The relationship between the process of ethanol preference formation in rat pups periodically separated from mothers during the first half of the nest period and the intensity of maternal behavior of females was studied. The progeny of females with poor maternal behavior and/or separated from mothers is characterized by slow somatic development and high level of ethanol consumption. The quality of maternal care was inessential for the formation of ethanol preference in rats separated from mothers.
Hyperprolactinemia (HP) is one of the most common neuroendocrine disorders. In 60% of cases, pathological HP is caused by pituitary prolactin-secreting adenoma. Therapy with agonists of dopamine type 2 receptors (D2 receptor agonists) is a method of choice for the treatment of pathological HP which allows to achieve prolactin normalization and reduction of pituitary adenoma in most cases. However, 15-20% of patients are resistant to D2 receptor agonists, and the question of overcoming this resistance is highly relevant. Different approaches are considered to solve this problem, one - is to increase the dose of D2 receptor agonists up to the maximally tolerated. In this article, we present a clinical observation of a patient with a partial resistance to D2 receptor agonists who demonstrated a good response to treatment with high doses of cabergoline.
In recent years there has been an active discussion about the relationship between diabetes mellitus (DM) and chronic liver diseases (CLD). On the one hand, patients with diabetes have an increased risk of developing CLD. On the other hand, patients with CLD very often identify abnormal glucose metabolism which ultimately leads to impaired glucose tolerance and the development of diabetes. This review outlines potential causal relationships between some CLD and DM. Common mechanisms that provoke metabolic and autoimmune disorders in the development of various nosologies of the CKD group, leading to steatosis, insulin resistance, impaired glucose tolerance and the development of diabetes are described. Certain features of the assessment of carbohydrate metabolism compensation in patients with hepatic dysfunction, anemia and protein metabolism disorders are described.
Национальный медицинский исследовательский центр эндокринологии, Москва ОБОСНОВАНИЕ. Прошло менее года с начала пандемии новой коронавирусной инфекции COVID-19, вызванной вирусом SARS-CoV-2. Первые опубликованные результаты исследований демонстрируют частое повышение показателей гликемии у пациентов без предшествующих нарушений углеводного обмена, обсуждается связь состояния углеводного обмена и течения COVID-19. ЦЕЛЬ. Выявить частоту ранее установленного и впервые выявленного сахарного диабета (СД) у пациентов, госпитализированных в связи с COVID-19. Оценить взаимосвязь уровня гликированного гемоглобина (HbA 1c) с маркерами воспалительного процесса и тяжестью инфекционного заболевания. МЕТОДЫ. В одноцентровое одномоментное ретроспективное исследование были включены 155 пациентов, госпитализированных в ФГБУ «НМИЦ эндокринологии» МЗ РФ с клинико-лабораторной картиной COVID-19 и двусторонней полисегментарной вирусной пневмонией. Для диагностики нарушений углеводного обмена всем больным проводилось определение глюкозы крови при поступлении (ГКПП), глюкозы плазмы натощак (ГПН) и гликированного гемоглобина (HbA 1c). В зависимости от наличия СД в анамнезе пациенты были разделены на 2 группы: 1) без ранее установленного СД и 2) с СД в анамнезе (Группа D). Пациенты без СД в анамнезе по уровню HbA 1c были подразделены на подгруппы: с HbA 1c ≤6,0% (Группа А), с HbA 1c >6,0% и <6,5% (Группа В), с HbA 1c ≥6,5% (Группа С). Дополнительно у всех пациентов оценивали маркеры воспаления (скорость оседания эритроцитов (СОЭ), С-реактивный белок (СРБ), интерлейкин-6 (ИЛ-6)), степень поражения легочной ткани по данным компьютерной томографии легких, степени насыщения крови кислородом (SpO 2) по данным пульсоксиметрии, длительность госпитализации, исходы лечения. РЕЗУЛЬТАТЫ. Больные с ранее установленным диагнозом СД 2 типа (СД2) составили 16,7% (n=26). Из пациентов без СД в анамнезе по совокупности показателей НbA 1c , ГПН и ГКПП впервые диагноз СД2 был установлен у 8 больных (5,2%), у 66 больных (42,6%) все три показателя соответствовали нормальным значениям углеводного обмена. У остальных больных (n=55) интерпретация состояния углеводного обмена была затруднена в связи с обнаруженным фактом несоответствия уровня HbA 1c показателям ГПН и ГКПП: в частности, уровень HbA 1c ≥6,5% (что соответствует диагностическому порогу СД) был выявлен у 19 больных (12,2%) при нормальных показателях ГПН и ГКПП. Стрессовой гипергликемии при поступлении и по состоянию гликемии натощак зарегистрировано не было. Вне зависимости от наличия подтвержденного СД отмечалась значимая положительная корреляция уровня HbA 1c с маркерами воспаления (СОЭ, СРБ, ИЛ-6) и отрицательная-со степенью сатурации кислорода (SpO 2). Пациенты с HbA 1c ≥6,5% без СД в анамнезе имели наиболее тяжелое течение заболевания: самую большую длительность госпитализации, наибольшее поражение легочной ткани, высокую летальность. ЗАКЛЮЧЕНИЕ. Частота СД среди госпитализированных с COVID-19 больных составила 21,9% (из них у 16,7% диагноз СД был установлен ранее, у 5,2%-выявлен впервые). Это в ...
