Lege Artis Medicinae

[Flu - Avian flu - Is pandemy a danger?]

BUDAI József

MARCH 20, 2005

Lege Artis Medicinae - 2005;15(03)

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Lege Artis Medicinae

[VASCULARIS NEUROLOGY AS A NEW DIRECTION IN CLASSICAL NEUROLOGY]

NAGY Zoltán

[In the last decades the classical clinical specialties have further differentiated. Increasing number of different new subspecialties were born due to the consequences of the robust progress in basic sciences and medical technology. This process has further accelerated due to the new challenges and possibilities in patients' care. Similar tendencies could be seen in neurology. Recently, significant demand has arisen for educational programs for neurologists who want to be familiar in stroke management. These tendencies are also substantiated by stroke epidemiology. In industrialized countries rapid increase in stroke morbidity has been predicted by the increasing life-expectancy. The management of different acute stroke syndromes, the rehabilitation and treatment of post-stroke states needs education and special skills in the field of vascular neurology. Special postgraduate educational programs in vascular neurology (stroke-ology) are formulated in USA as a new subspecialty and it is under preparation in some countries in Europe as well. In Hungary, the Hungarian Stroke Society has initiated the special clinical training and educational programs as preconditions of issuing a license in vascular neurology.]

Lege Artis Medicinae

[THE EFFECT OF SEXUAL HORMON ALTERATIONS ON THE FREQUENCY OF OEDEMATOUS ATTACKS IN PATIENTS WITH HEREDITARY ANGIONEUROTIC EDEMA]

FELVINCI Réka, VISY Beáta, NÉMETH Éva, VARGA Lilian, JAKAB László, FARKAS Henriette

[INTRODUCTION - Changes in the body's hormonal equilibrium may alter the frequency of angioedema attacks in patients with hereditary angioneurotic edema. We assessed the relations between the angioedema attacks and puberty, menstruation, anticoncipient pill taking, pregnancy, delivery and menopausa. We also studied the possible impact of an embryo with hereditary angioneurotic edema on the frequency of attacks during pregnancy. PATIENTS, METHODS AND RESULTS - 53 female patients were included in the study. Data was surveyed by a questionnaire and detailed gynecological examination. We pointed out that the frequency of the attacks increased in 34% of the patients during puberty, in 58% of the patients at the time of menstruation and in 63% of the contraceptive pill users. In 36% of the women the frequency decreased in the postmenopausal state. In case the pregnancy affected the disease, the embryo with hereditary angioneurotic edema increased the number of attacks during pregnancy. CONCLUSION - Our analysis shows that conditions with sexual hormon alterations have an effect on the number of edematous attacks, therefore patients with hereditary angioneurotic edema need more attention both in nursing and therapy when they are in a life-period of hormonal change. Our results offer the oppurtunity of a better prediction of edematous attacks thus the oppurtunity of better therapy and better quality of life.]

Lege Artis Medicinae

[Appreciation of older doctors a just expectation and a sensible interest]

HIRSCHBERG Jenő

Lege Artis Medicinae

[Diabetes: in the focus]

WINKLER Gábor

Lege Artis Medicinae

[Pregnancy in women with systemic lupus erythematosus]

KISS Emese, BHATTOA P. Harjit, BETTEMBUK Péter, BALOGH Ádám, SZEGEDI Gyula

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[Avoiding unlimited energy drink consumption is a matter of our heart]

DOJCSÁKNÉ Kiss-Tóth Éva

[Energy drinks have been gaining unbroken popularity, especially among youngsters and children since they were introduced to the market. Manufacturers promise to improve performance and stamina with consuming the products, classified as non-alcoholic soft drinks. In addition to the vitamins and plant extracts, they contain a significant amount of caffeine and other stimulants (taurine, guarana). Among the active ingredients, caffeine has an outstanding effect and thereby a danger, since its overconsumption – in addition to milder he­mo­dynamic changes – can cause severe cardio­vascular consequences, cardiac arrhythmias, ion channel diseases, increased blood coagulation, myocardial infarction or reduced cerebral blood flow in susceptible consumers. Many case studies have also reported serious cardiovascular attacks among young chronic energy drink consumers. Health impairments of excessive and long-term consumption of energy drinks have been studied increasingly, however there is limited and contradictory evidence on the safety of consumption and the effectiveness of performance enhancement. ]

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[Molecular mechanisms leading to renal fibrosis: the origin of myofibroblasts]

