Current issue

Current Health Sciences Journal

vol. 48 no. 3, 2022

1. Postmortem Evaluation of First Trimester Fetal Heart

D. Ruican, A.M. Petrescu, A.M. Istrate-Ofiteru, D.G. Iliescu

Due to rapid technology advancement and increasing diagnostic expertise, fetal medicine is rapidly improving. Prenatal diagnostic advancements made it possible to identify structural abnormalities in fetuses as early as the first trimester of pregnancy. However, to validate the echocardiographic diagnosis that led to the pregnancy termination, the termination of pregnancy owing to severe fetal deformities should be audited in accordance with a correct anatomic diagnosis. Following the PRISMA declaration, a systematic literature search was done to find articles on post-mortem first trimester human fetal heart evaluation. Thirteen suitable studies were found using the search method. It is theoretically possible to examine the human fetal heart after death in early pregnancy however these methods are not widely available due the costs associated with the procedure and the equipment, the effects of tissue coloration and distortion brought on by the fixation and contrasting processes (for micro-CT), the current requirement for a skilled operator to acquire, reconstruct, and process the images, and data storage requirements greater than those of conventional clinical scans.

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2. Metabolic Alterations in Acute Cerebral Ischemia

A.M. Poenaru , M. Ionescu, C.V. Albu, I. Rogoveanu , T.A. Balseanu

Cerebral ischemia is a major health problem worldwide, that affects millions of people, leaving a major percentage of them with major disabilities, therefore becoming one of the most resource consuming pathology. Beside the blockage of blood supply of the brain that leads to loss of cellular function and neuronal necrosis, metabolic processes are modified in the whole body through mechanisms that are not fully explained yet. The results in the analysis of the 2 groups, one with 70 patients with stroke and another with 68 patients with no cerebral infarction, revealed that brain ischemia is more often found in patients with atrial fibrillation and higher blood pressure values. The metabolic changes, found in the stroke group, are represented by increased values of blood glucose, serum urea and lower levels of creatinine levels. Also, the value of leucocytes count and the erythrocyte sedimentation rate were shown to be increased in stroke patients, indicating that inflammation is highly present in cerebral infarction. In the regard of these findings, cerebral ischemia is associated with major systemic disruptions that could be significant pathogenic factors and also effects of the complex processes that take place in the affected brain region, but further investigation should be done in order to explain all the mechanisms involved and also the possible impact in prophylaxis and acute management of stroke.

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3. Combined Effects of Doxorubicin and Temozolomide in Cultured Glioblastoma Cells

C. Baloi, A. Oprita, L.E. Semenescu, D.E. Tache, O.S. Popescu, G.A. Staicu, A. Dricu

The oncological field benefits of extensive medical research and various types of cancer notice improvements, however glioblastoma multiforme remains one of the deadliest cancers in humans with virtually no advance in survival and clinical outcome. Temozolomide, the FDA approved drug for glioblastoma, faces numerous challenges such as resistance and side effects. To overcome these challenges, many combination therapies are currently studied. The present study analyses the effects of temozolomide in combination with doxorubicin on a glioblastoma cell line. Our results showed that both drugs displayed a cytotoxic effect on the studied cells in single administration (55% for 100μM temozolomide at 14 days, 53% for 100μM doxorubicin at 14 days), but without a synergistic effect in dual therapy. Although the results failed to produce the expected effect, they propose new research perspectives in the future.

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4. QRS and QT Interval Modifications in Patients with Type 2 Diabetes Mellitus

E. Chavez-Gonzalez, Y.M.E. Calero, S. Harrichand, E.B. Mensah

Introduction: Diabetes Mellitus imbricates inflammatory processes on their pathophysiology, it could affect cardiac electrophysiology. Cardiac inflammatory process leads electrocardiogram changes. Nevertheless, there are discrepancies about whether it prolongs or decreases waves and intervals such as QRS and QT. Furthermore, QRS dispersion has not been studied. Objective: To identify QRS complex and QT interval modifications in type 2 diabetic patients. Methods: A descriptive cross-sectional study was carried out in 59 type 2 diabetic patients selected by non-probabilistic sampling. Electrocardiogram was performed, QRS and QT interval were measured manually by two observers. Dispersion of both variables was calculated to compare with normal values. Results: Two variables showed differences for sex, QRS dispersion was higher in females (45.84), p=0.0001 vs. reference value; QT dispersion (63.12) showed significance difference (p=0.0246) vs. reference value for males. Greater than five years of illness was related to higher QRS values (124.11 vs. 137.28), p=0.005 and corrected QT dispersion (61.81 vs. 78.79), p=0.022. Conclusions: The electrocardiographic differences between sexes may suggest a gender influence. The longer duration of diabetes diseases could increase cardiovascular risk of arrhythmias due to greater QRS duration and corrected QT interval prolongation.

