Evaluating efficacy and safety of differential therapy with atorvastatin, fenofibrate and their combination in patients with type 2 diabetes

Statins are the basis pharmacotherapy in the treatment of atherogenic dyslipidemia in diabetes mellitus (DM) type 2. [1, 3] For dyslipidemia with high triglyceride (TG) level and low concentrations of high density lipoprotein cholesterol (HDL-C) fibrates are traditionally used. [2, 4] Russia has limited experience with statins, fenofibrate and combination of these drugs in patients with diabetes type 2

Characterization of carbohydrate and lipid metabolism at the onset of different types of diabetes mellitus

The study of the prevalence of different types of diabetes mellitus (DM) is essential for choosing the right treatment for this group of patients. Among 56 patients presented with diabetes, 16% were diagnosed with diabetes type 1, 37.5% with diabetes type 2, 18% with diabetes against a background of chronic pancreatitis, and 28.5% with gestational DM. The characteristic features of diabetes type 1 and 2, pancreatogenic diabetes and relevant risk factor for gestational diabetes were identified. At the onset, the majority of patients demonstrated classic signs of the disease. Patients with diabetes mellitus type 1 differed by more significant changes in carbohydrate metabolism both according to HbA1c testing and individual measurement of glucose level with the help of modern, high-quality and easy-to-handle glucose meters. For most patients, the onset of any type of diabetes was characterized by a lipid metabolism disorder. Abdominal obesity and blood glucose levels in diagnosing diabetes mellitus are closely related to the level of C-peptide

CLINICAL CASE OF GIANT ADENOMA OF PARATHYROID GLAND

Objective: to analyse and provide a description of the clinical case of a giant parathyroid adenoma, to show the fetures of clinical course, diagnosis, the results of surgical treatment and tactics of conducting in the postoperative period. Materials and methods. Patient S., aged 60, with a 10-year history of severe osteoporosis with fractures, urolithiasis, hypertension, low back pain, was consulted by a rheumatologist. In respect that there was the combination of severe osteoporosis with nephrolithiasis and elevated serum calcium level, the patient was directed to a consultation with the endocrinologist and was hospitalized in the city endocrinology department.Results. When examining in the endocrinology department, violations of phosphorus-calcium metabolism, an increase in parathyroid hormone, characteristic of hyperparathyroidism of bone skeleton changes were revealed. Based on the results of ultrasound and magnetic resonance imaging of the neck, neoplasm of the lower parathyroid gland was revealed on the left side. A puncture biopsy and surgical treatment was performed. A dense tumor of dark color, 45 × 30 × 20 mm in size, was removed, according to a histological study – a mixed-cell adenoma with cellular polymorphism. The early postoperative period was complicated by the development of hypoparathyroidism that was corrected by taking calcium and cholecalciferol preparations. In the future, the condition stabilized, a partial regression of the symptoms of hyperparathyroidism was observed.Сonclusion. In this clinical case, features of the clinical course of parathyroid adenoma of large size, the role of interdisciplinary interaction in diagnosis, the results of surgical treatment and the difficulties of postoperative management are presented

EXPERIENCE OF LONG-TERM TERIPARATIDE USE FOR THE TREATMENT OF POSTOPERATIVE HYPOPARATHYROIDISM ASSOCIATED WITH OSTEOPOROSIS IN ELDERLY PATIENT

The aim of study is to reflect the possibilities and effectiveness of teriparatide for the treatment of postoperative hypoparathyroidism associated with severe systemic osteoporosis, based on the data of the clinical case.Materials and methods. Patient N., aged 69, having a history of resection of 2/3 of the stomach according by Bilrot-2, urolithiasis, hypertension; since 2011 has been repeatedly hospitalized in National Medical Research Centre of Endocrinology, Ministry of Health of Russia, for secondary hyperparathyroidism and severe systemic osteoporosis. In 2016 thyroidectomy was performed in connection with papillary thyroid cancer and removal of left parathyroid gland adenoma, after which the patient developed postoperative hypoparathyroidism with severe uncontrolled hypocalcemia. As a replacement therapy, a synthetic analogue of parathyroid hormone, teriparatide, was used. For this work we used epicrisis of 2011–2016, as well as the results of the patient’s examination performed during the inpatient treatment in the Endocrinology Department of City Clinical Hospital № 4 (Ivanovo) from 2016 to 2018.Results. As a result of treatment with teriparatide in this patient, according to the results of a three-year follow-up, there is a positive clinical effect in the form of absence of convulsive syndrome, normalization of total and ionized calcium levels, absence of new compression fractures of vertebral bodies. Since the recovery of parathyroid gland function after surgery has not occurred, the use of this drug to the patient is recommended for the life term.Conclusion. The study describes a clinical case involving teriparatide as a therapy for postoperative hypoparathyroidism in combination with severe systemic osteoporosis and impaired calcium absorption in an elderly patient. The clinical effect of this type of treatment over a period of 3 years was proved in the form of normalization of phosphorus-calcium metabolism and the processes of bone remodeling in the absence of any side effects

