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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.]

Lege Artis Medicinae

APRIL 18, 2020

[The relationship of traumatic experiences and eating disorders – therapeutical options]


[In the etiology of eating disorders (espe­cially bulimia nervosa and binge eating) traumatic experiences (sexual, physical, emo­tional abuse, neglect) play an important role. Traumatization can have a serious impact, which is influenced by the parameters of the traumatization, risk and protective factors, and the resiliency of the traumatized patient. The consequences may lead to the development of specific psychiatric and somatic disorders, and may cause lifetime revictimization. The exploration of data related to the traumatization is essential in eating disorders as well. If traumatic expericences can be detected in the back­ground of eating disorders, the targeted therapy of eating disorders while applying its specific elements should also follow the guide­lines of the general trauma-therapy. Providing safety in therapeutical relation­ship is fundamental. The therapeutic options are extensive. Along with psychodynamically oriented therapies, the newer methods based on cognitive-behavioral therapy (e.g., dialectic behavior therapy, integrative cognitive analytic therapy) are also proposed. Hyp­no­therapy can also be useful. ]

Clinical Neuroscience

MARCH 30, 2016

Cerebral amyloid angiopathy related inflammation: is susceptibility weighted imaging the clue for diagnosis?


Background - Cerebral amyloid angiopathy-related inflammation (CAA-ri) is characterized by various neurological symptoms such as gradually developing confusion, progressive cognitive decline, seizure or headaches; T2 hyperintensities on magnetic resonance imaging (MRI); and neuropathological evidence of cerebral amyloid angiopathy (CAA) and associated vascular or perivascular inflammation. Although histological confirmation is necessary for accurate diagnosis, in case of typical clinical features and neuroimaging, the diagnosis can be established without biopsy. Case summary - We present the case of a 57-year-old man with a history of hypertension who presented to the emer¬gency department 3-week history of progressive headache and a gradually developing altered mental status. On examination, he was found to have left sided weakness and decreased pscyhomotility. Routine clinical work-up (lab investigations, CT, cerebrospinal fluid analysis) did not show obvious diagnosis, so we performed an MRI. It raised the suspicion of CAA-ri which diagnosis was verified by neuroradiological evaluation. High dose steroid treatment was initiated. The patient rapidly responded to treatment, his focal neurological signs resolved. Control MRI after 1.5 months showed multiple haemorrhagic laesions in the field of previous inflammation which posteriorly supported the previous supposed work-diagnosis. Conclusions - Although histopathology is the gold standard for the diagnosis of cerebral amyloid angiopathy, the typical clinical presentation, good response to steroids and accurate neuroradiological criteria make biopsy unnecessary to diagnose CAA-ri.

Clinical Neuroscience

MARCH 30, 2020

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


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.

Lege Artis Medicinae

DECEMBER 10, 2019

[Risk assessment for child sexual abuse in the American legal practice]

KÓRÁSZ Krisztián

[The paper gives introspection into the child sexual abuse risk assessment practice in the USA by reviewing the literature. According to the definition of the World Health Organization, sexual assault is considered to be any act involving a child in a sexual activity if he or she can not be considered as prepared for the child's age or development. The author also makes an attempt to present some issues and pos­sible solutions regarding the current practice. ]

Lege Artis Medicinae

OCTOBER 20, 2019

[Experiences with the Hungarian version of the Sexual Risk Behavior Beliefs and Self-efficacy Scales ]


[INTRODUCTION - One of the most em­phasized areas of school health education is sexual safety. For risk reduction, adolescent’s beliefs and self-efficacy about sexual safety are decisive; however, no Hungarian measurement tool for this construction was available before. The aims of the present study were to adapt the Sexual Risk Behavior Beliefs and Self-efficacy Scales (SRBBS) to Hungarian, to explore the gender differences, and to assess predictors of condom use among high school students. METHOD - 9th and 10th class high school students in a north-Hungarian city were involved in our cross-sectional study (N = 649; 52.5% boys; mean age: 16.7 years; SD = 1.01 years). Measures: SRBBS questionnaire, sexual behavior issues. RESULTS - The psychometric analysis of SRBBS has yielded encouraging results. The theoretical factor structure is largely supported, the internal consistency of the scales is adequate and its test-retest reliability is mostly acceptable. 35.5% of the participants had sexual intercourse during their lifetime and 65.8% had used condoms at the last occasion. The boys (OR = 2.17, p = 0.021) and those who had more positive attitude towards condom use (OR = 1.24, p = 0.002) were significantly more likely to use a condom during the last act than girls, and subjects with less favorable attitude towards condom use. CONCLUSIONS - SRBBS questionnaire should be introduced into domestic research to measure the effectiveness of health check-ups and school health education programs. ]

Hypertension and nephrology

FEBRUARY 20, 2019

[Sexual problems in CKD – a narrative review]

TÖRÖK Marietta, JÖRGEN Hegbrant, GIOVANNI Strippoli

[Sexual dysfunction is highly prevalent in patients with CKD, especially those receiving dialysis. Given the high prevalence of sexual problems in CKD patients, there has been growing interest in finding effective treatments for sexual dysfunction. PDE5i and zinc have been found promising interventions for treating sexual dysfunction in men with CKD in a systematic review of RCTs, but the evidence supporting their routine use in CKD patients is limited. In the Collaborative Depression and Sexual Dysfunction (CDS) Study, over a cohort of 1611 men in hemodialysis, 83% reported erectile dysfunction and 47% reported severe erectile dysfunction, with depression strongly correlated to this problem. Similarly, sexual dysfunction was highly prevalent in women undergoing hemodialysis. Of the 659 respondents, 555 (84%) reported sexual dysfunction and more than half of sexually active women reported sexual dysfunction, associated with age, depressive symptoms, menopause, low serum albumin, and diuretic therapy.]

