The Predisposition for Type 2 Diabetes Mellitus and Metabolic Syndrome.

Type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) are diseases caused by the interaction of genetic and non-genetic factors. Therefore, the aim of our study was to investigate the association between six common genetic polymorphisms and T2DM and MetS in males. A total of 120 T2DM, 75 MetS, and 120 healthy controls (HC) were included in the study. ACE ID, eNOS 4a/b, ATR1 A1166C, OXTR (A>G), SOD1 +35A/C, CAT-21A/T gene polymorphisms were genotyped by PCR or PCR-RFLP techniques. T2DM was diagnosed at an earlier age compared to MetS (54 vs 55 years old, p=0.0003) and the difference was greater in carriers of the OXTR G allele (54 vs 56 years old, p=0.0002) or both OXTR G and eNOS b alleles (54 vs 56, p=0.00016). The SOD1 AA genotype (O.R.=0.11, p=0.0006) and the presence of both ACE I and OXTR1 A (O.R.=0.39, p=0.0005) alleles revealed to be protective for T2DM. SOD1 AA and AC genotypes were protective factors for triglyceride (p=0.0002 and p=0.0005, respectively) and HDL cholesterol (p=0.0002 and p=0.0004, respectively) levels in T2DM patients. ACE DD was identified more frequently in hypertensive T2DM patients (O.R.=3.77, p=0.0005) and in those who reported drinking alcohol (p=0.0001) comparing to HC and T2DM patients who did not drink alcohol, respectively. We observed that T2DM patients who reported drinking alcohol had an increased frequency of ACE DD and eNOS bb (p<0.0001), or ACE DD and OXTR G (p<0.0001) compared to non-drinkers. No gene polymorphisms were associated with MetS.

CHARACTERIZATION OF PATIENTS IN THE POST-ACUTE PHASE OF COVID-19 WHO PRESENTED THEMSELVES TO AN EMERGENCY DEPARTMENT.

Background: Patients that recovered from COVID-19 may remain with symptoms which can persist for an uncertain period of time. Aim: The purpose of this study was to investigate the reasons why patients who passed the acute phase of COVID-19 presented themselves to the Emergency Department. Patients and Methods: We selected 87 patients admitted to the Emergency Department of the Bucharest University Emergency Hospital between 01.01.2021-31.05.2021. Patients had pulmonary fibrosis (11.49%), pleural effusion (16.09%) or a history of hypertension (73.56%), type 2 diabetes (42.53%), stroke (24.14%), malignant diseases (10.34%). Results: Association between neutrophil levels and acute stroke and between fibrinogen levels and alveolar condensation were identified. The percentage of deaths was significantly higher in the subgroup of subjects that had maxim 11 days of hospitalization (p=0.004); we observed a trend of association between the age of more than 51 years old and admission in the Emergency Unit at less than a month after the SARS Cov2 infection, the positive result at the RT-PCR test or a lung damage of over 30% (p<0.05). Conclusion: A significant percentage of patients that were admitted to the Emergency Unit post COVID-19 had chronic pathologies and their characteristics were associated with neutrophilia, high fibrinogen levels or length of hospitalization.

Growth assessment in diagnosis of Fetal Growth Restriction. Review.

The assessment of fetal growth represents a fundamental step towards the identification of the true growth restricted fetus that is associated to important perinatal morbidity and mortality. The possible ways of detecting abnormal fetal growth are taken into consideration in this review and their strong and weak points are discussed. An important debate still remains about how to discriminate between the physiologically small fetus that does not require special surveillance and the truly growth restricted fetus who is predisposed to perinatal complications, even if its parameters are above the cut-off limits established. In this article, we present the clinical tools of fetal growth assessment: Symphyseal-Fundal Height (SFH) measurement, the fetal ultrasound parameters widely taken into consideration when discussing fetal growth: Abdominal Circumference (AC) and Estimated Fetal Weight (EFW); several types of growth charts and their characteristics: populational growth charts, standard growth charts, individualized growth charts, customized growth charts and growth trajectories.

Predictive factors for intrauterine growth restriction.

Reduced fetal growth is seen in about 10% of the pregnancies but only a minority has a pathological background and is known as intrauterine growth restriction or fetal growth restriction (IUGR / FGR). Increased fetal and neonatal mortality and morbidity as well as adult pathologic conditions are often associated to IUGR. Risk factors for IUGR are easy to assess but have poor predictive value. For the diagnostic purpose, biochemical serum markers, ultrasound and Doppler study of uterine and spiral arteries, placental volume and vascularization, first trimester growth pattern are object of assessment today. Modern evaluations propose combined algorithms using these strategies, all with the goal of a better prediction of risk pregnancies.

