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Risk Factors for Diabetes Type 2 Development. Comparison of 6 Major Risk Factors Prevalence Between Newly Diagnosed Diabetes Patients from Bihor County and the Population with Normal Glucose Tolerance from Predatorr Study

Abstract

Diabetes mellitus represents a public health problem because of its growing prevalence and the enormous costs for its treatment and complications. There are numerous risk factors for diabetes mellitus development but the most important ones are the modifiable factors. In Bihor County the prevalence of obesity and sedentary behaviour in the population of newly diagnosed patients are increased compared to their prevalence in the population without diabetes. Promotion of healthy eating habits and increased physical effort are the most important measures to prevent diabetes mellitus type 2, which accounts for 90-95% of total diabetes cases. Public health programs that bring together physicians, nutritionists, teachers and target groups (children, young people, obese and overweight people)must be initiated in general population from an early age and maintained in order to promote the adherence to a healthy lifestyle.

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Risk Factors for Hepatocellular Carcinoma

HBs Ag-positive blood donors with special reference to effect of drinking and smoking on development of liver cancer. Int J Cancer 1984;34:775-779 22. Tsukuma H, Hiyama T, Oshima A, et al. A case-control study of hepatocellular carcinoma in Osaka, Japan. Int J Cancer 1990;45:231-236 23. Tanaka K, Hirohata T, Koga S, et al. Hepatitis C and hepatitis B in the etiology of hepatocellular carcinoma in the Japanese population. Cancer Res 1991;51:2842-2847 24. Yu M-W, You S-L, Chang A-S, Lu S-N, Liaw Y-F, Chen C-J. Association between hepatitis C virus

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Rapidly Progressive Glomerulonephritides, Diagnostic and Therapeutic Urgency

Abstract

Rapidly progressive glomerulonephritides are relatively rare but serious disorders of diverse etiology, which share some clinical features: rapid evolution, progressive to renal failure, often accompanied by oliguria or anuria. They are characterized histopathologically by an intense extracapillary proliferation, with the development of crescents (semilunar lesions) in over 50% of examined glomeruli. The following pathological entities are referred to as rapidly progressive glomerulonephritides: ANCA-positive pauci-immune vasculitides (microscopic polyangiitis, granulomatosis associated with microscopic polyangiitis, allergic granulomatosis associated with microscopic polyangiitis), extracapillary proliferative glomerulonephritides by immune complexes and glomerulonephritides by anti-glomerular basement membrane antibodies. Due to major histopathological and functional complications, their evolution to death or renal replacement therapy occurs within 6-2 months after the diagnosis, if they are not treated, but the evolution is favorably influenced by aggressive immunosuppression, whether or not associated with plasmapheresis.

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Polymialgia Rheumatica, Giant Cell Arteritis or Both?

Abstract

Giant cell arteritis (GCA), or temporal arteritis, is the most common systemic vasculitis, and the greatest risk factor for developing GCA is aging. The disease almost never occurs before age 50, and its incidence rises steadily thereafter, peaking between ages 70 to 79, the risk of development being two times higher in women.

Polymialgia rheumatica (PMR) is an inflammatory rheumatic condition characterized clinically by aching and morning stiffness at the shoulders, hip girdle, and neck. PMR is almost exclusively a disease of adults over the age of 50, with a prevalence that increases progressively with advancing age. The peak incidence of PMR occurs between ages 70 and 80, the same as in the case ofGCA. PMRis 2-3 times more common in women than in men.

PMR is two to three times more common than GCA and occurs in about 50% of patients with GCA. The percentage of patients with PMR who experience GCA at some point varies widely in reported series ranging from 5 to 30 percent. PMR can precede, accompany or follow GCA. The diagnostic in the case of PMR is made first of all on clinical features, in the patients in whom another disease to explain the findings is not present. For GCA we must follow the diagnostic algorithm presented below (figure 1) and keep in mind that a negative result for temporal artery biopsy does not exclude the diagnostic if clinical suspicion of GCA is high

We present the case of a 81 year-old male with signs and symptoms from both conditions, PMR and GCA.

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Liraglutide exerts an anti-inflammatory action in obese patients with type 2 diabetes

Abstract

Introduction. Liraglutide (L) is the analogue of human glucagon-like peptide 1 which stimulates glucose-dependent insulin secretion and can modify the level of inflammatory biomarkers.

L can influence NF-kB inflammatory cascade, but the mechanisms of anti-inflammatory activities of L remain to be determined. In animal models L influenced an activity of Sirtuin 1(SIRT1). Moreover, recent evidences strongly suggest that SIRT1 up-regulation may serve as a potent therapeutic approach against development and progression of diabetic complications. The aim of this study was to investigate L effects directed on the pro-inflammatory NF-kB pathway and expression of SIRT1 in obese patients with type 2 diabetes mellitus (DM).

Materials and Methods. 15 obese patients with type 2 diabetes were studied, all using metformin (1-2 g/day) and sulfonylurea (glimiperide). All patients received L 1.2 mg daily add-on to stable therapy for 6 weeks. Blood samples were collected before, 6 weeks after start of treatment and after an overnight fast 6 weeks after stopping L, mononuclear cells (MNC) were isolated. The mRNA expressions of TNF-α, TLR2, TLR4, NOD1, IL-2 and SIRT1 were measured in MNC by RT-PCR. Ceruloplasmin concentration was measured in plasma by photometric method.

