Severity Of Metabolic Disorders Research Articles

International Alliance of Urolithiasis (IAU) guidelines on the management of pediatric urolithiasis.

The aim of this study was to construct the sixth in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis (IAU) that by providing a clinical framework for the management of pediatric patients with urolithiasis based on the best available published literature. All recommendations were summarized following a systematic review and assessment of literature in the PubMed database from January 1952 to December 2023. Each generated recommendation was graded using a modified GRADE methodology. Recommendations are agreed upon by Panel Members following review and discussion of the evidence. Guideline recommendations were developed that addressed the following topics: etiology, risk factors, clinical presentation and symptoms, diagnosis, conservative management, surgical interventions, prevention, and follow-up. Similarities in the treatment of primary stone episodes between children and adults, incorporating conservative management and advancements in technology for less invasive stone removal, are evident. Additionally, preventive strategies aiming to reduce recurrence rates, such as ensuring sufficient fluid intake, establishing well-planned dietary adjustments, and selective use pharmacologic therapies will also result in highly successful outcomes in pediatric stone patients. Depending on the severity of metabolic disorders and also anatomical abnormalities, a careful and close follow-up program should inevitably be planned in each pediatric patient to limit the risk of future recurrence rates.

Features of portal hemodynamics in patients with fatty liver disease: mechanisms of formation, clinical significance

There are few data in the literature on the state of portal and hepatic blood flow in patients with fatty liver disease, and portal hemodynamics at the pre-cirrhotic stage is practically not covered. The aim of the study was to study the features of portal hemodynamics in patients with fatty liver disease at the pre-cirrhotic stage. Materials and methods. The study included 43 patients (25 - patients with fatty liver disease and 18- a comparison group who applied to outpatient clinics of therapeutic profile aged 18-89 years (41.9% of men, 58.1% of women). The average age of the patients was 45.1± 19.4 years. Criteria for inclusion in the study: age 18 years and older; presence of fatty liver disease associated with metabolic conditions. Criteria for not being included in the study: the presence of viral hepatitis, alcoholic liver disease, autoimmune liver diseases, pregnancy, lactation, taking any medications, narcotic drugs, the presence of acute or exacerbation of chronic diseases. The anthropometric indicators of patients were evaluated: waist circumference (OT), body mass index (BMI), steatotic indices (St-index, Fatty Liver Index), liver fibrosis index (Fib 4). Portal hemodynamics was assessed using ultrasound Dopplerography on a Philips Affiniti 50 device. Sensor C5-1. The following criteria were evaluated: vessel diameter (mm), its cross-sectional area (PPP, cm2), time-averaged maximum velocity (TAMX, cm/s), time-averaged average blood flow velocity (TAV, cm/s), Doppler perfusion index was calculated using the formula: V vol SPA / V vol SPA + V vol BB), the stagnation index was calculated using the formula: PPP/TAV. The results obtained. In patients with fatty liver disease, structural and hemodynamic shifts in the portal blood flow system are recorded: an increase in the diameter of the portal and inferior vena cava, a larger cross-sectional area, a low time-averaged maximum blood flow velocity and time-averaged average blood flow velocity, an increase in the stagnation index for these vessels, which reflects the process of remodeling the liver as a target organ in fatty liver disease and its vascular bed, forming a “stagnant liver”. Patients have lower values of the time-averaged average blood flow rate through the splenic vein, which indicates the initiation of collateral blood flow. Portal hemodynamics indicators correlate with metabolic parameters (anthropometric characteristics of patients (OT, BMI), steatotic indices (St index, FLI), but not with the liver fibrosis index (Fib 4). These hemodynamic features at the pre-cirrhotic stage of the disease, correlating with the severity of metabolic disorders, exacerbate structural changes in the liver and necessitate their correction in patients with fatty liver disease.

Evaluation of metabolic disorders and aging rates depending on SIRT1 polymorphism in patients with arterial hypertension and subclinical hypothyroidism

