[Fibrophysematous lung changes and microbiota changes in senile persons.]

Research on the condition of the lungs in senile people is an urgent task. This is due to the fact that degenerative or age-associated changes in the respiratory system play an important role in the formation of senile asthenia syndrome and a decrease in the age-related viability of the body as a whole. CT-scans of patients aged 80-90 years were analyzed (n=31). Age-associated changes were evaluated: the presence of linear fibrosis, increased pulmonary pattern by the type of reticular (reticular) changes, the presence of gross fibrous reticular changes with cystic cavities and air bullae (by the type of «cellular lung¼), as well as the presence of pulmonary emphysema. Most naturally, senile people show changes characteristic of linear pulmonary fibrosis and emphysema. The progression of the process leads to diffuse reticular changes in the interalveolar and intersegmental septa and, in adverse cases, to the formation of gross changes in the type of «cellular lung¼. Fibro-emphysematous changes are significantly more common in men. A microbiological study of the microbiota of the lower respiratory tract in elderly people was also carried out (n=16). When studying the microbiocenosis of the lower respiratory tract in elderly people, the following data were obtained: resident microflora was found in 71% and clinically significant microorganisms were found in 29%.

Relationship of zinc level with pathogenetically significant homeostasis disorders in severely burned patients.

The aim of the study was to assess the zinc content and identify the relationship between the concentration of this element and changes in the biochemical status of patients and markers of inflammation during burn shock. We examined 23 patients aged 45.3±16.1 years with burns of I-II-III degree, area of 31-80%. The serum concentrations of zinc, albumin, interleukin-6, C-reactive protein (CRP), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined. The majority of patients (21/23) had severe hypocincemia, correlated with burn area (r=-0.53; p=0.008). A decrease in zinc levels during burn shock was associated with the development of hypoalbuminemia (r=0.52, p=0.01). The association of deviations in ALT and AST activity with changes in zinc concentration was revealed (-0.59<γ<-0.61, 0.008

[Prognostic potential of inflammatory factors in older patients diagnosed with COVID-19.]

The COVID-19 pandemic requires a quick and accurate diagnosis and assessment of the condition of patients, correctly chosen by the tactics of treatment and prediction of the course of the disease, especially in older patients. The most promising direction is the study of the potential of inflammatory factors among people over 60 years of age. This paper analyzed serum level characteristics of analytes such as C-reactive protein, procalcitonin, IL-6, troponin, ferritin and brain natriuretic peptide. The findings demonstrate the prognostic value of IL-6 and procalcitonin in both middle-aged and older-aged individuals. For people of senile age, the diagnostic informativity of both IL-6 and Pct reached an acceptable level. C-reactive protein is statistically significantly higher in fatal patients.

[Features of the coefficient of variation of hematological indicators in persons of middle, elderly and senile age with pneumonia.]

Pneumonia is the leading mortality rate among all infectious diseases. It has been established that the reliable risk group for morbidity and mortality from this nosology includes persons over 60 years of age, and with age the severity of the disease only increases. According to literary data, one of the reasons for the decline in adaptation capabilities of older persons is the phenomenon of «age desinhronosis¼, which manifests itself in significant fluctuations in the parameters of the internal environment of the body. The purpose of this work was to compare the coefficients of intra- and interindividual biological variation. For this purpose, a retrospective study of clinical blood analysis in patients suffering from pneumonia of unspecified etiology was carried out in terms of three age groups: medium, elderly and senile. Features of biological variation depending on age have been found, the differences identified have been justified according to available theories.

[Age-related changes in hematological parameters in patients with acute coronary syndrome.]

Over the past decade, there has been a great interest in hematological indicators as markers for assessing the severity of coronary artery disease and stratifying the risk of cardiovascular events in patients with acute coronary syndrome. To understand the possibility of using hematological indicators as predictors of adverse outcomes in this category of patients, the question of clarifying their age-related changes became a question. This study discusses age-related changes in hematological parameters in patients with acute coronary syndrome.

Influence of exogenous and endogenous factors on the quality of the preanalytical stage of laboratory tests (review of literature).

