Publications by authors named "Romulus Timar"

54 Publications

Impact of COVID-19 Pandemic on the Implantation of Intra-Cardiac Devices in Diabetic and Non-Diabetic Patients in the Western of Romania.

Medicina (Kaunas) 2021 May 3;57(5). Epub 2021 May 3.

Department VII, Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy "Victor Babes" Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania.

: COVID-19 pandemic severely impacted public health services worldwide, determining a significant decrease of elective cardiovascular (CV) procedures, especially in patients with associated chronic diseases such as diabetes mellitus (DM). : This study was first started in 2019 in the western of Romania, to analyze the differences regarding the implantations of intra-cardiac devices such as permanent pacemakers (PPM), cardiac resynchronization therapy (CRT), or implantable cardioverter-defibrillators (ICD) in 351 patients with and without DM and the situation was reanalyzed at the end of 2020. : of the first 351 patients with and without DM. 28.20% of these patients had type 2 DM ( = 0.022), exceeding more than twice the prevalence of DM in the general population (11%). Patients with DM were younger ( = 0.022) and required twice as often CRT ( = 0.002) as non-diabetic patients. The state of these procedures was reanalyzed at the end of 2020, a dramatic decrease of all new device implantations being observed, both in non-diabetic and in patients with type 2 DM (79.37%, respectively 81.82%). : COVID-19 pandemic determined a drastic decrease, with around 75% reduction of all procedures of new intra-cardiac devices implantation, both in non-diabetics, this activity being reserved mostly for emergencies.
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http://dx.doi.org/10.3390/medicina57050441DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8147827PMC
May 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

Improvement of Platelet Respiration by Cell-Permeable Succinate in Diabetic Patients Treated with Statins.

Life (Basel) 2021 Mar 28;11(4). Epub 2021 Mar 28.

Department IX Surgery-Surgical Semiotics I, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. no. 2, 300041 Timișoara, Romania.

Diabetes mellitus (DM) is the most severe metabolic disease that reached the level of a global pandemic and is associated with high cardiovascular morbidity. Statins are the first-line lipid-lowering therapy in diabetic patients with or without a history of atherosclerotic disease. Although well tolerated, chronic treatment may result in side effects that lead to treatment interruption. Mitochondrial dysfunction has emerged as a central pathomechanism in DM- and statin-induced side effects. Assessment of mitochondrial respiration in peripheral platelets has been increasingly used as a mirror of organ mitochondrial dysfunction. The present study aimed to assess the: (i) changes in mitochondrial respiration elicited by statins in patients with type 2 DM and (ii) the effects of cell-permeable succinate (NV118) on respiratory parameters in platelets harvested from these patients. No significant changes were found in global mitochondrial respiration of intact platelets isolated from diabetic patients treated with either atorvastatin or rosuvastatin. Similarly, no significant changes in mitochondrial respiration of permeabilized platelets were found between diabetic patients treated with atorvastatin and healthy controls. Acute ex vivo administration of NV118 significantly improved respiration in isolated platelets. These results prompt further research on the role of permeable succinate as a therapeutic alternative for improving mitochondrial function in metabolic pathologies and point to the role of peripheral platelets as a potential biomarker of treatment response.
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http://dx.doi.org/10.3390/life11040288DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065590PMC
March 2021

Cell-Permeable Succinate Rescues Mitochondrial Respiration in Cellular Models of Statin Toxicity.

Int J Mol Sci 2021 Jan 3;22(1). Epub 2021 Jan 3.

Mitochondrial Medicine, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, BMC A13, 221 84 Lund, Sweden.

Statins are the cornerstone of lipid-lowering therapy. Although generally well tolerated, statin-associated muscle symptoms (SAMS) represent the main reason for treatment discontinuation. Mitochondrial dysfunction of complex I has been implicated in the pathophysiology of SAMS. The present study proposed to assess the concentration-dependent ex vivo effects of three statins on mitochondrial respiration in viable human platelets and to investigate whether a cell-permeable prodrug of succinate (complex II substrate) can compensate for statin-induced mitochondrial dysfunction. Mitochondrial respiration was assessed by high-resolution respirometry in human platelets, acutely exposed to statins in the presence/absence of the prodrug NV118. Statins concentration-dependently inhibited mitochondrial respiration in both intact and permeabilized cells. Further, statins caused an increase in non-ATP generating oxygen consumption (uncoupling), severely limiting the OXPHOS coupling efficiency, a measure of the ATP generating capacity. Cerivastatin (commercially withdrawn due to muscle toxicity) displayed a similar inhibitory capacity compared with the widely prescribed and tolerable atorvastatin, but did not elicit direct complex I inhibition. NV118 increased succinate-supported mitochondrial oxygen consumption in atorvastatin/cerivastatin-exposed platelets leading to normalization of coupled (ATP generating) respiration. The results acquired in isolated human platelets were validated in a limited set of experiments using atorvastatin in HepG2 cells, reinforcing the generalizability of the findings.
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http://dx.doi.org/10.3390/ijms22010424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796258PMC
January 2021

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

Risk factors for sexual dysfunction in Romanian women with type 1 diabetes mellitus and chronic autoimmune thyroiditis: a comparative cross-sectional study.

