[A model for assessing and correcting the risk of developing pressure ulcers in the system of long-term care for geriatric patients with limited mobility.]

The article is devoted to the results of the third stage of the scientific and practical project on the introduction of advanced social practices based on innovative gerontotechnologies into the system of long-term care for geriatric patients. It has been established that senile xerosis or skin «frailty¼ occurs in 75% of the population over 65 years old, when increased dryness of the skin leads to peeling, the formation of microcracks, the appearance of senile itching, sleep disturbances, the development of pressure ulcers and, as a result, a decrease in motor activity. During the project, a tactic was developed for the care of «frail¼ skin in patients with senile xerosis and the risk of pressure ulcers. The article presents information about the current problems of diagnosis, correction and prevention of pressure ulcers in patients with limited mobility of elderly and senile age. The results of a comparative analysis of the severity of pressure ulcers and their impact on the quality of life in the system of long-term care for geriatric patients with limited mobility before and after the use of Cicalfate+ Eau Thermale Avène («Pierre Fabre¼, France) emollient were presented. A model was built and practical recommendations were given on the use of the most informative and adequate scales for predicting and assessing the risk of developing pressure ulcers in patients of older age groups.

[Current problems of polypharmacy in geriatric patients when taking drugs with a risk of photosensitivity.]

The article presents an overview of the current problems of polypharmacy in geriatric patients when taking drugs with a risk of photosensitivity. The article contains information about emerging adverse drug reactions, as well as methods for diagnosing, correcting and preventing phototoxic and photoallergic reactions in patients of older age groups. The main aspects of dermatological support in the system of long-term care for geriatric patients when taking drugs with a risk of photosensitivity are outlined. Clinical signs of senile xerosis and skin manifestations of adverse drug reactions were studied when taking drugs with the risk of photosensitization before and after the use of a photoprotector in elderly patients.

[The role of optical coherence tomography angiography in the assessment of retinal microcirculation in thrombotic microangiopathy associated with malignant arterial hypertension]. / Rol' opticheskoi kogerentnoi tomografii s funktsiei angiografii v otsenke retinal'noi mikrotsirkulyatsii pri tromboticheskoi mikroangiopatii, assotsiirovannoi so zlokachestvennoi arterial'noi gipertenziei.

Optical coherence tomography angiography (OCT-A) allows detailed assessment of the state of local blood flow in various systemic ischemic diseases, which include thrombotic microangiopathy (TMA) associated with malignant arterial hypertension (MAH). PURPOSE: To evaluate retinal microcirculation using OCT-A imaging data in the group of patients with TMA associated with MAH. MATERIAL AND METHODS: The study consisted of a qualitative and quantitative analysis of OCT-A data from 7 patients (14 eyes) with TMA associated with MAH and verified by renal biopsy. The control group included 7 healthy individuals (14 eyes). The following parameters were analyzed: area size of the foveal avascular zone FAZ, mm, vessel density (VD, %) and vessel skeleton density (VSD, %). The indicators were measured separately in the deep and superficial vascular plexuses and divided by localization into: the total density of the entire measured area, central density, density by quadrants (superior, inferior, nasal and temporal). All quadrants were subdivided into inner (corresponding to parafovea) and outer (corresponding to perifovea). RESULTS: Local foci of vascular attenuation of the deep retinal capillary plexus, pathological tortuosity of blood vessels in the deep and superficial retinal capillary plexuses were found in 100% of study group patients. Per-quadrant analysis of OCT-A finding in the macular zone revealed a statistically significant decrease in VD of the deep retinal capillary plexus (p<0.05). A direct correlation was found between glomerular filtration rate and the VD index in the outer inferior (r=0.567; p=0.034) and inner temporal quadrants (r=0.613; p=0.020) of the deep retinal capillary plexus, as well as the level of hemoglobin in blood serum and VD in inner temporal quadrant of the deep vascular plexus (r=0.596; p=0.025). CONCLUSION: Changes revealed with OCT-A are the symptoms of TMA in MAH patients spreading to the retinal microvasculature, mainly at the level of the deep retinal capillary plexus.

[Ocular ischemic changes in thrombotic microangiopathy associated with malignant arterial hypertension (case study)]. / Ishemicheskie izmeneniya glaza pri tromboticheskoi mikroangiopatii, assotsiirovannoi so zlokachestvennoi arterial'noi gipertenziei (klinicheskoe nablyudenie).

The article presents a clinical observation of visual organ damage as an extrarenal manifestation of thrombotic microangiopathy in malignant arterial hypertension with an analysis of structural and functional changes in the eye by modern examination methods. The presence of renal thrombotic microangiopathy was verified by kidney biopsy. Optical coherence tomography was used to determine structural changes in the inner and outer layers of the retina in the form of their disorganization, areas of thickening of the nerve fiber layer, intraretinal inclusions and cysts, alterations of the ellipsoid zone and retinal pigment epithelium. Optical coherence tomography angiography revealed areas of vascular pattern attenuation in the deep and superficial retinal plexuses corresponding to OCT-detected foci of disorganization of the inner retinal layers. Color Doppler imaging showed absence of the diastolic component of the Doppler spectrum with an increase in the peripheral resistance index RI up to 1.0 in the central retinal artery and posterior short ciliary arteries in both eyes. Functional changes observed with multifocal electroretinography and microperimetry corresponded to the structural changes. Taking into account the similarity of microcirculation in the kidneys and the eyes, the probable pathogenetic mechanism underlying the detected structural and functional symptoms of ischemic damage to the visual organ in malignant arterial hypertension is chronic thrombotic microangiopathy. An interdisciplinary approach to studying thrombotic microangiopathy, including those associated with malignant arterial hypertension, using high-tech examination methods can be useful for timely diagnosis and treatment of this pathology.

