Terapevticheskii arkhiv

 

About

The journal Therapeutic archive (ISSN key title is "Terapevticheskiy arkhiv") was founded by the prominent Russian therapists M.P. Konchalovsky and G.F. Lang in 1923. Then its editors-in-chief were Professors V.N. Vinogradov and A.G. Gukasyan. Since 1972, E.I. Chazov, Academician of the Russian Academy of Sciences, has been heading the editorial board of the journal.

Over 90 years, there have been more than 1000 issues where the authors and editorial staff have done their best for readers to keep abreast of current advances in medical science and practice and for physicians to master the advanced principles of recognition and treatment of a wide spectrum of visceral diseases.

The papers published in the journal (editorials, original articles, lectures, reviews, etc.) cover both current scientific achievements and practical experience in diagnosing, treating, and preventing visceral diseases. The authors of publications are not only Russian, but also foreign scientists and physicians. All papers are peer-reviewed by highly qualified Russian specialists.

The journal is published monthly. Traditionally, each issue has predominantly certain thematic areas covering individual therapy specializations. Every year, one of the issues is devoted to related problems in practical medicine (allergology and immunology, neurology and psychiatry, obstetrics, oncology, etc.). This all draws the attention of the reading public to the journal.

 

Editor-in-Chief

Irina Chazova
MD, PhD, Professor, Academician of the Russian academy of Sciences
ORCID: http://orcid.org/0000-0002-1576-4877

 

Publications

Monthly issues publish in print and online in Open Access under the Creative Commons NC-ND 4.0 International Licensee.

 

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Current Issue

Vol 92, No 10 (2020)

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Editorial
Iodine deficiency disorders as a non-infectious epidemic: a look at the problem at the tome of COVID-19 pandemic
Mel’nichenko G.A., Troshina E.A., Gerasimov G.A.
Abstract

Radioactive iodine, flying out of the destroyed reactor of the Chernobyl nuclear power plant, like a corona virus quickly spread throughout Europe. Iodine deficiency in the regions of Ukraine, Belarus and Russia adjacent to nuclear power plants became a factor in increased uptake of radioactive iodine by the thyroid gland in children and after 5 years led to an epidemic of thyroid cancer. Optimal iodine intake could become a kind of «vaccination», which sharply reduces the risk of developing thyroid cancer, as has happened after the accident at the Fukushima nuclear power plant in Japan. Endemic goiter was eliminated 50 years ago, but returned to the country in the early 1990s after the collapse of iodized salt production and has not been eliminated to this day due to the lack of a legislative framework for mandatory salt iodization. The actual average consumption of iodine by residents of Russia is from 40 to 80 mcg per day, which is 2–3 times less than the recommended norm. Mild and moderate iodine deficiency was detected throughout the Russian Federation, and it is more typical for the the rural population. The iodine deficiency has the greatest negative effect on the psychomotor development of the child during the critical period – «the first 1000 days of life» – from the moment of conception to the end of the second year of life. According to WHO, over the past 20 years, iodine deficiency has been eliminated in 115 countries of the world, and the number of iodine-deficient countries has dropped to 25, but Russia is still among them. We believe that after the COVID-19 pandemic, it will no longer be necessary to prove the need for effective support for the prevention of both infectious and non-infectious diseases, and the declared preventive direction of Russian medicine will indeed become such.

Terapevticheskii arkhiv. 2020;92(10):4-8
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Original articles
The prevalence of newly diagnosed autoimmune diseases among patients with Graves’ disease and autoimmune polyglandular syndrome of adults
Troshina E.A., Larina A.A., Sheremeta M.S., Malisheva N.M.
Abstract

Graves’s disease is a common part of Autoimmune polyglandular syndrome (APS) and among thyroid autoimmune disorders is usually preceded the onset of the syndrome.

Aim. The aim of this study was to determine the frequency of occurrence of APS type 2, 3 among patients with Graves’ disease.

Materials and methods. Sera of 94 patients with Graves’s disease, 116 patients with APS 2–4 types and 80 healthy subjects were screened for 21-OH Ab, insulin-Ab (IAA), Islet Cell-Ab (ICA), glutamic acid decarboxylase-Ab (GADA), protein tyrosine phosphatase-Ab (IA2), Zinc Transporter 8-Ab (ZnT8), Anti-gliadin-Ab (IgA+IgG) (AGA), Anti-transglutaminase-Ab (IgA+IgG) (Anti-tTG), Anti-parietal cell-Ab (APCA), Intrinsic Factor-Ab (IF), Rheumatoid factor (RF), Anti Ovarian Antibodies (AOA). Serum cortisol, fasting plasma glucose levels were measured.

