Introduction: Matrix metalloproteinases (MMPs) are key enzymes involved in degradation of extracellular colagen matrix during periodontal disease progression. The aim of our work was to study the levels of MMP-1, MMP-2, MMP-7, MMP-9 and MMP-10 in saliva of patients with chronic periodontitis. Materials and methods: The study included 22 patients with chronic periodontal disease and 15 controls. We collect unstimulated whole saliva from all volunteers included in the study. Salivary levels of mentioned MMPs were analyzed using magnetic bead-based multiplex assays and Luminex technology. Results: MMP-1, MMP-7, MMP-9 and MMP-10 present statistically increased salivary levels at patients with periodontal disease versus the control group (p<0.05). Salivary level of MMP-2 at patients with chronic periodontitis was increased but statistically insignificant compared with healthy subjects (p=0.1). Conclusions. The increased level of these enzymes in patients diagnosed with periodontal disease reflects their implication in periodontal tissue degradation. Saliva is an excellent fluid useful in monitoring the severity of this oral disease that affects about half of the adult population around the world.
Pregnancy-specific dermatoses are a heterogeneous group of inflammatory dermatoses associated exclusively with pregnancy. Although these dermatoses are rare, it raises problems in medical practice because of their appearance, being difficult to diagnose, treat and the possibility of the fetus being affected. Pemphigoid Gestationis (PG) is a rare, autoimmune, strongly pruritic, vesiculobullous dermatosis with a strong impact on the patient. Polymorphic Eruption of Pregnancy (PEP) is a benign, self-limited inflammatory skin disorder that usually affects first pregnancy in the third trimester or immediately in the postpartum period. Other dermatoses associated with pregnancy include: Intrahepatic Cholestasis of Pregnancy (ICP), Atopic Eruption of Pregnancy (AEP) and Pruritic Folliculitis of Pregnancy (PFP). We will extensively present PG and PEP, to draw attention to the importance of correct diagnosis and the implications of treatment during pregnancy.
Introduction. Even though, primary thyroid lymphoma (PTL) is a rare thyroid malignancy and extranodal non-Hodgkin lymphoma, this type of disease should not be disgraced in order to achieve an early diagnosis and multimodal treatment. Materials and method. We selected for discussions a primary thyroid lymphoma patient with absent constitutional (B-type) symptoms, who undergoes a multidisciplinary approach of the disease, chemotherapy and radiotherapy. In this clinical case report a 84 yo male patient with stage IE diffuse large B-cell histological type (Ann Arbor staging) was treated using R-CHOP chemotherapy, followed by involved field radiotherapy, with an excellent treatment response and disease control. Results and Discussion. Usually this type of extranodal non-Hodgkin lymphoma is present in the seventh decade of life, with males being affected earlier than females. One of the most common presentations of thyroid lymphoma is an enlarging neck mass and a history of Hashimoto’s thyroiditis, which is the major risk factor. The most common PTL subtypes are diffuse large B-cell lymphoma (the most aggressive histological subtype, representing 70% of all PTLs) and MALT lymphoma (30% of the PTLs). Advances in both diagnosis and treatment in the last years have improved the early diagnosis and shortened the time for treatment implementation.
Background: This topic is aimed to review the treatment approach in adult patients diagnosed with urosespsis, in order to decrease mortality and to maximize the outcome of the antibiotic stewardship efforts. Methods: We present an approach of antibiotic therapy in urosepsis from an infectious diseases physician perspective, based on the recently published data integrating the epidemiology of the urinary tract infections in a multidisciplinary hospital from Romania. Results: The principles of therapy in urosepsis should have five goals, but not limited to rapid diagnosis, specific intensive care unit treatment, obtaining urine and blood cultures, anti-infective treatment and identifying and correction of underlying risk factors. Due to the higher prognostic value, the antimicrobial therapy in urosepsis should consist in “two steps” regimen: initial antimicrobial therapy, based on “empirical” approach for the first 48 - 72 hours and directed or “definitive” antimicrobial therapy adapted to the susceptibility profile of the isolated pathogens, the penetration into the urinary tract and the patient clinical response. Clinicians should be aware of the different antibiotic susceptibility profile of the bacteria from the hospital compared to the community. Thus, the initial choice of antimicrobial agents depends on several criteria like the severity of illness and the risk factors for multidrug resistant pathogens: the immune status of the patient (age, debilitating chronic illnesses, immunosuppressive treatment or uncontrolled malignancies), broad-spectrum antimicrobial use and health care environment exposures in the previous 3 to 6 months, susceptibility of prior urinary isolates, and local community resistance prevalence of bacteria. Conclusions: Our important messages highlighted the need of a holistic approach of urosepsis, in a multidisciplinary team, with integration of risk factors for AMR, focusing on the first phase of antibiotic treatment as the main driven of the survival rate.
