Polymorbid Pathology Research Articles

Features of gender, age, social factors and polymorbidity in patients, undergone COVID-19

Aim of the study was to identify the features of susceptibility to a new coronavirus infection СOVID-19 depending on gender, age, social factors and polymorbidity. Material and methods. An analysis of the structural features of gender, age, and social factors in 620 patients who underwent examination and treatment at the Federal Research Center of Fundamental and Translational Medicine clinic (Novosibirsk) was carried out. The patients were divided into 2 groups: the main group (group 2, age 56.4 ± 0.7 years) included 272 patients who underwent a new coronavirus infection COVID-19, confirmed by a positive PCR test or antibody testing, a comparison group (group 1, age 60.7 ± 0.7 years) – 348 people who did not have COVID-19 and were undergoing examination and treatment for chronic non-communicable diseases. Results. An analysis of the incidence of COVID-19 depending on gender showed that disease was more common, by 22 %, in women than in men. Patients who had COVID-19 were statistically significantly more likely (30%) to be in the second adult age period than those in the comparison group. When studying the social features of patients who underwent COVID-19, it was found that employees and employees of the administrative and managerial apparatus were significantly more likely to suffer from this infectious disease. An analysis of the structure of polymorbid pathology revealed that patients with COVID-19 had a significantly higher value of transsystemic polymorbidity.

The choice of a method for restoring coronary blood flow in myocardial infarction with ST segment elevation (literature review)

In the structure of total mortality, cardiovascular diseases are in the first place in the world. The main and most common reason for this is the incidence of myocardial infarction (MI). The basis of the pathogenesis of MI with ST elevation is persistent and complete thrombotic occlusion of the large epicardial branch of the coronary artery, leading to extensive necrosis of the heart muscle with the development of life-threatening complications, including death, the frequency of which is 8–10 %. The prognosis for MI is influenced by the presence of risk factors, complications, hemodynamic status, polymorbidity, as well as tactics for restoring coronary blood flow. To eliminate acute coronary artery occlusion, conservative treatment is used – thrombolytic therapy, surgical – primary percutaneous intervention, thromboextraction, coronary bypass surgery, as well as their combination. Today, there are scattered and isolated studies characterizing the approach to treatment in patients with MI with ST elevation in various diseases and with polymorbid pathology, the relationship with risk factors and laboratory and instrumental data has not been established, among which predictors of rapid response and death in patients with polymorbid pathology for emergency physicians have not been determined. It can be assumed that the chosen optimal patient management tactics in a specific clinical situation, taking into account the above-mentioned factors, will reduce the development of complications and increase the survival rate of patients with MI.

КОМОРБИДНОСТЬ ЗАБОЛЕВАНИЙ ПОЛОСТИ РТА И ВНУТРЕННИХ ОРГАНОВ

Abstract. Introduction. Literature analysis is presented showing the existence of both phylogenetic and functional interrelation of internal diseases and oral-cavity diseases. Comorbidities contribute to the patients’ longer stay in hospital, reduce the quality of measures taken to prevent disabilities, and increase the number of post-surgical complications. Aim of the study is a review of the current information on the functional relationship between internal diseases and oral-cavity diseases. Material and Methods. Published topical studies were studied that deal with investigating the mechanisms of the relationship between oral infections and secondary systemic manifestations. Results and Discussion. Data are presented on the pathogenetic unity of the occurrences of somatic and dental diseases. Causal relationships are substantiated between them, arising from the impaired immunologic balance, interleukin regulation, and nonspecific resistance in human body. We noticed the negative comorbidity of internal and oral-cavity diseases, namely, the dependence of dental diseases on the general body condition and the influence of chronic infection foci in the oral cavity on the development of common diseases. Odontogenic transient bacteremia was proven at the dentist’s office, and conditions are shown for its transformation into any infectious disease. We identified the need for unified systemic approaches to the treatment of polymorbid pathology. Conclusions. Influence of comorbid pathology on clinical manifestations, diagnoses, prognoses, and treatment of many diseases is multifaceted and individual.

