Vol 91, No 10 (2019)

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.

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.

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).

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.

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.

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.

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.

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.

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.

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.