[Criteria of syndrome frailty in Parkinson´s disease]. / Kriterii starcheskoi astenii pri bolezni Parkinsona.

OBJECTIVE: To evaluate syndrome frailty by the Fried phenotype in patients with Parkinson's disease (PD). MATERIAL AND METHODS: Seventy-three patients over 65 years of age with Hoehn and Yahr stage 2-4 PD were tested for the presence of subjective criteria of the Fried phenotype of syndrome frailty: fatigue, difficulty in performing habitual activities, weight loss and objective criteria: grip strength and walking speed. The relationships of the objective criteria of Fried with indicators of age, sex, sports history, prescription of PD, the number of medications, blood pressure and MDS UPDRS part III scores, the severity of depression on the Beck scale and cognitive disorders on the MOCA were evaluated. RESULTS: All patients complained of fatigue, difficulties in performing habitual activities. Four people noted a decrease in body weight of more than 5 kg per year. Objective criteria of Fried were absent in 38 (51%) patients, 23 (32%) people had one objective criterion: reduced walking speed (less than 0.8 m/s) or hand strength (less than 16 kg for women and 26 kg for men), in 12 (17%) people both objective criteria were reduced. The values of objective criteria of weakness were correlated with age, sex and MDS UPDRS part III total scores. CONCLUSION: Frailty syndrome is difficult to diagnose in patients with PD due to the coincidence of complaints of the underlying disease and the syndrome. Objective criteria of the Fried phenotype suggest the presence of syndrome frailty in patients. The increase in the age of the patient, the female sex and the severity of PD are interrelated with the presence of objective criteria for the frailty of an elderly person.

[Rehabilitation's possibility of the patients with severe Parkinson's disease]. / Vozmozhnosti reabilitatsii patsientov na razvernutoi stadii bolezni Parkinsona.

OBJECTIVE: The application of the individual rehabilitating approach by hypokinesia and lack of physical activity in severe Parkinson's disease patient. MATERIAL AND METHODS: In the study were 43 patients with Parkinson's disease (17 men and 26 women; at the age 68.39±7.18 years) with 3-4 stage Hoehn and Yahr included. The physical state was previously defined. 10 individual complex lessons with the power exercises, the transfer training with external cueing, flexibility, balance-therapy, preparation of somatoreception to walking and the walking were in patient's stage with walking speed evaluation after the therapy conducted. RESULTS: Before the treatment 25 (58%) persons could not the test «6 minutes walking¼ perform, the time of the test «Up and Go¼ was lengthened and the grip strength was decreased, moreover in women the grip strength was less critical level. After the treatment the all patients participated in the test «6 minutes walking¼. Walking distance increased by 32.17 meter; p<0.01. THE CONCLUSION: The individual complex rehabilitation in patient stage's approach in severe Parkinson's disease patient let improve the walking.

Monomeric form of C-reactive protein in the assessment of the residual inflammatory cardiovascular risk in patients with subclinical carotid atherosclerosis.

Aim      To study the relationship between monomeric C-reactive protein (mCRP) and the progression of asymptomatic carotid atherosclerosis in patients with a moderate risk for cardiovascular diseases (CVD) as assessed with the SCORE model.Material and methods  The study included 80 men and women aged 53.1±5.8 years assigned to the category of a moderate risk for CVDs by the SCORE model with a low-density lipoprotein cholesterol (LDL-C) level of 2.7-4.8 mmol/l and asymptomatic, hemodynamically insignificant (<50% luminal narrowing) carotid atherosclerosis according to ultrasonic data. All patients were prescribed atorvastatin to achieve a LDL-C level <2.6 mmol/l. After 7 years of follow-up, ultrasonic examination of carotid arteries was performed, and concentrations of high-sensitivity C-reactive protein (hsCRP) and mCRP were measured.Results A concentration of LDL-C <2.6 mmol/l was achieved in all patients. The progression of atherosclerosis as determined by an increased number of atherosclerotic plaques (ASPs), was observed in 45 (56 %) patients. At 7 months of follow-up, concentrations of cCRP were higher in the group of patients with progressive carotid atherosclerosis, while the levels of hsCRP did not differ between the groups. Increased mCRP concentrations were associated with changes in variables of the "atherosclerotic load", including the number of ASPs, total ASP height, and the intima-media thickness (IMT). In patients with a median mCRP concentration of 5.2 [3.3; 7.1] µg/l and more, the increases in mean ACP number and total ASP height were considerably higher than in patients with mCRP concentrations lower than the median (3.9 and 2.7 times, respectively), whereas the odds ratio for the progression of asymptomatic carotid atherosclerosis was 5.5 (95 % confidence interval, CI: 2.1-14.6; p=0.001). ROC analysis showed that the concentration of hsCRP had no predictive value for prognosis of asymptomatic carotid atherosclerosis (p=0.16), while the area under the ROC curve (AUC) for mCRP was 0.75±0.056 (95 % CI: 0.64-0.86; p=0.001).Conclusion      According to the results of 7-year follow-up, the plasma concentration of mCRP was significantly higher in patients with an increased number of ASPs than in patients without this increase. An increased level of mCRP may indicate a higher inflammatory risk of CVD.

