COVID-19-Associated Rhinocerebral Mucormycosis, an Incidental Finding or a Matter of Concern - Mixed-Method Systematic Review.

With the advent of COVID-19, the number of patients diagnosed with mucormycosis has increased, especially in developing countries. The reason behind this increase is that COVID-19 causes hypoxia that promotes the growth of fungus. To identify the association between mucormycosis and COVID-19, in critically ill or immunocompromised COVID-19 patients. The literature included in the review was researched from October 1, 2021, to November 1, 2022, by using the Google Scholar database as the search engine. Of the 20 articles included, there were 4 case reports, 2 case series, 10 narrative reviews, and 4 quantitative studies. Mucormycetes growth is caused by several factors, including hyperglycemia owing to previously existing diabetes or excessive use of steroids, increased ferritin levels owing to the inflammatory cascade initiated by COVID-19, and immunosuppression caused by the use of steroids or other immunosuppressive therapy. Reduced white-cell count and activity in COVID-19 leads to increased germination of fungal spores hence developing a catastrophic picture of rhinocerebral mucormycosis. Considering that the hematological patient is frequently treated with cortisone, immunosuppressed due to the underlying condition, but also through the administered therapy, the association with a possible diabetes makes this patient susceptible to developing rhinocerebral mucormycosis during COVID-19 infection. Despite being severe, the association between mucormycosis and COVID-19 is specific and treatable. Development of mucormycosis in hematological patients suffering from severe COVID-19 disease is dangerous, yet not compulsory and can be prevented. Using a common steroid-dose protocol with hyperbaric oxygen and necessary preventive measure reveals the disease as a superadded infection. Hypoxia, poor glycemic control and overuse of steroids or immunosuppressive drugs cause it.

Immunotherapy Combined with Radiation in Malignant Melanoma without BRAF Mutations Brain Metastases-Favorable Response after Immunotherapy Continued beyond Progression.

We present the case of a patient who was diagnosed in 2018 with nodular Malignant Melanoma (MM) without BRAF V 600 mutations stage 3 C (pT4b pN1a M0), and who underwent adjuvant citokines treatment with Interferon alpha 2b-48 weeks. Immunotherapy was initiated in January 2021 for lung and lymph node metastases. In June 2021, there was a partial response of the lung and lymph node metastases, but there was also progression to brain metastases. Immunotherapy was continued and Whole Brain Radiotherapy (WBRT) was performed. In September 2023, the imaging investigations revealed a favorable response, with no lesions suggestive of secondary determinations. The combination of Radiotherapy (RT) and Immunotherapy (IT) with Immune Checkpoint Inhibitors (ICI) has an abscopal effect. There is a coordinated action in the combination of RT and IT in order to obtain a common result, with the antitumor effect being greater than if RT or IT acted separately.

Importance of radiological examination in the evaluation of canal fillings performed with bioceramic sealers.

Bioceramic-based fillers have been evaluated in several in vitro studies but in vivo studies are still limited. The present study examined 36 postoperative radiographic analyses that were divided into four groups, of which three used bioceramic-based fillers, namely Total Fill, BioRoot RCS and Biodentine, while the fourth group was used as control and implemented the resin-based AH Plus Jet sealer. The present results did not indicate significant differences in radiopacity between sealers at a certain level of obturation. Biodentine-based fillers have a radiodensity close to that of dentin, which makes it difficult for the physician to radiologically assess the correctness of the canal filling.

Materials for ossicular chain reconstruction: History and evolution (Review).

The middle ear represents the anatomic space between the external auditory canal and the inner ear (Cochlea). It is comprised of the tympanic membrane, the ossicular chain [malleus (hammer), incus (anvil) and stapes (stirrup)] with the corresponding muscles and ligaments and the cavity of the middle ear. The main function of the middle ear is to convey vibratory energy (sound pressure) from the air to the cochlear fluids of the internal ear via the ossicular chain. Tympanoplasty represents a number of procedures used to re-establish the continuity of sound transmission from the tympanic membrane to the inner ear. Ever since the beginning of otologic surgery, various materials have been tested for ossicular chain reconstruction (OCR). The present review aimed to present, in a chronological sequence, the evolution of knowledge regarding this field of medicine, and to also discuss the advantages and disadvantages of different materials and designs of ossicular prostheses. The constant search for more efficient, easily tolerated and lighter materials has improved the acoustic rehabilitation process and has markedly reduced the rate of functional failure of these small prostheses.

