Vaccination of patients with diabetes mellitus

Diabetes mellitus stays an important medical, economic and social problem worldwide. Infectious diseases in people with diabetes mellitus are often more severe with an increased frequency of hospitalizations and complications. The presence of chronic hyperglycemia leads to decreased immune function and an increased predisposition to infections. Infections lead to uncontrolled hyperglycemia, which worsens the course of infections, thus forming a vicious circle of violations.Mass vaccination with an emphasis on people belonging to the high-risk group reduces the number of infected and, hospitalized people, and also has clear economic advantages. However, in many countries the proportion of vaccinated remains low.Vaccine prophylaxis in Russia is regulated by a number of regulatory legal acts, of which the main one is Federal Law No. 157-FZ of September 17, 1998 (edited on July 2, 2021) «About Immunoprophylaxis of Infectious Diseases». Each country has a National Vaccination Schedule, which shows a routine vaccination schedule at a specific age against infections that are widespread and / or pose a serious threat to health and life), as well as a National Epidemic Indication Vaccination Schedule. In Russia, these documents are approved by Order of the Ministry of Health of the Russian Federation of March 21, 2014 N 125n «About the approval of the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications.»This article discusses vaccination against the most socially significant infections associated with a high worldwide prevalence and increased risk among people with diabetes

Risk Assessment at the Cosmetic Product Manufacturer by Expert Judgment Method

A case study was performed in a cosmetic product manufacturer. We have identified the main risk factors of occupational accidents and their causes. Risk of accidents is assessed by the expert judgment method. Event tree for the most probable accident is built and recommendations on improvement of occupational health and safety protection system at the cosmetic product manufacturer are developed. The results of this paper can be used to develop actions to improve the occupational safety and health system in the chemical industry

Structurall features of the pancreas in patients with type 1 diabetes mellitus

BACKGROUND: Observation of changes in the volume and size of the pancreas has a long history, however, the results of studies are still not unambiguous, the specific causes of changes in pancreatic volume, as well as their consequences, are not clear. According to some data, the decrease of pancreas volume in life expectancy is 35–45% in the population of patients with a long history of type 1 diabetes, and about 20–25% during the first year of the disease. Interestingly, in T1D in 20–45% of cases, the development of exocrine pancreatic insufficiency is noted, one of the manifestations of which is pancreatic atrophy, leading to a decrease in life expectancy.AIM: Assess the volume and size of the pancreas, as well as factors that can influence on their changes.MATERIALS AND METHODS: The study included 78 patients with type 1 diabetes mellitus, the control group consisted of 23 people without previously identified disorders of carbohydrate metabolism, comparable in age and anthropometric parameters with the study group. RESULTS: The volume and dimensions of the pancreas were statistically significantly less in patients with T1D than in the control group. In addition, the influence of the duration of T1D and the age of onset of the disease on these indicators has been proven.CONCLUSION: The volume and size of the pancreas in patients with T1D is less than in healthy individuals. It is necessary to  study the effect of these changes on the function of the pancreas

A clinical case of exocrine pancreatic insufficiency in a patient with type 1 diabetes mellitus

The pancreas belongs to the glands of mixed secretion and simultaneously performs both endo- and exocrine functions. Exocrine pancreatic insufficiency (EPI) is the general name for the malabsorption process caused by inadequate production and decreased activation of the enzymes of the pancreas acinar cells, such as amylase, lipase and protease, which are necessary for digestion. The prevalence of EPI in patients with type 1 diabetes, according to many authors, varies from 25 to 59%, which is determine by the data of pancreatic elastase-1. In this work, we present a clinical case of confirmed exocrine pancreatic insufficiency in a patient with a 6-year history of type 1 diabetes, which became the main cause of the development of episodes of hypoglycemia after meals. In the course of further studies, antibodies to lactoferrin and a reduced prostate volume, determined by MRI data, high levels of antibodies to glutamate decarboxylase and zinc co-transporter 8, as well as residual insulin secretion based on the level of C-peptide on an empty stomach detected

Long-term β-cells autoimmune destruction markers persistence and residual C-peptide secretion in type 1 diabetes mellitus

Backgraund: It believed that autoimmune process maintained only during the first 5 years of diabetes mellitus type 1 (T1D). Recently scientists discovered the high levels of islet autoantibodies (Ab) in long-standing T1D and some of these patients had residual insulin secretion, determined by the level of C-peptide. According to various sources, the prevalence of such observations ranges from 12 to 48%.Aims: The aim of our study was to assess the duration of autoimmune β-cells destruction markers persistence and residual fasting C-peptide secretion in the long-standing T1D, as well as to determine the possible causes and patterns of these processes.Materials and methods: In the study included 237 patients (91 men, 146 women) with T1D. Patients divided in 4 groups, according to disease duration: а — up to 1 year, n=69 (29%); b — 1–5 years, 52 (22%); c — 5–10 years, 57 (24%); d — more than 10 years, 59 (25%). Ab to glutamic acid decarboxylase (GADA), tyrosine phosphatase-like IA-2 (IA2) and zinc T8 (ZnT8A) were detected by Enzyme Immunoassay. Also detected C-peptide levels and retrospectively HbA1с.Results: Antibodies to antigens of β-cell components were detected in 26 (37%) patients in group A, in 17 patients (33%) in group B, in 15 (29%) in group C and in 14 (23%) — G.In the control group (n = 19), an increased level of antibodies was not revealed. Fasting C-peptide levels were as follows: in group «A» — 0.86 ng / ml [0.53; 1.4], «B» — 0.65 ng / ml [0.27; 0.98], « B «- 0.19 ng / ml [0.17; 0.33],» D «- 0.01 ng / ml [0.01; 0.01]. However, in 13 (22%) patients in group D, fasting C-peptide levels were more than 0.09 ng / ml.Conclusion: The data obtained indicate a long-term persistence of markers of the autoimmune process in patients with T1DM. In groups with a long (more than 5 years) course of T1DM, levels of fasting C-peptide more than 30 pmol/L (0.09 ng / ml or 0.03 nmol / L) were noted in 39 (33.6%) cases

