EPIDEMIOLOGY AND PROGNOSTIC FACTORS IN PATIENTS WITH SUBDURAL HEMATOMA

SDH was first described in 1658 and in 1914 trauma was recognized as one of the causes. Acute SDH is more common in younger population while chronic is common in the elderly with the peak of incidence of 7.35/100000 per year in the age group 70-79 years. Trauma is one of the main causes of SDH although in 30-50% of patients direct trauma to the head can be omitted. Other predisposing factors include: anticoagulant therapy, epilepsy, and hypertension. The aim of the study was to determine risk factors and prognostic factors for the occurrence of SDH, also to show what age group is most at risk for developing chronic and acute SDH. Identify the diagnostic steps in proving SDH and the best method of treatment. The study includes 267 patients treated in the period from 1.1.2019 to 31.12.2019 at the Clinic for Neurosurgery CCS. SDH was diagnosed by neurological examination and brain CT in all patients and all were treated conservatively or surgically. The analytical statistics were used parametric and non-parametric tests of difference. The study included 185 men and 82 women of middle age 68 ± 17.19 years. Most patients were between 6-8 decades. Multiple changes in CT were observed in 63.3% of patients. Chronic SDH had 50.5% of patients and 45.6% had acute SDH. The most common symptoms were headache, psycho-organic syndrome, and hemiparesis. Patients with a GCS score of more than 8 had a better prognosis and outcome. Surgical treatment was the main course of treatment in our study. CT with / without contrast is the gold standard in detecting SDH. Men are at higher risk for the occurrence of SDH. Symptoms can occur later in the clinical presentation so we need to take caution when performing neurological examination. Factors that can lead us to suspect possible SDH are: age, gender, type of injury, clinical presentation, and time of occurrence.

The features of psychopathology and cognitive impairments in various variants of the psychoorganic syndrome

Mental disorders and cognitive impairments are more or less inherent in most organic brain diseases. The psychoorganic syndrome is the consequence and one of the fundamental manifestations of such diseases. The article discusses the results of the analysis of the features of psychopathology and neurocognitive symptom complex in patients with psychoorganic syndrome of different aetiologies, with an assessment of impairments of higher cortical functions depending on the variant of the psycho-organic syndrome.

Therapeutic strategies against cancer cachexia

Cancer cachexia has two main components: anorexia and metabolic alterations. The main changes associated with the development of this multi-organic syndrome are glucose intolerance, fat depletion and muscle protein hypercatabolism. The aim of this paper is to review the more recent therapeutic approaches designed to counteract the wasting suffered by the cancer patient with cachexia. Among the most promising approaches we can include the use of ghrelin agonists, beta-blockers, beta-adrenergic agonists, androgen receptor agonists and anti-myostatin peptides. The multi-targeted approach seems essential in these treatments, which should include the combination of both nutritional support, drugs and a suitable program of physical exercise, in order to ameliorate both anorexia and the metabolic changes associated with cachexia. In addition, another very important and crucial aspect to be taken into consideration in the design of clinical trials for the treatment of cancer cachexia is to staging cancer patients in relation with the degree of cachexia, in order to start as early as possible this triple approach in the course of the disease, even before the weight loss can be detected.

Clinical and neurophysiological features of mental disorders in patients with HIV infection

Summary.Te aim of the study was to study the clinical signifcance of changes in bioelectric activity for the purpose of identifying them as biological markers of mental disorders in patients with HIV infection. A cross-sectional study was conducted to diagnose mental disorders and search for neurophysiological markers in 62 patients with HIV infection at the St. Petersburg Center for the Prevention and Control of HIV and Infectious Diseases.Results: 50% of patients with HIV infection without abuse disorders have mental disorders characterized mainly by adaptive reactions and mild cognitive impairment. Normal indicators of bioelectrical activity were determined in 16.1% of 62 patients. In the majority of patients (59.7%), bioelectrical activity was determined with a predominance of excitation in the medio-different areas and a decrease in activity of the cerebral cortex. In 41.9% of patients, the processes of CNS excitation were increased in the form of an intensifcation of the reaction to photostimulation. Neurophysiological differences were revealed in patients with neurotic and stress-related disorders and organic changes in the CNS. For neurotic disorders in comparison with organic disorders, the EEG was normal or the disorganized type with predominance of alpha and beta activity were more likely, while in the case of organic disorders the desynchronous type of EEG was more ofen noted. Te development of psycho-organic syndrome in HIV patients is confrmed by deep restructuring of bioelectrical activity in the anterior parts of the brain.

Folate deficiency and psycho-organic syndrome in elderly subjects: review of the literature

Psychological syndrome is a mental disorder caused by organic brain damage accompanied by cognitive and memory deficits. According to recent estimates of incidence in the elderly population worldwide, this is likely to increase more and more over the next few years; the increase in life expectancy which in itself is a positive result, on the other hand, leads to an increase in the incidence of brain degenerative diseases that in elderly subject need to be addressed through appropriate therapeutic strategies. The lack of folates, as it is at the base of the cascade of events that lead to the development of cardio/cerebrovascular problems, anemia and depression, typical characteristics of the psycho-organic syndrome, becomes a condition that is important to correct. Several epidemiological studies show the efficacy of folates in reducing the clinical expressions typical of the syndrome, in particular the metabolic active form of folic acid, 5-methyltetrahydrofolate, is characterized by high bioavailability and rapidity of action. In clinical practice these peculiarities could be very useful both at the beginning of therapy, when it is important to have a quick and effective response, and in the maintenance, with a reduction of administration.