Hypogonadism in Male Sexual Dysfunction

Normal testosterone level is influencing all the steps of the male psychosexual development: intrauterine neonatal and final psychosexual development.. At pubertal stage, the quality of testosterone secretion is conditioning the development of the mature male phenotype. In adult life, eugonadism sustains desire, arousal, determines spontaneous erections, facilitates stimulated erection, influencing the response rate to medication. Moreover, eugonadism sustain daydreaming and phantasies, both needed for a normal sexual life. The pathogenic mechanism of all these actions is presented. Talking about hypogonadism means not only the classical types of hypogonadism: due to classical testicular disease of central, hypothalamic and hypophysis disease, but also the partial testosterone deficiency induces by aging (late onset hypogonadism), weight increase (up to 30% of males with metabolic syndrome and 50% of males with diabetes) or secondary hypogonadism described in chronic use of steroids or after long exposure to stress, especially in young males. All these types of hypogonadism, that affect young, middle aged or old males will be presented separately. A therapeutic approach that is individualized for each type of hypogonadism, should consider positive and possible negative effects and all alternatives will be presented: life style changes, sustained weight loss, increase exercise, supplemental therapy, pro fertility treatment

Shear-Wave Elastography in Diffuse Thyroid Diseases

The diagnosis and evaluation of diffuse thyroid pathologies is often a challenge for clinicians. Ultrasonography has an essential contribution in thyroid imaging, but elastography adds more accuracy. Frequently used in the evaluation of thyroid nodules, elastography has become a necessary tool in assessing the risk of malignancy. Diffuse thyroid pathologies such as Graves’ disease, chronic autoimmune thyroiditis, and subacute thyroiditis, are diagnosed based on laboratory tests completed with imaging. Recently it has been shown that elastography is useful in the evaluation and differentiation of these cases due to the differences in elasticity. This chapter describes the general principles of shear-wave elastography, examination technique, features found in diffuse thyroid disease, but also the limitations of this type of investigation for a better understanding of its use in assessing diffuse thyroid pathology

Microbiological aspects in periodontal disease and diabetes mellitus

Background and Aims. Scientists are constantly showing a high interest for the relationship between Periodontal Disease (PD) and Diabetes Mellitus (DM). PD, “the sixth complication” of DM is recognized to be a chronic gram-negative anaerobic infectious disease. This paper is aimed at reviewing and evaluating the correlations between PD and DM from a microbiological point of view. Treatment implications of PD’s management as an important component of DM care is reviewed in the light of microbiological current knowledge. Materials and Methods. Microbiological studies and clinical trials were selected from medical and dental journals, and studied thoroughly. Results. Plaque biofilm and prolonged hyperglycemia increase the risk of PD development in DM. These two features determine inflammatory reactions that end-up in tissue destruction and impaired healing responses. Few pathogens are considered highly prevalent periodontal pathogens, with destructive actions. Studies have shown that metabolic balance or lack of balance determines bacterial variations in diabetic patients with PD. Other results demonstrate the importance of microbial tests (especially PCR techniques) as indicators for healing or disease progression. Conclusions. There aren’t many studies assessing the relationship between PD and DM from microbiological points of view. In light of increasing evidence, larger interventional studies are neede

