Lege Artis Medicinae

[Harmony Physicians’ Club]

NEMESÁNSZKY Elemér, GYIMESI Andrea

JULY 20, 2006

Lege Artis Medicinae - 2006;16(07)

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[In the focus: periferal vascular diseases - Readers’ questions answered by dr. Éva Meskó]

MESKÓ Éva

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LENGYEL Mária, BODA Zoltán, PETHÔ Imre Iván

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[DIARRHOEA AND PSEUDOMEMBRANOUS COLITIS ASSOCIATED WITH ANTIBIOTIC TREATMENT]

LAKATOS László, LAKATOS Péter László

[Antibiotic treatment is complicated by diarrhea in 5 to 25% of the cases. Its prevalence depends on the antibiotic used, the patient’s age, the concomittant diseases and the immune response. The severity of the diarrhoea is variable ranging from a mild self-limiting disease lasting for 1 or 2 days to a severe condition with high mortality. The diarrhea may result from a direct effect on the gut, but more commonly it is the consequence of changes in resident gut flora. Clostridium difficile is responsible for 10 to 20% of all antibiotic-associated diarrhea cases. The clinical presentation varies from asymptomatic carriage to fulminant pseudomembranous colitis. This latter typically develops as a nosocomial infection, mainly in patients treated with cephalosporins, amoxicillin-clavulanic acid combination or clindamycin. Risk factors are advanced age, severe underlying disease, treatment in an intensive care unit, long hospitalization and invasive medical procedures. The clinical picture is characterized by frequent, watery (occasionally bloody) diarrhea, abdominal pain, tenesmus, fever, weakness. Fulminant colitis develops in 3-5% of cases. The diagnosis is based on testing for C. difficile toxins, but in selected cases rapid diagnosis can be made by flexible sigmoidoscopy. The treatment consists of the withdrawal of the implicated antibiotic along with administration of oral metronidazole or vancomycin which target C. difficile itself. Most patients respond to this treatment; however, the mortality of fulminant cases or those with severe underlying disease is high. Fifteen to 20% of the patients relapse and management of the recurrent cases is difficult. Combination treatment, probiotics and/or passive immunization may be used. Preventive measures include judicious use of antibiotics and aggressive control of the spread of C. difficile infection.]

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GRÉTSY Zsombor

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[Advanced Parkinson’s disease characteristics in clinical practice: Results from the OBSERVE-PD study and sub-analysis of the Hungarian data]

TAKÁTS Annamária, ASCHERMANN Zsuzsanna, VÉCSEI László, KLIVÉNYI Péter, DÉZSI Lívia, ZÁDORI Dénes, VALIKOVICS Attila, VARANNAI Lajos, ONUK Koray, KINCZEL Beatrix, KOVÁCS Norbert

[The majority of patients with advanced Parkinson’s disease are treated at specialized movement disorder centers. Currently, there is no clear consensus on how to define the stages of Parkinson’s disease; the proportion of Parkinson’s patients with advanced Parkinson’s disease, the referral process, and the clinical features used to characterize advanced Parkinson’s disease are not well delineated. The primary objective of this observational study was to evaluate the proportion of Parkinson’s patients identified as advanced patients according to physician’s judgment in all participating movement disorder centers across the study. Here we evaluate the Hungarian subset of the participating patients. The study was conducted in a cross-sectional, non-interventional, multi-country, multi-center format in 18 countries. Data were collected during a single patient visit. Current Parkinson’s disease status was assessed with Unified Parkinson’s Disease Rating Scale (UPDRS) parts II, III, IV, and V (modified Hoehn and Yahr staging). Non-motor symptoms were assessed using the PD Non-motor Symptoms Scale (NMSS); quality of life was assessed with the PD 8-item Quality-of-Life Questionnaire (PDQ-8). Parkinson’s disease was classified as advanced versus non-advanced based on physician assessment and on questions developed by the Delphi method. Overall, 2627 patients with Parkinson’s disease from 126 sites were documented. In Hungary, 100 patients with Parkinson’s disease were documented in four movement disorder centers, and, according to the physician assessment, 50% of these patients had advanced Parkinson’s disease. Their mean scores showed significantly higher impairment in those with, versus without advanced Parkinson’s disease: UPDRS II (14.1 vs. 9.2), UPDRS IV Q32 (1.1 vs. 0.0) and Q39 (1.1 vs. 0.5), UPDRS V (2.8 vs. 2.0) and PDQ-8 (29.1 vs. 18.9). Physicians in Hungarian movement disorder centers assessed that half of the Parkinson’s patients had advanced disease, with worse motor and non-motor symptom severity and worse QoL than those without advanced Parkinson’s disease. Despite being classified as eligible for invasive/device-aided treatment, that treatment had not been initiated in 25% of these patients.]

