The lack of systemic mass iodine prophylaxis in the Russian Federation is the main reason for the annual increase in the inci dence of thyroid pathologies throughout the country. Despite the set of measures aimed at implementing the Strategy for Improving the Quality of Food Products in the Russian Federation (RF) until 2030, approved by the RF Government Decree of 29.06.2016 No. 1364, including providing for the supply of iodized salt to retail organizations, food units of healthcare institu tions, kindergartens, schools and other institutions, the prevalence of thyroid pathologies in the regions remains high. The arti cle presents the results of the study assessing the severity of iodine deficiency and the prevalence of thyroid pathology among the population of the Tula region, conducted by specialists of the “Endocrinology research center” of the Ministry of Health of Russia together with the Ministry of Health of the Tula Region.BACKGROUND: The relevance of research on the assessment of iodine status and the study of the structure of thyroid pathol ogy among residents of certain territories of the Russian Federation, which are characterized by natural iodine deficiency and past technogenic radiation contamination, is associated with the need to clarify the mechanisms of development of thyroid pathology, including comorbid conditions, and will allow the implementation of scientifically justified preventive measures. AIM: To conduct a comprehensive study to assess the current iodine sufficiency of the population of the Tula region — an area affected by the Chernobyl nuclear power plant accident in 1986, analyze the actual prevalence and structure of thyroid pathol ogy compared to official statistics, and formulate conclusions about necessary preventive measures.MATERIALS AND METHODS: During the study in the Tula region, 589 people were examined, including 303 school-age chil dren (7–11 years old) and 286 adults (18 years and older). The epidemiological part of the study was conducted among the child population using the cluster method in three districts of the region (Tula — 90 children, Arsenyevsky district — 118 children, Yasnogorsky district — 95 children) and included: collection of anamnesis and questionnaires, measurement of anthropomet ric indicators (height, weight), examination by an endocrinologist with palpation of the thyroid gland, thyroid ultrasound with volume calculation, determination of iodine concentration in urine, examination of samples of table salt from households for the presence of iodine in them. A cross-sectional cohort survey of the adult population was conducted from June 8 to 10, 2022, in three districts of the Tula region: Yasnogorsk (n=79), Arsenyevsky (n=70), Shchekinsky (n=137) and included: collection of anamnesis and questionnaires, examination by an endocrinologist, thyroid ultrasound, determination of thyroid-stimulating hormone (TSH) and thyroid peroxidase antibodies (TPO-AT) in the blood serum, as well as a study of samples of table salt from households for the presence of iodine. RESULTS: According to the results of the epidemiological study in the Tula region, mild iodine deficiency (ID) was established (median urinary iodine (mUI) — 69.1 μg/l, share of diffuse goiter in children according to ultrasound data — 8.5%), with the allocation of the Arsenyevsky district, in which the mUI of 41.5 μg/l indicates moderate ID and a large proportion of goiter in children was detected — 13.5%. The share of households in the Tula region using iodized salt is very low — 18.5%. The results of the examination of the adult population of the Tula region confirmed the high prevalence of thyroid pathology in the region (ultrasound signs of structural changes in the thyroid gland were detected in 52.8% of those examined), which is mostly rep resented by nodular forms of goiter (76.8%). The combination of ultrasound signs of autoimmune and nodular thyroid pathol ogies occurs in 11.3% of cases of the overall prevalence of structural changes in the thyroid gland. When comparing with the data from previously conducted expeditions, a negative dynamics has been noted in the form of an increase in the prevalence of diseases of the thyroid glands detected by ultrasound in the study areas, from 26% in 1995 to 65–85.7% in 2022.CONCLUSION: Monitoring of the epidemiological situation in the Tula region has demonstrated a persisting inadequate level of iodine sufficiency among the population, which is reflected in the increasing prevalence of thyroid diseases and indicates the inefficiency of episodic measures for preventing iodine deficiency disorders (IDD). Taking into account the ecological status of the region, from the standpoint of medical and social significance, it is extremely important for regional health authorities to take urgent measures, namely, the development and implementation of a regional target program for the prevention of IDD with an emphasis on mass prevention using iodized salt.