Features of management of patients with cardiometabolic polymorbidity phenotype: focus on the efficacy and safety of bisoprolol

The presence of coexisting chronic non-infectious diseases is associated with reduced quality of life and increased risk of early disability and mortality. The coexistence of two or more diseases in a patient is defined by the term polymorbidity. Currently, there is an increase in polymorbid pathology not only among elderly patients, but also among young and middle-aged people, which entails significant health care costs and has a negative impact on the economy of the country as a whole. Therefore, the problem of polymorbidity and the management of such patients in real clinical practice is urgent and key in the field of public health. According to major foreign and domestic studies, the most common polymorbidity phenotype is the cardiometabolic phenotype. Taking into account the fact that in our country almost every second patient with arterial hypertension has metabolic disorders and, therefore, polymorbid pathology, approaches to the management of such patients should be personalized already from the beginning of drug therapy. In this regard, this review reviews some key pathophysiological mechanisms of the relationship between arterial hypertension and metabolic disturbances occurring in patients with the cardiometabolic phenotype of polymorbidity, presents features of antihypertensive therapy in such patients, in particular, describes in more detail the class of beta-blockers with pathogenetic validity of use in this case. Also, a review of the available clinical trial data concerning the effects of the highly selective beta-adrenoblocker bisoprolol in patients with arterial hypertension is presented, emphasizing its effect on metabolic status and its importance for comprehensive clinical management.

Clinical case of the sepsis development in a patient with bullous pemphigoid

Patients with rare diseases, particularly skin conditions, can be particularly problematic for doctors of intensive care units. The present study shows the features of the course of sepsis in bullous pemphigoid in terms of clinical case management. A 66-year-old patient with polymorbid pathology was admitted for scheduled hospitalization to the Endocrinology Department with a diagnosis of non-insulin-dependent diabetes mellitus with multiple complications, and examined. She complained of pain in the small of the back and abdomen irradiating to the inguinal region, and increased oedema of the lower extremities. A few hours after admission to the Endocrinology Department, she was transferred to the intensive care unit due to the deterioration of her condition. Analysis of the severity and prognosis assessment of her condition was performed: 9 scores according to SOFA, 20 scores according to APACHE II. The patient underwent clinical, laboratory (biochemical, immunological, bacteriological, cancer markers, blood gases), instrumental methods of examination (Doppler ultrasonography of the lower extremity veins, brain MRI, chest MRI, lumbar puncture). A skin biopsy for morphological study was taken. The analysis of test results showed a critical condition of the patient with a high risk of death, which was prognostically dangerous. Bullous pemphigoid diagnosis was established by morphological and immunological assays. The patient was prescribed therapy with due account for her polymorbidities: prednisolone 80 mg orally, antibiotic therapy, later on she was transferred to the mechanical ventilation. A session of substitutive renal therapy CVVHD using the Prismaflex system was performed. After treatment, improvement was observed. Over the 3-month follow-up care, the patient's condition has been stabilised. It is critical for doctors of various specialties to identify signs of bullous pemphigoid in a timely manner, assess the risk of developing sepsis and take appropriate therapeutic measures in case of secondary infection, as the polymorbidity of pathological conditions can lead to death.

Cardiac syncope in an elderly patient: a clinical case from practice

Syncope is the most important, frequently occurring, and difficult to diagnose problem in modern clinical medicine. Often, syncope in the elderly is the first and only symptom of life-threatening arrhythmias and, if not diagnosed in time, increases the risk of sudden cardiac death. The presence of concomitant pathology, primarily cardiological and neurological, makes it difficult to differentiate syncope in elderly and old patients. The combination of the patient’s complaints about transient short-term loss of consciousness and electrocardiographic signs of bifascicular heart block makes the cardiac – arrhythmic cause of syncope to be more probable. The article is devoted to the possibility of diagnosing arrhythmic causes of syncope in elderly and old patients with polymorbid pathology.

