Timisoara Medical Journal doi: 10.35995/tmj20250101

Authors: DENISA PESCARI Andreea Borlea Corina Paul Simina Monica Mihuta Ioana Mozos Dana Stoian

(1) Background: Exploring eating habits has revolutionized nutrition studies by elucidating the intricate relationship between food, nutrient interactions, and body composition, highlighting the need for deeper dietary analyses due to the global surge in obesity and its associated health risks, with bioimpedance-based body analysis emerging as a precise tool for body composition assessment. (2) Material and Methods: Using the TANITA BC 418 body composition analyzer, we examined 1015 subjects aged 18-74 years old. The study's objective was to identify risk factors for obesity. Demographic data, clinical characteristics, personal and family history of cardiovascular diseases (CVD), bioimpedance measurements and metabolic disease and 38 parameters/questions regarding dietary habits were recorded. Participants were categorized into four BMI groups: overweight, obese grade I, obese grade II, and obese grade III. (3) Results: Significant gender distribution differences were observed across BMI classes (p < 0.001), with more females in overweight and obese categories. Dietary habits such as two-course lunches showed potential associations between BMI groups (p=0.05). Psychological and behavioral factors like eating for pleasure (p=0.008) and eating alone (p=0.03) differed significantly among subgroups, underscoring emotional aspects in obesity management. Environmental factors revealed differences in weekend eating habits (p=0.02). Physical activity duration inversely correlated with BMI (p=0.009), with home cooking also showing significance (p=0.03). While current smoking status had marginal links to obesity (p=0.05), smoking cessation did not show significant associations (p=0.46). (4) Conclusions: Our study revealed significant differences in eating habits, medical histories, and physical activity among individuals with varying degrees of obesity. These findings underscore the complex interplay of biological, behavioral, and environmental factors contributing to obesity. Personalized approaches are crucial in addressing obesity, considering unique lifestyle factors and medical histories of patients. Our study provides valuable insights for the development of more effective strategies in obesity management and prevention.

Timisoara Medical Journal doi: 10.35995/tmj20240227

Authors: Andreea Herascu Vlad Avram Iulia Grosu Laura Gaita Adina Braha Alexandra Sima Bogdan Timar

Abstract: Chronic hyperglycemia in the context of type 2 diabetes predisposes patients to developing diabetic chronic kidney disease. The following clinical case covers a 55-year old patient with a longstanding history of type 2 diabetes and essential hypertension admitted for typical symptoms of uncontrolled diabetes to the Diabetes Department of "Pius Brinzeu" Emergency Hospital. Clinical evaluation and laboratory results pointed to the diagnosis of nephrotic syndrome, however, did not present at first a clear cause for such high levels of proteinuria. This report follows the meticulous logic needed in order to establish the cause of nephrotic syndrome, all the way to a justifiable renal biopsy. Once diabetic nephropathy was established, adding treatment with an SGLT2i was considered a valid treatment option due to its antiproteinuric effects.

Timisoara Medical Journal doi: 10.35995/tmj20240228

Authors: Claudia Ramona Bardan Ioana Ionita Maria Iordache Diana Lighezan Adrian Gluhovschi Ileana Enatescu Elena Bernad

Iron deficiency anemia (IDA) and vitamin D deficiency are among the most prevalent micronutrient deficiencies worldwide, particularly affecting pregnant women. The physiological demands for both iron and vitamin D increase significantly during pregnancy to support maternal health, fetal development, and placental function. Failure to meet these demands leads to adverse outcomes, including preterm birth, low birth weight, preeclampsia, and maternal infections. Hepcidin, a liver-derived peptide hormone, is central to systemic iron regulation. It modulates dietary iron absorption and mobilization from body stores through its interaction with ferroportin. In healthy pregnancy, hepcidin levels are physiologically suppressed to enhance iron bioavailability. However, inflammation or vitamin D deficiency may elevate hepcidin levels, exacerbating IDA and complicating its management. Vitamin D, primarily recognized for its role in calcium metabolism, is also a key regulator of hepcidin expression. Through receptor-mediated pathways, vitamin D suppresses hepcidin synthesis, improving iron absorption and mobilization. The coexistence of IDA and vitamin D deficiency during pregnancy creates a complex clinical scenario, compounded by overlapping risk factors like poor diet, limited sun exposure, and chronic inflammation. Emerging evidence highlights hepcidin as a dynamic biomarker capable of differentiating IDA from anemia of inflammation. This review explores the intricate relationship between vitamin D deficiency and IDA, with a focus on hepcidin as both a regulator and biomarker. We discuss physiological and pathological mechanisms, diagnostic applications of hepcidin, and therapeutic opportunities, including the synergistic role of vitamin D and iron supplementation. By addressing the dual burden of vitamin D deficiency and IDA, this review provides a comprehensive framework for improving maternal and neonatal outcomes through targeted interventions and biomarker-guided therapies. Future research should focus on refining diagnostic tools and exploring innovative therapies to optimize anemia management in pregnancy.

Timisoara Medical Journal doi: 10.35995/tmj20240226

Authors: Sorin Mihali Dan Lolos Adrian Jantea Liliana Porojan Loredana Mitariu Mihai Mitariu Daian Popa Raul Chioibas Bogdan Lolos Roxana Oancea Stefania Dinu

This case report details the clinical use of layered lithium disilicate crowns, employing a customized technique that combines a modified chamfer on the vestibular surface with Vertical-Prep on the lingual surface. This concept was applied on six mandibular anterior teeth (4. 1, 4. 2, 4. 3, 3. 1, 3. 2, 3. 3) trying to achieve mechanical advantage of the vertical preparations alongside the aesthetic accomplishment of the modified chamfer technique. The lithium disilicate material used was characterized by high strength and biologic characteristics of the material made it possible to achieve highly satisfactory esthetic result with the color near to the patient’s original teeth. In terms of function, the restorations provided good stability and comfort to the patients and none of the patients complained any discomfort in the six-year follow up period. Both the crowns were proved to have long term sturdiness with out any fractures or wearing and thus this treatment modality can be held as successful outcome. This case also supports the concept of having a well-developed mode of preparation in tandem with using high quality ceramics in the creation of durable, esthetical dental restorations.

Timisoara Medical Journal doi: 10.35995/tmj20240225

Authors: Dan Lolos Sorin Mihali Adrian Jantea Liliana Porojan Loredana Mitariu Mihai Mitariu Daian Popa Raul Chioibas Bogdan Lolos Roxana Oancea Stefania Dinu

This case report describes the use of a minimally invasive approach to the anterior dentition using feldspathic ceramic veneers with two axes of insertion. It was developed to restore as much of the hard structures of teeth as possible while at the same time giving the best esthetic outcome. Unlike other types of veneers that require extensive changes to the tooth shape due to single-axis placement, the technique presented allows for two axes of insertion. This approach enables minimal preparation and preserves most of the tooth structure. The veneers were applied on both maxillary and mandibular anterior teeth and additional six years follow up did not show any sign of fractures, debonding or marginal degradation hence proving the long-term success of this concept. The case highlights the significance of rigorous bonding sequence and the particularity of the fabrication process to achieve long-term outcome stability of the restorations. This work further confirms the applicability of double veneer technique as a reliable option for patients who desire change in their teeth appearance but without undergoing surgical procedures, but more research needs to be done with respect to its versatility in dentistry.

Timisoara Medical Journal doi: 10.35995/tmj20240208

Authors: Ioana Martu Carmen Savin Diana Diaconu-Popa Alexandra Jitareanu Giorgio Nichitean Liliana Pasarin Oana Maria Butnaru Emanuela Crăciunescu

Background: Recognized widely for its irreversible effects, periodontal disease stands as one of the most prevalent conditions, particularly emphasizing the potential for permanent damage caused by gingivitis, extending to encompass the entirety of the supportive complex, including the connective tissue and alveolar bone. Patients necessitating comprehensive periodontal and prosthetic treatments require an interdisciplinary approach, involving the coordination of pre-treatment procedures and appropriate prosthetic strategies. The adoption of advanced materials and techniques can prove beneficial in addressing complex dental issues. (2) Methods: Forty specimens were prepared using the prescribed procedure, with 20 acting as controls and the other 20 integrating AgNPs. The initial step involved crafting wax patterns of distinct shapes: dumbbell shapes for tensile testing and rectangular shapes for roughness assessments. These dimensions were aligned with ASTM D-638 and ISO 527-2 standards and adjusted to match the specifications of the analysis device for mechanical properties. (3) Results: In this case, the results indicate minimal differences in heat-curing acrylic resins compared to the control samples at a 5% concentration. However, notable disparities arise at concentrations of 10% and 20%. (4) Conclusions: Temporary prosthetic constructions are essential for preventing functional imbalances and complications. Incorporating AgNPs at a 5% concentration maintains mechanical properties while providing antibacterial effects for long-term interim prosthodontic restorations. Higher nanoparticle concentrations may reduce resin mechanical properties without affecting material surface condition

Timisoara Medical Journal doi: 10.35995/tmj20240207

Authors: Alina Doina Tănase Emanuela Lidia Petrescu Cosmin Sinescu Meda-Lavinia Negruțiu Daniela Maria Pop Andreea Codruța Novac Daliana Emanuela Bojoga Kristian Miok Traian Marius Leretter

(1) Background: This study delved into a current topic in dental medical practice to analyse the role and impact in communication of messages within health promotion campaigns. (2) Methods: This study analyses the patients' opinions about the role and importance of using an effective communication style in health promotion campaigns. The main aspects aims to analyse based on patients' opinions, the consistency of messages in health promotion campaigns, the repetitive nature of these messages, the adaptation of communication methods according to the target group's background and the importance of collaboration between state bodies and those organizing health promotion campaigns. (3) Results: The results of this study once again emphasize the close connection between the efficiency of health promotion campaigns, the way campaigns are coordinate and the messages for the target population. Most patients are aware about an effective communication in health promotion campaigns, believing that may influence the recipients' decision to adopt a healthy lifestyle concerning oral health. Regarding the effectiveness of health promotion campaigns for oral health, the study’s results reveal a significant lower positive impact among rural patients compared to urban ones. This indicates the need of change in how information is communicated to the population and to increase the level of health education. (4) Conclusions: In conclusion, the data obtained provides valuable and profound insights into how patients perceive the importance and role of communication in health promotion campaigns. The understanding of their perceptions and requirements forms the basis for developing and implementing efficient health communication and strategies, ultimately leading to improved community health and well-being. By personalizing and adapting the messages and communication methods, health promotion campaigns can become much more effective with a greater impact on health-related behaviours and attitudes.

