Interview with Alla S. Avedisova, Dr. of Sci. (Med.), Professor, Chief Researcher of the Department of Borderline Psychiatry, Federal State Budgetary Institution V.P. Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health Russian Federation, State Budgetary Healthcare Institution Z.P. Solovyev Research and Practical Psychoneurology Center of Moscow Department of Healthcare, Honoured Doctor of Russia.

Interview with Alexander M. Lila, Dr. of Sci. (Med.), Professor, Director of Federal State Budgetary Scientific Institution V.A. Nasonova Research Institute of Rheumatology, Head of Department of Rheumatology, Russian Medical Academy of Continuing Postgraduate Education, Corresponding Member of the Russian Academy of Sciences.

Cryptogenic embolic stroke (embolic strokes of undetermined source, ESUS) is an intermediate diagnosis in patients with unknown etiology of stroke and implies the absence of large sources of cardioembolism and significant extra- and intracranial stenoses and probably embolic pathogenesis of cerebral infarction. In the previous parts of the article, we discussed the issues of diagnosis and secondary prevention of ESUS with underlying potential aortoaortic sources of embolism, paradoxical embolism and atrial cardiopathy. This article discusses the issues of epidemiology, pathogenesis, diagnosis and secondary prevention of ischemic stroke with underlying antiphospholipid syndrome (APS) and cancer-associated stroke (RAI). Both mechanisms of stroke are associated with hypercoagulability, often manifest as multifocal cortical brain lesions, and respond to anticoagulant therapy. While APS should be suspected primarily in young women with pathology of pregnancy, arterial and venous thrombosis, as well as livedo reticularis (racemosa), RAI does not have a specific clinical picture, but can manifest as diffuse cortical infarcts (symptom of three pools) combined with increased D-dimer level. If APS is suspected, appropriate haematological screening is required, followed by the use of the Sydney diagnostic criteria. Possible diagnosis of RAI often requires transesophageal echocardiography (ruling out non-bacterial thromboendocarditis) and oncological screening. Secondary prevention of APS consists in prescribing warfarin with the target international normalized ratio (INR) of 2.0 to 3.0. RAI is treated with anticoagulants, but the choice of a drug and dose is determined by the balance between thrombotic/thromboembolic and hemorrhagic risks.

Cerebral stroke (CS) remains the most important medical and social problem. According to available data, only 25% of stroke survivors return to the premorbid level of daily or work activity, most patients have residual neurological disorders of varying severity. Effective rehabilitation of patients with CS requires not only timely initiation of treatment, but also an individual choice of rehabilitation program. To optimize the rehabilitation strategy in each case, it is necessary to set goals and objectives taking into account the rehabilitation potential (RP) and the prognosis of the patient’s recovery. This paper provides a definition of RP and ways to describe it. The existing neurophysiological methods for assessing the RP of functional recovery after CS, such as electroencephalography, evoked potentials and diagnostic transcranial magnetic stimulation (TMS), are considered. Information about neuroimaging diagnostic methods – computer (CT) and magnetic resonance imaging (MRI) in the context of determining RP is presented. The possibilities of functional and diffusion-t ensor MRI of the brain for assessing RP in various periods of the disease are highlighted in detail. Other possible predictors of the restoration of impaired functions are also considered – the volume and localization of the brain lesion, the patient’s age, cognitive functions and laboratory parameters. Modern complex approaches to the formation of algorithms for the quantitative assessment of RP are described. In particular, the current algorithms for evaluating RP – PREP2 for the upper limb and TWIST for predicting the recovery of walking disorders are described. Currently, there are no generally accepted methods for determining and quantifying RP. The instruments proposed for this purpose are insufficiently sensitive and specific or are not suitable for routine clinical practice.

