[Risk factors for venous thromboembolic complications in elderly and senile patients with diabetes mellitus planned for spinal surgery.]

The search for literature sources in domestic and foreign databases showed the absence of works devoted to the study of risk factors for venous thromboembolic events (VTE) in patients of the older age group with diabetes mellitus who are planned to undergo surgical interventions on the spine, which was the impetus for this study. The aim of the study was to study the risk factors for VTE in elderly and senile patients with diabetes mellitus who are scheduled for spinal surgery. A single-center retrospective study included 119 elderly and senile patients (64 men, 55 women, mean age 74,2±6,5 years) who underwent various surgical interventions on the spinal column. According to the binary logistic regression model, the following parameters are statistically significantly associated with the development of VTEC in the studied group of respondents: age of patients over 75 years (p=0,048), HbA1C levels over 7,5% (p=0,007) and D-dimer over 0,5 mg /l FEU (p=0,034), as well as high risk (5 points or more) of VTE according to Caprini scale (p=0,012). In order to reduce the incidence of VTE in elderly and senile patients with diabetes mellitus who are planned to perform surgical interventions on the spine, it is necessary to verify the above clinical and laboratory parameters in the early stages of hospitalization.

[Facet joint distraction as a risk factor for poor clinical outcomes in older patients after anterior cervical discectomy and fusion.]

The search for literature sources in domestic and foreign databases showed the absence of works devoted to the study of the influence of the degree of distraction of the facet joints in elderly and senile patients who underwent anterior cervical discectomy and fusion (ACDF). The purpose of the study was to study the effect of the degree of facet joint distraction on clinical outcomes in patients of the older age group who underwent ACDF. A single-center retrospective study included 47 elderly and senile patients who underwent ACDF for radiculopathy due to degenerative diseases of the cervical spine. A statistically significant correlation was found between the differences in the value of the interfacet distance and the severity of pain in the cervical spine according to VAS (p<0,01). Patients with X-ray semiotics of facet distraction more than 0,55 mm 12 months after the operation were significantly more likely to experience increased pain in the cervical spine according to VAS (p=0,028) and significantly limited daily activities due to pain in the neck NDI (p=0,043). The choice of indications for ACDF in patients of the older age group should be based on a rigorous analysis of facet distraction, cervical sagittal parameters in combination with the functional status of patients.

[Cicatricial tracheal stenosis in elderly and senile patients: immediate and long-term results of treatment]. / Rubtsovyi stenoz trakhei v pozhilom i starcheskom vozraste: neposredstvennye i otdalennye rezul'taty lecheniya.

OBJECTIVE: To present treatment outcomes in elderly and senile patients with cicatricial tracheal stenosis (CTS) and features of their perioperative management. MATERIAL AND METHODS: The study included 46 elderly and senile patients with CTS. We analyzed their gender and age, body mass index, etiology, extent and degree of stenosis, comorbidity index and ASA grade, postoperative complications according to TMM grading system. RESULTS: Age of patients varied from 61 to 95 years (mean 66.38±8.65). Post-intubation stenosis was detected in 7 (15.2%) patients, post-tracheostomy CTS - in 39 (84.8%) patients (2 (4.3%) ones with tracheoesophageal fistula and 18 (39.1%) ones with tracheomalacia). CTS length ranged from 8 to 65 mm. The causes of invasive mechanical ventilation were traumatic brain and spinal trauma in 6 cases, emergency surgery in 11 cases and therapeutic diseases in 29 cases. CTS of cervical trachea was found in 21 patients, subglottic larynx and cervical trachea - 8 patients, cervical and upper thoracic trachea - 12 patients, thoracic segment - 3 patients, multifocal lesions - 2 patients. The Charlson index ranged from 5 to 12 points. ASA grade II was observed in 8 (17.4%) patients, III - 28 (60.9%), IV - in other ones. Circular resection was performed in 5 patients, laryngotracheoplasty - in 37 patients. CTS repair and tracheoesophageal fistula closure with laryngotracheoplasty were carried out in 2 patients. Postoperative complications occurred in 18 (39.1%) patients, mortality was 2.17%. In 21.7% of cases, complications were associated with tracheal suture. Endoscopic procedures, cryosurgery and hyperbaric oxygenation were used for correction. Good and satisfactory treatment outcomes were achieved in 86.5% of patients. CONCLUSION: Surgical treatment of CTS in elderly and senile patients requires participation of interdisciplinary team with special experience. Laryngotracheoplasty is safe and effective in these patients, and indications for circular resection are still limited.

