Lege Artis Medicinae

[Antibiotics from the rood nodules]

KOVÁCS Ferenc

MARCH 20, 2019

Lege Artis Medicinae - 2019;29(03)

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Lege Artis Medicinae

[Psychology of machiavellism - ruthless tactics]

BRYS Zoltán

[This type of man, who pursues his goals in a cold, manipulative and tactical way, has long been a subject of interest to psychologists. The Jungian Trickster is probably a similar character: the hyper-rational archetype endowed with various deceptive tactics, can be found in most mythologies. He is sometimes a kindly, likeable character, but often ruthlessly cunning. Later, Erich Fromm defiend the Exploitative Orientation: for such a person, Fromm says, all the sources of good are outside the self; he is characterised by caprice, violence, exploitation and exploitation wherever he can, distrust and cynicism...]

Lege Artis Medicinae

[From disease-centrism to P4 medicine - a route to a health system placing the human “wholeness” into the center]

VÁLYI Péter

Lege Artis Medicinae

[Medicine at the crossroads]

OBERFRANK Ferenc

Lege Artis Medicinae

[Five nine year results of „Comprehensive Health Screening of Hungary 2010-2020-2030”]

BARNA István, DAIKI Tenno, KÉKES Ede, DANKOVICS Gergely

[2010 a new, complex screening program started in Hungary, named Nationwide Comprehensive Health Protection Screening Program in Hungary 2010-2020-2030. The screening was installed on a specially furnished lorry, which is able and will be able to get anywhere from big cities to the smallest villages. The Program as part of the “Heart and Vascular National Program” works with the support of 74 professional-scientific societies and companies. The screening program took place in a specially furnished lorry. The lorry has an easy access to the disabled, operation was performed with the quality control and permission of ÁNTSZ. Near the lorry there were activities for the preservation of health and prevention of illnesses. Within the framework of the Program in the largest mobile diagnostics center in Hungary 37 comprehensive surveys in free form. This enormous special screening station allows 5,100 tests to be performed at each of the 200 screening stations nationwide. The screening program for over 20 years provides 15 million trials on 3,000 scenes and 1 million adult visitors in free humanitarian. The European National Health Program and the National Program for the Prevention and Treatment of Car­dio­vascular Diseases co-ordinated by the Asso­ciation of Hungarian Medical Asso­ciations (MOTESZ) are implemented by con­sensual cooperation. Based on the results, it was re-confirmed that Hungarian population belonged to the high risk group in several aspects. Authors also outlined solution plans for general risk reduction and disease prevention. ]

Lege Artis Medicinae

[The atherosclerosis can not only be prevented, but also can be cured ]

MÁRK László

[The process of atherosclerosis nowadays plays an important role in the health care not just as a major cause of the most common cardiovascular diseases which lead to death, but also as a major factor in the loss of age-related elasticity in the blood vessels. Over the past two decades, large studies have shown that the treatment of high cholesterol levels can reduce the frequency of cardiovascular events and death and have confirmed the ability to reduce the already existing atherosclerotic plaque, which is almost unique in pharmacotherapy. Using lipid lowering therapy, if we do it properly, we can not only prevent vascular events, but can also cure atherosclerosis. Currently there are three drug groups (statins, ezetimibe and PCSK9- inhibitors), which have complete evidence that their use can reduce the number of cardiovascular events and plaque regression can be achieved. Despite many convincing clinical trials, lipid-lowering therapy is on the cardiovascular prevention palette in the just tolerated or forced applied category. In order to take advantage of its potentials at an appropriate level, as doctors, we have to approach to it by considering its importance. We should communicate to our patients that it’s about a life-long treatment, which not only can reduce the possibility of cardiovascular events, but also can slow down the aging process of the arteries. ]

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Lege Artis Medicinae

[Negative pressure wound care while covid-19 pandemic: treatment of necrotizing fasciitis and retroperitoneal abscess]

ZÁDORI Gergely, SUSÁN Zsolt, TÓTH Csaba Zsigmond, TÓTH Dezső, SZENTKERESZTY Zsolt

