Fennel Essential Oil as a Complementary Therapy in the Management of Diabetes.

Diabetes is a serious pathology that affects a significant number of people worldwide. Its progression is rapid and leads to serious complications if glycemic control is missing. The micro and macrovascular complications of diabetes produce disabilities over time that affect the daily lives of patients. The major challenge of diabetes therapy is to reach a stable glycemic state and to delay the onset of specific complications. Aromatherapy is considered an alternative or complementary therapy, but in recent years, there has been a tendency to overuse essential oils. The present study was designed to evaluate and compare the effects produced by the topical and oral administration of fennel essential oil to diabetic rats. Eighteen compounds in fennel essential oil were identified by gas chromatography-mass spectrometry (GC-MS) analysis. The major compounds were trans-anethole (64.6%) and fenchone (24.5%). The in vivo study revealed that after a four-week treatment with fennel essential oil, the rats' glycemic levels were significantly reduced (p ≤ 0.05). Furthermore, there were no differences between the two routes of administration. In addition, an ex vivo study underlined the potential effect of this essential oil in the prevention of cataract formation.

Case Report: Coexistence of generalized arterial calcification of infancy (GACI) and maternal infections with cytomegalovirus and Toxoplasma gondii-unexpected fatal complication in a newborn.

Generalized arterial calcification of infancy (GACI) is an extremely rare autosomal recessive condition characterized by the storage of calcium at the level of internal elastic membrane of arteries. The main consequences are intimal fibrous thickening and arterial occlusion. We present the case of a preterm male infant, born from an improperly dispensed pregnancy. At birth, the newborn presented generalized edema and hypotonia, and abolished heart sounds, without response to stimulation. Despite the mechanical ventilation, the infant died 2 h after birth. The death was clinically presumed to be related to the maternal infection with cytomegalovirus (CMV) and Toxoplasma gondii. The infant's mother affirmed the history of 6 previous miscarriages and a non-consanguineous marriage. At autopsy, microscopic examination showed generalized vasculitis secondary to minimal calcification of the large and medium-sized vessels of the lungs, liver, and tongue. These findings supported the diagnosis of GACI. Hydrothorax, non-infective ascites, and necrosis of the brain parenchyma were also associated. The premature infant died due to tonsillar herniation associated with decreased vessel compliance and refractory pulmonary hypertension thus leading to congestive cardiac failure. CMV was not detected on histopathological assessment nor were signs of any other infections. To the best of our knowledge, this is the first case of GACI occurring in a baby from a mother co-infected with CMV and T. gondii.

Burnout in the light of cognitive emotion regulation among Hungarian physicians. / Kiégés a kognitív érzelemreguláció tükrében magyar orvosok között.

