Could Endothelin-1 Be a Promising Neurohormonal Biomarker in Acute Heart Failure?

Acute heart failure (AHF) is a life-threatening condition with high morbidity and mortality. Even though this pathology has been extensively researched, there are still challenges in establishing an accurate and early diagnosis, determining the long- and short-term prognosis and choosing a targeted therapeutic strategy. The use of reliable biomarkers to support clinical judgment has been shown to improve the management of AHF patients. Despite a large pool of interesting candidate biomarkers, endothelin-1 (ET-1) appears to be involved in multiple aspects of AHF pathogenesis that include neurohormonal activation, cardiac remodeling, endothelial dysfunction, inflammation, atherosclerosis and alteration of the renal function. Since its discovery, numerous studies have shown that the level of ET-1 is associated with the severity of symptoms and cardiac dysfunction in this pathology. The purpose of this paper is to review the existing information on ET-1 and answer the question of whether this neurohormone could be a promising biomarker in AHF.

Risk Scores for Prediction of Major Cardiovascular Events in Non-Alcoholic Fatty Liver Disease: A No Man's Land?

Over the past 100 years, cardiovascular disease (CVD) has become a leading cause of mortality and morbidity in developed countries, and similar trends have occurred for chronic liver disease. Subsequent research also indicated that people with non-alcoholic fatty liver disease (NAFLD) had a twofold increased risk of CV events and that this risk was doubled in those with liver fibrosis. However, no validated CVD risk score specific for NAFLD patients has yet been validated, as traditional risk scores tend to underestimate the CV risk in NAFLD patients. From a practical perspective, identifying NAFLD patients and assessing severity of liver fibrosis when concurrent atherosclerotic risk factors are already established may serve as an important criterion in new CV risk scores. The current review aims to assess current risk scores and their utility for the prediction of CV events among patients with NAFLD.

Zinc Chloride Enhances the Antioxidant Status, Improving the Functional and Structural Organic Disturbances in Streptozotocin-Induced Diabetes in Rats.

Background and Objectives: Diabetes mellitus (DM) is a complex disease affecting the whole metabolic balance of the body and resulting in multiple organ complications: cardiovascular, neuronal, renal, etc. Our study focuses on investigating the effect of zinc chloride (Zn) on certain blood parameters suggestive for assessing the metabolic disturbances, the liver and kidney function, the oxidative stress and the immune defense capacity in experimental-induced DM with streptozotocin (STZ) and cholesterol in rats. Materials and Methods: The animals were assigned to three groups, as follows: Group 1 (Control): buffer citrate solution 0.1 mL/100 g body; Group 2 (STZ): 20 mg/kg body STZ and fat diet (10 g cholesterol/100 g diet); Group 3 (STZ+Zn): 20 mg/kg body STZ + 5 mg/kg body Zn chloride and the same fat diet. DM was induced by administering STZ in a single take daily, for three consecutive days, Zn and citrate buffer were administered orally for a month. The protocol was approved by the Ethics Committee of the University 'Grigore T Popa' Iasi, in agreement with the International Regulations about the handling of laboratory animals. Results: The use of STZ in rats fed with cholesterol was correlated with important weight gain, hyperglycemia, the intensification of the transaminases activity and the increase in serum alkaline phosphatase, cholesterol, triglyceride, urea, creatinine and in malondialdehyde. Conclusions: The treatment with Zn resulted in weight loss and a decrease in blood sugar in diabetic rats. Supplementation with Zn notably reduced oxidative stress, preserved the pancreatic architecture and restored the liver and kidney function and structure in STZ-induced DM in rats.

Clinical Parameters Affecting the Therapeutic Efficacy of SGLT-2-Comparative Effectiveness and Safety of Dapagliflozin and Empagliflozin in Patients with Type 2 Diabetes.