Diabetol Metab Syndr 2020 27;12:94. Epub 2020 Oct 27.

Second Department of Internal Medicine - Diabetes, Nutrition and Metabolic Diseases, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.

Background: Female sexual dysfunction (FSD) is one of the chronic complications of diabetes as is male sexual dysfunction, but the former is less studied. Therefore, the aim of this study was to assess of the prevalence and risk factors associated with FSD in Romanian women with type 1 diabetes mellitus (T1DM) and chronic autoimmune thyroiditis (CAT).

Methods: The study sample included 104 Romanian women with both T1DM and CAT, and 101 Romanian matched controls with only T1DM. The presence of FSD was established using two validated tests: The Female Sexual Function Index and the Female Sexual Distress Scale-revised. The presence of depression was assessed using Beck's Depression Inventory-II.

Results: We found that almost half of the women in the group with T1DM and CAT presented with sexual dysfunction (49 vs. 33.7% in the control group; p = 0.025): 27.9 vs. 8.9 (p < 0.001)-desire, 23.1 vs. 7.9% (p = 0.003)-orgasm, 21.2 vs. 5.9% (p = 0.002)-lubrication, 17.3 vs. 6.9% (p = 0.023)-arousal, 9.6 vs. 1% (p = 0.006)-pain, and 20.2 vs. 9.9% (p = 0.040)-satisfaction problems. Multivariate regression analysis revealed that age was a significant risk factor for FSD, along with DM and body mass index. Coexisting CAT, polyneuropathy, depression, and the use of insulin pumps were significant risk factors for FSD.

Conclusions: Women with T1DM and CAT are more likely to present with FSD than those without. It is important for patients to address depression, if present, and exercise caution while using insulin pumps. Moreover, DM complications such as polyneuropathy are significant risk factors for FSD; thus, it is crucial to ensure satisfactory glycemic control and optimal DM management.
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http://dx.doi.org/10.1186/s13098-020-00602-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590467PMC
October 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

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

Screening for Liver Fibrosis and Steatosis in a Large Cohort of Patients with Type 2 Diabetes Using Vibration Controlled Transient Elastography and Controlled Attenuation Parameter in a Single-Center Real-Life Experience.

J Clin Med 2020 Apr 6;9(4). Epub 2020 Apr 6.

Department of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.

Background: Type 2 diabetes mellitus (T2DM), obesity, hyperlipidemia, and hypertension are considered risk factors for developing non-alcoholic fatty liver disease (NAFLD). This study aims to assess steatosis and fibrosis severity in a cohort of T2DM patients, using vibration controlled transient elastography (VCTE) and controlled attenuation parameter (CAP).

Material And Method: We performed a prospective study in which, in each patient, we aimed for 10 valid CAP and liver stiffness measurements (LSM). To discriminate between fibrosis stages, we used the following VCTE cut-offs: F ≥ 2-8.2 kPa, F ≥ 3-9.7 kPa, and F4 - 13.6 kPa. To discriminate between steatosis stages, we used the following CAP cut-offs: S1 (mild) - 274 dB/m, S2 (moderate) - 290dB/m, S3 (severe) - 302dB/m.

Results: During the study period, we screened 776 patients; 60.3% had severe steatosis, while 19.4% had advanced fibrosis. Female gender, BMI, waist circumference, elevated levels of AST, total cholesterol, triglycerides, blood glucose, and high LSM were associated with severe steatosis (all -value < 0.05). BMI, waist circumference, elevated levels of AST, HbA1c, and CAP were associated with advanced fibrosis (all -values < 0.05).

Conclusion: Higher BMI (obesity) comprises a higher risk of developing severe steatosis and fibrosis. Individualized screening strategies should be established for NAFLD according to different BMI.
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http://dx.doi.org/10.3390/jcm9041032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230646PMC
April 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

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

Transient Hyperthyroidism following the ingestion of complementary medications containing kelp seaweed: A case-report.

Medicine (Baltimore) 2019 Sep;98(37):e17058

2nd Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy.

