Summary Insulin autoimmune syndrome (Hirata’s disease) is a disorder caused by development of autoantibodies to insulin and manifested by hypoglycaemic syndrome. The overwhelming majority of physicians do not include it in the differential diagnosis of hypoglycaemic states because of a misconception of an extremely low prevalence of this condition. This results in unnecessary drug therapy and unjustified surgical interventions in patients that otherwise would be successfully treated conservatively. This disease is strongly associated with certain alleles of the HLA gene. In most cases, this condition develops in predisposed individuals taking drugs containing sulfhydryl groups. Formation of autoantibodies to insulin may be observed in patients with other autoimmune disorders, as well as in those with multiple myeloma or monoclonal gammopathy of undetermined significance. This paper presents the first Russian case report of insulin autoimmune syndrome in an adult patient. Learning points: Insulin autoimmune syndrome, Hirata’s disease, anti-insulin antibodies, and hypoglycaemia.

Background. In the Russian Federation (RF), the problem of iodine deficiency(ID) remains in. Major ongoing events are regional program. In our opinion it is necessary to evaluate their effectiveness and suggestions for improvements of preventive measures if necessary. Aims — to analyze the dynamics of the main epidemiological indicators of iodine deficiency disorders (IDD) in children, adolescents and adults population of the RF, sing the figures in the statistical form № 63 «Information on diseases related to micronutrient deficiency» and the statistical form №12 «Data on number of diseases registered at patients, living in area of medical service of medical institutions» (retrospective study), to evaluate the effectiveness of preventive measures for elimination of ID and formulate possible solutions. Material and methods. It have been analyzed the main epidemiological indicators of IDD among children (0—14 years), adolescents (15—17 years) and adult (18 and older) population of the RF for the period 2009—2015. For the assessment of the key epidemiological indicators was constructed a linear regression model, calculated the slope of the trend line (k-factor; a quantitative expression of the dynamics of prevalence/incidence), using Student’s t-test assessed the significance of k: were considered reliable (presence of speakers) at the level of p value p<0.05. Data processing was performed using Microsoft Excel 2010, R (version 3.2.3). Results. Latest analytical data on the prevalence and incidence of IDD has shown that despite preventive actions, the problem IDD is still remaining, as evidenced by the increase in the prevalence and incidence of IDD. The downward trend in the prevalence and incidence of some IDD is likely to be associated with the implementation of regional programs for the prevention of IDD. Also challenges and successes in managing ID in RF highlighted, given some normative-legal acts related to salt iodization. Conclusions. Formulate practical proposals to improve preventive measures to prevent the development of IDD.

Список сокращений АГ-артериальная гипертензия АД-артериальное давление ВMК-ванилилминдальная кислота КТ-компьютерная томография МАО-моноаминоксидаза МЙБГ-метайодбензилгуанидин МРТ-магнитно-резонансная томография МЭН-множественная эндокринная неоплазия ОФЭКТ-однофотонная эмиссионная компьютерная томография ПЭТ-позитронно-эмиссионная томография ФДГ-фтордезоксиглюкоза ФДОФА-фтордофамин ФХЦ/ПГ-феохромоцитома и параганглиома ЦНС-центральная нервная система ЧСС-частота сердечных сокращений HU-единица Хаунсфилда NF1-нейрофиброматоз I типа SDH-сукцинатдегидрогеназа VHL-болезнь фон Гиппеля-Линдау

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Worldwide, the number of patients with type 2 diabetes mellitus (T2DM), obesity, and cardiovascular diseases (CVD) continues to increase steadily. Despite long-term studies of obesity and concomitant diseases, the molecular genetic bases for the development of these pathological conditions have remained the subject of numerous investigations so far. Recent investigations point to the involvement of miRNAs as dynamic modifiers of the pathogenesis of various pathological conditions, including obesity, T2DM, and CVD. MicroRNAs are involved in various biological processes underlying the development of CVDs, including endothelial dysfunction, cell adhesion, and atherosclerotic plaque formation and rupture. Some of them are considered as potential sensitive diagnostic markers of coronary heart disease and acute myocardial infarction. Approximately 1,000 microRNAs are found in the human body. It has been determined that miRNAs regulate 30% of all human genes. Among them there are about 50 circulating miRNAs presumably associated with cardiovascular diseases. This review provides recent data on the participation of some miRNAs in various pathological and physiological states associated with CVD in DM and obesity. An extended and exact understanding of the function of miRNAs in the gene regulatory networks associated with cardiovascular risk in obesity will be able to reveal new mechanisms for the progression of disease, to predict its development, and to elaborate innovative therapeutic strategies.

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The article raises the problem of the population aging and the expected significant increase in the proportion of the elderly population in Russian in the next 1015 years. Population aging will cause the need to attract additional financial resources for pensions to 1214% of GDP, which is approximately 1.5 1.6 times more than is provided for by the program of the Government of Russia aimed at improving the pension System in the period until 2025. The existing pension system and social security system only partially takes into account the aging process. Mechanisms for adapting the elderly to work have not yet been created, a well-thought-out state policy in this area has yet to be developed. In addition, the aging of the population leads to an increase in the older age groups of the risks of diseases with severe and catastrophic consequences, to prevent and reduce which is the number one task before the social policy of the state for this population group. The costs of medical care and care help are exorbitant in scope for the vast majority of retirees, so the elderly remain virtually defenseless against the risks of old age. It is emphasized that before medicine the task is not simply to increase life expectancy, but to prolong the labor activity of a citizen. The article suggests measures to improve the policy of interaction between state institutions and civil society in overcoming the negative consequences of aging and social adaptation of older persons.

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