Results. The presence of Addison’s disease and the onset of Type 1 DM was not determined among Graves’ disease patients. None of the patients with Graves’ disease and in the healthy control group had 21-OH-antibodies detected. The frequency of 21-OH-Ab was 4.2% in APS type 3 (p=0.07) and 91.6% in APS type 2, 4 (p<0.001). The prevalence of diabetes-associated autoantibodies was 20.2% among Graves’s disease patients against 8.75% in healthy subjects control group (p<0.05); OR 2.64; 95% CI 1.05–6.66 and 30.2% in APS of adults (DM 1 negative group) (p=0.18). The prevalence of APCA-markers of autoimmune gastritis – was 31.9% in Graves’s disease, 48.3% in APS 2–4 types (p=0.01); OR 1.99; 95% CI 1.18–3.51, and 12.5% in control group (p<0.01); OR 3.28; 95% CI 1.49–7.24. There were no significant differences in the frequency of occurrence of IF-Ab and RF-Ab in the groups. The frequency of AGA and ATA was 28.7% in Graves’ disease, 36.2% in APS types 2–4 (p=0.3), 10% – in the control group ((р<0.01); OR 3.63; 95% CI 1.54–8.54. Graves’ disease patients with risk of developing APS type 3 (positive diabetes-associated and other autoantibodies) had relatives with autoimmune diseases in 57.5% of cases (p=0.05); OR 2.18; 95% CI 1.03–4.63.

Conclusion. Graves’ disease patients are at high risk for future development of APS 3 type, especially those with inheritance for autoimmune diseases. Screening for the immunological markers, pathognomonic for coexisting autoimmune diseases in such patients with Graves’ disease, as well as in patients with APS type 3, should be done regularly.

Terapevticheskii arkhiv. 2020;92(10):9-14
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Obesity without diabetes: the role of hormonal regulation
Shestakova E.A., Sklyanik I.A., Panevina A.S., Nikankina L.V., Shestakova M.V., Dedov I.I.
Abstract

Aim. Obese patients without diabetes present an interesting phenotype to explore protective mechanisms against type 2 diabetes (T2D) development. In our study we looked for specific hormonal features of obese patients without T2D.

Materials and methods. We included 6 groups of patients with different metabolic profiles (n=212): controls with BMI<25 kg/m2, HbA1c<6%, age <30 years; patients with 25≤BMI<30 kg/m2 and HbA1c<6%; patients with 25≤BMI<30 kg/m2 and HbA1c≥6%; patients with BMI≥30 kg/m2 and HbA1c<6% (“+ Obesity - T2D”) – obese patients without T2D or prediabetes; patients with BMI≥30 kg/m2 and newly-diagnosed T2D/prediabetes, HbA1c≥6%; patients with known history of T2D on glucose-lowering drugs with BMI≥30 kg/m2. Insulin, GLP-1, GIP were measured during glucose-tolerance test at 0, 30 and 120 minutes; insulin resistance (IR) was assessed by HOMA-IR.

Results. Waist circumference was bigger in patients with obesity despite their metabolic profile comparing to patients without obesity (p<0.001). Waist-to-hip ratio was similar in patients with different metabolic status. According to IR “+ Obesity - T2D” group had intermediate position: IR was higher in that group comparing to people without obesity, but was less that in patients with obesity and HbA1c≥6% (p<0.001). “+ Obesity - T2D” group had the most potent baseline insulin secretion, assessed by НОМА-%b and the highest postprandial secretion, measured by insulinogenic index among all patient groups with obesity (p<0.001). There was no significant difference in GLP-1 secretion; GIP secretion was higher in patients with BMI≥30 kg/m2 comparing to people with BMI<30 kg/m2 (p<0.01).

Terapevticheskii arkhiv. 2020;92(10):15-22
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Angiogenesis system, as a part of endothelial dysfunction in patients with diabetes mellitus type 2: relationship with obesity
Severina A.S., Shestakova M.V.
Abstract

Aim. To investigate parameters of angiogenesis system in patients with diabetes mellitus and their relationship with obesity.

