[Economic and clinical aspects of postoperative bandages selection: in search of the best solution]. / Ekonomicheskie i klinicheskie aspekty vybora posleoperatsionnykh povyazok: v poiskakh optimal'nogo resheniya.

OBJECTIVE: Investigation of the clinical and economic advisability of using self-adhesive wound bandages of plaster type (on the example of Cosmopor E steril) compared to gauze bandages in the conditions of medical organization. METHODS: Study design - a retrospective analysis of literature data. Methods of pharmacoeconomic analysis - cost minimization analysis, «impact on budget¼ analysis. The Unified Information System in Procurement was the information source of the self-adhesive bandages cost. The charges of gauze bandages production were calculated on the basis of data provided by structural subdivisions of SamSMU Clinics. RESULTS: It was determined that the use of self-adhesive bandages of plaster type is economically feasible as a result of the analysis of cost minimization and impact on the budget. Saving during 1 year can be from 259 466 to 532 603 rubles (in total for three departments - 1.1 million rubles). Sensitivity analysis showed the stability of the obtained results to the variation of entry conditions (costs for gauze bandages and bandages of plaster type) in a wide range of values. CONCLUSION: The data obtained from the study showed that the use of bandages of plaster type for different types of surgical treatment is more justified in terms of cost saving.

[Frequency of selected chronic noncommunicable diseases in older patients with senile asthenia syndrome.]

An important area of medical and social research is prospective studies of a cohort of older patients with chronic non-communicable diseases aimed at studying the level of mortality, taking into account the presence/absence of senile asthenia syndrome. A prospective clinical and epidemiological study was conducted on 1 261 people aged 80 years and older receiving medical care on an outpatient basis. Three groups of patients were formed: without senile asthenia syndrome (7,6%), in a state of pre-asthenia (23,5%), with senile asthenia (68,9%). After a calendar year, an analysis was made of the causes of death of respondents in all three groups. A high statistically significant incidence of chronic diseases in patients with senile asthenia syndrome compared with those without signs of this syndrome was noted in arterial hypertension, chronic heart failure, osteoarthritis, age-related macular degeneration, chronic kidney disease, dementia, cancer, anemia, uncomplicated diabetes mellitus. In the structure of causes of death in patients aged 80 years and older, diseases of the circulatory system, nervous system, neoplasms, liver diseases, and diabetes mellitus predominated. The odds ratio of the risk of dying within a year in patients without frailty syndrome is 0,32 (compared to patients with frailty, in which the risk is taken as 1).

[Medical and social status of patients over 80 years old subject to single or joint residence.]

The study of the living conditions of the elderly living alone or together with other family relatives is relevant to the organization of medical and social care and the strengthening of coordination between medical and social services. We analysed information of 1 261 people aged 80 years and older in ambulatory care settings, of whom 40% lived alone and 60% lived in the family. The proportion of single residents increases with age. It was determined several socio-demographic characteristics of patients, including age, gender, and household composition, calculated the prevalence of senile asthenia syndrome and the main chronic non-infectious diseases for single and family patients, and identified gender differences. Single men in the «Age is not a hindrance¼ screening more often revealed senile asthenia and had more severe pain syndrome compared to men living in a family. In contrast to men, senile asthenia and pain summation were more frequently registered for women living in a family than for women living alone. For the organization of medical and social care, it is important to consider the relationship between gender and marital status, as well as how this relationship changes over time.

[The assessment of the clinical efficacy and tolerability of complex treatment of patients with acute low-back pain]. / Otsenka klinicheskoi effektivnosti i perenosimosti kompleksnoi terapii patsientov s ostroi bol'yu v nizhnei chasti spiny.

