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Clinical Neuroscience

JANUARY 30, 2016

Unanswered questions in the transcranial magnetic stimulation treatment of patients with depression

MORVAI Szabolcs, NAGY Attila, KOVÁCS Attila, MÓRÉ Csaba, BERECZ Roland, FRECSKA Ede

According to the WHO fact sheet depression is a common mental disorder affecting 350 million people of all ages worldwide. Transcranial Magnetic Stimulation (TMS) is a technique which allows the investigator to stimulate and study cortical functions in healthy subjects and patients suffering from various mental and neurological disorders. In the early 1990s, studies revealed that it is possible to evoke long term mood changes in healthy volunteers by rapid rate repetitive, TMS (rTMS) over the frontal cortex. Subsequent studies involving depressed patients found frontal cortical rTMS administered daily to be clinically effective. In the past two decades, numerous trials examined the therapeutic potential of rTMS application in the treatment of mood disorders with constantly evolving treatment protocols. The aim of this paper is to review the literature of the past two decades, focusing on trials addressing the efficacy and safety of rTMS in depressed patients. Our primary goal is to evaluate the results in order to direct future studies which may help investigators in the development of treatment protocols suitable in hospital settings. The time is not far when TMS devices will be used routinely by practitioners primarily for therapeutic purpose rather than clinical research. To our knowledge, a widely accepted “gold standard" that would offer the highest efficacy, with the best tolerability has not been established yet. In order to approach this goal, the most important factors to be addressed by further studies are: localization, frequency, intensity, concurrent medication, maintenance treatments, number of pulses, trains, unilateral, or bilateral mode of application.

Clinical Neuroscience

JANUARY 30, 2020

[Correction of the physiological artefacts at pre-surgical clinical functional MR]

KISS Máté, GÁL Andor Viktor, KOZÁK Lajos Rudolf, MARTOS János, NAGY Zoltán

[Introduction/aim of the study - Pre-surgical functional MRI (fMRI) is an important modality of examinations before brain surgery. There are several artefacts (e.g. motion, susceptibility) which may hinder the evaluation of fMRI data. Physiological artefacts (breathing, pulsation) also affect the sensitivity and specificity of anatomical localization. The aim of this study is to demonstrate the efficiency of physiological artefact identification and removal methods for presurgical evaluation. Materials and methods - Siemens Magnetom Verio 3T MRI scanner was used to collect data. The physiological parameters (breathing, pulse) were recorded with the MRI system’s built-in devices. Data from fourteen patients - with primary brain tumour - were evaluated with SPM12 utilizing the RETROICOR/RVHR tool to detect and decrease the effect of physiological artefacts. We compared the statistical maps obtained with and without the physiological correction using the Jaccard similarity coefficient, and ROI analyses. Results - Significant differences were found in the mean ROI values (p<0.0016) and the extensions of eloquent activations (p<0.0013), when using the physiological correction (RETORICOR/RVHR) based on convolution method. On the other hand, no significant differences were found between the ROIs’ standard deviations (F=0.28). The RETROICOR/ RVHR method helps to define the precise localisation of eloquent areas (p<0.009). The number of irrelevant (non-significant) voxels were increased (p<0.001). Conclusions - Minimising of physiological artefacts in fMRI data calculations, the (RETROICOR/RVHR) method based on convolution has been successfully adapted. This algorithm could be helpful before neurosurgical intervention. The activity pattern became more reliable. ]

Clinical Neuroscience

SEPTEMBER 30, 2019

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.

Hypertension and nephrology

FEBRUARY 20, 2019

[Methods of using telemedicine devices (smartphones, tablets) during home blood pressure measurement]

KÉKES Ede

[Despite the use of advanced antihypertensive drugs, patients with hypertension are still insufficient to reach the target blood pressure. In this area, home blood pressure measurement was a significant step forward, but it is not at all how the method of home blood pressure measurement is done, on the other hand, it needs to be much closer to the doctor-patient relationship. This is the goal of introducing telemedicine tools and methods into the every day clinical practice. Three methods are known: In the first one the user uses a special application on the smartphone and writes your data into the smartphone. Solution 2 is that data are automatically transferred from the measuring device into the smartphone in the third, the smartphone itself performs the measurement. Really, the first application can be disseminated with a broadly compatible doctor-patient collaboration strategy.]

