Lege Artis Medicinae

[Who is a doctor?]

MAGYAR László András

OCTOBER 28, 2021

Lege Artis Medicinae - 2021;31(10)

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Lege Artis Medicinae

[Mental and physical health in light of health behaviours among sexual and gender minorities]

GUBÁN Zsuzsanna, CSEKÔ Csilla, SZÉL Zsuzsanna

[In a large proportion the reason behind enlisting both primary and secondary care are psychophysiologic disorders or symp­toms. In this current study we reviewed the literature regarding the physical and mental health of a subpopulation (sexual and gender minorities) and their patterns of health behavior. The literature examined in our study contains publications from January of 2009 to March of 2019. Based on the minority stress theory and the biopsychosocial model, the people from sexual and gender minorities face increased level of stress which affects their health and health behaviour in a negative way. Because of the factors mentioned above this group is more exposed to certain illnesses than the majority society – such conditions are cardiovascular diseases, lung diseases and several types of tumors and cancer. Furthermore the excess stress affects their psychological wellbeing and mental health. Summarizing the literature regarding the health and health behavior of people belonging to sexual and gender minorities our aim was to create an inventory of information for health care workers to help enhance the quality of care the members of these minorities receive. It could also support developement of cultural competence for the circle of professionals in education, law enforcement agencies, social care and health care system, in additional it might decreas health inequity.]

Lege Artis Medicinae

[Cardiovascular prevention 2021 – Guidelines of European Society of Cardiology 2021. General principles]

VÁLYI Péter, KÉKES Ede

[On 31 August 2021, the European Society of Cardiology published its guideline “Prevention of cardiovascular disease in clinical practice”. This guideline provides a comprehensive review about risk factors of atherosclerotic cardiovascular disease, their assessment, potential modifiers, treatment and prevention of the cardiovascular disease itself at societal and individual levels respectively. The previous guideline issued 2016, had to be updated due to the recent significant advances in risk prediction of cardiovascular disease on atherosclerotic background and due to the beneficial effects of treatment, emerging new drugs and therapeutic targets. The risk assessment system has undergone a major overhaul and now predicts the risk of fatal and non-fatal cardiovascular events together over a 10-year horizon and over a lifetime. In the new guideline, age plays a more important role in risk classification than before. The risk assessment and staged management of apparently healthy people or patients with established atherosclerotic cardiovascular disease, diabetes mellitus and other specific diseases or conditions are detailed. The positive impact of influencing risk factors, the years of life gained can recently be presented in a lifetime perspective, which will help to make an individually tailored decision on the extent of interventions, taking into account also the patient'’s preferences.]

Lege Artis Medicinae

[Hyperinflammation and its modulation in critically ill Covid-19 patients]

ZÁDORI Noémi, MOLNÁR Zsolt

[The COVID-19 pandemic has claimed the life of millions worldwide in 2020. The most common cause of fatal outcome is the severe respiratory syndrome or multiple organ failure. The dysregulated immune response of the body plays probably an important role in the pathomechanism of this process like in the generalised sepsis. In particular, serum concentrations of pro-inflammatory cytokines are elevated during the progressing disease, which may suggest if the treatment with pharmaceuticals like monoclonal antibodies or the binding of circulating cytokines by extracorporeal, non-selective hemoadsorption have a be­neficial effect on the course of the dis­ease and its outcome respectively. The current review aims to provide a brief summary of our knowledge about the role of cytokines and immunomodulatory treatment in Co­vid-19.]

Lege Artis Medicinae

[Telephone hotline crisis intervention during the Covid-19 pandemic]

TÓTH Mónika Ditta

[The COVID-19 pandemic and the successive restrictive measures are placing a huge psychological burden on the population worldwide. Isolation, narrowing of social relationships, constant fear, and the illness itself contributed to the development of various mental disorders. The mental strain on healthcare workers, in addition to their heavy physical workload is also a particular problem. In this situation, easily accessible, telephone counselling services, which does not require physical meeting, are one of the most important resources for mental health intervention worldwide. The present study demonstrates the mental challenges caused by the pandemic, the brief history of telephone crisis care, and studies about its effectiveness. In addition, this study focuses on the effects of COVID-19 pandemic on using of telephone counselling services. Several countries are presented with significantly increased use of these services. Finally, the Hungarian situa­tion is demonstrated with the nature of COVID-19 related calls of the Hungarian hotline service. ]

Lege Artis Medicinae

[Ways of treatment in traditional, complementary and integrative medicine of COVID-19]

SZÔKE Henrik, DARÓCZI Zoltán, VERZÁR Zsófia

[This study presents the results and expert opinions about the most important, amply evidence based, most widespread and af­fordable therapeutic procedures and supp­lementary preparations, which may support or and possibly replace conventional treatments. Traditional, complementary, and integrative medicine offers a number of options to enhance physical, psychic and mental resilience that may also be useful in the prevention and treatment of COVID-19 patients. It will be worthwhile to analyse the evidences of clinical experiences on potential benefits. This brief summary might serve as a useful starting point for further research on this topic.]

