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Clinical Neuroscience

SEPTEMBER 30, 2016

[Our experience with the use of Active-C cervical prosthesis]


[Objective - The most widely used surgical procedure in the treatment of cervical spine disc hernias have been the anterior cervical discectomy and fusion for decades. The usage of cervical disc prostheses enabled us to preserve the movements of the affected segments, hereby reducing the overexertion of the adjacent vertebrae and discs. Our goal is to follow our patients operated with Active-C prosthesis (which is used in the Institute since 2010) to gather information about the change of their complaints and about the functioning and unwanted negative effects of the prostheses. Question - Is the usage of Active-C prosthesis an efficient procedure? Methods - Between 2010 and 2013, performing the survey of neurological conditions and functional X-ray examinations. We measured the complaints of the patients using the Visual Analogue Scale, Neck Disability Index and Cervical Spine Outcomes Questionnaire. The control group consisted of patients who were operated in one segment using the fusion technique. Results - In the study group according to the Neck Disability Index scale after 18 months, seven patients had no complaints, while twelve persons reported mild and the remaining six moderate complaints. In the control group, moderate complaints were present in four patients, while twelve patients reported mild complaints. The other eight persons showed no complaints. According to the results of the Visual Analogue Scale in the group of prosthesis, the degree of referred pain decreased from 8.6 to 1.84 one and a half years after the surgery. A decrease was observable in the case of axial pain too, from 6.6 down to 1.92 (p<0.01). In case of three from the twenty-five patients there was no sign of movement in the level of the prosthesis. Conclusions - According to the present short- and mediumterm studies, the usage of the cervical disc prosthesis can be considered as an efficient procedure, but at the same time the advantages can only be determined in the long run, therefore further following and studies are required.]

Clinical Neuroscience

MAY 30, 2016

The relationship between serum cholesterol and verbal memory may be influenced by body mass index (BMI) in young healthy women

DARNAI Gergely, PLÓZER Enikõ, ALTBACKER Anna, PERLAKI Gábor, ORSI Gergely, KŐSZEGI Tamás, NAGY Szilvia Anett, LUCZA Tivadar, KOVÁCS Norbert, JANSZKY József, CLEMENS Zsófia

The objective of this study was to examine the relationship between verbal memory and total cholesterol (TC) levels related to body mass index (BMI) in healthy young women. Verbal memory was assessed using the Rey Auditory-Verbal Learning Test (RAVLT) while total serum cholesterol was measured by enzymatic colorimetric test. In order to analyze the potential significance of BMI subjects were divided into three groups according to their calculated BMI percentile values. No significant correlation was found when assessing the group as a whole. However a remarkable pattern of correlation emerged when assessing the BMI groups separately: a close-to-significant positive correlation was found for total learning score and TC in the low BMI group, no correlation emerged in the medium BMI group while a strong inverse correlation was found in the high BMI group. These findings indicate that the relationship between verbal memory and serum TC level is also influenced by BMI.

Clinical Neuroscience

MAY 30, 2016

[Disease burden of Duchenne muscular dystrophy patients and their caregivers]


[Background and purpose - Data on the disease burden of Duchenne Muscular Dystrophy are scarce in Hungary. The aim of this study was to assess patients’ and their caregivers’ health related quality of life and healthcare utilisations. Methods - A cross sectional survey was performed as part of the European BURQOL-RD project. The EQ-5D-5L and Barthel Index questionnaires were applied, health care utilisations and patients’ informal carers were surveyed. Results - One symptomatic female carer, 50 children (boys 94%) and six adult patients (five males) participated in the study, the latter two subgroups were included in the analysis. The average age was 9.7 (SD=4.6) and 24.3 (SD=9.8) years, respectively. Median age at time of diagnosis was three years. The average EQ-5D score among children and adults was 0.198 (SD=0.417) and 0.244 (SD=0.322), respectively, the Barthel Index was 57.6 (SD=29.9) and 53.0 (SD=36.5). Score of satisfaction with healthcare (10-point Likert-scale) was mean 5.3 (SD=2.1) and 5.3 (SD=2.9). 15 children were hospitalised in the past 12 months for mean 12.9 (SD=24.5) days. Two patients received help from professional carer. 25 children (mean age 11.1, SD=4.4 years) were helped/supervisied by principal informal carer (parent) for mean 90.1 (SD=44.4) hours/week and further family members helped in 21 cases. Correlation between EQ-5D and Barthel Index was strong and significant (0.731; p<0.01) as well as with informal care time (-0.770; p<0.01), but correlation with satisfaction with health care was not significant (EQ-5D: 0.241; Barthel Index: 0.219; informal care: -0.142). Conclusion - Duchenne muscular dystrophy leads to a significant deterioration in the quality of life of patients. Parents play outstanding role in the care of affected children. This study is the first in the Central and Eastern European region that provides quality of life data in this rare disease for further health economic studies.]

