Lege Artis Medicinae

[Ferenc Keresztúri, Professor of Medicine at the Moscow University ]

V. MOLNÁR László

APRIL 20, 2013

Lege Artis Medicinae - 2013;23(03-04)

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Lege Artis Medicinae

[Comment on the article „Public health care prevention in Hungary: are we doing what we should?”]

PÉTER Árpád, KISS István

Lege Artis Medicinae

[Oral Cavity Tumours of Two Late American Presidents ]

GERLINGER Imre

Lege Artis Medicinae

[A new option in insulin therapy that decreases the risk of hypoglycaemia]

BECHER Péter, MÁJER Katalin, PATAI Árpád

[Insulin degludec is a novel, ultra-long acting basal insulin analogue with a safety and efficacy similar to those of insulin glargine. Its main advantage is its ability to significantly reduce hypoglycaemia, particularly nocturnal hypoglycaemia. We present in detail the results of the BEGIN clinical studies with degludec.]

Lege Artis Medicinae

[The Museum of Fine Arts’ Spring Exhibitions ]

NAGY Zsuzsanna

Lege Artis Medicinae

[Detection of endemic MRSA colonisation in a retirement home]

STÁNITZ Éva, TOMPITY Tünde, UNGVÁRI Erika, PÁSZTI Judit

[Methycillin-resistant Staphylococcus aureus (MRSA) colonisation was proved in a retirement home. A resident of the social institution (a 83-year-old man) was hospitalised and was cared for in a ward where a patient positive for MRSA was treated. Screening tests of the above mentioned resident, one of his room-mates at the retirement home as well as three of the four nurses being on duty at the weekend when the man returned to the social institution from the hospital proved the presence of MRSA colonisation. The screening test, which had been extended to the whole staff due to epidemiological reasons and also because of their anxiety, revealed MRSA positivity in the throat and nasal mucus of a fourth nurse. We presumed that the patient released from the hospital had infected his roommate as well as the four nurses. In order to investigate the epidemiological correlations we requested the cultured strains to be typified. With the use of phage typification, three different types of MRSA strains were identified in the six persons positive for MRSA, and a further MRSA strain could not be typified with the basic phage sequence. We review some interventions with regard to the avoidance and prevention of methycillin- resistant Staphylococcus aureus infection, which we had the opportunity to order as well as implement at the retirement home. We raise some of the problems we encountered.]

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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.

Clinical Neuroscience

[Earlier and more efficiently: the role of deep brain stimulation for parkinson’s disease preserving the working capabilities]

GABRIELLA BALÁS, ISTVÁN KOMOLY, SÁMUEL DÓCZI, TAMÁS JANSZKY, JÓZSEF ASCHERMANN, ZSUZSANNA NAGY, FERENC BOSNYÁK, EDIT KOVÁCS

[Background – The recently published “EarlyStim” study demonstrated that deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD) with early fluctuations is superior to the optimal pharmacological treatment in improving the quality of life and motor symptoms, and preserving sociocultural position. Our retrospective investigation aimed to evaluate if DBS therapy was able to preserve the working capabilities of our patients. Methods – We reviewed the data of 39 young (<60 years-old) PD patients who underwent subthalamic DBS implantation at University of Pécs and had at least two years follow-up. Patients were categorized into two groups based on their working capabilities: Patients with active job (“Job+” group, n=15) and retired patients (without active job, “Job-” group, n=24). Severity of motor symptoms (UPDRS part 3), quality of life (EQ-5D) and presence of active job were evaluated one and two years after the operation. Results – As far as the severity of motor symptoms were concerned, similar (approximately 50%) improvement was achieved in both groups. However, the postoperative quality of life was significantly better in the Job+ group. Majority (12/15, 80%) of Job+ group members were able to preserve their job two years after the operation. However, only a minimal portion (1/24, 4.2%) of the Job- group members was able to return to the world of active employees (p<0.01, McNemar test). Conclusion – Although our retrospective study has several limitations, our results fit well with the conclusions of “EarlyStim” study. Both of them suggest that with optimal timing of DBS implantation we may preserve the working capabilities of our patients.]

Lege Artis Medicinae

[Interdisciplinary Issues in Medicine A Discussion with Mária Kopp MD]

FERENCZI Andrea

Clinical Neuroscience

A case with reversible neurotoxicity induced by metronidazole

EREN Fulya, ALDAN Ali Mehmet, DOGAN Burcu Vasfiye, GUL Gunay, SELCUK Hatem Hakan, SOYSAL Aysun

Background - Metronidazole is a synthetic antibiotic, which has been commonly used for protozoal and anaerobic infections. It rarely causes dose - and duration - unrelated reversible neurotoxicity. It can induce hyperintense T2/FLAIR MRI lesions in several areas of the brain. Although the clinical status is catastrophic, it is completely reversible after discontinuation of the medicine. Case report - 36-year-old female patient who had recent brain abscess history was under treatment of metronidazole for 40 days. She admitted to Emergency Department with newly onset myalgia, nausea, vomiting, blurred vision and cerebellar signs. She had nystagmus in all directions of gaze, ataxia and incompetence in tandem walk. Bilateral hyperintense lesions in splenium of corpus callosum, mesencephalon and dentate nuclei were detected in T2/FLAIR MRI. Although lumbar puncture analysis was normal, her lesions were thought to be related to activation of the brain abscess and metronidazole was started to be given by intravenous way instead of oral. As lesions got bigger and clinical status got worse, metronidazole was stopped. After discontinuation of metronidazole, we detected a dramatic improvement in patient’s clinical status and MRI lesions reduced. Conclusion - Although metronidazole induced neurotoxicity is a very rare complication of the treatment, clinicians should be aware of this entity because its adverse effects are completely reversible after discontinuation of the treatment.

LAM KID

[Why twins are different? - About twin research]

ERDŐS Edina, BÁLINT Bálint László

[Twin studies had an important role in the development of medicine. In this review, we present the available data of Hungarian twin studies and the number of twins in Hungary on the basis of statistical data. Comparing these data with international ones and taking into account probable prevalences, we aim to provide an estimation of the number of twins in Hungary who have cancerous diseases. Our estimation suggests that creation of a national database for such twins is feasible and could provide a great help for a better understanding of the causes and mechanisms of cancerous diseases.]