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Martin S.,Carol Davila University of Medicine and Pharmacy | Sirbu A.,Carol Davila University of Medicine and Pharmacy | Sirbu A.,Victor Babes Institute | Betivoiu M.,Elias Hospital | And 2 more authors.
Hormones | Year: 2015

OBJECTIVE: Thyroid hormones influence the GH/IGF1 axis, but previous studies have reported discrepant results regarding serum IGF1 levels in hyperthyroidism. We have therefore investigated, at diagnosis, the relationship between serum IGF1 levels and the main characteristics of Graves’ disease (GD): severity of hyperthyroidism, goiter size, presence of active Graves’ ophthalmopathy (GO), antythyroid antibodies status and titer. DESIGN AND METHODS: This cross-sectional study included 98 newly diagnosed hyperthyroid patients with GD who presented consecutively at our clinic. The main measured parameters were: TSH, FT4, FT3, TT3, thyroglobulin, anti-thyroid peroxidase antibodies (TPOAb), anti-thyroglobulin antibodies (ATA), thyrotropin receptor antibodies (TRAb), IGF1. Patients were considered IGF deficient if IGF1 z score was ≤-2SD from mean for age. RESULTS: In GD patients, men had higher IGF1 levels (p=0.023) and IGF1 z scores (p=0.013) than women. 18.4% of GD patients were, at diagnosis, IGF1 deficient. Compared to patients without IGF1 deficiency, these patients presented higher thyroglobulin (median=72.55, IQR=116.02 vs median=11.40, IQR=80.74 ng/ml, p=0.002) and FT3 (median=11.30, IQR=7.64 vs median=7.33, IQR=5.72 pg/ml, p=0.027), and lower ATA (median=20, IQR=0 vs median=34.05, IQR=161 iu/ml, p<0.001) levels. Thyroglobulin was independently associated with IGF1 deficiency (AUROC=0.732, 95% CI: 0.620-0.844, p=0.002; cut-off for thyroglobulin=50.40 ng/ml, Se=77.8%, Sp=70%). IGF1 status was not influenced by gender (p=0.084), current smoking (p=0.558), goiter size (p=0.533), active ophthalmopathy (p=0.334), TRAb (p=0.239) or TPOAb status (p=0.367). CONCLUSIONS: Nearly one fifth of newly diagnosed GD patients had IGF1 deficiency. IGF1 deficiency was associated with lower ATA titers, higher thyroglobulin levels and more severe FT3 hyperthyroidism at diagnosis. © 2015, Hellenic Endocrine Society. All Right reserved.


Martin C.S.,Carol Davila University of Medicine and Pharmacy | Blaga C.,Elias Hospital | Lambrescu I.M.,Carol Davila University of Medicine and Pharmacy | Fierbineanu-Braticevici C.,Carol Davila University of Medicine and Pharmacy | And 2 more authors.
Journal of Clinical Pharmacy and Therapeutics | Year: 2015

What is known and objective Budesonide, an oral glucocorticoid indicated for the treatment of Crohn's disease, rarely interferes with the hypothalamic-pituitary-adrenal axis because more than 80% of it is metabolized by cytochrome P450 enzymes. Case summary A 33-year-old female patient diagnosed with Crohn's disease, treated with oral budesonide, was admitted for Cushingoid symptoms and signs. The onset coincided with the use of fluvoxamine, a serotonin reuptake inhibitor and also a potent inhibitor of cytochrome P450 enzymes that presumably led to budesonide accumulation. What is new and conclusion Practitioners should take into consideration the possibility of iatrogenic Cushing's syndrome caused by the association of oral budesonide with a P450 cytochrome inhibitor. Iatrogenic Cushing's syndrome caused by the association of oral budesonide with a P450 cytochrome inhibitor. © 2015 John Wiley & Sons Ltd.


Ioacara S.,N Paulescu National Institute of Diabetes | Guja C.,N Paulescu National Institute of Diabetes | Ionescu-Tirgoviste C.,N Paulescu National Institute of Diabetes | Fica S.,Elias Hospital | And 4 more authors.
Diabetes Research and Clinical Practice | Year: 2011

Aim: To investigate the historical changes in survival with diabetes in adult type 2 diabetes patients. Methods: We analyzed 9066 deaths, 54.2% males, registered at "I. Pavel" Bucharest Diabetes Centre, aged 40-64 years and deceased between 1943 and 2009. We split the analysis in three time periods according to year of death: 1943-1965, 1966-1988 and 1989-2009. Results: The mean age at diabetes onset was 55.5 ± 6.2 years, with mean disease duration at death 12.7 ± 8.2 years and mean age at death 68.2 ± 8.7 years. The mean disease duration at death was 9.9 ± 7.3 years in 1943-1965 period, followed by a significant (p< 0.001) rise to 12.2 ± 8.2 years in 1966-1988, and 14 ± 8.1 years (p< 0.001) in 1989-2009. There was a significant increase for coronary heart diseases and cancer and a significant decrease for infections and end-stage renal disease as causes of death. Conclusion: We found a significant increase in age at onset and survival with diabetes leading to a significant increase in age at death. © 2011 Elsevier Ireland Ltd.


