Publications by authors named "Bogdan Timar"

68 Publications

Exploring the relation between mortality and left ventricular structure and function in stable hemodialysis treated patients, a longitudinal multicenter cohort study.

Sci Rep 2021 Jun 16;11(1):12694. Epub 2021 Jun 16.

Department of Internal Medicine II - Division of Nephrology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania.

Left ventricular (LV) structure and function anomalies are frequent during the CKD continuum and are associated with increased risk of mortality. Cross section and longitudinal ultrasound data are available for advanced CKD and transition to ESKD. Less information is available about LV changes during stable, long-term hemodialysis (HD) treatment. All stable HD patients from 9 HD centers (1034 patients, 671 males, age 58.71 ± 12.94 years) have been enrolled in January 2015. The cohort was followed-up for 4 years, kidney transplantation or death. Yearly, two-dimensional and M-mode continuous and Pulse Doppler echocardiography were performed. During the follow-up, the prevalence of cardiovascular comorbidities significantly increased (p < 0.0001), coronary artery disease (CAD) from 73.5 to 88.8%, peripheral artery disease (PAD) from 29 to 40.9%, cerebral vascular disease (CVD) from 20.4 to 30.8%, heart valves calcification (VC) from 65.6 to 89.3% and left ventricular hypertrophy (LVH) from 67.6 to 76.5%. The mortality risk increased with the presence of CAD (1.59-fold), PAD (1.61-fold), CVD (1.59-fold), and VC (1.77-fold). Mortality risk was increased in those with LVEF < 50% (LVEF 40-49% 1.5-fold and LVEF < 40% 2.3 fold). Among the survivors of the first year, LVEF varied (> 5% decrease, > 5% increase and ± 5% variations). More than 5% increase of LVEF was associated with higher mortality risk (crude 1.5-fold, adjusted 1.43-fold) compared to stationary EF (p = 0.001). Cardiovascular disease progresses during stable long-term HD therapy and increases mortality risk. HF becomes highly prevalent but only HF with decreased LVEF < 50% is associated with increased risk of mortality.
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http://dx.doi.org/10.1038/s41598-021-91431-9DOI Listing
June 2021

The Mental Status in Patients with Diabetes Mellitus Admitted to a Diabetes Clinic After Presenting in the Emergency Room: The Application of the SCL-90 Scale.

Diabetes Metab Syndr Obes 2021 28;14:1833-1840. Epub 2021 Apr 28.

Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.

Background: Diabetes mellitus (DM) is one of the most serious public health problems, involving increasing costs worldwide. The mental state of a person with DM is varied and ever-changing, such as stress, the pressure to always do everything by the book, sadness, anger, and even denial of the disease, all these are feelings patients with DM will experience throughout their life.

Aim: The aim of our study was to assess the presence of mental and psychiatric disorders (anxiety, depressive states, paranoid ideation, phobia, obsessive-compulsive disorder) in a group of patients with DM after hospitalization in the Clinic for Diabetes, Nutrition, and Metabolic Diseases, for various exacerbations of the underlying condition, looking for possible correlations with other cardiovascular risk factors.

Patients And Methods: Clinical and biological parameters, the presence of acute and chronic complications of the diabetic patients have been evaluated. To assess mental health, the symptom checklist (SCL)-90 questionnaire was conducted for all admitted patients.

Results: We observed that the number of patients with obsessive-compulsive disorders was relatively high (23.3%), while depression was present in 17.1% of the patients. Also, 10.6% of patients had hostility and 15.6% had delusional ideation. The presence of psychiatric disorders was associated with a higher age (62 vs. 46.5 years; <0.001), a longer diabetes duration (11 vs. 9 years; <0.001), higher fasting glycemia (188 vs. 132 mg/dL; 0.001) and postprandial glycemia (212 vs. 152 mg/dL; 0.001), and triglycerides (125 vs. 110 mg/dL; 0.001). Patients with altered mental status have shown statistically significantly more altered clinical and biological parameters compared to those without these mental disorders.

Conclusion: Patients with DM represent a psychologically vulnerable population, which is why they should undergo early and regular screening for both psychological and psychiatric conditions, especially at admission.
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http://dx.doi.org/10.2147/DMSO.S304904DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8089080PMC
April 2021

Shear Wave Elastography in Patients with Primary and Secondary Hyperparathyroidism.

J Clin Med 2021 Feb 10;10(4). Epub 2021 Feb 10.

Endocrinology Department, "Victor Babes" University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania.

Objectives: In this study, we aim to determine the elastographic characteristics of both primary and secondary hyperparathyroidism using shear wave elastography. We also aim to evaluate the elastographic differences between them, as well as the differences between the parathyroid, thyroid, and muscle tissue, in order to better identify a cutoff value for the parathyroid tissue.

Methods: In this prospective study, we examined a total of 68 patients with hyperparathyroidism, divided into two groups; one group consisted of 27 patients with primary hyperparathyroidism and the other group consisted of 41 selected patients with confirmed secondary hyperparathyroidism. The elasticity index (EI) was determined in the parathyroid, thyroid, and muscle tissue. The determined values were compared to better identify the parathyroid tissue.

Results: The median value of mean SWE values measured for parathyroid adenomas from primary hyperparathyroidism was 4.86 kPa. For secondary hyperparathyroidism, the median value of mean SWE was 6.96 KPa. The median (range) presurgical values for parathormone (PTH) and calcium were 762.80 pg/mL (190, 1243) and 9.40 mg/dL (8.825, 10.20), respectively. We identified significant elastographic differences between the two groups ( < 0.001), which remained significant after adjusting elastographic measures to the nonparametric parameters, such as the parathormone value and vitamin D ( < 0.001). The cutoff values found for parathyroid adenoma were 5.96 kPa and for parathyroid tissue 9.58 kPa.

Conclusions: Shear wave elastography is a helpful tool for identifying the parathyroid tissue, in both cases of primary and secondary hyperparathyroidism, as there are significant differences between the parathyroid, thyroid, and muscle tissue. We found a global cutoff value for the parathyroid tissue of 9.58 kPa, but we must keep in mind that there are significant elastographic differences between cutoffs for primary and secondary hyperparathyroidism.
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http://dx.doi.org/10.3390/jcm10040697DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916795PMC
February 2021

Death by SARS-CoV 2: a Romanian COVID-19 multi-centre comorbidity study.

Sci Rep 2020 12 10;10(1):21613. Epub 2020 Dec 10.

University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu Str., 020021, Bucharest, Romania.

Evidence regarding the relation between SARS-CoV-2 mortality and the underlying medical condition is scarce. We conducted an observational, retrospective study based on Romanian official data about location, age, gender and comorbidities for COVID-19 fatalities. Our findings indicate that males, hypertension, diabetes, obesity and chronic kidney disease were most frequent in the COVID-19 fatalities, that the burden of disease was low, and that the prognosis for 1-year survival probability was high in the sample. Evidence shows that age-dependent pairs of comorbidities could be a negative prognosis factor for the severity of disease for the SARS-CoV 2 infection.
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http://dx.doi.org/10.1038/s41598-020-78575-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730445PMC
December 2020

Factors Associated with the Remission of Type 1 Diastolic Dysfunction after Dapagliflozin Treatment in Patients with Type 2 Diabetes.

