Introduction. Given due regard to the urgency of the issue of pharmaceutical support in neurorehabilitation after stroke, an open multicenter study was designed and conducted.

Aim. To evaluate the efficacy and safety of therapy with Brainmax®, which is an original combination of two drugs: ethylmethylhydroxypyridine succinate (EMHPS) (100 mg/ml) and meldonium dihydrate (100 mg/ml) in the form of a solution for intravenous and intramuscular injections in patients with ischemic stroke in the acute and early recovery period.

Materials and methods. The study included 60 patients aged 18 to 80 years with the first ischemic stroke in the carotid or vertebrobasilar system, meeting the  inclusion/exclusion criteria. The total duration of  therapy was 24  days. The efficacy of therapy was assessed using the following tools: modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), Rivermead Mobility Index (RMI), Montreal Cognitive Assessment scale (MoCA).

Results. All patients showed improvement of their general condition by the end of therapy. The vast majority of patients noted that they had fewer difficulties with movement, self-care and daily activities as compared to the first visit. There was also a  significant improvement in  the total scores on the  NIHSS scale, the  Rivermead Mobility Index, and the  Montreal Cognitive Assessment Scale (p < 0.05) by the end of therapy. The proportion of patients with reported adverse events (AEs) accounted for 3.33%. All AEs were transient and did not require cessation of the therapy. No serious side effects were recorded in any of the groups.

Conclusions. The study showed significant improvement of the key symptoms of ischemic stroke: regression of neurological deficit, functional and cognitive impairment. On top of that, it was noted that the incidence of adverse events associated with the use of Brainmax® was low, which did not lead to cessation of therapy. No serious side effects were recorded in any of the groups.

Important aspects of the treatment of cognitive impairments are their early detection, prevention and timely prescription of drug therapy. The method of non-drug prevention and, at the same time, the treatment of cognitive impairment is cognitive training. There are cognitive training, cognitive stimulation and cognitive rehabilitation. The content of  cognitive training should be determined by the type and severity of the patient’s cognitive impairment; effectiveness depends, among other things, on the duration of the sessions and on the commitment of patients to cognitive training. At the Department of Nervous Diseases and Neurosurgery of Sechenov University, guidelines have been developed that allow cognitive training for patients with mild and moderate cognitive impairments. The effectiveness of methodological recommendations has been confirmed by studies; they were introduced into the work of the neurological and neurosurgical departments of the clinic of nervous diseases of the Sechenov University. Taking into account the development of modern technologies, it seems interesting and important to create methods of cognitive training that will allow the patient to study using a smartphone, tablet or computer, and the doctor to remotely monitor the well-being and track the results of the patient’s therapy. In the fall of 2022, the Health Formula program will be launched on the basis of the My Health app, designed specifically to support patients with cognitive impairments. Health Formula is an online service for remote communication between a doctor and a patient, the purpose of which is to increase patient compliance and the effectiveness of the treatment itself. The application will contain a set of cognitive exercises to complement the prescribed drug therapy. At the initial stage, the course will be a balanced selection of video exercises, which will later be included in the global interactive program for patients with CI.

Introduction. The identification of risk factors for cognitive decline during ageing is of great importance for prevention of dementia. Being married or cohabited is considered a protective factor for health. The impact of marital status on age-related decrease of cognitive functions (CF) is understudied.

The aim of the study was to investigate the relationship between the indicators of CF and marital status in a cross-sectional analysis and in 2 serial measurements over 9 years in a population sample of middle to older age in Russia.

Materials and methods. The study was based on a random population sample of men and women aged 45–69 years old examined at baseline in 2003–2005 in Novosibirsk (n = 9360, HAPIEE project). Present analysis included a subsample of persons with repeated serial measurements – 3153 people. The average follow-up period was 9.2 (SD = 0.7) years. CF was assessed using standard validated methods, including immediate and delayed recall of 10 words, semantic verbal fluency and letter cancellation test. Marital status was determined by standardized questionnaires, groups of single and married/cohabiting participants were identified.

