Iris Bararu - Academia.edu (original) (raw)

Papers by Iris Bararu

Nephrology Dialysis Transplantation, 2014

Introduction and Aims: Hyperkalaemia is a risk factor for mortality in patients with cardiovascul... more Introduction and Aims: Hyperkalaemia is a risk factor for mortality in patients with cardiovascular disease and chronic kidney disease (CKD) (Goyal, 2012; Torlen, 2012) and limits use of renin-angiotensin-aldosterone system inhibitors (RAASi) in these patients. Sodium (or calcium) polystyrene sulfonate (SPS/CPS) has uncertain efficacy and has been associated with substantial adverse events, as well as poor gastrointestinal tolerability, and hence is suboptimal for acute use and unsuitable for chronic use (Harel, 2013; Sterns, 2010). Therefore, there is a need for a hyperkalaemia treatment that rapidly reduces serum potassium (K+) and is safe and well tolerated in these patients. ZS-9, a nonabsorbed cation exchanger designed to specifically entrap excess K +, significantly reduced K+ vs placebo over 48 hr with excellent tolerability in patients with CKD (Ash, 2013). We report acute-phase efficacy in a Phase 3 trial of ZS-9 in patients with hyperkalemia. Methods: Patients (N=753) with serum K+ 5.0-6.5 mmol/L were randomised (1:1:1:1:1) to ZS-9 (1.25g, 2.5g, 5g or 10g) or placebo given three times daily (TID) with meals for 48 hr (acute phase), after which those with K+ ≤4.9 mmol/L (n=542) were re-randomised to ZS-9 or placebo once daily for Day 3-15. Serum K+ was measured at baseline and at predefined intervals, including 1, 4, 24, and 48 hr after the first dose. The acute-phase primary efficacy endpoint was the rate of K+ change over the first 48 hr, using longitudinal modeling to account for all post-baseline data. Results:Mean K+ at baseline was 5.3 mmol/L. Substantial percentages of patients had CKD (60%), a history of heart failure (40%), or diabetes (60%) or were on RAASi therapy (67%). ZS-9 demonstrated significant dose-dependent reductions in K+; the acute-phase primary efficacy endpoint was met for ZS-9 2.5g (p=0.0009), 5g (p<0.0001) and 10g TID (p<0.0001; Fig. 1). There was a significant decrease in K+ by -0.11 mmol/L with ZS-9 10g vs an increase of +0.01 mmol/L with placebo (p=0.009) 1 hr after the first dose. At 48 hr K+ fell by -0.73 mmol/L with 10g TID vs -0.25 mmol/L with placebo (p<0.001); other significant reductions vs placebo are shown in Fig 2. Rates of all adverse events (AEs) and gastrointestinal AEs were not significantly different in the ZS-9 and placebo groups. Conclusions: ZS-9 produced significant dose-dependent reductions in K+ when given TID for 48 hr, with an AE profile similar to placebo. The significant reduction in serum K+ 1 hr after the first ZS-9 10g dose further suggests that ZS-9 is effective in removing K+ from the small intestine fluid, where it is in equilibrium with blood levels. ZS-9 may address an important unmet clinical need by rapidly correcting hyperkalaemia in high-risk patients, many of whom require RAASi for end-organ protection. SP321 PHASE 3, MULTICENTER, RANDOMISED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIALOF ZS-9: SUBGROUP ANALYSIS STRATIFIED BY BASELINE SERUM POTASSIUM LEVELS

Revista medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi

To analyze the correlations between inflammation markers and ApoB100 and angiotensin converting e... more To analyze the correlations between inflammation markers and ApoB100 and angiotensin converting enzyme (ACE) gene polymorphism and the severity of coronary artery disease (CAD).

