[Visual deficit as a marker of cognitive impairment.]

Glaucoma and cataract continue to be the leading causes of visual deficits, especially in older age groups, but the association of visual deficits with cognitive impairments has not been sufficiently studied. The aim of this study is to study visual impairment as a marker of cognitive impairment in patients with cataracts and glaucoma. The study included 326 elderly patients with cataracts and 318 elderly patients with primary open-angle glaucoma. The degree of cognitive impairment was determined using the Mini-Mental State Examination (MMSE) scale. Visual deficit was assessed by visual acuity without correction and maximum corrected visual acuity, and the severity of visual deficit was assessed by the scale we proposed. It was found that with low visual deficit (visual acuity without correction 0,51-0,60 and over 0,61) in the examined patients, the average score on the MMSE scale varied from 28,4±0,6 to 28,7±0,8 points (p>0,05), corresponding to subjective cognitive disorders. However, with a pronounced visual deficit (visual acuity without correction to 0,20 and 0,21-0,30), the average score is 13,9±0,3 and 16,5±0,4 (p<0,001), which indicates moderate dementia. Practically similar patterns about the association of cognitive impairments with the magnitude of visual deficit were also obtained when assessing visual deficit by maximum corrected visual acuity. The associativity of cognitive impairment with visual defect in patients with cataract and glaucoma was confirmed by the correlation method, according to which the correlation coefficient with visual acuity without correction is r=+0,428 (p<0,05), and with maximum corrected visual acuity - r=+0,385 (p<0,05). The results of the study allow us to consider visual deficit as a marker of cognitive impairment.

[The social and medical aspects of falls in elderly and senile age under eyesight deficiency].

The aging of population is accompanied by simultaneous increasing of rate of age-associated ophthalmic diseases resulting in vision decreasing. However, visual impairment in elderly and senile age is rarely considered in the epidemiology of falls in these groups. The purpose of the study is to investigate medical social aspects of falls in older age groups with visual impairment. The retrospective methodology was applied to study falls in 4832 elderly and senile patients with visual impairment due to cataract glaucoma, diabetic retinopathy and age-related macular degeneration. The high incidence of falls in men and women aged 80 and older, amounting to 82.6 and 125.7 cases per 1000 of population of corresponding age respectively was established. The falls in elderly patients with low vision is more often registered in case of diabetic retinopathy than of glaucoma, cataract and age-related macular degeneration without significant differences at the age 50-59 years and 60-69 years. The diabetic retinopathy is the most common cause of falls requiring hospitalization in all age groups. To In reducing prevalence of falls and resulted hospitalization, to optimize traumatological care of patients of older age groups, the priority is for early identification and treatment of people with diabetic retinopathy.

[Allostatic load in patients with diabetic retinopathy]. / Allostaticheskaya nagruzka u patsientov s diabeticheskoi retinopatiei.

Diabetic retinopathy (DR) occupies a special place among the causes of progressive decline and loss of visual acuity, it significantly impairs the quality of life and viability of elderly patients, and allostatic load is considered its integral indicator. However, the allostatic load in patients suffering from diabetic retinopathy, as well as in other ophthalmological diseases, has not been extensively studied, so biomarkers characterizing the allostatic load of patients with diabetic retinopathy remain unknown. PURPOSE: This study investigates the allostatic load in patients with diabetic retinopathy and attempts to identify the biomarkers that determine it to the fullest extent. MATERIAL AND METHODS: Allostatic load was studied in 78 elderly patients with diabetic retinopathy and type 2 diabetes mellitus, and in 62 patients with type 2 diabetes mellitus without diabetic retinopathy. Allostatic load was evaluated by analyzing systolic and diastolic blood pressure, body mass index, glycated hemoglobin, total cholesterol, triglycerides, albumins, C-reactive protein, homocysteine in the blood and glomerular filtration rate. RESULTS: It was found that in patients with diabetic retinopathy the most pronounced and statistically significant excess was in the content of glycated hemoglobin in the blood up to 10.2% versus 7.4%, and homocysteine up to 15.5 mmol/L versus 7.9 mmol/L compared to patients with diabetes mellitus without diabetic retinopathy, respectively. The value of the allostatic index was significantly higher in patients with diabetic retinopathy, amounting to 4.6±0.4 points, versus 2.9±0.3 points in patients with diabetes mellitus without the studied ophthalmic pathology (p<0.001). Factor analysis made it possible to identify biomarkers of allostatic load in patients with diabetic retinopathy - glycated hemoglobin, homocysteine, triglycerides and albumins. CONCLUSION: The identified biomarkers can be used for assessing the viability and the effectiveness of rehabilitation measures carried out in patients with diabetic retinopathy.

