Efficacy of high dose systemic versus combined (systemic and intratympanic) corticosteroid therapy in idiopathic sudden sensorineural hearing loss: A prospective randomized trial and risk factor analysis.

The pathophysiology and the proper treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) are an ongoing subject of debate. Locally or systemic administered corticosteroids are the most accepted drugs of treatment in reference to ISSNHL (idiopathic sudden sensorineural hearing loss), however, no strong evidence nor guidelines regarding their effectiveness yet exists. In our prospective, randomized, controlled trial 78 participants were enrolled. Patients were randomly assigned based on the day of admission to two groups according to treatment: group SS (n = 43) received intravenous systemic methylprednisolone alone, and group CT (n = 35) received intratympanic dexamethasone + systemic methylprednisolone. The primary outcome was to compare the hearing outcomes between the treatment groups based on different, widely accepted categories (Siegel, Kanzaki, modified Siegel and PTA4 gain). In consideration of the secondary outcome, we examined the effect of the various risk factors on the hearing improvement. No differences were detected regarding hearing improvement between the two groups, based on any criteria [Siegel's criteria (p = 0.604); Kanzaki's criteria (p = 0.720); modified Siegel's criteria (p = 0.524) and PTA 4 gain (p = 0.569)]. However, several clinical factors such as vertigo (p = 0.039), or cardiovascular comorbidity (p = 0.02) and the severity of initial hearing loss (p = 0.033) were found to bear a significant impact upon the hearing outcome. To the best of our knowledge, this is the first randomized controlled trial comparing high dose systemic and combination corticosteroid therapy in ISSNHL patients. Our findings suggest coexisting cardiovascular comorbidity, vertigo and severity of the initial hearing loss may bear a significantly higher impact upon hearing improvement, than the additional intratympanic steroid administration. The presented trial was registered in the European Union Drug Regulating Authorities Clinical Trials Database (name: Combinated systemic and intratympanic steroid therapy in idiopathic sudden sensorineural hearing loss, No.: 2017-000658-20) and with the ethical approval of The National Institute of Pharmacy and Nutrition (OGYÉI) (protocol No.: 7621, on 2017.02.16.).

A new approach to radon temporal correction factor based on active environmental monitoring devices.

The present study aims to identify novel means of increasing the accuracy of the estimated annual indoor radon concentration based on the application of temporal correction factors to short-term radon measurements. The necessity of accurate and more reliable temporal correction factors is in high demand, in the present age of speed. In this sense, radon measurements were continuously carried out, using a newly developed smart device accompanied by CR-39 detectors, for one full year, in 71 residential buildings located in 5 Romanian cities. The coefficient of variation for the temporal correction factors calculated for combinations between the start month and the duration of the measurement presented a low value (less than 10%) for measurements longer than 7 months, while a variability close to 20% can be reached by measurements of up to 4 months. Results obtained by generalized estimating equations indicate that average temporal correction factors are positively associated with CO2 ratio, as well as the interaction between this parameter and the month in which the measurement took place. The impact of the indoor-outdoor temperature differences was statistically insignificant. The obtained results could represent a reference point in the elaboration of new strategies for calculating the temporal correction factors and, consequently, the reduction of the uncertainties related to the estimation of the annual indoor radon concentration.

Comprehensive survey on radon mitigation and indoor air quality in energy efficient buildings from Romania.

Over the last 10 years applied scientific research has been carried out in Romania to tacked the residential radon issues. The increased interest to reduce the carbon footprint of buildings has lead to the implementation and use of new architectural solutions aimed to save energy in houses and other buildings. As a consequence, the degree of retrofit in existing buildings and energy efficiency of new buildings promoted the need to not only mitigate indoor radon, but improve indoor air quality overall. The present study found that the while the best performance in radon reduction was confirmed to be based on sub-slab depressurization (61% - 95% reduction), centralized and decentralized mechanical supply and exhaust ventilation with heat recovery yielded a good efficiency in overall improvement of indoor air quality (CO2, VOC, RH, temperature). The outcome of our research, as well as future perspectives, take into account the recommended harmonization of energy efficiency programs with those of public health by finding and applying the best technologies in compliance with energy saving and indoor environmental quality.

