Lege Artis Medicinae

[Action on Secondary Prevention through Intervention to Reduce Events]

MATOS Lajos1

MARCH 01, 2000

Lege Artis Medicinae - 2000;10(03)

AFFILIATIONS

  1. Gottsegen György Országos Kardiológiai Intézet

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Further articles in this publication

Lege Artis Medicinae

[The role of coronary artery revascularization in the management of heart failure and systolic left ventricular disfunction]

LENGYEL Mária

[Ischemic heart disease accounts for about 70% of chronic systolic heart failure and severe systolic left ventricular dysfunction. Prognosis of ischemic heart failure is worse than that of non-ischemic heart failure and can only be moderately improved with optimal drug treatment. Further improvement may be expected from revascularization in the presence of reversible left ventricular dysfunction which is called myocardial viability. Viability associated with chronic left ventricular dysfunction is caused by hibernation. Low dose dobutamine stress echocardiography is the best imaging modality to predict the improvement of left ventricular function after revascularization. Myocardial contrast echocardiography can further improve the diagnostic value of dobutamine echocardiography. The disadvantage of nuclear imaging methods for the diagnosis of viability is their low specificity. Revascularization surgery improves left ventricular function and survival when the amount of viable myocardium is adequate. However, the non-revascularized viable myocardium is an unstable condition which can effect the prognosis adversely. Although there are no randomized studies, coronary bypass surgery is considered indicated for severe left ventricular dysfunction if the viability of the myocardium and the operability of the coronary arteries are estabilished, even in the absence of angina. To establish these criteria for revascularization imaging studies (preferably low dose dobu tamine stress echocardiography) and coronary angiography are required. ]

Lege Artis Medicinae

[The microbiology pharmacokinetics and clinical use of carbapenems]

BÁN Éva, PRINZ Gyula

[ Imipenem and meropenem the two currently available carbapenems inhibit the synthesis of the cell wall similarly to other bactericidal B-lactam antimicrobials. These agents have excellent activity against the vast majority of aerobic and anaerobic Gram-positive and Gram-negative organisms. In addition to other B-lactam resistant microbes (e.g. Chlamydia, Mycoplasma) only Stenotrophomonas maltophilia and Enterococcus faecium bacteria are naturally resistant to carbapenems. Carbapenems are extremely stable compounds against nearly all types of B-lactamases: from the penicillinase of Staphylococcus to Class A and Class B types of B-lactamase enzymes of Gram-negative bacteria. Secondary resistance against carbapenems was described in case of the following bacteria: penicilline resistant S. pneumoniae, methicilline resistant Staphylococcus aureus, Pseudomonas aeruginosa, Enterobacter cloaceae, less frequently Enterobacter aerogenes, Serratia mercescens, Klebsiella pneumoniae and Acinetobacter baumannii. The pharmacokinetic profile of imipenem and meropenem are very similar. Carbapenems are valuable as empirical monotherapy due to their broad spectrum of antimicrobial activity and ß lactamase stability in the treatment of severe nosocomial infections, lower respiratory tract or intraabdominal infections and febrile neutropenia. The use of imipenem in central nervous system infection is not approved due to the high incidence of seizures. ]

Lege Artis Medicinae

[Confined placental mosaicism and uniparental disomy]

PAPP Zoltán, BODA Anikó

[Chromosomal mosaicism is defined as the presence of two or more cell lines having different chromosomal complements in the same individual. In the conceptus the extent of the mosaicism depends on the timing of chromosomal mutation occurance, the cell lineage affected, and the viability of the mutation. The resultant mosaicism can be either generalized, confined placental or confined embryonic. The process of the loss or removal of one of the three chromosomes from the trisomic conception, at least from the cells that will form the proper fetus is known as trisomic zygote rescue. As the result of this phenomenon, the embryo/fetus becomes disomic, while the placental compartment remains trisomic or mosaic. After losing a chromosome, the remaining pair might originate from the same parent. The presence of two chromosomes from one parent in a disomic cell line is termed uniparental disomy. Uniparental disomy is one form of aberrant origin for disomic cells, and the term „pseudodisomy" is also used. Uniparental disomy can involve homozygosity for the chromosome, and the term ,,isodisomy" has been suggested for this phenomenon. If the homozigosity for the chromosome is not complete, the term „heterodisomy" is used. Depending on the pathologic chromosome, the clinical consequences of the confined placental mosaicism and uniparental disomy can be intrauterine and/or postnatal growth restriction, spontaneous abortion. Increased perinatal morbidity and mortality, minor congenital malformations can result from the phenomena. Confined placental mosaicism and uniparental disomy are well known in syndromatology too. The connections of mosaic trisomy 7 and Silver-Russell syndrome, mosaic trisomy 15 and Angelman syndrome, mosaic trisomy 15 and Prader-Villi syndrome are described. Due to the presence of aneuploid cells in the placenta, confined placental mosaicism may cause placental dysfunction, hydropic degeneration of the placenta or „unexplained" highly increased serum hCG level. ]

