Влияние нарушений мочеиспускания на качество жизни при урогенитальной форме диабетической автономной нейропатии у пациенток с сахарным диабетом 1 и 2 типов = Influence of urination disorders on quality of life in the urogenital form of diabetic autonomic neuropathy in patients with diabetes mellitus type 1 and 2

Kravchun N. A., Tkachuk E. Y., Shuhtin V. V., Goydyk V. S. Влияние нарушений мочеиспускания на качество жизни при урогенитальной форме диабетической автономной нейропатии у пациенток с сахарным диабетом 1 и 2 типов = Influence of urination disorders on quality of life in the urogenital form of diabetic autonomic neuropathy in patients with diabetes mellitus type 1 and 2. Journal of Education, Health and Sport. 2016;6(9):682-690. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.159072 http://ojs.ukw.edu.pl/index.php/johs/article/view/3897 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015). 755 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Author (s) 2016; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 02.09.2016. Revised 24.09.2016. Accepted: 24.09.2016. Влияние нарушений мочеиспускания на качество жизни при урогенитальной форме диабетической автономной нейропатии у пациенток с сахарным диабетом 1 и 2 типов Н. А. Кравчун, Е. Ю. Ткачук В. В. Шухтин, В. С. Гойдык ГУ «Институт проблем эндокринной патологии имени В.Я. Данилевского НАМН Украины», г.Харьков; Областная клиническая больница – Центр экстренной медицинской помощи и медицины катастроф, г.Харьков Украинский научно-исследовательский институт медицины транспорта МЗ Украины, Одесса Резюме Изучено влияние нарушений мочеиспускания на качество жизни при урогенитальной форме диабетической автономной нейропатии у 195 пациенток с сахарным диабетом 1 и 2 типов. Оценка качества жизни проводилась при помощи Short Form Medical Outcomes Study (SF-36), а для выявления нарушения мочеиспускания использовалась разработанная нами шкала-опросник при сахарном диабете. Установлено, что в зависимости от степени тяжести нарушений мочеиспускания качество жизни у пациенток с указанной патологией достоверно ухудшается, психический компонент качества жизни угнетается в большей степени. Ключевые слова: сахарный диабет, урогенитальная форма, нарушение мочеиспускания, качество жизни, SF-36. Influence of urination disorders on quality of life in the urogenital form of diabetic autonomic neuropathy in patients with diabetes mellitus type 1 and 2 N. A. Kravchun, E. Y. Tkachuk, V. V. Shuhtin, V. S. Goydyk SI “V. Danilevsky Institute for Endocrine Pathology Problems named of the NAMS of Ukraine”, Kharkiv; Regional Clinical Hospital – Centre of emergency medical care and emergency medicine, Kharkiv Ukrainian Scientific Research Institute of Transport Medicine, Ministry of Health of Ukraine Summary Was studied effect of voiding disorders on quality of life in the urogenital form of diabetic autonomic neuropathy in 195 patients with diabetes mellitus type 1 and 2. Quality of life assessment was performed using the Short Form Medical Outcomes Study (SF-36), and to detect urination disorders used the scale - a questionnaire we have developed for patients with diabetes. It was found that, depending on the severity of urinary disorders quality of life of patients with this pathology significantly worsens the mental component of quality of life is inhibited to a greater extent. Key words: type 1 and 2 diabetes mellitus, the urogenital form of diabetic autonomic neuropathy, urination disorders, quality of life, SF-36. Вплив порушень сечовипускання на якість життя при урогенітальній формі діабетичної автономної нейропатії у пацієнток з цукровим діабетом 1 і 2 типів Н. О. Кравчун, О. Ю. Ткачук. В. В. Шухтін, В. С. Гойдик ДУ «Інститут проблем ендокринної патології імені В.Я. Данилевського НАМН України», м. Харків; Обласна клінічна лікарня - Центр екстреної медичної допомоги та медицини катастроф, м. Харків. Український науково-дослідний інститут медицини транспорту МОЗ України, Одеса Резюме Вивчено вплив порушень сечовипускання на якість життя при урогенітальній формі діабетичної автономної нейропатії у 195 пацієнток з цукровим діабетом 1 і 2 типів. Оцінка якості життя проводилась за допомогою Short Form Medical Outcomes Study (SF-36), а для виявлення порушень сечовипускання використовувалась розроблена нами шкала-опитувальник при цукровому діабеті. Встановлено, що в залежності від ступеня тяжкості порушень сечовипускання якість життя у пацієнток із зазначеною патологією достовірно погіршується, психічний компонент якості життя пригнічується більшою мірою. Ключові слова: цукровий діабет 1 і 2 типу, урогенітальна форма діабетичної автономної нейропатії, порушення сечовипускання, якість життя, SF-36