J Clin Med 2020 Nov 23;9(11). Epub 2020 Nov 23.

Second Department of Internal Medicine, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timisoara, Romania.

Patients with type 2 diabetes (T2DM) are at high risk of developing cardiovascular disease and heart failure (HF), both with preserved and reduced ejection fraction of the left ventricle. Previous research demonstrated that dapagliflozin treatment is associated with the remission of type 1 diastolic dysfunction (DD1) in patients with T2DM. The main aim of this study was to evaluate the possible baseline predictors associated with the remission of DD1 in patients with T2D after one year of dapagliflozin treatment. In this prospective and observational study, 45 patients with T2DM were evaluated before and after one year of treatment with 10 mg dapagliflozin daily added to their background therapy. In the studied group, 73.3% (33/45) of the patients had DD1 at baseline. The primary outcome of this research was DD1 remission. DD1 remission was associated with improvement of liver stiffness, an increase in estimated glomerular filtration rate (eGFR), and a decrease in hemoglobin A1c (HbA1c). Independent predictors for the remission of DD1 were a more than 0.4 kPa difference in the initial stiffness score and the 1-year assessment fibrosis score and a duration of diabetes ≤8 years. Age, body mass index (BMI), or patient weight after one year did not influence the DD1 outcome. Patients with a T2DM duration of less than eight years have the additional benefit of DD1 remission associated with dapagliflozin treatment beyond the conventional benefits such as improvements in glycemic control, cardiovascular, renal, and hepatic risk reductions. In patients with T2DM, the remission of DD1 was associated with decrease of liver stiffness.
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http://dx.doi.org/10.3390/jcm9113779DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700333PMC
November 2020

Metformin Treatment: A Potential Cause of Megaloblastic Anemia in Patients with Type 2 Diabetes Mellitus.

Diabetes Metab Syndr Obes 2020 21;13:3873-3878. Epub 2020 Oct 21.

Second Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.

Introduction: Vitamin B12 (cobalamin) deficiency is a frequent cause of megaloblastic anemia, manifested through various symptoms. Screening for this deficiency can be justified in case of patients with one or more risk factors present from the following: gastric resections, inflammatory bowel disease, use of metformin over a prolonged period of time, administration of proton pump inhibitors or H2 histamine receptor blockers for more than 12 months and in case of adults over 75 years of age. One method of determining vitamin B12 deficiency is measuring its serum levels, as well as performing measurements of serum levels of methylmalonic acid and homocysteine levels, which experience an increase in the early stages of vitamin B12 deficiency.

Clinical Case: We bring to your attention, the case of a 62 years old patient diagnosed with Type 2 Diabetes Mellitus in 2015 that presented in the emergency room in October 2019 with an altered general condition, nausea, vomiting, abdominal pain, palpitation, and dyspnea. Treatment with metformin was initiated from the diagnosis of Type 2 Diabetes Mellitus, four years before. Investigations established the diagnosis of megaloblastic anemia by vitamin B12 deficiency. The symptoms disappeared after the injection of vitamin B12.

Conclusion: Periodical dosing of vitamin B12 should be performed in the case of patients with Type 2 Diabetes Mellitus treated with metformin, especially if they associate anemia and/or peripheral diabetic polyneuropathy.
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http://dx.doi.org/10.2147/DMSO.S270393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7586010PMC
October 2020

Comparison of early pregnancy serum concentration of neopterin, neopterin/creatinine ratio, C-reactive protein, and chitotriosidase, in pregnant women with birth at term and spontaneous preterm birth.

Exp Ther Med 2020 Sep 21;20(3):2449-2454. Epub 2020 May 21.

Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.

Inflammatory mechanisms are involved in achieving a normal pregnancy and in the development of certain pregnancy complications. These changes are more intense in pregnant women that suffer of pregnancy complications, such as spontaneous preterm birth (SPB). This study compared the course of inflammatory markers (IM) [neopterin (Neo), neopterin/creatinine ratio (Neo/Cre), C-reactive protein (CRP), and chitotriosidase (Chito)] serum concentration in the early pregnancy of women with birth at term (BT) and preterm birth (PB). IM concentration was measured in 90 sera sampled from 45 pregnancies with BT and 30 sera from 15 pregnancies with PB. Two sera were sampled from each pregnant woman: one in the first trimester and another one in the second trimester. Early pregnancy IM concentration showed a direct correlation with gestational age: Neo (rho=0.262, P=0.004), Neo/Cre (rho=0.372, P<0.001), CRP (rho=0.187, P=0.041), and Chito (rho=0.039, P=0.66). The correlation was present in both categories of patients with BT and PB. Patients with PB before 34 week of pregnancy (wp) and 32 wp showed higher Neo and Neo/Cre concentration than BT patients. A significant association was found between the risk of PB before 34 wp, PB before 32 wp, and Neo concentration (PB <34 wp: odds ratio (OR) =5.13, P=0.035) (PB <32 wp: OR=8.2, P=0.020) and, respectively, Neo/Cre concentration (PB <34 wp: OR=5.29, P=0.015) (PB <32 wp: OR=9.25, P=0.006). No association between CRP or Chito and PB age was found. IM concentration correlates with the gestational age at the time of blood sampling. Increased Neo and Neo/Cre concentration are associated with PB. Further studies are needed to evaluate the usefulness of these markers in clinical practice.
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http://dx.doi.org/10.3892/etm.2020.8784DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7401568PMC
September 2020

The efficacy of a mobile phone application to improve adherence to treatment and self-management in people with chronic respiratory disease in Romanian population - a pilot study.

BMC Health Serv Res 2020 May 27;20(1):475. Epub 2020 May 27.

Internal Medicine Discipline, Medical Clinical Disciplines I, "Ovidius" University of Constanta, Faculty of Medicine, Constanta, Romania.

Background: Many studies assessed the effect of mobile phone applications on self-management outcomes in patients with asthma, but all of them presented variable results. In this paper. we examined the effect of a mobile phone application on self-management and disease control in Romanian population.

Methods: This study included 93 patients diagnosed with asthma that were recalled every three months for a year for assessment and treatment. Patients were divided into two groups. The first group included patients that received treatment, and the second group received treatment and also used the smartphone application. Number of exacerbations and asthma control test (ACT) were recorded.

Results: The ACT score was significantly higher for asthma patients using also the mobile application than for the patients using the treatment alone, for all the evaluation moments (Mann-Whitney U test, p <  0.001). Also, we found significant differences between the ACT score with-in each group, observing a significant improvement of the score between evaluations and baseline (related-samples Friedman's test with Bonferroni correction, p <  0.001). When considering the exacerbations rate, significantly less patients using the application presented exacerbations, 10.30% vs. 46.30% (Pearson Chi-square test, X (1) = 13.707, p <  0.001).

