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Clinical Neuroscience

JANUARY 30, 2021

[Cases of inborn errors of metabolism diagnosed in children with autism ]

ÇAKAR Emel Nafiye, YILMAZBAŞ 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

JUNE 30, 2020

[Examination of the Strength of Core- and Perineal Muscles in Case of Different Movements]

KISS Noémi, BAJSZ Viktória, PAKAI Annamária, CSÁSZÁR Gabriella Edit

[Aims of the study: to measure the strength of core-, perineal muscles in three groups, to compare different exercises for the aspect of these muscles. 11 sedentary-, 10 women’s doing Pilates, 13 inactive female sudent’s core- and perineal muscles were measured in longitudinal study by DAVID-machine, modified Plank-test, FemiScan at Univerity of Pécs, Faculty of Health Sciences, Zalaegerszeg, 2016. february-november. Data analysis: ANOVA, Scheffe Post Hoc test, two-tailed T-test. The TS-group’s muscles became more symmetrical (p=0.043). According to Plank test, the TS-group’s 3th result became stronger than FH-group (p=0.001) and the PT-group (p=0.018) at first. About the perineal-muscles: usually the PT-group achieved the best results. The FH-group’s perineal-muscles in case of relaxation were significantly symmetrical (p=0.038) than the TS-group’s after training. Pilates-method turned out to be effective to improve the strength and stamina of core muscles. Core-training is effective to improve core muscles, but not enough for perineal muscles with the given frequency and intensity. ]

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. ]

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 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.]

Journal of Nursing Theory and Practice

DECEMBER 30, 2019

[Perfusionist’s status in Hungary and the application of the low prime in coronary artery bypass]

DEÁK András, FUSZ Katalin, PRÉMUSZ Viktória, RAPOSA L. Bence, VÁRADYNÉ Horváth Ágnes, MADARÁSZ Ildikó, OLÁH András

[With the development of the equipments of extracorporeal circulation, international studies underline reducing the amount of filling fluid. Our retrospective study was conducted at the Heart Surgery Clinic of the University of Pécs between 1 January 2017 - 31 December 2017 with ECC cardiac operated patients. During the document analysis, data were collected from 157 patients between 50 and 70 years who underwent CAB surgery. They were classified into Low- (n=47) and Standard-prime (n=110) group. Medium negative correlation (r=-0.28; p<0.001) was found between prime/body surface area and haematocrit during last perfusion. As inflammatory parameter, the last measured CRP values were 36.00 mg/l (low) vs. 70.62 mg/l (standard). Our research justified the use of low-prime during ECC. The implementation of the method requires the scientific advancement of perfusionists, the preparation of national protocols and the improvement of the perfusionist’s training and legal background. ]

Hypertension and nephrology

NOVEMBER 04, 2020

[The role of stress management in the care of hypertension and the treatment of cardiovascular disease]

SOMOGYI Éva, KISS Zoltán, STAUDER Adrienne

[The aim of this paper is to give an overview of the relationship between stress and hypertension and cardiovascular diseases, furthermore to introduce an evidence based stress management intervention available in Hungary. The correlation between cardiovascular disease and psychosocial factors (including concomitant mental disorders as well as personality traits or the effect of social environment) has been established in numerous studies aimed at investigating pathogenesis or various clinical endpoints. The 2016 Guidelines of the European Society of Cardiology include the assessment and the management of psychosocial problems with behavioral medicine interventions as a I.A level recommendation. The implementation of these guidelines in everyday clinical practice is crucial to decrease cardiovascular risk. This involves the training of health care professionals, the facilitation of multidisciplinary collaboration and the integration of behavioral intervention into everyday care. The Williams Life Skills (WLS) program is an evidence based behavioral medicine intervention aiming to improve stress management and communication skills which implemented internationally and also available all over Hungary. It involves the learning of simple coping strategies that facilitate the successful management of every day psychosocial stress situations and the self-conscious reduction of bodily and psychological tensions. In cardiovascular disease, this improves quality of life and survival. The WLS program is especially recommended for healthcare workers to decrease the negative health consequences of their high stress load and to prevent burnout. Stress may affect both doctors and patients during their interactions. Bálint groups have a positive impact on the physician-patient collaboration and help to reduce burnout by improving the understanding of the diseases from a more complex approach.]

Hypertension and nephrology

SEPTEMBER 30, 2020

[Post-career development of cardiometabolic changes and hypertension in competitive athletes]

LELBACH Ádám, KÁNTOR Márk, KOLLER Ákos

[Regular physical activity is essential in delaying the aging processes (e.g. arterial remodelling – stiffening, metabolism, bodyweight), the beneficial effects of competitive sports – especially strength sports – according to the recent data of the literature are questionable. The beneficial effects of physical activity on the cardiovascular (CV) system are well known, however less is known regarding the delayed impacts of high intensity competitive sports on the CV system, especially after the sport career is over. This review summarizes the effects of active competitive sport and the post-career period on the cardiometabolic system with special attention to the systemic blood pressure and the development of metabolic syndrome. After sport career, the welldeveloped high performance cardiovascular- and metabolic system suddenly is much less used, but still supported by sport-level diet. It is well known that hypertension is a significant pathogenic factor in the development of cardiovascular diseases, characterized – among others – by reduced elasticity of large- and medium- sized vessels thereby importantly contributing to the development of systolic hypertension. Inflammation and thrombus formation both play an important role in the development of vascular injury and atherosclerosis. The increased tone of microvessels can impair the blood supply of certain organs, including the coronary circulation. It has been ample shown, that regular non-competitive, aerobic exercise activities are important factors in preventing hypertension. Such pathological changes become more evident after the development of post-career obesity, as well as the development of hypertension due to the activation of the renin-angiotensin system through sodium retention and other metabolic changes (increased glucose tolerance, insulin resistance, type II diabetes mellitus). It has been ample shown, that regular non-competitive, dynamic aerobic exercise activities are important factors in preventing hypertension. The frequency, intensity, type, and time (FITT) principle of exercise prescription is the first and common therapeutic approach, which represents the translation of cardiovascular basic science research results into hypertension treatment, thus can provide a personalized physical activity program/therapy according to medical needs not just for the post-career sportspersons, but the wide range of patients.]