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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.

Lege Artis Medicinae

APRIL 18, 2020

[Interrelations between antidepressants and diabetes]

HARGITTAY Csenge, GONDA Xénia, MÁRKUS Bernadett, VÖRÖS Krisztián, TABÁK Gy. Ádám, KALABAY László, RIHMER Zoltán, TORZSA Péter

[Diabetes and depression are frequent comorbidities. They are a heavy burden by themselves, however, as comorbidities increase additionally the number of diabetes-related complications, morbidity, and mortality. In the background of interrelations, there are both well-known and hypothetical mechanisms. The aim of the present review is to outline these interrelations between antidepressants and diabetes and to discuss the effect of medications on carbohydrate metabolism respectively. Anti­depressant treatment on the one hand may improve mood, cognitive function and medication adherence leading to an improved glucose metabolism, on the other hand through their metabolic side effects, they may worsen carbohydrate metabolism. Concerning metabolic side effects, selec­tive serotonin reuptake inhibitors are the sa­fest, while tricyclic antidepressants and mo­noamine oxidase inhibitors should be administered under close monitoring. Se­rotonin and noradrenaline reuptake inhibitors may deteriorate gly­cae­mic control via increased noradre­nergic activation. Novel antidepressants, how­ever, have a neutral or positive impact on gly­caemic measures. Screening for and temporally adjusted treatment of depres­sion may decrease the risk of comorbidities ge­nerated complications. While caring for diabetic patients with depression, one should consider metabolic side effects of antidepressants and close monitoring of carbohydrate metabolism.]

Clinical Neuroscience

MARCH 30, 2016

The electrophysiological changes after 1 hz RTMS in ALS patients. A pilot study

MAJOR Zsigmond Zoltán, VACARAS Vitalie, MARIS Emilia, CRISAN Ioana, FLOREA Bogdan, MAJOR Andrea Kinga, MURESANU Fior Dafin

Motor neuron diseases are disabling poor prognostic conditions, with no successful treatment. Repetitive transcranial magnetic stimulation might offer a temporary functional improvement. Objective - We intended to evaluate the extent of the functional improvement using electrophysiological and clinical tests. Methods - Patients with motor neuron disease (amyotrophic lateral sclerosis) were included. Muscle strength and respiratory function assessment represents the clinical approach, and central motor conduction time, motor unit number estimation, blink reflex and H-reflex stands for electrophysiology. Two tests were performed using the whole battery prior and after low frequency repetitive transcranial magnetic stimulation, using 1 Hz stimulation frequency for five consecutive days, 20 minutes daily, at 80% of the individual resting motor threshold. Results - Central motor conduction time, muscle strength and pulmonary function showed no statistically significant differences, but a tendency towards improvement. Motor unit number estimation, blink reflex and H-reflex showed a significantly better outcome after the five day repetitive transcranial magnetic stimulation treatment. Conclusion - Low frequency repetitive transcranial magnetic stimulation influences beneficially electrophysiological parameters in amyotrophic lateral sclerosis, but with little clinical impact; further studies are needed to validate the extent of the effect.

Clinical Neuroscience

JANUARY 30, 2016

[Event-related potentials and clinical symptoms in schizophrenia]

DOMJÁN Nóra, CSIFCSÁK Gábor, JANKA Zoltán

[The investigation of schizophrenia’s aetiology and pathomechanism is of high importance in neurosciences. In the recent decades, analyzing event-related potentials have proven to be useful to reveal the neuropsychological dysfunctions in schizophrenia. Even the very early stages of auditory stimulus processing are impaired in this disorder; this might contribute to the experience of auditory hallucinations. The present review summarizes the recent literature on the relationship between auditory hallucinations and event-related potentials. Due to the dysfunction of early auditory sensory processing, patients with schizophrenia are not able to locate the source of stimuli and to allocate their attention appropriately. These deficits might lead to auditory hallucinations and problems with daily functioning. Studies involving high risk groups may provide tools for screening and early interventions; thus improving the prognosis of schizophrenia. ]

Clinical Neuroscience

MARCH 30, 2016

[Hungarian adaptation of a short eating disorder questionnaire (SCOFF)]

DUKAY-SZABÓ Szilvia, SIMON Dávid, VARGA Márta, SZABÓ Pál, TÚRY Ferenc, RATHNER Günther

