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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. ]

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.

Clinical Neuroscience

JANUARY 30, 2021

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Journal of Nursing Theory and Practice

FEBRUARY 28, 2020

[Physical Dimensions of Quality of Life on Dialysis and Renal Transplant Patients]

BABARCI Ágnes, BOROS Edit, BALOGH Zoltán

[End stage renal failure is a disease with a serious impact on the everyday life of patients. The aim of this study is to measure and compare the quality of life of patients on hemodialysis and following renal transplant in Szeged, based primarily on physical dimensions and to compare the results with similar national and international data. Throughout the research the authors used the Kidney Disease Qualitiy of Life Questionnary- Short Form-36, the Illness Intrusiveness Rating Scale, and their own questionnary. They involved 111 patients into their study from September 2018 to May 2019. The results show that among the dimensions regarding physical health the pain subscale in the renal transplant cohort reached the highest scores: 76±26 (average±SD) vs. 55±33 in the dialysis cohort. (p<0,001). The result of physical role functioning subscale was the lowest, reaching 69±25 points vs. 50±30 in the dialysis cohort. (p<0001). Analyzing the correlation of quality of life and illness intrusiveness, they found that the higher the quality of life result, the lower is the illness intrusiveness result (r=-0,478). Due to the results of the present study, it can be stated, that the quality of life in the dialysis cohort is lower in Szeged. These results may contribute to a holistic view of care of our patients. ]

Journal of Nursing Theory and Practice

FEBRUARY 28, 2020

[The Future Nurse –Work Value Preferences of the Generation Z]

KISS Ibolya, PAPP Katalin

[To explore the work value preferences of nurses born after 1995 and those of different generations. The Super Job Value Preference Questionnaire was completed by nurses of different qualifications (N=106). In the analysis, we ranked the average of each value range to determine the rank, and also the standard deviation value. Preferred values for nurses of each generation: hierarchy, physical environment, ma­teriality for Baby Boomers; for X generation: altruism, hierarchy, physical environment; for the Y generation: altruism, hierarchy, security; and for Z generation: hierarchy, altruism, social relationships. We found differences in preferred work values between generations, and also found the similarities and differences among the generations. ]

Hypertension and nephrology

DECEMBER 19, 2020

[Possibility of ARNI (angiotensin receptor-neprilysin inhibitor) treatment in hypertension]

KÉKES Ede

[The natriuretic peptide (NP) is an important endocrine, autocrine and paracrine system that is in constant interaction with RAAS and the sympathetic nervous system in order to ensure a continuous cardio-renal homeostasis. In abnormal conditions – if the pressure/volume load develops in the heart or there are some disorder in the vascular tone or in sodium-water balance, the NP system triggers the body’s defense mechanism. The neutral endopeptidase (NEP) inactivates the vasodilator NPs, bradykinin and vasoconstrictor angiotensin II and endothelin I as well. From this knowledge, the idea that inhibition of the effect of NEP (NEPg) offers a potentially beneficial option in the treatment of heart failure and hypertension was initiated, only the stimulatory effect of angiotensin II needs to be blocked. After a lengthy search, they arrived at a dualacting molecule with a beneficial effect of NEP inhibition (secubitrile) and the angiotensin II AT1 receptor antagonist valsartan (ARNI). Several clinical studies have shown that ARNI alone and in combination with other antihypertensive agents significantly reduces SBP and DBP in hypertensive patients. Its effect is also present in isolated systolic hypertension and in chronic kidney disease with high risk. Do not administer with an ACE inhibitor. Based on clinical experience to date, there is a logic expectation that ARNI will also be classified as a useful antihypertensive agent in the near future.]

Lege Artis Medicinae

DECEMBER 21, 2020

[The metamizole]

DUMELE Andreea

[Metamizole in use for almost 100 years, is reviving in our days since it has proved its efficiency and gained popularity during the past years. By its special triple effect (analgesic, antipyretic and spasmolytic) it has a wide range of indications. Among the non-opioid analgesics it is one of the most powerful painkillers. Metamizole is a prodrug, since it transforms into active metabolites within the human body. Its action mechanism is complex, not completely understood so far. Contrasted to classic non-steroidal anti-inflammatory drugs, metamizole has low anti-inflammatory effect. Its severe, but very rare side effect – i.e. the agranulocytosis - hindered its administration for years and even today it is under intense discussions. Based on international studies, it proved to be a well tolerable, safe medication. Its side effect profile differs from non-steroidal anti-inflammatory drugs, thus in NSAID contraindications it provides an excellent alternative. Its good water solubility makes metamizole suitable for both oral and parenteral administration. For its efficiency and good safety profile, metamizole has been correctly reintroduced to the supply of over-the-counter painkillers in our country.]

