Introductions: Relevance of the study is due to the unrecognized effect of carbohydrate metabolism disorders on bone tissue metabolism in patients with acute otitis media (AOM). Aim: to determine the peculiarities of bone tissue metabolism in patients with AOM caused by disorders of carbohydrate metabolism. Materials and methods: Our study included 73 patients aged 18 to 79 (29 males and 44 females) who were randomized into 4 groups according to the aim of the research: Group 1 – 17 patients with AOM, Group 2 – 15 patients with AOM combined with paranasal sinus pathology, Group 3 – 20 patients with AOM on the background of type 2 diabetes mellitus, Group 4 – 21 patients with AOM combined with transitory disorders of glucose metabolism. On the basis of clinical examination all patients were tested for glycosylated hemoglobin (HbAlc), blood calcium level and parathormone as a marker of bone resorption and osteocalcin as a marker of bone remodeling. Results of the study and discussion: The statistical evaluation of the indicators identified a reliable difference between groups 1-2 and groups 3-4, while between groups 1 and 2, 3 and 4 reliable difference in metabolic parameters of bone tissue has not been established. The level of glucosylated hemoglobin was significantly elevated even for transitory signs of carbohydrate metabolism disorders (5,17±0,17%, 4,95±0,17%, 9,8±0,46% and 7,78±0,19% in groups 1,2, 3 and 4 respectively).The value of parathormone was within the reference values, but it proved to be significantly (p˂0,001) higher in glucose metabolism disorders (56.8±3.02pg/ml and 52.56±2.7pg/ml in groups 3 and 4, respectively).The amount of osteocalcin and calcium tended to decrease in type 2 diabetes mellitus (group 3) and in transitory disorders (group 4), but without a significant difference (p˃0.05). Correlation analysis revealed a strong correlation between glucose and glucosylated hemoglobin levels in patients in group 3 and the average strength in patients in group 4 (r=0.832 and r=0.44, respectively). The increase of parathormone level on the basis of carbohydrate metabolism disorders was due to the presence of correlation with the level of glucosylated haemoglobin in groups 3 and 4 (r=0.705 and r=0.81 respectively). Calcium correlations of r=-0.77 and r=-0.56 with parathormone level and r=-0.79 and r=-0.44 with glucosylated haemoglobin level were found in patients of groups 3 and 4 accordingly. In the absence of glucose metabolism disorders in groups 1 and 2, no significant correlations were found, except for physiologically determined correlations of parathormone and calcium levels in group 1 (r=-0.489). Conclusions: Disorders of carbohydrate metabolism negatively affect metabolism of bone tissue due to activation of bone resorption processes. This is manifested by correlated with the level of glycosylated hemoglobin by an increase in the amount of parathormone with pathogenetic significance of both type 2 diabetes mellitus and transitory disorders of carbohydrate metabolism.In this category of patients, the level of parathormone and its dynamics, as well as the determination of glucosylated hemoglobin are informative even in transitory disorders of carbohydrate metabolism.

