Search

Oana Albai,1– 3 Adina Braha,1,2 Bogdan Timar,1– 3 Alexandra Sima,1– 3 Loredana Deaconu,1 Romulus Timar1– 3 1Department of Second Internal Medicine- Diabetes, Nutrition, Metabolic Diseases, and Systemic Rheumatology, ”victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania; 2Department of Diabetes, Nutrition and Metabolic Diseases Clinic, ”Pius Brînzeu” Emergency Clinical County University Hospital, Timisoara, 300723, Romania; 3Centre for Molecular Research in Nephrology and Vascular Disease/MOL-NEPHRO-VASC, ”Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, RomaniaCorrespondence: Adina Braha, Department of Second Internal Medicine- Diabetes, Nutrition, Metabolic Diseases, and Systemic Rheumatology, Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, Timisoara, 300041, Romania, Email braha.adina@umft.roPurpose: Patients with diabetes mellitus (DM) are more susceptible to viral and bacterial infections, facing a more severe prognosis and higher mortality rates. The study’s main aim was to evaluate the survival and mortality rates of patients with type 2 diabetes (T2DM) and SARS-CoV-2 virus infection alongside the main factors influencing the prognosis.Patients and Methods: The present study included 186 patients with T2DM and SARS-CoV-2 virus infection admitted to the COVID-19 Department of the “Pius Brînzeu” Emergency Clinical County University Hospital between November 2020 and March 2021. Patients had investigations performed upon arrival in the emergency room and during hospitalization. We analyzed the risk of negative prognosis based on clinical data (oxygen saturation (SatO2), respiratory rate (RR), lung damage), glycemic control (HbA1c, glycemia at hospital admission), and the duration of T2DM.Results: The mortality rate in the studied group was 36.6%. All deceased patients had previously been diagnosed with hypertension; 95.58% had a body mass index (BMI) greater than 25 kg/m2, and 79.41% presented with cardiovascular disease (CVD). Compared to those who recovered, statistically significant differences were observed in BMI, glycemic levels at admission, glycosylated hemoglobin levels (HbA1c), SatO2, RR, and lung damage. Valid statistically significant predictors for death in T2DM patients with COVID-19 were hyperglycemia at admission > 198mg/dl, HbA1c> 8.6%, and SatO2≤ 87%.Conclusion: SatO2, glycemia at hospital admission, and HbA1c had the highest sensitivity and specificity to predict the prognosis of T2DM patients with SARS-CoV-2 infection. Glycemic control is essential in the prognosis of patients with DM and COVID-19 infection. The prognosis was worse if other comorbidities were associated, especially hypertension and CVD.Keywords: SARS-CoV-2 infection, type 2 diabetes mellitus, negative prognostic factors, mortality rate

Adriana Gherbon,1– 3 Mirela Frandes,4 Marioara Nicula-Neagu,5 Romulus Timar,1– 3 Bogdan Timar1– 3 1Department VII Internal Medicine - Diabetes, Nutrition, Metabolic Diseases and Systemic Rheumatology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 2Centre of Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 3Department of Diabetes, Nutrition, and Metabolic Diseases, “Pius Brinzeu” Emergency Hospital, Timisoara, Romania; 4Department of Functional Sciences - Biostatistics and Medical Informatics, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 5Banat’s University of Agricultural Sciences and Veterinary Medicine “King Michael I of Romania”, Timisoara, RomaniaCorrespondence: Mirela Frandes, Department of Functional Sciences - Biostatistics and Medical Informatics, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq, Timisoara, 300041, Romania, Email mirela.frandes@umft.roIntroduction: The COVID-19 lockdown influenced the glycemic control and other metabolic parameters in people with type 1 and 2 diabetes mellitus.Objective: To study the effects of COVID-19 lockdown on glycemic control in people with type 2 diabetes mellitus (T2DM).Material and Methods: Our study group included 120 Romanian people with T2DM from both urban and rural areas. We employed a structured questionnaire with multiple-choice to collect data about DM management during lockdown, the interaction with their diabetologist, the access to treatment, and what other factors influenced their DM management during the lockdown.Results: We did not observe an increase of numbers of hyper or hypoglycemia during the restriction period in people with T2DM. The number of glycemic imbalances was higher in people treated with insulin than those with oral antidiabetics (OAD) (p=0.003, X2=8.91). Regarding the causes of imbalances, we did not obtain a significant difference during the restriction period, neither between patients following treatment with insulin nor with OAD. On the contrary, we observed that only 26.7% of people with T2DM managed to maintain their weight or lost weight vs 73.3% patients who gained several extra kg (p< 0.001, X2=52.26).Conclusion: The findings of this study have demonstrated that in people with T2DM, the COVID-19 lockdown determines better glycemic control among patients treated with OAD compared to those treated with insulin therapy. Anxiety, stress, and emotions were the main reasons that led to the increase in glycemic values of these patients. Also, most patients have gained weight either due to lack of physical activity or due to stress.Keywords: type 2 diabetes, COVID-19, lockdown, diabetes management, body mass index

