Lege Artis Medicinae

[Dependency, Self-Help, Recovery]

NAGY Zsolt

NOVEMBER 20, 2009

Lege Artis Medicinae - 2009;19(11)

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Lege Artis Medicinae

[Wolf or lamb?]

NEMESÁNSZKY Elemér

Lege Artis Medicinae

[In wine, the truth?]

FEHÉR János

Lege Artis Medicinae

[Diabetes mellitus and cancer risk]

BECHER Péter, PATAI Árpád, MÁJER Katalin

[In the past decades, the prevention of micro- and macrovascular complications has been the main target of diabetes treatment. On the basis of the latest publications that have created a storm we have to highlight the associations between diabetes mellitus, its treatment protocols and tumours. Analysing the often controversial human results, in the absence of relevant prospective studies, we have to consider preclinical observations to choose a safe treatment method.]

Lege Artis Medicinae

[Cirrhosis and its complications: diagnostic and treatment options]

PÁR Alajos

[During the past two decades, the management of complications of cirrhosis has dramatically changed, which substantially improved the patients’ survival. The present paper provides an overview of the diagnosis, treatment and prevention of cirrhosis and its complications including portal hypertension, variceal bleeding, ascites, hepatorenal and hepatopulmonary syndromes, encephalopathy and bacterial infection. Besides noninvasive diagnostic methods, pharmacological and endoscopic treatment modalities are discussed, with emphasis of the importance of nonselective beta-blockers, vasoactive therapy, antibiotic and albumin medication. Prevention and early diagnosis of cirrhosis as well as new pharmacological agents under development presumbaly result in further development in the management of patients with advanced, chronic liver disease.]

Lege Artis Medicinae

[Treatment of severe infections: principles of therapy and problems of resistance]

LUDWIG Endre

[The basic principles of the treatment of severe infections have recently been delineated : after having samples for microbiological tests, empiric therapy based on local resistance patterns should be introduced immediately, possibly within 1 hour in severe sepsis or in septic shock, the empiric therapy should be simplified according to the results of microbiological tests and/or improvement of the condition of patient , the antibiotics should be applied according to their pharmacodynamic properties, the duration of therapy should be shortened to the minimum time, in case of well responding non-complicated infection to 5-7 days., The most frequent problem pathogens in Hungary are the MRSA and ESBL-producing Gram-negatives. In severe infections with MRSA bacteremia, the therapy sholud be based on the vancomycin MIC of the pathogen. If MIC is below 1,5 mg/l, vancomycin is probably effective with a serum minimum concentration of 15 mg/l, while in case of less sensitive pathogens the administration of an alternative agent, such as linezolid, tigecyclin or daptomycin should be considered. In severe infections due to ESBL-producing pathogens, the carbapenems are the firts line antibiotics, while tigecyclin seems to be a promising alternative agent. The treatment of severe infections requires thorough care of the patient and skillnes in antimicrobial therapy in the period of multiresistant pathogens]

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Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

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Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

Clinical Neuroscience

[The Comprehensive Aphasia Test in Hungarian]

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[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]

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[Association between cyclothymic affective temperament and hypertension]

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[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

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[Correlations Between Burnout and Socio-demographic and Workplace Related Factors Among Health-care Workers During The Covid-19 Pandemics]

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[The present study aimed to assess the level of burn-out among health-care workers in 2020 and its correlations with socio-demographic and workplace related factors. The cross-sectional study was conducted by the means of a self-constructed online survey in the beginning of 2021. The responses of 1965 people were analysed with the help of SPSS 23.0. Descriptive statistics, chi-square and Kruskal-Wallis probes were run (p<0.05). Severe burnout was present in 46.7% of the responders. Age, marital status, type of health-care provided and years spent in the health-care system didn’t show any correlation with burnout. Unsure vision, opinion about salary raise and uncertainty at the workplace influenced the level of burnout significantly (p<0.000). The mental health of health-care workers is in continuous decline, in which the COVID-19 pandemic might play a big role. People with worse mental health feel more uncertain regarding their future and job; this might make providing health-care more and more difficult.]

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[Operational Efficiency Investigation from APN Perioperative Perspective]

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[In the healthcare system operating theatres have to put great emphasis on quality work, patient safety and efficiency as well, and to achieve this, optimal utilization of theatres is extremely important. The results of researches in this topic in Hungarian and international literature draw attention to a lot of aspects. The study of perioperative periods, and the evaluation of the analysed processes show that theatres could be operated more effectively. As a result of this, more operations could be carried out and waiting time would also reduce. In order to increase the efficiency of the processes, APNs can play a prominent role at several points. According to the experience, the number of people using health care and the number of people waiting for surgery is increasing, which is further increased by the development of the ongoing SARS-CoV-2 (COVID-19) epidemic. Thereby, patients are not satisfied with the service. The work of APNs would also help increasing the contentment of patients during the operation procedures. Taking advantage of the multifunctional role of the nurse due to her knowledge and training, she actively participates in the operation, in the smooth running of the scheduled daily surgical program and contributes to the reduction of the number of missed, planned surgeries.]