Vol 31, No 6 (2020)

Older patients with cognitive impairment present a challenge for physicians of various specialties in terms of both diagnosis and choice of effective therapy. Not every decrease in cognitive function is steadily progressing and leads to the development of dementia. The timely identification and prescription of pathogenetically substantiated therapy are fundamentally important, since these contribute to the functional restoration of cerebral structures and result in reversible consequences.

The authors reviewed current data, which could establish a pronounced association between the prevalence of cholelithiasis and liver diseases. A century-and-a-half discussion about the prevalence of the basic concepts of the pathogenesis of cholelithiasis led to the unification of metabolic and infectious theories. Currently, surgical tactics involving cholecystectomy in individuals with symptomatic or complicated cholelithiasis predominates in an approach to treating gallstones. A multidisciplinary view on the diagnosis, pathogenesis, treatment, and prevention of cholelithiasis and the recognition of a close relationship between the functional state and pathology of the liver and biliary tract justifies the feasibility of a thorough diagnosis of pathology of the liver and correction of its functional state in patients with cholelithiasis. Ursodeoxycholic acid is a good example of therapy that improves both the functional state of the liver and that of the biliary tract.

The aging process affects the structure and function of various organs and systems. The adrenal glands are also subject to age-related changes. Questions: hormones and aging, what is primary and what is secondary, where is the cause, and where is the consequence - scientists have been worried for a long time. The lack of answers to these questions makes it relevant to study age-related changes in the adrenal glands and their impact on the work of various organs and systems Purpose: to study the effect of age-related changes in the adrenal glands on the work of various organs and systems. Materials and methods: analysis of literature data on search words - aging, hormones, endocrine system, old age, senile age, adrenal glands, hypothalamus, pituitary gland glucocorticoids, dehydroepiandrosterone for 2000-2019 in computer databases: PubMed, Scopus, Medical-Science, Elibrary, Web of Science, Ceeol. Results. Normal aging leads to changes in the activity of the axis of the hypothalamus-pituitary-adrenal gland (HPA) and the production of adrenal hormones. Significant is an increase in the average daily levels of cortisol in the serum of older people with changes in the circadian secretion rhythm. Excess glucocorticoids in the elderly can affect the structural integrity and function of various areas of the brain, associated with muscle loss, hypertension, osteopenia, visceral obesity, and diabetes mellitus. In contrast, levels of other adrenal cortical hormones (aldosterone, dehydroepiandrosterone) in the elderly have been proven to be reduced. The main mechanisms for their reduction remain unclear. Catecholamine secretion is also subject to age-related changes. Conclusion. In the process of aging, numerous structural and functional changes in the adrenal glands occur, which affects the functioning of many organs and systems.

The task has been completed by choosing and using sorbents in the dehelmintization process. Objective: to determine the efficiency of detoxification in patients diagnosed with helmin-thiases. To study the combined use of anthelmintic agents and plant sorbents for endotoxemia elimination and in the dehelmintization process. Subjects and methods. There were a total of 180 patients, including 41% with skin allergy and 59% with gastrointestinal tract diseases. The patients took nemozole tablets for dehelmintization. They used in parallel plant enterosorbents, such as bran, zosterin-ultra, beet root powder. Enterosgel was used as a control. Fecal changes were monitored by histological and coprological surveys. Results and discussion. Pectins have a fairly potent sorption activity and, unlike the control (enterosgel), antibacterial, therapeutic, and nutritional effects. The use of enterosorbents is mandatory in all patients before and during dehelmintization. Patients with a family history of allergy should additionally take antihistamines.

Due to the spread of the novel coronavirus infection in Russia, people over 65 years of age are advised to observe a lockdown regime, as in the patients older than 65 years, the new coronavirus infection generally occurs severely and often leads to death. The complications are pneumonia, resulting in pulmonary edema. The article provides simple exercises to maintain physical activity for patients older than 65 years who are under lockdown. It gives recommendations (including affordable digital technologies - the World Health Organization Integrated Care for Older People (ICOPE) Handbook App) for primary care physicians working with these patients.

The paper gives an example of successful surgical correction of the forefoot with the most used up-to-date surgical techniques worldwide in a patient with severe hemophilia A, hollow foot (pes cavus), and grade III hammertoe deformity according to the classification of M.I. Kuslik.

The paper presents the results of 30-year clinical use of peptide retinoprotectors in the treatment of degenerative retinal diseases, retinitis pigmentosa in particular. The findings suggest that peptide retinoprotectors have a high clinical effect and that these peptide drugs are promising for use in older people.

Objective: to select those, for whom the treatment with sustained-release lappaconitine hydrobromide (Allaforte®) is indicated, among the patients with high ventricular ectopic activity; to study the antiarrhythmic efficacy of the drug in patients with various non-coronarogenic diseases; to analyze the role of instrumental studies in the evaluation of ventricular arrhythmias and their importance in monitoring the efficiency of performed therapy.