Lege Artis Medicinae

[Elevation of IgG antibodies against tissue transglutaminase as a diagnostic tool for coeliac disease in selective IgA deficiency]

KORPONAY-SZABÓ Ilma1, DAHLBOM I2, LAURILA K3, KOSKINEN S4, WOOLEY N4, PARTANEN J4, KOVÁCS JB1, MÄKI M3, HANSSON T2

JUNE 22, 2004

Lege Artis Medicinae - 2004;14(06)

AFFILIATIONS

  1. Heim Pál Gyermekkórház, Budapest
  2. Pharmacia Diagnostics, Uppsala
  3. Gyermekgyógyászati Kutató Központ, Tampere
  4. Finn Vöröskereszt Transzfúziós Központ, Helszinki

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Lege Artis Medicinae

[MEDICAL ANTHROPOLOGICAL APPROACH TO CHILDREN'S SURMISES ON SMOKING]

BAK Judit, PIKÓ Bettina

[INTRODUCTION - The aim of our study was to explore school children'’s surmises on smoking. The following questions were in the focus of our analysis: what concepts children have about smoking and smoking-related diseases before adolescence? Have they already tried smoking? METHODS - The study was conducted among 3rd, 4th and 5th year school children (N=128) in two towns of Békés County, namely in Békés and Köröstarcsa. The sample consisted of 57% males and 43% females. Regarding sampling we followed international studies with similar aims where samples of 9-11-year-old average children were thought to be ideal for such study purpose using the draw-and-write technique. RESULTS - Most respondents from the study have not tried smoking yet. On the other hand, there are great number of adults who smoke in children’s environments, in many times, both parents do. Despite these facts, children’s attitudes toward smoking is rather negative. Children'’ s opinions reflect many negative aspects of smoking: the health-damaging effect, the financial aspects, the negative effects for social and physical environment. CONCLUSIONS - Similar to previous international studies, children of our sample possess correct and comprehensive knowledge of the smoking-related health problems. Findings of our study provides a support to the need of a smoking prevention program for children in the age of their negative opinions of smoking and well before the peer group effect is getting significant.]

Lege Artis Medicinae

[ONCOHEMATOLOGIC MALIGNANCIES WITH SKIN SYMPTOMS]

BENE Ibolya, ERŐS Nóra, KÁROLYI Zsuzsánna, TAKÁCS István, RADVÁNYI Gáspár

[INTRODUCTION - Haematologic malignancies can originate from the skin (cutaneous lymphomas, rarely acute myelomonocytic leukemia) or can infiltrate the skin secondarily during the progression of the disease (nodal and systemic non-Hodgkin’s lymphomas, Hodgkin'’s disease, chronic lymphocytic leukemia). PATIENTS AND METHODS - The clinical history of seven patients treated by the authors between 1997-2003, is reviewed. CONCLUSIONS - The clinical and histopathologic features of each entity are discussed, emphasizing differences in the clinical course between cutaneous and nodal lymphomas, considering diagnostic difficulties, conventional and recent therapeutic approaches.]

Lege Artis Medicinae

[Postgraduate conference on hepatology]

TELEGDY László

Lege Artis Medicinae

[INCIDENCE RATES OF CHILDHOOD TYPE 1 DIABETES WITHIN EUROPE AND HUNGARY BASED ON EURODIAB DATA]

GYÜRÜS Éva, SOLTÉSZ Gyula

[Type 1 diabetes is generally believed to be be the result of an immune destruction of pancreatic ßcells in genetically susceptible individuals exposed to environmental risk factors. To study the epidemiology of childhood-onset type 1 diabetes mellitus in Europe, the EURODIAB collaborative group established in 1988 prospective geographicallydefined registers of new cases diagnosed under 15 years of age. The 10-year-old study shows a greater than 10-fold range in incidence rate of childhood diabetes in Europe. The standardised average annual incidence rate during the period 1989-1998 ranged from 3,6 cases per 100 000 per year in Macedonia to 43,9 cases per 100 000 per year in Finland. Combined data from all centres indicates that the annual rate of increase in incidence was 3,2% but in some central and eastern European countries it was higher. The age-group-specific rates of increase were 5% for children aged 0-4 years, 3,7% for 5-9 years, and 2,1% for 10-14 years, which shows that the highest rates of increase occurred in the youngest age group. The Hungarian Childhood Diabetes Registry has collected the data of all newly diagnosed children with type 1 diabetes aged 0-14 years since 1st January 1978. The standardised incidence rate during the period 1978-2002 was 8,6 cases per 100000 per year, the lowest in the youngest (0-4 yr), highest in the10-14-year-old-children. There was a linear increasing trend in incidence with the average rate of annual increase of 5,1%. Comparing our incidence rate with other European countries Hungary belongs to the medium-risk countries with similar age- and sex-specific incidence rates. The results of the EURODIAB study confirm a very wide range of incidence rates of childhood type 1 diabetes within Europe and show that the increase in incidence varies from country to country. Such variation seems to be unlikely to be explained by genetic differences, since Europeans (except some small populations) are more homogeneous compared with other populations of other continents. The rapid increase in incidence may be explained by changes in environmental factors.]

Lege Artis Medicinae

[NEW METHODS FOR NON-INVASIVE ASSESSMENT OF AIRWAY DISEASES]

HORVÁTH Ildikó

[In chronic obstructive airway diseases there are several unsolved questions regarding the early diagnosis, monitoring treatment, simple detection of exacerbations and the questions of differential diagnosis. These problems indicate the need for the development of new diagnostic methods and their application in clinical practice. This need is further emphasized by the fact that in most chronic airway diseases, including asthma and chronic obstructive pulmonary disease inflammation has a central role in the pathomechanism and its suppression is the main aim of treatment, but so far, we do not have adequate method for the assessment of inflammation intensity in clinical practice. In recent decades non-invasive sampling techniques directly from the airways have made a progress in respiratory research and at present some of them are available for clinical use. Among these techniques sputum induction, measurement of exhaled biomarkers including exhaled nitric oxide and mediators in exhaled breath condensate samples are used increasingly. The present review summarises our current knowledge on these methods and the most important findings obtained by their applications.]

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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.]