Characteristics of brain lesions found using MRI imaging in patients with post-COVID with signs of cognitive decline.

OBJECTIVE: Aim: To describe and evaluate abnormalities of the brain in post-COVID patients with neurologic symptoms and cognitive deficits using MRI imaging of the brain. PATIENTS AND METHODS: Materials and Methods: We included 21 patients with a previous positive PCR testing for SARS-CoV-2 and one or more of the following symptoms: memory and cognitive decline, dizziness, anxiety, depression, chronic headaches. All patients had MRI imaging done at onset of symptoms, but after at least 1 year after positive testing for COVID-19 based on the patient's previous medical history. RESULTS: Results: All of the patients complained of lack of concentration, forgetfulness, hard to process information. 15 patients suffered from confusion, 10 from anxiety. Of the 21 patients 14 had isolated chronic headaches, 3 had isolated dizziness, 4 patients had both symptoms upon inclusion. All patients underwent MRI imaging as a part of the diagnostic workup and had varying degrees of neurodegeneration. CONCLUSION: Conclusions: Our data correlates with existing research and shows tendency for cognitive decline in post-COVID patients. This provides groundwork for further research to determine correlation between acceleration of neurodegeneration and post-COVID.

PREDICTING PROGRESSION TYPE 2 DIABETES MELLITUS: A 3-YEAR FOLLOW-UP STUDY EXAMINING RISK FACTORS FOR TYPE 2 DIABETES IN PATIENTS WITH PREDIABETES.

OBJECTIVE: Aim: To study the risk factors in patients with prediabetes that can lead to the progression of impaired glucose tolerance in the form of type 2 diabetes mellitus. PATIENTS AND METHODS: Materials and methods: The selection of patients for this study was carried out on an outpatient basis at the Department of Therapy and Family Medicine, Uzhhorod National University. Patients with prediabetes were identified based on the American Diabetes Association criteria. Informed consent was obtained from all patients before the start of the study. Patients were randomly assigned to one of two groups: Group 1 (n=37) that received typical treatment according to the recommendations of the American Diabetes Association and the control Group 2 (n=42). At the 3rd year of the study, we determined the body mass index, glucose levels and glycated hemoglobin levels of the patients, also their medical documentation was analyzed and patients were interviewed about concomitant diseases. RESULTS: Results: Analyzing the 3-year follow-up of patients with prediabetes, cases of type 2 diabetes mellitus were detected in both groups, but there is no statistically significant difference when comparing the indicators between the groups (p>0.05). CONCLUSION: Conclusions: In our study, we analyzed the risk factors in patients with prediabetes that can lead to type 2 diabetes. During a 3-year follow-up, we identified cases of type 2 diabetes mellitus.

EFFECT OF INTERMITTENT FASTING ON CARBOHYDRATE, LIPID AND ULTRASONOGRAPHIC PARAMETERS IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE AND PREDIABETES.

OBJECTIVE: The aim: To study intermittent fasting (IF) treatment in patients with non-alcoholic fatty liver disease (NAFLD) and prediabetes. PATIENTS AND METHODS: Materials and methods: Patients with NAFLD (n=95) were examined. The patients were divided into 2 groups: Group 1 - NAFLD with obesity, Group 2 - NAFLD and prediabetes. All patients in both groups had Body mass index (BMI) within the 2nd degree of obesity range (30.0 kg/m2 to 34.5 kg/m2). RESULTS: Results: The effect of IF on anthropometric parameters, carbohydrate and lipid levels in patients with NAFLD with obesity and NAFLD with prediabetes, 6 and 12 months after treatment is shown. CONCLUSION: Conclusions: Intermittent fasting has a statistically significant effect on anthropometric parameters in NAFLD with obesity and NAFLD with prediabetes. Metformin administration after intermittent fasting in 12 months showed a statistically significant improvement in lipid and carbohydrate profiles.