Ioacara S.,N Paulescu National Institute of Diabetes | Guja C.,N Paulescu National Institute of Diabetes | Fica S.,Elias Hospital | Ionescu-Tirgoviste C.,N Paulescu National Institute of Diabetes
Diabetes Research and Clinical Practice | Year: 2013

Aim: To investigate the historical changes in survival with diabetes in elderly people with diabetes. Research design and methods: We analyzed 6504 deaths (44.5% males) registered in a large urban population, aged ≥65 years, and deceased between 1943 and 2009. We split the analysis into three time periods according to year of death: 1943-1965, 1966-1988 and 1989-2009. The parallel changes in the corresponding general population were available. Results: The mean age at diabetes onset was 70.8 ± 4.7 years, with mean disease duration at death 7.5 ± 5 years, and mean age at death 78.3 ± 5.9 years. The mean survival loss due to diabetes (expected minus observed survival) was 4.5 ± 5.1 years (4.9 ± 5.1 years for females versus 4.1 ± 5.2 years for males, p< 0.001). The mean disease duration at death was 6.4 ± 5.7 years in the period 1943-1965, followed by a significant (p= 0.019) rise to 7 ± 5 years in 1966-1988, and 8.3 ± 4.9 years (p< 0.001) in 1989-2009. There was a significant increase in coronary heart disease and stroke, and a significant decrease in infections and end-stage renal disease as causes of death. Conclusions: We found a significant increase in age at onset and survival with diabetes leading to a significant increase in age at death. Females had a higher survival loss due to diabetes compared with males. © 2012 Elsevier Ireland Ltd.


Burnei Gh.,Emergency Hospital for Children Maria Sklodowska Curie | Draghici I.,Emergency Hospital for Children Maria Sklodowska Curie | Gavriliu T.,Emergency Hospital for Children Maria Sklodowska Curie | Georgescu I.,Emergency Hospital for Children Maria Sklodowska Curie | And 4 more authors.
Chirurgia (Romania) | Year: 2013

Background: The purpose of our study is to assess primitive and secondary malignant pulmonary tumors in children. The presence of lung tumors in newborns and infants is a point of interest to specialists in pediatric surgery, thoracic surgery and genetics due to the high death rate. The 5-years survival rate communicated by EUROCARE-study is less than 10% for primitive tumors and less than 15% in lung metastases. Materials and Method: We performed a retrospective study which analysed 11 children with pulmonary primary or metastatic tumors admitted in the Pediatric Surgery Department "Prof. Dr. Al. Pesamosca" of the Emergency Clinical Hospital for Children "Maria Sklodowska Curie", Bucharest. The analysed and operated patients underwent surgery by Prof. Dr. Al. Pesamosca and the authors during the period of 1985-2011. In our series there where 4 primitive lung tumors and 7 secondary ones: 8 underwent surgery and 2 died before being operated on. The incidence of primitive pulmonary lung malignancies is higher for females, 3 to 1, and secondary ones are more frequent in males, 6 to 1. Results: Patients with primitive pulmonary malignancies were late diagnosed. Their age ranged between 1 to 6 years; 3 were operated on, out of which 2 died, and 1 operated still survives. The 7 patients with secondary pulmonary malignancies were late diagnosed, too, probably as a consequence of a late diagnosis of the origin tumor. Conclusions: Even if all malignancies require an early diagnosis and treatment, this aim regarding malignant lung tumors is still a desideratum animating all practitioners. Primitive tumors are diagnosed presenting the main clinical manifestation a bronchopulmonary infection. Secondary lung malignancies are usually asymptomatic and are diagnosed when monitoring a patient for a malignancy with another origin. Chemotherapy, radiotherapy and surgery of malignant primitive tumors or metastatic ones in children remain unsatisfactory because of the late diagnosis and the limited methods of treatment. Nowadays genetics identified the responsible oncogenes for pulmonary blastic explosion and better results could be obtained by genetic surgery. Copyright © Celsius.

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