[Efficiency of the treatment of osteoporosis - lessons from a health insurance fund’s database analysis]
JULY 03, 2012
LAM KID - 2012;2(02)
JULY 03, 2012
LAM KID - 2012;2(02)
[INTRODUCTION - All forms of diabetes are associated with increased fracture risk. In type 2 diabetes, bone mineral density is increased. In order to determine whether increased bone density is a consequence of diabetes-related metabolic changes or rather a primary alteration independent of these changes, we examined women and men with the following characteristics: normal glucose tolerance; genetically determined risk of T2DM but healthy on the basis of detailed metabolic tests; or incipient glucose intolerance, praediabetic state. PATIENTS AND METHODS - We included 72 men with normal glucose tolerance; seven men with normal glucose tolerance and first-degree relative(s) with diabetes; 64 body fat mass adjusted and BMI-adjusted men with glucose intolerance; 36 healthy women with normal glucose tolerance; 12 women with normal glucose tolerance and first-degree relative(s) with T2DM and 88 women with glucose intolerance. Muscle glucose uptake was measured by hyperinsulinaemic-normoglycaemic clamp, and bone density was measured by DEXA. RESULTS - In healthy men, the connection between leptin and BMDL1-4 is positive and the relationship between testosterone and BMDL1-4 is negative, but both correlations disappear in the early praediabetic stage. In the whole female study population, negative correlations were found between total BMD and adiponectin (r=-0.318, p<0.0001), and osteocalcin (r=-0.412, p<0.0000), which stayed significant after adjustments for body fat percent and age in case of impaired glucose tolerance. CONCLUSION - In women with healthy glucose metabolism who have first-degree relative(s) with diabetes, increased bone density is not related to changes in glucose metabolism. Our study emphasizes the substantial gender differences in the relationship between density of the femur and vertebrae and metabolism. Our data question the mediatory role of adiponectin shown in animal studies in the insulin-sensitizing, glucose metabolism improving effect of osteocalcin in men.]
[Teriparatide has become one of the most important drug in the treatment of osteoporosis in Hungary. Although this is not a new drug, a number of questions arise regarding its use in everyday practice. When should we use it as first-line treatment? When should we change the used therapy to teriparatide? What kind of effect can we expect after the start of teriparatide therapy? What are the potential side effects? Financing rules limit, but do not fully control our therapeutic decisions, as these are mostly based on scientific data. In this review, we summarise new and older scientific data regarding teriparatide from practical aspects.]
Hypertension and nephrology
[This consensus document is intended to provide guidance for the effective and efficient treatment of asymptomatic individuals with high uric acid levels and gout patients.]
[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmelweis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]
We aimed to analyze the clinical, laboratory and neuroimaging findings in patients with sporadic Creutzfeldt-Jakob disease (CJD) in a single center as well as to review other published cases in Turkey. Between January 1st, 2014 and June 31st, 2017, all CJD cases were evaluated based on clinical findings, differential diagnosis, the previous misdiagnosis, electroencephalography (EEG), cerebrospinal fluid and cranial magnetic resonance imaging (MRI) findings in our center. All published cases in Turkey between 2005-2018 were also reviewed. In a total of 13 patients, progressive cognitive decline was the most common presenting symptom. Two patients had a diagnosis of Heidenhain variant, 1 patient had a diagnosis of Oppenheimer-Brownell variant. Seven patients (53.3%) had been misdiagnosed with depression, vascular dementia, normal pressure hydrocephalus or encephalitis. Eleven patients (87%) had typical MRI findings but only 5 of these were present at baseline. Asymmetrical high signal abnormalities on MRI were observed in 4 patients. Five patients (45.4%) had periodic spike wave complexes on EEG, all appeared during the follow-up. There were 74 published cases in Turkey between 2005 and 2018, with various clinical presentations. CJD has a variety of clinical features in our patient series as well as in cases reported in Turkey. Although progressive cognitive decline is the most common presenting symptom, unusual manifestations in early stages of the disease might cause misdiagnosis. Variant forms should be kept in mind in patients with isolated visual or cerebellar symptoms. MRI and EEG should be repeated during follow-up period if the clinical suspicion still exists.
Interest in the hippocampal formation and its role in navigation and memory arose in the second part of the 20th century, at least in part due to the curious case of Henry G. Molaison, who underwent brain surgery for intractable epilepsy. The temporal association observed between the removal of his entorhinal cortex along with a significant part of hippocampus and the developing severe memory deficit inspired scientists to focus on these regions. The subsequent discovery of the so-called place cells in the hippocampus launched the description of many other functional cell types and neuronal networks throughout the Papez-circuit that has a key role in memory processes and spatial information coding (speed, head direction, border, grid, object-vector etc). Each of these cell types has its own unique characteristics, and together they form the so-called “Brain GPS”. The aim of this short survey is to highlight for practicing neurologists the types of cells and neuronal networks that represent the anatomical substrates and physiological correlates of pathological entities affecting the limbic system, especially in the temporal lobe. For that purpose, we survey early discoveries along with the most relevant neuroscience observations from the recent literature. By this brief survey, we highlight main cell types in the hippocampal formation, and describe their roles in spatial navigation and memory processes. In recent decades, an array of new and functionally unique neuron types has been recognized in the hippocampal formation, but likely more remain to be discovered. For a better understanding of the heterogeneous presentations of neurological disorders affecting this anatomical region, insights into the constantly evolving neuroscience behind may be helpful. The public health consequences of diseases that affect memory and spatial navigation are high, and grow as the population ages, prompting scientist to focus on further exploring this brain region.
Acquired idiopathic generalised anhidrosis is an uncommon sweating disorder characterized by loss of sweating in the absence of any neurologic, metabolic or sweat gland abnormalities. Although some possible immunological and structural mechanisms have been proposed for this rare entity, the definitive pathophysiology is still unclear. Despite some successfully treated cases with systemic corticosteroid application, the dose and route of steroid application are controversial. Here, we present a 41-year-old man with lack of generalised sweating who has been successfully treated with high dose pulse intravenous prednisolone. We have discussed his clinical and histopathological findings as well as the treatment options in view of the current literature.
Clinical NeuroscienceAlexithymia is associated with cognitive impairment in patients with Parkinson’s disease
Lege Artis Medicinae[COVID-19-cardiology at spring, 2020]
Clinical NeuroscienceLate carcinomatous meningitis as vertigo
Lege Artis Medicinae[Another book about doctor–patient legal relations]
Lege Artis Medicinae[Jus gladii of the university]
Lege Artis Medicinae[Respect the patient – that is the most important]
Lege Artis Medicinae[We do not know that the phenotype of the coronavirus would have changed]
Lege Artis Medicinae[Teleconsultations in general practice during coronavirus epidemiological emergency]