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The aim of the study was to evaluate the clinical manifestations and survival of patients with giant cell arteritis (GCA). MATERIALS AND METHODS: . A retrospective study included 166 patients with newly diagnosed GCA. Clinical, laboratory, and instrumental data and three sets of classification criteria were used to confirm the diagnosis: the American College of Rheumatology (ACR) 1990, the revised ACR criteria of 2016 and/or the new ACR and European Alliance of Rheumatologic Associations (EULAR) 2022 criteria. Some of the patients underwent instrumental investigations: temporal artery ultrasound Doppler (n = 61), contrast-enhanced computed tomography (n = 5), CT angiography (n = 6), magnetic resonance imaging (n = 4), MR angiography (n = 3), and 18F-FDG PET/CT (n = 47). Overall and recurrence-free survival rates were analyzed using survival tables and Kaplan-Meier method. RESULTS: . The most frequent first manifestations of GCA were headache (81.8%), weakness (64%), fever (63.8%), and symptoms of rheumatic polymyalgia (56.6%). Changes in temporal arteries in color duplex scanning were detected in 44 out of 61 patients. GCs therapy was performed in all patients who agreed to be treated (n = 158), methotrexate was used in 49 out of 158 patients, leflunomide in 9 patients. In 45 (28.5%) out of 158 patients, a stable remission was achieved as a result of GC monotherapy; in 120 (75.9%) patients, long-term maintenance therapy with GCs was required to prevent exacerbations, including 71 (44.9%) patients in combination with methotrexate or other immunosuppressive drugs. The follow-up period of patients with a history of relapses was 21.0 (8.0-54.0) months. Relapses developed in 73 (46.2%) patients. The overall one-year survival rate was 97.1% [95% CI 94.3; 99.9], and the five-year survival rate of patients was 94.6% [95% CI 90.2; 99.0]. The one-year relapse-free survival rate was 86.4% [95% CI 80.5; 92.3], and the five-year relapse-free survival rate was 52.4% [95% CI 42.0; 62.8]. Twelve (7.2%) of 166 patients died. The cause of death was myocardial infarction in two patients, stroke in two patients, and breast cancer in one patient; in the remaining seven cases, the cause of death was not determined. CONCLUSIONS: : Given the high frequency of disease exacerbation, patients with GCA require long-term follow-up, especially during the first year after diagnosis.
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Arterite de Células Gigantes , Arterite de Células Gigantes/diagnóstico por imagem , Arterite de Células Gigantes/tratamento farmacológico , Humanos , Estudos Retrospectivos , Feminino , Idoso , Masculino , Prognóstico , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Artérias Temporais/diagnóstico por imagem , Artérias Temporais/patologiaRESUMO
AIM: To study the real-world efficacy and safety of netakimab in the treatment of ankylosing spondylitis (AS) and psoriatic arthritis (PsA). MATERIALS AND METHODS: The retrospective analysis included 23 patients (13 males; 56.5%) aged 23 to 73 years (median 42, interquartile range 28 to 52 years) with AS (n=12) or PsA (n=11) who received netakimab therapy from February 2021 to April 2023. Disease activity was assessed every 3-6 months based on the C-reactive protein (CRP) level for all patients according to the BASDAI and ASDAS-CRP indices for AS, DAPSA and PASI for PsA. These indicators were analyzed before therapy and at the last visit to assess the effectiveness of treatment. The results are presented as median (interquartile range). RESULTS: In all patients treated with netakimab (median duration of treatment 11 months), the CRP level decreased from 10.6 (3.1; 17.3) to 3.1 (1.9; 8.9) mg/L (absolute difference -7.5 mg/L, median relative reduction -60%; p=0.008), and the proportion of patients with elevated CRP decreased from 70 to 41%; p=0.039. In patients with AS (median duration of treatment 9 months), BASDAI score decreased from 5.8 (4.7; 6.5) to 3.0 (1.9; 3.8) points (absolute difference -2.8 points, median relative reduction of -45%; p=0.008) and ASDAS-CRP score decreased from 2.8 (1.9; 3.9) to 1.9 (1.7; 2.6) points (absolute difference -0.9 points, median relative reduction -21%; p=0.007). The proportion of patients with high AS activity (BASDAI≥4) decreased from 90% to 20% (p=0.031); however, there was no significant change in the CRP level (absolute difference -4.9 mg/L, median relative reduction -57%; p=0.110). In patients with PsA (median duration of treatment 18 months), the CRP level decreased from 12.0 (4.5; 17.3) to 3.3 (2.0; 7.8) mg/L (absolute difference -8.7 mg/L, median relative reduction -80%; p=0.041), the DAPSA score decreased from 23.0 (19.0; 30.5) to 6.3 (5.2; 13.5) points (absolute difference -16.7 points, median relative reduction -69%; p=0.018). Three (13%) patients reported mild to moderate adverse events. CONCLUSION: The obtained data confirm the effectiveness and safety of netakimab in treating AS and PsA in real-world practice.
