2020, volume 16

Purpose: to analyze the dynamics of formation and changes in the quality of life of multimorbid patients with chronic cholecystitis and gastroesophageal reflux disease (GERD). Material and Methods. 186 patients were examined: 82 patients were diagnosed with chronic cholecystitis in combination with GERD, 58 were diagnosed-only with chronic cholecystitis and 46 were diagnosed-only with GERD. The diagnosis of GERD was established according to modern criteria adopted by the International Consensus Group that studied the reflux disease and was confirmed by the results of daily esophageal pH measurements. Chronic cholecystitis was diagnosed on the basis of complaints, laboratory and clinical data and was confirmed by ultrasound analysis. The quality of life of patients was assessed using the SF-36 questionnaire. Results. In most cases gastroesophageal reflux (GERD) develops over the background of chronic cholecystitis (53.4%) while the reverse situation occurs only in 25.5% of cases. Simultaneous development of both diseases was observed only for 18.9% of patients. In most cases (45.1 %) GERD manifests itself during the 2nd to 4th year of chronic cholecystitis. The quality of life in patients with GERD has been ascertained to be lower than in those with chronic cholecystitis. The summary index of physical health in patients with chronic cholecystitis made 171.4±0.4 scores, while in the GERD group it did not exceed 146.8±0.2. Similar tendency was observed in the summary index of psychological health: in patients with GERD it was 26.3% (p<0.05) lower than in those with chronic cholecystitis. With polymorbidity developed against the background of chronic cholecystitis, the summary index of physical health reduces from 171.4±0.4 to 140.9±1.1 scores (p<0.05), while that of psychological health — from 254.8±0.6 to 144.5±0.8. In patients with GERD, chronic cholecystitis is practically non-essential for the state of physical health, while their psychological health declines substantially: from 188.5±0.6 to 144.5±0.8 scores (p<0.05). Conclusion. The risk of GERD development against the background of chronic cholecystitis is 1.9 times higher that of the reverse process. GERD usually develops over the 2nd to 4th year of chronic cholecystitis. Development of multimorbid state decreases the quality of life for patients with GERD and chronic cholecystitis with psychological health aspects being the most affected according to SF-36 questionnaire. The primary cause of the decreased quality of life for patients diagnosed with chronic cholecystitis and GERD is the almost twofold increase in the number of GERD exacerbations per year due to formation of multimorbid state.

A clinical observation of a comorbid state in a 72-year-old patient with chronic bronchopulmonary pathology is presented in the work. Gastroesophageal reflux disease and large Zenker's diverticulum have been revealed. Diseases manifested simultaneously, progressed in parallel, but were not regarded as comorbid, which did not allow optimizing their therapy and prognosis.

Amniotic fluid embolism (AFE) is one of the most severe complications of pregnancy, childbirth and early postnatal period, being associated with high risk of maternal mortality. AFE manifests as significant coagulopathy with hypocoag-ulation and activation of fibrinolytic system. In recent years, coagulopathy caused by amniotic fluid entry into maternal circulation is successfully treated with recombinant coagulation factors, including prothrombin complex concentrate, and activated blood coagulation factor Vila (Eptacog alfa activated). Authors present a case of successful sequential use of the above-mentioned blood coagulation factors for combined treatment of coagulopathic syndrome in patient with AFE, which clinically manifested during early postoperative period after delivery with caesarean section. The aim of this article is to demonstrate that above-mentioned drugs are not identical and to prove that all of them should be used only when clinical indications are present, confirmed by results of laboratory studies.

Objective: determination of the clinical and epidemiological features of familial multiple sclerosis (MS) in the population of Rostov-on-Don. Material and Methods. Subjects of the research were patients with idiopathic inflammatory demyelinating diseases (HDD) numbering 806 people, among them 710 people with MS according to McDonald criteria (2010, 2017), living in Rostov-on-Don. Results. In the analyzed population 78 family cases were revealed; among them was a patient with clinically isolated syndrome (CIS), one with radiologically isolated syndrome (RIS) in 44 families. The general risk of repetition in the population demyelinating account for 3.7%. The prevalence rate of the familial MS in the population was 6.9 per 100000 people. In the male-to-female correlation for cases of familial MS makes 1:3.5. In most analyzed cases of familial MS (61.2%), a woman had the disease. The onset age in the first generation was considerably higher than the one in the following generations, on average 13.1±4.8 years more. The first remission continued 2.6 years in the familial MS group. In the group of the familial MS, the average disease development speed is 0.8±0.3 points per year. An analysis of clinical features revealed a predominance of polysymptomatic debut, which was noted in 20.63% of cases. Conclusion. A burdened family history in patients with MS may bean unfavorable prognostic factor for the aggressive course of the disease, and given the predominance of women as "progenitors", it is possible to suggest the role of mitochondria in the pathogenesis of the disease.

Objective: to investigate the intelligence quotient (IQ) in children born to mother with epilepsy; to analyse possible factors affecting childhood IQ. Material and Methods. The Wechsler test (WAIS for adults and WISC for children) examined 47 pairs of "a mother with epilepsy — her child". Twelve women did not take antiepileptic drugs, 24 had monotherapy, 11 had polytherapy Treatment with valproic acid (VK) was received during pregnancy by 23 women (48.9%). Statistical processing was carried out by the method of correlation (according to Pearson) and variance (according to Fisher) analysis, by the method of "classification trees" CART. Results. The average indicators of the general, verbal and non-verbal IQ of children amounted to 118.7 points (Cl09579.5-158.0); 106.3 (Cl 67.7-144.9) and 128.0 points (Cl 93.2-162.7). The correlation between the age of the mother, taking VC and the level of IQ of the child was revealed. Univariate analysis of variance did not reveal the effect of the treatment regimen (mono-, polytherapy, without antiepileptic drugs, using VK, without VK) on the total IQ of the child (p>0.05), but a decrease in IQ was found in children who were brought up in single-parent families. Multifactor analysis showed that a decrease in the total IQ of the child is most likely to occur with the use of VK drugs in mothers with a total IQ level below 113 and at the age of the child's birth >32 years of age. Conclusion. Children of women with epilepsy are characterized with normal IQ level. When planning pregnancy, it is necessary to consider factors that affect the IQ of the offspring.

