Romanian Journal of Diabetes Nutrition and Metabolic Diseases

On reasonable truth-telling for unreasonable patients

Robert Agafiței, Oana Șerban, Petru Armean — Fri, 25 Nov 2022 00:00:00 +0000

The aim of this article is to explain to what extent the mechanisms of truth-telling diagnostics and other relevant information to the patients suffering from vascular dementia (VaD) must be adapted to the seven stages of evolution represented by the pathology of this disease. We argue in favor of preserving a deontological moral approach of truth-telling for the first three stages of VaD in order to shift to a consequentialist moral background of guiding the moral actions and communicative acts of speech with VaD patients in the last three stages of their disease. The middle stage, known as stage 4, appears to be the most problematic since empirical observations of the patient’s medical state are needed to shift from a deontological to a consequentialist approach at the first sign of the patients’ compromised autonomy. As we develop and critically expose pro and against deontological and consequentialist mechanisms of truth-telling to VaD patients, our arguments lead to a puzzle of moral beliefs that we engage in these two moral backgrounds. We argue that the shift of these two moral types of truth-telling mechanisms depending on the patient’s cognitive decline lies in the following assumptions: autonomy is a moral principle related to memory, and autonomy is regarded as a principle merely assigned to lucidity.

Hyperglobulinemia as a marker in the development of immune deficiency and complications in inflammatory breast cancer patients with type 2 diabetes mellitus

Fri, 25 Nov 2022 00:00:00 +0000

Dynamic monitoring of cryoglobulinemia throughout the postoperative period in patients with inflammatory breast cancer may indicate changes in their concentration in blood serum depending on the time of observation. The study aimed to determine cryoglobulin levels and plasma glucose levels as influencing factors in the development of immune system deficiency in inflammatory breast cancer, which could lead to different types of postoperative complications. In all patients, blood serum cryoglobulinemia conditions and plasma glucose levels were observed on the third, fifth and seventh day after the procedure and the content of lymphocyte subpopulations in the early postoperative period. Twenty patients with inflammatory breast cancer were divided into two groups: the first included 10 patients with normal levels of cryoglobulins in blood serum 60–80 mg/l (less than 108 mg)/l, corresponding to level 0-I of cryoglobulinemia and blood glucose range 4.4–6.6 mmol/l. The second group included 10 patients with primary hypercryoglobulinemia 298.6±2.5 mg/l; 1.3±0.08% (more than 280 mg/l), corresponding to level II-III of cryoglobulinemia and blood glucose range over 10.0 mmol/l. In both groups of patients, there was an increase in the concentration of cryoglobulins and plasma glucose levels on the third day after surgery. Thus, studies have shown that patients with cryoglobulinemia and type 2 diabetes mellitus operated for tumor-induced inflammatory breast cancer have formed a secondary immune deficiency. This is determined by abnormalities in the cellular and humoral immune system and as a consequence of developing postoperative inflammatory complications in patients with diabetes mellitus.

Astaxanthin administration reduces body weight and abdominal fat weight, but does not lower the neutrophil-lymphocyte ratio in obese male rats (rattus norvegicus)

Shierly Shierly, Agus Eka Darwinata, I Gusti Made Aman, Chandra Wirawan — Fri, 25 Nov 2022 00:00:00 +0000

Obesity has been known as global health. Astaxanthin is an antioxidant which also has an anti-obesity effect. This research aimed to identify the effect of astaxanthin on body weight, abdominal fat weight, and neutrophil-to-lymphocyte ratio (NLR) in obese male Wistar rats. A group of male Wistar rats was divided into three and fed either a standard or high-fat diet. Twenty-eight days later, rats in the high-fat diet group were divided into two and treated with astaxanthin 6 mg/kg body weight in glycerin or glycerin alone. On the 74th day, body weight and abdominal fat weight were measured. 1cc blood sample was obtained from medical canthus sinus orbitalis to perform a routine blood count (NLR). The results showed that body weight in the treatment group was lower than in the placebo group (p<0.001 95%CI 41.16–82.84). Consistently, the abdominal fat weight in the treatment group was also lower in the placebo group (p<0.009 95%CI 0.34–2.13). Furthermore, NLR’s mean was not statistically significant (p<0.118). Astaxanthin reduces body weight and abdominal fat weight but does not lower NLR in obese male Wistar rats.

