Category Archives: AMM 2023

Multiorgan morphological changes caused by
hyperthermia: Case study on experimental model

Emina Dervišević1, Nina Čamdžić2, Suada Kuskunović-Vlahovljak2, Muamer Dervišević3

1. Department of Forensic Medicine, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
2. Department of Pathology, Faculty of Medicine, University of Sarajevo,Sarajevo, Bosnia and Herzegovina
3. Clinic for Lung Diseases “Podhrastovi”, University Clinical Centre of Sarajevo, Sarajevo, Bosnia and Herzegovina

DOI: 10.2478/amma-2023-0026

Morphologic changes in organs vary from nonspecific to specific ones, depending on causes of sudden death, e.i whether it is an acute, subacute or chronic event. The aim of this pilot study was to observe the appearance and occurrence of morphological characteristics on organs that were exposed to long-term effects of hyperthermia. A sample of 7 rats was exposed to a water temperature of 41°C, which is defined in the literature as “heat stroke temperature”, both sexes, weighing 250 to 300 g were used. Tissue samples, obtained by dissection of rats, were fixed in 10% buffered neutral formalin, at room temperature, then incorporated into paraffin blocks, cut at 4-5 microns, mounted and stained with standard hematoxylin-eosin (HE) method. In order to prove/exclude lipid and glycogen accumulation in hepatocytes we did additional histochemical staining, using Sudan black and Periodic Acid Shiff (PAS) method, respectively. We obtained samples from kidney, liver, pancreas, spleen, lung and brain. Analyzing tissue samples of different organs obtained from seven Wistar rats, we gained insight into morphological changes caused by induced hyperthermia. All sampled organs showed congestion and some degree of oedema. The most prominent changes were observed in liver and lung samples. Tissue samples of the lung of all seven rats showed signs of acute bronchitis and bronchiolitis, together with signs of initial bronchopneumonia. We also noticed signs of focal acute emphysema as well as focal accumulations of foamy macrophages. Our study suggests that changes in the vascular bed occur soon after hyperthermia and while some organs are more tolerant to heat stroke than others, most organs show similar changes consisting of capillary dilation, congestion and interstitial extravasation, observed after 30 minutes at a temperature of 40.5°C, with the most significant changes observed in liver and lung samples.

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The role of diet in modulating the intestinal microbiota in healthy adults: Is the evidence enough?

Florina Ruta1, Elena Mardale2, Andrada Pintea1, Calin Avram1

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Regina Maria Health Network, Civic Center, Brasov, Romania

DOI: 10.2478/amma-2023-0025

The diet is an important factor that can influence the structures and function of the population of germs that compose the intestinal microbiota. This review presents current data on the response of the intestinal microbiota depending on the diet. While many studies have shown that the intestinal microbiota is influenced by macronutrient and micronutrient compounds of the diet, the studies on healthy human subjects were fewer and showed only to a small extent the influence of cooked food on the intestinal microbiota. Additional research is still needed regarding the effect of the way food is cooked can have on the intestinal microbiota, before beneficial dietary recommendations can be made.

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Correlation between diabetic nephropathy and diabetic retinopathy as a long term complications of diabetes mellitus

Muamer Dervišević1, Damir Rebić2, Emina Dervišević3

1. Pulmonoloy Clinic, Clinical Center University of Sarajevo, Bosnia and Herzegovina
2. Nephrology Clinic, Clinical Center University of Sarajevo, Bosnia and Herzegovina
3. Department of Forensic Medicine, Faculty of Medicine, University of Sarajevo, Bosnia and Herzegovina

DOI: 10.2478/amma-2023-0024

Background/aim: Diabetes mellitus is a metabolic disorder of multiple etiologies characterized by a lack of insulin, with a consequent disordered metabolism of glucose, fats, and proteins. A number of complications, such as diabetic nephropathy and retinopathy, may develop as a result of long-term diabetes. The aim of this study aimed to determine the correlation between diabetic nephropathy and diabetic retinopathy as long-term complications of diabetes mellitus.
Materials and methods: Retrospective, descriptive, and analytical research was conducted at the department of Endocrinology, Clinical Center, University of Sarajevo. The study included 158 patients hospitalized in time between 1st of January and 31st of December 2012.
Results: New-onset diabetes was found in 38%, and diabetes type 2 patients 132 (83.5%), female 105 (66.5%) while older than 60 years were 100 (63.3%). Upon discharge from hospital 83,7% of patients were discharged with glycemia <10 mmol / l. We found that 47,5% of patients had HbA1c> 10%. Reduced kidney function, different degrees of failure was at 66.5%. More than half (62.7%) patients had proteinuria as a sign of diabetic nephropathy. Diabetic retinopathy was diagnosed with different types in 54.4%.
Conclusion: Diabetes leads to an increase in nitrogen compounds, and the development of diabetic nephropathy manifests as various degrees of renal insufficiency. The duration of diabetes and occurrence of diabetic retinopathy were significantly interrelated. The correlation between the degree of renal failure and changes in the ocular fundus has not been proven, but more severe renal insufficiency is associated with a higher incidence of diabetic retinopathy compared to patients with less impaired renal function.

