Category Archives: Current

Chest wall secondary chondrosarcoma caused by malignant degeneration of an enchondroma: case report and literature review

DOI: 10.2478/amma-2022-0006

Introduction: Enchondromas are benign tumors originating in the cartilaginous tissue of the hyaline gristle, rarely located in the chest wall. They sometimes undergo a sarcomatous transformation, becoming secondary chondrosarcomas.
Case presentation: We present the case of a 53-year-old patient who, following a chest computed tomography scan performed after a thoracic trauma, was diagnosed with an osteolytic tumor at the chondrocostal junction of rib 4. Surgery was performed, with partial straight resection of ribs 3–5. Histopathological examination of the resection piece identified the existence of a chest wall chondrosarcoma on the background of malignant degeneration of an enchondromatosis lesion. The postoperative evolution was favorable, and the patient was discharged on the eighth postoperative day.
Conclusion: In patients with even asymptomatic chest wall enchondromas, periodic clinical evaluation of these lesions is required, given their risk of malignant degeneration.

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Rehabilitation of maxillary arch with attachment-retained reinforced single complete denture

DOI: 10.2478/amma-2022-0003

Introduction: Fracture of maxillary complete denture is a common problem for dentists and denture wearers, occurring especially when it is opposing mandibular natural teeth or fixed and implant-sustained restorations; to prevent it, various methods and materials are available.
Case presentation: This case is of a patient losing his old maxillary removable partial denture due to the mobility of the frontal abutments. Considering the age of the patient and the status of the mandibular arch, completely restored and having a mix of natural teeth, fixed and implant-sustained restorations, the functional and esthetic rehabilitation of the maxillary arch, and also the long-term resistance of the denture, are a serious prosthetic challenge. An association between ball attachments, metal-casted reinforcement and masking agents for both are described, underlying their role in the treatment’s succes.
Conclusion: The age and health status of the patient and the situation of the mandibular arch imposed the construction of a functional, strong and stable maxillary denture; the technique described in this article offers a good functional and esthetical result and benefits the patient, even if the implant-prosthetic therapy is not available.

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The influence of transport condition and processing time on plasma ammonia results

DOI: 10.2478/amma-2022-0005

Objective: Ammonia is extremely unstable in blood specimens and has special requirements during transport, processing and storage. The aim of our study was to determine the stability of ammonia in EDTA K3 blood samples and to establish a protocol for sample handling.
Methods: In this study, 36 healthy subjects and 47 inpatients diagnosed with type 2 diabetes mellitus were enrolled. Two peripheral blood samples were collected from healthy volunteers (Sample A1 and A2) and one peripheral blood sample was collected from the inpatients diagnosed with type 2 diabetes mellitus (Sample B). Sample A1 and B were transported in ice bath within 15 minutes of blood collection, centrifuged immediately and processed. The sample was re-centrifuged after 15 minutes and a second ammonia result was obtained. Sample A2 was transported at room temperature and stored between 2 and 4 hours, centrifuged and plasma ammonia measurement was performed. The sample was re-spun after 15 minutes and a fourth ammonia result was obtained.
Results: In our study, in healthy group the difference between sample A2 and set point value (on ice, 15 minutes) is 25.08 µg/dl, showing an increase of 55.29%. After another 15 minutes, an increase of 82.02% was observed compared with the standard value. In diabetes mellitus group, after 30 minutes of blood collection, an increase of 11% over the set point value was observed.
Conclusions: The blood specimen should be transported on ice to the laboratory and analyzed within 15 minutes of blood collection due to plasma ammonia spontaneously increase.

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Unified protocols for transdiagnostic treatment versus the Beckian’s approach of cognitive behavioral therapy for medical students with emotional disorders

DOI: 10.2478/amma-2022-0002

Background: Emotional disorders are highly prevalent among medical students, impacting their academic performance and general quality of life. It was shown that cognitive-behavioral and emotion regulation strategies are efficient for reducing anxiety and depressive symptoms in young people.
Objective: This study aims to compare the efficiency of standard individual Cognitive-Behavioral Therapy (CBT) to a group intervention based on the Unified Protocol for Transdiagnostic Treatment (UPTT) of emotional disorders in two groups of medical students with similar baseline characteristics.
Method: The sample of this research was composed of 64 medical students in total, of which 34 were included in the CBT group (Mage= 19.5 years, SD= 0.96) and 30 were included in the UPTT group (Mage= 19.4 years, SD= 0.93). The level of irrational beliefs and emotional distress were measured before and after the interventions, which were carried out by certificated psychotherapists.
Results: Statistically significant differences were observed between pre-test and post-test in both groups. The level of irrational beliefs dropped after the CBT (M=62.91, SD=21.30, p<0.05) and the UPTT intervention (M=67.33, SD=34.89, p<0.05), respectively. Similarly, the profile of emotional distress changed after the CBT (M=77.62, SD=16.97, p<0.05) and the UPTT intervention (M=68.77, SD=20.06, p<0.01).
Conclusion: Psychological interventions relying on cognitive-behavioral approaches, including standard, individual psychotherapy and a group intervention designed according to a transdiagnostic protocol, are suitable methods for reducing emotional disorders among medical students.

