Lege Artis Medicinae

[Subserous uterinal myoma with unusual dimensions]

KRUTSAY Miklós, NAGY Zoltán

FEBRUARY 14, 2014

Lege Artis Medicinae - 2014;24(01-02)

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Lege Artis Medicinae

[The Eighth Church ]

NAGY Zsuzsanna

Lege Artis Medicinae

[Promising results about decreasing of cardiovascular mortality with coenzyme Q10 and selenium replacement]

LIPTÁK Judit

Lege Artis Medicinae

[How to detect it? Dementia screening in primary care]

KÁLMÁN János, PAPP Edina, PÁKÁSKI Magdolna

[The early stage of dementia, the diagnostic and clinical importance of prodromal stages of dementia have been increasingly recognised in the past few years. Nowa - days, simple, rapid, easy to use cognitive screening tests are available, such as the recently developed Early Mental Test and the standardised Mini-Mental State Exami - nation, Clock Drawing Test, which could help general practicioners in the recommended regular dementia screening. The aim of this review is to help general practicioners understand the nature and importance of prodromal and manifest stages of dementia syndromes, and to summarise the characteristics, advantages and disadvantages of dementia screening tests that can be used in primary care. In addition, practical hints are also integrated regarding the diagnosis, screening and referral of persons with high risk for dementia.]

Lege Artis Medicinae

[Treatment of hungarian chronic hepatitis C genotype 1 patients with severe fibrosis or compensated cirrhosis in the international telaprevir Early Access Program: Interim analysis of the week 16 results]

TORNAI István, BÁNYAI Tivadar, GERVAIN Judit, HORVÁTH Gábor, MAKARA Mihály, MARTYIN Tibor, NEMES Zsuzsanna, PÁR Alajos, PÁR Gabriella, PÉTERFI Zoltán, SZALAY Ferenc, SZINKU Zsolt, TÓTH Tamás, VINCZE Áron, ISABELLE Lonj

[The approval of the first two direct acting antiviral agents, boceprevir and telaprevir, has been a major step forward in the treatment of chronic hepatitis C. Both protease inhibitors must be added to the dual peginterferon and ribavirin combination therapy. The triple combination therapy resulted in significantly higher rates of recovery both in naive patients and in those previously unresponsive to therapy. Following the approval of telaprevir, an Early Access Program has been initiated in 16 countries. In Hungary 132 patients were enrolled into this program. In the first interim analysis, data from the first 16 weeks of treatment of 92 patients are included. Liver cirrhosis (F4) was detected in 70% of the patients and severe fibrosis (F3) was found in the other 30%, on the basis of either liver biopsy or transient elastography. During their previous antiviral treatment, 64% of the patients were non-responders (partial and nullresponders), 26% were relapsers, and only 10% were treatment naives. The efficacy of the triple combination was excellent, as 82% of the patients had undetectable HCV RNA at week 12. Further - more, 48% had negative HCV RNA at week 4 as well as at week 12. Cessation of i.e. negative HCV RNA at week 4 through week 12. Only 5.4% of the patients had virologic failure and needed to stop therapy prematurely. The most frequent adverse event was anemia, hemoglobin level decreased below 100 g/l in 40% of the patients. In the majority of these patients ribavirin dose reduction was sufficient to treat anemia, only 16% needed blood transfusion. The rate of severe rash was 6%. Although this group of patients represents a difficult-to-treat population, both efficacy and safety data are similar to published data in international clinical trials. A very effective, triple combination therapy with telaprevir, peginterferon and ribavirin can be provided for patients with advanced liver disease, to reduce the risk of liver failure and hepatocellular carcinoma.]

Lege Artis Medicinae

[Our body as an ecosystem, or the „brave new world” of metagenomics]

FALUS ANDRÁS, BARCS István, DUDA Ernő

[Micro-organisms (e.g. bacteria) are generally associated with diseases. We rarely consider that these organisms are living creatures, which pursue to survive and reproduce themselves. Obviously, they are dependent on and also have an active impact on their living environment. This interaction might be beneficial but also harmful - a situation they try to avoid. This complex network represents an extremely complicated multi-directional control, the disruption of which may result in serious diseases.]