Adriana Gherbon,1,2 Mirela Frandes,3 Romulus Timar,1,2 Bogdan Timar1,2 1Second Department of Internal Medicine - Diabetes, Nutrition and Metabolic Diseases, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 2Department of Diabetes and Metabolic Diseases, “Pius Brinzeu” Emergency Hospital, Timisoara, Romania; 3Department of Functional Sciences - Medical Informatics and Biostatistics, “Victor Babes” University of Medicine and Pharmacy, Timisoara, RomaniaCorrespondence: Mirela Frandes, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq, Timisoara, 300041, Romania, Tel +40 731 117 020, Email mirela.frandes@umft.roIntroduction: The COVID-19 pandemic has brought major changes not only at the economic and social level but especially in the medical system.Objective: To evaluate the impact of COVID-19 lockdown on the quality of glycemic control in Romanian patients with type 1 diabetes mellitus (T1DM).Material and Method: Our study group included 102 Romanian volunteers’ patients with T1DM from both urban and rural areas. Data were collected during an interview, based on a structured questionnaire with multiple-choice questions about diabetes management during lockdown, how they interact with their diabetologist, how they accessed the treatment and what other factors influenced their diabetes management during the lockdown.Results: Blood glucose levels were significantly higher in the MDII group as a consequence of delayed administration of insulin corrections due to inadequate insulin dosing (60% vs 31.81%; χ2 = 5.51, p = 0.018). In addition, insulin pump users had improved response to stress and anxiety (ie, additional therapeutic safety being provided by use of insulin pump; in some devices, blood glucose being continuously monitored, leading to premature detection of important blood glucose excursions) compared to insulin pen users (χ2 = 5.09, p = 0.024). In the context of hypoglycemia, we observed that in the pen MDII group, more users have administered an excess of insulin, compared with the pump users (80% vs 45.45%; χ2 = 10.34; p = 0.001).Conclusion: A lower impact of COVID-19 lockdown on glycemic control was observed in patients with T1DM treated using insulin pumps compared to patients with T1DM who administered their insulin using insulin pens. Telemedicine and online consultations have brought significant improvements in diseases management. Stress, emotions, and anxiety were among the main reasons that led to increases in blood sugar levels, suggesting that the psychological impact may have long-term complications.Keywords: COVID-19, lockdown, type 1 diabetes mellitus, insulin pumps, diabetes management

Oana Albai,1 Mirela Frandes,2 Romulus Timar,1 Bogdan Timar,1 Teodora Anghel,3 Vlad Florian Avram,1 Alexandra Sima1 1Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 2Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 3Department of Neuroscience, “Victor Babes” University of Medicine and Pharmacy, Timisoara, RomaniaCorrespondence: Mirela FrandesDepartment of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu, Timisoara, 300041, RomaniaTel +40-731117020Fax +40-256462856Email mirela.frandes@umft.roBackground: Diabetes mellitus (DM) is one of the most serious public health problems, involving increasing costs worldwide. The mental state of a person with DM is varied and ever-changing, such as stress, the pressure to always do everything by the book, sadness, anger, and even denial of the disease, all these are feelings patients with DM will experience throughout their life.Aim: The aim of our study was to assess the presence of mental and psychiatric disorders (anxiety, depressive states, paranoid ideation, phobia, obsessive-compulsive disorder) in a group of patients with DM after hospitalization in the Clinic for Diabetes, Nutrition, and Metabolic Diseases, for various exacerbations of the underlying condition, looking for possible correlations with other cardiovascular risk factors.Patients and Methods: Clinical and biological parameters, the presence of acute and chronic complications of the diabetic patients have been evaluated. To assess mental health, the symptom checklist (SCL)-90 questionnaire was conducted for all admitted patients.Results: We observed that the number of patients with obsessive-compulsive disorders was relatively high (23.3%), while depression was present in 17.1% of the patients. Also, 10.6% of patients had hostility and 15.6% had delusional ideation. The presence of psychiatric disorders was associated with a higher age (62 vs. 46.5 years; p < 0.001), a longer diabetes duration (11 vs. 9 years; p < 0.001), higher fasting glycemia (188 vs. 132 mg/dL; p < 0.001) and postprandial glycemia (212 vs. 152 mg/dL; p < 0.001), and triglycerides (125 vs. 110 mg/dL; p < 0.001). Patients with altered mental status have shown statistically significantly more altered clinical and biological parameters compared to those without these mental disorders.Conclusion: Patients with DM represent a psychologically vulnerable population, which is why they should undergo early and regular screening for both psychological and psychiatric conditions, especially at admission.Keywords: mental disorders, cardiovascular risk, cardiovascular risk factors, insulin-resistance, compliance, adherence to treatment

