The paper considers the key areas of antithrombotic therapy for ischemic stroke (IS). Antiplatelet therapy is shown to be a multistage and multidisciplinary strategy of treatment for patients with IS, which begins with the appearance of the first symptoms of the disease and continues throughout life. Each stage, including fibrinolytic therapy, early use of antithrombotic and anticoagulant drugs, and personalized antithrombotic prevention of recurrent cerebral disorders, is important in itself and serves a common goal. As a result, all efforts should be aimed at reducing mortality rates in the acute phase of stroke and the functional dependence of a patient and at preventing venous thromboses, recurrent stroke, and all cardiovascular events to increase life expectancy and to improve quality of life. Fibrinolytic therapy increases the patient’s chances of a full neurologic recovery and improves the quality of later life. Antithrombotic drugs reduce the risk of cardiovascular death, early recurrences of stroke, and recurrent noncardioembolic stroke. Parenteral anticoagulants in acute stroke decrease the risk of venous thrombosis/thromboembolism, oral anticoagulants reduce that of recurrent cardioembolic stroke.

Statistics of the World Health Organization (WHO) show that the cerebrovascular disease is the second most frequent cause of death and the third – as the main disabling factor in the working age population. Timely treatment is the key to quickly recovering ischemic tissue. According to the different ischemic cascade stages, the variety of the treatment combinations are proposed. American Stroke Association guidelines 2018 contains no neuroprotectors. In this regard, there remains a need for a biochemical agent successfully blocking one or more stages of the ischemic cascade, preventing cell apoptosis. Melatonin is also considered as such substance due to its neuroprotective properties. The main function of melatonin is the regulation of the sleep-wake cycle. The nuclear and membrane receptors in various organs determines other biological effects of this hormone. The ability of melatonin to regulate the blood pressure, oncogenesis, ovaries cycle, retina function and differentiation of osteoblasts was found. The significant neuroprotective potential of melatonin is realized through the antioxidant, anti-excitotoxic and anti-inflammatory properties. The positive effect on the ischemic lesion size and stroke-related pathological conditions (delirium, insomnia) has been demonstrated both in animal experiments and in clinical studies.

Introduction. We present the results of our own observational cohort study of patients with stage I-II discirculatory encephalopathy treated with a combination of dihydroergocriptine and caffeine (Vazobral®). Interest in this issue is due to the fact that cerebrospinal venous insufficiency plays a role in the pathogenesis of neurodegenerative and vascular diseases of the brain, leading to the development of cognitive impairment, the formation of secondary headaches, and reducing the quality of life of patients.

The purpose of the study was to evaluate the effectiveness and safety of the drug Vazobral® in patients with stage I-II discirculatory encephalopathy due to venous discirculation in the presence of chronic cerebrospinal venous insufficiency.

Material and methods: 102 outpatients (average age 63.5 ± 3.74 years, 25 (25.5%) men and 77 (74.5%) women) suffering from chronic cerebral ischemia and having signs of chronic cerebrospinal venous insufficiency . Stage I dyscirculatory encephalopathy with mild cognitive impairment was diagnosed in 58 (59.2%) patients, stage II dyscirculatory encephalopathy with mild cognitive impairment was diagnosed. All observed had a duplex scan of the branches of the aortic arch, jugular and vertebral veins, with a measurement of the linear velocity of blood flow; the intensity of headaches, cognitive status, the severity of affective syndrome using special questionnaires were evaluated. For 3 months, patients took Vazobral® 8/80 mg per day. The data obtained were analyzed using computer programs SPSS and Statistica. Significance of differences – with a 95% CI, p <0.05.

Results. Significant positive dynamics was observed in patients with Vazobral®: a decrease in headache intensity (from 4.11 to 0.67 points), cognitive function assessment increased by 14% from the initial level, the severity of the anxiety-depressive symptom complex, significantly decreased by 38–56%

Conclusion. The drug Vazobral® can be recommended to increase the effectiveness of the treatment of patients suffering from stage I-II discirculatory encephalopathy with venous discirculation phenomena. 

