Gabriela Florina Dale, Loredana Popa and Amorin Popa
The hypothesis that under some circumstances enteroviral infections can lead to type1 diabetes (T1D) was proposed several decades ago, based initially on evidence fromanimal studies and sero-epidemiology. The mechanisms leading to the diseaseinvolve complex interactions between the virus, host target tissue (pancreas) and theimmune system. The following article is intended as a review of several recentinformation of the topic based on human studies that try to establish a connectionbetween a viral infection and Type 1 diabetes. Through understanding better thisassociation and it’s implications in the onset of T1D potential new ways ofprevention and treatment may emerge.
Introduction. Iatrogenic hypoglycemia increases cardiovascular morbidity sometimes even with fatalities, and also increases cognitive disorders in most people with type 1 diabetes (T1D) and type 2 diabetes (T2D). Hypoglycemia is characterized by unawareness if the sympathoadrenal response is attenuated during the night, in autonomic neuropathy or in elderly patients. Therefore, hypoglycemia is a limiting factor in the glycemic management of diabetes.
Methods. We aimed to analyze the hypoglycemic events and the time spent with low glucose level (glucose <3.9 mmol/l) in patients with diabetes (T1D, T2D) with insulin therapy (basal or basal-bolus), in ambulatory or hospital setting. The glucose variability was assessed via the interstitial glucose concentration, measured with a Continuous Glucose Monitoring (CGM) system over 72 hours.
Results. The incidence, severity and duration of hypoglycemia are not correlated with HbA1c, disease’s duration and patient’s age. In patients with T1D, severe hypoglycemia is more frequent in patients with a long duration of diabetes. In this analysis, the type of basal analog insulin did not influence the presence of hypoglycemia (p=0.7), but the duration of nocturnal hypoglycemia was longer with insulin glargine U100 than with insulin detemir. The basal regimen is more protective for hypoglycemia than basal-bolus insulin.
Conclusions. The study suggested that hypoglycemic events are common, silent and prolonged in 1/3 of patients with T1D and T2D. The CGM system is beneficial for all patients with T1D and for patients with T2D with hypoglycemic risk and complications, to adjust medication in order to prevent cardiovascular events.
Background and aims: It is known that the majority of critical unacknowledged hypoglycemia has an increased incidence in patients with type 1 diabetes (T1DM) with a long evolution. The aim of this research is to evaluate the variability of glucose level and hypoglycemic events in patients with type 2 diabetes (T2DM) having pharmacological interventions with hypoglycemic risk. These events are sometimes asymptomatic also in T2DM: frequently in elderly, patients with autonomic neuropathy, or having a long evolution of disease.
Material and method: This analysis includes 72 patients with T2DM, with a relative good metabolic control, and possible glucose fluctuations. Glucose variability was appreciated using continuous glucose monitoring systems (CGMS) used for more than 72 hours in hospital or ambulatory setting.
Results: The incidence, duration and severity of hypoglycemia are not correlated with HbA1c value, age, disease duration or treatment. Approximately a quarter of patients had nocturnal hypoglycemia and in 37,5% of events hypoglycemia was prolonged, more 45 minutes. Clinical manifestations in diurnal hypoglycemia were presents in only 40% of the recorded events.
Conclusions: The study suggested that CGMS is beneficial for patients with type 2 diabetes, with hypoglycemic risk and complications, to adjusted medication, education and prevention the cardiovascular events.
Adela-Gabriela Firănescu, Adina Popa, Maria-Magdalena Sandu, Diana Cristina Protasiewicz, Simona Georgiana Popa and Maria Moţa
Diabetes Mellitus (DM) and Tuberculosis (TB) are two chronic diseases which have a major impact on the population health in developing countries. DM is a chronic, noncommunicable disease, characterized by hyperglycemia, caused by insulin-resistance, inadequate insulin secretion or both. TB is a disease caused by Mycobacterium tuberculosis, an airborne bacteria. DM implies a three times greater risk of developing TB and their association can be considered one of the most important challenges regarding TB control. TB can cause a temporary impaired glucose tolerance, which is a risk factor for DM development. The possibility of relapse or death of a patient with TB is significantly higher when the patient also has DM. The DM-TB association represents an important threat to the population health and requires the implementation of adequate programs in order to reduce the prevalence and incidence of the two diseases.
Diana Cristina Protasiewicz, Adina Popa, Maria-Magdalena Roşu, Adela-Gabriela Firănescu, Simona Georgiana Popa and Maria Moța
Humans spend almost one third of their life sleeping, thus sleep deprivation or poor sleep quality will have consequences upon the quality of life. Obstructive sleep apnea (OSA) is the most common sleep disorder that represents a respiratory cessation for at least ten seconds, which appears repeatable during sleep and it is accompanied by decreased oxygen saturation. The diagnosis of OSA is possible by filling in the STOP, STOP BANG, BERLIN questionnaires and performing the polysomnography, an accessible and more accurate method but yet very expensive. The prevalence of OSA is continuously increasing, but because of the nonspecific symptoms, the percentage of un-diagnosed cases is further increased. Data from 11 epidemiological studies published between 1993 and 2014 indicated an OSA prevalence of 22% in men and 17% in women. It has been suggested that there is a bidirectional causal relationship between OSA and obesity, and numerous studies have shown association of OSA with insulin resistance, diabetes mellitus, diabetic micro- and macrovascular complications and atrial fibrillation.
