Romanian Journal of Diabetes Nutrition and Metabolic Diseases

A case series of epulides in diabetic and non-diabetic patients: is there a link?

Ioanina Părlătescu — 2023-06-30

The epulis is a tumor caused by the chronic irritation or trauma of restorations, of any sharp and overhanging edges of crowns/bridges, or mobile prostheses, found mostly in the buccal side of the gingiva and interdental papillae. It appears like a sessile lesion with a smooth or ulcerated surface. The main scope of this study is to show some clinical and histological features of epulides from patients suffering or not from diabetes mellitus. The study is a series of 15 cases of patients with and without diabetes melitus. The diagnosis of epulis was made by an oral medicine specialist based on clinical and histopathological features. In most cases, the epulides were located on the buccal side of the gingiva and near an irritating factor (dental crowns or bridges). The most frequent histopathological diagnosis was the fibrous pattern with abundant chronic perivascular and interstitial lymphoplasmacytic infiltrate covered by acanthotic non-keratinized stratified squamous epithelium.

Epidemiological, clinical characteristics and outcomes of patients presenting with acute organophosphorus poisoning to a tertiary care institution in North India

Mohammad Hayat Bhat — 2023-06-30

Organophosphates (OP) poisoning continues to be a major cause of deliberate self-harm and an important cause of morbidity and mortality in India. We aim to study the clinico-epidemiological features in patients presenting with OP poisoning. This prospective observational study involved 400 patients above 18 years of age admitted to the emergency department of a tertiary care institution in Northern India. The study cohort was graded into mild, moderate & severe based on the Peradeniya Organophosphorus Poisoning (POP) scale and degree of cholinesterase inhibition. The majority of patients (40%) in our study population were aged between 18–25 years. There was a significant female preponderance (82% vs. 18%; P=0.000). Suicide was the most common motive (93%) and ingestion was the most common mode of poisoning (99%). The muscarinic and nicotinic symptoms were common at the presentation. Seizures were present in 11% of patients. On the POP severity scale, mild, moderate and severe poisoning was seen at 50%, 35% and 15%, respectively. Cholinesterase inhibition was mild (>2 kU/L) in 31%, moderate (1–2 kU/L) in 46% and severe (<1 kU/L) in 23%. A total of 48% of patients had complications. Ventilator support was needed in 43% of the patients. An overall mortality of 18% was observed in the study. OP poisoning is a serious public health problem, but timely intervention may help to reduce morbidity and mortality, especially in a resource-limited country like India.

Effect of vanadium and chromium citrates on lipid composition in the blood of rats with experimental diabetes

Olha Sushko — 2023-06-30

In clinical endocrinology, diabetes is one of the most important pathologies due to the high, ever-increasing prevalence and frequent development of complications, including dyslipidemia. The aim of the research was to investigate the effect of organic compounds of vanadium and chromium citrates at the dose of 0.5 μg/ml and 0.1 μg/ml on the metabolism of lipids in the blood of rats with alloxan-induced diabetes. The total amount of lipids was determined by weighing dry using a residue gravimetric method. The separation of lipids into classes was carried out by thin-layer chromatography. Lipid profile showed that non-esterified cholesterol, phosphatidylserine, and lysophosphatidylcholine increased, and esterified cholesterol and phosphatidylethanolamine decreased in diabetic rats. The content of phospholipid, non-esterified cholesterol and triacylglycerol decreased. However, the content of monoacylglycerols and diacylglycerols increased in the blood of diabetic rats with a daily diet of vanadium and chromium citrates at the dose of 0.5 μg/ml and 0.1 μg/ml. Changes in phospholipid content were also noted. Our results indicate the normalization of lipid metabolism with the additional introduction of vanadium and chromium citrates to the diet of animals with hyperglycemia. This may indicate that the present compounds may be the progression of diabetes and the risk of deterioration.