Timisoara Medical Journal doi: 10.35995/tmj20240206

Authors: Andrei Ardelean Diana Federica Balta Carmen Neamtu Andreea-Adriana Neamtu Mihai Rosu Bogdan Totolici

This study aimed to explore the relationship between inflammatory markers, apolipoprotein E (ApoE) levels, renal function, and mortality in patients with diabetic foot ulcers (DFUs). Conducted as a single-center prospective study at the Clinical County Emergency Hospital of Arad, Romania, the study included 90 patients diagnosed with infected DFUs. The main objective was to determine the risk factors for mortality over a three-year follow-up period, focusing on early versus late deaths. The results indicated a significant correlation between elevated levels of ApoE, pentraxin 3 (PTX3), procalcitonin (PCT), and impaired renal function with increased mortality. Patients with higher levels of these biomarkers, particularly those with impaired renal function, were more likely to experience early death, especially within the first 90 days after surgery. The findings underscore the critical role of these factors in predicting mortality and highlight the need for early intervention and aggressive management of these risk factors to improve outcomes in this vulnerable population. Despite advancements in medical and surgical care, the prognosis for patients with DFUs remains poor, particularly due to the recurrent nature of the ulcers and the presence of comorbidities like chronic kidney disease.

Timisoara Medical Journal doi: 10.35995/tmj20240105

Authors: Eliza Stefania Tănasie Valentin Nanescu Emilia Amzoiu Manuel Ovidiu Amzoiu Andreea Gabriela Mocanu Felicia Ciulu-Costinescu Liviu Chirigiu

In the conducted study, we investigated the total phenolic content of the alcoholic extracts from various vegetative organs of two plants of Romanian wild flora, Oltenia region: Dipsacus laciniatus and Armoracia rusticana. The antioxidant activities were determined by ferric reducing antioxidant power (FRAP), and 1,1-diphenyl-2-picryl hydrazyl (DPPH) radical scavenging methods. We also determined total polyphenol and flavonoid content. The results showed significant differences among plant various vegetative organs, the highest content of polyphenols being found for the leaves extract of Dipsacus laciniatus species, followed by Armoracia rusticana leaves. The highest antioxidant reducing power was obtained for the Armoracia leaf extract (IC50= 101.94 µg/ml), followed by the leaves of Dipsacus (IC50= 77.86 µg/ml).

Timisoara Medical Journal doi: 10.35995/tmj20240104

Authors: Oana Slușanschi Liliana Gârneață Adrian Țandără Lavinia Brătescu Carmen Bărbulescu Cristian Funieru

Background and objectives: Studies report a more precarious oral health status, with a higher prevalence of periodontal disease, in hemodialysis patients. Also, oral inflammation foci, mainly periodontal disease, are related to systemic inflammation and malnutrition which have a negative impact on morbidity and mortality in these patients. The aim of this study is to observe the influence of dental on the general status of these patients. Material and Methods: The study is a series of cases and was conducted in two phases: data collection and treatment phase and monitoring phase. Dental treatment was performed on 13 patients, with ages between 43-69 years of age, diagnosed with moderate or severe periodontal disease. Oral status parameters (plaque and gingival bleeding index, pocket depth, attachment level, DMFT and CPITN index) and general parameters (C-reactive protein, albumin, hemoglobin, calcium phosphate product, calcium and phosphate levels, erythropoietic-stimulating agents) were registered and monitored. Conventional periodontal treatment, dental extractions, endodontic treatments were performed. Results: Oral assessment showed a statistically significant improvement of oral parameters, at both 1 month and 3 months post-treatment. Mean values for albumin, C-reactive protein, hemoglobin, calcium phosphate product and calcium levels had a slight improvement, but the difference was not statistically significant. Conclusion: The oral status, characterized by the measured periodontal parameters, improved visibly and statistically significant after the dental treatment. The parameters of the general status did not change significantly following the intervention.

Timisoara Medical Journal doi: 10.35995/tmj20240102

Authors: Alina Doina Tanase Emanuela Lidia Petrescu Cosmin Sinescu Meda Lavinia Negrutiu Andreea Cojocariu Daniel Pit Kristian Miok Daliana Emauela Bojoga

(1) Background: This study examines the issue of malpractice accusations related to medical procedures in case of minor patients belonging to specific religious sects, focusing on both legal and ethical perspectives. The analysis particularly addresses the consequences of disregarding the refusal of legal guardians to consent to blood transfusions. (2) Methods: The present study is analyzing the opinion of doctors that practie in various hospital units regarding a series of aspects related to the refusal of blood transfusions in the case of minor patients who belong to certain religious sect. These aspects mainly targeted their level of awareness regarding the relevant legislation, the incidence rate of such cases in practice, and the risk of malpractice accusations. For this observational-prospective study, a questionnaire consisting of ten closed-ended questions was delivered to fifty doctors. Before starting to complete the questionnaire, the doctors were asked for their consent to participate in the study, being informed about its purpose. Doctors answers were analysed and interpredeted in order to revel if doctors are informed about the legal aspects, thei protection offered by the law and their attitude regarding the boold transfusions for this cathegory of patients. (3) Results: The results of this study show that most doctors are aware of the Romanian legislation regarding the rules on the expression of consent to the medical act in the case of minor patients by the latter's legal representatives, but they feel threatened by the danger of being exposed to accusations of malpractice when they are put in the situation of providing medical care to minor patients who belong to a certain religious cult, because they are faced with the vehement refusal of their family members who do not accept the idea of medicine based on blood transfusions. Although there is this rule from which the legal representatives of minor patients belonging to a particular religious cult do not deviate, the results showed that doctors believe that the best interests of those seeking medical services must be emphasised, prioritising the fundamental values that protect life or health. (4) Conclusions: Protecting the best interest of minor patients by prioritizing their health should be the main guideline for any legal representative when they need to make a decision regarding the medical care. From a legal perspective, however, it must be accepted that there is no unified viewpoint on this extremely delicate and complex issue, with voices condemning the physician's attitude of violating the will of the legal representatives of minor patients, adherents of a certain religious sect, by applying blood transfusion-based treatments.

Timisoara Medical Journal doi: 10.35995/tmj20240103

Authors: Laurentiu Braescu

Epicardial and perivascular adipose tissues have gained significant attention in the past decade due to their involvement in complex metabolic shifts and inflammatory changes in cardiovascular diseases. Statins, the cornerstone of lipid-lowering therapy, have pleiotropic effects, including the potential of alleviating epicardial adipose dysfunction and inflammation, although their impact on local oxidative stress has received less scrutiny. This study was purported to assess the production of reactive oxygen species (ROS) in epicardial and perivascular fat samples harvested from patients undergoing elective cardiac surgery and who were treated or not with statins. Here, we report that patients chronically treated with statins (atorvastatin and rosuvastatin) exhibited significantly lower levels of ROS in their epicardial and perivascular adipose tissues. Additionally, a positive correlation was observed between adipose tissue oxidative stress and the diameter of the right ventricle. Larger studies are required to provide mechanistic insights regarding the sources of epicardial ROS and signal transduction pathways activated by statins.

Timisoara Medical Journal doi: 10.35995/tmj20240101

Authors: Raluca-Ștefania Georgescu Roxana Oancea Ruxandra Sfeatcu

This paper aims to study an adult population’s perception and knowledge of orthodontic treatment within the context of Romania, aiming to underscore the pivotal role of this kind of treatment in improving oral health and enhancing quality of life. Acknowledging malocclusion as a prevalent oral health issue, it is observed that while an increasing number of people seek orthodontic treatment, significant misperceptions remain, emphasizing the need for patient adherence to and knowledge of the effective planification of orthodontic treatment plans. Utilizing a cross-sectional methodology, the authors developed a questionnaire and disseminated it via social media platforms to examine the attitudes and awareness levels among 132 Romanian adults regarding orthodontic treatment. The findings reveal a strong awareness concerning orthodontic procedures. Most of the subjects (61.4%) were of the opinion that, during orthodontic treatment, patients look good and 80.3% assessed the treatment as being expensive. In total, 73.5% of the participants were aware that during orthodontic treatment patients have food restrictions and that neglect can affect the treatment, while 78% thought that brackets and wires can break if care is not taken. Notably, respondents with prior orthodontic treatment showed a higher level of comprehension of the process, including an acknowledgment of the necessity for augmented oral hygiene practices and the implications of non-compliance. The results show a generally affirmative opinion on orthodontic treatment, with a recognition of its long-term benefits for oral health and aesthetics. Nevertheless, the perceived economic and physical barriers to access, underscore a need for patient education. In summary, understanding patient perceptions and knowledge of orthodontic treatment not only fosters enhanced patient–orthodontist relationships but also empowers dental professionals to customize educational strategies that amplify treatment efficacy. The study advocates for sustained efforts to disseminate information related to orthodontic care, promoting its benefits as a key aspect of oral health.

Timisoara Medical Journal doi: 10.35995/tmj20230203

Authors: Amalia Ridichie Adriana Ledeți Denisa Ivan Carmen Tomoroga Laura Sbârcea Lenuța-Maria Șuta Răzvan Bertici Anca Dragomirescu Florentin Crăineanu Ionuț Ledeți

Mupirocin is a topical antibiotic widely used to treat various skin infections caused by Gram-positive and Gram-negative bacteria, being the first-line treatment in the case of an infection with methicillin-resistant Staphylococcus aureus (MRSA). Due to the unique mechanism of action, it does not possess any cross-resistance with other antibiotics, leading to its global use in different hospital departments. The main disadvantage of mupirocin is represented by its pharmacokinetic properties, leading to the main purpose of this study, namely, to fully characterize the physicochemical properties of the active pharmaceutical ingredient. Currently, it is used in different combinations with other active substances, for example metronidazole, to decrease the risk of developing resistance to mupirocin and to improve the therapeutic response. This leads to the second purpose of this study, i.e., to characterize the physico-chemical profile of metronidazole and to find out if there are any chemical interactions between the two compounds, and to establish if there is a possibility of using them in the same pharmaceutical formulation, thus increasing the compliance of the patient to the treatment.

