BACKGROUND: The problem of diagnosis, treatment and prevention of fat liver disease (FLD) is one of the actual problems of modern medicine. In this regard, the need for the creation of reliable experimental models of the FLD, which would be as close as possible to the pathogenetic patterns of the development of this disease in humans.

AIM: To create an experimental model of FLD and compare the efficiency of its reproduction in rats of different ages.

MATERIALS AND METHODS: The study was conducted on male Wistar rats, whose ages at the beginning of the experiment were 3 and 18 months. Control animals were fed a standard diet. The experimental rats were kept on a diet with excess fat (45 %) and carbohydrates (31 %) for 12 weeks. The liver tissue samples were taken for morphological studies of FLD. Histological preparations were made according to the standard technique. Morphometry on digital images of micropreparations was conducted using the computer program «IMAGE J». The concentration of lipids, cholesterol, and triglecerides in the liver tissue was determined, and the concentration of ALT in the blood serum was determined. To assess the biophysical properties of the liver tissue, the method of multifrequency bioimpedance measurement was used.

RESULTS: The transfer of animals to a high-calorie diet developed by us led to the development of FLD. This was evidenced by an increase of the liver mass, its pale shade and soft consistency. Morphometric signs of FLD were also revealed. Hypertrophy of hepatocytes was observed with a simultaneous decrease in the nuclear-cytoplasmic ratio; accumulation of numerous lipid inclusions in the cytoplasm and the appearance of large lipid droplets replacing the voids of dead hepatocytes. The number of binuclear hepatocytes and nucleolus in the nucleus, the relative area of the sinusoid network were decreased. An increase in the concentration of lipids, cholesterol and triglecerides in the liver tissue of experimental rats, as well as the activity of ALT in the blood serum, was observed. Changes in the bioimpedance measurements of the liver tissue also indicated the  development of severe fatty degeneration of the liver in both young (to a greater extent) and old rats.

CONCLUSION: The model of FLD we have advanced based on a combined (fat-carbohydrate) high-calorie diet. It leads to the development of pronounced morphological, biochemical and biophysical signs of this pathology in all experimental rats. The most pronounced manifestations of FLD are observed in young animals.

BACKGROUND: Vitamin D deficiency and insufficiency are widespread medical abnormalities, but their frequency in endocrine diseases has generally not been studied.

AIM: To provide a comparative assessment of vitamin D levels in patients with diabetes mellitus type 2, primary hyperparathyroidism (PHPT), central hypercortisolism (Cushing’s disease; CD) and acromegaly.

MATERIALS AND METHODS: Total 25(OH)D was determined using the immunochemiluminescent method (the laboratory participates in the DEQAS program). All patients had GFR > 60 ml/min, no history of use of vitamin D supplementation within previous month.

RESULTS: The study included 365 patients who, after applying the inclusion/exclusion criteria, were divided into 5 main research groups: 33 patients with diabetes mellitus type 2, 23 patients with PHPT, 68 patients with CD, 22 patients with acromegaly, and 141 apparently healthy patients. Significantly low levels of vitamin D were found in patients with diabetes mellitus type 2 (14.8 ng/ml), acromegaly (14.9 ng/ml), CD (14.6 ng/ml), and PHPT (15.9 ng/ml) compared with a group of otherwise healthy patients (18.8 ng/ml).

CONCLUSION: The results of the study demonstrate a high prevalence of vitamin D deficiency not only in groups of patients with chronic diseases, but also among practically healthy patients. Further studies are needed to address the causes of high vitamin D deficiency in the described endocrine diseases.

BACKGROUND: alimentary-constitutional obesity due to it’s high prevalence, is the key problem of modern healthcare system. However, obesity is not always accompanied with metabolic disorders, leading to early invalidization and mortality. That’s why it is important to study risks of metabolical nonhealth in obesity.

AIM: to detect factors, increasing risks of development of metabolic disbalance in alimentary-constitutional obesity.

MATERIALS AND METHODS: In patients with alimentary-constitutional obesity there was performed an examination including anthropometry (body mass index, Waist Circumference, Hip Circumference,waist to hip ratio), blood pressure measurement, laboratory tests – metabolic indexes: glucose, insulin, insulin resistance indexes, leptin, cholesterol, cholesterol of lipoproteins, triglycerides, aspartate aminotransferase, alanine aminotransferase, gamma-glutamiltransferase), body composition measurement by bioelectrical impedance analysis; patients were also interviewed on their behavior (food habits) and physical activity.