Introductions: Comorbidity is a current world problem, which has various aspects from the simple combination of etiopathogenetic diseases in one patient to syntropy. This involves the formation and presence of complications that are not usual for the main disease. The influence of comorbidity is particularly increasing with age and also due to the presence of concomitant diabetes and (or) metabolic syndrome. These data and our previous studies (determining the effect of hyperglycemia on the formation of a complicated course of acute otitis media) make the study relevant. Aim: to create a typical "clinical portrait" of a patient with type 2 diabetes on the basis of clinical and laboratory indices, taking into account pathogenetic links of bone resorption. Materials and methods: The study included 45 patients aged 38 to 75 years with type 2 diabetes without acute middle otitis media who underwent examination and treatment at the "V.Y. Danilevsky Institute of Endocrine Pathology Problems" during the period from 2019 to 2021. Patients were included in the study according to the randomized simple sampling method in the order of admission to the hospital and were divided into groups for further analysis according to the level of glucosylated hemoglobin (HbA1c): 1st group – 15 patients with HbA1c up to 7%; 2nd – 21 patients with HbA1c levels of 7-10%; 3rd – 9 patients with HbA1c levels higher than 10%. The examined patients were subjected to clinical examinations of blood, urine, blood glucose level with determination of the average glucemia and its fluctuations, level of glucosylated hemoglobin (HbA1c), total and ionized calcium in the blood, lipidogram, the level of interleukin 6 (IL-6) and tumor necrosis factor (TNF-α), the level of parathormone in the blood. Results: According to the received data, the general portrait of a patient with type 2 CD is as follows: a patient of a certain age group (over 50 years old) with increased body weight (BMI for the whole group was 31.07±0.84 kg/m2 with fluctuations from 22 to 44 kg/m2), with comorbid pathology (the most frequent were metabolism encephalopathy with liquor-venous distension (95.5%), hypertonic disease and polyneuropathy (91.1%), retinopathy (86.7%) and cardiopathy (60%), thyroid pathology and fatty hepatosis (55.6% and 57.8% respectively), obesity and cardiosclerosis (46.7% and 44.4% respectively), and the presence of a diabetes in the family history (62.2%). Laboratory indicators show an increase in blood glucose level (8.15±0.29 mmol/l), glucosyl haemoglobin (8.8±0.29%), significant changes in lipid profile of the blood (an increase in the level of total cholesterol, Atherogenicity coefficient, low lipoproteins, decrease of high lipoproteins), increased levels of proinflamation cytokines (IL-6 and FNP-α) and negative correlation of parathormone and calcium in blood. Conclusions: According to the results of the investigation, we found that the changes in the clinical portrait of patients with type 2 CD indicate the presence of subclinical poliorgan inflammation in each patient. Specified features of homeostasis under certain conditions are also able to cause a latent inflammatory process anywhere, including in the mastoid process during a certain period of time before the occurrence of clinical signs. Taking this into account, further search of general criteria and significance of their combination for diagnostics and treatment of patients with acute otitis media with type 2 diabetes mellitus and metabolic syndrome is relevant.

The article presents the features of the clinical course of tonsillitis caused by hemolytic streptococcus in children infected with human herpes simplex virus type 6 (HHV 6). It was revealed that tonsillitis in children with background infection with HHV 6 is characterized by a prolonged course, prolonged maintenance of fever, impaired general condition, the presence of signs of hepatomegaly and regional lymphadenitis, and as a result, a longer stay of such patients in the hospital. The characteristic clinical and laboratory features of tonsillitis in children infected with HHV 6 include the presence in the debut of the disease subfebrile body temperature, regional lymphadenopathy, hepatomegaly, thrombocytopenia, signs of a parenchymal reaction of the liver and mesadenitis. Latent HHV 6 infection in children affects the frequency of registration and the duration of certain symptoms of tonsillitis.