Comparison of serum nitric oxide, sialic acid and alkaline phosphatase in type 2 DM patients with and without chronic periodontitis

Ankur Tailor — 2023-06-30

Periodontitis and diabetes cause a hyperinflammatory immune response with elevated reactive oxygen species and cytokines. A few mediators of the ensuing inflammation are nitric oxide (NO), sialic acid (SA) and ALP (alkaline phosphatase). Hence, this study aimed to compare and correlate the level of serum NO, SA and ALP in diabetes mellitus with and without chronic periodontitis patients prior to and after non-surgical periodontal treatment. A total of 100 patients were included: healthy controls (Group A), DM (Group C, D) and chronic periodontitis (Group B, C). Serum samples of NO, sialic acid and ALP were analyzed before and after the treatment. Post-hoc Tukey HSD test was used for intergroup comparison levels, and the Analysis of Variance Test (ANOVA) was used to compare values before and after treatment in all groups. P<0.05 was considered statistically significant. Baseline means NO, SA and ALP levels were highest in DM with periodontitis (65.37, 156.09, 272 µM/L), respectively. Inter-group comparison of NO, SA and ALP values before and after treatment was statistically significant (P<0.001). Diabetes significantly impacts the exacerbation of inflammation and elevation of serum NO, SA and ALT in periodontitis. Additionally, periodontal therapy produced a beneficial result.

Characteristics of metabolic homeostasis and hematological indicators in young women with menstrual disorders against the background of overweight and obesity

Yurii Mykolaiovych Pavlushynskyi — 2023-06-30

Overweight and obesity are among the leading factors of menstrual dysfunction. The aim of the study was to assess the relationship between clinical and metabolic indicators, hematological parameters and features of iron metabolism in young women with obesity and menstrual disorder. Assessment of anthropometric parameters and complex clinical and metabolic examination of 120 patients with menstrual dysfunction against the background of excess body weight (50 people – group 1), class I-II obesity (40 people – group 2) and normal body mass index (30 patients) aged from 18 to 35 years old, were carried out. The results of the study of carbohydrate metabolism, the levels of C-reactive protein, ferritin, hemogram parameters and biochemical indicators were analyzed analytically. It was found that a high body mass index (BMI) at a young age (up to 29 years) and a long smoking history are significant factors in the development of menstrual dysfunction such as oligo-hypomenorrhea, secondary amenorrhea and dysphoric premenstrual disorders. An elevated BMI, even in the case of a risk weight (overweight), is associated with an increase in the concentration of C-reactive protein, serum ferritin and insulin resistance index; the concentration of serum iron was also lower in the group of obese women. Characteristics of microcytic hypochromic anemia were found in a third of patients with obesity and menstrual dysfunction. Assessment of markers of systemic inflammation as a criterion for early detection of the progressive development of obesity is a relevant and promising direction for the optimization of preventive measures.

The association between ABO/RH blood groups and type 2 diabetes mellitus in Dhamar Governorate, Yemen

Bushra Samer — 2023-06-30

The literature shows that ABO blood groups and demographic characteristics influence susceptibility to type 2 diabetes mellitus (T2DM) and may be used to stem the rising incidence of the disease. However, these associations vary geographically, which necessitates the need to determine the association in every locality. So far, no study has been performed in Dhmar Governorate to look for the association of diabetes mellitus (DM) with blood groups. We studied the association of ABO blood groups with type 2 diabetes mellitus. This study was conducted in Dhamar Governorate from February to May 2022. The study included 332 people, including patients diagnosed with type 2 diabetes and healthy controls. All participants were examined for ABO and Rh by a slide test method. In addition, sociodemographic and clinical data were collected with a semi-structured pretested questionnaire. The questionnaire included clear questions to collect the relevant data. The order of prevalence of diabetes mellitus noted in the blood group types were O, A, B and AB, respectively. The maximum prevalence of type 2 diabetes mellitus was noted with the O+ blood group at 39.5% and the least with the blood group AB- at 0.6%. There was a significant association between A and O blood groups and the risk of developing T2DM. The present work confirms that blood group A is an alarming risk factor for susceptibility to T2DM.

The status of self-care behaviors among type 2 diabetic patients: a cross-sectional study

Maryam Nikbina — 2023-06-30

Performing self-care behaviors is an essential method that helps the patient to control and manage the disease. The present study was conducted to determine the status of self-care behaviors in patients with type 2 diabetes. In this cross-sectional study, 322 patients with type 2 diabetes referred to comprehensive health centers in Andimeshk city, Iran, were examined. The required data were collected through socio-demographic questionnaires and the summary of diabetes self-care activities (SDSCA) measure. The total self-care score was 59.32±18.54 and at an average level. The highest score was related to the specific diet aspect, and the lowest was assigned to the foot care aspect. Less than a quarter (23.91%) of the patients reported a good self-care level. It seems necessary to plan for continuous and permanent training about self-care activities in patients with diabetes mellitus.