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5. The Ability of Doppler Uterine Artery Ultrasound to Predict Premature Birth

I.V. Camen, M.M. Manolea, S.C. Vrabie, M.S. Sandulescu, M.S. Serbanescu, M.V. Boldeanu, S.D. Neamtu, A.M. Istrate-Ofiteru, A.L. Dijmarescu, M.B. Novac

Objective. Demonstration of the predictive capacity of Doppler Uterine Artery (UtA) on preterm birth (PB) by serial measurement at various ages of pregnancy. Methods. The prospective study included a group of 116 pregnant women, of whom 85 gave birth prematurely and 31 pregnant women gave birth at term, constituting the control group. UtA Doppler measurement was performed by the abdominal approach. Quantitative wave evaluations were performed by the pulsatility index (PI), the systole/diastole ratio (S/D), as well as the qualitative analysis of the flow rate waveform (notch). UtA Doppler evaluation was performed in 3 pregnancy periods: 18.0-22.6 weeks, 28.0-31.6 weeks, and 32.0-35.6 weeks. Results. Only at the third examination, at 32.0-35.5 weeks of gestation, was there a statistically significant difference between the S/D-UtA ratio and PI-UtA correlated with the risk of premature birth (p<0.05). Although there was an association between UtA Doppler and late preterm birth, the predictive ability was low. Also, UtA Doppler was not statistically significant for preterm birth before 32 weeks of gestation. Conclusions. Although we did not find a statistical association between second-trimester UtA Doppler and preterm birth, we do suggest a closer look at women with abnormal UtA Doppler in the second trimester. We believe that, according to the results obtained, UtA Doppler can predict especially iatrogenic premature birth depending on the prediction of the most severe complications, severe preeclampsia, and SGA.

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6. Classification and Grading Systems in Gastric Adenocarcinomas

O.I. Creu, A.E. Stepan, C.E. Simionescu, D. Marinescu, M.D. Stepan

Gastric adenocarcinomas are lesions that raise important issues in clinical practice, due to their incidence and biological behavior. Over time, various systems have been used for classifying and grading of gastric adenocarcinomas, in the hope of increasing the diagnostic accuracy. In this study we statistically analyzed 112 cases of gastric adenocarcinomas in relation to different classification and grading systems, in order to identify their efficacy and concordance in the histopathological diagnosis. The results indicated a significant association of the Lauren and World Health Organization 2019 classifications and also between these and the three-tier and two-tier grading systems, which supports their practical utility in establishing the diagnosis and assessment of the tumor aggressiveness, for the differentiated therapy.

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7. Comparative Study of Moderate Sedation with Propofol Versus Propofol Combined with Midazolam for Ambulatory Care Digestive Endoscopic Procedures

D.A. Popa-Ion, D.I. Gheonea, M.D. Denicu, L.C. Chiuu

Anesthesia is essential during colonoscopy because it provides patients with necessary sedation to perform the investigation safely and nonetheless to obtain the highest quality of the results. We aimed here to evaluate and establish which of the combinations of anesthetic drugs most frequently used for sedation purposes for gastrointestinal endoscopic procedures performed in the ambulatory best covers the needs of the patient and the gastroenterologist. This is a prospective, randomized, double-blind study carried out on a total of 100 patients, aged between 18 and 80 years, who meet the conditions for inclusion in the study. Patients were randomly allocated into either group A (Propofol) or group B (Midazolam plus Propofol). Evaluation of the dose of Propofol used in the 2 groups, awakening time, anesthetic induction, as well as the occurrence of episodes of bradycardia and hypotension represented the parameters followed in the study. In group A, 50 patients received on average 218.6mg of Propofol in bolus of 10-20mg. In group B, 50 patients received 0.1mg/kg Midazolam and an average of up to 129.2mg of Propofol in bolus of 10-20mg. Awakening time was shorter in group A-3.18 minutes, than in group B-15.7 minutes. Bradycardia and hypotension were met in a larger number in group B than in group A. The quality of the endoscopic evaluation was similar in both groups. The conclusion of our study was that the group to which only Propofol was administered had the best results from all aspects (rapid anesthetic induction, stability of vital functions, lower cost, awakening time much faster) compared to the combination of Propofol with Midazolam.

