Author Archives: administrare

Cardiac Autonomic Neuropathy in Diabetes Mellitus Patients – Are We Aware of the Consequences?

DOI: 10.2478/amma-2020-0003

Cardiovascular autonomic neuropathy is the most frequent clinical form of autonomous diabetic neuropathy and appears secondary to cardiac autonomous fibre involvement, actively involved in cardiac rhythm impairment. Type 2 diabetes mellitus patients can present cardiac autonomic neuropathy early in the disease. Autonomous nerve function in DM patients should be assessed as early as the diagnosis is set in order to establish the optimal therapeutic strategy. The most frequent cardio-vagal test used is heart rate variability. An abnormal heart rate variability in the presence of orthostatic arterial hypotension indicates a severe cardiac autonomic neuropathy diagnosis. The development of cardiac autonomic neuropathy is subjected to glycaemic control, duration of the disease and associated risk factors. The glycaemic control is extremely important, especially early in the disease. Therefore, a poor glycaemic control carries unfavourable long-term effects, despite an ulterior optimal control, a phenomenon named “hyperglycaemic memory”. In type 2 diabetes mellitus patients, the association of cardiac autonomic neuropathy with intensive glycaemic control increases the mortality rate, due to the fact, that, secondary to autonomous impairment, the patients do not present the typical symptoms associated with hypoglycaemia. Stratifying the cardiac autonomic neuropathy aids the clinician in assessing the morbidity and mortality risk of diabetes mellitus patients, because it is an independent risk factor for mortality, associated with silent myocardial infarctions and the risk of sudden death.

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Comparative study of Clinical Characteristics in Patients with Mild and Severe Reflux Esophagitis

DOI: 10.2478/amma-2020-0002

Objective: This study aims to determine the correlation between risk factors and erosive esophagitis development. Methods: We conducted a retrospective observational study on a consecutive series of 19.672 patients who underwent upper gastrointestinal endoscopy between 01.01.2011-31.12.2017. A total of 3005 patients, diagnosed with erosive esophagitis, were included in the present study and stratified according to Los Angeles classification. Results: During the studied period we found 3005 patients with erosive esophagitis, sex ratio male to female was 1.3/1, the most common forms of esophagitis being grade A and B: 74.54% patients with esophagitis grade A, 14.80% patients with grade B; 5.29% patients were with grade C and 5.35% patients with esophagitis grade D. In severe esophagitis the male predominance was more prevalent (249 males, 71 female), with a sex ratio 3.50/1. The correlation of male gender with severe esophagitis was highly statistically significant (p < 0.0001, OR 2.97; 95% CI 2.25-3.91). Hiatal hernia was diagnosed in 1171 patients, the presence of large hiatal hernias, being an important predictor, with statistical significance (p < 0.0001, OR 3.41; 95% CI 2.22-5.21), for severe esophagitis development. Incidence of Helicobacter pylori infection was 11.51%, in the entire study group, with no statistical significant difference between patients with mild or severe esophagitis (12.02% vs 7.18%). Conclusion: Erosive esophagitis is a frequent disease, the most common forms being grade A and B. Male gender and the presence of hiatal hernia are the most important risk factors for erosive esophagitis development, in our study group.

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Factors Involved in the Pathogenesis of Acne and Its Psycho-Social Impact

DOI: 10.2478/amma-2020-0001

With acne as one of the most common and frequent conditions of young adult patients, we looked for significant associations, associated conditions with influence on the skin condition with the idea of outlining a different approach of the acne patient. With a multifactorial, multidisciplinary etiopathogeny, the purpose of this study was to highlight the factors involved in the pathogenesis of this condition and to identify those that should be taken into account when prescribing the treatment.

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Genetic Investigation and Clinical Aspects in a Romanian Treacher Collins Syndrome Family – A Case Report

DOI: 10.2478/amma-2019-0026

Introduction: In approximately 96% of probands, the diagnosis of Treacher Collins Syndrome (TCS) is confirmed by molecular genetic tests. These tests can detect heterozygous mutation of TCOF1 gene (coding treacle protein) and variants of POLR1D gene (coding RNA polymerase I subunit D) with autosomal dominant inheritance, or biallelic variants of POLR1C gene (coding RNA polymerase I subunit C) and POLR1D with autosomal recessive inheritance. Case presentation: We present a neonate proband with family history of clinical features suggestive for TCS. Our patient was investigated for copy number changes (CNCs) of TCOF1 gene using SALSA MLPA P310-B3 TCOF1 probemix to perform Multiplex Ligation-dependent Probe Amplification (MLPA), the results being normal. Dysmorphic features revealed “bird-like” face with trigonocephaly, craniosynostosis, hypoplastic supraorbital rims, underdeveloped zygomas, mandibular hypoplasia and retrognathia (mandibulofacial dysostosis). Other clinical features, like abnormal position and structure of the external ears (microtia, with a bilateral low-set ears, crumpled and malformed pinnae and aural atresia), were also observed. Conclusion: Taking into account our results, and also data found in literature, we consider that all TCS cases, but in particular patients with specific TCS features and without CNCs, require additional investigations using sequencing techniques.

