Vol 30, No 3 (2023)

Cardiovascular diseases (CVD) of atherosclerotic genesis still remain the leading cause of death and disability among the population of many countries of the world. The key to reducing the risk of developing cardiovascular complications and adverse outcomes in patients with CVD is the control of cardiovascular risk factors. The article discusses the prevalence and significance of CVD risk factors. A significant increase in the prevalence of such CVD risk factors as type 2 diabetes and overweight/obesity is emphasized. In real clinical practice, doctors are faced with various disorders of lipid metabolism. Dyslipidemia is recognized as a leading risk factor for atherosclerosis. Therapeutic targets of lipid-lowering therapy, optimal values of lipid parameters depending on the risk category, issues of lipid-lowering therapy are discussed. The mechanisms of action of statins and fibrates have been disclosed. The strategy of combined lipid-lowering therapy is considered as a way to reduce residual risk. Simplification of therapeutic regimens using a fixed combination of rosuvastatin and fenofibrate increases patient adherence to treatment and its outcome.

The novel coronavirus infection (COVID-19) pandemic has been declared by the WHO as a public health emergency of international concern around the world. The results of numerous studies have convincingly shown that the impact of SARS-CoV-2 extends not only to the respiratory system, but also to other organs and systems, which significantly affects the prognosis of the disease. This review presents research data on the role of SARS-CoV-2 in the development of thyroid diseases, including subacute thyroiditis, diffuse toxic goiter, euthyroid pathology syndrome, chronic thyroiditis with impaired thyroid function. The pathogenesis of endocrine damage in COVID-19 remains unexplored. In addition to the direct cytopathogenic effect of the virus on the thyroid tissue, great importance is attached to the development of an immunoinflammatory syndrome, impaired immune tolerance, and the effect of anticoagulant, antiviral, and anticytokine therapy. Viral damage also affects the central links of endocrine regulation, violating the mechanisms of hypothalamic-pituitary-thyroid regulation. Autoimmune disorders in genetically predisposed persons are considered as one of the main mechanisms of thyroid dysfunction. In addition, a number of thyroid diseases can worsen the course and prognosis of COVID-19. The article discusses the reasons for the development of thyroid dysfunction due to currently known mechanisms of the damaging effect of SARS-CoV-2. The analysis of the accumulated experience in managing patients with COVID-19 presented in the review open the way to develop effective recommendations for the prevention and treatment of thyroid diseases in patients infected with the SARS-CoV-2 virus.

The review article discusses the main problematic issues of the epidemiology, etiology, and pathogenesis of amiodarone-induced thyrotoxicosis (AmIT). The effect of iodine on the thyroid gland (TG) is described in detail. Particular attention is paid to the pathogenetic aspects of the development of this type of thyrotoxicosis. Issues of «type specificity» of thyroid dysfunction caused by amiodarone are discussed. The complex issues of differential diagnosis of the 1st and 2nd types of AmIT are considered. The problem of identifying the so-called mixed type is discussed. Various innovative approaches to therapy including first-line agents with or without consideration for the pathogenetic AmIT type are compared. The indications for radical treatment of this type of thyrotoxicosis are specified. The issues of cancellation and re-appointment of amiodarone and the algorithm of actions in this type of thyropathies are discussed.

The pathological combination of arterial hypertension with atherogenic dyslipidemia, obesity, impaired glucose tolerance or type 2 diabetes mellitus creates the basis for the rapid development of atherosclerosis, significantly increases cardiovascular morbidity and mortality. In Russia, at least 2 components of the metabolic syndrome are present in 40% of the population. Many of the manifestations of the metabolic syndrome are reversible at the initial stages. Early diagnosis, successful and timely treatment are the most important components in the prevention of cardiovascular accidents, improving the quality and life expectancy, and maintaining reproductive potential. In this regard, all available opportunities for improving the condition of patients should be considered using both rational pharmacotherapy and the most effective non-drug methods. In particular, the use of balneotherapy in complex treatment regimens can contribute to the normalization of carbohydrate and lipid metabolism.

