Lege Artis Medicinae

[Fair play?!]

BODA Domonkos

JUNE 01, 2000

Lege Artis Medicinae - 2000;10(06)

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Lege Artis Medicinae

[Infectiosus diseases - Past, present, future]

SZALKA András

[The complex interactions between microorganisms and humans include the well known, traditional infectious diseases and also the symbiotic relationship with the human endogenous normal flora. Forty years ago everybody was convinced that medicine would soon be able to eradicate most of the infectious diseases. Perception of victory over infectious diseases has been blunted in recent years by nosocomial infections and by the new and re-emerging diseases. The spectrum of infectious diseases is expanding and many of those once thought conquered are increasing in numbers. Moreover, the problems of infection are present in all aspects of medicine and with the field turning more and more complex its challenge for practitioners has become increasingly demanding. It is now clear, that at the dawn of the new millennium infectious disease remains the number one killer in the world. ]

Lege Artis Medicinae

[Practical aspects of screening for microalbuminuria in diabetic patients]

JERMENDY György, FARKAS Klára, NÁDAS Judit, DARÓCZY Atilla, PÉTERFALI Éva

[INTRODUCTION - The importance of measuring microalbuminuria is well established, however, controversy still exists regarding the type of urine specimen to be used for detecting early renal impairment of diabetic patients. PATIENTS AND METHODS – To evaluate practical aspects, albumin concentration and albumin to creatinine ratio of first void urine samples as well as urinary albumin excretion in timed specimens were determined by immunoturbidimetric method 3 times within 3 weeks in 192 adult diabetic patients (136 men, 56 women; type 1/type 2: 90/102; age: 51.4=10.8 years; duration of diabetes: 15.3+9.1 years; body mass index: 27.9+4.6 kg/m2; HbA1c: 8.5+1.5 %; actual blood pressure: 13814/82+8 mmHg; serum creatinine: 94+20 umol/l; x+SD). RESULTS - According to the urinary albumin excretion values, one third of patients (31.2%-30.7%-34.4%) were normoalbuminuric (<30 mg/24 hours), more than half of the patients (55.8%-57.3%-53.6%) proved to be microalbuminuric (30-300 mg/24 hours), while the remaining group of patients (13.0%-12.0%–12.0%) was macroalbuminuric (>300 mg/24 hours). Comparing the results of successive measurements good correlation was found between the same laboratory values (urinary albumin excretion: K=0.64; K=0.67; urinary albumin concentration: K=0.60; K=0.62; albumin to creatinine ratio: K=0.54; K=0.61; first vs. second and second vs. third measurements, respectively). The percentage of patients being in the same range of albuminuria (i.e. normo-, micro-or macroalbuminuria) at successive measurements was 79.7-81.2% with urinary albumin excretion values, 77.1-77.6% with urinary albumin concentration and 74.5-78.6% with albumin to creatinine ratio. Good correlations were found between urinary albumin excretion and urinary albumin concentration (K=0.54; 0.54; 0.57) and nearly the same correlations were observed between urinary albumin excretion and albumin to creatinine ratio (K=0.49; 0.47;0.54) at different series. Using values of urinary albumin excretion for comparison at all measurements, 79.3% sensitivity and 69.5% specifity were found for urinary albumin concentration whereas 74.6% sensitivity and 68.8% specifity were documented for albumin to creatinine ratio. CONCLUSION - Beside the standard measurement of urinary albumin excretion in timed urine samples, the use of the more convenient morning urinary spot collection could also provide useful results (urinary albumin concentration or albumin to creatinine ratio) for detecting early renal involvement in diabetic patients. ]

Lege Artis Medicinae

[Hypertension And BPH Intervention Trial]

MATOS Lajos

Lege Artis Medicinae

[Postnatal development of the human hippocampal formation]

SERESS László

[Jean Piaget's theory suggests that cognitive development proceeds in discrete steps. The first is the sensorimotor period that happens in the first two years of life. In recent years it became clear, that it is necessary to have an intact and mature hippocampus for adequate memory formation, both in experimental animals and humans. In the present study, the morphological development of the human hip pocampus was correlated with the developmental changes of intellectual development. Our results suggest that neuronal cell formation of the human hippocampus terminates several weeks before birth. In the dentate gyrus, a small number (less than 1%) of granule cells are still formed around birth. Immature granule cells migrate through the hilar region to their final position in the granule cell layer during the first six postnatal months. Light microscope studies of individual neurons indicate that connections between granule cells and their target neurons are not yet formed at birth. Such connections develop during the third postnatal year. If the development of the synaptic connections is damaged in experimental animals, the hippocampal function will be permanently impaired. Newborns may have basic synaptic circuits for memory formation, but the postnatal morphological changes suggest the significant modification of the hippocampal circuits happening continuously from the newborn age until late childhood. These changes may cause the phenomenon of the "infantile amnesia". ]

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Clinical Neuroscience

[Treatment options for enormous carotid thrombus as a complication of SARS-CoV-2 infection]

KONCZ Júlia, OROSZ Viktor, SULYOK Zoltán, ANDRÁS Emőke, KÁDÁR Balázs, OLÁH Csaba

[In SARS-CoV-2 positive patients with corresponding neurological symptoms the presence of carotid bifurcation macrothrombus should always be considered. Hypercoagulopathy caused by viral endotheliitis, systemic inflammation and cytokine storm play an important role in its development. Here we present two patients treated with different treatment strategies because of carotid bifurcation macrothrombus as a complication of SARS-CoV-2 infection. In both cases, the soft macrothrombus was eliminated and the patients’ neurological condition were improved. Intravenous thrombolysis, acute carotid stenting with embolic filter protection device and mechanical thrombectomy with aspiration are effective treatments.]

