Lege Artis Medicinae

[Fine Art; From the sickbed to world fame]

TUROK Margit1

APRIL 01, 2000

Lege Artis Medicinae - 2000;10(04)

AFFILIATIONS

  1. Szépművészeti Múzeum, Budapest

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Further articles in this publication

Lege Artis Medicinae

[THE ROLE OF INFECTIOUS AGENTS IN THE ETIOLOGY AND PATHOGENESIS OF ATHEROSCLEROSIS]

VÁLYI-NAGY István, PETŐ Mónika, CSÁSZÁR Albert, VIRÓK Dezső, BURIÁN Katalin, HELTAI Krisztina, GÖNCZÖL Éva

[The well-known risk factors of atherosclerosis (high level of serum cholesterol, high blood pressure, diabetes, smoking) can only be re cognized in about half of the patients. Athero sclerosis begins in childhood. In vivo and in vitro data suggest that certain pathogens, like the intracellular bacterium Chlamydia pneu moniae (member of the Chlamydia genus) and cytomegalovirus (member of the herpesvirus family) may play a role in the development of atherosclerosis. Both pathogens infect the pop- ulation in childhood. Infected patients are often symptom-free, sometimes Chlamydia pneumoniae may cause respiratory disease. Both Chlamydia pneumoniae and cytomega- lovirus can be detected in atherosclerotic plaques and patients with atherosclerosis carry pathogen-specific antibodies more frequently and in higher titers. Aortic lesions similar to human atherosclerotic plaques can be indu ced by infection with Chlamydia pneumoniae or cytomegalovirus in experimental animals. Antichlamydial treatment results in the regres sion of these lesions in the infected animals. In vitro infection of tissue culture cells of human arterial origin with Chlamydia pneumoniae or cytomegalovirus results in the induction of cel- lular changes characteristic to atherosclerosis. Strategies to prevent or treat atherosclerosis might be complemented by antimicrobial treatment if the infectious origin of the disease is further confirmed. ]

Lege Artis Medicinae

[Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography]

MATOS Lajos

Lege Artis Medicinae

[Disparity in the perception of the disease in asthmatics and their pulmonologists plus resource in Hungary (HUNAIR study)]

MAGYAR Pál, GYURKOVITS Kálmán, HERJAVECZ Irén, BÖSZÖRMÉNYI Nagy György

[INTRODUCTION - Bronchial asthma is a chro­nic disease having an increasing prevalence in childhood and adulthood, affecting about 3-5% of the population in the developed countries. The AIR study in the United Kingdom compared the perception of the disease in asthmatic patients' to the view of their physicians (pulmonologists). Based on the results of AIR Study the Hungarian Board of Pulmonologists conducted a partially different survey in Hungary (H UNAIR Study). The fundamental objective of the HUNAIR Study was to address the following questions: 1. The persisting symptoms and limitations in daily activity of treated pediatric and adult asth­matic patients. 2. Comparison of the GINA classification of asthmatic patients (based on self-assessed symptom severity) and their pulmonologists. 3. Determination of the total asthma-related drug costs in different severity categories. 4. Determination of the total asthma-related cost for the society and its components (total drug costs, cost of lost workdays, cost of emergency visits, cost of specialist visits, cost of GP visits, cost of hospitalisation) in the different severity categories. 5. Potential differences in total cost between adult and pediatric asthmatic patients. PATIENTS AND METHODS - Data collection based on questionnaires was carried out from October 1998 to May 1999 and was directed by the Board of Pulmonologist. 699 adults and 375 children participated in the survey. The study was conducted in 19 adult and 8 pediatric cent­res in Hungary with the participation of 103 pulmonologists. RESULTS - Significant difference was found in the severity classification (based on GINA ) done by the physicians or the patients themselves. Substantial proportion of patients complained of more symptoms and limitations considering their own condition more severe than indicated by their physicians. Minor difference was found in the use of inhaled steroids among patients with mild, moderate and severe persistent asth­ma. An approximate "one-third " rule could be set up by the health economic evaluation: about 1/3 of the total cost was made up by lost work­ days, 1/3 by drug costs and 1/ 3 by other costs. One-third of the total drug cost was made up by controller and reliever antiasthmatics , 1/3 by emergency medicines and 1/3 by other medi­cines. Cost distribution of controller and reliever medicines: in case of adult patients 1/3 of the costs was constituted by controller medication and 2/3 (73%) by reliever medicines. That ratio was reversed in children: about 2/3 (73%) of the costs was spent on controller and '1 3 on reliever medicines. Further findings: 1. The increased health care resource utilisation correlated with the physician's perception more than the patient's self-assessment; 2. the resource utilisa­tion was twice as high in asthmatic children as in adults ; 3. the resource utilisati on was not affected by the usage of inhaled steroids during the 14 days of the study. CONCLUSIONS - lt can be concluded that in real life situations the current medical treatment of asthmatic patients is unsatisfactory (vs. in clinical trials). The cost-effectiveness of any medication can only be studied in a complex way, considering all the costs incurred in real life situations. New end-points are needed to assess the condition of asthmatics, which con­sider the limitations of patients in their daily routine activities and are not based exclusively on lung function tests.]

