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Journal of Nursing Theory and Practice

FEBRUARY 28, 2019

The issue of social inclusion of the Roma minority in the Czech Republic from the viewpoint of the Model of the culturallyminded and adapted care

TOUMOVÁ Kristyna, TOTHOVA Valérie, OLISAROVÁ Vera

Objective: The aim of the research was to map out the area of social inclusion of the Roma minority according to the Model of culturally-minded and adapted care. Above all to find out the subjective opinion of the Roma on their lives in the Czech Republic, the distribution of family roles or the respect of Roma traditions and customs. Methods: Data collection was carried out using a quantitative survey, in the form of a non-standardised questionnaire. The research group consisted of 600 members of the Roma minority across the Czech Republic. Results: The results show that the Roma minority feels some intolerance, in some cases even discrimination from the majority of society. Although in a Roma family the traditional division of the roles of the mother - maternal role, the father - the family breadwinner persists, these roles change slightly depending on the style of family upbringing and cohabitation with the older generations. The life of a Roma according to Roma traditions and customs subsides slightly into the background. Younger and single Roma no longer follow traditions like their parents. Therefore, there is an obvious large influence from the majority of society towards the Roma minority. Conclusion: The Roma minority is a group of people with many specifics. To coexist with a majority society, therefore, there is a need for understanding and tolerance on both sides. For a better understanding of this minority, the conceptual model of the following authors J. N. Giger and R.E. Davidhizar can help us, as it complexly approaches the specific needs of an individual with a different culture or religion.

Lege Artis Medicinae

JULY 20, 2019

[The red eye]

IMRE László

[Eye redness may be a sign of a variety of eye diseases with different severity. Most often redness is relatively harmless, such as conjunctivitis, but it can be a serious illness with visual impairment and even lasting consequences in the background of redness. It is therefore important for non-ophthalmologists to be informed and to know the basic types of redness of the eye and to recognize typical and characteristic forms of appearance. Based on these, they can decide whether the patient can be treated or forwarded to an ophthalmic institution. In the present continuing education article we try to summarize the causes of the red eye, primarily according to the characteristics of the redness of the eye and the anatomical localization. During the investigation of a patient with red eye, the type of the redness can be determined most by diffuse illumination and by naked eye inspection without any other means. It is important to know the principal features and causes of redness of conjunctival or ciliary or scleral origin, possible other recognizable differences (e.g. conjunctival papillae or follicles or conjunctival chemosis). We have attempted to illustrate these with a number of photographs, starting with a schematic representation of the characteristic features of redness. We tried to emphasize cases suitable for treating by non-ophthalmologists and tried to draw attention to the importance of referral un­clear or complicated cases.]

Clinical Neuroscience

JULY 30, 2019

Investigation of risk factors, topographic location and stroke mechanisms of unilateral isolated and posterior cerebral ARTERY thalamic infarcts

GÖKCAL Elif, SENGUL Yildizhan, USLU Ilgen Ferda

Aim - In this study, we aimed to examine the risk factors, topographic features and stroke mechanisms of acute ischemic unilateral infarcts of thalamus. Methods - Patient with isolated thalamic infarct and those with posterior cerebral artery (PCA) infarction who were admitted to our hospital between January 2014 and January 2017 with acute unilateral thalamic infarction (TI) were included in this study (isolated thalamic infarction/ isolated TI; thalamic and posterior cerebral artery infarction/PCA+TI). Demographic characteristics and vascular risk factors of the patients were determined. Thalamic infarct areas were recorded topographically as anterior, posteromedial, ventrolateral, posterolateral, more than one area, and variant areas. Stroke mechanism was determined according to the criteria of „Trial of Org 10172 in Acute Stroke Treatment” (TOAST). Patients with isolated TI and PCA TI were compared according to risk factors, stroke mechanism and infarct topography. Results - Forty-three patients with a mean age of 63.3 ± 14.5 years were included in the study. Twenty-eight patients (60.1%) were found to have isolated TI and the remaining 15 patients (34.9%) had PCA+TI. 32.1% of patients with isolated TI had sensory symptoms on presentation, and 60% of patients with PCA-TI had sensorimotor symptoms. The mean age, the mean score on National Institutes of Health Stroke Scale (NIHSS) and the mean frequency of atrial fibrillation were higher in PCA+TI patients than in isolated-TI patients (p: 0.04, p: 0.004, p: 0.02 respectively). 32.6% of the patients had ventrolateral, 30.2% had posteromedial involvement. Ventrolateral topography was seen in 46.7% of the PCA+TI patients, while posteromedial topography was seen in 39.3% of the isolated-TI patients. 53.6% of the isolated-TI had small vessel disease etiology, while 40% of the PCA+TI had cardioembolic etiology, and the other 40% had large artery atherosclerosis. Conclusion - Our study showed that the most ommon stroke mechanism in patients with thalamic infarction is the small vessel disease. Isolated TI and PCA+TI patients differ in terms of etiologic mechanism and infarct topography. Variant territorial involvement and multiple area involvements can be quite common in thalamic infarcts.