Rationale: The prevalence of obesity has increased over the past few years, becoming a public health problem. Generally, the primary therapeutic remedies are diet, physical exercise, medication, and bariatric surgery. However, an increased number of obese and overweight people are using complementary and herbal slimming supplements.

Patient Concerns: A 70-years-old Caucasian woman presented to the outpatient clinic with tachycardia (>100 bpm), insomnia, anxiety, and recent weight loss (6 kilos in 3 months). She had no previous thyroid disease, but she presented transient hyperthyroidism at 3 months after ingestion of tablets containing kelp seaweeds.

Diagnoses: Hypertensive and obese patient, without previous thyroid disease, presented with transient hyperthyroidism at 3 months following ingestion of tablets containing kelp seaweed.

Interventions: The kelp-containing tablets were discontinued, and antithyroid therapy with Methimazole was initiated as follows: Methimazole at 15 mg/day for 1 month, at 10 mg/day in the second month, and 5 mg/day for the third month.

Outcomes: After 3 months of antithyroid therapy and without the consumption of kelp - containing tablets, normal thyroid function was regained. Further analysis revealed normal thyroid function, so the hyperthyroidism reversed completely.

Lessons: Adults who consume complementary medication based on kelp seaweed should be informed of the risk of developing thyroid dysfunction also in the absence of any pre-existing thyroid disease. Due to the high iodine content, supplements containing kelp should be taken with the supervision of a physician and with monitoring of thyroid function.
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http://dx.doi.org/10.1097/MD.0000000000017058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750240PMC
September 2019

Assessment of Nutritional Intakes in Individuals with Obesity under Medical Supervision. A Cross-Sectional Study.

Int J Environ Res Public Health 2019 08 22;16(17). Epub 2019 Aug 22.

Genetics Discipline, Center of Genomic Medicine Timișoara, "Victor Babeș" University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timișoara, Romania.

People with obesity in Romania are often under medical supervision, which is aimed to decrease body weight and treat accompanying metabolic disorders and cardiovascular implications. However, there is limited information regarding the implementation of dietary recommendations in adults with obesity. We aimed to evaluate the prevalence of reaching the recommended intakes of macro- and micro-nutrients in adults with obesity under medical supervision. Individuals with obesity, recruited in the context of a study with a larger scope (NutriGen ClinicalTrials.gov NCT02837367), who were under medical supervision underwent four 24 h recalls in order to assess daily food intakes. Macro- and micro-nutrient intakes were computed, and the prevalence of reaching recommended dietary allowances (RDAs) for each nutrient was calculated. The majority of subjects did not meet the recommended intakes for most nutrients. Energy from fat exceeded the threshold of 35% recommended intake, even in the lowest quartile of energy intake. The micronutrients with less than 5% of individuals reaching the RDAs were vitamin D, vitamin E, fluoride, and omega-3 fatty acids for both males and females, and choline, magnesium, and potassium in females. The burden of inadequate nutrition in individuals with obesity should be acknowledged and properly addressed within efforts to reduce obesity rates and associated disorders.
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http://dx.doi.org/10.3390/ijerph16173036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6747404PMC
August 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

Sleep duration and body mass index: moderating effect of self-perceived stress and age. Results of a cross-sectional population-based study.

Eat Weight Disord 2019 Dec 12;24(6):1089-1097. Epub 2019 Mar 12.

Department of Diabetes and Nutrition, Iuliu Hatieganu University of Medicine and Pharmacy, 2-4 Clinicilor Street, 400006, Cluj-Napoca, Romania.

Purpose: The objective of this analysis was to assess whether the association between sleep duration and BMI and between sleep duration and waist circumference is moderated by age and self-perceived stress.

Methods: We analyzed data from 2034 participants enrolled in 2014 in the cross-sectional study Obesity in Romania Study-study of the prevalence of obesity and related risk factors in Romanian general population (ORO study).

Results: Interaction between sleep duration, self-perceived stress and age, with BMI as dependent variable, was statistically significant after adjustment for demographic and lifestyle factors (p value for interaction 0.003). In participants without self-perceived stress, a linear negative association between sleep duration and BMI was observed only in those 18-39 years old (p = 0.049), with BMI decreasing in parallel with increased sleep duration. In participants with self-perceived stress, a U-shaped relationship was observed between BMI and sleep duration in those 40-64 years old, with higher BMI in those sleeping ≤ 6 h and ≥ 9 h/night compared to those sleeping > 6 and < 9 h/night (p = 0.002 and 0.005). Those ≥ 65 years old with self-perceived stress sleeping ≥ 9 h/night had a significantly higher BMI compared to those in other sleep duration categories (p = 0.041 vs. those sleeping ≤ 6 h/night and p = 0.013 vs. to those sleeping > 6 and < 9 h/night). No interaction between age, self-perceived stress and sleep duration, with waist circumference as dependent variable was observed.