Timisoara Medical Journal doi: 10.35995/tmj20230201

Authors: Ali Yusuf Shqera Afraa Samee Ali Radwan Aziz Haffaf

Purpose: To study the characteristics of the third molar by panoramic radiography in a sample of Syrian patients. Materials and methods: We analyzed 335 panoramic radiographs of Syrian patients with at least one third molar. The sample consisted of 169 males (50.5%) and 166 females (49.5%). Third molars were classified according to Pell and Gregory’s classification and Winter’s classification. Results: The incidence of impaction was higher among females than males. The most common pattern was of vertically mandibular third molars at level A and class II, followed by vertically maxillary third molars at level B. Conclusions: The early diagnosis of impacted third molars by panoramic radiographs is useful for determining the position and depth of these molars and for proper planning for extraction.

Timisoara Medical Journal doi: 10.35995/tmj20230202

Authors: Iulia Burcos Andreea Vătăman (Tălîngă) Roxana Ramona Onofrei

(1) Background: The aim of this study was to assess the short-term effects of one manual therapeutic intervention by quantifying the biomechanical and viscoelastic properties of upper trapezius myofascial trigger points. (2) Materials and Methods: Fourteen volunteer subjects (six males and eight females) aged 22 to 47 years, with myofascial trigger points in the upper trapezius muscle on both sides participated in this study. The biomechanical and viscoelastic properties were assessed with the Myoton Pro (Estonia) before the application of manual therapy (T0), then immediately after the end of the treatment session (T1) and finally one hour after the end of the treatment session (T2) in order to evaluate the effectiveness of the applied treatment. (3) Results: The oscillation frequency in the right upper trapezius muscle was significantly lower than in the left upper trapezius muscle both immediately, after the end of the manual therapy session (p = 0.03) and one hour after the session (p = 0.03). Regarding the state of tension in the right upper trapezius, a significant decrease was observed one hour after treatment compared to baseline (p = 0.04). In the left upper trapezius muscle, one hour after treatment, the dynamic stiffness value was significantly higher than in the right upper trapezius (p = 0.01). (4) Conclusions: Myotonometry could become a useful method to assess the biomechanical and viscoelastic properties of muscles, identifying trigger points and monitoring the results of therapy.

Timisoara Medical Journal doi: 10.35995/tmj20230103

Authors: Ramona Dumitrescu Ruxandra Sava-Rosianu Daniela Jumanca Daniel Negru Octavia Bălean Ioana Giorgiana Pașca Roxana Oancea Atena Gălușcan

(1) Background: This research is part of the Romanian oral health survey for children, aiming to determine correlations between the oral health status of 11–14-year-old schoolchildren and their parents’ educational levels, taking into account preventive behaviour and socioeconomic parameters. (2) Methods: a representative sample of 133 schoolchildren (72 boys and 61 girls), average age 12.26 ± 0.6 years, was examined by calibrated dentists. After obtaining ethical approval, a visual examination using ICDAS criteria was performed to classify visual caries lesion severity. Statistical analyses of the data were performed using SPSS 23, Spearman’s rank correlation and the Pearson correlation. (3) Results: Mean DMFT within the sample was 2.93 ± 2.70. High school was the most common level of education completed by the parents. A positive relationship was recorded between the mother’s level of education and the frequency of toothbrushing in children (rs = 0.02 *, p < 0.01), as well as with oral hygiene aids (rs = 0.17 *, p < 0.05). A negative significant correlation resulted between D3T index and the mother’s level of education (rs = −0.26 **, p < 0.01), as well as with the father’s education (rs = −0.17 **, p < 0.01). (4) Conclusions: The results of this study show that high caries prevalence could be associated with low educational level and socio-economic county-level variables, having an impact on the presence and severity of such lesions, as well as the absence of existing treatments.

Timisoara Medical Journal doi: 10.35995/20230104

Authors: Larissa Dăniluc Adrian Apostol Oana Sandu Carina Bogdan Viviana Ivan

Oncological pathology and the management of patient with cancer are real challenges in cardiology practice. Unpredictable situations triggered by this pathology, as well as adverse reactions of oncological therapy on the cardiovascular system, are increasing. A 71-year-old female patient who was known with HER2-positive breast cancer, with sectorial mastectomy and treated with chemo-radio-immunotherapy in 2018, then diagnosed with liver metastases and ulcerated gastric adenocarcinoma in May 2022, was referred to the Cardiology Clinic for chest pain and dyspnea. On the ECG, ST-segment depression was seen in the infero-lateral territory. Positive myocardial necrosis enzymes were documented, and also moderate microcytic hypochromic anemia. The current clinical, electrical, and biological picture was suggestive for acute coronary syndrome. It should be mentioned that the patient has been on monoclonal antibody therapy with Trastuzumab, recently discontinued after echocardiographic evaluation where decreased systolic performance was noted. Considering all the particular aspects of this case, as cardiotoxicity of oncological therapy, acute coronary event and anemic syndrome, multidisciplinary management is required, with adjustment of cardiovascular therapy and cancer treatment.

Timisoara Medical Journal doi: 10.35995/20230105

Authors: Luciana Maria Goguţā Florin Topalā Andrei Faur Anca Jivānescu

Background: The aim of this study was to assess the accuracy of printed interim fixed partial dentures (i-DPSs) fabricated on 3D-printed models using different printing angles. Materials and Methods: Six printing angles were chosen, namely 90°, 75°, 60°, 45°, 30° and 15°, to fabricate sixty i-DPSs, ten for each. The measurements were performed at 100 points cervical and 100 points axial occlusal. Statistical analyses were carried out using Med Calc software and the Kolmogorov–Smirnov and Kruskal–Wallis tests. Results: The marginal fit ranged between 39.302 µm and 74.470 µm, with the best values for the 60° (39.302 µm) and 30° (43.287 µm) printing angles. The mean values for the internal fit were between 72.876 µm and 114.26 µm, with the best values for the 30° (72.876 µm) and 60° (78.049 µm) printing angles. The Kruskal–Wallis test returned a p value of p < 0.0001.

Timisoara Medical Journal doi: 10.35995/tmj20230102

Authors: Maria I. Brumboiu Alexandru M. Durla-Pașca Irina Iaru

Post-vaccine adverse reactions are unwanted medical events that concern both the public and healthcare professionals. The objective of this paper is to present a detailed analysis of the case of an extensive local adverse reaction after the administration of a vaccine dose containing diphtheria–tetanus anatoxins. A good knowledge of post-vaccine side effects allows for complete and correct diagnosis, as well as appropriate individualized recommendations. Such an approach contributes to restoring public confidence in vaccines and vaccinations. The patient was a 6-year-old boy, with a history of asthma under chronic treatment with corticosteroids. He developed extensive local inflammatory lesions accompanied by functional disorders of the left arm, which began six hours after the administration of the fifth dose of the diphtheria–tetanus–pertussis–poliomyelitis vaccine. The lesions, which extended to the forearm, were locally treated with antiseptics and systemically treated with hydrocortisone hemisuccinate. They completely remitted within 14 days. Laboratory investigations revealed neutrophilia (6,870 neutrophils/µL), which could be related to the long-term treatment with steroids. The investigation needed the plasma concentration of diphtheria and tetanus anatoxins antibodies and the pro-inflammatory cytokines to be complete.

Timisoara Medical Journal doi: 10.35995/tmj20230101

Authors: Darius G. Buriman Adrian P. Merce Anca M. Bînă Laurențiu A. Brăescu Andrei E. Grigorescu Adrian Sturza Danina M. Muntean Horea B. Feier

Aortic stenosis is the most common valvular disease worldwide. Coronary artery disease (CAD) is often associated with degenerative aortic stenosis, particularly among older patients. Surgical treatment of the combined pathologies is highly recommended because the results are durable. Assessment of mitochondrial respiration in blood cells has recently emerged as a potential biomarker of the bioenergetic health but data regarding the changes in the setting of cardiopulmonary bypass (CPB) are scarce. A 67-year-old man was referred to the clinic for progressive breathlessness, constrictive thoracic pain and fatigue. Investigations revealed severe aortic stenosis and triple-vessel CAD. The aortic valve was replaced with a mechanical aortic prosthesis and coronary artery bypass graft was performed under mild hypothermia. We assessed platelet complex I (CI)- and complex II (CII)-dependent mitochondrial respiration and found a significant increase in the net active respiration supported by CI and the maximal uncoupled respiration in platelets harvested after CPB compared to those isolated pre-CPB. At variance, the active coupled respiration and electron transfer capacity for CII were decreased. The relative contribution of the complex cardiac pathology and CPB to the impairment of CII-dependent respiration and/or a possible relation with patients’ outcome are worth further investigation in a pilot study.

Timisoara Medical Journal doi: 10.35995/tmj20220206

Authors: Luciana Goguță Diana Lungeanu Codruța Gruia Anca Jivănescu

(1) Introduction: Information technology is seen as instrumental in shifting the paradigm of teaching and learning towards active learning. Students and young professionals have been suggested as being more prone to mobile technology addiction compared to the general population, with profession-characteristic patterns and possible consequences for long-term professional development. (2) Materials and methods: An original questionnaire was developed to assess the attitude towards mobile technology in active learning in a dental school in Romania. The study was conducted among 214 students in dentistry to identify any possible patterns of using mobile devices. Consistency analysis was conducted on the closed-ended questions by employing the reliability Cronbach’s alpha. Furthermore, inter-item correlation and principal components analysis (PCA) with varimax rotation was conducted to investigate the underlying motivational framework in the use of the internet. The Kaiser–Meyer–Olkin (KMO) test of sampling adequacy and Bartlett’s test of sphericity were applied to verify the data suitability for factor analysis. (3) Results: Principal component analysis and subsequent K-means clustering were applied on the data, leading to the conclusion that the underlying motivation of frequent use within these youngsters is mostly rooted in their professional interests, rather than compulsive or social pressure. For the two resulting clusters, the R-scores proved to be significantly different, with a median (IQR) of 43 (41–47) and 48 (44–54) for the first and the second cluster, respectively (Mann–Whitney U test, p < 0.001). Statistical analysis was conducted on de-identified data using SPSS v.20 and the R v.3.4 software packages, with a 0.05 level of significance. (4) Conclusion: The increasing need of constant network connection comes from the high pressure of the professional environment. This study results provide data grounds for diagnosing a possible behavioral addiction syndrome, which certainly is an intrinsic part of our ordinary life, both in professional and leisure activities.

