LAM KID

[Final results of the DAPS (Denosumab Adherence Preference Satisfaction) study - A 24-month, randomized, crossover comparison with alendronate in postmenopausal women]

BALLA Bernadett

SEPTEMBER 20, 2012

LAM KID - 2012;2(03)

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Further articles in this publication

LAM KID

[The effect of nonsteroidal anti-inflammatory drugs on articular cartilage]

GÁTI Tamás, JUHÁSZ István, ROJKOVICH Bernadette

[In developed countries, the treatment of osteoarthritis costs up to 1-2% of the GNP. The poor hygroscopy of hyaline cartilage and of glycosaminoglycan (GAG) molecules that are components of proteoglycans plays a key role in the development of the disease. Age-related osteoarthritis mostly affects the weight-bearing joints of the lower extremities, the hips and knees, and - more frequently than the former ones - the small joints of the hands, causing chronic pain and disability. Nonsteroidal anti-inflammatory drugs (NSAIDs) used for the treatment of osteoarthritis-related pain influence not only pain but also cartilage metabolism, and - among others - GAG molecules. NSAIDs diminish the biosynthesis of prostaglandins (PG) that have a role in inflammatory processes, and influence oxygen free radicals, the levels of interleukins (ILs) and the function of metalloproteinases. The ideal NSAID for the joints stimulates cartilage formation, reduces cartilage resorption, and the level of katabolic cytokines. Aceclofenac was found to have the most beneficial effect on multiple aspects of cartilage metabolism.]

LAM KID

[Estimating the risk of new fracture - Which factors confer an increased fracture risk?]

TAKÁCS István

[This risk of osteoporosis-related fractures is influenced by a number of well-known risk factors. Among the approaches to quantify bone fracture risk, the FRAX questionnaire is the most widespread in everyday practice. However, this method only provides a probability percentage for the physician, and it is unable to specify or weigh the factors that may have a particular importance in evaluating individual fracture risk, or choosing the appropriate therapy in patients with previous osteoporotic fracture. This summary aims to provide practical help for the evaluation of individual fracture risk in patients who have had bone fractures.]

LAM KID

[Association between osteoporosis and nutrition during the history of human evolution]

KISS Zoltán, KISS István, JÓZSA László

[From the Palaeolithic age to the twentieth century, nutritional habits as well as the quality and composition of nutritients changed dramatically. The protein-based calorie intake of former Homo species had been replaced by a carbohydrate-based nutrition since the Neolithic revolution (the transition to agriculture). The start of food production also changed the range of nutrients and the start of sedentary lifestyle. At the same time, approximately five thousand years ago osteoporosis appeared. In this paper, the authors give a short review of eating habits and foods of early Homo species in the Palaeolithic Age and of Homo sapiens in Neolithic Age, Antiquity, Middle Ages and Modern Age, and discuss the possible relationship of nutrition and osteoporosis.]

LAM KID

[Efficiency of osteoporosis treatment in Hungary - An analysis of the Hungarian National Insurance Company’s data]

LAKATOS Péter, TÓTH Emese, SZEKERES László, POÓR Gyula, HÉJJ Gábor, TAKÁCS István

[The treatment of osteoporosis and its consequences place a significant burden on the health care of developed countries. Modern therapeutical approaches are able to efficiently decrease the risk of osteoporotic bone fractures. However, we do not know whether the interventions introduced in the past 15 years have significantly reduced the number of osteoporotic fractures in real life, and if they have, how cost-effective this effect was. To answer these questions, we have analysed data of the Hungarian National Insurance Company collected between 2004-2010. During these 7 years, the number of bone fractures among patients treated for osteoporosis continuously decreased. This was also observed in the incidence of hip fractures. Interestingly, the mortality of osteoporotic patients was significantly lower than that of the same age group in the average population. Besides the efficient treatment of osteoporosis, this finding is also due to the outstanding general care provided by the specialised osteoporosis centers of the country. As a consequence of the reduction in fractures, 3.4 billion HUF was saved per year by the insurance company, which is approximately equal to the 3.5 billion HUF spent on the reimbursement of medicines used for the treatment of osteoporosis, which means that the investments show a return. The calculation of the quality- adjusted life years, which is the internationally accepted method of the WHO for the study of cost-effectiveness, shows that the above results were achieved in a remarkably cost-efficient way. At the same time, it is noteworthy and calls for caution that the decrease in reimbursement by the insurance company in 2007 resulted in a 51% drop in the number of patients receiving treatment, which radically reduced the observed efficiency.]

LAM KID

[Vitamin D deficiency and infections]

LUDWIG Endre, KRIVÁN Gergely

[Studies performed in the past few years have confirmed that vitamin D is essential for maintaining the optimal immune defense, and its immunomodulatory effect has a role in the defense against infections as well. A lot of data suggest that low serum 25-(OH)-D concentration is associated with an increased frequency of certain infections and it adversely influences pathological processes. Data on this adverse effect are available mostly in case of Mycobacterium tuberculosis, respiratory viral infections in general, HIV, hepatitis C and sepsis. The outcomes of severe infections are usually influenced by a number of factors and it seems that vitamin D deficiency is one of those factors that shift the process towards an unfavourable outcome. Further studies should evaluate the significance of this role and the influence of vitamin D supplementation on pathological processes.]

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Clinical Neuroscience

Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

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.

Lege Artis Medicinae

[Comment to the article titled “Exploratory study of outcomes of blood sample mass examinations by rank correlations”]

Lege Artis Medicinae

[The author’s response to the comment on “Exploratory study of outcomes of blood sample mass examinations by rank correlations”]

Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

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.

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[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.]