Conclusions: In our sample, the association between sleep duration and BMI was moderated by self-perceived stress and age.
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http://dx.doi.org/10.1007/s40519-019-00665-0DOI Listing
December 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

Prevalence of dyslipidemia and its association with cardiometabolic factors and kidney function in the adult Romanian population: The PREDATORR study.

Diabetes Metab Syndr 2019 Jan - Feb;13(1):596-602. Epub 2018 Nov 13.

Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, 2-4 Clinicilor Street, Cluj-Napoca, Romania.

The aims were to assess the prevalence and characteristics of dyslipidemia phenotypes in a Romanian population-based sample from the PREDATORR study.

Methods: PREDATORR was an epidemiological study with a cross-sectional, cluster random sampling design. Participants were classified into four dyslipidemia phenotypes based on the NCEP ATP III criteria: isolated hypertrigliceridemia, isolated hypoHDL-C, isolated hyperLDL-C and mixed dyslipidemia (≥2 standard lipid abnormalities). Overall, 2656 were included in the analysis by dyslipidemia phenotypes.

Results: An estimated 67.1% of Romanian adults have at least one lipid abnormality: 27.5% (95%CI26.0-28.9%) have elevated TG, 29.4% (95%CI27.9-30.8%) have low HDL-C and 47.8% (95%CI46.3-49.2%) have elevated LDL-C (26.2% had LDL-C levels ≥2.58 mmol/l associated with CHD or CHD risk equivalent). Also, 30% Romanian adults have mixed dyslipidemia with 7.6% (95%CI6.1-9.0%) having all three lipid abnormalities. THE AGE: and sex-adjusted prevalence of isolated dyslipidemia phenotypes in Romanian adult population was 23.7% (95%CI22.2-25.1%) for hyperLDL-Cholesterolemia, 9.3% (95%CI7.8-10.7%) for hypoHDL-Cholesterolemia and 4.1% (95%CI2.6-5.5%) for hypertriglyceridemia. Among participants with triglycerides ≥2.25 mmol/l, 15.2% (95%CI13.7-16.6%) of Romanian adults have non-HDL-C levels ≥3.36 mmol/l.

Conclusions: The PREDATORR survey indicated a high prevalence of dyslipidemia phenotypes in the Romanian population aged 20-79 years, providing data on its association with several cardiometabolic risk factors.
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http://dx.doi.org/10.1016/j.dsx.2018.11.033DOI Listing
April 2019

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

Methylene blue alleviates endothelial dysfunction and reduces oxidative stress in aortas from diabetic rats.

Can J Physiol Pharmacol 2018 Oct 12;96(10):1012-1016. Epub 2018 Jun 12.

a Department of Functional Sciences - Pathophysiology, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania.

Endothelial dysfunction and the related increase in reactive oxygen species (ROS) production are important events in the pathophysiology of diabetes mellitus (DM). Methylene blue (MB) has been systematically investigated for its protective effects against refractory hypotension and mitochondrial dysfunction. We have previously demonstrated that MB improved mitochondrial respiration and partially decreased oxidative stress in diabetic rat hearts. The present study was aimed to investigate whether MB modulates vascular function and ROS production in thoracic aortic rings isolated from rats with streptozotocin-induced DM (after 4 weeks of hyperglycemia). The effects of MB (0.1 μM, 30 min ex vivo incubation) on vascular reactivity in organ chamber (phenylephrine-induced contraction, acetylcholine-induced relaxation) and HO production (assessed by ferrous iron xylenol orange oxidation assay) were investigated in vascular preparations with intact endothelium and after denudation. DM elicited a significant alteration of vascular function: increased contractility to phenylephrine, attenuation of acetylcholine-dependent relaxation, and augmented HO generation. Ex vivo incubation with MB partially reversed all these changes (by approximately 70%) in vascular segments with intact endothelial layer (but not in denuded vessels). In conclusion, MB might be useful in alleviating endothelial dysfunction and mitigating endothelial oxidative stress, observations that clearly require further investigation in the setting of cardiometabolic disease.
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http://dx.doi.org/10.1139/cjpp-2018-0119DOI Listing
October 2018

Extensively drug-resistant - a case series of urinary tract infections in immunocompromised patients.

Infect Drug Resist 2018 18;11:743-749. Epub 2018 May 18.

Department of Microbiology, "Victor Babeş" University of Medicine and Pharmacy, TimisŞoara, Romania.

Purpose: We report an outbreak of urinary tract infections (UTIs) caused by , which occurred in the largest clinical hospital in western Romania.

