Background Of Diabetes Mellitus Type Research Articles

BH03 Lipoedematous scalp occurring in two female siblings: further evidence of a genetic role?

Abstract Lipoedematous scalp (LS) is a rare disorder characterized by thickening of the adipose subcutaneous scalp layer. We describe an unusual case of two female siblings presenting with the same condition. A 58-year-old black Caribbean woman presented with a 7-year history of an itchy, painful and scaly scalp, without any associated hair loss. Mycology had been negative. There was a history of paranoid schizophrenia and bipolar disorder, for which she was taking olanzapine. Body mass index (BMI) was 39 mg kg–2. Examination revealed a thickened scalp with a spongy consistency, with no associated surface change or hair loss. Scalp ultrasound was performed, demonstrating a scalp thickness of 12 mm at the vertex (normal range 5–6 mm). Scalp biopsy revealed prominent fat in the dermis around the hair follicles, with follicular distortion and some focal perifollicular fibrosis. Based on these findings, a clinicopathological diagnosis of LS was made. The patient’s 63-year-old sister presented with similar scalp symptoms. She had a background of diabetes mellitus type 2, migraine and hypomania and was taking metformin, gliclazide, atorvastatin, sodium valproate and mirabegron; her BMI was 26 mg kg–2. Scalp ultrasound revealed diffuse thickening of the subcutaneous fat measuring 9 mm at the vertex, which was also consistent with a diagnosis of LS. The pathogenesis of LS is poorly understood. It is more common in females, and there appears to be an association between LS and obesity (Yasar S, Gunes P, Serdar ZA, Tosun I. Clinical and pathological features of 31 cases of lipedematous scalp and lipedematous alopecia. Eur J Dermatol 2011; 21:520–8). Studies have implicated leptin, a hormone that regulates distribution of adipose tissue. There is limited evidence for a genetic role in LS. We identified three female cases of LS in the literature with a positive family history in their daughters (Yasar et al.) but no cases of siblings with LS. We identified one reported case of the related disorder, lipoedematous alopecia, occurring in a pair of female siblings (Koç Yıldırım S, İğde B. Lipedematous alopecia: report of two female siblings. J Cosmet Dermatol 2022; 21:1324–5). Our case highlights a possible genetic role in the pathogenesis of LS, and further studies are needed to investigate this link further.

The level of peripheral myelin protein and vitamin D in blood serum among patients suffering diabetes mellitus type II and hearing impairment

The level of peripheral myelin protein and vitamin D in blood serum among patients suffering diabetes mellitus type II and hearing impairment

Cardiovascular Pathology – a Factor of the Adverse Course of Diabetic Polyneuropathy

Diabetic polyneuropathy (DP) and angiopathy are interdependent processes, as disturbances in the microcirculatory system of peripheral nerves lead to increased axonal damage and is a kind of predictor of polyneuropathy progressing [6]. 80% of deaths from diabetes mellitus (DM) are associated with cardiovascular catastrophes, including coronary heart disease (CHD), stroke and peripheral artery disease [3]. The objective: to analyze the most common cardiovascular pathology (CVP) and show its impact on the course of DP in type I and II DM. Materials and methods. Was clinically examined 101 patient with DP. The examined patients were divided into groups: with DP on the background of type 1 DM (group I) (n=54) and with DP on the background of type II DM (group II) (n=47), and also were divided into subgroups: DP on the background of type I and II DM and existing CVP (including diabetic angiopathy) 82 (82%) (subgroup А) and with the DP on the background of DM type I and II without CVP – 19 (19%) (subgroup В). Patients were examined to determine the neurological status, were performed laboratory and instrumental methods of examination. Static calculation was performed in MS Excel 2003 and in the programme STATISTICA 10. Results. Regarding to the patients of subgroup А and В we noted the natural predominance of trophic disorders, changes in the reflex sphere and sensitivity in subgroup А. Patients of group II more often than in group I had pathology of the cardiovascular system. Hypertension (HT) and CHD in both cases were registered with a high frequency. In subgroup А there was a combination of several nosologies: from the respiratory, urinary, gastroenterological system (1%), urinary and gastroenterological (3%), gastroenterological and endocrine (2%), urinary and endocrine (1%). In subgroup В diseases of urinary and gastroenterological pathology were found in (5%), gastroenterological (5%), endocrine (11%). The examined patients from group I and with the concomitant CVP have lower linear velocity of blood flow (LVBF) on both tibial arteries, patients in group II – have marginally higher LVBF. Analysis of the results of duplex scanning of lower extremity arteries showed a high incidence of stenosis, in particular the anterior tibial arteries (ATA) up to 30–40%, posterior tibial arteries (PTA) up to 40–50% and occlusion (PTA and femoral, popliteal, tibial segment) in individuals of group I. Conclusions. In patients with DP on the background of type I and II DM and available CVP (subgroup А), the clinical manifestations of polyneuropathy were quite pronounced, especially in the field of trophic disorders, because CVP enhances the ischemia of the microsaceous channel of the peripheral nerves. In addition, persons with concomitant CVP have a wide range of another comorbid pathology, which accelerates the onset of DM complications.

