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Introduction: Varicella zoster virus (VZV) is a type of alpha-herpesvirus that specifically targets the nervous system. The initial infection, typically occurring during childhood, results in varicella (commonly known as chickenpox), after which the virus enters a dormant state in cranial nerve ganglia, dorsal root ganglia, and autonomic ganglia throughout the entire neuroaxis. Aim of the study: Molecular and genetic studies of viruses are an important tool for virus development and identifying viral treatments to combat the diseases. The aim of the study was to determine the whole ORF4 sequence of the local VZV strains for phylogenetic analysis to determine the variability in the viral sequence. Material and methods: Ten samples of VZV DNA were subjected to the sequencing of the whole ORF4 region following identification using the PCR method. Results: Sequences from five samples have been successfully analyzed. All clinical strains were discovered to possess a genome with a length of 124,884 base pairs. The sequences exhibited the occurrence of two distinct mutations, one being a transversion and the other a transition, with the latter resulting in an alteration of the amino acid. A phylogenetic tree was constructed using the maximum likelihood method based on the sequences of five nucleotide sequences from clinical samples and nine reference VZV strains. The tree displayed the evolutionary distances between these sequences. The analysis of the phylogenetic tree revealed the presence of five primary clades, with four of them originating from India (isolates S1, S2, S4, S5), while S3 exhibited similarity to a strain from the United Kingdom.

Acute cerebrovascular accident (CVA) is a severe condition in children and adolescents with a high risk of disability. A literature review was carried outon intensive stroke care in children and adolescents using databases such as PubMed, Science Direct, and eLibrary. The search utilized keywords suchas "acute cerebrovascular accident", "stroke", "children", "clinical manifestations", and "intensive care". The review includes sources for the last 10years (2014-2024). The inclusion criteria consisted of descriptions of clinical manifestations and intensive care management for stroke in childhood and adolescence. The exclusion criteria referred to articles on the clinical presentation and treatment of stroke in adult patients. The main factors for stroke in childhood include sickle cell anemia, cardiovascular diseases, cancer pathology, and genetic disorders. The manifestations of stroke in children and adolescents have nonspecific clinical features. There are currently no approved protocols for the treatment of stroke in children, and there are insufficient clinical studies for this condition. Therefore, pediatric practice often extrapolates aspects of intensive care for stroke from the adult population. The type of stroke, such as arterial ischemic stroke (AIS) or hemorrhagic stroke (HS), cerebral venous sinus thrombosis, or stroke due to sickle cell anemia, determines the emergency care required for children. Intensive therapy should be carried out in a pediatric intensive care unit (PICU), focusing on stabilizing vital functions and maintaining optimal cerebral perfusion pressure. Developing specific protocols for intensive stroke treatment in children and adolescents is necessary to improve the quality of emergency care for this patient population

Cognitive impairment is a common stroke-induced complication that aggravates the outcome of the disease. Post-stroke cognitive processes are an important research issue: unlike motor disorders, cognitive impairments prevent patients from adapting to their new state, which leads to social and professional maladjustment, as well as complicates the rehabilitation. This article describes the functioning of cognitive processes in post-stroke patients. The methods involved Schulte Table Test, Pictogram Method, Wartegg Test ("Circles"), Masselon Test, Gordon’s questionnaire, Benton Visual Retention Test (BVRT), McNair and Kahn’s Scale, Hospital Anxiety and Depression Scale (HADS), Frontal Assessment Battery (FAB), and Addenbrooke’s Cognitive Examination Revised (ACE-R). Most participants demonstrated cognitive impairments. Moderate cognitive impairments of multifunctional amnestic type predominated; severe cognitive impairments were less numerous; mild cognitive impairments were scarce. Subjective cognitive disorders occurred very often and correlated with anxiety and depression. To test the age-dependance hypothesis, the participants were divided into two groups, i.e., those under 65 y.o. and those over 65 y.o. The 65-plusers were more prone to disorders of memory, attention, speech, thinking, imagination, gnosis, and praxis. The younger participants initially demonstrated subjective cognitive impairments, which were not confirmed by further neuropsychological tests.

The aim of the study is to identify social and economic factors associated with the development of coronary and cerebral ischemic events in urban residents based on the results of a three-year follow-up. Material and methods. The prospective non-interventional observational study included 431 patients. Data on the coronary and cerebral ischemic events in history, and social, economic and demographic data were collected at the baseline. Follow-up appointments were scheduled 3 years later to assess new cases of coronary and cerebral ischemic events. Taking into account the presence or absence of the adverse events in history at the baseline and follow-up visit, four groups of patients were formed. There were 350 (81.2 %) people without a coronary history (group 1), and 81 (18.8 %) with it (group 2). Respondents without a coronary history were divided into a subgroup with the absence of new ischemic (coronary and cerebral) events at the repeat stage, numbering 246 (57.1 %) people (1a), as well as a subgroup with their development – 104 (24.1 %) (1b). Similarly, respondents with a coronary history were divided into a subgroup with the absence of adverse events at the second stage, which included 35 (8.1 %) people (2a), as well as a subgroup with their occurrence – 46 (10.7 %) (2b). Results. At the baseline, only 18.8 % out of 431 patients had coronary events in history. At the follow-up visit, 150 (34.8 %) patients presented with new coronary or cerebral ischemic events: 10.7 % of those cases were fatal, 1.9 % – new cases of myocardial infarction, 3.5 % – cases of stroke, 13.5 % – new cases of angina pectoris, and 5.3 % – other diseases associated with coronary artery disease. One third out of 350 patients without coronary events in history and half of patients with coronary events in history presented with newly developed adverse events. Young respondents (35–49 years old) with no coronary history were 3 times more likely to have coronary and cerebral ischemic events over 3 years than people of the same age, but with previous diseases of the cardiovascular system. During the 3-year followup period, the risk of coronary and cerebral ischemic events in patients with coronary events in history was associated unemployment odds ratio (OR) 2.74 (95 % confidence interval (CI) 1.33; 5.66, p = 0.006), widowhood OR 2.98 (95 % CI 1.32; 6.74, p = 0.008), living in a rural area OR 2.30 (95 % CI 1.16; 4.55, p = 0.017) and female gender OR 2.63 (95 % CI 1.28; 5.43, p = 0.008). Conclusions. The risk of coronary and cerebral ischemic events during the 3-year follow-up period in the population of urban residents is associated with social and economic determinants such as female gender, unemployment, living in a rural area, and widowhood in the presence of a coronary history. 35–49-year-old men without a coronary history should also be considered as a group of special attention for the prevention of adverse events.

Relevance. Stroke is a public health problem, with over 90 % of cases worldwide attributable to a combination of individual clinical or behavioural risk factors, which are generally classified as non-modifiable and modifiable risk factors. The aim of this study was to determine the stroke risk factors prevalent among stroke patients in Bujumbura, the economic capital of Burundi. Materials and Methods. This was a descriptive and prospective study performed over a 6-month period from February to August 2020. 71 stroke patients who were hospitalized for a stroke confirmed by cerebral CT scan in the two teaching hospitals of Bujumbura were collected. Results and Discussion. Stroke risk factors were frequently found among stroke patients in Bujumbura. In fact, 91.55 % had at least one risk factor for stroke, with an average of 2.86 per patient. These factors are mainly cardiovascular (91.62 %), with hypertension accounting for the largest share (46.48 %), followed by regular alcohol consumption (33.80 %). Age was the most common non-modifiable risk factor in these patients, with 73.25 % aged over 50 and an average age of 59.87. There was a predominance of male patients, the sex ratio was 1.29. As in the literature, ischemic stroke predominated (69.01 %), while the recurrence rate was 14.6. Other risk factors that were found to be significant were sedentary lifestyle (26.76 %), diabetes (16.90 %), obesity (8.45 %) and smoking (5.63 %). The positive HIV/AIDS seroprevalence rate was 8.5 %, whereas the national prevalence rate was 2.97 %. Conclusion. Risk factors for stroke are found in the large majority of patients in Bujumbura. They are diverse, but are mainly dominated by cardiovascular pathologies, in particular hypertension.