The topicality of the issues of effective treatment and prevention of cerebrovascular diseases (CVD) is not doubtful in view of their leadership in the top ranked causes of high mortality and disability in the general population almost all over the world, including Russia. The pathogenetic aspects of chronic CVD caused by hypoperfusion, which triggers a chain of successively developing metabolic disorders, represent a potential therapeutic target for the development of new dosage forms. The enormous clinical experience has been accumulated and evidence of therapeutic benefits in patients with various types of vascular and metabolic disorders accompanied by ischemia, including cerebrovascular disease, has been obtained over almost thirty years of active clinical use of ethylmethylhydroxypyridine succinate (6-methyl-2-ethylpyridin-3-ol butanedioate, EMHPS). It proved that EMHPS has such important effects as antioxidant, membrane-protective, antihypoxic, and anti-ischemic properties, as well as confirmed its hypoglycemic, hypolipidemic, antiplatelet and antithrombotic actions, which makes it an important component of the complex therapy of CVD. Progress in the development of innovative drugs is the result, on the one hand, of the availability of highly active pharmacological substances and, on the other hand, of the creation or selection of new dosage forms. The use of matrix tablets as a modern dosage form allowed us to efficiently optimize the pharmacokinetics of EMHPS, which led to the creation of a drug with a high predictive efficacy and safety. Thus, the developed new prolonged dosage form of EMHPS enables a constant-rate daily release of the active substance for 20 hours and reduces the likelihood of not only side effects, but also skipped intake during the day. The new dosage form of EMHPS is available at 375 and 750 mg doses, which makes it possible to take just 1 tablet per day and get all the therapeutic benefits while staying compliant.

Cognitive impairment (CI) is one of the leading causes of disability in the elderly, most often caused by neurodegenerative disease (NDD) and/or cerebrovascular disease (CVD). Mild CI (MCI) represents an intermediate state between normal cognitive functions (CF) and dementia and occurs in a significant proportion of the elderly. Patients with MCI have a higher risk of developing dementia than in the general population; therefore, prevention of the progression of MCI is an important area of modern neurology. Currently, no drugs have been found that can slow the progression of CI caused by CVD or NDD; drugs effective for dementia do not have a significant effect at the stage of MCI. In the prevention of dementia at the stage of MCI, an important role is noted for non-drug methods (regular physical activity, rational nutrition, mental activity, smoking cessation and alcohol abuse) and drug interventions (antihypertensive therapy, antithrombotic therapy, statins). In recent years, the use of nitric oxide in CVD and NDD has been discussed in order to attenuate the processes of oxidative stress, the release of cytokines, and the processes of apoptosis. In our country, there is a positive experience of inhaled use of nitric oxide with the help of an apparatus synthesized from the air for pulmonary, cardiovascular diseases and CVD. The effectiveness of inhaled nitric oxide using an apparatus synthesized from air is currently being studied in patients with MCI due to CVD and NDD. A clinical observation of a patient with MCI is presented, in which a month after the inhalation use of nitric oxide, an improvement in CF was noted according to neuropsychological examination.

Pain in the cervical spine is a widespread condition that significantly disrupts the quality of life, often leads to disability and requires significant economic costs. The most common type of neck pain is nonspecific (vertebrogenic cervicalgia). The most frequent (in 36–67% of cases) anatomical source of nonspecific neck pain is considered to be the lesion of the intervertebral facet joints. Tests to determine the anatomical sources of nonspecific pain are unreliable, in addition, their detection does not significantly affect treatment. Degenerative changes of the spine are often detected during neuroimaging, depend on age, but do not correlate with clinical symptoms and severity of symptoms. In the absence of red flags of anxiety and negative results of neurological examination, neuroimaging or laboratory methods of research are not required. An assessment of prognostic factors is important. Factors contributing to chronization include: female sex, old age, high intensity of pain at the onset of the disease, the presence of psychosocial problems. Modern classifications, the basics of diagnosis, treatment and prevention of nonspecific neck pain are given. Modern effective methods of treatment are physical therapy, manual therapy and psychological programs, a multimodal approach to treatment is optimal. There is a very low level of evidence for electrotherapy, traction, laser therapy, acupuncture, dry needle treatment, thermal or cold procedures. The use of drug therapy is recommended, both separately and in combination with other methods of treatment. The most effective painkillers for neck pain are non-opioid analgesics – NSAIDs and paracetamol. The use of cervical orthosis is not recommended. Clinical cases of patients with acute and chronic nonspecific neck pain are described. The effectiveness of an integrated approach to the management of this category of patients, in accordance with modern recommendations, is shown. The treatment included drug and non-drug methods (therapeutic gymnastics, educational conversation). Dexketoprofen was used as pharmacotherapy according to a step-by-step regimen. 