[Neurological complications and consequences of new coronavirus COVID-19 infection in elderly and old patients (literature review).]

Based on the available publications, the article systematizes information about some forms of lesions of the central nervous system (CNS), their pathogenesis, and clinical manifestations in COVID-19. Risk factors, developmental mechanisms, diagnostic approach, age characteristics of patients with neurological complications of COVID-19 are discussed. The specific mechanisms of the neuroinvasiveness and neurovirulence of the SARS-CoV-2 virus, regardless of the age of patients and the presence of risk factors, lead to systemic damage to the endothelium of small-caliber vessels, generalized thrombovasculitis, and an increased risk of ischemic and hemorrhagic strokes. At the same time, the most vulnerable category is elderly and senile patients with cardiovascular and metabolic disorders (arterial hypertension, obesity, diabetes mellitus), which sharply worsen treatment outcomes. The clinical experience accumulated during the COVID-19 pandemic indicates the development of the following most frequent post-covid neurological complications and consequences in mainly elderly and senile patients: cranial mononeuropathies, chemosensory dysfunction, encephalopathy, insomnia, stroke, acute meningoencephalitis, acute disseminated encephalomyelitis syndrome acute polyneuropathy Guillain-Barré, transverse myelitis. The benefits of vaccination against COVID-19 far outweigh the risks of possible post-vaccination neurological complications and consequences, especially in elderly and senile patients.

[A specialized product of therapeutic nutrition is a dry protein composite mixture enriched with calcium of dairy origin, in the postoperative rehabilitation of elderly and senile patients.]

The study of a specialized product of therapeutic nutrition - a mixture of protein composite dry, enriched with calcium of dairy origin, in the program of complex postoperative rehabilitation of elderly patients, as a dietary remedy for the treatment of enteral insufficiency and prevention of its complications - protein-energy deficiency (BEN). 268 patients aged 61-75 years, operated for various gastroduodenal diseases, were examined. A group of patients (184 people, i. e. 68,6%) without signs of BEN was identified. Of these, the study group consisted of 92 patients, the remaining 92 patients - the control group. The patients of the study group throughout the entire inpatient and post-stationary rehabilitation periods with a total duration of 3 months, in addition to the traditional therapeutic and rehabilitation nutrition of surgical patients, a specialized food product of a dry protein-composite mixture (SBCS) enriched with calcium of dairy origin was added daily in the amount of 27 g. 92 patients of the control group received a similar postoperative surgical diet, but not enriched with calcium. Clinical and laboratory studies have shown that in patients in the study group, during dietary treatment with the use of SBCS enriched with calcium of dairy origin, the indicators of protein, vitamin, mineral metabolism significantly and significantly improved, which served as a preventive factor against the development of BEN in 79,1% of patients. There were only 32,6% of such patients in the control group. Conclusion: a specialized product of therapeutic nutrition - a dry protein composite mixture enriched with calcium of dairy origin, should be included in the postoperative rehabilitation of elderly and senile patients.

[Features of the course and therapeutic aspects of deep vein thrombosis in elderly and senile patients]. / Osobennosti techeniya i lechebnye aspekty trombozov glubokikh ven u bol'nykh pozhilogo i starcheskogo vozrasta.

The problem of deep vein thrombosis (DVT) and pulmonary embolism in elderly and senile people, despite its obvious relevance, is not sufficiently covered in modern literature. It is known that about 70% of all thromboses develop in patients over 60 years of age Despite the higher risk of venous thromboembolic events (VTE) in older patients and higher rates of morbidity, mortality and treatment costs, the proportion of elderly patients is underrepresented in many clinical studies, and Clinical guidelines usually extrapolate the results of studies involving younger healthy patients to older people. It is unclear whether these recommendations are actually optimal for older people with VTE. The latest registry studies showed many aspects of course, treatment and prognosis of elderly patients with VTE. It became clear that in patients of this category, the risk of both bleeding as a result of therapy and the risk of recurrence of thromboembolic complications is seriously increased. This is especially noticeable in the presence of additional risk factors and comorbidity, especially an active tumor process. Thus, the need for special attention of medical specialists in relation to patients of the older age group should be emphasized in terms of the possibility of developing DVT and VTE.