Revista medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi, 2014

UNLABELLED The aim of our study was to investigate whether the disorder of coagulation and fibrin... more UNLABELLED The aim of our study was to investigate whether the disorder of coagulation and fibrinolysis factors are mechanisms that contribute to the prothrombotic state in patients with polycythemia vera (PV) syndrome with or without cardiovascular disease (CVD), in order to identify the patients having high risk for thrombotic events. MATERIAL AND METHODS The study comprises 20 patients divided in 2 groups: 10 patients with PV syndrome (PV) and 10 patients with PV and cardiovascular diseases associated (PV+CVD). The patients were tested by determining three factors of coagulation profile: protein S, free fraction (PS), antithrombin III (AT III) and Protein C (PC). RESULTS The level of the three parameters were found significantly modified in the both groups (p < 0.05); comparing the results between the two groups of patients, in the second group (PV+CVD) the level of the parameters were significantly lower than in the first group (PV). CONCLUSIONS In PV syndrome the risk for th...

Revista medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi, 2016

Aim To analyze the correlations between inflammation markers and ApoB100 and angiotensin converti... more Aim To analyze the correlations between inflammation markers and ApoB100 and angiotensin converting enzyme (ACE) gene polymorphism and the severity of coronary artery disease (CAD). Material and Methods We conducted a study in 58 patients with acute coronary syndromes (ACS) who underwent coronarography at the Iasi "Prof. Dr. George I.M. Georgescu' Institute of Cardiovascular Diseases. the patients included in the studies were selected from those who needed a coronarography for unstable angina or acute myocardial infarction. The data were uploaded and processed using the statistical functions in SPPS 18.0 at a 95% materiality threshold. Results Elevated inflammation markers were found in all study patients, with small differences in distribution. None of the study patients presented ApoB100 gene mutations. As to ACE polymorphism, a predominance of genotype II in unicoronary patients and ID and DD genotypes in bicoronary and tricoronary patients was found. Conclusions The res...

Coronary artery disease (CAD) is the most prevalent cause of morbidity and mortality worldwide. I... more Coronary artery disease (CAD) is the most prevalent cause of morbidity and mortality worldwide. It is a multifactorial disease, which is influenced by genetic and environmental factors. The major risk factors of CAD are age, male gender, hypertension, diabetes, hyperlipidemia, smoking, family history of CAD and obesity. Genetic factors add further information in predicting CAD. The relationship between genetic risk factors and the development of CAD is not well understood, likely due to the complex interrelation of genetic and environmental risk factors. One of the currently explored genetic factors is angiotensin converting enzyme (ACE) polymorphisms, which may have an influence on the progression of coronary artery disease. We present the results of several recently published studies (2012,2013) on the association between traditional cardiovascular risk factors and novel genetic risk factors (polymorphisms of ACE gene: insertions/deletions). The results of these studies are contro...

Diabetes is a very common disease characterized by a prothrombotic status involving both the chro... more Diabetes is a very common disease characterized by a prothrombotic status involving both the chronic activation of the clotting system and a decrease in the endogenous fibrinolytic capacity. The existing data regarding the hemostatic alterations in diabetic patients are insufficient and contradictory due to the heterogeneity of the studied population, the presence of cardiovascular complications, glycemic status, other associated risk factors, and the type of treatment. The metabolic changes found in diabetic patients cause disturbances in platelet activity, hemostasis, endogenous fibrinolysis and rheology favoring a prothrombotic status. These systemic changes may lead to an extensive atherosclerotic process derived from the thrombophilic status, thus partially explaining the frequent coronary atherosclerosis in type 2 diabetic patients. Moreover, the hemostatic alterations seen in diabetic patients seem to be responsible for the microvascular localization of coronary atheroscleros...

Although ischemic heart disease is the major cause of death in diabetic patients, diabetic cardio... more Although ischemic heart disease is the major cause of death in diabetic patients, diabetic cardiomyopathy (DCM) is increasingly recognized as a clinically relevant entity. Considering that it comprises a variety of mechanisms and effects on cardiac function, increasing the risk of heart failure and worsening the prognosis of this patient category, DCM represents an important complication of diabetes mellitus, with a silent development in its earlier stages, involving intricate pathophysiological mechanisms, including oxidative stress, defective calcium handling, altered mitochondrial function, remodeling of the extracellular matrix, and consequent deficient cardiomyocyte contractility. While DCM is common in diabetic asymptomatic patients, it is frequently underdiagnosed, due to few diagnostic possibilities in its early stages. Moreover, since a strategy for prevention and treatment in order to improve the prognosis of DCM has not been established, it is important to identify clear ...