Összefoglaló. Bevezetés: A kiégés olyan mentális, érzelmi és fizikai tünetcsoport, amely krónikus stressz, érzelmi megterhelés hatására lép fel. A kiégés szakirodalma széles, a külso és az intrapszichés oki tényezok népszeru kutatási területté váltak. A növekvo számú vizsgálatok ellenére a segíto foglalkozásúakat - elsosorban orvosokat - tekintve a kognitív érzelemszabályozás és a kiégés közötti összefüggés kevéssé kutatott terület. Csupán néhány vizsgálat foglalkozik ezen témakörrel, amelyek azt mutatták, hogy a kognitív érzelemreguláció maladaptív technikái és a kiégés között pozitív irányú együttjárás van. Célkituzés: Célunk annak feltárása, hogy a kiégés a kognitív érzelemreguláció mely tényezoivel mutat összefüggést. Módszer: Kvantitatív keresztmetszeti vizsgálatot végeztünk online kérdoíves módszerrel, szakmájukban minimum egy éve tevékenykedo magyar orvosok (N = 108) részvételével. A kognitív érzelemszabályozás mérésére a Kognitív Érzelemreguláció Kérdoívet (CERQ), a kiégés vizsgálatára pedig a Maslach Kiégés Leltárt (MBI) alkalmaztuk. Pearson-féle korrelációt, valamint többszörös lineáris regressziós elemzést használtunk. Eredmények: A katasztrofizálás (ß = 0,351; p<0,001), a rumináció (ß = 0,191; p = 0,037) és a pozitív átértékelés (ß = -0,23; p = 0,009) szignifikánsan jelzi elore az érzelmi kimerülés magasabb szintjét, a pozitív átértékelés fordított irányban. Az önvád (ß = 0,263; p = 0,002) és a pozitív átértékelés (ß = -0,406; p<0,001) szignifikánsan jelzi elore a kiégés személyeshatékonyság-csökkenésének magasabb szintjét, a pozitív átértékelés fordított irányban. Az önvád (ß = 0,41; p<0,001), mások hibáztatása (ß = 0,282; p = 0,001) és a tervezés (ß = -0,307; p<0,001) szignifikánsan jelzi elore a deperszonalizáció magasabb szintjét, a tervezés fordított irányban. A kiégés faktorai a maladaptív kognitív érzelemregulációs módszerekkel pozitív irányú kapcsolatot, az adaptív érzelemszabályozási technikákkal negatív irányú szignifikáns összefüggést mutatnak. Következtetés: Kutatásunk fontos gyakorlati jelentoséggel bír: felhívja a figyelmet arra, hogy a kiégés megelozésénél, kezelésénél nélkülözhetetlen figyelembe venni ezen intrapszichés tényezoket és hangsúlyt helyezni az adaptív kognitív érzelemszabályozás fejlesztésére egy olyan szakmát tekintve, ahol az érzelmi megterhelés fokozott a mindennapos munkában. Orv Hetil. 2022; 163(8): 319-327. INTRODUCTION: Burnout is a group of mental, emotional, and physical symptoms that occur as a result of chronic stress and emotional strain. The literature on burnout is extensive, and external and intrapsychic causal factors became a popular area of research. Despite the growing number of studies, the relationship between cognitive emotion regulation and burnout among individuals having helping professions, primarily physicians, is an area of little research. Only a few studies address this topic, which showed that there is a positive interaction between maladaptive techniques of cognitive emotion regulation and burnout. OBJECTIVE: Our aim is to explore which factors of cognitive emotion regulation are associated with burnout. METHOD: We performed a quantitative cross-sectional study using an online questionnaire method, with the participation of Hungarian physicians operating for at least one year in their profession. The Cognitive Emotion Regulation Questionnaire (CERQ) was used to measure cognitive emotion regulation, and the Maslach Burnout Inventory (MBI) was used to examine burnout. Pearson correlation as well as multiple linear regression analysis were used. RESULTS: Catastrophizing (ß = 0.351; p<0,001), rumination (ß = 0.191; p = 0.037) and positive refocusing (ß = -0.23; p = 0.009) significantly predict a higher level of emotional exhaustion, reverse relationship with positive refocusing. Self-blame (ß = 0.263; p = 0.002) and positive refocusing (ß = -0.406; p<0.001) significantly predict a lower level of personal effectiveness, reverse relationship with positive refocusing. Self-blame (ß = 0.41; p<0.001), blaming others (ß = 0.282; p = 0.001) and planning (ß = -0.307; p<0.001) significantly predict a higher level of depersonalization, reverse relationship with planning. Burnout factors have a positive relationship with maladaptive cognitive emotion regulation methods, and they show a significantly negative relationship with adaptive emotion regulation techniques. CONCLUSION: Our study has important practical significance, drawing attention to the fact that it is essential to take these intrapsychic factors into account in the prevention and treatment of burnout, and to emphasize the development of adaptive cognitive emotion regulation in a profession where emotional stress is increased in everyday work. Orv Hetil. 2022; 163(8): 319-327.

Cystic low-grade collecting duct renal carcinoma with liver compression - A challenging diagnosis and therapy: A case report.

BACKGROUND: A collecting duct carcinoma is a very rare, malignant renal epithelial tumor. Distant metastases are present in one third of cases at the time of diagnosis. It is known to have a poor prognosis. CASE SUMMARY: A 42-year-old male was sent to our surgery clinic for removal of a 119.2 mm × 108.3 mm encapsulated cystic mass, which was localized in the 8th segment of the right liver lobe. The lesion was first identified on ultrasonography. A computed tomography scan confirmed the presence of a Bosniak type III cystic lesion, which affected the liver and convexity of the right kidney. Surgical intervention involved a right nephrectomy, with removal of the cystic mass. The patient was mobilized on the first postoperative day and was discharged after 7 d. The histological and immunohistochemical examination revealed a low-grade collecting duct renal carcinoma, which is a rare variant of papillary carcinoma, with low malignant potential. The patient did not receive chemotherapy and after 21 mo of follow-up, a radiological examination and laboratory analyses showed normal aspects. No relapse or other complications were reported. CONCLUSION: To manage renal tumors properly, a correct histopathological diagnosis is crucial, as is early diagnosis and correct surgical treatment.

Helicobacter pylori and cytokine gene variants as predictors of premalignant gastric lesions.