A literature review in the article presents an analysis of the influence of endogenous and exogenous factors on quality of preanalytical phase of laboratory testing. The review shows significance of external and internal factors influencing blood samples at preanalytical phase of laboratory testing. Among the exogenous factors considered: phlebotomy, test tubes for samples, transportation and storage. A number of factors exist at this phase that significantly affect test results. We examined these aspects of phlebotomy process: staff training, disinfectant contamination, needle diameter, needle material contamination. The review considers possible contamination with tube components and the importance of choosing the right anticoagulants and excipients. Transportation and storage of biological samples can be a source of errors at the preanalytical phase of laboratory testing. We analyzed the problem of determining the stability of analytes during storage and aspects of transportation samples by modern means. Among the endogenous factors considered: hemolysis, lipemia, icterricity, cell metabolism.. Hemolysis is one of the most frequent consequences of errors at the preanalytical phase. We analyzed importance of choosing a method for identifying hemolized tubes and the heterogeneity of bias results on different analytical systems. The review shows contribution of various classes of lipoproteins to turbidity of sample, possible preanalytical errors and impact on analytical tests. We examined possible effects of high bilirubin concentrations on analyte measurements. In the review, we also examined metabolism of some cells and its effect on samples.

[Age and nosological structure of ophthalmological diseases of patients of the ophthalmological center of Saint-Petersburg in 2015-2019.]

About 1,3 billion people live on our planet with visual disorders such as cataract and glaucoma, the prevalence of which is significantly higher in the elderlypopulation. Eye diseases remain a global medical, social and economic problem, associated with both the progression of the disease to blindness and the lack of pathogenetic therapy methods. A retrospective analysis of the long-term dynamics and structure of cases of ophthalmological diseases of patients treated in a large multidisciplinary hospital was carried out. The age and nosological structure of eye diseases is described. Natural features of the structure of diseases relative to different age groups have been revealed, as well as patterns in dynamics have been found.

[Features of the picture of blood cells in elderly persons with primary open-angle glaucoma.]

Around 1,3 billion people live worldwide with visual analyzer disorders such as glaucoma and cataract. These diseases are particularly common among the elderly. From glaucoma every year 10 million people completely lose vision, one of the factors of which is untimely diagnosis. Donosological diagnosis and laboratory screening can play a key role in detecting this pathology and significantly improving the quality of life of the older generation. The article presents the results of comparative analysis of the general blood analysis of glaucoma patients with a control group. The hematological indices are also compared by sex and age. Changes in some indicators consistent with existing theories of glaucoma pathogenesis have been identified. Promising directions of application of general blood analysis as a routine method of additional diagnostics of glaucoma in the future are planned.

[Laboratory predictors of glaucoma in patients with middle and old age - a tool to improve the quality of life (literature review).]

There are about 1,3 billion people worldwide with visual disorders such as cataract and glaucoma, the prevalence of which is significantly higher in elder persons. Eye diseases remain a global medical, social and economic problem, associated with both the progression of the disease up to blindness and the lack of pathogenetic therapy methods. Timely detection of pathology is secondary prevention of glaucoma. At present, a number of diagnostic techniques have been developed, including mainly instrumental techniques. Undoubtedly, laboratory indicators should be used as screening methods of early diagnosis. Today, a group of biomarkers with different degrees of sensitivity and specificity has been identified. However, these markers have some difficulty in indicating. Finding signs of glaucoma in complete blood count is an important task. Glaucoma is recognized as a systemic disease, which should be reflected in the change in morphofunctional properties of blood elements.

[Algorithm to stratify the risk of myocardial infarction in patients with acute coronary syndrome at primary examination.]

The episode of acute coronary syndrome is most often preceded by the development of systemic and local inflammation, which plays a significant role in the pathogenesis of the disease. General clinical blood analysis, directly or indirectly reflecting systemic pathological processes in the patient's body based on quantitative and morphological assessment of blood composition, is one of the most affordable methods of laboratory diagnostics in modern public health. Taking into account the growing number of digital data obtained by diagnosticians from analytical systems, there is a growing potential for the use of machine learning methods to increase the effectiveness of provided diagnostic information in the interests of the patient. The aim of this study was to create an algorithm for stratifying the risk of myocardial infarction based on the methods of machine learning in patients with acute coronary syndrome at primary examination. A prospective pilot study was conducted. In total 307 patients with acute coronary syndrome (169 men and 138 women) were examined. The average age of patients was 68.6 ± 12.5 years. Retrospectively, the patients were divided into two groups: the main group - patients with the final diagnosis "Myocardial infarction" and the control group with the diagnosis "Unstable angina pectoris". All patients at hospitalization at the primary laboratory examination along with the study of the concentration of cardiac troponin I by a highly sensitive method were examined by a general clinical bloodanalysis on an automatic hematological 5-diff analyzer. As a result of the application of the ensemble method as a method of machine learning and artificial neural networks as 6 independent models of the ensemble it was possible to achieve the area under the ROC curve = 0.77 on the test set when assessing the quality of patient stratification. Taking into account the volume of the training sample in 214 patients and the results of similar studies, the achieved stratification quality can be considered acceptable and promising for further accumulation of the database with the purpose of additional training of the developed algorithm and improvement of the disease prognosis accuracy characteristics.

