Lege Artis Medicinae

[Network analysis in medicine]

BRYS Zoltán, BUDA Béla, PLUHÁR András

JULY 20, 2012

Lege Artis Medicinae - 2012;22(06-07)

[Network analysis is an increasingly used research method in medicine. Network analysis is a research and interpretation model at the same time. Our article outlines the various applications of network research in medicine and at its interdisciplinary boundaries. ]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[A Winter in Mallorca – Chopin and George Sand ]

KÖVES Péter

Lege Artis Medicinae

[Suggestive Communication in Medicine ]

BUDA Béla

Lege Artis Medicinae

[Bath Culture in the Antiquity]

BECHER Péter, MÁJER Katalin, PATAI Árpád

Lege Artis Medicinae

[Saint Agatha’s Cult in Northern Italy ]

HORVÁTH Zoltán György

Lege Artis Medicinae

[Some thoughts in the hospital]

GAJDOS Ágoston

All articles in the issue

Related contents

Lege Artis Medicinae

[NEPHROPATHY CAUSED BY PHYTOTHERAPY - LESSONS LEARNED]

KAKUK György

[Modern medical science, the ‘officially’ recognised medicine, relies on evidence based medicine, in contrast to the ancient, empirical practice that is gradually gaining ground in the population. This is now referred to as complementary alternative medicine. Alternative medicine has been present throughout the whole history of medicine and gaining popularity these days. Complementary medicine with its various branches and methodology, however, remains controversial - even in some aspects hazardous - due to the lack of scientifically valid evidence. The article deals in detail with the severe side effects of phytotherapy, with an illustration of the so-called ‘chinese herb nephropathy’, an ailment that afflicted more than 100 women on diet in Belgium. For two consecutive years these women took plant extracts labelled Stephania tetranda and Magnolia officinalis plus fenfluramin, diaethylpropion, cascara powder, acetazolamide, extracts of belladonna and meprobamate. The results: chronic renal failure, precancerous urinary tract conditions and aortic valve damage. Detailed analysis suspects the toxic substance of aristolochic acid found in one of the herbs to be the likely cause for the organ and tissue damage. These cases illustrate the need for the cautious approach towards phytotherapy and suggest that in the case of complementary medicine therapy one can not ignore the results of evidence based medicine. In this article, we critically analyse the state of modern and alternative medicine and emphasize that two separate types of medicine does not exist - only one, that has to integrate the methods of complementary medicine that are acceptable, and at the same time charlatan practice must not prevail.]

Clinical Neuroscience

Electrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study

NALBANTOGLU Mecbure, AKALIN Ali Mehmet, GUNDUZ Aysegul, KIZILTAN Meral

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission. Autonomic dysfunction is not a commonly known association with MG. We conducted this study to evaluate autonomic functions in MG & subgroups and to investigate the effects of acetylcholinesterase inhibitors. This study comprised 30 autoimmune MG patients and 30 healthy volunteers. Autonomic tests including sympathetic skin response (SSR) and R-R interval variation analysis (RRIV) was carried out. The tests were performed two times for patients who were under acetylcholinesterase inhibitors during the current assessment. The RRIV rise during hyperventilation was better (p=0.006) and Valsalva ratio (p=0.039) was lower in control group. The SSR amplitudes were lower thereafter drug intake (p=0.030). As much as time went by after drug administration prolonged SSR latencies were obtained (p=0.043).Valsalva ratio was lower in the AchR antibody negative group (p=0.033). The findings showed that both ocular/generalized MG patients have a subclinical parasympathetic abnormality prominent in the AchR antibody negative group and pyridostigmine has a peripheral sympathetic cholinergic noncumulative effect.

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

Atypical presentation of late-onset Sandhoff disease: a case report

SALAMON András , SZPISJAK László , ZÁDORI Dénes, LÉNÁRT István, MARÓTI Zoltán, KALMÁR Tibor , BRIERLEY M. H. Charlotte, DEEGAN B. Patrick , KLIVÉNYI Péter

Sandhoff disease is a rare type of hereditary (autosomal recessive) GM2-gangliosidosis, which is caused by mutation of the HEXB gene. Disruption of the β subunit of the hexosaminidase (Hex) enzyme affects the function of both the Hex-A and Hex-B isoforms. The severity and the age of onset of the disease (infantile or classic; juvenile; adult) depends on the residual activity of the enzyme. The late-onset form is characterized by diverse symptomatology, comprising motor neuron disease, ataxia, tremor, dystonia, psychiatric symptoms and neuropathy. A 36-year-old female patient has been presenting progressive, symmetrical lower limb weakness for 9 years. Detailed neurological examination revealed mild symmetrical weakness in the hip flexors without the involvement of other muscle groups. The patellar reflex was decreased on both sides. Laboratory tests showed no relevant alteration and routine electroencephalography and brain MRI were normal. Nerve conduction studies and electromyography revealed alterations corresponding to sensory neuropathy. Muscle biopsy demonstrated signs of mild neurogenic lesion. Her younger brother (32-year-old) was observed with similar symptoms. Detailed genetic study detected a known pathogenic missense mutation and a 15,088 base pair long known pathogenic deletion in the HEXB gene (NM_000521.4:c.1417G>A; NM_000521:c.-376-5836_669+1473del; double heterozygous state). Segregation analysis and hexosaminidase enzyme assay of the family further confirmed the diagnosis of late-onset Sandhoff disease. The purpose of this case report is to draw attention to the significance of late-onset Sandhoff disease amongst disorders presenting with proximal predominant symmetric lower limb muscle weakness in adulthood.