ЦЕЛЬ: оценка йодной обеспеченности населения Республики Крым. МАТЕРИАЛЫ И МЕТОДЫ: исследование проводилось в 2020 г. в общеобразовательных школах четырех районов Республики Крым -в гг. Симферополь, Белогорск, Бахчисарай и Саки. Объем исследования -356 детей допубертатного возраста (8-10 лет), всем были выполнены: сбор анамнеза и измерение антропометрических показателей (рост, вес), осмотр врача-эндокринолога с пальпацией щитовидной железы (ЩЖ), ультразвуковое исследование (УЗИ) ЩЖ, получение разовых порций мочи и образцов пищевой поваренной соли, которая ежедневно используется в питании в их семьях. УЗИ ЩЖ выполнялось в положении лежа с использованием портативного ультразвукового аппарата LOGIQe (China) с мультичастотным линейным датчиком 10-15 МГц. Определение концентрации йода в разовых образцах мочи (n=356) проводилось с помощью церий-арсенитного метода (на базе лаборатории ФГБУ «НМИЦ эндокринологии» Минздрава России). Качественное исследование на наличие йодата калия в образцах пищевой поваренной соли (n=203) осуществлялось на месте экспресс-методом. От всех родителей/опекунов детей получены информированные согласия на проведение обследования и обработку персональных данных. Разрешение локального этического комитета ФГБУ «НМИЦ эндокринологии» Минздрава России получено 25 марта 2020 г., №5.РЕЗУЛЬТАТЫ: по результатам обследования 356 детей младшего школьного возраста медианная концентрация йода в моче составила 97 мкг/л и варьировала от 78 до 98 мкг/л. Доля проб мочи со сниженной концентрацией йода составила 51,2%. Доля использования в семьях школьников йодированной соли составила 12,3% (диапазон значений от 10 до 15%). Средняя частота распространенности зоба у детей по данным УЗИ -9,5% (диапазон значений от 1,7 до 16,3%).ВЫВОДЫ: 1. Показатель медианной концентрации йода в моче свидетельствует о недостаточной йодной обеспеченности населения Республики Крым. 2. Распространенность зоба у детей младшего школьного возраста по данным УЗИ ЩЖ соответствует легкой степени тяжести йодного дефицита в регионе. 3. Доля домохозяйств, использующих йодированную соль, крайне низкая и составляет 12,3%, что не соответствует рекомендациям ВОЗ для регионов с природным дефицитом йода (от 90% и более).
Background: The article presents the results of a control and epidemiological study conducted in September 2020 by specialists of the Federal State Budgetary Institution «NMIC of Endocrinology» of the Ministry of Health of Russia, aimed at assessing the current state of iodine provision in the population of the Republic of Crimea. The study in Crimea is part of a number of activities and work carried out on behalf of the Ministry of Health of the Russian Federation within the framework of state assignments «Scientific assessment of the need for additional regulatory legal and other measures to eliminate iodine deficiency in pilot regions with severe iodine deficiency» and «Epidemiological and molecular-cellular characteristics of tumor, autoimmune and iodine deficiency thyropathies as a basis for prevention of complications and personalization of treatment.The data obtained reflect the state of the problem of iodine consumption on the territory of the Crimean Peninsula and indicate the relevance of the adoption of a regional preventive program aimed at eliminating iodine deficiency in the diet of the population and related diseases.Aim: Assessment of iodine supply of the population of the Republic of CrimeaMaterials and methods: The research was carried out in secondary schools of four districts of the Republic of Crimea — in the years. Simferopol, Belogorsk, Bakhchisarai and Saki.The volume of the study — 356 schoolchildren of 8-10 years old, all were completed: taking anamnesis and anthropometric parameters (height, weight), examination by an endocrinologist with palpation of the thyroid gland (thyroid gland), ultrasound examination of the thyroid gland (thyroid ultrasound), obtaining single portions of urine and samples of table salt (5-10 grams), which is used daily in the diet in their families. The measurements of the height and weight of the children by the standard method were carried out during the examination by a specialist. Thyroid ultrasound was performed in the supine position using a portable LOGIQe ultrasound machine (China) with a 10-15 MHz multifrequency linear transducer. All urine samples (n = 356) in disposable Eppendorf microtubes were immediately frozen at a temperature of minus 20-25°! for further determination of the concentration of iodine in urine using the cerium-arsenite method (based on the clinical diagnostic laboratory of the Federal State Budgetary Institution NMITs endocrinology «of the Ministry of Health of Russia). A qualitative study for the presence of potassium iodate in food table salt samples (n = 203) was carried out on site by the express method.Informed consent was obtained from all parents / guardians of children for the examination and processing of personal data. The permission of the local ethical committee of the Federal State Budgetary Institution «NMIC of Endocrinology» of the Ministry of Health of Russia was received on March 25, 2020, No. 5.Results: According to the results of a survey of 356 children of primary school age, the median concentration of iodine in urine (mCIM) is 97 pg / l and varies from 78 to 98 pg / l in the surveyed areas, the proportion of urine samples with a reduced iodine concentration was 51.2%. The share of iodized salt use in the families of schoolchildren was 12.3% (values range from 10% to 15%). The average incidence of goiter in children according to ultrasound data is 9.5% (range of values from 1.7% to 16.3%).Conclusion.The indicator of the median concentration of iodine in urine indicates an insufficient iodine supply of the population of the Republic of Crimea.The prevalence of goiter in children of primary school age according to the ultrasound examination of the thyroid gland corresponds to the mild severity of iodine deficiency in the mild degree of goiter endemic in the region.The share of households using iodized salt is extremely low and amounts to 12.3%, which does not meet the WHO recommendations for regions with natural iodine deficiency (from 90% or more).
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A pheochromocytoma is a rare tumor that develops from adrenomedullary chromaffin cells and produce ones or more catecholamines, including adrenaline, norepinephrine, and dopamine. On rare occasions a pheochromocytoma is hormonally inactive. Cyanotic heart disease is also a relatively rare pathology. One of its least frequently occurring variants is the single ventricle of the heart. Presumably, in patients with cyanotic heart defects, the occurrence of pheochromocytes and paragangliomas will be higher due to the presence of certain germinative and somatic mutations. In cyanotic heart defects, the development of malignant arrythmias is one of the frequent causes of death. A combination of a pheochromocytoma with a single ventricle of the heart is extremely rare: only eight such cases have been described in the literature. This article describes a young patient with a unique case of a single ventricle of the heart, pheochromocytoma and sustained ventricular tachycardia. The cause of the ventricular tachycardia, in all likelihood, was inappropriate medical care in this case, a prescription for verapamil. The surgical excision of the pheochromocytoma and the referral of the patient for cardiac surgery became possible only after correcting the antihypertensive and antiarrhythmic therapy. Verapamil was replaced with a combination of doxazosin and amiodarone, resulting in relatively satisfactory blood pressure readings and sinus rhythm.
The article is devoted to the study of the syndrome of euthyroid pathology phenomenon that is a kind of adaptive reaction of the body to changes in the level of thyroid hormones.
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