Prakapienė, Edita

„Endokrinologija. II dalis. Cukrinis diabetas“ – vadovėlis, kuriame specialistai pateikia išsamią ir aktualią informaciją apie vaikų ir suaugusiųjų endokrininę sistemą bei jos sutrikimus. Knygoje aptariama endokrininė reguliacija, kuri yra bene svarbiausia endokrininės sistemos funkcija, žinomiausias medžiagų apykaitos sutrikimas – cukrinis diabetas, nurodomos ir analizuojamos hipofizės, antinksčių, skydliaukės, reprodukcinės sistemos ligos, kalcio apykaitos ir lyties vystymosi sutrikimai. Gvildenamos aktualios augimo ir brendimo, nutukimo, hipoglikemijos bei hiponatremijos temos. Taip pat aptariami neuroendokrininiai navikai, priklausantys retų ir nevienalyčių navikų grupei, bei dinaminiai mėginiai endokrininių ligų diagnostikoje. „Endokrinologija. II dalis. Cukrinis diabetas“ – būtina priemonė endokrinologams, endokrininės sistemos chirurgams, ginekologams, pediatrams ir kitiems gydytojams, kuriems reikalinga išsami informacija apie šią daugialypę sritį.

„Endokrinologija. I dalis. Bendroji endokrinologija“ – vadovėlis, kuriame specialistai pateikia išsamią ir aktualią informaciją apie vaikų ir suaugusiųjų endokrininę sistemą bei jos sutrikimus. Knygoje aptariama endokrininė reguliacija, kuri yra bene svarbiausia endokrininės sistemos funkcija, žinomiausias medžiagų apykaitos sutrikimas – cukrinis diabetas, nurodomos ir analizuojamos hipofizės, antinksčių, skydliaukės, reprodukcinės sistemos ligos, kalcio apykaitos ir lyties vystymosi sutrikimai. Gvildenamos aktualios augimo ir brendimo, nutukimo, hipoglikemijos bei hiponatremijos temos. Taip pat aptariami neuroendokrininiai navikai, priklausantys retų ir nevienalyčių navikų grupei, bei dinaminiai mėginiai endokrininių ligų diagnostikoje. „Endokrinologija. I dalis. Bendroji endokrinologija“ – būtina priemonė endokrinologams, endokrininės sistemos chirurgams, ginekologams, pediatrams ir kitiems gydytojams, kuriems reikalinga išsami informacija apie šią daugialypę sritį.

Aims: To investigate the association between depressive symptomatology and health markers in type 1 diabetes. Methods: Four countries from the InterDiane Consortium had adopted the Finnish Diabetic Nephropathy Study protocol, including the Beck Depression Inventory (BDI). Associations between depression symptomatology, diabetes complications (diabetic nephropathy, proliferative retinopathy, major adverse cardiovascular events [MACE]) and vascular risk factors (metabolic syndrome, body mass index, glycaemic control) were investigated. Results: In a sample of 1046 participants (Croatia n=99; Finland n=314; Latvia n=315; Lithuania n=318), 13.4% displayed symptoms of depression (BDI score ≥16) with no statistically significant difference in the prevalence of depression among the cohorts. The highest rates of diabetic nephropathy (37.1%) and proliferative retinopathy (36.3%) were observed in Lithuania. The rates of MACE and metabolic syndrome were highest in Finland. In joint analyses, individuals exhibiting depression symptomatology had higher HbA1c (79 vs. 72 mmol/mol, p<0.001) and higher triglyceride concentration (1.67 vs. 1.28 mmol/l, p<0.001), than those without. In the multivariable model, BDI score was positively associated with the presence of diabetic nephropathy, proliferative retinopathy, MACE, and metabolic syndrome and its triglyceride component. Moreover, BDI score was positively associated with the number of metabolic syndrome components, triglyceride concentration, and HbA1c. Conclusions: Comorbid depression should be considered a relevant factor explaining metabolic problems and vascular outcomes. Causality cannot be inferred from this cross-sectional study.

