Number Of Concomitant Diseases Research Articles

High Creatinine Level Secondary to Use of CDK 4/6 Inhibitor Treatment (Palbociclib and Ribociclib) + Endocrine Therapy (ET).

The aim of this study is to share real-life data on the increase in creatinine due to CDK 4/6 inhibitor treatment and patients diagnosed with HR+/HER2-MBC and treated with ribociclib or palbociclib combined with ET were included in the study. While creatinine increase was observed in 17.9% (n = 19) of the 106 patients in the study population, 8.5% (n = 9) had Grade 1, 8.5% (n = 8) had Grade 2, and % 0.9 (n = 1) had Grade 3 creatinine elevation. The increase in creatinine occurred in 25% (n = 12) of ribociclib users and 12.1% (n = 7) of palbociclib users. No patient required a dose reduction or discontinuation of treatment due to elevated creatinine. Of the patients with high creatinine levels, 36.8% (n = 7) were over 65 years of age. Those with multiple comorbidities, blood urea nitrogen (BUN) >13.5 mg/dl, creatinine >0.66 mg/dl, BUN/creatinine ratio >19.95, glomerular filtration rate (GFR) >96.05 ml/min, and uric acid >4.69mg/dl. It was observed that the increase in the creatinine level was statistically significant (p <0.001). In conclusion, this study revealed that the increase in the serum creatinine secondary to ribociclib and palbociclib treatments is associated with kidney function tests and the number of concomitant diseases. Key Words: CDK 4/6 inhibitor, Creatinine elevation, Palbociclib, Ribociclib.

Sarcopenia Prevalence among Hospitalized Patients with Severe Obesity: An Observational Study.

Background: Sarcopenic obesity (SO) is the combination of excess fat, skeletal muscle and muscular strength/function deficit. The ESPEN/EASO have proposed new diagnostic criteria, but the SO prevalence in patients with severe obesity remains to be established. The aim of this study was to establish the SO prevalence in a large cohort of inpatients with obesity, considering sex, age, BMI, type, and number of concomitant diseases. Methods: Patient data of both genders aged between 18 and 90 years with a body mass index (BMI) of ≥30 kg/m2 underwent hospital evaluation including bioelectrical impedance analysis (BIA) and handgrip strength (HS). QoL scores were obtained by the Psychological General Well-Being Index questionnaire. The study was approved by the institutional Ethic Committee. Results: Among the 3858 patients, 444 (11.51%) exhibited a strength deficit, while 3847 (99.71%) had skeletal muscle mass deficit. The prevalence of SO was then 11.48%, with higher rates in women (12.39%), in individuals aged >70 years (27%), and in those reporting a 'poor' QoL (12.6%). No significant difference in SO prevalence was found when stratifying by BMI (30-40 kg/m2 vs. >40 kg/m2, p = 0.1710). In SO patients, osteoarticular diseases (57%), hypertension/heart failure (38%), type 2 diabetes mellitus (34%), and obstructive sleep apnea (32%) were the more frequent comorbidities. Conclusions: The application of ESPEN/EASO-SO criteria in a cohort of inpatients with severe obesity revealed 11.48% SO prevalence, which was associated with age (particularly > 70 years), gender (women), but not BMI, as determinants. Disease staging and QoL screening may improve the identification of SO high-risk patients.

Risk factors for severe COVID-19 in patients with rheumatic diseases

The aim – to study risk factors for severe COVID-19 in patients with rheumatic diseases (RD).Patients and methods. The study included medical histories of 464 patients with RD who were admitted at the V.A. Nasonova Research Institute of Rheumatology from September 27, 2021 to April 26, 2023Results. Age over 60 years, hypertension, obesity, lung disease, chronic kidney disease, coronary heart disease, diabetes mellitus, acute cerebrovascular accident or a history of pulmonary tuberculosis increase the risk of hospitalization in patients with RD with COVID-19 by 3–5 times. In addition, with an increase in the number of concomitant diseases, an increase in the risk of hospitalization was noted by 2–6 times. Taking glucocorticoids, including at a dose of ≥10 mg per day for prednisolone, mycophenolate mofetil and rituximab, leads to an increase risk of hospitalization by 1.5–4.5 times, while patients taking hydroxychloroquine or tumor necrosis factor α inhibitors was more often required outpatient treatment.Conclusions. It has been established that older age, the presence of comorbid pathology and the use of glucocorticoids, including at a dose of ≥10 mg per day for prednisolone, mycophenolate mofetil and rituximab, are risk factors for severe COVID-19.

