Polymorbid Pathology Research Articles

Patient with polymorbid pathology. Possibilities of therapy with monoclonal antibodies

With the widespread increase in the number of patients with allergic pathology, doctors in clinical practice increasingly have to observe the simultaneous development of several nosological forms in the same patient. Frequent occurrence of a combination of lesions of the skin and respiratory tract in patients with atopy (atopic dermatitis, allergic rhinitis, and atopic bronchial asthma) is traditionally considered within the framework of comorbidity and suggests a number of therapeutic interventions given the similarity of the pathogenesis. However, phenotypic or endotypic differences exist between patients (e.g., triggers, age, persistence of manifestations, degree and type of inflammation, severity of symptoms, and response to treatment), for which it is more correct to use the term multimorbidity. The strategy of precision medicine for patients with several immune-mediated diseases should focus on identifying not only the general features of the disease, but also the pathogenetic mechanisms in the target organs. Because of these differences, the sensitivity to therapeutic interventions by target organs can vary. Herein, a clinical case of a patient with comorbid pathology ― chronic spontaneous urticaria, allergic rhinitis, and bronchial asthma ―was analyzed. Respiratory manifestations (rhinitis and asthma) were mild to severe. Chronic urticaria had the most severe disease course and resistant to antihistamines, which are considered first and second lines of drugs according to federal and international clinical guidelines that required the use of monoclonal antibodies. Anti-IgE therapy with omalizumab had a rapid and complete effect on urticaria symptoms, but respiratory symptoms were less responsive to treatment. In patients with multimorbid pathology, therapy should be individualized in terms of targeted drugs and their dosage.

THE ORGANIZATION OF THE NURSING PROCESS DURING EMERGENCY CONDITIONS WHEN POLYMORBIDITY PATHOLOGY IN THE ELDERLY

Summary. Urgency. In recent years, the concept of nursing process has been actively introduced. It is especially relevant in geriatric practice, where the issues of nursing prevail over those in young and middle age. There are forms of organization of care, where it is the average medical staff is leading in providing medical care (hospices, nursing hospitals, homes for the elderly, etc.). In these conditions, the nurses ' responsibility in making and implementing medical decisions in the event of emergency conditions increases.
 Purpose of research. To substantiate and develop the principles of the organization of the nursing process in the event of emergency conditions in the elderly in combination with polymorbid pathology.
 Method of research. The methods of statistical calculation were used: determination of the required number of observations (n), comparison of relative and average values using parametric correlation methods, as well as analytical and comparative analysis methods. A total of 1188 elderly patients with polymorbid pathology were examined.
 Results. The main complaints of elderly patients presented by them at admission to the hospital were identified. The first six places were: General weakness 42.9%, abdominal pain 32.2%, shortness of breath 31.1%, nausea 19.6%, chest pain 18.1%, dry mouth 17.8%.
 Complaints, which occurred in more than 5% of cases, were taken for the development and scientific justification of clinical and organizational algorithms of the nursing process in the event of emergency situations in the elderly and senile age which are based on symptoms.
 Summary. The following principles should be implemented in the construction of a nursing diagnosis:
 
 Completeness of examination. Nursing examination does not depend on the medical and can not be replaced by them, as before these examinations are different tasks. The task of the nursing examination is to collect information about the patient's health and its analysis.
 Correctly collected anamnesis. The purpose of this principle is to find out the time of onset of the disease, the initial symptoms, their features, their dynamics, clarify existing diseases, risk factors, allergoanamnesis, in order to suggest tactics based on complaints and anamnesis data.
 Consistent, detailed physical examination of the patient nurse conducts by examining and observing the patient, as well as conventional methods (eg, thermometry, measurement of blood PRESSURE, respiratory rate).
 The principle of reasonable sufficiency should be observed in each case.

