[Clinical and epidemiological indicators of stroke during the COVID-19 pandemic and in the post-COVID period in the Moscow region]

OBJECTIVE

To analyze the dynamics of clinical and epidemiological indicators of stroke and the features of providing specialized care to patients in the Moscow region in the period 2019-2023.

MATERIAL AND METHODS

Mortality rates, the average annual population, and the number of deaths in one-year age groups were analyzed based on the «Brief Nomenclature of Causes of Death» by ROSSTAT and the database of the Registry Office of the Moscow Region. Depersonalized data on deceased individuals aged 18 years and older were obtained from this database, including codes and names of diseases or conditions specified in Parts I and II of the medical death certificate, age, sex, and place of death for the period 2019-2023. Data on the number and type of reported stroke cases, the number of hospitalized patients, routing, duration of hospitalization, methods of specialized medical care, and hospital mortality were also obtained from the electronic database of the Moscow Regional Medical Information and Analytical Center.

RESULTS

The overall incidence of stroke during the 2019-2023 did not change significantly, averaging 4.3±0.1 cases per 1.000 residents. In 2020, mortality increased by 8.6%, followed by a clear downward trend in this parameter, reaching 15.2% by 2023. The proportion of deaths caused by a combination of stroke and COVID-19 was 7.7%, with the highest figure being 12.2% in 2021. There was a statistically significant increase in the percentage of patients with hemorrhagic stroke (HS) during 2020 and 2021. A sharp (by 30% compared to 2019) drop in the rate of hospitalization of patients with acute cerebrovascular accident within 4.5 hours from the onset of the first symptoms was noted, while the rate of specialized hospitalization in vascular centers increased. After an initial decrease in the number of thrombolytic therapy procedures in 2020, an increase in this indicator to 10% by 2023 was noted. An increase in the proportion of patients who received thromboembolectomy, carotid endarterectomy, and neurosurgical care was also noted.

CONCLUSION

During the COVID-19 epidemic in the Moscow region, there was a small but statistically significant increase in HS and mortality from stroke. The number of cases of stroke combined with COVID-19 was small (7.7%), and it did not significantly affect morbidity, mortality, or hospital lethality. Despite the end of the epidemic, its impact on the healthcare system can still be seen in the form of fewer vascular centers compared to 2019, and an insufficient number of hospitalized patients during the «therapeutic window».

[Results of evaluation of the effectiveness of the drug Cellex in patients with small vessel disease]

OBJECTIVE

To study the effect of the drug Cellex on the severity of cognitive impairment in patients with small vessel disease (SVD).

MATERIAL AND METHODS

A non-interventional observational controlled prospective observational study in parallel groups was conducted. 118 patients with CHEM who received unified therapy were under observation. Group 1 consisted of 40 patients who, in addition to basic therapy, received 10 injections of Cellex subcutaneously (0.2 ml 1 time/day), group 2 - 39 patients who received 2 courses of injections of Cellex subcutaneously (0.1 ml 1 time/day) with an interval of one month, patients 3-both groups (n=39) received only basic therapy. The examination included an assessment of the clinical status and neuropsychological testing (the MOS questionnaire and the clock drawing test - TRCH), analysis of the results of MRI of the brain. The blood levels of homocysteine (HC), C-reactive protein (CRP), asymmetric dimethylarginin (ADMA), and von Willebrand factor (FW) were determined in dynamics.

RESULTS

A statistically significant improvement in the performance of the MoCA and TRP questionnaire tests in groups 1 and 2 was demonstrated, with a more pronounced and persistent effect in patients who received repeated courses of treatment. Clinical improvement was accompanied by normalization of the concentration of studied markers of inflammation (CRP) and endothelial dysfunction (HC, ADMA, FW) in the blood, while the dynamics was most pronounced in patients of group 2. The treatment was characterized by good tolerability, low frequency and insignificant severity of adverse events.

CONCLUSION

The drug Cellex has demonstrated significant effectiveness in the treatment of patients with SVD with cognitive impairment, against the background of treatment, there was a decrease in markers of inflammation and endothelial dysfunction, therapy was characterized by good tolerability.

