Introduction. Bridging therapy is the main method of treating ischemic stroke (IS) due to proximal occlusion, the effectiveness of which depends on the speed of its implementation. It is possible to increase the speed of systemic thrombolytic therapy (STT) and reduce the delay before mechanical thrombectomy (MT) by using bolus forms of thrombolytic drugs.

Aim. To evaluate the efficacy and safety of using non-immunogenic staphylokinase compared to alteplase in bridging therapy of IS in real clinical practice of a regional stroke center (RSC).

Materials and methods. A retrospective study of the combined use of STT and MT for the treatment of IS due to proximal occlusion was conducted from the reperfusion therapy registry of the RSC of the Tomsk Regional Clinical Hospital from 2017 to 2023. The final analysis included 49 patients who received non-immunogenic staphylokinase and 26 patients who received alteplase.

Results. The time between the stages of bridging therapy was 92.0 [65.0–130.0] min in the non-immunogenic staphylokinase group and 35.0 [25.0–50.0] min in the alteplase group (p < 0.001). No intergroup differences were found in the incidence of symptomatic hemorrhagic transformation: 8.1% in the non-immunogenic staphylokinase group and 3.8% in the alteplase group (p = 0.476). Mortality in both groups did not differ significantly and was 30.6% and 26.9%, respectively. Favorable functional outcome was observed in 40.8% of patients in the non-immunogenic staphylokinase group and in 23.1% in the alteplase group (p = 0.151).

Conclusion. Comparable efficacy and safety of non-immunogenic staphylokinase and alteplase in the context of staged reperfusion therapy were revealed. The use of non-immunogenic staphylokinase is associated with a decrease in the time between the stages of bridging therapy.

Depression is a clinically significant and growing public health issue. As a major global disease burden, its prevalence has been steadily increasing over the years, affecting different demographic groups. Depressive disorder is characterized by a low mood, loss of strength, sadness, insomnia, and inability to feel pleasure. In outpatient settings, up to one-third of patients with depressive symptoms may have a comorbidity. Many different diseases have been associated with depressive symptoms. Cardiovascular, metabolic, inflammatory, oncological, and neurological disorders are associated with an increased risk of depression, potentially due to chronic inflammation, neurochemical dysregulation, and emotional and social issues. As different drugs can cause depressive symptoms, the patient's medical history should include an assessment of the use of such drugs. Primary care physicians play an important role in identifying and treating depression. It is recommended to perform depression screening in all adult female patients in primary care facilities. There are general recommendations for the initial treatment of mild to moderate depressive disorder in adults. In mild depression, initial preference should be given to psychotherapy and symptom monitoring, and if improvement is insufficient, pharmacotherapy is to be used. Psychotherapy, pharmacotherapy or a combination of both should be considered for patients with moderate depression. Psychiatric consultation is recommended for patients with severe depression and urgently for any patient with psychotic symptoms or suicidal thoughts and behaviour. Antidepressants are the basic therapy for depression. Selective serotonin reuptake inhibitors are considered the first-line drugs to treat depression.

Anxiety disorders (AD) are one of the main health care challenges. Epidemiological studies indicate that ADs occur in 21–30% of the population over a lifetime. The annual prevalence of AD in the USA is 18.1%, with a lifetime prevalence of 28.2%. In Europe, the annual prevalence ranges from 12 to 27%, with a lifetime prevalence of about 21–30%. In Russia, the frequency of AD varies from 16 to 31%, more commonly found in women and starting at a young age. Treating AD is complex due to the potential negative impact of medications on psychophysiological functions. It is important to select therapy considering its effectiveness, safety, and availability, especially after the COVID-19 pandemic. Treatment of AD includes psychotherapy and psychopharmacotherapy. Normally, neurons that limit and implement anxiety are in equilibrium. During anxiety, the activity of neurons limiting anxiety decreases, while the activity of neurons implementing anxiety increases. The goal of therapy is to activate GABAergic and serotonergic neurons to reduce anxiety. In recent years, a comprehensive therapy consisting of two types of drugs has been used in the treatment of AD: SSRIs and a serotonin tranquilizer called buspirone. Buspirone is a non-benzodiazepine anxiolytic effective in treating AD. It has fewer side effects compared to benzodiazepines. Buspirone acts on serotonin receptors of the 1A-type, providing a gradual reduction of anxiety. It can also be used for monotherapy of GAD, augmentation of antidepressant therapy, and is actively applied in routine neurological practice. It has significant therapeutic potential, a sufficiently small profile of side effects, and good tolerability. The article is illustrated by a clinical case of the successful use of buspirone.