RESULTS: There were formed two groups depending on metabolic health indexes: main group – metabolically non-healthy obesity (MNHO) - 241 persons (aged 41±12,09, duration of obesity 12,5±9,51 years) with alimentary-constitutional obesity and two or more signs of MS, a comparison group – of metabolically healthy obesity (MHO) – 120 persons (aged 35,5±10,03; p<0,05, duration of obesity 8,0±7,39 years; p<0,05) with alimentary-constitutional obesity and one sign of MS or without it. Data analysis of studied risk factors for development of metabolically non-healthy alimentary-constitutional obesity confirmed that most relevant factor in development of MNHO is abdominal fat mass distribution (increasing of Waist Circumference over 88 sm in females and over 102 sm in mails). At the same time MNHO had correlation not only with classical signs of MS, but also with blood insulin level, insulin resistance indexes, fat metabolism disbalance and liver disfunction. More severed risk for appearance of metabolic disorders have patients over 45 years old with decreased active cell mass (less than 45%), duration of obesity above 10 years and obesity-burdened heredity. In food habits risk of development of metabolically non-healthy obesity was increased in taking of fat milk food, and, on the contrary, - frequent snacks, alcohol free sweet drinks didn’t affect it.

CONCLUSION: Development of MNHO is associated not only with the age of patient, duration of obesity, carbohydrate and fat metabolism indexes, but also with decreased percentage of metabolically active tissues and some food habits.

BACKGROUND: Obesity and overweight are more common, especially among women of reproductive age. Therefore, the approach to maternal obesity requires a multidisciplinary approach, especially health professionals working in primary care preventive health services.

AIM: The aim of the study is to determine the effect of maternal obesity on maternal and newborn health in Al Khansaa Teaching Hospial, City of Mosul, Iraq.

MATERIALS AND METHODS: The study, which was planned as à case-control study, was conducted in the Al Khansa Teaching Hospital City of Mosul, Iraq.The inclusion criteria included women in postnatal period in the same Hospital, speaking and understanding Arabic, knowing her pre-pregnancy weight, not having any chronic disease (diabetes, hypertension, trioid diseases, etc.) before pregnancy, pre-pregnancy body mass index (BMI) 18.5–25, those with a BMI >29.9, and those with primary school or higher education were included. The exclusion criteria included multiple pregnancies, without any formal education, physical disability (that prevented the completion of the data collection forms), and mental health problems. Data were collected with the data collection form and Edinburgh Postpartum Depression Scale.

RESULTS. The study was completed with 286 women, 142 cases and 144 control groups. There was no statistical difference between the case and control groups in terms of family type and employment status (p>0.050). While the mean age, pregnancy and number of living children of the women in the case group were statistically higher, their educational status was found to be lower (p<0.050). It was found that women with obesity experienced health problems such as urinary tract infection, anemia, gestational diabetes, psychological problems, and preeclampsia/gestational hypertension at a higher rate than women in the control group (p<0.010), and women in the control group gained 13.94±5.29 kg (p=0.001).

CONCLUSION In conclusion, it was found that women in the case group experienced pregnancy, early and late postpartum complications at a higher rate than the control group, while there was no difference between the groups in terms of depression at the end of the sixth week postpartum.

Patients with chronic kidney disease are characterized by the development of mineral disorders due to a decrease in the number of functioning nephrons. These changes manifest by the development of secondary hyperparathyroidism (the overproduction of intact parathyroid hormone (PTH) associated with the serum hypocalcemia, hyperphosphatemia), dysfunctional vitamin D metabolism, bone mineralization and also extraosseous calcifications. Decreased serum PTH levels associated with hypercalcemia are suspicious for adynamic bone disease, but at the same time requires an extended differential diagnostic search (e.g. metastatic processes). One of the rare causes of hypercalcemia is a defect in 24-hydroxylase (CYP24A1). We present a case of a patient on hemodialysis with atypical secondary hyperparathyroidism and an established CYP24A1 defect.

Obesity is a global social and economic problem. The bariatric surgery is a most effective treatment for obesity. The presented clinical case demonstrates the usage of principles of enchanced perioperative rehabilitation for the preoperative preparation of a patient with super obesity and with severe obstructive sleep apnea and alveolar hypoventilation syndrome.