Introduction One of the stages of reproduction of SARS-CoV-2 is the S-protein glycosylation to facilitate penetration into target cells. It has been suggested that SARS-CoV-2 is able to enter erythrocytes, interact with heme and porphyrin, which could influence HbA1c levels. Assessment of HbA1c levels in individuals with acute COVID-19 and after recovery may show clinical relevance of this hypothesis. Aim To assess HbA1c levels in patients with COVID-19 in the acute phase and in early (6–8 weeks) and late (52±2 weeks) periods after recovery. Materials and methods We conducted a multicenter prospective study, which included patients hospitalized in Endocrinology Research Centre and the City Clinical Hospital № 52" diagnosed with COVID-19, virus identified/ not identified. Patients were divided into three groups according to baseline HbA1c level and the presence or absence of previous history of diabetes previous history of diabetes mellitus (DM): HbA1c ≤ 6.0%, HbA1c > 6.0% and patients with DM. Patients were examined during the acute COVID-19 phase and in early (6–8 weeks) and late (52±2 weeks) periods after recovery. Oral glucose tolerance test was performed in the group with initial HbA1c > 6.0% to clarify the diagnosis. Results We included 194 patients in the study. During the follow-up, 52 patients were examined in 6–8 week period: 7 with HbA1c ≤ 6.0%, 34 with HbA1c > 6.0%, 11—with previously diagnosed DM. Carbohydrate metabolism assessment in the later stages (52±2 weeks) after recovery was performed in 78 patients: 33 patients with HbA1c ≤ 6.0%, 36 patients with HbA1c > 6.0% and 9 patients with previously established diabetes. HbA1c median in patients with HbA1c ≤ 6.0% was 5.7% [5.3;5.8], with HbA1c>6.0% -6.4% [6.2; 6.6], with previously diagnosed DM—7.7% [7.2; 8.9]. Statistically significant decrease in HbA1c over time 6–8 weeks after extracts were obtained in both groups of individuals without a history of DM (Wilcoxon test, p<0.05). After 52±2 weeks we observed HbA1c decrease in all three groups (Fridman test, p<0.05): in patients with HbA1c ≤ 6.0% median HbA1c was 5.5[5.3;5.7], with HbA1c>6.0% - 6.1[6.15;6.54], with previously diagnosed DM—7.8 [5.83; 8.08]. Development of DM after 52±2 weeks was recorded in 7.24% of all examined patients without a history of DM, which is 16.6% of the total number of patients examined in dynamics with HbA1c > 6.0%. Conclusion HbA1c elevation during the acute phase of COVID-19 may be false due to the effect of SARS-CoV-2 on hemoglobin kinetics and/or detection on the surface of the SARS-CoV-2 virion highly glycosylated S-proteins by high performance liquid chromatography determinations. Upon detection HbA1c > 6.0% in patients with COVID-19 in the active phase of the disease without concomitant hyperglycemia re-determine the level of HbA1c after recovery is recommended.
Introduction: COVID-19 can trigger either transient stress-induced state, or newly onset diabetes mellitus (DM). It is well known that HbA1c serves as an indicator of glycemic status 12 weeks before the acute disease. Aim: To examine glycemic status at admission and 6 weeks after hospital discharge in patients with confirmed COVID-19 but no previous DM-history. Methods: Of 155 patients hospitalized with COVID-19 and pneumonia 111 persons had no previous DM-history. The levels of HbA1с, fasting and admission plasma glucose (FPG and APG) were measured at admission and 6 weeks after the discharge. The severity of COVID-19 was confirmed by CT scan, SpO2, serum IL-6, CRP, D-dimer. Results: All 111 patients had normal FPG and APG values. According to HbA1c level all the patients were divided into two groups: A) HbA1c≤6.0% (n=64, median 5,8%) and B) HbA1c>6,0% (n=47, median 6,4%). Our particular interest was focused on the group B due to the discrepancy of high HbA1c level and normal FPG and APG. Group B patients were retested for glycemic status in 6±1 week after the discharge. Surprisingly the median HbA1c level dropped down from 6,4% to 5,7% in such a short period of time with no antidiabetic drugs. COVID-19 severity markers were significantly higher in the group B. Conclusions: We suggest two explanations for this faster than expected HbA1c decrease: 1) patients with HbA1c>6,0% will progress to DM later, and, therefore, a longer follow-up is needed; 2) SARS-CoV-2 virus has extensively glycosylated spike(S)-protein that may bind to erythrocytes. High-pressure liquid chromatography (the standard method for HbA1c) probably fails to separate the glycated 1-β-chain of hemoglobin from glycated viral spikes. In this case, abnormally high HbA1c in COVID-19 patients with no DM-history may serve as a marker of severe viral erythrocyte damage rather than a marker for the glucose control. This hypothesis is confirmed by the prompt (in 6 weeks) normalization of HbA1c level following the virus elimination. Disclosure M. V. Shestakova: None. I. Kononenko: None. Z. Kalmykova: None. A. Zheleznyakova: None. N. Mokrysheva: None. Funding Ministry of Science and Higher Education of the Russian Federation (075-15-2020-899)
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