Presence Of Diabetes Mellitus Type Research Articles

Long-Term Outcome of Lower Extremity Bypass Surgery in Patients with Chronic Kidney Disease and Critical Limb Ischemia in Germany

The aim of this study is to present short- and long-term outcomes after lower extremity bypass (LEB) surgery in patients with chronic limb-threatening ischemia (CLTI) and chronic kidney disease (CKD), differentiated by peripheral artery disease (PAD) Fontaine stage III and IV. Methods: Retrospective analysis of anonymized data from a nationwide German health insurance company (AOK). Data from 22,633 patients (14,523 men) who underwent LEB from 2010 to 2015, were analyzed, presenting 18,271 with CKD stage 1/2, 2,483 patients with CKD stage 3 and 1,879 with CKD stage 4/5. Results: Perioperative mortality (60-day mortality) was 7.2% for CKD stage 1/2, 12.4% for CKD stage 3, and 18.0% for CKD stage 4/5. Patients with PAD stage IV had a significantly higher perioperative mortality (43.2%) than patients with PAD stage III (22.7%). The perioperative major amputation rate depended significantly on PAD stage IV (Odds Ratio (OR): 2.57 CI: 2.16 – 3.05, p < .001), the LEB level below the knee and crural/pedal (OR: 2.49 CI: 2.14 – 2.90, p < .001), CKD stage 4/5 (OR: 1.28, CI: 1.06 – 1.54, p = .009), and the presence of diabetes mellitus type 2 (OR: 1.19, CI: 1.05 – 1.36, p = .007). Kaplan-Meier estimated long-term survival of up to 9 years after surgery was 31.7% for patients with CKD stage 1 and 2, 14.3% for CKD stage 3, and only 10.1% for CKD stage 4 and 5 (p < .001). PAD Fontaine stage IV vs. III (Hazard Ratio (HR): 1.64, CI: 1.56 – 1.71, p < .001), but not bypass level had an independent adverse influence on long-term survival. Conclusion: CKD and PAD stage were equally significant independent predictors of patient survival and MACE with higher PAD and CKD stages associated with less favorable long-term outcomes.

Tuberculosis (TB) treatment challenges in TB-diabetes comorbid patients: a systematic review and meta-analysis

Background The Directly Observed Treatment-Short Course (DOTS) Programme was implemented by WHO and includes a combination of four anti-tuberculosis (TB) drugs (isoniazid, pyrazinamide, ethambutol and rifampicin) for a period of six months to eradicate the TB infection completely. Diabetes mellitus (DM) is recognized as one of a strong contributor of TB according to World Health Organization (WHO). The presence of diabetes mellitus type 2 (DM type 2) makes TB treatment complicated. Thus, the objective of the current meta-analysis was to identify and quantify the impact of type 2 DM on treatment outcomes of TB patients treated under the DOTS Programme. Methods This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Through a systematic review of relevant literature, we focused on studies investigating treatment outcomes including extended treatment duration and recurrence for individuals with both TB and DM undergoing DOTS therapy. The extracted information included study designs, sample sizes, patient characteristics and reported treatment results. Results In 44 studies from different parts of the world, the pooled HR for the impact of DM on extended treatment duration and reoccurrence were HR 0.72, 95% CI 0.56–0.83, p < .01 and HR 0.93, 95% CI 0.70–1.04, p = .08, respectively. The pooled HR for impact of DM on composite TB treatment outcomes was calculated as 0.76 (95% CI 0.60–0.87), p < .01 with an effect size of 41.18. The heterogeneity observed among the included studies was moderate (I 2 = 55.79%). Conclusions A negative impact of DM was found on recurrence and extended treatment duration in TB patients treated with DOTS therapy. DM type 2 is responsible for the TB treatment prolongation and TB recurrence rates. By implementing effective management strategies and advancing research, the challenges can be mitigated, arising due to the complex interaction between DM and TB.

