Vol 91, No 10 (2019)


Diabetes epidemiology in Russia: what has changed over the decade?

Shestakova M.V., Vikulova O.K., Zheleznyakova A.V., Isakov M.A., Dedov I.I.


The National diabetes register (NDR) was created as unified dynamic database in online format. It allows providing clinical and epidemiological monitoring of diabetes mellitus (DM) in the whole country. Aim. To analyze the epidemiological characteristics of diabetes over the past decade, to access the dynamics of the prevalence of acute (coma) and chronic (micro - and macrovascular) complications of DM. Materials and methods. The object of the study was the depersonized NDR database of DM patients. It consists of 84 regions of the Russian Federation (RF), included in the online registry system on 01.01.2019. Results and discussion. The total number of patients with DM in RF on 01.01.2019 was 4 584 575 (3.12% of the population), comprising 256.2 thousand patients with T1DM, 4.24 million with T2DM, 89.9 thousand other types of DM. Since 2000, the number of DM patients in RF has grown 2.2 times. 34.7% patients with T1DM reached target level of HbA1c <7% in 2018, with T2DM - 52.2%. There is a decrease in prevalence of complications in T1/T2 patients compare with 2007 year: ketoacidotic coma in 3/4 times, blindness in 2/4.4, diabetic foot syndrome in 1.5/3 times, respectively. Detailed analysis of DM complications became available after NDR was transferred to the online format (for the period since 2013). The article presents data of the prevalence of diabetic retinopathy and blindness, chronic kidney disease, diabetic foot syndrome, amputations and cardiovascular complications in DM patients. Conclusions. Despite the continued increase in the number of DM patients, significant achievements have been made in the management of DM in RF over the past decade. There is a significant improvement in the quality of diagnosis of complications and decrease in its frequency. The priority remains the development of specialized diabetes care at all levels from primary care to regional centers, as well as standardization of screening algorithms and early diagnosis methods.
Terapevticheskii arkhiv. 2019;91(10):4-13
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Relationship of the ovarian reserve with autoimmune thyroid diseases in the reproductive period

Grigoryan O.R., Krasnovskaya N.S., Mikheev R.K., Yarovaia I.S., Andreeva E.N., Dedov I.I.


Aim. To compare ovarian reserve in healthy women of reproductive age - carriers of antithyroid antibodies (ATA) and in healthy women of reproductive age negative for ATA. Materials and methods. 70 healthy women of young reproductive age in the state of euthyroidism (from 18 to 38 years old) were examined. Participants were divided into equal groups (n=35) depending on the status of the presence of antithyroid antibodies (AT-TPO, AT-TG). On the 2nd-4th days of the menstrual cycle, the following markers of the ovarian reserve were determined: serum levels of anti-Müllerian hormone (AMG), inhibin B, FSH, LH, estradiol, testosterone and progesterone, as well as ultrasound parameters - the number of antral follicles and the volume of the ovaries. In addition, to determine the predisposition to premature ovarian failure, an analysis was performed to the number of CGG repeats in the FMR1 gene. Results and discussion. Statistically significantly differs such parameters as the level of estradiol and testosterone, while the differences were not clinically significant. All the parameters evaluated were within the normal range, the main predictors of the ovarian reserve (levels of AMG and inhibin B, the number of antral follicles) remained in the normal range. An increase in the number of repeats of CGG in the FMR1 gene was not detected in any of the participants in the study. Conclusion. In healthy young reproductive age women, the status of ATA does not have a direct effect on the ovarian reserve.
Terapevticheskii arkhiv. 2019;91(10):14-18
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Problems of optimal nutrition of elderly and senile patients with comorbidities against obesity

Starodubova A.V., Varaeva Y.R., Kosyura S.D., Livantsova E.N.


