Investigation on the true identity of Entomobryanigriventris Stach, 1929 (Collembola, Entomobryidae) with the description of a new species.

The present paper gives a detailed and illustrated redescription of Entomobryanigriventris Stach, 1929, and the description of a new species collected from open sand steppe habitat in Hungary. Based on the colour pattern, E.arenaria Winkler, Flórián & Dányi, sp. nov. is close to E.violaceolineata Stach, 1963 but differs from it by the morphology of the labral papillae and the dorsal macrochaetotaxy of the head, Th II, and Abd II-IV. The new species is also characterised by dark ventral body colouration in adult specimens. In this regard, an overview of European Entomobrya species in which the dark ventral side may occur is also provided.

[Hyponatraemia in palliative care regarding a case report]. / Hyponatraemia a palliatív ellátásban egy esetbemutatás kapcsán.

Hyponatremia is a very common abnormality in palliative care which can cause a sudden decline in the patient's general condition. The diagnostic and therapeutic procedures are based on the patient's symptoms and life-expectancy. The inadequate diagnostic and therapeutic interventions result in an unnecessary burden, while the adequate treatment could improve the quality of life. In palliative care, acute hyponatremia is very rare, the chronic form without any symptoms or mild complaints is more common. Asymptomatic patients should be observed. In patients with mild symptoms and months or years plus prognosis contributing factors should be discontinued. The electrolyte abnormality of patients with moderate or severe symptoms and at least weeks prognosis should be treated. Patients with day prognosis needs no treatment. This case report of an early palliative care patient with moderate symptoms caused by chronic, severe hyponatremia aims to give a suggestion for the management of the most common electrolyte abnormality in everyday palliative care. Orv Hetil. 2023; 164(18): 713-717.

Management of diabetes in patients receiving palliative care / A diabetes mellitus kezelése palliatív ellátásban részesülo betegekben

Introduction: The prevalence of diabetes mellitus is increasing worldwide. According to Hungarian data from 2014, it affects 7,3% of the population. At the time of their cancer diagnosis, 8-18% of all patients have preexisting diabetes mellitus. Some studies have identified a diabetes prevalence up to 30% of cancer patients. The treatment of diabetic patients in palliative care differs from the curative methods and this is very important to be communicated with the patient, the family members and health-care providers. Objective: The aim of this publication is to develop a method of control and treatment of the palliative care patients with diabetes mellitus. Method: Based on studies in international literature, a suggestion can be made that can be applied in domestic practice. Suggestions: This suggestion introduces individual and more liberal control and management methods for a better quality of life in this special patient group. Conclusion: The suggestion for the treatment of diabetes helps provide quality care for palliative patients.

Inverse association between use of broad spectrum penicllin with beta-lactamase inhibitors and prevalence of type 1 diabetes mellitus in Europe.

Increasing incidence of type 1 diabetes is supposed to be induced by environmental factors. Microbiome modulated by antibiotics seems to serve as one of the environmental factors which could influence the development of T1DM. Mitochondria, as autochthonous environmental bacteria living in our cells, and other bacteria share many common enzymes including beta-lactamases and it is supported by evidence that some beta-lactamase inhibitors are able to interact with counterpart enzymes. Thus, antibiotics may utilize two different pathways influencing the development of T1DM; one through modulation of microbiome and a second one via the interaction of mitochondrial enzymes. Data of consumption of penicillin (both narrow and broad spectrum) and beta-lactamase inhibitors in 30 European countries were collected from the database of the European Centre for Disease Prevention and Control. These data were correlated with the prevalence reported by the International Diabetes Federation (2019) referring to type 1 diabetes in Europe. No correlation was found between total penicillin consumption or use of broad spectrum penicillin and the prevalence of type 1 diabetes. Nevertheless, broad spectrum penicillin, in combination with beta-lactamase inhibitor, was in inverse correlation with the prevalence of type 1 diabetes (r = - 0.573, p = 0.001). On the other hand, narrow spectrum penicillin was in positive correlation with type 1 diabetes (r = 0.523, p = 0.003). Prevalence of type 1 diabetes showed an inverse correlation with the use of beta-lactamase inhibitors and a positive one with that of narrow spectrum penicillin. Such a detailed analysis has not so far been provided referring to the penicillin group. In the background of this association either microbiomal or direct mitochondrial effects can be supposed.

The first experiences with the palliative tumor board discussions in the University of Pécs / Az elso tapasztalatok a palliatív onkoteamrendszer muködésével kapcsolatban a Pécsi Tudományegyetemen.