A study to find out the correlation between urine microalbumin and serum uric acid levels among type-2 diabetic patients with nephropathy

Priyanka Ramakrishnan — 2023-06-30

Diabetic nephropathy is one of the most common complications of diabetes mellitus. Early detection of the complication is required for proper effective and timely treatment. This article aims to determine the role of serum uric acid and microalbumin levels in diagnosing diabetic nephropathy. We collected the data from 100 cases with diabetic nephropathy and 100 with diabetes but without nephropathy controls. Fasting plasma glucose, postprandial blood glucose, uric acid, blood urea nitrogen (BUN) and creatinine levels, microalbumin and eGFR levels were assessed in all the subjects. As a result, the independent sample t-test showed a significant difference in the levels of FBS, BUN, creatinine, uric acid and microalbumin levels among cases and controls (p-value<0.05). Pearson correlation showed a significant positive correlation between serum uric acid and microalbumin. ROC curve showed AUC for HbA1c, serum uric acid and microalbumin as 0.814, 0.713 and 0.706, respectively. In conclusion, serum uric acid can be used as a biomarker for the early detection of diabetic nephropathy.

Angiotensinogen (AGT RS4762) and guanine nucleotide-binding protein BETA-3 (GNB3 RS5443) genes predict left ventricular hypertrophy in hypertensive patients

Kseniia Voroniuk — 2023-06-30

This study aims to evaluate polymorphic variants of AGT (rs4762) and GNB3 (rs5443) genes as predictors of myocardium left ventricular hypertrophy (LVH) in patients with essential arterial hypertension (EAH). The case-control study involved 100 patients with EAH stage II, high-very high cardiovascular risk. There were 21% men, and 79% women; the average age was 59.86±6.22 years old. The control group consisted of 60 practically healthy subjects. AGT (rs4762) and GNB3 (rs5443) genotyping was performed by Real-Time PCR. As a result, centric LVH (ELVH) in EAH patients is more common in T-allele carriers of AGT gene (rs4762), CC-genotype subjects of GNB3 gene (rs5443) by 26.29% and 22.22%, respectively. Concentric LVH (CLVH) dominates in homozygous C-allele patients of AGT gene (rs4762), and T-allele of GNB3 gene (rs5443) by 29.13%, 22.22%, correspondingly. ELVH risk increases in hypertensive T-allele carriers of AGT gene (rs4762) 4.5 times and in CC-genotype of GNB3 gene (rs5443) almost 5 times. CLVH risk increases in CC-genotype patients of AGT gene (rs4762) almost 5 times, in T-allele of GNB3 gene more than 4 times. Blood pressure (BP) ≥160/≥100mmHg increases ELVH risk 3 times. In conclusion, LV hypertrophic models associate with AGT (rs4762) and GNB3 (rs5443) genes polymorphic variants in hypertensive patients, as well as ELVH with BP elevation.

The prevalence of hypercalcemia-associated acute kidney injury among bodybuilders and athletes

Mohammed Younus Naji Al Atbee — 2023-06-30

Acute kidney injury (AKI) results in the retention of urea and other nitrogenous waste products accompanied by fluid and electrolyte deregulation that portend serious consequences. Bodybuilders and athletes frequently use a lot of dietary supplements containing non-standardized formulas of multivitamins, including vitamin D, leading to severe vitamin D intoxication along with hypercalcemia-associated AKI. To evaluate the incidence of hypercalcemia-associated AKI with vitamin D intoxication and to analyze the spectrum of causes of AKI among hospitalized patients. A cross-sectional study was conducted between June 2016 to March 2022 by recruiting eighty patients who presented with AKI and were admitted to the hospital. The patients were reviewed to ascertain the causes of AKI and a complete blood investigation was conducted for the quantitative determination of electrolytes and vitamin D. Vitamin D intoxication was diagnosed by measuring the 25 hydroxyvitamin D level, and a level beyond 150 ng/mL was considered toxic. All 16 patients affected by AKI with vitamin D intoxication were bodybuilders/athletes. They showed a strong correlation with hypercalcemia (100%), increased urinary calcium (hypercalciuria: 100%), and hypervitaminosis D (100%) but showed normal serum phosphate levels (24.2%). Renal ultrasound findings revealed renal stones (66.7%) and nephrocalcinosis (100%). This study reinforces the necessity of awareness among bodybuilders/athletes regarding the intake of unprescribed/unstandardized supplements and monitoring their renal function, vitamin D, and calcium levels. Nephrologists should be aware of the early diagnosis and treatment of AKI with vitamin D intoxication for the improvement in renal outcome.