Background : The Republic of Tyva is a region with a proven severe natural iodine deficiency and a high prevalence of IDD (iodine deficiency disorders). However, in the region in certain periods of time, measures were taken to eliminate iodine deficiency in the diet of the population. The article presents the results of the October 2020. by specialists of the Endocrinology Research Centre, a control and epidemiological study aimed at assessing the current state of iodine supply in the population of the Republic of Tyva. The study was carried out on behalf of the Ministry of Health of Russia within the framework of the state task «Scientific assessment of the need to take additional regulatory legal and other measures to eliminate iodine deficiency in pilot regions with severe iodine deficiency». Aim : Assessment of iodine supply of the population of the Republic of Tuva. Materials and methods : The research was carried out in three settlements of the republic — years. Kyzyl, Shagonar, Saryg-Sep settlement. A total of 227 pre-pubertal schoolchildren (8–10 years old) were examined with anamnesis collection, examination by an endocrinologist, palpation of the thyroid gland, collection of single urine samples into disposable eppendorfs, followed by freezing to minus 20–25 degrees to further determine the concentration of iodine in urine with using the cerium-arsenitic method in the laboratory (clinical diagnostic laboratory of the Federal State Budgetary Institution «National Medical Research Center of Endocrinology» of the Ministry of Health of Russia). In addition, all schoolchildren underwent an ultrasound examination of the thyroid gland (using a portable ultrasound machine LOGIQe (China) with a multifrequency linear transducer 10–15 MHz, in the supine position). The height and weight of children was determined according to the standard method at the time of the examination. A collection of samples of edible salt, which is used in families of schoolchildren, was carried out and the presence of iodine in it was determined by an express method for the qualitative determination of potassium iodate. Parents of schoolchildren signed informed consent for the examination of children. Permission of the local ethical committee of the Endocrinology Research Centre — received, date: March 25, 2020, N 5. Results : 227 schoolchildren of 8–10 years old were examined. The median concentration of iodine in urine was determined, the presence of iodine in food salt was investigated, and an ultrasound examination of the thyroid gland was carried out in order to clarify the iodine supply, the coverage of the use of iodized salt in nutrition and the prevalence of goiter. The median concentration of iodine in urine was 153 μg/l, the frequency of goiter was 7.7%, and the proportion of households using iodized salt was 95.2%. Conclusion : Results of assessment (median urinary iodine concentration) confirm that population of Tuva, Russian Federation, has optimum iodine nutrition. The prevalence of goiter in schoolchildren significantly decreased compared to earlier assessments. The proportion of households using iodized salt indicates the effectiveness of preventive measures in the ­region.

