Background: The presence of even subclinical forms of heart failure in type 2 DM is associated with a negative prognosis of the disease, leading to a significant increase in the frequency of hospitalizations and mortality. Aims: Identification of left ventricle subclinical dysfunction in terms of its diastolic function, deformation parameters and rotational properties of the myocardium in patients with type 2 diabetes. Materials and methods: A prospective case-control single-center study, performed simultaneously in groups of patients with type 2 diabetes and hypertension. To identify left ventricular dysfunction (LV), an echocardiographic study was performed, including tissue dopplerography and Speckle Tracking Echocardiography. Results: We examined three groups of patients comparable in age and sex distribution, with no obvious clinical signs of heart failure. Group I comprised 56 patients with type 2 diabetes and moderate hypertension. Group II included 52 patients with type 2 diabetes without an increase of blood pressure. Group III (54 people) consisted of patients with hypertension without diabetes. The use of tissue dopplerography and Speckle Tracking Echocardiography allows more often (p˂0.05) to detect signs of LV dysfunction in patients with type 2 diabetes compared with routine echocardiography methods. In patients with a combination of type 2 diabetes and hypertension, an unfavorable restrictive variant of diastolic dysfunction is more common (p˂0.05) in contrast to patients with diabetes without hypertension or those with hypertension without diabetes. The combination of type 2 diabetes and hypertension to a greater extent leads to an increase in the longitudinal global deformation of the left ventricle compared with patients who had only one of these diseases (p˂0.05). A decrease in the Global area strain was expressed (p˂0.05) in patients with type 2 diabetes, regardless of the presence of concomitant hypertension. Conclusions: This study shows the importance of using tissue dopplerography and Speckle Tracking Echocardiography in the diagnosis of subclinical heart failure. The results indicate a high prevalence of subclinical systolic-diastolic LV dysfunction in type 2 diabetes, which is aggravated in the presence of concomitant hypertension in patients without obvious clinical signs of heart failure and other cardiovascular diseases.

Aim — the development of method for early diagnosis of microangiopathy in patients with type 1 diabetes mellitus (DM) by capillaroscopy with functional tests: the cuff occlusion of the upper extremity, tests with the cooling and heat exposures on the upper extremity.Material and methods. We investigated 54 patients with DM type I (mean age 24,1±3.2 years), who were divided into 2 groups: I group — 28 (51.6%) patients with duration DM <5 years; group II — 26 (48.4%) with duration DM >7 years. All the patients were underwent complex laboratory and instrumental examinations and also capillaroscopy and functional tests. Control group was consisting of 26 healthy people.Results. We revealed early stages of the diabetic microangiopathy even before the appearance of structural changes in patients with DM type at functional tests. We were identified the functional disorders: increasing recovery time of capillaroscopic parameters after carrying out functional tests to baseline versus control.Conclusion. We were to diagnose structural changes of microcirculation in diabetic patients with disease duration more than 7 years by capillaroscopy. In the early stages of the disease we were observed functional disorders which appearance before the structural changes using functional tests. It was lengthened recovery time of capillaroscopic dates after carrying out functional tests to baseline values in comparison with the control group. Recovery time may be used as early diagnostic criteria of diabetic microangiopathy when carrying out functional tests in patients with DM.

Objective: of article was to study the level of cerebral natriuretic peptide in patients with type 2 diabetes mellitus with diastolic dysfunction and with various types of left ventricular remodeling. Materials and methods: 256 patients with type 2 diabetes mellitus (DM) who had moderate arterial hypertension (AH) and no clinical signs of chronic heart failure were examined. The control group consisted of 30 practically healthy persons, comparable in age and sex with the examined patients. All patients were determined the concentration of brain natriuretic peptide (BNP) in blood plasma. The structural and functional parameters of the heart were determined by echocardiography in B- and M-modes according to the standard technique. Results: in patients with type 2 diabetes and diastolic dysfunction, the BNP concentration was 156 (84; 228) pg / ml, in patients without diastolic filling disorders — 24 (12; 38) pg / ml. The highest BNP values were found in the subgroup of patients with a restrictive type of transmitral flow. Also, BNP values were higher in the group of patients with concentric and eccentric left ventricular (LV) hypertrophy. Conclusion: in all patients with type 2 diabetes and concomitant moderate hypertension, even in the absence of clinical signs of CHF, there is an increase in the BNP level compared to the control group. The highest BNP values were observed in patients with severe diastolic dysfunction and unfavorable variants of LV remodeling.

No abstract

In recent years, ideas about the pathogenesis of urinary tract infections have been changed significantly. Various pathogenetic factors of microorganisms and new defense mechanisms against them have been discovered. A significant part of pathogens is inactivated by the first line of defense - innate immunity which includes epithelial barriers (mucous membranes), cellular (phagocytes, dendritic cells, NK-cells) and humoral (chemokines, cytokines, complement) components, as well as antimi­crobial proteins). The second and more specific line of defense is the acquired (adaptive) immune system - humoral (B-cells, antibodies) immunity and cellular (T-cells) immunity. However, epithelial cells play an important role in the immune response. These cells interact with the components of both innate immunity and acquired one. Antimicrobial proteins are one of the most ancient and primitive components of the immune system and they are very widely spread in nature. More than 800 antimicro­bial proteins have been described and more than 100 of them have been found in the human body. The mechanism of these proteins is mainly connected with the violation of the bacterial membrane integrity. Nevertheless, some proteins can inhibit protein and/or DNA synthesis. The most common protein in the urine is uromodulin (Tamm-Horsfall protein), synthesized in the thick ascending section of the Henle loop. Uromodulin does not have direct antimicrobial activity, but it is involved in the pathogenesis of many inflammatory kidney diseases. In addition, uromodulin acting through the TLR4 signaling pathway pro­motes the maturation of dendritic cells, thereby further activating innate and acquired immunity. Currently, the role of antimi­crobial proteins and dendritic cells in the pathogenesis of the infectious process is being actively studied. It will probably have a significant practical value. Thus, the development of urinary tract infections is the process of competing for the interaction of the uropathogenic and the macroorganism. The treatment of these diseases (especially chronic) should not be limited to the use of antibacterial drugs. An important component of the pathogen eradication is to increase the activity of its own protective mechanisms.