Patients And Methods: From June to August 2017, four strains of were isolated from the urine samples of patients hospitalized in the urology, diabetes, and surgery departments. Hospital records of all patients whose urine cultures were positive for were reviewed retrospectively. We also reviewed the cases reported in the literature.

Results: All UTIs, except one, were hospital-acquired infections. All patients with UTIs were immunocompromised. Three patients underwent urinary catheterization with a Foley's catheter upon admission in the emergency department and one presented for replacement of ureterostomy tubes. All isolates were resistant to almost all the tested antibiotics. Two patients were successfully treated with tigecycline and one was receiving antimicrobial treatment for another infection at the time of isolation of the microorganism.

Conclusion: Although is an uncommon pathogen, clinicians should be aware of its ability to cause UTI outbreaks, especially in the immunocompromised population. Due to its multi-drug resistance, it is important to rapidly identify spp. in order to choose the best treatment regimen.
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http://dx.doi.org/10.2147/IDR.S161069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5965371PMC
May 2018

Is Kidney Stiffness Measured Using Elastography Influenced Mainly by Vascular Factors in Patients with Diabetic Kidney Disease?

Ultrason Imaging 2018 09 31;40(5):300-309. Epub 2018 May 31.

1 Nephrology Department, University of Medicine and Pharmacy "V. Babes" Timisoara, Romania.

Studies published so far using ultrasound-based elastography in the kidneys, lack to prove a clear relationship between kidney shear wave speed (KSWS) and renal disease progression. Taking into account that the kidney is a highly vascularized organ, the present study aims to find a relationship between KSWS and vascular factors (blood pressure [BP], arterial stiffness). Our study included 38 diabetic kidney disease patients (mean age 56.52 ± 16.12 years, 19 female, 19 male). KSWS, an indicator of renal stiffness, was measured using point Shear Wave Elastography (pSWE; Siemens Acuson S2000). In every patient, we recorded BP, and we measured aortic augmentation index (AAI) and brachial pulse wave velocity (PWV), using oscillometry. We found statistically significant indirect correlations of KSWS with indicators of arterial stiffness, such as PWV ( r = -.41, p = .036), and AAI ( r = -.37, p = .031). We found also an indirect correlation of KSWS with diastolic BP ( r = -.65, p = .02) and systolic BP ( r = -.54, p = .008). We found no correlation of KSWS with estimated glomerular filtration rate (eGFR), urinary albumin/creatinine ratio, stage of diabetic retinopathy, or glycated hemoglobin. Our study shows that high BP and the progression of arteriosclerosis (high PWV and AAI), leads to a decrease of renal stiffness. Thus, it seems that KSWS is influenced by renal blood flow, rather than other factors, such as albuminuria or chronic kidney disease stage.
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http://dx.doi.org/10.1177/0161734618779789DOI Listing
September 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

2D-Shear Wave Elastography in the Evaluation of Parathyroid Lesions in Patients with Hyperparathyroidism.

Int J Endocrinol 2017 6;2017:9092120. Epub 2017 Aug 6.

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

Background And Aims: 2D-shear wave elastography (2D-SWE) is a relatively new elastographic technique. The aim of the present study is to determine the values of the elasticity indexes (EI) measured by 2D-SWE in parathyroid benign lesions (adenomas or hyperplasia) and to establish if this investigation is helpful for the preoperative identification of the parathyroid adenoma.

Material And Methods: The study groups were represented by 22 patients with primary or tertiary hyperparathyroidism, diagnosed by specific tests, and 43 healthy controls, in whom the thyroid parenchyma was evaluated, in order to compare the EI of the thyroid tissue with those of the parathyroid lesions.

Results: The mean EI measured by 2D-SWE in the parathyroid lesions was 10.2 ± 4.9 kPa, significantly lower than that of the normal thyroid parenchyma (19.5 ± 7.6 kPa; = 0.007), indicating soft tissue. For a cutoff value of 12.5 kPa, the EI assessed by 2D-SWE had a sensitivity of 93% and a specificity of 86% (AUC = 0.949; < 0.001) for predicting parathyroid lesions.

Conclusion: A value lower than 12.5 kPa for the mean EI measured by 2D-SWE can be used to confirm that the lesion/nodule is a parathyroid adenoma.
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http://dx.doi.org/10.1155/2017/9092120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5563409PMC
August 2017

Chaotic time series prediction for glucose dynamics in type 1 diabetes mellitus using regime-switching models.

Sci Rep 2017 07 24;7(1):6232. Epub 2017 Jul 24.