[Telmisartan chronotherapy and its influence on the indicators of the daily profile blood pressure.]

Arterial hypertension is one of the most common life-threatening diseases, adequate control of which is largely achieved by antihypertensive drugs, including the use of telmisartan. The aim of the study was to evaluate the effect of telmisartan chronotherapy on the parameters of daily monitoring of blood pressure during the daytime and at night in elderly patients with hypertension. The study is based on a comprehensive examination of 150 patients aged 60-74 years suffering from hypertension, who are divided into 2 groups: the main (n=76) and control (n=74). Patients with hypertension in the main group received telmisartan at a dose of 80 mg/day in the evening (20.00-22.00 hours), and in the control group - in the morning at the same dose (80 mg/day). Before treatment, after 3 months and after 6 months, patients of both groups underwent daily monitoring of blood pressure with the «BPLab monitor Mn SDP-3¼. It was found that the evening intake of telmisartan at a dose of 80 mg/day has a more significant effect than the morning intake of the same dose of telmisartan on the indicators of daily monitoring of systolic blood pressure and diastolic blood pressure in the evening, the systolic blood pressure time index in the evening. Chronotherapy with telmisartan in elderly patients with hypertension more effectively normalizes the daily blood pressure profile with the transfer of «non-dipper¼ to «dipper¼, reduces the hypertensive load and contributes to the achievement of target blood pressure levels.

[The effect of sarcopenic obesity and age-associated ophthalmopathology on patients' daily activities.]

Along with an increase in the number of elderly and senile populations, there will simultaneously be an increase in the prevalence of age-associated ophthalmopathology and sarcopenic obesity, which can potentially contribute to a decrease in patients' activities in everyday life, but the latter remains practically unexplored, and if analyzed, then without the use of special scales for patients with visual organ pathology or quality of life indicators. The aim of the study was to study the effect of sarcopenic obesity and age-associated ophthalmopathology on the activities of patients in everyday life. 125 mature and elderly patients suffering from sarcopenic obesity combined with cataract and 138 patients of similar age with sarcopenic obesity combined with glaucoma were examined. Sarcopenic obesity was detected by the presence of obesity with a body mass index ≥30 kg/m2 and sarcopenia on the scale of the European Working Group on Sarcopenia in older people, supplemented by carpal dynamometry. It was found that, in comparison sarcopenic obesity with age-related cataracts, it has a more significant effect on changing activities in daily life, contributing to the formation of complete dependence on outside help (12,18 points) compared with sarcopenic obesity and glaucoma (10,18 points), p<0,001, when moderate dependence on others was found. However, regardless of the nosology of the ophthalmic disease, in both clinical groups, the leading limitations of activities in daily life were needle threading (1,84±0,03 vs 1,52±0,02 points), nail clipping - 1,75±0,03 vs 1,43±0,04 points, respectively. The results obtained can be used in gerontology in the implementation of measures to correct and maintain functionality in the daily life of patients with sarcopenic obesity combined with glaucoma and cataracts.

[Prognostic value of matrix metalloproteinases in the development of diabetic retinopathy in the elderly].

