ТАРГЕТНОЕ ИСПОЛЬЗОВАНИЕ ИНСТРУМЕНТОВ КОМПЛЕКСНОЙ ГЕРИАТРИЧЕСКОЙ ОЦЕНКИ В КАРДИОЛОГИИ. ЧАСТЬ I (обзор литературы)

Obliterating atherosclerosis ranks third in the system of cardiovascular disease. With age the incidence of peripheral artery disease increases and makes 3-5% in general population. The most difficult group of patients with peripheral artery disease (PAD) or obliterating atherosclerosis is elderly patients. Currently there is a tendency to increase the life expectancy and aging of the Belarusian population. Elderly and senile patients with obliterating atherosclerosis (PAD) are characterized by a multi-level lesion and damage to the distal parts of the arterial bed, an increase in the number of comorbidities, a high risk of cardiovascular death, and seeking medical help often at the stage of critical lower limb ischemia. Patients at high risk of cardiovascular complications with intermittent lameness are subject to conservative treatment. When developing a clinic for critical lower limb ischemia, due to the low effectiveness of conservative methods of treatment, it is worth considering revascularization of the lower limb arteries. Open surgical methods of treatment are associated with a high risk of complications and mortality. X-ray endovascular methods of treatment of patients of the older age group are characterized by a lower risk of complications, lower injury rate. The use of low-injury x-ray endovascular and hybrid methods of treatment in elderly and senile patients can improve the results of treatment (reduce the frequency of amputations, reduce the risk of complications, improve the quality of life).

UK Fifth National Colorectal Cancer Consensus Meeting 2010

Aim To study prognostic significance of the degree of stenosis of carotid and lower-extremity arteries (LEA) in patients at high and very high risk of cardiovascular complications (CVC).Material and methods The study included men and women aged 40-67 years at high and very high risk of CVC. Duplex ultrasound scanning of carotid arteries and LEA was performed for all patients. Laboratory tests included measurements of glucose, glycated hemoglobin, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, uric acid, creatinine with estimation of glomerular filtration rate (GFR) using the CKD-EPI Creatinine Equation formula, and high-sensitivity C-reactive protein (hsCRP). Composite endpoint was death from CVC, nonfatal myocardial infarction, nonfatal stroke, and coronary revascularization.Results The study included 214 patients from groups of high and very high risk of CVC. Median age of patients was 59.0 [53.2; 64.0] years. A very high risk was identified in 141 (65.8 %) patients and a high risk of CVC in 73 (34.1 %). Atherosclerotic plaques in at least one vascular bed were found in 191 (89.3 %) patients. Duration of the follow-up period was 32.0 [13.7; 49.1] months. Outcomes comprising the composite endpoint were observed in 36 (16.8 %) patients. Presence of carotid stenosis ≥35 % was not statistically significantly associated with the occurrence of outcomes comprising the composite endpoint (relative risk, RR: 1.22; 95 % confidence interval, CI: 0.56-2.66; p=0.607). In contrast, the presence of LEA stenosis ≥35 % was associated with a 2.51 times increased RR of CVC (95 % CI: 1.02-6.23; p=0.044).Conclusion In patients from the groups of high risk and very high risk of CVC, the presence of LEA stenosis ≥35 % predicted the development of severe CVC with a 69.4% sensitivity and a 61.8% specificity. The presence of LEA stenosis ≥35 %, but not of carotid arteries, was an independent predictor of severe CVC (RR, 2.51; 95 % CI: 1.02-6.23; p=0.044) after adjustments for sex, age, presence of arterial hypertension, diabetes mellitus, ischemic heart disease, obesity, smoking, LDL-C, GFR, and drug therapy.

