Gulnora Rakhimbaeva

Background: Post-Stroke Cognitive Impairment (PSCI) is a common consequence of ischemic stroke, but reliable early biomarkers remain limited. Vascular Endothelial Growth Factor (VEGF) is involved in angiogenesis and vascular permeability, yet its relationship with cognitive outcomes after stroke remains unclear. We investigated whether acute serum VEGF was associated with PSCI and functional outcome at three months. Methods: This prospective cohort study included 119 patients with first-ever ischemic stroke. Serum VEGF was measured on day 5 using ELISA. Stroke severity was assessed using the NIHSS at admission, while cognition and functional outcome were evaluated at three months using the MoCA and modified Rankin Scale. Multivariable logistic regression and ROC analyses were performed. Results: PSCI developed in 48 patients (40.3%). VEGF levels were significantly higher in patients with PSCI than in those without PSCI (786.68 ± 263.26 vs. 388.22 ± 159.87 pg/mL, p < 0.001). After multivariable adjustment, both NIHSS (OR = 1.446, 95% CI: 1.200-1.744) and VEGF (OR = 1.004 per pg/mL, 95% CI: 1.002-1.006) remained significantly associated with PSCI (both p < 0.001). ROC analysis yielded an AUC of 0.844, with a cut-off of 440.3 pg/mL providing 85.4% sensitivity and 78.9% specificity. VEGF was not independently associated with functional outcome after adjustment. Discussion: Higher acute VEGF levels were associated with subsequent cognitive impairment. This may reflect the complex neurovascular response to ischemic injury, although the underlying mechanisms were not directly examined in this study. Conclusion: Elevated acute serum VEGF was significantly associated with PSCI at three months after ischemic stroke. These findings support further investigation of VEGF as a potential candidate biomarker of post-stroke cognitive outcome, requiring validation in independent cohorts.

Objective. To evaluate the impact of long-term carbamazepine monotherapy on bone metabolism and bone mineral density in women with epilepsy. Material and methods. The study included 60 women with epilepsy alongside a control group of 55 healthy women. Serum levels of interleukin-7 (IL-7), estradiol, transforming growth factor-beta4 (TGF-β4), alkaline phosphatase, calcium, and phosphorus were measured in all participants. Bone mineral density and structure were assessed using dual-energy X-ray absorptiometry (DEXA). Results. The findings from the early osteoporosis diagnosis examination revealed that the levels of estradiol, IL-7, and TGF-β4 were outside the normal range. In contrast, calcium, phosphorus, and alkaline phosphatase levels remained within reference ranges. Bone mineral density and T-score measurements obtained via DEXA in the lumbar spine, right radius, and right hip exhibited positive correlations with serum levels of estradiol, IL-7, and TGF-β4. Conversely, significant negative correlations were observed with serum calcium, phosphorus, and alkaline phosphatase. Conclusions. Prolonged carbamazepine treatment considerably increases the risk of osteoporosis in women by disrupting hormonal and cytokine regulation, underscoring the critical need to monitor biomarkers such as estradiol, TGF-β4, and IL-7 to facilitate early diagnosis and prevention of osteoporosis.