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Clinical Neuroscience

Creutzfeldt-Jakob Disease: A single center experience and systemic analysis of cases in Turkey

USLU Ilgen Ferda, ELIF Gökçal, GÜRSOY Esra Azize, KOLUKISA Mehmet, YILDIZ Babacan Gulsen

We aimed to analyze the clinical, laboratory and neuroimaging findings in patients with sporadic Creutzfeldt-Jakob disease (CJD) in a single center as well as to review other published cases in Turkey. Between January 1st, 2014 and June 31st, 2017, all CJD cases were evaluated based on clinical findings, differential diagnosis, the previous misdiagnosis, electroencephalography (EEG), cerebrospinal fluid and cranial magnetic resonance imaging (MRI) findings in our center. All published cases in Turkey between 2005-2018 were also reviewed. In a total of 13 patients, progressive cognitive decline was the most common presenting symptom. Two patients had a diagnosis of Heidenhain variant, 1 patient had a diagnosis of Oppenheimer-Brownell variant. Seven patients (53.3%) had been misdiagnosed with depression, vascular dementia, normal pressure hydrocephalus or encephalitis. Eleven patients (87%) had typical MRI findings but only 5 of these were present at baseline. Asymmetrical high signal abnormalities on MRI were observed in 4 patients. Five patients (45.4%) had periodic spike wave complexes on EEG, all appeared during the follow-up. There were 74 published cases in Turkey bet­ween 2005 and 2018, with various clinical presentations. CJD has a variety of clinical features in our patient series as well as in cases reported in Turkey. Although progressive cognitive decline is the most common presenting symptom, unusual manifestations in early stages of the disease might cause misdiagnosis. Variant forms should be kept in mind in patients with isolated visual or cerebellar symptoms. MRI and EEG should be repeated during follow-up period if the clinical suspicion still exists.

Clinical Neuroscience

[Surgical treament of sacro-coccygeal chordoma]

VARGA Péter Pál

[Chordoma is an uncommon malignant tumor with unusual characteristics developing in the remnants of the notochord and usually manifesting itself in patients in their forties and fifties. It is usually located in the body's symmetrical axis or attached to it. The pathological structure is rather characteristic to benign tumors. Although not painful, it is a mercilessly aggressive local tumor, in some cases resulting metastatic progression and might alter its histological picture in longlived patients. It is found most prevalently (about 60 percent) in the sacrococcygeal region and at the clivus and manifesting itself spinally (over the sacrum) most likely in the lumbar region. Between 1992 and 2002, the authors have treated surgically 37 patients with sacrococcygeal chordoma. They applied wide resection following which only seven patients required re-operation. They show detailed data regarding this patient group and discuss the technical aspects of the wide tumorresection.]

Clinical Neuroscience

Patient with a spontaneously evolving carotid cavernous fistula in the emergency department

SZABÓ István, ZAG Levente, CSONTOS Amarilla, TAKÁCS F. Irma, SZIKORA István

Background - Approximately 2% of patients admitted to the emergency department present with headache, which is often associated with vomiting, ocular pain, and earache. In rare cases, the presence of an abnormal communication between a cavernous sinus and the carotid arterial system that creates a carotid cavernous fistula is the main cause of these symptoms. Case presentation - A 32-year-old woman presented at the emergency department with unilateral headache associated with earache on the same side, and pulsating tinnitus. On examination, we observed unusual appearance of our patient (small stature, unusually visible skin, lobeless ears). In the first 5 hours of our observation no neurological symptoms had been present, but after a severe vomiting, exophthalmos, subconjunctival suffusion and moderate ptosis developed. First, regarding the initial general symptoms, otorhinolaryngologist assessed the patient, and did not find any abnormality. Further, we ordered computed tomography and consulted a neurologist. Despite of the negative results we continued the observation because her symptoms did not improve. After appearance of neurological symp-toms, carotid cavernous fistula was suspected. Magnetic resonance imaging and ophthalmologist consultation verified the diagnosis. For therapy, she was transferred to interventional neuroradiology. Because of the unusual appearance and carotic cavernous fistula, we ordered genetic examination. This indicated the presence of Ehlers-Danlos syndrome type IV in the background. The first major manifestation of the syndrome was observed at our department. Conclusions - Carotid cavernous fistula is an uncommon diagnosis in the emergency department; however, the early recognition of symptoms and early treatment can prevent further consequences of this potentially severe condition.

