LAM Extra for General Practicioners

[THE IMPORTANCE OF THE RECOGNITION AND TREATMENT OF LIPID METABOLISM DISORDERS IN THE SECONDARY PREVENTION OF CEREBROVASCULAR DISEASES]

FOLYOVICH András, HORVÁTH Eszter

APRIL 21, 2009

LAM Extra for General Practicioners - 2009;1(02)

[The high world prevalence of cerebrovascular diseases, and the particularly bad morbidity rates of Hungary are well known. The physiological properties of the brain make stroke prevention outstandingly important. Effective prevention will be reflected in the reduction of the late complications that are otherwise common and expensive to treat. Because of the common simultaneous development of stroke, cardiovascular and peripheral vascular diseases, overall vascular disease prevention is preferred, even if the various vascular diseases manifest in different degrees in a patient. Hungarian data also indicate the high risk of recurrence of cerebrovascular diseases, therefore, the importance of secondary prevention is obvious. Large international studies have proven the strokepreventing effect, and, by a pleiotropic drug action, additional benefits, of the efficient treatment of blood lipid disorders. Consensus conferences in recent years defined clear and even stricter lipid-lowering target values, mostly to be reached by “double inhibition”, bile acid binding resins, fibrates and nicotinic acid derivatives, beside the most common statin treatment. Neurological and stroke departments and clinics play a pivotal role in vascular prevention.]

COMMENTS

0 comments

Further articles in this publication

LAM Extra for General Practicioners

[USE OF DRUGS FOR GASTRIC ACID REDUCTION IN GENERAL PRACTICE]

HAJNAL Ferenc

[In order to facilitate (general) practitioner’s therapeutic decisions, this overview reviews advantages and disadvantages of three drug classes used for acid reduction, as to antacids, histamine 2-receptor antagonists (H2RAs), and proton pump inhibitors (PPIs). The possibilities and mechanisms of gastric acid reduction are detailed. This can be achieved either by neutralization of gastric acid by systemic or non-systemic antacids, or by inhibiting acid secretion by H2RAs and PPIs. PPIs are the strongest acid reducing agents indispensable in gastro-esophageal reflux disease (GERD), eradication therapy for Helicobacter pylori ulcers and Zollinger- Ellison syndrome, and they are first choice in non-steroidal anti-inflammatory drug (NSAID) induced gastropathy, epigastric pain syndrome, and functional upper GI dyspepsia. Nonetheless, antacids and H2RAs are faster in relieving pain in the latter pain syndrome and in acute heartburn. Contraindications and adverse effects of these three drug classes are also detailed. The author has concluded that physicians’ up-to-date awareness of these compounds’ pharmacological properties contributes to their ability to tailor acid reduction therapy to patients’ individual needs. Refreshing and expanding this knowledge will finally benefit patients seen in everyday practice.]

LAM Extra for General Practicioners

[Umbilical hernia of extreme size in decompensated hepatic cirrhosis]

NEMESÁNSZKY Elemér

LAM Extra for General Practicioners

[Focus on GPs’ activities as official experts]

KRAMER Imre

All articles in the issue

Related contents

Journal of Nursing Theory and Practice

[Use of the ankle-brachial index in occupational healthcare]

SZOBOTA Lívia, HIRDI Henriett Éva

[Elevated risk of fatal and non-fatal cardiovascular events is associated with high prevalence of peripheral arterial disease (PAD). Nurses working in occupational healthcare are ideally situated to identify individuals with undiagnosed PAD. The aim of the study: This study aimed to demonstrate that the ankle-brachial index (ABI) is a tool to be used by occupational health nurses in prevention of cardiovascular disease (CVD). A cross-sectional study was carried out with patients (N=638) from an occupational healthcare setting in 2021. The ABI was measured with an oscillometric blood pressure device. The measurements were analysed with the help of SPSS 22.0; descriptive statistics were calculated. A total of 638 patients were included. Mean age of the population studied was 46.5 ± 8.2 years; 38.4% were men and 61.6% were women. Mean ABI were 1.08 in right legs, 1.06 in left legs. Only 11 subjects (1.72%) had an ABI < 0.90. Occupational health nurses are able to identify key factors related to PAD, including use of the ABI, and to identify individuals with the disease. The determination of ABI using an oscillometric blood pressure device is feasible and easy to implement in occupational healthcare.]