THE EVALUATION OF OBESITY-RELATED CARDIOMETABOLIC DISEASES: A SIMPLE ANTHROPOMETRIC TOOL FOR A COMPLICATED MATTER

Introduction. Anthropometric measurements are simple clinical tools that can be used for the evaluation of obesity-related cardiometabolic complications. Objective. To identify obesity-related cardiometabolic outcomes and to compare the relevance of BMI or WHtR for early diagnosis in a group of obese children and adolescents. Material and methods. The study included 174 children diagnosed with simple obesity during a three year period. Anthropometric measurements (including BMI and WHtR) and biochemical variables were analyzed. Results. 4.28% of children were overweight, 31.43% were obese and 64.29% had extreme obesity. The main cardiometabolic complication was insulin resistance (47.76%) followed by hyperinsulinism, alteration of the lipid metabolism and hypertension. All children had a WHtR ≥ 0.5. One Way ANOVA with post-hoc t-test analysis was used for the comparative evaluation of the BMI and WHtR; there were no statistic signifi cant differences between groups. Conclusion. Obesity defi ned by BMI and a WHtR ≥ 0.5 is in the majority of cases associated with adverse cardiometabolic outcomes. Both anthropometric indexes should be used as evaluation tools in medical practice, but WHtR has some important advantages

EVALUAREA COMPLICAŢIILOR CARDIO-METABOLICE ASOCIATE OBEZITĂŢII: O METODĂ ANTROPOMETRICĂ SIMPLĂ UTILIZATĂ ÎNTR-O PROBLEMĂ COMPLICATĂ

Introducere. Măsurarea indicilor somato-metrici reprezintă o metodă clinică simplă, ce poate fi utilizată pentru evaluarea complicaţiilor cardio-metabolice asociate obezităţii. Obiective. Identifi carea complicaţiilor cardio-metabolice asociate obezităţii şi evaluarea relevanţei utilizării IMC sau a raportului circumferinţă talie-înălţime pentru diagnosticul precoce al acestora, într-un grup de copii şi adolescenţi obezi. Material şi metode. Studiul a inclus 174 de copii diagnosticaţi cu obezitate primară pe o perioadă de 3 ani. Varia bilele analizate au fost: indicii antropometrici (inclusiv IMC, raportul circumferinţă talie-înălţime) şi rezultatele investigaţiilor biochimice. Rezultate. 4,28% dintre copii prezentau suprapondere, 31,43% obezitate şi 64,29% obezitate extremă. Principalele complicaţii cardio-metabolice diagnosticate au fost: insulinorezistenţa (47,76%), hiperinsulinismul, alterarea metabolismului lipidic şi hipertensiunea arterială. Toţi copiii au avut un raport circumferinţă talieînălţime ≥ 0,5. Pentru compararea celor doi indici antropometrici s-a folosit testul ANOVA unifactorial şi analiza post-hoc; nu au existat diferenţe statistic semnifi cative între loturile analizate. Concluzii. Obezitatea defi nită prin valoarea IMC şi raportul circumferinţă talie-înălţime ≥ 0,5 se asociază, în majoritatea cazurilor, cu complicaţii cardio-metabolice. În practica medicală atât IMC, cât şi WHtR ar trebui utilizaţi ca şi metode de evaluare dar, raportul circumferinţă talie-înălţime prezintă câteva avantaje importante

DIFICULTĂŢI DE DIAGNOSTIC ÎN HIPOGLICEMIA SUGARULUI

Introducere. Hipoglicemia cu diversele ei cauze este frecvent semnalată în patologia pediatrică, începând din perioada neonatală şi până în adolescenţă. Prin consecinţele ei atât cele imediate (convulsii, comă), cât şi cele tardive (afectare neurologică), hipoglicemia trebuie cunoscută, prevenită, evitată şi tratată. Obiective. Prezentarea evoluţiei clinice a unei paciente cu hipoglicemie severă simptomatică încă din perioada de nou-născut. De la naştere, valoarea glicemiei prezintă o dinamică fl uctuantă, iar scăderea glicemiei, izolat, nu reprezintă neapărat o situaţie patologică, dar poate fi un simptom al unei patologii subiacente. Material şi metodă. Pacienta este internată în clinica noastră la vârsta de nou-născut, în vederea stabilirii etiologiei şi tratamentului hipoglicemiilor. Am realizat profi lul biologic şi hormonal, am efectuat determinări san guine metabolice şi teste genetice. Rezultate. Am stabilit diagnosticul de hipoglicemie severă persistentă. Interpretarea rezultatelor a fost în greunată de evoluţia trenantă a bolii, vârsta mică şi complianţa scăzută din partea familiei. Concluzii. Hipoglicemia persistentă are cauze multiple. Managementul unui sugar cu hipoglicemie severă poate fi difi cil şi impune o abordare complexă