One of the great dreams of humanity has been the improvement of its behavioural, affective and emotional status. Depression represents the suffering of beings over their existential course, as a point of passage between the human condition and its destiny. The attempts of psychiatry to introduce efficient and increasingly performing antidepressants represent one of medicine’s great achievements. At the same time, antidepressant overdosing may lead to cardiotoxic manifestations presenting lethal risks as consequences [1]. We hereby present the case of a patient that was poisoned with tianeptine, ingested for suicidal purposes, who survived repetitive episodes of ventricular fibrillation, electrically converted to sinusal rhythm. The GC/MS analytical diagnosis played an essential part in detecting tianeptine in the biological samples. The rapid and very competent therapeutic intervention allowed for the patient’s survival, despite further complications. A review of main tianeptine information is also presented, as this type of intoxication may have deadly consequences.
Opioid use disorder is a worldwide challenge for an increasing number of patients, and still the therapeutic options presented in clinical guidelines for this condition are very few. The first line pharmacological therapies for opioid use disorder continue to be opioid agonists as substitution treatment, but the need to find new treatments without the effect of prolonging opioid dependence become more and more obvious. This systematic review presents the most supported by evidence pharmacological agents that can be used as monotherapy for opioid use disorder patients (i.e., naltrexone, extended release/implant and oral formulation), or as adjuvants to substitution therapy (e.g. olanzapine for aggressive behaviours, memantine or dextromethorphan for reducing inflammatory processes related to opioid use). More good quality data derived from larger, well designed trials are needed in order to find solid recommendations for non-opioid agonists in the treatment of opioid use disorder.
Diabetes mellitus is a serious condition, causing multiple health problems due to the disease itself, but also to the complications that these patients are predisposed to. Being a current health problem, many patients tend to disregard the doctor's recommendations concerning the necessary measures to maintain adequate and continuous control of the glycaemia levels. This, in turn, may cause complications, which include neuropathy, microangiopathy and a predisposition to infections due to weak local defence mechanisms. In otorhinolaryngology, the infectious pathology is one of the most often causes for presentation to the physician. Ranging from common otitis, acute pharyngitis or laryngitis and sinusitis, these different entities will cause significant discomfort for the patient, prompting the need for medical care. In patients with diabetes, the natural course of the disease is altered, with more severe symptoms, a more extended period of recovery and the predisposition for aggravated cases with the tendency to complications. Such complications may be life-threatening if we take into account the complications associated with acute sinusitis for example, which include orbital or cerebral abscesses. Our paper aims to present the authors experience on the complete approach of patients with infectious pathology concerning the sinuses associating diabetes mellitus. Always, we must keep in mind that patients with diabetes represent a particular class of patients that require a personalized approach. They are predisposed to a vicious circle, in which the infection causes diabetes imbalance, which in turn decreases the defense mechanism and predisposes to complications. The correct management must always include a proper control of diabetes, a complete evaluation that will determine if complications are already present and aggressive management of the infection, with regular check-ups to determine the evolution of the patient.
Renal angiomyolipomas (AML) are the most common benign renal tumors. By containing an important amount of fat tissue they are easily identifiable on CT and MRI images, thus no biopsy should be needed for a diagnosis. However there is a small percentage of AMLs that have very little fat tissue and are very difficult to differentiate from renal cell carcinoma. Along fat tissue, they also contain smooth muscle and blood vessels. Renal AMLs can occur as a sporadic finding, or more frequently in association with tuberous sclerosis complex (TSC) or pulmonary lymphangioleiomyomatosis (LAM). These tumors are usually an incidental finding on imaging tools, but sometimes a serious presentation is rupture and hemorrhage, which can easily evolve to shock. Therapeutical management vary from active surveillance to surgical removal, and it needs to be individualized for every patient and according to the clinical presentation.
The aim of this study was to compare two computerized digital esthetic design methods (DSD and Visagismile) in order to properly choose the appropriate form of the maxillary frontal teeth for complete bimaxillary edentulous patients and to validate the use of these applications in complete edentulism. An online questionnaire was submitted to a group of 100 persons (dental doctors, dental medicine students and persons activating in other fields); the respective persons were requested to choose the form of maxillary frontal teeth for a group of four complete bimaxillary edentulous patients, whose esthetic design had been performed by using the two computerized progams. Following the respondents’ analysis of the esthetic previews elaborated for the four patients 60% of the total answers were in favour of DSD while the remaining 40% were in favour of Visagismile; these percentages are identical with the ones obtained on the basis of the answers given by dental doctors and dental medicine students. In case of the respondents activating in other fields the percentages were 66% in favour of DSD and 34% in favour of Visagismile. Based on the results of the study the two computerized methods were validated also for cases of complete edentulism but further studies to confirm this validation are still required. These two methods improve the dental doctor/patient communication and certainly provide a higher predictability of the esthetic results of prosthetic restorations not only for dentate patients but also in cases of complete edentulism.
Retroperitoneal tumors grow quietly and are generally large in size, more than half of them being larger than 20 cm at the time of diagnosis. They usually present several therapeutic challenges because of their rarity, relative late presentation and anatomical location, often in close relationship with several important structures in the retroperitoneal space. Due to intimate relationships with vital organs in retroperitoneum, extensive surgery with en bloc resection of the involved organ is often required, most frequently the kidneys, followed by colon, pancreas and spleen. Malignant tumors have a poor prognosis, the most significant factors regarding survival rates being delayed diagnosis, high histological grade, inoperability due to invasion into vital organs, and a positive surgical border.
