2018, volume 14

Aim: to study the effect of hyperglycemia on the course and clinical outcome of ischemic stroke (IS) in the acute period. Material and Methods. A total of 862 patients with IS (370 men, 492 women), mean age was 66.1±10.8 years. The degree of neurological deficit (NIHSS scale) and functional disorders (Rankin scale), clinical outcome were assessed. When admitted to hospital, a study of the level of glycemia on an empty stomach was conducted. Results. In 186 (21.6%) patients type 2 diabetes Mellitus (DM) was diagnosed. In 27.8% of patients without DM and 76.3% of patients with DM hyperglycemia was detected. In patients without DM with hyperglycemia, higher than in patients with normoglycemia, the representation of women (by 9.9%), cardioembolic stroke (by 10.5%), severe neurological deficit (by 14.7%), gross impairment of vital activity (by 14.0%), a decrease in the frequency of noticeable positive dynamics (by 14.8%), an increase in mortality (by 11.5%). In patients with DM, hyperglycemia was associated with a higher assessment rate on the Rankin scale of 4-5 points (by 25.6%) and a decrease in the incidence of noticeable positive dynamics (by 27.7%). Conclusion. Development of IS is characterized by high representation of disorders of carbohydrate metabolism (21,6%). The severity of glucose metabolism disorders is interrelated with the severity and clinical outcome of the disease.

Objective: to study the clinical case of a patient with fungal dacryocanaliculitis. The patient with dacryocanaliculitis received a standard ophthalmological examination and tests with the disappearance of the dye. The contents of the lacrimal duct were examined. Only a comprehensive examination of the patient using various diagnostic methods may allow specialists to make a diagnosis and to administer the necessary treatment.

The absence of a single classification and generally accepted terminology of comorbidity leads to a different understanding of the issues of diagnosis of comorbidity. Comorbidity is a complex system in which the patient is both an integral object and part of this system, which includes diseases complexes. As it is known, the success of solving diagnostic problems, especially in the presence of comorbidity ultimately determines the consistency and validity of the findings, and, consequently, the effectiveness of the diagnosis as a whole. Previously, we proposed an integrative method which, preserving the system approach and the method of comparison, suggests using the sum of data from genetic, constitutional, immunological, anthropological and other types of examination to obtain the most complete representation not only of the nature of the disease, but, first of all, the patient himself. Proceeding from the foregoing, the present review focuses not only on the features of compiling a "patient diagnosis" in the presence of comorbidity but also on the sequence in which the pathological conditions should be considered and reflected in the main diagnosis in the presence of several active processes.

The aim of the article is to present a clinical case of rapid generalization of eosinophilic granulomatosis with polyangiitis. The course of disease with multiple organ lesions and the heart being affected the most is described. Remission is achieved by combined therapy with corticosteroids and cyclophosphamide.

The adipose tissue is the endocrine organ secreting polypeptide factors, such as adipokines, which are involved in the regulation of feeding behavior, the metabolic, endocrine and inflammatory processes and insulin sensitivity. In obesity and type 2 diabetes mellitus (DM2), the production of adipokines and the activity of their signaling pathways are changed, which plays an important role in the relationship between obesity, insulin resistance and DM2. In the review (according the types of obesity) the data on the production of adipokines with diabetogenic (leptin, visfatin, chemerin, vaspin, apelin, resistin) and antidiabetic (adiponectin, omentin) properties by the adipose tissue, as well as the possible role of adipokines in the development of obesity and DM2 were discussed.

Aim: to reveal gender and age peculiarities of daily dynamics of systolic aortic pressure (SBPao), diastolic aortic pressure (DBPao), mean hemodynamic aortic pressure (MBPao) and pulse aortic pressure (PPao) in healthy adolescents. Material and Methods. Ambulatory blood pressure monitoring was performed in 354 healthy adolescents (184 girls, 170 boys) aged 12-17 years. Results. Daytime, nighttime and diurnal levels of SBPao and PPao were significantly lower in girls, than that of boys. Boys had significantly lower daytime and diurnal levels of DBPao than girls. Nighttime level of MBPao was significantly higher in boys than in girls. Growth positively correlated with daytime, nighttime and diurnal levels of SBPao (r=0.3, r=0.4and r=0.4 respectively) in boys 12-17 years old. Correlation analysis in girls 12-17 years showed a weak positive relationship between growth and nighttime, daytime and diurnal levels of SBPao (r=0.14, r=0.2 and r=0.14 respectively). Conclusion. The observed differences between age subgroups could be associated with the different velocity of pubertal development in the examined adolescents, as well as with the different role of hormonal and neuronal regulation mechanisms in the formation of aortic pressure level and its diurnal dynamics.

Aim. This study was conducted to establish levels of knowledge in the general population, and also to determine the impact of educational sessions on stroke knowledge. Material and Methods. Two groups (2014 and 2017 years) completed a stroke knowledge questionnaire (435 respondents). Results. Overall, most of respondents could list 2 or more risk factors, but only 50% in 2014 could list 3 warning signs. More than 80% would call emergency number in response to stroke, but only 25% had heard of thrombolytic therapy. Overall stroke knowledge scores decreased in 2017 despite the public awareness in the media. Conclusion. Currently the knowledge of stroke risk factors, warning signs, and treatment is poor in Saratov. Our study demonstrates that more educational campaigns should be conducted for improve knowledge of stroke symptoms, and therapy.

 The article presents clinical observation of patient H, 2007 year of birth., with X-linked adrenoleukodystrophy (X-ALD). This is a rare hereditary metabolic disease, not only in Russia but also worldwide. It belongs to the group of peroxisomal diseases, is associated with the accumulation of fatty acids with a very long chain and is characterized by a combined lesion of the nervous system and adrenal glands. X-ALD in neurology and Pediatrics require a targeted individual approach to each patient, genetic tests in relatives and prenatal diagnosis among patients at risk.

Toxoplasmosis is one of the most common opportunistic infections in HIV-positive patients. The onset of HIV-infection with cerebral toxoplasmosis makes this disease a multidisciplinary problem and requires the participation of doctors of various specialties (infectious disease specialists, neurologists, neurosurgeons, general practitioners, etc.). Early diagnosis and treatment of this disease will reduce the risk of deaths and severe consequences. We carry out an analysis of the clinical case of toxoplasma encephalitis in a HIV-infected patient. We have identified errors in the establishing diagnosis. We have given a detailed account a patient management plan. We also comment on some of the problem early disease detection HIV-infection.

The aim was to examine the longitudinal association between myasthenia gravis clinical severity and concentration of acetylcholine receptor (AChR) antibodies to evaluate if AChR-antibody variations correlate to disease severity. Material and Methods. Antibodies were determined by enzyme immunoassay. The International Clinical Classification (MGFA) was used to grade the severity of the disease. The level of antibodies was compared with the severity of the condition and the form of the disease at the stage of diagnosis in 65 patients, as well as in repeated studies in 26 patients. Results. The titer of AChR-antibodies did not correlate with the severity of the condition, however, a direct relationship between the change in the level of acetylcholine receptor antibodies and the change in the clinical state during the course of the disease was obtained. Conclusion. Repeated AChR-antibody measurements will help to predict the clinical state of the patient and can be used to correct immunosuppressive therapy.