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Clinical Neuroscience

MAY 30, 2020

hirdetés

[Family planning in multiple sclerosis: conception, pregnancy, breastfeeding]

RÓZSA Csilla

[Family planning is an exceptionally important question in multiple sclerosis, as women of childbearing age are the ones most often affected. Although it is proven that pregnancy does not worsen the long-term prognosis of relapsing-remitting multiple sclerosis, many patients are still doubtful about having children. This question is further complicated by the fact that patients – and often even doctors – are not sufficiently informed about how the ever-increasing number of available disease-modifying treatments affect pregnancies. Breastfeeding is an even less clear topic. Patients usually look to their neurologists first for answers concerning these matters. It falls to the neurologist to rationally evaluate the risks and benefits of contraception, pregnancy, assisted reproduction, childbirth, breastfeeding and disease modifying treatments, to inform patients about these, and then together come to a decision about the best possible therapeutic approach, taking the patients’ individual family plans into consideration. Here we present a review of relevant literature adhering to international guidelines on the topics of conception, pregnancy and breastfeeding, with a special focus on the applicability of approved disease modifying treatments during pregnancy and breastfeeding. The goal of this article is to provide clinicians involved in the care of MS patients with up-to-date information that they can utilize in their day-to-day clinical practice. ]

Lege Artis Medicinae

JULY 01, 2020

[Avoiding unlimited energy drink consumption is a matter of our heart]

DOJCSÁKNÉ Kiss-Tóth Éva

[Energy drinks have been gaining unbroken popularity, especially among youngsters and children since they were introduced to the market. Manufacturers promise to improve performance and stamina with consuming the products, classified as non-alcoholic soft drinks. In addition to the vitamins and plant extracts, they contain a significant amount of caffeine and other stimulants (taurine, guarana). Among the active ingredients, caffeine has an outstanding effect and thereby a danger, since its overconsumption – in addition to milder he­mo­dynamic changes – can cause severe cardio­vascular consequences, cardiac arrhythmias, ion channel diseases, increased blood coagulation, myocardial infarction or reduced cerebral blood flow in susceptible consumers. Many case studies have also reported serious cardiovascular attacks among young chronic energy drink consumers. Health impairments of excessive and long-term consumption of energy drinks have been studied increasingly, however there is limited and contradictory evidence on the safety of consumption and the effectiveness of performance enhancement. ]

Clinical Neuroscience

JANUARY 30, 2016

Long term follow-up of lesional and non-lesional patients with electrical status epilepticus in slow wave sleep

HEGYI Márta, SIEGLER Zsuzsa, FOGARASI András, BARSI Péter, HALÁSZ Péter

Objectives – A retrospective study has been done at the Bethesda Children’s Hospital Epilepsy Center with those patients whose EEG records fulfilled in one or more records the criteria of electrical status epilepticus in slow wave sleep (ESES) pattern, occupying at least 75% of NREM sleep with bilateral discharges, and had detailed disease history and long term follow-up data, between 2000 and 2012. Patients and methods – Thirty-three patients (mean 11.1±4.2 years of age) were studied by 171 sleep EEG records. Sleep was recorded after sleep deprivation or during spontaneous sleep at least for one hour length of NREM. From the 492 EEGs, 171 sleep records were performed (average five/patient). Average follow-up time was 7.5 years. Eighty-two ESES records have been analyzed in 15 non-lesional and 18 lesional (11 with dysgenetic and seven with perinatal - asphyxic or vascular origin) patients. Variability of seizure types, seizure frequency and frequency of status epilepticus was higher in the lesional group. Impairment of the cognitive functions was moderate and partial in the non-lesional, while severely damaged in the lesional group. Results – EEG records of 29 patients showed unihemispherial spike fields with a perpendicular axis (in anterior, medial and posterior variants) to the Sylvian fissure, regardless their lesional or non-lesional origin. Only three (1one non-lesional and two lesional) patients had bilateral synchronous spike-wave discharges with bilateral symmetric frontocentral spike fields. The individual discharges of the sleep EEG pattern were very similar to the awake interictal records except their extension in time and field, their increased number, amplitude, and continuity of them and furthermore in the increased trans-hemispheral propagation and their synchronity. Conclusions – Assumed circuits involved in the pathomechanism of discharges during NREM sleep in ESES are discussed based on our findings.

Hypertension and nephrology

APRIL 24, 2020

[Possibilities and limitations. Dietary difficulties of chronic renal failure in childhood]

REUSZ György, SZABÓ Adrienn

[In chronic kidney disease (CKD), the role of the kidney in assuring homeostasis is gradually deteriorating. Besides fluid, electrolyte and hormonal disturbances, detoxification and control of blood pressure is insufficient without external help. In children, in addition to achieving equilibrium it is also essential to ensure optimal physical and cognitive/psychological development. Adequate calorie intake is a major determinant of growth during infancy. Among the therapeutic options it is essential to ensure a proper diet. In addition to reflecting the special needs of renal failure in its composition, it must be palatable for the child. Children with kidney disease should have a normal energy diet. Protein intake should not be reduced from the baseline recommendation, but lower phosphorus and high bioavailability should be preferred. A low sodium and potassium diet is recommended for a significant proportion of patients and is based on dietary advice. Further, diet planning may be problematic if the child has special dietary requirements and is in need of nasogastric tube feeding. Because diet planning is a complex task, it is difficult to achieve optimal protein supply and mineral restriction along with high energy intake. In such cases, enteral nutrition with special formulas/ drinks developed for pediatric nutrition may provide a solution.]

