesterase inhibitors and a glutamatergic transmission modulator in post-stroke neurorehabilitation, and provides recommendations for their rational and safe use. The clinical efficacy of Mexidol, which has a polymodal effect on a wide range of post-stroke disorders, especially in long-term sequential therapy, is discussed. A complex use of post-stroke rehabilitation methods with the determination of individual tactics based on the clinical picture of the patient and the defined rehabilitation goals is recommended. The inclusion of Mexidol in the complex therapy of patients with stroke consequences for tasks related to improving motor, affective and cognitive functions and self-care and quality of life looks promising. It is necessary to continue high-quality clinical studies to assess the pharmaceuticals efficacy in relation to post-stroke disorders.
Keywords: stroke, hemiparesis, spasticity, depression, dementia, neurorehabilitation, pharmacotherapy.
Original and generic drugs: what does the clinician need to know?
Author:
A.V. SHCHULKIN, A.A. FILIMONOVA
Ryazan State Medical University, Ryazan, Russia
Summary:
In the review article modern approaches to testing and registration of generic drugs are discussed. The article presents the history of the formation of the methodology for testing generic drugs and the current legislation of the Russian Federation. The stages of confirmation of equivalence of original and generic drugs are described: pharmaceutical equivalence, bioequivalence and therapeutic equivalence. The methods of assessing bioequivalence — as the main research in the registration of generic drugs — are discussed in detail. Using the example of the original neuroprotector — Mexidol (ethylmethylhydroxypyridine succinate) and its generics, it is described how legislative acts are implemented in practice. It is concluded that not all generic drugs are interchangeable for the original drug. Keywords: original and generics drugs, ethylmethylhydroxypyridine succinate, 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.
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.
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.
Neuron specific enolase as a measure of the efficacy of mexidol in patients with neurologic complications of primary hypothyroidism
Author:
E.B. KUZNETSOVA
Razumovsky Saratov State Medical University, Saratov
Summary:
Objective. To evaluate the activity of neuron specific enolase (NSE) in patients with primary hypothyroidism (PGT) treated with mexidol. Material and methods. Patients with PGT (n=110) were examined before and after treatment. Neuropsychological and neurological status of the patients was studied. To assess the status of the peripheral nervous system, electroneuromyography was performed and serum NSE level was determined. Results and conclusion. The NSE activity depended on gender, age of the patient, duration of endocrinopathy and presence/absence of neurological symptoms. The clear positive dynamics of the majority of the parameters studied was noted during mexidol treatment. The efficacy of antioxidant therapy in these patients was confirmed.
Keywords: neurological complications, primary hypothyroidism, neuron specific enolase, electroneuromyography, mexidol.
Cerebrovascular diseases: perspectives of pathogenetic metabolic correction treatment
Author:
M.M. TANASHYAN, O.V. LAGODA, K.V. ANTONOVA
Research Centre of Neurology, Moscow, Russia
Summary:
Metabolic syndrome is a serious risk factor for acute and chronic cerebrovascular disease, which are a leading cause of disabling conditions. The association of proatherogenic effects of the main components of metabolic syndrome - hyperinsulinemia, arterial hypertension, dyslipidemia and obesity - leads to prominent haemorheological and hemostasis changes, which in turn play a pivotal role in the initiation, course and outcome of cerebrovascular pathology. Metabolic syndrome also influences the efficacy of the main pathogenetic therapy of cerebrovascular diseases — antithrombotic therapy. Thus, primary and secondary prevention of cerebrovascular disease in patients with metabolic syndrome should include haemangiocorrective, antithrombotic, antioxidant and endothelium-protective treatment, as well as therapy of the main components of metabolic syndrome.
Keywords: cerebrovascular disease, metabolic syndrome, haemorheology and haemostasis, antithrombotic therapy, antioxidants.
Specific features of neurological complications developing in patients with type 2 diabetes mellitus and metabolic syndrome: Possibility for correction and prevention
Author:
V.N. SHISHKOVA
Center for Speech Pathology and Neurorehabilitation, Moscow Healthcare Department, Moscow, Russia
Summary:
The prevalence of type 2 diabetes mellitus (DM) and preceding metabolic disturbances has reached epidemic proportions. Oxidative stress plays a significant role in the development of micro- and macrovascular complications in patients with DM. The accumulation of free radicals is responsible for the development of systemic and vascular inflammation, endothelial dysfunction, and hypercoagulable and ischemic states. Since vascular and nervous system damages do not level off even under adequate glycemic control, there is a need for complex pathogenetic treatment strategies. Antioxidant therapy using mexidol is one of the compulsory components of combination therapy for complications of DM.
Keywords: type 2 diabetes mellitus, metabolic syndrome, oxidative stress, mexidol.
Cognitive impairments as a universal clinical syndrome in a therapist’s practice
Author:
V.N. SHISHKOVA
Center for Speech Pathology and Neurorehabilitation, Moscow Healthcare Department, Russia
Summary:
The problem of cognitive dysfunctions in patients with somatic diseases occupies a prominent place now since they are one of the most common manifestations of organic brain lesions. The early detection of potentially cured cognitive impairments is one of the important tasks of a present-day therapist, cardiologist, endocrinologist, and family doctor as the patients with early-stage cognitive impairments constitute the majority of those who have sought medical advice. In the modern world, primary health care physicians’ actions are decisive in predicting the development of dementia since the detection of early non-dementia forms of cognitive impairments and neuroprotective therapy with mexidol in particular are frequently quite sufficient to considerably reduce the degree of the impairments and to improve the prognosis of dementia.
Keywords: cognitive impairments, dementia, mexidol.