The paper introduces clinical guidelines on frailty that have been developed by the Russian Association of Gerontologists and Geriatricians. These guidelines are specifically designed to assist geriatricians, internists, general practitioners, family physicians, and other healthcare specialists who work with adult patients. Within the paper, there are screening instruments, diagnostic tools, and treatment options provided for individuals with frailty. Additionally, the paper also includes information on prevention, rehabilitation, and medical care organization for this cohort of patients.

The aim of the study was to evaluate the clinical manifestations and survival of patients with giant cell arteritis (GCA). Methods . A retrospective study included 166 patients with newly diagnosed GCA. Clinical, laboratory and instrumental data, three sets of classification criteria were used to confirm the diagnosis: the American College of Rheumatology (ACR) 1990, the revised ACR criteria of 2016 and/or the new ACR and European Alliance of Associations for Rheumatology (EULAR) 2022 criteria. Some of the patients underwent instrumental investigations: temporal artery ultrasound Doppler ( n =61), contrast-enhanced computed tomography (CT) ( n =5), CT angiography ( n =6), magnetic resonance imaging ( n =4), magnetic resonance angiography ( n =3) and 18F-FDG positron emission tomography/CT ( n =47). Overall and recurrence-free survival were analyzed using survival tables, Kaplan – Meier method. Results . The most frequent first manifestations of GCA were headache (81.8%), weakness (64%), fever (63.8%) and symptoms of rheumatic polymyalgia (56.6%). Changes of temporal arteries in color duplex scanning were detected in 44 out of 61 patients. GCs therapy was performed in all patients who agreed to be treated ( n =158), methotrexate was used in 49 out of 158 patients, leflunomide – in 9 patients. In 45 (28.5%) out of 158 patients a stable remission was achieved as a result of GCs monotherapy, in 120 (75.9%) patients long-term maintenance therapy with GCs was required to prevent exacerbations, including 71 (44.9%) patients – in combination with methotrexate or other immunosuppressive drugs. The follow-up period of patients with a history of relapses was 21.0 (8.0–54.0) months. Relapses developed in 73 (46.2%) patients. The overall one-year survival rate was 97.1% [95% confidence interval (CI): 94.3; 99.9], and the five-year survival rate of patients was 94.6% [95% CI: 90.2; 99.0]. The one-year relapse-free survival rate was 86.4% [95% CI: 80.5; 92.3], and the five-year relapse-free survival rate was 52.4% [95% CI: 42.0; 62.8]. 12 (7.2%) of 166 patients died. The cause of death was myocardial infarction in two patients, stroke in two patients, and breast cancer in one patient; in the remaining seven cases, the cause of death was not determined. Conclusion . Given the high frequency of disease exacerbation, patients with GCA require long-term follow-up, especially during the first year after diagnosis.

The population of older and oldest-old individuals is increasing at a rapid pace, leading to a notable proportion of this age group requiring surgical procedures due to multimorbidity. It is known that, compared with young people, patients over 60 have a whole set of factors, such as decreased physiological functions, the presence of several concomitant diseases, polypharmacy, cognitive dysfunction and specific geriatric syndromes, which may lead to a higher risk of postoperative complications and prolonged recovery. Therefore, an integrated multidisciplinary approach on management is necessary for this group of patients, but the use of such an approach is currently rare. The purpose of this document is to review the literature, summarize current recommendations, and provide a set of expert recommendations to assist practicing geriatricians, surgeons, anesthetists, and allied health professionals.

В современной фотонике существует запрос на технологии воспроизводимого и контролируемого получения наноструктур, поскольку многие интересные и важные оптические процессы разыгрываются на характерном для таких структур субдифракционном масштабе. Однако для работы со светом на нанометровых расстояниях требуется нанометровая точность в позиционировании объектов, добиться которой стандартными методами оказывается подчас крайне непросто. Одним из новых подходов, способных стать ответом на этот вызов, является использование ДНК- оригами: строение полимерной молекулы ДНК позволяет, с одной стороны, химически «настраивать» ее геометрию для придания ей произвольной формы на естественном для нее нанометровом масштабе, а с другой, – адресно размещать нанообъекты в любой позиции вдоль ее цепи. В настоящем обзоре рассмотрены некоторые практические аспекты получения ДНК-оригами.