The main objective of this research was to evaluate the association of insulin resistance (IR) with micro- and macrovascular complications, sex hormones, and other clinical data. METHODS: Cross-sectional study of patients older than 18 years old with type 1 diabetes mellitus (T1DM) was performed. Participants filled in questionnaires about T1D, disease duration, smoking, glycemic control, chronic diabetes complications, and hypertension status. Data about chronic diabetic complications (neuropathy, retinopathy, and nephropathy) were collected from medical records. History of major cardiovascular events such as angina, myocardial infarction, and stroke were collected from medical records also. Laboratory tests including creatinine, cholesterol levels, testosterone (T), sex hormone-binding globulin (SHBG), estradiol levels, and albumin in 24-h urine sample were performed. IR was calculated using the following formula: estimated glucose disposal rate (eGDR) = 24.31 - [12.22 × waist-to-hip ratio (WHR)] - [3.29 ×  hypertension status (defined as 0 = no, 1 = yes)] - [0.57 × glycated hemoglobin (HbA1c)]. The data was considered statistically significant at p < 0.05. RESULTS: A total of 200 people (mean age 39.9 ± 12.1 years) with T1D were included in the study. Patients with T1D were analyzed according to eGDR levels stratified by tertiles. The cutoff value of eGDR which reflects IR was less than 6.4 mg kg-1 min-1. When eGDR was less than 6.4 mg kg-1 min-1, diabetes microvascular complications occurred significantly more often (p < 0.001); the cutoff of eGDR for cardiovascular disease (CVD) events was less than 2.34 mg kg-1 min-1. Lower eGDR, longer diabetes duration, and lower HbA1c significantly increased CVD outcomes risk. eGDR was also significantly lower in smokers (7.3 ± 2.5 vs. non-smokers 8.2 ± 2.6, p = 0.011), the obese (lean 8.25 ± 2.47 vs. obese 5.36 ± 2.74, p < 0.000) [...].

Algoritmas (lot. algorismus

BACKGROUND: Although diabetic kidney disease demonstrates both familial clustering and single nucleotide polymorphism heritability, the specific genetic factors influencing risk remain largely unknown. METHODS: To identify genetic variants predisposing to diabetic kidney disease, we performed genome-wide association study (GWAS) analyses. Through collaboration with the Diabetes Nephropathy Collaborative Research Initiative, we assembled a large collection of type 1 diabetes cohorts with harmonized diabetic kidney disease phenotypes. We used a spectrum of ten diabetic kidney disease definitions based on albuminuria and renal function. RESULTS: Our GWAS meta-analysis included association results for up to 19,406 individuals of European descent with type 1 diabetes. We identified 16 genome-wide significant risk loci. The variant with the strongest association (rs55703767) is a common missense mutation in the collagen type IV alpha 3 chain (COL4A3) gene, which encodes a major structural component of the glomerular basement membrane (GBM). Mutations in COL4A3 are implicated in heritable nephropathies, including the progressive inherited nephropathy Alport syndrome. The rs55703767 minor allele (Asp326Tyr) is protective against several definitions of diabetic kidney disease, including albuminuria and ESKD, and demonstrated a significant association with GBM width; protective allele carriers had thinner GBM before any signs of kidney disease, and its effect was dependent on glycemia. Three other loci are in or near genes with known or suggestive involvement in this condition (BMP7) or renal biology (COLEC11 and DDR1). CONCLUSIONS: The 16 diabetic kidney disease-associated loci may provide novel insights into the pathogenesis of this condition and help identify potential biologic targets for prevention and treatment.

