Описаний клінічний випадок атипового перебігу гіпотиреозу в сплученні з параксизмальною артеріальною гіпертензією у пацієнтки 1953 р.н. Ретельне обстеження хворої дало змогу діагностувати у неї стеноз ниркової артерії, що призводило до нападів підйомів артеріального тиску при комперсованому тиреоїдному статусі. Правильно підібрана терапевтична корекція призвела до покращення самопочуття пацієнтки.

Потреба у нутрицевтичній підтримці при лікуванні пацієнтів із ЦД 2 типу для необхідного глікемічного контролю є актуальним напрямком у сфері охорони здоров'я. Протягом останнього десятиліття терапія ЦД 2 типу значно поліпшилася завдяки впровадженню ряду нових антигіперглікемічних препаратів, які широко застосовуються в клінічній практиці. Однак, синтетичні цукрознижуючі засоби мають негативні побічні ефекти при тривалому використанні у певних груп пацієнтів. У той же час, ліки, отримані з природних джерел, демонструють широкий спектр структурних та фізико-хімічних характеристик, які були адаптовані через еволюцію для селективного зв'язування з функціональними макромолекулами в організмі людини. Проведеним дослідженням доведено, що комплексна терапія з додаванням добавки дієтичної «Омнідіа», яка приймалася по 3 капсули тричі на добу за 30-60 хвилин до прийому їжі протягом 12 тижнів, надавала антигіперглікемічний і гіполіпідемічний ефекти у пацієнтів із ЦД 2 типу. Також рослинний засіб «Омнідіа» добре переноситься пацієнтами і не викликає побічних ефектів при тривалому застосуванні. Додавання добавки дієтичної «Омнідіа» до комплексного лікування хворих на ЦД у окремих пацієнтів дозволило знизити дозу цукрознижувальних препаратів та інсуліну.

Представлений рідкісний випадок вродженої гіперплазії кори надниркових залоз у пацієнта з класичним варіантом недостатності 21-гідроксилази. Внаслідок антенатальної гіперандрогенії розвинувся хибний жіночий гермафродитизм. Таким чином, при народженні, було помилково зареєстровано чоловічу стать. Діагноз встановлено у тримісячному віці, але, через відмову батьків, патогенетичне лікування не проводилось впродовж багатьох років. Пацієнт виховувався, як хлопчик, гендерної дисфорії не мав. Систематична замісна гормонотерапія преднізолоном розпочата тільки з 31 року після проведеного оперативного втручання – видалення матки з придатками. Додавання до терапії тестостерону та симптоматичних препаратів забезпечило задовільний стан пацієнта, збереження працездатності і чоловічої потенції. Однак вимушена відміна тестостерону та зміна дозування преднізолону привела до декомпенсації та погіршення загального і психо-емоційного стану. Це обумовлено симптомами гіпокортизолемії, зниженням потенції та, як наслідок, напруженими стосунками зі статевим партнером. Корекція замісної терапії забезпечила повернення пацієнта до відносно нормального життя. Звертає на себе увагу той факт, що після видалення матки з придатками та відновлення гормональної терапії у хворого зникли епілептичні скарги. Крім того, на момент теперішнього обстеження виявлено утворення лівого наднирника, що потребує верифікації та спостереження.