Lege Artis Medicinae

[MUMMIFIED ANCYLOSTOMA DUODENALE IN THE DUODENUM CAUSING SEVERE ANAEMIA]

KOVÁCS Valéria, SZABÓ Andrea, GODA Mária, MAGYAR Éva, RÁCZ István

[INTRODUCTION - We report on a patient with the remains of a mummified hookworm (Ancylostoma duodenale) found in his duodenal bulb which was later successfully removed with a polypectomy snare. CASE PRESENTATION - An 81-year-old man who took 100 mg aspirin daily was admitted because of severe iron-deficiency anaemia. After transfusion with 5 units of packed red blood cells upper endoscopy was performed. On the anterior wall of the duodenal bulb an 8 to10 mm long thread-like foreign body was found embedded in a sessile polyp-like mucosal protuberation with ulcerated inner margin. The entire pathologic structure was removed by mucosectomy. Histologically the thread-like body was found to be a lifeless female Ancylostoma duodenale containing a large amount of eggs and the surrounding ulcerated mucosa was also deeply infiltrated by hookworm particles. Follow-up endoscopy after four months showed normal gastroduodenal mucosa. CONCLUSION - An interesting case of hookworm infection is reported where an old infection caused chronic mucosal injury with reactive inflammation and mucosal ulceration. Aspirin therapy provoked chronic occult bleeding causing severe anaemia. With the endoscopic removal of the unusual structure total mucosal and clinical healing was achieved.]

Journal of Nursing Theory and Practice

[Empathy research among nurses - comparison of the scales empathy: Jefferson Scale of Physician Empathy (JSPE) and the Interpersonal Reactivity Index (IRI)]

NAGY Ivett Klára, ÖREG Zsolt

[Aim of the research: comparison of the two internationally validated self-administered questionnaire (Jefferson Scale of Physician Empathy (JSPE) (Hojat et al., 2001, 2002a, 2002b, 2003) and the Interpersonal Reactivity Index (IRI) (Davis, 1983) - during empathy research among nurses. Research and sampling methods: a quantitative cross-sectional study applying two internationally validated self-administered questionnaire (Interpersonal Reactivity Index (IRI), Jefferson Scale of Physician Empathy (JSPE)), as well as home-made socio-demographic survey, shared online. The online questionnaires have been completed by 101 nurses in different age, having different qualification levels and working currently in Hungary in different areas of health care. The sample consists of 91 women and 10 men nurses. 89 nurses work in hospitals in the sample, 7 of them work in health centre one of them is ambulance officer and 4 of them are home nurse. Results: The applied questionnaire is acceptable based on the reliability statistical analysis (Cronbach’s  0.798 and 0.817). The results of IRI show in scale exploiting the professional specificity. In case of Perspective taking the used scale range is 11-28, while in the case of personal distress it shrank to 2-22 interval (as long as the total range is 1-28). Average and standard deviation in each dimension are (s): EC = 19.4 (s = 4.26); PT = 18.5 (s = 4.26); FS = 17.23 (s = 5.32), and PD = 10.85 (s = 4.66). In the total range of JSPE scale the mean empathy level is 98.5 and the standard deviation is 14.425. The same correlation relationship turned up between these two questionnaires as the developer published. These underline profession specific dimensions with direct association of the patient care (r factor EC=0,507, PT=0,447). Most of the questions related to socio-demographic factors have not been verified. Relationship emerged between the gender and the IRI personal distress dimension and the empathy value of JSPE according to the assumption for the benefit of women. It appears in scale of JSPE in perspective taking factor primarily. The extra working time had no show link with empathy, but private sector workers’ empathic concern was higher. The religion as a sociological characteristics was represented in the fantasy scale dimension of the IRI with a significantly higher value. It failed to detect any connection between the empathy and satisfaction of needs. Conclusion: Based on the study the JSPE questionnaire is admissible in Hungary. Next to the IRI it can reveal the empathy dimensions major from the patient’s view and it can make so comparable the empathy levels in other similar research projects. The women’s higher emphatic level was verified, but the length of the practice, the qualification and other socio-demographic aspects need further investigation, their effect aren’t discovered even in the research literature. Researchers steady emphasize how important is the empathy in the patient care to improve the efficacy of which would be accounted in Hungarian postgraduate courses as well. ]