ACTA ENDOCRINOLOGICA (BUC)

Background. Vascular calcifications (VCs) represent an important complication in dialysis patients. It is still a subject of debate whether VCs are associated with low or high intact parathormone (iPTH), or if it is not any relation.\r\nThe purpose of this study was to assess the predictive value of iPTH and other mineral markers for VCs development.\r\nMethods. The study evaluated peripheral VCs in haemodialysis (HD) and peritoneal dialysis (PD) patients using radiographies. We counted a semiquantitative score ranging from 0 to 8. Each category was divided into two groups according to VCs score. We assessed the relationship between the VCs score and mineral markers.\r\nResults. A VC score=2 was positively associated with male gender, serum Ca, P, CaxP, ALP and iPTH levels in HD patients. There was no correlation with age, HD vintage, received treatment. In PD patients, did CaxP have a higher significance with VC score>/2; were iPTH, CaxP and P of higher significance for a score=5.\r\nConclusions. Hyperparathyroidism can be considered a predictor for VCs development in dialysis patients. Other risk factors are increased serum Ca, P, CaxP and ALP levels. In PD patients, high iPTH could predict VCs only for severe calcifications, but the CaxP could even predict for less extended VCs.

Context. Four major modifiable behavioral risk factors are considered responsible for the current burden of the non-communicable diseases: tobacco use, physical inactivity, unhealthy diet and excessive alcohol consumption. Limited data on the lifestyle habits in Romanian population is currently available. Objective. To assess the eating patterns and physical activity habits and other lifestyle components in various age groups in the population included in the ORO study. Design. ORO was a cross-sectional, epidemiologic, multicenter non-interventional study conducted from January 2014 until August 2014 in 8 study centers spread in the main historical regions of Romania Results. Eating 3 meals/day every day was more frequently reported in the 60-79 years and ≥ 80 years age groups (53.0% and 51.7%) than in the 18-39 years and 40- 59 years age groups (26.8% and 35.8%), p <0.001. The frequency of eating breakfast every day increased with age from 43.5% in the youngest age group to 79.3% in the oldest one (p <0.001). Intense and moderate leisure-time physical activity was more frequent among participants in the 18- 39 years age group. Leisure time physical activities were associated with younger age groups, male sex, rural area, higher educational level and non-smoking status. Regular breakfast and regular consumption of 3 meals/day was associated with older age group, male sex and non-smoking status. Conclusions. Our analysis showed a high frequency of unhealthy lifestyle habits among the younger age groups as compared to the older ones, with the highest frequency of these unhealthy behavior reported in the 18-39 years age group.

Aims. The aims of our study were to assess the prevalence of prostate tumors in patients with metabolic syndrome.\r\nMaterial and methods. Subjects were patients recruited from three medical centers in Bucharest, Romania. For this study we selected men over 45 years of age with metabolic syndrome. The anthropometric measurements included height, weight, waist circumference and hip circumference. We calculated the body mass index (BMI) and measured the\r\nblood pressure. Biochemical tests included fasting plasma glucose (FPG), HbA1c, total cholesterol (TC), TG, HDL-C, fasting plasma insulin (FPI), prostate-specific antigen (PSA)and free-PSA. The prostate gland volume was measured by transrectal ultrasound. The diagnosis of prostatic cancer was based on a positive finding of the histological\r\nexamination obtained from 14-core biopsy.\r\nResults. There was a high prevalence of prostate tumors (benign and malignant) - 82.85% (n=343). Prostate cancer was\r\ndiagnosed in 7.9% of patients (n=33) using DRE, PSA, free PSA/PSA ratio and TRUS. The prevalence of BHP was 74.9% (n=310). The results of the present study indicate that\r\nPSA detects a significant number of prostate tumors missed in DRE. The use of DRE, PSA and TRUS, in combination, provided the highest rate of detection of prostatic tumors in patients with metabolic syndrome without infectious diseases of the prostate.\r\nConclusions. The prevalence of prostatic tumors, prostate cancer and benign prostatic hyperplasia in metabolic syndrome patients is high. Due to its increased prevalence, the BPH can be considered as a feature of metabolic syndrome.

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.

