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Hypertension and nephrology
NOVEMBER 04, 2020
[Covid-19 and the diabetes mellitus]
[In late 2019 the epidemic of new coronavirus disease (Covid-19) from Wuhan, China, posed major challenges to the health systems of even the most developed countries. High mortality of the disease has been observed mainly in the elderly and in those with various cardiovascular and metabolic comorbidities. In this summary, the relationship between diabetes mellitus]
Lege Artis Medicinae
OCTOBER 21, 2020
[Epidemiology of diabetes mellitus and diabetes-related eye complications in Hungary]
[Diabetes mellitus is a disease of civilization and a leading cause of blindness among people of working age in developed countries. It’s prevalence is estimated to be 9.9% in the adult population in Hungary, based on this, the estimated number of people with diabetes mellitus was 807 000 in 2015 in our country. Almost every fifth people with diabetes mellitus has some form of diabetic retinopathy in Hungary. Among diabetic persons 0.3% is blind and 0.3% has serious visual impairment due to not adequately treated diabetes mellitus. The total prevalence-based diabetes retinopathy-associated economic burden was 43.66 billion HUF in 2018 in our country. The two major cost drivers were anti-VEGF injections and vitrectomies; they covered almost the four-fifths of the total cost among people with diabetes mellitus. We have to emphasize the importance of prevention, healthy nutrition and frequent sport activity in the fight against diabetes mellitus and overweight. With at least annually performed eye examinations in people with diabetes mellitus and timely treatment of diabetic retinopathy, visual impairment and blindness due to complications of diabetes mellitus can be prevented. ]
Hypertension and nephrology
SEPTEMBER 30, 2020
[Treatment and care of hypertensive patients during and after the Covid-19 pandemic. Possibilities and effectiveness of telemedicine]
[The course and outcome of an pandemic caused by coronaviruses are determined by many factors, such as the strength and dose of the infectious virus, the immune system of the affected individual, the underlying diseases, the speed of virus spread, age and environmental factors and methods of control. In old age, there is a significantly higher risk of developing severe cases and fatalities. The rate of loss of life is particularly high in social care and nursing homes. Hypertension as the underlying disease is the most common cause of death, but hypertension alone is not an independence risk factor, but the main reason is the co-morbidities and complications associated with viral infection. In the epidemic situation, the treatment and care of hypertensive patients poses special challenges for health and active primary and specialist care workers and, of course, for hypertonologists. The Hungarian Society of Hypertension expressed its opinions and recommendations to patients living at home and to doctors performing treatment and care during the Covid-19 virus epidemic and summarized the decision-making possibilities derived from the data obtained during the telemedicine consultation. We would like to present the details of the possibilities provided by telemedicine, the practical possibilities and advantages of the different methods of teleconsultation, and the models that can be implemented in a domestic environment. We have taken into account international experience to date, the new e-health strategy for chronic, non-communicable diseases and the WHO concept. Telemedicine, continuous teleconsultation ensures an optimal relationship between the patient and the doctor, increases the patient’s sense of security, improves drug adherence. The doctor receives reliable data about the patient’s condition and can send him instructions as well as information. The development of a harmonious balance between personal contact and telecommunications already shows the future, and the application of these methods must be developed in the epidemic-free period as well. Previous international (TASMINH-4, HOMED-BP etc.) and domestic (CONADPER-HU) studies have proved that telemonitoring of hypertensive patients can be successfully solved, improves patients’ drug adherence, increases the target blood pressure achievement rate and at the same time the patient will be the active part of the treatment. The method is especially useful in rural settlements without a doctor. Telemedicine monitoring of elderly and multimorbid patients is especially useful in social institutions and nursing homes. It is solved the continuous control of vital functions, ensures continuity of contact with the supervising physician and in urgent cases, allows for rapid intervention. Telemedicine is also of great importance due to the lack of human resources, as many things can be solved with such technology, there are no need so many personal encounters. In addition to influencing the course of this pandemic, it also plays an important role in efficiency, headcount, management and “convenience” in general practice and in all formes of medicine. The proposed models can not only be applied in an epidemic situation, but should continue to be part of everyday health work in future.]
