Search Results (13)

Background/Objectives: This study aimed to evaluate adipose tissue dysfunction, assessed through adipocytokines and proinflammatory cytokines, in relation to hepatic steatosis (HS) in patients with newly diagnosed type 2 diabetes (T2D). Methods: An observational study evaluated 155 consecutive patients with new-onset T2D; 118 (76.1%) were found to have HS, while the remaining 37 served as the control group without steatosis. Anthropometric status and body mass index (BMI) were evaluated. The biochemical assessment encompassed the measurements of fasting serum lipids, fasting plasma glucose (FPG), liver function tests, adiponectin, leptin, resistin, tumor necrosis factor (TNF-α), and interleukin 6 (IL-6). Insulin resistance (IR) was determined using the homeostasis model assessment (HOMA). HS was evaluated using ultrasonographic criteria. Quantitative evaluation of HS was performed by calculating the hepatic steatosis index (HSI). Results: There were statistically significant differences between the groups for age, BMI, weight, waist circumference (WC) and hip circumference, HSI, glucose profile (fasting plasma glucose (FPG), HOMA-IR), liver function tests, adiponectin, leptin, resistin, TNF-α, and IL-6. In multivariate logistic regression analysis, age, smoking, BMI, WC, HOMA-IR, and hypoadiponectinemia were the only independent factors associated with HS. Conclusions: The adipose tissue dysfunction assessed through adipocytokines and proinflammatory cytokines is part of the associated disorders in HS and new-onset T2D. In patients with newly diagnosed T2D, age, smoking, and hypoadiponectinemia consistently emerged as independent predictors of hepatic steatosis. More prospective trials are needed to clarify the “the temporal onset” of adipose tissue dysfunction. Full article

Background: Olmesartan medoxomil (OLM) is the prodrug of olmesartan, an angiotensin II type 1 receptor blocker that has antihypertensive and antioxidant activities and renal protective properties. It exhibits low water solubility, which leads to poor bioavailability and limits its clinical potential. To improve the solubility of OLM, a host–guest inclusion complex (IC) between heptakis(2,6-di-O-methyl)-β-cyclodextrin (DMβCD) and the drug substance was obtained. Along with active substances, excipients play a crucial role in the quality, safety, and efficacy of pharmaceutical formulations. Therefore, the compatibility of OLM/DMβCD IC with several pharmaceutical excipients was evaluated. Methods: IC was characterized in both solid and liquid states, employing thermoanalytical techniques, universal-attenuated total reflectance Fourier-transform infrared spectroscopy, powder X-ray diffractometry, UV spectroscopy, and saturation solubility studies. Compatibility studies were carried out using thermal and spectroscopic methods to assess potential physical and chemical interactions. Results: The 1:1 OLM:DMβCD stoichiometry ratio and the value of the apparent stability constant were determined by means of the phase solubility method that revealed an A_L-type diagram. The binary system showed different physicochemical characteristics from those of the parent entities, supporting IC formation. The geometry of the IC was thoroughly investigated using molecular modeling. Compatibility studies revealed a lack of interaction between the IC and all studied excipients at ambient conditions and the thermally induced incompatibility of IC with magnesium stearate and α-lactose monohydrate. Conclusions: The results of this study emphasize that OLM/DMβCD IC stands out as a valuable candidate for future research in the development of new pharmaceutical formulations, in which precautions should be considered in choosing magnesium stearate and α-lactose monohydrate as excipients if the manufacture stage requires temperatures above 100 °C. Full article

Background and Objectives: Lower extremity amputations (LEAs) represent a significant health problem. The aim of our study was to analyse the type and trends of diabetes-related LEAs in patients hospitalized in one surgical centre in Bucharest between 2018 and 2021. The second aim was to assess the impact of the COVID-19 pandemic on the trends of LEAs. Materials and Methods: We performed a retrospective analysis of all lower limb amputations performed between 01 January 2018 and 31 December 2021 in the Department of Surgery, Dr. I. Cantacuzino Clinical Hospital, Bucharest, Romania. We evaluated demographic parameters, type of LEA, the level, the laterality and trends of the amputations, the main aetiologies leading to amputation, and the length of hospitalization. Results: During the study period, 1711 patients underwent an LEA. The mean age was 64.53 ± 9.93 years, 71.6% (n = 1481) being over 60. Men outnumbered women by a ratio of 3.62:1. The most frequent interventions were ray amputations in 41.2% (n = 705) of patients; then, there were amputations of the toe (20.4%, n = 349), transtibial amputations (18.9%, n = 323), transfemoral amputations (10.6%, n = 181), and midfoot amputations (9%, n = 154). Wet gangrene was the most frequent aetiology (40.9%, n = 699). The total number of LEAs decreased constantly throughout the analysed period, such that 616 LEAs were performed in 2018 and 323 LEAs in 2021 (p < 0.001). There was a statistically significant increase in the rate of major LEAs in the pandemic vs. pre-pandemic period (37% vs. 24.4%, p < 0.001). Conclusions: In our study, the total number of LEAs decreased throughout the analysed period, but there was an increase in the rate of major LEAs in the pandemic vs. pre-pandemic period. Being over 65 years of age, leucocytosis, sepsis at presentation, and diabetic polyneuropathy were important risk factors for the necessity of LEA in complicated diabetes-related foot disease. Full article