Clinical Features and Paraclinical Findings in Patients with SARS CoV-2 Pneumonia and the Impact of Pulmonary Rehabilitation on the Instrumental Activities of Daily Living in POST-COVID-19 Patients.

The functional sequelae grouped under the name "long COVID" most often bring the patient in front of a team of specialists in pulmonary rehabilitation. The aim of this study was to evaluate clinical features and paraclinical findings in patients with SARS CoV-2 (Severe Acute Respiratory Syndrome-Corona Virus-2) pneumonia and to also evaluate the impact of rehabilitation in this category of patients. This study included 106 patients diagnosed with SARS CoV-2. The division of the patients into two groups was performed based on the presence of SAR-CoV-2 pneumonia. Clinical symptoms, biochemical parameters, and pulmonary functional and radiological examinations were recorded and analyzed. The Lawton Instrumental Activities of Daily Living (IADL) scale was applied to all patients. Patients in group I were included in the pulmonary rehabilitation program. Among demographic characteristics, age over 50 years (50.9%; p = 0.027) and the female sex (66%; p = 0.042) were risk factors for pneumonia in patients with SARS CoV-2. Over 90% of the 26 patients included in the rehabilitation program were less able to feed, bathe, dress, and walk. After 2 weeks, approximately 50% of patients were able to eat, wash, and dress. It is important to provide longer rehabilitation programs in cases of moderate, severe, and very severe COVID-19 patients, in order to significantly improve patients' participation in daily activities and their quality of life.

Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review.

BACKGROUND: Hemorrhoidal disease (HD) is considered a low-severity pathology by both general population and physicians, but the lengthy conservative therapy and postoperative complications suggest otherwise. AIM: To assess the effectiveness of different treatment options, both conservative and surgical, in contrast with some preexisting comorbidities. METHODS: We conducted a retrospective, 10-yearlong study between January 2011 and December 2021 in two surgical centers, a private and a state-owned hospital. We compared the efficacy and safety of several treatment options, such as open hemorrhoidectomy, stapled hemorrhoidopexy, rubber band ligation and infrared coagulation in terms of complication rates and types and their correlation with different preexisting comorbidities such as inflammatory bowel disease (IBD), use of anticoagulant medication (AM) and liver cirrhosis. We also conducted a 20-years long PubMed research (1.263 articles) for relevant comparisons. RESULTS: Our study recorded 10940 patients with HD, 10241 with conservative and 699 with surgical treatment. Out of these, the male-to-female ratio of 1.3, and a peak in age distribution between 59 and 68 years old (32% of patients). For the entire study, we recorded a 90% incidence of immediate pain, immediate bleeding in 1.5% (11 cases), delayed bleeding in 1.0% (7 cases), and 0.6% surgical site infections. Urinary retention was also present, with 0.2% of patients, anal stricture in 1% and fecal incontinence for 0.5% of patients (4 cases). We recorded no severe complications such as Fournier`s gangrene or rectovaginal perforations. IBD accounted for 6% of the patients, with ulcerative colitis in 12% and Chron`s disease in 10.5%. 6.6% of the patients had AM, determining 4% immediate and 2% delayed bleeding, in surgically treated patients. CONCLUSION: Our study determined that most common complications (pain, urinary retention, bleeding, and stricture) are correlated with each surgical technique and pre-existing comorbidities.

Clinical, histopathological and immunohistochemical changes of the superficial marginal periodontium caused by orthodontic treatment with fixed metallic orthodontic appliances.

Malocclusions negatively influence dental function, physical well-being, and quality of life. According to data provided by the World Health Organization (WHO), malocclusions represent the third most widespread oral health problem, after dental caries and periodontal diseases. In recent years, more and more people call for orthodontic treatment with fixed braces that aim at establishing a dental, aesthetic, and functional balance, compatible with a normal life. Our study assessed the histopathological and immunohistochemical changes that occurred in superficial marginal periodontal components, in a number of 23 patients diagnosed with malocclusions, as a result of orthodontic treatment with fixed metal braces. The purpose of the study was to evaluate the remodeling of the tissues in the superficial periodontium during orthodontic migration, microscopic aspects that are essential to evaluate the effectiveness of the orthodontic treatment.

Rare Gene Mutations in Romanian Hypoacusis Patients: Case Series and a Review of the Literature.