Clinical Neuroscience
SEPTEMBER 30, 2020
[Pompe disease treated with enzyme replacement therapy in pregnancy]
[Pompe disease is a rare lysosomal storage disease inherited in a recessive manner resulting muscular dystrophy. Due to the lack of the enzyme alpha glucosidase, glycogen accumulates in the cells. In the infantile form of Pompe disease hypotonia and severe cardio-respiratory failure are common leading to death within 2 years if left untreated, while the late-onset form is characterized with limb-girdle and axial muscle weakness accompanied with respiratory dysfunction. Pompe disease has been treated with regular intake of the missing enzyme since 2006, which significantly improved the survival and severity of symptoms in patients of both subtypes. The enzyme replacement therapy (ERT) is safe and well tolerated. However, limited data are available on its use in pregnancy. Our goal is to share our experience and review the literature on the safety of enzyme replacement therapy for Pompe disease during pregnancy and post partum.]
Clinical Neuroscience
SEPTEMBER 30, 2020
Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT
Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.
Lege Artis Medicinae
SEPTEMBER 30, 2020
[Thyroid disease – essentials for the everyday practice]
[Thyroid disorders are very frequent not only among endocrine diseases but also the general conditions. Every clinician, regardless of their specialty, meet patients with thyroid disorders during their everyday practice. While diagnostic and therapeutic options remained almost unchanged in the past decade, there are several intensively researched topics in the patient’s care, advances of which we ought to familiarize ourselves with. In this present paper we sought out to cover three of these fiercly discussed topics. ]
Lege Artis Medicinae
SEPTEMBER 30, 2020
[Case report about the choice of care at Olajág Elderly Home in Budapest during the COVID-19 epidemic in spring 2020]
[During the COVID-19 pandemic caused by the SARS-CoV-2 virus, elderly people in long-term nursing homes were especially risks exposed. In this study, the authors analyse the causes of local outbreak at the Olajág Elderly Home Vezér street facility in Budapest and the means and ways to curb the spreading of infection. They summarise the measures, which proved to be effective in isolation and treating the patients. The number of infected residents as well as the course of the disease are demonstrated by statistical data. The authors consider as pre-eminently important to identify asymptomatic but infected residents, further the rapid introduction of screening tests, strict compliance with protocols, patient path regulation and the use of enhanced, supportive communication.]
Lege Artis Medicinae
JULY 01, 2020
[Sarcopenia – muscle loss – pathomechanism, clinical presentation and metabolic comorbidities]
[Sarcopenia, or the age-related involution of muscle strength and muscle mass, is a serious public health concern, due to the growing number of elderly population caused by nowadays demographic changes i.e. prolonged life expectancy. By ageing, the muscle tissue is shrinking gradually, leading to the loss of muscle strength and masses. This condition is called sarcopenia. Sarcopenia is the simultaneous decrease of muscle mass, muscle strength and functional independence. In parallel the physical performance deteriorates (weakness, slowness and poor physical balancing). Fatigue, elderly behaviour and weight loss are the consequences of these accumulating deficits, which associate with cognitive decline and result in increasing social isolation. The primary form of sarcopenia is the decrease of the energy production of muscle cells and then the death of muscle cells. Secondary, endocrine dysfunctions, diseases of the nervous system, decreased physical activity, malnutrition or malabsorption, chronic infection accelerate the process and aggravate the patient’s condition. Complex genetic, biochemical and endocrine mechanisms take part in the development of sarcopenia. This involution is due to the impaired balance of restoring and depleting processes of muscles. A questionnaire and algorithm have been developed to recognize, screen and diagnose the risks of sarcopenic condition; these separate the sarcopenic and non-sarcopenic patients with specific cut-off values. Sarcopenia can be diagnosed based on walking speed, decreased handgrip strength and measured or calculated muscle mass in persons over 65. Sarcopenia can be considered as a phenomenon of “physiological” aging, however, it becomes a disease when diagnostic cut-offs are exceeded and the patient experiences functional disability and declining quality of life. Prevention and treatment of sarcopenia and reducing the risk of falling are based on regular active resistance and coordination exercises. Options for pharmaceutical treatments are limited since despite of identified molecular targets there are no convincingly effective innovative therapy on the horizon. Nevertheless, there are some weak evidence for efficacy of the application of amino acids stimulating muscle cell differentiation, such as leucine or the analogue of beta-hydoxy-methylbutyrate beside exercise therapy.]
