Vol 89, No 10 (2017)

Articles
Is it possible to achieve sustained remission or cure of type 2 diabetes mellitus in the 21st century?
Shestakova M.V., Sklyanik I.A., Dedov I.I.
Abstract
A practitioner has a wide range of the hypoglycemic drugs for type 2 diabetes mellitus (T2DM) treatment, which can be used within a normal or near-normal range for long-term glycemic control. However, the question remains whether there are ways to achieve not only satisfactory glycemic control, but also T2DM remission (or even complete cure). The review presents an update on the concept of T2DM remission and describes the ways of its possible achievement with non-drug and drug treatments and surgery. The mechanisms of T2DM remission are given.
Terapevticheskii arkhiv. 2017;89(10):4-11
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Impact of various wound dressings on wound bed neoangiogenesis in patients with different forms of diabetic foot syndrome
Zaitseva E.L., Tokmakova A.Y., Doronina L.P., Voronkova I.A., Galstyan G.R., Shestakova M.V.
Abstract
Aim. To investigate the impact of various wound dressings on wound bed neoangiogenesis in patients with different forms of diabetic foot syndrome (DFS). Subjects and methods. The clinical (local tissue oxygenation) and immunohistochemical (CD31) markers of foot soft tissue neoangiogenesis were evaluated in patients with DFS receiving negative pressure (NP) therapy and collagen-containing dressings (CCDs) versus standard treatment. 63 patients with neuropathic and neuroischemic (without critical ischemia) forms of DFS were examined after wound debridement. In the postoperative period, 21 patients received NP treatment, CCDs were applied to 21 patients, and 21 patients had standard treatment. Results. During NP therapy, there was statistically significantly intensified local microhemodynamics, as evidenced by transcutaneous oximetry (p < 0.05); the remaining two groups showed no statistically significant differences in transcutaneous oxygen tension during the treatment. Immunohistochemical examination revealed a significant increase in the number of newly formed vessels, as shown by anti-CD31 antibody staining (p < 0.05), in patients who had NP therapy and CCDs (p < 0.05). Conclusion. Vacuum (NP) therapy versus standard therapy most effectively affects wound bed neoangiogenesis. This is reflected in the increased local tissue microhemodynamics, as confirmed by immunohistochemical examination.
Terapevticheskii arkhiv. 2017;89(10):12-16
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A 20-year prospective follow-up study to evaluate the development of retinopathy and nephropathy after the onset of type 1 diabetes mellitus: Contribution of glycemic control and metabolic memory
Bolotskaya L.L., Bessmertnaya E.G., Shestakova M.V., Shamkhalova M.S., Nikankina L.V., Ilyin A.V., Glek I.S., Zolotukhin A.V., Dedov I.I.
Abstract
Aim. To assess the time course of changes in the level of glycated hemoglobin (HbA1c) for 20 years after the onset of type 1 diabetes mellitus (T1DM) and to compare its correlation with the development of microvascular complications, such as diabetic retinopathy (DR) and diabetic nephropathy (DN). Subjects and methods. A total of 187 children with new-onset T1DM were registered in Moscow in 1994. During the 20-year follow-up study, these patients underwent regular check-ups at the Endocrinology Research Center, Ministry of Health of the Russian Federation, which included assessment of physical data, HbA1c 2-4 times a year, biochemical blood and albuminuria tests (once per year), and ophthalmologic examination (twice a year). A total of 155 people fully completed the 20-years follow-up study. Results. During the 20-year follow-up period after the onset of T1DM, 86 of the 155 patients developed microvascular complications: DR and DN in 86 (55.5%) and 24 (15.5%) cases, respectively; while DR concurrent with DN were noted in 20 patients. By the time of their last visit, 69 (44.5%) patients had no evidence suggesting the presence of microvascular complications. The level of HbA1c at the onset of the disease in patients who later developed the complications was higher than in those without complications (10.2±0.6 and 8.5±0.2%, respectively (p = 0.003). The statistically significant differences in HbA1c levels between the groups persisted during subsequent 15 years of follow-up, averaging 9.2±1.5, 9.7±0.9, and 8.1±0.7% after 5, 10, and 15 years, respectively, in the complication group and 7.1±0.3, 8.1±0.4, and 7.2±0.2% in the non-complication group (p < 0.01). Over the last 5 years of the follow-up, the mean HbA1c level between the groups was not significantly different, which at the end of the 20-year follow-up period was 7.8±0.3 and 7.4±0.6%, respectively (p > 0.05). The mean duration of T1DM, in which DR developed, was 9.6±6.2, 11.0±2.0, and 13.6±4.6 years for the non-proliferative, pre-proliferative, and proliferative stages, respectively. That of T1DM, in which DN developed, was 11.8±0.6 years for microalbuminuria and 16.1±1.3 years for macroalbuminuria. Conclusion. The 20-year clinical follow-up of patients who had fallen ill with T1DM in childhood showed that diabetic microangiopathies developed with the long-term preservation of poor blood glucose control (BGC) starting at the onset of the disease. At the same time, the complications progressed to more severe stages, despite a clear trend toward better BGC. This may be suggestive of the negative metabolic memory phenomenon, which necessitates stable BGC, starting at the onset of the disease, for the prevention of microvascular complications.
