Digestive involvement in Long- COVID syndrome

Background and aim. The SARS-CoV-2 infection which caused a worldwide epidemic was considered first a lung disease. Later on, it was found that the disease caused by this virus, SARS-CoV-2, can affect most organs, including the digestive system. The long-term effects of this infection are now progressively detected and called Long-COVID. This review aims is to present the updated knowledge of the digestive sequelae after SARS-CoV-2 infection. Methods. A search was performed in the main medical literature databases. The following search terms were used: long-covid, gastrointestinal or gastric sequelae SARS-CoV-2 and COVID-19. Data on gastrointestinal symptoms after 12 weeks were collected and presented. Observational studies were included. Studies that focus only on acute COVID-19 infection (<4 weeks) were excluded. Results. The main symptoms that can occur in the long term are: diarrhea, nausea, vomiting, abdominal pain, along with increased liver enzymes. Patients with chronic diseases have a higher risk of developing long-term sequelae, but it is not documented that digestive sequelae are influenced by the presence of chronic diseases. Conclusions. The SARS-CoV-2 virus can affect any part of the digestive system not only in the acute infection phase but also for longer time, leaving long-term sequelae.

Medicine and Pharmacy in the works of Dante Alighieri (1265-1321)

The 700th commemorative year of Dante’s death began on 25 March 2021, the day of the Annunciation of the Lord, of the creation of the world, the New Year’s Day in old Florence according to ab Incarnatione. On 25 March 2021, Holy Father Francis published the apostolic letter Candor Lucis Aeternae solemnly uniting the voice of the catholic church with the chorus of all the ones honoring the memory of the illustrious poet Dante Alighieri. In professional fraternity the voices of the guild colleagues join in, physicians and pharmacists, descendants of those in Arte dei Medici e degli Speziali, which proudly included among their members Dante Alighieri, at the crossing between the 13th and 14th centuries.

The use of digital dental photography in an Eastern European country

Aims. To assess the use of digital photography in dentistry and its relation with the professional experience of the dental practitioners in Romania. Methods. An anonymous questionnaire including eight questions was distributed online to collect information on the use of dental photography. Results. 84.84% of the respondents were using a photographic equipment in their clinical practice. Regarding the type of photographic equipment used, 51.79% of the participants indicated DSLR cameras, 44.05% smartphones, 2.38% compact cameras and 1.78% other devices for taking clinical images. There was a significant association (p<0.05) between the experience of the practitioners and the use of dental photography, type of equipment and protocol used. Conclusions. Respondents with more than 10 years of experience were more likely to use digital photography in their practice than those with less experience. Most of the digital photography users with more than 10 years of experience were taking images with a DSLR Camera (65.52%) followed by 31.04% smartphone users. Conversely, 56.42% of the clinical photography users with less than 5 years of experience mainly preferred a smartphone device and 41.02% a DSLR Camera.

Effect of micro osteo-perforations (MOP) on the rate of tooth movement and levels of interleukin-1β - a split mouth study

Introduction. Various procedures are available today to enhance tooth movement, with relative success rates, one among them being Micro Osteo Perforation (MOP). Our aim is to assess the rate of tooth movement and interleukin 1β levels in gingival crevicular fluid levels (GCF)after MOPs. Methodology. A group of 22 patients were selected, who required first premolars extraction and were designated for the split mouth study with equal allocation. MOP was performed on the right side, three vertical MOPs were given using 1.2 X 8 mm mini implants with the gap of 2 mm between them and surgical depth of the implant insertion was 5 mm. The left side was used as control. The individual canine retraction was initiated with placement of 150 grams on 19*25 SS wire. The case was evaluated at different timelines for canine retraction and Interleukin 1β levels. Results. There was a significant difference in the rate of canine movement at 45 days (1.42 mm) and end of canine retraction on experimental side(2.61 mm). The GCF levels were raised at T1 and T2 intervals on the side of MOP and were statically significant (p=0.00). Conclusion. MOP is a minimally invasive procedure which accelerates the tooth movement by 20%. The increase in IL 1βlevels indicates a higher rate of chemical interaction on the surgically assisted side. For enhanced efficiency MOPs should be repeated every 6-8 weeks.

