Category Archives: Number

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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Air guns: An underestimated danger – case presentation, literature review and legal interpretation

Cosmin Carasca1, Timur Hogea1, Katalin Siklodi Palfi2, Carmen Corina Radu1

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Institute of Forensic Medicine, Targu Mures, Romania

DOI: 10.2478/amma-2023-0013

Introduction: The compressed air weapon is a type of arm to which the projectile is propelled due to the compression of air in a sealed chamber. These types of weapons belong to the category of non-lethal weapons and ammunition subject to authorization. However, accidental fatal cases, suicides or even deaths with intention attributed to these types of weapons are described in the literature.
Case presentation: We are discussing the case of a 5-year-old boy who, at a picnic with several families, is shot and killed with a compressed air rifle, left unattended. The medical crew arrived at the scene could not save the boy’s life. Necroptic examination revealed a gunshot wound through the heart, with the projectile stuck in the lateral-internal wall of the right ventricle. The projectile identified was a metal type projectile (lead), with a length of 8.5 mm and a diameter of 4.5 mm.
Conclusions: Compressed air weapons, although considered non-lethal, have proven over time their extremely dangerous potential through the fatal injuries produced. Raising public awareness, limiting use and enforcing strict legislation could prevent tragic events.

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Clinical characteristics and endoscopic findings in autoimmune gastritis – a retrospective study

Gabriella Gabos1, Valentin Nădășan2, Iris Nădășan2, Mădălina Petruț1, Ioana Bernatchi1, Mădălin Bălășescu3, Carmen Nicolau1

1. Gastroenterology Department, Lotus Image Medical Center Actamedica SRL, Targu Mures, Romania
2. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Intensive Care Unit, Mureș County Clinical Hospital, Targu Mures, Romania

DOI: 10.2478/amma-2023-0012

Objectives: Autoimmune gastritis (AG) is a rare condition that increases the risk of developing stomach adenocarcinomas or carcinoid tumours. The objectives of the present research were to summarise the clinical traits of AG patients, together with gastroscopic and histopathologic findings, demographic data, and hematologic characteristics.
Patients and methods: A medical centre assessed 58 AG patients from January 2019 to December 2022.
Results: The majority of the patients were female (73.7%), and the mean age of the participants at the time of the diagnosis was 57.7 ± 12.1 years. We identified pernicious anaemia (54.4%), iron deficiency anaemia (21.1%), as well as autoimmune disorders (96.5%). Though 78.9% of patients reported having gastrointestinal symptoms, 69% presented exclusively upper gastrointestinal symptoms, 17% only had lower, and 14% had concurrent upper and lower gastrointestinal symptoms.  All 58 AG patients were examined for associated gastric lesions, although abnormal injuries were detected in only 22 of them. One patient (1.8%) had adenocarcinoma, while five patients (8.8%) had type 1 neuroendocrine tumours (NET). In addition, hyperplastic polyps were found in 16 (28.1%) individuals.
Conclusions: Other autoimmune diseases were present with AG, which showed a female predominance. Clinicians should give AG more significant thought by allowing access to interdisciplinary teams.

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Intermittent fasting for the management of NAFLD: Is there enough evidence?

Simona Cernea1,2, Florina Ruţa3

1. Department M3, Internal Medicine I, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Diabetes, Nutrition and Metabolic Diseases Outpatient Unit, Emergency County Clinical Hospital, Târgu Mureş, Romania
3. 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-2023-0001

