Lege Artis Medicinae

[Ethics in epidemiology]

JENEI Ilona

FEBRUARY 24, 1993

Lege Artis Medicinae - 1993;3(02)

[Do epidemiologists need a code of ethics? This was the question discussed at the Industrial Epidemiology Forum Conference, which brought together bioethicists, epidemiologists and industry professionals to discuss the current state of epidemiology in the United States from an ethical perspective and to develop a draft professional code of ethics (1).]

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[Antiphospholipid syndrome]

GERGELY Péter

[Antiphospholipid syndrome is a recently recognized clinical entity characterized by the presence of deep vein and cerebral thrombosis, thrombocytopenia and recurrent fetal loss. The syndrome is caused by autoantibodies directed against phospholipid antigens. The clinical syndrome is most frequently associated with systemic lupus erythematosus.]

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[Intraoperative ultrasonography during laparoscopic cholecystectiomia ]

ANTAL András, SCHMIDT Pál, TAKÁCS Judit, HADIJEV Janaki

[Our preliminary experience with intraoperative ultrasonography during laparoscopic cholecystectomy is presented. The importance of intraoperative diagnostic procedures in biliary surgery such as cholangiography and operativ ultrasonography are discussed.]

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[Xamoterol in severe heart failure]

MATOS Lajos

[The two groups did not differ from each other in terms of improvement in clinical symptoms. Using a visual analogue scale and the Likart questionnaire, breathlessness appeared to be relieved with the active agent, but the duration of exertion or exercise capacity was found to be the same. Exercise-induced tachycardia and blood pressure elevation were attenuated with xamoterol (p < 0.01). The drug showed no arrhythmogenic effect. At 100 days after randomisation, 32 patients in the xamoterol group (9.1%) had died, compared with 6 (3.7%; p=0.02) of those treated with placebo.]

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[Alcohol induced organ and tissue injury]

BÉLY Miklós

[The patho-histological characteristics of alcohol induced acute and chronic organ and tissue injuries were reviewed. Neuropathy and brain lesions, gastrointestinal tract in alcoholism, alcoholic liver disease, pancreatitis, cardiomyopathy, aseptic bone necrosis, rhabdomyolysis were discussed based on the literature. ]

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[Oral precancerous lesions and conditions]

DOMBI Csaba, CZEGLÉDY Ágota, BÁNÓCZY Jolán

[Each year tumours, including oral cancers, result in more and more deaths in Hungary. The oral cavity has a special position, because the precancerous lesions and conditions which occur in it can be detected by simple procedures. The authors use the latest definitions and disease classifications approved by WHO, to systematize the essential knowledge for the early diagnosis of the most frequent precance roses in Hungary, taking into consideration aspects of clinical morphology, epidemiology, localizational frequency, the risk/level of the tumour and the main principles of treatment. In addition to a detailed description of leukoplakia, erythroplakia, smoker's palate, actinic cheilitis, lichen and sideropenic anaemia, cheilitis glandularis, cornu cutaneum, naevus pigmentosus, discoid lupus erythematosus, submucosus fibrosis, xeroderma pigmentosum and tertiery syphilis are also mentioned. The purpose of the review is to call attention to the fact, that, due to the significant increase in mortality caused by oral tumours, the early diagnostic activity of dentists should be supported by the awareness of general practitioners and a national stomatooncological screening network should be established. ]

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Cyanocobalamin and cholecalciferol synergistically improve functional and histopathological nerve healing in experimental rat model

ALBAY Cem, ADANIR Oktay, AKKALP Kahraman Asli, DOGAN Burcu Vasfiye, GULAEC Akif Mehmet, BEYTEMUR Ozan

