Monica Simina Mihuta

Introduction: Congenital heart defects (CHDs) are the most frequent group of major congenital anomalies and impose a disproportionate burden on neonatal services. Antenatal detection determines where and how an affected newborn is delivered, yet reported detection rates differ several-fold between European countries. We aimed to quantify the postnatal occurrence and the antenatal detection of CHDs in a tertiary obstetric center in Western Romania and to place both figures in a comparable international context. Material and Methods: Retrospective observational study of all 10,113 births registered at the “Pius Brînzeu” County Clinical Emergency Hospital, Timișoara, between 2018 and 2022. Newborns with at least one cardiac lesion recorded on indication-based postnatal echocardiography were identified from the hospital electronic record. Interatrial communications and ductal patency recorded at the neonatal-index examination were counted inclusively and are analyzed separately from structural defects. A defect was classified as antenatally detected when it had been reported at any prenatal ultrasound scan and was subsequently confirmed postnatally. Proportions are reported with Wilson score 95% confidence intervals (CIs), separately at the level of the newborn and at the level of the individual lesion. Results: A total of 541 newborns carried at least one recorded cardiac lesion, giving an occurrence of 5.35% of births (95% CI 4.93–5.81); 670 individual lesions were recorded, a mean of 1.24 per affected newborn. Interatrial communication (n = 319; 47.6% of lesions) and ductal patency (n = 90; 13.4%) accounted for 61.0% of lesions; among the 261 structural defects, ventricular-septal defect was the most frequent (n = 121; 46.4%). An antenatal diagnosis had been made in 151 of 541 newborns (27.9%; 95% CI 24.3–31.8). Detection was highest for lesions distorting the four-chamber view, hypoplastic left-heart syndrome 4/5, and ventricular septal defect 80/121 (66.1%; 95% CI 57.3–73.9), and lowest for lesions requiring outflow-tract or arch views, including pulmonary stenosis 3/27 (11.1%; 95% CI 3.9–28.1) and aortic stenosis 0/12. Restricting the count to structural defects gives 13.1 to 25.8 affected newborns per 1000 births, against a EUROCAT total prevalence of 8.0 per 1000. Conclusions: The occurrence recorded here reflects tertiary referral, indication-based echocardiography, and an inclusive case definition rather than a genuine population excess, and is not interchangeable with registry prevalence. The antenatal detection rate of 27.9% sits between European settings without organized screening and those performing two or three routine scans per pregnancy. The detection deficit is concentrated in lesions that require outflow-tract or arch views. Because the views obtained at each scan were not recorded and detection was not stratified by prenatal-care status, the contribution of examination protocol and of access to care is inferred rather than demonstrated; both are testable hypotheses for a prospective, protocolized study.

Background/Objectives: Type 1 diabetes mellitus (T1DM) has historically been associated with impaired linear growth and delayed pubertal development due to chronic insulin deficiency. Advances in intensive insulin therapy and glucose monitoring may have substantially reduced these effects. This study evaluated growth and pubertal development in children with T1DM treated with multiple daily injections (MDIs) or continuous subcutaneous insulin infusion (CSII) compared with non-diabetic controls and investigated whether metabolic control was associated with anthropometric outcomes. M ethods: This retrospective observational study included 177 children aged 3–18 years: 102 with T1DM (60 treated with MDI and 42 with CSII) and 75 non-diabetic hospital-based controls. Height SDS, BMI SDS, Tanner stage, biochemical parameters, and diabetes-related variables were analyzed. Comparisons, correlations and multiple linear regression analyses were performed to evaluate associations between metabolic control and anthropometric parameters. Results: No significant differences were observed between children with T1DM and healthy controls regarding height SDS, BMI SDS, or pubertal development. Likewise, no anthropometric differences were identified between the MDI and CSII groups. Fasting plasma glucose was significantly lower in the CSII group (p < 0.001), whereas HbA1c was comparable between treatment modalities. Neither HbA1c nor other routinely assessed metabolic parameters showed significant associations with height SDS or BMI SDS in correlation or multivariable regression analyses. Conclusions: Children and adolescents with T1DM showed no significant differences in height SDS, BMI SDS, or Tanner stage compared with controls, and similar anthropometric findings were observed in patients receiving MDI and CSII. These results suggest that major disturbances in attained height and pubertal status were not evident in this contemporary cohort of children with T1DM. However, given the retrospective cross-sectional design, longitudinal studies are needed to determine how contemporary diabetes management and long-term metabolic control influence growth trajectories and pubertal progression.