The relevance of the study is due to the lack of data to determine the pathogenetic significance of cytokine profile specifics and correlation pleiades in patients with acute otitis media (AOM) on the background of disorders of glucose metabolism and dyslipidemia manifestations. The aim of our research: to determine the peculiarities of cytokine profile of peripheral blood in the amount of IL-4, IL-6 and TNF-α and to investigate the correlation pleiades in patients with AOM on the basis of glucose metabolism disorders with regard to the processes of glucose formation, dyslipidemia, and bone tissue metabolism. Materials and methods: We examined 73 patients with AOM aged 18 to 79 (29 males and 44 females), who were randomized into 4 groups.1 and 2 groups (comparison) (17 patients with acute AOM and 15 patients with AOM with paranasal sinus pathology in groups accordingly) and groups 3 and 4 (main groups) (20 patients with AOM with type 2 diabetes and 21 patients with AOM with glucose metabolism disorders accordingly). Apart from the clinical examination, all patients were tested for glucosylated hemoglobin (HbAlc), IL-4, IL-6, TNF-α and low-density lipoproteins (LDL). The pathogenetic significance of the observed changes was assessed by determining the correlations of the indices given, taking into account the previously established metabolism of bone tissue in the amount of parathormone, osteocalcin, and calcium. Results of the study and discussion: In patients with acute otitis media with impaired glucose metabolism there was a significant (p˂0.001) increase in the pool of proinflammatory cytokines IL-6 (10.26±0.46 pkg/ml and 10.94±0.5 pkg/ml in groups 3 and 4 accordingly) and TNF-α (11.05±0.5 pkg/ml and 9.7±0.5 pkg/ml accordingly in groups 3 and 4).The increase in the level of TNF-α was 1.9 times greater in patients with type 2 diabetes and 1.7 times greater in patients with transient disorders of glucose metabolism, in relat ion to the increase in the amount of IL-6 (1.1 to 1.3 times in groups 3 and 4, respectively).The amount of antiinflammatory cytokine IL-4 was within the reference norms for the methodology used, but was consistent ly lower in patients with glucose metabolism disorders (7.27±0.2 pkg/ml and 7.79±0.2 pkg/ml in groups 3 and 4 respectively, p˂0,001).We also found a significant (p˂0,001) increase in low density lipoproteins as a manifestation of dyslipidemia in patients with AOM against the background of impaired glucose metabolism 1.8 times in group 3 patients (4,6±0,25 mmol/l) and 1.7 times in group 4 patients (4,27±0,2 mmol/l). Influence of carbohydrate metabolism disorders on formation of cytokine profile and significance of dyslipidemia in pathogenesis of AOM is confirmed by the determined authenticity of variations in glucose content, HbAlc and these indices in patients in the main groups (groups 3 and 4) and the comparison groups (groups 1 and 2) due to the absence of differences in the data between groups 1 and 2 and 3 and 4 (p˃0,05). The study of the correlat ion pleiades of the indices with the markers of bone tissue metabolism revealed the inimitability of their presence, number and strength in patients in groups 1-2 due to the lack of correlation with indicators of glucose and HbAlc, IL-6, LDL and parathormone, which may indicate that in these patients only the mucous membrane of the middle ear is involved in the process. In patients with AOM with type 2 diabetes mellitus, multiple interactions of moderate strength, both direct (glucose – TNF-α, IL-6; HbAlc – LDL, TNF-α, IL-6; parathormone – IL-6, LDL; LDL – TNF-α) and inverse (calcium – TNF-α, LDL; IL-6 – calcium, IL-4), with the effect on bone tissue metabolism were found. In patients of group 4, the presence and strength of the interrelationships were similar to the above on the background of type 2 diabetes with a decrease in their number and a strong direct correlation of HbAlc – parathormone, IL-6; parathormone – IL-6, LDL; LDL – IL-6. Conclusions: Blood cytokine profile in patients with acute otitis media with impaired glucose metabolism is characterized by a significant increase in the pool of proinflammatory cytokines ІL-6 and TNF-α, a decrease in the level of anti-inflammatory cytokine ІL-4 in dyslipidemia by indicators of a significant increase in LDL. Multiple interrelationships of the studied indicators in patients with AOM on the background of type 2 diabetes characterize the complex proinflammatory background with an impact on the indicators of bone tissue metabolism. Similar interrelations on the background of transient disorders of glucose metabolism indicate their importance in the pathogenesis of a particular AOM, which is also confirmed by the validity of differences in the indicators and observed correlations in patients of groups 1-2 and 3-4. Taking into account the presence and peculiarities of the influence of any disorders of carbohydrate metabolism, including transient ones, is valuable for increasing the efficiency of diagnosis and treatment of AOM in adults.