Restructuring of erythropoiesis and immune status in hypotrophic calves with comorbid pathologies based on the use of aminoseleferon-B

The article presents the results of comparative therapeutic efficacy of a complex biogenic drug aminoseleferon-B based on recombinant interferons on Holstein calves with hypotrophy and comorbid pathology (anemia, immunodeficiency) in the neonatal period. According to the principle of pairanalogues, four groups of 6 individuals (hypotopic calves with comorbid pathology) were formed and the fifth – 6 normotrophic calves. The calves of the first experimental group were administered aminoseleton, the calves of the second experimental group - biferon-B, the calves of the third experimental group - the drug aminoseleferon-B. The drugs were administered subcutaneously, three times on days 1, 3 and 30 at a dose of 1 ml per 10 kg of animal weight. The calves of the fourth experimental group - negative control and the calves of the fifth group - positive control, the studied drugs were not used. The use of aminoseleferon-B leads to an earlier stabilization (on day 7 of our studies) of the morphological and immunological blood composition, whereas in the comparison groups, the studied indicators were optimized on day 30. In the animals of the 3rd experimental group, the level of erythrocytes increased by 9.3% and 6.4% compared to those in hypotrophic calves, a similar pattern was noted in the amount of total hemoglobin - increased by 13.7% and 7.7%. Humoral and cellular links of nonspecific protection were restored in the calves of the 3rd experimental group, due to normalization of serum compliment, lysozyme and bacterial activity, phagocytic index and number. The use of aminoseleferon-B in the treatment of polymorbid pathology (anemia, immunodeficiency) in calves with hypotrophy has a pathogenetically mediated mechanism of action and a pronounced anti-anemic and immunomodulatory effect that together improves the state of the calves body during early neonatal adaptation.

Хроническая боль у пациентов пожилого и старческого возраста: клинические рекомендации и сложности реальной практики

Chronic pain syndrome is one of the most common geriatric syndromes, it has an impact on person’s self-management, worsens the life quality and shortens life expectancy. Reduced mobility, the need for external assistance due to chronic pain lead to an increase in the costs of the healthcare system. The peculiarity of the elderly and senile patient management with chronic pain is the need to assess not only the pain syndrome itself, but also polymorbid pathology and other geriatric syndromes that affect the pain pathogenesis. A patient-centered care for elderly persons with chronic pain, developed on the basis of a comprehensive geriatric assessment, should include interventions aimed at correcting geriatric syndromes, the range and activity of movements and the pain negative consequences. The drug treatment of pain syndrome is determined by its intensity and the risks of developing adverse events (especially in the case of nonsteroidal anti-inflammatory drugs). The most correct treatment tactics of chronic pain is the basic therapy indication for diseases that cause the pain development. KEYWORDS: chronic pain, geriatric syndromes, comprehensive geriatric assessment, osteoarthritis, autonomy, mobility, nonsteroidal anti- inflammatory drugs, symptomatic slow-acting drugs. FOR CITATION: Naumov A.V., Khovasova N.O., Polyanskaya A.R., Tokareva L.G., Tkacheva O.N. Chronic pain in elderly and senile patients: clinical recommendations and difficulties in real practice. Russian Medical Inquiry. 2023;7(10):680–686 (in Russ.). DOI: 10.32364/2587-6821- 2023-7-10-11.

Прогноз динамики полиморбидной патологии

A unified methodological approach is proposed to describe the nosological structure of polymorbidity, to systematize its clinical and epidemiological properties and patterns, as well as for the phenomena associated with it. A probabilistic model is used to describe at the phenomenological level the picture of the formation of the resulting statistics of polymorbidity in a population. The ergodic hypothesis underlies the model of morbidity in the population. The results have the meaning of ensemble averages. The microscopic (internal) states of the system can take on all possible values compatible with the given values of the macroscopic (external) parameters. Of all the possible microscopic states, those that have the highest statistical weight are realized with the maximum probability. The real system defines the block diagram of the model. Those aspects of the system that correspond to the objectives of the study are displayed. The direct task is to draw up an epidemiological picture according to the clinical parameters of the disease. The inverse task is the formation of an individual (clinical) description of nosology based on epidemiological (population average) data. A special state probability linear regression method is proposed to compare theoretical results with observations. The test allows estimating the parameters of the real distribution. The adequacy of the model is checked when it is "fitted" to the observational data. The fitting parameters rationally characterize polymorbid pathology – the structure and incidence rate.

