Pub Date : 2024-04-19DOI: 10.22141/2224-0721.20.2.2024.1374
I. Kamyshna, L. Pavlovych, V. Pankiv, A. Khodorovska, O. Bilous, O. Kamyshnyi
Neurological disorders affect a large population, often leading to different levels of disability and resulting in a decreased quality of life. Neurorehabilitation is the process of restoring the functions of the nervous system after injuries, diseases, or other impairments. The molecular basis of neurorehabilitation includes various aspects such as changes in gene expression, regulation of synaptic connections, nerve cell growth, and repair, among others. Typical objectives in rehabilitating the patient with neurologic disease are to minimize pain, reestablish normal neural pathways, prevent secondary complications, and ultimately improve quality of life. It is also essential not to worsen neurologic function or pain in patients with spinal instability. A decreased free triiodothyronine and thyroid stimulating hormone levels upon admission may predict an unfavorable outcome at the end of early rehabilitative treatment. Thus, thyroid hormone levels are not only important during acute treatment but also in prolonged critical illness. Thyroid hormones, specifically thyroxine and triiodothyronine, can influence these molecular processes through their receptors in nervous tissue. Thyroid hormones are essential for the normal functioning of the nervous system, including neurogenesis (the formation of new neurons) and synaptic plasticity (changes in the strength and structure of connections between neurons). Research has shown that thyroid hormones can affect the expression of genes related to the growth and survival of neurons, as well as synaptic plasticity processes, which may be relevant for rehabilitation after nervous system injuries. A deficiency of thyroid hormones such as in hypothyroidism can lead to disturbances in the development and functioning of the nervous system, which, in turn, can complicate the neurorehabilitation process. Thus, understanding the molecular basis of neurorehabilitation and the influence of thyroid hormones can help improve approaches to the rehabilitation of patients with various nervous system impairments.
{"title":"The molecular fundamentals of neurorehabilitation and their modulation by thyroid hormones","authors":"I. Kamyshna, L. Pavlovych, V. Pankiv, A. Khodorovska, O. Bilous, O. Kamyshnyi","doi":"10.22141/2224-0721.20.2.2024.1374","DOIUrl":"https://doi.org/10.22141/2224-0721.20.2.2024.1374","url":null,"abstract":"Neurological disorders affect a large population, often leading to different levels of disability and resulting in a decreased quality of life. Neurorehabilitation is the process of restoring the functions of the nervous system after injuries, diseases, or other impairments. The molecular basis of neurorehabilitation includes various aspects such as changes in gene expression, regulation of synaptic connections, nerve cell growth, and repair, among others. Typical objectives in rehabilitating the patient with neurologic disease are to minimize pain, reestablish normal neural pathways, prevent secondary complications, and ultimately improve quality of life. It is also essential not to worsen neurologic function or pain in patients with spinal instability. A decreased free triiodothyronine and thyroid stimulating hormone levels upon admission may predict an unfavorable outcome at the end of early rehabilitative treatment. Thus, thyroid hormone levels are not only important during acute treatment but also in prolonged critical illness. Thyroid hormones, specifically thyroxine and triiodothyronine, can influence these molecular processes through their receptors in nervous tissue. Thyroid hormones are essential for the normal functioning of the nervous system, including neurogenesis (the formation of new neurons) and synaptic plasticity (changes in the strength and structure of connections between neurons). Research has shown that thyroid hormones can affect the expression of genes related to the growth and survival of neurons, as well as synaptic plasticity processes, which may be relevant for rehabilitation after nervous system injuries. A deficiency of thyroid hormones such as in hypothyroidism can lead to disturbances in the development and functioning of the nervous system, which, in turn, can complicate the neurorehabilitation process. Thus, understanding the molecular basis of neurorehabilitation and the influence of thyroid hormones can help improve approaches to the rehabilitation of patients with various nervous system impairments.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":" 377","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140682446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-19DOI: 10.22141/2224-0721.20.2.2024.1372
O. Paienok, A.V. Paienok, B.V. Zadorozhna, B. Hrytsyshyn, S. Ihnatovych
Background. Thyroid disease is the second most common endocrine disorder after diabetes in pregnancy. Thyroid hormones are crucial for the growth and maturation of many target tissues, especially the brain and skeleton. During critical periods in the first trimester of pregnancy, maternal thyroxine is essential for fetal development as it supplies thyroid hormone-dependent tissues. The purpose of the study was to research the features of the bioelectrical activity of the brain in pregnant women with thyroid pathology and determine the frequency of such changes. Materials and methods. The state of bioelectrical activity of the brain was evaluated by electroencephalography in 160 pregnant women with thyroid pathology. The biopotentials of the brain in the subjects were studied with software and hardware complex DX-NT32 (DX Complexes software, Kharkiv, Ukraine) and computer processing of electroencephalography data. Electrodes in the amount of 16 pieces were applied according to the international scheme 10/20 in the bipolar interpretation. Results. Specific changes in electroencephalograms characteristic of each type of thyroid pathology and dependent on its severity were revealed in pregnant women. Acquired disorders adversely affect the course of pregnancy and childbirth in women with thyroid pathology. Increased anxiety with depressive tendencies, reduced general activity, a feeling of depression, anxiety, and low mood were detected in women with thyroid disorders. The identified criteria make it possible to attribute these changes to the manifestations of a pathological neurotic state in conditions of maladaptation, which was confirmed by electroencephalography data. Conclusions. The detected disorders of spontaneous and evoked brain activity indicate the existence of a cerebral basis of psychological stress, which has a qualitative effect on electroencephalography. Acquired disorders negatively affect the course of pregnancy, childbirth, perinatal outcomes, and future development of the child.