Clinical Neuroscience

JULY 30, 2019

Relationship between Status Epilepticus Severity Score and etiology in adult NCSE patients

GENC Fatma, ERDAL Abidin, AKCA Gizem, KARACAY Ertan, GÖKSU Özaydın Eylem, KUTLU Gülnihal, GÖMCELI Bicer Yasemin

Purpose - Nonconvulsive status epilepticus (NCSE) is a heterogeneous, severe neurological disorder of different etiologies. In this study, the outcomes of NCSE episodes was assessed in a large series of adult patients. Our objective was to evaluate relationship between Status Epilepticus Severity Score (STESS) and etiology and the role of etiological factors on predicting the outcomes. Method - In this retrospective study, the medical records of 95 patients over 18 years of age who were diagnosed with NCSE between June 2011 and December 2015 were reviewed. Their treatment and follow-up for NCSE was performed at the Epilepsy Unit in Department of Neurology, Antalya Research and Training Hospital. Etiological factors thought to be responsible for NCSE episodes as well as the prognostic data were retrieved. The etiological factors were classified into three groups as those with a known history of epilepsy (Group 1), primary neurological disorder (Group 2), or systemic/unknown etiology (Group 3). STESS was retrospectively applied to patients. Results - There were 95 participants, 59 of whom were female. Group 1, Group 2, and Group 3 consisted of 11 (7 female), 54 (33 female), and 30 (19 female) patients, respectively. Of the 18 total deaths, 12 occurred in Group 2, and 6 in Group 3. The negative predictive value for a STESS score of ≤ 2 was 93.88% (+LR 2.05 95% CI: 1.44-2.9 and -LR 0.3 95% CI 0.10-0.84 ) in the overall study group. While the corresponding values for Group 1 (patients with epilepsy), Group 2 (patients with primary neurological disorder), and group 3 (patients with systemic or unknown etiology) were 100%, 92.59% (+LR 2.06 95%CI: 1.32-3.21 and -LR 0.28 95% CI 0.08-1.02 ) 83.33% (+LR 1.14 95%CI: 0.59-2.9 and -LR 0.80 95% CI 0.23-2.73). Conclusions - This study included the one of the largest patients series ever reported in whom STESS, a clinical scoring system proposed for use in patients with status epilepticus, has been implemented. Although STESS appeared to be quite useful for predicting a favorable outcome in NCSE patients with epilepsy and primary neurological disorders, its predictive value in patients with systemic or unknown etiology was lower. Further prospective studies including larger NCSE samples are warranted.

Lege Artis Medicinae

MAY 20, 2019

[Immuno-oncology therapy in patients with non-small cell lung cancer]

CSÁNKY Eszter

[Despite decades of smoking cessation programs, and lung cancer screening programs, mortality due to bronchial cancer leads the mortality statistics among cancer deaths worldwide. Platinum-based chemotherapy has not fundamentally altered the effectiveness of treating non-small cell lung cancer (NSCLC). One of the newest approaches to the use of immunotherapeutic treatments in recent years is the so-called. use of immune checkpoint blocking agents. PD-1 and PD-L1 blockers of this type have been subjected to a large number of clinical trials in lung cancer and were reported by the tumor III.b / IV. stage. Last year, in 2018, we again came up with a milestone in the treatment of lung cancer immuno-oncology, as compared to the previous stage, III.a / III.b Durvalumab con­solidation therapy for non-small cell lung cancer after inoperative, non-chemo-radiotherapy phase I, is based on the results of the PACIFIC clinical trial. PACIFIC was a triple-phase, randomized, double-blind, placebo-controlled, multicentre study to evaluate the efficacy and safety of durvalumab consolidation therapy, irresistible, III. patients with non-small cell lung carcinoma who have not progressed after platinum-based chemo-radiotherapy. The PD-L1 expression level of the tumor was not an admission criterion. In the study, 713 patients were randomized to durvalumab and placebo for 2:1, progression-free survival (PFS) and over­all survival (OS) as their primary endpoint. Summarizing the results of the study, durvalumab provided significant benefit to patients at both endpoints. PFS and OS values were also significantly longer for durvalumab than placebo, and the safety profile of durvalumab was consistent with previous PD-1, PD-L1 inhibition tests.]

