Lege Artis Medicinae

[Editor’s Commentary to Attila Bánfalvi’s Publication ‘The Faith of Faithlessness’ ]

KAPÓCS Gábor

DECEMBER 15, 2017

Lege Artis Medicinae - 2017;27(10-12)

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Lege Artis Medicinae

[Considerations for the design and evaluation of qualitative research]

ZÖRGŐ Szilvia

[Communication, opinions, and experiences signify a vital part of medical knowledge and researching these realms necessitates qualitative methods. Scientific rigor is an equally valid expectation for qualitative research, and many facets have been proposed in related discourse. Aside from demonstrating the relevance and clinical application of a qualitative initiative, paying heed to its level of transferability is also crucial. The credibility and dependability of the project are pivotal, which can be enhanced through transparency, confirmability, and consistency in procedures employed during the processes of planning, implementation, and analysis. Furt­hermore, continual reflexivity denotes a chief aspect of scientific rigor throughout every phase of research, inviting the researcher to take a critical stance concerning their own preconceptions, as well as their effect on the topic under scrutiny. Apart from methodology, quantitative and qualitative worldview may be very different, for example in the way they treat and interpret reality. We may consider the various paradigms and methods as complementary in the quest of furthering medical knowledge. In this methodological spectrum, each element bears its own limitations and possibilities, thus in order to select the most adequate tool, these must be weighed in light of the research question and objectives.]

Lege Artis Medicinae

[The Faith of Faithlessness ]

BÁNFALVI Attila

Lege Artis Medicinae

[What turns labour pain into suffering? The individual ways of coping]

RADOS Melinda, MÉSZÁROS Judit

[INTRODUCTION - Pain is not only a sensory experience, but includes emotional, motivational and cognitive dimensions, thus women’s perceptions of labour pain are largely influenced by individual attitudes. The distinction between pain and suffering sheds light on valuable information. Our aim was to study the relationship between women’s labour pain and their sense of suffering, and the effects of epidural analgesia on their judgements of pain, stress and satisfaction. SAMPLE AND METHOD - 342 women participated in our study. Their pain was assessed with the Numerical Rating Scale, sense of suffering with the shortened Perceived Stress Scale, which were followed by questions of epidural analgesia administration, its perceived effects and satisfaction. RESULTS - Women’s feelings of pain and sense of suffering show a strong positive correlation (R=0,283, p<0,001); but with the increase of these dimensions their satisfaction decreased (R=-0,162 and R= -0,444 respectively, p<0,001). The administration of epidural analgesia did not have a significant effect on their judgements of pain, stress and satisfaction. Perceived stress had the strongest determining influence on satisfaction (b=-0,534, p<0,001). CONCLUSIONS - According to our results on pain relief, we suggest the wider use of various non-pharmacological methods. Alleviation of maternal fear and suffering through non-judgemental, patient and supportive attitude of caregivers is of paramount importance.]

Lege Artis Medicinae

[Memorial Board for Professor Romics]

Lege Artis Medicinae

[Differential diagnosis of anemia and abdominal pain - case report of a lead poisoned family]

NÉMETH Aliz, LISKA Zsófia, TÖRÖK Eszter, NÁDAI Mária, SCHANDL László, KIS János Tibor

[The authors describe a patient’s case, who was hospitalized with stomach pain. During the study of the patient, a microscopic examination of the blood vessel helped the diagnosis. Basophil eruptions of red blood cells raised the suspicion of lead poisoning, which was confirmed by a high lead level in the serum. The source of the lead poisoning was a lead covered jug, in which the family stored a homemade syrups that is popular among Hungarians. At several members of the family, who had been consumed the syrup, we measured high non-symptomatic lead levels. The patient and his family were successfully treated with a chelating therapy. The au-thors summarize the symptoms of lead poisoning through a case report. Call the attention that excessive lead exposure in Hungary is rarely recognized, and the symptoms are often misleading.]

