The Clinical Management of Deconditioned Patient.

The current study was designed to investigate the clinical management of deconditioned patients. In the current study, we investigate the clinical manifestations of deconditioned patients. A subacute functional deficiency was determined when getting up from a supine position and developing tachycardia with an increase in heart rate by 30 or more per minute for 10 minutes. This study included 172 elderly patients aged 65 to 74 years. The average age of the patients was 69.2+2.2 years. There were 102 men and 70 women in the study. These patients were registered at the dispensary with the therapists of outpatient clinics after an infectious disease. Within 6 months after the treatment, a comprehensive geriatric assessment of patients was performed. All patients were divided into four groups depending on the indicators of motor activity, which in the framework of this study was the criterion of the adaptive function of the body and viability. Patients with normal motor activity indicators did not have the decondition and were designated as a control group. Patients with the decondition did not have normal indicators of motor activity. The obtained results were processed statistically. According to the results of our study, it was noted that the assessment of the six months after the treatment showed heterogeneity of patients from a functional point of view with a homogeneous somatic structure. Six months after the treatment, out of 172 people, 45 people (26.2%) had normal motor activity indicators (39-40 points); according to the questionnaire "Assessment of motor activity in the elderly", the average score was 39.6+0.2; 42 people (24.4%) had mild motor activity disorders (34-38 points), the average score was 36.1+0.4; moderate disorders (21-33 points) were registered in 47 people (27.3%), the average score was 27.9+2.1; significant motor activity disorders (0-20 points) occurred in 38 people (22.1%), the average score was 13.2+1.4. The fall syndrome was characteristic of those patients with the decondition who demonstrated moderate and significant motor activity disorders 6 months after the treatment. In particular, in people with significant motor activity disorders, there was a decrease in muscle strength in the lower extremities by 48.3+3.2% and in the upper extremities - by 27.1+3.1% (P<0.05). As a result of the presence of the decondition, an unfavorable cascade of geriatric syndromes is formed in the form of an increase in the level of situational anxiety from 21.9-24.8 to 58.4-75.3 points on the Spielberger-Hanin scale, a deterioration in morale with an increase in the severity of depression from 5.8-6.0 to 11.0-14.9 points, a decrease in the quality of sleep on the ten-point visual analog scale from 8.3-8.4 to 5.2-5.7 points on the Beck scale, an increase in the proportion of patients at risk of developing malnutrition syndrome from 4.8-6.7% to 46.8-68.4%, the development of the fall syndrome, which, in turn,, it is a predictor of the development of dinapenia in the form of a decrease in the strength of the upper extremities by 22.7-27.1%, a decrease in the strength of the lower extremities by 29.6-49.6%, with a faster rate of decrease in the strength of the lower extremities compared to the upper extremities by 1.8 times, which, accordingly, reduces the rehabilitation potential. Clinical manifestations of the decondition in elderly patients were such geriatric syndromes as anxiety, depression, cognitive decline, sleep disorders, hypomobility, dinapenia, risk of developing malnutrition syndrome and falls syndrome.

[Epidemiology of chronic renal disease in the North-West of Russia: setting-up the register]. / épidemiologiia khronicheskoi bolezni pochek v Cevero-zapadnom regione Rossii: na puti k sozdaniiu registra.

AIM: To study epoidemiology of chronic renal disease (CRD) in the North-West region of the Russian Federation. MATERIAL AND METHODS: A population retrospective trial was performed from 01.07.98 to 30.06.99 in the Vologda region, towns Veliky Novgorod and Syktyvkar (total population 1840000). 490 cases of chronic renal failure (CRF) with creatinin levels > 300 mcmol/l corresponding to CRD stage IV and V by glomerular filtration rate were detected. CRD stage IV-V prevalence, morbidity including sex- and age-specific parameters, cumulative survival in different etiology of CRD regarding replacement therapy (RT) and nephrologist supervision were estimated. RESULTS: Mean prevalence and morbidity were 266 and 108 cases per million. Number of affected males and females was the same. CRD was provoked by chronic glomerulonephritis (CGN)--41%, chronic interstitional nephritis--16%, diabetes mellitus--14%, renal polycystic disease--8%, amyloidosis--6%, hypertension nephrosclerosis--2%, other causes--3%, cases of unclear etiology--10%. Among patients with primary renal pathology on RT, number of CGN patients was higher--61% while diabetic and amyloidosis shares were much lower 1.6 and 0.8%. 31.1% patients given no RT had Cr > 500 mcmol/l and glomerular filtration rate < 10 ml/min. Incidence of CRD stage IV-V in RT patients was 80 per million, 8 patients per million for 1 year started RT for the first time. CRF mortality was 85 patients per million a year. 88.4% of deaths in patients given no RT was due to uremia. Cumulative survival for RT patients and RT untreated was 90 and 50% a year, respectively. Survival of the RT untreated observed by the nephrologist was significantly higher (p = 0.003). CONCLUSION: New cases of CRD stage IV-V were comparable in number to European incidence rate while prevalence was much less because of lower number of old patients and RT treated. The problem of CRD treatment is urgent for RF and requires updating nephrological service and development of RT programs.

[Epidemiological characteristics and the importance of carriers of the surface antigen of the hepatitis B virus (HBsAg)]. / Epidemiologicheskaia kharakteristika i znachenie nositelei poverkhnostnogo antigena virusa gepatita B (HBsAg).

The occurrence of HBsAg carriership in Leningrad has been found to be 1.4% according to the results of countercurrent immunoelectroosmophoresis (CIEO) and 2.1% according to the results of the passive hemagglutination (PHA) test. In children HBsAg occurs with higher frequency: 1.9% according to the results of CIEO and 3.4% according to the results of the PHA test. The latter test reveals HBsAg carriers more completely, especially in women who have usually less pronounced antigenemia than men. Most of chronic HBsAg carriers are patients with chronic forms of hepatitis B (chronic active hepatitis and chronic persistent hepatitis); frequently they become the source of infection among their relatives under the conditions of family contacts. A complex of antiepidemic measures is necessary in the foci of chronic HBsAg carriership.