Complicated Course Research Articles

Psycho-emotional state of patients with chronic non-communicable diseases: important aspects of therapy

Psycho-emotional disorders such as depression and anxiety disorders are important modifiable risk factors for the development and complicated course of many common chronic non-communicable diseases. A particular feature of such comorbidity is the significant impact of psycho-emotional disorders on the motivation and adherence of patients to a healthy lifestyle and various therapy options, which increases the risks of complications and, as a consequence of this, the healthcare expenditures. The topicality of the issues of screening and management of psycho-emotional disorders in the general practitioner practice is caused, on the one hand, by high rate of these disorders in patients with chronic non-communicable diseases, deterioration in quality of life and an increase in adverse outcomes, and on the other hand, inadequate awareness of the possibilities to manage the psycho-emotional state of patients with comorbidities. The therapy for psycho-emotional disorders includes both drug and non-drug methods, however, the effectiveness of such therapy in relation to the clinical course and prognosis in patients with different comorbidities is not the same. This review presents the most common comorbidities of psycho-emotional disorders and somatic diseases in therapeutic practice. A buspirone and tofisopam therapy for psycho-emotional disorders in patients with various comorbidities was discussed. The efficacy and safety of tofisopam and buspirone have been studied in numerous studies in patients with chronic diseases and a wide range of anxiety disorders, including a long-term administration.

Same-gender differences in perioperative complications and transfusion management for lower limb arthroplasty

IntroductionTotal hip (THA) and knee arthroplasty (TKA) are surgical interventions for patients with primary and posttraumatic osteoarthritis. The present clinical investigation compared gender differences in THA and TKA.MethodsData from 419 patients following primary THA and TKA were collected. The occurrence of systemic and surgery-related complications, the units of blood transfused, and the change in Hb were investigated. Hb was collected preoperatively and at 1, 2, 4 and 7 days postoperatively. Statistical analysis was performed using the software IBM SPSS 28.ResultsThere was no significant difference in surgery-related and general complications in men between THA and TKA. A significant difference between THA and TKA in systemic complications in women was observed. No significant difference between THA and TKA in related to surgery-related complications was evidenced. In men, no difference in Hb progression was observed. In women, a significant Hb drop was evidenced (p = 0.03). The rate of blood transfusion units in women was significantly greater in TKA than in THA (p = 0.001). No statistically significant difference was observed in men in the rate of transfusion between THA and TKA.ConclusionPerioperative care should be organized differently for women and men. Furthermore, a differentiation between the procedures for each sex could prevent the occurrence of perioperative complicated courses.

The Value of Stress-Gated Blood Pool SPECT in Predicting Early Postoperative Period Complications in Ischemic Cardiomyopathy Patients: Focus on Mechanical Dyssynchrony.

(1) Objective: The objective of this study was to assess the prognostic value of stress-gated blood pool SPECT (GBPS) estimates in patients with ischemic cardiomyopathy (ICM) in the early postoperative period. (2) Methods: A total of 57 patients (age 59.7 ± 6.6, 47 men) with ICM and LV ejection fraction (30 [27.5; 35]%) were enrolled in the study. Before surgical treatment, all patients underwent GBPS (rest-stress, dobutamine doses of 5/10/15 µg/kg/min). Stress-induced changes in left ventricular (LV) ejection fraction, peak ejection rate, volumes, and mechanical dyssynchrony (phase histogram standard deviation, phase entropy (PE), and phase histogram bandwidth) were estimated. Two-dimensional transthoracic echocardiography was performed baseline. Serum levels of NT-proBNP were analyzed with enzyme-linked immunoassay. (3) Results: After surgical treatment, patients were divided into two groups, one, with death, the need for an intra-aortic balloon pump (IABP) or/and inotropic support with a stay in the intensive care unit for more than two days and two, without complications in the early postoperative period (EPOP). Complicated EPOP (CEPOP) was observed in 17 (30%) patients (death-2, IABP-4, extra inotropic support in intensive care unit-11), and 40 patients had no complications (NCEPOP). GBPS showed differences in LV EDV (mL) (321 [268; 358] vs. 268 [242; 313], p = 0.02), LV ESV (mL) (242 [201; 282] vs. 196 [170; 230], p = 0.005), and stress-induced changes in PE (1 (-2; 3) vs. -2 (-4; 0), p = 0.02). Aortic cross-clamp time and stress-induced changes in PE between rest and dobutamine dose of 10 µg/kg/min were the only independent predictors of CEPOP. An increase in LV entropy ≥ 1 on the dobutamine dose of 10µg/kg/min in comparison to rest investigation showed AUC = 0.853 (sensitivity = 62%, specificity = 90%, PPV = 71%; NPV = 85%; p < 0.0001). Conclusion: Stress-induced changes in PE obtained during low-dose dobutamine GBPS are associated with a complicated course of the early postoperative period after surgical treatment for ICM.

