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Clinical Oncology

FEBRUARY 28, 2020

[The treatment of the locally advanced and the metastatic gastric cancer]

SIPŐCZ István

[Although signifi cant progress has been made in the treatment of stomach cancer recently, survival results are still quite modest. The purpose of this overview is to take a look into the history of the treatment of locally advanced and metastatic stomach cancer and to present the current treatment standards. It focuses on recent changes in perioperative treatment, as well as the changing of treatment of metastatic patients. The use of multiple line of palliative chemotherapy and the place of the available targeted treatments in metastatic tumours will be analysed in detail. The increasing use and the future possibilities of immunocheckpoint inhibitors will also be discussed. Molecular subtypes of gastric cancer are also mentioned as possible indicators of the choice of therapy. Finally, it intends to give therapeutic proposals to make recommendations to treat the disease taking into account the opportunities in Hungary.]

Lege Artis Medicinae

SEPTEMBER 30, 2020

[The pain-trigger role of cytokines in the nervous system – the direct analgesic effect of anti-cytokine therapy ]

HODINKA László, VERECKEI Edit

[Nociceptive, neuropathic and central me­chanisms are involved in the perception, transmission and processing of chronic pain and shaping of cerebral pain image. Alar­mins – molecules alarming defence and signing the presence of pathogens and tissue damage - trigger a series of pathogenic events resulting in inflammatory pain stimuli. Proinflammatory cytokines play a determining role in the pain perception at the level of the nervous system. Continuous inflammatory stimuli while sensitizing the periferic and central neurons activate the pain-related cerebral areas and develop the complex pain image, the pain matrix. Ce­reb­ral functional connections are operating in networks and can be visualized by functional MRI. Cytokines activate the neurons directly or indirectly by other neuromediators. Cytokine receptors are expressed on no­ciceptors and even on higher-level neurons and on various non-neural cells, such as microglia and astrocytes. The most ubiquitous cytokines are the Tumour Necrosis Factor and Interleukin 6 in the nervous sys­tem. The signaling pathways are the Nuclear Factor κB and the Janus-kinase enzyme system. The proinflammatory cytokines and the Janus-kinase are therefore primary therapeutic targets. Anti-cytokine biologicals and small molecular kinase inhibitors decrease the pain and improve functional activity in rheumatoid arthritis. Decrease of pain was more pronounced than expected only from the decrease of the clinical biomarkers of inflammation. The early and ra­pid painkiller effect of targeted biological and chemical-biological response modifiers is attributed to their direct analgesic effect on the brain.]

Clinical Neuroscience

MAY 30, 2020

Autonomic nervous system may be affected after carpal tunnel syndrome surgery: A possible mechanism for persistence of symptoms after surgery

ONDER Burcu, KELES Yavuz Betul

After carpal tunnel surgery, some patients report complaints such as edema, pain, and numbness. Purpose – The aim of this study was to evaluate autonomic nervous system function in patients with a history of carpal tunnel surgery using sympathetic skin response (SSR). Thirty three patients (55 ±10 years old) with a history of unilateral operation for carpal tunnel syndrome were included in the study. The SSR test was performed for both hands. Both upper extremities median and ulnar nerve conduction results were recorded. A reduced amplitude (p=0.006) and delayed latency (p<0.0001) were detected in the SSR test on the operated side compared to contralateral side. There was no correlation between SSR and carpal tunnel syndrome severity. Although complex regional pain syndrome does not develop in patients after carpal tunnel surgery, some of the complaints may be caused by effects on the autonomic nervous system.

Clinical Neuroscience

NOVEMBER 20, 2015

[Health insurance aspects of physiotherapeutic care of neurology disorders in outpatient care]

MOLICS Bálint, BONCZ Imre, LEIDECKER Eleonóra, HORVÁTH Cs. Zoltán, SEBESTYÉN Andor, KRÁNIZC János, KOMOLY Sámuel, DÓCZI Tamás, OLÁH András