Background/Objectives: Type 1 diabetes mellitus (T1DM) has historically been associated with impaired linear growth and delayed pubertal development due to chronic insulin deficiency. Advances in intensive insulin therapy and glucose monitoring may have substantially reduced these effects. This study evaluated growth and pubertal development in children with T1DM treated with multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) compared with healthy controls and investigated whether metabolic control was associated with anthropometric outcomes. Methods: This retrospective observational study included 177 children aged 3–18 years: 102 with T1DM (60 treated with MDI and 42 with CSII) and 75 healthy controls. Height SDS, BMI SDS, Tanner stage, biochemical parameters, and diabetes-related variables were analyzed. Comparisons, correlations and multiple linear regression analyses were performed to evaluate associations between metabolic control and anthropometric parameters. Results: No significant differences were observed between children with T1DM and healthy controls regarding height SDS, BMI SDS, or pubertal development. Likewise, no anthropometric differences were identified between the MDI and CSII groups. Fasting plasma glucose was significantly lower in the CSII group (p<0.001), whereas HbA1c was comparable between treatment modalities. Neither HbA1c nor other routinely assessed metabolic parameters showed significant associations with height SDS or BMI SDS in correlation or multivariable regression analyses. Conclusions: Children and adolescents with T1DM achieved growth and pubertal development comparable to healthy peers, regardless of insulin treatment modality. Routine markers of metabolic control were not independently associated with anthropometric outcomes, suggesting that contemporary intensive diabetes management is sufficient to preserve normal growth in most pediatric patients with T1DM.

Type 2 diabetes mellitus (T2DM) is considered a chronic, progressive and irreversible condition; however, evidence accumulated over the past decade demonstrates that remission of this disease can be achieved through targeted nutritional interventions. This mini review aims to synthesize current data regarding nutritional interventions that may lead to T2DM remission, with emphasis on the underlying mechanisms, clinical outcomes and implications for both research and clinical practice. Evidence supporting the role of structured dietary strategies, including low-energy diets, the Mediterranean dietary pattern, ketogenic approaches, and time-restricted eating, in improving glycemic control and facilitating remission is analyzed, mainly through the reduction of ectopic fat and the improvement of insulin sensitivity. Remission is more likely in individuals with a short duration of diabetes, a more favorable initial glycemic status, and significant and sustained weight loss, particularly when visceral and hepatic fat are reduced. Beyond weight loss, emerging data suggest that meal timing, macronutrient quality, and adherence to nutritional interventions play important modulatory roles. Despite promising results, current evidence is limited by heterogeneity in remission definitions, short follow-up periods, and difficulties related to implementation in real-world clinical practice and long-term sustainability. Nevertheless, there are insufficient data regarding predictors of relapse and the safety of nutritional interventions in vulnerable populations. In the future, research should prioritize long-term randomized studies primarily oriented toward remission and using personalized nutritional interventions. Therefore, nutrition-induced T2DM remission represents a feasible and clinically relevant therapeutic objective, with the potential to redefine current management strategies under the application of individualized, multidisciplinary, and long-term recommendations.

Background/Objectives: Obesity remains a major public health concern, and effective dietary strategies for reducing cardiovascular risk are still under investigation. This interventional non-randomized study aimed to evaluate the short-term effects of the modified ketogenic diet (KD) and time-restricted eating (TRE) on cardiovascular risk, as assessed by the QRISK3 score. Methods: Forty-nine adults with obesity were assigned to either the KD (n = 23) or TRE (n = 26), based on voluntary presentation to a nutrition clinic. Interventions were monitored by a certified clinical nutritionist over 12 weeks. Anthropometric parameters, metabolic markers, and QRISK3 scores were measured at baseline and post-intervention. Results: Both dietary approaches led to significant reductions in body weight and QRISK3 scores. However, the KD resulted in more pronounced improvements in the lipid profile, systolic blood pressure, and glycemic control. Interaction analysis suggested that older participants and those with a higher baseline risk benefited more from the KD. Conclusions: Over 12 weeks, both diets improved cardiovascular risk and metabolic markers in individuals with obesity. The modified diet ketogenic dietary pattern showed more pronounced short-term benefits in the lipid profile, blood pressure, and glycemic control. These results suggest its potential utility in clinical practice, though long-term effectiveness and safety remain to be established.