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8. Subtle Immunoreactivity Differences in the Fractal Patterns of Membrane E-Cadherin in Gastric Adenocarcinoma

I.M. Liliac, M.V. Sacerdoianu, B.S. Ungureanu, L.Mogoanta, C. Margaritescu, D. Pirici, A. Saftoiu, A.E. Crisan

Gastric cancer continues to be a significant malignancy worldwide, accounting for approximately one million new cases in 2020. Scientists are focusing on the cancerous cells' plasma membrane (PM) as a potential therapeutic target in cancer because it functions as the cell's interface with its environment through a variety of mechanisms. The capacity of membrane shape and its structures to influence biological processes frequently occurs through the regulation of enzymes or preferential protein binding to membranes via membrane shape changes. We aimed here to assess the morphological irregularities of the cellular membranes in gastric adenocarcinoma tumors, and to find any putative differences from normal gastric mucosae epithelial cells. We analyzed the pattern of E-cadherin at the level of the cell membrane using the fractal dimension (FD) analysis on fluorescence immunohistochemistry samples labeled with E-cadherin in gastric well/moderate and solid gastric adenocarcinoma from patients without any associated chemotherapeutic treatment or radiotherapy. Images were binarized based on a fixed threshold of the E-cadherin fluorescence channel, and then the FD of the binarized image outlines has been calculated in order to assess the ruggedness of the cellular membranes. Overall assessment of the FD revealed that the subtle membrane variations were evident enough to deem a statistically significant difference and the complexity of the membrane roughness was clearly higher for adenocarcinoma cases. We intended to evaluate if separating adenocarcinoma cases as low grade (G1 and G2) and high grade (G3 and solid), FD analysis could still differentiate membrane patterns and check if the available clinical parameters like age, gender, tumor location, lymph ganglia involved might correlate with FD values for adenocarcinoma patients. Altogether, the morphological analysis of a simple marker for the cell membrane can identify and distinguish tumor cells. Although there was a lim

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9. Calcium and Phosphorus Deficiencies in Patients with Liver Cirrhosis

C.M. Ionele, M.S. Subtirelu, B.S. Ungureanu, M.S. Serbanescu, I. Rogoveanu

Patients with cirrhosis often develop malnutrition and micronutrient deficiencies, leading to a worse prognosis and increased mortality. Our purpose was to assess the prevalence of micronutrient deficiencies especially calcium and phosphorus in patients with decompensated liver cirrhosis (LC). This was a retrospective study including 143 consecutive patients hospitalized for acute decompensation of cirrhosis, most of them with alcoholic etiology along with viral B or viral C and autoimmune induced cirrhosis. A blood test including minerals was performed on admission. Lower serum calcium levels were found in patients with a more severe forms of LC and also the ones diagnosed with viral and alcoholic LC rather than autoimmune induced LC. Peritoneal ascitic fluid was observed in 51 patients with hypocalcemia and only 24 patients with normal calcium levels had fluid accumulation. Low levels of phosphorus were noted in patients with a more severe form of LC (chi-square: 20.2504; p-value 0.000446). Ascitic fluid was found in patients with low values of phosphorus as well as in those with hypocalcemia (chi-square 5.235; p-value 0.022137). In conclusion, this study confirmed that patients with advanced liver disease had lower values of calcium and phosphorus and a more severe form of LC can be associated with hypocalcemia and hypophosphatemia.

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10. Anticipatory Grief in the Families of Patients with Palliative Requiring Metastatic Cancer