Materials and methods. 104 patients with diabetes mellitus type 2 were included in the study. Patients were divided in 2 groups: Obesity+ (body mass index ≥30 kg/m2n=63) and Obesity- (body mass index <30 kg/m2n=41). In all patients was performed clinico-diagnostical examination. mRNA expression levels of vascular endothelial growth factor (VEGF), its receptors flt-1 (fms-like tyrosine kinase 1), KDR (human kinase insert domain receptor) were determined in blood mononuclear cells.

Results. There were no statistically significant differences in investigated parameters between study groups. mRNA expression level of VEGF was slightly lower in men compared to women: 0.19 (0.14; 0.32) vs 0.28 (0.12; 0.4) respectively, р=0.2236. MRNA expression level of flt-1 was lower in men compared to women: 0.14 (0.04; 0.3) vs 0.25 (0.12; 0.38), р=0.0321 (statistically significant). We found statistically significant correlations of mRNA expression level of VEGF with mRNA expression level of flt-1 and KDR. Also we found strong positive correlations of BMI and mRNA expression levels VEGF, flt-1, KDR (r=0.86107, r=0.86125, r=0.86112, respectively, p<0.001).

Conclusion. Results of the study displayed relationship of obesity and angiogenesis system condition in patients with diabetes mellitus type 2. Further investigations are perspective for the future as a way to new therapeutical approach of obesity and its complications treatment.

Terapevticheskii arkhiv. 2020;92(10):23-28
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Contrast-induced acute kidney injury in chronic coronary artery disease patients with diabetes mellitus and obesity
Mironova O.I., Staroverov I.I., Sivakova O.A., Deev A.D., Fomin V.V.
Abstract

Aim. To assess the influence of diabetes mellitus and obesity on contrast-induced acute kidney injury risk in patients with chronic coronary artery disease requiring percutaneous coronary intervention.

Materials and methods. 1023 patients with chronic coronary artery disease were enrolled in a prospective, open, cohort study (ClinicalTrials.gov ID NCT04014153). Contrast-induced acute kidney injury was defined as an increase of 25% or more, or an absolute increase of 0.5 mg/dl or more in serum creatinine from baseline value, assessed at 48 hours following the administration of the contrast. The majority of the patients were overweight male ones with BMI 29.2±5.5 kg/m2. The primary endpoint of the study was the development of contrast-induced acute kidney injury according to KDIGO criteria.

Results. The prevalence of contrast-induced acute kidney injury was 12.9% (132 patients). 21.2% suffered from diabetes mellitus, 43% were obese and 12.9% had both diabetes mellitus and obesity. Diabetes wasn’t a statistically significant independent risk factor of the contrast-induced acute kidney injury, as well as the combination of diabetes and obesity. In the group of obese patients the prevalence of contrast-induced acute kidney injury was higher (13.4% vs 12.5%), but didn’t meet statistical significance (p=0.7, OR 0.924, 95% CI 0.64–1.325). According to the multiple logistic regression model, female gender, age, BMI, weight, arterial hypertension, baseline creatinine were the risk factors of the contrast-induced acute kidney injury development (AUC 0.742, p<0.0001).

Conclusion. Diabetes mellitus was not associated with higher incidence of contrast-induced acute kidney injury. The prevalence of contrast-induced kidney injury was higher in the group of patients with BMI≥30 kg/m2, but didn’t meet statistical significance and needs further evaluation in larger studies.

Terapevticheskii arkhiv. 2020;92(10):29-33
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Treatment of metabolic syndrome in young patients with vitamin D deficiency
Alekseeva N.S.
Abstract

Aim. The purpose of the study is to increase the effectiveness of treatment of metabolic syndrome (MS) in young patients with vitamin D deficiency.

Materials and methods. The study involved 54 patients with MS and vitamin D deficiency (50% of women, 50% of men), aged 20–44 years. To assess the concentration of melatonin at a young age, a control group of 42 practically healthy volunteers with comparable demographic characteristics with no signs of MS was formed.

