Natalia G. Zhukova

Background: Erectile dysfunction (ED) is one of the manifestations of long COVID-19 and in most cases has an endothelial and neurogenic nature. Many experimental and clinical investigations have revealed the high efficacy of transcutaneous electrical nerve stimulation (TENS) of the pudendal nerve and low-level laser therapy (LLLT) in the treatment of ED. Purpose: To compare LLLT and TENS, and investigate the dynamics of their efficacy when combined in the treatment of patients with post-COVID-19 ED using the International Index of Erectile Function-15 (IIEF-15). Materials and Methods: This interventional, randomized controlled trial enrolled 82 patients with ED following COVID-19. All patients had their first ED diagnosis after COVID-19 within one month of the onset of respiratory symptoms. The duration of patients’ ED was not less than six months, but less than one year. Patients were divided into four groups, one of which received sham LLLT and TENS (n = 20). The remaining patients underwent effective treatment using LLLT (n = 21), TENS (n = 21), and combined LLLT and TENS (n = 20). To study the effectiveness of the treatment, IIEF-15 and an assessment of tactile sensation in the genital area before and after the treatment, as well as 3 months after the end of the treatment, were used. Results: Both LLLT and TENS had a significant effect in improving erectile function, of 38% (p ≤ 0.01) and 27% (p ≤ 0.01), respectively. The improvement in erectile function after LLLT was higher than after TENS by 8.2% (p ≤ 0.05), but the combination of these methods exceeds the result of using LLLT alone by 20% (p ≤ 0.01). The reduction in hypoesthesia after LLLT did not exceed 17.4% (p ≤ 0.05). However, after TENS, the reduction in hypoesthesia reached 48.7% (p ≤ 0.01), and with a combination of the two methods, it reached 60.9% (p ≤ 0.01). Treatment outcomes in LLLT, TENS, and LLLT + TENS groups were stable for 3 months. Conclusions: According to IIEF-15 dynamics, LLLT and TENS are both very beneficial in treatment of post-COVID-19 ED, with LLLT showing a moderately better outcome than TENS. LLLT and TENS were found to have significant positive therapeutic effects on orgasm, sexual desire, and sexual satisfaction, among other aspects of sexual function. Nevertheless, the combination of LLLT and TENS proved to be much more successful in enhancing all IIEF domains, expanding the therapeutic effect spectrum, and improving the TENS effect following LLLT application. Only after TENS did genital hypoesthesia reliably regress, and the effect was amplified when TENS and LLLT were combined.

Background. Parkinson's disease is a neurodegenerative disorder that leads to severe disability, especially in its advanced stages. Medical care should be performed in accordance with modern clinical recommendations and standards. Assessment of the quality of medical care in the Russian Federation is carried out via examination of medical documentation by insurance experts regarding compliance with Russian standards and other regulatory documents.Objective. To study the predictors for unfavorable course of Parkinson's disease based on routine examinations of the quality of medical care.Methods. The cohort retrospective study included 7,264 examinations of the medical care quality of 1,754 patients with Parkinson's disease for the period from 2011 to 2018 in the Russian Federation. The study focused on two indicators: presence/absence of disease progression and determination/aggravation of a degree of disability or maintenance of the previous social and professional activity. The obtained data were used to develop diagnostic tables with prognostic factors of Parkinson's disease according to A. Wald. Statistical analysis of the results was carried out using Statistica 13 (StatSoft, USA). Results. Diagnostic tables have been developed to determine the prognostic factors affecting the progression of Parkinson's disease and, accordingly, decreasing the degree of social and/ or professional activity and to assess the diagnostic factors when the risk of the disease aggravation will be more than 95%.Conclusion. The greatest progression of Parkinson's disease (p < 0.05) was observed in the cases of poor collection of complaints, history and clinical evaluation of the patient's condition, inadequate prescription or absence of prescription of levodopa when indicated, as well as defects in the correction of additional disorders. The likelihood of social disadaptation in patients with Parkinson's disease (p < 0.05) was found to be greater in the cases of poor collection of complaints and history, neurological examination and clinical evaluation of the patient's condition as well as inadequate prescription or absence of prescription of levodopa when indicated.

Among neurological adverse reactions in patients with schizophrenia treated with antipsychotics (APs), drug-induced parkinsonism (DIP) is the most common motility disorder caused by drugs affecting dopamine receptors. One of the causes of DIP is the disruption of neurotransmitter interactions that regulate the signaling pathways of the dopaminergic, cholinergic, GABAergic, adenosinergic, endocannabinoid, and other neurotransmitter systems. Presently, the development mechanisms remain poorly understood despite the presence of the considered theories of DIP pathogenesis.

