Development Of Further Complications Research Articles

Chronic otorrhea and osteomyelitis of the external auditory canal by Achromobacter xylosoxidans: an uncommon diagnosis

PurposeAchromobacter xylosoxidans is an emerging pathogen mainly associated with resistant nosocomial infections. This bacteria had been isolated in the ear together with other pathogens in cultures from patients with chronic otitis media, but it had never been reported as a cause of osteomyelitis of the external auditory canal.Case presentationWe present a unique case of a healthy 81-year-old woman who presented with left chronic otorrhea refractory to topical and oral antibiotic treatment. Otomicroscopy revealed an erythematous and exudative external auditory canal (EAC) with scant otorrhea. The tympanic membrane was intact, but an area of bone remodeling with a small cavity anterior and inferior to the bony tympanic frame was observed. Otic culture isolated multi-drug-resistant A. xylosoxidans, only sensitive to meropenem and cotrimoxazole. Temporal bone computed tomography showed an excavation of the floor of the EAC compatible with osteomyelitis. Targeted antibiotherapy for 12 weeks was conducted, with subsequent resolution of symptoms and no progression of the bone erosion.ConclusionsAtypical pathogens such as A. xylosoxidans can be the cause of chronic otitis externa. Early diagnosis and specific antibiotherapy can prevent the development of further complications, such as osteomyelitis. In these cases, otic cultures play an essential role to identify the causal germ. This is the first case of EAC osteomyelitis due to A. xylosoxidans reported to date.

Intelligent diagnostic model for malaria parasite detection and classification using imperative inception-based capsule neural networks

Malaria is an acute fever sickness caused by the Plasmodium parasite and spread by infected Anopheles female mosquitoes. It causes catastrophic illness if left untreated for an extended period, and delaying exact treatment might result in the development of further complications. The most prevalent method now available for detecting malaria is the microscope. Under a microscope, blood smears are typically examined for malaria diagnosis. Despite its advantages, this method is time-consuming, subjective, and requires highly skilled personnel. Therefore, an automated malaria diagnosis system is imperative for ensuring accurate and efficient treatment. This research develops an innovative approach utilizing an urgent, inception-based capsule network to distinguish parasitized and uninfected cells from microscopic images. This diagnostic model incorporates neural networks based on Inception and Imperative Capsule networks. The inception block extracts rich characteristics from images of malaria cells using a pre-trained model, such as Inception V3, which facilitates efficient representation learning. Subsequently, the dynamic imperative capsule neural network detects malaria parasites in microscopic images by classifying them into parasitized and healthy cells, enabling the detection of malaria parasites. The experiment results demonstrate a significant improvement in malaria parasite recognition. Compared to traditional manual microscopy, the proposed system is more accurate and faster. Finally, this study demonstrates the need to provide robust and efficient diagnostic solutions by leveraging state-of-the-art technologies to combat malaria.

Retained stone retrieval basket causing chronic pancreatitis: a case report.

Endoscopic retrograde cholangiopancreatography is a common procedure performed for choledocholithiasis and gallstone pancreatitis. Although a relatively low risk procedure, it is not without its complications. Cases of impacted Dormia baskets during stone retrieval have been reported, but these are usually retrieved surgically during the same setting. A 40-year-old man presented to our hospital with an episode of epigastric pain and discomfort. He has a prior background of recurrent episodes of pancreatitis of which he underwent prior endoscopic therapy in his home country. Initial investigations revealed a metallic object seen on abdominal x-ray, computer tomographic scan of the abdomen and pelvis, and magnetic resonance imaging of the pancreas. Further evaluation was done with endoscopy, which revealed a retained stone extraction basket from a previous endoscopic retrograde pancreatography, resulting in recurrent episodes of acute chronic pancreatitis. Although the retained foreign body was removed, he subsequently developed further complications of portal vein thrombosis as a result of recurrent acute chronic pancreatitis, which required anticoagulation. This case highlights the importance of retrieving any foreign body from the pancreas, especially on the head, to prevent the development of further complications.

