Objective: Cognitive dysfunction is common in multiple sclerosis (MS). The Brief International Cognitive Assessment for MS (BICAMS) battery of tests has been suggested as a measure for the evaluation of the cognitive status of MS patients. This study aims to validate the BICAMS battery in the Russian population of MS patients. Methods: Age- and sex-matched MS patients (n = 98) and healthy individuals (n = 86) were included in the study. Symbol Digit Modalities Test (SDMT), California Verbal Learning Test, 2nd edition (CVLT-II) and the Brief Visuospatial Memory Test – Revised (BVMT-R) were administered to all participants. The battery was readministered 1 month later to 44 MS patients to investigate the test–retest reliability. Results: MS patients exhibited a significantly lower performance in testing with BICAMS than the control group in all three neuropsychological tests. Test–retest reliability was good for SDMT and CVLT-II (r = .82 and r = .85, respectively) and adequate for BVMT-R (r = .70). Based on the proposed criterion for impairment as z score below 1.5 SD the mean of the control group, we found that 34/98 (35%) of MS patients were found impaired at least in one cognitive domain. Patients with Expanded Disability Status Scale score ≥3.5 performed significantly worse than controls (SDMT, p < .0001; CVLT–II, p = .03; BVMT-R, p = .0004), while those with ≤3.0 scores did not. Conclusion: This study demonstrates that the BICAMS battery is a valid instrument to identify cognitive impairment in MS patients and it can be recommended for routine use in the Russian Federation.
It is known that use of indirect anticoagulants (IAC) is the main method of treatment and prevention of thrombosis and thromboembolism in patients. Bleeding is the most important and dangerous complication of treatment with indirect anticoagulants. The incidence of bleeding during treatment IAC is 0.9 to 2.7 %, fatal bleeding constitutes 0.07 to 0.7 %, and hemorrhagic strokes account for 2 % of all bleeding. Therefore, the aim of our study was to evaluate quality of therapy with indirect anticoagulants of patients observed in the Northern Branch of the Hematology Research Center (HRC) in Arkhangelsk. According to the results of our study, frequency of hemorrhagic complications (GC) against long-term treatment of NAC was 7.8 % (95 % CI: 7.8 - 9.4) (n = 94), fatal bleeding as a hemorrhagic stroke constituted 0.1 % during 2.5 years of observation. The number of patients who achieved therapeutic hypocoagulation exceeded 60 % (n = 721). Such factors as taking Cordarone (p = 0.019), use of generic coumadin Russia (p = 0.05), ambulatory monitoring of the international normalized ratio (INR) (p = 0.028) as well as dosages of NAC influenced hemorrhage progression statistically significantly, the main factors reflected in bleeding and level of anticoagulation (INR less than 1.6) were the dose of NAC (p = 0.004) as well as control of the INR (p = 0.001). Taking into account the main factors influencing the level of anticoagulation, it is possible to reduce the number of bleeding cases and prediction of NAC doses. This approach will improve commitment to the NAC therapy of different specialists and enhance quality of patients’ life.
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