Category Archives: AMM 2022, Volume 68, Number 3

Single-plaque psoriasis: a single-clue diagnostic challenge

Luminita Emilia Decean1, Roxana Flavia Ilies2, Andreea Sasu3, Iulia Barsan4, Adriana Mihai1

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
3. First Psychiatric Clinic, Targu Mures County Hospital, Romania.
4. Elitemed Anatomical Pathology Laboratory, Targu Mures, Romania

DOI: 10.2478/amma-2022-0019

Introduction: Psoriasis is a chronic, common immune inflammatory condition of the skin, affecting 2-3% of the population, with regional variability. Classically, psoriasis presents as one of the following types: plaque, guttate, inverse, pustular or erythrodermic psoriasis. Typically, the patient will present with several symmetric psoriatic plaques on typical areas of the body, leading the clinician towards the diagnosis of psoriasis.
Case report: The present case report series focuses on an atypical presentation of psoriasis noted in 2 patients who presented to our office with a single large, erythematous plaque located on the lower leg. Due to poor response to previous treatment, a biopsy was performed and upon analysis, revealed a diagnosis of psoriasis. The lesions showed significant improvement under local therapy.
Conclusion: In spite of significant research on such a common and seemingly well-understood dermatosis, the present case reports plead for further study with regards to atypical presentations of psoriasis.

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Clear or White? A RT-PCR plate comparison for SARS-CoV-2 diagnosis

Elena Cristina Preda1, Valeriu Moldovan1, Oana Roxana Oprea2

1. County Emergency Clinical Hospital, Târgu Mureș, Romania
2. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2022-0024

Objective: During the COVID-19 pandemic, laboratories have used various extraction and amplification kits, associated with different auxiliary materials. This study aims to investigate how different types of plates may affect RT-PCR performance.
Methods: Data on the positive controls (PCs) of RT-PCR runs for SARS-CoV-2 detection between December 2020 and April 2022 was collected retrospectively in the Molecular biology department of the County Emergency Clinical Hospital of Târgu Mureș’s clinical laboratory. The materials used consisted in MOLgen SARS-CoV-2 (Adaltis) and EliGene COVID19 CONFIRM 500 R amplification kits, 96-well full-skirted white and clear plates, and clear films. Microsoft Excel was used for the database and it included information about Cycle threshold (Ct) and maximum fluorescence. Statistical analysis, performed in MedCalc, consisted of Grubbs test, Kolmogorov–Smirnov Test, F test, T student test, and Mann-Whitney test to compare central tendencies. The significance threshold was set at p<0.05.
Results: The Ct comparison for MOLgen kit white plates vs clear plates: FAM channel- U=1052.5, Z=2.07, p=0.038, medians for white plates and clear plates were 22.80 and 23.25, respectively; ROX channel- U=784, Z=3.21, p=0.001, medians 21.93 and 21.43, respectively; Cy5 channel- U=1028.5, Z=1.95, p=0.518, medians 22.12, 21.75, respectively. For EliGene kit: U=848.5, Z=3.27, p=0.001, medians 28.26 (white plates) and 28.0 (clear plates). Comparison of the maximum fluorescence reached on both kits with white and clear plates computed p values <0.0001.
Conclusions: Between white and clear plates there are statistically significant differences considering Ct values and maximum read fluorescence, but with no impact on test outcome.

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Is the pulmonary microbiome involved in lung cancer pathophysiology?

Corina Eugenia Budin1, Iuliu Gabriel Cocuz1, Hédi Katalin Sárközi1, Adrian Horatiu Sabau1, Bianca Liana Grigorescu2

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Anesthesia and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2022-0021

Bronchopulmonary cancer represents the neoplasms associated with the highest mortality rate, despite diagnostic and therapeutic advances in recent decades. Early diagnosis is often difficult due to the paucity of symptoms or superinfections. Screening subjects at risk of developing lung cancer include clinical, bacteriological, inflammatory status, and genetic profile assessment. The personal microbiome has an essential role in the physiology of the human body. The gut-lung axis plays an essential role in carcinogenesis, being involved in various pathways. The lung microbiome can contribute to the development of lung cancer either directly by acting on tumor cells or indirectly by modulating the tumor-associated immune response. The gut microbiome can directly affect the response to immunotherapy in patients with non-small cell lung cancer.

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Reattachment of coronal tooth fragments: Aesthetic management of a complicated anterior maxillary crown fracture

Preethesh Shetty1, Raksha Bhat1, Arjun Kini2

1. Nitte (Deemed to be University), AB Shetty Memorial Institute Of Dental Sciences (ABSMIDS), Department of Conservative Dentistry and Endodontics,
Mangalore, India
2. New York University College of Dentistry, New York, NY, USA.