{"title":"The influence of thyroid disorders on the state of brain’s bioelectrical activity in pregnant women","authors":"O. Paienok, A.V. Paienok, B.V. Zadorozhna, B. Hrytsyshyn, S. Ihnatovych","doi":"10.22141/2224-0721.20.2.2024.1372","DOIUrl":"https://doi.org/10.22141/2224-0721.20.2.2024.1372","url":null,"abstract":"Background. Thyroid disease is the second most common endocrine disorder after diabetes in pregnancy. Thyroid hormones are crucial for the growth and maturation of many target tissues, especially the brain and skeleton. During critical periods in the first trimester of pregnancy, maternal thyroxine is essential for fetal development as it supplies thyroid hormone-dependent tissues. The purpose of the study was to research the features of the bioelectrical activity of the brain in pregnant women with thyroid pathology and determine the frequency of such changes. Materials and methods. The state of bioelectrical activity of the brain was evaluated by electroencephalography in 160 pregnant women with thyroid pathology. The biopotentials of the brain in the subjects were studied with software and hardware complex DX-NT32 (DX Complexes software, Kharkiv, Ukraine) and computer processing of electroencephalography data. Electrodes in the amount of 16 pieces were applied according to the international scheme 10/20 in the bipolar interpretation. Results. Specific changes in electroencephalograms characteristic of each type of thyroid pathology and dependent on its severity were revealed in pregnant women. Acquired disorders adversely affect the course of pregnancy and childbirth in women with thyroid pathology. Increased anxiety with depressive tendencies, reduced general activity, a feeling of depression, anxiety, and low mood were detected in women with thyroid disorders. The identified criteria make it possible to attribute these changes to the manifestations of a pathological neurotic state in conditions of maladaptation, which was confirmed by electroencephalography data. Conclusions. The detected disorders of spontaneous and evoked brain activity indicate the existence of a cerebral basis of psychological stress, which has a qualitative effect on electroencephalography. Acquired disorders negatively affect the course of pregnancy, childbirth, perinatal outcomes, and future development of the child.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":" 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140685714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-19DOI: 10.22141/2224-0721.20.2.2024.1375
V.A. Serhiyenko, V. B. Sehin, M. Hotsko, L. Serhiyenko, О.О. Serhiyenko
In recent years, there has been an interest in studying the specifics of the relationships between metabolic syndrome (MetS), sleep disorders and melatonin (MEL). Dyssomnia and insomnia are important risk factors for insulin resistance, obesity, MetS, and type 2 diabetes mellitus with a degree of influence similar to traditional factors. Thus, the treatment of dyssomnia is one of the key tasks in the prevention and treatment of MetS. The regulation of sleep and circadian rhythms by exogenous intervention (in particular, the use of melatonergic drugs) is likely to play a central role in the prevention and treatment of dyssomnia in MetS. MEL acts as a powerful antioxidant that can cross the blood-brain barrier, suppress oxidative stress, chronic inflammation, and interact with the gut microbiome. From a clinical point of view, an imbalance of MEL may indicate a “darkness deficit”. It has been proven that the neurohormone has systemic effects due to its mechanisms of action, the potential to influence the course of many chronic diseases. Currently, melatonergic drugs are approved exclusively for the treatment of insomnia, jetlag, and depression accompanied by sleep disorders. However, MEL potentially has therapeutic properties in the treatment of neurodegenerative diseases, post-traumatic stress disorder, neuropsychiatric disorders, dementia, autoimmune and allergic diseases. The increasing need for the use of MEL products has prompted the search for safe but environmentally friendly medicines. It is reported that phytomelatonin may have advantages related to improved bioavailability and efficacy. The purpose of this review is to analyze the specifics of the relationship between MetS, dyssomnia, and MEL. The search was conducted in Scopus, Science Direct (from Elsevier), and PubMed, including MEDLINE databases. The keywords used were “metabolic syndrome”, “dyssomnia”, “insomnia”, “obstructive sleep apnea”, and “melatonin”. We conducted a manual search of the bibliography of publications to identify research results that were eluded during the online search.