Aim. To analyze demographic, anamnestic and clinical parameters in subjects with coronary artery disease (CAD) or peripheral artery disease (PAD) included in the XATOA study from Russian centers and to compare them with the total population of the international registry.Material and methods. XATOA study is an international, multicenter, prospective registry, where characteristics of patients receiving dual pathway inhibition therapy with rivaroxaban 2,5 mg twice a day and low-dose acetylsalicylic acid (ASA) daily were analyzed. The secondary endpoint of the study was to assess clinical outcomes and bleeding rates in real world setting.This analysis was based on the comparison of indicators presented in tables of descriptive statistics from the XATOA study database for subjects from Russia and the general study database respectively. The methodology of this sub-analysis is descriptive only and does not imply any statistical difference assessment.Results. The Russian population included 795 subjects: 232 (29.2%) subjects with CAD; 293 (36.9%) subjects with PAD and 270 (34.0%) subjects with both. The average follow-up period was 14.4 months. The most common antithrombotic treatment regimen for patients with CAD or PAD prior enrollment in the registry was ASA monotherapy (81.3%); ACE inhibitors/ARBs were prescribed in 61.8%, lipid-l owering therapy in 68.9%. After the enrollment and prescription of rivaroxaban 2.5 mg BID + ASA, the incidence of myocardial infarction, stroke or cardio-v ascular death in subjects in the Russian Federation remained at 1.9%, and the incidence of major adverse limb events (MALE) at 0.8%, which corresponds to the results obtained in the COMPASS randomized controlled trial. Major bleeding was reported in 1 subject (

Aim. To evaluate the contribution of arterial hypertension (AH), high lowdensity lipoprotein cholesterol (LDL-C) level and their combination to the development of (myocardial infarction) MI and stroke.Material and methods. The analysis is based on data from 1 and 2 observations of ESSE-RF study (Epidemiology of cardiovascular diseases in various regions of the Russian Federation)". A multi-s tage cluster random sample was used, formed according to the territorial principle on the basis of medical and preventive institutions (health facilities). Socio-demographic data (gender, age, education, wealth), smoking status and medical history were determined. Blood pressure (BP) was measured twice, on the right arm, in a sitting position with an automatic blood pressure monitor. Blood samples and its derivatives (serum and plasma) were stored at a temperature of -70ºC. LDL-C value was also included into analysis (LDl- C ≥3 mmol/l). Prospective monitoring of new cases was carried out in the initial sample without patients with coronary artery disease, MI, and stroke. The median follow-up time is 7.5 years. The sample size was 19 794. 356 non-fatal cases were identified, including 222 cases of MI and 174 cases of stroke.Results. The average age was 44.7 years, in men — 43.2, and in women — 45.3. The prevalence of isolated forms of hypertension, high LDL-C level and its combination were 12.7%, 30.3% and 32%, respectively. It was revealed that the age was the lowest in healthy and those with an increased LDL-C, whereas those with hypertension and combined conditions were older. The risk of nonfatal cases of MI and stroke in the Cox models, was adjusted for gender, age and region. There was a significantly higher risk of new cases of nonfatal CVD in individuals with isolated hypertension compared with those with isolated LDL-C.Conclusion. The frequency of isolated AH and isolated LDL-C were 13% and 30%, respectively. The combined condition was detected in 30%. The presence of AH, isolated LDL-C and their combinations in the sample doubled the risk of new CVD events.

The management of patients with cognitive impairment (CI) is one of the urgent problems of modern medicine. Vascular CI (VCI) is the second most common cause of dementia after Alzheimer's disease. The diagnosis of VCI is based on the results of a neuropsychological examination, the presence of clinical and neuroimaging signs of cerebrovascular disease, and the absence of data for other causes of CI. Socio-psychological methods, stroke prevention, correction of vascular risk factors, and stimulation of patients to regular physical and mental activity are of leading importance in the management of patients with VCI. The effectiveness and safety of citicoline in VCI are discussed.

The development of acute cerebrovascular events is one of the main causes of mortality and disability. Currently, in developed countries, due to the development of new technologies and improvement of medical care and prevention, there is a tendency to decrease the mortality and morbidity of cerebral venous thrombosis. Timely and adequate use of antithrombotic therapy in patients in this category for primary and secondary prevention of acute cerebrovascular events is an extremely important aspect of management and reliably reduces the risks of recurrent cerebrovascular accidents, increases survival and contributes to a more favorable prognosis for the recovery of impaired functions and quality of life in the long term.

Proton pump inhibitors (PPIs) are the most effective drugs for treating acid-related diseases. In recent decades, the use of PPIs has increased exponentially. From gastroenterological practice, PPIs are being actively introduced into other specialties, in particular in cardiology and rheumatology, where they are used to protect the mucous membrane of the gastrointestinal tract and prevent gastrointestinal bleeding during long-term antithrombotic therapy and long-term use of non-steroidal anti-inflammatory drugs. For a long time, PPIs were considered completely safe drugs for both short-term and long-term use. However, modern clinical guidelines note that when prescribing PPIs in large doses for a long period, the possibility of side effects should be taken into account. In recent years, a number of foreign reviews have been published that examine the relationship between PPIs and a number of diseases/conditions, including the question of a possible association of PPI use with an increased risk of cardiovascular complications, but note the inconsistency of these data. We searched the PubMed and Scopus information databases for publications on the safety of PPI use, including sources up to 12/01/2023. In this review, we examined the possible cardiovascular risk of long-term use of PPIs. Analysis of publications, despite a number of contradictions, allows us to conclude that the cardiovascular risk with long-term use of PPIs is real and must be taken into account when prescribing PPIs for a long period and to comorbid/multimorbid patients.

Stroke, myocardial infarction (MI), and other main non-communicable diseases (NCDs) remain major causes of mortality and disability globally. Up to 80% of cardiovascular events and up to 60% of NCDs are associated with potentially controlled risk factors (RFs). State-of-the-art digital technologies can help bridge the gap between evidence-based prevention methods and their critically low availability in routine clinical practice. An innovative digital platform named PreventS-MD® is a specially developed tool for healthcare professionals to be used under time constraints. With PreventS-MD®, clinicians can estimate patient's 10-year cardiovascular risk within several minutes. Then, they automatically get adapted results and recommendations to address identified RFs as well as graphical representation of specific RF contribution to overall stroke and MI risks. If some additional time is available, the clinician and the patient can collaboratively set customized achievable goals to correct modifiable RFs. An integrated analytical module provides healthcare managers with current digital risk profiles of the relevant population to evaluate prevention effectiveness and to forecast the load throughout the healthcare levels. PreventS-MD® has several unique advantages, including time-saving design, the function to activate motivated RF correction, individually tailored recommendations, and information on personally changed digital profiles of vascular risks. As cardiovascular diseases and main NCDs have a lot of common RFs, PreventS-MD® implemented into routine clinical practice will utilize a complex approach to the prevention of main NCDs, decreasing both stroke and MI burden and addressing complications of chronic pulmonary and kidney disease, tumors of any type, dementia, etc.

BACKGROUND: Motor disorders of the upper limbs often develop after stroke. The use of traditional meth-ods to restore the motor functions of the upper limbs has limited effectiveness thus making the search and development of new rehabilitation approaches important. We propose to use a proactive selection of a purposeful movement as such an approach. AIM: to investi-gate the influence of different strategies of the upper limb movement regulation on the mo-tor decision making and hand kinematics parameters in stroke patients. METHODS: Ten pa-tients with stroke participated in the study during their hospital stay. They were divided into 2 groups and performed the task of selecting a movement target and performing arm movements for 10 sessions of 10 minutes each. The sessions were performed on separate days. When performing the task, patients selected one of the targets, either the near target or the distant one. The groups differed in the type of presentation of the distant target; the near target was stationary. The stimuli were presented on a touch screen arranged hori-zontally. A patient sat in front of the screen and placed the hand with a foam ball fixed in it on the starting area. The patient’s forearm was supported by means of a pendant. The pa-tient selected a target to reach in each attempt and then performed the movement by swip-ing the ball on the touch screen. The frequency of the target selection to perform the movement, the range of the selected target, the latencies of the movement onset, the hand speed and acceleration, and the accuracy in reaching the target were assessed. RESULTS: The results indicate that amidst the overall effects represented by a reduced movement on-set time [F (9.72)=8.59; p 0.001], a greater movement speed in reaching the distant tar-get [F (9.72)=2.79; p=0.007], a lower selection rate [F (9.72)=2.78; p=0.008] and a re-duced mean distance of the selected distant target [F (9.72)=2.19; p=0.033], the differ-ences in the distant target presentation between the groups have an impact on the hand movement dynamics in patients. Presenting a target at a random distance results in a greater selected target distance [F (1.8)=17.04; p=0.003], and an increased hand speed [F (9.72)=3.03; p=0.004] compared to the adaptive presentation. There is also a greater decrease in the movement onset time [F (9.72)=2.71; p=0.009] in the group of patients with the adaptive presentation of the distant target compared to the group with the random presentation. CONCLUSION: The differences in the target presentation strategy are reflected in the motor decision making and hand movement dynamics of stroke patients. A random-ized range of target presentation results in a higher amplitude arm movement closer to the activation threshold of the stretch reflex. The results of the study may be useful for selecting the rehabilitation strategies for stroke patients.

