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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.

Background: Type 2 diabetes mellitus (T2DM) is associated with increased mortality and morbidity, including cardiovascular diseases and obstructive sleep apnea (OSA). The aim of this study was to assess the associations between cardiovascular risk, chronic diabetes complications and the risk of OSA in adult patients with T2DM. Methods: The study included 529 patients with T2DM in whom moderate-to-severe OSA risk was assessed using the STOP-Bang questionnaire, dividing the subjects into two groups: group 1: STOP-Bang score

Non-alcoholic fatty liver disease (NAFLD) is associated with metabolic impairments, being a component of metabolic syndrome. Considering the involvement of fat accumulation and insulin resistance in NAFLD, triglyceride and glucose (TyG) index was proposed as a marker of NAFLD progression. The "gold standard" for the evaluation of liver lesions characteristic for NAFLD remains the liver biopsy. The aim of this study was to establish the links between TyG index, assessing insulin resistance, and histopathological lesions of liver samples obtained by liver biopsy in patients with metabolic syndrome.We conducted a study over a period of three years, including 113 adult patients with metabolic syndrome in whom hepatic disorders were assessed by liver biopsy and insulin resistance was evaluated by TyG index.In our study, steatosis had a frequency of 92.03%, being identified 26 cases with mild steatosis, 48 with moderate steatosis and 31 with severe steatosis. Regarding non-alcoholic steatohepatitis (NASH), the frequency of this disorder in our study group was 29.2% in the subjects with liver steatosis, while liver fibrosis had a frequency of 53.09%. When we analyzed the relationships between TyG index and the presence of each type of lesion necessary for NASH diagnosis, we obtained statistically significant differences for the presence of hepatocyte ballooning (p=0.01) and a high statistically significance for the NAFLD activity score (NAS) (p0.0001).TyG index is a facile tool that can be used to identify patients at risk for advanced NAFLD lesions evaluated by liver biopsy.

Major depressive disorder (MDD) is beyond doubt a common, disabling, and costly condition. MDD associates hypothalamic-pituitary-adrenal (HPA) axis alterations. We sought to investigate two candidate variants which could have a role in the genetic susceptibility for stress or corticoid-induced MDD: glucocorticoid receptor (GR) - nuclear receptor subfamily 3 group C member 1 (NR3C1) rs41423247 and brain-derived neurotrophic factor rs6265 BDNF:c.442GA Val66Met. We enrolled 82 Romanian subjects, 1:2 male to female ratio, 53.54±8.98 years old, diagnosed with an episode of major depression at the Clinical Neuropsychiatry Hospital in Craiova, Romania, and 286 healthy controls, 34.28±16.34 years old. All subjects were genotyped using specific ThermoFisher Scientific assays on a ViiA™ 7 real-time polymerase chain reaction (PCR) system. The impact of certain genetic variants may be ethnic-specific. In our Romanian cohort, rs41423247 NR3C1:c.1184+646CG has a minor allele frequency of 29.2%, and rs6265 BDNF:c.442GA of 22.2%. Neither reached significance in our study, under any of the association models - dominant, recessive, or allelic. Interpretation of our negative findings requires caution: literature provides arguably more evidence for the association between the analyzed polymorphisms; our study has sample size challenges, from which refined phenotyping limitations derive.

Non-alcoholic steatohepatitis (NASH) is a progressive form of liver steatosis that involves a risk of progression towards fibrosis, cirrhosis, and end-stage liver disease. Low-grade inflammation is recognized to be involved in non-alcoholic fatty liver disease (NAFLD) pathogeny. Additionally, adipose tissue dysfunction plays an important role in the development of metabolic diseases.We conducted a study on 68 patients with liver steatosis confirmed through liver biopsy during the surgery. In all the patients, we recorded anthropometric parameters and we performed blood tests for systemic inflammation [high-sensitivity C-reactive protein (hs-CRP), fibrinogen] and serum adipokines related to adipose tissue inflammation (leptin, adiponectin). Additional to histopathological examination, we also performed the immunohistochemical study of inflammatory mononuclear cells.The 68 patients had a mean age of 56.57±4.94 years old, had a mean value of hs-CRP of 2.30±0.91 mg∕L, a mean value of leptin of 14.02±17.02 ng∕mL and a mean value of adiponectin of 7.54±0.38 mg∕L. In all the cases studied by liver biopsy, the steatosis exceeded 5% of hepatocytes, but the frequency of NASH was 26.47%. Cluster of differentiation (CD)45-positive, CD4-positive, and CD8-positive T-lymphocytes predominated in the studied cases. We obtained a statistically significant high association between definite NASH and the values of hs-CRP, serum adiponectin and leptin∕adiponectin ratio (p0.0001).Systemic and adipose tissue inflammation was statistically significant associated with histological lesions of steatosis and NASH, suggesting that the determination of hs-CRP and serum adipokines in dynamics in patients with NAFLD is predictive for the progression of the disease.