STUDY OF PREDICTION AND CLASSIFICATION MODELS IN THE PROBLEMS OF DIABETES AMONG PATIENTS WITH A STROKE IN DIFFERENT LIVING CONDITIONS

The subject of the study in the article is the methods of predicting the development of diabetes. Diabetes mellitus is a non-communicable disease that has affected 425 million people, and by 2045 the number will only increase by 1.5 times. It has been proven to be an independent contributing factor to stroke development. When there is too much sugar in the blood, it negatively affects the arteries and blood vessels. People with this disease are more likely to develop atherosclerotic plaques and blood clots, which can lead to heart blockage and ischemic stroke. Having diabetes increases the risk and worsens the course of a stroke. According to the Framingham Study, the number of recurrent cases doubles. The aim of the study is to investigate methods of predicting and classifying the development of diabetes among people, in particular stroke patients, to prevent the development of other diseases. The complexity of the problem lies in the fact that there are as many undiagnosed cases as diagnosed ones, so about half of people suffer from the disease and the resulting complications due to improper or delayed diagnosis. Therefore, timely diagnosis of a disease that is difficult to detect is important in order to prevent the development of further complications. The article solves the problem of a multi-criteria task of choosing the best algorithm for predicting the occurrence of a disease. The following methods are used in this paper: multilayer perceptron, k-nearest neighbors method, decision tree, and logistic regression. Nowadays, machine learning has begun to apply to similar problems. In the 1950s and 1960s, there were attempts to combine the approaches to creating neural networks that existed at the time, which made it possible to calculate quantitative descriptions of human intelligence, and memorize, analyze, and process information, which resembled the work of the human brain. Medicine is one of the main areas of human activity where various classifier and neural network algorithms are gaining popularity yearly. They are trendy in disease diagnostics. Results: the initial conditions for choosing the best model are met by logistic regression. Conclusions: as a result of the study, the optimal model for predicting the development of the disease was selected.

The effect of halogen-containing anesthetics on the indicators of the gas composition of the blood of horses

The aim of the work was to determine the parameters of the gas composition and acidbase state (CBS) of blood to assess the adequacy of general anesthesia of horses with halogen-containing anesthetics in clinical and instrumental studies. The object of the study was 18 horses aged four to six years, which were castrated. The paper compared the dynamics of blood gas composition indicators at various stages of inhalation anesthesia with fluorotane, isoflurane and sevoflurane in order to prevent and timely detect hypoxemia and hypercapnia in horses. Based on a comprehensive assessment of the clinical examination data, laboratory studies of the gas composition of arterial blood, objectively determine the severity of hypoxemia and hypercapnia, which made it possible to provide the necessary assistance to the animal in a timely manner. The study of blood gas composition indicators has established that the amount of carbon dioxide tension in arterial blood (РaСO2) with both types of anesthesia is subject to the greatest changes during induction and during awakening. During the induction period, it increased both with the inhalation of fluorotane and with the use of isoflurane and sevoflurane, respectively, by 41%, 3.1% and 3.4% compared to the initial values. During the period of awakening, the value of РaСO2 returned to the initial level with anesthesia with isoflurane, with anesthesia with sevoflurane and fluorotane remained above the initial values by 21.8% and 42.8%, respectively. Early detection of signs of hypoxemia and hypercapnia made it possible to avoid the development of further complications during general anesthesia in horses

Experience in the treatment of a primary infected kidney transplant

Introduction. Infectious complications contribute to a significant decrease in graft and recipient survival rates. The article describes a case report of transplantation of the primary infected kidney transplant. Material and methods. A 33-year-old patient with type 1 diabetes mellitus and end-stage renal disease underwent kidney transplantation. The deceased donor was a 46-year-old man with a confirmed brain death as a result of acute cerebrovascular accident. Results. The early postoperative period was complicated by the development of primary infection of kidney transplant. Despite the ongoing treatment aimed at preserving the transplant, we had to remove it in order to prevent the development of further complications. Conclusion. Kidney transplantation improves the quality of life of patients with end-stage renal disease. In case of uncontrolled course of the infectious process after primary infected graft transplantation, it is necessary to perform transplantectomy in a timely manner in order to save the recipient’s life, since the graft itself is the source of infection.

The first TIPS surgery performed in the Udmurt Republic in a young patient with secondary biliary cirrhosis