Bilateral ectopic third molar in the maxillary sinuses associated with dentigerous cyst: a case report

A dentigerous cyst is an epithelial-lined odontogenic cyst formed by an accumulation of fluid between the reduced enamel epithelium and the crown of an unerupted tooth. About 70% of dentigerous cysts occur in the mandible and 30% in the maxilla and the most involved teeth are maxillary canines and maxillary third molar. Dentigerous cysts often displace the related tooth into an ectopic position. In the maxilla when the cyst expands into the sinus, usually causes total or partial occupation of the sinus cavity and can extend to the nose. We report a rare case of a 24-year-old female with bilateral maxillary third molars inside the maxillary sinuses attached to a dentigerous cyst and treated with a minimally invasive endoscopic surgery through the middle meatal meatotomy.

Combined conservative treatment of a recurrent mandibular keratocyst by enucleation, diode laser, 5-Fluorouracil and dental implants: a case report with 18 years-follow up

In 2017, the World Health Organization classified the odontogenic keratocyst as a developmental odontogenic cyst. The posterior parts of the mandible, especially the angle and the ramus, are the most involved sites. Due to their high recurrence rate, keratocysts are managed surgically with careful complete excision. Additionally, chemical solutions such as Carnoy's solution, modified Carnoy's solution, and 5-Fluorouracil have been associated with surgical treatment. Diode lasers generate diverse wavelengths that have photothermal and photochemical special properties and could have some effects on the lining epithelium remnants of the cyst. In this paper, we discuss a case of mandibular recurrent odontogenic keratocyst treated with 5-Fluorouracil topical application after enucleation and diode laser application with 18 years follow-up and teeth replacement with dental implant. 5-Fluorouracil and diode laser have been found to be very effective in the treatment of keratocysts.

The role of thrombocytapheresis in the management of extreme thrombocytosis: a 6 years’ experience from a tertiary care center

Background. According to the American Society for Apheresis (ASFA) guidelines, thrombocytapheresis is a Category II indication in symptomatic patients and is a Category III indication when used as secondary or prophylactic treatment. The role of thrombocytapheresis is to prevent untoward complications that might occur even before the cytoreductive agents can exert their action. Methods. A retrospective analysis of patients who underwent thrombocytapheresis between 2012 to 2018 was conducted. Demographic details, complete blood counts, diagnosis and indication for thrombocytapheresis were noted. Results. A total of 12 patients with thrombocytosis were included in the study. The cause of thrombocytosis was primary in 3 (25%) patients and secondary in 9 (75%) patients. The average percentage reduction in platelet count was 47.1% (range 12.3%-65.64%). There was a significant decrease in platelet count, platelet crit, and mean platelet volume after the procedure when compared to pre-procedure. Conclusion. Thrombocytapheresis selectively reduces platelet counts with no effect on other cellular and plasma components. The role of thrombocytapheresis in extreme thrombocytosis is to be considered for an immediate decrease in platelet count and to minimize the risks associated with thrombocytosis.

Implants displaced into the maxillary sinus, an endoscopic approach - a report of two cases

Accidental implant displacement into the maxillary sinuses and accompanying complications are well documented in the literature. Two surgical approaches have been suggested to remove the displaced implants and to handle the related complications: an intraoral approach and the nasal endoscopy. The intraoral approach is preferred in cases of absence of local infection, ostium obstruction, and oroantral communication needing to be closed. The nasal approach, besides retrieval of displaced implants, allows the treatment of any associated pathology and reestablishment of the mucociliary clearance as well as the natural ventilation through the ostium. This article reports two clinical cases of implant displacement in the maxillary sinus treated with a nasal endoscopy through the middle meatal meatotomy. This article reports two clinical cases of implant displacement in the maxillary sinus treated with a nasal endoscopy through the middle meatal meatotomy. Implants accidentally displaced can be avoided by a proper exploration of the preoperative x-ray, selecting an appropriate treatment plan, and esteeming the surgical skills. The most appropriate approach to handle these complications is close cooperation between oral surgeons and otolaryngologists.

