Category Archives: Original Research

Comparative clinical evaluation of xenograft (Cerabone) versus allograft combined with platelet-rich fibrin for treatment of grade II mandibular furcation defects

DOI: 10.2478/amma-2023-0016

Aim: The present study aims to evaluate the efficacy of naturally-derived bovine hydroxyapatite (Cerabone) versus demineralized freeze-dried bone allograft both combined with platelet-rich fibrin for treatment of grade II mandibular furcation defects.
Method: This clinical study included 20 systemically healthy patients, with grade II mandibular furcation defects, performed over 6 months. Control group comprised of open flap debridement + demineralized freeze-dried bone allograft + platelet-rich fibrin and test group comprised of open flap debridement + Cerabone + platelet-rich fibrin. Clinical parameters included: Plaque index, Modified Sulcular bleeding index, Vertical probing pocket depth, Horizontal probing depth, Probing clinical attachment level, Radiographic furcation depth, and radiographic bone fill percentage.
Results: Both groups showed satisfactory bone regeneration and improvement in clinical parameters. The test group exhibited greater reduction in vertical probing pocket depth, horizontal probing depth, and higher radiographic bone fill percentage when compared to control group, although these findings were not statistically significant.
Conclusion: Both bone grafts were equally effective in treatment of grade II furcation defects. Further long-term studies are required to explore their maximum regenerative potential.

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Clinical characteristics and endoscopic findings in autoimmune gastritis – a retrospective study

DOI: 10.2478/amma-2023-0012

Objectives: Autoimmune gastritis (AG) is a rare condition that increases the risk of developing stomach adenocarcinomas or carcinoid tumours. The objectives of the present research were to summarise the clinical traits of AG patients, together with gastroscopic and histopathologic findings, demographic data, and hematologic characteristics.
Patients and methods: A medical centre assessed 58 AG patients from January 2019 to December 2022.
Results: The majority of the patients were female (73.7%), and the mean age of the participants at the time of the diagnosis was 57.7 ± 12.1 years. We identified pernicious anaemia (54.4%), iron deficiency anaemia (21.1%), as well as autoimmune disorders (96.5%). Though 78.9% of patients reported having gastrointestinal symptoms, 69% presented exclusively upper gastrointestinal symptoms, 17% only had lower, and 14% had concurrent upper and lower gastrointestinal symptoms.  All 58 AG patients were examined for associated gastric lesions, although abnormal injuries were detected in only 22 of them. One patient (1.8%) had adenocarcinoma, while five patients (8.8%) had type 1 neuroendocrine tumours (NET). In addition, hyperplastic polyps were found in 16 (28.1%) individuals.
Conclusions: Other autoimmune diseases were present with AG, which showed a female predominance. Clinicians should give AG more significant thought by allowing access to interdisciplinary teams.

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Inter-observer variability on the value of endoscopic images for the documentation of upper gastrointestinal endoscopy – our center experience

DOI: 10.2478/amma-2023-0015

Objective: Endoscopy is an essential and invaluable diagnostic tool in the arsenal of every gastroenterologist. ESGE presented additional guidelines for standardized image documentation in upper and lower gastrointestinal endoscopy. Clinical disagreement is a common challenge in most, if not all, fields of medicine. Settling disagreements is important so as to find ways to minimize it. Clinical disagreement in gastroscopy may be demonstrated by studying the observer variability.
Methods: We retrospectively recruited 120 random patients that underwent conventional upper gastrointestinal endoscopy between 2021-2022 in our Department of Gastroenterology, all of them performed by one endoscopist. As part of the study, all video-endoscopic recordings were stored using one internal server. In order to study interobserver variability, four physicians (endoscopists and gastroenterologist specialists) were invited to complete the questionnaire.
Results: The interobserver variability in our study ranged from moderate to very good in the assessment of the esophagus, with the highest degree of agreement in response to questions concerning characteristic findings such as normal mucosa, esophagitis Class A Los Angeles, hiatal hernia for the esophagus endoscopic evaluation, benign ulcer niche in gastric antrum, normal gastric corpus mucosa, intestinal metaplasia and angiodysplasia in gastric corpus. The question on atrophic mucosa in the first and second part of the duodenum was the most difficult to agree upon.
Conclusion: The present study found that the variability between observers in the assessment of images obtained from patients that underwent conventional upper gastrointestinal endoscopy in our center was acceptably good.