Treatment of patients with iatrogenic injuries of the biliary tract is the most difficult and important section in hepatobiliary surgery. When analyzing the causes, it was found that in 70–94 % of cases this type of injury is observed during cholecystectomy. We present a rare clinical case of the development of secondary biliary cirrhosis due to iatrogenic trauma of the biliary tract. This injury caused long-term suffering for the patient due to the further development of complications of cirrhosis, specifically of portal hypertension. The latter caused repeated recurrent profuse bleeding from varicose veins of the esophagus. The use of a minimally invasive transjugular intrahepatic portosystemic shunt procedure for the first time in the Udmurt Republic was of particular relevance in solving this problem. This procedure has become a key one in solving the abovementioned problems and will become the preventive measure for the cirrhosis progression in the future. It is also important to focus on prophylactic measures aimed at preventing iatrogenic injuries of the biliary tract, as this problem can cause irreversible complications. Prevention should include adequate examination and visualization of the bile ducts and gallbladder before surgery, their careful mobilization, compliance with the rules of operation with electrosurgical instruments, as well as the use of additional minimally invasive techniques such as choledoscopy, cholangiography and intraoperative ultrasound. Besides that, all manipulations should be carried out under strict control and clear visualization of instruments and anatomical structures of organs. The article provides a detailed description of the technique of transjugular intrahepatic portosystemic shunt surgery, as well as presents X-ray images obtained during this operation.

Features of diagnosis and course of acute appendicitis during the COVID-19 pandemic

This article provides a brief description of acute appendicitis, methods of its diagnosis, discusses typical clinical cases, examples of tactics for managing patients with acute appendicitis. The sequence of management of a patient with acute appendicitis, steps to a speedy recovery of the patient, including surgical interventions, his discharge with positive dynamics are summarized. Special attention is paid to the course and further development of complications of acute appendicitis during the COVID-19 pandemic. The need for timely treatment of the population for medical care is emphasized in order to avoid the development of complications (in particular, from acute conditions), for a qualitatively better prognosis and a speedy recovery in the postoperative period. Aim of the research : to identify possible complications and course of appendicitis in a pandemic coronavirus infection. Objectives : to study and analyze clinical cases in patients with appendicitis during a pandemic coronavirus infection. Materials and methods : clinical cases, case histories, educational literature. Conclusions : the course of acute appendicitis was accompanied by various complications that developed due to untimely medical care, due to the huge burden on the sphere of health protection of the Russian Federation. There was a tendency for the transition of acute appendicitis to peritonitis, abscess of the stump of the appendix, pilefl ebitis, due to coronavirus infection. Pathological activity of the immune system was also revealed in patients with appendicitis (lymphatic infi ltration of appendix tissues).

Repurposing benzbromarone as antifolate to develop novel antifungal therapy for Candida albicans.

Fungal infections in humans are responsible for mild to severe infections resulting in systemic effects that cause a large amount of mortality. Invasive fungal infections are having similar symptomatic effects to those of COVID-19. The COVID-19 patients are immunocompromised in nature and have a high probability of developing severe fungal infections, resulting in the development of further complications. The existing antifungal therapy has associated problems related to the development of drug resistance, being sub-potent in nature, and the presence of undesirable toxic effects. The fungal dihydrofolate reductase is an essential enzyme involved in the absorption of dietary folic acid and its conversion into tetrahydrofolate, which is a coenzyme required for the biosynthesis of the fungal nucleotides. Thus, in the current study, an attempt has been made to identify potential folate inhibitors of Candida albicans by a computational drug repurposing approach. Based upon the molecular docking simulation-based virtual screening followed by the molecular dynamic simulation of the macromolecular complex, benzbromarone has been identified as a potential anti-folate agent for the development of a novel therapy for the treatment of candidiasis.Supplementary informationThe online version contains supplementary material available at 10.1007/s00894-022-05185-w.

Obstetric and perinatal aspects of retrochorial hematomas

The problem of pregnancy loss has medico-social, scientific and practical significance. Almost 85% of pregnancy loss occur in the I trimester of gestation (up to 13 weeks), and 15% – II and III trimesters. One of the causes of bleeding in the I trimester of gestation is retrochorial hematoma (RCH) – the accumulation of blood in the retrochorial space due to partial detachment of the chorionic plate from the adjacent of decidua in a genetically normal embryo. The article provides an analysis of scientific publications that highlight the obstetric and perinatal aspects of the characteristics of RCH, the etiological features of their occurrence and important points of the treatment to avoid the development of further complications, the preservation and prolongation of pregnancy. The features of diagnostics and subsequent therapy to provide early support for pregnancy and reduce the incidence of gestational complications are considered. Ultrasound examination of the uterus is of the great prognostic importance in the diagnosis of RCH, which can identify the threatening signs of pregnancy associated with preterm birth, development of fetal growth retardation, placental abruption in the ІІ and ІІІ trimesters, low fetal birth weight. The data of modern researches indicate that the diagnosis of RCH in the presence of a living genetically normal embryo, the appointment of pathogenetic therapy based on gestagenic and antifibrinolytic therapy is the key for the success of treatment of this perinatal pathology, a significantly decreasing the rate of pregnancy losses and an improvement in the quality of gestational process. Today, obstetricians and gynecologists have a deal with the task to find new preclinical signs to predict possible complications of pregnancy and develop effective algorithms for prevention and treatment, which will prolong pregnancy with RCH and achieve positive perinatal outcomes.