Survery of healthcare professionals to assess the awareness, knowledge and self-reported behavior regarding recent fluoroquinolones safety issues

Background and aims. The impact of fluoroquinolone (FQ)-induced long-lasting, disabling, and potentially irreversible serious adverse drug reactions (ADRs) on the overall benefit-risk balance and the need for adequate risk minimization measures has been recently assessed. The present study aims to evaluate physicians and pharmacists' awareness and knowledge of the recent safety issues communicated through a direct healthcare professional communication (DHPC), regarding FQs, at a national level, in Romania, as well as healthcare professionals (HPs) self-reported behavior regarding the management of the risk. Methods. Cross-sectional, online survey study, conducted in Romania. Results. A total of 127 participants responded to the survey. Six (4.7%) were physicians and 121 (95.3%) were pharmacists. The predominant age was 31-40 years (N=52, 40.9%), and most respondents were females (N=117, 92.1%). A majority of 101 (79.5%) were reportedly aware of the existence of the new safety issues associated with FQs, and slightly less were aware of the DHPC (N=86, 67.7%) issued in 2019. In terms of knowledge, slightly more than half of the respondents had correctly selected the responses regarding key safety messages on most important ADRs and restrictions / cautions for use. The impact of the communication on HPs self-reported behavior was high or very high in almost half of the participants (N=63, 49.6%). Conclusions. A high percentage of participants were aware of the FQ-associated safety concerns. Knowledge was relatively good for the key safety concerns among HPs. A notable impact on behavior was observed, mostly in terms of counselling of the patient and disseminating the information to colleagues.

Application of Design of Expert software for evaluating the influence of formulation variables on the encapsulation efficacy, drug content and particle size of PEO-PPO-PEO/Poly(DL-lactide-co-caprolactone) nanoparticles as carriers for SN-38

Background and aims. Hydrophobic substances are mainly encapsulated into polymer nanocarriers in order to improve their solubility, enable their administration, at the same time to empower targeted tissue or cell specific delivery of the drug using the encapsulating vehicle as targeting and controlled release platform. 7-Ethyl-10-hydroxycamptothecin (SN-38) is an active metabolite of Irinotecan, showing 100- fold to 1000-fold higher effect than Irinotecan, but its clinical use is limited because of its extreme hydrophobicity, as it is practically insoluble in most physiologically compatible and pharmaceutically acceptable solvents. Method. In order to fully exploit the potential of the nanoprecipitation as a method for preparation of Poly(DL-lactide-co-caprolactone)- poly(ethylene oxide) - poly(propylene oxide) - poly(ethylene oxide) (P(DL)LCL/PEO-PPO-PEO) nanoparticles and evaluate the influence of the polymer P(DL)LCL, stabilizing agent PEO-PPO-PEO copolymer (Lutrol F127) and the drug concentration (SN-38) upon drug entrapment efficiency, size and drug content, a D-optimal experimental design for response surface using Design Expert Version 9.0.4.1. software investigation was created and statistically analyzed. Results. We have observed that at higher SN-38 concentration during the preparation procedure (nanoprecipitation, solvent diffusion method), and due to its extremely low water solubility, the drug will start to precipitate as unprotected crystals at a faster pace compared to polymer aggregation, leading to extremely low encapsulation efficacy and waste of the active compound. The most desirable combination of factor settings are SN-38=0.5 mg, Polymer=5mg and F127=4%. Conclusion. This investigation utilizes the design of experiment approach and extends the primary understanding of impact of formulation development of P(DL)LCL/PEO-PPO-PEO nanoparticles as carriers for SN-38.