Lege Artis Medicinae

[Early Nasojejunal Feeding in Acute Pancreatitis]

OLÁH Attila1, PARKAVI Gábor1, BÉLÁGYI Tibor1, NAGY Attila1, ISSEKUTZ Ákos1, GAMAL E. Mohamed1

OCTOBER 20, 2003

Lege Artis Medicinae - 2003;13(07)

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  1. Petz Aladár Kórház Sebészeti Osztálya, Győr

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Lege Artis Medicinae

[Antibiotic Treatment of Community-Acquired Respiratory Infections: Strategies Intended to Ensure Optimal Outcome and to Minimize the Development of Resistance]

BALL P., BAQUERO F., CARS O., FILE T., GARAU J., KLUGMAN K., LOW E. D., RUBINSTEIN E., WISE R.

Lege Artis Medicinae

[The 18th International Conference on Allergy and Clinical Immunology 7-12 September 2003, Vancouver]

HIRSCHBERG Andor

Lege Artis Medicinae

[THE USE OF EARLY BIOMARKERS IN PREVENTION. - THE MARKERS OF THE EXPOSITION, EARLY EFFECT AND INDIVIDUAL SENSITIVITY]

EMBER István, KISS István, SÁNDOR János, FEHÉR Katalin, NÉMETH Katalin, LUKÁCS Péter

[The molecular and predictive epidemiology plays more and more important role in the prevention of cancer. With the help of early biomarkers, high risk population could be identified for primary preventive intervention modalities. It uses both molecular biological methods and elements of risk assessment plus a testing system based on animal experiments. Its specificity is not high enough to establish the diagnosis but it can be used to monitor the disease and to follow the effectivity of the therapy (e.g. "minimal residual disease") and the preventive interventions. It is also suitable for risk assessment with the markers of individual susceptibility. As to everyday practice there are many problems because of limited therapeutic possibilities, but we hope that the molecular and predictive epidemiology becomes an important part of medicine in the near future.]

Lege Artis Medicinae

[NEW MODALITIES IN THE TREATMENT OF CHRONIC VIRAL HEPATITIS C: PEGYLATED INTERFERONS]

GERVAIN Judit, NEMESÁNSZKY Elemér, CSEPREGI Antal

[Interferon-α proved to be the most effective therapy of chronic hepatitis C. Its combination with ribavirin enhances the antiviral activity and this modality has become the therapeutic standard recommended worldwide during the past few years. Metaanalysis of the international studies revealed that only 12-19% of the patients became virus-free following a 48-week long course of α interferon monotherapy. The combination treatment with ribavirin for 48 weeks increased the proportion of sustained responders to 35-45%. The introduction of pegylated interferons resulted in significantly higher response rates. The new therapeutic possibilities are due to the modified pharmacokinetic characteristics of the drug by changing the size and the structure of the molecules. Multicentre studies investigating the clinical effectiveness of the 40 kD sized pegylated interferon α-2a as well as the 12 kD sized pegylated interferon α-2b in combination with ribavirin reported 56% and 54% response rate, respectively. However, there is significant heterogeneity in the results according to the type of drug administered and to the genotype of the hepatitis C virus, as well as in the basal viral level and the stage of hepatic fibrosis, respectively. The message and the conclusion of the viral kinetic studies are worth remembering: if the result of the HCV nucleic acid test is still positive at week 12 or 24, therapy should be ceased due to the patient non-responder status. Since pegylated interferons are also available in Hungary the authors felt useful to give an overview of the current knowledge, summarizing the results of the relevant studies and provide a suggested state-of-the-art therapeutic protocol based on international consensus.]

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Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

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Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

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Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

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In aging societies, the morbidity and mortality of dementia is increasing at a significant rate, thereby imposing burden on healthcare, economy and the society as well. Patients’ and caregivers’ quality of life and life expectancy are greatly determined by the early diagnosis and the initiation of available symptomatic treatments. Cholinesterase inhibitors and memantine have been the cornerstones of Alzheimer’s therapy for approximately two decades and over the years, more and more experience has been gained on their use in non-Alzheimer’s dementias too. The aim of our work was to provide a comprehensive summary about the use of cholinesterase inhibitors and memantine for the treatment of Alzheimer’s and non-Alzheimers’s dementias.

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[Non-pharmacological prevention and treatment for postoperative delirium in elderly patients with hip fracture - a systematic review]

VIDA Nóra, PAPP László

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