[Ethical dilemmas]
KOVÁCS József
SEPTEMBER 19, 2007
Lege Artis Medicinae - 2007;17(08-09)
KOVÁCS József
SEPTEMBER 19, 2007
Lege Artis Medicinae - 2007;17(08-09)
Lege Artis Medicinae
[Different antihypertensive agents, while having the same blood pressure lowering effect, will have significantly and clinically important different impact on the serum levels of glucose, lipids, insulin, potassium, creatinine, as well as on albumin excretion, heart rate, body weight, central pressure, various hypertensive target organ damages, and, in particular, 24-hour blood pressure dinamics. There is agreement in that the main benefits of first-line antihypertensive agents are related to the lowering of blood pressure itself. Some other drugs, however, have shown preventive and protective cardiovascular properties in certain patient groups, independent of their blood pressure lowering effect as measured traditionally.]
Lege Artis Medicinae
[Detemir is the newest base insulin analogue. In phase III trials and the PREDICTIVE study, the use of insulin detemir in various treatment regimens (basal-bolus or in combination with an oral antidiabetic) did not lead to weight gain in either types of diabetes, in contrast to what is usually observed with insulin therapy. Similar results were obtained when neutral protamine Hagedorn insulin or glargine were replaced by detemir, or insulin-naive patients received detemir as a new therapeutic regime. The mechanism of the beneficial effect on body weight is not clear yet. It may be related to the reduction in the number of hypoglycaemic episodes. It may also be associated with a stronger action of detemir on hepatocytes compared to peripheral tissues due to its acylation, which results in an effective suppression of hepatic glucose output without promoting lipogenesis in the adipocytes. Detemir reaches the insulin receptors of the hypothalamus faster than regular insulin, therefore, satiety develops in a shorter time. These hypotheses still require further studies.]
Lege Artis Medicinae
[The term inflammatory bowel disease includes two similar, but distinct intestinal diseases so far of unknown ethiology - ulcerative colitis and Crohn’s disease. They used to be considered diseases of young adults, but in recent decades they have become more common among children, with characteristics different from those in adults. In the past they were considered severe, incurable diseases, but today, owing to modern nutrition, medical and surgical treatment, both diseases have became well manageable, even though complete recovery can not yet be expected.]
Lege Artis Medicinae
Clinical Neuroscience
[Background – Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose – To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods – Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results – There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology – including genetic background –, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion – Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions. ]
Lege Artis Medicinae
Lege Artis Medicinae
Lege Artis Medicinae
Lege Artis Medicinae
[Recently, physicians and medical literature are more concerned about end-of-life care. A review is given of studies dealing with the rights of the dying patient, with advance directives and with possible treatments in the last days of life. A survey was done in author's department on medical therapy of the terminal period of 103 inpatients, died between 01. 10. 2001. and 31. 03. 2002. Comparing these data with those of American, Finnish etc. authors, the treatments seem to be more generous - probably because in Hungary it is not (yet?) usual to ”declare” endof- life care and to withdraw active therapy. However, indication of antibiotics seems to be more clinical (28.1%, vs. 42%-88% given by similar foreign data). Antibiotics are not palliative means, however, they may be administered in the last days, if the patient is suffering from a terminal infection. Indications and choice of antibiotics are suggested in these cases; medical and ethical problems discussed. Physicians can relieve the physical and mental distressing symptoms of the dying patient and ensure human dignity and peace of the last days.]
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Clinical Neuroscience
Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease3.
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Clinical Neuroscience
Cases of inborn errors of metabolism diagnosed in children with autism2.
Clinical Neuroscience
[The first Hungarian patient with Guillain-Barre syndrome after COVID-19]3.
Clinical Neuroscience
Retinal morphological changes during the two years of follow-up in Parkinson’s disease4.
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