The assessment of the depressive states severity and their relationship with concomitant type 2 diabetes and obesity in patients with chronic heart failure of ischemic origin

The aim is to assess the prevalence and expressiveness of depressive disorders in patients with chronic heart failure (CHF) of the ischemic origin, depending on the presence of concomitant type 2 diabetes mellitus (T2DM), obesity and their combined course, as well as to assess the influence of existing metabolic disorders on the development of depression in individuals of this cohort. Materials and methods. The study included 154 patients with CHF of ischemic origin. Group 1 included patients with CHF with coronary heart disease (CHD), T2DM and obesity (n = 42). The second group consisted of patients with CHF on the background of CHD with concomitant T2DM (n = 46), and the third group – with concomitant obesity (n = 36). The comparison group was formed from patients who had signs of CHF of ischemic origin without metabolic disorders (n = 30). The Beck Depression Inventory (BDI) was used to assess the presence and nature of depressive disorders. Results. In patients with isolated CHF of ischemic origin, depression was found in 60 % of cases, according to BDI. In the second group depression was manifested in 80.6 % of cases, and in the third group – in 91.3 % of cases. 95.2 % of patients of the first group had depressive disorders. The average value of scores in patients of the first group significantly exceeded that of the patients of the fourth group by almost two times. Comparing the scores of patients of the second and third groups with the fourth group determined their increase by 57 % and 36 %, respectively. It was established that in patients with CHF of ischemic origin against the background of the combined course of T2DM, mild depression was found in 1/3 of patients, a quarter of patients had manifestations of moderate depression, 9.5 % of patients had severe depression and 4.8 % of people in this group had symptoms of mild depression. Conclusions. The presence of type 2 diabetes mellitus is associated with the development of depression in patients with chronic heart failure of ischemic origin. The combined course of type 2 diabetes mellitus and obesity is a risk factor for the development of depression and its progression to a marked/severe form

Galectin-3 and its relationship with the state of coronary arteries in patients with acute myocardial infarction and concomitant obesity

The aim of the study - to evaluate the condition of the coronary arteries according to quartile of galectin-3 serum level in patients with acute myocardial infarction and obesity. Materials and methods. A total of 31 patients with acute myocardial infarction and I and II degree of obesity were examined. A coronaroventriculography was performed with stenting of the infarct-dependent coronary artery within 12 hours from the pain syndrome onset. Galectin-3 was determined using a Human Galectin-3 ELISA kit (China). The degree of coronary atherosclerosis severity was assessed by coronaroventriculography (CVG) using the Gensini score. Results. The most common atherosclerotic lesion was found in the right interventricular artery – 89 % of cases followed by the right coronary artery (59.3 %), about half of patients (48.1 %) had a lesion of the circumflex artery. The greatest vulnerability of the right interventricular artery was accompanied by the highest mean stenosis values – 77.3 % followed by the right coronary artery, the mean stenosis value of which was 68.2 %. The development of acute myocardial infarction predominantly (57.1 %) was due to occlusion of the right interventricular artery. The increase in the level of galectin-3 to 23.48–41.42 ng/ml, which corresponds to 3–4 quartiles of galectin-3 level, was associated with an increase in the number of affected vessels and segments with high Gensini scores. Conclusions. The right interventricular and right coronary arteries are the most vulnerable according to the angiographic findings, both in terms of frequency and degree of lesion, and frequency of hemodynamically significant stenoses in patients with acute myocardial infarction and obesity. An increase in galectin-3 level up to 3 and 4 quartiles is accompanied by a parallel increase in parameters characterizing the progression of atherosclerotic lesion of the coronary arteries. Galectin-3 can be considered as a marker of atherosclerotic process in patients with acute myocardial infarction and obesity due to the association between galectin-3 level and the degree of coronary artery lesion severity

