Percutaneous Gastrostomy Tube Placement under Quadratus Lumborum Block: A Case Report

The quadratus lumborum block is a technique that is not widely applied in abdominal surgery. The influence of the mode of anesthesia on the outcome of polymorbid patients is a controversial issue in the medical literature. We report a case in which we performed a quadratus lumborum block type 2 on a woman who was admitted to Riga's 1st hospital in need of gastrostomy, due to difficulty swallowing solid foods and liquids caused by hypopharynx carcinoma. On account of the patient's difficult airway, general anesthesia was deemed unsafe for the patient, with a risk of patient death. Percutaneous gastrostomy tube placement under a quadratus lumborum block type 2 was performed successfully.

[Ethnic features of multipathology in elderly and senile patients of the Republic of Sakha suffering from chronic brain ischemia]

OBJECTIVE

To study ethnic characteristics of multipathology in elderly and senile patients with chronic cerebral ischemia living in the Republic of Sakha (Yakutia).

MATERIAL AND METHODS

The study included 522 inpatients, aged 60 to 89 years, who were divided into subgroups depending on the stage of chronic cerebral ischemia, ethnicity (Evens, Yakuts and Russians) and age (elderly and senile).

RESULTS

In addition to vascular cerebral pathology, comorbidities were identified in patients of older age groups. At the same time, polymorbidity was less pronounced in the Evens, the indigenous inhabitants of the northern regions of Yakutia, than in the Yakuts and representatives of the non-indigenous population - Russians.

CONCLUSION

The relatively rare occurrence of comorbid pathologies in Evens is presumably associated with greater adaptation to the extreme climatic conditions of the North.

[Problems of choosing hypoglycemic therapy in elderly patients (literature review).]

Type 2 diabetes mellitus is one of the most common non-infectious diseases in the world. Among people with type 2 diabetes, patients of the older age group predominate: 60,5% of all patients are over 65 years old, and the peak prevalence is at the age of 65-69 years. The treatment of this pathology in elderly patients has certain features, which is associated with a high level of polymorbidity in these patients. Therapy for type 2 diabetes should be aimed not only at compensating the level of glycemia, but also at treating and preventing complications of diabetes, and improving the quality of life of patients. The choice of hypoglycemic therapy should take into account the effect of drugs on the cardiovascular system and kidney function, as well as the risk of hypoglycemia, which is more common in older people and affects the cognitive function of such patients. This review discusses the possibilities of using various groups of antidiabetic drugs in elderly and old patients.

[Management of patients with insomnia and polymorbidity: expert consensus]

Sleep disorders are becoming increasingly important due to the high comorbidity with other diseases and a significant impact on the patient's quality of life. Insomnia is the most common sleep disorder both in the general population and in patients with multimorbid pathology. Its prevalence in the general population is 6-15%, while in patients with somatic diseases it increases up to 20-40% and can reach 90% in patients with comorbid mental disorders. Another problem is the development of drug-induced insomnia. Insomnia has negative impact on the prognosis of comorbid diseases, including an increased risk of death, more severe disease, and a worse quality of life. The presence of sleep disorders makes it difficult to effectively treat the underlying disease, so it is extremely important to identify and correct these disorders in the early stages, therefore recommendations for the diagnosis of insomnia in polymorbid patients are proposed. Modern methods of treating acute and chronic insomnia and features of insomnia treatment in polymorbid patients are also discussed.

[Efficacy evaluation of symptom-complex physiotherapy in polymorbidity based on randomized comparative studies]

The problem of comprehensive physical therapy in polymorbidity (PM) identifies among the most urgent difficulties of modern rehabilitation medicine. It is known that PM are more common than it is generally accepted, and their impact on the endpoints of rehabilitative treatment is more significant. Yet, many problems of PM have not been investigated and properly solved.

OBJECTIVE

To evaluate the efficacy of comprehensive physical therapy (CPT) in PM in the age aspect on the basis of correlation analysis and ANOVA indicators (OR, RR, Q, x2, r2), as well as evidence-based medicine (EBM), in particular randomized comparative study (RCS).

MATERIAL AND METHODS

A number of patients with PM equal 554 underwent CPT, of which 204 (36.8%) were male and 350 (63.2%) female. The identified age cohorts were following: the 1st group - 188 (33.9%) patients aged from 45 to 59; the 2nd group - 366 (66.1%) patients aged from 60 to 74. The ratio of middle-aged and elderly patients was 1.9:1.

RESULTS

The efficacy of CPT in patients with PM was judged, first of all, by documentary (medical histories and medical records of patients) and mathematical data (OR, RR, Q, x2, r2). The evidence level of CPT effect was determined on the basis of the analysis of the particular method's study results.

