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Aim. To describe best practices in using human normal immunoglobulin in patients with immune-mediated neurological disorders according to the data of one clinical center.Materials and methods. From 2016 to 2021, 20 patients with various autoimmune disorders of the peripheral and central nervous system were treated with human normal immunoglobulin at the Neurology Unit No.1 of Pavlov First Saint Petersburg State Medical University. Treatment efficacy was assessed by changes in the neurological examination data according to specialized scales for specific diseases or clinical manifestations (INCAT, QMGS, MoCA, EDSS). Safety of the therapy was assessed considering the instructions to the drug.Results. In the vast majority of patients, treatment allowed to stabilize the course of the disease or was accompanied by pronounced regression.Conclusion. The considered clinical cases of the use of human normal immunoglobulin preparations demonstrate the possibility of their use in the treatment of a number of autoimmune neurological diseases for unregistered indications.

The aim – to study and analyze the clinical and functional characteristics and parameters of lipid metabolism in patients after acute myocardial infarction (MI), depending on the progression of atherosclerosis according to the data of repeated coronary angiography (CAG) during a three-year follow-up.Materials and methods. The study prospectively included 91 patients with primary Q-MI, 47 of whom underwent a full cardiac rehabilitation (CR) program with physical training (FT), 44 patients – had only complexes of physical exercises and distance walking in accordance with the terms of MI. For three years, CAG was performed in 38 patients, in 18 (group 1) of whom the progression of the atherosclerotic process was established, in 20 (group 2) progression was not visualized in CAG. 53 patients (group 3) had a stable satisfactory condition and refused to repeat CAG. Treatment was performed in accordance with modern guidelines with urgent stenting of the infarct-dependent coronary artery. All patients underwent dosed testing on a bicycle ergometer, echocardiography and an evaluation of lipid metabolism indicators. Control examinations were carried out at discharge on the 10-15th day of myocardial infarction and in dynamics after 1 and 3 years.Results and discussion. Undesirable cardiovascular events (recurrent MI, coronary artery bypass grafting, restenosis, and hemodynamic significant stenoses) occurred only in the 1st group: 7 events – during the first year, also 7 – during the second year, and the last 14 – during the third year. In the second group, in the first week of myocardial infarction stent thrombosis occurred in 2 patients, coronary bypass grafting was performed according to the data of urgent coronary angiography also in 2 patients. During the 3-years follow up in the group with the progression of atherosclerosis the number of patients with diabetes mellitus tripled, and there was also a tendency to an increase in body mass index. According to the results of the exercise test on a bicycle ergometer and echocardiography, significant differences in the groups were not established, however, a positive trend in the dynamics of observation was noted in patients of the 2nd group without progression of atherosclerosis. Low-density lipoprotein cholesterol values ​​were obtained on the 5–7th day of myocardial infarction at the background of high-intensity statin therapy and were considered as basic. Further results showed the best performance in the first 6–12 months after myocardial infarction with better adherence to medical recommendations in the period as close as possible to acute MI. In the group of patients with progression of atherosclerosis, the maximum decrease in the level of low-density lipoprotein cholesterol (up to 2.10 (1.79–2.38) mmol/L) was observed after 6 months, followed by an increase in 1 and 3 years to a level exceeding the baseline. Variations in this indicator in patients without progression were 1.85–2.02–1.83 mmol/L, which was close to the recommended target values ​​(up to 2019).Conclusions. In the group with the progression of the atherosclerotic process, the number of patients with diabetes mellitus increased over 3 years and a tendency towards an increase in body mass index was observed. Most of the patients returned to smoking by the end of the first year after myocardial infarction, but then 3 years later, some of the patients in group 2 stopped smoking again, which may indicate the effectiveness of training and the psychological component of cardiac rehabilitation in the group without progression of the atherosclerotic process. The results of echocardio­­graphy and the level of exercise tolerance at the time of examination did not differ in patients with and without progression of the atherosclerotic process. Maintaining the target levels of LDL cholesterol is possible only under the condition of long-term high-intensity statin therapy under the supervision of a physician, adherence to the comprehensive recommendations of stage III CR at each contact with the patient.

