Lege Artis Medicinae

[8th Congress of Cardiology in Debrecen]

SEREG Mátyás

MAY 20, 2003

Lege Artis Medicinae - 2003;13(04)

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Lege Artis Medicinae

[Human adult lactose intolerance: diagnosis and therapy]

BERÓ Tamás

[Human adult-onset lactase decline, characterised by a decrease in intestinal lactase enzyme activity is a biologic feature characteristic of the maturing intestine in the majority of the world's population. It demonstrates an autosomal recessive pattern of inheritance and it is regulated primarily by the rate of lactase gene transcription. Ingestion of high quantities of lactose-containing foods by patients with adultonset lactase decline results in intestinal symptoms, including bloating, distension, cramps, flatulence and diarrhoea. Due to the differences in the rates of gastric emptying and intestinal transit as well as the abundance of lactosemetabolising bacteria in the colon, the symptoms of lactose intolerance are often quite variable from persons to person. Lactose intolerance usually leads to self-imposed dietary restriction of dairy products, the main source of calcium intake, therefore it appears to be a risk factor for development of osteoporosis. Consumption of milk with solid foods can reduce symptoms in many individuals. Yoghurt containing active cultures are useful substitute for whole milk. Prehydrolized milk and lactase enzyme containing tablets are also available in the treatment.]

Lege Artis Medicinae

[Continuous glucose monitoring system]

TÓTH-HEYN Péter

Lege Artis Medicinae

[52nd Congress of American College of Cardiology]

KISS Róbert Gábor

Lege Artis Medicinae

[MIRACL ]

MATOS Lajos

Lege Artis Medicinae

[Actual questions of nitrate therapy]

KIRÁLY Csaba, CZURIGA István, KRISTÓF Éva, ÉDES István

[The nitrates are one of our oldest medicine. This article summarizes the general and the cardiovascular effect of the nitrates, the question of the nitrate tolerance and the ways of avoiding this. On the basis of the clinical studies the article describes the theoretical and practical results of the nitrate therapy in myocardial infarct and post-MI patients. It also summarizes the cardiac and extracardiac indications of the nitrates with special regard to acute cardiac conditions (acute heart failure, pulmonary edema) and analyses the side effects and the contrindications of the drug.]

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[Diagnosis and treatment of microvascular coronary heart disease. Specialities of conditions in Hungary]

SZAUDER Ipoly

[Invasive investigations show that in two-thirds of patients the myocardial ischaemia persists without obstructive coronary disease and any other heart conditions (INOCA). The underlying cause may be microvascular dysfunction (CMD) with consecutive microvascular coronary disease (MVD) and microvascular or epicardial vasospastic angina (MVA). The modern practice of clinical cardiology while using the developed non-invasive cardiac imaging permits exact measuring of the coronary flow with its characteristic indices. All of these improve the diagnosing of CMD-induced myocardial ischemia and provide opportunity to determine primary MVD cases. Since the recognition and treatment of MVD is significantly underrep­resented in the Hungarian medical care, the primary stable microvascular angina (MVA) is described in detail below with its modern invasive and non-invasive differential diagnosis and treatment, concerning especially its frequency provoked by high blood pressure and female coronary heart diseases. There are highlighted all recommended diagnostic procedures available under domestic conditions.]

Clinical Neuroscience

Comparison of hospitalized acute stroke patients’ characteristics using two large central-eastern european databases

ORBÁN-KIS Károly, SZŐCS Ildikó, FEKETE Klára, MIHÁLKA László, CSIBA László, BERECZKI Dániel, SZATMÁRI Szabolcs

Objectives – Stroke is the third leading cause of death in the European region. In spite of a decreasing trend, stroke related mortality remains higher in Hungary and Romania when compared to the EU average. This might be due to higher incidence, increased severity or even less effective care. Methods – In this study we used two large, hospital based databases from Targu Mures (Romania) and Debrecen (Hungary) to compare not only the demographic characteristics of stroke patients from these countries but also the risk factors, as well as stroke severity and short term outcome. Results – The gender related distribution of patients was similar to those found in the European Survey, whereas the mean age of patients at stroke onset was similar in the two countries but lower by four years. Although the length of hospital stay was significantly different in the two countries it was still much shorter (about half) than in most reports from western European countries. The overall fatality rate in both databases, regardless of gender was comparable to averages from Europe and other countries. In both countries we found a high number of risk factors, frequently overlapping. The prevalence of risk factors (hypertension, smoking, hyperlipidaemia) was higher than those reported in other countries, which can explain the high ratio of recurring stroke. Discussion – In summary, the comparatively analyzed data from the two large databases showed several similarities, especially regarding the high number of modifiable risk factors, and as such further effort is needed regarding primary prevention.

