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The redefinition of the new world order is based on different political, social and economic visions that lead to conflict and ethnic or religious tensions in different parts of the world. The vision of the United Nations among others is to create a world without mines; a world in which ground-emplaced mines and explosive remnants of war do not threaten civilians. Therefore, UN aims to accomplish this specific vision materialized in the strategic plan of the United Nations Mine Action Service (UNMAS).

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.

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

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.

Introduction. Gestational diabetes mellitus (GDM) is caused by numerous risk factors, the most common being old age, obesity, family history of diabetes mellitus, GDM, history of fetal macrosomia, history of polycystic ovary syndrome or treatment with particular drugs, multiple births, and certain races. The study proposed to analyze the risk factors causing GDM. Method. In the study, we included 97 pregnant women to whom there was an OGTT performed between weeks 24th and 28th of pregnancy, divided into two groups, with GDM and without GDM. The statistical analysis was performed with SPSS 26.0, the tests being statistically significant if p value < 0.05. Results. The favoring risk factors for the onset of GDM were analyzed, with statistically significant differences between the GDM group and the group without GDM related to the delivery age ( 32.39 ± 4.66 years old vs. 28.61 ± 4.71 years old), history of fetal macrosomia (13.7% vs. 0%), presence of GDM during previous pregnancies (7.8% vs. 0%), HBP before pregnancy (9.8% vs. 0%), gestational HBP (17.6% vs. 0%), glycemia value at first medical visit ( 79.37 ± 9.34 mg / dl vs. 71.39 ± 9.16 mg / dl ), and weight gain during pregnancy ( 14.61 ± 4.47 kg vs. 12.48 ± 5.87 kg ). Conclusions. Identifying the risk factors for the GDM onset has a special importance, implying an early implementation of interventional measures in order to avoid the onset of GDM and associated maternal and fetal complications.

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 and Objectives: Gestational diabetes mellitus (GDM) represents one of the most common complications during pregnancy, being associated with numerous maternal and neonatal complications. The study aimed to analyze maternal and neonatal complications associated with GDM. The risk factors of GDM and of the maternal and neonatal complications were studied in order to prevent their occurrence. Materials and Methods: The study included 97 women in the study, who underwent an oral glucose tolerance test (OGTT) between weeks 24–28 of pregnancy, consequently being divided into two groups: pregnant women with and without GDM. Statistical analysis was performed using the SPSS 26.0 software and MATLAB fitglm, the results being considered statistically significant if p &lt, 0.05. Results: We observed statistically significant differences between the group of women with and without GDM, regarding gestational hypertension (17.6% vs. 0%), preeclampsia (13.72% vs. 0%), and cesarean delivery (96.1% vs. 78,3%). Data on the newborn and neonatal complications: statistically significant differences were recorded between the two groups (GDM vs. no GDM) regarding the average weight at birth (3339.41 ± 658.12 g vs. 3122.83 ± 173.67 g), presence of large for gestational age (21.6% vs. 0%), macrosomia (13.7% vs. 0%), excessive fetal growth (35.3% vs. 0%), respiratory distress (31.4% vs. 0%), hospitalization for at least 24 h in the Neonatal Intensive Care Unit (9.80% vs. 0%), and APGAR score &lt, 7 both 1 and 5 min following birth (7.8% vs. 0%). Additionally, the frequency of neonatal hypoglycemia and hyperbilirubinemia was higher among newborns from mothers with GDM. Conclusions: The screening and diagnosis of GDM is vital, and appropriate management is required for the prevention of maternal and neonatal complications associated with GDM. It is also important to know the risk factors for GDM and attempt to prevent their appearance.

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).

Type 1 diabetes mellitus (T1DM) is a chronic disease which represents a major issue for public health. Type 1 diabetes is occurred most frequently in childhood and adolescence, although in recent years due to the increase in the prevalence of obesity in this category of population has been registered a growing number of cases of type 2 diabetes among children and adolescents (1, 2).

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.

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a new term that no longer excludes patients that consume alcohol or present other liver diseases, unlike nonalcoholic fatty liver disease (NAFLD). The aim of this study was to evaluate the role of different biomarkers as predictors of MAFLD in patients with type 2 diabetes mellitus (T2DM). In this regard, a cross-sectional, non-interventional study was conducted over a period of 8 months in patients with T2DM. Liver steatosis displayed by abdominal ultrasound certified the MAFLD diagnosis. A percentage of 49.5% of the studied patients presented MAFLD. Through logistic regression adjusted for gender, age, T2DM duration, lipid-lowering therapy, smoking status, nutritional status, we demonstrated that elevated triglycerides (TG) levels, high non-high-density-lipoprotein (HDL)-cholesterol-to-HDL-cholesterol (non-HDL/HDL) ratio, high atherogenic index of plasma (AIP), and increased Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) had predictive value for MAFLD in patients with T2DM. Furthermore, we calculated the optimal cut-off values for these biomarkers (184 mg/dL for TG, 0.615 for AIP, 3.9 for the non-HDL/HDL ratio, and 2.01 for HOMA-IR) which can predict the presence of MAFLD in patients with T2DM. To our knowledge, this is the first study to assess the predictive value of the non-HDL/HDL ratio for MAFLD in patients with T2DM.

