Obesity takes epidemic proportions, encompassing different groups of society. In turn, cerebrovascular pathology holds a leading position in the spectrum of neurological disorders. Researchers indicate a role of obesity in the development of cognitive impairment. However, the cellular and biochemical mechanisms underlying that connection are still poorly understood. In addition, despite the obvious association of obesity with the deterioration of mental activity demonstrated in clinical trials for a long time it was unclear whether these disorders are caused by obesity per se or related conditions, such as metabolic syndrome, diabetes or cardiovascular disease. Currently there is scarse systematic data on a cause-effect relationships of these two pathologies.

Fortification of flour and bakery products with folic acid (FA) to reduce the number of neural tube defects as well, as anemia, is practiced in some countries. The purpose of our review is to discuss is folic acid supplement reasonably everyone?

It is well established, that folic acid has numerous significant beneficial effects. Folic acid prevents neural tube defects like spina bifida and anencephaly, it prevents development of macrocytic anemia. The ability of folic acid to decrease homocysteine level is associated with its protective influence on cardiovascular disease. Moreover, combination of high folate level with vitamin B12 deficiency may be associated with an increased risk of cognitive impairment and anemia. According to available information, folate has a dual effect on cancer, protecting against cancer initiation, but facilitating progression and growth of neoplastic cells and promote methastasis. However, relationship between folate supplementation and cancer, is, perhaps, one of the most controversial subjects in the field.

Whether increased circulating folic acid is a risk factor for certain pathologies, or it might have a beneficial effect is not clear at present. Scientific community does not have a true consensus view on whether mandatory fortification is true approach.

 

Conference on the development of the international expert consensus to address frequently asked questions related to a medical condition of testosterone deficiency (TD, male hypogonadism) and testosterone therapy was held in Prague (Czech Republic) on October 1, 2015. The included experts were representatives from a variety of medical specialties, including urology, endocrinology, diabetology, internal medicine, as well as representatives of basic medical sciences. An international team of experts came to the following conclusions: TD - an important medical condition that affects the health and well-being of men; TD symptoms is a consequence of low testosterone levels, regardless of whether background etiology installed; TD consequences are global; care must be taken in an attempt to use any uniform threshold levels of testosterone for a decision on the appointment of testosterone therapy; a person does not have any reason to refrain from appointing testosterone therapy only on the basis of age; the existing evidence does not suggest increasing the prostate cancer or cardiovascular disease risk during testosterone therapy; there is evidence conserning the feasibility of a major research initiative to explore possible cardioprotective beneficial effects of testosterone therapy in men with metabolic disorders, including diabetes.

This article is dedicated to the problem of glycaemic durability of drugs used in treatment of type 2 diabetes. The results of studies comparing durability of glycemic control as monotherapy or in combination of metformin with different drugs: dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, sulfonylurea, inhibitors of sodium-glucose cotransporter-2 are shown. The article discusses the results of original research and meta-analysis.

At present, the prevalence of overweight people in the world is more than 1.7 billion; 312 million people are obese. The 25% of them consist of reproductive age women. In the modern world contraception is not only the way to prevent unscheduled pregnancy but also the opportunity to treat endocrine and gynecological diseases. While choosing the method of contraception, it is important to realize it’s pharmacological effect on carbohydrate and lipid metabolism, hemocoagulation/fibrinolysis system, cardiovascular and other systems of body that are involved in cascade of pathological processes. Selection of contraception for overweight/obese patients needs an individualized approaches with evaluation of efficiency/risk for every specific method of fertility correction.

Nowadays cases of severe primary hyperparathyroidism (PHPT) are rare. Doctors of different specialties are informed better about PHPT “masks” and overall PHPT is diagnosed much earlier. We present a case report of a patient with nephrolithiasis and primary hyperparathyroidism with both bone and visceral complications, who showed deterioration of renal function up to chronic kidney disease stage 5 and was referred to renal transplantation.

Objectives: To study the lipid metabolism and secretion of GLP-1 and GIP in obese patients with type 2 diabetes before and 3 months after biliopancreatic diversion (BPD) in Hess-Marceau modification.

Materials and methods: 22 patients (44 [38.0; 55.0] years) with morbid obesity (BMI of 50.1 [41.3; 53.8]) and type 2 diabetes were included in the study. Total cholesterol, LDL-C, HDL-C, TG, GLP-1, GIP were evaluated before and 3 months after BPD.

Results: At 3 months after BPD there were decreases in weight by 15.8% and a reduction in total cholesterol levels and LDL-C, an increase in the number of patients with a target value of total cholesterol and LDL-C (from 4/22 (18%) to 20/22 (91%, p = 0.0001)). TG levels during the first 3 months after BPD did not change, but there was a trend to an increase in the number of patients with TG target levels (from 8/22 (32%) to 15/22 (68%, p = 0.058)). Due to the reduction of total cholesterol intake after malabsorbtive surgery, we saw a regular decrease in HDL-cholesterol. 3 months after BPD there was an increase in basal secretion of GLP-1 and GIP as compared to preoperative levels, and a strong positive association of the basal GIP with the HDL-C (r = 0,8, p = 0.007) and a strong negative association – with the atherogenic index (r = – 0,7, p = 0.009) at 3 weeks after surgery.

Conclusions: The majority of patients with obesity and type 2 diabetes as early as at 3 months after BPD in the modification by Hess-Marceau achieve a significant improvement in the parameters of lipid metabolism; expect positive impact of the GIP on lipid metabolism.

Objectives: The aim of the study was to investigate the genetic predictors of standard low-calorie diet at different polymorphic variations ApoE and LPL genes in obese patients.