Impact of hypoglycemia on daily life of type 2 diabetes patients in Ukraine

This study evaluates the impact of hypoglycemia on the lives of Ukrainian patients with type 2 diabetes mellitus. The secondary objective was to explore patient-physician relationships and the attitudes of patients towards various informational resources on diabetes management. Three focus groups with 26 patients were conducted. Qualitative information was evaluated using content analysis. The results show that patients with type 2 diabetes mellitus in Ukraine are adapting to potential attacks of hypoglycemia; however, they still experience periodic manifestations of hypoglycemia that significantly affect their psychological well-being. This result is similar to observations made in other countries. Ukrainian patients >40 years old mainly receive information on disease management from endocrinologists, and rarely use internet resources on diabetes management. Information provision was especially important at the early stage of the disease, when patients lack information on hypoglycemia manifestations and could therefore fail to identify and manage it properly

Revealing weak A and B antigens in patients with knee and hip joint arthroplasty

АНТИГЕНЫКРОВЬАНТИТЕЛА АНТИИДИОТИПИЧЕСКИЕАНТИ-АНТИТЕЛААНТИГАММА-ГЛОБУЛИНОВЫЕ АНТИТЕЛААНТИГЛОБУЛИНЫАНТИИДИОТИПНЫЕ АНТИТЕЛАКОМПЛЕМЕНТКОМПЛЕМЕНТБЕЛКИ КОМПЛЕМЕНТАРНЫЕКОМПЛЕМЕНТА БЕЛКИЭРИТРОЦИТЫЦель. Провести анализ методов выявления слабых А и В антигенов на эритроцитах в системе АВ0. Материал и методы. Проведено обследование пациентов с эндопротезированием коленного и тазобедренного суставов с целью определения группоспецифической принадлежности с выявлением слабых А и В антигенов на эритроцитах. Использованы методы абсорбции, реакция агглютинации, агглютинация в присутствии комплемента и антиглобулиновый тест. Результаты. Антиглобулиновый тест с использованием как поликлональной сыворотки, так и сыворотки, содержащей только IgG антитела, позволил выявить слабые A и B подгруппы на эритроцитах при 37{o}С. В реакции абсорбции с анти-А, анти-В поликлональными сыворотками у некоторых пациентов на эритроцитах выявлены А и В антигены, также проявившиеся в реакции агглютинации при 37{o}С, но не обнаруженные при инкубации при комнатной температуре. Агглютинационный тест с использованием комплемента и сыворотки с IgG антителами также способствовал проявлению слабых антигенов. Присутствие IgG антител было определено после обработки сыворотки унитиолом в антиглобулиновом тесте. Наличие в сыворотке только IgG антител, соответствующих антигенам, при участии комплемента приводило к более выраженным изменениям эритроцитов по сравнению с присутствием обоих классов антител – IgM и IgG. Появление гемолиза ассоциировалось с увеличением размеров эритроцитов и гипохромией. Присутствие слабых подгрупп в большинстве случаев было ассоциировано с гемолизирующими, а не агглютинирующими свойствами сыворотки пациента, а также наличием комплементсвязывающих IgG антител. Заключение. Применение абсорбции, агглютинация при 37{o}С, антиглобулиновый тест при 37{o}С с сывороткой, как подвергшейся, так и не подвергшейся обработке унитиолом, а также реакция агглютинации с использованием комплемента способствовали определению слабых антигенов в системе АВ0.Objective. To analyze the methods of revealing weak A and B antigens on the erythrocytes in AB0 system. Methods. Patients after knee and joint arthroplasty were examined on group-specific characteristics with revealing weak A and B antigens on the erythrocytes. Methods of absorption, agglutination, agglutination with complement and antiglobulin test were used. Results. Antiglobulin test with the use of polyclonal serum as well as serum containing the only IgG allowed revealing weak A and B subgroups on erythrocytes at 37{o}С. In some patients A and B antigens on erythrocytes were found while absorption with anti-A, anti-B polyclonal sera and also revealed in agglutination at 37{o}С, but were not revealed while incubation at the room temperature. Agglutination test with the use of complement and IgG was also helpful in determining the weak antigens. Presence of IgG antibodies was revealed by the treatment of the serum with unithiol in antiglobulin test. Presence of complement and only IgG antibodies corresponding to the antigens led to the more expressed changes of erythrocytes as compared to the presence of both types of antibodies – IgM and IgG. Appearance of hemolysis was associated with the increased sizes of erythrocytes and hypochromia. Presence of weak subgroups was mostly associated with hemolytic rather than agglutinating abilities of the patient’s serum, as well as with the presence of complement binding IgG antibodies. Conclusions. Absorption, agglutination at 37{o}С, antiglobulin test at 37{o}C with serum both treated and non-treated with unithiol and agglutination with use of the complement helped to define weak antigens in AB0 system

Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to 300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m 2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049