Many studies have demonstrated the high effectiveness of bariatric surgery in patients with grade 23 obesity and type 2 diabetes mellitus. Currently, surgery is one of the most effective ways to decrease body mass, to maintain long-term weight loss and to manage type 2 diabetes mellitus. Particular interest has been generated by the strong influence of bariatric surgical interventions on the disruption of carbohydrate metabolism in patients who undergo surgery. This change leads to an improvement in the course of type 2 diabetes mellitus as well as its full remission. This review presents information on the mechanisms that are needed to improve glycaemic control in patients with obesity even after bariatric surgery. This review also contains a comparative analysis of how various surgical interventions influence the course of diabetes, the reasons for postbariatric glycaemia and predictors of the effectiveness of bariatric surgeries in terms of metabolic control in patients with type 2 diabetes mellitus. Until recently, the primary focus of the studies by bariatric surgeons was on patients with grade 23 obesity and type 2 diabetes mellitus. However, in this review, special attention is given to the patients with a body mass index that ranges from 30 to 35 kg/m. Gained experience of the bariatric surgeons leads to high effectiveness with respect to the influence on the course of diabetes in patients with grade 1 obesity, which allows us to significantly expand the range of patients who should be recommended for this surgery. In addition, some information concerning surgical and metabolic complications of bariatric surgical intervention is provided, which allows us to seriously consider this treatment.
Currently, much attention is paid to pathogenetic methods of treatment of community-acquired pneumonia. As a rule, pneumonia is accompanied by a violation of the balance of formation and discharge of bronchial secretions. In order to normalize the drainage function of the bronchi, both pharmacological and mechanical methods of influencing the muciliary clearance are successfully used. The comprehensive use of the entire arsenal of therapeutic capabilities allows you to minimize the duration of the patient's stay in a hospital bed, as well as speed up the process of restoring impaired lung functions after pneumonia. The study was conducted in the pulmonology Department of the district hospital of the Eastern military district. The effectiveness of using the device of vibroacoustic influence on the chest using the BARK VibroLUNG device in the treatment of community-acquired pneumonia was studied. In addition to the traditional therapy regimens, 5 to 7 sessions of hardware vibration massage were performed. In patients who received a course of vibroacoustic massage, there was a decrease in the duration of General intoxication, productive cough, and physical signs of lung tissue consolidation. Regression of the main clinical manifestations of pneumonia was accompanied by an increase in sputum discharge, simultaneously with a decrease in the time of its production. The main group of patients was characterized by the best time for normalization of acute-phase indicators, restoration of lung ventilation function, and resolution of pneumonic infiltration according to X-ray data. The use of a course of vibration exposure to the chest allowed to reduce the duration of stationary treatment by an average of 3 days.
Сахарный диабет 2 типа (СД2) является, без сомне-ния, одной из актуальнейших проблем современной медицины как ввиду его высокой распространенности, так и по причине ассоциированных с ним осложнений [1].Если прогноз СД 1 типа (СД1) во многом определяет-ся микроангиопатиями, то летальность при СД2 на 80% связана с неблагоприятными сердечно-сосудистыми событиями, риск развития которых у пациентов с СД2 в 2-3 раза выше, чем у лиц без диабета. Отчетливая вза-имосвязь СД2 и сердечно-сосудистых заболеваний (ССЗ) является хорошо известным фактом и подтверждена результатами больших популяционных исследований. Недавно закончившиеся исследования кардиоваскулярной безопасности препаратов эмпаглифлозин и лираглу-тид продемонстрировали убедительное снижение сердечно-сосудистой смертности у больных сахарным диабетом 2 типа (СД2). Эти результаты вызвали множество вопросов, касающихся причин подобного феномена, поскольку дан-ные препараты имеют абсолютно различные механизмы действия, а их сахароснижающее действие в обсуждаемых исследованиях было в лучшем случае умеренным. Однако общим свойством для эмпаглифлозина и лираглутида явля-ется их способность опосредованно улучшать чувствительность к