Proton pump inhibitors are the most effective drugs for the treatment of acid-related diseases. In recent decades, the use of PPIs has increased exponentially. For a long time, PPIs were considered completely safe drugs for both short-term and long-term use. However, modern clinical guidelines note that when prescribing PPIs in large doses for a long period, the possibility of side effects should be taken into account. There are no reviews in the domestic literature on the safety of PPIs during long-term use. In this regard, a search was conducted in the PubMed and Scopus information databases for publications on the safety of PPI use, including sources up to November 15, 2023, which showed that long-term use of PPIs is associated with the possible development of numerous side effects. The first publications examined the likely side effects of long-term use of PPIs: the development of infections, increased risk of fractures and kidney pathology, and possible side effects: the risk of cancer and electrolyte disturbances. This review examines the possible cardiovascular risk of long-term PPI use and a number of rare side effects, many of which have been described in recent years. The key to mitigating side effects is judicious use of PPIs at the lowest effective dose and as quickly as possible. If there are clear indications for long-term PPI use, monitoring should be carried out to identify side effects.

Asthenic disorders are seen in approximately half of poststroke patients. The mechanisms underlying poststroke asthenia (PSA) are related to brain connectome damage, as well as neuroinflammatory and neuroendocrine mechanisms. PSA is associated with a lack of energy, lassitude, and fatigue that do not improve after rest or sleep; it is differentiated from depression, apathy, and daytime drowsiness. Risk factors for PSA include female gender, anxiety and depressive disorders, severe neurological deficit, sleep disorders, diabetes etc. Treatment of PSA includes cognitive behavioral therapy graded physical activity, and pharmacotherapy.

Introduction. Non-invasive brain–computer interfaces (BCIs) enable feedback motor imagery [MI] training in neurological patients to support their motor rehabilitation. Nowadays, the use of BCIs based on functional near-infrared spectroscopy (fNIRS) for motor rehabilitation is yet to be investigated. Objective: To evaluate the potential fNIRS BCI use in hand MI training for comprehensive post-stroke rehabilitation. Materials and methods. This pilot study included clinically stable patients with mild-to-moderate post-stroke hand paresis. In addition to the standard rehabilitation, the patients underwent 10 nine-minute MI fNIRS BCI training sessions. To evaluate the quality of fNIRS BCI control, we assessed the percentage of time during which the classifier accurately detected patient's mental state. We scored the hand function using the Action Research Arm Test (ARAT) and the Fugl-Meyer Assessment (FMA). Results. The study included 5 patients at 1 day to 12 months of stroke. All the participants completed the study. All study participants achieved BCI control rates higher than random (41–68%). While three patients demonstrated the clinically significant improvements in their ARAT scores, one of them also showed an improvement in the FMA score. All the participants reported experiencing drowsiness during training. Conclusions. Post-stroke patients can operate the fNIRS BCI system under investigation. We suggest adjusting the feedback system, extending the duration of training, and incorporating functional electromyostimulation to enhance training effectiveness.

Over the past 10 years of studying the complications of type 2 diabetes mellitus (DM) and ways to deal with them, significant progress has been made in one of the most important areas of treatment — the prevention of cardiovascular and renal complications. Thus, when using inhibitors of type 2 sodium-glucose cotransporter, a significant reduction in the risks of cardiovascular mortality and progression of chronic heart failure, which occupy the main place in the structure of mortality in this cohort of patients, as well as a positive effect on diabetic nephropathy, one of the most common complications of type 2 diabetes, has been proven. However, there are other complications that significantly affect the duration and quality of life of patients. In particular, these include stroke, which occupies the 2nd-3rd place in the frequency of death of people with type 2 diabetes, and albuminuria, a frequent manifestation of diabetic kidney disease, which is associated with an increased risk of cardiovascular complications (including stroke) and chronic renal failure. Recent studies indicate the important role of sodium-glucose cotransporter type 1 in the development of these complications. Canagliflozin has the highest affinity for these transporters among iSGLT-2 registered in the Russian Federation. This article aims to evaluate the mechanisms of action of canagliflozin and its possible role in the prevention of stroke and albuminuria.

Dietary supplements are regularly consumed by more than 70 % of the US population, as well as by competitive and non-competitive athletes. Anabolic-androgenic steroids (AAS) are frequently found in dietary supplements, and have the potential for multi-organ toxicity, including significant effects on the cardiovascular system. Cardiovascular toxicities of AAS include coronary artery effects, e.g. spasm, thrombosis and plaque rupture, leading to acute coronary syndromes and myocardial infarctions, as well as direct myocardial toxicity, causing left ventricular hypertrophy, fibrosis and dysfunction. Coronary and myocardial effects converge towards a common final pathway, causing heart failure, life-threatening arrhythmias and sudden cardiac death. The unregulated nature of AAS in dietary supplements has many ramifications. Both coaches and athletes should be aware that testing positive for a prohibited substance (including AAS) constitutes a potential doping violation. We advocate for improved education of the public at large regarding the potential for AAS to be included in dietary supplements, as well as its regulation by the appropriate authorities.

The presented work focuses on the description of issues related to ischemic stroke and the presentation of the patient's care process after this incident. The first part is a clinical description of the disease, and the second part is a case report of a patient after an ischemic stroke staying in a neurological ward. The work also includes a description of the course of hospitalization, nursing problems, nursing interventions undertaken and evaluations of nursing activities.

Aim – to identify the differences in sleep architecture of patients in the early recovery period after ischemic and hemorrhagic stroke. Methods. The study involved 143 patients in their early post-stroke recovery period, the patients’ average age was 59.6 ± 7.4 years. Among subjects there were 69 males (48.2%) and 74 females (51.8%). A total of 62% (89 patients) had ischemic lesions, 38% (54 patients) had hemorrhagic lesions. Patients with insomnia were identified based on the results of preliminary questionnaire survey involving the use of the screening assessment scale of subjective sleep characteristics. Objective assessment of the night sleep architecture features was performed by polysomnography. Results. Comparative assessment of sleep architecture showed that the majority of surveyed patients had a combination of phenomenological sleep disorder types, however, predominance of presomnic disorders was reported in patients after ischemic stroke, while patients after hemorrhagic stroke showed predominance of intrasomnic disorders. The sleep stage duration alterations (larger share of superficial sleep and smaller share of deep sleep) were typical for both types of cerebrovascular disease, they were slightly more prominent in patients after ischemic stroke, which could be due to the brain tissue necrosis, cystic-gliotic changes in the affected area. Conclusions. The differences in sleep architecture identified are consistent with the papers by domestic and foreign researchers on the impaired structure and lower effectiveness of sleep in post-stroke patients. To date, the cause of significant alterations of sleep architecture in patients after ischemic stroke is poorly understood and requires further research in this area.

Stroke is amongst the leading causes of morbidity and mortality globally. Majority of strokes are ischemic and up to 1/3rd ischemic strokes have infective etiology. In this post-pandemic era, SARS-CoV-2 is an established infectious agent which can precipitate it by various mechanisms. Though post-vaccination incidence of COVID-19 has dropped drastically, still new cases get reported with typical or atypical presentations. Irrespective of causation, malignant cerebral edema in stroke necessitates salvage neurosurgery. Hereby authors present an interesting diagnostic chase in a young female who presented in altered sensorium, underwent emergency decompressive craniectomy and neurologically recovered over subsequent days. Despite being double vaccinated, she developed potentially fatal COVID-encephalitis, cerebral venous sinus thrombosis (CVST), ischemic infarcts and hemorrhagic transformation. Suprisingly, there were cross reacting antibodies against antigens of herpes simplex virus (HSV), leptospira and cytomegalovirus (CMV) yielding false positivity on serology screening test, which spoofed us while carrying out infectious disease work up of stroke.