Materials and methods: Our study involved 88 obese patients aged 19 to 67 years (27 men and 61 women, mean age 38.40 ± 2.82 years and the average BMI 41.71 ± 1.23). Study of lipid metabolism includes the determination of total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein determined by spectrophotometry and immuno turbidimetry. Analysis of polymorphisms of LPL gene Ser447Ter (c.1595C>G), Cys112Arg (c.388T>C) and Arg158Cys (c.526C>T) of ApoE gene was performed by polymerase chain reaction.

Results: The results show significant differences in the efficacy of diet, depending on the genotype. We found that obese patients have significantly higher carrier genotypes c.388 T/T + c.526 C/C (by 20% reduced total cholesterol, by 19% – triglycerides, by20 % – low density lipoprotein, by 16% – high density lipoprotein, and by 9% – glucose), c.388 T/T + c.526 C/T ApoE gene (by 24% reduced total cholesterol, by 20% – triglycerides, and by 2% increased level of high-density lipoprotein) and C/C LPL gene (by 18% reduced total cholesterol concentration, by 17% – triglycerides, by 16% – high density lipoprotein, by 18% – low density lipoprotein, and by 9% – glucose).

Conclusions: Thus, ApoE and LPL genes alleles can be used as biomarkers of prognosis of efficiency of a standard low-calorie diet therapy in obese patients.

Objectives: To assess serum levels of endothelial monocyte activating polypeptide-II (EMAP-II) in patients with arterial hypertension with and without type 2 diabetes mellitus and obesity.

Materials and methods: We examined 41 hypertensive patients with type 2 diabetes, 18 obese hypertensive patients without diabetes, 9 non-obese hypertensive patients without diabetes, and 18 healthy control subjects.

Results: We found an increased serum level of EMAP-II in hypertensive patients with type 2 diabetes compared to controls (4.86±2.3 and 1.08±0.53 ng/ml respectively, р<0.01), in hypertensive patients with obesity (2.92±1.42 ng/ml) compared to controls, and in non-obese hypertensive patients (2.02±0.33 ng/ml) compared to controls. Also, the levels of EMAP-II significantly correlated with HbA1c, blood glucose, serum insulin levels, HOMA, lipids, and body mass index (р<0.01).

Conclusions: The revealed changes could reflect an endothelial dysfunction mostly pronounced in patients with arterial hypertension, type 2 diabetes mellitus and obesity. Hyperglycemia, dyslipidemia, insulin resistance, obesity appear to be significant contributing factors leading to the elevation of EMAP-II.

Objectives: To investigate the role of IGF-1 in the development of cardiac remodeling in patients with overweight and mild obesity.

Materials and Methods: The study included 75 men (mean age 55.3 ± 6.3 years), which are overweight or have mild obesity (body mass index (BMI) 28.6 ± 3.6) without diabetes. Group 1 included 46 patients with normal weight and overweight (BMI 26.5 ± 3.6). Group 2 included 27 patients with obesity (mean BMI 32.4 ± 3.5). Coronary artery disease was confirmed by treadmill test and coronarography. All participants were evaluated by impaired glucose tolerance test (IGT), cholesterol, triglycerides (TG), IGF-1 and LPHD, and LPLD levels, geometry of the heart chambers by echocardiography.

Results: Patients in both groups did not differ by age, blood pressure, percent of CAD and impaired glucose tolerance. IGF-1 levels were not significantly different among the study groups (210.1 and 216.6 ng/ml, p>0.05). High circulating IGF-1 levels were frequently observed in Group 2 (in 50% and 25% patients, respectively; р=0.039). The concentric remodeling for patients with normal IGF-1 seen in 38% of patients compared to 52% in patients with high level of IGF-1. The eccentric hypertrophy for patients with normal IGF-1 was not observed compared to 16% in patients with high level of IGF-1. The concentric hypertrophy for patients with normal IGF-1 was 30.7% compared to 4% in patients with high level of IGF-1.

Conclusions: IGF-1 has a significant effect on cardiac remodeling in patients with coronary artery disease and obesity. IGF-1 may be an important marker of prognosis of chronic heart failure in patients with obesity and an indicator of hypertension and associated cardiac remodeling.

Objectives: To assess the risk of pregnancy and fetal pathology in patients with prolactin-secreting tumors treated with cabergoline in the early stages of gestation.

Materials and methods: The study included 24 patients in the age from 24 to 38 years old with prolactin-secreting tumors, become pregnant during therapy with cabergoline (Dostinex). A retrospective analysis of the course and outcomes of 33 pregnancies based on available medical records and questioning of the patients data.

Results: Of the 33 pregnancies resulted in births 26 (78.8%), registered a spontaneous miscarriage at 7 weeks period (3%), six women required medical abortions due to the undeveloping pregnancy for a period of 4 to 7 weeks (18.2%). In 6% of cases (two pregnant) gestational diabetes mellitus (GDM) has been diagnosed. The average gestational age was 39.8 weeks (36–41 weeks). Preterm delivery occurred in 4 women, accounting for 15.3%. In 6% of cases (two pregnant) gestational diabetes mellitus (GDM) has been diagnosed. In total 27 children were born (in 1 case - twins), 26 (96.3%) of which at the time of birth – are healthy. The vast majority of pregnancies ended with the birth of a healthy child growth and development that did not differ from those of their peers in the general population, which corresponds to the data released by the majority of foreign researchers.

Conclusions: The study confirms the absence of direct adverse effects of cabergoline (Dostinex) on the course and outcome of pregnancies in women receiving the drug at therapeutic doses before pregnancy and during the first 8 weeks of gestation.