The Impact of Lipid and Glucose Metabolism Disorders on Geriatric Syndromes

In people over 60 years, the most common diseases are the cardiovascular system and geriatric syndromes. Dyslipidemia and hyperglycemia are traditional cardiovascular risk factors. However, their impact on the major geriatric syndromes development among people over 60 years remains unclear. The relationship between the presence of diabetes mellitus type 2 and the development of frailty, sarcopenia, cognitive impairment depends on age. With increasing age, the influence of chronic hyperglycemia on geriatric syndromes decreases and in centenarians it acquires a neutral role. Recent studies have shown that in people over 60 years old low HDL levels are associated with the development of frailty, sarcopenia, cognitive impairment.

Prevalence of autoimmune, cholestatic and nonalcoholic fatty liver disease in celiac disease.

While there is higher prevalence of autoimmune, cholestatic and fatty liver disease in celiac disease (CeD), most data is from small-scale studies. We evaluated the prevalence and risk factors of the same using large cohort data. A population-based cross-sectional study was conducted using Explorys, a multi-institutional database. Prevalence and risk factors of autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC) and nonalcoholic fatty liver disease (NAFLD) in CeD were assessed. Out of 70 352 325 subjects, 136 735 had CeD (0.19%). The prevalence of AIH (0.32%), PBC (0.15%), PSC (0.004%) and NAFLD (0.7%) were high in CeD. After adjusting for age, gender, Caucasian race and anti-tissue transglutaminase antibody (anti-TTG), CeD subjects had higher odds of AIH [adjusted odds ratio (aOR) 7.06, 95% confidence interval (CI) 6.32-7.89] and PBC (aOR 4.16, 95% CI 3.46-5.0). Even after adjusting for CeD, anti-TTG positivity concurred with higher odds of AIH (aOR 4.79, 95% CI 3.88-5.92) and PBC (aOR 9.22, 95% CI 7.03-12.1). After adjusting for age, gender, Caucasian race, diabetes mellitus (DM), obesity, hypothyroidism and metabolic syndrome, there was higher prevalence of NAFLD in CeD, with the aOR in the presence of DM type 1 being 2.1 (95% CI 1.96-2.25), and in the presence of DM type 2 being 2.92 (95% CI 2.72-3.14). Subjects with CeD are more likely to have AIH, PBC, PSC and NAFLD. AIH and PBC have higher odds in the presence of anti-TTG. The odds of NAFLD in CeD are high regardless of type of DM.

Investigation of metabolic pathways from gut microbiome analyses regarding type 2 diabetes mellitus using artificial neural networks

BackgroundType 2 diabetes mellitus is a prevalent disease that contributes to the development of various health issues, including kidney failure and strokes. As a result, it poses a significant challenge to the worldwide healthcare system. Research into the gut microbiome has enabled the identification and description of various diseases, with bacterial pathways playing a critical role in this context. These pathways link individual bacteria based on their biological functions. This study deals with the classification of microbiome pathway profiles of type 2 diabetes mellitus patients.MethodsPathway profiles were determined by next-generation sequencing of 16S rDNA from stool samples, which were subsequently assigned to bacteria. Then, the involved pathways were assigned by the identified gene families. The classification of type 2 diabetes mellitus is enabled by a constructed neural network. Furthermore, a feature importance analysis was performed via a game theoretic approach (SHapley Additive exPlanations). The study not only focuses on the classification using neural networks, but also on identifying crucial bacterial pathways.ResultsIt could be shown that a neural network classification of type 2 diabetes mellitus and a healthy comparison group is possible with an excellent prediction accuracy. It was possible to create a ranking to identify the pathways that have a high impact on the model prediction accuracy. In this way, new associations between the alteration of, e.g. a biosynthetic pathway and the presence of diabetes mellitus type 2 disease can also be discovered. The basis is formed by 946 microbiome pathway profiles from diabetes mellitus type 2 patients (272) and healthy comparison persons (674).ConclusionWith this study of the gut microbiome, we present an approach using a neural network to obtain a classification of healthy and type 2 diabetes mellitus and to identify the critical features. Intestinal bacteria pathway profiles form the basis.

