A Romanian therapeutic approach to peripheral nerve injury.

The study of nerve regeneration and functional recovery of the injured peripheral nerves represents a worldwide subject of clinical and scientific research. Our team aimed to obtain the first guide for nerve regeneration, bioartificial and biodegradable, using exclusively Romanian resources and having the advantages of price and quality, over the imported nerve conduits already used in clinical practice. First steps of this project consisted in obtaining the prototype of nerve guide conduit and its' testing in vitro and in vivo. Tests of physicochemical characterization, FTIR (Fourier Transform Infrared) spectrometry, thermal analysis (differential calorimetry, thermo-gravimetry), electron microscopy, water absorption and enzymatic degradation of the obtained prototype were followed by in vivo testing. The first results, obtained on a group of Brown Norway rats who suffered experimental lesions of 1 cm at the level of left sciatic nerve, which have then been repaired using the Romanian conduit prototype, are favorable in terms of biocompatibility, biodegradable capacity and support of nerve regeneration.

Association of +35A/C (intron3/exon3) polymorphism in SOD1-gene with diabetic nephropathy in type 1 diabetes.

Diabetic nephropathy is a major complication of type 1 diabetes whose pathogenesis is insufficiently known, but oxidative stress and genetic susceptibility seem to be involved. The purpose of this study is to assess the possible association of +35A/C (rs2234694) polymorphism in SOD1-gene with advanced stages of diabetic nephropathy in patients with type 1 diabetes in Romania. There have been enrolled 238 unrelated patients, having type 1 diabetes, divided into group A (106 patients) with diabetic nephropathy - macroalbuminuria or ESRD (End Stage Renal Disease) and group B (132 patients) without diabetic nephropathy. The genomic DNA was extracted from the peripheral venous blood and the genotyping of +35A/C (rs2234694) polymorphism has been made using the PCR-RFLP technique. The statistical analysis has been made using De Finetti's program. There has not been a significant deviation from the Hardy-Weinberg equilibrium for any group (p=0.229 and p=0.894, respectively). The data analysis revealed that the presence of a C-allele confers a significant risk (p=0.008) for the advanced diabetes nephropathy (OR=4.940, 95% C.I.=1.341-18.198), and the CA-genotype (p=0.015) confers a little lower risk (OR=4.491, 95% C.I.=1.203-16.766). This study shows the association of a mutant C-allele of rs2234694 polymorphism in SOD1-gene with the advanced stages of diabetic nephropathy in patients with type 1 diabetes in Romania, suggesting the involvement of the defense against oxidative stress, as an important link in the pathogeny of diabetic nephropathy.

The glycemic control and temporal characteristics of diabetes as risk factors for the occurence of diabetic renal disease.

Diabetes is one of the most spread pandemy, which affects nowadays the world, its incidence increasing globally. The chronic complications of diabetes are extremely important, out of which the diabetic kidney disease (DKD) being by far the most expensive and severe. On the basis of statistic studies, we tried to identify the risk factors within some epidemiological studies. The research started in two directions: the hypothesis of environmental factors and associated diseases and the hypothesis of genetic factors. In this article we are trying to assess the role of glycaemic control, age, total duration and post-pubertal duration of diabetes as risk factors for diabetic nephropathy. The glycaemic control proved to be an essential risk factor in developing microvascular complications and DKD, the "normal" glycaemia being the only limit below which there are no microvascular complications. We do not know for sure exactly the role played by the total duration of diabetes and age in developing the diabetic nephropathy as well as other microvascular complications. The age of onset and the post-pubertal duration seem to be better associated to the development of nephropathy, but the causality has not been demonstrated yet. These are a part of the 21 risk factors quoted in the speciality literature as influencing the occurrence of DKD.

[Puberty, pregnancy, gender and hormonal status--putative risk factors for diabetic nephropathy]. / Pubertatea, sarcina, sexul si statusul hormonal--posibili factori de risc pentru nefropatia diabetica.