EFFECTS OF ATORVASTATIN ON ENDOTHELIAL DYSFUNCTION IN TYPE 2 DIABETIC PATIENTS WITH DIFFERENT DURATION F THE DISEASE

Aim. To evaluate dynamics of endothelial vasoregulatory function in type 2 diabetic patients after 6 months of combined treatment with atorvastastin 20 mg/day depending on the disease duration and target lipid levels achievement.Material and methods. The total of 161 type 2 diabetic patients with dyslipidemia were enrolled into non-randomized open-label study, of which 149 patients were assigned to a group of follow-up (group 1) and 12 to a group of comparison (group 2). All the patients received combined antihypertensive and glucose-lowering therapy. Patients of group 1 were additionally receiving atorvastatin 20 mg/day. Parameters of glucose and lipid metabolism and reactive hyperemia test were assessed in all patients initially and 6 months later.Results. Patients with newly diagnosed diabetes were more likely to restore endothelial vasoregulatory function as compared to the patients with 1-5 and 6-10 years of diabetes duration (56% vs 42% and 35%, respectively). Patients who reached target lipid levels as compared with those who didn’t, more often revealed normalization of endothelial function (38% vs 33%, respectively). Atorvastatin benefited was more effective in newly diagnosed diabetic patients who had achieved target lipid levels.Conclusion. Addition of atorvastatin to glucose-lowering and antihypertensive treatment can restore endothelial vasoregulatory function in 6 months in more than half of new-onset type 2 diabetic patients. Maximal effect of combined therapy with atorvastatin is obtained at early stages of diabetes mellitus and at target lipid levels achievement.</p

Diagnosis of Late Periprosthetic Joint Infection. Which Diagnostic Algorithm to Choose?

Background. Nowadays, according to the foreign and native registers data, the number of patients with periprosthetic infection (PJI) tends to increase. The early PJI diagnostics allows to provide timely effective treatment. Several widely used PJI diagnostic algorithms PJI exist. The objective of the study is comparative analysis of diagnostic value, accuracy and specificity of contemporary diagnostic algorithms. Materials and methods. A post-hoc analysis of 242 patients undergoing revision arthroplasty in 2018, held at FSFI FCTOE, was carried out. According to the study design, 127 patients were included in this study. PJI was diagnosed according to three known algorithms: ICM (International Consensus Meeting 2018), WAIOT (The World Association against Infection in Orthopedics and Trauma), EBJIS (The European Bone and Joint Infection Society 2018). Diagnostic sensitivity, specificity and total accuracy of each algorithm was carried out. The evaluation of ICM diagnostic algorithm was made with 2 variants: “not convincing = no infection”, “not convincing = infection”. The presence of infection was confirmed by bacteriological examination of synovial fluid aspirate, intraoperative biopsy of materials and sonification of explanted components. Results. The highest value of common accuracy was achieved in ICM 2018 algorithm — “not convincing = infection” was 91.3%, with sensibility and specificity — 89.3% and 93.0% respectively. The best specificity was shown by the algorithms WAIOT and ICM (“not convincing = no infection) – 95.8%, with sensibility and common accuracy — 80.4% and 89.0% respectively. The sensibility and specificity of EBJIS algorithm was 87.5% and 84.5%, respectively, the common accuracy — 85.8%. Conclusion. All included in investigation diagnostic algorithms showed high specificity values in diagnostics of hip and knee PJI without significant differences. Patients with subclinical PJI and low virulent pathogens have the biggest difficulties in PJI diagnostics. It seems that the selection of analyzed algorithms doesn’t play an important role, however PJI diagnostics requires complex approach with the use of different clinical and laboratory values

Microwave-induced spin-flip scattering of electrons in point contacts

We investigate resonant interaction of conduction electrons with an electromagnetic field that irradiates a point contact between a ferromagnetic and a normal metal in the presence of a strong magnetic field of order 1 T. We show that electron spin-flips caused by resonant absorption and stimulated emission of photons result in a sharp peak in the magnetic-field dependence of the point-contact resistance. The height of the peak is shown to be directly proportional to the net rate of energy transfer to the electromagnetic field in the point contact due to absorption and stimulated emission of photons. Estimations indicate that our theory can serve as a basis for the explanation of recent experiments [A.M. Kadigrobov et al., New J. Phys. 13, 023007 (2011)]