A significant problem of modern medicine is the presence of several diseases in the same patient, which complicates not only the diagnosis of each of them, but also therapy. It is necessary to distinguish between the terms “comorbidity”, “multimorbidity” and “polymorbidity”. The principles of therapy for comorbid patients differ from those for patients with mononosology. А large number of Russian and foreign studies have shown that patients with chronic pain syndromes, including chronic back pain, often have a number of comorbid conditions. In particular, in patients with osteoarthritis, which is one of the most common causes of back pain, diseases of the cardiovascular system, lungs, gastrointestinal tract, diabetes mellitus, and obesity are more often recorded. The article describes a clinical case of a patient with the simultaneous presence of several diseases: myofascial pain syndrome, peroneal tunnel neuropathy, diabetes type 2, polyosteoarthritis, joint hypermobility syndrome, herniated disc, obesity. At the same time, some of these diseases are comorbid, while the other part is a multimorbid disease, which must be taken into account when making a diagnosis and selecting therapy. In addition, the described case from practice illustrates the priority of the clinical method of examining a patient over paraclinical ones. The choice of pharmacological drugs and non-drug methods of treatment recommended to the patient was dictated by the mixed nature of the pain. A non-steroidal anti-inflammatory drug, SYSADOA, and a muscle relaxant have been recommended to combat non-specific musculoskeletal pain. Neuropathic pain treatment, in accordance with clinical recommendations, the following groups of drugs were included: gabapentinoids, vitamins B, anticholinesterases.

Acute vestibular vertigo is most commonly due to the disorders of the peripheral vestibular system: vestibular neuronitis, Meniere's disease, benign paroxysmal positional vertigo, and vestibular migraine. An acute cerebrovascular accident or transient ischemic attack in the vertebrobasilar arterial system is the significantly less common cause of acute vestibular vertigo. In our country, vestibular system disorders remain difficult to diagnose. Many patients with peripheral nervous system affection are misdiagnosed with cerebrovascular disease, vertebrobasilar insufficiency, and cervical osteochondrosis. The development of acute vestibular vertigo in vestibular neuronitis may be accompanied by high blood pressure in patients with arterial hypertension, which is often interpreted by doctors as a manifestation of cerebrovascular disease. However, absence of signs of a stroke on neuroimaging of the brain does not help determine the correct diagnosis, in which case, as a rule, vertebrobasilar insufficiency is diagnosed.

In this situation, it is especially important to conduct a clinical neurovestibular examination, including assessment of nystagmus, Halmagyi head thrust maneuver, assessment of skew deviation, as well as a caloric test, which makes it possible to establish a correct diagnosis. Modern diagnostic methods and effective therapeutic regimens have been developed for each of the nosological forms. A comprehensive approach to the management of patients with vertigo is most preferable. The conducted studies showed a significant decrease in the severity of vertigo in the treatment of patients with unilateral vestibular neuritis, Meniere's disease and other disorders of the peripheral and central vestibular system with a low-dose combination of cinnarizine 20 mg + dimenhydrinate 40 mg. This drug is well tolerated and does not depress vestibular compensation. The comparison of the effectiveness of the low-dose combination of cinnarizine + dimenhydrinate and betahistine dihydrochloride showed that treatment of vestibular neuritis with the combination drug results in more significant regress of acute vestibular vertigo than the treatment with betahistine. Treatment of acute vestibular vertigo proved to be more effective when the drug therapy was combined with vestibular gymnastics.

The presented clinical case describes the management of a patient with chronic migraine (CM), drug-induced headache (LIH), and generalized anxiety disorder. It shows the influence of genetic factors (hereditary predisposition to the development of addiction, anxiety disorder), biological factors (migraine attacks from adolescence, overuse of painkillers), psychological factors (stress, development of generalized anxiety disorder, pain catastrophizing), social factors (lack of rational supportive family environment) on the clinical picture of CM.

A modern, evidence-based approach to the preparation of a treatment plan for a patient with CM and concomitant LIH and generalized anxiety disorder has been demonstrated. The interdisciplinary plan was developed and successfully applied for the treatment of the patient. It included withdrawal of painkillers, due to which LIH developed, symptomatic pharmacotherapy for the withdrawal period, an alternative drug for the relief of headache with a limited number of doses and dosage frequency allowed to the patient, prophylactic pharmacotherapy for CM, pharmacotherapy for the concomitant generalized anxiety disorder, and psychological methods such as cognitive behavioural therapy (CBT) and mindfulness. Recent studies showed that mindfulness helps patients with LIH successfully overcome the period of painkiller withdrawal, the effectiveness of mindfulness is  comparable to the effectiveness of preventive pharmacotherapy during the period of pain killer withdrawal. Mindfulness therapy was included in the structure of the CBT sessions. The CBT helped to replace the patient's misperceptions of her disease and maladaptive behaviour towards pain and anxiety with alternative, realistic ideas about her disease, adaptive behaviour towards pain and anxiety. The interdisciplinary treatment resulted in the conversion from chronic to episodic migraine, regression of LIH, and significant improvement of her emotional state in just 3 months. At the 12-month follow-up the treatment showed a persistent positive effect.