Quality of life of patients with polymorbid pathology

Multimorbidity is an urgent problem of modern medicine, associated with a greater severity and more serious prognosis of diseases, a large number of complications, difficulty and the high cost of diagnosis and treatment. The study of the quality of life of patients with multimorbidity is necessary for the competent distribution of health resources. Aim of the study was to investigate the effect of transnozologic multimorbidity (TMM) on the components of quality of life (QoL) in patients of a therapeutic clinic. Material and methods . A total of 116 patients, men and women aged 20 to 75 years were examined at the clinic of the Federal Research Center for Fundamental and Translational Medicine in Novosibirsk. TMM was evaluated by the average number of nosologies corresponding to the three-digit classification of ICD-10. Assessment of QoL indicators was carried out using the validated questionnaire SF-36. To assess the number and severity of chronic diseases in the structure of TMM, the CIRS (Cumulative Illness Rating Scale) system was used. Results . Depending on the severity of TMM, 3 groups of patients were formed – with low ( n = 42), medium ( n = 52) and high TMM ( n = 22). A comparative analysis of indicators of QoL, as well as TMM structure in 3 groups was carried out. A comparative analysis showed a significant decrease in the level of physical functioning (by 27 %), physical and mental health components (by 26.3 % and 15.8 %, respectively), and the integral indicator of quality of life (by 19.2 %) in patients with a high level TMM, compared with patients with low TMM. Correlation analysis confirmed the presence of a statistically significant relationship between an increase in TP and a decrease in the main indicators of QoL. Conclusion . An increase in the degree of TMM in patients is significantly associated with a decrease in the main indicators of QoL.

Динаміка якості життя осіб похилого віку з старечою астенією та паркінсонізмом під впливом засобів фізичної терапії у постіммобілізаційному періоді після перелому променевої кістки у типовому місці

In old age, due to the spread of age-related diseases, there are changes in the functioning of many organs and systems due to and against the background of polymorbidity, which affects the quality of life and requires correction. The purpose of the study was to determine the dynamics of the quality of life of elderly people with frailty and parkinsonism under the influence of physical therapy in the post-immobilization period after fracture of the radial bone in a typical place. Material and methods. We examined 27 elderly people with frailty and Parkinson's disease in the early postimmobilization period after fracture of the distal metaepiphysis of the radial bone (in a typical place). Group 1 engaged in the principles of outpatient rehabilitation with a predominance of preformed physical factors and group 2 engaged in a developed program of physical therapy, created in terms of patient-centric model of rehabilitation taking into account the specifics of each polymorbid condition using functional body training, massage, nutrition correction, expansion of social activity. The effectiveness of the program was evaluated in the dynamics before and after a month of implementation based on the results of the comparison of quality of life on the questionnaire "Medical outcomes study short form" (SF-36). 36 points were grouped into eight scales: Physical health: Physical Functioning, Role-Physical, Bodily Pain, General Health and Mental Health, Vitality, Social Functioning, Role-Emotional. Results and discussion. At the initial examination the examined people revealed a significant decrease in the results of all scales of physical and mental components of the quality of life of the questionnaire SF-36. The parameters of both groups did not differ statistically significantly (p> 0.05). At retesting, the difference between the results of the physical component of health in the primary and re-study on the physical functioning scale for individuals in group 1 was 18.9%, group 2 – 29.0%, role-physical – 19.8% and 35.5%, respectively, bodily pain – 12.3% and 33.1%, general health – 25.8% and 30.1%. The improvement of the mental component compared to the initial result on the vitality scales in patients of group 1 was 14,0%, group 2 – 27,4%, social functioning – 17,5% and 41,3%, respectively, role-emotional – 15,0% and 23,8%, mental health – 20,5% and 30,2%. The results of testing on all scales were statistically significantly better in individuals of group 1 compared with the result of group 2 (p <0,05). Conclusion. Elderly patients with polymorbid pathology and traumatic bone injuries require the development of pathogenetically based physical therapy programs taking into account and correcting the specifics of each disease, increases the overall effectiveness of rehabilitation and, consequently, quality of life

Динаміка функціональної активності осіб похилого віку з хворобою Паркінсона та синдромом старечої астенії з наслідками перелому шийки стегнової кістки під впливом засобів фізичної терапії