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Anatomical variations of nutrient foramina on the long bones of the upper extremities – Importance and application in everyday clinical practice

DOI: 10.2478/amma-2023-0011

Objectiv: Anatomic characterization of the nutrient artery of upper extremity long bones differs among the several textbooks on human anatomy. To elucidate the anatomical features of the nutrient foramen (NF) through which the nutrient arteries pass, we examined the morphology and topography of the NF on the diaphysis of the long bones of the upper extremities.
Methods: A total of 150 (50 humeri, 50 radii, 50 ulnae) macerated and degreased adults, long bones of the upper extremities, unknown age, and gender were used as material in this study. The following parameters were determined for each bone: total number of NF, foramina index (FI), total bone length, position of the NF based on the FI value and the surface of the shaft/body of the bones, and obliquity of the nutritional canal (NC).
Results: The largest number of NF was found on the middle third of the anteromedial side of the humerus diaphysis, with NC directed distally, that is, towards the elbow. Radius and ulna had predominantly one NF, on middle third of anterior surface, with NC directed proximally.
Conclusion: This study provides additional and important information on the location and number of NF in the long bones of the upper and lower extremities in the Bosnian and Herzegovinian population.

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Testosterone deficiency is associated with clinically relevant depression symptoms

DOI: 10.2478/amma-2023-0008

Objective: To investigate the association between testosterone deficiency and depressive and/or anxiety symptoms.
Methods: A cross-sectional study was conducted at the urology outpatient clinic from Ludus County Hospital. A set of validated questionnaires ((International Prostate Symptoms Score (IPSS), Depression Anxiety and Stress Scale (DASS-21), Zung Self-rating Depression Scale (Zung SDS)) were self-administrated. Inclusion criteria: age > 40 years. Exclusion criteria: any relevant psychiatric, cardiovascular, or cancer comorbidity. Statistical analyzes were performed using the statistical software Statistical Package for Social Sciences (SPSS, version 23, Chicago, IL, USA).
Results: From the total of 55 participants included in the study, 23 (41.8%) had testosterone deficiency. Most were from the 60-69 years decade, 23 participants (41.8%), and the mean age was 59.3 (SD 9.03) years. Eleven (20%) patients had depressive symptoms according to the depression subscale, of these, 7 had mild symptoms and 4 according to Zung SDS. Testosterone deficiency was associated with an increased DASS-21 global score, p=0.021, and depression score, p=0.047.
Conclusions: Patients with testosterone deficiency are presenting symptoms of depression. Therefore, these patients need a multi-disciplinary approach that should include a psychological evaluation before making a further management decision.

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Comparison of two different file systems on postoperative pain after root canal instrumentation: A randomized controlled trial

DOI: 10.2478/amma-2023-0006

Introduction: In this study post instrumentation pain is evaluated between rotary hyflex CM files and conventional k-files at different time intervals.
Methodology: fifty patients were equally assigned into two groups and instrumented using hyflex cm or conventional files. VAS for pain was noted before the start of a root canal and after the procedure at 12, 24, and 48 hours.
Results: There was no significant difference at 12, 24, and 48 hours with P values being 0.127, 0.867, and 0.846 respectively.
Conclusion: There is no significant difference in causing post-instrumentation pain between hyflex CM and conventional files at different time intervals. However, when accessing preop pain of the conventional file group, it had more pain mean score compared to hyflex group. According to this study, Conventional files may be able to slightly decrease the chances of post-instrumentation pain more than hyflex CM instrumentation.

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Evaluation of effects on hepatocellular carcinoma cell line of Cocos nucifera: In vitro study

DOI: 10.2478/amma-2023-0004

Objective: Cancer is one of the most important diseases today. The use of chemical drugs, surgical operations, and transplants is very common in its treatment. In addition to these treatment methods, studies include the effects of natural and plant-derived substances. Various substances are used in these studies, which are called phytotherapy. The antioxidant activity and cytotoxic effects of Cocos nucifera on hepatocellular carcinoma HepG-2 and the mouse fibroblast L929 cell line were investigated in this study.
Methods: In this study, in vitro cytotoxic effects of C. nucifera at different concentrations (7.81-500 mg/ml) were investigated on the L929 Mouse Fibroblast cell line and HepG-2 Hepatocellular Carcinoma cell line. In addition to these studies, their antioxidant capacity was evaluated via spectrophotometric methods. In this work, different concentrations of C. nucifera were examined.
Results: According to the results, C. nucifera had a cytotoxic effect in HepG-2 and ensured the proliferative effect of cells in the L929 cell line. Among C. nucifera extracts according to total antioxidant capacity results, C. nucifera extract was found to be the richest in antioxidants with 2.79 mmol/L, while the material with the lowest antioxidant capacity was determined to be C. nucifera milk. DPPH free radical scavenging activity results show the opposite.
Conclusion: In line with the data we obtained, it is thought that C. nucifera can be used in liver cancer studies, and its antioxidant effect may play an important role in balancing against oxidative stress. Simultaneously, the data show that the exposure time and concentrations of the active substance are related to the cytotoxic effect. However, it may be considered that the use of C. nucifera water, extract, and milk in cancer patients may be supported by more comprehensive clinical studies.

