Clinical Neuroscience

[Experiment with the sociometric method in psychiatry in a psychiatric ward]

PERTORINI Rezső1, KLEININGER Ottó1

AUGUST 01, 1961

Clinical Neuroscience - 1961;14(08)

[In our male closed class, we observed a negative behavioural phase associated with group formation, which we were able to analyse well using sociometric tests. Based on our studies, it seems that it is necessary to include doctors and nurses in the group of patients and to avoid giving patients with many negative personality traits a leading role, because this may cause difficulties not only in direct but also in indirect effects within the group, which can be well detected by sociogram methods. The aim in psychiatric ward work is group psychotherapy, but unfortunately the conditions for this are often not in place. ]

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  1. Debreceni Orvostudományi Egyetem Ideg- és Elmegyógyászati Klinikája

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[Glioma behaviour in tissue culture]

PÁLYI Irén, AFRA Dénes, CSANDA Endre

[To date, the authors have performed tissue culture of 107 human brain tumours with different histological structures. In the present communication, they report the tissue culture results of 21 tumours classified histologically as astrocytoma-glioblastoma. By observing the biological and cytological phenotypes provided by tissue culture, data were sought to address neuropathological classification issues. On the basis of the results obtained so far, Kernohan's grading is seen to be justified primarily in the astrocytoma - astrocytoma malignum group. The inclusion of glioblastoma diagnosed tumours as a simple additional malignancy grade is not supported by the culture results so far, but the separation of glioblastoma multiforme as a separate tumour group seems to remain justified.]

Clinical Neuroscience

[Frenolone and perphenazine in psychiatric in psychiatric practice]

BÖSZÖRMÉNYI Zoltán, BURUCS János, NAGY Tibor

[The authors report on 44 psychiatric patients treated with perphenazine and 86 with Frenolone. They conclude that both agents represent a major enrichment of therapeutic options, but that Fr. has also been shown to be more effective and less toxic than perphenazine. In 64% of their patients, most of whom were chronic, Fr. achieved symptom relief or significant improvement: extrapyramidal complications were relatively less severe, patients were better activated, and their contactus recovered more quickly. Two illustrative cases are presented. If necessary, the Fr. treatment can be supplemented with anesthetics and electroshock treatment. According to clinical and EEG observations, Fr. hardly dulls cortical activity, it relieves inhibition well, perhaps by suppressing certain subcortical inhibitory mechanisms. Thus, by its mild psycho sedative but powerful antipsychotic action, it is a major adjuvant to occupational and psychotherapy: it also allows the initial ambulant treatment of certain psychoses and neuroses of an asthenic nature. In epileptics, a possible increase in seizures should be expected. ]

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Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Clinical Neuroscience

Atypical presentation of late-onset Sandhoff disease: a case report

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Sandhoff disease is a rare type of hereditary (autosomal recessive) GM2-gangliosidosis, which is caused by mutation of the HEXB gene. Disruption of the β subunit of the hexosaminidase (Hex) enzyme affects the function of both the Hex-A and Hex-B isoforms. The severity and the age of onset of the disease (infantile or classic; juvenile; adult) depends on the residual activity of the enzyme. The late-onset form is characterized by diverse symptomatology, comprising motor neuron disease, ataxia, tremor, dystonia, psychiatric symptoms and neuropathy. A 36-year-old female patient has been presenting progressive, symmetrical lower limb weakness for 9 years. Detailed neurological examination revealed mild symmetrical weakness in the hip flexors without the involvement of other muscle groups. The patellar reflex was decreased on both sides. Laboratory tests showed no relevant alteration and routine electroencephalography and brain MRI were normal. Nerve conduction studies and electromyography revealed alterations corresponding to sensory neuropathy. Muscle biopsy demonstrated signs of mild neurogenic lesion. Her younger brother (32-year-old) was observed with similar symptoms. Detailed genetic study detected a known pathogenic missense mutation and a 15,088 base pair long known pathogenic deletion in the HEXB gene (NM_000521.4:c.1417G>A; NM_000521:c.-376-5836_669+1473del; double heterozygous state). Segregation analysis and hexosaminidase enzyme assay of the family further confirmed the diagnosis of late-onset Sandhoff disease. The purpose of this case report is to draw attention to the significance of late-onset Sandhoff disease amongst disorders presenting with proximal predominant symmetric lower limb muscle weakness in adulthood.

Lege Artis Medicinae

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[What has Go to do with making clinical decisions? One of the greatest intellectual challenges of bedside medicine is making decisions under uncertainty. Besides the psychological traps of traditionally intuitive and heuristic medical decision making, lack of information, scarce resources and characteristics of doctor-patient relationship contribute equally to this uncertainty. Formal, mathematical model based analysis of decisions used widely in developing clinical guidelines and in health technology assessment provides a good tool in theoretical terms to avoid pitfalls of intuitive decision making. Nevertheless it can be hardly used in individual situations and most physicians dislike it as well. This method, however, has its own limitations, especially while tailoring individual decisions, under inclusion of potential lack of input data used for calculations, or its large imprecision, and the low capability of the current mathematical models to represent the full complexity and variability of processes in complex systems. Nevertheless, clinical decision support systems can be helpful in the individual decision making of physicians if they are well integrated in the health information systems, and do not break down the physicians’ autonomy of making decisions. Classical decision support systems are knowledge based and rely on system of rules and problem specific algorithms. They are utilized widely from health administration to image processing. The current information revolution created the so-called artificial intelligence by machine learning methods, i.e. machines can learn indeed. This new generation of artificial intelligence is not based on particular system of rules but on neuronal networks teaching themselves by huge databases and general learning algorithms. This type of artificial intelligence outperforms humans already in certain fields like chess, Go, or aerial combat. Its development is full of challenges and threats, while it presents a technological breakthrough, which cannot be stopped and will transform our world. Its development and application has already started also in the healthcare. Health professionals must participate in this development to steer it into the right direction. Lee Sedol, 18-times Go world champion retired three years after his historical defeat from AlphaGo artificial intelligence, be­cause “Even if I become the No. 1, there is an entity that cannot be defeated”. It is our great luck that we do not need to compete or defeat it, we must ensure instead that it would be safe and trustworthy, and in collaboration with humans this entity would make healthcare more effective and efficient. ]

Journal of Nursing Theory and Practice

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Journal of Nursing Theory and Practice

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[To identify recent national trends in the employment and earnings of nursing personnel in primary healthcare and determine whether salaries and wage growth are associated with changes in the employment. The cross-sectional survey was conducted between 17 May 2021 and 17 June 2021 among nurses working in general, child and family practices, and dental practices selected using a random, sampling method (N=2007). The data gathering took place using a web-based, anonymous, self-completion questionnaire. The authors analysed the gathered data with Microsoft Excel 2007 and SPSS 22.0 software, employing descriptive statistical methods. Participants are highly experienced, with 80% reporting more than 16 years of experience. 7.9% of nurses are educated at or above the baccalaureate level. The majority (89.5%) work full-time as employees of their organizations (95.4%). The GP’s territorial care obligation disparities in nurses salaries documented here should spark healthcare policymakers to conduct pay equity assessments of employees’ salaries to identify and ameliorate pay inequality. The study findings also indicate that tailoring salaries to qualification for the individual nurses may aid in recruiting and retaining nurses in practice. ]