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Recent progress in apoptosis triggering facilitated by HeLa Studies

Maria Teodora Constantin1, Marius Alexandru Beleaua2,3

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

DOI: 10.2478/amma-2023-0022

Objective: Cancer is a leading cause of death globally, prompting numerous efforts to find effective treatments. HeLa cells, derived from Henrietta Lacks’ cancerous squamous cells, have played a crucial role in cancer research due to their origin, resistance, and rapid growth. They are particularly useful for studying ways of cellular death triggering, or apoptosis, without an immune response. Thus, the objective of this paper was to review the latest publications on the subject of HeLa apoptosis so that a brief view to be available on the otherwise so extended subject.
Methodology: To provide a concise review of the extensive research on this topic, a search was conducted using the phrase “HeLa cells apoptosis triggering” on PubMed. The articles that were published in English, in the last 6 years, presenting results sustained by valid morphological and chemical apoptotic changes present in cells, were selected and reviewed. A comprehensive table presenting the apoptotic mechanism exerted by each substance was made to assure a concise presentation of the results.
Results: The reviewed studies have shown that many natural substances exhibit pro-apoptotic activity on malignant cells and can be used as chemotherapeutic agents. Some synthetic molecules were showed to have good results too. Important facts about these substances, their intervention site and metabolic modifications are presented in a concise form. The use of nano-carriers for targeted delivery was shown to increase their specificity towards cancerous cells.
Conclusions: HeLa cells were a groundbreaking discovery that revolutionized scientific research. Although there is ongoing research towards cancer cures using HeLa cells, there are still many trials and considerations that need to be addressed. With the countless existing HeLa cell lines, the scientific possibilities for research are endless.

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Effects of vitamin D3 (cholecalciferol) supplementation on diabetic polyneuropathy in patients diagnosed with diabetes mellitus

László Marton1, Monica IM Szabó1,2

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

DOI: 10.2478/amma-2023-0023

Introduction: Peripheral sensorimotor polyneuropathy is present in nearly half of the patients diagnosed with diabetes mellitus. Over the past 10 years, animal and human studies have suggested that vitamin D3 treatment may have a role in preventing or reducing neuropathic complaints and symptoms.
Material and method: Our clinical, prospective, interventional, placebo-controlled study investigated the therapeutic effect of 2.000 IU oral cholecalciferol administered for three months on diabetic polyneuropathy. Patients treated with vitamin D and B, thioctic acid, and other analgesics were excluded. Using the single-blind technique, they were randomly assigned into vitamin D-treated and placebo-treated groups. In addition to recording anamnestic data, the study included – a Toronto Clinical Neuropathy Scoring System and Michigan Neuropathy Screening Instrument based – questionnaire to assess subjective symptoms and a physical examination including sensory tests (fine touch-, temperature awareness, pain-, vibration perception). Vitamin D levels were measured. After three months of therapy, the examination was repeated.
Results: Most of the patients were found to have vitamin D deficiency (36% of the total population) or insufficiency (43%). In the cholecalciferol-treated group, but not in the control group, subjective symptoms decreased in intensity and/or frequency, and a significant improvement in the overall complaint scale was observed (p = 0.006), but no change regarding the sensory tests (p > 0.05).
Conclusions: Our results show that oral administration of cholecalciferol for three months significantly reduced subjective symptoms and neuropathic pain as assessed by our questionnaire, however, there was no significant change in the results of the sensory tests. Vitamin D deficiency/insufficiency was common in diabetic patients (79% in our population), therefore screening is recommended.

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Detection of serum telomerase and fibronectin as precursor markers of cervix cancer in patients with a positive Pap test

Toader Septimiu Voidăzan1, Florin Francisc Rosznayai2, Cosmina Cristina Uzun3, Zsolt Kovacs3, Sabin Gligore Turdean4, Budianu Mihaela-Alexandra1

1. Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Obstetrics Gynecology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department of Biochemistry, Environmental Chemistry, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2023-0021

Introduction: Cervical cancer is a type of cancer that appears in cervical cells, in the lower part of the uterus, being characterized by the proliferation of atypical cancerous cells, which can spread rapidly, representing a serious disease, with significant medical and social impact among affected individuals, and a severe evolution particularly when detected in advanced stages. The aim of this study was to evaluate the alterations found in cervical cells, caused by persistent HPV infection, using inflammatory protein biomarkers such as fibronectin and telomerase.
Material and method: This study included a total of 169 women, both asymptomatic and symptomatic, aged between 30 and 64 years. Those women underwent routine gynecological consultations or were referred to a gynecologist because of their symptoms. After selecting the patients, a Pap test and blood samples (5 ml) were taken. Using a questionnaire, information regarding sexual characteristics and behaviors, as well as personal medical history, were collected.
Results: The median value for telomerase was 0.1 ng/ml, with a minimum of 0.01 ng/ml and a maximum of 30.09 ng/ml. Based on the telomerase results, 66 (39.1%) patients had positive results (more than 0.215 units) and 103 (60.9%) had negative results. The median value for fibronectin was 3.72 ng/ml with a minimum of 0.55 ng/ml and a maximum of 89.9 ng/ml. Of all women included in the study, 36 (21.3%) had positive results (more than 10 ng/ml), and 133 (78.7%) had negative results. Also, 15.2% of patients with positive telomerase and 16.7% with positive fibronectin presented Atypical Squamous Cells of Undetermined Significance. Mature squamous metaplasia and inflammatory cells have been identified among positive and negative results of fibronectin and telomerase.
Conclusions: Positive and negative results for fibronectin and telomerase were similar in correlation with cytological results and information about HPV infection or sexual practices/characteristics were similar.