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.

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.

Rheumatoid arthritis is a systemic inflamatory disease that affects primarily the synovial joints and it is associated with a progressive disability and a important socio-economic burden. [1] Although the main characteristic is the joint involvement, it is important to remember that RA is a disorder with systemic involvement mainly due to it�s chronic inflamation. Patients with RA have a higher risk of cardio-vascular mortality that in general population. There are numerous studies that sugest that inflamation plays a key�role in the develompent of aterosclerosis and heart disease, therefore a better understanding of the inflamatory response in RA may lead to better outcomes for patients with RA. Metabolic Syndrome is described as a congregate of major risk factors for cardiovascular diseases (CVD): Diabetes and raised fasting plasma glucose, abdominal obesity, high cholesterol and high blood presure[2]. The clustering of CVD risk factors that typifies the metabolic syndrome is now considered to be the driving force for a new CVD epidemic [3]. The conducted study aims to assess and evaluate the presence of metabolic syndrome (MetS) in RA patients. 120 patients with RA (89 women and 31 men) and 120 (85 women and 35 men) patients without RA were included in the study. The prevalence of MetS in RA patients was 39.16% and 22.5% for the control group. RA patients with MetS had significantly higher disease activity score of 28 joints index (DAS28-ESR) than patients without MetS ( 3.70 � 0.644 vs. 3.35 �0.725; p=0.006).

Chronic kidney disease (CKD) affects about 10-13% of the general population with a small proportion in the terminal renal disease stage requiring renal replacement therapy or renal transplantation. CKD is the new cause of mortality in the US. CKD�s prevalence increases with age. Diabetes mellitus is responsible for 50% of cases of chronic kidney disease being the most common cause.

Idiopathic short stature (ISS) deficiency reflects a major public health issue. In Romania the incidence is 1/3000 - 6000 births, with an increased prevalence in boys. ISS is the condition where the height of a subject is more than -2.5 DS below the height of the population for the population in which it is included, below the mean height for age and sex, but without any nutritional, systemic or chromosomal abnormalities. Significant for children with ISS is that weight is normal at birth and growth hormone levels are normal. This study shows the evolution of the height to normal values specific to the biological age, reaching the normal stature, according to auxological parameters, after growth hormone therapy.

Depression is a significant contributor to the overall burden of disease on a global scale. Thyroid hormones thyroxine (T4) and triiodothyronine (T3) have been shown to play a critical role in the development and normal function of the brain. It has been suggested that dysregulation of thyroid function could be associated with depression, especially hypothyroidism, but not all studies support this hypothesis. We enrolled a cohort of 96 subjects with major depressive disorder and tested TSH and FT4 levels for 80 of them in order to assess the status of the hypothalamic-pituitary-thyroid axis (HPT). We found 7 cases (8.75% of the tested) of subclinical hyperthyroidism and 1 case (1.25%) of overt hyperthyroidism. While we did not find supporting evidence for association between TSH and FT4 levels and depression, our findings question whether screening depressive patients for HPT axis anomalies could be clinically relevant, if anything, in a regional context.

Cardiovascular risk means the degree of risk for atherosclerotic cardiovascular pathology, predictable by quantifying the risk factors (RF) existing in each individual. Global cardio-metabolic risk is the overall risk of developing type 2 diabetes mellitus (T2DM) and/or CVD, including myocardial infarction (MI) and stroke, which is due to a bundle of risk factors. The cardio-metabolic risk is based on the concept of continuous risk. The importance of cardiovascular / cardio-metabolic risk is particular because controlling its components may affect atherogenesis and its clinical consequences: chronic ischemic heart disease, cerebrovascular disease and peripheral arteriopathy, but also diabetes mellitus (DM). Currently there is no method to use all the known risk cardio-metabolic factors to quantify cardiovascular risk or diabetes risk.

The importance of cardiovascular/cardiometabolic risk is a special one, because it may influence atherogenesis and its clinical consequences: ischemic heart disease, cerebrovascular disease, peripheral artery disease, but also diabetes mellitus (DM). To evaluate the cardiometabolic risk associated with visceral obesity, a useful indicator for the clinical practice was searched. The visceral adiposity index (VAI) could become an easy-to-use tool to evaluate the cardiometabolic risk in everyday practice. VAI indicates the function of visceral adipose tissue and its growth is independently correlated with cardiovascular and cerebrovascular risk. The medical world tried to identify an easy way to assess cardiovascular risk, so the visceral adiposity index was introduced, whose formula includes a number of cardiovascular risk factors.