The development of diabetic retinopathy is associated with matrix metalloproteinases, but they are rarely used to predict this pathology. The aim of the study was to predict the development of non-proliferative diabetic retinopathy in old age by the level of matrix metalloproteinases in blood plasma. The main study group consisted of 63 patients aged 60-74 years with type 2 diabetes mellitus and non-proliferative diabetic retinopathy, the control was 56 patients of the same age with type 2 diabetes mellitus and the absence of diabetic retinopathy and other ophthalmopathology at present and in the anamnesis. Examination of patients of both groups included: tonometry, visiometry, standard fundus photoregistration, optical coherence tomography, optical coherence tomography-A, fluorescent angiography. Determination of matrix metalloproteinases was carried out by the method of solid-phase enzyme immunoassay. There was a statistically significant increase in matrix metalloproteinase-9 in the main group of patients to 55,7±2,6 ng/ml versus 40,2±1,9 ng/ml in the age control, matrix metalloproteinase-2 to 269,8±4,2 ng/ml versus 221,9±3,6 ng/ml, respectively. Based on the level of matrix metalloproteinases-2 (X1) and -9 (X2) in the blood, a regression model was created by the regression method to predict the development of diabetic retinopathy, having the form Y=28,315+3,892·X1+2,453·X2, which will allow detecting the disease at an early stage.

[Effect of combined diabetic retinopathy and cataract on instrumental functional activity of patients.]

A potential factor that significantly reduces the social activity of older people is visual impairment due to age-associated eye diseases - cataracts and diabetic retinopathy, which dominate in this age cohort. The aim of the study was to study the social activity of elderly patients with diabetic retinopathy and cataracts. According to a special questionnaire, 115 people 60-74 years old with combined cataract and diabetic retinopathy and 102 people 60-74 years old without ophthalmological diseases were questioned based on the Tambov branch of the MNTK «Academician S.N.Fedorov Eye Microsurgery¼. It was found that the average score of social activity in patients with cataract and diabetic retinopathy is statistically significantly lower, amounting to 3,10±0,08 points, versus 5,38±0,09 points in people without ophthalmopathology. The main reasons that reduce social activity in patients with visual impairment are problems with making various purchases and using public or personal transport. Factor analysis confirmed that the contribution of these reasons to the decrease in social activity is the highest and amounts to 0,876 and 0,708, respectively. Therefore, it is recommended to increase social assistance to patients with cataracts and diabetic retinopathy in solving the problems of using transport and purchasing various goods.

Psychological Continuum of Elderly Patients Suffering from Arterial Hypertension with Metabolic Syndrome, Against the Background of Chronotherapy with a Fixed Combination of Amlodipine, Lisinopril and Rosuvastatin.

Aim        To study the psychological continuum in elderly patients with arterial hypertension associated with metabolic syndrome during the chronotherapy with a fixed combination (FC) of amlodipine, lisinopril, and rosuvastatin.Material and methods        In the inpatient conditions, 63 patients aged 60-74 years with arterial hypertension associated with metabolic syndrome were treated with chronotherapy with a FC of amlodipine, lisinopril, and rosuvastatin (5 / 10 / 10 mg/day in the evening). These patients composed the main group. The control group (58 patients aged 60-74 years with arterial hypertension associated with metabolic syndrome) was treated with the FC of amlodipine, lisinopril, and rosuvastatin at the same dose of 5 / 10 / 10 mg/day in the morning.Results   At one year, the disorders of psychological continuum were significantly decreased with the chronotherapy (evening dosing) with the antihypertensive FC of amlodipine, lisinopril, and rosuvastatin compared to the traditional treatment (morning dosing) at the same dose of 5 / 10 / 10 mg/day in both groups. With the chronotherapeutic approach, the dynamic of cognitive disorders in patients aged 60-74 years with arterial hypertension associated with metabolic syndrome was characterized by a significant increase in the Mini-Mental-State-Examination scale score from 17.8±0.3 at baseline to 23.5±0.4 with the evening dosing (р<0.001) vs. the increase from 16.9±0.3 to 20.4±0.4 (р<0.001) with the morning dosing. The situational anxiety score decreased from 40.0±2.2 to 30.6±1.8 (р<0.05) and from 40.8±2.5 to 33.5±1.9  (р<0.05), and the trait anxiety score decreased from 48.8±2.0 to 26.4±1.9 (р<0.001) and from 44.9±1.9 to 30.7±1.7  (р<0.01) with the evening and morning dosing, respectively. Depressive disorders slightly decreased with the chronotherapy by 14.1 % vs. 7.7 % with the traditional regimen; nevertheless, they were consistent with depressive spectrum disorders in both groups.Conclusion            The study results showed a higher effectiveness of the chronotherapeutic treatment compared to the traditional treatment with FC of amlodipine, lisinopril, and rosuvastatin in arterial hypertension with metabolic syndrome.

