Lege Artis Medicinae

[2022 Annual Interdisciplinary Forum of MOTESZ]

MAY 26, 2022

Lege Artis Medicinae - 2022;32(04-05)

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Lege Artis Medicinae

[Blood pressure variability and its clinical importance]

KÉKES Ede, VÁLYI Péter

[The 24-hour and longer-term (weeks, months, years) as well as seasonal, regional variations and fluctuations of blood pressure have been known for long time in both normotensive and hypertensive patients. It is also well known and established that blood pressure variability is greater in patients with more severe hypertension and in the elderly population. In the last decade and actually, the variability of blood pressure has come into new light by meticulous analysis of numerous causal factors and consequences influencing its fluctuation. The real diagnostic and prognostic value of blood pressure variability and its role in the assessment of successful antihypertensive treatment have also been favoured. In our review, we summarise the physiological and pathophysiological principles of blood pressure variability, including also the significant importance of allostasis in the new approach. We overview the methods of measuring the blood pressure variability and its real importance related to the results obtained. We analyse the importance of non-adaptive levels of blood pressure variability in asymptomatic cases and apparent conditions, further in diagnostic projections and monitoring the treatment. Based on our own experience, we also present the future options of exploring the fluctuating blood pressure.]

Lege Artis Medicinae

[Options for assessing the quality of postoperative pain relief: multidimensional measurement tools]

LOVASI Orsolya, GAÁL Péter, LÉBER Andrea, LÁM Judit

[Inadequat treatment of postoperative pain may have several adverse consequences. Its effective and efficient management requires regular pain assessments with valid and re­liable pain assessment tools. The main features of unidimensional pain assessment scales were discussed in our previous paper. Their most important disadvantage is that they measure only the pain intensity, which did not necessarily provide sufficient and re­liable basis for clinical decision making. The main goal of this paper is to review multi­dimensional measurement tools for assessment of postoperative pain, their main components, and applications based on summary of the relevant literature. While using the PICO (population, intervention, control, and outcomes) technique of systematic literature research, we identified 396 accessible and evaluable articles in total, from which we summarize the results of the most important 41 English and 4 Hungarian publications. Among the multi­dimensional pain assessment tools we discussed thoroughly the American Pain So­ciety Pa­tient Outcome Questionnaire (APS-POQ-R), the Swedish Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP) questionnaire, and the characteristics of the patient outcome questionnaire of the German Quality Im­provement in Postoperative Pain Mana­ge­ment Project (QUIPS). Contrasted to unidimensional scales, multidimensional measurement tools do not evaluate only the intensity of pain, but its other dimensions, and psychosocial aspects. Thus they give a more accurate picture of its nature, however, their application of specific scales requires more time and diligence, and the scope of patients is more restricted. Consequently, unidimensional scales are more suitable for supporting the clinical practice, in cases where the multidimensional questionnaires cannot be used. In contrast, whenever the circumstances permit, multidimensional scales should be used, especially for quality improvement and research purposes.]

Lege Artis Medicinae

[The importance of continuous glucose monitoring in modern diabetes care]

KOCSIS Gyôzô

[It is no exaggeration to say that there is a paradigm shift in the diabetes care. Since 2015, the driving force behind are primarily the widely spreading sensor technologies instead of the new insulin products and treatment regimens. The rapidly spreading sensor technologies are applied in more and more countries financially supported in type 1 diabetes since 2015. The use of Continuous Glucose Monitoring (CGM, tissue glucose sensor, simplified as sensor), which includes both real-time CGM (RT-CGM) and intermittently scanned CGM (isCGM), has grown rapidly over the past few years by improving sensor accuracy, greater convenience and ease of use, and expanding support of reimbursement. Numerous studies have demonstrated the significant clinical benefits of using CGM in diabetic patients, regardless of the type of insulin treatment. In this summary, we review the practical aspects of glucose monitoring, the optimal frequency of monitoring, the effectiveness, re­liability, and role of continuous glucose mo­­nitoring systems.]

Lege Artis Medicinae

[The effect of COVID-19 pandemic on eating disorders]

BABUSA Bernadett, TÚRY Ferenc

[The COVID-19 pandemic increased the incidence of many mental disorders inclusive that of eating disorders as it was realised in case of anorexia nervosa, bulimia nervosa, and other eating disorders. As a result, eating disorder symptoms were worsening and the relapse rate became higher. In the back­ground the following factors may have played an important role: change in the food availability, increase of fearing weight gain, the impact of social media, some special webpages became more important in the light of social isolation, social comparison became more pronounced, exercise limitations, negative effects of stressful life events as the increase of family conflicts. The mental health consequences of pandemic highlight the importance of psychoeducation, primary and secondary prevention in the field of eating behaviours as well. ]

Lege Artis Medicinae

[The significance of recognising spinal muscular atrophy]

CSÁTI Anett, KLIVÉNYI Péter

[Spinal muscular atrophy (SMA) is a rare autosomal recessive, progressive neuromuscular disorder leading to severe proximal muscle weakness and atrophy. The spectrum of dis­ease severity ranges from early onset severe form to the slowly progressive adult-onset type. Milder and adult forms of SMA are underdiagnosed. Due to understanding the genetic background of SMA, an increasing number of disease-modifying treatment options have become available in recent years, responsible for the modification of the natural course of the disease. Updated consensus statement for standard of care is necessary. Besides the motor function alterations, health-related quality of life measurements are highlighted for estimating the impact of SMA, and the effectiveness of specific the­rapies.]