Динаміка рівня ендотеліального моноцитактивуючого пептиду-ІІ у хворих на гострий інфаркт міокарда з супутнім цукровим діабетом 2 типу

The purpose of the study was to investigate the dynamics of endothelial monocyte activating polypeptide-ІІ in patients with acute myocardial infarction with concomitant diabetes mellitus type 2 six months after a coronary event. Materials and methods. 120 patients participated in the study: group 1 – patients with acute myocardial infarction with diabetes mellitus type 2 (n=70), group 2 – patients with acute myocardial infarction (n=50). The control group included 20 practically healthy people. All patients underwent laboratory and instrumental examination on the first day of acute myocardial infarction and 6 months after it. The level of endothelial monocyte activating polypeptide-ІІ was determined using the test system “Human Endothelial Monocyte Activating Polypeptide-ІІ ELISA KIT”. Results and discussion. The average level of endothelial monocyte activating polypeptide-ІІ on the first day of an acute myocardial infarction was: in patients who were part of the 1st group – 4.54 ± 0.331 ng/ml; 2nd – 2.74 ± 0.21 ng/ml; control group – 1.1 ± 0.037 ng/ml (р&lt;0.05). In patients of the 1st group, half a year after acute myocardial infarction, the average level of endothelial monocyte activating polypeptide-ІІ was equal to 3.6 ± 0.11 ng/ml; 2nd – 2.28 ± 0.05 ng/ml (р&lt;0.00001). Re-examination of patients, depending on treatment tactics, showed the following results: in patients with acute myocardial infarction with concomitant diabetes mellitus type 2 after cardiac ventriculography, the endothelial monocyte activating polypeptide-ІІ level was equal to 3.5 ± 0.04 ng/ml; in patients with acute myocardial infarction with concomitant diabetes mellitus type 2 after standard anticoagulant therapy it was 3.71 ± 0.03 ng/ml; in patients with isolated acute myocardial infarction after cardiac ventriculography – 2.24 ± 0.01 ng/ml; in patients with isolated acute myocardial infarction after standard anticoagulant therapy – 2.33 ± 0.04 (р&lt;0.01). Conclusion. Endothelial monocyte activating polypeptide-ІІ is a marker of endothelial dysfunction that has prognostic properties in relation to comorbid pathology in the form of acute myocardial infarction with. diabetes mellitus type 2. In patients with an acute myocardial infarction in the presence of diabetes mellitus type 2, a higher level of endothelial monocyte activating polypeptide-ІІ was noted on the 1st day of a coronary event and 6 months after it, compared to patients with an isolated acute myocardial infarction and individuals of the control group (p&lt;0.05). After cardiac ventriculography in patients, the level of endothelial monocyte activating polypeptide-ІІ was significantly lower compared to this indicator after standard anticoagulant therapy

ASSOCIATION OF LEFT ATRIAL SPONTANEOUS ECHO CONTRAST WITH CLINICAL AND HEMODYNAMIC CHARACTERISTICS OF PATIENTS WITH LONG-TERM EPISODES OF PERSISTENT ATRIAL FIBRILLATION.

The aim: To identify clinical and hemodynamic factors, associated with left atrial spontaneous echo contrast (LASEC) (LASEC in general, and the dense LASEC), in non-valvular persistent atrial fibrillation (AF) patients with the duration of AF episode ≥90 days. Materials and methods: The cross-sectional study consecutively enrolled 115 persistent AF patients with the duration of its episode ≥90 days (82 (71,3 %) males; mean age 59 ± 11 years). Transthoracic (TEE) and transesophageal echocardiography (TEE) were performed. LASEC (by TEE) was observed in 79 (68,7 %) patients. The dense (moder¬ate-to-severe) LASEC was detected in 23 (20,0 %) cases. Results: Heart failure (HF) stage C (OR 2,09 (95 % CI 1,24-3,53); p=0,006), lower TEE-derived left atrial appendage (LAA) flow velocity (FV) (OR 0,94 (95 % CI 0,91-0,98); p=0,003), and the presence of TTE-derived pulmonary hypertension (PH), appeared to be strongly associated with LASEC (AUC for logistic regression model: 0,83 [95 % СI 0,75- 0,89]). The presence of diabetes mellitus type 2 (DM) (OR 2,34 (95 % CI 1,13-4,86); p=0,027), along with lower LAA FV (OR 0,83 (95 % CI 0,76-0,91); p<0,001), were strongly associated with dense LASEC (AUC: 0,89 [95 % CI 0,82-0,94]). Conclusions: The TEE-derived LASEC in patients with long term episodes (≥90 days) of persistent AF was strongly associated with HF stage C and TTE-derived PH, and with lower TEE-derived LAA FV. The presence of DM, in addition to lower LAA FV, was related to dense LASEC.

