Current issue

Current Health Sciences Journal

vol. 44 no. 4, 2018

1. Desquamative Gingivitis - A Clinicopathological Review

ELENA CRISTINA TOFAN, IOANINA PARLATESCU, SERBAN TOVARU, CARMEN NICOLAE, ADELINA SMARANDA PREDA, CRISTIAN FUNIERU

This article aims to review the etiology, clinical features and diagnosis of desquamative gingivitis in order to outline all the aspects necessary to increase the efficiency of patient management. Because of the polymorphic etiology, dental practitioners may elude the correct diagnose. Consequently, we find it important to underline all the clinical features that desquamative gingivitis may have as well as the associated oral lesions. Also we shortly review the systemic disorders that frequently associate desquamative gingivitis. It is important to know that the muco-cutaneous disorders frequently involved can have an abrupt onset with lesions sometimes confined to the gingiva. In evolution these diseases can be life threatening and a quick treatment can assure not only a more favorable evolution but also a better life quality. Laboratory analyses are mandatory in order to correctly diagnose the main systemic disorder. Histology and direct immunofluorescence investigations are the most accurate. Remission of the underlining disease brings improvement or even resolution of the oral lesions.

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2. In Vivo Evaluation of Teeth Shade Match Capabilities of a Dental Intraoral Scanner

CARINA CULIC, MIHAI VARVARA, GEORGE TATAR, MEDA-ROMANA SIMU, RADU RICA, ANCA MESAROS, SMARANDA BUDURU, CRISTINA GASPARIK, BOGDAN CULIC

Intraoral scanners were introduced in order to increase patient comfort and improve dentist lab communication. Acquiring optical impressions of the prepared teeth eliminates the need for conventional impression procedures and improves patient comfort. Intraoral scanner software offers since 2017, color shade determination, by analyzing the tooth shade of the obtained 3D model. In this study we tested the accuracy of an intraoral scanner color selection capabilities compared with a dental spectrophotometer, considered as reference. Statistical differences were found between the two system tested when the results were expressed in both Vita Classical and Vita 3D Master shade tabs codification.

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3. Evaluation of Gastric Carcinomas Histological Patterns in Relation to Tumors Aggressiveness Parameters

MARIA DOBRIOIU, ALEX EMILIAN STEPAN, CRISTIN-CONSTANTIN VERE, CRISTIANA EUGENIA SIMIONESCU

Gastric carcinomas are frequent tumors with variable growth patterns that may interfere with the evaluation of histopathological prognostic parameters of the lesions. In this study we analyzed the incidence and statistical relation of histological growth patterns depending on the prognostic parameters of gastric carcinomas for 95 cases. Pure forms were present in 82.2% of cases, from which more frequent subtypes were low grade tubular carcinomas and poorly cohesive with signet-ring cells carcinomas. Mixed forms were present in 17.8% of cases, with the highest incidence of tumors containing well differentiated tubular carcinoma and poorly differentiated papillary carcinoma areas. Analysis of the identified types and subtypes in relation to the histological prognostic parameters indicated significant differences regarding the tumor stage, the mixed subtypes being more frequent in advanced stages. Although mixed subtypes were more commonly associated with vascular and perineural invasion, the aspects were statistically insignificant. Together with tumor stage, the lymphovascular and/or perineural invasion should be taken into consideration as prognostic indicators in the postoperative management of gastric cancer.

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4. Clinical and Ultrasound Assessment of Enthesis in Psoriatic Arthritis in a Romanian Cohort

ALESANDRA FLORESCU, CRISTIN CONSTANTIN VERE, LUCIAN-MIHAI FLORESCU, ANCA EMANUELA MUSETESCU, ANDREI BONDARI, PAULINA LUCIA CIUREA

