Decompensated Type Research Articles

Pathogenetic and clinical rationale for syntropic pathology based on metabolic syndrome, coronary heart disease and type 2 diabetes mellitus

Pathogenetic and clinical rationale for syntropic pathology based on metabolic syndrome, coronary heart disease and type 2 diabetes mellitus

Evaluation of chronic idiopathic tinnitus and its psychosocial triggers.

The tinnitus susceptibility patterns in relation to different psychological and life stressors are unknown in different cultures. To determine the comorbid psychosocial factors and behaviors associated with tinnitus and the predictors for the increase in its severity. Participants were 230 adults (males = 70; females = 160; mean age = 38.6 ± 3.3). They underwent audiograms, speech discrimination and masking testing, and neuropsychiatric evaluation. Measures used for assessment included tinnitus handicap inventory, depression anxiety stress scale 21 (DASS-21), perceived stress scale (PSS), and insomnia severity index (ISI). Patients had mean duration of tinnitus of 11.5 ± 2.5 mo. They had intact hearing perception at 250-8000 Hz and 95 (41.3%) had aggravation of tinnitus loudness by masking noise. Decompensated tinnitus was reported in 77% (n = 177). The majority had clinically significant insomnia (81.3%), somatic symptoms (75%) other than tinnitus and perceived moderate (46.1%) and high (44.3%) stress to tinnitus. The severe/extremely severe symptoms of depression, anxiety and stress were reported in 17.4%, 35.7% and 44.3%, respectively. Patients with decom-pensated type had significantly higher scores for ISI (P = 0.001) and DASS-21 (depression = 0.02, anxiety = 0.01, stress = 0.001) compared to those with compensated tinnitus. Psychiatric interviewing showed that 35.7% had non-specific anxiety disorder, 17.4% had major depression, and 19.6% fulfilled the criteria of somatization disorder. Multivariate analysis showed that the only independent predictors for tinnitus severity were the duration of tinnitus [odd ratios (OR) = 0.832, 95%CI: 0.640-1.158; P = 0.001] and PSS (OR = 0.835, 95%CI: 0.540-1.125; P = 0.001) scores. To the best of our knowledge, this is the first study in our culture to evaluate the causal relationship between psychological factors and tinnitus onset, severity and persistence. Tinnitus could be the earliest and dominant somatic symptom induced by life stressors and psychological vulnerabilities. Therefore, multidisciplinary consultation (psychologists, psychiatrists, and neurologists) is important to acknowledge among the audiologists and otolaryngologists who primarily consult patients.

Effectiveness and safety of a modified short-term regimen of antimycobacterial therapy to treat rifampicin-resistant tuberculosis in elderly patients with concomitant diabetes (a clinical case)

Aim. To analyze the effectiveness and safety of a modified short-term regimen (mSTR) of antimycobacterial therapy (AMBT) for rifampicin-resistant tuberculosis (RR-TB) in a 71-year-old patient with type 2 diabetes mellitus (T2DM) on the clinical case example of own observation. Materials and methods. A clinical case from own observation of the patient who was treated at the clinical base of the Department of Phthisiology and Pulmonology of Zaporizhzhia State Medical University – Pulmonary Tuberculosis Department No. 2 of the Communal Non-profit Organization “Zaporizhzhia Regional Phthisio-Pulmonology Clinical Treatment and Diagnostic Center” is presented. Results. The presented case demonstrates the high safety and efficacy of all oral mSTR, including Lfx-Bdq-Lzd-Cfz-Cs, in the elderly person with RR-TB and concomitant decompensated T2DM who was smear-negative after 4 months as a result of treatment with 9-month mSTR AMBT (Lfx, Bdq, Lzd, Cfz, Сs). Positive radiological dynamics were observed all the time and residual changes in the lungs after tuberculosis were diagnosed at the end of the treatment course. These results complement indications for the use of mSTR, including Lfx-Bdq-Lzd-Cfz-Cs, in RR-TB patients. Conclusions. mSTR AMBT (Lfx, Bdq, Lzd, Cfz, Сs) is effective and safe in elderly patients with RR-TB and concomitant decompensated type 2 diabetes mellitus when adequate treatment of diabetes and timely correction of antimycobacterial drug side effects are undertaken.

