LAM Extra for General Practicioners


LUDWIG Endre, SERHAT Ünal, MIRON Bogdan, ROMAN Chlíbek, YAVOR Ivanov, ROMAN Kozlov, HARTMUT Lode, MÉSZNER Zsófia, ROMAN Prymula, GALIA Rahav, SKOCZYNSKA Anna, SOLOVIC Ivan, ABDULLAH Sayiner

SEPTEMBER 20, 2014

LAM Extra for General Practicioners - 2014;6(04)

[BACKGROUND - An important development in the field of adult pneumococcal vaccination since the last Consensus Statement, published by the Expert Panel of Central and Eastern Europe and Israel (the Region) in September 2012, was the licensure of the 13-valent pneumococcal conjugate vaccine (PCV13) for adults aged 50 years and older. DISCUSSION - The Expert Panel has developed this Position Statement as an update to its previous Consensus to address the following topics which are likely to be on the agenda of national scientific societies during the ongoing updates of vaccination recommendations in the Region: the availability of a pneumococcal conjugate vaccine for adults over 50 years of age, the available clinical evidence on its use in adults, and the future place of conjugate vaccines in adult pneumococcal vaccination. The Expert Panel concluded that there is sufficient epidemiologic immunogenicity and safety evidence to use PCV13 in adults over 50 years of age. RESULTS - The use of conjugate vaccine induces immunological memory and can overcome some limitations associated with the plain polysaccharide vaccine (PPV). It was also agreed that, if the use of PPV is considered appropriate, PCV13 should be administered first, regardless of prior pneumococcal vaccination status.]



Further articles in this publication

LAM Extra for General Practicioners



[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used medicines all over the world. In the year 2012 in the LAM, we summarized data on cardiovascular (CV) safety of these drugs. We emphasized that all NSAIDs may potentially be harmful on the CV system, as they can increase the blood pressure, the risk of coronary events (angina, myocardial infarction), and that of stroke, as well as they may deteriorate renal functions. We also outlined that in this respect there are substantial differences between different compounds, and the CV risk does not depend on the ratio of COX- 1/COX-2 selectivity. The newly available data of original papers and metaanalyses shed light on further details. Even naproxen which drug was previously considered the less harmful on CV system can increase the risk of blood pressure, stroke, and gastrointestinal (GI) complications. We have to emphasize that the most important risk of NSAIDs is still the GI bleeding. This adverse effect is significantly less for drugs which are more selective for COX-2 than COX-1 enzyme, but other, pleiotropic effects can also beneficially modify the GI as well as the CV risk. E.g. the aceclofenac was found to be among NSAIDs with the less adverse effects on GI system and is also among those having the less CV risk.]

LAM Extra for General Practicioners


SOMOGYI Péter, GAÁL János, SPEER Gábor

[The significance of osteoporosis is well known, however, the number of patients receiving treatment is only a small fraction of ideal. Besides, the fact that the population is uninformed, the difficulties of making an appointment with a specialist and the unsatisfactory communication of the doctor all play a part in the fact that a high proportion of patients receiving mediation give up treatment prematurely. The Inter - na tional Osteoporosis Foundation supports the establishment of public patient clubs with regular training courses and grants and by doing so it also acknowledges their importance in the prevention and treatment of osteoporosis. The publication, based on the questionnaire filled in by the members of the first Hungarian patient club, the Hungarian Society of Osteopo - rosis Patients in district 3rd, introduces the Hungarian results and points out how important patient clubs are in increasing the success of treatment and it also draws attention to the necessity of establishing further patient clubs in the future.]