Clinical Neuroscience

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

PÉNTEK Márta, HERCZEGFALVI Ágnes, MOLNÁR Mária Judit, SZŐNYI László Pál, KOSZTOLÁNYI György, PFLIEGLER György, MELEGH Béla, BONCZ Imre, BRODSZKY Valentin, BAJI Petra, SZEGEDI Márta, POGÁNY Gábor, GULÁCSI László

[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.]

Lege Artis Medicinae

[RAAS inhibitors therapy – COVID-19 pandemic]

KÉKES Ede

[Acute respiratory syndrome with various signs and outcomes caused by the SARS-CoV-2 virus is the biggest challenge facing health systems worldwide today. The renin-angiotensin-aldosterone and kinin-kallikrein systems and within these two endopeptidases (ACE and ACE2) play a crucial role in the developing clinical feature of COVID-19. Adverse effects of the ACE-stimulated Ang II/AT1R axis (oxidant, pro-inflammatory effect, vasoconstriction) are counterbalanced by the ACE2-induced AT2R and MasR activities (antioxidant, anti-inflammatory effect, vasodilation). The severity of SARS-CoV-2 pneumonia and systemic inflammation explains the impairment of ACE2 (as an important defence factor of the lungs) caused by the biding spike protein of the SARS-CoV-2, which decreases the ACE2 levels. In parallel, bradykinin production also increases and intensifies the SARS-CoV-2-induced cytokine storm through the BKB1 and BKB2 receptors. Since the RAAS inhibitors (ACEI, ARB) affect the two regulatory systems and enzymes at different sites and to different degrees, their role must urgently have been clarified in the COVID-19 since their use is essential and general of many population-wide diseases (hypertension, cardiovascular, renal and metabolic conditions). Based on pathophysiological and experimental data, it is reasonable to hypothesize that in COVID-19 with comorbidities, especially in the elderly, the decreased ACE2 expression may be restored by RAAS inhibitors and the missed or reduced protective effect may be revitalised. This protective effect applies to both RAAS inhibitors. Clinical trials clearly support the declared opinion of many international societies that the use of RAAS inhibitors does not increase the risk of the occurrence of SARS-CoV-2 in itself let alone the severe and critical cases. Accordingly, initiated RAAS inhibitor therapy not only may rather must be continued during the development of COVID-19.]

Clinical Neuroscience

[F-DOPA PET/MR based target definiton in the 3D based radiotherapy treatment of glioblastoma multiforme patients. First Hungarian experiences ]

SIPOS Dávid, TÓTH Zoltán, LUKÁCS Gábor, BAJZIK Gábor, HADJIEV Janaki, CSELIK Zsolt, REPA Imre, KOVÁCS Árpád

[Introduction - Radiotherapy plays important role in the complex oncological treatment of glioblastoma multiforme (GBM). The modern 3D radiotherapy treatments are based on cross-sectional CT and MR information, however more attention is being paid to functional hybrid imaging describing the biological and functional morphology of tumor lesions. 18F-DOPA is an amino acid tracer with high specificity and sensitivity, which may play an important role in the precise definition of target volume in the irradiation process of GBM patients. Our study presents the first experiences with 18F-DOPA based PET/CT/MR 3D irradiation planning process. Methods - In Hungary the 18F-DOPA radiotracer has been available for clinical use since September 2017. Between September 2017 and January 2018, at the Somogy County Kaposi Mór Teaching Hospital Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center 3 histologically verified glioblastoma multiforme patients received 18F-DOPA based 3D irradiation treatment. In the contouring process the native planning CT scanes were fused with the PET/MR series (T1 contrast enhanced, T2 and 18F-DOPA sequences). We defined 18F-DOPA uptake volume (BTV-F-DOPA), the T1 contrast enhanced MRI volume (GTV-T1CE), and the volume of the area covered by oedema on the T2 weighted MRI scan (CTV-oedema) in all patients. We also registered the BTV-F-DOPA volumes not covered by the conventional MR based target volumes. Results - Examining the 3 cases, the average volume of 18F-DOPA tumor was 22.7 cm3 (range 15.3-30.9; SD = 7.82). The average GTV T1 CE was found to be 8.7 cm3 (range 3.8-13.2; SD = 4.70). The mean CTV oedema volume was 40.3 cm3 (range 27.7-57.7; SD = 15.36). A non-overlapping target volume difference (BTV-F-DOPA not covered by CTV oedema area) was 4.5 cm3 (range 1-10.3; SD = 5.05) for PTV definition. Conclusion - Based on our results the tumor area defined by the amino acid tracer is not fully identical with the MRI defined T2 oedema CTV. 18F-DOPA defined BTV can modify the definiton of the PTV, and the radiotherapy treatment. ]

Hypertension and nephrology

[Hypertension-infertility. Can be any connection between them?]

KAPOCSI Judit

[Summary – Considering the pathomechanism, the risk factors, as well as the environmental and toxic effects, some associated illnesses, unhealthy life-style habits in the background of hypertension and infertility, significant overlapping can be found. The question arises; does play any role the hypertension in the development of infertility? In this article the author review the connection between the hypertension and infertility. ]