Indirect revascularization in patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus

Objective. Determination of clinical efficacy of the mesenchymal stem cells transplantation in patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus.
 Materials and methods. There were examined 11 patients, suffering critical ischemia of the lower extremities on background of diabetes mellitus Type II with purulent-necrotic processes of the foot, in whom conditions for the direct revascularization of extremity were absent. Microbiological monitoring for the wound discharge, determination of the ankle brachial index and transcutaneous oximetry was performed. The technology elaborated have consisted of two stages. On the first of them a purulent focus sanation (in all the patients the distal amputations of the foot, preserving arterial arch) was done. On the second stage the therapy of the wounds was conducted, using negative pressure, injections of cellular suspension (mesenchymal stem cells) while applying long fine cannula under aponeurosis into the muscles along obliterated vessels in the (10 ± 5) ml quantity with subsequent closure of the wound surface, using fibroblastic matrix.
 Results. In a year after the treatment critical ischemia in 1 patient was noted, the ischemia Grade III - in 3, and in 7 a IIB Grade have persisted.
 Conclusion. Performance of indirect revascularization, using autologous mesenchymal stem cells, constitutes an effective and secure procedure.

The condition of bioelectrical activity of the brain among the patients suffering diabetes mellitus type II with hearing impairment

Topicality: The sensorineural hearing loss (SNHL) is a polyetiological disease with a complex pathogenesis. Sensorineural hearing loss is also caused by metabolic disorders and system diseases, including diabetes mellitus (DM).Quite often at sensorineural hearing loss there are extraauralic manifestations of the central nervous system (CNS). On the other hand, with diabetes, there are also observed the affection of the nervous system both in the form of polyneuropathy and certain disorders of the CNS. Electroencephalography (EEG) is a reliable, universal, objective, non-invasive method of research the functional condition of the CNS. Aim: to investigate changes in the condition of bioelectrical activity of the brain according to electroencephalography among patients with diabetes mellitus type II with impaired auditory function. Materials and methods: 43 patients with diabetes mellitus type II were examined, who, according to subjective audiometry, revealed impairments of auditory function and 15 persons of the control group. The EEG research was performed using a computer electroencephalograph from the company “DX-System” (Ukraine) according to the generally accepted method. Results and discussion: The qualitative analysis of EEG results among patients with diabetes revealed abnormalities in the functional condition of the CNS in the form of diffuse changes in bioelectrical activity of the brain, disorganization and desynchronization of basic rhythms, signs of irritation of brain structures, amplified by functional loads. Among the examined patients using background EEG we observed the expressed irritative changes, decrease in bioelectrical activity of a brain, desynchronization and disorganization of rhythms. Among many of them there were periodic sharp peaks and potentials, a tendency to accelerating the basic rhythm, and against this background, the increase in the content of slow waves (theta), mainly in the front leads. Moreover, the most pronounced changes in bioelectrical activity took place in the temporal and frontal leads. Thus, in patients with diabetes mellitus type II with SNHL disorganization and desynchronization of the EEG picture was detected in 34 patients (79.1 % cases). The expressed irritative changes were registered in 39 persons (90.6 % cases), hypersynchronous bursts were detected in 15 patients (34.8%), sharp peaks and potentials were present in 21 person (48.8 %) Many patients had smoothed zonal differences – 25 persons (58.1%) and lack of reaction to eye opening – 15 patients (34.8%)The decrease of bioelectrical activity reached 86.0 % cases. The