Coronavirus pandemic and the Slovak medical faculties.

The Covid-19 pandemic has fully opened the debate on the complexity of the problem, which goes far beyond medical and epidemiological analyzes and proposals, although these are key to the decisions of leaders in the decisive sphere. Critical situations always force us to look for new methods. This is also indicated by paradigmatic changes in the overall functioning and position of medical faculties in Slovakia and abroad (1,2,3). The adaptation of the faculty administration at the time of this crisis is admirable in many respects and essential for the long-term societal struggle with the pandemic. (Ref. 3). Keywords: COVID-19, Coronavirus 2019, pandemic, public health, medical faculties in Slovakia.

The importance of interictal electroencephalography in paroxysmal states.

INTRODUCTION: Electroencephalography (EEG) is a non-invasive investigation method playing an important role in differential diagnostics of seizures. In this article authors point out to its importance, but also limitations. MATERIAL AND METHODS: Native interictal EEG findings were evaluated in inpatients after solitary unprovoked epileptic seizures (n=84), patients with sporadic epileptic seizures (n=179), patients with "chronic" epilepsy (n=324), outpatients with epilepsy (n=300), patients with syncope (n=100), patients with neurocardiogenic syncope (n=70), patients with migraine (n=100) and patients with tetanic syndrome (n=100). EEG findings were evaluated as normal or abnormal and abnormal findings were further divided into epileptic and non-epileptic, focal and generalized. RESULTS: In native EEG, epileptic manifestations were registered in 14.29 % of patients after solitary unprovoked epileptic seizures, in 25.7 % of patients with sporadic epileptic seizures, in 37.34 % of patients with chronic epilepsy and in 32 % of outpatients with epilepsy. Interictal EEG abnormalities (epileptiform and non-epileptiform) in non-epileptic diagnoses were at least registered in patients with syncope, but also in this group abnormal findings occurred in 30 % of them. We registered epileptiform abnormalities in 5 % of patients with migraine, in 4 % of patients with tetanic syndrome and in 2 % of patients with syncope. CONCLUSION: The diagnosis of epilepsy and non-epileptic seizures is a only a clinical diagnosis. EEG is a very important investigational method in this group of patients, but still only additional (Tab. 4, Fig. 2, Ref. 14).

Mild traumatic brain injury.

Traumatic Brain Injury (TBI) is among the most frequent neurological disorders. Of all TBIs 90% are considered mild with an annual incidence of 100­300/100.000. Intracranial complications of Mild Traumatic Brain Injury (MTBI) are infrequent (10%), requiring neurosurgical intervention in a minority of cases (1%), but potentially life-threatening (case fatality rate 0,1%). Hence, a true health management problem exists because of the need to exclude the small chance of a life threatening complication in large numbers of individual patients. The 2002 EFNS guidelines used a best evidence approach based on the literature until 2001 to guide initial management with respect to indications for CT, hospital admission, observation and follow up of MTBI patients. This updated EFNS guideline version for initial management inMTBI proposes a more selectively strategy for CT when major (dangerous mechanism, GCS<15, 2 points deterioration on the GCS, clinical signs of (basal) skull fracture, vomiting, anticoagulation therapy, post traumatic seizure) or minor (age, loss of consciousness, persistent anterograde amnesia, focal deficit, skull contusion, deterioration on the GCS) risk factors are present based on published decision rules with a high level of evidence. In addition clinical decision rules for CT now exist for children as well. Since 2001 recommendations, although with a lower level of evidence, have been published for clinical in hospital observation to prevent and treat other potential threads to the patient including behavioral disturbances (amnesia, confusion and agitation) and infection.

Clinical, neurophysiologic, neuropsychological findings and short genetic analysis in patients with idiopathic Parkinson's disease.

UNLABELLED: The aim of this paper is to analyze the results of correlation of clinical symptoms and their characteristics with the results of neurophysiologic, neuropsycologic investigations and short genetic analyses in patients with Idiopathic Parkinson's disease (IPD). MATERIAL AND METHODS: The paper is a prospective and retrospective study of 15 IPD patients and 25 patients with different forms of parkinsonism. RESULTS: Patients with idiopathic Parkinson's disease had all cardinal symptoms characteristic for the disease: tremor, rigidity and reduced postural reflexes in 100%. CONCLUSION: Clinical, neurophysiologic, neuropsychologic and neuroimaging methods of investigations showed changes that are nonspecific in proportions corresponding to those in available literature (Tab. 3, Fig. 2, Ref. 11).