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Artrite Psoriásica , Espondilite Anquilosante , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Estudos Retrospectivos , Espondilite Anquilosante/tratamento farmacológico , Artrite Psoriásica/tratamento farmacológico , Proteína C-Reativa/análise , Proteína C-Reativa/metabolismo , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/farmacologia , Anticorpos Monoclonais Humanizados/uso terapêutico , Resultado do Tratamento , IdosoRESUMO
The effect of hyperenhancement of Raman scattering (RS) appearing on microcracks of the metal deposition (silver and gold) of uniaxially stretched polymer track-etched membranes is investigated. Deformation of membranes with a combination of high surface density and small diameter of their pores leads to the development of many microcracks in the metal coating. The efficiency of the surface enhancement RS (SERS) of the synthesized metasurfaces has been investigated on the example of organic compound malachite green, and the possibility to recognize extremely low fractions of the substance was demonstrated. An increase in the SERS signal with an increase in the deformation of the samples and even greater enhancement after their unloading and relaxation were found. The experiment on tensile strain and relaxation of the deformation of the samples and the consequent change in their electrical conductivity confirm the assumption that SERS appears on microcracks edges with a rather small distance between their boundaries. The SERS technique is proposed to analyze the formation of micro- and nanocracks on metal coatings.
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BACKGROUND: A low hemoglobin level in older adults impairs cognitive ability and functional status and associates with risk of falls and fractures, sarcopenia, malnutrition, depression, frailty, and decreased autonomy. Epidemiological data on the anemia prevalence in the geriatric population in our country is not available. AIM: To assess the prevalence of anemia and analyze its associations with geriatric syndromes (GS) in subjects aged 65 years. MATERIALS AND METHODS: 4308 subjects (30% of men) aged 65107 years, living in 11 regions of the Russian Federation, were examined and divided into age groups (6574 years, 7584 years and 85 years). All the participants underwent a comprehensive geriatric assessment and determined hemoglobin level. RESULTS: The anemia prevalence in older adults was 23.9%. It has been shown that with an increase in age per 1 year, the risk of anemia detection increases by 4%. The incidence of anemia was higher in males than females (28.1% versus 22.1%; p0.001). In most cases, anemia was mild. The results of a comprehensive geriatric assessment show that patients with anemia had lower hand grip force, Barthel Index, the sum of points on Lawton instrumental activities of daily living scale, Mini Nutritional Assessment scale, the Mini-Cog test and higher the sum of points on the Geriatric Depression Scale (GDS-15) and the Age Is No Barrier scale. Patients with anemia were more likely to use hearing aids, absorbent underwear, and assistive devices during movement. Patients with anemia had a higher incidence of all GS, except for orthostatic hypotension and chronic pain syndrome. The presence of GS is associated with an increased risk of anemia by 1.33.4 times. CONCLUSION: EVKALIPT study obtained domestic data on the prevalence of anemia in older patients and examined its associations with other GS.
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Atividades Cotidianas , Anemia , Masculino , Feminino , Idoso , Humanos , Prevalência , Força da Mão , Avaliação Geriátrica/métodos , Síndrome , Anemia/epidemiologia , HemoglobinasRESUMO
BACKGROUND: Osteoarthritis (OA) in elderly and senile patients is not only common, but also one of the main diseases affecting the duration of active life, its quality, the appearance of addictions and loss of autonomy. Data on the relationship between OA and geriatric syndromes (GS) in our country are extremely scarce. AIM: To estimate the prevalence of OA and to analyze its associations with HS in persons aged 65 years. MATERIALS AND METHODS: The study included 4308 people (30% of men) aged 65 to 107 years, living in 11 regions of Russia. The patients were divided into 2 groups: with OA (n=2464) and without OA (n=1821). All patients underwent a comprehensive geriatric assessment. RESULTS: The prevalence of OA was 57.6%. With age, the frequency of OA increased significantly. According to the results of a comprehensive geriatric assessment, patients with OA had lower walking speed, the sum of points on the Bartel, Lawton scales and a short battery of physical functioning tests and higher the sum of points on the geriatric scale of depression and the age is not a hindrance scale. Patients with OA rated the quality of life and health status lower and higher the intensity of pain syndrome. Patients with OA were more likely to use any assistive device, with the exception of a wheelchair. In patients with OA, the most common HS were chronic pain syndrome (92%), senile asthenia syndrome (64%), basic (66%) and instrumental (56%) dependence in everyday life, cognitive impairment (62%), probable depression (51%) and urinary incontinence (50%). Univariate regression analysis showed that OA is associated with a 1.23.0-fold increase in the risk of a number of GS and a 28% decrease in the risk of malnutrition. CONCLUSION: OA is widespread in the elderly population. The presence of OA is associated with a number of GS associated with loss of autonomy.