There is an increase in the frequency and severity of metabolic disorders in patients with arterial hypertension (AH) in combination with subclinical hypothyroidism (SH), that is accompanied by accelerated aging rates, but the research findings on the aging rates in this category of patients are extremely few in number. Therefore, the aim of our study was to assess metabolic disorders and the aging rates depending on the SIRT1 rs7069102 polymorphism in patients with AH and SH. A total of 132 patients with a median age of 47.6 years were included in the study and divided into 3 groups: a control group (n=30), a group of patients with AH without SH (n=49) and patients with AH in combination with SH (n=53). Anthropometric parameters, biochemical parameters, pro-inflammatory and oxidative states were evaluated in all pa­tients. The aging rates were assessed using two different methods. The frequencies of SIRT1 rs7069102 genotypes carriers in the study sample of patients were 8% for the CC genotype, 51% for the CG genotype and 41% for the GG genotype. There was a significant difference in the incidence of CC homozygosity and carriers of the G allele between groups of patients with AH depending on the SH presence (p<0.001). We showed that carriers of the G allele and GG genotype of the SIRT1 gene (rs7069102) polymorphic marker with AH and SH had significantly higher (p<0.05) insulin resistance, higher levels of low-density lipoprotein cholesterol, alkaline phosphatase, C-reactive protein and lower glomerular filtration rate, which negatively affected the aging processes in this category of patients. In addition, patients with AH had a marked effect of carrying the G allele on the lipid profile and biological age of patients. Therefore, timely detection of a polymorphic variant of the SIRT1 gene may be effective in premature aging prevention in patients with AH and SH.

Study of metabolic processes in cows with hyperbilirubinemia in the postpartum period

Highly productive dairy farming requires strict adherence to the technology of feeding and keeping cows and competent herd management. Cows with liver pathologies during the transit period are tough to treat. We conducted studies of cows' health status after calving to identify biochemical signs of liver pathology and associated metabolic disorders. The survey of highly productive cows was carried out on four farms in the Leningrad region of the Russian Federation. Cows received different rations, differing in composition and nutritional value. A total of 108 animals were examined. Blood was taken from cows 10‐20 days after calving and examined in a biochemical laboratory for the content of metabolites, enzymes, hormones. The results of the study showed significant differences in the biochemical profile of cows in different farms. The incidence of hyperbilirubinemia in cows ranged from 12.5 to 45.8%. The severity of metabolic disorders was assessed depending on the degree of hyperbilirubinemia. It was found that the minor metabolic effects were observed in cows with bilirubin levels from 7 to 10 μmol / L (n = 11), which was accompanied by a slight increase in the concentration of β‐hydroxybutyrate (1.36 ± 0.12 mmol / L), as well as an increase in activity creatine phosphokinase (CK‐NAC) up to 319.3 ± 27.7 IU / L and lactate dehydrogenase (LDH) up to 1193.9 ± 31.5 IU / L. The concentration of glucose and cholesterol was in the reference range. In cows of this group, the concentration of cortisol and thyroxine was within the reference limits (76.5 ± 2.5 and 50.3 ± 2.7 nmol / l, respectively). In the study of cows with a moderate degree of hyperbilirubinemia from 10.0 to 16.0 μmol / L (n = 9), a predisposition to a decrease in glucose levels to 2.03 ± 0.12 mmol / L was noted against the background of an increased content of β‐hydroxybutyrate 1.84 ± 0.13 mmol / L, the level of cholesterol in cows was 2.43 ± 0.21 mmol / L. The activity of LDH and CK‐NAC was 1310.8 ± 69.3 and 401.5 ± 41.9 IU / L, respectively. A decrease in thyroxine concentration was found in 33.3% of animals, an increase in cortisol concentration ‐ in 55.5% (mean group values ‐ 48.4 ± 3.4 and 78.8 ± 6.5 nmol / l). In cows with the highest degree of hyperbilirubinemia from 17.0 to 39.0 μmol / l (n = 8), the most severe metabolic consequences were revealed, which practically did not give hope for the restoration of body functions. All cows showed an increase in β‐hydroxybutyrate to 2.79 ± 0.39 mmol / L, a decrease in cholesterol concentration to 1.8 ± 0.06 mol / L in the absence of hypoglycemia. In cows, the activity of CPK (1140.7 ± 222.7 IU / L) and LDH (2150.1 ± 94.4 IU / L) are significantly increased. The concentration of thyroxine in the studied cows was 22.03 ± 2.0 nmol / l. All cows in this group showed hypercortisolemia (140.2 ± 11.4 nmol / l). The studies made it possible to identify the relationship between the degree of liver damage and dysregulation of almost all types of metabolism.