Internal Medicine

Cardiovascular diseases cause approximately one-third of deaths worldwide and an increasing numbe... more Cardiovascular diseases cause approximately one-third of deaths worldwide and an increasing number of individuals with non-fatal ischemic heart disease live with chronic disabilities and impaired quality of life. Cardiac rehabilitation is designed to limit the physiological and psychological effects of cardiac illness, reduce the risk for sudden death or re-infarction, control cardiac symptoms and enhance the psychosocial and vocational status of selected patients. The study group included a group of 78 patients who had a coronary event no more than 3 months ago and who are included in cardio-vascular recovery programs. The patients were echocardiographic evaluated at the first admission and later at 6 months. The evolution of the patients was a favorable one, being objectified an increase of both the ejection fraction of the left ventricle, as well as an improvement of MAPSE and TAPSE.

Revista de Chimie

Cardiopulmonary exercise testing (CPET) has become the golden standard in the assessment of exerc... more Cardiopulmonary exercise testing (CPET) has become the golden standard in the assessment of exercise capacity and intensity of the patients who are performing cardiac rehabilitation. The purpose of our study was to objectify the relationships between the parameters of CPET and the lipid profile after the cardiovascular rehabilitation. We found a significant increase in oxygen consumption (VO2) values, anaerobic threshold, effort capacity and maximum heart rate and an improvement in the lipid profile, marking a reduced cardiovascular risk.

Romanian Biotechnological Letters

Type 2 diabetes mellitus (T2DM) is a very common disease, which is characterized by a prothrombot... more Type 2 diabetes mellitus (T2DM) is a very common disease, which is characterized by a prothrombotic status, very frequently leading to severe complications.The thrombophillic status results from chronic activation of the coagulation system, associated with a decrease in the endogenous fibrinolytic capacity. The objective of this study was to evaluate the thrombotic status in type 2 diabetic patients and to establish if the genomic polymorphisms of the haemostatic factors favor the increase of thrombosis in insulin resistance statuses. The research was done on a group of 60 patients with T2DM. Metabolic parameters such asserum glucose, total cholesterol, LDL, HDL, triglycerides, glycated hemoglobin and renal function indicators were assessed after 12 hours of fasting. The haemostasis was investigated through the levels of fibrinogen, thrombocytes count and morphology, the antithrombin III plasmatic concentration, the presence of different PAI-1 and coagulation factor XIII genotypes. The study revealed that PAI-14G/4G genotype was associated with high glycated hemoglobin levels and with increased total and LDL cholesterol, while the other PAI-1 genotypes had no such associations. Our research also showed that the mutant WT+MT factor XIII heterozygote was associated with high total and LDL cholesterol levels and with increased CRP concentrations.

Journal of Diabetes Research, 2017

Although ischemic heart disease is the major cause of death in diabetic patients, diabetic cardio... more Although ischemic heart disease is the major cause of death in diabetic patients, diabetic cardiomyopathy (DCM) is increasingly recognized as a clinically relevant entity. Considering that it comprises a variety of mechanisms and effects on cardiac function, increasing the risk of heart failure and worsening the prognosis of this patient category, DCM represents an important complication of diabetes mellitus, with a silent development in its earlier stages, involving intricate pathophysiological mechanisms, including oxidative stress, defective calcium handling, altered mitochondrial function, remodeling of the extracellular matrix, and consequent deficient cardiomyocyte contractility. While DCM is common in diabetic asymptomatic patients, it is frequently underdiagnosed, due to few diagnostic possibilities in its early stages. Moreover, since a strategy for prevention and treatment in order to improve the prognosis of DCM has not been established, it is important to identify clear ...

