LAM Extra for General Practicioners

[THE BIOLOGICAL BASIS OF SCREENING: NATURAL HISTORY OF MALIGNOUS TUMOURS]

DÖBRŐSSY Lajos, KOVÁCS Attila, BUDAI András

MARCH 20, 2013

LAM Extra for General Practicioners - 2013;5(01)

[The development of malignous tumours is a prolonged, multistage process. The onset of clinical symptoms and subjective complaints is preceded by the preclinical detectable phase, during which the tumour does not cause any symptoms but it has some signs and can be detected by screening. Information on the tumour’s natural history is of practical importance for choosing the screening strategy. When evaluating screening results, the various biases related to biological reasons need to be taken into consideration.]

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LAM Extra for General Practicioners

[ANTIDIABETIC THERAPY OF PATIENTS WITH TYPE 2 DIABETES MELLITUS - THE PLACE OF INSULIN ADMINISTRATION]

GYIMESI András

LAM Extra for General Practicioners

[DABIGATRAN: A NEW ORAL ANTICOAGULANT AGENT FOR THE PREVENTION OF STROKE AND SYSTEMIC EMBOLISM IN NONVALVULAR ATRIAL FIBRILLATION]

KANCZ Sándor

[In this article, we summarise the available information on dabigatran, focusing on clinical practice, in particular on the prevention of stroke and systemic embolism, the critical aspects of anticoagulant treatment with dabigatran, potential drug-drug interactions and adverse reactions in nonvalvular atrial fibrillation. The most important molecular characteristics of dabigatran are also described. We highlight the implications of safety issues that have emerged during everyday clinical practice.]

LAM Extra for General Practicioners

[EXPERIENCE WITH COENZYME Q10 IN HEART FAILURE]

KOHUT László

[INTRODUCTION - The protein complex coenzyme Q10 (CoQ10) has a role in ATP production as a mitochondrial electron transport molecule, and it also has a strong antioxidant effect. Several studies have proved the correlation between the decrease in CoQ10 level and the severity of heart failure. Heart failure is a multifactorial syndrome, the development of which is greatly influenced by an abnormal energy metabolism. CASE REPORT - The 61-year-old woman developed heart failure after a myocardial infarction. She complained of fatigue, dyspnoea and reduced physical endurance even with optimal treatment. When her therapy was completed by CoQ10, her endurance and life quality significantly improved and her symptoms ameliorated. CONCLUSIONS - Medical treatment of chronic heart failure is an evidence-based, complex therapy. Despite the complex management, morbidity and mortality of this condition remain high. A number of studies have shown that CoQ10 substitution can improve the clinical and haemodynamical parameters of patients with heart failure. On the basis of these results, the use of CoQ10 as an adjuvant therapy to complex treatment has an increasing role.]

LAM Extra for General Practicioners

[NON-HDL-CHOLESTEROL AND ITS SIGNIFICANCE]

SIMONYI Gábor

[The role of LDL-cholesterol in cardiovascular risk has been established in a number of studies. According to current recommendations, therefore, the primary goal of lipidlowering therapy is reducing the level of LDL-cholesterol. Of lipid-lowering drugs, statins are the most efficient in reducing cardiovascular risk. According to large studies on statins, however, there is a significant residual risk even in patients receiving aggressive treatment. It is well known that many patients continue to have dyslipidaemia despite statin therapy, and not all patients with cardiovascular disease have elevated LDL-cholesterol levels. These observations indicate that lipids other than LDL-cholesterol also have a role in the development of atherosclerosis. A growing attention is paid to non-HDL-cholesterol as a cardiovascular risk factor. Calculating non-HDL-cholesterol target is easy: LDL-cholesterol measurement plus 0,8. Non-HDL-cholesterol incorporates a number of atherogenic lipoprotein particles [VLDL-cholesterol, IDL-cholesterol, LDL-cholesterol, and lipoprotein(a)]. As the atherogenic effect of apoB-containing lipoproteins (LDL, IDL-C és VLDL) is significant, they may be stronger predictors of coronary heart disease (CHD) risk than LDL-cholesterol is. Considering the strong correlation between apoB and non-HDLcholesterol and the limitations of apoB measurement (standardisation, cost), non- HDL-cholesterol is a more useful parameter and therapeutic target, especially if triglyceride levels are greater than 2.26 mmol/l.]

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[Early mental test - developing a screening test for mild cognitive impairment]

KÁLMÁN János, PÁKÁSKI Magdolna, HOFFMANN Ildikó, DRÓTOS Gergely, DARVAS Gyöngyi, BODA Krisztina, BENCSIK Tamás, GYIMESI Alíz, GULYÁS Zsófia, BÁLINT Magdolna, SZATLÓCZKI Gréta, PAPP Edina