Control Level of Type 2 Diabetes Mellitus in the Elderly Is Associated with Polypharmacy, Accompanied Comorbidities, and Various Increased Risks According to the Beers Criteria.

Comorbidity rates in the geriatric population have increased because of rising life expectancy; thus, patients have had to use more medications. Type 2 diabetes mellitus, one of the most common diseases, may influence the number of drugs used in geriatric patients. The present study was designed to investigate the association between the level of type 2 DM and polypharmacy. Fifty patients with type 2 diabetes over the age of 65 were included according to the inclusion criteria; 23 were well-controlled and 27 had poorly controlled diabetes. The groups were similar in terms of age, sex, WBC, Hb, Plt, AST, ALT, serum creatinine, fasting glucose, and eGFR levels. Patients with HbA1c values above 7.5 were classified as poorly controlled diabetes patients, and those below were considered well-controlled diabetes patients and were evaluated for inappropriate medication use. The number of medications used daily by the cases (p < 0.001), the number of concomitant diseases (p = 0.001), and the number of increased risks according to the Beers Criteria (p = 0.02) were observed to be high in poorly controlled type 2 diabetes mellitus subjects. HbA1c levels were related to the number of medications (r = 0.4, p = 0.004), comorbidities (r = 0.28, p = 0.04), and the number of increased risks according to the Beers Criteria (r = 0.31, p = 0.014). In conclusion, the number of medications used in patients with poorly controlled type 2 diabetes mellitus was found to be more elevated than in individuals with well-controlled type 2 diabetes mellitus. The HbA1c values varied among patients regarding polypharmacy, comorbidities, and increased risks according to the Beers Criteria.

Chronic gastritis in pediatrics

Chronic gastritis is one of the most common diseases of the gastrointestinal tract. High rates of gastritis in children are associated with poor nutrition, physical inactivity, drug abuse, bad habits, a number of concomitant diseases, immune disorders, allergization of the body, and stress. Although a significant proportion in the structure of chronic gastritis is occupied by gastritis associated with Helicobacter pylori infection, many clinical forms are diagnosed that are not associated with the presence of a microbial pathogen in the gastric mucosa. The goal is to highlight the problem of chronic gastritis in children, including risk factors, etiology, clinical manifestations, diagnosis and treatment. Materials and methods. To achieve these goals, a literature search was carried out in the PubMed and Google Scholar databases. The search depth did not exceed 5 years. Uninformative and duplicate articles were excluded. The final list of references included 42 articles. Results. In addition to traditional risk factors for adults, the incidence of chronic gastritis in children is influenced by artificial feeding, pathology of pregnancy and childbirth, respiratory infections, decreased mobility, and concomitant pathology. Helicobacter pylori infection is detected in 56% of children referred to a gastroenterologist for gastrointestinal symptoms. Manifestations of gastritis vary from asymptomatic to epigastric pain with dyspeptic symptoms. Conclusion. 1) Currently, up to 30-40% of children suffer from chronic gastritis. 2) Triple therapy regimens are traditionally used to eradicate Helicobacter pylori, but quadruple therapy is used in populations with high resistance to antimicrobial drugs. 3) In the treatment of eosinophilic gastritis, the drugs benralizumab and vedolizumab demonstrate high effectiveness, leading to depletion of the pool of eosinophils in the blood and tissues of the stomach, as well as clinical improvement. 4) Effective treatment for collagen gastritis has not yet been developed. The treatment regimen includes an elimination diet, proton pump inhibitors, and iron supplements.