INTRODUCTION: Palliative, symptomatic and end-of-life care of advanced and metastatic cancer patients is a great challenge for every health care system. With the initiation and establishment of the multidisciplinary palliative tumor board (MPTB), our aims were the timely referral of patients to palliative care, and the avoidance of multiple unnecessary emergency visits and over-diagnostics without further treatment consequences. METHOD AND RESULTS: The MPTB meetings were held biweekly. The core members of the team were: palliative care consultant, medical oncologist, internal medicine physician, psychologist, psychiatrist, and oncology and palliative medicine nurses. From May 2019 till January 2020, we discussed the medical history of 97 cases of 93 cancer patients with advanced disease states; in one meeting the team usually discussed over 6-10 complex patient histories. In every case we determined the actual form of the necessary palliative care, e.g., outpatient clinic, home care, or institutional referral, and we decided on further possible and realistic oncology treatment regimes. A few months after the introduction of the new MPTB, we detected a decrease of the unnecessary emergency unit referrals considering the patients whose histories were discussed. CONCLUSIONS: Although the initial MPTB discussions had an intense emotional tone, they shortly became thoughtful and operational expert meetings. We believe that the MPTB system fully promotes the early and timely access of advanced cancer patients to appropriate palliative care and facilitates gradual changes in the medical oncologists' approach from the absolute curative determination to a supportive medical attitude. Orv Hetil. 2020; 161(34): 1423-1430.

Elevated urinary orosomucoid excretion as a novel biomarker in Crohn's disease.

BACKGROUND: Laboratory markers are essential tools in the follow-up of patients with Crohn's disease (CD). Our aim was to investigate urinary concentrations of orosomucoid in relation to the inflammatory activity of CD and to compare it with clinical indices and conventional laboratory parameters. MATERIALS AND METHODS: Blood and urine samples of 86 patients (55 adults and 31 children) with CD and 68 healthy individuals (38 adults and 30 children) as controls were analysed. Patients were categorized according to their clinical scores (Harvey-Bradshaw Index [HBI] or Pediatric Crohn's Disease Activity Index [PCDAI]). Urinary orosomucoid (u-ORM) was determined by automated immune turbidimetric assay, and values were referred to urinary creatinine (u-ORM/u-CREAT, mg/mmol). RESULTS: U-ORM/u-CREAT values were seven times higher in children with active CD (0.50 vs 0.07 mg/mmol, P < 0.001) and two times higher in adults (0.32 vs 0.14 mg/mmol, P = 0.01) compared with patients with inactive disease. U-ORM/u-CREAT showed good correlation with conventional inflammatory markers (hs-CRP, serum ORM; P < 0.01) and activity indices (HBI, P = 0.018; PCDAI, P < 0.001). U-ORM/u-CREAT had similar discriminative performance to hs-CRP and serum ORM in the differentiation of active from inactive paediatric CD patients. CONCLUSIONS: Our findings suggest that u-ORM/u-CREAT might serve as a valuable additional marker in the follow-up of CD patients, especially in children for whom the non-invasive sampling is a further advantage.

Potential urinary biomarkers of disease activity in Crohn's disease.

OBJECTIVE: Measurement of the immunoreactive urinary albumin (ir-uAlb) concentration by immunological methods was found to be an effective method to identify disease activity in Crohn's disease (CD). Recently a size-exclusion (SE) high performance liquid chromatography (HPLC) method was developed to measure both ir-uAlb and non-immunoreactive urinary albumin (total, t-uAlb). We aimed to follow-up one of our CD patients with frequent remissions and exacerbation phases comparing the changes of disease activity parameters and the concentration of ir-uAlb and t-uAlb. The surprising results led us to perform measurements in greater depth. MATERIAL AND METHODS: Concentration of ir-uAlb was measured by immunoturbidimetry (IT) and t-uAlb by SE-HPLC. Albumin peak of SE-HPLC was collected and applied to a reversed-phase (RP) HPLC and to gel-electrophoresis. Eluted peaks of RP-HPLC and identified bands of gel-electrophoresis were analyzed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF/MS). RESULTS: The concentration of t-uAlb was 15 times higher than that of the ir-uAlb during active state. The RP-HPLC and the gel-electrophoresis separation proved that albumin peak by size-exclusion consists of three different peaks. MALDI-TOF/MS measurements identified α1-acid-glycoprotein and Zn-α2-glycoprotein as major, and albumin as minor protein. CONCLUSIONS: Peak of albumin of SE-HPLC contains a significant amount of glycoprotein during the active phase of CD, which could not be detected in remission. Urinary α1-acid-glycoprotein and/or Zn-α2-glycoprotein could be an ideal disease activity biomarker of CD.

Storage at -80 degrees C decreases the concentration of HPLC-detected urinary albumin: possible mechanisms and implications.

