Lege Artis Medicinae - 2019;29(06-07)

Lege Artis Medicinae

JULY 20, 2019

[Epidemiology, comorbidity, etiology of depression and cardiovascular diseases]

PÉTER László, RIHMER Zoltán

[Psychiatric problems are a common comorbid condition in patients with cardiovascular disease. Depression is a well-known risk factor for the development of cardiovascular disease and mortality too. Psychiatric and cardiovascular diseases are prevalent public health problems in the western world. Depression is associated with endo­thelial dysfunction and increased platelet aggregation, which may explain the consequent cardiovascular complications. Specific affective temperaments may be associated with special cardiovascular diseases. Antidepressant therapy does not only reduce depression but also cardiac mortality.]

Lege Artis Medicinae

JULY 20, 2019

[The Good, the Bad and the Ugly ]

BENCZÚR Béla, BAJNOK László, REIBER István, TSCHÜRTZ Nándor

[Reading the title most of us (but not everyone) can recall from our memories the classic heroes of the movie of Sergio Leone and we can almost hear (or not?) the melody of Ennio Morricone. This sentence is full of strangeness, isn’t it? However it’s hardly at all sure that everyone had seen the movie (indeed certainly not) and the catching music is maybe elusive. Like or not we are related to classics of lipidology, as well. Most of the readers of this review of the three clinicians know much (but not everything!) of these topics but probably for some of them this paper will arise their further interest. We are going to separate the “inseparable”, only together functioning whole thing in order to build a model in our thinking regarding its operation. This is what we do with the scientific cognition. We are making models, simplifying indeed… (sometimes erroneously) proclaiming. Let’s throw out our (or at least try to do it) the stereotypes living inside us. Let’s talk about the “always” good HDL-cholesterol, the bad LDL-cholesterol and the ugly (or cruel) triglyceride, actually (and now the analogy is lost of the three key players of the classic western movie) about the other faces of the together ugly and bad lipoprotein(a) according to a lot of opinions! As everything is connected with everything in the human body and nothing is accidental - nothing can be only good, bad or ugly nor the Good, the Bad and the Ugly yet.]

Lege Artis Medicinae

JULY 20, 2019

[The red eye]

IMRE László

[Eye redness may be a sign of a variety of eye diseases with different severity. Most often redness is relatively harmless, such as conjunctivitis, but it can be a serious illness with visual impairment and even lasting consequences in the background of redness. It is therefore important for non-ophthalmologists to be informed and to know the basic types of redness of the eye and to recognize typical and characteristic forms of appearance. Based on these, they can decide whether the patient can be treated or forwarded to an ophthalmic institution. In the present continuing education article we try to summarize the causes of the red eye, primarily according to the characteristics of the redness of the eye and the anatomical localization. During the investigation of a patient with red eye, the type of the redness can be determined most by diffuse illumination and by naked eye inspection without any other means. It is important to know the principal features and causes of redness of conjunctival or ciliary or scleral origin, possible other recognizable differences (e.g. conjunctival papillae or follicles or conjunctival chemosis). We have attempted to illustrate these with a number of photographs, starting with a schematic representation of the characteristic features of redness. We tried to emphasize cases suitable for treating by non-ophthalmologists and tried to draw attention to the importance of referral un­clear or complicated cases.]

Lege Artis Medicinae

JULY 20, 2019

[How many cardiovascular events can be avoided by a lipid lowering therapy based on preventive guidelines?]

MÁRK László

[The lipid lowering therapy became one of the most important elements in the cardiovascular prevention, yet it is not appropriately evaluated neither by the doctors, nor by the patients. The lipid goal attainment should to be improved according to Hungarian and international data. Using a recommendation guided lipid lowering therapy the most benefit can be expected in the patients at very high risk who alrea­dy had a cardiovascular event, where the LDL-cholesterol goal is 1.8 mmol/L. Calculating upon the data of 170000 patients of Cholesterol Treatment Trialists’ Collaboration a decrease of LDL-cholesterol level from 2.5 mmol/L to 1.8 in 100 patients in 10 years would avoid 3 myocardial infarctions, strokes or death, lowering that from 3.5 mmol/L to the goal would prevent these 3 events within 5 years. Using the traditional LDL-cholesterol lowering medication, high dose statin and ezetimibe, if the attitude of doctors and the compliance of patients would be ideal, the 1.8 mmol/L goal attainment rate would be over 80%. Unfortunately, up to now the reimbursed administration of ezetimibe in Hungary is still bound to a specialist’s recommendation, adding it to any dose of any statin an additional 20% LDL-cholesterol can be expected. The reimbursed administration of PCSK9-inhibitors is possible only based on a special request to National Health Insurance Fund. To achieve a better national cardiovascular morbidity and mortality the attitude of the doctors and the adherence of the patients to the lipid lowering therapy should be improved (it’s the goal of the present paper as well).]