CONCLUSION

The incidence of positive CPT result in middle-aged patients was higher than in elderly. The positive strong statistical correlation between comprehensive physical therapy and the endpoint in most classes of diseases of patients with PM. The comparative assessment of CPT efficacy based on the EBM principles revealed the advantages of their use for elderly patients relative to middle-aged group.

Neuropathologic Changes of Alzheimer's Disease and Related Dementias: Relevance to Future Prevention

BACKGROUND

Decedents with late-life dementia are often found at autopsy to have vascular pathology, cortical Lewy bodies, hippocampal sclerosis, and/or TDP-43 encephalopathy alone or with concurrent Alzheimer's disease (AD) lesions. Nonetheless, it is commonly believed that AD neuropathologic changes (NC) are the dominant or exclusive drivers of late-life dementia.

OBJECTIVE

Assess associations of end-of-life cognitive impairment with any one or any combination of five distinct NC. Assess impairment prevalence among subjects having natural resistance to each type of NC.

METHODS

Brains from 1,040 autopsied participants of the Honolulu-Asia Study, the Nun Study, and the 90 + Study were examined for NC of AD, Lewy body dementia, microvascular brain injury, hippocampal sclerosis, and limbic predominate TDP-43 encephalopathy. Associations with impairment were assessed for each NC and for NC polymorbidity (variable combinations of 2-5 concurrent NC).

RESULTS

Among 387 autopsied decedents with severe cognitive impairment, 20.4% had only AD lesions (ADNC), 25.3% had ADNC plus 1 other NC, 11.1% had ADNC plus 2 or more other NC, 28.7% had no ADNC but 1-4 other NC, and 14.5% had no/negligible NC. Combinations of any two, three, or four NC were highly frequent among the impaired. Natural resistance to ADNC or any other single NC had a modest impact on overall cohort impairment levels.

CONCLUSION

Polymorbidity involving 1-5 types of concurrent NC is a dominant neuropathologic feature of AD and related dementias. This represents a daunting challenge to future prevention and could explain failures of prior preventive intervention trials and of efforts to identify risk factors.

[MEDICAL AND SOCIAL SUPPORT OF CHRONIC PATIENTS: OLD PROBLEMS, NEW SOLUTIONS]

The purpose of the article is to study approaches to medical and social support of patients with chronic diseases in Russia and abroad in order to identify possible ways to solve emerging problems in this area of modern healthcare development. The reasons of comorbidity (polymorbidity), disadvantages of algorithms for accompanying patients with two or more chronic diseases, models of management of patients with chronic diseases and priorities of their use are considered. Based on the analysis of Russian and foreign publications, as well as the systematization of the opinions of experts interviewed during the scientific and practical expert session conducted by the authors (April 2022), conclusions are drawn about existing problems and possible ways to solve them. A proposal has been put forward to organize an information and coordination center for the support of patients with two or more chronic diseases. The purpose, tasks (and the order of their solution), the structure of the center, the need for the work of a curator leading patients (and who can perform the duties of a curator), the possibilities of integrating types of care (medical, social, psychological) to patients who need to be accompanied by specialists-representatives of organizations of very different orientation: medical, rehabilitation, social and preventive. It is shown that the increase in the number of polymorbid patients is a serious burden for modern healthcare systems around the world, and requires the search for effective approaches to solving the problem. The importance of self-preserving behavior of patients and the responsibility of the person himself for adherence to the treatment and prevention of diseases, as well as maintaining a healthy lifestyle is emphasized.

The Effect of Probiotic Strains on Myocardial Infarction Size, Biochemical and Immunological Parameters in Rats with Systemic Inflammatory Response Syndrome and Polymorbidity

Numerous experimental and clinical studies have shown the effectiveness of various probiotic strains in metabolic disorders, gastrointestinal and liver diseases, immune system pathology. The effects of probiotics on cardiovascular dysfunction are less well known. The development and validation of a new experimental model in rats, including obesity, acute colon inflammation and antibiotic-induced dysbiosis, with common characteristics of systemic inflammatory response syndrome (SIRS), became the basis for investigating the effects of probiotic drugs on myocardial resistance to ischemic-reperfusion injury (IRI) using an in vivo model of infarction after coronary occlusion. A 24% increase in myocardial infarction compared to intact animals (p < 0.05) and significant changes in leukogram, biochemical and immunological parameters were found in Wistar rats with SIRS modelling. Introduction of a mixture of strains of Lactobacillus acidophilus (LA-5) and Bifidobacterium animalis subsp. lactis (BB-12) to animals with SIRS reduced infarct size to a value close to the control. Rats treated with LA-5 and BB-12 also showed normalization of the leukocyte count, bile acids, transforming growth factor-β, interleukins: IL-1α, IL-2, IL-6, IL-8, tumor necrosis factor-α, lipopolysaccharide and monocyte chemoattractant protein-1 in blood in comparison with the SIRS group and with the groups treated with other probiotic strains. The obtained data convincingly show the prospects for further study of the cardiotropic potential of probiotic microorganisms in translational studies.