Background. Neutrophil gelatinase-associated lipocalin (NGAL) belongs to the superfamily of lipocalins whose main function is the binding and transportation of hydrophobic molecules, si­derophores, as the most important ligands of NGAL. The diagnostic significance of NGAL as a marker of renal dysfunction, as well as its prognostic value in terms of the further prognosis of the course of renal pathology has now been confirmed. The purpose of the study: to determine the role of NGAL in the development of renal dysfunction in hypertensive patients with comorbid type 2 diabetes (T2D) and obesity. Materials and methods. One hundred and eleven patients with hypertension (50 men, 61 women) aged 54.37 ± 1.18 years and 20 controls were examined. During the examination, they were divi­ded into 4 groups depending on the presence of comorbid pathology: hypertension — the first group (n = 22); hypertension combined with obesity — the second group (n = 30); hypertension combined with T2D — the third group (n = 31); hypertension, T2D and obesity — the fourth group (n = 28). In all patients, body weight and height were measured, body mass index was calculated, levels of glycated hemoglobin, lipid metabolism, systolic and diastolic blood pressure were measured. The content of NGAL in blood serum was evaluated by the enzyme-linked immunosorbent assay. Results. The level of NGAL in all patients included in the study was significantly higher compared to the control group (p < 0.01). However, it was highest in comorbidity of hypertension, T2D and obesity, which, in turn, indicates a high risk of interstitial fibrosis in these patients. A significant correlation was found between the level of NGAL and the concentration of cardiotrophin (p < 0.032), catestatin (p < 0.001), β2-microglobulin (p < 0.001), cystatin (p < 0.021), atherogenic coefficient (p < 0.011), NT-proBNP (p < 0.014), vitamin D (p < 0.004). The obtained data demonstrate the significant role of NGAL in the development of early cardiovascular and renal complications in our patients. Conclusions. A significant increase in the level of NGAL was found in patients with hypertension, hypertension with T2D, hypertension with obesity, hypertension with T2DM and obesity compared to healthy individuals (p < 0.01). A significant correlation of the NGAL level with the serum concentration of cardiotrophin, catestatin, cystatin C, β2-microglobulin, atherogenic coefficient, NT-proBNP, and vitamin D in the exami­ned patients was proved.

Objective: To investigate the effect of lipid metabolism, biomarkers of fractalkin and clusterin inflammation on the development and progression of chronic heart failure (CHF) in patients with post-infarction cardiosclerosis, type 2 diabetes and obesity. Design and method: A retrospective analysis of a comprehensive examination of 67 patients with postinfarction cardiosclerosis with concomitant type 2 diabetes and obesity. All patients were divided into 3 groups depending on the functional class (FC) of CHF: 1 group (n = 22) - patients with CHF II FC; Group 2 (n = 23) - patients with CHF III FC; Group 3 (n = 22) - patients with CHF IV FC. All patients were examined clinically, they underwent instrumental, biochemical and hormonal examinations. Results: With the progression of CHF from FC II to FC III there is a deterioration of lipid metabolism: a significant increase in cholesterol levels by 5.5%, TG – by 15.7%, LDL cholesterol – by 74.4%, VLDL cholesterol – by 15.9%, reduction of HDL cholesterol by 27.6% (p<0,05). An analysis of the fractal equation showing that ailing on CHF is advised by FC; and the level of clusterine - on the contrary decreases. Classical changes in patients with postinfarction cardiosclerosis with CHF and concomitant type 2 diabetes mellitus and obesity, which are the formation of atherogenic lipid metabolism disorders associated with body weight, as well as changes in the latest indicators such as fractalkin and clusterin, indicating the role of these molecules in the progression of CHF. Conclusions: Due to the progression of chronic heart failure in patients with postinfarction cardiosclerosis and AH concomitant type 2 diabetes and obesity, an increase in all fractions of lipoproteins at stage III functional class was diagnosed, and then their decrease, which may indicate a deterioration in this category of patients, due to the progression of metabolic shifts, stagnation, dysfunction of the main parenchymal organs. Increased circulatory levels of fractalkin and decreased clusterin content in patients with postinfarction cardiosclerosis with concomitant type 2 diabetes mellitus and obesity is accompanied by an increase in the functional class of chronic heart failure.