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Risk Assessment of Failures in Generic Drug Development and Approval Procedure under Competitive Generic Drug Therapy and Patent Challenge Exclusivities Provided by the United States Food and Drug Administration

DOI: 10.2478/amma-2022-0004

Objective: The United States Food and Drug Administration implemented two exclusivity programs Competitive generic therapy and Patent Challenge exclusivity to develop generic drugs, which provide a 180-day monopoly market for first generic applicants in the United States of America. The aim of the present study is to find the root cause of failures in developing and filing the first generic drugs under these exclusivities and to compare both the exclusivities to find the merits and demerits.
Methods: We used descriptive statistics for data analysis of both the exclusivities and Risk assessment was conducted on 14 industries to find the root cause of failures in every stage of the approval procedure by FMECA (Failure mode, Effects and Criticality Analysis).
Results: We found 44% of rejections in competitive generic therapy drugs and 30% of rejections in patent challenge exclusivity drugs. The risk analysis conducted on failures found that, in drug selection, 6% of failures are occurred due to rare diseases. In drug development, 9% of failures are occurred due to formulation failures. In pre-approval, 10% of failures are occurred due to secondary patents. In post-approval, 6% of failures are occurred due to product changes after approval.
Conclusion: We hope this study can give an idea for small and medium companies in developing countries for the early development of generic drugs for life-threatening diseases.

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Maturogenesis of an immature necrotic tooth with an extensive perirapical lesion using platelet rich fibrin

DOI: 10.2478/amma-2022-0001

Introduction: Earlier, treatment of immature necrotic tooth focussed only on surgical endodontic management and apexification procedures. Regenerative endodontic therapies have called for a paradigm shift in management of such cases. Prognosis becomes challenging though at times due to chronicity of infection, inadequate disinfection of canal space and cytotoxic nature of irrigants used hindering the survival of the apical stem cells.
Case presentation: This report highlights the management of a long-standing case of an immature necrotic tooth with an extensive periapical lesion in a 12 year old male patient. The protocol of regenerative endodontic procedure using platelet rich fibrin (PRF) was followed. Follow up visits at 1week, 3months and 12 months revealed a successful clinical and radiological outcome leading to progressive maturogenesis of the tooth.
Conclusion: The case report favours the possibility of stem cells of apical papilla being viable even in chronic periapical lesions. Hence conservative approach involving regenerative endodontic therapies should always be sought for as first line of treatment in such cases.

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Emotional disorders associated to multiple sclerosis and psychological interventions: a literature review

DOI: 10.2478/amma-2021-0042

Multiple sclerosis is an unpredictable neurologic disease affecting 2.8 million people worldwide. Individuals with MS experience multiple physical and psychological symptoms such as depression, anxiety, fatigue, and pain that impact their general functioning and quality of life. The aim of this review is to highlight the importance of psychological interventions in reducing depression and anxiety symptoms associated with the diagnosis of multiple sclerosis. Cognitive and behavioral techniques are also useful in relieving the specific symptoms of multiple sclerosis. However, few studies have captured the psychological processes involved in reducing the symptoms of depression and anxiety, which is why greater concern is recommended in future studies in order to develop better psychological interventions tailored for patients with multiple sclerosis.

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The antibacterial potential of biosynthesized silver nanoparticles using beech bark and spruce bark extracts

DOI: 10.2478/amma-2021-0043

Introduction: Lately, nanotechnology focuses on the green synthesis of AgNPs, using different plant materials, as this method is accessible, cost-efficient, and ecological. The study aimed to investigate the antibacterial potential of AgNPs synthesized using beech/spruce bark extracts (BBE/SBE) and silver salts (acetate/nitrate).
Method: The growth rates of Staphylococcus aureus ATCC 25923 and Escherichia coli ATCC 25922 were evaluated in the presence of the AgNPs solutions. The checkerboard method was performed to evaluate if these solutions exert synergistic activity with gentamicin.
Results: For E. coli, synergistic effects were observed for the combination of gentamicin 0.25mg/L with AgNP BBE Nit (0.145mg/mL) and with AgNP SBE Ac (0,09mg/mL). For S. aureus, no synergistic effects were observed. Overall, the AgNP BBEs solutions combined with gentamicin presented lowest values of fractional inhibitory concentration than the ones registered for the combination of AgNP SBEs with gentamicin, for both bacterial strains. The growth rate of S. aureus was inhibited by all the tested AgNPs at the measured time points. For E. coli, after 24 hours of incubation, the growth rate was inhibited only in the presence of AgNP SBE Ac. After 6 hours of incubation, the growth rate of E. coli was almost stationary in the presence of AgNP BBE Nit.
Conclusions: The biosynthesis of AgNPs is a valuable choice for obtaining substances with antibacterial potential.

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Apathy as Non-Motor Manifestation in Amyotrophic Lateral Sclerosis

DOI: 10.2478/amma-2021-0041

Although the term of amyotrophic lateral sclerosis (ALS) is often used interchangeably with motor neuron disease, ALS is universally accepted as a multisystem disorder. Cognitive impairment is an acknowledged feature of ALS, affecting language, memory and behaviour, and apathy is considered to be the prevalent behavioural alteration in ALS. It can be divided in three subtypes: executive, emotional and initiation apathy. Out of the three subtypes, initiation apathy is common among patients with ALS. Even in patients that do not meet the criteria for ALS with frontotemporal dementia, low-key neuropsychiatric and cognitive changes can be observed. Apathy has also been found to be systematically associated with disruptions in medial frontal cortex and subcortical structures in several neuroimaging studies that confirm the pre-existing brain lesions in the early stages of this disease. Thus, there is a growing body of evidence that motor signs and symptoms are accompanied or even preceded by cognitive and behavioural alterations, and screening for non-motor signs and symptoms can be clinically relevant.

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