Эволюция взглядов на болезнь в России как возможная основа интерпретации проблемы: «Близорукость: болезнь или биологический вариант нормы?»

The presented lecture is focused on the lack of generally accepted ideas about myopia: is it a disease or a biological condition within normal range? The focus is made on the evolution of views on the disease in Russia. In accordance with modern concepts of general pathology, the reaction of cells and tissues to pathological agents (adaptive reaction) is mentioned, and some morphological data on experimental models of myopia are given. The structure of polymorbid pathology in children with acquired myopia is described. Key words: disease, biological version of the refraction norm, hypermetropia, myopia, emmetropia, culture, adaptation

Comorbid pathology issues in pediatric gynecology

The problems of diagnosis, therapeutic tactics and medical prognosis in comorbid, polymorbid pathology stand out among the most actual problems of modern health care. Purpose - to study the frequency and nature of comorbid conditions in patients with pubertal abnormal uterine bleeding (PAUB). Materials and methods. The study included 342 girls aged 11-17 suffering from PAUB. All patients were examined by a multidisciplinary team of doctors. Results. It has been shown that menstrual irregularities are combined with other somatic, mental and endocrine pathologies in the vast majority of patients. Only 9.6% of the patients examined had no concomitant pathologies. More than half of girls have a combination of more than three comorbidities. The first three ranks are occupied by endocrine, mental and digestive system disorders. More than a third of patients with endocrine disorders had deviations in terms of body weight - overweight and obesity, which is much more often accompanied by changes in carbohydrate and lipid metabolism. In patients with mental disorders astheno-neurotic syndrome and vegetative-vascular dystonia syndrome prevailed. Functional disorders of the biliary tract were mainly recorded among the disorders of the digestive system, about 18% of girls suffered from gastritis, cholecystitis. The presence of comorbid pathology reduced the effectiveness of non-hormonal therapy by 1.5 times and increased the number of relapses by 3.5-4 times. The effectiveness of non-hormonal therapy was 81.8% on the absence of concomitant pathology; relapses were recorded only in 16.7%. Conclusions. Comorbid pathologies in patients with PAUB aggravate the severity of the girl’s condition, reduces adaptive capabilities, adversely affects the effectiveness of non-hormonal therapy, contributes to the recurrence of the disease and is a risk factor for the development of serious metabolic, endocrine and cardiovascular diseases in the future. The category of patients with concomitant pathology requires a special examination algorithm and the appointment of an adequate therapeutic intervention, taking into account all the identified nosological forms and drug compatibility. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Waldenstrom's macroglobulinemia in geriatric practice

Using the clinical case of Waldenstrom's macroglobulinemia in an older patient, a research was carried out to find an algorithm for diagnosing the disease in patients of advance age, whose frequent polymorbid pathology makes it difficult to diagnose and detect the disease at an early stage. The study of Waldenstrom's macroglobulinemia has great relevance due to the dim clinical picture and high prevalence among the older population. This condition is relatively rare, but its timely detection is very important to prevent the development of complications. We analyzed the literature dedicated to study Waldenstrom's macroglobulinemia, as well as pathways of transformation a monoclonal gammopathy of undetermined significance into Waldenstrom's macroglobulinemia.