NON-ALCOHOLIC FATTY LIVER DISEASE IN THE CONTEXT OF ALTERED GUT MICROBIOTA.

OBJECTIVE: The aim: To analyze the relationship between non-alcoholic fatty liver disease and changes in the gut microbiota. PATIENTS AND METHODS: Materials and methods: The publications of domestic and foreign editions in the databases of the United European Gastroenterology (UEG) Journal, PubMed, MEDLINE, Web of Science were processed and analyzed. CONCLUSION: Conclusions: In recent years, non-alcoholic fatty liver disease was placed among the important diseases in gastroenterology. During this time, more and more data appear on the link between changes in the human intestinal microbiome and the development of metabolic diseases, including NAFLD. Contemporary research has indeed found evidence of such a relationship. Thus, some strains of microorganisms have been identified in more detail, which directly or indirectly affect the development or course of the above-mentioned disease. For a better understanding of the strategies for the treatment of pathologies, it is necessary to delve into the study of etiological factors, therefore, NAFLC cannot be considered a pathology that has been sufficiently studied. Indeed, recent data indicate that the development and severity of the course of the disease are not always associated with the physiological processes already known to us.

SHORT- AND LONG-TERM EFFECTS OF NSAIDS ON THE GASTROINTESTINAL MUCOSA: COMPLEX ANALYSIS OF BENEFITS AND COMPLICATIONS PREVENTION.

OBJECTIVE: The aim: To analyse data from recent studies, dedicated to the use of non-steroidal anti-inflammatory drugs (NSAIDs); to evaluate the best clinical practice in the use of NSAIDs in order to prevent side effects (SEs) in different clinical scenarios; to optimise treatment of patients at risk of NSAIDs-related SEs. PATIENTS AND METHODS: Materials and methods: A comprehensive bibliographic search was performed using the keywords "NSAIDs", "NSAID gastropathy", "NSAID enteropathy", "complications of NSAID therapy", "cardiovascular disease", "cardiovascular risk" in the PubMed, Web of Science, Cochrane Library, Google Academy databases. CONCLUSION: Conclusions: NSAID-induced gastrointestinal lesions are а relevant problem of internal medicine, this is due to the fact that the pathogenic mechanisms of this process are still unclear. All the gastrointestinal tract (GIT) related risk factors(RFs) for gastro- and enterocolonopathies associated with the use of NSAIDs should be taken into consideration by physicians of all specialties. The examination and diagnostic of the GIT should be performed regularly to prevent complications. Uncontrolled, long-lasting, unprescribed NSAID usage should draw the attention of doctors, especially in patients with comorbid states.

THE CLINICAL PRESENTATION OF SUBCLINICAL HYPOTHYROIDISM IN PATIENTS WITH TYPE 2 DIABETES MELLITUS ASSOCIATED WITH OBESITY, ITS IMPACT ON CARDIOVASCULAR RISK, AND WAYS OF ITS CORRECTION.

OBJECTIVE: The aim: Calculate CVR in patients with T2DM, obesity and SH and analyze it. PATIENTS AND METHODS: Materials and methods: The selection of patients was carried out based on the Uzhhorod District Clinical Hospital, in the period from November 2016 to July 2021. All examined patients were divided into 3 groups: 1 (n=108) with T2DM and concomitant obesity and SH, 2 (n=91) with T2DM and SH, 3 (n=46) with obesity and SH. The observation and treatment period lasted 1 year. Using American College of Cardiology (ACC) / American Heart Association Guideline on the Assessment of Cardiovascular Risk (AHAGACR) (2013) (ASCVD Risk) and Framingham Risk Score (FRS), CVR was determined in all patients before and at the end of the study. RESULTS: Results: According to the data obtained, patients in each group had a 10-year risk of CVE, however, worse CVR was observed in patients in group 1. In a more detailed analysis and comparison of the obtained data of patients with 10-year risk of CVE, worse CVR values were observed in patients with concomitant SH than without it (p<0.05). CONCLUSION: Conclusions: The presence of SH in consumers may be an additional risk factor for unwanted CVE over a 10-year period.

