Category Archives: Volume 69

Nucleostemin and p-STAT3 as early diagnostic potential markers in oral squamous cell carcinoma

DOI: 10.2478/amma-2023-0050

Oral cancer is considered the sixth most common type of cancer worldwide, out of which India contributes to about one-third of the total cases [1]. Oral squamous cell carcinoma (OSCC) is the most dominant of all oral cancer cases and may develop from a potentially malignant disorder with a detectable pre-clinical phase. The primary causes of OSCC include tobacco consumption that involves smokeless tobacco, chewing of betel-quid and excessive consumption of alcohol, unhygienic oral practices, periodontal diseases, and sustained viral infections caused by human papillomavirus (HPV) [2]. Instead of these traditional risk factors (alcohol consumption and cigarette smoking), oncogenic HPV is found to be the main causative factor for the increasing incidence of OSCC. Furthermore, HPV etiology is linked to increased survival following conventional treatments. [More]

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Maternal sepsis – challenges in diagnosis and management: A mini-summary of the literature

DOI: 10.2478/amma-2024-0001

Sepsis is still one of the leading causes of maternal mortality and morbidity, being the third most common cause of maternal death, after hemorrhage and hypertensive disorders. Maternal sepsis may appear due to obstetric causes such as: chorioamnionitis, endometritis, abortion-related uterine infections, and wound infections. For non-obstetric causes of maternal sepsis, the most common are urinary tract infections and respiratory tract infections. This mini summary presents the challenges in early diagnosis and prompt management, caused by pregnancy physiological changes. Physiological alterations during pregnancy, like an increase in white cell count, heart rate, and respiratory rate, associated with a decrease in blood pressure are also known signs of infection, making the diagnosis of sepsis during pregnancy more difficult. The three pillars of sepsis treatment are early antibiotics, vital organ support and fluid therapy, the last one being controversial. A more restrictive approach for fluid resuscitation could be more suitable for pregnant women, considering the risk of fluid overload and pulmonary edema. Criteria for early recognition and appropriate management customized for maternal sepsis are mandatory.

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Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in Mureș County, Romania: Incidence and impact of reclassification over a six-year period (2016-2021)

DOI: 10.2478/amma-2023-0048

Objective: In 2016 a group of expert endocrine pathologists proposed a new terminology, NIFTP (Non-invasive follicular thyroid neoplasm with papillary-like nuclear features) for a histological subtype of thyroid carcinoma (encapsulated follicular variant of papillary thyroid carcinoma, non-invasive type). In this study, we aimed to assess on a retrospective basis the epidemiological trend and overall incidence of NIFTP in Mureș county, Romania, over a six-year period (2016-2021).
Methods: All NIFTPs registered between 2016-2021 in Târgu-Mureş Pathology Departments were reevaluated. NIFTP’s incidence was calculated by dividing the number of NIFTPs with the number of papillary thyroid carcinomas (PTCs). Further on, we compared NIFTP’s incidence between 2016-2018 with NIFTP’s incidence between 2019-2021, as the diagnostic criteria of NIFTP were revised in 2018.
Results: Forty-six cases of NIFTP were registered in our departments between 2016-2021, resulting in an overall NIFTP incidence of 17.9 % [CI (95%): 7.6-32.5] among the 257 PTCs. When we compared the NIFTP’ incidence between the two study periods (2016-2018 versus 2019-2021), our data revealed that the NIFTP’s overall incidence has dropped from 21.4 % [CI (95%): -14.5-60.1] to 15% [CI (95%): -8.2-43] in the second evaluated period (p=0.034).
Conclusion: The overall NIFTP incidence was low in our departments between 2016-2021. Moreover, NIFTP’s incidence decreased after 2018, following revision of the diagnostic criteria. Our results highlight that very stringent morphologic criteria need to be apply when making a diagnosis of NIFTP, in order to avoid a misdiagnosis and/or an overtreatment of a tumor with indolent behavior.