The high risk of fall-risk in patients with Parkinson's disease leads to traumatic consequences, in particular, to the femoral neck fractures. Predictors of fall-risk are old age, sarcopenia, and polymorbidity. All of these conditions are independent indications for carrying out rehabilitation measures; but their combination in one patient should introduce specific features into the recovery process aimed at leveling the signs of each disease. The purpose of the study was to assess the dynamics of functional activity in older people with Parkinson's disease and frailty with the consequences of femoral neck fractures under the influence of physical therapy. Material and methods. We examined 21 elderly patients with Parkinson's disease and frailty in the recovery period after the femoral neck fracture. They were divided into two groups: group 1 practiced according to the principles of polyclinic rehabilitation with a predominance of the use of preformed physical factors and general principles of physical therapy and group 2 practiced according to a developed program of physical therapy with an emphasis on functional training aimed at improving physical qualities, movement stereotype, primarily movement and self-service, taking into account the polymorbidity of the pathology. The developed physical therapy program lasted 3 months; corrective sessions were held three times a week. The program was created taking into account the setting and consistent achievement of individual short- and long-term rehabilitation goals. The effectiveness of the program was assessed based on the results of the Barthel Activities of the daily living Index and the Lawton Instrumental activities of the daily living Scale. Results and discussion. In elderly patients with Parkinson's disease and frailty in the recovery period after the femur neck fracture, a low level of basic (according to the Bartel index) and instrumental (according to the Lawton scale) functional activities is diagnosed, which leads to restrictions in everyday activities and self-care. The developed program of physical therapy revealed a statistically significantly better effect on the indices of the basic and instrumental functional activities of the examined persons in comparison with the general polyclinic program: the increase in the general level of the basic functional activity of the Bartel index in group 1 was 15.52%, in group 2 was 35.59% (p <0.05). Improvement in the overall score of instrumental activity on the Lawton scale in group 1 was 18.70%, in group 2 it was 36.11% (p <0.05). Conclusion. Elderly patients with polymorbid pathology with traumatic bone injuries require the preparation of pathogenetically based physical therapy programs, taking into account and correcting the specificity of each disease, which increased the overall effectiveness of rehabilitation and, as a consequence, the functional activity of patients

Bioimpedance analysis of body composition in elderly and old men with polymorbid pathology

Aim to compare the parameters of bioimpedance analysis of body composition in elderly and old men with polymorbid pathology.
 Material and methods. The study involved 123 men aged from 65 to 84 years (mean age 73.7 5.9 years) with polymorbid pathology. The Group 1 included 65 elderly men; the Group 2 consisted of 58 old men.
 Results. The study revealed the decrease in strength, mass and muscle function parameters related to aging. The bioimpedance phase angle was lower in the group of old men than in the group of elderly men. The correlations of the phase angle with anthropometric and functional parameters, as well as with body composition were revealed.
 Conclusion. The decrease in muscle mass parameters and low phase angle may be associated with degenerative processes in skeletal muscles due to aging and polymorbidity. The bioimpedance analysis of body composition can be used in geriatric practice for the diagnosis of sarcopenia syndrome in elderly and old men.

Features of polymorbid pathology in patients with autoimmune bullous dermatosis

Autoimmune bullous dermatosis (ABD) is a group of inherited and acquired skin diseases, the main morphological elements of which are the bullas, developed as a result of autoantibody production directed against protein structures of the epidermis and dermo-epidermal junction, leading to epidermal detachment and blistering on the skin and mucous membranes. The aim of the research is to analyze the detection rate and structure of polymorbid pathology in patients with autoimmune bullous dermatoses and to determine the Charlson index and 10-year viability in patients before and after prescription of glucocorticosteroid therapy. Materials and methods. The research included retrospective and prospective stages. At the first stage, the analysis of primary medical records was carried out, and histories of 70 patients over 18 years old, before the onset of autoimmune bullous dermatosis were analyzed. Clinical and epidemiological data were taken into account, the main and concomitant diagnoses were determined in accordance with ICD X. The Charlson index was calculated for all patients, the 10-year viability rate of patients with autoimmune bullous dermatoses was determined. Results. Polymorbid pathology was recorded in 81.4% of patients, before the onset of autoimmune bullous dermatosis. 48.6% of patients had two or more concomitant diseases. Among patients with diseases of internal organs, those with cardiovascular pathology (52.8%) occupied the first place, patients with gastroenteric pathology (41.4%) occupied the second place, patients with endocrinopathy held the third place (20.0%). The Charlson index median in patients of this group was 2.5 (1–3), the risk of fatal outcome over a 10-year period was 16.5%. Subsequently, after the onset of autoimmune bullous dermatosis, 65.7% of patients required the prescription of glucocorticosteroid therapy. Decompensation of concomitant pathology was diagnosed in 39.1% of patients, therefore they needed consultation of related specialists. The median polymorbidity index increased to 3.5 (2–5), the risk of a death increased to 34.5% ( p < 0.05). Conclusion . Polymorbid pathology worsens the course of autoimmune bullous dermatoses, increases the risk of disability and mortality, especially in patients receiving systemic glucocorticosteroid therapy, and therefore these patients should be under regular medical check-up not only of a dermatovenereologist, but also of related specialists.