DIAGNOSIS DIFFICULTIES IN INFANT’S HYPOGLYCEMIA

Introduction. Hypoglycemia with its diverse causes is frequently encountered in the pediatrics pathology, beginning with the neonatal period and until the adolescent one. Through its consequences, both, the early (seizures, coma) and the late ones (neurological impairment), hypoglycemia must be identifi ed, prevented, avoided and treated. Objectives. To present the clinical evolution of a female patient with severe, symptomatic hypoglycemia even since the neonatal period. Since birth, the value of glycaemia presents a fl uctuant dynamic, and the isolated decrease of glycaemia does not necessary represent a pathological situation, but can be a symptom of an underlying disorder. Material and method. The patient is admitted in our clinic at the age of newborn in order to establish the etiology and treatment of hypoglycemia. We achieved the biologic and hormonal profi le, we performed metabolic blood determinations and genetic tests. Results. We established the diagnosis of severe persistent hypoglycemia. The burden of the results interpretation was represented by the prolonged evolution of the disease, the small age and the family’s low compliance. Conclusions. Persistent hypoglycemia has multiple causes. The management of an infant with severe hypoglycemia can be diffi cult and it imposes a complex approach

TUMORA DE GLANDĂ PINEALĂ

Tumorile de glandă pineală reprezintă 3-8% din totalul tumorilor cerebrale la copil. Vârsta medie de debut se situează între 10-13 ani. Simptomatologia clinică este în strânsă legătură atât cu relaţiile anatomice ale glandei pineale, cât şi cu structura histologică a formaţiunii tumorale. Cele mai frecvente simptome includ cefaleea, greţurile, vărsăturile, toate având ca substrat compresiunea pe structurile învecinate şi hidrocefalia consecutivă. Autorii prezintă cazul unei fetiţe în vârstă de 6 ani, internată în Clinica II Pediatrie pentru vărsături incoercibile, cefalee în cască. La examenul fundului de ochi se observă papila nervului optic cu contur şters iar examinarea RMN evidenţiază tumoră de glandă pineală cu hidrocefalie triventriculară

The Oscillometric Pulse Wave Analysis Is Useful in Evaluating the Arterial Stiffness of Obese Children with Relevant Cardiometabolic Risks

Early detection of all complications of childhood obesity is imperative in order to minimize effects. Obesity causes vascular disruptions, including early increased arterial stiffness and high blood pressure. This study’s aim is to assess the reliability of pulse wave analysis (PWA) in obese children and how additional risk factors influence the evaluated parameters. We analyzed 55 children aged 6–18 years old by measuring their pulse wave velocity (PWV), augmentation index (AIx), peripheral blood pressure (SBP, DBP), heart rate, central blood pressure (cSBP, cDBP) and central pulse pressure (cPP). We used the oscillometric IEM Mobil-O-Graph and performed a single-point brachial measurement. The subjects were divided into two groups: obese (n = 30) and normal-weight (n = 25) and were clinically and anamnestically assessed. BMI and waist circumference are significantly correlated to higher values for PWV, SBP, DBP, cSBP, and cDBP. Weight significantly predicts PWV, SBP, DBP and cPP. The risk factors that significantly influence the PWA and BP values are: a cardiometabolically risky pregnancy (higher PWV, AIx, SBP), active and passive smoking (higher PWV, SBP, cSBP, cDBP), sleep deprivation (higher PWV, SBP, cSBP) and sedentariness (higher PWV, AIx, peripheral and central BP). We conclude that obese children with specific additional cardiometabolic risk factors present increased arterial stiffness and higher blood pressure values