[An experience of using divasa in the treatment of cerebrovascular insufficiency]

[Pathogenesis of endothelial dysfunction in cerebral atherosclerosis and their correction]

The authors review the studies on oxidative stress in the pathogenesis of cerebrovascular diseases (CVD) and highlight a contribution of endothelial dysfunction to the CVD development. Own experience of using divasa in patients of old and very old age with chronic CVD comorbid to cerebral atherosclerosis is described.

Endothelial dysfunction a significant marker of adverse clinical outcome in patients with atrial fibrillation after cardioembolic stroke

Aim. To study the prognostic significance of endothelial dysfunction (ED) markers in the development of adverse clinical outcome (death) in patients with atrial fibrillation (AF) within a year after cardioembolic stroke. Materials and methods. 260 patients with newly diagnosed (nAF), paroxysmal, persistent and permanent forms of AF who underwent stroke were included. Duration of observation-12 months. V1 - the beginning of the study: V2 - 180 (±5) days and V3 - 360 (±5) evaluated the level of von Willebrand factor (fW), antithrombin III (AT III) and plasminogen. Results and discussion. During the year of follow-up, patients with AF who underwent and had a high mortality rate. During the whole period 38 (14.6%) patients died, 15 (23.0%) - in the group with nAF, 6 (9.2%) - in the group with paroxysmal AF, 7 (10.8%) - in the group with persistent AF and 10 (15.4%) - in the group with permanent AF. After a year of follow-up, the level of fW in patients with nAF was higher than in patients of all groups, and statistically significant in patients with paroxysmal and persistent forms of AF. At III was important in the group of patients with nAF and with a constant form of AF, in the same groups there was no statistically significant increase in a year of follow-up. It was found that in survivors with nAF at III (73.54±8.67%) higher (p=0.002) compared with the dead (65.77±6.01%). In the group of patients with paroxysmal AF in survivors of III (77.75±10.15%) higher (p=0.031) compared with the dead (69.25±5.80%). In patients with persistent AF, the survivors of III (76.57±9.09%) were higher (p=0.002) compared to the dead (65.60±2.21%). Taking into account the results of the analysis of the dynamics of ed markers, it can be assumed that AT III is the most accurate prognostic marker for the studied cohort of patients. Conclusion. Detection and correction of ED in AF in patients within a year after stroke can optimize the tactics of management of patients and improve the prognosis of the diseas.

[Dynamics of the cognitive sphere indicators and neurotrophic factors in the course of balneotherapy of dyscirculatory encephalopathy]

BACKGROUND

The natural factors of therapeutic significance play an important role in the rehabilitation of the patients suffering from chronic disorders of cerebral circulation since they are known to promote the development of the compensatory and adaptive processes. However, there is virtually no information in the relevant literature publications about the influence of balneotherapy on the dynamics of the cognitive sphere indicators and neurotrophic factors.

AIMS

The objective of the present study was to evaluate the effectiveness of balneotherapy as a component of the combined treatment of the patients presenting with discirculatory encephalopathy based on the investigations into dynamics of the neuropsychological status and the quantitative content of the neurotrophic factors in the peripheral blood, with special reference to the brain-derived neurotrophic factor (BDNF) and ciliary neurotrophic factor (CNTF), in the patients receiving the balneotherapeutic treatment based at they at the 'Kluchi' health resort.

MATERIAL AND METHODS

A total of 72 patients presenting with the 1st and 2nd stages of chronic cerebral ischemia were examined (including 9 men and 63 women at the mean age of 62.2±2.1 years). They were given the health resort -based treatment during 14 days while staying at the 'Kluchi' resort located in the Perm region. The examination of all the patients included the psychometric testing and the determination of blood serum neurotrophic factors (BDNF and CNTF). The patients were allocated to three groups depending on the character of the prescribed treatment. The first group consisted of 29 subjects, who were given the conventional therapy (the alternation of hydrogen sulphide muds and baths number 7, daily massage of the neck-collar region in the combination with exercise therapy). The second group was comprised of 32 persons who received the standard course of chloride-sodium bromine baths number 7. The third group was composed of 11 persons suffering from chronic cerebral ischemia who received no balneo- or peloid therapy whatever.

RESULTS

The study has revealed the different stages of cognitive and emotional disorders combined with the initially reduced level of BDNF in the blood serum of the examined patients. The level of BDNF in the peripheral blood of the patients comprising the first group increased from 3.68±2.15 to 5.02±2.88 ng/ml after the course of balneotherapy. These values were significantly higher than before the treatment (p=0.000). In the patients of the second group, the level of situational and personal anxiety estimated with the use of the Spielberger-Khanin test decreased in association with the improvement in the cognitive sphere after they received the standard course of balneotherapy including the usual chloride-sodium bromine baths. Simultaneously, the level of BDNF in the peripheral blood of these patents increased from 4.00±2.3 to 5.39±2.44 ng/ml (p=0.02). The patients of the third group, who were given no treatment whatever displayed no statistically significant changes of the studied parameters.

CONCLUSION

The health resort-based treatment including the course of chloride-sodium bromine baths has a direct beneficial influence on the neuroreparative and neuroprotective functions in the patients presenting with chronic cerebral ischemia owing to the increase in the level of neurotrophic factors in the blood.

[Results of multicenter study of efficacy and safety of divaza in the treatment of the asthenic and mild to moderate cognitive disorders in elderly and senile subjects]

AIM

To study the efficacy and safety of divasa in elderly and senile subjects with asthenic and mild to moderate cognitive disorders.

MATERIAL AND METHODS

The study included 126 patients with clinically significant asthenia and mild to moderate cognitive disorders. Asthenia was assessed with MFI-20, cognitive disorders with MMSE, clock drawing test and verbal association test. All patients were treated with divasa in dose 2 tablets 3 times a day.

RESULTS AND CONCLUSION

The efficacy and safety of divasa in asthenic and mild to moderate cognitive disorders in elderly and senile subjects were shown. There is a need for a multicenter placebo-controlled trial on the efficacy of divasa to treat cognitive and asthenic disorders in elderly patients.