Lege Artis Medicinae

[Information leaflet on the national inspection of core boxes]

MERSÁNY Géza, NÉMETH Zsuzsa

APRIL 27, 1994

Lege Artis Medicinae - 1994;4(04)

[The family doctor fills in the master file of each insured Hungarian citizen who registers with him/her at the time of registration. This document provides a brief summary of the health status of all registered insured Hungarian citizens. This enables the GP to plan effective prevention and further medical care.]

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Lege Artis Medicinae

[Laboratory control of the oral anticoagulant therapy]

VAJDA Zoltán, PÁL András, SIKOS Zita, SAS Géza

[There are two basic requirements in the treatment and prophylaxis of thromboembo lic diseases by chronic anticoagulation with coumarin (Syncumar). The first is the preven tion of a new thrombosis while the second is the avoidance of concomitant bleeding complications. For this reason it is necessary to achieve an appropriate anticoagulation level which can be characterised by labora tory measurement of the prothrombin level. In this paper, the theoretical and practical as pects of the laboratory control of Syncumar treatment are reviewed. The most serious problem is that the prothrombin level (Quick time) determinations utilising thromboplastin preparations from different sources give diffe rent values in the same patient plasma, which makes comparison of data from different laboratories impossible. The paper gives a brief overview of the definition and practical use of the International Sensitivity Index (ISI), characterising the different thromboplastin preparations, and the International Normali sed Ratio (INR) which can be calculated on the basis of the ISI. In spite of unquestionable improvements, the uncertainty about instrument-thromboplastin-ISI relationships reduces confidence in the INR system, especially when differences in INR values have clinical significance. Efforts need to be directed toward providing local, laboratory/instrument specific ISI values. ]

Lege Artis Medicinae

[The clinical significance of amaurosis fugax]

HORVÁTH Sándor, SOMLAI Judit

[The symptoms of amaurosis fugax (transient monocular loss of vision) indicate not only atherosclerotic disease of the ocular or extra cranial cerebral vessels, but also that of the systemic circulation. The prognostic significance of amaurosis fugax developing after the age of 50-55 years is similar to that of transient ischaemic attack of the brain: it could be a harbinger of atherosclerotic disease of the extra- and intracranial brain vessels as well as the coronary arteries. According to the mortality data, patients presenting with symptoms suggestive of amaurosis fugax will die due to heart disease, primarily myocardial infarct. Diagnostic evaluation should include not only ophthalmological, but also neurological and cardiovascular in vestigation to verify carotid and coronary atherosclerosis. Therapy of the whole disease and not just the symptoms will influence life expectancy in patients with amaurosis fugax. ]

Lege Artis Medicinae

[Methylprednisolone pulse therapy in systemic lupus erythematosus]

GERGELY Péter

[The aim of this retrospective study was to assess the efficacy and safety of methylprednisolone pulse therapy. Thirty five patients with severe systemic lupus erythematosus (lupus nephritis, severe hemolysis and antiphospholipid syndrome with central nervous system involvement, arterial occlusion and thombocytopenia) were treated by pulse methylprednisolone, followed by long-term corticosteroid (and cyclophosphamide) therapy. Thirty four patients achieved remission, after a mean of 4.7 weeks, which lasted on average for > 2.7 years. Six patients presented with an exacerbation after 1-2.5 years. Twenty eight patients are still in remission. No side effects were observed during pulse therapy. Methylprednisolone bolus therapy is safe and effective in severe systemic lupus erythematosus, including cases of lupus nephritis and severe central nervous system manifestations, but an appropriate choice of long-term therapy is essential.]

Lege Artis Medicinae

[The value of immunoscintigraphy in patients with metastatic malignant melanoma]

PAPÓS Miklós, LÁNG Jenő, CSERNAY László, SZEKERES Lenke, KUBA Attila

[Immunoscintigraphy with 99MTc-labeled F(ab'),fragments of monoclonal antibody (reactive with a high molecular associated antigen) was performed in patients with malignant melanoma. 24 investigations on 23 patients were carried out. A total of 40 lesions in 23 patients were detected by chest radiography, ultrasound, CT, bone scintigraphy or histology. 24 of the 40 lesions (60%) were visualized by immunoscintigraphy. Following correction of the physiological liver background by digital subtraction, 3 liver metastases were localized. These results indicate that immunoscintigraphy with radiolabeled F(ab')2 fragments can provide clinically useful information. ]

Lege Artis Medicinae

[Methodological letter from the Public Health and Epidemiology Technical College on vegetarian and similar diets in crèches and educational establishments]

[The nutritional status of vegetarians is strongly influenced by the type of diet they eat. While semi-vegetarian and lacto-ovo-vegetarian diets can meet the nutrient needs of young children, provided they are carefully and professionally planned, strict vegetarian or macrobiotic diets may not meet the needs for some nutrients and may be deficient in both children and adults. ]

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Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Clinical Neuroscience

Cases of inborn errors of metabolism diagnosed in children with autism

CAKAR Emel Nafiye, YILMAZBAS Pınar

Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

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. ]

Lege Artis Medicinae

[Vaccines against COVID-19 pandemic]

FALUS András, SZEKANECZ Zoltán

[The rapidly spreading SARS-CoV2 respiratory virus has evoked an epidemic with serious aftermath around the world. In addition to the health effects, the global economic damage is actually unpredictable. At the same time, the pandemic has launched a series of unprecedented collaborative scientific research, including the development of vaccines. This study summarizes up-to-date information on vaccines, immune memory, and some emerging clinical effects.]

Lege Artis Medicinae

[History of vaccine production in Hungary ]

ÓCSAI Lajos

[This study presents the complete history of the Hungarian vaccine production, partly in association with the process of fighting vaccine-preventable infectious diseases, and underlines the fact that every government actively contributed to the age-adjusted mandatory vaccination schedule of the past 140 years. It demonstrates the various achievements from the smallpox lymph production through the launch of diphtheria serum production at Phylaxia and the establishment of the National Public Health Institute (OKI) with its vaccine production and the later institutional transformation of OKI into Humán as economic corporation to its closure. Among all OKI’s vaccine production activities, this study focuses on the production of influenza vaccines, due to its international importance in the 1960s and 1970s. The vaccine production against diphtheria tetanus and pertussis stands out from Humán’s activities, and the tetanus component of this vaccine is still used in the products of a multinational vaccine manufacturer. ]