Heterogeneity of abdominal obesity in patients with cardiovascular diseases

Aim: To assess the content of visceral adipose tissue (VAT) in patients with abdominal obesity and its relationship with metabolic disorders.Material and methods. Patients with abdominal obesity (n=107) were included in the study. All participants had an assessment of anthropometric parameters (height, weight), calculation of body mass index (BMI), proportion of total adipose tissue and VAT (bioimpedance analyzer), high-density lipoprotein cholesterol (HDL-c) levels, triglycerides, fasting blood glucose, epicardial thickness adipose tissue (two-dimensional echocardiography).Results. The median share of VAT (bioimpedance method) was 13%. Patients with abdominal obesity are divided by VAT into 2 groups: ≥14% or ≤13%. Patients with VAT≥14% had significantly higher levels of triglycerides (1.76 [1.27; 2.38] mmol / L) and glucose (6.33 [5.78; 7.87] mmol / L), and below HDL-c levels (0.95 [0.85; 1.21] mmol / L) compared with patients with VAT≤13% (1.32 [1.02; 1.50], 5.59 [5, 11; 6.16] and 1.31 [1.07; 1.58] mmol / L, respectively; p<0.001 for all three comparisons). A significant correlation was found between VAT and triglyceride, glucose and HDL-c levels (r=0.40; r=0.40; r=-0.31, respectively; p<0.001).Conclusion. Persons with abdominal obesity are heterogeneous in the proportion of VAT. The proportion of VAT above the median is associated with metabolic disorders that are significant for the development and progression of atherosclerosis. An increase in BMI in obese individuals is not associated with an increase in VAT and an increase in the severity of metabolic disorders.

Modern methods for adhesive bowel obstruction diagnosis

Topicality.Adhesive intestinal obstruction is a common disease in abdominal surgery with a significant increase from year to year. During the last 20 years, the frequency of cases of adhesive intestinal obstruction (SCN) has increased by 2 times and has no tendency to decrease. In the UK, small bowel obstruction was an indication for 51% of all emergency laparotomies. Scott et al. reported seven emergency surgeries, accounting for 80% of all hospital admissions, morbidity, mortality, and health care costs in relation to general surgery in the United States. These seven operations included partial colectomy, small bowel resection, cholecystectomy, peptic ulcer surgery, adgeolysis, appendectomy, and laparotomy. Adhesive intestinal obstruction of the small intestine was the most frequent diagnosis in the behavior of four out of seven surgical interventions (partial colectomy, resection of the small intestine, adgeolysis and laparotomy). Postoperative adhesive processes are the main cause of small intestine obstruction, accounting for 60% of cases. Among all cases of intestinal obstruction, acute small intestine is 64.3–80%, while having a severe course and a worse prognosis. This causes a high mortality rate in this pathology. It ranges from 5.1% to 8.4%, occupying a leading place among all urgent diseases.The purpose of the studywas to evaluate various modern methods of diagnosing adhesive intestinal obstruction.Material and methods.In this study, the method of classical analysis of domestic and foreign literature was applied, based on current data on the diagnosis of adhesive intestinal obstruction.Results.Historically, there has been a certain algorithm for examining patients arriving with suspected adhesive intestinal obstruction, which includes: complaints, anamnesis of the disease and life, objective status, as well as additional diagnostic methods. Patients with OCD usually present a wide range of complaints, such as nausea, vomiting and periodic abdominal pain. Nausea and vomiting follow the appearance of pain and are an early sign of proximal adhesive OCN. However, clinical symptoms are only partially able to diagnose adhesive intestinal obstruction. Laboratory data are of little significance in the diagnosis of intestinal obstruction, but they help to determine the presence and severity of metabolic disorders, homeostasis disorders, as well as to indicate possible starngulation. For the diagnosis of OCN, OBP survey radiography is routinely used. Computed tomography (CT) has a higher sensitivity and specificity compared to abdominal X-ray examination and is recommended by the Bologna Guidelines. Ultrasound examination (ultrasound) is increasingly used in the diagnosis of OCD. Ultrasound is a relatively simple inexpensive non-invasive imaging method that is devoid of radiation exposure, but depends on the operator's experience. To minimize the effects of ionizing radiation in children and pregnant women, magnetic resonance imaging is an effective alternative to computed tomography for intestinal obstruction.Conclusion.The problem of adhesive intestinal obstruction remains highly relevant, given the prevalence of the disease and high mortality rates. Currently, new promising methods for diagnosing this disease, including biomarkers and high-tech methods for visualizing the pathological process, such as computed tomography and magnetic resonance imaging, are acquiring high importance. At the same time, one should not forget about the routine research methods – X-ray of the abdominal cavity and classical methods of examining the patient – collecting complaints, anamnesis and determining the objective status.

