Lege Artis Medicinae

[World, crisis, change]

KAPÓCS Gábor

DECEMBER 19, 2008

Lege Artis Medicinae - 2008;18(12)

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Lege Artis Medicinae

[Getting in Harmony]

KOLIN Péter

Lege Artis Medicinae

[ASTHMA THERAPY ACCORDING TO THE REVISED INTERNATIONAL RECOMMENDATION]

HERJAVECZ Irén, BÁNKÚTI Beáta, CSOMA Zsuzsanna

[A comprehensive workshop report entitled “A Global Strategy for Asthma Management and Prevention - Global Initiative for Asthma (GINA)” first published in 1995, has been widely adapted, translated and reproduced, and forms the basis for many national asthma guidelines. The 2006 report contains important new themes. It asserts that it is reasonable to expect that in most patients with asthma, control of the disease can be achieved and maintained, and recommends a change in approach to asthma management with asthma control, rather than asthma severity, being the focus of treatment decisions.]

Lege Artis Medicinae

[Similar to Similar – Homeopathy in Hungary]

KÖLNEI Lívia

Lege Artis Medicinae

[ROSIGLITAZONE IN THE HEAT OF THE DEBATE]

POGÁTSA Gábor

[The meta-analysis by Nissen and Wolski suggested a potential ischemic cardiac side effect of rosiglitazone. Studies in order to verify this suggestion finished until now had a short duration and a low frequency of harmful cardiac events that made them unable to decide this question. Nevertheless, several running studies will presumably have an adequate follow-up period of ten or more years and the desired frequency of observed cardiac events. Completion of these studies and publication of their results can be expected in the following two years. Until then, the European Medicines Agency’s standpoint of 18th October 2007 will be valid stating the benefits of rosiglitazone surpass its risks.]

Lege Artis Medicinae

[Coecum or Not?]

BALOGH István

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Clinical Neuroscience

Myasthenia gravis, Guillain-Barré syndrome, or both?

ERDOGAN Cagdas, TEKIN Selma, ÜNLÜTÜRK Zeynep, GEDIK Korkut Derya

Myasthenia gravis (MG) and Guillain-Barré syndrome (GBS) are autoimmune disorders that may cause weakness in the extremities. The coexistence of MG and GBS in the same patient has rarely been reported previously. A 52-year-old male presenting with ptosis of the left eye that worsened with fatigue, especially toward evening, was evaluated in our outpatient department. His acetylcholine receptor antibody results were positive, supporting the diagnosis of MG. His medical history revealed a post-infectious acute onset of weakness in four extremities, difficulty in swallowing and respiratory failure, which was compatible with a myasthenic crisis; however, his nerve conduction studies and albuminocytologic dissociation at the time were compatible with GBS. With this case report, we aimed to mention this rare coincidental state, discuss possible diagnoses and review all other similar cases in the literature with their main features.

Clinical Neuroscience

Acute bilateral drop foot as a complication of prolonged squatting due to haemorrhoid

KOKSAL Ayhan, DOGAN Burcu Vasfiye

Drop foot is defined as difficulty of dorsiflexion of the foot and ankle due to weak anterior tibial, extensor hallucis longus and extensor digitorum longus muscles. Cauda equina syndrome, local peroneal nerve damage due to trauma, nerve entrapment, compartment syndrome and tumors are common etiologies. A 32-year-old male patient was applied with difficulty in dorsiflexion of both of his toes, feet and ankles after he had squatted in toilette for 6-7 hours (because of his haemorrhoid) after intense alcohol intake 2 weeks before. Acute, partial, demyelinating lesion in head of fibula segment of peroneal nerves was diagnosed by electromyography. This case was reported since prolonged squatting is an extremely rare cause of acute bilateral peroneal neuropathy. This type of neuropathy is mostly demyelination and has good prognosis with physical therapy and mechanical devices, but surgical intervention may be required due to axonal damage. People such as workers and farmers working in the squatting position for long hours should be advised to change their position as soon as the compression symptoms (numbness, tingling) appear.