Since chronic obstructive pulmonary disease COPD and obesity became global public health challenges, the nutritional status evaluation is more important. How malnutrition and obesity will impact COPD prognosis and treatment is relevant and we considered need a separate approach. The new adiposity based chronic disease concept explains the role played by adiposity, and important studies, like European Community Health Survey ECRHS are highlighting the correlation between adiposity and lung function decline. On the other side, malnutrition decreases effort capacity and impairs the strength of respiratory muscles. Foods, nutrients and dietary patterns are influencing COPD prognosis and Mediterranean Diet, integrated in a healthy lifestyle should be part of COPD management. The important benefic role played by fibers, whole grains, combined with anti-inflammatory and antioxidant effects of fruits and vegetables, together with poly-unsaturated fatty acids PUFA, fish, vitamins and minerals, is detailed below, in contrast with the detrimental role of Western Diet. A multidisciplinary approach in COPD should be considered, integrating lifestyle interventions as important tools in COPD management.

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.

Gestational diabetes mellitus (GDM) is a major public health issue of our century due to its increasing prevalence, affecting 5% to 20% of all pregnancies. The pathogenesis of GDM has not been completely elucidated to date. Increasing evidence suggests the association of environmental factors with genetic and epigenetic factors in the development of GDM. So far, several metabolomics studies have investigated metabolic disruptions associated with GDM. The aim of this review is to highlight the usefulness of maternal metabolites as diagnosis markers of GDM as well as the importance of both maternal and fetal metabolites as prognosis biomarkers for GDM and GDM’s transition to type 2 diabetes mellitus T2DM.

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.

Postoperative eventration is a pathology whose treatment is exclusively surgical, and is one of the most frequent interventions in general surgery along with other abdominal parietal defects. In large part, in the occurrence of postoperative eventrations, in addition to the local and general factors associated with the patients, the incision, the technique of wound closure, made during the previous intervention and the materials that are used have a special involvement.

Rheumatoid arthritis (RA) is the most widespread inflammatory rheumatic disease with about 10% of all rheumatic diseases and a global prevalence of about 1%. Through its features - joint proliferation, articular panic, articular cartilage degradation and bone erosion � RA has a destructive and disabling character and a major socio-economic impact. Osteoporosis is a bone system disease characterized by loss of bone mass and alteration of bone architecture, with consequences on bone fragility correlated with an increased fracture risk. With a major socio-economic impact, the World Health Organization (WHO) has declared osteoporosis as a public health problem, third on cardiovascular and oncological.

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.

Obesity is has become a major problem worldwide. Since 1975, the prevalence of obesity nearly trippled, and nowadays we are facing an obesity epidemic. Obesity is a major risk factor for many diseases such as cardiovascular ones (mainly heart disease and stroke) -being the leading cause of death worldwide, musculoskeletal disorders or type 2 diabetes mellitus (DM).

Background and Aims: Studies have shown an increased incidence of chronic complications in people with type 1 diabetes mellitus (T1DM) with insulin resistance (IR) compared to people with T1DM without IR. Estimated glucose disposal rate (eGDR) is an important indicator of IR in patients with T1DM, lower eGDR levels indicating greater IR. It was shown that T1DM patients with chronic complications (diabetic retinopathy - DR, diabetic peripheral neuropathy - DPN or diabetic kidney disease - DKD) exhibit higher IR compared to patients without chronic complications. The aim of our study was to evaluate eGDR as a marker for the assessment of IR in T1DM patients. Materials and Methods: The study was observational, cross-sectional and included 140 T1DM patients with diabetes duration>10 years. The collected data were analyzed using the Statistic Package for Social Sciences (SPSS) version 22 software (IBM Corporation, Armonk, NY, USA). Results: eGDR presented statistically significant correlations (p10 years. Conclusions: eGDR represents a reliable marker for assessing the IR in T1DM.

Insulin resistance (IR) is a fundamental disorder of type 2 Diabetes Mellitus (DM), but it is also involved in the etiopathogenesis of type 1 DM, with important implications in the onset and progression of micro- and macrovascular complications in type 1 DM. Overweight plays the main role in the increased incidence of both types of DM, exacerbating IR. The epidemic increase of overweight and obesity makes it difficult to diagnose the exact phenotype of DM, as IR and autoimmunity often coexist. Many studies showed an increase in incidence of micro- and macrovascular complications in patients with type 1 DM with IR, compared to patients with type 1 DM without IR. The gold standard of IR evaluation is represented by the method of euglycemic-hyperinsulinemic clamp, applied on a reduced scale in research. Thus, it is necessary to identify early IR markers (clinical or biological markers), less laboured ones, that could be used on a large scale in current medical practice, for the IR determination in type 1 DM. Clinicians and health experts should prevent/ reduce the epidemic of overweight and obesity in young people, thus decreasing IR, and implicitly the chronic complications of DM.

