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Clinical Neuroscience

SEPTEMBER 30, 2020

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]

Lege Artis Medicinae

APRIL 18, 2020

[Digitally-assisted treatment planning in precision oncology]

PETÁK István, VÁLYI-NAGY István

[The progress of molecular information based on personalized precision medicine has reached a new milestone. Actually, about 6 million mutations of 600 genes may be related to the development of cancer, and on average, 3-4 of these “driver” mutations are present in each patient. Due to the progress in molecular diagnostics, we can now routinely identify the molecular profile of tumors in clinical settings. By clinical translation, there are actually available more than 125 targeted pharmaceuticals and hundreds of such therapies are under clinical trial. As a result, we have many first-line and licenced treatment options to be elected by molecular information as the optimal one for every patient. There is an increasing need for complex informatics solutions by medical software. Geneticists, molecular biologists, molecular pathologists, molecular pharmacologists are already using bioinformatics and interpretation software on their daily work. Today, online digital tools of artificial intelligence are also available for physicians for assisted treatment planning. Telemedicine, videoconferencing provide solutions for interdisciplinary virtual molecular tumor boards, which democratizes the access to precision oncology for all doctors and patients. ]

Hypertension and nephrology

SEPTEMBER 30, 2020

[Non-pharmacological treatment of hypertension and reducing cardiovascular risk in general practitioners’ clusters]

MOHOS András, KOZMA Anna, MARKÓ-KUCSERA Mária, MESTER Lajos

[Hypertension and cardiovascular diseases are major public health issues. In their treatment non-pharmacological methods have a role in every case either alone or as a complement. Patient adherence is a key factor. The role of primary care is very important in the management and with general practitioners’ cluster model and with the involvement of new primary care professionals (for example: dietetitian, physiotherapist) the opportunities are expanding. In the A GP Cluster and in the Marosmenti GP Cluster the analysis of the patients’ results who participated in an individual health status examination, in dietetic and in physiotherapy services. Assessing the professionals’ attitudes towards GP cluster model. In the A GP Cluster 2409 people, in the Marosmenti GP Cluster 1826 people participated in an individual health status examination. 14.6% and 19.9% of the participants were under the age of 18. 58.9% and 60.7% of the participants over the age of 18 were female. 1083 and 232 patients used physiotherapy services, 147 and 187 people used dietetic services. The age distribution of the individual health status examinations is correspond to the Hungarian age pyramid. In addition to the preventive approach came into view the community based local health care services. The GP cluster model was welcomed by the patients, the physiotherapy was more popular than dietetic among them. All professionals of the GP clusters had a positive opinion of the professional work done in the project. Conclusion: There is a demand both from the patients and the healthcare professionals for the GP cluster concept. The establishing of an appropriate monitoring system and creating long-term, sustainable operating conditions are essential for achieving lasting social health gains. ]

Lege Artis Medicinae

JULY 01, 2020

[Minority students in Hungarian medical training]

SZÉL Zsuzsanna

[General health of minority people is usually worse than that of their majority peers and they often expe rience discrimination in the healthcare system. According to international literature, physicians belonging to any minority group are more likely to care for other mi nority people, therefore they may play a key role in reducing healthcare inequities. Anonymous, online questionnaire was distributed to medical students of the four Hungarian universities with medical schools (response rate was 8.86%). In this paper, we analyze our collected data about perceived discrimination with descriptive statistical methods. Results of confirmative statistical analyses (statistical tests) were considered exploratory in nature. 29.6% of respondents self-identified as a member of any minority. 63.0% of minority students and 53.8% of women indicated that they realized discriminated or were harassed in the last 12 months, meanwhile, 37.8% of non-minority students and 31.9% of males have experienced discrimination. Dis­cri­mi­na­tion related to ethnic origin, sexual orientation and disability are regarded as the most widespread forms of discrimination according to our respondents. Students are most likely to say that there is no age related discrimination on the grounds of age – both being under 30 years old (12.0%) and being over 55 (8.6%). Being the member of any minority group seems to have no effect on student’s/ one’s opinion how widespread the forms of dis crimination are. Minority students are more comfortable to work with a member of another minority. However male students feel more uncomfortable to work with a member of sexual or gender minorities compared to female counterparts. Mi­no­rity students tend to be more critical to the universities’ efforts to enhance diversity. Minority students and females may play a key role in reducing discrimination in medical training and in the healthcare system and in providing high-quality care for individuals who belong to any minority. Although there are more females than males in medical training they still report higher occurrence of perceived discrimination. However, it is important to emphasize the low response rate in our study, which does not allow us to draw any general conclusions.]

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

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

Clinical Neuroscience

JULY 30, 2020

[Advanced Parkinson’s disease characteristics in clinical practice: Results from the OBSERVE-PD study and sub-analysis of the Hungarian data]

TAKÁTS Annamária, ASCHERMANN Zsuzsanna, VÉCSEI László, KLIVÉNYI Péter, DÉZSI Lívia, ZÁDORI Dénes, VALIKOVICS Attila, VARANNAI Lajos, ONUK Koray, KINCZEL Beatrix, KOVÁCS Norbert

