Lege Artis Medicinae

[Changes to the Mind ]

TAKÁCS Szilvia

SEPTEMBER 22, 2013

Lege Artis Medicinae - 2013;23(09)

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Lege Artis Medicinae

[Efficacy and safety of apixaban compared with warfarin according to patient risk of stroke and of bleeding in atrial fi brillation: a secondary analysis of a randomised controlled trial]

LIPTÁK Judit

Lege Artis Medicinae

[A Hungarian Textbook on Medical Anthropology]

BUDA Béla

Lege Artis Medicinae

[Drug use and death-seeking behaviour attitudes toward death among opiate users]

PAP Ágota, HEGEDÛS Katalin

[Many times, behind mens’ fears there is the fear of death. Drug use can be defined as a kid of self destruction, so it is directly linked to attitudes toward death. In Hungary, suicide among young people is one of the leading causes of death, which is often associated with some kind of addiction or substance abuse. We can also say that drug use is an indirect way of “death search”, which prolongs the agony and the time of suffering. Drug-related death can be directly attributed to drug overdose. Intravenous drug use may cause a risk of infectious diseases (such as sharing needles/syringe/filter use) - HCV, AIDS, etc. Intravenous drug use is mostly - but not exclusively - characteristic to opiate users. Heroin’s mode of action is described as causing an intense feeling of euphoria and a way of feeling augmenting to stupor. Its addictive potential is very high, the degradation is visible and can be fatal. In this paper, we discuss previous observations on overdose that is the validity of harm reduction justified by former research, the possible predictors of overdose and the identification of the prevention area.]

Lege Artis Medicinae

[Prevention of infections in patients with absent or dysfunctional spleen: adaptation of international guidelines]

KULCSÁR Andrea

[Individuals with an absent or dysfunctional spleen are at increased risk of severe infection. The greatest risk of infection is within two years after splenectomy. A spectrum of infecting microorganisms may cause serious infections, especially in young or immunocompromised patients. The commonest pathogens are Streptococcus pneumoniae, Neisseria meningitidis and in some countries Haemophilus influenzae type b (Hib). The international guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen are inconsistent. Most of the evidence is obtained from expert committee reports or opinions and/or clinical experiences of respected authorities. This area in Hungary also represents an unmet need. Patients who have undergone surgical removal of the spleen and those with medical conditions that may predispose to functional hyposplenism must be educated about the danger of their condition, must be immunised and must be treated with prophylactic antibiotics according to national epidemiological and microbiological protocols. In Hungary we have an urgent need for a definite guideline for infection profilaxis of individuals with an absent or dysfunctional spleen. This paper is written by a vaccination consultant with the intention of raising awareness and to provide some assistence for physicians and their patients.]

Lege Artis Medicinae

[Lixisenatide: a new GLP-1-receptor agonist with mainly prandial effect for the treatment of patients with type 2 diabetes]

JERMENDY György

[Recently, lixisenatide, a new incretin mimetic GLP-1-receptor agonist with a mainly prandial effect has been registered for the treatment of patients with type 2 diabetes mellitus. The amino acid sequence of lixisenatide and that of human native GLP-1 is 50% identical. Due to its altered amino acid sequence and conformation, lixisenatide is resistant to inactivation by DPP-4. Lixisenatide is a specific agonist of GLP-1- receptors and its binding has a pharmacologic GLP-1-agonist effect. Lixisenatide is used subcutaneously, its normal daily dose is 1×20 μg. It is mostly used in combination with metformin, but it can be also used to supplement sulfanylurea or basal insulin therapy. Clinical efficiency of lixisenatide has been investigated in the phase-III GetGoal trials. In these trials, adequate glycaemic control and a marked decrease in postprandial blood glucose values were observed. During lixisenatide therapy, a decrease in body weight and no substantial increase in the risk of hypoglycaemia were observed, whereas transient gastrointestinal side effects might occur after initiation of treatment. Lixisenatide as an add-on treatment to basal insulin should be considered as a new treatment approach in the management of type 2 diabetes.]