Non-alcoholic fatty liver disease (NAFLD), the most common form of liver disease, is now recognized as a major public health problem worldwide. Tumor necrosis factor alfa (TNF-α), a member of the TNF/TNFR cytokine family, is an intercellular transmission molecule that has been reported in a wide range of human noninfection diseases. The aim of the study was to determine the circulating levels of TNF-α and the nature of its relationships with the components of insulin resistance, both metabolic and hormonal, in patients with type 2 diabetes; and establishing the nature of cardiovascular complications (taking into account TNF-α gene polymorphism) in the presence and absence of NAFLD. Materials and methods. Case-control study included information about 50 practically healthy people from the city of Kharkiv and the region. The examined population (except control subjects) consisted exclusively of patients with type 2 diabetes mellitus with a long-term existence of the disease against the background of metabolic syndrome, with varying degrees of glycemic control and violations of liver homeostasis in the absence of renal failure. 117 people were selected for analysis: 63 of them with type 2 diabetes in the presence of NAFLD and 54 patients with type 2 diabetes without NAFLD. Genotyping for single nucleotide polymorphism -308 G>A of the TNF-α was performed by the method of polymerase chain reaction with appropriate primers and NcoI endonuclease. Testing of statistical hypotheses was carried out using the odds ratio and χ2 criteria at the significance level of P≤0.05. Results. The contribution of the genetic component to the formation of the predisposition to the development of type 2 diabetes mellitus based on the single-nucleotide polymorphism -308 G>A of the TNFα gene was determined, which makes it possible to consider the carrier of the A allele as a factor of increased risk for the development of type 2 diabetes mellitus. No association of the studied polymorphism with the risk of developing NAFLD was found. The obtained data make it possible to assume that the studied polymorphism -308 G>A of the TNFα gene is more associated with the risk of developing type 2 diabetes, and the occurrence or progression of NAFLD primarily depends on metabolic imbalance, and not on the contribution of the studied polymorphism. Conclusions. Non-alcoholic fatty liver disease is closely related to hormonal and metabolic risk factors and markers of cardiovascular disease and type 2 diabetes and may increase the risk of developing and progressing cardiovascular complications. The contribution of the genetic component to the formation of the predisposition to the development of type 2 diabetes mellitus based on the single-nucleotide polymorphism -308 G>A of the TNFα gene was determined, which makes it possible to consider the carrier of the A allele as a factor of increased risk for the development of type 2 diabetes mellitus.

Background. It is known that single nucleotide polymorphisms (SNPs) in adipokine genes can influence the development of pathological conditions associated with obesity, type 2 diabetes mellitus, non-alcoholic fatty liver disease and their complications. In this study, we aimed to investigate the link between common -2548G>A (rs7799039) promoter variant of the human leptin gene (LEP) with leptin levels in type 2 diabetes patients with non-alcoholic fatty liver diseasese. Materials and methods. 61 patients with T2D aged from 28 to 80 years old (34 men/27 women, age 56.40±0.62 yrs, diabetes duration 7.72±0.45 yrs, BMI 32.20±0.43 kg/m2, WHR 1,00 ±0,01, HbA1c 7.80±0.19 %) with varying degrees of glycemic control and overweight, without renal insufficiency and 51 sex and age-match control subjects were examined. Genotyping according to SNP LEP 2548G>A was performed using the polymerase chain reaction method with appropriate primers and HhaI endonuclease. Results. In our study of T2DM patients with NAFLD compared to T2DM patients without NAFLD features of dyslipidemia i.e. significant increase in triglycerides (p <0,001), LDL cholesterol (p <0,1), lower HDL cholesterol ( p <0.001) were found. Stratification of the diabetic patients in the presence and absence of NAFLD showed more pronounced increase in circulating leptin levels in the presence of NAFLD (84.73 ± 13.80 vs. 52.57 ± 6.86 ng / ml, respectively), (p <0.01), which justifies the feasibility of using this indicator for further needs as a diagnostic parameter of the above complication. In our study in GG carriers genotype of the G2548A LEP gene polymorphic locus type 2 diabetes patients with NAFLD the highest level of leptin was observed (159.15 ng/ml), compared to other genotypes. Thus, it can be assumed that the G allele is associated with increased leptin levels in the blood of patients with NAFLD. This study showed that women with type 2 diabetes mellitus carrying the GG genotype with the G-2458A polymorphic variant of the LEP gene have 3.4 times higher leptin levels than men carrying the same genotype (p<0.03). The data obtained regarding the 2548G>A polymorphic variant of the LEP gene can be used as a basis for personalized prevention and the formation of risk groups for the development of NAFLD.