BACKGROUND:The Republic of Tyva is a region with a proven severe natural iodine deficiency and a high prevalence of IDD (iodine deficiency disorders). However, in the region in certain periods of time, measures were taken to eliminate iodine deficiency in the diet of the population. The article presents the results of the October 2020. by specialists of the Endocrinology Research Centre, a control and epidemiological study aimed at assessing the current state of iodine supply in the population of the Republic of Tyva. The study was carried out on behalf of the Ministry of Health of Russia within the framework of the state task «Scientific assessment of the need to take additional regulatory legal and other measures to eliminate iodine deficiency in pilot regions with severe iodine deficiency».AIM:Assessment of iodine supply of the population of the Republic of Tuva.MATERIALS AND METHODS:The research was carried out in three settlements of the republic - years. Kyzyl, Shagonar, Saryg-Sep settlement. A total of 227 pre-pubertal schoolchildren (8-10 years old) were examined with anamnesis collection, examination by an endocrinologist, palpation of the thyroid gland, collection of single urine samples into disposable eppendorfs, followed by freezing to minus 20-25 degrees to further determine the concentration of iodine in urine with using the cerium-arsenitic method in the laboratory (clinical diagnostic laboratory of the Federal State Budgetary Institution «National Medical Research Center of Endocrinology» of the Ministry of Health of Russia). In addition, all schoolchildren underwent an ultrasound examination of the thyroid gland (using a portable ultrasound machine LOGIQe (China) with a multifrequency linear transducer 10-15 MHz, in the supine position). The height and weight of children was determined according to the standard method at the time of the examination. A collection of samples of edible salt, which is used in families of schoolchildren, was carried out and the presence of iodine in it was determined by an express method for the qualitative determination of potassium iodate.Parents of schoolchildren signed informed consent for the examination of children. Permission of the local ethical committee of the Endocrinology Research Centre - received, date: March 25, 2020, N 5.RESULTS:227 schoolchildren of 8-10 years old were examined. The median concentration of iodine in urine was determined, the presence of iodine in food salt was investigated, and an ultrasound examination of the thyroid gland was carried out in order to clarify the iodine supply, the coverage of the use of iodized salt in nutrition and the prevalence of goiter.The median concentration of iodine in urine was 153 μg/l, the frequency of goiter was 7.7%, and the proportion of households using iodized salt was 95.2%.CONCLUSION:Results of assessment (median urinary iodine concentration) confirm that population of Tuva, Russian Federation, has optimum iodine nutrition. The prevalence of goiter in schoolchildren significantly decreased compared to earlier assessments. The proportion of households using iodized salt indicates the effectiveness of preventive measures in the -region.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Aims . To study of the polymorphisms of the TPN2 and GNB3 genes in obese patients and their effect on weight loss in patients on sibutramine therapy. Materials and methods . The research study included 118 patients with exogenous-constitutional obesity who received Reduxin (sibutramine + CMC) at the dose of 10 mg. Term follow-up was 3 months. A genetic study was performed to assess ТРН2 and GNB3 gene polymorphisms. The response to the therapy was evaluated after 3 months by the dynamics of body weight. Results . In the study the G703T polymorphism of the GNB3 gene showed that during 3 months of observation, carriers of the TT genotype had a greater decrease in body weight in comparison with carriers of the allele C – -8 kg (-12; -5) vs. -5 kg (-8; -3), p = 0.018. In carriers of different variants of the genotype of the TPH2 gene (polymorphism C825T), there was no difference in body weight dynamics with sibutramine therapy. There was no correlation between the foresaid polymorphisms of the TPH2 and GNB3 genes with the indices of blood pressure and heart rate. Conclusions . 1. The result of sibutramin therapy may depend on genetic factors: in carriers of the TT-genotype C825T of the GNB3 gene the body weight loss was higher than among the carriers of the C allele. 2. Changes in blood pressure and heart rate did not show any statistically significant relationship with polymorphisms of the TPH2 and GNB3 genes.

Objective: The aim of the study was to assess the effectiveness and safety of long-term sibutramine therapy in routine clinical practice. Methods: In total, 98,774 patients (82.3% women, 17.7% men) from 142 cities of the Russian Federation were enrolled in the PRIMAVERA program. The mean age of the patients was 39.39 ± 10.38 years, the mean body weight was 99.1 ± 14.28 kg, and the mean BMI was 35.7 ± 4.41 kg/m2. The duration of the sibutramine therapy was determined by physicians: 59.3% of patients took the drug for 6 months, the treatment course of 37.7% of patients was 12 months, and 3% of patients had treatment for 3 months. Results: The BMI reduction correlated with the treatment duration: 3.4 ± 1.53 kg/m2 after 3 months of therapy, 5.4 ± 2.22 kg/m2 after 6 months, and 7.2 ± 3.07 kg/m2 after 12 months. The body weight reduction after 3, 6 and 12 months of treatment was 9.5%, 15.1%, and 19.7%, respectively. The body weight loss associated with sibutramine treatment was accompanied by a slight decrease in blood pressure and did not lead to any significant increases of the heart rate. Conclusions: The results of the PRIMAVERA study confirmed the lack of increased risk of using sibutramine in routine clinical practice in patients without underlying cardiovascular disease and low rate of adverse events.