Background. Acute cerebrovascular disorders are one of the main causes of severe disability in modern society. Russian and foreign researchers register the emerging trend towards rejuvenation of the patients with stroke, which, in turn, significantly increases the relevance of the treatment and rehabilitation of these patients at various stages.The aim. To study the social and hygienic characteristics of the stroke patients and to determine their need for medical rehabilitation in the early recovery period.Materials and methods. We studied the social and hygienic characteristics of 109 patients who had stroke in 2020 and 2021 and underwent rehabilitation in the specialized rehabilitation department of the Southern District Medical Center of the Federal Medical and Biological Agency, and determined their need for medical rehabilitation using the analytical method, the method of expert assessments and questionnaires.Results. The average portrait of a patient with a stroke in the early recovery period is as follows: this is a man aged 61 to 70 years with a higher or secondary specialized education, unemployed, living in the city. Up to 30 % of stroke survivors were recognized as disabled; among which, the persons with more severe disability (groups I and II) predominate – up to 90 %. Implementation of rehabilitation measures in the acute period in the hospital and in the early recovery period in the outpatient clinic is carried out at a fairly low level. The percentage of patients being examined by a multidisciplinary rehabilitation team ranges from 17.4 to 10.1 %.Conclusion. The availability of medical rehabilitation measures in a specialized rehabilitation center is quite limited; more than half of the surveyed contingent (52.3 %) experienced problems in obtaining a referral to treatment, about half of the respondents (46.8 %) waited up to 6 months for a referral, which indicates the need to expand the network of such institutions at the regional level.

Introduction. COVID-19-related stroke is associated with a significantly higher mortality than COVID-19 or stroke alone. Mechanisms underlying the increased mortality of patients with stroke and COVID-19 should be thoroughly studied. Objective: to analyze predictors of hospital mortality associated with COVID-19-related stroke. Materials and methods. We retrospectively analyzed 1,386 cases of COVID-19-related stroke reported by an infectious diseases inpatient clinic in 2020. We studied clinical, laboratory, and instrumental parameters in patients with different outcomes. Logistic regression was used to identify independent predictors of mortality. Results. 539 (38.9%) patients died during their hospital stay, with 437 (38.0%) deaths from ischemic stroke and 102 (42.7%) deaths from hemorrhagic stroke (p = 0.0001). Independent predictors of mortality associated with COVID-19-related stroke included age, neurological deficit severity measured by NIHSS, COVID-19 severity, and laboratory parameters including white blood cell count, creatinine, glucose, and D-dimer blood levels. Discussion. The results of logistic regression analysis were able to explain only 41% of the variability in hospital deaths among patients with stroke associated with COVID-19. Conclusion. Hospital mortality in patients with COVID-19-related stroke is associated with severity of inflammatory response, impaired coagulation, age, neurological deficit severity, and somatic comorbidities.

Background. Ischemic stroke (IS) and cerebral microbleeds (CMB) are the most common types of neurological complications of infective endocarditis (IE), while their combination is poorly understood. Aim. To evaluate the pattern of combination of cortical-subcortical infarction with lobar CMB or subarachnoid hemorrhage (SAH) in patients with left-sided IE. Materials and methods. A retrospective case-control study was conducted, including patients with IE who received cardiac surgery at the Federal Center for Cardiovascular Surgery. Inclusion criteria: age of patients 18 years; definite or possible (Duke criteria) IE of the left heart (aortic and/or mitral valves). The control group included patients without IE, with non-lacunar (likely embolic) IS. In both groups, the pattern of combination of cortical-subcortical infarction with lobar CMB or SAH was assessed. Differences between groups of patients were assessed using the 2 test, Fisher's exact test and the MannWhitney test. Additionally, odds ratios for binary features were calculated. To assess the information content of the studied pattern, classical classification quality metrics were calculated: accuracy, sensitivity, and specificity. Results. In patients with IS, infarcts corresponded to the main characteristics of cardioembolism: involvement of multiple cerebral arterial territories (84%), multiple infarcts (88%), cortical-subcortical localization (100%), and a high incidence of hemorrhagic transformation (44%). CMB was detected in 64% of cases (in 93.8%, CMB localization was lobar), SAH in 28% of patients (with CMB in 6 out of 7 cases). The pattern of combination of cortical-subcortical infarction with lobar CMB or SAH was observed in 64% in the IE group (in the control group in 12%). Odds ratio for the presence of IE was 13.0 (95% confidence interval 3.0455.9; p0.001). The accuracy of the sign was 76%, specificity 71%, sensitivity 84%. Conclusion. The combination of cortical-subcortical infarcts with lobar CMB or SAH may be a sign characteristic of IE-associated stroke.

Atrial fibrillation (AF) is associated with dramatic increasing of stroke risk. Development of this serious complication is accompanied by high mortality and disability. Nowadays we know many different scores that predict stroke risk,butthe most popular is CHA2DS2-VASc risk score. At the same time, this score does not have high predictive accuracyand that is why a lot of modifications with inclusion/deletion of different indicators were introduced.The aim of this review was to estimate the different modifications of CHADS2 и CHA2DS2-VASc scores in predicting stroke risk in patients with AF. In this review R2CHADS2, CHA2DS2-VASc-R, CHA2DS2-VA, mCHA2DS2-VASc and CHA2DS2-VAK scores are evaluated with the use of C-statistics and net reclassification index compared to the original CHA2DS2-VASc score. The search of studies was performed according to PubMed database (https://pubmed.ncbi.nlm.nih.gov/) from 2011 until 2021 years. In this review were included studies written in English with free full text. Literature reviews, books, abstracts books, studies performed on less than 900 patients and studies without C-statistics data available were excluded from this review. Despite of the numerous attempts to improve the quality of CHA2DS2-VASc score, existing modifications nowadays could not become more popular in clinical practice. At the same time, developing of the new score systems, that will have better predictive values in stroke prognosis than CHA2DS2-VASc score, is still an actual problem in modern cardiology.

Introduction. Modern transplantation and biological therapy methods are associated with a wide range of adverse events and complications. Incidence and variety of neurological complications mostly depend on myelo- and immunosuppression severity and duration as well as on donor's and recipient's characteristics. The most frequent complications involving the nervous system include neurotoxic reactions, infections, autoimmune and lymphoproliferative diseases, and dysmetabolic conditions as well as cerebrovascular complications that potentially affect transplantation outcomes. Objective. To evaluate the impact of post-transplantation cerebrovascular events (CVEs) on transplantation outcomes in patients with hematologic malignancies. Materials and methods. We analyzed 899 transplantations performed at the Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology, and Transplantation, Pavlov First Saint Petersburg State Medical University, from 2016 to 2018. We assessed transplantation parameters and donor's and recipient's characteristics by intergroup comparison, pseudo-randomization (propensity score matching), KaplanMeier survival analysis, and log-rank tests. Results. Post-transplantatively, CVEs developed in 2.6% (n = 23) of cases: 13 (1.4%) ischemic strokes and 11 (1.2%) hemorrhagic strokes or intracranial hemorrhages were diagnosed. CVEs developed on days 99.5 39.2 post hematopoetic stem cell transplantation (HSCT). There were more patients with non-malignant conditions in the CVE group as compared to the non-CVE group (21.7% vs 7.9%; p = 0.017). Patients with CVE had a significantly lower Karnofsky index (75.6 21.3 vs 85.2 14.9; p = 0.008). Statistically, we also note some non-significant trends: patients with CVE more often underwent allogenic HSCT (82.6% vs 64.0%; p = 0.077) while donors were more often partially (rather than totally) HLA compatible for recipients (39.1% vs 21.1%; p = 0.33). Patients with CVE more often had a history of venous thromboses (13.3% vs 4.2%; p = 0.077). Post-HSCT stroke decreased post-transplantation longevity by approximately 3 times (331.8 81.6 vs 897.9 25.4 post HSCT; p = 0.0001). In the CVE group, survival during first 180 days post HSCT (landmarks post-HSCT Day+60 and Day+180) was significantly lower as compared to that in the CVE-free group. If CVE developed during first 30 days and 100 days post HSCT, vascular catastrophe did not affect post-HSCT survival significantly. Conclusion. Whereas ischemic stroke is a long-term HSCT complication (beyond D+100 post transplantation), hemorrhagic stroke is a short-term complication (D0D+100 post HSCT). CVEs affect survival in patients with hematologic malignancies, especially those developed between D+60 and D+180 post HSCT. History of venous abnormalities, low Karnofsky index at HSCT initiation, and the type of allogenic HSCT, especially from half-matched donors, can be considered as negative outcome risk factors in post-HSCT CVE.

Introduction. In the COVID-19 pandemic, high lethality as well as long-term outcomes are getting more and more relevant. According to the accumulated study results, COVID-19 affects the nervous system both directly and indirectly. Objective: to study the variants of post-COVID syndrome based on the data from the State Novosibirsk Regional Clinical Hospital from July 2020 to February 2022. Materials and methods. We have performed post hoc analysis of the medical records of 1,500 patients with a past history of COVID-19 admitted following various neurological disorders manifested from July 2020 to February 2022. Results. While temporary and pathogenetic association with past COVID-19 was revealed in 455 patients, primary involvement of the central nervous system was reported in 91.6% of cases, primary involvement of the peripheral nervous system in 8.1% of cases, and musculoskeletal disorder (idiopathic myodystrophy) in 0.3% of cases. Conclusion. Prevalence of the neurological variants of post-COVID syndrome is still unknown. However, patients with severe COVID-19 are more susceptible to neurological complications during the following six months.