Timisoara Medical Journal doi: 10.35995/tmj20220205

Authors: Emrah Doğan Cenk Elibol

(1) Object: Our study aims to identify the common and diverging points in the superior attachment of the nasal uncinate process (SAUP) classifications and to draw attention to the pitfalls in these evaluation processes. (2) Material and Methods: This study was performed on 200 patients (males/females, 100/100; mean age/range: 37.13 ± 16.14/16–84), and 400 sides were bilaterally evaluated. Potential pitfalls were investigated. All UPs were classified according to the Landsberg and Friedman (LF) and Stammberger and Hawke (SH) classifications, and these two classifications were compared. (3) Results: There was a high statistically significant correlation between SH and LF. SH Type IV and LF Type 0 and SH Type III and LF Type 6 completely overlapped. SH Type I corresponded to LF Types 2 and 3 and SH Type II to LF Type 2, 3, 4, and 5 groups. There was no significant difference between genders or sides (right and left) in terms of the LF or SH classifications. (4): Conclusions: Following the thick band and paying attention to concavity and convexity helps to accurately evaluate the anatomical structure. Only two groups overlapped one to one. For SH Types II and III, and LF Types 1, 2, 3, 4, and 5, knowing the SAUP group in one classification does not give an exact idea about the group of the other classification. Therefore, it is not possible to make comparisons between reports or studies using different classifications.

Timisoara Medical Journal doi: 10.35995/tmj20220204

Authors: Diana Nitusca Anca Marcu Edward Seclaman Razvan Bardan Ioan Ovidiu Sirbu Ovidiu Balacescu Adina Ioana Bucur Sorin Ursoniu Catalin Marian

(1) Background and Objectives: Responding to the need for more optimized biomarkers for prostate cancer (PCa) diagnosis, a high number of studies have shown that microRNAs (miRNAs) could serve as novel, more reliable diagnostic tools. The usefulness of these miRNAs in assessing the presence of PCa is still under debate, given the discrepancies in their diagnostic performances. In this respect, hsa-miR-141 is among the miRNAs of particular interest, being very much investigated in PCa biology. (2) Material and Methods: Here, we provide a meta-analysis of miR-141 data published until May 2019, whose diagnostic accuracy was assessed using the Quality Assessment for Diagnostic Accuracy Studies-2 (QUADAS-2) tool, by analyzing several parameters including sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR) and the area under the curve (AUC). The six studies that matched our selection and were included in our meta-analysis comprise 283 PCa patients, 114 healthy controls, with 84 patients suffering from benign prostate diseases. (3) Results and Conclusions: Our results indicate a very good diagnostic accuracy for miRNA-141 (0.78 sensitivity, 0.96 specificity, DOR of 89, LR+ of 21, LR- of 0.23 and AUC of 0.87), underlying its utility as a PCa diagnostic biomarker.

Timisoara Medical Journal doi: 10.35995/tmj20220203

Authors: Fabio Liebenspacher Patrick Siegfried

This scientific paper aims to collect and analyze various digital technologies connected to pharmacies and Health 4.0. Thus, the goal is to give basic recommendations for actions for pharmacies to remain successful businesses in the digital future of healthcare. While the total health sector is growing continuously, the total number of pharmacies is shrinking. To be able to face the competitive pressure on the pharmaceutical market, pharmacies have to integrate more efficient digital technologies to be able to increase customers’ experience. Hence, the acceptance and attitude of the German society towards digital health solutions are examined using a short survey and a precise questionnaire. After a detailed analysis of the survey results and the questionnaire answered by a pharmacist, specific digital methods and technologies which make sense for pharmacies can be elaborated. As the future of pharmacies is still quite unexplored, while the health market is shifting to more efficient digital solutions, pharmacies have to adapt to current developments fast. Therefore, this paper can serve as a guideline for pharmacies in the rapid changes toward more digital markets.

Timisoara Medical Journal doi: 10.35995/tmj20220202

Authors: Adrian P. Merce Anca M. Bînă Vlad F. Avram Darius G. Buriman Ana Lascu Horea B. Feier Lucian Petrescu Danina M. Muntean Eskil Elmér Octavian M. Crețu

Open-heart surgery with cardiopulmonary bypass (CPB) remains the standard approach for complex cardiac pathologies, such as advanced coronary heart disease and severe valvular defects. Platelet dysfunction has been widely reported, with both structural and functional changes being elicited by the CPB circuit. Succinate is a mitochondrial substrate that is metabolized through complex II (CII) but is impermeable to cellular membranes when given exogenously. Cell-permeable succinates are novel prodrugs developed to support mitochondrial electron transport (ET) and prevent energy depletion in various pathologies. The aim of the present pilot study was to investigate the role of NV118 (diacetoxymethyl succinate), a cell-permeable succinate, on platelet respiration in a pilot group of patients undergoing CPB. Blood samples (20 mL) were collected from participants before (prior to heparin administration) and after CPB (within 10 min after protamine sulphate administration). Platelets were isolated through a two-step centrifugation protocol. Mitochondrial respiration was analyzed by means of high-resolution respirometry in the presence of NV118 or its solvent (DMSO). The main respiratory parameters recorded were as follows: ROUTINE respiration, LEAK respiration, and maximal uncoupled respiration for both CI and CII (ET capacity) and for CII solely after CI inhibition (ET CII capacity). Here, we report that NV118 elicited a global increase in platelet respiration both pre- and post-CPB. In conclusion, NV118, a cell-permeable succinate, improved platelet bioenergetics in the setting of cardiopulmonary bypass. Whether the compound can support platelet function and/or provide organ protection at the mitochondrial level during CPB are clearly worthy and important areas for future investigation.

Timisoara Medical Journal doi: 10.35995/tmj20220201

Authors: Raluca Lavinia Nițu Ruxandra Sfeatcu Ioana Giorgiana Pasca Lia Raluca Damian Ramona Cristina Dumitrescu Roxana Oancea

(1) Background: The current practice in dental medicine aims to perform non-invasive treatments, which preserve as many hard tissues as possible. This trend is based on the final appearance, which should be as aesthetic and as close to natural teeth as possible. The use of Icon DMG can be considered revolutionary in the treatment of white spot lesions (WSLs) caused by various factors. (2) Methods: A diagnosis was established after clinical inspection, transillumination, or based on the patient’s medical history. Icon infiltration was followed according to the producer’s indications. Chromatic stability was assessed by two examinators with Vitapan 3D Master, and gum health improvement was assessed using the gingival index (GI). (3) Results: Ten dental units were observed for one year and showed chromatic stability. Gum health was improved. No side effects occurred. (4) Conclusions: An easy, non-invasive technique and painless treatment are the desired results from the use and implementation of resin in current practice. Following the infiltration protocol offers the desired aesthetic results.

Timisoara Medical Journal doi: 10.35995/tmj20220105

Authors: Bogdan Ioncioaia Călin Lucian Morar Luminița Miron

Peripheral nerve injuries have a significant negative impact on daily activities and quality of life. Considering that the compression of more than one peripheral nerve may have an increased negative emotional impact, it is, therefore, important to make a thorough diagnosis and speed up the surgical treatment. We present the case of a 71-year-old male patient with multiple simultaneous compression neuropathies of the distal right arm involving the posterior interosseous, median and ulnar nerves, who sought medical care during the first year of the COVID-19 outbreak.

Timisoara Medical Journal doi: 10.35995/tmj20220104

Authors: Roopashri Rajesh Kashyap Rajesh Shanker Kashyap

Acute necrotizing ulcerative gingivitis or Vincent’s stomatitis is a painful infectious condition of gingiva due to endogenous bacteria. It is an uncommon disease of gingiva, usually seen in patients with impaired immunity, which may be due to some underlying systemic diseases such as HIV infection, malignancy, or diabetes mellitus. Rarely, it is also seen in immunocompetent patients living a stressful life. Here, we report a case of Vincent’s stomatitis with the acute ulcerative involvement of gingiva and pseudomembranous ulceration of tonsils in a general medical practitioner living a busy life.

Timisoara Medical Journal doi: 10.35995/tmj20220103

Authors: Edip Güvenç Çekiç Nesrin Filiz Başaran Özgür İlhan Çelik Fevziye Burcu Şirin Nigar Yilmaz Güray Soydan

(1) Aim of the Study: In this study, we aimed to evaluate the vascular damage and the effects of nitric oxide synthase (NOS) enzyme inhibitors in hepatic damage caused by high doses of acetaminophen (APAP). (2) Material and methods: Fifty-three Swiss albino male mice were used for this study. Hepatic and thoracic aorta toxicity caused by 2 or 6 h exposures to APAP (300 mg/kg intraperitoneally (i.p.)) were evaluated. The general NOS inhibitor NG-nitro-L-arginine methyl ester (L-NAME: 25 mg/kg and 50 mg/kg, i.p.) and the neuronal NOS inhibitor 7-nitroindazole (7-NI: 15 mg/kg, i.p.) were administered one hour before APAP exposure. (3) Results: Significant morphological deteriorations were observed after 6 h of APAP exposure in histopathological examinations of hepatic sections. Pre-treatment with L-NAME (at 50 mg/kg) or 7-NI before a 6 h APAP exposure significantly decreased hepatic toxicity (p < 0.05). Significant increases in ALT levels in 6 h of APAP exposure were decreased by both L-NAME (with the 25 mg/kg but not at 50 mg/kg) and 7-NI pre-treatments. No significant change was observed in the measured nitrate/nitrite levels and total antioxidant status in either serum or liver homogenates. No significant deteriorations were observed during either hematoxylin-eosin or immunohistochemical staining in thoracic aorta sections. In the thoracic artery sections, no statistical difference was found in acetylcholine-mediated relaxation, which may indicate endothelial dysfunction. (4) Conclusions: This study demonstrated that APAP-induced hepatic toxicity, especially neuronal NOS inhibitors, may decrease hepatic toxicity. It was also shown that APAP-induced hepatic toxicity was not accompanied by vascular dysfunction.

