Cognitive impairment (CI) is one of the causes of acquired disability in post-stroke patients. The article presents an analysis of the prevalence, pathogenesis, manifestations, diagnosis, treatment and prevention of post-stroke CI. It is noted that CI can be caused not only by focal vascular brain damage, but also by the presence of concomitant vascular and degenerative lesions in stroke patients. The authors present the results of their own study of CI in 350 patients after stroke within 5 years. The treatment and prevention of CI progression are based on stroke prevention, non-pharmaceutical and pharmaceutical methods for improving cognitive functions. The article discusses data on the use of Cerebrolysin in post-stroke patients, the results of the two latter meta-analyses of Cerebrolysin use.

The article discusses neuropsychological tests for diagnosing cognitive impairment. It presents data on the experience in using memantine (akatinol memantine) to treat dementia of various genesis. An analysis of efficacy of non-pharmacological approaches to the treatment of dementia including cognitive training is provided.

Cognitive disfunction in depressive disorders have become a relevant aim of research in recent years. At the same time, the question of the influence of psychopharmacological drugs on the cognitive functioning of patients with depression also retains its significance. The article presents the results of a prospective study of the effect of sertraline on cognitive functions in patients with nonpsychotic unipolar depressive disorders. The study included 36 patients who received sertraline monotherapy for at least 12 weeks. The dynamics of depressive symptoms was assessed by the MADRS and HAM-D scales. The study of cognitive functions included memory testing (memory for faces), attention (Landolt rings), reaction time (sensorimotor reaction), psychomotor (tapping test) and executive functions (Stroop test, stress test, reaction to a moving object) with the help of the computer psychodiagnostic complex «Multipsychometer-05». The cognitive profile of the studied patients was characterized mainly by deficit of executive and psychomotor functions. The index of psychomotor activity significantly correlated with the severity of depressive symptoms. The use of sertraline contributed significantly to the reduction of depressive symptoms, as well as to the improvement of almost all the studied parameters of the cognitive profile, including memory, attention, reaction rate, psychomotor and performance functions.

Treatment of insomnia is an important medical and social problem due to its widespread prevalence and significant negative impact on human health. The state of chronic cerebral hyper-activation, which has cognitive, electrophysiological and metabolic manifestations, plays an important role in the development of insomnia. The sleep disorder has been proven to be a risk factor for the development of arterial hypertension, metabolic syndrome, immunodeficiency disorder and cognitive impairment. Nonmedicinal and medicinal products are used to treat insomnia. Cognitive-behavioural therapy may be effective as a psychotherapy.  Non-benzodiazepine GABA-receptors agonists are most often used to treat chronic insomnia and histamine receptor blockers to treat acute insomnia among the other drugs of this group.

Anxiety disorders are considered as the most common class of mental disorders of adolescence. Anxiety affects all areas of a teenager’s life, significantly worsening his state of health, school performance indicators and relationships in the family and society. The article describes the characteristics of anxiety disorders in the adolescent period from the position of etiopathogenesis, classification, clinical features. The need for an integrated approach to the therapy of anxiety disorders in adolescents is grounded, which includes, in addition to full-fledged pharmacotherapy, a wide range of psychotherapeutic, physiotherapeutic and social rehabilitation activities.

The article presents a clinical case of diagnosis and treatment of the initial presentations of chronic cerebral ischemia (CCI) in the form of cognitive impairments in a middle-aged patient. The authors describe such features of cognitive impairments (CI) as the predominance of «subcortical» symptoms (bradyfrenia, fluctuation), which is typical for CCI. The article presents modern approaches to the diagnosis of CCI, according to which it is necessary to focus on the assessment of higher brain functions, while the significance of «focal microsymptoms» is not large.  The article discusses the treatment issues of CCI, which should first include the achievement of the maximum possible control over the underlying vascular disease. It also provides the results of recent studies of the effectiveness of pathogenetic neurometabolic therapy for vascular CIs.

The article presents a modern view of the pathogenic mechanisms of cerebrovascular diseases was Observed that currently available data indicate the existence of different variants of ischemic lesions of the brain and their clinical manifestations. Based on the available data and the results of our own studies, it is concluded that therapeutic strategies in patients with CVD should take into account the variety of clinical manifestations, the existence of various options for ischemic lesions of the brain substance, especially the course of the disease, heterogeneity of pathogenetic mechanisms and risk factors, as well as multi-morbidity of patients. Discusses the use of the drug Vazobral in CVD.

The article presents the findings of questionnaire-based survey on the use of non-steroidal anti-inflammatory drugs conducted by the Chelyabinsk practitioners. It discusses the main indications for use of NSAIDs. The authors outline the key issues of the choice of drugs from the NSAID group, taking into account efficacy, safety and area of intended use. They also present the findings of the latest research studies conducted in Russia and abroad on the issues of efficacy, safety, epidemiology of the use of NSAIDs and paracetamol.

The article considers the ethiological factors for the formation of such a widespread disease of the peripheral nervous system as polyneuropathy. The classification, modern approaches to the diagnosis of various types of diseases are presented. The authors emphasize on the therapeutic approaches to the treatment of such common forms as diabetic and alcoholic polyneuropathies. Particular attention is paid to the complex of B vitamins. The effectiveness and safety of the injectable form of vitamins for the therapy of polyneuropathies are demonstrated.

