Timisoara Medical Journal

(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. Full article

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. Full article

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. Full article

(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. Full article

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. Full article