[Aim - Eating disorders are becoming an increasingly relevant health issue, therefore the fast and accurate screening of people at risk is of great practical importance. The aim of SCOFF questionnaire is to assess this risk and the extent to which a person is affected, by using five simple yes or no questions. The objective of our study was to assess the validity of the Hungarian version of the test Methods - 777 medical students (210 men, 567 women, mean age 22.3±2.33 years) participated in the survey. The online questionnaire contained anthropometric data, the Eating Behaviour Severity Scale and, beside the SCOFF, the Eating Disorder Inventory (EDI). Results - The SCOFF is excellent at screening clinical eating disorders. Its sensitivity was 100% and specificity 85.1%. It is less efficient at detecting subclinical cases, but it does not show worse results than EDI. According to the data SCOFF is better at identifying more serious cases. Applying on the same sample SCOFF had higher sensitivity and lower specificity than EDI. Discussion - SCOFF is suitable for primary screening of eating disorders with a non-diagnostic purpose, taken two “yes” answers out of five as the critical margin, specified by the authors.]

Clinical Neuroscience

MARCH 30, 2020

To handle the HaNDL syndrome through a case: The syndrome of headache with neurologic deficits and cerebrospinal fluid lymphocytosis

ÇOBAN Eda, TEKER Ruken Serap, SERİNDAĞ Helin, SAKALLI Nazan, SOYSAL Aysun

The syndrome of headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HaNDL) is a rare entity. This disease has been related to migrainous headaches. It is a benign, self-limited disorder, which is characterized by fluctuating neurological symptoms and cerebrospinal fluid lymphocytosis. We describe a case of a 47 years old man with acute onset of headache and aphasia. Cerebrospinal fluid analysis revealed a lymphocytic pleocytosis (25 cells/μl, 100% lymphocytes). Electroencephalogram showed moderate slow rhythm in the left hemisphere, with temporoparietal predominance, and without epileptiform activity. His blood tests as well as magnetic resonance imaging (MRI) results were normal. With the diagnosis of HaNDL syndrome the patient was accepted in the Department of Neurology and discharged with full recovery.

Clinical Neuroscience

MARCH 30, 2020

CANOMAD syndrome with respiratory failure

SALAMON András, DÉZSI Lívia, RADICS Bence, VARGA Tímea Edina, HORTOBÁGYI Tibor, TÖMÖSVÁRI Adrienn, VÉCSEI László, KLIVÉNYI Péter, RAJDA Cecília

CANOMAD (chronic ataxic neuropathy, ophthalmoplegia, M-protein agglutination, disialosyl antibodies) syndrome is a rare polyneuropathy. IgM paraproteins react with ganglioside-containing disialylated epitopes resulting in dorsal root ganglionopathy and B-lymphocyte infiltration of cranial and peripheral nerves. Clinical features include ataxia, slight muscle weakness, areflexia, sensory- and cranial nerve symptoms. Case studies have reported the efficacy of rituximab and intravenous immunoglobulin (IVIg) treatments. We present the case of a 57-year-old man, who had difficulty walking, with numbness and clumsiness in all limbs. He had areflexia, vibratory sensation loss and ataxia. Laboratory tests showed IgM monoclonal components and disialosyl antibodies in the serum. Nerve conduction studies indicated severe sensorimotor demyelinating polyneuroradiculopathy. Despite IVIg and rituximab treatments, the patient’s disease course gradually worsened and he died of respiratory failure. Neuropathological examination revealed dorsal column- and dorsal root atrophy with mixed mononuclear cell infiltration. This article aims to draw attention to this syndrome, and the use of early potent immunosuppressive treatment to improve patients’ quality of life.

Lege Artis Medicinae

MARCH 10, 2020

[Nutritional status, realizing sarcopenia and the importance of prehabilitation in surgical departments]