The contribution of K.N. Tretyakoff and the staff of the Department of Nervous Diseases to the organization of neurological care during the Great Patriotic War in Saratov is considered. The materials of the library of the Saratov Medical University, the archives of SSMU, Internet resources are analyzed.

Objective: to analyze awareness level among Saratov's population about stroke, and to identify regional characteristics of risk factors for the development of acute cerebrovascular accident (ACVA) based on the results of a survey. Material and Methods. A personal questionnaire was conducted through a personal conversation with the residents of Saratov who applied for medical care in polyclinics as part of the campaign "World Day Against Stroke" October 29, 2019. Results. The survey involved 123 people. Most respondents showed a high level of awareness of such risk factors for ACVA as arterial hypertension, obesity, high blood cholesterol, alcohol abuse, and smoking. The significance of cardiac arrhythmias, a history of transient ischemic attacks, and a hereditary predisposition to the development of stroke were underestimated by the participants of the action. The level of knowledge of the population about thrombolytic therapy and surgical intervention on the vessels of the neck and brain as the leading methods of treating stroke is insufficient. Conclusion. Public informing is necessary to increase the level of awareness about stroke, which allows motivating citizens to remain committed to a healthy lifestyle and eliminate risk factors for developing ACVA.

Objective: to study the level of thiamine in the blood plasma of patients undergoing long-term program hemodialysis, and the variability of dialysis-associated thiamine losses, to study possible thiamine-deficient neurological disorders in dialysis patients. Material and Methods. 85 patients who did not take vitamin-containing preparations for 1 year or more were examined. Patients were divided into a main group and a control group. The main group consisted of 45 patients with the dialysis stage of chronic kidney disease (dialysis experience of 75.2±59.0 months), the control group (n=40) is divided into 2 subgroups: 20 patients of the pre-dialysis period and 20 relatively healthy individuals. Blood plasma thiamine levels were analyzed by high performance liquid chromatography. Results. An analysis of the thiamine content in the blood plasma of patients of the main group revealed low levels of thiamine in all patients. The studied indicator did not exceed 54% of the norm. The frequency of detecting severe thiamine deficiency was 53.3%, moderate deficiency of 40% of cases, and plasma thiamine deficiency was observed in 6.7%. In the 1st control subgroup, a less pronounced decrease in thiamine content was detected, the average value was 73.7±11.1%. The average thiamine content in plasma in the 2nd control subgroup was 92.2±4.1 %. Conclusion. Among patients on program hemodialysis, there was a deficiency of thiamine and a neurological spectrum of disorders, including thiamine-deficient encephalopa-thy and polyneuropathy.

Objective: to assess the effect of changes in homeostatic constants of blood parameters in patients with cardioembolic stroke (CEI) on the clinical course and prognosis of the disease. Material and Methods. 90 patients were treated and examined in the acute period of CEI: 60 patients were discharged (main group) and 30 died (control group). A detailed study was made: general blood count, hemostasis, and biochemical changes in the blood. Neurological deficit was evaluated according to the NIHSS, Rivermead, and Rankin scales. Results. All homeostatic blood constants are higher than normal in patients who died compared to survivors (p <0.05). In patients with mortality on the first day, changes in blood biochemical parameters are more pronounced than in patients who died at a later date. The most pronounced changes in the biochemical analysis of blood (glucose, urea, creatinine, AsAT, AIAT), acid-base imbalance are associated with severe clinical manifestations of CEI and a high probability of death. The diabetes mellitus in patients with CEI is a kind of pathognomonic sign, marker and predictor of adverse outcome. Metabolic acidosis prevailed in the group of deceased patients, and respiratory acidosis prevailed in the group of survivors. Conclusion. Marked changes in homeostatic blood constants and pronounced neurological deficit at the time of the development of the disease are associated with severe clinical manifestations of CEI and a high probability of death.

Objective: to establish the frequency of occurrence of impaired hand function and evaluate the dynamics of its recovery in patients with lacunar ischemic stroke (LS). Material and Methods. 137 patients with acute LS were examined. All patients underwent clinical and neurological examination with a quantitative assessment of strength, sensitivity, coordination, praxis and hand function according to the use of Action Research Arm Test and 9-Hole Peg Test. Results. Hand dysfunction was revealed in 79% of patients with LS. The most pronounced disorders were observed with purely motor and sensorimotor variants of LS. In the first two weeks after the development of LS, a significant improvement, including complete restoration of upper limb function, was observed in 79% of patients and was associated with the initial severity of disorders. «Dysarthria — clumsy hand» syndrome more often than other variants of LS was characterized by a complete recovery of manual capacity. Conclusion. Hand function is impaired in most patients with acute lacunar stroke. The rate of its recovery depends on the initial severity of hand dysfunction and the lacunar stroke clinical variant. The obtained data can be used in the development of individual rehabilitation programs for this category of patients