Hypertension and nephrology

FEBRUARY 20, 2019

[Hypertension and atrial fibrillation. Part 3. Screening of atrial fibrillation with active involvement of patients. New telemedicine devices]

KÉKES Ede

[In the early detection of atrial fibrillation, new devices and methods with smart phone applications for patients’ self-control a regaining increasing role. The author provides a detailed description of a number of reliable, validated - working on smart phones or without her solutions - equipment with pulse or ECG recording and the irvalue in every day clinical practice. They promote closer physician - patient cooperation and signal the future of prevention and care of atrial fibrillation. In the early detection of atrial fibrillation, new devices and methods with smart phone applications for patients’ self-control a regain in gin creasing role.]

Journal of Nursing Theory and Practice

AUGUST 30, 2018

[Academic and Practical Skills of Supraglottic Airway Management among Nurses ]

SÓS András

[Aim of the study: The research goal is to measure supraglottic airway management academic and practical skills of working nurses considering education level and workplace. Methods: The research was conducted between 1 December 2015 and 15 March 2016 among nurses in one Hungarian hospital and nurses in ambulance service. The online questionnaire was volunteer and anonym. The results (N=90) were processed in Microsoft Excel 2013. Results: The none device method results shows that the OKJ nurses reached 76%, the practical nurses 74,4% and the nurses with diploma reached 78,3%, they got nearly the same results. Looking the airway management with devices OKJ nurses reached 60%, the practical nurses 74,3%, and nurses with diploma got 79,1%. In both cases the ambulance nurses got the highest result which is reached above 90%. Conclusion: The results shows that the workplace is strongly and the education level is barely affects the supraglottic airway management skill.]

Hypertension and nephrology

AUGUST 20, 2018

[The role of telemedicine is to help the optimal patient-doctor cooperation in the treatment of hypertension]

KÉKES Ede, SZEGEDI János, †KISS István

[Telemedicine is now an indispensable part of healthcare and has overtaken the development of hospital information systems. Modern basic and specialized care requires the development of a state-of-the-art communication system between the patient and the physician. One of the main reasons for this is the attempt to raise the level of disease to a higher level, increase the level of prevention and care, involve the patient in the treatment, and care process as an active participant. The latter as a demand is growing ever since the various forms of telecommunication are becoming more and more informed. The technical solutions of telemedicine appear in two forms: In one, the signs and the values of the medical devices (sensors) through the various telecommunication systems are transmitted to the physician. The other solution is using smart phones and other devices (iPad, tablet), where patients send signals, data, and symptoms to your doctor. However, patient information (eg diet, lifestyle, etc.) and instructions from your doctor may arise, a continuous medical consultation can be established in which the patient is a doctor’s partner. This solution is promoted by the rapid spread of telecommunication tools in all layers of society. Authors present the methods of both solutions and details the practical aspects of telemedicine methods in hypertension disease.]

Hypertension and nephrology

AUGUST 20, 2018

[The CONADPER-HU program. Objective and methodology of the program. Patients. Basaline data]

KISS István, ALFÖLDI Sándor, BARNA István, JÁRAI Zoltán, SIMONYI Gábor, SZEGEDI János, PAKSY András, UGRAI Péter, KÉKES Ede

[The aim of the study was to increase the rate of target blood pressure and reduce blood pressure variability. This dual objective ensures optimal therapeutic success. In order to reach this goal, we wanted to increase the care of patients with hypertension by increasing patient-physician-assistant cooperation and providing telemedicinal devices.]

Hypertension and nephrology

SEPTEMBER 14, 2018

[International guidelines for blood pressure measurements, requirements]

LIZICZAI Imre

[The author presents the classification of current blood pressure measuring devices, the validation procedure, then lists the values of the measuring devices that have passed the international protocol validation procedure.]