Lege Artis Medicinae


WITTMANN István, WAGNER László, WAGNER Zoltán, MOLNÁR Gergő Attila, TAMASKÓ Mónika, LACZY Boglárka, MARKÓ Lajos, MOHÁS Márton, NAGY Judit

DECEMBER 20, 2005

Lege Artis Medicinae - 2005;15(12)

[The stages of abnormal albuminuria are microand macroalbuminuria. The isolated abnormal albuminuria is a special form of proteinuria. For the detection of abnormal albuminuria one can use immunological or liquid chromatographic methods. The latter seems to be more appropriate than the immunological methods for the measurement of albuminuria in normo- and microalbuminuric diabetic patients. In diabetes mellitus, the circulating glycated and oxidized albumin is degraded and eliminated in the kidney. Decrease of the glomerular filtration rate is a valuable measure of renal insufficiency and this loss of kidney function is followed by the decrease of albuminuria as a sign of the glomerular closure. Albuminuria is an important cardiovascular risk factor and the decrease of the abnormal albuminuria is associated with a diminishing cardiovascular risk. Thus, albuminuria is a cardiovascular therapeutic target, as well. Therefore, the major points of the management of diabetic albuminuria are the achievement of euglycaemia, the use of angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers.]



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Lege Artis Medicinae



[INTRODUCTION - Streptococcus pneumoniae (S. pneumoniae) is a very important pathogene of community acquired invasive infections. The aim the study was to collect data on the serotype distribution of invasive S. pneumoniae strains in Hungary and their resistance. In the light of the results it can be determined how effective the currently available polysaccharide vaccine is against the infections caused by invasive S. pneumoniae strains. MATERIALS AND METHODS - The seroprevalence and antibiotic sensitivity of 44 randomly selected isolates of Streptococcus pneumoniae isolated from sterile sites of human body were analysed over a 4 year period (2000-2003). Samples were randomly analysed by the Quellung method. Detection of sensitivity of S. pneumoniae to penicillin and erythromycin were carried out by disc diffusions and E-test method in the microbiological laboratory of the St. Laszlo Hospital. RESULTS - The invasive isolates belong to 22 different serotypes. The prevalence of penicillin and erythromycin sensitivity was 79,5%, and 68% respectively. CONCLUSION - The 23 valent polysaccharide vaccine could provide coverage of 82% of invasive pneumococcal diseases caused by strains analysed in this study.]

Lege Artis Medicinae

[Against the Pharma Industry or for the More Reliable Knowledge?]


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[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

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[The modern therapy of lipid disorders in the daily practice ]


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[Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most common pain relief and anti-inflammatory medications all over the World, and many formulations are also available over-the-counter. Beyond the well-known gastrointestinal risks, emerging evidence supports increased incidence of cardiovascular events associated with the use of NSAIDs. This cardiovascular risk seems to be independent of the cyclooxygenase selectivity of these drugs. Distinct side effect profiles of various NSAIDs were summarized in a former issue of the Journal: LAM 2014;24(7): 327. In this paper, we aimed to summarize some of the yet unpublished results of a major research project of the European Medicines Agency (EMA), that was conducted in order to establish the relative risk of CV outcomes (myocardial infarction, ischaemic stroke and hospitalization for heart failure) associated with the use of various NSAIDs. In this epidemiological study, seven European healthcare databases on a source population of 35 million subjects were linked and analyzed. Most of the results are currently only available on the project homepage; however, analyses of heart failure data have already been published in a recent issue of The BMJ. ]

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[Practical aspects of therapy by erythropoiesis stimulating agents in renal anaemia]

DEÁK György, HERSZÉNYI Eszter, AMBRUS Csaba, KISS István

[Prevalence of renal anaemia due to insufficient production of erythropoietin increases progressively in the course of renal function deterioration. Renal anaemia is treated by erythropoesis stimulating agents (ESA). Outcomes of randomized clinical trials have taught us to avoid the strategy of normalization of hemoglobin (HGB) levels by ESA therapy as it may increase the risk of cardiovascular events and mortality. The Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Anaemia published in 2012 recommends to start ESA therapy in the 90-100 g/l HGB range and suggests to keep HGB concentrations below 115 g/l. It is an inappropriate strategy to aim at normalizing hemoglobin (HGB) levels by ESA therapy because it may lead to progressive escalation of ESA doses even in the presence of diminished ESA responsiveness. High ESA doses and diseases causing ESA hyporesponsiveness eg. infections, chronic inflammation, malnutrition, insufficient dose of dialysis, severe hyperparathyroidism, iron deficiency are related to increased risk of mortality. KDIGO Clinical Practice Guideline for Anaemia emphasizes the importance of assessing and treating causes of ESA hyporesponsiveness, limits ESA dose escalation and recommends gradually changing ESA doses to avoid high amplitude HGB oscillation.]

Lege Artis Medicinae

[Changes of diabetes deaths in Hungary from 2000 to 2009]

VOKÓ Zoltán, ZSÓLYOM Adriána, JERMENDY György

[INTRODUCTION - Official mortality statistics underestimate the etiological role of diabetes in mortality. METHODS - With the use of attributable risk ratio we estimated the proportion of total mortality and mortality under age 65 years due to diabetes in Hungary in 2000-2009. We corrected the analysis for the co-occurrence of diabetes and hypertension. The prevalence figures of diabetes were taken from the National Health Interview Surveys 2000, 2003 and 2009; the relative mortality figures in patients with diabetes from the Canadian Chronic Disease Sur­veillance System of the Public Health Agency Canada; and the Hungarian age-, and sex-specific mortality figures from the Demographic Yearbooks of the Central Statistical Office. RESULTS - The total mortality decreased by 15%, mortality under age 65 years by 16% in the studied period in Hungary. Mean­while diabetes attributable mortality corrected for hypertension decreased by only 6%, premature mortality increased by 4%. As a consequence, the proportion of diabetes attributable mortality within total mortality increased from 4.6% to 5%, premature mortality from 4.3% to 5.5% by 2009, as the prevalence of diabetes increased from 6.9% in 2000 to 8.2% in 2009. Diabetes attributable mortality is approximately 2.5 times higher than the figures in the official mortality statistics. CONCLUSION - Diabetes and its main risk factors, overweight and obesity due to unhealthy diet and physical inactivity are one of the most important public health challenges nowadays. The burden of diabetes and its complications is already enormous. Mortality attributable to diabetes is much higher than it is reflected in the official mortality statistics. ]