COVID-19 AND PRIMARY CARE: POSSIBILITIES FOR INCREASING POSITIVE OUTCOMES.

OBJECTIVE: The aim: Determine the most common non-communicable diseases which are associated with an increased rate of moderate and severe COVID-19 infection. Identify the best tools for diagnosing COVID-19 and predicting the deterioration of the disease. PATIENTS AND METHODS: Materials and methods: Publications were processed and analyzed according to the keywords of the topic of work "COVID-19", "non-communicable disease", "obesity", "hypertension", "Comorbidities", "frailty", "diabetes", "chronic obstructive pulmonary disease", "cardio-vascular diseases", "liver diseases", "diagnostic tools", "outcomes" in the databases of PubMed, MEDLINE, Web of Science. CONCLUSION: Conclusions: As a result of the analysis, we found that patients with concomitant obesity, diabetes mellitus, COPD, CVD and liver diseases have an increased the risk of severe forms and death from COVID-19.

ASSESSMENT OF CARDIOVASCULAR RISK IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND ASSOCIATED OBESITY AND WAYS OF ITS CORRECTION.

OBJECTIVE: The aim: To analyze and calculate CVR in patients with T2DM and concomitant obesity. PATIENTS AND METHODS: Materials and methods: The selection of patients was carried out based on the Uzhhorod District Clinical Hospital, in the period from November 2016 to January 2020. All patients were divided into 3 groups: 1 (n=93) with T2DM and concomitant obesity, 2 (n=87) with T2DM, 3 (n=39) with obesity. The treatment period lasted 1 year and included dosed exercise for at least 30 minutes per day and dietary recommendations. Patients in groups 1 and 2 received metformin 850 mg twice daily in combination with dapagliflozin 10 mg once daily. CVR was determined at the time of enrollment and after 1 year of treatment using: American College of Cardiology / American Heart Association Guideline on the Assessment of Cardiovascular Risk (2013) (ASCVD Risk) and Framingham Risk Score (FRS). RESULTS: Results: The data obtained as a result of the study revealed the highest CVR in patients of group 1, in contrast to group 2 and 3 (p<0.05). After 1 year of complex treatment, CVR indicators were statistically significantly reduced in all experimental groups (p<0.05). CONCLUSION: Conclusions: Determining CVR parameters and exposure to them within 10 years can remove unwanted cardiovascular complications.

EFFECT OF PROLONGED TREATMENT WITH BIOLOGICAL THERAPY IN PATIENTS WITH ULCERATIVE COLITIS WITH CONCOMITENT JOINT DAMAGE.

OBJECTIVE: The aim: Is to compare the effects of tofacitinib, adalimumab and budesonide clinical and laboratory signs of patients with moderate UC with concomitant articular syndrome. PATIENTS AND METHODS: Materials and methods: 100 patients with moderately severe UC. Patients were divided into 2 groups. The I group consisted of patients with UC, which were treated with tofacitinib 10mg bid (TOF; n=28). II group consisted of patients who were treated with adalimumab with a starting dose of 160 mg and 80 mg on the 2nd week of treatment, after which they received a subsequent dosage of 40 mg per week (ADA; n=32). Patients in the III group received budesonide 9mg qd (BUD; n=40). RESULTS: Results: As a result of treatment in the TOF research group, leukocyte and CRP levels decreased compared to readings before treatment (from 13.6±2.4*109/l and 1698 14.0±1.4mg/l to 10.6±1.2*109/l and 11.0±2.1 mg/l respectively, p<0.05). Hemoglobin levels in this group slightly increased (from 104.2±9.2 g/l to 126.1±10.2 g/l, p<0.05). Among ADA patients, there was also an improvement in laboratory signs: leukocyte and CRP levels decreased (from 13.8±2.8*109/l and 16.0±1.2 mg/l to 6.0±2.2*109 /l and 11.8±1.2 mg/l respectively, r<0.05), hemoglobin increased (from 103.8±8.2 g/l to 118.6±8.6 g/l/l r<0.05). CONCLUSION: Conclusions: Tofacitinib and adalimumab in the treatment of patients with ulcerative colitis of moderate severity with concomitant joint damage showed a higher clinical and laboratory effectiveness compared to treatment with budesonide.

