Unsolved Issues of Atherosclerosis Prevention and of Adequate Lipid-lowering Therapy in Patients with Acute Ischemic Cerebrovascular Accident

The existing system of medical care for patients with acute cerebrovascular accident of atherothrombotic genesis, namely lipid metabolism disorders, the modern evidence base for lipid-lowering therapy in this category of patients and the feasibility of interdisciplinary interaction of cardiologists and neurologists were discussed at a meeting of the expert council of cardiologists and neurologists in Moscow on 2021 July 7.

SOME ASPECTS OF ACUTE CEREBROVASCULAR PATHOLOGY IN POSTPARTUM WOMEN

В данной статье, представлены результаты обследования 17 женщин, перенесших острое нарушение мозгового кровообращения в послеродовом периоде, с 2017 по 2021 годы, в возрасте от 19 до 39 лет. Показано, что у женщин в послеродовом периоде, перенесших острое нарушение мозгового кровообращения, выявлено преобладание ишемического инсульта над геморрагическим, что составило 64,7% и 35,3% соответственно. Неврологические признаки церебрального инсульта в послеродовом периоде характеризуются двигательными, речевыми расстройствами, нарушением чувствительности, а также часто психоэмоциональными проявлениями. Генерализованные тонико-клонические приступы чаще наблюдались у пациенток с геморрагическим инсультом (33,3%), в сравнении с ишемическим инсультом (9,1%). У женщин в послеродовом периоде, перенесших острое нарушение мозгового кровообращения, наиболее значимыми факторами риска являются: наличие хронических заболеваний, в том числе отягощенный акушерско-гинекологический анамнез, прием пероральных контрацептивов, а также курение. Биоэлектрическая активность головного мозга характеризовалась выраженной дельта и тета активностью, эпилептиформными разрядами в виде острых волн, спайков и комплексов «пик-волна», с преобладанием у пациенток с геморрагическим инсультом. Более значительное повышение индекса когерентности в дельта и тета диапазонах у пациентов, перенесших геморрагический инсульт, может указывать на более грубые межполушарные нарушения, в сравнении с ишемическим инсультом. Отмечено повышение интегрального индекса диапазона медленно-волновой активности и преобладание процентного отношения спектральных мощностей медленных волн (дельта, тета) к быстрым волнам (альфа, бета), особенно выраженное у больных с геморрагическим инсультом (р < 0,05), в сравнении с ишемическим инсультом. Наиболее тяжелое течение послеродового периода наблюдалось у пациенток с геморрагическим инсультом, именно в этом случае было 2 летальных исхода. This article presents the results of a survey of 17 women with acute cerebrovascular accident in the postpartum period, from 2017 to 2021, aged 19 to 39 years. It is shown that the period in women in the postpartum period, who underwent acute cerebrovascular accident, revealed the prevalence of ischemic stroke over hemorrhagic, which amounted to 64,7% and 35,3%, respectively. Neurological signs of cerebral stroke in the postpartum period are characterized by movement, speech disorders, impaired sensitivity, and often psychoemotional manifestations. Generalized tonic-clonic seizures were more often observed in patients with hemorrhagic stroke (33,3%) in comparison with ischemic stroke (9,1%). In postpartum women who have suffered acute cerebrovascular accident, the most significant risk factors are: the presence of chronic diseases, including a burdened obstetric and gynecological history, taking oral contraceptives, as well as smoking. The bioelectrical activity of the brain was characterized by pronounced delta and theta activity, epileptiform discharges in the form of sharp waves, spikes and peak-wave complexes, with a predominance in patients with hemorrhagic stroke. A more significant increase in the coherence index in the delta and theta ranges in patients after hemorrhagic stroke may indicate more severe interhemispheric disorders in comparison with ischemic stroke. An increase in the integral index of the range of slow-wave activity and a predominance of the percentage of the spectral powers of slow waves (delta, theta) to fast waves (alpha, beta), especially pronounced in patients with hemorrhagic stroke (p <0,05), in comparison with ischemic stroke. The most severe postpartum period was observed in patients with hemorrhagic stroke, in this case there were 2 deaths.

Tactics of a general practitioner in case of suspected acute cerebrovascular accident and measures to prevent it

Acute cerebrovascular accident (stroke) is a fairly common severe pathology, which is one of the main causes of death in most countries. Every year in the world, a stroke occurs in 15 million people, of whom about 5 million die, and the same number become disabled. The disease is based on a sudden sharp failure of the normal blood supply to the brain substance due to a rupture or blockage of a blood vessel. Mortality in the first weeks after a stroke can reach 30-35%. Depending on the pathogenesis of the lesion, stroke can be ischemic and hemorrhagic (ischemic occurs about 6 times more often); clinical symptoms will depend on which area of the brain is involved in the pathological process. Predisposing factors include heredity, gender (more often observed in men), age (in elderly age, the risk of stroke increases every year), arterial hypertension, diabetes mellitus, obesity, hypodynamia. Since in 80% of cases after a stroke people become disabled, often unable to take care of themselves, the problem of acute cerebrovascular accident has long passed from the category of purely medical issues to the category of socio-economic ones. The tasks of the general practitioner include the timely identification of factors predisposing to the development of a stroke and minimization of the possible risks of this formidable condition, and in the case of a stroke, active participation in the patient's rehabilitation process.

