[Non-alcoholic fatty liver disease and type 2 diabetes mellitus: general approaches to the choice of therapy].

Currently, there is a growing interest in one of the most common diseases in hepatology - non-alcoholic fatty liver disease (NAFLD). There is evidence that approximately 75% of cases of NAFLD occur against the background of obesity, dyslipidemia or type 2 diabetes mellitus (T2DM). At the present stage, a persistent pathophysiological interaction between NAFLD and T2DM has been demonstrated. Insulin resistance is one of the main pathogenetic causes of the development of T2DM and NAFLD. At the same time, it is necessary to highlight the role of the intestinal microbiota and epigenome in the manifestation and progression of NAFLD. Therefore, treatment approaches should be comprehensive. Diet therapy should be aimed at calorie restriction. However, in real clinical practice, phisicians face a low commitment to appropriate and long-term dietary recommendations necessary for weight loss. At the same time, use of dietary fibers, which are part of the preparation Mucofalk, helps to slow down the passage of food through the digestive tract, increase the saturation period. Use of a low-calorie diet with a significant fat restriction may increase the risk of gallstones. Ursodeoxycholic acid preparations (Ursofalk) can be recommended for the prevention of cholelithiasis. Considering the role of intestinal microflora in the pathogenesis of NAFLD, it is necessary to correct dysbiotic changes as well as basic pharmacotherapy. Thus, a comprehensive approach to the management of patients with NAFLD and T2DM should be aimed not only at therapy, but also at the prevention of associated metabolic disorders.

[Historical aspects of diagnosis and control of diabetes mellitus].

Diabetes mellitus is a group of metabolic diseases affecting carbohydrate, lipid, and protein metabolism. This pathology has a long history, and it was considered a disease of the kidneys until the middle of the 19th century. Descriptions have been found in Egyptian papyri, in ancient Indian and Chinese medical literature, in the writings of ancient Greek and Arab doctors. Aretaeus of Cappadocia gave the first accurate description of the disease, coining the term "diabetes". Thomas Willis first differentiated diabetes from other causes of polyuria by the sweet taste of urine. Matthew Dobson proved the presence of glucose in urine by evaporation. Claude Bernard demonstrated that hyperglycemia contributes to glucosuria. This is how the concept of the renal threshold appeared. In domestic practice, the term "renal threshold" was introduced by endocrinologist V.G. Baranov. The development of qualitative tests for determining glucose in the urine, the creation of test strips and glucometers has significantly improved the quality of life of patients with diabetes. The current stage of development of glucometry includes the determination of fasting plasma glucose, postprandial glycemia, glycated hemoglobin, as well as continuous glucose monitoring. Continuous glucose monitoring systems make it possible to estimate the time in target range, show the rate of rise or fall of glucose levels. It affects the rate and degree of carbohydrate metabolism compensation and allows for maximum control of the disease.

[The influence of weight loss interventions on psycho-emotional state of young men with obesity].

AIM: To assess the relationship of psychoemotional changes with obesity in young men, depending on the age of manifestation of the disease and against the background of the program of weight loss. MATERIALS AND METHODS: The study included 48 young men with obesity, aged 17 to 24 years. The subjects were divided into two groups. Group A consisted of 26 men with manifestation of obesity since childhood, group B 22 patients with onset of the disease from puberty. Subsequently, the study patients were subdivided depending on the type of obesity treatment (complex and non-pharmacological). The psychological status and anthropometric parameters were assessed on screening and after 12 weeks of treatment. RESULTS: Depressive disorders were initially observed in 40.9% of patients in group B and in 19.2% of patients in group A. In young men who underwent complex treatment of obesity, regardless of the time of manifestation of the disease, a clinically significant decrease in symptoms of depression was revealed. All types of eating behavior were revealed in the subjects, and these manifestations are more common in patients with manifestation of the disease since childhood. In group A, the restrained eating was in 50% of young men, external eating in 42.3%, and emotional eating in 30.7%. In group B, emotional eating in 9% of patients, external eating in 40.9%, and restrained eating in 31.8% of young obese men. CONCLUSION: In the group of patients with manifestation of obesity since puberty, the frequency of depressive disorders was higher than in the group of young men with onset of obesity since childhood.

[Molecular markers as risk factors for thyroid cancer].

Thyroid cancer is the most common malignant tumor of the endocrine system. An increase in the incidence of thyroid cancer has been noted over the past decade, mainly due to papillary cancer. The influence of environmental factors, increased availability of medical care, including sensitive diagnostic tests, such as ultrasound and fine - needle aspiration (FNA), can affect the fact of the growth of this incidence. Palpation of thyroid gland has very low diagnostic value for detecting thyroid cancer, while thyroid ultrasound and FNA can detect malignant tumors in 20% of cases. Today, the FNA is the fastest, most accurate, economically accessible, and quite safe method for cytological diagnosis of the thyroid nodules. And molecular genetic testing of FNA samples could serve as an additional reliable diagnostic tool in the case of atypia of undetermined significance.