Comparison of the effects of tofacitinib and adalimumab on transcolonoscopic ph and calprotectin levels in patients with ulcerative colitis.

OBJECTIVE: The aim: To investigate the transcolonoscopic pH-metry and calprotectin in patients with ulcerative colitis. PATIENTS AND METHODS: Materials and methods: the research included 110 patients both male and female between the ages of 18 to 75 years old, who were treated for UC of medium and severe activity, in active phase. All patients were divided into 3 groups. The first group received standard therapy (ST; n=50), the second group received adalimumab (ADA; n=32), and the third group was treated with tofacitinib (TOF; n=28). The control group consisted of healthy individuals between the ages of 18 and 65 years old. RESULTS: Results: UC patients had lower pH levels in all sections of the large intestine, compared to the control group (р<0,05). Calprotectin level is a better predictor of the course of the disease. CONCLUSION: Conclusions:Tofacitinib, compared to adalimumab and budesonide, has better influence on clinical, endoscopic and laboratory parameters of UC.

Comparison of the effect of dapagliflozin on contrast to standard therapy of the patients with type 2 diabetes mellitus and concomitant obesity, their effect on laboratory and anthropometric parameters.

OBJECTIVE: The aim: Evaluate clinical and laboratory parameters of the patients with type 2 diabetes mellitus and concomitant obesity after a course of dapagliflozin treatment and compare with a standard treatment regimen. PATIENTS AND METHODS: Materials and methods: Conducted a comprehensive clinical laboratory examination and measurement of the anthropometric parameters of the patients with type 2 diabetes mellitus and concomitant obesity, with subsequent statistical calculations. RESULTS: Results: The data obtained at different stages of the study revealed a statistically significant effect of glucose treatment and glycosylated hemoglobin (HbA1c). Since the 6th month of dapagliflozin treatment, we have shown a tendency to lose weight compared to baseline in this group of patients and controls. CONCLUSION: Conclusions: Type 2 diabetes mellitus and obesity significantly increase the risk of developing a number of complications. Complex control and effects on clinical laboratory and anthropometric parameters can statistically significantly influence the development of the complications, and in this context, dapaglifloflozin showed statistically better results than standard metformin monotherapy.

Peculiarities of diagnostics of depressions and clinical manifestations in patients with obesity and concomitant type 2 diabetes mellitus.

OBJECTIVE: Introduction: According to the World Health Organization, depression is a common mental disorder characterized by despair, loss of interest or joy, feelings of guilt and low self-esteem, sleep disturbance or appetite, lethargy, and poor concentration. There is a series of studies that show the presence of depressive disorders in patients with obesity concomitant type 2 diabetes mellitus, but in our study, we wanted to demonstrate the degree of severity of these changes. The aim: Diagnose depression in patients with obesity and concomitant type 2 diabetes mellitus. PATIENTS AND METHODS: Materials and methods: Examine patients with obesity and concomitant type 2 diabetes mellitus and select them for research. For the diagnosis of depression were used: Patient Health Questionnaire - 2 and 9, Hospital Anxiety and Depression Scale and Hamilton Depression Scale. Along with hypoglycemic therapy, all patients with diagnosed depression were given individual psychotherapy: cognitive behavioral therapy - 12 sessions per week, interpersonal therapy - 12 sessions per week and bibliotherapy. RESULTS: Results: Using the questionnaires scales, we found depressive disorders in patients with obesity and concomitant type 2 diabetes mellitus. Along with the diagnosis of depression, we managed to correct it using individual psychotherapy. CONCLUSION: Conclusions: Patients with obesity and concomitant type 2 diabetes mellitus are in a cohort with an increased risk of depression and should be diagnosed early. Given these patients polypharmacotherapy, treatment for depression should begin with non-drug therapy.

