Background and Objectives: A magnetic resonance imaging (MRI) scan is part of the diagnostic prot... more Background and Objectives: A magnetic resonance imaging (MRI) scan is part of the diagnostic protocol in pituitary adenoma patients. The goal of the present study is to present and analyse the MRI appearances of the sphenoid sinus (SS) in patients with non-functioning pituitary adenoma (NFPA). Materials and Methods: This is a retrospective case-control study conducted between January 2015 and December 2023 in a tertiary referral hospital. Forty NFPA patients were included in the study group, while the control group consisted of 30 age-and gender-matched cases. Results: The sellar type of SS pneumatization was the most frequently encountered pattern among both groups. The presence of the lateral recess of the SS, mucosal cysts, and sphenoethmoidal cells was similar in both patient groups. The proportion of patients with SS mucosal thickness greater than 3 mm was 42.5% in NFPA group and 3% in the control group, and this difference was statistically significant (p < 0.001). The space between the two optic nerves was significantly larger in the NFPA group as compared to the control group (p < 0.001). Conclusions: Our study was able to establish a statistically significant association between the presence of NFPA and both the thickening of the SS mucosa and increased space between optic nerves.
Background: Leadership represents a mixture of traits, qualities and behaviors that enable the pa... more Background: Leadership represents a mixture of traits, qualities and behaviors that enable the participation, development, and commitment of the followers in the organization. Dental practitioners, due to the nature of their practice, are expected to have knowledge of practice management and to become effective leaders of their teams. Purpose: This research aims to provide an overview of the research documenting leadership perceptions, behaviors and practices in oral healthcare. Moreover, it is also aimed to document potential barriers leadership imposes to dentists, and the types of leadership training offered in dental education. Methodology: Three databases (PubMed, ScienceDirect and Scopus) were searched by using the syntax: (leadership AND dentistry) OR (leadership AND dentists) OR (leadership AND dental practice) OR (leadership AND oral health). 880 articles were initially identified. 260 articles remained after applying the inclusion criteria: (1) research documenting leadership in dentistry, (2) written in English, (3) published in peer-reviewed journals, (4) access to full electronic text, ( ) full text available. 199 articles remained after scanning for duplicates, out of which 123 were original research. After scanning them by the title, abstract and keywords, 11 articles were found relevant, and were included for the final analysis. Results: Leadership was studied from the perspectives of dental practitioners, dental academia, dental leaders and dental students. Leadership and leadership training were perceived important across all groups. Perceived indicators of leadership included being recognized as an expert, teaching and research activities, and being involved in policy. Clinical, transformational, and entrepreneurial leadership definitions were given. Leadership practices were related to practice management, dental organizations and activities in the community. Leadership behaviors included teamwork, conflict management, shared decision-making processes and staff engagement. The main barriers to leadership for dentists were lack of training, money, time constraints, family obligations, and government reforms. All groups advocated for incorporating leadership training in dental education. Discussion: To the best of the researcher's knowledge, this is the first systematic review on leadership in dentistry. Different dimensions of leadership occur at each stage of professional development. Dentists need to be aware of leadership practices and behaviors so that they could effectively manage their practice, and achieve high quality care for their patients. However, all dental professionals agreed that leadership was important in dentistry and that training can help dentists become effective leaders.
Background: Wound healing of the nasal mucosa after endoscopic sinus surgery (ESS) is frequently ... more Background: Wound healing of the nasal mucosa after endoscopic sinus surgery (ESS) is frequently complicated by scaring and consequently recurrences are encountered. Methods of optimizing results have been sought. In the present study we evaluated the effects of a powerful antioxidant, astaxanthin, on nasal mucosa healing after surgery, comparing it to the extensively studied properties of dexamethasone. Materials and Methods: 63 Wistar rats were used. The nasal mucosa from one side was damaged employing the brushing method. They were randomly divided into three experimental groups, one treated with astaxanthin, the second treated with dexamethasone and the third one acted as the control and was given normal saline. The rats were killed on days 5, 14 and 28 following injury. We observed the temporal evolution of the wound healing process and quantified the results by assessing four parameters: the epithelial thickness index (ETI), the subepithelial thickness index (STI), the goblet cell count and the subepithelial fibrosis index (SFI). Results: At 28 days, the ETI was significantly lower in the astaxanthin group (p < 0.05) compared to the other two groups. The STI was also lower in the astaxanthin group (p < 0.05), but comparable to the dexamethasone group at 28 days. The goblet cell count was higher in the astaxanthin group. The SFI had similar results in both dexamethasone and astaxanthin groups, with lower values compared to the control group. In the astaxanthin group there was no synechia formation. Conclusion: Astaxanthin given in the post injury period significantly decreases fibrosis, inhibits synechia development and significantly decreases subepithelial fibrosis. Moreover, it has no general or local toxic effects.