Oana Albai,1,2 Bogdan Timar,2,3 Diana Loreta Paun,4 Alexandra Sima,1,2 Deiana Roman,1,2 Romulus Timar1,2 1Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 2Department of Diabetes and Metabolic Diseases, “Pius Brinzeu” Emergency Hospital, Timisoara, Romania; 3Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 4Department of Public Health, Associate Professor in the Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, Bucuresti, RomaniaCorrespondence: Bogdan Timar“Victor Babes“ University of Medicine and Pharmacy, 2 Eftimie Murgu, Timisoara 300041, RomaniaTel +40741528093Email timar.bogdan@umft.roIntroduction: Vitamin B12 (cobalamin) deficiency is a frequent cause of megaloblastic anemia, manifested through various symptoms. Screening for this deficiency can be justified in case of patients with one or more risk factors present from the following: gastric resections, inflammatory bowel disease, use of metformin over a prolonged period of time, administration of proton pump inhibitors or H2 histamine receptor blockers for more than 12 months and in case of adults over 75 years of age. One method of determining vitamin B12 deficiency is measuring its serum levels, as well as performing measurements of serum levels of methylmalonic acid and homocysteine levels, which experience an increase in the early stages of vitamin B12 deficiency.Clinical Case: We bring to your attention, the case of a 62 years old patient diagnosed with Type 2 Diabetes Mellitus in 2015 that presented in the emergency room in October 2019 with an altered general condition, nausea, vomiting, abdominal pain, palpitation, and dyspnea. Treatment with metformin was initiated from the diagnosis of Type 2 Diabetes Mellitus, four years before. Investigations established the diagnosis of megaloblastic anemia by vitamin B12 deficiency. The symptoms disappeared after the injection of vitamin B12.Conclusion: Periodical dosing of vitamin B12 should be performed in the case of patients with Type 2 Diabetes Mellitus treated with metformin, especially if they associate anemia and/or peripheral diabetic polyneuropathy.Keywords: megaloblastic anemia, metformin, vitamin B12 deficiency

Oana Albai,1,2 Mirela Frandes,3 Bogdan Timar,2,3 Diana-Loreta Paun,4 Deiana Roman,1 Romulus Timar1,2 1Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 2Department of Diabetes and Metabolic Diseases, “Pius Brinzeu” Emergency Hospital, Timisoara, Romania; 3Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 4Department of Public Health, Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, Bucuresti, RomaniaCorrespondence: Mirela FrandesDepartment of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu, Timisoara 300041, RomaniaTel +40 731117020Fax +40 256462856Email mirela.frandes@umft.roBackground: In developing countries, cancer incidence has progressively increased, becoming the second cause of mortality after cardiovascular diseases. Type 2 diabetes mellitus (T2DM) is associated with an increased risk of malignant neoplastic disorders, especially pancreatic cancer, colorectal cancer, and breast cancer.Aim: The main aim of our study was to establish the prevalence of malignant neoplastic disorders in patients previously diagnosed with T2DM. Also, we have investigated the association between the components of the metabolic syndrome (MetS) and the different types of diagnosed malignant neoplasms.Methods: We performed a retrospective, population-based cohort study of 1,027 patients with T2DM from the Center for Diabetes Treatment of the “Pius Brînzeu” Emergency Hospital in Timisoara, Romania. The patients were followed up every three or six months, depending on their antidiabetic treatment. The patients who developed malignant neoplasms were registered and referred to oncology centers. The potential risk factors for malignancies in patients with T2DM were evaluated using logistic regression adjusting for possible confounders.Results: The prevalence of malignant neoplastic disorders in our study group was 7.1%; more precisely, we found 2.2% colon neoplasm, 2.9% mammary neoplasm, 0.7% lymphomas, 0.6% pulmonary neoplasm, 0.3% pancreatic neoplasm, and 0.4% prostate neoplasm. The presence of malignant neoplastic disorders was associated in our cohort of patients with T2DM with higher cholesterol (237.71± 47.82 vs 202.52± 52.16 mg/dL; p=0.005) and triglycerides levels (215.91± 52.41 vs 180.75± 54.32 mg/dL; p< 0.001), as well as higher body mass index (33.37± 3.87 vs 28.42± 3.56 kg/m2; p< 0.001) and abdominal circumference (110.11± 14.48 vs 98.12± 15.73 cm; p< 0.001). Also, we found that insulin-based treatment was an independent risk factor, the patients presenting ten times higher odds of developing malignant neoplastic disorders.Conclusion: The prevalence of malignant neoplastic disorders in our study group was 7.1%. Also, the prevalence of malignant neoplastic disorders was higher in patients with T2DM and MetS as compared to the general population of T2DM patients.Keywords: malignant neoplastic disorders, type 2 diabetes mellitus, hyperinsulinemia, metabolic syndrome, insulin resistance