The relationship between the metabolic syndrome and its components and bone status in postmenopausal women.

UNLABELLED: The association between metabolic syndrome (MS) and bone status remains controversial. We aimed to study the relationships between MS, bone mineral density (BMD), and bone metabolism in postmenopausal women. MATERIAL AND METHODS: MS was assessed in 218 white postmenopausal women. BMD (lumbar spine and hip) was measured by dual energy X-ray absorptiometry (DXA). Serum carboxyterminal cross-linked telopeptide of type 1 collagen (CTX), undercarboxylated osteocalcin (uOC), bone alkaline phosphate (BAP) and vitamin D were assayed. RESULTS: Postmenopausal women with MS had a significantly higher lumber spine BMD than women without MS (p < 0.05). A progressive increase of the BMD at both sites with the number of MS components was observed. Bone turnover markers and vitamin D levels were not significantly influenced by the presence of MS. BMD at both sites positively correlated with body mass index (BMI), waist circumference (WC) and glucose in unadjusted analysis. In multiple regression analysis, WC was independently associated with BMD at both sites, while hypertension was associated only with lumbar spine BMD. CONCLUSIONS: In postmenopausal women, MS is associated with increased lumbar spine BMD and this relation is explained mainly by the higher BMI and WC in the MS group.

Bone metabolism regulators and arterial stiffness in postmenopausal women.

BACKGROUND: Osteoprotegerin (OPG), osteopontin (OPN) and matrix Gla protein (MGP) are markers of bone metabolism but they are also involved in vascular calcification. However, their precise role is not completely understood. Arterial stiffness is considered an independent predictor of cardiovascular events and it may be one of the causes of the increased cardiovascular risk associated with postmenopausal status. Medial and intimal calcification may increase arterial stiffness. The aim of our study was to assess the relationship of OPG, OPN and MGP with aortic pulse wave velocity (aPWV) as a marker of arterial stiffness in postmenopausal women. MATERIALS AND METHODS: Circulating OPG, OPN and serum total MGP were measured in 144 postmenopausal women using the enzyme-linked immunosorbent assay method. Aortic PWV was determined by an oscillometric method. RESULTS: Osteoprotegerin correlated with age (p<0.001, r=0.27), aPWV (p<0.001, r=0.32) and hypersensitive C reactive protein (hsCRP) (p<0.001, r=0.37), OPN correlated directly with hsCRP (p<0.001, r=0.39) and inversely with high density lipoprotein cholesterol (p=0.02, r=-0.02). No significant association was found between total MGP and clinical, biochemical and vascular parameters. The correlation between OPG and aPWV persisted even after the adjustment for various potential confounders (p=0.02, r=0.19). In multiple regression analysis in the whole study population the most important predictors of aPWV were OPG (ß=0.230, p=0.006), hsCRP (ß=0.212, p=0.01) and systolic blood pressure (ß=0.163, p=0.04). After exclusion of patients treated with statins the independent predictors were hsCRP (ß=0.275, p=0.005) and OPG (ß=0.199, p=0.04). CONCLUSION: Circulating OPG, but not OPN and total MGP, is associated with aPWV and may be a marker of the increased arterial stiffness and cardiovascular risk in postmenopausal women.

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.

Arterial stiffness, carotid atherosclerosis and left ventricular diastolic dysfunction in postmenopausal women.

BACKGROUND: Postmenopausal women have an increased cardiovascular morbidity that may be due to the increase in classical cardiovascular risk factors and also to the arterial structure and function alterations. The aim of our study was to evaluate the association of aortic pulse wave velocity (PWV), and carotid intima-media thickness (IMT), with left ventricular diastolic dysfunction (LVDD) in postmenopausal women. PATIENTS AND METHODS: In 96 women without overt cardiovascular disease (age 62±7.7 years), and with normal left ventricular systolic function, aortic PWV was assessed by using an oscillometric device, intima-media thickness was measured by B-mode ultrasonography and the parameters of left ventricular diastolic function were evaluated by a transthoracic echocardiographic study. RESULTS: LVDD, defined as an E/A ratio≤1 was found in 50 patients (52%). All of them had mild LVDD. In these patients we found significant increase in age (p<0.001), aortic PWV (p<0.001), carotid IMT (p=0.002) and plaque score (p=0.004) when compared with patients without LVDD. In a logistic regression analyzed, after adjusting for age, only aortic PWV was a significant predictor of LVDD (2.15, 95% CI 1.39-3.31, p=0.0006). CONCLUSIONS: This study among postmenopausal women provides evidence that increased arterial stiffness as measured by aortic PWV and not carotid IMT may be a marker or a risk factor for LVDD, independent of other classical risk factors.

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.

Vitamin K and vascular calcifications.