Aim. To analyze the effectiveness of the main and low - calorie standard diets in elderly and senile patients with comorbidities against obesity. Materials and methods. Retrospective analysis of the inpatient data. Patients received the main or low - calorie standard diet at the Nutrition clinic. The analysis included clinical, laboratory, body composition (bioimpedance) parameters and the results of indirect calorimetry. The primary endpoint was anthropometric and body composition data. Statistical analysis was performed using Statistica 10.0 for Windows 6.1 (StatSoft Inc., USA). Results and discussion. 46 patients were included in the analysis. The average age was 65 years (95% CI 63.63-66.37 years). All patients had abdominal obesity. 44 patients (97.78%) had hypertension, 32 (71.11%) - osteoarthrosis, 28 (60.87%) - dyslipidemia, 16 (35.56%) - diabetes mellitus; and сoronary artery disease was detected in 9 patients (20%). Diet therapy caused a statistically significant decrease in body weight, waist and hip circumferences, fat mass, lean mass, total body fluid and muscle mass (in particular, 25.35% weight loss was due to muscle mass loss), as well as the improvement of lipid profile. Conclusion. Dietary interventions, such as main and low - calorie standard diets, routinely used for inpatient settings allow us to reduce body weight and improve anthropometric parameters in elderly and senile obese patients with comorbidities, which is accompanied by positive changes in lipid and carbohydrate metabolism even in a short - term follow - up. However, the protein content for standard diets is insufficient for this target group and leads to the loss of both fat and muscle mass.
Terapevticheskii arkhiv. 2019;91(10):19-27
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Ghrelin deficiency in patients with type 2 diabetes: the relationships with obesity, adipose tissue dysfunction and glucose variability

Klimontov V.V., Bulumbaeva D.M., Fazullina O.N., Orlov N.B., Konenkov V.I.


Aim. Ghrelin, a peptide hormone mostly produced by stomach, plays an important role in regulation of feeding behavior, energy balance and glucose homeostasis. The aim: to determine the relationships between fasting serum levels of ghrelin, body composition, adipose tissue endocrine function and glucose variability (GV) in type 2 diabetic subjects with and without obesity. Materials and methods. We observed 124 individuals with type 2 diabetes, including 42 non - obese subjects and 82 patients with obesity. Thirty non - obese healthy subjects were acted as control. The concentrations of ghrelin, leptin, resistin, and visfatin in the fasting serum were determined by Multiplex analysis. Body composition was assessed with DEXA. The 24-hour and nocturnal GV parameters were derived from continuous glucose monitoring. Results and discussion. Ghrelin levels in patients with diabetes were decreased significantly as compared to control (p<0.00001). Subjects with obesity demonstrated lower ghrelin concentrations then non - obese patients (p=0.002). The levels of ghrelin correlated negatively with body mass index, total and gynoid fat mass. Total fat mass was most reliable predictor of ghrelin concentration in multiple regression analysis (R2=0.18). In patients with diabetes significant increase in the levels of leptin, resistin and visfatin was revealed (all p<0.001). Ghrelin correlated negatively with resistin and visfatin levels. Positive correlations were found between ghrelin and nocturnal GV parameters: SD, Mean Amplitude of Glucose Excursions, and High Blood Glucose Index. Conclusion. The reduced fasting serum level of ghrelin is associated with obesity, adipose tissue dysfunction and nocturnal GV in subjects with type 2 diabetes.
Terapevticheskii arkhiv. 2019;91(10):28-33
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Glycemia normalization in patients with obesity and type 2 diabetes mellitus: bariatric surgery vs pharmacological therapy

Sklyanik I.A., Shestakova E.A., Yurasov A.V., Yashkov Y.I., Shestakova M.V.