Conclusion: Our study indicates that smartphone applications are an effective way to improve asthma control and self-management when used continually in our population. We found significant positive effects in disease control and exacerbation frequency.
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http://dx.doi.org/10.1186/s12913-020-05340-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254754PMC
May 2020

Long-term Risk of Malignant Neoplastic Disorders in Type 2 Diabetes Mellitus Patients with Metabolic Syndrome.

Diabetes Metab Syndr Obes 2020 23;13:1317-1326. Epub 2020 Apr 23.

Second Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.

Background: In developing countries, cancer incidence has progressively increased, becoming the second cause of mortality after cardiovascular diseases. Type 2 diabetes mellitus (T2DM) is associated with an increased risk of malignant neoplastic disorders, especially pancreatic cancer, colorectal cancer, and breast cancer.

Aim: The main aim of our study was to establish the prevalence of malignant neoplastic disorders in patients previously diagnosed with T2DM. Also, we have investigated the association between the components of the metabolic syndrome (MetS) and the different types of diagnosed malignant neoplasms.

Methods: We performed a retrospective, population-based cohort study of 1,027 patients with T2DM from the Center for Diabetes Treatment of the "Pius Brînzeu" Emergency Hospital in Timisoara, Romania. The patients were followed up every three or six months, depending on their antidiabetic treatment. The patients who developed malignant neoplasms were registered and referred to oncology centers. The potential risk factors for malignancies in patients with T2DM were evaluated using logistic regression adjusting for possible confounders.

Results: The prevalence of malignant neoplastic disorders in our study group was 7.1%; more precisely, we found 2.2% colon neoplasm, 2.9% mammary neoplasm, 0.7% lymphomas, 0.6% pulmonary neoplasm, 0.3% pancreatic neoplasm, and 0.4% prostate neoplasm. The presence of malignant neoplastic disorders was associated in our cohort of patients with T2DM with higher cholesterol (237.71±47.82 vs 202.52±52.16 mg/dL; p=0.005) and triglycerides levels (215.91±52.41 vs 180.75±54.32 mg/dL; p<0.001), as well as higher body mass index (33.37±3.87 vs 28.42±3.56 kg/m; p<0.001) and abdominal circumference (110.11±14.48 vs 98.12±15.73 cm; p<0.001). Also, we found that insulin-based treatment was an independent risk factor, the patients presenting ten times higher odds of developing malignant neoplastic disorders.

Conclusion: The prevalence of malignant neoplastic disorders in our study group was 7.1%. Also, the prevalence of malignant neoplastic disorders was higher in patients with T2DM and MetS as compared to the general population of T2DM patients.
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http://dx.doi.org/10.2147/DMSO.S243263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7185322PMC
April 2020

Cross-cultural adaptation and validation of the Romanian knee disability and osteoarthritis outcome score for joint replacement (KOOSJR).

BMC Musculoskelet Disord 2020 Mar 7;21(1):155. Epub 2020 Mar 7.

Department of Orthopedics, Traumatology and Pediatric Orthopedics, "Iuliu Hatieganu" University of Medicine and Pharmacy, No 8 Victor Babes Str, Cluj-Napoca, Romania.

Aim: To perform validation of the Romanian Knee disability and Osteoarthritis Outcome Score for Joint Replacement (KOOSJR).

Method: Ninety-six patients (101 knees) with advanced osteoarthritis (OA) scheduled for total knee replacement completed Romanian translations of KOOSJR and IKDC (International Knee Documentation Committee - subjective knee form) and Euroqol EQ-5D-5 L, and the treating physician completed the original knee society score (KSS).

Results: Average age was 66.4 (range 50-83) years and male to female ratio 1:3.76. There was moderate correlation between the test-retest (average 4 days) KOOSJR (r = 0.618, n = 45) and IKDC (r = - 0.671, n = 99), weak between KOOSJR and EQ-5D-5 L Index (r = - 0.431, n = 100) and VAS (r = - 0.364, n = 99) and very weak to KSS score (r = - 0.133, n = 98) and function (r = - 0.072, n = 97) For the first KOOSJR, Cronbach's alpha was 0.816 and intraclass correlation coefficient (ICC) 0.816 (95% CI 0.755-0.866) for average measures. For the retest, Cronbach's alpha was 0.841 (95% CI 0.760-0.903) for averages.

Conclusion: The Romanian Knee disability and Osteoarthritis Outcome Score for Joint Replacement (KOOSJR) is a valid, reliable, consistent and reproducible clinical score for patients with OA requiring arthroplasty.
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http://dx.doi.org/10.1186/s12891-020-3183-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7060578PMC
March 2020

Cross-cultural adaptation and validation of the Romanian International Knee Documentation Committee-subjective knee form.

PeerJ 2020 3;8:e8448. Epub 2020 Feb 3.

Department of Orthopedics, Traumatology and Pediatric Orthopedics, University of Medicine and Pharmacy of Cluj-Napoca, Cluj-Napoca, Romania.

Aim: We aimed to translate and cross-culturally adapt the International Knee Documentation Committee-subjective knee form (IKDC) in Romanian.

Method: The original (US) IKDC-subjective knee form was translated according to recommended guidelines. Validity was tested using Spearmans's correlation coefficient between score sand test-retest reproducibility. Reliability and internal consistency were determined using Cronbach's alpha coefficient and intraclass correlation coefficient (ICC).

Results: A total of 106 data sets were available for processing. The average age was 52 years and the male to female ratio was 40:66. Fifty-five subjects repeated the form after an average of 4 days. There were no floor or ceiling effects (range 3.4-74.7). There was a strong correlation between the first and repeated administration of the IKDC-subjective knee form ( = 0.816,  = 50) and moderate compared to Tegner-Lysholm knee rating scale ( = 0.506,  = 102), KOOSJR (Knee disability and Osteoarthritis Outcome Score for Joint Replacement,  =  - 0.622,  = 96), EuroqolEQ-5D-5L Index ( = 0.633,  = 100) and visual analogue scale VAS ( = 0.484,  = 99). Internal consistency was moderate with Cronbach's alpha 0.611 ( = 102) and ICC 0.611 for average measures (95% CI 0.493-0.713).

Conclusion: The Romanian translation of the IKDC-subjective knee form is a valid, consistent and reproducible outcome measure in patients with knee pain and dysfunction.
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http://dx.doi.org/10.7717/peerj.8448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003694PMC
February 2020

Influence of depression and self-esteem on oral health-related quality of life in students.

J Int Med Res 2020 Feb;48(2):300060520902615

University of Medicine and Pharmacy "Victor Babeș", Department of Neuroscience, Discipline of Psychiatry, Timisoara, Romania.