LAM Extra for General Practicioners


BÁNFAI Bálint, RADNAI Balázs, MARTON József, PÉK Emese, DEUTSCH Krisztina, BETLEHEM József

[INTRODUCTION - Based on statistics, accidents from various mechanisms are among the most common causes of death all over the world. Children are mostly affected in this situations. Our aim was to examine the first aid and accident prevention knowledge and attitude of the parents. PATIENTS AND METHODS - In this study parents of 3-7 years old children were involved in six kindergarten located in Hungary. A self-fill-in questionnaire was used to collect data. In the investigation 307 parents (N=307) were included. Out of them 234 respondents filled out the questionnaire correctly. The statistical analysis was made with SPSS 20.0 statistical software. For analyses deescriptive statistics, Chisquare- test and ANOVA were used. RESULTS - Three-quarters of the children have suffered at least one accident earlier (74.3%). Most of the accidents occured at home (88.5%). 174 parents attended first aid course earlier (74.4%), the previous knowledge is based mainly on the driving license (81.6%). Based on the answers it is important to teach children first aid (70.5%) and prevention (89.7%) knowledge in the kindergarten. There were only 10 parents, who answered all the situation questions correctly (4.3%). Between the subjective judgment of the financial status and the correct answers we found a significant correlation (p=0.03). The previously accomplished first aid training (p<0.05) and the educational attainment (p=0,029) had a positive impact on the results. CONCLUSION - The level of first aid knowledge of parents is lower than expected. Participate in first aid courses the level of knowledge could increase. It would be important, because some of the accidents can be prevented by acquiring proper knowledge.]

All articles in the issue

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Clinical Neuroscience

Acute transverse myelitis after inactivated COVID-19 vaccine

ERDEM Şimşek Nazan, DEMIRCI Seden, ÖZEL Tuğba , MAMADOVA Khalida, KARAALI Kamil , ÇELIK Tuğba Havva , USLU Ilgen Ferda, ÖZKAYNAK Sibel Sehür

Vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been rapidly developed to prevent coronavirus disease 2019 (COVID-19) pandemic. There is increasing safety concerns regarding COVID-19 vaccines. We report a 78-year old woman who was presented with tetraparesis, paresthesias of bilateral upper extremities, and urinary retention of one-day duration. Three weeks before these symptoms, she was vaccinated with CoronaVAC vaccine (Sinovac Life Sciences, China). Spine magnetic resonance imaging showed longitudinally extensive transverse myelitis (TM) from the C1 to the T3 spinal cord segment. An extensive diagnostic workup was performed to exclude other possible causes of TM. We suggest that longitudinally extensive TM may be associated with COVID-19 vaccination in this case. To the best of our knowledge, this is the first report of longitudinally extensive TM developing after CoronaVac vaccination. Clinicians should be aware of neurological symptoms after vaccination of COVID-19.

Clinical Neuroscience

[Prevention of invasive meningococcal infection, recognition and first treatment of the disease in primary care]


[Neisseria meningitidis, the meningococcus, is a Gram-negative diplococcal bacterium that is only found naturally in humans. The meningococcus is part of the normal microbiota of the human nasopharynx and is commonly carried in healthy individuals. In some cases systemic invasion occurs, which can lead to meningitis and/or septicemia. Invasive disease caused by Neisseria meningitidis is potentially devastating, with a high case fatality rate and high rates of significant sequelae among survivors after septicaemia or meningitis. Between 2006-2015 every year between 34 and 70 were the numbers of the registered invasive disease because of Neisseria meningitis, the morbidity rate was 0.2-0.7⁰⁄₀₀₀₀. Half of the diseases (50.7%) were caused by B serotype N. meningitidis, 23.2% were C serotype. In this article the authors summarise what you must do and must not do as primary care physician when suddenly meeting a young patients suspected of having meningococcus infection. ]

Clinical Neuroscience

[Post-operative management of primary glioblastoma multiforme in patients over 60 years of age]

DARÓCZI Borbála, SZÁNTÓ Erika, TÓTH Judit, BARZÓ Pál, BOGNÁR László, BAKÓ Gyula, SZÁNTÓ János, MÓZES Petra, HIDEGHÉTY Katalin