Lege Artis Medicinae

[Modern approach to functional gastrintestinal disorders]

LONOVICS János

[Functional gastrointestinal disorders defined as a variable combination of chronic or recurrent gastrointestinal symptoms not explained by structural or biochemichal abnormalities, are everpresent in the society and in physicians' offices. These conditions account for half of the referrals to gastroenterologists, at least in the ,,developed countries". The pathophysiological mechanisms involved in the pathogenesis of these disorders are complex. The symptoms are believed to be biologically multidetermined, abnormalities in motor activity, visceral sensation (hypersensitivity and hyperalgesia) and/or central perception are the best known pathogenetic factors. Cultural/familiar influence, psychosocial status, life stress and early life events may also play important role in the development or amplification of the symptoms. Since functional gastrointestinal disorders are interrelated in their pathophysiology and clinical expression, many patients will have overlapping clinical features. Predominant symptoms, however, may be used for classifying these disorders (functional dyspepsia, irritable bowel syndrome etc) and for the positive (symptom-based) diagnostic approach of the functional gastrointestinal disorders. A biopsychosocial model created to explain complex pathophysiology described above provides the rationale also for the use of a multidisciplinary approach in the therapy. ]

Lege Artis Medicinae

[Funcitonal Dyspepsia]

SIMON László, LONOVICS János

[Functional dyspepsia is defined as a group of different epigastric symptoms without definite morphological, biochemical or infectious origin, having overlapping clinical features. The pathogenesis of the syndrome is surely multi factorial, involving the alterations of visceral perception, as well. Gastric acid hypersecretion does not play an essential role in the development of symptoms, however its pharmacological inhibition may result in symptomatic improvement. Several clinical studies have proved recently that Helicobacter pylori infection has secondary importance in the clinical history of functional dyspepsia patients, nevertheless (in the ulcer-like functional dyspepsia subgroup) eradication therapy is generally accepted as a preventive tool. The dysmotility-type subgroup of the functional dyspepsia syndrome is caused primarily by a multifactorial mixture of gastrointestinal motility disorders and altered visceral perception. The need for positiv diagnosis is emphasized by the authors. The correct doctor-patient relationship plays the most important role in the management of functional dyspepsia patients, complete with a well proven series of acid-inhibitory, prokinetics and anti-anxiety drugs.]

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Lege Artis Medicinae

[Vaccines against COVID-19 pandemic]

FALUS András, SZEKANECZ Zoltán

[The rapidly spreading SARS-CoV2 respiratory virus has evoked an epidemic with serious aftermath around the world. In addition to the health effects, the global economic damage is actually unpredictable. At the same time, the pandemic has launched a series of unprecedented collaborative scientific research, including the development of vaccines. This study summarizes up-to-date information on vaccines, immune memory, and some emerging clinical effects.]

Lege Artis Medicinae

[A short chronicle of three decades ]

KAPRONCZAY Katalin

[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]

Lege Artis Medicinae

[Focus on Lege Artis Medicinae (LAM)]

VASAS Lívia, GEGES József

[Three decades ago, LAM was launched with the goal of providing scientific information about medicine and its frontiers. From the very beginning, LAM has also concerned a special subject area while connecting medicine with the world of art. In the palette of medical articles, it remained a special feature to this day. The analysis of the history of LAM to date was performed using internationally accepted publication guidelines and scientific databases as a pledge of objectivity. We examined the practice of LAM if it meets the main criteria, the professional expectations of our days, when publishing contents of the traditional printed edition and its electronic version. We explored the visibility of articles in the largest bibliographic and scientific metric databases, and reviewed the LAM's place among the Hun­ga­rian professional journals. Our results show that in recent years LAM has gained international reputation des­pite publishing in Hungarian spoken by a few people. This is due to articles with foreign co-authors as well as references to LAM in articles written exclusively by foreign researchers. The journal is of course full readable in the Hungarian bibliographic databases, and its popularity is among the leading ones. The great virtue of the journal is the wide spectrum of the authors' affiliation, with which they cover almost completely the Hungarian health care institutional sys­tem. The special feature of its columns is enhanced by the publication of writings on art, which may increase Hungarian and foreign interest like that of medical articles.]

Lege Artis Medicinae

[Second game, 37th move and Fourth game 78th move]

VOKÓ Zoltán

[What has Go to do with making clinical decisions? One of the greatest intellectual challenges of bedside medicine is making decisions under uncertainty. Besides the psychological traps of traditionally intuitive and heuristic medical decision making, lack of information, scarce resources and characteristics of doctor-patient relationship contribute equally to this uncertainty. Formal, mathematical model based analysis of decisions used widely in developing clinical guidelines and in health technology assessment provides a good tool in theoretical terms to avoid pitfalls of intuitive decision making. Nevertheless it can be hardly used in individual situations and most physicians dislike it as well. This method, however, has its own limitations, especially while tailoring individual decisions, under inclusion of potential lack of input data used for calculations, or its large imprecision, and the low capability of the current mathematical models to represent the full complexity and variability of processes in complex systems. Nevertheless, clinical decision support systems can be helpful in the individual decision making of physicians if they are well integrated in the health information systems, and do not break down the physicians’ autonomy of making decisions. Classical decision support systems are knowledge based and rely on system of rules and problem specific algorithms. They are utilized widely from health administration to image processing. The current information revolution created the so-called artificial intelligence by machine learning methods, i.e. machines can learn indeed. This new generation of artificial intelligence is not based on particular system of rules but on neuronal networks teaching themselves by huge databases and general learning algorithms. This type of artificial intelligence outperforms humans already in certain fields like chess, Go, or aerial combat. Its development is full of challenges and threats, while it presents a technological breakthrough, which cannot be stopped and will transform our world. Its development and application has already started also in the healthcare. Health professionals must participate in this development to steer it into the right direction. Lee Sedol, 18-times Go world champion retired three years after his historical defeat from AlphaGo artificial intelligence, be­cause “Even if I become the No. 1, there is an entity that cannot be defeated”. It is our great luck that we do not need to compete or defeat it, we must ensure instead that it would be safe and trustworthy, and in collaboration with humans this entity would make healthcare more effective and efficient. ]

Lege Artis Medicinae

[Artworks in the autopsy room, or recollections of an art historian]

NÉMETH István