Category Archives: Review

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

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

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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Oral cancer chemoprevention: A review

DOI: 10.2478/amma-2023-0010

Oral cancer is increasing in prevalence and its treatment is associated with high degree of morbidity and mortality. Thus, prevention of oral cancer is of utmost importance. Chemoprevention is the use of natural, synthetic, or biologic compounds to halt, reverse, or prevent the initial phases of carcinogenesis or the progression of neoplastic cells to cancer. This modality has been extensively researched in the last two decades for the prevention of oral cancer with the emergence of new information. Retinoids were the first chemopreventive agents to be tested in clinical settings. Since then, a number of new agents such as COX2 inhibitors, EGFR inhibitors, p53 targeted agents, thiazolidinediones and several natural agents have shown promise in oral cancer prevention. Chemopreventive trials in oral cancer tend to be long term studies and are thus challenging. This review article looks into the clinical evidence for the application of chemopreventive agents in clinical settings and also highlights the recent trends in oral cancer chemopreventive trials.

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Blood biomarkers predicting adverse clinical
outcomes in congenital heart disease patients, with consideration for pulmonary valve replacement

DOI: 10.2478/amma-2023-0009

Objective: This review aims to make a brief overview of blood biomarkers’ clinical decision limits, possibly aiding in outcome prediction in all-aged Tetralogy of Fallot patients. Potentially, these biomarkers could also assist in necessity and timing of pulmonary valve replacement. Methods: Studies with all-aged patients with Tetralogy or Pentalogy of Fallot and blood biomarkers, BNP, NT-proBNP and hs-cTn, usage in clinical outcome prediction were included. Additionally, pulmonary valve replacement indications were considered. Other congenital heart diseases, biomarkers irrelevant to clinical outcome and associated pathologies or physiological status were the exclusion criteria. Keywords, Tetralogy and Pentalogy of Fallot, pulmonary valve replacement, blood biomarkers, yielded 69 suitable studies from Google Scholar, PubMed and Web-of-Science. 30 studies were selected. Results: Blood biomarkers were increased in TOF patients in comparison to controls; the higher the values, the worse adverse outcomes. Blood biomarkers combined with other biomarkers, imagistic methods or parameters showed promising results in outcome prediction. Conclusions: Blood biomarkers are validated as follow-up predictors in congenital heart disease paediatric patients. Further research is required to establish age-appropriate clinical decision limits. Pulmonary valve replacement timing remains controversial.

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Prevalence of human Papillomavirus associated oropharyngeal and oral squamous cell carcinoma in Asian countries: A systematic review and large-scale meta-analysis

DOI: 10.2478/amma-2023-0005

Human Papillomavirus (HPV) associated with oropharyngeal and oral squamous cell carcinoma (OPSCC and OSCC) is escalating over the years. Hence, the present review aims to determine the prevalence of HPV-OSCC and HPV-OPSCC in Asian countries over the last decades. An electronic search was conducted using nine online databases to identify English-language articles on the prevalence of HPV-OPSCC and HPV-OSCC in Asian countries from January 2011 to June 2022. The risk of bias was assessed using the JBI critical appraisal checklist and the level of evidence was determined based on the OCEBM guideline. Single-arm meta-analysis was used to estimate the weighted mean prevalence of HPV-OPSCC and HPV-OSCC among patients in Asia. Subgroup analysis meta-regression and Egger’s tests were also conducted. 59 eligible studies were included with a higher prevalence of HPV-OPSCC (32.6%-37.4%) as compared to HPV-OSCC (10.9%-23.5%). Subgroup analysis revealed that the weighted mean prevalence of HPV-OPSCC was significantly higher (P<0.001) among East Asians, while the weighted mean prevalence of HPV-OSCC was significantly higher (P<0.001) among South Asians. All studies showed a low to moderate risk of bias with the level of evidence ranked between 2 and 3. The diagnostic tools utilised and geographical locations significantly affect the findings.