Cardiovascular disease is the leading cause of death in the European Union (EU), and while the mortality rates of diabetes, myocardial infarction, and the total fat intake have been extensively studied, we believe that understanding the interaction between such closely correlated determinants is crucial to the development of effective health policies in the EU. Our paper’s novelty is represented by the econometric modelling, and its ability to capture both temporal and unit variations. The research methodology consists of using a panel data model with fixed effects for the 27 EU member states over the period 2010–2021. The results of the study show that the standardized mortality rate for deaths preventable by prevention and treatment and diabetes-related mortality are significant predictors of total mortality in the EU. The standardized mortality rate for deaths preventable by prevention and treatment had a significant positive impact, suggesting that improved preventive and therapeutic interventions can significantly reduce total mortality. Diabetes-associated mortality also showed a strong positive correlation with total mortality, emphasizing the need for effective diabetes management and prevention strategies. These results are useful for the formulation of public health strategies aimed at improving life expectancy and reducing the burden of chronic diseases. Full article

Chronic kidney disease (CKD) is a microvascular complication that frequently affects numerous patients diagnosed with diabetes. For the diagnosis of CKD, the guidelines recommend the identification of the urinary albumin/creatinine ratio and the determination of serum creatinine, based on which the estimated rate of glomerular filtration (eGFR) is calculated. Serum creatinine is routinely measured in clinical practice and reported as creatinine-based estimated glomerular filtration rate (eGFRcr). It has enormous importance in numerous clinical decisions, including the detection and management of CKD, the interpretation of symptoms potentially related to this pathology and the determination of drug dosage. The equations based on cystatin C involve smaller differences between race groups compared to GFR estimates based solely on creatinine. The cystatin C-based estimated glomerular filtration rate (eGFRcys) or its combination with creatinine (eGFRcr-cys) are suggested as confirmatory tests in cases where creatinine is known to be less precise or where a more valid GFR estimate is necessary for medical decisions. Serum creatinine is influenced by numerous factors: age, gender, race, muscle mass, high-protein diet, including protein supplements, and the use of medications that decrease tubular creatinine excretion (H2 blockers, trimethoprim, fenofibrate, ritonavir, and other HIV drugs). The low levels of creatinine stemming from a vegetarian diet, limb amputation, and conditions associated with sarcopenia such as cirrhosis, malnutrition, and malignancies may lead to inaccurately lower eGFRcr values. Therefore, determining the GFR based on serum creatinine is not very precise. This review aims to identify a new perspective in monitoring renal function, considering the disadvantages of determining the GFR based exclusively on serum creatinine. Full article

The Roma population is Europe’s largest ethnic minority, yet data on the prevalence of non-communicable diseases remain scarce in medical literature. This study aimed to compare the clinical and metabolic particularities of a Roma population with diabetes with a group of non-Roma. We conducted an observational, transversal study and evaluated 808 adult patients with diabetes mellitus, from a tertiary diabetes care hospital. The prevalence of metabolic syndrome was high among both groups, 94.3% in the Roma patients and 89.1% in the non-Roma. A slightly higher mean value of the triglyceride–glucose (TyG) index was observed among the Roma group (10.07 ± 0.71 versus 9.71 ± 0.82). Among the non-Roma, variables that were significantly associated with the TyG index were glycated hemoglobin (HbA1c), total cholesterol (TC), high density lipoprotein–cholesterol (HDL-c), and low-density lipoprotein-cholesterol (LDL-c), while among the Roma, HbA1c and HDL-c were correlated with this index. There were no differences concerning myocardial infarction; however, the number of patients with a history of stroke was 2.1 times higher in the Roma group compared to the non-Roma group. The prevalence of cardiovascular risk factors, cardiovascular disease, and microvascular complications among the study’s Roma population are quite significant, underscoring the importance of ethnic disparities in approaching healthcare management strategies. Full article