The aim of our study was to investigate whether the disorder of coagulation and fibrinolysis fact... more The aim of our study was to investigate whether the disorder of coagulation and fibrinolysis factors are mechanisms that contribute to the prothrombotic state in patients with polycythemia vera (PV) syndrome with or without cardiovascular disease (CVD), in order to identify the patients having high risk for thrombotic events. The study comprises 20 patients divided in 2 groups: 10 patients with PV syndrome (PV) and 10 patients with PV and cardiovascular diseases associated (PV+CVD). The patients were tested by determining three factors of coagulation profile: protein S, free fraction (PS), antithrombin III (AT III) and Protein C (PC). The level of the three parameters were found significantly modified in the both groups (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05); comparing the results between the two groups of patients, in the second group (PV+CVD) the level of the parameters were significantly lower than in the first group (PV). In PV syndrome the risk for thrombosis is also due to the changes in coagulation factors. Patients with associated cardiovascular disease, present a more severe risk for trombothic events, so regarding the disorder of coagulation factors, this represent a major mechanism implicated in the etiology of thrombosis in these categories of patients.

American Journal of Kidney Diseases, 2010

In patients with euvolemic and hypervolemic hyponatremia, the effect of vasopressin antagonists i... more In patients with euvolemic and hypervolemic hyponatremia, the effect of vasopressin antagonists is yet undefined. Systematic review and meta-analysis of randomized controlled trials (RCTs). In- and outpatients with euvolemic or hypervolemic hyponatremia. We included all RCTs regardless of publication status or language. Vasopressin antagonists with or without fluid restriction versus placebo or no treatment with or without fluid restriction. Response rate defined as normalization of serum sodium level or significant increase in serum sodium level at 3-7 days (primary) and later, change from baseline serum sodium level at 3-7 days and later, adverse events, rate of rapid sodium level correction, and rate of hypernatremia. 15 RCTs were identified. Vasopressin antagonist treatment significantly increased response rate both early (RR, 3.15; 95% CI, 2.27-4.37; 11 trials) and late (RR, 2.27; 95% CI, 1.79-2.89; 4 trials). Response rates were high in trials assessing mostly euvolemic patients and those assessing mostly hypervolemic patients, with greater effect estimate in the former. Change from baseline serum sodium level was significantly increased both early (weighted mean difference, 5.27 mEq/L; 95% CI, 4.27-6.26, 13 trials) and late (weighted mean difference, 3.49 mEq/L; 95% CI, 2.56-4.41, 8 trials). Although there was an increased rate of rapid sodium correction (RR, 2.52; 95% CI, 1.26-5.08, 8 trials) with vasopressin antagonists, hypernatremia rates were not significantly higher (RR, 2.21; 95% CI, 0.61-7.96; 5 trials), adverse events were not increased, and there were no reports of osmotic demyelination syndrome. Significant heterogeneity in the primary outcome. Vasopressin antagonists are effective for the treatment of hypervolemic and euvolemic hyponatremia.

Revista medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti din Iaş̧i

The aim of our study was to investigate whether the disorder of coagulation and fibrinolysis fact... more The aim of our study was to investigate whether the disorder of coagulation and fibrinolysis factors are mechanisms that contribute to the prothrombotic state in patients with polycythemia vera (PV) syndrome with or without cardiovascular disease (CVD), in order to identify the patients having high risk for thrombotic events. The study comprises 20 patients divided in 2 groups: 10 patients with PV syndrome (PV) and 10 patients with PV and cardiovascular diseases associated (PV+CVD). The patients were tested by determining three factors of coagulation profile: protein S, free fraction (PS), antithrombin III (AT III) and Protein C (PC). The level of the three parameters were found significantly modified in the both groups (p < 0.05); comparing the results between the two groups of patients, in the second group (PV+CVD) the level of the parameters were significantly lower than in the first group (PV). In PV syndrome the risk for thrombosis is also due to the changes in coagulation f...