Introduction: Spondyloarthritis (SpA) is a group of chronic inflammatory disorders which includes ankylosing spondylitis (SA), psoriatic arthritis (PsA), reactive arthritis (ReA), arthritis associated with inflammatory bowel disease (IBD) and undifferentiated spondyloarthritis (uSpA). The enthesis, the area of insertion of the tendon, ligament or joint capsule onto the bone, can be characterized as a central feature in PsA. Material and methods: The study included a number of 28 patients, 18 females and 10 males, with PsA hospitalized during 2016-2018 in the Department of Rheumatology of the Emergency County Hospital of Craiova. All the patients were diagnosed with psoriatic arthritis according to CASPAR criteria and had a history of entheseal pain, mandatory criteria for inclusion in the study. All patients underwent clinical examination, laboratory tests and musculoskeletal ultrasonography (MSUS). Results: The Belgrade Ultrasound Enthesitis Score (BUSES) was not significantly associated either with ESR (p=0.536) or CRP (p=0.965) values. Furthermore, the clinical evaluation through the LEEDS enthesitis index (LEI) showed no significant association with ESR (p=0.067) or CRP (p=0.206). Despite MSUS and clinical findings, there was no significant correlation between disease activity in psoriatic arthritis (DAPSA) and BUSES (p=0,549) or LEI (p=0,197). However, clinical and echographic scores (BUSES and LEI) were significantly associated (p=0.001). Conclusions: Our study proved a significant correlation between LEI and BUSES, although in literature the evidence is contrasting. This is probably due to the fact that the majority of the patients had high disease activity which made the clinical assessment similar to the US. Further studies on more numerous groups of patients have to be conducted in order to debate the inconsistencies related to clinical and US examinations in patients with PsA.

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5. Epidemiological Aspects of Cognitive and Socio-Professional Integration in Schizophrenia

CERASELA SARBU, GEORGE-STEFAN BADESCU, ALEXANDRA-ELISABETA HROMEI, IZABELA DORA STANIA

Schizophrenia is one of the major psychiatric disorders with global impairment of cognition, emotional status and personality destruction having a major medical, social and economic impact worldwide. In this paper, we evaluated the correlation of disease progression with cognitive deficit, socio-professional and family disjunction using the MMSE (Mini Mental State Examination) and GAFS (Global Assessment of Functioning Scale) scales on a group of 191 schizophrenic patients admitted to the Psychiatric Clinic II Craiova during 2017. The fact that both scales show reduced values in patients with schizophrenia reveals a significant alteration in the quality of life of patients with this pathology having major implications on the individuals and on the community.

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6. Architectural Histopathological Changes in Ovarian Serous Carcinomas

CORINA DOCHI, ALEX EMILIAN STEPAN, CLAUDIU MARGARITESCU, CRISTIANA EUGENIA SIMIONESCU

Ovarian serous carcinomas have a very large spectrum of growth patterns that contrast with the most primitive ovarian carcinomas, in which the morphology varies very much less. Serous carcinomas growth patterns include papillary and glandular aspects, but also cribriform, solid, microcystic and trabecular, some being common to the both high- and low-grade types of ovarian serous carcinomas, others being distinct. The study included 45 cases of ovarian serous carcinomas out of which five cases with low grade and 40 cases with high grade. High grade serous carcinomas were associated with mixed growth patterns, with large complex papillae, glands with irregular shape lined by stratified epithelia, often with areas of extended necrosis. In the case of low grade ovarian carcinomas we observed the association with more uniform growth patterns, micropapillary or glandular, the presence of optically empty slit-like spaces, psammoma bodies, the absence of necrosis and the association with a borderline or benign component. The recognition of the common histopathological aspects, allows a more accurate diagnosis of the ovarian serous carcinoma types and subtypes, which has a great importance in the actual era of personalized therapy.

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7. Implications of the Iron Deficiency in Lower Tract Respiratory Acute Infections in Toddlers

DESDEMONA STEPAN, DALIA DOP, ARITINA MOROSANU, BIANCA VINTILESCU, CARMEN NICULESCU

Iron deficiency anemia can result in an abnormal immune response and an increased incidence of the respiratory tract infections. In this study we analyzed statistically the association of acute lower respiratory tract infections with anemic status and associated risk factors for a number of 166 toddlers (1-3 years), using a control group of 26 cases without infectious status. The statistical analysis indicated the significant association of the infectious status with the anemic status of the patients as well as with the rural living areas, non-natural nutrition, prematurity and respiratory history. At the same time, we found a statistically significant association of anemic status with rural living areas and non-natural diet. The results obtained can be used to stratify patients for standardized treatment to regulate the iron metabolism and implicitly to combat the infectious disease.

