Vol 58, No 6 (2012)

Predictors of the development of chronic wound defects in the soft tissues of the lower extremities in the patients with type 1 diabetes mellitus and lipoid necrobiosis
Semenova D.A., Repina E.A., Stepanova S.M., Prokofiev S.A., Matushevskaya E.V., Tokmakova A.Y.
Abstract

A total of 50 patients presenting with type 1 diabetes mellitus (DM1) were available for the clinical and immunological examination. They were allocated to two groups, one comprised of 25 patients with DM1 and lipoid necrobiosis (LN), the other consisting of 25 patients with DM1 without LN. Expression of Toll-like receptors (TLR2, TLR3, and TLR4) was evaluated in monocytes and neutrophils obtained from peripheral blood. In addition, the state of peripheral circulation and innervation of the lower extremities was evaluated. It was shown that the impairment of expression and fluorescence of TLR2 and TLR4 in monocytes as well as TLR3 in neutrophils was associated with the manifestations of skin lesions in the patients with DM1 and LN. It is concluded that the measurement of Toll-like receptors in the patient presenting with type 1 diabetes mellitus and lipoid necrobiosis can be used in clinical practice for the prediction of the development of dermatosis.

Problems of Endocrinology. 2012;58(6):13-18
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The level of vitamin D and its relationship with the amount of fatty tissue and adipocytokine content in the women of reproductive age
Karonova T.L., Grineva E.N., Mikheeva E.P., Belyaeva O.D., Krasil’nikova E.I., Nikitina I.L.
Abstract

The patients with obesity are known to suffer 25-hydroxy vitamin D (25(OH)D) deficiency, but the relationship between these two conditions remains unclear. The blood 25(ON)D levels in practically healthy women were compared with the amount and distribution patterns of the fatty tissue and with the content of plasma adipocytokines. The absence or deficit of vitamin D was documented in 61.3% of the women included in the present study. They exhibited negative correlation between 25(ON) D levels and body weight. The patients with obesity were characterized by correlation between the 25(ON)D levels and waist circumference, body weight, BMI, and the amount of fatty tissue. The women of reproductive age with the reduced blood 25(ON)D level (OR 1.86 [0.88—3.95]; CI 95%) or 25(ON)D deficiency (OR 2.23 [1.03—4.80]; CI 95%) were at a higher risk of development of obesity compared with the women in whom the 25(ON)D levels were in excess of 75 nmol/l. The study confirmed correlations between adypocytokine levels and the amount of fatty tissue even though it failed to demonstrate a significant relationship between the levels of adipocytokines and vitamin D.

Problems of Endocrinology. 2012;58(6):19-23
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Endocrine ophthalmopathy: state-of-the-art approaches
Petunina N.A., Trukhina L.V., Martirosyan N.S.
Abstract

The issues pertaining to etiology, pathogenesis, clinical manifestations, and treatment of endocrine ophthalmopathy (EOP) are discussed. EOP is a heterogeneous autoimmune eye disease most frequently associated with Graves’ disease even though it is just as well encountered both in the patients presenting with chronic autoimmune thyroiditis and in the absence of thyroid dysfunction. Although pathogenesis of EOP remains to be elucidated its autoimmune nature with the involvement of sensitized T-lymphocytes and autoantibodies against orbital tissues leaves no doubt. The understanding of mechanisms underlying the development of EOP gave impetus to the creation of new groups of medicines selectively acting on various pathogenic processes associated with this disease. The management of EOP remains a challenging problem requiring a multi-disciplinary approach for its solution.

Problems of Endocrinology. 2012;58(6):24-32
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The incretin system in type 2 diabetes mellitus: cardiovascular effects
Sukhareva O.Y., Shmushkovich I.A., Shestakova E.A., Shestakova M.V.
Abstract
Cardiovascular diseases are the commonest cause of high mortality rate among the patients with type 2 diabetes mellitus. (DM2). The safety of hypoglycemic agents considered as potential risk factors of cardiovascular pathology becomes an increasingly important concern in the choice of the strategy for the treatment of DM2 as recommended in the relevant domestic and international guidelines. The data of multifaceted action exerted by incretins on the cardiovascular system have recently become available. The potential cardioprotective properties of incretin-based pharmaceutical products and mechanisms of their action are discussed
Problems of Endocrinology. 2012;58(6):33-42
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The use of dipeptidyl peptidase-4 inhibitors for the treatment of patients with type 2 diabetes mellitus and chronic renal disease
Shamkhalova M.S., Shestakova M.V.
Abstract