amplitude of the basic alpha rhythm of the EEG among the examined patients diabetes mellitus type II with SNHL is significantly (p<0.01) lower than the norm in the temporal, parietal and occipital leads, which was 31.8±2.5, 44.1±3.1 and 43.5±4.2 мkV, respectively. In a significant part of the examined patients (88.3 %) with hearing impairments on the background of diabetes mellitus type II, these manifestations were increasing by hyperventilation. Violations of bioelectrical activity of the brain in 97.6% of cases were symmetrical, which indicates diffuse cerebral changes in the functional condition of the CNS in this category of patients. Irritations of the cortical structures of the brain were registered in all examined patients with diabetes mellitus type II. In many of these patients (97.6%) cortical irritation was combined with the involvement of deep brain structures. Thus, dysfunction of the diencephalic structures of the brain occurred in 48,8% of cases, diencephalic-stem – in 39,5%, mediobasal – in 9.3% cases. Only one patient had irritation of only the cortical structures. So, among our examined patients with diabetes mellitus type II with impaired auditory function according to EEG there are pronounced violations of bioelectrical activity according to EEG, including changes in the cortical and deep - diencephalic and stem structures of the brain. Conclusions: 1. The researches made by EEG method in patients with diabetes mellitus type II and SNHL objectively confirm the violation of the functional condition of the CNS among such patients. 2. In patients with diabetes mellitus type II and SNHL there are changes in bioelectrical activity mainly in the form of decreasing of bioelectrical activity of the brain (86,0%), expressed irritative changes (90.6%), irritation of deep structures of the brain (97,6), disorganization and desynchronization of the EEG picture (79.1% cases). 3. In patients with SNHL on the background of diabetes mellitus type II there is significantly (p<0.01) lower decreasing of amplitude of the alpha rhythm in comparison with the control values in temporal, parietal and occipital leads to 31.8±2.5, 44.1±3.1 and 43.5±4.2 mkV, respectively.

Complete left bundle branch block as predictor of cardiogenic shock in patient with acute myocardial infarction on the background of diabetes mellitus type 2

Cardiogenic shock is the leading cause of death in patients with acute myocardial infarction, with high hospital mortality rates ∼80 %. The incidence of cardiogenic shock among myocardial infarction patients is approximately 7 %. Cardiogenic shock patients are found that pre-existing diabetes is associated with an increased risk of cardiogenic shock and it worsens outcomes, with a longer hospital stay. Cardiogenic shock develops approximately twice as often among diabetics as among nondiabetic patients with acute myocardial infarction. Diabetes mellitus and left bundle branch block are predictors of cardiogenic shock complicating acute myocardial infarction. Except for bad prognosis, left bundle branch block can be a marker of a slowly progressing, degenerative, ischemic or non-ischemic cardiac disease, affecting not only the muscle but also the heart conduction system. Immediate diagnosis and management are required. In this article, a clinical case of acute posterior myocardial infarction complicated by complete left bundle branch block and cardiogenic shock in the patient with concomitant diabetes mellitus type 2 is demonstrated. This article emphasizes the priority of referring patients with left bundle branch block to primary percutaneous coronary intervention, usage of more specific ECG criteria for acute coronary syndrome, the role of myocardial infarction biomarker including sensitive assays for cardiac troponins, and bedside echocardiography which may improve diagnostic accuracy and result in timely intervention in such patients. This article also underlines the role of mechanical circulatory support, urgent reperfusion therapy, and strict control of glycemia in the acute phase of myocardial infarction which may contribute to clinical stability of patients with diabetes mellitus and myocardial infarction complicated by cardiogenic shock.

