Lege Artis Medicinae - 2011;21(08-09)

Lege Artis Medicinae

SEPTEMBER 20, 2011

[Empirical versus preemptive antifungal therapy of invasive fungal infections in patients with oncohaematological diseases]

RÓKUSZ László

[Fungal infections present a significant problem among immunocompromised patients. The essence of empirical antifungal therapy is to collect data, physical signs and symptoms that confirm the clinically suspected invasive fungal infections and enable initiation of antifungal therapy. With the improvement of early diagnosis of invasive fungal infactions, the diagnosisdrived application of antifungal preparations has been re-evaluated. However, no consensus exists to date regarding preemptive antifungal therapy. After evaluating the benefits and potential side effects of the therapy, the relevant centers decide whether the preemptive or the empirical method should be preferred.]

Lege Artis Medicinae

SEPTEMBER 20, 2011

[The use of carvedilol following invasive interventions]

KOVÁCS Imre

[The primary goals of the treatment of AMI are to rapidly open - either mechanically or by thrombolysis - the blocked blood vessel and to keep it open. Restarting of the blood flow in blocked vessels results in an increased load in volume, pressure and metabolism in the blood vessel's supply area, which triggers the activation of a pathophysiological cascade. Pathophysiological processes accompanying the opening of the blood vessel include activation of catecholamines, RAS and neutrophils and subsequent free radical production, and increases in the levels of proinflammatory citokines and intracellular CA levels, that is, the so called oxygen paradox. The above mentioned processes can be blocked by beta receptor blockers (BRB) as demonstrated by class I, type A evidence. A number of clinical studies have shown their clinical efficiency following PCI. The PAMI, StentPAMI, AirPAMI and CADILLAC studies have proved that BRBs decrease mortality and morbidity after the intervention. The third-generation BRB carvedilol, which acts as a beta and alpha blocker in patients with STEMI successfully treated with PCI, and is also a Ca-channel blocker and a free radical trap, is the firstchoice agent for both theoretical and clinical reasons. Animal studies have shown that carvedilol results in greater reductions in the levels of markers indicating postinfarction reperfusion and ventricular remodeling (MCP1, MMP2, TIMP2) compared with metoprolol. Animal studies have also showed that carvedilol is the most efficient BRB for preventing the damaging of gap junction structure in reperfusion, and for inhibiting the ventricular arrhythmias induced by reperfusion, through restoring connexin 43. The beneficial effect of this drug on the cardiovascular events and mortality following myocardial infarction have been demonstrated in a number of human studies with hard endpoints. The unique efficiency of carvedilol in vascular prevention following PCI has been demonstrated by the short-term and longterm efficiency of carvedilol-filled stents, compared with BMSE-filled stents. Information on the postintervention, long-term (3-year) efficiency of carvedilol in a large (N :7500) patient group is expected to be published in 2015 in the CAPITAL-RCT study coordinated by the University of Kyoto. In summary, the results of experimental and clinical studies on carvedilol have shown that within the BRB group, carvedilol is highly recommended for the prevention of oxygen paradox following successful PCI and preserving the myocardium.]

Lege Artis Medicinae

SEPTEMBER 20, 2011

[The development of insulin treatment from discovery of insulin to analogue preparations]

KÁPLÁR Miklós, PARAGH György

[The discovery of insulin was a milestone in the treatment of diabetes mellitus. Animalderived (porcine and cattle) insulins available at the beginning were later replaced by human insulins. Recently, analogue insulins are the most widespreadly used. Besides the increase in the quantity and improvement in the quality of the insulin products, the growth of the treatment regimes is apparent, as well. That varies from the once-given daily basal insulin treatment added to oral antidiabetic drugs to intensified insulin therapy, administering insulin 4-5 times daily. Considering the benefits proved by previous basic and clinical studies, the authors summarize the most important properties of the commonly used insulin treatment regimes in this review. They also briefly outline the important aspects of the patient-centered personalized therapy and the connection between insulin therapy and carcinogenesis.]

Lege Artis Medicinae

SEPTEMBER 20, 2011

[Advantages of fixed combinations in the treatment of hypertensive patients]

FARSANG Csaba

[In 60-70% of patients with hypertension, a significant decrease in blood pressure can only be achieved by a combination of antihypertensive drugs. International as well as national guidelines emphasise the numerous advantages and the importance of combination treatment. Fixed combinations are particularly advantageous, as their use improves patients’ compliance. This paper summarises the available information on the possible combinations of the nine major antihypertensive drug groups distributed in Hungary, and for details the results published on the recently approved and introduced fixed combination of telmisartan and amlodipine.]

Lege Artis Medicinae

SEPTEMBER 20, 2011

Lege Artis Medicinae

SEPTEMBER 20, 2011

[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.]

Lege Artis Medicinae

SEPTEMBER 20, 2011

[Fourth-year medical students’ views about informal payment in Hungary]

HORVÁTH Ferenc, TEREBESSY András, BALÁZS Péter

[Introduction - Scientific evaluation from ethical, legal and economical aspects of gratuity (informal) payment in the Hungarian health care system was initiated first in the 1980s and was completed by the end of the 1990s. Since then, there are no unanswered scientific questions regarding the evaluation of this phenomenon; however, theoretical studies did not have any practical consequences. Healthcare policy has been experimenting with indirect initiatives, relying on the changing behaviour of all involved partners. Parallelly, in the past two decades opinion polls were published on the sum and allocation of informal payments as well as empirical surveys on the attitudes of stakeholders. Among these surveys, we consider it particularly important to study the views of medical students who are not yet directly interested in gratuity business but who have already gained some clinical experiences. Material and methods - Our study was conducted among fourth-year medical students at Semmelweis University in the 2009/2010 and 2010/11 academic years. 701 students completed the self-administered questionnaire; the answer rate was 84.5%. Conclusions - We established that students closely follow the debate about gratuity, they have well-defined expectations regarding the policy on physicians’ income policy, and their attitudes do not indicate any encouraging views that would favour the future success of the indirect policy on informal payment.]

Lege Artis Medicinae

SEPTEMBER 20, 2011

Lege Artis Medicinae

SEPTEMBER 20, 2011

[The role of measuring galactomannan in the modern therapy of invasive aspergillosis]

SINKÓ János

[Invasive aspergillosis is a life threatening mycosis prevalent in groups of patients with specific risk factors. To establish the diagnosis a specimen for histological examination has to be obtained. However, the vast majority of patients are not suitable for biopsy or this procedure can only be performed late in the course of the disease. Current diagnostic workup is based on high resolution thoracic CT scans and serum galactomannan antigen testing. Antigen detection can either be used for screening to detect early phase infection or to prove the full-blown disease. Here clinical aspects of galactomannan antigen testing and its role in current management of aspergillosis are reviewed.]