Impact of climate change on soil thermal and moisture regimes in Serbia: An analysis with data from regional climate simulations under SRES-A1B.

We considered temporal and spatial variations to the thermal and moisture regimes of the most common RSGs (Reference Soil Groups) in Serbia under the A1B scenario for the 2021-2050 and 2071-2100 periods, with respect to the 1961-1990 period. We utilized dynamically downscaled global climate simulations from the ECHAM5 model using the coupled regional climate model EBU-POM (Eta Belgrade University-Princeton Ocean Model). We analysed the soil temperature and moisture time series using simple statistics and a Kolmogorov complexity (KC) analysis. The corresponding metrics were calculated for 150 sites. In the future, warmer and drier regimes can be expected for all RSGs in Serbia. The calculated soil temperature and moisture variations include increases in the mean annual soil temperature (up to 3.8°C) and decreases in the mean annual soil moisture (up to 11.3%). Based on the KC values, the soils in Serbia are classified with respect to climate change impacts as (1) less sensitive (Vertisols, Umbrisols and Dystric Cambisols) or (2) more sensitive (Chernozems, Eutric Cambisols and Planosols).

Beryllium-7 and (210)Pb atmospheric deposition measured in moss and dependence on cumulative precipitation.

This paper focuses on analysis of the time series of (7)Be and (210)Pb activity measured in moss, and the amount, as well as duration of precipitation, to gain a better understanding of the possible relationships between airborne radionuclide deposition and precipitation. Here we consider whether the amount of these airborne radionuclides in moss samples is a cumulative measure of radionuclide deposition and decay, and a new approach for analyses of the relationships between precipitation and moss activity concentrations is suggested. Through these analyses it was shown that comparison of cumulative activity measured at one location using moss, normalized by values of cumulative amount or duration of precipitation, showed different regimes of airborne radionuclide deposition.

Prevalence of accessory tooth cusps in a contemporary and ancestral Hungarian population.

Dental morphological characteristics are useful for providing information for phylogenic and genetic studies and understanding variations within and among species. Carabelli and talon cusps are expressed in several degrees and different frequencies between humans, thus being useful in comparing and characterizing populations. The purpose of this study was to examine the incidence and degree of expression of a Carabelli tubercle and talon cusps in a contemporary Hungarian population compared with similar findings in the dentition of skulls dating from the 11th century, the so-called Arpád-era. The data were collected by examination of dental plaster casts of 600 children aged 7-18 years (304 males, 296 females) undergoing orthodontic treatment. The dentitions of 147 skulls, dating from the 11th century, from the ancient Halimba-Cseres cemetery stored at the Hungarian Natural History Museum were also examined. The incidence and degree of expression of a Carabelli cusp was investigated for the upper first permanent molars and scored according to an eight-grade classification system. The talon cusps on the upper permanent lateral incisors were also examined. A chi-square test was used for statistical analysis. The prevalence of Carabelli cusps was 65.34 per cent in the contemporary and 34 per cent in the 11th century population (P < 0.01). The contemporary group showed a prevalence of talon cusps of 2.5 per cent compared with 40.8 per cent for the skills from the Arpád-era, which was significant (P < 0.001). These findings demonstrate that the contemporary Hungarian population is a mixture of European and Mongoloid races. The data are in agreement with linguistic evidence that shows that distant Hungarian ancestors belonged to the Finno-Ugrian family of people, whose habitats extended from the Baltic to the middle Urals.

[Microscopic study of dental calculus in cadavers from the 18th-19th centuries]. / 18-19. századi múmiák fogköveinek mikroszkópos vizsgálata.

The authors studied the dental calculus of 20 mummies with ligth microscopy, polarized ligth microscopy and scanning electron microscopy. Gram positive bacteria could be detected in all preparates, while Gram negative bacteria in 12 and fungi only in 3 dental calculus was visible. Animal food remains within five, and plant remains in all dental calculus were identified. Anorgic element and cell debris were seen in all preparates.

