Lege Artis Medicinae

[4th International Congress of Pathophysiology]

ROSIVALL László, MONOS Emil

JANUARY 20, 2003

Lege Artis Medicinae - 2003;13(01)

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[Evidence-based practice guidelines for nursing and rehabilitation of stroke patients]

BALOGH Zoltán

[Stroke is a common problem, being the third most frequent cause of death in the United Kingdom and Hungary, accounting for about 20% of bed occupancy. It is also an important cause of morbidity and disability mainly for those aged over 65. As a result, stroke care constitutes as an important part of health services use. Home care services working in the field of stroke rehabilitation have not used a unified evidence-based approach and well-described professional principles and protocols. There was little cooperation between the teams working in the institutional rehabilitation and home care rehabilitation services. No agreed rehabilitation processes, and standardised scales and documentation, showing the change of quality of life, were in use. There were no quality indicators and efficiency measures of nursing and no provision of services either. The Hungarian Nursing Association played a pioneering role in the introduction and dissemination of Evidence Based Nursing in Hungary and in adopting it into routine clinical practice. The successful implementation of the Association's project could be a good example for another field of care and nursing in Hungary and other countries in Europe. Our projects are supported by the Department For International Development (UK) in the framework of the TUDOR project. The Hungarian Nursing Association (HNA) developed a postgraduate training programme entitled "Evidence based nursing in practice". The participants were required to be members of the HNA, have a degree in the field of nursing (nurse teacher, degree nurse, nurse director). Members of the target group were all working in the field of stroke rehabilitation at hospitals or out-patient clinics and home nursing. The Hungarian Nursing Association's professional group developed an evidence based practice guideline for rehabilitation of stroke patients, which was published in the Bulletin of the Ministry of Health (11/2002, 23rd May, 2002). These evidence-based stroke rehabilitation guidelines focused on bladder management, position therapy and patient information.]

Lege Artis Medicinae

[Errors and mistakes in laboratory medicine]

ENDRŐCZI Elemér

[The unacceptable results of laboratory testing derive from the insufficient preanalytical, analytical and postanalytical processes. In addition to the analytical errors, there are inappropriate testing orders which reflect the failures of diagnostic strategy, and either result in excess testing orders without additional new informations, or in the lack of testing order that would be necessary for efficiency of patient's care. An increasing number of study demonstrate that in majority of cases the cause of erroneous results can be traced back to mistakes in the preanalytical phase (preparation of patient, sample collection). The total quality of the diagnostic strategy depends both on the compliance of tests according to the health condition of patient and the quality performance of laboratory processes. The elimination of the preanalytical errors and the formulation of proper diagnostic strategy requires a close cooperation between physicians and the diagnostic workplaces as well as the application of multidisciplinary guidelines which specify the quality requirements of the whole diagnostic process. Such guidelines are not prepared for specific professional activities and do not replace lower-level professional standards (e.g. for test procedures). Based on evidence-based medicine and the recommendations of international experts such guidelines should cover all elements of quality assurance necessary to achieve efficient diagnostic strategy and testing. There is little doubt that such recommendations will also be useful for rational financing of the health care system.]

Lege Artis Medicinae

[Randomized phase III study of gemcitabine-cisplatin versus etoposide-cisplatin in the treatment of locally advanced or metastatic non-small-cell lung cancer]

REINDL Ildikó

Lege Artis Medicinae

[The efficacy, tolerability and gastrointestinal safety of celecoxib in osteoarthritis and rheumatoid arthritis]

SZEKANECZ Zoltán

Lege Artis Medicinae

[Advances in sleep diagnostics]

HORVÁTH Róbert

[Despite the insufficient financial support, the number of the laboratories for sleep diagnostics and the examined patients are rising. The CPAP (Continuous Positive Airway Pressure) equipment playing the main role in the treatment of the obstructive sleep apnoe syndrome (OSAS) is recently available from three neurological centres (Budapest, Debrecen, Pécs). These centres can prescribe the machine as a ”model experiment” with 85% support given by the State Health Care. The increase of the number of the licensed hospitals is expected in the near future, the only condition is the polysomnography background. Differential diagnostics (narcolepsy, RLS, PLMS, sleepdependent laryngospasm, disorders of the circadian rhythm) and the follow-up of the CPAP using patients (indication, contraindication, compliance, CPAP pressure setting, CPAP therapy control) have been emphasized.]

All articles in the issue

Related contents

Lege Artis Medicinae

[Focus on Lege Artis Medicinae (LAM)]

VASAS Lívia, GEGES József

[Three decades ago, LAM was launched with the goal of providing scientific information about medicine and its frontiers. From the very beginning, LAM has also concerned a special subject area while connecting medicine with the world of art. In the palette of medical articles, it remained a special feature to this day. The analysis of the history of LAM to date was performed using internationally accepted publication guidelines and scientific databases as a pledge of objectivity. We examined the practice of LAM if it meets the main criteria, the professional expectations of our days, when publishing contents of the traditional printed edition and its electronic version. We explored the visibility of articles in the largest bibliographic and scientific metric databases, and reviewed the LAM's place among the Hun­ga­rian professional journals. Our results show that in recent years LAM has gained international reputation des­pite publishing in Hungarian spoken by a few people. This is due to articles with foreign co-authors as well as references to LAM in articles written exclusively by foreign researchers. The journal is of course full readable in the Hungarian bibliographic databases, and its popularity is among the leading ones. The great virtue of the journal is the wide spectrum of the authors' affiliation, with which they cover almost completely the Hungarian health care institutional sys­tem. The special feature of its columns is enhanced by the publication of writings on art, which may increase Hungarian and foreign interest like that of medical articles.]