ROLE OF HYPERCORTISOLEMIA IN PROGRESSION OF THE COMORBID COURSE OF CORONARY ARTERY DISEASE, DIABETES MELLITUS TYPE 2 AND ANEMIA

INTRODUCTION: Hyperactivation of stress-limiting mechanisms of the organism is a unique physiological response of the human being to chronic hypoxia of different origins.
 OBJECTIVES: Investigation of dynamics of cortisol synthesis changes in patients with coronary artery disease with comorbid diabetes mellitus type 2 and anemic syndrome in patients of older age groups.
 METHODS: Blood cortisol level was measured in 40 old and senile coronary artery disease patients with comorbid diabetes mellitus type 2 and anemic syndrome of different degrees of severity. The control group consisted of 12 patients with coronary artery disease without comorbidities that were not significantly different through gender and age from the patients of the research groups. Possible effects of telmisartan on the degree of chronic hypoxia were also investigated.
 RESULTS: In patients of old and senile age with coronary artery disease and comorbid anemic syndrome, same as in case of coronary artery disease and anemic syndrome on the background of diabetes mellitus type 2, activation of the cortisol synthesis is observed, likely in response to hypoxia as a stress factor in anemia. The degree of severity of the detected changes was different depending on the degree of anemia severity. There was no normalization of cortisol content in blood in any of the major experimental groups regardless the prescribed treatment with ACE inhibitors or telmisartan.
 CONCLUSIONS: In patients with coronary artery disease, same as in the case of a comorbid course of coronary artery disease and diabetes mellitus type 2, an increase of cortisol secretion in response to anemic hypoxia was observed. As the degree of severity of the anemic syndrome progressed, gradual decreasing of cortisol blood level was detected. Reduction of the intensity of stress-limiting systems in the organism by telmisartan prescription may help to eliminate the adverse effects of hypercortisolemia on the progression of coronary artery disease, especially on the background of comorbid diabetes mellitus type 2 and anemia.

Патогенетическое обоснование терапии синдрома диабетической стопы на современном этапе

Цель. Изучение влияния экзогенного серотонина и стволовых клеток жировой ткани на репаративные процессы гнойно-некротических ран мягких тканей при ишемической форме синдрома диабетической стопы (СДС).
 Материалы и методы. В исследование включено 35 больных, из которых 20 имели ІІ стадию, 15 - ІІІ стадию ишемической формы СДС по классификации Фонтейна-Покровского на фоне сахарного диабета 2-го типа. Контрольную группу составили 15 здоровых людей, при обследовании которых не были выявлены признаки поражения артерий нижних конечностей. О степени выраженности атеросклероза судили по данным липидограммы и рентгенографии дуги аорты. В эксперименте изучено влияние стволовых клеток жировой ткани на регенеративные процессы в хронической язве кролей.
 Результаты. Внутривенное введение серотонина адипината улучшало кровоток в нижних конечностях, что может быть связано, во-первых, с механизмами эндотелиальной зависимости вазорелаксации, во-вторых, с усилением выработки эндотелиальных вазодилататоров. Проведенные экспериментальные исследования по изучению влияния стволовых клеток жировой ткани на репаративные процессы в хронической язве показали потенциальные возможности применения этих клеток в лечении пациентов с язвенно-некротическими дефектами.
 Выводы. Внутривенное введение серотонина адипината благоприятно влияет на патогенетические механизмы развития ишемии атеросклеротического генеза. Клеточная терапия стволовыми клетками жировой ткани у животных с хроническими язвенными дефектами улучшает репаративные процессы в поврежденных тканях. Это позволяет заключить, что такая терапия обладает потенциальными возможностями в лечении больных с гнойно-некротическими ранами мягких тканей.