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http://dx.doi.org/10.1177/0300060520902615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7111024PMC
February 2020

Dynamics of Epicardiac Fat and Heart Function in Type 2 Diabetic Patients Initiated with SGLT-2 Inhibitors.

Diabetes Metab Syndr Obes 2019 5;12:2559-2566. Epub 2019 Dec 5.

Second Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.

Purpose: The aim of this study was to assess the dynamics of epicardiac adipose tissue (EAT) thickness and total volume as well as that of systolic and diastolic dysfunction in a group of patients with type 2 diabetes (T2D) after initiation of sodium glucose co-transporter 2 (SGLT 2) inhibitors therapy.

Patients And Methods: This prospective, observational study included 53 patients with T2D who received SGLT-2 inhibitors for 24 weeks. In all patients, echocardiographic screening for EAT, systolic and diastolic dysfunction and non-contrast computed tomography scans were performed, both before and after 24 weeks of SGLT-2 inhibition. Imagistic evaluation was followed by the association's analysis between the dynamics of EAT and heart function, as well as the patient's clinical and biological parameters. We considered a decrease or increase of more than 10% in EAT as being clinically significant.

Results: The mean volume of EAT decreased significantly after SGLT 2 inhibition (37.8±17.2 vs. 20.7±7 cm; <0.001). Median values of EAT thickness also decreased significantly (5.95 vs. 3.01 mm; p<0.001). Most patients, 75.4% (40/53), presented more than 10% decrease in EAT volume, 9.5% (5/53) had stable EAT volume values, while in 15.1% (8/53) the means of EAT volume increased. 73.5% of the patients had diastolic dysfunction type 1 (DD 1) at baseline. No significant change was observed in the left ventricular ejection fraction or diastolic dysfunction after 24 weeks of treatment. Although not statistically significant, an improvement in cardiac function has been noticed throughout the duration of 1 year of treatment with SGLT 2 inhibitors.

Conclusion: This study showed the beneficial effect of SGLT 2 inhibitors on EAT after a short period of treatment, but there were no significant changes in the systolic function during the 1st year of study. However, reducing epicardial fat has led to remission of diastolic dysfunction.
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http://dx.doi.org/10.2147/DMSO.S223629DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901055PMC
December 2019

Inhaler technique errors in Romanian patients with asthma - a multicenter study.

Patient Prefer Adherence 2019 19;13:1401-1414. Epub 2019 Aug 19.

Faculty of Medicine, Internal Medicine Discipline, Medical Clinical Disciplines I, "Ovidius" University of Constanta, Constanta, Romania.

Background: Non-adherence to treatment is associated with poor asthma control, increased exacerbations, decline in lung function, and decreased quality of life. M-health applications have become increasingly in the last years, but little research regarding the efficiency of the instructional videos for correct inhaler use exist. The aim of this study is to assess and improve the inhalator technique and to establish which types of errors were made more often with the help of a mobile health application.

Materials And Methods: Seventy-five patients with partially controlled or uncontrolled asthma, using any of turbuhaler, diskus, pressurized metered dose inhaler (pMDI) or soft mist inhaler (SMI), were included in the study. When they first entered the study, the patient's inhaler technique was assessed by a trained medical professional and the technique errors were categorized in handling, respectively inhalation errors. After the first evaluation, the patients downloaded an application on their Smartphone and were encouraged to use the application as much as needed to remind them the correct inhalation technique. The patients were re-called every three months for evaluation, treatment, and assessment of inhalation technique.

Results: We analyzed both handling and inhalation errors for each of the four considered inhalers. We observed a significantly reduced number of inhalation technique errors after using the mobile phone application. Turbuhaler median errors were 6.00, and after six months we did not observe errors. Diskus median error was 6.00, and after six months we observed a maximum of one error. pMDI median errors were 7.00, and after six months we observed just one error. Similarly, SMI median error was 7.00, and after six months we observed just one error.

Conclusion: Although technique inhalation errors are very common among asthma patients, video instructions provided through specific mobile phone applications could improve the inhaler technique in order to achieve a better control of the disease.
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http://dx.doi.org/10.2147/PPA.S209717DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6707372PMC
August 2019

Ultrasound mapping of lung changes in idiopathic pulmonary fibrosis.

Clin Respir J 2020 Jan 14;14(1):54-63. Epub 2019 Nov 14.

Department of Pulmonology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.

Introduction: Idiopathic pulmonary fibrosis (IPF) is the most common and severe form of idiopathic interstitial pneumonia, accounted for 20% of cases of interstitial lung disease (ILD). In this study, we sought to compare the lung changes of IPF using a lung ultrasound (LUS) protocol of 12 zones with "current standard" high resolution computed tomography (HRCT) diagnostic method and overlap it with the functional pulmonary test as a complete clinical and imaging evaluation.

Methods: Thirty-one patients were included in the study and performed HRCT and pulmonary functional tests (PFT). A 12-lung zones' LUS protocol was used and compared with HRCT and PFT.

Results: The HRCT total fibrotic score had a correlation coefficient of 0.454 (P < 0.005) with predicted FVC and 0.713 with predicted DLCO (P < 0.001). Both the median of the number of B-lines and the average of the thickness of the pleural line obtained in the LUS assessment had a positively and statistically significant correlation with the HRCT fibrotic score P < 0.001. The pleural thickness of 2.4 mm is the cut-off value of the mild form of fibrosis with a sensitivity of 0.958 and a specificity of 0.994.

Conclusion: B-lines and the average thickness of the pleural line as LUS markers of the fibrotic interstitial syndrome are highly and positively correlated with HRCT score, FVC and DLCO. LUS as a complementary method in the clinical management of IPF could be used more often by skilled clinicians to assess patients in terms of possible diagnosis and monitoring of IPF.
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http://dx.doi.org/10.1111/crj.13101DOI Listing
January 2020

The Impact Of Hyperuricemia On Cardiometabolic Risk Factors In Patients With Diabetes Mellitus: A Cross-Sectional Study.

Diabetes Metab Syndr Obes 2019 3;12:2003-2010. Epub 2019 Oct 3.

Department of Diabetes and Metabolic Diseases, "Pius Brinzeu" Emergency Hospital, Timisoara, Romania.

Purpose: Hyperuricemia (HUA) is linked to a variety of non-communicable diseases such as atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD) and hypertension, with evidence showing its role in the development of diabetes mellitus (DM). Our study's main aim was to explore the associations of HUA with other traditional risk factors in Romanian patients with DM and to assess the impact of the increase of serum UA on DM complications and HbA1c.

Patients And Methods: In this cross-sectional, non-interventional study, we enrolled, according to a population-based, consecutive-case principle, 133 patients previously diagnosed with DM. HbA1c, uric acid, lipid profile, urinary albumin/creatinine ratio, glomerular filtration rate, TSH and FT measurements were performed, while the diagnosis of retinopathy and of diabetic neuropathy was established using standardized methods.