[The majority of patients with advanced Parkinson’s disease are treated at specialized movement disorder centers. Currently, there is no clear consensus on how to define the stages of Parkinson’s disease; the proportion of Parkinson’s patients with advanced Parkinson’s disease, the referral process, and the clinical features used to characterize advanced Parkinson’s disease are not well delineated. The primary objective of this observational study was to evaluate the proportion of Parkinson’s patients identified as advanced patients according to physician’s judgment in all participating movement disorder centers across the study. Here we evaluate the Hungarian subset of the participating patients. The study was conducted in a cross-sectional, non-interventional, multi-country, multi-center format in 18 countries. Data were collected during a single patient visit. Current Parkinson’s disease status was assessed with Unified Parkinson’s Disease Rating Scale (UPDRS) parts II, III, IV, and V (modified Hoehn and Yahr staging). Non-motor symptoms were assessed using the PD Non-motor Symptoms Scale (NMSS); quality of life was assessed with the PD 8-item Quality-of-Life Questionnaire (PDQ-8). Parkinson’s disease was classified as advanced versus non-advanced based on physician assessment and on questions developed by the Delphi method. Overall, 2627 patients with Parkinson’s disease from 126 sites were documented. In Hungary, 100 patients with Parkinson’s disease were documented in four movement disorder centers, and, according to the physician assessment, 50% of these patients had advanced Parkinson’s disease. Their mean scores showed significantly higher impairment in those with, versus without advanced Parkinson’s disease: UPDRS II (14.1 vs. 9.2), UPDRS IV Q32 (1.1 vs. 0.0) and Q39 (1.1 vs. 0.5), UPDRS V (2.8 vs. 2.0) and PDQ-8 (29.1 vs. 18.9). Physicians in Hungarian movement disorder centers assessed that half of the Parkinson’s patients had advanced disease, with worse motor and non-motor symptom severity and worse QoL than those without advanced Parkinson’s disease. Despite being classified as eligible for invasive/device-aided treatment, that treatment had not been initiated in 25% of these patients.]

Clinical Neuroscience

JULY 30, 2020

[The complex intensive care and rehabilitation of a quadriplegic patient using a diaphragm pacemaker]

FODOR Gábor, GARTNER Béla, KECSKÉS Gabriella

[A 21 year female polytraumatized patient was admitted to our unit after a serious motorbike accident. We carried out CT imaging, which confirmed the fracture of the C-II vertebra and compression of spinal cord. Futhermore, the diagnostic investigations detected the compound and comminuted fracture of the left humerus and femur; the sacrum and the pubic bones were broken as well. After the stabilization of the cervical vertebra, a tracheotomy and the fixation of her limbs were performed. She spent 1.5 years in our unit. Meanwhile we tried to fix all the medical problems related to tetraplegia and respiratory insufficiency. As part of this process she underwent an electrophysiological examination in Uppsala (Sweden) and a diaphragm pacemaker was implanted. Our main goal was to reach the fully available quality of life. It is worth making this case familiar in a wider range of public as it could be an excellent example for the close collaboration of medical and non-medical fields.]

Clinical Neuroscience

MAY 30, 2020

[Early experiences in surgical treatment of thoracic disc herniation from posterior transdural approach at Neurosurgery Clinic Szeged University]

MÁRKOS-GERGELY Gellérd, WATFA Kerim, BALÁZSFI Márton, SZEGETI Andrea, BARZÓ Pál

[Background – Because of the rare occurrence of thoracic disc herniation and surgery needed treatment the used approaches and their efficiency are still subjects of discussions. In Hungarian practice, the most frequent explorations are costotransversectomy and laminectomy, but there are many other important methods available like thoracoscopic and posterior transdural approaches. This case report will present the benefits and the surgical procedure of posterior transdural sequesterectomy, carry out for the first time in Hungary at the Neurosurgical Department on Szeged University. Case presentation – A 50-year-old female patient with achondroplasic nanism has been operated several times since 2011. She suffered from a progressive, multi-segment affected degenerative discopathy and myelopathy. Finally in the background of the recurrent paraparesis was confirmed thoracic disc herniations at the levels of T8 and T9. The use of intraoperative electrophysiology was not feasable, because the earlier described cervical myelopathy. For this reason we used the posterior transdural approach, as the best and safest, visual control warranted technique. Conclusions – The posterior transdural approach offers an alternative option for experienced surgeons, furthermore in contrast with traditional, technically difficult to implement or special instrumentation demanding approaches this technique seems to be more efficient.]

Clinical Neuroscience

MARCH 30, 2016

[Antecedents to the commencement and history of the West- Pannonic neurological forum]

GARZULY Ferenc, GRUBITS János, NIKL János

[Introduction - Numerous professional groups and sections for the medical specialities have been organized since 1953 in the West-Transdanubian region of Hungary, but such association of neurologists had not occured. Establishing the West-Pannonic Neurological Forum - The lack of regional collaboration among neurologists was related to several factors, among which the most important factor was the lack of a regional medical university, which could coordinate the professional activities. This severe gap necessitated in 1998 the organization of a professional group, that has become a driver for case-consulting conferences and different postgraduate trainings for the physicians specialized in neurology, neurosurgery and neurorehabilitation in counties of Győr-Moson-Sopron, Vas, Veszprém and Zala. The functioning of the Forum - Meetings are organized twice a year for physicians and paramedical staff (nurses, hospital attendants, physiotherapists) on Thursdays afternoons in different towns of the region, in two sections. The lectures are followed by a buffet, after which everyone can get home before too late. Ocasionally guest-lecturers are invited to present scientific topics from Hungarian universities or abroad. However, the main form of the presentations is defined as case discussion. Conclusions - The numbers of platform and other presentations in the physicians’s section have exceeded half a thousand, while in the paramedical section reached the threehundreds. At the 38. meeting of the Forum in January of this year, the number of participants was more than twohundreds, reflecting that both physicians and their coworkers are greatly interested in this form of interactions.]