FEATURES OF COMORBIDITY IN COMBATANTS WITH ARTERIAL HYPERTENSION

Objective: Comprehensive assessment of comorbidity in patients with arterial hypertension of participants in modern armed conflicts in order to implement timely preventive measures with the aim of prolonging their health status for military service. Design and method: By design, the research was a passive retrospective one-time (cross-sectional) type. The medical charts of inpatient patients of 213 male combatants, aged 27-59 years, average age 45.0 ± 6.8 years, who underwent treatment during 2018-2021, were analyzed by the method of random sampling. The examined were stratified according to the stage of hypertension: 126 patients with stage I hypertension and 87 patients with stage II hypertension. Results: The value of the indicator of the complex assessment of comorbidity depending on the stage of hypertension (the overall assessment of comorbidity according to the CIRS cumulative scale of diseases was 7.1 ± 2.1 and 8.8 ± 2.9 points in patients with hypertension of the I and II stages, respectively, p &lt; 0.05 . The value of the indicators of the comprehensive assessment of comorbidity (the overall assessment of comorbidity according to the CIRS cumulative disease scale) in stage II hypertension is due to an increase in the number of causal diseases, which were 3.1 ± 0.8 in stage II hypertension and 2.2 ± 0.9 in stage I hypertension, p &lt; 0.05. No statistically significant differences were found in the number of diagnoses of competitive diseases: 4.1 ± 2.1 in stage II hypertension and 3.7 ± 1.7 in stage I hypertension, p &gt; 0.05. Conclusions: With the progression of high blood pressure in military personnel who are participants in modern armed conflicts, suffering from high blood pressure, the number of concomitant diseases and the indicator of the comprehensive assessment of comorbidity (the overall assessment of comorbidity according to the CIRS cumulative disease scale) increase, which are caused by an increase in the number of causal diseases. In order to extend the state of health for military personnel, patients with hypertension, participants of modern armed conflicts, measures for the secondary prevention of causal diseases are appropriate.

ФАРМАКОЭПИДЕМИОЛОГИЧЕСКИЕ АСПЕКТЫ ВЛИЯНИЯ КОМОРБИДНОСТИ НА ВЫЖИВАЕМОСТЬ У ГЕРИАТРИЧЕСКИХ ПАЦИЕНТОВ ПСИХОНЕВРОЛОГИЧЕСКОГО ДИСПАНСЕРА

The aim of the study was to determine the comorbidity index in geriatric patients of a neuropsychiatric hospital and to assess its impact on their survival. A pharmacoepidemiological study was conducted to assess comorbidity and its effect on survival in geriatric patients of a neuropsychiatric dispensary. There were analyzed 90 inpatient records of geriatric patients, men and women in equal numbers. The average Charlson index in the study group of patients was 13 %, which shows a low survival rate of geriatric patients with significant concomitant pathology. In addition, the average index of the Charl-son index was determined depending on the number of concomitant diseases and it revealed a tenden-cy to decrease the probability of survival of elderly patients over a 10-year period, with an increase in the level of comorbidity.

The role of INTERCheckWEB digital innovation in supporting polytherapy management

The study aims at defining the factors affecting the clinicians’ decision of changing or confirming the treatment options for frail patients in polytherapy, supporting prescribing patterns, thus also figuring out if the inclination of the clinicians towards digital solutions (INTERCheckWEB) and specific guidelines, could play a role in their decision. A literature review was performed, revealing the main individual, organizational and decisional factors, impacting on the clinicians’ propensity to change the current patients’ therapy: the clinician perceptions of support in case of clinical guidelines use or INTERCheckWEB use were studied. A qualitative approach was implemented, and thirty-five clinicians completed a questionnaire, aimed at evaluating fifteen different clinical cases, defining if they would change the patient’s current therapy depending on the level of information received. Three methodological approaches were implemented. (1) Bivariate correlations to test the relationships between variables. (2) Hierarchical sequential linear regression model to define the predictors of the clinician propensity to change therapy. (3) Fuzzy Qualitative Comparative Analysis—fsQCA, to figure out the combination of variables leading to the outcome. Patient’s age and autonomy (p value = 0.000), as well as clinician’s perception regarding IT ease of use (p value = 0.043) and seniority (p value = 0.009), number of drugs assumed by the patients (p value = 0.000) and number of concomitant diseases (p value = 0.000) are factors influencing a potential change in the current therapy. The fsQCA-crisp confirms that the clinical conditions of the patients are the driving factors that prompt the clinicians towards a therapy change.

Correlation between handgrip strength and nutritional indicators and its influencing factors in patients with stable COPD: a cross-sectional study