[Necrotizing fasciitis is a rare and high mortality condition. Most commonly it is spreading in the extremi­ties, abdominal wall soft tissues and perineal region, but occurs rarely in the retroperitoneal space too. Primary treatment is debridement with administered antibiotics, supported by negative pressure wound care. The present case report concerns a successful treatment of an extensive necrotizing fasciitis spreading from the hip region and ending up in a retroperitoneal abscess. A gradually increasing, painful, ulcerated swelling developed in the patient’s right hip region. On the first examination, elevated laboratory markers of inflammation were identified while the necrotizing lesion raised concerns of sarcomatic background. Initially, we started antibiotics and took tissue samples. The prompt CT scan confirmed a large abscess complex involving also the retroperitoneal space. The surgical exploration verified a typical necrotizing fasciitis and after removing debridement negative pressure wound care was started. After 14 days of this treatment the patient recovered successfully. Negative pressure wound therapy is pivotal in the treatment of necrotizing fasciitis. The number of wound dressings and of medical staff – patient contacts can be significantly reduced by this me­thod. It has a major advantage in the COVID-19 pandemic, since minimalizing close contacts is of vital importance in controlling the spread of the virus.]

Clinical Neuroscience

Nerve conduction study and gastrocnemius H reflex response in rheumatoid arthritis

EMRE Ufuk, ORTANCIL Özgül, UNAL Aysun, KIRAN Sibel, SAPMAZ Perihan, ATASOY Tugrul

Objectives - We aimed to evaluate nerve conduction studies and gastrocnemius H reflex responses in rheumatoid arthritis (RA) patients and compared to the healthy adult subjects. Materials and methods - Twenty-six RA patients and twenty-two healthy adult subjects were included in the study. The nerve conduction study (NCS) findings and bilateral gastrocnemius H reflex responses were evaluated in all the groups. Age, gender, subcutaneous nodules, joint deformities, laboratory parameters, duration of disease, anti-rheumatic drug and steroid usage were recorded. Activity of disease was assessed using a 28-joint disease activity score (DAS28).The functional status was measured using the health assessment questionnaire (HAQ), pain intensity measured using a visual analog scale (VAS). Results - The rate of electroneuromyographic (ENMG) abnormalities was 73% in RA patients. The most common diagnosis was carpal tunnel syndrome (61.4%). There were no significant correlations between ENMG findings and clinical and laboratory features evaluated. Right H reflex latencies were statistically longer in RA patients (p=0.03). According to calculated cut-off levels, there were more subjects with longer H reflex latencies in RA patients. Conclusions - In this study, entrapment neuropathies were found common as independent identity from duration and severity of disease in RA patients. For H reflex latencies, cut-off values were longer in RA patients. It may provide information about the early neuropathic involvement of long peripheral nerves in RA patients. But this findings are needed to be supported by larger population study.

LAM Extra for General Practicioners

[Changes in infectology over the past two decades]

SZALKA András

[Infectious diseases and various infections are the major causes of morbidity and mortality in developing as well as in industrialised countries. Despite the advances in the past decades in our understanding of microbes, efficient treatment of diseases and preventive approaches, more than 13 million people die every year due to infectious diseases. In the past two decades, more and more new pathogens and infections diseases have been emerging and old diseases that were almost forgotten have re-emerged. There are many new diseases for which we do not have or have hardly any efficient antimicrobial drugs and no efficient vaccines. Despite an increasing frequency of multi- and panresistant microbes, the development of new antibiotics to be used against these infections is unlikely to occur in the near future. The big pharmaceutical companies have stopped the research of antibiotics. In this situation, the only option we have is to use antibiotics rationally and to take prevention and control of infections seriously, both in the outpatient system and in hospitals. Preserving the effectiveness of currently used antibiotics is in everyone’s interest and is everyone’s responsibility]

Lege Artis Medicinae

[In the focus: antibiotics]

SZALKA András

Lege Artis Medicinae

[Genetic background of thyroid cancers]

HALÁSZLAKI Csaba, LAKATOS Péter, KÓSA P. János, BALLA Bernadett, JÁRAY Balázs, TAKÁCS István

[Molecular genetics has become an indispensable diagnostic tool in a number of diseases. The most frequent thyroid tumours are associated with genetic alterations that might be used for diagnostic purpose in the future. Somatic mutations and rearrangements in BRAF, RAS family RET/PTC and PAX8/PPAR-gamma genes may occur in papillary and follicular thyroid carcinomas. Other mutations of the RET gene can be found in medullary carcinomas (in sporadic as well as hereditary types), whereas mutations of the genes TP53, RAS, and BRAF are associated with poorly differentiated and anaplastic carcinomas. At present, the most reliable diagnostic tool for the differential diagnosis of thyroid nodules is fine-needle aspiration cytology. However, the existing malignancy cannot be unequivocally proven in up to 10-40% of all samples. On the basis of previous results, genetic examination of fine needle aspiration samples from thyroid nodules can contribute to a more precise diagnosis and the timely removal of potentially malignant nodules.]