Evolutive Models, Algorithms and Predictive Parameters for the Progression of Hepatic Steatosis.

The utilization of evolutive models and algorithms for predicting the evolution of hepatic steatosis holds immense potential benefits. These computational approaches enable the analysis of complex datasets, capturing temporal dynamics and providing personalized prognostic insights. By optimizing intervention planning and identifying critical transition points, they promise to revolutionize our approach to understanding and managing hepatic steatosis progression, ultimately leading to enhanced patient care and outcomes in clinical settings. This paradigm shift towards a more dynamic, personalized, and comprehensive approach to hepatic steatosis progression signifies a significant advancement in healthcare. The application of evolutive models and algorithms allows for a nuanced characterization of disease trajectories, facilitating tailored interventions and optimizing clinical decision-making. Furthermore, these computational tools offer a framework for integrating diverse data sources, creating a more holistic understanding of hepatic steatosis progression. In summary, the potential benefits encompass the ability to analyze complex datasets, capture temporal dynamics, provide personalized prognostic insights, optimize intervention planning, identify critical transition points, and integrate diverse data sources. The application of evolutive models and algorithms has the potential to revolutionize our understanding and management of hepatic steatosis, ultimately leading to improved patient outcomes in clinical settings.

Uncovering the Impact of Lymphadenectomy in Advanced Gastric Cancer: A Comprehensive Review.

Gastric cancer is a significant health concern worldwide, and lymphadenectomy plays a crucial role in its treatment. However, there is ongoing debate regarding the optimal approach-D1 or D2 lymphadenectomy. This paper aims to synthesize the available evidence by conducting a comprehensive literature review and comparing the advantages and disadvantages of both techniques. The analysis includes studies, clinical trials, and systematic reviews that assess survival outcomes, morbidity, and quality of life. The selected studies revealed different outcomes associated with D1 and D2 lymphadenectomy, including lymph node harvest, disease control, recurrence rates, and overall survival. Postoperative complications also varied between the two techniques. These findings highlight the complex considerations involved in selecting the most suitable lymphadenectomy approach for individual patients. Therefore, the decision requires an individualized assessment that considers the potential benefits and risks of D1 and D2 techniques. A collaborative approach involving interdisciplinary teams is crucial for developing personalized treatment plans that optimize both oncological outcomes and postoperative quality of life.

Gestational Diabetes and Preterm Birth: What Do We Know? Our Experience and Mini-Review of the Literature.

BACKGROUND: Gestational diabetes mellitus (GDM) is a form of diabetes that develops during pregnancy. The incidence of GDM has been on the rise in tandem with the increasing prevalence of obesity worldwide. We focused on the study of what causes premature births and if there are methods to prevent these events that can result in long-term complications. METHODS: This study was a prospective, non-interventional study that lasted for 4 years from December 2018 to December 2022. From the group of women enrolled in the study, we selected and analyzed the characteristics of women who gave birth prematurely. Additionally, we performed a systematic review examining the association between GDM and the frequency of adverse pregnancy outcomes. RESULTS: In total, 78% underwent an emergency caesarean and had polyhydramnios. The results indicate that women who had a preterm delivery had a significantly higher maternal age compared to those who had a term delivery (p < 0.001). Conversely, there was no significant difference in preconception BMI between the two groups (p = 0.12). CONCLUSIONS: In terms of the understanding of GDM and preterm birth, several gaps in our knowledge remain. The association between GDM and preterm birth is likely multifactorial, involving various maternal factors.

Profile of Patients with Cardiovascular Diseases during the Pandemic in a Cardiology Clinic of a COVID-19 Support Hospital.

BACKGROUND: During the pandemic, our hospital became a COVID support hospital and consequently the cardiology clinic had restricted activity; thus, it received only suspect and/or patients confirmed positive with the various COVID-19 strains that were associated with a chronic/flaring cardiovascular pathology. METHODS: Two batches of patients admitted during a one-year period were compared in the cardiology clinic over two different periods of time: BATCH I (1 April 2019 to 31 March 2020), in a non-COVID context (BATCH I N-COV) and BATCH II (1 July 2020 to 30 June 2021) comprising patients that presented with respiratory infection of SARS-CoV-2 (BATCH II COV-2), associated with chronic and/or acute cardiovascular condition. To determine the profile of the patients admitted in our clinic, we observed the following parameters: age, type of cardiac condition, and admission mode (for the N-COV group). RESULTS: The data obtained as absolute numbers and as percentages in relation to the total number of admissions were presented in separate tables and graphs for both of the studied groups. CONCLUSIONS: The SARS-CoV-2 pandemic, in its almost two years of evolution, has divided the medical world in two main categories: COVID and non-COVID. Admission of the patients with chronic, but non-COVID cardiac conditions, in our case, dropped to almost one-quarter when we compared the two absolute admission numbers: 1382 in the year prior to pandemic compared with only 356 in the pandemic year. We believe that the number of deaths due to SARS-CoV-2 infection was infinitely higher than the reported ones and uncountable, in as much as COVID-19 did not kill only the infected patients, but it has also yielded a very large number of collateral victims among chronic patients who had no contact with the disease, but were unable to be admitted and treated for chronic heart disease.

