Lege Artis Medicinae

[Csontváry, the Painter of the “Way of the Sun” ]

CZEIZEL Endre

APRIL 20, 2013

Lege Artis Medicinae - 2013;23(03-04)

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Lege Artis Medicinae

[Comment on the article „Public health care prevention in Hungary: are we doing what we should?”]

PÉTER Árpád, KISS István

Lege Artis Medicinae

[Ferenc Keresztúri, Professor of Medicine at the Moscow University ]

V. MOLNÁR László

Lege Artis Medicinae

[A new option in insulin therapy that decreases the risk of hypoglycaemia]

BECHER Péter, MÁJER Katalin, PATAI Árpád

[Insulin degludec is a novel, ultra-long acting basal insulin analogue with a safety and efficacy similar to those of insulin glargine. Its main advantage is its ability to significantly reduce hypoglycaemia, particularly nocturnal hypoglycaemia. We present in detail the results of the BEGIN clinical studies with degludec.]

Lege Artis Medicinae

[The Museum of Fine Arts’ Spring Exhibitions ]

NAGY Zsuzsanna

Lege Artis Medicinae

[Detection of endemic MRSA colonisation in a retirement home]

STÁNITZ Éva, TOMPITY Tünde, UNGVÁRI Erika, PÁSZTI Judit

[Methycillin-resistant Staphylococcus aureus (MRSA) colonisation was proved in a retirement home. A resident of the social institution (a 83-year-old man) was hospitalised and was cared for in a ward where a patient positive for MRSA was treated. Screening tests of the above mentioned resident, one of his room-mates at the retirement home as well as three of the four nurses being on duty at the weekend when the man returned to the social institution from the hospital proved the presence of MRSA colonisation. The screening test, which had been extended to the whole staff due to epidemiological reasons and also because of their anxiety, revealed MRSA positivity in the throat and nasal mucus of a fourth nurse. We presumed that the patient released from the hospital had infected his roommate as well as the four nurses. In order to investigate the epidemiological correlations we requested the cultured strains to be typified. With the use of phage typification, three different types of MRSA strains were identified in the six persons positive for MRSA, and a further MRSA strain could not be typified with the basic phage sequence. We review some interventions with regard to the avoidance and prevention of methycillin- resistant Staphylococcus aureus infection, which we had the opportunity to order as well as implement at the retirement home. We raise some of the problems we encountered.]

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Lege Artis Medicinae

[PErindopril-Amlodipine Reducing Blood Pressure Level Trial - The PEARL Study]

NAGY Viktor, LANTOS Éva, HABONY Norbert

[Background and aims - In order to reach target blood pressure values more successfully and to achieve better therapeutic compliance, concomitant use of more antihypertensive agents with different mechanisms of action has gained much attention recently. In the PEARL study we investigated the antihypertensive effect of fixed dose combinations of perindopril and amlodipine (5/5, 5/10, 10/5, 10/10 mg Covercard) by measuring blood pressure values in the doctor’s office and with a 24-hour ambulatory blood pressure monitor (ABPM) in outpatients with primary, grade 1 or 2 hypertension, whose target values could not be reached with prior treatment. We also assessed changes of metabolic parameters and how patients felt themselves throughout the study. Patients and methods - In this open-label, multicentre, non-interventional, observational, 3 month long study we evaluated the data of 10 335 patients (5 483 female, 4 852 male, mean age: 61.0±12.4 years, waist circumference 99.0±13.8 cm). The mean duration of hypertension was 9.5±7.7 years. After signing the informed consent form, patients attended three visits (inclusion, months 1 and 3), and they were asked to fill in the data sheets (visit 1: gender, age, waist circumference, blood pressure and heart rate measured at the doctor’s office, duration of hypertension, risk factors, complications, accompanying diseases, previous antihypertensive treatments, complaints), laboratory blood tests and ABPM were optionally performed; visits 2 and 3: blood pressure and heart rate measured at the doctor’s office, adverse events, patient’s evaluation about the way they felt themselves, treatment, optionally performed laboratory blood tests and ABPM. Patients were asked to take perindopril-amlodipine fixed combination tablets in the mornings; the dose was increased if no normalization of blood pressure was observed. Data were analyzed with a one-sample t-test. The consistency of the different frequency distributions was tested with a Chi-square test. The two-sided level of significance was set at 5%. Results - All the parameters sensitive to treatment efficacy (blood pressure values measured on-site and with ABPM) were significantly improved with perindopril-amlodipine fixed combination treatment. Blood pressure measured at the doctor’s office reduced from 158/93 mmHg to 132/80 mmHg, while 24-hour mean blood pressure reduced from 145/84 mmHg to 128/76 mmHg (p<0.001), the diurnal index sensitive to blood pressure variability did not change and a dipper curve was observed throughout the study. Target blood pressure (<140/90 mmHg) was reached by 75.5 % of the patients. The mean dosage at the end of the study was 8 mg perindopril and 7.3 mg amlodipine. The results were consistent across subgroups of different previously received treatments and cardiovascular risks. Regarding laboratory findings, the reduction of total cholesterol from 5.67 to 5.21 mmol/L and that of LDL cholesterol from 3.18 to 2.83 mmol/L (p<0.001 for both) were of clinical importance. Eighty-five percent of the patients evaluated the way they felt themselves as excellent or improved. No serious adverse events were reported. Conclusion - Perindopril-amlodipine fixed combination can be administered effectively and safely to a large population of hypertensive patients who do not reach target blood pressure values.]

