[Brave new world?]
KAPÓCS Gábor
MARCH 26, 2024
Lege Artis Medicinae - 2024;34(3)
KAPÓCS Gábor
MARCH 26, 2024
Lege Artis Medicinae - 2024;34(3)
Szöveg nagyítása:
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Lege Artis Medicinae
[Migraine is a headache disorder affecting 14% of general population, being even more prevalent (20%) among women in the 20–64 age group, who are actively working and are mainly at reproductive age. 18–25% of migrainous women have an attack related to menstrual cycle, 7% of them having an attack only at this period. Fluctuation of estrogen level may be responsible for these attacks, we can use NSAIDs, slowly acting triptans or progestin-only treatment as short-term prophylaxis. Hormonal contraception is not contraindicated in migraine. Combined (estrogen+progestin) treatment is proposed only in migraine without aura, but in case of more frequent and/or severe attacks or the appearence of an aura treatment should be stopped. In migraineurs with elevated risk of stroke combined hormonal contraception should be used with caution. In migraine with aura patients progestin-only contraception is possible. During pregnancy in 55–91% of migraineus women attacks disappear or are less severe. In most cases migraine with aura attacks occur during this period. Non-pharmacological treatments should be considered as first in the treatment off attacks, with consideration of risk/benefit ratio paracetamol, metamizol or triptans may be used. With the menopause in 2/3 of patients migraine gets better but because of the fluctuation of hormon levels it can be worse than before. Hormonal replacement therapy is not contraindicated in migrainous women but it can result in worsening of migraine. ]
Lege Artis Medicinae
[Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia that can lead to thromboembolic events, including cerebral vascular catastrophe and peripheral embolization. AF treatment while managing directly the arrhythmia aims anticoagulation therapy and prevention of thromboembolic events too.
This study overviews the factors influencing the risk of bleeding while managing AF, and focuses especially on appropriate anticoagulant choice, its tailored use to patient characteristics, management of comorbidities and strategies of reducing risks of bleeding.
This analysis compares the efficacy and safety of specific anticoagulants (VKA, DOAC) while considering the patient characteristics such as renal function and comorbidities in anticoagulation treatment.
The risk of bleeding can be reduced by appropriate anticoagulant choice and its patient-specific administration. Consideration of comorbidities is a key issue to ensure safe and effective treatment. VKA requires maintenance of stable INR values, while DOACs lead to fewer major bleeding events. For planned and emergency interventions, the use of bleeding risk reduction strategies is also important. Consideration of patient characteristics, such as renal function and comorbidities, as well as appropriate anticoagulant choice and use are essential to ensure efficient and safe anticoagulation therapy.
]
Lege Artis Medicinae
[Indication for recanalization therapy of acute ischemic stroke is based on imaging procedures. In order to minimize the time loss passing by recognizing the condition and the transfer of images to other facility, we established a stroke imaging network (eStroke network) supported by Artificial Intelligence (AI) in Hungary. Our study aims to present this system.
Organized by the National Institute of Mental Health, Neurology, and Neurosurgery (NIMNN), we included a total of 28 stroke centers, among them 4 thrombectomy centers. An earlier network of the University of Pécs and the widened network parallel with the NIMNN project cover 10 centers thus the service is now available in 38 stroke centers of this country. Stroke CT scans are automatically transmitted via the central teleradiology server to a central image processing server which analyzes the size of the ischemic area (ASPECT score), detects large vessel occlusion and it’s localization, analyzes the quality of collateral circulation and standard CT perfusion parameters using an AI based software (eStroke, Brainomix Ltd.). Results and processed images are sent automatically back to the PACS system of the sending institution and that of the concerning thrombectomy center and become available in anonymous form via cloud by desktop computers or mobile application.
During the first year of operation, the system has processed 38,060 scans of 16,276 patients. In NIMNN experience by samples of 65 and 152 cases, for drip and ship patients the time from the first alerting of the ambulance service, until arrival at the thrombectomy center was reduced by 38 minutes from 4:18 to 3:40 minutes.