Results. In patients with MS and vitamin D deficiency, there was a significant decrease in the average daily level of 6-sulfatoxymelatonin in the urine by 3.7 times, compared with the group of individuals without MS. Patients with MS and vitamin D deficiency (n=54) were randomly assigned to two groups with comparable clinical and demographic characteristics. Patients of the 1st group (n=27) observed dietary recommendations and took the drug Metformin at a dose of 1700 mg/day for 12 months. In the 2nd group (n=27), in addition to the one indicated in the 1st treatment group, correction of vitamin D deficiency was performed (a micelled preparation of cholecalciferol at a dose of 4000 IU/day, for 6 months, then 2000 IU/day for another 6 months) and the level of melatonin (melatonin preparation at a dose of 3 mg/day for 6 months). After treatment in young patients with MS, there was a significant change in the median of the studied parameters in all therapeutic groups, but more pronounced dynamics was observed in group 2 in terms of: WC in women, BMI, insulin resistance index, LDL cholesterol, TG, hs-CRP, hs-TNF-á, IL-6, leptin.

Conclusion. To increase the effectiveness of MS treatment in young patients with vitamin D deficiency, it is necessary to determine the level of melatonin (urinary 6-sulfatoxymelatonin) and, if it decreases, carry out correction of melatonin and 25 (OH) vitamin D in addition to the standard therapy of this syndrome.

Terapevticheskii arkhiv. 2020;92(10):34-39
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Association of polymorphisms of genes TCF7L2, FABP2, KCNQ1, ADIPOQ with the prognosis of the development of type 2 diabetes mellitus
Mel’nikova E.S., Rymar O.D., Ivanova A.A., Mustafina S.V., Shapkina M.J., Bobak M., Maljutina S.K., Voevoda M.I., Maksimov V.N.
Abstract

Aim. To study the possibility of using polymorphisms of genes TCF7L2FABP2KCNQ1ADIPOQ as markers for predicting the development of type 2 diabetes mellitus (T2D) in the population of Novosibirsk.

Materials and methods. On the basis of prospective observation of a representative population sample of residents of Novosibirsk (HAPIEE), 2 groups were formed according to the “case-control” principle (case – people who had diabetes mellitus 2 over 10 years of observation, and control – people who did not developed disorders of carbohydrate metabolism). T2D group (n=443, mean age 56.2±6.7 years, men – 29.6%, women – 70.4%), control group (n=532, mean age 56.1±7.1 years, men – 32.7%, women – 67.3%). DNA was isolated by phenol-chloroform extraction. Genotyping was performed by the method of polymerase chain reaction with subsequent analysis of restriction fragment length polymorphism, polymerase chain reaction in real time. Statistical processing was carried out using the SPSS 16.0 software package.

Results and discussion. No significant effect of rs1799883 of the FABP2 gene, rs2237892 of the KCNQ1 gene, and rs6773957 of the ADIPOQ gene on the risk of developing T2D was found. Genotypes TT and TC rs7903146 of the TCF7L2 gene are genotypes for the risk of developing T2D (relative risk – RR 3.90, 95% confidence interval – CI 2.31–6.61, p<0.001; RR 1.86, 95% CI 1.42–2.43, p<0.001, respectively). The CC genotype rs7903146 of the TCF7L2 gene is associated with a protective effect against T2D (RR 0.37, 95% CI 0.29–0.49, p<0.001). When the TCF7L2 gene is included in the model for assessing the risk of developing T2D rs7903146, it retains its significance in both men and women.

Conclusion. The rs7903146 polymorphism of the TCF7L2 gene confirmed its association with the prognosis of the development of T2D, which indicates the possibility of considering it as a candidate for inclusion in a diabetes risk meter. Variants of risk meters have been developed to assess the prognosis of the development of diabetes mellitus 2 in men and women aged 45–69 years during 10 years of follow-up. The association with the prognosis of the development of T2D polymorphisms rs1799883 of the FABP2 gene, rs2237892 of the KCNQ1 gene and rs6773957 of the ADIPOQ gene was not found.

Terapevticheskii arkhiv. 2020;92(10):40-47
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Early postoperative measurement of growth hormone level for prognosis of surgical outcomes in acromegaly
Tsiberkin A.I., Tsoy U.A., Cherebillo V.Y., Polezhaev A.V., Kuritsyna N.V., Paltsev A.A., Alkhazishvili A.V., Grineva E.N.
Abstract

Aim. To investigate the value of 24 hours post-surgery measurement of growth hormone (GH) level for prognosis of surgical outcomes in acromegaly.

Materials and methods. A prospective cohort study included 45 patients with newly diagnosed acromegaly. The degree of parasellar extension was measured on the preoperative sellar magnetic resonance imaging according to the Knosp’s classification. All patients underwent a transsphenoid adenomectomy performed by one neurosurgeon. Basal GH level was measured at 24 hours after surgery. The efficacy of transsphenoidal adenomectomy evaluated at 12 months after surgery.