Aims. To compare glucose - lowering and weight reduction capacity of bypass operations (gastric bypass (GB), biliopancreatic diversion (BPD) vs GLP-1 agonist liraglutide 3.0 mg (models of maximum incretin effect) for 6 months. Materials and methods. 46 patients with type 2 diabetes and long history (≥10 years) of obesity were divided into 2 groups: surgery - group (n=23) and liraglutide - group (n=23), where liraglutide 3.0 mg in dose - escalation manner was added to baseline glucose - lowering therapy. Anthropometric parameters, HbA1c and insulin resistance (IR) by hyperinsulinemic euglycemic clamp (M-value) were measured before and 16 weeks after the intervention. With the stabilization of glycemia (≤6.5 mmol/l at fasting state, ≤8 mmol/l postprandial) the initial glucose - lowering therapy was canceled. Results and discussion. Both surgery and liraglutide 3.0 mg provided target HbA1c in 16 weeks. Bypass operations led to elimination of glucose - lowering therapy in 82.6% patients due to a more significant weight reduction and decrease in IR. In liraglutide - group previous glucose - lowering therapy was cancelled in 78.3% patients, mainly receiving baseline mono - and two - component therapy. The most significant difference between interventions was achieved in BMI (-8.9 kg in surgery group vs -3.8 kg in liraglutide group, p<0.05) and M-value (+3.9 in surgery vs +0.2 in liraglutide, p<0.05). Conclusion. Bypass operations are more effective in reducing body weight and insulinresistance, but similar in glucose - lowering effect comparing with adding liraglutide 3.0 mg to the initial glucose - lowering therapy in patients with obesity and type 2 diabetes. Liraglutide 3.0 mg glucose - lowering effect is more prominent in patients initially receiving mono - and two - component therapy.
Terapevticheskii arkhiv. 2019;91(10):34-38
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Treatment of influenza and other acute respiratory viral infections in patients with diabetes mellitus

Sitnikov I.G., Fazylov V.K., Silina E.V.


Purpose of the study. The study of the influenza and ARVI clinical performance, the development of patients with diabetes mellitus, evaluation of the effectiveness and safety application of antiviral therapy, carried out in the framework of routine clinical practice. Materials and methods. 126 patients aged from 22 to 83 years (27.8% of men) with ARVI or influenza that occurred with medical care during the first 5 days of the disease (60.3% in the first 48 hours) are included. All patients suffer from diabetes, for the treatment of which oral hypoglycemic agents or insulins were constantly taken. The patients were divided into two groups: the first group received standard symptomatic treatment of ARVI; antiviral drug Kagocel. Results and conclusion. Diabetes and other acute respiratory viral infections. There is an increase in the incidence of bacterial complications - 2.2 times, an increase in the frequency of systemic antibiotics - 2.3 times. The purpose of the drug prescription led to a more rapid regression of all the symptoms of influenza and ARVI, but the most striking positive dynamics was observed in the symptoms of general weakness and headache. The prescription of Kagocel was accompanied by a 58% reduction in the number of bacterial complications and a 53% reduction in the use of antibiotics, which led to a reduction in the number of cases of the disease and an improvement in initial diseases, with an frequency increase in 1.8 times. The most significant effect achieved with early treatment and early initiation of antiviral therapy (in the first 48 hours of the disease).
Terapevticheskii arkhiv. 2019;91(10):39-47
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Lipid status and oxidative stress in menopausal women with obstructive apnea syndrome

Kolesnikova L.I., Semenova N.V., Osipova E.V., Madaeva I.M.


Aim: to assess lipid profile, lipid peroxidation and antioxidant system parameters in peri - and postmenopausal women with obstructive sleep apnea syndrome (OSAS). Materials and methods. 37 perimenopausal women and 43 postmenopausal ones were examined. OSAS diagnosis was made on the basis of the clinical picture and the polysomnography results. In perimenopause, the main group consisted of 18 women, in postmenopausal women - 17. All comparison groups are comparable by age and body mass index. Lipid profile, lipid peroxidation and antioxidant system parameters by spectrophotometric methods were determined. Non - parametric criteria were used to analyze the group differences for the independent samples. Results and discussion. The increase of total cholesterol (TC) and low - density lipoprotein cholesterol (LDL-C) levels were observed in perimenopausal women with OSAS as compared to control. The increase of TC, triacylglycerol (TG), LDL-C, very - low - density lipoprotein cholesterol (VLDL-C) levels and decrease of high - density lipoprotein cholesterol (HDL-D) level were found in postmenopausal women with OSAS as compared to control. Accumulation of ketodienes and conjugated trienes in perimenopausal women with OSAS and thiobarbituric acid reactants with a decrease of total antioxidant activity of blood serum in postmenopausal women with OSAS as compared to control was observed. Moreover, postmenopausal women with OSAS have a higher lipid peroxidation substrates and diene conjugates levels with a lower α-tocopherol level and total antioxidant activity compared with perimenopausal patients.The integral indicator of oxidative stress assessment indicates an imbalance in the lipid peroxidation and antioxidant system in menopausal women with OSAS. Conclusion. The results obtained indicate a violation of lipid metabolism and the development of oxidative stress in patients with OSAS. This is most pronounced in the postmenopause due to the aggravation of the pathological condition.
Terapevticheskii arkhiv. 2019;91(10):48-53
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Atherosclerosis of peripheral arteries in patients with coronary artery disease and type 2 diabetes mellitus