Background and aim. Dental care usually faces the traditional doctor-patient relationship, accord... more Background and aim. Dental care usually faces the traditional doctor-patient relationship, according to which the doctor does not seek feedback and patients feel uncomfortable when being involved in the healthcare process. The current study aims at analyzing patients' attitudes and knowledge about dental care and asses the level of communication between them and their dentists. Methods. A series of telephone interviews (N=40) were applied to patients in the city of Cluj-Napoca in order to identify attitudes and knowledge about dental care. The interview guide was applied separately to each respondent and each interview was audio recorded with the verbal consent of the respondent. The data collected was assessed and we performed thematic analysis on the provided answers. Results. When asked about the dentist's attitude during the consultation, the respondents reported only positive attitudes. The majority of the respondents stated that the communication with their dentist was an efficient and professional one, focused on their dental problems. When asked if they understood the verbal and written information received from the dentist, the majority of respondents said they understood the information without any problems. Identifying the patients' health literacy about dental services leads to better communication between dentist and patient, which is essential for establishing a quality management system in dentistry. Effective communication leads to a high level of patient involvement.
Hemorrhagic or ischemic pituitary apoplexy is a rare neuro-endocrine emergency, potentially leadi... more Hemorrhagic or ischemic pituitary apoplexy is a rare neuro-endocrine emergency, potentially leading to coma. Neuro-ophthalmic symptoms or complications are amongst the most prevalent clinical features at onset, especially in previously asymptomatic patients. Usually, permanent pituitary insuffi ciency of various degrees follows, implying long-term hormone substitutive therapy. Rarely, the association of pituitary apoplexy with diabetes insipidus has been noticed. We report the case of a young, apparently healthy 32-yearold man presenting with thunderclap headache, fever, optic chiasm compression, central diabetes insipidus and central thyro-gonadic insuffi ciency. Magnetic resonance imaging and neurosurgery revealed a clinically non-functioning macro-adenoma developing pituitary hemorrhage. One year after the apoplectic episode, complete recovery of diabetes insipidus and pituitary function was confi rmed.
The aim of the present study is to evaluate the presence of biofilms in patients with chronic rhi... more The aim of the present study is to evaluate the presence of biofilms in patients with chronic rhinosinusitis (CRS), with or without nasal polyps, and their relationship to eosinophils and plasma cells. We compared the results with those obtained in nonCRS patients. Methods. A total of 50 patients were included in the study, 30 CRSwNP patients, 10 CRSsNP cases and 10 control patients who were operated for deviated septum. Biofilm detection was performed by means of H&E staining and SEM. Eosinophil and plasma cell values were recorded and compared between groups. Results. Biofilms were identified in 30 patients (60%), 76.6% (23 out of 30) of the CRSwNP patients, 70% (7 out of 10) of the CRSsNP patients and none of the septoplasty patients. Eosinophil and plasma cell values were more elevated in CRS patients, being strongly correlated to biofilm presence and nasal polyposis. Biofilm presence was demonstrated in many of the CRS patients, with no evidence in the control cases. Our study findings indicate that inflammatory cell counts are higher in patients with CRS compared to controls, but also more elevated in patients with polyposis. In biofilm-positive patients, eosinophil and plasma cell counts were greater than those in patients without biofilms, demonstrating the proinflammatory action of the biofilm in the sino-nasal pathology.
