Lege Artis Medicinae

[Defending the statins]

MÁRK László

AUGUST 20, 2016

Lege Artis Medicinae - 2016;26(07-08)

[Taking into account the frequent occurrence of coronary heart disease and the mortality related to this, it is obvious that the primary and secondary prevention of cardiovascular events is nowadays a major challenge in medicine. The lipid lowering therapy has become the basic element of the prevention and the statins are first-choice drugs in this field. Despite the great amount of the evidences coming from studies based on the principles of the evidence based medicine, the statins are frequently in the crossfire of undeserved offensives. The unexplainable reluctance to statins is frequent not only among the misled patients but among doctors too. The attitude of the latter to the treatment determines the patients’ compliance. The change of this attitude is the aim of this paper. This potential change and the continuous education of the patients are the most common possibilities for the improvement of the bad statin persistence and adherence. ]



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[Young men’s knowledge about the human papillomavirus]

BALLA Bettina Claudia, TEREBESSY András, TÓTH Emese, BALÁZS Péter

[Introduction - Nearly the fifth of more than 100 HPV serotypes affect the anogenital region causing genital warts, penile and anal cancer. The incidence of male pathologies is lower than that of females (genital warts, vaginal, vulvar, cervical and anal cancer), however they are equally important in epidemiological terms. Methods - The aim of our questionnaire-based cross-sectional study was to assess the HPV-related knowledge of young men in 19 randomly selected high schools in Budapest. The anonymous questionnaires contained 54 items about socio-demographic and lifestyle factors, HPV-related knowledge and the attitude toward HPV vaccination. Results - We collected 530 completed questionnaires (86.74% response rate). 35.3% of the students knew that HPV was an STD and 3.2% was aware of transmission via skin contact. The majority (52.5%) linked cervical cancer to the viral infection, 7.7% linked HPV to the genital warts of females and 8.3% to the genital warts of males, 9.8% to penile cancer and 4.2% to anal cancer. 44.7% of the young men would have their future children vaccinated, while 24.5% remained uncertain. Conclusions - The young men’s knowledge about HPV was poor and they underestimated the risk of infection. This emphasizes the importance of targeted health education in this population. However, the students were mostly in favour of the HPV vaccination.]

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Risk factors for ischemic stroke and stroke subtypes in patients with chronic kidney disease

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Background - The aim of this study was to compare ischemic stroke subtypes with the effects of risk factors, the relationship between grades of kidney disease and the severity of stroke subtypes. Methods - The current study was designed retrospectively and performed with data of patients who were hospitalised due to ischemic stroke. We included 198 subjects who were diagnosed with ischemic stroke of Grade 3 and above with chronic kidney disease. Results - In our study were reported advanced age, coronary artery disease, moderate kidney disease as the most frequent risk factors for cardioembolic etiology. Hypertension, hyperlipidemia, smoking and alcohol consumption were the most frequent risk factors for large-artery disease. Female sex and anaemia were the most frequent risk factors for small-vessel disease. Dialysis and severe kidney disease were the most frequent risk factors in unknown etiologies, while male sex, diabetes mellitus, prior stroke and mild kidney disease were the most frequent risk factors for other etiologies. National Institute of Health Stroke Scale (NIHSS) scores were lower for small-vessel disease compared with other etiologies. This relation was statistically significant (p=0.002). Conclusion - In order to improve the prognosis in ischemic stroke with chronic kidney disease, the risk factors have to be recognised and the treatment options must be modified according to those risk factors.

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[Stroke prevention - A population screening day in district XII of Budapest]