{"title":"Metabolic syndrome, dyssomnia, and melatonin","authors":"V.A. Serhiyenko, V. B. Sehin, M. Hotsko, L. Serhiyenko, О.О. Serhiyenko","doi":"10.22141/2224-0721.20.2.2024.1375","DOIUrl":"https://doi.org/10.22141/2224-0721.20.2.2024.1375","url":null,"abstract":"In recent years, there has been an interest in studying the specifics of the relationships between metabolic syndrome (MetS), sleep disorders and melatonin (MEL). Dyssomnia and insomnia are important risk factors for insulin resistance, obesity, MetS, and type 2 diabetes mellitus with a degree of influence similar to traditional factors. Thus, the treatment of dyssomnia is one of the key tasks in the prevention and treatment of MetS. The regulation of sleep and circadian rhythms by exogenous intervention (in particular, the use of melatonergic drugs) is likely to play a central role in the prevention and treatment of dyssomnia in MetS. MEL acts as a powerful antioxidant that can cross the blood-brain barrier, suppress oxidative stress, chronic inflammation, and interact with the gut microbiome. From a clinical point of view, an imbalance of MEL may indicate a “darkness deficit”. It has been proven that the neurohormone has systemic effects due to its mechanisms of action, the potential to influence the course of many chronic diseases. Currently, melatonergic drugs are approved exclusively for the treatment of insomnia, jetlag, and depression accompanied by sleep disorders. However, MEL potentially has therapeutic properties in the treatment of neurodegenerative diseases, post-traumatic stress disorder, neuropsychiatric disorders, dementia, autoimmune and allergic diseases. The increasing need for the use of MEL products has prompted the search for safe but environmentally friendly medicines. It is reported that phytomelatonin may have advantages related to improved bioavailability and efficacy. The purpose of this review is to analyze the specifics of the relationship between MetS, dyssomnia, and MEL. The search was conducted in Scopus, Science Direct (from Elsevier), and PubMed, including MEDLINE databases. The keywords used were “metabolic syndrome”, “dyssomnia”, “insomnia”, “obstructive sleep apnea”, and “melatonin”. We conducted a manual search of the bibliography of publications to identify research results that were eluded during the online search.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":" 42","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140683730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-19DOI: 10.22141/2224-0721.20.2.2024.1369
M. Derbak, N. V. Lizanets, O. Hanych, V. V. Mashura, H. Y. Mashura, O. V. Ustych, L. M. Rostoka, MD DSc Mariya Derbak
Background. In patients with advanced stages of liver fibrosis, progression of liver fibrosis and obesity may be observed after complete elimination of hepatitis C virus. The aim of the research was to study the impact of antiviral therapy on lipid metabolism indicators in patients with chronic hepatitis C (CHC) combined with non-alcoholic fatty liver disease (NAFLD). Materials and methods. Eighty-two patients were under observation, 56 with CHC combined with NAFLD and 26 with CHC. They were divided into three groups: first one (n = 23) — patients with CHC with NAFLD and obesity, second (n = 33) — participants with CHC, NAFLD and overweight, third group (n = 26) — CHC patients with normal body weight. All patients underwent determination of blood lipid spectrum and cytokines Ang-2, TGF-β1, TNF-α and neopterin, IL-6. The degree of liver fibrosis and steatosis was determined using FibroMax. Patients received sofosbuvir 400 mg, daclatasvir 60 mg once a day for 12 weeks. Results. The study found that 8 patients had liver fibrosis F3–4, 11 people — F2–3, 23 — F1–2, and 37 people — F0–1. Sustained virological response was achieved in 95.1 % of patients with CHC. No response was received in 4.9 % of patients who had advanced stages of liver fibrosis and obesity or increased body weight. After the treatment, a slight increase in the level of high-density lipoprotein cholesterol was registered in 61.1 % of patients in group 3, 50 % in group 2, and only in 31.2 % of patients in group 1. Content of total cholesterol tended to increase in patients of groups 1 and 2 and remained unchanged in group 3. Although the changes in the levels of low- and very low-density lipoprotein were statistically significant, they were not large in terms of absolute values. In 62.5 % of CHC patients with concomitant NAFLD who had obesity or increased body weight and F3–4 fibrosis, even after complete elimination of the virus, the levels of Ang-2 and TGF-β1 remain high and positively correlate with the degree of steatosis and the stage of liver fibrosis. Conclusions. After the successful elimination of the hepatitis C virus, lipid metabolism disorders are registered in patients with concomitant non-alcoholic fatty liver disease, F3–4 fibrosis and increased body weight