Timisoara Medical Journal doi: 10.35995/tmj20220101

Authors: Aimee Rodica Chiș Paula Diana Muntean Alexandra Ioana Moatăr Cristian Oancea Octavian Marius Crețu Ioan Ovidiu Sîrbu

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused worldwide losses from all points of view. Although there are efficient vaccines against this virus, rapid detection remains essential for controlling its spread. The gold standard for the COVID-19 diagnostic is the use of quantitative real time polymerase chain reaction (RT-qPCR) from naso-/oro-pharyngeal swabs and, alternatively, saliva specimens. A faster alternative to the RT-qPCR method, the colorimetric reverse transcription loop-mediated isothermal amplification (cLAMP) has a good sensitivity and specificity and has been proposed as an efficient screening method. In this study, we analyzed several sets of LAMP primers for COVID-19 testing using purified RNA samples and raw saliva samples, and tested several reaction conditions. Our results showed that the sensitivity of cLAMP reactions on raw saliva samples can be significantly augmented by the addition of guanidine hydrochloride to levels, which allow its use for COVID-19 screening.

Timisoara Medical Journal doi: 10.35995/tmj20220102

Authors: Cătălin Vlăduț Ionuț Feier Andra Olariu Sorin Olariu

(1) Aim of the study: Our study aims to analyze the influence of biological parameters such as hemoglobin, albumin, total protein, on the management and duration of treatment of colon cancer patients who have undergone elective surgery. (2) Material and methods: Data of 147 patients from the Surgery Clinic 1 of the County Clinical Hospital of Timisoara who underwent an elective surgery for colon cancer treatment were statistically analyzed using statistical tests such as Anova or Chi square with a p < 0.05 considered to be statistically significant. (3) Results: Differences between preoperative and postoperative parameters were correlated with the duration of surgery (hemoglobin, p = 0.014). The average length of hospital stay was correlated with the difference between the preoperative and postoperative level of hemoglobin (p = 0.043). There was a direct correlation between the length of postoperative hospital stay and the difference between the plasmatic levels of albumin (p = 0.033). There were differences in the average Charlson index value of patients who required albumin, with no statistical significance. (4) Conclusions: The difference between preoperative and postoperative levels of biological parameters (hemoglobin, albumin, total protein) has an influence on the management of patients with colon cancer undergoing elective surgery, affecting the number of days the patients spend in the hospital after the surgical procedure, as well as the total number of days spent in the hospital (from day one to discharge). The greater the variation of those differences, the longer recovery period needed, showing that an early correction of those parameters can lead to a shorter hospital stay, a faster postoperative recovery and a shorter postoperative hospital stay.

Timisoara Medical Journal doi: 10.35995/tmj20210205

Authors: Cristina Pîrvu Anca Axante Cristina Preoteasa Ioanina Pârlătescu Mariana Cărămidă Daniela Pîrvu

(1) Background: Dentistry is acknowledged as being particularly physically demanding, considering access difficulty and visibility of the operating field. The issue of posture is frequently discussed in the literature due to its significant contribution in the etiology of musculoskeletal disorders, but never enough to encourage all dentists to adopt safe, healthy working positions. (2) Methods: This article presents the arguments that justify the attention needed to be paid to the balanced posture recommended to dentists and goes further and outlines a logical model that could help in maintaining a balanced posture as much as possible during the therapeutic act. Describing the balanced posture alone has a limited practical utility, and thus we have detailed the aspects that involve the spatial relationship of the doctor with the patient sitting on the dental chair. (3) Results: An optimal working distance and postural symmetry are the main objectives to be considered, each of them being conditioned by several elements. These elements have been detailed throughout the article, always taking into account the realities of the daily practice, with its challenges and limitations. (4) Conclusions: A greater attention paid to maintaining the optimal working position provides doctors the chance to perform their activity in comfortable and safe conditions.

Timisoara Medical Journal doi: 10.35995/tmj20210201

Authors: Loredana Nicoleta Ionică Raluca Șoșdean Alexandru Silvius Pescariu Cristian Mornoș Danina Mirela Muntean Adina Ionac Adrian Sturza Constantin Tudor Luca Horea Feier

Mitral valve regurgitation (MR) is the most common valvular heart disease. Diagnosing and managing mitral regurgitation is often challenging and requires a structured approach, integrating findings on history, physical examination and imaging. A common cardiac anomaly is myxomatous mitral valve prolapse. Excess myxomatous leaflet tissue, bileaflet prolapse or billowing, chordae elongation and annular dilatation are all features of Barlow’s disease. Currently, there is no successful pharmacological treatment available to prevent or slow its progression. Here, we report the case of a 30-year-old male patient, with no previous significant medical background and no medication at home, who was diagnosed with severe mitral regurgitation at a regular check-up and was admitted to our clinic with mild exertion dyspnea and fatigue. Transthoracic echocardiography showed intensely thickened mitral leaflets with a myxomatous appearance, prolapse of the middle scallop of the posterior leaflet (P2), apparently with ruptured chordae, and severe mitral regurgitation with a holosystolic eccentric jet. While oxidative stress is a central pathomechanism of cardiovascular disease, information regarding valvular oxidative stress in the literature is rather scarce. In this respect, we assessed oxidative stress through confocal microscopy in a sample of a mitral valve harvested during valvular surgery. We found an increased production of reactive oxygen species in the mitral valve sample that was alleviated after incubation with the angiotensin 2 receptor type I (AT1) antagonist irbesartan. This case is worth mentioning as a starting point for a prospective study aimed at assessing the role of valvular oxidative stress and mitochondrial dysfunction in patients with various degrees of primary and secondary mitral regurgitation.

Timisoara Medical Journal doi: 10.35995/tmj20210204

Authors: Oana Deteșan Lucia Mihaela Custură Brigitta Irén Kovács Reka Annamaria Schmiedt Mariana Cornelia Tilinca

Maturity-onset diabetes of the young (MODY) is associated with familially inherited monogenic diabetes. It is characterized by genetic mutations leading to pancreatic β-cell dysfunction and subsequent insulin production. Clinical features of MODY include young-onset hyperglycemia associated with a lack of beta cell autoimmunity or insulin resistance. Glucose-lowering agents are the main therapeutic options for MODY. In this review, we have outlined the particular aspects of the most common types of MODY in order to assist clinical practitioners in this field.

Timisoara Medical Journal doi: 10.35995/tmj20210203

Authors: Pooja Sharma Pratyaksha Raina Sachit Sharma

(1) Background: Placenta accreta spectrum (PAS) is a pathologic invasion of the placental trophoblasts to the myometrium and beyond. This study evaluates the demographic features, risk indicators, feto–maternal outcome, and treatment options in PAS women at our center. (2) Methods: This is a retrospective study carried out in 39 patients with placenta accreta spectrum in our tertiary health care center Sri Maharaja Gulab Singh (SMGS) Hospital, from July 2019 to September 2020. (3) Results: Most patients in our study were in the 30–35 years age group. The previous lower segment Caesarean section (LSCS) was the most critical risk factor for PAS in our research. Thirty-two of the women with PAS (82.05%) had undergone a hysterectomy, and eight patients did not undergo a hysterectomy. Twenty-eight patients needed Intensive Care Unit (ICU) care, 13 of them required ventilatory support, and three of them died due to hemorrhagic shock. In our study, preterm birth occurred in 26 patients (53.84%), while 21 (53.8%) required Neonatal Intensive Care Unit (NICU) admission, and six (15.4%) had early neonatal death and stillbirth. (4) Conclusion: PAS is a devastating event in women’s pregnancy. It leads to high maternal morbidity, mortality, and adverse neonatal outcome. The critical risk indicators for PAS are previous LSCS and placenta previa. Every case with these two concurrent conditions should be operated on in a planned way in the presence of senior obstetricians and of an anesthesiology team.

Timisoara Medical Journal doi: 10.35995/tmj20210202

Authors: Alexandru Popa Patricia Lupulescu Nicoleta Iacob Roxana Sirli

Gaucher Disease (GD) is a rare inherited lysosomal storage disease caused by biallelic mutations in the gene encoding the lysosomal enzyme acid β-glucocerebrosidase, with progressive accumulation of the sphingolipid glucosylceramide in the lysosomes of macrophages, mainly in the liver, spleen, bone, and bone marrow. It is characterized by anemia, thrombocytopenia, hepatosplenomegaly, sometimes severe bone involvement and, in certain forms, neurological involvement. We present the case of a 77-year-old male, diagnosed in 2006, at 63, with GD type1. At the onset, the patient presented fatigue, asthenia, upper abdominal discomfort, skin pallor and minor bone pain. During follow-up, CT was performed and displayed an enlarged spleen (25 cm) and a well-defined mass in the kidney cortex, but it could not establish whether it was malignant or not. Considering the patient refused surgery at that moment, a new CT exam was performed six months later, and the kidney tumor significantly increased in size. Nephrectomy and necessity splenectomy were performed, and recovery was uneventful. The histopathological examination revealed clear cell renal cell carcinoma, grade 2 Fuhrman. Enzyme substitution therapy with Imiglucerasum was initiated in 2012 with favorable evolution. Seven years later, during a routine ultrasound follow-up, a 4/3.8 cm hyperechoic mass was found in the eighth liver segment. The biological tests revealed a high value of alpha-fetoprotein (AFP-185.2 ng/mL). Considering the patient’s history, possible diagnoses of the newly found focal liver lesion were: gaucheroma, metastasis secondary to kidney cancer, or a primitive liver tumor. Core biopsy was performed, and it was suggestive of a poorly differentiated hepatocellular carcinoma G3. A non-anatomical resection of liver segments VII and VIII with partial resection of inferior vena cava was performed, followed by full post-operative recovery. A histopathological examination confirmed the initial diagnosis. Currently, one month postoperatively, the patient in good clinical condition, continues the enzyme replacement treatment and is undergoing oncological follow-up. We presented a complex case of GD, diagnosed at an advanced age, who responded well to substitution therapy in regard to hematologic and bone symptoms, but who unfortunately developed two types of cancer managed aggressively despite the advanced age.