DOI: 10.2478/amma-2022-0027

The trauma of anterior teeth is a frequent occurrence in young patients. Reattachment of fractured fragments is one of the various treatment modalities proposed in anterior tooth coronal fractures. The reattachment of fractured fragments grants the advantage of immediate aesthetic rehabilitation and restoration of function, which is a relatively rapid and less arduous procedure. The manuscript presents a case report depicting the management of a complicated crown root fracture of anterior maxillary teeth first treated endodontically, followed by reattachment of the same fragment with a cast post-reinforcement. Reattachment of fractured coronal tooth fragments is a feasible restorative option, rapidly restoring the function and aesthetics of the tooth by a conservative and inexpensive approach.

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Postpartum pancreatitis in young female – a rare case in the Emergency Department

Adrienn Nemeth1,2, Puiu Popescu2

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Emergency Department, Emergency County Hospital, Targu Mures, Romania

DOI: 10.2478/amma-2022-0018

Introduction: Acute pancreatitis is a condition that leads to multiple organ failure syndromes if not diagnosed and treated correctly. The most frequent causes of acute pancreatitis are gallstones, alcohol consumption, and elevated triglyceride serum level.
Case Presentation: A 21-year-old female presented to the emergency department with epigastric pain, nausea, vomiting, and diaphoresis. The patient had a non-complicated vaginal birth four months prior, had no personal history of illness, reported no alcohol consumption, and had a slender body constitution. Laboratory tests outlined a white blood cell count of 22.000/µL, elevated neutrophil count, lactate dehydrogenase 294 U/L, and lipemic serum sample reported for chemistry laboratory test. In addition, the contrast-enhanced computed tomography scan revealed severe pancreatitis, with an intraabdominal fluid collection.
Conclusions: This case report highlights the importance of correct early diagnosis in the postpartum and late postpartum period and raises awareness concerning the possibility of acute pancreatitis in a postpartum woman even if she does not have the two most common risk factors: gallstones or alcohol consumption.

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Nutrition in pregnancy – impact on anaemia in pregnant women

Oana Liliana Atomei1, Paula Paraschiva Monor1,2, Bogdan Aurelian Stana3,4, Monica Tarcea5

1. Faculty of Medicine and Biological Sciences, „Ștefan cel Mare” University of Suceava, Romania
2. Emergency County Hospital „Sfântul Ioan cel Nou” Suceava, Romania
3. Physiology Department, Faculty of Medicine, „Gr. T. Popa” University of Medicine and Pharmacy, Iași, Romania
4. 2nd Pediatrics Clinic – Emergency Clinical Hospital for Children „St. Maria”, Iași Romania
5. Department of Community Nutrition and Food Safety, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2022-0016

Aim: Most pregnant women can achieve their caloric and nutritional needs by careful food choices during pregnancy, but there are fairly common situations when pregnant women develop anaemia, which needs to be managed properly to avoid maternal-foetal complications. The main objective of the study was to identify the nutritional factors favoring the occurrence of iron deficiency anaemia in pregnant women.
Methods: Data collection for the cross-sectional study was carried out using a questionnaire that provided information on nutrition and risk factors during pregnancy in a group of patients from Suceava. The questionnaire was given to pregnant women admitted to the Emergency County Hospital „Sfântul Ioan cel Nou” Suceava, Romania, between March and May 2017.
Results: The anaemia occured in 46.3% of pregnant women. Although 22.2% of pregnant women received oral iron supplementation, effects on anaemia correction were not observed (p=0.02). We found that weight status did not influence anaemic status (p=0.51), and the presence of anaemia in pregnancy was independent of risk factors for pregnancy (smoking, p=0.05; alcohol consumption, p=0.66), iron absorption inhibitors in the diet (coffee, p=0.33; tea, p=0.53), water intake (p=0.52) or night eating (p=0.27).
Conclusions: The results of dietary survey showed no direct link between the prevalence of anaemia and nutritional factors. Lower pre-pregnancy BMI was not associated with higher risk of iron deficiency anaemia, and daily iron supplementation during pregnancy did not meet the needs to counteract the anaemic syndrome. Nutrition education is particularly important for the prophylaxis of iron deficiency anaemia in pregnant women.

