Background Hypertension frequently coexists with type 2 diabetes (T2D) and may contribute to the development of diabetic complications. Objective This study aimed to assess the association between hypertension and microvascular and macrovascular complications in patients with type 2 diabetes (T2D). Methods We conducted a retrospective cross-sectional study based on a review of medical records, including 500 patients with T2D followed in the Department of Endocrinology, Diabetology, and Nutrition. Patients were grouped according to the presence of hypertension, with 204 patients in the hypertension group and 296 patients in the non-hypertension group. Clinical, biological, and complication-related data were collected and analyzed using appropriate statistical methods. Results The mean age was 58.3 ± 12.8 years, and hypertension was present in 40.8% of cases. Poor glycemic control (glycated hemoglobin [HbA1c] >10%) was observed in 52.2%. Patients with hypertension had higher frequencies of several microvascular and macrovascular complications compared with patients without hypertension. Nephropathy was more frequent among patients with hypertension than among those without hypertension (32.8% vs. 14.2%; OR = 2.96, 95% CI: 1.91–4.58; p < 0.001). Higher grades of hypertension were significantly associated with peripheral arterial disease and cerebrovascular accident. Longer diabetes duration was associated with retinopathy, neuropathy, and cerebrovascular accident, whereas longer hypertension duration was significantly associated with peripheral arterial disease. Conclusions Hypertension is significantly associated with a higher prevalence of both microvascular and macrovascular complications in patients with T2D. These findings support the importance of early identification and integrated management of hypertension, glycemic control, and other cardiovascular risk factors to reduce the burden of diabetic complications.
Background Sarcopenia is characterized by the progressive loss of muscle mass and strength, associated with increased risk of fractures, frailty, morbidity, and mortality. Despite being a preventable and potentially reversible condition, its diagnosis remains challenging due to variability in diagnostic criteria and methods. The Global Leadership Initiative in Sarcopenia recommends including both muscle mass and strength in the diagnostic definition of sarcopenia. This review aims to explore different diagnostic approaches for sarcopenia, focusing on their accuracy, feasibility, clinical utility, and existing limitations. Methods A narrative review was conducted using PubMed to identify studies on sarcopenia diagnosis and assessment. Articles were selected based on relevance to muscle strength, muscle mass, and physical performance, with predefined inclusion and exclusion criteria. Consensus guidelines from major international working groups were also included. Key findings Assessment of muscle mass in sarcopenia is constrained by a fundamental imbalance between measurement accuracy and clinical feasibility. In clinical settings, dual-energy X-ray absorptiometry and bioelectrical impedance analysis remain at the forefront of muscle mass evaluation despite the limitation of being indirect methods. Muscle ultrasound is emerging as a promising method for the future and can be used adjunctly to evaluate muscle architecture. Cross-sectional direct imaging techniques such as CT and MRI can be used opportunistically as they provide high accuracy but lower feasibility. D3-creatine dilution is emerging as an accurate assessment tool for the future but requires further research into clinical implementation. Overall, assessment of muscle strength and muscle mass remains central to the diagnosis of sarcopenia, while physical performance measures are important for outcome prediction. Conclusion No single diagnostic method is sufficient on its own, and substantial heterogeneity remains in sarcopenia assessment. A pragmatic approach combining measures of muscle strength, muscle mass, and physical performance is therefore required.
Background Hereditary angioedema (HAE) is a rare, potentially life-threatening disease characterized by unpredictable swelling attacks. Early administration of acute treatment is essential, with self-administration playing a key role. This study evaluated the acceptance of intravenous self-administration and the effectiveness of a structured training program among patients with HAE in Romania. Methods Two face-to-face training sessions were organized for adults and adolescents with HAE from Romania, as well as for parents of adolescent patients registered in the national HAE Registry. Each session included a theoretical component followed by hands-on training using an artificial arm. Participants completed pre- and post-training questionnaires developed by HAE experts to assess knowledge, experience, skills, and confidence related to the intravenous self-administration. Results Of the 93 patients informed about the training, 38 (41%) expressed interest in the first session and 13 (14%) in the second. A total of 24 individuals ultimately participated, with a mean age of 40.8 years. The majority were adults (23, 95.8%), female (18, 75%), and diagnosed with HAE type 1 (23, 95.8%). Twenty participants (83.3%) rated the training as extremely useful. The practice resulted in significant improvements in self-reported knowledge, experience, and confidence regarding intravenous self-administration, with large effect sizes across all domains. Sixteen patients (66.7%) reported willingness to try this type of self-administration, whereas two (8.3%) indicated they would not prefer this route, and five (20.8%) stated they would not choose it even if administered by a healthcare professional. Notably, during the second session, none of the participants was willing to attempt the practical component. Conclusions These findings suggest that while patients generally perceive home treatment as beneficial, the intravenous route remains a significant barrier and may be a suitable option only for selected HAE patients. While structured training improves cognitive and affective domains, continued practical reinforcement is required to ensure consistent technical proficiency.
