Florin Mihălţan and Anca Hâncu
Anca Hâncu and Gabriela Radulian
Background and Aims: The aim of the present study was to investigate the relationship between visceral fat area (VFA), estimated by bioimpedance, and cardiovascular risk factors independent of BMI and waist circumference in a cohort of Romanian patients. Material and Methods: This was a cross-sectional study, in which were collected data from 751 patients ≥18 years of age from Cluj-Napoca. Anthropometric, biochemistry, body composition and medical history parameters were recorded from patients’ files. Results: Compared with the participants with VFA <100 cm2, those with VFA ≥100 cm2 had significantly worse levels of the laboratory parameters describing the glycemic metabolism, lipid metabolism and liver functions (p <0.05 for all). A higher percentage of participants with VFA ≥100 cm2 had diabetes, obesity, hypertension, hypertriglyceridemia and hypo-HDL cholesterolemia (p <0.05 for all). VFA was correlated with systolic and diastolic blood pressure, total and LDL-cholesterol levels, triglycerides, ALT, previous diagnosis of diabetes, hypertriglyceridemia and hypo-HDL cholesterolemia independent of BMI and waist circumference. Conclusions: Among this cohort of Romanian adults, an increasing level of visceral adiposity was correlated with worse lipid and glucose metabolism parameters as well as with increased levels of ALT, which probably reflects liver fat deposition.
Anca Hâncu, Florin Mihălţan and Gabriela Radulian
High prevalence of noncommunicable diseases with their associated costs are related more and more to unhealthy behaviours such as unappropriated diets, lack of physical activity and smoking. Lifestyle medicine is now more and more scientific and with evidence-based fundament. The key in lifestyle change is negotiation and cooperation. Physicians should do more than education, should empower and motivate the patient in planning a healthy lifestyle leading to sustained change.
Cristian-Ioan Crăciun, Anca-Elena Crăciun, Adriana Rusu, Corina Ioana Bocşan, Nicolae Hâncu and Anca Dana Buzoianu
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.
Anca-Elena Crăciun, Cornelia Bala, Cristian Crăciun, Gabriela Roman, Carmen Georgescu and Nicolae Hâncu
Background and aims. The aim of our research was to evaluate the impact of short-time continuous glucose monitoring (CGM) on glycemic control evaluated by HbA1c and within-day glucose variability. We also assessed if the initiation of insulin therapy in conjunction with lifestyle recommendations may prevent the weight gain. Materials and
method. We included 28 patients with type 2 diabetes with 2 consecutive CGMS recordings available (baseline and follow-up) and for which were collected data on weight, body mass index (BMI), percentage (%) of body fat, visceral fat area, HbA1c and glycemic variability. Results. The HbA1c decreased significantly from 8.8% at baseline to 7.3% at follow-up (p <0.0001) in the whole group, and from 10.5% to 7.5% in the subgroup for which the insulin therapy was initiated at baseline (p=0.011). The BMI, % body fat and visceral fat area decreased significantly from 29.2 kg/m2 to 28.4 kg/m2; from 32.3% to 30.4%; and from 141.6 to 129.3 (cm2), respectively. No increase of these parameters was observed in the subgroup for which the insulin therapy was initiated at baseline. Conclusion. The use of CGMS in combination with individualized lifestyle and therapeutic recommendations may have a beneficial effect on glycemic control and may prevent the weight gain associated with insulin initiation.
Ramona Maria Ştefan, Cristina Niţă, Anca Crăciun, Adriana Rusu and Nicolae Hâncu
Background and Aims: We assessed the effect of intensive therapy on modifiable cardiovascular (CV) risk factors and CV risk as compared to conventional therapy in patients with newly diagnosed type 2 diabetes mellitus (T2DM).
Material and Methods: This was an observational, prospective study, conducted in Romania. During 1-year follow-up period the enrolled participants received either multi-factorial pharmacotherapy associated with intensive therapeutic education (Intensive group), or conventional therapy (Control group). Current analysis included data (anthropometric measurements, blood pressure and biochemical parameters) recorded at months (M) 0, 6 and 12. CV risk was calculated at M1 and M12 using the UK Prospective Diabetes Study Risk Engine.
Results: 138 patients aged 57.02±10.05 years were included in this analysis (69 in each group). At M6 and M12 a significant improvement of the majority of the modifiable risk factors in the Intensive group compared to the Control group was observed. At M12, coronary heart disease (CHD)/fatal-CHD risks were significantly lower in the Intensive (7.5%/3.1%) than in the Control (17.95%/10.3%) group (p<0.05). A similar trend was observed for the stroke/fatal-stroke risks.