The role of the gut microbiota in the development of type 1 diabetes mellitus

At the beginning of the XXI century, with the advent of technical capabilities and new methods of genes sequencing, the attention of researchers to the study of the human metagenome has significantly increased. The interaction between changes in the qualitative and quantitative composition of the gut microbiota (GM) and various diseases is being actively studied, a search for specific metabolites and genes of microorganisms that may be associated with the development, in particular, of immune-mediated diseases is underway. In recent years, a lot of new data have been published on the possible contribution of gut flora dysbiosis to the development of Type 1 Diabetes Mellitus (T1DM), while the first assumptions were put forward as far back as 1970s. The search for pathogenetic mechanisms of GM influence on the development and progression of T1DM is becoming an increasingly relevant objective, since in recent years the incidence of T1DM is rapidly increasing, which is a serious health problem throughout the world.This review discusses the current ideas about the role of GM in the immunopathogenesis of T1DM, new data on the near-term prospects in the study of the human macrogenome, current ideas about the role of GM in the immunopathogenesis of T1DM, and the possibility of applying this knowledge by the practitioner

Slowly evolving, immune-mediated diabetes in 14-year-old patient: a case report

Slowly developing immune-mediated diabetes, often called latent autoimmune diabetes in adults, is characterized by the presence of autoantibodies (ATs) to glutamic acid decarboxylase (GADA), the patient's age at the onset over 35 years, and the absence of the need for insulin therapy for 6-12 months to 6 years from the moment of diagnosis, according to the WHO classification of 2019, refers to hybrid forms of diabetes mellitus (DM). In this article, we present a case history of slowly developing immune-mediated diabetes in a 14-year-old boy who was transferred from metformin monotherapy and a diet with restriction of digestible carbohydrates to the intensified insulin therapy only 4 years after the onset of diabetes mellitus with a glycated hemoglobin (HbA1c) level of less than 6.5% throughout the disease. As a result of the studies, the patient was found to have a homozygous genotype highly predisposing to the development of Type 1 Diabetes Mellitus (T1DM), as well as increased levels of ATs to GADA and tyrosine phosphatase (IA-2A). The initially preserved level of basal C-peptide and the clinical course of the disease in this patient do not allow us to classify this case as a classic variant of the course of Type 1 Diabetes Mellitus

Infectious bursal disease virus: identification of the novel genetic group and reassortant viruses

The results of the phylogenic analysis of the nucleotide sequence of the IBDV A and B genome segments have been presented. Traditionally the IBDV isolates are classified based on the phylogenic analysis of the hypervariable region of the VP2 gene. The analysis of the VP2 gene segments of the isolates detected in the Russian Federation demonstrated that most of them belong to the genetic group comprising highly virulent IBDV isolates. However, not all isolates belonging to one genetic group have the same phenotypic characteristics. This is related to the fact that the virulence is determined not only based on the characteristics of the VP2 gene (A segment) but on the characteristics of the VP1 gene (B segment) as well. The IBDV genome segmentation allows formation of reassortant viruses which can be identified as a result of the genome segment analysis. The phylogenic analysis of the nucleotide sequences of VP2 and VP1 genes of 28 IBDV isolates detected at RF, Ukrainian and Kazakh poultry establishments in 2007 and 2019 showed that 15 of them are reassortant viruses. Different combinations of the genome segments have been identified among these reassortant viruses. Detection of different combinations of IBDV genome segments is indicative of the fact that the heterogeneous virus population circulates on the poultry farms. Pathogenicity studies of the three IBDV isolates showed that the most virulent was an isolate having two genome segments characteristic of the highly virulent virus. Two reassortant viruses having only one genome segment A or B, characteristic of the infectious bursal disease, demonstrated less pronounced virulent properties

Pancreatic exocrine insufficiency in diabetes mellitus

Diabetes is disease of both the endo- and exocrine parts of the pancreas. Pancreatic exocrine insufficiency (PEI) can occur in every 2–3 patients with diabetes and affect not only the quality, but also life expectancy. At the same time, the diagnosis and treatment of PEI is not getting enough attention. The endocrinologist, as the main specialist leading patients with diabetes, can diagnose and treat patients with pancreatic exocrine insufficiency and diabetes using adequate doses of pancreatic enzyme replacement therapy (PERT)

Aurora kinase A drives the evolution of resistance to third-generation EGFR inhibitors in lung cancer.

Although targeted therapies often elicit profound initial patient responses, these effects are transient due to residual disease leading to acquired resistance. How tumors transition between drug responsiveness, tolerance and resistance, especially in the absence of preexisting subclones, remains unclear. In epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma cells, we demonstrate that residual disease and acquired resistance in response to EGFR inhibitors requires Aurora kinase A (AURKA) activity. Nongenetic resistance through the activation of AURKA by its coactivator TPX2 emerges in response to chronic EGFR inhibition where it mitigates drug-induced apoptosis. Aurora kinase inhibitors suppress this adaptive survival program, increasing the magnitude and duration of EGFR inhibitor response in preclinical models. Treatment-induced activation of AURKA is associated with resistance to EGFR inhibitors in vitro, in vivo and in most individuals with EGFR-mutant lung adenocarcinoma. These findings delineate a molecular path whereby drug resistance emerges from drug-tolerant cells and unveils a synthetic lethal strategy for enhancing responses to EGFR inhibitors by suppressing AURKA-driven residual disease and acquired resistance