The rapid increase in the number of patients with type 2 diabetes mellitus and renal pathology necessitates the revision of the presently adopted approaches to renal replacement therapy with a view of relieving the economic and financial burden imposed by the use of expensive therapeutic methods on the health budgets of the developed countries. The importance of achievement and maintenance of the target blood sugar levels for the prevention of the development and progression of renal lesions has been demonstrated in a series of large-scale clinical studies. Compensation of disorders of carbohydrate metabolism at the late stages of chronic renal disease in the patients presenting with diabetes mellitus encounters difficulties arising from the danger of hypoglycemia associated with the impairment of renal gluconeogenesis, cumulation of antiglycemic agents and their metabolites, decreased clinical significance of glycated hemoglobin levels under conditions of developing anemia and marked hyperglycemia. Discontentedness with the currently available means for the control of carbohydrate metabolism that fail to meet the up-to-date-requirements for the effectiveness and safety in a given clinical situation accounts for the ever increasing interest in the possibility of using innovative incretin-based medicines taking into account their pharmacological profile (they are known to change insulin secretion in response to variations in blood glucose levels, improve the function of beta-cells, have beneficial effect on the cardiovascular system, and control body weight).

Problems of Endocrinology. 2012;58(6):43-48
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Modern possibilities for the intensification of hypoglycemic therapy in the patients presenting with type 2 diabetes mellitus
Ametov A.S., Abaeva F.T.
Abstract

The results of the UKPDS study have demonstrated the importance of achieving an ideal level of glycemic control to guarantee the prevention or significant slowdown of the development of complications of diabetes mellitus (DM). However, a later study put in question the necessity of strict control in all the patients presenting with type 2 diabetes mellitus (DM2) because low HbA1c levels proved to be by no means always associated with the improvement of prognosis and even increased the risk of cardiovascular complications. Further investigations revealed the expediency of the treatment of diabetes mellitus on an individual basis with respect to both hypoglycemic therapy and formulation of its goals. The notion of safety of DM therapy acquired the primary significance. In this context, any novel approach ensuring the safety of treatment deserves serious attention. One such approach consists of taking advantage of the physiological benefits provided by the use of incretins that are intestinal hormones possessed of hypoglycemic activity. Our experience with the use of one of the DPP-4 inhibitors, vildagliptin, allows to recommend this preparation for the treatment of diabetic patients.

Problems of Endocrinology. 2012;58(6):49-52
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The choice of oral hypoglycemic agents: the current view of the problem
Demidova T.Y.
Abstract

The advantages of combined therapy of diabetes mellitus (DM) with the use of fixed combinations, such as glybenclamide plus metformin are discussed. The principal ones are the lowered dose of each component without the loss of therapeutic efficacy, marked reduction in the frequency of adverse reactions affecting the gastrointestinal tract, minimal risk of hypoglycemic episodes, etc. The fixed combination of glybenclamide plus metformin makes it possible to prescribe flexible dosage regimes, enhanves compliance, ensures psychological comfort, and improves the quality of life. 

Problems of Endocrinology. 2012;58(6):53-59
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In memory of Professor Victor Vasilievich Trusov
Kazakova I.A., Rudenko I.B.
Abstract
June 29, 2012 died a famous scientist, doctor, teacher - prof. Viktor Vasilievich Trusov.
Problems of Endocrinology. 2012;58(6):65-66
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Original Studies
The clinical and instrumental rationale for the choice of therapy of arterial hypertension in the patients presenting with diabetes mellitus
Tatarchenko I.P., Pozdnyakova N.V., Mordovina A.G.
Abstract

Cardiovascular disorders are the main cause of high disability and mortality rates among the patients with diabetes mellitus. The objective of the present work was to estimate the clinical and hemodynamic characteristics during the treatment of arterial hypertension with the use of olmesartan (hypertension/angiotensin II receptor antagonist, ARA) in the patients with type 2 diabetes mellitus suffering diastolic heart failure. The study included 56 patients (26 men and 30 women) of the mean age 58.2±5.3 years. They were given a course of olmesartan (cardosal) therapy 40 weeks in duration. This treatment was shown to result in positive dynamics of structural and geometric characteristics of the left ventricle and its diastolic function in conjunction with the improvement of the vasomotor function of arterial endothelium.

Problems of Endocrinology. 2012;58(6):8-12
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