[Prevention of the development of geriatric syndromes and acute functional deficiency in patients with frailty.]

One of the most difficult tasks in medical practice is pharmacotherapy in elderly and senile patients. The complexity of pharmacotherapy in elderly patients is due to age-related physiological changes, high frequency of multimorbidity. The age of patients no longer precludes surgical intervention, and surgical procedures are often performed on elderly patients with complex comorbidities. Over the past 15 years, the number of emergency hospitalizations has increased significantly worldwide.

[Psychoemotional disorders in elderly and senile patients with urinary incontinence as a medical and social problem.]

The article discusses the issues of changing the quality of life of patients with urinary incontinence and the prevalence of psychoemotional disorders as a concomitant disease. The study involved patients who had not previously consulted specialist doctors on account of urinary incontinence. A total of 281 patients were examined, including 56 (19,93%) patients aged 20-59 years, 156 (55,52%) elderly age, 69 (24,56%) senile age. The comorbidity of urinary incontinence with psychoemotional disorders was confirmed in all groups of patients, but the most pronounced results were obtained in the elderly and senile age.

Effect of Daily Rhythms of Cortisol Secretion on the Rate of Aging in Men.

The phenomenon of human aging is the result of a complex interaction among several factors in which the immune system plays a key role. Cortisol is a glucocorticoid secreted by the adrenal gland and has a specific secretion pattern. The current study aimed at identifying the cause and pathogenesis of premature aging using biological markers. This study was performed based on the results of clinical and instrumental examinations on 91 middle-aged men aged 45-59 years. VaseraVS-1500 sphygmomanometer based on standard methods was used to measure biological age. The relationship between biological age and circadian rhythms of cortisol secretion was calculated to elucidate the pathophysiological mechanisms of aging development. The recorded data showed that the violation of the circadian rhythms of cortisol secretion characterized by a consistently high level of the hormone throughout the day was typical among individuals with accelerated types of aging. Based on the obtained data, a formula for determining the biological age of the studied groups of patients was prepared by considering the circadian rhythm of cortisol secretion, which can be an additional tool for early detection of aging in men.

Prevention of Cognitive Frailty in Patients of Older Age Groups after Open-Heart Surgery under Cardiopulmonary Bypass.

Acute change in mental state is characterized by an impaired level of consciousness, decreased attention, and cognitive changes, and has a variable course throughout its period. Delirium is common in the elderly and hospitalized patients, especially after major surgeries, and increases mortality and morbidity in patients. This study was designed to investigate the relationship between the incidence of delirium after heart surgery and some intrusive factors during surgery. A total of 263 middle-aged, elderly, and chronic patients with functional class III-IV heart failure were classified based on the New York Heart Association classification and valvular heart disease. Cognitive impairment screening was performed using the Mini-Cog test and clock drawing test in addition to standard general clinical examinations on patients. Cognitive impairment was diagnosed in patients with coronary heart disease preparing for planned surgical treatment, regardless of age, while the results of both tests were significantly worse in elderly patients than in their middle-aged counterparts. In the early postoperative period, both among the middle-aged and elderly patients, there was a significant improvement in the results of the clock drawing test. Middle-aged patients also showed improved results on the Mini-Cog test, while the elderly patients showed an increase in cognitive dysfunction. In the third stage of the examination of cognitive function in the two studied groups of patients with valvular pathology at the first checkpoint, no statistically significant differences were found in the Mini-Mental State Examination (MMSE), Mini-Cog, and clock drawing test. The results of the clock drawing test in the main and control groups were recorded at 8.9±0.4 and 5.8±0.3 points, respectively (P<0.05). The MMSE results were estimated at the points of 27.1±0.1 and 24.1±0.2 in the main and control groups, respectively, while the results of the Mini-Cog test were calculated at 2.2±0.2 and 1.2±0.4 words in the main and control group, respectively (P<0.05). The application of the algorithm for the prevention of cognitive frailty in patients of older age groups after open-heart surgery under cardiopulmonary bypass would possibly lead to a decrease in the number of early and late postoperative complications, which shows the necessity of using it for patients of older age groups in multimodal programs to prepare them for surgical interventions.