[Background and purpose – The aim of our study is to analyse the ambulatory rehabilitation care of patients with neurological disorders in the field of physiotherapy. Methods – Data derive from the database of the Hungarian National Health Insurance Fund Administration (year 2009). The analyses covered patients with diagnosis „G00–G99 Diseases of the nervous system” according to the International Classification of Diseases and underwent physiotherapy treatment. Results – In 2009 altogether 190986 patients with neurological disorders received physiotherapy treatment in outpatient care, representing 1331675 cases and got 388.215 million Hungarian Forint health insurance reimbursement. The number of patients with nerve, nerve root and plexus disorders was 39 patients/10 000 population for males and 66 patients/10000 population for females. The number of patients with cerebral palsy and other paralytic syndromes was 49 patients/10000 population for males and 35 patients/10000 population for females. The number of patients with episodic and paroxysmal disorders was 33 patients/10000 population for males and 52 patients/10000 population for females. Conclusion – In the outpatient physiotherapy care the utilization indicators of females were higher in nerve, nerve root and plexus disorders and episodic and paroxysmal disorders, while in cerebral palsy and other paralytic syndromes the utilization of male was higher. There are important age and gender inequalities in the utilization of physiotherapy care of patients with neurological disorders.]

Clinical Neuroscience

MARCH 30, 2020

Evaluation of anxiety, depression and marital relationships in patients with migraine

DEMIR Fıgen Ulku, BOZKURT Oya

Aim - The aim of this study was to evaluate the frequency and characteristics of attacks in patients with migraine, to determine the effects of anxiety or depressive symptoms, and to evaluate the marital relationships of patients with migraine. Method - Thirty patients who were admitted to the neurology outpatient clinic of our hospital between July 2018 and October 2018 and were diagnosed with migraine according to the 2013 International Headache Society (IHS) diagnostic criteria were included in this cross-sectional study. Age, sex, headache frequency and severity, depressive traits, marital satisfaction and anxiety status were examined. We used the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Maudsley Marital Questionnaire (MMQ) and Visual Analogue Scale (VAS) for measuring relevant parameters. Results - The mean severity of migraine pain according to VAS scale was 6.93 ± 1.41 and the mean number of migraine attacks was 4.50 ± 4.24. The mean BDI score of the patients was 12.66 ± 8.98, the mean MMQ-M score was 19.80 ± 12.52, the mean MMQ-S score was 13.20 ± 9.53, the mean STAI-state score was 39.93 ± 10.87 and the mean STAI-trait score was 45.73 ± 8.96. No significant correlation was found between age, number of migraine attacks, migraine duration, migraine headache intensity, and BDI, STAI and MMQ scores (p>0.05). But there was a positive correlation between MMQ-S and scores obtained from the BDI and STAI-state scales (p<0.05). Conclusion - In this study more than half of the migraine patients had mild, moderate or severe depression. A positive correlation was found between sexual dissatisfaction and scale scores of depression and anxiety.

Journal of Nursing Theory and Practice

AUGUST 30, 2019

[The effect of whole body electrostimulation for the pelvic floor muscles ]

ARANYNÉ Molnár Tímea, NAGY Edit, DOMJÁN Andrea, FEKETE Zoltán, SURÁNYI Andrea, BÓDIS József

[The aim of the study: Few studies research the effects of trunk stabilizer muscle strengthening on pelvic floor dysfunctions. We assessed a new core strengthening method on the pelvic floor muscles. Material and method: Female patient (70 years) with stressincontinence and low back pain received the Whole Body Electric Muscle Stimulation for 10 weeks (2x25 minutes/week). The EMG (for the conditioning ability of pelvic floor muscle such as maximal isometric contraction, dynamic endurance and relaxation values), urodynamic assessment, introitus and the transabdominal ultrasound were used before and after training. Results: The patient’s the stressincontinence, low back pain and the conditioning ability of pelvic floor muscles improved. The urodynamic and ultrasounds values showed improvement in functions of the bladder neck and deep abdominal muscle. Conclusion: This method would increase the trunk stabilization and pelvic floor muscle strength of the eldery age group, which might decrease the prevalence of urinary incontinence.]