Clinical Neuroscience

MAY 30, 2019

The methylation status of NKCC1 and KCC2 in the patients with refractory temporal lobe epilepsy

UNAL Yasemin, KARA Murat, GENC Fatma, OZTURK Aslan Dilek, GÖMCELI Bicer Yasemin, KAYNAR Taner, TOSUN Kursad, KUTLU Gülnihal

Purpose - Methylation is a key epigenetic modification of DNA and regarding its impact on epilepsy, it is argued that “DNA methylation may play an important role in seizure susceptibility and maintenance of the disorder”. DNA methylation status of KCC2 (SCL12A5) and NKCC1 (SCL12A2) associated with refractory temporal lobe epilepsy was investigated in our study. Materials and methods - Thirty-eight patients with temporal lobe epilepsy (TLE) who were diagnosed by video EEG monitoring and 32 healthy control subjects were included in the study. Twenty-three patients in TLE group were men and the remaining 15 were women. Among them, 27 had unilateral temporal focus (9 with right; 18 with left) and 11 patients had bilateral TLE. We analyzed promoter region methylation status of the KCC2 (SCL12A5) and NKCC1 (SCL12A2) genes in the case and control groups. Gene regions of interest were amplified through PCR and sequencing was accomplished with pyro-sequencing. Results - We found a significant relationship between TLE and methylation on the NKCC1. However, there was no association between TLE and methylation on the KCC2 gene. Also, we found no association between right or left and unilateral or bilateral foci of TLE. There was no relationship between TLE and methylation on the NKCC1and KCC2 genes in terms of mesial temporal sclerosis in cranial MRI, head trauma or febrile convulsions. Conclusion - The methylation of NKCC1 can be a mecha­nism of refractory temporal lobe epilepsy. There are limited findings about DNA methylation in TLE. Therefore, further studies with large sample sizes are necessary.

Clinical Oncology

MAY 10, 2018

[Immunotherapy of lungcancer – an update]

OSTOROS Gyula

[Ten years ago the median survival of small cell lung cancer (SCLC) and non small cell lung cancer (NSCLC) was less than one year. In the case of SCLC the situation did not change. There are revolutionary new possibilities in the treatment of NSCLC (histology based cytotoxic chemotherapy, molecular targeted therapy etc.). Unfortunately there is no signifi cant development in treatment strategy of SCLC in the last 30 years. Nowadays in NSCLC immune check point inhibitor therapy is a novel treatment method in the clinical praxis as well. The integration of the PD axis and the CTLA4 inhibitors in the complex therapy of the management of NSCLC is a new challenge. The pembrolizumab monotherapy in fi rst line setting is a new standard of care with high PDL1 expression. In second line setting the pembrolizumab, nivolumab and atezolizumab widely used in clinical praxis as well. In locally advanced disease of NSCLC after radiochemotherapy the durvalumab maintenance monotherapy showed a signifi cant progression free survival benefi t, comparing to placebo. We have got new treatment possibilities in the treatment of SCLC as well. The results of clinical trials with antibody conjugate therapy are promising. The nivolumab monotherapy and the combination treatment of nivolumab + ipilimumab gave promising results as well. In the treatment of SCLC and NSCLC there is a need for biomarker selected therapy (tumor mutational burden [TMB], DLL3, cMyc etc.). Based on the new positive results of the clinical trials there is a possibility to transform lung cancer from a subacute disease to a chronic illness.]