The elusive diploic veins: anthropological and anatomical perspective.

Diploic veins (Canales diploicae), which were identified in dogs by Dupuytren more than 200 years ago (Hecker [1845] Die anatomische Verhaltnisse und Krankheiten der Venae diploicae und Vasa emissaria. Erfahrungen und Abhandlungen im Gebiete der Chirurgie und Augenheilkunde. Erlangen), have remained inadequately understood and scantily referenced in the anatomical and anthropological literature. The tunnels formed by diploic veins are among the few known skeletal markers of soft tissue alteration. Protected by two bony laminae, diploic vein tunnels often resist postdepositional destruction and may provide a new way to assess living and extinct hominid populations. This basic research was carried out to enable future utilization of the diploic venous channels in anthropologic research. In the present study, diploic venous channels were observed radiographically in 108 human adults aged 19 years and above, 18 infants and children aged 1-18 years (Hamann-Todd Osteological Collection), eight fetuses aged 7-9 months (the Johns Hopkins Collection), and seven nonhuman primates (Hamann-Todd Osteological Collection). In addition, seven documented cases of parents and children were radiographed for genetic evaluation (Osteological Collection of The Hungarian Natural History Museum). Five distinct diploic distribution patterns were identified and described in this study. This was at variance with the impressions reported in dissection-based studies. Independence of diploic vein pattern from demographic (gender and age) and size factors and their tendency to be symmetrical make them amenable and reliable traits for skeletal population study. Diploic vein patterns appeared to be more complicated in humans than in nonhuman primates, raising the possibility of future phylogenetic applications.

[Pacemaker syndrome without a pacemaker]. / Pacemaker szindróma pacemaker nélkül.

Circulatory consequences of cardiac arrhythmias are not always evident. Proper interpretation of the clinical symptoms in certain cases requires assessment of the patients' other hemodynamic characteristics. The authors present the case of a patient with left ventricular hypertrophy, who developed severe circulatory failure at the time of artrioventricular dyssynchrony in association with junctional rhythm. Analogy between the circulatory consequences of the junctional rhythm and ventricular pacing was documented by hemodynamic measurements. The patient was subsequently treated by implanting an atrioventricular pacemaker.

[Carotid sinus syncope: the vasodepressor component]. / Carotis sinus syncope: a vasodepressoros komponens.

Carotis sinus syncope is one of the leading indications for pacemaker implantation in Hungary. Although the role of the vasodepressor component is emphasized in our current guidelines, documentation of the vasodepression in technically difficult and therefore often abandoned. A case of a patient is presented who received a VVI pacemaker in spite of documented mixed carotid sinus syncope. Subsequent to the pacemaker implantation, patient's condition deteriorated, characterized by frequent syncopal episods. Replacing the VVI pacemaker by a DDD device resulted in prompt relief of symptoms. The importance of invasive or noninvasive hemodynamic monitoring in the diagnostic workup of these patients is emphasized.

[Defecation syncope following pacemaker implantation]. / Defecatiós syncope jelentkezése pacemaker beültetést követóen.

A case of syncope is reported, where hemodynamic responses compatible with pacemaker syndrome occurred during defecation. A 73 year old female received a VVI pacemaker for complete heart block. Subsequently she sustained repeated episodes of defecation syncope. Hemodynamic investigations revealed an abnormal blood pressure drop occurring at the overshoot phase of the Valsalva maneuver in association with alternation of sinus and pacemaker rhythm. This modified Valsalva response in the presence of contributing factors, such as hypovolemia and nitroglycerin therapy manifested as defecation syncope. The abnormal condition was treated by eliminating the contributing factors, and by programming a low pacemaker frequency, thus precluding sinus-pacemaker alterations.

[Micturition syncope]. / Micturitiós syncope.

