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Vol 26, No 3 (2020)

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Reviews

COVID-19: from neurotropism to neurorehabilitation under a pandemic condition

Merkulov Y.A., Kostenko E.V., Merkulova D.M., Lyamina N.P.

Abstract

In the review presented, based on the relevant literature data from foreign experts, the mechanisms of the neurotrophic action of the SARS-CoV-2 virus are considered, as well as the consequences of its neuroinvasion in the form of documented neurological manifestations during the COVID-19 pandemic. The risks of neurological diseases and methods of their treatment are analyzed, which in turn can affect the susceptibility to COVID-19. The range of rehabilitation syndromes is systematized, and relevant aspects of medical rehabilitation of patients after COVID-19 with an emphasis on its neurological manifestations are highlighted.

Medical Journal of the Russian Federation. 2020;26(3):179-187
pages 179-187 views

Cochleovestibular disorders: clinical and pathogenetic aspects

Tardov M.V., Damulin I.V.

Abstract

The article discusses the pathogenetic and clinical aspects of vestibular and cochlear disorders such as dizziness, tympanophony, and vestibular ataxia. It is emphasized that the vestibular system provides not only the relationship between motor and sensory processes but its functions are also much more significant. The uniqueness of the vestibular system consists of its multisensory cortical projections. The analysis of vestibular information is provided by a network of connections, which its epicenter is located in the depths of the Sylvian fissure and the surrounding parietal-temporal regions, and the retroinsular region. It has been suggested that the vestibular cortex can be considered a network of connections between all cortical areas receiving impulses from the vestibular system, including regions where vestibular information affects the analysis of other sensory (i.e., somatosensory and visual) and motor activity. The pathogenetic mechanisms of dizziness, tympanophony, and ataxia are discussed. The conclusion is made about the significance of connectome disorders in this patient category.

Medical Journal of the Russian Federation. 2020;26(3):188-194
pages 188-194 views

Clinical medicine

One single or stage carotid endarterectomy from two sides?

Kazantsev A.N., Chernykh K.P., Zarkua N.E., Leader R.Y., Kubachev K.G., Bagdavadze G.S., Kalinin E.Y., Zaitseva T.E., Chikin A.E., Linets Y.P.

Abstract

The work aimed to analyze hospital complications of bilateral single-step carotid endarterectomy (CEE): phased CEE with intervals of 7 days and 1 month.

Material and methods. This cohort, comparative, retrospective, open-label study, from January 2008 to April 2020, included 949 patients with bilateral hemodynamically significant stenosis of the internal carotid arteries (ICAs). The inclusion criteria were as follows: (1) asymptomatic ICA stenosis ≥70%, (2) symptomatic ICA stenosis ≥60%, (3) a comparable degree of bilateral ICA stenosis, (4) lack of contralateral ICA occlusion, (5) the implementation of the conventional CEE, (6) visit of patients for both revascularization stages with a phased strategy, and (7) absence of pathology that limits follow-up in the long-term postoperative period. Depending on the time interval between two revascularizations, all patients were divided into three groups: group 1 with single-staged bilateral CEE (n = 178), group 2 with bilateral CEE (n = 312), and group 3 with bilateral CEE with a 1-month interval (n = 459).

Primary control points were taken as the development of adverse cardiovascular events, such as fatal outcome, myocardial infarction, acute cerebrovascular disorder/transient ischemic attack, and thrombosis/restenosis in the reconstruction area, combined endpoint.

Results. In the hospital follow-up period, all cardiovascular events were recorded in Groups 2 and 3. Moreover, the vast majority of them were identified in the intervals between the stages of revascularization.

Conclusion. Simultaneous bilateral CEE has demonstrated its efficacy and safety in the form of absence of adverse cardiovascular events in the postoperative period with respect to phased revascularization methods. An additional advantage of this method is the achievement of complete revascularization of the brain in patients with bilateral ICA stenosis and low compliance, which is protective in case of the patient’s failure to visit the next stage of surgical correction and development of ischemic complications in the nonoperated field.

