Persistent Depressive Disorder: the Clinical Approach of the Patient Associating Depression and Dental Pathology - Case Report and Clinical Considerations

Growing research literature has documented an increased association between depression and dental problems. Patients with severe dental problems suffer from psychosocial consequences, distress and psychiatric problems.AIM: To emphasize the relationship between resistant depression and poor dental health.METHOD:  This case report demonstrates the association between resistant depression and poor dental health in a 46-year-old female patient. Scores on clinical assessment measures suggested clinically severe levels of anxiety, worry, stigmatization, depression, sleeping and eating disorders and decreased satisfaction in quality of life at the beginning of the intervention. The theoretical rationale and treatment implications are presented.RESULTS: The scores on all these measures improved at the end of the dental interventions and no intense remaining depressive symptoms were reported afterward. Increased scores on life satisfaction and quality of life were documented as well. This case illustrates the potential benefit of dental treatment associating psychiatric treatment. A definitively positive association exists between poor dental health and depression. Once simultaneous treatment is initiated, there are chances for patients to have a positive evolution and social reinsertion.CONCLUSION: The high occurrence of depression, anxiety and stress among patients with dental problems highlights the importance of providing support programs and implementing preventive measures to anticipate and help persons with this type of pathology, particularly those who are most susceptible to higher levels of these psychological conditions.</p

Diabetes mellitus and necrotizing fasciitis – a deadly combination; case report

Necrotizing fasciitis is a rapidly destructive affliction of soft tissues, with a mortality rate that may reach 73% of the cases. It is characterized by a progressive inflammation and extended necrosis of the subcutaneous tissue and the fascia. Necrotizing fasciitis was first described in 1848, and later in 1920 Meleney identified 20 patients in China in which the infection was presumably triggered by hemolytic streptococcus, linking pathological bacteria to the condition. In 1952, Wilson coined the term necrotizing fasciitis although without successfully identifying the specific pathological bacteria involved. In most cases, both risk and aggravating factors are present, the main risk factors being diabetes mellitus, liver cirrhosis, renal failure, and immunosuppressant states. Location may vary, but most frequently the disease occurs in the limbs, the trunk, and the perineum. Treatment depends on the location and the time of diagnosis and may range from large incisions with extensive debridement to organ amputations such as those of the limbs or breasts. Treatment is complex and expensive, and besides surgery, includes the administration of broad-spectrum antibiotics, anti-inflammatory drugs, intensive therapy support, and long-term hospitalizations. The prognosis is guarded. The present case entails a 56-year old female patient who presented with many risk factors favoring the occurrence of necrotizing fasciitis, namely diabetes mellitus, liver cirrhosis (decompensated with ascites and portal encephalopathy phenomena), untreated hepatitis B infection, chronic renal failure with diabetic nephrotic syndrome, and obesity

Diabetes mellitus and necrotizing fasciitis – a deadly combination; case report

Necrotizing fasciitis is a rapidly destructive affliction of soft tissues, with a mortality rate that may reach 73% of the cases. It is characterized by a progressive inflammation and extended necrosis of the subcutaneous tissue and the fascia. Necrotizing fasciitis was first described in 1848, and later in 1920 Meleney identified 20 patients in China in which the infection was presumably triggered by hemolytic streptococcus, linking pathological bacteria to the condition. In 1952, Wilson coined the term necrotizing fasciitis although without successfully identifying the specific pathological bacteria involved. In most cases, both risk and aggravating factors are present, the main risk factors being diabetes mellitus, liver cirrhosis, renal failure, and immunosuppressant states. Location may vary, but most frequently the disease occurs in the limbs, the trunk, and the perineum. Treatment depends on the location and the time of diagnosis and may range from large incisions with extensive debridement to organ amputations such as those of the limbs or breasts. Treatment is complex and expensive, and besides surgery, includes the administration of broad-spectrum antibiotics, anti-inflammatory drugs, intensive therapy support, and long-term hospitalizations. The prognosis is guarded. The present case entails a 56-year old female patient who presented with many risk factors favoring the occurrence of necrotizing fasciitis, namely diabetes mellitus, liver cirrhosis (decompensated with ascites and portal encephalopathy phenomena), untreated hepatitis B infection, chronic renal failure with diabetic nephrotic syndrome, and obesity

The use of NDYAG laser combined with pulsed light in the treatment of rosacea

Rosacea is a chronic inflammatory skin disease with a complex pathogenesis that mainly affects the central part of the face, with a global incidence of 5.46%. The present study was performed on a group of 68 patients with rosacea 1 and 2 subtypes, patients between 34-63 years old. The treatments were performed using a Cutera Xeo laser, using 2 types of probes: NdYag 1064nm for telangiectasias and LimeLight 520-1100nm for diffuse facial erythema, papules, and pustules, having an 10x30mm window. For patients with diffuse facial erythema, etc., the optimal number of sessions was between 3 and 6 with or without anesthetic cream, using energies between 14-19J / cm. The average recovery time was 5 days. Registered effects included bruises, pustules, burning sensation, transient stinging, and hypopigmentation. For patients with telangiectasia, the optimal number of sessions was two, performed at an average interval of once per month/ monthly