Rapid genome diagnosis of alveolar capillary dysplasia leading to treatment in a child with respiratory and cardiac failure.

Alveolar capillary dysplasia (ACD) is a fatal disorder that typically presents in the neonatal period with refractory hypoxemia and pulmonary hypertension. Lung biopsy is traditionally required to establish the diagnosis. We report a 22-mo-old male who presented with anemia, severe pulmonary hypertension, and right heart failure. He had a complicated hospital course resulting in cardiac arrest and requirement for extracorporeal membrane oxygenation. Computed tomography of the chest showed a heterogenous pattern of interlobular septal thickening and pulmonary edema. The etiology of his condition was unknown, lung biopsy was contraindicated because of his medical fragility, and discussions were held to move to palliative care. Rapid whole-genome sequencing (rWGS) was performed. In 2 d it resulted, revealing a novel FOXF1 gene pathogenic variant that led to the presumptive diagnosis of atypical ACD. Cases of atypical ACD have been reported with survival in patients using medical therapy or lung transplantation. Based on the rWGS diagnosis and more favorable potential of atypical ACD, aggressive medical treatment was pursued. The patient was discharged home after 67 d in the hospital; he is currently doing well more than 30 mo after his initial presentation with only one subsequent hospitalization and no requirement for lung transplantation. Our case reveals the potential for use of rWGS in a critically ill child in which the diagnosis is unknown. rWGS and other advanced genetic tests can guide clinical management and expand our understanding of atypical ACD and other conditions.

Case report of metastatic colorectal cancer associated with &lt;i&gt;KRAS&lt;/i&gt; A146V and A59G mutations

In colorectal cancer (CRC) in addition to the most common mutations in the second exon of KRAS, there are rarer mutations that are not well understood as prognostic markers.Description of cases. We describe two clinical cases of moderately differentiated adenocarcinoma (low-grade, G2), which manifested a complicated course in a 67-year-old woman – intestinal obstruction (case 1) and in a 62-year-old man – paratumorous abscess (case 2). Both cases were characterized by the development of regional and distant metastases (liver, brain) and a short relapse-free period. We found rare sporadic mutations of KRAS A146V and A59G with microsatellite stability and no mutation in the V600 BRAF site.Discussion. In the presented case 1, the KRAS A146V mutation was detected, the frequency of its detection in our practice of testing 2103 cases of CRC was 0.48%. Case 2 shows the extremely rare A59G mutation. Among the patients with CRC we studied, we found mutations in codon 59 in only two, which amounted to 0.095%. Both rare mutations represent separate molecular subgroups of CRC, characterized by an unfavorable clinical outcome and requiring the development of special treatment regimens.