Adina Braha,1 Bogdan Timar,2 Laura Diaconu,3 Raluca Lupusoru,1,4 Lucian Vasiluta,3 Alexandra Sima,3 Adrian Vlad,3 Mircea Munteanu,3 Alin Albai,3 Daniela Cipu,5 Romulus Timar3 1First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 2Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 3Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 4Department of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 5Department of Orthopedics-Traumatology, Urology and Medical Imaging, “Victor Babes” University of Medicine and Pharmacy, Timisoara, RomaniaCorrespondence: Bogdan TimarDepartment of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu, Timisoara 300041, RomaniaTel +40 741 528 093Fax +40 256 462 856Email timar.bogdan@umft.roPurpose: The aim of this study was to assess the dynamics of epicardiac adipose tissue (EAT) thickness and total volume as well as that of systolic and diastolic dysfunction in a group of patients with type 2 diabetes (T2D) after initiation of sodium glucose co-transporter 2 (SGLT 2) inhibitors therapy.Patients and methods: This prospective, observational study included 53 patients with T2D who received SGLT-2 inhibitors for 24 weeks. In all patients, echocardiographic screening for EAT, systolic and diastolic dysfunction and non-contrast computed tomography scans were performed, both before and after 24 weeks of SGLT-2 inhibition. Imagistic evaluation was followed by the association’s analysis between the dynamics of EAT and heart function, as well as the patient’s clinical and biological parameters. We considered a decrease or increase of more than 10% in EAT as being clinically significant.Results: The mean volume of EAT decreased significantly after SGLT 2 inhibition (37.8±17.2 vs. 20.7±7 cm3; p

Laura Gaita,1 Romulus Timar,1,2 Nicoleta Lupascu,1 Deiana Roman,1 Alin Albai,1,2 Ovidiu Potre,3,4 Bogdan Timar2,5 1Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 2Department of Diabetes and Metabolic Diseases, “Pius Brinzeu” Emergency Hospital, Timisoara, Romania; 3First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 4Department of Hematology, Municipal Emergency Hospital, Timisoara, Romania; 5Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timisoara, RomaniaCorrespondence: Romulus TimarSecond Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu, Timisoara 300041, RomaniaTel +4 0748 331 294Email timar.romulus@umft.roPurpose: Hyperuricemia (HUA) is linked to a variety of non-communicable diseases such as atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD) and hypertension, with evidence showing its role in the development of diabetes mellitus (DM). Our study’s main aim was to explore the associations of HUA with other traditional risk factors in Romanian patients with DM and to assess the impact of the increase of serum UA on DM complications and HbA1c.Patients and methods: In this cross-sectional, non-interventional study, we enrolled, according to a population-based, consecutive-case principle, 133 patients previously diagnosed with DM. HbA1c, uric acid, lipid profile, urinary albumin/creatinine ratio, glomerular filtration rate, TSH and FT4 measurements were performed, while the diagnosis of retinopathy and of diabetic neuropathy was established using standardized methods.Results: An increased uric acid level was associated with a significant increase in the risk for development of stroke (OR=1.526; p=0.004). A weak, positive and statistically significant correlation can also be observed between the BMI and the presence of hyperuricemia (r=0.131; p=0.034), and between the triglyceride levels and hyperuricemia (r= 0.173; p=0.004). Glomerular filtration rate was correlated to hyperuricemia in a strong and negative manner, having an important statistical significance (r=−0.818; p=0.003). In our study, UA levels and HbA1c were negatively correlated, without reaching statistical significance.Conclusion: Serum UA is strongly correlated with the BMI, triglyceride level and GFR in Romanian patients with DM and HUA is significantly associated with a higher risk of stroke in these individuals.Keywords: uric acid, diabetes mellitus, metabolic syndrome, chronic diseases

Nicoleta Lupascu,1 Bogdan Timar,2,3 Alin Albai,1,3 Deiana Roman,1 Ovidiu Potre,4,5 Romulus Timar1,31Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 2Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 3Department of Diabetes and Metabolic Diseases, “Pius Brinzeu” Emergency Hospital, Timisoara, Romania; 4First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 5Department of Hematology, Municipal Emergency Hospital, Timisoara, RomaniaPurpose: To validate and to evaluate the performance in depression screening of the Patient’s Health Questionnaire – 9 (PHQ-9) for Romanian patients with Type 2 Diabetes Mellitus (T2DM).Patients and methods: In a consecutive-case, population-based, non-interventional study design 107 hospitalized patients with T2DM were enrolled. The PHQ-9 was evaluated in regard to its acceptability, ceiling and floor effect, reproducibility, and test–retest performance. Its validity was tested by comparing it to the Beck depression scale, which is a validated tool for this patient population.Results: The PHQ-9 questionnaire had an excellent acceptability, having no non-responders for any of its questions and a median completion time of 3 mins and 12 s, a good reliability with a Cronbach’s α=0.897 [0.865–0.924] 95%CI, a good test–retest performance (Spearman’s rho =0.972; p

