Lege Artis Medicinae

[In the focus: antibiotics]

SZALKA András

FEBRUARY 21, 2006

Lege Artis Medicinae - 2006;16(02)

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Lege Artis Medicinae

[THE WORLDWIDE EPIDEMIC OF TYPE 2 DIABETES - CAUSES AND CONSEQUENCES]

JERMENDY György

[The prevalence of type 2 diabetes mellitus has recently dramatically increased worldwide. While many factors contribute to the startling data, including changes in the diagnostic criteria of glucose intolerance, increase of life expectancy, manifestation of diabetes at younger ages, and increased detection of unrecognized diabetes due to more efficient screening, the genuine, steep rise in the incidence of diabetes is explained by the increasing prevalence of obesity. Among the late complications of both diabetes and obesity, cardiovascular diseases are particularly important. Insulin resistance due to visceral obesity plays a central role in the pathomechanism of type 2 diabetes. In the prevention of both type 2 diabetes and obesity, non-pharmacological intervention such as life style changes should be considered first. Supplementary pharmacological treatment should target all cardiovascular risk factors.]

Lege Artis Medicinae

[Are medical libraries still needed?]

FENYVESI Tamás

Lege Artis Medicinae

[Sustainable Healthcare Elemér Bugovics: Sustainable Healthcare, or the Pathology of Healthcare]

FRENKL Róbert

Lege Artis Medicinae

[THE GENETICS OF INFLAMMATORY BOWEL DISEASE]

LAKATOS Péter László, LAKATOS László

[The pathogenesis of inflammatory bowel disease is only partly understood; various environmental and host factors (e.g., genetic, epithelial, immune and non-immune) are involved. It is a multifactorial polygenic disease probably with genetic heterogeneity; some genes confer susceptibility to IBD in general, while others specifically increase the risk of ulcerative colitis or Crohn's disease or affect location (localized or extensive) and/or behaviour (e.g., mild, severe, aggressive). This review presents recent advances in the genetics of inflammatory bowel disease including chromosome segments newly recognized to be involved in inflammatory bowel disease as well as the role of NOD2/CARD15, SLC22A4/A5 and DLG5. The increasing genetic information provides, for the time being, a better understanding of the pathogenesis of the disease thus setting a basis for potential targets for therapeutic intervention. In the future, however, genetics may also help in refining the diagnosis or predicting disease course.]

Lege Artis Medicinae

[Napoleon’s Death]

SZENDI Gábor

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Neuroscience highlights: Main cell types underlying memory and spatial navigation

KRABOTH Zoltán, KÁLMÁN Bernadette

Interest in the hippocampal formation and its role in navigation and memory arose in the second part of the 20th century, at least in part due to the curious case of Henry G. Molaison, who underwent brain surgery for intractable epilepsy. The temporal association observed between the removal of his entorhinal cortex along with a significant part of hippocampus and the developing severe memory deficit inspired scientists to focus on these regions. The subsequent discovery of the so-called place cells in the hippocampus launched the description of many other functional cell types and neuronal networks throughout the Papez-circuit that has a key role in memory processes and spatial information coding (speed, head direction, border, grid, object-vector etc). Each of these cell types has its own unique characteristics, and together they form the so-called “Brain GPS”. The aim of this short survey is to highlight for practicing neurologists the types of cells and neuronal networks that represent the anatomical substrates and physiological correlates of pathological entities affecting the limbic system, especially in the temporal lobe. For that purpose, we survey early discoveries along with the most relevant neuroscience observations from the recent literature. By this brief survey, we highlight main cell types in the hippocampal formation, and describe their roles in spatial navigation and memory processes. In recent decades, an array of new and functionally unique neuron types has been recognized in the hippocampal formation, but likely more remain to be discovered. For a better understanding of the heterogeneous presentations of neurological disorders affecting this anatomical region, insights into the constantly evolving neuroscience behind may be helpful. The public health consequences of diseases that affect memory and spatial navigation are high, and grow as the population ages, prompting scientist to focus on further exploring this brain region.

Clinical Neuroscience

The methylation status of NKCC1 and KCC2 in the patients with refractory temporal lobe epilepsy

UNAL Yasemin, KARA Murat, GENC Fatma, OZTURK Aslan Dilek, GÖMCELI Bicer Yasemin, KAYNAR Taner, TOSUN Kursad, KUTLU Gülnihal

Purpose - Methylation is a key epigenetic modification of DNA and regarding its impact on epilepsy, it is argued that “DNA methylation may play an important role in seizure susceptibility and maintenance of the disorder”. DNA methylation status of KCC2 (SCL12A5) and NKCC1 (SCL12A2) associated with refractory temporal lobe epilepsy was investigated in our study. Materials and methods - Thirty-eight patients with temporal lobe epilepsy (TLE) who were diagnosed by video EEG monitoring and 32 healthy control subjects were included in the study. Twenty-three patients in TLE group were men and the remaining 15 were women. Among them, 27 had unilateral temporal focus (9 with right; 18 with left) and 11 patients had bilateral TLE. We analyzed promoter region methylation status of the KCC2 (SCL12A5) and NKCC1 (SCL12A2) genes in the case and control groups. Gene regions of interest were amplified through PCR and sequencing was accomplished with pyro-sequencing. Results - We found a significant relationship between TLE and methylation on the NKCC1. However, there was no association between TLE and methylation on the KCC2 gene. Also, we found no association between right or left and unilateral or bilateral foci of TLE. There was no relationship between TLE and methylation on the NKCC1and KCC2 genes in terms of mesial temporal sclerosis in cranial MRI, head trauma or febrile convulsions. Conclusion - The methylation of NKCC1 can be a mecha­nism of refractory temporal lobe epilepsy. There are limited findings about DNA methylation in TLE. Therefore, further studies with large sample sizes are necessary.

