The role of spinal ultrasound in the diagnosis of spinal dysraphism – correlation with MRI examination

The paper presents the clinical, ultrasound and MRI appearances in the case of the closed spinal dysraphisms with a cutaneous/subcutaneous mass: lypomyelomeningocele, posterior meningocele and cervical meningocele. There is mentioned first the classification of these defects, then, for each type, a case example is presented, showing the clinical aspect of the lesion, the ultrasound features and the correlation of ultrasound with MRI images. The examples show a good correlation between ultrasound and MRI, entitling the ultrasound exam to be the first line of exploration in the case of this category of patients

Spinal ultrasound – Identification of the normal structures

The incomplete ossification of the spinal processes allows the ultrasonographic evaluation of the spinal cord and the adjacent structures in neonates and small infants. The paper describes the ultrasonographic examination of the spinal structures and the normal appearance of the spinal cord, the structures within the spinal canal, and the bony and muscular adjacent structures. Sagittal and axial sections at cervical, thoracic, lumbar, and sacral levels are described. There are also mentioned findings in the M mode and Doppler examinations

Menopause and oral health

At menopause, a woman's body undergoes radical hormonal changes, which predisposes to damage of the oral cavity. The onset of menopause is a series of morpho functional physiological adaptive changes with systemic and oral action in women. Oral health is closely related to dental hygiene, a major concern in menopause. The addressability of women to dental services tends to increase due to perimenopausal changes that occur in the gums and teeth and the oral microbiome. These changes have a hormonal substrate that significantly influences the evolution of oral health. The purpose of this review is to understand the occurrence and evolution of oro-dental complications in menopause and the systematization of therapeutic regimens. The PubMed and Web Of Science databases searched identified approximately 21 eligible articles. Periodontal damage is the most common, followed by dryness and burning sensation in the mouth. The role of hormone replacement therapy is controversial in terms of prophylaxis or the obvious therapeutic aspect of menopausal women with oral symptoms. The lack of extensive research, at least for the time being, does not establish clear therapeutic protocols to resolve these dental conditions

Gestational periodontitis impact on the fetus and neonate

Maternal oral pathologies during pregnancy represent a controversial subject. The incidence of periodontal disease is approximatively 40% among pregnant women. Periodontal disease has been associated with several unfortunate outcomes; among them, the most important are cardiovascular disorders, respiratory infections, diabetes and Alzheimer's disease. Regarding mechanisms, bacteria enter the blood stream and cross the placenta or the inflammatory mediators can affect the fetoplacental unit or generate an increased inflammatory response with subsequent consequences on the fetus. The most disputed subjects concerning periodontal disease in pregnancy are related to the effects on the pregnancy outcome and the offspring, respectively the associations between maternal periodontal disease and small for gestational age, preeclampsia, arteriosclerosis, gestational diabetes and perinatal mortality. In order to improve neonatal outcome and ensure maternal oral health, we should assure that the necessary dental treatment is provided during the entire pregnancy, preferably between 14 and 20 gestational weeks. Moreover, women should be encouraged to received dental treatment preconceptionally

Case report of a rare bullous variant of oral lichen planus

The aim of this report is to describe the lichen planus on the oral mucosa in the bullous variant of the disease. It is often misdiagnosed with other mucosa disorders (allergies, bullous dermatosis). A 37-year-old-female patient presented for oral mucosa painful lesions of 3 months duration. A microscopic examination of the lesional areas was consistent with the diagnosis of oral lichen planus and direct immunofluorescence confirmed it. This case showed that although a rare condition the variant of bullous lichen planus can be encountered in daily clinical practice

Vitamin D supplementation – still a subject of debate

Vitamin D is a standard vitamin supplementation for children in many countries, used mainly for preventing rickets. Many studies were published about the efficiency of vitamin D administration in children and adults for other pathologies besides rickets. Very often the results were contradictory, but nevertheless, more and more articles are published on this matter. There is no consensus for the effective vitamin D dosage nor for the vitamin D normal serum values. Both vitamin D deficiency and vitamin intoxication are dangerous for children. Recently some studies are showing controversial data that advise being more careful in prescribing vitamin D as a routine

Probiotics effect in prevention and treatment of atopic dermatitis and eczema in children