Results: An increased uric acid level was associated with a significant increase in the risk for development of stroke (OR=1.526; p=0.004). A weak, positive and statistically significant correlation can also be observed between the BMI and the presence of hyperuricemia (r=0.131; p=0.034), and between the triglyceride levels and hyperuricemia (r= 0.173; p=0.004). Glomerular filtration rate was correlated to hyperuricemia in a strong and negative manner, having an important statistical significance (r=-0.818; p=0.003). In our study, UA levels and HbA1c were negatively correlated, without reaching statistical significance.

Conclusion: Serum UA is strongly correlated with the BMI, triglyceride level and GFR in Romanian patients with DM and HUA is significantly associated with a higher risk of stroke in these individuals.
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http://dx.doi.org/10.2147/DMSO.S222570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6781154PMC
October 2019

Validation and cross-cultural adaptation of the depression Patient's Health Questionnaire - 9 in the Romanian population of patients with Type 2 Diabetes Mellitus.

Diabetes Metab Syndr Obes 2019 30;12:841-849. Epub 2019 May 30.

Second Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.

To validate and to evaluate the performance in depression screening of the Patient's Health Questionnaire - 9 (PHQ-9) for Romanian patients with Type 2 Diabetes Mellitus (T2DM). In a consecutive-case, population-based, non-interventional study design 107 hospitalized patients with T2DM were enrolled. The PHQ-9 was evaluated in regard to its acceptability, ceiling and floor effect, reproducibility, and test-retest performance. Its validity was tested by comparing it to the Beck depression scale, which is a validated tool for this patient population. The PHQ-9 questionnaire had an excellent acceptability, having no non-responders for any of its questions and a median completion time of 3 mins and 12 s, a good reliability with a Cronbach's =0.897 [0.865-0.924] 95%CI, a good test-retest performance (Spearman's rho =0.972; <0.001 between two administrations of the test) without any ceiling or floor effect observed for the total score. At the same time, the score demonstrated a good validity when compared to a more complex and previously validated instrument like the Beck depression scale (Spearman's rho =0.777; <0.001). The limits of agreement (Bland-Altmann analysis) between the two measurements are 2.6 to -2.5 points. The PHQ-9 is a valid, useful instrument for depression screening in Romanian patients with T2DM.
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http://dx.doi.org/10.2147/DMSO.S203099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6549435PMC
May 2019

Contrast-Enhanced Ultrasound for the Characterization of Malignant versus Benign Focal Liver Lesions in a Prospective Multicenter Experience - The SRUMB Study.

J Gastrointestin Liver Dis 2019 Jun 1;28:191-196. Epub 2019 Jun 1.

Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, and Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.

Aim: This study evaluated the accuracy of contrast-enhanced ultrasound (CEUS) for the differential diagnosis of benign vs. malignant focal liver lesions (FLL) in a real-life, multicenter experience.

Methods: This prospective study, including 14 Romanian centers, was performed over a 6 year period (February 2011- April 2017) and included 2062 FLLs assessed by CEUS. Inclusion criteria were: newly diagnosed FLL on B-mode ultrasound, less than three lesions/patient, all FLLs evaluated by CEUS and by a second-line imaging technique (contrast enhanced CT or contrast enhanced MRI) or histology, considered as reference. The trial was registered in clinicaltrials.gov (Identifier NCT01329458).

Results: From the 2062 FLLs included in the study, 57.2% (1179) were malignant and 42.8% (883) were benign. CEUS had 83.9% sensitivity (Se), 97.8% specificity (Sp), 98.1% positive predictive value (PPV), 82.2% negative predictive value (NPV) and a diagnostic accuracy (Ac) of 89.9% for the positive diagnosis of malignant lesions. For the benign lesions, CEUS had 97.8% Se, 83.9% Sp, 82.2% PPV, 98.1% NPV 89.9% Ac. The diagnostic performance of CEUS for hepatocellular carcinoma was 76.6% Se, 98.4% Sp, and 91.2% Ac; for hemangioma: 89.2% Se, 99% Sp, and 96.9% Ac and for metastases: 90.9% Se, 98.4% Sp, and 96.9% Ac.

Conclusions: CEUS proved a high accuracy in differentiating the malignant vs. benign character of a FLL. It can be confidently used as a first line imaging method in daily practice.
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http://dx.doi.org/10.15403/jgld-180DOI Listing
June 2019

C-reactive protein as a prognostic risk factor for loss of arteriovenous fistula patency in hemodialyzed patients.

J Vasc Surg 2019 Jul 18;70(1):208-215. Epub 2019 Feb 18.

Department of Hemodialysis, Arad Municipal Clinical Emergency Hospital, Arad, Romania; Department of Internal Medicine, Faculty of Medicine, "Vasile Goldis" Western University of Arad, Arad, Romania; B. Braun Avitum Dialysis Center Arad, Arad, Romania.

Background: Inflammation is a cardiovascular risk factor in hemodialysis patients, but its influence on vascular access patency is still debatable. Our prospective study investigated this issue.

Methods: A total of 258 patients receiving an arteriovenous fistula (AVF) between 2006 and 2016 at the Municipal Hospital Arad were included. Demographic, clinical, and laboratory characteristics were collected at the time of creation of the AVF. The primary study end point was AVF patency loss, defined as an event occurring at least 2 months after AVF formation and requiring surgical revision or replacement of the fistula. The patients were followed up for a median time of 26 months.

Results: In our group, the mean age was 59.7 ± 13.2 years (median, 62 years), and 60.1% were male. During follow-up, 134 patients (51.9%) maintained AVF patency, whereas 124 (48.1%) lost AVF patency within a mean time of 23.3 ± 28.1 months (median, 10.5 months). We found that age (hazard ratio [HR], 1.015; P = .035) and C-reactive protein (CRP) level (HR, 1.17; P < .0001) were associated with a higher risk of loss of AVF patency. The protective factors for AVF patency were autosomal dominant polycystic kidney disease (HR, 0.336; P = .009), pre-emptive AVF (HR, 0.648; P = .031), and higher level of triglycerides (HR, 0.998; P = .035). In the multivariate adjusted Cox model, CRP level remained an independent predictor for loss of AVF patency (HR, 1.17; 95% confidence interval, 1.1-1.3; P < .0001).

Conclusions: In our study, CRP level was an independent predictor of AVF patency loss, whereas better AVF survival was independently associated with autosomal dominant polycystic kidney disease and pre-emptive AVF. As a simple noninvasive marker of chronic inflammation, CRP level may be a useful tool to predict AVF outcomes. Further research is needed to assess the protective effects of inflammation reduction on AVF survival.
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http://dx.doi.org/10.1016/j.jvs.2018.10.100DOI Listing
July 2019

Haematology panel biomarkers for humeral, femoral, and tibial diaphyseal fractures.

Int Orthop 2019 07 6;43(7):1567-1572. Epub 2019 Feb 6.

Department of Pharmacology, 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.

Purpose: The neutrophil to lymphocyte ratio (NLR) is a simple predictor used in oncology and cardiology. We aimed to analyze the NLR profile of patients with diaphyseal fractures of the humerus, femur, and tibia.

