Sleep duration and body mass index: moderating effect of self-perceived stress and age. Results of a cross-sectional population-based study.

PURPOSE: The objective of this analysis was to assess whether the association between sleep duration and BMI and between sleep duration and waist circumference is moderated by age and self-perceived stress. METHODS: We analyzed data from 2034 participants enrolled in 2014 in the cross-sectional study Obesity in Romania Study-study of the prevalence of obesity and related risk factors in Romanian general population (ORO study). RESULTS: Interaction between sleep duration, self-perceived stress and age, with BMI as dependent variable, was statistically significant after adjustment for demographic and lifestyle factors (p value for interaction 0.003). In participants without self-perceived stress, a linear negative association between sleep duration and BMI was observed only in those 18-39 years old (p = 0.049), with BMI decreasing in parallel with increased sleep duration. In participants with self-perceived stress, a U-shaped relationship was observed between BMI and sleep duration in those 40-64 years old, with higher BMI in those sleeping ≤ 6 h and ≥ 9 h/night compared to those sleeping > 6 and < 9 h/night (p = 0.002 and 0.005). Those ≥ 65 years old with self-perceived stress sleeping ≥ 9 h/night had a significantly higher BMI compared to those in other sleep duration categories (p = 0.041 vs. those sleeping ≤ 6 h/night and p = 0.013 vs. to those sleeping > 6 and < 9 h/night). No interaction between age, self-perceived stress and sleep duration, with waist circumference as dependent variable was observed. CONCLUSIONS: In our sample, the association between sleep duration and BMI was moderated by self-perceived stress and age.

The dynamic changes in the pattern of liver function tests in pregnant obese women.

Obesity is an important problem in healthcare regarding gestating women. The objective of the present study was to highlight the impact that obesity has on the hepatic function in pregnant women by comparing the functional tests used in current practice. In addition, the aim was to identify possible predictors of liver damage by analyzing specific anthropometric data. The present study was descriptive, observational, retrospective, and based on the observation sheets found in the database of the Institute for the Health of the Mother and Child, the Obstetrics Gynecology Department of Polizu Hospital. Patients who presented for consultation in each trimester of pregnancy were included in the study. Demographic data taken into account included age, body mass index (BMI), provenance environment, anthropometric data: Abdominal circumference and the complete set of paraclinical data from which we extracted these specific liver tests: Aspartate aminotransferase (AST), alanine transferase (ALT), direct bilirubin (BD), serum albumin and gamma-glutamyl transferase (GGT). The present study included 157 patients divided into two groups, distributed as follows: Group A: 66 obese pregnant women (BMI >25 kg/m2) and group B: 91 patients with normal weight (BMI <25 kg/m2). Measurement of serum ALT and AST were the most useful tests for routine diagnosis of liver disease. The effects of pregnancy on serum levels of ALT and AST are controversial. In some studies, there was a slight increase in ALT and AST during the second and third trimesters, a fact confirmed by our study, albeit the result was not statistically significant Most published studies claim that serum ALT and AST levels do not change during pregnancy. In conclusion, obesity during pregnancy does not drastically influence liver function. However, patients with greater abdominal circumference are prone to developing minor hepatic cytolysis syndrome during the gestation period. The liver functional tests described in the aforementioned groups agree with the results provided by the specialized studies.

Diabetic neuropathy: A narrative review of risk factors, classification, screening and current pathogenic treatment options (Review).

Diabetic neuropathy (DN) is a frequent complication of diabetes mellitus (DM) with severe consequences as it progresses and influences all human body systems. This review discusses the risk factors for DN, the main characteristics of the clinical forms of DN, the screening methods and the current therapeutic options. Distal symmetric DN is the primary clinical form, and DM patients should be screened for this complication. The most important treatment of DN remains good glucose control, generally defined as HbA1c ≤7%. Symptomatic treatment improves life quality in diabetic patients. Pharmacological agents such as alpha (α)-lipoic acid and benfotiamine have been validated in several studies since they act on specific pathways such as increased oxidative stress (α-lipoic acid exerts antioxidant effects) and the excessive production of advanced glycosylation products (benfotiamine may inhibit their production via the normalization of glucose). Timely diagnosis of DN is significant to avoid several complications, including lower limb amputations and cardiac arrhythmias.