Amyotrophic lateral sclerosis (ALS) is an incurable chronic progressive neurodegenerative disease with the progressive degeneration of motor neurons in the motor cortex and lower motor neurons in the spinal cord and the brain stem. The etiology and pathogenesis of ALS are being actively studied, but there is still no single concept. The study of ALS risk factors can help to understand the mechanism of this disease development and, possibly, slow down the rate of its progression in patients and also reduce the risk of its development in people with a predisposition toward familial ALS. The interest of researchers and clinicians in the protective role of nutrients in the development of ALS has been increasing in recent years. However, the role of some of them is not well-understood or disputed. The objective of this review is to analyze studies on the role of nutrients as environmental factors affecting the risk of developing ALS and the rate of motor neuron degeneration progression. Methods: We searched the PubMed, Springer, Clinical keys, Google Scholar, and E-Library databases for publications using keywords and their combinations. We analyzed all the available studies published in 2010–2020. Discussion: We analyzed 39 studies, including randomized clinical trials, clinical cases, and meta-analyses, involving ALS patients and studies on animal models of ALS. This review demonstrated that the following vitamins are the most significant protectors of ALS development: vitamin B12, vitamin E > vitamin C > vitamin B1, vitamin B9 > vitamin D > vitamin B2, vitamin B6 > vitamin A, and vitamin B7. In addition, this review indicates that the role of foods with a high content of cholesterol, polyunsaturated fatty acids, urates, and purines plays a big part in ALS development. Conclusion: The inclusion of vitamins and a ketogenic diet in disease-modifying ALS therapy can reduce the progression rate of motor neuron degeneration and slow the rate of disease progression, but the approach to nutrient selection must be personalized. The roles of vitamins C, D, and B7 as ALS protectors need further study.

Alzheimer’s disease (AD) is a neurodegenerative disorder, and represents the most common cause of dementia. In this study, we performed several different analyses to detect loci involved in development of the late onset AD in the Russian population. DNA samples from 472 unrelated subjects were genotyped for 63 SNPs using iPLEX Assay and real-time PCR. We identified five genetic loci that were significantly associated with LOAD risk for the Russian population (TOMM40 rs2075650, APOE rs429358 and rs769449, NECTIN rs6857, APOE ε4). The results of the analysis based on comparison of the haplotype frequencies showed two risk haplotypes and one protective haplotype. The GMDR analysis demonstrated three significant models as a result: a one-factor, a two-factor and a three-factor model. A protein–protein interaction network with three subnetworks was formed for the 24 proteins. Eight proteins with a large number of interactions are identified: APOE, SORL1, APOC1, CD33, CLU, TOMM40, CNTNAP2 and CACNA1C. The present study confirms the importance of the APOE-TOMM40 locus as the main risk locus of development and progress of LOAD in the Russian population. Association analysis and bioinformatics approaches detected interactions both at the association level of single SNPs and at the level of genes and proteins.

Apathy is one of the most frequent, disabling and difficult to treat non-motor symptoms manifesting in many neurodegenerative diseases, particularly in Parkinson disease and Huntington disease. Aim is to evaluate and compare the clinical profile of apathy in patients with Parkinson disease (PD) and Huntington disease (HD). Materials and methods. The individual registration card was filled in for each patient containing demographic data, clinical features of the disease, the results of validated scales and questionnaires evaluating motor activity (The Movement Disorder Society-Unified Parkinson's Disease Rating Scale - MDS-UPDRS, the Unified Huntington's Disease Rating Scale - UHDRS), cognitive functions (MoCA-test), anxiety-depressive symptoms (hospital scale for evaluating anxiety and depression, Beck's depression scale-II), apathy (apathy rating scale). Patients with dementia or severe depression were excluded from the study. Results. The study included 265 patients: 250 with PD and 15 with HD. Apathy was diagnosed in 57.8% of cases in patients with neurodegenerative diseases (139 out of 250 patients with PD and 9 out of 15 patients with HD). In both groups of patients apathy was associated with the severity of motor manifestations. Patients with PD showed a positive correlation of apathy with more severe depression (r=0.488; p<0.0001), anxiety (r=0.300; p<0.0001) and drowsiness (r=0.254; p<0.0001); a negative correlation with a short duration of the disease (r=-0.160; p=0.021), a lower dose of dopaminergic drugs, LEDD (r=-0.203; p=0.03). In patients with HD, apathy was associated with disease duration (8 (4; 11) years in patients without apathy and 5 (3;9) years in patients with apathy, U =3791.5; p=0.020) and cognitive impairment (26 (19;37) points, without apathy - 18 (12;26), U =3548.5; p=0.003). Conclusions. Similar frequency of apathy was found in patients with PD and HD, but with different clinical correlations due to the involvement of different brain regions in the pathological process, which requires further research to develop targeted therapy.

Diabetes mellitus (DM) is a risk factor for the development of cognitive impairment, when unsatisfactory glycemic control is associated with glioma biomarkers and changes in neuronal integrity. Given some limitations in the performance of neuropsychological testing, it is important to indicate specific markers of brain damage.

Currently, diabetes mellitus (DM) is the most common metabolic disorder, which is manifested by hyperglycemia and leads to vascular and cognitive impairment. Mechanisms of cognitive dysfunction in patients with DM remain highly unclear, thus complicating the search for effective strategies for the prevention and treatment of dementia. Recently, scientists have discussed the issues regarding the relationship between DM and Alzheimers disease (AD), such as risk factors that trigger the cascade of pathological reactions. Patients with DM show an increased risk of developing AD. Similarly, patients with AD have been shown to have impaired insulin and glucose metabolism. Both these diseases have common nosology, pathology and biochemical basics, including oxidative stress, formation of advanced glycation end products, dysregulation of glucose metabolism and altered insulin signaling pathways. The microtubule-associated tau protein is involved in one of the causative mechanisms underlying the development of AD. We provide an overview of the major domestic and foreign data analyses regarding tau protein and the development of cognitive disorders in experimental DM.