THE ASSESSMENT OF COMPENSATION OF CARBOHYDRATE METABOLISM IN PATIENTS WITH TYPE 2 DIABETES MELLITUS WITH METABOLIC SYNDROME BEYOND THE LIMITS OF GLYCATED HEMOGLOBIN.

OBJECTIVE: The aim: To investigate glycemic variability in type 2 diabetes patients with metabolic syndrome (MS) and to assess its effect on diabetes compensation. PATIENTS AND METHODS: Materials and methods: We used traditional indicators of glycemia variability according to the recommendations of the American Diabetes Association Professional Practice Committee. We proved that patients with type 2 diabetes mellitus with MS reliably have worse CGM indicators: Time in range TIR: (3.9-10.0 mmol/l) - 53.30±5.90%; Time above range (TAR): (time above range) (>10.1 mmol/l) - 43.33±5.96%; Time above TAR range (>13.9 mmol/l) - 22.1±3.91%; Glucose Variability СV - 44.10±4.89% compared to patients with type 2 diabetes without MS, which proves the negative effect of insulin resistance on compensation of diabetes. RESULTS: Results: Determination of the level of EI in the blood, calculation of the Caro index, HOMA-IR are informative for verifying the presence of IR in patients with type 2 diabetes with MS. For optimal diabetes control, in addition to HbA1c, we must consider CGM data and % Time in range (TIR). CONCLUSION: Conclusions: TIR should be used as a target point and an indicator of glycemic control in routine clinical practice. TIR provides accurate data on a patient's glycemic status and helps better control diabetes.

Clinical-laboratory and ultrasound parallels of changes in the liver and thyroid gland in diffuse toxic goiter.

Detection of liver dysfunction in patients with diffuse toxic goiter (DTG) at an early stage allows for correcting it in time with appropriate therapy; therefore, diagnosing hepatobiliary system lesions in these patients is an important medical issue. We examined 62 patients, divided into two groups depending on the duration of the disease. The first group included patients with a disease duration of up to two years, the second group - patients with a disease duration of more than two years. The study and comparison of laboratory and multiparametric ultrasound criteria of liver and thyroid dysfunction were performed. Analysis of ultrasound signs of hepatobiliary system lesions in patients in the two groups showed that they were more common in the second group. There is a correlation between the stiffness of the parenchyma of the thyroid gland and liver and the duration of the disease, the level of free thyroxine (T4f), and antibodies to thyroid-stimulating hormone receptors (ArTTG). Increased liver stiffness was more common in patients with ArTTG levels above 20 IU/ml, and the degree of F1 fibrosis was higher at T4f greater than 50 pmol/l. To assess the condition of a patient with DTG and the need to correct treatment tactics, it is advisable to use the criteria of multiparametric ultrasound examination of the hepatobiliary system and thyroid gland.

Hybrid Revascularization for Aorto-Iliac Occlusive Disease with Common Femoral Artery Involvement: Early Outcomes of a Single Centre.

OBJECTIVE: To study the early outcomes of aorto-iliac occlusive disease with common femoral artery involvement by hybrid methods of revascularization - iliac stenting with femoral endarterectomy. We report the initial experiences of a single centre and discuss issues that arose. METHODS: Ninety-eight critical limb ischaemia (CLI) patients with aorto-iliac occlusive lesions TASC-II C and D were treated using HR between January 2017 and September 2020 in the Ivano-Frankivsk Regional Clinical Hospital. Prospective data were recorded and analysed including demographics, technical success, 30-day and early patency outcomes, re-intervention, and death. RESULTS: The mean age of patients was 65 ± 7.2 years (61 men and 37 women). Using classification by TASC-II, 77% of the lesions were class D. Technical success was seen in 98% of patients. Two patients underwent a crossover femoro-femoral bypass due to failure to re-enter the true lumen of the aorta during endovascular lesion crossing. There were no deaths during the 30-day period. No re-interventions for thrombosis were needed. Additional delayed bypass procedures were required in 19 patients (19.3%) with distal occlusions and minor and major tissue loss. The overall complication rate was 16.3% (16 patients). The 30-day patency rate was 100%. The median follow-up period was 18 months (range 1-36 months) with a primary patency rate of 87.2%, and cumulative primary assisted and secondary patency rate of 93.4%. Four patients died during the study period. CONCLUSIONS: Hybrid revascularization is a safe and less traumatic method of managing aorto-iliac occlusive disease with common femoral artery involvement. Good early patency results and low major complication rates indicate that HR is an excellent alternative to traditional open surgery, especially for high-risk patients.