[Background and purpose - Mild cognitive impairment (MCI) is a heterogenous syndrome considered as a prodromal state of dementia with clinical importance in the early detection of Alzheimer’s Disease. We are currently developing an MCI screening instrument, the Early Mental Test (EMT) suitable to the needs of primary care physicians. The present study describes the validation process of the 6.2 version of the test. Methods - Only subjects (n=132, female 95, male 37) over the age of 55 (mean age 69.2 years (SD=6.59)) scoring at least 20 points on Mini-Mental State Examination (MMSE), mean education 11.17 years (SD=3.86) were included in the study. The psychometric evaluation consisted of Alzheimer’s Disease Assessment Scale Cognitive subscale (ADAS-Cog) and the 6.2 version of EMT. The statistical analyses were carried out using the 17.00 version of SPSS statistical package. Results - The optimalised cut-off point was found to be 3.45 points with corresponding 69% sensitivity, 69% specificity and 69% accuracy measures. The Cronbach-α, that describes the internal consistence of the test was 0.667, which is higher as compared with the same category in the case of the ADASCog (0.446). A weak negative rank correlation was found between the total score of EMT 6.2 and the age of probands (rs=-0.25, p=0.003). Similarly, only a weak correlation was found between the education levels and the total score of EMT 6.2 (rs=0.31, p<0.001). Two of the subtests, the repeated delayed short-time memory and the letter fluency test with a motorical distraction task had significantly better power to separate MCI and control groups than the other subtests of the EMT. Conclusion - The 6.2 version of EMT is a fast and simple detector of MCI with a similar sensitivity-specificity profile to the MMSE, but this version of the test definitely needs further development.]

Clinical Oncology

[Fatigue - symptom or side effect]

TOKODI Zsófia

[Cancer-related fatigue (CRF) is common in most cancer patient, which has a high impact on the quality of their life. It affects not only the patient itself, but also their families and relationships. It is the most underreported, overlooked and undertreated symptom. The screening and adequate treatment of CFR is getting more attention nowadays and it became the subject of guidelines of several international expert groups like the ASCO) and the NCCN. In this review we would like to summarize the contributory factors of CRF, the screening methods, the clinical assessment and the interventions of patients with cancer related fatigue. We try to give guidance to distinguish fatigue as a symptom of disease progression or as a side effect that we can treat. But lastly the most important question becomes that why CRF is so underreported.]

Lege Artis Medicinae

[Current diagnostics and treatment of adolescent hypertension]

PÁLL Dénes, KATONA Éva, FÜLESDI Béla, JENEI Zoltán, POLGÁR Péter, PARAGH György, KAKUK György

[As the prevalence of hypertension in young people aged 14-18 is reported to be 1-1.5%, regular blood pressure measurement is proposed by the international committees in the adolescence, at least once a year. To establish the diagnosis of hypertension, repeated blood pressure measurements and sex-, age-, heightand weigt-based nomograms are needed. If casual blood pressures are consequently elevated, an ABPM measurement may provide additional informations, e.g. about white coat hypertension, daytime and nighttime blood pressure patterns and target organ damage. Thus, in such cases ABPM measurement is proposed to become the part of the routine examination. Following the diagnosis of hypertension in the adolescent, a further important step is to clarify the causes of the disease. In the majority of adolescent cases, essential hypertension is the diagnosis, but secondary (especially renal causes) are more frequent than in adulthood. First line treatment of adolescent hypertension is definitely non-pharmacologic. Pharmacologic treatment may be indicated if blood pressure is significantly increased (diastolic blood pressure, especially), if secondary hypertension is diagnosed or target-organ damage is present, or there are consistent complains related to the increased blood pressure. Treatment can be initiated with any of the antihypertensive drugs used in adults, but most frequently the use of beta-blockers and ACEinhibitors is recommended.]

Hungarian Radiology

[Az emlődaganatok radiológiai vizsgálatának újdonságai Onco Update, 2007]

FORRAI Gábor, BODOKY György

[Experiences about the breast diagnostic methods are accumulating year-to-year, rapidly. Therefore the current examination algorithm is changing continuously. New diagnostic and therapeutic modalities are entering into the daily practice. Some of them became obsolete, so far their application is becoming a faulty decision. Some other methods become obligatory steps in the diagnostics. These are the reasons why the up-to-date knowledge of the literature is mandatory. Systematic review of the most recent articles of the last two years (January 2005-December 2006) of breast radiological diagnostics and the actual place of the imaging and interventional methods are presented. The following topics are summarized: breast cancer screening with conventional and digital mammography, computer assisted diagnostics (CAD), high risk patients' screening, US, MRI, MSCT, PET/CT, diagnostic interventions, differential diagnostics, percutaneous tumour ablation, therapy-related questions in the diagnostic work up.]

Hypertension and nephrology

[The importance of recognition and proper treatment of hypertension and the maintenance of adherence in hypertension care]

NEMCSIK János, PÁLL Dénes, JÁRAI Zoltán

[Hypertension is the leading cause of death and disability-adjusted life years. In the United States hypertension accounts for more cardiovascular (CV) deaths than any other modifiable CV disease risk factor and was second only to cigarette smoking as a preventable cause of death for any reason. In our country the situation is similar. In Hungary the number of subjects with hypertension is approximately 3.5 million and this high prevalence contributes markedly to the poor Hungarian CV morbidity and mortality figures. The recognition of hypertension, the initiation of drug therapy and the long-term follow- up of the patients is mainly the task of primary care. Besides that it inheres high responsibility, this is also a grateful commitment, as hypertension in most of the cases can be treated properly with lifestyle-changes and medications leading to a marked decrease of CV complications, especially stroke. In our review article we would like to focus on the high prevalence of hypertension worldwide as well as in our country, the exact implementation of screening, the risk reduction potential of the proper treatment and the importance of the long-term maintenance of treatment adherence.]