Results. In studied population sample (n = 3153, 62% of women), the mean age of participants at baseline examination was 60.3 ± 6.8 years old, and at follow-up examination – 69.5 ± 6.9 years old. During the 9-year follow-up, a significant negative dynamics of the studied cognitive domains (p < 0.001) was revealed in single for both sexes. In multivariable-adjusted models, the rate of CF regress per year did not differ by marital status in both sexes, except for increased rate of decline in semantic verbal fluency in women, partly it was explained by high baseline level. Married or cohabiting women had faster rate of decline in this indicator (p = 0.007) compared with single, regardless of age and other risk factors.

Conclusion. The findings obtained in this population sample in Novosibirsk support a potential protective effect of marriage or cohabitation on CF preservation during ageing.

Skeletal-muscular (nonspecific) lumbar pain (lumbodynia), often with spread to the leg (lumboishialgia), is one of the most common causes of consultations with a physician and temporary disability in the population. In many cases, the development of pain is associated with lesions of the lumbar facet joints (LFJ) and sacroiliac joint (SI). What are the causes, clinical features, and diagnosis of lumbar pain caused by lesions of the LFJ and SI? What should be the medical tactics for lumbar pain caused by LFJ and SI lesions? What is the actual practice of treating such patients? Leading experts discuss the problem of managing patients with lumbar musculoskeletal pain:

Parfenov Vladimir Anatolievich – Dr. Sci. (Med.), Professor, Neurologist, Head of the Department of Nervous Diseases and Neurosurgery, Sklifosovskiy Institute of Clinical Medicine? First Moscow State Medical University (Sechenov University)

Karateev Andrey Evgenyevich – Dr. Sci. (Med.), Head of the Laboratory of Pathophysiology of Pain and Clinical Polymorphism of Musculoskeletal Diseases Nasonova Research Institute of Rheumatology.

Introduction. The original English-language questionnaire for identifying the risks of developing chronic back pain The Keele STarT Back Screening Tool was developed in 2007 and adapted for use in many languages. The article describes the linguistic adaptation of the Russian version of the questionnaire The Keele STarT Back Screening Tool conducted in accordance with generally accepted rules.

Aim. Linguistic adaptation of the Russian-language version of The Keele STarT Back Screening Tool.

Materials and methods. Linguistic adaptation was carried out in five stages: 1) direct translation by three translators; 2) development of one version of direct translation; 3) reverse translation by two native English speakers; 4) development of one reverse version and its discussion by a committee of experts; 5) preliminary testing of the Russian version in a group of 30 patients (10 men and 20 women) aged from 28 to 84 years (average age 61.3 ± 8.7 years) with acute back pain, who in the period of April-June 2022 were on outpatient or inpatient treatment at the Clinic of Nervous Diseases of Sechenov University for nonspecific back pain (n = 21) and radiculopathy (n = 9).

Results and discussion. All patients reported that the wording of the questionnaire items was clear and did not raise additional questions. The response time to the questions ranged from 30 seconds to 2 minutes 20 seconds (on average – 1 minute 18 seconds).

Conclusion. The adapted Russian version of The Keele STarT Back Screening Tool questionnaire to identify the risks of developing chronic back pain did not cause comments from patients and experts. This version can be used to confirm its psychometric properties.

Back pain is one of the most common causes of a doctor visit and occupy the first place among all non-infectious diseases in terms of the number of years of life, lost due to persistent deterioration in health. Nonspecific (musculoskeletal) pain represents the most common cause of pain and can be caused by the intervertebral disc extrusion, the lesion of the facet joints, the sacroiliac joints pain (SJP), the myofascial syndrome. A comprehensive (interdisciplinary) approach to the treatment of chronic back pain is aimed not only at reducing pain, but also at increasing physical, social and domestic activity, improving the emotional state, and developing effective stereotypes of behavior. The personalized approach is based on the patient clarifying both anatomical causes of pain and social and psychological, including erroneous ideas about the causes of back pain and its forecast, depression, increased anxiety and insomnia. Kinesitherapy represents the most effective direction when conducting patients with chronic back pain and should be combined with avoiding excessive static and physical exertion. In addition to therapeutic exercises, regular walks are of great importance, the intensity and volume of which can gradually increase. Psychological methods of therapy, mainly cognitive-behavioral therapy (CBT), are effective for chronic nonspecific back pain, they also use in the presence of emotional disorders and insomnia. In case of damage to the facet joints, the SJP, combined osteoarthritis of the knee and hip joints for  chronic back pain as additional therapy, combined drugs of  chondroitin sulfate and glucosamine sulfate are used. Unfortunately, in our country, a personalized approach is rarely used, including the CBT, but its use can help many patients with chronic back pain.