INFLUENCE OF GENDER, AGE AND METABOLIC FACTORS ON THE COURSE OF ARTERIAL HYPERTENSION IN PATIENTS WITH METABOLIC SYNDROME

According to the World Health Organization, more than 2.1 billion adults are overweight, while about 600 million are obese. Arterial hypertension is a component of the complete metabolic syndrome, its severity, the possibility of effective correction depends on the severity of metabolic disorders in the patient.
 The aim of our study was to study age, sex and metabolic parameters affecting the course of AH in MS in order to optimize therapy for patients with MS.
 Material and methods. The study included 316 patients with hypertension and metabolic syndrome aged 35 to 65 years. The average age of the patients was 51.8 ± 6.4 years. In total, 154 (48.73%) women and 162 (51.27%) men were examined. The patients were divided into three age groups: group 1 – patients aged 35-44 years, group 2 – from 45 to 54 years old, group 3 – from 55 to 65 years old. Clinical examination of patients included a clinical-anamnestic method (collection of complaints and anamnesis, examination) and work with medical records.
 The diagnosis of metabolic syndrome was verified based on the recommendations of the All-Russian Scientific Society of Cardiology (VNOK, 2009) if the patient had one main and at least two additional criteria.
 The main criterion for MS was the “central” (abdominal) type of obesity; additional signs – arterial hypertension; increased TG levels; a decrease in the level of HDL cholesterol; an increase in the level of LDL cholesterol; an increase in fasting plasma glucose; impaired glucose tolerance.
 For statistical processing of the research results, the Statistica for «Windows 10.0» software package was used.
 Results. The development of hypertension in different age groups depends on a combination of various factors that are interrelated with age-related changes in the cardiovascular system and metabolic parameters, which in general characterizes the features of its clinical course. MS itself has a significant impact on the development of hypertension.
 Conclusion. The comorbidity of obesity and the development of severe hypertension was revealed: there is an increase in the severity of hypertension with an increase in the degree of obesity. Age and obesity are both predictors of severe hypertension in MS. According to the predictive model, the following factors: male gender, with increasing age and degree of obesity, increases the likelihood of developing severe hypertension in MS. A comprehensive analysis of the total significance of risk factors, symptoms of target organ damage, taking into account age and gender factors, will make it possible to verify the individual variant of hypertension in MS, which will optimize the therapy of such patients and ensure a decrease in cardiovascular risk.

The hemostatic parameters in pregnant women with different types of diabetes mellitus

BACKGROUND: The prevalence of diabetes mellitus (DM) in pregnancy is on the rise. Despite that gestational hypercoagulability is a physiological condition, diabetic pregnancy is associated with a high risk of venous thromboembolic complications (VTEC). There are many surveys related to the hemostatic parameters in non-pregnant women, but studies in pregnant women are not enough.AIMS: To assess the coagulation and vascular-platelet hemostasis parameters in pregnant women with various types of diabetes mellitus, taking into account its correction method. The data were compared with these indicators in women with preeclampsia and healthy pregnant women at the same gestational age.MATERIALS AND METHODS: An observational, single-center, retrospective cohort study was carried out at D.O. Ott ­Research Institute of Obstetrics, Gynecology, and Reproductive Medicine. The study included 1994 pregnant women who presented several groups taking into account the type of DM and its correction method, a group of women with preeclampsia (PE), and healthy women. The analysis of clinical data was carried out at 28–32 gestational weeks from 2012 to 2017. The study’s primary endpoint was taken as indicators of fibrinogen content, prothrombin index, thrombin time, activated partial thromboplastin time (APTT), and international normalized ratio (INR) antithrombin III, D-dimer, von Willebrand factor, and fibronectin. Additionally, the incidence of VTEC during pregnancy and within six weeks after delivery, gestational arterial hypertension, preeclampsia, fetal growth restriction, premature birth, and stillbirth cases was assessed.RESULTS: in pregnant women with various types of diabetes mellitus and preeclampsia, a state of pathological hypercoagulation was observed compared to the control group. These changes were characterized by an increase and activation of the following blood parameters: fibrinogen, the degree and rate of platelet aggregation, D-dimer, homocysteine, von Willebrand factor, and fibronectin. At the same time, the content of antithrombin III was significantly reduced in patients with DM. Correlation analysis established a direct relationship between the range of the studied factors with the degree of glycemic control and the frequency of obstetric complications.CONCLUSIONS: Diabetes mellitus in pregnancy is associated with a hypercoagulation condition and overexpression in the synthesis of endothelial dysfunction markers. Moreover, the severity of these processes depends on the type of DM and the severity of metabolic disorders. In diabetic pregnancy, exceptional attention to coagulation indicators, regular monitoring, and preventive treatment is required in order to improve the perinatal outcomes.