{"title":"Lipid metabolism in patients with chronic hepatitis C, non-alcoholic fatty liver disease and obesity under the influence of treatment","authors":"M. Derbak, N. V. Lizanets, O. Hanych, V. V. Mashura, H. Y. Mashura, O. V. Ustych, L. M. Rostoka, MD DSc Mariya Derbak","doi":"10.22141/2224-0721.20.2.2024.1369","DOIUrl":"https://doi.org/10.22141/2224-0721.20.2.2024.1369","url":null,"abstract":"Background. In patients with advanced stages of liver fibrosis, progression of liver fibrosis and obesity may be observed after complete elimination of hepatitis C virus. The aim of the research was to study the impact of antiviral therapy on lipid metabolism indicators in patients with chronic hepatitis C (CHC) combined with non-alcoholic fatty liver disease (NAFLD). Materials and methods. Eighty-two patients were under observation, 56 with CHC combined with NAFLD and 26 with CHC. They were divided into three groups: first one (n = 23) — patients with CHC with NAFLD and obesity, second (n = 33) — participants with CHC, NAFLD and overweight, third group (n = 26) — CHC patients with normal body weight. All patients underwent determination of blood lipid spectrum and cytokines Ang-2, TGF-β1, TNF-α and neopterin, IL-6. The degree of liver fibrosis and steatosis was determined using FibroMax. Patients received sofosbuvir 400 mg, daclatasvir 60 mg once a day for 12 weeks. Results. The study found that 8 patients had liver fibrosis F3–4, 11 people — F2–3, 23 — F1–2, and 37 people — F0–1. Sustained virological response was achieved in 95.1 % of patients with CHC. No response was received in 4.9 % of patients who had advanced stages of liver fibrosis and obesity or increased body weight. After the treatment, a slight increase in the level of high-density lipoprotein cholesterol was registered in 61.1 % of patients in group 3, 50 % in group 2, and only in 31.2 % of patients in group 1. Content of total cholesterol tended to increase in patients of groups 1 and 2 and remained unchanged in group 3. Although the changes in the levels of low- and very low-density lipoprotein were statistically significant, they were not large in terms of absolute values. In 62.5 % of CHC patients with concomitant NAFLD who had obesity or increased body weight and F3–4 fibrosis, even after complete elimination of the virus, the levels of Ang-2 and TGF-β1 remain high and positively correlate with the degree of steatosis and the stage of liver fibrosis. Conclusions. After the successful elimination of the hepatitis C virus, lipid metabolism disorders are registered in patients with concomitant non-alcoholic fatty liver disease, F3–4 fibrosis and increased body weight","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":" 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140682761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-19DOI: 10.22141/2224-0721.20.2.2024.1378
P.M. Lyashuk, R.P. Lyashuk, Yu.F. Marchuk
We present a case report describing the diagnosis and management of a patient who presents with a rare diagnosis of Menetrier’s disease. This condition poses a diagnostic challenge to clinicians due to its nonspecific clinical presentation and is oftentimes misdiagnosed for more common gastric disorders. Menetrier’s disease is characterized by gastric mucosal hypertrophy and subsequent protein loss, resulting in gastric symptoms and widespread edema. While the etiology remains unclear, notable associations have been observed with Helicobacter pylori infection and overexpression of transforming growth factor alpha. The management often involves supportive measures with medical and surgical interventions for refractory cases and when necessary. This report includes a comprehensive review of the literature on the clinical presentation, diagnostic approach, and management of this rare disease. By documenting such cases in the medical literature, we aim to enhance the clinician’s ability to recognize and manage this disorder, thereby preventing the development of more severe manifestations such as diabetes mellitus. Menetrier’s disease is a rare disorder that should be suspected in patients with upper gastrointestinal complaints and hypertrophied gastric mucosa. With a rather broad differential diagnosis consisting of Zollinger-Ellison syndrome, hypertrophic lymphocytic gastritis, hypertrophic hypersecretory gastropathy, gastric adenocarcinoma, gastric polyps, infections such as histoplasmosis and tuberculosis, autoimmune-like inflammatory conditions such as sarcoidosis, and more commonly, gastrointestinal disease, it is often overlooked in the diagnostic workup. Therefore, it is crucial for clinicians to conduct a thorough evaluation and maintain a high clinical suspicion when there is concurrent H.pylori infection and/or imaging findings suggestive of hypertrophied gastric mucosa to avoid missing this disease.