Background and Objectives: Chronic rhinosinusitis with nasal polyps (CRwNP) has multiple clinical... more Background and Objectives: Chronic rhinosinusitis with nasal polyps (CRwNP) has multiple clinical presentations, and predictors of successful treatment are correlated to different parameters. Differentially expressed microRNAs in nasal polyps emerge as possible facilitators of precise endotyping in this disease. We aimed to evaluate the correlation between the clinical parameters of CRSwNP and two different microRNAs. Materials and Methods: The expression of miR-125b and miR-203a-3p in nasal polyps (n = 86) and normal nasal mucosa (n = 20) was determined through microarray analysis. Preoperative workup included CT scan, nasal endoscopy, blood tests, symptoms and depression questionnaires. Results: MiR-125b showed significant overexpression in NP compared to the normal nasal mucosa. miR-125b expression levels were positively and significantly correlated with blood eosinophilia (p = 0.018) and nasal endoscopy score (p = 0.021). Although high CT scores were related to miR-125b overexpression, the correlation did not reach statistical significance. miR-203a-3p was underexpressed in nasal polyps and was significantly underexpressed in CRSwNP patients with environmental allergies. Conclusions: Both miR-125b and miR-203a-3p are potential biomarkers in CRSwNP. miR-125b also correlates with the clinical picture, while miR-203a-3p could help identify an associated allergy.
Objective: The aim of this study was to discuss the presenting signs and symptoms important for t... more Objective: The aim of this study was to discuss the presenting signs and symptoms important for the early diagnosis and to review the medical and surgical management of patients presenting with intracranial complications of sinusitis. Methods: Retrospective review of the medical records of all patients admitted with intracranial infections between 1990 and 1999 at the Department of Otolaryngology, Department of Neurosurgery and Department of Infectious Diseases, University of Cluj, Romania. Results: Sixteen patients had 23 intracranial complications of sinusitis. These were meningitis (6 cases), frontal lobe abscess (6 cases), epidural abscess (5 cases), subdural abscess (4 cases), and cavernous sinus thrombophlebitis (2 cases). In almost all patients, early symptoms included headache and fever. Clinical diagnosis was confirmed by imaging. Management of these infections included intravenous broad-spectrum antibiotics, appropriate neurosurgical and sinus drainage. Among these patients, there was one death and 4 patients developed significant neurologic sequelae. Poor prognosis was associated with the presence of subdural abscess and a prolonged time interval between the onset of symptoms and the beginning of treatment. Conclusion: Early diagnosis of intracranial complication of sinusitis can reduce morbidity and mortality associated with these complications.
Chronic rhinosinusitis (CRS) is one of the most common chronic medical conditions worldwide, affe... more Chronic rhinosinusitis (CRS) is one of the most common chronic medical conditions worldwide, affecting all age groups. Its estimated incidence is 12.3% in the USA, 10.9% in Europe and 13% in China . CRS is also a condition leading to a significant decrease in the quality of life of patients . It has been demonstrated that CRS had a greater effect on social function that ischemic heart disease or chronic heart failure . Furthermore, it is documented that CRS is also an economic burden for society. It is estimated that in the USA, the direct costs associated with CRS are approximately USD 10-13 billion per year . Moreover, indirect costs of CRS are due to missed workdays, absenteeism and productivity loss, and are estimated to exceed USD 20 billion per year in the USA . It is well acknowledged that the Journal of Clinical Medicine (JCM) publishes well-performed basic research and well-conducted clinical studies. As a result of a demanding peer-review process and careful selection process, relevant articles to an extensive readership are issued regularly in the journal. The special issue of JCM, entitled Prevention, Diagnosis and Management of Chronic Rhinosinusitis exemplifies the attempt to deliver high-quality topics relevant for both clinicians and researchers. Staphylococcus aureus is one of the bacteria commonly found in CRS patients, and S. aureus biofilms are frequently associated with recalcitrant or recurrent disease . It has been demonstrated that S. aureus is able to penetrate the barrier of the columnar epithelium of the paranasal sinuses, thus enhancing the inflammatory process . In this issue of JCM, Hu et al. studied the effects of sub-inhibitory clindamycin and azithromycin on the production of S. aureus exoproteins and the ensuing effect of decreasing inflammation, epithelial barrier disruption and invasion. The study was performed on primary human nasal epithelial cells (HNECs) from patients undertaking endoscopic skull base techniques without clinical or radiological evidence of CRS. This study emphasizes that S. aureus exoproteins induce severe cytotoxicity and interrupt the mucosal barrier, upsetting its function and decreasing inflammation. The authors demonstrated that sub-inhibitory clindamycin successfully blocked S. aureus exoprotein production, subsequently preventing toxicity, reversing the damaging effects on the mucosal barrier architecture and function and modulating its pro-inflammatory features. To a lesser degree, sub-inhibitory azithromycin had comparable effects on these actions. Moreover, the authors demonstrated that subinhibitory clindamycin or azithromycin was able to considerably decrease the S. aureus biofilm protein assembly. S. aureus treated with clindamycin-but not azithromycin-no longer display an invasive ability on HNECs. This study has important clinical consequences, as these antibiotics might decrease inflammation associated with S. aureus biofilm exoproteins. Understanding the CRS pathophysiology may offer better diagnostic techniques and permit the development of new treatment strategies. The contribution of nitric oxide (NO) in CRS is discussed in the current literature . Vlad et al. [15] assessed the arginase (ARG) expression in the mucosa of CRS patients. Increased ARG concentration can decrease NO levels by lessening the accessibility of its precursor, L-arginine.