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Osteoartrite , Qualidade de Vida , Masculino , Idoso , Humanos , Prevalência , Acidentes por Quedas , Avaliação Geriátrica/métodos , Síndrome , Osteoartrite/epidemiologiaRESUMO
Anemia in older patients can be seen as a geriatric syndrome that impairs quality of life, functional status, reduces autonomy, and affects prognosis. Anemia is associated with other geriatric syndrome such as frailty, sarcopenia, falls and fractures, vitamin D deficiency, dementia and others. Iron deficiency anemia is the most common. Most often in older persons, the causes of its development are chronic blood loss and malnutrition. Laboratory criteria confirming iron deficiency anemia are hemoglobin reduction, microcytosis, low serum iron and ferritin. This is the basis for the administration of iron preparations, among which two- and threevalent ones are isolated. Trivalent iron preparations are most preferred in older patients because they have better tolerance and less frequency of side effects with comparable efficacy with divalent preparations.
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Anemia Ferropriva , Anemia , Idoso , Idoso de 80 Anos ou mais , Anemia/diagnóstico , Anemia/etiologia , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/epidemiologia , Estado Funcional , Humanos , Prognóstico , Qualidade de VidaRESUMO
in 3 mL on patients with knee osteoarthritis (OA) in a multicenter prospective study. MATERIALS AND METHODS: 79 outpatients (predominantly females 81.0%) from 5 RF constituent territories with primary tibiofemoral KellgrenLawrence score grade II or III knee OA, 40 mm pain intensity during walking on visual analogue scale (VAS), requiring NSAIDs intake (for at least 30 days during 3 months prior to enrollment) were included into the study after signing the informed consent form. Mean age was 60.38.7 years, mean BMI 29.24.7 kg/m2, disease duration 6 (310) years. Grade II OA was documented in 68.4% of patients, Grade III in 31.6%. The study lasted for 6 months. Efficacy and safety evaluations were made based on VAS pain assessment, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) [WOMAC pain (0500), WOMAC function (01700), WOMAC stiffness (0200)], VAS patients health status, EQ-5D-based assessment of patients quality of life, global physicians and patients efficacy assessment, and daily NSAIDs requirements. RESULTS: Obtained results demonstrate statistically significant VAS pain reduction during walking already in 1 week after intra-articular injection of the combination [respectively, 62 (5572) and 41 (3251) mm, Ñ0.0001]. Moreover, pain continued to subside during all 3 months of follow up [in 1 month 28 (2042), in 3 month 22 (1437) mm]. A significant pan reduction achieved at Mo 3 persisted until Mo 6 20 (1442) mm, without documented pain increase. Similar trends were observed with total WOMAC score [1125 (8991540) at baseline, and 552 (309837) mm by the end of the study, p0.0001], and all WOMAC sub-scores [268 (189312) baseline WOMAC pain, 91 (48171) mm by the end of the study p0.0001; stiffness 101 (59130) and 40 (2061) mm, p0.0001; function 802 (6471095) and 402 (191638) mm, p0.0001, respectively]. Median time to the onset of therapeutic effect was 7 (518) days. Statistically significant improvement of patients quality of life by EQ-5D and general health status was observed during all follow up period [respectively, 0.52 (-0.020.59) and 0.69 (0.590.80), Ñ0.0001; 48 (3060) and 72 (6080) mm, Ñ0.0001]. One injection of the drug resulted in dose reduction or discontinuation of NSAIDs therapy: at baseline 76 patients (96.2%) were taking NSAIDs, in one week 31 (39.2%) patients discontinued NSAIDs, in 1 month 72.2%, in 3 months 73.4%, and by the end of the study at Mo 6 54.4% were not taking NSAIDs. These data were consistent with physicians and patients global assessment of the efficacy of treatment, who stated significant improvement and improvement in the majority of cases, with only few no effect or worsening cases documented in analyzed population. Adverse events, such as worsening of pain and/or swelling of the joint, were documented in 8 patients (10.1%); they resolved spontaneously or following NSAIDs intake. CONCLUSION: These results suggest that intra-articular injections of hyaluronic acid plus chondroitin sulfate in patients with knee OA are efficient and safe. A single injection of the drug resulted in statistically significant reduction of pain and stiffness, reduction in NSAIDs intake, as well as improvement in patients quality of life and function.
