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The prevalence of diabetic retinopathy among people with pre-diabetes and newly diagnosed type 2 diabetes.
Three hours later after two-fold injections of 3H-T LNI dynamics in all areas LN decreased, though in varying degrees: in the germinal center — 1.25; follicularr — to 2.9; parafollicular areas — 2.0 times on average compared with the previous term experience. Only in the dome LN, it increases 1.3 times. After 24 hours, after a two-fold administration of 3H-T the LNI of lymphoid cells in the germinal centers, follicular area and a small dome, located at the level of such after one-fold injection marks. Only in parafollicular zone LNI almost 4 times higher than after a single injection of 3H-T.
Thus, based on the analysis LNI after two-fold injections 3H-T should be noted it is also non-uniform growth and decrease in various structural-functional zones of LN of Payer's patch. On the one part, it reflects the constant and irregular migration of T- and B-lymphoid cells from blood into the area. On the other hand, het-erochronous changes of LNI in T- and B-dependent and mixed areas of lymphoid nodules should be considered as a measure of the optimum adaptation of the small intestine by reacting MMIS afferent and efferent units, peripheral and central parts of the immune system in the regulation of immune homeostasis.
References:
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Ismailov Saydiganikhoja Ibragimavich, Republican Specialized Scientific and Practical Medical Centre of Endocrinology, Director, Professor, Doctor of Medical Sciences
E-mail: ismailov.said@list.ru Akbarov Zairkhoja Sabirovich, Republican Specialized Scientific and Practical Medical Centre of Endocrinology, Professor, Doctor of Medical Sciences
Yusupova Madina bonu, Republican Specialized Scientific and Practical Medical Center of Endocrinology, Research Assistant, ophthalmologist, the department of diabetology E-mail: madina.yusupova81@mail.ru
The prevalence of diabetic retinopathy among people with pre-diabetes and newly diagnosed type 2 diabetes in Tashkent city and Tashkent region
Abstract: The article contains information about the prevalence of diabetic retinopathy in people with pre-diabetes in Tashkent city and Tashkent region of Uzbekistan. In patients with diabetic retinopathy (DR) detected was found in 14.3 % of cases. The defeat of the retina is observed before manifestation of diabetes in some surveyed patients with violation glucose metabolism (VGM).
Keywords: Diabetes mellitus, Diabetic retinopathy, Uzbek Republic, Tashkent, prevalence.
Diabetic retinopathy (DR) has been and remains the most According to the data of regional endocrinology dispensaries
serious complication of diabetes mellitus, occupying one of of the Republic of Uzbekistan in 2014 over 68,158 patients with the first places among the causes of blindness in people of diabetic retinopathy have been registered and 847 patients are suf-working age [2; 7]. fering ofblindness due to diabetes complications. Prevalence of DR
Section 6. Medical science
among the patients with diabetic mellitus (DM) consists 47.2 % and 0.6 % blindness.
These data do not show the real picture of the DR prevalence in Uzbekistan. In other countries indicates that the real number of patients with type 2 diabetes in several times (3-5 times) higher than reported. It is important to note that at the time of the manifestation of type 2 diabetes in 16-37 % of patients has a DR at various stages of development [2; 3; 4; 5].
The only real way to early detection of DR is a widespread population screening tests. Implementation of the DR screening according to the St Vincent Declaration Protocol allows saving vision of approximately 60 % of patients within 10 years [6].
All of the above indicate the need for early detection of DR in patients with type 2 diabetes to assign an adequate therapy to prevent serious and not reversible complications.
The main objective
The study of the prevalence of DR in Tashkent and Tashkent region among people with impaired fasting glycaemia (IFG), impaired glucose tolerance (IGT) and patients with newly diagnosed type 2 diabetes (NDD2).
Materials and methods
Examination of involved healthy population (n = 1014) to identify a violation glucose metabolism (VGM) in Tashkent city and Tashkent region within the state grant project "The ADSS 15.12.2." in 2015. There were identified 217 people with VGM. The screening has been conducted on DR among people with a diagnosis of exposed (according to WHO classification proposed in 1999). IFG (n = 26), IGT (n = 95) and NDD2 (n = 96) [1].
Fundus examination was conducted by dilated pupil by direct ophthalmoscopy (Heine mini 3000) using the drug "Midoptik". Identified changes were classified, according to ophthalmic criteria proposed by E. Kohner and M. Porta in 1998, into the following diagnoses:
• nonproliferative diabetic retinopathy (NPDR);
• preproliferative diabetic retinopathy (PPDR);
• proliferative diabetic retinopathy (PDR).
Results and discussion
According to the results of the study among persons with VGM (n = 217) in the group of patients with IFG the retinopathy was not detected. DR frequency among persons with IGT was 13.7 % (n = 13) and only NPDR. As well as patients with type 2 NDD2, DR — 18.8 % (n = 18). Among people with NDD2 the NPDR accounted for 11.5 % (n = 11), PPDR — 5.2 % (n = 5), the PRD — 2.1 % (n=2).
Comparison of the screening data of DR in 2008 and 2015 of introduced the following: IGT (2008, DR - 9.6 %; 2015, DR - 13.7 %) and NDD2 (2008, DR - 15.1 %; 2015, DR - 18.8 %). So, the quantity of people with DR has increased respectively by 4.1 % and 3.7 % [5].
Of the total number of ophthalmic examined people (n = 217), DR is set at 14.3 % (n = 31): NPDR — 11 % (n = 24) PPDR — 2.3 % (n = 5), the PRD — 1 % (n = 2).
Gender a difference in the frequency of DR patients that we surveyed is not revealed as indicated in Akbarov Z. S., at all. [1]. It was identified direct dependence of the DR frequency on age of the patients. In subjects with IGT in the age group of49-55 years old DR frequency was 40 %, while in the group of 56 years and elder—60 %, of patients with NDD2 the DR frequency was respectively 50 % and 50 %.