Cukrinis diabetas (CD) yra globali visuomenės sveikatos problema, kurią sukelia kasos beta ląstelių nepakankamumas, disfunkcija ir rezistentiškumas insulinui. Visame pasaulyje didėja sergamumas šia liga, ir tai siejama su bendros populiacijos senėjimu, fiziniu nejudrumu, greita urbanizacija, gyvensenos ir mitybos pokyčiais. Tarptautinės diabeto federacijos duomenimis, prognozuojama, kad CD sergančių asmenų skaičius pasaulyje nuo 382 mln. 2013 m. padidės iki 592 mln. 2035 metais. Diabetinė neuropatija (DN) yra viena iš svarbiausių ilgalaikių CD komplikacijų ir viena iš dažniausių galutinio inkstų nepakankamumo priežasčių pasaulyje. DN vystosi sergant 1 tipo ar antriniu CD. Ji apibrėžiama kaip struktūrinė ir funkcinė inkstų pažaida, kuriai būdinga patologinė albuminurija ir normalus ar sumažėjęs glomerulų filtracijos greitis (GFG). Tai viena iš mikrokraujagyslinių CD komplikacijų, priklausanti nuo CD trukmės, aplinkos ir genetinių veiksnių. DN prasideda praėjus 10-15 metų nuo susirgimo 1 tipo CD, anksti prasideda sergant 2 tipo CD, nes tokiu atveju diabeto diagnozė dažnai nustatoma pavėluotai. DN diagnozuojama apie 20-40 proc. 1 ar 2 tipo CD sergančių pacientų. Pasaulyje yra daugiau kaip 150 mln. žmonių, sergančių DN. Sergamumas DN ir naujų DN atvejų skaičius pasaulyje didėja, nes, gerėjant CD sergančių pacientų gydymo kokybei, ilgėja šių pacientų vidutinė gyvenimo trukmė. DN paplitimas skiriasi įvairiuose geografiniuose regionuose.[...].2015 m. Lietuvoje CD sirgo 117 tūkst. žmonių. Šiuo metu Lietuvoje apie 15-16 proc. dializuojamų pacientų galutinį inkstų nepakankamumą sukėlė DN. Leidinys "Diabetinė nefropatija"– pirmasis ir kol kas vienintelis Lietuvos leidinys, skirtas šiai CD komplikacijai. Šią mokslinę-praktinę monografiją parengė dviejų universitetų medikai. Leidinio tikslas–atkreipti dėmesį į DN rizikos veiksnius, patogenezę, morfologiją, genetiką,

Introduction Ectopic adrenocorticotropic hormone (ACTH) production by the pulmonary neuroendocrine tumour (p-NET) is rare, and is considered an aggressive variant of carcinoid tumours with poor prognosis. Case presentation 59-year-old male with fast progressing generalized fatigue, abdominal discomfort, and diarrhea was hospitalized in gastroenterology unit of Hospital of Lithuanian University of Health Sciences, Kauno klinikos (HLUHS KK). Digestive tract diseases were ruled out. Persistent hypokalaemia (up to 2.2 mmol/l) was observed and endocrine pathology changes were considered. Examinations revealed markedly elevated plasma ACTH (44.4 pmol/l) and cortisol (O1665 nmol/l) levels, diabetes, osteoporosis. No suppression of serum cortisol level with high-dose dexamethasone test was found, confirming ACTH dependent Cushing syndrome. The treatment with Metirapone was started. Pituitary and abdominal magnetic resonance imaging (MRI), abdominal computer tomography (CT) scans were normal. Thoracic CT scan showed nodules in the S2, S3, S6 of the left lung. No cytologic changes were found in repetitive bronchial leachates through endoscopic bronchoscopy. There were two episodes of pneumonia (Pseudomonas aeruginosa) and two episodes of sepsis (Staphylococcus aureus and Enterococcus faecium). Suspected fungal infection, intended antifungal treatment. Single nodule in S3 of the left lung with no changes in size was found in repeated chest CT. 99MTc-tectrotyd SPECT-CT showed left lung S3 neuroendocrine tumour. The radical surgery (bilobectomia superior sinistri) was performed. Histological result was well-differentiated p-NET (pT1a N0 R0 G1). No radiochemotherapy was suggested. On the follow up visit after three months normal glycaemia, potassium and cortisol were found. Conclusion We present ectopic ACTH secreting neuroendocrine lung carcinoma with likely good prognosis. No clearly defined guidelines of follow up exist.