Introduction - Peripheral nerve injury (PNI) is a frequent problem among young adults. Hopefully, regeneration can occur in PNI unlike central nervous system. If nerve cut is complete, gold standard treatment is surgery, but incomplete cuts have been tried to be treated by medicines. The aim of the study was to evaluate and compare clinical and histopathological outcomes of independent treatment of each of Vitamin B12 (B12) and Vitamin D3 (D3) and their combination on sciatic nerve injury in an experimental rat model. Materials and methods - Experimental animal study was performed after the approval of BEH Ethics Committee No. 2015/10. 32 rats were grouped into four (n=8) according to treatment procedures, such as Group 1 (controls with no treatment), Group 2 (intraperitoneal 1 mg/kg/day B12), Group 3 (oral 3500 IU/kg/week D3), Group 4 (intraperitoneal 1 mg/kg/day B12+ oral 3500 IU/kg/week D3). Sciatic Functional Index (SFI) and histopathological analysis were performed. Results - SFIs of Group 2, 3, 4 were statistically significantly higher than controls. Group 2 and 3 were statistically not different, however Group 4 was statistically significantly higher than others according to SFI. Axonal degeneration (AD) in all treatment groups were statistically significantly lower than in Group 1. AD in Group 4 was significantly lower than in Group 2 and 3; there was no significant difference between Group 2 and 3. There was no significant difference between Group 1,2 and 3 in Axonolysis (A). But A of Group 4 was significantly very much lower than all others. Oedema- inflammation (OE-I) in all treatment groups were significantly lower than in Group 1; there was no significant difference between Group 2 and group 4. OE-I in Group 2 and 4 were significantly lower than in Group 3. There were no significant differences between Group 1, 2 and 3 in damage level scores; score of Group 4 was significantly lower than of Group 1. Conclusions - B12 and D3 were found effective with no statistically significant difference. But combined use of B12 and D3 improve nerve healing synergistically. We recommend combined use of B12 and D3 after PNI as soon as possible.

Clinical Neuroscience

[Epidemiology, cost and economic impact of cerebral palsy in Hungary]

FEJES Melinda, VARGA Beatrix, HOLLÓDY Katalin

[Objective - The purpose of our communication was to determine the total cost of cerebral paretic patients in Hungary between 0 and 18 years and to assess their impact on the national budget. Methods - Based on the data of Borsod county we calculated the CP characteristics. The cost of CP was determined by routine care of individuals. Lost Parental Income and Tax were calculated on the basis of average earnings. The ratio of GDP, Health and Social Budget and Health Budget to CP is based on CP annual average cost and frequency. We have developed a repeatable computational model. Results - Of the risk groups, premature birth (30.97%), low birth weight (29.64%), perinatal asphyxia (19.47%) were the most common. Source is unknown of 37.61% of the cases. CP prevalence was 2.1‰. The two-sided (59.7%) and the one-sided (19.0%) spastic pareses dominated. The most serious form is the two-sided spastic paresis (42.5% GMFCS 3-5 degrees). Epilepsy was 22.0%, incontinence was 27%, mental involvement was 46%. Care for one child up to 18 years of age costs an average of 73 million HUF (€ 251,724). The lost family income was 27.36 million HUF (€ 94,345), and lost tax and health care contributions were 14.46 million HUF (€ 49,862). Additionally, 0.525% of the GDP, 0.88% of the full health and social budget and 1.83% of direct medical costs were spent for CP families. Conclusion - The cost of CP disease is significant. Costs can be reduced by improving primary prevention. From the perspective of the family and government, it is better to care for families so they can take care of their disabled children.]

Hypertension and nephrology

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[In the last 30-35 years, dialysis care in Hungary has been a major development: both the incidence and prevalence of patients have increased year by year. Over the last decade, growth has slowed and is becoming more and more stabilized (similar trends can be seen in dialysis statistics in developed countries). Behind the dialysis indication the acute kidney injury (AKI) is more common than the end-stage renal disease (ESRD). The latter incidence has been stable for last 6 years (200-230 patient/million population). The annual average growth rate of prevalent dialysis patients was only 0.9%/year in the last 6 years. Among prevalent dialysis patients, the proportion of diabetic patients has remained unchanged for 10 years (26-27%), but those have increased who had hypertension nephropahty. The average age of incident and prevalent dialyzed patients has decreased gradually over the past 8 years (between 2009 and 2017 incident rate was from 67.1 to 63.0 years, prevalent rate was from 65.6 to 61.8 years). Unfortunately, just over half of the patients who dialyzed due to chronic kidney disease (CKD) have reached dialysis day 91. This is due to the high proportion of patient who was in urgent need of dialysis. In chronic hemodialysis (HD) program, the proportion of patients treated with arterovenous fistulas (AVF) decreases, while the rate of central venous catheter (CVC) users increases. The Hungarian peritoneal dialysis program in Europe is very good. The number of prevalent patients receiving renal replaement therapy (RRT) in Hungary in 2017 was 1005 for 1 million inhabitants.]