The composition of the intestinal microbiota plays an important role in the occurrence of allergies. Based on the immunomodulating capabilities of bacteria, various studies have investigated the potential role of probiotics in the prevention of eczema and atopic dermatitis in children. Atopic dermatitis (AD) is one of the first manifestations in the evolution of allergies, with a continuously increasing incidence worldwide. In the literature, various risk factors are described to play a role in the occurrence of DA, but the actual cause of the disease is still unknown. The intestinal flora seems to be involved in the development of AD, as patients with AD show quantitative, qualitative and functional changes. An imbalance of the human gut microbiota in the first years of life is a possible risk factor for immune-mediated disorders such as allergies. With the aim of modulating the gut microbiota, probiotic supplementation in the first months of life has been used to prevent allergic diseases in infants, with variable success. However, not much is known about the long-term consequences of the use of probiotics in the newborn on the composition of the gut microbiota. The aim of this paper is to highlight the positive links between the use of probiotics and the prevention or cure of eczema and atopic dermatitis

Assessment tools of disability status after stroke

Stroke is the second leading cause of death worldwide. The global incidence of stroke has increased in recent years, although low and middle-income countries have been heavily affected. Because of the complicated and diversified physical and emotional disruption, stroke survivors are likely to face a variety of difficulties in daily life activities. Because of the wide impact of a stroke on all body structures and functions, there is no gold standard instrument to evaluate impairment and all elements of recovery after a stroke, and there is no single scale that can capture all the effects of a stroke. The International Classification of Impairments, Disability, and Handicaps (ICIDH) categorized the consequences of the diseases into three categories: impairment, disability, and handicap. Using the biopsychosocial model in 2001 WHO defines and classifies disability by using International Classification of Functioning Disability and Health (ICF). The ICF divides the impairment into three categories: body function and structure, activity, and participation. This article aims to review the most important tools that are reliable and valid in assessing the disability left after a stroke: The National Institute of Health Stroke Scale (NIHSS), Barthel index (BI), The modified Rankin scale (mRS), Instrumental activities of daily living (IADL), Glasgow outcome scale (GOS), The Functional Independence Measure (FIM), The World Health Organization Disability Assessment Schedule (WHODAS 2.0). The WHODAS 2.0 questionnaire is validated in several countries and it would be useful to be validated, also, in our country

Levonorgestrel intrauterine device as a non-invasive approach of abnormal uterine bleeding caused by cesarean scar defect

Cesarean scar defect, niche or isthmocele represents a poor healing in the anterior uterine wall after performing a cesarean section. The cesarean scar defect can be asymptomatic, or the patient could present abnormal uterine bleeding, chronic pelvic pain, dysmenorrhea, dyspareunia, cesarean scar pregnancy or abnormal placenta. Abnormal uterine bleeding caused by cesarean scar defect presents as a postmenstrual spotting and has become more and more common among women with a history of minimum one cesarean section delivery. The most studied risk factors are: multiple cesarean section deliveries, single layer suture, locked suture, retroflexed uterus and cesarean section delivery performed during active labor with a cervical dilatation of 5 cm. There have been described several surgical approaches: hysteroscopic, laparoscopic or vaginal. From our experience, we have treated successfully symptomatic patients with cesarean scar defect with the levonorgestrel-releasing intrauterine system. Although the therapeutic indications do not include this specific use, we have obtained significant improvement of abnormal uterine bleeding due to cesarean scar defect in our patients. Our results sustain the necessity of extensive interventional studies

Management of biliary lithiasis in pregnancy – an updated overview

It is estimated that 2% of pregnant women develop gallstones during pregnancy. Symptoms of biliary lithiasis may vary during pregnancy, from a slight added digestive discomfort to biliary colic of varying intensity, acute cholecystitis, or acute pancreatitis. Ultrasonography is the gold standard for diagnosis of sludge and gallstones, being both highly sensitive and specific. Initial management overlaps with the out-of-pregnancy management, initiating conservative, supportive care, as well as an adequate diet. Laparoscopic cholecystectomy is considered a safe intervention in pregnancy, being the second most common surgery after appendicectomy. If open laparoscopy is preferred, the major risk - perforation of the uterus - is avoided. Important complications of gallstones in pregnancy, jaundice and acute pancreatitis can be resolved safely and quickly by cholangiopancreatography (ERCP) techniques, with stone removal, sphincterotomy or stent mounting. After remission of pancreatic symptoms, laparoscopic cholecystectomy can be performed. Recent scientific data and current practice suggest an increase of biliopancreatic emergencies during pregnancy (probably due to rising incidence of obesity, age of gravida, prolonged use of oral combined contraceptives, dyslipidemia, etc.). Surgeons, as well as obstetricians, should be aware of the prompt modern management of these cases