LAM Extra for General Practicioners

[THE PLACE OF SULPHONYLUREA COMPOUNDS IN THE BLOOD GLUCOSE LOWERING THERAPY OF TYPE 2 DIABETES]

WINKLER Gábor

DECEMBER 15, 2011

LAM Extra for General Practicioners - 2011;3(05)

[The mechanism of blood glucose lowering action of sulphonylureas, their advantages and potencial risks are overviewd in the article. The author delineates the present place of the sulphonylurea group in the antihyperglycemic therapy of type 2 diabetes, listing possibilities of monotherapeutic as well as combined applications. It is emphasized that traditional insulin-secretagogue compounds have their place in the therapy of type 2 diabetes even beside of the new, incretin-type secretagogues.]

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LAM Extra for General Practicioners

[ECG ARTEFACTS]

TOMCSÁNYI János, BEZZEG Péter

[The recognition of ECG artefacts is becoming increasingly important for physicians working in the field of internal medicine. At the same time, however, very little information about artefacts is published in either articles or textbooks. The authors provide a summary of the generation, types and recognition of ECG artefacts. The aim of the article is to draw the attention of clinicians to the dangers of this increasingly common phenomenon. Unrecognised artefacts can often prompt further (unnecessary) investigations and may result in establishing wrong diagnosis as well as erroneous treatment decisions.]

LAM Extra for General Practicioners

[METFORMIN - BUT WHAT ELSE IS IN THE BOX?]

KISS Zsófia, KIS János Tibor

[Metformin is currentlly the most commonly prescribed oral antidiabetic drug for the treatment of patients with type 2 diabetes mellitus. Its administration is limited by the contraindications and the possible gastrointestinal side effects. In Hungary, metformin is currently available in numerous forms, among which the extended-release tablets are distinguished because of their tolerability. The authors summarise the most recent data about the favourable features of metformin, help clinicians to choose the appropriate preparation of metformin, and highlight the administration procedures that help to avoid gastrointestinal side effects.]

LAM Extra for General Practicioners

[ANTIHYPERTENSIVE THERAPY IN PATIENTS WITH COPD - THE SIGNIFICANCE OF NEBIVOLOL]

FARSANG Csaba

[The occurrence of hypertension associated with chronic obstructive pulmonary disease (COPD) is increasing. Recognising COPD is important in order to choose the appropriate antihypertensive drugs. Antihypertensive drugs that can be used to treat patients with hypertension and COPD include diuretics, ACE-inhibitors, angiotensine receptor blockers (AT1 receptor antagonists) and calcium antagonists, as well as cardioselective beta blockers, as these drugs decrease total and cardiovascular mortality. Of these agents, the importance of the most cardioselective one, nebivolol should be stressed, as this drug has no clinically significant effect on parameters of respiratory function, and, through its additional effects (namely by increasing the synthesis of NO), it has a beneficial effect on COPD-related deterioration of respiratory functions, haemodynamic alterations (cor pulmonale) and local factors that participate in the respiratory inflammation and endothelial dysfunction.]

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[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

Lege Artis Medicinae

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[Aim of the research: To evaluate the efficacy of the treatment and incidence of complications in diabetes type 1 and 2 patients treated with peritoneal dialysis. Research and sampling methods: During a retrospective study with 85 diabetic PD patients (19 type 1 patients and 66 type 2 patients) was compared data of 22 years with regard to the following parameters: Glucose metabolism, body weight, changes in residual urine clearance values, distribution of quantity and glucose content of the solutions used, incidence of infections, and average duration in PD programme before transferring to haemodialysis. Results: All patients, irrespective of their type of diabetes: spend the same time in PD on average, gained body weight during PD. Diabetes type 1 patients: had a lower residual urine clearance, had HbA1c values decreasing during PD, reported peritonitis less frequently, had a higher incidence of catheter-related infections. Diabetes type 2 patients: had a better glucose metabolism, had a higher body weight from the beginning of therapy, required PD solution with higher glucose concentration. Conclusions: Diabetes patients, irrespective of the type of diabetes, can successfully be treated with PD, but require more attention because of their underlying disease and associated complications. ]

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[Polyphenols, which belong to the group of flavonoids, can be found in a number of plants, and are present in a high concentration in the French maritime pine bark. The authors summarise results of large-scale experimental and clinical studies on pycnogenol, the standardised extract of French maritime pine bark. Pycnogenol decreases production and effects of free radicals (antioxidant effect). It has antiinflammatory properties, and, by the stimulation of eNOSsynthesis, it increases the production of vasodilatory compounds (e.g. NO, prostacyclin) and decreases that of vascoconstrictor compounds (endothelin-1, thromboxane) materials. These changes lead to vasodilation, which results in increased tissue perfusion and decreased blood pressure. Pycnogenol also decreases platelet aggregation and LDL-cholesterol level and increases HDL-cholesterol level. Its antidiabetic effect has also been shown. Consequently, it may substantially decrease cardiovascular risk. In addition to these results, pycnogenol has been also found to have antibacterial and antiviral effects. It has been successfully used in children with attention deficit hyperactivity disorder, as well as in adults with dysmenorrhea, climacterial disturbances, glaucoma or asthma bronchiale.]

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