Type 2 diabetes mellitus (T2DM) patient outcomes, treatment options, and corresponding healthcare expenses are affected by the presence of different comorbidities. The aim of this work was to develop an algorithm for predicting the risk of hypothyroidism development in patients with T2DM according to a mathematical model obtained by regression analysis, for the timely implementation of appropriate preventive measures among T2DM patients. We analyzed 538 medical records of T2DM patients. It was found the following risk factors influencing the occurrence of hypothyroidism in patients with T2DM: hemoglobin, total cholesterol, non-HDL-cholesterol, glycated hemoglobin, and thyroid stimulating hormone levels. Prognostic model of the risk of hypothyroidism development in T2DM patients was built using multiple regression analysis. In order to stratify the risk of hypothyroidism development in T2DM patients, the following criteria were proposed: no risk at RC HT ≤ 5.0; low risk at 5.1≤ RC HT≤14,9; high risk at RC HT ≥15.0; where RC HT — risk coefficient for the hypothyroidism development in T2DM patients. Therefore, the developed algorithm and mathematical model for predicting the development of hypothyroidism in T2DM patients are highly informative and allow to determine in advance the contingent of patients with a high probability of hypothyroidism risk based on routine laboratory data.
Background. The issue of the pathogenetic influence of cortisol on the development of metabolic syndrome (MS) in children is considered. The above-threshold values of cortisol are proposed to be taken as a marker of MS. The purpose was to study the relationship between blood cortisol and MS components in children.
Materials and methods. We have examined 44 children with MS (study group; waist circumference > 90th percentile of the distribution according to age and sex) and 14 children without signs of MS (controls). The children of the study groups did not differ in age and gender. Anthropometric parameters (body weight, height, body mass index, neck, waist, and hip circumferences, waist/hip circumference index), blood cortisol and leptin, blood lipid and carbohydrate spectrum (total cholesterol, high- and low-density lipoprotein cholesterol, triglycerides, blood glucose, and insulin, HOMA-IR and glucose/insulin indices) were evaluated. The measurement of blood pressure with the calculation of the average level was conducted three times. The diagnosis of MS was formed according to the IDF guidelines, 2007.
Results. It was found that the level of blood cortisol in children with MS (362.9 (255.5–634.1) μg/l) was 37.9 % lower than in controls (р > 0.05). The frequency of the above-threshold blood cortisol values in children of both groups was 31.8 and 50.0 %, respectively (р > 0.05). The study of dependence using the Spearman’s rank correlation coefficient between blood cortisol and anthropometric parameters (rmax = 0.16; p > 0.05), lipids (rmax = 0.4; р > 0.05), carbohydrate metabolism (rmax = 0.26; р > 0.05), and blood leptin (r = 0.19; р > 0.05) did not reveal any significance. A significant correlation was found between cortisol and systolic blood pressure. Conclusions. In children with MS, there was no significant difference in the level of blood cortisol compared to those without MS criteria. The association of blood cortisol and MS criteria other than systolic blood pressure has not been found. Although cortisol is important in the formation of systolic blood pressure, it cannot serve as a marker of MS in children since it is not a criterion-forming sign of MS.
The aim: To investigate the relationship between serum bilirubin level and the presence of the APS in women with a history of spontaneous miscarriages.
Materials and methods: Fifty six women aged 22-38 (median 27) years with a history of spontaneous miscarriages were divided into two groups: 33 women with the APS and 23 without. Patients were tested for the presence of lupus anticoagulant, anticardiolipin, anti-β2-glycoprotein 1, antiphospholipid antibodies and genetic thrombophilic defects.