OBJECTIVE: To compare the efficacy and tolerability of different combinations of domestic generics meloxicam (amelotex), tolperisone (calmirex) and B vitamins (compligam B) in the treatment of acute low-back pain. MATERIAL AND METHODS: Ninety patients with acute low-back pain (ICD-10 M54.5) were studied. Indications and prescribing of the drugs was carried out under the international generic name. Pain was assessed using a visual analog pain scale in mm (VAS). To relieve pain, all patients received the non-steroidal anti-inflammatory drug with a favorable safety profile meloxicam (amelotex). With the aim of optimization, 3 therapy regimens were proposed: group 1 (n=30) received amelotex, calmirex, and B vitamins (compligam B). Group 2 (n=30) received amelotex and calmirex. Group 3 (n=30) was treated with amelotex and compligam B. With a decrease in pain by 50% or more from the baseline level and a VAS <40 mm, patients could reduce the dose of amelotex from 15 to 7.5 mg or stop taking it. RESULTS: During treatment, all groups showed a significant regression of pain according to VAS: in group 1 from 77 to 9 mm, in group 2 from 74 to 12 mm, in group 3 from 69 to 14 mm. The maximum statistically significant reduction in pain and the degree of muscle tone was observed in group 1. Adverse reactions occurred in all groups, but they were weak and transient, and did not require correction or discontinuation of therapy. Only one patient from group 3 had a persistent rise in blood pressure. The average duration of temporary disability was 5.8 days in group 1, 7.4 in group 2, and 9.5 days in group 3. High efficacy and good tolerability of all 3 therapy regimens were noted. The combination of amelotex, calmirex and compligam B received the highest rating in the opinion of doctors and patients. CONCLUSION: All 3 treatment regimens optimize therapy in patients with acute low-back pain, reduce the dose and timing of the NSAID administration as well as the risk of adverse reactions. The results indicate that the combination of amelotex, calmirex and compligam B is a synergy of three pain relief systems due to the effect on different pathogenetic mechanisms, thereby providing the maximum analgesic effect, shortening the course of treatment and duration of temporary disability, reducing the risk of relapse and chronicity of pain.

[Antiresorptive-cytokine effects of the chondroprotective therapy in patients with lower back pain]. / Antirezorbtivno-tsitokinovye effekty khondroprotektivnoi terapii u patsientov s bol'yu v nizhnei chasti spiny.

OBJECTIVE: To evaluate the antiresorptive-cytokine effects of chondroitin sulfate on non-specific lower back pain in patients with knee osteoarthritis (OA). MATERIALS AND METHODS: Using the envelope method, 231 patients were randomized into two groups: group 1 (n=116, main) received nonsteroidal anti-inflammatory drugs (NSAIDs) and chondrogard, group 2 (n=115, comparison) received only NSAIDs. The 2-month study included 3 visits (V): V1 - at the beginning of the study, V2 - after 10 days, V3 - after 60 days with the assessment of blood parameters: transforming growth factor ß1 (TFR ß1), interleukin (IL)-1ß and IL-6, beta-Crosslaps, bone matrix formation indicator P1NP (n-terminal propeptide procollagen type 1), and determination of the level of deoxypyridinoline (DPID) in the urine. RESULTS AND CONCLUSION: At the end of the study, there is a significant decrease in all studied cytokines in patients of group 1 compared to group 2, as well as indicators of beta-Crosslaps (p<0,001) and DPID (p<0,001), which may indicate the presence of its own antiresorptive-cytokine effect in chondroitin sulfate.

[Antiresorptive activity of pharmacological chondroitin sulfate in the older age group].

The prevalence of osteoarthritis (OA) increases in proportion to age, so in the population of people over 65 years of age. The pathogenesis of OA is based on inflammation of the cartilage tissue of the joint, which leads to damage to the cartilage, activation of signaling pathways and increased levels of cytokines. AIM: To study the literature data on bone and cartilage remodeling with the development of resorptive processes and discuss possible algorithms and recommendations for the management of patients with OA on the background of chondroprotective therapy. MATERIALS AND METHODS: A comprehensive analysis of data presented in open sources, published and available on such resources as PubMed, EMBASE, Cochrane, and Library. RESULTS: According to the available recommendations and the opinion of experts, among the methods of OA therapy, drugs containing pharmaceutical chondroitin sulfate are currently being discussed, which in a number of studies has demonstrated high antiresorptive effectiveness. CONCLUSION: The use of drugs based on pharmaceutical chondroitin sulfate (Chondroguard) contributes not only to the reduction of pain in OA, but also has a positive effect on the processes of inflammation, including those associated with age-related changes in the body.

[Therapy of nonspecific lower back pain in patients with high cardiovascular risk]. / Terapiia nespetsificheskoi boli v nizhnei chasti spiny u patsientov s vysokim kardiovaskuliarnym riskom.

