[Ophthalmic manifestations in COVID-19-associated multiple mononeuropathy of the cranial nerves (clinical observation)]. / Oftal'mologicheskie proyavleniya pri mnozhestvennoi mononevropatii kranial'nykh nervov, assotsiirovannoi s COVID-19 (klinicheskoe nablyudenie).

Clinical manifestations of the new coronavirus infection can vary greatly and affect different organs and systems. Despite the lack of convincing data on the possible direct damage to the structures of the eyeball by the SARS-CoV-2 virus, indirect involvement of the organ of vision both in the acute period of the disease, during the period of convalescence, and as a part of the post-COVID syndrome is common in clinical practice. The condition of the ocular surface is not given much attention during the treatment of the main disease, especially in severe cases, which can lead to serious complications and visual acuity loss after recovery. Timely measures can prevent the loss of visual acuity. This article presents a description and discusses a rare case of multiple neuropathy of the cranial nerves associated with COVID-19, with bilateral involvement of the olfactory (I), trigeminal (V), facial (VII) and sublingual (XII) nerves, as well as the right optic nerve (II), which required staged rehabilitation.

[Chronic musculoskeletal pain in degenerative changes of the spine in young and middle-aged patients]. / Khronicheskaya skeletno-myshechnaya bol' pri degenerativnykh izmeneniyakh pozvonochnika u patsientov molodogo i srednego vozrasta.

OBJECTIVE: To identify clinical and laboratory indicators associated with the development of chronic musculoskeletal pain syndrome in young and middle-aged patients with degenerative changes of the spine. MATERIAL AND METHODS: The study included 103 patients (59 women and 44 men) with a mean age 42 [36; 47] years with chronic musculoskeletal back pain. To verify degenerative changes of the spine, MRI was performed using Magnetom Symphony (Siemens; Germany), Magnetom Verio (Siemens; Germany) devices. The intensity of the pain syndrome, the neuropathic component of pain sensations, and affective disorders were assessed. Blood levels of osteocalcin, parathyroid hormone, thyroid stimulating hormone were determined using an immunochemiluminescent analyzer Immulite 2000 (Siemens, USA), vitamin D - using an immunochemical analyzer Architect i2000SR (Abbott, USA), vitamin PP and 17-hydroxyprogesterone by sandwich-type ELISA on a plate reader VICTOR 2 (Perken Elmer, USA). The levels of interleukin-1ß, interleukin-6 and interleukin-8 and tumor necrosis factor alpha (TNF-α) in the blood were determined by enzyme-linked immunosorbent assay (ELISA) on a Real-best plate ELISA analyzer (Russia) using Cloud Clone Corparation kits (USA, China). RESULTS: The main causes of musculoskeletal pain in the main group (83 patients) with a mean age of 42 [38; 46] years, were degenerative changes of the spine without signs of compression of the spinal nerves and spinal canal stenosis. In the control group (20 patients) with a mean age of 41 [34; 47] years, main causes were static and functional disorders. Patients with degenerative changes of the spine often led a sedentary lifestyle and had an increased body mass index. Tobacco smoking was noted in 48.2% of patients of the main group and 25% of patients in the control group (p=0.080). The intensity of pain in patients in both groups had a moderate degree, the neuropathic component of pain was not detected. Asthenia, situational and personal anxiety were mild or elevated in both groups In the main group, there was an increase in the levels of pro-inflammatory factors (C-reactive protein, TNF-α, IL-1ß, IL-6 and IL-8), as well as a decrease in the level of osteocalcin. CONCLUSION: The revealed increase in the levels of pro-inflammatory factors (C-reactive protein, TNF-α, IL-1ß, IL-6 and IL-8) in the blood confirms the role of inflammatory reactions in the pathogenesis of degenerative changes of the spine and the associated musculoskeletal pain syndrome. A decrease in the level of osteocalcin with a normal content of parathyroid hormone in the blood in patients of main group may be associated with desorganized bone remodeling and increased bone resorbtion.

[Prevention of ischemic stroke in atrial fibrillation from the point of view of a neurologist. Standards and real clinical practice].

The article outlines aspects of the current state of the problem of the priority choice of an oral anticoagulant for indefinite prevention of stroke and systemic thromboembolism in patients with atrial fibrillation. The advantages of direct oral angicoagulants over warfarin are presented, as well as a comparative analysis of the individual characteristics of the main direct oral angicoagulants from the point of view of personification of preventive therapy in accordance with modern treatment standards. The efficacy and safety of oral anticoagulant therapy has been reviewed in terms of the net clinical benefit. Particular attention is paid to the age-related aspects of choosing an anticoagulant for indefinite prophylaxis; an assessment of anticoagulants is presented in accordance with the FORTA concept, which regulates the use of drugs in elderly patients. In conclusion, recommendations are formulated for the choice of an anticoagulant in patients with atrial fibrillation in the most common clinical situations. As a general rule, the choice of a particular drug should be individualized based on risk factors, tolerability, net clinical benefit, patient preference, potential adverse interactions, and other clinical characteristics.