Oana Albai,1 Mirela Frandes,2 Romulus Timar,1 Deiana Roman,3 Bogdan Timar2 1Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 2Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 3Municipal Clinical Emergency Hospital, Timisoara, Romania Background: Dementia and cognitive dysfunction have many causes. There is strong evidence that diabetes mellitus (DM) increases the risk of cognitive impairment and dementia. Optimal glycemic control, identification of diabetic risk factors, and prophylactic approach are essential in the prevention of cognitive complications.Aims: The main purpose of this study was to establish the cognitive impairment in DM patients, cared for in the Diabetes Center from Timisoara. Also, we investigated the prevalence of dementia in our group as well as the risk factors involved in the progression of mild cognitive impairment (MCI) to dementia.Patients and methods: We considered a sample of 207 type 2 DM (T2DM) patients, aged between 33 and 81 years, mean 57.49 (±11.37) years. We established the diagnosis of dementia based on the Mini-Mental State Examination (MMSE) test, as well as on the psychological testing, psychiatric and neurological investigations, and imaging tests (computerized tomography and MRI).Results: A percentage of 42.03% of patients presented MCI, mean age 63 (57.00–71.00) years, being older than patients without MCI, mean age 52.00 (45.00–61.00) years, P

Monica Licker,1,2 Teodora Sorescu,3,4 Maria Rus,5,6 Natalia Cirlea,6 Florin Horhat,1 Cristiana Jurescu,5,6 Mircea Botoca,7,8 Alin Cumpănas,7,8 Romulus Timar,3,4 Delia Muntean1,2 1Department of Microbiology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 2Clinical Laboratory, “Pius Brînzeu” Emergency Clinical County Hospital, Timisoara, Romania; 3Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 4Diabetes Clinic, “Pius Brînzeu” Emergency Clinical County Hospital, Timisoara, Romania; 5“Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 6“Pius Brînzeu” Emergency Clinical County Hospital, Timisoara, Romania; 7Department of Orthopaedics – Traumatology, Urology and Medical Imaging, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 8Urology Unit, “Pius Brînzeu” Emergency Clinical County Hospital, Timisoara, Romania Purpose: We report an outbreak of urinary tract infections (UTIs) caused by Myroides odoratimimus, which occurred in the largest clinical hospital in western Romania. Patients and methods: From June to August 2017, four strains of M. odoratimimus were isolated from the urine samples of patients hospitalized in the urology, diabetes, and surgery departments. Hospital records of all patients whose urine cultures were positive for M. ­odoratimimus were reviewed retrospectively. We also reviewed the cases reported in the literature. Results: All UTIs, except one, were hospital-acquired infections. All patients with M. odoratimimus UTIs were immunocompromised. Three patients underwent urinary catheterization with a Foley’s catheter upon admission in the emergency department and one presented for replacement of ureterostomy tubes. All Myroides isolates were resistant to almost all the tested antibiotics. Two patients were successfully treated with tigecycline and one was receiving antimicrobial treatment for another infection at the time of isolation of the microorganism. Conclusion: Although M. odoratimimus is an uncommon pathogen, clinicians should be aware of its ability to cause UTI outbreaks, especially in the immunocompromised population. Due to its multi-drug resistance, it is important to rapidly identify Myroides spp. in order to choose the best treatment regimen. Keywords: Myroides odoratimimus, urinary tract infection, resistance, outbreak

Teodora Chiţă,1,2 Bogdan Timar,1,2 Delia Muntean,1,2 Luminiţa Bădiţoiu,1,3 Florin Horhat,1,2 Elena Hogea,1 Roxana Moldovan,1,3 Romulus Timar,1,2 Monica Licker1,2 1Victor Babes University of Medicine and Pharmacy Timisoara, 2Pius Brinzeu Emergency Hospital, 3Regional Centre of Public Health, Timisoara, Romania Aim: Patients with diabetes mellitus (DM) have an increased risk of infections, especially urinary tract infections (UTIs). The aim of this study was to assess the prevalence and etiology of UTIs and identify the risk factors for their development in patients with DM. Patients and methods: In this retrospective, noninterventional study, the medical records of 2,465 adult patients with DM who were hospitalized in a Diabetes Clinic were reviewed. Data regarding the presence of UTI and possible associated risk factors were collected and their possible relation was analyzed. The study protocol and procedures were approved by the Ethics Committee of Timişoara Emergency Hospital. All data were collected and analyzed using SPSS v.17 statistical software. Results: The prevalence of UTIs in patients with DM was 12.0% (297 cases), being higher in females than in males and higher in patients with type 2 DM compared with patients with type 1 DM. In univariate logistic regression analysis, risk factors associated with UTIs were female gender, age, type 2 DM, longer duration of DM, and the presence of chronic kidney disease and coronary artery disease. Multivariate analysis identified age, duration of DM, and metabolic control (hemoglobin A1c levels) as independent risk factors for UTIs. The gram-negative bacilli from the Enterobacteriaceae family were predominant, with Escherichia coli being the most frequent of them (70.4%). Conclusion: UTIs are a frequent condition associated with DM. It is necessary to improve the care and the screening of UTIs in patients with DM to prevent the occurrence of possible associated severe renal complications. Keywords: urinary tract infections, diabetes mellitus, epidemiology, incidence