Results. Acromegaly remission was achieved in 19 (42%) of 45 patients at 12 months after surgery. Pituitary microadenomas and the absence of paracellular invasion, corresponding to Knosp Grade 0–2, had low prognostic value for long-term remission due to low sensitivity (31.6%) and low specificity (38.5%), respectively. The highest prognostic value for acromegaly remission was showed for 24 hours post-surgery GH level with cut-off <1.30 ng/ml with sensitivity of 96.2% (95% confidence interval 81.1–99.8%) and specificity of 84.2% (95% confidence interval 62.4–94.4%).

Conclusion. The study demonstrated the possibility of using GH level at 24 after surgery as a predictor for acromegaly remission. GH level <1.30 ng/ml at 24 hours after surgery showed better predictive value for long-term remission compared with the presence of microadenomas and Knosp Grade 0–2. The absence of decrease of GH level on the first day after surgery may serve as a reason for more close monitoring of patients in the postoperative period. Further studies in a larger number of observers are required to confirm our findings.

Terapevticheskii arkhiv. 2020;92(10):48-53
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The pharmacogenetics of hypoglycemia and the glycemic variability at the patients ith type 2 diabetes mellitus
Chernikova N.A., Kamynina L.L., Ametov A.S., Sychev D.A., Grishina E.A., Ryzhikova K.A.
Abstract

Aim. To investigate the link between the hypoglycemia (registrated accurately by the professional Continuous Glucose Monitoring – CGM; severe hypoglycemia at home) and the hetero-/homozygote carriage of single nucleotide polymorphisms (SNP) of cytochrome system’s gene CYP2C9 (rs1799853 CYP2C9*2 и rs1057910 CYP2C9*3) at the patients with Type 2 Diabetes Mellitus (T2DM) used sulphonylurea (SU).

Materials and methods. In Study “Case-Control” 120 T2DM-SU-patients genotyped by SNPs of gene CYP2C9 (using PCR-RT) had been done the professional CGM (System iPro2, Medtronic) recorded Time in Range of Hypoglycemia (TIR-HYPO), level of Minimal CGM-hypoglycemia (MinGl) and standard CGM-parameters of Glycemic Variability. Severe hypoglycemia at home was recorded from visit to visit. The odds ratio (OR) of metabolic disturbances had been assessed for carriage SNPs in comparison with wide alleles.

Results. The Study established that carriage of SNPs rs1799853 and rs1057910 gene CYP2C9 at T2DM-SU-patients associated with rising of Glycemic Variability and frequency of CGM-hypoglycemia (MinGl decreasing, increasing of TIR-HYPO and number of Glycemia Excursion >4 mmol/L/h), as well as increasing severe hypoglycemia at home (p<0.05). Thus, OR at the carriage of rs1799853 and rs1057910 respectively equaled: for CGM-hypoglycemia – 7.78 (3.02–20.01) and 5.80 (0.23–145.87); number of Glycemia Excursion >4 mmol/L/h – 5.76 (2.29–14.43) and 4.44 (1.43–13.76); MinGl<3.9 mmol/L – 4.39 (1.79–10.75) and 6.26 (1.84–21.30); CV>40% (vs<30%) – 3.63 (1.04–12.62) and 15.22 (0.59–393.94); p<0.05.

Conclusion. At the real clinical practice the assessment of carriage of SNPs of gene CYP2C9 before inclusion of SU to glucose-lowering scheme of T2DM-therapy it necessary to carry out for the detecting patients with a higher risk of hypoglycemia and rising of Glycemic Variability.

Terapevticheskii arkhiv. 2020;92(10):54-62
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Dynamic changes of renin-angiotensin-aldosterone system parameters after surgery of primary hyperparathyroidism
Dobreva E.A., Bibik E.E., Eremkina A.K., Ajnetdinova A.R., Nikankina L.V., Malysheva N.M., Mokrysheva N.G.
Abstract

Aim. To study an activity of the Renin-Angiotensin-Aldosterone System (RAAS) components in patients with primary hyperparathyroidism (PHPT) before and after parathyroidectomy (PTE).

Materials and methods. A comparative study of patients with PHPT and control group. The first stage of the study included 56 patients with PHPT (group 1) before and on the third day after PTE. The second stage was carried out in 27 patients with remission of PHPT (group 2). All patients and healthy volunteers were tested for the main parameters of phosphorus-calcium metabolism and the RAAS parameters (plasma renin activity – PRA, serum aldosterone, angiotensin II – AT II).