Persistent hyperlactatemia in decompensated type I diabetes with hepatic glycogenosis and hepatomegaly: Mauriac syndrome: a case report

BackgroundWe describe a case of Mauriac syndrome, which is a rare complication of poorly controlled type I diabetes that combines glycogenosis, hepatomegaly, growth retardation with a Cushingoid appearance that is most often present in children but also in young adults. Here we also describe another finding with this syndrome, which is hyperlactatemia.Case presentationThe case is of a 16-year-old female of North African ethnicity with history of poorly controlled type I diabetes who was brought to the emergency department for dyspnea and tachycardia, treated initially for diabetic ketoacidosis. Her persistent hyperlactatemia helped to reveal a more subtle condition known as Mauriac syndrome after multiple examinations and follow-up.ConclusionsThis case reports shows that Mauriac syndrome is a rare condition that should be considered in a setting of poorly controlled type I diabetes, hepatomegaly, Cushingoid appearance, and hyperlactatemia. The current treatment of this condition is a strict control of blood glucose levels with an attempt to achieve an acceptable glycated hemoglobin value.

The role of the psychoemotional stress during gestation in the development of obstetrical and perinatal patology

The complex investigation of the perinatal pathology at acute and c/1,1-onic psyclioemotliional stress dunng gestation has been perf 01 wed. Jt was sliown (by tlie metliod of the retrospective analyses) the inaease in the relat-ive 1-isf of tlie premature delivery (1,4-8,0), severe and mild gestosis (3,0-10,0), placental pathology (2,2-3,3 ), anomalies of delivery (2,0-7,0 ), obstetlical Blending (2,0- 2,8 ), late delivery (2,0-7,0) dunng the acute stress. The relationship between tlie pelinatal patology and gestation term was shown dunng the acute stress. Dm'ing- i-lie clironic stress tlie frequency and seventy of pennatal patliology is dependent upon the type of psyclioemotional reaction on the st-ress. The seventy of patliofog-y is more prominent at decompensated type of psychological reaction t-lian at subcompensated type. Tlie newbom infants of motlias witli psyclioemotional stress recuired long rehabilitation in 39,2-50,0% cases.

Clinical features of post-COVID-19 period. Results of the international register “Dynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARS-CoV-2)”. Data from 6-month follow-up

Aim.To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register.Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months.Results.According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure.Conclusion.According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period.

Діагностична та прогностична цінність гормональних показників, ліпідного спектра таультрасонографічних параметрів міокарда приметаболічному синдромі, ускладненому хронічною ішемічною хворобою серця і цукровим діабетом 2-го типу

Актуальність. Синтропічна патологія, зумовлена поєднанням метаболічних і гормональних змін, призводить до розвитку ускладнень серцево-судинної патології як безпосередньої причини смертності та зменшення тривалості чи якості життя населення. Щодо ролі гормонів при даній комплексній патології слід зауважити, що не повністю доведена їх патогенетична і клінічна взаємозалежність та кореляція із морфофункціональними параметрами стану міокарда. Методологічні труднощі таких досліджень полягають у потребі аналізувати десятки лабораторно-клінічних показників у багатьох групах порівняння. Мета дослідження: встановити діагностичні маркери при метаболічному синдромі, а також їх взаємозалежність порівняно із синтропічною патологією, представленою хронічною ішемічною хворобою серця (ІХС) та цукровим діабетом (ЦД) 2-го типу. Матеріали та методи. У дослідження залучені 319 пацієнтів, розподілених на 6 груп. Першу групу становили 82 пацієнти з метаболічним синдромом (МС), другу— із МС та ЦД компенсованим (39 осіб), третю— із МС та ЦД декомпенсованим (35 осіб), четверту— 44 особи з МС та появою ІХС, п’яту— 44 хворі на ІХС та ЦД 2-го типу в стані компенсації, що виник на тлі МС, шосту — 75 пацієнтів з ІХС та ЦД 2-го типу в стані декомпенсації на тлі МС. У контрольну групу увійшли 40 практично здорових осіб (чоловіки— 17, жінки— 23). Результати. У жінок віком до 40 років із МС без ЦД 2-го типу при підвищеному рівні пролактину, кортизолу та тиреотропного гормона (ТТГ) діагноз ІХС об’єктивно не підтверджується. При цьому спостерігалися вже початкові зміни ліпідного обміну за рахунок підвищення рівня тригліцеридів та ліпопротеїнів дуже низької щільності. Поява ІХС на фоні МС (лише за умови відсутності ЦД 2-го типу) характеризується наближеними до контролю рівнями пролактину та кортизолу на фоні значного підвищення ТТГ у всіх пацієнтів незалежно від статі. У четвертій групі пацієнтів з ІХС на тлі МС високому значенню суми індексів (∑і) ліпідного спектра відповідає найнижчий показник суми індексів гормонів. Для шостої групи з ІХС у поєднанні з декомпенсованим ЦД 2-го типу характерні найвищі показники ∑і як ліпідного обміну, так і гормонів. При поєднанні МС з ІХС та компенсованим ЦД 2-го типу рівні гормонів та ліпідів не відрізнялися від таких при МС з ІХС без ЦД 2-го типу. При МС, ускладненому декомпенсованим ЦД 2-го типу та ІХС, спостерігались підвищені рівні кортизолу і пролактину, при цьому рівень ТТГ був у нормі. Висновки. Установлено діагностичні маркери (гормональні показники, параметри ліпідного спектра й ультрасонографічні параметри міокарда) при МС, а також виявлено їх взаємозалежність порівняно із синтропічною патологією, представленою ІХС та ЦД 2-го типу.

