Lege Artis Medicinae

[Benefits of the combination therapy of multiple cardiovascular risk factors and further advantage of the single-pill form]

CSÁSZÁR Albert

APRIL 20, 2012

Lege Artis Medicinae - 2012;22(04)

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Lege Artis Medicinae

[Ethical Issues in Psychotherapy – Part I]

KOVÁCS József

Lege Artis Medicinae

[Roma cancer patients’ illness cognition and their attitudes toward medical treatment]

ROHÁNSZKY Magda, NÓTÁR Ilona, SZABÓNÉ Kármán Judit, KONKOLY THEGE Barna

[INTRODUCTION - In this qualitative pilot study, our goal was to investigate the illness representation of gipsy cancer patients and to examine their attitudes toward medical treatment. SAMPLE AND METHODS - Deep interviews were made with 20 persons (60% female; Mage=39.2±15.1 years). The included participants approximately represented the group composition of the Hungarian Roma population. RESULTS - For most of our respondents, cancer is a frightening disease meaning some kind of punishment and the end of life. The potential causes of the disease usually remain completely incomprehensible. The participants proved to be very under-informed in relation to their treatment - even when compared to the low level of information among Hungarian cancer patients in general. In the face of the supporting presence of family members, our respondents often stated that there was nobody to share their deeper emotional problems with. About half of the patients reported on impolite and inefficient treatment attributed to prejudice against their Gipsy identity. However, deeper analyses revealed, that in most of these cases, mistreatment was a consequence of the general shortcomings of the health care system (e.g. lack of time) - being labelled as discrimination by our respondents. Almost every participant sees his/her only role in recovery merely in the participation in medical treatment - not attributing enough significance to life style changes and even less to alternative / complementary medicine. CONCLUSION - Special training to improve communication skills with gipsy patients is needed - especially for general practitioners. We also suggest preparing handouts to Roma cancer patients that provide easy-to-understand information on the medical treatments and health behaviours that serve the coping with cancer and their prevention.]

Lege Artis Medicinae

[What have we flawed and what went wrong?]

BALOGH Sándor

Lege Artis Medicinae

[Inhibitors of the renal sodium-glucose cotransporter: possible new drug in armamentarium of diabetologists]

BECHER Péter, PATAI Árpád, MÁJER Katalin

[An important aim of diabetologists is prescribing modern antidiabetic drugs with not only glucose lowering but also an insulin sensitivity increasing property with weight loss without hypoglycaemic episodes and with positive effects on the pancreatic β-cells. A selective inhibition of the renal sodium-glucose cotransporter 2 protein leads to glucosuria, reduces HbA1c and body weight without hypoglycaemias. This benefits can also moderate the cardiovascular risk in diabetic patients. At the moment this molecules are under examination in different phase clinical studies. It seems that the first drug from this group for the clinical use will be the molecule dapagliflozin. The main side effect may be a vulvovaginal mycotic infection.]

Lege Artis Medicinae

[Surveillance-examination in the department of internal medicine of a frequented hospital]

SCHAREK Petra, LÉTAY Erzsébet, KATONA Katalin, RÓKUSZ László

[OBJECTIVES - In November 2010, wescreened patients admitted to the MilitaryHospital, 1st Department of Internal Medi-cine for meticillin-resistant Staphylococcusaureusand Gram-negative, extended spec-trum beta-lactamase producing bacteria.We detected the prevalence of colonisationor infection by these strains during hospitalstay. METHODS - We compiled a datasheet toregister patient data and results. Swabsfrom one of the anterior nares, the throatand the rectal area were taken at admissionand discharge after informed consent of thepatients. Microbiological samples wereprocessed by current microbiology guide-lines. RESULTS - During the one-month studyperiod, 134 adult patients were admitted,105 of who consented to the examination.At admission, six patients (5.7%) carriedmeticillin-resistant Staphylococcus aureusand five patients (4.76%) carried extendedspectrum β-lactamase producing Esche-richia coli. In one patient (0.95%) nosoco-mial extended spectrum β-lactamase pro-ducing Enterobacter cloacaewas identifiedin the rectal sample. In two patients (1.9%),rectal colonisation by Streptococcus pyogeneswas detected. CONCLUSIONS - Screening patients formeticillin-resistant Staphylococcus aureusin our department is important because ofthe high rate of patients returning to thehaematologic department, and consideringthat 4.5% of patients admitted to ourDepartment were transported to surgicaldepartments in 2010. It is particularlyimportant to determine the sampling location. The prevalence of rectal colonisatonby extended spectrum β-lactamase produc-ing bacteria was in accordance with international data. We didn’t detect infectionprovoked by the examined bacteria duringthe study period.]

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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.

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.

Hypertension and nephrology

[About the care of patients with hyperuricaemia and gout]

[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.]

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.]

Clinical Neuroscience

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]