Insomnia is becoming increasingly common in modern society and leads to significant issues for people’s health and well-being. Sex differences in sleep begin at an early age and continue throughout life. At the same time, women report poorer sleep quality and have higher risk for insomnia than men. Some studies show that men and women differ in their neurohormonal secretion, biological processes, and brain morphology. A significant number of women experience sleep difficulties in the approach to menopause and beyond, with the most common symptoms being difficulty in initiating sleep, short sleep duration, and poor sleep quality. The aetiology of sleep disorders in postmenopausal women isn’t yet still clear and seems to be different according to the specific symptoms of sleep disorder. However, potential factors include menopause itself, ageing, vasomotor symptoms, depression, anxiety, and many other diseases such as cardiovascular, endocrine, and psychosocial factors. Insomnia may occur alone or with other medical or mental health conditions. If left untreated, it may increase the risk for developing and worsening any of these conditions. Menopause is often associated with elevated risks of cardiovascular diseases. Insomnia is considered as an established risk factor for myocardial infarction, including in women. Sex differences have been detected in studies of sleep problems, with significant associations in women with regard to hypertension, the prevalence of dyslipidaemia, obesity, and diabetes. Diagnosis of insomnia is largely based on skilled history taking. Insomnia treatment is based on two strategies that may be used isolatedly or in combination: cognitive behavioural therapy for insomnia and pharmacological treatment.

Chronic nonspecific low back pain (chronic lumbalgia) is one of the most common causes of disability in the adult population. Currently, effectivemethods of treatment of chronic nonspecific lumbalgia have been proposed, which include an educational program, kinesiotherapy, psychologicalmethods of treatment and optimization of drugtherapy. However, these methods are not often used in real clinical practice, which reflects the observation of a 52-year-old patient who had no positive effect from therapy for 6 months. According to the MRI data, the patient had herniated discs at the level of the lower lumbar discs, with which the patient associated a persistent pain effect. However, the examination revealed signs of damage to the facet joints and sacroiliac joint, which were of leading importance as an anatomical cause of pain. The patient also had emotional disorders, the phenomenon of catastrophization, and painful behavior. An educational conversation was held with the patient, therapeutic exercises were selected, Novema in the afternoon and Novema Night in the evening were prescribed as a non-steroidal anti-inflammatory drug. After 7 days, the pain decreased significantly, sleep improved, adherence to therapeutic gymnastics increased, after 1.5 months the pain syndrome regressed, the patient became active as before the disease. The issues of optimizing the management of patients with chronic lumbalgia and the possibility of widespread implementation of an integrated approach in clinical practice are discussed.

The article presents a clinical observation of an ischemic stroke resulted from the vertebral artery dissection, a rare complication of whiplash injury of the cervical spine. Acute condition developed with a delayed onset in the form of headache and pain in the cervical spine after a minor car accident in a young woman with signs of mesenchymal vascular dysplasia, followed by a transient episode of ataxia, dysarthria. The assessment of a patient’s neurological status on admission to the clinic showed focal neurological symptoms (right-sided hemianopsia and hemihypesthesia). Brain MRI revealed an ischemic lesion in the occipital lobe in the left hemisphere. Duplex scanning and CT angiography showed stenosis of both vertebral arteries (60–70%) due to their dissection. Vertebral and myofascial syndromes at the cervical level were detected after the patient underwent neuroorthopedic examination; the neuropsychological test battery findings demonstrated a high level of anxiety and depression. The patient received treatment with heparin followed by switching to acetylsalicylic acid, nimesulide, sertraline, phenazepam and omeprazole, as well as complex non-drug treatment: kinesiotherapy, elements of psychological correction. The treatment resulted in the regression of clinical symptoms, pain relief, and decreased level of anxiety and depressive disorders. The follow-up vessel examination demonstrated a gradual regression of lumbar artery stenosis. The article discusses the issues of pathogenesis, diagnosis, management of whiplash injury and artery dissection. It ought to be noted that symptoms of uncomplicated whiplash injury and artery dissection