КЛИНИКО-МОРФОЛОГИЧЕСКИЕ ХАРАКТЕРИСТИКИ ЭОЗИНОФИЛЬНОГО ЭЗОФАГИТА У ДЕТЕЙ. ДАННЫЕ КОГОРТНОГО ИССЛЕДОВАНИЯ

Number of children with eosinophilic esophagitis (EoE) observed has recently increased, therefore significant experience has been gained in the diagnosis and treatment of this disease. However, the systemic data from Russian pediatric centers’ registers that would summarize the signs of the disease in childhood has not been published as yet. The purpose of this research was to study the demographic, clinical, endoscopic and morphological features of EoE in children and to form the unified register of patients on the basis of a single yet multidisciplinary pediatric hospital. Materials and methods used: a single-center retrospective cohort study included 50 pediatric (under the age of 18 y/o) patients’ (13 (26%) girls/37 (74%) boys) records of those who were included in the National Medical Research Center for Children’s Health (Moscow, Russia) Register of EoE patients in July 2020-May 2023. Demographic indicators were assessed as well as the clinical manifestations, endoscopic and morphological changes and concomitant diseases. Results: the median age of children at the time of the diagnosis onset was 12 (8; 15) y/o. The age and the gender characteristics of patients were typical for the disease: boys aged 11 to 17 y/o had prevailed. The frequency of the EoE detection among children who had underwent esophagogastroduodenoscopy (EGD test) for various reasons was a single case per 253 EGD tests (0.4%). Among the clinical manifestations, dysphagia (44%) and abdominal pain (70%) were noted more often; GERD-like symptoms and poor weight gain were less common. The vast majority of children (84%) had concomitant allergic pathologies. EoE had proceeded comorbidly with other diseases in 60% of cases. Endoscopic manifestations of EoE were described and analyzed in detail. Thus, swelling of the mucous membrane, longitudinal striation and exudate had prevailed. Complicated course of EoE with the formation of esophageal stenosis was noted in 14%. There were no statistically significant differences between the age groups of children aged 1 to 10 y/o and 11 to 17 y/o in relation to clinical manifestations, endoscopic and morphological characteristics of EoE. Conclusion: thorough registration of pediatric patients with EoE does allow studying and summarizing of the features of this disease, in detail, with further provision of the useful information for clinical practice.

Association of Postoperative Delirium and Parkinson Disease After Common United States Surgical Procedures

IntroductionTo determine the association of Parkinson disease (PD) and postoperative delirium following common surgical procedures. MethodsWe performed a retrospective database analysis of the National Inpatient Sample. We used a matched sample of patients with and without PD who underwent any of ten common surgical procedures in the US, 2005-2014. Primary outcome measure was postoperative delirium for patients with and without PD. Secondary measures included disposition, length of stay, and hospital costs. ResultsThere were 3,235,866 patients receiving any of the ten most common operative procedures, 2005-2014. There were 35,743 patients with and without PD matched based on age, sex, elective admission status, Charlson Comorbidity index, and presence of dementia. Median age was 77 y (interquartile range 72-82), median Charlson Comorbidity index was 1 (standard deviation 0-2), 46.6% were female, and 46.8% were admitted electively. The three most common operative procedures were hip arthroplasty (28.5%), knee arthroplasty (16.1%), and percutaneous coronary angioplasty (14.9%). Postoperative delirium was present in 1519 patients with PD compared to 828 matched patients without PD (4.2% versus 2.3%; P < 0.001). The adjusted odds ratio of postoperative delirium for PD compared to the matched cohort without PD was 1.88 (95% confidence interval 1.73-2.05). Those undergoing spinal fusion (adjusted odds ratio 2.99, 95% confidence interval 2.06-4.38) had the greatest odds of delirium. For patients with PD, adjusted length of stay, adjusted hospital costs, and adjusted odds of postacute care facility discharge were greater compared to the matched cohort without PD. ConclusionsPatients with PD are more likely to develop postoperative delirium and have a more complicated postoperative course with longer length of stay and greater hospitalization costs.