BACKGROUND: Urinary albumin is now measured by high-performance liquid chromatography (HPLC) which also detects albumin missed by traditional immunochemical methods. A predictive effect of HPLC-detected albuminuria on mortality has just been reported in the AusDiab study, measuring albuminuria with HPLC after 7 years of -80 degrees C storage. However, there are already some data suggesting that HPLC-detected albuminuria is affected by -80 degrees C storage. We aimed to measure changes in HPLC-detected albuminuria after 2.5 years and find the factors which may be responsible for this alteration. METHODS: Urinary albumin was measured by the US Food and Drug Administration approved HPLC Accumin kit. Total free sulfhydryl groups (TFSG) of urine samples were measured by Ellman's reagent. RESULTS: We found a significant 24% average decrease in HPLC-detected albuminuria and a correlation between the magnitude of decrease and urinary pH. We found a correlation between changes of urinary albumin dimeric to monomeric ratio of stored urine and pH; however, only changes of monomeric form were found to be significant. A correlation was also found between the TFSG of fresh urine samples and pH. Less TFSG could be detected, and a correlation between TFSG and pH was absent in stored urine. CONCLUSIONS: We conclude that measurement of albuminuria by HPLC in long-term -80 degrees stored urine gives unreliable results. Decrease of HPLC-detected albuminuria is pH-dependent and may be due to the reducing capacity of urine. Prospective studies need to decide whether the predictive properties of HPLC-detected albuminuria decrease during longterm storage.

[Hyperplastic and inflammatory fibroid polypoid lesions of the stomach. Case report and a mini review]. / A gyomor polipjairól egy hyperplasticus és egy inflammatoricus fibroid elváltozás kapcsán.

The authors report the case of a 75-year-old woman with significant gastrointestinal bleeding caused by a large hyperplastic polyp and a smaller inflammatory fibroid polyp. Both polyps were removed endoscopically successfully. The authors give an overview of the endoscopic picture of the different kinds of stomach polyps with their histologic patterns, etiology, relation to Helicobacter pylori infection, malignant potential and therapeutic options based on the available literature.

Serum total LDH activity and LDH-2 isozyme in nephrotic syndrome.

BACKGROUND/AIMS: Proteinuria, hypoproteinaemia, hypoalbuminaemia and oedema are major characteristics of nephrotic syndrome. Aims of this study were to detect serum total LDH activity and its isozymes in nephrotic syndrome. METHODS: In a cross-sectional study, clinical parameters were compared in three cohorts, namely kidney patients with or without nephrotic syndrome and hypoalbuminaemic controls (NEPHR, NON-NEPHR, CONTR, respectively). RESULTS: Serum total LDH activity in the NEPHR group was increased compared with the NON-NEPHR and CONTR groups (p < 0.001) and correlated with serum total protein (r = -0.549, p < 0.001), serum albumin (r = -0.596, p < 0.001), proteinuria (r = 0.456, p < 0.001) and serum total cholesterol (r = 0.523, p < 0.001). LDH isozyme pattern was analysed in three subgroups of the patients. Serum LDH-2 activity was higher in the NEPHR subgroup compared with the NON-NEPHR and CONTR subgroups (p < 0.001). Serum LDH-2 activity correlated with serum total protein (r = -0.665, p < 0.001), serum albumin (r = -0.615, p < 0.001), proteinuria (r = 0.694, p < 0.001), and serum total cholesterol (r = 0.723, p < 0.001). Linear regression analysis revealed that serum total protein proved to be an independent predictor of serum total LDH activity, while serum total protein and proteinuria were predictors of LDH-2. CONCLUSIONS: These findings suggest that serum total LDH activity might be a marker of the activity of the nephrotic syndrome.

[Secondary IgA-nephropathy in gastroenterological diseases]. / Szekunder IgA-nephropathia gasztroenterológiai betegségekben.

IgA-nephropathy is the most common primary chronic glomerulonephritis worldwide. Beside the primary IgA-nephropathy (IgA-nephropathy with an unknown origin), there are more and more cases, which are associated with diseases of other organs. Although the causality is often not obvious, these forms are called secondary IgA-nephropathy. In this study, the authors cover only the secondary forms of IgA-nephropathy with relation to gastroenterology in a broader sense that includes the liver. They would like to draw the attention to the necessity of analyzing also the associate occurrence of gastrointestinal diseases (principally liver diseases, coeliac disease, Crohn's disease, ulcerative colitis) in patients with IgA-nephropathy, as well. They think that it would be expedient to organize a nationwide clinical analysis that would search the frequency of occurrence of IgA-nephropathy in the above mentioned gastrointestinal diseases.

[Prolonged hiccups causing worsened quality of life--successful medical therapy]. / Az eletminoség romláshoz vezeto makacs csuklas--sikeres gyógyszeres kezelés.

Hiccups are intermittent, involuntary spasmodic contractions of the diaphragm and the intercostal muscles leading to the cessation of inspiration due to an abrupt closure of the glottis. Hiccups are usually innocuous phenomena, which could easily be terminated by simple manoeuvres but sometimes they become permanent and intractable causing significant decline in the patient's quality of life. Besides a number of provoking exogenous factors hiccups are caused by organic or psychical disorders. This why in cases of permanent hiccups detailed investigations are important. Beyond physical manoeuvres, pharmacotherapy, surgical intervention and some other therapeutic measures may be effective forms of treatment. In the present report the authors give a review of two patients, whose permanent hiccups were successfully treated with combined medical therapy. They review the causes and therapy of permanent hiccups and call the attention to the therapeutic value of baclofen, a gamma-aminobutyric acid analog compound.