L. Semenescu, A. Dracea, D. Zimta, A. Crisan

Background/Aim. When dealing with metastatic cancer patients, family distortions, such as anticipatory mourning, psychiatric and psychosocial disorders may occur. In the case of anticipatory mourning, there exists the risk of the patient being “given up” as if he is already gone, which will only make the patient feel lonely, with numerous problems occurring in the subsequent period of familial mourning. Currently, the importance of identifying the type of mourning affecting families of cancer patients has become more and more clear, as this allows not only for greater therapeutic success, but also avoids a high number of risks and complications that appear during the critical care period. Our paper aims to identify and assess these risk factors in order to contribute to the optimization and success of palliative therapy. Material and Method: We performed this study on a group of 78 subjects with metastatic cancer. We developed a questionnaire in order to assess the patient-family relationship, family profile and the patient’s unique psychological traits, in order to identify potential risk factors. Data processing was performed using Microsoft Excel; the XLSTAT package was used to perform complex statistical tests (χ2 test, Spearman correlation coefficient). Results and Conclusions: Women are more prone to fears related to developing cancer themselves. No risk factors leading to the development of significant pathological mourning were identified in our study group. However, the clinician who deals with the treatment of the terminally ill cancer patient will have to include the following objectives related to the relatives in the therapeutic plan: to motivate their involvement, but with the maintenance of a separation in order to maintain the individuality; to keep their realism and to distinguish between normal/pathological mourning.

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11. Educational Potential of Three-Dimensional Volumes Based on Seriate Histological Slices of First Trimester Fetal Hearts

D. Ruican, A.M. Petrescu, N.R. Ciurea, D.G. Iliescu

The advantages of earlier diagnosis give the family more time to adjust to the fetal cardiac and related extracardiac diagnoses and to make informed pregnancy decisions. If a severe fetal CHD is detected in the first trimester and pregnancy termination is selected, the intervention may have a lower risk for the mother's physical and mental health. Training medical staff is a crucial part of implementing obstetric ultrasonography services well, since effective patient care depends on their ability to use the equipment skillfully and interpret results properly. In many low-and middle-income nations, there is a scarcity of healthcare professionals trained to offer ultrasound services and one of the reasons for this issue is the lack of available lectures, simulations and instruments to explain how ultrasound sections are acquired. We propose an alternative method of visualizing the ultrasound planes of interest using three-dimensional volumes of fetal hearts reconstructed from seriate histological slices. This method may aid trainees in understanding echocardiography.

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12. The Cytotoxicity of Dental Restorative Materials on Gingival Stromal Mesenchymal Cells-an In Vitro Study

D. Onet, A. Roman, A. Soanca, A. Ciurea, I.C. Micu, S.C. Vesa, D.M. Popescu, A.M. Rica

Background: Due to their minimally invasive high-quality adhesive, aesthetic and mechanical qualities, composite resins are the most frequently used materials in modern restorative dentistry. However, polymerization shrinkage and cytotoxicity are still unresolved drawbacks associated with these biomaterials. Purpose: The present study aimed to assess the cytotoxicity of some restorative resin-based materials on gingival mesenchymal stromal cells (gMSCs), assuming that no differences in their behavior will be highlighted. Material and methods: The cytotoxicity of the tested materials was evaluated by comparing the behavior of gMSCs cultured in normal conditions and in association with disc-shaped material samples indirectly through functionality tests (colony-forming unit-fibroblast assay, migratory potential) and directly through the MTT assay. The results were statistically analyzed with the ANOVA test and Tukey’s Honest Significant Difference test. Results: According to the MTT assay, there are no statistically significant differences regarding the viability of gMSCs cultured in normal conditions or in the presence of resin-based material samples. On the other hand, the present study identified a significantly reduced number of colonies formed by the gMSCs cultured in association with BF and B discs, compared to that of gMSCs cultured in normal conditions. Also, the migratory potential was significantly lower for control gMSCs when compared to ZE-gMSCs and significantly higher for ZE-gMSCs when compared to BF-gMSCs or BFL-gMSCs. Conclusions: The results of the present study highlight a possible risk of cytotoxicity when using resin based-materials in dental practice, but they cannot be directly extrapolated to in vivo situations.

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13. A Rare Case of Neglected Giant Basal Cell Carcinoma in a Nurse-Case Report and Literature Review

A. Cojocaru, O.A. Orzan, C. Birjovanu, N.C. Andreea, D. Petrache, E.M. Marinescu, M.E. Ciurea

Basal cell carcinoma (BCC) is the most common skin cancer in the fair-skinned adult population over 50 years of age and the incidence is rising. Generally, BCC has an indolent course, low mortality and a good prognosis due to low rates of metastasis. Giant basal cell carcinoma is a rare reported oncological entity which accounts for 0.5% to 1% of all cases of BCC and has a diameter larger than 5cm. Basosquamous carcinoma is a rare high-risk type of BCC with clinical and histopathological features of both BCC and squamous cell carcinoma. A 61-year-old female presented to our clinic for a giant bleeding tumor located under her left breast. She initially noted the tumor almost 15 years ago. Although the patient was a nurse, she was afraid to seek medical advice until an episode of significant bleeding. At presentation the tumor was a 15/7cm in size, was invading the underlying structures and had a central ulceration. The margins of the tumoral plaque had several nodules and pearly structures suggesting the possible clinical diagnosis of BCC.