The frequency of occurrence of geriatric syndromes (senile asthenia, depression, cognitive disorders) investigated in relation to some factors of cardiovascular risk (arterial hypertension, obesity) in patients of older age groups – residents of the city (1st sample) and rural (2nd sample) of Smolensk region. A comprehensive geriatric assessment of 480 patients over 65 years old was carried out with the analysis of case histories and outpatient records. The scale for screening senile asthenia (“Age is not a hindrance”), MMSE scale, GDS-15 was used. The analysis of the obtained results showed that the frequency of occurrence of senile asthenia among the residents of the village was lower than among the residents of the city (p <0.05). In both samples, the incidence of depression was twice as high in patients with senile asthenia and was associated with the female sex. At the age of 65–74, the incidence of depression among rural residents was comparable to urban residents (31% and 29.7%, respectively, p > 0.05), but among people over 75 years of age, its prevalence was lower among rural residents (35, 5% versus 52.3%, respectively, p < 0.05). A decline in cognitive status in patients under 75 years of age is associated with high blood pressure, while in those over 75 years of age, this relationship was inverse. The prevalence of obesity was higher in patients without senile asthenia.

Aim of the study: to determine the prevalence of the main risk factors and analyze the risk of developing cardiovascular complications in the adult population in the Vladimir region of the Russian Federation. Material and methods:The cross-sectional population-based study included 1,350 men and women aged 30-69 years from 5 cities of the Vladimir region (Vladimir, Kovrov, Murom, Yuryev-Polsky and Vyazniki).The response to the study was 87%.The study was completed by 1174 people (424 men -36.1% and 750 women -63.9%).Using a survey, instrumental and biochemical studies, the following risk factors were determined taking into account gender indicators: smoking, hypertension, hypercholesterolemia, hyperglycemia and obesity.The risk of developing fatal cardiovascular complications was assessed using the classic European score scale.Depending on the total score, the risk was assessed as follows: low risk <1%, moderate risk -from 1% to 5%, high risk -from 5% to 9% and very high risk -10-14%.Results: In the surveyed unorganized population, every third man is obese, while among women this figure was significantly high (33.7%versus 42.1%, p<0.001).The incidence of hypertension among men and women was comparable (41.5% and 39.9%, respectively).The frequency of tobacco smoking among men was 38.4%, which is 4 times higher than in women (p <0.0001).Every second person had a total cholesterol level > 5 mmol/l.Its frequency was comparable among men and women (53.2% and 51.5%, respectively).In 23.1% of women and in 18.5% of the unorganized population from 5 cities of the Vladimir region, fasting blood glucose above 6.1 mmol/l was detected.The high and very high risk of cardiovascular complications among men was 32%, among women the risk was 2 times lower (15.5%).Low and moderate risk predominated among women (66.3%), which is 1.5 times more common than men (43.6%).With comparable rates of hypertension and hypercholesterolemia, male gender and smoking status contributed to the total cardiovascular risk.The frequency of very high risk of cardiovascular complications among men in certain cities of the Vladimir region was 2.5-4 times higher compared to women.

New Criteria to Identify Patients at Higher Risk for Cardiovascular Complications After Percutaneous Coronary Intervention

As the global population ages, the incidence of chronic kidney disease (CKD) in the elderly has increased year by year. Due to changes in the physical, psychological, economic, and social status of the elderly, CKD in the elderly has its own particularity. Elderly patients with CKD are prone to diabetes, hypertension, cardiovascular and cerebrovascular diseases, and other basic diseases, and the possibility of drug treatment and surgical treatment is high, which increases the chance of kidney damage. Elderly patients with CKD are also prone to decline of physical and cognitive function, depression, malnutrition, osteoporosis, and weakness, which need comprehensive evaluation. Elderly patients with CKD have a high risk of complications and death. Thus it is necessary to evaluate the patients′ conditions individually to predict the risk of death or progression to ESRD, so as to decide whether to mainly provide supportive treatment for protecting the kidney, or to provide supportive treatment together with preparing the renal replacement therapy. High-quality clinical studies in elderly CKD patients should be conducted to provide more evidence-based data for the diagnosis and treatment. Key words: Chronic kidney disease; Elderly; Diagnosis; Complication

