Jurkutė, Erika

Background. Obstructive sleep apnea (OSA) is a chronic sleep disorder characterized by repeated episodes of the upper airway obstruction during sleep, resulting in hypoxemia, hypercapnia, sleep fragmentation. Individuals with sleep apnea are often unaware of their breathing difficulties during sleep, leading to frequent underdiagnosis of the condition. If left untreated, OSA can lead to hypertension, cardiovascular diseases, neurocognitive impairments, and metabolic dysfunction. OSA is frequently associated with type 2 diabetes (T2D), with prevalence reaching up to 86%, particularly among obese diabetic patients. OSA increases cardiovascular risk and is associated with high oxidative stress levels and inflammation. Under conditions of increased oxidative stress, the accumulation of advanced glycation end-products (AGEs) is accelerated. Higher AGEs levels are associated with metabolic syndrome, cardiovascular disease, and diabetes-related complications. This study aimed to analyze the relationship between AGEs levels and the presence of OSA in patients with diabetes. Materials and methods AGEs concentration in the skin was non-invasively measured using AGE Reader in 117 patients with type 1 diabetes (T1D, n Z61) and T2D (n Z56), with low (nZ39), intermediate (n Z42) and high (n Z36) risk of OSA. The STOP-BANG questionnaire, validated and adapted for Lithuanian patients, was used. High risk for OSA was defined by as any of the following: a total score of 5-8 points; positive responses to R2 of 4 questions plus male gender or plus BMI O35 kg/m2 or plus neck circumference R40 cm. Intermediate risk was defined by 3-4, low risk by 0-2 positive answers. Data on patients’ clinical characteristics were collected from medical records. Results The median diabetes duration was 16 years (range1-60), age – 56 years (range 20- 81). The study cohort consisted of 67 (57.3%) women and 50 (42.7%) men. The risk of developing OSA significantly depended on gender (P!0.001) and type of diabetes (P!0.001). Men and patients with T2D have higher risk of developing OSA compared with woman and patients with T1D. There were no significant associations between OSA and HbA1c or the duration of diabetes (P Z 0.602 and P Z 0.267, respectively). However, we revealed a progressive increase in AGE median values as OSA risk increases (P!0.05). Conclusions Patients with T2D, particularly males, demonstrate a higher risk of developing OSA. Our findings suggest that non-invasive measurement of skin AGEs could be useful additional tool for OSA risk evaluation as the association between higher AGEs levels and OSA risk shows the potential role of oxidative stress in the pathophysiology of both conditions.

Algoritmas (lot. algorismus

Introduction: Advanced glycation endproducts (AGEs) are sugar-modified products that arise during the non-enzymatic glucose oxidation process. AGEs promote oxidative stress and are associated with poor diabetes mellitus (DM) control, metabolic syndrome, and cardiovascular disease.Objective: to evaluate AGEs accumulation in the diabetic patients‘ skin and its relationship with DM type, disease duration, and complications.Methods: 116 patients (19-85 years, 66 females and 50 males) with type 2 (T2DM) and type 1 (T1DM) DM, were enrolled in the study during the 2022 year. AGEs were measured non-invasively using an AGE Reader device (DiagnOptics Technologies B.V., SN 00010604, The Netherlands). Patients filled out questionnaires about diabetes and data on diabetes type, duration, and control were collected from medical records. Patients were divided into groups according to: DM types, disease duration (<15 (n=61) and ≥15 (n=54) years), microvascular DM complications (with ≥1 microvascular complication (n=72) and without (n=43)), macrovascular DM complications (with ≥1 complication (n=24) and without (n=92)).Results: 50 T1DM (30 females and 20 males; age 40±12.4 SD years; DM duration 18.8±0.495 SD years) and 60 T2DM (36 females and 30 males; age 63.4±9.4 SD years; DM duration 11.6±8.4 SD years) participated in the study. A significantly higher mean AGEs concentration was found in T2DM vs T1DM patient group (2.4±0.4 SD vs 2.2±0.5 SD, respectively, P=0.011). Also, higher mean levels of AGEs were found in patients with longer duration of DM (≥15 years) (2.2±0.4 SD vs 2.4±0.4 SD, respectively, P=0.047). No significant difference in AGEs concentration between the groups of patients with and without microvascular complications was found (2.4±0.5 SD vs 2.3±0.4, P=0.327). However, a higher mean concentration of AGEs was observed in the group of patients with macrovascular DM complications (2.6±0.4 SD vs 2.3±0.4 SD, respectively, P=0.002).Conclusion: A significantly higher AGEs accumulation was found in patients with T2DM, those with macrovascular complications, and longer than 15 years of disease duration. The presence of microvascular complications was not related to concentration.