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14. Isolated Lichen Planus of the Lower Lip: Report of a Rare Case with an Updated Literature Review

S. Hasan, S. Mansoori, K. Sircar, D.B. Popli

Lichen planus (LP) is a chronic inflammatory, autoimmune entity typically affecting the skin, oral and genital mucosa, and skin appendages, with an underlying malignant potential. Oral lichen planus (OLP) represents the mucosal counterpart of the cutaneous LP and exhibits episodes of exacerbation and remissions. OLP typically manifests as bilateral symmetrical lesions on the buccal mucosa, followed by tongue, and gingiva. However, the occurrence of LP lesions solely on the lip is rarely reported in the literature. The altered clinical appearance of the lip lesions poses a diagnostic threat and raises the possibility of a misdiagnosis. Our aim was to report an unusual case of isolated lower lip LP, and also to carry out a literature review about isolated lip LP lesions, thus, emphasizing the demographic, clinicopathologic attributes, and therapeutic regimen. We report an uncommon occurrence of an isolated lichen planus on the lower lip in a 53-year-old male patient. Clinical evaluation revealed a diffuse erosive crusted lesion bordered by peripheral lacy radiating streaks on the lower lip. After a confirmed OLP histopathology, the patient was treated with low potency topical steroids and Vaseline therapy, with almost completely resolved lesions after 2 months of therapy. We report a rare case of isolated lip LP, and our detailed review revealed 44 reported cases of lip LP till date. The majority of the cases were seen on the lower lip and exhibited an age and gender affinity (mostly in middle-aged males). Significant healing was observed after topical steroid therapy.

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15. Oncocytic Papillary Cystadenoma, an Unusual Variant Presenting as a Laryngeal Ventricular Cyst

S.K. Kavuri, A. Ullah, E. Iyoha, K. Ballur, L. Gilstrap, S.N. Mattox

Cystadenoma arising from the larynx is a rare benign minor salivary gland tumor that can show mucinous or papillary morphology. The epithelial lining of the salivary gland tumor can present with oncocytic features, which is attributed to an increased number of mitochondria. We present a rare case of oncocytic papillary cystadenoma (OPC) of the larynx which has a combination of these features. The WHO defines OPC tumors as entities which closely resemble Warthin tumor, but lack its classic lymphoid component. The immunohistochemical profile and molecular genetic features are largely unknown. We present an 84-year-old female, former smoker, who presented with progressive dysphonia, dysphagia, and shortness of breath. Laryngoscopy revealed a large, smooth mass originating from the ventricle of the right vocal fold. Subsequent biopsy demonstrated cyst wall fragments lined by a bilayer of large columnar to cuboidal oncocytic cells that had granular eosinophilic cytoplasm, round to oval nuclei with finely dispersed chromatin, and small but distinct nucleoli. The surrounding stroma was slightly fibrotic with scant lymphoid elements. No nuclear pleomorphism, increased mitosis, or necrosis was identified. In the larynx, benign salivary gland tumors are rare and less frequent than malignant neoplasms. Awareness of rare benign entities like OPC help ensure proper management and aid in avoiding unnecessary therapy.

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16. An Unusual Presentation of Bilateral Split Hand-Foot Malformation (SHFM) in Family: A Tale of Two Generations

S.V. Singh, G. Puri, A.E. Gemmy

Split-hand/foot malformation (SHFM), also called as ectrodactyly. SHFM is a natural limb deformity, characterized by a deep standard split of the hand and/ or foot due to the absence of the central shafts. SHFM may happen as a separate existent or as part of a syndrome. Both forms are constantly established in association with chromosomal rearrangements resemblant to translocations or deletion. It is clinically and genetically diverse and shows substantially autosomal dominant heritage with variable expressivity and reduced penetrance. Cases presenting with SHFM features should be rigorously diagnosed, clinically examined, and submitted to pertinent cytogenetic and/ or molecular testing. We presented two months old male child and his paternal grandmother with SHFM.

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