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Olga N Tkacheva,1 Nadezda K Runikhina,1 Arkadiy L Vertkin,2 Irina V Voronina,1 Natalia V Sharashkina,1 Elen A Mkhitaryan,1 Valentina S Ostapenko,1 Elena A Prokhorovich,2 Tamar Freud,3 Yan Press3–5 1Russian Gerontology Clinical Research Center, Pirogov Russian National Research Medical University of Ministry of Healthcare of the Russian Federation, 2Moscow State University of Medicine and Dentistry named after AI Evdokimov, Moscow, Russia; 3Department of Family Medicine, Faculty of Health Sciences, Sial Family Medicine and Primary Care Research Center, Ben-Gurion University of the Negev, 4Comprehensive Geriatric Assessment Unit, Clalit Health Care Services, Yassky Clinic, 5Community-Based Geriatric Unit, Division of Community Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel Background: Delirium, a common problem among hospitalized elderly patients, is not usually diagnosed by doctors for various reasons. The primary aim of this study was to evaluate the effect of a short training course on the identification of delirium and the diagnostic rate of delirium among hospitalized patients aged ≥65 years. The secondary aim was to identify the risk factors for delirium. Methods: A prospective study was conducted in an acute-care hospital in Moscow, Russia. Six doctors underwent a short training course on delirium. Data collected included assessment by the confusion assessment method for the intensive care units, sociodemographic data, functional state before hospitalization, comorbidity, and hospitalization indices (indication for hospitalization, stay in intensive care unit, results of laboratory tests, length of hospitalization, and in-hospital mortality). Results: Delirium was diagnosed in 13 of 181 patients (7.2%) who underwent assessment. Cognitive impairment was diagnosed more among patients with delirium (30.0% vs 6.1%, P=0.029); Charlson comorbidity index was higher (3.6±2.4 vs 2.3±1.8, P=0.013); and Barthel index was lower (43.5±34.5 vs 94.1±17.0, P=0.000). The length of hospitalization was longer for patients with delirium at 13.9±7.3 vs 8.8±4.6 days (P=0.0001), and two of the 13 patients with delirium died during hospitalization compared with none of the 168 patients without delirium (P=0.0001). Conclusion: Although the rate of delirium was relatively low compared with studies from the West, this study proves that an educational intervention among doctors can bring about a significant change in the diagnosis of the condition. Keywords: delirium, elderly, inpatients, Russia

A distinctive property of phlebotropic drugs consists in their intrinsic capability of exerting pronounced pleiotropic (multiple) effects. The authors discuss the fundamental mechanisms of pleiotropy, advantages and disadvantages of various types of targeted therapy (mono- and polytargeted therapy) in treatment of chronic venous diseases. Special attention is paid to analysing the nature of adverse drug interactions, methods of reducing the risk of their development. An electronic service known as the Drug Interactions Checker is proposed as a tool for assessing drug interactions in everyday practice of the angiologist/phlebologist.

Aim: To reveal the clinical and morphological features and predictors of a fatal outcome in patients with community-acquired pneumonia., Material and Methods: The results of almost 6,500 autopsies were studied; out of them there were 1631 (25%) deaths from pneumonia: 134 and 1497 cases occurring at home and at hospital, respectively., Results: Both groups were considered in terms of pneumonia as a primary disease or as a fatal complication, with 6.4% having the former and 93.6% having a fatal complication of chronic obstructive pulmonary disease, chronic alcohol intoxication, cardiovascular diseases, or cancers. After negative prognosis assessment using the CURB-65 scale, pneumonia was rated as severe and requiring admission to the intensive care unit in 92% of the cases; PORT scale assessment showed that 60% cases of pneumonia necessitated hospitalizations to these units. The major clinical and morphological form of pneumonia was established to be disseminated, lobular, or overwhelming., Conclusion: In practice, risk factors for death are underestimated; the disease course is not monitored; current diagnostic and therapeutic approaches are inadequately applied.