Introduction. The patients with cardiometabolic/ cardiovascular risk are commonly found in clinics and ambulatory clinics. The cardiovascular (CV) or cardiometabolic (CM) risk factors and biomarkers are certain characteristics of the person without CV disease, which are independently correlated with the subsequent occurrence of CV disease, without necessarily having a causal relationship between factor and disease. The visceral adiposity index (VAI) indicates the function of visceral adipose tissue and its growth is independently correlated with cardiovascular and cerebrovascular risk. The objective of the study was to evaluate the lifestyle and visceral adiposity index as possible cardiometabolic risk factors in patients with diabetes, prediabetes, and in the general population. Methods. The study was epidemiological, transversal, noninterventional, and was performed by analyzing 300 subjects, divided into three groups: group 1 (100 patients with type 2 diabetes), group 2 (100 pre-diabetic patients), and group 3 (control) consisting of 100 individuals randomly recruited without diabetes. Results. The accumulation of cardiovascular risk factors results is an increased risk of cardiovascular disease. We found statistically significant differences between the three groups in terms of BMI, CT, VAI, CT, HDL-c and LDL-c values, which were higher in patients with diabetes mellitus (DM) than in prediabetics or in the general population, which also coincided with higher cardiovascular risk in these patients. Conclusions. We emphasize the importance of both early cardiovascular risk assessment and the importance of controlling cardiovascular risk factors, both by non-pharmacological methods, and by associating early drug therapy when necessary.

Metabolic syndrome (MS) is defined as a complex entity that involves the accumulation of cardiovascular and metabolic risk factors represented by: abdominal obesity, insulin resistance, hypertension, dyslipidemia [1]. The presence of MS correlates with the risk of cardiovascular disease in people without diabetes mellitus (DM), as well as those with type 2 DM [2-8].Visceral adipose tissue is an active metabolic organ and abdominal obesity is an independent risk factor for metabolic disorder present in MS [9,10,11], associated with the development of cardiovascular disease and type 2 diabetes in children, adolescents and adults [12-15]. Our findings have shown an association of visceral adiposity index (VAI) with MS in both men and women with prediabetes and diabetes, these findings allow us to conclude that VAI is a simple but effective indicator for estimating the presence of MS among adults.

Thyroid cancer is the most frequent endocrine neoplasia. The incidence of the disease has been increasing in the past few decades in many regions, especially where the population was subject to some forms of accidental exposure. Among all the histopathological forms, papillary thyroid cancer (PTC) is the most common histological subtype of malignant thyroid tumor, representing about 80-90% of all malignant thyroid tumors. Although it is generally accepted that tumor stroma plays an essential role in the development and metastasis of tumor cells, histopathological studies focused on tumor cells characteristics. In this study, we evaluated the characteristics of tumor stroma histopathologically and immunohistochemically examining a total of 18 cases of papillary thyroid carcinomas, of which 18 cases were classic papillary carcinomas, 11 cases papillary carcinomas, follicular forms, five cases were papillary carcinomas - formed with tall-cells, three cases of papillary carcinomas, solid variants and one case was interpreted as an oncocytic variant. Most papillary carcinomas have been typically characterized by the presence of neoplastic papillae, composed of a central axis of fibro-vascular, branched, and coated by one or more layers of cubic or prismatic epithelial cells. In three typical papillary carcinomas, the stroma was composed of coarse connective axes rich in collagen fibers. The predominantly fibrous stroma, consisting of connective septum was observed in four cases, while in one case of papillary carcinoma, solid variant, we have identified a hyaline stroma; in one case was revealed a myxoid stroma. Diffuse stromal calcifications have been identified in two cases only. In the tumoral stroma, there were identified inflammatory infiltrates in nine cases, formed mostly of lymphocytes, and in one case, there was observed the presence of aggregated lymphoid nodules. The immunostaining with anti-CD34 antibody showed that in papillary thyroid carcinomas there is a well-represented vascularity, mostly made of small vessels (arterioles, venules, capillaries) with diameters between 7 and 50 μm, and immunostaining with anti-vimentin and anti-α-SMA antibody showed an increased number of fibroblasts, respectively myofibroblasts in the tumoral stroma. We believe that in the same thyroid tumor there are several clones of neoplastic cells that reshape the stroma, giving it certain histopathological characteristics.