The diagnosis of chronic cerebral ischemia (CHI) is based on the presence of vascular cognitive disorders (CD). Many patients diagnosed with CHI have other neurological or mental illnesses (primary headaches, vestibulopathies, anxiety and depressive disorders), which, unfortunately, are not diagnosed. Prevention of stroke, which is based on the correction of risk factors (smoking, alcohol abuse, low physical activity, and obesity), the treatment of hypertension, diabetes and other diseases is of major importance in the management of patients with CHI. Inhibitors of central acetyl cholinesterase and akatinol memantine showed efficacy in the management of significant vascular CD. The article discusses the issues of use of Divaza for the management of CHI, provides the results of DIAMANT multicentre observational study.

The results of the evaluation of a сellex drug effect on dynamics of a neurologic deficit regression in an acute ischemic stroke in patients with movement disorders and aphathic disorders are presented. 40 patients aged from 47 to 84 years, including 24 women and 16 men, in acute ischemic stroke with the development of motor and aphathic disorders were examined. Based on the results of the study, it was concluded that the early use of the drug сellex in complex therapy in the treatment of patients in the acute period of ischemic stroke with aphathic and motor disorders is effective. The drug helps to increase the effectiveness of logopedic exercises, non-drug methods of motor function recovery, thereby increasing the rehabilitation potential. 

The issue is devoted to modern approaches to the diagnosis and treatment of insomnia in patients with cerebrovascular pathology. A modern International classification of sleep disorders, a change in the classification and diagnostic criteria of insomnia is considered. The analysis of prevalence of sleep disorders, at the patients with stroke is carried out. The advantage of correcting these disorders with the help of Melaxen was shown.

Back pain is one of the most common reason for all physician visits, which makes the problem of rational therapy especially urgent. Non-specific dorsalgia is the most common in clinical practice, that is subdivided into acute, sub-acute or chronic. Modern guidelines for the treatment of acute and chronic non-specific back pain offer primarily the use of non-drug methods – cognitive-behavioural therapy and therapeutic gymnastics, and if they are ineffective – rational pharmacotherapy, taking into account the comorbid pathology in patients. Non-steroidal anti-inflammatory drugs, in particular Dexalgin, are the drugs of choice for the management of pain syndrome.

Status epilepticus (SE) is a medical emergency when a seizure lasts without a breach of continuity or when seizures occur close together. The International Antiepileptic League assigns a key value in the new definition of SE to the dynamics of the SE progression. The identification of acute symptomatic status epilepticus is of practical importance.  Pathophysiological processes occurring in a patient with SE can be divided into two phases: compensation and decompensation. The article provides the recommendations developed for each stage of medical care rendered to a patient with SE. 38 patients hospitalized with epileptic seizures for the period from January 2017 to April 2018 received medical examination and treatment. 7 patients had to be managed in the intensive care unit (18.4%). 64.3% of patients received parenteral therapy with valproate, 28.5% with levetiracetam, 7.1% additional anaesthesia and a third of patients underwent therapy correction  with tableted forms of antiepileptic drugs. The availability of drugs is an important economic indicator at the present stage of medical care.  Valproates, prolonged forms, including ready-made solutions for intravenous administration, continue to be ranked number one.

The long-term therapy of Parkinson’s disease (PD) with dopaminergic drugs is naturally accompanied by the fluctuations in symptoms and dyskinesia, and these complications are an extremely important factor that adversely affects the quality of life. The hyperactivity of glutamate NMDA receptors of the striatum plays an important role in the pathophysiology of medicinal dyskinesia, so the use of anti-glutamatergic agents, primarily amantadine, is currently the common method of combating dyskinesia. This article summarizes the current understanding of the mechanisms of action and the clinical effects of amantadine derivatives in patients with different stages of PD, with an emphasis on the antidiskinetic effect of this group of antiparkinsonian agents. It also presents the advantages of amantadine sulphate (PK-Merz) over other dosage forms (pharmacokinetics, duration of effect, tolerability, possibility of intravenous infusion administration), including those in the treatment of acute decompensation of PD.

The article presents clinical cases of patients with cerebral palsy (CP) in adolescence. The possibility of complex rehabilitation with the use of botulinum therapy (Xeomin) to reduce spasticity, improve active and passive movements is shown. Conclusion. The use of InkobotulinumtoxinА (Xeomin) has shown a significant, persistent, long-term effect on reducing spasticity, passive function and walking in adolescent patients with cerebral palsy. The use of the drug in the total dose of 7,8 to 9,1 U/kg body weight was effective and safe.

This article presents a clinical case of suboptimal response to multiple sclerosis therapy and an algorithm for treatment, taking into account the existing performance criteria.

The management of patients with osteoarthritis and comorbidity in the general medical practice is an urgent task. The article presents the recommendations of recent years on this problem, both international and national ones. The basic therapy for comorbid patients with osteoarthritis includes slow-acting anti-arthrosis drugs, mainly chondroitin sulfate and glucosamine, as well as their combination. The efficacy and safety of the combination has been proved by studies in recent years. The article presents an algorithm for managing comorbid patients with osteoarthritis by a primary care physician, taking into account concomitant diseases.

Objective. To assess the efficacy and safety of amtolmetin guacil (AMG) in patients with knee joint osteoarthritis (KJOA) and associated dyspepsia in real clinical practice.

