Vitamin D and autoimmune thyroid diseases (part 1)

Autoimmune thyroiditis (AIT) and Graves’ disease (GD) are common autoimmune diseases, and their prevalence assessed as 5 % of general population. Currently, selective immunosuppressive agents for pathogenetic treatment of autoimmune pathology are being developed. Vitamin D with the known anti­inflammatory and immunoregulatory properties, is also of great interest. The first part of the article reviews the roles of various immune cells in the pathogenesis of autoimmune thyroid diseases, which is necessary to reveal the therapeutic potential of calcitriol in these disorders. Classically, AIT was considered to be mediated by T­helpers type 1 (Th1), and GD — by T­helpers type 2 (Th2). This misunderstanding was based on the idea that humoral immunity is controlled by Th2 cytokines, and cellular immunity — by Th1. In the past decades, the role of new subsets of immune cells in the pathogenesis of autoimmune thyroid diseases is being studied, displacing the traditional paradigm of Th1/Th2 dichotomy. It has been established that T­helpers type 17 (Th17) play an important role in the development of various inflammatory and autoimmune diseases, previously classified as Th1­dependent pathologies. The involvement of T­ and B­regulatory lymphocytes in the autoimmune process is also of particular interest. It was found that these cells accumulate in inflamed thyroid tissue in patients with thyroid pathology, but they are unable to suppress the immune response effectively. Further research will help to find out which immune cells can become targets for vitamin D agonists in the complex treatment of autoimmune diseases.

Type 2 diabetes mellitus in children and adolescents in the world and in Ukraine

Introduction. Recently, many studies have been devoted to the study of type 2 diabetes mellitus (DM2) worldwide. In most countries of the world, the increase in the prevalence of DM2 among children and adolescents is accompanied by an increase in childhood obesity. The presence of obesity or overweight in children can complicate the diagnosis of various types of DM. Detection and treatment of DM2 is extremely important for the society due to the wide range of severe diabetes complications.The aim of this work was to analyze the frequency of DM2 according to the Register of patients with DM, and to determine the state of glycemic control in children with DM2. Materials and methods. An analysis of glycemic control in children with DM2 who received various treatment regimens: with diet and lifestyle modifications, or with additional oral hypoglycemic agents (metformin monotherapy, or combination with insulin therapy). The glycemic control was assessed by measurement of glycated hemoglobin (HbA1c) level. Results. According to the data Register in Ukraine, the prevalence of DM among children has a tendency to rise — from 8.6 per 10 thousand children in 2005, to 13.14 — in 2019 year. The prevalence of DM2 in 2019 was 0.47 % of all cases of DM, and its prevalence contained 0.062 per 10 thousand children under 19 years of age with significant differences in the frequency of its diagnosis in different regions of Ukraine. We analyzed the state of glycemic control in children with DM2 aged from 9 up to 19 years old (Me 16.2 [15.5; 18.0]), with a disease duration 0.5—12 years (Me 4.5 [1.0] ; 7.5]). The age of diagnosis of DM2 was 2-17 years old (Me 11.7 [8.5; 15.0]), and 91.3 % of patients had obesity. Diet and lifestyle modifications were used in 34.8 % of patients, metformin monotherapy in 52.2 %, and metformin and insulin combination therapy in 13 % of patients. HbA1c values ​​ranged from 5.0 to 11.4 % (Me 7.2 % [5,8; 8,0]). The proportion of children who had ideal or optimal glycemic control (HbA1c 7.0—7.5 %) was 52.2 %, suboptimal (HbA1c 7.6—9.0 %) — 39.1 %, high-risk glycemic control (HbA1c> 9.1 %) — 8.7 % of children. The most unsatisfactory HbA1c levels ​​were registered in children who received metformin in combination with insulin (Me 10.6 % [10,15; 11,4]). Chronic complications of DM2 have not been reported.Conclusions. We found a low prevalence of DM2 among the pediatric population in Ukraine, more likely due to the low quality of its detection among children diagnosed with DM, as well as among children among high risk groups. Most children with DM 2 were obese. The majority of patients with DM2 (52.2 %) received metformin monotherapy, more than a third did not receive oral hypoglycemic agents. In most children with DM2 (52,2 %), the state of glycemic control corresponded to the optimal (< 7.5 %), but higher levels of HbA1c were found children who received metformin in combination with insulin.

Laurence-Moon-Bardet-Biedl syndrome

Lawrence-Moon-Bardet-Biedl syndrome is a rare autosomal recessive genetic disorder, which may result in a number of multiorgan abnormalities, including impaired brain function, eye diseases, kidney and limbs’ dysfunction. The main symptoms of this syndrome include retinal degeneration, polydactyly, obesity, hypogonadism, congenital kidney abnormalities and mental retardation. However, Lawrence-­Moon­-Barde­-Biedl syndrome may also present with other secondary abnormalities, including ataxia, diabetes insipidus, and dental abnormalities. Clinical changes of the eyes include retinitis pigmentosa, low visual acuity, and vision loss, often due to photoreceptor disorders in the retinal tissue with macular degeneration, leading to night blindness and then, in most cases, can cause complete blindness. In patients with an archetypal manifestation of Lawrence­-Moon­-Barde-­Biedl syndrome, abdominal obesity is common, even if the birth weight is usually normal. In addition, this group of patients has type 2 diabetes mellitus. A distinctive feature of this syndrome is postaxial polydactyly. Hypogonadism, which is a common sign of the disease, as usual can be diagnosed at early age in men in a form of micropenis and testicular hypoplasia).The paper presents clinicalcase of Lawrence­-Moon­-Barde-­Bidle syndrome in a thirteen-year-old boy who referred to endocrinologist with complaints of excessivegain of body weight, memoryloss, visual impairment, difficulties in school, delayedsexual development. Ad ditional investigations enabled to establish the diagnosis of Laurence­-Moon­-Bardet­-Biedl syndrome.