Introduction. The prevalence of obesity has reached alarming levels in the European Union, including in Romania. Data on the prevalence of obesity is only available at the national populational level, but this may hide the increased levels in disadvantaged groups. The purpose of this study was to evaluate the prevalence of overweight and obesity in the Roma population in Southern Romania. Material and method. This cross-sectional, epidemiological, non-interventional study was conducted from March 2014 to May 2017 in several settlements from Calarasi County. Screening procedures included interviews about medical history, lifestyle, anthropometric and clinical measurements and fasting capillary glucose. Results. The study population consisted of 1120 adult subjects, of which 735 Roma. In Roma population group, the prevalence of underweight, normal weight, overweight and obesity was 4.5% (n=33), 25% (n=184), 25.3% (n=186) and 45.2% (n=332) respectively. In Romanian Caucasians group, the prevalence of underweight, normal weight, overweight and obesity was 2.3% (n=9), 20% (n=77), 33.8% (n=130) and 43.9% (n=169) respectively. Among the Romanian Caucasians significant predictors of obesity were a sedentary lifestyle and current smoking. The odds of being obese in Roma population were higher in sedentary lifestyle persons and lower in current smokers, with primary education, and in those living in rural settlements. The family history of obesity had a significant association with obesity only in Roma population. Conclusions. Our results confirm the need to implement prevention programs in high-risk populations due to the double burden of malnutrition, lack of medical education and preventive healthcare, low socio-economic level.

Context. Angiotensin converting enzyme 2 (ACE2) is highly expressed in the kidney and cleaves angiotensin II to Angiotensin (1–7), annihilating the deleterious effects of angiotensin II which is known to be a strong activator of oxidative stress. Objective. We aimed to evaluate the relationship of oxidative stress to urinary ACE2 (uACE2) in type 2 diabetes mellitus (T2DM) patients. Design. We included consecutive normo or microalbuminuric T2DM patients in an observational transversal study. Routine laboratory investigations, plasma malondialdehyde (MDA, fluorimetric thiobarbituric method) as a marker of prooxidant capacity and superoxide dismutase (SOD, cytochrome reduction method) and catalase (CAT) activity (in erythrocyte lysate by the modification of absorbance method) as two measures of serum antioxidant capacity and uACE2 (ELISA method) were assessed. Results. MDA showed a negative correlation with SOD (r=-0.44, p=0.001), CAT (r=-0.37, p=0.006), uACE2 (r=-0.33, p=0.016) and a positive correlation with glycated haemoglobin (HbA1c) (r=0.49, p<0.001) and associated cardiovascular disease (r=0.42, p=0.001). CAT as also positively correlated to uACE2 (r=0.29, p=0.037). SOD was also negatively correlated with glycemia (r=-0.71, p<0.001) and HbA1c (r=-0.53, p<0.001). Patients with lower MDA (when divided according to median value of 3.88 nmol/ mL) had higher uACE2 57.15(40.3-71.2) pg/mL compared to 38.5(31.8-45.95) pg/mL in patients with higher MDA (p<0.001). In multivariate logistic regression uACE2 was the only predictor for MDA above or below its median (OR=0.94, 95%CI[0.90-0.98], p=0.002). Conclusion. Increased prooxidant serum capacity is associated with lower uACE2 levels in T2DM patients.

Objective. The aim of the study was to test whether a correlation exists between the Epworth Sleepiness Scale (ESS) and respiratory sleep parameters in patients with\r\ntype 2 diabetes.\r\nDesign. Subjects and Methods.The records of 83 consecutive patients (mean age 54.6? 9.8 years) with type 2 diabetes\r\nthat accepted to perform an in-hospital sleep study for screening of sleep apnea have been retrospectively evaluated.\r\nResults. There was a weak positive correlation between apnea/hypopnea index (AHI), oxygen desaturation index and ESS, and a weak negative correlation between ESS and mean O2 saturation. When data was separately analyzed in men and\r\nwomen, it could not be identified any correlation between sleep respiratory parameters and ESS in men. In women,\r\ncorrelation coefficients increased, proving a stronger relationship between ESS and AHI (r=0.65, p<0.001), mean O2 saturation (r=-0.52, p=0.005) and oxygen desaturation index (r=0.60, p=0.001). ESS had only a moderate level of accuracy in identifying patients with moderate and severe sleep\r\napnea (sensitivity 84.1%, specificity 74.1%, PPV 84.1%, NPV 74.1%). In women ESS showed a higher sensitivity than in men\r\n(92% vs. 80.6%), but a lower PPV (63% vs.78.1%) in predicting the presence of an AHI &#8805; 15.\r\nConclusions. In women with type 2 diabetes, it is possible to suspect the existence of SAS solely on the basis of the\r\nESS score. In male population, symptoms evaluated by questionnaires, such as the ESS, provide additional information which combined with clinical findings are helpful in selecting patients who are candidates for further detailed sleep studies.