Affective disorders represent an extremely topical issue in modern healthcare. Prevalence of anxiety disorders in clinical practice increased significantly since 2019 due to various situational causes, and the trend will probably continue in the coming years. Besides, due to aging of the population and significant growth of the number of patients with neurodegenerative diseases, so called secondary affective disorders also increase. These are linked to organic lesion of the zones strategically important for emotional process implementation, and damaging of the key neurotransmitter systems neurons often seen in neurodegenerative pathological process. Development of anxiety is chiefly based on the defect of the “threat-fear” bound, with the reaction developing in the organism not equivalent to the degree of danger. On pathophysiological level this can be explained by disruption of interaction between limbic system structures that provide “fight or flight” reflex response to the threat, and the neocortex responsible for cognitive processing and adaptation of out emotional reactions. Three key theories of anxiety development can be identified: insufficiency of control, generalization of fear, and hypersensibilization to threat. The first mechanism is most often linked to development of generalized anxiety disorder, the second theory reveals most fully the mechanisms of post-traumatic stress disorder development, while the hypersensibilization of prefrontal cortex best allows to explain sociophobia development. An important mechanism of development and chronification of various affective disorders is neuroinflammation, the role of which will also be highlighted in detail in this review. Understanding of the mechanisms of anxiety spectrum disorders development is important for differentiated drug and non-drug therapy and establishing the optimal strategy of treatment for such patients.

A share of older persons among the general population has been increasing. Mental health is the most important determinant of health status of older people. Anxiety in later life is the most common mental disease. Various diseases and symptoms often occur at the advanced age. In older adults, anxiety disorders are associated with an increased risk of comorbidities. Although insomnia is not a normal part of the ageing process, its prevalence increases with age. Many older people experience dissatisfaction with the quantity and quality of sleep, even if they get enough sleep. Ageing is associated with some changes in parameters of sleep architecture and continuity. There are several demographic, psychosocial, biological, and behavioural factors that may contribute to insomnia later in life. Older people are subject to greater risk for the physical and mental consequences of insomnia. Patients with long-term insomnia usually experience anxiety and depression. Evidence suggests that there is a complex bidirectional relationship between insomnia and anxiety in the elderly. Sleep disturbances are part of the anxiety disorder pattern. Therefore, healthcare workers must obtain comprehensive information about the health and sleep status of older people to correctly diagnose insomnia, anxiety, and identify potential correlates of these disorders. Taking a careful and complete medical history and performing a thorough physical examination is the most important aspect of their evaluation. If insomnia and anxiety are diagnosed in later life, therapy should include non-drug and drug treatments, taking into account possible side effects.

Polyneuropathies are a heterogeneous group of diseases that can be caused both by a primary lesion of peripheral nerves, and secondarily, against the background of various somatic diseases. The most common cause of chronic polyneuropathy is distal symmetrical diabetic polyneuropathy. In clinical practice, it is important to be aware of dysimmune polyneuropathy, such as Guillain Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and paraproteinemic polyneuropathy, which lead to severe motor impairment and disability in patients. Identification of the cause of polyneuropathy requires real art, which includes knowledge of the clinical, electrophysiological picture and variants of the course of the disease, as well as a wide range of conditions leading to their development. Timely diagnosis of polyneuropathies and early assignment of etiological and pathogenetic therapy reduce the risk of developing irreversible changes in peripheral nerves caused by axonal degeneration. In the treatment of polyneuropathy of various origins, a special place is occupied by B vitamins, which have a neurotropic effect. Cyanocobalamin is a pathogenetic therapy in patients with diabetes who take metformin for a long time and who developed polyneuropathy due to vitamin B₁₂ deficiency. In one patient, a combination of several variants of polyneuropathies is possible. The article presents a clinical case of a patient with type 1 diabetes mellitus (DM) who developed dysimmune chronic inflammatory demyelinating polyneuropathy (CIDP) associated with DM on the background of distal symmetrical painless diabetic polyneuropathy after a COVID- 19 infection. A feature of the development of CIDP was the acute onset of the disease. Variants of the clinical picture, ENMG criteria, as well as features of treatment, the effectiveness of therapy and the prognosis of CIDP in patients with DM are discussed.