Evaluation of the cytokine profile and vascular elasticity in middle-aged men with essential hypertension and combined pathology

The diagnosis and management of patients with polymorbid cardiovascular pathology is a significant challenge. The pathogenesis of many cardiovascular diseases, such as arterial hypertension, coronary heart disease, angina pectoris, as well as diabetes mellitus, obesity and dyslipidemia are associated with systemic inflammation. The inflammatory process, both at the systemic and local levels, can make a significant contribution to the progression of atherosclerosis and endothelial dysfunction, and provoke the destabilization of blood pressure. Therefore, it is important to develop new approaches to the identification of patients with polymorbid pathology and chronic inflammatory processes in the body. It is known that the presence of the oral cavity inflammation increases the risk of cardiovascular disease. Periodontal pathology, leading to an increased expression of pro-inflammatory cytokines, affects the initiation of atherosclerosis, endothelial dysfunction, vasospasm, and blood pressure dysregulation. It can be assumed that the oral cavity inflammatory processes against the arterial hypertension increase the probability of early vascular aging, the overall cardiovascular risk, and also increase the chance of other diseases of the cardiological profile The research subject was to determine the vascular elasticity parameters and the dynamics of blood pressure daily profile, as well as the level of pro-inflammatory and anti-inflammatory cytokines in persons with arterial hypertension, considering the presence of inflammatory processes in the oral cavity. The structure of comorbidity and a number of laboratory and instrumental data of middle-aged men with arterial hypertension in combination with periodontitis were analyzed in comparison with patients with arterial hypertension without periodontitis and healthy volunteers of the same age. A correlation was shown between the periodontal inflammation level in men with arterial hypertension and the polymorbid cardiovascular pathology presence (diabetes mellitus, dyslipidemia, anxiety and depressive disorders, coronary heart disease, signs of left ventricular hypertrophy by ECG, high ankle-brachial index as a marker of peripheral atherosclerosis), significant variability in blood pressure, an altered cytokine profile with a predominance of pro-inflammatory cytokines, an increase in “vascular age” on the ASCORE scale, and increased vascular stiffness, assessed by 24-hour blood pressure monitoring using the “VasotensOffice” program.

Expert roundtable: use of ramipril to treat hypertension in elderly patients. The view of the GP and cardiologist

Arterial hypertension that can lead to the life-threatening conditions such as stroke and myocardial infarction still holds leading positions in the current cardiovascular disease profile in elderly patients. The patients often are not even aware of the existence of their hypertension, and therapy is not conducted. The situation is also aggravated by the widespread combination of concomitant arterial hypertension diseases and target organ damage. We asked our questions about modern ways to solve the problem to the leading domestic experts: GP Dmitry I. Trukhan, Dr. of Med. (Sci.), Associate Professor, Professor of Department of Polyclinic Therapy and Internal Diseases, Omsk State Medical University, and Cardiologist Olga D. Ostroumova, Dr. of Med. (Sci.), Head of Department of Therapy and Polymorbid Pathology, Russian Medical Academy of Continuous Professional Education, Professor of Department of Clinical Pharmacology and Propedeutics of Internal Diseases, I.M. Sechenov First Moscow State Medical University (Sechenov University).