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Ácido Hialurônico , Osteoartrite do Joelho , Sulfatos de Condroitina , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Resultado do TratamentoRESUMO
The refractive index n is one of the most important materials parameters of solids and, in recent years, has become the subject of significant interdisciplinary interest, especially in nanostructures and meta-materials. It is, in principle, a macroscopic quantity, so its meaning on a length scale of a few nanometers, i.e., well below the wavelength of light, is not clear a priori and is related to methods of its measurement on this length scale. Here we introduce a novel experimental approach for mapping the effective local value [Formula: see text] of the refractive index in solid films and the analysis of related local-field enhancement effects. The approach is based on the imaging and spectroscopy of single chromophore molecules at cryogenic temperatures. Since the fluorescence lifetime T1 of dye molecules in a transparent matrix depends on the refractive index due to the local density of the electromagnetic field (i.e., of the photon states), one can obtain the local [Formula: see text] values in the surroundings of individual chromophores simply by measuring their T1 times. Spatial mapping of the local [Formula: see text] values is accomplished by localizing the corresponding chromophores with nanometer accuracy. We demonstrate this approach for a polycrystalline n-hexadecane film doped with terrylene. Unexpectedly large fluctuations of local-field effects and effective [Formula: see text] values (the latter between 1.1 and 1.9) were found.
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The review presents current information on the role of NSAIDs in the development of cardiovascular disasters. The development of non-desirable cardiovascular effects and an increase in cardiovascular risk with the administration of NSAIDs, most experts assess in terms of the antagonistic effect on the platelet-vascular homeostasis of metabolites of COX-thromboxane A2 and prostaglandin I2 (prostacyclin). All the presented reviews confirming an increase in the risk of MI complications in the administration of NSAIDs, indicate the class-specificity of this undesirable effect, not homogeneous for different representatives of the group. Important clinical aspects of prescribing NSAIDs for patients with low and moderate cardiovascular risk are the clinical features of the patient and the individual set of risk factors for CVD. Such pharmacokinetic characteristics of NSAIDs as a short half-life, a high degree of binding to blood plasma albumins are indicative of greater safety of NSAIDs, but the final decision must be made based on the accumulated data of clinical trials and meta-analyzes. Keywords: nonsteroidal anti-inflammatory drugs, cardiovascular diseases, cardiovascular risk, lornoxicam, diclofenac sodium, thrombo-elastogram, myocardial infarction, stroke.
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Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Doenças Cardiovasculares/tratamento farmacológico , Diclofenaco/administração & dosagem , Diclofenaco/efeitos adversos , Infarto do Miocárdio/tratamento farmacológico , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , Humanos , Fatores de RiscoRESUMO
Aging is an independent risk factor for the development of many diseases and geriatric syndromes. Osteoarthritis (OA), as the most common joint disease in the elderly, can be attributed to age - associated conditions. And the most significant geriatric syndrome, which dramatically affects the management and prognosis of an elderly, is frailty. The review provides current information on the prevalence of OA and frailty, their clinical and prognostic significance, and also shows the mutually aggravating role of these two conditions. The difference between non - and medication management of patients with OA and frailty is emphasized.
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Envelhecimento , Anti-Inflamatórios não Esteroides/uso terapêutico , Fragilidade/complicações , Osteoartrite/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Sulfatos de Condroitina/uso terapêutico , Dor Crônica , Idoso Fragilizado , Glucosamina/uso terapêutico , Humanos , Osteoartrite/complicações , SíndromeRESUMO
The literature review is devoted to the peculiarities of treating co-morbid patients with acute conditions of chronic pain. The proved effect of NSAIDS must always correlate with the side effect risk. Patented microcrystalline glucosamine sulfate (pCGS) is likely to have an effect similar to NSAIDS because it can cause decrease of COX-2 and PGE2 gene expression. Randomized trials show, that patented microcrystalline glucosamine sulfate can impede complex structure changes and have a positive effect on the symptoms at the early stage of knee OA. Pharmacokinetic evidence demonstrates that repeated oral intake of microcrystalline glucosamine sulfate can cause the increase of GS in synovial fluid. It is necessary to monitor OA biomarkers during microcrystalline GS treatment, recommend appropriate physical exercise and study the neuropathic component of chronic pain.