Medical Journal of the Russian Federation. 2020;26(3):145-151
pages 145-151 views

Diagnostic and treatment algorithm for patients with electrical injury

Sachkov A.V., Grin A.A., Sinkin M.V., Godkov M.A., Spiridonova T.G., Zhirkova E.A., Svetlov K.V., Aleynikova I.B., Klychnikova E.V., Migunov M.A.

Abstract

Determining the amount of tissue damage in electrical injury at an early stage is an extremely urgent task since the approach and therapeutic strategy depend on it to a great extent. We evaluated the informative value of various diagnostic methods, which enabled us to establish the degree and amount of tissue damage in the early stages after the electrical injury and to develop an algorithm for examining and treating the patients. The algorithm included studying the sensitive and motor function of the affected extremity and determining the creatine phosphokinase level, electroneuromyography, and stimulation neuromyography (preoperatively and intraoperatively). The algorithm allowed an accurate diagnosis of the damage and initiation of surgical treatment at an earlier stage.

Medical Journal of the Russian Federation. 2020;26(3):152-160
pages 152-160 views

Method of conscious correction of scoliosis and postural disorders in comprehensive remedial treatment of idiopathic scoliosis of the lumbar spine

Levkov V.Y., Shavyrin I.A., Lobov A.N., Panyukov M.V., Andronova L.B., Polyaev B.A., Plotnikov V.P., Butorina A.V., Tsoy S.V.

Abstract

The study aimed to substantiate the effectiveness of applying a new method of physiotherapy exercise called Conscious Correction of Scoliosis and Postural Disorders (CCS) in children and adolescents with a diagnosis of 1º–3º idiopathic scoliosis (IS) of the lumbar spine.

Material and methods. Seventy patients diagnosed with IS were under our supervision. The curvature arc was localized in the lumbar spine, and no compensatory arches were noted in other regions. The radiographs were performed in a standing position in a direct projection before and after 2 years of comprehensive therapy, including individual isometric, derotational, respiratory, and other complexes of physiotherapy exercises according to the methods of CCS, Schrot, and Chéneau corsets, were analyzed.

The patients were divided into three groups depending on the disease severity. The average age was 12.4 (9–15) years, with a predominance of women (84%). The angle of curvature was between 6° and 35°, according to Cobb.

Conclusion. The complex application of the early diagnostics system and timely treatment of lumbar spine IS using physiotherapy exercises according to the CCS method achieved regression and stabilized the disease course in patients with a deformity of up to 16°. The use of a Chéneau-type corset with IS of 20° or more achieved significant correction and stabilization.

Medical Journal of the Russian Federation. 2020;26(3):161-164
pages 161-164 views

Intellectual and mnestic disorders in children with spastic forms of infantile cerebral palsy depending on the level of gross motor functions

Dzhomardly E.I., Lorer V.V., Koltsov A.A., Zolotareva A.A.

Abstract

Background. The clinical manifestations of infantile cerebral palsy (ICP) are caused by both basic neurological and other comorbid conditions, such as secondary orthopedic and statodynamic disorders, hearing and speech disorders, nutritional disorders, epilepsy and, often, intellectual and mnestic disorders. Accordingly, the approach to treatment and rehabilitation of such patients should be interdisciplinary. To improve the quality of communication between different specialists, the International Classification of Functioning, Disability, and Health (ICF) has been developed and is actively being introduced into clinical practice.

The study aimed to investigate the intellectual and mnestic functions in children with spastic forms of ICP depending on the gross motor function level.

Material and methods. A prospective examination of 73 pediatric patients with spastic forms of ICP, aged 4 to 17 years, included by random sampling, was performed. The patients were divided into five groups based on the classification of the Gross Motor Function Classification System (GMFCS). The study methodological basis is ICF basic provisions. To assess the intellectual and mnestic functions, six categories were used, which are included in the ICF section “Mental functions.”