Сraniocervicalgia is a collective clinical term that unites pain syndromes localized in the occipital and cervical area, which can spread to the frontal, temporal and orofacial areas. Clinically, the most common types of сraniocervicalgia are cervicogenic headache (CH), neck pain caused the temporomandibular joint dysfunction and craniocervicalgia caused of the vertebral arteries dissection. Diagnosis of craniocervicalgia should be based on the diagnostic criteria of the International Classification of Headache Disorders, 3rd revision (2018) with an analysis of the individual pain features. The characteristic of the CH is defined in the name itself. The most significant point is dysfunction of the three upper cervical segments. Pathological changes in the anatomical structures of the spinal column (facet joints, annulus fibrosus, ligaments, periosteum), muscles and tendons innervated by the upper cervical segments may be the source of CH. The convergence of the upper cervical sensory nerves (C1-C3) and trigeminal nerve fibers in spinal trigeminal nucleus at the upper cervical segments is believed to be more important for the development of CH. Usually, it`s a dull, aching, unilateral pain, which is provoked by a prolonged forced head position (uncomfortable posture) and movements in the cervical spine (turns, tilts of the head). Cervical movement restrictions in one or more directions is noted. In general, the diagnosis is mainly based on clinical examination, but can be confirmed by a diagnostic blockade of the cervical facet joints, after which patients can get partial or complete pain relief. We present a clinical case with a typical progress of CH. The patient was recommended daily 15–30 minute exercise therapy, hourly a few exercises for activation and stabilization of the cervical spine muscles, and increase general physical activity. Symptomatic treatment with a non-steroidal anti-inflammatory drug was prescribed – Nurofen Express Forte, containing 400 mg of ibuprofen in a capsule with liquid contents, twice a day for 2 weeks. During a follow-up examination after 15 days, the patient reported a pain relief at rest, the maximum pain intensity according to the visual analog scale decreased from 5 to 1 mm during movement. The patient’s general well-being and tolerance to prolonged postural tension significantly improved. Further recommendations included a training program for spine stabilization the and muscles endurance. After 3 months of patient observation, a therapeutic stability was noted. Considering the high antinociceptive efficacy of Ibuprofen, use of Nurofen Express Forte should be recommended in the complex treatment of patients with CH.

Introduction. Kinesiotherapy is effective in the complex treatment of patients with tension-type headache (TTH) and patients with chronic nonspecific back pain (CNBP). However, few randomized studies have been conducted on the effectiveness of kinesiotherapy in patients with TTH and CNBP.

Aim. To evaluate the effectiveness of complex treatment, including kinesiotherapy, in patients with TTH and CNBP.

Materials and methods. The study included 100 patients (23 men, 77 women, mean age 38.8 ± 9.3 years). Patients were randomized into two groups. Group 1 received complex treatment (specialized kinesiotherapy, standard drug and non-drug therapy), group 2 – standard therapy. All patients were assessed for clinical and psychological parameters at baseline and after 3 and 6 months of treatment.

Results. After 3 months of treatment, the clinical effect (CE) in the treatment of TTH (decrease in headache (H) frequency by 50% or more) and CNBP (decrease in back pain (BP) intensity according to the numeric rating scale, the Oswestry questionnaire indicator by 30% or more) in group 1 was achieved by 88% of patients, which is statistically significantly (p < 0.05) greater than in group 2 (44% of patients). More than a third (36%) of patients in group 1 did not have H and BP after 3 months, while there were no such patients in group 2. After 6 months of observation, all achieved CEs were maintained in group 1, 38% of patients achieved complete remission of H and BP; in group 2, CE was maintained only in 33% of patients, and no patient showed complete regression of HB and BP.

Conclusion. Complex treatment, including kinesiotherapy, in patients with TTH in combination with CNBP leads to a rapid (after 3 months) positive effect, which lasts for a long time (6 months).

Introduction. Spinal muscular atrophy 5q is a common childhood disease in the practice of a pediatrician and pediatric neurologist. Despite the introduction of neonatal screening in the Russian Federation since 2023, there is a cohort of patients who were not included in neonatal screening and the relevance of knowledge of the clinical symptoms of SMA remains.

Aim. To study the reasons for delayed diagnosis of spinal muscular atrophy in the Russian Federation.

Materials and methods. We analyzed the data of the registry of 1452 patients with SMA: the time of delay in diagnosis from the onset of the first clinical symptoms, identified the first clinical symptoms and analyzed erroneous primary diagnoses that increased the time of correct diagnosis. Patients were divided into two groups: group 1 of patients (1170) born before 2019, the second group of patients (274) born from 2019 to 2023. An analysis of the medical records of 330 patients with SMA observed at the Veltischev Scientific Research Institute was conducted in order to analyze the clinical symptoms of SMA that were underestimated by primary care physicians and led to a delay in correct diagnosis.

