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

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

VÁLYI Péter

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 modern therapy of lipid disorders in the daily practice ]

REIBER István

[Elevated LDL-C and/or triglycerides and decreased HDL-C levels contribute to development of vascular lesions. In the absence of detectable vascular disease the lipid values of providing vascular protection preferably with a healthy diet, regular physical activity and by trying to get out of harmful passions. If the healthy lifestyle is not effective enough, lipid-lowering medication may also be necessary in primary prevention. In the cases of inherited lipid disorders and in patients with high or very high cardiovascular risk it is necessary to take lipid lowering medications in effective dose. The Hun­ga­rian and the international guidelines have been formulated the targets of lipid values for vascular protection. The paper is trying to help for everyday medical practice, how to treat the dyslipidemic patients with the application of widely available lipid parameters and lipid lowering medications effectively. ]

Lege Artis Medicinae

[Is it necessary? - Opinions and experiences about a first aid programme for children - pilot study]

BÁNFAI Bálint, PANDUR Attila, SCHISZLER Bence, RADNAI Balázs, BÁNFAI-CSONKA Henrietta, BETLEHEM József

[INTRODUCTION - Starting first aid education in early childhood can be an effective method of knowledge transfer. AIM - Our aim was to examine first aid education related opinions of kindergarten- and primary school children, educators, and parents. MATERIALS AND METHODS - 871 people (children, educators, parents) were involved in our study. Opinions were measured with self-administered questionnaires, containing mainly open questions. RESULTS - General opinion of parents and educators on first aid education in childhood were mainly positive, but they also gave negative ones. The majority of participants had a positive opinion about our completed program. Based on the opinions of parents and educators first aid education is recommended by health care professionals. Opinions were independent from gender, age, lenght of time of working with children in all cases (p>0.05). CONCLUSIONS - General opinion of parents and educators was varied, but it was generally positive concerning our program. Based on this results opinions can be changed with concrete activities. ]

Lege Artis Medicinae

[Psychology of machiavellism - ruthless tactics]

BRYS Zoltán

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[The choice of antibiotic therapy from the viewpoint of an economist]

KIS Zoltán

[OBJECTIVES - Antimicrobial resistance (AMR) in various bacterial infections is a growing problem in everyday clinical practice. The development of resistance is related to the clinical use of antibiotics, which substantially influences the efficiency of antimicrobial therapy. Inappropriately chosen therapy may increase the cost of treatment because of reduced efficacy and potential unwanted outcomes, adverse effects. Prolonged duration of treatment and increased use of diagnostic and therapeutic resources (including all medication expenses) contribute to the increased costs of treatment. The aim of our study was to demonstrate the differences in the total cost of therapy during hospitalization in certain patient groups, depending on the efficiency of the chosen antibiotic therapy. METHODS - We examined acute abdominal episodes, which represent one of the most typical surgical diseases. We analysed 59 hospital in-patient episodes that occurred in a six-month period, using aggregated hospital data. On the basis of the first choice of antibiotic we compared the average duration of antibiotic therapy and hospital stay, the incidence of medical complications and the cost of all these factors. RESULTS - The available results of our pilot study show that the length of hospital stay and the total cost of treatment may substantially increase even in the short term as a result of an inadequate choice of antibiotic, as the total cost of treatment is affected not only by the daily cost of antibiotic therapy, but also by its efficiency. In the long term, the risk of potentially developing resistance also necessitates an accurate choice of therapy, which requires institutional infection control and the prescription and implementation of protocols. These must be supported by cost-effectiveness analyses that include costs as well as results.]

Clinical Neuroscience

[Traumatic prepontine tension pneumocephalus (in English language)]

