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

Pregnancy in the context of Multiple Sclerosis

Multiple Sclerosis is a chronic autoimmune neurodegenerative disorder which affects brain, spinal cord and optic nerve. During last years the perception over the disease changed dramatically, now being considered a handleable disease. The particularity of this subject is that Multiple Sclerosis is a disease which affects mostly young women, many of them not having any children at the moment of diagnosis. This article highlights the fact that women diagnosed with Multiple Sclerosis are allowed to get pregnant, and, moreover, they are encouraged to live a normal life. In most cases, disease activity freezes during pregnancy, only a small percentage of women will continue to have clinically and radiologically active disease. For those women, IFN-β and Glatiramer Acetate are the first-choice therapies that should be given. In cases when the disease is not responding to common medication, refractory to treatment forms may be successfully treated with Natalizuab, during the first and the second trimester. Breastfeeding is also encouraged, as it has a protective effect on disease progression. The main purpose of this article is to make a literature review in which to summarize the updates regarding pregnancy and postpartum management, relapses management and, also, the impact of pregnancy on Multiple Sclerosis course. The analysis was limited to articles written in English and published between August 2019 - October 2022 on PubMed, NCBI and Medical Journals

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

Managing intrauterine growth restriction

The fetal growth normally depends on sufficient delivery of oxygen and nutrients mainly via the placenta. Inadequate fetal nutrition may result in poor development and adaptation that permanently alter the fetus' metabolism and physiology. Intrauterine Growth Restriction is defined as a deviation on the fetal growth pattern. An estimated fetal weight (EFW) that is below the 10th percentile for gestational age is commonly used to describe fetal growth restriction. Usually obtained sonographically, there is evidence that ultrasound imaging of the uterine artery, middle cerebral artery, and fetal umbilical artery during the late third-trimester (approximately 35-37 weeks) significantly improves the detection and diagnosis of IUGR. In obstetrics, an increased risk of perinatal mortality and morbidity is associated with the diagnosis of IUGR

Oligohydramnios: A review of etiology and management options

Oligohydramnios is both a consequence of fetal malformations and of uteroplacental insufficiency. Its existence is associated with a high rate of both antepartum and intrapartum complications. It is vital that its occurrence is detected as early as possible so that we can manage it correctly. The main causes of its occurrence are identified and described in this review. The management of oligohydramnios is most often expectant, the timing of delivery also being determined by Doppler examination and changes in parameters measuring fetal growth and development

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

Breef overview of gestational diabetes mellitus

As obesity increases worldwide, so do the incidence of gestational diabetes mellitus (GDM) and the related perinatal complications. Pancreatic β-cell secretion is altered by hormonal changes during pregnancy. It appears, however, that patients who develop gestational diabetes have pre-existing insulin resistance. However, there are other risk factors to be considered, such as obesity, age, ethnicity, and polycystic ovary syndrome. Screening for gestational diabetes is very important to avoid maternal and fetal complications. For most pregnant women, glycemic control is achieved through dietary and lifestyle changes, although a small percentage requires pharmacological treatment

An Extremely Rare Case of Sebaceous Adenoma Involving the Parotid Gland

Sebaceous adenoma is an extremely rare tumor located in the parotid gland. In the English literature, less than 10 cases have been reported. Sebaceous adenoma represents 0.5% of all monomorphic adenomas. The authors are presenting a case of sebaceous adenoma of the parotid gland in a 65-year-old female who presented a mass on the left parotid area that had been gradually enlarging for one year without symptoms of pain. On imaging (ultrasound), a well-defined mass lesion in the left parotid area was seen. Histopathological findings were consistent with sebaceous adenoma. Surgical excision is curative. The prognosis is excellent, with a low recurrence rate. The present case report will increase the awareness and possibility of this rare tumor occurring at an unusual site, thereby avoiding any chance of misdiagnosis

The potential protective effect of Hydrastasis Canadensis on the cervico-vaginal lesions

Homeopathic principles have been widely investigated and proposed even from the ancient times in order to treat different wounds, to prevent inflammation and to treat infections. Although initially they have been tested in regard to skin wounds, their use was also tested in regard to different internal viscera with promising results. Therefore, such extracts have been proposed as part of the topical products proposed for treating certain pathologies of the uterine cervix such as infections, cervicitis or even in order to prevent the risk of uterine cervical cancer development. The aim of the current paper is to discuss about the potential protective role of Hydrastasis Canadensis in treating different cervico-vaginal lesions