Transient Polyhydramnios during Pregnancy Complicated with Gestational Diabetes Mellitus: Case Report and Systematic Review.

Polyhydramnios is an obstetrical condition defined as a pathological increase in the amniotic fluid and is associated with a high risk of maternal-fetal complications. Common causes of polyhydramnios include fetal anatomical and genetic abnormalities, gestational diabetes mellitus, and fetal viral infections. We present the case of a 30-year-old Caucasian woman with transient polyhydramnios associated with gestational diabetes mellitus and obstetric complications. The diagnosis was based on the ultrasound assessment of amniotic fluid volume during a common examination at 26 weeks. Two weeks prior, the patient had been diagnosed with gestational diabetes mellitus. After 4 days, the patient was examined, and the amniotic fluid index returned to normal values. At 38 weeks, the patient presented to the emergency room due to lack of fetal active movement. Ultrasound revealed polyhydramnios, the patient was admitted for severe fetal bradycardia, and fetal extraction through emergency cesarian section was performed. Six weeks after birth, the patient underwent an oral glucose tolerance test with normal values, confirming gestational diabetes mellitus. We performed a systematic review of the literature on polyhydramnios, from January 2016 to April 2022, to analyze all recent published cases and identify the most common etiological causes and important aspects related to maternal-fetal outcomes.

Triglyceride and Glucose Index as a Screening Tool for Nonalcoholic Liver Disease in Patients with Metabolic Syndrome.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is regarded as a component of metabolic syndrome, which involves insulin resistance (IR) as the primary physiopathological event. The aim of this study was to establish the association between IR, assessed using the triglyceride and glucose index (TyG), and histopathological features of NAFLD lesions. METHODS: The study included 113 patients with metabolic syndrome. Fasting plasma glucose (FPG), fasting lipid profiles and liver enzymes were measured. IR was assessed by the TyG index. Liver biopsy was performed for assessment steatosis and fibrosis. RESULTS: the TyG index had a mean value of 8.93 ± 1.45, with a higher value in the patients with overweight (p = 0.002) and obesity (p = 0.004) characteristics than in the patients with normal weight. The TyG index mean value was 8.78 ± 0.65 in subjects without NASH, 8.91 ± 0.57 in patients with borderline NASH and 9.13 ± 0.55 in patients with definite NASH. A significant difference was found between subjects without NASH and the ones with definite NASH (p = 0.004), as well as in patients with early fibrosis vs. those with significant fibrosis. The analysis of the area under the ROC curve proved that the TyG index is a predictor of NASH (p = 0.043). CONCLUSION: the TyG index is a facile tool that can be used to identify individuals at risk for NAFLD.

New strategies of diagnostic and therapeutic approach to emergencies in the evolution of patients with diabetes mellitus (Review).

Diabetes mellitus, known as the most widespread disease in the world, along with four other chronic diseases, involves major expenditures and significant human resources for care, thus representing a burden on any type of health care system especially due to its rapid evolution of acute and chronic complications. For the emergency department (ED), the requirements of patients with acute complications of diabetes, determine expenses which are three times higher than those for non-diabetic patients and their hospitalizations are four times more frequent. The acute complications for which patients with diabetes most frequently require the ED are hypoglycemic, hyperosmolar, or ketoacidosis coma as well as alterations of the general condition that is typical of hypoglycemia, diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state and new-onset hyperglycemia. Hypoglycemia and the Somogyi phenomenon are the most common complications of type 1 diabetes but they can also occur in patients with type 2 diabetes who are treated with insulin through its overdose. DKA can occur in type 1 and 2 diabetes either by administering inadequate doses of insulin or due to the existence of precipitating factors such as stress, acute myocardial infarction, infections, sepsis, and/or gastrointestinal bleeding. Hyperosmolar hyperglycemic status is the most common complication in patients with type 2 diabetes and DKA. Treating the acute complications of diabetes in the ED involves, besides taking immediate measures to assess and maintain vital functions, monitoring patients, assessing blood sugar, electrolytes, urea, creatinine, and bicarbonate, and applying appropriate immediate therapeutic measures for each type of acute diabetes complication.