A rare clinical case of syringomyelia progression in the presence of Chiari I malformation following the surgery

Today, an Arnold-Chiari malformation is defined as a developmental pathology of the craniovertebral junction manifested by a discrepancy between the volume and contents of the posterior cranial fossa, which in turn leads to compression of neurological structures and changes in the cerebrospinal fluid circulation. There are several theories of the correlation between Chiari malformation and syringomyelia, but the exact mechanism of syringomyelia development remains unclear.This article describes a clinical case of treatment of a child with Chiari I malformation and syringomyelia within the cervical and thoracic segments of the spinal cord; after complete posterior fossa decompression, syringomyelia progressed in the early postoperative period with the development of a severe neurological deficiency. Since there is no standard treatment of such postoperative complications, a decision was made on the expectant management of the patient. From the twentieth day of the postoperative period, the patient showed complete regression of the neurological deficiency and positive MRI dynamics of syringomyelia.The presented clinical case raises such issues as not only the pathophysiology of syringomyelia progression after complete posterior fossa decompression, but also the determination of patient management tactics in case of a complicated postoperative course of the disease.The presented clinical case is of interest due to the rarely described aggravation of syringomyelia with enhancing neurological symptoms in the early postoperative period after complete posterior fossa decompression. Our observation suggests that the expectant management of the patient, despite syringomyelia progression with neurological deficiency aggravation after posterior fossa decompression, allowed a favorable long-term outcome of Chiari I malformation.

Systematic Review of Photodynamic Therapy in Gliomas.

Over the last 20 years, gliomas have made up over 89% of malignant CNS tumor cases in the American population (NIH SEER). Within this, glioblastoma is the most common subtype, comprising 57% of all glioma cases. Being highly aggressive, this deadly disease is known for its high genetic and phenotypic heterogeneity, rendering a complicated disease course. The current standard of care consists of maximally safe tumor resection concurrent with chemoradiotherapy. However, despite advances in technology and therapeutic modalities, rates of disease recurrence are still high and survivability remains low. Given the delicate nature of the tumor location, remaining margins following resection often initiate disease recurrence. Photodynamic therapy (PDT) is a therapeutic modality that, following the administration of a non-toxic photosensitizer, induces tumor-specific anti-cancer effects after localized, wavelength-specific illumination. Its effect against malignant glioma has been studied extensively over the last 30 years, in pre-clinical and clinical trials. Here, we provide a comprehensive review of the three generations of photosensitizers alongside their mechanisms of action, limitations, and future directions.

Let’s Get That Bread Clip: Mechanical or Malignant Large Bowel Obstruction?

A 60-year-old female presented with symptoms consistent with a large bowel obstruction (LBO). Following confirmation of LBO using imaging, she progressed to a laparotomy which potentially revealed a large rectosigmoid tumor with surrounding adhesions, deemed unresectable. The postoperative course was complicated by an enterocutaneous fistula. She was transferred to a tertiary center and underwent a repeat laparotomy which revealed a large fibrotic mass associated with an intra-luminal bread clip (expiry date 2002). This case report details the interesting causative nature of this LBO and the subsequent surgical management, and complicated postoperative course.

ACUTE KERATOUVEITIS WITH CORNEAL GRAFT MELTING AS A LATE COMPLICATION OF MILD CHEMICAL BURN POTENTIALLY ASSOCIATED WITH COVID-19 INFECTION: A CASE REPORT.

