Association of drug therapy with falls in elderly and senile patients: Subanalysis of the epidemiological study EVKALIPT

Aim to evaluate the structure of drug therapy in patients with falls and to identify the associations of falls with drug administration. Material and methods. This work is a subanalysis of the epidemiological study EVKALIPT. 4301 patients who had information about presence or absence of falls in the previous year were selected. The patients were divided into 2 groups: 1 group (n = 1307) having falls, 2 group (n = 2994) without falls. We studied the complaints and medical history, conducted general examination and analyzed medical documentation to get the information on drug treatment. A regular intake of 5 or more drugs was considered polypharmacy. Results. All patients had chronic diseases. In patients with falls, most diseases were more common, the Charlson Comorbidity Index was higher (5.532.4 versus 4.732.03, p0.001), as well as the proportion of high comorbidity (62.2% versus 47.7%, p0.001). All study participants took medications, on average 5.4 2.6 drugs. The patients with falls received higher number of drugs (5.732.6 versus 5.32.5, p0.001). The frequency of polypharmacy was 64.6% and 56.7% (p0.001) in groups 1 and 2, respectively. The patients with falls were more likely to take sartans, beta-blockers, diuretics, centrally acting antihypertensives, anticoagulants, nitrates, amiodarone, insulin, NSAIDs, proton pump inhibitors, calcium, vitamin D, anti-osteoporrotic therapy. Administration of a number of drugs was associated with falls (OR 1.18-2.15). For some drugs, a trend in favor of falls was revealed. Only statin therapy was associated with a 24% reduction in the odds of falling. The presence of polypharmacy increased the risk of falls by 1.3 times (OR 1.27, 95% CI 1.10-1.46, p=0.001). Conclusion. Polypharmacy and drug evaluation are important in assessing the risk of falls. In clinical practice, it is necessary to regularly conduct an audit of medications in elderly patients

Dependence in instrumental activities of daily living and its associations with other geriatric syndromes in people over 65 years of age: data from the Russian epidemiological study EUCALYPT

Aim – to assess the frequency of disability in instrumental activities of daily living (IADLs) and to analyze its associations with other geriatric syndromes in persons aged ≥65 years. Material and methods. The study involved 4,308 people (30% male) living in 11 regions of the Russian Federation, aged 65 to 107 years (average age 78 ± 8 years). The majority (60%) of participants were examined in a polyclinic, every fifth – in a hospital (20%) or at home (19%), 1% – in nursing homes. All patients underwent a comprehensive geriatric assessment, including an assessment of instrumental activities of daily living on the Lawton scale. Results. Among the elderly, a high (54%) prevalence of dependence in IADLs was revealed, and with increasing age, this indicator increased significantly, reaching 82% in people over 85 years old. In patients with disability in IADLs, the frequency of all geriatric syndromes, except orthostatic hypotension, was higher, of which the most common were chronic pain syndrome (90%), frailty (80%), dependence in basic activities of daily living (ADLs) (78%), cognitive impairment (75%), probable depression (63%) and urinary incontinence (54%). One-factor regression analysis showed that the presence of disability in IADLs increases the chances of detecting other geriatric syndromes by 1.6–5.9 times. Conclusion. The results of the EUCALYPT epidemiological study demonstrate a high prevalence of dependence in IADLs among the Russian population. The study also gives an idea of the relationship of dependence in IADLs with various geriatric syndromes

Anemia and comorbidity in people over 65: data from the Russian study EUCALYPTUS

Background. Anemia is an essential component of comorbidity, being both a complication of chronic diseases and a factor in their progression. Comorbidity patients with low hemoglobin have a greater number of diseases, worse geriatric status parameters and the lowest survival. Especially negative consequences of a decrease in hemoglobin were noted in people of the older age group. Aim. To investigate the relationship between anemia and comorbidity in patients aged 65 years and older. Materials and methods. The results of a sub-analysis of the multicenter cross-sectional study EUCALYPTUS, which involved 4308 people (30% of men) aged 65 to 107 years (average age – 78 years), are presented. The comorbidity was assessed and the Charlson comorbidity index was calculated, and the complete blood count was studied. Results. The frequency of comorbidity was 89%, anemia – 24%. The value of the Charlson comorbidity index in patients with anemia was greater than in those without anemia – 5 (4; 7) vs. 4 (3; 6) points (p0.001). For every 1-point increase in Charlson index values, the odds of having anemia increase by 21% (odds ratio 1.21; 95% confidence interval 1.17–1.25; p0.001). Multivariate regression analysis identified 9 independent predictors of anemia (age ≥82 years, male, history of myocardial infarction and stroke, peptic ulcer disease, atrial fibrillation, stage 4 and 5 chronic kidney disease, active cancer, no hypertension) with an odds ratio of 1.25 to 3.14. In the presence of 2–4 predictors, the risk of anemia increases 1.3–2.6 times, 5 predictors – almost 5 times, 6 or more – almost 13 times. Conclusion. Comorbidity patients are at risk for the development of anemia, which requires timely treatment, including iron supplements if absolute or functional iron deficiency is confirmed