Genkel V.V., Salashenko A.O., Shamaeva T.N., Sumerkina V.A., Nikushkina K.V., Shaposhnik I.I.


Aim. To study the features of atherosclerosis of peripheral arteries in patients with coronary artery disease (CAD) depending on the presence of type 2 diabetes mellitus (T2DM) and to identify factors associated with multifocal atherosclerosis. Materials and methods. The study included 140 patients (77 men and 63 women) with CAD (mean age 62.0 (56.0-66.0) years). The first group included 70 people with CAD and T2DM, and the second group included 70 patients with CAD without T2DM. All patients underwent duplex scanning of the carotid and lower limb arteries (LLA). Local vascular stiffness of the common carotid artery (CCA) was assessed by ultrasound scanning. The Peterson elasticity modulus, distensibility and strain of the CCA were determined. The ankle - brachial index (ABI) was measured by the Doppler method. Results and discussion. In the group of patients with T2D, there were statistically more patients with atherosclerotic plaques in both carotid arteries and LLA. Also among patients with T2DM the severity of stenosis of carotid arteries and LLA at all levels was significantly greater. Local carotid stiffness was higher in the first group of patients. The proportion of individuals with reduced ABI <0.9 among the patients in the first group was greater in comparison with patients in the second group. According to stepwise logistic regression analysis, independent predictors of multifocal atherosclerosis in patients with CAD were T2DM, intermittent claudication and an increase in carotid stiffness. Conclusion. Patients with CAD and T2DM compared with nondiabetic patients differed significantly greater severity of carotid and lower limb arteries atherosclerosis. Independent predictors of multifocal atherosclerosis in patients with CAD were T2DM, intermittent claudication and an increase in carotid stiffness.
Terapevticheskii arkhiv. 2019;91(10):54-62
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The effect of bisphosphonate therapy on reducing the risk of cardiovascular complications associated with chronic heart failure, type 2 diabetes and osteoporosis in postmenopausal women

Teplyakov A.T., Berezikova E.N., Shilov S.N., Popova A.A., Samsonova E.N., Yakovleva I.V., Molokov A.V., Grakova E.V., Kopeva K.V.