BLOOD CORTISOL CONCENTRATION, HEMODYNAMICS AND METABOLISM OF PATIENTS WITH SECONDARY HYPERPARATHYROIDISM, POSSIBILITIES OF PERIOPERATIVE CORRECTION

Secondary hyperparathyroidism (SHPT) affects a majority of patients with chronic kidney disease (CKD) of stage 3 or worse with manifestations of chronic renal failure (CRF) who undergo hemodialysis. Most of them have severe metabolic disorders, metabolic acidosis and a range of disorders associated with hyperparathyroidism and require parathyroid surgery (PTS). Aim of research. To assess the possibilities of metabolic correction in patients with SHPT with PTS, depending on the level of blood cortisol. Materials and methods. The study was carried out in the clinic of SIS «RPC PCM» SAD, Kyiv, Ukraine, was prospective, not randomized. The study group (n=133) included patients with severe SHPT manifestations due to end-stage chronic renal failure due to CKD, who underwent PTS. Patient age: 21-75 years old. Men – 69 (51,9%), women – 64 (48,1%). The degree of preoperative risk of ASA III-IV. Surgical interventions were performed under general anesthesia using the inhalation anesthetic sevoflurane and the narcotic analgesic fentanyl under conditions of low-flow artificial ventilation. The patients underwent a personalized energy monitoring developed and implemented in our clinic, using indirect calorimetry, by determining the index of current metabolism (Metabolic Rate Index, MRI, cal min-1 m2 ), basal metabolism (Basal Metabolic Rate Index, BMRI, cal min-1 m2), target metabolism (Target Metabolic Rate Index) and severity of metabolic disorders (Metabolic Disordes, MD,% = ). The patients were divided into two groups. The first group (I,72) consisted of patients who had reference values of the morning blood cortisol level before the operation – 171,03 and higher (173-374) nmol/L. The second group (II, 61) consisted of patients who had cortisol levels below this limit (91,5-168 nmol/L). In group I, intensive perioperative therapy was standard and aimed at supporting and correcting vital signs, according International Standards for a Safe Practice of Anesthesia 2010, WFSA. In group II, patients additionally received intravenous drip of 125-250 mg of prednisolone and further situationally hydrocortisone under the control of energy monitoring indicators. Results. In 45.9% of patients with SHPT and end-stage CKD, glucocorticoid insufficiency and low metabolic rate were diagnosed, which can lead to irreversible changes in organs or the life support system and increase the risks of perioperative complications and death in PTS. Preventive and perioperative administration of glucocorticoids under the control of energy monitoring, restores homeostasis indicators. Patients with normal blood cortisol levels did not have significant metabolic disorders. It was enough for them to follow the standard protocol of perioperative intensive care. Conclusions. Mandatory preoperative monitoring of blood cortisol levels in patients with SHPT against the background of end-stage CKD, who are on programmed hemodialysis, who are planned for PTS, is required in order to achieve a differential approach to treatment: to determine the need and dose of intravenous glucocorticoids.

Рання діагностика гіпотиреозу як фактора прогресування остеоартрозу та коморбідних процесів, особливості фітокорекції

Мета: вивчити поширеність і форми гіпотиреозу у хворих на остеоартроз (ОА) та дослідити вплив фітозасобу зобофіт на функціонально-морфологічний стан щитоподібної залози, прояви коморбідних захворювань, оксидантний статус, фібринолітичну і протеолітичну активність крові. Матеріал і методи. У 312 хворих на ОА досліджено прояви коморбідних процесів і серед них — явища гіпотиреозу. Використовували клінічні, біохімічні, радіоімунологічні, ультразвукові методи. Результати. У всіх хворих на ОА після 50 років відзначаються зростаюча кількість і вираженість коморбідних процесів. Серед них у 4,48 % виявлено маніфестний і у 13,78 % — субклінічний гіпотиреоз. Ознаки гіпотиреозу спостерігаються в осіб після 55, особливо 60 років. Субклінічний гіпотиреоз незначно погіршував клінічну симптоматику ОА та коморбідних процесів, але посилював явища оксидативного стресу, зниження фібринолітичної і підвищення протеолітичної активності крові, погіршення швидкості клубочкової фільтрації нирок. Зазначене розглядається як неспецифічна патофізіологічна основа прогресування виявлених хвороб. Тримісячне застосування фітозасобу зобофіт у більшості пацієнтів нормалізувало тиреоїдний гомеостаз, покращило загальні результати лікування основного і коморбідних захворювань, зменшило вираженість метаболічних порушень. Висновки. У хворих на ОА у віці старше 50 років і з високим рівнем коморбідності необхідно здійснювати скринінг на гіпотиреоз. При виявленні ознак субклінічного гіпотиреозу в такого контингенту хворих доцільно застосування полікомпонентних фітозасобів із різноплановою тиреоїдотропною дією.

Male infertility, metabolic syndrome and obesity

The review article is devoted to the current understanding of the mechanisms that can have a negative impact on the reproductive function of men with metabolic syndrome and obesity. The article presents the results of clinical studies proving the existence of a relationship between the severity of metabolic disorders, copulatory activity, ejaculate parameters, the likelihood of pregnancy, as well as the health of the offspring.