Contemplation of non-genetic risk factors that are influencing the onset and development of diabetic nephropathy (diabetic kidney disease--DKD) is very important. This article is integrative, assessing the existent data about several possible risk factors for DKD. Because the age of onset and postpubertal duration of diabetes seems to be strongly correlated with DKD, it is feasible for puberty to be another independent risk factor. Data analysis regarding puberty and possible explanatory mechanisms to link it with DKD, as the connection with DKD of other situations, with special hormonal status (like pregnancy), is also part of this article. Summing up the data about hormonal status, we can conclude that ANF levels are a risk factor for diabetic nephropathy because they are implicated in diminution of urinary Na elimination and hypertension and subsequent urinary albumin excretion (UAE) in case of inadequate glycaemic control. The evidences regarding GH are indicating that it is a risk factor for DKD and that he is probably implicated in glomerular hypertrophy onset at puberty. The urinary elimination levels of GH are very strong correlated with UAE being putative early marker for DKD. Also the GH deficiency seems to be a protective mechanism for DKD apparition. GH is strongly correlated with IGF-1 that has very high urinary levels in microalbuminuric patients. These levels are very well related to UAE, kidney volume--important markers for glomerular hypertrophy. The evidences accumulated until now regarding the role of masculine gender, testosterone and estrogens in DKD are inarticulate.

Allergic reactions to antithyroid drugs are associated with autoimmunity a retrospective case-control study.

UNLABELLED: Thiamazole is the most used antithyroid drug for thyrotoxicosis in Basedow-Graves' (BG) (autoimmune) disease and in toxic multinodular goitre (TMG) (non-autoimmune). This study aims to find whether allergic reactions to thiamazole occur more frequently during the treatment of BG than of TMG. METHOD: Retrospective study, of 128 patients newly diagnosed and treated for thyrotoxicosis in the first 6 months of 2006, in the Endocrinology Department of "Elias" Hospital, Bucharest. Cases were all patients treated with thiamazole who developed allergic reactions. Controls were all patients treated with thiamazole without allergic reactions. Risk factor was considered to be the presence of BG. RESULTS: Cases group consisted of 6 patients. All 6 started treatment with thiamazole for BG, and developed allergic reactions after 2-4 weeks of treatment. When thiamazole was withdrawn, allergic symptoms ceased under antihistamines and steroids. In order to control the thyrotoxicosis, antihistamines and oral steroids was administered, together with thiamazole in slow increasing doses. After about 4 weeks under this combination, a tolerance to thiamazole seems to appear. Control group consisted of 122 patients who started thiamazole: 66 for BG and 56 for TMG (without allergic reactions). CONCLUSION: Allergy to thiamazole was significantly associated with the autoimmune BG, and not with TMG (p = 0.03, OR = 11.04). None of the patients with TMG developed allergic reactions to the drug. Tolerance to this drug may occur.

[Lipodystrophy syndrome in HIV-infected patients. Clinical and diagnostic features]. / Sindromul lipodistrofic la pacientii infectati HIV--elemente clinice si de diagnostic.

After the introduction of HAART (Highly Active Anti-Retroviral Therapy) in patients infected with HIV, a new syndrome--Lipodystrophy syndrome--has been described, in 1998. Lipodystrophy syndrome in patients with HIV infection comprises several conditions: lipoatrophy, lipohypertrophy, mixed syndrome (lipoatrophy and lipohypertrophy), often associated with dyslipidemia and insulin resistance. Lipoatrophy and lipohypertrophy can occur independently, being associated with different constellations of host, disease and drug risk factors. Until a working clinical definition on HIV-related lipodystrophy syndrome is developed, it will be difficult to monitor patients and compare studies, because, at present, investigators, clinicians and patients have different working definitions.

[Pathogenic mechanisms for fat redistribution in patients with HIV disease]. / Ipoteze privind patogenia sindromului lipodistrofic la pacientii infectati cu HIV.

Lipodystrophy syndrome is a common term in the literature traditionally used to describe several morphologic (lipoatrophy; lipohypertrophy; mixed syndrome) and metabolic (dyslipidemia, insulin resistance) disturbances found in patients with HIV disease, with or without treatment with highly active antiretroviral therapy (HAART). Increasing evidence suggests these disorders, though commonly clustering in a syndrome pattern, have distinct pathologic pathways and can occur independently of each other. The pathogenesis of these disorders is complex, but recent hypotheses and evidence suggest that impairment to adipocyte differentiation, in particular through alterations in the expression of the transcription factor sterol responsive element binding protein-lc (SREBP1c), impairment of adipokine regulation, unopposed production of proinflammatory cytokines, adipocyte apoptosis mediated by proinflammatory cytokines such as tumor necrosis factor (TNF-alpha) and IL-6, dysregulation of 1l-beta-hydroxysteroid dehydrogenase, and mitochondrial toxicity may play a role.