Category Archives: Number

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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Non syndromic congenital agenesis of multiple permanent teeth: Case series and recent literature review

Sowmya Sridhar1, Savil R Uchil1, Anupama P Nayak1, Ravikiran Ongole2, Suprabha BS1, Ashwin Rao1, Karuna YM1

1. Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
2. Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India

DOI: 10.2478/amma-2022-0013

Introduction: Hypodontia refers to the congenital absence of less than six teeth. This absence may be unilateral or bilateral. Though the congenital agenesis of bilateral mandibular/ maxillary incisors has often been reported in literature, however, the congenital absence of bilateral mandibular and maxillary incisors, as well as the mandibular second molar- giving rise to a total of six missing permanent teeth in an apparently healthy individual has not been reported earlier.
Case presentation: This case series presents two cases of a 10- and 11-year-old children with presence of retained deciduous anterior in both arches with absence of permanent successors and also aims to review the literature regarding etiology, clinical implications and management in such cases.
Conclusions: It is essential that practitioners monitor the developing dentition with establishment of a proper review schedule. Non-eruption of the permanent tooth more than one year later than expected, or even after six months following the emergence of the contralateral tooth, warrants a high degree of suspicion. A multidisciplinary team, including pediatric, restorative and orthodontic specialists, is advised. In addition, prior to formulation of any treatment plan, due consideration to the general issues such as the patient’s systemic and oral health, motivation and expectations should be given.

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Comparative analysis of mandibular changes after orthodontic treatment with and without extraction of four premolars – A digital cephalometric study

Anithab Alex, Keerthan Shashidhar, Kuttappa M N, Krishna U S Nayak, Sai Kalyan Menta, Anushree A

Department of Orthodontics and Dentofacial Orthopedics, A B Shetty Memorial Institute of Dental Sciences; NITTE Deemed to be University, Mangalore, Karnataka, India

DOI: 10.2478/amma-2022-0012

Objective: To compare and evaluate the cephalometric hard and soft tissue changes of mandible after orthodontic treatment with and without extraction of four first premolar.
Methodology: 60 individuals with Class I skeletal pattern were selected as per inclusion criteria. They were divided into two groups: 30 in the extraction group and 30 in the non-extraction group. Each group consists of 15 males and 15 females. Pre-treatment and post-treatment lateral cephalograms of the selected subjects were obtained, analysed and compared to assess the changes might have occurred. Descriptive statistics of the explanatory and outcome variables were calculated by mean and standard deviation for quantitative variables. Paired t test was applied to check the statistical difference of pre-treatment and post-treatment cephalometric parameters within the group (Extraction and non-extraction). Unpaired t test was used to check the statistical difference between extraction and non-extraction groups. The level of significance is set at 5%.
Results: B point moved backward with lower incisor retraction. N-A-Pog shows a statistically significant decrease in the extraction group (P=0.003). B-NP shows a statistically significant decrease in extraction group (P=0.001). N- A’-Pog’ shows a statistically significant increase in non-extraction group (P=0.046). Soft tissue thickness in chin increases in extraction group and decreases in non-extraction group.
Conclusion: The results indicate that premolar extraction will have a flattening effect on the midface. With proper diagnosis and treatment planning, premolar extractions have high potential to improve the facial profile.

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Use of the continuous glucose monitoring system in the management of hypoglicemia in insulin autoimmune syndrome

Andrada Raluca Pop1, Claudia Emanuela Ruscanu2, Gabriela Roman1, Ionela Maria Pascanu2

1. Diabetes Center, Emergency County Hospital Cluj Napoca, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania
2. Endocrinology Center, Emergency County Hospital Targu Mures, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2022-0011

Background: Insulin autoimune syndrome (IAS), also known as Hirata’s disease, is a rare cause of spontaneous hyperinsulinemic hypoglicemia characterised by the presence of autoantibodies directed against human insulin (IAA).
Case Report: A 48-year-old Caucasian female patient with IAS was studied in two different periods, for 7 days each, using a continuous monitoring system (CGM) under various treatment regimens, i.e diet modification and corticosteroids therapy.
Discussions: The use of CGM in autoimmune hypoglycemia is encouraged and must be taken into consideration in order to prevent episodes of hypoglicemia. Including of IAS and quantification of IAA in differential diagnosis in patients with hypoglicemia episodes and negative imaging results can prevent patients from going through unnecessary procedures.

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