LAM KID

[Efficiency of the treatment of osteoporosis - lessons from a health insurance fund’s database analysis]

NÉMETH Éva

JULY 03, 2012

LAM KID - 2012;2(02)

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LAM KID

[Bone status in praediabetic state - Relationship of bone density and energy homeostasis before the manifestation of type 2 diabetes mellitus]

BUDAY BARBARA, VITAI Márta, PACH Péter, LITERÁTI Nagy Botond, PÉTERFAI Éva, BEZZEGH Katalin, PAUER József, KORÁNYI LÁSZLÓ

[INTRODUCTION - All forms of diabetes are associated with increased fracture risk. In type 2 diabetes, bone mineral density is increased. In order to determine whether increased bone density is a consequence of diabetes-related metabolic changes or rather a primary alteration independent of these changes, we examined women and men with the following characteristics: normal glucose tolerance; genetically determined risk of T2DM but healthy on the basis of detailed metabolic tests; or incipient glucose intolerance, praediabetic state. PATIENTS AND METHODS - We included 72 men with normal glucose tolerance; seven men with normal glucose tolerance and first-degree relative(s) with diabetes; 64 body fat mass adjusted and BMI-adjusted men with glucose intolerance; 36 healthy women with normal glucose tolerance; 12 women with normal glucose tolerance and first-degree relative(s) with T2DM and 88 women with glucose intolerance. Muscle glucose uptake was measured by hyperinsulinaemic-normoglycaemic clamp, and bone density was measured by DEXA. RESULTS - In healthy men, the connection between leptin and BMDL1-4 is positive and the relationship between testosterone and BMDL1-4 is negative, but both correlations disappear in the early praediabetic stage. In the whole female study population, negative correlations were found between total BMD and adiponectin (r=-0.318, p<0.0001), and osteocalcin (r=-0.412, p<0.0000), which stayed significant after adjustments for body fat percent and age in case of impaired glucose tolerance. CONCLUSION - In women with healthy glucose metabolism who have first-degree relative(s) with diabetes, increased bone density is not related to changes in glucose metabolism. Our study emphasizes the substantial gender differences in the relationship between density of the femur and vertebrae and metabolism. Our data question the mediatory role of adiponectin shown in animal studies in the insulin-sensitizing, glucose metabolism improving effect of osteocalcin in men.]

LAM KID

[Secondary osteoporosis in gastrointestinal diseases]

FUSZEK Péter

[Gastrointestinal disease is often overlooked or simply forgotten as a cause of osteoporosis. In a number of gastrointestinal diseases, sometimes because of the medicines used for their treatment, malabsorption syndrome may occur. Malabsorption might lead to insufficient absorption of calcium, phosphate, magnesium, vitamin D, vitamin K and proteins, which can cause osteopenia, osteoporosis and osteomalacia. In this paper, we aim to review the gastroenterological diseases that can lead to osteoporosis and treatment strategies.]

LAM KID

[Practical questions regarding the use of teriparatide]

TAKÁCS István

[Teriparatide has become one of the most important drug in the treatment of osteoporosis in Hungary. Although this is not a new drug, a number of questions arise regarding its use in everyday practice. When should we use it as first-line treatment? When should we change the used therapy to teriparatide? What kind of effect can we expect after the start of teriparatide therapy? What are the potential side effects? Financing rules limit, but do not fully control our therapeutic decisions, as these are mostly based on scientific data. In this review, we summarise new and older scientific data regarding teriparatide from practical aspects.]

LAM KID

[Thyroid hormone replacement in old age - practical advices - Treatment often causes more problems than no treatment!]

SZABOLCS István

LAM KID

[Strontium ranelate effect in postmenopausal women with different clinical levels of osteoarthritis]

BALLA Bernadett

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[This consensus document is intended to provide guidance for the effective and efficient treatment of asymptomatic individuals with high uric acid levels and gout patients.]

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[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

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[The connection between the socioeconomic status and stroke in Budapest]

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[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

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[Thiazide- or thiazide-like diuretics should be used in the treatment of patients with hypertension? Particularities of the situation in Hungary]

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[Diuretics have remained the cornerstone of the antihypertensive treatment since their widespreading in the 1960s. According to the 2018 ESC/ESH Guidelines for the management of arterial hypertension, in the absence of evidence from direct comparator trials and recognizing that many of the approved single-pill combinations are based on hydrochlorothiazide, this drug and thiazide-like indapamide can be considered suitable antihypertensive agents. In the 2018 Hungarian guidelines indapamide is named as the most efficacious diuretic in the treatment of patients with hypertension. The aim of the publication is redefining thiazide- and thiazide-like diuretic use in the treatment of hypertensive patients, with particular attention to presently available hydrochlorothia­zide and indapamide, and their combination drugs in Hungary.]

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[Risk of nonsteroidal antiinflammatory drugs. Focus on aceclofenac]

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[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deterio­rate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable.]