Lege Artis Medicinae

[Hungarian discoveries in the background of Nobel price in medicine 2021]

VARGA János

OCTOBER 28, 2021

Lege Artis Medicinae - 2021;31(10)

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Lege Artis Medicinae

[Cardiovascular prevention 2021 – Guidelines of European Society of Cardiology 2021. General principles]

VÁLYI Péter, KÉKES Ede

[On 31 August 2021, the European Society of Cardiology published its guideline “Prevention of cardiovascular disease in clinical practice”. This guideline provides a comprehensive review about risk factors of atherosclerotic cardiovascular disease, their assessment, potential modifiers, treatment and prevention of the cardiovascular disease itself at societal and individual levels respectively. The previous guideline issued 2016, had to be updated due to the recent significant advances in risk prediction of cardiovascular disease on atherosclerotic background and due to the beneficial effects of treatment, emerging new drugs and therapeutic targets. The risk assessment system has undergone a major overhaul and now predicts the risk of fatal and non-fatal cardiovascular events together over a 10-year horizon and over a lifetime. In the new guideline, age plays a more important role in risk classification than before. The risk assessment and staged management of apparently healthy people or patients with established atherosclerotic cardiovascular disease, diabetes mellitus and other specific diseases or conditions are detailed. The positive impact of influencing risk factors, the years of life gained can recently be presented in a lifetime perspective, which will help to make an individually tailored decision on the extent of interventions, taking into account also the patient'’s preferences.]

Lege Artis Medicinae

[Telephone hotline crisis intervention during the Covid-19 pandemic]

TÓTH Mónika Ditta

[The COVID-19 pandemic and the successive restrictive measures are placing a huge psychological burden on the population worldwide. Isolation, narrowing of social relationships, constant fear, and the illness itself contributed to the development of various mental disorders. The mental strain on healthcare workers, in addition to their heavy physical workload is also a particular problem. In this situation, easily accessible, telephone counselling services, which does not require physical meeting, are one of the most important resources for mental health intervention worldwide. The present study demonstrates the mental challenges caused by the pandemic, the brief history of telephone crisis care, and studies about its effectiveness. In addition, this study focuses on the effects of COVID-19 pandemic on using of telephone counselling services. Several countries are presented with significantly increased use of these services. Finally, the Hungarian situa­tion is demonstrated with the nature of COVID-19 related calls of the Hungarian hotline service. ]

Lege Artis Medicinae

[Hyperinflammation and its modulation in critically ill Covid-19 patients]

ZÁDORI Noémi, MOLNÁR Zsolt

[The COVID-19 pandemic has claimed the life of millions worldwide in 2020. The most common cause of fatal outcome is the severe respiratory syndrome or multiple organ failure. The dysregulated immune response of the body plays probably an important role in the pathomechanism of this process like in the generalised sepsis. In particular, serum concentrations of pro-inflammatory cytokines are elevated during the progressing disease, which may suggest if the treatment with pharmaceuticals like monoclonal antibodies or the binding of circulating cytokines by extracorporeal, non-selective hemoadsorption have a be­neficial effect on the course of the dis­ease and its outcome respectively. The current review aims to provide a brief summary of our knowledge about the role of cytokines and immunomodulatory treatment in Co­vid-19.]

Lege Artis Medicinae

[Ways of treatment in traditional, complementary and integrative medicine of COVID-19]

SZÔKE Henrik, DARÓCZI Zoltán, VERZÁR Zsófia

[This study presents the results and expert opinions about the most important, amply evidence based, most widespread and af­fordable therapeutic procedures and supp­lementary preparations, which may support or and possibly replace conventional treatments. Traditional, complementary, and integrative medicine offers a number of options to enhance physical, psychic and mental resilience that may also be useful in the prevention and treatment of COVID-19 patients. It will be worthwhile to analyse the evidences of clinical experiences on potential benefits. This brief summary might serve as a useful starting point for further research on this topic.]

Lege Artis Medicinae

[Mental and physical health in light of health behaviours among sexual and gender minorities]

GUBÁN Zsuzsanna, CSEKÔ Csilla, SZÉL Zsuzsanna

[In a large proportion the reason behind enlisting both primary and secondary care are psychophysiologic disorders or symp­toms. In this current study we reviewed the literature regarding the physical and mental health of a subpopulation (sexual and gender minorities) and their patterns of health behavior. The literature examined in our study contains publications from January of 2009 to March of 2019. Based on the minority stress theory and the biopsychosocial model, the people from sexual and gender minorities face increased level of stress which affects their health and health behaviour in a negative way. Because of the factors mentioned above this group is more exposed to certain illnesses than the majority society – such conditions are cardiovascular diseases, lung diseases and several types of tumors and cancer. Furthermore the excess stress affects their psychological wellbeing and mental health. Summarizing the literature regarding the health and health behavior of people belonging to sexual and gender minorities our aim was to create an inventory of information for health care workers to help enhance the quality of care the members of these minorities receive. It could also support developement of cultural competence for the circle of professionals in education, law enforcement agencies, social care and health care system, in additional it might decreas health inequity.]

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Lege Artis Medicinae

[LAM 30: 1990–2020. Facing the mirror: Three decades of LAM, the Hungarian medicine and health care system]

KAPÓCS Gábor

Clinical Neuroscience

[The connection between the socioeconomic status and stroke in Budapest]

VASTAGH Ildikó, SZŐCS Ildikó, OBERFRANK Ferenc, AJTAY András, BERECZKI Dániel

[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

Clinical Neuroscience

[The Comprehensive Aphasia Test in Hungarian]

ZAKARIÁS Lilla, RÓZSA Sándor, LUKÁCS Ágnes

[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

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.]