The aim Of the study was to determine the relationship between depression and anxiety symptoms and chronic diabetes complications, disease duration, glycaemic control in type 1 diabetic patients. Methods 18–54 year old 215 patients with T1DM were enrolled in the study. Participants filled questionnaires about DM, disease duration, complications and Beck’s depression (DB) and anxiety (BA) inventory. All patients were evaluated for microvascular complications. Laboratory tests: HbA1c, creatinine, albumin in 24 h urine sample were performed. Results 124 females (57.67%) and 91 males (42.33%) participated in the study. Cohort consisted of 66 participants with DN (mean age 32.44G6.5 years) and 149 without DN (mean age 31.53G9.99). The group without DN consisted of 53 patients without any complications (mean age 29.49G9.25) and 96 patients with DP and/or DR (mean age 31.07G9.11). The emotional state of females was worse than males (BD: female 9.78G9.07; male 7.51G7.11; P!0.05; BN: female 13.86G9.99; male 8.86G7.79; P!0.01). There was no statistically significant difference between BD among patients with or without complications (PO0.05). There was a statistically significant difference (PZ0.04) between BA scores among patients without any complications (NZ53, female 31/male 22) (BA 9.42G8.1) and those with DN (NZ66, female 36/male 30) (BA 12.05G8.84). The emotional state of patients with longer disease duration (O30 years) (BD 13.59G11.49; BN 15.61G9.79) was worse than patients with shorter one (!10 years) (BD 8.14G8.55; BN 10.86G9.67) (P!0.05). There was nofound statistically significant differencebetween the emotional state and glycaemic control in T1DM patients. Conclusions The emotional state of females’ with type 1 diabetes mellitus is worse than males’. Patients with chronic diabetes complications have more anxiety symptoms than those without any complications. Emotional state is worse in diabetics whose dise

Aim The aim of this study was to evaluate the influence of age, disease duration, glycaemic control and diabetic nephropathy for the sexual function of women with type 1 diabetes mellitus (T1D). Methods Study subjects – 18–52 year old women with type 1 diabetes. Participants filled the Female Sexual Function Index (FSFI) and questionnaires about T1D, disease duration, glycaemic control and complications. Laboratory tests including glycated hemoglobin (HbA1C), creatinine, testosterone, Sex hormone-binding globulin (SHBG), estradiol levels and albumin in 24h urine sample were performed. Postmenopausal women were excluded from the study. Female sexual dysfunction (FSD) was diagnosed based on FSFI total score lower than 26.55. Results 113 women (mean age 34.82G8.34) with T1D were included to the study. Diabetic nephropathy (DN) was diagnosed to 43.4% (mean age 35.24G9.50), 56.6% had no DN (mean age 34.50G7.50). FSD was diagnosed to 42.6% (NZ40) of participants. Neither age nor disease duration had influence to FSD. Worse glycaemic control had a statistically significant impact to the prevalence of FSD (PZ0.028). Negative correlations between participant age and FSFI subscales of desire and arousal were observed (P!0.001). Lubrication (PZ0.015) and orgasm (PZ0.027) subscales were negatively affected by age only in the group of DN. Statistically significant negative impact was found between glycaemic control and lubrication in group without DN (PZ0.009). There was no statistically significant difference between FSFI scores or sex hormones and disease duration or DN. Free androgen index had impact neither to the FSFI subscale scores nor to total score. Negative SHGB and high glycaemic level correlation was observed only in DN group (PZ0.031). Conclusion Female sexual function is often diagnosed in women with type 1 diabetes mellitus. Sexual function correlates with glycaemic control and age. Worse glycaemic control has [...].