Anxio-depressive disorders in a pandemic context: A comparative analysis: year 2019 versus 2020

The outbreak of SARS-CoV-2 pandemic has resulted in increased rates of anxiety and depression worldwide. Objective. To comparatively evaluate factors associated with the psychological impact of Coronavirus disease between 2019 and the pandemic year 2020. Materials and Methods. The study was performed on a group of 3224 patients, of which 197 were hospitalized, selected from Jan 1st 2019 until 30th Dec 2020 in a tertiary care center for psychiatric disorders. Data were collected from the observation charts. Results. The incidence of anxiety disorders is higher in the age range 40-70 years with an average value of 53 years old. In 2019, a third of patients (29,45%) had alcohol-related conditions and developed anxiety-depressive disorder. In 2020, the percentage was lower (9.38%), but also the number of admitted patients significantly decreased (p<0.0001). There were not found significant differences in age, gender or environment. Hypnotic disorders were more predominant in 2019 (54.6% vs 37.5%, p=0.01), whereas in 2020 anxiety and agitation increased significantly (34.4% vs 84.38%, p=0.0001). Relapses were similarly frequent in both years, in half of the cases. Conclusions. Coronavirus pandemic lead to a decrease in both presentations and admission to hospital. Although there were not found significant differences in age or gender, more patients from urban environment were admitted, which can have several explanations. Anxiety and agitation became the main reason for hospitalization in 2020

Surgical, Dermatological and Morphopathological Considerations in the Diagnosis and Treatment of Cutaneous Lymphoproliferative Tumors, Primary CD4+

Primary cutaneous lymphomas are a heterogeneous group of T-cell (CTCL) and B-cell lymphomas (CBCL) developing in the skin and without signs of extracutaneous disease at the time of diagnosis. The term &ldquo;primary small/medium CD4+ T-cell lymphoma&rdquo; was changed to &ldquo;primary small/medium cutaneous CD4+ lymphoproliferative disorder&rdquo; due to its indolent clinical behavior and uncertain malignant potential. This paper presents a rare case of primary cutaneous lymphoma with small to medium CD4+ T-cells. A 37-year-old patient presented with a tumor in the frontal region that had occurred approximately 8&ndash;9 months earlier. The tumor had a diameter of about 8&ndash;9 mm, well demarcated macroscopically, it was round in shape, about 6&ndash;7 mm high, pink in color, firm in consistency and painless during palpation. Surgical excision of the tumor was performed with a margin of safety of 8 mm and deep to the level of the frontal muscle fascia. The histopathological examination supported the diagnosis of cutaneous lymphoproliferation with a nodular disposition in the reticular dermis and extension around the follicular epithelia and sweat glands, composed mainly of dispersed medium-large lymphocytes. Additional immunohistochemical examination was requested. Immunohistochemical examination confirmed the diagnosis of &ldquo;primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder.&rdquo; Patient monitoring was carried out through clinical dermatological controls at 3, 6, and 12 months. After one year, a cranio-cerebral MRI was performed. For the following 5 years, an annual dermatological examination accompanied by cranio-cerebral MRI, blood count, and pulmonary X-ray were recommended. Similarly to all solitary skin lesions, the prognosis is excellent in this case, the only treatment being surgical excision

Clinical Study of Serum Serotonin as a Screening Marker for Anxiety and Depression in Patients with Type 2 Diabetes

Over time, studies have shown the importance of determining serotonin levels to diagnose somatic and psychiatric disorders. There are theoretical premises and practical ways to achieve a subtle correlation between the existence of comorbid psychiatric disorders and somatic diseases caused by the changes observed in serotonin levels. The present study, classified as retrospective and quantitative, provides evidence for determining the serotonin levels in patients with diabetes and anxiety or depression. A total of 48 patients with diabetes type 2 were enrolled in the study. Blood glucose level, glycated haemoglobin, and serum serotonin were noted, and they completed Hamilton A and Beck Depression Inventory questionnaires. We found robust correlations between serum serotonin and blood glucose (Sig. = 0.008), serum serotonin and HbA1c (Sig. = 0.007), serum serotonin and anxiety (Sig. = 0.000), and serum serotonin and depression (Sig. = 0.000). It is also noteworthy that women recorded extreme values higher than men for glycated haemoglobin (95% confidence interval: 6.92&ndash;7.79 in women and 6.30&ndash;7.23 in men). In conclusion, using serotonin as a marker of the mentioned diseases in clinical practice is of significant utility, considering the benefits in terms of the evolution and prognosis of comorbidities in patients with type 2 diabetes and anxiety and depressive symptoms