[Dear Colleagues and Readers!]
SEPTEMBER 11, 2007
Ca&Bone - 2007;10(03)
SEPTEMBER 11, 2007
Ca&Bone - 2007;10(03)
[NEWS OF THE HUNGARIAN OSTEOPOROSIS AND OSTEOARTHROLOGY SOCIETY, 2007;10(03)]
[INTRODUCTION - The treatment of pediatric leukemia has become increasingly successful, with a survival rate over 80%. Thus interest has been increasingly focused on the long-term side-effects of the treatment. The questions of reduced fertility rate, occurance of second malignancies, cardiomyopathy, impaired renal and pulmonal function have been extensively studied. Changes of bone metabolism in connection with the disease itself and the treatment have been analysed in the past decade. CASE REPORT - We present the case of a 15-year-old boy with acute lymphoblastic leukemia, who had bone pain soon after the diagnosis. During the course of chemotherapy his complaints were fluctuating, and he developed severe osteoporosis. The level of a bone resorption marker, β-CrossLaps, was elevated. In the second year of therapy an acute pain of the left hip occured with fever and restriction of joint movement, which was diagnosed and treated as osteomyelitis. A few months later avascular necrosis of the left femoral head was revealed. Both pharmaceutic (calcium, vitamin D, calcitonin, bisphophonate) and orthopedic treatment were used, as a result bone mineral density and movement restriction improved; his leukemia is now in remission. CONCLUSIONS - The factors influencing bone metabolism in leukemic children are reviewed. Firstly the effects of malignant cells on bone mineral content are analyzed, then the chemotherapeutic drugs’ mechanisms of action are examined extensively. The direct and indirect effects of secondary factors (hospitalization, immobility, lack of sun exposure, malabsorption, immunsuppression, peripheral neuropahty) are also analyzed. The advantages and disadvantages of drugs used in preventing and treating childhood osteopenia are reviewed.]
[The current reimbursement regulations that came into effect this summer for the prevention and the treatment of osteoporosis require calcium and vitamin D supplementation in addition to antiporotic agents if appropriate conditions are met. In this paper, the author reviews those conditions that represent contraindications for calcium and vitamin D supplementation. Among these, the extremely rare vitamin D intoxication is mentioned and a detailed list of disorders resulting in hypercalcaemia is given with emphasis on the most common causes such as hypercalcaemia associated with malignancy and primary hyperparathyroidism. With hypercalcuria and renal stone disease, the diet low in calcium appears to have no effect on the outcome; moreover recent studies demonstrate beneficial effect of increased calcium intake, although the optimal calcium and vitamin D supplementation needs further clarification in these conditions. This review highlights the role of additional factors in increasing the risk such as hyperoxaluria, hyperuricosuria, hypocitraturia, as wells as the excessive protein and potassium-chloride intake or the pharmacological differences of various calcium supplements. The article underscores the use of activated vitamin D products in severe renal failure to prevent secondary hyperparathyroidism and renal osteodystrophy. The new regulations represent a significant improvement in the therapy of patients with osteoporosis, however the individualized therapy and follow up, the good relationship between patient and physician contribute to the optimal therapeutic effects and to minimize the side effects.]
We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.
Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.
Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.
Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithymia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share common pathology of neuroanatomical structures. We hypothesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship between WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.
[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]
Lege Artis Medicinae[Vaccines against COVID-19 pandemic]
Lege Artis Medicinae[Diagnosis and treatment of microvascular coronary heart disease. Specialities of conditions in Hungary]
Clinical NeuroscienceCholinesterase inhibitors and memantine for the treatment of dementia
Journal of Nursing Theory and Practice[Nursing Bag Technique, Practice in home health care]
Journal of Nursing Theory and Practice[Changes in Quality of Life in Patients with Parkinson’s Disease following Deep Brain Stimulation (DBS) Surgery]
Journal of Nursing Theory and Practice[Analysis of the impact of dysphagia among stroke patients in acute care]
Journal of Nursing Theory and Practice[Changing in the daily nursing duties – epidemiological interventions and protocols in residential care facilities related to elderly care]
Journal of Nursing Theory and Practice[The importance of teamwork in healthcare during the COVID-19 pandemic]