Lege Artis Medicinae

JANUARY 20, 2019

[What brings ICD-11 to psychiatry? ]


[On 18 June 2018, after 10 years of working the World Health Organization released the 11th edition of International Clas­si­fi­cation of Diseases. User-friendly development was a definite goal. For the first time, it is completely electronic. The renewal in regard to both formal and content aspects reflects dynamic development of medicine. It contains new chapters on immune sys­tem disorders, sleep disorders, sexual health and traditional medicine. The new edition contains 55000 possible codes. It comes to effect from January 2022 in the member states and that requires users, doctors, insurers, and universities to be well prepared. Coding of mental and behavioral disorders also changes significantly. Fol­lo­wing a brief general description we look at the most important changes in the field of psychiatry. ]

Hypertension and nephrology

SEPTEMBER 12, 2018

[Treatment of hypertension in kidney transplant patients]


[Most of the renal transplant recipients suffer from hypertension. Hypertension substantially contributes to the high cardiovascular mortality in this population. The recommendation of the Hungarian Society of Hypertension and the international guidelines suggest to achieve less than 130/80 mmHg as target blood pressure in these patients. Several factors may be in the background of hypertension after kidney transplantation, which can be summarized as factors from the recipient-side, the donorside and factors provoked by transplantation itself. In most of the cases early after transplantation high doses of immunosuppressive drugs (especially calcineurin inhibitors and steroids) are responsible for the increased blood pressure. There are some further special methods apart from the general recommendations which are needed during the examination of hypertension of kidney transplant patients: e.g. measurement of blood trough-level of immunosuppressive drugs, investigation of bone-mineral disorder, screening for the level and causes of anaemia, check-up of the renal graft circulation. Kidney transplant patients suffering from hypertension usually need more than two antihypertensive drugs beyond the use of non-pharmaceutical antihypertensive methods. In the early posttransplantation period calcium channel blockers are preferred antihypertensive medications, because they counterbalance the vasoconstrictive effect of calcineurin inhibitors. The administration of renin-angiotensin-aldosterone inhibitors are rather suggested after the stabilization of renal function (from the 1-3 months posttransplantation). When designing antihypertensive strategy, comorbidities and special factors should be regarded as well, especially volume overload, proteinuria, allograft function (GFR), diabetes, other cardiovascular risk factors, previous cardiovascular events. The setup of an individual therapeutical strategy is advised in view of all these factors, which is different according to the timing after transplantation: the perioperative, the early postoperative phases and from 1-3 months after transplantation have special focuses.]

Hypertension and nephrology

MARCH 20, 2018

[Nebivolol’s unique molecule structure and its effect onthe quality of life]


[The β receptor blockers have very different effects depending on their receptor selectivity, ISA effect, which gives a wide opportunity of beneficial therapeutic choice. Resulting from its unique molecule structure nebivolol has its unique effects. It consists two isomers in 1:1 ratio. D-nebivolol is a highly β1 receptor blocker, while l-nebivolol causes NO release resulting vasodilatation. As a result of this dual effect, nebivolol more strongly reduces the blood pressure. The pressure reducing effect of nebivolol is stronger than 25 mg of atenolol, and is equal with the effect of 100 mg of atenolol. Nebivolol has a significantly higher responders’ rate than bisoprolol, and significantly fewer adverse effect. Comparing to losartan nebivolol produces significantly higher reduction in systolic and in diastolic blood pressure as well. Nebivolol has beneficial haemodynamic effects. It raises the stroke volume by 20.6 percent, the cardias output by 7.1 per cent, the ejection fraction by 7.8 per cent while reduces the peripheral resistance by 13.2 per cent. Both at rest and during exercise nebivolol cases significantly higher reduction in pulmonary wedge pressure than atenolol. Nebivolol has a better profile of adverse effects. The following adverse effects were observed: fatigue in 1.3 per cent, cold extremities in 0.8 per cent, impotence in 0.08 per cent and dyspnea in 0.05 per cent. It has also a beneficial effect on erectile dysfunction. It cases a significant elevation in erectile dysfunction score from 17.22 to 22.09. The number of sexual activity also raised from 3.41 to 6.38 during nebivolol treatment. The prevalence of erectile dysfunction is also significantly lower as compared to any β receptor blocker. Nebivolol has a synergic effect on PDE5 blockers, raises the cGMP concentration in the erectile tissue. There is also a significant difference among the β receptor blockers in the reduction of exercise tolerance. The nonselective β receptor blocker cause 40 per cent, carvedilol 35 per cent, the β1 selective receptor blocker 25 per cent while nebivolol 6 per cent reduction in the duration time.]