ОСОБЛИВОСТІ КЛІНІЧНОЇ КАРТИНИ ТА АНТРОПОМЕТРИЧНИХ ПОКАЗНИКІВ У ХВОРИХ НА НЕАЛКОГОЛЬНУ ЖИРОВУ ХВОРОБУ ПЕЧІНКИ

The work is devoted to the study of the features of the clinical picture of nonalcoholic steatosis and steatohepatitis in patients with pre-diabetes and type 2 diabetes mellitus (DM). A survey of 117 patients with a background of NADH and pre-diabetes and type 2 diabetes was performed. The prevalence of non-alcoholic steatosis and steatohepatitis in patients with pre-diabetes was studied. It has been shown that patients with NAGHP and pre-diabetes should be classified as very high cardiovascular risk (CD). The peculiarities of carbohydrate and lipid metabolism in patients with NADH on the background of pre-diabetes and type 2 diabetes were studied.Material and Methods. This work reflects the results of a comprehensive survey of 141 patients with type 2 diabetes and pre-diabetes.Results. The leading symptoms in patients with NADH are nausea, pain, flatulence and stomach upsets. Significant differences between patients in groups I and II were detected only with complaints such as: flatulence, general weakness, sense of bitterness in the oral cavity and nausea.Conclusions NSCLC was diagnosed in 98.4 % of patients with type 2 diabetes, including steatosis in 54.84 %, and steatohepatitis in 45.16 %. In persons with pre-diabetic NADH, 70.5 % were established, of which 85.45 % were steatosis and 14.55 % were steatohepatitis (p<0.05). The features of the clinical picture of NADH are oligosymptomy, comorbidity and the predominance of dyspeptic syndrome (flatulence was found in 43.59 %, pain in the right hypochondrium and discomfort in the abdominal cavity – 29.91 % and 28.21 % respectively, and a feeling of bitterness in the oral cavity – by 21.37 %). Работа посвящена изучению особенностей клинической картины неалкогольного стеатоза и стеатогепатита у пациентов с предиабетом и сахарным диабетом (СД) 2 типа. Проведено обследование 117 больных на НАЖБП и предиабет и СД 2 типа. Изучены распространенность неалкогольного стеатоза и стеатогепатита у пациентов с предиабетом. Доказано, что больных НАЖБП и предиабет следует относить к группе очень высокого кардиоваскулярного риска (КР). Исследованы особенности углеводного и липидного обменов у пациентов с НАЖБП на фоне предиабета и СД 2 типа.Материал и методы. Данная работа отражает результаты комплексного обследования 141 пациента с СД 2 типа и предиабетом.Результаты. Ведущими симптомами у больных НАЖБП являются тошнота, боль, метеоризм и нарушение стула. Достоверно значимые различия между пациентами I и II групп были обнаружены только по таким жалобам как метеоризм, общая слабость, ощущение горечи во рту и тошнота.Выводы. НАЖБП диагностирована у 98,4 % больных СД 2 типа, в том числе стеатоз встречался у 54,84 %, а стеатогепатит – у 45,16 %. У лиц с предиабетом НАЖБП установлена в 70,5 %, из них у 85,45 % – стеатоз и у 14,55 – стеатогепатит (р<0,05). Особенностями клинической картины НАЖХП являются олигосимптомность, коморбидность и преобладание диспепсического синдрома (метеоризм встречался у 43,59 %, боль в правом подреберье и дискомфорт в брюшной полости – у 29,91 % и у 28,21 % соответственно, запор и ощущение горечи в ротовой полости – по 21,37 %).Робота присвячена вивченню особливостей клінічної картини неалкогольного стеатозу та стеатогепатиту в пацієнтів з предіабетом та цукровим діабетом (ЦД) 2 типу. Проведено обстеження 117 хворих на неалкогольну жирову хворобу печінки (НАЖХП) та предіабет і ЦД 2 типу. Вивчено поширеність неалкогольного стеатозу та стеатогепатиту у пацієнтів з предіабетом. Доведено, що хворих на НАЖХП та предіабет слід відносити до групи дуже високого кардіоваскулярного ризику (КР). Досліджено особливості вуглеводного та ліпідного обмінів у пацієнтів з НАЖХП на фоні предіабету та ЦД 2 типу.Матеріал і методи. У роботі відображено результати комплексного обстеження 141 пацієнта з ЦД 2 типу та предіабетом.Результати. Провідними симптомами у хворих з НАЖХП є нудота, біль, метеоризм та порушення випорожнень. Достовірно значимі відмінності між пацієнтами І та ІІ груп були виявлені тільки за такими скаргами як метеоризм, загальна слабкість, відчуття гіркоти в ротовій порожнині та нудота.Висновки. НАЖХП діагностовано у 98,4 % хворих на ЦД 2 типу, в тому числі стеатоз зустрічався у 54,84 %, а стеатогепатит – у 45,16 %. У осіб з предіабетом НАЖХП встановлено у 70,5 %, з них у 85,45 % – стеатоз та у 14,55 % – стеатогепатит (р<0,05). Особливостями клінічної картини НАЖХП є олігосимптомність, коморбідність і переважання диспепсичного синдрому (метеоризм зустрічався у 43,59 %, біль у правому підребер'ї та дискомфорт у черевній порожнині – у 29,91 % та у 28,21 % відповідно, запор та відчуття гіркоти в ротовій порожнині – по 21,37 %).