Background: Tuberculosis and COVID-19 co-infection poses significant clinical challenges, with pulmonary TB (PTB) and extrapulmonary TB (extraPTB) potentially influencing disease progression and outcomes differently. This study aims to compare the clinical manifestations, inflammatory markers, and outcomes between PTB and extraPTB patients with SARS-CoV-2 co-infection. Methods: A retrospective, cross-sectional study was conducted on 55 hospitalized adults with TB-COVID-19 co-infection from March 2020 to March 2022. Patients were divided into PTB (n = 32) and extraPTB (n = 23) groups. Demographic, clinical, laboratory, and imaging data were collected and analyzed using statistical models, including ANCOVA, LASSO regression, and Random Forest classification, to identify key predictors of hospitalization duration and mortality. Results: PTB patients had significantly lower BMI, worse oxygenation status, and greater lung involvement on CT compared to extraPTB patients. CRP was elevated in PTB, while IL-6 levels were higher in extraPTB. Hospitalization duration was primarily influenced by inflammatory and coagulation markers (IL-6, D-dimer, neutrophil count, systemic inflammatory index), while higher BMI was associated with shorter stays. Mortality risk was strongly correlated with oxygenation impairment (worst SpO₂, SpO₂ at diagnosis), inflammatory burden (CRP, LDH), and CT severity score, rather than TB localization. Conclusions: TB localization did not independently affect hospitalization duration or mortality risk. Instead, severe lung involvement, systemic inflammation, and hypoxemia were the strongest predictors of poor outcomes. These findings emphasize the importance of early risk stratification based on respiratory and inflammatory markers to optimize patient management. Further research is needed to clarify the long-term impact of TB-COVID-19 co-infection, particularly in extraPTB cases.

Background: Tuberculosis and COVID-19 co-infection poses significant clinical challenges, with pulmonary TB (PTB) and extrapulmonary TB (extraPTB) potentially influencing disease progression and outcomes differently. This study aims to compare the clinical manifestations, inflammatory markers, and outcomes between PTB and extraPTB patients with SARS-CoV-2 co-infection. Methods: A retrospective, cross-sectional study was conducted on 55 hospitalized adults with TB-COVID-19 co-infection from March 2020 to March 2022. Patients were divided into PTB (n=32) and extraPTB (n=23) groups. Demographic, clinical, laboratory, and imaging data were collected and analyzed using statistical models, including ANCOVA, LASSO regression, and Random Forest classification, to identify key predictors of hospitalization duration and mortality. Results: PTB patients had significantly lower BMI, worse oxygenation status, and greater lung involvement on CT compared to extraPTB patients. CRP was elevated in PTB, while IL-6 levels were higher in extraPTB. Hospitalization duration was primarily influenced by inflammatory and coagulation markers (IL-6, D-dimer, neutrophil count, systemic inflammatory index), while higher BMI was associated with shorter stays. Mortality risk was strongly correlated with oxygenation impairment (worst SpO₂, SpO₂ at diagnosis), inflammatory burden (CRP, LDH), and CT severity score, rather than TB localization. Conclusions: TB localization did not independently affect hospitalization duration or mortality risk. Instead, severe lung involvement, systemic inflammation, and hypoxemia were the strongest predictors of poor outcomes. These findings emphasize the importance of early risk stratification based on respiratory and inflammatory markers to optimize patient management. Further research is needed to clarify the long-term impact of TB-COVID-19 co-infection, particularly in extraPTB cases.