[Vitamin D deficiency in elderly with arterial hypertension and left ventricular diastolic dysfunction.]

The aim of the study was to evaluate the relationship between serum vitamin D deficiency and the risk of diastolic dysfunction in elderly patients with arterial hypertension. The study included 162 elderly patients (mean age 65,4±5,2 years) with arterial hypertension. The first group consisted of 67 patients with hypertension without vitamin D deficiency, the second-95 patients with hypertension with deficiency. It was revealed that the patients with vitamin D deficiency in the blood serum were significantly older (Δ7,3%, p<0,05), had a higher body mass index (Δ9,6%, p<0,05), a shorter distance in the 6-minute walk test (Δ10,4%, p<0,05), and more often (72,6%) had left ventricular diastolic dysfunction (LV DD). Patients with hypertension with LV DD in the presence of vitamin D deficiency in serum had a worse metabolic profile - they had higher values of total cholesterol (Δ15,7%, p<0,05), triglycerides (Δ15,2%, p<0,05), the НOMA-IR index (Δ12%, p<0,05) and lower HDL values (Δ11,9%, p<0,05). In patients with hypertension with LV DD in the presence of vitamin D deficiency, the quality of life is lower than in patients with adequate levels of it. Conclusions. Elderly patients with hypertension had a slight difference in the incidence of LV DD between the study groups with different vitamin D status. However, elderly patients with hypertension with serum vitamin D deficiency had more pronounced disorders of LV diastolic dysfunction, lipid and carbohydrate metabolism. The quality of life according to the SF-36 questionnaire in elderly patients with hypertension with vitamin D deficiency in the blood serum was significantly lower than in the group with adequate vitamin D content.

[Aging foot syndrome: patients screening and routing.]

The article proves that when providing medical and social care to patients of older age groups, it is advisable to pay attention not only to the patients' somatic and geriatric status, but also to perform screening of local geriatric syndromes that affect the patients' functional status, such as, in particular, aging foot syndrome. Implementation of rehabilitation treatment measures that we propose allows to maintain the patients' mobility level and consequently their general functional capability level and quality of life.

Effect of Electroactive Water Solutions on Homeostasis and Healing Processes of Intestinal Anastomosis Combined with Simulated Anemia in Wistar Rats.

Gastroduodenal bleeding is one of the most challenging issues in surgery nowadays. The crude mortality rate due to severe blood loss in gastrointestinal bleeding is very high. Therefore, the use of medications to prevent severe blood loss and protect cells from the harmful effects of hypoxia should be the focus of attention in these conditions. This experimental study was carried out to establish changes in blood parameters and humoral immunity in rats after intestinal anastomoses combined with acute blood loss after the application of catholyte and anolyte. The study included 45 male Wistar rats weighing 290-320 g that were divided equally (15 animals per group) into three groups of intact animals (group 1), animals exposed to the small bowel resection (1.5 cm) with the end-to-end anastomosis and simulated acute blood loss (group 2), and animals exposed to the small bowel resection with end-to-end anastomosis and simulated acute blood loss that were daily given catholyte in the postoperative period group (group 3). After the surgery, the rats were given a catholyte solution per os, and the operative wound was treated with an anolyte. The blood samples and the wall of the small intestine in the anastomotic zone were used as a biological substrate to study the effect of catholyte on changes in the body during the healing process. The experiment was conducted for 15 days, and the data were recorded in two intervals on the 5th and 15th days after starting the experiment. The analyzed materials evidenced that the use of catholyte and liquid with negative oxidoreduction potential (ORP) (minus 500-520 mV) resulted in positive changes in the blood cell count, humoral immunity, and phagocytic activity impaired after the small bowel resection and blood loss. The use of an anolyte disinfectant (liquid with positive ORP+710-770 mV) prevented bacterial contamination of the surgical wound. The obtained findings proved that the catholyte had a positive effect on humoral immunity and healing processes in the anastomotic zone. Furthermore, the anolyte prevented the development of purulent complications and inflammation in the area of the surgical wound, and therefore, promoted the healing processes.