Terapevticheskii arkhiv. 2017;89(10):17-21
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The attitude of patients with types 1 and 2 diabetes mellitus towards having the disease
Sapozhnikova I.E., Zotina E.N.
Abstract
Aim. To analyze the types of attitude towards disease, their relationships to its course in patients with diabetes mellitus (DM). Subjects and methods. 418 patients with DM, including 318 with type 2 DM (T2DM) and 100 with Type 1 (T1DM), were examined. Clinical and laboratory examinations were performed; the types of attitude towards the disease were studied. Results. The patients with T2DM were more frequently found to have anxious (12.9%) and hypochondriacal (10.7%) types of attitude towards the disease; those with T1DM had euphoric types. The paranoiac type of disease attitude, which was characterized by the presence of peculiar notions about the disease, was detected in 15.1% of the patients with T2DM and in 13% of those with T1DM. Hypernosognosia (overreaction to disease) was more often identified in T2DM (62.3% versus 39% in T1DM (χ2; p < 0.001). In the T2DM group, hypernosognosia was more frequently seen in women, unemployed persons, and obese patients. With the comparable awareness about the disease and degree of self-control, the patients with T2DM with no signs of hypernosognosia had a lower glycated hemoglobin level [7.35 (6.6; 8.6)%] than those with hypernosognosia [7.9 (7; 9.4)%] (p = 0.024). Conclusion. The revealed peculiarities of attitude towards the disease in patients with DM justify the need for increased attention to their psychological characteristics. The situation could be improved if the physicians are be informed, the time of outpatient care is prolonged, and psychotherapists and/or clinical psychologists are widely involved in the management of diabetic patients.
Terapevticheskii arkhiv. 2017;89(10):22-27
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Microcirculatory parameters in compensated and decompensated type 2 diabetes mellitus
Suchkova O.V., Gurfinkel Y.I., Sasonko M.L.
Abstract
Aim. To reveal the features of microcirculatory parameters in compensated and decompensated type 2 diabetes mellitus (T2DM). Subjects and methods. A total of 196 patients with T2DM were examined and divided into 2 groups: 1) 52 patients (40.4% of men) aged 52.8±8.7 years with compensated T2DM (glycated hemoglobin (HbA1с), 6.3±0.5%); 2) 68 patients (38.2% of men) aged 52.8±8.1 years with decompensated T2DM (HbA1с, 9.4±1.7%). Both patient groups had concomitant hypertension (its prevalence, degree, stage of hypertension were comparable). A control group consisted of 76 volunteers (40.8% of men) aged 52.2±8.7 years with normal carbohydrate metabolism and without signs of cardiovascular disease (HbA1с, 5.3±0.49%). Capillary blood flow in the finger nail-fold area was investigated in all the participants. A digital optical capillaroscope with image-processing software was used to obtain quantitative blood microcirculatory parameters. The diameters of arterial and venous capillary segments were measured, by calculating the remodeling rate. The degree of capillary tortuosity, network density, and polymorphism and the size of the perivascular zone (PZ) were estimated. Blood rheological properties and capillary blood flow velocity were also investigated. Results. The decompensated T2DM group compared to the compensated T2DM group was found to have a narrowing of the arterial capillary segment diameter (8.4±2.0 µm; p=0.009) and an increase in remodeling rates (1.47±0.22; p=0.000). The tendency of the PZ size to be larger in patients with decompensated T2DM compared to those with compensated T2DM (p=0.080) and the increase in this indicator compared to the control group (p=0.001) reflect the presence of edema syndrome in Group 2, as laboratory confirmed by a statistically significantly elevated sodium level (p=0.000; p=0.006). The enlarged venous capillary segment demonstrates involvement of the venous component in microcirculatory disorders in T2DM. The reduction in the density of the capillary network and the increase in capillary tortuosity and polymorphism, which were also observed in the patients of both groups versus the control group, are referred to as disorders that are characteristic of T2DM. Conclusion. In decompensated T2DM, capillary bed structural and functional changes are found as a narrowing of the arterial capillary segment, an increase in the rate of remodeling, and enlargement of the PZ. Digital capillaroscopy opens up new possibilities for assessing the magnitude of changes in the microcirculatory system in DM and can simultaneously evaluate the efficiency of treatment, by monitoring the status of the microvasculature.
