Lege Artis Medicinae

[Is pay for performance a viable option in the health sector?]

STEPHEN Valley

DECEMBER 28, 1994

Lege Artis Medicinae - 1994;4(12)

[After reviewing our department's employment statistics a few weeks ago, I was not surprised to see that we have performed almost twice as many radiology examinations in the past year as the Royal College of Radiologists' recommended number of examinations. Since 1990, the number of outpatient examinations in our department has increased by 48%, the number of inpatient examinations by 13% and the number of accident and emergency examinations by 6%. Most other specialists could report similar figures.]

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Lege Artis Medicinae

[The first 15 years of the AIDS epidemic ]

FÖLDES István

[AIDS represents the most exciting infectious disease of the last 15 years. In addition to the fact that there are more than 4 million estimated AIDS patients and more than 16 million estimated HIV-infected individuals this can be explained by the peculiar features of the disease, including limited routes of infection, long latency period, a quasi 100% lethality, diversity of the clinical picture, difficulties in therapy and vaccination, the theoretically 100% possibility of prevention and the serious social problems associated with AIDS. After giving a short review of the development of our knowledge about AIDS, the author to explains the special features of AIDS mentioned above on the basis of the structure, regulation and replication cycle of the virus. The primary conclusion is that education and prevention should be stressed in the battle against AIDS.]

Lege Artis Medicinae

[The role of transesophageal echocardiography in the investigation of stroke]

LENGYEL Mária

[Ischaemic infarction accounts for 85% of stroke aetiology (1). Approximately 60-70% of these are of cerebrovascular, i.e. carotid arteriosclerosis, origin (2). The proportion of cardiogenic embolism was previously estimated at 15% (1), but autopsy data suggest that embolism is the cause of half of fatal strokes (3). There are two reasons for this large discrepancy: 1) the intracardiac source is difficult to identify in vivo; 2) cardiogenic embolism has a more severe outcome than stroke of other origin. Probably both are true, but there is no doubt that before the introduction of transesophageal echocardiography (TE), the detection of intracardiac sources was rare and uncertain.]

Lege Artis Medicinae

[A multicentre, randomised, crossover, double-necked trial of contamination of conventional and bow-tie dressings in routine obstetric and gynaecological practice]

MARINKO M Biljan, CHARLES A Hart, DEBORAH Sunderland, PAUL R Manasse, CHARLES R Kingsland

[In the 19th century, the usual dress of doctors was a small bow tie tied in a flat knot "once round" in addition to a stiff standing collar (1). As fashions have changed, the wearing of bow ties has become less common and is now worn almost exclusively by a small minority of obstetricians, who often claim that they are more hygienic than the traditional tie in the delivery room, which is contaminated with blood and amniotic fluid. There is currently no evidence for this. We therefore examined the contamination of traditional and bow ties worn by obstetricians during a typical working week. ]

Lege Artis Medicinae

[Clinical and laboratory parameters in ulcerative colitis]

NAGY Ferenc, PAPÓS Miklós, CSERNAY László

[The clinical and laboratory parameters which correlate with the intensity of the inflammatory process in ulcerative colitis patients were analyzed in this study. The severity of the inflammatory process was assessed with leukocytescinti graphy by colorectal segments using a scoring method in 36 patients (group A). The sum of the segmental scores were considered to represent the intensity of the inflammatory process and were compared with clinical and laboratory parameters. From among the 36 patients, acute ulcerative colitis was established with biopsy in 30 cases. Two toxic patients were not tested and four patients had inactive disease. In 20 (16 acute, 4 inactive) of 36 patients, the intensity of the inflammatory process was assessed by segments with score values of biopsy samples and leukocyte scintigraphy (group B). The sum of the score values was used to determine the correlation of the two methods. The intensity of the inflammatory process assessed by scintigraphy showed a good correlation (r = 0.6564, p = 0.0016) with histological findings (group B), as well as with the ESR (r = 0.6398), serum fibrinogen (r = 0.5424), alfa2 globulin level (r = 0.4721), number of bloody stools (r = 0.4605), and the thrombocyte count (r = 0,4594) in group A. Five clinical and laboratory parameters proved to be suitable to assess the actual severity of the inflammatory process in ulcerative colitis. The values of the parameters may help to choose the right examination in new cases and to evaluate the efficacy of the therapy. ]

Lege Artis Medicinae

[Prenatal diagnosis of endocardial fibroelastosis]

KÁDÁR Krisztina, KIRÁLY László

[The authors report two cases of prenatally diagnosed endocardial fibroelastosis with echocardiography for the first time in Hungary. This disease is rare and usually fatal. Diagnoses were confirmed by autopsy and in one case by postnatal echocardiography as well. Principles for the diagnosis of endocardial fibroelastosis are discussed. Echocardiography makes possible the prenatal diagnosis of endocardial fibroelastosis and is recommended from the 18th week of pregnancy in high risk individuals.]

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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

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

KAPÓCS Gábor

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Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

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[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. ]

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.]