Diabetes mellitus (DM) is one of the most common diseases of the 21st century. An important option for effective treatment of diabetes is self-monitoring of glycemia by the patient at home. The article discusses modern means of monitoring glycemia using a mobile application that provides remote control of diabetes. The problem of self-control of DM in the modern world does not lose its relevance. Guidelines for the management of diabetic patients are updated annually. New approaches to self-monitoring of glycemia are being developed, innovative glucometers such as system with a mobile application are being introduced.

Background. Acromegaly is a heterogeneous disease combining many histological subtypes of somatotrophic tumors which differ in clinical and pathological manifestations, final size, development scenario, immunological profile, and sensitivity to treatment.

Objective. Comprehensive clinical, morphological and radiological stratification of somatotrophic tumors in order to clarify the tumor morphotype and predict the success of the proposed treatment.

Methods. We examined 82 patients with acromegaly who underwent non-radical adenomectomy and received 1st generation somatostatin analogues (SA1) for a long time. The results of treatment were compared with the clinical, immunophenotypic and radiological features of somatotrophic tumors.

Results. It was found that densely granulated somatotrophic tumors (DGST) were characterized by a pronounced expression of the 2nd subtype somatostatin receptors (SR) and good sensitivity to SA1, while sparsely granulated somatotrophic tumors (SGST) were larger, with low expression of the 2nd subtype SR and resistance to SA1. During radiological examination, DGST and SGST showed comparative hypo- or hyperintensity of the tumor signal on T2-weighted MRI. Based on the results of SA1 treatment, biochemical remission was achieved in patients with DGST, while disease activity remained in patients with SGST.

Conclusion. The results of the work confirm the existence of fundamental clinical, morphological and radiological differences between DGST and SGST, as well as the need for a differentiated approach to the pharmacotherapy of acromegaly. The magnitude of the decrease in insulin-like growth factor-1 after 3–6 months of treatment of more than 55% of the initial level was an additional predictor of the long-term effectiveness of SA1. The introduction of the indicator of the relative intensity of the tumor signal on T2-weigthed MRI into clinical practice will improve the diagnosis of acromegaly and optimize the treatment strategy.

Background. Insomnia and metabolic disorders often accompany the use of glucocorticosteroids (GCS). It has been shown that melatonin receptor gene polymorphisms are associated with the listed abnormalities. Previously, associations of polymorphic MTNR1A, MTNR1B variants with insomnia and metabolic changes during GCS therapy have not been determined.

Objective. Evaluation of the association of single nucleotide polymorphisms of the melatonin receptor genes MTNR1A (rs34532313), MTNR1B (rs10830963) with the occurrence of insomnia, the severity of insomnia and metabolic disorders during corticosteroid pulse therapy in patients with multiple sclerosis.

Methods. Patients diagnosed with MS receiving corticosteroids for exacerbation were examined. Fasting blood glucose, lipid profile, and insomnia severity index were monitored before and after therapy. In all patients, MTNR1A (rs34532313) and MTNR1B (rs10830963) gene polymorphisms were determined using real-time polymerase chain reaction. Statistical analysis was performed using the StatTech v. 3.0.9.

Results. The study included 80 patients (71.2% women), mean age 36.26±10.03 years, duration of multiple sclerosis 6 (2.75–10.00) years. A statistically significantly higher level of total cholesterol after GCS (P=0.025), low-density lipoprotein levels before and after GCS therapy (P=0.023 and P=0.010, respectively) were found in the carriers of the G allele rs10830963. Insomnia was more often observed during corticosteroid therapy among patients with CG and GG genotypes (P<0.001), more severe sleep disorders during corticosteroid therapy (P=0.002) were also observed in carriers of the G allele rs10830963 of the MTNR1B gene. The association of rs34532313 MTNR1A with the above parameters was not confirmed.

