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IMPACT OF HORMONE REPLACEMENT THERAPY ON HYPERANDROGENICITY AND GLUCOSE HOMEOSTASIS IN POSTMENOPAUSAL DIABETIC WOMEN
(Bioscientifica on behalf of the Society for Endocrinology, 2016)
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Hyperandrogenicity in women is closely associated with insulin resistance and a risk factor for cardiovascular disease and noninsulin-dependent diabetes mellitus. It is known that hormone replacement therapy (HRT) decreases hyperandrogenicity and improves glucose homeostasis in postmenopausal diabetic women. To investigate the role of HRT on hyperandrogenicity and glucose homeostasis in postmenopausal diabetic women. A total of 40 type 2 diabetic postmenopausal women were prospectively enrolled and followed for 12 months. The examined group consisted of 20 women who were assigned to take HRT, while the rest were left without hormone therapy. HRT consisted of 17β- estradiol (E2) 1 mg and DRSP (drospirenone) 2 mg. Fasting blood glucose ( FPG), glycosylated hemoglobin (HbA1C), insulin, sex hormone binding globuline (SHBG) and total testosterone were measured, free androgen index (FAI) was calculated by formula and insulin sensitivity was determined by the homeostatic model assessment of insulin resistance ( HOMA-IR). All metabolic measurements were taken at baseline and after 12 months.HRT treatment, compared with control group, was followed by a marked increase of SHBG (from 29.0 ± 12.3 to 56.0 ± 8.54 nmol/l) and significant decrease of free testosterone (5.17 ± 1.2 to 1.92 ± 1.3), FPG (7.8 ± 0.86 to 6.9 ± 0.6 mmol/l), HbA1C(7.6 ± 0.54 to 7.2 ± 0.43 % and HOMA-IR (4.23 ± 1.7 to 3.18 ± 1.4 µU/ml-mmol/l).HRT in postmenopausal diabetic women ameliorated hyperandrogenicity, accompanied by marked improvements in glucose homeostasis.
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Cardiac and lipid markers as predictors for coronary artery disease in prediabetic patients
(SHMSHM / AAMD, 2020)
Introduction: Coronary artery disease (COPD) is the leading cause of mortality and morbidity in patients with type 2 diabetes mellitus (DMt2). One of the diagnostic methods for assessing CAD is laboratory blood tests that include: lipid status and cardiac markers. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a cardiac biomarker whose predictive power for cardiovascular events in patients with DMT2 and prediabetes is the target of this case study. Apolipoproteins A and B are lipid biomarkers that correlate with atherosclerosis and are factors for cardiovascular events. Materials and Methods: This is a case study of a 38-year-old patient followed over a 12-month period. The respondent was called for laboratory tests every 3 months in the first year. The change in the levels of cardiac and lipid markers NT-proBNP and apolipoprotein A and B was monitored. Results: The case study examines the correlation between the increased values of NT-proBNP and Apolipoprotein A and B with the predictability for CAD at the beginning and during follow-up in a patient with prediabetes. In patients with prediabetes, the increased value of cardiac and lipid biomarkers is expected to be a predictor of coronary events. Antilipemic and antiaggregation therapy is also expected to have a protective effect on cardiovascular events. Conclusion: Determining the association of elevated cardiac and lipid marker values in the occurrence of CAB in patients with prediabetes and timely use of antiliepemic and antiaggregation therapy may prevent unwanted cardiovascular events in diabetic patients.
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Invasive Fungal sinusitis in post COVID-19 patient with multiple comorbidities - case report
(Macedonian Otorhinolaryngology society, 2022-06-01)
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Introduction: Secondary invasive Fungal Infections (FI) involving paranasal sinuses is a rare life-threatening opportunistic infection in immunocompromised individuals. The number of patients with FI is rising constantly globally due to the use of immunosuppressant drugs, increased use of antibiotics(AB) and long hospital stay. The critical point for sharp increase in FI Sinusitis was in post COVID-19 Patients with overuse of AB and comorbidities like Diabetes. Case Presentation: A 68 Year old male patient with multiple comorbidities including Diabetes Melitus 2, was admitted in the state Covid center (GOB 8mi septemvri) and treated 13 days for Covid complications including pneumonia with multiple AB and corticosteroid drugs, including insulin. After hospital discharge, he presented severe headache with dizziness and was hospitalized for 4 days in the neurology clinic. Another course of AB drugs was conveyed because of the lab inflammatory markers, while a specific diagnose was found. The patient developed new symptoms including bulbar propulsion, blurred vision, and somnolence. A CT scan was performed on the second day where an invasive sinusitis with orbital and susp. intracranial complications were found. The patient was urgently transferred to our clinic and prepared for surgical treatment. An orbital abscess incision and FESS (including orbital decompression) was performed. Massive pus collections ware drained. During the ethmoidal openings a classical sign of fungal sinusitis with fungal hypha’s were found and eradicated. Beside the complete and successful endonasal operation the patient situation post op was worsening and he was transferred to the intensive care unit on mechanical ventilation, with complication of cavernous sinus thrombosis. Two days later the patient destabilized and died. Conclusion: COVID-19 patients required multidisciplinary approach in treatment and post hospital care, including ENT specialist. Patient comorbidities should remain in focus during the treatment of the primary illness. The lack of protocols at the start of the pandemics lead to overuse of drugs, such as AB and corticosteroids. Every patient should be individually accessed for determining the right diagnose auspicious.

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