Nephrology Dialysis Transplantation, 2014

Introduction and Aims: Hyperkalaemia is a risk factor for mortality in patients with cardiovascul... more Introduction and Aims: Hyperkalaemia is a risk factor for mortality in patients with cardiovascular disease and chronic kidney disease (CKD) (Goyal, 2012; Torlen, 2012) and limits use of renin-angiotensin-aldosterone system inhibitors (RAASi) in these patients. Sodium (or calcium) polystyrene sulfonate (SPS/CPS) has uncertain efficacy and has been associated with substantial adverse events, as well as poor gastrointestinal tolerability, and hence is suboptimal for acute use and unsuitable for chronic use (Harel, 2013; Sterns, 2010). Therefore, there is a need for a hyperkalaemia treatment that rapidly reduces serum potassium (K+) and is safe and well tolerated in these patients. ZS-9, a nonabsorbed cation exchanger designed to specifically entrap excess K +, significantly reduced K+ vs placebo over 48 hr with excellent tolerability in patients with CKD (Ash, 2013). We report acute-phase efficacy in a Phase 3 trial of ZS-9 in patients with hyperkalemia. Methods: Patients (N=753) with serum K+ 5.0-6.5 mmol/L were randomised (1:1:1:1:1) to ZS-9 (1.25g, 2.5g, 5g or 10g) or placebo given three times daily (TID) with meals for 48 hr (acute phase), after which those with K+ ≤4.9 mmol/L (n=542) were re-randomised to ZS-9 or placebo once daily for Day 3-15. Serum K+ was measured at baseline and at predefined intervals, including 1, 4, 24, and 48 hr after the first dose. The acute-phase primary efficacy endpoint was the rate of K+ change over the first 48 hr, using longitudinal modeling to account for all post-baseline data. Results:Mean K+ at baseline was 5.3 mmol/L. Substantial percentages of patients had CKD (60%), a history of heart failure (40%), or diabetes (60%) or were on RAASi therapy (67%). ZS-9 demonstrated significant dose-dependent reductions in K+; the acute-phase primary efficacy endpoint was met for ZS-9 2.5g (p=0.0009), 5g (p<0.0001) and 10g TID (p<0.0001; Fig. 1). There was a significant decrease in K+ by -0.11 mmol/L with ZS-9 10g vs an increase of +0.01 mmol/L with placebo (p=0.009) 1 hr after the first dose. At 48 hr K+ fell by -0.73 mmol/L with 10g TID vs -0.25 mmol/L with placebo (p<0.001); other significant reductions vs placebo are shown in Fig 2. Rates of all adverse events (AEs) and gastrointestinal AEs were not significantly different in the ZS-9 and placebo groups. Conclusions: ZS-9 produced significant dose-dependent reductions in K+ when given TID for 48 hr, with an AE profile similar to placebo. The significant reduction in serum K+ 1 hr after the first ZS-9 10g dose further suggests that ZS-9 is effective in removing K+ from the small intestine fluid, where it is in equilibrium with blood levels. ZS-9 may address an important unmet clinical need by rapidly correcting hyperkalaemia in high-risk patients, many of whom require RAASi for end-organ protection. SP321 PHASE 3, MULTICENTER, RANDOMISED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIALOF ZS-9: SUBGROUP ANALYSIS STRATIFIED BY BASELINE SERUM POTASSIUM LEVELS

Revista medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi

To analyze the correlations between inflammation markers and ApoB100 and angiotensin converting e... more To analyze the correlations between inflammation markers and ApoB100 and angiotensin converting enzyme (ACE) gene polymorphism and the severity of coronary artery disease (CAD).