The effect of reducing the damaged organ cell number and size in different areas of the human body (in case of carcinomas, cerebral thrombosis, heart attacks, damaged chest and cervical vertebrae areas, in case of coronavirus and dental pulpitis) was studied using a halogen lamp. The tests were conducted on patients when curing different diseases using periodic implementation of halogen lamp (500 W) with duration from 0.5 to 1 hour, while controlling its light frequency and intensity. The tests were carried out on a group consisting of 170 patients. The results were successful when it came to curing: coronavirus – up to 80 % success rate; cancerous tumors, strokes, heart attacks, and damaged parts of the cervical vertebrae – up to 70 % success rate; and dental pulpits – up to 90 % success rate. By analyzing the practical results received, one can come to a conclusion that the effect of reducing the number and size of damaged organ cells by using a halogen lamp can be used to cure many diseases. The most important is to cure COVID-19.

AIM. To assess cognitive dysfunction in clinical practice, depending on the task being solved in the examination, different neuropsychological research methods are used. To identify the specific cause of the dysfunctions in the structure of various mental functions (neuropsychological characteristics of the defect) and in the brain functions (topical diagnosis), methods of qualitative analysis of the detected symptoms of the disorder are used. Psychometric (quantitative) methods are used to assess numerically the severity of disorders and the dynamics of changes in the state of individual mental functions, as well as for screening assessment of e possible cognitive decline level in general. Methods of cognitive dysfunctions qualitative assessment are focused on the search for a «missing link» in the structure of the examined mental functions. Psychometric tests, in most cases, describe the general state of either individual mental functions, or, in the case of screening, a set of cognitive functions. Thus, one or more aspects of mental functions are evaluated, in which several cognitive functions are involved at once. The article presents the results of a literature review with a description and analysis of preferences, methods used and corresponding techniques for neuropsychological examination of cognitive disorders in domestic clinical practice in vascular brain lesions.

Objectives. To assess the influence of classical and new risk factors, as well as comorbid pathology on the development of MACE (major adverse cardiac events) in urban unorganized population. Material and methods. In 2007/2008 – 2020/2021 the 5-year and 13-year prospective randomized studies of 3,500 people of the urban unorganized population of Vitebsk were conducted. Four screenings were carried out: in 2007/2008, 2010/2011, 2012/2013 and 2020/2021. During the survey, the socio-demographic data were recorded, all subjects were examined with the WHO questionnaires, the anthropometry data were taken into account, instrumental and laboratory examination methods were used. Results. According to the 5-year prospective study the development of MACE was connected with the age (p

INTRODUCTION. Proprioceptive deficits are one of the common sensory impairments after stroke and have a negative impact on motor activity. AIM. Evaluation of the effect of stabilization training on the dynamics of clinical and functional indices and the efficiency of motor rehabilitation in patients after stroke. MATERIAL AND METHODS. The dynamics of motor (motor functions, activity) and non-motor (cognitive and emotional volitional) consequences of stroke, as well as the quality of life under the influence of complex application of stabilization training with the use of scales (National Institutes of Health Stroke Scale, Medical Research Council Scale, Modified Ashworth Scale of muscle spasticity, «Memory for images» and «10 words», Schulte-Platonov Table, Lusher Color Test, The Hospital Anxiety and Depression Scale), International Classification of Functioning (ICF), EQ-5D questionnaire and stabilography method. The effectiveness of motor rehabilitation was evaluated by the dynamics of the integral index of health level. RESULTS AND DISCUSSION. After complex rehabilitation in stroke patients the regression of neurological disorders was detected (almost half of patients after rehabilitation showed mild degree of impairment, in 6 % of cases full recovery of paretic leg muscle strength was achieved, the share of patients with severe and moderate paresis decreased, hypertonicity of paretic muscles decreased). Complementing the complex of motor rehabilitation with stable exercise led to a decrease in the degree of functional limitations (in 48.5 % of patients after rehabilitation the Hauser walking index indicated a mild degree of walking disorder, patients became able to walk around the room without using aids, reduced dependence on others in everyday life), improved quality of balance function and quality of life, a positive impact on the psychoemotional state of patients and increased effectiveness of rehabilitation measures. CONCLUSION. Stabilotraining application in the complex of motor rehabilitation of patients allowed to improve walking and balance functions, psycho-emotional state of patients, to increase their quality of life and, accordingly, to increase the effectiveness of rehabilitation measures after stroke.

Background: Systemic thrombolytic therapy (STLT) with alteplase is the method of choice in all patients with acute ischemic stroke (IS) within the first 4.5 hours after the symptom onset. There is a noticeable difference between men and women in the clinical characteristics and results of stroke treatment; however, results of studies have been contradictory. Aim: To evaluate the efficacy of STLT with alteplase in women compared to men, depending on the presence of some risk factors for stroke. Materials and methods: This open-label prospective observational non-interventional cohort study of STLT in IS included 209 patients (102 women, the main group, and 107 men, or the comparison group) aged 32 to 86 years. All patients received STLT with alteplase within 4.5 hours from the onset of IS symptoms. The primary endpoint of the study was 28-day survival, and the secondary endpoint was the achievement of mobility independence (0 to 2 points by the modified Rankin Scale (mRS)). Results: The demographic and clinical patient characteristics of both groups were comparable, but women were on average 5 years older than men (p = 0.003). The index IS was not the first one in 31.4% of women and 23.4% of men (p 0.05). There were no significant differences in the severity of stroke and the timing of STLT. Men had a high mortality rate in the acute period of IS, but the difference was non-significant. PST-STLT hemorrhagic transformation was more common in men, with the difference being non-significant (2 0.743, p = 0.389). Women were more likely to have type 2 diabetes mellitus (DM2) (37.3% and 20.6%, respectively, 2 7.111, p = 0.008). In women, there was a trend towards better symptom regression by about 1 point (p = 0.129). The women with DM2 had a 13% higher survival than men (p = 0.038). The numbers of patients achieving independence (02 points on the mRS scale) by Day 28 was not different (56 women and 52 men). No between-groups differences were found in the numbers of patients with arterial hypertension and atrial fibrillation. Only 13 women (12.75%) and 21 men (20%) had a normal body mass index, while 56.3% of women and 46.7% of men had obesity 2 or 3 grades, with the gender differences being non-significant. Conclusion: In women, who have received STLT in the acute period of IS, the death rates and the functional outcomes were non-inferior to those in men, despite their older age, hyperglycemia in the acute period and past history of DM2. The risk factors for stroke in women, compared to men, could be the potential cause of more frequent IS recurrence (every third case in women and every fourth in men was recurrent). Despite a number of negative factors (age, obesity, metabolic syndrome, hyperglycemia, DM2, atrial fibrillation), there was a trend towards better outcomes of STLT in women.

Thromboprophylaxis is one of the most important aspects of atrial fibrillation (AF) management as irregular atrial contractions foster formation of blood clots that may result in ischemic stroke. Strokes caused by AF are relatively large and often lead to death or sever disability, but they may be avoided with appropriate anticoagulation therapy. Unfortunately, the risk factors for stroke overlap with risk factors for bleeding, creating a genuine challenge for clinicians seeking to strike a balance in preventing these two types of complications. This is why risk assessment scores CHA2DS2-VASc and HAS-BLED have been developed. While their role to optimize the anticoagulation therapy was confirmed in multiple studies, the misinterpretation of the criteria within these scores and their inappropriate application can result in suboptimal treatment and needlessly expose patients to the risk of stroke, hemorrhage, or both. This review aims to present appropriate interpretation of CHA2DS2-VASc and HAS-BLED scores and discuss how anticoagulation therapy of AF patients should be guided by those two scores.

Stroke is a prevalent health issue worldwide, often leading to lower extremity deficits and posing a significant challenge for physiotherapists in terms of gait rehabilitation. With the advent of technological advancements, new rehabilitation tools like EMG-driven robots have been developed. However, their effectiveness in rehabilitation needs to be explored due to their high cost. Therefore, this study aimed to determine whether EMG-driven robot therapy was more effective than conventional physiotherapy for gait rehabilitation in stroke patients. The researchers conducted a literature search using the PubMed, Cochrane, and PEDro databases and included only randomized controlled trials (RCTs) focused on stroke patients with gait impairment, assessed using clinical functional scales. The treatment compared EMG-driven robot therapy for the lower extremities with conventional therapy. The analysis included three studies, which showed no significant improvement in locomotion, functional outcomes, or balance parameters with EMG-driven robots alone. However, when combined with conventional physiotherapy, EMG-driven robots demonstrated improvement in these outcomes. Positive effects were observed for spasticity and thigh circumference. In conclusion, EMG-driven robots can be an effective way to improve gait rehabilitation in stroke patients; however, further research with a specific protocol and explanation of the adaptation to each patient is needed.