Fig. 1. VGM — a violation glucose metabolism; IFG — impaired fasting glycaemia; IGT — impaired glucose tolerance; NDD2 — newly diagnosed type 2 diabetes; DR — diabetic retinopathy; NPDR — nonproliferative diabetic retinopathy; PPDR — preproliferative diabetic retinopathy; PDR — proliferative diabetic retinopathy
Features of clinical picture of cystic dilatations of the biliary ducts in children
Study Design
It should be noted that the persons with DR among VVSD2 already suffer ofdecompensated stage oftype 2 diabetes. Fasting glycae-mia 11.5 ± 2.4 mmol/l, postprandial glycaemia — 15.7 ± 5.2 mmol/l, the average level of glycated hemoglobin (HbA1c) is 9.4 ± 2.5 %.
Among the people with IGT the DR average indicators were as follows: fasting glycaemia 4.36 ± 0.55 mmol/l, blood glucose after glucose load 75 g. — 9.5 ± 0.4 mmol/l, the average level of HbA1c — 5.3 ± 0.8 %.
The DR prevalence study depending on the compensation of carbohydrate metabolism is of high interest. In more than 7.5 % patients with HbA1c, regardless of gender, the number of recorded cases of DR is 2 times higher than that of the patients with less than 7.4 % HbA1c. These data confirm once again the need for close
collaboration between ophthalmologists and endocrinologists in detection and monitoring of these patients.
Conclusions:
1. In patients with DR detected was found in 14.3 % of cases. In patients with IFG DR has not been revealed. In IGT and NDD2 DR detected accordingly in 13.7 % and 18.8 % of cases. The defeat of the retina is observed before manifestation of diabetes in some surveyed patients with VGM.
2. The patients with HbA1c more than 7.5 %, irrespective of gender, the number registered cases of DR is 2 times higher than patients with less than 7.4 % HbA1c.
3. Persons with VVSD2 complicated with DR were all decompensated.
References:
1. Akbarov Z. S., Alieva A. V. Screening for diabetes and intermediate hyperglycaemia in Tashkent//Journal of Theoretical and Clinical Medicine. - 2016. - № 1. - P. 50-56.
2. Galstyan G. R., Udovichenko O. V., Tokmakova A. Y., Antsiferov M. B. Diabetic neuropathy: epidemiological and clinical aspects//Dia-betes XXI century. - 2000. - № 1. - P. 19-21.
3. Ismailov S. I., Berdykulova D. M., Khaydarov F. A. Rasprostranennost late complications of diabetes mellitus in the regions of the Republic of Uzbekistan//International Endocrinology Journal. - Tashkent, Republic of Uzbekistan, 2010. - № 1(25).
4. Ismailov S. I., Berdykulova D. M. Late complications of diabetes mellitus in persons living in the Tashkent region of Uzbekistan/International Journal of Endocrinology. - Tashkent, Republic of Uzbekistan, 2012. - № 8(48).
5. Kayumova D. T. Abstract "Vascular lesions in patients with intermediate hyperglycaemia and newly diagnosed diabetic patients". -Tashkent, 2008.
6. Hall Michael and Felton Anne-Marie. The St Vincent Declaration 20 years on - defeating diabetes in the XXI century// Diabetes Voice. - June 2009. - Vol. 54, Iss. 2. - P. 42-44.
7. Kohner E. M. The evolution and natural history of diabetic retinopathy//Int. Ophthalmol. Clin. - 1978. - Vol. 18. - P. 1-16.
Yakubov Erkin Amongeldievich, Ergashev Nasriddin Shamsiddinovich, Tashkent Pediatric Medical Institute, Republic of Uzbekistan E-mail: yakubov. e.a.1972@mail.ru
Features of clinical picture of cystic dilatations of the biliary ducts in children
Abstract: This work presents characteristic clinical signs of the cystic dilatations of the extrahepatic biliary ducts in 76 children of the age from neonatal period to 16 years, receiving treatment in the clinic in 1979-2016. There were determined frequency, special features of some clinical signs, character of their association and occurrence of various complications. The features of current of separate clinical attributes, character of their combination and occurrence of various complications are determined frequency.
Keywords: cysts of biliary ducts, clinical picture, complication, children.
Until recently time the cystic dilatations of the extrahepatic biliary ducts have been considered as relatively rare pathology among the congenital anomalies of the development of the organs of hepatobiliary zone. The number of publications based on the analysis of the large clinical material has been significantly increased [3; 4]. However, in the literature the features of clinical expressions of cystic dilatations ofthe extrahepatic biliary ducts are insufficiently elucidated (CDEHBD).
The classic triad consists ofjaundice, pain syndrome and palpated tumor in the abdominal cavity [1]. As a rule, the clinic of cystic transformation can be limited by one or two symptoms from this triad [2]. At occurrence of complications the clinical manifestations of illness essentially vary. Quite often the choledochal cysts may be in general not shown in any way for years and are diagnosed as a
casual find or are not distinguished not only at clinical examination, but even during surgical intervention.
The purpose of research was to analyze features of clinical manifestations of cystic dilatations of the extrahepatic biliary ducts in children on the basis on the basis of the own clinical material.
Materials and methods of research
In the clinical bases of the faculty of hospital children's surgery, children's oncology of the Tashkent Pediatric Medical Institute in 1979-2016 there were studied and treated 76 patients (60 girls and 16 boys) ofthe age from the neonatal period to 16 years with cystic dilatations of the extrahepatic biliary ducts.
The distribution of the patients by a type of cystic dilatation was performed according to classification of Alonso-Lej F. with