Introduction. In the treatment of a patient with gout, it is important to achieve the target level of uric acid (UA) < 360 μmol/l, which reduces the frequency of acute attacks of arthritis and improves the prognosis of comorbid diseases. Relief of acute gouty arthritis causes much less difficulty compared with the appointment of urate-l owering therapy (UST). The reasons for not achieving the target level of MC can be both objective and subjective.

Aim. To analyze the objective and subjective components of the activity and effectiveness of UST in real outpatient practice.

Material and methods. A cross- sectional study of 117 randomly selected outpatient records of patients diagnosed with gout. Mean age 58.6 ± 13.1, mean UA level 423.7 ± 122.4 μmol/L. Additionally, an anonymous survey of doctors and patients with gout was conducted on the issues of UST.

Results. Patients with gout in the analyzed group were characterized by a high degree of polymorbidity: women and men, respectively, had arterial hypertension in 100 and 79%, type 2 diabetes mellitus in 39 and 23%, osteoarthritis in 73 and 57%. With inevitable polypharmacy, UST was prescribed in 37.6% of patients. Achievement of target levels of UA was registered in 23.8% of men and 39.4% of women. Failure to achieve the target sUA was associated with diuretics, elevated creatinine, and body mass index. Physicians were more than 70% active in prescribing UST, but knowledge of a single target UA level was demonstrated by 6 to 13%, depending on work experience, with an excessive assumption of UST use during an acute gout attack (19 to 36.5%). 

Conclusion. All components of the diagnostic and therapeutic process of curing a gouty patient need to be improved.

Introduction. Biological disease modifying drugs (bDMARD) in the treatment of ankylosing spondylitis (AS) have shown good results with the achievement and long-term preservation of remission. There is a discussion about the withdrawal of drugs without loss of effect in order to reduce the economic burden, drug load, adverse events, the possibility of interrupting therapy during surgical treatment.

Aim. To evaluate the potential for sustaining the therapeutic effect of netakimab (NTK) after its discontinuation in patients with AS who have achieved remission.

Materials and methods. A cohort of 11 patients diagnosed with ankylosing spondylitis (AS) who had achieved remission was included in this study. The patients were closely observed for 52 weeks after discontinuing NTK treatment. AS exacerbations, pain intensity, disease activity scores (BASDAI, ASDAS), enthesitis evaluations (MASES), functional impairments (BASMI and BASFI), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels were documented, as well as radiographic and MRI assessments of the sacroiliac joints and spine were performed.

Results. Out of the 11 patients, 5 (45.5%) experienced AS exacerbations within the 12-month observation period. Patients who developed flare-ups had higher baseline levels of BASDAI, ASDAS, BASMI, and CRP at the time of NTK discontinuation. They also had a longer disease duration and were older compared to patients without relapse (p < 0.05). The presence of flare-ups was significantly associated (p < 0.05) with a history of peripheral arthritis, previous treatment with IFN-alpha, and the number of comorbidities. By week 52 of the observation period, patients demonstrated a deterioration in both activity and functional limitations (p < 0.05). Elevated ASDAS-CRP levels were found to be correlated (p < 0.05) with higher radiographic stages of sacroiliitis, the presence of syndesmophytes, functional limitations based on BASMI at the time of drug discontinuation, and the absence of continuous NSAID use. Significant prolongation of remission was associated with a substantial decline in ASDAS-CRP under NTK treatment (rSp = 0.996; p < 0.05), especially among younger patients (rSp = 0.607; p < 0.05).

Conclusions. Approximately half of the patients who discontinued NTK therapy after achieving clinical and laboratory remission were able to sustain it. Maintenance of remission for 1 year was more prevalent in younger patients with shorter duration of AS, achieving inactive disease status based on ASDAS-CRP, fewer functional limitations, absence of peripheral arthritis, and comorbidities. Nevertheless, regular patient monitoring is necessary to promptly identify disease recurrence. 

Introduction. Low-energy fractures in patients with rheumatoid arthritis (RA) occur more often than in the general population, reduce the quality and life expectancy of patients. Establishment of predictors of fractures will allow to personalize treatment and preventive measures.