[The assessment of physical fitness level, the functional status and the social features of the elderly that decided to engage in physical exercises.]

For the sake of maintaining active longevity of the elderly the adequate, individually selected physical activity, that was get after the integrated assessment of physical fitness level, the functional status and the social features, is necessary. 121 women (mean age 66,77±5,37) who decided to engage in physical exercises were included in the study. For every participant professional, social and sport anamnesis, the presence of illnesses, the clinical information and the functional tests (Stange, orthostatic, «6 minutes walking¼, «Up and go¼) were evaluated. Was get, that 75,21% participants of the study had hypertension. The normal type of systolic blood pressure reaction during orthostatic test was present in 71,07% people, by diastolic blood pressure - in 84,29% people. The body mass index corresponded to the excess body weight. The indices of the grip strength, spirometry were decreased, but were not critical. The indices of the grip right and left arm correlated with age (R=0,33; p<0,01; R=0,31; p<0,01). The results of the tests «Up and Go¼ and «6 minutes walking¼ were evaluated as normal. The orthopedic examination has revealed the flatfoot and scoliosis. 91,73% of the retired individuals did not have a job. Cause of retirement for the majority of patients were stuff cuts after the age 60, which was not in accordance with the satisfactory physical state of the participants of the investigation. Therefore, nowadays the questions of part-time employment of the elderly and re-education of the people with the age «50+¼, together with the development of physical exercise programs are of great importance.

[The high blood pressure in patients with Parkinson's disease]. / Povyshennoe arterial'noe davlenie u bol'nykh bolezn'yu Parkinsona.

OBJECTIVE: To evaluate the relationships between blood pressure (BP), duration of the high BP, reaction of the cardiovascular system on the physical load with the duration of Parkinson's disease (PD) and motor disorders in PD patients. MATERIAL AND METHODS: Fifty-six women with PD and high BP in the anamnesis and 91 women with arterial hypertension, stage 1 were included in the study. The groups of the patients did not differ by age (67.14±7.75 vs. 67.24±5.70 years; p>0.05). The patients were asked about the duration of high BP, the maximal systolic and diastolic BP (SBP and DBP) and presence of antihypertensive therapy, the patients with PD were additionally asked about the duration of the disease, the medicine for PD treatment, the vegetative dysfunction features. The assessment of the orthostatic reaction was determined by transition of the patient from the supine position to the sitting position. Three types of the reaction were isolated: normal, orthostatic hypotension and hypertension. The assessment of motor function in patients with PD was performed using MDS UPDRS, part III. RESULTS: Before and after the orthostatic test, patients with PD and history of arterial hypertension showed normal SBP and DBP levels, while those with isolated hypertension had elevated mean BP corresponding to the high-normal level: the difference in BP levels between the two groups was significant (134.89±17.19 vs. 124.64±18.19 mm Hg; p<0.05; 130.43±19.88 vs. 122.80±19.08 mm Hg; p<0.05). Patients with isolated hypertension were less likely to receive BP-lowering treatment - 30 (32.61%) vs. 10 (18.87%); p=0.04. There were no differences in the frequency of hypertensive and orthostatic reactions between the groups. The total score of motor disorders in patients with PD was correlated with the duration of high BP (R= -0.26; p=0.04). Among the patients with PD, 37 had hypertension prior to the neurologic disorder, 7 were diagnosed with two diseases simultaneously, while the remaining 12 had PD as the initial diagnosis, developing hypertension later in life. The score of the points of the motor disturbances was greater in patients who had developed two diseases simultaneously with the simultaneous developing of the illnesses (15.88±9.36 vs. 19.84±8.01 vs. 26.14±9.68; p<0.05, χ2=10.47, df=2). CONCLUSION: The development of arterial hypertension in patients with PD aggravates the disease.

[Nordic walking in winter as the multitask training in patients with Parkinson's disease]. / Zimnyaya skandinavskaya khod'ba kak mul'tizadanie u patsientov s bolezn'yu Parkinsona.