Definition of the relationships between ambulatory blood pressure characteristics and blood glucose levels in type 2 diabetes patients with well-controlled arterial hypertension

Nataliia Pertseva — 2023-06-30

Arterial hypertension is the most common comorbidity in patients with type 2 diabetes mellitus (T2DM). The combined effects of hyperglycemia and elevated blood pressure (BP) may increase the risk of macro- and microvascular complications. This study aimed to investigate BP characteristics over a 24-hour period and to evaluate the relationship between continuous glucose monitoring (CGM) parameters and ambulatory BP monitoring (ABPM) indicators in T2DM patients with well-controlled BP. 53 T2DM patients and 10 controls were examined. All subjects were conducted with CGM and ABPM. Disturbances of BP circadian rhythm were observed in 81.1% of patients. Compared with controls, the patients with T2DM had significantly higher average daily systolic BP, diastolic BP and pulse BP and their variabilities. Glucose variability, together with hypoglycemia, affects the ABPM indicators and determines them by 60.55%, with the greatest impact on the systolic pressure area index and systolic pressure time index (R=0.82 (χ²=261.76; p=0.001). Thus, the patients with T2DM and well-controlled arterial hypertension have disturbances in circadian BP rhythm with the predominance of “non-dipper” and the appearance of “night-peaker” patterns. We indicated a strong significant relationship between systolic BP load indicators and high glucose variability together with hypoglycemia.

Phytochemical effects of soy isoflavones consumption on urinary estrogen levels in premenopausal and postmenopausal women with breast cancer

Ibtissam Abood Radi — 2023-06-30

Breast cancer is the first of the top ten malignancies in Iraq. The benefits of consuming soy foods for hormone-positive breast cancer women are controversial. This study aimed to evaluate the effects of soy isoflavones on urinary estrogens levels and to investigate the association between urinary estrogens and urinary isoflavones in premenopausal (PreM) and postmenopausal (PostM) women with hormone-positive breast cancer treated with anti-estrogens. A randomized, interventional comparison study was carried out on 120 Iraqi women with hormonal-positive and HR2 Negative breast cancer. Participants were asked to fill out a questionnaire and to get urine samples. All participants were given (½ cup of soymilk daily) for one month and (one cup of soymilk daily) for another month. The fasted morning urine samples were collected monthly for urinary isoflavones and estrogens HPLC analysis. The mean estradiol level in PreM was significantly higher than in PostM, but after low and high doses of soymilk, it was much lower in PreM than in PostM women. While the mean estrone concentrations at low dose of soymilk were higher in PreM than in PostM women, but after high dose soymilk lower in PreM than in PostM women. Estrone level has biphasic non-significant change after isoflavone intake. Estrodail and Didazain level in PreM is lower than in PostM women after soy intake. Genstaine levels in PreM are higher than in PostM beyond soy intake. Patients who experience low urinary estradiol levels on soy food have less tendency to disease progression.

Liraglutide as an effective tool for obesity management in type 1 diabetes – case report

Fedir Laniush — 2023-06-30

Glucagon-like peptide-1 receptor agonists (GLP-1-RA) are recommended for the management of type 2 diabetes as well as for obesity treatment. They have multiple effects, including stimulation of insulin secretion, inhibition of glucagon release, gastric emptying delay, and food intake suppression. Type I diabetes melitius (DMT1) requires life-long insulin therapy. However, obesity is caused by overeating; thus, additional insulin injections pose a risk for cardiovascular events, osteoarthritis, and obstructive sleep apnea. In this case report, we inform about a patient with DT1 and binge-eating behavior who used liraglutide 3.0 mg for 3 months for obesity management with significant improvement in HbA1c level (7.5% vs. 6.9%), weight (82.6 vs. 75.2 kg), BMI (32.3 vs. 29.4 kg/m2), waist circumference (94 vs. 88 cm), and leptin level (24.5 vs. 10.3 ng/ml). Further studies of GLP-1-RA in DT1 management can help to reduce the risks of obesity-related conditions and decrease the daily insulin dose requirement.

