Lege Artis Medicinae

[Mental Asylums in Hungary until 1900 ]

MAGYAR László András

JANUARY 20, 2018

Lege Artis Medicinae - 2018;28(01-02)

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Lege Artis Medicinae

[Faces of dementia]

FULLAJTÁR Máté, HIDASI Zoltán

[Dementia is defined as a combination of symptoms or as a syndrome. In different types of dementia syndromes cognitive, behavioural and psychological symptoms can be distinguished according to clinical aspects. The prevalence of dementia increases continuously with age, causing significant challenges for the health care system of developed countries. Early diagnosis and early intervention by progression slowing therapy can be defined as goals in treating dementia. At the same time, the education and psy­chological support of the patients, their relatives and health care providers are also essential. A more accurate knowledge of the pathomechanisms behind the symptoms is ne­cessary in order to develop more effective therapies in the future. The authors review the most important types of mild cognitive impairment and dementia syndromes, their clinical and diagnostical criteria and therapeutic possibilities, focusing on early diagnosis and prevention.]

Lege Artis Medicinae

[From Graffiti to Public Space Art ]

HÁRDI István

Lege Artis Medicinae

[The modern approach of child-adult transition in chronic diseases]

MAJOR János, ÁDÁM Szilvia

[Adolescence is the age of great biological, psychological, social changes and time of coming-of-age, however it is also associated with significant vulnerability. 15-20% percent of teenagers have special health needs and are transfered later to adult care, but the vulnerability of adolescents is more pronounced. The handover of adolescents with chronic medical condition to adult care can be achieved through a simple transfer of care or transition, which is a purposeful, planned movement of adolescents and young adults with chronic medical conditions from child-centred to adult-oriented health-care system. The transition of care requires a holistic approach and covers medical, psychosocial and educational aspects. In the transition the patient, the family, the paediatrician, and the adult specialist are also involved together with the multidisciplinary team including a psychologist as well. The transition according to the international literature improves adherence to care, self-management, knowledge of the di-sease and the adjustment to adult health services. In this review article, the author summarizes the latest knowledge of transition of care from different subspecialties expecting better joint work between the different medical specialties.]

Lege Artis Medicinae

[The Experience of Illness and Recovery – Patient Representation in the European Medicines Agency ]

CZIGLÉNYI Boglárka

Lege Artis Medicinae

[Psychiatry or an Alternative?]

ZÖRGŐ Szilvia

[Complementary and alternative medicine (CAM) use is increasing in the plural healthcare market of our globalized world. Aside from a healthcare market, we may also speak of a “worldview market” in which various concepts of health and illness compete with each other and in which patients strive to orient themselves. In a milieu of prolific information production, “facts” are increasingly under subjective judgement. Thus topics such as mechanisms underlying the appraisal of information sources regarding healthcare, as well as processes behind decision-making and building or losing trust have risen in significance. Orientation in the sea of information is largely determined by global trends, societal-level phenomena, as well as cultural dispositions or preferences that take root in the individual; these factors also influence therapy choice. Such preferences include that of “holism” and the “natural”, as well as a desire for initiation; these dispositions play a vital role in information processing and decision-making, for example when the patient is weighing whether to turn to a psychiatrist or a CAM specialist. ]

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[Advanced Parkinson’s disease characteristics in clinical practice: Results from the OBSERVE-PD study and sub-analysis of the Hungarian data]

TAKÁTS Annamária, ASCHERMANN Zsuzsanna, VÉCSEI László, KLIVÉNYI Péter, DÉZSI Lívia, ZÁDORI Dénes, VALIKOVICS Attila, VARANNAI Lajos, ONUK Koray, KINCZEL Beatrix, KOVÁCS Norbert

