Персонализированная программа реабилитации пациентов старшего возраста с остеоартритом

Objective: to develop a personalized rehabilitation program for improving age-related resilience (AR), antioxidant status (AOS), the quality of life and reducing pain in elderly patients with osteoarthritis (OA).Patients and methods. The program consisted of two parts. In the first part, we conducted a comparative study to assess the AR (Mahnach test), geriatric status, and AOS (amperometric flow-injection analysis) in 181 subjects in total, with coxarthrosis (n=92) and without it (n=89). The average age of patients in two groups was comparable: 72.1±1.1 and 71.9±1.1 years. Using factor analysis, we developed the personalized rehabilitation program based on the obtained data. The effectiveness of the program was evaluated in the second part of our work. We conducted an additional comparative study of changes in AR, AOS, severity of joint pain (by visual analogue scale, VAS) and quality of life (according to SF-36 questionnaire) in patients with coxarthrosis (n=114).Results and discussion. Patients with coxarthrosis had significantly lower level of AR, total antioxidant, and antiradical activity, and a higher content of Schiff bases as compared to subjects without coxarthrosis (p<0.05). The program of rehabilitation, which included a course of treatment with Chondroquard, significantly improved AR, AOS, quality of life and reduced hip pain compared to the standard OA therapy (p<0.05).Conclusion. The personalized rehabilitation program has a complex positive effect on pain, quality of life, AR and AOS in elderly patients with OA.Цель исследования – разработка персонализированной программы реабилитации, направленной на повышение возрастной жизнеспособности (ВЖ), улучшение антиоксидантного статуса (АОС), уменьшение боли и улучшение качества жизни у пациентов старшего возраста с остеоартритом (ОА).Пациенты и методы. Программа состояла из двух частей. В первой части для оценки резервных показателей организма было проведено сравнительное исследование ВЖ (тест Махнача), гериатрического статуса и АОС (амперометрический проточно-инжекционный анализ) у 181 пациента с коксартрозом (n=92) и без такового (n=89). Средний возраст пациентов двух групп был сопоставим: 72,1±1,1 и 71,9±1,1 года. На основании полученных данных с использованием факторного анализа была разработана персонализированная программа реабилитации. Во второй части работы проводилась оценка ее эффективности. Было выполнено дополнительное сравнительное трехмесячное исследование динамики ВЖ, АОС, выраженности боли в суставах (по визуальной аналоговой шкале) и качества жизни (по SF-36), в которое вошли 114 пациентов с коксартрозом.Результаты и обсуждение. У пациентов с коксартрозом отмечались значимо более низкие показатели ВЖ, общей антиокислительной, антирадикальной активности и более высокое содержание шиффовых оснований по сравнению с таковыми у лиц без коксартроза (р<0,05). Разработанная программа реабилитации, включавшая курсовое лечение Хондрогардом, по сравнению со стандартной терапией ОА значимо улучшала ВЖ, АОС, качество жизни и уменьшала боль в тазобедренных суставах (р<0,05).Заключение. Персонализированная программа реабилитации оказывает комплексное положительное влияние на боль, качество жизни, ВЖ и АОС у пациентов старших возрастных групп с ОА

Neuroimmune and endocrine mechanisms of unfavorable geriatric status in patients with acute coronary syndrome

Background: Acute coronary syndrome (ACS) is the cause of above 70% of deaths in patients of older age. Frailty that develops in elderly patients provokes pro-inflammatory and neuroimmune inflammatory responses in the body that promote deterioration of the ACS course.Aim: To study neuroimmunoendocrine alterations in elderly patients with ACS depending on the presence or absence of the frailty syndrome.Materials and methods: The study was performed by retrospective, cross-sectional and prospective evaluation of the ACS patient registries within an international project GIRAFFE (Gerontological Research International Against Frailty: Fit Experience) in 2011–2015. We analyzed the results of measurement of serum tumor necrosis factor alfa (TNF-α) and the interleukin family (IL-1β, IL-4, IL-6, IL-10) in 633 patients with non-ST ACS (n = 270) and with ST-ACS (n = 363) at days 5, 12, and 26 from the beginning of the pain syndrome. From those, 265 patients were non-frail, 97 were pre-frail, and 271 patients had the frailty syndrome. The control group included 116 patients without significant somatic disease.Results: In all study groups of patients with non-ST ACS, there was an increase in IL-4, IL-6 and IL-10 levels, compared to their reference ranges, at day 5 from the beginning of the pain syndrome. Subsequently, these parameters were changing with therapy, similarly in all groups: IL-4 level gradually decreased by the end of the follow-up, IL-10 level increased by day 12 from the beginning of the pain syndrome and decreased by day 26. The lowest IL-10 levels compared to the reference range (1.5 ± 0.2 pg/mL) were seen in the elderly frail patients: 2.9 ± 0.6 pg/mL at day 5 from the beginning of the pain syndrome, 7.2 ± 1.2 pg/mL at day 12, and 1.9 ± 0.3 pg/mL at day 26, compared to 8 ± 1.2, 15.5 ± 1.6 and 6.2 ± 1.1 pg/mL in the isolated ACS group, respectively (all p < 0.05). In the group with non-ST ACS, higher TNF-α and IL-1β levels, compared to the control, were registered only in the elderly frail patients. Under treatment, these parameters did not reached the reference ranges, being 187.7 ± 6.5 and 310.2 ± 29.5 pg/mL at day 5 from the beginning of the pain syndrome, 165 ± 6 and 299.5 ± 29.4 pg/mL at day 12 and 154 ± 5.9 and 265.9 ± 27.9 at day 26, respectively, compared to 68.7 ± 3 pg/mL (p < 0.05 for all comparisons to the control group). In the ST-ACS patients, TNF-α, IL-1β, IL-4, IL-6, and IL-10 levels exceeded the reference ranges in all groups studied for the whole study duration. In the patients with the elderly frailty syndrome the serum concentrations of TNF-α, IL-1β, IL-6 and IL-10 were higher than in the non-frail and pre-frail patients with ST-ACS. The IL-4 levels were not informative for the assessment of the contribution of the elderly frailty to the ST-ACS course.Conclusion: The frailty syndrome of the elderly provokes the activation of the pro-inflammatory system that is confirmed by the consistent increase of serum pro-inflammatory mediators associated to the degree of the frailty syndrome in ACS patients

Progressive multifaceted approach to the management of geriatric patients with cardiac arrhythmias

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