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8. The Effectiveness of Shockwave Therapy in Patients with Lateral Epicondylitis

OTILIA-CONSTANTINA ROGOVEANU, ANCA EMANUELA MUSETESCU, CRISTINA-ELENA GOFITA, MAGDALENA RODICA TRAISTARU

Shockwave therapy is based on generating a very intense energy in a very short period of time. It creates a mechanical pressure over the affected tissues that leads to an increased cellular permeability, thus increasing the microcirculation and the cellular metabolism. Therefore, the healing process is accelerated. Lateral epicondylitis represents a common arm injure, which usually affects early to late middle-aged patients, more common and with a longer evolution period in women, characterized by inflammation of the arm muscles’ tendon insertion and manifests with pain on elbow extension and forearm rotation. Our study aims to investigate the efficacity of the shockwave therapy in comparison with a classical treatment of local and systemic drugs. The 50 patients were evenly split into two groups. The diagnosis of lateral epicondylitis was based on exhaustive physical examination. Enthesis evaluation was performed through power Doppler ultrasound. The pain was quantified using the visual analogue scale for pain intensity. All parameters were evaluated at diagnosis and after 30 days, following treatment. One group received shockwave therapy, while the other group received nonsteroidal anti-inflammatory drugs and local topics associated with laser and ultrasound application. The results of our study report that both groups experienced significant improvement after treatment. The shockwave therapy recorded a higher improvement rate in all the parameters. Consequently, this new non-invasive, effective and safe technique can be successfully used in the treatment of abarticular pathology of the elbow.

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9. Diagnostic of Early Onset Polycystic Kidney Disease in Neonates

DIANA STEFANIA MATEESCU, MIHAELA GHEONEA, SERENADA BALA, GABRIELA-CAMELIA ROSU, DANIEL PIRICI, ION ROGOVEANU

Polycystic kidney disease represented by autosomal dominant polycystic kidney disease (ADPKD) and autosomal recessive polycystic kidney disease (ARPKD) have a major impact of mortality in children. We conducted a study of a premature infant with an estimated gestation date of 32 weeks with a presumptive prenatal diagnosis of right polycystic kidney. A 28-year-old primigravida with pre-eclampsia was admitted at the gynecology unit of Clinical Emergency County Hospital of Craiova. The clinical examination revealed a large abdominal distention due probably to the right polycystic kidney, suspected on prenatal ultrasound and radiography. The preterm neonate undergone right nephrectomy 5 days after birth. Histopathology of the kidney was performed in the Pathology Department of the Emergency County Hospital of Craiova and in the Center for Microscopic Morphology and Immunology of U.M.F. of Craiova. Microscopy revealed dilated cysts lined by simple cuboidal or flattened epithelium, and islets of remnant kidney parenchyma separated by edematous stroma. Immunohistochemistry for CD34 revealed incomplete blood arcades which did not seem to be in contact with all the tubular elements of the parenchyma, when compared to a control age-matched kidney. The patient had a favorable postoperative evolution, she was clinically stable on discharge from the hospital with a follow-up strategy including genetic testing.

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10. Non-Specific Onset of Pulmonary Adenocarcinoma

KAMAL CONSTANTIN KAMAL, LIGIA FLOREA, DIANA KAMAL, DRAGOS OVIDIU ALEXANDRU, ADINA MARIA KAMAL

Skin metastases are rarely found in lung cancer compared to other types of neoplasia. Of the types of lung cancer that can have skin metastases, the most common one is adenocarcinoma. Pulmonary cancer metastasizing to the skin has poor prognosis, usually the survival rate of the patients is 4-6 months. We present the case of a 59-year-old woman, smoker, high blood pressure, dyslipidemia, with two skin ertitemato-nodular lesions, incompletely delimited, with a diameter of 4-5cm, in the left arm (1/3 medio-external) and left latero-thoracic (near IV intercostal space) area, discovered during a regular medical examination at her family doctor’s practice. After multiple clinical and paraclinical investigations, almost 3 months after the initial presentation, the patient was diagnosed with stage IV pulmonary adenocarcinoma with supra and subdiaphragmatic lymph-node metastases, soft tissue metastases, liver metastases and breast metastases. Oncological treatment was initiated, but the patient's progression was unfavorable, her passing occurring 6 months after being diagnosed.