Gastric cancer remains the third leading cause of mortality from cancer worldwide and carries a poor prognosis, due largely to late diagnosis. The importance of the interaction between Helicobacter pylori (H. pylori) infection, the main risk factor, and host-related genetic factors has been studied intensively in recent years. The genetic predisposition for non-hereditary gastric cancer is difficult to assess, as neither the real prevalence of premalignant gastric lesions in various populations nor the environmental risk factors for cancer progression are clearly defined. For non-cardiac intestinal-type cancer, identifying the factors that modulate the progression from inflammation toward cancer is crucial in order to develop preventive strategies. The role of cytokines and their gene variants has been questioned in regard to non-self-limiting H. pylori gastritis and its evolution to gastric atrophy and intestinal metaplasia; the literature now includes various and non-conclusive results on this topic. The influence of the majority of cytokine single nucleotide polymorphisms has been investigated for gastric cancer but not for preneoplastic gastric lesions. Among the investigated gene variants onlyIL10T-819C, IL-8-251, IL-18RAP917997, IL-22 rs1179251, IL1-B-511, IL1-B-3954, IL4R-398 and IL1RN were identified as predictors for premalignant gastric lesions risk. One of the most important limiting factors is the inhomogeneity of the studies (e.g., the lack of data on concomitant H. pylori infection, methods used to assess preneoplastic lesions, and source population). Testing the modifying effect of H. pylori infection upon the relationship between cytokine gene variants and premalignant gastric lesions, or even testing the interaction between H. pylori and cytokine gene variants in multivariable models adjusted for potential covariates, could increase generalizability of results.

[Health-related quality of life from a new perspective - The role of illness representations in patients with breast cancer]. / Az életminõség vizsgálata egy új oldalról ­ a betegségreprezentációk befolyásoló szerepe emlõdaganatos betegeknél.

In the modern oncology care the subject of quality of life has an emphasized importance. In our research we assessed aspects which may predict the quality of life. We hypothesized that after controlling the demographical and some medical factors, psychological distress and illness representations would have significant roles as predictors. The research has been carried out in Budapest at the Radiology Diagnostic Department of the National Institute of Oncology; participants were women (N=221) treated for malignant breast tumour (C50). The research tools included the Shortened Beck Depression Inventory, Quality of Life Questionnaire (EORTC QLQ-C30, QLQBR23), Spielberger's State-Trait Anxiety Inventory (STAI-T), and the Revised Illness Perception Questionnaire (IPQ-R). In terms of functional (ß=-0.705, p=0.000; ß=0.493, p=0.003), and symptom quality of life (ß=0.517, p=0.000) negative affectivity has an outstanding role as predictor. Among the illness representations, the functional quality of life is influenced by cognitions concerning the illness consequences (ß=0.243, p=0.008) and by emotional representations (ß=0.220, p=0.034). Cognitive representations influencing the symptom quality of life are serious consequences (ß=0.240, p=0.016) and illness perception (ß=0.212, p=0.011). In the improvement of quality of life, treating negative affectivity has determining and the modification of dysfunctional illness cognitions play important roles.

The evaluation of Ki67, p53, MCM3 and PCNA immunoexpressions at the level of the dental follicle of impacted teeth, dentigerous cysts and keratocystic odontogenic tumors.

UNLABELLED: The aim of this study is to analyze the immunoexpression of Ki67, p53, MCM3 and PCNA markers in epithelial remnants of dental follicles of impacted teeth and to identify a possible correlation between the immunoexpression of these markers in dentigerous cysts and keratocystic odontogenic tumors in order to evaluate their evolutionary behavior. MATERIALS AND METHODS: A total of 102 cases were included in the study and divided into three subgroups: the first subgroup consisted of 62 cases with dental follicles of impacted teeth, the second included 20 cases of dentigerous cysts and the third subgroup comprised a number of 20 cases with keratocystic odontogenic tumors. Immunomarking with the four antibodies was performed. RESULTS: A positive marking was obtained in over 60% of the dental follicles for all markers. Statistically significant differences were also obtained in dentigerous cysts and keratocystic odontogenic tumors for Ki67, p53 and MCM3. Assessment of the four antibodies in the two layers of keratocystic odontogenic tumors shows a positive correlation between Ki67 and MCM3 both for the basal and parabasal layer, with slightly increased values in the latter. CONCLUSIONS: In order to determine the proliferative capacity of epithelial remnants in the dental follicles, Ki67 and PCNA, Ki67 and MCM3 are the most useful markers in practice; they have similar behavior and are more likely to help in distinguishing between dentigerous cysts and keratocystic odontogenic tumors.

[Therapy helps -- psychosocial support for patients diagnosed with breast cancer, reducing anxiety and depression]. / A terápia segit -- emlorákos betegek pszichoszocialis támogatása, a depresszió és a szorongás csökkentése.