Terapevticheskii arkhiv. 2017;89(10):28-35
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Glycemic variability and oxidative stress in patients with type 2 diabetes mellitus during combined glucose-lowering therapy
Butaeva S.G., Ametov A.S., Bugrov A.V., Dolgov V.V.
Abstract
Aim. To evaluate the impact of intensified glucose-lowering therapy on carbohydrate metabolic indicator, such as glycated hemoglobin, fasting blood glucose level (BGL) (FBGL), postprandial BGL (PBGL), and glycemic variability (GV) in patients with type 2 diabetes mellitus (T2DM) during metformin monotherapy before and 3 months after therapy intensification. Subjects and methods. The investigation enrolled 51 patients with T2DM treated with metformin 1000 mg twice daily, who failed to achieve satisfactory glycemic control. During randomization, the treatment was intensified by addition of sitagliptin 100 mg/day in Group 1 (n=25) or gliclazide MB 60 mg/day in Group 2 (n=26). Before and 3 months after the treatment, carbohydrate metabolic indicators were investigated, 24-hour BGL monitoring (continuous glucose monitoring system (GMS)) was performed, and the body’s antioxidant status was examined by determining the total antioxidant capacity of blood plasma (overall sound pressure levels (OASPL)). Results. During 3-month treatment, Group 1 had a significantly reduced FBGL compared to that before the therapy; in Group 2 this index did not change significantly. Both study groups showed a significant decrease in PBGL and glycated hemoglobin (HbA1c). The mean amplitude of glycemic excursion (MAGE) was significantly decreased in the sitagliptin intensification group. In both groups, the standard deviation (SD) reduced significantly by 26% in Group 1 and by 38% in Group 2. Both groups also displayed a significant increase in blood OASPL (p<0.05). Conclusion. The addition of sitagliptin significantly affected the change in the indicators of both the standard carbohydrate metabolism (FBGL, PBGL, and HbA1c) and GV (MAGE, SD), whereas that of gliclazide MV altered some studied parameters. OASPL significantly increased in both groups.
Terapevticheskii arkhiv. 2017;89(10):36-39
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Risk of type 2 diabetes mellitus in the Kyrgyz population in the presence of ADIPOQ (G276T), KCNJ11 (Glu23Lys), TCF7L2 (IVS3C>T) gene polymorphisms
Isakova Z.T., Talaibekova E.T., Asambaeva D.A., Kerimkulova A.S., Lunegova O.S., Aldasheva N.M., Aldashev A.A.