(1) Background. We aimed to assess long-term efficacy and safety in inadequately controlled type 2 diabetes (T2DM) of two SGLT-2 inhibitors: empagliflozin (Empa) and dapagliflozin (Dapa), combined with metformin, other oral antidiabetics or insulin, according to the protocols in Romania. (2) Methods. The data of 100 patients treated for T2DM with associated dyslipidemia and/or cardiovascular diseases at the University Hospital and Consultmed Medical Center in Iasi were retrospectively reviewed (2017-2021). In total, 48 patients had received dapagliflozin (10 mg with oral antidiabetics or insulin) and 52 patients received empagliflozin (10 mg /25 mg with oral antidiabetics). (3) Results. In both groups, the lowering of BMI was significant: Dapa group (32.04 ± 4.49 vs. 31.40 ± 4.18 kg/m2; p = 0.006), and Empa group (34.16 ± 5.08 vs. 33.17 ± 4.99 kg/m2; p = 0.002). Blood sugar average levels decreased significantly (170 vs. 136 mg/dL; p = 0.001 for Dapa; 163 vs. 140 mg/dL; p = 0.002 for Empa) and also average levels of HbA1c (7.90% vs. 7.51%; p = 0,01 for Dapa; 7.72% vs. 7.35%; p = 0.004 for Empa). (4) Conclusions. Better results in all variables were observed in younger male patients with a shorter duration of diabetes and threshold BMI levels of 34.1, treated with SGLT2, and more significantly with Empa.

Possible Involvement of Vitamin C in Periodontal Disease-Diabetes Mellitus Association.

Ascorbic acid (vitamin C) is an important water-soluble vitamin found in many fruits and vegetables. It has well-documented beneficial effects on the human body and is used as a supplement, alone or in combination with other vitamins and minerals. Over recent years, research has focused on possible new therapeutic actions in chronic conditions including periodontal disease (PD). We conducted a systematic review on clinical trials from four databases (PubMed, Clinical Trials, Cochrane, Web of Science) which measured plasmatic/salivary levels of ascorbic acid in PD-diabetes mellitus (DM) association. Six studies were included in our review, three of them analyzing patients with different grades of PD and DM who received vitamin C as a treatment (500 mg vitamin C/day for 2 months and 450 mg/day for 2 weeks) or as part of their alimentation (guava fruits), in combination with standard therapies and procedures. Decreased levels of vitamin C were observed in PD patients with DM but data about efficacy of vitamin C administration are inconclusive. Given the important bidirectional relationship between PD and DM, there is a strong need for more research to assess the positive effects of ascorbic acid supplementation in individuals suffering from both diseases and also its proper regimen for these patients.

LOW LEVELS OF SERUM CYANOCOBALAMIN IN A METFORMIN-TREATED PATIENT. CASE REPORT AND COMPARISON WITH LITERATURE DATA.

Metformin is a widely used oral antidiabetic biguanide compound. According to the literature, metformin may lower the serum cyanocobalamin levels. We present the case of a 71-old-male treated with metformin for 15 years. When presenting to a periodic checkup, low serum cyanocobalamin levels where found. Laboratory tests showed levels below normal range for hemoglobin (12.7 g/dL) and hematocrit (37.8%). After patient reevaluation, a change in antidiabetic treatment will be considered if metformin will be found the cause of low serum cyanocobalamin levels. Other cases reported in the literature support this hypothesis, justifying the study of the influence of metformin therapy on serum vitamin B12 levels in patients diagnosed with diabetes. The influence of patient age, metformin dosage, duration of treatment and time since diabetes diagnosis on serum levels of vitamin B12 also need to be determined.

Skin necrosis caused by prallethrin-A worldwide used insecticide.

We report a case of necrosis caused by the use of prallethrin (mosquito repellent) on the skin in a 67-year-old diabetic female patient suffering from delusions of parasitosis. Cutaneous toxicity due to pyrethroids is less known or reported, despite well-documented pyrethroid poisoning involving the gastrointestinal, respiratory, cardiac, and nervous systems. Skin irritation has been described after acute accidental exposure but, as far as we know, no data have been published on the effects of pyrethroids when applied directly to the skin.

Electrocardiographic changes in the most frequent endocrine disorders associated with cardiovascular diseases. Review of the literature.