[Age-related issues of the quality of life in patients with chronic heart failure middle range ejection fraction of elderly and senile age against the background of pharmacotherapy.]

The article deals with the issues of changing the quality of life of elderly and senile people with chronic heart failure with middle range ejection fraction (CHFmrHF) during long-term (12 months) pharmacotherapy. 377 patients were examined, including 129 people aged 45 to 59 years (middle age), 128 people aged 60 to 74 years (elderly), and 120 people aged over 75 years (senile age). The diagnosis was made in accordance with the Recommendations for the diagnosis and treatment of CHF (2013, 2016). The quality of life was assessed according to the MLHFQ questionnaire. There was an improvement in the quality of life after 12 months of therapy in all groups of patients, but the most pronounced results were obtained in old age. The maximum decrease in the level of anxiety was observed in men in the middle age group, in women - in the elderly. In the elderly and senile age, there was a comparable decrease in the scores on the Zung depression scale in both men and women.

[Bio-psycho-social model of energizing care of the elderly and senile age at home.]

Due to the introduction of new medical technologies, there is an increase in the number of people, including the elderly and senile age, who have extended their lives, but who need constant care from medical and social services at home. In the study of age differences of biological needs in home care, it was found that for middle-aged people the greatest difficulties and contribution to the reduction of quality of life brought insufficient nutrition, limited independence in the performance of household manipulations due to joint damage, pain and other biological causes, as well as hypothermia syndrome compared with elderly and senile age. For people of older age groups was characterized by the need to bridge the lack of communication; enhancing the role of the family in the implementation of care; increased confidence in caregivers; increased availability of medicines; and increased availability of religious services. Developed on the basis of identified age-based determinants of quality of life, the original model of the bio-psychosocial activating care for the geriatric contingent of patients at home, the difference from traditional approaches is the use of activating kinesitherapy and cognitive exercises, contributes to the achievement of a higher level of functionality and independence of the geriatric patient, which is accompanied by improving the quality of life.

[Aging and growthhormone: assumptions and facts (review of literature).]

Growth hormone is a powerful metabolic hormone with pleiotropic effects, which is positioned as a "source of youth". Somatotropin has various functions: stimulation of bone growth, regulation of carbohydrate, protein, lipid metabolism, metabolic function of the liver and energy balance. At the cellular level, somatotropic hormone regulates cell growth, differentiation, apoptosis, and cytoskeleton reorganization. The review article presents the results of topical studies that reflect the relationship of growth hormone deficiency or resistance to it with the development of aging and diseases associated with age, as well as with an increase in life expectancy.

Chlorhexidine markedly potentiates the oxidants scavenging abilities of Candida albicans.

The oxidant scavenging ability (OSA) of catalase-rich Candida albicans is markedly enhanced by chlorhexidine digluconate (CHX), polymyxin B, the bile salt ursodeoxycholate and by lysophosphatidylcholine, which all act as detergents facilitating the penetration of oxidants and their intracellular decomposition. Quantifications of the OSA of Candida albicans were measured by a highly sensitive luminol-dependent chemiluminescence assay and by the Thurman's assay, to quantify hydrogen peroxide (H2O2). The OSA enhancing activity by CHX depends to some extent on the media on which candida grew. The OSA of candida treated by CHX was modulated by whole human saliva, red blood cells, lysozyme, cationic peptides and by polyphenols. Concentrations of CHX, which killed over 95 % of Candida albicans cells, did not affect the cells' abilities to scavenge reactive oxygen species (ROS). The OSA of Candida cells treated by CHX is highly refractory to H2O2 (50 mM) but is strongly inhibited by hypochlorous acid, lecithin, trypan blue and by heparin. We speculate that similarly to catalase-rich red blood cells, Candida albicans and additional catalase-rich microbiota may also have the ability to scavenge oxidants and thus can protect catalase-negative anaerobes and facultative anaerobes cariogenic streptococci against peroxide and thus secure their survival in the oral cavity.