Clinical Neuroscience

[Experiences of hypothalamic hamartoma surgeries]

NOVÁK László, KISS Máté Tamás, KLEKNER Álmos, NAGY Andrea, FEDORCSÁK Imre, BOGNÁR László

[Background and purpose - Hypothalamic hamartomas are focal, benign congenital malformations that frequently associated with gelastic seizures. Behavioural disturbances, cognitive decline and the appearance of precocious puberty can also be observed. The most effective way to relieve the symptoms is the surgical disconnection between the hamartoma and the hypothalamus. In our study, we retrospectively analyzed the surgical indications and effectiveness of each approach. Methods - Between 1996 and 2014 we operated on 10 hypothalamic hamartomas. Endoscopic assisted resection was performed in three patients. Six patients underwent direct microsurgical resection in various approaches and one patient was treated with Gamma Knife. Results - We achieved significant decrease in the number of seizures in every patient presenting with various seizure types. The surgical resection was effective in the arresting of the puberty praecox as well. However the surgery of these lesions at their special location holds the danger of the appearance of new endocrinological symptoms. According to our observations the operation on hamartoma less effectively ameliorates the psychiatric symptoms than the others. Conclusion - The surgical treatment is effective in the reduction of the initial symptoms and we had no mortality. According to our analysis therapeutic success is anticipated but we couldn’t archive total symptomatic relief in every case. The first approach to these lesions should be the surgery which type must be tailored to each patient.]

Clinical Neuroscience

[Role of zonisamid in treating epilepsy, Parkinson disorders and other neurological diseases]

JANSZKY József

[On the basis of six randomized controlled trials, zonisamide (ZNS) can be prescribed as add-on treatment in focal adulthood epilepsy in USA and Europe. In Japan, it can be prescribed as first-line monotherapy drug - independent of age. ZNS may also be effective in idiopathic generalized epilepsy and some difficult-to-treat epilepsies including West, Lennox-Gastaut, or Dravet syndromes. The most frequent side effects of ZNS are related to central nervous system occurring in 19%. Kidney stones and oligohidrosis are ZNS-specific side effects. Loss of appetite and weight are usually “beneficial” effects. ZNS is not recommended in pregnancy. ZNS can be taken once daily, which may be beneficial in non-compliance. The pathomechanism of ZNS is different from other antiepileptic drugs. ZNS has an effect on the voltage-gated Na+- and T-type Ca2+ channels as well as on the dopaminerg, glutamaterg, cholinerg, and GABAerg systems. The multiple way of action may be the reason why ZNS seems to be a broad-spectrum drug and beneficial in various neurological disorders. ZNS reduces production of free radicals according to in vitro and in vivo studies. Animal experiments suggest that ZNS may be a neuroprotective agent. Based on an adequate randomized controlled trial, ZNS is effective in adjuctive treatment of Parkinson disorder. A peculiar benefit of the ZNS is that parallel to its positive effect on motor impairment it also reduces severity of dyskinesias. ZNS may be effective in bipolar disorder, obesity, eating disorders, and migraine prophylaxis.]

Lege Artis Medicinae

[The Painter’s Revolt against the Father, or Jesus Chastised ]

GEREVICH József

Lege Artis Medicinae

[Evaluation of body image by means of body shape test and the priming phenomenon]

KOVÁCS Gyöngyvér Xénia, PRIEVARA Dóra Katalin, PIKÓ Bettina

[INTRODUCTION - Body image plays a significant role in the way how the individuals evaluate their own health and in the motivation for health promotion and disease prevention. Consumer culture provides controversial messages for the population, on one hand it motivates to try foods of high calories, on the other hand it also supports the thin body for the ideal. Not surprisingly, besides obesity, eating disorders and distorted body image disorders also tended to increase during the past decades. Therefore, it would be relevant to investigate the background variables of body image. METHODS - One hundred and sixty seven healthy working adults participated in our study that included a self-completed, voluntary and anonymous questionnaire with a focus on the so called body shape test. First, based on projecting figures on slides, the participants evaluated their own figure and the ideal one as perceived by them. Then we projected figures of skinny models. After this they re-evaluated themselves. The goal of this investigation was to detect the priming effect of projecting slim figures that is frequently used in the media. RESULTS - Based on the projection of the skinny models, there was a change in 55.6% of the sample in the evaluation of one’s own figure. On a Likert-type scale of 1-7 points, previously they had evaluated themselves with an average of 3.23 points (thinness scale) that turned into 3.35 after the projection of the skinny models. In addition, their view about their own ideal body (4.57 points), and about female and male ideal body also changed into a slimmer one. These changes were statistically significant (p < .001) by paired t-test both for men and women. Finally, men and women did not show significant difference in the evaluation of female and male ideal body. CONCLUSIONS - These results justified the role of the pictures’ priming effect in body image both in terms of the perception of one’s own figure and the ideal body. The change was particularly relevant in the case of evaluation of one’s own figure due to the choice of the slimmer body as compared to the view of the ideal body. Evaluation of female and male ideal body was similar to the first projection of the pictures as compared to what they would think as ideal for themselves. After the projection images of the female and male ideal body moved to the slimmer figures in a smaller account as compared to the own ideal body image. All these suggest that pictures projected by the media may have a significant role in the population’s body image. Clarifying the phenomenon may help in health promotion and dieting related disease prevention. ]