Car- diovascular abnormalities associated with endocrine diseases are often frequent and due to complex relationships between endocrine glands (with internal secretion) and cardiovascular system (heart and vessels). Certain hormones secreted by the endocrine glands (particularly the thyroid and pituitary gland) excesses or deficiencies, are involved in morphogenesis, growth processes and activity regulation of cardiovascular system, most often in connection with the autonomic nervous system. There are also a lot of electrocardiographic changes caused by hormonal disorders that requires differential diagnosis and represents the source of erroneous diagnosis. Endocrine pathology occurred later than a heart disease, may worse heart function. Ignoring the cardiovascular events that may occur in the evolution of endo- crine diseases, may induce increased mortality due to cardiovascular complications.

Adequate weight gain in pregnancy: an analysis of its determinants in a cross-sectional study.

INTRODUCTION: Prenatal care is considered an important tool for promoting a healthy lifestyle, but has not been studied as a predictor for maternal weight gain during pregnancy, especially in Romania, where evidence about pregnancy and nutrition is scarce. OBJECTIVE: This study has aimed to explore the relationship between pre-gestational body mass index (BMI), adequacy of prenatal care and weight gain during pregnancy. METHODS: We carried a cross-sectional study on a sample of 400 pregnant women admitted at the "Cuza Voda" Obstetrics and Gynecology Hospital in Iasi. Information regarding demographic characteristics, number of prenatal visits, date of the initial hospital record, nutritional education during pregnancy were registered throughout a questionnaire filled out by means of a direct interview. The anthropometric indicators analyzed were the pre-gestational BMI and the pregnancy weight gain. Data on caloric intake were obtained using a food frequency questionnaire. RESULTS: Weight gain within the limits of the Institute of Medicine recommendations was noticed at 44.35% of the women who declared that they received nutritional advice compared to 40.7% of those who did not receive advice regarding diet during pregnancy. Overweight (53.1%) and obese women (66.7%) had a larger weight gain than those with a normal pre-pregnancy BMI (29.8%) (p<0.001). The variables that were identified with an effect on weight gain in this sample of pregnant women were: inadequate prenatal care, pre-gestational BMI and energy intake. CONCLUSION: Identifying the pre-gestational BMI and diet changes as predictors of weight gain underline the importance of an individualized prenatal care.

Associated factors of ejection fraction in insulin-treated patients with type 2 diabetes.

AIM OF THE STUDY: to evaluate the relation between ejection fraction (EF), diabetes characteristics and cardiovascular risk factors. MATERIAL AND METHODS: We carried out a cross-sectional study in 171 patients with insulin-treated type 2 diabetes hospitalized at the Sf. Spiridon Emergency Clinical Hospital, Iasi. All patients were evaluated for asymptomatic organ damage and cardiovascular risk factors of hypertension and diabetes metabolic control. Global ejection fraction (EF) was evaluated through 2-D echocardiography. RESULTS AND DISCUSSION: In the studied group the ejection fraction had significant negative correlations with the duration of the disease (p=0.007) and the presence of microalbuminuria (p=0.001). There were some differences between the categories realized by grouping the patients according to the presence of hypertension and/or previous myocardial infarction. In patients without personal history of cardiovascular disease EF was correlated only with LDLc levels. In the hypertensive patients without myocardial infarction it was correlated with diabetes duration, Hb A1e and LDLc, In those patients with both conditions, EF had significant correlations with Hb A1e and microalbuminuria. CONCLUSIONS: These results emphasized that the determinants associated with heart failure in patients with type 2, insulin-treated diabetes, differ according to the presence of high blood pressure and myocardial infarction.

Nutritional knowledge as a determinant of vitamin and mineral supplementation during pregnancy.