Lege Artis Medicinae

JULY 20, 2019

[Gynecological correlations of eating disorders]

GALIGER-DOBOS Kitty, TÚRY Ferenc

[In recent decades, the incidence of eating disorders (its two major forms are anorexia nervosa and bulimia nervosa) has increased, their course has been delayed, and their complications are becoming more frequent and severe. Eating disorders cannot only damage physical and mental health but also affect reproductive health, future mothers and their children. Understanding the biological and psychosocial factors that explain the gynecological conditions related to eating disorders is essential regarding fertility and pregnancy. The present review summarizes data published from 2000 about the gynecological effects of eating disorders. In daily practice, the multidisciplinary collaboration is particularly important to pro­vide women with eating disorders with comprehensive care. The appropriate information of women who plan to have children is essential in order to increase the likelihood of conception and reduce the risk of miscarriage. ]

Lege Artis Medicinae

JULY 20, 2019

[Empirical examination of the persistence value among the students studying health-care at the beginning of student professionalization]

DINYÁNÉ Szabó Mariann, PUSZTAI Gabriella

[INTRODUCTION – Students in healthcare studies can help maintain the mental base and maintain their health if the lecturers know the degree of student persistence. When entering higher education, it is possible to measure the pre-university experience. Persistence determines the student's relationship to learning and can be a predictor of learning success. PARTICIPANTS AND METHODS – A questionnaire study (N = 200) of the 1st year student (N = 200) of the Health Care Organization (BSc) of the University of Debrecen and Semmelweis University. For the continuous Persistence Variable a descriptive statistical method was used, an independent two-sample t-test was used for comparison between groups, and Hedges-g was used to express the effect size. We used the GLM (General Linear Model) model for fitting the persistence model. By means of factor analysis, we constructed factors from the significant predictor variables of the GLM model, which helped us assessing students' chances of learning. To quantify the strength of evidence against null hypothesis P < 0.05 (5% significance) was chosen as a standard level for concluding that there is evidence against the hypothesis tested. Statistical analysis was performed with IBM SPSS Statistics 24.0 (SPSS, Chicago, IL). RESULTS – The persistence factor loadings can be divided into three types: high, medium and low. High persistence rearranges student preferences, low interest persistence, minimal interest in academic engagement. In the case of middle-ranking people, the importance of volunteering (life-experience) and friendship is paramount. CONCLUSIONS – The results indicate that at the beginning of the student life there is a willingness, diligence, acceptance of academic values, interest or lack of interest in future success studies. During the stu­dies, these features can be monitored and the necessary interventions can be made in time.]

Lege Artis Medicinae

JULY 20, 2019

[Severe polymyositis associated with multiplex pulmonary abscesses]

SZABÓ Katalin, VINCZE Anett, NAGY-VINCZE Melinda, DANKÓ Katalin, GRIGER Zoltán

[INTRODUCTION – Idiopathic inflammatory myopathies are heterogeneous autoimmune diseases characterized by immune mediated inflammation of the skeletal muscles. CASE REPORT – A case of a 62-year-old male patient with severe proximal muscle weakness, elevated creatine kinase and swallowing difficulity is presented. Electromyography showed myogenic pattern, thus probable polymyositis was diagnosed. Radiological examination has confirmed bilateral multiplex lung lesions, which were caused by the possibility of tumor, tuberculosis, vasculitis and abscess as well. The condition of the patient deteriorated, nasogastric feeding, high dose steroid treatment was initiated, which reduced the patient's creatinine kinase values, but muscle strength was not changed. Based on the results of various investigations, the condition of the patient was finally confirmed by the development of myositis, resulting dysphagia, chronic aspiration, and multiplex lung abscess. Antibiotic therapy, steroid treatment was continued and finally intravenous immunoglobulin treatment was administered. The condition of the patient gradually improved, the swallowing dysfunction disappeared, and the lung abscesses were resolved. As a result of physiotherapy and rehabilitation treatment, the patient could walk again. CONCLUSIONS – Nasogastric feeding is recommended to prevent aspiration in the case of myositis-associated dysphagia. In case of steroid refractory therapy, the use of intravenous immunoglobulin may be effective. ]

Lege Artis Medicinae

JULY 20, 2019