DEVELOPMENT OF SYNTHETIC GROWTH CHARTS FOR ROMANIAN POPULATION.

There are no new national growth references for the Romanian population and the current recommendations for short stature evaluation is the use of the Swiss growth charts developed based on a longitudinal study.The aim of the present paper is to present the new synthetic growth references for Romanian children. MATERIAL AND METHODS: We used local Romanian data from 9 studies with information on height and weight obtained between 1999 and 2016. Based on their plausibility and methodology six studies were selected for generating the National Synthetic Growth References for Romanian Children based on the specific methodology described previously. The selected studies included 8407 subjects measured in schools/kindergartens. Age is reported in years covering a range from 3-18 years. Height and weight were measured at a precision of 0.1 cm and 0.1 kg. All children were measured at normal temperature, in light clothes, without footwear. RESULTS: We present the charts and tables with the common centiles for height, weight and body mass index for boys and girls. CONCLUSION: We suggest synthetic growth references based upon recent growth data from 6 different Romanian regions as new National Growth Charts for Romanian children.

[Pattern laser trabeculoplasty and argon laser trabeculoplasty for treatment of glaucoma]. / Pattern-Laser-Trabekuloplastik und Argon-Laser-Trabekuloplastik zur Glaukombehandlung.

INTRODUCTION: Argon laser trabeculoplasty (ALT) and pattern laser trabeculoplasty (PLT) are two laser surgery methods for treatment of open angle glaucoma and the effect in reducing intraocular pressure (IOP) of these methods was compared in a retrospective study. METHODS: The IOP, the best corrected visual acuity (BCVA) and the eye drop glaucoma medication used by patients who were treated by ALT or PLT in this clinic between January 2011 and December 2012 were compiled and evaluated. RESULTS: An ALT was carried out on 22 eyes from 22 patients (13 right and 9 left eyes in patients with an average age of 71.1 ± 1.5 years, 7 men and 15 women) and a significant average reduction of IOP from 18.6 ± 0.9 to 15.3 ± 0.7 mmHg (p < 0.001) was observed an average of 8.2 ± 0.8 weeks after ALT. The number of dropped glaucoma medications per eye (p = 0.19) and the mean BCVA both remained constant (p = 0.15). A PLT was carried out on 20 eyes from 20 patients (12 right and 8 left eyes in patients with an average age of 69.9 ± 2.6 years, 10 men and 10 women) and a significant average reduction of IOP from 20.2 ± 1.1 to 15.6 ± 0.8 mmHg (p < 0.001) was observed an average of 8.3 ± 0.6 weeks after PLT. The number of dropped glaucoma medications per eye (p = 0.08) and the mean BCVA both remained constant (p = 0.59). The difference in the reduction of IOP between the ALT and PLT groups was not significant (p=0.26). CONCLUSION: Both PLT and ALT are effective methods for treatment of open angle glaucoma and lead to similar significant reductions in IOP.

Laparoscopic sleeve gastrectomy improves reproductive hormone levels in morbidly obese males -- a series of 28 cases.

BACKGROUND: Obese males frequently present with low androgen levels that may improve after weight loss achieved by bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) has been used often in the last decade as treatment for morbid obesity. The aim of this study was to evaluate modifications in the male reproductive hormone profile after LSG. PATIENTS AND METHODS: The prospective study included 28 males with body mass index (BMI) 35 kg m2 who underwent LSG.Total Testosterone (TT), Sex Hormone Binding Globulin(SHBG) and Luteinizing hormone (LH), together with biochemical and anthropometric data, were evaluated at baseline and after LSG. RESULTS: Baseline patients had a mean BMI of 50.10 (+-11.19)kg m2, SHBG 23.37 (+-17.47) nmol L, LH 3.83 (+-1.76)mUI ml and TT 8.31 (+-3.24) nmol L. After LSG, patients showed a mean BMI of 35.87 (+-7.02) kg m2 (p 0.001),SHBG 37.81 (+-18.95) nmol L (p 0.05), LH 4.76 (+-2.49)mUI ml (p 0.05), whereas mean TT was 12.7 (Â+-3.8) nmol L(p 0.001). The percentage of excess body weight loss (%EBL)was 43.07 (+-9.56) and metabolic syndrome prevalence decreased significantly from 75% to 25% (p 0.001). CONCLUSIONS: Beyond BMI loss, LSG significantly improved reproductive hormone levels in morbidly obese males.