Clinical Oncology

FEBRUARY 10, 2015

[Oncological management of gastro-entero-pancreatic neuroendocrine neoplasias]


[Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are unusual and relatively rare neoplasms. They characteristically synthetize, store and secrete a variety of peptides and neuroamines, which can lead to development of disctinct clinical syndromes. Clinical symptoms and presentations vary depending on the location and hormones produced by the tumor. The diagnosis of NETs is established by histological examination and the immunohistochemical detection of general neuroendocrine markers, such as chromogranin A (CgA) and synaptophysin. An update of the WHO classifi cation has resulted in a new classifi cation dividing neuroendocrine neoplasms into neuroendocrine tumors (NETs) including G1 (Ki67 index ≤2%) and G2 (Ki67 index 3-20%) tumors and neuroendocrine carcinomas (NECs) with Ki67 index >20%, G3. The different available therapeutic approaches, including surgery, liver-directed ablative therapies, peptide receptor radionuclide therapy, and systemic hormonal, cytotoxic or targeted therapy, are discussed in this overview.]

Clinical Neuroscience

SEPTEMBER 30, 2015

Restless legs syndrome and insomnia frequency in patients with psoriasis

GULER Sibel, TEKATAS Aslan, ARICAN Özer, KAPLAN Sarı Özlem, DOGRU Yüce

Background - To assess the prevalence and severity of RLS in psoriasis patients and to investigate its effects on sleep and quality of life. Methods - Seventy patients with psoriasis in Trakya University Medical Faculty Dermatology Department and also applied to Neurology Department in the same center and 70 volunteer controls were enrolled in the study. Severity of the Restless Legs Syndrome (RLS) was determined using International Restless Legs Syndrome Study Group (IRLSSG) criteria among the patients who have been diagnosed with RLS based on IRLSSG criteria. The presence of insomnia in patients was detected using International Classification of Sleep Disorders (ICSD-II) criteria. Additionally, to evaluate the severity of the disease and quality of life, Psoriasis Area Severity Index (PASI) and Dermatology Life Quality Index (DLQI) tests were applied to the patients with psoriasis. Results - RLS frequency in patients with psoriasis was 28 (40%) compared to the control group 10 (14.2%), and the difference was statistically significant (p<0.001). IRLSSG severity scores were higher in patients with psoriasis who had insomnia secondary to RLS compared to those who did not have insomnia (p<0.001). The mean values of PASI were 7.54±6.52 in the presence of insomnia and 3.27±2.69 in the absence of insomnia. The difference was statistically significant (p<0.001). No significant difference was found in DLQI scores between patients with RLS and without RLS or between patients with and without insomnia (p>0.05). Discussions - RLS frequency in patients with psoriasis was significantly higher than in the control group. In addition, we found that RLS is more common but RLS severity was mildly high in patients with psoriasis relative to controls. However, there was a correlation between the increase in severity of RLS with secondary insomnia patients who were diagnosed with RLS. It may be beneficial to consider RLS and insomnia for each patient diagnosed with psoriasis.

Lege Artis Medicinae

JULY 20, 2015

[Incisional hernia and diabetes. Could we improve the results?]