In this case report, we describe the course and treatment of a patient with chemical alkali burns of both eyes. This study reports the outcomes of an ocular alkali burn patient who became infected with COVID-19 and where severe keratouveitis with corneal graft melting and hypopyon occurred, ultimately resulting in evisceration of the eye. We report the case of a 35-year-old woman, after an alkali burn of both eyes. Complete re-epithelialization of both corneas occurred within three weeks. Due to this observation, we assumed a satisfactory healing prognosis. However, corneal lysis occurred in the left eye over time. Thecondition was managed, but subsequently severe keratouveitis with hypopyon and corneal lysis occurred in the left eye, apparently in connection with the COVID-19 infection, which ultimately led to the evisceration of the affected eye. In the case report, we describe the management of a mild chemical alkali burn of the right eye and a complicated moderate burn of the left eye with an alkaline chemical. Both eyes were completely healed within three weeks. However, the findings on the left eye became complicated, which ultimately led to the evisceration of the affected eye. The disease of COVID-19 could have contributed to the deterioration of the findings on the cornea, or it could have just been a coincidence of two diseases, with the keratouveitis having a serious course due to the previous difficult course of healing and many complications after the chemical burn.

Intractable complicated course of tricuspid valve infective endocarditis due to non-compliance of treatment with clinical guidelines with a decisive role of molecular biological study in etiological diagnosis: a case report

A clinical observation of the treatment non-compliance consequences with clinical guidelines and principles of empirical therapy selection in a female patient with intravenous drug abuse, viral hepatitis C and HIV infection, with a history of a COVID-19 and the development of uncontrolled staphylococcal infective endocarditis (IE) of the tricuspid valve, complicated recurrence of early prosthetic IE is presented. Successful treatment was achieved only by a combination of tricuspid valve replacement and the appointment of etiotropic therapy for S. aureus (MSSA). The typical clinical scenario was not accompanied by the choice of adequate empirical antibiotic therapy, despite the high suspicion of association with MSSA, which determined the complicated course of IE. Only the polymerase chain reaction of the heart valve tissue played a key role in the etiological diagnosis. The use of valve tissue polymerase chain reaction in addition to traditional microbiological methods is a valuable diagnostic study.

Changes in Functional Outcomes After an Inpatient Rehabilitation Program for Solid-Organ Transplant Recipients.

Introduction: Outpatient exercise training has been shown to be beneficial for solid organ transplant recipients. Little is known about the effects of inpatient rehabilitation programs for recipients with a more complicated postoperative course. Research Question: This study was designed to (1) describe the changes in functional outcomes after an inpatient rehabilitation program, and (2) determine whether the changes in lower body strength and quadriceps strength are associated with changes in functional exercise capacity. Design: This was a single-arm prospective longitudinal study. The recipients participated in an inpatient rehabilitation program twice a day, 7 days a week for 3 to 4 weeks. Outcome Measures Included: 2-Minute Walking Test, Timed Up and Go, Berg Balance Scale, 30-Second Sit to Stand, biceps and quadriceps strength, Functional Independence Measure, SF-36, and Canadian Occupational Performance Measure. Results: Twenty-eight patients (54% female, mean age = 55 [11]) completed the study. Participants were mostly liver (42%) and lung recipients (35%). There were statistically significant improvements in all outcomes after the intervention. There was no relationship between changes in functional exercise capacity and quadriceps strength or lower body strength. Conclusion: An inpatient rehabilitation program may improve several functional outcomes and health-related quality of life in transplant recipients with a complicated postoperative course.

Chronic duodenal obstruction complicated by the course of chronic pancreatitis

The annular pancreas (CPJ) is mainly considered in pediatric surgical practice as a pathology of the newborn period, manifested by a picture of duodenal obstruction and having the potential for complete cure. Nevertheless, during the course of life, patients with this defect may develop complications such as chronic pancreatitis, peptic ulcer, pancreatic tumors, changes in the biliary tract, etc., which develop in adulthood and often cause complications and deaths. There are very few descriptions of such complications in children in the available literature, and therefore, we want to provide a clinical case of an 8-year-old boy with a complicated course of CPJ.