Objective. to investigate the factors associated with postprandial glucose excursions in\r\npatients with type 2 diabetes.\r\nResearch Design and Methods. A complete medical history and physical examination\r\nwere assessed in 118 consecutive patients with type 2 diabetes attending the Diabetes\r\nOutpatient Clinic, Cluj-Napoca. Blood samples were collected in fasting state, and HbA1c\r\nand lipid profile were assessed. A six points blood glucose profile measured by patients at\r\nhome was performed. To determine variables associated with higher postprandial glycemic\r\nlevels, factor analysis followed by linear regression model was performed.\r\nResults. The study group had a median age of 59.2 years, 43.4% were females. The\r\nmedian duration of diabetes was 5 years. By factor analysis we have extracted 4 factors that\r\nexplained 75.6% of the variance of postprandial glycemia: factor 1 with positive loadings of\r\ntotal cholesterol and LDL cholesterol, factor 2 with positive loadings of body mass index\r\nand waist circumference, factor 3 with positive loadings of diabetes duration and age, factor\r\n4 with positive loadings of triglycerides and glycosylated hemoglobin (HbA1c). After\r\nadjustment for the sex and treatment, only factor 2 and factor 4 remained significantly associated\r\nwith postprandial glycemic values (p=0.003 and p<0.001), indicating that the postprandial\r\nglycemia is best predicted by a multiple regression that included body mass index, waist\r\ncircumference, tryglicerides and HbA1c as independent variables (r=0.54, p<0.001).\r\nConclusion. The results of our study shows that low body mass index and waist\r\ncircumference, high triglycerides and HbA1c levels are independently associated with\r\npostprandial glucose excursions.

Background. Organophosphate exposure induces many endocrine effects. Aim. In this study we observed the effects of acute stress induced by cholinesterase inhibition on the main hormonal axes. Materials and Methods. We included thirteen weanling Wistar rats that were subjected to organophosphate exposure. They were first tested for baseline levels of butyrylcholinesterase, cortisol, free triiodothyronine, thyroxine, thyroid-stimulating hormone and prolactin. Secondly, chlorpyrifos was administered. Next samples were taken to determine the level of all the above-mentioned parameters. Results. Butyrylcholinesterase was significantly decreased after exposure (p<0.001). Cortisol levels were significantly higher after clorpyrifos administration (358.75±43 vs. 241.2±35 nmoL/L)(p<0.01). Although prolactin had a growing trend (450.25±24.65 vs. 423±43.4 uI/mL), the results were not statistically significant. Both free triiodothyronine and thyroxine were significantly higher after exposure. Surprisingly, thyroid-stimulating hormone level almost doubled after exposure with high statistical significance (p<0.001), suggesting a central stimulation of thyroid axis. Butyrylcholinesterase level was proportional with thyroid-stimulating hormone level (p=0.02) and thyroxine level was inversely correlated to the cortisol level (p=0.01). Acute cholinesterase inhibition may induce high levels of cortisol, free triiodothyronine, thyroxine and thyroid-stimulating hormone. From our knowledge this is the first study dedicated to the assessment of acute changes of hormonal status in weanling animals after low-dose organophosphate exposure. Conclusion. Acute cholinesterase inhibition may cause acute phase hormonal disturbances specific to shocked patients.

Background. Recent experimental data show that increased plasma adiponectin in chronic kidney disease could be a response to inflammation.\r\nObjective. To identify factors influencing adiponectinemia in patients with type 2 diabetes (T2DM) and microalbuminuria or low grade proteinuria.\r\nDesign. 32 patients with urinary albumin excretion rate (UAER)> 30 mg/g creatinine but without significant proteinuria (< trace COMBUR) were included and compared to 59 normalbuminuric T2DM controls. History, anthropometric measurements, laboratory analysis, total plasma adiponectin were obtained.\r\nResults. In our patients with UAER of 273.51?57.26 mg/g creatinine and estimated glomerular filtration rate (eGFR) 64.92?4.56 mL/min, in simple regression, adiponectinemia\r\ncorrelates inversely to eGFR (p=0.02, r= -0.38), triglyceridemia (p=0.03, r=-0.37) and hemoglobin\r\n(Hb -p= 0.01, r=-0.45) and positively to HDL cholesterol (p=0.001, r=0.54) and UAER (p<0.0001, r=0.71); the two latter parameters remain significant in multiple regression. In controls, adiponectinemia correlates inversely to age (p=0.04, r=-0.26) and BMI (p=0.04, r=-0.24); these and UAER predict adiponectinemia in multiple regression. 11 patients have UAE superior to 300 mg/g creatinine and 21 are strictly microalbuminuric (mean UAER 653.16?97.02 and 83.68?10.28mg albumin/g creatinine respectively). In microalbuminuric patients serum C reactive protein (CRP) correlates positively (p=0.0008, r=0.68) and Hb negatively (p=0.04, r=-0.41) to adiponectinemia; in multiple regression adiponectinemia only depends on CRP. In proteinuric patients CRP and\r\nglycated Hb correlate to adiponectinemia in stepwise multiple regression.\r\nConclusion. Adiponectinemia is mainly predicted by UAER in our cohort whereas it depends on age and BMI in normalbuminuric T2DM controls; in strictly microalbuminuric\r\npatients CRP is a major predictor of adiponectinemia.