(1) Background: In this paper, we report on three cases of hypoacusis as part of a complex phenotype and some rare gene variants. An extensive review of literature completes the newly reported clinical and genetic information. (2) Methods: The cases range from 2- to 11-year-old boys, all with a complex clinical picture and hearing impairment. In all cases, whole exome sequencing (WES) was performed, in the first case in association with mitochondrial DNA study. (3) Results: The detected variants were: two heterozygous variants in the TWNK gene, one likely pathogenic and another of uncertain clinical significance (autosomal recessive mitochondrial DNA depletion syndrome type 7-hepatocerebral type); heterozygous variants of uncertain significance PACS2 and SYT2 genes (autosomal dominant early infantile epileptic encephalopathy) and a homozygous variant of uncertain significance in SUCLG1 gene (mitochondrial DNA depletion syndrome 9). Some of these genes have never been previously reported as associated with hearing problems. (4) Conclusions: Our cases bring new insights into some rare genetic syndromes. Although the role of TWNK gene in hearing impairment is clear and accordingly reflected in published literature as well as in the present article, for the presented gene variants, a correlation to hearing problems could not yet be established and requires more scientific data. We consider that further studies are necessary for a better understanding of the role of these variants.

Post Placement and Restoration of Endodontically Treated Canines: A Finite Element Analysis Study.

The purpose of this study was to show the improved outcomes of restoring endodontically treated teeth with fiberglass posts compared to restorations using metal posts. In our study, we used the Finite Element Method (FEM), which is based on the principle that a physical model that supports a given load distributes the stress throughout its volume. We sought to assess what stress results in a tooth when it is restored using a fiberglass post compared to restoration using a metal post. The finite element analysis showed that a system consisting of a tooth with a fiberglass post is more stable in terms of the maximum stress than a system consisting of a tooth with a metal post. The maximum displacements and deformations were obtained in the case of a canine restored with a fiberglass post, which showed that this system had a high elasticity, therefore, higher strength than a canine restored with a metal post, which had high rigidity.

Some Manifestations of Tuberculosis in Otorhinolaryngology - Case Series and a Short Review of Related Data from South-Eastern Europe.

Tuberculosis is a disease of global outreach that may affect the entire human body but is most commonly located in the lungs. Otorhinolaryngological manifestations of tuberculosis are rare, mostly occurring secondary to pulmonary disease but nevertheless represent significant diagnostic challenges. Nasopharyngeal tuberculosis is rare, representing around 1% of all upper air-way localizations and the most common presentation is in the form of adenoids. Tuberculous glossitis (oral tuberculosis) is even scarcer and may present in various clinical forms, usually mimicking a malignant neoplasm, or, less often, trauma or other infectious lesions. Oropharynx tuberculosis is usually misdiagnosed as hypertrophic chronic tonsillitis. We present four rare cases of ENT tuberculosis, primary adenoiditis and tonsillitis in a 13-year-old girl, a curious case of tuberculous glossitis in a 65-year-old woman, clinically diagnosed as a lingual neoplasm and two cases of tuberculous lymphadenopathy uncommonly located in the submandibular and supraclavicular regions. A comprehensive review of literature follows the case presentations. Tuberculous manifestation in the ear, nose and throat area remains a difficult diagnosis to establish, particularly because of its rarity and non-specific clinical appearance, and should be included in the differential diagnosis of pharynx lesions. An early diagnosis is essential to avoid occurrence of complications.

Modeling and Simulating an Orthodontic System Using Virtual Methods.

Cone beam computed tomography (CBCT) is a modern imaging technique that uses X-rays to investigate the structures of the dento-maxillary apparatus and obtain detailed images of those structures. The aim of this study was to determine a functional mathematical model able to evaluate the elastic force intensity on each bracket and tube type element and the ways in which those components act on the orthodontic system being used. To analyze a real orthodontic system, we studied the case of a 13-year-old female patient. To transfer geometric information from tomographic images, we used the InVesalius software. This software can generate three-dimensional reconstructions based on sequences and files in the DICOM format and was purchased from CBCT equipment. We analyzed and processed the geometries of the converted tissues in InVesalius using the Geomagic software. After using the Geomagic software, we exported the resulting model to the SolidWorks software used in computer-aided design. In this software, the model is transformed into a virtual solid. After making the geometric model, we analyzed the model using the Ansys Workbench software, which incorporates finite element analysis techniques. Following the simulations, we obtained result maps, which showed the complete mechanical behavior of the analyzed structures.

Rare and unusual benign tumors of the sinonasal tract and pharynx: Case series and literature review.