Obesity and pregnancy.

Introduction: Obesity is the most frequent metabolic disturbance that can target women of reproductive age, among other population groups, and when obese pregnant women become patients, it represents a serious risk factor for both mother and fetus. Aim: The aim of this study is to offer an overview of the effects exerted by this disturbance on pregnancy. Materials and methods: The study targets 157 pacients admitted to "Alessandrescu-Rusescu" National Institute for Mother and Child Health - Polizu (INSMC), Bucharest, Romania. In order to define the criterion for obesity, WHO classification (body mass index > 30 kg/m²) was used. Data was collected restrospectively after acceptance by the Ethics Committee. Also, we gathered anthropometric data (weight, body mass index and analysis regarding the metabolic profile, including total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride, blood sugar, glycosylated haemoglobin) from all subjects. Each analysis was correlated with each patient's body mass index. Another correlation was made between metabolic profile, antenatal complications and onset of gestational diabetes and premature birth. Statistical analysis was conducted using GraphPad 8 and MedCalc 14.1. Results: Patients had an average body weight of 66.75 kg with a standard deviation of 12.99 kg and a median of 64 kg. Average body mass index was 25.05 kg/m², with a standard deviation of 5,03 kg/m² and a median of 24.2 kg/m². There is a directly proportional and statistically significative correlation between the values of blood sugar, glycosylated haemoglobin, LDL, TG, uric acid and BMI. Also, there is a inversely proportional and statistically significative correlation between the values of HDL and BMI. The CT/HDL ratio, low HDL level and elevated LDL level are the main risk factors for premature birth, while the CT/HDL ratio, low HDL level and elevated TG are the main risk factors for the onset of gestational diabetes. Conclusions: According to the results of this study, the onset of obesity in pregnant woman is rather dependent on each patient's metabolic profile than body weight.

Current Data Regarding the Relationship between Type 2 Diabetes Mellitus and Cardiovascular Risk Factors.

Reducing cardiovascular risk (CVR) is the main focus of diabetes mellitus (DM) management nowadays. Complex pathogenic mechanisms that are the subject of this review lead to early and severe atherosclerosis in DM patients. Although it is not a cardiovascular disease equivalent at the moment of diagnosis, DM subjects are affected by numerous cardiovascular complications, such as acute coronary syndrome, stroke, or peripheral artery disease, as the disease duration increases. Therefore, early therapeutic intervention is mandatory and recent guidelines focus on intensive CVR factor management: hyperglycaemia, hypertension, and dyslipidaemia. Most important, the appearance of oral or injectable antidiabetic medication such as SGLT-2 inhibitors or GLP-1 agonists has proven that an antidiabetic drug not only reduces glycaemia, but also reduces CVR by complex mechanisms. A profound understanding of intimate mechanisms that generate atherosclerosis in DM and ways to inhibit or delay them are of the utmost importance in a society where cardiovascular morbidity and mortality are predominant.

Risk factors for adiposity in the urban population and influence on the prevalence of overweight and obesity.

Obesity and overweight are major contributors to the morbidity and mortality of modern civilization. This study determined the prevalence of certain risk factors for adiposity and assesses their impact on overweight/obesity prevalence. Nine hundred individuals were evaluated, aged between 18-65 years, including clinical examination, evaluation of medical history, BMI determination and completion on questionnaires assessing nutritional intake and presence of depression symptoms. Overweight prevalence was 29.56% and obesity prevalence was 21.33%. Fast-food consumption was the most frequent risk factor for adiposity found in 61.67% of individuals, eating <3 meals/day was found in 58.89%, sedentary lifestyle in 53.33%, sleeping time <6 h/day in 44.22%, hypercaloric nutrition in 43.56%, excessive alcohol consumption in 42.89% and depression symptoms in 31.78%. Unhealthy lifestyle a composite risk factor was identified in 67.33% of individuals. Fast-food consumption increases the risk for adiposity by 1.85-fold while sedentary lifestyle by 1.79-fold. Risk factors for adiposity play an important role in increasing the prevalence of overweight and obesity. Public health measures are necessary in order to educate the general population regarding the importance of healthy nutrition and physical exercise.

