Lege Artis Medicinae

[Christmas in Medicine ]

KISS László

DECEMBER 21, 2011

Lege Artis Medicinae - 2011;21(12)

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Lege Artis Medicinae

[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.]

Lege Artis Medicinae

[They are really saved]

FARSANG Csaba

Lege Artis Medicinae

[Bedside decision making - Prognostic functions]

VOKÓ Zoltán

Lege Artis Medicinae

[The newest DPP-4-inhibitor: linagliptin]

KIS János Tibor

[Linagliptin is a xantin-based, highly selective, potent inhibitor of dipeptidyl peptidase- IV (DPP-4). By inhibiting DPP-4, linagliptin reduces the degradation of endogenous incretin hormones, and thus increases insulin secretion and decreases glucagon secretion in the pancreatic islets in a glucose-dependent manner. The author summarises the most important clinical trials with linagliptin, which highlight those features of linagliptin that distinguish it from other DPP-4 inhibitors.]

Lege Artis Medicinae

[Genomics, the science of biological complexity]

FALUS ANDRÁS

All articles in the issue

Related contents

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.

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. ]

Lege Artis Medicinae

[Medicine: a Ship on the Sea of Culture – The “Cheap Drug Debate” and its Cultural Aspects]

BÁNFALVI Attila

Clinical Neuroscience

[The role of zonisamide in the management of pediatric partial epilepsy]

ROSDY Beáta, KOLLÁR Katalin, MÓSER Judit, MELLÁR Mónika

[In our review we discuss the group of approved antiepileptic drugs for children in Hungary. We cite the results of the review conducted by the International League Against Epilepsy on antiepileptic drug efficacy and effectiveness as initial monotherapy for newly diagnosed epileptic seizures and syndromes in pediatric age group. 25% of pediatric epilepsy is therapy resistant, so we further need new drugs, which must be investigated according to the rules of the European Medicine Agency. The ethical dilemmas of childhood drug studies lead to the situation that the new antiepileptic drugs, approved as monotherapy in adult epilepsies, are in the majority just in add-on regimen tested in pediatric patients. As clinicians we appreciate open label extension safety studies. An old-new antiepileptic drug in Europe is zonisamide. Though it was approved for first line monotherapy in pediatric and adult patients with partial and generalised epilepsy in 1989 in Japan, the European Medicine Agency licensed its use as adjunctive therapy in children aged 6 years or older with partial seizures (with or without secondary generalisation) just in 2013. The results of the openlabel extension study appeared in 2014. The mean dose received was 7.5 mg/kg/day. During the open label phase 11% of the patients achieved seizure freedom and it was maintained throughout the study. The drug was generally well tolerated. The most frequently reported treatment-related adverse events were decreased weight (6%), decreased appetite (4%), and headache (2%). No new or unexpected side effects emerged. In conclusion oral zonisamide as adjunctive therapy in pediatric patients aged 6-17 years with partial seizures demonstrated an acceptable safety and tolerability profile and efficacy over a period at least 1 year. So it is a good treatment option in this population.]

Lege Artis Medicinae

[Medicine: Development, Successes and Issues – James Le Fanu: The Rise and Fall of Modern Medicine ]

BUDA Béla