Carbon monoxide poisoning: assessment, treatment, and outcomes

Many complications can occur secondary to carbon monoxide (CO), including serious complications to the cardiovascular system and neurological complications that might even end up with death. It has been estimated that around 30-40% of patients suffering from CO poisoning usually die before presenting at the emergency department. Accordingly, management of these patients is a critical approach to enhance the outcomes and prognosis of the affected patients. In the present literature review, we have discussed the current evidence regarding the assessment, treatment, and outcomes of patients with CO poisoning. Our results indicate that attending clinicians should adequately assess the suspected patients with their clinical manifestations, laboratory parameters, and history of exposure to CO. Besides, imaging techniques can also be indicated in some cases with a suspected brain injury. After the diagnosis has been successfully established, management of symptoms and administration of the validated therapeutic modalities should be rapidly performed to enhance the outcomes and intervene against the development of further complications. However, it should be noted that even after achieving adequate management, long-term complications might develop with the survivors and can even lead to death. Accordingly, further research is needed to help formulate successful interventions that can enhance the prognosis of the condition.

Фізична терапія дітей першого року життя з вродженою м’язовою кривошиєю

he article considers the peculiarities of the use of physical therapy in innate muscular torticollis in children of the first year of life. It was found that the most effective means of physical therapy for this age group of children with this pathology are kinesitherapy, massage, hydrokinesiotherapy and preformed physical factors. The peculiarities of the application of kinesitherapy and massage techniques depending on the side of the lesion are reflected. It is established that the above means are aimed at eliminating the deformation and preventing the development of further complications of the musculoskeletal system in children of the first year of life.

Association of Physical Activity with Lipid Profile in Healthy Subjects: A Cross Sectional Study in Tertiary Care Hospital from Central Rural India.

Context:Physical activity is an important factor for healthy aging, and lack of it has been associated with chronic noncommunicable diseases (NCDs). Research in sedentary behavior has indicated that it is an independent risk factor of morbidity and mortality, separate from lack of physical activity.Methods:This cross-sectional study was conducted in the department of medicine in a tertiary care hospital on apparently healthy relatives of patients without chronic NCDs. Metabolic equivalents of tasks (METs) were calculated by the global physical activity questionnaire (GPAQ).Statistical Analysis:We correlated the various parameters [age, sex, body mass index (BMI), waist-hip ratio (WHR), and lipid panel with METs] by Pearson correlation coefficient.Observations and Results:Total of 750 patients with a mean age of 42.55 ± 10.93 years were included, and 389 (51.9%) were male in the present study. In our study, a strong negative correlation was found between physical activity and BMI, moderate negative correlation between physical activity with triglycerides (TG), total cholesterol (TC), and WHR. There was a high degree of positive correlation between sedentary lifestyle (SLS) duration with BMI and TC. A moderate degree positive correlation was found between SLS duration and WHR, TG, and low-density lipoproteins (LDL).Conclusion:The clinician should be aware of various obesity indices, and it was found that lipid profile is inversely correlated with physical activity and directly correlated with SLS in healthy individuals. Lifestyle changes and exercise may reduce obesity and lipid disorders and thereby reduce further development of complications in those patients.

CYTOKINE RESISTIN IN METABOLIC AND CARDIOVASCULAR DISEASE.

The rise in metabolic syndromes is known to be the root cause of major cardiovascular diseases mainly Coronary Artery Disease (CAD) in India. A biological marker will thus help to determine the disease before its onset and help cure it at early stages, reducing the chances of development of further complications. There are various pro-inammatory markers (cytokines) which can be used to determine the onset of disease one such marker known is resistin. Resistin is known to be a pro-inammatory adipokine secreted mainly from Peripheral mononuclear cell (PMNC), bone marrow cells and macrophages in humans [1]. Inammatory response is generated due to rise in metabolic syndromes which in turn leads to the secretion of various cytokines. The levels of these cytokines released help in determining the severity of disease.

International Multi-Center Analysis of In-hospital Morbidity and Mortality of Low-Voltage Electrical Injuries.

