Lege Artis Medicinae

[Drog prevention]

FRENKL Róbert

AUGUST 20, 2002

Lege Artis Medicinae - 2002;12(08)

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Lege Artis Medicinae

[SCIENTIFIC DIGEST]

Lege Artis Medicinae

[38th Annual Meeting of the European Association for the Study of Diabetes]

JERMENDY György

Lege Artis Medicinae

[ESPS-2 (European Stroke Prevention Study 2)]

MATOS Lajos

Lege Artis Medicinae

[The importance of endothelial dysfunction and possibilities of its treatment in chronic heart failure]

MOHÁCSI Attila, LIZANECZ Erzsébet

[Endothelial cells - under autocrine and paracrine control - may have a central role in the regulation of vascular tone. Endothelial dysfunction is a very early sign of heart failure but the clinical consequence is not well understood. Recent evidence suggests that upregulation of the neuro-endocrine-, and the renin-angiotensin-aldosterone system would lead to increased tissue- and circulating angiotensin-II levels. Elevated concentration of angiotensin-II provides a mechanism by which vasomotor responses to nitric oxide, prostaglandins are blunted, while the effects of vasoconstrictors such as thromboxans, endothelin and chatecholamins are enhanced. The higher basal vascular tone leads to the degeneration and atrophy of skeletal muscle, moreover to the the ischaemic damage of myocardial cells. Because renin-angiotensinaldosterone system is under genetic control, the deleterious effects of angiotensin-II depends on the angiotensin-converting enzyme gene. Pharmacological attempts to counteract endothelial dysfunction in heart failure may include the angiotensin-converting enzyme inhibitor, which can potentially improve the endothel dependent vasodilatation response. The importance of measuring endothelial function by non-invasive techniques is yet unknown, thus, before we introduce the widespread testing of patients for endothelial function, more research has to be done.]

Lege Artis Medicinae

[Gestational diabetes mellitus and neuropathy: examining the relationship]

STELLA Péter, KERÉNYI ZSUZSA, NÁDASDI Ágnes, TAMÁS GYULA

[BACKGROUND - Little is known about the relationship between gestational diabetes and late diabetes complications. The relationship between these abnormalities was investigated in this study. PATIENTS, METHODS - Besides reclassification of their glucose tolerance, the prevalence and correlating factors of diabetic neuropathy were evaluated in 123 gestational diabetic (GDM) women controlled prior by our team during their pregnancies. 26 pregestational type 2 diabetic patients served as controls. Mean follow-up time was 7.2 years. Vibration perception threshold was measured to diagnose peripheral neuropathy, while cardiovascular autonomic neuropathy was evaluated using the battery of four cardiovascular reflex-tests. RESULTS - From 123 prior GDM women, 63 were characterized as having diabetes (52.9%), while 14 had impaired glucose tolerance (11.8%). Peripheral neuropathy was diagnosed in 23.6 %, parasympathetic neuropathy in 37.4 %, while sympathetic neuropathy was confirmed in 7.3 % of the patients evaluated during follow-up visit. Association between abnormal glucose tolerance and neuropathy was statistically significant only in the case of parasympathetic neuropathy (p=0.0001), and this relationship was independent from elevated BMI, microalbuminuria and the higher rate of hypertension observed in these women (p=0.006). Since the number of abnormal neuropathy tests were also higher than expected in women with normal glucose tolerance, we hypothetised a cross-sectional link between neuropathy and insulin resistance. An additional analysis comfirmed this association between insulin resistance and parasympathetic neuropathy independent of metabolic status of these patients (p=0.005). CONCLUSIONS - The importance of gestational diabetes, which is sometimes underestimated by many clinicians, was highlighted by our study since it projected a high frequency of parasympathetic cardiovascular neuropathy in these patients. This form of diabetes not only projects the development of late onset type 2 diabetes, but could also act as a predictor of late diabetes complications. According to our results diabetic parasympathetic neuropathy may be linked to type 2 diabetes/ insulin resistance syndrome, and could play a role in the excess cardiovascular mortality observed in these patients.]

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Lege Artis Medicinae

[Defending the statins]

MÁRK László

[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. ]

Lege Artis Medicinae

[THE POSSIBILITIES OF USING PROBIOTICS IN DIGESTIVE DISEASES]

DEMETER Pál

[The mammalian intestinal tract contains a complex, dynamic and diverse society of microorganisms. The beneficial effects of developing a normal bacterial flora are: colonic resistance against pathogens, immunmodulation and intact intestinal barrier. Probiotics are live microbial supplements which beneficially affect the host by improving its intestinal microbial balance after oral administration. The health benefits of probiotics have been the subject of increased research interests. This paper gives a review of the literature that study the roles of probiotics in the prevention and treatment of antibiotic-associated diarrhea, traveller's diarrhea, irritable bowel syndrome, inflammatory bowel disease, Helicobacter pylori infection and hepatic encephalopathy. In human studies the examined probiotics are safe, tolerable and seem to be effective in conditions of diarrhea caused by antibiotics, traveller's diarrhea and pouchitis. In other above-mentioned conditions further randomized and controlled clinical trials are needed to evaluate their efficacy. Based on these results, in the research and manufacturing of genetically-engineered probiotic bacteria a major leap is expected.]

Lege Artis Medicinae

[Medicine-induced osteonecrosis of the jaw]

VASZILKÓ Mihály, CSÉPLŐ Krisztina, NÉMETH Zsolt, BARABÁS József, UJPÁL Márta

[INTRODUCTION - Bisphosphonates are often used in the treatment of osteoporosis and of certain tumors with bone defects. Thus their rare side effect, necrosis of the jaw becomes more and more frequent. CASE REPORT - Between September 2005 and March 2008 we have treated 40 patients with bisphosphonate induced osteonecrosis in the maxillofacial region at our hospital. From this group, we selected two cases where typical complications emerged. CONCLUSION - Based upon data from the international literature and on our own experiences, we would like to draw attention to the importance of prevention. If symptoms are emerging, referral to a specialized department prepared to the treatment of this condition is recommended.]

Lege Artis Medicinae

[Diagnosis of diabetes mellitus, treatment and care of diabetic patients in the adulthood - Novelties in the position statement of the Hungarian Diabetes Association, 2011]

JERMENDY György

[The position statement of the Hungarian Diabetes Association has been renewed in 2011. The new version of the position statement, comparing to that of the formerly published one in 2009, implies some new data which are currently reviewed. Besides target value of antidiabetic treatment the importance of the target range is emphasized. Details about the monogenic forms of diabetes and the role of the continuous glucose monitoring system are discussed. A treatment algorithm for type 2 diabetes is published and the use of newly available antidiabetic drugs is summarized. Finally, the importance of the early diagnosis and the prevention of diabetes mellitus are pointed out.]

Lege Artis Medicinae

[The modern therapy of lipid disorders in the daily practice ]

REIBER István

[Elevated LDL-C and/or triglycerides and decreased HDL-C levels contribute to development of vascular lesions. In the absence of detectable vascular disease the lipid values of providing vascular protection preferably with a healthy diet, regular physical activity and by trying to get out of harmful passions. If the healthy lifestyle is not effective enough, lipid-lowering medication may also be necessary in primary prevention. In the cases of inherited lipid disorders and in patients with high or very high cardiovascular risk it is necessary to take lipid lowering medications in effective dose. The Hun­ga­rian and the international guidelines have been formulated the targets of lipid values for vascular protection. The paper is trying to help for everyday medical practice, how to treat the dyslipidemic patients with the application of widely available lipid parameters and lipid lowering medications effectively. ]