Polypharmacy in polymorbid pregnancies and the risk of congenital malformations-A systematic review

With an increased prevalence of concurrent morbidities during pregnancy, polypharmacy has become increasingly common in pregnant women. The risks associated with polypharmacy may exceed those of individual medication because of drug-drug interactions. This systematic review aims to evaluate the risk of congenital malformations in polymorbid pregnancies exposed to first-trimester polypharmacy. PubMed, Embase and Scopus were searched to identify original human studies with first- trimester polypharmacy due to polymorbidity as the exposure and congenital malformations as the outcome. After screening of 4034 identified records, seven studies fulfilled the inclusion criteria. Four of the seven studies reported an increased risk of congenital malformations compared with unexposed or monotherapy, odds ratios ranging from 1.1 to >10.0. Particularly, short-term anti-infective treatment combined with other drugs and P-glycoprotein substrates were associated with increased malformation risks. In conclusion, knowledge is limited on risks associated with first-trimester polypharmacy due to polymorbidity with the underlying evidence of low quantity and quality. Therefore, an increased focus on pharmacovigilance to enable safe drug use in early pregnancy is needed. Large-scale register-based studies and better knowledge of placental biology are needed to support the clinical management of polymorbid pregnancies that require polypharmacy.

[Relationship of kidney functions with geriatric syndromes in elderly and old women.]

Against the background of aging, there is an increase in the number of diseases associated with age, geriatric syndromes that contribute to the development of disorders of physical and functional activity, the risk of disability and mortality increases. One of the widespread diseases is chronic kidney disease (CKD), which is dangerous not only in itself, but also as a factor in the progression of other age-associated diseases and geriatric syndromes, including frailty and sarcopenia. Among patients of older age groups, CKD is more common in women than in men. A number of researchers are studying the problems of polymorbidity, the development and progression of geriatric syndromes in patients with CKD in the pre-dialysis and dialysis stages. Undoubtedly, the negative role of severe late stages of CKD in the development of senile asthenia and sarcopenia, at the same time, the relationship of these geriatric syndromes with early pre-dialysis stages of CKD has been insufficiently studied. Therefore, it is of undoubted scientific interest to identify correlations between signs of sarcopenia and frailty in elderly and senile women, depending on renal function, stage of CKD.

[Risk factors of frailty in elderly women with the chronic non-infectious diseases.]

Against the background of an aging population, there is an increase in the frequency and prevalence of chronic non-infectious diseases with age. The syndrome of frailty, the frequency of which also increases with aging, is considered as a prognostic factor for the adverse outcomes of chronic diseases and mortality among geriatric patients. Moreover, in women, frailty is more common than in men. An earlier diagnosis and identification of signs of frailty is necessary to prevent the progression of both the syndrome itself and multiple age-associated chronic diseases.

[What is primary: frailty or sarcopenia? (literature review).]

Among the many geriatric syndromes, undoubtedly, one of the first places is, in other words, the leading positions are occupied by frailty and sarcopenia. Despite their wide coverage in the modern scientific medical literature, the question of the relationship of these geriatric syndromes with each other is still relevant. Which of the above syndromes is primary and which is secondary? Do they compete with each other, mutually burden each other, do not depend on each other, or are they united by common pathological mechanisms? This literature review is devoted to these issues.

[Comorbidity/polymorbidity - problems of terminology and application of index indicators (review).]

The review presents a literature analysis on controversial issues of the use of the terms polymorbidity, multimorbidity, comorbidity. Increasing publication activity on the topic of comorbidity/multimorbidity is noted. The main discussion is conducted in several areas: what term should be used - comorbidity, multimorbidity or polymorbidity; use or not use index indicators of comorbidity; if used, specifically for what purpose; what is the effectiveness of these indicators. It is concluded, that many issues have not yet been resolved and further research is needed on this issue. It is time to define terminology and specify WHERE and WHEN comorbidity/polymorbidity indexes are needed.