Timisoara Medical Journal doi: 10.35995/tmj20210105

Authors: A.F.M. Shakilur Rahman Tamiral Jannat

(1) Purpose: The employment of platelet-rich fibrin (PRF) in the extracted teeth socket has been shown to aid tissue healing. It also minimizes detrimental consequences. The rationale of this systematic review is to observe the possible association between PRF employment and postoperative consequences following mandibular third molar surgery. (2) Materials and Methods: The following databases were explored electronically (till 28 February 2021): PubMed, Cochrane library, Embase, International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov. A manual explore was accomplished on various journals regarding the subject of oral and maxillofacial surgery. The online explore applied the keywords “platelet-rich fibrin or PRF,” and “mandibular third molar.” To review the efficiency of PRF, the accompanying post-operative consequences were collected: pain, swelling, trismus, inter-incisal distance, analgesic consumption, soft tissue healing, bone healing, socket complications, and periodontal parameters. (3) Results: Just 9 full-text studies out of 26 were comprised of review for qualitative analysis. All of the studies were randomized clinical trials (RCTs), with eight split-mouth designs and one parallel design study. Significant outcomes were usually observed for pain, postoperative swelling, mouth opening, periodontal pocket depth, soft tissue healing, and the incidence of alveolar osteitis or dry sockets, but not constantly. The qualitative scrutiny disclosed that the PRF had no considerable outcome in bone healing. (4) Conclusions: Local administration of PRF is a practical way of alleviating pain, trismus, oedema, and enhancing soft tissue healing following mandibular third molar extraction. PRF tends to have no function in bone healing following extraction. More controlled clinical trials and RCTs are necessitating exploring the end results of PRF following mandibular third molar extraction.

Timisoara Medical Journal doi: 10.35995/tmj20210104

Authors: Marius Niculescu Tiberiu Bataga Dan Anusca Manuel Sava Nicolae Gheorghiu

(1) Aim: To analyze the publication output from Romania in the Web of Science (WoS) category of orthopedics. (2) Methods: We have used the WoS Core Collection Advanced Search between 2009 and 2018. (3) Results: Under the WoS Orthopedics category in SCI-Expanded, we found 72 articles with Romania as the country of origin, representing 0.105% of the total Romanian research output. Using journal rankings, distribution by quartile was: 1–12 (16.7%), 2–33 (45.8%), 3–9 (12.5%) and 4–18 (25%). Average citations in total and per year by category were: 1–22.6 range 1–91 (2.56), 2–8.85 range 0–30 (1.64), 3–8.44 range 1–30 (1.25), and 4–4.11 range 0–16 (0.74). Thirteen articles published from 1986 to 2008 were excluded by limiting the timespan. When searching for all document types and all WoS core collection citation indexes, we found 107 items; the total citations increased from 714 to 806. (4) Conclusions: Orthopedic publications from Romania have increased in the last decade, but are still low compared to category averages; however, the bibliometric qualitative distribution and patterns mostly resemble that of comparators.

Timisoara Medical Journal doi: 10.35995/tmj20210102

Authors: Aimee Rodica Chiș Alexandra Ioana Moatăr Ioan-Ovidiu Sîrbu

This review discusses the current research data on using microRNAs as biomarkers for the diagnostics and screening of Parkinson’s Disease (PD). We provide a comprehensive, critical analysis of the overwhelmingly diverse data on circulant microRNAs associated with PD. We also highlight the possible underlying molecular pathogenesis-related circulant microRNAs in the context of the natural history of PD.

Timisoara Medical Journal doi: 10.35995/tmj20210103

Authors: Flaviu Bob

Renal elastography is a real-time ultrasound-based imaging method that can potentially be used in order to assess diffuse diseases of native kidneys. In order to find a place in the clinical practice for renal elastography, what is influencing the obtained results should be known. The kidney shear wave speed is influenced by different factors such as age, gender, measurement depth or urinary pressure. The relationship with renal function and also with renal fibrosis is different across different studies, with not all studies showing an increase in renal stiffness in more advanced renal diseases. However, the changes in renal blood flow seem to influence renal elastography, and a decrease in renal blood flow could be the cause of the decrease in the shear wave speed and could have a bigger influence on elastography compared to renal fibrosis. This paper provides a summary about the factors that seem to influence renal elastography and also regarding the limitations of this method according to the published studies thus far.

Timisoara Medical Journal doi: 10.35995/tmj20210101

Authors: Mariana Cărămidă Mihaela Adina Dumitrache Ioanina Părlătescu Cristina Pîrvu Laura Tribuș

(1) Background: Parents need an increased level of awareness regarding the role of fluoride in maintaining optimal oral health of their children. This cross-sectional study aimed to assess the level of parents’ knowledge and behavior towards fluoride administration in children. (2) Methods: an online self-administered Google Forms questionnaire was used. (3) Results: 73.97% did not administer fluoride products to their children. From 16 parents who have given their child local fluoride products, 15.06% made it on the recommendation of the dentist. In total, 71.23% did not know exactly the importance of using fluoride for optimal oral health of the child. In total, 63.01% did not know the possible side effects of excess fluoride. (4) Conclusions: The dentist has an important role to educate the parents and also their children on the appropriate use of fluoride at home and in dental offices, explaining to them the benefits it brings for optimal oral health status and to motivate patients for adequate oral hygiene, proper diet and regular check-ups.

Timisoara Medical Journal doi: 10.35995/tmj20200210

Authors: Maytham Razaq Shleghm Ion Mircioiu Valentina Anuta Constantin Mircioiu Roxana Sandulovici

The article provides an extensive analysis of the data obtained in bioequivalence studies, which can be considered for further evaluation in the development of general and individual therapeutic regimens. Concrete data obtained in two bioequivalence studies compared amiodarone formulations and included plasma levels of amiodarone and the active metabolite desethylamiodarone. The analysis included mean data and variability in plasma concentrations and pharmacokinetic parameters. In addition, a global and structural meta-analysis of the individual plasma level sets was performed. The half-life of amiodarone was not well defined and the total area below the plasma level curves was less appropriate for estimating bioequivalence.

Timisoara Medical Journal doi: 10.35995/tmj20200209

Authors: Marius Murariu Sabin Pop Sorin Olariu

(1) Background: Infection with Echinococcus granulosus is the cause of hydatid cysts located frequently in the liver and lungs, but also in the kidneys, bones, spleen, brain and muscles. Cystic echinococcosis is sometimes complicated to treat, requiring radical surgery and prolonged medication. The hydatid cyst in the retroperitoneal space is frequently asymptomatic, unless it grows and produces symptoms caused by high intracystic pressure, secondary infection, wall breaking and allergy. (2) Case Report: We present the case of a 47-year old male patient, admitted for a giant bilobed retroperitoneal hydatid cyst. Following diagnosis, the patient was operated on using an anterior midline abdominal approach. The cyst was inactivated, the contents were evacuated and the cavity was drained and cleaned by opening the cyst in the middle area and at its lower pole, respectively. Subsequently, the cyst required re-installation of the drain. The evolution of the case was finally favorable but confirmed that the postoperative evolution of large hydatid cysts can be unexpected and even followed by complications. (3) Conclusions: For the presented case, the classic surgical method was the appropriate choice, considering the large size of the hydatid cyst. Bilobed cysts and those with calcified walls may cause problems with the spontaneous closing of the remaining cavity. For complicated cysts, the treatment is radical or conservative surgery, while for uncomplicated cysts, minimally invasive treatment is an appropriate choice.

Timisoara Medical Journal doi: 10.35995/tmj20200207

Authors: Alexandra Ulici Andreea Milan Marius Mioc Roxana Ghiulai Roxana Racoviceanu Codruța Șoica

Pentacyclic triterpenes represent an important class of intensively studied substances in the past two decades due to their wide spectrum of pharmacological effects. Even though this class is being thoroughly researched for the development of new drugs, to date, no representative has qualified to become a suitable candidate for various therapies. Although a large part of past and ongoing studies focuses on triterpene chemical derivatization or formulation to increase its bioavailability, other researchers are focused on obtaining semisynthetic derivatives not necessarily with increased hydrophilicity but with a superior biological effect compared to their parent compound. The current review aims to report the biological assessment of several ring-modified pentacyclic triterpene derivative series.

Timisoara Medical Journal doi: 10.35995/tmj20200208

Authors: Mihaela-Roxana Pătruică Florica Gădălean Adrian Vlad Adrian Sturza Dragos Cătălin Jianu Lavinia Balint Silvia Ienciu Ligia Petrica Danina M. Muntean Carmen Socaciu

Chronic kidney disease (CKD) affects around 13% of the adult population, has become a considerable concern worldwide, and is characterized by inadequate renal clearance, resulting in the accumulation of various potential toxic compounds. Metabolomics, one of the many important parts of “omics” science, refers to the systematic study of metabolites in a living system and their changes because of pathophysiological and genetic modifications. The use of metabolomics in the nephrology field of research has offered a better understanding of the pathomechanisms of CKD. The most recent technologies used for the evaluation of plasma and urinary metabolites are nuclear magnetic resonance (NMR) and mass spectroscopy (MS). A major research direction of modern medicine is to develop new therapies and new biomarkers for the early diagnosis of patients with CKD. Experimental studies of renal metabolism unequivocally demonstrated that kidney function has a huge impact on several circulating metabolites. Moreover, metabolites themselves appear to have an essential role in CKD pathogenesis/complications, being recognized as potential biomarkers with prognostic, diagnostic, and therapeutic value for the disease. The present paper provides a bird’s eye view on metabolomics and a summary of the most recent studies of metabolomics carried out in patients with CKD.

Timisoara Medical Journal doi: 10.35995/tmj20200206

Authors: Ionuț Andrei Păunescu Răzvan Bardan Bogdan Petruț Ovidiu Bălăcescu Alin Cumpănaș Alis Dema Anca Marcu Cătălin Marian Edward Șeclăman Ioan Ovidiu Sîrbu

(1) Introduction: Prostate cancer is the second leading cause of cancer-related death in men in developed countries. Due to the existing biomarkers’ limitations, there is a stringent need to develop novel, better non-invasive markers for prostate cancer diagnostic and monitoring. (2) Material and methods: We assessed, by real-time PCR, the expression level of 84 long non-coding RNA (lncRNA) in plasma and the exosomes isolated from prostate cancer patients’ plasma and urine. (3) Results: Only a few lncRNAs were detected in high abundance (Ct between 25 and 30 cycles) across all sample types, the vast majority showing relatively modest levels (Ct > 30 cycles). As expected, plasma and plasma exosomes contain far more lncRNA species than urine, irrespective of whether they originate from patients or controls. We identified two statistically significant dysregulated lncRNAs in prostate cancer samples vs. controls: RBM5-AS1, 2.89 times downregulated in plasma (p = 0.036), and SNHG16, 13.69 times upregulated (p = 0.029) in urine exosomes. (4) Conclusions: These preliminary data need further validation in additional independent, more extensive studies before they can be considered as biomarkers for prostate cancer.