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A study of the impact of solid cast removable dentures with silver electroplating on the condition of patients

DOI: 10.2478/amma-2023-0002

Objectives: The aim of our study was to determine the effectiveness and biocompatibility of the use of solid clasp dentures with silver plating in the restoration of partial defects of the dentition.
Methods: The study involved 23 patients with partial secondary adontia after oral rehabilitation. At the first stage, before the start of treatment and after a month of using a clasp prosthesis, patients underwent studies of blood biochemical parameters, Schiller-Pisarev’s test and Papillary-marginal-alveolar index. At the second stage of the research, silver electroplating was applied to the metal parts of the clasp prosthesis and after a month of use, its effect on oral hygiene and blood biochemical parameters was assessed.
Results: After installation of the removable prosthesis with solid structures, the PMA index after the use of silver-plated clasp prosthesis decreased to medium severity, which is explained by positive impact on the inflammatory process in the gums. We can see the stability of biochemical parameters of blood in patients with solid removable prostheses can serve as a justification for the administration of silver electroplating for prophylactic and therapeutic purposes.
Conclusions: The effectiveness of the use of silver plating in the treatment of partial defects of the dentition eliminates the clinical manifestations of the pathological condition and prevents possible complications in the oral cavity.

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Hereditary hemochromatosis: Retrospective study on clinical data from Emergency County Hospital Mures

DOI: 10.2478/amma-2022-0031

Objective: Hereditary hemochromatosis, or primary hemochromatosis, is a recessive genetic liver disorder caused by iron accumulation in tissues. This study evaluates patients with hereditary hemochromatosis to determine correlations between clinical and laboratory data.
Methods: The data analyzed in this study was gathered from the discharge records from 2019 to 2021 of the Gastroenterology Department of the Mures Country Emergency Clinical Hospital. 15 patients with hemochromatosis were sampled during the studied period.
Results: Hepatic cirrhosis is present in 67% of the studied group of patients, 40% of patients presented hypertension and 20% of patients showed diabetes mellitus and portal hypertension. Positive correlations were obtained between serum iron and alkaline phosphatase (r=0.8536), between serum iron and lactate dehydrogenase (r=0.7381), and between serum iron and urea (r = 0.79). Positive, strong correlation between ferritin and serum iron (r=0.7719), GOT (r=0.778) and GPT (r=0.6108). total bilirubin and direct bilirubin (r = 0.85), between total bilirubin and GOT (r = 0.68) and GPT (r = 0.82).
Conclusions: Excess iron stored is influencing organ function trough reactive oxygen species, the hepatic signs being a main participant in the clinical presentation, while serum iron cause damage to other tissues such as myocardium, pancreas and kidneys. Treatment for hemochromatosis includes phlebotomies, and iron chelation with Deferoxamine.

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The effect of postprandial in vivo and experimental in vitro hyperlipidemia on human peripheral blood monocytes

DOI: 10.2478/amma-2022-0026

Objective: In this study, we aimed to investigate the effect of transient postprandial in vivo and prolonged experimental in vitro hyperlipidemia on human peripheral blood monocytes.
Methods: Peripheral blood was collected from seven healthy subjects after an overnight fast and three hours after a standardized high-fat meal. Both fasting and postprandial samples were stained for surface markers CD14/CD11b and intracellular lipids using BODIPY493/503. Postprandial samples only were used for isolation of peripheral blood mononuclear cells that were further incubated overnight with postprandial hyperlipidemic autologous plasma, then stained as described above. All samples were analyzed on a FACSAria III flow cytometer.
Results: Flow cytometric analysis revealed two monocyte populations (CD14+): CD14low and CD14high. In fasting, these populations show similar morphology (FSC/SSC), but different expressions of CD14, CD11b, and BODIPY493/503. At three hours postprandially, a moment of maximum hyperlipidemia, neither population suffered significant changes. After the 24-hour incubation, cell activation was observed in both populations: similar fold change increase in SSC, increase in FSC for CD14high cells only, similar foldchange increase in CD14, slightly higher foldchange increase in CD11b for CD14low monocytes, and significantly higher foldchange increase in lipid content for CD14high monocytes. CD14high monocytes appear to undergo a more intense activation than CD14low monocytes.
Conclusions: We conclude that all monocytes react after prolonged in vitro exposure to plasma lipids, each subset having its own activation pattern. All monocyte types may play a role in inflammation and the development of plaques. Monocyte assays are a valuable tool for the investigation of atherosclerosis at the cellular level.

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