Lege Artis Medicinae

[Can be human behavior predicted?]

DARUKA István

NOVEMBER 20, 2014

Lege Artis Medicinae - 2014;24(10-11)

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Lege Artis Medicinae

[Education and psychological support of parents in cases of postnatally detected Down syndrome]

MÁTÉ Orsolya, KÍVÉS Zsuzsanna, OLÁH András, FULLÉR Noémi, PAKAI Annamária

[OBJECTIVE - Since the 60’s several publications dealt with the phenomenon how physicians inform parents of newborns about postnatal recognition of Down’s syndrome and the support they receive right after breaking the bad news. Howe - ver, the rest of these studies concentrated on surveying parental satisfaction, while relatively few international studies deal with the other side of the communicational situation, the opinion of the informer. Our study focused on the circumstances of parental information in Hungarian institutions of obstetrics in order to evaluate the possibilities for interventions. METHODS - The Down’s team operating at the University of Pécs Faculty of Health Sciences carried out a national survey in 2005 - an interview-based questionnaire filled by physicians of institutions of obstetrics - with the help of the National Register for Congenital Diseases of the National Centre for Epidemiology and Down’s Foun dation. RESULTS - The coverage of the survey reached 74%. Rest of the surveyed institutions did not have information protocol, however, 70% of them believes it would be necessary. Only 44% of the physicians received communication training and 81% of them believe they can manage communication, 33% have felt that the mother of a newborn with Down’s syndrome would expect special help that the institutions are unable to provide. CONCLUSION - There are serious problems with the circumstances of parental informing in Hungarian institutions of obstetrics. This situation would obviously require intervention. An aimed communicational training based on international experience and exploiting the openness of physicians, as well as the establishment of information protocol could be elements of such intervention.]

Lege Artis Medicinae

[Vortioxetin, the new antidepressant]

ÁGOSTON Gabriella

Lege Artis Medicinae

[The prevalence of musculoskeletal symptoms among ambulance personnel in a national subsample]

PÉK Emese, BÁNFAI Bálint, DEUTSCH Krisztina, JEGES Sára, BETLEHEM József

[BACKGROUND - The ambulance workers face a lot of mental stress and physical demands in their everyday life. The physical demands can be originated from caring heavy equipment and moving patients. The poor mental health can strengthen physical problems, too. In this study our aim was to detect and compare the musculoskeletal status of ambulance personnel in two regions of Hungary. SAMPLE AND METHODS - On a voluntary base a cross-sectional anonymous, standardized self-fill-in questionnaire (Nordic Musculoskeletal Questionnaire) was used with additional items. All ambulance personnel over 18 years old were involved in the study who worked in direct patient care either in the North-Hungarian or in the West-Hungarian Region of the country. RESULTS - In the regional representative sample N=810 workers answered our questions. Out of them 587 persons (72.5%) reported about some musculoskeletal problem during his lifespan. Most of them suffered from lower back pain (448 persons, 55%), back pain (318 persons, 39%), neck pain (250 persons, 30.9%). Parallel with the aging and with the time spent working for the ambulance service more and more overall discomfort can be detected (p=0.013; p=0.020). Having a second job affected the level and frequency of discomfort negatively (p=0.005). CONCLUSIONS - More than 70% of the ambulance workers experienced musculoskeletal problem during his emergency workers carrier which may worsen the quality of his work and his personal life. To handle the situation primary prevention, screening and possibilities for recreation should be forced among ambulance workers. ]

Lege Artis Medicinae

[Investigation of vitamin D supply in hospitalized patients]

FATA Emőke, ÁGOTA Katalin, HORVÁTH Dóra Eszter, VIRÁGH Éva, KÁNYÁSI Mária, KOVÁCS LÁSZLÓ, BALOGH Dóra, SCHAFFER Éva, OLÁH András, LŐCSEI Zoltán, SALAMON Antal, TOLDY Erzsébet