Building an AI based central stroke imaging network for improving of stroke care’s results is technically feasible. Operation of the eStroke system is capable of reducing patient transportation times, however, further optimization is needed. ]
Lege Artis Medicinae
[Diabetic neuropathy is an early detectable microvascular complication of diabetes. Most often, we can recognize it by its symptoms of distal-type symmetric polyneuropathy, further the damage to the autonomic nervous system is increasing the cardiovascular mortality. Screening for diabetic neuropathy is essential in clinical practice, since the signs of nerve damage related to diabetes can be detected at an early stage and open the way to therapeutic interventions. Proper diagnosis and continuous monitoring of diabetic neuropathy is also important during the patient care. This summary concerns the importance and diagnostic options of diabetic neuropathy for clinical practice.]
Lege Artis Medicinae
[After a serious brain injury or trauma, there is damaged the functional capacity of the affected persons and their self-image too. Traditional rehabilitation pays little attention to the female patients’ lost femininity. The aim of this study was to present the way of supporting women to realize again their femininity psychologically and physically alike after a brain injury.
In the Brain Injury Rehabilitation Unit of the National Institute for Medical Rehabilitation, the authors completed the female patients’ rehabilitation with special group sessions once a week. The topics were tailored to the needs of participants. There were targeted two specific objectives: achieving to perceive femininity in an autonomous way and regaining the feeling of femininity in the changed life circumstances due to the injury.
Occupational therapist, physiotherapists and nurses provided service to develop functional abilities. A psychologist helped the participants in trauma processing. Since the beginning in January 2022, two therapy cycles have been completed so far, each of which with 10-12 sessions. A total of 31 female patients and 8 supporting team members participated in these two groups so far.
Personalised rehabilitation was adjusted to the involved persons’ life circumstances, individuality, personality, family and social relations. Our experimental female group helped the participants to experience their femininity physically, mentally and psychologically too, according to their feedback.]
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
[The rapidly spreading SARS-CoV2 respiratory virus has evoked an epidemic with serious aftermath around the world. In addition to the health effects, the global economic damage is actually unpredictable. At the same time, the pandemic has launched a series of unprecedented collaborative scientific research, including the development of vaccines. This study summarizes up-to-date information on vaccines, immune memory, and some emerging clinical effects.]
Lege Artis Medicinae
[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
[Spinal muscular atrophy (SMA) is an autosomal recessive disease leading to progressive muscle weakness and atrophy, in severe cases also affecting the bulbar and respiratory muscles.The clinical spectrum of the disease is extremely variable, in the most severe cases resulting in perinatal death, while at the least severe end of the spectrum causing some motor deficits in old age without the loss of ambulation.]
Lege Artis Medicinae
[Three decades ago, LAM was launched with the goal of providing scientific information about medicine and its frontiers. From the very beginning, LAM has also concerned a special subject area while connecting medicine with the world of art. In the palette of medical articles, it remained a special feature to this day. The analysis of the history of LAM to date was performed using internationally accepted publication guidelines and scientific databases as a pledge of objectivity. We examined the practice of LAM if it meets the main criteria, the professional expectations of our days, when publishing contents of the traditional printed edition and its electronic version. We explored the visibility of articles in the largest bibliographic and scientific metric databases, and reviewed the LAM's place among the Hungarian professional journals. Our results show that in recent years LAM has gained international reputation despite publishing in Hungarian spoken by a few people. This is due to articles with foreign co-authors as well as references to LAM in articles written exclusively by foreign researchers. The journal is of course full readable in the Hungarian bibliographic databases, and its popularity is among the leading ones. The great virtue of the journal is the wide spectrum of the authors' affiliation, with which they cover almost completely the Hungarian health care institutional system. The special feature of its columns is enhanced by the publication of writings on art, which may increase Hungarian and foreign interest like that of medical articles.]
1.
Clinical Neuroscience
[Headache registry in Szeged: Experiences regarding to migraine patients]2.
Clinical Neuroscience
[The new target population of stroke awareness campaign: Kindergarten students ]3.
Clinical Neuroscience
Is there any difference in mortality rates of atrial fibrillation detected before or after ischemic stroke?4.
Clinical Neuroscience
Factors influencing the level of stigma in Parkinson’s disease in western Turkey5.
Clinical Neuroscience
[The effects of demographic and clinical factors on the severity of poststroke aphasia]1.
2.
Clinical Oncology
[Pancreatic cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up]3.
Clinical Oncology
[Pharmacovigilance landscape – Lessons from the past and opportunities for future]4.
5.