KUNCZ Ádám, ROOS Arne, LUJBER László, HAAS Daniella, REFAI Mohamed Al

[Objective - A case of prepontine tension pneumocephalus after temporal bone fracture is presented. Case report - An 8-year-old girl suffered a head injury due to a fall off her bicycle. She lost her consciousness, and when she was admitted to the local hospital the Glasgow Coma Score (GCS) was 8/15 (eye opening: 2; verbal answer: 2; motor response: 4) and there was bleeding from the right ear. The patient's condition deteriorated rapidly and she needed intubation and ventilation. CT of the brain revealed large amount of air in the prepontine region, displacing the brainstem posteriorly. Patient was kept ventilated, meanwhile cerebrospinal fluid (CSF), as otorrhea appeared on the right side. CT was repeated 36 hours later, showing significantly less air in the prepontine area. The patient was weaned off the respirator, extubated and the level of consciusness improved. Later the patient developed meningitis, which was treated by systemic antibiotics with lumbar CSF drainage applied for five days. A high resolution CT scan of the petrous bone revealed a fracture crossing the middle part of the pyramid. Patient showed a full recovery except a right-sided mixed hearing loss. Conclusion - Rapid neurological deterioration following head injury can be a consequence of tension pneumocephalus. Prepontine pneumocephalus can be caused by minor fracture of petrous bone. High resolution CT is necessary to visualize minor fracture of the petrous bone. Conservative treatment may be satisfactory to treat tension hydrocephalus.]

Lege Artis Medicinae

[ANTIBIOTIC TREATMENT OF SKIN AND SOFT TISSUE INFECTIONS - THE USE OF RESPIRATORY FLUOROQUINOLONS]

MAGYAR Tamás

[The paper reviews the classification and grading of skin and soft tissue infections and their most common pathogens. The recommended antibiotics are itemized taking into account their antibacterial and pharmacokinetic properties and side effects. The use of levofloxacin, an antibiotic that have so far been almost exclusively given in respiratory tract infections, is noted as a new therapeutic option. In unusually severe infections hospitalisation of the patient can be avoided since levofloxacin can also be prescribed by general practitioners. Both published data and the author's own experience suggest that levofloxacin may gain a prominent role in the treatment of skin and soft tissue infections both in primary and specialist care.]

Hungarian Radiology

[Xanthogranulomatous cholecystitis]

BERÉNYI Zsolt, MORVAY Zita, PALKÓ András

[INTRODUCTION - The xanthogranulomatous cholecystitis is a rare and benign form of lesions associated with diffuse thickening of the gall bladder wall. It is important to recognize it radiologically because it can be mistaken easily for gall bladder carcinoma. The characteristic US, CT and MR findings, however, may be helpful in the differential diagnosis. CASE REPORT - We present the cases of two middleaged female patients suffering from right upper quadrant, radiating abdominal pain for several weeks without occurrence of fever. In both patients, the ultrasound examination revealed marked thickening of the gall bladder wall containing hypoechoic nodules. Further, non-specific sign such as cholecystolithiasis and fine infiltration of the adipose tissue surrounding the gall bladder and dilatation of extrahepatic or intrahepatic bile ducts were visible. On the post contrast CT images, rim enhancement was detectable. MR/MRCP examination showed a sharp delineation of the gall bladder from the liver parenchyma. Both patients underwent cholecystectomy. The pathological examination excluded malignancy and confirmed the diagnosis of xanthogranulomatous cholecystitis. CONCLUSION - The characteristic features of xanthogranulomatous cholecystitis (hypoechoic xanthogranulomas in the markedly thickened gall bladder wall and the presence of calculi) can be detected by ultrasound examination. CT or MRI may play an important role in confirmation of the diagnosis of an inflammatory process and provide useful information in exclusion of gall bladder carcinoma.]

Hungarian Radiology

[Atypical breast cyst: problems of differential diagnosis]

PAPP László, KOVÁCS Zsolt, SZABÓ Éva, MINIK Károly, ANTALFI Bálint, BENDE Sándor

[INTRODUCTION - Cystic breast masses detected by ultrasound can be devided into several groups upon their morphology. One of them is the group of progressive atypical cysts. CASE REPORT - A young female patient presented multiple palpable nodules in the central part and in the upper-medial quadrant of the left breast. Ultrasound examination showed cystic lesions of middle size and with smooth walls. The cytological results of two consecutive punctures of the cyst was C2, consistent with acute inflammatory hemorrhagic cystic content. The patient was followed up by ultrasound, which 4-6 months later demonstrated considerable progression in size and morphological changes of the cysts. The presence of intracystic nodules and the pericystic solid lesions made the use of MRI examination justified but it couldn’t exclude the possibility of multicentric malignancy. The breast team decided the excision of the cystic lesions, at first. The biopsy revealed multiple intraductal and intracystic papilloma surrounded by normal breast tissue. CONCLUSION - Considering the problems of differential diagnosis which raised the suspicion of similar morphological histological entities (intracystic papillar carcinoma, adenoid cystic carcinoma, DCIS) surgery was justified. According to the authors’s suggestion, despite of the frightening morphological, radiological and clinical status, the less radical surgery should be performed.]