Гендерні та вікові особливості ремоделювання серця у хворих із постінфарктним кардіосклерозом, цукровим діабетом 2-го типу та ожирінням

У статті було визначено гендерні та вікові особливості ремоделювання серця у хворих із постінфарктним кардіосклерозом, цукровим діабетом (ЦД) 2-го типу й ожирінням.Із цією метою проведено обстеження 295 хворих із постінфарктним кардіосклерозом. Гендерні та вікові особливості ремоделювання серця у 215 хворих із постінфарктним кардіосклерозом, цукровим діабетом 2-го типу та ожирінням порівнювали з такими у хворих, які не мали діабету й ожиріння (група порівняння (n = 80)). Усі хворі з постінфарктним кардіосклерозом були розподілені на групи залежно від наявності ЦД 2-го типу (перша група (n = 68)), ожиріння (друга група (n = 76)) та їх поєднаного перебігу (третя група (n = 71)). Усі групи були порівнянні за віком (64,38 ± 1,08; 64,87 ± 1,98; 65,13 ± 1,43 та 63,47 ± 1,28 року відповідно). Верифікацію діагнозу проводили на підставі чинних критеріїв. Усім хворим проводили загальноклінічні та інструментальні обстеження. Ехокардіографічні дослідження проводили за стандартною методикою Х. Фейгенбаума на ультразвуковому апараті RADMIR (Ultima PRO 30) (Харків, Україна).Гендерний аналіз показав вірогідне збільшення розмірів лівого шлуночка та лівого передсердя на тлі більш вираженого зниження систолічної функції у чоловіків із постінфарктним кардіосклерозом, ЦД 2-го типу та ожирінням порівняно з жінками незалежно від віку. У хворих похилого віку спостерігалися такі самі зміни, як у хворих середнього віку. У всіх обстежених хворих виявлялося порушення геометричної адаптації, із них концентричний тип ремоделювання був переважно в осіб жіночої статі, в обстежених чоловіків частіше траплялося ексцентричне ремоделювання лівого шлуночка.Таким чином, у жінок валідними факторами, що визначають тяжкість ураження міокарда лівого шлуночка і перебігу хронічної серцевої недостатності на тлі перенесеного інфаркту міокарда, є ЦД 2-го типу, надлишкова маса тіла й перевага сприятливого концентричного типу ремоделювання лівого шлуночка зі збереженою його систолічною функцією. Тоді як у чоловіків ремоделювання міокарда має менш сприятливий перебіг зі збільшенням розмірів лівого шлуночка та лівого передсердя на тлі більш вираженого зниження систолічної функції.

Metabolic, inflammatory and imaging biomarkers in evaluation of coronary atherosclerosis severity in patients with coronary artery disease and diabetes mellitus type 2

To study interconnections between epicardial adipose tissue thickness (EATt), parameters of glucose metabolism/insulin, C-reactive protein (hsCRP), serum adipokines and severity of coronary artery disease (CAD) depending on the presence of diabetes mellitus type 2 (DM 2); to determine significant markers of CAD severity in patients with DM 2. The study involved 106 patients with CAD (m/f 64/42, 60.96.8 years), including patients with DM 2 (group 1, n=35) and non-diabetic patients (group 2, n=71). Severity of CAD was evaluated according to angiography data with calculation of Gensini Score (GS). EATt was assessed via echocardiography. Serum levels of glucose/insulin metabolism parameters, lipid fractions, hsCRP and adipokines were evaluated. Clinical parameters, including GS, did not differ between groups. EAT thickness median was elevated in gr.1 (5.1 mm vs. 4.4 mm in group 2), while adiponectin levels were decreased (6.55 g/ml vs. 7.71 g/ml). Linear regression of body mass index and resistin levels on EATt was revealed in gr.1; in gr.2 EATt linearly increased with waist circumference increment when EATt6 mm. Linear regression of EATt on GS was revealed in gr.1 when EATt8 mm, while linear regression in the whole GS range was obtained for HDL-C and hsCRP levels. Study results demonstrate differences in mechanisms of deposition and functioning of epicardial and abdominal adipose tissue depending on the presence or absence of diabetic status. Patients with DM2 are characterized by the excessive EAT deposition and decrease of serum adiponectin levels compared to non-diabetic patients in the equal conditions. Independent markers of CAD severity in DM 2 are decreased HDL-C and increased hsCRP levels, but not EATt.