Monitoring and personalization in treatment of breast cancer patients with metastatic bone lesions

The aim. To increase the efficiency of treatment of BC patients with metastatic lesions of long tubular bones by using, Multidetector computed tomography (MDCT) and bone marrow markers for diagnostics and monitoring the clinical course of the oncologic process, accompanied by surgical intervention with endoprosthetics along with the treatment of polymorbid pathology in a specific patient.
 Materials and methods. Authors provide systemic personification including visualization of the tumor site and its vascularization; printing out the 3D model; surgical planning, including optimal surgical access to the tumor site considering the volume and topographic and anatomical location and dissemination of the tumor, the convenience of intraoperative tasks (removal of the tumor, bone grafting or endoprosthetics), preoperative planning of bone resection lines with maximum preservation of intact bone tissue.
 Results. Personalization of the treatment of breast cancer patients with metastatic bone lesions contributes to a significant reduction in postoperative complications of endoprosthetic replacement of large joints (up to 15.2 %) and increases the overall three-year survival rate (up to 40.6 %), as well as significantly improves their quality of life.
 Conclusions. The personalization of treatment of patients with tumor lesions of the skeletons contributes to a significant decrease in the indicator of postoperative complications of endoprosthetics of great joints and to an increase in the total three-year survival rate, as well as to the improvement of the quality of life after the conducted treatment.

Which NSAID to choose for treatment of pain syndrome in polymorbid patients?

A polymorbid patient is a patient with several diseases occurring simultaneously at different stages and phases of their development. Patients with polymorbid pathology have a statistically significant almost 2.5 times higher risk (odds ratio [OR] = 2.41; p = 0.01) of pain syndrome and other diseases (for example, depression, arterial hypertension, etc.), which will contribute to the progression of polymorbidity. Individuals with chronic pain have a significantly increased risk of all causes’ death (hazard ratio [HR] = 1.95; 95 % confidence interval [CI]: 1.26–3.03) and cardiovascular causes (RR = 2.72; 95 % CI: 1.41–5.26) compared to patients without chronic pain. Therefore, in order to improve the prognosis and quality of life of the patient, both acute and chronic pain must be treated with non-pharmacological (exercise therapy, taping, virtual reality, etc.) and pharmacological methods. Non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for mild to moderate pain. The rational choice of NSAIDs in polymorbid patients can be difficult due to the presence of pathologies that limit their use or conditions that are risk factors of complications of drug therapy. In this article, the author present approaches to choosing the optimal NSAID in polymorbid patients, and justify efficacy and safety of administration of original meloxicam in these individuals (Movalis®, Boehringer Ingelheim International).

Metabolic and anxiety-depressive disorders in patients with polymorbid cardiovascular disease

The peculiarities of the influence of the metabolic disorders and depressive spectrum disorders in the development of polymorbid pathology are investigated. 160 male patients were examined, divided into three groups. The first group included 56 young men, 3940.2 years old, body mass index 34.235 kg/m2, suffering from the polymorbid cardiovascular pathology, in which the presence of coronary heart disease, angina pectoris of the functional class III, arterial hypertension 23 degrees, obesity 12 degrees, depressive spectrum disorders was considered. The second group included 56 middle-aged men, 47.548.3 years old, body mass index 36.236.9 kg/m2 with a similar combination of diseases of the first group. The third (control group) included 48 young men, 39.640.9 years old, body mass index 24.124.9 kg/m2, suffering from the polymorbid cardiovascular pathology without the metabolic syndrome and obesity. The anthropometric status, glucose, insulin, total cholesterol, triglycerides, and low-density lipoproteins were assessed. Instrumental diagnostics of the coronary heart disease and hypertension was carried out, anxiety and depressive disorders were established based on the results of a questionnaire and a consultation with a psychiatrist. It was found that in a group of young and middle-aged patients suffering from the polymorbid cardiovascular pathology, in combination with a metabolic syndrome and depressive spectrum disorders, psychopathological disorders (borderline anxiety-depressive state) are associated with the metabolic disorders, high prevalence of pain-free form of myocardial ischemia and unfavorable variants of two-phase blood pressure rhythm during the day, according to the type of insufficient degree of reduction of nocturnal blood pressure non-dippers and a steady increase in the night blood pressure night-peakers, which determines a high risk of cardiovascular complications.