Vitamin D Deficiency as an Independent Predictor of Myocardial Infarction in the Elderly.

Cardiovascular diseases are among the most common causes of disability and death in the world, and the number of patients with this category of diseases is increasing every year. This study aimed to investigate the role of vitamin D and the problems caused by its deficiency on the cardiovascular system. Level of D-(25(OH]D) in blood was studied by enzyme immunoassay in 95 elderly patients with myocardial infarction (MI) (the main group) and 92 elderly patients with no history of MI. The level of lipid metabolism as an indicator was determined using a KoneLab 300 auto-analyzer. Based on the results of this study, it was found that the elderly group without MI had the highest amount of D-(25(OH]D)(24.5±1.2), compared to the elderly group with MI (14.8±1.3). The rates of expressed deficiency, deficiency, and insufficiency in the group of elderly with MI were 53.6±5.1, 23.2±4.4, and 12.6±3.4%, respectively. This experiment has shown that D-(25(OH]D) is involved in lipid metabolism and reduces the accumulation of cholesterol by macrophages. The content of vitamin D in blood plasma was a prognostic predictor of MI, which improved MI in the elderly. Regardless of pathological changes, the deficit level of D-(25(OH]D) should be considered a laboratory predictor of MI in the elderly.

[The social hygienic risk factors to be applied in acute endometritis prognostication].

The article presents the results of investigation of prevalence and prognostic significance of socio-hygienic risk factors of acute endometritis in 187 patients with this disease and 150 patients with non-complicated postnatal period. It is established that development of acute endometritis is associated more with quality of life indices, early (up to 14 years of age) onset of sexual activity, presence in anamnesis of medical and spontaneous abortion. These risk factors should be considered in the process of prognosticating development of acute endometritis.

[Diagnosis and prediction of the course of primary open-angle glaucoma by the level of local cytokines]. / Diagnostika i prognozirovanie pervichnoi otkrytougol'noi glaukomy po urovnyu mestnykh tsitokinov.

Glaucoma is the leading cause of irreversible blindness in all countries and is expected to increase in patients with this pathology in the coming years. Currently, the development of the disease is associated with a change in the interleukin profile of the lacrimal fluid, but the diagnostic significance of interleukins has not been sufficiently studied. PURPOSE: To determine the diagnostic significance of interleukins at the local level to improve the diagnosis and prognosis of glaucoma. MATERIAL AND METHODS: The study examined the content of interleukins in the lacrimal fluid of 109 patients with stage II glaucoma and 52 healthy individuals by sandwich-variant of enzyme-linked immunosorbent assay (ELISA) with calculation of the information content of immune parameters. RESULTS: The study has established high diagnostic significance for the verification of glaucoma IL-2, IL-17, IL-8, which is proposed to be used in laboratory diagnosis and prognosis of the disease. CONCLUSION: The created regression model provides high-accuracy prediction of the course of glaucoma progression with increasing IL-2, IL-17, IL-8.

[The information content and predictive value of cardiac markers in myocardial infarction in the elderly.]