Methods: We performed a cross-sectional, consecutive-case population-based study including 148 patients (41.9% men respectively 58.1% women) with humeral (23.0%), femoral (30.4%), and tibial (46.6%) diaphyseal fractures, admitted for surgical treatment in our level 1 trauma centre over two years.

Results: The differences in NLR between the studied subgroups were not significant (p = 0.067), the highest value being observed in patients with femoral fracture (5.6) in contrast to patients with humeral fracture (4). In the global cohort, there was a significantly positive correlation between NLR and PLR (platelet to lymphocyte ratio; Spearman's r = 0.595; p < 0.001). The stratified subgroup analysis found significant association between NLR and duration of admission only for patients with femoral fracture (Spearman's r = - 0.308; p < 0.001). When compared with controls, all three fracture types had significantly higher neutrophil numbers and NLR and lower thrombocyte numbers.

Conclusions: NLR are elevated in femur diaphyseal fractures compared with tibia and humerus, up to cut-off values with negative prediction of outcome in malignancy and cardiovascular patients. Increased NLR are predictive of longer hospital admissions for femur fractures.
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http://dx.doi.org/10.1007/s00264-019-04305-1DOI Listing
July 2019

Impact of moderate to severe obstructive sleep apnea on the cognition in idiopathic pulmonary fibrosis.

PLoS One 2019 1;14(2):e0211455. Epub 2019 Feb 1.

Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy, Timişoara, Romania.

Introduction: Idiopathic pulmonary fibrosis (IPF) is a relentlessly progressive lung disease with a fatal prognosis to whose rapid evolution multiple comorbidities may contribute, one of the most common being obstructive sleep apnea (OSA). There are several potential factors and conditions for the emergence of a cognitive deficit in relation to IPF or associated morbidities.

Objectives: The goals of this study were to assess cognition in patients with IPF in stable phase and to identify clinical cognition modifiers.

Methods: In a cross-sectional study, 23 patients with IPF were evaluated using Montreal Cognitive Assessment (MoCA), an instrument for detecting mild cognitive impairments and were screened for OSA through overnight cardiorespiratory polygraphy and for anxiety and depression with three specific scale (Generalized Anxiety Disorder 7-item scale: GAD-7; the Patient Health Questionnaire: PHQ-9; Hospital Anxiety and Depression Scale: HADS).

Results: MoCA score was lower in patients with IPF when compared to controls subjects (24 [21,26] vs. 27 [26,28], p = 0.003) but not as significantly as in COPD patients (21 [18.8,23.3], p<0.0001). OSA was diagnosed in 19 (82.6%) IPF patients, 12 patients showed the presence of moderate-severe forms (63.15%). IPF patients with cognitive impairment (MoCA<23) exhibit a higher severity of OSA (apneea hypopnea index-AHI: 33.0±19.1 vs. 12.44±8.2, p = 0.018), and a higher Epworth score (7.1±3.3 vs. 4.3±1.8, p = 0.013). Anxiety and depression scores were not correlated with MoCA results.

Conclusions: Impaired cognition in patients with IPF is mild and affect the areas of visuospatial abilities, language and working memory. OSA could be a possible predictor of IPF cognition deficit. Given the high prevalence of multiple types of sleep disorders in IPF patients, these should be investigated at least by cardiorespiratory polygraphy.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211455PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6358087PMC
November 2019

Risk factors for developing dementia in type 2 diabetes mellitus patients with mild cognitive impairment.

Neuropsychiatr Dis Treat 2019 3;15:167-175. Epub 2019 Jan 3.

Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania,

Background: Dementia and cognitive dysfunction have many causes. There is strong evidence that diabetes mellitus (DM) increases the risk of cognitive impairment and dementia. Optimal glycemic control, identification of diabetic risk factors, and prophylactic approach are essential in the prevention of cognitive complications.

Aims: The main purpose of this study was to establish the cognitive impairment in DM patients, cared for in the Diabetes Center from Timisoara. Also, we investigated the prevalence of dementia in our group as well as the risk factors involved in the progression of mild cognitive impairment (MCI) to dementia.

Patients And Methods: We considered a sample of 207 type 2 DM (T2DM) patients, aged between 33 and 81 years, mean 57.49 (±11.37) years. We established the diagnosis of dementia based on the Mini-Mental State Examination (MMSE) test, as well as on the psychological testing, psychiatric and neurological investigations, and imaging tests (computerized tomography and MRI).

Results: A percentage of 42.03% of patients presented MCI, mean age 63 (57.00-71.00) years, being older than patients without MCI, mean age 52.00 (45.00-61.00) years, <0.001. We observed that diabetes duration was a significant risk factor for developing dementia. Also, patients with MCI presented higher values of body fat than patients without MCI. Moreover, we found that glucose levels, low-density lipoprotein cholesterol levels, the presence of stroke events, and the presence of cardiovascular disease were significant risk factors for MCI conversion to dementia.

Conclusion: Patients with T2DM at early to severe stages of MCI are more likely to develop dementia and should be regularly evaluated for their cognitive status. Regular administrations of the MMSE test can be done to detect early stages of MCI development. Also, to reduce the progression of cognitive impairment to dementia, it is worthwhile to give greater importance to glycemic control and overall DM management.
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http://dx.doi.org/10.2147/NDT.S189905DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322491PMC
January 2019

A Meta-Analysis on Randomised Controlled Clinical Trials Evaluating the Effect of the Dietary Supplement Chitosan on Weight Loss, Lipid Parameters and Blood Pressure.

Medicina (Kaunas) 2018 Dec 12;54(6). Epub 2018 Dec 12.

Department of Biology-Chemistry, Advanced Environmental Research Laboratory, West University of Timisoara, Timisoara, 300086, Romania.

Erratic results have been published concerning the influence of the dietary supplement chitosan used as a complementary remedy to decrease the body weight of overweight and obese people. The published articles mention as secondary possible benefits of usage of chitosan the improvement of blood pressure and serum lipids status. We performed a meta-analysis evaluating body weight, body mass index, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglycerides, systolic and diastolic blood pressure among overweight and obese patients. Searching MEDLINE, Cochrane up to December 2017 on clinical trials that have assessed the influence of chitosan used as a dietary supplement on overweight and obese patients. An additional study was identified in the References section of another meta-analysis. A total of 14 randomised control trials (RCT) were used to assess the effect on body weight, serum lipids and blood pressure. The usage of chitosan as a dietary supplement up to 52 weeks seems to slightly reduce the body weight (-1.01 kg, 95% CI: -1.67 to -0.34). Considering the other parameters studied, the most significant improvement was observed in systolic and diastolic blood pressure: -2.68 mm Hg (95% CI: -4.19 to -1.18) and -2.14 mm Hg (95% CI: -4.14 to -0.14) in favour of chitosan versus a placebo. Based on the meta-analysis realized with 14 RCT we concluded that the usage of chitosan as a dietary supplement can lead to a slight short- and medium-term effect on weight loss and to the improvement of serum lipid profile and cardiovascular factors.
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http://dx.doi.org/10.3390/medicina54060109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306953PMC
December 2018

Rapid decline of kidney function in diabetic kidney disease is associated with high soluble Klotho levels.