Due to the processes of globalization and transition to the information society their negative effects started to become apparent, namely virtually unlimited access to an abundance of information. Information overload occurs when the amount of information exceeds the perceptual abilities of accepting human being. It questions the impact of this process on health and sleep. Such phenomena as mind scrolling, communicative overload, distrust of digital security, cyber violence, digital inequality as mediators or consequences of information overload are considered. This article reviews the types of the information overload, ways of disseminating information, mechanisms of influence on the self-rated health and psychological condition and sleep, connections with anxiety and depression. This subject became especially relevant in  the context of  COVID-19 pandemic, since isolation, restriction of motor activity, and increased time spent behind the screen have become important predictors not only of sleep disorders, but also of other health problems. The article addresses the issue of subjects of studies are usually teenagers and people under 35 (generation Z), as the most active smartphones, messengers, social networks and mass media users. The problem of providing unfair information to users of social networks of different regions of residence, socio-economic levels is raised. Most scientists agree that the ways to solve the described problems are to limit the time behind the screen, the amount of content consumed per day, and compliance with sleep hygiene. Additional studies are required to determine the exact pathophysiological mechanisms of the effect of stress on sleep.

Insomnia is a common clinical condition characterized by difficulty initiating or maintaining sleep, accompanied by symptoms such as irritability or fatigue during wakefulness. Insomnia is often divided into subtypes based on the prevailing symptom. Insomnia is a risk factor for developing other somatic and mental disorders such as cerebrovascular diseases, hypertension, diabetes mellitus, depression, and causes increased healthcare costs. Given the bidirectional association of insomnia with the development of other somatic and mental diseases, the term “comorbid insomnia” may be used. The etiology and pathophysiology of insomnia involve genetic, environmental, behavioural, and physiological factors. The goals of insomnia treatment are to improve quantitative and qualitative aspects of sleep, to reduce the distress and anxiety associated with poor sleep, and to improve daytime function. Efficacious treatments for insomnia include behavioural, cognitive, and pharmacological interventions. Simple behavioural interventions may be provided in primary care facilities, but lack of training in these techniques limits their use. Among pharmacological interventions, the most evidence exists for benzodiazepine receptor agonist drugs, although on-going concerns focus on their safety as compared to modest efficacy. Different “natural” and OTC drugs are used as sleeping medications, for instance melatonin-based drugs. Behavioural treatments should be used whenever possible, and drugs should be limited to the lowest necessary dose and shortest necessary duration.

Colchicine is an alkaloid isolated from plants of the Colchicum genus. Colchicine has been used for thousands of years and remains one of the few drugs whose use remains relevant today. The therapeutic use of colchicine is widely known for gout, familial Mediterranean fever, Behcet’s disease, cardiovascular diseases (pericarditis, coronary heart disease, pericarditis, after coronary artery bypass grafting, etc.) and other diseases and is due to anti-inflammatory effects, which are based, including , inhibition of NLRP3 inflammasome and interleukin (IL)-1β production. The mechanisms of anti-inflammatory action of colchicine are diverse. It is primarily an inhibitor of mitosis and microtubule assembly. Colchicine destroys the structure of microtubules and reduces the elasticity and relaxation of neutrophils, thereby preventing the extravasation of neutrophils from blood vessels to the site of inflammation. Systemic inflammation is also a hallmark of coronavirus disease (COVID-19), which develops immunological disorders accompanied by the  production of  a large number of  pro-inflammatory cytokines, including interleukin-1. Coronavirus disease 2019 (COVID-19), which has become the most urgent medical problem in the world in the last 2 years, given the mechanisms of inflammation similar to rheumatic diseases, is also considered a disease with the potential effectiveness of colchicine treatment. SARS-CoV-2 vaccines also have a trigger factor for the development of an exacerbation of arthritis. On average, colchicine use was associated with a 47% reduction in post-vaccination arthritis. This article provides an update on the mechanisms of action and current experience with colchicine in COVID-19, including in patients with microcrystalline arthritis.