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[Opportunities in drug therapy of biliary tract cancer. Past - present- future]

RUBOVSZKY Gábor, HITRE Erika, LÁNG István

[Biliary tract cancer is relatively rare tumour, but the dismal prognosis renders it frightful. Biliary tract cancers which consist of gall bladder cancers and bile duct cancers can be cured only with surgery thus it is exceedingly important that the surgery should take place in dedicated centres. The multidisciplinary approach may involve drug therapy, too, as an adjunct to surgery or for palliation. This publication summarizes present data about systemic treatment with some chronological point of view. Starting from therapeutic nihilism of the past and projecting anticipatory development of the future it shows the present state of medical treatment in this patient population.]

Lege Artis Medicinae

[New opportunities for the estimation of health loss in Hungary]

VITRAI József, VARSÁNYI Péter, BAKACS Márta

[BACKGROUND - The Global Burden of Disease Study has been publishing its reports since the early 1990’s. The last one from 2010 covers 291 diseases, and 67 risk factors for 187 countries. AIMS - Presenting examples of the Hungarian health burden status the authors advocate the use this unique data source. METHODS - The authors downloaded the 1990 and 2010 data for Hungary from the Global Burden of Disease Study website. To quantify the economic burden they calculated the change in GDP related to the absence from work as a consequence of risks and diseases. RESULTS - In the publication the authors presented some of the versatile utilization methods of the GBD data and the data visualization tools available on GDB’s website. In 2010 the DALY for Hungary was 3,714,900 years which is the 84% of the country’s DALY in 1990. The most Years Lived by Disability was caused by musculoskeletal disorders (YLD: 28.4%), while cardiovascular and circulatory diseases caused the most Years of Life Lost (YLL: 40.3%). In 2010 the dietary risk was the leading risk factors in Hungary accountable for 840 thousand of life years lost which economic cost was over 950 milliard Hungarian forints. CONCLUSIONS - The use of the result provided by the Global Burden of Disease Study can significantly contribute for planning and evaluating interventions to promote healthy lifestyle, to advance supporting living conditions, and to distribute health care capacity efficiently.]

Clinical Neuroscience

[Diseases with peripheral motor symptoms ]

DELI Gabriella, KOMÁROMY Hedvig, PÁL Endre, PFUND Zoltán

[Diseases with peripheral motor symptoms are a rare, but important subgroup of the all peripheral neuropathies, radiculopathies and neuronopathies. In these mostly progressive neuropathies, the clinical features include pure motor symptoms with weakness and wasting of the striated muscles. The differentiation of these diseases is frequently a challenge for qualified clinical neurologists. A careful history taking, the disease time course, the findings of routine clinical physical examination and the electrophysiological studies are all necessary in the diagnostic procedure. The aim of this publication is to overview the clinical characteristics of the pure motor peripheral neuropathies, to consider the diagnostic steps and the differential diagnosis, and finally to summarize the treatment options. ]

LAM Extra for General Practicioners

[MODERN BETA-BLOCKER THERAPY FROM THE CARDIOLOGIST’S VIEWPOINT]

ÉDES István

[Following the publication of some large, randomised trials (LIFE, ASCOT), the benefits of the use of beta-blockers in hypertension have been questioned. On the basis of these clinical trials it has been posited that beta-blockers administered for the treatment of hypertonia are less effecient for stroke prevention. It has been suggested that first-generation beta-blockers (atenolol) have adverse metabolic effects (insulin sensitivity, lipid parameteres), which might contribute to the differences observed in clinical outcomes. On the basis of a number of clinical trials and meta-analyses performed in recent years it is now evident that the most important goal is to reach target blood pressure levels, which is usually achieved by combination therapy. Choosing drugs on the basis of strict protocols is less important. In general, beta-blockers remain one of the most important drug class for the treatment of hypertension. The author reviews the pharmacology of the cardioselective, vasodilatory drug nebivolol in detail, as well as clinical trials on nebivolol. Nebivolol has a neutral (or rather beneficial) effect on metabolic parameters (lipid parameters, blood glucose level and insulin sensitivity) as well as on left ventricular function. If hypertension is associated with cardiovascular diseases (left ventricular dysfunction, ischaemic hears disease, atrial fibrillation), nebivolol offers an excellent therapeutic alternative due to its excellent tolerability and side effect profile]

Lege Artis Medicinae

[Letter from the editor]

KAPÓCS Gábor, FRENKL Róbert