AIM: To evaluate the possibility of using symptomatic slow acting drugs for osteoarthritis (SYSADOA) in patients with nonspecific lower back pain and high cardiovascular risk. MATERIAL AND METHODS: The study registered as the observational program 'Possibilities of SYSADOA-therapy in patients with nonspecific lower back pain and high cardiovascular risk' was organized in outpatient clinics with sequential inclusion of patients (n=315) with lower back pain. All patients randomized into 5 main groups by method of envelopes were treated with different SYSADOA. The control group (group 6) included 63 patients without lower back pain syndrome. The duration of follow-up was 9 months. The results of the first 3 months of observation of group 1 treated with chondroitin sulfate (chondroguard) compared to the control group are presented. RESULTS: On the 21st day of therapy, the pain level decreased by more than 62% in group 1. There were no changes in the plasma hemostasis parameters (thrombin time, prothrombin index, activated partial thromboplastin time) and glomerular filtration rate, which was comparable with the control group. CONCLUSION: Chondroguard is safe for patients with comorbid osteoarthritis and high cardiovascular risk both in short and repeated long-term treatment.

Endothelial dysfunction a significant marker of adverse clinical outcome in patients with atrial fibrillation after cardioembolic stroke.

AIM: To study the prognostic significance of endothelial dysfunction (ED) markers in the development of adverse clinical outcome (death) in patients with atrial fibrillation (AF) within a year after cardioembolic stroke. MATERIALS AND METHODS: 260 patients with newly diagnosed (nAF), paroxysmal, persistent and permanent forms of AF who underwent stroke were included. Duration of observation-12 months. V1 - the beginning of the study: V2 - 180 (±5) days and V3 - 360 (±5) evaluated the level of von Willebrand factor (fW), antithrombin III (AT III) and plasminogen. RESULTS: During the year of follow-up, patients with AF who underwent and had a high mortality rate. During the whole period 38 (14.6%) patients died, 15 (23.0%) - in the group with nAF, 6 (9.2%) - in the group with paroxysmal AF, 7 (10.8%) - in the group with persistent AF and 10 (15.4%) - in the group with permanent AF. After a year of follow-up, the level of fW in patients with nAF was higher than in patients of all groups, and statistically significant in patients with paroxysmal and persistent forms of AF. At III was important in the group of patients with nAF and with a constant form of AF, in the same groups there was no statistically significant increase in a year of follow-up. It was found that in survivors with nAF at III (73.54±8.67%) higher (p=0.002) compared with the dead (65.77±6.01%). In the group of patients with paroxysmal AF in survivors of III (77.75±10.15%) higher (p=0.031) compared with the dead (69.25±5.80%). In patients with persistent AF, the survivors of III (76.57±9.09%) were higher (p=0.002) compared to the dead (65.60±2.21%). Taking into account the results of the analysis of the dynamics of ed markers, it can be assumed that AT III is the most accurate prognostic marker for the studied cohort of patients. CONCLUSION: Detection and correction of ED in AF in patients within a year after stroke can optimize the tactics of management of patients and improve the prognosis of the diseas.

[Vitamin D - prognostic marker of the risk of exacerbation in patients older than 60 years with osteoarthritis of the knee (results of the observation program DIANA)].

Aim to study the prognostic significance of vitamin D as a marker of the risk of exacerbation of osteoarthritis (OA) of the knee in patients over 60 years. MATERIALS AND METHODS: The study was conducted from 2016-2018 on the of Samara polyclinics with the inclusion of patients who have applied to a doctor for any reason and have a history of OA of the knee joint with the time of the last exacerbation of no more than 6 months. We evaluated clinical and demographic parameters, information on the drugs taken (drugs), the nature of pain by DN4, the level of cognitive deficiency by MMSE, office blood pressure data, left ventricular ejection fraction, determined the level of hemoglobin, glucose, uric acid, interleukin (IL) 1ß and IL-6, 25(OH)-D. the Duration of follow - up was 36 months. RESULTS: During 2 years of follow - up, 79 (38.3%) patients had exacerbation, which occurred in 19.4% (n=40) of cases during the first year, and in 18.9% (n=39) of cases respectively during the second year. In 35.4% of cases, the neuropathic component of pain was noted with an index of 4.37±1.05 points. Age, 25-OH-vitamin D, IL-1ß, and the presence of diabetes mellitus and chronic kidney disease are factors that affect the prognosis of exacerbation in patients with OA of the knee joint. CONCLUSION: The prognostic significance of vitamin D for the risk of exacerbation in patients with OA older than 60 years (χ2=160.9, р.

[Anxiety-related blood pressure variability in patients with atrial fibrillation after cardioembolic stroke]. / Trevozhno-assotsiirovannaia variabel'nost' arterial'nogo davleniia u patsientov s fibrilliatsiei predserdii, perenesshikh kardioémbolicheskii insul't.