[Central hypothyroidism].

Central hypothyroidism is a rare cause of hypothyroidism, consequence of various disorders affecting pituitary (secondary) or hypothalamus (tertiary hypothyroidism). Difficulties in the diagnosis and management of patients are due to the nontypical clinical picture, frequent combination with impaired function of other pituitary hormones, difficulties in laboratory assessment in high TSH levels or low - normal T4 free levels. Diagnosis is based on a confirmed decrease in the level of free T4 with a low or normal level of TSH. The standard treatment for hypothyroidism of any etiology remains monotherapy with levothyroxine, which allows to restore the euthyroid state in most patients. The criterion for the effectiveness of therapy is to maintain the level of T4 free in the upper half of the reference norm interval. The article presents a modern understanding of epidemiology, pathogenesis and strategies for managing patients with central hypothyroidism.

Association between polymorphic markers in candidate genes and the risk of manifestationof endocrine ophthalmopathy in patients with Graves' disease.

AIM: To analyze the association between the polymorphic markers in CTLA4, TNF, IL10 and IL16 genes and the risk of manifestation of endocrine ophthalmopathy (EO) in patients with Graves' disease (GD). MATERIALS AND METHODS: Case-control study included 248 patients with GD. Using polymerase chain reaction we studied the distribution of alleles and genotypes of polymorphic markers such as A60G (rs3087243) in CTLA4 gene, G(-308)A (rs1800629) in TNF gene, G(-1082)A (rs1800896) in IL10 gene, T3249C (rs4778641) in IL16 gene among 141 patients with Graves' disease and EO and 107 patients with GD without EO. RESULTS: The frequencies of A alleles and the AA genotypes were significantly increased and the frequencies of G alleles and the GG genotype polymorphic markers rs3087243 of CTLA4 gene and rs1800896 of IL10 gene, as well as the GG genotype polymorphic marker rs1800629 of TNF gene were reduced in patients with GD and EO. The polymorphism in CTLA4 gene was also associated with the activity and the severity of EO. The comparative analysis of the allele and genotype frequency distribution of polymorphic markers of IL16 gene did not show the significant difference. CONCLUSION: The risk of manifestation and the development of EO in patients with Graves' disease can be caused by not only environmental, but also genetic risk factors.

[Association of CTLA4 and TNF gene polymorphisms with endocrine ophthalmopathy in ethnic Russian patients with Graves' disease]. / Assotsiatsiya polimorfnykh markerov genov CTLA4 i TNF s endokrinnoi oftal'mopatiei u patsientov russkogo proiskhozhdeniya s bolezn'yu Greivsa.

AIM: To analyze the associations of the rs3087243 CTLA4 polymorphism and the rs1800629 TNF polymorphism with endocrine ophthalmopathy (EOP) in ethnic Russian patients with Graves' disease (GD). MATERIAL AND METHODS: The case-control study enrolled 205 patients with GD. The distribution of alleles and genotypes of the rs3087243 CTLA4 and rs1800629 TNF polymorphisms was studied in 141 patients with GD and EOP (a GD+EOP group) and 64 patients with GD without EOP (a GD-EOP group). The polymorphic alleles were identified by polymerase chain reaction-restriction fragment length analysis. RESULTS: The patients with GD in their history and EOP had significantly higher frequencies of A allele and AA genotype and a lower proportion of G allele and GG genotype of the rs3087243 CTLA4 polymorphism. Comparative analysis revealed no significant differences in the frequency of the alleles and genotypes of the rs1800629 TNF polymorphism. CONCLUSION: The rs3087243 CTLA4 polymorphism is associated with the risk of EOP in ethnic Russian patients with GD.

[Predictive value of body mass index for perioperative hyperglycemia occurrence in cardio-surgical patients without diabetes mellitus].

UNLABELLED: Purpose of the study was to assess a predictive value of body mass index for perioperative hyperglycemia occurrence in cardio-surgical patients without a diabetes mellitus. MATERIALS AND METHODS: Retrospective analysis of glycemic profile, frequency and level of perioperative hyperglycemia was performed 120 patients without a diabetes mellitus, undergoing elective cardiac surgeries with cardiopulmonary bypass were included in the study. All patients were divided into three groups. Group-1 included patients with normal body weight (body mass index (BMI) < 25), Group-2--patients with increased body weight (BMI 25-29.9), Group-3--patients with obesity (BMI > 30). RESULTS: Elective cardiac surgeries with artificial circulation accompanied with episodes of hyperglycemia. Hyperglycemia occurrence did not have relation with initial glycemic profile of the patients. Glycemia level increased during surgery and the highest levels of both glycemia increasing of hyperglycemia frequency were fixed during cardiopulmonary bypass and postperfusion period. Increased body weight and obesity are predisposing causes of perioperative hyperglycemia.

[Clinical guidelines developed by the Russian Association of Endocrinologists for the diagnosis and treatment of nodular goiter].