Acute nonspecific lumbosacral pain (LSP) is one of the most common reasons people visit their doctor. This disease has a favourable prognosis, however, the low back pain can progress to a chronic course, if the treatment is inadequate. In this regard, timely diagnosis and adequate treatment of acute nonspecific LSP are of great clinical importance. The diagnosis of acute non-specific LSP is established after discogenic radiculopathy, lumbar stenosis and other specific causes of back pain have been excluded. 15 clinical guidelines for the treatment of acute nonspecific LSP were reviewed in 2018, and it was concluded that they match in basic therapeutic principles. The basis for effective treatment of acute nonspecific LSP includes informing the patient about a favourable prognosis of pain, the recommendation to maintain an active lifestyle and optimal pharmacotherapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in relieving the low back pain. The choice of NSAIDs depends on the concomitant diseases of the patient and the risk of side effects. If NSAIDs provide poor efficacy, a drug from the muscle relaxants group can be added. NSAIDs combined with B vitamins (thiamine, pyridoxine, cyanocobalamin) is a new direction in the pharmacotherapy of acute non-specific LSP. The article discusses the results of clinical trials of the efficacy and safety of NSAIDs combined with B vitamins, the advantages of this combination in patients with LSP. The authors analyse the use of B vitamins-containing Milgamma as a co-analgesic drug combined with NSAIDs in acute nonspecific back pain.

Back pain in terms of socio-economic losses over the past 5 years has come to the first place among the causes of disability, and therefore the problem of rapid effective anesthesia and rehabilitation of this large group of patients is topical. In most cases, the main sources of back pain are the structures of the musculoskeletal system, and the reasons are their microtraumatization due to sudden unprepared movements, prolonged stay in a static position, heavy physical labor. The task of clinical and instrumental examination is to exclude specific causes of dorsalgia. It is also important to present the results of the survey in an accessible form, in particular to correctly interpret the data from neuroimaging research methods. Adequate anaesthesia for acute back pain, informing the patient about the favorable prognosis of the disease and early motor activation are essential to prevent the transition of the physiological feeling of pain into the pathological process - chronic pain syndrome. When dealing with chronic pain, the interaction of specialists of different profiles in the multidisciplinary team is required. Kinesiotherapy, ergotherapy, cognitive-behavioural therapy are the main methods of non-drug treatment of lower back painIt is recommended that the patient maintains the usual level of physical activity and then increases it. It is necessary to teach the patient to correctly perform movements in the social, professional and domestic spheres, to explain how to avoid unsafe movements that can provoke dorsalgia. The article presents the observation of a patient with chronic back pain. Success in treatment has been achieved through effective anesthesia through rational selection of non-steroidal anti-inflammatory drugs (Dexalgin), local administration of local anesthetics to overcome kinesiophobia, and a combination of cognitive-behavioural therapy, kinesiotherapy, and ergotherapy.

The prevalence of dementia increases progressively, which actualizes the issue of prevention. Primary prevention of dementia involves preventing the transformation of mild cognitive impairment (MCI) into dementia, secondary prevention involves the early detection and early treatment of dementia, and tertiary prevention involves slowing down the progression of dementia. Current studies pay much attention to the correction of modifiable risk factors due to lifestyle, as primary prevention. Physical activity is a very important component of a healthy lifestyle, which is aimed at preventing the development of cognitive decline. The mechanisms of the positive effect of physical activity on cognitive functions are associated with decreased risk of cardiovascular disease, increased cerebral perfusion and cerebral blood flow, changes in neurogenesis and neuronal plasticity. Nutrition strategies focus on dieting, among which the Mediterranean diet has produced hopeful results. Sleep normalization is also considered a very important aspect of the prevention of cognitive impairment, because sleep disturbances provoke the development of cardiovascular pathology and affect the amyloid metabolism. However, along with combating risk factors, more and more attention is now being paid to the possibilities of drug treatments to prevent dementia. The experimental studies confirmed the neuroprotective effect of Akatinol (memantine). The clinical studies proved the efficacy of Akatinol in the treatment of Alzheimer’s disease and vascular dementia and showed the disease-modifying effect.

