Category Archives: Volume 69

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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Psychotherapy, pharmacotherapy, and their combination in the treatment of major depressive disorder: How well are we making use of available therapies?

DOI: 10.2478/amma-2023-0042

Major depressive disorder stands as a profound challenge in the realm of psychiatric illnesses disrupting the well-being and daily existence of affected individuals. This heterogeneous condition continues to baffle researchers due to the elusive nature of its full neurological mechanisms. This review delves into the complex landscape of major depressive disorder, exploring the diverse therapeutic avenues available, from the nuanced realms of psychotherapy to the pharmacological and non-pharmacological approaches that have been the focus of extensive research. In the relentless pursuit of relief for those afflicted, substantial efforts and resources are tirelessly channeled into the exploration of novel antidepressants and the refinement of existing therapeutic protocols. This review juxtaposes the efficiencies of existing treatments, unraveling their comparative effectiveness, and shedding light on their respective strengths and limitations. Even so, the question remains, how well are we managing the treatment of major depressive disorder, and which is the best option not only to treat this condition but also to reach full remission. Consequently, we have compiled findings on treatment selections and how efficient they are in relation to each other. The more we understand how to treat depression effectively the more we can improve the quality of life of individuals affected by this disorder. By comprehensively evaluating the diverse modalities, this review aims to guide clinicians and researchers toward evidence-based decisions, facilitating the formulation of individualized and targeted treatment protocols.

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Gallbladder metastasis from occult lobular breast
carcinoma: A case report

DOI: 10.2478/amma-2023-0040

Introduction: Bones, lungs, brain and liver are the most common metastatic sites of breast carcinoma, although invasive lobular carcinoma can give metastases to less common sites, such as the gastrointestinal tract and the female genital tract.
Case presentation: We present the case of a 57-year-old female with colic abdominal pain that was sent to surgery for cholecystectomy. Histopathology revealed a poorly cohesive individual or in single file neoplastic cells infiltrating all layers of the gallbladder. Immunohistochemistry revealed these cells to be CK 116, CK7, GCDFP-15, ER and PR positive, and CK20, HER-2, S-100 and E-cadherin negative. PET/CT showed numerous lytic bone lesions, but ultrasound, mammography, MRI and PET/CT revealed no breast mass.
Conclusion: Although rare and poorly understood, metastases of invasive lobular carcinoma to gallbladder do exist in a minor percentage of patients, presenting usually as exacerbated cholecystitis. The problem are silent cases and patients with no history of breast carcinoma. This case is unique in that even after the diagnosis of metastatic lobular breast carcinoma to the gallbladder, the primary tumour of the breast was not detected.

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Marcus Gunn jaw-winking syndrome: A case report

DOI: 10.2478/amma-2023-0040

Marcus Gunn jaw wink phenomenon or Trigeminal oculomotor synkinesis, is a congenital disorder in which the upper lid moves synkinetically in response to jaw movement during chewing. The term synkinesis describes the simultaneous movement or a coordinated sequence of movements of muscles, which are supplied by different nerves or by separate peripheral branches of the same nerve. Although it rarely manifests bilaterally, it is typically unilateral. In 1883, Dr Robert Marcus Gunn, a Scottish Ophthalmologist described a 15-year-old girl with a peculiar type of congenital ptosis that included an associated winking motion of the affected eyelid on the movement of the jaw. It is known to affect both men and women equally. This phenomenon has been reported to be a similar phenomenon affecting 2-13% of all cases of congenital ptosis. It can be congenital or acquired, for example through trauma. The Congenital Marcus Gunn jaw wink phenomenon is thought to arise from the connection between the branch of the trigeminal nerve (responsible for chewing) supplying the middle or lateral pterygoid muscle and the branch of the oculomotor nerve supplying the upper superior levator ocular defect. Here we present a case report of Marcus Gunn’s Jaw-Winking Synkinesis in congenital ptosis.

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