[Along with advances in the treatment of acute stroke, new efforts have been made to enhance efficiency of the prevention of cerebrovascular diseases. Population screening is a way to contact high-risk patients, and there is an increasing international and national experience with the procedure. However, efforts are associated with high costs, so an efficient method, complying with local features, should be selected from the various methods. A stroke prevention day was organized in Szent János Hospital, localized in district XII, and data were analyzed. Taking advantage of the potentials of a large hospital, a comprehensive risk assessment - within the capacity of health care workers - was performed. Program and contact information of the screening day was published in the local newspaper of the district. Data of 48 residents of the district were analyzed. In addition to neurologists, a radiologist, a cardiologist and an ophtalmologist, as well as health care workers were involved in the project. A data sheet was filled in for all participants, including known risk factors, BMI, blood pressure and serum cholesterol levels. All participants had duplex sonography of the cervical vessels, cardiac evaluation and ophtalmic examination. Data were analyzed anonymously, and - if participants approved - postcode and educational level were also recorded. Among the 48 individuals screened, 35 were female and 13 were male. Average age was 62.86 (±8.57) years, and participants were typically of higher educational level. 5 individuals had no known risk factors, most of them had 2-3 risk factors, and multiple risk factors were not uncommon. Individuals with six and seven risk factors were also found. 20 of 27 patients with known hypertension had target blood pressure levels. By duplex sonography, 36 individuals had mild, 4 had significant atherosclerosis. There was no significant carotid stenosis or occlusion. Based on ophtalmic evaluation, 26 patients had signs of vascular disease (mainly hypertensive fundus changes). Cardiac evaluation detected 14 patients with cardiovascular risk. The high standard of primary care in the district was reflected by the fact that all the 6 highrisk individuals were already taken care of by general practitioners (GP-s). One of the leading conclusions from the evaluation of the data is that local press, family ties and local communities play a major role in recruiting people for a screening day. In order to increase efficiency and cost-efficacy of the program, GP-s should also be involved in the planning process, because efficiency may be increased by pre-selecting high-risk individuals.]

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[Is the evolvement of schizophrenia preventable?]


[Considering the developmental nature of the majority of mental disorders, these days prevention has increasingly come into the focus of psychiatry. Schizophrenia - one of the disorders that are most frequently associated with psychosis, one of the most serious psychiatric syndromes - is the leading cause of permanent disability of the young adult generation. A prodrome lasting for several years precedes the onset of the first psychotic episode, which offers an opportunity for preventive interventions. Currently, we have two strategies for the predicition of the outburst of psychotic disorders. The Ultrahigh-risk approach can predict the first psychotic episode regardless of diagnosis, while the Basic symptom strategy predicts the development of schizophrenia specifically. However, there is an inverse relationship between the sensitivity and the specificity of different predictive criteria, which raises clinical and ethical dilemmas for the doctors. The methods of repeated assessments of the help-seeking individuals’ clinical states with designation of syndrome stages, and multivariate analyses of emprirically derived markers have proven promising tools for establishing more balance between the sensitivity and specificity of predictive criteria. Interven­tions of the secondary prevention aim to decrease the morbidity of the underlying pathomechanisms, and to help individuals’ coping with alterations of their experiences. We can consider here the psychosocial interventions as evidence based choices, which we can combine with certain food supplements and well-chosen psychopharmacons de­pending on the clinical state. With our in­terventions, we can influence the process of the individual development with vulnerable basis and steer it toward resilience. ]

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[Holistic approach to cardiovascular prevention]


[Cardiovascular diseases, primarily the organic manifestations of atherosclerosis, such as coronary artery disease, ischaemic stroke, and peripheral arterial diseases, represent the largest healthcare problem in the developed countries, since the mortality, disability, and need for hospitalisation caused by them constitute a bigger burden than that caused by all other diseases combined. A modern, holistic approach to cardiovascular prevention should consider the complete cardiovascular continuum, including genetic predisposition, social-economicalcultural background, environmental factors, the integrated effect of atherosclerotic risk factors, the inhibition of progression of functional and morphologic damages that have already developed, and, if possible, the promotion of regression. Besides targeting the individual, prevention at the public and social level is also important.]

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[The evaluation of statin adherence in patients from the village of Méhkerék]

HANYECZ Vince, DANI Győző, MÁRK László

[INTRODUCTION - One of the basic elements of cardiovascular prevention is lipid lowering therapy, the quality of which is indicated by the increasing rate of lipid target values achieved during recent years. Further improvement is needed and for this the enhancement of patient adherence to statin treatment is a possible way. PATIENTS AND METHODS - The prescription habits in 81 patients taking statins (41 atorvastatin and 40 rosuvastatin) from 392 randomly selected ones for another study were analysed from the database of general practitioner in the village called Méhkerék in Békés County, Hungary. RESULTS - The statin adherence of the patients was evaluated in two different ways: the estimation by the general practitioner and the determination of prescribed drug boxes during one year. There was no significant difference between the two methods. Similarly, no significant difference was found between the atorvastatin or rosuvastatin adherence. The reduction of total cholesterol was significantly greater in patients taking rosuvastatin (p=0.03). A significant correlation was found between the prescribed box numbers and the decrease of LDL- and total cholesterol. CONCLUSIONS - The patients’ adherence seems to be independent from the type of statin. For the evaluation of patient adherence the GP's simple estimation and determination of prescribed drug boxes during one year are equally appropriate. This suggests, that the GP would be able to select those patients whose education needs longer time. ]