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Determination of isohydrafural and methyluracil in ear drops by high performance liquid chromatography

DOI: 10.2478/amma-2023-0049

Objective: The aim of current study was the development and validation of a reversed-phase high-pressure liquid chromatography (RP-HPLC) method for the quantitative determination of two active ingredients, isohydrafural (IHF) and methyluracil (MU) in fixed dose combination ear drops.
Methods: An efficient separation of the two compounds was achieved on a Teknokroma C1 5μm (150*4,6mm) column, with a methanol: water 60:40 (V: V) mobile phase, at 300C temperature and 0.6 mL/min flow-rate. The total analysis time was 5.5 min.
Result: The verified validation parameters were: linearity, selectivity, specificity, precision (repeatability and reproducibility), robustness, limit of detection and quantification.
Conclusions: Good separation and lack of interference from other chromatographic peaks, rapidanalysis times were obtained. The newly developed chromatographic method can be applied for the analysis of fixed dose combination ear drops with isohydrafural and methyluracil.

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Packed cell volume and its relation to obesity, gender and smoking status

DOI: 10.2478/amma-2023-0047

Objective: Our aim was to evaluate the packed cell volume (PCV) correlation with body mass index, body fat percentage, also differences between genders and smokers & non-smokers, among Iraqi students.
Methods: A cross-sectional study was done on 112 healthy individuals (from which 52.7% were males), aged between 18-23 years old, in December 2022. A short informative history was taken through a questionnaire, anthropometric measures were taken to calculate body mass index and body fat percentage, and the determination of packed cell volume was done by the Microhematocrit method.
Results: Packed cell volume among males was higher 47.45±3.409% than for females 39.90±3.169%, with a difference statistically significant (p=0.000), also the correlation of PCV revealed direct significance with body mass index (p=0.011) and indirect statistically significant with body fat percentage (p=0.000). The prevalence rate of smoking was 13.4% and the level of PCV among smokers was 46.80±6.085%, significantly higher (p=0.015) than among non-smokers 43.43±4.702%.
Conclusion: Packed cell volume showed a direct correlation with body mass index, an inverse one with the body fat percentage, and was significantly higher among young smokers, emphasising the idea that this parameter can help to evaluate the health risk and to be included in preventive programs and assessment protocols.

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The outcome in critically ill patients admitted for thoracic trauma – A single center analysis over one year

DOI: 10.2478/amma-2023-0046

Objective: The main objective of the current study was to examine the outcome of critically ill patients in relation to clinical and thoracic injuries. The secondary objectives were to assess the role of CT in the evaluation of the diaphragm and to provide an analysis of prognostic abilities with respect to diaphragm changes.
Methods: This single-center retrospective observational cohort study was conducted in the ICU of Târgu Mureș County Emergency Clinical Hospital, Romania. This study identified 52 critically ill blunted or penetrating chest trauma patients admitted to the ICU from 01 January 2021 to 31 December 2021. CT scan was used to identify thorax injuries and diaphragm thickness. The outcome of all patients was analyzed.
Results: Most of the patients experienced traffic accidents (44.23%) or falls (26.93%). The predominant characteristics associated with chest trauma were rib fractures (92.30%), lung contusions (63.50%), and pneumothorax (53.80%). The most common injury seen in the study was rib fractures, accounting for 92.30% of cases. This was followed by lung contusions, which were present in 63.50% of patients, and pneumothorax, which occurred in 53.80% of cases. It was examined ROC AUC for thickness of the right and the left diaphragm and severity scores. When assessing the thickness of the diaphragm in deceased and survivors, no statistically significant differences were found.
Conclusion: Although no significant differences were found regarding the prognosis between the survivors and the deceased, diaphragm thickness might potentially serve as a predictor for the severity of the injury.