Conclusions: CHD/fatal-CHD and stroke/fatal-stroke risk burden decreased in newly diagnosed diabetic patients following multi-factorial pharmacotherapy association with intensive lifestyle changes during 1-year follow-up.
D. Balasa, Carmen Ciufu, R. Baz and Anca Hancu
We present a patient with left compressive L5-S1 lumbar disc hernia in lateral reces and foramina revealed by high intensity pain (Visual Autologus Scale 7/10) and paresthesias on the left S1 dermatoma for 5 months. He refused surgery and followed conservative treatment with very good results after 6 months. The radicular S1 pain became of a small intensity (Visual Autologus Scale 2-3/10) and intermitent and after one year it completely disapeared. After 4 years he repeated the lumbar magnetic resonance imaging which proved the disapearance of the L5-S1 lumbar disc hernia.
Daniel Balasa, Gabriela Butoi, Radu Baz and Anca Hancu
Spinal epidural haematoma (SEH) is a rare entity. We present the case of a 45 years old patient with lumbar epidural hematoma produced by a L3 vertebral tumoral (metastatic) fracture. Neurological status: cauda equina syndrome with sphincterian deficits, incomplete paraplegia (Frankel C), with neurological level L1. Emergency surgery was performed (L3-L2-bilateral laminectomy, L1 left laminectomy, posterior stabilization L2-L4 by titan screws) offering the possibility to progressive motor, sensitive and sphincterian deficites recovery.
Abbreviations: Computer Tomography-CT, Magnetic resonance Imaging-MRI, Spinal epidural haematoma-SEH, Visual analogue scale of pain-VAS.
Conclusion: We present a patient with a compressive subacute extradural haematoma, due to a traumatic fracture on a vertebral metastatic tumor who produced cauda equina syndrome. Surgical emergency intervention was mandatory for a good neurological outcome.
F. Casoinic, D. Sampelean, Anca D. Buzoianu, N. Hancu and Dorina Baston
Introduction. Oxidative stress is one of the key mechanisms responsible for disease progression in non-alcoholic fatty liver disease. The aim of this study was to evaluate the serum levels of oxidative stress markers in patients with type 2 diabetes mellitus (DMT2) and non-alcoholic steatohepatitis (NASH) and test their relationships with clinical and biochemical patient characteristics, compared to patients with DMT2 without non-alcoholic fatty liver disease (NAFLD), and controls.
Materials and methods. In all, 60 consecutive patients with DMT2 and NASH, 55 with DMT2 without NAFLD, and 50 age-and-gender-matched healthy subjects participated in the study. The serum levels of protein carbonyls and 8-isoprostane were determined by ELISA methods, while the serum levels of malondialdehyde (MDA) were detected by means of the spectrophotometric method. Clinical, demographic, and laboratory parameters were examined for all the subjects included in the study. Multivariate logistic regression was used to test the independent predictive factors in the relationships investigated here.
Results. Patients with DMT2 and NASH displayed significantly higher serum levels of protein carbonyls (1.112 ± 0.42 nmol/dL), MDA (6.181 ± 1.81 ng/mL), and 8-isoprostane (338.6 ± 98.5 pg/mL) compared to patients with DMT2 without NAFLD, and controls. Results of multivariate logistic regression analyses indicate that in patients with DMT2 and NASH, the serum levels of oxidative stress markers were independently and positively associated with: HbA1c, duration of diabetes, the UKPDS cardiovascular risk score (for protein carbonyls); age, LDL-cholesterol (for 8-isoprostane); and triglycerides serum levels (for MDA).
Conclusions. Our findings indicate that the process of oxidative stress tends to increase in patients with DMT2 and NASH, compared to patients with DMT2 without NAFLD, and controls. This evidence suggests that an antioxidant therapy might prove useful in the treatment of patients with DMT2 and NASH.
D Balasa, M Schiopu, A Tunas, R Baz and Anca Hancu
An association between delayed ruptured lumbar disc hernia, L5 vertebral wedge fracture and posttraumaticL4 pincer vertebral fracture (A2.3-AO clasification) at different levels is a very rare entity. We present the case of a 55 years old male who falled down from a bicycle. 2 months later because of intense and permanent vertebral lumbar and radicular L2 and L3 pain (Visual Scal Autologus of Pain7-8/10) the patient came to the hospital. He was diagnosed with pincer vertebral L4 fracture (A2.3-AO clasification) and L2-L3 right ruptured lumbar disc hernia in lateral reces. The patient was operated (L2-L3 right fenestration, and resection of lumbar disc hernia, bilateral stabilisation, L3-L4-L5 with titan screws and postero-lateral bone graft L4 bilateral harvested from iliac crest).