Contribution of adipoq genetic polymorphism to the formation and course of comorbidity of non-alcoholic fatty liver disease and renoparinchemal arterial hypertension

Introduction. Nowadays nonalcoholic fatty liver disease (NAFLD) consider as multisystem disease that is primarily associated with components of the metabolic syndrome and is associated with cardiovascular and renal impairment. The comorbidity of NAFLD with renoparenchymal arterial hypertension (RPAH) has not been sufficiently studied. The purpose of the study was to investigate the influence of G276T genetic polymorphism of ADIPOQ on the severity of metabolic disorders, inflammation, liver, artery and kidney damage in the comorbidity of NAFLD and RPAH. Materials and methods. The study included 87 patients with comorbidity of NAFLD and RPAH, grade 2. The mean age of patients was 50.78 ± 9.35 years. The vast majority of patients were overweight or obese. The control group was composed of 20 healthy volunteers. Parameters of carbohydrate and lipid metabolism, liver and kidney’s function, adiponectin, fetuin-A, cytokeratin-18, pro-inflammatory cytokines levels were investigated. For diagnostic of non-alcoholic steatosis and indication parameters of arteries, an ultrasound method was used. Results. It was found that the T allele was detected in 62 (35.6%) patients of the main group, which was significantly (p<0,05) different from the control group (22.5%). In the presence of patients with comorbidity NAFLD and RPAH G/T and T/T genotypes, carbohydrate metabolism disorders are more pronounced than in the G/G genotype. Thus, index HOMA in this group was 4.52 ± 0.87, which was significantly higher than patients with G/G genotype - 3.77 ± 0.53 (p <0.01).The G276T polymorphism of the ADIPOQ is not associated with markers of liver and kidney damage in patients with NAFLD + RPAH. The presence of G/T and T/T genotypes in patients with comorbidity of NAFLD and RPAH is associated with an increase in interleukin-6 and fetuin-A compared to the G/G genotype. Patients with comorbidity of NAFLD + RPAH and with the T allele of the polymorphic marker G276T of the ADIPOQ gene are more likely to have impaired endothelium-dependent vasodilation, indicating more significant vascular reactivity disorders - 7.72 ± 1.25% for the genotype G/G, and 7.00 ± 1.10% for the genotype G/T (p <0,01). Conclusions. The presence of the T allele of the polymorphic marker G276T of the ADIPOQ is associated with the development of comorbidity of NAFLD and RPAH.

Особенности состояния коагуляционного и сосудисто-тромбоцитарного звена гемостаза у беременных с различными типами сахарного диабета

BACKGROUND: The prevalence of diabetes mellitus (DM) in pregnancy is on the rise. Despite that gestational hypercoagulability is a physiological condition, diabetic pregnancy is associated with a high risk of venous thromboembolic complications (VTEC). There are many surveys related to the hemostatic parameters in non-pregnant women, but studies in pregnant women are not enough. AIMS: To assess the coagulation and vascular-platelet hemostasis parameters in pregnant women with various types of diabetes mellitus, taking into account its correction method. The data were compared with these indicators in women with preeclampsia and healthy pregnant women at the same gestational age. MATERIALS AND METHODS: An observational, single-center, retrospective cohort study was carried out at D.O. Ott ­Research Institute of Obstetrics, Gynecology, and Reproductive Medicine. The study included 1994 pregnant women who presented several groups taking into account the type of DM and its correction method, a group of women with preeclampsia (PE), and healthy women. The analysis of clinical data was carried out at 28–32 gestational weeks from 2012 to 2017. The study’s primary endpoint was taken as indicators of fibrinogen content, prothrombin index, thrombin time, activated partial thromboplastin time (APTT), and international normalized ratio (INR) antithrombin III, D-dimer, von Willebrand factor, and fibronectin. Additionally, the incidence of VTEC during pregnancy and within six weeks after delivery, gestational arterial hypertension, preeclampsia, fetal growth restriction, premature birth, and stillbirth cases was assessed. RESULTS: in pregnant women with various types of diabetes mellitus and preeclampsia, a state of pathological hypercoagulation was observed compared to the control group. These changes were characterized by an increase and activation of the following blood parameters: fibrinogen, the degree and rate of platelet aggregation, D-dimer, homocysteine, von Willebrand factor, and fibronectin. At the same time, the content of antithrombin III was significantly reduced in patients with DM. Correlation analysis established a direct relationship between the range of the studied factors with the degree of glycemic control and the frequency of obstetric complications. CONCLUSIONS: D iabetes mellitus in pregnancy is associated with a hypercoagulation condition and overexpression in the synthesis of endothelial dysfunction markers. Moreover, the severity of these processes depends on the type of DM and the severity of metabolic disorders. In diabetic pregnancy, exceptional attention to coagulation indicators, regular monitoring, and preventive treatment is required in order to improve the perinatal outcomes.