Life Expectancy of Colorectal Cancer Patients With Geriatric Syndromes

of the Ministry of Health of Ukraine "Optimization of anesthetic support for operations with diabetic foot syndrome in obese patients" (state registration number 0120U10217).Introduction.Diabetic foot syndrome (DFS) is one of the most severe complications of diabetes mellitus, often requiring surgical intervention up to high limb amputation.These interventions are accompanied by significant physiological loads, especially in patients with comorbid conditions such as obesity and systolic myocardial dysfunction.Anesthetic management of such patients poses a significant challenge due to the expected high risk of cardiovascular complications, ventilation disorders, hemodynamic instability, increased sensitivity to hypovolemia and a tendency to a pronounced stress response and is

In the general geriatric population, Geriatric syndromes (GSs) predict greater likelihood of hospitalization, increased health care use and cost. The present study aimed to compare GSs among young and elderly patients with rheumatoid arthritis (RA). In a cross-sectional study a total of 98 participants, including 65 elderly (≥60 years) and 33 young adult patients (<60 years) with RA who referred to the geriatric and rheumatologic clinic were enrolled. Patients were categorized into three groups (healthy elderly, n=27; elderly with RA, n=38; and young people with RA, n=33). GSs were assessed using mini-mental state exam (MMSE), five-item geriatric depression scale-15 (GDS-15), mini nutritional assessment (MNA), and asking patients about history of falls in the past year. The RA activity in patients was assessed using disease activity for rheumatoid arthritis score-28 (DAS-28) scale, serum ESR (mm/h) level. There was a statistically significant differences in terms of DAS-28 (2.23±1.01 vs. 0.64±0.97, P=0.025) and ESR (28.10±6.64 vs. 23.09±7.65 mm/h, P=0.042) between healthy elderly and RA elderly patients. Elderly patients with RA were significantly more prone to have cognitive impairment (P=0.002), fall (P=0.005), malnutrition (P<0.001), urinary incontinence (P<0.001), and functional disability (P=0.021) compared to healthy elderlies and young RA patients. The results of binary logistic regression revealed that in elderly RA patients, higher DAS-28 score [odds ratio (OR) = 1.96; 95% CI 1.03, 3.84; P=0.041] was an independent risk factors for the GSs. The prevalence of some features of GSs were higher in the elderly RA patients than healthy elderly and young RA patients.

We evaluated data on blacks and whites with acute ST-segment-elevation myocardial infarction treated with either fibrinolysis or primary percutaneous coronary intervention from the National Registry of Myocardial Infarction (NRMI)-4 and -5 participating centers between July 2000 and December 2006 to determine race-related differences in bleeding and outcomes. We found that among patients with ST-segment-elevation myocardial infarction receiving fibrinolysis, the bleeding rates were higher for blacks (n2283) than whites (n42 243; 10.9% versus 10.3%; adjusted odds ratio, 1.21; 95% confidence interval, 1.02-1.43). Similarly, in patients receiving primary percutaneous coronary intervention, the bleeding rates were higher in blacks (n2826) than whites (n46 332; 10.3% versus 7.8%; adjusted odds ratio, 1.33; 95% confidence interval, 1.13-1.56). Bleeding was associated with a higher risk of death in both ethnic groups. However, there was no overall racial difference in in-hospital mortality among those with bleeding or without bleeding treated with either fibrinolysis or primary percutaneous coronary intervention. We concluded that race-related differences existed in bleeding risk among patients with ST-segmentelevation myocardial infarction receiving reperfusion therapy that portend poor prognosis. Thus, the efficacy and safety of many new drugs or treatment strategies for any disease observed in clinical trials that enroll predominantly white patients may not be similar in other ethnic groups that are underrepresented in these trials.