Introduction. The efficacy of pharmacological treatment of arterial hypertension depends of many factors. Some of them are polymorphisms of ABCB1 and CYP3A genes which take part in drug metabolism. The aim of present study was to determine the influence of ABCB1 (rs4148738) and CYP3A4*22 (rs35599367) polymorphisms on the efficacy and safety of antihypertensive therapy with amlodipine. Methods. The study included 100 patients diagnosed with essential arterial hypertension (I-II stages) who received amlodipine, 53 of them are men and 47 are women (mean age 60.15 ± 10.31 years). Genotyping of ABCB1 (rs4148738) and CYP3A4*22 (rs35599367) polymorphisms was performed by reaL-time polymerase chain reaction. To evaluate the efficacy of antihypertensive therapy an office bLood pressure measurement was used before and after 12-week treatment with amlodipine. The safety of treatment was estimated by physical examination. Results. During the research of ABCB1 (rs4148738) polymorphism 19 patients with the CC genotype, 49 patients with the CT genotype and 32 with the TT genotype were identified. The distribution obeys the Hardy-Weinberg Law (х 2 = 0.001; p = 0.97) which indicates that the sample is representative. Comparison of the three groups of patients by ABCB1 polymorphism revealed significant differences in the frequency of adverse drug reactions caused by amlodipine treatment (Pearson’s chi-squared test, p = 0.02). The greatest number of them was observed in patients with the TT genotype, the minimal - in patients with the CC genotype. There were no statistically significant differences in the change of systolic (SBP) and diastolic (DBP) blood pressure between the three groups (Kruskal-Wallis test, p = 0.41 and p = 0.08 respectively). However when comparing patient groups carriers of at least one T-allele and non-carriers of this allele (CT + TT and CC) greater DBP reducing was found in patients with CC genotype (Mann-Whitney U test, p = 0.025). For the CYP3A4*22 (rs35599367) polymorphism the distribution was: 98 patients with CC genotype and 2 heterozygotes CT. Due to low genotype frequency of CT genotype it was impossible to estimate the role of this polymorphism in treatment with amlodipine. Conclusions. Based on the results obtained it can be concluded that lower efficacy of amlodipine in reducing DBP was performed in patients who are carriers of at least one T-allele. The genotype TT is most associated with the emergence of adverse effects while in patients with the CC genotype their frequency is minimal and for the CT genotype it is at an intermediate level.

Aims. To study of the polymorphisms of the TPN2 and GNB3 genes in obese patients and their effect on weight loss in patients on sibutramine therapy. Materials and methods. The research study included 118 patients with exogenous-constitutional obesity who received Reduxin (sibutramine + CMC) at the dose of 10 mg. Term follow-up was 3 months. A genetic study was performed to assess ТРН2 and GNB3 gene polymorphisms. The response to the therapy was evaluated after 3 months by the dynamics of body weight. Results. In the study the G703T polymorphism of the GNB3 gene showed that during 3 months of observation, carriers of the TT genotype had a greater decrease in body weight in comparison with carriers of the allele C – -8 kg (-12; -5) vs. -5 kg (-8; -3), p = 0.018. In carriers of different variants of the genotype of the TPH2 gene (polymorphism C825T), there was no difference in body weight dynamics with sibutramine therapy. There was no correlation between the foresaid polymorphisms of the TPH2 and GNB3 genes with the indices of blood pressure and heart rate. Conclusions. 1. The result of sibutramin therapy may depend on genetic factors: in carriers of the TT-genotype C825T of the GNB3 gene the body weight loss was higher than among the carriers of the C allele. 2. Changes in blood pressure and heart rate did not show any statistically significant relationship with polymorphisms of the TPH2 and GNB3 genes.

Among comorbidities of obesity, hypothyroidism is the most common endocrinopathy. The pathogenesis of both diseases is based on serotonin deficiency. The article tells about a clinical case of a patient with obesity and subclinical hypothyroidism; a comprehensive examination allowed to choose the efficient and safe pathogenetic therapy.

Pharmacotherapy is an essential component of obesity treatment, as well as efforts focused on changing the lifestyle, correcting the food consumption and increasing the physical activity. The administration of central-acting drugs as pharmacotherapy of obesity is pathogenetically justified and allows improving the effectiveness of treatment. In this article, the use of sibutramine, a serotonin and norepinephrine reuptake inhibitor, is considered in various aspects of endocrinologist’s practice. In addition to aforesaid there is an application of a specific clinical observation.

