Emergency Medical Care for Patients in Coma in Ryazan in 2016-2020

The study objectives were to investigate the prevalence and to determine the most frequent causes of coma in patients in Ryazan; to determine the frequency of fatal outcomes at the stage of medical evacuation and the frequency of hospitalizations; to identify the features of emergency medical care in the prehospital period. Materials and methods. We analyzed statistical data on the number of witnesses who applied for emergency medical aid in cases of disturbance of consciousness in patients who were subsequently diagnosed as comatose patients; we revealed main causes and types of comatose states, number of fatal outcomes and frequency of hospitalizations in Ryazan. Materials of the study – cards of calls of ambulance crews in Ryazan in 2016-2020. Results of the study and their analysis. Analysis of statistical data for Ryazan in 2016-2020 showed a steady increase in the number of ambulance calls to patients in coma. In Ryazan, as in Russia as a whole, cerebral coma prevailed, with diabetic coma in second place and toxic coma – in third. In 2016-2020, the proportion of coma-related deaths was 2.7% in the prehospital period and had no upward trend. In 84% of cases patients were hospitalized in medical treatment organisations, patients with hypoglycemic coma sometimes refused hospitalization, there was no tendency in increase of the number of refusals. In the prehospital period, ambulance care for patients with coma was provided in accordance with the algorithms, average time to reach the call was 12.4 min, which corresponds to the respective norms for emergency calls for Ryazan.

Diabetes mellitus type 1 in children and adolescents in Moscow. Data from the Moscow Segment of the Federal Register of Diabetic Patients 2015–2020

BACKGROUND: Therapy for type 1 diabetes mellitus (T1DM) is still largely an unsolved clinical problem. Despite the introduction into clinical practice of modern insulin preparations, devices for its administration, as well as continuous monitoring of glucose levels, the goals of therapy are often not achieved. At the same time, the International Diabetes Federation (IDF) notes an increase in the prevalence and incidence of T1DM in children and adolescents in the world. The Federal Register of Diabetes Mellitus (FRDM) is a dynamically updated database of patients with diabetes, which allows assessing prevalence and incidence rates, achievement of glycemic control goals and the incidence of diabetes complications.AIM: analyze the epidemiological data of T1DM (prevalence, morbidity) in children and adolescents (patients from birth to 18 years of age) in Moscow according to the FRSD data and to assess their dynamics, as well as the dynamics of achieving the goals of glycemic control and the incidence of T1DM complications in 2015-2020.MATERIALS AND METHODS: The object of the study is a sample from the database of the Moscow segment of the FRDM of a cohort of patients with type 1 diabetes under 18 years of age who were registered for the period 01.01.2015-01.01.2021. Epidemiological prevalence and incidence rates are calculated per 100,000 of the relevant population.RESULTS: the number of children and adolescents with type 1 diabetes in Moscow as of 01.01.2021 was 4024 people (2962 children and 1062 adolescents). Over the period from 2015 to 2020, there was an increase in the prevalence of T1DM (possibly due to an increase in the quality of data registration in the FRSD) and a decrease in the incidence of both children and adolescents. There was also a decrease in the level of HbA1c and the proportion of patients with HbAc1> 8.0% among children with T1DM. Both children and adolescents with T1DM showed a decrease in the incidence of diabetic coma and ketoacidosis with a simultaneous increase in the incidence of severe hypoglycemia, as well as a decrease in the incidence of retinopathy and nephropathy. However, the incidence of neuropathy decreased among children and increased among adolescents.CONCLUSION: The data obtained on the dynamic management of adolescents with T1DM are the basis for considering the development of a profile program for their dynamic observation, taking into account the need for psychological and social support for patients and their families.

About insulin

The treatment of diabetes mellitus, in spite of numerous attempts to use various medicines, remains to this day strictly ditic, and in severe cases of diabetes the diet, as it is known, does not lead to reduction of hyperglycaemia, does not stop glycosuria, and the patient remains under constant threat of diabetic coma, at the appearance of which our therapy most often does not give results. Such a state of affairs in the treatment of diabetes is connected with our very imperfect ideas about the essence of the processes underlying the disease, and if the chemical and biological deviations in the metabolism of carbohydrates and fats in diabetes are more or less studied, then the pathogenesis of this disease remains largely unexplained.

Metabolic and Endocrine Challenges

This review aims to provide an overview of metabolic and endocrine challenges in the setting of intensive care medicine. These are a group of heterogeneous clinical conditions with a high degree of overlap, as well as nonspecific signs and symptoms. Several diseases involve multiple organ systems, potentially causing catastrophic dysfunction and death. In the majority of cases, endocrine challenges accompany other organ failures or manifest as a complication of prolonged intensive care unit stay and malnutrition. However, when endocrine disorders present as an isolated syndrome, they are a rare and extreme manifestation. As they are uncommon, these can typically challenge both with diagnosis and management. Acute exacerbations may be elicited by triggers such as infections, trauma, surgery, and hemorrhage. In this complex scenario, early diagnosis and prompt treatment require knowledge of the specific endocrine syndrome. Here, we review diabetic coma, hyponatremia, hypercalcemia, thyroid emergencies, pituitary insufficiency, adrenal crisis, and vitamin D deficiency, highlighting diagnostic tools and tricks, and management pathways through defining common clinical presentations.

Chemical Factors which Prompt Oral Pathological Phenomena In Some Nutrition Diseases

In so-called general pathology, the centre of gravity must fall precisely on the experimental pathology, on the analysis of experimental pathological processes. To understand the life of a diseased organism, it is necessary to know the morphological changes at different stages of development of the pathological processes. Morphopathology deals with the study of morphological changes in a diseased organism. Both disciplines, namely both pathophysiology, as well as morphopathology, complement each other and together constitute a vast field of medical knowledge, namely the so-called pathology (pathos = suffering, disease, and logos = science). Physiopathology uses the data of the morphological changes found as a result of the pathological processes and it is closely related to the pathological anatomy, which deals with the same problems, but from another point of view: both have the same object of study, namely, the diseased human organism. Any pathological action provokes from the very beginning a defence of the body, directed against the injurious agent or the lesion. Pathological phenomena are recognized not only by studying the functional changes of the body and its various parts; taking into account the unity between function and form, it is necessary to study the morphological changes. From the research carried the following resulted: from the total of 165 cases, 102 cases (61.81%) presented diabetes, 34 cases (20.62%) obesity, 29 cases (17.57%) gout. In the treatment of oral mucosal lesions, strong antiseptics will be avoided since these are necrotizing (multiple cases of diabetic angiopathy are known), attention should also be paid to performing fixed or mobile prosthetic works that do not have to traumatize the periodontium and the mucosa of the prosthetic field in order to avoid the possibility of over-infection. Avoid bleeding manoeuvres in case of a diabetic patient with high blood sugar, taking into account the risk of diabetic coma.