Chronic obstructive pulmonary disease (COPD) is a widespread condition markedly deteriorating quality of life; it is the fourth most frequent cause of death after cardiovascular diseases, diabetes mellitus and injuries. There is significant association between the severity of androgen deficiency occurrence, duration and pharmacotherapy of COPD. Androgen deficiency in men should be regarded as a new systemic pathogenetic mechanism of COPD complicating its clinical course, prognosis of the disease and concomitant pathologies. Therefore, pharmacotherapy of COPD should be prescribed taking into account the androgenic status of the patients.

Chronic obstructive pulmonary disease (COPD) is a systemic disease that affects not only the respiratory system. Sex hormones deficiency in men can be correlated with the COPD stages and make a negative contribution during its progression. Up to date, there are no long-term trials evaluating the effects of androgens on the parameters of respiratory function in patients with COPD. Changes of testosterone levels in patients with COPD correlate with forced expiratory volume, and hypoxemia and hypercapnia levels. Glucocorticosteroids exacerbate androgen deficiency in patients with COPD, and the use of hormone replacement therapy with testosterone in these patients is justified. Androgens, in particular drug nebido, testosterone depot, can be effectively used in treatment and rehabilitation of patients with COPD.

We studied effect of time on the outcome of acute coronary syndrome and elevated ST segment at the prehospital stage. Logistic regression analysis revealed two time-dependent predictors: "symptom-needle" time and total call service time. In patients undergoing prehospital thrombolysis, these indices (88 and 85 min respectively) reliably predicted the probability of fatal outcome. Their values of 71 and 77 min respectively predicted the risk of unfavourable outcome. The total call service time may serve as an indicator of the quality of work of an ambulance crew at the prehospital stage of management of acute coronary syndrome with elevated ST segment.

Contemporary data on mechanisms of development, types, and clinical picture of hypertensive crisis (HC) are presented. Algorithms of rational therapy of uncomplicated and complicated HC are considered. Appropriateness of the use in HC of antihypertensive drugs with multifactorial action is stressed. These drugs include urapidil - an antihypertensive agent with complex mechanism of action. Blocking mainly the postsynaptic 1-adrenoreceptors urapidil attenuates vasoconstrictor effect of catecholamines and decreases total peripheral resistance. Stimulation of 5HT1-receptors of medullary vasculomotor center promotes lowering of elevated vascular tone and prevents development of reflex tachycardia.

Patients with acute coronary syndrome and elevated ST segment in the pre-hospital phase were treated with metoprolol succinate (MS) and thrombolytic therapy. Severe and moderate pain decreased by 54.1 and 16.1% respectively within 60 min after MS intake. Systolic (SAP) and diastolic (DAP) arterial pressure dropped by 35.7 and 16.8 mmHg during the same period. The heart rate (HR) decreased by 25.1 beats/min. 21.8 and 25.3% of the patients showed positive dynamics of ST segment 90 and 180 min after intake of MS. The height of the ST segment was normal in 18.4 and 31.0% of the patients respectively. No cases of external heart rupture were documented at autopsy whereas it was a cause of death in 39.1% of the patients given standard thrombolytic therapy. It is concluded that the use of MS starting from the pre-hospital stage in patients with acute coronary syndrome decreases pain intensity. HR, DAP and SAP and helps to prevent heart rupture.

Terminology and synonyms of comorbidity are discussed in much detail along with historical prerequisites of combined pathology, factors influencing its development and progression, and classifications of its variants. A review of advantages and drawbacks of the most popular models of comorbidity and methods of its evaluation based on standard scales is presented. Much attention is given to the structure of definitive diagnosis and principles of its formulation.

The paper is devoted to the topical problem of maintaining somatic and psychic health of the women of reproductive age by rational pregnancy planning and prevention of abortions by modern methods of contraception including combined oral hormonal contraception. Unfortunately, this approach is rarely employed in this country (5-6%). Results of retrospective analysis of medical documentation, clinical efficacy and safety of modern combined oral hormonal contraception are presented.

