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.
To identify and to determine the resistance pattern of bacterial pathogens involved in infections of the elderly patients (� 65 years) admitted in the intensive care unit (ICU) at County Emergency Clinical Hospital Craiova, Romania. A retrospective study of bacterial pathogens was carried out on 463 elderly patients (� 65 years) admitted to the ICU, from January to December 2017. The analysis of the resistance patterns for the action of the appropriate antibiotics was performed using Vitek 2 Compact system and diffusion method. In this study there were analyzed 617 samples from 463 elderly patients (� 65 years). A total of 776 bacterial isolates were obtained, of which 175 strains of Klebsiella spp. (22.55%), followed by MRSA - Methicillin-Resistant Staphylococcus Aureus (108 -13.91%) and Escherichia coli (99 -12.75%). The most common isolates were from respiratory tract (572 isolates -73.71%). High rates of MDR were found for Pseudomonas (73.07%), MRSA (62.03%) and Klebsiella (44.57%). The study revealed an alarming pattern of antibiotic resistance in the majority of ICU isolates from elderly patients (�65 years), which draws attention to the need for judicious use of antibiotics and for careful monitoring of the drug resistance of patients.
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.
Heart failure is a disease characterized by cardiac remodeling or progressive dilation of left ventricle and a consequent reduction in contraction. Ventricular remodeling has been shown to be a negative prognostic factor alone, and therefore the most beneficial drugs are those that prevent or reduce left ventricular dilation. The pharmacological therapy of heart failure, although maximal, has proven to be not fully effective. The aim of our research was to evaluate resynchronization therapy in a lot of patients, monitoring their cardiac performance before and after cardiac resynchronization therapy.
Cardiac affectation is one of the leading causes of death in the world. Rhythmic disorders such as ventricular extrasystoles, atrial extrasysoles, atrial fibrillation, atrial flutter represent a major risk factor with a gloomy progression and prognosis. Our goal was to analyze the existing arrhythmia risk in patients with chronic hepatic disease. Being known the alteration of the somatic status of the patient with liver cirrhosis or other chronic liver disease in the presence of comorbid cardiac symptoms, we consider vital to prevent arrhythmia risk in hepatic pathology.
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