A 54-year-old patient was hospitalized with complaints of obesity, impossibility of persistent weight loss conservatively, severe daytime sleepiness, frequent nocturnal awakenings (up to 8 times per night). The patient’s weight was 230 kg with a height of 157 cm (BMI 93.5 kg / m²). The examination revealed a syndrome of sleep apnea of mixed genesis of extremely severe degree, chronic night hypoxemia of an extremely severe degree. Preoperative preparation was performed in accordance with the program of enchanced perioperative rehabilitation. The duration of preoperative preparation was 19 days; weight loss — 40 kg (%WL -17,4), compensation of comorbidities was achieved as well. After that the patient underwent a laparoscopic sleeve gastrectomy. There were no complications in the postoperative period. Length of postoperative hospital stay was 6 days. At follow-up examination one year after surgery, body weight dropped from 230 to 153 kg (% WL-33.5), a significant improvement of the quality of life was achieved.

The enchanced perioperative rehabilitation program can be successfully used as an effective method for preoperartive preparation of the patients with morbid obesity in combination with severe obstructive sleep apnea syndrome.and obesity hypoventilation. It can be a reasonable alternative to the standard program with preoperative intragastric balloon treatment. The use of this technique allows to increase the effectiveness of treatment of these high-risk patients, as well as to reduce the risk of perioperative complications.

Thyrotoxicosis, which characteristics are increased excitability, emotional lability, tachycardia episodes, increasing of free fractions of tetraiodothyronine (T4) and triiodothyronine (T3) is one of the most common endocrinological syndromes. However, during the interpretation of thyroid status it is very important to take into account the possibility that a patient has TSH-secreting pituitary adenoma. Timely diagnosis of TSH-secreting adenomas plays prominent role in guiding the treatment course since it is associated with an improvement of long-term prognosis and an increase of the patient’s total life expectancy. Needed to underline that in some patients with TSH-secreting adenomas manifestations of the other pituitary hormones hypersecretion (first of all — somatotropin and prolactin) come to the fore, that lead to the development of acromegaly and hyperprolactinemia accordingly. Our work basing on two clinical cases presents main principles of diagnosis and specific clinical manifestations of TSH-secreting pituitary adenomas and demonstrates efficacy of somatostatin analogues in the treatment of this pathology.

Sleeve gastrectomy, originally proposed as part of a two-stage operation, more than 15 years ago, is recognized as an independent, effective intervention for the treatment of obesity. The purpose of this review was to evaluate the effectiveness of sleeve gastrectomy based on data on long-term follow-up of patients. A search was performed in two databases, 33 literary sources were selected based on the results of the selection. In this review, the authors evaluated some parameters characterizing the effectiveness of sleeve gastrectomy in the long term after surgery. The percentage of follow-up of patients in the long-term period (follow up, %) varied from 5,6% to 97%, the expected decrease in % follow up over time did not occur. The authors have suggested similar results due to the heterogeneity of the data of the analyzed sources. By the five-year period, the detected average % of follow-up did not correspond to the optimal recommended level of follow-up for operated patients by this time. The most common criterion for assessing the return of weight is an increase in body weight by more than 10 kg from the lowest achieved. The prevalence of this phenomenon ranged from 26.3% to 44%. Among the reasons predisposing to weight loss are the initial high BMI, old age, dilatation of the formed stomach. In the absence of a universal definition of various terms (follow up, unsatisfactory result of surgery, weight loss, etc.), the results among the same patients when using different definitions will differ, there is a need to adopt standards when describing these phenomena. Despite the likelihood of weight loss after longitudinal resection, this operation is relatively simple from a technical point of view, safer, it can be used to improve the course of concomitant pathology (diabetes mellitus, hypertension), improve the quality and increase the life expectancy of patients.

The COVID-19 pandemic is a challenging problem of the present. Another essential problem causing serious health consequences is the global obesity epidemy. Our article notes the importance of studying the combinations and correlations of mentioned pandemic processes. We analyzed scientific reports of co-presence of obesity, diabetes and coronavirus infection. According to the analyzed data combination of COVID-19 with obesity and diabetes leads to the higher rate of the hospitalisation. These patients more often required the transfer to the intensive care unit and artificial lung ventilation. Our review contains scientific observations of the first reported cases of higher mortality rate of obese and diabetic patients during the period of previous influenza pandemics (including H1N1). The results of the 2020 year shows that the outcomes of coronavirus infection with underlying obesity much more threatening and harmfull. In our article, we present the correlation of the average body mass and mortality rate index in different countries (according to the WHO and the World Obesity Federation). Comparative results in the Central Asia countries are given as well. The paper analyzes the suggestions for obesity policy and advocacy provided by World Obesity Federation in “ROOTS: A framework for action”. The conclusions marks the importance of implementing the proposed measures against obesity during a pandemic and in the post-COVID era.