Одной из ключевых задач современной фотоники является разработка методов экономически эффективного синтеза наноструктур с заданным химическим составом и морфологией. Наряду с традиционными методами CVD, эпитаксии, литографии, лазерной печати и абляции, коллоидного и электрохимического синтеза, в последние годы стремительно набирает популярность метод ДНК-оригами. В статье описаны принципы, лежащие в основе метода ДНК-оригами, а также приведены некоторые примеры его применения.

Diseases of the musculoskeletal system in Russia affect 19.2 million people. Untimely diagnosis and inadequate therapy of pain syndrome negatively affect the daily functioning and quality of life of patients, and create significant socioeconomic problems. The most common variants of musculoskeletal pain (MSP) are osteoarthritis (OA) and low back pain (LBP). OA is seen in 57.6% of individuals over 65 years of age. It should be noted that chronic pain syndrome, rather than anatomical and degenerative changes detected by imaging studies, determines to a greater extent the quality of life of patients with OA and prognosis during the course of the disease. The global burden of disability associated with LBPD increased in all age groups between 1990 and 2019 and was highest in the 50-54 age group.

In recent decades, the prevalence of osteoarthritis (OA), one of the most disabling diseases, has increased worldwide, which imposes a significant burden on society. At the international multidisciplinary meeting, experts of various specialties (rheumatology, neurology, endocrinology, geriatrics, rehabilitation, traumatology and orthopedics) from Russia, Uzbekistan, and Kazakhstan discussed the importance of an individualized approach to the treatment of patients with OA, taking into account comorbidities, identified the most important and common clinical phenotypes of the disease, discussed known symptom- and structure-modifying effects of a combination of glucosamine and chondroitin sulfate, and new data on additional (pleiotropic) effects of these drugs that may have a positive impact on the course of comorbid diseases and conditions. The resolution of the Expert Council summarizes the results of the discussion and focuses on issues that are important for the further development of therapeutic approaches and recommendations for the management of such patients.

A fall is defined as an event, which results in a person coming to rest inadvertently on the ground or floor or other lower level, except in cases, which are the result of a blow, loss of consciousness, sudden paralysis or an epilepsy [1]. Falls and fear of falling cause serious health problems, which, in turn are associated with high injury rate, high medical costs and a negative impact on quality of life. Older and senile patients with cardiovascular disease (CVD) are at high risk of falling. However, in clinical practice, the prevalence of falls and the risks of falls are not well understood and underestimated by physicians and patients themselves. An increased risk of falling is associated with various factors, such as drugs, structural heart disease, orthostatic hypotension and arrhythmias, as well as gait and balance disorders, physical weakness, sensory disturbances. These risks are especially important with the growing number of older people with cardiovascular disease. All physicians involved in the care of patients with CVD should pay attention to the assessment, prevention and treatment of falls in adults with heart disease, and the treatment of cardiovascular disease in patients at risk of falls.

To compare the diagnostic value of classification criteria for giant cell arteritis (GCA).