Aim. To study the influence of SERT and GNB3 gene polymorphisms on the results of the treatment of obesity by serotonin-norepinephrine reuptake inhibitors. Methods. Patients who didn’t achieve significant weight loss in 3 month period during PrimaVera Study were selected for the genetic evaluation and compared with the group of “effective treatment”. study included 66 patients (57 females and 9 males), mean age 39.29 ± 12.64 years, who received Reduxin (sibutramine + MCC) at the dose of 10 mg. Term follow-up was 3 months. Clinical examination and determination of biochemical parameters was performed at baseline and at the end of the observation period. In order to assess the type of eating behavior and identify hidden depressions a validated questionnaire was used (questionnaire The types of eating disorders» (DEBQ), Beck Depression Scale). Also conducted a genetic study to assess SERT and GBN3 gene polymorphisms. Results. In the second group presence of S-allele SERT-gene was significantly associated with higher rates of external type of eating behavior. A statistically significant correlation between the genotype or allele of either body weight, rates of blood pressure, heart rate and cholesterol have not been found. In the first group there was a statistically significant association of S-allele carrier with less weight loss -2.8 kg (compared to l-allele) and higher rates at baseline glucose 5.38 ± 0.63 mmol / l (compared to L-allele of -3.28 kg and 5.04 ± 0.91 mmol / l). In the study of GBN3 polymorphism in the second group among CC genotype carriers there were higher levels of systolic blood pressure (SBP) before treatment (129.27 ± 9.16 mmHg), SBP and diastolic blood pressure after 3 months of treatment (127.36 ± 8.16 and 78.36 ± 4.3 mmHg) compared with CT genotype (117.27 ± 12.5; 115.45 ± 10.6; 72.91 ± 6.0 mm Hg, respectively) (p <0.05). Also among the carriers of C-allele there were more severe manifestations of depressive syndrome in comparison with T-allele carriers. Conclusion. Among the carriers of S-allele of SERT gene body weight loss during Reduxin treatment was lower than among the carriers of the L-allele; among the carriers of CC genotype of GBN3 gene higher blood pressure was higher at baseline and during Reduxin treatment, as well as more severe symptoms of a depressive syndrome.

Aim: To assess interim results of the Russian observational program PrimaVera on efficacy and safety sibutramine (Reduxin®) for treatment of obesity within routine medical practice. Materials and methods: This multicenter observational program included patients with obesity aged below 65 years, excluding those with uncontrolled arterial hypertension, coronary heart disease, heart failure and cerebrovascular disease. All patients were administered sibutramine for treatment of their obesity. During out-patient follow-up visits, physicians assessed changes in patients’ body mass, blood pressure and heart rate, as well as registered adverse events. Maximal treatment duration was 12 months. In this report, the results from 16 515 patients are analyzed, 82% of whom (n=13 192) were females.Results: After 3 months of treatment body mass index (BMI) decreased by 2.81±1.0 kg/m², after 6 months, by 5.17±2.15 kg/m². At 12 months decrease in BMI was 1.3-fold higher compared to 6 months’ results and amounted to 6.76±2.93 kg/m². Reduction of body mass with longterm (above 6 months) treatment with sibutramine under supervision of a physician was associated with a decrease in systolic and diastolic blood pressure levels (by 4.1 mm Hg, in both cases) and did not lead to an increase in heart rate (Δ=-1.02 bpm). Based on data from 16 515 medical records processed up to now, 397 episodes of adverse events were registered, with none of them being serious.Conclusion: This interim results of the program PrimaVera confirmed favorable safety profile of Reduxin® and its high efficacy in the treatment of obesity.

In today's world the problem of obesity is discussed in the context of non-communicable diseases, leading to significant encumbrances on society. This article provides information about the basics of the regulation of energy balance and eating behavior. Particular attention is paid to the role of neurotransmitters, including serotonin, a metabolic disorder that is one of the suspected causes of eating disorders. Demonstrated experience in the use of sibutramine in the world, and in the Russian practice, taking into account the impact on the development of comorbid conditions and their complications.