Clinical Oncology

MAY 10, 2018

[Fluid in preformed cavity to malignancy]

SZÖLLŐSI Regő

[The malignancy associated fl uids like pleural effusion, ascites and pericardiac fl uid are a common problems in patients with cancer. Despite the existence of typical types of cancer for these fl uid accumulations, nearly all types of cancer can cause malignancy associated fl uids. The presentation of these fl uids is generally a sign for disease progression, and forecast a poor prognosis. The prognostic factors include the type of cancer, the response to antitumorous therapy and the general condition of the patient, which include age, ECOG status and so on. In most of the cases, the treatment of these fl uid accumulations is supposed to decrease the symptoms, and guarantee an acceptable quality of life, consequently the treatment has a palliative intent. Indeed, there are some exceptions such as cardiac tamponade. From the large scale of available treatments, we have to choose upon careful risk analysis.]

Lege Artis Medicinae

MARCH 20, 2019

[The atherosclerosis can not only be prevented, but also can be cured ]

MÁRK László

[The process of atherosclerosis nowadays plays an important role in the health care not just as a major cause of the most common cardiovascular diseases which lead to death, but also as a major factor in the loss of age-related elasticity in the blood vessels. Over the past two decades, large studies have shown that the treatment of high cholesterol levels can reduce the frequency of cardiovascular events and death and have confirmed the ability to reduce the already existing atherosclerotic plaque, which is almost unique in pharmacotherapy. Using lipid lowering therapy, if we do it properly, we can not only prevent vascular events, but can also cure atherosclerosis. Currently there are three drug groups (statins, ezetimibe and PCSK9- inhibitors), which have complete evidence that their use can reduce the number of cardiovascular events and plaque regression can be achieved. Despite many convincing clinical trials, lipid-lowering therapy is on the cardiovascular prevention palette in the just tolerated or forced applied category. In order to take advantage of its potentials at an appropriate level, as doctors, we have to approach to it by considering its importance. We should communicate to our patients that it’s about a life-long treatment, which not only can reduce the possibility of cardiovascular events, but also can slow down the aging process of the arteries. ]

Lege Artis Medicinae

MARCH 20, 2019

[Long-term CPAP compliance among Sleep Apnea Patients at the Sleep Laboratory of the Hungarian Defense Forces Medical Center ]

DOMBOVÁRI Magdolna, BERNÁT István, TERRAY-HORVÁTH Attila, CSATLÓS Dalma, HARGITTAY Csenge, TORZSA Péter

[Obstructive sleep apnea syndrome (OSAS) is the most common sleep disorder, with a prevalence of 2-4% in the overall popula­tion. It is a risk factor for cardiovascular diseases and its daytime symptoms significantly impair the patients’ quality of life and increase the risk of work and road accidents. Its first-line treatment is the CPAP device (Continuous Positive Airway Pres­sure) the effectiveness of which is significantly determined by the compliance of the patient. Although the issue of compliance in such treatment is a very important factor, long-term studies including a large number of patients have not been published yet, and there are no known data about it in Hungary. OBJECTIVE - Examining the long-term compliance of CPAP among OSAS patients in a sleep laboratory in Hungary. METHOD - 3403 OSAS patients were selected for our study between January 1, 2007, and September 30, 2017. The diagnosis and titration of effective CPAP pressure were determined by polysomnography. Patients were controlled after 2 months of therapy and then every 6 and 12 months. During the care, their compliance value was determined by data downloaded from their device's memory card. RESULTS - The mean age (± SD) of patients was 59.0 (± 10.5) years, most of them were male, 2676 (78.6%), their average body mass index (BMI) was 32.6 (± 5.25) kg/m2, their average Epworth Sleepiness Scale score was 11.4 (± 5.0), their average Apnea-Hypopnoe index was 51.0 (± 19.5) events/hour. The average usage time of the CPAP device was 5.0 (± 1.9) hours. 72.3% of the patients used the device for over 4 hours and 27.7% used it for less than 4 hours. 34.7% of the patients used the device for more than 6 hours. The Epworth Sleepiness Score showed a significant and dose-dependent improvement over CPAP treatment, with a greater improvement among patients who used the machine for longer hours. The highest score improvement was achieved by users who used CPAP between 6-7 hours, averaging 7.3 (± 3.2) points (p <0.001). CONCLUSIONS - Our present study shows that high average compliance can be achie­ved among well-adjusted and well-maintained patients. ]