Lege Artis Medicinae

[An Instant Culture Demands for Medicine – An Interview with Béla Buda]

NAGY Zsuzsanna

JUNE 20, 2011

Lege Artis Medicinae - 2011;21(06-07)

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Lege Artis Medicinae

[Bedside decision making - Diagnostic functions]

VOKÓ Zoltán

Lege Artis Medicinae

[Throat catarrh]

GERLINGER Imre

Lege Artis Medicinae

[Sugar as a Medicine in the Arabic Middle Ages]

BECHER Péter, PATAI Árpád, MÁJER Katalin

Lege Artis Medicinae

[Oral allergy syndrome in childhood]

CSIMA Eszter, CSERHÁTI Endre, MEZEI Györgyi

[As the prevalence of pollen allergy is increasing, the incidence of oral allergy syndrome is becoming more frequent. We expect, therefore, an increasing incidence of this syndrome among in children as well. The prevalence of oral allergy syndrome among adults with birch pollen allergy is estimated to be 20-70%. The prevalence of the disease among children is currently unknown. The aims of our study were to identify the characteristics of oral allergy syndrome in children and to assess its frequency. In order to identify children with oral allergy syndrome, we have used the children’s medical history, measured total IgE and serum specific IgE levels, performed skin prick tests and food challenge tests. Among the 743 children suffering from allergic rhinitis and/or bronchial asthma we found 463 children with pollen allergy, 6 of who had oral allergy syndrome. Thus, the prevalence of oral allergy syndrome among children with pollen allergy was 1.3%.]

Lege Artis Medicinae

[From the medical aspect]

BÁNFALVI Attila

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[Vigilance for Drug Safety: the SCOPE Project – An Interview with Mick Foy, Pharmacovigilance Working Group Leader of the British Medicines Authority (MHRA) ]

CZIGLÉNYI Boglárka

Clinical Neuroscience

[Decisional collisions between evidence and experience based medicine in care of people with epilepsy]

RAJNA Péter

[Background – Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose – To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods – Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results – There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology – including genetic background –, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion – Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions. ]

Clinical Neuroscience

A case with reversible neurotoxicity induced by metronidazole

EREN Fulya, ALDAN Ali Mehmet, DOGAN Burcu Vasfiye, GUL Gunay, SELCUK Hatem Hakan, SOYSAL Aysun

Background - Metronidazole is a synthetic antibiotic, which has been commonly used for protozoal and anaerobic infections. It rarely causes dose - and duration - unrelated reversible neurotoxicity. It can induce hyperintense T2/FLAIR MRI lesions in several areas of the brain. Although the clinical status is catastrophic, it is completely reversible after discontinuation of the medicine. Case report - 36-year-old female patient who had recent brain abscess history was under treatment of metronidazole for 40 days. She admitted to Emergency Department with newly onset myalgia, nausea, vomiting, blurred vision and cerebellar signs. She had nystagmus in all directions of gaze, ataxia and incompetence in tandem walk. Bilateral hyperintense lesions in splenium of corpus callosum, mesencephalon and dentate nuclei were detected in T2/FLAIR MRI. Although lumbar puncture analysis was normal, her lesions were thought to be related to activation of the brain abscess and metronidazole was started to be given by intravenous way instead of oral. As lesions got bigger and clinical status got worse, metronidazole was stopped. After discontinuation of metronidazole, we detected a dramatic improvement in patient’s clinical status and MRI lesions reduced. Conclusion - Although metronidazole induced neurotoxicity is a very rare complication of the treatment, clinicians should be aware of this entity because its adverse effects are completely reversible after discontinuation of the treatment.

LAM Extra for General Practicioners

[The impact of vitamin D in infertility and the role in pregnancy and in nursing period]

SPEER Gábor

[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, the target vitamin D level is 20 ng/ml, whereas the Endocrine Society recommends 30 ng/m as the minimum target value. These differences show that the two Society have different views on the risk of adverse effects. Screening, however, is not recommended by either society. In this review I summarize the role of the vitamin D supplementation in the prevention of infertility. Also, I suggest the protective effect of the vitamin D during the pregnancy. In my opinion screening program against D hypovitaminosis should be performed in case of infertility and in pregnancy, because data show a protective role of vitamin D against many disease of newborn. ]

Lege Artis Medicinae

[Striving for Completeness Basics of Internal Medicine, I-II.]

HORVÁTH Csaba