Lege Artis Medicinae

[Experiences of loss, grief, coping strategies in pre- and perinatal care]

ZSÁK Éva, HEGEDÛS Katalin

MARCH 20, 2017

Lege Artis Medicinae - 2017;27(03)

[Pre- and perinatal losses tend to be­come a phenomenon of complicated grief, a burden for the parents, for their families and for the helping professionals, yet it is a little studied topic. Our aim is to systematically review the literature concerning the grief experienced by the health care staff, caused by pre- and perinatal loss to present an overall picture of the international and national attitudes and existing solutions. The importance and complexity of the problem need greater attention, the existence of active and up-to-date programmes on all professional levels. ]

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Lege Artis Medicinae

[Starting Again and Again – Parallel Memoirs of a Psychoanalytic Married Couple]

KELEMEN Gábor

Lege Artis Medicinae

[An analysis of the ankle-brachial index in patients with diabetes in general practice]

GALVÁCS Henrietta, HASITZ Ágnes, BALOGH Zoltán

[INTRODUCTION - Diabetic macroangiopathy is one of the most prevalent complications of chronic diabetes mellitus. In Hungary, diabetic foot diseases and atherosclerosis are the most common causes of lower limb amputations. In this paper, we aim to present the correlations between the ankle-brachial index in patients with diabetes mellitus, and risk factors such as HbA1c levels, smoking and gender, in order to prevent atherosclerosis and to facilitate its rapid diagnosis. PATIENTS AND METHODS - Ankle-brachial index (ABI) of diabetic patients was measured and statistically analysed. Our goal was to determine potential correlations between ABI and the three above mentioned risk factors. The study population consisted of patients with a known history of diabetes mellitus (n=65) who visited the general practitioner's office between July 2015 and September 2016. RESULTS - 47.69% of patients exhibited a pathological ankle-brachial index. The ankle-brachial index showed a statistically significant correlation with gender (p=0,054). There was no significant correlation between the ankle-brachial index and smoking (p=0.838) or between the ankle-brachial index and HbA1c levels (p=0.430). CONCLUSION - Our research suggests that primary care physicians should regularly assess the ankle-brachial index in diabetic patients as preclinical atherosclerosis is frequently present in this population. Regular screening can facilitate early diagnosis and reduce the risk of severe macrovascular complications.]

Lege Artis Medicinae

[Who are the happy family physicians in Hungary?]

GYŐRFFY Zsuzsa, TORZSA Péter

[INTRODUCTION - Mental and somatic morbidity of healers is the most commonly researched issue in physician related studies. Few of them focus on the positive as-pects of the physicians’ profession though. METHODS - A focus group qualitative study of family physicians (n=14), who work in Budapest, was conducted. Three important topics were analyzed in this study - the positive aspects of the daily routine, the issue of the work-family balance and the decisive aspects of the patient - doctor relationship. RESULTS - The main positive elements of the family physicians’ professional lives are the independent working conditions, the diversity of patients, an intensive relationship with families and communities, and a special patient-doctor relationship. Beside professional fulfilment, the possibility of ba­lance between work,family and private time are the key components of their wellbeing. CONCLUSIONS - According to both our results and the findings of international literature, the happiness of family physicians depends on independence. This independence is present in their professional life, in the balance of work and family life and in time management as well.]

Lege Artis Medicinae

[The Hospital of the Holy Spirit in Rome ]

KRUTSAY Miklós

Lege Artis Medicinae

[MOTESZ]

KISS István, TÍMÁR József, KARÁDI István, OBERFRANK Ferenc

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[Assessment of health related quality of life among epileptic patients in the context of coping strategies and subjective disease perception]

KOVÁTS Daniella, CSÁSZÁR-NAGY Noémi, JUHOS Vera, SALLAY Viola, BÉKÉS Judit, FABÓ Dániel, KELEMEN Anna, KURIMAY Tamás

[Purpose – Psychosocial condition and life quality of epileptic patients are greatly determined by the existence of the disease-related comorbid disorders, like depression, anxiety, and the subjective disease perception, as well as the neuropsychological consequences of the seizures. (Whitehead et al. 2015; Goldstein et al. 2005). It has been examined in patients living with epilepsy how subjective disease perception and coping strategies influence life quality, comorbid depression and the condition of anxiety. Methods – Study patients were asked to fill in a self-completion questionnaire, which examined their psychosocial condition (HADS, Beck Depression Scale), life quality (Qolie-31), coping strategies (FKV-LIS), and subjective disease perception (IPQ-R), as well as sociodemographic and disease variables. The subjects of the study: the data of epileptic patients between the age of 18 to 70 was recorded. Patients were selected from the adult outpatients of a national centre, a regional hospital and two private health care centres located in Budapest. Results – Based on the multiple regression analysis. Beck’s depression (b coefficient=-0.351, t=-4.703, p<0.001**). Depressive coping strategy (FKV Dep) (b coefficient = -0.235, t=-3.123, p=0.002**). Subjective health perception (b coefficient =0.232. t=3.643, p<0.001**). Sex (women; b coefficient =-0.162, t=-3.008, p=0.003**). IPQ consequences (b coefficient =-0.161, t=-2.572, p=0.012*). Active coping strategy (FKV Act; b coefficient =0.146, t=2.572, p=0.012*). Type of seizure (b coefficient =-0.138, t=-2.527, p=0.013*), and Sleep quality (b coefficient =-0.125, t=-1.995, p=0.049) explain some 75.6% of the variance of life quality’s total score (model3: F=33.333, p<0.001**. adjusted R2=0.733). Conclusions – Among the factors of the subjective disease perception (IPQ-R), the physical, mental and social consequences play the most important role. Similarly, the impact of negative emotional representation, as well as the erratic nature of the seizures are decisive. Emotional representation, cyclicity and disease coherence have an important role in coping with disease-related negative emotions. ]

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.

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[About the care of patients with hyperuricaemia and gout]

[This consensus document is intended to provide guidance for the effective and efficient treatment of asymptomatic individuals with high uric acid levels and gout patients.]

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.]