Metabolic changes in elderly people with sarcopenia

Sarcopenia is a special condition that develops in older people. Sarcopenia represents a loss of muscle strength and mass in the elderly and is a common disease and is also associated with several adverse health effects. Due to the impact of sarcopenia on quality of life, disability and mortality, greater awareness is needed to correctly identify this condition and in particular its biological immunoendocrine markers. The purpose of the study was to study the characteristics of metabolism in sarcopenia in elderly people at the molecular, cellular and organizational levels. Material and methods. The study included 402 elderly people (199 men and 203 women, average age 68.9 ± 1.2 years), who are divided into three groups depending on the presence or absence of arterial hypertension and sarcopenia. The state of adipose and muscle tissue was studied using anthropometric measurements, bioimpedansometry and dynamometry. Results and discussion. The present study revealed a significant increase in energy exchange tension in patients with arterial hypertension, expressed in the increase in ADP content, but it was not enough to maintain the ATP/ADP ratio at the proper level. In patients with arterial hypertension and sarcopenia, a pronounced deficiency in ATP and ADP content, as well as ATP/ADP ratio was observed. The energy deficiency can also be explained by increase in lactate dehydrogenase activity in patients with arterial hypertension to compensate for energy deficiency by enhancing glycolysis processes. However, when sarcopenia was attached, this sanogenetic compensatory mechanism no longer worked. Conclusions. Dysfunction of adipose tissue in patients with arterial hypertension precedes the development of sarcopenia, while there is an increase in tension in energy exchange, expressed in elevation of ADP content, but when sarcopenia joins, there is a pronounced deficiency in both ATP and ADP content, as well as ATP/ADP ratio

The role of hematological parameters as predictors of mortality in elderly patients in the hospital period

The development of algorithms for predicting adverse outcomes, including death in elderly and senile patients, is an urgent issue. Potential predictors include hematologic parameters. A clinical blood test is one of the most affordable diagnostic methods in practical medicine, reflecting systemic pathological processes in the human body based on a quantitative assessment of the cellular composition and blood morphology. The aim of this study was to evaluate hematological parameters as predictors of in-hospital mortality in patients of the elderly and senile age with acute coronary syndrome.Material and methods. The study included 277 patients with acute coronary syndrome. The study of hematological parameters was carried out on a CELL-DYN Sapphire hematology analyzer (Abbott Laboratories, USA). The values of neutrophil-lymphocytes ratio and platelet-lymphocytes ratio were also evaluated as predictors of in-hospital mortality.Results. High content of leukocytes (above 10.45 x 109/l) during hospitalization in patients with ACS aged 60-74 years are associated with a higher risk of death at the hospital stage. Among patients with ACS aged 75-89 years, the risk of death is associated with the following changes in peripheral blood upon admission: a decrease in the absolute number of eosinophils below 0.086 x 109/l, an increase in the absolute number of basophils above 0.079 x 109/l and a decrease in platelet-lymphocytes ratio below 31.06

OPTIMIZATION OF THE HEART RATE CONTROL IN ATRIAL FIBRILLATION BY MONITORING OF THE DIGOXIN CONCENTRATION IN ELDERLY PATIENTS