Pyrenean ptarmigans decline under climatic and human influences through the Holocene.

In Europe, the Quaternary is characterized by climatic fluctuations known to have led to many cycles of contraction and expansion of species geographical ranges. In addition, during the Holocene, historical changes in human occupation such as colonization or abandonment of traditional land uses can also affect habitats. These climatically or anthropically induced geographic range changes are expected to produce considerable effective population size change, measurable in terms of genetic diversity and organization. The rock ptarmigan (Lagopus muta) is a small-bodied grouse occurring throughout Northern hemispheric arctic and alpine tundra. This species is not considered threatened at a continental scale, but the populations in the Pyrenees are of concern because of their small population size, geographical isolation and low genetic diversity. Here, we used 11 microsatellites to investigate genetic variations and differentiations and infer the overall demographic history of Pyrenean rock ptarmigan populations. The low genetic variability found in these populations has been previously thought to be the result of a bottleneck that occurred following the last glacial maximum (i.e., 10,000 years ago) or more recently (i.e., during the last 200 years). Our results clearly indicate a major bottleneck affecting the populations in the last tenth of the Holocene. We discuss how this decline can be explained by a combination of unfavorable and successive events that increased the degree of habitat fragmentation.

Association of serum adiponectin and insulin-like growth factor I levels with parameters of cardiac remodeling in severely obese patients.

BACKGROUND: Obesity is associated with various changes in cardiac geometry and this process involves both hemodynamic and non-hemodynamic factors, among which adipocitokines and growth factors may play an important role. The aim of this study was to identify the extent and pattern of cardiac remodeling in a group of severely obese patients and analyze the relationship between adiponectin, IGFI and cardiac parameters reflecting obesity-associated structural changes. SUBJECTS AND METHODS: Our study included 344 patients (104 men) with severe obesity [mean body mass index (BMI)= 45.7 ± 8.5 kg/m(2)], extensively evaluated clinically and biologically (complete metabolic tests, serum adiponectin, and IGF-I measurements). Left ventricular (LV) mass index (LVMI), left atrium (LA) size, and LV geometry were determined by means of cardiac ultrasound. RESULTS: The most prevalent pattern of LV geometry was eccentric hypertrophy (28.7% of patients). In a gender-, age-, BMI-, diabetes- and hypertension-adjusted general linear model, patients with concentric or eccentric hypertrophy had significantly lower values of adiponectin than those with normal geometry (6.75 ± 0.41, 6.96 ± 0.53, vs 9.04 ± 0.42 mg/l, p<0.05). In multivariate analysis, independent determinants for LVMI were BMI (ß=0.364, p<0.001), systolic blood pressure (BP) (ß=0.187, p=0.004), age (ß=0.246, p<0.001), adiponectin (ß=-0.151, p=0.012), and IGF-I z-score (ß=0.134, p=0.025) while factors independently related to LA size were systolic BP (ß=0.218, p<0.001), BMI (ß=0.194, p<0.001), age (ß=0.273, p<0.001), gender (ß=-0.195, p<0.001), and adiponectin (ß=-0.180, p=0.005). CONCLUSIONS: In patients with severe obesity, IGF-I z score and adiponectin correlate with parameters of cardiac remodeling independently of anthropometric, hemodynamic or metabolic factors.

Metabolic imbalance in affective disorders.

