WINKLER Gábor1,2, KIS János Tibor3
[The introduction of incretin-based blood glucose lowering drugs, the dipeptidyl peptidase inhibitors, and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have opened up new perspectives in the antidiabetic treatment of type 2 diabetes. Beneficial properties of these drugs have directed the attention to study further enterohormones with potentially favourable effects on carbohydrate metabolism. Since the point of attack of these hormones is partly different partly identical, based on theoretical considerations, activating simultaneously their receptors in terms of glycemic control may result in synergistic and additive effects. This study reviews the concept of lowering the blood sugar level in type 2 diabetes based on multiagonistic receptor stimulation further the potential benefits of co-stimulating GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptors. It also briefly discusses the first data on tirzepatide as the first representative of dual receptor agonists accepted for clinical use by the FDA.]
Lege Artis Medicinae
[Minors’ end-of-life dilemmas are among the most difficult decisions. Premature infants’ chance of survival has greatly improved thanks to the development of technology. Under-age children’s quality of life, as an aspect, does not appear in the effective Hungarian legislation. The aim of our study is to survey the change in NICU (neonatology intensive care unit) workers’ opinions/attitudes after a 20-year-period about restrictions in severely impaired new-borns’ intensive cares. Quantitative, complete sociological surveys in the Hungarian NICUs using self-administered, anonymous questionnaires (n = 728). Cross-Tabulation analysis and Pearson chi-squared test have been used for the data evaluation. In both studies, the majority of participants agreed that if the condition is fatal, it may be appropriate to limit the intensive care. Acceptance of treatment withdrawal has increased, but active euthanasia is still not accepted. Most healthcare workers are unsatisfied with the current legal order and there is a need for change, especially in cases of fatal and poor prognosis. Despite the fact that the effective Hungarian health care regulation does not allow withdrawal of treatment even in severe conditions, a significant number of those working at Hungarian NICUs would consider it as acceptable in some cases, moreover the share of acceptance has increased in the last two decades. Comparing the results with the current regulations, it can be suggested that it is necessary to increase the sensitivity of the legislators and to change the related legislation.]
Lege Artis Medicinae
[The use of medicinal plants in the prevention and treatment of Covid-19 started soon after the pandemic began. In some countries (e.g. China), the use of medicinal plants for this purpose was an officially declared goal. The plants used in therapy were selected on the basis of in silico studies, preclinical data or extrapolation of folk medicinal experience. In other parts of the world, the majority of medicinal plants are used by Covid patients outside of formal medicine, typically as food supplements. In this article, we review randomised controlled clinical trials of herbal preparations, indtoducing the potential place of herbal preparations in the therapy of Covid-19. A total of 17 trials were identified, most of which studied the effect on disease symptoms. Although most of the products tested were shown to be effective in at least one endpoint, the quality of the studies (mostly open-label, using non-standardised formulations) does not allow positive conclusions on efficacy. ]
Lege Artis Medicinae
[Obesity is a recurrent, progressive chronic disease associated with body fat accumulation the body. Due to the nature of the disease, its treatment and care is a life-long program. Elements of therapy: lifestyle modification (diet and exercise), psychological treatment, medication and if necessary, surgery. The Hungarian Society of Obesity and Exercise, recommends a low-carbohydrate and high-protein diet in the first half year of the weight loss program. During physical activity, dynamic, aerobic forms of movement (e.g. walking, jogging, swimming, cycling, etc.) are preferred. The options of drug treatment in Hungary are orlistat, naltrexone/bupropion fixed dose combination and liraglutide sc (3.0 mg) and bariatric surgery, which all can contribute successfully to the weight loss program.]