The aim – to use multislice computed tomography (MSCT)-coronary angiography data to determine the presence of atherosclerotic process progression in coronary vessels in the dynamics of the three-year follow-up period in patients after STEMI and coronary artery stenting.Materials and methods. 66 MSCT-coronary angiography studies were performed in 19 men after primary myocardial infarction with ST-segment elevation (STEMI) and coronary artery stenting. All patients were male, ranging in age from 38 to 66 years, with a mean (Me 55.6; (Q1–Q3 (49–64)) years, and 18 of 19 (94.0 %) patients developed Q-MI. 1 patient (6 %) had non-Q-MI. A month after acute MI, patients underwent MSCT of the heart with coronary vascular contrast. Re-examination was performed one, two and three years after the development of STEMI. According to the results of MSCT coronary angiography determined the functional status of stents, as well as the presence or exclusion of signs of restenosis (about 50 % or more) or thrombosis 100 % – occlusion) in the stent coronary artery and in non-infarction-causing arteries. With the progression of atherosclerotic plaque, an increase in atherosclerotic plaque of more than 20 % was taken into account compared to the previous study.Results and discussion. By the end of the first year after MI in 11 of 19 (57.9 %) patients according to MSCT-coronary angiography, no progression of atherosclerotic lesions of the coronary arteries was observed. 1 patient (5.6 %) had stent restenosis, which was confirmed by CAG data. Progression of atherosclerotic lesions was observed in 7 patients (36.8 %), 3 of them (16.6 %) in the stent artery, and in 4 patients in the non-infarction-causing artery. In the second year after myocardial infarction, compared with the annual examination, in 6 of 14 (42.9 %) no progression of atherosclerosis was observed, and in 7 of 14 (50 %) progression of atherosclerotic lesions not in the stent artery, and only in 1 of 14 – progression of atherosclerosis in the stent artery. In the third year after the development of MI, 10 of 14 (71.4 %) had no progression of atherosclerosis, and 4 patients showed progression in both IOA and other arteries.Conclusions. MSCT coronary angiography is an informative method in assessing the functional status of stents and determining the progression of coronary atherosclerosis in the infarct-causing artery and other coronary arteries in patients after MI and coronary artery stenting in the dynamics of three-year follow-up. The lack of progression of atherosclerosis was accompanied by slightly lower levels of low-density lipoprotein cholesterol, compared with patients with progression of atherosclerosis.

The aim – to study the clinical and functional characteristics of patients after myocardial infarction (MI) who referred stage II of cardiac rehabilitation (CR) with physical training (PT) during 3 years follow-up. Materials and methods. The study included 91 patients with primary Q-MI in the absence of contraindications to the CR. Criteria for inclusion were an early postinfarct angina, large aneurysm of the left ventricle, intracavitary formation of thrombus, the reduction of the EF to 35 % and below, complex cardiac arrhythmias and disturbances of conduction, the atrial fibrillation at the time of inclusion in the study, multivessel lession of coronary arteries, left bundle branch block, disorders of the musculoskeletal system, which prevented holding bicycle ergometry test, acute violation of cerebral circulation in the anamnesis, cancer and decompensation of comorbidities. Treatment was carried out according to modern recommendations; at admission coronary angiography with stenting of the infarct-occluded coronary artery was performed. Depending on the volume of rehabilitation measures, the patients were divided into two groups: group 1 consisted 47 patients who in the early post-hospital phase accomplished the program of PT on the bicycle ergometer; group 2 consisted of 44 patients in whom CR was carried out only in the form of distance walking and complexes of therapeutic exercises. Dosed physical load test on a bicycle ergometer, echocardiography, lipid metabolism indexes were evaluated in all patients at discharge from hospital. All exams were performed in dynamics in 4 months (the period corresponding to the end of the program 30 PT), after 1, 2 and 3 years. Results and discussion. At baseline the patients of both groups did not differ in any of the clinical-functional and anamnestic data. The clinical course was evaluated by the following indices: recurrent MI, coronary artery bypass grafting and stenting. Events increased after 2 (7 patients in 1 and 9 patients in 2 group) and 3 (6 and 15 patients, respectively) years. During the first year, all patients took 100 % of P2Y12 receptor blockers, rosuvastatin and beta-blockers; aspirin was used in 95 % of patients in each group; the number of patients who have received ACE inhibitors increased to 81 % in group 1 and 91 % in group 2. A decrease in the doses of statins at the outpatient stage as they move away from acute MI has led to an increase in LDL cholesterol over the years. This index in 4 months after MI in 1st group was 1.82 (1.39–2.20) and 2nd group was 1.83 (1.49–2.21) mmol/l, after 1 year – 1.79 (1.48–2.04) and 2.80 (2.33–3.21) mmol/l, after 2 years – 2.48 (2.12–2.98) and 2.34 (1,93–3.01) mmol/l, after 3 years – 2.29 (2.15–2.49) and 2.40 (2.26–2.61) mmol/l, respectively. The tolerance to physical load with the best hemodynamic efficiency of the work has increased significantly to (140.0; 125.0–150.0) W after 1 year compared with the 2nd group (p