The role of vitamin K in the synthesis of some coagulation factors is well known. The implication of vitamin K in vascular health was demonstrated in many surveys and studies conducted over the past years on the vitamin K-dependent proteins non-involved in coagulation processes. The vitamin K-dependent matrix Gla protein is a potent inhibitor of the arterial calcification, and may become a non-invasive biochemical marker for vascular calcification. Vitamin K(2) is considered to be more important for vascular system, if compared to vitamin K(1). This paper is reviewing the data from recent literature on the involvement of vitamin K and vitamin K-dependent proteins in cardiovascular health.

Malignant insulinoma with hepatic and pulmonary metastases associated with primary hyperparathyroidism. Case report and review of the literature.

Malignant insulinomas are rare tumors (10% of insulinomas) that often present as mnulticentric macro nodules with multiple liver metastases before diagnosis. We report the case of a 55 year old female with a medical history of severe hypoglycemic attacks for two months. Blood tests showed a decreased value of glycemia (30 mg/dl) associated with increased insulin level (l6 microU/ml) and an increased glycemia/insulinemia ratio of 1.87 supporting the diagnosis of insulinoma. Abdominal CT showed a 1.5 cm mass localized in the head of the pancreas with disseminated hepatic tumors, confirmed as neuroendocrine metastases by biopsy (which proved the presence of a malignant insulinoma). Primary hyperparathyroidism was diagnosed based on mild elevation of calcium (10.4 mg/dl) associated with a high level of PTH (71.2 pg/ml). The coexistence of the two endocrinopathies suggested the presence of type 1 multiple endocrine neoplasia (MEN 1). Because of multiple hepatic masses and liver function impairment, surgery and hepatic artery embolization were not performed. Somatostatin analog therapy was started with symptomatic control in the beginning, but rapid loss of beneficial effect. Finally, systemic chemotherapy with doxorubicin was administered, but the disease was progressive and after three months we decided to stop it. The patient died at home after one month, probably in hypoglycemic coma.

[Renal osteodystrophy (3); its treatment in dialysis patients]. / Ostéodystrophie rénale (3); Son traitement chez le dialysé.

The prevalence and the clinical gravity of the various histopathological varieties of renal osteodystrophy in dialysis patients depends on the severity of both the aluminium intoxication and that of hyperparathyroidism. The prevalence of bone pains, fractures and hypercalcemias are the highest in adynamic bone diseases (ABD) with severe aluminium intoxication, then in osteitis fibrosa and mixed osteopathy, in the ABD with moderate aluminium intoxication and rare in the mild lesion in spite of similar moderate aluminium intoxication. In the absence of aluminium intoxication, hypercalcemia and hyperphosphatemia prevalence is higher only when intact PTH is more that 4 times the upper limit of normal. When PTH is between 1 and 2 folds the ULN this prevalence is null and bone mineral density is the highest. 2. The low turnover aluminic bone diseases (osteomalacic or adynamic) will be cured by long term deferoxamine treatment. The hazards of such treatment justify the performance of a bone biopsy to ensure the diagnosis. Their prevention relies on adequate treatment of tapwater and definitive exclusion of long term administration of aluminum phosphate binders. 3. Non aluminic osteomalacia will be treated according to the same guidelines given for the uremic patients before dialysis. 4. Non aluminic adynamic bone disease will be cured by means aiming at stimulating PTH secretion as discontinuing 1 alpha hydroxylated vitamin D derivatives, and, if there is no hyperphosphatemia by discontinuation of calcium supplement. In case of hyperphosphatemia in dialysis patients CaCO3 doses have to be nevertheless increased after the dialysate calcium concentration (DCa) has been decreased in order to induce a negative perdialytic calcium balance for PTH secretion stimulation. In the near future substitution of CaCO3 by non calcemic non aluminic phosphate binders will suffice. 5. Osteitis fibrosa due to hyperparathyroidism will be treated first by securing an optimal vitamin D repletion (bringing plasma 25OH vitamin D around 30 and 60 ng/ml or 75-150 nmol/l) and by correcting hypocalcemia and hyperphosphatemia by CaCO3 at high doses (3-12 g/day) taken with the meals. In case of hypercalcemia dialysate calcium concentration will be decreased to correct it or, in a near future, CaCO3 will be decreased to 3 g/day and hyperphosphatemia will be controlled by non calcemic, non aluminic phosphate binders. When hyperphosphatemia is controlled whereas plasma calcium is normal or low, 1 alpha hydroxylated vitamin D derivatives can be administered. 6. Instrumental parathyroidectomy should be considered when plasma levels of intact PTH remain above 7 folds the upper limit of normal whereas hyperphosphatemia persists and hypercalcemia occurs in order to prevent thining of the corticals and subsequent fracture risk. In case of previous exposition to aluminum, a deferoxamine test and/or a bone biopsy will be performed to decide a long term DFO treatment before the parathyroidectomy in order to prevent the transformation of a mixed osteopathy into an aluminic adynamic bone disease. 7. The difficulty of hyperparathyroidism control in dialysis patients is due to poor compliance to phosphate binders and to irreversible parathyroid hyperplasia with occured before the dialysis stage. This stress the primary importance if its early prevention without iatrogenia by first CaCO3 and vitamin D repletion, as soon as the creatinine clearance decreases below 60 ml/min/1.73 m2.