The prevalence and characteristics of non-functioning and autonomous cortisol secreting adrenal incidentaloma after patients\u2019 stratification by body mass index and age

BackgroundThe escalating prevalence of adrenal incidentaloma (AI) has been associated with the improvement of radiologic techniques and widespread imaging in aging population. It is currently unclear whether patients with obesity more likely develop AI and the current rise in the prevalence of AI could be at least partly associated with the respective rise in obesity. We compared the prevalence and characteristics of non-functional (NF) and autonomous cortisol secreting (ACS) adrenal incidentalomas (AIs) after the study population was stratified by different body mass indexes (BMI) and age groups.MethodsRetrospective cross-sectional study comprising of 432 patients (40.6% male, 59.4% female) with NFAI (N = 290) and ACS (N = 142), of median age 63.4 (54.0–71.6) years and median BMI 28.6 (25.5–31.7) kg/m2. The data collection contained 11.132 points including demographic, anthropometric, radiologic, hormonal and metabolic parameters.ResultsWe observed 68–87% higher prevalence of AI across different age groups in NFAI and ACS in obese/overweight compared to normal weight subjects. Patients with ACS were older (P = 0.008), with higher basal cortisol (P < 0.001), lower basal DHEAS (P = 0.001), lower suppression DHEAS (P = 0.027) and higher aldosterone (P = 0.039). AIs with ACS were larger than NFAI (P < 0.001). Interestingly, ACS group had lower body mass (P = 0.023) and did not differ in BMI, blood pressure, heart rate, lipid profile, fasting glucose and presence of diabetes mellitus type 2 when compared to NFAI., By contrast to the similarity of metabolic profiles in ACS and NFAI, some components of adverse metabolic traits were rather associated with higher BMI and older age, in particular in NFAI.ConclusionThe prevalence of NFAI and ACS were significantly higher in overweight/obese subgroup across the age distribution. Stratification by age and BMI displayed significant differences in some metabolic traits, in particular in NFAI.

Diagnosis and treatment of osteoporosis in elderly patients with type 2 diabetes

Osteoporosis, falls and low-energy fractures have a high prevalence in elderly, which is increasing in the presence of diabetes mellitus type 2 (T2DM). Patients with T2DM have a low rate of bone metabolism, a pronounced change in bone microarchitecture. The use of trabecular bone score in evaluating of densitometry and the FRAX scale improves the sensitivity of the methods in patients with diabetes. Integrated approach is required in elderly patient with type 2 diabetes and includes assessment of geriatric status, diabetes status, correction of multiple complications of diabetes, carbohydrate metabolism, vitamin D deficiency, selection of the most effective hypoglycemic and anti-osteoporetic therapy and development of preventive and treatment methods aimed to reduce falls risk and fractures rate.

Exocrine pancreatic dysfunction in children with obesity: characteristics of clinical picture and diagnostics