The pathogenesis of the non-alcoholic fatty liver disease (NAFLD) has been described as multifactorial, with genetic and environmental factors acting synergistically and causing excessive hepatic lipid accumulation, insulin resistance, and downstream pathogenetic insults. High-calorie diets, particularly those rich in foods with high (saturated) fat and sugar content, and sugar-sweetened beverages, are among the behavioral risk factors with a crucial role in the disease pathogenesis. In addition, meal frequency and meal timing appear to be relevant factors associated with NAFLD. Current guidelines recommend a hypocaloric, preferably Mediterranean diet as the main dietary intervention approach, but various other dietary models have been evaluated in patients with NAFLD. Among these, several intermittent fasting regimens have shown promising results. Diets based on Time-Restricted Feeding and Intermittent Energy Restriction have demonstrated some improvements in body adiposity, liver enzymes, and hepatic steatosis, but most studies included a small number of subjects, were of relatively short-duration, and used surrogate markers of NAFLD. The best intermittent fasting regimen for NAFLD is not yet known, and further well-designed research that evaluates the feasibility (mainly on long-term), safety and efficacy outcomes of these dietary interventions is still needed. Our review has evaluated the up-to-date information regarding the intermittent fasting dietary intervention in NAFLD and generated some key-point messages that are relevant to physicians and dietitians involved in the care of patients with NAFLD.

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Inter-observer variability on the value of endoscopic images for the documentation of upper gastrointestinal endoscopy – our center experience

Ioana Natalia Bernatchi1, Septimiu Voidazan2, Madalina Ioana Petrut1, Gabriella Gabos1, Madalin Balasescu3, Carmen Nicolau1

1. Gastroenterology Department, Lotus Image Medical Center, Târgu Mureş, Romania
2. Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Intensive Care Unit, Mureș County Clinical Hospital, Targu Mures, Romania

DOI: 10.2478/amma-2023-0015

Objective: Endoscopy is an essential and invaluable diagnostic tool in the arsenal of every gastroenterologist. ESGE presented additional guidelines for standardized image documentation in upper and lower gastrointestinal endoscopy. Clinical disagreement is a common challenge in most, if not all, fields of medicine. Settling disagreements is important so as to find ways to minimize it. Clinical disagreement in gastroscopy may be demonstrated by studying the observer variability.
Methods: We retrospectively recruited 120 random patients that underwent conventional upper gastrointestinal endoscopy between 2021-2022 in our Department of Gastroenterology, all of them performed by one endoscopist. As part of the study, all video-endoscopic recordings were stored using one internal server. In order to study interobserver variability, four physicians (endoscopists and gastroenterologist specialists) were invited to complete the questionnaire.
Results: The interobserver variability in our study ranged from moderate to very good in the assessment of the esophagus, with the highest degree of agreement in response to questions concerning characteristic findings such as normal mucosa, esophagitis Class A Los Angeles, hiatal hernia for the esophagus endoscopic evaluation, benign ulcer niche in gastric antrum, normal gastric corpus mucosa, intestinal metaplasia and angiodysplasia in gastric corpus. The question on atrophic mucosa in the first and second part of the duodenum was the most difficult to agree upon.
Conclusion: The present study found that the variability between observers in the assessment of images obtained from patients that underwent conventional upper gastrointestinal endoscopy in our center was acceptably good.

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Should we screen for sarcopenia in Romanian patients with osteoporosis? An overview of the current knowledge on osteosarcopenia

Gabriela Mihai, Ionela Maria Pascanu

Department of Endocrinology, University of Medicine,Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2023-0014

The combination of osteoporosis and sarcopenia is wider known as “osteosarcopenia”, and it is considered to be a “hazardous duet” for the patient. The clinical consequences of this geriatric syndrome include a higher risk of fractures and mortality compared to osteoporosis or sarcopenia alone. Fractures are considered to be a burden for the patient but also for the health care system from an economic point of view, therefore it is important to prevent them. Emerging evidence shows that osteosarcopenia is an increasingly prevalent disease. The Fracture Risk Assessment Tool (FRAX) is of major importance for the management of a patient, however, muscle weakness is not part of this instrument. It has been suggested to go “beyond the FRAX” and to evaluate muscle mass/strength besides bone mineral density when it comes to the management of a patient with a sustained fragility fracture. In this review we try to answer whether this is feasible or not when it comes to Romanian patients.

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