Ekaterina S. Malysheva

There is a small number of studies in the literature regarding the impact of concomitant type 2 diabetes mellitus (DM 2) on functional outcomes after surgical treatment of late-stage osteoarthritis, including the results of total knee arthroplasty (TKA). The aim of the study is to investigate the features of functional recovery after TKA in patients with concomitant DM 2. Material and methods . A prospective study was conducted with the inclusion of 154 patients with terminal stage of gonarthrosis who underwent TKA. 104 participants did not have concomitant DM 2 (group 1), whereas 50 patients were identified (group 2). All patients were assessed for functional knee joints 2 and 6 months after discharge using the KOOS (Knee Injury and Osteoarthritis Outcome Score). Results. In group 2, the average HbA1c level was close to the target (7.5 ± 0.68%), due to strict preoperative patient selection. There were no differences in the duration of surgery and inpatient treatment between groups 1 and 2 (p > 0.05), but functional recovery according to the KOOS scale was delayed in the presence of DM 2. In groups 1 and 2, after 2 months, the quality of life parameter was 75 [56; 84.5] vs 34.5 [13; 50] (p < 0.0001), and after 6 months, it was 75 [75; 88] vs 50 [25; 63] (p < 0.0001). In the DM2 group, correlations were found between glycemic variability during hospitalization (SD) and KOOS indicators: after 2 months, for the scales “pain” — R = −0.31 (p = 0.029), “symptoms” — R = −0.33 (p = 0.022), “physical activity” — R = −0.28 (p = 0.043), “sports” — R = −0.39 (p = 0.019), respectively; after 6 months for the scale “physical activity” — R = −0.32 (p = 0.023). Conclusion. With adequate preoperative selection, concomitant DM2 does not worsen the course of the perioperative period in TEP KS, but slows down the function.

Дистанционное управление гликемией с применением устройств для беспроводной передачи данных у детей с сахарным диабетом 1 типа: промежуточные результаты клинической апробации

Introduction. The past COVID-19 pandemic has influenced the course of many diseases including endocrine pathology. However, little is known about the clinical and pathogenetic features of thyroid pathology of the post-COVID-19 period.Aim. Evaluate the clinical and pathogenetic features of thyropathies diagnosed during the post-COVID-19 period.Materials and methods. A cross-sectional study included 250 patients with newly diagnosed thyroid diseases. 73 participants denied a history of COVID-19 and 177 suffered from it within the previous 9 months. Thyroid status and thyroid ultrasound examination were assessed. IgG SARS-Cov-2 levels were tested in 40 patients with a history of COVID-19. Fine needle aspiration biopsy was performed in 61 patients including 41 with a history of COVID-19. In the main group, all the samples were additionally investigated by immunocytochemical analysis with SARS-CoV-2 protein antibodies.Results. Among the patients with COVID-19 history higher levels of fT4 (13.6 [12.4; 15.5] vs 12.8 [11.0; 15.3] pmol/l, p = 0.046) and a lower proportion of patients with euthyroidism (122 (68.9%) vs 59 (80.8%), p = 0.037) were detected. In the main group there were more cytological samples with macrophages accumulations (16 (39.0%) vs 2 (10.0%), p = 0.017), however, immu-nocytochemical study did not reveal any SARS-Cov-2-positive samples. During the post-COVID-19 period, approximately 60% of patients with subclinical thyroid dysfunctions experienced spontaneous normalization. There were correlations between IgG SARS-Cov-2 levels and parameters characterizing the structural and functional state of the thyroid gland.Conclusion. The most typical clinical feature of post-COVID-19 thyropathies was a smaller proportion of individuals with euthyroidism. Mild thyroid dysfunctions identified during the post-COVID-19 period tended to develop spontaneous normalization in 60% of cases. The immunocytochemical tests indicate the absence of SARS-Cov-2 persistence in the thyroid tissue. COVID-19- associated immunopathological reactions are involved in the pathogenesis of post-COVID-19 thyropathies.

BACKGROUND: The role of antidiabetic drugs in inpatient with COVID-19 and type 2 diabetes mellitus (T2DM) is usually considered in the context of target glycemiа maintaining. Except for insulin therapy sulfonylurea may be used in moderate COVID-19. The use of original gliclazide MR has advantages due to low risk of hypoglycemia and established cardio- and nephroprotective effects. But it is not clear whether the choice of antidiabetic drugs during hospitalization may affect patient’s condition in post-COVID period.AIM:. To assess the 12-month dynamics of carbohydrate metabolism in patients with T2DM after hospitalization for COVID-19 considering the character of hypoglycemic therapy in the hospital and the use of gliclazide MRMATERIALS AND METHODS: A 12-month prospective study was performed; T2DM patients were observed after hospitalization for COVID-19. They received in hospital: 1) original gliclazide MR (Diabeton MR, n=20) and 2) insulin (control group, n=20). Changes in antidiabetic therapy, glycemic control and biochemical tests were assessed at baseline and after 3, 6, 12 months. RESULTS: In the main and control groups the intensification of T2DM therapy was observed: the proportion of patients without hypoglycemic drugs decreased within a year by 3.0 (p = 0.001) and 2.8 (p =0.010) times respectively. Mean HbA1c values,the dynamics of inflammation markers and transaminases in both groups were similar (p>0.05 at all visits). Blood creatinine was at baseline 82.9±18.67 and 120.9±45.52 µmol/l (p=0.010), after 3 months — 88.0±18.77 and 104, 5±17.99 µmol/l (p=0.024), after 6 months — 89.3±12.17 and 97.5±9.03 µmol/l (p=0.072), after 12 months — 86.7±10.50 and 93.9±16.76 µmol/l (p=0.16). According to the data obtained during «3 months» visit, the dose of original gliclazide MR was directly correlated with the improvement in renal function in terms of glomerular filtration rateGFR (R=0,59, р=0,010). In addition, there was a close-to-significance correlation between continued gliclazide MR at visit 3 and improvement in GFR at visit 6 (R=0.31, p=0.076).CONCLUSION: The post-hospital period in patients with COVID-19 and T2DM was characterized by a tendency to hyperglycemia and increased need for hypoglycemic therapy. The use of original gliclazide MR by in patients with moderate COVID-19 and T2DM is appropriate and safe in terms of clinical and metabolic parameters dynamics during long-term post-hospital follow-up. When original gliclazide MR is continued during the post-hospital period its nephroprotective properties may contribute to the process of renal functions normalization which should be confirmed by further research.

Инсулинотерапия у больных сахарным диабетом и COVID-19 и ее взаимосвязь с факторами риска неблагоприятных исходов