Introduction. During the last twenty-five years the occurrence of obesity in children and teenagers has increased significantly. Materials and methods. 110 adolescents of 12–17 years old, with alimentary-constitutional obesity and involvement of pancreas and without its injury, as compared to the 30 healthy children of control group, were examined. The research provided determination of the sizes and elasticity of pancreas. The detection of the total cholesterol, high density lipoproteins and leptin level was carried out. Intensity of clinical symptoms (spastic pain in epigastrium and left subcostal arc; abdominal pain without localization, vomit without relief, general weakness) have been made accordingly to sum of points (from 0 to 3 points). If sum of points makes from 0 to 2 – intensive character of abdominal pain is low, from 3 to 5 points – it is high, from 5 to 10 points – it is very high. Normal level of amylase in a blood serum (Karavey’s method) is 12–32 g/(hour l), аnd diastase in urine – 20–160 g/(hour l). We made a screening test for elastase-I level by ELISA test. Normal activity of this enzyme in feces is 200 мkg/g. We have used sonographic method for detection of pancreatic diseases in obese children due to echo-structure of parotid gland. The analysis and statistical data processing were made by computer program "Statistica 7.0" and MS Excel XP. Research data. Physical inspection of our patients confirms prevalence of І degree over II degree obesity (52.7 % and 47.3 %, respectively; Р &lt; 0.05). We have confirmed valid risk factor of pancreatic lesion in obese children – presence of diabetes mellitus type I in close relatives (80 % and 65 %, χ2 = 2,05; Р &lt; 0.05). The changes of exocrine function of the pancreas in children with the stage II obesity were established. Echographic signs of the pancreas lesion in teenagers with obesity indicate the presence of functional changes: edema of head or entire edema, partial increase of parenchymal echogenicity, insufficient enlargement of the duct of Wirsung.

TYPE 2 AUTOIMMUNE POLYGLANDULAR SYNDROME: ALERT OF RISK OF ADDISONIAN CRISIS PRECIPITATED BY A MISDIAGNOSEED PRIMARY HYPOTHYROIDISM

Introduction: Autoimmune polyglandular syndrome consists of association of two or more autoimmune glandular disease, with signs and symptoms simulating isolated disease and may be classified at autoimmune polyglandular syndrome 1, 2, 3 and 4. Case report: The case reported here presents an individual female, 37 years with autoimmune polyglandular syndrome 2, having as base pathologies Addison disease associated with autoimmune thyroid disease. It is also important that the autoimmune polyglandular syndrome 2, may be accompanied by the presence of diabetes mellitus type 1, or still have as secondary manifestations other autoimmune comorbidities, not endocrinological ones. Conclusion: The clinical and laboratory diagnosis based on hormonal measurements and specific antibodies should be fast and accurate, and this is the correct treatment fundamental to prevent fatal consequences arising from the adrenocortical failure.

Pentraxin-3 diagnostic value and its association with clinical types of coronary artery disease in patients with concomitant diabetes melitus type 2

Summary. Great attention is paid recently to studying of coronary artery disease (CAD) pathogenesis on the background of diabetes mellitus (DM). One of the pathogenetic mechanisms of atherosclerosis is generalized or chronic inflammation. In particular, the question of the role of an inflammatory component role in development of atherosclerosis in patients with DM 2 types is studied. One of new perspective markers of immune inflammation is pentraxin-3 (PTX-3). The purpose of the study –to evaluate the diagnostic value of pentraxin-3 and to study the relationship with the clinical types of coronary heart disease in patients with concomitant type 2 diabetes mellitus. Material and methods. The comprehensive examination of 110 patients with CAD was conducted. Patients were divided into groups depending on presence of DM type 2: the first group included 75 patients with stable CAD and DM type 2, the group of comparison consisted of 35 patients with CAD without DM type 2.Also patients were distributed in groups depending on the IHD clinical form: stable stenocardia, post-infarct cardiosclerosis (PIC) and diffusive cardiosclerosis. Results. In patients with CAD with concomitant DM type 2 there was defined pentraxinemia level depending on clinical types of CAD: in patients with PIC the PTX-3 level in blood serum was 5.68±0.51 ng/ml (r&lt;0.05). In patients with stable stenocardia the PTX-3 level was 6.18±0.49 ng/ml (r&lt;0.05). In patients with diffusive cardiosclerosis the PTX-3 level was 4.92±0.47 ng/ml (r&lt;0.05). Pentraxinemia level in patients with CAD without DM type 2 depending on clinical types of CAD was defined as follows: in patients with PIC the PTX-3 level in blood serum constituted 3.76±0.51 ng/ml (r&lt;0.05). In patients with stable stenocardia the PTX-3 level was 4.18±0.39 ng/ml (r&lt;0.05). In patients with a diffusive cardiosclerosis the PTX-3 level was 2.34±0.48 ng/ml (r&lt;0.05). Distribution of PTX-3 had same character, both in patients with DM type 2, and in patients without DM type 2. Conclusions. The diffusive cardiosclerosis was met more often in patients with coronary artery disease and the accompanying diabetes melitus type 2 (in 58.7%). The diagnostic value of pentraxin-3 is to increase the level of pentraxinemia in patients with coronary heart disease with concomitant type 2 diabetes. The pentraxin-3 levels in patients with stable stenocardia were authentically higher, than in patients with diffusive and post-infarct cardiosclerosis that is caused by more distinct activation immune inflammation.