Hemichorea-Hemiballismus as an Unusual Presentation of Hyperosmolar Hyperglycemic Syndrome

Diabetes mellitus can lead to a diverse array of systemic complications. Poorly managed hyperglycemia can result in serious neurological consequences ranging from peripheral neuropathy to seizures and coma. A rare neurologic disorder seen in acute decompensated type 2 diabetes mellitus (T2DM) is hemichorea-hemiballismus (HCHB). HCHB is a movement disorder primarily associated with cerebrovascular accidents of infarct or hemorrhagic origin. It is a condition that can occur in a diabetic patient, especially when no other signs or symptoms of hyperglycemia are present. It is urgent to recognize HCHB movement disorder quickly as it may be the only presenting sign of hyperglycemia and can alert medical personnel to a possible hyperosmolar hyperglycemic state (HHS). We report an unusual case of HCHB in a patient with HHS, whose only presenting sign was unilateral hyperkinesis, which completely resolved after adequate blood glucose control. Prompt treatment and management of hyperglycemia yields an excellent prognosis in HCHB.

Effects of Bariatric Surgeries on the Size of Myocardial Infarction and Ghrelin Level in Rats with Experimental Decompensated Type 2 Diabetes Mellitus

The effects of bariatric surgeries (sleeve gastrectomy and ileal transposition) on the dynamics of changes in ghrelin level were studied in rats with severe decompensated type 2 diabetes mellitus under conditions of glucose challenge as well as on the size of myocardial infarction in these animals. Diabetes was modelled by high fat diet and a single administration of streptozotocin (25 mg/kg, intraperitoneally). Both bariatric surgeries significantly decreased glucose-induced ghrelin level in the blood of rats with type 2 diabetes mellitus, which attested to an increase in the tissue sensitivity to ghrelin. Sleeve gastrectomy resulted in a decrease in the size of myocardial infarction in diabetic rats, which was calculated as the ratio of the necrosis zone to the zone of the risk of myocardial infarction. Ileal transposition had no effect on this parameter. Our data can be used as the basis for optimization of treatment approaches when using bariatric surgery in the treatment of patients with severe forms of type 2 diabetes mellitus with a high risk of cardiovascular diseases.

Russian federal clinical guidelines on the diagnostics, treatment, and prevention of osteoporosis