ACE (rs4646994) and MTHFR (rs1801133) single nucleotide polymorphisms in type 2 Diabetes Mellitus patients with dyslipidemia

Fri, 25 Nov 2022 00:00:00 +0000

Dyslipidemia associated with diabetes mellitus (DM) is the most common cause of coronary artery disease mortality. Both genetic and environmental factors have a role in the development of type 2 DM and dyslipidemia. The current study aims to find the role of angiotensin-converting enzyme (ACE) (rs4646994) and methyl-tetra-hydro-folate reductase (MTHFR) (rs1801133) polymorphisms with dyslipidemia in type 2 DM patients. One hundred and fifty (150) type 2 DM patients with dyslipidemia were included in this study, in addition to 150 type 2 DM patients without dyslipidemia and 150 healthy age and sex-matched control group. Venous blood samples were collected for the different laboratory workups and the gene polymorphism testing using the polymerase chain reaction-restriction enzyme fragment polymorphism (PCR-RFLP) technique. Both demographic and clinical parameters were collected from the study population. The results showed significant associations between ACE and MTHFR polymorphisms among the two patient groups (type 2 DM with dyslipidemia, with p-value<0.001 and 0.011, respectively), (type 2 DM without dyslipidemia with p-value=0.007 and 0.016, respectively). This study supports the notion that these commonly found ACE and MTHFR polymorphisms could be incriminated in the pathogenesis of dyslipidemia associated with type 2 DM.

Hypertension status and adherence to treatment among Ukrainian and Egyptian patients

Viktor Mykolayovych Meretskyi, Iryna Volodymyrivna Meretska — Fri, 25 Nov 2022 00:00:00 +0000

Hypertension is the third-largest killer in the world, about 1 in 8 deaths worldwide is due to hypertension. The WHO estimates that nearly 1 billion people are affected by hypertension. This study aims to review the essential hypertension status among the Egyptian and Ukrainian adult population, the practice of the utilization of hypotensive drugs, and adherence to treatment in patients with hypertension. A population of 120 patients with hypertension was enrolled in the study. General and systemic examination, laboratory and instrumental investigations were done for all participants. All subjects completed a questionnaire. A comparative analysis of the socio-demographic profile, awareness of complications of hypertension and blood pressure level meaning, pharmacotherapy of arterial hypertension, adherence to treatment and relationship to long-term medication and diet of Ukrainian and Egyptian participants was performed. The majority of Ukrainian and Egyptian participants started medication as soon as diagnosed with hypertension. The use of ACEI/ARBs surpassed the use of all other classes of antihypertensives among both groups. A high level of regular antihypertensive therapy with an understanding to complete the prescription was detected; on the other hand, a significant frequency of changes or refusal of therapy, in general, was established.

Estimation of salivary omega-6 and omega-3 fatty acid levels in children and its relationship to varying levels of dental caries

Geethu Jose, Srikala Bhandary — Fri, 25 Nov 2022 00:00:00 +0000

Omega 3 and omega 6 are essential polyunsaturated fatty acids (PUFA) that must be obtained from dietary sources. Dental caries is an infectious disease with multi-factorial etiology and is the major reason for tooth loss in children & adolescents. The aim was to assess and compare the levels of salivary omega-6 and omega-3 fatty acids in children with varying levels of dental caries. A number of 205 children aged 7–14 years were selected and grouped based on the ICDAS-II classification system into Group I (Active caries), Group II (Arrested caries) and Group III (Controls). Saliva samples were collected and subjected to Gas Chromatography to quantify all the fatty acids. Group III had the highest mean omega-3 fatty acids value, followed by Group I and Group II. Group II had the highest mean omega-6 fatty acids value, followed by Group III. Group I had the least mean of Omega-6. The highest levels of omega-3 fatty acids were observed in the control group, the lowest in the arrested caries group, and the omega-6 levels were the highest in the arrested caries group and the lowest in the active caries group.

Effect of vitamin D3 on serum lipid profile and HbA1c levels in type 2 diabetes mellitus: a randomized controlled study

