[Features of the course of COVID-19 in patients with type 2 diabetes mellitus]

AIM

To identify the features of the course of COVID-19 in patients with type 2 diabetes mellitus (T2DM), depending on the intake of hypoglycemic therapy at the prehospital stage, in conjunction with the functional state of the kidneys.

MATERIALS AND METHODS

A retrospective analysis of 291 case histories of patients with COVID-19 and T2DM hospitalized in the infection department of Semashko Regional Clinical Hospital from January to December 2021, including the main clinical and laboratory parameters. Results. Among hospitalized patients with COVID-19, patients with T2DM had a higher mortality rate. An analysis of the case histories of deceased patients with COVID-19 and T2DM showed that at admission, body mass index (BMI), C-reactive protein, and creatinine were higher than those of survivors and amounted to BMI - 33 [30; 39] and 33 [28; 36] kg/m3; p=0.039, C-reactive protein - 77 [47.5; 106.0] and 57 [27.0; 89.0] mg/l; p=0.015, in terms of creatinine level - 89 [70.0; 144.0] and 82 [66.0; 101.0] µmol/l; p=0.039, respectively. It was found that in the second week of hospitalization in the group of deceased patients with COVID-19 and T2DM, the creatinine level was statistically significantly higher than in surviving patients and amounted to 94.5 [71.5; 141.0] and 72.5 [57.0; 88.0] µmol/L; p<0.001, respectively. The probability of death in hospitalized patients with type 2 COVID-19 and T2DM depended on BMI and creatinine levels at the second week of hospitalization. Patients with prehospital correction of hyperglycemia dipeptidyl peptidase-4 inhibitors (iDPP-4)/ glucagon-like peptide-1 receptor agonists (agGLP-1)/ sodium-glucose co-transporter 2 inhibitors (iSGLT-2) had significantly lower creatinine levels at week 2 of hospitalization.

CONCLUSION

In patients with moderate to severe COVID-19 with concomitant T2DM, special attention should be paid to the combination of high BMI and creatinine in the second week of hospitalization, which is a prognostically unfavorable predictor of death in such patients.

[The dynamics of erythrocyte metabolism in severe forms of meningococcal infection and suppurative meningitis in children]

In 63 children with severe meningococcal infection (MI) and meningitides of another origin red cell metabolism was studied: levels of ATP, ADP, AMP, ATP/ADP, ATP/AMP, energetic charge, 2,3-DPG, FAD, piruvate, lactate, activity of lactate dehydrogenase, piruvate kinase, glucose-6-phosphate dehydrogenase, glutatione reductase, Mg2+, Na+, K(+)-dependent ATPase. All the disease periods were characterized by combined pathobiochemical shifts of different degree typical for varying metabolic systems and correlating with the infection severity. The discussion covers pathogenetic and clinical significance of red cell metabolism shifts in patients with MI and purulent meningitides.

[Erythrocyte metabolism in meningococcal infection and purulent meningitis]

The red blood cell metabolic parameters ATP, ADP, sigma AN, ATP/ADP, ATP/ATP, energy charge, PAD, 2,3-DPH, Pn were studied in 106 patients with generalized meningococcus infection (GMI) and meningitis of other etiology over their natural history. There was a typical adaptative red blood cell response that featured glycolytic stimulation on hypoxia that ran with impaired red blood cell energy metabolism (RBCEM), negative energy balance. It was the most pronounced at the peak of disease. RBCEM changes occurred in the presence of antioxidative disorders of red blood cells as lowered PAD levels. When early complications, such as shock, brain edema, death developed, there was a high incidence of signs of erythrocytic biochemical disadaptation. The RBCEM changes were associated with the magnitude of cytolysis, i.e. serum AST and AST/ALT levels. The significance of the metabolic changes found in the red blood cells in the pathogenesis and clinical picture of GMI and purulent meningitis is discussed in the paper.

[Effect of intravascular laser irradiation of the blood on blood cells in pancreatitis]

Inpatient examinations included 17 patients with necrosis of the pancreas (4 patients had hemorrhagic and 14 fat necrosis): synthetic lymphocyte activity was studied by the luminescent method and the erythrocyte content of adenyl nucleotides by thin-layer chromatography in the toxic phase of pancreatitis. Synthetic lymphocyte activity was found to be decreased and the ATP pool of erythrocytes exhausted in the toxic phase of pancreatitis. Intravascular laser irradiation of the blood caused recovery of lymphocyte activity and increase in the ATP content in erythrocytes.

[Radiation-induced meningiomas of the brain]

From the observation over 62 patients with meningioma of the brain a connection was detected between previous X-ray irradiation of the skin on the head and the occurrence of the meningioma. Predominance of parasagittal localization of the tumors was revealed which, evidently, was associated with the peculiarities of the method of X-ray therapy applied and with the possibility of the growth of the meningiomas from arachnoid-endothelial aggregations in the dura mater. Multiple meningiomas were encountered in 23% of the patients. The cases are described.

[Hemodynamics of the fundus oculi and brain of patients with parasagittal meningiomas]

The retinal blood flow was studied by fluorescent angiography of the fundus oculi in 22 patients with parasagittal meningiomas before and after surgery. A total of 82 fluorescence-angiographic examinations were performed and disorders of retinal hemodynamics were found irrespective of the presence or absence of intracranial hypertension. Prolongation of the venous phase of retinal circulation alone without signs of intracranial hypertension is an early symptom of impaired venous flow from the cranial cavity and deficient development of pathways compensating for venous drainage. The arterial phase is prolonged at a later stage of the tumorous process, when the cerebral blood flow is much slower. Marked disorders of retinal venous blood flow are still found one month after removal of parasagittal meningiomas. It is shown that the flow of venous blood from the cranial cavity is mainly impaired in patients with parasagittal meningiomas.

[Complex study of the hemodynamics, impedance, and bioelectrical activity of the brain of patients with parasagittal meningiomas]

Combined use of radioisotope and impedance methods in the examination of cerebral and peripheral circulation and EEG recording in 40 patients with parasagittal meningiomas revealed a correlation between the rheographic characteristics of the tonus and blood filling of the cerebral vessels and the quantitative values of cerebral hemodynamics. Specific features of cerebral circulatory disorders characteristic of parasagittal tumors were revealed before operation and in the postoperative period. The prognostic significance of examination of the cerebral blood flow and impedance in the early postoperative period is demonstrated.