Introduction. Dawn phenomenon could have deleterious effect on overall glycemic control. Glycemic variability may be an independent risk factor for the development of diabetes chronic complications. The study aimed to evaluate any correlations between the dawn phenomenon and parameters of glycemic variability in a cohort of type 2 diabetes patients (T2DM). Material and methods. This retrospective observational study included 131 T2DM patients. Continuous glucose monitoring (CGM) has been performed. Data from the first 24h of full recording were used for analysis of glycemic variability indices: mean level of 24h interstitial glucose value and standard deviation; % coefficient of variation; J index; mean amplitude of glycemic excursion - MAGE; continuous overall net glycemic action (CONGA) at 1, 2, 4 and 6 hours; mean of daily differences (MODD) index. Results. Mean age was 56.04 ± 9.91 years, 35.9% women, 17.6% on diet, 53.4% on oral therapy and 29% on insulin. Dawn phenomenon was more frequent in patients below 60 years (70%) and in oral therapy group (72.85%). Significant correlations between the dawn phenomenon and j-index, MAGE, CONGA-4 and CONGA-6 have been found in T2DM patients on diet therapy alone. The amplitude of dawn phenomenon was 46.10 ± 24.40 mg/dl and significantly correlated (p<0.05) after adjustment for age, gender and treatment with % CV, MAGE, CONGA-1, CONGA-2, CONGA-4, CONGA-6 and MODD. Conclusions. The dawn phenomenon significantly increases the glycemic variability parameters in drug-naive T2DM patients, with no impact in T2DM on oral or insulin therapy.
Predictors of Changes in Physical Properties of Skin in Patients with Diabetes Mellitus
Introduction: The skin, the largest human organ, is often affected by diabetes mellitus (DM). We know that DM affects the hydration of stratum corneum (SC), the sebum content of the skin and to some extent, the barrier function of the epidermis and elasticity, but we do not know the factors leading to these changes. Objectives: The objectives of this study were to determine the factors associated with changes in physical properties of the skin (skin hydration degree, sebumetry, transepidermal water loss and skin elasticity) in patients with diabetes. Materials and methods: The physical properties of the skin were assessed using the Multi Probe Adapter Systems MPA ® (Courage-Khazaka, Germany) in 57 patients with diabetes and 46 non-diabetic. Results: Statistical analysis of the entire group of 103 subjects showed a significant association between female gender and decreased SC hydration (p<0.05 in all cases), decreased values of transepidermal water loss (TEWL) (β=-0.282, p=0.006) and decreased elasticity of the skin in forearm (β=-0.216, p=0.043). Also, the presence of DM was negatively associated with levels of SC hydration measured on the forearm (β=-0.281, p=0.005). Furthermore, in patients with diabetes, the presence of diabetic neuropathy (DNP) was negatively associated with the hydration of SC measured at all levels (forearm: β=-0.465, p<0.001; leg: β=-0.590, p<0.001; tight: β=-0.198, p<0.001). The observed relationship was independent of age and sex of the participants (p<0.05 after adjustment for age and sex). Regarding skin elasticity, increasing age was associated with lower levels of skin elasticity both in entire group and in patients with DM, at all sites of measurements (p<0.05 in all cases). Additionally, in patients with diabetes, elasticity of the skin measured at forearm and tight was negativelly associated with type of DM (forearm: β=-0.335, p=0.023; tight: β=-0.522, p<0.001). In our study, nor diabetes neither DNP were not associated with TEWL values. Conclusions: The presence of DNP seems to be the main predictor of decreased SC hydration in all measuring points and skin elasticity is significantly associated with age. There are some gender-related modification in physical properties of the skin. Surprisingly, type 2 DM was associated with reduced elasticity in the thigh, and this association was independent of age and sex.
Chronic hyperglycemia is an important cause for the development of chronic complications of diabetes, but glycemic variability has emerged in recent years as an independent contributor to diabetes-related complications. Our objective was to evaluate glycemic variability in patients with T2DM treated with insulin compared with other antidiabetic drugs. In this retrospective study, we collected 24-hour continuous glucose monitoring (CGM) recording data from 95 patients with T2DM, of which 27 treated with insulin and 68 with non-insulin treatment. We calculated and compared 16 glucose variability parameters in the insulin-treated and non-insulin treated groups. Insulin treated patients had significantly higher values of parameters describing the amplitude of glucose value fluctuations (standard deviation of glucose values, percentage coefficient of variation [%CV], and mean amplitude of glycemic excursion [MAGE], p <0.05) and time-dependent glucose variability (percentage of time with glycemic values below 70 mg/dl and continuous overall net glycemic action [CONGA] at 2, 4 and 6 hours, p <0.05). In conclusion, insulin therapy in T2DM is correlated with significantly higher glycemic variability.
Background and aims: The present study aimed to assess the relative validity of the Romanian version of a food frequency questionnaire (FFQ) in evaluating habitual dietary intake.
Material and methods: We used an FFQ that comprised questions on 90 beverage and food items from Nurses Health Questionnaire. The linguistic interchangeability between translation and original questions of the FFQ was assessed in 50 bilingual adults. Also, the FFQ was validated against the 24-h recall diary in 85 participants from ORO study enrolled in Cluj County.