Background and Objectives: Cardiac autonomic neuropathy (CAN) is a severe complication of diabetes mellitus (DM) strongly linked to a nearly five-fold higher risk of cardiovascular mortality. Patients with Type 2 Diabetes Mellitus (T2DM) are a significant cohort in which these assessments have particular relevance to the increased cardiovascular risk inherent in the condition. Materials and Methods: This study aimed to explore the subtle correlation between the Ewing test, Sudoscan-cardiovascular autonomic neuropathy score, and cardiovascular risk calculated using SCORE 2 Diabetes in individuals with T2DM. The methodology involved detailed assessments including Sudoscan tests to evaluate sudomotor function and various cardiovascular reflex tests (CART). The cohort consisted of 211 patients diagnosed with T2DM with overweight or obesity without established ASCVD, aged between 40 to 69 years. Results: The prevalence of CAN in our group was 67.2%. In the study group, according SCORE2-Diabetes, four patients (1.9%) were classified with moderate cardiovascular risk, thirty-five (16.6%) with high risk, and one hundred seventy-two (81.5%) with very high cardiovascular risk. Conclusions: On multiple linear regression, the SCORE2-Diabetes algorithm remained significantly associated with Sudoscan CAN-score and Sudoscan Nephro-score and Ewing test score. Testing for the diagnosis of CAN in very high-risk patients should be performed because approximately 70% of them associate CAN. Increased cardiovascular risk is associated with sudomotor damage and that Sudoscan is an effective and non-invasive measure of identifying such risk. Full article

Wearable exoskeleton solutions for upper limb rehabilitation or assistance, particularly for the hand area, have become increasingly attractive to researchers, proving to be effective over time in treating hand movement impairments following various neurological diseases. Our aim in the present work is to design a wearable exoskeleton device for active hand rehabilitation/assist control based on myoelectric signal (EMG) capture from forearm muscles, which is easy to wear by the user, comfortable, lightweight, and relatively inexpensive to make. The actuators use two different lengths to increase biocompatibility with the anatomy of the hand, and PneuNets fluid actuators are used. Their design to meet force and bending requirements was based on finite element numerical simulations, and the actuators were designed based on a clear design methodology to achieve the best possible quality. Tests on healthy subjects show that the EMG-based control strategy meets the needs of rehabilitation/assistive hand therapy, finding a comfortable and easy-to-use device. Future directions will focus on developing the device to meet rehabilitation needs for the entire upper limb and integrating the device into virtual reality (VR) through immersive devices. Full article

Type 1 diabetes mellitus is a chronic autoimmune disease that affects millions of people and generates high healthcare costs due to frequent complications when inappropriately managed. Our paper aimed to review the latest technologies used in T1DM management for better glycemic control and their impact on daily life for people with diabetes. Continuous glucose monitoring systems provide a better understanding of daily glycemic variations for children and adults and can be easily used. These systems diminish diabetes distress and improve diabetes control by decreasing hypoglycemia. Continuous subcutaneous insulin infusions have proven their benefits in selected patients. There is a tendency to use more complex systems, such as hybrid closed-loop systems that can modulate insulin infusion based on glycemic readings and artificial intelligence-based algorithms. It can help people manage the burdens associated with T1DM management, such as fear of hypoglycemia, exercising, and long-term complications. The future is promising and aims to develop more complex ways of automated control of glycemic levels to diminish the distress of individuals living with diabetes. Full article

Background and Objectives: The primary objective of this study was to investigate the incidence of lower extremity amputations (LEAs) in a representative population from Romania, in both diabetic and non-diabetic adults, including trauma-related amputations. The secondary objective was to evaluate the trends in LEAs and the overall ratio of major-to-minor amputations. Material and Methods: The study was retrospective and included data from the Romanian National Hospital Discharge Records, conducted between 1 January 2015 and 31 December 2019. Results: The overall number of cases with LEAs was 88,102, out of which 38,590 were aterosclerosis-related LEAs, 40,499 were diabetes-related LEAs, and 9013 were trauma-related LEAs, with an ascending trend observed annually for each of these categories. Of the total non-traumatic amputations, 51.2% were in patients with diabetes. Most LEAs were in men. The total incidence increased from 80.61/100,000 in 2015 to 98.15/100,000 in 2019. Conclusions: Our study reported a 21% increase in total LEAs, 22.01% in non-traumatic LEAs, and 19.65% in trauma-related amputation. The minor-to-major amputation ratio increased over the study period in patients with diabetes. According to these findings, it is estimated that currently, in Romania, there is one diabetes-related amputation every hour and one non-traumatic amputation every 30 min. Full article

