Lege Artis Medicinae

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MATOS Lajos

OCTOBER 20, 2003

Lege Artis Medicinae - 2003;13(07)

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Lege Artis Medicinae

[Antibiotic Treatment of Community-Acquired Respiratory Infections: Strategies Intended to Ensure Optimal Outcome and to Minimize the Development of Resistance]

BALL P., BAQUERO F., CARS O., FILE T., GARAU J., KLUGMAN K., LOW E. D., RUBINSTEIN E., WISE R.

Lege Artis Medicinae

[The 18th International Conference on Allergy and Clinical Immunology 7-12 September 2003, Vancouver]

HIRSCHBERG Andor

Lege Artis Medicinae

[THE USE OF EARLY BIOMARKERS IN PREVENTION. - THE MARKERS OF THE EXPOSITION, EARLY EFFECT AND INDIVIDUAL SENSITIVITY]

EMBER István, KISS István, SÁNDOR János, FEHÉR Katalin, NÉMETH Katalin, LUKÁCS Péter

[The molecular and predictive epidemiology plays more and more important role in the prevention of cancer. With the help of early biomarkers, high risk population could be identified for primary preventive intervention modalities. It uses both molecular biological methods and elements of risk assessment plus a testing system based on animal experiments. Its specificity is not high enough to establish the diagnosis but it can be used to monitor the disease and to follow the effectivity of the therapy (e.g. "minimal residual disease") and the preventive interventions. It is also suitable for risk assessment with the markers of individual susceptibility. As to everyday practice there are many problems because of limited therapeutic possibilities, but we hope that the molecular and predictive epidemiology becomes an important part of medicine in the near future.]

Lege Artis Medicinae

[NEW MODALITIES IN THE TREATMENT OF CHRONIC VIRAL HEPATITIS C: PEGYLATED INTERFERONS]

GERVAIN Judit, NEMESÁNSZKY Elemér, CSEPREGI Antal

[Interferon-α proved to be the most effective therapy of chronic hepatitis C. Its combination with ribavirin enhances the antiviral activity and this modality has become the therapeutic standard recommended worldwide during the past few years. Metaanalysis of the international studies revealed that only 12-19% of the patients became virus-free following a 48-week long course of α interferon monotherapy. The combination treatment with ribavirin for 48 weeks increased the proportion of sustained responders to 35-45%. The introduction of pegylated interferons resulted in significantly higher response rates. The new therapeutic possibilities are due to the modified pharmacokinetic characteristics of the drug by changing the size and the structure of the molecules. Multicentre studies investigating the clinical effectiveness of the 40 kD sized pegylated interferon α-2a as well as the 12 kD sized pegylated interferon α-2b in combination with ribavirin reported 56% and 54% response rate, respectively. However, there is significant heterogeneity in the results according to the type of drug administered and to the genotype of the hepatitis C virus, as well as in the basal viral level and the stage of hepatic fibrosis, respectively. The message and the conclusion of the viral kinetic studies are worth remembering: if the result of the HCV nucleic acid test is still positive at week 12 or 24, therapy should be ceased due to the patient non-responder status. Since pegylated interferons are also available in Hungary the authors felt useful to give an overview of the current knowledge, summarizing the results of the relevant studies and provide a suggested state-of-the-art therapeutic protocol based on international consensus.]

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Clinical Neuroscience

The effect of sniffing Turkish coffee on olfactory disorders in COVID-19 patients: An experimental clinical study

BULBULOGLU Semra, ALTUN Yasar

The current study aimed to examine the effect of sniffing Turkish coffee on the sense of smell in COVID-19 patients. This study utilized the experiment-control method. Data were collected using a patient and disease information form and the Connecticut Chemosensory Clinical Research Center (CCCRC) Test. An experimental group of patients sniffed Turkish coffee, and the coffee’s effect on the patients’ sense of smell was examined. All data were analyzed using SPSS version 25 (IBM). Of the patients in the experimental group, 25% had moderate hyposmia, 58.3% had severe hyposmia, and 16.7% had anosmia prior to sniffing Turkish coffee. After sniffing the Turkish coffee, 13.3% of these patients regained their ability to smell normally, while 18.3% had mild hyposmia, 45% had moderate hyposmia, 6.7% had severe hyposmia, and 16.7% had anosmia. There was no difference in the control group between first and second measurement. COVID-19 patients who sniffed Turkish coffee intermittently regained some of their sense of smell for one hour. Turkish coffee is cheap, fragrant, widely available, and easy to access. Therefore, results of this study suggest that it may be recommended for treating olfactory disorder in COVID-19 patients.