A rapid method to estimate the concentration of citrate capped silver nanoparticles from UV-visible light spectra.

We present a generalized table of extinction coefficient data for silver nanoparticles from 8 to 100 nm. This table allows for easy and quick estimation of the concentration and size of modified and mono-dispersed silver nanoparticles from their optical spectra. We obtained data by determining the silver content of citrate-stabilised silver nanoparticles using sodium cyanide to dissolve the nanoparticles, and measuring solution conductivity with a pH meter and a cyanide-ion selective electrode. The quantification of the silver ion concentration enabled the calculation of extinction coefficients. Experimentally calculated extinction coefficients, in the current work, are in good agreement with collated literature values measured by different authors with non-standardized methodology and each for a limited range of particle size. They are also in good agreement with our theoretical calculations using Mie theory. Thus, we provide a highly standardized and comprehensive tabulated reference data-set.

[The details of clinical examination of elders].

At present, the ever-increasing number of persons of elderly and senile age does not receive from health and social care agencies sufficient volume of health services and social care they require. This article reveals the essence of such a concept as the phenomenon of senile asthenia. It also describes the characteristic of the algorithm of the specialized geriatric examination of elderly patients, which includes not only traditional but also very important for an elderly person special part, in particular, balance and gait assessment, identification of nutritional status to objectify the syndrome of malnutrition, assessment of mental function, activity level of an elderly person, the state of movement, a detailed identification of the social features of life of an elderly person, the quality of his life. The application of this algorithm will significantly improve the quality of geriatric care provided through the objectification of the pathology in the elderly person and assessment of the volume of medical and social care he needs.

The dual function of nitrite under stomach conditions is modulated by reducing compounds.

Salivary nitrite plays a role in the lipid peroxidation process of muscle tissue in simulated gastric fluid. The objectives of our study were to elucidate the fate of nitrite in the presence of reducing compounds and to evaluate its effect on lipid peroxidation during digestion. Nitrite at pH 3 (possibly NO(2.), not NO.) can oxidize beta-carotene, but the addition of reducing compounds, ascorbic acid or polyphenols, alters its effect. Ascorbic acid alone promoted the formation of NO. from nitrite only up to pH 3, but the addition of iron ions facilitated the formation of NO. up to pH 5.5. NO prevented membranal lipid peroxidation under stomach conditions. Nitrite, only in the presence of reducing compounds, achieved the same goal but at much higher concentrations. Addition of polyphenols to nitrite synergistically improved its antioxidant effect. Therefore, to promote NO. production and to achieve better control of the lipid peroxidation process in the stomach, a nitrite-rich meal should be consumed simultaneously with food rich in polyphenols.

Saliva plays a dual role in oxidation process in stomach medium.

The aim of this study was to evaluate the role of saliva in the oxidation process under the acidic condition of the stomach. Saliva specimens played varied roles in the lipid peroxidation process of heated muscle tissue in simulated gastric fluid: pro-oxidant effects, no effects, and antioxidant effects. To elucidate these differences, selected saliva components were examined. The pseudoperoxidase activity of lactoperoxidase increased lipid peroxidation, while thiocyanate and nitrite-reduced lipid peroxidation. The effect of a saliva specimen on lipid peroxidation was correlated with the concentration of nitrite in the specimen, but not with that of other saliva components. The inhibitory effect of nitrite may be due to its conversion to NO. Elucidation of the antioxidant effect of saliva on co-oxidation of d-alpha-tocopherol in gastric fluid, demonstrated that saliva alone cannot protect d-alpha-tocopherol from co-oxidation, although it partially protected against lipid peroxidation. The presence of red wine polyphenols in stomach medium totally inhibits food lipid peroxidation and d-alpha-tocopherol co-oxidation.