[GOALS - Diabetes mellitus is considered as a risk factor concerning surgical interventions as well. Connection between incisional abdominal hernias and diabetes mellitus were investigated in this prospective four years study. The primary aim was to evaluate the proportion of recurrencies, the secondary aim was determining the ratio of surgical complications in the investigated two groups (Group I: non diabetic, group II: diabetic patients). PATIENTS AND METHOD - The results of the incisional and abdominal hernia operations performed between 01. 01. 2011. and 31. 12. 2014. were investigated. Data for study was gained from the consecutively and obligatorily registered database of the authors’ institution. The type of reconstruction, elective or acute character of surgery, primary or recidive operation, the patients’ body mass index (BMI), as well as among complications the seroma and fistula formations, the reoperations and postoperative infections were registered. Patients with type I and type II diabetes mellitus were not differentiated. The HgbA1c was investigated separately in elective and acute operations. RESULTS - There were 56 (8.94%) diabetic patients (39 male, 17 women, avr. age 54.3 years) out of all 626 patients operated on incisional and/or abdominals wall hernias. Total recurrency rate was 19.6% during the average 32 months (6-66 months) follow-up period. The recurrency rate in diabetic patients was 50.0% (48.7% in women, 52.9% in men). Non-diabetic patients’ recurrency ratio were only 8.3% (11.2% and 5.4% in men and women, respectively). Median BMI is significantly higher in patients with diabetes than in those of non diabetics (35.4kg/m2 vs 27.75kg/2). Ratio of the elective and acute operations were 69.6% and 28.6%, respectively. The most frequently used operations technique was the direct transversal abdominal wall suture (14.3%) and the direct suture plus synthetic mesh implantation (64.3%). Eleven (19.7%) diabetic patients with incisional hernia were reconstructed with a so-called autologous tension free dermal flap. In 2 (18.2%) out of 11 patients were registered recurrency. Seroma and haematoma formation was occured in four patient (36.4%) and in one (9.1%), respectively after dermal flap reconstructions. Mean recurrency time after surgery in non-diabetic and in diabetic patients was 12.3 months and 9.2 months, respectively. The average HgbA1c level was significantly higher (8.1% in electively operated patients than in those acutly operated ones (9.8%). There were two lethal (0.36%) postoperative complications in this study. CONCLUSION - Considering the recurrency ratio of the incisional hernias and the postoperative complications, diabetes mellitus is a significant risk factor compared the data to non-diabetic patients. Seroma and haematoma formations, postoperative complications ratio are significantly higher in patients with diabetes than in those of non-diabetic. Appearance of recurrencies require significantly shorter time in patients with diabetes mellitus The rate of recidive and postoperative complication after the autolog, dermal, traction free abdominal wall reconstructions made by authors was lower, than in abdominal hernias reconstructed in other ways (direct suture, direct suture plus xenograft).]

Lege Artis Medicinae

JUNE 01, 2015

[Survey on the dietary habits of children between the age of 4-10]

KISS-TÓTH Bernadett, BÍRÓ Lajos

[INTRODUCTION - The prevalence of overweightness and obesity among children is increasing in Hungary, while the inadequate or excessive intake of some nutrients is also representative. Keeping these inappropriate lifestyle habits in adulthood could significantly worsen the health status of the rising generation. METHOD - The sample is representative for the 4-10 year old children of Budapest and Kecskemét city. The dietary assessment was executed, using the internationally accepted 3 day dietary record method. Body mass index was also calculated from the measured body weight and height, creating BMI categories according to the Cole methodology. RESULTS - The ratio of overweightness and obesity resulted in 21% (19% for the 4-6 year old, 24% for the 7-10 year old), while 13% of them belonged to the underweight category. The nutritional problems, identified by adults, like the excessive fat intake, its inappropriate composition, the high sodium-, low calcium- and vitamin D intake already appears in the early stages of life. CONCLUSION - The results prove, that the education for healthy nutrition among children is in high priority, in which all stakeholders, like the parents, the governmental and non-governmental organisations, the educational institutes as well as the food industry plays an important role. ]

Clinical Neuroscience

MAY 30, 2015

[Validation of the Hungarian Unified Dyskinesia Rating Scale]

HORVÁTH Krisztina, ASCHERMANN Zsuzsanna, ÁCS Péter, BOSNYÁK Edit, DELI Gabriella, PÁL Endre, KÉSMÁRKI Ildikó, HORVÁTH Réka, TAKÁCS Katalin, BALÁZS Éva, KOMOLY Sámuel, BOKOR Magdolna, RIGÓ Eszter, LAJTOS Júl