BACKGROUND: Pregnancy is a critical period for both woman and baby from a nutritional perspective. Nutritional education is considered an important tool for promoting a healthy lifestyle, but has not been studied as a determinant for maternal use of supplements during pregnancy, especially in Romania, where evidence about pregnancy and nutrition is scarce. This study aimed to evaluate the relationship between nutritional knowledge and the use of folic acid, iron and multivitamin supplements during pregnancy and to assess the influence of socio-demographic factors and prenatal care. METHODS: We conducted a cross-sectional study on a sample of 400 pregnant women admitted to the Cuza-Voda Obstetrics and Gynaecology Clinical Hospital in Iasi, Romania, during August-September 2010. We collected self-reported data regarding socio-demographic characteristics, number of prenatal check-ups and the use of folic acid, iron and multivitamin supplements during pregnancy. We assessed nutritional knowledge using a standardized questionnaire divided into three sections: general nutritional recommendations for pregnant women; the roles of nutrients; and sources of nutrients. We used logistic regression to analyse the associations between these factors. RESULTS: The prevalence of the use of supplements during pregnancy was 48% for folic acid, 45.3% for iron and 68% for multivitamins. Above-average nutritional knowledge was independently associated with the use of folic acid (aOR, 4.7; 95% CI, 1.6-13.8), iron (aOR, 2.6; 95% CI, 1.2-5.7) and multivitamins (aOR, 2.8; 95% CI, 1.2-6.8). The use of folic acid was independently associated with a higher level of formal education (aOR, 5.2; 95% CI, 2.1-12.8) and an early start in prenatal care (aOR, 3.4; 95% CI, 1.0-11.1). Women with a higher education (aOR, 2.3; 95% CI, 1.1-4.9), more than 10 prenatal visits (aOR, 7.2; 95% CI, 3.4-15.0) and those who received advice on breastfeeding (aOR, 2.0; 95% CI, 1.1-3.5) were more likely to use iron during pregnancy. Similar results were found when analysing the contributing factors for the use of multivitamins: more than 12 years of schooling (aOR, 3.4; 95% CI, 1.4-7.9) and appropriate prenatal care (aOR, 9.4; 95% CI, 4.5-19.5). CONCLUSIONS: Level of nutritional knowledge has a strong independent association with the use of supplements during pregnancy.

Metformin induced lactic acidosis--particularities and course.

Diabetes mellitus is a widespread disease with many serious chronic complications. An improvement in the oral antidiabetic medication in respect to its mechanism of action and toxicology was needed in order to have effective therapies with high compliance and minimum side effects. In this context, metformin is a widely used oral antidiabetic drug, which, through its mechanism of action, has no risk of hypoglycemia. However, a rare but serious side effect of biguanides is lactic acidosis. This paper presents a number of 13 cases of metformin-associated lactic acidosis, which outline the circumstances triggering the adverse event and the clinical therapeutic measures applied in the poisoned patients. The main situations that favor metformin-associated lactic acidosis are renal impairment and tissue hypoxia, and the intervention is adapted to the particular patient condition and symptoms, such as marked hypotension and cardiac arrest. Although there are commonalities in describing the consulted patients, the final prognosis is not dependent on the dose or metformin plasma levels, but rather on the associated pathologies and medication.

[Method for the molecular diagnosis of lipoprotein lipase genetic deficiency]. / Metoda de diagnostic molecular al deficitului genetic al lipoprotein lipazei.

Modifications of plasma lipid profile is one of the major causes of a high cardiovascular risk. They can be the consequences of mutations in the gene encoding lipoprotein lipase (LPL), an enzyme that has an important role in the metabolism of plasma lipoproteins. The aim of the present study was to put into practice a method for detecting the Gly188Glu mutation in the LPL gene. The search was performed on a group of 107 patients with cardiovascular diseases and/or dyslipidemias. DNA investigation consisted, in a first stage, in the enzymatic digestion of exon 5 of the LPL gene, previously amplified by the PCR reaction, with the AvaII restriction endonuclease. Three of the subjects were further investigated by the sequencing of exon 5, in order to search for the presence of other mutations. We didn't detect the Gly188Glu mutation in none of the cases, and no other mutation in exon 5 was found in the three patients tested by DNA sequencing. We conclude that the amplification-restriction method can be used for the detection of known mutations in the LPL gene, allowing an early identification of the subjects with a high cardiovascular risk and the onset of the appropriate therapy. In order to detect mutations which don't affect the recognition sequence of a restriction enzyme and eventually new mutations, the sequencing of that gene is recommended.