Oxymyoglobin oxidation and membrane lipid peroxidation initiated by iron redox cycle: prevention of oxidation by enzymic and nonenzymic antioxidants.

The red color of muscle is principally due to the presence of oxymyoglobin. Oxidation of heme iron from the ferrous to the ferric state produces a brownish color, which consumers find undesirable. The aim of this study was to use enzymic and nonenzymic antioxidants to simulate in situ muscle antioxidation reactions in order to understand better the mechanism by which the iron redox cycle catalyzes membrane lipid peroxidation and oxymyoglobin oxidation. The inclusion of superoxide dismutase (SOD) in the model system decreased oxymyoglobin oxidation by 10% without affecting lipid peroxidation. Addition of catalase decreased oxymyoglobin oxidation by approximately 40% but not lipid peroxidation. Increasing the ceruloplasmin concentration inhibited lipid peroxidation but increased oxymyoglobin oxidation, which was inhibited by SOD and catalase. Conalbumin (50 microM), a specific iron chelator, inhibited peroxidation and oxymyoglobin oxidation by almost 50%. The addition of the antioxidant catechin (500 microM) decreased lipid peroxidation by 90% but oxymyoglobin oxidation by only 50%. Feeding turkeys with vitamin E at several levels significantly increased the alpha-tocopherol level of membranes, thus preventing oxymyoglobin and lipid oxidation. In conclusion, oxymyoglobin stability in the model system was affected by two pathways: (a) oxygen active species, such as O(2)*(-), H(2)O(2), HO*, and ferryl, generated during autoxidation of myoglobin and oxidation of ferrous ions and ascorbic acid; and (b) lipid radicals, such as ROO*, RO*, and hydroperoxides, generated during lipid peroxidation. Maximum inhibition could be achieved only by introducing inhibitors of both pathways into the system.

Oxymyoglobin oxidation and membranal lipid peroxidation initiated by iron redox cycle.

Oxymyoglobin is the main pigment in muscle tissues, responsible for the bright red color of fresh meat. Oxidation of the heme iron from the ferrous to the ferric metmyoglobin produces the brownish color that consumers find undesirable in fresh meat. The aim of this study was to elucidate the mechanism of oxymyoglobin oxidation in muscle tissues by using a model system containing oxymyoglobin and muscle membranes oxidized by an iron redox cycle. Oxidation of oxymyoglobin was determined from the decrease in absorption of the solution measured by a spectrophotometer at 582 nm. Lipid peroxidation was determined by accumulation of TBARS and conjugated dienes. The higher rates of oxidation of oxymyoglobin (20 microM) and lipid oxidation were achieved by using ferric iron and ascorbic acid at concentrations of 50 and 200 microM, respectively. Increasing the concentration of ascorbic acid to 2000 microM switched its effect to antioxidative. Increasing the concentration of oxymyoglobin from 20 to 80 microM inhibited lipid peroxidation by >90% and partially prevented oxymyoglobin oxidation.

[Changes in lung function in the postoperative period during tube feeding]. / Izmenenie funktsii legkikh v posleoperatsionnom periode v usloviiakh zondovogo pitaniia.

39 patients after surgery for laryngeal cancer have been examined. It has been shown that enteral nutrition with high carbohydrate content is accompanied by an increase in O2 consumption, CO2 release, minute lung ventilation, disturbances in lipid metabolism, blood hypercoagulation and does not promote the recovery of the lung function. Diets with predominant fat content led to the normalization of gas exchange, correction of lipid metabolism and hemostasis and, therefore, were recommended in the postoperative period for patients with laryngeal cancer.