This study aimed to explore the Correlation between handgrip strength and nutritional indicators and its influencing factors in patients with stable chronic obstructive pulmonary disease (COPD) to provide evidence for early nutritional intervention. Stable COPD patients who visited the respiratory department clinic of a Tertiary Grade A hospital in Guangxi from January 2021 to March 2022 were chosen using a convenient sampling method. The general information questionnaire and mini nutritional assessment short-form (MNA-SF) were used for investigation, and the HGS, anthropometric, and laboratory indicators were collected. Correlation analysis was used to analyze the relationship between HGS and nutritional indicators in patients with stable COPD. Multiple linear regression analysis was used to examine the factors influencing HGS in patients with stable COPD. A total of 232 patients with stable COPD were included, and the HGS was (25.18±7.95)kg. Correlation analysis showed that height, body weight, body mass index (BMI), calf circumference, hemoglobin concentration, total protein concentration, albumin concentration, prealbumin concentration were positively correlated with HGS in stable COPD patients (P <0.05), whereas age was negatively correlated with HGS in stable COPD patients (P <0.05). Multiple linear regression analysis showed that gender, age, number of concomitant diseases, and nutritional status were the influencing factors of HGS in patients with stable COPD (P <0.05), explaining 31.3% of the total variation of HGS in patients with stable COPD. Patients with stage COPD need to improve their HGS, which correlates with nutrition-related indicators. HGS levels are low in female COPD patients who are older, have multiple comorbidities, and are malnourished. Outpatient medical workers should pay attention to the HGS level of stable COPD patients, quickly screen the nutritional status of COPD patients, implement early nutritional intervention, and improve the overall health level of patients.

РЕЗУЛЬТАТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ПОВРЕЖДЕНИЙ ТАЗОБЕДРЕННОГО СУСТАВА

Hip neck fractures occur most often in elderly and senile people. The fracture is also facilitated by concomitant osteoporosis, which is observed at this age. The purpose of surgical treatment of patients with femoral fractures is early immobilization; therefore, in the practice of modern medical institutions, methods are used that contribute not only to early fixation, but also to the load on the limb. The aim of the study is to study the results of surgical treatment of patients with various types of hip joint injuries in the Department of Orthopedics of the Khorezm branch of the RSSPMC of Traumatology and Orthopedics. Material and methods. The results of primary hip end prosthesis were studied in 32 patients: 20 women (62.5%), 12 men (37.5%). All patients were admitted to the clinic within 20 days to 3 months after the injury. Results. Wound healing by primary tension was observed in 29 patients (90.6%). In 3 patients (9.3%), the wound healed by secondary tension. Femoral neck fractures were detected in 10 (31.2%) patients, 22 (68.7%) patients with a false hip joint. In the group with hip fractures, 10 patients (53.2%) had positive results. In the group of patients - 20 (47.6%) with false joints, excellent results were noted in 16 (80%) patients. Satisfactory results were observed in 4 (20%) patients. Conclusion. End prosthesis of large joints of the lower extremities, in particular the hip joint, is one of the most common orthopedic operations. Every year there is an increase in the need for such interventions. The number of patients requiring end prosthesis is characterized by an increase in age and the number of concomitant diseases. To obtain optimal treatment results, it is necessary to avoid a long delay in surgery after indications for joint end prosthesis.

The small bowel microbiome changes significantly with age and aspects of the ageing process.

Gut microbiome changes have been associated with human ageing and implicated in age-related diseases including Alzheimer's disease and Parkinson's disease. However, studies to date have used stool samples, which do not represent the entire gut. Although more challenging to access, the small intestine plays critical roles in host metabolism and immune function. In this paper (Leite et al. (2021), Cell Reports, doi: 10.1016/j.celrep.2021.109765), we demonstrate significant differences in the small intestinal microbiome in older subjects, using duodenal aspirates from 251 subjects aged 18-80 years. Differences included significantly decreased microbial diversity in older subjects, driven by increased relative abundance of phylum Proteobacteria, particularly family Enterobacteriaceae and coliform genera Escherichia and Klebsiella. Moreover, while this decreased diversity was associated with the ‘ageing process' (comprising chronologic age, number of medications, and number of concomitant diseases), changes in certain taxa were found to be associated with number of medications alone (Klebsiella), number of diseases alone (Clostridium, Bilophila), or chronologic age alone (Escherichia, Lactobacillus, Enterococcus). Lastly, many taxa associated with increasing chronologic age were anaerobes. These changes may contribute to changes in human health that occur during the ageing process.

