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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

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

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

[Case report about the choice of care at Olajág Elderly Home in Budapest during the COVID-19 epidemic in spring 2020]

PETRÓ Kata, PETKE Zsolt, RADNAI Zoltán, SZIRMAI Viktor

[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.]

Clinical Neuroscience

JULY 30, 2020

Life threatening rare lymphomas presenting as longitudinally extensive transverse myelitis: a diagnostic challenge

TOLVAJ Balázs, HAHN Katalin, NAGY Zsuzsanna, VADVÁRI Árpád, CSOMOR Judit, GELPI Ellen, ILLÉS Zsolt, GARZULY Ferenc

Background and aims – Description of two cases of rare intravascular large B-cell lymphoma and secondary T-cell lymphoma diagnosed postmortem, that manifested clinically as longitudinally extensive transverse myelitis (LETM). We discuss causes of diagnostic difficulties, deceptive radiological and histological investigations, and outline diagnostic procedures based on our and previously reported cases. Case reports – Our first case, a 48-year-old female was admitted to the neurological department due to paraparesis. MRI suggested LETM, but the treatments were ineffective. She died after four weeks because of pneumonia and untreatable polyserositis. Pathological examination revealed intravascular large B-cell lymphoma (IVL). Our second case, a 61-year-old man presented with headache and paraparesis. MRI showed small bitemporal lesions and lesions suggesting LETM. Diagnostic investigations were unsuccessful, including tests for possible lymphoma (CSF flow cytometry and muscle biopsy for suspected IVL). Chest CT showed focal inflammation in a small area of the lung, and adrenal adenoma. Brain biopsy sample from the affected temporal area suggested T-cell mediated lymphocytic (paraneoplastic or viral) meningoencephalitis and excluded diffuse large B-cell lymphoma. The symptoms worsened, and the patient died in the sixth week of disease. The pathological examination of the presumed adenoma in the adrenal gland, the pancreatic tail and the lung lesions revealed peripheral T-cell lymphoma, as did the brain and spinal cord lesions. Even at histological examination, the T-cell lymphoma had the misleading appearance of inflammatory condition as did the MRI. Conclusion – Lymphoma can manifest as LETM. In cases of etiologically unclear atypical LETM in patients older than 40 years, a random skin biopsy (with subcutaneous adipose tissue) from the thigh and from the abdomen is strongly recommended as soon as possible. This may detect IVL and provide the possibility of prompt chemotherapy. In case of suspicion of lymphoma, parallel examination of the CSF by flow cytometry is also recommended. If skin biopsy is negative but lymphoma suspicion remains high, biopsy from other sites (bone marrow, lymph nodes or adrenal gland lesion) or from a simultaneously existing cerebral lesion is suggested, to exclude or prove diffuse large B-cell lymphoma, IVL, or a rare T-cell lymphoma.

Clinical Neuroscience

JULY 30, 2020

[Decisional collisions between evidence and experience based medicine in care of people with epilepsy]

RAJNA Péter

[Background – Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose – To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods – Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results – There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology – including genetic background –, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion – Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions. ]

Clinical Neuroscience

JANUARY 30, 2020

Valproic acid associated pleuropericardial effusion: case report

DEMIR Figen Ulku

Introduction - Valproic acid is an effective antiepileptic and mood stabilizer used in the treatment of many neurological and psychiatric disorders. Although there are frequently seen side effects, effusions between layers of pleural and pericardial membranes are rare to be seen. Case - Pleuropericardial effusion was detected in a 23 years old woman who was under valproic acid treatment because of epileptic seizure. After 1 year of valproic acid treatment, patient complained of dyspnea. As all the researches intended on etiology were usual, valproic acid has been thought to be responsible for the matter. Control examination after 1.5 months regarding the end of treatment revealed complete recovery of pleuropericardial effusion. Discussion - Pleural and pericardial effusions are rarely seen complications related to the use of valproic acid. It must also be kept in mind that valproic acid causes a potential for such side effects which can be blamed etiologically when the other possibilities for patients are excluded.

Journal of Nursing Theory and Practice

JUNE 30, 2019

Nurses‘ competences in preventive cardiology

IVANA Chloubová, VALÉRIE Tóthová

Introduction: The nurse education in the Czech Republic is based on the recommendations of the European Union, respecting the outcoming knowledge and skills of general nurses, formulated in basic competence criteria. Cardiovascular diseases rank among the main causes of death not only in many developed countries, but also in developing countries. Accent should be put on prevention of these diseases and the nurses should provide for efficient education. Goals and methods: The goal of the article consists in presenting the results of the analysis of the available sources focused on nurse education and the resulting competences in the field of cardiology, as well as in describing the system of health-educational activities of nurses in preventive cardiology in selected EU countries. The methods of research and structured interview were used. Results: The nurse‘s task in prevention of cardiovascular diseases consists in educating the public on influenceable risk factors which have significant impact on the incidence of cardiovascular diseases, but also on people‘s quality of life. It is important to alert the people to changes in their own risk behaviours and to motivate them to activities leading to improved life style. Conclusion: It can be concluded that the nurses in preventive cardiology make use of the competences acquired through pregradual studies. However, the current practice requires increasing competences within postgradual education.

