Volume 68, Number 4, 2022
Keywords:
Category Archives: AMM 2022
Post maxillectomy definitive rehabilitation in post-covid mucormycosis patients using conventional and 3D printed obturator: A twin case report
DOI: 10.2478/amma-2022-0032
Maxillectomy is the surgical removal or resection of the maxilla or upper jaw bone. Maxillectomy may be total or partial. It is performed during surgical treatment of cancer and infections (bacterial. fungal) of the oral cavity, nasal cavity and maxillary sinuses. Patient affected from post-Covid mucormycosis require local debridement or surgical resection resulting in maxillectomy. After surgery, patient has difficulty in mastication, speech, and swallowing because of communication between oral and nasal cavity. This may also give rise to psychological challenges and social exclusion. The prosthodontic rehabilitation of such patient using obturator provide a separation between oral and nasal cavity and improve the quality of life of the patient. There are various techniques and materials used for fabrication of definitive obturator. This article discusses the prosthodontic rehabilitation after maxillectomy in post-covid mucormycosis patients using obturator by conventional and 3D printed techniques.
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Non-surgical approach to a paediatric pilocytic astrocytoma with MRI follow-up. Case report and brief literature review
DOI: 10.2478/amma-2022-0022
Introduction: Pilocytic astrocytoma is a common tumour in paediatric patients. A low-grade glioma, it is most commonly treated by surgery, with various post-surgical side effects. New methods of treatment and follow-up are constantly evolving to offer alternative options to paediatric patients whose nerve structures are developing.
Case presentation: A 9-year-old patient diagnosed with a pilocytic astrocytoma by MRI and histopathological examination underwent a biopsy and evacuation procedure of the cystic component after which the patient’s condition improved significantly. The ‘wait-and-see’ approach using MRI instead of total surgical excision of the tumour was preferred, and the patient had favourable results on control imaging.
Conclusions: Paediatric patients suffering from pilocytic astrocytoma with favourable imaging and histopathological features may consider MRI follow-up instead of surgical excision until the character of the tumour changes or until the brain has reached full development.
Keywords: pilocytic astrocytoma, low-grade glioma, paediatric brain tumour, magnetic resonance imaging
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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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Artificial intelligence based model for establishing the histopathological diagnostic of the cutaneous basal cell carcinoma
DOI: 10.2478/amma-2022-0020
Introduction: Artificial intelligence (AI), a component of computer science, has the ability to process the multitude of medical data existing in the medical system around the world. The goal of our study is to build an AI model, based on Machine Learning, capable of assisting pathologists around the world in the diagnosis of the basal cell carcinoma of the skin.
Material and Method: Our study is represented by the development of a Mask-RCNN (Mask Region-based Convolutional Neural Network) model, for the detection of cells with typical basal cell carcinoma tumoral changes. A number of 258 digitized histological images were used. The images emerged from Hematoxylin&Eosin stained pathology slides, diagnosed with cutaneous basal cell carcinoma between January 2018 and December 2021, at the Pathology Service of the Mureș County Clinical Hospital.
Results: All the used images have the unique resolution of 2560×1920 pixels. For the learning process, we divided these images into two datasets: the learning dataset, representing 80% of the total images; and the test dataset, representing 20% of the total images. The AI model was trained using 1000 epochs with a learning rate of 0.00025 and only one classification category: basal cell carcinoma.
Conclusions: The AI model successfully identified in 85% of the cases the areas with pathological changes present in the input images.
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Cannabidiol in the context of sleeping disorders-induced oxidative stress
DOI: 10.2478/amma-2022-0023
Sleep disorders can be the result of psychiatric or neurological conditions, such as post-traumatic stress disorders, depression, anxiety, Alzheimer’s disease, Parkinson’s disease. At the same time, changes in sleep, known as sleep disorders, are closely related to various metabolic dysfunctions, which in turn are the result of the generation of reactive oxygen species, or otherwise known as oxidative stress. For this reason, cannabinoid derivatives are increasingly used for this purpose. Among the most used are delta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD). These agents interact with the endogenous endocannabinoid system, either by direct action on specific receptors, or by increasing the availability of endocannabinoids, modifying particular mental states (anxiety, depression). The results of the studies specified in this article provide promising evidence regarding the positive effects of CBD, which extend beyond the scope of sleep disorders, with possible applications also in the case of the accumulation of reactive oxygen species.
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Digitally designed fixed dental prosthesis with stress breaking effect using non-rigid connector for pier abutment: A case report
DOI: 10.2478/amma-2022-0033
Rigid connectors between pontic and retainer are preferred way of fabricating fixed partial dentures for many decades as they provide desirable strength, retention and stability to the prosthesis. However, it is not ideal for cases such as lone-standing abutments (pier abutment), maligned teeth where occlusal stress can extrude the restoration. This may lead to marginal leakage and secondary caries on the abutment teeth. Conversely, it is recommended to use non-rigid connectors which act as a stress breaker, where the tensile stresses are concentrated on the surrounding bone and not on the connectors. With advancement in digital technology in dentistry, the non-rigid connectors can be fabricated using additive manufacturing technology. The present case report discusses the Direct Metal Laser Sintering (DMLS) designed fixed dental prosthesis with key and keyway (Tenon and Mortise) non-rigid connector for rehabilitation of pier abutment in maxillary posterior region.
Keywords: 3D printing, pier abutment, direct metal laser sintering, fixed dental prosthesis, non-rigid connectors
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Alpha adrenergic receptors in clinical practice – Present and future
DOI: 10.2478/amma-2022-0030
In this review we discuss the adrenergic pathways for alpha 1 and alpha 2 receptors and the current as well as potential future medication targeting these receptors. Overall, there is ongoing research into a multitude of directions with a promising outlook for alpha 1 and alpha 2 adrenergic receptors. The alpha 1-adrenergic receptor subfamily is currently modulating only a modest number of nervous system functions due the fact, that only a relatively small number of selective commercial products are available. Chronic stress can affect the long-term depression of alpha 1 receptors. Recent studies are searching for new molecular targets which might act on these receptors. Presynaptic alpha 2 receptors play an important role in modulating release of several neurotransmitters in the central nervous system. The future of alpha 2 adrenergic receptors in clinical practice looks even more promising and versatile than that of alpha 1 adrenergic receptors. Alpha 2 adrenergic receptors show different responses, especially regarding hypertension and heart failure treatment, and current research suggests a genetic component as a cause, which is being explored further.
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Nano-scale surface modification of dental implants – An emerging boon for osseointegration and biofilm control
DOI: 10.2478/amma-2022-0029
Implant therapy is a commonly based method of replacing missing teeth. A range of physical, chemical, and biological modifications have been applied to the surface of titanium implants to improve their biological performance and osseointegration outcomes. Implant surface characteristics play an important function in several peri-implant cellular and molecular mechanisms. Clinicians are commonly placing dental implants with various surface roughness and modifications including plasma-sprayed, acid-etched, blasted, oxidized, hydroxyapatite-coated, or combinations of these procedures. Surface modifications are to facilitate early osseointegration and to ensure a long-term bone-to-implant contact without substantial marginal bone loss can be accomplished. It is apparent that different modifications have a range of beneficial effects, it is essential to consider at what time point and in what conditions these effects occur. This article reviews existing surface modification technologies of mainstream dental implants and the correlation between implant surface coatings and their performance of osseointegration or anti-bacterial ability it needs to be evaluated.
Keywords: dental implants, nano level implant modification, osseointegration, surface topography, coatings
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