Clinical Neuroscience

A rare entity of acquired idiopathic generalised anhidrosis which has been successfully treated with pulse steroid therapy: Does the histopathology predict the treatment response?

ÖKTEM Özdemir Ece, ÇANKAYA Şeyda, UYKUR Burak Abdullah, ERDEN Simsek Nazan, YULUG Burak

Acquired idiopathic generalised anhidrosis is an uncommon sweating disorder characterized by loss of sweating in the absence of any neurologic, metabolic or sweat gland abnormalities. Although some possible immunological and structural mechanisms have been proposed for this rare entity, the definitive pathophysiology is still un­clear. Despite some successfully treated cases with systemic corticosteroid application, the dose and route of steroid application are controversial. Here, we present a 41-year-old man with lack of genera­lised sweating who has been successfully treated with high dose pulse intravenous prednisolone. We have discussed his clinical and histopathological findings as well as the treatment options in view of the current literature.

Clinical Neuroscience

TLR4 (Toll-like receptor-4) expression and frontal-cingulate volumes in schizophrenia

LI Hua, KÉRI Szabolcs

Evidence suggests that pathogen-associated pattern recognition receptors (Toll-like receptors, TLRs) are implicated in the pathophysiology of schizophrenia. TLRs are important in both peripheral immune responses and neuronal plasticity. However, the relationship between peripheral TLR expression and regional brain volumes is unknown in schizophrenia. We therefore assessed 30 drug-naïve, first-episode patients with schizophrenia. TLR4+/TLR1+ monocytes were measured using flow-cytometry. High resolution magnetic resonance images (T1 MRI) were obtained and analyzed with FreeSurfer. Results revealed significant negative correlations between the percentage of TLR4+ monocytes, mean fluorescent intensities, and brain volumes in frontal and anterior cingulate regions. The measures of TLR1+ monocytes did not show significant relationships with regional brain volumes. These results raise the possibility that abnormal TLR-activation is associated with decreased brain volumes in schizophrenia.

Clinical Neuroscience

[Family planning in multiple sclerosis: conception, pregnancy, breastfeeding]

RÓZSA Csilla

[Family planning is an exceptionally important question in multiple sclerosis, as women of childbearing age are the ones most often affected. Although it is proven that pregnancy does not worsen the long-term prognosis of relapsing-remitting multiple sclerosis, many patients are still doubtful about having children. This question is further complicated by the fact that patients – and often even doctors – are not sufficiently informed about how the ever-increasing number of available disease-modifying treatments affect pregnancies. Breastfeeding is an even less clear topic. Patients usually look to their neurologists first for answers concerning these matters. It falls to the neurologist to rationally evaluate the risks and benefits of contraception, pregnancy, assisted reproduction, childbirth, breastfeeding and disease modifying treatments, to inform patients about these, and then together come to a decision about the best possible therapeutic approach, taking the patients’ individual family plans into consideration. Here we present a review of relevant literature adhering to international guidelines on the topics of conception, pregnancy and breastfeeding, with a special focus on the applicability of approved disease modifying treatments during pregnancy and breastfeeding. The goal of this article is to provide clinicians involved in the care of MS patients with up-to-date information that they can utilize in their day-to-day clinical practice. ]

Clinical Neuroscience

[Zonisamide: one of the first-line antiepileptic drugs in focal epilepsy ]

JANSZKY József, HORVÁTH Réka, KOMOLY Sámuel

[Chronic administration of antiepileptic drugs without history of unprovoked epileptic seizures are not recommended for epilepsy prophylaxis. Conversely, if the patient suffered the first unprovoked seizure, then the presence of epileptiform discharges on the EEG, focal neurological signs, and the presence of epileptogenic lesion on the MRI are risk factors for a second seizure (such as for the development of epilepsy). Without these risk factors, the chance of a second seizure is about 25-30%, while the presence of these risk factors (for example signs of previous stroke, neurotrauma, or encephalitis on the MRI) can predict >70% seizure recurrence. Thus the International League Against Epilepsy (ILAE) re-defined the term ’epilepsy’ which can be diagnosed even after the first seizure, if the risk of seizure recurrence is high. According to this definition, we can start antiepileptic drug therapy after a single unprovoked seizure. There are four antiepileptic drugs which has the highest evidence (level „A”) as first-line initial monotherapy for treating newly diagnosed epilepsy. These are: carbamazepine, phenytoin, levetiracetam, and zonisamide (ZNS). The present review focuses on the ZNS. Beacuse ZNS can be administrated once a day, it is an optimal drug for maintaining patient’s compliance and for those patients who have a high risk for developing a non-compliance (for example teenagers and young adults). Due to the low interaction potential, ZNS treatment is safe and effective in treating epilepsy of elderly people. ZNS is an ideal drug in epilepsy accompanied by obesity, because ZNS has a weight loss effect, especially in obese patients.]