Results. A correlation between the intellectual and mnestic disorders and the GMFCS level was revealed. Multiple pairwise intergroup comparisons showed statistically significant differences (p < 0.05) for all categories under study between Groups GMFCS 1 and GMFCS 5, GMFCS 2 and GMFCS 5, and GMFCS 3 and GMFCS 5, although the difference between Groups GMFCS 4 and GMFCS 5 was identified in only three categories.

Conclusion. The severity of disorders of the intellectual and mnestic functions in ICP pediatric patients varies widely depending on the level of gross motor functions. A correlation was revealed between the main intellectual and mnestic function indicators and the GMFCS level. Assessment of intellectual and mnestic functions due to its variability in pediatric patients with different levels of GMFCS when choosing the optimal treatment approach is appropriate.

Medical Journal of the Russian Federation. 2020;26(3):165-172
pages 165-172 views

Clinical pharmacology and pharmaceuticals

Possibility of application of the disk diffusion method for studying the sensitivity of coagulase-negative staphylococcus to ceftaroline

Bozhkova S.A., Gordina E.M., Shneider O.V.

Abstract

Ceftaroline is a modern broad-spectrum antibiotic (generation V of cephalosporin), an active metabolite of ceftaroline fosamil. The bactericidal effect of the drug is due to its high affinity of penicillin-binding protein PSP2a (mecA gene), which is responsible for the resistance of staphylococcus strains to methicillin. To determine the antibiotic sensitivity of microorganisms in the bacteriological laboratories of the Russian Federation, the disk diffusion method is widely used, which determines the sensitivity categories as resistant, moderately resistant, or sensitive. However, for several antibacterial drugs, including ceftaroline, criteria for assessing the efficiency only for Staphylococcus aureus are regulated, although coagulase-negative staphylococci (CoNS) are capable to cause various nosocomial infections and are a reservoir of mobile genetic elements determining staphylococci resistance to beta-lactam antibiotics. In cases of testing the sensitivity of CoNS to ceftaroline without established criteria for sensitivity/resistance, doctors cannot interpret the results reliably. In our study, we analyzed the sensitivity of 227 strains of seven CoNS species to ceftaroline. In 93.4% of cases, Staphylococcus epidermidis cultures were identified, and Staphylococcus saprophyticus and Staphylococcus lungdunensis were detected in 3.1% and 2.2% of cases, respectively. Based on the difference in the control points for cefoxitin for S. aureus and S. epidermidis, we proposed options for evaluating the sensitivity/resistance to ceftaroline for CoNS strains. In accordance with these criteria, 88.4% of the cultures selected demonstrated sensitivity to the drug. Moreover, 97.5% of the strains of methicillin-sensitive S. epidermidis were sensitive to ceftaroline, and only 2.5% were moderately resistant. Resistance to ceftaroline was demonstrated by 4.5% of methicillin-resistant S. epidermidis isolates, which in turn were characterized by poly- and pan-resistance. Representatives of the other six species being studied were sensitive to ceftaroline in 100% of cases. The results confirm the high activity of ceftaroline against CoNS. The proposed evaluation criteria interpreted the results more accurately, supplemented the existing antibioticograms, and used ceftaroline in treatment of infections caused by such bacteria.

Medical Journal of the Russian Federation. 2020;26(3):173-178
pages 173-178 views

Health care organization and public health

Organization of educational activities within the continuing medical education

Morozov S.L., Mironova A.K., Dlin V.V., Kubatkina N.G., Tsaregorodtsev A.D.

Abstract

This article discusses the issues of continuing medical education in the Russian Federation and its various forms. Particular attention is paid to the principles of organizing educational activities in the system of continuing medical education. As everywhere in the world, in Russia, educational activities contribute to the professional development of specialists since the events organized include the results of the recent scientific achievements in diagnostics, treatment, and prevention of the most common diseases. These events are the driving forces of practical health care, as they are at the forefront, and solve educational problems successfully. The example presented in the article represents the main approaches to organizing major events in the system of continuing medical education.

Medical Journal of the Russian Federation. 2020;26(3):138-144
pages 138-144 views


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