Fri, 25 Nov 2022 00:00:00 +0000

The purpose of this study was to review the effect of vitamin D3 (VD3) supplementation on glycemic control and lipid profile in patients with Type 2 Diabetes Mellitus (T2DM). A total of 68 T2DM patients with hemoglobin A1C (HbA1c)>6.5 and 25(OH) VD3<30 ng/ml were included in the study. They were randomly divided into two groups: placebo (n=34), and VD3 (n=34). Patients received weekly (VD3 (50,000 IU)/placebo) for 8 weeks. HbA1c levels, FBS and lipid profiles were assessed at baseline and after 8 weeks. A number of 62 people included VD3 (n=30) and placebo (n=32) completed the study, 25(OH) VD3 serum increased significantly after 8 weeks in the VD3 group compared to the placebo group (P<0.001). HbA1c levels, slightly higher, had decreased in the VD3 group compared to the placebo group (-0.35±1.2 vs. -0.13±1.50%, P=0.50). FBS levels slightly decreased in the VD3 group, compared to the placebo group (-6.93±39.57 vs. 5.53±42.21 mg/dl, P=0.07). In contrast to the slight decrease in total cholesterol (TC) and LDL levels in the VD3 group, was observed a slight increase in TC and LDL levels in the placebo group, and this increase was almost significant for TC (-1.26±36.72 vs. 14.65±41.56 mg/dl, P=0.05). The effect of VD3 may increase in improving hyperglycemia and lipid profile levels with increasing intervention time and sample size.

Association of glycaemic control with demographics, diabetes management information and body fat composition in persons with type 2 diabetes mellitus (T2DM): a need for multi-disciplinary management

Fri, 25 Nov 2022 00:00:00 +0000

Type 2 diabetes mellitus (T2DM) is a chronic condition that can cause complications due to poor glycaemic control. The demographic characteristics, information related to DM and management, anthropometric variables, and the body fat composition of T2DM individuals are important factors influencing glycaemic control. This study was conducted to explore the association between glycaemic control and selected demographic characteristics, information on T2DM management, and body fat composition in T2DM patients. This cross-sectional survey amongst people with T2DM was conducted in the Udupi district of South India. A number of 467 participants were selected for the study using a simple random sampling technique. The survey included three parts: a questionnaire, an anthropometric and body fat composition measurement, and a biochemical assessment. The multivariate logistic regression model showed that not consulting the dietician (OR=6.074); the presence of complications (OR=2.955); visceral fat ≥10 (OR=2.037); non-compliance to exercise (OR=2.007); availing treatment from the private sector (OR=1.85); and non-consumption of traditional remedies (OR=1.651) were the associated factors to poor glycaemic control in T2DM patients. Not consulting dieticians, complications, non-compliance to exercise, not consuming traditional remedies, visceral fat ≥10 and availing treatment at private setup were the significant associated factors for the poor glycemic control.

Prediction of subclinical gouty nephropathy by using neural networks

Maksym Franchuk, Svitlana Smiyan, Ulyana Franchuk — Fri, 25 Nov 2022 00:00:00 +0000

Gouty nephropathy may have a subclinical course for years, but with what probability may it occur? We used neural networks or “artificial intellect” to solve this problem. This study aims to recognize the risk factors that correlate with significantly high microprotein indices and build a neural network that will predict the development of subclinical course of gouty nephropathy in percentage without additional tests. A one-center cohort prospective study included 117 gouty arthritis patients who were on scheduled in-patient treatment at the rheumatology department during 2018–2021. All patients had no history of ongoing kidney disease. The study aimed to recognize the risk factors that correlate with significantly high microprotein indices and build a neural network that will predict the development of subclinical course of gouty nephropathy in percentage without additional tests. We can distinguish the factors that are most associated with the development of kidney disease and correlate with microalbumin (r1) and α1-microglobulin (r2) in the urine: hyperuricemia (r1=0.85; r2=0.73), hypouricosuria (r1=-0.79; r2=-0.63), hypertriglyceridemia (r1=0.84; r2=0.78), an increase in LDL levels (r1=0.77; r2=0.79). There were also established correlations between renal disease and the fact of arterial hypertension (r=0.81), diabetes mellitus (r=0.59). The neural network was built. That is why, having input data, it is easy to predict the risk of gouty nephropathy development by using the proposed calculator and beginning early target prophylaxis, even if kidney disease may have a subclinical course.

Using chemerin and vaspin as non-invasive methods in diagnosing and monitoring chronic hepatitis C infection

Amina Hamed Ahmed Alobaidi, Sanarya Kamal Tawfiq, Staar Mohammed Qader — Fri, 25 Nov 2022 00:00:00 +0000

Hepatitis C virus infection represents a healthcare problem in Iraq and worldwide. Early infection diagnosis ameliorates the disease’s natural course and reduces morbidity and mortality. The study aimed to illustrate the connection between chemerin and vaspin in incessant hepatitis C disease. A cross-sectional investigation was completed in Kirkuk city from January to May 2019, which included 50 patients with chronic hepatitis C infection and 30 age and gender-matched controls. As a result, patients with chronic HCV had significantly (P<0.05) higher mean serum levels of chemerin than controls. In contrast, the mean serum level of vaspin was significantly (P<0.05) lower in patients with chronic HCV infection compared to controls. Chemerin’s mean serum level was higher in grade 4 liver cirrhosis, while the lowest level was in those without cirrhosis (grade 0). However, the mean serum vaspin level increased with the grading of cirrhosis but declined in grade 4 to a level lower than that of stage 1. (P<0.05). Alanine aminotransferase transaminase serum levels were positively correlated with chemerin and vaspin serum levels. In conclusion, chemerin and vaspin serum levels may be used to monitor and predict stage liver fibrosis in chronic HCV.