Comparison of premade clevidipine and pharmacy-prepared nicardipine in time to goal systolic blood pressure in acute cerebrovascular accident

Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To compare pharmacy-prepared nicardipine and premade clevidipine with regard to time to goal systolic blood pressure (SBP) in acute cerebrovascular accident (CVA). Methods A retrospective, observational study was conducted comparing patients with acute CVA who received nicardipine or clevidipine. The primary objective was time to goal SBP. Secondary objectives included time from order to administration, time from administration to goal SBP, percentage of SBP readings below goal, total volume administered, hospital and intensive care unit lengths of stay, inpatient mortality and adverse events. Results Seventy-one patients were included in the study, 37 in the nicardipine group and 34 in the clevidipine group. A significant difference was found in mean time to goal SBP (150.9 minutes in the nicardipine group vs 69.3 minutes in the clevidipine group, P &lt; 0.01). Time from order to administration was 80.1 minutes in the nicardipine group and 35.2 minutes in the clevidipine group (P &lt; 0.01). Mean time from administration to goal SBP was 70.9 minutes in the nicardipine group and 42.3 minutes in the clevidipine group (P = 0.02). There was no difference between groups in percentage of SBP readings below goal, total volume administered, length of stay, or inpatient mortality. Adverse events occurred in 13 (35.1%) of the nicardipine-treated patients and 17 (50%) of the clevidipine-treated patients (P = 0.42). Conclusion Compared to use of pharmacy-prepared nicardipine, use of premade clevidipine was associated with a shorter time to goal SBP in patients with acute CVA. There were no significant between-group differences in safety outcomes. Premade clevidipine should be considered over pharmacy-prepared nicardipine when rapid blood pressure lowering is warranted in acute CVA.

The role of micronutrients in the rehabilitation of patients after acute cerebrovascular accident

The broad benefits of vitamin and mineral supplementation can improve rehabilitation outcomes in patients with stroke. In this aspect, the most compelling evidence exists for vitamin C, vitamin E, potassium, and magnesium. Individualized nutritional counseling was also associated with positive outcomes.

EP.FRI.221Safe delivery of emergency laparotomy using Personal Protective Equipment (PPE) during the first peak of the COVID-19 pandemic

Aims To evaluate emergency laparotomies and examine operating surgeon use of PPE as per guidelines in the first COVID-19 peak. Methods The NELA database for our hospital was interrogated to examine for emergency laparotomy cases between March to September 2020. Data was recorded on age, pathology, NELA mortality score, post-operative destination, mortality COVID-19 swab status as an inpatient and use of PPE. Results 55 laparotomies were undertaken. The median age was 67 years. 48% had a Clinical Frailty Score &gt;4. 53% of patients were 'high-risk' in their NELA mortality score (&gt;5%). 56% were ASA &gt;3. 44% went to intensive care post-operatively. 18% and 36% had significant cardiac and respiratory co-morbidities. The mean NELA mortality score was 10% pre-operatively. Mean post-operative risk of mortality score was 67%. Only 1 patient contracted COVID-19 whilst an inpatient and subsequently died of acute cerebrovascular accident unrelated to her COVID-19. PPE was available and used as per guidelines in all cases. Conclusions Our department remained busy throughout the first peak however there was a reduction in cases compared with 2019. Our population is generally heavily co-morbid based on ASA scores and cardiorespiratory co-morbidity. Nevertheless only 1 patient contracted COVID whilst an inpatient in this cohort. Access to adequate amounts of personal protective equipment is paramount to ensure safe and timely access to emergency laparotomy for patients and surgeons alike.

The effect of intranasal administration of an IL-1b antagonist (RAIL) on the state of the nitroxydergic system of the brain during modeling of acute cerebrovascular accident

Introduction: This study was designed to evaluate the effect activity of RAIL-gel in comparison with Citicoline on nitroxydergic system during acute cerebrovascular accident. Methods: In this study, 80 white nonlinear rats were randomly assigned to 4 groups (20 rats in each): 1) intact; 2) control - untreated with acute cerebrovascular accident (ACVA), examined on the 4th day; 3) animals with ACVA, receiving RAIL, examined on the 18th day; 4) animals with ACVA, treated with Citicoline, examined on the 4th day. The expression of inducible NOS was determined by Western blotting. The nitrosative stress marker, nitrotyrosine, was determined using the ELISE kit NITROTYROSINE (kit no. HK501-02, series 12825k1212-k). To assess the state of iNOS mRNA expression, we used the method of polymerase chain reaction with reverse transcription in real time (RT-PCR). Results: Our research demonstrated that course administration of the RAIL and Citicoline to animals with ACVA for 4 days leads to the stabilization of the parameters of the brain nitroxydergic system. However, Citicoline does not provide a full effect on the shifts of the NO system in the brain. It does not have the proper effect on such an important link in the pathogenesis of ischemic brain damage as nitrosative stress. RAIL leads to a significant decrease in NOS activity due to its inducible form (decrease in the expression of iNOS and iNOS mRNA) and a decrease in NO metabolits, and inhibition of nitrosative stress (decrease in nitrotyrosine). Conclusion: IL-1b antagonist RAIL (Intranal Gel) significantly exceeds Citicoline in terms of the severity of the effect on the nitroxydergic system indicators.