The article presents basic information about the role and structure of cartilage tissue and its components, the impact of an imbalance in the structure of nutrition on the well-being of the joints, evidence of the symptomatic and structural-modifying effect of chondroitin and glucosamine in the composition of original drugs and dietary supplements in the treatment of osteoarthritis. Particular attention is paid to the structure and synthesis of collagen, its biological role in the body in the formation of the cell structure of various tissues, especially cartilage. Found 28 types of collagen, differing in amino acid sequence and degree of modification, which are encoded by more than 40 genes. It was noted that the activity of enzymes involved in the synthesis of collagen depends on sufficient intake of products containing ascorbic acid (vitamin C), and the degradation and decrease in the amount of collagen is associated with the development and progression of osteoarthritis and other diseases of the musculoskeletal system. The use of type 2 collagen, including in combination with chondroitin and glucosamine, is considered as a promising method for preventing joint problems. It is emphasized that the main substances necessary for the syn thesis of cartilage components come from food. An imbalance in the structure of nutrition (reducing the consumption of proteins, microelements and vitamins, excessive consumption of fats and carbohydrates) negatively affects the state of the connective tissue and causes problems for all structures that form the joint. One way to correct eating behavior and replenish essential deficiencies is through the use of vitamin-mineral complexes and dietary supplements, which are gaining interest in the medical community as evidence accumulates for their effectiveness in supporting joint well-being.

The key role in the development of chronic autoimmune inflammation is played by pro-inflammatory cytokines, in particular, interleukin 6 (IL-6). The introduction into clinical practice of monoclonal antibodies inhibiting IL-6 is a significant event in rheumatology and is currently considered as a promising direction in the treatment of immuno-inflammatory rheumatic diseases. The first inhibitor of IL-6 (IL-6), which entered the practice of rheumatologists, was tocilizumab (TCZ), the second – sarilumab (SAR). Numerous studies have shown the high effectiveness of iIL-6: the use of drugs leads to a rapid decrease in the clinical manifestations of rheumatoid arthritis (RA) and a decrease in laboratory signs of inflammation, contributing to the achievement of low activity or remission, improves the quality of life of patients, and also slows down the X-ray progression of the disease. At the same time, iIL-6 has a satisfactory safety profile. The universal problem of our time – the pandemic of a new coronavirus infection – has led to attempts to use IL-6 in patients with severe and critical disease, since IL-6 plays an important role in the pathogenesis of COVID-19, which is confirmed by the results of numerous studies. However, data on the efficacy and safety of these drugs in COVID-19 are contradictory, which requires conducting larger-scale controlled studies. This review examines the issues of the effectiveness and safety of TCZ and SAR in rheumatological patients and in patients with COVID-19. The review is illustrated with examples from real clinical practice.

Introduction. From the perspective of evidence-based medicine, bisphosphonates (BP) represented by several drugs with various routes of administration and dosing regimens have been recognized as the gold standard for the treatment of osteoporosis (OP). Generic BPs are widely used for the treatment of OP due to the availability and optimal balance of cost and effectiveness.

The aim is to compare the tolerability of the generic zoledronic acid 5 mg (Osteostatics) and the original zoledronic acid 5 mg (Aclasta).

Materials and methods. A total of 54 women aged 56–65 years with postmenopausal OP were enrolled in the study and divided into two groups: 28 patients (Group 1) received intravenous infusions of Osteostatics 5 mg, 26 (Group 2) received Aclasta. Patients in both groups received concomitant therapy with calcium carbonate (1000 mg once a day) and vitamin D (2000 IU once a day). Adverse event data were collected within a week.

Results. Among side effects, it was fever that occurred most often: 57.1% in patients receiving Osteostatics (Group 1), and 61.5% in patients receiving Aclasta (Group 2). Headache occurred in 53.5% and 50% of cases, respectively. Side effects such as arthralgia and flu-like syndrome were less common and accounted for 17.8% and 15.4% of cases. Nausea only occurred in 14.2% and 11.5%, myalgia in 42.8% and 38.4%, respectively. In most cases the side effects did not last for more than 48 hours. The frequency and severity of side effects were comparable in patients with comorbidities in both groups.