Health impact of obesity

Mariana Spătărelu — 2023-06-30

Obesity is considered a global health concern. According to the World Health Organization, the available data indicates that globally almost a third of the population is diagnosed with obesity and might be at risk of developing more than ten types of oncological conditions later in life. Weight gain is a modifiable health risk factor resulting from complex interactions between behavioral and environmental factors that might increase the burden of obesity-related noncommunicable diseases, such as cardiometabolic diseases and cancer. The urbanization process, better food and beverages access, availability, affordability, the effect of eating habits, and the enhanced neural cue reactivity to taste and visual food stimuli might highlight delayed satiety and some types of eating disorders. Healthy behaviors are usually determinants of a negative energy balance, improved health outcomes, a disease-free life, better weight management and better quality of life.

The current state of cervical diseases prevention in women of reproductive age taking into account the vaginal biocenosis – review

Larysa Malanchuk — 2023-06-30

In recent years, cervical pathology has taken a leading place in the structure of cancer in the whole world. The variety of pathological lesion forms of the lower part of internal genital organs requires a personalized approach to solving complex treatment tactics. The study of the ectopic columnar epithelium (ECE), which according to the literature, is about 40% and results from the ineffective treatment of previous cervical pathology, represents great interest on practical grounds in gynecology. At first glance, all benign processes do not occur as a significant cancer risk. However, they do significantly impact reproductive health and leave much to be discussed about treatment and prevention. According to most researchers, vaginal biocenosis is a complex micro-ecosystem, where the key role belongs to the vaginal microflora, which in turn changes dynamically during the cycle and age of women and depends on many factors: anatomical and histological structure of the genital area, immune response and others. The modern classification of benign cervical and vaginal tumors includes various conditions and diseases. Further observation and treatment require verification of squamous epithelial cells with atypia of unclear genesis, especially in women of reproductive age with HPV infection on the background of aberrant microbiocenosis of the vagina. Thus, in our opinion, the state of modern medical knowledge in the direction of expanding the study of disorders of the microbiocenosis of the vagina in the prevention of cervical oncological pathology is a promising study. Namely, the study of the interaction of micro- and macroorganisms among women of reproductive age with benign pathology under HPV load and different cytological pictures will allow to develop a mathematical model for predicting the pathological process progression and become a prerequisite for quality prevention.

Knowledge and oral health literacy in patients with type 2 diabetes: a systematic review

Ahmad Moradi — 2023-06-30

Knowledge has a direct relationship with oral health. Since the oral health of patients with type 2 diabetes (T2DM) is affected by their blood sugar levels; therefore, the present systematic study was conducted to examine oral health literacy in patients with T2DM. Studies conducted in this field were searched in reliable scientific databases such as PubMed, CINAHL, Web of Science Core, Inform it Health Databases, Scopus, Google Scholar, ProQuest, PsycINFO and DoPHER, and were selected based on the study inclusion criteria and the main purpose of the research in 2022. As a result, among 6572 reviewed articles, 15 articles were included in the study. A number of 8642 patients with T2DM with an average age of 52.7 years were examined. The total awareness of these people with T2DM regarding oral health literacy was 48%. Pacients’ oral health knowledge was investigated, which was about 43% in men and 58% in women. In 9 studies of patients with diabetes, oral health literacy was less than 50%. In 6 studies, it was observed that the level of oral health knowledge was higher than 50%, and a significant correlation was observed between patients with T2DM and their level of oral health literacy. City residents had higher oral health literacy. In conclusion, oral health literacy in people with T2DM was generally low and needed more attention. Some factors, such as urban life, access to the Internet and virtual space, as well as the gender of persons with T2DM, were effective on the level of oral health literacy.

Metabolic syndrome as a risk factor for the development of preeclampsia in pregnant women

Ulyana Franchuk — 2023-06-30

The main task of modern obstetrics, along with reducing maternal and perinatal mortality, is improving the health of the expectant mother, fetus and newborn. In recent decades, one of the leading topics that concern doctors all over the world, including obstetricians and gynecologists, is metabolic disorders, which in turn is the starting point for the development of complications from the second half of pregnancy. Preeclampsia is a complication of pregnancy characterized by a profound disorder of the functions of vital organs and systems of the expectant mother. Undoubtedly, preeclampsia, which from a pathogenetic point of view is one of the clinical manifestations of the “great obstetric syndrome” and is a multisystem pathological condition, continues to be an urgent problem of modern obstetrics. It is preeclampsia that makes up a significant share in the structure of maternal and perinatal morbidity and mortality. Perinatal mortality in severe forms of preeclampsia is 18–30%, and perinatal morbidity is 64–78%.