Background and Aims: Diabetes mellitus (DM) is a chronic disease which can evolve towards devastating micro and macro-vascular complications. Chronic kidney disease (CKD) is a worldwide public health problem, with adverse outcomes of kidney failure, cardiovascular disease (CVD) and premature death. The aim of our study was to evaluate the prognosis in patients with DM and CKD, depending on estimated glomerular filtration rate (eGFR) and albuminuria, according to the classification of Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (KDIGO) from 2013 Materials and Methods: The study was epidemiological, transversal, non interventional type, with 600 subjects unselected patients divided into three subgroups: 200 patients with T1DM, 200 patients with T2DM and 200 age matched subjects without DM. The recorded data have been analyzed using the Statistic Package for Social Sciences (SPSS), the 17.00 software (IBM Corporation, Armonk, NY, United States of America). Results:. We found a statistically significant difference among the three study groups (p < 0.0001) regarding the prognosis of CKD. Conclusions: DM represents an important risk factor for the appearance of CKD but also a negative prognosis factor for the patients with CKD.

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

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.

The aim of our study is to present the results of a screening program for 401 patients in relation to chronic kidney disease and diabetes, shading new light on managing these pathologies and bringing into discussion the use of innovative analytical tools. The whole group of patients has been divided in two sub-groups: one presenting diabetes (204 subjects) and the other one with no diabetes (197 subjects). All subjects have been investigated via the following categories of parameters: (i) General health parameters: high blood pressure, overweight and obesity, kidney disorders, dyslipidemia, lower limb peripheral arteriopathies, cardiac disorders, endocrinologic disorders, hepatic steatosis, pancreatic disorders and (ii) Biological parameters: glycaemia, glycated haemoglobin - HbA1c, cholesterol-total, cholesterol- HDL, cholesterol-LDL, triglycerides, urea, creatinine, uric acid, glomerular filtration rate, total lipids, albumin, C Cystatin. In addition to these, if the case, psychological assistance has been be provided. All collected data for the two sub-groups of patients have been presented and critically analyzed. Furthermore, several correlations between various sets of variables have been proposed, setting up favorable initial conditions for developing an integrated model for managing these pathologies.

It is an original paper, which shows how the hierarchical model with two levels, can be used to determine the linear non-homogeneous credibility premiums at the sector level and at the contract level. The fact that it is based on complicated mathematics, involving conditional expectations, shouldn’t bother the user more than it does when he applies statistical tools like SAS, GLIM, discriminant analysis, and scoring models. These techniques can be applied by anybody on his own field of endeavor, whether it is economic, medical, insurance, or accounting. We give a rather explicit description of the input data for the used hierarchical model of Jewell, only to show that in practical situations there will always be enough data to apply credibility theory to a real insurance portfolio.

The cardiovascular effect of liraglutide, a glucagon-like peptide 1 analogue, when added to standard care in patients with type 2 diabetes, remains unknown. METHODS In this double-blind trial, we randomly assigned patients with type 2 diabetes and high cardiovascular risk to receive liraglutide or placebo. The primary composite outcome in the time-to-event analysis was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The primary hypothesis was that liraglutide would be noninferior to placebo with regard to the primary outcome, with a margin of 1.30 for the upper boundary of the 95% confidence interval of the hazard ratio. No adjustments for multiplicity were performed for the prespecified exploratory outcomes. RESULTS A total of 9340 patients underwent randomization. The median follow-up was 3.8 years. The primary outcome occurred in significantly fewer patients in the liraglutide group (608 of 4668 patients [13.0%]) than in the placebo group (694 of 4672 [14.9%]) (hazard ratio, 0.87; 95% confidence interval [CI], 0.78 to 0.97; P, Novo Nordisk; National Institutes of Health; LEADER ClinicalTrials.gov

Breast cancer is the most common type of cancer in women worldwide and the second most common cancer overall, making it a major international concern from both socio and economical point of view. World Health Organisation (WHO) estimated that worldwide over 508.000 women died in 2011 due to breast cancer. American Cancer Society�s (ACS) study conducted in 2017 showed important numbers about the burden of breast cancer. Therefore, they estimated a number of 252,710 new breast cancer to be diagnosed in women and 2,470 in men in 2017- only in America. On 1st of January , there were about 3.5million US women with a history of breast cancer. The paper presents the correlations between recurrences of the tumor in breast cancer trated with conservative surgery and their immunohistochemical expression.