инсулину, что во многих фундаментальных работах ассоциировалось со снижением кардиоваскулярного риска. Инсулинорезистентность, являющаяся патофизиологи-ческой основой для развития сердечно-сосудистых заболеваний у больных с СД2 и станет предметом рассмотре-ния в данной статье. В настоящем обзоре мы обсудим различные подходы по влиянию на инсулинорезистентность, включая изменение образа жизни, медикаментозное лечение и метаболическую хирургию. При этом отдельно будут проанализированы свойства и особенности так называемых сахароснижающих кардиопротекторов -препаратов, которые в рандомизированных клинических исследованиях (UKPDS, PROactive, IRIS, LEADER, EMPA-REG OUTCOME) по-казали протективные эффекты в отношении сердечно-сосудистых исходов у больных СД2.Анализ приведенных данных позволяет сделать вывод, что потенциал снижения кардиоваскулярного риска опреде-ляется не столько сахароснижающей эффективностью того или иного воздействия, сколько способностью уменьшать инсулинорезистентность, что в значительной степени меняет парадигму в терапии СД2.КЛЮЧЕВЫЕ СЛОВА: сахарный диабет 2 типа; сахароснижающие препараты; инсулинорезистентность, кардиоваскулярный риск; кардиопротекция; сердечно-сосудистые исходы
Relevance. The results of the structural and functional condition of the heart in patients with chronic heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction and chronic kidney disease stage 3 were analyzed. Purpose. To study clinical and laboratory parameters, as well as the structural and functional condition of the myocardium in patients with chronic kidney disease stage 3 and chronic heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction. Materials and methods. A total of 41 patients with chronic stage 3 kidney disease and chronic heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction were examined. Structural and functional changes in the myocardium were estimated by means of echocardiography and tissue Doppler imaging. Results and conclusion. In patients with chronic heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction, the presence of chronic kidney disease stage 3b in comparison with stage 3a is characterized by a more significant interatrial conduction abnormality, AV-node and bundle of the His, and also more significant violation of systolic function, not only the left, but also right ventricles. In the patients with chronic heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction and the presence of chronic kidney disease stage 3a, diastolic dysfunction of the left ventricle of the I type prevails significantly more often. In the patients with chronic kidney disease of 3b stage diastolic dysfunction of the left ventricle type II is more common.
Relevance. The article analyze the results of changes in the diuretic and natriuretic response to standard hypervolemic load and the injection of a diuretic in patients with chronic heart failure with preserved and reduced left ventricular ejection fraction. Purpose. Evaluation of changes in the natriuretic response to hypervolemia and diuretic injection in patients with chronic heart failure. Materials and methods. 25 men with chronic heart failure were examined; the average age was 68 y. o. (67; 73). Of these, 13 patients with chronic heart failure and a left ventricular ejection fraction (LVEF) of less than 50 % entered the first studied group and 12 patients with chronic heart failure with preserved LVEF (more than 50%), who entered the second studied group. In all the patients, hypervolemia was induced by Ringers solution, followed by the injection of furosemide and the registration of diuresis and natriuresis. Results. When analyzing natriuresis in the studied patients, it was found that at the same concentration of serum sodium, there is a multidirectional reaction to the excretion of sodium in the urine in both groups. At the same time, the rates of diuresis in both groups did not differ significantly. Conclusion. Thus, with chronic heart failure and reduced LVF less than 50% patients had a lower natriuresis compared to those studied with preserved LVF. In the patients with chronic heart failure fluid overload on the mixed response it is noted that if the urine sodium level is at the lower limit of normal in patients with reduced LVF less than 50%, then, against the background of stimulation of diuresis, sodium begins to be excreted more intensively. In the patients with chronic heart failure with preserved LVF, the urine sodium level is at the upper limit of the norm and when furosemide is stimulated, there is a decrease in its excretion.
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