Relevance. Relevance of the research is caused by the clinical necessity to increase efficiency of diagnostics and treatment of acute otitis media (AOM) from the modern positions personalized medicine and the feasibility of statistical verification of the validity of the hypothesis about the influence of glucose metabolism disorders on the formation of clinical and pathogenetic features of acute otitis media in adults. Objective. To carry out statistical verification of the hypothesis about the influence of carbohydrate metabolism disorders on the complicated course of AOM on the basis of cluster analysis and to determine its informativity. Materials and methods. The cluster analysis included 73 with AOM. The 1 group (n=17) - patients with AOM; 2 group (n=15) - patients with AOM with presence of the sinus pathology; 3 group (n=20) - patients with AOM due to type 2 diabetes mellitus (DM2); 4 group (n=21) - patients with AOM due to transient glucose metabolism disorders. Apart from the clinical examination, all patients were tested for HbAlc, parathormone, osteocalcin, total calcium, IL-4, IL-6, FNP-α, and low-density lipoproteins (LDL). Cluster analysis on the basis of laboratory indicators was performed by the hierarchical method using the iterative algorithm of k-means and prior standardization of the data. Result. The hypothesis was tested at the level of stratification of patients into 4 and 2 clusters. In the first case, 28.8 %, 31.5 %, 15.6 %, and 24.6 % of the total number of patients were included in clusters I, II, III, and IV. Patients with AOM due to impaired glucose metabolism were predominantly in clusters I and II, comprising 51.2 % and 69.5 % of the cluster contingent respectively, while DM2 prevailed in cluster I and transient glucose metabolism disorders in cluster II (61.9 % and 62.5 % accordingly), 72.7 % and 94.4 % of patients with AOM without impaired glucose metabolism were stratified in clusters III and IV. The analysis of laboratory indicators using the k-means algorithm showed a general tendency for the increase in glucose, HbAlc, parathormone, TNF-α and LDL in patients with AOM in clusters I and II with increased levels of osteocalcin, calcium and IL-4 in patients in clusters III and IV with the presence of a significant difference (p˂0.05). At the level of patients' grouping into two clusters, cluster I included 41.9 % of the total number of patients due to the presence of all glucose metabolism disorders (of these, DM2 occurred in 57.6 % and transient glucose metabolism disorders in 43.3 %). The II cluster (58.9 % of patients) included all patients with AOM without impaired glucose metabolism, accounting for 74.4 % of its structure, and 25.6 % of patients with impaired glucose metabolism (6.97 % for DM2 and 18.6 % for transient impairments). The k-means algorithm revealed a clear and reliable distribution of clusters for all 9 studied indicators, which resulted in an increase in glucose content, HbAlc, levels of parathormone, IL-6, TNF-α and LDL and decreased osteocalcin, calcium and IL-4 in I cluster compared to II. Differences in the indicators at the group-group levels, group-cluster and cluster-cluster revealed a sufficient difference in the first and third cases (with the exception of osteocalcin) and their absence at the group-cluster level (with the exception of parathormone for cluster I, p˂0.01 and glucose and HbAlc for cluster II, p˂0.05). Conclusion. The cluster analysis was informative and confirmed the hypothesis about the influence of glucose metabolism disorders on peculiarities of AOM pathogenesis in adults according to laboratory indices. The principal importance of the presence or absence of impaired glucose metabolism in patients with AOM is confirmed by stratification of patients into two clusters. Thus, all patients without glucose metabolism disorders were included in one (II) cluster. The contingent of patients with impaired glucose metabolism was not homogeneous, with cluster I comprising only patients with impaired glucose metabolism, but 15 % of patients with DM2 and 38.1 % of patients with transient disorders were in cluster II. Therefore, to improve the quality of diagnostics of complicated course of acute otitis media on the basis of glucose metabolism disorders it is necessary to supplement the laboratory indicators with informative clinical criteria. Parathormone level, as well as the combination of IL-6, TNF-α and LDL levels can be used as a marker of impaired glucose metabolism.