{"title":"Comorbidity of Menetrier’s disease and diabetes mellitus. A clinical case","authors":"P.M. Lyashuk, R.P. Lyashuk, Yu.F. Marchuk","doi":"10.22141/2224-0721.20.2.2024.1378","DOIUrl":"https://doi.org/10.22141/2224-0721.20.2.2024.1378","url":null,"abstract":"We present a case report describing the diagnosis and management of a patient who presents with a rare diagnosis of Menetrier’s disease. This condition poses a diagnostic challenge to clinicians due to its nonspecific clinical presentation and is oftentimes misdiagnosed for more common gastric disorders. Menetrier’s disease is characterized by gastric mucosal hypertrophy and subsequent protein loss, resulting in gastric symptoms and widespread edema. While the etiology remains unclear, notable associations have been observed with Helicobacter pylori infection and overexpression of transforming growth factor alpha. The management often involves supportive measures with medical and surgical interventions for refractory cases and when necessary. This report includes a comprehensive review of the literature on the clinical presentation, diagnostic approach, and management of this rare disease. By documenting such cases in the medical literature, we aim to enhance the clinician’s ability to recognize and manage this disorder, thereby preventing the development of more severe manifestations such as diabetes mellitus. Menetrier’s disease is a rare disorder that should be suspected in patients with upper gastrointestinal complaints and hypertrophied gastric mucosa. With a rather broad differential diagnosis consisting of Zollinger-Ellison syndrome, hypertrophic lymphocytic gastritis, hypertrophic hypersecretory gastropathy, gastric adenocarcinoma, gastric polyps, infections such as histoplasmosis and tuberculosis, autoimmune-like inflammatory conditions such as sarcoidosis, and more commonly, gastrointestinal disease, it is often overlooked in the diagnostic workup. Therefore, it is crucial for clinicians to conduct a thorough evaluation and maintain a high clinical suspicion when there is concurrent H.pylori infection and/or imaging findings suggestive of hypertrophied gastric mucosa to avoid missing this disease.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":" 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140684111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-19DOI: 10.22141/2224-0721.20.2.2024.1371
N. Kulaiets
Background. Heart failure (HF) is the final stage of the cardiovascular diseases and one of the main causes of mortality due to them. The prevalence of HF has been steadily increasing in recent years and is ≈ 2 % of the adult population. Diabetes mellitus (DM) is among factors that worsen the prognosis of HF. Type 2 DM is an independent risk factor for the occurrence of HF, and the level of fasting plasma glucose, as well as an increased content of HbA1c are significantly associated with an elevated risk of developing HF. The purpose of the study was to investigate the features of the course of HF, which occurred against the background of postinfarction cardiosclerosis, in patients with concomitant atrial fibrillation (AF) and DM. Materials and methods. Three hundred and ninety-eight patients with HF on the background of postinfarction cardiosclerosis aged 45–65 (54.3 ± 7.2) years were examined, 198 (49.7 %) women and 200 (50.3 %) men. Two hundred and twenty-six (56.8 %) patients had permanent AF, 102 (25.6 %) had concomitant type 2 DM. Diagnoses of AF and HF were carried out in accordance with the clinical protocol for providing medical care to patients with atrial fibrillation and heart failure approved by the Order of the Ministry of Health of Ukraine dated July 3, 2006 No. 436 and in accordance with the 2021 European Society of Cardiology Guidelines for the diagnosis and treatment of acute and chronic heart failure. In addition to general clinical and biochemical blood tests, enzyme immunoassays were performed to determine brain natriuretic peptide, NT-proBNP, galectin-3 and ST-2. A standardized echocardiographic examination was conducted with calculations of the left ventricular ejection fraction (LVEF) and heart dimensions during hospitalization. Results. Patients with HF and concomitant DM, compared to participants without impaired carbohydrate metabolism, have a higher frequency of the disease phenotype with preserved LVEF (48.0 %), higher New York Heart Association functional classes (FC III — 70.0 %) and the risk of re-hospitalization (hazard ratio (HR) = 3.14 (2.05–5.68)). For patients with HF and a permanent AF, but without existing DM, a more pronounced dilatation of the heart cavities, a lower LVEF (by 15 %) and a high risk of re-hospitalization during the first year (HR = 1.235 (1.024–1.489)) are typical. Patients with HF and a concomitant combination of AF and DM have the most unfavorable course of heart pathology: the increased size of the left ventricle is more often registered, and its systolic function is worse (by 19.3 %), with high frequency of the phenotype with reduced LVEF (51.9 %), FC IV (46.2 %), the highest risk of re-hospitalization (HR = 11.30 (4.73–27.04)) and one-year death (HR = 2.95 (2.00–4.36)). Conclusions. Given the risk of re-hospitalization and one-year mortality, the most unfavorable combination of concomitant pathology in patients with heart failure of ischemic origin is atrial fibrillation and diabetes m
