LAM Extra for General Practicioners

[Changes in infectology over the past two decades]

SZALKA András

OCTOBER 20, 2011

LAM Extra for General Practicioners - 2011;3(04)

[Infectious diseases and various infections are the major causes of morbidity and mortality in developing as well as in industrialised countries. Despite the advances in the past decades in our understanding of microbes, efficient treatment of diseases and preventive approaches, more than 13 million people die every year due to infectious diseases. In the past two decades, more and more new pathogens and infections diseases have been emerging and old diseases that were almost forgotten have re-emerged. There are many new diseases for which we do not have or have hardly any efficient antimicrobial drugs and no efficient vaccines. Despite an increasing frequency of multi- and panresistant microbes, the development of new antibiotics to be used against these infections is unlikely to occur in the near future. The big pharmaceutical companies have stopped the research of antibiotics. In this situation, the only option we have is to use antibiotics rationally and to take prevention and control of infections seriously, both in the outpatient system and in hospitals. Preserving the effectiveness of currently used antibiotics is in everyone’s interest and is everyone’s responsibility]

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Further articles in this publication

LAM Extra for General Practicioners

[Similarities and differences in the renal effects of statins]

ÁBRAHÁM György

[By efficiently reducing serum cholesterol level, statins significantly decrease both cardiovascular morbidity and mortality. Decreasing LDL-cholesterol level by 1% reduces coronary mortality risk by 1%, whereas increasing HDL-cholesterol level by 1% reduces the risk by 3%. At the same time, renal failure significantly increases cardiovascular events and/or mortality compared with the population mean. It is an exciting question whether statins are able to prevent and decelerate the deterioration of kidney function deterioration, preserve GFR and decrease albuminuria. Depending on the strength of their effect, statins have different cholesterol-lowering capacity (rosuvastatin and atorvastatin are especially effective). An important question is whether these differences can be detected in the renal function as well. The results of experimental data and major clinical trials (e.g. AURORA, PLANET I-II, SHARP) are often controversial. Nevertheless, statin therapy has advantages for patients with kidney diseases, although to a lesser extent than it has in the normal population.]

LAM Extra for General Practicioners

[Advantages of fixed Combinations in the treatment of Hypertensive patients ]

FARSANG Csaba

[In 60-70% of patients with hypertension, a significant decrease in blood pressure can only be achieved by a combination of antihypertensive drugs. International as well as national guidelines emphasise the numerous advantages and the importance of combination treatment. Fixed combinations are particularly advantageous, as their use improves patients’ compliance. This paper summarises the available information on the possible combinations of the nine major antihypertensive drug groups distributed in Hungary, and for details the results published on the recently approved and introduced fixed combination of telmisartan and amlodipine.]

LAM Extra for General Practicioners

[Újdonságok az ischaemiás stroke másodlagos prevenciójában a 2011-es amerikai ajánlás alapján]

CSIBA László

LAM Extra for General Practicioners

[Acute hepatitis caused by herpes simplex virus 1]

PATYI Márta, SEJBEN István, VÁGÓ Tibor, CSERNI Gábor, KISS Antal Zsolt, KISS József Zoltán

[INTRODUCTION - Herpes simplex virus is a rare and severe disease, which is often lethal, especially in children and those who underwent transplantation. Rapid diagnostic help determines therapy and facilitates recovery of the patient. CASE REPORT - The authors present a case of a 46-year-old patient with no underlying disease, in whom the diagnosis of hepatitis caused by herpes simplex-1 virus was suggested after histological evaluation of a blind liver biopsy specimen. The diagnosis was later confirmed by immunomorphological examination. The patient’s hepatitis resolved following acyclovir therapy, but he developed nosocomial pneumonia, sepsis caused by Candida albicans and anuria. The patient recovered due the joint efforts of an infectologist, a pathologist, an intensive care specialist and a nephrologist. CONCLUSION - During examination of the patient, immune suppression was not indicated either by HIV-serology or bone marrow biopsy. thus the findings were presumably explained by a generalised infection in an immunocompetent host. In the case described, histological examination of the liver biopsy was a life-saving procedure, because it allowed timely and efficient treatment.]

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[VITAMIN D TREATMENT: HORMONE THERAPY FOR PATIENTS WHO NEED IT OR SIMPLY A SUPPLEMENTATION FOR EVERYONE?]