Results: Groups were comparable by age, blood pressure, BMI, co-morbidity (anemia, heart abnormality, thyroid disease, overweight). Median serum total bilirubin levels were 7,2 μmol/L (interquartile range [5,8-9,7]) in women with the APS and 10,5 μmol/L (interquartile range [7,5-15,1]) in control group, p=0.005. The chance of detecting a total bilirubin level of less than 8 μmol/L is 4.1 times higher in the APS patients than in the control group (OR 4,1; 95% CI 1,274-13,213). Logistic regression analysis found a statistically significant association between total bilirubin and the presence of the APS (odds ratio, 0.856; 95% CI, 0.734-0.997, p =0.046). Patients with the APS had elevated serum C-reactive protein (medians 2,3 vs 1,1 mg/L, p=0.01) and fibrinogen (medians 2,8 vs 2,5 g/L, p=0.006) levels compared with controls. Correlation analysis revealed a significant correlation between all types of bilirubin and inflammatory markers.
Conclusions: All types of serum bilirubin (total, direct and indirect) are significantly reduced in women with APS, associated with higher inflammatory markers and lower levels of 25-hydroxyvitamin D, which may be the result of oxidative stress.
The aim: To study the epidemiological situation of ascariasis among women with pathology of the reproductive system on the basis of a literature database (PubMed, Medline, Google Scholar, PLoS, Hindawi) and to present our experience with ascariasis and pathology of reproductive system.
Materials and methods: We investigated parasitic invasions in 174 women reproductive losses and 186 patients with primary infertility.
Results: The results performed in women with infertility and reproductive losses have proved the role of parasitic infection in the emergence of disorders of hormonal homeostasis, endothelial-lymphocytic dysfunction, severe vaginal and intestinal dysbiosis and, as a consequence, reproduction of conditionally pathogenic flora, etiopathogenetic risk factors for the development of various forms of women’s reproductive health pathology.
Conclusions: More global attention to the diagnosis and treatment of parasitic infections in the examination of women with infertility and reproductive losses is warranted. The influence of ascariasis as a source of autoinfection of the gastrointestinal tract, allowed us to consider the presence of this invasion a risk factor for the development of chronic inflammatory process of the lower genital tract.
Значну частину проблем, які існували на початках впровадження онлайн-навчання, подолано, однак продовжують виникати питання щодо можливостей покращення дистанційного навчання. Метою цієї роботи стало виявлення відмінностей у сприйнятті різними групами респондентів основних аспектів дистанційного навчання. Було проведено анонімне добровільне онлайн-опитування, результати якого було оброблено за допомогою пакета програм Statistica 12. Технічне забезпечення онлайн-навчання, актуальність тематики занять та новизну тем визнали хорошими/відмінними більшість учасників, однак 59,3 % опитаних вважають, що дистанційне навчання є гіршим за очну форму, а продовжувати онлайн-навчання хотіли би лише 33,5 % респондентів. Порівняння результатів опитування студентів-медиків та лікарів-курсантів показало, що студенти достовірно нижче оцінили технічне забезпечення занять, актуальність тематики, обсяг та новизну знань, професійний рівень викладачів. Лікарі-курсанти та викладачі однаково високо оцінили актуальність тематики занять, але викладачі поставили істотно нижчі оцінки технічному забезпеченню занять, обсягу знань, їх новизні і навіть власному професійному рівню. Загалом курсанти були більш задоволені онлайн-навчанням, ніж викладачі. Студенти-медики надали достовірно нижчі оцінки актуальності, обсягу та новизні знань, а також професійному рівню викладачів, ніж викладачі. Респонденти віком понад 40 років дали вищу оцінку актуальності, обсягу та новизні знань, натомість визнали істотно гірший рівень володіння комп’ютером. Відмінностей за статтю виявлено не було. Респонденти позитивно оцінили дистанційну освіту, однак лише третина опитаних бажала продовжувати такий формат. Студенти гірше оцінили актуальність, обсяг та новизну знань, ніж лікарі-курсанти та викладачі. Викладачі були найменш задоволені онлайн-навчанням серед усіх респондентів. В осіб віком понад 40 років спостерігався нижчий рівень володіння комп’ютером, ніж у молодших респондентів.