Myocardial infarction in old age is the leading pathology and cause of deaths. The aim of the study was to evaluate the prognostic significance and informative value of cardiac markers of blood in elderly patients with myocardial infarction. The study of cardiac markers in 107 patients with myocardial infarction at the age of 65-75 years and in 83 patients with myocardial infarction at the age of 50-60 years was carried out by immunochromatographic, bioluminescent methods and by electrophoresis on cellulose acetate, followed by the calculation of informativeness and prognostic coefficients. 95 persons aged 65-75 years without myocardial infarction served as control. Troponin T, brain natriuretic peptide, glucose-6-phosphate dehydrogenase and lactate dehydrogenase-1 have the most informative and prognostic significance in elderly patients with myocardial infarction. The use of these cardiac markers will improve the diagnosis and isolation of patients with myocardial infarction at high risk.

[The effect of antihypertensive chronotherapy on indicators of the daily blood pressure profile in elderly patients with arterial hypertension with a history of myocardial infarction.]

Traditional treatment regimens for patients with hypertension are not always effective and need to be improved based on the principles of chronobiology. The purpose of this work is to analyze the effect of preventive chronotherapy with amlodipine, lisinopril, and rosuvastatin on daily blood pressure monitoring. In 62 patients with a history of myocardial infarction and hypertension at the age of 60-74, a fixed combination of amlodipine, lisinopril and rosuvastatin at a dose of 5/10/10 mg 2 hours before reaching maximum systolic blood pressure (preventive chronotherapy), in 63 patients with similar diseases and age, this drug is taken at a dose of 5/10/10mg in the evening, and in 58 people - in the morning (traditional treatment). Daily monitoring of blood pressure before and 6 months after treatment was performed by the «SpacelabsMedical¼ device (USA) with the calculation of generally accepted indicators. The greatest effectiveness of preventive chronotherapy in comparison with other treatment options for achieving the target blood pressure level, reducing the time indices and the variability of systolic blood pressure has been established, which allows us to recommend this fixed combination in geriatric practice.

[The children morbidity of bronchial asthma in municipal and rural districts of the Belgorod oblast].

The bronchial asthma is a common pathology among children of different countries, Russia included. However, comparative studies of the incidence of bronchial asthma in children in urban and rural areas are factually absent. The purpose of study is to analyze children morbidity of bronchial asthma in urban and rural areas of the Belgorod Oblast. The official statistics data was used to analyze primary and total morbidity of children with bronchial asthma in cities and rural areas of the Belgorod Oblast in 2012-2017. The continuous retrospective technique was applied. The level of primary morbidity of bronchial asthma in children is factually the same in urban and rural areas (P>0.05). However, total morbidity of bronchial asthma in children population is significantly higher in cities of the Oblast.

[Laboratory diagnostics of ovarian cancer among the elderly in the parameters of immunoglobulins and phagocytic activity of blood.]

Due to the increase in the proportion of elderly women, the prevalence of ovarian cancer is increasing, which requires the search for new methods of its diagnosis. The aim of the work is to analyze the content and informativeness of immunoglobulins and phagocytic activity of peripheral blood to improve the diagnosis of ovarian cancer among elderly women. In 78 patients with ovarian cancer aged 65-70 years immunological and spectrophotometric methods studied phagocytic activity and the level of peripheral blood immunoglobulins. 42 women of the same age with no ovarian cancer served as control. The primary importance of circulating immune complexes, phagocyte migration inhibition index and neutrophil activity index for laboratory diagnosis of ovarian cancer among the elderly was established. The use of highly informative parameters of systemic immunity improves the diagnosis of ovarian cancer in the elderly.

[The prognostication of development of peri-apical abscess under chronic periodontitis by blood parameters and cell immunity in children].