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Anti-Inflamatórios não Esteroides , Glucosamina , Osteoartrite , Anti-Inflamatórios não Esteroides/efeitos adversos , Comorbidade , Glucosamina/uso terapêutico , Humanos , Osteoartrite/tratamento farmacológico , SulfatosRESUMO
We studied space-charge-distribution phenomena in planar GaN nanowires and nanoribbons (NRs). The results obtained at low voltages demonstrate that the electron concentration changes not only at the edges of the NR, but also in the middle part of the NR. The effect is stronger with decreasing NR width. Moreover, the spatial separation of the positive and negative charges results in electric-field patterns outside the NR. This remarkable feature of electrostatic fields outside the NR may be even stronger in 2D material structures. For larger voltages the space-charge-limited current (SCLC) effect determines the main mechanism of transport in the NR samples. The onset of the SCLC effect clearly correlates with the NR width. The results are confirmed by noise spectroscopy studies of the NR transport. We found that the noise increases with decreasing NR width and the shape of the spectra changes with voltage increase with a tendency toward slope (3/2), reflecting diffusion processes due to the SCLC effect. At higher voltages noise decreases as a result of changes in the scattering mechanisms. We suggest that the features of the electric current and noise found in the NRs are of general character and will have an impact on the development of NR-based devices.
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We suggest a novel approach for spatially resolved probing of local fluctuations of the refractive index n in solids by means of single-molecule (SM) spectroscopy. It is based on the dependence T1(n) of the effective radiative lifetime T1 of dye centres in solids on n due to the local-field effects. Detection of SM zero-phonon lines at low temperatures gives the values of the SM natural spectral linewidth (which is inversely proportional to T1) and makes it possible to reveal the distribution of the local n values in solids. Here we demonstrate this possibility on the example of amorphous polyethylene and polycrystalline naphthalene doped with terrylene. In particular, we show that the obtained distributions of lifetime limited spectral linewidths of terrylene molecules embedded into these matrices are due to the spatial fluctuations of the refractive index local values.
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The paper considers the current pathogenesis, by choosing the actual targets of pharmacotherapy with available drugs. It reflects the cytokine mechanisms responsible for lesion of the synovial membranes, cartilage, and subchondral bone. Particular emphasis is laid on the role of chondroitin sulfate, glucosamine, vitamin D3 as drugs that affect the key components of pathogenesis, including the volume of resorptive cavities in the subchondral bone.
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Densidade Óssea/fisiologia , Reabsorção Óssea/tratamento farmacológico , Colecalciferol/uso terapêutico , Sulfatos de Condroitina/uso terapêutico , Citocinas/metabolismo , Glucosamina/uso terapêutico , Osteoartrite/etiologia , Densidade Óssea/efeitos dos fármacos , Conservadores da Densidade Óssea/uso terapêutico , Reabsorção Óssea/complicações , Reabsorção Óssea/metabolismo , Humanos , Osteoartrite/metabolismo , Osteoartrite/prevenção & controle , Resultado do TratamentoRESUMO
Diseases of the musculoskeletal system in Russia affect 19.2 million people. Untimely diagnosis and inadequate therapy of pain syndrome negatively affect the daily functioning and quality of life of patients, and create significant socioeconomic problems. The most common variants of musculoskeletal pain (MSP) are osteoarthritis (OA) and low back pain (LBP). OA is seen in 57.6% of individuals over 65 years of age. It should be noted that chronic pain syndrome, rather than anatomical and degenerative changes detected by imaging studies, determines to a greater extent the quality of life of patients with OA and prognosis during the course of the disease. The global burden of disability associated with LBPD increased in all age groups between 1990 and 2019 and was highest in the 50-54 age group.
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We present a method for the spectrally resolved analysis of fluorescence blinking of single quantum emitters. It is based on the well-known technique of repeated recording of single-molecule (SM) fluorescence excitation spectra. The potential of our approach is presented for the example of single tetra-tert-butylterrylene molecules in an amorphous polymer matrix (polyisobutylene), which exhibit fluorescence blinking at cryogenic temperatures. Measuring the spectral dependence of the blinking statistics improves the possibility to clarify the microscopic nature of the dark state(s) of the emitters. We demonstrate how the blinking statistics can be definitely attributed to conformational changes in the local environment of a SM and how the parameters of the corresponding elementary excitations can be measured. The analysis of the blinking statistics as a function of the optical excitation frequency allows us to discriminate between photo-induced and spontaneous transitions into a dark state.