Diabetes mellitus is one of the emergency situations worldwide. DM is the most common cause of neuropathy throughout the world that create a wide range of conditions associated with the damage of various nerves and various pathological mechanisms. The article considers the main pathogenetic mechanisms of neuropathy - the role of metabolic, vascular and genetic factors. It presents the main clinical manifestations, depending on what type of nerve fibers are affected. A modern classification of diabetic neuropathy is provided. The most common form - diabetic distal symmetric polyneuropathy is considered in detail. The authors describe the main drugs used for the treatment of diabetic neuropathy, which were proposed by the International Diabetic Federation (2017) in 2017. Lipoic acid supplements are examined in more details.

The personalization of therapy is one of the innovative approaches gaining an increasingly strong foothold in modern medicine, implying an individual approach to each patient, taking into account the individual characteristics of the patient and the specific clinical case. This same standpoint of personified therapy should be used to plan rational analgesic therapy, the most important component of managing patients with the most common and socially significant diseases, with conditions that have a significant impact on the patient’s quality of life and worsen the course of concomitant diseases. The Meeting of Experts of different specialties such as rheumatologists, neurologists, cardiologists and clinical pharmacologists considered the key aspects of the prescription of NSAIDs, the most widely used class of painkillers, including those used for the relief of musculoskeletal pain. It was noted that when choosing NSAIDs, the practitioner should take into account the diagnosis, the planned duration of  analgesic therapy, the intensity of pain, medical history data, the presence of comorbid diseases and risk factors for drug complications. There are different types of NSAIDs, some of which are most useful for urgent acute pain therapy (eg, ketoprofen), while others are most suitable for long-term pain management in chronic diseases (eg, etoricoxib). In any case, the practitioner should take into account the priority of patient safety and pay the utmost attention to the prevention of NSAIDassociated complications, and also keep in mind the duration of the specific drug administration permitted by the patient information leaflet. It was also noted that the launch of a new generic etoricoxib (Kostarox®) expands the possibilities of analgesic therapy for the Russian practitioners.

Differentiation between flare of a rheumatic disease (RD) and the development of infectious process is often extremely difficult due to the similarity of clinical and laboratory manifestations, as well as their lack of specificity.

Objective of the study: to assess the significance of procalcitonin (PCT) test as a specific marker of generalized and local infection in patients with RD, and also to determine its role in assessing the inflammatory process activity in various RDs.

Material and methods: The case records of 145 patients (101 women , 44 men,  age of 3–79 years), who were undergoing inpatient examination and treatment at Nasonova Research Institute of Reumatology, were examined during the retrospective study. The serum PCT level was determined by the quantitative electrochemiluminescence method using  the Cobas E 411 analyzer (Roshe, Switzerland).

Results: The infectious process was diagnosed in 85 patients, the generalized one in 13 and the local one in 72. Local infections were divided into those with the light course – 41 and with the severe course – 31. In patients with generalized infection, the PCT level exceeded 2.0 ng/ml in 77% of cases and  in 10.0 ng/ml in 46.2% of cases.  Median (Me) PCT was 3.6 [2.26; 10.5] in the group with generalized infection. Me PKT exceeded the threshold values   and amounted to 0.49 [0.19; 1.5] ng/ml in the case of a local infection with the severe course,  PCT indices did not significantly differ from those of the group without infection (Me = 0.13 [0.08; 0.25] and 0.09 [0.06; 0.18 ] ng / ml, p> 0.05).with a local infection of the lungs, The maximum values   of PCT in the absence of infection and with a high activity of the rheumatic process were detected in patients with Adult-onset Still’s Disease (AOSD) – Me = 0.26 [0.10; 0.61] ng/ml, moderate increase was detected in patients with systemic-onset juvenile idiopathic arthritis (JIA)– Me = 0.2 [0.14, 0.24] ng/ml, juvenile rheumatoid arthritis (JRA) – Me = 0.2 [0.1; 0.26] ng/ml, systemic lupus erythematosus (SLE) – Me = 0.19 [0.11, 0.39] ng/ml.

Conclusions: Determining PCT level undoubtedly contributes to the diagnosis of generalized infections, and differential diagnosis of systemic RD from the infectious process. Further research is required to determine the PCT threshold value for various RDs.

Severe or persistent stress can cause emotional disturbances, which worsens the human condition.  Psychological counselling is of paramount importance, however, some people may not have access to a psychologist or psychotherapist in a stressful situation and one has to resort to the medical therapy. 85 patients (mean age 26.5 ± 3.5 years) under professional stress (primary school teachers, nurses) diagnosed with “tension headaches, autonomic dysfunction” were included in the observational study.  Patients were explained the causes of the disease, given recommendations on lifestyle and prescribed Valocordin at the dosage of 15 drops 3 times a day for 3 weeks. All patients showed improvement; none of the patients reported difficulty remembering, attention failure, problems talking. 88.3% of patients showed positive effect after 6 months, 61.1% of patients after 9 months and 49.9% of patients after 12 months. Despite disagreements in the medical professional environment, Valocordin remains one of the most popular drugs in patients under stress. The short-term use of Valocordin at therapeutic doses under stress conditions effectively helps to cope with insomnia, increased anxiety, relieves nervous tension and autonomic dysfunction.