Результаты скрининга колоректального рака в Алматинской области Казахстана с использованием модифицированной организационной программы

Objective. To evaluate the effectiveness of a modified colorectal cancer screening program among the population of the Almaty region of Kazakhstan.Methods. Type of research: cross-sectional clinical-organizational study. The target group for evaluating the results of the implementation of the program were selected persons of both sexes aged 50-70 years, representatives of the urban and rural population, subject to screening in accordance with the age category. In total, the analysis group included 5370 people, divided into 2 subgroups - the main (2702) and comparison (2668). In the main group, a modified approach to organizing screening was used, based on increasing the activity of the healthcare system to attract respondents. Screening methods corresponding to the two-stage program adopted in the Republic of Kazakhstan were used as primary research methods.Results. An increase in the response to screening at stage I was determined for the entire contingent and two subgroups - men and persons in the age category of 62 years. At stage II, an increase in response was also determined for the entire contingent and men.Accounting for concomitant pathology determined an increase in response at stage I only in one of the selected categories (with the number of concomitant diseases 6-10). The presence of the influence of a large number of somatic pathologies and disabilities on response rates, as well as any significant influences at the II stage of screening, was not determined.Conclusion. There is an influence of a number of factors on the response to colorectal cancer screening and the possibility of their correction through a system of organizational measures.Keywords: colorectal cancer; screening; screening response.

Age and the aging process significantly alter the small bowel microbiome.

Gut microbial diversity decreases with aging, but existing studies have used stool samples, which do not represent the entire gut. We analyzed the duodenal microbiome in 251 subjects aged 18-35 (n= 32), 36-50 (n= 41), 51-65 (n= 96), and 66-80 (n= 82). Decreased duodenal microbial diversity in older subjects is associated with combinations of chronological age, number of concomitant diseases, and number of medications used, and also correlated with increasing coliform numbers (p< 0.0001). Relative abundance (RA) of phylum Proteobacteria increases in older subjects, with increased RA of family Enterobacteriaceae and coliform genera Escherichia and Klebsiella, and is associated with alterations in the RA of other duodenal microbial taxa and decreased microbial diversity. Increased RA of specific genera are associated with chronological age only (Escherichia, Lactobacillus, and Enterococcus), number of medications only (Klebsiella), or number of concomitant diseases only (Clostridium and Bilophila). These findings indicate the small intestinal microbiome changes significantly with age and the aging process.

Nutritional status and determinants of malnutrition in institutionalized elderly people, provisional data

Nutrition is an important factor for health, physical and cognitive function, vitality, quality of life and longevity. Elderly people oft en have low food intake, induced by multifactorial causes, as a result, malnutrition is an independent risk factor for increased morbidity and mortality, regardless of the underlying pathologies (chronic organ failure, cognitive impairment, cancer, cardiovascular disease, type 2 diabetes etc.) including overweight or obese subjects.The prevalence of malnutrition varies from 4% to 10% in the elderly population from the community, from 15% to 38% for institutionalized elderly people and from 30% to 70% for hospitalized ones. The purpose of this study was to assess the nutritional status of institutionalized elderly people and establish correlations between the determinants of malnutrition and fragility syndrome.Th e epidemiological study is part of the project 20.80009.8007.25 “Fragility: diagnosis and prophylaxis in relation to medicopsychosocial problems of the vulnerable elderly”, included 50 patients institutionalized in the Republican Asylum for the Disabled and Retired in Chisinau.All persons were examined by the complex geriatric evaluation, approved by the order of the Ministry of Health no. 619 of 07.09.2010. According to the results, both malnutrition and the risk of malnutrition were high in institutionalized elderly people.Among the determinants of malnutrition, the highest association had the number of concomitant diseases, decreased functionality of the elderly, the presence of depression syndrome and cognitive disorders. At the same time, the malnutrition syndrome correlated with the fragility criteria but also with the degree of severity of frailty of the institutionalized elderly people.

Endovascular treatment of native aortic coarctation in adults: Two case reports and detailed review of the literature

Coarctation of the aorta (CoA) forms 6-8% of congenital heart diseases (CHD). This narrowing typically occurs in the proximal descending aorta, close to the insertion of the patent ductus arteriosus and can be found with a number of concomitant diseases. CoA is a common cause of secondary arterial hypertension in young adults. Although CoA can be an isolated CHD, it is also commonly found in other congenital syndromes and cardiovascular anomalies. Herein this review paper we reported a brief history of management of aortic coarctation, and current treatment modalities concentrated on stent placement supported with two novel cases.