Lege Artis Medicinae

MARCH 10, 2020

[Summary data of Hungary's comprehensive health screening program (MAESZ) 2010-2019]

BARNA István, KÉKES Ede, HALMY Eszter, BALOGH Zoltán, KUBÁNYI Jolán, SZŐTS Gábor, NÉMETH János, PÉCSVÁRADY Zsolt, MAJOROS Attila, DAIKI Tenno, ERDEI Ottilia, DANKOVICS Gergely

[The comprehensive screening program of Hun­gary (MAESZ) 2010-2020-2030 is a unique initiative in Hungary and worldwide too. This largest humanitarian program provides by the latest technology free scree­ning tests for all residents in Hungary. The program developed by 76 pro­fessional organizations offers 38 scree­ning tests to every participants free of charge, in a special designed screening truck. Screening program performed by MAESZ includes cardiovascular, ophthalmologic, dermatologic, gynecologic, and neurologic investigations, lab tests, audiometry, blood pressure and arterial stiffness measurements, and venous Doppler ultrasound examinations. More­over, screening tests for lactose intolerance, colon malignancy, inflammatory bowel disease, reflux disease, urine incontinency, prostatic cancer and physical activity level were evaluated. Starting 2020, a dental screening station will be added to the mobile unit for early detection of oral cancers. Beyond screening tests, special attention is paid to assess health threatening risk factors, such as smoking, alcohol con­sumption, physical inactivity, un­healthy nutrition, and obesity. The program demonstrates the key elements of first aid from reanimation to bandage of burns in cooperation with professional and civil organisations. Furthermore, during the waiting time, participants get lifestyle recommendations and a health booklet with a bar code enabling the immediate computer analysis of test outcomes. Since the 2018/2019 school year the official prevention program for children entitled “Travel around the Empire of Health” was started. During its 10 years, the MAESZ performed 7 million free of charge screening tests on 1,886 scenes, enrolled 560,000 participants, invested 16,000 hours for prevention, handed out 1,200,000 health booklets and 391,000 prevention info packages to thousands of fami­lies. More than 20,000 health professionals (GPs, nurses, dietetics, health development agents, public health government officials, Accident Prevention Committee of National Police Headquarters, General Directorate of Social Affairs and Child Protection and non-governmental organizations) have been participated. The program designed to improve social health aims to help more and more Hun­garian citizens to be informed about their health status and to reminds them of the importance of prevention. ]

Hypertension and nephrology

DECEMBER 12, 2019

[Hypertension and brain function. Correlation of high blood pressure and demencia in aging. Hypertension in young-middle adults - demencia in elderly]

SZÉKÁCS Béla, KÉKES Ede

[The cerebral vascular damage caused by hypertension is manifested primarily in cognitive dysfunction, which is caused by hypoperfusion of brain tissue, ischemic, or bleeding stroke, or white matte injury. Hypertension may not only result in cerebral damage to the vascular background - dementia -, but may also contribute to the development and progression of classical gene-related Alzheimer’s disease. Blood pressure gradually increases in the elderly and in the very elderly, and the frequency of hypertension-mostly as isolated systolic hypertension - is 50% to 70%. High blood pressure predominately, or in full, means not only an increase in the circulatory resistance of the small children, but also, as part of the aging of the body, the rigidity (stiffness) of the arteries. At the same time, the incidence of dementia, along with age, rises sharply - up to 20% in those over 65 years of age, and over 40% in 80-90 years of age. The relationship between high blood pressure and dementia from the young age to the very old age may change as a function of current age. In the very old age of life, the varying influence of other pathological factors other than hypertension is becoming more and more important in the deterioration of both the vascular structure and the brain function. In this late stage of life, the very advanced rate of aging and nutritive blood flow often require higher perfusion pressure, and the not enough thought-out blood pressure reduction can be more damaging than a protective effect on brain condition or function. SPRINT MIND - the Intense Blood Pressure Reduction - hasn’t resolved the question, and we can legally assume that the 130-140 Hgmm SBP. Is the most favorable for dementia. The value of DBP 70 Hgmm is definitely unfavorable.]