Clinical Neuroscience

The applications of transcranial Doppler in ischemic stroke

FINNSDÓTTIR Herdis, SZEGEDI István, OLÁH László, CSIBA László

Background: This overview provides a summary of the applications of transcranial Doppler (TCD) in ischemic stroke. Results: A fast-track neurovascular ultrasound protocol has been developed for detecting occlusion or stenosis. The technique is more reliable in the carotid area than in the posterior circulation. By monitoring the pulsatility index the in­crea­sed intracranial pressure can be diagnosed. TIBI score was developed for grading residual flow. TCD has been shown to accurately predict complete or any recanalization. Regarding recanalization, TCD has a sensitivity of 92%, a specificity of 88%, a positive predictive value of 96%, a negative predictive value of 78% and an overall accuracy of 91%, respectively. Sonothrombolysis seemed to be a promising application but randomized controlled trials have shown that it does not improve clinical outcome. TCD examination can detect microembolic signals (MES) which are associated with an increased risk of stroke. Micro­em­boli were detected in symptomatic and asymptomatic carotid artery stenosis and during carotid endarterectomy. The number of microemboli can be decreased by antithrombotic therapy. Contrast en­chan­ced examination and Valsalva maneuver with continuous TCD monitoring can accurately screen for right-to-left shunt.

Clinical Neuroscience

[Relationships between COVID-19 disease, nutritional status, and dysphagia, particularly in stroke patients ]

KOVÁCS Andrea, SZABÓ Pál Tamás, FOLYOVICH András

[The new coronavirus, SARS-CoV-2, which causes the COVID-19 disease can lead to severe acute respiratory distress syndrome (ARDS). It poses a serious challenge to the health care system, especially intensive care. Neurological patients, usually of advanced age and with a myriad of comorbidities, are at particular risk through the impact of the new coronavirus on their condition and nutritional capacity. Stroke is a leader in morbidity and mortality data, with a focus on dysphagia and its complications due to COVID-19 disease and acute cerebrovascular accident. In the acute phase of stroke, 30-50% of patients suffer from dysphagia, which still shows a prevalence of 10% six months later. Dysphagia results in decreased or insufficient fluid and nutrient uptake, supp­lemented by inactivity, leading to malnutrition and sarcopenia, which worsens overall condition, outcome, and rehabilitation efficiency. Screening and early detection of swallowing disorders is a fundamental issue in order to develop a personalized and timely-initiated nutritional therapy strategy. Nutritional therapy plays a key role in frequent intensive care due to COVID-19 disease, where it increases the chances of recovery and reduces the length of stay in the intensive care unit and mortality. This is especially true in critically ill patients requiring prolonged ventilation. In COVID-19 diagnosed patients, screening for dysphagia, bedside assessment, and instrumental examination, followed by swallowing rehabilitation, are of paramount importance. Stroke can also be a complication of the COVID-19 infection. Care for cerebrovascular patients has also adapted to the pandemic, “triazination” has become systemic, and dysphagia screening for stroke patients and nutritional therapy adapted to it have also shed new light. ]

Lege Artis Medicinae

[The history of acute stroke care in Hungary ]

BERECZKI Dániel

[Stroke is one of the most frequent causes of death and the most important cause of permanent disability worldwide and also in Hungary. The Hungarian medical literature has mentioned this disease and has been giving recommendations for its treatment since 1690. Initially folk medicines, herbal preparations and phlebotomy were used as standard therapy. Later, cooling the head joined these methods. Pharmacy preparations emerged at the middle of the 19th century. From the middle of the 20th century, products of the pharmaceutical industry like blood flow enhancers and neuroprotective drugs were in the frontline of the acute care. Anti­hy­per­ten­sive, antithrombotic and lipid-lowering medications became part of stro­ke prevention. Imaging techniques – mainly computer tomography of the brain and ultrasound examination of the cervical large arteries – have radically changed the diagnostics of cerebrovascular diseases from the middle of the 1980s. Since the 1990s, diagnostic and therapeutic decisions are based on reliable evidence from good quality clinical trials. Since the beginning of the 21st century, reperfusion treatments (intravenous thrombolysis and mechanical thrombectomy) re­present the most effective emergency care. The current direction is the extension of the therapeutic time-window of reperfusion treatments based on sophisticated neruoimaging. This review provides a brief summary of the development of stroke care in the last three and a half centuries as reflected in the Hungarian medical literature. ]

Clinical Neuroscience

[Systemic thrombolysis and endovascular intervention in postpartum stroke]

BERECZKI Dániel Jr., NÉMETH Beatrix, MAY Zsolt, SZAKÁCS ZOLTÁN, GUBUCZ István, SZIKORA István, SZILÁGYI Géza

[Introduction - There are no previously published cases about intravenously applied recombinant tissue plasminogen activator in acute ischemic stroke during puerperium. Case presentation - We report a 40-year-old woman with postpartum acute ischemic stroke caused by multiple cervical artery dissections treated by systemic thrombolysis and endovascular intervention. Discussion - There are only limited data regarding thrombolytic treatment in acute stroke during pregnancy and puerperium. Current acute stroke treatment guidelines - while considering pregnancy as a relative exclusion criterion - do not deal with the postpartum state. Conclusion - As the condition is rare, randomized controlled trials are not feasible, therefore further reports on similar cases could eventually help us suggest guidelines or at least propose recommendations for the acute thrombolytic treatment of strokes occurring in pregnancy and puerperium.]