Introductions: Comorbidity is a current world problem, which has various aspects from the simple combination of etiopathogenetic diseases in one patient to syntropy. This involves the formation and presence of complications that are not usual for the main disease. The influence of comorbidity is particularly increasing with age and also due to the presence of concomitant diabetes and (or) metabolic syndrome. These data and our previous studies (determining the effect of hyperglycemia on the formation of a complicated course of acute otitis media) make the study relevant. Aim: to create a typical "clinical portrait" of a patient with type 2 diabetes on the basis of clinical and laboratory indices, taking into account pathogenetic links of bone resorption. Materials and methods: The study included 45 patients aged 38 to 75 years with type 2 diabetes without acute middle otitis media who underwent examination and treatment at the "V.Y. Danilevsky Institute of Endocrine Pathology Problems" during the period from 2019 to 2021. Patients were included in the study according to the randomized simple sampling method in the order of admission to the hospital and were divided into groups for further analysis according to the level of glucosylated hemoglobin (HbA1c): 1st group – 15 patients with HbA1c up to 7%; 2nd – 21 patients with HbA1c levels of 7-10%; 3rd – 9 patients with HbA1c levels higher than 10%. The examined patients were subjected to clinical examinations of blood, urine, blood glucose level with determination of the average glucemia and its fluctuations, level of glucosylated hemoglobin (HbA1c), total and ionized calcium in the blood, lipidogram, the level of interleukin 6 (IL-6) and tumor necrosis factor (TNF-α), the level of parathormone in the blood. Results: According to the received data, the general portrait of a patient with type 2 CD is as follows: a patient of a certain age group (over 50 years old) with increased body weight (BMI for the whole group was 31.07±0.84 kg/m2 with fluctuations from 22 to 44 kg/m2), with comorbid pathology (the most frequent were metabolism encephalopathy with liquor-venous distension (95.5%), hypertonic disease and polyneuropathy (91.1%), retinopathy (86.7%) and cardiopathy (60%), thyroid pathology and fatty hepatosis (55.6% and 57.8% respectively), obesity and cardiosclerosis (46.7% and 44.4% respectively), and the presence of a diabetes in the family history (62.2%). Laboratory indicators show an increase in blood glucose level (8.15±0.29 mmol/l), glucosyl haemoglobin (8.8±0.29%), significant changes in lipid profile of the blood (an increase in the level of total cholesterol, Atherogenicity coefficient, low lipoproteins, decrease of high lipoproteins), increased levels of proinflamation cytokines (IL-6 and FNP-α) and negative correlation of parathormone and calcium in blood. Conclusions: According to the results of the investigation, we found that the changes in the clinical portrait of patients with type 2 CD indicate the presence of subclinical poliorgan inflammation in each patient. Specified features of homeostasis under certain conditions are also able to cause a latent inflammatory process anywhere, including in the mastoid process during a certain period of time before the occurrence of clinical signs. Taking this into account, further search of general criteria and significance of their combination for diagnostics and treatment of patients with acute otitis media with type 2 diabetes mellitus and metabolic syndrome is relevant.
Publications suggesting that thyroid nodule might be associated with insulin resistance (IR) and metabolic syndrome are quite interesting. In a very recent report, increased thyroid volume and nodule prevalence were also reported in patients with IR in an iodine-sufficient area []. The purpose of the work is to analyze the association between anthropometric indicators IR and IGF-1 in patients with nodular goiter. Materials and methods. During the study the authors examined 73 patients with euthyroid single-node (n = 34) and multinodular goiter (n = 39) aged 17 to 74 years (mean - (51.0 ± 10.6) years), determining WC, WC / HC, BMI, WHtR, ABSI, BFD, BRI, CI, AVI, BAI, IGF-1, TSH, fT4, fT3. Thyroid volume, its structure, number, size and location of foci was assessed by an ultrasonic complex Aloka SSD-1100 (Japan), using a linear sensor 7.5 MHz. Results and their discussion. In the total number of patients with nodular goiter IGF-1 is nonlinearly negatively associated with BMI (r = -0.30; P = 0.016), WC (r = -0.26; P = 0.036), WHtR (r = -0.30) ; P = 0.020), AVI (r = -0.27; P = 0.03), ABSI (r = -0.31; P = 0.015), nonlinear positive with BFD (r = 0.27; P = 0.033) ), BRI (r = 0.29; P = 0.02) and linearly positive with BAI (r = 0.36; P = 0.004); thyroid volume is linearly positively associated with age (r = 0.35; P = 0.009), nonlinearly positively with WC / HC (r = 0.43; P = 0.001), BFD (r = 0.26; P = 0.06 ) and CI (r = 0.31; P = 0.02). In patients with nodular goiter with BMI≥35 kg / m2 thyroid volume is linearly positively associated with BMI (r = 0.71; P = 0.049). In patients with nodular goiter with IRF-1 above the sex-age norm, thyroid volume is nonlinearly positively associated with WC / HC (r = 0.71; P = 0.01), BAI (r = 0.66; P = 0.03 ) and nonlinearly negative with BFD (r = -0.52; P = 0.01). It has been found that BAI explains 82.37% of the variance of IGF-1 in the general group and more than 90% of the variance of its level in groups of patients with nodular goiter with high IGF-1 with / without obesity. In patients with nodular goiter with high IGF-1 and obesity, the predictor of increased thyroid volume is BRI, which explains 81.14% of the variance of its volume. Conclusions: Patients with nodular goiter with IGF-1 level in blood above the sex-age norm have significantly higher values of anthropometric indicators IR (WHtR, ABSI, BFD and BAI) compared with patients with a normal level of this indicator; in patients with nodular goiter with II degree obesity and above, thyroid volume is significantly associated with BMI; BAI (R2 = 82.37%) is a predictor of increased levels of IGF-1 in blood of patients with nodular goiter, regardless of the obesity; BRI (R2 = 81.14%) is a predictor of increased thyroid volume in patients with nodular goiter with IGF -1 high level and obesity. Key words: nodular goiter, anthropometric indicators, insulin resistance
The article analyses the survey on Russian poetic canon conducted by the Prosodia Poetry Media in 2021. The results of the survey help to deal with the general doubts about the very necessity to raise this topic today, and applicability of the concept itself. The survey, which comprises more than 20 questions, revealed different stands of the general readers, students, and experts, as well as poets themselves in their attitude to the established poetic canon, to its scope and range, to the question of who and how replenish it, and to the ways of its popularization. According to two thirds of respondents, the Russian poetic canon is limited to the names of one hundred poets. Among the criteria for particular poets belonging to canon, the respondents put forward recognition in the community of poets, and only then – among contemporaries and scholars. It was also allowed to the respondent to offer his/her own list of names of poets meant to be in the canon. At the same time, the majority of the respondents are still ready to entrust the compilation of the poetic canon to knowledgeable poetry experts. It is quite obvious that the canon is meaningful for readers, moreover, its popularization and professional study make it more accessible for the audience, which longs for getting acquainted with the heritage of Russian poetry.
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