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

In patients with type 1 diabetes mellitus (T1DM), glucose dynamics are influenced by insulin reactions, diet, lifestyle, etc., and characterized by instability and nonlinearity. With the objective of a dependable decision support system for T1DM self-management, we aim to model glucose dynamics using their nonlinear chaotic properties. A group of patients was monitored via continuous glucose monitoring (CGM) sensors for several days under free-living conditions. We assessed the glycemic variability (GV) and chaotic properties of each time series. Time series were subsequently transformed into the phase-space and individual autoregressive (AR) models were applied to predict glucose values over 30-minute and 60-minute prediction horizons (PH). The logistic smooth transition AR (LSTAR) model provided the best prediction accuracy for patients with high GV. For a PH of 30 minutes, the average values of root mean squared error (RMSE) and mean absolute error (MAE) for the LSTAR model in the case of patients in the hypoglycemia range were 5.83 ( ± 1.95) mg/dL and 5.18 ( ± 1.64) mg/dL, respectively. For a PH of 60 minutes, the average values of RMSE and MAE were 7.43 ( ± 1.87) mg/dL and 6.54 ( ± 1.6) mg/dL, respectively. Without the burden of measuring exogenous information, nonlinear regime-switching AR models provided fast and accurate results for glucose prediction.
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http://dx.doi.org/10.1038/s41598-017-06478-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5524948PMC
July 2017

Ultrasound-Based Shear Wave Elastography in the Assessment of Patients with Diabetic Kidney Disease.

Ultrasound Med Biol 2017 10 15;43(10):2159-2166. Epub 2017 Jul 15.

Department of Nephrology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Timişoara, Romania.

In previous studies of acoustic radiation force impulse (ARFI) elastography, using Virtual Touch tissue quantification (VTQ) (Siemens Acuson S2000), it was reported that the measurement of renal shear wave speed in patients with chronic kidney disease (CKD) is not influenced exclusively by renal fibrosis. The purpose of the present study was to analyze the role of VTQ in patients with diabetic kidney disease, considered the main cause of CKD. The study group included 164 patients: 80 patients with diabetic kidney disease (DKD) and 84 without renal disease or diabetes mellitus. In each subject in lateral decubitus, five valid VTQ measurements were performed in each kidney and a median value was calculated, the result being expressed in meters/second. The following means of the median values were obtained In DKD patients, the means of the median values were for VTQ right kidney, 2.21 ± 0.71 m/s, and for VTQ left kidney, 2.13 ± 0.72 m/s, whereas in the normal controls statistically significant higher values were obtained: 2.58 ± 0.78 m/s for VTQ right kidney (p = 0.0017) and 2.46 ± 0.81 m/s for VTQ left kidney (p = 0.006). Patients with an estimated glomerular filtration rate (eGFR) >60 mL/min (DKD stages 1 and 2 together with normal controls) had a significantly higher kidney shear wave speed compared with patients with an eGFR <60 mL/min (2.53 m/s vs. 2.09 m/s, p < 0.05). In the DKD group, there was a significant correlation between eGFR and VTQ levels for the right kidney (r = 0.28, p = 0.04). There was no correlation of VTQ values with proteinuria level, stage of diabetic retinopathy or glycated hemoglobin. Our study indicates that shear wave speed values in patients with diabetic kidney disease and eGFRs <60 mL/min are significantly lower compared with those of patients with eGFRs >60 mL/min (either normal controls or diabetic patients with DKD stages 1 and 2), and values decrease with the decrease in eGFR. However, proteinuria, diabetic retinopathy and glycated hemoglobin have no influence on VTQ.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2017.04.019DOI Listing
October 2017

Associations of smoking with cardiometabolic profile and renal function in a Romanian population-based sample from the PREDATORR cross-sectional study.

Eur J Gen Pract 2017 Dec;23(1):164-170

i Department of Diabetes , University of Medicine and Pharmacy 'Victor Babeş' Timişoara , Timişoara , Romania.

Background: The impact of smoking on morbidity is well known, but in Romania, limited data are available regarding the smoking prevalence and relationship with cardiometabolic profile and kidney function.

Objectives: To assess the association of smoking with cardiometabolic traits and kidney function, in a Romanian population-based sample from the PREDATORR study.

Methods: PREDATORR was an epidemiological cross-sectional study. Between 2012 and 2014, participants were randomly selected from the lists of general practitioners and enrolled if they were aged 20 to 79 years, born and living in the past 10 years in Romania. Sociodemographic and lifestyle characteristics were collected through interviewer-administered questionnaires.