Adrenoleukodystrophy--a new mutation identified.

INTRODUCTION: X-linked adrenoleukodystrophy from the group of peroxisomal disorders presents with an extensive spectrum of phenotypes. The mutation affects the ABCD1 gene encoding a peroxisomal membrane protein. So far, its detailed function has not been clarified. However, it plays an essential role in the ethiopathogenesis of X-linked adrenoleukodystrophy. Its defect causes accumulation of the very long chain fatty acids in the tissues of the central and peripheral nervous system, adrenal glands and in the body fluids. PURPOSE: To review the clinical presentations and diagnostic issues in X-adrenoleukodystrophy diagnosed in the one affected family. METHODS: A case report. Measurement of very long chain fatty acids. Molecular analysis of the adrenoleukodystrophy gene. RESULTS: A new "unique" mutation in the initiation codon in the first'exon of ABCD1 gene was identified. We present a phenotype description of a patient with this mutation. CONCLUSIONS: X-linked adrenoleukodystrophy is a disease with the incidence rate approximately 1:16,800. Detection of new mutations contributes to better understanding of this rare disease and makes the diagnostic more available and precise. The importance of an adequate diagnosis is justified not only by a different therapeutic approach, but also by the need of prenatal diagnostics and the need of genetic counselling in the affected families. As demonstrated in our case, it is necessary to consider this diagnosis also in the adult age, e.g. within the differential diagnosis of spastic paraparesis (Tab. 1, Fig. 4, Ref 23). Full Text (Free, PDF) www.bmrj.sk.

Asserting Bologna Declaration in restructuring of school system at Comenius University Medical School Bratislava.

Asserting Bologna Declaration into university education is a long-term and challenging process. New features have to be asserted sensitively in order to develop school system and to strengthen the baseline for Declaration. Slovakia has started the restructuring of university system and study programs undergoing the process of accreditation, however marked support (or reform) for covering the costs of university education is missing (expressed as % of gross domestic product, Slovakia is still not comparable to other EU countries). At present, not satisfactory economic conditions prevent from reaching the content, personal and equipment preconditions at universities (Ref. 7).

The role of medical physics in the scheme of diagnostic and therapeutic processes by keeping safety and hygienic regulations.

According to Standards of European Union the pregradual education should tend toward preparation of multidisciplinary working teams that can manage the health service using principles of evidence-based medicine, nowadays. The primary aims of teaching process is to direct the students to acquire, identify, analyze, process and select the reproducible results of physical measurements, to that the medical interpretation will be assigned. Our scientific research was directed at the existing conditions for professional use of different types of medical technique in the surgical and internal disciplines in health service institutions in all the regions of Slovakia. It also looked at the possibilities of eliminating the various unwanted effects of certain physical factors (Fig. 3, Ref. 9).

Position of information science in the medical and health studies curricula.

Innovation of both the content and forms of informatics teaching directed on exploitation of technical facilities and methods of information and communication technologies (ICT) in non-informatics universities study programmes and in life-long education is still actual today. Expanding knowledge base of the life and health sciences requires to form new skills to educate the end-users and facilitate an immediate information access. Theoretical and practical teaching in pregradual medical and health studies includes the basic contacts of students with the modern technique and special medical devices supported or completed by computers. The teaching of information science and corresponding subjects represents small but important part of medical and health studies curricula at all medical faculties in Slovakia (Fig. 2, Ref. 8).

The preparation of students of medical faculties and other public colleges for educative activities within the national programme of health support.

The tradition of education of physicians at the Medical Faculty of Comenius University (MFCU) has been developing for more than 85 years. Currently, the education has been widened by non-medical fields of study (nursing, obstetrical assistance, rehabilitation, public health care and laboratory and examination methods). After joining EU, the accreditation study programmes have been subject to transformation in compliance with current world trends in education. In accord with the transformation of content and forms of medical physics training, the authors demonstrate the main objectives and goals of this process. The goal is to prepare the graduates on high theoretical and practical levels, to teach them to work in team, and to prepare them for whole-life education. Practical skills in pre-clinical and clinical disciplines are being strengthened. One of the important outputs of pre-graduate education is the readiness of graduates for educative activities in favour of the National Programme of Health Support. (Tab. 1, Fig. 1, Ref. 7.)

Compressions of carotid and vertebral arteries in assessment of intracranial collateral flow: correlation between angiography and transcranial Doppler ultrasonography.