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Related contents

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

[A short chronicle of three decades ]

KAPRONCZAY Katalin

[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]

Clinical Neuroscience

[Epidemiology, cost and economic impact of cerebral palsy in Hungary]

FEJES Melinda, VARGA Beatrix, HOLLÓDY Katalin

[Objective - The purpose of our communication was to determine the total cost of cerebral paretic patients in Hungary between 0 and 18 years and to assess their impact on the national budget. Methods - Based on the data of Borsod county we calculated the CP characteristics. The cost of CP was determined by routine care of individuals. Lost Parental Income and Tax were calculated on the basis of average earnings. The ratio of GDP, Health and Social Budget and Health Budget to CP is based on CP annual average cost and frequency. We have developed a repeatable computational model. Results - Of the risk groups, premature birth (30.97%), low birth weight (29.64%), perinatal asphyxia (19.47%) were the most common. Source is unknown of 37.61% of the cases. CP prevalence was 2.1‰. The two-sided (59.7%) and the one-sided (19.0%) spastic pareses dominated. The most serious form is the two-sided spastic paresis (42.5% GMFCS 3-5 degrees). Epilepsy was 22.0%, incontinence was 27%, mental involvement was 46%. Care for one child up to 18 years of age costs an average of 73 million HUF (€ 251,724). The lost family income was 27.36 million HUF (€ 94,345), and lost tax and health care contributions were 14.46 million HUF (€ 49,862). Additionally, 0.525% of the GDP, 0.88% of the full health and social budget and 1.83% of direct medical costs were spent for CP families. Conclusion - The cost of CP disease is significant. Costs can be reduced by improving primary prevention. From the perspective of the family and government, it is better to care for families so they can take care of their disabled children.]

Hypertension and nephrology

[May measurement month: analysis of the Hungarian results of years 2017 and 2019]

NEMCSIK János, PÁLL Dénes, JÁRAI Zoltán

[Cardiovascular (CV) diseases are not only the leading causes of mortality in Hungary, but also the mortality rate is excessively high compared with the average of European Union, so screening programs identifying subjects with elevated blood pressure (BP) is of utmost importance. May Measurement Month (MMM) is an annual global initiative which began in 2017 aimed at raising awareness of high BP. Hungary, through the Hungarian Society of Hypertension has joined the campaign of MMM from the beginning. The results of years 2017 and 2019 are presented in this paper. ]

Clinical Neuroscience

[Is second-line immunomodulatory treatment effective in multiple sclerosis?]

RÁCZ Lilla, BERÉNYI Ervin, BARSI Péter, BERNÁTH Dávid, CSÉPÁNY Tünde

[Purpose - Natalizumab is the first evidence based monoclonal antibody, which was launched for treatment in relapsing remitting multiple sclerosis in Hungary in 2010. Standardized follow-up is required to use it. Our aim was to evaluate the efficacy and to monitor the safety of natalizumab treatment by using an electronic database established for MS registry. Clinical activity was measured by annual relapse rates, functional status of patients measured by EDSS and MFSC. Radiological activity was evaluated by standard MRI protocol. Data, results of MS patients and side effects of natalizumab treatment were recorded in iMed software. Results - 31 patients started the natalizumab treatment after 6.5±5.8 years from the onset of MS. The efficacy of treatment was evaluated after a mean of 67 (min: 14 max: 128) infusions in December 2016. The drop-out rate was low, due to the presence of neutralising antibodies in one case, pregnancy in two cases and development of malignant disease in one case which was not related to the natalizumab treatment. The treatment was well tolerated with excellent compliance without serious side effects. The annual relapse rate reduced from a mean of 1.7 to 0.03 (p<0.000001) in the first 12 months of treatment compared to the pretreatment 12 month activity, and it stayed at low level during the whole follow up. EDSS was stable or improved with an exception of two cases. In 23 subjects (77%) lack of new/enlarging T2 lesions and lack of gadolineum-enhancing lesions on MRI were observed. 18 patients (60%) had no evidence of disease activity (NEDA-3). PASAT test improved in most of the cases. Conclusion - The natalizumab therapy was very effective in all cases including those patients who had active disease under the previous immunomodulatory treatment.]