Aim. To study the frequency, structure, predictors of new and repeated low-energy fractures that occurred in patients with RA during long-term prospective follow-up.

Materials and methods. 123 women with RA, aged 63.7 ± 8.3 years, were included in an open, prospective, non-interventional study, the follow-up period was 9.4 ± 1.8 years. Initially and in dynamics, laboratory and X-ray examinations were performed (X-ray morphometry of the spine, X-ray densitometry of the lumbar spine (L1-4) and femoral neck (SB)).

Results. During the follow-up period, 101 low-energy fractures occurred in 63 (51%) patients: in 33 (52%) people – for the first time, in 25 (48%) – again. Two or more fractures occurred in 25 (39%) patients. There were 32 (32%) peripheral fractures, 69 (68%) vertebral fractures. A direct relationship was established between fractures and a longer duration of RA course (r = 0.231, p < 0.05), with X-ray stage of RA at baseline (r = 0.280, p < 0.05) and over time (r = 0.819, p < 0.05), intake of glucocorticoids (GC) initially (r = 0.202, p < 0.05) and over time (r = 0.308, p < 0.05), cumulative dose of GC initially (r = 0.239, p < 0.05) and over time (r = 0.268, p < 0.05), duration of GC use (r = 0.270, p < 0.05), history of low-energy fractures (r = 0.291, p < 0.05), and feedback with OP in SB (r = -0.190, p < 0.05).

Conclusions. А high frequency of repeated and first-time low-energy fractures was established in patients with RA, among which fractures of the vertebrae, distal forearm, humerus and lower leg bones predominated. Fracture predictors: GC intake, history of low-energy fractures, baseline radiological stage of RA. A mathematical model for assessing the risk of fractures with good predictive ability has been developed.

Outpatient neurological appointments in most cases consist of patients older than 45 years. The novel coronavirus pandemic has changed this statistic. Young patients began to turn to polyclinics more often with complaints of headache, feeling of weakness, decreased physical activity, forgetfulness, and changes in concentration. COVID-1 9 provoked the development of coagulopathy in patients with genetic mutations and signs of dysplasia. The percentage of patients with acquired or congenital thrombophilia has increased. Most of them had certain manifestations of undifferentiated dysplasia, with signs of impaired venous outflow with a characteristic cephalgic syndrome. The peculiarity of which is polymorphism, inconstancy, the absence, in most cases, of connection with specific vascular and hemodynamic factors (excluding headache in venous thrombosis), a decrease in the frequency of occurrence as the disease progresses. The presence of certain complaints (headache, asthenia, cognitive impairment) requires the appointment of specific therapy. Monotherapy with one drug, even if it has a pleiotropic effect, does not always achieve therapeutic goals, since one or another mechanism of pharmacological action prevails, and the rest are secondary, requiring enhancement or other drugs, or non-drug methods. Given the poor adherence of young patients to treatment, the way out of this situation is the use of combined drugs. Combination drugs can be used as multifunctional drugs, potentiating or summarizing their effects, while reducing the risk of polypharmacy and unwanted side reactions. One of the most promising combinations is Picamilon Ginkgo (Ginkgo biloba leaf extract + Nicotinoyl gamma-a minobutyric acid), which has established itself as an effective corrector of asthenia and cognitive impairment in patients of any age.

Introduction. The most important problems of clinical characterization and timely diagnosis of a new coronavirus infection COVID- 19 have been identified. The detection and treatment of patients with COVID-1 9 in the domestic health care system are carried out according to the Provisional Methodical Recommendations “Prevention, Diagnostics and Treatment of New Coronavirus Infection”. Its basic clinical manifestations are characterized by typical symptoms of acute respiratory viral disease: fever, dry cough, stuffy nose, headache, etc.

Objective. To study the nature of clinical manifestations of new coronavirus infection COVID-1 9, associated with delta strain of SARS-CoV-2 coronavirus with moderate and severe course.

Materials and methods. We analyzed the course of the disease in 50 patients treated as inpatients at Saransk Covid Hospital. Questionnaires to analyze complaints and anamnesis of diseases, data of medical records of in-patients were used. We used visual analog scale (VAS) to estimate the intensity of non-specific neurological disturbances, decreased sense of smell, taste and hearing, where 0 point means no neurological disturbance, 10 points – expressed disturbance. The presented data allowed to analyze the general, nonspecific and specific neurological manifestations of the new coronavirus infection COVID- 19 in the acute period in patients with moderate and severe course and to reveal their peculiarities.