Background. Digoxin takes important place in the management of patients with paroxysmal or persistent atrial fibrillation (AF). Monitoring of serum digoxin concentration (SDC) seems to be perspective way to improve the safety and efficacy of treatment. At the same time, there are no generally accepted reference ranges for SDC, especially in terms of the onset of therapy.Aim. To evaluate the potential contribution of SDC monitoring in the context of efficacy of AF treatment with the use of digoxin in elderly patients.Material and methods. A retrospective analysis of treatment of patients with recent-onset (n=91) or permanent (n=58) AF was performed. In all cases, the strategy of heart rate (HR) control was realized, including treatment with digoxin in 104 cases. SDC was measured twice during the digitalization: 20 hours after the first digoxin dose, and at the endpoint (time of sinus rhythm spontaneous restoration or, if the rhythm not restored, on day 7 of AF persistence).Results. The influence of digoxin on HR was dose-dependent since the 1st week of therapy, and the SDC dynamics was strictly associated with change in HR (r=-0.66, p<0.001). There was a negative correlation between the probability of the sinus rhythm restoration due to digoxin therapy and the SDC: its probability in high SDC was significantly lower compared to other approaches to the HR control (0% vs 76% in beta-blocker monotherapy; and vs 100% in therapy with beta-blocker + lower-SDC, p=0.036). In patients with persisted AF and low SDC, the digoxin was withdrawn more often due to lack of clinical efficiency.Conclusions. The SDC monitoring at the 1st week of digitalization could be used to improve the efficacy of therapy and to minimize the risks of spontaneous rhythm restoration, if not desired, and to reveal the disproportion between its high dose and low efficacy. The role of this diagnostic tool seems to be limited to safety control and negative predictive value for efficacy (the lower concentration, the higher risk of inefficiency), whereas its positive predictive value in terms of efficacy seems contradictory. The obtained data could be used for decision-making for recommendation of longterm digoxin usage if its contribution into HR control is doubtful

MONITORING OF SERUM DIGOXIN CONCENTRATION AND SAFETY OF THERAPY WITH DIGOXIN IN PATIENTS WITH ATRIAL FIBRILLATION

Background. Monitoring of serum digoxin concentration (SDC) is one of the approaches for controlling the safety of the long-term digoxin treatment, however, the benefits from SDC monitoring in paroxysmal arrhythmias have not been studied.Aim. To evaluate the potential benefits of digoxin laboratory monitoring at the initiation of digoxin therapy in patients with paroxysmal atrial fibrillation (AF).Material and methods. A retrospective analysis of SDC was performed in patients with paroxysmal or persistent (n=142) and permanent AF (n=48) who received digoxin therapy. Anthropometric features, comorbidity, anamnesis of the underlying disease, concomitant therapy, severity of signs of myocardial remodeling and the presence of cardiac rhythm and/or conduction disorders before and after the treatment were considered to analyze the results of treatment. SDC was measured in 20 hours after digoxin treatment initiation and after restoration of sinus rhythm, or in 1 week after the start of therapy if arrhythmia persisted.Results. During the first week after digoxin therapy initiation the rate of non-specific ECG repolarization abnormalities was 54%, the incidence of clinically significant conductivity disturbances – 28%. We found a relationship between SDC in the first week of treatment and the risk of high grade AVor SA-conduction abnormalities after the restoration of sinus rhythm (mean SDC 0.98Ѓ}0.72 ng/dL in the group of patients with complications and 0.45Ѓ}0.42 – in the group without them, p=0.015); these complications did not correlate with clinical signs of digitalization or intensity of digoxin therapy. The intake of digoxin was not an independent factor for the occurrence of cardiac rhythm disturbances. Comparison of the direct SDC measurements and the calculated values obtained with the valid calculators developed for the long-term digoxin use did not show reliable reproducibility of the calculated data.Conclusion. SDC monitoring may be used during the first week of therapy (before the establishment of a steady-state SDС) to minimize the risks of clinically significant adverse effects of digoxin on intracardiac conduction at the start of therapy. The existing empiric SDC calculators are not suitable as an alternative to the direct measurement. Further studies are needed to determine the clinically valid borderline values of the safe SDC in the condition of rapid digitalization

Statistical methods for river runoff prediction

Methods used to analyze one type of nonstationary stochastic processes?the periodically correlated process?are considered. Two methods of one-step-forward prediction of periodically correlated time series are examined. One-step-forward predictions made in accordance with an autoregression model and a model of an artificial neural network with one latent neuron layer and with an adaptation mechanism of network parameters in a moving time window were compared in terms of efficiency. The comparison showed that, in the case of prediction for one time step for time series of mean monthly water discharge, the simpler autoregression model is more efficient