The risks of developing adverse outcomes according to geriatric status in patients with coronary heart disease with plannedaorto-coronary artery bypass grafting

The article assesses the risks of developing adverse outcomes in patients with coronary heart disease who underwent planned aorto-coronary artery bypass grafting according to geriatric status using such scales as the cardiovascular health study frailt

Rehabilitation of patients with geriatric foot syndrome in out-patient settings

Geriatric (senile) foot, according to various authors, is one of the most common syndromes in the elderly and senile. This article describes the developed and scientifically substantiated tactics of rehabilitation treatment of patients with age-related foot syndrome in a clinic, which consists in identifying geriatric syndromes associated with age-related foot syndrome and the use of a set of measures to prevent their progression and treatmen

Results of lumbar interbody fusion in elderly patients with lumbar spinal stenosis associated with cauda equina syndrome

Background: Currently, there are no clear recommendations on the timing of surgical intervention for the slow development of cauda equina syndrome (CES) against the background of lumbar spinal stenosis (LSS) at the lumbar level in elderly patients. The information on the long-term effectiveness of decompressive and stabilizing interventions (DSI) in the lumbar spine in this pathology is also limited.Objective: To conduct a comparative analysis of the results of surgical treatment of elderly patients with LSS associated with CES after open and low-traumatic DSI.Material and methods: The retrospective study included 37 patients operated on between 2000 and 2020 for CES caused by LSS. Two groups were distinguished: in the first group (n = 17), an open DSI was performed with the median approach, in the second group (n = 20) a low-traumatic DSI was performed according to the author’s method. Technical features of interventions and specificity of the postoperative period, preoperative instrumental data, clinical parameters in dynamics, and complications were compared.Results: In a comparative analysis in the group of patients operated on with author’s low-traumatic DSI, smaller parameters were registered: the duration of the operation (p = 0.02), the blood loss (p = 0.003), the duration of inpatient treatment (p = 0.002), and the postoperative need for opioid analgesics (p < 0.05). In catamnesis, statistically significantly better clinical parameters of bladder sphincter control (p = 0.02) and motor function recovery (p = 0.01), Oswestry Disability Index (ODI) (p = 0.03) and the Short Form-36 (SF-36) (p = 0.01) were observed in patients of the group II, compared with the group I. A greater number of complications were noticed in the group of open DSI (p = 0.003), with a comparable frequency of reoperations in the follow-up period (p = 0.79).Conclusion: In elderly patients with CES-associated LSS, the advantages of the author’s low-traumatic DSI in comparison with open DSI were established of less blood loss and duration of hospitalization, low need for postoperative analgesia, the minimum number of complications, and the dynamics of neurological symptoms, better recovery of ODI and SF-36 in catamnesis

Developing an Individual Neurosurgical Strategy in Patients With a Two-Level Cervical Degenerative Disc Disease

Background: Little is written about substantiated clinical and biometric indications for dynamic stabilization, rigid fixation, and their combinations in patients with two-level degenerative disease of the cervical intervertebral discs (IVD).Objective: To study the risk factors for poor outcomes of two-segment interventions (total disk arthroplasty, TDA; anterior cervical discectomy and fusion, ACDF; and their combination) in patients with two-level degenerative diseases of the cervical IVD; to develop a custom clinical and instrumental assessment strategy for future interventions.Materials and methods: We retrospectively analyzed the outcomes in 118 patients with a two-level degenerative disease of the cervical IVD, who underwent TDA (n = 37), ACDF (n = 41), and their combination (n = 40) from 2005 to 2015. After this analysis, we built a mixed effects logistic regression model to identify and assess the impact of various risk factors on poor clinical outcomes in each intervention.Results: TDA correlated with favorable outcomes in patients with cervical lordosis over 12 °; I–III grade IVD changes according to Pfirrmann scale; I–II grade facet joints (FJ) changes according to Pathria criteria; no FJ tropism; segmental movements amplitude > 8 °; interbody space height ≤ 6 mm, and with no central spinal stenosis/spine interventions. Favorable ACDF outcomes may be achieved in patients with cervical lordosis ≥ 7 °; more than III grade IVD changes according to Pfirrmann scale; more than II grade changes in FJ according to Pathria criteria; segmental movements amplitude ≤ 8 °; interbody space height < 6 mm. FJ tropism, central spinal stenosis, and history of spine interventions do not affect ACDF outcomes.Conclusions: An individual approach to TDA, ACDF, and their combination as well as comprehensive preoperative clinical and instrumental assessment in patients with a two-level degenerative IVD disease contribute to the effective resolution of existing neurological symptoms, which reduced the pain severity in the cervical region and upper limbs, improve the patients’ functional status and quality of life in the late postoperative period, and reduce the number of postoperative complications and reinterventions

The risks of developing adverse outcomes according to geriatric status in patients with coronary heart disease with plannedaorto-coronary artery bypass grafting

The article assesses the risks of developing adverse outcomes in patients with coronary heart disease who underwent planned aorto-coronary artery bypass grafting according to geriatric status using such scales as the cardiovascular health study frailt