Effectiveness of using the drug “Bolus rozröd +” for prevention of obstetric polymorbid pathology of cows

To prevent postpartum pathologies in cows, the study used the drug “Bolus rozröd +” – boluses containing ionized iodine (1.0%), selenium (0.15%), cobalt (0.50%) and copper (13.4%) and their long-term digestibility (within 6-8 months). The choice of the drug “Bolus rozröd +” as a means of prevention of postpartum pathologies is due to the fact that it contains trace elements that are deficient in the diet of the dairy complex “Ekaterinoslavsky”, the lack of which is a leading link in the etiopathogenesis of postpartum pathologies. A significant advantage is that the drug is relatively inexpensive (~ 10 $), and its components have a long digestibility (within 6-8 months), which can significantly reduce the frequency of injections (single, repeated ─ if necessary), and hence the total cost for preventive measures, treatment of sick animals and reduction of their stress during active milking, which will also reduce financial losses from unproduced milk. The experimental group (25) was given the drug “Bolus rozröd +”, heated to a temperature of 15-200C, orally, using an applicator (bolus) at the rate of 1 bolus per animal. The effectiveness of the drug “Bolus rozröd +” was determined according to the dynamics of biochemical blood tests and clinical evaluation of the postpartum period in cows. It was established that the method of prevention of postpartum pathologies in cows using the drug “Bolus rozrod +” is therapeutically effective, because it improves the biochemical parameters of the blood of animals, in particular, and reduces the incidence of postpartum pathology in general. Thus, the drug reduced the clinical manifestations of the following diseases: ketosis-metritis, placental delay and ketosis, and the number of healthy animals was 20% higher than in the control group, which proves the positive effect of the drug “Bolus rozröd +”.

Clinical Features and Insulin Resistance in Men with a Metabolically Unhealthy Obesity Phenotype

Purpose of the study: The aim of study was to analyze the characteristics of hormonal-metabolic parameters in men with a metabolically unhealthy obesity phenotype; identify the value of special indicators for diagnosis of insulin resistance.Materials and methods: The examination included 108 patients with body mass index ≥25 kg/m2, which were hospitalized. According to the current national guidelines for the diagnosis and treatment of obesity, all examined patients were divided into 2 groups: 1 — with metabolically healthy obesity phenotype, 2 — with metabolically unhealthy obesity phenotype. The study presents the results of comparative simultaneous nonrandomized study of two groups with using of different methods of examination (anthropometric indicators, laboratory tests for inspection of the hormonal profile, biochemistry parameters, and calculation of TyG index for diagnosis of insulin resistance).Results and discussion: The study found that patients of working age with metabolically unhealthy obesity phenotype are characterized by unfavorable anthropometric and hormonal-metabolic parameters and more severe polymorbid pathology (first of all cardiovascular diseases). The results of study revealed the value of special indicators for the diagnosis of insulin resistance (visceral obesity index >1,85; TyG >3,98; fat mass >30,1).Conclusion: timely detection of insulin resistance indicators has great importance and practical application due to simplicity and accessibility.

A case of chronic tophi gout in morbidly obese patient after laparoscopic adjustable gastric banding

Currently, increasing attention is being paid to studying the metabolic activity of adipose tissue, a source of biologically active mediators involved in vascular remodeling, immunological and inflammatory reactions. Today obesity is considered not only as independent risk factor of development of chronic noninfectious diseases (such as arterial hypertension, diabetes mellitus types 2, pathology of a cardiovascular system, malignant neoplasms), but also as a significant predictor of metabolic disorders (dyslipidemia, insulin resistance, hyperuricemia), contributes to the early formation of metabolic syndrome and goat. Despite such an obvious problem, the current state of conservative therapy for overweight and obesity remains unsatisfactory. Most of patients, even after successful treatment, have a recurrence of the disease with the restoration of the initial anthropometric indicators or even an increase in body weight. In this regard, currently more widely used surgical methods of correction of obesity. However along with the expected positive effects of treatment bariatric surgery may be accompanied by the development of a number of specific surgical complications and impaired energy metabolism with aggravation of the existing polymorbid pathology. This clinical case demonstrates the association of obesity with the development of metabolic disorders, illustrates the development of severe tophaceous gout in a patient during 2 years after laparoscopic gastric banding. It shows the possible reasons for its debut and reflects the dynamics of the patients condition, as well as the nature and characteristics of the course of the joint syndrome in the postoperative period.