The authors examined 61 subjects with carotid angiography and 50 with vertebral angiography. Angiograms were evaluated for collateral flow through the ophthalmic, anterior communicating, and posterior communicating arteries. The authors evaluated the patency of collateral vessels directly using transcranial Doppler ultrasonography; they made indirect detection after the compression of carotid and vertebral arteries while monitoring flow velocities in the middle cerebral artery. They established criteria for the hemodynamic significance of tested collateral vessels. A combination of carotid compressions and transcranial Doppler ultrasonography detected the patency of the ophthalmic and anterior communicating arteries with a specificity and sensitivity of 1.00. Examination of the posterior communicating artery had a sensitivity of 0.97 and specificity of 0.98. Indirect evaluation of collateral vessels can not only detect their presence but also establish their hemodynamic significance with high accuracy.

Students' research and scientific activity at the Faculty of Medicine, Comenius University in Bratislava.

The Faculty of Medicine of the Comenius University in Bratislava commemorated the 85th Anniversary of its foundation. In the context of this anniversary the authors draw attention to an important component of the scientific life at the Faculty of Medicine, Comenius University--namely the Students scientific and research activity "SSARA." The commencement of SSARA is related to the Youth creativity contest. The first Faculty conference was held in 1950 as a all-faculty activity. One would say this conference has started the students scientific work at the faculty. In 1956 was the Students scientific board (SSB) instituted, headed by the Board of SSB. In 1967/68 a joint conference with JMF CU took place in Martin. At present one can say that SSARA at the Faculty of Medicine CU, Bratislava inspired not only faculties of CU, but also other faculties of the former Czechoslovakia to start with this activity. SSARA has become an important extension of the study and a preparation for diploma thesis. In consequence with application of credit forms of study we are in preparation of conditions allowing SSARA to become a part of optional forms of study. (Ref. 15.)

From the history of neurology in Slovakia.

According to archive sources, neurology in Slovakia started to develop in the first half of the past century. It was determined by two important events--the constitution of the Czechoslovak Republic in 1918, and the foundation of the Faculty of Medicine of Comenius University in Bratislava in 1919. In the new state, for the first time in their history, the Slovaks were given the access to national university education and the opportunity to develop science in Slovakia. The history of the first Department of Neurology of the Faculty of Medicine of Comenius University as well as neurology in Slovakia started on September 21, 1919 and was assigned to prof. MUDr. Zdenek Myslivecek, a professor of psychiatry and neurology. The further heads of this department were prof. MUDr. Miroslav Krivý, prof. MUDr. Stanislav Krákora. They devoted their scientific work to the problems of neuropathology, neurohistology, etc. Their department successors, professors Karol Matulay and Jozef Cernácek were Slovak physicians. Prof. Cernácek focused his work on the problems of neuroinfection, its resulting conditions and the dominance and interaction of the hemispheres. Prof. Matulay devoted his attention to epileptology and rehabilitation in psychiatry. Owing to their merit the neurological clinics engaged experts that were starting to grow in Slovakia, who were educated at the Faculty of Medicine in Bratislava. Owing to the merit of Dr. Závodný in Nitra, Dr. Gaspar in Levoca, Dr. Matis in Trencín, Dr. Hympán in Kosice, Dr. Trávnik in Martin and others, neurology has developed in Slovakia. The development of neurology was supported substantially by the foundation of the second Faculty of Medicine in Kosice in 1948. Both faculties helped in the education of experts and in the improvement in health care in this sphere, scientific research, postgradual education, as well as in contacts with foreign experts. The treatment of neurological diseases contributed to the gradual improvement of health in the Slovak population. (Ref. 6.).

Influence of geomedical factors on Guillain-Barré syndrome incidence in the region of western Slovakia.

During 5-years of follow-up we identified 58 cases of the Guillain-Barré syndrome in the Western Slovakia (approximately 1,300,000 inhabitants). The incidence of this disease fluctuated between 0.4-1.9 cases per 100,000 persons likewise mentioned in the literature. It was interesting to analyse the influence of bioclimatic conditions. We found that while higher altitude, cold and humidity increased the incidence of the GBS, warm weather had the opposite (beneficial) effect. This phenomenon might be related to a higher incidence of upper respiratory tract infections, which probably induce the autoimmune related disease. (Tab. 1, Fig. 4, Ref. 12.)