Blood pressure variability related to early outcome of acute ischemia stroke in a prospective observational study

Hypertension is a well-known risk factor for stroke, but the relationship between blood pressure variation (BPV) and prognosis remains unclear. This prospective observational study assessed the association between BPV and early functional outcomes in acute ischemic stroke patients. A total of 871 patients with acute ischemic stroke within 24 h of symptom onset were recruited from the Third Affiliated Hospital of Qiqihar Medical University between 2013 and 2016. Within 6 days of hospitalization, blood pressure was continuously measured from 8:00 to 9:00 every day, and the coefficient of variation (CV) of blood pressure was calculated (including systolic blood pressure [SBP] and diastolic blood pressure [DBP]). The modified Rankin scale was used to evaluate early functional outcomes at discharge. The coefficients of variation of SBP, DBP, and functional outcomes were included as primary outcome variables. Demographic characteristics and medical history were recorded as secondary outcome variables. We found that a greater CV level of SBP and DBP were associated with the poor early functional outcome at hospital discharge, and the odds ratio (OR) and 95% confidence interval (95%CI) of them were 1.56 (1.04-2.35) and 1.99 (1.31-3.03) respectively. A higher standard deviation (SD) of SBP and DBP significantly increased risk of poor early prognosis, OR (95%CI) was 1.78 (1.17-2.71) and 2.25 (1.47-3.45) respectively. Similar results were observed for SBP and DBP. The larger the range of SBP and DBP, the worse is the prognosis. In conclusion, the present study suggests that high BPV is a risk factor for poor early prognosis in acute ischemic stroke.

[Cellex in the therapy of patients with complex and central apnea in the early recovery period of ischemic stroke]

A variety of structural and functional post-stroke disturbances demands an integrated clinical/diagnostic approach. Persistent hypoxemia due to disturbance of a saturation of blood oxygen in sleep can decrease the effectiveness of neurorehabilitation. In some cases of sleep apnea, the efficiency of continuous positive airway pressure therapy is insufficient and it should be combined with course neuroprotective therapy. Modern approaches to neuroprotective and neuroreparative therapy are considered as the independent direction for treatment of the central sleep apnea syndromes in patients with stroke consequences that is obviously important aspect of secondary prevention of a stroke.

[Indicators of stroke morbidity and mortality from stroke in the territories included in the Federal program of caring for patients with stroke]

OBJECTIVE

To study and analyze the dynamics of stroke morbidity and mortality rates among men and women in the territories included in the Federal program for the reorganization of care for stroke patients.

MATERIAL AND METHODS

The study was based on data from the territorial-population register of strokes. The study included the following territories: Ivanovo region, Stavropol territory, the Republic of Bashkortostan, Sverdlovsk region, Irkutsk region, Sakhalin region, and the Republic of Tatarstan. Research period was from 2009 to 2016. A total of 29 779 stroke cases were analyzed. The age of the examined people was 25 years and older.

RESULTS AND CONCLUSION

In the study areas, a 2.2 - fold decrease in stroke mortality among men and a 3-fold decrease among women was found. The values of morbidity and mortality from stroke over the entire study period were higher among men. It was also revealed that in 2015-2016, the mortality rate was in a narrow range of values, which demonstrates the impact of comprehensive measures to reduce stroke mortality in all the studied territories. The results of cluster analysis of stroke incidence rates obtained from seven territories over an 8-year period indicate similar measures for primary stroke prevention among men. Among women, there are also similarities in primary stroke prevention measures, with the exception of two regions - the Stavropol territory (4.8 cases per 1000 population) and the Republic of Tatarstan (4.5 cases per 1000 population), where the highest values of the stroke incidence rate were found. The results of cluster analysis of stroke mortality rates among men indicate a fairly large variation in the indicator values. The dominant value of the stroke mortality rate among men was found in the Sakhalin region (1.61 per 1000 population). The significance of stroke mortality rates among women in the regions was similar: six territories with similar levels of values were identified. The exception was the Stavropol territory (2.48 cases per 1000 population), where the highest death rate from stroke was revealed.