[HDL-cholesterol--active or passive participant in the pathogenesis of atherosclerosis? (II)]. / HDL-colesterolul--participant activ sau pasiv in patogenia aterosclerozei? (II).

It is known that high sanguin levels of cholesterol and LDL-cholesterol (LDLc) have an important role in the pathogenesis of atherosclerosis. The treatment of hypercholesterolemia with statins and/or with fibrates have had beneficial effects on coronary heart disease and on other localization of atherosclerosis. The decreased of cholesterol and LDL-cholesterol is the most important effect of this treatment. The epidemiological studies have revealed that the treatment with statins and/or with fibrates produce an increase of HDL-cholesterol (HDLc), which is also very important in the regression of atherosclerosis. We tried in this review to explain the mechanisms of the increase of HDL-cholesterol, in concordance with the data from literature.

[HDL-cholesterol-- active or passive participant in the pathogenesis of atherosclerosis]. / HDL-colesterolul--participant activ sau pasiv în patogenia aterosclerozei?

It is known that high sanguin levels of cholesterol and LDL-cholesterol (LDLc) have an important role in the pathogenesis of atherosclerosis. The treatment of hypercholesterolemia with statins and/or with fibrates have had beneficial effects on coronary heart disease and on other localization of atherosclerosis. The decreased of cholesterol and LDL-cholesterol is the most important effect of this treatment. The epidemiological studies have revealed that the treatment with statins and/or with fibrates produce an increase of HDL-cholesterol (HDLc), which is also very important in the regression of atherosclerosis. We tried in this review to explain the mechanisms of the increase of HDL-cholesterol, in concordance with the data from literature.

[Evaluation of the systolic and diastolic function of the left ventricle in patients with diabetes mellitus and microalbuminuria]. / Evaluarea functiei sistolice si diastolice a ventriculului stâng la pacientii cu diabet zaharat cu microalbuminurie.

UNLABELLED: The objective of this study is to reveal the deterioration of the systolic and diastolic function of the left ventricle (LV) in patients with diabetes mellitus (DM), in correlation with type of DM, the edge and the complications of DM and the associated diagnosis. METHODS: The study included 43 patients with DM (29 patients with DM type 1 or 2 insulinodependent--DMID and 14 patients with DM type 2 nonisulinodependent--DMNID). The age of patients was between 21 years and 57 years, with a duration of DM between 1 year and 22 years. The ecocardiographic evaluation have determined 38 parameters (B mod, M mod, CWD, PWD, colour Doppler). From these parameters, 12 was used for the measurement of the systolic function of the LV and 18 was used for the determination of the diastolic function of the left ventricle. The clinical and biological exam have performed: glycaemia, proteinuria, dyslipidemic syndrome, complications of DM and ischaemic heart disease (ECG). RESULTS: The ejection fraction (EF) of the LV was ?60% in 23 patients, between 50% and 60% in 17 patients and between 40% and 50% in 3 patients. The values of MSER (mean systolic ejection rate) was between 221 ml/s si 515 ml/s and the values of MVCF (mean velocity of circumferential shortening) was between 0.9 circ/s si 1, 8 circ/s. The ratio of the E and A waves at the mitral valve was > 1 in 22 patients and < 1 in 21 patients. The LV isovolumic relaxation time (IVRT) was < 70 ms in 13 patients, > 100 ms in 14 patients and had normal values in 16 patients. The E wave deceleration time (EDT) was < 150 ms in 24 patients and had normal values in 19 patients. There is no connection between the systolic/diastolic function and the other determined parameters. CONCLUSIONS: The alteration of the LV systolic function was present in 20 patients from 43 patients. The LV diastolic dysfunction through relaxation troubles was present in 14 patients and the LV diastolic dysfunction through compliance trouble was present in 13 patients. A number of 16 patients had preserved (for the moment) a normal LV diastolic function. The number of patients with these two types of LV diastolic dysfunction was equal in our study. Other studies had found a predominance of LV diastolic dysfunction through compliance troubles in DM.