[Background and purpose - Optimal treatment for elderly patients with glioblastoma multiforme is not well defined. We evaluated the efficacy of post-operative radiotherapy with or without concomitant and/or adjuvant temozolomide in patients aged ≥60 years to assess survival and identify prognostic factors of survival. Methods - A retrospective analysis of overall survival and progression-free survival in patients with newly diagnosed glioblastoma multiforme aged ≥60 years treated with postoperative radiotherapy with or without temozolomide chemotherapy was conducted at our institutions. Prognostic factors were determined by univariate and multivariate analyses. Results - Of 75 study participants (54.7% male; median age at first diagnosis, 65.1 years), 29 (38.7%) underwent gross total resection, whereas others underwent partial resection or biopsy only. All but 1 patient received radiotherapy. Twenty patients received concomitant temozolomide only. Adjuvant temozolomide (1-50 cycles) was administered in 42 patients; 16 received ≥6 cycles. Median overall survival was 10.3 months. One- and 2-year overall survival rates were 42.6% and 6.7%, respectively. Median progression-free survival was 4.1 months. Radiochemotherapy was generally well tolerated. Median overall survival was 15.3 and 29.6 months for patients who received 6-12 cycles and >12 cycles of adjuvant temozolomide, respectively. There were no significant differences in overall survival between age groups (60-64, 65-69, and ≥70 years). Adjuvant temozolomide, Karnofsky performance status ≥70, and additional surgery after progression were significant prognostic factors of longer overall survival (p<0.05). Conclusions: Radiochemotherapy, including ≥6 cycles of adjuvant temozolomide, was safe and prolonged survival of glioblastoma patients aged ≥60 years. Aggressive therapy should not be withheld from patients aged ≥60 years with good performance status because of age.]

Clinical Oncology

[Geriatric oncology]


[Geriatric oncology has an increasing role since in several types of cancer the median age at diagnosis is above 60 years of age. The treatment of elderly patients are frequently set back by prejudice, stereotypes and lack of information. All these lead to the fact that even in well-developed countries elderly cancer patients often do not receive the necessary treatments. This is even more true in poor-countries, where the fi nancial defi cit accumulated in health care is often attempted to be reduced by the treatment of elderly. If a paediatric oncology patient does not get suffi cient cancer treatment there is a fi erce protest, but everybody is silent if this occurs in the case of an 80 years old patient. For this unacceptable situation both authorities (fi nancing) and professional bodies (treatment, education) are responsible. Clinical data show that elderly cancer patients get the same benefi t of active oncology treatment, as younger ones. Age on its own does not contraindicate any cancer treatment. The aim of this review is to prove by data, that elderly cancer patients should also get active oncology treatment. The questions of assessment include frailty, the relationship of cancer development and ageing, and other problems related to the oncology treatment of elderly patients are also discussed.]

Lege Artis Medicinae

[Efficiency and safety of the vaccination against H1N1 influenza virus in inflammatory bowel disease]

FARKAS Klaudia, JANKOVICS István, MELLES Márta, NAGY Ferenc, SZEPES Zoltán, WITTMANN Tibor, MOLNÁR Tamás

[INTRODUCTION - Inactivated influenza and H1N1 vaccination is recommended yearly for patients with inflammatory bowel disease receiving immunosuppressive therapy; however, immunomodulator and biological therapy might impair the immune response to the vaccination. In our study, we assessed whether immunity can develop in response to H1N1 influenza vaccination in patients receiving immunomodulator and/or biological therapy. We also assessed the occurrence of side effects after the immunisation in these patients. PATIENTS AND METHODS - In our prospective study, blood samples were obtained from 24 patients (12 Crohn’sdisease, 12 ulcerative colitis) one month after immunisation against influenza A/California/ 07/2009 (H1N1) virus. At the time of vaccination, all patients have been receiving immunomodulator and/or biological therapy for at least three month. Antiviral antibodies were detected by using microneutralisation assay. The safety of the vaccination was assessed by questionnaires. RESULTS - Every patient developed complete immunity against influenza A (H1N1) virus, independently from the type of immunosuppressive therapy. Regarding side effects, local symptoms occurred in six patients and systemic symptoms in another six patients. Mild diarrhea occurred in five patients. Moderate exacerbation of the disease was observed in 2 patients with Crohn’s disease and in one patient with ulcerative colitis. CONCLUSIONS - According to our results, immunocompromised patients with IBD can be safely advised to receive the vaccination. In our study, all patients developed adequate immunity according to microneutralisation titers.]