The aim of the work was to find out the significance of vaspin and omentin in metabolic shifts, endothelial dysfunction, cardiovascular diseases and other vascular disorders in patients with type 2 diabetes mellitus based on the analysis of modern literature sources and their own research. Material and methods. A thorough review of modern literature sources, including the results of clinical and experimental data, on studies of the importance of the hormones vaspin and omentin in the development of cardiovascular complications in patients with type 2 diabetes mellitus against the background of obesity, was carried out. 75 patients with type 2 diabetes mellitus, overweight and obese of varying degrees were examined. Serum vaspin and omentin levels were determined. The presence and strength of the relationship between factors were calculated using the Spearman — rs rank correlation coefficient. As a result of the analysis of literature data, it was found that at the present stage, the biological and pathophysiological effects of vaspin and omentin in the human body are not fully clarified, and data on their prognostic and diagnostic value in patients with type 2 diabetes mellitus with cardiovascular pathology against the background of obesity are extremely small, so when studying their own data on finding out the role of these adipokines in the development of metabolic disorders, namely, obesity of varying degrees, as a predictor of cardiovascular complications in the above patients, the inverse correlation of vaspin with waist circumference indicators is proved, fat mass and body mass index and straight-with the outline of the hips. As for omentin, data were obtained that indicate the presence of a direct correlation between this adipokin and waist circumference, fat mass and body mass index, the opposite — with hip circumference. It has also been suggested that these adipokines can be used as prognostic markers of cardiovascular complications in the above individuals. It is concluded that vaspin and omentin play an important role in the development of metabolic disorders, but require further research.

In the current conditions, coronavirus infection is often the cause of the development of inflammatory and autoimmune diseases of the thyroid gland. One of these diseases can be subclinical hypothyroidism — the initial stage of development of manifest hypothyroidism. Signs of hypothyroidism include weight gain, edema, decreased mental activity, increased drowsiness, dry skin, bradycardia, cardiomyopathy, constipation, muscle cramps, and paraesthesia. Because SG is asymptomatic by definition, 25–50% of patients have slow but characteristic signs of hypothyroidism, manifested by disorders of many organs and systems. Unfortunately, in most cases, such clinical manifestations are assessed retrospectively after the detection of characteristic hormonal changes. The expediency of treating both subclinical hypothyroidism and manifest hypothyroidism is evaluated individually, especially for the elderly, depending on the level of Thyroid-Stimulating Hormone and the presence of comorbid pathology. Synthetic levothyroxine remains the drug of choice for all forms of hypothyroidism. The generally accepted starting dose of levothyroxine for adult 13 patients, according to the recommendations of ATA, is considered a dose of 1.6–1.8 mcg/kg of body weight. Eutirox is a drug that has a unique line of 6 dosages in increments of 25 mcg of Levothyroxine and now the drug has an updated composition that fully ensures the balanced functioning of the thyroid gland. The updated composition is completely bioequivalent to the previous composition with similar tolerability. The increased requirements for the composition of the active substance, which was achieved in the updated composition of Eutirox, has advantages for patients, since hormone fluctuations will be minimized and this will help to avoid the development of adverse clinical consequences.

Актуальність. Важливість своєчасної діагностики надлишку маси тіла та ожиріння з урахуванням, крім індексу маси тіла, і параметрів структури тіла, у тому числі особливостей змін його рідинних секторів, обумовлена значним збільшенням поширеності ожиріння та його ускладнень. Мета: вивчити особливості розподілу рідинних секторів організму та взаємозв’язку з показниками компонентного складу тіла в осіб із надлишковою масою тіла та ожирінням на прикладі дорослого населення м. Харкова. Матеріали та методи. Обстежено 485 мешканців м. Харкова віком понад 18 років. Методом біоімпедансного аналізу залежно від індексу маси тіла та статі оцінено рівні загальної води (л); загальної; позаклітинної, внутрішньоклітинної, інтерстиціальної рідини (л). Результати. Установлено, що в пацієнтів із надлишком ваги різного ступеня разом з абсолютним збільшенням загальної води та загальної, позаклітинної, у т.ч. інтерстиціальної, та внутрішньоклітинної рідини відзначається відносний дефіцит цих параметрів. Виявлені зміни поглиблюються з прогресуванням ступеня ожиріння. Розуміння цих закономірностей важливе для розробки персоніфікованих підходів до надання допомоги населенню з надлишком маси тіла. Висновки. Для використання в клінічній практиці запропоновано математичні формули для визначення параметрів рідинних секторів тіла в міського населення України без застосування інструментальних методів.

Diabetic polyneuropathy (DPN) is the most common chronic complication of diabetes mellitus. It is known that DPN not only significantly reduces the quality of life of patients, but also causes more formidable consequences of the disease - diabetic foot syndrome and limb amputation. Given the key role of hyperglycemia in the pathogenesis of DPN, the main direction in the prevention and treatment of this condition is adequate control of blood glucose and glycosylated hemoglobin (HbA1c) levels.