Causes of Mortality in Patients with Chronic Cerebral Ischemia in Multifocal Atherosclerosis

The objective: to evaluate the causes of death in patients with chronic brain ischemia with multifocal atherosclerosis.Materials and methods. The study included 137 patients aged 40 to 84 years with chronic brain ischemia (CBI) against the background of multifocal atherosclerosis, which were divided into three clinical groups depending on the localization of vascular pool affection by stenosic atherosclerosis. The causes of death for 10 years were analyzed.Results. In the general group of investigated causes of death comorbid pathology (myocardial infarction, CHD with hypertensive disease) prevailed – 66,7 % of cases (30 among 45 dead) at p<0,01. Strokes of various types amounted to 20.0 % of cases (9 among 45 dead) and polymorbid pathology – 13.3 % (6 among 45 dead). The age of those who died between 50 and 60 years was 8.9 %, between 60 and 70 years old – 22.2 % and over 70 years old – 68.9 % of cases. Among the causes of death in all clinical groups, comorbid pathology significantly prevailed over stroke: in the first group – in 16.7% and 3.3% respectively, in the second group – in 24.1 % and 5.7 % respectively, and in the third group – in 20.0 % of cases of comorbid pathology without strokes. Mortality rate in chronic course of the disease was 47.8 %, in CBI with TIA – 13.4 %, in CBI with another stroke in the history – 30.5%, in CBI with repeated strokes in the history – 35.0 %. Strokes among the causes of death were more often established in the group of patients with CBI with recurrent strokes.Conclusions. Comorbid pathology as a modifiable factor, irrespective of the combination of vascular pools affected by atherosclerosis and the nature of the CBI flow, prevailed among the causes of death in patients with CBI in the background of multifocal atherosclerosis. Strokes of various types were the second leading cause of death in patients with CBI. In the analysis of mortality among patients with different types of CBI course was established reliably high its frequency in the group of persons with chronic course of disease without acute episodes of ischemia in the history with high rate of mortality from comorbid pathology.

The use of nonsteroidal anti - inflammatory drugs in polymorbid pathology

The literature review presents the possibilities of using non - steroidal anti - inflammatory drugs (NSAIDs) for polymorbid pathology. The mechanism of NSAIDs action, risk factors for the development of undesirable effects on the cardiovascular, digestive, urinary and other systems are considered; prevention measures and drug selection options are discussed, NSAIDs prescribing algorithm is considered.

Falls and pathology of the musculoskeletal system in the older age groups

Fall in the elderly is considered as a geriatric syndrome, which increases the risk of new falls, decreases physical functioning and autonomy and is associated with other geriatric syndromes. One of the most common risk factors for falls is the pathology of the musculoskeletal system, including osteoarthritis, sarcopenia, osteopenia and osteoporosis, as well as chronic pain. To characterize diseases of the musculoskeletal system in elderly patients with falls. The study included 289 patients (mean age 75,8±7,9 years, 224 women) who underwent falls during the last year. All patients had polymorbid pathology (mean number of diseases 5,13±2,3, the Charlson index 5,63±1,8 points). All patients underwent general clinical studies, a comprehensive geriatric assessment, X-ray examination of the joints, dual-energy X-ray absorptiometry. The risk of falls assessed with a self-assessment scale as 7,45±3 points had 90,3% of patients, 34,6% of patients had the high hospital risk of falls. All patients had aggravated geriatric status (on average 7 geriatric syndromes). Among the risk factors for falls, one of the most common was the condition associated with the pathology of the musculoskeletal system: chronic pain (84,7%), physical inactivity (56,1%), disorders of balance (60,2%) and gait (35,9%), the use of mobility aids (30,4%), orthopedic pathology (9,7%) and vitamin D deficiency (86,1%). Osteoarthritis prevailed (75,8%) among nosological forms. One hundred and forty-two (64,8%) patients had pain in the joints, the duration of pain was 6,2±5,6 days, the pain intensity was 47,2±20,7 mm on a visual analogue scale and 106,3±112,3 points by WOMAC. The neuropathic component was diagnosed on DN4 scale in 34 (23,9%) patients. Dynapenia was detected in 109 (37,7%) patients, and sarcopenia in 28 (25,6%) of them. The risk of osteoporotic fractures was 17,4±7,9%. The significantly higher incidence of dynapenia, insufficiency and deficiency of vitamin D and a higher risk of osteoporotic fractures was observed in 289 patients with falls compared to 213 people without falls.