[The majority of patients with advanced Parkinson’s disease are treated at specialized movement disorder centers. Currently, there is no clear consensus on how to define the stages of Parkinson’s disease; the proportion of Parkinson’s patients with advanced Parkinson’s disease, the referral process, and the clinical features used to characterize advanced Parkinson’s disease are not well delineated. The primary objective of this observational study was to evaluate the proportion of Parkinson’s patients identified as advanced patients according to physician’s judgment in all participating movement disorder centers across the study. Here we evaluate the Hungarian subset of the participating patients. The study was conducted in a cross-sectional, non-interventional, multi-country, multi-center format in 18 countries. Data were collected during a single patient visit. Current Parkinson’s disease status was assessed with Unified Parkinson’s Disease Rating Scale (UPDRS) parts II, III, IV, and V (modified Hoehn and Yahr staging). Non-motor symptoms were assessed using the PD Non-motor Symptoms Scale (NMSS); quality of life was assessed with the PD 8-item Quality-of-Life Questionnaire (PDQ-8). Parkinson’s disease was classified as advanced versus non-advanced based on physician assessment and on questions developed by the Delphi method. Overall, 2627 patients with Parkinson’s disease from 126 sites were documented. In Hungary, 100 patients with Parkinson’s disease were documented in four movement disorder centers, and, according to the physician assessment, 50% of these patients had advanced Parkinson’s disease. Their mean scores showed significantly higher impairment in those with, versus without advanced Parkinson’s disease: UPDRS II (14.1 vs. 9.2), UPDRS IV Q32 (1.1 vs. 0.0) and Q39 (1.1 vs. 0.5), UPDRS V (2.8 vs. 2.0) and PDQ-8 (29.1 vs. 18.9). Physicians in Hungarian movement disorder centers assessed that half of the Parkinson’s patients had advanced disease, with worse motor and non-motor symptom severity and worse QoL than those without advanced Parkinson’s disease. Despite being classified as eligible for invasive/device-aided treatment, that treatment had not been initiated in 25% of these patients.]

Hungarian Radiology

[The quality control of radiological equipments in Hungary]

PELLET Sándor, PORUBSZKY Tamás, BALLAY László, GICZI Ferenc, MOTOC Anna Mária, VÁRADI Csaba, TURÁK Olivér, GÁSPÁRDY Géza

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The prevalence of sarcopenia and dynapenia according to stage among Alzheimer-type dementia patients

YAZAR Tamer, YAZAR Olgun Hülya

Aim - In this study, the aim was to identify the prevalence of sarcopenia and dynapenia according to disease stage among Alzheimer-type dementia (AD) patients and collect data to suggest precautions related to reducing the disease load. Method - The study was completed with 127 patients separated into stages according to Clinical Dementia Rating Scale (CDR) criteria and 279 healthy volunteers aged 18-39 years and 70-80 years abiding by the exclusion criteria who agreed to participate in the research. Our prospective and cross-sectional study applied the CDR and mini mental test (MMSE) to patients with disorder in more than one cognitive area and possible AD diagnosis according to NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association) diagnostic criteria. The patient and control groups had skeletal muscle mass index (SMMI), muscle strength and physical performance assessed with sarcopenia diagnosis according to European Working Group on Sarcopenia in Older People (EWGSOP) diagnostic criteria. Results - In our study, in parallel with the increase in disease stage of AD patients, the prevalence of sarcopenia (led by severe sarcopenia) and dynapenia was higher compared to a control group of similar age. Conclusion - In chronic, progressive diseases, like AD, identification of changes in parameters, like muscle mass and strength and reductions in physical performance in the early period, is important for identification and to take precautions in the initial stages considering the limitations of the preventive effects of treatment applied after diagnosis of AD.

Clinical Neuroscience

[Sturge Weber type 3 presenting with occipital epileptic seizure: case report ]

SERİNDAĞ Cansu Helin, EREN Fulya, KARAHAN Gökçen Muazzez, GUL Gunay, SELCUK Hakan, KARA Batuhan, SOYSAL Aysun

[Sturge Weber syndrome is the third most common neurocutaneous syndrome after neurofibromatosis and tuberous sclerosis. Three distinct types were identified. Type 3 with leptomeningeal involvement alone is the rarest among other types. The reported case is a 21-years-old female patient without any known chronic disease. She admitted to the emergency department after visual symptoms and headache, followed by generalized tonic clonic seizure. EEG of the patient showed left occipital seizure activity. The contrast enhanced magnetic resonance imaging (MRI) showed left occipital leptomeningeal angioma. Digital substraction angiography (DSA) revealed minimal blushed contrast enhancement on late venous phase and lack of superficial cortical veins. Her focal seizures were under control with levatiracetam and lacosamide treatment. The reported case is unique because of the late onset presentation with focal seizure without mental retardation.]

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.]