Conclusion. The tolerability of the generic zoledronic acid Osteostatix at a dose of 5 mg is comparable to the original drug Aklasta.

Post-Cognitive Impairment, including in  the young population, is an urgent medical and social problem. It is known that COVID-19, even in the absence of direct brain damage associated with covid-associated stroke or encephalitis, regardless of the severity of the infection during the acute period and the age of patients, can cause long-term and maladaptive cognitive impairment. The pathogenesis of these disorders is complex, and it is not completely clear today and continues to be actively studied. There is also no standardized diagnostic and therapeutic approach in the management of patients with post-COVID cognitive impairment. The presented clinical observation demonstrates the experience of treating cognitive impairment after COVID-19 in a young patient using the available knowledge of pathogenesis. A review of modern publications on the problem of post-COVID cognitive impairment was carried out. Based on the available literature data, the role of various pathogenetic factors in the development of post-covid cognitive impairment in the presented patient is discussed. Based on a specific clinical example, the rationale for the choice of treatment strategies and the need to further increase knowledge about the postCOVID syndrome, conduct future research in  the field of  pathogenesis, diagnosis and treatment of  post-COVID cognitive impairment, which will create an evidence base for the development of clinical recommendations, is given.

Anxiety disorders are widespread among patients of primary care physicians and are the cause of increased morbidity and access to healthcare. Anxiety is a reaction of the body to the effects of stress and is manifested by the development of psychovegetative syndrome. In the general population, 5 to 7% of people have clinically significant anxiety, and in the practice of primary care physicians, these disorders are detected in every fourth patient. Anxiety disorder contributes to the development of psychogenic somatic pathology and/or negatively affects the course of background disease. Most patients with anxiety disorders suffer from various sleep disorders. In general practice, the frequency of sleep disorders reaches 73%. Chronic sleep disorder can act as a  stressor that contributes to the  development of  pathophysiological changes in  the body and increases anxiety. The above determines the need for early detection of sleep disorders and its timely treatment. The current treatment strategy for patients with sleep disorders involves an individualized approach to insomnia therapy. The existing arsenal of drugs used to treat sleep disorders allows this principle to be applied taking into account concomitant diseases (including anxiety disorders). The choice of product is also determined by good tolerability, efficacy and high safety profile. The optimal drug that answers the above requirements is doxylamine succinate, which allows you to effectively stop both anxiety symptoms and sleep disorders. Due to its high safety profile, doxylamine succinate can be used in the treatment of insomnia in pregnant women. The release form determines the convenience of use and the possibility of selecting an individual dose of the drug.

Management of patients with chronic low back pain and fibromyalgia is an urgent problem of modern medicine. In real clinical practice, fibromyalgia (FM) is often undiagnosed, with chronic back pain no combined diseases are detected, so patients do not receive comprehensive therapy, as demonstrated by two clinical observations. One patient suffered from chronic lumbodynia (skeletal-muscular lumbar pain against the background of lower lumbar facet joint lesions), chronic insomnia, anxiety disorders. The second patient suffered from FM combined with osteoarthritis of the hip joints and sacroiliac joint. Comprehensive personalized treatment, which included identifying and treating comorbidities, working with patients’ misconceptions about the causes of pain, predicting and planning physical activity, conducting an educational program with elements of cognitive behavioral therapy (CBT), regular exercise therapy, and pharmacotherapy, led to significant improvement in the patients’ condition. In both observations, a persistent (for 6 months) positive effect in the form of pain reduction, improvement of the functional state, emotional status, and sleep of the patients was achieved.he study also discusses the issues of effective therapy of chronic musculoskeletal chronic lumbar pain and FM, doctors’ poor awareness of FM and criteria for its diagnosis. It is noted that regular therapeutic exercises, restriction of excessive physical and static loads form the basis of management of patients with chronic back pain. Patients with chronic back pain often have misconceptions about their disease, its prognosis, and effective therapies, so identifying and resolving these problems using CBT contributes to a positive treatment outcome.