The chronic periodontitis in children is frequently complicated by development of periapical abscess under inadequate conservative therapy. However, prognostic models of estimation of probability of its development are lacking. The purpose of study is to develop regression models of prognostication of periapical abscess under chronic periodontitis in children according indices of peripheral blood and systemic cellular immunity. The chronic periodontitis complicated with periapical abscess is analyzed in 120 children aged from 8 to 15 years. The prognostication of periapical abscess was implemented by stepwise regression technique using parameters of blood and systemic cellular immunity. The mathematical models are developed for prognostication of periapical abscess in children with chronic periodontitis on the basis of indices of peripheral blood and systemic cellular immunity permitting to prognosticate development of the given complication with needed quality. The prognostication periapical abscess requires using the given models, absolute number of lymphocytes, percentage of stab bond neutrophils, ESR, absolute number of T-lymphocytes in blood, T-helpers, T-suppressors and relative content of T-suppressors.

[The Dynamics of General Morbidity of Salpingoophoritis as a Problem of the Regional Health Care].

The article presents the results of studying dynamics of total morbidity of salpingoophoritis in the Belgorod oblast in 2009-2014 testifying negative tendencies. The maximal increasing of of total morbidity of salpingoophoritis among female adolescents and adult women in oblast rural districts was established. The obtained data can be used as a basis for developing target regional programs directed to improvement of functioning of specialized obstetrician gynecological service.

[Diagnosis of acute endometritis on hematologic indicators, and given discriminant models.]

Diagnosis of acute endometritis, despite advances in modern medicine due to the prevalence of erased forms remains difficult. The purpose of the study is to improve the diagnosis of acute endometritis by informative indicators of peripheral blood and discriminant models. In 154 patients with acute postpartum endometritis and 103 patients with uncomplicated post-Natal period studied, the indicators of General blood analysis with the assessment of informativeness, with the construction of the correlation and discriminant models. On the basis of mathematical models has high diagnostic significance of band neutrophils, erythrocyte sedimentation rate. These blood parameters have the largest number of reliable correlations with the other formed elements. The development of acute endometritis is accompanied by an increase in the number of representative correlations between blood parameters. The discriminant model accurately diagnose acute endometritis in to 86.7-87.4%, other cases are informative indicators of the General analysis of blood.

[Immunoassay and discriminant analysis to improve the diagnosis of ovarian cancer in the elderly.]

Ovarian cancer is a common pathology in the structure of tumors among elderly women. The aim of the work is to identify the leading indicators of interleukin profile to improve the diagnosis of ovarian cancer in the elderly. Enzyme immunoassay studied serum levels of interleukins in 78 patients with ovarian cancer stage IIB-IIIB according to the classification of FIGO at the age of 65-70 years and 42 women of similar age without ovarian cancer at the time of the study and in history. The differentiation of the compared groups is carried out by means of discriminant method. The leading diagnostic interleukins for ovarian cancer in the elderly are IL-1α, IL-1ß, IL-8 and TNF-α. The constructed discriminant models allow to differentiate patients with ovarian cancer and control women with an accuracy of 93.2-93.8%. The use of enzyme immunoassay and discriminant analysis improve the diagnosis of ovarian cancer in the elderly.

[The development of diagnostic of acute endometritis on the basis of modeling and cluster analysis of parameters of local immunity.]

The acute endometritis provoking expressed disorders of local immunity is considered as one of the prevalent complications of postnatal period and abortions. The purpose of study is to develop diagnostic of acute endometritis on the basis of applied correlation modeling and cluster analysis techniques diagnostically priority-driven immunological indices of vaginal cervical mucus. The sample included main group (154 patients with acute endometritis) and control group (103 patients with uncomplicated post-natal period). Both groups were subjected to enzyme-linked immunosorbent assay to analyze content of immunoglobulins, components of complement and lysozyme in vaginal cervical mucus. The sampling of diagnostically significant indices was implemented using correlation and cluster analysis techniques. It is established that chief diagnostic indices of local immunity in case of acute endometritis are IG M, sIg A, С4 components of complement and lysozyme. The established diagnostically significant parameters of local immunity provide development of detection of acute endometritis according less number of indices.