Cardiovascular Outcomes with Ertugliflozin in Type 2 Diabetes

BACKGROUND The cardiovascular effects of ertugliflozin, an inhibitor of sodium–glucose cotransporter 2, have not been established. METHODS In a multicenter, double-blind trial, we randomly assigned patients with type 2 diabetes and atherosclerotic cardiovascular disease to receive 5 mg or 15 mg of ertugliflozin or placebo once daily. With the data from the two ertugliflozin dose groups pooled for analysis, the primary objective was to show the noninferiority of ertugliflozin to placebo with respect to the primary outcome, major adverse cardiovascular events (a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke). The noninferiority margin was 1.3 (upper boundary of a 95.6% confidence interval for the hazard ratio [ertugliflozin vs. placebo] for major adverse cardiovascular events). The first key secondary outcome was a composite of death from cardiovascular causes or hospitalization for heart failure. RESULTS A total of 8246 patients underwent randomization and were followed for a mean of 3.5 years. Among 8238 patients who received at least one dose of ertugliflozin or placebo, a major adverse cardiovascular event occurred in 653 of 5493 patients (11.9%) in the ertugliflozin group and in 327 of 2745 patients (11.9%) in the placebo group (hazard ratio, 0.97; 95.6% confidence interval [CI], 0.85 to 1.11; P<0.001 for noninferiority). Death from cardiovascular causes or hospitalization for heart failure occurred in 444 of 5499 patients (8.1%) in the ertugliflozin group and in 250 of 2747 patients (9.1%) in the placebo group (hazard ratio, 0.88; 95.8% CI, 0.75 to 1.03; P=0.11 for superiority). The hazard ratio for death from cardiovascular causes was 0.92 (95.8% CI, 0.77 to 1.11), and the hazard ratio for death from renal causes, renal replacement therapy, or doubling of the serum creatinine level was 0.81 (95.8% CI, 0.63 to 1.04). Amputations were performed in 54 patients (2.0%) who received the 5-mg dose of ertugliflozin and in 57 patients (2.1%) who received the 15-mg dose, as compared with 45 patients (1.6%) who received placebo. CONCLUSIONS Among patients with type 2 diabetes and atherosclerotic cardiovascular disease, ertugliflozin was noninferior to placebo with respect to major adverse cardiovascular events. (Funded by Merck Sharp & Dohme and Pfizer; VERTIS CV ClinicalTrials.gov number, NCT01986881.)

Dynamics of Staphylococcus Aureus Antibiotic Resistance to Fluoroquinolones in Vitro

Introduction. S. aureus is the main pathogen of skin, soft tissues and otorhinolaryngological infections as well as the cause of osteomyelitis, meningitis and endocarditis. In recent years the importance of S. aureus mediated infections has grown not only because of their spreading, but also due to their antibiotic resistance. Recent obser­vations showed that the resistance is developed to each new antibacterial agent after 5 years of its intensive use. Based on the studies conducted in Ukraine, it is known that the resistance of S. aureus to fluoroquinolones varies in different regions and ranges from 4.00-6.00 % to gatifloxacin to 45.20-49.00 % to norfloxacin and pefloxacin. Considering that in the overwhelming majority of cases antibacterials are prescribed empirically, an important background for successful antibiotic therapy is taking into account the regional and mostly the local antimicrobial resistance patterns. The aim of the study was to evaluate the antibiotic resistance profile of S. aureus isolates to fluoroquinolones and its changing during 2011-2016. Materials and methods. 355 S. aureus strains isolated from adult patients who were treated in Uzhgorod med­ical institutions due to bacterial tonsillitis or pharyngitis during 2011-2016 were included in the study. After isolation of a pure culture, susceptibilities were tested by using the disk diffusion method. The following antimicrobial disks were tested on Muller-Hinton agar (Biolife, Italy): ofloxacin (5.0 pg), ciprofloxacin (5.0 pg), levofloxacin (5.0 pg), gatifloxacin (5.0 pg), Sparfloxacin (10.0 pg), pefloxacin (10.0 pg), and norfloxacin (10.0 pg). Research methods were used with respect for human rights, according to the current legislation in Ukraine in accordance to international ethical requirements and do not violate the ethical standards in science and standards for conducting biomedical research. Results. Analysis of S. aureus resistance to fluoroquinolones found that this parameter remained at a relatively low level and, in majority of cases, did not exceed 12.00 %. However, constant increasement of antimicrobial re­sistance was noticed during 2011-2016. Thus, the S. aureus resistance to norfloxacin, levofloxacin and ciprofloxacin increased significantly from 0.00 %, 0.00 % and 1.54 % in 2011 to 11.76 %, 13.73 % and 9.80 % in 2016 respec­tively. Resistance to ofloxacin and gatifloxacin in 2011-2016 rised from 3.08 % and 0.00 % to 11.76 % and 1.96 %, respectively, but this difference was not statistically significant. The S. aureus susceptibility to fluoroquinolones fluctuated within 80.00-90.00 % during 2011-2016 and gradually decreased. For instance, susceptibility to norfloxacin, ofloxacin and levofloxacin decreased significantly from 93.85 %, 96.92 % and 100.00 % to 80.39 %, 88.24 % and 84.31 % respectively over the past 6 years. However, for pefloxacin there was a significant increase in susceptibili­ty from 90.77 % to 100.00 % during the investigated period. The prevalence rates of intermediate resistant S. aureus isolates during the study period was negligible and in majority of cases this type of strains were not detected at all. Conclusions. Relatively low rates of resistance and high rates of susceptibility allowed to recommend fluoro­quinolones for the empirical therapy of S. aureus caused infections. However, the gradual increase of resistance to these antibiotics, requires strict compliance with the antimicrobial stewardship

FOCUS 1: a randomized, double-blinded, multicentre, Phase III trial of the efficacy and safety of ceftaroline fosamil versus ceftriaxone in community-acquired pneumonia

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