Aim. To determine the frequency and assess the risk factors of sarcopenia (SP) in elderly people living at home.

Materials and methods. The study included 230 people aged 65 years and older who lived at home and were observed in outpatient clinic. To detect SP, grip strength was measured and muscle mass was determined using dual-energy absorptiometry (DXA). Severe SP was diagnosed based on the results of Short physical performance battery (SPPB) and the “Up and Go” test. The diagnosis of SP was made according to the criteria of EWGSOP2 (2018). The laboratory examination included clinical and biochemical blood analysis, determination of the level of 25 (OH) D.

Results. Probable SP was found in 64.8 %, confirmed SP – in 28.7 %, and severe SP – in 21.3 % of older people. The frequency of SP increased with age from 19.6 % in 65–74 years to 52.9 % in 85 years and older (p <0.05). The results of multivariate analysis showed that the probability of SP increased with a BMI of less than 25 kg / m² (OR 5,459; 95 % CI: 1,939–15,369; p = 0.0013), severe comorbidity calculated by the Charlson index (OR 5,178; 95 % CI: 1,597–14,128; p = 0.0030) and the presence of such laboratory indicators like level 25 (OH) D less than 20 ng / ml (OR 4,989; 95 % CI: 1,321–12,626; p = 0.0420), total protein less than 64 g / l (OR 8,567; 95 % CI: 2,658–27,617; p = 0.00032), CRP more than 5 mg / l (OR 14,279; 95 % CI: 3,511–58,071; p = 0.00020) and moderately reduced renal function (GFR <60 ml / min / 1.73 m (OR 12,108; 95 % CI: 3,944–37,170; p = 0.00001).

Conclusions. Among elderly people, a high frequency (28.7 %) of SP was detected, which increased with age. A BMI of less than 25 kg / m², a deficiency of 25(OH)D, total protein level of less than 64 g / l and CRP of more than 5 mg / l, a decrease in GFR of less than 60 ml / min were associated with the presence of SP.

Aim. To study the severity of atherosclerosis of the carotid arteries during the period of hospitalization and one year after acute coronary syndrome (ACS) in elderly patients and to determine the factors influencing the progression of the atherosclerotic process.

Materials and methods. The study included 105 patients with ACS aged 75 and over and with the presence of atherosclerosis of the carotid arteries according to duplex scanning. The data of 86 patients were re-analyzed one year after ACS. The degree of stenosis of the carotid arteries, the structure of atherosclerotic plaques (ASP) with the determination of signs of instability were assessed during the period of hospitalization and one year after ACS.

Results. One year after ACS, 56,9 % patients had adverse clinical outcomes, including death. Progression of the atherosclerotic process was detected in 31,4 %, regression – 7,2 %, unchanged – 61,4 %. During the period of hospitalization and one year after ACS, the regression of signs of instability was found when assessing the structure of ASP: heterogenous structure – 29 and 19,5 % (p = 0,019), irregular surface – 9,2 and 4,9 % (p = 0,605), hypoechogenic component – 27,6 and 17,3 % (p = 0,012), signs of local calcification – 14,7 and 8,8 % (p = 0,075), ulcerated ASP – 2,8 and 1,3 % (p = 0,329). The relationship between the progression of atherosclerosis and adherence to therapy was found. The presence of stenoses of the carotid arteries of 50 % and more: OR = 2,53 (95 % CI: 0,65–9,86, p <0,001) and heterogenous structure of ASP: OR = 2,4 (95 % CI: 0,86–6,73, p = 0,026) can affect the progression of the atherosclerotic process.

Conclusion. 56,9 % of elderly patients one year after ACS had adverse clinical outcomes. Progression of atherosclerosis of the carotid arteries was in 31,4 %. Regression of signs of instability was detected one year after ACS when assessing the structure of ASP in the carotid arteries. The relationship between the progression of ASP and adherence to therapy was found. The greatest influencing factors on the progression of the atherosclerotic process in the carotid arteries have been determined, which can help reduce the risk of developing cerebrovascular and recurrent cardiovascular events. 