Vesa Cosmin Mihai, Popa Loredana, Daina Lucia, Moisi Mădălina, Popescu Mircea, Radulian Gabriela, Timar Romulus and Popa Amorin Remus
Insulin resistance is a determinant factor for the increased prevalence of hypertension and dyslipidemia in type 2 diabetes patients. In this study we determined those modifications of clinical and biochemical parameters associated with insulin resistance in the diabetic patient, these alterations can offer us indications concerning the pathophysiological mechanisms that lead to the diabetes development in the case of most patients. Also we determined a correlation between insulin resistance and cardiovascular risk, through the combined effect of age and insulin resistance on this risk.
Adela-Gabriela Firănescu, Adina Popa, Maria-Magdalena Roşu, Diana Cristina Protasiewicz, Simona Georgiana Popa, Mihai Ioana and Maria Moța
Worldwide, tuberculosis (TB) is a major cause of morbi-mortality, about 30% of the population having a Mycobacterium tuberculosis infection. Patients with diabetes mellitus (DM) have a threefold increased risk of developing the disease. The prevalence of DM is rapidly increasing, especially in countries with low and middle income, where TB incidence is also increased, thus baffling the efforts for TB control. The DM-TB co-epidemic is more frequent in married, older men, with reduced level of education, low income, without a steady job, with lifestyle habits such as alcohol consumption, smoking, sedentarism, living in an urban environment, in crowded areas, in insanitary conditions. These patients have a higher body mass index (BMI) compared with those without DM and frequently present family history of TB, family history of DM, longer duration of DM and reduced glycemic control. TB associated with DM is usually asymptomatic, more contagious, multidrug resistant and is significantly associated with an increased risk of therapy failure, relapse and even death. Thus, the DM-TB comorbidity represents a threat to public health and requires the implementation of urgent measures in order to both prevent and manage the two diseases.
Background and aims: The purpose of this study was to evaluate the frequency of demographic and clinical risk factors for fetal macrosomia, maternal pregestational, gestational and intra partum pathology associated with macrosomia, and to investigate the dynamic of these parameters in a decade.
Material and method: We conducted two studies, a case-control study of 261 mothers who delivered macrosomic babies and 241 mothers who delivered normal weight babies in 2016, and then we compared the parameters obtained from the study group of 261women who delivered in 2016 macrosomic babies with those of a study group of 220 women who delivered macrosomic babies in 2006 at Gynecology I County Hospital of Cluj-Napoca. The data was stored and analyzed using Microsoft Excel.
Results and conclusions: Overweight before pregnancy, the excessive weight gain during pregnancy, and the delivery of a macrosomic baby increase the risk to deliver in the future a macrosomic baby. Mothers who delivered macrosomic babies had a higher incidence of thyroid gland pathology (hypofunction) and gestational diabetes than those who delivered normal weight babies.
Theodor Moica, Iosif Gabos Grecu, Gabriela Elena Buicu, Melinda Ferencz, Marieta Gabos Grecu, Andreea Sălcudean and Cosmin Octavian Popa
Objective: The aim of this paper was to evaluate if depressed patients have an increased level of morning serum cortisol compared to healthy persons and to assess the relation between high levels of cortisol and prosocial coping mechanisms, in the context of Recurrent Major Depressive Disorder. Methods: Morning serum cortisol level was measured in 15 depressed patients hospitalized in First Clinic of Psychiatry Tirgu Mures and in 15 healthy controls. We have analyzed 3 behavioral coping strategies with The Strategic Approach of Coping Scale (SACS): social joining (SJ), seeking social support (SSS) and cautious action (CA). Results: 30 participants were included, the mean value of the cortisol for females was Mcort_female= 16.38 μg/dl and for males Mcort_male= 16.31 μg/dl. Independent sample t test showed that the cortisol level in depressed group was higher than the cortisol level in the control group: t = 2.394, p < 0.05 (0.024). In the MDD group the Spearman correlation between the level of serum cortisol and prosocial coping strategies was: rcortisol-SJ= -0.519; rcortisol-SSS= -0.107; rcortisol-CA= -0.382. Conclusions: Although the studied sample patient was small, we can conclude that the patients with Recurrent Major Depressive Disorder have an increased level of morning serum cortisol compared to healthy persons. In these patients there is an inverse correlation between the increased levels of morning cortisol and the frequency of use of the effective prosocial coping strategies, particularly the social joining type.
Stelian Atila Balan, Şerban Ion Bubenek-Turconi, Gabriela Droc, Elena Marinescu, Elisabeta Nita, Mihaela Camelia Popa, Dana Popescu-Spineni and Dana Tomescu
Background and aims. This study aims to identify the extent to which Burnout syndrome is present among medical staff in the anaesthesia and intensive care units in Romania and if there are significant differences dependant on age or sex.
Methods. Maslach Burnout Inventory (MBI), structured in three dimensions: Emotional Exhaustion – 9 items (EE), Depersonalization – 6 items (D) and Reduction of personal achievement – 10 items (RPA), was used for the evaluation of Burnout Syndrome in 275 medical staff in anaesthesia and intensive care physician and nurses from departments in Romania.
Results. Burnout syndrome among medical staff with MBI had a total score of 68 and average scores for all syndrome categories. There were no statistically significant differences dependant on age and sex (p < 0.05, chi-squared test). The logistic regression has highlighted three elements that are risk factors, which belonged to the psycho-emotional sphere, communication abilities and the degree of organization and professional planning (item – I feel at the end of my rope, item – I do not communicate easily with people regardless of their social status and character, and item – I have professional disillusion). The risk factor with the most reliable range was the item “I feel at the end of my rope”.
Conclusion. The level of Burnout syndrome is medium regardless of sex or age category. Possibly, the concern of the ICU medical staff for the psycho-emotional life is not efficient, as well as for identifying/ developing communication abilities. The association between risk factors for burnout syndrome and psycho-emotional life development require further research.