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Lege Artis Medicinae

[Second game, 37th move and Fourth game 78th move]

VOKÓ Zoltán

[What has Go to do with making clinical decisions? One of the greatest intellectual challenges of bedside medicine is making decisions under uncertainty. Besides the psychological traps of traditionally intuitive and heuristic medical decision making, lack of information, scarce resources and characteristics of doctor-patient relationship contribute equally to this uncertainty. Formal, mathematical model based analysis of decisions used widely in developing clinical guidelines and in health technology assessment provides a good tool in theoretical terms to avoid pitfalls of intuitive decision making. Nevertheless it can be hardly used in individual situations and most physicians dislike it as well. This method, however, has its own limitations, especially while tailoring individual decisions, under inclusion of potential lack of input data used for calculations, or its large imprecision, and the low capability of the current mathematical models to represent the full complexity and variability of processes in complex systems. Nevertheless, clinical decision support systems can be helpful in the individual decision making of physicians if they are well integrated in the health information systems, and do not break down the physicians’ autonomy of making decisions. Classical decision support systems are knowledge based and rely on system of rules and problem specific algorithms. They are utilized widely from health administration to image processing. The current information revolution created the so-called artificial intelligence by machine learning methods, i.e. machines can learn indeed. This new generation of artificial intelligence is not based on particular system of rules but on neuronal networks teaching themselves by huge databases and general learning algorithms. This type of artificial intelligence outperforms humans already in certain fields like chess, Go, or aerial combat. Its development is full of challenges and threats, while it presents a technological breakthrough, which cannot be stopped and will transform our world. Its development and application has already started also in the healthcare. Health professionals must participate in this development to steer it into the right direction. Lee Sedol, 18-times Go world champion retired three years after his historical defeat from AlphaGo artificial intelligence, be­cause “Even if I become the No. 1, there is an entity that cannot be defeated”. It is our great luck that we do not need to compete or defeat it, we must ensure instead that it would be safe and trustworthy, and in collaboration with humans this entity would make healthcare more effective and efficient. ]

Clinical Neuroscience

How to manage MuSK antibody-positive myasthenic crisis during pregnancy?

ÇETİNER Mustafa , AKDAĞ Gönül , AKKOYUN ARIKAN Fatma, CANBAZ KABAY Sibel

Myasthenia gravis (MG) is an autoimmune disease that is characterised by the formation of antibodies against acetylcholine receptors in the postsynaptic membrane of the neuromuscular junction. The course of the disease cannot be predicted during pregnancy. A subtype of MG with positive muscle-specific receptor tyrosine kinase (anti-MuSK) antibodies exhibits more localised clinical characteristics and a poor response to treatment compared with the disease subtype that involves positivity for acetylcholine receptor antibodies. Myasthenic crisis is more frequently observed in anti-MuSK-positive myasthenia patients. Anti-MuSK-positive myasthenic crisis management is very difficult and a risky situation during pregnancy. The reported case was 30 years old, female, 9 weeks pregnant and musk antibody positive. She stopped her treatment without asking her doctor because she was planning pregnancy in the 6-month period before her hospitalization. She was intubated for a long time in the intensive care unit due to myasthenic crisis and was very resistant to treatment. During this period, her pregnancy was terminated due to fetal anomaly. Plasmapheresis, IVIg and immunosuppressive treatments were applied. Our patient was discharged after a period of about 10 weeks. We share our treatment management.

Clinical Neuroscience

[Can we influence the negative drug attitude? Interpretation of the rejection of COVID-19 vaccine in the light of results of a pilot study ]