[The special problems of occupational guidance]. / Probleme speciale ale orientarii profesionale.

The professional guidance for the motor deficient child is a very important problem due to the fact that our decision will influence the life of the individual from here on. The aspect that must be taken into account when we discuss about professional guidance is the coordination of the movements. Our study is based on 151 school girls with neurologic deficiencies and is focus on the job that the children are trained for. A series of tests were used in order to asses the motricity of the girls. The results obtained showed that many children have been improper orientated, the jobs that they are trained for demanding more physical abilities. In order to improve the social status of the motor deficient person we must choose a profession that will use all his abilities but will not require skills affected by the deficiency.

[Nutrition and old age]. / Alimentatia si vârsta a treia.

The cellular and extracellular degenerative changes that take place simultaneous with aging in elderly will determine changes in the life style. In order to reach the ideal age, the elderly must have a balanced diet, sufficient physical activity and to quit smoking and drinking. In addition to this requirements, the society must provide the economic means, that will allow the elderly a decent life, and free access to medical services.

[An evaluation of interpersonal dependency in physically handicapped children]. / Aprecierea dependentei interpersonale la copii cu handicap fizic.

In assessing the problems of handicapped persons, the social relations represents an important element. The emotional thrust in other persons put in evidence the need for assistance, only 25.1% of the subjects having normal affective relations. The lack of self-thrust and a choosing of a model from the closed community is met in 70.1% of the cases. The expression of the autonomy depends on the degree of motor handicap; 36.1% consider themselves as dependent, but a part of them have only a physical dependence.

[The extra-auditory effects of noise]. / Efecte extrauditive ale zgomotului.

Noise affects not only the ear, but the body as a whole. Noise exposure can trigger a series of functional changes related or not with hearing loss, consisting mainly in sleep disturbances, blood pressure increases, changes in the amplitude and frequency of the respiratory movements, decreases in the visual function and psychological disorders.

[The problems of self-image formation in children with motor deficiencies]. / Probleme legate de formarea imaginii de sine la copii cu deficiente motorii.

Self-image is a representation that each person has on its own body. The personality of an individual develops through progressive knowledge of its own body. Children with motor deficiencies have a modified self-image. For the evaluation of self-image a 1 to 10 self-assessment scale for three items (smart, resourceful, beautiful), and two time periods (now and in the future) was used. As to the dynamic components, the area "locus of control" showed significant positive differences between present and future situations (an increase from 22.1% to 56.5% for smart item, from 35.9% to 65.5% for resourceful item and only a small variation from 30.5% to 37.4% for handsome item, regarding the high marks self-assentiment).

[Illumination in schools, a health problem for the developing body]. / Iluminatul în scoli, problema de sanatate pentru organismul în dezvoltare.

The relationship between lightening degree in schools and vision problems was investigated in a series of 500 pupils (aged between 11 and 14 years) from both rural and urban areas, schooled in 21 different classrooms. The tests revealed that natural lightening is observing the health standards in a percentage of 100% in the urban classrooms and is deficient with 16.64% in the rural ones. Artificial lightening is inappropriate in all investigated classrooms (both rural and urban). Vision, estimated by visual acuity test, proved to be more affected in the rural areas (14% of the children) where lightening conditions are more deficient, than in the urban pupils (12.8%). It was also noticed that the active detection index of vision disturbances is lower in the rural as compared to urban pupils (5.7% and 28.12%, respectively). School lightening should be a priority in the public health programs.

[Difficult pneumonological diagnoses. I. Diagnoses that have not been established]. / Diagnostice pneumologice dificile. Nota I. Diagnostice care nu au fost stabilite.

The authors show that the medical pneumologic practice meets cases in which, after the accumulation and interpretation of the clinical and paraclinical investigation results and after leaving aside the sets of the improbable, no certain diagnosis can be established. The possible reasons of this failure are: the physician's lack of experience in a radiographic chapter, lack of endowment of that medical unit, patient's refusal to be examined or the atypical evolution of the disease. The authors present two such cases, in which, due to the above-mentioned reasons, no certain diagnosis could be established.