The micturition syncope is a special manifestation of the so called "situational syncopes". These reflex syncopes share efferent mechanisms with the neurocardiogenic, or vasovagal syncope. A case of a patient is reported, who presented with micturition syncope. The patient's tendency for vasovagal syncope was documented by a positive tilt table test. The uniform premonitory symptoms preceding the two fainting attacks indicated the relation between the episodes. The authors review the literature of the micturition syncope, and discuss the potential pathomechanisms.

[Correlations between clinical picture and coronary angiography in unstable angina]. / A klinikai kép és a coronaria angiographiás eredmények összefüggése instabil anginában.

In a one year period (from 01.07. 1993 to 30. 06. 1994) 103 patients were admitted to the Central Intensive Care Unit of the Albert Szent-Györgyi Medical University with the diagnosis of unstable angina. In this cohort of patients the authors assessed the correlation of clinical and angiographic data. Significant coronary artery disease was found in 84% (85 patients), single-vessel disease in 23% (24 patients), double-vessel disease in 38% (29 patients), triple-vessel disease in 20% (21 patients), left main stenosis in 8% (8 patients). The culprit lesion was determined in 73 cases. The distribution of the culprit lesion severity was the following: 50-70% in 17% (12 cases), 70-90% in 27% (20 cases), greater than 90% in 44% (32 cases), 100% in 12% (9 cases). Simplex lesions were seen in 43 cases, complex lesions in 9 cases, diffuse irregularities in 5 cases and total occlusions in 9 cases. Abnormalities indicating intracoronary thrombin-us were seen on 5 coronarograms. No correlation could be demonstrated between the clinical classes according to Braunwald and the angiographic morphology.

[Persistent atrial flutter induced by propafenone (Rytmonorm)]. / Propafenon (Rytmonorm) által kiváltott tartós pitvarlebegés.

The case history of two patients with atrial fibrillation are presented. In order to prevent/terminate fibrillation propafenone (Rytmonorm, 450-600 mg/day) was started, however this therapy resulted in permanent atrial flutter of 230-270/min mainly with 2:1 antrioventricular conduction. Analyzing the cases the authors emphasize that although Class Ic antiarrhythmic drugs (flecainide, encainide, propafenone) are capable to prevent or terminate atrial fibrillation, they may also induce atrial flutter in approximately 3.5-5% of these patients. The mechanism and recognition of this atrial proarrhythmic action are discussed.

Porotic hyperostosis on fossil skulls. A study, using scanning electron microscopy.

Fine structural alterations of cancellous bone in all three forms of porotic hyperostosis (porotic, cribrotic, and trabecular) were examined by the authors. The architecture of cancellous bone was altered, resulting in extended and dilated medullary spaces. Single-bone trabeculae, too, differed from normal by alteration of internal collagen structure and lamellae.

[Diabetes mellitus and development of kidney insufficiency]. / Diabetes mellitus und Entwicklung der Niereninsuffizienz.

With respect to the great number of diabetics in our population and the development of renal insufficiency as a fatal complication at diabetic patients (15-25% of chronic haemodialysis patients suffer from diabetes mellitus) we examined diabetics of a rural district. We registered a total of 1164 diabetics: 690 of them showed normal renal function while 405 patients had serum creatinine in threshold values and 69 patients' serum creatinines exceeded 120 mumol/l. The age of onset and the duration of diabetes mellitus, its type and the metabolic control, furthermore symptoms of proteinuria, hypertension, obesity and retinopathy were registered in relation to renal function. The duration of diabetes, the metabolic control, proteinuria turned out to be prognostically important factors.

[Attempted suicide with verapamil]. / Ongyilkossági kísérlet Verapamillal.

A 26-year old woman took 4000 mg (100 tablets) of VerpamilR (Orion Pharmaceutica, Helsinki) with suicidal intestions. As a consequence of the poisoning cardiogenic shock, 3rd grade AV block and cardiac arrest occurred. The disturbance of stimulus formation and conduction was treated with a temporary pacemaker. Discussing the therapeutical possibilities it is stated that cardiovascular symptoms may be influenced successfully by Ca++ preparations (Calcium gluconicum, Calcium chloratum) and beta-receptor stimulants (isoproterenol, dopamine, orciprenalin) possibly also with glucagon.