Parkinson’s disease (PD) is the second most common neurodegenerative disease that is characterized by steady progression and results into persistent disability. It has been known that more than 10 years may elapse between the onset of cell death in certain structures of the nervous system and the onset of clinical symptoms of the disease, and most of the dopaminergic neurons are lost during this period. The identification of patients in the period between the expected onset of dopaminergic cell loss and the onset of clinical parkinsonism may be crucial for the development of effective neuroprotective treatment strategies. The scientists around the world are currently paying special attention to the search for reliable clinical, neuroimaging and molecular markers that could help diagnose PD in the early stages, distinguish it from other pathological conditions, track progression, and detect a positive response to therapy. The article provides an overview of the status update on the problem of early diagnosis and search for early clinical signs, preclinical biochemical, genetic and neuroimaging markers of PD, the main modern directions of PD therapy. Symptomatic pharmacotherapy, which compensates for dopaminergic deficiency and is able to alleviate motor and some nonmotor symptoms of parkinsonism, as well as some neuroprotective treatment options, have been analysed. Among other factors, the role of amantidines is described in detail. The foreign and domestic experience of their use as monotherapy and complex treatment of PD is presented. The author provides an analysis of the clinical case of PK-Merz therapy of the initial stage of PD.

Hyperuricemia (HU), traditionally considered as an important risk factor and therapeutic target for patients with gout, currently draws attention of many researchers from the perspective of its contribution to the pathogenesis of metabolic syndrome and metabolic syndrome-associated diseases. The study aimed to determine the frequency of detection of HU and its conjugation with burden of metabolic comorbidities in outpatients. HU was detected in 253 (27.1%) of 933 people referred to the determination of the uric acid (UA) level. The investigators took into account the presence of established diagnosis of gout, cardiovascular system diseases associated with metabolic syndrome, type 2 diabetes mellitus, chronic kidney disease (CKD) and urolithiasis, and nonalcoholic fatty liver disease. The study showed that patients with HU had four times higher metabolic comorbidity level than individuals with normal UA levels. Not only gout (6.25 times), but also urolithiasis with CKD (2.2 times) and cardiovascular disease (CVD) (1.9 times) were more common in people with elevated UA levels. Among patients with HU, women were 2.2 times more likely to have type 2 diabetes than men. Patients with type 2 diabetes and CVD, especially women, need to correct HU to reduce the risk of progression of metabolic disorders. The article presents a brief overview of modern drugs for the management of GU.

Despite progress in pharmacotherapy, there still are urgent needs in the development of new methods of drug therapy of rheumatoid arthritis (RA). New prospects for drug therapy are currently associated with sarilumab (SAR), recently registered in the Russian Federation for the treatment of moderate to highly active RA in adult patients. SAR binds to both membrane and soluble interleukin-6 receptors (IL-6r), blocking its pro-inflammatory effect. SAR has certain differences from its predecessor, tocilizumab: it is a fully human, not humanized, antibody, it is injected subcutaneously once every 2 weeks, it has a more pronounced affinity for IL-6r. SAR is a highly effective treatment for patients with RA, it has shown higher efficacy in monotherapy compared to the representative of the class of TNF inhibitors adalimumab. Clinical studies have shown approximately equal clinical efficacy parameters and a safety profile for SAR and tocilizumab. Sarilumab should be considered as a first-line biologic drug in patients with high inflammatory activity, as well as in patients resistant to anti-TNF.

Introduction: the article describes the most common variants of paraarticular tissue pathology (PTP) - enthesitis of the upper and lower extremities, back. The issues of enthesitis etiology, pathogenesis, clinic presentation, diagnosis, differential diagnosis are considered. The historical background, technique and mechanism of action of perifocal syringe injections are presented.

Objective of the study: evaluate the clinical efficacy of perifocal syringe injection of Alflutop in patients with enthesitis of the upper and lower extremities and back.

Materials and methods of the study: 76 patients with shoulder joint enthesitis (30 patients), epicondylitis (10), back pain (14), trochanteritis (13), anseritis of the knee joints (9) received treatment with perifocal injections of Alflutop as a course of 5 injections with an interval of 1 injection every 2 -3 days. We evaluated general well-being, local pain at rest, during palpation and movement, range of motion. The diagnosis was established clinically, and using the results of x-ray examination, ultrasound, MRI.