BACKGROUND:A low hemoglobin level in older adults impairs cognitive ability and functional status and associates with risk of falls and fractures, sarcopenia, malnutrition, depression, frailty, and decreased autonomy. Epidemiological data on the anemia prevalence in the geriatric population in our country is not available.AIM:To assess the prevalence of anemia and analyze its associations with geriatric syndromes (GS) in subjects aged 65 years.MATERIALS AND METHODS:4308 subjects (30% of men) aged 65107 years, living in 11 regions of the Russian Federation, were examined and divided into age groups (6574 years, 7584 years and 85 years). All the participants underwent a comprehensive geriatric assessment and determined hemoglobin level.RESULTS:The anemia prevalence in older adults was 23.9%. It has been shown that with an increase in age per 1 year, the risk of anemia detection increases by 4%. The incidence of anemia was higher in males than females (28.1% versus 22.1%; p0.001). In most cases, anemia was mild. The results of a comprehensive geriatric assessment show that patients with anemia had lower hand grip force, Barthel Index, the sum of points on Lawton instrumental activities of daily living scale, Mini Nutritional Assessment scale, the Mini-Cog test and higher the sum of points on the Geriatric Depression Scale (GDS-15) and the Age Is No Barrier scale. Patients with anemia were more likely to use hearing aids, absorbent underwear, and assistive devices during movement. Patients with anemia had a higher incidence of all GS, except for orthostatic hypotension and chronic pain syndrome. The presence of GS is associated with an increased risk of anemia by 1.33.4 times.CONCLUSION:EVKALIPT study obtained domestic data on the prevalence of anemia in older patients and examined its associations with other GS.

Background: Falls and frailty are associated geriatric syndromes. Knowing the features of falls in patients with different functional status will make it possible to personalize the fall prevention and reduce the progression of frailty.Aim: To characterise falls in older depending on geriatric status (robust, prefrailty and frailty).Materials and methods: Included 1002 patients (77,5±8,2) hospitalized in the geriatric department. The frailty was screened on the scale «Age Not Interference». With the score 1–2, frailty was not diagnosed. With the score 3 or more, comprehensive geriatric assessment was carried out and 2 more groups were allocated: with prefrailty (n=199, 19.9%) and with frailty (n=482,48.1%). All patients found out the fact of falls during the year, if there was, they were characterized by falls. To analyze the effect of falls on functional status, it was evaluated in patients with frailty and falls and frailty without falls.Results: With increasing severity of geriatric status, the prevalence of falls increased, reaching 57% in patients with frailty. 63.7% previously noted falls, 44.7% formed a fear of falls. One in 10 falls resulted in a serious consequence, which caused hospitalization. The risk of falls increased depending on geriatric deficiency: patients with frailty at high risk were 2 times greater compared to robust patients. The findings demonstrate that patients with frailty undergoing falls compared to patients without falls.In patients with frailty and falls, compared to patients without falls, despite younger age and lower comorbidity, functional status was worse. They had a significantly lower score on the MNA, higher score on the PHQ-9 and anxiety score, and performed the chair stand longer. Multivariate analysis showed that a reduction in the sum of the SPPB by 0.35 and the PHQ-9 scale by 0.77, an increase in SARC-F by 0.68 and a time of performance of the chair stand by 3.39 seconds is associated with a fall in older people with frailty adjusted for age and comorbidity.Conclusion: Frailty is a conditionally reversible syndrome, and falls is often prevented. Considering the identified features of falls in patients with reduced functioning will allow individualizing the fall prevention plan.

OBJECTIVE:To study evaluation of the effectiveness of a comprehensive personalized protocol for the prevention of repeated falls in elderly and senile patients.MATERIAL AND METHODS:Over the course of one year, 300 patients aged 60 and older who suffered two or more falls during the year were observed. Patients of group 1 (n=100) were recommended a comprehensive personalized protocol for the prevention of repeated falls, the observance of which was regularly monitored; patients of group 2 (n=100) received standard recommendations for the prevention of falls upon discharge from the hospital, the observance of which was not actively monitored; patients of group 3 (n=100) were observed by a therapist on an outpatient basis. Primary endpoints: frequency of falls, death from any cause; secondary endpoints: the frequency of fractures, the frequency of hospitalizations for any reason.RESULTS:In group 1, after a year, the frequency of falls decreased by 5 times (100% vs. 21%, p<0.0001), in groups 2 and 3 - by 38% (p=0.013) and 81% (p<0.001). There was no significant decrease in the number of all fractures in any group, but in group 3, the frequency of vertebral fractures increased during the year (p=0.029). Statistically significant positive dynamics of indicators characterizing the geriatric status has been established: walking speed, values on the basic activity scale, a short nutrition assessment scale, the results of the drawing hours test have increased, the intensity of pain has decreased. No one died in group 1, unlike 5 patients in group 2 and 8 in group 3 (p=0.011).CONCLUSION:The use of a comprehensive personalized protocol for the prevention of repeated falls can reduce the number of complications in elderly and senile patients.