[Risk factors of adverse clinical outcomes in the elderly and senile patients with stroke-associated pneumonia.]

In the domestic and foreign specialized literature, there are no studies devoted to the study of risk factors of mortality in the older age patients with stroke-associated nosocomial pneumonia. The purpose of the study was to study the risk factors of adverse clinical outcomes in elderly and senile patients with stroke-associated nosocomial pneumonia. The study included 247 elderly and senile patients (139 men, 108 women, mean age -- 74,1±6,3 years) who were hospitalized with signs of ischemic or hemorrhagic stroke. According to the binary logistic regression model, the following parameters are statistically significantly associated with adverse clinical outcomes in the studied group of respondents: age over 75 years (p=0.011), degree of disability according to mRS ≥3 (p=0,009), and C-reactive protein levels over 100 mg/l (p=0,023) and urea more than 7 mmol/l (p=0,044). In order to reduce the incidence of adverse clinical outcomes in patients of the older age group with stroke-associated nosocomial pneumonia, it is necessary to verify the above clinical and laboratory parameters at the early stages of hospitalization.

Clinical efficacy of percutaneous transforaminal endoscopic TESSYS technique in the treatment of senile lumbar spinal stenosis.

OBJECTIVE: To evaluate the clinical efficacy percutaneous transforaminal endoscopic TESSYS technique in the treatment of senile lumbar spinal stenosis. METHODS: 157 senile with lumbar spinal stenosis were prospectively recruited at this study. The subjects in the experimental group received TESSYS operation, and the control group received traditional open surgery for posterior lumbar interbody fusion. The clinical pain relief, indexes of perioperative period, dysfunction of the lumbar spine and clinical effect of the two groups were measured. RESULTS: The operation time of experimental group was (53.32±10.27) min, average blood loss in operation was (50.01±5.74) ml, and length of hospitalization was (6.73±3.21) d, which were all better than the control group (97.46±13.47) min, (172.23±8.61) ml, (13.94±2.15) d, with statistical significance (P < 0.05). The VAS scores at one day, one week, 1 month and 3 months were significantly lower than those before operation (P < 0.05). The VAS scores of the two groups were significantly lower than those of the open surgery group (P < 0.05). ODI scores of patients were significantly lower than those before operation (P < 0.05). The MACNAB scores of the two groups were significantly lower than those of the open surgery group (P < 0.05). CONCLUSION: Percutaneous transforaminal TESSYS technique is a safe and minimally invasive technique for the treatment of lumbar spinal stenosis in the elderly. Compared with traditional open surgery for posterior lumbar interbody fusion, percutaneous transforaminal endoscopic TESSYS technique has less trauma and does not damage the stability of the spine. It can significantly shorten the hospitalization and operation time, reduce intraoperative fluoroscopy and blood loss, reduce the degree of pain and postoperative complications, and quickly restore daily life function. and thus an effective and more advantageous scheme for the treatment of elderly lumbar spinal stenosis.

[Portable telemedical complex usage perspectives for medical care of elderly and senile patients with cerebrovascular pathology.]

The article discusses perspectives of medical care in elderly and senile patients with cerebrovascular pathology with portable telemedical complex use. Analysis of telemedical cooperation physician-consultant-patient and discussion of medical equipment criteria for telemedical complex selection and organizational together with legal issues of medical data transfer, storage and access were performed. The important clinical features of cerebrovascular pathology in elderly patients were presented, which determined necessity of highly qualified medical specialist involvement in management of such patients. The opportunities of portable medical complex usage were discussed.

[Personified monitoring of acute coronary syndrome and its outcomes in elderly patients. Angina. Heart failure (overview).]