Romulus Timar,1 Iulian Velea,2 Bogdan Timar,3 Diana Lungeanu,3 Cristian Oancea,4 Deiana Roman,5 Octavian Mazilu6 1Second Department of Internal Medicine, 2Department of Pediatrics, 3Department of Functional Sciences, 4Department of Infectious Diseases, 5Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy, 6First Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania Purpose: To evaluate the impact of several factors on the patient’s perception on quality of life in a group of patients with type 2 diabetes mellitus (T2DM).Patients and methods: In this cross-sectional study, 198 patients with T2DM were enrolled according to a consecutive-case population-based study design. In all participants, the perception on the quality of life was measured using the quality of life index – diabetes version III proposed by Ferrans and Powers. We evaluated the impact of several anthropometric and diabetes-related (ie, diabetes history and quality of glycemic control) factors on the patient’s perception on the quality of life.Results: The presence of diabetes complications was associated with a decreased quality of life: retinopathy (1 vs 5 points; P

Bogdan Timar,1 Romulus Timar,2 Adalbert Schiller,2 Cristian Oancea,3 Deiana Roman,1 Mihaela Vlad,2 Bogdan Balinisteanu,4 Octavian Mazilu5 1Department of Functional Sciences, 2Second Department of Internal Medicine, 3Department of Infectious Diseases, 4Department of Microscopic Morphology, 5First Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania Purpose: The purpose of this study was to evaluate the impact of the presence and severity of neuropathy and depression on the patient’s adherence to diabetes-related self-care activities (DRSCA) in a cohort of patients with type 2 diabetes mellitus (T2DM).Patients and methods: In this cross-sectional, noninterventional study, 198 patients with T2DM were enrolled according to a population-based, consecutive-case enrollment principle. In all patients, the adherence to DRSCA was evaluated using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire; a higher SDSCA score is associated with a better adherence. The presence and severity of neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI) and the severity of depression using the Patient Health Questionnaire-9 (PHQ-9).Results: The presence of neuropathy was associated with a decreased SDSCA score (26 points vs 37 points; P

Gabriela Mut-Vitcu,1 Bogdan Timar,2 Romulus Timar,1 Cristian Oancea,3 Ioan Cosmin Citu4 1Second Department of Internal Medicine, 2Department of Functional Sciences, 3Department of Infectious Diseases, 4Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania Purpose: To evaluate the prevalence of depression and its impact on the quality of diabetes-related self-care activities in elderly patients with type 2 diabetes. Patients and methods: In this cross-sectional study, 184 patients with type 2 diabetes were enrolled. Depression was evaluated using Patient Health Questionnaire-9 while the quality of diabetes-related self-care activities was assessed using the Summary of Diabetes-Related Self Care Activities Questionnaire. Results: In our study group, 53.3% of the patients had moderate depression, 17.9% had severe depression, and 28.8% had no depression symptoms. Patient’s age (P=0.024), presence of diabetic neuropathy (P

Simona Popescu,1,2 Bogdan Timar,2,3 Flavia Baderca,4,5 Mihaela Simu,6,7 Laura Diaconu,1,2 Iulian Velea,8,9 Romulus Timar1,2 12nd Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 2Clinic of Diabetes, Nutrition and Metabolic Diseases, Emergency Clinical County Hospital, 3Department of Functional Sciences, 4Department of Microscopic Morphology, “Victor Babes” University of Medicine and Pharmacy, 5Service of Pathology, Emergency City Hospital, 6Department of Neurosciences, “Victor Babes” University of Medicine and Pharmacy, 7Clinic of Neurology, Emergency Clinical County Hospital, 8Department of Pediatrics, “Victor Babes” University of Medicine and Pharmacy, 9Clinic of Pediatrics, Emergency Clinical County Hospital, Timisoara, Romania Abstract: Population aging is unprecedented, without parallel in the history of humanity. As type 2 diabetes mellitus is predominantly more prevalent in aging populations, this creates a major public health burden. Older adults with diabetes have the highest rates of major lower-extremity amputation, myocardial infarction, visual impairment, and end-stage renal disease of any age group. The aims of our study were to assess whether age is an independent factor for the occurrence of diabetic neuropathy (DN), and to evaluate the relationship between the presence and the severity of DN and the diabetes duration and blood glucose level. In this study, we enrolled 198 patients, previously diagnosed with type 2 diabetes mellitus. For all patients, we measured hemoglobin A1c (HbA1c), lipid profile, and body mass index and we assessed the presence and severity of DN using the evaluation of clinical signs and symptoms. Patients had a median age of 62 years, with a median of diabetes duration of 7 years; 55.1% of the patients were men and the average HbA1c in the cohort was 8.2%. The prevalence of DN according to Michigan Neuropathy Screening Instrument was 28.8%, being significantly and positively correlated with higher age (65 vs 59 years; P=0.001) and HbA1c (8.6% vs 8.0%; P=0.027). No significant correlations were observed between the severity of DN and diabetes duration, body mass index (31.9 vs 29.9 kg/m2), or the number of centimeters exceeding the normal waist circumference (25.2 vs 17.3 cm; P=0.003). In conclusion, age influences the presence of DN, independent on other risk factors. This influence persists even after adjusting for other, very important risk factors, like blood glucose level or diabetes duration. Keywords: peripheral neuropathy, elderly patients, type 2 diabetes mellitus, body mass index, hemoglobin A1c, diabetic neuropathy