Aim. To study the effectiveness of oral alendronate and ibandronate bisphosphonates for the prevention of cardiovascular complications in postmenopausal women with type 2 diabetes mellitus (DM) and osteoporosis during a 12-month prospective observation. Materials and methods. The study included 86 women with osteoporosis, chronic heart failure (CHF) and type 2 diabetes: the 1st group (n=52) included patients who received basic therapy for heart failure; the 2nd group (n=34) included patients who, in addition to the basic therapy of heart failure, were prescribed alendronic and ibandronic acid preparations for the treatment of osteoporosis. In order to identify the possibility of associating the studied factors with the nature of the course of heart failure, the patients were divided according to the results of a one - year follow - up into two subgroups: subgroup A (n=49) - patients with a favorable course of the disease and subgroup B (n=37) - patients with an unfavorable course of pathology. Results and discussion. After 12 months, a significant decrease in the levels of cerebral natriuretic peptide precursor (NT-proBNP), tumor necrosis factor-α, and interleukin-1β was found in the group of women treated with bisphosphonates compared to baseline. Significant associations of NT-proBNP levels (p=0.02) and the studied cytokines (p=0.01) with an unfavorable course of heart failure were revealed. A significant association of bisphosphonate therapy with a favorable course of heart failure (p=0.01) was also revealed. The probability of developing adverse cardiovascular events during the year in the treatment of heart failure with basic therapy drugs with additional therapy of osteoporosis with bisphosphonates is significantly (p=0.0025) lower than the treatment of patients with heart failure with only basic therapy and not taking bisphosphonates for the treatment of osteoporosis. Conclusion. In postmenopausal women with associated cardiovascular pathology (CHF, type 2 diabetes and osteoporosis), prophylactic therapy with oral alendronate and ibandronate oral bisphosphonates is effective, reduces the risk of progression of heart failure, inhibits inflammatory mediators, positively affects the combined endpoints of comorbid cardiovascular pathology.
Terapevticheskii arkhiv. 2019;91(10):63-69
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Abnormal values of trace elements and blood metals in patients with metabolic syndrome, depending on its components

Podzolkov V.I., Korolyova T.V., Kudryavtseva M.G.


Aim. To study the level of “toxic” (Al, Cd, Pb) and “essential” (Fe, Cu, Zn, Co, Cr, Ni, and Se) trace elements (TE) and blood metals (BM) in patients with metabolic syndrome (MS), depending on its individual components. Materials and methods. 112 patients with MS were examined (45 men and 67 women; average age 61.4±7.2 years, average duration of MS 8.7±5.2 years). The study of BM was carried out by atomic emission spectrophotometry with inductively coupled plasma . Results and discussion. To study the amount of TE and BM in the group of MS patients,it was significantly higher levels of “toxic” MEs - Al, Cd, Pb - were revealed along with a decrease in the content of the “essential” Zn element as compared to the control group. At the same time, a pronounced positive correlation between the fact of the presence of MS and the level of “toxic” microelements - Al (r=0.71; p<0.05), Cd (r=0.76; p<0.05) and Pb (r=0.67; p<0.05). We studied the content of TE and BM depending on dyslipidemia. An analysis of the relationship between the BM level and total cholesterol showed a significant positive correlation with the content of Cu (r=0.52; p<0.05), Fe (r=0.30; p<0.05), Cr (r=0.25; p<0.05), Al (r=0.34; p<0.05), Pb (r=0.43; p<0.05), Cd (r=0.34; p<0.05) and negative with Zn (r=-0.24; p<0.05). When comparing the concentrations of TE and BM in individuals suffering from MS in groups with impaired carbohydrate metabolism and with normal glycemia, statistically significant differences were revealed with respect to 7 chemical elements. Significantly higher levels of Fe, Cu, Cr, Al, Cd, Pb and low Zn were obtained in MS patients with hyperglycemia when compared with patients without hyperglycemia. Conclusion. In patients with MS, the level of Zn was significantly reduced and the level of Al, Cd, Pb was increased. In this case, a direct correlation between the content of Fe, Cu, Cr, Al, Pb, Cd and the levels of total cholesterol, LDL and TG and an inverse relationship with the level of Zn was revealed. A significant increase in the levels of Fe, Cu, Cr, Al, Pb, Cd and a decrease in the level of Zn in MS patients with impaired carbohydrate metabolism were noted.
Terapevticheskii arkhiv. 2019;91(10):70-75
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10-year risk of fractures (FRAX) in people with diabetes type 2

Mazurenko E.S., Malutina S.K., Shcherbakova L.V., Hrapova Y.V., Isaeva M.P., Rymar O.D.


