Lege Artis Medicinae

[I’ll Visit the Minister!]

KRAMER Imre

DECEMBER 16, 2006

Lege Artis Medicinae - 2006;16(12)

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Lege Artis Medicinae

[NEBIVOLOL FOR THE TREATMENT OF HYPERTENSION AND CARDIAC FAILURE]

JERMENDY György

[Beta-receptor blocking agents are considered a well defined class of drugs for treating hypertension and heart failure. Nebivolol, a thirdgeneration beta-blocker that combines marked beta-1-receptor selectivity with a vasodilator and antioxidant effect, has relatively recently become available in Hungary. The vasodilator effect of nebivolol has proved to be mediated by the endothelial NO pathway. Due to its neutral metabolic effect, nebivolol can safely be used in patients with glucose intolerance or lipid disorder. Nebivolol is a safe and well tolerated antihypertensive agent. Based on the results of recent clinical trials, nebivolol is also indicated for the treatment of heart failure.]

Lege Artis Medicinae

[The Art of Forgiving Michael E. McCullough, Steven J. Sandage, Everett L. Worthington: To Forgive Is Human: How to Put Your Past in the Past]

FERENCZI Andrea

Lege Artis Medicinae

[Chocolate]

MATOS Lajos, LENGYEL Margit

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[The Congress Organizer Syndrome – Outlines of a New Psychiatric Disorder]

TÚRY Ferenc, STAUDER Adrienne

Lege Artis Medicinae

[EFFECTS OF VITAMIN D AND THE EFFICACY OF VARIOUS VITAMIN D PRODUCTS]

BORS Katalin

[An increasing number of studies suggests that the effects of vitamin D is not limited to the regulation of calcium homeostasis, but it is also involved in several other physiologic processes. Vitamin D receptors are present on the surface and in the nucleus of most cells. Vitamin D as a steroid hormone has genomic and non-genomic effects. Vitamin D deficiency is an important problem worldwide, and so is in Hungary. Vitamin D promotes bone formation and mineralization and decreases the rate of bone absorption. Its extraskeletal effects include antitumour, muscle strength increasing, antiinflammatory, blood pressure lowering and insulin secretion increasing activites.]

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Clinical Neuroscience

[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.]

Ca&Bone

[The risk factors of osteoporosis and osteoporotic fractures in Hungarian women: the results of the NOKK study]

MEZŐ Tibor, TABÁK Ádám, BHATTOA Harjit Pál, LAKATOS Péter

[INTRODUCTION - It is widely accepted from Western European and the US studies that race and geography significantly affect the risk for osteoporosis. Less is known about similar associations in Eastern European subjects. Our aim was to describe the risk factors for osteoporotic fractures and osteoporosis in a selected female population in a cross-sectional, multi-center study performed under the guidance of the Hungarian Society for osteoporosis and Osteoarthrology. MATERIAL AND METHOD - From 10 randomly selected regional osteoporosis centers, altogether 2602 women >18 years of age, referred with any osteoarthrological reason, participated. During their visit data on risk factors, blood pressure, anthropometry, and bone mineral density were collected. RESULTS - Using multiple regression we found that older age, lower diastolic blood pressure, family history of bone fracture, fall in previous year and lower T-score were independently related to fractures. Independent risk factors for femoral osteoporosis included older age, lower weight, family history of fracture, less physical activity, fall in the previous year and glucocorticoid treatment. DISCUSSION - Our study is the first large-scale epidemiological survey describing risk factors of osteoporosis and fractures in a Hungarian female population. Our data may suggest that lower diastolic blood pressure might be related to osteoporotic fractures.]

LAM KID

[„HOPE for people with fracture”: Results of the HOPE (Hungarian Osteoporosis Project for Elderly) study]

SPEER Gábor, NÁDAS Katalin, FERENCZ VIKTÓRIA, MÉSZÁROS SZILVIA, HORVÁTH CSABA, BORS Katalin

[We conducted a multicentre, prospective, single cross-sectional, 12-month, open-label study for the assessment of treatment satisfaction using TSQM (Treatment Satisfaction Questionnaire for Medication) for zoledronic acid therapy used in patients with osteoporosis, who suffered minor traumatic fractures. PATIENTS AND METHODS - In total 1736 patients from 94 centers completed the study and filled in the TSQM questionnaire at both visit 1 and visit 2. TSQM is suitable for measuring the patient’s satisfaction with a treatment, by evaluating side-effects, efficacy and convenience of the treatment and the patient’s overall satisfaction rated on a scale of 0 to 100. RESULTS - Patients included in the study previously received a mean of 1.58 other therapies for osteoporosis and their case history included a mean of 1.24 fractures. This real-life study demonstrated that even one year of zoledronate treatment significantly (p<0.0001) improved the satisfaction of patients regarding efficacy (a mean change from a score of 56.15 to 70.89) as well as the occurrence of side-effects on a TSQM score. Regarding the convenience of treatment, the mean score increased from 62.96 to 79.34 (p<0.0001), whereas the overall treatment satisfaction changed from 59.3 to 75.48 by visit 2 (p<0.0001). CONCLUSIONS - Our study demonstrated beneficial TSQM results associated with zoledronic acid treatment, which is a basic requirement for appropriate adherence as well. ]

Lege Artis Medicinae

[Early detection of patients with dementia in Primary Care ]

OSTORHARICS-HORVÁTH György, TORZSA Péter

[Mental decline is becoming more and more frequent in the elderly these days. The symptoms of dementia may be best detected early in family practice. Physicians may detect the symptoms of mental decline of different levels. General practitioners play an important role in the early detection of patients with dementia. General practitioners keep contact and communicate with the caretaker of the patient regularly. If necessary General Practitioners visit the dementia patients in their own home environment, they can assess their patients’ circumstances and needs and if needed, they can prescribe home care. ]

Hungarian Radiology

[Current questions of quality assurance in diagnostic radiology in the light of a visit to England]

PORUBSZKY Tamás, GICZI Ferenc, BALLAY László, PELLET Sándor

[Physical-technical aspects of quality assurance in diagnostic radiology, because of its dependence on technology are of an extraordinary importance. The intention of Hungary to join EU makes at least the decrease of our lag in this respect unavoidable. Ministerial order 31/2001 (X. 3.) EüM which already came into force requires quality assurance in diagnostic radiology explicitly. This paper starts with definition of basic concepts, then outlooks shortly the history and present international situation of quality assurance in diagnostic radiology. We review preliminaries and the present situation in Hungary, including results of the National Patient Dose Assessment Programme till now. We think that the most efficient help to the initial steps of quality assurance in diagnostic radiology in Hungary may be the appropriate adaptation of experiences of the leading countries. Therefore we review experiences of one of the authors gained during visiting three medical physics centres in England in details. The following topics are discussed: legal requirements, types and levels of measurements, organizational problems, practical evaluation of measurements (including criteria of discarding equipment), patient dosimetry, personal dosimetry, mammography research, instrumentation of the radiology departments, calibration of measuring devices, questions of the so-called type testing and radiation protection training of workers.]