INTRODUCTION: Depression is the most frequent mental disorder encountered in all medical services. Multiple studies have shown that depression may predict the onset of different conditions, such as heart disease, diabetes, stroke and many other. The relation between depression and diabetes is still unclear. MATERIALS AND METHODS: In this study we evaluated patients with both major depressive disorder and type 1 or 2 diabetes, and observed the evolution of depressive and diabetes symptoms under adequate treatment. This observational, naturalistic study included 43 patients admitted in a psychiatric ward of "Alexandru Obregia" Clinical Hospital, Bucharest, diagnosed with Major Depressive Disorder (MDD) and Diabetes mellitus (DM) type 1 or 2. All patients received antidepressant and antidiabetic treatment. RESULTS: The majority of patients were women (60.5%), and the mean age was 49.7 years. Average hospitalization period was 23 days, with longer period of hospitalization of patients with DM type 1. Patients had severe depression. Mean value of fasting glycemia at admission was of 174 mg / dl, but it decreased at discharge, in paralel with the amelioration of depression. CONCLUSIONS: The depression associated with DM type 1 is more severe. These patients require higher doses of antidepressants and longer hospitalization period. Amelioration of depression seems to have a positive impact on the blood sugar level of depressed patients with diabetes.

Adiponectin, body mass index and hepatic steatosis are independently associated with IGF-I status in obese non-diabetic women.

OBJECTIVE: Low IGF-I levels have been associated with obesity, insulin resistance, hepatic steatosis, and were shown to predict cardiovascular mortality. Adiponectin, on the other hand, was proved to have an important protective role against metabolic and cardiovascular diseases. This study investigates the relation between hepatic steatosis, adiponectin and IGF-I levels in a group of non-diabetic obese Romanian women. DESIGN: This cross-sectional study included 201 obese non-diabetic women, with mean age of 41.1±11.9 years and mean body mass index (BMI) of 44.1±8.3 kg/m(2), consecutively admitted to the Endocrinology Department of a University Hospital to be evaluated as candidates for bariatric surgery. Main measured parameters included total adiponectin (detected by ELISA method), insulin, C reactive protein (CRP), and IGF-I (all by chemiluminescence methods). Insulin sensitivity was assessed using the Quantitative Insulin Sensitivity Check Index (QUICKI). Patients were considered IGF-deficient if IGF-I z score was ≤2 standard deviations from mean for age. Hepatic ultrasound was used to determine the presence of significant steatosis (SS+). RESULTS: Significant steatosis was observed in 60.7% of our patients and this feature was associated with reduced total adiponectin levels (p<0.001) and lower IGF-I z scores (p<0.001). IGF-I z score negatively correlated with BMI (r=-0.283, p<0.001), alanine aminotransferase (ALT) (r=-0.130, p=0.032), gamma glutamyltransferase (GGT) (r=-0.158, p=0.018) and logarithmic transformed (log) CRP (r=-0.232, p=0.001) and positively correlated with QUICKI (r=0.148, p=0.023) and log adiponectin (r=0.216, p=0.003). The relationship between IGF-I z score and log adiponectin remained significant after adjusting for age, BMI, ALT, QUICKI and log CRP (r=0.183, p=0.012). IGF-I deficiency was present in 33.3% of these obese women. In multivariate logistic analysis, BMI (p<0.001), ALT (p=0.003), log adiponectin (p<0.001) and SS (p=0.043) proved to be independently associated with IGF-I deficiency. CONCLUSIONS: Adiponectin is significantly correlated with IGF-I z scores and, along with BMI, ALT and significant steatosis, is independently associated with IGF-I deficiency in obese non-diabetic women.

Six months results of laparoscopic sleeve gastrectomy in treatment of obesity and its metabolic complications.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has become a popular bariatric surgical procedure, with proven results in achieving weight loss, however data regarding its effectiveness on metabolic syndrome (MetS) components are scarce. The aims of the present study were to assess the outcomes of LSG on weight loss and obesity associated metabolic complications at six months following intervention. PATIENTS AND METHODS: This was a retrospective study on 124 consecutive obese patients (29.8% men), who had undergone LSG between 01/01/2008 and 12/31/2010, in a highly specialized clinic. The dynamic of anthropometric and biochemical data between baseline and six months following LSG were evaluated. We also determined the change in MetS prevalence and used logistic regression to estimate predictors of MetS remission RESULTS: 6 months after LSG, the body mass index (BMI) decreased from 46.84 +/- 8.62 to 33.81 +/- 7.04 kg/m2 (p < 0.001). Mean excess BMI loss (EBL) was 65.24 +/- 25.16%. The best results on weight loss were observed in young patients, not affected by MetS, with lower initial BMI. Lipids profile suffered a significant improvement (HDL cholesterol increased, while LDL, total cholesterol, triglycerides decreased, p < 0.05 for each). HOMA-IR values decreased by 75.2%, from 5.24 +/- 4.49 to 1.30 +/- 1.22 (p < 0.001). MetS prevalence was reduced from 74.3% to 18.4% (p < 0.001). In multivariate analysis, % EBL remained the only significant predictor of MetS remission, the risk for lack of a MetS remission being practically 3 times higher in patients with EBL < 50%, compared to those with EBL > 50% (OR: 2.97, CI: 1.1-10.23, p < 0.05). CONCLUSIONS: As early as 6 months after LSG we recorded a significant weight loss and improvement in insulin resistance and lipids metabolism, as well as an impressive reduction in metabolic syndrome prevalence.