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[THE USE OF GENERIC DRUGS IN THE MEDICAL THERAPY OF EPILEPSY]

RAJNA Péter

[The author demonstrates the relationship between the innovative and generic antiepileptic drugs regarding the clinical aspects. Among the requirements for the registration of generics one can find small differences in the prescribed and the practical levels of bioequivalence. An important but not widely known fact is that these differences can lead to clinically important alterations if the effects of different generics or the effects on high risk patients are compared. While the increasing market of generics is due to economical factors (and rarely due to medical decisions), the safety of the drugs becomes extremely important. From this aspect, special patient populations eg. children, elderly people or patients with multiple illnesses under multidrug treatment are necessarily of greater medical importance. The characteristics of the antiepileptic drugs on the elderly patients, their increased sensitivity to particular adverse events and the possible somatic side effects are discussed in details. The type of epilepsy also has its special characteristics and is important in the choice of the most successful medicine. The development of the antiepileptic drugs shows a positive direction for their efficacy. In the discussion the author points out three main ways for using generic drugs: prescription of generic drug in monotherapy or as an additive in newly diagnosed patients, the exchange of the innovative agent to a generic and the exchange of one generic to another. The author also mentions the legal points and criticizies the regulations available in some countries allowing a free exchange of the bioequivalent drugs without the agreement of the physician or the patient. The final part of the paper reviews the results of the comparative studies on the effects of the generic antiepileptic drugs and the experiences of the physicians of their application based on surveys performed with questionnaires. The data of the literature is compared to the Hungarian methods of application and to his own experience. Recommendations for the application of generic antiepileptic drugs are summarized in „twelve points“.]

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BERTA Emese, ZELENA András

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[Who are the happy female physicians in Hungary?]

GYŐRFFY Zsuzsa

[BACKGROUND - The female Physicians’ well-being and happiness has become the latest researching field of the “Physicians studies”. In Hungary the researches haven't focused on this subject. Our aim was to examine the subjective well-being of the Hungarian female Physicians. METHODS - Representative, cross-sectional, quantitative survey on a representative sample of female Physicians (N=408). Modified version of WHO Well- Being Index was performed to measure of subjective Well-Being. RESULTS - We have found that the key to the Hungarian female Physicians’ wellbeing is the “time”. Significantly higher rate of well-being is associated with reduced work-hours (8 hour or less, p=0.000), and duty hours (p=0.042), having one hour free time daily (p=0.021) and they satisfied with the time of doctor-patient interaction (p=0.021). The higher rate of Well-Being scores haven't associated with age, marital status, number of children and the speciality. CONCLUSION - Similarly to the national trends, the Hungarian female Physicians' well-being is depending on the work and the satisfaction with work. The satisfied healer is the key of the health system therefore the future studies and the prevention and intervention have to focus on the Physicians’ well-being.]

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POLNER Kálmán

[Only few such outstanding physicians lived, whose achievements and personality influenced the development of the Hungarian nephrology as remarkably as professor István Taraba did. He started his university career as an experimental researcher at the Institute of Physiology on Semmelweis University, Budapest, then at the age of 34, after completing his Ph.D thesis, decided to treat patients to utilize his acquired knowledge in the field of renal failure’s pathophysiology. This way he devoted himself to cure patients with kidney failure being in very poor circumstances at that time. Besides his daily clinical activity, he accomplished outstanding organizing work in establishing and leading the Hungarian Nephrology Society, and also in initiating specialty training for nephrologists and nephrology nurses. The hallmark of his professional work was that in spite of extremely adverse circumstances he forced to improve the quality of dialysis treatment to approach European standards. Among the renal replacement treatment modalities- antecedently to his age - he respected peritoneal dialysis equal to hemodialysis, and attempted to popularize it in his country. Under his leadership the Nephrology Department of Margit Hospital in Budapest became the therapeutic and educational centre of Hungarian nephrology. His achievements have been acknowledged internationally, and his early death is substantial loss for Hungarian nephrology as a whole. It was a great honour to me to work beside him during the whole period he spent in the Margit Hospital, and since March of 1997 I have the opportunity to lead the department he had established in his intellectuality.]