Screening using the Fracture Risk Assessment Tool (FRAX) is recommended in all postmenopausal woman and mеn over 50 (A1) in order to identify individuals with high probability of fractures. It is recommended to diagnose osteoporosis and start treatment in patients with fragility fracture of large bones of the skeleton and/or high individual probability of major fragility fractures (FRAX) and/or detected decrease in bone mineral density (BMD) up to –2.5 T-score as assessed by DXA in the femoral neck and/or lumbar vertebrae (A1). Patients with back pain, lifetime height loss of 4 cm or height loss of 2 cm since a previous medical examination, those who receive glucocorticoids, patients with long lasting decompensated type 2 diabetes mellitus, or those receiving insulin therapy, as well as patients who were previously diagnosed with fragility fractures at the other sites are advised to underwent standard lateral X-ray imaging of the spine (Th4—L5) in order to verify the presence of compression vertebral fractures (B1).
 Dual-energy X-ray absorptiometry (DXA) is recommended for individuals whose 10-year probability of major osteoporotic fracture (FRAX) falls within the medium risk group (B1). It is recommended to include the trabecular bone score (TBS) the FRAX algorithm in order to improve the sensitivity of this method (B1).
 Laboratory testing is recommended for the differential diagnosis with other causes of increased skeletal fragility in all patients with newly diagnosed osteoporosis and when previously prescribed antiosteoporostic treatment was ineffective (B1).
 Bisphosphonates (BPs), antibodies to receptor activator of nuclear factor kappa-beta ligand (RANKL) (denosumab), or parathyroid hormone analogue (teriparatide) are equally recommended to prevent fragility fractures and increase BMD in patients with osteoporosis (A1). Denosumab is also recommended to prevent BMD loss and fractures in females receiving aromatase inhibitors therapy for breast cancer and males with prostate cancer receiving hormone-deprivation therapy and having no bone metastases (A1). Since teriparatide has the anabolic effect, it is recommended as the first line treatment in patients with severe osteoporosis having history of vertebral fractures, in the individuals with very high risk of fragility fractures, or in the cases when antiresorptive treatment was ineffective (B1). All medications for treatment of osteoporosis are recommended in combination with calcium and vitamin D supplements (A1).

Salivary protective factors in patients suffering from decompensated type 2 diabetes

PurposeDefining the level of protective factors in saliva of patients suffering from decompensated type 2 diabetes. Material and methods50 Patients with diagnosis of decompensated type 2 diabetes, including 32 women and 18 men at the age of 57.9±9.2 years. The control group consisted of 50 people among whom there were 38 women and 12 men whose average age was estimated at 51.2±9.9 years. ResultsIt was stated the increased concentration of total protein by 60% and decreased concentration of IgA by 70%, of lysozyme by 27% and of lactoferrin by 40% in resting saliva of patients with type 2 diabetes if compared to the control group. These outcomes were really statistically meaningful. The evaluation of dependences between the analyzed protective factors and the indicator of oral cavity condition proved the positive correlation between the concentration of total protein and the number of DMFT (i.e. the rate of caries intensity). The remaining coefficients of correlation being evaluated proved to be negative and statistically meaningless. ConclusionThe obtained outcomes prove a high influence of proteins included in saliva on the prevalence and development of caries at patients with decompensated type 2 diabetes.

Sitagliptin versus saxagliptin in decompensated type 2 diabetes mellitus patients

Sitagliptin and saxagliptin are oral hypoglycemic agents inhibitors of DPP-4, indicated in the treatment of type 2 diabetes mellitus in combination with metformin, in patients who have not achieved adequate glycemic control. In our study we enrolled 128 decompensated type 2 diabetes patients while on metformin maximum dosage. At time 0’ we have detected, body mass index (BMI), total cholesterol, high- and low-density lipoproteins (HDL and LDL), triglycerides, transaminases and pancreatic amylase; patients were randomized to receive sitagliptin or saxagliptin; follow-up was performed after 4 months with the revaluation of the same variables and adverse events. In both sitagliptin and saxagliptin groups we observed a significant reduction in fasting glucose, glycated hemoglobin, weighing, BMI, triglycerides, while the reduction in total cholesterol, LDL cholesterol did not reach statistical significance. There was no suspension of therapy, adverse events appeared minor and temporary. In conclusion, our observations highlight the almost identical efficacy of sitagliptin and saxagliptin. These data reinforce even more the idea that we should think about this class of drugs as the next step in patients failing therapy with metformin.

Helicobacter pylori is not the predominant etiology for liver cirrhosis patients with peptic ulcer disease

Patients with liver cirrhosis (LC) often develop peptic ulcers. The differentiation of Helicobacter pylori etiology in LC patients from that of peptic ulcers in non-LC patients is critical. This study aimed to determine whether H. pylori plays a central role in LC patients with peptic ulcers. LC was defined by International Classifications of Diseases, Revision 9, and Clinical Modification (ICD-9-CM) codes 571.2, 571.5, and 571.6. To be defined as non-LC, we did not identify patients in an inpatient setting or by one or more ambulatory care claims containing the International Classifications of Diseases, Revision 9, and Clinical Modification codes 571.2, 571.5, and 571.6. The sample included 9465 H. pylori-positive patients and 3418 H. pylori-negative patients. A logistic regression model was used to calculate the odds ratio (OR) and a 95% confidence interval was used to determine whether LC was an independent factor of lower H. pylori infection rates in peptic ulcer patients. This study included 102 decompensated LC patients with peptic ulcers, 39 H. pylori-positive and 63 H. pylori-negative. There were 360 compensated LC patients with peptic ulcers, 193 H. pylori-positive and 167 H. pylori-negative. Among the non-LC patients with peptic ulcers, 9233 were H. pylori-positive and 3188 were H. pylori-negative. On the basis of logistic regression analysis, decompensated LC patients (OR=0.23, P<0.001) and compensated LC patients (OR=0.48, P<0.001) had lower H. pylori infection rates. H. pylori is not the predominant etiology for LC, especially the decompensated type, either with peptic ulcer disease or with recurrent ulcer disease.

