Lege Artis Medicinae

[CURE]

MATOS Lajos

JANUARY 21, 2004

Lege Artis Medicinae - 2004;14(01)

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Lege Artis Medicinae

[LOCAL INEQUALITIES IN THE UTILIZATION OF SPECIAL HOME NURSING IN THE SOUTH-TRANSDANUBIAN REGION]

BONCZ Imre, SÁNDOR János, OLÁH András, BETLEHEM József, SEBESTYÉN Andor, KISBENEDEKNÉ Gulyás Kinga, DÓZSA Csaba

[INTRODUCTION - The aim of this study is to analyse the local inequalities in the access and utilization of special home nursing within Hungary focusing on the South-Transdanubian Region. DATA AND METHODS - In the first part of the study we compared the indicators of the access and utilizations of special home nursing at national and county level. In the second part of the analyses we made a detailed analyses of utilization data of home nursing in the three counties (Baranya, Somogy, Tolna) of the South- Transdanubian Region of Hungary. Data is derived from the financial database of the National Health Insurance Fund of Hungary for the period 1998-2002. RESULTS - The access of population to the special home nursing increased from 83,8% (1998) to 95,1% (2002). The utilization rate increased from 74,8% (1998) to 84,1% (2002). Within the South-Transdanubian Region we found significant local inequalities in the utilization of services (number of cases, number of visits), which were represented by the tools of geographical information system. CONCLUSIONS - There have been significant differences in the access and utilization of home nursing with remarkable within country inequalities.]

Lege Artis Medicinae

[Cardiovascular aspects of impaired glucose tolerance: A review through the STOP-NIDDM Trial]

BOSNYÁK Zsolt, KERÉNYI ZSUZSA

Lege Artis Medicinae

[A NEW DISCIPLINE IN THE CENTER OF MEDICAL RESEARCH AND CLINICAL PRACTICE - THOUGHTS ON BIOINFORMATICS]

FALUS ANDRÁS, BERKE Tamás, ORTUTAY Csaba Péter, SUHAI György

[Bioinformatics is one of the most important element of genomic research revolutionising biomedical science. This review describes the phenomena of genomic variance and comparative genomics. Briefly, the review summarises the identification procedure of new genes and gene expression patterns highly important in diagnostics. Bioinformatic procedures make possible the rapid detection of pathogens and have principal role in molecular drug design technologies.]

Lege Artis Medicinae

[THE METABOLIC SYNDROME CLINICAL APPEARANCE, DIAGNOSIS, PATHOMECHANISM]

KÉKES Ede, CZURIGA István

[The metabolic syndrome has gone by several names over the past two decades. The diagnostic criteria were proposed by the ATP III of NCEP in 2001 and were accepted by European Society of Cardiology and European Society of Hypertension in 2003. The criteria (abnormal waist rate, HDLcholesterol, triglyceride, blood pressure and fasting glucose) are listed and the presence of any three of these factors is considered sufficient for diagnosis. The prevalence of syndrome affects about a quarter of the Hungarian population with hypertension. The metabolic syndrome is associated with premature cardiovascular morbidity and mortality including an excess of sudden deaths. According to the recent literature data the main component of the syndrome, the obesity, especially with abdominal fat distribution is associated with hypertension, hyperinsulinemia and insulin resistance with related abnormalities of carbohydrate and lipid metabolism. The low HDL cholesterol, high triglyceride level and the small, dense LDL cholesterol particles are the parts of lipid component of syndrome. A variety of environmental (obesity, smoking, physical inactivity) and genetic factors (genetic mutations of lipoprotein lipase, hepatic lipase, CETP and PPA receptors) and the impaired FFA metabolism have all been related to lipid abnormalities. Sympathetic hyperfunction participates in the pathogenesis and complications of metabolic syndrome. Possible factors augmenting sympathetic activation include alterations of insulin, leptin, FFA, cytokines, sleep apnoe. Other important factors as the endocrin concept, the hypothalamus-hypophysis- adrenal axis, endothelial dysfunction are discussed. The impaired muscle insulin stimulated glycogen synthesis (FFA induced GLUT-4 inhibition) is the major cellular factor of insulin resistance. There is a continuous process from the insulin resistance state (with hyperinsulinemia) into the 2T diabetes mellitus (with hypoinsulinemia).]

Lege Artis Medicinae

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[Novelties in the management of Hodgkin lymphoma]

ILLÉS Árpád, MOLNÁR Zsuzsa, MILTÉNYI Zsófia

[Hodgkin lymphoma is a lymphoproliferativ disease, it is about 12-18% of all lymphomas. It has typical morphologic, clinical and therapeutic features, which can distinguish from other lymphoma types. Due to risk- and PET/CT adapted treatment Hodgkin lymphoma is a curable lymphoma with an 80-90% long-term survival, however, refracter- and relapsed patients’ therapy is a great challange. Cure rate can increase due to the development of the diagnostic and treatment modalities, but the use of standard recommendation is necessary. The aim of this review is to show new WHO 2016 lymphoma classifi cation, role of the new diagnostic options, especially 18FDG-PET/CT, Lugano classifi cation and fi rst-line and salvage therapeutic possibilities and to introduce the immunotherapy, like brentuximab vedotin and PD1 inhibitors. Certain points of hemopoietic stem cell transplantation will be also covered.]

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[Haemophilia today]

KARDOS Mária

[Haemophilia is the most well-known inherited bleeding disorder, which has an X-linked inheritance and affects men. Its severity is classified on the basis of the amount of circulating functional clotting factors: patients with values < 1% have severe disease, those with values of 1-5% have moderate disease, and those with values >5% are classified as having mild disease. Severe haemophilia is characterised by frequent, spontaneous bleeding episodes, whereas in those with moderate or mild haemophilia, bleeding is only caused by trauma or surgery. Although bleeding can occur almost anywhere, the most common clinical manifestation is haemarthrosis. Haemophilic arthrpathy that develops as a result of repeated episodes of joint haemorrhage is the most important factor of morbidity in those with haemophilia. Intravenous replacement of the missing clotting factor is used to treat and prevent bleeding episodes. Controlled therapy at home that provides immediate replacement is the optimal early approach. Prophylaxis includes administration of clotting factors at regular intervals to prevent bleeding, which must be the main goal of management until a cure becomes available. The development of inhibitors during treatment is the most significant complication of factor replacement, and management of bleeding in patients with such inhibitors is difficult.]

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. ]

LAM KID

[New approaches to the treatment of osteoporosis]

LAKATOS Gergely

[Osteoporosis is a significant health care problem, and its treatment is of major interest. Despite of the wide spectrum of therapeutical modalities, the effective cure for all forms of this condition has not yet been developed. For this reason, the focus is on the development of new pharmacological approaches. The RANK/RANKL/OPG system discovered one and a half decades ago provides a tool for the neutralization of the osteoclast-stimulating RANKL by the use of monoclonal antibodies. Catepsin-K inhibitors offer another pathway for the inhibition of bone degradation. Anti-sclerostin and anti-Dkk-1 antibodies may stimulate bone formation by the release of Wnt signal transduction system. Other administration methods for PTH analogs, new generations of selective estrogen receptor modulators and antibodies against vitronectin receptors as well as potential new drug targets will enable us to fight bone loss more efficiently.]