Background. Intravenous (i.v.) lidocaine exhibits multimodal analgesic, anti-inflammatory, and anticancer properties. However, concerns regarding systemic toxicity and impaired hepatic drug clearance during liver resection necessitate caution in perioperative dosing protocols. This study aimed to evaluate the clinical recovery parameters and systemic inflammatory markers following continuous perioperative i.v. lidocaine infusion in patients undergoing elective hepatectomy for hepatocellular carcinoma (HCC). Methods. In this prospective, randomized controlled trial, 60 patients undergoing elective surgical resection for HCC were assigned (1:1 ratio) to either a lidocaine group (n=30) or a control group (n=30). The lidocaine group received an intraoperative IV bolus (1.5 mg/kg) followed by a continuous infusion (1 mg/kg/h), maintained throughout surgery and for 24 hours postoperatively. Primary endpoints evaluated 24 hour opioid consumption, Numeric Rating Scale pain scores, return of bowel function, length of hospital stay, and perioperative inflammatory response. Results. No statistically significant differences were observed between the lidocaine and control groups across clinical recovery outcomes. Intraoperative fentanyl consumption was identical between groups 0.8±0.1 mg (vs. 0.8±0.2 mg; p=0.957). The lidocaine group demonstrated a non-significant trends toward reduced 24-hour postoperative morphine consumption (13.5±13.3 mg vs. 19.5±15.8 mg; p=0.224), lower mean 24-hour NRS pain scores (3.36±1.77 vs. 3.80±1.85; p=0.275), and faster recovery of bowel motility (3.0±0.9 vs. 3.4±1.5 days; p=0.215). Length of hospital stay was comparable (9.46±3.15 vs. 8.47±3.09 days; p=0.340). Both groups exhibited significant postoperative increases in CRP and leukocyte levels (p<0.05), with no significant between-group differences postoperatively. Conclusion. A modified, lower-dose perioperative i.v. lidocaine regimen tailored for toxicity safety in patients with liver resection is well-tolerated but does not yield statistically significant reductions in postoperative opioid consumption, pain scores, bowel recovery time, systemic inflammatory markers, or hospital stay following open hepatectomy. Further, adequately powered studies are needed.
Backgrounds:The fibrosis-4 index is a simple biomarker tool widely recommended to diagnose advanced hepatic fibrosis in patients with type 2 diabetes mellitus (T2DM). The primary aim of this study was to assess liver fibrosis risk among type 2 diabetes mellitus patients using the Fib-4 score, secondary to compare the prevalence of degenerative complications between patients according to Fib-4 index risk, and to evaluate the prevalence of metabolic dysfunction-associated-steatotic liver disease in our population. Methods:This is a descriptive-analytical cross-sectional study including 600 patients with type 2 diabetes mellitus who were followed at the Endocrinology-Diabetology and Nutrition Department of a university hospital center, for a period of 8 years and 10 months from January 2016 to October 2024. Results:The mean age in our population was 59±12.8 years. The median duration of diabetes was 6.4 years (1-15 years) with a median HbA1c value of 10.2±2.7%. Overweight and obesity were found in 39.2% and 34.5% of patients respectively, with a mean BMI of 28.2±5.9 kg/m2. The median of fibrosis-4 index was 1.09. Sixty-one percent of patients had a low risk of advanced liver fibrosis, 31% had an intermediate risk, and 8% had a high risk to develop an advanced liver fibrosis. Patients with a Fib-4 score ≥1.3 (indicating intermediate to high risk of liver fibrosis) had a statistically significantly higher prevalence of all microvascular complications and ischemic heart disease (p<0.001) compared to those with a Fib-4<1.3. There was no significant difference in HbA1c, arterial hypertension, metabolic syndrome, and dyslipidemia. However, the mean LDL-cholesterol was lower in the group with a Fib-4≥1.3 (p:0.024). Liver ultrasonography showed signs of metabolic dysfunction-associated steatotic liver disease in 47.7% of cases. Conclusion:Fibrosis-4 index should be considered for routine screening of liver fibrosis in patients with type 2 diabetes mellitus. This simple and cost-effective tool can help identify patients at high risk. The current study highlighted the benefits of using this score among patients with T2DM and supported the high prevalence of microvascular complications and ischemic heart disease among patients with Fib-4 index ≥1.3. Furthermore prospective studies are required to evaluate the incidence outcomes in this population.