The guidelines presented do not pretend to be a systematic presentation of all aspects of the diagnosis and treatment of nodular goiter and are not intended to replace guidelines for various medical disciplines. In real clinical practice, situations may arise that are beyond the scope of the recommendations presented, in connection with which the final decision regarding a specific patient and responsibility for him lies with the attending physician.The recommendations presented are mainly devoted to the diagnosis and treatment of nodular (multinodular) euthyroid colloid, differently proliferating goiter in adults (over 18 years of age) and are the agreed opinion of the RAE experts who developed them. Nodular (multinodular) toxic goiter, tumors (malignant and benign), as well as other diseases that can manifest themselves by nodular formations of the thyroid gland (thyroid gland), are discussed mainly in the context of differential diagnosis. The recommendations also do not affect the features of diagnosis and treatment of nodular goiter in children and adolescents.

[Comparison of determination methods and application of a computer program using a screening coordinate system to interpret hemoglobin A1c in patients with diabetes types 1 and 2]. / Sravnenie metodov opredeleniia i primenenie vychislitel'noi programmy s ispol'zovaniem ékrannoi sistemy koordinat dlia interpretatsii gemoglobina A1c u bol'nykh sakharnym diabetom tipov 1 u 2.

The aim of the work is to compare methods of hemoglobin A1c determination in ratio with basic metabolism indices using computer program with graphic interpretation of results in patients with diabetes of 1 and 2 types. It was found out that more specific hemoglobin determination by isoelectrofocusing method more completely reflects the state of carbohydrate metabolism in diabetic patients. The importance of hemoglobin A1c determination in case of 2 type diabetes is particularly emphasized.

[Indications for surgical treatment of diffuse toxic goiter]. / O pokazaniiakh k khirurgicheskomu lecheniiu diffuznogo toksicheskogo zoba.

The results of examination and treatment in 129 patients with toxic goiter (TG) were analyzed. Thyroid status, stable intrathyroid iodine content, thyroid-stimulating hormone (TSH) receptor antibody titer, the volume and echostructure of thyroid tissue were studied either during their first visit and during conservative treatment. The findings suggests that the relapse rate is higher with slow reduction in thyroxine levels and prolonged suppressed TSH during treatment, with higher TSH receptor antibody titer after treatment, with large thyroid volumes when TG manifests it self and in the absence of positive changes in the volume and echostructure of thyroid tissue during treatment, with lower intrathyroid iodine content and its greater reduction during treatment. Earlier surgical intervention should be recommended 2 patients having these risk factors (their combination, in particular).

Complex association analysis of graves disease using a set of polymorphic markers.

Graves disease is complex autoimmune thyrotoxicosis. A number of genes may contribute to the development of the disorder. Some of them may be genes that encode cytotoxic T-lymphocyte-associated serine esterase-4 (CTLA4), subunit 2 of large multifunctional protease (LMP2), thyroid-stimulating hormone receptor (TSHR), and interleukin 1 receptor antagonist (IL1RN). We studied polymorphism of Ala17Thr CTLA4, H60R LMP2, Pro52Thr TSHR, and IL1RN-VNTR in healthy controls (n = 93) and patients with Graves disease (n = 78) using PCR. To study CTLA4, H60R, and TSHR polymorphism, PCR products were digested with MboI, Hin6I and PsyI, respectively. Comparative analysis using chi(2) test showed significant differences in allele and genotype frequency of Ala17Thr polymorphic marker between the two groups studied. Thus, the CTLA4 gene may be involved in the pathogenesis of Graves disease in a Moscow population.

[The use of highly purified Iletin-II-type porcine insulins and human insulin preparations in clinical practice]. / Primenenie vysokoochishchennykh svinykh insulinov tipa Iletin-II i preparatov insulina cheloveka v klinicheskoi praktike.

The paper presents the results of treatment with insulins of iletin-II and humulin series. Decreased insulin doses, absence of complications, stable compensation of diabetes mellitus, reduction of insulin antibodies titer suggest high clinical effectiveness of the above preparations. Because of low immunogenicity humulin insulins are preferable when compared to iletin-II ones.

[T-cell immunity and immunomodulators in the comprehensive treatment of diffuse toxic goiter]. / Sostoianie T-sistemy immuniteta i primenenie immunomoduliatorov v kompleksnom lechenii bol'nykh diffuznym toksicheskim zobom.

Age-specific and related to DTG severity lowering of T-lymphocyte count, active and autologous T-lymphocyte number, thymic serum activity were found in 83 DTG patients. These shifts made justified the use of immunomodulator tactivin in 32 DTG patients. The drug was administered in daily subcutaneous doses (1 ml of 0.01% solution) for 5 days. As a result, the T-cell immunity returned to normal values. The highest response occurred in young subjects with moderate hyperthyroidism. Because a single tactivin course failed to bring up a persistent effect, repeat courses are needed to achieve good clinical and immunologic responses.