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Lege Artis Medicinae

JULY 20, 2019

[Epidemiology, comorbidity, etiology of depression and cardiovascular diseases]

PÉTER László, RIHMER Zoltán

[Psychiatric problems are a common comorbid condition in patients with cardiovascular disease. Depression is a well-known risk factor for the development of cardiovascular disease and mortality too. Psychiatric and cardiovascular diseases are prevalent public health problems in the western world. Depression is associated with endo­thelial dysfunction and increased platelet aggregation, which may explain the consequent cardiovascular complications. Specific affective temperaments may be associated with special cardiovascular diseases. Antidepressant therapy does not only reduce depression but also cardiac mortality.]

Clinical Neuroscience

JANUARY 30, 2021

Cases of inborn errors of metabolism diagnosed in children with autism

CAKAR Emel Nafiye, YILMAZBAS Pınar

Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

Lege Artis Medicinae

DECEMBER 21, 2020

[30 year history of surgery and the surgeon’s future ]

KUPCSULIK Péter

[During the past 3 decades, laparoscopic surgery has launched a revolution in operative medicine. The German gynaecologist Kurt Semm transformed the diagnostic laparoscopy for therapeutic procedure, as he performed the first laparoscopic ap­pen­dectomy. The surgeon Erich Mühe contributed with laparoscopic cholecystectomy to the set of surgical instruments. All over the world, a wide spectrum of laparoscopic procedures has been app­lied. Several laparoscopic procedures are now preferred over open approaches. Morbid obesity is associated with significant comorbidity and mortality. In­suffi­ciency of dietary measures lead to development of surgical interventions that resulted in unexpected excellent outcomes. “Metabolic surgery” was born. New methods and rising market of socio-medical requirements inspired progress in plastic surgery. Thanks to innovations in technology, reconstructive breast surgery has opened new ways. In the 1990s the prototype of “mas­ter–slave” robot controlled by a surgeon was constructed. Future of robotic surgery depends on cost reduc­tion, development of new technologies and creating the best applications. Coo­pe­ra­tion with partner medical specialities is essential for further development in surgery. Despite of obvious impact of new technologies the surgeon's way of thinking, personal qualities decision-making and professional knowledge remain cru­cial for further evolution. ]

Clinical Neuroscience

MAY 30, 2020

The etiology and age-related properties of patients with delirium in coronary intensive care unit and its effects on inhospital and follow up prognosis

ALTAY Servet, GÜRDOGAN Muhammet, KAYA Caglar, KARDAS Fatih, ZEYBEY Utku, CAKIR Burcu, EBIK Mustafa, DEMIR Melik

Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes. This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as <65 years old, 65-75 yo, 75-84 yo and> 85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups. A total of 1108 patients (mean age: 64.4 ± 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p<0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p<0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p<0.05). Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.

Clinical Neuroscience

NOVEMBER 30, 2019

The effect of psychiatric comorbidities and stress-coping strategies on perceived quality of life in migraine

PETROVICS-BALOG Anna, MAJLÁTH Zsófia, LUKÁCS Melinda, HOLCZER Adrienn, MUST Anita, TAJTI János, VÉCSEI László

Purpose – Migraine is one of the most disabling primary headache conditions. We aimed to detect hidden symptoms of anxiety and depression and to survey stress-coping mechanisms and related quality of life in a large migraine population without any known psychiatric comorbidity. Method – 123 migraine patients (MG) and 66 healthy subjects (HC) completed the Beck Depression Inventory-II (BDI-II), the State and Trait Anxiety Inventory (S-STAI and T-STAI), the Stress and Coping Inventory (SCI) and the 36-Item Short Form Health Survey (SF-36). Results – MG patients reached significantly higher scores on the BDI-II and the T-STAI yielding previously undetected anxiety and depression symptoms. Significant differences were present on the SCI: higher stress scores and lower coping levels suggested impaired stress-coping strategies in migraine. MG patients achieved significantly lower scores on most of SF-36 subscales indicating lower perceived quality of life. Significant correlations were found between BDI-II, T-STAI, SCI scores and subscales of the SF-36. Conclusion – Unrecognized symptoms of anxiety and depression, as well as less effective stress-coping strategies might be related to the lower perceived quality of life in migraine. The screening of these symptoms might lead to more focused and efficient therapeutic strategies. Addressing stress management techniques could improve quality of life on the long-term.

Hypertension and nephrology

SEPTEMBER 10, 2019

[Hypertension and pregnancy]

JÁRAI Zoltán, VÁRBÍRÓ Szabolcs

[Hypertension complicates approximately 10% of the pregnancies and with this high blood pressure is the most frequent cardiovascular comorbidity during pregnancy. Hypertension during pregnancy accounts for a substantial maternal and perinatal morbidity and mortality risk. In our review we focus on the forms, diagnosis and therapeutic possibilities of gestational hypertension according to the European and domestic guidelines.]