Lege Artis Medicinae

[Changes in the medical-ethical and legal understanding of tissue and organ transplantation I.]

MATKÓ Ida

NOVEMBER 30, 1994

Lege Artis Medicinae - 1994;4(11)

[The possibility of tissue and organ transplantation is undoubtedly one of the most important advances in modern medical science. At the same time, they are more intertwined with ethical and legal issues than any other medical intervention and depend crucially on the consent of people outside the patient.]

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Lege Artis Medicinae

[The use of in situ hybridization in basic biomedical research and clinical medicine]

MIHÁLY András

[The essential purpose of in situ hybridization is the histochemical and/or autoradiographic detection of specific nucleic acid sequences in cells, tissues or chromosomes. The method is based on the use of artificially manufactured DNA or RNA fragments which are label led with isotope, enzymes, biotin or digoxigenin. The specific attachment of these labelled single-stranded nucleic acid probes to intra nuclear or intracytoplasmic nucleic acids can be used for the study of gene expression, for the establishment of viral infections, for the diagnosis of specific tumours and for the detection of hereditary diseases and chromosomal aberrations. The present review discusses the molecular basis of the method, the possibilities of labelling and detection and various other applications.]

Lege Artis Medicinae

[The role of nutrition in the etiology and prevention of dental caries]

BÁNÓCZY Jolán

[Nutritional factors play an important role in the development of both dental caries and periodontal diseases. Dental caries is a multi factorial disease. The changes in the composition and accumulation of dental plaque, caused by physical and chemical components of the diet, are influenced by quantitative, qualitative and frequency factors of carbohydrate consumption. In the course of bacterial degradation of consumed sugars, acids are formed on the tooth by inherent dental plaque monosaccharides, and enamel demineralization occurs. Due to the multifactorial etiology of dental caries, prevention is a complex activity. In addition to fluoride prevention, appropriate oral hygiene measures, directives for a healthy diet, changes in life-style and behaviour are also important factors. For the elimination of the deleterious influence of carbohydrates, the decrease of between-meal snacks, and the use of non-acidogenic sugar substitutes (xylitol) is recommended, which might contribute to a decrease in the high caries prevalence rates in Hungary. ]

Lege Artis Medicinae

[Activated protein c response: a novel disorder causing thrombophilia]

PÁL András, SAS Géza, HAYNAL Imre, VAJDA Zoltán, KUNCZ Gabriella, MOHAMED A. Lateiwish, RÓNA Tas Ágnes

[In 1993 Dahlbäck described the so-called in vitro activated protein C response phenomena, according to which, the addition of activated protein C to citrated plasma samples prolongs the activated partial thromboplastin times. It was hypothesised that this phenomenon is the result of the action of a new protein C cofactor, and in 1994, Dahlbäck demonstrated that this phenomenon is linked to variations of the factor V, which surprisingly serves as a cofactor for protein C. In this study, forty-one highly selected thrombophilic patients and forty controls were investigated for the activated protein C response phenomenon. The response to activated protein C was expressed as the ratio of two activated partial thromboplastin times, the first in the presence of and the second in the absence of activated protein C. Eighteen patients demonstrated a decreased response, i. e. the ratio of the times was below 2.0 (mean 1.3). The average of the entire group was 1.86. The average ratio of the control group was 3.12, and there were 2 persons with ratios below 2.0. The results of this study correspond with the data in the literature. This newly recognised phenomenon may be responsible for the majority of the formerly unrecognised biochemical defects leading to the clinical picture of thrombophilia. ]

Lege Artis Medicinae

[Treatment for simplex glaucoma, eye drops or early surgery?]

HOLLÓ Gábor

[Primary open-angle glaucoma (simplex) occurs in -0.5-2% of the European population over 40 years of age and is one of the most common causes of blindness in countries with good public health. The visual field and visual impairment that has already developed with glaucoma is irreversible, so diagnosing the disease at an early stage and starting treatment at an early stage is a prerequisite for saving sight. Unfortunately, initiating treatment does not mean that retinal ganglion cell death and the resulting visual field loss will disappear. Although its rate slows down, progression can be detected in a significant proportion of eyes even with treatment. This is why the focus of glaucoma research today is to analyse the long-term efficacy of treatment.]

Lege Artis Medicinae

[News]

[MOTESZ is admitted to the European Union of Medical Specialists (UEMS); Hungarian-French medical education seminar; Smoking in the third trimester hinders foetal development; In Canada, cigarettes will only be sold in plain packaging in the future; Smoking during pregnancy can cause asthma in the unborn child; Smoking or health centre in NEVI; Smoking ban has not reduced restaurant sales in the US; Smoking during pregnancy can cause limb developmental abnormalities in the foetus; Dr. Zoltán Ajkay's five studies on health insurance reform; Diagnostic centre in Pécs; International meeting in Balatonszárszó; New information centre in Budapest;]

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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.

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Cases of inborn errors of metabolism diagnosed in children with autism

CAKAR Emel Nafiye, YILMAZBAS Pınar

Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

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.

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

[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.]