Relevance. The cognitive symptoms associated with schizophrenia have been a subject of controversy and are often viewed through a dualistic lens. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), these cognitive symptoms can be further elucidated within specific neurocognitive domains. Many of the symptoms of schizophrenia manifest behaviorally and can be challenging to differentiate from the consequences of organic brain impairment, especially when these symptoms involve the frontal and temporal cortex or have a diffuse presentation. Aim – to evaluate neurocognitive deficit in patients with residual schizophrenia with history of ischemic stroke. Materials and methods. A comprehensive study was conducted involving 100 patients diagnosed with recurrent schizophrenia (ICD-10: F20.5) at the Communal Non-Profit Enterprise "Regional Clinical Institution for the Provision of Psychiatric Care". We selected 59 patients: 32 patients with residual schizophrenia without history of stroke (Group 1, G1) and 27 patients with residual schizophrenia with history of stroke (Group 2, G2). Neuropsychological testing was used to evaluate neurocognitive violations. Due to massive distortions that brought to testing results by schizophrenia negative symptoms, only general evaluation was made to reflect critical or non-critical to no violations in separate functions. Statistical method of chi-square test was used to compare results in groups. Study results. To compare neurocognitive violations in G1 and G2 we performed neuropsychological testing in basic neurocognitive domains. G2 patients, diagnosed with both schizophrenia and a stroke, generally exhibit heightened cognitive impairments compared to G1 patients with only schizophrenia. Notably, deficits in Sustained Attention, Divided Attention, Processing Speed, Working Memory, Mental Flexibility, immediate memory, implicit learning, and both expressive and receptive language are more pronounced in G2 patients. However, for functions like Selective Attention, Planning, Decision-Making, recent and very-long-term memory, and interpersonal understanding, the added influence of a stroke in G2 doesn't drastically differentiate them from G1. In essence, while schizophrenia inherently poses cognitive challenges, the co-occurrence of a stroke amplifies certain deficits but not others. This data suggests a complex interplay between schizophrenia and stroke in influencing cognitive function. Conclusions. The coexistence of schizophrenia and a history of stroke in G2 patients frequently exacerbates certain cognitive impairments when compared to those diagnosed solely with schizophrenia. This underlines the compounded cognitive challenges faced by patients with comorbid conditions. However, for some cognitive domains, the severity of impairments is primarily governed by schizophrenia, irrespective of the presence of an additional stroke history. This comprehensive analysis underscores the complex interplay of multiple conditions on cognitive function and emphasizes the importance of individualized care and intervention strategies tailored to the specific cognitive challenges faced by each patient group.

The subject of the study in the article is the methods of predicting the development of diabetes. Diabetes mellitus is a non-communicable disease that has affected 425 million people, and by 2045 the number will only increase by 1.5 times. It has been proven to be an independent contributing factor to stroke development. When there is too much sugar in the blood, it negatively affects the arteries and blood vessels. People with this disease are more likely to develop atherosclerotic plaques and blood clots, which can lead to heart blockage and ischemic stroke. Having diabetes increases the risk and worsens the course of a stroke. According to the Framingham Study, the number of recurrent cases doubles. The aim of the study is to investigate methods of predicting and classifying the development of diabetes among people, in particular stroke patients, to prevent the development of other diseases. The complexity of the problem lies in the fact that there are as many undiagnosed cases as diagnosed ones, so about half of people suffer from the disease and the resulting complications due to improper or delayed diagnosis. Therefore, timely diagnosis of a disease that is difficult to detect is important in order to prevent the development of further complications. The article solves the problem of a multi-criteria task of choosing the best algorithm for predicting the occurrence of a disease. The following methods are used in this paper: multilayer perceptron, k-nearest neighbors method, decision tree, and logistic regression. Nowadays, machine learning has begun to apply to similar problems. In the 1950s and 1960s, there were attempts to combine the approaches to creating neural networks that existed at the time, which made it possible to calculate quantitative descriptions of human intelligence, and memorize, analyze, and process information, which resembled the work of the human brain. Medicine is one of the main areas of human activity where various classifier and neural network algorithms are gaining popularity yearly. They are trendy in disease diagnostics. Results: the initial conditions for choosing the best model are met by logistic regression. Conclusions: as a result of the study, the optimal model for predicting the development of the disease was selected.

Summary. Rehabilitation of post-stroke patients is a pressing and socially significant problem throughout the world, and Kyrgyzstan is no exception. The study addresses the problem of joint pain, which is often encountered by patients who have suffered a stroke. The purpose of the study was to evaluate the effectiveness of kinesio taping for joint pain in the rehabilitation of post-stroke patients. Materials and methods. The study included 60 patients who were divided into two groups. The first group consisted of patients who underwent kinesiotherapy with the use of kinesio tape during rehabilitation and the second group consisted of patients who underwent rehabilitation only with kinesiotherapy without the use of kinesio tape. All patients were surveyed about the degree of pain experienced before and after training, using a standard 10-point pain scale. The NIHS (National Institute of Health Stroke Scale) and Barthel Activity Scale were directly completed before and after 10 days of rehabilitation. Results. The study revealed that according to the NIHS and Barthel scales, good recovery results were obtained in the first and second groups. According to the results of the pain scale, patients who used kinesio tape complained less about joint pain, were able to perform all the exercises shown by the trainer, and did not need painkillers. Thus, the number of patients with mild joint pain was 66.67%, while those with moderate pain increased by 20%. In the second group, at the end of the training, the number of patients with moderate pain was 40%, and 33.33% asked for painkillers due to severe pain. Conclusion. Thus, it has been revealed that kinesiotherapy in combination with kinesiotaping helps patients overcome pain during training, as a result of which training is more effective and the body’s endurance to stress increases, and also helps reduce the use of painkillers. [ABSTRACT FROM AUTHOR]

INTRODUCTION. The prevalence of upper limb dysfunction and cognitive impairments are frequently observed following stroke, but are often considered as distinct entities, and there is little evidence regarding how they are related, as well as rehabilitation methods are aimed at monodomain restoration of any of these impairments. AIM. To analyze the data of recent years on the impact of rehabilitation interventions on cognitive and the upper limb (UL) motor functions in patients with stroke, and to establish how they are related. MATERIAL AND METHODS. The search was carried out in the Medline, Web of Science, PubMed and Scopus sources in accordance with the PRISMA principles and initially revealed 2,841 records. Of these, 35 articles were included in the study with publication 2011–2022. Keywords were used: stroke, movement, motor, upper limb, cognition, cognitive, cognitive-motor, motor-cognitive function. The relationship between cognitive impairments and the degree of restoration of the UL motor function under the influence of various rehabilitation interventions was assessed. RESULTS. Five studies were selected for meta-analysis with the inclusion of 180 stroke patients. It is shown that the improvement of cognitive tests (MoCA) is accompanied by an improvement in UL motor impairments (FMA, Jebsen-Taylor Hand Function Test), while hand dexterity (Box and blocks, NHPT, Minnesota manual dexterity test) remained without statistically significant changes during medical rehabilitation. CONCLUSION. The meta-analysis provides evidence of the relationship and mutual influence of cognitive functions on motor recovery and manual dexterity. However, the small sample size and heterogeneity of available studies are still limiting factors for obtaining unambiguous conclusions.

Background. Although persistent headaches are a common post-stroke pain syndrome, the epidemiology and clinical features of persistent headache after first-ever ischemic stroke have not been considered previously. There is no exact data on how often headache attributed to stroke persists for more than 3 months, i.e. meets the criteria for persistent headache after stroke and what are their distinctive clinical features. The tasks of our study were: to analyze the occurrence/incidence of persistent headaches after the first-ever ischemic stroke; to determine clinical characteristics and types of persistent headaches in comparison with headaches at the onset of stroke. Materials and methods. The study included 550 patients (mean age 63.1 years, 54% men) with first-ever ischemic stroke, of which 529 patients were followed up for at least three months after the stroke. Standardized semi-structured interview forms were used to assess these headaches during professional face-to-face interviews at the onset of stroke and 3 months after the stroke using telephone interview by neurologist. Results. Among 529 follow up patients 55 (10.4%) had persistent headaches after first-ever ischemic stroke. Among these 55 patients 34 patients had persistent new-type headaches which arose for the first time during the onset of stroke, they included predominated migraine-like headaches (n=20), tension-type-like headaches (n=9) and thunderclap-like headaches (n=5). 21 patients had persistent headaches with altered characteristics: predominated tension-type-like headaches (n=16), and less common migraine-like headaches (n=5). Persistent headaches after stroke had the following characteristics compared to headaches at onset of stroke: severe headache intensity, a gradual decrease of occurrence of accompanying symptoms (photo- and phonophobia; p=0.03), the transition of unilateral headaches in bilateral (p=0.004), the presence of headaches 15 days per month in 30.9% of the patients. Conclusion. Persistent post-stroke headaches represent a persistent pain syndrome with severe intensity and frequency of attacks, which requires their further study and creation of guidelines for their management.