Lege Artis Medicinae
JULY 01, 2020
[Persisting Hashimoto’s thyroiditis converting to Graves’ disease]
[Graves’disease and Hashimoto’s thyroiditis are the two most important types of autoimmune thyroid diseases. Autoimmune hyperthyroidism commonly leads later on to hypothyroidism. The conversion from persisting Hashimoto-thyroiditis to hyperthyroidism is rare in the literature. The author presents the cases of two patients, whose Hashimoto’s thyroiditis treated with thyroxin for years, changed into Graves’ hyperthyroidism spontaneously. CASE REPORT – The patients had been diagnosed with autoimmune hypothyroidism since several years. The clinical symptoms, the low peripheral hormone levels, the high level of antithyroid antibodies and the ultrasound imaging confirmed the hypertrophic form of Hashimoto’s thyroiditis. After several years of high dose levothyroxin treatment, clinical symptoms of hyperthyroidism have appeared. After omitting the substitution, the thyroid hormone levelled off at high values and the level of anti-TSH receptor antibodies raised too. The diffuse, obviously increased blood flow of the thyroid glands, and in one of the patients the thyroid scan, confirmed the Graves’ disease. During the thyreostatic treatment, the symptoms of the patients disappeared, they became euthyreoid and the antibody levels decreased as well. The Graves’ disease and the Hashimoto’s thyroiditis have many common features. These immunological, genetic and other common features enable the mutual transition of these two diseases.]
Hypertension and nephrology
JUNE 24, 2020
[Not all young, athletic university students have optimal blood pressure. Results of the May 2019 Measurement Month (MMM19)]
[For about 100 years, it has been known that persistently high blood pressure (hypertension) is the leading cause of cardiovascular disease deaths, such as major risk factors for heart failure, myocardial infarction, stroke, kidney and eye disease. Unfortunately, one of the characteristics of hypertension is that it remains undetected for a long time until damage to one or more organs has already occurred. Therefore, it is very important that systemic blood pressure is monitored from time to time, especially above 45 years of age. The prevalence of hypertension is more than 35% in the Hungarian population. Recent data have pointed out that hypertension may occur at a younger age, although at a lower frequency. Our studies were conducted in the context of the May 2019 Measurement Month (MMM19), an international campaign that draws attention to hypertension and the lack of systematic screening at population level. We hypothesized that hypertension may occur in young, apparently healthy university students. The studies were conducted among students of the University of Physical Education (n = 33; 25 males, 8 females). The mean age was 24.3 years (20–34 years). To measure blood pressure, an automatic blood pressure monitor (Omron MIT5) was used, placed on individuals’ upper arms, as specified in the guidelines, in a relaxed, sitting position. The measurements were repeated three times at one-minute intervals and the average of the three measurements was statistically analyzed. Blood pressure values (mean ± SEM, averaged over 3 measurements) in the student population were systolic 121.9 ± 14.4 mmHg, diastolic 75.1 ± 9.1 mmHg, mean 90.7 ± 10.9 mmHg, and heart rate: 46.8 ± 5.3 mmHg. Although mean blood pressure was within the normal range, higher values were also found in some individuals. Systolic blood pressure fell by 33% due to elevated normal blood pressure, respectively of Grade 1 hypertension. These data confirmed our hypothesis that hypertension may occur at a young age, despite the fact that members of the study population exercise regularly, which is an important preventive factor in the development of cardiovascular disease. These results underscore the importance of regular blood pressure measurement in adolescents, which may reduce the global spread of hypertension and prevent the development of a number of cardiovascular diseases, including stroke, heart attack, renal failure and mental decline.]
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Clinical Neuroscience
Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease
08. JUN
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Clinical Neuroscience
[Cases of inborn errors of metabolism diagnosed in children with autism ]
19. JAN
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Clinical Neuroscience
[The first Hungarian patient with Guillain-Barre syndrome after COVID-19]
19. JAN
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Clinical Neuroscience
Retinal morphological changes during the two years of follow-up in Parkinson’s disease
19. JAN
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