Lege Artis Medicinae

[Embracing the national spa project]

JOBST Ágnes

JULY 10, 2001

Lege Artis Medicinae - 2001;11(06-07)

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Lege Artis Medicinae

[Platelet aggregation inhibitors in the prevention of coronary coronary artery disease. „Handle with care!"]

NAGY Viktor

[Platelets play pivotal role in the pathophysiology of unstable angina, acute myocardial infarction and in complications following percutaneous coronary intervention. Three classes of platelet-inhibiting drugs, aspirin, thienopyridines and platelet glycoprotein IIb/IIIa inhibitors are now commonly used for the prevention and treatment of the disorders of coronary artery thrombosis. For the last several decades, aspirin has been the sole option for antiplatelet therapy in the treatment and prevention of the manifestations of cardiovascular disease. However, a wider selection of antiplatelet agents, including the thienopyridines (ticlopidine and clopidogrel) and the platelet glycoprotein IIb/IIIa receptor antagonists are available today. This review summarizes these drugs and scientific data that have led to their use in primary and secundary prevention, unstable angina, myocardial infarction and percutaneous coronary intervention.]

Lege Artis Medicinae

[Grafics of Gábor Roskó]

Lege Artis Medicinae

[Current therapy of Hodgkin’s disease]

ROSTA András, MOLNÁR Zsuzsanna, SCHNEIDER Tamás, VÁRADY Erika, DEÁK Beáta, ÉSIK Olga

[Hodgkin’s disease is a clonal B-cell disease. The exact etiology of the disease has not yet been identified, research data showing the crucial role of the Epstein-Barr virus. The Hodgkin’s disease is curable in 70-80 % of the cases. In the early stage of the disease, the treatment of choice should be the combined modality therapy. The required number of cycles of combined chemotherapy, the dose and the field extension of radiotherapy are all subjects of recent clinical trials. In the advanced stage of Hodgkin’s disease more (6- 8) cycles of combined chemotherapy and, if necessary, radiotherapy of the affected field is the treatment of choice. In advanced Hodgkin’s disease with unfavourable prognosis, the role of higher dose-intensity and the combination of more potent chemotherapeutic agents are evaluated in clinical trials, with special consideration to the danger of late toxicity (BEACOPP, Stanford V protocol). In the treatment of early (within 1 year) chemosensitive relapses of Hodgkin’s disease, high-dose chemotherapy with autologous peripheral stem cell transplantation has improved therapeutic results. Current results of advanced cases with unfavourable prognosis, of primary progressive and resistant disease, relapsing Hodgkin’s disease and the treatment of elderly patients are yet unsatisfactory. The main trends of recent research are: development of new potent chemotherapeutic agents, application of allogeneous "mini" transplantation (graft versus Hodgkin’s disease effect) and the therapeutic use of mono or bispecific monoclonal antibodies. It is desirable, that primary, secondary and further treatments of Hodgkin’s disease are performed in specific hematological or oncological centers where necessary experience of complex treatment is available, as well as the application of aggressive treatment methods, modern radiotherapy and also the facilities for handling unwanted complications.]

Lege Artis Medicinae

[Simple statistic methods II.]

HAJTMAN Béla

Lege Artis Medicinae

[The hierarchy of evidence and of endpoints]

SORONCZ-SZABÓ Tamás

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The prevalence of sarcopenia and dynapenia according to stage among Alzheimer-type dementia patients

YAZAR Tamer, YAZAR Olgun Hülya

Aim - In this study, the aim was to identify the prevalence of sarcopenia and dynapenia according to disease stage among Alzheimer-type dementia (AD) patients and collect data to suggest precautions related to reducing the disease load. Method - The study was completed with 127 patients separated into stages according to Clinical Dementia Rating Scale (CDR) criteria and 279 healthy volunteers aged 18-39 years and 70-80 years abiding by the exclusion criteria who agreed to participate in the research. Our prospective and cross-sectional study applied the CDR and mini mental test (MMSE) to patients with disorder in more than one cognitive area and possible AD diagnosis according to NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association) diagnostic criteria. The patient and control groups had skeletal muscle mass index (SMMI), muscle strength and physical performance assessed with sarcopenia diagnosis according to European Working Group on Sarcopenia in Older People (EWGSOP) diagnostic criteria. Results - In our study, in parallel with the increase in disease stage of AD patients, the prevalence of sarcopenia (led by severe sarcopenia) and dynapenia was higher compared to a control group of similar age. Conclusion - In chronic, progressive diseases, like AD, identification of changes in parameters, like muscle mass and strength and reductions in physical performance in the early period, is important for identification and to take precautions in the initial stages considering the limitations of the preventive effects of treatment applied after diagnosis of AD.