Lege Artis Medicinae

[Cardiovascular prevention 2021 – Guidelines of European Society of Cardiology 2021. General principles]

VÁLYI Péter, KÉKES Ede

[On 31 August 2021, the European Society of Cardiology published its guideline “Prevention of cardiovascular disease in clinical practice”. This guideline provides a comprehensive review about risk factors of atherosclerotic cardiovascular disease, their assessment, potential modifiers, treatment and prevention of the cardiovascular disease itself at societal and individual levels respectively. The previous guideline issued 2016, had to be updated due to the recent significant advances in risk prediction of cardiovascular disease on atherosclerotic background and due to the beneficial effects of treatment, emerging new drugs and therapeutic targets. The risk assessment system has undergone a major overhaul and now predicts the risk of fatal and non-fatal cardiovascular events together over a 10-year horizon and over a lifetime. In the new guideline, age plays a more important role in risk classification than before. The risk assessment and staged management of apparently healthy people or patients with established atherosclerotic cardiovascular disease, diabetes mellitus and other specific diseases or conditions are detailed. The positive impact of influencing risk factors, the years of life gained can recently be presented in a lifetime perspective, which will help to make an individually tailored decision on the extent of interventions, taking into account also the patient'’s preferences.]

Lege Artis Medicinae

[Paradigm shift in the drug therapy of HFrEF]

HEPP Tamás, VARJAS Norbert, BENCZÚR Béla

[The incidence and prevalence of heart failure (HF) is constantly increasing, its mor­bidity and mortality are still high, thus the disease burden is huge and its proper treatment is of paramount importance. Subs­tantial evidence on improving its prognosis remains available only by the treatment of chronic heart failure with reduced left ventricular function (HFrEF). There have been published a number of “milestone” studies in the last decades, the results of which fundamentally determined the HF therapy until recently. Baseline therapy for HFrEF has been placed on three pillars for a long time: angiotensin-converting-en­zyme inhibitors (ACEI), beta-blocker (BB), and mi­ne­ralocorticoid receptor antagonist (MRA) are included in different heart failure guide­lines with I/A level recommendation. The ground-breaking highly important PARADIGM-HF study was published in 2014, and examined an entirely new class of drugs, the sacubitril/valsartan, which belongs to the group of angiotensin receptor blocking/neprilysin inhibitors (ARNI) in HFrEF patients. Results of this study showed that sacubitril/valsartan significantly reduced the primary composite endpoint of CV mortality and HF hospitalization by 20% and reduced overall mortality by 16% compared to an active comparator enalapril, which has the broadest evidence in HFrEF therapy. The 2016 European Society of Cardiology (ESC) HF guidelines recommended the use of sacubitril/valsartan with an I/B evidence level as a replacement for an ACEI to further reducing the risk of HF hospitalization and death of out-patients with HFrEF who remained symptomatic despite optimal treatment with an ACEI, a BB and an MRA. Later, several smaller studies concerned sacubitril/valsartan with slightly different indications and in other patient groups. The PIONEER-HF study demonstrated that early initiation of sacubitril/valsartan therapy after the stabiliza­tion of acute HF is safe and effective in HFrEF patients, reduces more rapidly the NT-proBNP levels - which correlates with HF prognosis -, than the enalapril. The TRANSITION and TITRATION studies provided useful information on the initiation of sacubitril/valsartan therapy and the strategy of dose titration. The appearance of sacubitril/valsartan opened a new era in HFrEF therapy a few years ago, an era we are actually experiencing in Hungary. Thanks to SGLT-2 inhibitors, it is also possible that we are at the door of an even newer therapeutic era. This question is expected to be answered in the new ESC HF-guidelines to be published soon this year. ]