PP164 Prescribed Medication Use, Complications, And Cost of Type 2 Diabetes Mellitus In The Real World

IntroductionType 2 diabetes mellitus (T2DM) is one of the major diseases threatening the health of Chinese residents. Insufficient glycemic control results in inevitable and sometimes irreversible complications. The condition can be more complicated for patients with comorbidities. To maintain appropriate glycemic control, patients may need to add or switch to different classes of drugs as the disease progresses. The complicated drug treatment for diabetes poses a high risk for drug-drug interactions and challenges patient compliance, which is the most important factor affecting the ability to achieve glycemic control. In addition, T2DM is a life-long disease that is associated with a heavy economic burden for patients’ families and for society. Therefore, this paper aims to characterize the complexity of prescribed medications used to treat T2DM and to assess the trends in the number of complications, medications used, and costs incurred among these patients.MethodsData were retrieved from two tertiary hospitals. The population consisted of patients receiving at least one diagnosis of diabetes (International Classification of Diseases-10 codes: E11, E12, E13, and E14) between October 2007 and May 2017. Three measures were assessed, including the number of patients with different complications, concomitant drug use, and costs. Patients with a short disease duration (&lt; 5 years) were compared with patients who had a longer disease duration (≥ 5 years).ResultsOf 31,071 patients, about half of those with a longer disease duration had at least five concomitant diseases, compared with nine percent of patients with a shorter disease duration. The maximum number of concomitant diseases was nine for both disease duration groups. Patients with longer disease duration were more likely to use multiple classes of drugs, compared with patients in the short disease duration group. The average annual medical costs for patients without concomitant disease was CNY 1,894 (USD 265).ConclusionsOverall, the results demonstrated that T2DM is a relatively complex disease. Firstly, patients have up to nine concomitant diseases and use twenty-two classes of drugs. Secondly, patients with more complications tended to use more medications. Thirdly, patients with a longer disease duration tend to have a higher number of concomitant diseases, use more classes of drugs, and have higher medical costs than patients with a shorter disease duration.

Safety of Convicts and Correctional Staff in Pandemic

The Author studies safety of convicts and staff during conviction. It is emphasized that infectious or viral diseases of pandemicnature are among potential threats which endanger life and health of convicts and correctional staff. The article notes that convicts andcorrectional staff are the most vulnerable to infectious or viral diseases of pandemic nature. It is related to the fact that correctionalfacilities (CF) are the locations where people are most congregated while many of them have number of concomitant diseases like seriousinfection, incurable illness, TB, hepatitis, HIV, etc.It is emphasised that the state’s primary task is not only ensure but also develop sound measures to protect the above individualsin practice. The article notes that the implementation of these measures will be more efficient if the components of the term of “safety”are clearly defined. This will allow to define comprehensive measures required to save as many human lives as possible and ensuregood health as human life and health are the highest priorities for the society and state. The article provides analysis of the definitionof the term of “safety” and its components. The conclusion goes that in order to ensure safety of convicts and correctional staff the statemust take all required measures to protect life and health of the above from any source of danger during conviction.The article acknowledges that proper living conditions in Ukraine are still not ensured, the minimum essential sanitary standardsin CF are inadequate, despite of a number of laws designed to improve conviction conditions have been passed. It is noted that it’s theresponsibility of the government to protect life and health of the convicts and correctional staff, however due to various factors not allmeasures are efficient enough to successfully prevent COVID-19.&#x0D; Multiple convict and staff safety violations are found in CF during the pandemic in Ukraine. The article includes recommendationsof international organisations including WHO, recommendations of the CE Commissioner for Human Rights, High UN Commissionerfor Human Rights, European Committee for the Prevention of Torture and Inhuman or Degrading Treatment on all requiredmeasures to ensure to life and health of convicts and correctional staff.The Author provides the following recommendations on resolving the problem of safety of convicts and correctional staff:amnesty; adequate social, economic, organisational and legal measures; sufficient funding of CF’s; amending of penal correction le -gislation aimed at its improvement.

Modern methods of treatment of patients with intolerance to dental construction materials

