No 5 (2017)

8-9 июня 2017 г. во Владивостоке в стенах Тихоокеанского государственного медицинского университета прошел I Съезд терапевтов Дальневосточного федерального округа. Организаторами мероприятия являлись Российское научное медицинское общество терапевтов (РНМОТ), Министерство здравоохранения РФ, Комитет по социальной политике Совета Федерации, Общество врачей России, Департамент здравоохранения Приморского края, Тихоокеанский государственный медицинский университет (ТГМУ), РОО «Амбулаторный врач», Общественная организация врачей первичного звена Приморского края при участии Международного общества внутренней медицины (ISIM), Европейской федерации внутренней медицины (EFIM) и Евразийской ассоциации терапевтов (ЕАТ).

Aim. To study parameters of ß-cell secretory activity and peripheral insulin resistance in DM2 patients received dapagliflozin. Materials and methods. 27 patients with uncontrolled DM2 were included in our study. HOMA-B was calculated as 20 x fasting insulin {μIU/ml}/FG {mmol/l} - 3.5 in group of patients without insulin therapy (n=14). Insulin resistance was estimated by the HOMA-IR index, where HOMA-IR=fasting insutin x FPG/22.5 in all patients. Data were analysed using Statistica. Data were expressed as mean±standard deviation. Results. There were 33.3% men and 66.6% women. The average age was 55.14±2.52 year old. The average BMI was 35.11 ± 1.19 kg/m2. DM2 duration was 11.1±1.2 years. FPG was 12.4±0.5 mmol/l. HbA1c was 10.3+0.3%. At baseline, HOMA-B was 40.80+10.12 and HOMA-IR was 12.27±1.24. All patients received dapagliflozin 10 mg once daily during one year. FPG and HbA1c levels were decreased to 7.74±0.31 mmol/l and 8.9±0.2%, representively. Weight was decreased by 6.02±9.91 kg. Systolic and diastolic BP levels were decreased by 12.6 mmHg (p=0.0002) and 5.0 mmHg (p=0.017), representively. HOMA-B was increased to 59.7±13.4 (p=0.007). HOMA-IR was decreased to 5.42±0.79 (p=0.0004).

Obesity is a chronic disease associated with a variety of other diseases: type 2 diabetes, atherosclerosis, hypertension, ischemic heart disease, stroke, etc. Modern principles of diagnosis and treatment of obesity are presented, emphasizing the importance of an integrated approach to examination of patients with this condition, a targeted search for possible complications and early intensification of treatment, if necessary, including surgical treatment according to indications.

The article describes the clinical case of addisonian crisis in a female patient with previously undiagnosed primary chronic adrenocortical insufficiency. The authors present brief information about chronic adrenocortical insufficiency, emphasizing the gradual development of the disease and the probability of its late diagnosis only when the addisonian crisis develops in the patient. In support of this thesis, the case of diagnosis of primary hypocorticism in a female patient admitted to the intensive care unit with symptoms of an addisonian crisis is described. The authors describe the medical case history and the course of examination, which resulted in the diagnosis of chronic autoimmune thyroiditis with hypofunction. Replacement and rehydration therapy as well as the results of treatment are described in detail. The analysis of the discussed case, and the recommendations on diagnostics in similar clinical situations are presented.

The authors consider the rote of arterial hypertension in the development of vascular complications in patients with type 2 diabetes mellitus and the features of its manifestations in this category of patients. The description of methods for assessing cardiovascular risk in arterial hypertension in DM2 patients is presented. The methods for detecting asymptomatic lesion of target organs in arterial hypertension against the background of DM2 are described in detail. Separately, methods for assessing the state of the myocardium, coronary and peripheral blood flow, and renal function are considered. The evaluation of the prognostic value of EchoCG, stress-echography, perfusion scintigraphy, carotid ultrasound, ankle-brachial index, and pulse wave velocity for evaluating the thickness of the intima-media complex is discussed. The authors separately focus on the methods of assessing blood pressure, highlighting the role of 24-hour blood pressure monitoring for determining the BP variability, the magnitude of sleep-time decline and morning BP surge, and also consider the effect of various types of disturbance of the 24-hour BP profile on the risk of cardiovascular complications in DM2 patients.

Metabolic syndrome (MS) is a complex of metabolic disorders, leading to an increased risk for cardiovascular diseases and diabetes. MS components include abdominal obesity, arterial hypertension, specific disorders of lipid and carbohydrate metabolism. This article presents the results of a systematic analysis of the molecular mechanisms of the action of the peptide components of the Laennec on the pathophysiological components of MS. Laennec peptides counteract development of MS by: 1) increasing cell survival (cytoprotection), 2) restoring the sensitivity of cells to glucose and eliminating insulin resistance, 3) reducing elevated blood pressure, 4) eliminating dyslipidemia, reducing fatty infiltration and restoring liver function, 5) anti-inflammatory and 6) antioxidant action.

The article discusses the challenging issue of differential diagnosis of diseases manifested as fibromyalgia syndrome. The authors describe the "old" and new criteria for the clinical diagnosis of fibromyalgia. It is emphasized that a proficient clinical evaluation to clarify the causes of pain syndrome is of greater importance than additional diagnostic testing. The diagnosis of fibromyalgia can be made in primary care settings using the criteria of the American College of Rheumatology (ACR, 2010), given normal results of physical examination and routine laboratory testing excluding other diseases. The main groups of diseases to consider in the differential diagnosis of fibromyalgia include the following: musculoskeletal and connective tissue diseases, endocrine, gastrointestinal, infectious diseases, cancer, neurological and mental health disorders, iatrogenic pain. Particular attention should be paid to ankylosing spondylitis and myofascial pain syndrome. Problems in treating fibromyalgia are discussed. The authors review the properties of flupirtine (Nolodatak) that help resolve complex diagnostic challenges when it is impossible to rapidly diagnose a disease manifested by pain syndrome.

The article is devoted to Matvey Yakovlevich Mudrov who is the outstanding Russian physician. The authors assess the contribution of M.Ya Mudrova in the development of clinical medicine. The years of work of M.Ya. Mudrov in the St. Petersburg naval hospital, attending lectures of professors of the St. Petersburg Medical-Surgical Academy, and the participation of M.Ya. Mudrov in the fight against the cholera epidemic in St. Petersburg are discussed in detail.