Passport and biological age in the choice of metabolic geroprophylactic therapy

We compared the effectiveness of geroprophylactic means of gas and metabolic therapy (hypoxytherapy, hyperbaric oxygenation, ozone therapy, dry carbonic baths, amino acid arginine, regulatory tripeptides H- Glu-Asp-Arg-OH u H-Lys-Glu-Asp-OH, interleukin-2 in medium therapeutic dosages by their ability to reduce biological age when tested on practically healthy people or patients with mild subclinical forms of polymorbid pathology at the age of 35 – 74 years. It has been established that the effectiveness of agents and effects in terms of the degree of decrease in biological age depends on the type of geroprophylactic agent, as well as in the part of research – the passport age of patients. In this case, the biological age of the subjects after treatment decreased in the range from 12.8 to 1.3 years, depending on the means used and, in some cases, on the passport age. The greatest efficiency was achieved after the use of a combination of peptide bioregulators in the age group with a passport age of 35 – 59 years. When prescribing metabolic geroprophylaxis, it is necessary to take into account, in addition to the indications and contraindications of the means used or the correction method, the state of the body, also the calendar age and the degree of decrease in biological age.

Влияние реабилитационных мероприятий на когнитивную дисфункцию пациентов старших возрастных категорий после хирургического лечения ядерной катаракты

Background. The high prevalence of nuclear cataracts in older age groups is accompanied by a simultaneous decrease in cognitive abilities as a result of this ophthalmic disease, and other General somatic polymorbid pathology. Aim. To study the cognitive abilities of elderly and senile patients with nuclear cataracts during medical rehabilitation. Materials and methods. In clinical conditions, 68 elderly and senile patients with nuclear cataract underwent femtolaser-assisted cataract phacoemulsification with intraocular lens implantation, and in the postoperative period, medical and non-drug rehabilitation was performed (the main group). The control group con-sisted of 65 patients with nuclear cataract of the same age who also underwent the above-mentioned surgery without rehabilitation measures. The MMSE scale was used to assess cognitive impairment. Results. 9 months after surgical treatment, the cognitive status of patients in the main group improved from 17.4±0.2 to 20.7±0.3 points (p>0.05). Moderate initial cognitive dysfunction in patients of the main group changed to mild after 9 months, while in the control group it remained the same. At the same time, the proportion of patients with moderate cognitive impairment decreased significantly in the main group from 61.71±5.9% before rehabilitation to 13.2±4.1% after it was completed, and the number of patients with no cognitive deficit increased (p<0.001). In the control group, the number of patients with moderate cognitive impairment decreased from 60.0±6.0 to 46.2±6.2% (p>0.05). Conclusion. The implementation of rehabilitation measures in the postoperative period helps to improve the cognitive status of older patients with nuclear ca-taracts.

Polymorbidity: a View on Combined Pathology

Aim. To describe clinical cases exhibiting a rare combination of dermatoses in one patient in order to prevent iatrogenic errors.Results. The present article describes clinical cases of patients with polymorbid pathologies, which constitutes one of the current interdisciplinary healthcare problems. The described clinical cases indicate the co-occurrence and overlap of various diseases, which complicates the final diagnosis. Polymorbidity in modern patients turns the diagnostic process into a search for an optimal solution, which frequently requires innovative approaches. A mixed clinical picture leads to iatrogenic errors. A detailed differential diagnostics should be performed when establishing the final clinical diagnosis, which could reduce the frequency of medical-diagnostic and tactical errors. In this connection, a prolonged diagnostic route contributes to the timely detection of interdependent pathologies. The analysis of clinical cases related to managing patients with polymorbid pathologies facilitates the prevention of the progression of each disease, as well as the determination of prognostic aspects.Conclusion. Considering the narrow specialisation of medical institutions, the management of patients with polymorbid pathologies is a challenging problem. The management of such patients requires adherence to a clear clinical diagnostic algorithm and a multidisciplinary approach, which allows diagnostic errors and complications associated with drug therapy to be avoided, thus improving the quality of healthcare services. Polymorbid pathology constitutes an interdisciplinary problem requiring the development of a unified procedure for the management of patients, which should be aimed at the early detection of combined pathology, eliminating polypharmacy, reducing the overall risk of diseases and improving the life quality of patients.