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11. Postpartum Spontaneous Subcapsular Hepatic Hematoma (SSHH)-Conservative Management. Case Report and Review of Literature

MARIUS CRISTIAN MARINAS, GABRIEL FLORIN RAZVAN MOGOS, ROXANA CRISTINA DRAGUSIN, STEFANIA TUDORACHE, DOMINIC GABRIEL ILIESCU

Spontaneous subcapsular hematoma of the liver, with no history of preeclampsia and HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelet count.), represents an exceptionally rare clinical condition in pregnancy and postpartum. The complications can be devastating in terms of fetal and maternal mortality. We hereby present a case of a 33-year-old female that underwent an emergency Cesarean section (C-section) at term with the extraction of a live foetus. Few hours after delivery, she complained of intense epigastric and abdominal pain. The diagnostic work-up suggested a SSHH. The condition was managed conservatively in a multidisciplinary team.

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12. A Primary Retroperitoneal Diffuse Large B-Cell Lymphoma: A Challenging Diagnosis

ALINA CONSTANTIN, ALINA DANIELA TANASE, ADRIAN SAFTOIU, CATALIN COPAESCU

Although quite rare, retroperitoneum can harbour malignant limphomas. On the grounds that the anatomical location is uncommon and the symptoms are scarce, the diagnosis is usually late and challenging. Imaging methods such as magnetic resonance imaging, computed tomography (CT) and positron emission tomography-computed tomography (PET-CT), can characterize and locate the tumor while endoscopic ultrasound fine needle aspiration (EUS-FNA) may provide pathological confirmation. We present the clinical case of a fifty-five-year-old female that is admitted to our hospital with epigastric discomfort, nausea and vomiting. CT showed a homogenously enhancing mass lesion that encased the pancreas, in contact with the portal vein, inferior vena cava, invading splenomesenteric confluence. To investigate further, EUS-FNA was decided and it revealed lymphocyte proliferation suggestive for the diagnosis of lymphoma. Hereinafter, surgical intervention was performed and immunohistochemical analysis and sub classification of lymphoma was obtained. The final diagnosis was non-Hodgkin lymphoma, Diffuse Large B-Cell Lymphoma (DLBCL). Poly-chemotherapy with R-CHOP was initiated. At the end of the treatment fluorodeoxyglucose positron emission tomography (FDG-PET) was performed and no pathological findings were found. A brief review of literature is also provided.

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13. Clear Cell Acanthoma with Atypical Location -Case Report and Literature Review-

VIRGIL PATRASCU, LILIANA GEOLOAICA, RALUCA NICULINA CIUREA

Clear cell acanthoma is an uncommon, benign lesion, usually present in middle-aged and elderly patients. It looks like an erythematous papule, solitary, with squama at the periphery, regularly located on the lower limbs. We present the case of an 80-year-old female, who was admitted in the Dermatology Clinic of Craiova for an infiltrative plaque, erythematous-squamous-crusty, well delimited, with sizes 1,2/1,5cm, polycyclic shape, located in the right groin. The onset of the condition was 7-8 years ago, with slow growth in size. The excision of the lesion was performed and the histopathological examination confirmed the diagnosis of clear cell acanthoma. Our case is atypical by location. Because clear cell acanthoma is difficult to be clinically diagnosed, with a wide range of lesions that make a differential diagnosis, we highlight the importance of histopathological examination for a positive diagnosis. The treatment depends on the type of lesion and on the patient’s preference, usually consisting in surgical excision.

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