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An overview of the microflora of the patients admitted in an Ear Nose and Throat tertiary hospital from Romania

Radu Ovidiu Togănel, Răzvan Lucian Coșeriu, Camelia Vintilă, Anastasia Simion

County Clinical Hospital Mures, Romania

DOI: 10.2478/amma-2022-0017

Objective: The purpose of this retrospective study is to describe clinical, epidemiological and bacteriological findings on the Ear, Nose and Throat infections from patients admitted in a tertiary hospital from Romania, which might bring supportive data for the management of the ENT patients.
Methods: Clinical data from 146 patients admitted in a clinic from Romania, between February 2016 and April 2018 were collected from the official registries of the Microbiology Laboratory, where the collected samples were processed by classical microbiological methods.
Results: From 164 analyzed biological samples, 45.1% were suggestive for infection. Methicillin-sensitive Staphylococcus aureus was the most prevalent bacterial isolate (28.72%), followed by Pseudomonas aeruginosa (12.77%). There were 26 different species of microbes. Out of a total of 77 bacterial isolates, 62.33% were Gram positive and 37.66% Gram negative. The study showed that 11 ear discharge samples were positive in female and male patients. Upper respiratory tract exudates were positive on 3 females (21.4%) and on 17 males (28.8%). There were 7 positive pus samples from females, and from 25 males.
Conclusions: Men were more affected by Ear Nose and Throat infections, caused by bacteria mostly from the genus Staphylococcus and Pseudomonas. More attention at the samples collection and a rigorous clinical examination should reduce the load on bacteriology laboratory. In specific cases, a negative bacteriological result can prove as an exclusion diagnostic.

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Development of a low-grade glioma in an ischemic brain territory that evolved into a glioblastoma. A case report and brief literature review

Andrei-Cristian Fülöp1, Zeno Opriș1, Eugen-Francisc Fülöp2, Ioana-Geanina Ghilință3, Rita Szodorai4, Attila Kövecsi4

1. Department of Radiology, Emergency County Hospital, Targu Mures, Romania
2. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department of Paediatric Cardiology, Emergency County Hospital, Targu Mures, Romania
4. Department of Pathology, Emergency County Hospital, Targu Mures, Romania

DOI: 10.2478/amma-2022-0015

Introduction: Glioblastoma is one of the most common and aggressive brain tumours with a very high mortality rate. It often evolves from a late or misdiagnosed astrocytoma. Stroke is one of the most common pathologies of the brain, affecting approximately 1.1 million Europeans each year. This article presents the sequential development of a low-grade astrocytoma in an ischemic brain territory into a high-grade glioblastoma.
Case presentation: A 59-year-old patient presented to our hospital with severe headache and transient loss of balance and vision. Clinical findings and control imaging revealed the presence of an ischemic brain area in the left temporal lobe of the brain. Monthly brain magnetic resonance imaging (MRI) follow-up revealed the development of a low-grade astrocytoma in the ischemic territory, which later evolved into a glioblastoma.
Conclusions: Patients who suffer from a stroke should be closely monitored via MRI to prevent the rare development of tumour pathology in the affected territory.

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Computed tomography evaluation of diaphragm alterations in 20 critically ill COVID-19 positive patients

Oana Elena Branea1, AnaMaria Romina Budeanu2, Răzvan Gabriel Budeanu3, Adrian Ștefan Chiuzan4, Ioana Lăcrămioara Nazaret5, Sanda Maria Copotoiu1, Alexandra Elena Lazăr1

1. Department of Anesthesia and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, România
2. Department of Anesthesia and Intensive Care, Emergency Clinical County Hospital of Târgu Mureș, România
3. Department of Radiology, Emergency Clinical County Hospital of Târgu Mureș, România
4. Department of Radiology, Emergency Clinical County Hospital of Bistrița, România
5. Department of Anesthesia and Intensive Care, Emergency Clinical County Hospital of Piatra Neamț, România

DOI: 10.2478/amma-2022-0014

Objective: Diaphragmatic dysfunctions are multiple and critical illnesses often lead to the muscular atrophy that affects respiratory and peripheral muscles. The primary objective was to investigate diaphragm thickness in hospitalized patients. Secondary objectives were to assess clinical evolution and outcome. Methods: In a mean time period of 7.9 days, two different chest computed tomographies were used in order to examine diaphragm alterations of right and left diaphragm in 20 critically ill patients tested Real-Time Polymerase Chain Reaction positive to Severe Acute Respiratory Syndrome Coronavirus-2. Patients were divided in two groups (one group <5% decrease in diaphragm thickness and another group ≥5% decrease in diaphragm thickness).
Results: Results showed that patients presented low 10 years predicted survival rate (Charlson Comorbidity Index > 7.7±3.08), marked inflammatory status (C-Reactive Protein = 98.22±73.35, Interleukine-6 = 168.31±255.28), high physiologic stress level (Neutrophil/Lymphocyte Ratio = 31.27±30.45), respectively altered acid-base equilibrium. Half of the investigated patients had decrease in diaphragm thickness by at least 5% (right diaphragm = -7.83%±11.11%, left diaphragm = -5.57%±10.63%). There were no statistically significant differences between those with decrease of diaphragm thickness and those without diaphragm thickness, regarding length of stay in Intensive Care Unit and in hospital, inflammatory markers, and acid-base disorders.
Conclusions: Patients were admitted in Intensive Care Unit for acute respiratory failure and half of the investigated patients displayed diaphragm alterations at CT scan.

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