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.

VARIANTS OF METABOLIC SYNDROME OF THE PATIENTS WITH COLORECTAL CANCER: A RELATIONSHIP WITH CLINICAL AND MORPHOLOGICAL PARAMETERS

The objective is to study the incidence of metabolic syndrome (MS) and overweight in patients with colorectal cancer as well as to evaluate the relationship with clinical and morphological features and to analyze the incidence of 3-, 4- and 5- components МS in patients with colorectal cancer. Materials and methods. The investigation involved 99 people with the prevalence of the tumor process T2-3N1-2M1. Depending on the presence of MS or overweight patients were divided into 3 groups. The recommendations of the International Diabetes Federation (2005) were used for inclusion in the group with MS. Statistical processing of the results was made with the Statistica 10.0 software package. Results. About 78% of patients with colorectal cancer had metabolic disorders: 67% had MS, 11% had overweight. The patients with colorectal cancer had mainly the 3- and 4-components variants of MS (46% and 47%, respectively), the 5 components MS occurred in 7% of cases. No significant relationship was found between the presence/absence of the MS, and MS variant and age, sex, stage, and localization of the tumor process. A significant correlation was revealed between the presence of MS/ MS variants and tumor Grade. In particular, G3 adenocarcinomas meet more often in the presence of MS5. An association of MS and its individual components was identified with recurrence- free / overall survival, in particular, the presence of MS, an increase in body mass index, waist size, and the presence of diabetes mellitus type II is associated with a decrease in recurrence-free survival. Increased blood triglyceride levels are associated with a decrease in overall survival.

Investigation of the processes for the restoration of peroxide lipids in blood and tissues of kidney of rats in the modeling of acute pyelonephritis and concomitant diabetes mellitus type II

In the pathogenesis of acute pyelonephritis, complicated by diabetes mellitus, an important role is played by impaired activity of the antioxidant system, the intensification of the processes of peroxidation and free radical oxidation. The development of an imbalance in the prooxidant-antioxidant system causes negative structural and functional changes in the kidneys, the search for drugs with an antioxidant effect to correct established metabolic disorders is relevant. Modeling of acute pyelonephritis in the presence of diabetes mellitus type II in rats was accompanied by a significant decrease in the recovery of peroxide lipids by glutathione peroxidase in blood plasma and kidney tissue. The application of the proposed method of drug correction contributed to a significant activation of the recovery of peroxide lipids by glutathione peroxidase in blood plasma and in the kidney tissue of animals with reconstituted acute pyelonephritis and concomitant diabetes.

Diabetes-induced Alterations in HDL Subfractions Distribution.

Diabetes mellitus (DM) due to its increasing prevalence and associated morbidity and mortality has become a serious public health problem. In DM, HDL may lose its beneficial features and become proatherogenic due to its altered biological activity thus increasing cardiovascular risk. The aim of this study was to assess the influence of the presence of diabetes mellitus type 2 and its duration on the distribution of HDL subfractions. Moreover, the effect of statin treatment on HDL subfraction share was analysed in this study. The study group consisted of 50 patients with newly diagnosed DM and 50 persons with DM for longer than 10 years while the control group consisted of 50 healthy volunteers. HDL subfractions were analysed with the use of Lipoprint. We demonstrated progressive worsening of heart functioning and impairment of its structure in the course of diabetes mellitus. Moreover, we observed that HDL-6 subfraction and intermediate HDL fraction are lowest in the group with advanced DMt2 compared to the group with newly diagnosed DM and a healthy control group. Finally, the results of our study indicated the effect of statin treatment on HDL subfractions that seems not to be advantageous. It seems that in patients with diabetes mellitus compromised antiatherogenic properties of HDL, as a result of oxidative modification and glycation of the HDL protein as well as the transformation of the HDL proteome into a proinflammatory protein, increase cardiovascular risk.