Lege Artis Medicinae

[Home management of chronic obstructive pulmonary disease]

MÜHLBACHER Szilvia, VADÁSZ Imre

[Cessation of smoking is the primary condition for the successful management of COPD. The aim of pharmacotherapy is to diminish symptoms (dyspnoe, cough and expectoration) to increase cardiorespiratory performance and to improve the quality of life. Pharmacotherapy is based upon administration of bronchodilators (anticholinergic and beta-agonist preparations as well as theo phyllin). In the case of acute exacerbation anti- biotic treatment is indicated. Effectiveness of inhalative corticosteroids is not established well yet, whereas the oral and parenteral administration of corticosteroids is limited by severe side effects. In the advanced stage of disease long term oxygen therapy can increase survival and improve the quality of life. Respiratory rehabilitation is an essential component in the management, it facilitates expectoration and corrects respiratory technique, increases muscular force and performance, improves quality of life. Active cooperation of patients is necessary for the successful management of the desease; the patient should be informed on the particulars of the disease and on the required contribution.]

Lege Artis Medicinae

[Why are there more asthmatic children?]

ENDRE László

[Data for prevalence of asthma in children are presented from different countries of the world in 1998 and 1999. The disease is observed very frequently everywhere. Prevalence of asthma in children in Budapest increased from 1,88+0,87% to 2,26+0,95% between 1995 and February of 1999, as diagnosed by medical doctors. The increased prevalence (20%) could not be explained with the worsening of the city's air pollution (NO2, CO2, CO, ozone and particulate matter), or with the considerable increase of the pollen count of allergising plants. During the same 4 years the number of live births in Hungary decreased by 13%. The author discusses a few factors that may play an important role in the increasing frequency of asthma, and gives recommendations for slowing down the trend.]

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[The connection between the socioeconomic status and stroke in Budapest]

VASTAGH Ildikó, SZŐCS Ildikó, OBERFRANK Ferenc, AJTAY András, BERECZKI Dániel

[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

Lege Artis Medicinae

[A short chronicle of three decades ]

KAPRONCZAY Katalin

[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]

Lege Artis Medicinae

[History of vaccine production in Hungary ]

ÓCSAI Lajos

[This study presents the complete history of the Hungarian vaccine production, partly in association with the process of fighting vaccine-preventable infectious diseases, and underlines the fact that every government actively contributed to the age-adjusted mandatory vaccination schedule of the past 140 years. It demonstrates the various achievements from the smallpox lymph production through the launch of diphtheria serum production at Phylaxia and the establishment of the National Public Health Institute (OKI) with its vaccine production and the later institutional transformation of OKI into Humán as economic corporation to its closure. Among all OKI’s vaccine production activities, this study focuses on the production of influenza vaccines, due to its international importance in the 1960s and 1970s. The vaccine production against diphtheria tetanus and pertussis stands out from Humán’s activities, and the tetanus component of this vaccine is still used in the products of a multinational vaccine manufacturer. ]

Lege Artis Medicinae

[Risk of nonsteroidal antiinflammatory drugs. Focus on aceclofenac]

FARSANG Csaba

[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deterio­rate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable.]

Clinical Neuroscience

[Is the implementation of Vojta therapy associated with faster gross motor development in children with cerebral palsy? ]

SANZ-MENGIBAR Jose Manuel , MENENDEZ-PARDIÑAS Monica , SANTONJA-MEDINA Fernando

[Vojta therapy has been reported as clinically beneficial for strength, movement and gross motor activities in individual cases and is being included within the second of three levels of evidence in interventions for cerebral palsy. The goal of this study is to understand the effect of Vojta therapy on the gross motor function. Our clinical trial followed a one group, pre-post design to quantify rates of changes in GMFM-88 after a two-months period undergoing Vojta therapy. A total of 16 patients were recruited. Post-intervention acceleration rates of GMFM-88-items acquisition (0.005; p<0.001) and Locomotor Stages (1.063; p<0.0001) increased significatively following Vojta the­rapy intervention. In this study, Vojta therapy has shown to accelerate the acquisition of GMFM-88-items and Loco­motor Stages in children with cerebral palsy younger than 18 months. Because functional training was not utilised, and other non-Vojta therapy intervention did not influence the outcome, Vojta therapy seems to activate the postural control required to achieve uncompleted GMFM-88-items. ]