POGÁNY László , HORVÁTH A. András, LAZÁRY Judit

[Vaccination refusal is a serious obstacle to minimizing the spread of COVID-19. Nevertheless, the rejection of vaccine can be considered the result of a negative attitude towards medical treatment, and according to our previously published data, it can be influenced by the underlying affective state. Increased incidence of affective disorders and anxiety could be observed globally during the pandemic, which may have a significant impact on vaccination acceptance. The aim of our pilot study was to determine the association between clinical improvement of affective and neurocognitive symptoms and change of drug attitude and health control beliefs in a sample of psychiatric patients. A data set of 85 patients with psychiatric disorder has been analysed with the use of Patient’s Health Belief Questionnaire on Psychiatric Treatment (PHBQPT) with 5 subscales (Negative Aspect of Medication – NA; Positive Aspect of Medication – PA; Doctor health locus of control- Doctor HLOC; Internal HLOC; Psychological Reactance – PR); Hospital Anxiety Depression Scale (HADS-Anx; HADS-Dep) and neurocognitive tests, such as the Stroop test and the Trail Making Tests. All the tests were performed before and after a 14 days treatment. Paired t-tests and generalized linear models were performed to assess the associations between the variables. The baseline scores of NA and HADS-Anx correlated significantly (p=0.001) and after two weeks of treatment NA decreased (p=0.001), while Doctor HLOC and Internal HLOC increased (p=0.001 and p=0.006). The patients performance of the neurocognitive tests improved (all p<0.05). The reduction of HADS-Anx (p=0.002) and HADS-Dep (p=0.006) scores showed significant associations with the decrease of NA. Increase of the PA score was associated with reduction of HADS-Dep (p=0.028). Improvement of neurocognitive functions had no effect on PHBQPT scores. Important conclusions can be drawn regarding the rejection of the COVID-19 vaccine based on the associations found between the intensity of affective and anxiety symptoms and the attitude towards treatment. Our findings suggest that affective symptoms have a negative influence on the attitude towards treatment and that the improvement of these symptoms can facilitate the acceptance of the therapy, regardless of diagnosis. The modest effect of the improvement of neurocognitive functioning on the attitude towards drugs and the significant role of affective-emotional factors suggest that the accep­tance of vaccination probably cannot be facilitated solely with the aid of educational programs. Considering the increasing incidence of affective disorders during the COVID-19 pandemic, the screening of affective and anxiety symptoms and treatment of these disorders could be an important step towards the acceptance of the vaccine. Although psychiatry is not considered as a frontline care unit of the COVID cases, more attention is needed to pay on the availability of mental health services because refuse of vaccine can develop due to affective disorders too.]

Clinical Neuroscience

[Investigating cognitive impairment in communities of practice – lessons learned]

VAJER Péter, JANCSÓ Zoltán, CSENTERI Orsolya, SZÔLLÔSI Gergô József, ANDRÉKA Péter

[In the “Three Generations for Health” programme, general practitioners were responsible for screening for dementia in their practices using mini-COG and Mini Mental State Examination. The aim was to present the screening results of those included, their assessment by the doctor and the further fate of the patients. After mini-COG test, MMSE test was performed in case of suspected dementia. The examiner categorized the result as abnormal or no abnormal, recorded the referral, and recorded the data in an online interface. Our study is a cross-sectional study; the evolution and distribution of the parameters described in the objectives are described with raw case numbers and proportions. Patients aged 55 years and over were recruited consecutively. Only those cases (29 730) where mini-COG and MMSE test results were available, their assessment by the physician, and referral data to specialist care were analyzed. The Mini-COG test revealed that 64% of the subjects were suspected of cognitive decline. Misclassification occurred in 13 015 cases, with 21% of the Mini-Cog test scores matching cognitive decline and 21% of lesions considered abnormal by GPs. The MMSE test raised the suspicion of dementia in 34% of the sample (10 174 people), with 4 262 (42%) of the participating GPs considering the result abnormal. 11% (2095 people) of people with abnormal Mini-Cog test scores and 17% (1709 people) of people with suspected dementia based on MMSE test scores were referred to specialist care. Our study assessed the practice of detecting cognitive decline in primary health care. The tools adopted for screening for dementia were used by practices, but the assessment of results and referral of suspected cases of dementia to specialist care were below the expected level. There is a need to improve primary care providers’ knowledge of dementia detection and treatment and to strengthen links with specialist care.]

Lege Artis Medicinae

[Commemorating the Lipótmező. Part 1.]

RIHMER Zoltán

[“What did Lipótmező mean to you?” My friends and acquaintances asked frequently this question in the past decades, concerning the National Institute for Psychiatry and Neurology or well known as the Lipótmező my past workplace and the role it played in my life thus far. It is difficult to give a short answer, but the three and a half decades I have spent there were certainly of decisive importance in my professional and private life as well. Since I was banned from tobacco smoking due to my disease ten years ago, I cannot keep my pipe in my mouth any more. Thus, I decided to recollect the dearest stories kept in my memory, which had the deepest impact on me during my 35 years in Lipótmező both as a doctor and as a man. ]