Lege Artis Medicinae

[ACTION ]

MATOS Lajos

NOVEMBER 21, 2004

Lege Artis Medicinae - 2004;14(11)

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Lege Artis Medicinae

[The 46th Congress of the Hungarian Society of Gastroenterology]

ABONYI Margit

Lege Artis Medicinae

[SCIENTIFIC DIGEST]

Lege Artis Medicinae

[PHYSICAL AND PSYCHOLOGICAL CONDITION OF HEALTH CARE WORKERS DEALING WITH THE SERIOUSLY ILL]

HEGEDÛS Katalin, RISKÓ Ágnes, MÉSZÁROS Eszter

[INTRODUCTION - Health care professionals undertaking treatment/nursing of the seriously ill are equally overburdened emotionally, intellectually and physically. This condition might have several, sometimes irreversible negative consequences: avowed difficulties within the communication with patients, families and colleagues, various harms of accumulating, unprocessed stress, severe physical and psychological symptoms of mental burn-out which is very frequent and failures and difficulties of the private life. In our survey we aimed to gain a realistic image of the physical and psychological condition and quality of life of professionals working in Hungarian clinical care in order to provide with indelayable help. METHODS - The basis of the survey was a version of the Hungarostudy 2002 questionnaire, modified for health care professionals. In our sample there were 200 health care professionals dealing with seriously ill and in the control groups 1356 non health care professionals, and 227 health care professionals, choosen from the Hungarostudy survey. In all three groups the proportion of gender, age and education were the same. The results were analysed by the SPSS 10.0 statistical program and the relationship analysis was completed by ANOVA test. RESULTS - The analysis of the answers of those attending in our questionnaire survey - compared to those working in other health care field and to the control group of non health care workers - proves that the ratio of exhaustion and stress-dependent physical and psychological symptoms are prominently, in many cases significantly higher among health care workers dealing with the seriously ill, addiction is more frequent and social net is more unfavourable. These data are even worse for nurses than for doctors and other graduates. CONCLUSION - In treating difficult cases we can start to help with special education that should be general both in gradual and postgradual training.]

Lege Artis Medicinae

[MAGNETIC RESONANCE IMAGING IN MUSCULOSKELETAL DIAGNOSTICS]

MESTER Ádám

[The aim of the author is present a practical MRI guideline for partners clinicians working in general or specialist patient care related to musculoskeletal diseases. The evidence based diagnostic decision-making process requires specific and realistic expectations related to MRI in daily practice. The focus message of the article is that the more exact and specific clinical question arrives, the more accurate and precise answer of the radiologist is achieved. The importance of detailed clinical information based optimal planning is emphasized versus “general” studies based on poor clinical information. It is not less important for the referring physician to prepare and inform the patient prior to the MRI study, with the exclusion criteria and contrast agent application all explained. Very few technical details are presented, only as little as possible to understand the clinically relevant properties of the imaging process.]

Lege Artis Medicinae

[LIPID-LOWERING THERAPY BASED ON RISK ASSESSMENT]

PARAGH György, BALOGH Zoltán

[The authors’ brief review follows the changes made to therapeutic guidelines based on primary and secondary prevention trials. They describe the main characteristics of National Cholesterol Education Program Adult Treatment Panel-I (NCEP ATP-I), ATP-II and ATP-III, and the decisions of the Hungarian Consensus Conference with respect to the lowering of lipids. The authors highlight the clinical importance of the evaluation of cardiovascular risk factors before the commencement of lipid-lowering therapy. They emphasize the significance of achieving the target values for low-density lipoprotein. Current dyslipidemia treatment guidelines focus on determining coronary heart disease risk status and matching the intensity of plasma LDL-C reduction to that perceived risk. Adding plasma C-reactive protein measurement to current risk assessment techniques may improve the identification of patients in the primary prevention population who may require more aggressive lipid-lowering therapy.]