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Oral manifestations of amyloidosis in a multiple
myeloma patient: A case report

Jayachandran Sadaksharam1, Sophia Jeba Priya1, Sripriya Subramaniam1, Archana Muralidharan2

1. Department of Oral Medicine and Radiology, Tamil Nadu Government Dental College and Hospital, Chennai, India
2. Department Oral Medicine and Radiology, Manipal College of Dental Science Mangalore, Manipal Academy of Higher Education, Manipal, India

DOI: 10.2478/amma-2023-0019

The term amyloidosis refers to a wide range of diseases in which amorphous, extracellular, eosinophilic proteinaceous deposits form at various locations. In this article, we describe a case of amyloidosis with multiple myeloma in which the oral symptoms of the disease served as the main diagnostic clues. A male patient in his early 60s who had multiple tongue swellings presented to our department. Following an incisional biopsy, histological analysis revealed the presence of eosinophilic, amorphous hyaline-like material that was positive for Congo red staining and was indicative of amyloidosis. The presence of abnormal plasma cells in the patient’s bone marrow aspiration after the biopsy was done was suggestive of multiple myeloma. The patient is currently undergoing the CyBorD (Cyclophosphamide, Bortezomib, and Dexamethasone) treatment for multiple myeloma that has just been diagnosed. We offer this instance to demonstrate that, although uncommon, amyloidosis can initially only manifest as numerous swellings on the tongue.

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Vincristine, doxorubicin and cyclophosphamide chemotherapy induced oral chronic hyperplastic candidiasis and xerostomia in a young patient with Ewing’s sarcoma: A case report

Harshita Sharma, Charisma Thimmaiah, Almas Binnal, Manoj Kumar Golla, BS Suprabha

Manipal College of Dental Sciences, Mangalore Manipal Academy of Higher Education, Manipal, India

DOI: 10.2478/amma-2023-0018

A common primary bone malignancy in childhood and adolescence is Ewing’s sarcoma. Here we report multidisciplinary approach in the management of chronic hyperplastic candidiasis and xerostomia secondary to chemotherapy with vincristine, doxorubicin and cyclophosphamide (VDC) in a pediatric male patient with Ewing’s sarcoma of Ethmoid sinus. The initial diagnosed oral lesion was treated with topical clotrimazole 1%w/v for two weeks and Sucralfate 1g/10mL oral rinse for one month. Upon subsequent VDC chemotherapy cycle, the patient developed grade IV oral mucositis, severe neutropenia and associated oesophageal candidiasis. Treatment included combination of topical clotrimazole 1%w/v and Fluconazole 300mg/day (IV for 5 days and Tablet for 14 days). To prevent caries risk, pit and fissure sealants were applied and topical fluoride therapy was given; patient was encouraged to have frequent sips of water and prescribed kids xylitol gum for 15 days to minimize xerostomia. At 5-week follow up, reduction in burning sensation and resolution of white lesion was noted.

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The importance of early diagnosis and surveillance in Peutz-Jeghers Syndrome: A case report

Marina-Georgia Balosin

3rd Department of Gastroenterology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

DOI: 10.2478/amma-2023-0017

Introduction: Peutz-Jeghers syndrome is a rare autosomal dominant inherited disorder characterized by hamartomatous intestinal polyps and mucocutaneous pigmentation. Most cases appear to be linked to the mutation of the STK11 gene. Patients are at a lifetime risk of gastrointestinal and non-gastrointestinal cancers.
Case Presentation: The present study offers the case of this rare disorder in a young woman revealed by jejunal obstruction caused by intussusception. A 32-year-old woman was referred to the surgical department with symptoms suggestive of an obstructive syndrome. On examination, there were multiple perioral pigmented lesions. An urgent exploratory laparotomy revealed bowel obstruction caused by an intussusception with a large polyp. The patient suffered another similar episode 4 years before leading to the diagnosis of Peutz-Jeghers Syndrome, however she was under no surveillance. Patients with pigmented lesions and a family member suffering from the mentioned syndrome should perform endoscopy and genetic tests to diagnose early and avoid complications.
Conclusion: Peutz-Jeghers Syndrome is difficult to treat due to its nonspecific symptomatology and late diagnosis. Life-threatening complications such as intussusception and various types of cancer are unanticipated. It is vital to diagnose and perform routine screening, which will make it possible to prolong the survival of many patients.

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

Suhina Mitra1, Deepa G. Kamath1, Nishmitha D. Shetty1, Srikanth N2

1. Department of Periodontology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 575001, India
2. Department of Oral Pathology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 575001, India

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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