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The effectiveness of predicting the dynamics of the coronavirus pandemic for Russia as a whole and for Moscow is studied for a two-year period beginning March 2020. The comparison includes well-proven population models and statistic methods along with a new data-driven model based on the LSTM neural network. The latter model is trained on a set of Russian regions simultaneously, and predicts the total number of cases on the 14-day forecast horizon. Prediction accuracy is estimated by the mean absolute percent error (MAPE). The results show that all the considered models, both simple and more complex, have similar efficiency. The lowest error achieved is 18% MAPE for Moscow and 8% MAPE for Russia.
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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.
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Acidentes por Quedas , Fraturas Ósseas , Acidentes por Quedas/prevenção & controle , Idoso , Fraturas Ósseas/etiologia , Fraturas Ósseas/prevenção & controle , Avaliação Geriátrica/métodos , Hospitalização , Humanos , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
BACKGROUND: Older adults with severe osteoporosis are the most vulnerable group of geriatric patients. They are shown the purpose of anti-osteoporotic therapy, which should be effective and safe. Teriparatide showed a decrease in the risk of fractures, an increase in BMD. In Russia, the use of teriparatide in the geriatric population is extremely scarce. AIM: assess clinical course, bone metabolism parameters and efficacy of bone-anabolic therapy in elderly and senile patients with severe osteoporosis and falls. MATERIALS AND METHODS: The longitudinal prospective study included 100 patients 60 years and older with severe osteoporosis who had one or more falls within the last year. All patients were prescribed calcium and vitamin D preparations and bone-anabolic therapy (teriparatide 20 mg daily subcutaneously). The duration of follow-up was 24 months and included 3 visits: screening, at 12 and 24 months. The effectiveness of bone-anabolic therapy was carried out on the basis of assessing the frequency of new fractures, reduction of pain, changes in BMD according to X-ray densitometry, dynamics of bone metabolism markers. RESULTS: All patients had severe osteoporosis and aggravated comorbidity status, suffered a fall within the last year, and also low-energy fractures in the past. One in three patients had a vertebral fracture, one in five had a proximal femoral fracture. Prior to the start of the study, 61 patients received antiosteoporotic therapy. During the follow-up, 4 patients died, 96 patients completed the study. Against the background of teriparatide therapy, a decrease in the number of new cases of low-energy fractures and the number of patients with chronic pain was obtained. An increase in BMD was noted in the lumbar spine after 24 months and in the femoral neck after 12 months. There was no negative dynamics of the BMD. Also after 12 months, an increase in P1NP and C-terminal telopeptide of collagen type 1 was noted, after 24 months - osteocalcin and C-terminal telopeptide. CONCLUSION: The use of teriparatide can be recommended as an effective intervention to treat severe osteoporosis in geriatric patients with falls.
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Conservadores da Densidade Óssea , Fraturas Ósseas , Osteoporose , Acidentes por Quedas , Idoso , Densidade Óssea , Conservadores da Densidade Óssea/farmacologia , Conservadores da Densidade Óssea/uso terapêutico , Remodelação Óssea , Colo do Fêmur , Fraturas Ósseas/induzido quimicamente , Fraturas Ósseas/tratamento farmacológico , Humanos , Osteoporose/induzido quimicamente , Osteoporose/complicações , Osteoporose/tratamento farmacológico , Estudos Prospectivos , Teriparatida/farmacologia , Teriparatida/uso terapêuticoRESUMO
The large amount of data accumulated so far on the dynamics of the COVID-19 outbreak has allowed assessing the accuracy of forecasting methods in retrospect. This work compares several basic time series analysis methods, including machine learning methods, for forecasting the number of confirmed cases for some days ahead. Year-long data for all regions of Russia has been used from the Yandex DataLens platform. As a result, accuracy estimates for these basic methods have been obtained for Russian regions and Russia as a whole, in dependence on the forecasting horizon. The best basic models for forecasting for 14 days are exponential smoothing and ARIMA, with an error of 11-19% by the MAPE metric for the latest part of the course of the epidemic. The accuracies obtained can be considered as baselines for more complex prospective models.