[Multiple sclerosis and new imaging methods]. / Sclerosis multiplex a niektoré nové zobrazovacie metódy.

UNLABELLED: BACKGROUND OF PROBLEM: The recognition of the power of MRI and CT to show the involvement of the central nervous system in multiple sclerosis, as well as in other neuropathological phenomena, stimulate considerably their use in the assessment of diagnosis. Much experience gained during the development and clinical application of imaging on the basis of magnetic resonance (MRI) justify the use of this method also in verification of the diagnosis of multiple sclerosis. The development and clinical application of specific pulse sequences and unconventional techniques as e.g. "magnetisation transfer imaging", and other new methods with greater resolution are used in applied research. Routine clinical examinations of the brain and spinal cord are performed especially by use of "dual echo spin images". Flair sequences are not always more significantly sensitive, however, they can provide surprisingly remarkable facts. SUBJECTIVES: The aim of this study is to support the firm or tentative clinical diagnosis of multiple sclerosis. METHODS AND MATERIAL: 131 patients with multiple sclerosis were hospitalized at our clinic and examined by use of computerised tomography (CT) and magnetic resonance (MRI). The results of these examinations confirmed firmly the diagnosis of multiple sclerosis in 98 patients. The tentative diagnosis assessed in 33 patients was not supported by MRI. The findings gained by brain examination were evaluated according to the conditions assessed by Fazekasz and American Multiple Sclerosis Association. Examinations were performed by Signa Contour 0.5 Tesla magnetic resonance on transverse planes, and on sagital planes in T1 VO and T2 VO. RESULTS: During the initial period (1995-1996), CT examination of the brain was performed in 16 patients with firm diagnosis of multiple sclerosis, out of whom only 24% had the pathological periventricular finding within the white matter. Therefore, a majority of patients were subdued to MRI. In these patients, the characteristic finding of hyperintensive lesions were found within T2 VO. They were situated within periventricular white matter as well as in cerebellum, and in 24 patients they were located within the cervical part of the spinal cord. The patients forming the latter group had severe neurologic findings, and ranged 4-9 of the Kurtzke scale. MRI enabled to assess the diagnosis of multiple sclerosis in all patients. Out of the group of 33 patients, only 2 were subdued to CT of the brain. Their findings did not yield any changes in shape of brain tissue structures. MRI findings in these patients did not verify the diagnosis of multiple sclerosis sufficiently. The neurological findings were not pronounced, achieving the 1-3 degree of Kurtzke scale. CONCLUSION: Current techniques of CNS imaging, either by use of computerised tomography of MRI do not enable the assessment of the firm diagnosis of multiple sclerosis to full extent. MRI is capable only of supporting it. (Ref. 7.)

[Effect of weather on the occurrence of cerebral stroke]. / Vplyv pocasia na výskyt náhlych cievnych mozgových príhod.

In this paper a set of medical and meteorological data for the period of years 1985-1987 is elaborated and statistically evaluated in order to find correlations between daily occurrence of ischemic and haemoragic forms of cerebral stroke and particular biotropic types of weather. For tracing we gathered clinical medical data from eight health-service institutions in Bratislava. We compared both annual and seasonal courses of biometeorological types of weather in the investigated period with annual and seasonal courses of the followed sickness rate. We have found that the most unfavourable weather type is the central low pressure area with transition of the frontal system. The most favourable atmospheric type is a sunny weather in the warm high pressure area without surface inversion. (Tab. 2, Fig. 4, Ref. 10.)

Significance of specific antibody determination in Lyme borreliosis diagnosis.

The diagnosis of Lyme borreliosis, except in cases characterised by pathognomonic clinical manifestation, usually requires confirmation by means of microbiological diagnostic assay, mainly by antibody detection methods. In our study antibodies to B. burgdorferi were tested in neurological patients with suspected Lyme borreliosis, depending on syndrome and clinical diagnosis. Antibodies were tested with IFT, ELISA and immunoblot. Blood samples of patients tested with IFT and ELISA tests were positive in 88 patients. Positive indirect immunofluorescence tests were found in 83 patients; in 5 patients the antibody level was borderline. Of these, 40 were positive also in ELISA but a correlation between IF titers and ELISA-positivity was not established. The immunoblot method confirmed specific antibody positivity in 36 of 88 patients (45.45%) who were positive (or borderline positive) in the indirect IF test, and in 28 of 40 (70%) ELISA-positive patients. Antibody specificity was found in 8 indirect IF-positive patients who were ELISA negative. This may be explained by the higher immunoblot sensitivity in comparison with ELISA. The Lyme borreliosis diagnosis was clinically established in 19 patients; antibodies to B. burgdorferi were only found in 13 patients in all three tests, and in 4 patients only in the indirect IF test. The results of serological tests for antibodies to B. burgdorferi should be interpreted with caution, as the tests are not standardized and may show false positive or false negative results. A two-step serological examination with the immunoblot test is recommended, whereby some nonspecific reactions may be eliminated. The results of serological tests have only supportive value and cannot be deemed conclusive when establishing an etiological diagnosis.