OBJECTIVE: To evaluate an influence of 8-week course of winter nordic walking as the multitask on the spatial-temporal characteristics of walking and motor disturbances in patients with Parkinson's disease (PD). MATERIAL AND METHODS: Eleven patients (3 men and 8 women, mean age 66.82±3.97 years) with Hoehn and Yahr stage 1 to 2 PD were included in the study. Preliminary medical examination, including the anthropometric profile with the calculation of the body mass index (BMI), the grip strength on the right and left sides, spirometry, functional tests with the physical load (orthostatic test with the determination of systolic and diastolic blood pressure (SBP and DPB) and type of reaction (normal, hypertonic, hypotonic), the 6 Minute Walk Test, timed Up and Go test), was performed to evaluate the physical state. The evaluation of motor function was performed using the unified Parkinson's disease rating scale of the Movement Disorder Society (MDS UPDRS), part III. A 8-week course of nordic walking training was carried out at the certified track on the stadium localized outside of the city, in the wood and parks area in the winter. RESULTS: Compared to the first training, gait velocity increased at the 3rd session, the step length at the 6th. The improvement of the spatial-temporal characteristics of walking was accompanied by the improvement of the motor function as measured by MDS UPDRS, part III. CONCLUSION: Winter nordic walking as multitask is the effective measure of exercise treatment in patients with PD, because it improves the spatial-temporal characteristics of walking and the motor function.

[The correction of motor disorders by special physical exercises in patients with the late cerebellar ataxia]. / Korrektsiia dvigatel'nykh rasstroistv spetsial'nymi fizicheskimi uprazhneniiami u bol'nykh s pozdnei mozzhechkovoi ataksiei.

AIM: The selection of special physical exercises for patients with late cerebellar ataxia based on the biomechanics of balance and gait and evaluation of the clinical effect of therapy. MATERIAL AND METHODS: Twelve male patients with the diagnosis of late cerebellar ataxia were included in the study. The mean age was 49.33±8.80 years. The daily program of therapeutic exercises included training lessons with the exercise physician. The duration of training lessons was 25-30 minutes every day besides the independent task-repetitions 5-6 times a day during 12 days. To evaluate a clinical effect, the Scale for the assessment and rating of ataxia (SARA) was administered before the lessons and on the 12-th day of therapy. RESULTS AND CONCLUSION: The authors developed the program of physical exercises for patients with late cerebellar ataxia based on the feeling of body weight and consecutive movements of the sole that were taken from techniques of classical dance steps. After 12 days of training, the total scores on SARA decreased (12.75±4.47 vs. 9.00±4.81, p<0.01) due to the decrease in the scores of gait (3.41±1.16 vs. 2.25±0.86, p<0.01) and stance (2.67±0.98 vs. 1.42±1.08, p<0.01). Therefore, special physical exercises are a necessary component of the therapy of late cerebellar ataxia.

[The power exercises as a risk factor of Parkinson's disease]. / Silovaia fizicheskaia nagruzka kak faktor riska bolezni Parkinsona.

AIM: To study the relationship between the physical condition, degree of motor disturbances and power loading in former athletes with Parkinson's disease (PD). MATERIAL AND METHODS: The study included 20 men with PD, including 10 power athletes with training loads in the youth for more than 5 years and 10 non-athletic patients. A medical history of PD and accompanied hypertension were analyzed, body mass index and power hand index were measured and the orthostatic test from supine to sitting position was made. Motor function was assessed with the unified Parkinson's disease rating scale of the Movement Disorder Society (MDS UPDRS) - part III. RESULTS AND CONCLUSION: Former athletes with PD were younger compared to non-athletic patients (57.44±8,14 vs. 66.78±4.29 years; p<005) and had longer duration of the disease (6.56±5,36 vs. 3.60±3.50 years; p<0.05). The orthostatic reaction of the former athletes was accompanied by increasing of diastolic blood pressure (DBP), while there was a decrease in DBD in the non-athletic men. Hypokinetic syndrome was more pronounced in the former athletes. The slowing of movements (bradykinesia) were accessed as 3 points on MDS UPDRS in 6 people and 4 points in 4. The results show the impact of power training on the course and presentations of PD in former athletes.

[Otogenic and rhinogenic intracranial complications: meningitis and brain abscess in adults]. / Vnutricherepnye oslozhneniia vospalitel'nykh zabolevanii nosa i ukha: meningit i abstsessy mozga u vzroslykh.