Combined therapy with antiaggregants and anticoagulants is a routine practice in the management of acute coronary syndrome without ST segment elevation (AC-ST) in patients with iron deficiency anemia. But some of these patients are at high risk of hemorrhagic complications. This work is aimed at choosing the therapeutic strategy for such patients. The retrospective analysis of medical cards of 2473 patients referred to the Department of Cardiac Animation with diagnosis of AC-ST included the estimation of the efficacy and safety of anticoagulant dalteparin sodium introduced in the treatment of iron deficiency anemia in terms of the frequency of thrombotic and hemorrhagic complications and prognosis of the outcome compared with the patients given no anticoagulants. The prospective study included 83 patients. The antithrombotic treatment should be prescribed to such patients taking account of the risk of thrombotic complications. High frequency of iron deficiency anemia in patients with CS-ST necessitates elucidation and assessment of hemorrhage risk factors (CRUSADE scale) the results of which determine the choice of modalities for further treatment.

To determine the effect of valsartan on the androgen status and erectile function in hypertensive patients. 60 hypertensive patients of 40-65 years of age were included in the study. All patients filled in the questionnaire on aging male symptoms scale and international index of erectile function before and 3 months after the course of antihypertensive therapy. Patients of the first group received angiotensin II receptor antagonist (valsartan) as monotherapy. Valsacor was administered starting from the first 24 hours after destabilization of blood pressure, and the dose was titrated from 80 up to 160 mg/day. Traditional treatment of hypertension including angiotensin converting enzyme inhibitors, calcium antagonists, diuretics and beta-blockers was prescribed to controls. Valsacor treatment reduced the intensity of the symptoms of erectile dysfunction in hypertensive males (by 11,3 against 2,2% in the control group, p<0,05). In addition, this therapy led to a decrease in androgen deficiency symptoms (20,2 against 12,1%, respectively, p < 0,05). Systolic and diastolic blood pressure reduction was comparable in both groups. There was an increase in the number of "dippers" at valsacor treatment, while the number of other categories ("over-dipper", "non-dipper", "night-peaker") decreased (p<0,05). In the control group, circadian blood pressure profile was not changed. Thus, therapy with valsartan normalizes diurnal variations in blood pressure, reduces the symptoms of androgen deficiency and does not contribute to erectile dysfunction.

Osteoarthritis (OA) is one of the most common medical conditions in elderly people. This article presents the survey data on a problem of poly-morbidities (co-morbidities) at osteoarthritis. Special attention is paid to a combination of osteoarthritis with cardiovascular pathology, and also the data testifying the association between osteoarthritis and the increased death rate from cardiovascular pathology. On the basis of the literature data analysis a hypothesis about an etiopathogenic interrelation between osteoarthritis and cardiovascular pathology is presented. According to the authors, potential pathogenetic links include a chronic nonspecific inflammation and metabolic infringements. There are also evidences that vascular pathology may initiate and/or worsen the disease progression. The important factors aggravating a current cardiovascular disease in patients with osteoarthritis are: the restriction of physical activities and irrational pharmacotherapy of osteoarthritis clinical symptoms (increased risk of cardiovascular accidents is considered as a class-specific side-effect for all NSAIDs). The authors present the own data on rational pharmacotherapy of patients with osteoarthritis and somatic pathology by means of SYSADOA influencing the disease symptoms and being able to modify structural changes (glucosamine, chondroitine sulphate - ARTRA).

Safety of testosterone undecanoate in relation to initiation of cancer and prostatic adenoma (PA) in patients with androgenic deficiency and erectile dysfunction (ED) was studied for 12 months in 49 patients aged 57 to 73 years treated with intramuscular testosteron injections. The size of the prostate in patients with adenoma was 46.34 +/- 21.12 cm3 while in adenoma-free patients--19.11 +/- 6.57 sm3. Diabetes mellitus of type 2 (DM-2) was diagnosed in 46.9% patients. All the patients had documented hypogonadism and ED. Tests for PSA and transrectal ultrasound investigation was made in all the patients. 12 month testosterone therapy produced normalization of a mean level of testosterone in both groups, index of erectile function increased. In one patient PSA rose higher than normal value. None of the patients developed obstruction of the urinary tract. Body mass index, lipid spectrum and carbohydrate metabolism also improved. Thus, long-term therapy with testosterone undecanoate has no effect on PSA level, does not induce urinary obstruction with enlarged prostate. The presence of DM-2 is not a contraindication for androgen therapy in adenoma patients. By reducing body mass index, total cholesterol, triglycerides and LDLP, testosterone therapy lowers the risk of prostatic cancer.

