The relationship of vitamin D status with the development and course of diabetes mellitus type 1

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease that develops as a result of a genetic predisposition and environmental factors. Literature data indicate that the suboptimal status of vitamin D can be considered as a risk factor for the development of T1DM, especially at some stages of life. Adequate vitamin D supplementation in childhood may provide a protective effect and reduce the risk of developing T1DM at a later age. Pathogenesis of T1DM predisposes to abnormalities in the metabolism of vitamin D, including the development of vitamin D deficiency. Moreover, the immunomodulating effect of calcitriol (induction of immune tolerance and T-cell anergy, impaired B-cell activity and antibodies production) suggests the therapeutic potential of vitamin D in autoimmune diseases, including T1DM. A number of studies have demonstrated the positive clinical effects of various vitamin D preparations with respect to maintaining residual β-cell function, improving glycemia control in patients with T1DM. Determining the optimal doses of vitamin D for patients with T1DM may contribute to disease control and prevention of complications

Differential diagnosis of hypercalcemia in a patient with CKD G5D

Patients with chronic kidney disease are characterized by the development of mineral disorders due to a decrease in the number of functioning nephrons. These changes manifest by the development of secondary hyperparathyroidism (the overproduction of intact parathyroid hormone (PTH) associated with the serum hypocalcemia, hyperphosphatemia), dysfunctional vitamin D metabolism, bone mineralization and also extraosseous calcifications. Decreased serum PTH levels associated with hypercalcemia are suspicious for adynamic bone disease, but at the same time requires an extended differential diagnostic search (e.g. metastatic processes). One of the rare causes of hypercalcemia is a defect in 24-hydroxylase (CYP24A1). We present a case of a patient on hemodialysis with atypical secondary hyperparathyroidism and an established CYP24A1 defect

Pegvisomant and current approaches to the medical treatment of acromegaly (literature review and case report)

This review provides the main results of clinical trials and the literature on the experience of using pegvisomant, the first drug from the class of growth hormone receptor antagonists. The mechanism of action of the drug, its effectiveness with respect to disease control and its effect on complications, information on adverse events, and brief information on the experience of use during pregnancy are discussed in detail. In conclusion, a clinical observation of successful use of pegvisomant in resistant to standart treatment acromegaly is given. A discussion of the available literature data, the results of clinical studies and practical experience allows us to conclude that the drug is highly effective in terms of achieving biochemical remission of acromegaly, and also has a number of additional valuable properties: it is capable of improvement of patients’ glucose metabolism and quality of life and has a minimal amount of adverse events. Pegvisomant is currently registered in the Russian Federation only for use in monotherapy; the possibility of combination therapy with somatostatin analogues will additionally allow to reliably control the growth of the pituitary adenoma and significantly cut treatment costs by reducing the dose of pegvisomant. These features of the drug make it very relevant when discussing issues related to drug therapy of acromegaly, and suggest a good prospect for use in clinical practice

Clinical Aspects of Using of Etiotropic Immunotherapy in Complex Treatment of Patients with Acute Optic Neuritis Associated with Herpesvirus Infection

Purpose. To study the clinical effectiveness of the system of complex treatment of optic neuritis (ON) associated with herpesvirus infection(HVI), including methods of immunopharmacotherapy. Patients and methods. The clinical study involved 55 people (55 eyes) with acuteON associated with HVI. The treatment regimen for all patients included 10 days the addition of Dexamethasone solution to optic nerve on decreasing scheme, Emoxypine 1% 0.5 ml, and Dicynone 12.5% 0.5 ml through irrigation system implanted in retrobulbar space, in combination with appoint of neuroprotective drugs (Picamilon and Semax). Depending on features of immunotherapy, all patients were divided into 3 groups. The first group consisted of 20 patients, whose treatment in addition to the above included intravenously infusions 6 mg of Polyoxidonium from the moment they entered the eye hospital. The second group included 17 patients who received in addition to Polyoxidonium, muscle injections of Cycloferon, in mode and doses according to the manufacturer's instructions. The third group of patients (18 peoples) — with using etiotropic immunotherapy that consisted of combination of Polyoxidonium, Cycloferon and endonasal electrophoresis of 0.25% solution of Derinat. The duration of immunotherapy was 10–12 days. Results. The analysis of obtained datas showed that more significant positive dynamics was noted in the clinical course of ON in patients of the 3rd group of observation, who simultaneously received complex of 3 immunotropic drugs in comparison with group 1 and 2, in the treatment of which we used one immunotropic drug Polyoxidonium, or its combination with Cycloferon, without Derinat. Conclusions. The method of etiotropic and pathogenetic immunotherapy developed by us, represented by the combination of Polyoxidonium, Cycloferon and Derinat, at ON, associated with herpesvirus infection, allows to shorten by 2 times or more the period of stopping of signs of inflammation in optic nerve, to exceed the average visual acuity in the period of clinical recovery by 0.5–1.3 times and improve functional results of treatment in the absence of recurrence of the disease within 1 year of observatio