Possibility of non-invasive diagnostics of liver fibrosis in patients after chemotherapy with normal weight and overweight

Fri, 25 Nov 2022 00:00:00 +0000

According to the World Health Organization, diseases of the gastrointestinal tract rank third place after cardiovascular disease and cancer and more than 2 billion people suffer from hepatic diseases and toxic hepatitis is one of them. Given the complexity of differentiation and confirmation of iatrogenic toxic hepatitis and broad spectrum of possible medication side effects, there is a real problem with precise statistics of hepatic drug lesions. This study aims to improve the possibility of diagnosing liver fibrosis in patients with normal weight and overweight and determine and study the relationship between the level of polyfunctional cytokine TGF-β1 with BMI. We examined 44 patients with a history of breast cancer of I-II degree according to the TNM classification (TNM-8 system, 2016) without malignancy and who belonged to the III clinical group (persons with proven malignant tumors who have completed radical treatment and are in remission) aged 35 to 79 years. Patients were divided into two main groups. The first group included patients without signs of toxic liver disease and the second group represented patients with signs of toxic hepatitis. In addition to biochemical analysis, the subjects were examined to determine the FibroTest index to verify the fibrosis stage. Additionally, the FIB-4 index was calculated. This study found that FIB-4 and fibrotest may be sensitive and reliable methods for liver fibrosis screening in patients after cancer chemotherapy. The presence of excess body weight may be an important factor in predicting the development of severe fibrosis in such patients. The level of profibrogenic cytokine TGF-β1 may be an additional predictor of fibrosis progression.

The impact of online food delivery on the nutritional status of work-from-home workers during the COVID-19 pandemic

Ratih Kurniasari, Linda Riski Sefrina, Sabrina Sabrina — Fri, 25 Nov 2022 00:00:00 +0000

Social restriction policies increase the risk of obesity in society because it is influenced by increasingly narrow space for movement so that physical activity is reduced and consumption increases due to feeling bored at home. The effects of the COVID-19 pandemic have caused people’s lifestyles to change from those previously operating offline to online, including how to get food. Large-scale social restriction policies make food service providers cooperate with the Online Food Delivery (OFD) platform to make it easier to reach consumers. This study aimed to analyze the effect of using an online food delivery application on improving the nutritional status of office workers during the COVID-19 pandemic. This research is an analytic observational study with a cross-sectional design. The study involved 408 workers in Jakarta who experienced the impact of COVID-19. The data analysis technique used SPSS 20, which adjusted test results to the variable data scale. It is known that there was an increase in body weight and nutritional status (p<0.05) during the large-scale social restriction policy implementation. There is a correlation between physical activity and nutritional status (p<0.05). There is no significant correlation between the frequency of ordering food online with nutritional status. There is an increase in body weight and an increased risk of obesity during the COVID-19 pandemic.

Diagnosis and treatment of Charcot foot in patients with diabetes mellitus

Fri, 25 Nov 2022 00:00:00 +0000

In recent years, we have seen a significant increase in the number of works devoted to the Charcot foot. The aim was to propose and evaluate the optimal approach to diagnosing and treating Charcot foot in patients with type 2 diabetes. We treated 115 patients with type 2 diabetes and Charcot foot. Patients were separated into two groups: the TCC group (65), where it was administrated the treatment with a total contact cast (TCC) and the ORTHOSIS group, where immobilization with rigid orthoses was carried out. The TCC group showed worse results (p=0.004). In the TCC group, the frequency of recurrence of Charcot arthropathy in the next 2 months after the end of treatment was significantly higher (p=0.04). The frequency of development of Charcot arthropathy on the contralateral limb during treatment or in the coming months after it did not differ significantly between patient groups (p=0.14). X-ray in patients with Charcot foot is ineffective in establishing a clinical diagnosis and choosing treatment tactics. MRI of the foot with or without intravenous contrast should be chosen. Staged conservative treatment of Charcot foot shows a positive effect in 80.9% of observations.