Biliary system functional condition in patients with chronic cholecystitis against the background of diabetes mellitus type 2

Overlay of diseases of the biliary system to diabetes mellitus type 2 can contribute to the enhancement of disorders of protein, lipid and carbohydrate metabolism and affect the mechanisms of regulation at the cellular molecular level. Therefore, the need for early diagnosis and study of the features of the course of chronic cholecystitis against the background of diabetes mellitus type 2 is a pressing issue of internal medicine. The motor-evacuation and cholecretory functions of the biliary system and the features of the course of chronic cholecystitis on the background of diabetes mellitus type 2 were studied. 93 patients were examined, of which 62 were patients with combined diabetes mellitus type 2 and chronic cholecystitis and 31 patients with isolated chronic cholecystitis. The control group was represented by 20 apparantly healthy individuals, who were representative of the age and number of male and female probands. The course of chronic cholecystitis was found to be accompanied by impaired gallbladder motor (evacuation) function, which was manifested by an increase in the latency period, the volume of the cavity of the gallbladder, the emptying coefficients in the dynamics and a decrease in the index of contraction of the gallbladder. In the presence of diabetes mellitus type 2, an atypical course of chronic cholecystitis may be formed, characterized by motor-evacuation disorders of the biliary tract and physico-chemical changes in bile, the severity of which exceeds those of isolated chronic cholecystitis. The peculiarities of the course of chronic cholecystitis in patients with diabetes mellitus type 2 are manifested by insignificant clinical symptoms and distinct changes at both stages of cholecystosonography, which may be the result of the development of autonomic neuropathy. In diabetes mellitus type 2, it is advisable to determine the status of the gallbladder (cholecystosonography) in order to prevent the risk of complications (cholelithiasis) and timely administration of antimicrobial therapy in the presence of an additional inflammation.

THE ROLE OF AMINO ACID COMPOUNDS OF BLOOD PLASMA AND ITS INDICES IN THE DEVELOPMENT OF ARRHYTMIC COMPLICATIONS AND STRATTIFICATION OF CARDIOVASCULAR RISK IN PATIENTS WITH STABLE ISCHEAMIC HEART DISEASE ON THE BACKGROUND OF DIABETES MELLITUS TYPE 2

Objective: to improve the prediction of arrhythmic complications, the stratification of cardiovascular risk (СVR) and to develop a differentiated approach to the appointment of metabolic cardiopotectors (MC) based on the study of the amino acid composition of blood (ASC).
 Object and methods of investigation The data of examination of 72 patients with stable ischemic heart disease (IHD) on the background of diabetes mellitus type 2 (DM 2) (38 men and 34 women, median ages -65,1 year) and 22 patients with stable coronary heart disease without violations of carbohydrate metabolism were analyzed. 20 amino acids (AMC) and the relationships between them were determined, in which AMCs were combined by a competitive mechanism of transport into the cell. According to the results of holter ECG monitoring, patients were divided into 2 groups: with and without arrhythmias of ischemic genesis (AIG) of high grades.
 Results For patients with IHD, against the background of DM 2, AIG is characterized by a reduced content of taurine (Tau) (by 38.4%), an increase in alanine (Ala) (by 21.42%), a total content of aromatic amino acids (ARA) (by 32.97%) in comparison with patients with prognostically indifferent arrhythmias. The risk of AIG is associated with Tau / Ala indices (<0.048) and aromatic amino acids/ metionin (ARA / Met) (> 34.41), regardless of the availability of demographic, anamnestic and clinico-laboratory risk predictors.
 Conclusion: Amino acid indices should be used as prognostic markers of AIG for the purpose of treatment of patients with IHD on the background of CD2. Tau and ARL are the most suitable for screening purposes, Тau / Ala (<0.048) and ARA / Met (> 34.41), it is more appropriate to use for the intended purpose of MC and as a control of treatment.