Pitfalls of solving polypharmacy problems

Polymedication is associated with a higher incidence of negative health indicators including falls, morbidity and mortality. Despite efforts, the solution to this problem is still unsatisfactory. The two main causes of polymedication are population aging and polymorbidity and, on the other hand, the development of the pharmaceutical industry and the availability of a wide range of medicines. The authors discuss the main shortcomings in the investigation of this issue, such as inconsistent terminology used, methodological shortcomings in data acquisition, lack of recommended guidelines for the polymorbid patients treatment, etc. They discuss whether polymedication is the cause or marker of increased falls, frailty and mortality. In the end they critically evaluate possible solution of polymedication in future - personalised medicine.

[The characteristics of morbidity of population older than able-bodied age in the Russian Federation in 2012-2018]

The indices of population health exhibit tendency to deteriorate with age. The high level of morbidity, prevalence of chronic diseases, polymorbidity, atypical course of disease, continuous rehabilitation period, frequent complications and exacerbations are specific for individuals over able-bodied age. The purpose of study is to analyze dynamic, structure and characteristics of morbidity of population over able-bodied age in the Russian Federation. The study established specific features in dynamics and structure of morbidity of elderly population during 2012-2018. They are associated with high prevalence of cardiovascular diseases, diseases of musculoskeletal system and connective tissue. Furthermore, there is variety in morbidity rates of neoplasms, endocrine, nutritional and metabolic diseases, mental and behavioral disorders, diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism, diseases of the eye and adnexa, diseases of ear and mastoid process and also symptoms, signs and abnormal clinical and laboratory findings, not classified in other rubrics. The analysis of indices of primary and common morbidity of pneumonia in elderly population of different regions of the Russian Federation was carried out.

[The use of nonsteroidal anti - inflammatory drugs in polymorbid pathology]

The literature review presents the possibilities of using non - steroidal anti - inflammatory drugs (NSAIDs) for polymorbid pathology. The mechanism of NSAIDs action, risk factors for the development of undesirable effects on the cardiovascular, digestive, urinary and other systems are considered; prevention measures and drug selection options are discussed, NSAIDs prescribing algorithm is considered.

[Extragenital diseases, comorbidities, and polymorbidity in maternal death]

OBJECTIVE

To study the structure and significance of comorbidities and polymorbidity in maternal death.

MATERIAL AND METHODS

Sixty-five autopsy protocols of maternal deaths in the Novosibirsk Region in the period of 1994 to 2018 were analyzed.

RESULTS

Extragenital diseases are the leading diseases in the nosological structure in maternal mortality. Preeclampsia/exlampsia and obstetric hemorrhages lost their leading positions. The increasing role of extragenital pathology in the structure of maternal mortality is due to many factors, such as a larger number of comorbidities and polymorbidity, in pregnant women. Infectious diseases, benign and malignant tumors, and diseases of the heart and blood vessels are the main diseases in the structure of extragenital diseases.

[Elderly and frail patients with polymorbidities: what quality of life?]

Polymorbidity is frequent in very old people, particularly in nursing homes, where patients are often extremely frail. They are particularly at risk of polypharmacy and iatrogenic effects, which can result in worsen the quality of the end of life of these patients. A new approach must be found, centred on the patient rather than the disease.

Сomorbidity and polymorbidity of the patient with chronic obstructive pulmonary disease and cardiovascular diseases

AIM

the study of comorbid status and characteristics of clinical course of ischemic heart disease (IHD) in patients with chronic obstructive pulmonary disease (COPD).

MATERIALS AND METHODS

We conducted a retrospective analysis of case histories of 958 IHD patients aged 32 to 93 years (mean age of 60.8±10.2 years), including men - 525 (54.8%), women - 433 (45.2%) who were treated in the cardiology Department of city clinical hospital №5 of Nizhny Novgorod. Related COPD was diagnosed in 251 patients (26.3%). We compared two groups patients: with IHD and COPD, and the second - persons suffering from only IHD (without COPD).

RESULTS

Myocardial infarction was transferred by 62.2% of patients in Group 1, which is 16.3% more than in Group 2 (p&lt;0.05). Arterial hypertension in patients with COPD was 13.6% more frequent than in patients without COPD (p&lt;0.05), and 6.4% more often (p&lt;0.05), with comorbid pathology there was a chronic and paroxysmal forms of atrial fibrillation. In patients with IHD in combination with COPD it is 21.5% more often (p&lt;0.05) than in IHD without COPD, there was shortness of breath and 32.1% more often (p&lt;0.05) of the heartbeat. In patients with IHD with COPD, a higher level of was C-reactive protein detected (p&lt;0.05) and more pronounced violations of the lipid profile (p&lt;0.05).