Results: Overall, 2704 participants were included in the analysis, 18% of them being current smokers and 30.8% former smokers. Current smokers compared to non-smokers had higher total cholesterol (220.6 ± 50.4 versus 213.9 ± 86.8 mg/dl, P = 0.017), LDL-cholesterol (137.8 ± 45.2 versus 130.7 ± 83.7 mg/dl, P = 0.004) and glomerular filtration rate (96.9 ± 16.8 versus 90.7 ± 19.1 ml/min/1.73 m, P <0.001) in women and higher triglycerides (170.7 ± 129.8 versus 144.3 ± 94.2 mg/dl, P = 0.007), glomerular filtration rate (97.6 ± 17 versus 90.3 ± 18 ml/min/1.73 m, P < 0.001) and lower HDL-cholesterol (48 ± 15.5 versus 50.4 ± 14.1 mg/dl, P = 0.002) in men. Active smoking was associated with hypercholesterolaemia [OR: 1.40 (95% CI: 1.01-1.96), P = 0.04] and low HDL-cholesterolaemia [OR: 1.39 (95% CI: 1.01-1.91), P = 0.04] and negatively associated with overweight/obesity [OR: 0.67 (95% CI: 0.48-0.94), P = 0.02]. Male former smokers had higher prevalence of abdominal obesity (82.4% versus 76.4%, P = 0.02), hypertriglyceridaemia (43.6% versus 35.6%, P = 0.01), hypertension (64% versus 56.4%, P = 0.01) and ischaemic vascular disease (40.5% versus 30.9%, P = 0.003) than male non-smokers.

Conclusion: The PREDATORR study showed a high prevalence of smoking in the adult Romanian population providing data on the association of smoking with cardiometabolic traits.
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http://dx.doi.org/10.1080/13814788.2017.1324844DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774259PMC
December 2017

Association of Mild-to-Moderate Reduction in Glomerular Filtration Rate with Subclinical Atherosclerosis in Postmenopausal Women.

J Womens Health (Larchmt) 2017 11 24;26(11):1201-1213. Epub 2017 May 24.

4 Department of Nephrology, County Emergency Hospital Timisoara, "Victor Babes" University of Medicine and Pharmacy , Timisoara, Romania .

Background: Due to loss of hormonal protective effects, postmenopausal women have an increased cardiovascular (CV) risk. Chronic kidney disease (CKD) is a well-established risk factor for CV disease, but little is known whether mild-to-moderate kidney dysfunction is associated with atherosclerosis burden in the postmenopausal asymptomatic women.

Materials And Methods: Subclinical atherosclerosis was evaluated in 125 postmenopausal women with no clinical form of atherosclerosis, by carotid and femoral ultrasonography, ankle-brachial index (ABI), and flow-mediated dilation (FMD). Carotid and femoral atherosclerosis were defined as increased intima-media thickness (IMT) and/or the presence of plaques. Endothelial function was assessed by endothelial dependent (flow-mediated dilation at 1 minute [FMD]) and independent (flow-mediated dilation after nitroglycerin [FMD]) vasodilation. Classical CV risk factors (age, smoking, obesity, diabetes, blood pressure, and lipids) were evaluated. Kidney function was evaluated in terms of estimated glomerular filtration rate (eGFR) calculated by the CKD-EPI formula. Univariate linear regression and multivariate logistic regressions were used to evaluate the independent associations between kidney function and markers of subclinical atherosclerosis.

Results: In the unadjusted linear analysis, eGFR showed a significant negative association with markers of subclinical atherosclerosis: carotid IMT (R = 0.305; p < 0.001), femoral IMT (R = 0.19, p < 0.001), carotid plaques (R = 0.22; p < 0.001), femoral plaques (R = 0.09; p = 0.0005), ABI (R = 0.05; p = 0.01), FMD (R = 0.45; p < 0.001), and FMD (R = 0.205, p < 0.001). After adjustment for classical CV risk factors the association remained significant.

Conclusions: Mild-to-moderate reduced eGFR is related to subclinical atherosclerosis, independent of traditional CV risk factors. It is important to detect renal function decline, even if it is mild, to improve risk stratification of subclinical atherosclerosis in postmenopausal women.
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http://dx.doi.org/10.1089/jwh.2016.6081DOI Listing
November 2017

Renal function is similar in solitary kidneys from patients with and without diabetes.

Nefrologia 2017 Mar - Apr;37(2):195-198. Epub 2017 Mar 3.

Emergency County Clinical Hospital, University of Medicine and Pharmacy "V.Babes", Timisoara, Romania; Department of Diabetes and Nutritional Diseases, University of Medicine and Pharmacy "V.Babes", Timisoara, Romania.

Objectives: Due to the shortage of living kidney donors and the current diabetes mellitus (DM) pandemic, studying the association of solitary kidney (SK) with DM is of paramount importance. Our aim was to assess the significance of the association between SK and DM.