Hypertension and nephrology

OCTOBER 23, 2019

[Non-invasive evaluation of cardiovascular risk in pediatric chronic kidney disease patients]

BÁRCZI Adrienn, DÉGI Arianna Amália, KIS Éva, REUSZ György

[Cardiovascular diseases are the leading cause of mortality and morbidity in children with chronic kidney disease (CKD). Similar to adults, children with CKD experience a high burden of traditional and uremia-associated risk factors. Recent years, several studies were published in connection with cardiovascular risk factors, patomechanism, and early markers of cardiovascular diseases. Early signs of cardiomyopathy, such as left ventricular hypertrophy or dysfunction, and markers of atherosclerosis, such as increased intima-media thickness of the carotid artery or increased wall stiffness of the aorta are frequently present in early stages of CKD in children. As prevention is important in pediatrics, the evaluation of subtle changes of the cardiovascular system provide opportunity for early treatment and that enables children to develop normally and have a better long-term quality of life. Recently, newer non-invasive cardiovascular imaging modalities have been emerged to diagnose subclinical alterations of the heart and vessels in this specific population with kidney disease. In this review, we provide an overwiev of the emerging imaging techniques used to detect early subclinical organ damage in pediatric chronic kidney disease patients.]

Lege Artis Medicinae

OCTOBER 20, 2019

[Donizetti's ailment: mood disorder, Barbaja, or luetic derailment?]

JANKA Zoltán, SZAKÁCS Réka

[The occurrence of specific forms of mood disorders is significantly higher among eminent creative persons, thus the talent and creative skills show some connections or may have common roots with mood swings. This phenomenon can be observed among composers as well. Our paper briefly summarizes several aspects of Gaetano Do­ni­zetti’s life (1797-1848), and some characteristic features of his operas. After his musical studies and initial successes Donizetti was hired by the opera impresario Domenico Bar­baja who pressed him under contract to write operas in a considerable number. Do­ni­zetti’s personal tragedy was that his wife and three children have died young. He composed more than 70 operas, wrote the librettos for some of them, had drawing skills, and a sense for theatre Gesamtkunst. His composing technique was incredibly fast, partly due to the external pressure (es­pecially by the impresario Barbaja). Beside the feverish speed (hypomania) he suffered of episodes with genuine fever, headache, and nausea. From 1845 onward full apathy, depression (occurred already earlier), and paralysis (progressiva?) developed hindering any creative power and meaningful interpersonal contact, so he was admitted to a closed mental facility. His illness was considered syphilis, but prevailing bipolar mood disorder may strongly be presumed today which is supported by early emerging creativity and hypomanic signs, transient mood swings, the composing technique, his multimodal talent, the abundance of his works (output of 3-4 operas a year), the vein (mood) streaming from the operas (’maddening scenes’ alongside lax and sparkling characters) and by certain circumstances (he was able to write opera buffas during his greatest personal tragedies). To all these com­ponents there can certainly be added an exogenous environmental pressure factor: Domenico Barbaja, the ’prince’ (and taskmaster) of opera impresarios. ]

Clinical Neuroscience

SEPTEMBER 30, 2019

Role of positioning between trunk and pelvis in locomotor function of ambulant children with and without cerebral palsy

SANZ-MENGIBAR Manuel Jose, SANTONJA-MEDINA Fernando

Purpose - To understand if children with and without cerebral palsy share the same lumbar postural control threshold on the sagittal plane for the transition between each walking locomotor stage. Method - Observational analysis of sagittal trunk-pelvis kinematics of 97 children with cerebral palsy and 73 with typical development, according to their locomotor stage. Results - Among children with typical development, all average and minimum measurements of the sagittal lumbar curve during the gait events were correlated with age and the locomotor stages of development. Among children with cerebral palsy, there were significant correlations between all average and minimum values of the sagittal lumbar curve and locomotor stages of development but not age. Conclusions - We conclude that, for the same locomotor level, there are no common postural patterns between children with typical development and those with spastic bilateral cerebral palsy for the position between trunk and pelvis in the sagittal plane. Maximal lordosis reduction between trunk and pelvis may change with age or even training, but does not make a positive effect on the locomotor level, while basal and maintenance capacities could explain locomotor function. Trials that failed to assess quality of movement may now have a better understanding of how different interventions improve posture towards the next functional level.

Lege Artis Medicinae

JULY 20, 2019

[Gynecological correlations of eating disorders]

GALIGER-DOBOS Kitty, TÚRY Ferenc

[In recent decades, the incidence of eating disorders (its two major forms are anorexia nervosa and bulimia nervosa) has increased, their course has been delayed, and their complications are becoming more frequent and severe. Eating disorders cannot only damage physical and mental health but also affect reproductive health, future mothers and their children. Understanding the biological and psychosocial factors that explain the gynecological conditions related to eating disorders is essential regarding fertility and pregnancy. The present review summarizes data published from 2000 about the gynecological effects of eating disorders. In daily practice, the multidisciplinary collaboration is particularly important to pro­vide women with eating disorders with comprehensive care. The appropriate information of women who plan to have children is essential in order to increase the likelihood of conception and reduce the risk of miscarriage. ]