Should we be giving high concentration oxygen to all patients treated in an ambulance?

Oxygen is one of the most widely used drugs. It is important to recognise that oxygen administration carries risks as well as benefits. While adequate oxygen saturation of arterial blood is an important factor in tissue oxygen delivery, oxygen administration to patients with chronic obstructive pulmonary disease can lead to decompensated type II respiratory failure. In this debate, Dr Lavery makes the case that high concentration oxygen should be given to all patients treated in an ambulance, while Professor Corris argues against this position.

Survival and quality of life for patients with COPD or asthma admitted to intensive care in a UK multicentre cohort: the COPD and Asthma Outcome Study (CAOS)

Background:Non-invasive ventilation is first-line treatment for patients with acutely decompensated chronic obstructive pulmonary disease (COPD), but endotracheal intubation, involving admission to an intensive care unit, may sometimes be required. Decisions...

Virusassoziierte hämorrhagische Kolitis als Differentialdiagnose der perakuten Enddarmblutung

Severe anal bleeding together with increasing abdominal discomfort occurred in an 81-year-old woman previously hospitalized numerous times because of decompensated type II B diabetes. A suspected rectal cancer was excluded by biopsy from the lower to middle rectum, but the biopsy revealed histologically indurated and bleeding ulcerations. Typical nuclear inclusion bodies provided the diagnosis of virus-associated proctocolitis. Serological tests supported the diagnosis of infection with herpes simplex and cytomegalic virus. Laser coagulation stopped the bleeding. At the same time a Guillain-Barré syndrome was noted which improved after administration of cortisone and high parenteral doses of acyclovir.

Doppler diagnostic study of the functional status of cerebral Circulation in lacunar infarcts and arterial hypertension

Seventy five patients with lacunar infarcts (LI) in the presence of arterial hypertension (AH), 40 patients with AH without signs of lacunar syndromes, and 25 apparently healthy individuals were examined to study the functional status of cerebral circulation in LI and AH. The site and sixes of ischemic foci were specified by the results of brain computed tomography. The functional status of cerebral circulation was evaluated by Doppler transcranial evidence, by using the compression test. There was a reduction in the linear blood flow velocity (LBFV) in the middle cerebral arteries (MCA) and an increase in the pulsation index in the group of patients with LI as compared with the controls. The autoregulation reserve estimated by the overshoot coefficient was preserved in all the examinees. The greatest differences between groups were found in estimating the reserves of col lateral circulation (CC). The signs of decompensated CC were considered to be a less than 23,4 cm/sec decrease in LBFV in the MCA during compression of the common carotid artery (V 2 ). a greater than 10,8 sec increase in the recovery time of the baseline LBFV after compression (T), discriminant equation values more than 0,728 at D = 0.186 x T — 0,102 x V 2 + 1,116. The decompensated type of CC was revealed in 67.556 of the patients with LI versus 17,5 % of those with AH and 8 % in the control group. It is suggested that decompensated CC detected by the compression serves as a marker of the parallel development of angiopathy of connective and perforating arteries and as the background for LI development.

Alcoholic ketoacidosis associated with hyperglycaemia: A diagnostic dilemma

AbstractThe acute presentation of alcoholic ketoacidosis accompanied by hyperglycaemia is rare, but it may lead to the misdiagnosis of metabolically decompensated Type 1 (insulin‐dependent) diabetes and to inadvertent treatment with insulin. A case of alcoholic ketoacidosis is described in which recent excessive alcohol consumption was concealed by the patient, which resulted in a diagnosis of diabetic ketoacidosis. The blood glucose concentration in alcoholic ketoacidosis may be determined by the extent to which endogenous insulin secretion is suppressed and the extent of the peripheral insulin resistance induced by alcohol and the concomitant secretion of counter‐regulatory hormones.