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Development of semisolid pharmaceutical forms with mometasone furoate

DOI: 10.2478/amma-2023-0045

Objective: This study aims to develop semisolid pharmaceutical forms for the topical administration of mometasone furoate.
Methods: Two creams (O1 and O2) and four hydroxypropyl methylcellulose-based hydrogels were prepared (H3-H6). Two different sorts of hydroxypropyl methylcellulose were used in concentrations of 15 and 20%. Consistency, spreadability, viscosity, and pH were measured. In vitro drug release was determined by a vertical, Franz diffusion cell. Mathematical models were applied for a better understanding of release phenomena.
Results: O1 and O2 presented lower values for penetration depth and spreadability. Hydrogel viscosity is influenced by the type and concentration of the gel-forming agent. Viscosity decreases in the order H6, H5, H4, and H3. pH varies between 4.6 to 5.92, fulfilling the requirements of European Pharmacopiea. Creams showed 5.49 and 6.59% of mometasone released after 6 hours. The lowest viscosity hydrogel presented the best dissolution of 40.11% mometasone after 6 hours.
Conclusions: H3 hydrogel releases the highest amount of mometasone furoate after 6 hours. The release is best described by the Korsmeyer-Peppas model explained by water diffusion and polymeric chain relaxation happen during the swelling of the polymer.

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Solid pseudopapillary neoplasm – Management of an extremely rare case of pancreatic tumor in a young patient

DOI: 10.2478/amma-2023-0044

Introduction: Franz Tumor or the solid pseudopapillary neoplasm is a very rare form of pancreatic cancer, that can be held responsible for approximately 0.2-2% of the exocrine pancreatic tumors.
Case report: We report a case of a 20-year-old woman, without any comorbidities, admitted to our department accusing mild abdominal pain at the level of the left hypochondrium and epigastrium, that started approximately half a year ago. Computed tomography and magnetic resonance imaging showed a voluminous encapsulated tumor, with mixed structure, apparently adherent to the tail of the pancreas, left kidney and adrenal gland, though being unable to certainly establish its visceral origin.
Management and results: After analyzing all aspects of the case, we decide in favor of a left subcostal laparotomy approach; the intraoperative aspect is that of a relatively well delineated mass, adherent at the level of the pancreatic tail, therefore a complete excision of the tumor alongside with the pancreatic tissue that came in contact with it was performed. The pathological analysis reveals an encapsulated tumor with solid and pseudopapillary structure, with hemorrhagic and cystic degeneration regions; therefore, we reach the following final diagnosis: pT3 stage pseudopapillary-solid pancreatic neoplasm.
Conclusions:  In spite of its malignant behavior and impressive tumor volume, the surgical intervention was curative with favorable prognosis.

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Epidemiological and histological characteristics of cutaneous squamous cell carcinoma and its precursor lesions – A single-center study

DOI: 10.2478/amma-2023-0043

Objective: Cutaneous squamous cell carcinoma (cSCC) is a skin malignancy that is one of the non-melanocytic skin cancers (NMSCs). The objective of our study was to highlight the epidemiological and histological characteristics of cSCC diagnosed in a clinical county hospital.
Methods: A retrospective cross-sectional study was performed of histopathologically diagnosed cases of cSCC from the clinical Pathology Department of the Mures Clinical County Hospital, Târgu Mureș, Romania. We included 96 cases that were diagnosed between January 1, 2017, and December 31, 2020.
Results: Of the 96 cases included in the study, 82 were identified as cSCC, 5 as Bowen Disease, and 9 as keratoacanthoma. The majority of the cases were diagnosed in 2018 (n = 30; 31.25%) and 2019 (n=36; 37.50%). The median age of the patients was 63.0 years. Slightly over half of the patients were male (n=50; 52.08) and 49 patients (51.04%) grew up in urban areas. Forty-six cases (56.10%) were well differentiated; 25 (30.49%) moderately differentiated, and 11 (13.41%) poorly differentiated. Almost all of the lesions (93; 96.88%) were removed within the safety excision margins.
Conclusion: Most of the patients were diagnosed with cSCC in 2018 and 2019 and were over 70 years old. The majority were males who grew up in urban areas. Even though most of the lesions were well differentiated and completely excised surgically, the differential diagnoses between cSCC and other skin malignancies were made based on the morphological aspects of the lesions, followed by an immunohistochemical profile when necessary.

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