The results of treatment: significant outcomes in patients, which included improved well-being, reduced pain, increased range of motion. 69 of 76 patients demonstrated significant improvement and improvement - the effectiveness of therapy was 90.8% with high tolerability of the drug. 

According to modern ideas, pain is a multidisciplinary problem with serious medical and socio-economic importance. The most common pain occurs in various structures of the musculoskeletal system. It is noted that the universal mechanism of acute and chronic pain is inflammation, which requires therapy with nonsteroidal anti-inflammatory drugs (NSAIDs). Data on the effectiveness and good tolerability of local NSAIDs are presented. The latest recommendations of the international Committee ESCEO 2019 on the management of patients with osteoarthritis (OA), which confirms the effectiveness and safety of local forms of NSAIDs, in connection with which, ESCEO recommends their use in elderly patients, in patients with comorbid conditions and at high risk of adverse reactions. It is also envisaged to use these drugs for the treatment of OA before the appointment of systemic NSAIDs. The results of randomized clinical trials (RCTS) and meta-analyses confirming clinical efficacy and safety in the treatment of acute and chronic pain by one of the representatives of local NSAIDs-diclofenac sodium gel are presented. Diclofenac sodium gel has been shown to be more effective than placebo in the treatment of acute and chronic pain. Good tolerability of the drug was observed in patients in different age groups, including patients older than 65 years, and in patients with comorbid conditions. The results obtained indicate the effectiveness and good tolerability of diclofenac sodium gel, including long-term, and allow the drug to be widely used as symptomatic therapy for the treatment of acute and chronic pain, including in elderly patients and patients with comorbid conditions.

Aim: To evaluate the effectiveness, safety and anti-destructive effect of anti-B-cell therapy (rituximab) in various combinations (RTM-mono, RTM + DMARD, RTM + GK) in patients with rheumatoid arthritis in real clinical practice.

Materials and methods: Clinical and radiological evaluation of 110 patients with rheumatoid arthritis who received rituximab therapy (RTM) as monotherapy (group 1), in combination with methotrexate (group 2), leflunomide (group 3), and group 4 with other basic anti-inflammatory drugs.

Results: When assessing at 48 weeks of treatment with these regimens, the achievement of remission and a low degree of activity was observed in 22.36% of patients. An X-ray evaluation showed the absence of progression in the total score in 60.9%. When assessing progression in the monotherapy group, there was no progression in 76.92%, in the group of PTM + MT – in 54.29%, in the group of PTM + LEF – 65.0%, in the group of other DMARDs – 50% of patients. When assessing the clinical effect in the group receiving GK – remission and a low degree of activity – 19.67% of patients, in the group without GK – 21.05%. Assessing the radiological dynamics, it was shown that in the group not receiving GK – inhibition by the total score occurred in 54.55%, receiving – 61.54%.

Conclusion: This work has demonstrated the high therapeutic efficacy of RTM in real clinical practice. There were no significant differences in the degree of progression depending on the concomitant therapy of DMARDs or GK. In the treatment of RTM, inhibition of articular destruction is possible even against the background of clinical deterioration. 

Back pain is a common clinical and socioeconomic problem. Back pain is a symptom, not a nosological form. Osteoporosis is a skeletal disease in which, despite normal bone mineralization, bone loss and bone (structure) integrity is observed. The article considers the main causes of primary and secondary osteoporosis. The main modifiable and unmodifiable risk factors for osteoporosis and fractures are presented. The main pathological conditions and diseases associated with the risk of osteoporosis are described. The problem of osteoporosis of the spine as one of the causes of mechanical painful episodes in the back of elderly patients is considered in depth. Clinical features of compression vertebral fractures in osteoporosis in women after menopause are presented. The methods of conservative treatment of osteoporosis are considered. The greatest attention is paid to such effective antiosteoporotic drugs as bisphosphonates. The data on the efficacy and tolerability of alendronic acid preparations as the most studied preparation from the group of bisphosphonates are analyzed. The information on the new medicinal form of alendronic acid – sparkling soluble tablets (Binosto) is presented.