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Spleen Derived Immune Cells in Acute Ischemic Brain Injury: A Short Review

DOI: 10.2478/amma-2019-0025

Spleen-derived immune cells are considered to play central role in the progression of ischemic brain damage contributing to both the local and systemic inflammatory response initiated by an ischemic insult in the brain tissue. Brain-spleen communication in acute ischemic brain injury has been studied especially in rodent models of stroke, which mimic the acute focal brain ischemia in humans. Rodent spleens decrease in size after experimentally induced stroke, due mainly by the release of spleen`s immune-cells into the circulation. Splenectomy prior to middle cerebral artery occlusion is protective to the ischemic brain resulting in decreased infarct volume and reduced neuroinflammation. Various therapeutic strategies in clinical use aiming to protect the neural tissue after stroke were found to involve the modulation of splenic activity, altogether indicating that the spleen might be a potential target for therapy in ischemic brain injury. Importantly, the most clinical studies demonstrated that the splenic response in stroke patients is similar to the changes seen in rodent models. Thus, despite the limitations to extrapolate the results of animal experiments to humans, rodent models of stroke represent an important tool for the study and understanding of brain-spleen communication in the pathogenesis of acute brain ischemia.

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Fatal Road Traffic Accidents in Mureș County, Romania – A Retrospective Autopsy Based Study

DOI: 10.2478/amma-2019-0024

Objective: The main objective of this study is to evaluate the medico-legal aspects of fatal road traffic accidents.
Methods: This is a retrospective study consisting of 80 forensic autopsies performed at the Institute of Legal Medicine – Tîrgu Mureș, Romania during a two years period, between January 1st, 2016 to December 31st, 2017. The information obtained was based on the medical records and the evaluation of autopsy reports.
Results: Male victims involved in road traffic accidents were nearly three times more numerous than women (72.5% vs. 27.5%). Divided into 3 age groups (under 35 years old, 36-59 years old and over 60 years old) we noticed a relatively uniform distribution of the victims, with a slight dominance of the 36-59 age group and the over 60 years of age group. The highest number of victims was among the pedestrians (36.25%), followed in decreasing order by the drivers (33.75%), passengers (17.5%), cyclists (7.5%) and motorcyclists (5%). Positive alcohol testing was found in 14 of drivers (81 %). The analysis of lesions found during necropsies of the deceased at the scene of the accident highlights some particularly life-incompatible injuries that resemble any rescue effort on the part of the medical crew moved to the scene of the accident.
Conclusion: Inappropriate road conditions and indiscipline in traffic of both drivers and pedestrians contribute to unacceptably high mortality.

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The Association between Various Lifestyle Patterns and the Body Mass Index in Adolescents

DOI: 10.2478/amma-2019-0023

Objective: The study aims to analyze obesogenic behavioral patterns of adolescents living in Mureş County, Romania, as well as to establish a relationship between these behaviors and their Body Mass Index (BMI), in an attempt to provide effective prevention strategies for obesity.
Material and Methods: 153 students between 9th to 12th grade, aged between 14 and 19 years old, from the Vocational and Art Highschool of Târgu Mureş were included in the study. All the candidates filled out an evaluation questionnaire of lifestyle and risky behaviors. The analyzed data were sex, age, residence, BMI and risky eating behavior defined as the consumption of carbohydrates (bread, potatoes, sweets), sodas, junk food, alcohol (wine, distilled beverages, beer), beer separately, level of physical activity (school and extra-school sports activities), sedentary behaviors (≥2 hours/day in front of a screen: personal computer-PC and television-TV), and spending ≥2 hours/day separately on the PC and on the TV.
Results: A statistically significant association was observed between BMI and consumption of fast-food, tobacco, beer, sedentary behavior and spending ≥2 hours/day in front of the PC. Moreover, there was a statistically significant difference between the BMI values of adolescents presenting all studied risk behaviors compared to those who did not.
Conclusions: Obesity among adolescents from Mureș County is influenced by lifestyle choices like fast-food, tobacco, beer, sedentary behavior and spending ≥2 hours/day in front of the PC.

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Clinical Study on the Perception of Patients with Orthodontic Appliances Regarding the Periodontal Change

DOI: 10.2478/amma-2019-0021

Introduction: The orthodontic treatment helps in reestablishing a functional occlusion, improving the aesthetics and functionality of the dento-facial complex. A correct alignment of the teeth, through the correction of some dental or skeletal anomalies, enhances the possibilities of dental hygiene, thus reducing the risk of periodontal affections. Nevertheless, the presence of orthodontic appliances in the oral cavity may reduce the efficacy of the means of oral hygiene by creating retentive areas for food, thus producing damages at the level of the marginal periodontium.
Objective: The evaluation of oral hygiene practices for patients in the course of fixed orthodontic therapy and the identification of changes appeared at the level of the marginal periodontium caused by the orthodontic appliances.
Material and methods: A questionnaire with 20 questions was distributed to a number of 129 patients undergoing the active phase of orthodontic treatment in the Orthodontic and Dentofacial Clinic of the Medical Dental School Tîrgu Mureș or in some private practices in the Bucharest metropolitan area.
Results: The majority of patients surveyed are aware of the means of dental hygiene and practice a daily brushing, associated with auxiliary means. The iatrogenic effects of the fixed therapy are represented by gingival recession, gingival overgrowth and bleeding during brushing but these were visible only in the case of a small number of patients.
Conclusions: The fixed orthodontic treatment must be started only after a thorough evaluation of the marginal periodontium, with a close orthodontist – periodontist collaboration and avoidance of jiggling-like movements.

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