BACKGROUND: The poor outcomes of chronic hepatitis C (CHC) and type 2 diabetes determine the socio-economic significance of the combined pathology since they lead to premature death. The proportion of patients with type 2 diabetes with markers of viral hepatitis (VH) in the Russian Federation is not known, which does not allow us to estimate the burden for the state of this medical problem.OBJECTIVE: Assessment of the prevalence of concomitant pathology, HCV infection and type 2 diabetes, as well as the proportion of severe liver damage in its structure, according to the analysis of the primary medical records of four Moscow hospitals.MATERIALS AND METHODS: A retrospective analysis of the medical records of patients with HCV infection and diabetes mellitus, who admitted at different periods to four hospitals in Moscow, was carried out, as well as a total examination for the presence of anti-HCV in the blood of all patients with diabetes who were admitted within a certain period to the endocrinology department of a multidisciplinary hospital. Additionally, to determine the proportion of patients with liver cirrhosis (LC), an additional examination of patients with this combined pathology was carried out in accordance with the standards for the diagnosis of hepatitis C.RESULTS: In total, according to data from 4 hospitals in Moscow, over a certain period, 2% (105/5298) of diabetes patients with anti-HCV in their blood were identified. Sex ratio for men: women = 54 (51%): 51 (49%). Patients aged 50–69 years prevailed — 70% (74/105). Seroprevalence of HCV in cohorts of patients with type 2 diabetes according to the analysis in 3 health facilities: 0.9% (20/2196), 1.9% (8/432), 1.9% (28/1500). A significant drawback was revealed that did not allow assessing the true seroprevalence of HCV: not all patients were hospitalized with the results of a VH test, and not all of them were assigned an examination for VH markers if it was not performed before hospitalization. The proportion of type 2 diabetes patients with anti-HCV in the blood according to the results of total screening (3.7%; 16/432) became comparable to the proportion of type 2 diabetes patients among patients with CHC admitted to an infectious hospital (4.2%; 49 / 1170). The proportion of patients with LC according to the analysis of the medical records of the infectious hospital is 65% (32/49), in the group of endocrinological patients with additional examination it is 18% (13/71).CONCLUSION: For the first time in the Russian Federation, data were obtained on the prevalence of HCV infection in combination with type 2 diabetes. The results of the study indicate the need to develop effective screening programs to detect active HCV infection in the group of patients with diabetes, as well as patients among them with severe hepatic fibrosis for the timely conduct of highly effective antiviral therapy, which will prevent poor outcomes in a separate perspective.

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Type 2 diabetes mellitus is a serious medical and social problem. The danger of the disease is associated with epidemic growth rates and chronic complications, leading to early disability, decreased quality of life and mortality. The prevention of diabetes complications is based on the optimal glucose-lowering therapy with the achievement of target metabolic parameters from the date the diagnosis of T2DM was established and throughout the patient’s life. The complex pathogenetic mechanisms of T2DM are the underlying rationale for drug therapy with a simultaneous effect on various disorders, which will provide a greater hypoglycemic potential and maintain effective glycemic control as T2DM progresses. The main reasons for poor disease control include clinical inertia, untimely intensification of drug therapy, and the use of treatment regimens that are insufficiently effective given the progressive course of the disease. The therapy for T2DM is based on clinical guidelines. The pathogenetic therapy options associated with the use of vildagliptin and metformin are considered. Much attention in modern diabetology is paid to the study of the influence of various therapeutic approaches on the disease progression rates from the perspective of improving prognosis and long-term maintenance of target glycemic control. The advantages of combined glucose-lowering therapy at the onset of T2DM are considered in comparison with the stepwise intensification of glucose-lowering therapy. The VERIFY study examined the long-term efficacy and safety of two treatment approaches: early vildagliptin and metformin combination therapy versus the traditional stepwise approach starting with metformin as initial therapy. The combined glucose-lowering therapy is an important direction in the treatment of patients with newly diagnosed type 2 diabetes.

