Lege Artis Medicinae

[Actualities in the epidemiology, diagnostics and therapy of Clostridium difficile infections - a European outlook]

NAGY Erzsébet

FEBRUARY 14, 2014

Lege Artis Medicinae - 2014;24(01-02)

[Despite of the facts that Clostridium difficile has been accepted as an enteral pathogen since 1978 and during the past years we have learned a lot about its pathogenic toxins and about diagnostic possibilites, this pathogen has not attracted major interest until the early 2000s. The rapid increase of nosocomial diarrhoea caused by some hypervirulent ribotypes of C. difficile in a number of countries, followed by the increased number of community-acquired cases and the appearance of new risk factors besides antibiotic-related diarrhoeas have put C. difficile infections (CDI) in the focus of research. The rapid and correct diagnosis of the hospital or community acquired diarrhoeas enables clinicians to discontinue - if possible - the usage of the antibiotic therapy responsible for the symptoms, to start treatment early and introduce hospital hygiene measures as soon as possible. The aim of this article is similar to that of the “CDI Europe Report”, an initiative led by European experts: to draw attention on the importance of C. difficile infections in Hungary and in Europe by summarising the latest epidemiological data, the recommended diagnostic algorithm, therapeutic options and the importance of local and national surveillance and infection control measures in hospitals. Clostri]



Further articles in this publication

Lege Artis Medicinae

[Public health prevention in Hungary II.: established methods, adequate information, real screening results „Comprehensive Health Screening of Hungary 2010-2020” - four-year results]

KISS István, BARNA István, DANKOVICS Gergely, DAIKI Tenno

[In the past 10 years, a number of screening programs with various goals have been started in Hungary, with varying degrees of success. The „Comprehensive Health Screening of Hungary 2010-2020” program has been touring the country (with a screening truck), either joining organised events or as an independent screening, collaborating with local healthcare centers (primary care, occupational healthcare etc). The screening program has been conducted in a special truck, in which various examinations were performed in a set time. Those who participated in the screening received a prevention information pack (for studying and reading at home) and the official publication of the program (Health Book), in which the program and the screening results were described. In the past four years the screening truck has been to 725 places in Hungary and travelled 83,145 kilometers. 87,935 people have participated in comprehensive screening. 194,549 visitors received lifestyle counseling and 142,319 received Prevention Packs. In total 2,901,855 examinations have been performed, which required 6711 hours of work of 1132 healthcare professionals. 5,856,114 answers were given to queries of the survey related to the health status of the Hungarian population. The program has already overfulfiled its original goals to visit 1500 locations and perform 8 million examination during this period. It is of particular significance that the average age of participants was 40 years. As cardiovascular risk is still the leading health risk, screening for such risk factors has to be part of all general and complex screening programs. In this program, an increasing number of validated, rapid and effective risk-estimation tests were used. It is remarkable that 20% of the tests related to colorectal cancer risk has positive results. Also of importance are the test results for hearing loss (7% positive) and various degrees of visual impairment (over 50%). Both results have significant social and economical implications for both individuals and the society. Unfortunately, the general level of health consciousness is still low. This might be improved not only by the screening itself but the opportunity to inform the public and provide organised counselling and printed materials, for which the activity and expertise of professional healthcare worker is essential. ]

Lege Artis Medicinae

[By the Chronicler’s Eyes]

NEMESI Zsuzsanna

Lege Artis Medicinae

[The role of goserelin in breast cancer therapy]

BÁNHEGYI Róbert János, FÜLÖP Ferenc, MELLÁR Erzsébet, PIKÓ Béla

Lege Artis Medicinae

[The Eighth Church ]

NAGY Zsuzsanna

Lege Artis Medicinae

[Promising results about decreasing of cardiovascular mortality with coenzyme Q10 and selenium replacement]


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[Vitamin D treatment: hormone therapy for patients who need it or simply a supplementation for everyone?]


[Various medical associations issue different recommendations for the prevention and treatment of vitamin D deficiency. These significant differences are partly explained by the different definition of normal vitamin D level and the use of completely different mathematical models to predict the increase in vitamin D level as a response to therapy. According to the Institute of Medicine (IOM), the target vitamin D level is 20 ng/ml, whereas the Endocrine Society (ES) recommends 30 ng/m as the miminum target value. According to the ES, a 1 ng/ml increase of vitamin D level can be reached by a daily intake of 100 NE, while the IOM recommends 3.6 ng/ml. Moreover, the IOM states that the effect of therapy on serum level is nonlinear. These differences show that the ES and IOM have different views on the risk of adverse effects. The IOM recommends 400 IU vitamin D daily for children younger than 1 year, 800 IU for those above 70 years and 600 IU/per day for everyone else. The ES recommend 400-1000 IU daily for all infants and 1500- 2000 IU for adults. Screening, however, is not recommended by either society. To decrease uncertainty concerning the side effects of higher-dose vitamin D treatment, it is important to understand, use and support the function of the pharmacovigilance system of the pharmaceutical industry that manufactures and markets various (prescription, over-the-counter) preparations. This is what the author aims to highlight in the second part of this article. Using this system, both the doctor and the patient can help support and accept the justification of higher-dose vitamin D therapy.]