There are a number of benign tumors of the nose and pharynx that are seldomly reported in literature but that can sometimes prove difficult to treat and extremely important for differential diagnosis. The present study presents cases of rare benign tumors localized in the pharynx, nasal and sinus cavities, as well as reviews of literature and historical references for each type of tumor. Unilateral nasal hemangioma in a 72-year-old male which, although not a rare pathology, raised problems due to auto-resection of the tumor. The surgeon was able to pull it out with ease without bleeding; it is possible that the mass would have eventually fallen out. Pilomatrixoma is a relatively uncommon ectodermal benign tumor of the skin derived from hair matrix cells. Surgical resection is curative but recurrence is possible (≤5% risk). The presented case is of a 26-year-old female with a pilomatrixoma of the left cheek who, for aesthetic reasons, refused a classical external surgical approach. Trans-oral resection was performed, which proved feasible but laborious and prone to recurrence. Inverted Schneiderian papilloma is a rare benign tumor of the nasal and sinus cavities with increased potential for invasion, recurrence and malignant transformation compared with other types of papilloma and other benign tumors of the area. The tumor represents 0.5-4.0% of all nasal tumors and has been described under different names, such as villiform cancer and cylindrical/transitional papilloma. The present study reports a rare case of bilateral papilloma in a 68-year-old male. He presented with bilateral evolving nasal obstruction and hyposmia. Following surgery, the patient was treated by a multidisciplinary team and followed by a respiratory rehabilitation program.

Analysis of long-term anatomic results of radical mastoidectomy.

A long-term, retrospective, non-controlled study was performed on the drainage results of mastoidectomy (both radical and modified radical) and the relevant statistical factors that could influence the anatomic outcome were defined. The present study took into consideration the same cohort of 200 patients we have communicated with before in our previous studies concerning the long-term functional results of mastoidectomy and long-term results of ossicular replacement with biovitroceramic prosthesis. The patients were clinically followed for the same period of 8.12 years. The drainage (anatomic) results, similar to previously published functional results, were defined by analytical function of the severity and the period of evolution of disease. The main goal was to define the situations and factors (presence of complications, type of disease, type of tympanic perforation or status of ossicular chain) that influenced the drainage results that could provide us with some type of anatomical prognosis. The follow-up started at the moment of complete epithelization for each cavity as time represents the main study comparison criteria. Drainage failure was assessed by the number of otorrhea episodes. It was concluded that practically and ideally, a maximum of 84% of the mastoid and petrous cells can be cleaned out. The results of 78% drainage success are congruent to this theory. The remaining 16% of cells may contain irreversible lesions.

Analysis of long-term functional results of radical mastoidectomy.

We performed a long-term, retrospective, non-controlled study on the functional results of mastoidectomy (both radical and modified radical) and defined the relevant statistical factors that may influence the hearing outcome. In a cohort of 200 patients, we performed both radical and modified radical mastoidectomy (MRM) and followed them clinically for a period of 8.12 years. The functional results were defined by the analytical function of the severity and the period of evolution of the disease. These parameters were defined by assessing the pre-operative absolute hearing threshold (AHT), bone conduction threshold (BCT) and age of the patient at the moment of the operation. The two parameters evolved inversely proportional to the functional results and represented a complete and precise analytical tool. The global average hearing gain ratio was 32% and the ratio for unmodified pre-operative hearing (status quo ante) was 61%. With favorable prognostic factors, the average gain rate was 56% and the hearing-loss rate was 5% (1-dB SPL nominal value). The maximum ratio for gain was 81% and for hearing loss this was 0%.

Prevalence of GJB2 gene mutations correlated to presence of clinical and environmental risk factors in the etiology of congenital sensorineural hearing loss of the Romanian population.

Although etiologically heterogeneous at least 50% of all early on-set hearing losses have a genetic cause and of these, the large majority, 75-80% are most probably autosomal recessive and 70% are non-syndromic. The rest of the congenital hearing losses are determined by clinical and environmental factors such as ototoxic medication, prematurity, and complications at birth. During the last decade it became clear that 50-80% of all such afflictions result from mutations in a single gene, GJB2, which encodes the protein Connexin 26. In order to, at least partially clarify this problem, especially in an emerging country such as Romania, where the problem is not studied adequately, we developed a comprehensive study of genetic, clinical and environmental risk factors for congenital hearing loss. The two most common variations of this gene, 35delG and W24X in children with positive diagnosis of bilateral severe to profound sensorineural hearing loss were investigated. A cohort of 34 children (20 female and 14 male), ages between 2 and 10 (mean age 4.62 years), coming from 33 non-related families were evaluated. All cases were diagnosed with severe or profound bilateral congenital SNHL. A statistical comparison of genetic and environmental/clinical prevalence was also attempted since the presence of a genetic disorder cannot rule out the role of other documented risk factors in the etiology of SNHL. The results showed that, 29.4% of cases (10/34) were homozygotic for the 35delG mutation 35delG/35delG), also known as genotype Δ/Δ. 5.88% of cases (2/34) belong to the heterozygotic bi-genic group 35delG/W24X. The clinical factors with high statistical significance for SNHL in a non-genetic group have no significance for genetic SNHL patients. Thus, the present study confirms the relatively high prevalence of the 35delG and W24X mutations in cases of congenital non-syndromic severe of profound bilateral SNHL.

