2015, volume 11

The aim of the research is to improve the efficiency of diagnosis and treatment of NSAID-induced enteropathy at elderly patients with chronic pain (osteoarthritis, dorsopathy). Material and Methods. 300 elderly with osteoarthritis or dorsopathies regularly (8 weeks or more) receiving diclofenac at 75 mg per day were inspected. Clinical features, morphology, components of the diffuse endocrine system of the small intestine were studied. Results. It is defined, that at elderly patients with regular use of NSAIDs in 25% of cases postbulbar erosive duodenitis, in 75% of cases inflammatory and atrophic changes of the distal duodenum were diagnosed. Diagnosis of NSAID-induced enteropathy at elderly should include faecal calprotectin and morphology analysis of postbulbar area of the duodenum. Use meloxicam and sulfasalazine at older patients helps to eliminate or reduce intestinal dyspepsia, malabsorption, and intestinal inflammation on the results of faecal calprotectin and of histology of the small intestine. Conclusion. Elderly patients are at high-risk group for NSAID-induced enteropathy due to functional disturbances in the neuroendocrine system of the small intestine.

The article analyzes the Russian and foreign publications on the issue of treatment of elderly and senile patients with critical limb ischemia and diabetes mellitus. It is shown that the topic is relevant, and, despite its wide coverage in the press, does not have the final decision. Currently unresolved issues include the terms and indications for reconstructive surgery, the amount and the method of amputation, postoperative care.

The given work summarizes external data and self-obtained results on development and diagnostic of kidney involution modifications. Article discusses definition of "senile kidney" as a clinical and pathomorphological term. Major statements on pathophysiological causes of age-associated renal disorders and their prognosis, specifics of chronic kidney disease in elderly and senile patients have been reviewed. Phenomenon of renal "multimorbidity" in eldely maximizes worsening risk of unmodifiable kidney function.

Purpose: to characterize biomarker panel in senile patients with heart failure with preserved ejection fraction (HF-pEF). Material and Methods. 356 senile patients with chronic heart failure with preserved ejection fraction (HFpEF) were examined to form the study sample of 48 male patients without atrium fibrillation, anemia, diabetes mellitus, onco-pathology and missing clinical data. NT-proBNP, galectin-3 (gal-3) and proANT assay was performed by commercially available ELISA kits. Results. In patients without left ventricular (LV) regional wall motion abnormalities (RWMA). gal-3 (2,13 (0,98; 3,50) vs 5.16 (4,34;9.63) ng/mL, p = 0.011) and NT-proBNP (5,59 (1,00; 10.13) vs 32,04 (15,40; 46,18) fmol/mL, p=0,006) levels were significantly lower than in patients with LV RWMA. Contrarily proANP level was lower in patients with LV RWMA (3,24 (2,47; 3,75) vs 1,38 (0,83; 2,29) nmol/mL, p=0.071). proANP was the only biomarker to increase significantly in long livers (7,30 (4,52; 7,63) vs 2,68 (1,88; 3,32) nmol/mL, p=0.006). NT-proBNP positively correlated with glucose level and negatively with hsCRP (R=0,52, p=0,007). Conclusion. Biomarker panel in senile heart failure patients with preserved ejection fraction has characterized: increase in NT-proBNP and galectin-3 is associated with more severe clinical course and presence of regional wall motion abnormalities in senile patients.

The purpose of the study was to estimate clinical signs and course of coronary heart disease in long-livers and centenarians. Material and Methods. The study included overall population of Saratov — Engels agglomeration's long-livers (>=90 years old, n=198). Results. The rates of major clinical forms of coronary heart disease were detected: atrial fibrillation — 10.6%, chronic heart failure (with preserved ejection fraction) — 10.1 % and angina — 5.1 %. Myocardial infarction was verified in 9.6% of long-livers. Myocardial scar criteria prevailed over myocardial infarction history. Received data corroborated dissolving phenomena of coronary heart disease and noninsulin dependent diabetes mellitus in long-livers. Gender differences in electrophysiological parameters were detected in long-livers. Centenarians with the history of myocardial infarction preserved a satisfactory level of physical activity. Conclusion. Received data confirm a presence of an excessive security: prevention of coronary heart disease manifestation and progression in longevity. Long-livers should be considered as a natural model of an antiatherogenic factors and mechanisms.