Negative consequences of treatment are observed at least in 16% patients at multidisciplinary hospitals and may result from the causes that are independent of medical staff, but more frequently from errors and inadequate treatment standards due to human factors. Systematic improvement of professionalism, which should be started from some educational reforms at medical institutes, is needed.

The facts that the clinical manifestations of alcohol-associated urgent conditions are polymorphic, and that terms traditionally used by doctors to characterize these conditions are diverse, determine objective difficulties in rendering medical aid in such situations. However, the number of urgent alcohol-associated conditions grows every year. Analysis of diagnostic errors demonstrates that 30% of doctor's errors are subjective. Mistaken diagnosis is followed by casual treatment, independently on its cost and length. Treatment of alcohol-associated pathology is prerogative of general practitioners, which makes knowledge of clinical picture, terminology, legal aspects of rendering medical aid, expertise of the ability to work, and therapeutic tactics in urgent alcohol-associated conditions, important to doctors of all specialties.

Aim: To study nebivolol efficacy in pregnant and puerperal women with hypertension., Material and Methods: Monitoring of endothelial function, central and peripheral hemodynamics (HD), myocardial function, intrarenal circulation and microalbuminuria (MAU) was performed in 90 pregnant (67 hypertensive and 23 normotensive) and 18 puerperal women who were diagnosed to have hypertension in pregnancy. The above parameters were estimated in 23 hypertensive gravidas and 18 puerperas treated with nebivolol., Results: Hypertensive gravidas had marked endothelial dysfunction (ED), impaired intrarenal HD, MAU, high total peripheral vascular resistance and left ventricular myocardial mass index (LVMMI). The puerperas with hypertension had ED, MAU, frequently HD disorders and a trend to a LVMMI rise. Nebivolol effectively reduced blood pressure, had a nephroprotective action, and improved HD and endothelial function., Conclusion: Nebivolol (a highly selective beta 1-adrenoblocker) administration is effective pathogenetic treatment of pregnant and puerperal women with hypertension and may improve short- and long-term prognoses of such patients.

Twenty four hour blood pressure and ECG monitoring, assessment of sexual function (questionnaires, penile artery Doppler flowmetry) were carried out in male hypertensives treated with atenolol, metoprolol, or bisoprolol. Compared with atenolol and metoprolol bisoprolol was found to be more effective and safe. The use of bisoprolol was associated with no negative changes and even with improvement of some parameters of sexual function. Sildenafil could be used for correction of male sexual dysfunction occurring during treatment with other beta-blockers.

132 patients (mean age 46.9 +/- 1.4 years) with exacerbation of gastroduodenal ulcer (GDU) positive by Helicobacter pylori (HP) were examined clinically and using laboratory tests. All the patients received treatment with anti-HP drugs. Side effects were registered in 81(61.4%) patients. Negative trend in colon biocenosis occurred in all the patients. The treatment was poorly tolerated by women, aged patients and those with ulcer in the stomach. Biocenosis aggravation is indication for administration of eubiotics.

Efficacy of a novel eradication treatment with ranitidine, trichopol and jozamycin was compared to that of the standard three-component therapy and monotherapy with ranitidine in 76 patients with exacerbation of gastric and duodenal ulcer. Therapeutic monitoring of ranitidine was performed. In relation to healing of ulcer defect and eradication of Helicobacter pylori, jozamycin is not less effective and more safe than standard three-component therapy. Interaction of the scheme components increases plasma concentration of ranitidine especially in patients with concomitant hepatic and renal diseases.