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Clinical Neuroscience

Mid-term oral isotretinoin therapy causes a predominantly sensory demyelinating neuropathy

ALTUN Yasar, INAN Esra

Aim - The purpose of this prospective study was to investigate whether mid-term treatment with oral isotretinoin may impact peripheral nerve function. Methods - In this study, we included 28 patients with no apparent neurological or neurophysiological findings. The patients received treatment with oral isotretinoin for papulopustular or nodulocystic acne. The patients with normal findings in the first examination were given 1 mg/kg/day oral isotretinoin. Neurological examinations and electroneurographic studies were performed before and 6 months after the onset of isotretinoin treatment. Results - Clinical examinations and electroneurographic evaluations prior to treatment revealed no abnormalities in any of the patients. However, 20 patients (72%) displayed one or more abnormal values in the tested parameters after treatment. Although the mean amplitudes of compound muscle action potential of the ulnar and median nerves did not vary, significant decreases were observed in the mean sensory conduction velocities of median, ulnar, sural, medial plantar, medial dorsal cutaneous, and dorsal sural nerves 6 months after the onset of treatment. Conclusion - Systemic use of isotretinoin may cause electroneurographic changes. Probable electroneurographic alterations may be detected at a much earlier period via dorsal sural nerve tracing when electrophysiological methods used in routine clinical practice cannot detect these changes.

Clinical Neuroscience

[Vinpocetin in neurological diseases]

SZAPÁRY László, KÉSMÁRKY Gábor, TÓTH Kálmán, MISNYOVSZKY Melinda, TÓTH Tímea, BALOGH Ágnes, NAGY Krisztián, NÉMETH György, FEHÉR Gergely

[Introduction - Stroke is the third leading cause of death worldwide (following cardiovascular and cancer mortality) and associated with serious disability for the vast majority of patients. There is no salvage therapy for irreversibly damaged brain areas, improving the circulation of the surrounding hypoperfused territories may be associated with benefitial clinical states. Cerebral hypoperfusion may play a role in the pathogenesis of other kind of neurological diseases, improvement of global circulation may have a preventive effect on these conditions. Aims - The aim of our study was to review the experimental and clinical articles focusing on the role of vinpocetin in different neurological conditions. Results - Vinpocetin appears to have several different mechanisms of action that allow for its antiinflammatory, antioxidant, vasodilating, antiepileptic and neuroprotective activities in experimental conditions. On the other hand, several meta-analysis of the existing studies in acute stroke examining short and long term fatality rates with vinpocetin was unable to assess efficacy. In chronic cerebrovascular patients, vinpocetin improves impaired hemorheological variables, has significant vasodilating properties, improves endothelial dysfunction, neuroimaging studies showed selective increase in cerebral blood flow and cerebral metabolic rate, all of which are potentially beneficial in cerebrovascular disease and may improve cognitive functions. Summary - Based on the above mentioned results vinpocetin plays an important role both in basic research and in clinical management of different neurological diseases.]

Clinical Neuroscience

Stress-induced corticosterone rise maintain gastric mucosal integrity in rats

LUDMILA Filaretova, MARINA Myazina, TATIANA Bagaeva

Background - To investigate contribution of glucocorticoids to the maintenance of gastric mucosal integrity during stress we predominantly used ulcerogenic stress models. Using these models we demonstrated that glucocorticoids released in response to the ulcerogenic stimuli attenuated their harmful action on the gastric mucosa. Purpose - In the present study we hypothesized that mild stressors does not damage the gastric mucosa due to gastroprotective action of glucocorticoids released in response to these stressors. Methods - To verify the hypothesis the effects of normally non-ulcerogenic mild stimuli (15-30 min cold-restraint) on the gastric mucosal integrity have been studied under the circumstances of inhibition of the hypothalamic-pituitaryadrenocortical axis in rats. The hypothalamic-pituitary-adrenocortical axis was inhibited by: 1) fast inhibitory action of metyrapone, inhibitor glucocorticoid synthesis; 2) fast inhibitory action of NBI 27914, the selective antagonist of cortricotropin- releasing factor receptor type 1; 3) delayed inhibitory action of a single pharmacological dose of cortisol injected one week before the onset of stress stimulus. Results - Each of these pretreatments significantly decreased 15-30 min cold-restraint-produced corticosterone levels: 37.2±1 vs 22.5±1.2 (p<0.05) after metyrapone; 52.1±0.9 vs 41.4±1 (p<0.05) after NBI, and 64.2±4.2 vs 16.7±1.5 (p<0.05) after cortisol pretreatment. The inhibition of stress-induced corticosterone rise resulted in an ap - pearance of gastric lesions after the onset of these mild stressors in rats. Conclusions - The results suggest that in rats with inhibited stress-induced corticosterone rise normally non-ulcerogenic stimuli are transformed into ulcerogenic ones and confirm the hypothesis. The findings further support for the point of view that glucocorticoids released during acute stress are gastroprotective factors.