Stress induced hyperglycemia is a transient increase glucose blood level during the acute phase of ischemic stroke. Hyperglycemia enhances initiated by cerebral ischemia neuronal death, blood-brain barrier destruction, leads to hemorrhagic transformation, promotes the formation of brain edema. This increases the size of ischemic penumbra and increases the severity of neurological deficit. Stress hyperglycemia as a consequence of stress-realizing system activation is a significant pathogenetic link in ischemic stroke patients.

The article discusses the clinical features of cardioembolic stroke (CES). Approaches to the examination of a patient with clinical suspicion of CES are discussed within the framework of the concept of atrial cardiopathy and its main markers. The principles for choosing the timing of oral anticoagulant administration for the purpose of secondary prevention are presented. The article discusses the special aspects of direct oral anticoagulants prescription in difficult clinical situations, in particular, in elderly and senile patients, after reperfusion therapy, with the development of hemorrhagic transformation, in the presence of combined atherosclerosis, cerebral microangiopathy, anamnesis of intracerebral hemorrhage, as well as severe cognitive impairment. Approaches to the choice of oral anticoagulant in terms of purely clinical benefit are presented.

Background. Psoriasis is a systemic chronic immune-mediated inflammatory skin disease of a multifactorial nature that affects about 2 to 3% of the population worldwide. Given the systemic nature of the disease, the level of comorbid diseases is high, especially those associated with damage to the cardiovascular system. According to the results of various meta-analyzes, it has been proven that among patients with psoriasis, the risk of developing hypertension is high. Aim. To evaluate the prevalence of arterial hypertension (AH) among patients with psoriasis. Materials and methods. We present an open, prospective, observational clinical trial, which includes 60 patients diagnosed with psoriasis vulgaris of varying severity and psoriatic arthritis. All patients underwent clinical and laboratory tests, including the level of total cholesterol, glucose, creatinine, C-reactive protein, calculation of glomerular filtration rate. Body mass index, blood pressure level according to the Korotkov method, severity of the disease by determining psoriasis area and severity Index (PASI), dermatological quality of life index (DLQI), levels of hospital anxiety and depression according to the HADS scale were also assessed. The SCORE2 scale was used to assess cardiovascular risk in patients aged 40 to 69 years, the SCORE 2OP scale for patients aged 70 to 89 years, respectively. Cardiovascular risk was defined as low for patients under 40 years of age. All study participants were examined for the presence of AH. Results. The prevalence of hypertension was 25%, with prevalence among men (15%). The prevalence of hypertension is directly proportional to the severity of psoriasis (13% with hypertension in patients with severe psoriasis, 12% with hypertension with moderate psoriasis, 2% with hypertension with mild psoriasis). Conclusion. Given the high prevalence of AH among patients with psoriasis, it is necessary to form a multidisciplinary approach to the treatment of patients, including a thorough assessment of cardiovascular risk in clinical practice.

Objective ‒ to analyze the clinical course of patients with intracerebral hypertensive hemorrhages depending on age and gender. Materials and methods. An analysis of the treatment of 238 patients with hypertensive intracerebral hemorrhages, who were treated at the Kyiv City Clinical Hospital of Emergency Medical Care from 2018‒2019, was conducted. The majority of patients were men (163). Results. The average age of patients was 60 years. Patients are divided into age groups according to the WHO classification (2016). Young age (18‒44 years) ‒ 25 (23 men and 2 women), average age (45‒59 years) ‒ 91 (74 men and 17 women), old age (60‒74 years) ‒ 90 (52 men and 38 women), old age (75‒90 years) ‒ 32 (14 men and 18 women). There are no long-lived people (>90 years). 84 patients were operated on, and 94 surgical interventions were performed. Patients with lobar and lateral hematomas, as well as with significant hemorrhages with a breakthrough in the ventricular system, who underwent fluid-draining surgical interventions, were operated on. The total mortality was 39.5 %. Surgical mortality rate was 46.4 %. Conclusions. According to the conducted analysis and the data of the Center for Medical Statistics of the Ministry of Health of Ukraine, the incidence of hemorrhagic stroke is many times more frequent in men, which is most likely due to a more aggressive lifestyle, lack of control over arterial hypertension, bad habits (alcohol consumption and smoking). The highest mortality rate was observed in elderly patients (47 %) and young patients (48 %), regardless of the patient’s condition at the time of admission.

Over the past twenty years, it has been proven that a history of preeclampsia entails a 4-fold risk of hypertension, coronary heart disease, stroke, type 2 diabetes, metabolic syndrome in the affected women at the age of 50-55 years. Evaluation of intima-media thickness (IMT) has diagnostic value for the assessment of remodeling and atherosclerotic vascular lesions and practical importance as a predictor of vascular accidents in patients with hypertension and atherosclerosis. The aim. To evaluate the IMT as an integrative biomarker of the occurrence of cardiovascular pathology in women with hypertensive disorders of pregnancy in their advanced reproductive age and in perimenopausal age. Materials and methods. We studied 51 women at the age of 48-55 years with the history of severe preeclampsia. The women were asked to fill out a questionnaire in which they indicated the presence of a diagnosis of hypertension, angina pectoris at the time of filling the questionnaire. The diagnosis of hypertension and angina attacks as well as other descriptions of the disease were taken away from the results of the women’s questionnaire. The investigators were not given copies of medical records. The control group consisted of 20 women aged 48-55 who had no history of preeclampsia or any other hypertensive disorders of pregnancy. Ultrasound imaging of the carotid arteries was performed according to the recommendations of the American Society of Echocardiography 2020 in women of both groups using SonoAce-8000 Ex scanner (Medison, South Korea) with a linear sensor UST5524 with a frequency of 7 MHz. IMT less than 0.7 mm was taken as a normal value for women. Results. It was revealed that almost every fourth woman at the age of 48-55 with the history of preeclampsia had signs of early angina attacks, and 30% suffered from hypertension. A threatening fact is that almost 6% of women at the age of 48-55 had the history of vascular thrombosis which is a manifestation of early atherosclerotic vascular lesions in the group of women with gestational hypertensive disorders. It is noteworthy that 21 (41.2%) women with the history of severe preeclampsia felt healthy and did not have any complaints. Importantly, among the women surveyed who had no health complaints, 66.6% (14 of 21) had IMT 0.85±0.01 mm. This accounts for about one third (27.4%) among 51 patients. This category of women is at high risk of developing cardiovascular complications in the future and require further monitoring and detailed examination. Thrombotic complications (dynamic bowel obstruction, mesenteric vascular thrombosis) were observed in 3 (5.9 %) women at the age of 48-55 with the history of severe preeclampsia. Conclusions. Examinations of women with the history of preeclampsia revealed that women at the age of 48-55 had increased IMT. It should be noted that increased IMT was found both in women with cardiovascular pathology (hypertension, thrombosis, angina attacks) and in asymptomatic patients. Taking into account that increased IMT is one of the characteristics of target organ damage in patients with hypertension and the marker of cardiovascular events in asymptomatic patients, it is important to include this examination in follow-up for women with the history of severe preeclampsia in order to avoid the development of early severe cardiovascular pathologies.

Infective endocarditis is a serious diagnostic and therapeutic challenge for doctors of many specialties. In order to form a structured approach to patient management, the article discusses the key points regarding the neurological aspects of the disease, which are formulated in ten rules. They cover the clinical diagnosis of endocarditis in patients with stroke, features of reperfusion therapy, approaches to prescribing antithrombotic and antibiotic therapy, as well as issues of surgical treatment.