Contribution of intergenic interactions of polymorphic variants of candidate genes to the development of gastric ulcer

Introduction: Gastric ulcer is a chronic disease with a recurrent course. The morphological substrate during periods of exacerbation are ulcers of the gastric mucosa. Peptic ulcer disease has a high prevalence among the adult population and is often characterized by a complicated course. Hereditary predisposition, along with other external and internal risk factors, plays a role in the etiopathogenesis of the disease. The aim of the study: To evaluate the effect of polymorphic variants of cell adhesion molecule genes on the development of Helicobacter pylori-negative gastric ulcer (GU). Materials and methods: 119 patients with Helicobacter pylori-negative GU and 347 individuals of the control group were examined. The regulatory potential of 7 polymorphic loci of genes of cell adhesion molecules pathogenetically significant for the development of gastric ulcer (rs6136 of the SELP gene, rs8176720, rs2519093, rs507666 of the ABO gene, rs651007, rs579459, rs649129 of the ABO/RF00019 gene) was evaluated using the HaploReg v4.1, PolyPhen-2, GTEx Portal Internet resources. DNA samples isolated from peripheral blood were genotyped by PCR. The analysis of associations was carried out by the method of logistic regression in the framework of allelic, additive, dominant and recessive genetic models. Results: The T allele of the RF00019/ABO gene (rs651007) is a protective factor in the development of H. pylori-negative GU (OR=0.14). This polymorphism is located in the region of histones marking promoters, regions of hypersensitivity to DNAse and the HNF4 regulatory motif, is associated with the expression of the ABO and SURF1 genes and alternative splicing of the ABO and LCN1P1 genes in various organs (tissues), including in the organs of the digestive and nervous systems.

Lateral ventricle subependymoma resected with a transcallosal approach: illustrative case.

Subependymomas are World Health Organization grade I tumors, and 30% occur in the lateral ventricles. Surgery is the mainstay of treatment, and the transcallosal or transcortical/transsulcal approaches are preferred for those tumors occurring near the foramen of Monro or atrium. Visualization, proximity to the fornix and basal ganglia, hydrocephalus, and brain retraction during surgery make these operations challenging. The authors present the case of a 65-year-old male with a subependymoma located in the left lateral ventricle. The tumor was completely resected using an interhemispheric/transcallosal approach. The authors analyze the anatomopathological features of subependymoma, along with the clinical behavior and therapeutic options. The authors discuss in detail the advantages and disadvantages of the interhemispheric/transcallosal approach for resection of these tumors. Subependymomas are slow-growing lesions with an indolent yet complicated course making surgical removal challenging yet feasible using the correct techniques. The interhemispheric transcallosal approach offers an excellent route for the resection of large subependymomas, but there is still a significant risk for postoperative complications.

Management of Donor Site Wounds after Autodermoplasty

Introduction. Autodermoplasty with split autodermografts is the major option for surgical treatment of deep burns, and it requires management of donor site wounds in the postoperative period. There is no consensus on the most optimal dressing for the treatment of donor site wounds. The main requirements for such dressings are the simplicity and availability of application.The aim of the study was to analyse the effectiveness of diverse dressings applied for donor site wound management and to select the most optimal one.Methods. The study included 143 patients with deep burns. The authors analysed the effectiveness of diverse dressings applied for donor site wound management.Results. Application of diverse synthetic and biological dressings for donor site wound management resulted in the reduction in epithelialization by 1-3 days compared to conventional wet-drying gauze dressings with antiseptics; however, a complicated course of the wound process with accumulated wound discharge and suppuration was registered more often in these cases. All patients reported about moderate pain, especially in the first days after surgery, regardless of the type of dressings applied. The terms of complete donor site wound healing were almost the same in the compared groups and ranged from 14 to 18 days. This was evidenced by repeated harvesting of autodermal grafts from the donor site, the fact being an objective criterion for wound healing.Conclusion. It is recommended to treat donor site wounds resulted from split autodermal grafting using single application of a gauze dressing impregnated with antiseptic solutions. It is reasonable to treat donor site wounds limited in area with hydrocolloid dressings.

Impact of diabetes on COVID-19 patient health outcomes in a vulnerable racial minority community.