Objective. Evaluation of the comparative efficacy and safety of ethylmethylhydroxypyridine succinate therapy with Mexidol, solution for intravenous and intramuscular administration, 50 mg/ml, and Mexidol FORTE 250, film-coated tablets, 250 mg, during their sequential use in patients in the acute and early recovery periods of ischemic stroke (IS) compared to placebo. Material and methods. The clinical trial was conducted as a prospective international multicenter randomized double-blind placebo-controlled parallel-group trial. Data from the randomized patients in the acute and early recovery periods of ischemic stroke were collected at 4 visits. Patients were divided into two equal groups: the main group (standard therapy+Mexidol at a dose of 500 mg twice a day administered intravenously in 100—200 ml of 0.9% NaCl solution for 10 days, followed by Mexidol FORTE at a dose of 250 mg three times a day for 60 days) and the placebo group (standard therapy+placebo administered following the same scheme as the main group). The primary efficacy endpoint was the amount of change in patient status assessed with the Modified Rankin Scale (mRS) at the end of the therapy compared to the baseline level (measured in scores). Results. A total of 304 patients in the acute and early recovery periods of IS were randomized into the trial. The trial groups were matched for sex, age and anthropometric characteristics. The statistically significant differences confirming the efficacy of therapy with Mexidol were obtained. The Mexidol group showed a significant reduction in the degree of disability, according to the Modified Rankin Scale (mRS), a neurological improvement, according to the National Institutes of Health Stroke Scale (NIHSS), an increase in mobility, according to the Rivermead Mobility Index, and a strong tendency to the reduction of cognitive deficit, according to the Montreal Cognitive Assessment (MoCA). Statistically significant differences in favor of Mexidol compared to placebo were observed for the difference in median mRS scores at Visit 4 against the baseline level (p=0.003), the difference in median NIHSS scores (p<0.001) and in median Rivermead Mobility Index scores (p=0.014). Treatment with Mexidol was also associated with a reduction in the number of disabled patients (p=0.016) and an increase of patients with scores of 0—1 on the mRS at Visit 4 (p=0.002) when compared to placebo. Adverse events (AEs) were reported in 35 patients (23%) in the Mexidol group (42 AEs in total) and in 35 patients (23%) in the placebo group (43 AEs in total) (p=1.000). Conclusion. According to the clinical trial results, statistically significant differences were obtained, which confirm the greater efficacy of therapy using Mexidol compared to placebo in patients in the acute and early recovery periods of IS of moderate severity. This was observed in terms of reducing the degree of patients’ disability and the severity of neurological symptoms, in terms of improving motor capabilities and increasing mobility. A similar safety profile was demonstrated for the long-term sequential therapy with Mexidol and Mexidol FORTE 250 and placebo.

Background. Due to progress in the treatment of patients who have suffered a stroke, the prevalence of post-stroke epilepsy (PSE) has been increasing. The search for biomarkers that determine the prognosis of ischemic stroke (IS) complications and PSE development along with creating a diagnostic protocol subsequently is useful for advancing tactics of PSE therapy.Objective: to investigate the blood serum levels of neuron-specific enolase (NSE) and vascular endothelial growth factor (VEGF) in PSE patients paralleled by assessing clinical and neuroimmunological correlations.Material and methods. A total of 140 patients aged 28 to 84 years with the first IS was examined. Of these, 70 patients newly developed late epileptic seizures (main group), 70 patients had IS without epileptic seizures (comparison group). The control group consisted of 30 patients without IS or epilepsy. IS severity was assessed according to the National Institutes of Health Stroke Scale (NIHSS), the degree of disability – according to the modified Rankin Scale (mRS), the level of patient’s basic functional activity – according to the Barthel Index (BI). Prediction of post-IS onset of late seizures was performed according to the SeLECT scale (SEverity of stroke, Large artery atherosclerosis, Early seizure, Cortical involvement, Territory of the middle cerebral artery). To assess severity of epilepsy, the K. Lühdorf et al. classification was used. The levels of NSE neurotrophic factor and VEGF angiogenesis factor were measured in blood serum samples from all patients by using enzyme-linked immunosorbent assay (ELISA).Results. A significantly increased NSE and VEGF levels were noted in main group (by 4.72- and 1.59-fold, respectively) and in comparison group (by 4.45- and 1.54-fold, respectively) compared to control group. In addition, NSE and VEGF levels in main group significantly exceeded those in comparison group (by 1.06- and 1.03-fold, respectively). Both biomarkers also tended to increase in patients with moderate and severe PSE. The level of NSE/VEGF correlation characterizing damage to the nervous tissue and angiogenesis as well as degree of severity, disability, rehabilitation potential, patients’ everyday life activity, NSE and VEGF prognostic significance in development and severity level of epilepsy in IS patients with epileptic seizures was determined.Conclusion. NSE and VEGF hyperexpression is important in predicting development or progression (worsening) of epilepsy after IS.

The development of COVID-19 is associated with damage to various organs and organ systems, including the development of acute ischemic stroke (AI). The article examines modern ideas about the pathogenesis of AI in COVID-19. The data on the choice of optimal therapy for patients with acute AI and COVID-19, as well as on the possibility of improving the effectiveness of rehabilitation measures, are analyzed. Information is provided on the efficacy of the drug Mexidol in patients with AI and COVID-19.