Indicators of metabolic homeostasis in patients with recurrent depressive disorders against diabetes mellitus

Due to high prevalence of depressive disorders in general medical practice, it is not surprising that depression and somatic diseases are often comorbid conditions. Diabetes mellitus (DM) is one of the modern diseases that has a constant tendency to increase. It is known that patients with DM suffer from depression almost three times more often than patients without it. As a result of the presence of depression, the emotional state is disturbed, which quite often leads to the refusal of the patient from the prescribed adequate treatment, and eventually decompensation of DM occurs. In turn, DM causes episodes of depression, which requires the appointment of psychotropic measures and psychotherapy. But to date, there are no works on the state of metabolic homeostasis in the comorbidity of these diseases. The purpose of the study was to determine the state of metabolic homeostasis in patients with recurrent depressive disorders against the background of type 2 DM. We examined 128 patients with recurrent depressive disorder (RDD). All patients were divided into 4 groups. Patients of the first three groups had mild (group I), medium (group II) and severe (group III) degrees of severity of an ongoing RDD episode. In group IV patients, mild RDD was accompanied by type 2 DM. As a result of the study, the patients of all groups were found to have violations of the indicators of metabolic homeostasis in the form of an increase in the intensity of lipoperoxidation processes against the background of a decrease in the indicators of the enzyme link of the system of antioxidant protection, a significant increase in PGF2α and less significant PGE2, pathological changes in the indicators of cyclic nucleotides. These changes were minimal in group I, maximal in group IV, which confirms the significant influence of DM as a comorbid condition on the severity of metabolic disorders in RDD. Keywords: recurrent depressive disorders, lipoperoxidation, antioxidant system, prostaglandins, cyclic nucleotides, diabetes mellitus.

Вплив дисліпідемії і інсулінорезистентності на перебіг гніздової алопеції, асоційованої з метаболічним синдромом

Alopecia areata (AA) is a tissue-specific disease of the hair follicles, manifested by foci of alopecia on a scalp and other areas of skin. The objective of our study was to evaluate the values of blood lipids and carbohydrate metabolism in patients with АА associated with metabolic syndrome (MS) to determine the relationship between disease severity and metabolic disorders. Materials and methods. Clinical and anamnestic characteristics and laboratory values of lipid spectrum and carbohydrate metabolism were analysed in 50 patients with AA associated with MS. Results. As a result of the study, the following regularities have been established: values of blood lipids (cholesterol, triglycerides, high-density lipoproteins) and carbohydrate metabolism (blood glucose, glycosylated haemoglobin, HOMA index) statistically significantly deteriorate with increasing number of the MS components (p <0.05); in patients with mild AA there is a statistically significantly (p <0.05) smaller number of MS components compared with patients with moderate to severe forms (φemp=2,645 < φcr=1,64); HOMA index increases statistically significantly with increasing severity of the disease: by 14.14% in patients with moderate form compared with patients with mild form, and in the presence of severe form by 28.31% compared with patients with moderate and by 46.46% compared with patients with mild forms of AA (p <0.05); the rate of triglycerides in the blood increases statistically significantly depending on the severity of AA: by 36.17% in patients with moderate form and by 41.78% in patients with severe form compared with mild form of AA (p <0.05); the content of high-density lipoproteins in the blood decreases statistically significantly depending on the severity of AA: by 2.12% in patients with moderate form compared with mild form and by 9.53% in patients with severe form compared with moderate form (p <0.05); no relationship has been found between the severity of MS, given the number of its components, and the stage of AA: active and chronic. Conclusions. As a result of the study, the relationship between the severity of AA and the severity of metabolic disorders in the presence of MS in patients has been established. An important area is the study of correction of dyslipidaemia and insulin resistance in a comprehensive therapy of AA associated with MS.

Features of conservative therapy of benign prostatic hyperplasia in patients with metabolic syndrome: "treat to target"