The consensus statement provides expert opinion on key items in planning and designing clinical trials for medications that are intended for use mainly or probably in geriatric patients.

Chronic pain syndrome is one of the most common geriatric syndromes. Chronic pain negatively affects the mobility and autonomy of the older person, reducing the quality of life and longevity. An active screening for chronic pain in the geriatric population improves the geriatric status. Treatment strategies for chronic pain in older patients include non-pharmacological measures as well as drug administration. However, advanced age is associated with high comorbidity, polypharmacy, and in some cases does not allow the active use of systemic non-steroidal anti-inflammatory drugs (NSAIDs). In this connection, the use of parenteral symptomatic slow-acting drugs, the representative of which is chondroitin sulfate (CS), becomes an alternative. The efficacy and safety of CS has been proven by the mean of clinical studies meta-analysis data of osteoarthritis treatment effectiveness with parenteral chondroitin sulfate, including patients with back pain.

Железодефицитная анемия — полиэтиологичное заболевание, развитие которого связано с дефицитом железа в организме из-за нарушения поступления, усвоения или повышенных потерь данного микроэлемента, характеризующееся микроцитозом и гипохромной анемией. В практическом руководстве подробно описывается этиология, лабораторная и инструментальная диагностика, тактика ведения пациентов в различных клинических ситуациях. Практическое руководство предназначено для специалистов практического здравоохранения, оказывающих первичную медико-санитарную помощь, в том числе врачей-терапевтов, врачей общей практики (семейной медицины), кардиологов, гастроэнтерологов и других специалистов, оказывающих помощь пациентам с железодефицитной анемией.

Osteoarthritis (OA) is the most common joint disease due to the increasing life expectancy of the world's population. Every 2nd patient over the age of 50 suffers from knee or hip OA, and this is directly related to the increased burden on healthcare. Accumulated data on the comorbid profile of patients with OA dictate the need to identify disease phenotypes in order to provide personalized care. Individual clinical manifestations of OA also require a differential approach: the pain treatment requires consideration of the patient's psycho-emotional profile and the possibility of involving nociceptive pathways in the process. However, due to the ambiguity of existing clinical guidelines, most experts note a number of difficulties in prescribing treatment for patients with OA.The resolution presents an agreed opinion of experts on the algorithms for managing patients with OA, starting from the primary level, with the gradual involvement of related specialists. Some issues of a personalized approach are considered depending on the presence of comorbid pathology and the severity of individual symptoms of the disease. The prospects of the combined use of pharmacological and non-drug methods of treatment are noted; emphasis was placed on the importance of rehabilitation measures at the first level of medical care, provided to patients with OA, long before the development of structural changes.The proposed algorithms for managing patients can be considered as the basis for future recommendations for managing patients with this pathology.

BACKGROUND:Older adults with severe osteoporosis are the most vulnerable group of geriatric patients. They are shown the purpose of anti-osteoporotic therapy, which should be effective and safe. Teriparatide showed a decrease in the risk of fractures, an increase in BMD. In Russia, the use of teriparatide in the geriatric population is extremely scarce. AIM:assess clinical course, bone metabolism parameters and efficacy of bone-anabolic therapy in elderly and senile patients with severe osteoporosis and falls. MATERIALS AND METHODS:The longitudinal prospective study included 100 patients 60 years and older with severe osteoporosis who had one or more falls within the last year. All patients were prescribed calcium and vitamin D preparations and bone-anabolic therapy (teriparatide 20 mg daily subcutaneously). The duration of follow-up was 24 months and included 3 visits: screening, at 12 and 24 months. The effectiveness of bone-anabolic therapy was carried out on the basis of assessing the frequency of new fractures, reduction of pain, changes in BMD according to X-ray densitometry, dynamics of bone metabolism markers. RESULTS:All patients had severe osteoporosis and aggravated comorbidity status, suffered a fall within the last year, and also low-energy fractures in the past. One in three patients had a vertebral fracture, one in five had a proximal femoral fracture. Prior to the start of the study, 61 patients received antiosteoporotic therapy. During the follow-up, 4 patients died, 96 patients completed the study. Against the background of teriparatide therapy, a decrease in the number of new cases of low-energy fractures and the number of patients with chronic pain was obtained. An increase in BMD was noted in the lumbar spine after 24 months and in the femoral neck after 12 months. There was no negative dynamics of the BMD. Also after 12 months, an increase in P1NP and C-terminal telopeptide of collagen type 1 was noted, after 24 months - osteocalcin and C-terminal telopeptide. CONCLUSION:The use of teriparatide can be recommended as an effective intervention to treat severe osteoporosis in geriatric patients with falls.