Traditional and Non-traditional Clinical and Biochemical Risk Factors for Altered Kidney Function in Type II Diabetes mellitus Patients.

Background:Exploring the risk factors associated with increased albumin excretion is necessary in patients with type 2 diabetes mellitus, due to the fact that such patients are exposed to an increased risk of progression to diabetic kidney disease and that non-traditional newly emerging factors could be corrected in order to reduce the progression rate. Material and methods:218 patients with type 2 diabetes mellitus were investigated regarding their urinary albumin/creatinine ratio. Clinical and laboratory data was collected from them, with biochemical investigations including serum uric acid and serum 25-hydroxi-vitamin D (25-OH-vitamin D) measurements. The prevalence of traditional and non-traditional risk factors for increased albumin excretion rate (albumin/creatinine ratio>30 mg/g), hyperuricemia and 25-OH-vitamin D deficiency, was determined after dividing patients into two groups, one with microalbuminuria and the other one with micro- or macroalbuminuria. Results:Of all patients, 104 (47.93%) had microalbuminuria, while 9.22% (20) presented macroalbuminuria. Poor glucose control (HbA1c .7%), female sex, hyperuricemia (uric acid .7 mg/dL), vitamin D deficiency (25-OH-vitamin D .50 nmol/L), hypertension (systolic hypertension or diastolic hypertension or hypertension treatment) and hypertriglyceridemia (triglycerides .150 mg/dL) had a statistically significant higher prevalence (p<0.05) in the 124 patients with microalbuminuria or macroalbuminuria compared to the 94 subjects wit normaoalbuminuria. Conclusion:Glucose control, hypertension and dyslipidemia are relevant traditional risk factors for an altered kidney function defined as urinary albumin/creatinine ratio >30 mg/g. However, hyperuricemia and 25-OH-vitamin D deficiency are long time ignored factors that could play an important role in the progression towards diabetic kidney disease.

The importance of the histopathological examination in establishing the diagnosis of delayed splenic rupture. Report of a case and literature review.

In forensic activity, splenic ruptures occur frequently in cases involving abdominal trauma due to road traffic collision, strokes, falls and work accidents. Splenic lesions can occur either immediately after the trauma or within variable timeframes after it, the last scenario being the case of a delayed splenic rupture. Delayed splenic rupture is ranked third in abdominal traumatology frequency, after liver and intestine rupture. Delayed splenic rupture is more frequently the result of abdominal contusions or compressions, rather than the result of direct wounds located in the left flank. In the first stage, an intraparenchymatous hematoma is formed. The second stage occurs within a variable timeframe (between two days and one month), either spontaneously or following a second trauma, when the capsule ruptures leading to secondary peritoneal hemorrhage. In order to correctly determine the chronology of splenic lesions, histopathological (HP) investigations have an important role to play. The presence of hemosiderin highlighted by Hematoxylin-Eosin (HE) staining or special stainings, confirms the diagnosis of delayed splenic rupture. This study will present the case of a 55-year-old male from the countryside, a chronic alcohol consumer, animal care provider, who suffered multiple traumatic injuries four days prior to his death. He was found lying on the ground, presenting an open craniocerebral trauma (CCT) with a bleeding wound on the scalp. The autopsy showed CCT with meningeal hemorrhage and subdural hematoma, along with a splenic rupture presumably produced in two stages. The HP investigations did not reveal the presence of hemosiderin in the tested specimen samples. Using this scientific diagnostic criterion, it was thus confirmed that the splenic rupture occurred after the aggression, in another traumatic stage, the same one where the other thanatogenerator lesions occurred, as a result of the victim's collapse from the same level and hitting the planes with irregular surfaces.

What antibiotics for what pathogens? The sensitivity spectrum of isolated strains in an intensive care unit.