Conclusion. Carrying the allele G rs10830963 of the MTNR1B gene is associated with insomnia, more severe sleep disorders during corticosteroid therapy, and lipid metabolism disorders. The identified associations may help in further study of the effect of melatonin on the development of metabolic and sleep disorders against the background of corticosteroid therapy.

Background. The present study is aimed at evaluation of the occurrence of postpartum (postoperative) infection by analyzing the information content of its predictors in patients with a somatic burden for the subsequent development of recommendations for treatment and prevention.

Objective. Assessment of the prevalence and structure of metabolic and endocrine diseases in puerperas with endometritis after caesarean section to determine their prognostic value as an independent predictor of the development of postoperative infectious and inflammatory complications.

Methods. A retrospective study of case histories and data from primary medical documentation of 406 puerperas with endometritis after caesarean section was carried out.

Results. The prevalence of pregravid obesity in puerperas with endometritis was 21.4% (every fifth patient with a BMI ≥30.00 kg/m²). Approximately with the same frequency (20.4%), various disorders of carbohydrate metabolism were diagnosed, gestational diabetes mellitus prevailed in their structure (78.3%). Obesity complicated the course of pregnancy 1.7 times more often in puerperas with endometritis compared with puerperas with an uncomplicated postoperative course (21.4 vs. 12.4%; χ²=8.36; P=0.004), and carbohydrate metabolism disorders – by 2.2 times (20.4 vs. 9.1%; χ²=14.391; P<0.001).

Conclusion. Concomitant metabolic diseases are significant predictors of the development of postoperative infectious and inflammatory complications in obstetrics.

The review presents the history of the development of ideas about the role of microangiopathy in pathogenesis of the chronic diabetes complications. The tendency to shift the focus from the study of morphological changes to functional disorders of neurological regulation is demonstrated. Modern views on the pathology of microcirculation in diabetic patients are presented. The main functional tests for the study of neurocirculatory regulation with their application in clinical practice are described.

Background. Modern approaches to the therapy of diabetes mellitus (DM) involve the assessment of the success of therapy and glycemic control by the glycated hemoglobin level. Recently, however, the assessment of glycemic variability (GV) has become of great importance. Previously, assessment of GV required continuous monitoring of glycemia. Currently, such a tool as a of glycemic variability diary (GVD) is available.

Description of case series. Five clinical cases of patients with decompensated DM2 are presented. All patients underwent an assessment of glycemic control according to GVD before and after changing therapy. GVD that makes it possible to assess the efficacy and safety of DM therapy, and glycemic variability is used as an independent risk factor for the development of severe hypoglycemic conditions, diabetic micro- and macroangiopathy [1].

Conclusion. GVD has proven to be effective and important in the outpatient setting. The improvement of carbohydrate metabolism compensation when switching to ultra-long-acting insulin degludec with an increase in the time spent in the target glycemic range, a decrease in glycemic variability has been clearly demonstrated.

Background. The practical interest in the mild form of primary hyperparathyroidism (PHPT) is attributable to the asymptomatic course of the disease and the difficulty of timely diagnosis due to the lack of a widespread study of the blood calcium level. In some cases, the detection of a normocalcemic variant of the mild form of PHPT can be considered as an early diagnosis of overt PHPT.

Description of the clinical case. The article considers a clinical case of diagnosis of normocalcemic variant of PHPT in a 42-year-old woman.

Conclusion. The initial stages of PHPT and mild forms are asymptomatic, patients rarely complain, which often leads to slowly progressive irreversible changes in a number of organs and systems: in the kidneys, causing the possible development of renal failure; in the gastrointestinal tract (GIT) with recurrent erosions and ulcers; in the bone skeleton with development of osteopenia and osteoporosis and, as a result, to a decrease in the quality of life and disability. The description of this clinical case demonstrates the importance of routine determination of calcium levels and vitamin D concentrations in the absence of complaints.