Abstract
Aim. To analyze the association of genotype combinations of the polymorphic markers G276T in the ADIPOQ gene, Glu23Lys in the KCNJ11 gene, and IVS3C>T in the TCF7L2 gene with the development of type 2 diabetes mellitus (T2DM) in the Kyrgyz population. Subjects and methods. The investigation enrolled 23 Kyrgyz people, of whom there were 114 patients with T2DM and 109 without T2DM (a control group). T2DM was diagnosed in accordance with the WHO criteria (1999). The genotypes of ADIPOQ (G276T), KCNJ11 (Glu23Lys), and TCF7L2 (IVS3C>T) gene polymorphisms were identified using the restriction fragment length polymorphism analysis. Results. When typing at the polymorphic loci G276T in the ADIPOQ gene, Glu23Lys in the KCNJ11 gene, and IVS3C>T in the TCF7L2 gene, the development of T2DM in the Kyrgyz population was associated with the T allele (odds ratio (OR), 1.68; p=0.025), the heterozygous G276T genotype (OR 1,8; p=0.036) in the ADIPOQ gene; the 23Lys allele (OR, 1.62; p=0.019) in the KCNJ11 gene; a two-locus genotype combination in the genes ADIPOQ/KCNJ11: G276T/Glu23Lys (OR, 4.88; p=0.0013), G276G/Lys23Lys (OR, 4.65; p=0.019), G276T/Glu23Glu (OR, 3.10; p=0.022), a two-locus genotype combination in the genes ADIPOQ/TCF7L2: G276T/СС (OR, 1.97; p=0.04); two-locus genotype combinations in the genes KCNJ11/TCF7L2: Lys23Lys/CC (ОR, 2.65; p=0.042), Glu23Lys/CT (OR, 3.88; p=0.027); and a three-locus genotype combination in the genes ADIPOQ/KCNJ11/TCF7L2: G276T/Glu23Lys/CT (OR, 14.48; p=0.02). Conclusion. The development of T2DM in the Kyrgyz population is genetically determined by ADIPOQ (G276T) gene, KCNJ11 (Glu23Lys), and TCF7L (IVS3C>T) gene polymorphisms with the predisposing value of the T allele of the heterozygous G276T genotype in the ADIPOQ gene; the 23Lys allele in the KCNJ1 gene; as well as by genotype combinations in the genes ADIPOQ/KCNJ11 (G276T/Glu23Lys, G276G/Lys23Lys, G276T/Glu23Glu); ADIPOQ/TCF7L2 (G276T/SS); KCNJ11/TCF7L2 (Lys23Lys/CC, Glu23Lys/CT); ADIPOQ/KCNJ11/TCF7L2 (G276T/Glu23Lys /CT). The IVS3C>T locus in the TCF7L2 gene is not independently statistically significantly associated with the development of T2DM; however, its predisposing effect has been identified in its combination with the variant genotypes of the polymorphic loci G276T in the ADIPOQ gene and Glu23Lys in the KCNJ11 gene.
Terapevticheskii arkhiv. 2017;89(10):40-47
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Shereshevsky-Turner syndrome: Estrogen replacement therapy and cardiovascular risk factors
Yevstigneeva O.A., Andreeva E.N., Grigoryan O.R., Volevodz N.N., Melnichenko G.A., Dedov I.I.
Abstract
Aim. To investigate the impact of menopausal hormone therapy (MHT) on the expression of risk factors for cardiovascular events (CVEs) in patients with Shereshevsky-Turner syndrome (STS); to elaborate an algorithm for patient management using MHT. Subjects and methods. From 2010 to 2012, a total of 41 patients aged 14 to 35 years with STS were examined in the framework of a prospective observational study. 100 STS case histories in 2000 to 2009 were retrospectively analyzed. The indicators of the so-called cardiometabolic risk, such as body mass index (BMI), lipidogram readings, venous plasma glucose levels, and blood pressure, were estimated in relation to the type of MHT. In the prospective part of the investigation, an angioscan was used to estimate vessel characteristics (stiffness, wall tone, endothelial function (EF)), by using the examination data. Results. 90% of the patients with STS were found to have risk factors for CVEs: atherogenic dyslipidemia (85%; 51% in the general female population of the same age), diastolic hypertension (36%; no more than 5% that is not typical for age-matched healthy general female population). In addition to increased arterial wall stiffness (AWS), obvious EF disorder is typical for STS patients. MHT was accompanied by a dose-dependent (estradiol, at least 2 mg) reduction in diastolic blood pressure by an average of 13% over 24 months, an increase in high density lipoprotein levels by more than 10% over 24 months and also contributedto a decrease in AWS and an improvement in EF. Conclusion: By favorably affecting the EF of vessels and reducing the severity of atherogenic dyslipidemia, MHT potentially enables a reduction in CV risk in patients with STS.