Metformin, a biguanide, remains the most widely used first-line type 2 diabetes drug. It is generally considered weight-neutral with chronic use and does not increase the risk of hypoglycaemia. Most patients eventually require more than one antihyperglycemic agent to achieve target blood glucose levels. The primary objective of this non-interventional study was to describe and compare the main criteria used by physicians from regular outpatient setting in selecting the add-on therapy in patients with inadequately metformincontrolled type 2 diabetes in 2 time points at 1-year distance by assessment of patient, and/or agent characteristics and/or physician decision. At the end of phase one of the study, the mean duration of type 2 diabetes was 6.8 years. The majority of patients included in the study were overweight (32%) and obese (62%), and presented diabetes complications (59.6%). In 50% of the cases, the major reason for selecting the second-line therapy was related to patient characteristics, while agent characteristics and physician decision were the main categories in 38% and 12%, respectively. Importance to achieve glycemic control and estimated treatment efficacy were selected in 73.9% and 82.4% of patients, calculated as percentage in the respective categories. [ABSTRACT FROM AUTHOR]

Context. Nonalcoholic fatty liver disease is common in type 2 diabetes mellitus patients, being difficult to diagnose. Objective. To find a correlation between elastographic parameters and lab results, for facilitating the diagnosis of nonalcoholic fatty liver disease. Design. This is a cross sectional study, conducted at the Departments of Diabetes, Nutrition and Metabolic Diseases, and Gastroenterology and Hepatology, of the Clinical Emergency Hospital "Pius Brinzeu" Timisoara. Subjects and Methods. We included 190 type 2 diabetes mellitus patients, collected data regarding medical history, clinical and biological features and applied the Alcohol Use Disorders Identification Test. We excluded patients with other causes of liver disease. Liver steatosis and fibrosis were evaluated through transient elastography, yielding two parameters: liver stiffness as an indicator of liver fibrosis stage, expressed in kPa, and liver steatosis stage, assessed by controlled attenuation parameter, expressed in dB/m. Data were analyzed using SPSS 15. Results. The analyzed group comprised 113 patients. Elastographic measurements showed that 93.8% of the patients had steatosis (controlled attenuation parameter =232.5 dB/m) and 70.8% severe steatosis (controlled attenuation parameter =290 dB/m). Severe steatosis was more common in women (75.7%) than in men (68.1%) (p<0.0001). From the patients with steatosis, 47.2% had liver stiffness values suggestive for fibrosis and 19.8% for cirrhosis. Most patients with steatosis and severe fibrosis were obese (66.7%). Triglycerides/HDLc ratio >4 correlated with hepatic steatosis (p=0.04), being more common in patients with severe fibrosis/cirrhosis (58.3%) than in those with absent or mild fibrosis (36.2%). Conclusions. Our study found a clear correlation between type 2 diabetes mellitus and the presence of liver steatosis. It correlates with body mass index, waist circumference (in men) and triglycerides/HDLc ratio. Controlled attenuation parameter is a useful noninvasive method for detection and quantification of liver steatosis. [ABSTRACT FROM AUTHOR]

Hypoglycemia from a non-insulin-secreting extrapancreatic tumor is a paraneoplastic syndrome characterized by the tumor production of a substance with an insulin-like effect (insulin-like growth factor 1 or 2 - IGF 1 or 2). Diagnosis is confirmed by the determination of IGF-1 and IGF-2 and finding an elevated IGF - 2/IGF-1 ratio. The availability of these tests is limited in many laboratories, so prompt recognition and therapies are late. We present the case of a 70-year-old patient diagnosed with right lower lobe bronchopulmonary neoplasm who presented to the emergency department with an altered general condition and hypoglycemic coma. The evaluation revealed low levels of insulin and C-peptide along with an elevated IGF-2/IGF-1 ratio of more than 10, suggesting a diagnosis of lung sarcoma with production of IGF-2. Because the tumor could not be resected in this case, chemotherapy and radiotherapy were performed, along with glucocorticoid therapy to prevent recurrent hypoglycemia. In the case of a patient with lung sarcoma and recurrent hypoglycemia (especially severe hypoglycemia or coma), extrapancreatic non-hyperinsulinemic hypoglycemia should be determinate tumor IGF-2 secretion. [ABSTRACT FROM AUTHOR]