Lege Artis Medicinae


PÁR Alajos

[As the results of antiviral therapy for hepatitis B and C infections are still suboptimal, attention has been given to the strategies to maximize the effectiveness of currently available therapeutic modalities. In this approach, individualized management - based on predictive factors that influence response to treatment - is a key component. The paper summarizes how predictors can assist in optimizing therapy of patients with chronic viral hepatitis. In chronic hepatitis B, a favorable response to interferon or nucleoside/ nucleotide therapy can be expected in young, HBeAg-positive patients with alanine aminotransferase (ALT) values >2-5× upper limit of normal, histological activity >4-10, HBV DNA <105 copies/ml (<20,000 IU/ml), and infection with HBV genotype A or B. Virological response at 12 and 24 weeks (>1 log10 decrease in HBV DNA titer or a titer of <400 IU/ml) may assist in decisions about treatment continuation or switching to another therapeutic option. In chronic hepatitis C, before interferon/ribavirin treatment, non-modifiable predictors are age, sex, race, cirrhosis, HCV genotype and HCV RNA titer. HCV1 genotype is an important negative predictor. Modifiable factors are body mass index, insulin resistance, diabetes, depression and cytopenias, which can be corrected in order to improve the chance of therapeutic success. During treatment, rapid (week 4), early (week 12), or slow (week 24) virological response may determine the duration of treatment (24, 48, or 72 weeks), and predict the likelihood of sustained virological response. Most important positive predictor is rapid response at week 4, similarly complete early response (at week 12) is also of value concerning the duration of therapy and even in the aspect of re-treatment. Body weight-adapted ribavirin dosing and patient adherence are important factors of therapeutic success, as well.]

Clinical Neuroscience

[Epidemiology, cost and economic impact of cerebral palsy in Hungary]

FEJES Melinda, VARGA Beatrix, HOLLÓDY Katalin

[Objective - The purpose of our communication was to determine the total cost of cerebral paretic patients in Hungary between 0 and 18 years and to assess their impact on the national budget. Methods - Based on the data of Borsod county we calculated the CP characteristics. The cost of CP was determined by routine care of individuals. Lost Parental Income and Tax were calculated on the basis of average earnings. The ratio of GDP, Health and Social Budget and Health Budget to CP is based on CP annual average cost and frequency. We have developed a repeatable computational model. Results - Of the risk groups, premature birth (30.97%), low birth weight (29.64%), perinatal asphyxia (19.47%) were the most common. Source is unknown of 37.61% of the cases. CP prevalence was 2.1‰. The two-sided (59.7%) and the one-sided (19.0%) spastic pareses dominated. The most serious form is the two-sided spastic paresis (42.5% GMFCS 3-5 degrees). Epilepsy was 22.0%, incontinence was 27%, mental involvement was 46%. Care for one child up to 18 years of age costs an average of 73 million HUF (€ 251,724). The lost family income was 27.36 million HUF (€ 94,345), and lost tax and health care contributions were 14.46 million HUF (€ 49,862). Additionally, 0.525% of the GDP, 0.88% of the full health and social budget and 1.83% of direct medical costs were spent for CP families. Conclusion - The cost of CP disease is significant. Costs can be reduced by improving primary prevention. From the perspective of the family and government, it is better to care for families so they can take care of their disabled children.]

Clinical Oncology

[Practical use of meta-analyses in predicting disease risk, outcome, and therapy response in breast cancer]

KAHÁN Zsuzsanna, TARI Gergely, ENYEDI Márton, HARACSKA Lajos

[Germinal BRCA status infl uences patient care both in early and advanced/metastatic breast cancer. Ideally, the patient should make the decision on the type of surgery or the avoidance of radiotherapy being aware of the BRCA status; based on the most recent clinical studies, this knowledge may infl uence the type of chemotherapy in the neoadjuvant, adjuvant, or metastatic setting or may raise the use of emerging targeted therapies. DNA-targeting cytostatic agents, mostly platinum agents and PARP inhibitors that act by inducing synthetic lethality, provide specifi c therapies in BRCA-mutant cases. The optimum place and sequence of these specifi c agents in treatment, however, are not known yet. International guidelines promote BRCA testing for the specifi cation of treatment strategy in all HER2-negative advanced/metastatic breast cancer cases (NCCN) or at least in all cases when, based on certain predictors, the presence of mutations is likely (ESMO). Recently, the methods employed for BRCA testing have improved immensely and are widely available through the services of various providers. For the identifi cation of the mutation, sequencing of the whole genes is needed, which can be achieved faster and more cost-effi ciently using next-generation sequencing (NGS) platforms compared to previous methods. It is the responsibility of the physician to consider the possibility of BRCA mutations and to raise the issue of BRCA testing to the patient if the family history, the age, previous malignant disease(s) of the patient, or the cancer features are suggestive of genetic risk.]

Journal of Nursing Theory and Practice

[The nursing aspects of the use of Point of Care Testing laboratory diagnostics]


[Aim of the study: The author’s aim was to present the Point of Care Testing (POCT) laboratory diagnostic methods used during the treatment of emergency cases, on the basis of feedback from paramedical professionals. The survey also investigated the opportunities using the procedure more widely, in keeping with the specifi c professional requirements of the various departments. Methodology and sample: The data was gathered in Budapest, at various departments of the Hungarian National Defence Hospital. A name-based sampling method was used, and the quantitative research involved a prospective cross-sectional, descriptive correlation study using an internet-based questionnaire survey. Results: Based on the opinions of paramedical professionals at the surveyed departments, a signifi cant difference was demonstrated in the ranking of the types of POCT clinical tests. The procedure proved to be exceptionally useful in the treatment of acute cases, although the perception of its effectiveness differed between departments. Conclusions: Priority needs to be given to propagating the theoretical aspects and deepening the practical skills related to POCT clinical procedures. Based on a complex survey of several departments, the POCT procedures proved to be quick, accurate and economical, provided that the paramedical professionals have the appropriate theoretical grounding.]