Clinical and biological complexity is the rule rather than the exception in geriatric psychiatric syndromes. Typically, geriatric psychopathology develops in the context of medical and neurological disorders. Under these circumstances, ascertainment of symptoms and signs is difficult. Moreover, behavioral abnormalities, cognitive deficits, and physical symptoms and signs are often contributed by more than one psychiatric, neurological, or medical condition. Finally, symptoms change over time as various coexisting disease processes progress or subside, further complicating clinical assessment and diagnosis. Complexity has been viewed as an obstacle to medical research, which by necessity depends on reduction. Biological and psychosocial hypotheses are nothing but logical reductions, designed to permit understanding of a small part of a larger problem. Experimental design is an operational reduction intended at giving the best chance for hypothesis testing. Such reduction processes become complicated by the clinical intricacies of geriatric psychiatry syndromes. Despite the logical and experimental challenges posed by geriatric syndromes, their complexity has begun to provide meaningful clinical and biological information. Studying depression in Alzheimer’s disease patients exemplifies how comorbid geriatric syndromes can help address clinical and biological questions. In the study by Zubenko et al. in this issue [May 2003], the high prevalence of depression in patients with probable Alzheimer’s disease was confirmed. The study also observed that the depressive syndrome of Alzheimer’s patients is of mild severity and characterized by indecisiveness and diminished ability to concentrate but with limited depressive ideation and sleep disturbances. This symptom profile is difficult to distinguish from an uncomplicated dementia syndrome, thereby contributing to the underrecognition of depression. The increased frequency of psychotic symptoms in depressed Alzheimer’s disease patients further complicates ascertainment of depression. The difficulty in diagnosing depression is evidenced by the wide differences in depression prevalence estimates among patients with Alzheimer’s disease. Improving the methods of ascertainment (1) and treatment of depression in Alzheimer’s patients is critical, since depression contributes to excess disability, personal suffering, family disruption, and premature institutionalization. In addition to highlighting an important clinical problem, the comorbidity of depression and dementia has served as the stimulus for answering both clinical and biological questions. The early concept of “pseudodementia” was based on the assumption that the biological abnormalities of depression were the unitary cause of reversible Clinical and Biological Interactions in Affective and Cognitive Geriatric Syndromes George S. Alexopoulos, M.D.

Geriatric Assessment in Older Adults with Newly Diagnosed Multiple Myeloma

Cataract in patients of older age groups is one of the reasons for the deterioration of geriatric status, the manifestations of which are geriatric syndromes, but insufficient attention paid to the study of the latter.Purpose. To study the prevalence of geriatric syndromes among patients with UC, depending on visual acuity without correction.Patients and methods. Geriatric syndromes were studied in 220 elderly patients with UC, in 240 elderly patients with FC and 200 elderly patients without UC based on methods of complex geriatric assessment. The following geriatric syndromes were analyzed: sarcopenia, hypomobility, malnourishment, pain syndrome, and disorders of general motor activity, psychological problems, cognitive disorders, anxiety-depressive status, sleep disorders and urination.Results. It was found that the deterioration of visual acuity without correction of less than 0.3 is accompanied by an increase in the majority of geriatric syndromes in elderly and senile patients with UC and especially in 75–89 years of hypomobility syndrome to 93.2 ± 2.5 cases of cognitive impairment to 89.3 ± 3.0 cases, malnutrition to 88.3 ± 3.2 cases and psychological problems to 79.6 ± 4.0 cases per 100 examined, which is significantly higher by 2.0–2.4 times compared to patients of the same age with UC with visual acuity without correction more than 0.3. A decrease in visual acuity of less than 0.3 in patients with UC contributes to an increase in the prevalence and average number of geriatric syndromes in old age to 8.2 ± 1.0 cases versus 3.9 ± 0.8 cases in old age with UC with visual acuity of more than 0.3 (P &lt; 0.001).Conclusion. The revealed dependence of the prevalence of geriatric syndromes, taking into account visual acuity, indicates the relevance of timely correction.

Management of elderly patients with locoregionally confined head and neck cancer