Background : Patients with high- and low-voltage electrical injuries differ in their clinical presentation from minor symptoms to life-threatening conditions. For an adequate diagnosis and treatment strategy a multidisciplinary team is often needed, due to the heterogeneity of the clinical presentation. To minimize costs and medical resources, especially for patients with mild symptoms presenting after low-voltage electrical injuries, risk stratification for the development of further complications is needed.Methods : During 2012–2019 two independent patient cohorts admitted with electrical injuries in two maximum care university hospitals in Germany and Austria were investigated to quantify risk factors for prolonged treatment, the need of surgery and death in low-voltage injuries. High-voltage injuries were used as reference in the analysis of the low-voltage electrical injury.Results : We analyzed 239 admitted patients with low-voltage (75%; 276 ± 118 V), high-voltage (17%; 12.385 ± 28.896 V) or unclear voltage (8%). Overall mortality was 2% (N = 5) associated only with high-voltage injuries. Patients with low-voltage injuries presented with electrocution entry marks (63%), various neurological symptoms (31%), burn injuries (at least second degree) (23%), pain (27%), and cardiac symptoms (9%) including self-limiting thoracic pain and dysrhythmia without any therapeutic need. Seventy three percentage of patients with low-voltage injury were discharged within 24 h. The remaining patients stayed in the hospital (11 ± 10 days) for treatment of entry marks and burns, with an overall need for surgery of 12% in all low-voltage injuries.Conclusions : The only identified risk factors for prolonged hospital stay in patients with low-voltage electrical injuries were the treatment of burns and electric marks. In this multi-center analysis of hospitalized patients, low-voltage electrical injuries were not associated with cardiac arrhythmia or mortality. Therefore, we suggest that asymptomatic patients, without preexisting conditions, with low-voltage injury can be discharged after an initial check-up without prolonged monitoring.

Multiple Peri-Operative Complications are Associated with Reduced Long Term Amputation Free Survival Following Revascularisation for Lower Limb Peripheral Artery Disease: A Population Based Linked Data Study

To determine, in a population based linked data study, the relationship between peri-operative multiple complications and longer term outcomes, specifically the combined outcome of two year amputation or death, after lower limb revascularisation for peripheral artery disease (PAD). State wide health administrative data and death records were probabilistically linked for all patients who had lower limb artery surgery between 2010 and 2012 in New South Wales, Australia. Multivariable Cox regression modelled the impact of medical and surgical complications on the combined outcome of amputation or death two years after discharge. Open surgery was performed on 3004 patients (26.7%), and endovascular on 8263 (73.3%). Of the 10971 patients discharged alive, 3747 (34.1%) experienced at least one complication, and 2113 (19.3%) had multiple complications. Older patients, those with high comorbidity scores, or those with chronic limb threatening ischaemia were at increased risk of multiple complications. After adjusting for procedure type, patients with multiple complications experienced more than three times the hazard ratio (HR) of amputation or death two years after the procedure than those without complications (adjusted HR 3.4, 95% confidence interval 3.1-3.7), and increasing complications progressively multiplied the risk. In particular, non-surgical complications such as stroke, acute renal failure, delirium, and cardiac events were associated with the highest rates of two year amputation or death. Multiple complications after surgery for lower limb PAD carried a compounding risk of reduced long term amputation free survival. Patients experiencing at least one complication form a high risk group that requires increased attention to prevent the potential development of further complications.

Cardiorespiratory fitness and right ventricular mechanics in uncomplicated diabetic patients: Is there any relationship?

This study investigated the association between cardiorespiratory fitness and right ventricular (RV) strain in uncomplicated diabetic patients. This cross-sectional study involved 70 controls and 61 uncomplicated patients with type 2 diabetes, who underwent laboratory analysis, comprehensive echocardiographic study and cardiopulmonary exercise testing. RV endocardial and mid-myocardial longitudinal strains were significantly reduced in diabetic subjects (- 27.5 ± 4.2% vs. - 25.3 ± 4.3%, p = 0.004 for endocardial strain; - 25.6 ± 3.5% vs. - 24.1 ± 3.2%, p = 0.012 for mid-myocardial strain). The same was revealed for endocardial and mid-myocardial of RV free wall. There was no difference in RV epicardial strain. VO2 was significantly lower in the diabetic group (27.8 ± 4.5ml/kg/min vs. 21.5 ± 4.2ml/kg/min, p < 0.001), whereas ventilation/carbon dioxide slope was significantly higher in diabetic subjects (25.4 ± 2.9 vs. 28.6 ± 3.3). Heart rate recovery was significantly lower in diabetic patients. HbA1c and global RV endocardial longitudinal strain were independently associated with peak VO2 and oxygen pulse in the whole study population. Diabetes impacts RV mechanics, but endocardial and mid-myocardial layers are more affected than epicardial layer. RV endocardial strain and HbA1c were independently associated with cardiorespiratory fitness in the whole study population. Our findings show that impairment in RV strain and cardiorespiratory fitness may be useful indicators in early type 2 diabetes, prior to the development of further complications.