Methods. 220 patients with KJOA with severe pain syndrome in KJ ≥ 40 mm in VAS and dyspepsia were included in the observation study. AMG was administered at a dose of 600 mg twice daily for 28 days. Patients had three visits: before starting treatment, on Day 14 ± 3 (visit 2), on Day 28 ± 3 (final visit) to assess the pain dynamics (according to VAS), stiffness and functional activity according to WOMAC index, general health assessment (according to VAS) and a quantitative assessment of dyspepsia (SODA index).

Results. Of 219 patients, about 72.5% reported pain reduction from 65 to 27 mm at the end of the study. All indicators of three scales of the WOMAC index decreased statistically significant (р<0,001). There was also a significant decrease of non-pain and pain signs of dyspepsia and an increase in the “treatment satisfaction” index (р<0,001). The patients showed better tolerability of AMG than that of previously taken NSAIDs.

Conclusion. AMG proved to be an effective drug with good tolerability and positive effect on associated dyspepsia.

Osteoporosis and its complications (low-energy fractures) are one of the significant health problems in many developed countries. Socio-economic costs aimed at the prevention and treatment of this disease are increasing every year due to the increased life expectancy of the population. Almost all drugs with an anti-fracture effect for the treatment of osteoporosis, which are used in the world,   are used in Russia. However, the incidence of fractures in the population is reduced insufficiently, which is due to not so much ineffective treatment as to low adherence to it. The article presents data of the observational study of 154 patients (4 men and 150 women, mean age 65 ± 7 years), who had osteoporotic fractures of four main localizations. Only 36% of the questioned persons started taking pathogenetic drugs. Patients with rheumatic diseases, which were followed up by a rheumatologist, received treatment statistically more often.  When analysing the reasons for the absence of pathogenetic therapy for osteoporosis, it turned out that no recommendations of a traumatologist, a therapist or general practitioner, who followed up patients after a fracture, were provided in 36% of cases.  Not a single patient had their repeated fracture risk estimated using FRAX probabilities, and only 12% of people were referred to densitometric examination. After consultation in a specialized osteoporosis center, the proportion of people who started taking anti-osteoporotic therapy increased almost 2 times.

The prevalence of hyperuricemia and gout is increasing, but comparative efficacy and safety of various treatment methods have not yet been evaluated. The network meta-analysis was aimed at comparing the efficacy and safety of various treatments for hyperuricemia. The systemic review included 15 randomized controlled trials (RCTs) involving 7246 patients during the period until January 2016 aimed at comparing the efficacy of various drugs that lower the level of uric acid (UA) (allopurinol, benzbromarone, febuxostat, pegloticase and probenecid) in hyperuricemia. The efficacy and safety of drugs (as the outcomes of this analysis) were evaluated after reaching the target level of UA in the serum and the occurrence of adverse events (AEs) regardless of their presence. Efficacy (its values expressed as odds ratios (OR) and 95% confidence intervals (CIs)), and drug safety were assessed by cumulative gradation probabilities. The results show that febuxostat, benzbromarone, probenecid, pegloticase and allopurinol were very effective for the treatment of hyperuricemia compared with placebo. Febuxostat was more effective and safer than other drugs. In addition, febuxostat 120 mg QD was more effective in lowering urate levels (OR: 0.17, 95% CI: 0.120.24) and safer (OR: 0.72, 95% CI: 0.56-0.91) than allopurinol.

Nowadays, HIV infection remains one of the major threats to global public health. The clinical signs of HIV infection are extremely diverse and associated with many, including rheumatic diseases. This review examines the issue of osteoarticular disorders in HIV positive patients. The article presents a detailed clinical description of individual nosological forms (HIVassociated arthritis, reactive arthritis, psoriatic arthritis, etc.) and considers the issues of differential diagnosis of these diseases. Modern approaches to the treatment of inflammatory joint diseases in HIV infection, including genetic engineering biological preparations are analysed.

The article is devoted to medical support of rehabilitation measures for post-stroke motor disorders. The approach to the selection of neurocytoprotectors from the positions of the concept of neuroplasticity and multimodal action is considered. The results of our own observation of the use of citicoline (Ceraxon ®) in the complex program of medical rehabilitation of patients after ischemic stroke are presented. The high efficiency of citicoline application in complex rehabilitation of patients in the early recovery period of ischemic stroke is shown in the form of improving walking function, increasing functional independence, daily activity and quality of life.

Conclusions. The use of modern neurocytoprotectors in a complex of rehabilitation programs is an important and indispensable component for achieving the maximum possible results of rehabilitation aimed at improving the functioning and quality of life of patients.

The work is devoted to the study of cognitive impairment in physicians with different modes of work. It is demonstrated that a large number of medical duties, a shifting schedule of work and long work with a computer worsen cognitive and psychoemotional characteristics of doctors. The use of standardized extract EGb 761® allows to prevent these pathological changes.

Diabetes mellitus is one of the frequent diseases. The article describes diabetic neuropathy as the actual problem of modern neurology. It also provides the classification of central and peripheral nervous system impairments in diabetes mellitus and detailed description of such diseases as distal symmetric sensorimotor polyneuropathy, diabetic encephalopathy, acute neuropsychic disorders, cerebrovascular diseases and features of cognitive impairment in diabetes mellitus. Great attention is paid to the tactics of managing patients with above forms. The role of alpha-lipoic acid products in the treatment of diabetic impairments of the nervous system is thoroughly considered.