Lege Artis Medicinae

[Vigilance for Drug Safety: the SCOPE Project – An Interview with Mick Foy, Pharmacovigilance Working Group Leader of the British Medicines Authority (MHRA) ]

CZIGLÉNYI Boglárka

Clinical Neuroscience

Investigation of risk factors, topographic location and stroke mechanisms of unilateral isolated and posterior cerebral ARTERY thalamic infarcts

GÖKCAL Elif, SENGUL Yildizhan, USLU Ilgen Ferda

Aim - In this study, we aimed to examine the risk factors, topographic features and stroke mechanisms of acute ischemic unilateral infarcts of thalamus. Methods - Patient with isolated thalamic infarct and those with posterior cerebral artery (PCA) infarction who were admitted to our hospital between January 2014 and January 2017 with acute unilateral thalamic infarction (TI) were included in this study (isolated thalamic infarction/ isolated TI; thalamic and posterior cerebral artery infarction/PCA+TI). Demographic characteristics and vascular risk factors of the patients were determined. Thalamic infarct areas were recorded topographically as anterior, posteromedial, ventrolateral, posterolateral, more than one area, and variant areas. Stroke mechanism was determined according to the criteria of „Trial of Org 10172 in Acute Stroke Treatment” (TOAST). Patients with isolated TI and PCA TI were compared according to risk factors, stroke mechanism and infarct topography. Results - Forty-three patients with a mean age of 63.3 ± 14.5 years were included in the study. Twenty-eight patients (60.1%) were found to have isolated TI and the remaining 15 patients (34.9%) had PCA+TI. 32.1% of patients with isolated TI had sensory symptoms on presentation, and 60% of patients with PCA-TI had sensorimotor symptoms. The mean age, the mean score on National Institutes of Health Stroke Scale (NIHSS) and the mean frequency of atrial fibrillation were higher in PCA+TI patients than in isolated-TI patients (p: 0.04, p: 0.004, p: 0.02 respectively). 32.6% of the patients had ventrolateral, 30.2% had posteromedial involvement. Ventrolateral topography was seen in 46.7% of the PCA+TI patients, while posteromedial topography was seen in 39.3% of the isolated-TI patients. 53.6% of the isolated-TI had small vessel disease etiology, while 40% of the PCA+TI had cardioembolic etiology, and the other 40% had large artery atherosclerosis. Conclusion - Our study showed that the most ommon stroke mechanism in patients with thalamic infarction is the small vessel disease. Isolated TI and PCA+TI patients differ in terms of etiologic mechanism and infarct topography. Variant territorial involvement and multiple area involvements can be quite common in thalamic infarcts.

Clinical Neuroscience

Risk factors for ischemic stroke and stroke subtypes in patients with chronic kidney disease

GÜLER Siber, NAKUS Engin, UTKU Ufuk

Background - The aim of this study was to compare ischemic stroke subtypes with the effects of risk factors, the relationship between grades of kidney disease and the severity of stroke subtypes. Methods - The current study was designed retrospectively and performed with data of patients who were hospitalised due to ischemic stroke. We included 198 subjects who were diagnosed with ischemic stroke of Grade 3 and above with chronic kidney disease. Results - In our study were reported advanced age, coronary artery disease, moderate kidney disease as the most frequent risk factors for cardioembolic etiology. Hypertension, hyperlipidemia, smoking and alcohol consumption were the most frequent risk factors for large-artery disease. Female sex and anaemia were the most frequent risk factors for small-vessel disease. Dialysis and severe kidney disease were the most frequent risk factors in unknown etiologies, while male sex, diabetes mellitus, prior stroke and mild kidney disease were the most frequent risk factors for other etiologies. National Institute of Health Stroke Scale (NIHSS) scores were lower for small-vessel disease compared with other etiologies. This relation was statistically significant (p=0.002). Conclusion - In order to improve the prognosis in ischemic stroke with chronic kidney disease, the risk factors have to be recognised and the treatment options must be modified according to those risk factors.

Journal of Nursing Theory and Practice

[How it all started: Untold Chapters of Nursing History in Hungary as testified by foxed Documents Part 1.]

SÖVÉNYI Ferencné, PERKÓ Magdolna, FEDINECZNÉ Vittay Katalin

[The article elaborates on the untold chapters of nursing history in Hungary, based on research in archives. The situation of nursing in Hungary in the first half of the 20th century is described, when nursing and nursing education became issues of outstanding importance and secular nursing appeared alongside faith based nursing. Several nursing organisations worked to address the unacceptable situation of nursing and strove to raise the status of nursing so as to allow this self-sacrificing vocation to take its rightful place in society. The tools to achieve this goal included providing professional education and training, creating professional literature and safeguarding nurses’ interests. The Hungarian National Association of Female and Male Nurses that came into being as a grass-root organisation in 1902, and its president, József Michalicza, an unreasonably forgotten figure in Hungarian secular nursing were instrumental in pursuing these goals. The article also mentions several dedicated figures in Hungarian nursing history, due to whose commitment Hungarian nurses were represented in the International Council of Nurses from 1933 until the interference of politics. ]