Childhood obesity is a growing public health concern with long-term metabolic and cardiovascular consequences. It results from a complex interplay of genetic, environmental, and behavioral factors, leading to systemic inflammation, insulin resistance, dyslipidemia, and endothelial dysfunction—key contributors to early-onset atherosclerosis. Beyond excess adiposity, multiple risk factors influence vascular health, including maternal obesity, gestational diabetes, birth weight abnormalities, family history of cardiometabolic disease, smoking exposure, hypertension, physical inactivity, and sleep deprivation. Maternal health during pregnancy can impact fetal cardiovascular programming, while postnatal influences such as sedentary lifestyles and poor sleep further exacerbate metabolic dysfunction and vascular alterations. Carotid intima-media thickness (CIMT) is a well-established, non-invasive marker for subclinical atherosclerosis, offering valuable insights into early vascular changes in obese children. Studies demonstrate significant correlations between CIMT and metabolic parameters, making it a promising tool for cardiovascular risk stratification. However, its interpretation should consider the broader spectrum of obesity-related risk factors. A comprehensive approach to childhood obesity management must address metabolic dysfunction, vascular health, and early intervention strategies. Public health initiatives, maternal health optimization, and lifestyle modifications play a critical role in preventing long-term complications. Integrating CIMT assessment with clinical and biochemical evaluations enhances early risk detection, ultimately improving long-term cardiovascular outcomes in obese children.

Background: Obesity contributes to cardiometabolic risk, including subclinical atherosclerosis and insulin resistance. This study examines the predictive roles of trimethylamine N-oxide (TMAO) and resistin in relation to carotid intima-media thickness and metabolic parameters; Methods: Sixty adults (18–71 years) with varying body weights were assessed for body composition, subclinical atherosclerosis, and blood biomarkers, including TMAO and resistin; Results: TMAO correlated strongly with CIMT (r = 0.674, p < 0.001), indicating its role in subclinical atherosclerosis. Logistic regression identified TMAO (threshold 380; AUC = 0.880, accuracy = 91.7%) as a predictor of cardiometabolic risk. Resistin was associated with CIMT, WHR, and total cholesterol, inversely linked to LDL cholesterol (p = 0.003). Less active participants exhibited higher TMAO (p = 0.001) and resistin (p = 0.02). Family histories of obesity and diabetes correlated with elevated TMAO, while resistin linked to shorter sleep duration and diabetes history, highlighting their importance in obesity-related cardiometabolic risks; Conclusions: TMAO is strongly linked to abdominal fat, insulin resistance, and subclinical atherosclerosis, while resistin is associated with lipid metabolism and aging. Their combined assessment enhances the prediction of obesity-related cardiometabolic risk, supporting their role in risk stratification and targeted interventions.

Background/Objectives: Obesity is a growing public health issue, particularly among young adults, with long-term dietary strategies still under debate. This study evaluates the impact of the ketogenic diet (KD) and time-restricted eating (TRE) on QRISK3 cardiovascular risk scores over three months in individuals with obesity. Methods: Forty-nine participants were assigned to either a KD (n=23) with a controlled macronutrient composition or TRE (n=26) without specific macronutrient distribution. A certified clinical nutritionist prescribed and monitored the dietary interventions. Anthropometric measurements, body composition analysis, and QRISK3 scores were assessed at baseline and after 12 weeks to evaluate cardiovascular risk modifications. Results: Both interventions significantly reduced BMI (TRE: p < 0.001, KD: p < 0.001), waist circumference (WC) (TRE: p < 0.001, KD: p < 0.001), and waist-to-hip ratio (WHR) (TRE: p < 0.001, KD: p < 0.001). However, the KD led to superior metabolic improvements, including increased HDL-C (p < 0.001) and a lower TC/HDL-C ratio (p < 0.001), while TRE showed no significant HDL-C changes (p = 0.30). Systolic blood pressure improved significantly only in the KD group (p < 0.001). QRISK3 scores declined in both groups (TRE: p = 0.05, KD: p < 0.001), with a greater reduction in KD. Linear regression (adjusted R² = 0.975) identified baseline QRISK (p < 0.001) as the strongest predictor of final QRISK scores, while fasting glucose (p = 0.015) and atrial fibrillation (p = 0.048) were associated with increased cardiovascular risk. Interaction analysis (adjusted R² = 0.495) showed that older participants in the KD group experienced a more pronounced QRISK reduction (p = 0.011); Conclusions: The ketogenic diet proved to be more effective than time-restricted eating in reducing cardiovascular risk, improving lipid profile, and enhancing glycemic control. These findings support KD as a superior dietary intervention for individuals with obesity and metabolic dysfunction.