Terapevticheskii arkhiv. 2017;89(10):48-53
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Associations between metabolic syndrome and reduced lung function in young people
Kovalkova N.A., Ragino Y.I., Travnikova N.Y., Denisova D.V., Shcherbakova L.V., Voevoda M.I.
Abstract
Aim. To reveal possible associations between metabolic syndrome (MS) and reduced lung function. Subjects and methods. In 2013—016, a cross-sectional survey was conducted in 908 Novosibirsk dwellers, which included spirometry to evaluate external respiratory function (ERF). For the detection of MS, the investigators used the 2009 All-Russian Research Society of Cardiologists criteria: waist circumference (WC) > 80 cm for women and >94 cm for men in combination with two of the following criteria: blood pressure (BP) ≥130/85 mm Hg, triglycerides (TG) ≥1.7 mmol/l, high-density lipoproteins (HDL) cholesterol <1.0 mmol/l for men and <1.2 mmol/l for women, low-density lipoprotein (LDL) cholesterol >3.0 mmol/l, and glucose ≥6.1 mmol/l. Results. The mean values of WC were significantly greater with a forced expiratory volume in one second (FEV1) <80% than those with a FEV1 of ≥80% in both men (p=0.002) and women (p=0.050); in women, the mean values of WS were higher than those with a FEV1/forced vital capacity (FVC) <70% than those with a FEV1/FVC of ≥70% (p=0.047); the mean systolic and diastolic BP levels were significantly more with reductions in FEV1 and FVC, and the level of HDL cholesterol was significantly lower than that with a FEV1 of < 80% in men only. Significant correlations were found between FEV1 and all components of MS in men, between the majority of components of MS and FVC in men, between WC, BP, and FEV1/FVC in men and women, between plasma glucose levels and FEV1/FVC in women. Linear regression analysis revealed significant inverse correlations of FEV1 with TG, glucose, BP; those of FVC with TG, glucose; at the same time a positive association with HDL cholesterol in men, and only a negative correlation of FEV1/FVC with WC. Conclusion. The revealed associations between MS and reduced lung function can most likely be explained by the greater prevalence of both MS and its components (hypertension, hypertriglyceridemia, hyperglycemia, LDL hypercholesterolemia) among Novosibirsk men. This is consistent with the assertion that the decline in ERF, particularly FEV1, may be a marker of future cardiovascular disease morbidity and mortality.
Terapevticheskii arkhiv. 2017;89(10):54-61
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CYP7A1 gene polymorphism and the characteristics of dyslipidemias in patients with nonalcoholic fatty liver disease concurrent with hypothyroidism
Zhaldak D.A., Melekhovets O.K., Orlovskyi V.F.
Abstract
Aim. To investigate the association of the polymorphic variants -204A > C (rs 3808607) in the CYP7A1 gene with the development of dyslipidemias in healthy individuals, in patients with non-alcoholic fatty liver disease (NAFLD) and in those with NAFLD concurrent with hypothyroidism. Subjects and methods. DNA samples and lipidograms were examined in 180 patients, including 60 healthy individuals (Group 1), 60 patients with hypothyroidism concurrent with NAFLD (Group 2), and 60 patients with NAFLD (Group 3). All the patients underwent ultrasound examination of the thyroid gland and abdominal cavity organs; FibroMax scores were calculated. Results. All the study groups most frequently showed a homozygous AA genotype (86.6% of cases in Group 1, 80% in Group 2, and 83.3% in Group 3). The development of NAFLD in CC genotype carriers is characterized by the most pronounced changes in lipid metabolism (atherogenic index (AI), 7.32 in Group 3) compared to the genotypes AA (AI, 4.56 in Group 2 and 1.73 in Group 1) and CC (AI, 6.43 in Group 2 and 2.52 in Group 1) in functional insufficiency of thyroid hormones and relative normal conditions. Conclusion. The analysis of the relationship of polymorphic variants CYP7A1 rs 38088607 to lipid metabolic disturbances in the study groups showed that the significantly higher levels of atherogenic cholesterol fractions were determined in the CC genotype compared to AA genotype carriers and they did not depend on the presence of NAFLD and hypothyroidism. The findings make it possible to consider the AA homozygous genotype of variant mutation CYP7A1 rs 38088607 as protective against dyslipidemia. However, in functional insufficiency of thyroid hormones, the level of triglycerides is significantly higher in both genotypes, which suggests that hypothyroidism plays an essential role in the development of dyslipidemia and NAFLD.