Revista medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi, 2014

UNLABELLED The aim of our study was to investigate whether the disorder of coagulation and fibrin... more UNLABELLED The aim of our study was to investigate whether the disorder of coagulation and fibrinolysis factors are mechanisms that contribute to the prothrombotic state in patients with polycythemia vera (PV) syndrome with or without cardiovascular disease (CVD), in order to identify the patients having high risk for thrombotic events. MATERIAL AND METHODS The study comprises 20 patients divided in 2 groups: 10 patients with PV syndrome (PV) and 10 patients with PV and cardiovascular diseases associated (PV+CVD). The patients were tested by determining three factors of coagulation profile: protein S, free fraction (PS), antithrombin III (AT III) and Protein C (PC). RESULTS The level of the three parameters were found significantly modified in the both groups (p < 0.05); comparing the results between the two groups of patients, in the second group (PV+CVD) the level of the parameters were significantly lower than in the first group (PV). CONCLUSIONS In PV syndrome the risk for th...

Revista medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi, 2016

Aim To analyze the correlations between inflammation markers and ApoB100 and angiotensin converti... more Aim To analyze the correlations between inflammation markers and ApoB100 and angiotensin converting enzyme (ACE) gene polymorphism and the severity of coronary artery disease (CAD). Material and Methods We conducted a study in 58 patients with acute coronary syndromes (ACS) who underwent coronarography at the Iasi "Prof. Dr. George I.M. Georgescu' Institute of Cardiovascular Diseases. the patients included in the studies were selected from those who needed a coronarography for unstable angina or acute myocardial infarction. The data were uploaded and processed using the statistical functions in SPPS 18.0 at a 95% materiality threshold. Results Elevated inflammation markers were found in all study patients, with small differences in distribution. None of the study patients presented ApoB100 gene mutations. As to ACE polymorphism, a predominance of genotype II in unicoronary patients and ID and DD genotypes in bicoronary and tricoronary patients was found. Conclusions The res...

Coronary artery disease (CAD) is the most prevalent cause of morbidity and mortality worldwide. I... more Coronary artery disease (CAD) is the most prevalent cause of morbidity and mortality worldwide. It is a multifactorial disease, which is influenced by genetic and environmental factors. The major risk factors of CAD are age, male gender, hypertension, diabetes, hyperlipidemia, smoking, family history of CAD and obesity. Genetic factors add further information in predicting CAD. The relationship between genetic risk factors and the development of CAD is not well understood, likely due to the complex interrelation of genetic and environmental risk factors. One of the currently explored genetic factors is angiotensin converting enzyme (ACE) polymorphisms, which may have an influence on the progression of coronary artery disease. We present the results of several recently published studies (2012,2013) on the association between traditional cardiovascular risk factors and novel genetic risk factors (polymorphisms of ACE gene: insertions/deletions). The results of these studies are contro...

Diabetes is a very common disease characterized by a prothrombotic status involving both the chro... more Diabetes is a very common disease characterized by a prothrombotic status involving both the chronic activation of the clotting system and a decrease in the endogenous fibrinolytic capacity. The existing data regarding the hemostatic alterations in diabetic patients are insufficient and contradictory due to the heterogeneity of the studied population, the presence of cardiovascular complications, glycemic status, other associated risk factors, and the type of treatment. The metabolic changes found in diabetic patients cause disturbances in platelet activity, hemostasis, endogenous fibrinolysis and rheology favoring a prothrombotic status. These systemic changes may lead to an extensive atherosclerotic process derived from the thrombophilic status, thus partially explaining the frequent coronary atherosclerosis in type 2 diabetic patients. Moreover, the hemostatic alterations seen in diabetic patients seem to be responsible for the microvascular localization of coronary atheroscleros...

Although ischemic heart disease is the major cause of death in diabetic patients, diabetic cardio... more Although ischemic heart disease is the major cause of death in diabetic patients, diabetic cardiomyopathy (DCM) is increasingly recognized as a clinically relevant entity. Considering that it comprises a variety of mechanisms and effects on cardiac function, increasing the risk of heart failure and worsening the prognosis of this patient category, DCM represents an important complication of diabetes mellitus, with a silent development in its earlier stages, involving intricate pathophysiological mechanisms, including oxidative stress, defective calcium handling, altered mitochondrial function, remodeling of the extracellular matrix, and consequent deficient cardiomyocyte contractility. While DCM is common in diabetic asymptomatic patients, it is frequently underdiagnosed, due to few diagnostic possibilities in its early stages. Moreover, since a strategy for prevention and treatment in order to improve the prognosis of DCM has not been established, it is important to identify clear ...