Динаміка біохімічних показників у пацієнток з клімактеричним синдромом на тлі цукрового діабету іі типу під впливом комплексної терапії із застосуванням препаратів Клімакт-хель та Мулімен

Динаміка біохімічних показників у пацієнток з клімактеричним синдромом на тлі цукрового діабету іі типу під впливом комплексної терапії із застосуванням препаратів Клімакт-хель та Мулімен

Зміни вмісту метаболітів азоту та ендотеліну-1 в ротовій рідині хворих на генералізований пародонтит на тлі цукрового діабету 1 типу з кардіоміопатією

The work adduces the parameters of endothelial dysfunction according to indices (NO2+NO3) and endothelin-1 (ET–1) in оral serum in patients with generalized parodontitis on the backdround of diabetes mellitus type 1 with cardiomiopathy (main group) and in persons with GP without general somatic diseases (comparative group). When comparative evaluation of frequency of change of ET-1, NO2+NO3 it was established that patients with GP on the background of diabetes mellitus type 1 with cardiomiopathy differs from patients with GP without general somatic diseases more significant changes of metabolites of nitrogen and endothelin-1, where when intensifying of processes in examined patients’ parodontium the meaning of analyzed indices characterized more pronocenced disbalance.

The relationship of diurnal variability and level of glycemia with structural and functional parameters of heart in patients with chronic heart failure and diabetes mellitus type 2

An important contribution in the development of diabetes mellitus (DM) complications makes not only the chronic hyperglycemia but also the intense diurnal glycemia variability (GV). The aim of research was to assess systolic and diastolic heart functions in patients with chronic heart failure (CHF) of ischemic genesis on the background of DM type 2 depending on GV profile and the mean level of glycemia during the last 3 month.Methods: There were examined 65 patients who were divided into groups twice on the different categoric indicators. The first indicator – an intensity of glycemia profile (GP) variability, the second – the mean calculated level of glucose concentration in patients during the last 3 month. All patients underwent dopplerechocardiography, the standard declination and the coefficient of GP variations were calculated. An assessment of reliability of the results of statistic study was carried out by nonparametric method.Results: in patients with the high GP variability was detected the reliably greater size of the left atrium, decrease of the left ventricle output fraction, tendency to the transition of diastolic dysfunction from the I type to the II one comparing with the group with low GP variability. There was not revealed any reliable difference between groups or correlative connection of the mean level of glycemia with parameters that characterize contractility and diastolic myocardium function.Conclusions: There was revealed the negative influence of the high glycemia variability on systolic and diastolic heart functions, left atrium size and there was not revealed any reliable influence of the mean level of glycemia on cardiohemodynamics

Gender-specific changes in laboratory indexes and structural parameters of the left ventricle myocardium in chronic heart failure on the background of diabetes mellitus type 2 and obesity

Modern studies have shown that the prevalence of cardiovascular disease and chronic heart failure (CHF) specifically, in patients with diabetes mellitus (DM) is about 50%. Aim . To study gender-specific changes in laboratory indexes and structural myocardial parameters of left ventricle (LV) in CHF on the background of diabetes mellitus (DM) type 2. 111 patients with I–III functional class of disease with normal, overweight and abdominal obesity I–III degree were examined. Methods and results. Clinical and biochemical blood tests? glomerular filtration rate were used. Structural parameters of the myocardium were estimated with echocardiography. It is established that in CHF on the background of DM type 2 and obesity there is a tendency to develop anemia and renal dysfunction in women. Structural changes of the myocardium is more pronounced in men and presents the prevalence ofLV hypertrophy and dilatation of the heart cavities. Conclusion. This demonstrates different ways of negative impact of gender factor on the laboratory indexes and structural myocardial parameters in CHF on the background of DM type 2 and obesity.

Лікування переломів вертлюжної ділянки стегнової кістки у хворих на цукровий діабет II типу

Робота присвячена покращенню результатів лікування переломів вертлюжної ділянки стегнової кістки у хворих на цукровий діабет ІІ типу. Результати дослідження ґрунтуються на клінічному спостереженні та лікуванні 13 хворих із переломами вертлюжної ділянки стегнової кістки на фоні цукрового діабету ІІ типу. Отримані дані свідчать про залежність успішності лікування від корекції рівня цукру в крові пацієнтів протягом усього періоду лікування.