Insulin resistance quantified by the value of HOMA-IR and cardiovascular risk in patients with type 2 diabetes.

Cardiovascular disease (CVD) is recognized as a leading cause of death worldwide. Obesity, dyslipidemia, insulin resistance (IR), interconnected pathological conditions constitute risk factors that are closely associated with CVD. The aim of the present study was to highlight the association of IR with cardiovascular risk (CVR). The epidemiological, cross-sectional, non-interventional study was conducted over 12 months (2019-2020) within a research grant and included a sample of 400 subjects divided into 2 subgroups: group 1 (control) subjects did not have diabetes (n=200) and group 2 had type 2 diabetes (T2DM) (n=200). The Framingham risk score (FRS) was calculated according to the 2008 general CVD risk model from the Framingham Heart Study. Subsequent to a correlation of the value of homeostasis model assessment of insulin resistance (HOMA-IR) with the degree of CVR, the IR was higher in both groups, and CVR also increased. After being quantified by the Spearman correlation coefficient, the correlation in group 2 was higher at 0.625 compared to group 1 where this coefficient had a value of 0.440. A high FRS (FRS of 20%) was significantly associated with IR. The results therefore show that HOMA-IR is an independent risk factor for high FRS. New therapies focused on decreasing IR may contribute to decreased CVD.

An Update of Medical Nutrition Therapy in Gestational Diabetes Mellitus.

Gestational diabetes mellitus (GDM) is a serious and frequent pregnancy complication that can lead to short and long-term risks for both mother and fetus. Different health organizations proposed different algorithms for the screening, diagnosis, and management of GDM. Medical Nutrition Therapy (MNT), together with physical exercise and frequent self-monitoring, represents the milestone for GDM treatment in order to reduce maternal and fetal complications. The pregnant woman should benefit from her family support and make changes in their lifestyles, changes that, in the end, will be beneficial for the whole family. The aim of this manuscript is to review the literature about the Medical Nutrition Therapy in GDM and its crucial role in GDM management.

Insulin Resistance and Chronic Kidney Disease in Patients with Type 1 Diabetes Mellitus.

Background and Aims. Diabetes mellitus (DM) is a chronic disease which can evolve towards devastating micro- and macrovascular complications. DM is the most frequent cause of chronic kidney disease (CKD). Insulin resistance plays an important role in the natural history of type 1 diabetes. The purpose of the study was to determine the prevalence of CKD in T1DM and the correlation with insulin resistance (IR) in patients with CKD. Materials and Methods. The study was conducted over a period of three years (2010-2013) and included patients with DM registered in the Clinical Centre of Diabetes, Nutrition and Metabolic Diseases of Dolj county. The study design was an epidemiological, transversal, noninterventional type. Finally, the study group included 200 subjects with type 1 DM. Insulin resistance (IR) was estimated by eGDR. The subjects with eGDR ≤ 7.5 mg/kg/min were considered with insulin resistance. Results. CKD was found in 44% of the patients. Analyzing statistically the presence of CKD, we found highly significant differences between patients with CKD and those without CKD regarding age and sex of the patients, the duration of diabetes, glycosylated hemoglobin (HbA1c), the estimated glucose disposal rate (eGDR), and the presence of hypertension, dyslipidemia, and hyperuricaemia. In patients with CKD, age and diabetes duration are significantly higher than in those who do not have this complication. CKD is more frequent in males than in females (50.9% men versus 34.5% women, p = 0.022). From the elements of metabolic syndrome, high blood pressure, hyperuricemia, and dyslipidemia are significantly increased in diabetic patients with CKD. eGDR value (expressed as mg·kg-1·min-1) is lower in patients with CKD than in those without CKD (15.92 versus 6.42, p < 0.001) indicating the fact that patients with CKD show higher insulin resistance than those without CKD. Conclusions. This study has shown that insulin resistance is associated with an increased risk of CKD, but, due to the cross-sectional design, the causal relationship cannot be assessed. However, the existence of this causality and the treatment benefit of insulin resistance in type 1 diabetes are issues for further discussion.