Lege Artis Medicinae

[Education and psychological support of parents in cases of postnatally detected Down syndrome]

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[OBJECTIVE - Since the 60’s several publications dealt with the phenomenon how physicians inform parents of newborns about postnatal recognition of Down’s syndrome and the support they receive right after breaking the bad news. Howe - ver, the rest of these studies concentrated on surveying parental satisfaction, while relatively few international studies deal with the other side of the communicational situation, the opinion of the informer. Our study focused on the circumstances of parental information in Hungarian institutions of obstetrics in order to evaluate the possibilities for interventions. METHODS - The Down’s team operating at the University of Pécs Faculty of Health Sciences carried out a national survey in 2005 - an interview-based questionnaire filled by physicians of institutions of obstetrics - with the help of the National Register for Congenital Diseases of the National Centre for Epidemiology and Down’s Foun dation. RESULTS - The coverage of the survey reached 74%. Rest of the surveyed institutions did not have information protocol, however, 70% of them believes it would be necessary. Only 44% of the physicians received communication training and 81% of them believe they can manage communication, 33% have felt that the mother of a newborn with Down’s syndrome would expect special help that the institutions are unable to provide. CONCLUSION - There are serious problems with the circumstances of parental informing in Hungarian institutions of obstetrics. This situation would obviously require intervention. An aimed communicational training based on international experience and exploiting the openness of physicians, as well as the establishment of information protocol could be elements of such intervention.]

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[Elderly patients with end-stage renal disease, its epidemiology and questions regarding it in Hungary]

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[The number of elderly people and the kidney disease’s importance connected to it has increased worldwide, therefore the chronic kidney disease became an endemic. Parallel to the dwindling of population the people in it age. Because of the men’s higher mortality rate the proportion of women in the elderly is greater. Prognosis indicates that by 2060 every third citizen will be aged 65 or more. Between 1990 and 2015 the life expectancy at birth increased by 6.95 years in the case of men (in 1990 it was 61.13, and in 2015 it was 72.08) and by 4.9 years in the case of women (in 1990 it was 73.7, and in 2015 it was 78.6) in Hungary. Chronic kidney disease concerns 10 to 14 % of the population and 1% of all of them suffers from end stage kidney failure. In the end of 2015 3.52 million patients received kidney replacement therapy around the globe (2.42 million received hemodialysis, 329000 received peritoneal dialysis and 704 000 lived with transplanted kidneys). Of all the risk factors of chronic kidney disease age, hypertension, diabetes mellitus and obesity stand out as the most important ones. The kidneys’ anatomy and function change in elderly age, making it possible for the kidney disease to manifest in greater numbers. The elderly dialysis patients’ number increases worldwide which is connected to their higher life expectancy and better life prospects which on the other hand ultimately means that more and more patient lives to suffer from kidney disease. It cannot be disregarded either that the increasing number of elderly patients suffering from hypertension or diabetes means that because these are causes of kidney disease, the latter’s numbers are also increasing. International data indicates that in the case of incident ESRD patients their number was between 68-2784 and the older than 75 years was 142-1660 per million population. In Hungary there was 778/pmp and 677/pmp, respectively. In 2015 the ratio of incident dialysis patients the ones aged above 65 was 58,9% in the case of incident patients and 50,3% in the case of prevalent patients. The ratio of the ones aged above 75 was 28,2% in the case of incident patients and 22,6% in the case of prevalent patients. The number of elderly dialysis patients differs by region too. Dialysis treatment started in elderly age requires special knowledge and teamwork, similarly to the question of refusing the treatment. The latter team work, adequate experts (doctors and nurses) and the related professions’ representatives build the foundations of a proper clinical practice.]