Purpose: to evaluate interaction of obesity, inflammation and myocardial dysfunction in senile myocardial infarction survivors. Material and Methods. Patients aged 70 and older were involved in the study (n=108) and divided into 2 groups according to the history of myocardial infarction (Ml) — 5 years before involvement: senile Ml survivors (n=26) vs senile patients without history of Ml (n=82). Measurements of serum levels of adipokines (leptin, adiponectin), myocardial dysfunction markers (BNP, NT proBNP, proANP, galectin 3) and inflammatory cytokines (TNF, interleukin 6) were performed. Results. Both groups were comparable by age and major clinical characteristics. Ejection fraction was preserved in both groups under the study (67 (64; 70) %vs67 (64; 68) %, p=0,655). Frequency of diastolic dysfunction was comparable in both groups. However it was more severe in Ml survivors. BNP and NT proBNP levels were significantly lower in patients without the history of Ml (p=0,021; 0,004, respectively). On the contrary serum levels of proANP had tendency to increase in patients with the history of Ml, but not significantly: p=0,821. Adiponectin and galectin-3 were significantly higher in patients with the history of Ml (p=0,019and p=0,011). Conclusion. Pathogenetic peculiarities of chronic heart failure with preserved ejection fraction in senile patients with and without myocardial infarction history were revealed. More expedient biomarker panel appropriate for senile patients with probable heart failure should include NT-proBNP, galectin-3 and adiponectin.

The purpose of the study: to examine age-dependent dynamics of parameters of biochemical screening in long-livers. Material and methods. The study included 201 long-livers divided (Saratov) into two groups: the main group (centenarians) and the control group (90-99 y.o.). Basic parameters of biochemical screening were analyzed. Results. The suited sample of centenarians characterized by significantly lower levels of total cholesterol, triglycerids, glucose and creatinine. All studied parameters progrediently decreased from early long-livers age to centenarians. Maximal rates of age dependencies allowed us to confirm maximal weight of lipids in early longevity and glucose and creatinine in centenarians. Conclusion. All present results are most likely explained by the combined effects of genetic, environmental and "hundred years" factors leading to dynamic remodeling of control systems. Major result of such remodeling is age-dependent optimal level of metabolic factors as a mechanism of successive ageing.

Present article summarizes the results of long-term studies of cardiovascular health parameters in war veterans of Saratov region admitted to Saratov regional hospital for war veterans. Cardiovascular disease spectrum and its prevalence dynamics were studied in war veterans. Clinical signs and disease course features of cardiovascular pathology were systematized including Great Patriotic War veterans, who successfully had reached the state of longevity.

Purpose of the study was to estimate current state of quality of life of Great Patriotic War veterans. Materials and methods. The study included 368 veterans of the Great Patriotic War according to Federal State "Concerning veterans" #5, 1995. Protocol of the study included adapted fragments of WHOQOL, WHOQOL-Old, SF-36, SIP questioners as well as visually-analog scale of self-assessment of quality of life with further going quality of life index calculations. Re-sults. In the studied sample of the Great Patriotic War (GPW) veterans including long-livers comparably was detected high level of quality of life (QOL) by physical criteria and independence level. It was revealed that QOL by self-service criteria in the GPW veterans was low and extremely variable by other criteria groups. Both ageing and gender influenced upon physical activity, self-service and QOL self-assessment. Women were outstanding by psychological criteria and independence with no association with age group. Conclusion. QOL indication in the GPW veterans of studied sample elucidated a satisfactory level of healthcare in the region, which allows veterans in certain way preserve both physical and psychological health, as well as grounds positive self-assessment of personal position in society and values system according to their life-goals and expectations.

The article summarizes the results of healthcare management of Great Patriotic War veterans for the last 20 years. This period included approbation and improvement of high-technology science-based and efficient healthcare system for war veterans. Healthcare managerial, medical and diagnostical activities are based on original analytical development including population system approach, biophysical approach to human organism, ageing, and senile and stress-induced disorders.