[Personified monitoring of acute coronary syndrome and its outcomes in elderly patients. Angina. Heart failure (overview).]

Review is about current information on the features of heart failure and angina diagnosis and monitoring in elderly and senile patients. One of the main problem in patients over 65 years is comorbidity, which requires corrective action in the risk stratification and prediction of clinical outcomes. The priority of non-invasive diagnostic tests is noted. Authors of the article recommend frailty as an obligatory part of diagnostic process in patients with heart failure and angina due to a clear connection with the worst prognosis in terms of quality of life, hospitalization and mortality.

[The value of in vitro diagnostic testing in the provision of medical care to patients with cardiovascular diseases.]

In vitro diagnostics are used at all stages of patient care. The aim of this study was to assess the impact of laboratory examination on clinical decision-making in providing medical care to patients with a cardiovascular profile. We also took into account the level of financing for the laboratory industry in the Russian Federation. We divided our study on three sequential steps: literature review, survey of clinicians and test-survey of clinicians. The share of costs for the laboratory tests in 2017 amounted to about 8% of the total funding for Russian health care. About 80% (70; 90) of the visits of the attending physicians are associated with the appointment of laboratory tests. Among patients who were prescribed any laboratory test - in 62.1% (95% CI 16.9-24.9) cases, the results of these tests influenced clinical decision making related to the initiation, modification or termination of any treatment. All visits of clinicians were divided by purpose: tests were prescribed in almost 100% (90; 100) cases during the initial examination, in 40% (20; 60) cases during repeated visits, and in 40% (15; 40) cases when patients were examined before discharge. In more than half of cases (57,4%; n=31), doctors correctly assumed about the about the share of financing of the laboratory industry. The majority of respondents considered the amount of expenses adequate and recommended to maintain the current level in the future. According to attending physicians, new laboratory markers should demonstrate additional information about clinical relevance to improve patient outcomes. Thus, in current economic realities, future laboratory tests should be financially maximally available and at the same time be clinically highly effective auxiliary instruments. It creates new challenges in finding laboratory biomarkers and putting them into clinical practice.

[Comparative evaluation of scales for the assessment of senile asthenia syndrome in patients with acute coronary syndrome.]

The syndrome of senile asthenia (frailty) in patients with acute coronary syndrome is recognized as one of the risk factors for the development of adverse outcomes after undergoing cardiosurgical interventions, and the search for an optimal method for assessing this syndrome could be a screening to identify patients at increased risk. This study compares two methods for assessing senile asthenia syndrome in patients with acute coronary syndrome, its prevalence in this category of patients, its relationship with clinical characteristics and 1-year mortality after hospitalization. According to the results of the study, senile asthenia syndrome was observed more often in the group of patients older than 75 years. Patients with senile asthenia assessment using the Green scale had a higher risk on the GRACE scale and the presence of this syndrome was an independent 1-year mortality predictor after hospitalization.

[Plasma D-dimer volume as a subclinical marker of thrombotic risk in elderly patients with atrial fibrillation.]

Aged patients with atrial fibrillation (AF) are at high risk of both thromboembolic and haemorrhagic complications of disease and of its treatment. A study was provided to assess the role of D-dimer plasma level as a marker of thrombosis in aged patients with AF having no clinical signs of active thrombosis depending on used treatment strategy and quantitative thrombotic and haemorrhagic risk of AF. The results show that D-dimer plasma levels correlate with scores of thromboembolic and haemorrhagic risks in group on antiplatelet agents but not anticoagulants, with the difference in D-dimer level driven by subgroup on CHA2DS2-VASc score ≥5. High D-dimer level was associated with in-hospital mortality and rhythm of AF at the moment of blood sample collection. Therefore, an accuracy of risk prognosis of fatal complications of AF for elderly patients may be increased by using the laboratory markers of thrombus formation such as D-dimer and by using the obtained results to guide an antithrombotic therapy.

[Personified monitoring of acute coronary syndrome and its outcomes in elderly patients. Report 1. Acute coronary syndrome (overview).]