Internal Medicine

Cardiovascular diseases cause approximately one-third of deaths worldwide and an increasing numbe... more Cardiovascular diseases cause approximately one-third of deaths worldwide and an increasing number of individuals with non-fatal ischemic heart disease live with chronic disabilities and impaired quality of life. Cardiac rehabilitation is designed to limit the physiological and psychological effects of cardiac illness, reduce the risk for sudden death or re-infarction, control cardiac symptoms and enhance the psychosocial and vocational status of selected patients. The study group included a group of 78 patients who had a coronary event no more than 3 months ago and who are included in cardio-vascular recovery programs. The patients were echocardiographic evaluated at the first admission and later at 6 months. The evolution of the patients was a favorable one, being objectified an increase of both the ejection fraction of the left ventricle, as well as an improvement of MAPSE and TAPSE.

Revista de Chimie

Cardiopulmonary exercise testing (CPET) has become the golden standard in the assessment of exerc... more Cardiopulmonary exercise testing (CPET) has become the golden standard in the assessment of exercise capacity and intensity of the patients who are performing cardiac rehabilitation. The purpose of our study was to objectify the relationships between the parameters of CPET and the lipid profile after the cardiovascular rehabilitation. We found a significant increase in oxygen consumption (VO2) values, anaerobic threshold, effort capacity and maximum heart rate and an improvement in the lipid profile, marking a reduced cardiovascular risk.

Romanian Biotechnological Letters

Type 2 diabetes mellitus (T2DM) is a very common disease, which is characterized by a prothrombot... more Type 2 diabetes mellitus (T2DM) is a very common disease, which is characterized by a prothrombotic status, very frequently leading to severe complications.The thrombophillic status results from chronic activation of the coagulation system, associated with a decrease in the endogenous fibrinolytic capacity. The objective of this study was to evaluate the thrombotic status in type 2 diabetic patients and to establish if the genomic polymorphisms of the haemostatic factors favor the increase of thrombosis in insulin resistance statuses. The research was done on a group of 60 patients with T2DM. Metabolic parameters such asserum glucose, total cholesterol, LDL, HDL, triglycerides, glycated hemoglobin and renal function indicators were assessed after 12 hours of fasting. The haemostasis was investigated through the levels of fibrinogen, thrombocytes count and morphology, the antithrombin III plasmatic concentration, the presence of different PAI-1 and coagulation factor XIII genotypes. The study revealed that PAI-14G/4G genotype was associated with high glycated hemoglobin levels and with increased total and LDL cholesterol, while the other PAI-1 genotypes had no such associations. Our research also showed that the mutant WT+MT factor XIII heterozygote was associated with high total and LDL cholesterol levels and with increased CRP concentrations.

Journal of Diabetes Research, 2017

Although ischemic heart disease is the major cause of death in diabetic patients, diabetic cardio... more Although ischemic heart disease is the major cause of death in diabetic patients, diabetic cardiomyopathy (DCM) is increasingly recognized as a clinically relevant entity. Considering that it comprises a variety of mechanisms and effects on cardiac function, increasing the risk of heart failure and worsening the prognosis of this patient category, DCM represents an important complication of diabetes mellitus, with a silent development in its earlier stages, involving intricate pathophysiological mechanisms, including oxidative stress, defective calcium handling, altered mitochondrial function, remodeling of the extracellular matrix, and consequent deficient cardiomyocyte contractility. While DCM is common in diabetic asymptomatic patients, it is frequently underdiagnosed, due to few diagnostic possibilities in its early stages. Moreover, since a strategy for prevention and treatment in order to improve the prognosis of DCM has not been established, it is important to identify clear ...