Aim. To study indicators of bone mineral densit (BMD) and trabecular bone score (TBS) and to reveal the 10-year fracture risk (FRAX®) taking into account the data obtained in persons with type 2 diabetes (DM2). Materials and methods. A clinical study of the type of case - control. The study included 122 people with and without DM2. All persons were: questionnaires, anthropometry, densitometry, determination of TBS and fracture risk on the FRAX®. Results and discussion. Persons with DM2 who underwent a fracture had lower T-score values in all areas except the spine, unlike those with DM2, but without fracture. However, persons with DM2 had a fracture at high values of T-score in vertebrae and hips in comparison with persons without DM. Using the TBS, we did not get a significant difference in any of the examined groups. We also found no differences in the risk of recurrent fractures among women with and without DM2 using FRAX® without densitometry and FRAX® adjusted for TBS. The values of FRAX® by T-score in the group of persons with DM with fractures were significantly lower (p=0.029 for major fractures, p=0.024 for hip fractures) than in persons without DM with fractures. Conclusion. Persons with DM2 and fractures have higher BMD values, lower than the FRAX fracture risk values adjusted for the T-score, do not differ significantly in TBS, which determines the difficulties in diagnosis, the need to find additional methods for early diagnosis of increased fracture risk in patients with DM2.
Terapevticheskii arkhiv. 2019;91(10):76-81
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Association of food patterns with different forms of small intestinal bacterial overgroth syndrome and treatment efficacy

Pilipenko V.I., Isakov V.A., Morozov S.V., Vlasova A.V., Naydenova M.A.


Aim. To assess food patterns in patients with different types of SIBO and their impact onto the course and treatment outcomes. Materials and methods. The data of 988 patients who signed informed consent surved as a source data. On the basis of lactulose breath test (LBT; GastroCH4eck, Bedfont, UK), the patients were selected into one of the studied groups: SIBO-H2, SIBO-CH4, SIBO-CH4-H2 and control. Twenty - four hours food recall test was used to analyze nutritional habits. In patients with SIBO-H2, standard treatment with Tilichinol 100 mg/Tilbrochinol 200 mg (Intetrix, Beaufour-Ipsen International, France) 2 caps BID for 10 days) was provided. Efficacy of treatment was assessed on the bass of the result of LBT 2 month after treatment completion. Mann-Whitney T test (Statistica 10, StatSoft, USA) was used to compare nutritional patterns in patients with or without SIBO, in different types of SIBO and in accordance to the results of treatment. Results and discussion. Nine hundred eighty eight patients were enrolled. On the basis of hydrogene breath test they were divided into 4 main groups: SIBO of hydrogen - producing flora (SIBO-H2, n=526), methane - producing flora (SIBO-CH4, n=129), SIBO with hyperproduction of methane and hydrogene (SIBO-CH4-H2, n=225). The control group consisted of 108 patients with no no excessive gas production on LBT. In contrast to controls, nutritional patterns of patients with SIBO were characterized by low dietary fiber and amount of red meat dishes in the rations. Those with SIBO-CH4 consumed more fruits (p=0.03), vegetables (p=0.003), and fish (p=0.026), compared to those with other variants of SIBO and the control group. Nutritional patterns of SIBO-H2 group were characterized by larger amount of poultry meat consumption (p=0.026) compared to other SIBO groups and controls. In SIBO-H2 “cured” group greater amounts of buckwheat (p<0.001), millet (p=0.047), poultry (p=0.01) and butter (p<0.01) consumption was found, but they consumed less cottage cheese (p=0.018) compared to the treatment - failed group. Conclusion. Nutritional patterns may affect the presence of small intestinal bacterial overgrowth syndrome and the variant of it. Efficacy of treatment of SIBO-H2 patients with Tilichinol/Tilbrochinol depends on the habitual nutrition.
Terapevticheskii arkhiv. 2019;91(10):82-90
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Primary hyperaldosteronism: difficulties in diagnosis

Shifman B.M., Platonova N.M., Molashenko N.V., Troshina E.A., Sitkin I.I., Belcevich D.G., Kovalevich L.D., Romanova N.Y., Kolesnikova G.S.