Hypertension poses a significant burden in the general population, being responsible for increasing cardiovascular morbidity and mortality, leading to adverse outcomes. Moreover, the association of hypertension with dyslipidaemia, obesity, and insulin resistance, also known as metabolic syndrome, further increases the overall cardiovascular risk of an individual. The complex pathophysiological overlap between the components of the metabolic syndrome may in part explain how novel antidiabetic drugs express pleiotropic effects. Taking into consideration that a significant proportion of patients do not achieve target blood pressure values or glucose levels, more efforts need to be undertaken to increase awareness among patients and physicians. Novel drugs, such as incretin-based therapies and renal glucose reuptake inhibitors, show promising results in decreasing cardiovascular events in patients with metabolic syndrome. The effects of sodium-glucose co-transporter-2 inhibitors are expressed at different levels, including renoprotection through glucosuria, natriuresis and decreased intraglomerular pressure, metabolic effects such as enhanced insulin sensitivity, cardiac protection through decreased myocardial oxidative stress and, to a lesser extent, decreased blood pressure values. These pleiotropic effects are also observed after treatment with glucagon-like peptide-1 receptor agonists, positively influencing the cardiovascular outcomes of patients with metabolic syndrome. The initial combination of the two classes may be the best choice in patients with type 2 diabetes mellitus and multiple cardiovascular risk factors because of their complementary mechanisms of action. In addition, the novel mineralocorticoid receptor antagonists show significant cardio-renal benefits, as well as anti-inflammatory and anti-fibrotic effects. Overall, the key to better control of hypertension in patients with metabolic syndrome is to consider targeting multiple pathogenic mechanisms, using a combination of the different therapeutic agents, as well as drastic lifestyle changes. This article will briefly summarize the association of hypertension with metabolic syndrome, as well as take into account the influence of antidiabetic drugs on blood pressure control. Full article

(1) Background: Pulse oximetry (PO) is an effective method of dental pulp status monitorization but still lacks practical implementation in dentistry, as well as clear reference values for different tooth types. The study’s aim was to investigate the age-related variation of blood oxygen saturation (SpO₂) from the dental pulp during different stages of tooth development in all types of primary and permanent teeth of children. (2) Methods: The pulps of 600 healthy primary and permanent teeth (incisors, canines, premolars, and molars) of patients aged 2–15 years were tested with an adapted PO device, and the results were statistically analyzed; (3) Results: Statistically significant differences (p < 0.05) were found between open-apex and closed-apex teeth and between the canines and other tooth types in both primary and permanent dentitions. (4) Conclusions: Values of SpO₂ tended to decrease with age progression in both primary and permanent dentitions. Enamel and dentine thickness and their optical properties and the shape and volume of coronal pulp, which differed among tooth types, seemed to have some influence on the reading as well. The study indicates that factors such as the root development and the tooth type must be taken into account when establishing reference SpO₂ values for the dental pulp. Full article

Background and Objectives: The simplified interpretation of serum ferritin levels, according to which low ferritin levels indicate iron deficiency and high levels indicate hemochromatosis is obsolete, as in the presence of inflammation serum ferritin levels, no longer correlate with iron stores. However, further data are needed to interpret serum ferritin levels correctly in patients with ongoing inflammation. Our study aimed to assess serum iron and ferritin dynamics in patients with long intensive care unit (ICU) stay and the possible correlations with organ dysfunction progression and outcome. Materials and Methods: We conducted a prospective study in a university hospital ICU over six months. All patients with an ICU length-of-stay of more than seven days were enrolled. Collected data included: demographics, Sequential Organ Failure Assessment (SOFA) score, admission, weekly serum iron and ferritin levels, ICU length-of-stay and outcome. Interactions between organ dysfunction progression and serum iron and ferritin levels changes were investigated. Outcome predictive value of serum ferritin was assessed. Results: Seventy-two patients with a mean ICU length-of-stay of 15 (4.4) days were enrolled in the study. The average age of patients was 62 (16.8) years. There were no significant differences between survivors (39 patients, 54%) and nonsurvivors (33 patients, 46%) regarding demographics, serum iron and ferritin levels and SOFA score on ICU admission. Over time, serum iron levels remained normal or low, while serum ferritin levels statedly increased in all patients. Serum ferritin increase was higher in nonsurvivors than survivors. There was a significant positive correlation between SOFA score and serum ferritin (r = 0.7, 95% CI for r = 0.64 to 0.76, p < 0.01). The predictive outcome accuracy of serum ferritin was similar to the SOFA score. Conclusions: In patients with prolonged ICU stay, serum ferritin dynamics reflects organ dysfunction progression and parallels SOFA score in terms of outcome predictive accuracy. Full article