Review is about current information on the features of heart failure and angina diagnosis and monitoring in elderly and senile patients. One of the main problem in patients over 65 years is comorbidity, which requires corrective action in the risk stratification and prediction of clinical outcomes. The priority of non-invasive diagnostic tests is noted. Authors of the article recommend frailty as an obligatory part of diagnostic process in patients with heart failure and angina due to a clear connection with the worst prognosis in terms of quality of life, hospitalization and mortality.

[Risk factors for adverse clinical events after carotid arteries stenting in elderly and senile patients.]

The safety of the use of carotid arteries stenting (CAS) in elderly and senile patients remains a controversial issue. The reasons for the development of adverse events in this group of patients after CAS surgical procedure are unknown. The purpose of this study was to evaluate the risk factors for the development of adverse clinical events after CAS surgical procedure in elderly patients group. The study included 147 patients (94 men, 53 women, average age -- 72,1±3,5 years) of elderly and senile patients hospitalized to perform CAS for stenosis of the carotid arteries. According to the constructed model of binary logistic regression, the following parameters are statistically significantly associated with the development of complications after CAS: the presence of stroke in the anamnesis (p=0,013), symptomatic stenosis of the carotid arteries (p=0,011) and the degree of disability according to mRS (Modified Rankin Scale) ≥3 (p=0,002). In order to identify the identified risk factors and minimize the incidence of complications in elderly patients who underwent CAS surgery, a detailed preoperative assessment of their somatic status is necessary with an emphasis on the state of the cardiovascular system.

[Personified monitoring of acute coronary syndrome and its outcomes in elderly patients. Report 1. Acute coronary syndrome (overview).]

The overview describes the clinical features of acute coronary syndrome in patients of older age groups. Atypical symptoms present in this cohort very often. It associated with a worse prognosis, partly due to delays in diagnosis, treatment, and insufficiently substantiated drug therapy. Comorbidity is one of the important factors complicating the diagnosis of elderly patients. Frailty, hyperglycemia, anemia, and chronic kidney disease are comorbid conditions, it identify in patients of older age groups often. High-sensitive cardiac markers is especially important for the differential diagnosis of acute coronary syndrome without ST elevation in elderly patients, because sometimes echocardiography does not provide additional information for interpreting the clinical case and there are no significant diagnostic changes on the ECG.

[Personified monitoring of acute coronary syndrome and its outcomes in elderly patients. Report 2. Invasive diagnostic and treatment methods (review).]

Literature review describes the features of diagnosis and monitoring of elderly and senile patients with coronary heart disease, that will undergoing coronary angiography, percutaneous coronary intervention or coronary artery bypass surgery. Review notes the advantage of the routine invasive strategy in elderly patients with a high risk of NSTEMI. The authors recommend a preliminary assessment of frailty before coronary angiography. Radial access for coronary angiography or percutaneous coronary intervention is considered preferable. It has lower frequency of access and bleeding complications. Daily activity of elderly patients after PCI should be used to predict mortality. CHA2DS2VASc as a predictor of the risk of adverse cerebrovascular episodes is recommended in addition. Aortic calcification and diffuse atherosclerotic changes in the walls of the coronary arteries are important factors in the risk verification scales EuroSCORE and EuroSCORE II in patients after 70 years who underwent CABG intervention.

[Influence of amiodarone on the spectral analysis of heart rate variability in patients with atrial fibrillation elderly and senile age.]

Atrial fibrillation is more common among elderly patients. Number of comorbidities, such as heart failure, coronary heart disease, disorders of the conduction system of the heart increases with age. Atrial fibrillation is a health problem. In developed countries, there is a high prevalence of the disease. The disease affects more than 33 million people worldwide. Spectral analysis of heart rate variability can be successfully used to evaluate the effectiveness of therapy. The use of this method gives an idea of the role of the autonomic nervous system in the regulation of chronotropic function of the heart. These data help to define conditions of manifestation of efficiency of antiarrhythmic drugs. In this study, spectral analysis were studied in patients with different forms of atrial fibrillation. The effect of amiodarone class III antiarrhythmic drug were studied this study. It is shown that the structure of spectrum of heart rate variability in patients with newly diagnosed atrial fibrillation differs significantly from that in patients with disease duration from 6 months to several years on the background of amiodarone.