Clinical Neuroscience

JANUARY 30, 2020

Neurocognitive functions in patients with hepatitis C infection

HORVÁTH Gergely, KELETI Teodóra, MAKARA Mihály, UNGVARI S Gabor, GAZDAG Gábor

Background - With improving treatment options, more attention is being paid to the neurocognitive symptoms related to hepatitis C infection (HCI). While HCI-related neurocognitive impairments are frequently subclinical, they can influence patients’ quality of life and fitness to work. Objective - The aim of this study was to assess HCI patients’ neurocognitive functions and explore the correlations between disease variables and neurocognitive symptoms. Method - The study was conducted between January 1, 2013 and December 31, 2015. All patients with HCI were included in the study who were registered at the Hepatology Outpatient Clinic of Szent István and Szent László Hospitals, met inclusion criteria and volunteered to participate. Patients’ sociodemographic data and medical history were recorded in a questionnaire designed for the study. The 21-item Beck Depression Inventory was used to detect depressive symptoms. Six computerized tests were used to evaluate patients’ neuropsychological functions. Results - Sixty patients participated in the study. In comparison with general population standards, patients demonstrated poorer performance in several neurocognitive tests. Neuropsychological performance was correlated with age, sex, length of time since HCI diagnosis, Fibroscan score and the number of previous antiviral treatments. Conclusions - The study’s main finding is that compared to general population standards, patients with hepatitis C virus-related disease exhibit impaired neuropsychological functioning in visuomotor and visuospatial functions, working memory, executive functions, and reaction time. Executive functions and reaction time were the most sensitive indicators for the length and severity of disease. Deterioration in these functions has a major negative effect on work performance particularly in certain occupations.

Clinical Neuroscience

JANUARY 30, 2020

[The quality of life of the cluster headache patients during the active phase of the headache]

DIÓSSY Mária, BALOGH Eszter, MAGYAR Máté, GYÜRE Tamás, CSÉPÁNY Éva, BOZSIK György, ERTSEY Csaba

[Introduction - Cluster headache (CH), which affects 0.1% of the population, is one of the most painful human conditions: despite adequate treatment, the frequent and severe headaches cause a significant burden to the patients. According to a small number of previous studies, CH has a serious negative effect on the sufferers’ quality of life (QOL). In the current study, we set out to examine the quality of life of the CH patients attending our outpatient service between 2013 and 2016, using generic and headache-specific QOL instruments. Methods - A total of 42 CH patients (16 females and 26 males; mean age: 39.1±13.5 years) completed the SF-36 generic QOL questionnaire and the headache- specific CHQQ questionnaire (Comprehensive Headache- related Quality of life Questionnaire), during the active phase of their headache. Their data were compared to those of patients suffering from chronic tension type headache (CTH) and to data obtained from controls not suffering from significant forms of headache, using Kruskal-Wallis tests. Results - During the active phase of the CH, the patients’ generic QOL was significantly worse than that of normal controls in four of the 8 domains of the SF-36 instrument. Apart from a significantly worse result in the ‘Bodily pain’ SF-36 domain, there were no significant differences between the CH patients’ and the CTH patients’ results. All the dimensions and the total score of the headache-specific CHQQ instrument showed significantly worse QOL in the CH group than in the CTH group or in the control group. Conclusion - Cluster headache has a significant negative effect on the quality of life. The decrease of QOL experienced by the patients was better reflected by the headache-specific CHQQ instrument than by the generic SF-36 instrument. ]

Clinical Oncology

DECEMBER 10, 2018

[Medical use of marihuana especially in oncology]

VÉGH Éva

[The medical use of marijuana has gained a considerable attention among wide range of cancer patients lately in Hungary. Consequently, oncologist sare facing questions related to cannabinoids more and more in their clinical practice. This article aims to clarify some basic concepts and to give a brief introduction on the current international and national legislation on their accessibility. Numerous publications have dealt with the application of marijuana in various indications. Among the tumour related indications, the concerned studies mainly refer to chemotherapy induced nausea and vomiting, chronic pain, sleep disorders, anorexia and cachexia. The article also to uches upon on knowledge connected to the causal treatment of malignant tumours, which are currently limited to glioblastoma. Information on the carcinogenic potential of cannabis and information on the popularity and attitudes of American oncologists can be found in this article. This paper gives a literature review in the above mentioned themes.]

Journal of Nursing Theory and Practice

JUNE 30, 2019

[Postoperative pain management today in Hungary - Part 2 ]

LOVASI Orsolya, LÁM Judit

[According to the literature, the practice of postoperative pain relief in Hungary is an area to be developed. Postoperative pain is a key issue for patients. Surveys show that more than 59% of patients are worried about postoperative pain. Their concerns are not baseless, as recent studies have consistently shown that pain has not been properly treated after surgery. It has also been shown that postoperative pain can lead to a deterioration in the quality of life of patients. The aim of our study was to assess the degree of postoperative pain in patients and their satisfaction with pain relief. We conducted interviews based on personal inquiries with a total of 168 patients, with the involvement of certain surgical departments of three Hungarian institutions. Based on our results, we found that patients report remarkable pain after surgery, so the practice of postoperative pain relief is in many cases unsatisfactory. Comparing the results and the international literature, postoperative analgesic practice can be considered as an area to be developed. ]