Results: The Spearman correlation coefficients between the Romanian and English versions of the FFQ ranged between 0.614 and 1.000, with the majority having values >0.900 (p <0.05 for all). Caloric and nutrient intake estimated from FFQ was significantly correlated with that derived from 24-h dietary recall (correlation coefficients 0.243 to 0.339; p-values <0.05). >70% of the participants were classified in the same or adjacent quartiles of energy and nutrient consumption showing a good agreement between FFQ and 24-h dietary recall. Tested FFQ questionnaire had a good internal consistency with Cronbach’s alpha coefficients of 0.931 and 0.949, respectively.
Conclusion: Tested FFQ had an acceptable relative validity and can be used to estimate caloric and macronutrient intake.
Introduction: Oral mucositis characterized by inflammation of the oral mucosa, ulcers, angular cheilitis, accompanied by pain in the maxillary facial area are symptoms of patients who have undergone cytostatic treatment, affecting over 75% of high-risk patients.
Material and methods: From the total of 182 patients with hematological malignancies, we selected 59 patients, diagnosed with malignant lymphomas and treated at the Hematology Department of the Medical Clinic 1 in Tîrgu Mureș, between July 2013 and June 2016, analyzing the data in the data observation sheets. The study is a retrospective one.
Results: In the group of patients studied, who were treated based on the aforementioned cytostatic plans, we found that the CVP + Rituximab plan frequently causes 1st and 2nd class stomatitis, with no patients with 3rd and 4th class stomatitis. The CHOP + Rituximab therapy plan in a total of 80 applications had complications of 1st and 2nd class stomatitis, much more frequent 1st class without stomatitis of 2nd and 4th degree. Grade III stomatitis occurs in two cases in the CHOP-Bleo belts. Introducing dental medicine in the context of medical multidisciplinarity in oncology hematology is a real necessity because the oral complications of chemotherapy treatments by their severity can lead to compromise of the treatment protocol by reducing the doses or even stopping the treatment
Conclusions: Malignant hemopathies represent a significant percentage in dental disorders, and among them, the maximum severity belongs to the non-Hodgkin and Hodgkin malignant lymphomas. Stomatitis, also called gingivotoxic stomatitis caused by medication, is an acute oral complication, with erythema and edema of the entire oral cavity. The role of the dentist in the diagnosis, prevention and treatment of oral lesions, following the cytostatic therapy, is extremely important.
Background: Osteonecrosis of the jaw is an uncommon but serious complication related to oral and intravenous bisphosphonate (BP) therapy. Its pathogenesis is not well understood, and there are no universal protocols accepted to treat it.
The aim of our study was to use the same questionnaire as four years ago to evaluate the awareness of dentists in Tîrgu Mureș regarding the dental treatments that can be applied in patients on BP therapy, and to assess how their knowledge on the subject has evolved over these years.
Material and method: We used the same questionnaire-based study as four years ago among dentists in Tîrgu Mureș, raising important issues such as: is the patient asked about current or previous treatments with BPs, do they perform surgical treatment in these patients, do they know under what conditions they can perform this treatment, or do they deem it necessary to contact the prescriber before surgical treatment.
Results: One-hundred twenty questionnaires were returned. The majority of respondents (n = 113, 94.2%) included the question regarding the use of BPs in their medical records. Of all respondents, 48 (40%) perform dental or surgical treatments on patients undergoing BP therapy, 68 (56.7%) do not perform dental or surgical treatments on these patients, and four of the respondents (3.3%) did not know the answer. One hundred (83.3%) respondents always contact the prescriber prior to surgery in these patients, regardless of how BPs are administered.
Conclusions: According to the findings of the present study, many of the respondent doctors have heard about BPs and their complications, but they are not aware of the fundamental concepts of bisphosphonate-related osteonecrosis of the jaw prevention and treatment protocols. In the absence of appropriate protocols, the quality of life of these patients is compromised.
Introduction: Edentation is a major emergency and has an echo over the entire stomatognathic system. The treatment of partial edentation has undergone major changes in the last decades for multiple causes, including increasing the level of dental, medical education, introducing new techniques, methods, and materials, increasing the duration of retention of teeth on the arch.
Aim of the study: The aim of this study is to determine the degree of satisfaction of patients with a fixed prosthetic denture, to highlight the importance of communication between doctor and patient with repercussions on the results of prosthetic treatment, and evaluate the degree of awareness of oral health and oral hygiene practices.
Material and Method: For this study it was used a self-designed questionnaire, which explored both clinical and non-clinical dental services. The questionnaire consisted of three parts: first part (A) includes socio-demographic indices, part two (B) includes questions related to the doctor-patient relationship, and in the third part (C) the questionnaire asks questions regarding the general satisfaction of the patients with reference to the prosthetic tratament. The questionnaire also includes the material (s) from which the prosthetic denture is performed and the area of the edentation.
Results: The present study was performed on a batch of 117 people, 48 female, and 69 males between the ages of 21 and 60. Our results show that the majority of patients present metallic-ceramic dentures, located in most cases in the lateral area, and the majority of patients are satisfied with the prosthetic tratament. There were no patients complaining about the result of the tratament. Pacients are delighted by their relationship with medical staff.
Conclusions: The most important finding of this study states that a large proportion of patients showed a lack of knowledge regarding oral hygiene measures and the importance of maintaining a fixed prosthetic denture using a dental abutment. Also, the majority of the doctors did not pay attention to the post-treatment instructions regarding the maintenance of a fixed prosthetic denture.