Materials And Methods: Eighty-four patients with SK and DM (group A), with a mean age of 62.46±12.72 years, of whom 36 were males and 48 were females, were enrolled in the study. The control group (group B) comprised 84 SK patients without DM of similar age and duration of existence of a SK. Mean age: 61.58±8.22 years, 23 males and 61 females. Serum creatinine, GFR (CKD-EPI), glycaemia, cholesterol, triglycerides, uric acid, proteinuria/24h, systolic blood pressure (SBP), diastolic blood pressure (DBP) and BMI were assessed.

Results: The group of patients with SK and DM (group A) had a higher BMI (p=0.0007), higher metabolic abnormalities (higher glycaemia [p<0.001], triglycerides [p=0.0004], uric acid [p=0.019] and proteinuria/24h [p=0.006]). The study group also had a higher prevalence of hypertension (p=0.003) and coronary artery disease (p=0.031).

Conclusions: We found a higher value of proteinuria in the study group, significant metabolic abnormalities, as well as a higher prevalence of hypertension and coronary artery disease. However, no differences with respect to GFR were found, which could have significant implications for transplantation.
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http://dx.doi.org/10.1016/j.nefro.2016.09.019DOI Listing
April 2018

Urinary tract infections in Romanian patients with diabetes: prevalence, etiology, and risk factors.

Ther Clin Risk Manag 2017 16;13:1-7. Epub 2016 Dec 16.

Victor Babes University of Medicine and Pharmacy Timisoara; Pius Brinzeu Emergency Hospital.

Aim: Patients with diabetes mellitus (DM) have an increased risk of infections, especially urinary tract infections (UTIs). The aim of this study was to assess the prevalence and etiology of UTIs and identify the risk factors for their development in patients with DM.

Patients And Methods: In this retrospective, noninterventional study, the medical records of 2,465 adult patients with DM who were hospitalized in a Diabetes Clinic were reviewed. Data regarding the presence of UTI and possible associated risk factors were collected and their possible relation was analyzed. The study protocol and procedures were approved by the Ethics Committee of Timișoara Emergency Hospital. All data were collected and analyzed using SPSS v.17 statistical software.

Results: The prevalence of UTIs in patients with DM was 12.0% (297 cases), being higher in females than in males and higher in patients with type 2 DM compared with patients with type 1 DM. In univariate logistic regression analysis, risk factors associated with UTIs were female gender, age, type 2 DM, longer duration of DM, and the presence of chronic kidney disease and coronary artery disease. Multivariate analysis identified age, duration of DM, and metabolic control (hemoglobin A1c levels) as independent risk factors for UTIs. The gram-negative bacilli from the family were predominant, with being the most frequent of them (70.4%).

Conclusion: UTIs are a frequent condition associated with DM. It is necessary to improve the care and the screening of UTIs in patients with DM to prevent the occurrence of possible associated severe renal complications.
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http://dx.doi.org/10.2147/TCRM.S123226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5179217PMC
December 2016

Factors influencing the quality of life perception in patients with type 2 diabetes mellitus.

Patient Prefer Adherence 2016 8;10:2471-2477. Epub 2016 Dec 8.

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

Purpose: To evaluate the impact of several factors on the patient's perception on quality of life in a group of patients with type 2 diabetes mellitus (T2DM).

Patients And Methods: In this cross-sectional study, 198 patients with T2DM were enrolled according to a consecutive-case population-based study design. In all participants, the perception on the quality of life was measured using the quality of life index - diabetes version III proposed by Ferrans and Powers. We evaluated the impact of several anthropometric and diabetes-related (ie, diabetes history and quality of glycemic control) factors on the patient's perception on the quality of life.

Results: The presence of diabetes complications was associated with a decreased quality of life: retinopathy (1 vs 5 points; <0.001), chronic kidney disease (-1 vs 5 points; <0.001), and neuropathy (-1 vs 5 points; <0.001). A significant reverse correlation was found between the patient's quality of life and depression's severity (Spearman's =-0.345; <0.001) and body mass index (Spearman's =-0.158; =0.026). A positive association between the quality of life and the quality of diabetes-related self-care activities was found (Spearman's =0.338; <0.001). No significant association was found between the patient's quality of life and the quality of glycemic control, diabetes duration, age, gender, or smoking status.

Conclusion: To improve the patient's quality of life, special care should be given to the modifiable diabetes-related factors: the prevention and treatment of diabetes complications, treatment of depression, and weight loss in obese and overweight patients.
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http://dx.doi.org/10.2147/PPA.S124858DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5158177PMC
December 2016