Background: Diabetes-induced prolonged elevated plasma glucose levels result in the formation and accumulation of complex and heterogeneous groups of compounds - advanced glycation end-products (AGEs). AGEs normally accumulate slowly, but this process occurs at a faster rate in patients with conditions such as diabetes or cardiovascular disease. Accumulation of AGEs increases oxidative stress and induces an inflammatory reaction, which has a significant influence on the exacerbation of diabetic vascular complications. One of the most common complications resulting from uncontrolled diabetes is diabetic retinopathy (DR). However, it is necessary to clarify the role of AGEs in the pathology of DR to improve the quality of life for diabetic patients.Aim: The aim of this study was to investigate the relationship between AGEs levels and DR progression.Materials and Methods: 120 patients (age ≥18) with type 1 (T1D) and type 2 diabetes (T2D), were enrolled. Patients were divided into 3 groups: no diabetic retinopathy (n=50), non-proliferative diabetic retinopathy (n=49), and proliferative diabetic retinopathy (n=11). AGEs levels in the skin were non-invasively measured with AGE Reader (Diagnoptics B.V., The Netherlands). Data on patients’ clinical characteristics were collected from medical records.Results: The median diabetes duration of the patients was 14.5 years, age – 55 years. The study cohort consisted of 64 (58.2%) women and 46 (41.8%) men. Patients with a longer duration of diabetes had more severe form of diabetic retinopathy (P<0.001). Age and HbA1c were comparable in groups with different severity of diabetic retinopathy (P=0.320 and P=0.094, respectively). However, the concentration of AGEs was higher in the group of patients with proliferative DR than in patients with non-proliferative DR and patients without DR (P<0.05). HbA1c levels were not related to AGEs concentration (P=0.354). AGEs levels increased with age (r=0.420, P<0.001) and duration of diabetes (r=0.331, P<0.001).Conclusions: AGEs levels in the skin increase with progression of DR. These results support the evidence that AGEs have an important role as a prognostic biomarker for vascular risk assessment.

Introduction: diabetes control often considers as challenging disease in pediatric patients. In this case, we present the importance of nowadays inventions for better diabetes control. Case report: In 2007, a 6 years old male was diagnosed with insulin-dependent diabetes (HbA1c 10.7 %.), although antibodies of beta cells islets were negative after 5 years of disease (anti-GAD65 0.37 kU/L and anti-IA2 <0.1kU/L, C-peptide 0.03 nmol/L). The family was educated about diabetes self-care and multiple insulin injections have begun. Despite the given treatment and education, the family presented a lack of motivation, and as a result diabetes control was poor (HbA1c >9%). At 12 years, the patient was hospitalized with diabetic ketoacidosis. Later on, regular appointments with an endocrinologist were skipped for 4 years and the patient repeatedly was hospitalized due to ketonemia (HbA1c 13%) at the age of 15.5. During this time was diagnosed with diabetic polyneuropathy, nephropathy (A/C ratio 16 mg/mmol), proliferative retinopathy, maculopathy, short stature (height 152 cm, -2.72 standard deviation (SD)) with normal puberty maturation (Tanner stage P3G3). The continuous glucose monitoring (CGM) system was started and diabetes control became better with higher motivation. Due to diabetes complications, patient was treated with ACF inhibitors, vitamin B, alfa-lipoic acid, and ranibizumab injections to both eyes (6 courses were applied). Insulin pump therapy was started after one year of better disease control and due to the manifested “dawn“ phenomenon. The HbA1c variated between 7 and 8 %, controlled and slow down the progression of diabetes complications, but achieved final height was only -2.22 SD (164 cm). Conclusion: it is important to start the use of advanced technologies in the early stages of disease in order to achieve normal physical development and reduce the risk of diabetes complications in the future.