Clinical Neuroscience

[Family planning in multiple sclerosis: conception, pregnancy, breastfeeding]

RÓZSA Csilla

[Family planning is an exceptionally important question in multiple sclerosis, as women of childbearing age are the ones most often affected. Although it is proven that pregnancy does not worsen the long-term prognosis of relapsing-remitting multiple sclerosis, many patients are still doubtful about having children. This question is further complicated by the fact that patients – and often even doctors – are not sufficiently informed about how the ever-increasing number of available disease-modifying treatments affect pregnancies. Breastfeeding is an even less clear topic. Patients usually look to their neurologists first for answers concerning these matters. It falls to the neurologist to rationally evaluate the risks and benefits of contraception, pregnancy, assisted reproduction, childbirth, breastfeeding and disease modifying treatments, to inform patients about these, and then together come to a decision about the best possible therapeutic approach, taking the patients’ individual family plans into consideration. Here we present a review of relevant literature adhering to international guidelines on the topics of conception, pregnancy and breastfeeding, with a special focus on the applicability of approved disease modifying treatments during pregnancy and breastfeeding. The goal of this article is to provide clinicians involved in the care of MS patients with up-to-date information that they can utilize in their day-to-day clinical practice. ]

Clinical Neuroscience

Is isolated hand weakness associated with subtypes of stroke?

YILDIRIM Ahmet, GÜNGEN Dogan Belma

Background and aim - Isolated hand weakness is an uncommon condition in stroke patients. It is frequently confused with peripheral nerve system (PNS) pathologies; misdiagnosis may delay identification of the etiology and treatment of stroke. Herein, we aimed to underline the necessity of keeping the diagnosis of stroke in mind in case of patients with isolated hand weakness and to assess the etiology of stroke. Materials and methods - A total of eight patients (four females and four males), who are presented with isolated hand weakness and had acute cortical infarction documented via cranial MRI, were enrolled in the study. Demographic characteristics, physical and radiological findings of the patients, as well as the lateralization and etiology of infarction were evaluated. Results - The mean age of the patients was 61.8 ± 12 years. Isolated hand weakness was in the dominant hand in four patients. According to the etiology and clinical signs, the stroke was cardioembolic in three patients and they had predominant radial-side (thumb and index) finger weakness. Large vessel atherosclerosis was present in three patients; two patients with predominant ulnar-side (little and ring) finger weakness and one patient with uniform finger weakness; there were two patients with stroke of undetermined etiology and they had uniform finger weakness. Conclusion - Keeping stroke in mind together with PNS pathologies in case of isolated hand weakness is critical for early diagnosis and treatment of the patients. In addition, cardioembolic focus should be considered in case of predominant radial-side finger weakness, whereas particular attention should be paid to carotid artery diseases in case of predominant ulnar-side finger weakness.

Lege Artis Medicinae

[WAYS OF PREVENTION OF SEPTIC COMPLICATIONS IN ACUTE PANCREATITIS]

OLÁH Attila

[Similarly to other acute inflammatory responses, the mortality curve of acute pancreatitis has two distinct peaks. The first one, which coincides with a hyperinflammatory phase, is due to the development of an overwhelming systemic inflammatory response syndrome and subsequent multi-organ failure. The second peak of mortality is detected much later, after 14 days from the onset of the disease, when the compensatory antiinflammatory phase results in the infection of the necrotising pancreatic glandular substance. Since no therapy has been shown to efficiently prevent the activation of inflammatory and proteolytic cascades that evoke and sustain the disease, the treatment of acute pancreatitis is basically symptomatic. Beside adequate fluid and volume replacement and pain relief, medical and mechanical support may become necessary if organ failure develops. Recent studies suggest that there are ways to decrease the incidence of infection in pancreatic necrosis, which is usually due to bacterial translocation from the gut. The results of attempts to decrease the frequency of septic complications are controversial. A number of studies support the need of antibiotic prophylaxis but the evidence is weak. Furthermore, the increasingly observed infections by multi-resistant strains of Gram-positive bacteria and Candida species are due to long-term antibiotic use, which strongly questions the grounds for prophylactic antibiotic treatment. Recently, various clinical studies aimed to decrease bacterial translocation in other ways, including probiotic use and enteral feeding. This paper provides a systematic review of the data available in the evidence-based literature on the use of antibiotics and the role of alternative and adjuvant therapy in the treatment of severe acute pancreatitis.]