[Features of chronic kidney disease in elderly patients.]

The purpose of the work is to study the characteristics of the course of chronic kidney disease in elderly patients based on the analysis of the register of chronic kidney disease (CKD) for 2015-2018. in the Department of Nephrology, the Komi Republican Clinical Hospital. There are 484 patients in the register, of whom 231 are men (47,7%), 253 women (52,3%). The average age is 58,8±15,8 years old. The patients were divided into 3 groups: persons under the age of 59 years old - 218 people (group 1); from 60 to 74 years old - 207 people (group 2); and over 75 years old - 59 people (group 3). Most patients are between the ages of 60 and 69 years old. In the 1st group, the chronic glomerulonephritis is the leading cause of CKD - 27,1%; in the 2nd group - the chronic tubulo-interstitial nephritis (TIN) - 21,7%, the diabetic nephropathy (DN) - 20,8% and the hypertensive nephropathy - 15,9%; in the 3d group - TIN (27,1%), the chronic pyelonephritis (PN) (15,9%) and DN (13,6%). With increasing age, the incidence of TIN (p<0,1), MO (p<0,05), coronary kidney disease (IBP) (p<0,05), gouty nephropathy (p<0,1) were raised. The average reduction in GFR is 3,99 ml/min/1,73 m2 per year of observation. The rate of decline in GFR in the 1st group is 3,36±1,8 ml/min/1,73 m2 per year, in the 2nd - 2,43±1,2 (p<0,001 between group 1 and 2), in the 3rd group - 1,82±1,1; with aging the negative correlation was observed (p<0,05). 39 patients received hemodialysis, including: in the 1st group - 20 people (9%), in the 2nd group - 18 (8,7%), in the 3rd group - 1 patient (1,7%). Making the register of the patients with CKD allows us to know the number of patients and the causes of CKD among the patients of elderly and senile ages, to assess the clinical situation, the rate of decline in GFR and treatment tactics in these patients.

[Clinical course and outcomes of myocardial infarction in women].

We selected all case histories of patients living in the area served by the Syktyvkar policlinic #3 and treated in Republican Cardiological Dispensary in 2003-2009 with diagnosis of myocardial infarction (MI). Data on survival of patients after MI (mean duration of follow-up 4.6 years) was derived from information on date and cause of death of patients obtained from statistical office of the policlinic. Overall we analyzed data on 778 patients (46.3% women, mean age 63.7 years). For detection of independent factors related to lethal outcome we used binary logistic regression, for assessment of survival we used Kaplan-Meier method and Cox regression model of proportional hazards. From positions of gender differences we assessed pharmacoepidemiology of MI, efficacy of thrombolytic therapy, determined factors of hospital and long term mortality. No increase of risk of hospital or long term mortality associated with female sex was revealed by multifactorial analysis. Greatest prognostic significance in relation to unfavorable outcome irrespective of patients sex was established for the following factors: age, severity of MI course, severity of renal dysfunction. In acute period of MI in addition to these factors we revealed unfavorable influence of hyperglycemia and protective role of preceding hypertensive disease.

[Coronary stenting in elderly patients with acute myocardial infarction (review)].

Cardiovascular disease and coronary heart disease are now the leading causes of death and disability in elderly and senile age. Patients with acute coronary syndrome (ACS) and myocardial-infarction (MI) constitute a large portion of emergency hospital admissions among patients with cardiovascular diseases. According to numerous studies, the coronary artery stenting in MI is an effective procedure for the superior results of all the hither to known methods of treatment of ACS. However, the role of endovascular treatment in the acute period of MI in Russia remains underestimated due to lack of awareness of cardiologists and specialists in primary care on this issue. Review of leading Russian and foreign advice and articles on the algorithm of patient care in elderly with ACS and systematization of the information can objectively evaluate the benefits of interventional procedures in the shortest time in AMI.

[Renal functional state in patients with myocardial infarction].

AIM: To study renal dysfunction in patients with myocardial infarction (MI). SUBJECTS AND METHODS: 670 case histories of patients diagnosed with acute coronary syndrome, including 369 (55.8%) men and 292 (44.2%) women at the age of 33 to 85 years (mean age 64.8 +/- 11.7 years), were retrospectively studied. The authors considered comorbidities and analyzed complaints, history data, and the results of physical examinations, biochemical blood tests for plasma glucose, troponin, MB fractions of creatine phosphokinase and creatinine, and cholesterol in all the patients. Instrumental studies involved electro- and echocardiography. Glomerular filtration rate (GFR) was estimated using the MDRD formula. The patients were divided into groups according to GFR values: 1) > 90 ml/min/1.73 m2; 2) 60 to 89 ml/min/1.73 m2; 3) 30 to 59 ml/min/1.73 m2; 4) less than 30 ml/min/1.73 m2. RESULTS: Most patients were found to have a moderate or significant reduction in kidney function. Worsening renal function in patients with MI was associated with advanced patient age, the lower proportion of men in the patient structure, the higher prevalence of concomitant cardiovascular diseases, such as arterial hypertension, chronic heart failure, and prior MI, and diabetes mellitus. CONCLUSION: The findings suggest that kidney dysfunction is of essential value in developing the multiplicity of comorbidities in patients with MI. The wide introduction of a GFR calculating method in daily medical practice will be able to adequately and timely identify renal filtration function and to make a correction into a treatment regimen, thus decreasing the number of poor outcomes.

[Survival of elderly patients after coronary stenting in acute myocardial infarction during the eight years of observation: retrospective analyses].

This article shows the results of analysis of hospital and long-term mortality and survival of elderly patients who underwent coronary artery stenting in acute myocardial infarction, compared with those patients who received only conservative therapy. Eight-year mortality in the stented patients was significantly lower and amounted to 12.5%, whereas in the group treated conservatively--56.0% (p < 0.05). Among the patients of middle age this index was 0 and 23.0% respectively, which indicates the high efficacy of coronary stenting in acute myocardial infarction compared with isolated medical therapy among middle-aged and elderly patients.

[Clinical forms of cholangiogenic infection in surgical practice]. / Klinicheskie formy kholangiogennoi infektsii v khirurgicheskoi praktike.

The acute cholangiogenic infection may have a favorable course or acquire a purulent or septic form. Chronic cholangiogenic infection often having subclinical features is sometimes septic and is responsible for the transition of bacterial cholangitis from the complication to the independent disease. Of greatest significance are septic forms of cholangiogenic infection because of high lethality. The diagnosis and treatment of cholangiogenic infection include the determination of the character of bile duct obstruction, state of immunity, character of microflora and kind of toxemia.