COVID-19 AND STROKE: POSSIBLE CAUSES AND PATHOGENESIS (REVIEW)

Появляются доказательства того, что COVID-19 может вызывать выброс цитокинов, состояние гиперкоагуляции и повреждение эндотелия, которое может привести к острому нарушению мозгового кровообращения (ОНМК). В данной статье авторы обсуждают взаимосвязь между COVID-19 и ОНМК, и о возможных факторах, способствующих возникновению инсульта. Как свидетельствует увеличение D-димера, фибриногена, фактора VIII и фактора фон Виллебранда, инфекция SARS-CoV-2 вызывает коагулопатию, нарушает функцию эндотелия и способствует состоянию гиперкоагуляции. В совокупности это предрасполагает пациентов к цереброваскулярным нарушениям. Механизм, лежащий в основе COVID-19 и инсульта, требует дальнейшего изучения, равно как и разработка эффективных терапевтических или профилактических мер. Evidence is emerging that COVID-19 can cause cytokine release, hypercoagulable states, and endothelial damage that can lead to acute cerebrovascular accident (ACVI). In this article, the authors discuss the relationship between COVID-19 and stroke and the possible contributing factors to stroke. As evidenced by an increase in D-dimer, fibrinogen, factor VIII and von Willebrand factor, SARS-CoV-2 infection causes coagulopathy, disrupts endothelial function and hypercoagulability. Collectively, this predisposes patients to cerebrovascular disorders. The mechanism underlying COVID-19 and stroke requires further study, as does the development of effective therapeutic or preventive measures.

Experimental research of cerebroprotective activity of the new 4-aminobutatanoic acid derivative

The aim. To study the cerebroprotective activity of a new derivative of 4-aminobutanoic acid the compound KGM-5 on the effect on survival and behavioural responses, cognitive impairment and neurological deficits in rats with acute cerebrovascular accident. Materials and methods. Acute cerebrovascular accident (ACVA) was simulated in rats by irreversible unilateral carotid occlusion (UCO) under anesthesia with sodium thiopental (35 mg/kg, intraperitoneally, IP). Five groups of animals were used: intact control (IC, n=6), a group of animals with ACVA, which were not treated (control pathology, CP, n=13); group of animals with ACVA, which were treated for 5 days after surgery (first injection 30 min before surgery) with the compound KGM-5 (ACVA+KGM-5, n=14) at a conditionally effective dose of 30 mg/kg body weight of animals, a group of animals with ACVA (ACVA+CD “Picamilon”, n=13), who received IP for 5 days, the comparison drug (CD) “Picamilon” at a dose of 17 mg/kg and pseudo-operated animals (POA), n=8), which were operated without ligation of the carotid artery, which allows to level the effect of anesthesia and surgery on the studied indicators. The cerebroprotective effect of the studied agents was assessed by an integral criterion – survival of animals (throughout the experiment), indicators of neurological deficit (24, 48, 72, 94 hours after ACVA modelling), the state of cognitive functions in the test of extrapolation escape test (EET) (72 hours after ACVA modelling) Results. The KGM-5 compound contributed to a significant reduction in the severity of neurological deficit, as evidenced by significant differences in this indicator compared with CP, respectively, the first (0.5 points vs. 1.25 points, p<0.05), the third (0.0 points against 1.0 point, p<0.05) and the fourth day (0.0 points vs. 0.5 points, p<0.05) after OCO. Under the influence of CD “Picamilon” reduction of neurological deficit compared with CP was observed on the first, third and fourth days, but these differences were insignificant (p>0.05). Both studied agents - the compound KGM-5 and CD “Picamilon” contributed to the improvement of cognitive functions of rats with ACVA, as evidenced by a significant reduction (p<0.05) of the latent period of diving in the EET, respectively, 1.8 and 1.7 times compared with CP and did not show a significant effect on animal survival. Conclusion. The cerebroprotective activity of a new 4-aminobutanoic acid derivative in the conditions of acute cerebrovascular accident in rats was established in terms of the ability to reduce the severity of neurological deficits and improve cognitive functions in the extrapolation escape test. The severity of cerebroprotective activity of the new compound is not inferior to GABA-ergic drug “Picamilon”.