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Management of denture stomatitis: An overview

DOI: 10.2478/amma-2023-0007

Denture stomatitis is a common inflammation of the palatal mucosa beneath removable dentures. The objective of this article was to examine the systematic reviews and clinical trials pertaining to the treatment of denture stomatitis. For this research, electronic databases (PubMed, Embase, Scopus, and ISI Web of Science) were searched from January 2000 to June 2021 using specified MESH keywords. Irrelevant articles were eliminated in three steps based on their titles, abstracts, and body texts. In the final analysis, 47 papers were selected, which included 12 systematic reviews and 35 clinical trials. Herbal compounds and denture disinfection were the interventions most commonly indicated. We concluded that, possibly due to the complex nature of this lesion’s etiology, there is no present definitive therapy guideline for this prevalent lesion.

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Cannabidiol in the context of sleeping disorders-induced oxidative stress

DOI: 10.2478/amma-2022-0023

Sleep disorders can be the result of psychiatric or neurological conditions, such as post-traumatic stress disorders, depression, anxiety, Alzheimer’s disease, Parkinson’s disease. At the same time, changes in sleep, known as sleep disorders, are closely related to various metabolic dysfunctions, which in turn are the result of the generation of reactive oxygen species, or otherwise known as oxidative stress. For this reason, cannabinoid derivatives are increasingly used for this purpose. Among the most used are delta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD). These agents interact with the endogenous endocannabinoid system, either by direct action on specific receptors, or by increasing the availability of endocannabinoids, modifying particular mental states (anxiety, depression). The results of the studies specified in this article provide promising evidence regarding the positive effects of CBD, which extend beyond the scope of sleep disorders, with possible applications also in the case of the accumulation of reactive oxygen species.

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Alpha adrenergic receptors in clinical practice – Present and future

DOI: 10.2478/amma-2022-0030

In this review we discuss the adrenergic pathways for alpha 1 and alpha 2 receptors and the current as well as potential future medication targeting these receptors. Overall, there is ongoing research into a multitude of directions with a promising outlook for alpha 1 and alpha 2 adrenergic receptors. The alpha 1-adrenergic receptor subfamily is currently modulating only a modest number of nervous system functions due the fact, that only a relatively small number of selective commercial products are available. Chronic stress can affect the long-term depression of alpha 1 receptors. Recent studies are searching for new molecular targets which might act on these receptors. Presynaptic alpha 2 receptors play an important role in modulating release of several neurotransmitters in the central nervous system. The future of alpha 2 adrenergic receptors in clinical practice looks even more promising and versatile than that of alpha 1 adrenergic receptors. Alpha 2 adrenergic receptors show different responses, especially regarding hypertension and heart failure treatment, and current research suggests a genetic component as a cause, which is being explored further.

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Nano-scale surface modification of dental implants – An emerging boon for osseointegration and biofilm control

DOI: 10.2478/amma-2022-0029

Implant therapy is a commonly based method of replacing missing teeth. A range of physical, chemical, and biological modifications have been applied to the surface of titanium implants to improve their biological performance and osseointegration outcomes. Implant surface characteristics play an important function in several peri-implant cellular and molecular mechanisms. Clinicians are commonly placing dental implants with various surface roughness and modifications including plasma-sprayed, acid-etched, blasted, oxidized, hydroxyapatite-coated, or combinations of these procedures. Surface modifications are to facilitate early osseointegration and to ensure a long-term bone-to-implant contact without substantial marginal bone loss can be accomplished. It is apparent that different modifications have a range of beneficial effects, it is essential to consider at what time point and in what conditions these effects occur. This article reviews existing surface modification technologies of mainstream dental implants and the correlation between implant surface coatings and their performance of osseointegration or anti-bacterial ability it needs to be evaluated.

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Is the pulmonary microbiome involved in lung cancer pathophysiology?

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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