Results. In the 1st group of patients, 146 patients with SMA type 1, 531 SMA type 2, 493 – SMA type 3, 8 – SMA type 4 were registered. The delay in diagnosis was 4 months, 2 years 4 months, 5 years 2 months, 11 years, respectively. In the 2nd group of patients, 176 patients with SMA type 1, 81 – SMA type 2, 17 – SMA type 3 were registered. The delay in diagnosis was SMA1 – 2 months, SMA2 – 6 months, SMA3 – 6 months. Since 2019, there has been a significant decrease in the delay in diagnosis, especially for SMA types 2 and 3 up to 6 months. The primary and most significant clinical symptoms for patients with different types of SMA are determined.

Conclusions. Underestimating of clinical symptoms of spinal muscular atrophy leads to late molecular genetic diagnosis of the disease. The identified initial clinical signs of spinal muscular atrophy of different types will allow primary care physicians to suspect the disease in time and refer patients for confirmatory molecular genetic diagnostics.

Introduction. Systemic sclerosis is a connective tissue disease with the development of obliterating arteriolopathy and active fibrosis formation both in internal organs and in the skin. Pulmonary arterial hypertension is a life-threatening manifestation of systemic sclerosis, leading to death if diagnosed late. The search for predictors, as well as associated disease phenotypes, can facilitate early diagnosis and improve prognosis.

Aim. To characterize the features of the visceral form in comparison with the limited variant in patients with pulmonary arterial hypertension associated with systemic sclerosis.

Materials and methods. 14 patients with visceral and 63 with a limited variant of systemic sclerosis associated with pulmonary arterial hypertension were studied. The diagnosis of systemic sclerosis was established based on the 2013 ACR-EULAR criteria; pulmonary arterial hypertension was verified by right heart catheterization. In all patients, other causes of pulmonary hypertension – heart disease, lung disease, thrombophilia were excluded.

Results. At the time of inclusion in the study, patients with visceral systemic sclerosis were younger (48 (35; 56) years) than those with limited systemic sclerosis (54 (49; 63) years, but the differences only approached significant (p = 0.057). All patients had the Raynaud’s syndrome, with limited systemic sclerosis, digital ischemic disorders were more often observed (41% compared to 14%, p = 0.11). Anticentromere antibodies caused by pulmonary arterial hypertension predominated; antibodies to topoisomerase-I were detected only in two patients with limited systemic sclerosis. The severity index was significantly higher in patients with limited systemic sclerosis (p < 0.05). The clinical manifestations of pulmonary arterial hypertension in both groups were also the same. When studying central hemodynamics, no significant differences were found. The median follow-up of patients was 68 (39; 111) months. Survival also did not differ: with visceral systemic sclerosis it was 63 (40; 99) months, with limited systemic sclerosis – 69 (36; 116) months.

Conclusion. A comparative analysis demonstrated the similarity of the two systemic sclerosis phenotypes, which suggests the universality of approaches to the early diagnosis of pulmonary arterial hypertension.

The article discusses the problem of osteoarthritis, its increasing prevalence and high comorbidity. The data on the effect of osteoarthritis on the course of comorbid conditions, as well as the influence of a number of common diseases, such as hypertension on the development of osteoarthritis, are presented. In matters of therapy, data are provided on the effectiveness of the use of glucosamine, chondroitin sulfate and diacerein. The article presents the results of studies demonstrating the pleiotropic properties of these molecules. Thus, the most important pleiotropic effects of glucosamine include a preventive role in the development of atherosclerosis, an effect on reducing the risk of general cardiovascular events by 15% and the risk of individual cardiovascular events by 9–22%. Glucosamine intake is also associated with a reduced risk of lung cancer and mortality from lung cancer. The results of large cohort studies demonstrated that glucosamine use was associated with a 17% reduction in the risk of developing DM2, as well as a lower risk of developing gout in women and a lower risk of developing dementia. The use of chondroitin sulfate increased the bone mineral density of rats with diabetes mellitus, and also relieved the symptoms of hyperglycemia, polydipsia and polyphagia caused by diabetes in rats. The article also presents the results of a study that demonstrated significant inhibition of HCT-116 xenograft tumor development in mice by suppressing proliferation and inducing apoptosis while taking chondroitin sulfate. In other studies, it has demonstrated the ability to reduce oxidative stress and increase the amount of antioxidants that are important for neuroregeneration. The use of diacerein helps to increase insulin secretion and improve metabolic control in patients with type 2 diabetes mellitus. Thus, regular intake of glucosamine, chondroitin sulfate and diacerein can affect comorbid conditions, improving their course, as well as reduce cardiovascular risks.