Long-term histological results of ossicular chain reconstruction using bioceramic implants.

Middle ear problems are addressed using tympanoplasty, which requires a mobile tympanic membrane and secure sound-conducting mechanism. The present is a long-term, retrospective, non-controlled study on the results of ossiculoplasty using bioceramic implants of autochthonous origin and which defined the statistical relevant factors that could influence the rate of implant rejection. In a cohort of 108 patients ossiculoplasties with bioceramic implants were performed and patients were followed up clinically for a period of minimum 7 years. Several factors were identified that could influence the results of the implantation and the statistical correlations were studied. The rejection rate after 9.12 years was 21% (23 patients). Histological integration rate was 79% (85 patients), similar to results reported in literature for both bioceramic and titanium implants. Hydroxyapatite has many of the ideal characteristics required to be a good prosthesis with a high degree of biocompatibility, very low extrusion rate, low risk of disease transmission and good functional results. Although perhaps considered of historical interest, bioceramic implants are cheaper and can be produced locally, which is a great advantage for struggling economies.

Evaluation of Vibrant® Soundbridge™ positioning and results with laser doppler vibrometry and the finite element model.

The etiology of hearing loss originates from genetic factors and includes several other events including infections, working or living environment, as well as several endocrine and metabolic disorders. The Vibrant® Soundbridge™ (VSB) is an implantable hearing aid whose floating mass transducer (FMT) is attached to the long process of the incus. The device is used for pure sensorineural hearing loss with an intact middle ear. Variations in the manner of attachment may occur. Knowledge of the impact of such variations on the overall device performance may guide towards optimal transducer attachment during surgery. A mechanical modelling of the ear was first reported by von Békésy and indicated that the tympanic membrane (TM) moves as a stiff plate, and that the mallear and incudal ligaments act as a rotation axis for the ossicular chain at low frequencies. Experimental investigations and simulations with the model yield the same main results. The first fitting situation, where the FMT floats freely in the middle ear, provides by far the worst possible results. Contact to the stapes supra-structure of the FMT is necessary for optimal performance of the FMT. The mastoid specimen preserves its acoustic properties that have been shown to be similar to those in the vital human ear, under these conditions. Properly coupling the electromagnetic transducer to the ossicles can be difficult and it requires a certain degree of experience. A finite-element model (FEM) is useful for functional evaluation of the VSB since it enables easy modelling of the complicated middle ear structures and simulation of their dynamic behavior which makes it easy to understand it in detail without experiments.

Feasibility Study of a Mechanical Real-Time Feedback System for Optimizing the Sound Transfer in the Reconstructed Middle Ear.

OBJECTIVE: To evaluate electromechanical excitation as an alternative excitation mode for middle ear transfer function (METF) measurements as well as real-time feedback in prosthetic ossicular reconstruction. METHOD: In eight human cadaveric temporal bones, the ossicular chain was excited using acoustic and mechanical (floating mass transducer, FMT) stimulation to determine the METF. After disconnecting the ossicular chain and reconstruction with partial or total prosthesis the METFs were measured again. Continuous FMT stimulation was then applied to improve the prosthesis' position using real-time feedback of the METF. RESULTS: Mechanical stimulation of ossicular vibration showed characteristic differences to acoustic excitation resulting from the force characteristics of the FMT. Furthermore, the interspecimen METF variability was greater with electromechanical than acoustic stimulation because of interspecimen variability in the FMT coupling conditions. When the METF with FMT excitation was used as a real-time feedback tool, a measurable improvement in the quality of ossicular reconstruction could be achieved. CONCLUSIONS: Mechanical excitation is an effective and suitable alternative stimulation method in experimental METF measurements. The system provides real-time feedback for ossicular reconstruction in the experimental setting. Some influencing factors still need to be distinguished for reliable measurements. However, the method does not yet meet the requirements for clinical application as an intraoperative, real-time monitoring tool. However, the system could be an excellent model for high-end cadaveric temporal bone training in ossiculoplasty.