Lege Artis Medicinae
[In a three-part article series, we present (1) the clinical protocol used by the Early Childhood Eating and Sleep Disorders Outpatient Clinic of the Heim Pál National Pediatric Institute; (2) the follow-up monitoring methodology of treatment efficacy; and (3) the first results obtained by this monitoring program in a three-part article. The Clinic with in-patient background was the first in the Hungarian health care system to provide organized care by interdisciplinary methods for families of infants and young children struggling with early childhood emotional and behavioural regulation problems. The present first article concerns the clinical protocol of our facility based on the international literature and our own prior experiences. In the literature review, we emphasize especially the early childhood range of care for eating and sleep disorders. Thus, we justify the rationale of structure and activities of our Outpatient Clinic launched in 2017 by a brief summary of the international literature. Our aim is to inspire further health care providers to set up similar interdisciplinary services by a detailed description of our facility. ]
Lege Artis Medicinae
[For two and a half millennia, the subject of shame, either in a toxic form that results in the masking of errors or in an adaptive form that may promote patient safety, has been almost missing from the narrative of medicine. The author traces the path of medical problematization of shame, mainly in the light of the work of those Hungarian psychoanalytic doctors who have played a role in this process. In the light of the concept of a “good enough” doctor, he examines the negative consequences of perfectionism for excellence. ]
Lege Artis Medicinae
[Recently, lixisenatide, a new incretin mimetic GLP-1-receptor agonist with a mainly prandial effect has been registered for the treatment of patients with type 2 diabetes mellitus. The amino acid sequence of lixisenatide and that of human native GLP-1 is 50% identical. Due to its altered amino acid sequence and conformation, lixisenatide is resistant to inactivation by DPP-4. Lixisenatide is a specific agonist of GLP-1- receptors and its binding has a pharmacologic GLP-1-agonist effect. Lixisenatide is used subcutaneously, its normal daily dose is 1×20 μg. It is mostly used in combination with metformin, but it can be also used to supplement sulfanylurea or basal insulin therapy. Clinical efficiency of lixisenatide has been investigated in the phase-III GetGoal trials. In these trials, adequate glycaemic control and a marked decrease in postprandial blood glucose values were observed. During lixisenatide therapy, a decrease in body weight and no substantial increase in the risk of hypoglycaemia were observed, whereas transient gastrointestinal side effects might occur after initiation of treatment. Lixisenatide as an add-on treatment to basal insulin should be considered as a new treatment approach in the management of type 2 diabetes.]
Lege Artis Medicinae
[Incretins are hormone-like peptides secreted by specific cells of the small intestine mucosa. Their two main representatives are the glucagon-likepeptide- 1 (GLP-1 and the glucose-dependent insulinotropic peptide, (GIP) the release of which is stimulated by meals. The main action of incretins is to enhance insulin secretion following meals. They are rapidly metabolized in the circulation by the enzyme dipeptidyl peptidase IV (DPP-IV). Patients with type 2 diabetes have markedly impaired incretin-mediated insulin secretion mainly due to decreased secretion of GLP-1. Research in the last years has opened up a new therapeutic option to treat patients with type 2 diabetes. Continuous intravenous use of GLP-1 cannot be widely used in clinical practice; however, GLP-1-mimetics that have an agonist effect on the receptors but are resistant to degradation by DPP-IV have been developed. The GLP-1 agonist xenatide, due to its incretin mimetic property, stimulates postprandial insulin secretion, suppresses glucagon secretion, delays gastric emptying and increases sense of fullness thus resulting in weight reduction. In experimental settings, exenatide has a documented beta-cell protecting property. Its disadvantages include the fact that it can only be administered subcutaneously and that it has a well characterized side effect profile. On the contrary, the DPP-IV inhibiting incretin enhancers (sitagliptin, vildagliptin) can be used orally and are well tolerated. Exenatide, sitagliptin and vildagliptin are the first representatives of incretin mimetics and incretin enhancers. Sitagliptin has been available in Hungary since August, 2008. Their effect to reduce blood glucose and HbA1c should mainly be exploited in combination therapy, preferably with metformin. The availability of incretin mimetics and incretin enhancers will offer new therapeutic options for treating patients with type 2 diabetes. Nevertheless, the final assessment of these new drugs will require long-term experience in the clinical practice.]
Clinical Neuroscience
Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of patient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.
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Journal of Nursing Theory and Practice
[Correlations Between Burnout and Socio-demographic and Workplace Related Factors Among Health-care Workers During The Covid-19 Pandemics]5.
Journal of Nursing Theory and Practice
[Operational Efficiency Investigation from APN Perioperative Perspective]1.
Journal of Nursing Theory and Practice
[The Occupational Health Nurse’s Role in the identification and management of alcohol-related problems]2.
Journal of Nursing Theory and Practice
[Nurses’ opinion about Covid-19 vaccines during the pandemic]3.
Journal of Nursing Theory and Practice
[Current issues in providing health care for sexual and gender minority individuals]4.
Journal of Nursing Theory and Practice
[What is the origin of expression of „Védőnő” – Maternal Childhealth Nurse?]5.
Clinical Neuroscience
[COVID-19 with strange hallucinations and focal EEG abnormalities: Two case reports]
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