LAM KID

[Functioning on estrogen receptor in light of the newest studies]

BOJCSUK Dóra, ERDŐS Edina, BÁLINT Bálint László

MAY 30, 2014

LAM KID - 2014;4(02)

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LAM KID

[Diclofenac/orphenadrin as a combined analgetics in relief of pain. Systemic literature review]

ROJKOVICH Bernadette

[The objectives of this paper are to discuss the safety and tolerability of combined infusion -Neodolpasse(®) - containing nonsteroidal antiinflammarory drug, diclofenac and central muscle relaxant orphenadrin on the basis of recent data. The author reviewed phase IV randomised, controlled studies published on Medline and in the Hungarian literature. On the basis of the available data, diclofenac/orphenadrin infusion is an effective and safe analgesic, which is easy to administer and to combine with other painkillers in acute low back pain and other painful rheumatic conditions, as well as postoperative pain.]

LAM KID

[The effect of biological therapy on generalised osteoporosis in patients with rheumatoid arthritis]

JUHÁSZ Péter

[In rheumatoid arthritis, the inflammation and damage of multiple joints can lead to generalised osteoporosis. This process is mostly mediaated by cells and cytokines that are also important for maintaining inflammation, by inhibiting bone formation as well as stimulating bone resorption. Data from the literature show that biological therapies that effectively decrease inflammation can also stimulate bone formation and inhibit bone resorption. This results in an increased bone density and bone protection, which is highly important to prevent subseqent fractures.]

LAM KID

[Determining sclerostin level in healthy men]

MOLNÁR Zsuzsanna, WAMWAKI John, PETHŐ Zsófia, KALINA Edit, FÖLDESI Róza, BALOGH Ádám, ANTAL-SZALMÁS Péter, BHATTOA Harjit Pál

[The aim of this study is to evaluate the relationship of serum sclerostin levels with age, cystatin C, bone mineral density (BMD) and biochemical markers of bone turnover in healthy Hungarian men over 50 years of age. We determined serum levels of sclerostin and examined its relationship with age, cystatin C, osteocalcin, C-terminal telopeptides of type-I collagen, procollagen type 1 amino-terminal propeptide, 25- hydroxyvitamin D, parathyroid hormone, and L1-L4 (LS) and femur neck (FN) BMD data available from 194 randomly selected ambulatory men belonging to the HunMen cohort. In the study population as a whole (n=194; age (median, range): 59 (51-81) years), statistically significant correlation was found between sclerostin and age (r=0.211; p=0.003), cystatin C (r=0.246; p=0.001), FN-BMD (r=0.147; p=0.041) and LS BMD (r=0.169; p=0.019). Compared with middle-aged men (age: ≤ 59 years, n=98), elderly men (age > 59 years, n=96) had significantly higher serum sclerostin levels (67.8±15.9 pmol/l vs. 63.5±14; p=0.047). Among men with normal (T score >-1,0) FN-BMD, the elderly had significantly higher serum sclerostin levels as compared with the middle-aged (70.4±17 pmol/l vs. 63.9±11.5 pmol/l; p=0.019). Furthermore, among the elderly men cystatin C was the only significant predictor of serum sclerostin levels (standardized regression coefficient (béta) = 0,487; p<0,001). Our results show that in the studied healthy elderly cohort sclerostin levels significantly increase with age, along with the deterioration of kidney function as determined by plasma cystatin C levels. ]

LAM KID

[Recognition of the characteristics of rare types of arthritis]

ROJKOVICH Bernadette, MÉSZÁROS Györgyi

[Recognition of the characteristics of arthritis is crucial for making a correct diagnosis. Several aspects of the history and physical examination could help the diagnosis, such as the mode of onset (acute, insidious), duration of symptoms (self-limiting, chronic), number of affected joints (mono-, oligo-, polyarthritis), distribution of joint involvement (symmetrical, asymmetrical), localisation of affected joints (axial, peripherial) and sequence of involvement (additive, migratory, intermittent). Other important aspects for the correct diagnosis are the characteristics of the patient (gender, age, family history) and the presence or absence of extra-articular features of disease. The articular pattern may change with time in the course of a disease, and the single clinical pattern of joint disease may correspond to more than one diagnosis. Evidence of some distinct articular patterns may limit the spectrum of diagnostic options and reduces unnecessary diagnostic testing. The diagnostic process may require the addition of laboratory examination, imaging techniques, and other tests to refine the analysis. In this article, we report a case where joint punction and histological elucidation was necessary to make the correct diagnosis, because a syndrome of acute, destructive sterile arthritis mimicking articular infection might be present in a variety of joint disorders. In this paper, we highlight those characteristics that are distinctive for particular rheumatological disorders, in order to help starting treatment early.. In a substantial number of patients the cause of the diseases remains undetermined. However, a detailed anamnesis and physical examination remain the cornerstone of a diagnostic evaluation.]

LAM KID

[Short history of lactose: nutrition, growth of population and disease]

BALLA Bernadett

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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.

Lege Artis Medicinae

[Risk of nonsteroidal antiinflammatory drugs. Focus on aceclofenac]

FARSANG Csaba

[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deterio­rate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable.]

Clinical Neuroscience

Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

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.

Clinical Neuroscience

Neuroscience highlights: The mirror inside our brain

KRABÓTH Zoltán, KÁLMÁN Bernadette

Over the second half of the 19th century, numerous theories arose concerning mechanisms involved in understanding of action, imitative learning, language development and theory of mind. These explorations gained new momentum with the discovery of the so called “mirror neurons”. Rizzolatti’s work inspired large groups of scientists seeking explanation in a new and hitherto unexplored area of how we perceive and understand the actions and intentions of others, how we learn through imitation to help our own survival, and what mechanisms have helped us to develop a unique human trait, language. Numerous studies have addressed these questions over the years, gathering information about mirror neurons themselves, their subtypes, the different brain areas involved in the mirror neuron system, their role in the above mentioned mechanisms, and the varying consequences of their dysfunction in human life. In this short review, we summarize the most important theories and discoveries that argue for the existence of the mirror neuron system, and its essential function in normal human life or some pathological conditions.

Clinical Neuroscience

A variant of Guillain-Barre syndrome after SARS-CoV-2 vaccination: AMSAN

TUTAR Kaya Nurhan, EYIGÜRBÜZ Tuğba, YILDIRIM Zerrin, KALE Nilufer

Introduction - Coronavirus disease 2019 (COVID-19) is a respiratory infection that has rapidly become a global pandemic and vaccines against SARS-CoV-2 have been developed with great success. In this article, we would like to present a patient who developed Guillain-Barré syndrome (GBS), which is a serious complication after receiving the inactive SARS-CoV-2 vaccine (CoronaVac). Case report – A 76-year-old male patient presented to the emergency department with nine days of progressive limb weakness. Two weeks prior to admission, he received the second dose of CoronaVac vaccine. Motor examination revealed decreased extremity strength with 3/5 in the lower extremities versus 4/5 in the upper extremities. Deep tendon reflexes were absent in all four extremities. Nerve conduction studies showed predominantly reduced amplitude in both motor and sensory nerves, consistent with AMSAN (acute motor and sensory axonal neuropathy). Conclusion - Clinicians should be aware of the neuro­logical complications or other side effects associated with COVID-19 vaccination so that early treatment can be an option.