Clinical Neuroscience

[Current questions of multiple sclerosis: the secunder progressive form of the disease]

VÉCSEI László

[Recent data suggest that long-term worsening is common in relapsing-remitting multiple sclerosis patients and is largely independent of relapses or new lesion formation on brain MRI. The current definition of secunder progressive multiple sclerosis is worsening of disability independent of relapses over at least 6-month interval. Early focal inflammatory disease activity and spinal cord lesion are predictors of very-long term disease outcomes in relapse - onset multiple sclerosis. The potential of PET imaging to visualize hidden inflammation in MS brain in vivo is an important contribution for better understanding the progression of the disease. Therefore, PET imaging is a promising tool in detecting the conversion from relapsing remitting multiple sclerosis to secunder progressive form of multiple sclerosis. Furthermore, neuro-axonal damage is the pathological substrate of permanent disability in different neurological disorders including multiple sclerosis. The neurofilament proteins have promise in this context because their levels rise upon neuro-axonal damage not only in the cerebrospinal fluid but also in blood. Patients with increased serum levels of neurofilament at baseline, independent of other clinical and MRI variables, experience significantly more brain and spinal cord volume loss over 2 years and 5 years of follow-up. The kynurenine-pathway abnormalities may be associated with the swich from early-mild stage multiple sclerosis to debilitating progressive forms of the disease. Analysis of these metabolites in serum may have application as multiple sclerosis disease biomarkers. Free radical action has been suggested as a causal factor in the illness. Increased free radical production and consumption of the scavenger molecules were found during the active phase of the disease. Based on the clinical findings (EXPAND Study) and pathomechanism of the disease siponimod is approved by the US Food and Drug Administration for the treatment of relapsing remitting forms of multiple sclerosis, to include secunder progressive multiple sclerosis with active disease, relapsing-remitting multiple sclerosis and clinically isolated syndrome.]

Hypertension and nephrology

[Importance, prevalence and therapy of vitamin D deficiency]

SZABÓ András

[Annual citations in the PubMed database on vitamin D were approximately 5000, this represents a doubling in the last decade and a 20% increase in the last year. There is renewed interest in vitamin D synthesis, metabolism and action. The two principal reasons for increased interest can be: 1. new knowledge regarding the nonhormonal, autocrine, and paracrine actions of 1,25-dihydroxylated vitamin D metabolites in man, 2. the worsening, worldwide trend to vitamin D insufficiency. Clinical vitamin D research in last years has confirmed the presence of a worldwide problem of vitamin D depletion, a problem that appears to be worsening. Largescale population based studies bear out long-held concerns that low serum 25(OH)D levels are associated with a number of adverse outcomes in the human musculoskeletal, innate immune, and cardiovascular systems. In fact, low vitamin D levels are significantly associated with all-cause mortality in the U.S. population and Hungary respectively. It is hypothesized that the global rise in incidence of obesity contributes to the worsening of the problem of vitamin D deficiency, amplifying adverse impacts on the host skeleton, immunoreactivity to microbes, and metabolic status. Finally, it should be remembered that treatment of vitamin D deficiency has two phases: restoration of 25(OH)D levels up to more than 30 ng/ml; and maintenance of the serum 25(OH)D level in that range. The present upper level (UL) of vitamin D intake that is deemed to be safe (2000 IU/day) must be re-evaluated considering data acquired over the past 15 years.]