Results. Patients with active PHPT demonstrated changes in RAAS activity (lower PRA, higher AT II level) comparing to control group, that have statistical significance in group 1 (p<0.001 for both parameters). There were no significant differences in aldosterone levels (p1=0.090; p2=0.140). On the third day after PTE (group 1), a decrease in aldosterone level (p=0.009) and a tendency to decrease in PRA (p=0.030) were detected. However, an increase in PRA (p=0.018), a decrease in AT II concentration (p=0.032) comparing to the initial values and their normalization were observed 12 months after surgery when permanent normal serum calcium and PTH levels had been achieved. There were controversial correlations between the parameters of phosphorus-calcium metabolism and RAAS. The influence of angiotensin-converting-enzyme inhibitors and AT II receptor blockers on phosphorus-calcium metabolism in patients with PHPT was not observed.

Conclusion. In patients with PHPT, there were no сlear correlations of phosphorus-calcium metabolism parameters with RAAS, however an increase of AT II concentration was noted, that can take part in a development of hypertension for this endocrinopathy. PTE can have a positive effect on AT II level.

Terapevticheskii arkhiv. 2020;92(10):63-69
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Heart arrhythmias and conduction disorders in patients with acromegaly: the role of cardiac magnetic resonance imaging
Melkozerov K.V., Przhiyalkovskaya E.G., Tarbaeva N.V., Almaskhanova A.A., Kuklina M.D., Alferova P.A., Gomova I.S., Belousov L.A., Belaya Z.E., Vorontsov A.V., Kalashnikov V.Y.
Abstract

Cardiovascular complications including arrhythmias and cardiac conduction disorders are one of the main reasons of high mortality rate in acromegaly, while they have not been well explored.

Aim. To estimate arrhythmias frequency in acromegaly, identify risk factors leading to the development of arrhythmia and cardiac conduction disorder, to determine the role of cardiac MRI in detecting structural and functional changes.

Materials and methods. A single-center prospective cohort study, which included 461 patients (151 men and 310 women) with acromegaly, was conducted. All the patients underwent a standard medical examination, including hormonal blood test, electrocardiogram, echocardiography, electrocardiogram daily monitoring. 18 patients with arrhythmias (11 men and 7 women) had cardiac MRI with gadolinium-based contrast.

Results. The results of our research show high frequency of arrhythmias and cardiac conduction disorders in patients with acromegaly – 42%. Most frequent kinds of arrhythmias and cardiac conduction disorders were sinus bradycardia – 19.1% of the cases and conduction disorders of bundle branch blocks – 14.5%. Men were more likely to suffer from arrhythmias and cardiac conduction disorders than women (54.2% and 37.4%, respectively, p=0.0005). Not acromegaly activity but duration of the disease was a main risk factor of arrhythmias and cardiac conduction disorders. Patients with arrhythmias had a long anamnesis of acromegaly (10 and 7 years, respectively, p=0.04). Meanwhile, cardiac conduction disorders were commonly observed in the patients who were treated with somatostatin analogs comparing to the patients who didn’t undergo this therapy (50% and 38.6% respectively, p=0.004). We showed that 61% of patients with acromegaly and cardiac conduction disorders who underwent magnetic resonance imaging (MRI) had the signs of myocardial fibrosis. The value of the ejection fraction of the left ventricle according to MRI was higher than with echocardiography (p=0.04).

Conclusion. Arrhythmias and cardiac conduction disorders are often observed in patients with acromegaly even with remission of the disease. High risk group need careful diagnostic and monitoring approaches. Cardiac MRI is the «gold» standard for visualization of structural and morphological changes in the heart. Use of cardiac MRI in acromegalic patients expands our understanding of arrhythmias and cardiac conduction disorders in this disease. There are no specific laboratory markers of diffuse myocardial fibrosis, and the role of myocardial fibrosis in the occurrence of cardiac arrhythmias and conduction disorders needs further studying.