[Is there a role for a random measurement of 24-hour urine calcium excretion and serum total alkaline phosphatase in the determination of fracture risk in osteoporotic postmenopausal women?]. / Rolul fosfatazei alcaline totale si al Calciuriei in determinarea riscului de fractura, la femei cu osteoporoza de postmenopauza.

UNLABELLED: Our objective was to explore whether a casual determination of 24-hour urinary calcium excretion and serum total alkaline phosphatase (TAP), in osteoporotic postmenopausal women are independent predictors for osteoporotic fracture. Subjects were 121 women with postmenopausal osteoporosis (mean age 62.8 +/- 9.9) segregated in two study groups based on prevalence of osteoporotic fractures (51 women with prevalent fractures and 70 without fractures), similar in terms of age and BMI. We measured bone mineral density (BMD) by DXA at lumbar spine and femoral neck. Vertebral fracture assessment was done by plain X ray evaluation. Routine blood tests and extensive endocrine evaluation were performed in all patients to exclude secondary causes of osteoporosis. Serum TAP, calcium, phosphate and urinary calcium excretion was measured to evaluate bone metabolism. We did not find any significant differences between groups regarding lumbar T score (-3.1/-2.9 SD), femoral neck T score (-2.2/-1.8 SD), lumbar Z score (-1.5/-1.9 SD) or femoral neck Z score (-1.5/-1.8 SD). Serum TAP was higher in fracture group (211.5 UI) comparing to non-fracture osteoporotic women (208.3 UI) without statistical significance. We were not able to find any significant difference between groups in terms of urinary calcium excretion (9.13/5.4 mEq/24h) or serum total calcium (4.8/4.9 mmol/l). CONCLUSION: in spite of a mean TAP near the upper limit of normal range which could be related to low bone mass, there is no significant relationship to fracture risk in osteoporotic postmenopausal women. Based on our data, a casual measurement of urinary calcium excretion seems irrelevant for BMD independent fracture risk assessment in this clinical setup.

[Laser phacoemulsification--a method of cataract surgery]. / Laserul--formaa de energie alternativa în facoemulsificare.

Today, ultrasound phacoemulsification is the most used method of cataract surgery. Because the side effects (injury of corneal endothelium and other nearly tissues), was tried to find alternative energy forms. Erbium laser was proven to be the most effective method among all of these.

[High-altitude retinopathy]. / Retinopatia de mare altitudine.

High-altitude retinopathy is a very rare ocular disease in our country, which can occur isolately or as a part of high-altitude illness. This paper presents the case of a patient with high-altitude illness and the diagnosis and treatment problems of this case.

The presence of interferon and type A immunoglobulins in the nasopharyngeal secretions of volunteers immunized with an inactivated influenza vaccine.

The presence of interferon and type A immunoglobulins (IgA) was followed up in the nasopharyngeal washings collected from volunteers immunized intranasally with an inactivated influenza vaccine [strain A/Rom 1/73 (H3N2)]. Interferon was detected 24 hours after vaccine administration, its incidence being similar to that in the course of acute infection. Intranasal administration of inactivated influenza vaccine stimulated the production of secretory IgA in 3 of 10 samples collected 12 days after vaccination. At the same time, IgA were found in 4 samples collected before vaccination, and inhibited in certain cases the stimulation of interferon synthesis. The practical importance of the route of influenza vaccine administration is discussed.