[Evaluation of hyperglycemia impact on outcomes of acute coronary syndrome in elderly and senile patients.]

Acute coronary syndrome (ACS) in elderly and senile patients has a number of features and requires special attention to providing medical care. These patients is associated with significant comorbidity and atypical symptoms in the course of the disease. Diabetes mellitus is a common background disease in patients with ACS.A retrospective cohort study was performed, 2945 patients with ACS were examined. Patients were divided into three age groups: group 1 - patients aged 18 to 63 years; group 2 - patients aged 64 to 75 years; group 3 - patients older than 75 years. Number of patients with glucose concentrations above 11.1 mmol/L is significantly higher in elderly and senile groups than in group of patients from 35 to 59 years old. The number of patients with impaired renal function after administration of a contrast medium in the study group with ACS increased with increasing age. Significant difference was revealed between the middle and senile age groups, as well as between the elderly and senile age groups. An increase in the relative number of patients with fatal outcomes in groups with a significant increase in glucose levels was revealed. The connection between the pathological level of glucose and repeated myocardial infarction is proved. Conclusion. The presented statistical picture suggests a particularly high risk of recurring cardiovascular events among patients with ACS and pathological glucose levels. The correlation between the number of deaths and glucose levels during the initial examination allows the use of glucose tests as an additional criterion in the stratification of risks and outcomes in patients with ACS.

Flexible ureteroscopic holmium laser lithotripsy with PolyScope for senile patients with renal calculi.

The present study reported the clinical experience of using a PolyScope with holmium laser lithotripter in managing renal calculi in senile patients. Between December 2013 and December 2016, 157 senile patients (69.1±6.1 years old) were treated with PolyScope holmium laser lithotripsy for renal calculi at Xin Hua Hospital (Shanghai, China). The mean stone digitized surface area was 154.2±57.7 mm2 (range, 55.8-478.3 mm2). A thorough medical history investigation, and laboratory and radiological examination were followed by proper preoperative management. The PolyScope was then passed into the renal cavities following the position of the ureteral access sheath, with laser energy maintained at 1.0-2.0 J, frequency 10-15 Hz. The demographical and operative information of senile patients were compared with that of the 332 non-senile patients operated at the same period time. The average operative time was 54.6±13.2 min (range, 37-124 min). No major complications, including ureteral perforation or sepsis were encountered. The single session stone-free rate (SFR) was 81.5% and the overall SFR was 89.2%, similar to that of the non-senile group. PolyScope combined with holmium laser lithotripter is safe and effective in managing renal calculi in senile patients compared with non-senile patients, with considerately high SFRs and low complication rates.

[Hybrid vascular interventions on the peripheral arteries in the treatment of critical ischemia in elderly patients.]

Peripheral arterial disease has a huge contribution to the overall mortality rate of the population, especially in the group of patients of old and old age. The likelihood of an adverse outcome is increased against a background with other possible nosological forms. In particular, the combination of peripheral atherosclerosis with diabetes mellitus very often manifests itself in the form of a multilevel lesion of the lower limb arteries. The treatment of such patients is very difficult, since the use of only open or endovascular approaches has its own contraindications and limitations, and cannot be used throughout the course of the lesion. The way out of this situation is the use of a hybrid approach, which consists in the combination of an open surgical reconstruction on the upper floors of the lesion and balloon angioplasty on the arteries of the lower leg. This approach allows you to use the advantages of both methods and achieve good results of treatment. The article presents the experience of treatment using a hybrid approach in elderly and senile patients with multilevel lesion of the lower limb arteries on the background of diabetes mellitus.

[The treatment of elderly and senile patients with venous trophic ulcers and type 2 diabetes mellitus.]