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[Various medical associations issue different recommendations for the prevention and treatment of vitamin D deficiency. These significant differences are partly explained by the different definition of normal vitamin D level and the use of completely different mathematical models to predict the increase in vitamin D level as a response to therapy. According to the Institute of Medicine (IOM), the target vitamin D level is 20 ng/ml, whereas the Endocrine Society (ES) recommends 30 ng/m as the miminum target value. According to the ES, a 1 ng/ml increase of vitamin D level can be reached by a daily intake of 100 NE, while the IOM recommends 3.6 ng/ml. Moreover, the IOM states that the effect of therapy on serum level is nonlinear. These differences show that the ES and IOM have different views on the risk of adverse effects. The IOM recommends 400 IU vitamin D daily for children younger than 1 year, 800 IU for those above 70 years and 600 IU/per day for everyone else. The ES recommend 400-1000 IU daily for all infants and 1500- 2000 IU for adults. Screening, however, is not recommended by either society. To decrease uncertainty concerning the side effects of higher-dose vitamin D treatment, it is important to understand, use and support the function of the pharmacovigilance system of the pharmaceutical industry that manufactures and markets various (prescription, over-the-counter) preparations. This is what the author aims to highlight in the second part of this article. Using this system, both the doctor and the patient can help support and accept the justification of higher-dose vitamin D therapy.]

Clinical Neuroscience

[Dizziness - vertigo Warning symptoms in vertebrobasilar ischemia - Part I. ]

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[Dizziness and vertigo - like headache - are the most common complaints which leads patients to visit the doctor. In spite of the headache - which may be primary (e.g. migraine) or symptomatic - dizziness and vertigo do not appear to be a separate nosologic entity but rather the symptoms of several neurological disorders. For differential diagnosis, interdisciplinary thinking and activity is needed because the vestibular, neurological and psychiatric disorders might have a common role in the development of symptoms and further overlapping can also occur. The vascular disorders of the vertebrobasilar system are discussed in detail in this review. The importance, occurrence and causes of vertigo as a warning symptom is in the focus. The author draws attention to life-threatening conditions with acute onset in cases of the posterior scale ischemia and emphasizes the importance of the correct and early diagnosis. The author tries to clear up the nihilistic aspect in treating of stroke and stresses the necessity of thrombolysis and interventional radiological procedures which may be the only chance for the recovery of the patients. The pharmacological prevention of recurrent vascular events is also important and obligatory for the clinicians.]

Journal of Nursing Theory and Practice

Physical activity as primary prevention of metabolic syndrome

MARTINEK Lukas, TOTHOVA Valérie, KOVAROVA Maria, DUSICKOVA Tereza, KIMMER David

Metabolic syndrome is constantly discussed, together with cancer diseases, as one of the biggest threats to the 21st century. Despite the differing indicators of specific diseases behind the metabolic syndrome, it is to be understood as a very risky aspect of health. Primary prevention through life style modifications, specifically reduction of the sedentary way of life and integration of regular physical activity into daily life of children, adults and seniors is an appropriate tool of prevention of metabolic syndrome. A number of valid studies show that increasing physical motion contributes to improvement of diseases that stand behind the metabolic syndrome. However, healthy adult population of the Czech Republic shows distinctive dislike of physical activity and primary prevention is insufficiently supported both by experts dealing with this issue and at political level while secondary prevention prevails. Therefore we consider it imperative to involve more funding into programs supporting physical activity. It is also necessary to explore forms of education within the physically active life style.

Lege Artis Medicinae

[Holistic approach to cardiovascular prevention]

VÁLYI Péter

[Cardiovascular diseases, primarily the organic manifestations of atherosclerosis, such as coronary artery disease, ischaemic stroke, and peripheral arterial diseases, represent the largest healthcare problem in the developed countries, since the mortality, disability, and need for hospitalisation caused by them constitute a bigger burden than that caused by all other diseases combined. A modern, holistic approach to cardiovascular prevention should consider the complete cardiovascular continuum, including genetic predisposition, social-economicalcultural background, environmental factors, the integrated effect of atherosclerotic risk factors, the inhibition of progression of functional and morphologic damages that have already developed, and, if possible, the promotion of regression. Besides targeting the individual, prevention at the public and social level is also important.]

Lege Artis Medicinae

[Public health care prevention in Hungary: are we doing what we should?]

KISS István, DANKOVICS Gergely, BARNA István, DAIKI Tenno, KÉKES Ede

[Primary prevention means health protection and disease prevention in the population, whereas secondary prevention includes early diagnosis and treatment to prevent the progression of diseases and the development of complications. Both ways of prevention are present in public health programs, but primary prevention measures are usually less substantial. METHODS - The “Comprehensive Health Protection Screening Program of Hungary 2010-2020” was organised in 2010 as part of the National Cardiovascular Program. In this program, a mobile screening station (set up on a truck) tours the country and provides a complex health status and risk assessment at village fairs as well as at offices. RESULTS - In the past three years, this station provided complex screening for 65267 individuals and lifestyle counseling and health education for 132964 people at 528 locations, touring 58807 km. The aim of the Program is to provide a comprehensive overview of the health status of the Hungarian population, and to make it possible to measure and record the long-term changes of the health status of the Hungarian population. Another goal is to inform those being screened about their health status and to highlight the importance of health protection and disease prevention. On the basis of the results, in the past three years the Program has been able to achieve its targets, which provides a good basis for its continuation.]