CONCLUSION

COPD makes a significant contribution to the development of the cardiovascular continuum, modifying its course. A modern patient with COPD is a high-risk patient with severe cardiovascular comorbidity and various polymorbidity.

[Polymorbidity in elderly patients needing myocardial revascularization (a review article).]

In the present review, the main attention is focused on the problem of polymorbidity and age-related conditions in elderly patients with CAD who need myocardial revascularization. In addition to a high risk of mortality, elderly patients with polymorbidity are characterized reduced functional activity, cognitive impairment, low quality of life and frequent seeking medical help. There is evidence of the presence of common mechanisms that affect the aging process and the development of a number of associated diseases associated with age. Accordingly, the study of polymorbidity will allow us to develop strategies for the prevention it and understand the aging process and significantly reduce the risks of surgical intervention. In this regard, there is a necessity for research aimed at studying the causal relationship between coronary artery disease and polymorbidity in elderly patients with an additional assessment of functional and cognitive status for the development of specific prognostic tools and treatment strategies.

[General and primary morbidity of population older than able to work age of Belgorod area.]

In the article, the author presented the level and dynamics of the general morbidity of the population older than the working age of the Belgorod region for 2010-2017, which decreased by 10,9%. It showed differences in the incidence rates of the urban and rural population, which is 23,2% lower than the urban one. In the structure of general morbidity, circulatory system diseases ranked first (32,8%, rural - 39,6%); the second - diseases of the musculoskeletal system (11,9%, rural - 10,5%); third, respiratory diseases (9,5%, rural - 9%). He provided the incidence with the diagnosis established for the first time in his life, which decreased by 19,2%, the rural population increased by 9,3%, but it was 30,9% lower than the urban one. At the same time, in the form 025 / in persons with senile (75-84 years) and advanced age (85 years and older), 4 to 8 chronic diseases confirming polymorbidity were registered. Negative environmental factors of urban residents contribute to the greater accumulation of chronic diseases in them, on the one hand, and the difficulty of avoiding dubbing and the possibility of over-accounting, on the other. The rural population is less susceptible to the negative factors of urbanization, however, due to the lack of access to medical care, there is an underreporting of diseases and the incidence of diseases remains much lower - urban. This is indirectly confirmed by the high mortality rate of the rural population (higher by 24,1% - urban).

The prevalence of multimorbidity: discussion about the terminology, registration and its effect on patient's health care utilization

The purpose of the present review is to bring into focus the issues regarding terminological and registration aspects of multimorbidity we come across in the modern literature. Key questions regarding the definitions for the most widely used terms «comorbidity», «polymorbidity» and «multimorbidity» are discussed. We also considered the aspects of their origin and distinctive features between the concepts. The interaction between illnesses can exacerbate one another, modify the clinical picture and course of illnesses, the nature and severity of complications, lead to a progressive worsening of the prognosis and quality of life in patients. It has been proposed that the terms of "comorbidity» (in case of presence of the pathogenesis interrelation) or "polimorbidity» (in case of absence of the pathogenesis interrelation) are the most appropriate diagnostic and treatment patterns for practice and epidemiological study. «Multimorbidity» seems to be a more appropriate term for clinical practice usage, because it involves not only diagnosis but also interaction between diagnosises, symptoms/syndromes, the mobility or self-care problems et al. The algorithm of the managing patients with multimorbidity is presented. >.

[Immediate results of surgical treatment of complicated colorectal cancer in elderly and senile patients.]

The work analyzes the results of surgical treatment of 545 elderly and senile patients with complicated forms of colon cancer. Among colon cancer complications frequently encountered acute intestinal obstruction (AIO) - 413 (75,8%), less likely to have been identified - perifocal inflammation (PPV) with abscess - 80 (14,7%), bleeding - 30 (5,5 %) and tumor perforation - 22 (4%). Operations on the colon were performed as a traditional method - 408 (74,9%) and with the use of endovideosurgical technologies - 137 (25,1%). 335 (61,5%) of radical, 50 (9,2%) palliative, 160 (29,3%) symptomatic operations were performed. Operations on the colon, performed for the development of cancer complications, were accompanied by a high mortality rate (22,9%) and a high incidence of postoperative complications (37,1%). The most frequent wound complications were 105 (19,3%) and pneumonia 67 (12,3%). The highest postoperative mortality was observed after operations for tumor perforation of colon cancer (59,1%). Endomedosurgical operations on the large intestine were accompanied by fewer postoperative complications (17,5%) and postoperative lethality (2,2%).