The diagnostic model to highlight the high-risk groups of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus by the level of retinol-binding protein-4, high molecular weight adiponectin and body mass index using discriminant analysis was developed.

Insulin resistance (IR) and hyperinsulinemia (GI) play a leading role in the development of macrovascular complications in type 2 diabetes mellitus (DM), which are the main cause of mortality in these patients. Taking into account the decisive importance of gluco- and lipotoxicity in the development of microangiopathies, the main goal of antidiabetic pharmacological correction is to influence IR and dysfunction of β-cells of the pancreas

Women with a long course of hypertension, which leads to the development of chronic heart failure, valid factors are the presence of diabetes mellitus, coronary artery disease and the advantage of a favorable concentric type of LV remodeling with preserved systolic function. In men of the same age, myocardial remodeling has a less favorable course with an increase in the size of the left ventricle and LA on the background of a more pronounced decrease in systolic function.

Central hemodynamic parameters in 40 patients with arterial hypertension, postinfarction cardiosclerosis and type 2 diabetes were evaluated. Based on the study, it is proved that type 2 diabetes mellitus is a predictor of concentric LV myocardial hypertrophy, which can be considered as a reaction of the heart to prolonged increased load and disruption of myocardial microcirculation, contributes to complex structural and functional reorganization of the heart with a tendency to reduce myocardial contractility. Comorbidity of hypertension, postinfarction cardiosclerosis and type 2 diabetes increases the incidence of signs of left ventricular diastolic dysfunction type 1 (type of relaxation disorder), which leads to a worsening of the prognosis of cardiovascular complications.

The paper presents an analysis of current literature data on the use of the R-enantiomer of α-lipoic acid as an antihypertensive treatment in patients with hypertension and metabolic syndrome. An analysis of the literature was carried out on its use as an antiinflammatory agent in inflammatory diseases. Currently, a very important aspect of researches is the possibility of using R-α-lipoic acid as a micronutrient and therapeutic agent for the treatment of diabetic polyneuropathy and neurodegenerative diseases, especially Alzheimer’s disease, carbohydrate metabolism disorders and metabolic syndrome. Lipoic acid has now become an important ingredient in multivitamin formulas, anti-aging supplements. R-α-lipoic acid is a metabolic antioxidant, its molecule contains a dithiolane ring in oxidized form, this ring has the ability to cleave with formation of dihydrolipoic acid. And since α-lipoic acid, a physiological form of thioctic acid, is a strong antioxidant that relieves the symptoms of diabetic neuropathy, the literature review analyzed data from various authors on the antioxidant effects of the R-enantiomer of α-lipoic acid and found that it had strong antioxidant effects, and its dose of 300 mg is bioequivalent to 600mg of racemic α-lipoic acid. As presented in a sufficient number of analyzed sources, the biological role of lipoic acid is quite diverse. It is important to determine the exact causal relationship between lipoic acid and its immediate cellular targets. Lipoic acid can have a number of important and diverse physiological effects on the stimulation of neurohormonal function and, thus, indirectly affect multiple cellular signaling pathways in peripheral tissues.

В данном обзоре, состоящем из двух частей, рассматривается новая формула инсулина гларгин (рДНК происхождения) в форме инъекций 300 ЕД/мл (Gla-300, Тожео). Gla-300 представляет следующую генерацию базального инсулина с новой формулой инсулина гларгин, поставляющего то же количество инсулина, что и гларгин-100 (Gla-100) в 1/3 объема. После подкожной инъекции фармакокинетический и фармакодинамический профили Gla-300 являются более постоянными и продолжительными (более 24 часов) по сравнению с Gla-100, что обусловлено более постепенным и длительным выделением гларгина из подкожного депо (Gla-300 образует более компактное подкожное депо с уменьшенной поверхностью по сравнению с Gla-100). С акцентом на недавних результатах клинических исследований EDITION (3а-фаза) обсуждается клиническая эффективность и безопасность Gla-300 у больных сахарным диабетом 1-го и 2-го типа. Gla-300 демонстрировал сопоставимый гликемическиий контроль и подобный профиль безопасности при условиях более низкой частоты гипогликемических событий по сравнению с Gla-100. Gla-300 обеспечивал гибкий режим введения инсулина (24 ± 3 часа или утром vs вечером) и был ассоциирован с меньшим увеличением массы тела.