Evaluation of metabolic status of ewes infected with ketosis

Ketosis in ewes is one of the limiting factors for the development of sheep farming. But the lack of knowledge about this disease is an obstacle in the development of effective treatments and reliable methods of prevention. This article presents the results of studying the peculiarities of the state of metabolism in the body of ewes of the Tsigai breed of the Black Sea type during ketosis. To do this, in the farms of the Crimea the identification of ewes infected with ketosis, which had been subjected to clinical and laboratory research methods, was carried out. It has been established that with this pathology there is an increase in the intensity of ketogenesis against the background of severe energy deficit. This was manifested by a statistically significant increase in the concentration of the total amount of ketone bodies from 0.43±0.01 to 1.57±0.06 mol/l (p <0.001), which occurred mainly due to acetone and acetoacetic acid. Their relative share in the total number of ketone bodies was 28.66%, while in healthy ones - 5.58%. The blood glucose level was reduced by 28.6% compared with clinically healthy sheep. The presence of a negative correlative relationship was revealed between the concentration of glucose and the level of ketone bodies - r = -0.64. Besides, in ewes infected with ketosis, symptoms of hepatocyte damage were noted: an increase in the concentration of total serum protein, hypoalbuminemia, dysproteinaemia, an increase in the level of total bilirubin, total cholesterol, increased activity of AsAT, ALAT and GGTP. It proved the occurrence of the same polymorbid pathology (ketosis and hepatodystrophy) in the same animals. This was confirmed by the revealed positive correlative relationship between the concentration of ketone bodies and the activity of the enzymes under study: AsAT ‒ r = +0.57, ALAT ‒ r = +0.49, GGTP ‒ r = +0.55; and between the level of ketone bodies and total bilirubin ‒ r = +0.44. It has been concluded that the progress of liver dystrophy aggravating the course of the pathological process should be taken into account when developing or improving methods for treating ketosis in pregnant ewes.

REGIONAL FEATURES OF INFLUENCE OF RISK FACTORS FOR CHRONIC NON-COMMUNICABLE DISEASES ON FORMATION OF POLYMORBID PATHOLOGY

Purpose. To study regional features of the association of frequency of occurrence and the magnitude of the indices of the main risk factors for chronic non-communicable diseases (RF CNCD) with the degree of transnosological polymorbidity (PM) in male residents of the Novosibirsk Region (NR) and Saha (Yakutia) Republic. Methods. The analysis of 10 187 medical records of patients with therapeutic profile (men), examined and treated in the clinic of the Federal Research Center for Fundamental and Translational Medicine, Novosibirsk was carried out. The index of transnosological polymorbidity was assessed by the number of nosological forms in accordance with the ICD-10. According to the clinical and laboratory examination, the following RF CNCD were assessed: high blood pressure, increased blood levels of total cholesterol, low-density lipoprotein cholesterol, triglycerides, glucose, uric acid, decreased blood level of low-density lipoprotein cholesterol, obesity. Results. Both among the residents of the NR and of the Yakutia, with an increase in the index of polymorbidity, there was an increase in the severity and frequency of occurrence of the studied RF CNCD. There was an increase in the frequency of occurrence in persons with high PM in comparison with those with a low degree of PM: arterial hypertension among residents of NR and of the Yakutia - by 2 times (p < 0.001), increase in total cholesterol in the blood among residents of the NR and of the Yakutia - by 1.2 times (p < 0.001, p = 0.003 respectively), obesity - for residents of the NR by 2.4 times, for residents of the Yakutia - by 1.7 times (p < 0.001), hyperglycemia - in residents of NR - by 2 times (p < 0.001), hyperuricemia - among residents of NR - by 1.5 times (p < 0.001). Conclusion. The role of some hemodynamic and metabolic risk factors of RF CNCD in the development of polymorbid pathology among residents of the regions of Siberia and the North has been established. The obtained data indicate the need to take into account the region of residence of such patients in the course of personalized prophylaxis with mandatory detection and correction of the modifiable RF CNCD.