Background and objectives. Advanced glycation end-products (AGEs) are a complex and heterogeneous group of compounds. Studies indicate that AGEs have been linked to diabetes-related complications such as diabetic retinopathy (DR). AGEs normally accumulate slowly, but this process occurs more rapidly in patients with conditions such diabetes or cardiovascular disease. AGEs normally accumulate slowly, but this process occurs more rapidly in patients with conditions such as diabetes or cardiovascular disease. AGEs may be measured in human skin with non-invasive device AGE Reader using ultra-violet light to excite autofluorescence. The measurement of AGEs provides an immediate cardiovascular risk prediction. The aim of this study was to determine the association between AGEs levels calculated with Age Reader and DR severity. Material (patients) and research method used. AGEs concentration in the skin were non-invasively measured with AGE Reader in 71 diabetic patients (age≥18): no diabetic retinopathy (N=35), non-proliferative diabetic retinopathy (N=28), proliferative diabetic retinopathy (N=8; Fig.1). Data on patients' characteristics, the duration of diabetes, HbA1c were collected from medical records. {...].

Introduction Finding the cause of gynecomastia and galactorrhea can be challenging, hence one of the most important cornerstones is detailed case history. Hereby we present gynecomastia and galactorrhea case, caused by drug abuse. Case A 24-year-old male, 3 years suffering from gynecomastia and galactorrhea, came for an endocrinologist consultation in 2020. As known from documentation laboratory blood results, lungs X-ray and abdominal ultrasound did not reveal any pathological changes. Chest ultrasound confirmed gynecomastia without any lymph nodes changes, although repeated prolactin concentration (165,26 mU/l) stayed in the normal range (89-365 mU/l). Unfortunately, due to the pandemic of Covid-19, further investigation stopped. The patient was referred for the consultation of an endocrinologist in 2021 summer since heavy galactorrhea and gynecomastia remained. The patient denied any diseases, medication use, allergies, family history of endocrine diseases. Objective examination showed normal body mass (BMI 24,9 kg/m2 ), heavy whitish secretion from both nipples, normal volume testes (20 ml). Laboratory blood tests were done in July 2021- moderate hyperprolactinemia was observed (419,44 mU/l). The patient was referred for the head MRI, no pathological findings were identified in the hypothalamus-pituitary region. The case was discussed in the multidisciplinary meeting and it was suggested to abstain from the medical treatment, to repeat testicular and abdominal ultrasound, lungs Xray for ruling out an active oncology process, to perform a cytological examination of secretion, to review the history of the case including possible drug abuse. While planning further investigations during the next consultation, the patient unwillingly confirmed regular cocaine abuse and discontinued further testing. Conclusion after taking cocaine, the levels of prolactin in the blood fall to baseline. However, hyperprolactinemia develops within 4 days of dosing (in the absence of repeated administration) [1]. These prolactin fluctuations, as well as unwillingness to reveal drug abuse, makes gynecomastia and galactorrhea causes identification challenging in drug users.

Dilgėlinė yra viena iš dažniausių alerginių ligų. Manoma, kad dilgėline bent kartą gyvenime serga kas penktas pasaulio gyventojas. Šios ligos sergamumo dažnis yra didelis, todėl svarbu ją gerai išmanyti ir kuo geriau suvokti dilgėlinės kilmę, provokuojančius veiksnius ir priežastis, nes efektyviausias gydymas yra tų veiksnių vengimas. Kiekvienas dilgėlinės atvejis yra individualus ir dažniausiai pagrindinės ligos priežastis nerandama. Kuo labiau domėsimės ir analizuosime tam tikras šios ligos priežastis, tuo geriau suprasime ligos esmę. Šioje literatūros apžvalgoje aptariama dilgėlinės samprata, epidemiologija, etiologija, dažniausi provokaciniai veiksniai bei įvairios dilgėlinės rūšys. Literatūros apžvalgoje minime ir angioedemą, kuri yra glaudžiai susijusi su dilgėline.