Nefrologia (Engl Ed) 2019 May - Jun;39(3):250-257. Epub 2018 Nov 2.

Nephrology Department, Dialysis and Renal Transplant Center, "Dr. C.I. Parhon" University Hospital, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania.

Background: Klotho is found in two forms: a transmembrane form and a soluble form (s-Klotho). In order to be excreted, s-Klotho, that is too large to be filtered, will probably reach the proximal convoluted tubule by a transcytosis process. The aim of our study was to show the relationship between the levels of s-Klotho and tubular injury in patients with diabetic kidney disease (DKD), using as tubular injury marker the kidney injury molecule-1 (KIM-1).

Methods: Our study included 63 DKD patients (stages 1-5, mean eGFR 65.15±32.45ml/min) with a mean age 58.13±12 years. In all patients we determined serum levels of: KIM-1 and s-Klotho using ELISA, urinary albumin/creatinine ratio (UACR) and reduction in the estimated glomerular filtration rate (eGFR) per year.

Results: We found a strong statistically significant correlation of s-Klotho with the rate of reduction of eGFR/year (r=0.714, p=0.0004) and with the tubular injury marker KIM-1 (r=0.758, p=0.005) and strong correlations of UACR with the rate of reduction of eGFR/year (r=0.53, p<0.01), KIM-1 (r=0.49, p<0.05) and s-Klotho (r=0.52, p<0.01).

Conclusion: Despite previous published data, that shows a decrease of s-Klotho in chronic kidney disease, in our study the rapid annual decline of kidney function but not the level of eGFR was associated with increased s-Klotho. A possible explanation could be a more severe proximal tubule injury that could lead to a reduction of tubular excretion of s-Klotho as suggested by the correlation of s-Klotho levels with the serum levels of KIM-1.
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http://dx.doi.org/10.1016/j.nefro.2018.08.004DOI Listing
May 2020

Cross-cultural adaptation and validation of the Romanian Hip disability and Osteoarthritis Outcome Score for Joint Replacement.

Int J Qual Health Care 2019 May;31(4):307-311

Department of Orthopedics and Trauma, 'Victor Babes' University of Medicine and Pharmacy, 2 Eftimie Murgu Square, Timisoara, Romania.

Objective: Perform translation, cultural adaptation and psychometric testing of the Romanian translation of the Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS_JR).

Design: Assess construct validity, reliability, internal consistency and reproducibility.

Setting: Adults with chronic hip disability prior or at a minimum of 3 months after surgery.

Participants: Ninety-six patients (22 bilateral) with hip osteoarthritis or who had previous hip replacement or osteosynthesis for a fracture of the trochanteric region.

Intervention: Complete the HOOS_JR together with the Oxford Hip Score (OHS_RO), Harris Hip Score (HHS) and Euroqol EQ-5D. 57 patients repeated the HOOS_JR after 2 days.

Main Outcome Measure: Convergent validity using Spearmans's correlation coefficient; Cronbach's alpha coefficient, intraclass correlation coefficient (ICC, two-way mixed effects model) and inter-item correlation matrix and test-retest assessment after 2 days.

Results: The questionnaire had a high degree of reliability with a Cronbach's α of 0.923 at the initial completion and 0.924 at the second testing. The ICC was 0.923 for average measures for the first form and 0.910 for the second form. The two results were strongly, positively and significantly correlated (rs = 0.859; P < 0.001). The Romanian HOOS_JR strongly, significantly and positively correlated with the OHS_RO (rs = -0.880 initial and rs = -0.803 s; P < 0.001) and HHS (rs = -0.731 initial and rs = -0.654 s; P < 0.001) and moderately, significantly and positively correlated with the EQ-5D Index (rs = -0.580 initial and rs = -0.542 s; P < 0.001) and VAS (rs = -0.500 initial and rs = -0.690 s; P < 0.001).

Conclusions: The translated HOOS_JR is a reliable, reproducible and valid measure of function in patients with chronic hip disability.
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http://dx.doi.org/10.1093/intqhc/mzy156DOI Listing
May 2019

Cross-cultural adaptation and validation of the Romanian Oxford Shoulder Score.

Medicine (Baltimore) 2018 Jun;97(23):e10926

Department of Orthopedics and Trauma, 'Victor Babes' University of Medicine and Pharmacy, Timisoara Department of Orthopedics and Trauma, "Lucian Blaga" University, Sibiu Human Anatomy, University of Medicine and Pharmacy, Craiova Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara Department of Orthopedics and Trauma, 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania Associate Professor, USC Keck School of Medicine, Stetson Powell Orthopedics and Sports Medicine, Burbank, CA Feinberg School of Medicine, Northwestern Medicine, Chicago, IL.

Background: The use of validated patient reported outcome scores is critical to the reporting and monitoring of the effectiveness of clinical treatment. The aim of this study was to translate and culturally validate the English Oxford Shoulder Score (OSS) to Romanian.

Methods: Approximately, 125 patients with disorders of the rotator cuff and proximal humerus fractures completed the translated Oxford Shoulder Score (OSS_RO), the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and EuroQol 5-Dimension (EQ-5D-5L). The patients repeated the evaluation using the OSS_RO after 2 days.

Results: The OSS_RO had a high degree of internal consistency and reliability with a Cronbach's α of 0.954 at the initial completion and 0.945 at the second testing. The intraclass correlation coefficient (ICC, 2-way mixed effects model) was 0.953 (single measures) and 0.976 (average), P < .001. The OSS_RO was reproducible (Pearson's r = 0.953; P < .001). The OSS_RO was divergently valid with QuickDASH score (Pearson's r = -0.633 first and r = -0.672 second; P < .001) and convergent with the EQ-5D VAS (Pearson's r = 0.627 first and r = 0.640 second; P < .001) and the EQ-5D Index (Pearson's r = 0.759 first and r = 0.771 second; P < .001).

Conclusion: Our study showed that the Romanian translation of the OSS is a reliable, reproducible and valid measure of shoulder function in patients with variable shoulder pathology.
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http://dx.doi.org/10.1097/MD.0000000000010926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5999452PMC
June 2018

The reciprocal relationship between coping mechanisms and lung cancer diagnosis: findings of a prospective study.

Cancer Manag Res 2018 4;10:33-40. Epub 2018 Jan 4.

Department of Surgical Semiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.

Background/purpose: Lung cancer is a major stress factor for the affected individual, leading to psychological distress in over 50% of the diagnosed patients. Since coping styles describe different patterns in approaching serious problems, our study aimed at ascertaining if the diagnosis of lung cancer has an impact on the patient's coping styles and if there is a difference in psychical response among patients with different coping styles, as assessed by variance of anxiety and depression scores after diagnosis.