Results. In this add-on pilot clinical investigation we received new data that L can inhibit proinflammatory NF-kB pathway by increased SIRT1 expression in obese patients with type 2 DM improving metabolic profile. The mRNA expression in MNC of TNF-α, IkB, TLR2, TLR4, and plasma ceruloplasmin fell after 6 weeks of L. Expressions of IL-2 and NOD-1 were stable. There was a significant increase of SIRT1 mRNA expression. The mRNA expression in MNC of TNF-α, IkB, TLR2, TLR4, NOD1, SIRT1 and ceruloplasmin concentrations did not reverse to baseline levels after 6 weeks stopping of L treatment. IL-2 expression decreased in comparison with basic level.

Conclusions. L has a potent anti-inflammatory effect as do GLP-1 agonists due to inhibition of NF-kB pathways and up-regulate SIRT1 expression, down-regulating pro-inflammatory factors including cytokines (TNF-α), extra- and intracellular receptors (TLR2, TLR4), and inflammation markers such as ceruloplasmin. Long lasting effects of L can be mediated by epigenetic regulation of NF-kB pathway by SIRT-1.

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The Relationship between Hepatic Steatosis, inflammation and insulin Resistance in type 2 Diabetes with Metabolic Imbalance

F and Kenneth C. Management Of Nonalcoholic Fatty Liver Disease In Patients With Type 2 Diabetes: A Call To Action. Diabetes Care, 2017; 40(3):419-430. DOI:10.2337/dc16-1787. 16. Ormazabal V, Nair S, Elfeky O et al. Association between insulin resistance and the development of cardiovsacular disease. Cardiovasc Diabetol, 2018:17-122, DOI: 10.1186/s12933-018-0762-4 17. Frati G, Schirone L, Chimenti I et al. An overview of the inflammatory signalling mechanism in the myocardium underlying the development of diabetic cardiomyopathy. Cardiovascular

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The Severity of Non-Alcoholic Fatty Liver in Type II Diabetes

Cheah, Arthur J McCullough and George Boon-Bee Goh. Current Modalities of Fibrosis Assessment in Non-alcoholic Fatty Liver Disease. J Clin Transl Hepatol. 2017 Sep 28; 5(3): 261–271. 18. Haixia Liu, Jing Fu Ruixia Hong et al. Acoustic Radiation Force Impulse Elastography for the Non-Invasive Evaluation of Hepatic Fibrosis in Non-Alcoholic Fatty Liver Disease Patients: A Systematic Review & Meta-Analysis. PLoS One. 2015; 10(7): e0127782. 19. Adams LA, Waters OR, Knuiman MW, et al. NAFLDas a risk factor for the development of diabetes and the metabolic

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Medical evaluation and management of male and female voiding dysfunction: a review

-302. 61. KUO, H.C., Videourodynamic characteristics and lower urinary tract symptoms of female bladder outlet obstruction. Urology, 2005. 66 (5): p. 1005-9. 62. AKBAL, C., et al ., Dysfunctional voiding and incontinence scoring system: quantitative evaluation of incontinence symptoms in pediatric population. J Urol, 2005. 173 (3): p. 969-73. 63. AFSHAR, K., et al ., Development of a symptom score for dysfunctional elimination syndrome. J Urol, 2009. 182 (4 Suppl): p. 1939-43. 64. SINHA, S., Dysfunctional voiding: A review of the terminology

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Non-alcoholic fatty pancreas disease – practices for clinicians

F, MAHFUD M et al. The role of "fatty pancreas" and of BMI in the occurrence of pancreatic fistula after pancreaticoduodenectomy. J. Gastrointest. Surg., 2009; 13 (10): 1845-1851. 28. TOMITA Y, AZUMA K, NONAKA Y, KAMADA Y, TOMOEDA M, KISHIDA M et al. Pancreatic fatty degeneration and fibrosis as predisposing factors for the development of pancreatic ductal adenocarcinoma . Pancreas 2014; 43 (7): 1032-1041. 39. CATANZARO R., CUFFARI B., ITALIA A., MAROTTA F. Exploring the metabolic syndrome: Nonalcoholic fatty pancreas disease. World

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Evolution of Psychosomatic Diagnosis in DSM. Historical Perspectives and New Development for Internists

Abstract

The so-called “Psychosomatic symptoms” represent a real challenge for internists. These have often been described as non-specific, non-organic, functional, dysfunctional or idiopathic. These “diagnostic puzzles” are obviously difficult to treat. Psychosomatic symptoms have been categorized as hysteria, psychogenic, psychosomatic, conversion, somatization and somatoform disorder. It is only when modern classificatory systems such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) were developed that research was stimulated and new clinical developments became much stronger than any other time. The current paper is aimed at briefly presenting the evolution of psychosomatic symptoms in DSM while pointing out the major milestones as well as the benefits and challenges along the way. We discuss the perspectives open with the advent of the 5th edition the DSM-V.

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