The main symptoms of osteoarthritis (OA) are pain and dysfunction of the joints. Neuropathic pain (NP) occurs in more than half of patients with OA, it is refractory in nature and is the cause for seeking medical advice more frequently, poor quality of life and disability.Objective: to evaluate the frequency of NP and its relationship with geriatric syndromes (GS) in patients with OA aged 65 years and older. Patients and methods. The subanalysis of the study EVKALIPT included 2286 patients with OA and chronic pain syndrome. All patients underwent a comprehensive geriatric assessment (CGA) and diagnostics of NP using the DN4 questionnaire.Results and discussion. The prevalence of NP in patients with OA was 22.7%. Patients with OA and NP more often experienced pain of any localization with a large number of tender points, they had a higher frequency and intensity of pain syndrome, they more often took analgesics and noted limitations in daily life. When conducting a correlation analysis, correlations of medium strength were found between the sum of scores according to DN4 questionnaire and the pain intensity assessment on a numerical rating scale at the time of examination (r=0.26; p<0.001) and in the previous 7 days (r=0.29; p<0.001). CGA data in patients with OA and NP demonstrated worse geriatric status and a higher incidence of GS. The most common GSs were basic (81%) and instrumental (64%) dependence in everyday life, senile asthenia (70%), urinary incontinence (69%), depression (69%) and cognitive impairment (67%). Multivariate analysis showed that, in addition to age, the presence of NP was independently associated with sensory deficits, depression, falls, urinary incontinence, and bedsores (odds ratio 1.77–2.49). Patients with NP were more likely to use mobility aids, absorbent underwear, and orthotics.Conclusion. NP was diagnosed in 22.7% of OA patients aged 65 years and older. Such patients have worse functional status, they are more often diagnosed with a number of GSs.

The review examines the epidemiology and clinical manifestations of COVID-19 long-term neurological effects, main pathobiochemical mechanisms, and integrated circuits of redox status impairment in COVID-19, such as the decrease of adenosine triphosphate production, fatty acids levels, acylcarnitine, and amino acids, impairment of oxidative phosphorylation and glycolysis, hypometabolic state, redox imbalance with the increase of peroxides and superoxides, isoprostanes, the decrease of α-tocopherol, substances reacting with thiobarbituric acid, increased nitrosative stress with the increase of inducible synthase of nitric oxide, nitric oxide, peroxynitrite, and nitrate. Neuroprotective approaches aimed at suppressing excitotoxicity, oxidative stress, and neuroinflammation are presented. Recent data on the relationship between mechanisms of chondroitin sulfate and its derivatives (chondroitin sulfate glycoprotein disaccharide) neuroprotective effects and characteristics of their chemical structure are analyzed. The mechanism of action and neuroprotective effects of chondroitin sulfate and its derivatives in fatigue syndrome in patients with SARS-CoV2 infection are discussed (regulation of the PKC/PI3K/Akt activity, the increase of heme oxygenase-1 level, the decrease of reactive oxygen species). The position that chondroitin sulfate and its derivatives can become promising drugs to prevent the long-term neurological effects of COVID-19 is reasoned.