Objective: to develop algorithms for treating patients with intolerance to dental construction materials (IDCM) and evaluate the clinical effectiveness of using an insula­ting coating of tantalum pentoxide (Ta2O5) on the surface of prosthetic constructions. Materials and methods. 552 patients (507 women and 45 men) with IDCM were examined. Basic and additional research methods were used, including exposure and provocative tests, epicutaneous and intraoral epimucous allergological tests, mea­surement of impedance and galvanic current, and assessment of the psychological status of patients. Results. The average number of comorbidities per person in patients with an allergy and a combination of several types of IDCM is significantly higher than in patients with galvanosis and toxic-chemical stomatitis (p&lt;0.001). In patients with IDCM of an allergic nature and a combination of several types of IDCM, a direct correlation was found between the number of concomitant diseases per person and the probability of IDCM (r=0.614 and r=0.683, respectively, p&lt;0.01). Concomitant pathology of organs and tissues of the oral cavity was detected in 39.49% of patients with IDCM. In 57.6% of cases, patients with IDCM showed a high level of personal anxiety (Spielberger–Khanin personal anxiety scale). 23.1% of patients had a high level of alexithymia (more than 74 points on the Toronto Alexithymia Scale). The method of determining stress resistance and social adap­tation of Holmes–Rahe showed low resistance to stress in 23.1% of patients with IDCM. Treatment algorithms for patients with IDCM take into account the need to correct comorbidities and are based on the principles of comple­xity, consistency, individuality, systematicity and continuity of treatment. Conclusion. The proposed algorithms for treating patients with IDCM have shown their clinical effectiveness. The use of Ta2O5 as an insulating coating for metal and acrylic prosthetic constructions is an effective method of prevention and treatment of IDCM.

OSTEOPOROSIS TREATMENT ADHERENCE: RESULTS FROM A RETROSPECTIVE COHORT STUDY

Treatment adherence in patients with osteoporosis (OP) is rather low throughout the world, and 50 to 75% of patients stop taking anti-osteoporotic drugs within a year after therapy prescription.Objective: to establish determinants that affect patient adherence to OP therapy.Subjects and methods. The investigation enrolled 150 women older than 50 years (mean age, 68.8±9.4 years) with OP duration of ≥3 years who had made an outpatient visit to the V.A. Nasonova Research Institute of Rheumatology. Their examination consisted of a survey using a specially designed questionnaire. Treatment adherence was evaluated, by using the data on the duration of treatment for OP within 3 years prior to the study inclusion, as well as by calculating the drug use index.Results and discussion. During 3 years, 94 (63%) female patients were adherent to OP treatment, including those who took zoledronic acid (78%), denosumab (75%), and alendronate or ibandronate (60%); therapy with antiosteoporotic drugs was changed in 53% of patients. The most common reason for missing or discontinuing treatment was poor drug tolerance (33%); and that for self-replacement of recommended drugs was their cost (75%). Age, education, marital status, income, duration of disease and length of treatment, a familial history of fractures or a hip fracture, the number of concomitant diseases, and the total number of drugs taken did not affect medication adherence. Patients who were more adherent to OP treatment were those who underwent determination of serum vitamin D levels (p=0.009), calculation of a 10-year absolute osteoporotic fracture risk according to the FRAX® algorithm (p=0.022), an annual bone densitometry examination (p=0.0158) and, more often than annually, biochemical blood tests (p=0.0043), as well as those who had visited their physician 3 times or more during the estimated period (p=0.003). There were more people adherent to OP treatment among the patients receiving the parenteral formulations of drugs than among those who took drugs as tablets (p=0.036). Educational materials, brochures, and lectures on OP and a follow-up in a specialized center did not ensure that treatment adherence could be significantly increased (p&gt;0.05).Conclusion. Patient adherence to OP therapy is positively influenced by determination of serum vitamin D levels, calculation of a 10-year absolute osteoporotic fracture risk (FRAX®), annual therapeutic monitoring using bone densitometry and results of biochemical blood tests, regular visits to a physician who follows up the patient for OP, as well as simplification of a dosing regimen and administration of the parenteral formulations of drugs used to treat OP.

The experience of treatment Furnier’s gangren complicated by peritonitis

Fournier’s gangrene (FG) is a rare but rather formidable disease that has been occurring more and more often in surgical hospitals of the country in the last decade. Such situation, in our opinion, is explained by an increase in the number of immunocompromised patients. A number of concomitant diseases is a predisposing factor for the development of FG: diabetes mellitus, obesity, cirrhosis, malignant tumors, alcoholism, drug addiction, glucocorticoids, condition after chemotherapy, nutritional deficiency. The course of the disease is accompanied by a high mortality rate – up to 88.0 %, and among the surviving patients, about 30.0 % need constant care after discharge from the hospital and more than 50.0 % – in repeated reconstructive and plastic surgeries on the genitals and perineum. Annually in our clinic, up to 5–6 people are hospitalized with this diagnosis. In this article, we present a rare clinical observation of the treatment a patient with FG, complicated by the development of peritonitis with a favorable outcome.