Real-world experience with netakimab in the treatment of spondyloarthritis

Aim. To study the real-world efficacy and safety of netakimab in the treatment of ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Materials and methods. The retrospective analysis included 23 patients (13 males; 56.5%) aged 23 to 73 years (median 42, interquartile range 28 to 52 years) with AS (n=12) or PsA (n=11) who received netakimab therapy from February 2021 to April 2023. Disease activity was assessed every 3-6 months based on the C-reactive protein (CRP) level for all patients according to the BASDAI and ASDAS-CRP indices for AS, DAPSA and PASI for PsA. These indicators were analyzed before therapy and at the last visit to assess the effectiveness of treatment. The results are presented as median (interquartile range). Results. In all patients treated with netakimab (median duration of treatment 11 months), the CRP level decreased from 10.6 (3.1; 17.3) to 3.1 (1.9; 8.9) mg/L (absolute difference -7.5 mg/L, median relative reduction -60%; p=0.008), and the proportion of patients with elevated CRP decreased from 70 to 41%; p=0.039. In patients with AS (median duration of treatment 9 months), BASDAI score decreased from 5.8 (4.7; 6.5) to 3.0 (1.9; 3.8) points (absolute difference -2.8 points, median relative reduction of -45%; p=0.008) and ASDAS-CRP score decreased from 2.8 (1.9; 3.9) to 1.9 (1.7; 2.6) points (absolute difference -0.9 points, median relative reduction -21%; p=0.007). The proportion of patients with high AS activity (BASDAI≥4) decreased from 90% to 20% (p=0.031); however, there was no significant change in the CRP level (absolute difference -4.9 mg/L, median relative reduction -57%; p=0.110). In patients with PsA (median duration of treatment 18 months), the CRP level decreased from 12.0 (4.5; 17.3) to 3.3 (2.0; 7.8) mg/L (absolute difference -8.7 mg/L, median relative reduction -80%; p=0.041), the DAPSA score decreased from 23.0 (19.0; 30.5) to 6.3 (5.2; 13.5) points (absolute difference -16.7 points, median relative reduction -69%; p=0.018). Three (13%) patients reported mild to moderate adverse events. Conclusion. The obtained data confirm the effectiveness and safety of netakimab in treating AS and PsA in real-world practice

Gastrointestinal protection options for direct oral anticoagulants in patients with atrial fibrillation

Gastrointestinal bleeding (GIB) associated with the use of direct oral anticoagulants or, as they are also called, new oral anticoagulants (NOAC) is a serious medical problem, the relevance of which will only increase taking into account the constant expansion of the use of anticoagulants. It is especially important that most of the patients receiving NOAC are elderly people with multiple concomitant pathologies, including diseases of the gastrointestinal tract (GI), which makes them classified as patients with a high risk of GIB and, therefore, in need of prescribing gastroprotectors to protect the GI mucosa and prevent GIB. Considering that one of the mechanisms of GIB development during NOAC therapy is associated with their ability to inhibit GI mucosa healing, and the NOAC themselves are factors of aggression for GI and can lead to syndrome of increased epithelial permeability, the use of gastro- and the enteroprotector of rebamipide seems appropriate and probably pathogenetically justified. The randomized REGATA trial initiated at the Russian Gerontological Research and Clinical Center will provide additional information on the use of rebamipide in patients with atrial fibrillation receiving various NOAC

Gender features of awareness and attitudes of adolescents to a healthy lifestyle

Introduction. For the formation of the health of children and adolescents, it is essential to study their awareness of the risk factors for health disorders and the formation of stereotypes of a healthy lifestyle. Materials and methods. According to the questionnaire developed by us, “Awareness of adolescents about a healthy lifestyle”, a survey included 245 15-17 year adolescents (133 girls, 112 boys) attending secondary schools in Ivanovo. Results. In self-assessment of awareness, regardless of gender, adolescents highly value their knowledge of a healthy lifestyle. Adolescents often want to learn more about proper nutrition, health risk factors, reproductive health issues. Boys more often than girls consider it unnecessary to adhere to the rules of personal safety, safe reproductive behaviour, full compliance with medical recommendations, admit the possibility of self-medication, go to doctors only in case of illness, violate the principles of a healthy diet and daily routine. It is more difficult for boys than girls to maintain good personal hygiene. Of the negative school factors, girls more often than boys note high pedagogical loads difficulties in relationships with classmates and teachers. They often believe that they need to spend less time at the computer, observe the daily routine, spend enough time to sleep and rest in the fresh air, eat right. That is, they are more responsible and self-critical. Girls more often emphasize their independence in matters of a healthy lifestyle. They believe that for this, they need their conviction and time. Limitations. The study has age (15-17 year teenagers), regional (Ivanovo) and educational (students of secondary educational institutions) restrictions. Conclusion. The revealed gender characteristics of awareness and attitude of adolescents to healthy lifestyle make it necessary to take them into account when drawing up programs to improve adolescents’ knowledge. More attention should be paid to safety issues for boys, and for girls, psychological issues should be included.</jats:p

Effect of D42N substitution in Escherichia coli inorganic pyrophosphatase on catalytic activity and Mg2+ binding

AbstractAsp-42 located in the active site of E. coli inorganic pyrophosphatase (PPase) has been substituted by Asn by site-directed mutagenesis. This resulted in a 3-fold increase in hydrolytic activity measured under optimal conditions, a 15.5-fold increase in the Km value and retention of the pK values of groups for enzyme and enzyme-substrate complex. The active site of the enzyme contains 4 metal binding centers (I–IV) [Harutyunyan et al. (1996) Eur. J. Biochem., in press]. Asp-42 is located near centers II and IV. The D42N replacement had no effect on Mg2+ binding with center II. At the same time, occupation of center IV eliminates the inhibition of inorganic pyrophosphate hydrolysis by high Mg2+ concentrations typical of wild-type PPase. It is proposed that the increase in activity and decrease in affinity for substrate of the D42N PPase results from changes in Mg2+ binding to center IV. The Mg2+ binding centers of E. coli PPase are lined up in filling order