К вопросу о кетогенной диете при сахарном диабете 2-го типа

The article deals with the pressing issue of the medical use of the ketogenic diet in the type 2 diabetes mellitus treatment. Obesity has become one of the most acute worldwide problems. The medical community is concerned about a hike in the number of obese people in the world. This leads to heavy consequences, namely an increase in the incidence of diabetes and the development of further complications. The article highlights and reveals the features of the pathogenesis of obesity in adults and children; WHO statistics on this issue are provided. The purpose of this article is to study the latest basic research on the issue of ketogenic diet therapy of type 2 diabetes mellitus; identification of positive and negative results of clinical trials; summary of foreign practical experience. In conclusion, the author says that the issue of the medical use of the ketogenic diet stays open and requires further large-scale research both in Russia and abroad.

Chrysophanol, Physcion, Hesperidin and Curcumin Modulate the Gene Expression of Pro-Inflammatory Mediators Induced by LPS in HepG2: In Silico and Molecular Studies.

Hepatitis is an inflammatory condition that can develop hepatocellular carcinoma. Traditional medicine has always been the pillar of medical practice. However, it became less compatible with the current understanding of the diseases and the possible treatment. Therefore, in silico tools could be utilized for building the bridge between the legacy of the past and the current medical approaches allowing access to new therapeutic discoveries. In this work, a Chinese traditional medicine database was screened using structure-based virtual screening to identify molecules that could inhibit p38 alpha mitogen-activated protein kinase (MAPK). Out of the identified compounds, four selected compounds: chrysophanol, physcion, curcumin and hesperidin were isolated from their respective sources and their structures were confirmed by spectroscopic methods. These compounds decreased the gene expression of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and interleukin-1beta (IL-1β) in lipopolysaccharide (LPS) induced inflammation in a hepatocellular carcinoma cell line (HepG2) in a dose-dependent manner. The molecular docking study revealed the specificity of these compounds towards p38 MAPK rather than other MAPKs. In conclusion, the molecular and in silico studies suggest that the isolated compounds could be a potential treatment for hepatitis by resolving inflammation controlled by MAPKs, thus limiting the development of further complications and lower side effects.

The relationship between functional capacity and left ventricular strain in patients with uncomplicated type 2 diabetes.

We aimed to evaluate the association between functional capacity and left ventricular (LV) mechanics in the patients with uncomplicated type 2 diabetes. The present cross-sectional study included 80 controls and 70 uncomplicated diabetic patients. These participants underwent laboratory analysis, comprehensive echocardiographic examination and cardiopulmonary exercise testing. Global longitudinal (-21.6 ± 2.8 vs. -18.4 ± 2.3%, P < 0.001) and circumferential (-22.0 ± 2.9 vs. -19.5 ± 2.6%, P < 0.001) strains were significantly reduced in diabetic participants. The same was found for longitudinal and circumferential endocardial, mid-myocardial and epicardial strains. Peak oxygen uptake (27.0 ± 4.3 vs. 20.7 ± 4.0 ml/kg/min, P < 0.001) and oxygen pulse (14.1 ± 3.0 vs. 11.6 ± 3.2 ml/beat, P < 0.001) were significantly lower in the diabetic group, while ventilation/carbon dioxide slope was significantly higher in these patients. In the whole study population glycosylated hemoglobin, as well as LV endocardial longitudinal and circumferential strains were independently of other clinical and echocardiographic parameters of LV structure, systolic and diastolic function associated with peak oxygen consumption and oxygen pulse. Our investigation showed that diabetes equally affected all LV myocardial layers. Endocardial LV longitudinal and circumferential strains, as well as glycosylated hemoglobin - main parameter of glucose regulation, were independently associated with functional capacity in the whole study population. These findings indicate that determination of LV strain and functional capacity could detect subclinical target organ damage and prevent development of further complications in uncomplicated diabetes mellitus patients.