Primary hyperaldosteronism (PA) - is the clinical syndrome, results from autonomous of the major regulators of secretion, aldosterone overproduction by a tumorous or hyperplastic tissue in adrenal cortex. Being the most frequent cause of secondary hypertension, PA may be represented by disorders with unilateral or bilateral aldosterone overproduction and differential diagnosis between them is crucial for choosing a right therapeutic approache: lifelong medical therapy with mineralocorticoid receptor antagonists or unilateral adrenalectomy. Adrenal venous sampling (AVS) is currently the «gold standard» test for identifying laterality of excess hormone production, unlike imaging tests, sensitivity and specificity of which is not enough, due to inability to evaluate functional activity with confidence, and also to limitations in detecting tiny abnormalities of adrenals, such as microadenoma or hyperplasia. Excluding certain cases, AVS is recommended to patients with confirmed PA, planning surgical treatment, to determine the lateralization of aldosterone hypersecretion. Described clinical case of patient with confirmed lateralization from adrenal without any detected lesions on CT-imaging and nonfunctioning tumour on contralateral side, highlights the importance of using AVS for decision to refer patients for surgery.
Terapevticheskii arkhiv. 2019;91(10):91-99
pages 91-99 views

Critical illness - related corticosteroid insufficiency in patients after cardiac surgery and cardiologic emergencies

Komlev A.E., Kurilina E.V., Imaev T.E.


Critical illness - related corticosteroid insufficiency (CIRCI) is associated with elevated level of circulating biomarkers of inflammation, pro - coagulant effects, deterioration of systemic inflammatory response syndrome (SIRS) and, consequently, prolonged in - hospital stay and increased mortality of intensive care patients. Incidence of CIRCI widely varies depending on specific patient’s population and applied diagnostic thresholds being as high as 30% among postoperative patients on inotropes. CIRCI is a complex clinical and pathophysiological condition with substantial influence on immediate survival and prognosis. Clinical impact of CIRCI as well as pathogenetically based therapy arouse keen interest of intensive care specialists and clinical pathologists. The specific issues of CIRCI in patients after cardiac surgery and cardiology emergencies remain largely under - recognized, so further scrutinization is needed.
Terapevticheskii arkhiv. 2019;91(10):100-105
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Diabetes mellitus and chronic liver diseases. Part 1: general mechanisms of etiology and pathogenesis

Kalmykova Z.A., Kononenko I.V., Mayorov A.Y.


In recent years there has been an active discussion about the relationship between diabetes mellitus (DM) and chronic liver diseases (CLD). On the one hand, patients with diabetes have an increased risk of developing CLD. On the other hand, patients with CLD very often identify abnormal glucose metabolism which ultimately leads to impaired glucose tolerance and the development of diabetes. This review outlines potential causal relationships between some CLD and DM. Common mechanisms that provoke metabolic and autoimmune disorders in the development of various nosologies of the CKD group, leading to steatosis, insulin resistance, impaired glucose tolerance and the development of diabetes are described. Certain features of the assessment of carbohydrate metabolism compensation in patients with hepatic dysfunction, anemia and protein metabolism disorders are described.
Terapevticheskii arkhiv. 2019;91(10):106-111
pages 106-111 views

Molecular markers as risk factors for thyroid cancer

Rogova M.O., Novosad S.V., Martirosian N.S., Trukhina L.V., Petunina N.A.


Thyroid cancer is the most common malignant tumor of the endocrine system. An increase in the incidence of thyroid cancer has been noted over the past decade, mainly due to papillary cancer. The influence of environmental factors, increased availability of medical care, including sensitive diagnostic tests, such as ultrasound and fine - needle aspiration (FNA), can affect the fact of the growth of this incidence. Palpation of thyroid gland has very low diagnostic value for detecting thyroid cancer, while thyroid ultrasound and FNA can detect malignant tumors in 20% of cases. Today, the FNA is the fastest, most accurate, economically accessible, and quite safe method for cytological diagnosis of the thyroid nodules. And molecular genetic testing of FNA samples could serve as an additional reliable diagnostic tool in the case of atypia of undetermined significance.
Terapevticheskii arkhiv. 2019;91(10):119-123
pages 119-123 views

Diabetes mellitus and cognitive impairment

Surkova E.V., Tanashyan M.M., Bespalov A.I., Naminov A.V.


