Aim. To develop a progressive multifaceted approach to the management of geriatric patients with cardiac arrhythmias.Material and methods. The study was carried out in 2 stages. The study sample consisted of 262 elderly and senile people (mean age, 69,5±1,1 years). There 145 elderly (mean age, 68,4±1,2 years) and 117 senile patients (mean age 74,4±1,3 years). We analyzed medications used for six months in geriatric patients with arrhytmias and senile asthenia (SA) and without it. The combined strategy of management of geriatric patients with arrhytmias and SA was tested.Results. SA is most common in geriatric patients who are taking drugs such as class I a, b, c antiarrhythmics, class V antiarrhythmics (cardiac glycosides), diuretics (torasemide, furosemide), and statins. This indicates the need to avoid polypharmacy and to adjust the treatment of geriatric patients with cardiac arrhythmias in accordance with Beers criteria. Presented study revealed that in patients with SA, the total antioxidant activity is reduced, which indicates the need to restore antioxidant defence to such patients. A combined strategy has been developed for the management of geriatric patients with cardiac arrhytmias and SA.Conclusion. The combined strategy of managing older patients with arrhytmias and SA helped to improve the geriatric status, prevent SA, and increase antioxidant defence. A significant improvement in the quality of life was noted, in particular, in relation to the mental and psychological well-being.
Biological model of hypoxia can be used for the diagnosis o f functional changes in human erythrocytes under the effect of the hypoxic factor. The use of this model together with mod ern methods of scanning probe microscopy for evaluation o f the severity of pulmonological disease in senile patients will help to predict treatment efficiency and outcome.
Key W ords: scanning probe microscopy (SPM); Young' s modulus; pneumoniaPhysiological changes in human tissues during aging manifest in impaired adaptation capacity to metabolic stress and general deterioration of the health status. The older the individual, the higher is the risk o f disease development, o f which pulmonological diseases, in cluding acute community-acquired pneumonia (called pneumonia in the text below) are most hazardous [1]. Respiratory diseases often cause a potent unfavorable effect, oxygen deficit in tissues, and therefore, studies of tissue hypoxia is the main problem o f pulmonol ogy and physiology [2]. Studies o f the mechanisms of cell response in hypoxia, evaluation of regularities of disease development, and the search for prognostic and diagnostic criteria are expected to improve evalu ation of the severity and progress o f various diseases, including pneumonia [8]. Scanning probe microscopy (SPM) is an informative method for studies o f the physiological status in health and disease, specifically, for studies o f blood cell parameters. Extrapolation o f experimental data on animal blood obtained on a biological model to the data ob tained in studies of hypoxia in patients is expected to show the trend of changes in blood cell structure and functions, indicating the effect of the hypoxic stress factor on the organism.The strong impact of infection is essential in pneu monia, which can modulate the cell parameters, specif ically the erythrocyte values [1]. Use o f the biological model will help differentiate the hypoxic effects on changes in human blood erythrocyte characteristics from the bacteriological factor. If the trend of changes in the rat red blood cells is similar to changes in pa tients with pneumonia, presumably, it is the hypoxic, but not the bacterial factor, that is mainly responsible for changes in human erythrocytes.We used the biological model for SPM studies of the blood cell structure and functions in senile patients with pneumonia.
High blood pressure is a risk factor for cardiovascular morbidity and mortality, as well as cognitive decline and loss of autonomy in the elderly and old age. Randomized clinical trials (RCTs) in populations of older patients living at home with low comorbidity and preserved autonomy indicate the benefit of lowering elevated blood pressure in patients over 80 years of age. Older patients with senile asthenia, loss of autonomy and other geriatric problems were excluded from RCTs, and observational studies in these groups of patients indicate an increase in morbidity and mortality with lower blood pressure and antihypertensive therapy. Obviously, in very elderly patients, a universal strategy for the treatment of arterial hypertension cannot be applied due to the significant heterogeneity of their functional status. The geriatric approach to the management of arterial hypertension in older patients involves an assessment of the functional status, the presence of senile asthenia, and the degree of autonomy for the choice of antihypertensive therapy tactics.
Актуальность. Среди всех причин смерти пациентов старших возрастных групп на долю острого коронарного синдрома (ОКС) приходится более 70%. Синдром старческой астении (англ. frailty), развивающийся у пациентов пожилого и старческого возраста, усиливает провоспалительные и нейроиммуновоспалительные реакции в организме, что способствует ухудшению течения ОКС. Цель -изучить нейроиммуноэндокринные изменения у пациентов старших возрастных групп с ОКС в зависимости от наличия или отсутствия синдрома старческой астении. Материал и методы. Исследование выполнено путем ретроспективного, текущего и проспективного изучения регистров пациентов с ОКС в рамках международного проекта GIRAFFE (Gerontological International Research Against Frailty: Fit Experience) на протяжении 2011-2015 гг. Проведен анализ результатов определения в сыворотке крови 633 пациентов с ОКС без подъема сегмента ST (n = 270) и с подъемом сегмента ST (n = 363) фактора некроза опухоли-альфа (TNF-α) и линейки интерлейкинов (IL-1β, IL-4, IL-6, IL-10) на 5-, 12и 26-е сутки от начала болевого синдрома. Из пациентов основного регистра 265 человек были без синдрома старческой астении, 97с синдромом преастении, 271 -с синдромом
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