Medicine and Pharmacy Reports最新文献

Congenital adrenal hyperplasia (CAH) is determined in the vast majority of cases by mutations in the CYP21A2 gene, which cause the deficiency of the 21 hydroxylase enzyme, which is involved in the synthesis of cortisol and aldosterone. Generally, CAH phenotype and disease severity can be predicted with the genotypes and is related to the residual activity of 21 hydroxylase enzyme. It is divided into classical CAH with salt wasting and simple virilizing forms and non-classical or late-onset CAH forms, respectively. Patients with 21 hydroxylase deficiency, including those with non-classic forms face immense challenges to their fertility. Glucocorticoid therapy has been shown to be useful in obtaining and maintaining a pregnancy among these patients, but it must be used with caution. Given the relevance of CAH in reproductive medicine as well as the diagnostic challenges posed by the phenotypic overlap with polycystic ovary syndrome and by overlap of its own phenotypes (classic CAH-nonclassic CAH), we present the case of a woman with CAH due to 21 hydroxylase deficiency caused by the P30L mutation with a clinical and biochemical presentation between the non-classical form and the classic simple virilizing form. Further, the successful fertility management in this patient and an overview of fertility management in CAH is depicted, as well.

Background and aims: Bruxism is associated with a variety of factors, some of which are oral (occlusion, joint, face shape) while others are of a systemic nature (respiratory, cardiac, neurotransmitters, stress). The relationship between bruxism and occlusion has received great attention, but it still has a lot of ambiguity. This study aimed at investigating the parameters that may affect bruxism: dental interferences or premature contacts, vicious habits, temporomandibular joint (TMJ) pain, TMJ noises, TMJ morning fatigue, snoring, obstructive sleep apnea, which may occur before bruxism, or because of chronic parafunction.

Methods: We conducted an observational, analytical case-control study to determine the association between bruxism and oral cavity factors as well as general factors. Participants were chosen from a group of middle-aged Romanian population. An online questionnaire was used for data collection. A total of one hundred subjects were included in the sample. Fifty cases with bruxism were chosen as a study group, and another fifty persons of similar ages were chosen as a control group. Statistical analysis was performed using the MedCalc version 20.110 software.

Results: The study comprised subjects between 18 and 42 years old. The most prevalent age range was between 20-25 years. The female-male ratio was almost similar; 62% of the participants had sleep bruxism, 10% had awake bruxism and 28% had a combined form. The arithmetic means of the daily stress levels for both research groups' scores were 3.0 for the bruxism group and 3.24 for the control group, while the work stress was 3.04 for the bruxism group and 3.41 for the control group. Dental interferences or premature contacts, vicious habits, TMJ pain, TMJ noises, TMJ morning fatigue, snoring, and obstructive sleep apnea were evaluated. The majority of subjects received an oral splint (n=26).

Conclusions: Bruxism was associated with stress, occlusal parameters (premature contacts and occlusion interferences), and joint pathologies. Bruxism was not found to be positively correlated with obstructive sleep apnea syndrome. There was a moderately significant association between bruxism and snoring. There was no evidence of an association between bruxism and vicious habits, dental aesthetics, or obstructive sleep apnea. Treatment significantly improved the quality of life, the masticatory and joint functions.

Background and aims: Breast cancer (BC) is the most frequently diagnosed cancer and the leading cause of cancer-related death among women worldwide. For locally advanced diseases and high-risk tumors, neoadjuvant therapy (NAT) is the treatment of choice. Some studies show that mammographic density (MD) tumor margins and the presence of microcalcifications play a prognostic role in BC patients. Hence, the objective of this retrospective study was to assess if MD could predict the response to NAT among different molecular subtypes of BC patients undergoing NAT at The "Prof. Dr I. Chiricuta" Oncology Institute of Cluj-Napoca, Romania (IOCN). Furthermore, the association between MD, tumor margins and the presence of microcalcifications with clinico-pathological data was analyzed.

Methods: Eighty-four breast cancer patients diagnosed and treated at IOCN were included in this study. The morphological characteristics of the tumors were framed according to the BIRADS lexicon. The presence or absence of microcalcifications was also assessed. First, the significance of associations between breast density, margins and microcalcifications and clinico-pathological parameters of the patients were tested with Fisher or Fisher-Freeman-Halton Exact Test. Next, using multinomial logistic regression, we modelled the associations between the pathological response measured by Miller Payne and Residual cancer burden (RCB) systems and the BI-RADS. Variables having significant univariate tests were selected as candidates for the multivariable analysis (adjusted model).

Results: Breast densities were significantly associated with the age of the patients (p=0.01), number of positive lymph nodes (p=0.037), margins (p=0.002) and combined categories of Miller-Payne (p=0.034) and RCB pathological response (p=0.021). Margins was significantly associated with ki67 proliferation index (p=0.029), estrogen receptor (ER) (p=0.007), progesterone receptor (PR) (p=0.019), molecular subtype (p<0.001) and the number of clinically observed positive lymph nodes at diagnosis (p=0.019).

Conclusions: In our cohort, BC patients with lower MD had higher odds of achieving pCR following NAT, suggesting the role of MD as a clinical prognostic marker. Larger multicenter studies are warranted to validate the prognostic value of MD, which could aid in patients stratification based on their likelihood to respond to NAT.