Physiologically, autophagy is a major protective mechanism of β-cells from apoptosis, through can reserve normal β- cell mass and inhibit the progression of β-cells destruction. Beta-cell mass can be affected by differentiation from progenitors and de-differentiation as well as self-renewal and apoptosis. Shred evidence indicated that hypoglycemic drugs can induce β-cell proliferation capacity and neogenesis via autophagy stimulation. However, prolonged use of selective hypoglycemic drugs has induced pancreatitis besides several other factors that contribute to β-cell destruction and apoptosis initiation. Interestingly, some nonhypoglycemic medications possess the same effects on β-cells but depending on the combination of these drugs and the duration of exposure to β-cells. The paper comprehensively illustrates the role of the hypoglycemic drugs on the insulin-producing cells and the pathogeneses of β-cell destruction in type 2 diabetes mellitus, in addition to the regulation mechanisms of β-cells division in norm and pathology. The grasping of the hypoglycemic drug’s role in beta-cell is clinically crucial to evaluate novel therapeutic targets such as new signaling pathways. The present paper addresses a new strategy for diabetes mellitus management via targeting specific autophagy inducer factors (transcription factors, genes, lipid molecules, etc.).

The obesity epidemic has led to the growing number of bariatric operations and the expansion of indications for this operation as the most effective method of treatment, that’s why endocrinologists are increasingly faced the challenge of late complications, including postbariatric hypoglycemia. Postbariatric hypoglycemia is a rare but severe metabolic disorder that occurs months or years after upper gastrointestinal surgery. Postbariatric hypoglycemia can be accompanied by severe clinical symptoms and lead to disability and decreasing of the life’s quality. It is difficult to assess the prevalence of hypoglycemia after bariatric surgery due to the lack of clear diagnostic criteria, often a hidden clinical picture and ignorance of doctors and patients about this complication. Hypoglycemia in this case has postprandial and hyperinsulinemic nature. The mechanisms of development of this complication have recently been actively discussed. The exchange of incretins and dysregulation of insulin secretion are the subject of constant research in this area. Understanding the mechanisms of development of this condition makes it possible to develop optimal methods of diagnosis and treatment. The issues of pathophysiology, basic principles of diagnosis and treatment of post-bariatric hypoglycemia will be considered in this review.

Thanks to modern treatment protocols, childhood cancer survivors (CCS) are a very fast-growing population nowadays. Cancer therapy inevitably leads to different late adverse effects, where endocrine disorders are highly prevalent, including growth hormone deficiency (GHD) which is the most common endocrine outcome after cancer treatment in childhood and contributes to impaired growth. Short stature is a big issue, which leads to problems in psychological and social adaptation of patients and reduces their quality of life. Impact of GH treatment on various physiological processes and global outcome of CCS is of great interest. Several studies have demonstrated an influence of GH and IGF-1 on the development/tumour growth, cell proliferation. In this regard, the issue of increasing the risk of cancer recurrence and/or the development of secondary neoplasms in CCS, causes a lot of controversy and is the subject of continuous evaluation. In this review, we went through the available data on the prevalence and pathogenesis of GHD following chemo- and radiotherapy, in particular after treatment of brain tumors and acute lymphoblastic leukaemia in childhood. In addition, here we discuss the existing problems in the diagnosis of GHD, the safety of GH replacement therapy, as well as the treatment algorithm of the GHD in adults.

Hypogonadism in males, defined as a decrease in serum testosterone levels in combination with characteristic symptoms and/or signs, can be observed with pathological changes in the testicles and/or pituitary gland, such as Klinefelter’s syndrome, Kallman’s syndrome, as well as in men with metabolic (obesity, diabetes mellitus) or iatrogenic disorders leading to a decrease in androgen production. The draft guidelines cover the extensive range of pathologies that cause hypogonadism development (testosterone deficiency) and focus on its clinical variants, which make up the majority of cases of hypogonadism observed in men. The authors and reviewers are an interdisciplinary group of experts, consisting of endocrinologists, andrologists, urologists - members of the «Russian Association of Endocrinologists» and «Men’s and Reproductive Health» public organizations.

Clinical guidelines contain the most reliable evidence available to experts at the time of writing. Nevertheless, recommendations cannot replace clinical experience, and deciding on the start of treatment, choosing a method of therapy, or a drug should always consider the individual characteristics of a specific patient.