Role of lipoprotein (a) in the development of ischemic stroke and other cardiovascular diseases

The paper gives the data available in the literature on the role of a level of elevated lipoprotein (a) (Lp (a)) in the development of ischemic stroke and other cardiovascular diseases. It shows the normal level of Lp (a) and the typical distribution of its concentration for people of European origin and representatives of other races. There is evidence on the genetic determination and variability of the Apo (a) gene. The paper presents the results of the recent large survey of 8000 patients with coronary heart disease and 8000 control persons, which has studied candidate genes for cardiovascular diseases. It indicates the role of Lp (a) as a risk factor for early atherosclerosis and describes main pathomorphological mechanisms. The propositions that it is necessary to screen Lp (a) in different risk groups, its target level, and possible methods for correcting the elevated Lp (a) level are given

Cognitive impairments in epilepsy

Cognitive impairments in epilepsy are a current problem in neurology. The basis of the idea on the pathogenesis of higher nervous system dysfunctions is the interaction of a few factors that include the form and duration of the disease, gender differences, and the impact of antiepileptic therapy. The role of interattack epileptiform changes in the development of cognitive deficit in adults and epileptic encephalopathies in children is discussed. Up-to-date neurophysiological and neuroimaging diagnostic methods allow the detection of new features in the course and progression of higher nervous system dysfunctions in epilepsy

DNA-Free Recombinant SV40 Capsids Protect Mice from Acute Renal Failure by Inducing Stress Response, Survival Pathway and Apoptotic Arrest

Viruses induce signaling and host defense during infection. Employing these natural trigger mechanisms to combat organ or tissue failure is hampered by harmful effects of most viruses. Here we demonstrate that SV40 empty capsids (Virus Like Particles-VLPs), with no DNA, induce host Hsp/c70 and Akt-1 survival pathways, key players in cellular survival mechanisms. We postulated that this signaling might protect against organ damage in vivo. Acute kidney injury (AKI) was chosen as target. AKI is critical, prevalent disorder in humans, caused by nephrotoxic agents, sepsis or ischemia, via apoptosis/necrosis of renal tubular cells, with high morbidity and mortality. Systemic administration of VLPs activated Akt-1 and upregulated Hsp/c70 in vivo. Experiments in mercury-induced AKI mouse model demonstrated that apoptosis, oxidative stress and toxic renal failure were significantly attenuated by pretreatment with capsids prior to the mercury insult. Survival rate increased from 12% to >60%, with wide dose response. This study demonstrates that SV40 VLPs, devoid of DNA, may potentially be used as prophylactic agent for AKI. We anticipate that these finding may be projected to a wide range of organ failure, using empty capsids of SV40 as well as other viruses

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - An observational study in 29 countries

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (V T) size was 500 ml, or 7 to 9 ml kg−1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P ˂ 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P ˂ 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high V T and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome.</p

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Cognitive impairment in COVID-19 survivors

A new 2019 coronavirus disease has been spreading worldwide for more than a year, with a high risk of infection and death. Various sequelae and complications can develop in COVID-19 survivors, lasting from several weeks to several months after initial recovery, affecting different organs and systems. Various sequelae and complications can occur in COVID-19 survivors not only in adults and the elderly, but also in young people. A wide range of neurological manifestations of COVID-19 are now described in the available literature. The incidence of selected neurological symptoms, syndromes and nosological forms in individuals both in the acute period of COVID-19 disease and in the short- and long-term follow-up of these patients is presented. In this article, cognitive impairments occurring in individuals who have had coronavirus disease are discussed in depth. Data on the prevalence of cognitive impairment in different regions and at different periods of the disease are presented. The main possible pathophysiological processes and risk factors for the development of cognitive impairment in COVID-19 are described. Possible ways of drug and non-drug rehabilitation of patients with cognitive impairment in coronavirus infection that is a new problem of modern medicine are considered. Attention is also paid to neuroprotection as one of the therapy areas

Perimenopausal period and mood disorders

The article is devoted to the possibilities of correction of neuropsychiatric disorders in perimenopause, a condition associated with the cessation of menstruation in a woman and a decrease in the level of ovarian steroid hormones (estrogen and progesterone) due to the loss of the ovarian follicular mass. It is known that biological and endocrine changes during this period are often accompanied by autonomic symptoms. In perimenopause, women may experience symptoms such as hot flashes and night sweats, insomnia, vaginal dryness, mood disorders, etc. Although most symptoms are not life-threatening, they can have a negative impact on the quality of life, physical and mental health of perimenopausal women. During menopause, women are at higher risk of developing depression, stress, anxiety and emotional disorders. In addition, during perimenopause, women experience not only depressive symptoms but also cognitive impairment, which may be related to changes in hormonal background. Drugs that are used in the treatment of mood disorders affect different neurotransmitters, in particular serotonin, norepinephrine and gamma-aminobutyric acid (GABA). One of the benzodiazepine derivatives is Tofisopam, first developed in Hungary and marketed in a number of European countries under the name Grandaxin. It is indicated for the treatment of neurotic and somatic disorders associated with tension, anxiety, autonomic disorders, lack of energy and motivation, apathy, fatigue, depressed mood and alcohol withdrawal syndrome, including during perimenopause. Tofisopam has good anxiolytic activity with no observable sedative, anticonvulsant, amnestic or muscle relaxant effects

Endothelial function in normal and pathological conditions

The article presents the data on the state of endothelial function in the normally and in various diseases and conditions. The basic  functions of endothelium in modulation of vascular tone, atrombogenicity and thrombogenicity of the vascular wall, regulation of  vascular wall adhesion, regulation of vascular growth are described. The main causes leading to the formation of endothelial  dysfunction and the mechanisms underlying it are highlighted. Numerous studies on the evaluation of endothelial function in  various diseases are presented. The basic methods of drug and non-drug correction of endothelial dysfunction are presented

Back pain and spinal osteoporosis in clinical practice

Back pain is a common clinical and socioeconomic problem. Back pain is a symptom, not a nosological form. Osteoporosis is a skeletal disease in which, despite normal bone mineralization, bone loss and bone (structure) integrity is observed. The article considers the main causes of primary and secondary osteoporosis. The main modifiable and unmodifiable risk factors for osteoporosis and fractures are presented. The main pathological conditions and diseases associated with the risk of osteoporosis are described. The problem of osteoporosis of the spine as one of the causes of mechanical painful episodes in the back of elderly patients is considered in depth. Clinical features of compression vertebral fractures in osteoporosis in women after menopause are presented. The methods of conservative treatment of osteoporosis are considered. The greatest attention is paid to such effective antiosteoporotic drugs as bisphosphonates. The data on the efficacy and tolerability of alendronic acid preparations as the most studied preparation from the group of bisphosphonates are analyzed. The information on the new medicinal form of alendronic acid – sparkling soluble tablets (Binosto) is presented