The Clinical Case of Lactate-acidosis with Fatal Outcome in a Patient with 2 Type Diabetes

At the moment, lactate-acidosis coma in patients with diabetes mellitus is considered a rare and extremely urgent condition that occurs in patients with concomitant diseases as well as when taking the most widely used sugar reducing drug – metformin. This article describes a case of lactate-acidosis coma with a fatal outcome, which occurred against the background of taking metformin and alcohol abuse, in a woman with type 2 dia-betes mellitus aged 48 years.

EFFICACY OF TRIMETAZIDINE IN PATIENTS WITH ACUTE CORONARY SYNDROMES AND CO-MORBIDITIES

Acute coronary syndrome (ACS) is a serious clinical manifestation of coronary artery disease and is the major cause of morbidity and mortality worldwide. Established, that ACS and sudden death cause most IHD-related deaths, which represent 1.8 million deaths per year, with similar numbers of men and women dying from CAD. It is estimated that nearly half of patients with acute coronary syndrome (ACS) have one or more comorbid conditions, which have been linked to poor prognosis. The complexity of clinical decision-making in the presence of multiple comorbidities and the lack of explicit guidelines has been linked to poorer adherence to treatment protocols and worse outcomes for ACS patients. Under-usage of medication and standard-of-care procedures due to the unknown effects of certain therapies for patients with multiple comorbidities (e.g. percutaneous coronary interventions, dual antiplatelet therapy) and worse in-hospital and one year outcomes as well as increased mortality rates have been reported in ACS patients with multiple co-morbidites. Trimetazidine is a second-line medication for treatment stable angina and microvascular angina in European and national guidelines. The efficacy and safety of trimetazidine in ACS patients are under investigation. The purpose of research: to assess the short-term potential benefits and safety of trimetazidine added to standard evidence-based medical treatment in patients with ACS and co-morbidities: arterial hypertension and/or 2 type diabetes mellitus. Material and Methods. We observed of 184 patients with ACS with arterial hypertension (AH) and / or 2 type diabetes (DM). The diagnosis was verified by laboratory and instrumental methods according to European Society of Cardiology guidelines (2017, 2020) [10, 11]. All patients were divided into four groups: 1st group - 42 patients with ACS without AH or DM; 2nd group – 56 patients with ACS and previous AH; 3rd group – 42 patients with ACS and 2 type DM; and 4th group – 44 patients with ACS and AH and DM. Due to the treatment strategy patients from each group were divided into 2 subgroups: a – with guidelines-recommended therapy (GRT) and b – with GRT and trimetazidine (TMZ) 35 mg twice a day. The following laboratory tests were performed, in our trial: blood glucose, HbA1c, serum urea, serum creatinine, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride, serum sodium, serum potassium, CRP, cardiac troponin I, NT-proBNP. Results. The mean age of all observed patients with ACS was 64.6±11.9 years; 93 (50.5%) were males and 91 (49.5%) females among them (see table 1). ACS without persistent ST segment elevation was diagnosed in 44 (23.9%) cases; instead ACS with persistent ST segment elevation – in 140 (76.1%) cases. In all trimetazidine treatment groups, the weekly frequency of angina symptoms showed the significant reductions at 28-day visit compared with baseline (p<0.05). Similar, the short-acting nitrate consumption was significant low during the course of treatment with trimetazidine (p<0.05). Additional prescription of trimetazidine had significant effects for decrease of glucose, LDL cholesterol, CRP and NT-proBNP levels in patients with ACS and co-morbidities. Any serious adverse events were detected in the trimetazidine groups or in the placebo groups. Conclusions. Additional prescription of trimetazidine has significant effects for decrease of glucose, LDL cholesterol, CRP and NT-proBNP levels in patients with ACS and arterial hypertension and/or 2 type diabetes mellitus and has good safety.

PECULIARITIES OF THE COMPOSITION OF WHEAT AND RYE BRAN AND THEIR ROLE IN THE PREVENTION OF CHRONIC DISEASES OF HUMAN REVIEW

The paper analyzes the literature on the therapeutic and prophylactic effects of components of secondary products of processing of rye and wheat – dietary fiber and phenolic compounds – on human health. A special role is played by soluble arabinoxylans and xylooligosaccharides associated with ferulic acid, which have prebiotic, antioxidant and immunomodulatory properties. Experimental and epidemiological studies have shown that the inclusion of cereal bran in the diet has a positive effect on human health and helps to reduce the risk of diseases associated with the Western type of diet – atherosclerosis, second type diabetes, and various types of oncology.

White Blood Cells Ratios in Patients with Acute Coronary Syndromes in Association with Hypertension and Diabetes Mellitus

The aim: The purpose of this study was to evaluate of white blood cells ratios in patients with ACS in association with arterial hypertension and 2 type Diabetes Mellitus. Material and Methods: In this observational cohort trial we observed of 184 patients with ACS. All patients were randomized into four groups: 1st group – 42 patients with ACS without AH or DM; 2nd group – 56 patients with ACS and previous AH; 3rd group – 42 patients with ACS and 2 type DM; and 4th group – 44 patients with ACS and AH and DM. We studied of leukocytes count and their subpopulation ratios: neutrophils to lymphocytes ratio (NLR), neutrophils to monocytes ratio (NMR), neutrophils to lymphocytes+monocytes ratio (N/LMR), lymphocytes to monocytes ratio (NMR). Results: The mean white blood cells count was significant higher in patients with ASC, compared with control group (p<0.001). In patients with ACS the elevated NMR and NLR were observed: 15.04±1.28 vs 11.09±0.43 in control group (p<0.05), and 3.34±0.20 vs 2.60±0.06 (p<0.05), respectively. No significant differences between WBC ratios were revealed in observed patients with ACS with or without AH and/or DM. Conclusion: ACS is characterized of raised NLR and NMR which could be indicators of poor prognosis

What does the EMPA-REG OUTCOME study mean for a general practitioner?

At work we discuss the conclusions of the three-year EMPA-REG OUTCOME study in which patients with second type diabetes with high cardiovascular risk were treated with addition of empagliflozin.

DYNAMICS OF CHRONIC COMPLICATIONS OF TYPE 1 DIABETES IN CHILDREN AND ADOLESCENTS (OVER 20 YEARS)

During last decade the percent of complications of 1 type Diabetes mellitus in children decreased by 12 %, the structure of complications changed, but delay in growth and sexual development as well as fatty liver hepatosis occur in 25 % of cases. Decompensation of diabetes occurs more often in children between the ages of 11 to 16. The higher the level of HbA1c, the more complications occur. In patients with diabetes lasting 5 years or more the dose of insulin is more than 1 units/kg/day.