The data are reported on novel eubiotic biofor's effects on immune status of 213 patients with intestinal dysbacteriosis (39 surgical gastroenterological patients, 43 patients with diarrheal infections, 50 AIDS patients, 81 cancer patients exposed to radiation and chemotherapy). It was found that bioflor acts as an antidysbacteriosis drug and as an immunostimulator. It stimulates T-cell immunity, phagocytosis, B-cell immunity. Immunostimulating effect of bioflor depends on dysbacteriosis degree and is maximal at its first stages.

To check the proposed hypothesis that the relative content of individual polyunsaturated fatty acids (PUFAs)--substrates and inhibitors of prostanoid synthesis--in plasma can be regarded as a quantitative risk factor of blood clotting, a test was conducted on free fatty acids content in blood plasma of healthy people (group 0) and patients with heart ischemia before (group 1) and after (group 2) they were treated for a month with a food additive called "Eiconol," enriched with PUFA omega 3. Different proportions of PUFAs have been calculated in all cases, accounting for the contribution of each acid to the process of primary clotting. Comparison of PUFA rations among the three groups showed significant differences of means between groups 0 and 1 and also group 1 and 2 for 6 out of 7 proposed coefficients, which disappeared after "Eiconol" treatment (comparison of groups 0 and 2). The results led to the conclusion that out of the proposed PUFA proportions, the coefficients describing the relative content of arachidonic acid in blood plasma may be the most informative for diagnosis and treatment efficiently in evaluation of heart and vascular diseases.

A nutritional additive eikonol containing polyunsaturated fatty acids omega-3 was given for a month (8 g/day) to correct vascular complications in 60 patients with non-insulin-dependent diabetes mellitus (NIDDM). Eikonol-treated NIDDM patients with diabetic retinopathy, polyneuropathy, angiopathy of the legs combining with arterial hypertension exhibited a reduction in the levels of total cholesterol, triglycerides, low and very low density lipoproteins cholesterol, a rise in concentrations of high density lipoproteins cholesterol. Blood pressure went down, peripheral vascular resistance and microhemocirculation improved. The findings evidence prophylactic and therapeutic efficacy of eikonol in vascular complications of NIDDM.

Cardiovascular disease is the principal cause of morbidity, functional disability and fatal outcomes in patients with non-insulin-dependent diabetes mellitus (NIDDM). The results of administration of eikonol, food additive containing omega-3 unsaturated fatty acids, for 3 months were analyzed for 60 elderly NIDDM patients with ischemic heart disease. A single administration of eikonol leads to a decrease in accumulation of intracellular cholesterol by 15%. Diet eikonol decreased the level of total cholesterol and triglycerides in the blood by 23 and 43%, respectively. Moreover, the higher is the initial value of these parameters, the higher is the effect of the preparation. Eikonol proved to increase the level of lipoproteins of high density, produced a positive trends in NIDDM clinical picture. Food additive eikonol is recommended for wide administration in elderly NIDDM patients with atherogenic dyslipidemias.

From before treatment throughout its course a new hypotensive drug ebrantil was studied for clinical efficacy in 52 patients with essential, renal and thyrogenic arterial hypertension. Clinical instrumental and biochemical findings support the drug efficacy in management of a hypertensive crisis and sudden AF rise. The response was registered in 83.3% of the cases. A persistent hypotensive effect of 180 mg/day course ebrantil became obvious within the first week of the treatment, passing ahead of relevant changes in central hemodynamics and myocardial contractility. The drug acts by reducing both cardiac pre- and postload, the reduction being brought about due to diuretic effect. In response to AP decrease there was neither myocardial contractility depression nor reflex tachycardia. Psychoemotional testing confirmed the central effect of ebrantil promoting adaptation of patients to stress under long-term administration. The drug demonstrated good tolerance when used orally and intravenously. No bronchial pulmonary, carbohydrate and lipid metabolism, renal and hepatic function side effects were reported. 24-h AP monitoring proved ebrantil efficacy in essential and renal hypertension patients.