ASSESSMENT OF ANTIETY-DEPRESSIVE DISORDERS AND QUALITY OF LIFE IN MEN

Aim. To assess anxiety-depressive disorders and indicators of quality of life in men.Materials and methods. The study included 540 men with hormonal disturbances in the form of an age-related androgen deficiency, 270 men, aged 44-54 years (mean age  51.1±2.3), including 150 with "-" and 120 with "+" variant,  biological age and 270 men aged 55-64 years (mean age 59.2±2.4),  of which 150 with "-" and 120 with "+" version of  biological age. All patients, depending on the proposed variant of  nutritional support and physical activity, were divided into three  groups: the 1st (standard recommendations), the 2nd (standard  recommendations, Scandinavian walking and daily walks for at least 30 minutes), the 3rd (standard recommendations,  Scandinavian walking, daily walks for at least 30 minutes and  nutritional support). Assessment of the degree of depression was  carried out on the basis of the Beck scale. The quality of life was determined by the «SF-36 Health Status Survey», a visual  analogue scale for assessing the anxiety-depressive syndrome.Results. On the scale of assessing the level of depression, the level of anxiety-depressive syndrome in men, we obtained data on  improving this indicator when using nutritional support. The  maximum difference was noted in older persons with the "-" variant  of BV, which confirms the fact that nutritional support reduces the  degree of depression and the parameters of the anxiety-depressive  syndrome. On the scale of assessing the level of psychological  health, we obtained data on improving this indicator with nutritional  support, but a significant difference was found only in comparison  with patients who received neither nutritional support nor physical activity.Conclusion. Nutritional support improves the parameters of quality of life in elderly men, especially in terms of general health, depression and social functioning

IncobotulinumtoxinA in aesthetics: Russian multidisciplinary expert consensus recommendations

Yana Yutskovskaya,1 Elena Gubanova,2 Irina Khrustaleva,3 Vasiliy Atamanov,4 Anastasiya Saybel,5 Elena Parsagashvili,6 Irina Dmitrieva,7 Elena Sanchez,8 Natalia Lapatina,9 Tatiana Korolkova,10 Alena Saromytskaya,11 Elena Goltsova,12 Elmira Satardinova13 1Department of Dermatovenereology and Cosmetology, Pacific State Medical University, Vladivostock, 2Department of Skin and Venereal Diseases, Postgraduate Medical Institute, Moscow National University of Food Production, Moscow, 3Department of Plastic Surgery, IP Pavlov Medical State University, St Petersburg, 4Department of Reconstructive and Plastic Surgery, SN Fedorova, Federal State Institution, Novosibirsk, 5Clinic Ideal, Laser Technologies Center, Moscow, 6Aestima-clinic, 7Clinic “Academy”, St Petersburg, 8Eklan Medical Center of Cosmetological Correction, 9Clinic of Aesthetic Medicine and Plastic Surgery, Moscow, 10Department of Cosmetology, II Mechnikov North-Western State Medical University, St Petersburg, 11Plastic Surgery Clinic, Center of Aesthetic Medicine and Beauty Cosmetology, 12“Neo-Clinic,” Tyumen, 13Botulinum Toxin Therapy Department, Diagnostic Center of the Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia Background: Although there are various international consensus recommendations on the use of botulinum neurotoxin type A (BoNT/A) in facial aesthetics, there are no global or Russian guidelines on the optimal dose of incobotulinumtoxinA, free from complexing proteins, within specific aesthetic indications. This article reports the outcomes of two expert consensus meetings, conducted to review and analyze efficacy and tolerability data for incobotulinumtoxinA in various facial aesthetic indications and to give expert consensus recommendations to ensure best clinical practice among Russian clinicians. Methods: Thirteen dermatology and/or plastic surgery experts attended meetings held in Paris, France (November 2013), and Moscow, Russia (March 2014). The expert group reviewed and analyzed the existing evidence, consensus recommendations, and Russian experts’ extensive practical experience of incobotulinumtoxinA in aesthetics to reach consensus on optimal doses, potential dose adjustments, and injection sites of incobotulinumtoxinA for facial aesthetics. Results: All experts developed guidance on the optimal doses for incobotulinumtoxinA treatment of different regions of the upper and lower face. The expert panel agreed that there are no differences in the efficacy and duration of the effect between the four BoNT/As that are commercially available for facial aesthetic indications in Russia and that, when administered correctly, all BoNT/As can achieve optimal results. Experts also agreed that nonresponse to BoNT/A can be caused by neutralizing antibodies. Conclusion: On the basis of the scientific and clinical evidence available for incobotulinumtoxinA, coupled with the extensive clinical experience of the consensus group, experts recommended the optimal doses of incobotulinumtoxinA effective for treatment of wrinkles of the upper and lower face to achieve the expected aesthetic outcome. These first Russian guidelines on the optimal use of incobotulinumtoxinA for augmentation of glabellar lines, periorbital wrinkles, forehead lines, bunny lines, perioral wrinkles, depressor anguli oris, mentalis, masseters and platysmal bands, and performing the Nefertiti lift, are presented here. Keywords: incobotulinumtoxinA, free from complexing proteins, consensus guidelines, facial lines, dosage, aesthetics, Russi