Clinical case of a vasovagal syncope

Syncope is defined as a transient loss of consciousness due to cerebral hypoperfusion, characterized by a rapid onset, short duration, and spontaneous complete recovery of all vital functions without signs of neurological deficits. Syncope is a multidisciplinary medical problem common in clinical practice. As a rule, syncope occurs due to cardiovascular dysfunction of organic or functional origin, which either develops spontaneously or is induced by a trigger. Due to a various etiology differential diagnosis and prognostic evaluation is difficult. This clinical case demonstrates the features of differential diagnosis of vasovagal syncope in a patient with polymorbid pathology and the features of the choice of an adequate management, including recommendations for lifestyle modifications, specialized education regarding prodromal symptoms recognition methods and timely application of countermeasures.

Advantages and disadvantages of lockdown (self-isolation regime) introduced during the first wave of coronaviral infection for patients with polymorbid pathology

AIM: To study the structure of mortality not caused by coronavirus infection, in patients with polymorbid pathology during the period of self-isolation (lockdown).
 MATERIALS AND METHODS: Outpatient records of 2 423 patients with polymorbid pathology (841 males and 1 582 females, aged from 18 to 99 years) were examined. The mortality and its causes during three years including a period of lockdown were investigated.
 RESULTS: The overall mortality rate among patients with polymorbid pathology was 10.2% without differences in gender. The structure of the causes of death in patients with polymorbidity: cardiovascular diseases accounted for 50.8%, oncological diseases 21%, nervous system diseases 7.3%. During the lockdown, an increase in overall mortality by 34.3% was recorded (p 0.05), with an increase in the number of deaths of patients with cardiovascular diseases by 19.5% (p 0.05) (mostly patients with ischemic heart disease).
 CONCLUSION: An increase in the number of deceased patients with polymorbidity during the lockdown may be due to the limitation of physical activity, of the possibility of examination and consultation by profile specialists. Taking into account the vulnerability of this group of patients, there is an urgent need to develop preventive measures when the situation recurs.

METHOD FOR PREVENTION OF POSTNATAL POLYMORBID COW PATHOLOGY USING VITAPOL® PULVIS

A method for the prevention of postpartum polymorbid pathology of cows using the drug VITAPOL® pulvis, which increases the number of clinically healthy cows in the postpartum period by 22,5%, reduce the number of recorded cases of both individual and polymorbid diseases (placental retained and ketosis by 7,5%, metritis-hypoluteolysis and placental retained-ketosis-hypoluteolysis by 5%, ketosis-metritis and metritis – by 2,5%.) which significantly reduces the cost of treatment of animals and the time spent by specialists with sick animals.

По материалам научно-практической конференции «полиморбидных патология органов пищеварения в практике семейного врача»

No abstract

Polymorbidity and indicators of carbohydrate, lipid and purine metabolism in patients with arterial hypertension

Aim of the study was to investigate the peculiarities of the relationship of polymorbid pathology in arterial hypertension with disorders of lipid, purine and carbohydrate metabolism. Material and methods. Patients with arterial hypertension with the presence of polymorbid pathology, who underwent examination and treatment at the clinic of the Federal Research Center for Fundamental and Translational Medicine (Novosibirsk), were examined. A total of 9775 people were examined. The patients were divided into 2 groups: with arterial hypertension in the dyslipidemia absence (n = 561(252 men (44.9 %), 309 women (55.1 %), average age 57.1 ± 0.60 years) and in the dyslipidemia presence (n = 9214 (3879 (42.1 %) men, 5335 (57.9 %) women, average age 57.82 ± 0.12 years). Results and discussion. Hyperglycemia and hyperuricemia were more common in patients with arterial hypertension with dyslipidemia; the indicators were statistically higher: total serum cholesterol, low-density lipoprotein cholesterol, triglycerides, atherogenic index, serum glucose, uric acid compared with patients with arterial hypertension without dyslipidemia. In patients with dyslipidemia, compared with patients without dyslipidemia, arterial hypertension was more often combined with diseases of the endocrine system, nutritional disorders and metabolic disorders, and other diseases of the circulatory system. Conclusion. The data obtained can serve as a theoretical basis for the concept of care for polymorbid patients, based on the impact on the main key pathogenetic mechanisms of diseases, and new approaches to complex treatment, rehabilitation and personalized prevention, taking into account the impact on modifiable risk factors.