The thickness of the epicardial fat is the "visit card" of metabolic syndrome

Aims. On the basis of echocardiography to evaluate the thickness of epicardial fat (TEF) in patients with metabolic syndrome (MS) and to establish a connection with the main indicators of laboratory and instrumental methods of research.&#x0D; Materials and methods. The study included 76 patients, 43 patients with MS and 33 without MS. The average age of patients in the MS group at the time of inclusion in the study was 62.710.3 years in the control group (without MS) 6014.7 years. All patients underwent a comprehensive examination that included the collection of complaints, study of history, physical examination, anthropometric measurements, laboratory (including the study of the levels of caspase 8, leptin in blood plasma enzyme-linked immunosorbent assay using kits Platinum ELISA) and instrumental examination (echocardiography, ultrasound examination of organs of small pelvis). TEF was determined using transthoracic echocardiography on the machine Acuson Sequoia 512.&#x0D; Results. According transthoracic echocardiography was significantly higher in the group of patients with MS and was 4.671.7 mm, as compared to 2.661.15 mm in the control group (p0.001). Identified moderate and strong correlation between TEF and weight of the patients, waist circumference, ratio of waist circumference to hip circumference, body mass index, glucose levels in the blood plasma, the presence of diabetes mellitus type 2, ultrasonic signs of steatosis of the liver and pancreas, increased aminotransferases, the level of caspase-8 concentration in plasma leptin. Patients the MS group with increased TEF increases the risk of developing hypertension, ischemic heart disease, left ventricular hypertrophy, diastolic dysfunction of the left ventricle type 2, level of caspase-8 and concentration in plasma leptin.&#x0D; Conclusion. Based on the obtained data, the measurement of TEF is justified in patients with MS in everyday clinical practice. The correlations between the TEF and the clinical and metabolic parameters of the CVD and MS make it possible to consider the TEF as a new marker of the risk of developing MS and cardiovascular diseases.

The thickness of the epicardial fat is the "visit card" of metabolic syndrome

AIMS. On the basis of echocardiography to evaluate the thickness of epicardial fat (TEF) in patients with metabolic syndrome (MS) and to establish a connection with the main indicators of laboratory and instrumental methods of research.&#x0D; MATERIALS AND METHODS. The study included 76 patients, 43 patients with MS and 33 without MS. The average age of patients in the MS group at the time of inclusion in the study was 62.7±10.3 years in the control group (without MS) – 60±14.7 years. All patients underwent a comprehensive examination that included the collection of complaints, study of history, physical examination, anthropometric measurements, laboratory (including the study of the levels of caspase – 8, leptin in blood plasma enzyme-linked immunosorbent assay using kits «Platinum ELISA») and instrumental examination (echocardiography, ultrasound examination of organs of small pelvis). TEF was determined using transthoracic echocardiography on the machine Acuson Sequoia 512.&#x0D; RESULTS. According transthoracic echocardiography was significantly higher in the group of patients with MS and was 4.67±1.7 mm, as compared to 2.66±1.15 mm in the control group (p&lt;0.001). Identified moderate and strong correlation between TEF and weight of the patients, waist circumference, ratio of waist circumference to hip circumference, body mass index, glucose levels in the blood plasma, the presence of diabetes mellitus type 2, ultrasonic signs of steatosis of the liver and pancreas, increased aminotransferases, the level of caspase-8 concentration in plasma leptin. Patients the MS group with increased TEF increases the risk of developing hypertension, ischemic heart disease, left ventricular hypertrophy, diastolic dysfunction of the left ventricle type 2, level of caspase-8 and concentration in plasma leptin.&#x0D; CONCLUSION. Based on the obtained data, the measurement of TEF is justified in patients with MS in everyday clinical practice. The correlations between the TEF and the clinical and metabolic parameters of the CVD and MS make it possible to consider the TEF as a new marker of the risk of developing MS and cardiovascular diseases.