Lege Artis Medicinae

[Expert comment on „Electronic cigarette use among students in higher education”]

HORVÁTH Ildikó

MARCH 20, 2016

Lege Artis Medicinae - 2016;26(03)

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Lege Artis Medicinae

[Clinical trials for evaluating cardiovascular safety of SGLT-2- inhibitor drugs in patients with type 2 diabetes]

JERMENDY György

[SGLT-2-inihibitors are considered as a new class among oral antidiabetic drugs. The first derivatives of this class became available in the last couple of years in Hungary. According to the requirements from regulatory bodies, randomized, controlled clinical trials have been initiated in order to evaluate the cardiovascular safety of nearly all new antidiabetic drugs in patients with type 2 diabetes. Among SGLT-2-inhibitors, only one trial with empagliflozine has been completed so far. Based on the endpoints of the EMPA-REG OUTCOME trial a significant decrease in different cardiovascular events and total mortality was observed in type 2 diabetic patients with elevated cardiovascular risk. The exact pathomechanism of this beneficial effect has not been clearly understood. Currently, the position statements and scientific guidelines clearly describe the place of SGLT-2-inhibitor drugs in the treatment algorithm; the beneficial effect of empagliflozine on cardiovascular events should seriously be considered when making therapeutic decision. Together with the results of ongoing studies with SGLT-2-inhibitors (dapagliflozine: DECLARE, canagliflozine: CANVAS), these data will provide a more robust evidence about the cardiovascular safety of this new class of oral antidiabetic drugs. ]

Lege Artis Medicinae

[End-of-Life Decision Situations Physician-Assisted Death: Quebec, Canada ]

KŐMÜVES Sándor

Lege Artis Medicinae

[Electronic cigarette use among students in higher education]

PÉNZES Melinda, PONGOR Vince, KIMMEL Zsófia, BALÁZS Péter

[INTRODUCTION - Advantages and disadvantages of electronic cigarette (e-cigarettes) use with increasing popularity among young adults generated continuous debates both nationally and internationally. The aim of our study was to assess the prevalence of e-cigarette use in this population, and to explore sociodemographic, smoking-related and general health behavior predictors of its ever use. METHODS - Our cross-sectional study with anonymous, self-administered questionnaire was conducted among college/ university students (n=889) during a summer festival. Additionally to descriptive analyses, multivariate logistic regression model was applied (p<0.05) to identify factors predicting the initiation of e-cigarette use. RESULTS - One-third of our population has ever tried e-cigarettes, mostly daily smokers, but almost 15% of never smokers also tried it. In total, current use of e-cigarettes was only 1.2%. Odds ratios (ORs) of trying e-cigarettes were higher among daily smokers (OR=3.28) ever smokers (OR=2.10), males (OR=1.88) and those who did not care consciously for their health (OR= 1.65). CONCLUSIONS - Our sample in a recreational environment showed higher rates of ever use of e-cigarette however, current use proved to be lower if compared with previous international studies. Our results may provide basic information in this topic to further national and international surveys.]

Lege Artis Medicinae

[The Son of Saul Face to Face with Darkness ]

LENGYEL Dávid

Lege Artis Medicinae

[Tuberculous meningoencephalitis in a toddler child]

REISZ Zita, GÁL Péter, TAJTI Zsanett, TERHES Gabriella, URBÁN Edit, KISS Ildikó, BARZÓ Pál, KIS Dávid, SENONER Zsuzsanna, SZABÓ Nóra, SZAPPANOS Norbert, TISZLAVICZ László

[INTRODUCTION - Central nervous system complications occur in 1% of patients with Mycobacterium tuberculosis infection, but the mortality is very high, about 50 percent. CASE REPORT - A 1-year-old child in tenebrous condition was admitted to the hospital with suspicion of meningitis. MRI detected disseminated encephalitis and dilated ventricles. Examination of the serum and cerebrospinal fluid didn’t bring any results. The microscopic examination of the brain biopsy raised the possibility of tuberculous meningoencephalitis, and the culture and PCR from the brain tissue revealed meningoencephalitis caused by Mycobacterium tuberculosis Beijing. DISCUSSION - Tuberculous meningitis is a very rare, but severe consequence of extrapulmonary tuberculosis. Due to the high mortality, early diagnosis and whenever suspected, the use of empiric antituberculotic therapy are the only chances of recovery.]

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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.

Lege Artis Medicinae

[Comment to the article titled “Exploratory study of outcomes of blood sample mass examinations by rank correlations”]

Lege Artis Medicinae

[The author’s response to the comment on “Exploratory study of outcomes of blood sample mass examinations by rank correlations”]

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 etiology and age-related properties of patients with delirium in coronary intensive care unit and its effects on inhospital and follow up prognosis

ALTAY Servet, GÜRDOGAN Muhammet, KAYA Caglar, KARDAS Fatih, ZEYBEY Utku, CAKIR Burcu, EBIK Mustafa, DEMIR Melik

Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes. This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as <65 years old, 65-75 yo, 75-84 yo and> 85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups. A total of 1108 patients (mean age: 64.4 ± 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p<0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p<0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p<0.05). Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.