The results of epidemiological researches are alarming. It is anticipated that in the next few decades the number of patients suffering from malignant tumours will double. Caring for patients with cancer sets a serious challenge to the health services - not only to the oncology specialists, but among the others also to the psychiatrists and the psychologists. The diagnosis of cancer commonly pushes the patient into a depressed, hopeless and anxious emotional state that can persist for years after the diagnosis causing serious damage - a decline in the health-related quality of life, it narrows life opportunities, it makes coping and cooperating more difficult, and it predicts the progression of the disease and mortality. Treating these is crucial. Results published in related literature prove the positive effects of psychosocial interventions (a wide range of psychological and psychosocial support of the patients) on emotional distress. The most commonly applied interventions are the supportive-expressive therapies and cognitive methods. Recently a new trend started unfolding where the patients, as their complementary care instead of having single interventions they are offered complex programmes - psychotherapy, exercise, diet, education, etc. are all applied together, amplifying the synergic effects of the components. Our research is aimed to assess the results of a complex programme in decreasing emotional distress in women diagnosed with primer breast cancer (n=173, experimental group n=86, of whom 34 participated the programme, control group n=87) short term (at the end of the 15 week long programme) and longitudinally (15 months after the end of programme). The results are very promising: there were significant improvements in patients, a decrease in depression (Beck), as well as in anxiety (STAI), and some aspects of positive effects showed long-lasting.

Histopathological and immunohistochemical features of gastrointestinal stromal tumors.

Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal tumors of the gastrointestinal tract. Major advances in their definition and classification and the understanding of their molecular mechanisms have recently been made. These advances have become a model of targeted therapy in oncology. The diagnosis of GISTs relies on histological arguments - proliferation of spindle cells, seldom of epithelioid cells or both spindle and epithelioid cells - and on immunohistochemical arguments - expression of CD117 usually associated with CD34 expression. The evaluation of the prognosis is essential and based on a simple algorithm using two prognostic parameters, tumor size and mitotic index. The aim of this paper is a complex histopathological assessment, using both classic and modern (immunohistochemistry) techniques, of the GISTs comprised in the study. GISTs occur mainly in older adults (median age 60-69 years), anywhere along the gastrointestinal tract but also retroperitoneal. Most of them were nodular (75%), tumor necrosis and mucosal ulceration being the most frequent encountered secondary alterations; these modifications proved to be significantly correlated with large tumor size and high malignancy. Immunohistochemical evaluation revealed that 77 (97%) cases of GISTs presented a positive reaction for CD117, 50 (63%) cases were positive for CD34, 19 (24%) were positive for SMA and only 10 (13%) were positive for S100. Immunohistochemical evaluation remains an important tool of pathology in the diagnosis of GISTs, in the differential diagnosis from other gastrointestinal mesenchymal tumors and represents the gold standard for diagnosis of these tumors and an eligibility criterion for imatinib therapy.

[Psychiatric patient: the most vulnerable traveller]. / Pszichiátriai beteg -- a legkiszolgáltatottabb utazó

Authors analyse questions of medical evacuation of the psychotic patient from abroad to homeland. This task can be considered the most difficult problem for the attending physician and the escorting medical team as well. The main challenge is to recognise the psychotic patient in a foreign country with a different health-care system and to overcome the language barrier and the different cultural background. The second issue is to prepare the patients - who are usually in a poor condition - for the medical evacuation by commercial aircraft. Another important issue is to take the patient through the strict security control. All of these (partially unsolved) problems make the mentally ill patient defenceless. Although the repatriation of a mentally ill patient is vital and urgent, travel insurance policy mostly excludes to cover the cost of treatment and repatriation. The high cost of treatment and repatriation of the patient should be paid by the patient or the family, who are often in the position of insolvency. In this paper authors present the history of a patient and give a brief review on travel-related mental disorders, the epidemiology of mental alterations during travel as well as the problems of appropriate evacuation. Authors conclude that there is a need for a better approach of the airport authorities and insurance decision makers to the mentally ill patient travelling abroad.

Gastrointestinal stromal tumors: review on morphology, diagnosis and management.

Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal tumors of the gastrointestinal tract. Major advances in their definition and classification and the understanding of their molecular mechanisms have recently been made. These advances have become a model of targeted therapy in oncology. The diagnosis of GISTs relies on histological arguments--proliferation of spindle-shaped cells in 70% of cases, of epithelioid cells in 20%, histological variants are rare--, and on immunohistochemical arguments--expression of CD117 in 95%, usually associated with CD34 expression in 70% of cases. Most GISTs are associated with molecular abnormalities in low target genes: KIT and PDGFRA. The differential diagnosis of GISTs includes the other mesenchymal tumors of the gastrointestinal tract, such as leiomyomas, leiomyosarcomas, schwannomas and intra-abdominal fibromatosis. The evaluation of the prognosis is essential and is based on a simple algorithm using two histoprognostic parameters, tumor size and mitotic index. The treatment of localized GISTs is surgical resection and that of advanced or unresecable GISTs is based on the use of targeted therapy, imatinib, which is a pharmacological antagonist of the c-kit protein. Proper understanding and utilization of the diagnostic criteria and classification of GISTs by pathologists are essential for good patient management.