Policistinių kiaušidžių sindromu (PKS) serga nuo 5 iki 20% vaisingo amžiaus moterų ir yra viena pagrindinių nevaisingumą sukeliančių priežasčių. PKS yra įvairialypis susirgimas, susijęs su dažnesnėmis akušerinėmis komplikacijomis, kaip gestacinis diabetas ir preeklampsija, taip pat turi įtakos moters širdies - kraujagyslių bei endokrininėms sistemoms, yra siejamas su padidėjusia depresijos ir kiaušidžių bei endometriumo vėžio rizika. Šioms moterims dažniausiai būdingas antsvoris, jas kamuoja odos problemos – aknė ir hirsutizmas, dažni menstruacijų ciklo sutrikimai. Tačiau yra moterų, kurioms nepasireiškia įprasti simptomai ir PKS gali būti nepastebimas iki tol, kol neišsivysto komplikacijos, todėl svarbu įtarti galimą susirgimą ir anksti pradėti gydymą, kuris turi būti kompleksinis. Visų pirma, gydymas pradedamas nuo gyvenimo būdo keitimo, didinant fizinį aktyvumą ir keičiant mitybą. Nėštumo neplanuojančioms moterims simptomai kontroliuojami vartojant sudėtines kontraceptines tabletes (SKT), kurios turi būti parenkamos individualiai, atsižvelgiant į moters rizikos veiksnius. Moterims, kurioms natūraliai pastoti nepavyksta, pirmiausia siūloma ovuliacijos stimuliacija ir laparoskopinė kiaušidžių operacija, o jei gydymas neefektyvus, gali tekti imtis pagalbinio apvaisinimo. Visais atvejais labai svarbi antsvorio korekcija ir rezistentiškumo insulinui mažinimas, dėl ko didėja gydymo efektyvumas.

Antro tipo cukrinis diabetas (2TCD) bei nutukimas yra vienos iš dažniausių būklių šiuolaikinėje visuomenėje. Per didelį kūno svorio augimą lemia vis intensyviau propaguojami, sveikatai neigiamą poveikį turintys įpročiai ir nesveikas gyvenimo būdas. Pastebėta, kad itin dažnai nutukimas turi įtakos 2TCD išsivystymui, todėl pacientai, sergantys diabetu, dažniau turi per didelį kūno svorį. Šiuo metu 2TCD serga daugiau nei 400 milijonų žmonių. Deja, šis skaičius nepaliaujamai auga, ypatingai ekonomiškai išsivysčiusiose šalyse. Kovai su šiomis problemomis taikomi įvairūs sveikatos gerinimo metodai, skatinamas sveikesnis gyvenimo būdas ir įvairios svorio mažinimo programos, jei tai nepadeda – skiriami atitinkami medikamentai. Paskutiniuoju dešimtmečiu bandoma sukurti šiuolaikinių gydymo būdų, padėsiančių susidoroti su nutukimu ir 2TCD. Atlikti moksliniai tyrimai parodė, jog riebaluose tirpus vitaminas D yra susijęs su šiomis opiomis problemomis – pastebėta, kad nutukę ar 2TCD sergantys pacientai itin dažnai susiduria su vitamino D nepakankamumu ar trūkumu. Manoma, jog per maža vitamino D koncentracija kraujo serume galimai užima svarbų vaidmenį 2TCD bei nutukimo patogenezėje. Vis dėlto, trūksta duomenų ir nėra visiškai aišku, kaip vitaminas D moduliuoja kasos β ląstelių funkciją sergant 2TCD bei kaip, vyraujant nutukimui, kontroliuoja adipocitų diferenciaciją į aukštesnes formas. Dėl šios priežasties moksliniai tyrimai vis dar negali atsakyti, ar vitamino D papildai gali būti naudingi 2TCD antidiabetinio gydymo taktikoje, kūno svorio mažinime ir ar gali būti taikomi šių ligų prevencijai. Šioje literatūros apžvalgoje aptariami vitamino D metabolizmo aspektai žmogaus organizme, vitamino D įtaka kasos β ląstelėms ir insulino gamybai bei tiriamas vitamino D poveikis besivystančiai uždegiminei reakcijai, sergant 2TCD. [...].