Timisoara Medical Journal doi: 10.35995/tmj20200205

Authors: Dan Crisan Dinu Vermesan Radu Prejbeanu Bogdan Deleanu Sorin Craioveanu

(1) Background: Meniscal lesions are one of the most prevalent pathologies in orthopedics; meniscal root tears have been recognized as a specific subset with poor mid- to long-term results after standard treatment options (observation, physical therapy, arthroscopic partial meniscectomy) and frequent progression to osteoarthritis. Meniscal root repair has emerged as a new technique with promising results. We present a case report and review the current literature regarding the diagnosis, indications to repair, current techniques, alternatives and expected outcomes. (2) Case report: A 49-year-old woman, with a body mass index of 30 and no significant comorbidities or history of trauma, involved in moderate to heavy physical activity, presented with left knee pain at the internal meniscal line, which worsened over the last 4 months, despite an intra-articular steroid shot. Based on the magnetic resonance imaging (MRI), she was diagnosed with a type 2 medial meniscus posterior root tear and moderate internal compartment chondropathy (Outerbridge 2). She underwent side-to-side repair of the meniscal lesion and reattachment of the root through a bone tunnel over a button. Postoperatively, she was non-weight-bearing (NWB) for 6 weeks and with the knee immobilized at 30° of flexion. At 6 months’ follow-up, the patient was fully ambulant without crutches, with active knee flexion between 0° and 130°. (3) Conclusion: Meniscal root repair is reasonably accessible. It may provide additional benefits over current treatment options when used judiciously and with an adequate surgical technique.

Timisoara Medical Journal doi: 10.35995/tmj20200204

Authors: Ciprian Roi Emilia Ianeș Diana Nica Alexandra Roi Laura Cristina Rusu Ioana Badea Mircea Riviș

(1) Background: Oronasal communication is described in the scientific literature as a common complication that occurs after a cleft palate surgery. In some cases, it can also be a consequence of oral surgery procedures; the main problem of this type of rare accident is related to the correct healing process and treatment option. (2) Case report: A patient with oronasal communication caused by an unsuccessful attempt of a superior canine odontectomy presented at the Emergency Department of the Oral and Maxillofacial Surgery Hospital, Timișoara. The case management is described from the first consult to one-year follow-up. We consider that this pathology was optimally treated surgically, and the results are more than satisfactory, taking into consideration the high rates of recurrence. (3) Conclusion: This case report can be a useful to a general dentist who is trying to decide whether to perform the canine odontectomy or refer to a specialist surgeon due to the accidents and complications of this procedure.

Timisoara Medical Journal doi: 10.35995/tmj20200203

Authors: Raluca Șoșdean Laurențiu Pașcalău Monica Mircea Loredana Ionică Petru Baneu Alexandru Pescariu Adrian Sturza Cristian Mornoș Sorin Pescariu

(1) Background: Complete atrioventricular block is a well-known complication of alcohol ablation as a septal reduction therapy, implemented in selected patients with hypertrophic obstructive cardiomyopathy (HOCM). It usually occurs during or immediately after the intervention. Rare cases of late complete atrioventricular block (CAVB) have been reported, but data are still scarce in the literature regarding this issue. (2) Case report: We report the case of a 70-year-old male patient, with mild aortic stenosis, but with a significantly degenerated valve and perivalvular tissue, and a nonspecific intraventricular conduction delay, which developed intensely symptomatic CAVB, four months after alcohol septal ablation (ASA) for HOCM, along with left ventricular pressure gradient recurrence. Both problems were resolved by implantation of a dual chamber pacemaker, with pacing optimization to a short atrioventricular interval, along with a maximal tolerated betablocker therapy. With the description of the patient’s treatment and evolution in comparison with other reports and studies, this case report highlights the fact that a close clinical, electrical and echocardiographic surveillance is warranted for this kind of patients, as late CAVB may be a life-threatening complication. Previous electrical conduction problems and degenerated aortic valve and perivalvular tissue may be predisposed for this type of complication, independent of betablocker therapy. This treatment has several other beneficial effects and thus it should not be interrupted after the procedure.

Timisoara Medical Journal doi: 10.35995/tmj20200201

Authors: Mihaela Adina Dumitrache Mariana Caramida Alexandra Stefania Ene Roxana Romanita Ilici

(1) Background: Parents play an important role in children’s oral health by contributing to the development of proper oral hygiene and eating behaviors as well as offering the child access to dental services. The aim of this study was the evaluation of parents’ involvement in their child’s visits to the dental office. (2) Methods: The cross-sectional study was conducted in 2020 in Romania on a sample of 105 parents using an online self-administered questionnaire. (3) Results: Only 9.52% of parents brought their children to the dental office for their first visit in their 1st year of life; 51.53% of children visit the dentist at least once a year but for only 42.86% of children, the reason of their last visit was a regular dental check-up. (4) Conclusions: parents underestimate the role of dental service utilization for their children; the first visit to the dental office for most children is at an older age than optimal, the frequency of dental visits is less than recommended, and they are treatment-oriented.

Timisoara Medical Journal doi: 10.35995/tmj20200202

Authors: Ioanina Părlătescu Radu Cazacu Șerban Țovaru

(1) Background: Oral mucosal infections are a commonly encountered clinical pathology in patients who consult dentists, mainly for dental diseases. Currently, the involvement of oral and dental infections in cardiovascular and neurological diseases, among others, is widely discussed in the literature. In the present research, we elaborated a comprehensive report on rare oral mucosal infections, including oral syphilis and head and neck tuberculosis. (2) Methods: The research was performed by the authors using three databases (PubMed, Wiley, and ScienceDirect). Scientific articles published from January 2000 to January 2020 were selected and reviewed to assess the epidemiology, symptoms, and diagnosis of oral syphilis and head and neck tuberculosis. (3) Results: Oral syphilis was mainly noticed as ulcers and secondary types of disease. Tuberculosis of the head and neck was most frequently encountered as cervical lymphadenopathy. (4) Conclusions: Rare oral infections diagnosis may be challenging due to their evolving polymorphic clinical appearance and their ability to mimic various diseases in the oral cavity and head and neck area.

Timisoara Medical Journal doi: 10.35995/tmj20200105

Authors: Laura Cotoi Daniela Amzăr Ioan Sporea Andreea Borlea Oana Schiller Adalbert Schiller Gheorghe Nicușor Pop Dana Stoian

(1) Background: Primary hyperparathyroidism is a common disorder of the parathyroid glands and the third most frequent endocrinopathy, especially among elderly women. Secondary hyperparathyroidism is a common complication of chronic kidney disease, associated with high cardiovascular morbidity and mortality. In both primary and secondary hyperparathyroidism, the need to correctly identify the parathyroid glands is mandatory for a better outcome. Elastography can be an effective tool in the diagnosis of parathyroid lesions, by differentiating possible parathyroid lesions from thyroid disease, cervical lymph nodes, and other anatomical structures. There are currently no guidelines or recommendations and no established values on the elasticity of parathyroid lesions. (2) Material and Methods: In our studies, we have evaluated, by Shear Wave elastography (SWE), both primary and secondary hyperparathyroidism, determining that parathyroid glands have a higher elasticity index than both thyroid tissue and muscle tissue. (3) Results: For primary hyperparathyroidism, we have determined, using 2D-SWE, the parathyroid adenoma tissue (mean elasticity index (EI) measured by SWE 4.74 ± 2.74 kPa) with the thyroid tissue (11.718 ± 4.206 kPa) and with the surrounding muscle tissue (16.362 ± 3.829 kPa). For secondary hyperparathyroidism, by SWE elastographic evaluation, we have found that the mean EI in the parathyroid gland was 7.83 kPa, a median value in the thyroid parenchyma of 13.76 kPa, and a mean muscle EI value at 15.78 kPa. (4) Conclusions: Elastography can be a useful tool in localizing parathyroid disease, whether primary or secondary, by correctly identifying the parathyroid tissue. We have determined that an EI below 7 kPa in SWE elastography correctly identifies parathyroid tissue in primary hyperparathyroidism, and that a cut-off value of 9.98 kPa can be used in 2D-SWE to accurately diagnose parathyroid disease in secondary hyperparathyroidism.

Timisoara Medical Journal doi: 10.35995/tmj20200111

Authors: Octavian Crețu

Editorial

Timisoara Medical Journal doi: 10.35995/tmj20200109

Authors: Dan-Bogdan Navolan Florin Gorun Cristian Oancea Ioana-Mihaela Ciohat Daniel Malița Marius Lucian Craina

(1) Background: Toxoplasma gondii and cytomegalovirus belong to a group of pathogens entities called TORCH agents. TORCH represents an acronym which derives from the name of a series of certain pathogenic agents (Toxoplasma gondii, Other agents, Rubella virus, Cytomegalovirus, Herpes virus). They could cross the placenta barrier and cause serious damage to the fetus if a primary infection occurs in a pregnant woman. Immunized women are relatively protected against a reinfection and the risk of a materno-fetal infection in these categories of pregnant women is considered low. (2) Aim of the study: To analyze changes in the percentage of pregnant women seronegative to Toxoplasma gondii and cytomegalovirus along a period of ten years, from 2008 to 2018. (3) Material and Methods: We studied the changes in percentage of seronegative Toxoplasma gondii and Cytomegalovirus pregnant women along two periods: 2008–2010 and 2015–2018. Only pregnant women with declared medium of provenience and unequivocal results were enrolled in the study. (4) Results: In urban areas, we found an increase in the percentage of pregnant women seronegative to Toxoplasma gondii (RR = 1.488, p < 0.0001), respectively to cytomegalovirus (RR = 1.985, p < 0.0001), from 2008–2010 to 2015–2018. A similar increasing trend was found also in rural areas: Toxoplasma gondii (RR = 1.136, p < 0.0322), respectively cytomegalovirus (RR = 1.088, p < 0.8265) but it did not reach a significant threshold for cytomegalovirus. (5) Conclusion: Our study showed that the percentage of women seronegative to Toxoplasma gondii and cytomegalovirus antibodies increases along a period of ten years, from 2008–2010 to 2015–2018, in both urban and rural areas. Probably, the main cause of this trend is represented by the improvement in hygienic condition and food quality control. These results present an argument for continuing the TORCH screening of pregnant women.