{"title":"The features of heart failure of ischemic origin in patients with concomitant atrial fibrillation and diabetes mellitus","authors":"N. Kulaiets","doi":"10.22141/2224-0721.20.2.2024.1371","DOIUrl":"https://doi.org/10.22141/2224-0721.20.2.2024.1371","url":null,"abstract":"Background. Heart failure (HF) is the final stage of the cardiovascular diseases and one of the main causes of mortality due to them. The prevalence of HF has been steadily increasing in recent years and is ≈ 2 % of the adult population. Diabetes mellitus (DM) is among factors that worsen the prognosis of HF. Type 2 DM is an independent risk factor for the occurrence of HF, and the level of fasting plasma glucose, as well as an increased content of HbA1c are significantly associated with an elevated risk of developing HF. The purpose of the study was to investigate the features of the course of HF, which occurred against the background of postinfarction cardiosclerosis, in patients with concomitant atrial fibrillation (AF) and DM. Materials and methods. Three hundred and ninety-eight patients with HF on the background of postinfarction cardiosclerosis aged 45–65 (54.3 ± 7.2) years were examined, 198 (49.7 %) women and 200 (50.3 %) men. Two hundred and twenty-six (56.8 %) patients had permanent AF, 102 (25.6 %) had concomitant type 2 DM. Diagnoses of AF and HF were carried out in accordance with the clinical protocol for providing medical care to patients with atrial fibrillation and heart failure approved by the Order of the Ministry of Health of Ukraine dated July 3, 2006 No. 436 and in accordance with the 2021 European Society of Cardiology Guidelines for the diagnosis and treatment of acute and chronic heart failure. In addition to general clinical and biochemical blood tests, enzyme immunoassays were performed to determine brain natriuretic peptide, NT-proBNP, galectin-3 and ST-2. A standardized echocardiographic examination was conducted with calculations of the left ventricular ejection fraction (LVEF) and heart dimensions during hospitalization. Results. Patients with HF and concomitant DM, compared to participants without impaired carbohydrate metabolism, have a higher frequency of the disease phenotype with preserved LVEF (48.0 %), higher New York Heart Association functional classes (FC III — 70.0 %) and the risk of re-hospitalization (hazard ratio (HR) = 3.14 (2.05–5.68)). For patients with HF and a permanent AF, but without existing DM, a more pronounced dilatation of the heart cavities, a lower LVEF (by 15 %) and a high risk of re-hospitalization during the first year (HR = 1.235 (1.024–1.489)) are typical. Patients with HF and a concomitant combination of AF and DM have the most unfavorable course of heart pathology: the increased size of the left ventricle is more often registered, and its systolic function is worse (by 19.3 %), with high frequency of the phenotype with reduced LVEF (51.9 %), FC IV (46.2 %), the highest risk of re-hospitalization (HR = 11.30 (4.73–27.04)) and one-year death (HR = 2.95 (2.00–4.36)). Conclusions. Given the risk of re-hospitalization and one-year mortality, the most unfavorable combination of concomitant pathology in patients with heart failure of ischemic origin is atrial fibrillation and diabetes m","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":" 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140684746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-19DOI: 10.22141/2224-0721.20.2.2024.1368
Yurii Kazakov, O. Muravlova, T. V. Nastroga, O. Kitura, S. Shut
Background. Population aging has become a leading demographic feature of Ukraine. According to the World Health Organization, the number of elderly and senile people will increase to almost 40 % in the coming decades. Hypertension and type 2 diabetes mellitus (DM) are among the leading factors of cardiovascular risk. It is known that excessive oxidant stress and low-grade subclinical chronic systemic inflammation are determining factors of endothelial dysfunction, vascular reactivity disorders, increased peripheral vascular resistance, carbohydrate, and lipid metabolism disorders, which leads to increased blood pressure and plasma glucose levels. Hypertension and type 2 DM are among the leading cardiovascular risk factors. The purpose of the study was to increase the effectiveness of treatment and improve the quality of life of elderly patients with combined pathology of hypertension and type 2 DM by additional inclusion of empagliflozin and L-arginine in the basic therapy. Materials and methods. Fifty elderly patients with comorbid pathology were under our observation for second stage hypertension, coronary heart disease (functional class II) and type 2 DM in the stage of subcompensation. Participants were divided into two groups: the first one, controls (n = 25), received generally accepted basic therapy. In the second group (n = 25), the following drugs were added to the basic therapy: empagliflozin 10 mg/day, L-arginine 300 mg/day. Results. Clinical observation in outpatient conditions lasted for 3 months. Comprehensive therapy in the elderly patients with comorbid pathology of hypertension and type 2 diabetes, with the additional inclusion of empagliflozin and L-arginine to the basic therapy, contributes to a significant positive effect on the clinical course, reduces the risk of progression of this constellation. Conclusions. The application of the proposed comprehensive therapy in outpatient conditions under the control of a family doctor will significantly improve the quality of life of patients and prevent the development of complications