Terapevticheskii arkhiv. 2020;92(10):70-77
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Clinical notes
Adenoma of the parathyroid gland in a young woman with chronic kidney disease: primary or tertiary hyperparathyroidism?
Vetchinnikova O.N., Prokopenko E.I., Voronkova I.A.
Abstract

Clinical observation of a young woman with chronic kidney disease IV stage and hyperparathyroidism is presented. Ultrasound and 99mTc-sestamibi scintigraphy of the anterior surface of the neck visualized a tumor of the left upper parathyroid gland. In a histological examination of distant education was diagnosed a solid parathyroid adenoma. The difficulty of differential diagnosis between primary and secondary/tertiary hyperparathyroidism in chronic kidney disease is discussed.

Terapevticheskii arkhiv. 2020;92(10):78-82
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Primary aldosteronism: The Mayo Clinic approach
Young W., Ladygina D.O., Balutina O.V., Beltsevich D.G.
Abstract

Primary aldosteronism (PA) is the most common reason of secondary hypertension, that can be cured surgically or treated with targeting medical treatment. In many cases PA is not diagnosed on time, leading to aldosterone-specific cardiovascular and nephritic lesions. Effective methods of treatment make it reasonable to perform case detection testing for PA at least once in all patients with hypertension. Mayo Clinic approach is aimed to simplify primary case detection testing. There is no need to use plasma aldosterone concentration/plasma renin activity ratio, all tests can be completed, whilst the patient is taking antihypertensive and other medications. The next step is confirmatory testing. The choice of pharmacological or surgical therapy depends on the results of computed tomography scans of the adrenal glands and adrenal venous sampling. The last one is performed only after discussing with patient the advantages and disadvantages of all therapy methods and positive intention to surgery. Laparoscopic unilateral adrenalectomy is the procedure of choice in patients with unilateral adrenal disease. In patients with bilateral aldosterone hypersecretion, the optimal is a low-sodium diet and lifelong treatment with a mineralocorticoid receptor antagonist administered at a dosage to reach a high-normal serum potassium concentration.

Terapevticheskii arkhiv. 2020;92(10):83-87
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Reviews
The prevalence of autoimmune endocrine diseases in vitiligo patients
Troshina E.A., Volnukhin V.A., Petrov V.A., Nuralieva N.F., Yukina M.Y., Orlova E.M., Frigo N.V.
Abstract

Vitiligo is a common polygenic autoimmune disease in which the foci of depigmentation are formed on the skin and/or mucous membranes as a result of the death of melanocytes. There are several hypotheses for the pathogenesis of the disease, the leading role among them is played the autoimmune hypothesis. This review summarizes the available literature data on the prevalence and structure of comorbid endocrine autoimmune pathology in vitiligo patients. In most studies conducted in Europe, America and Asia the prevalence of autoimmune thyroid diseases (including autoimmune thyroiditis and Graves disease), diabetes mellitus and autoimmune adrenal insufficiency was higher in vitiligo patients than in the general population. The results of some studies indicate a frequent association of vitiligo with autoimmune polyglandular syndromes. In the structure of comorbid pathology the highest prevalence was in autoimmune thyroid diseases. A number of studies have established a higher prevalence of autoimmune endocrine diseases in women, as well as in nonsegmental vitiligo patients and in cases of family history of vitiligo and/or other autoimmune diseases. In addition, it was shown that the prevalence of endocrine diseases increases with increasing area of depigmentation. The data obtained justify the advisability of conducting a timely examination of vitiligo patients with the aim of early detection of comorbid diseases and the appointment of appropriate treatment. Further studies are needed to investigate the effect of the identified associations on the course of vitiligo and comorbid endocrinopathies, as well as the effectiveness of therapy and the quality of life of patients.

Terapevticheskii arkhiv. 2020;92(10):88-96
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Gut microbiota is a factor of risk for obesity and type 2 diabetes
Demidova T.Y., Lobanova K.G., Oinotkinova O.S.
Abstract

Gut microbiota (GM) is a set of bacteria which colonize the gastrointestinal tract. GM and its active metabolites take part in intestinal and hepatic gluconeogenesis, in the synthesis of incretin hormones, and affect the regulation of appetite. Thus, GM and its metabolites participate in the homeostasis of carbohydrates and fats. An imbalance in the set of the intestinal flora and a disturbance of the production of active metabolites sharply increases the risk of developing obesity and type 2 diabetes. There are conflicting data in the literature on the role of specific microorganisms in the development of metabolic disorders. Research is needed to identify specific types of bacteria and their active metabolites which affect the development of obesity and type 2 diabetes.

Terapevticheskii arkhiv. 2020;92(10):97-104
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