The purpose of this study is to review etiology, diagnosis and management strategies of rhinogenic and otogenic meningitis and brain abscess in adults. Current diagnostic procedures, effective surgery and antibiotic treatment are discussed. The clinical case of diagnosis and successful treatment of the patient with rhinogenic meningitis and brain abscesses is presented.

[The specific pathogenetic features of the development of chronic tonsillar pathology]. / Patogeneticheskie osobennosti formirovaniia khronicheskoi tonzilliarnoi patologii.

The authors discuss the mechanisms underlying the development of chronic tonsillar pathology confirmed by the methods of histological, autoradiographic, and bacteriological diagnostics. The new aspects of vital activity of microorganisms in the parenchymal tissue of the palatine tonsils are highlighted that account for the low effectiveness of the conservative therapy of chronic tonsillitis and give evidence of the necessity of the surgical treatment of this condition.

[Causes, consequences and overcoming ways of stigmatization of patients with substance abuse disorders]. / Prichiny, posledstviia i sposoby preodoleniia stigmatizatsii bol'nykh s narkologicheskimi rasstroistvami.

Stigmatization of people with drug and alcohol use disorders, its types and main causes of stigmatization have been analyzed. Main symptoms, types and consequences of stigmatization as for people with drug and alcohol abuse as well for society in whole have been described. Based on the complex of traits studied, the key causes and factors of stigma were analyzed and the variants of destigmatization of patients were suggested.

[The post-streptococcal diseases in the clinical practice].

The authors describe various clinical forms of streptococcal infections, the pathogenetic mechanisms underlying these conditions, and peculiarities of their clinical picture. Also considered are the modern methods employed for laboratory diagnostics of streptococcal infections. The probability of the risk of development of post-streptococcal diseases in the children is evaluated. Measures for the prevention of these conditions are proposed.

[Differential diagnostics of chronic tonsillitis based on the severity of manifestations of tonsillogenic intoxication of the organism].

The objective of the present study was to elucidate the objective diagnostic criteria for the differentiation between various forms of chronic tonsillitis (CT) based on the results of clinical, bacteriological, and serological investigations. A total of 13 patients presenting with various forms of CT were available for the examination. The mathematical analysis of the data thus obtained made it possible to identify the most clinically significant diagnostic criteria allowing to verify the form of CT. It is concluded that their application in the combination with the classification of chronic tonsillitis proposed earlier by B.S. Preobrazhensky and V.T. Pal'chun can be recommended for the choice of the most adequate strategy for the treatment of the patients chronic tonsillitis on an individual basis.

[OBSTRUCTION OF THE OUTFLOW TRACT OF THE LEFT VENTRICLE DURING CARDIAC SURGERY].

Obstruction of the outflow tract of the left ventricle is well understood as a complication of hypertrophic cardiomyopathy. But other clinical situations are not described in Russian. The aim of this work was the description of the clinical, echocardiographic criteria and pathogenetically substantiated therapy dynamic subaortic obstruction in operations with extracorporeal circulation. Routine echocardiographic monitoring allowed to register obstruction of the outflow tract of the left ventricle in 10 patients during heart surgery (7 men, 3 women) aged 71 ± 16 years, when dealing with extracorporeal circulation (66 ± 22 min): 2 cases--correction of defects of the heart valves, 7--coronary artery bypass grafting. Early diagnosis of this complication in 8 cases, provided a rational choice of effective treatment strategy providing for the rejection of cardiotonics, the appointment of a beta-blocker, infusion therapy maintaining a relative of hypertension. Two patients died, despite the measures taken. Thus, obstruction of the outflow tract of the left ventricle is a rare but dangerous complication of cardiac surgery. Its timely diagnosis is possible using intraoperative echocar- diography.

Detection of ischemical dyssynchrony in patients with normal duration of QRS at rest and during exercise echocardiography (Dyssynchrony in coronary artery disease patients during exercise).

AIM: Ischemic segments cannot develop a sufficient amount of strength during systole, so theoretically they begin to contract later in comparison with non-ischemic zones. There is a lack of information about methods that can detect dyssynchrony during exercise in patients with QRS not longer 100 ms. The aim of the study was to compare different methods of detection regarding left ventricular moving dyssynchrony in patients with significant coronary stenosis artery lesions: pulsed-wave of PW-TDI, strain (S) and strain rate (SR). METHODS: The study included 133 subjects: 106 consecutive patients who were scheduled for coronary angiography with previous stress-echocardiography and 27 healthy persons. All the patients underwent a supine bicycle exercise test. RESULTS: Seventy-six patients had stenoses and 30 subjects had no significant lesions by coronary angiography. There was a detectable difference between time parameters of left ventricle contraction for the two groups and controls before and during exercise using all Doppler methods. Subgroups of patients without previous myocardial infarction and without hypertrophy of left ventricle had the same results. Maximal difference was observed using strain method. There was a moderate correlation between time parameters and the existence of significant lesions of coronary arteries. CONCLUSION: Patients without prolongations of QRS with significant lesions of coronary arteries have detectable left ventricular dyssynchrony before and during exercise.