COVID-19-associated coinfections increase the patient’s risk of developing a severe form of the d... more COVID-19-associated coinfections increase the patient’s risk of developing a severe form of the disease and, consequently, the risk of death. The term “flurona” was proposed to describe the coinfection of the influenza virus and SARS-CoV-2. This report is about a case of a 7-month-old female infant who died due to flurona coinfection. A histopathological exam showed activation of microglia (becoming CD45 positive), bronchial inflammation, diffuse alveolar damage in proliferative phase with vasculitis, a peribronchial infiltrate that was predominantly CD20-positive, and a vascular wall infiltrate that was predominantly CD3-positive. The aggressiveness of the two respiratory viruses added up and they caused extensive lung inflammation, which led to respiratory failure, multiple organ failure, and death. Tissues injuries caused by both the influenza virus and SARS-CoV-2 could be observed, without the ability to certify the dominance of the aggression of one of the two viruses.
Background: The Delta variant (Pango lineage B.1.617.2) is one of the most significant and aggres... more Background: The Delta variant (Pango lineage B.1.617.2) is one of the most significant and aggressive variants of SARS-CoV-2. To the best of our knowledge, this is the first paper specifically studying pulmonary morphopathology in COVID-19 caused by the B.1.617.2 Delta variant. Methods: The study included 10 deceased patients (40-83 years) with the COVID-19 Delta variant. The necrotic lung fragments were obtained either by biopsy (six cases) or autopsy (four cases). Tissue samples were subjected to virology analysis for identification of the SARS-CoV-2 variant, histopathology, and immunohistochemistry (anti-SARS coronavirus mouse anti-virus antibody). Results: Virology analysis identified B.1.617.2 through genetic sequencing in eight cases, and in two cases, specific mutations of B.1.617.2 were identified. Macroscopically, in all autopsied cases, the lung had a particular appearance, purple in color, with increased consistency on palpation and abolished crepitations. Histopathologic...
Review for "Effect of the povidone iodine, hypertonic alkaline solution and saline nasal lavage on nasopharyngeal viral load in <scp>COVID</scp> ‐19
Acute esophageal necrosis is a rare condition, characterized by a distinctive endoscopic/necropsi... more Acute esophageal necrosis is a rare condition, characterized by a distinctive endoscopic/necropsic image–circumferential black area of the esophagus. This paper presents a case of a 78-year-old patient with recent history of a severe form of COVID-19 (2 months previously), with multiple comorbidities, which presents sudden death in hospital. Anatomic-pathological autopsy showed extensive esophageal necrosis, pulmonary thromboses, and coronarian and aortic atherosclerosis. The histopathological examination revealed necrosis of the esophageal mucosa and phlegmonous inflammation extended to the mediastinum, chronic pneumonia with pulmonary fibrosis, viral myocarditis, papillary muscle necrosis, and pericoronary neuritis. Thromboses and necroses were identified also in the liver, pancreas, and adrenal glands. Post-COVID-19 thromboses can manifest late, affecting various vascular territories, including esophageal ones. Their clinical picture may be diminished or absent in elderly and/or ...