[Recent studies have shown that adequate vitamin D level is essential in the maintenance of normal immunological status and presumably, it has a remarkable role even in the healing of some diseases. Vitamin D deficiency is a common phenomenon worldwide. Presently, the accepted marker of vitamin-D status is the total-25-hydroxy- D-vitamin [t-25(OH)D], its level depends on the specific (DBP) and aspecific (albumin) binding proteins. As known, the level of binding proteins may change in the hospitalised patients therefore, the presently used marker could not be reliable for the vitamin status in these cases. Our aim was to measure the D-vitamin supply among hospitalized patients, taking into account the level of binding proteins. METHODS - 401 cases (average age 70±14 years) were sorted from Internal Medicine (IM; 68), Intensiv Care Unit (ICU; 58), Traumatology (203 patients suffered hip fracture) and Dialysis Center (72 patients with end stage renal disease). 127 age and sex matched persons with active lifestyle served as control group. We determined t-25(OH)D, DBP, parathormon (PTHi), albumin and the albumin corrected Ca level. The bioavailable and free vitamin fractions and the free index were calculated. RESULTS - Based on the measured t- 25(OH)D, patients have more frequently suboptimal D-vitamin levels, compared to the control group (66% vs. 97%). Severe Dvitamin deficiency occured nearly 8 times more likely (6% vs. 47%) in the hospitalized patients. Chronic renal failure and malignant diseases seem to be significantly negative influencing factors in the metabolism of the vitamin D. The level of DBP, albumin, t-25(OH)D, Bio-25(OH)D was significantly lower in the patients who died. CONCLUSION - In most cases, t-25(OH)D levels show similar results about the vitamin- D supply than other calculated 25(OH)D fraction ,except for the patients of ICU and IM . The t-25(OH)D, the Bio- 25(OH)D, the DBP and the albumin levels seem to be a good prognostic marker of the outcome.]

Lege Artis Medicinae

[How can the fixed-dose atorvastatin/amlodipin combination help better adherence of patients to therapy?]

KIRÁLY Csaba, BENCZÚR Béla

[Among the main risk factors of cardiovascular disease which is the leading cause of death dyslipidemia has a great importance beyond hypertension, diabetes, smoking and obesity. These conditions rarely occure as isolated ones but very often a clustering of major CV risk factors within individual patients can be observed called metabolic syndrome. It’s a great challenge to convince asymptomatic but high-risk adults that they have to take a lot of medicine for a long time period uninterruptedly to prevent future vascular events (eg. MI or stroke) in the primary care settings. Mainly the low statin-adherence means the greatest problem particularly if a subject should take statin beside two or more drugs despite statins have the most prominent evidences in the field of cardiovascular prevention. The efficacy in improving adherence to therapy of fixed-dose atorvastatin/amlodipin combination was investigated in this paper based on the experiences of case reports derived from our clinical practice.]

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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.]

Clinical Neuroscience

[The Comprehensive Aphasia Test in Hungarian]

ZAKARIÁS Lilla, RÓZSA Sándor, LUKÁCS Ágnes

[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]

Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]

NEMCSIK János, BATTA Dóra, KŐRÖSI Beáta, RIHMER Zoltán

[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

Lege Artis Medicinae

[Thiazide- or thiazide-like diuretics should be used in the treatment of patients with hypertension? Particularities of the situation in Hungary]

VÁLYI Péter

[Diuretics have remained the cornerstone of the antihypertensive treatment since their widespreading in the 1960s. According to the 2018 ESC/ESH Guidelines for the management of arterial hypertension, in the absence of evidence from direct comparator trials and recognizing that many of the approved single-pill combinations are based on hydrochlorothiazide, this drug and thiazide-like indapamide can be considered suitable antihypertensive agents. In the 2018 Hungarian guidelines indapamide is named as the most efficacious diuretic in the treatment of patients with hypertension. The aim of the publication is redefining thiazide- and thiazide-like diuretic use in the treatment of hypertensive patients, with particular attention to presently available hydrochlorothia­zide and indapamide, and their combination drugs in Hungary.]