The aim – to evaluate the effectiveness l-carnitine and l-arginine complex in addition to standard therapy for patients with acute myocardial infarction (AMI). Materials and methods. The study included 60 patients whose average age was 48.9±19.2 years, with a verified diagnosis of AMI followed percutaneous coronary intervention. The observation period lasted 6 weeks. Patients were randomized into 2 groups. The first group included 30 patients, who received Tivorel (Yuria-Pharm, Ukraine) intravenous infusion of 100 ml once a day in addition to standard therapy, starting from 3–7 days of AMI for 10 days. The second group – 30 patients received only standard therapy (dual antiplatelet therapy, ACE inhibitors, β-blockers, statins). During the study, all patients underwent echocardiography with an assessment of volumetric parameters and ejection fraction (EF, Simpson), end diastolic volume, end systolic volume (ESV), bicycle ergometry, laboratory tests. Results and discussion. An additional appointment l-carnitine and l-arginine complex leads to a decrease in glucose levels to reference levels 6.1±2.8 mmol/l, in comparison with patients in the control group 7.2±3 3 mmol/l (p

In the treatment of patients with myocardial infarction, a special place belongs to cardiac rehabilitation (CR), which today is positioned as a multifaceted multidisciplinary science, combined with preventive cardiology. CR includes physical training, psychological rehabilitation, sessions with a social worker (motivation to return to work); consultations and training programs which embrace discussion of issues of secondary prevention, including modification of risk factors, stimulating adherence to physical activity and drug treatment. Its purpose is to maximize the recovery of the physical, psycho-emotional and social condition of patients with their return to work, to preserve the quality of life and provide long-term detention of the progression of atherosclerosis. The review presents the main historical aspects of the development of CR, provides statistical indicators of inclusion in the program of CR after a cardiac event – myocardial infarction, percutaneous coronary intervention or coronary artery bypass grafting, presents indications and contraindications for CR. The data are presented of registries and clinical examinations on the effectiveness of CR with physical training for reducing the rates of overall mortality, cardiovascular mortality, hospitalizations, improvement of quality of life, impact on lipid metabolism and processes of myocardial remodeling. Issues related to the time of the beginning of CR with exercise training after index event, duration and intensity of aerobic exercise, assignment of dynamic and static exercises were discussed. One of the main problems in assessing the effectiveness of CR is the existence of many programs in different countries and even in different centers, which limits the possibility of correct comparison of research results. We provide the results of our own study (n=91) in which 47 patients underwent training on a cycle ergometer 11–45 days after the infarction. No differences were found in load tolerance, depending on the start of training. The efficiency of CR with its physical component has been proved regarding the threshold power level and the hemodynamic value of the work performed. The results are presented of cycling ergometry after training in dynamics during 1 year of observation after myocardial infarction depending on the time of coronary circulation recovery in the infarct-determining coronary artery, the number of affected coronary arteries and the completeness of revascularization. Based on the data of leading associations of rehabilitation and preventive cardiology in Europe and America, the main perspective directions for further development of CR are outlined.

OBJECTIVE This study aimed to assess subjective sleep and wake disorders (SWD) in patients with osteoarthritis and comorbid end-stage renal disease (ESRD) receiving hemodialysis (ESRD-HD) compared to patients with osteoarthritis and without chronic kidney disease (CKD) as well as to clarify of the association of subjective sleep characteristics with the levels of anxiety and depression and pain, general health score and laboratory parameters in these cohorts. MATERIAL AND METHODS This pilot case-control study included the patients with stage III hip osteoarthritis with ESRD-HD (n=19) and without CKD (n=19) aged 18-85 years. The patients received the consultations of orthopedic surgeon and internal medicine specialist with anthropometry and clinical and biochemical blood tests. Subjective SWD were assessed with Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), Insomnia Severity Index (ISI), diagnostic criteria for restless legs syndrome (RLS) and Berlin questionnaire. Anxiety and depression were assessed with Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory (BDI). Subjective general health and osteoarthritis-related pain were assessed with visual analog scales (VAS). RESULTS Compared to the patients with osteoarthritis and without CKD, the patients with osteoarthritis and ESRD-HD had a lower VAS score for general health (50.00 (40.00-75.00) points and 80.00 (70.00-80.00) points, p=0.014), a higher PSQI (12.0 (8.5-14.5) points and 8.0 (6.0-11.0) points, p=0.046), a higher incidence of RLS (59% and 16.8%, p=0.017) and a lower level of anxiety according to HADS (0.0 (0.0-3.0) points and 3.0 (2.0-5.5) points, p=0.025). The correlation and regression analysis showed the association of PSQI score with VAS score for general health (b= -1.7 points, p=0.002 with adjustment for age, sex and ESRD-HD), as well as the association of SWD with laboratory markers (PSQI score with creatinine level, FSS with eosinophil count, RLS with creatinine, urea and potassium levels). CONCLUSION The results of our study demonstrated the high incidence of SWD in patients with osteoarthritis. These SWD have complex pathogenesis and require specific approach in patients with osteoarthritis and ESRD-HD.