CSIBA Borbála, NAGY Ákos, LUKOVICH Péter, BAROK Bianka

[INTRODUCTION - Malnutrition can significantly influence the surgery’s outcomes. Currently, patients risk grouping is based on the body mass index (BMI), and the preparation for surgery is concerned only as nut­rients administration. PATIENTS AND METHODS - The Nutrition Support Team established in our Department is assessing first the patients’ nutritional status (BMI, MUST), sarcopenia (skinfold measure, handgrip strength) and fitness status (6 min step test, sit to stand test). Risk group patients were suggested nutrients and physiotherapy prior to the surgical operation. In order to follow up our patients we created an online interface and repeated the tests immediately before the operation. RESULTS - 135 cancer patients (76 male and 59 female) were operated. Their average age was 69.6 years. 33 patients had weight loss before the first consultation (average=8.7 kg). Their average BMI was 26.3. 21 patients had gained weight in the last 6 months (average=7.8 kg). Patients with left descending colon, liver - and also pancreatic tumors had overweight BMI values while the rest of pa­tients ill with right colon and stomach neo­plasm had normal weight. Those patients who we enrolled to the online system had better results at the second assessment. CONCLUSIONS - According to our survey, most of the patients had overweight BMI values but had sarcopenia based on anthropometric tests. Therefore, the importance of in time recognized and preoperatively started nutritional therapy must be coupled with the parallel applied physiotherapy. ]

Lege Artis Medicinae

MARCH 10, 2020

[Summary data of Hungary's comprehensive health screening program (MAESZ) 2010-2019]

BARNA István, KÉKES Ede, HALMY Eszter, BALOGH Zoltán, KUBÁNYI Jolán, SZŐTS Gábor, NÉMETH János, PÉCSVÁRADY Zsolt, MAJOROS Attila, DAIKI Tenno, ERDEI Ottilia, DANKOVICS Gergely

[The comprehensive screening program of Hun­gary (MAESZ) 2010-2020-2030 is a unique initiative in Hungary and worldwide too. This largest humanitarian program provides by the latest technology free scree­ning tests for all residents in Hungary. The program developed by 76 pro­fessional organizations offers 38 scree­ning tests to every participants free of charge, in a special designed screening truck. Screening program performed by MAESZ includes cardiovascular, ophthalmologic, dermatologic, gynecologic, and neurologic investigations, lab tests, audiometry, blood pressure and arterial stiffness measurements, and venous Doppler ultrasound examinations. More­over, screening tests for lactose intolerance, colon malignancy, inflammatory bowel disease, reflux disease, urine incontinency, prostatic cancer and physical activity level were evaluated. Starting 2020, a dental screening station will be added to the mobile unit for early detection of oral cancers. Beyond screening tests, special attention is paid to assess health threatening risk factors, such as smoking, alcohol con­sumption, physical inactivity, un­healthy nutrition, and obesity. The program demonstrates the key elements of first aid from reanimation to bandage of burns in cooperation with professional and civil organisations. Furthermore, during the waiting time, participants get lifestyle recommendations and a health booklet with a bar code enabling the immediate computer analysis of test outcomes. Since the 2018/2019 school year the official prevention program for children entitled “Travel around the Empire of Health” was started. During its 10 years, the MAESZ performed 7 million free of charge screening tests on 1,886 scenes, enrolled 560,000 participants, invested 16,000 hours for prevention, handed out 1,200,000 health booklets and 391,000 prevention info packages to thousands of fami­lies. More than 20,000 health professionals (GPs, nurses, dietetics, health development agents, public health government officials, Accident Prevention Committee of National Police Headquarters, General Directorate of Social Affairs and Child Protection and non-governmental organizations) have been participated. The program designed to improve social health aims to help more and more Hun­garian citizens to be informed about their health status and to reminds them of the importance of prevention. ]

Journal of Nursing Theory and Practice

AUGUST 30, 2019

[Dangerous beauty - Health risks of beauty salon workers ]

PÁLVÖLGYI Éva, HIRDI Henriett Éva

[The aim of the study: The aim was to assess the health status and working conditions of the beauty salon workers (hairdressers, barbers, beauticians, manicurists and pedicurists), and their knowledge regarding workplace risk factors. Methods: The survey was conducted in December 2018 - January 2019 through self-constructed online questionnaire among Hungarian beauty salon workers which covered socio-demographic data, workers’ health issues and occupational health issues. Data were analysed with SPSS 22.0. Results: The online questionnaire filled out by a total of 166 beauty salon workers. workers (165 women and 1 man). The respondents had an average age of 35.21 years. The average working hours of the workers was 8.88 hours. 33.73% of the sample did not visited the occupational health setting at all. It can conclude that all of the respondents have chronical disease. Conclusions: The research confirmed that the employees of the beauty industry are exposed to a lot of health damaging factors, which is primarily the permanent contamination with chemical substances. The test results prove, that more emphasis should be placed on prevention and appearance in occupational health tests, as well as order to the personal protective equipment to use for healthy and safe working.]