Diabetes mellitus (DM) is a group of metabolic diseases characterized by chronic hyperglycemia, which is the result of impaired insulin secretion, insulin action, or both. Chronic hyperglycemia in diabetes is accompanied by damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Diabetes mellitus plays a significant role in the formation and is one of the significant risk factors for the development of chronic heart failure (CHF) through its glucose toxic effect, the effect on hyperlipidemia and blood coagulation, impaired autonomic regulation of the heart and a number of other mechanisms. Sodium-glucose cotransporter type 2 (SGLT2) inhibitors are a recently emerging class of antidiabetic drugs that act by inhibiting the reabsorption of glucose in the kidneys. Existing studies of the efficacy and safety of these drugs have shown that they have not only antidiabetic, but also a pronounced organoprotective, especially cardioprotective effect. Today it is believed that the main reason leading to this lies in a decrease in sodium reabsorption in the kidneys, a decrease in the content of intracellular calcium and sodium, and an increase in the concentration of calcium in mitochondria. The role of the ketogenic action of these drugs, their effect on oxidative stress and the processes of inflammation and fibrosis in the myocardium is also considered. The most common side effects of SGLT2 inhibitors include urinary tract and genital infections, euglycemic ketoacidosis. Other possible side effects include an increased risk of lower limb amputations, Fournier gangrene, breast cancer in women, bladder cancer in men, orthostatic hypotension and acute kidney injury, and an increased tendency to fracture. Most side effects can be avoided through adequate patient education and assessment of risk factors and contraindications before starting the use of drugs. Despite the clear need for more research on SGLT2 inhibitors, their widespread use will positively affect the health of the diabetic patient population.

Improving the quality of care for patients with oncological diseases due to the improvement of methods of chemoradiotherapy and surgical interventions, accessibility and modernization of diagnostic potential, is accompanied by a steady increase in the frequency of venous thromboembolic complications, which occupy one of the leading places among the causes of death.

Patients with oncological diseases are subject to various risk factors for thromboembolic complications, which are caused by the presence of a malignant neoplasm, due to the development of many coagulation abnormalities, initiating not only an increased tendency to thrombosis, but also a tendency to bleeding. Cancer-associated venous thrombosis, growing out of the framework of certain medical specialties, act as comorbid pathological conditions that require an interdisciplinary approach in developing rational methods of prevention and treatment. Improving the understanding of the pathophysiological mechanisms of venous thrombosis in cancer patients contributes to the development of modern methods of prevention and treatment, among which anticoagulant therapy plays a dominant role. The appearance of oral anticoagulants on the pharmaceutical market, the effectiveness and safety of which is confirmed by a series of randomized clinical trials, opens up new prospects for improving the quality of life and long-term survival in patients with malignant neoplasms.

Psoriatic arthritis (PsA) is a chronic inflammatory joint disease associated with psoriasis and characterized by various presentation, course, and response to treatment. A better understanding of the pathogenesis has led to the development of targeted therapeutic agents and innovative treatment strategies for PsA. The article is dedicated to a drug targeting interleukin-17A. Secukinumab is a fully human monoclonal antibody that selectively targets interleukin (IL) 17A, a pro-inflammatory cytokine involved in the pathogenesis of PsA. Secukinumab is the first antibody against IL 17 approved in many countries for PsA treatment in adult patients. In the Phase III FUTURE trial, secukinumab 150 and 300 mg subcutaneously showed high efficacy on disease activity in patients previously treated with non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and / or tumor necrosis factor (TNF) inhibitors and maintaining the effect for a long time of treatment (more than 5 years). In addition, in studies FUTURE 1 and 5 secukinumab suppressed structural joint damage and was associated with consistently low rates of radiological progression after 1–3 years of treatment. Treatment with secukinumab improved physical function and quality of life and was generally well tolerated in both short and long term. Secukinumab is effective in all key PsA domains and therefore represents a treatment option that may be an alternative to TNF inhibitors and other DMARDs in adult patients with PsA.

Osteoarthritis, both idiopathic and post-traumatic, is currently the most significant problem in orthopedics. It is particularly difficult to treat patient with comorbidities, when it is necessary to decide on surgery for a late-stage joint disease. An operation is associated with a great risk in such patients. Even if the patient does not have serious somatic disorders, the main task of doctors (and this is a multidisciplinary problem) is to prolong joint functioning and maintain the patient’s quality of life.

In this article, we report difficult cases, when a complex of non-pharmacological (therapeutic exercise, physiotherapy, orthobiology – PRP therapy) and pharmacological (nonsteroidal anti-inflammatory drugs, chondroprotectors, vitamins, calcium, tissue repair stimulants) treatments ensured a good effect, thereby maintaining the joint function and adequate quality of life without surgery. We also found that the use of Ambene® Bio (a chondroprotector) increased treatment efficacy.