[Peculiarities of clinical and laboratory characteristics of the activity of streptococcal infection in the patients presenting with tonsillar pathology].

The objective of the present study was to characterize peculiar clinical and laboratory features of trivial tonsillitis for the substantiation of the necessity of prescription of antibacterial therapy. A total of 386 patients presenting with various forms of trivial tonsillitis were available for the determination of anti-streptococcal antibody (ASLO, anti-DN-ase B, ASPH) levels. The results of the measurement were compared based on the Centor scale generally used to estimate the necessity of prescribing antibacterial therapy for the treatment of sore throat. It is concluded that laboratory studies of characteristics of S. Рyogenes activity are needed in all the patients presenting with tonsillitis in order to elucidate the etiological factors responsible for pharyngalgia and the necessity of prescription of antibacterial therapy for the prevention of pyogenic systemic complications of streptococcal infection.

[Modern approaches to diagnostics of the diseases associated with chronic tonsillitis].

The objective of the present study was to analyse risk factors and the clinical course of general diseases and disorders associated with chronic tonsillitis. We overviewed domestic and foreign periodicals and present the data thus obtained together with the results of our original investigations. The study permitted to elucidate the risk factors of the complicated clinical picture of chronic tonsillar pathology and substantiate the necessity of the active surgical treatment for the prevention of the development of toxico-allergic forms of this disease. The importance of thorough diagnostics of the diseases concomitant with chronic tonsillitis both for the purpose of identification of its form and for the prevention of the development of serious life-threatening complications is emphasized.

[The modern view of toxico-allergic manifestations of chronic tonsillar pathology, its etiological and pathological role in the evolvement and development of general diseases].

The objective of the present study was to analyse etiological and pathogenetic mechanisms underlying the development of toxico-allergic manifestations in the patients presenting with chronic tonsillitis. The overview of the publications in the Russian and foreign literature provided materials for substantiating the expediency of the treatment of various forms of chronic tonsillitis on an individual basis. The necessity of further studies of toxico-allergic manifestations of chronic tonsillitis and the use of the active surgical strategies for the management of toxico-allergic forms of the disease is emphasized.

[The new MRI pulse sequence: experience in emergency neuroradiology].

The new pulse sequence (PS) has been obtained on MRI tomography Ellipse, B=0,15 and Biospec 70/30, B=7 T. The new pulse images of the brain combine features of FLAIR and its sensitivity to magnetic field heterogeneity. We named its PS as the T2 Fluid Attenuation Gradient Echo (T2 FLAGE). The T2 FLAGE characteristics of tissue contrast as well as its efficacy in detection of ICH have been assessed in 57 patients with acute stroke and in 16 experimental rats. The analysis of tissue contrast of lesions and normal brain structure has revealed the greater visibility of T2 FLAGE images compared to FLAIR. At the same time, the images sensitivity of magnetic field heterogeneity is retained. The ROC-analysis has shown that T2 FLAGE images are more effective in differential diagnosis of stroke type compared to FLAIR.

[Comparative assessment of MR-semiotics of acutest intracerebral hematomas in low- and extra high-field frequency magnetic resonance tomography].

An objective of the study was to compare sensitivity of low- and extra high-field frequency magnetic resonance (MR) tomography of acutest intracerebral hematomas (ICH) and to assess differences between symptoms in obtained images. A study was conducted using experimental ICH in rats (n=6). Hematomas were formed by two injections of autologic blood into the brain. MR-devices "Bio Spec 70/30" with magnetic field strength of 7 T and "Ellipse-150" with magnetic field strength of 0,15 T were used in the study. MR-tomography was carried out 3-5 h after the injections. Both MR-devices revealed the presence of pathological lesion in all animals. Extra highfield frequency MR-tomography showed the specific signs of ICH caused by the paramagnetic effect of deoxyhemoglobin in T2 and T2*-weighted images (WI) and low frequency MR-tomography - in T2*-WI only. The comparable sensitivity of low- and extra high-field frequency MR-devices in acutest ICH was established.