AIM: To investigate whether of anxiety-related blood pressure (BP) variability can be corrected in patients with atrial fibrillation (AF) who have experienced cardioembolic stroke (CES). SUBJECTS AND METHODS: The investigation enrolled 125 patients (mean age, 68.5±5.7 years) with AF, who had experienced CES. The patients were randomized into 2 groups by the envelope technique: 1) 63 patients received antihypertensive drugs and an anxiolytic (adaptol) (a study group); 2) 62 patients had antihypertensive drugs only (a comparison group). Effectiveness was evaluated 2 and 6 weeks later from the time course of changes in BP readings obtained by 24-hour Holter monitoring in relation to reactive anxiety (RA) and personal anxiety (PA) scores. The latter were determined using the Spielberger-Hanin Anxiety Self-Esteem scale. RESULTS: The patients with AF who had experienced CES were noted to have high BP variability associated with increased RA and PA scores. Group 1 showed statistically significant improvements in RA and PA 2 and 6 weeks after the start of treatment. The efficiency of anti-anxiety therapy (adaptol at a dose of 500 to 1500 mg/day) in combination with antihypertensive drugs is confirmed by the normalized circadian BP profile. CONCLUSION: The incorporation of an anxiolytic into pharmacotherapy regimens could improve BP, namely, to reduce and stabilize its circadian profile.

[Cerebrovascular risks and prediction of complications in patients with backache during therapy with nonsteroidal anti-inflammatory drugs].

AIM: To study the impact of therapy with nonsteroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, meloxicam, etoricoxib, and nimesulide, on systolic and diastolic blood pressure (BP) changes in a short period (3 days), as well as the risk of acute transient ischemic attack, ischemic and hemorrhagic stroke, and acute cardiovascular events within 6 months after NSAID use. SUBJECTS AND METHODS: The follow-up included 66 patients (34 women and 32 men) who took NSAIDs for emergent low back pain. RESULTS: The findings may suggest that etoricoxib-based therapy is highly effective and relatively safe for the management of acute nonspecific backache in patients with comorbidity. The important feature is the established tendency towards BP destabilization in patients with chronic cerebrovascular diseases treated with NSAIDs (diclofenac, meloxicam, to a lesser extent, nimesulide). After completion of drug intake for 14 days or longer, acute cerebral circulatory disorder and acute cerebrovascular event developed within 4.5 months in 3 and 2 patients, respectively. CONCLUSION: Thus, the spectrum of possible adverse cardiovascular effects of NSAIDs is rather broad. It is advisable to identify two major groups of NSAID-associated complications: 1) destabilized hypertension; 2) cardiovascular and cerebrovascular events.

[Effect of nonsteroidal anti-inflammatory drugs on the indicators of cardiovascular risk in patients with acute nonspecific back pain].

AIM: To evaluate the safety of etoricoxib in patients with acute nonspecific back pain associated with the high risk of cardiovascular events (CVE) in clinical practice. SUBJECTS AND METHODS: The open prospective follow-up by a simple randomization method included 80 patients, including 49 women and 31 men (mean 60.8±4.7 years). The patients were randomized into 4 groups of 20 persons each: 1) etoricoxib 90 mg/day; 2) nimesulide 100 mg/day; 3) diclofenac 100 mg/day; 4) meloxicam 15 mg/day. The investigation lasted 90±4.5 days. The interim evaluation criteria (study points) were pain changes using a visual analog scale (VAS); blood pressure (BP) changes; diurnal BP rhythm; and changes in coagulation hemostatic parameters and blood biochemical markers. The primary evaluation criteria (study endpoints) were the incidence of CVE in the use of nonsteroidal anti-inflammatory drugs (NSAIDs). RESULTS: The patients with acute back pain were shown to have a high incidence of comorbidities during outpatient care. The administration of NSAIDs resulted in a significant reduction in the magnitude and intensity of pain syndrome according to VAS in all the groups just on day 3 of therapy with a more marked analgesia in patients receiving etoricoxib and diclofenac. All the groups exhibited an increase in average daily systolic and diastolic BP with the most favorable profile in Group 1 patients. The intake of etoricoxib and other NSAIDs provided no evidence for changes in hemostatic parameters and biochemical markers during 10 weeks. The safety of etoricoxib was comparable with that of NSAIDs in its effect on the plasma hemostatic system. CONCLUSION: Unlike nimesulide, diclofenac, and meloxicam, etoricoxib was characterized by a rapid steady-state analgesic effect with a less pronounced action on diurnal BP rhythm. Within 3 months after treatment, no acute CVE was recorded in the patients taking etoricoxib.