Antibiotic sensitivity spectrum of isolated strains differs according to hospital departments, the hospitals themselves, and countries. Discrepancies also exist in terms of antibiotic use and dosage. The aim of the present study is to compare the antibacterial agents, the types of infections, the number and type of pathogens, and the sensitivity to antibiotics used in the Intensive Care Unit (ICU) of the Emergency Clinical County Hospital of Oradea, Romania. Over a one-year period, data were gathered from the pharmacy computer system and medical records of inpatients. WHO Anatomical Therapeutic Chemical (ATC)/defined daily doses (DDD) methodology was used to assess drug administration data, and antibiotic use was expressed as DDD/1000 PD (patient days). The antibiotic susceptibility of isolated strains was expressed through the cumulative antibiogram. The overall consumption of antimicrobial agents was 1247.47 DDD/1000 PD. The most common drugs used were cephalosporins and fluoroquinolones (52.97% of the total). Ceftriaxone was the most commonly used, followed by levofloxacin. Infections of the respiratory and urinary tract were the most frequently diagnosed infections. The most commonly isolated bacteria type was Acinetobacter baumannii (22.12% overall), isolated especially from the respiratory tract and resistant to all the ß-lactam antibiotics including carbapenems. Antimicrobials intake at the ICU is much higher compared to medical and surgical wards. After we tested the existence of a possible connection between antibiotic consumption and antibiotic resistance of bacteria, it was revealed that on our sample exists a poor positive association.

Prevalence of diabetes mellitus and prediabetes in the adult Romanian population: PREDATORR study.

BACKGROUND: The PREDATORR (PREvalence of DiAbeTes mellitus, prediabetes, overweight, Obesity, dyslipidemia, hyperuricemia and chronic kidney disease in Romania) study is the first national study analyzing the prevalence of diabetes mellitus (DM) and prediabetes, and their association with cardiometabolic, sociodemographic, and lifestyle risk factors in the Romanian population aged 20-79 years. METHODS: This was an epidemiological study with a stratified, cross-sectional, cluster random sampling design. Sociodemographic, lifestyle, and anamnestic data were collected through self- and interviewer-administered questionnaires, and biochemical assays and oral glucose tolerance tests were performed. RESULTS: In all, 2728 participants from 101 clinics of general practitioners were randomly selected, with a probability proportional to population size according to the 2002 Romanian Census. The participation rate was 99.6%. Impaired glucose regulation (prediabetes, known and unknown DM) was found in 28.1% of the study population. The overall age- and sex-adjusted prevalence of DM was 11.6% (95% CI 9.6%-13.6%), of which 2.4% (95% CI 1.7%-3.1%) had unknown DM. The prevalence of DM increased with age and was higher in men than in women. The age- and sex-adjusted prevalence of prediabetes was 16.5% (95%CI 14.8%-18.2%), with the highest percentage in the 60-79 year age group and in women. Obesity, abdominal obesity, dyslipidemia, low education level, and a family history of diabetes were associated with glucose metabolism disorders. CONCLUSIONS: The PREDATORR study shows a high prevalence of impaired glucose regulation in the adult Romanian population, providing data on the prevalence of DM and prediabetes and their association with several risk factors.

Evolution assessment of head and neck infections in diabetic patients--a case control study.

This research aimed to assess the occurrence and progression of head and neck infections in diabetic compared to non-diabetic patients. A retrospective study was carried out over a period of 10 years in 899 patients with head and neck infections. The patients who met the inclusion criteria were divided into cases and controls according to the presence/absence of diabetes. Seventy-three patients (8%, 95% CI [6.45%-10.12%]) were included in the case group and 826 (92%, 95% CI [89.87%-93.55%]) were assigned to the control group. The extension of the infection proved to be significantly (p < 0.001) higher in diabetic patients compared to non-diabetic patients. The difference between the two groups was statistically significant (Mann-Whitney U statistics = 18205.500, p < 1.56 · 10(-8)). A more than 10 year history of diabetes was statistically related to a wider extent of head and neck infections (p < 0.001). Diabetes proved to be associated with large necrotic areas and the spread of head and neck infections to more than two cavities.