The review discusses literature data and the results of our own studies on the effect of diabetes on cognitive functions and cerebrovascular pathology, as well as possible ptogenetic mechanisms for the implementation of this effect. The results of studies on the effects of antidiabetic drugs on cognitive function are presented.
Terapevticheskii arkhiv. 2019;91(10):112-118
pages 112-118 views

Glycemic control in patients with diabetes mellitus on hemodialysis

Lobanova K.G., Severina A.S., Martinov S.A., Shamkhalova M.S., Shestakova M.V.


Achievement of stabilization of carbohydrate metabolism in patients with diabetes mellitus, receiving renal replacement therapy with hemodialysis, is a significant problem in endocrinology. It has to do with multiple factors of this cohort of patients, which affect the level of glycemia, pharmacokinetic of drugs, the efficiency of glycemic control. At the moment, the most efficiency method of glycemic control in patients with type 2 diabetes mellitus on hemodialysis is insulin therapy in the basis - bolus regime by analogues of human insulin. The use of oral hypoglycemic agents is significantly limited. The hemoglobin A1c (HbA1c) remains the main parameter of glycemic control. The simultaneous use of continuous glucose monitoring allows to reveal the true level of glucose of the blood and to carry out the timely correction of therapy in order to achieve targets for glycemic control and to decrease the risk of hypoglycemic episodes. At the moment other glycemic control markers such as glycated albumin and fructosamine are described. However, in routine practice at the moment these indicators are not used due to the lack of sufficient evidentiary base of their use in this cohort of patients.
Terapevticheskii arkhiv. 2019;91(10):124-134
pages 124-134 views

Central hypothyroidism

Petunina N.A., Trukhina L.V., Martirosian N.S.


Central hypothyroidism is a rare cause of hypothyroidism, consequence of various disorders affecting pituitary (secondary) or hypothalamus (tertiary hypothyroidism). Difficulties in the diagnosis and management of patients are due to the nontypical clinical picture, frequent combination with impaired function of other pituitary hormones, difficulties in laboratory assessment in high TSH levels or low - normal T4 free levels. Diagnosis is based on a confirmed decrease in the level of free T4 with a low or normal level of TSH. The standard treatment for hypothyroidism of any etiology remains monotherapy with levothyroxine, which allows to restore the euthyroid state in most patients. The criterion for the effectiveness of therapy is to maintain the level of T4 free in the upper half of the reference norm interval. The article presents a modern understanding of epidemiology, pathogenesis and strategies for managing patients with central hypothyroidism.
Terapevticheskii arkhiv. 2019;91(10):135-138
pages 135-138 views

Diabetic macroangiopathy

Verbovoy A.F., Pashentseva A.V., Verbovaya N.I.


Diabetes mellitus represents a significant medico - social problem for health care around the world. The main reason for an invalidism and a mortality of patients with diabetes mellitus are the lesions of heart and vessels united in the concept "diabetic macroangiopathty". This complication is often taped already at the time of diagnosis of a diabetes mellitus and demands active treatment.
Terapevticheskii arkhiv. 2019;91(10):139-143
pages 139-143 views

Eosinophilic inflammation in chronic obstructive pulmonary disease

Avdeev S.N., Trushenko N.V., Merzhoeva Z.M., Ivanova M.S., Kusraeva E.V.


Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease that combines various clinical manifestations and pathophysiological mechanisms. It underlies the separation of patients with COPD by phenotypes, endotypes and a personalized therapy of this disease. The implementation of this approach is possible only with the use of appropriate biomarkers. One of the most important biomarkers of COPD is eosinophilia of blood and/or sputum, which is considered as a predictor of frequent exacerbations and the effectiveness of inhaled glucocorticosteroids in patients with COPD. The literature discusses the impact of eosinophilic inflammation on the prognosis, clinical and functional parameters in COPD, and the role of the targeted therapy in the treatment of eosinophilic COPD.
Terapevticheskii arkhiv. 2019;91(10):144-152
pages 144-152 views

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