Terapevticheskii arkhiv. 2017;89(10):62-65
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Time course of changes in cytokines (IFN-γ, IFN-α, IL-18, TNF-α) in the treatment of moderate influenza A (H1N1) pdm09 (2013-2016) with oseltamivir (Tamiflu) and umifenovir (Arbidol) alone and in combination with Kagocel
Popov A.F., Simakova A.I., Dmitrenko K.A., Shchelkanov M.Y.
Abstract
Aim. To assess correlation of cytokines levels and therapy regimes a relationship of the time course of changes in the cytokines IFN-γ, IFN-α, IL-18, and TNF-α to the treatment option for influenza A (H1N1) pdm09 with umifenovir (Arbidol) 800 mg/day for 5 days (n=50); oseltamivir (Tamiflu) 150 mg/day for 5 days (n=50); umifenovir (Arbidol) 800 mg/day for 5 days in combination with Kagocel 72 mg/day for 2 days.; 36 mg/day for 2 days (n=50); oseltamivir ((Tamiflu) (150 mg/day for 5 days) in combination with Kagocel 72 mg/day for 2 days; 36 mg/day for 2 days (n=50). A comparison group consisted of 30 healthy volunteers. Material and methods. The state of immunologic reactivity was assessed twice: at admission of the patients to an infectious disease clinic (at 1—3 disease days) and in the early convalescent period (at 7—8 disease days): venous blood samples were collected to determine the concentrations of IFN-γ, IFN-α, IL-18, and TNF-α by a solid-phase enzyme immunoassay. Results. All the patients in the acute phase of influenza A showed a statistically significant increase in the levels of IFN-γ, IFN-α, and IL-18 as compared with the control group. The groups receiving monotherapy in the early convalescent period had a decrease in the IFN-γ, IFN-α, and IL-18 concentrations that could be compensated by the combined use of the immunomodulator Kagocel. No statistically significant changes in the levels of TNF-α were found in the patients of all the groups, but the groups receiving monotherapy exhibited its lower concentrations in the convalescence period. Conclusion. The combination of etiotropic antiviral drugs with Kagocel enhances the efficiency of antiviral therapy. Monitoring of antiviral cytokines during the treatment of influenza A is a convenient tool to verify the efficiency of antiviral therapy and needs to be more widely introduced into medical practice.
Terapevticheskii arkhiv. 2017;89(10):66-70
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Progressive pulmonary hypertension in a patient with type 1 Gaucher disease
Ponomarev R.V., Model S.V., Averbukh O.M., Gavrilov A.M., Galstyan G.M., Lukina E.A.
Abstract
Gaucher disease is the most common form of hereditary enzymopathies combined into a group of lysosomal storage diseases. The basis for the disease is a hereditary deficiency of the activity of acid β-glucosidase, a lysosomal enzyme involved in the catabolism of lipids, which results in the accumulation of nonutilized cellular metabolism products in the macrophage lysosomes. The main clinical manifestations of type 1 Gaucher disease are cytopenia, hepatomegaly, and splenomegaly, and bone lesion. One of the atypical clinical manifestations of Gaucher disease is damage to the lungs with the development of pulmonary hypertension, which is usually considered within the underlying disease — the development of pneumosclerosis due to macrophage dysfunction. The paper describes a case of progressive pulmonary hypertension in a patient with type 1 Gaucher disease.
Terapevticheskii arkhiv. 2017;89(10):71-74
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Long-term consequences of polycystic ovary syndrome
Grigoryan O.R., Zhemaite N.S., Volevodz N.N., Andreeva E.N., Melnichenko G.A., Dedov I.I.