Relationship between indicators of insulin resistance and oxidative balancein adolescents with androgen deficiency

The purpose of the work was to study the relationship between the indicators of insulin resistance (IR), free radical oxidation products (FRO) levels, and the antioxidant system activity in adolescents with androgen deficiency (AD).Materials and methods. 58 adolescents 13­—18 years old with AD were examined. Serum levels of total testosterone, glucose, insulin, tiobarbituric acid active compounds (TBA), carbonylated proteins (CB), glutathione peroxidase (GPx), superoxide dismutase (SOD), and catalase (CAT) activity were determined. The HOMA index and the coefficient of oxidative stress were calculated.Results and discussion. In the group of adolescents with AD without IR, an inverse correlation was found between the HOMA index and CAT activity. CAT activity negatively correlated with CB content and glucose concentration. In addition, an inverse relationship was found between the activity of GPO and SOD. IR indices indirectly, through feedback with the activity of CAT, influence to the formation of conditions for inhibition/activation of FRO of proteins.IR was revealed in 37.9 % of the examined adolescents with AD. Direct relationship was recorded between IR indicators and markers of oxidative stress, as well as between testosterone levels and GPx activity in the group of these patients. Direct correlation between the coefficient of oxidative stress and the content of TBA-­active compounds indicates the formation of oxidative stress due to the activation of lipid peroxidation. Reduced testosterone levels in adolescents with AD inhibits an increase in GPx activity and prevents compensation for excessive intensity of free radical processes. Conclusion. The results indicate that adolescents with AD have a close relationship between the processes of carbohydrate metabolism, FRO, and antioxidant protection.In adolescents with AD without IR, a balancebetween the studied parameterswas found.The formation of IR in adolescents with AD shifts the equilibrium of the oxidative balance towards the activation of FRO processes. Decreased testosterone levels in adolescents with AD do not maintain the body’s antioxidant status within normal limits.

Endocrinological carefor children of Kharkiv in the period 2015—2020

The purpose of the work was to analyze the state of medical care for children with endocrine pathology in the city of Kharkov in the period 2015—2019, to analyze the prevalence and structure of diseases of the endocrine system.Materials and methods. The data of the Center for Medical Statistics of the Ministry of Health of Ukraine were used (statistical reporting form 31 «Report on medical care for children»), with mathematical­statistical, bibliosemanticand content analysis.Results and discussion. A new form of endocrinological care for the child population is the creation of a city endocrinological office at a scientific multidisciplinary pediatric institution (State Institution «IOZDPNAMS»), which improved the registration of children, ensured the completeness of medical examination, the appointment of rehabilitation measures. Children who apply to the city endocrinology office have the opportunity to get a free consultation of a neurologist, psychiatrist, psychologist, ophthalmologist, ENT, dentist, gastroenterologist, undergo ultrasound diagnostics, REG, EEG, study at a school for self­monitoring of diabetes mellitusand obesity on the basis of the State Institution «IOZDPNAMS» In patients with diabetes mellitus and labile course, it is possible to control diabetes both by test systems and to carry out professional monitoring of glycemia free of charge at home, with an analysis of glycemic indicators by an endocrinologist.Conclusion. The most common endocrine pathology among all children of the city endocrinology office is type 1 diabetes. The specialists of the State Institution «IOZDPNAMS» have proposed an algorithm for staged support of children with type 1 diabetes, which includes glucose monitoring, training in injection techniques and increasing knowledge about diet and daily routine, physical activity. Also, for practical use, there are examples of calculations of some individual indicators, including in the presence of flash monitoring in a child. This will help to optimize the work of primary care specialists in helping children with endocrine pathology.

Irizin: a new myokine and its effect on metabolism

Muscles release hormones (myokines) into the bloodstream, which affect the production of cytokines and their metabolism in various organs and tissues. One of them is irisin, a new adipokine with important autocrine and endocrine functions. It is produced not only by muscle tissue, but also by lymphoid organs, adipose and nervous tissue. It has been proven that this myokine can play a role in the pathogenesis of metabolic and oncological diseases, inflammation, aging and neurogenesis. The content of irisin in the blood is regulated not only by physical activity, but also by diet, changes in body weight, and drugs. The increased interest in studying the relationship of irisin with metabolic diseases is due to the search for a potentially new point of application for overcoming type 2 diabetes mellitus and insulin resistance. Irisin plays a major role in the interaction of the muscle­adiposetissue­bone­brain axis. It has been found that exercise has a positive effect on the functioning of the nervous system. Irisin has an anabolic effect on the skeleton and plays a significant role in bone metabolism. It has been established that exercise is a protective factor in people with cancer, reduces the toxicity of chemotherapy and improves the quality of life of patients, although the mechanisms of this phenomenon require further study. The relationship between circulating irisin levels and impaired glucose metabolism in children is discussed. It is proposed to use irisin as one of the predictors of childhood obesity. Its protective role in pregnancy and in newborns is being studied. A decrease in serum irisin levels is considered a marker of gestational diabetes. It has been suggested that cord blood irisin levels may be a reliable predictor of obesity in the future. Further research is needed to better understand the mechanism of action of this myokine in various diseases in children and to identify the relationship between circulating irisin levels and the amount of brownadipose tissue in newborns of different gestational age and with different birth weights.