Clinical Neuroscience

[Earlier and more efficiently: the role of deep brain stimulation for parkinson’s disease preserving the working capabilities]

DELI Gabriella, BALÁS István, KOMOLY Sámuel, DÓCZI Tamás, JANSZKY József, ASCHERMANN Zsuzsanna, NAGY Ferenc, BOSNYÁK Edit, KOVÁCS Norbert

[Background – The recently published “EarlyStim” study demonstrated that deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD) with early fluctuations is superior to the optimal pharmacological treatment in improving the quality of life and motor symptoms, and preserving sociocultural position. Our retrospective investigation aimed to evaluate if DBS therapy was able to preserve the working capabilities of our patients. Methods – We reviewed the data of 39 young (<60 years-old) PD patients who underwent subthalamic DBS implantation at University of Pécs and had at least two years follow-up. Patients were categorized into two groups based on their working capabilities: Patients with active job (“Job+” group, n=15) and retired patients (without active job, “Job-” group, n=24). Severity of motor symptoms (UPDRS part 3), quality of life (EQ-5D) and presence of active job were evaluated one and two years after the operation. Results – As far as the severity of motor symptoms were concerned, similar (approximately 50%) improvement was achieved in both groups. However, the postoperative quality of life was significantly better in the Job+ group. Majority (12/15, 80%) of Job+ group members were able to preserve their job two years after the operation. However, only a minimal portion (1/24, 4.2%) of the Job- group members was able to return to the world of active employees (p<0.01, McNemar test). Conclusion – Although our retrospective study has several limitations, our results fit well with the conclusions of “EarlyStim” study. Both of them suggest that with optimal timing of DBS implantation we may preserve the working capabilities of our patients.]

Clinical Neuroscience

Frequency and types of headaches in patients with metabolic syndrome

DEMIRYÜREK Enes Bekir, EMRE Ufuk, KORUCU Osman, BARUT Özen Banu, TASCILAR Nida Fatma, ATASOY Tugrul Hüseyin, DEMIRYÜREK Esra, YAYLACI Selcuk, GENC Bilal Ahmet

Background - Metabolic Syndrome (MetS) and headaches are common public health problems in whole world. The relationship between headaches and the MetS isn’t understood clearly. Purpose - The aim of this study is to determine the prevalence and types of headaches, and evaluate the relationship between headache characteristics and clinical and laboratory parameters analyzed in patients diagnosed with MetS. Materials and methods - Of the patients diagnosed with MetS in Endocrinology outpatient clinics between July 2011 and July 2012, 202 patients were included in the study. Hemoglobin, fasting blood glucose (FBG), total cholesterol, triglyceride, HDL and LDL cholesterol, thyroid function tests and HbA1c values of all patients were recorded. Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were applied to all patients. The headache severity was assessed by Visual Analog Scale (VAS). Results - The prevalence of headache in patients with MetS was found to be 61.4%. The incidence of headache was higher in female patients (F: 86.4%, M: 13.6%). The distribution of the subtypes of headaches was as follows: Episodic Tension-Type Headaches (ETTH) 24.8%, Episodic Migraine 14.4%, Chronic Tension-Type Headaches (CTTH) 11.3%, Episodic Tension-Type Headaches (ETTH) and Episodic Migraine 7.9%, and other types of headaches (Cervicogenic Headache and Cluster Headache) 3%. No statistically significant relationship was found between headache and non-headache groups in terms of body mass index, waist circumference, and the laboratory parameters (p>0.05). The mean BDI and BAI scores were higher in the headache group (p<0.001 and p<0.001). No significant difference was found between the mean MIDAS scores in the subtypes of headaches (p=0.35). In the headache group, there was a significant relationship only between triglyceride levels and attack frequency, duration and severity. Conclusion - Prevalence of headache in patients with MetS was 61.4%. The incidence of subtypes of headaches was similar to those in the general population. A relationship was found between triglyceride levels and attack frequency and severity. The result may be important to draw attention to the evaluation of triglyceride levels for reducing the frequency and severity of attacks in patients with headaches.

Lege Artis Medicinae

[In vitro diagnostic medical testing laboratories and EU standards; basic elements]

DEBRECZENI Lóránd, FEKETE Mátyás, VÁSÁRHELYI Barna

[In the “in vitro diagnostic testing medical laboratories” particular attention should be paid to the confidental and reliable operation as to 60-75% of the information for medical decisions are derived from laboratory tests. The high-quality laboratory work is based on the standards created by the national professional boards. Laboratories in Hungary (as any other country around the world) should comply with the various directives and/or standards set out requirements: MSZ EN ISO 15189:2013, MSZ EN ISO 22870:2006, MSZ EN ISO 15197:2013, Guide to the Expression of Uncertainty in Measurements (GUM), guidelines of the International Union of Pure and Applied Chemistry (IUPAC), etc. Special attention should be devoted to the quality of the work (internal and external quality assurance). Participation in proficiency testing (MSZ EN ISO 17043:2010) is a must, where the results are evaluated by statistical methods as defined by the ISO 13528:2005 standard. Some aspects are summarized how to select appropriate laboratory services.]