Rare Iatrogenic Oronasal Communication after Superior Canine Odontectomy Attempt

(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.

Late Complications after Alcohol Septal Ablation in a Patient with Hypertrophic Obstructive Cardiomyopathy

(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.

Rare Infections of the Oral Mucosa

(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.

Parents’ Involvement in Children’s Dental Services Utilization

(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.

Parathyroid Elastography―Elastography Evaluation Algorithm

(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.

Increase in Percentage of Seronegative Toxoplasma gondii and Cytomegalovirus in Pregnant Women: An Improvement in Hygienic Conditions in Certain Areas?

(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.

Dealing with Superficial Femoral Artery Disease: An Ongoing Debate—Open vs. Endovascular Treatment—Preliminary Results

(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%.

Angiotensin-Converting-Enzyme 2 and SARS-CoV2: A Dangerous Liaison

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.

In Vitro and In Ovo Assessment of Betulinic Acid Antimelanoma Effect

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.