Development of a novel anthropometry-based equation for diabetes risk prediction

Anthony Chibuzor Nnamudi, Noghayin Jerry Orhue, Ifeoma Irene Ijeh — Fri, 25 Nov 2022 00:00:00 +0000

The increasing global burden of diabetes mellitus is a public health concern. In an attempt to stem the tide of the increasing prevalence of the disease, we decided to develop a diabetes risk prediction equation from precisely measured adiposity indices. We recruited 200 young adult Nigerians, 92 (46.0%) males and 108 (54.0%) females, aged 15–35 years, for this study. Participants filled out the Finnish diabetes risk scoring (FINDRISC) questionnaire and underwent anthropometric measurements following standard protocol. Pearson correlation and multiple regression analyses were utilized, while statistical significance was fixed at p<0.05. From the results, body mass index (BMI) correlated most significantly (r=0.610, p<0.001) with risk scores. We developed a diabetes risk prediction equation using the following adiposity indices; body mass index (BMI) (r=0.610, p<0.001), body adiposity index (BAI) (r=0.561, p<0.001), waist-to-height ratio (WHtR) (r=0.557, p<0.001) and waist circumference (WC) (r=0.495, p<0.001) while relying on the FINDRISC model for stratification of risk status. We recommend the utilization and validation of the developed prediction equation in other populations.

A case report of Guillain-Barre syndrome with demyelinating polyradiculoneuropathy

Anuradha Ganesan, Santhini Gopalakrishnan, Durga Venkata Satyamurthy Golla — Fri, 25 Nov 2022 00:00:00 +0000

Guillain-Barre syndrome (GBS) is an autoimmune disorder with the most common clinical presentation of neuromuscular paralysis. Here we have reported a rare case of GBS in a 64-year-old patient who presented with chief complaints of generalized body aches and difficulty in walking and sitting for the past five days. Laboratory investigations showed an elevation of protein level in the cerebrospinal fluid (122.1 mg/dl) and CK total (24315 U/L). A nerve conduction study done by sampling from Median, Ulnar, Peroneal, Tibial and Sural nerves was suggestive of asymmetrical severe sensory demyelinating polyradiculoneuropathy more prevalent in the lower limb than in the upper limbs. The patient was admitted and treated with antibiotics, analgesics, muscle relaxants, multivitamins and other supportive measures. Given the progressive worsening of symptoms, intravenous immunoglobulin infusion began, after which the patient’s condition gradually improved.

Pathogenesis of type-2 diabetes mellitus and its complications – a narrative review

Farhana Begum, Karpagavel Lakshmanan — Fri, 25 Nov 2022 00:00:00 +0000

Diabetes mellitus is the dynamic group of metabolic disorders whose progression leads to various complications. This review focuses on the dominance of type 2 diabetes among the diabetic population, risk factors, biomarkers, pathogenesis and therapeutic agents. It also explains the importance of drug therapy obtained from natural origin. In this review, we have presented an overview of the incidence of the glucose-induced release of insulin from β cells of the pancreas and its action on various tissues involved in the maintenance of blood glucose levels. Lifestyle modifications can be influential in preventing type 2 diabetes from further complications. In general, a sedentary lifestyle proved to be one of the crucial factors for the pathogenesis of type 2 diabetes. In addition, many biomarkers consort with type 2 diabetes and its complications. This review has shown a few important biomarkers to be examined at different stages of type 2 diabetes (prediabetes, newly diagnosed and known diabetes). Additionally, recent approaches to drug therapy that are conventional and traditional sources as an alternative therapy have been discussed.

The fascinating history of insulin

Fri, 25 Nov 2022 00:00:00 +0000

This year marks 100 years since the administration of the first insulin injection, the discovery of insulin (101 years ago) representing a cornerstone in the history of medicine. This moment transformed insulin-dependent diabetes from a certain death sentence into a chronic condition associated with a high life expectancy. Tens of millions of lives or more have been saved this way. The Romanian Nicolae Paulescu contributed decisively to the discovery of insulin in 1921. In early 1922, Banting and Best administered insulin to humans for the first time, to Leonard Thompson – a 14-year-old child, his health improving considerably after the administration of purified insulin, by the Canadian team. In the same year, insulin production began in Indianapolis, later expanding throughout the world. In 1923, the Nobel Prize for Physiology or Medicine was awarded to Banting and MacLeod, for the discovery of insulin, but great controversies were triggered, not extinguished to this day. In an attempt to calm the spirits, Banting shared his prize with Best and Macleod with Collip. However, Paulescu remained excluded and died full of bitterness, being unable to accept the fact that fraud can also occur in science.