Lege Artis Medicinae

[In vitro efficiency of doripenem, a new carbapenem against Gram-negative, aerob, problem bacteria - Prospective, multicentric, Hungarian study]

NAGY Erzsébet1, SAQQA Muhammad1, SZABÓ Judit2, MESTYÁN Gyula3, SZIKRA Lenke4, KONKOLY THEGE Marianne5

NOVEMBER 20, 2010

Lege Artis Medicinae - 2010;20(11)

[INTRODUCTION - Doripenem is a new carbapenem derivative, it’s chemical structure is similar to that of meropenem (substitution of one sulfamoxil-aminomethyl chain for the dimethylcarboxy chain) and has one 1-beta-methyl chain which provides resistance to dyhidropeptidase-I enzyme produced by the human kidney. It has a broad-spectrum of activity against multiresistant Gram-negative bacilli such as ESBL-producing Enterobacteriaceae and non-fermentative Gramnegativ bacilli including some strains of Pseudomonas aeruginosa that are resistant to other carbapenems. In 2010 between February and June a multi-centre comparative study was carried out including 5 Hungarian laboratories to investigate the in vitro activity of doripenem. MATERIAL AND METHODS - 1000 fresh, clinically relevant isolates were included both ESBLproducing and non-producing Enterobacteriaceae strains and resistant and multi-resistant Pseudomonas aeruginosa and Acinetobacter strains. The activity of doripenem and the comparator antibiotics (other carbapenems) were tested by the disc diffusion method. In the case of intermediate resistant strains the MIC of doripenem was also determined by the E-test methodology. RESULTS - All but one isolate belonging to the Enterobacteriaceae (592 isolates) were fully susceptible to doripenem. The only Enterobacter strain which proved to be intermediately susceptible to doripenem by the disc diffusion method was also found to be susceptible showing an MIC of 0.125 μg/ml. In the case of the 163 Pseudomonas aeruginosa and the 121 Acinetobacter spp isolates doripenem was the most active carbapenem compared with imipenem and meropenem (78.6% and 50.5% for doripenem versus 67.5% and 42.0% for imipenem and 68.7% and 30.2% for meropenem, respectively). CONCLUSION - According to our multi-centre study doripenem was highly active against both the ESBL-producing and ESBL-non-producing Enterobacteriaceae strains and against a great part of the Pseudomonas and Acinetobacter isolates often involved in nosocomial infections.]


  1. Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Klinikai Mikrobiológiai Diagnosztikai Intézet, Szeged
  2. Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Orvosi Mikrobiológiai Intézet Debrecen
  3. Pécsi Tudományegyetem, Általános Orvostudományi Kar, Orvosi Mikrobiológiai és Immunitástani Intézet, Pécs
  4. ÁNTSZ Laboratóriumi Kft. Fejér Megyei Mikrobiológiai Laboratórium, Székesfehérvár
  5. Marianne: Fôvárosi Önkormányzat Egyesített Szent István és Szent László Kórház-Rendelôintézet, Mikrobiológiai Laboratórium, Budapest



Further articles in this publication

Lege Artis Medicinae

[Trends of mortality amenable to health care in Hungary and in the Central Region, 1996-2006]

NAGY Csilla, JUHÁSZ Attila, PÁLDY Anna

[INTRODUCTION - Despite of the decreasing trend of amenable mortality it is a significant contributor to social and economic loss due to premature death. This paper assesses the trends of amenable mortality over time, its contribution to the years of potential life lost (YPLL), furthermore reveals the spatial inequalities of the amenable mortality in the central region in relation to socioeconomic status and number of the inhabitants of municipalities. METHODS - This study describes the trend of the years of potential life lost due to amenable mortality during the period 1996-2006 in Hungary, in Pest county and in Budapest. The spatial epidemiological analysis of the amenable mortality was carried out by using smoothed indirectly standardised mortality ratio calculated by full hierarchical Bayesian methods at municipality level. The association between the spatial distribution of amenable mortality and socio-economic status was assessed by using a “Deprivation Index” elaborated by the authors. RESULTS - The years of potential life lost of males were 7207 (per 100 000) and respectively for females these value was 3870 (per 100 000) in Hungary in 2006. The amenable mortality is a significant contributor to years of potential life lost despite its decreasing trend. The amenable mortality accounted for approximately one third of the males’ and the females’ years of potential life lost. The risk of amenable mortality is higher in the less populated areas and the less-favoured socioeconomic situation coexists with high mortality risk. CONCLUSION - Approximately in average 32 000 persons died due to amenable mortality per year during the investigation period in Hungary. The results of the study provide essential information to the local policy-makers, and managing health professionals. The results can be used principally to inform planning healthcare development programs.]

Lege Artis Medicinae

[Robert Schumann, the Romantic Composer ]


Lege Artis Medicinae

[Renal care - possibilities of complex organ protection]

WAGNER Gyula, AMMA Zoltán, JUHÁSZ László, KULCSÁR Katalin

[The authors analyse data of the last ten years of renal care. According to the principles of care they prefer to have contact at least once to all patients with an estimated clearance less than 60 ml/min, and on a regular basis to those with less than 30 ml/min. Their fundamental ambition is to develop the most favourable therapy for the patients together with general practitioners and with representatives of other specialities. The most important aim is to reduce cardio-renal morbidity and mortality. Early detection and effective treatment of target organ damage are the tools for this. It is clear from their previous work that it was not successful in the first period of care (2000-2005) especially in patients with diabetic nephropathy. Before the initiation of renal replacement therapy only half of the patients have been seen by a nephrologist. One-year-mortality after initiating dialysis was significant among patients who did not receive such care. Their medication was also not up-to-date. Through regular continuing medical education for general practitioners and in close collaboration with diabetologist colleagues the number of patients taken care of has doubled. Furthermore, the proportion of patients with hypertension or diabetes as an underlying disease among the patients receiving renal care increased to 68%. These findings may contribute to that their patients receive effective treatment taking the actual therapeutic recommendations into account. Hopefully it will be apparent in the hard end-points at the time of the analysis of the second period.]

Lege Artis Medicinae

[Diabetes mellitus and the liver]

BECHER Péter, PATAI Árpád, MÁJER Katalin

[In the past years, the prevention of micro- and macrovascular complications has been the main target of diabetes treatment. Its unfavourable effects on the liver have been forgotten: the accelerated progression of the liver diseaeses and the increased risk of hepatocellular carcinoma. The multimetabolic syndrome leads to non-alcoholic fatty liver diseases (steatosis, steatohepatitis, cirrhosis). On he other hand some types of liver cirrhosis (for example the common alcoholic form) are worsening the insulin resistance, so they may due to a hepatogenous diabetes mellitus, that’s treatment is different and needs more regard, than type 2 diabetes.]

Lege Artis Medicinae

[CHARM (ARBEIT) - Candesartan in Heart failure - Assessment of Reduction in Mortality and morbidity programme (Angiotensin Receptor Blocker is bEneficial In Therapy of elderlies)]


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Clinical Neuroscience

Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

Lege Artis Medicinae

[Comment to the article titled “Exploratory study of outcomes of blood sample mass examinations by rank correlations”]

Lege Artis Medicinae

[The author’s response to the comment on “Exploratory study of outcomes of blood sample mass examinations by rank correlations”]

Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

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.]