Results. At a moderately severe course of the disease, the characteristic symptoms of respiratory infection in combination with depressed mood and anxiety predominated. Of nonspecific neurological disorders, sleep disturbances, dizziness, and of specific manifestations, impaired sense of smell and taste prevailed. At a severe course the above symptoms were joined by myalgia, headache, dyspnea and shortness of breath, gastrointestinal disorders.

Conclusions. The severity of the course of COVID-1 9 coronavirus infection, associated with the delta strain of SARS-CoV-2 coronavirus, is determined by the severity of the generalized manifestations, involvement of the lower respiratory tract, gastrointestinal disorders.

Introduction. Blepharospasm (BS) is a form of focal dystonia in which botulinum therapy (BT) has been used successfully, however, data on typical practice of patient management and the effectiveness of long-term BT in BS in our country are insufficient.

Aim. To analyse the typical medical practice of management of patients with BS and the effectiveness of long-term BT.

Materials and methods. A total of 50 patients with idiopathic BS, mean age 58 years (of which 37 were women) were included in the study. All patients were treated with botulinum toxin type A. Typical medical practice, erroneous diagnosis, time required to reach a correct diagnosis, severity of dystonia, and quality of life before BT and during a three-year prospective observation were analysed. The severity of dystonia was determined using the BS Disability Index (BSDI), and the quality of life was measured using the EQ-5D questionnaire.

Results. The correct diagnosis was reached, on average, in 3 years. Upon onset of symptoms the majority of patients (84%) visited an ophthalmologist. Eye diseases and myasthenia gravis were the most common primary erroneous diagnosis in BS, which were treated with inadequate symptomatic therapy. After one-month BT, it was noted that the disability index decreased from an average of 13.6 ± 5.1 to 2.7 ± 2.3 scores (p < 0.001) according to BSDI and the quality of life increased from 59.9 ± 8.2 to 82.6 ± 6.4 scores (p < 0.001) according to the results of EQ-5D. Repeated BT injections (2–6 times a year) conducted for 3 years also resulted in essentially positive effect without significant adverse events. At the end of three years, the disability index decreased to 10.7 ± 4.7 scores, and the improvement in the quality of life reached 81.8 ± 5.9 scores according to the results of EQ-5D (p < 0.001).

Conclusion. The low awareness of doctors, especially ophthalmologists, about the symptoms of BS and the widespread use of ineffective drugs was noted. The long-term regular (2–6 times a year) use of BT reduces the symptoms of the disease, improves the quality of life of patients and has no significant side effects. 

Introduction. Postcovid syndrome is an urgent problem, due to its high frequency regardless of the severity of the infection and the age of the patient.

Aim. To evaluate the efficacy and safety of the use of a dietary supplement Metabovit^® Healthy Sleep with Glycine and Zinc in patients with postcovid syndrome.

Materials and methods. 50 patients with postcovid syndrome were included in the study, after randomization, Metabovit^® Healthy Sleep was added to therapy in group 1 (2 tablets 3 times a day), in group 2 patients received basic therapy for chronic diseases. The duration of observation was 21 days. Before and after the end of the study all patients underwent clinical and neuropsychological examination, which included: complaint analysis, the “Schulte tables” test, a verbal association test, a Trail Making Test, an MFI-20 self-questionnaire, a Reader test, a questionnaire on the level of life exhaustion, a hospital scale of anxiety and depression (HADS).

Results. In the group of patients receiving Metabovit^® Healthy Sleep 2 tablets 3 times a day, in comparison with the control group, the overall MFI-20 self-questionnaire score sugnificantly (p < 0.001) decreased by 16 [-19, -8] to 59 [52; 63] points performance time of "Schulte tables" test decreased by more than 13 seconds; performance time of the Trail Making Test was 26 seconds faster in part A and 40 seconds faster in part B, in the verbal association test, the results reached normative values for most participants; stress levels decreased by almost 25% in men and 11% in women; the indicator of life exhaustion decreased by 22%; the level of anxiety (HADS score) decreased by 5 [-7; -3] points which led to the normalization of this indicator in almost all participants of the group. By the end of the study, no significant changes in the studied parameters were detected in patients of the control group.

Conclusion. In the group of patients who received the Metabovit^® Healthy Sleep dietary supplement, there was a significant positive dynamics and regression of most of the symptoms of postcovid syndrome, in comparison with the control group.