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Clinical Neuroscience

Creutzfeldt-Jakob Disease: A single center experience and systemic analysis of cases in Turkey

USLU Ilgen Ferda, ELIF Gökçal, GÜRSOY Esra Azize, KOLUKISA Mehmet, YILDIZ Babacan Gulsen

We aimed to analyze the clinical, laboratory and neuroimaging findings in patients with sporadic Creutzfeldt-Jakob disease (CJD) in a single center as well as to review other published cases in Turkey. Between January 1st, 2014 and June 31st, 2017, all CJD cases were evaluated based on clinical findings, differential diagnosis, the previous misdiagnosis, electroencephalography (EEG), cerebrospinal fluid and cranial magnetic resonance imaging (MRI) findings in our center. All published cases in Turkey between 2005-2018 were also reviewed. In a total of 13 patients, progressive cognitive decline was the most common presenting symptom. Two patients had a diagnosis of Heidenhain variant, 1 patient had a diagnosis of Oppenheimer-Brownell variant. Seven patients (53.3%) had been misdiagnosed with depression, vascular dementia, normal pressure hydrocephalus or encephalitis. Eleven patients (87%) had typical MRI findings but only 5 of these were present at baseline. Asymmetrical high signal abnormalities on MRI were observed in 4 patients. Five patients (45.4%) had periodic spike wave complexes on EEG, all appeared during the follow-up. There were 74 published cases in Turkey bet­ween 2005 and 2018, with various clinical presentations. CJD has a variety of clinical features in our patient series as well as in cases reported in Turkey. Although progressive cognitive decline is the most common presenting symptom, unusual manifestations in early stages of the disease might cause misdiagnosis. Variant forms should be kept in mind in patients with isolated visual or cerebellar symptoms. MRI and EEG should be repeated during follow-up period if the clinical suspicion still exists.

Clinical Neuroscience

Valproic acid associated pleuropericardial effusion: case report

DEMIR Figen Ulku

Introduction - Valproic acid is an effective antiepileptic and mood stabilizer used in the treatment of many neurological and psychiatric disorders. Although there are frequently seen side effects, effusions between layers of pleural and pericardial membranes are rare to be seen. Case - Pleuropericardial effusion was detected in a 23 years old woman who was under valproic acid treatment because of epileptic seizure. After 1 year of valproic acid treatment, patient complained of dyspnea. As all the researches intended on etiology were usual, valproic acid has been thought to be responsible for the matter. Control examination after 1.5 months regarding the end of treatment revealed complete recovery of pleuropericardial effusion. Discussion - Pleural and pericardial effusions are rarely seen complications related to the use of valproic acid. It must also be kept in mind that valproic acid causes a potential for such side effects which can be blamed etiologically when the other possibilities for patients are excluded.

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

[Avoiding unlimited energy drink consumption is a matter of our heart]

DOJCSÁKNÉ Kiss-Tóth Éva

[Energy drinks have been gaining unbroken popularity, especially among youngsters and children since they were introduced to the market. Manufacturers promise to improve performance and stamina with consuming the products, classified as non-alcoholic soft drinks. In addition to the vitamins and plant extracts, they contain a significant amount of caffeine and other stimulants (taurine, guarana). Among the active ingredients, caffeine has an outstanding effect and thereby a danger, since its overconsumption – in addition to milder he­mo­dynamic changes – can cause severe cardio­vascular consequences, cardiac arrhythmias, ion channel diseases, increased blood coagulation, myocardial infarction or reduced cerebral blood flow in susceptible consumers. Many case studies have also reported serious cardiovascular attacks among young chronic energy drink consumers. Health impairments of excessive and long-term consumption of energy drinks have been studied increasingly, however there is limited and contradictory evidence on the safety of consumption and the effectiveness of performance enhancement. ]

Clinical Neuroscience

The prevalence of sarcopenia and dynapenia according to stage among Alzheimer-type dementia patients

YAZAR Tamer, YAZAR Olgun Hülya

Aim - In this study, the aim was to identify the prevalence of sarcopenia and dynapenia according to disease stage among Alzheimer-type dementia (AD) patients and collect data to suggest precautions related to reducing the disease load. Method - The study was completed with 127 patients separated into stages according to Clinical Dementia Rating Scale (CDR) criteria and 279 healthy volunteers aged 18-39 years and 70-80 years abiding by the exclusion criteria who agreed to participate in the research. Our prospective and cross-sectional study applied the CDR and mini mental test (MMSE) to patients with disorder in more than one cognitive area and possible AD diagnosis according to NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association) diagnostic criteria. The patient and control groups had skeletal muscle mass index (SMMI), muscle strength and physical performance assessed with sarcopenia diagnosis according to European Working Group on Sarcopenia in Older People (EWGSOP) diagnostic criteria. Results - In our study, in parallel with the increase in disease stage of AD patients, the prevalence of sarcopenia (led by severe sarcopenia) and dynapenia was higher compared to a control group of similar age. Conclusion - In chronic, progressive diseases, like AD, identification of changes in parameters, like muscle mass and strength and reductions in physical performance in the early period, is important for identification and to take precautions in the initial stages considering the limitations of the preventive effects of treatment applied after diagnosis of AD.