Purpose of the study. To improve the results of treatment of benign prostatic hyperplasia with symptoms of the lower urinary tract in the presence of concomitant metabolic syndrome.Materials and methods. The investigation included 103 patients aged 42 to 75 years with a reliable diagnosis of BPH and signs of MS, according to the criteria of GFCF (2009). Patients were randomized into two comparable groups: Group 1 included 52 men who were prescribed tamsulosin in combination with targeted correction of metabolic disorders; Group 2 consisted of 51 men who were prescribed tamsulosin monotherapy. After 6 and 12 months of the study, the dynamics of metabolic parameters, prostate volume, residual urine volume, maximum urine flow rate, and total IPSS and QoL score were evaluated in each group of patients.Results. A direct correlation was established between the severity of metabolic disorders and the progression of BPH /LUTS in the main assessed indicators. The use of combination therapy with metformin, ACE inhibitors / ARA and statins in combination with tamsulosin showed efficacy after 6 and 12 months of the study compared with tamsulosin monotherapy. The treatment is based on the rinciple of T2T ("Treat to Target"): maintaining target levels of blood pressure, glucose, blood lipid parameters, and body weight correction.Conclusion. Overweight, arterial hypertension, the atherogenic profile of dyslipidemia and hyperglycemia are risk factors for more pronounced progression of BPH / LUTS and a deterioration in the quality of life of patients. The investigation IMSYPA showed the effectiveness of pathogenetically based complex therapy aimed at eliminating metabolic imbalance.

Metabolic Disorders in Delirious Syndrome in Patients with Acute Poisoning with Gamma-Hydroxybutyric Acid and its Precursor

Abstract In 21 male patients aged 20 to 40 years, metabolic disorders in post-toxic delirious syndrome caused by gamma-hydroxybutyric acid poisoning and its precursors were studied. In the examined group of patients, hyperammonemia was detected in 71.4% of cases, metabolic lactic acidosis was revealed in 76.2%. The direct correlation between the severity of metabolic disorders and delirious syndrome according to DRS-R-98 scale was established. The statistically significant increase in capillary blood levels of lactate on day 3 of psychotic period was 4.9 mlmol/L and ammonia on day 5 was 187.0 mmol/L. The greatest severity of metabolic disorders was found in patients over the age of 27 years who systematically use the studied substances with narcotic effects for 7 months or more and combine their intake with other psychoactive substances.

Вплив поліморфізму гена адипонектину на тяжкість метаболічних порушень та деякі печінкові показники у пацієнтів з неалкогольною жировою хворобою печінки у поєднанні з гіпертонічною хворобою

Вплив поліморфізму гена адипонектину на тяжкість метаболічних порушень та деякі печінкові показники у пацієнтів з неалкогольною жировою хворобою печінки у поєднанні з гіпертонічною хворобою

Влияние степени выраженности метаболических нарушений на диаметр конкрементов в желчном пузыре: клинико-инструментальные и лабораторные данные

Влияние степени выраженности метаболических нарушений на диаметр конкрементов в желчном пузыре: клинико-инструментальные и лабораторные данные

Immunological markers of alimentary-induced hyperlipidemia in Wistar rats

Changes in plasma levels of the main groups of cytokines and adipokines may correlate with the severity of metabolic disorders in hyperlipidemia and obesity. The aim of the study was to assess the significance of ghrelin, leptin, their ratio (L/Gh), and the cytokine profile as biomarkers at dietary-induced hyperlipidemia. Material and methods. We used 48 female Wistar rats with an initial body weight of 123±1 g, which were divided into 6 groups. Group 1 (control) received a balanced semi-synthetic diet according to AIN93; group 2 - diet with excess fat (30% by weight); group 3 - a diet with the addition of 20% fructose solution instead of drinking water, group 4 - a diet with excess fat and fructose, group 5 - a diet with added cholesterol (0.5%), group 6 - a diet with cholesterol and fructose. On the 64th day of the experiment, the mass of internal organs was determined; the levels of cytokines and adipokines in blood plasma were measured by multiplex immunoassay. Results and discussion. A decrease in the level of leptin was found in group 5 compared with the control and with groups 2, 4 and 6 groups (p<0.05). The lowest level of ghrelin was found in group 2 (p<0.05) against the background of high concentrations of leptin. Significant correlations were found between L/Gh and the total mass of animals (r=0.321; р=0.034), the relative mass of adipose tissue (r=0.439; р=0.003) and with the relative mass of the spleen (r=-0.460; р=0.003). In group 2, at the maximum L/Gh ratio, a significantly higher weight of adipose tissue was found, whereas in groups 3 and 5, at the lowest L/Gh ratio, the relative amount of total fat was the lowest. L/Gh ratio correlated with the level of monocyte chemotactic protein-1 (MCP-1), RANTES, IL-18 and macrophage colony-stimulating factor (M-CSF). The concentrations of IL-17, IL-18, IL-4, IL-5, MIP-3a, IFN-γ, M-CSF and RANTES in the experimental groups were reduced compared with the control, with the most pronounced effect in group 5 together with the lowest L/Gh ratio. Conclusion. The presence of a significant correlation between L/Gh ratio and changes in the weight of rats' body, spleen, adipose tissue, as well as levels of cytokines involved in inflammation regulation, confirms the importance of L/Gh ratio as a biomarker in an in vivo model of dyslipidemia.