[Comprehensive personalized protocol for the prevention of repeated falls in elderly and senile patients]. / Kompleksnyi personifitsirovannyi protokol profilaktiki povtornykh padenii u patsientov pozhilogo i starcheskogo vozrasta.

OBJECTIVE: To study evaluation of the effectiveness of a comprehensive personalized protocol for the prevention of repeated falls in elderly and senile patients. MATERIAL AND METHODS: Over the course of one year, 300 patients aged 60 and older who suffered two or more falls during the year were observed. Patients of group 1 (n=100) were recommended a comprehensive personalized protocol for the prevention of repeated falls, the observance of which was regularly monitored; patients of group 2 (n=100) received standard recommendations for the prevention of falls upon discharge from the hospital, the observance of which was not actively monitored; patients of group 3 (n=100) were observed by a therapist on an outpatient basis. Primary endpoints: frequency of falls, death from any cause; secondary endpoints: the frequency of fractures, the frequency of hospitalizations for any reason. RESULTS: In group 1, after a year, the frequency of falls decreased by 5 times (100% vs. 21%, p<0.0001), in groups 2 and 3 - by 38% (p=0.013) and 81% (p<0.001). There was no significant decrease in the number of all fractures in any group, but in group 3, the frequency of vertebral fractures increased during the year (p=0.029). Statistically significant positive dynamics of indicators characterizing the geriatric status has been established: walking speed, values on the basic activity scale, a short nutrition assessment scale, the results of the drawing hours test have increased, the intensity of pain has decreased. No one died in group 1, unlike 5 patients in group 2 and 8 in group 3 (p=0.011). CONCLUSION: The use of a comprehensive personalized protocol for the prevention of repeated falls can reduce the number of complications in elderly and senile patients.

[The place of chondroitin sulfate and glucosamine sulfate in osteoarthritis pain therapy: a practical view from evidence-based medicine]. / Mesto khondroitina sul'fata i gliukozamina sul'fata v terapii boli pri osteoartrite.

Osteoarthritis is one of the leading causes of a chronic pain in elderly people. Old and very old age in itself is a risk factor of a comorbidity, which often limits the therapy specified in clinical recommendations. First of all, it concerns NSAID. In such situations, priority is given to chondroitin sulfate (CS) and glucosamine sulfate (GS) having the anti-inflammatory properties comparable with effects of NSAID. CS and GS also promote the delay in progression of degenerative processes and restoration of the structure of cartilaginous tissue. The drugs of CS and GS groups are Chondroguard and Sustaguard Artro having the considerable evidence-based efficacy and safety and also a polymodality of effects in patients with a combination of osteoarthritis and socially important diseases (atherosclerosis, diabetes mellitus type 2, oncological diseases) and also geriatric syndromes (sarcopenia) and aging in general.

[Microsurgical elimination of foot soft tissue defects with free vascularized flaps]. / Mikrokhirurgicheskoe ustranenie defektov miagkikh tkaneí stopy svobodnymi vaskuliarizirovannymi loskutami.

The results of 40 microsurgical transplantations of complex flaps in 37 patients with cicatricial-ulcerous foot deformations are analysed. The surgery was indicated in cicatricial soft tissues defects, unhealing trophic ulcers, inability to use local tissues for plastic surgery. The scapular flap was used in 34 cases, thoraco-dorsal flap in 5 cases, deltoid flap in 1 case. It was necessary to increase the square of the scapular flap in case of a vast cicatricial soft tissue defect of the talocrural joint and dorsal surface of the foot and the sole. A special expander was used for this purpose. The importance of ultrasound methods for evaluation of the vessels supplying the sole, as well as the state of the microvascular anastomoses in postoperative period is stressed. The long-term results were followed up for 1.5 to 5 years in 29 of 37 patients. The good results was noted in 18 patients, satisfactory in 7 patients, complications (unhealed trophic ulcers) in 4 patients. The complications were caused by calcanel tuber deformation with osteophyte, osteomyelitis, inradically removed scars.