Abstract
Polycystic ovary syndrome (PCOS) is the most common chronic endocrine disease in women. The prevailing complaints at a young age are menstrual irregularities, infertility, and hyperandrogenism-related problems. However, metabolic disorder-induced complications have been in the foreground over years. The review gives the current ideas on a change of clinical manifestations in the natural course of PCOS, as well as the pathogenetically grounded prevention of complications in patients.
Terapevticheskii arkhiv. 2017;89(10):75-79
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Recombinant human parathyroid hormone in the therapy of hypoparathyroidism
Eremkina A.K., Mokrysheva N.G., Kovaleva E.V., Krupinova Y.A.
Abstract
Hypoparathyroidism is an endocrine disease that results from deficiency or complete absence of parathyroid hormone (PTH), a biologically active 84-amino acid polypeptide. Standard therapy for chronic hypoparathyroidism includes oral calcium salts and active vitamin D metabolites and is aimed at maintaining a balance between optimal near-normal serum calcium concentration and normocalcuria. Traditional treatment regimens not always lead to the compensation for calcium and phosphorus metabolism. Until recently, hypoparathyroidism is the only endocrine disorder that has not been treated with the recombinant hormone. To date, two recombinant PTH forms have been synthesized, which can be used as pathogenetic therapy for hypoparathyroidism. This review is dedicated to replacement therapy for hypoparathyroidism, by using both the full-length PTH molecule (1—84) and its shorter, but fully active, PTH form (1—34). This review considers stages in the developmental of hormone replacement therapy for hypoparathyroidism, discusses the most rational dosing regimens, and compares their efficacy and safety, as well as prospects for the development of this area.
Terapevticheskii arkhiv. 2017;89(10):80-86
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Endothelial dysfunction and arterial wall stiffness: New targets in diabetic nephropathy
Murkamilov I.T., Sabirov I.S., Fomin V.V., Yusupov F.A.
Abstract
In recent years, one of the promising areas in clinical medicine is the study of impaired ments in endothelial function and arterial wall stiffness, which can be referred to as one of the important predictors of cardiovascular events in patients with chronic kidney disease, including that of diabetic etiology. There is strong evidence that endothelial function and great artery stiffness may be used as reliable clinical and instrumental indicators to evaluate the efficiency of therapeutic measures and the rate of progression of cardiovascular disorders in type 2 diabetes mellitus. The article presents data on the role of endothelial dysfunction and arterial wall stiffness in the progression of chronic kidney disease in type 2 diabetes mellitus and discusses the possibility of their correction with pharmacological agents.
Terapevticheskii arkhiv. 2017;89(10):87-94
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Enteral failure and metabolic syndrome: Common neurohormonal mechanisms of development, possibilities of their rational therapy
Vakhrushev Y.M., Lyapina M.V.
Abstract
The paper deals with small bowel (SB) functional disorders in metabolic syndrome (MS). The main components of a cascade of metabolic abnormalities in MS are closely due to SB functional changes. This is associated to some extent with the presence of common neurohormonal mechanisms in the development of enteropathy and MS. The paper gives the physical, laboratory and instrumental methods for identifying SB dysfunctions in patients with MS. Therapy for the latter is of particular interest in the context of SB functional recovery. The authors discuss the possibilities of enteropathy therapy in patients with MS; thus there is not only SB functional recovery, but also improved overall metabolic processes.
Terapevticheskii arkhiv. 2017;89(10):95-101
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New aspects of Helicobacter pylori infection: Association with metabolic disturbances
German S.V., Bobrovnitsky I.P.
Abstract
The review is devoted to the analysis of the literature on the possible association of Helicobacter pylori infection with type 2 diabetes mellitus, metabolic syndrome and its supposed mechanisms.
Terapevticheskii arkhiv. 2017;89(10):102-107
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Ferrous sulfate in the treatment of iron deficiency anemia: The positions continue
Dvoretsky L.I.
Abstract
The paper discusses treatment strategy and tactics for iron deficiency anemia. It gives data on the comparative efficacy of different iron sulfate drugs, their bioavailability, effects on peroxidation processes, and side effects. The paper also considers the clinical significance of a dosage form of iron-containing drugs with a sustained iron release, as well as ways to reduce the frequency and magnitude of side effects when ferrous sulfate is used.
Terapevticheskii arkhiv. 2017;89(10):108-112
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