Patients And Methods: In this prospective study, a cohort of 50 patients were evaluated using the COPE scale, Generalized Anxiety Disorder Questionnaire 7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9), both prior to and 1 month after learning about their lung cancer diagnosis. The baseline and the final parameters were compared and stratified with respect to coping styles.

Results: We observed that 1 month after learning the diagnosis, the patients had a significantly higher GAD-7 score (median score 12 vs 4 points; <0.001). At the same time, the PHQ-9 score was significantly higher at the 1 month follow-up time-point (median score 16 vs 7; =0.002). The increases in the anxiety scores were significant in patients with initial social support (13 vs 3; =0.014) and avoidance coping style (14 vs 6; =0.003). Regarding the depression scores, after the diagnosis, the only significant increase was observed in patients with initial avoidance coping style (18 vs 5; =0.014).

Conclusion: Our study demonstrates that patients who receive the diagnosis for cancer show a significant increase in anxiety and depression intensity. The most adaptive coping style turned out to be the problem-focused one while the least adaptive one was the avoidant style.
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http://dx.doi.org/10.2147/CMAR.S148341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5757489PMC
January 2018

Cross-cultural adaptation and validation of a patient-reported hip outcome score.

Int Orthop 2018 05 6;42(5):1001-1006. Epub 2018 Jan 6.

Department of Orthopaedics and Trauma, 'Victor Babes' University of Medicine and Pharmacy, Timisoara, 2 Eftimie Murgu Square, 300041, Timisoara, Romania.

Purpose: We aimed to perform psychometric testing for the translated Oxford Hip Score (OHS) for use as a recommended tool to measure treatment outcomes.

Methods: The original English questionnaire was translated and culturally validated using the instrument developer's guidelines and the ISPOR principles of good practice. One hundred patients completed the form together with the Harris Hip Score (HHS) and EQ-5D-5 L. Fifty patients repeated the form after two days. They were suffering from hip osteoarthritis, had had hip replacement or underwent osteosynthesis for a fracture of the trochanteric region.

Results: The questionnaire had a high degree of reliability with a Cronbach α of 0.917 at the initial completion and 0.917 at the second testing, respectively. The two results were strongly positive and significantly correlated (Pearson's r = 0.947; p < 0.001). The OHS was strongly and significantly correlated with the HHS (Pearson's r = 0.880 initial and r = 0.840 s; p < 0.001) and strongly, positive and significantly correlated with the EQ-5D-5 L VAS (Pearson's r = 0.614 initial and r = 0.704 s; p < 0.001).

Conclusions: Our study showed that the translation of the OHS is a reliable, reproducible and valid measure of function in patients who undergo treatment for hip pathology.
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http://dx.doi.org/10.1007/s00264-017-3742-5DOI Listing
May 2018

Time Trends, Regional Variability and Seasonality Regarding the Incidence of Type 1 Diabetes Mellitus in Romanian Children Aged 0-14 Years, Between 1996 and 2015

J Clin Res Pediatr Endocrinol 2018 06 30;10(2):92-99. Epub 2017 Oct 30.

Victor Babes University of Medicine and Pharmacy, Department of Diabetes and Metabolic Diseases, Timisoara, Romania

Objective: The incidence of type 1 diabetes mellitus in children is highly variable in the world. The aim of our study was to: 1) analyze the evolution of the incidence of childhood type 1 diabetes in Romania between 1996 and 2015, and: 2) to search for differences amongst age groups, gender, geographic regions and month of diagnosis.

Methods: Data on all new cases of type 1 diabetes, aged <15 years, obtained from two independent sources, were included in the study. The statistical methods included modeling of the incidence rates, adjusting for age, sex, calendar year, geographic region and seasonality.

Results: The study group was composed of 5422 children, with overall completeness of ascertainment estimated at 93.7%. The incidence rate (per 100.000 person-years) rose continuously, from 4.7 [95% confidence interval (CI) 3.9-5.7] in 1996 to 11.0 (95% CI 9.9-12.2) in 2015, by a yearly rate of 5.1%, highest in the youngest and lowest in the oldest children. The mean incidence was significantly higher (p<0.0001) in Transylvania (7.9, 95% CI 7.6-8.3) than in Moldavia (6.5, 95% CI 6.2-6.9) and Muntenia (7.0, 95% CI 6.7-7.3), probably due to differences regarding ethnicity and lifestyle. The monthly incidence showed a sinusoidal pattern, peaking in January and being minimum in June.

Conclusion: The incidence of type 1 diabetes mellitus in Romanian children increased continuously during the study period by a rate that, if maintained, would lead to its doubling every 14 years. Important differences were established between geographic regions and seasonality at diagnosis.
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http://dx.doi.org/10.4274/jcrpe.5456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5985393PMC
June 2018

The impact of acute kidney injury on in-hospital mortality in acute ischemic stroke patients undergoing intravenous thrombolysis.

PLoS One 2017 17;12(10):e0185589. Epub 2017 Oct 17.

Department of Cardiology, County Emergency Hospital Timisoara, Romania, 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.

Introduction: Acute kidney injury (AKI) increases the risk of death in acute ischemic stroke (AIS) patients. Intravenous thrombolytic therapy (iv. rt-PA) seems to be the most effective treatment for AIS patients. The effects of AKI on iv. rt-PA treated AIS cases is less studied. Our paper addresses this issue.

Methods: 45 consecutive stroke patients treated with iv. rt-PA (median age = 64 years; 29 male) and 59 age and sex matched controls not eligible for iv. rt-PA have been enrolled in our study. Subjects were followed-up until hospital release or death (median follow up time = 12 days).

Results: The prevalence of AKI did not differ between iv. rt-PA treated patients and controls (35.5% vs. 33.89%). In both groups, AKI was associated with increased in-hospital mortality: 50.0% vs. 3.4% p<0.0001 (in the rt-PA treated), and 45% vs. 30.7% (in controls). AKI iv. rt-PA treated patients had a significantly higher risk of in hospital mortality as compared to the no-AKI iv. rt-PA treated (HR = 15.2 (95%CI [1.87 to 124.24]; P = 0.011). In a Cox-multivariate model, the presence of AKI after iv. rt-PA remained a significant factor (HR = 8.354; p = 0.041) influencing the in-hospital mortality even after correction for other confounding factors. The independent predictors for AKI were: decreased eGFR baseline and elevated serum levels of uric acid at admission, (the model explained 60.2% of the AKI development).

Conclusions: The risk of AKI was increased in AIS patients. Thrombolysis itself did not increase the risk of AKI. In the iv. rt-PA patients, as compared to non-AKI, those which developed AKI had a higher rate of in-hospital mortality. The baseline eGFR and the serum uric acid at admission were independent predictors for AKI development in the iv. rt-PA treated AIS patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0185589PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5645137PMC
October 2017