The effectiveness of the inclusion of sulodexide in the pharmacotherapy of complex treatment of patients (n=52) elderly and senile with a combination of chronic diseases of the veins complicated by refractory trophic ulcers of the lower extremities, and type 2 diabetes mellitus was studied. Patients were randomly randomized in the 1st (n=26) and the 2nd (n=26) groups, the statistical differences between them in age (t1-2=0,2, p1-2=0,833), sex (χ21-2=0,008, p1-2=0,991), nosology (χ21-2=0,004, р1-2=0,993); the anamnesis of chronic diseases of veins (t1-2=0,14, p1-2=0,893); duration of trophic ulcers (t1-2=0,21, p1-2=0,827); planimetric parameters of trophic ulcers (t1-2=0,18, p1-2=0,865) were not recorded. Patients of the 1st group received treatment with sulodexide according to the standard schedule for 50 days. The primary outcome of the study is the complete closure of the trophic ulcer after 1 month. Secondary outcomes are epithelization after 2 months and dynamic planimetric indices within 12 months. The effectiveness of the use of sulodexide was assessed according to the VCSS scale, dynamic changes in the malleolar volume and changes in planimetric parameters. A statistically significant improvement in the overall VSCC score was observed in both the 1st (p=0,002) and the 2nd (p=0,0016) groups in all study outcomes. At the same time, a statistically significant improvement in the VSCC scores was more pronounced in the 1st group (p<0,05). After 2 and 6 months, a statistically significant decrease in the malleolar volume of the affected lower extremity was recorded both in the 1st (t=4,17, p=0,001) and in the 2nd (t=2,4, p=0,37) groups. Clinically and statistically significant decrease in malleolar volume was more pronounced in the 1st group (p<0,05). After 30 days, trophic ulcers were closed in 9 (34,6%) cases in the 1st group and in 5 (19,2%) patients in the 2nd group (p<0,05). On day 60 epithelization was achieved in 22 (84,6%) and 12 (46,1%) patients, respectively. The time of complete epithelization in patients of the 1st and the 2nd groups was 51,2±1,6 and 78,4±2,6 days (p<0,05). The conclusion is made that sulodexide is an effective and pathogenetically grounded pharmacological preparation for the treatment of patients of elderly and senile age with chronic clinical disease C6 of clinical class and type 2 diabetes mellitus.

Clinical analysis and treatment of antibiotic-associated diarrhea in senile patients with severe bacterial pneumonia / 实用医学杂志

Objective To explore the clinical manifestations ,risk factors and treatment of antibiotic asso-ciated diarrhea(AAD)in senile patients with severe bacterial pneumonia. Methods Retrospective analysis was made on senile patients of bacterial pneumonia combined with antibiotic associated diarrhea. Results There were 114 patients out of 572 cases had AAD. The incidence of AAD in these senile patients was 19.93%. There were 62.28% patients more than 80 years old. The incidence AAD was 37.3% with third generation cephalosporin treat-ment,28.6% penicillin with enzyme inhibitor treatment and 19.2% with carbopenems treatment. Conclusions The high risk factors of AAD in senile patients with bacterial pneumonia include patient′s age,and time, APACHE Ⅱ,category,combination therapyof antibacterial,and invasive operations. We should pay more atten-tion to AAD and related high risk factors when using these antibiotics in clinics. Rational selection and use of anti-bacterial are important measures to stop senile patients from ADD. Pharmaceutical care could help to optimize the treatment plan and reduce its adverse reaction of antibacterial in senile patients.

Clinical analysis and treatment of antibiotic-associated diarrhea in senile patients with severe bacterial pneumonia / 实用医学杂志

Objective To explore the clinical manifestations ,risk factors and treatment of antibiotic asso-ciated diarrhea(AAD)in senile patients with severe bacterial pneumonia. Methods Retrospective analysis was made on senile patients of bacterial pneumonia combined with antibiotic associated diarrhea. Results There were 114 patients out of 572 cases had AAD. The incidence of AAD in these senile patients was 19.93%. There were 62.28% patients more than 80 years old. The incidence AAD was 37.3% with third generation cephalosporin treat-ment,28.6% penicillin with enzyme inhibitor treatment and 19.2% with carbopenems treatment. Conclusions The high risk factors of AAD in senile patients with bacterial pneumonia include patient′s age,and time, APACHE Ⅱ,category,combination therapyof antibacterial,and invasive operations. We should pay more atten-tion to AAD and related high risk factors when using these antibiotics in clinics. Rational selection and use of anti-bacterial are important measures to stop senile patients from ADD. Pharmaceutical care could help to optimize the treatment plan and reduce its adverse reaction of antibacterial in senile patients.