Lege Artis Medicinae

DECEMBER 10, 2019

[The adverse effects of smoking on our respiratory system based on data of the Hungarian Public Health Screening 2010-2018 ]

KÉKES Ede, DAIKI Tenno, DANKOVICS Gergely, BARNA István

[The regular smoking with or without clinical symptoms causes structural changes in the lung tissue and this is reflected in res­pi­ratory function tests. During the last 9 years of Hungary's comprehesive health promotion screening (MÁESZ) between 2010 and 2018, spiro­metric examinations (PEF, FEV1, MEF25-75, FVC) were performed on 70822 women and 60187 men. We used the percentage of predictive values in the analysis to describe the deviation from normal. The carbon monoxide (eCO) content measurement of the exhaled air (in ppm) was performed on 24899 women and 22340 men. The COPD Evaluation Ques­tionnaire (CAT) was completed by 4166 wo­men and 3170 men. All four parameters of spirometry showed lower values for smokers in both sexes, but in men they were lower than in women. Ageing lowered significantly the values. The rate of changes from normal predictive values and the difference between smokers and non-smokers was the highest for MEF25-75 and FVC. The expiratory CO content (eCO) was significantly higher in smokers than in non-smokers in all age groups. In smokers, the incidence in percent of abnormal CAT score was significantly higher. Respiratory screening tests reveal the harmful effects of smoking, even without clinical symptoms, and indicate the risk of developing COPD.]

Journal of Nursing Theory and Practice

APRIL 30, 2019

[A Systematic Review of nurses knowledge of Incontinence-Associated Dermatitis ]

KÓSZÓ Lilla, NAGY Erika, PAPP Anita Tímea

[Background: Due to the growing incidence of incontinence, Incontinence-Associated Dermatitis (IAD) is one of the most important health problems nowdays. The most significant challange is the differentiation of IAD and ulcer pressure. Missclassification in practice causes suboptimal prevention and therapy. Thus, in order to provide optimal care, nurses need to be able to properly differentiate between the two illnesses. Objectives: The airm of this analysis was to identify how nurses can classify IAD from ulcer pressure, and how differentiation could be taught to nurses. Method: A systematic review was done wih ’pressure ulcer and ’classification’ and ’nurse’ search words using 3 databases, the Pubmed (NLM), the Science Direct and the Web of Science as basic sources. We relied on articles that were published before September 2018. From the total of 1268 records 7 studies met all the inclusion and exclusion criterias and were chosen for analysis. Results: We counted weighted arithmetic from the results of the studies. In total 4062 nurses participated in the clinical trials. Their weighted mean score was 33,2%. 2132 nurses got some types of education, The weighted mean score of their pre-test was 37%, while their post-test reached 66%. Conclusion: Differentional diagnosis between pressure ulcers and IAD is complicated. However, studies all agree that education in this field produces good results.. ]

Hypertension and nephrology

SEPTEMBER 10, 2019

[Kidney diet and the patient compliance issue ]

LADÁNYI Erzsébet

[There have been significant developments in the field of nephrology and dialysis as for the science and technology are concerned in the past decades. However, CKD patients still show high mortality and morbidity. From among the several factors determining the long-term outcome of CKD patients metabolic disorder and malnutrition play an important role. Malnutrition is often not diagnosed or is not paid enough attention to in the complex treatment of CKD patients. It is important to make both the patients and clinical staff more aware of proper nutrition and importance of prevention and treatment of malnutrition, respectively. The early diagnosis and treatment of malnutrition is of utmost importance in CKD patients. The long term renal failure and the accompanying malnutrition have a negative impact on their long term outcome and quality of life. Since the malnutrition causes a lot of complications, it is indispensable for dietitians and nephrologists to work closely together. Patient compliance is a determining factor in the successful implementation of renal diet.]

Journal of Nursing Theory and Practice

FEBRUARY 28, 2019

[A less known problem: Incontinence-Associated Dermatitis ]

KÓSZÓ Lilla, NAGY Erika, PAPP Anita Tímea

[Background: Incontinence-Associated Dermatitis (IAD) is a tissue integrity problem receiving more and more attention in the last 10 years. The number of incontinent patients is increasing. In this group IAD prevalence is high. In most cases patient sacquire IAD during their hospital care. However, diagnosis with IAD appears to be difficult due to its symptomal similarities with pressure ulcer, often leading to suboptimal nursing. Objectives: This rewiew is based on the latest studies and was written for nurses in order to clarify IAD definitions, causes and preventions, and therapial alternatives in Hungarian language. Results: The definition and the patomechanism of IAD is given. The study introduces the newest classification system, and the main points that help nurses in differentiating IAD from pressure ulcer. Prevention and therapy are also integral parts of thereview.]