Timisoara Medical Journal doi: 10.35995/tmj20200110

Authors: Andreea Luciana Rață Sorin Barac Roxana Ramona Onofrei Adela Dumitrașcu Mihai Ionac

(1) Background: Both open surgery and endovascular strategies are accepted methods for the treatment of critical limb ischemia (CLI) due to superficial femoral artery disease (SFA). There is currently only one randomized trial results (BASIL-1) that compared open vs. endo procedures for SFA treatment. In this study, we wanted to compare two treatment strategies for superficial femoral artery vascular disease. (2) Material and methods: A study was conducted on 235 patients (part of a national project—“Development of the public infrastructure research and development and creation of new infrastructure”) in which the open vs. endovascular strategy was compared in patients with critical limb ischemia and SFA disease. (3) Results: Primary outcomes are the time elapsed until major events related to the index leg or death. Secondary outcomes are amputation-free survival rate, reintervention on the index leg, major cardiovascular events and postoperative complications. (4) Conclusion: After 6 months, we had an overall mortality rate of 7.23% and an amputation-free survival of 89.36%.

Timisoara Medical Journal doi: 10.35995/tmj20200108

Authors: Adrian Sturza Cătălin V. Marian Danina M. Muntean Octavian M. Crețu

The renin–angiotensin–aldosterone system (RAAS) has been recognized as a key player in the complex scenario of cardiovascular regulation. Aside from its role in the cardiovascular diseases, RAAS dysregulation has emerged as a central pathomechanism in the severe acute respiratory syndrome coronavirus 1 (SARS-CoV1) epidemic, dating back to 2002–2004, and the current COVID-19 pandemic with SARS-CoV2, with the latter involving the interaction with angiotensin-converting enzyme 2 (ACE2). ACE2 is the enzyme responsible for Ang 1-7 production that partly counteracts the RAAS effects and promotes nitric oxide synthase activation; moreover, it has also been reported to act as a receptor for both SARS viruses. In the setting of the ongoing COVID-19 pandemic, the SARS–ACE2 interaction is highly debated with respect to both viral infectivity and usage/discontinuation of RAAS medication—ACE inhibitors (ACEi) and angiotensin-receptor blockers (ARBs)—in diagnosed or suspected SARS-CoV2 patients. Since ACE inhibitors and ARBs are largely prescribed in cardiovascular pathology, a better understanding of the interaction between SARS-CoV2 and RAAS is urgently needed. In this review, we will briefly discuss the SARS-CoV2 and ACE2 interaction and why the discontinuation of RAAS medication is unsafe for either diagnosed or suspected SARS-CoV2 patients.

Timisoara Medical Journal doi: 10.35995/tmj20200107

Authors: Cristian Zaharia Roxana Oancea Alin Gabriel Gabor Meda-Lavinia Negruțiu

Restorative dentistry is based on a continuous development of materials that make the best possible connection with dental tissues. Thus, dental adhesives have been researched with increasing interest. A successful adhesive system depends very much on its chemistry, as well as on the clinical procedures that must be appropriate for that type of dental adhesive. This review presents a retrospective of dental adhesives focusing on research into new types of adhesive systems that involves the use of nanoparticles. Dental adhesive systems are used in most clinical procedures related to restorative dentistry and can be classified into “etch-and-rinse” adhesives and “self-etch” adhesives. Recently, both types of adhesive systems have been modified, being loaded with different types of nanoparticles to try to improve them in terms of the thickness of the adhesive layer, but also to induce other special qualities. Therefore, in order to avoid compromising the restorative procedures by losing the restorations or by affecting the dental pulp due to cytotoxicity, several factors must be considered in choosing the adhesive system.

Timisoara Medical Journal doi: 10.35995/tmj20200106

Authors: Dorina Coricovac Iulia Pînzaru Ștefana Avram Ioana Macașoi Codruța Șoica Cristina Dehelean

Although it recorded a breakthrough for the treatment of metastatic melanoma in the last decade, this disease remains a challenge in terms of finding an efficient treatment, reducing secondary resistance to treatment, and understanding the complexity of the molecular mechanisms involved in its development, progression and metastasis. This study aims to verify the multitarget effect of a natural compound, betulinic acid (BA), a pentacyclic triterpene, as antimelanoma agent by applying two experimental models: a human melanoma cell line—A375 and the chick chorioallantoic membrane model. The methods applied in this study were: MTT cell viability assay for cytotoxicity assessment and the chorioallantoic membrane assay (CAM) for antiangiogenic evaluation. The results indicated a significant decrease of A375 cells viability after a 72 h BA treatment even at the lowest concentration tested—1 µM (61.95% viable cells), with a calculated IC50 of 9.437 µM. In addition, BA inhibited not only the in ovo A375-induced tumor growth but also the angiogenesis on the primary site at 72 h post application. These data highlight the potential antimelanoma effect of BA by targeting the tumor cells via multiples pathways as inducing cell death and suppressing the angiogenic process, a must have for tumor development.

Timisoara Medical Journal doi: 10.35995/tmj20200104

Authors: Denisa Circioban Ionuț Ledeți Gabriela Vlase Titus Vlase Adriana Ledeți

In this paper, the acetylcholinesterase inhibitor drug tacrine was investigated by two complementary instrumental techniques, namely infrared spectroscopy and thermal analysis, as pure drug and in solid binary mixtures with nine excipients frequently used in the pharmaceutical industry, namely starch, sodium carboxymethyl cellulose, polyvinylpyrrolidone K30, fumed silica (Aerosil), talc, anhydrous lactose, magnesium stearate, mannitol and calcium lactate pentahydrate. The corroboration of obtained data by the two complementary methods confirmed the incompatibility of this drug with anhydrous lactose, mannitol, magnesium stearate and calcium lactate under both ambient conditions and thermal stress, and thermally induced interactions between tacrine and silica. In the development of new generic solid formulations, four of the investigated excipients (i.e., starch, sodium carboxymethyl cellulose, polyvinylpyrrolidone K30 and talc) can be used, since they are compatible with tacrine under ambient conditions as well as under thermal stress.

Timisoara Medical Journal doi: 10.35995/tmj20200103

Authors: Roxana Jurca Camil Mihuța Emanuela Tudorache Diana Manolescu Cristian Oancea

(1) Background: In the current clinical practice of the COVID-19 infection, the focus should not be placed on the positive RT-PCR results, but rather on the epidemiological, clinical, and imaging aspects specific to the disease. (2) Case Report: We present the case of a 34-year-old female, who had contacts with both her parents, both of whom were confirmed to have SARS-CoV-2 infection by RT-PCR testing. She presented for about one week symptoms suggestive of COVID-19 infection, determining her to repeatedly go to the emergency room, where she had three negative SARS-CoV-2 RT-PCR tests. The blood tests revealed leukopenia with lymphocytopenia, with increased lactate dehydrogenase (LDH) and C-reactive protein (CRP). Moreover, the chest X-ray showed modifications specific for COVID-19, and the diagnosis of COVID-19 was set. Drug treatment with hydroxychloroquine, azithromycin, cephalosporins, systemic corticosteroids, anticoagulants, bronchodilators, and interleukin-6 inhibitors was initiated, together with oxygen therapy. (3) Discussion: SARS-CoV-2 RT-PCR testing may give false negative results due to inadequate biological sampling, or to the accuracy of the test methods. A significant contribution to the diagnosis is made by the specific computed tomography (CT) criteria of COVID-19. (4) Conclusions: A priority for COVID-19 diagnosis accuracy is epidemiological investigation, together with clinical criteria and CT imaging, even in the presence of a negative RT-PCR test.

Timisoara Medical Journal doi: 10.35995/tmj20200102

Authors: Marius Ioniţescu Radu Prejbeanu Dinu Vermesan Jenel Marian Patrascu Roxana Onofrei Horia Haragus

(1) Background: To determine the association between patient-reported outcome measures and return to work after knee arthroscopy. (2) Material and Methods: Retrospective analysis of data on patients scheduled for knee arthroscopy in 2019 for which symptom severity was available using International Knee Documentation Committee subjective knee evaluation form (IKDC), Knee Disability And Osteoarthritis Outcome Score For Joint Replacement (KOOS JR), Tegner Lysholm scale and Euroqol EQ5D5L. Paid sick leave was retrieved from electronic patient records. (3) Results: 61 patients (mean age 46.44 ± 7.61 years, 28 (45.9%) males) met the inclusion criteria. All patients ultimately returned to work. Forty-six (75.41%) received a mean of 28.5 (range 7–68) days of paid medical leave after surgery. Of those, three patients were already on medical leave. There were no differences in demographics and clinical scores between patients who received paid sick leave and those who did not. No significant correlation was found between days of absence and clinical scores. (4) Conclusions: There was no association between absence from work and commonly used clinical scores in patients undergoing knee arthroscopy.

Timisoara Medical Journal doi: 10.35995/tmj20200101

Authors: Bogdan Timar Adina Braha Lucica Grigorică Laura Gaiță Romulus Timar

The prevention of heart failure (HF) development in patients with diabetes mellitus (DM) represents one of the greatest challenges to date. Several studies have shown that targeting a very strict HbA1c does not reduce cardiovascular risk in type 2 diabetes (T2D) patients, concluding that there are additional factors that contribute to the risk of HF, as well as mechanisms possibly related to the therapeutic agents used to lower glycemic values. All these findings led to the reconsideration of T2D management. SGLT2 inhibitors (SGLT2i), a new generation of antihyperglycemic drugs, have gained the attention of cardiologists, since they proved cardioprotective effects by reducing three-point major adverse cardiovascular events (MACE) and heart failure hospitalizations in T2D patients. The mechanisms underlying the cardiovascular protection of SGLT2 inhibitors in T2D are complex and multifactorial, but not fully understood. This review discusses the onset and prognosis of heart failure in T2D patients treated with SGLT2 inhibitors.