[Detection and diagnosis of hereditary monogenic neurologic diseases in Slovakia]. / Záchytnost a diagnostika dedicných monogénne podmienených neurologických ochorení na Slovensku.

Authors present a clinical symptoms recapitulation of the most important monogenic hereditary neuromuscular diseases, their molecular-genetic causes and the possibilities of diagnostic on the level of DNA analysis. Low detectability of these pathologic states in Slovak republic is stressed and possible causes of this state are analyzed. (Ref. 10.)

Transformation of the system of education in health care services.

"Nursing" and "Public Health Care" are new study specializations which have been offered by the Faculty of Medicine, Comenius University in Bratislava from the study year 2002/2003 and from the study year 2003/2004 "Midwifery", "Laboratory and examination methods" and "Physiatrics, balneology and rehabilitation" accredited by AK SR have followed. It is the consequence of the transformation of the specialization Nursing and definition of the nurse's qualifications according to the European Strategy of WHO for education of so called regulated non-physician professions nurses and midwife. The government Regulation on further education of health care workers No. 157/2002 of the Statute has brought about new trends in the system of education in health services. As a consequence of these changes Faculty of Medicine of the Comenius University promptly reacted to this public requirement to increase the level of qualification of health care workers. (Ref. 5.)

Contribution to laboratory diagnostics of neuroborreliosis.

BACKGROUND: Neuroborreliosis affects peripheral and central nervous system. OBJECTIVES: Point out on possibilities of laboratory diagnostics of neuroborreliosis. SUBJECTS AND METHODS: During 1997-2001 we tested 666 pair samples of CSF and serum from 661 patients with different neurological diagnosis by ELISA, Westernblot, PCR, completed by biochemical and cytological investigations. RESULTS: We confirmed intrathecal specific IgG antibodies production by AI in 14 cases (2.1%) of total 666 samples tested. From those in 7 cases there were present also IgM antibodies in CSF. We found borderline AI values in 3 cases (0.5%) and isolated intrathecal production, antibodies present only in CSF, in 1 case (0.15%). There were normal AI values found in 25 cases (3.8%). Specific antibody possitivity by WB method was detected only in one case. DNA positivity by PCR was detected in one CSF from 43 samples during 2 years period. CONCLUSIONS: The microbiological test results should not be used in isolation but used in correlation with the biochemical and cytologic tests and also with clinical symptoms and epidemiological data to produce an overall clinical diagnosis. (Tab. 7, Fig. 1, Ref. 21)

Clinically unapparent central motor pathways lesion in patients with type I diabetes mellitus. A transcranial magnetic stimulation study.

OBJECTIVE: There is an evidence of central nervous system (CNS) involvement in diabetic patients. The aim of the study was to determine a conduction slowing in CNS pathways using a transcranial magnetic stimulation (TMS) and F-wave latency measurement. METHODS: Diabetic patients and a control group, both without clinical symptoms and signs of CNS lesion were evaluated. Motor evoked potentials were recorded from upper and lower extremities and central conduction time (CCT) was calculated according to formula: CCT = MEP-[0.5x(F-M-1)+M]. Obtained results and data from literature were compared. RESULTS: There was a significant prolongation of CCT recorded from lower extremities. The prolongation of CCT recorded from upper extremities was not statistically significant. Our results correlate with previously published data. CONCLUSION: In spite of missing clinical signs of CNS lesion in diabetic patients, a significant prolongation of CCT compared to control group and literature data was recorded. We assume a presence of diffuse subclinical CNS lesion induced by metabolic changes in DM. Difference between CCT obtained from upper and lower extremities implicate, that changes are analogical to peripheral neuropathies ("central length-dependent injury?"). Measurement of CCT using TMS could become a complementary electrophysiological method for assessment of subclinical CNS involvement in diabetic patients. (Tab. 4, Ref. 17.)