Background: Odontogenic sinusitis (ODS) is frequently encountered in ENT practice; however, there... more Background: Odontogenic sinusitis (ODS) is frequently encountered in ENT practice; however, there are no guidelines regarding its management. This study aims to analyse the results of endoscopic sinus surgery versus dental treatment in ODS. Additionally, we aim to demonstrate the benefit of associating endoscopic sinus surgery (ESS) to surgical closure of chronic oroantral fistulas (OAF) by comparing mean time to healing in patients who opted or not for concurrent ESS. Methods: Records of patients with ODS were reviewed. Group one consisted of patients with ODS caused by periapical pathology undergoing either endoscopic sinus surgery (ESS) or dental treatment. Resolution of ODS was considered treatment success and was compared between the two treatment strategies. Group two included patients with ODS and associated chronic oroantral communication. Time to healing was compared between patients undergoing OAF closure alone versus patients receiving associated ESS, using the Log-Rank t...
Objectives. The involvement of bacterial biofilms in the pathophysiology of chronic rhinosinusiti... more Objectives. The involvement of bacterial biofilms in the pathophysiology of chronic rhinosinusitis (CRS) is intensively debated, despite the acknowledgement of their negative impact on postoperative evolution of the disease. This study aimed to evaluate the relationship between bacterial biofilms and inflammatory infiltrate of sinus mucosa, and the influence of comorbidities on biofilm development. Materials and methods. The study comprised 50 CRS patients, treated by endoscopic surgery. For biofilm identification and inflammatory infiltrate evaluation, sinus mucosa samples were taken during surgical intervention and studied by haematoxylin-eosin and toluidine blue staining. Results. Biofilms were present in 34 patients (68%). Among them, 22 patients displayed an abundant inflammatory infiltrate of the sinus mucosa, this association being statistically significant (p < 0.001). Biofilm development was also significantly associated with the following comorbidities: bronchial asthma (p = 0.006) and atopic background (p < 0.001). Conclusions. Bacterial biofilms were significantly associated with an abundant inflammatory infiltrate of the sinus mucosa, demonstrating an intensive local inflammatory response. Among the comorbidities frequently associated with CRS, bronchial asthma and atopic background proved a significant increase in the odds of biofilm development.
Background: Establishing the diagnosis of COVID-19 and Pneumocystisjirovecii pulmonary coinfectio... more Background: Establishing the diagnosis of COVID-19 and Pneumocystisjirovecii pulmonary coinfection is difficult due to clinical and radiological similarities that exist between the two disorders. For the moment, fungal coinfections are underestimated in COVID-19 patients. Case presentation: We report the case of a 52-year-old male patient, who presented to the emergency department for severe dyspnea and died 17 h later. The RT-PCR test performed at his admission was negative for SARS-CoV-2. Retesting of lung fragments collected during autopsy revealed a positive result for SARS-CoV-2. Histopathological examination showed preexisting lesions, due to comorbidities, as well as recent lesions: massive lung thromboses, alveolar exudate rich in foam cells, suprapleural and intra-alveolar Pneumocystisjirovecii cystic forms, and bilateral adrenal hemorrhage. Conclusion: COVID-19 and P.jirovecii coinfection should be considered, particularly in critically ill patients, and we recommend the s...
Personalized medicine has the potential to improve our ability to maintain health and treat disea... more Personalized medicine has the potential to improve our ability to maintain health and treat disease, while ameliorating continuously rising healthcare costs. Translation of basic research findings to clinical applications within regulatory compliance is required for personalized medicine to become the new foundation for practice of medicine. Deploying even a few of the thousands of potential diagnostic biomarkers identified each year as part of personalized treatment workflows requires clinically efficient biosensor technologies to monitor multiple biomarkers in patients in real time. This paper discusses a critical component of a regulatory system, a microcavity optical biosensor for label-free monitoring of biomolecular interactions at physiologically-relevant concentrations. While most current biosensor research focuses on improving sensitivity, this paper emphasizes other characteristics a biosensor technology requires to be practical in a clinical setting, presenting robust microcavity biosensors which are easy to manufacture and integrate with microfluidics into flexible and redesignable platforms making the microcavity biosensors deployable for continuous monitoring of biomarkers in body fluids in the clinic, in dense 2D random arrays for high-throughput applications like drug-library screening in interactomics, and of the secretory behavior of single cells in the laboratory.
Uploads
Papers by Silviu Albu