Clinical Neuroscience

[The examination of burnout among healthcare workers]

FEJES Éva, MÁK Kornél, POHL Marietta, BANK Gyula, FEHÉR Gergely, TIBOLD Antal

[Health reforms in recent decades have been largely based on economic considerations and have led to a significant problem in the sector today, with the issue of human resources being pushed back, which is exacerbated by burnout syndrome. The aim of this questionnaire-based study was to examine the complex background of burnout among health care workers in the cities of Komló, Pécs and Kecskemét. Baseline demographic data were recorded. Burnout was assessed by the Maslach Burnout Inventory (MBI), and the intensity of dysfunctional attitudes were also studied. Depression was detected by the Beck Scale and social supports, and effort-reward dysbalance were also examined. Overall 411 employees participated in our study. Age group distribution was middle aged access, vast majority of the workers was between 36 and 55 years. Mean burnout scale was 58.6 (SD = 16.3), 63 workers had mild (14.2%), 356 had moderate (80.7%) and 22 had severe (5.1%) burnout. In a multivariate analysis the type of work (OR = 1.018), age (OR = 2.514), marital status (OR = 1.148), job type (OR = 1.246) the lack of social support (OR = 1.189) and allowance (OR = 9.719) were independently associated with burnout (p < 0.05 in all cases). There was a significant association among burnout, depression and dysfunctional attitudes. The vast majority of our social workers suffered from moderate and a small, but significant proportion suffered from severe burnout. Our work draws attention to the modifiable and unmodifiable risk factors of burnout in this population, which may help in the development of preventive strategies.]

Hypertension and nephrology

[Results of the CONADPER-HU program: blood pressure reduction, achieving target blood pressure, factors affecting the target, characteristics of medication]

KISS István, KÉKES Ede, PAKSY András, SZEGEDI János

[The authors analysed in detail the data of 4071 “active” and 2654 “nonactive” groups of patients. In the 18-64 age group, systolic and diastolic blood pressure was significantly reduced during the first three months of the baseline, and maintained for a further year. The largest systolic pressure drop was achieved by members of the active group using the Medigen application. The blood pressure target rate (< of 140/90 mmHg) in the active and non-active group was significantly higher than the baseline at all visit times (above 70%) and this decrease could be maintained throughout the observation period. Here the most favorable results were also found in Medigen software applications. Over the age of 65, reaching the target blood pressure increased significantly in the first three months as well, but due to the significantly uneven number of the two groups, the data received was only considered as approximate value. Main factors of non-achievement of target blood pressure: obesity, alcohol consumption, diabetes mellitus and peripheral vascular disorder, and the fact that the individual is male. Increases the access probabilities of Medigen users by 21% compared to non-users of the active group. Compared to the inactive group, this chance increase is 31%. The difference in target blood pressure reach between the active and non-active group was even more pronounced in diabetic hypertensive patients. The analysis demonstrates that drug treatment in domestic and ESH guidelines is fully consistent with and reflects well on domestic clinical practice.]

Clinical Neuroscience

[The role of transcranial magnetic stimulation in clinical diagnosis: motor evoked potential (MEP)]

ARÁNYI Zsuzsanna, SIMÓ Magdolna

[Transcranial magnetic stimulation allows painless, non-invasive stimulation, neurophysiological evaluation of nervous structure covered by bone or difficult to access for other reasons. In the clinical setting the technique is mainly used for the investigation of the corticospinal tract (motor evoked potential: MEP). Based upon our experience with patients examined over the course of four years, we have attempted to highlight the clinical situations, where diagnostic help is provided by this technique. MEP in general has proved to be a sensitive and reliable examination. Its significance is apparent mainly in situations where clinical signs of corticospinal tract dysfunction are not evident, or they are masked by lower motoneurone involvement, and where neuroimaging techniques are not informative. The demonstration of subclinical corticospinal lesion is often essential to establish the diagnosis in multiple sclerosis and amyotrophic lateral sclerosis. The technique however received little attention so far with respect to its role in the diagnosis of various spinal cord disorders, and in the demonstration of intact corticospinal function in case of weakness, psychogenic in origin. We have endeavoured to provide further evidence in support of this, and thereby advocating a wider clinical application of the technique.]

Clinical Oncology

[Long-term central venous access devices in oncology]

PAJKOS Gábor

[Long-term central venous access devices are essential in the management of oncology patients, as they minimize the discomfort caused by frequent venipuncture and cannulation. Indications of application of central venous accesses, possibilities of implantations, immediate and long term complications, they prevention and obviation has been reported based on guidelines and relevant publications. Long term implantable central venous accesses handled by well-trained and exercised team, working with principles of maintenance, these manipulations are effective and safe, therefore suitable in oncological practice.]