{"title":"Optimized treatment of elderly patients with type 2 diabetes mellitus and hypertension in general practice","authors":"Yurii Kazakov, O. Muravlova, T. V. Nastroga, O. Kitura, S. Shut","doi":"10.22141/2224-0721.20.2.2024.1368","DOIUrl":"https://doi.org/10.22141/2224-0721.20.2.2024.1368","url":null,"abstract":"Background. Population aging has become a leading demographic feature of Ukraine. According to the World Health Organization, the number of elderly and senile people will increase to almost 40 % in the coming decades. Hypertension and type 2 diabetes mellitus (DM) are among the leading factors of cardiovascular risk. It is known that excessive oxidant stress and low-grade subclinical chronic systemic inflammation are determining factors of endothelial dysfunction, vascular reactivity disorders, increased peripheral vascular resistance, carbohydrate, and lipid metabolism disorders, which leads to increased blood pressure and plasma glucose levels. Hypertension and type 2 DM are among the leading cardiovascular risk factors. The purpose of the study was to increase the effectiveness of treatment and improve the quality of life of elderly patients with combined pathology of hypertension and type 2 DM by additional inclusion of empagliflozin and L-arginine in the basic therapy. Materials and methods. Fifty elderly patients with comorbid pathology were under our observation for second stage hypertension, coronary heart disease (functional class II) and type 2 DM in the stage of subcompensation. Participants were divided into two groups: the first one, controls (n = 25), received generally accepted basic therapy. In the second group (n = 25), the following drugs were added to the basic therapy: empagliflozin 10 mg/day, L-arginine 300 mg/day. Results. Clinical observation in outpatient conditions lasted for 3 months. Comprehensive therapy in the elderly patients with comorbid pathology of hypertension and type 2 diabetes, with the additional inclusion of empagliflozin and L-arginine to the basic therapy, contributes to a significant positive effect on the clinical course, reduces the risk of progression of this constellation. Conclusions. The application of the proposed comprehensive therapy in outpatient conditions under the control of a family doctor will significantly improve the quality of life of patients and prevent the development of complications","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":" 491","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140682620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-19DOI: 10.22141/2224-0721.20.2.2024.1373
T. Bentsa
The increasing prevalence of nonalcoholic fatty liver disease (NAFLD) parallels the global epidemic of obesity and type 2 diabetes mellitus (T2DM) worldwide. NAFLD increases the risk of T2DM, cardiovascular disease, and chronic kidney disease. Conversely, obesity and T2DM increase morbidity and mortality from NAFLD. Synchronous metabolic dysfunction in obesity and T2DM and gut dysbiosis exacerbate hepatic and systemic inflammation due to direct activation of innate and adaptive immune responses. Gut dysbiosis can contribute to the emergence and development of NAFLD, as well as acceleration of its progression to liver cirrhosis and hepatocellular carcinoma. Currently, lifestyle changes based on diet and exercise are the first step in the treatment of patients with NAFLD. Specific dietary interventions contribute to the improvement of NAFLD by modulating the gut-liver axis. Physical activity increases the sensitivity of insulin receptors, and in combination with diet leads to a reliably significant improvement in biochemical and histological indicators in patients with NAFLD combined with obesity and T2DM. Physical activity also modulates gut microbiota composition. Specific pharmacological treatment is performed mainly in patients with nonalcoholic steatohepatitis and biopsy-proven fibrosis, as well as a high risk of progression (older age, T2DM, metabolic syndrome, persistent elevation of alanine aminotransferase). However, there are few available treatment options for NAFLD. Since gut microbiota is actively involved in the pathogenesis of NAFLD, exposure to it with probiotics, prebiotics or synbiotics in order to improve the liver phenotype is reasonable. At the congress of the European Association for the Study of the Liver, which took place in Vienna on June 21–24, 2023, a new classification and nomenclature of NAFLD was adopted. It was proposed to replace the term “nonalcoholic fatty liver disease” with the term “metabolic dysfunction-associated steatotic liver disease”. This diagnosis is established in patients with confirmed steatosis of the liver and one of five cardiometabolic risk factors: obesity, T2DM, insulin resistance, hyperlipidemia, atherosclerosis. The concept of “nonalcoholic steatohepatitis” has been changed to the concept of “metabolic dysfunction-associated steatohepatitis”. Coordination of the views of international and domestic experts in the field of studying this pathology will be important for clinical practice and scientific research.
{"title":"Nonalcoholic fatty liver disease associated with obesity and type 2 diabetes and gut dysbiosis","authors":"T. Bentsa","doi":"10.22141/2224-0721.20.2.2024.1373","DOIUrl":"https://doi.org/10.22141/2224-0721.20.2.2024.1373","url":null,"abstract":"The increasing prevalence of nonalcoholic fatty liver disease (NAFLD) parallels the global epidemic of obesity and type 2 diabetes mellitus (T2DM) worldwide. NAFLD increases the risk of T2DM, cardiovascular disease, and chronic kidney disease. Conversely, obesity and T2DM increase morbidity and mortality from NAFLD. Synchronous metabolic dysfunction in obesity and T2DM and gut dysbiosis exacerbate hepatic and systemic inflammation due to direct activation of innate and adaptive immune responses. Gut dysbiosis can contribute to the emergence and development of NAFLD, as well as acceleration of its progression to liver cirrhosis and hepatocellular carcinoma. Currently, lifestyle changes based on diet and exercise are the first step in the treatment of patients with NAFLD. Specific dietary interventions contribute to the improvement of NAFLD by modulating the gut-liver axis. Physical activity increases the sensitivity of insulin receptors, and in combination with diet leads to a reliably significant improvement in biochemical and histological indicators in patients with NAFLD combined with obesity and T2DM. Physical activity also modulates gut microbiota composition. Specific pharmacological treatment is performed mainly in patients with nonalcoholic steatohepatitis and biopsy-proven fibrosis, as well as a high risk of progression (older age, T2DM, metabolic syndrome, persistent elevation of alanine aminotransferase). However, there are few available