Ferric carboxymaltose prevents recurrence of anemia in patients with inflammatory bowel disease.

BACKGROUND & AIMS: Iron-deficiency anemia is the most common systemic complication of inflammatory bowel diseases (IBD). Iron-deficiency anemia recurs frequently and rapidly after iron-replacement therapy in patients with IBD. We performed a randomized, placebo-controlled trial to determine if administration of ferric carboxymaltose (FCM) prevents anemia in patients with IBD and low levels of serum ferritin. METHODS: We performed a single-blind, multicenter study of nonanemic patients who had completed the FERGIcor study. Serum levels of ferritin were assessed every second month, and patients were given FCM (total iron dose, 1181 ± 662 mg; n = 105) or placebo (n = 99) when levels decreased to less than 100 µg/L. The primary end point was time to recurrence of anemia within 8 months. Secondary end points included changes of quality of life, disease activity, results from laboratory tests, and adverse events. RESULTS: Anemia recurred in 26.7% of subjects given FCM and in 39.4% given placebo. The time to anemia recurrence was longer in the FCM group (hazard ratio, 0.62; 95% confidence interval, 0.38-1.00; P = .049). Markers of body levels of iron increased or remained at normal levels in subjects given FCM (ferritin increased by 30.3 µg/L, transferrin saturation increased by 0.6%) but decreased in the group given placebo (ferritin decreased by 36.1 µg/L, transferrin saturation decreased by 4.0%). Changes in quality of life and disease activity were comparable between groups. Adverse events were reported in 59.0% of the FCM group and 50.5% of the placebo group, and serious adverse events were reported in 6.7% and 8.1%, respectively. CONCLUSIONS: FCM prevents recurrence of anemia in patients with IBD, compared with placebo. Nevertheless, the high rate of anemia recurrence warrants optimization of the frequency and requirements for FCM treatment.

FERGIcor, a randomized controlled trial on ferric carboxymaltose for iron deficiency anemia in inflammatory bowel disease.

BACKGROUND & AIMS: Iron deficiency anemia (IDA) is common in chronic diseases and intravenous iron is an effective and recommended treatment. However, dose calculations and inconvenient administration may affect compliance and efficacy. We compared the efficacy and safety of a novel fixed-dose ferric carboxymaltose regimen (FCM) with individually calculated iron sucrose (IS) doses in patients with inflammatory bowel disease (IBD) and IDA. METHODS: This randomized, controlled, open-label, multicenter study included 485 patients with IDA (ferritin <100 µg/L, hemoglobin [Hb] 7-12 g/dL [female] or 7-13 g/dL [male]) and mild-to-moderate or quiescent IBD at 88 hospitals and clinics in 14 countries. Patients received either FCM in a maximum of 3 infusions of 1000 or 500 mg iron, or Ganzoni-calculated IS dosages in up to 11 infusions of 200 mg iron. Primary end point was Hb response (Hb increase ≥ 2 g/dL); secondary end points included anemia resolution and iron status normalization by week 12. RESULTS: The results of 240 FCM-treated and 235 IS-treated patients were analyzed. More patients with FCM than IS achieved Hb response (150 [65.8%] vs 118 [53.6%]; 12.2% difference, P = .004) or Hb normalization (166 [72.8%] vs 136 [61.8%]; 11.0% difference, P = .015). Both treatments improved quality of life scores by week 12. Study drugs were well tolerated and drug-related adverse events were in line with drug-specific clinical experience. Deviations from scheduled total iron dosages were more frequent in the IS group. CONCLUSIONS: The simpler FCM-based dosing regimen showed better efficacy and compliance, as well as a good safety profile, compared with the Ganzoni-calculated IS dose regimen.