[Treatment of painful diabetic polyneuropathy ]
KIS János Tibor1,2
KIS János Tibor1,2
[Diabetic polyneuropathy can be present in up to 20-60% of diabetics, making it the most common complication of diabetes, but it is often undiagnosed. The diagnosis is mainly based on symptoms, but also several test options are available. For the prevention of neuropathy, long-term control of glycemic parameters is the most important. The pain caused by diabetic polyneuropathy affects 13-26% of diabetics. After the diagnosis, there are a number of treatment options that can be divided into causal and symptomatic therapy. The author summarizes therapeutic options from a practical point of view. ]
Lege Artis Medicinae
Lege Artis Medicinae
Lege Artis Medicinae
Lege Artis Medicinae
Lege Artis Medicinae
[Peripheral artery disease (PAD) is of high prevalence, and one of the most common clinical manifestations of the atherosclerosis beside ischaemic heart disease and cerebrovascular disease. PAD should be considered as a systemic disease, PAD patients have two times higher ten-year cardiovascular mortality than the normal population. For these reasons, the early recognition of the disease, the appropriate secondary preventive medical and non-medical therapy are of great importance. Risk stratification, proper physical examination, ankle pressure, ankle-brachial index, toe pressure, transcutaneous partial tissue oxygen pressure measurement and duplex ultrasound are the cornerstones to an early diagnosis. This summary aims at calling attention to the fact that lower extremity pain can not only be caused by musculosceletal diseases but limb and/or life-threatening limb ischaemia can be revealed in the background. ]
Clinical Neuroscience
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 Oncology
[The role of obesity in the development of cancer is well-known from ages. However, these days we witness the explosion-like increase of obesity, globally, but mainly in the economically advanced population, and, which is even more alarming, among youngsters. The prognosis of the obesity-related cancer is rather poor, therefore, the prevention, including the screening, have outstanding importance. Unfortunately, the participation of the obes persons, especially obes women, in these programs is very low. The diagnostics and therapies should consider the special features of obesity, which are related to the magnitude, distribution, composition of fatty tissue connected to the changes in pharmacokinetics. Moreover, the problems might be complicated with obesity-associated non-tumorous severe diseases (e.g. cardiovascular, diabetes type 2).This review covers different aspects of obesity-cancer relationships, with an emphasis on everyday oncology.]
Clinical Oncology
[Hodgkin lymphoma is a lymphoproliferativ disease, it is about 12-18% of all lymphomas. It has typical morphologic, clinical and therapeutic features, which can distinguish from other lymphoma types. Due to risk- and PET/CT adapted treatment Hodgkin lymphoma is a curable lymphoma with an 80-90% long-term survival, however, refracter- and relapsed patients’ therapy is a great challange. Cure rate can increase due to the development of the diagnostic and treatment modalities, but the use of standard recommendation is necessary. The aim of this review is to show new WHO 2016 lymphoma classifi cation, role of the new diagnostic options, especially 18FDG-PET/CT, Lugano classifi cation and fi rst-line and salvage therapeutic possibilities and to introduce the immunotherapy, like brentuximab vedotin and PD1 inhibitors. Certain points of hemopoietic stem cell transplantation will be also covered.]
Clinical Oncology
[Current clinical practice for breast cancer originates in “evidence based medicine”. In this, each tumor receives a therapy optimal for a given patient population - which might not be optimal for each individual patient. Multigenic tests determining expression of a set of genes can provide additional support in this decision process. Two such tests (MammaPrint and Prosigna) have already received FDA clearance. A number of additional test are commercially available (IHC4, Oncotype DX, EndoPredict, BCI). A common property of these assays is their utility in estrogen receptor positive early breast cancer. The main clinical problem answered by them is the necessity of adjuvant chemotherapy. To date, no reliable algorithm has been identifi ed capable to pinpoint the most effective chemotherapy combination for a given patient. Furthermore, there is no trustworthy test for triple negative breast cancer. The assays utilize different technologies (immunohistochemistry, gene chips, RT-PCR) and a discrepant list of genes - these result in discordance of the predictions for the individual patient. Despite these shortcomings, multigenic tests quickly gained foothold in breast cancer therapy decision process. Their utility is supported by the cost reduction for the health care providers by lowering the number of patients eligible for chemotherapy.]
Lege Artis Medicinae
[Nowadays, there is an increasing incidence of depressive mood disorders, so we have more and more depressed patients in everyday clinical practice. Unfortunately, in many cases, this is not recognized and thus the treatment of depressed patients is not adequately addressed. Untreated depression not only increases the burden of the patient and his environment, but leads to serious and dangerous psychic and somatic complications. However, with modern and complex psychopharmacological, psychotherapeutic and sociotherapeutic methods, depressive mood disorders can be effectively treated. In this paper I review the etiologic background, the characteristics of depressive mood disorders and the most important steps of making diagnosis, as well as the state of the art therapeutic options. Rapid recognition and effective treatment of depressive symptoms has important therapeutic and preventive significance, so today, besides psychiatrists, there is an increasing role for general practitioners and other specialists (internists, neurologists, etc.).]
1.
2.
Clinical Neuroscience
Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease3.
4.
5.
1.
Clinical Neuroscience
[Cases of inborn errors of metabolism diagnosed in children with autism ]2.
Clinical Neuroscience
[The first Hungarian patient with Guillain-Barre syndrome after COVID-19]3.
Clinical Neuroscience
Retinal morphological changes during the two years of follow-up in Parkinson’s disease4.
COMMENTS
0 comments