LAM Extra for General Practicioners

[REGIONAL ADVISORY BOARD POSITION STATEMENT ON OPTIMAL PNEUMOCOCCAL VACCINATION IN ADULTS. UPDATE TO 2011 CONSENSUS ON ADULT PNEUMOCOCCAL DISEASE: UPDATE ON OPTIMAL PNEUMOCOCCAL VACCINATION IN ADULTS]

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.]

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LAM Extra for General Practicioners

[THE RISK OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS]

FARSANG Csaba, BEDROS J. Róbert, ALFÖLDI Sándor

[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

[ROLE OF PATIENT CLUBS IN SUCCESSFUL TREATMENT OF OSTEOPOROTIC PATIENTS]

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

[ACCIDENT PREVENTION AND FIRST AID KNOWLEDGE AMONG KINDERGARTEN CHILDREN’S PARENTS]

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.]

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[Geriatric oncology]

TELEKES András

[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.]

Hypertension and nephrology

[Therapy of isolated systolic hypertension III.]

FARSANG Csaba

[In the elderly and very elderly (˃80 yrs), a wealth of data from large clinical trials are available, showing the necessity of treatment mostly with drug combinations - fix-combinations are preferred for increasing the adherence/persistence to therapy. Using diuretics, ACE-inhibitors/ARBs with calcium antagonists, and in special cases diuretics and beta blockers are also suggested by recent European guidelines (ESH, HSH). The target is <140 mmHg, but in octogenarians <150 mmHg. Some studies are pressing for even lower SBP (to around 120 mm Hg), but it seems to be wise to balance advantages/disadvantages, so the optimal SBP may be around 130 mmHg.]

Clinical Neuroscience

[EPIDEMIOLOGY OF STROKE IN THE ELDERLY]

POZSEGOVITS Krisztián, KAZUO Suzuki, NAGY Zoltán

[Background - In the industrialized countries the very elderly stroke patient is more frequent than before. For the time being Japanese people have the highest expected lifespan, so the epidemiological features of stroke in the very elderly can be examined here quite easily. From a few publications with low case number it is known that in this group of patients the statistical characteristics of stroke is remarkably different from the youngers' one. Subjects and methods - The subjects aged 85 or more years were selected from the Akita Stroke Registry with first-ever acute stroke from 1996 to 1998. Results - 8,046 cases were recorded. There were 7362 patients aged <85 years, and 684 patients aged ≥85 years (8.5%). Sex ratio (women/men) was 1.89 in the two age groups. In the population of Akita the crude incidence of firstever stroke was 222/100,000/year, and 1,085/100,000/year in the very elderly, who were characterized with relatively lower prevalence of stroke risk factors, except that of atrial fibrillation (26.9%) and cardiac diseases (34.2%). The stroke subtype distribution (cerebral infarction 73.2%, intracerebral haemorrhage 20.6%, subarachnoidal haemorrhage 6.1%) was significantly different from the one known in Japan. Mortality rates were considerably high, especially in the SAH group. The most powerful prognostic factor of death was the consciousness level at onset. The following in order of predicting value was the SAH stroke subtype. Conclusion - While people aged 85 years or more had relatively lower prevalence of cardiovascular risk factors, they suffered stroke with very high frequency, the evolved cerebrovascular event caused very severe symptoms and led to death with high rate. Implicitly this is illuminating the complexity of aging as a procession, furthermore it raises the importance of prevention, more rather of the acute stroke care and rehabilitation in this high age group.]

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[Treatment of hypercholesterolemia in the elderly]

BARNA István

[The percentage of population aged ≥65 years is mounting worldwide, among them those over 75 years is also growing. Athe­ro­scle­rosis is one of the most important and common disorder in the elderly responsible primarily for premature death and cognitive declining and impaired quality of life. Adequate lipid lowering therapy can decrease the risk of cardiovascular events – the main cause behind mortality – can extend life expectancy and improve the quality of life of patients. Effect of dietary treatment on cardiovascular risk reduction is as beneficial as in the younger populations. Regular physical activity reduces the risk of cardiovascular and overall mortality by 26% in males and 20% in females aged ≥65 years. If the medical history is negative for vascu­lar disorders, statin administration as a primary prevention is indicated for patients 65>years. In the population aged 75≥years individual benefit/risk assessment is needed before statin administration. Larger risk reduction can be achieved between 65-75 years than in subjects over 75 years. Concerning secondary prevention, statin treatment is of pre-eminent significance, and its administration is evidence-based in the elderly. For achieving the lipid goals, combined therapy with statin and ezetimibe is recommended in the primary as well as secondary cardiovascular prevention. ]