Systemic sclerosis is an autoimmune, inflammatory disease, characterized by extensive fibrosis, vasculopathy, and immunological abnormalities. Among other complications, the patients with systemic sclerosis may develop an accelerated and premature atherosclerosis. Aim: The aim of the present study is represented by the assessment of endothelial function in patients with diffuse systemic sclerosis. Material and methods: The study was performed on two groups of subjects: group A, formed by 10 patients with diffuse systemic sclerosis without overt heart disease, and group B, formed by 10 healthy, sex- and age matched controls. Total cholesterol, HDL, LDL cholesterol, triglycerides, C-reactive protein, and blood pressure were determined in all subjects. Endothelial function was assessed by means of flow-mediated vasodilation on brachial artery, using B-mode ultrasonography, with linear transducer of 10 MHz. All the values were presented as mean ± standard deviation. The statistical analysis was done using Student's t-test, and Pearson'test, p < 0,05 was considered statistical significantly. Results: The mean age of patients with systemic sclerosis was 45,16 ± 7,28 years, and the mean length of disease evolution was 6,28 ± 2,68 years. The values of total cholesterol, LDL cholesterol, triglycerides, and blood pressure did not show significant differences between the patients and control subjects (p > 0,05). The value of C reactive protein was significantly higher in sclerodermic patients (p < 0,001). The value of FMD was significantly lower in sclerodermic patients (p < 0,001), being a significant negative correlation between FMD and C reactive protein (p < 0,05). Conclusions: The patients with systemic sclerosis present endothelial dysfunction, the first step in the atherosclerosis development. This disorder is not explained only by the traditional risk factors of atherosclerosis, but by the disease related factors. [ABSTRACT FROM AUTHOR]

Context. Scarce data on dietary habits in Eastern European countries is available and reports investigated individual food items and not dietary patterns in these populations Objective. To identify dietary patterns and to explore their association with obesity in a sample from Romanian population. Design. Cross-sectional. Subjects and Methods. This was an analysis of data collected from 1398 adult participants in ORO study. Data on lifestyle, eating habits and food frequency consumption were collected. Results. By principal component analysis we identified 3 dietary patterns explaining 31.4% of the diet variation: High meat/High fat pattern, Western pattern and Prudent pattern. High meat/High fat pattern was associated with male gender, lower educational level, living in a rural, smoking and a higher probability for the presence of obesity (OR 1.2 [95%CI: 1.1-1.4]). Western pattern was associated with younger age, a higher level of physical activity and smoking. Prudent pattern was associated with older age, female gender, a higher level of physical activity, not smoking status and a lower probability for the presence of obesity (OR 0.8 [95%CI: 0.7-0.9]). Conclusions. This study provides for the first-time information on the association between dietary patterns in adults from an Eastern European country and the presence of obesity. [ABSTRACT FROM AUTHOR]

A young Caucasian woman presents several episodes of severe fasting hypoglycemia. Fasting lab tests revealed: glycemia 28 mg/dL, insulinemia 143.3 μU/mL, insulin antibodies above 100 U/mL, leading to the diagnosis of insulin autoimmune syndrome. Due to lack of clinical improvement after 2 months, prednisone was started at 0.5 mg/kg/day, and then tapered by 5 mg every 5 days. Three weeks after discontinuing corticotherapy, the patient had no more severe fasting hypoglycemia, but occasionally postprandial mild hypoglycemia. Fasting lab tests showed: glycemia 83 mg/dL, insulinemia 58.6 μU/mL. At 5 hours during oral glucose tolerance test glycemia was 33 mg/dL, insulinemia 152.9 μU/mL. [ABSTRACT FROM AUTHOR]

Context. The socio-economic and medical burden of obesity represents a continuous challenge for both developing and developed countries. For Romania, the available data on the eating patterns, behavior and other components of lifestyle are scarce. Objective. The objective of this study was to assess the prevalence of overweight and obesity in the Romanian general population and to identify lifestyle patterns characteristic for the Romanian population in terms of eating patterns and physical activity. Design. Cross-sectional, epidemiologic, multicenter non-interventional study Subjects and methods. Between January 2014 and August 2014 were enrolled 2128 adults by 8 investigators spread in the main historical regions of Romania. The following data: demographic, anthropometric, employment status, education, family history, personal medical history, information on the lifestyle and eating habits. Results. The final population included in the analysis presented here consisted of 2103 participants with no missing information on height and weight. The prevalence of overweight and obesity was 31.1% and 21.3%, respectively. The prevalence of obesity was 9.9% in the 18-39 years age group, 30.1% in the 40-59 years age group, 41.6% in the 60-79 years age group and 24.1% in the =80 years age group (p <0.001). Irregular meals together with eating while watching TV were the most frequent unhealthy eating habits of the participants. Conclusions. We found a high prevalence of overweight and obesity among the participants enrolled. Our study has important implications for increasing the knowledge on the prevalence of overweight and obesity in Romania and associated lifestyle habits. [ABSTRACT FROM AUTHOR]