[Thyroid disorders during pregnancy]
DECEMBER 21, 2011
Lege Artis Medicinae - 2011;21(12)
DECEMBER 21, 2011
Lege Artis Medicinae - 2011;21(12)
[The hormones of the thyroid gland play a basic role in human reproduction and in the early development of the fetal brain, too. The frequency of hypo- and hyperthyroidism occuring in a pregnancy is between 1-2 per cent. Abnormal maternal thyroid function could result in harmful effects for both the mothers and their offsprings. An illness (gestational throphoblast disease) that is known to have an influence on the maternal thyroid function. Thyroid diseases occuring in pregnancy can result in diagnostical problems: the existing complaints and symptoms may be misdiagnosed as a consequence of pregnancy. Because of the changes in thyroid metabolism, which are typical to pregnancy, the analysis of the results of thyroid function may be difficult. Several diagnostical and therapeutical procedures (i. e. radioiodine techniques) are absolutely contraindicated during pregnancy. In the case of thyroid hormone replacement therapy one must take into consideration the continously changing maternal demand. Propylthiouracil is the choice of therapy regarding the treatment of the hyperthyreoidism during pregnancy. The incidence of thyroid cancer in pregnancy is 1 per 1000. Pregnancy itself does not appear to increase the risk of malignant tranformation or alter the course of thyroid cancer. The preferred period of the surgical intervention of the thyroid gland is the second trimester of the pregnancy. The introduction of a thyroid functional test (thyroid-stimulating hormone) as a screening method in the first trimester would be advisable in our country. Achieving this new procedure would reflect and expand a way of thinking in respect of prevention in our pregnancy care practice.]
Lege Artis Medicinae
[INTRODUCTION - Shift workers have an impaired circadian rhythm, which might have an adverse effect on their health. In order to assess cardiometabolic risk in shift workers, a cross-sectional study was performed among active workers (aged 25-66 years, with a minimal shift working experience of 5 years). METHODS - In total 481 workers (121 men, 360 women) registered by the occupational health service were enrolled in our study. Most participants worked in the light industry (58.2%) or in public service (23.9%). Following questionnaire-based data recording, anthropometric measurements and physical examination were performed and fasting venous blood sample was taken for measuring laboratory parameters. Data from shift workers (n=234, 54 men and 180 women, age: 43.9±8.1 years) were compared with those of day workers (n=247, 67 men and 180 women, age: 42.8±8.5 years). RESULTS - Compared with day workers, shift workers had bigger weight (76.6±16.1 vs 73.9±17.6 kg; p<0.05), higher BMI index (27.5±5.3 vs 26.0±4.9 kg/m2; p<0.01) and systolic blood pressure (123±19 vs 119±16 mmHg, p<0.01), and higher prevalence rate of diabetes (4.3 vs 1.2 %; p<0.05) and cardiovascular diseases (3.8 vs 0.8 %; p<0.05). In addition, the proportion of participants who performed regular physical activity was lower (20.6 vs 38.7 %; p<0.001) and that of current smokers were higher (35.0 % vs 19.5 %; p<0.001) in shift workers than in day workers. In laboratory findings, only one difference has been found: HDL-cholesterol level was lower among women (shift workers versus workers: 1.56±0.32 vs 1.68±0.36 mmol/l; p<0.01). CONCLUSION - Long-term shift work (day-night) results in a less healthy lifestyle and worse cardiometabolic risk factors compared with day work. Thus, our study highlights the importance of measures for preventing cardiovascular diseases in shift workers.]
[INTRODUCTION - It is known that the incidence of hypothyroidism is higher in long term survivor patients with Hodgkin's disease, and it is supposed to be the result of treatment, such as neck radiotherapy. The author believe that other etiologic factors may also play a role in the development of hypothyroidism. PATIENTS AND METHODS - Looking for the possible causes of hypothyroidism, the thyroid function of 151 patients treated for Hodgkin's disease since 1970 were examined. These patients with Hodgkin's disease in complete remission for at least one year and their data on thyroid autoantibody positivity [antithyroid peroxidase antibody (aTPO), antihuman thyroglobulin antibody (aHTG), TSH antireceptor antibody (TRAK)] were analysed. RESULTS - Among the patients with antibody positive 26 received ultrasound scanning and fine needle aspiration cytology of the thyroid, which confirmed autoimmun thyroiditis. There were no significant differences between the mean age, histologic subtypes and stage of the disease between the patients with antibody positive those with antibody negative. A significantly greater number of women in the group of antibody positive patients was found and thyroid dysfunction (two cases of hyper, and 13 cases of hyperthyroidism) was revealed in 53.6% of the patients. Though antibody positivity was more frequent in patients having been treated by neck irradiation, but no significant relationship was found between the form of Hodgkin’s disease treatment and the development of thyroiditis. Thus the authors cannot confirm the assumption according to which the autoantigens released from the thyroid gland damaged by neck irradiation for Hodgkin's disease would provoke the development of thyroiditis. Since - independently of the type of treatment received - the incidence of thyroiditis is higher in patients with Hodgkin's disease, it is probable that immune regulation disorders may also play a role in its development and thus hypothyroidism is the result of a multi-factor process. DISCUSSION - These results underline the importance of a regular control of thyroid hormones and thyroid autoantibodies in follow up Hodgkin’s disease patients. Levothyroxine administered as an isohormone treatment may inhibit the development of hypothyroidism in patients with thyroiditis may improve the quality of their life.]
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.
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.
Introduction - Our aim is to present a rare case where a child had delirium manifestation after instillation of cyclopentolate. Case presentation - A 7-year old patient was seen in our outpatient clinic, and cyclopentolate was dropped three times at 10 minutes intervals in both eyes. The patient suddenly developed behavioral disorders along with gait disturbance, and complained of visual hallucinations 20-25 minutes after the last drop. The patient was transferred to intensive care unit and 0.02 mg/kg IV. physostigmine was administered. The patient improved after minutes of onset of physostigmine, and was discharged with total recovery after 30 minutes. Conclusion - Delirium is a rare systemic side effect of cyclopentolate. The specific antidote is physostigmine, which can be used in severely agitated patients who are not responding to other therapies.
Clinical NeuroscienceAlexithymia is associated with cognitive impairment in patients with Parkinson’s disease
Lege Artis Medicinae[COVID-19-cardiology at spring, 2020]
Clinical NeuroscienceLate carcinomatous meningitis as vertigo
Hypertension and nephrology[Continuing medical education]
Hypertension and nephrology[Ventricular arrhythmia]
Hypertension and nephrology[Treatment and care of hypertensive patients during and after the Covid-19 pandemic. Possibilities and effectiveness of telemedicine]
Hypertension and nephrology[Post-career development of cardiometabolic changes and hypertension in competitive athletes]
Hypertension and nephrology[Kidney transplantation in Hungary]