Covid-19 can manifest with serious neurological complications and hypercoagulability. Latest data from China showed neurological complications in 36% of 214 COVID-19 patients- mainly ischemic stroke. Coagulopathy associated with Covid-19 was reported to increase the risk of stroke also in young adults without comorbidities. A 29-year-old patient with hypertension admitted to the hospital with dysarthric speech and balance disorders and dizziness with vomiting was referred for thrombectomy of an occluded basilar artery after ineffective RTPA therapy. After the thrombectomy, a gradual reduction in the neurological deficit was observed-the permeability of the basilar artery was restored. However, during the intervention, the posterior right cerebral artery was damaged and a short-term extravasation of the contrast blood to the subarachnoid space occurred. MRI showed minor multifocal ischemic changes in the area of the cerebellum, pons and cerebral peduncle. In the pre-hospital interview a week earlier, transient changes in smell and taste were noted. On the day of admission, the patient had a negative antigen and PCR tests for SARS-CoV-2- virus. Laboratory tests showed high D-Dimers (5696 H ng /ml) and reduced fibrinogen. After mechanical thrombectomy, the patient reported double vision when looking straight and left. He was correctly oriented with slight ataxia and a deficit of strength in the left limbs, meningeal symptoms were negative. It is important to understand the association between Covid 19 and the possibility of an ischemic stroke and coagulation changes in order to choose appropriate stroke treatment methods.

The aim of the study was to identify risk factors for ischemic events in residents of Kemerovo and Kemerovo region at 3-year follow-up. Material and methods. The study included participants (n = 638, ages 35 to 70 years), permanently residing in Kemerovo or the Kemerovo region of the prospective epidemiological study conducted at the Research Institute for Complex Issues of Cardiovascular Diseases from 2015 to 2020. The exclusion criteria were prior myocardial infarction (MI), angina pectoris and/or diagnosed peripheral artery disease. The main socio-economic and behavioral characteristic and health status of participants were determined by means of questionnaire, data of some participants were collected from medical records (case history, patient discharge summary, results of laboratory and instrumental examinations). Food Frequency Questionnaire was used to capture an individual`s usual food consumption. International Questionnaire on Physical Activity was used to measure health-related physical activity of participants. Data regarding the end points (all-cause death or death due to cardiovascular events, de novo angina, MI, stroke) were collected at 3-year follow-up. Results. Out of 638 participants, death was reported for 22 cases (of which 4 deaths were due to cardiovascular events), 6 developed non-fatal MI, 45 had de novo angina, and 12 had a non-fatal stroke at 3-year follow-up. A composite endpoint (CE) developed in 80 study participants during 3 years of follow-up. Logistic regression analysis revealed a significant association between CE and the following factors: obesity at the beginning of the study (odds ratio (OR) 2.09, 95 % confidence interval (95 % CI) 1.03–4.26) (an adjusted OR (AOR) 2.17, 95 % CI 1.06–4.44)), regular (at least once a month) alcohol consumption at the time of the survey (OR 2.33, 95 % CI 1.23–4.42 (AOR 2.29, 95 % CI 1.21–4.34)), participants stating that they have been thinking about death during previous month (OR 3.22, 95 % CI 1.54–6.76 (AOR 3.74, 95 % CI 1.73–8.07)). The following factors had the weakest association with the risk of ischemic events at 3-year follow-up: disability due to injury and occupational diseases (OR 0.19, 95 % CI 0.07–0.51 (AOR 0.21 (0.08–0.57)), taking medication for a month (OR 0.37, 95 % CI 0.17–0.81 (AOR 0.36, 95 % CI 0.16–0.80)), in particular, antihypertensive drugs (OR 0.43, 95 % CI 0.22–0.81 (AOR 0.43, 95 % CI 0.22–0.82)) and lipid-lowering drugs as a part of primary prevention (OR 0.33, 95 % CI 0.15–0.70 (AOR 0.33, 95 % CI 0.15–0.73)). Moreover, low physical activity associated with the use of transport in daily travels (car, bicycle) proved to be conditionally protective in relation to CE (OR 0.48, 95 % CI 0.25–0.94) (AOR 0.49, 95 % CI 0.25–0.96)). Conclusions. The identification of a number of significant «non-conventional» risk factors for development of ischemic events in residents of Kemerovo and Kemerovo region without prior atherosclerotic cardiovascular diseases at 3-year follow-up allows to consider them as additional modifiable risk factors within the framework of primary prevention.

Stroke in young patients is a disease based on a number of known specific non-modifiable factors (extracranial artery dissection, thrombophilia, open oval hole, etc.) and modifiable factors (alcohol abuse, drug use, smoking, etc.), in combination leading to the development of pathology. Smoking is a generally recognized modifiable risk factor for stroke, which is directly proportional to the number of tobacco-containing products smoked. Quitting smoking is the basis of prevention, an integral part of the treatment and rehabilitation of stroke patients. If it is impossible to completely give up smoking combustible cigarettes, it is advisable to switch to alternative smokeless products. This article presents the results of current studies on the comparative assessment of the risk of stroke in young people when using combustible cigarettes and smokeless analogues.

The review article describes modern approaches to hypoglycemia in diabetes mellitus (DM) patients, its clinical and laboratory diagnostics, and its current classification. Hypoglycemia has the highest impact on cardiovascular morbidity and mortality, including stroke. Cerebral damage in neuroglycopenia, as well as neurological aspects in this group of patients, are discussed. The authors describe glycopenia’s influence on cerebral metabolism, counter-regulatory response, and impaired hypoglycemia recognition, as well as modern neuroimaging techniques that may enhance differential diagnostics in complex cases. The epidemiology of neurocognitive disorders in DM patients and their association with hypoglycemic conditions is outlined, together with psychosocial aspects of its consequences — both for the patient and relatives and for the medical professionals. The search for ways to reduce the burden of hypoglycemia from the standpoint of an effective and safe strategy for treating patients with type 2 diabetes does not lose its relevance, and therefore data on the prevalence of hypoglycemic conditions of varying severity when using certain classes of hypoglycemic drugs are presented. A therapeutic approach that maximizes metabolic control while reducing hypoglycemia to a minimum may determine further possibilities for personalized DM management.

Introduction. More than 50,000 haematopoietic stem cell transplantations (HSCTs) are performed worldwide each year to treat malignant blood cancers, solid tumours, bone marrow aplasia, primary immunodeficiency conditions, autoimmune disorders, and storage disorders. The success of HSCTs depends on many factors, including patient's past medical history. Purpose. To assess the effect of an acute cerebrovascular accident (CVA) that occurred before the HSCT on the transplantation outcome in patients with blood cancer. Materials and methods. We examined the results of 899 transplantations conducted between 2016 and 2018 at the R.M. Gorbacheva Research Institute for Pediatric Oncology, Haematology and Transplantation of the Pavlov First Saint Petersburg State Medical University. We analysed transplantation parameters, as well as donor and recipient characteristics. Apart from intergroup comparisons, pseudo-randomization was performed using the Propensity Score Matching method. The survival rate analysis was conducted using the KaplanMeier estimate and the log rank test. Results. Sixteen patients (1.8%) had cerebrovascular events in their past history before the HSCT: ischaemic stroke in 0.4% of cases and haemorrhagic stroke or intracerebral haemorrhage in 1.4% of cases. Patients with a history of cerebrovascular events included more people with leukaemia (p = 0.02), had more often received an allogenic transplant (р = 0.01), the donors more often had a partial rather than a full HLA match with the recipient (р = 0.06), had a lower body mass index (р = 0.02), and a lower Karnofsky/Lansky score (р = 0.01) than patients in the control group. The presence of a cardiovascular event had a statistically significant association with reduced overall survival rate of HSCT recipients (р = 0.0012). Conclusion. Patients with blood cancer and stroke preceding the transplantation do not typically have any 'classical' risk factors (diabetes mellitus, venous system disorders, decreased cardiac output, significant atherosclerotic changes in precerebral arteries), therefore, secondary prevention guidelines for CVA during treatment of the main disease may not be effective and cannot be relied on. This article discusses the most likely causes of CVA in patients with blood cancer. A history of CVA before HSCT may have a significant effect on the transplantation outcome, but is not a contraindication for this treatment method. Recipient selection is a very important stage in HSCT planning. A multidisciplinary team should find a balance between the indications and contraindications for performing HSCT from an unrelated donor.

Today stroke is an urgent medical and social problem in our country, which is associated with a high disability of patients, especially people of working age. In this regard, one of the urgent tasks of the health care of the republic is to reduce the level of disability, improve the quality of life of patients after a stroke and return to work. In order to achieve such goals, it is necessary to introduce early rehabilitation methods into clinical practice, with a study of the issues of safety and effectiveness in the long term. To ensure the safety of the procedure and to determine the rehabilitation potential, the state of the autonomic nervous system has been actively studied in recent years. In this connection, we analyzed the literature data with the search for original articles on the early rehabilitation of patients with stroke over the past 10 years. [ABSTRACT FROM AUTHOR]