Aim. To study the influence of SERT and GNB3 gene polymorphisms on the results of the treatment of obesity by serotonin-norepinephrine reuptake inhibitors.Methods. Patients who didn’t achieve significant weight loss in 3 month period during PrimaVera Study were selected for the genetic evaluation and compared with the group of “effective treatment”. The study included 66 patients (57 females and 9 males), mean age 39.29 ± 12.64 years, who received Reduxin (sibutramine + MCC) at the dose of 10 mg. Term follow-up was 3 months. Clinical examination and determination of biochemical parameters was performed at baseline and at the end of the observation period. In order to assess the type of eating behavior and identify hidden depressions a validated questionnaire was used (questionnaire "The types of eating disorders» (DEBQ), Beck Depression Scale). Also conducted a genetic study to assess SERT and GBN3 gene polymorphisms.Results. In the second group presence of S-allele SERT-gene was significantly associated with higher rates of external type of eating behavior. A statistically significant correlation between the genotype or allele of either body weight, rates of blood pressure, heart rate and cholesterol have not been found. In the first group there was a statistically significant association of S-allele carrier with less weight loss -2.8 kg (compared to l-allele) and higher rates at baseline glucose 5.38 ± 0.63 mmol / l (compared to L-allele of -3.28 kg and 5.04 ± 0.91 mmol / l).In the study of GBN3 polymorphism in the second group among CC genotype carriers there were higher levels of systolic blood pressure (SBP) before treatment (129.27 ± 9.16 mmHg), SBP and diastolic blood pressure after 3 months of treatment (127.36 ± 8.16 and 78.36 ± 4.3 mmHg) compared with CT genotype (117.27 ± 12.5; 115.45 ± 10.6; 72.91 ± 6.0 mm Hg, respectively) (p <0.05). Also among the carriers of C-allele there were more severe manifestations of depressive syndrome in comparison with T-allele carriers.Conclusion. Among the carriers of S-allele of SERT gene body weight loss during Reduxin treatment was lower than among the carriers of the L-allele; among the carriers of CC genotype of GBN3 gene higher blood pressure was higher at baseline and during Reduxin treatment, as well as more severe symptoms of a depressive syndrome.

Aim. To elucidate the character of the relationship between gestational body weight gain (GBWG) and carbohydrate/lipid metabolism during pregnancy. Material and methods. This prospective cohort study enrolled 85 women with full-term sigleton pregnancy in the absence of signs of diabetes mellitus or severe somatic pathology including 15 ones with subnormal GBWG, 35 with excessive GBWG, and 36 with recommended GBWG. Detection of gestational body weight gain, carbohydrate tolerance test, measurement of baseline and stimulated insulin secreation, lipidograms obtained in the first, second, and third trimesters. Results. The biochemical profile in the patients with pathological GBWG has the following peculiarities in comparison with that of the women with recommended GBWG during pregnancy. The women with excessive GBWG in the second and third trimesters are characterized by enhanced levels of baseline and stimulated insulin secretion, high HOMO-IR index and LDLP concentration (p<0.05). The women with subnormal GBWG in the first trimester have a higher fasting blood glucose level whereas in the third trimester both fasting glycemia and insulin concentration in response to standard carbohydrate loading decrease to below the respective normal values (p<0.05). The biochemical and hormonal characteristics of carbohydrate and lipid metabolism undergo secondary changes following body mass variations. Conclusion. The results of this study show that changes in sensitivity to insulin are in all probability the consequence of pathological enhancement of body mass rather than its cause.

The paper presents data from competent drug controlling agencies form Russia, United States, Europe and other regions, comments on the main serious misconceptions of sibutramine-containing medicines, discusses the prerequisites for the analysis of the situation with sibutramine that initiated a SCOUT study, analyzes the history of sibutramine-containing drug Meridia. The results of observational research programs carried out in Russia (completed – "VESNA" and continued – "Primavera") are discussed in relation to the efficacy and safety of sibutramine-containing drug Reduxine for the target audience patients.