Diabetes is a growing health concern in the United States and especially New York City. New York City subsequently became an epicenter for the coronavirus pandemic in the Spring of 2020. Previous studies suggest that diabetes is a risk factor for adverse outcomes in COVID-19. To investigate the association between diabetes and COVID-19 outcomes as well as assess other covariates that may impact health outcomes. Retrospective cohort study of COVID-19 hospitalized patients from March to May, 2020. In total, 1805 patients were tested for COVID-19 and 778 tested positive for COVID-19. Patients were categorized into 2 groups: diabetes (measured by an Hba1c >6.5 or had a history of diabetes) and those without diabetes. After controlling for other comorbidities, diabetes was associated with increased risk of mortality (aRR = 1.28, 95% CI 1.03-1.57, p = 0.0231) and discharge to tertiary care centers (aRR = 1.69, 95% CI 1.04-2.77, p = 0.036). compared to non-diabetes. Age and coronary artery disease (CAD) increased the risk of mortality among diabetic patients compared to patients with diabetes alone without CAD or advanced age. The diabetes cohort had more patients with resolving acute respiratory failure (62.2%), acute kidney injury secondary to COVID-19 (49.0%) and sepsis secondary to COVID-19 (30.1%). This investigation found that COVID-19 patients with diabetes had increased mortality, multiple complications at discharge, and increased rates of admission to a tertiary care center than those without diabetes suggesting a more severe and complicated disease course that required additional services at time of discharge.

Complicated course of solitary kidney cysts in patients with a new coronavirus infection

Complicated course of solitary kidney cysts in patients with a new coronavirus infection

Mathematical model for assessing the prognostic significance of 25(OH)D deficiency in the progression of diabetic retinopathy in type 2 diabetes patients

Background. In modern medicine, modeling of pathological processes is actively implementing in clinical endocrinology and ophthalmology. This process provides an opportunity to predict the risk of occurrence, course, prognosis and development of complications of type 2 diabetes mellitus (T2DM), in particular diabetic retinopathy (DR). Nowadays, special attention is paid to the course of DR against the background of vitamin D deficiency. But in the scientific literature, there are no mathematical models for assessing the risk of DM progression in patients with type 2 diabetes against the background of vitamin D deficiency. Aim of the study is to develop an adequate mathematical model for assessing the prognostic significance of 25(OH)D deficiency in the progression of diabetic retinopathy in patients with type 2 diabetes. Materials and methods. An open observational single-center one-stage selective study was conducted. It was approved by the Local Ethics Committee. Seventy-one patients (138 eyes) with T2DM and DR (men and women; mean age 61.9 ± 2.4 years; mean HbA1c 8.12 ± 0.91 %) were divided into 3 groups, based on the stage of DR (according to fundus instrumental examination). The inclusion of patients in groups with DR was carried out in accordance with the ETDRS protocol (2019). Statistical processing included ANOVA, MANOVA and regression analysis with the construction of logistic regression models. Results. A statistically significant (p &lt; 0.001) decrease in the risk of a high degree of DR was found with an increasing concentration of 25(OH)D in the blood plasma for each 1 ng/ml (odds ratio = 0.46 (0.32–0.67)). The pseudocorrelation index (Nagelkerke) R2 is 0.54, area under a receiver operating characteristic curve is 0.92 (95% confidence interval (CI) 0.85–0.97), which indicates the presence of a strong relationship between the risk of a high degree of DR and the concentration of 25(OH)D in the blood, gender and HbA1c level. The obtained multifactorial model was represented by the appropriate mathematical formula. The sensitivity (according to the Youden index) of the obtained logistic regression model is 84.4 % (95% CI 73.1–92.2), specificity is 92.3% (95% CI 74.9–99.1). Conclusions. An adequate mathematical model of logistic regression was developed to assess the prognostic significance of total vitamin D deficiency in the progression of DR in patients with T2DM. Its prognostic significance is 96.4 % (95% CI 87.7–99.0).