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[There are about a quarter of million patients who need chronic renal replacement therapy in Europe, and the estimated number of patients with chronic kidney disease is about tenfold higher. Interestingly, regardless of the initiating cause the mechanism of fibrosis is similar to each other in the different chronic kidney diseases. In general, the damaged glomerular or tubular cells release danger signals and produce chemotactic stimuli, which trigger the rapid recruitment of leukocytes. The infiltrating immune cells and the damaged renal cells then produce high levels of proinflammatory cytokines, growth factors, chemokines and adhesion molecules which contribute to glomerular/tubular injury, accumulation of further leukocytes and myofibroblasts, which are the effector cells of renal fibrosis. However the origin of myofibroblasts is still controversial. Recent hypotheses suggest that they are originated from different renal cells, such as epithelial and endothelial cells, pericytes or bone marrow derived fibrocytes. The myofibroblasts thus generated serve as key cellular mediators of renal fibrosis. Myofibroblasts have migratory capacity, are resistant to apoptosis, produce several growth factors and cytokines and according to our present knowledge these cells are the main source of collagen-I and -III rich extracellular matrix in the fibrous tissue. Organ fibrosis is characterized with excessive deposition of extracellular matrix leading to glomerular sclerosis and renal tubulointerstitial fibrosis. The excessive deposition of fibrous tissue replaces healthy kidney tissue; nephrons disappear and kidney function declines gradually. In this article the knowledge is summarized on the molecular changes leading to the generation of renal myofibroblasts.]

Lege Artis Medicinae

[Prevention of infections in patients with absent or dysfunctional spleen: adaptation of international guidelines]

KULCSÁR Andrea

[Individuals with an absent or dysfunctional spleen are at increased risk of severe infection. The greatest risk of infection is within two years after splenectomy. A spectrum of infecting microorganisms may cause serious infections, especially in young or immunocompromised patients. The commonest pathogens are Streptococcus pneumoniae, Neisseria meningitidis and in some countries Haemophilus influenzae type b (Hib). The international guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen are inconsistent. Most of the evidence is obtained from expert committee reports or opinions and/or clinical experiences of respected authorities. This area in Hungary also represents an unmet need. Patients who have undergone surgical removal of the spleen and those with medical conditions that may predispose to functional hyposplenism must be educated about the danger of their condition, must be immunised and must be treated with prophylactic antibiotics according to national epidemiological and microbiological protocols. In Hungary we have an urgent need for a definite guideline for infection profilaxis of individuals with an absent or dysfunctional spleen. This paper is written by a vaccination consultant with the intention of raising awareness and to provide some assistence for physicians and their patients.]

Clinical Neuroscience

[The future in danger: a survey of the changes in the number of neurologists and a prognosis for 2010 in Hungary]

BERECZKI Dániel, CSIBA László, KOMOLY Sámuel, VÉCSEI László

[Lack of neurologists has become an obvious problem recently in Hungary, not only in small hospitals, but in major health care centers and also in university hospitals. With the current survey we set forth to estimate the number of board certified neurologists, and to evaluate the foreseeable changes in the next decade. In the beginning of 2010 there were 1310 physicians in Hungary with an official license to practice neurology. During 2009 neurological performance at least once during the year was claimed to the National Health Insurance Fund by 948 board certified neurologists. The number of those neurologists who are routinely involved in neurological patient care was estimated to be around 750. The lack of the young generation is characteristic for the age distribution of neurologists. In nine out of the 19 counties of Hungary the number of neurologists below the age of 35 is one or nil. In the ten-year period of 2000-2009 the annual mean number of new board certifications in neurology was 22. This number is much lower than that needed to replace those who get employed abroad and who leave the system for other reasons. The number of neurologists in the age range of 40-60 years will drop to 2/3 of the current number by 2020 even if emigration of neurologists will completely halt. If emigration will continue at the current rate and the number of those in neurological training will not increase considerably, then by 2020 only about 300 neurologists will have to cover neurological services throughout Hungary. As this number is insufficient for the task, and the tendency is clearly foreseeable, the health care government should urgently react to this situation to ensure an acceptable level of neurological services in the near future for the population of Hungary.]

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[Models of immune recognition: presence and future]

GERGELY János

[The prevailing theories of immune recognition for over 50 years were based on the idea that the immune system functions by discriminating self and nonself. Since the self-nonself theories failed to explain a number of immune phenomena new models were suggested, such as the ”infectious nonself” and the ”danger” models. The review outlines and compares these models of immune recognition.]