Introduction. Currently, the participation of women in space flights is increasing. In this regard, questions about the influence of space factors on the state of the female body arise inevitably. Model experiments, in particular, "dry" immersion, are most convenient for studying the influence of individual factors of space flight on the organism. The aim of this work is a comparative assessment of the state of the vaginal microbiota of 6 female volunteers before and after three-day "dry" immersion.Materials and methods. Microbial samples of all volunteers were stained according to Gram with a sequential culture study in accordance with the medical technology. The species identification of microorganisms was performed by MALDI-TOF-MS analysis using an Autoflex III time-of-flight mass spectrometer with Maldi BioTyper software.To assess changes in the state of the vaginal microflora and microflora of the cervical canal, eubiotic index was used. It reflects the number of positive states of microbiota to the number of negative ones.Results. After 3 days of "dry" immersion volunteers, who had high titer of aerobic microorganisms before isolation, had significant increase of the amount of aerobic microorganisms, while the number of lactobacilli decreased. The other group of volunteers showed activation of colonization resistance of the vaginal microflora. Volunteers, who had a significant contamination with anaerobic opportunistic microflora before isolation, had reduction of the number of all anaerobes, including lactobacilli. The eubiotic index, calculated for the cervical canal, decreased after 3 days of immersion. The data obtained indicate that after 3 days of isolation, the state of the microflora has deteriorated.

Расстройства мозгового кровообращения -одна из основных причин летальности и стойкой инвалидизации. Выделяют острые нарушения мозгового кровообращения (инсульт, транзиторная ишемическая атака) и хронические расстройства мозгового кровообращения (ХРМК). Последние рассматриваются в литературе как дисциркуляторная энцефалопатия, ангиоэнцефалопатия, цереброваскулярная недостаточность и др. В настоящее время в соответствии с МКБ-10 для унификации описания этой группы состояний используется термин «хроническая ишемия головного мозга», что обеспечивает более точный сбор эпидемиологиче-ских данных о ХРМК. Однако указанная классификация предусматривает возможность формулирования и кодирования диагноза как в соответствии с особенностями поражения сосудистого русла (I65 -закупорка и стеноз прецеребральных артерий, не приводящие к инфаркту мозга; I66закупорка и стеноз церебральных артерий, не приводящие к инфаркту мозга; I67.2 -церебральный атеросклероз), так и на основании выделения ведущего клинического синдрома (I67.3 -прогрессирующая сосудистая лейкоэнцефалопатия -болезнь Бинсвангера; F01.0 -сосудистая деменция с острым началом; F01.1 -мультиинфарктная деменция; Камчатнов П.Р. 1 , Евзельман М.А. 2 , Морозова Ю.А. 3 1 ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия; 2 медицинский факультет ФГБОУ ВО «Орловский государственный университет им. И.С. Тургенева», Орел, Россия; 3 ГБУЗ «Городская поликлиника № 56 Департамента здравоохранения Москвы», Москва, Россия 1 117997, Москва, ул. Островитянова, 1; 2 302026, Орел, ул. Комсомольская 95; 3 119121, Москва, ул. Плющиха, 42, стр. 1 Хронические расстройства мозгового кровообращения (ХРМК) -гетерогенная по механизмам развития группа синдромов, проявляющихся когнитивными, эмоциональными нарушениями и реже двигательными и сенсорными неврологическими симптомами. Профилактика ХРМК включает контроль артериального давления и гликемии, применение антитромбоцитарных и других препаратов. Однако в случае уже сформировавшегося дефекта эффективность таких мероприятий невысока. Подчеркнута необходимость тщательной оценки состояния пациента перед началом лечебных мероприятий. Более значимого клинического эффекта можно ожидать при комбинированном лечении, включающем вторичную профилактику цереброваскулярных заболеваний, препараты, улучшающие кровообращение и метаболизм головного мозга, и методики немедикаментозного воздействия. Рассматриваются возможности медикаментозной терапии, в том числе использования винпотропила, у пациентов с ХРМК. Ключевые слова: хроническая ишемия головного мозга; дисциркуляторная энцефалопатия; когнитивные нарушения; когнитивный резерв; пирацетам; винпоцетин; винпотропил. Контакты: Павел Рудольфович Камчатнов; pavkam7@gmail.com Для ссылки: Камчатнов ПР, Евзельман МА, Морозова ЮА. Хронические расстройства мозгового кровообращения: возможности повышения эффективности терапии. Неврология, нейропсихиатрия, психосоматика. 2017;9(3):105-110.