[Analysis of the course and outcomes of pregnancy in patients with advanced stages chronic kidney disease].

BACKGROUND: Pregnancy in patients with advanced chronic kidney disease (CKD) is associated with a high risk of adverse outcomes for the mother and the fetus, but data on the characteristics of the course of pregnancy in these women is limited. AIM: To analyse of the course and outcomes of pregnancy in patients with CKD stages 3a4. MATERIALS AND METHODS: Thirty five pregnant women with CKD stages 34 were included: 3a 12 (34.3%) patients, stage 3b 10 (28.6%), stage 4 13 (37.1%). RESULTS: Proteinuria, serum creatinine, blood pressure in dynamics, the presence of a physiological response were investigated. Pregnancy management included blood pressure correction, antianemic, antiplatelet, anticoagulant therapy, prevention and treatment of urinary infection, correction of metabolic disorders. All pregnant women had proteinuria of varying severity, which increased towards the end of pregnancy. Seventeen (51.5%) patients had hypertension, successfully corrected with antihypertensive drugs. The average delivery term was 34.6 weeks. Preeclampsia developed in 14 (42.4%) cases, an inverse relationship was found between the presence of a physiological response and preeclampsia (p=0.009; rs=-0.463). All children were born alive and viable. After delivery in patients with CKD 3a creatinine values returned to the pre-gestational level, in patients with grade 3b and 4 progression of CKD was noted. CONCLUSION: A favorable pregnancy outcome in women with late stages of CKD is possible with constant monitoring by a multidisciplinary team of doctors with mandatory monitoring of renal function, proteinuria, blood pressure, coagulation, markers of preeclampsia and indicators of fetal health. It was proposed to consider the physiological response of the kidneys to pregnancy as a predictor of a favorable outcome.

[IMPROVEMENT OF THE TRACHEAL INTUBATION PROCEDURE IN SURGICAL INTERVENTIONS].

Results of tracheal intubation during anesthesiological support of surgical interventions on facial skull in 127 patients, while presence of operative risk grade 2 (in accordance to ASA), were analyzed. While performing tracheal intubation a visual control of the endotracheal tube position on a distance of 0.5 ­ 1 сm from proximal edge of the wrap and while doing the wrap blowing was done. Application of the method proposed have promoted the reduction of duration of a standard orotracheal tracheal intubation performance, guaranteed a securing of correct and safe position of endotracheal tube, reduction of the wrap shift towards laryngeal pharynx and bronchi with partial obstruction of respiratory ways, traumaticity of tracheal intubation, and the raising of the ventilation efficacy as well.

[Effect of medical and social factors on quality of life of elderly inhabitants of St. Petersburg].

The study of health and social well-being of elderly inhabitants was carried out in St. Petersburg in 2004. The original questionnaire was developed and approved by the specialists of St. Petersburg City geriatric medical and social center. Using this questionnaire enables to evaluate an influence of medical and social factors on quality of life of elderly people living in mega polls. There has been discovered that the reduction of quality of life is connected not only with aged-related social and physical dependencies but with insufficient quality of healthcare and social protection system and also with reduction of availability of healthcare for elderly people in general.

[Effect of testosterone on protein synthesis of prostate cells in hypo- and hyperprolactinemia]. / Osoblyvosti vplyvu testosteronu na syntez klitynnykh bilkiv peredmikhurovoï zalozy pry hipo- ta hiperprolaktynemiï.

The influence of testosterone on the concentration and synthesis of nuclear and cytoplasmic prostate proteins were studied in rats with hypo- and hyperprolactinemia. Hyperprolactinemia was induced by "Lactin", and the hypoprolactinemia was modelled by "Parlodel". The rats were injected with 14C-protein hydrolysate i.p. for the investigation of the proteins biosynthesis and concentration of prostate cells. The androgen inhibited catabolism of nonhistone proteins and the proteins of nuclear juice in intact rats organism. Testosterone increased the synthesis of all proteins in rats with prolactin deficiency, but this enlarge was not connected with an elevation of their concentration. Thus, we suggest that in this case the proteins disintegration may be increased. Under hyperprolactinemia the concentration of all proteins, besides nonhistone proteins, was declined that reflected the enhancement their catabolism.

[Testosterone metabolism in the skin of women with hirsutism]. / O metabolizme testosterona v kozhe zhenshchin, stradaiushcikh girsutizmom.

A study was made of the endogenous testosterone (T) level in the blood plasma, the rate of T decomposition and the level of 5 alpha-dehydrotestosterone in the pubic skin of women with hirsutism of different genesis. As to T amounts the investigated form of androgenization can be placed in the following sequence: diencephalic form of ovarian polycystosis greater than congenital adrenogenital syndrome greater than ovarian form of polycystosis (before operation) greater than idiopathic form of hirsutism greater than ovarian form of polycystosis (after operation) greater than healthy women. The rate of T transformation into 5 alpha-dehydrotesosterone was higher but in patients with the idiopathic form of hirsutism whereas the level of 5 alpha-dehydrotestosterone was significantly decreased in all the patients. The highest amount of the metabolite was found in the patients with idiopathic hirsutism, the lowest in the diencephalic form of polycystosis and congenital adrenogenital syndrome. In all the investigated clinical forms of androgenization there is a reduced period of the presence of 5 alpha-dehydrotestosterone in the skin cells. An enhanced process of 5 alpha-dehydrotestosterone transformation into androstenediols is likely to be the most probable cause of this phenomenon. An assumption has been made as to a stimulating effect of androstenediols on the virile pattern hair growth in women.