Lege Artis Medicinae

NOVEMBER 30, 2020

[Economic features of rewarding physicians – changing for fair incomes in Hungary ]

BALÁZS Péter

[Since ages, rewarding physicians was a crucial problem. Among true professionals (priests, legal experts, physicians and teachers) only medical doctors are necessarily working in physical terms, which generates permanent uncertainty about their remuneration. Old Age manual services (surgery, obstetrics) were paid by artisans’ standards while patients of faith-healing (by priest-doctors) presented religious offers according to their capacities. Hippocrates’ business ethics transformed this pattern as price elasticity for profane providers. During the Medieval Ages, governments issued also for physicians fee schedules or in some countries like Hungary they agreed free on remuneration with their patients. Thus, Hungary’s physicians experienced 1891 the implementation of the Bismarck type social health insurance as a real shock-wave generated by the depressed fee proposals. After the first hit, during the following 100 years Hungary committed all possible financial failures down to the fall of Communism in 1989. After the age (1949–1989) of socialism in the health care, general practitioners returned to the self-employed business however under heavy custody of a single payer public fi­nan­cing. Specialist in out and in-patient care (if they used this opportunity) were “li­cenced” for earning money on the quasi pri­vate market of the under-the-table informal business. Actually, only the private dentistry preserved its legal free market share and by the cross-border “dental-tourism” Hungary joined also the competitive international dental market. All other specialists demonstrate income discontent by requiring higher wages, working abroad or fuelling debates on accepting informal payments of “thankful” patients. Contrasted to dentistry, there are actually no economic standards to ponder physicians’ income expectations and compare them with purchasing power of public and private financing. This study shows first the historic evidence of the relevant golden standard and its continuity un-der the present circumstances however supressed for political reasons. It would be able to settle debates about the public employees’ wages of doctors caught out of the thin air. ]

Clinical Neuroscience

NOVEMBER 30, 2020

[New results of neuroscience research – the background of symptomatological and etiological diversity of mental disorders]

OSVÁTH Péter

[Nowadays, the focus of genetic, neurobiological, neuropsychological and psychosocial research is on a more accurate discovery of the etiology of mental illnesses, especially with regard to the role and complex interactions of certain risk factors. It is increasingly challenging to interpret the results of different aspects and methodologies in a coherent theoretical framework, as this can only lead to a more accurate understanding of the complexity and mechanism of the psychiatric disorders. The main aim of this paper to overview recent studies on etiological background of mental disorders and to present the most important aspects of the Research Domain Criteria (RDoC) system. Review of reports from comprehensive studies published in the most important psychiatric journals over the past five years summarizing new findings on the etio­logy of mental disorders. Although current classifications indicate that mental disorders are strictly distinct diagnostic categories, new findings suggest that these marked differences in symptomatic, genetic, and neurobiological backgrounds are not detectable, as many mental disorders have been identified as having common molecular genetic risk factors, which may indicate common neurobiological pathomechanisms. Research results support the need for a rethinking of psychiatric nosology on an etiological basis and represent an important step forward in the more accurate exploration of the neurobiological background factors of mental disorders and thus in the development of more targeted therapeutic approaches. The development of the RDoC system can be a great help in this, as this dimensional approach offers the possibility of integrating the - often diffuse or even contradictory - neuroscientific research findings into a unified theoretical framework for the etiology, nosology and treatment of mental disorders. ]

Clinical Oncology

AUGUST 30, 2019

[Electrochemotherapy]

KIS Erika Gabriella

[Tumors with standard electrochemotherapy (ECT) has raised over the past decade from skin cancers to locally advanced or metastatic tumors. The procedure became a reliable alternative of other local tumor ablation methods, because of its patient tolerability, effi cacy across histotypes, and repeatability. ECT is based on the physical phenomenon of reversible electroporation; short electric pulses are applied to tumor nodules to achieve transient cell membrane permeabilization to otherwire poorly permeant chemotherapy drugs, which consequently increases cytotoxicity. At present recognized indications include superfi cial metastases of malignant melanoma, breast cancer, head and neck skin tumors, Kaposi sarcoma, primary and recurrent nonmelanoma skin cancers, and in well-selected patients mucosal oropharyngeal cancers. Emerging applications include skin metastases from visceral or hematological malignancies, vulvar cancer, certain benign skin lesions, and the combination of ECT with systemic immunotherapy. Thanks to the technical developments, the new ECT indications are deep-seated tumors, including bone metastases, liver malignancies, pancreatic and prostate cancers with the use of long needle variable geometry electrodes. Herein we review the present status of ECT from the basic principles to emerging applications, and report the effi cacy of standard ECT across histotypes.]