The overview describes the clinical features of acute coronary syndrome in patients of older age groups. Atypical symptoms present in this cohort very often. It associated with a worse prognosis, partly due to delays in diagnosis, treatment, and insufficiently substantiated drug therapy. Comorbidity is one of the important factors complicating the diagnosis of elderly patients. Frailty, hyperglycemia, anemia, and chronic kidney disease are comorbid conditions, it identify in patients of older age groups often. High-sensitive cardiac markers is especially important for the differential diagnosis of acute coronary syndrome without ST elevation in elderly patients, because sometimes echocardiography does not provide additional information for interpreting the clinical case and there are no significant diagnostic changes on the ECG.

[Personified monitoring of acute coronary syndrome and its outcomes in elderly patients. Report 2. Invasive diagnostic and treatment methods (review).]

Literature review describes the features of diagnosis and monitoring of elderly and senile patients with coronary heart disease, that will undergoing coronary angiography, percutaneous coronary intervention or coronary artery bypass surgery. Review notes the advantage of the routine invasive strategy in elderly patients with a high risk of NSTEMI. The authors recommend a preliminary assessment of frailty before coronary angiography. Radial access for coronary angiography or percutaneous coronary intervention is considered preferable. It has lower frequency of access and bleeding complications. Daily activity of elderly patients after PCI should be used to predict mortality. CHA2DS2VASc as a predictor of the risk of adverse cerebrovascular episodes is recommended in addition. Aortic calcification and diffuse atherosclerotic changes in the walls of the coronary arteries are important factors in the risk verification scales EuroSCORE and EuroSCORE II in patients after 70 years who underwent CABG intervention.

[Evaluation of hyperglycemia impact on outcomes of acute coronary syndrome in elderly and senile patients.]

Acute coronary syndrome (ACS) in elderly and senile patients has a number of features and requires special attention to providing medical care. These patients is associated with significant comorbidity and atypical symptoms in the course of the disease. Diabetes mellitus is a common background disease in patients with ACS.A retrospective cohort study was performed, 2945 patients with ACS were examined. Patients were divided into three age groups: group 1 - patients aged 18 to 63 years; group 2 - patients aged 64 to 75 years; group 3 - patients older than 75 years. Number of patients with glucose concentrations above 11.1 mmol/L is significantly higher in elderly and senile groups than in group of patients from 35 to 59 years old. The number of patients with impaired renal function after administration of a contrast medium in the study group with ACS increased with increasing age. Significant difference was revealed between the middle and senile age groups, as well as between the elderly and senile age groups. An increase in the relative number of patients with fatal outcomes in groups with a significant increase in glucose levels was revealed. The connection between the pathological level of glucose and repeated myocardial infarction is proved. Conclusion. The presented statistical picture suggests a particularly high risk of recurring cardiovascular events among patients with ACS and pathological glucose levels. The correlation between the number of deaths and glucose levels during the initial examination allows the use of glucose tests as an additional criterion in the stratification of risks and outcomes in patients with ACS.

[Results of troponin I testing by high sensitive method in three age groups of healthy population].

Article is about troponin I testing by high sensitive method in healthy population group. 165 people (employees of hospital) were examined, 71 % - women and 29 % - men. Inclusion criteria were as follows: absence of active complaints at the time of health examination and during the previous 30 days. All the examinees were divided into three age groups: 18-34 years (middle age, I period), 35-54 years (middle age, II period), above 55 years (old age). Research of correlation between cardiac troponin I and age of healthy population group was the main aim of investigation.

[Digoxin in elderly patients: therapeutic drug monitoring to increase the efficiency of therapy (a review)].

The focus of this review is on cardiac and non-cardiac effects of digoxin, a drug used for treating the heart failure, and on link between these effects and the serum digoxin concentration (SDC) in different dosing regimens. Elderly patients are at the spotlight, as they are both at high risk and high potential benefit from digoxin therapy, explaining potential usefulness from SDC monitoring in this cohort of patients. The laboratory and clinical approaches used to prevent digitalis intoxication are reviewed, with regard to their fidelity, clinical value, and practical usefulness. The role of endogenous cardiotonic steroids, sharing structural and functional similarity to digoxin and affecting the diagnostic value of laboratory tests, is also discussed.

[THE EXPERIENCE OF DETECTION OF SERUM CARDIO MARKERS IN PATIENTS AFTER PLANNED CORONARY ARTERY GRAFTING].

The article exposes the results of experience of laboratory diagnostic of myocardium infarction in patients subjected to operation of coronary artery bypass grafting. The study included patients hospitalized in a planned order and with further coronary artery bypass grafting carried out.