treatment options for NAFLD. Since gut microbiota is actively involved in the pathogenesis of NAFLD, exposure to it with probiotics, prebiotics or synbiotics in order to improve the liver phenotype is reasonable. At the congress of the European Association for the Study of the Liver, which took place in Vienna on June 21–24, 2023, a new classification and nomenclature of NAFLD was adopted. It was proposed to replace the term “nonalcoholic fatty liver disease” with the term “metabolic dysfunction-associated steatotic liver disease”. This diagnosis is established in patients with confirmed steatosis of the liver and one of five cardiometabolic risk factors: obesity, T2DM, insulin resistance, hyperlipidemia, atherosclerosis. The concept of “nonalcoholic steatohepatitis” has been changed to the concept of “metabolic dysfunction-associated steatohepatitis”. Coordination of the views of international and domestic experts in the field of studying this pathology will be important for clinical practice and scientific research.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":" 29","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140685750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-19DOI: 10.22141/2224-0721.20.2.2024.1376
O.V. Bilookyi, V.L. Vasiuk, O.A. Shupik
Thyroid dysfunction is a common endocrine disorder in the general population, with a reported prevalence of 10–15 %. This rate is higher in older adults, with an estimated prevalence of 25 % in some populations. Since elderly patients usually present more comorbidities than younger individuals, thyroid dysfunction may carry a synergistic negative health impact, mainly due to increased cardiovascular disease risk. Thyroid dysfunction in the elderly can be more difficult to diagnose due to its subtle or even asymptomatic clinical presentation, and the interpretation of thyroid function tests may be affected by drugs that interfere with thyroid function or by the coexistence of several diseases. Clinical experience shows that older people with hyperthyroidism display fewer signs or symptoms compared to younger people with hyperthyroidism. Moreover, older people with normal thyroid function tests have several clinical features of hypothyroidism. These observations suggest that there may be an age-related resistance to the actions of thyroid hormones. Laboratory experiments have consistently documented an age-related blunting of response to exogenously administered thyroid hormones. This resistance to thyroid hormones action has been attributed to reduced cellular transport of thyroid hormones. In light of these observations, along with epidemiologic studies, the diagnosis and treatment of thyroid disease in older people differ from the current treatment guidelines of younger people with thyroid disease. It is noteworthy that the age-related resistance to thyroid hormones is distinct from the congenital thyroid hormone resistance syndromes. This distinction is explained by the age-related changes in pituitary responsiveness to the feedback inhibition by thyroid hormones and reduced thyroid gland response to thyrotropin. The current evidence suggests that the age-related resistance to thyroid hormones is an adaptive process to prolong life span. In this review article, we summarize the current knowledge on the pathophysiology, diagnosis, and therapeutic management of thyroid dysfunction in elderly patients.
{"title":"Thyroid dysfunction in the ageing patient","authors":"O.V. Bilookyi, V.L. Vasiuk, O.A. Shupik","doi":"10.22141/2224-0721.20.2.2024.1376","DOIUrl":"https://doi.org/10.22141/2224-0721.20.2.2024.1376","url":null,"abstract":"Thyroid dysfunction is a common endocrine disorder in the general population, with a reported prevalence of 10–15 %. This rate is higher in older adults, with an estimated prevalence of 25 % in some populations. Since elderly patients usually present more comorbidities than younger individuals, thyroid dysfunction may carry a synergistic negative health impact, mainly due to increased cardiovascular disease risk. Thyroid dysfunction in the elderly can be more difficult to diagnose due to its subtle or even asymptomatic clinical presentation, and the interpretation of thyroid function tests may be affected by drugs that interfere with thyroid function or by the coexistence of several diseases. Clinical experience shows that older people with hyperthyroidism display fewer signs or symptoms compared to younger people with hyperthyroidism. Moreover, older people with normal thyroid function tests have several clinical features of hypothyroidism. These observations suggest that there may be an age-related resistance to the actions of thyroid hormones. Laboratory experiments have consistently documented an age-related blunting of response to exogenously administered thyroid hormones. This resistance to thyroid hormones action has been attributed to reduced cellular transport of thyroid hormones. In light of these observations, along with epidemiologic studies, the diagnosis and treatment of thyroid disease in older people differ from the current treatment guidelines of younger people with thyroid disease. It is noteworthy that the age-related resistance to thyroid hormones is distinct from the congenital thyroid hormone resistance syndromes. This distinction is explained by the age-related changes in pituitary responsiveness to the feedback inhibition by thyroid hormones and reduced thyroid gland response to thyrotropin. The current evidence suggests that the age-related resistance to thyroid hormones is an adaptive process to prolong life span. In this review article, we summarize the current knowledge on the pathophysiology, diagnosis, and therapeutic management of thyroid dysfunction in elderly patients.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":" January","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140682665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：