Lege Artis Medicinae

[Insulin pump therapy for type 1 diabetes mellitus]

KIS János Tibor1, KAUTZKY László1, GROSZ Andrea1

OCTOBER 20, 2009

Lege Artis Medicinae - 2009;19(10)

AFFILIATIONS

  1. Budai Irgalmasrendi Kórház Kft., Diabetológiai és Belgyógyászati Ambulancia

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Further articles in this publication

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[Successfulness of Antituberculotic Treatment in Hungary]

BÖSZÖRMÉNYI Nagy György

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[In vitro sensitivity of human anaerobic pathogenic bacteria for tigecycline and comparative antibiotics in Hungary - Prospective multicentre trial]

NAGY Erzsébet, URBÁN Edit, JAKAB Gabriella, SZIKRA Lenke, MISZTI Cecília, SZABÓ Judit

[INTRODUCTION - Tigecycline, the first member of the glycylcycline family of antibiotics, is a semisynthetic derivative of minocycline. The modified tetracycline nucleus is protected against the resistance mechanisms that inactivate tetracyclines, thus tigecycline is expected to be effective against tetracycline- resistant strains. The aim of this multicenter survey, performed in 2007 and 2008 by three Hungarian laboratories, was to examine the efficiency of this drug against antianaerobic bacteria in vitro. MATERIALS AND METHODS - The participating laboratories isolated 540 strains of Gram-positive and Gram-negative anaerobic bacteria from various infectious sites. These sites represent the classes of infections for which tigecycline was recently approved as a treatment option (skin and soft tissue and intra-abdominalinfections), or for which it will be licensed in the near future (lower respiratory tract infections). Evaluation of antibiotic susceptibility was performed by Etest, and the efficiencies of six antibiotics were determined using MIC values. RESULTS - The 540 strains belonged to 33 different species. Of the 104 strains of Gram-positive anaerobic cocci, 100% proved to be susceptible to tigecycline. Similarly, 98% of the examined Clostridium strains showed susceptibility to this antibiotic. Two of the 56 Prevotella strains were resistant against tigecycline. MIC50 and MIC90 values in the 280 Bacteroides strains were 0.5 μg/ml and 1 μg/ml, respectively, whereas only 1.8% of the tested strains showed low resistance. CONCLUSION - Similarly to the findings of international surveys, our results show that tigecycline is effective against the great majority (97.4% susceptibility) of relevant anaerobic bacteria that are isolated from skin and soft tissue, intra-abdominal and lower respiratory tract infections. Thus, empiric use of tigecycline is recommended in any infections where anaerobic bacteria alone or a mixed flora of aerobic and anaerobic bacteria are likely to be present.]

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[Rock Drawings, Shamans, Kings]

NAGY Gyula

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[Benefits of fixed-combination perindopril-indapamid therapy]

NAGY Viktor

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[Life Politics and the Modern Society]

KELEMEN Gábor

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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.

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Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes. This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as <65 years old, 65-75 yo, 75-84 yo and> 85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups. A total of 1108 patients (mean age: 64.4 ± 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p<0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p<0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p<0.05). Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.

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