The aim of our study was to investigate whether the disorder of coagulation and fibrinolysis fact... more The aim of our study was to investigate whether the disorder of coagulation and fibrinolysis factors are mechanisms that contribute to the prothrombotic state in patients with polycythemia vera (PV) syndrome with or without cardiovascular disease (CVD), in order to identify the patients having high risk for thrombotic events. The study comprises 20 patients divided in 2 groups: 10 patients with PV syndrome (PV) and 10 patients with PV and cardiovascular diseases associated (PV+CVD). The patients were tested by determining three factors of coagulation profile: protein S, free fraction (PS), antithrombin III (AT III) and Protein C (PC). The level of the three parameters were found significantly modified in the both groups (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05); comparing the results between the two groups of patients, in the second group (PV+CVD) the level of the parameters were significantly lower than in the first group (PV). In PV syndrome the risk for thrombosis is also due to the changes in coagulation factors. Patients with associated cardiovascular disease, present a more severe risk for trombothic events, so regarding the disorder of coagulation factors, this represent a major mechanism implicated in the etiology of thrombosis in these categories of patients.

American Journal of Kidney Diseases, 2010

In patients with euvolemic and hypervolemic hyponatremia, the effect of vasopressin antagonists i... more In patients with euvolemic and hypervolemic hyponatremia, the effect of vasopressin antagonists is yet undefined. Systematic review and meta-analysis of randomized controlled trials (RCTs). In- and outpatients with euvolemic or hypervolemic hyponatremia. We included all RCTs regardless of publication status or language. Vasopressin antagonists with or without fluid restriction versus placebo or no treatment with or without fluid restriction. Response rate defined as normalization of serum sodium level or significant increase in serum sodium level at 3-7 days (primary) and later, change from baseline serum sodium level at 3-7 days and later, adverse events, rate of rapid sodium level correction, and rate of hypernatremia. 15 RCTs were identified. Vasopressin antagonist treatment significantly increased response rate both early (RR, 3.15; 95% CI, 2.27-4.37; 11 trials) and late (RR, 2.27; 95% CI, 1.79-2.89; 4 trials). Response rates were high in trials assessing mostly euvolemic patients and those assessing mostly hypervolemic patients, with greater effect estimate in the former. Change from baseline serum sodium level was significantly increased both early (weighted mean difference, 5.27 mEq/L; 95% CI, 4.27-6.26, 13 trials) and late (weighted mean difference, 3.49 mEq/L; 95% CI, 2.56-4.41, 8 trials). Although there was an increased rate of rapid sodium correction (RR, 2.52; 95% CI, 1.26-5.08, 8 trials) with vasopressin antagonists, hypernatremia rates were not significantly higher (RR, 2.21; 95% CI, 0.61-7.96; 5 trials), adverse events were not increased, and there were no reports of osmotic demyelination syndrome. Significant heterogeneity in the primary outcome. Vasopressin antagonists are effective for the treatment of hypervolemic and euvolemic hyponatremia.

Revista medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti din Iaş̧i

The aim of our study was to investigate whether the disorder of coagulation and fibrinolysis fact... more The aim of our study was to investigate whether the disorder of coagulation and fibrinolysis factors are mechanisms that contribute to the prothrombotic state in patients with polycythemia vera (PV) syndrome with or without cardiovascular disease (CVD), in order to identify the patients having high risk for thrombotic events. The study comprises 20 patients divided in 2 groups: 10 patients with PV syndrome (PV) and 10 patients with PV and cardiovascular diseases associated (PV+CVD). The patients were tested by determining three factors of coagulation profile: protein S, free fraction (PS), antithrombin III (AT III) and Protein C (PC). The level of the three parameters were found significantly modified in the both groups (p < 0.05); comparing the results between the two groups of patients, in the second group (PV+CVD) the level of the parameters were significantly lower than in the first group (PV). In PV syndrome the risk for thrombosis is also due to the changes in coagulation f...