[Background - The Unified Dyskinesia Rating Scale (UDysRS) was published in 2008. It was designed to be simultaneous valid, reliable and sensitive to therapeutic changes. The Movement Disorder Society organizing team developed guidelines for the development of official non- English translations consisting of four steps: translation/back-translation, cognitive pretesting, large field testing, and clinimetric analysis. The aim of this paper was to introduce the new UDysRS and its validation process into Hungarian. Methods - After the translation of UDysRS into Hungarian and back-translated into English, it was reviewed by the UDysRS translation administration team. Subsequent cognitive pretesting was conducted with ten patients. For the large field testing phase, the Hungarian official working draft version of UDysRS was tested with 256 patients with Parkinson’s disease having dyskinesia. Confirmatory factor analyses (CFA) determined whether the factor structure for the valid Spanish UDysRS could be confirmed in data collected using the Hungarian Official Draft Version. To become an official translation, the Comparative Fit Index (CFI) had to be ≥0.90 compared to the Spanish-language version. Results - For the Hungarian UDysRS the CFI was 0.98. Conclusion - The overall factor structure of the Hungarian version was consistent with that of the Spanish version based on the high CFIs for the UDysRS in the CFA; therefore, this version was designated as the Official Hungarian Version Of The UDysRS.]

Journal of Nursing Theory and Practice

OCTOBER 30, 2014

[Contact between the polycystic ovary syndrome and the metabolic syndrome]


[Aim of the study: The objective of my thesis was to examine the presence of metabolic syndrome with the disorder of glucose metabolism among patients diagnosed with polycystic ovary syndrome (PCOS). Sample and methods: 98 female patients diagnosed with PCOS, aged 18-45, took part in the retrospective quantitative study, anthropometric data and laboratory parameters relevant to metabolic profile were analysed. We applied descriptive statistics with SPSS 17 software, as well as Chi2-test and regression analysis (p <0.05) Results: 46% of the study population were found to be overweight. There was a significant correlation between BMI index and blood pressure and lipid profile (p<0.05). Metabolic syndrome was confirmed by more than 40% of the patients Conclusion: The PCOS is an endocrine disease, which affects multiple organ systems. The patients should be screened towards metabolic syndrome to achieve a correct diagnosis, regardless of the BMI values. The findings of our research and the confirmed correlations highlight the need for a development in care protocols.]

Clinical Neuroscience

MARCH 25, 2015

[Measuring of functional impairment of lumbal spine]


[Background and purpose - The purpose of our study was to outline the Hungarian validation process of the Oswestry Disability Index, the Quebec Back Pain Disability Scale, the Roland-Morris Disability Questionnaire and the Core Outcome Measurement Index, as well as to draw up recommendations regarding their future applications. Methods - The Hungarian versions were brought to life after a cultural and linguistic adaptation. Next to the above-mentioned questionnaires, the questionnaire booklet used for validation also contained the WHOQoL-BREF general quality of life questionnaire and a pain measuring Visual Analog Scale. The data of low-back pain patients were registered twice in two weeks. We determined the internal homogeneity (Cronbach alpha), reproducibility, standard error of measurement and the minimal detectable change of the questionnaires. Patients were assigned into different two subgroups (surgical / non-surgical, with / without affection of nerve roots) and differences between the subgroups were examined with the help of the questionnaires. We determined the physical subscale of the WHOQoL-BREF and the correlation between the pain and the studied questionnaires. Results - The value of Cronbach alpha was between 0.85 and 0.95. All four questionnaires showed significant differences (p<0.001) between the subgroups. The correlation studies brought strong and significant results (p<0.001, r>0.5) in every case. The values of reproducibility were between 0.93-0.92. The results of standard measurement error: 4.8 (Oswestry), 5.2 (Quebec), 1.6 (Roland-Morris), 0.59 (Core Index). The minimal detectable change was 13; 14; 4, and 2 points, respectively. Conclusion - The Hungarian versions of all four questionnaires are valid. They can be applied with scientific certainty to measure low back pain patients. From the studied questionnaires, we especially recommend the wide-raging application of the Oswestry Disability Index and the Core Outcome Measurement Index based on their psychometric and application features. ]