In the study of 164 patients with atherogenic dyslipidemia the authors studied side effects of aiconol, concentrated cod liver oil. Its lipid component contains not less than 18% of omega-3 polyunsaturated fatty acids (PUFA). All the patients were divided into 4 groups: 51 subjects of group 1 received aiconol in the form of oil, 35 subjects of group 2 had protein dietetic caviar prepared from animal proteins with addition of 3% aiconol, 38 subjects of group 3 were given protein-oil emulsion containing 20% aiconol and 40 patients of group 4 took gelatin aiconol in capsules. Side effects of the above food ingredients enriched with omega-3 PUFA were found to be of metabolic nature. These manifested most evidently in patients on oil aiconol incorporating both maximal doses of omega-3 PUFA and the largest amounts of inert constituents acting as additional fat load on the liver and pancreas. Group 1 patients also suffered from aggravated chronic gastrointestinal, hepatic and pancreatic disorders. Because of reduced quantities of omega-3 PUFA in the diets of group 2, 3 and 4 patients, they displayed much less severe side effects.

The clinical efficacy of the foodstuff euconol was studied in 72 patients with coronary heart diseases, stable angina of effort, postinfarct cardiosclerosis, or silent myocardial ischemia. A good antianginal effect was achieved in 51.4% of patients treated with euconol. At month 4 of treatment, the patients with coronary heart disease displayed a significant decrease in the number of anginal episodes and nitroglycerin tablets; this was followed by a reduction in the number and duration of silent myocardial ischemic episodes. It is concluded that a prolonged euconol intake causes positive changes in the blood lipid composition and natural history of coronary heart disease.

A total of 74 patients with postinfarct cardiosclerosis (PC) and stable angina (SA) were examined by Holter monitoring, bicycle ergometry, echocardiography and 201Tl chloride myocardial scintigraphy and loading tests (transesophageal cardiac pacing and isometric hand exercise test). The detection rate for silent myocardial ischemia (SI) was found to be 57.1% with Holter monitoring, 52.3% by bicycle ergometry, 62.5% with echocardiography, 100% with myocardial scintigraphy with loading test and 88.8% with that without the loading test. The detection rate for PC was 33.9, 32.0, 64.7, 81.8, and 56.7%, respectively. Higher SI detection rates in postinfarct patients were more frequently observed when echocardiography and myocardial scintigraphy in combination with loading tests in patients with PC without angina. The efficiency of SI detection in patients with various coronary heart disease increases when loading tests are employed. The loading tests in echocardiography and myocardial scintigraphy ensure the most complete detection of SI in postinfarct patients without angina.

Holter monitoring, echocardiography and 201Tl myocardial scintigraphy were performed in 40 patients with postinfarction cardiosclerosis. The monitoring revealed silent myocardial ischemia (SMI), including 27 having SMI with concurrent anginal episodes, 7 with SMI alone. A direct correlation was found between the duration of SMI and silent myocardial infarction (r = 0.539; p less than 0.05). The patients with left ventricular failure and myocardial hypertrophy exhibited longer SMI, as evidenced by echocardiography. 201Tl myocardial scintigraphy revealed no relationship between the degree of SMI and the dimensions of a postinfarction scar. SMI was detected in 77.5% of the patients with postinfarction cardiosclerosis. The duration of SMI was longer with the presence of angina pectoris, left ventricular failure or myocardial hypertrophy.

Thirty-four patients with coronary heart disease who had silent myocardiac ischemic episodes as evidenced by long-term ECG monitoring were examined. Silent ST-segment elevations and depressions were encountered 2.7- and 4.9-fold as compared to manifest ones. The fact that the CHD patients had silent ST-segment depressions and/or prolonged high-amplitude silent ST-segment elevations suggests a grave severity of abnormal myocardial processes. There was a reduction in the number, duration of silent ST-segment elevations and depression episodes and in the amplitude of silent ST-segment depressions. This may indirectly indicate that the agent affects predominantly coronary blood flow and coronary vascular tone.