Lege Artis Medicinae

[Make music, doctors!]

BODA Domonkos

SEPTEMBER 01, 2000

Lege Artis Medicinae - 2000;10(09)

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Lege Artis Medicinae

[Bacteriophage therapy and prophylaxis; Renewal of earlier expectations]

MILCH Hedda

[Bacteriophages were discovered 84 years ago by the observation of a lysis of a bacterial culture. The aim of the earliest attempts was the therapeutic employment of bacteriophages. The experiments controlled unsatisfactorily, could not fulfill expecations and successful antibiotic testing resulted the rejection of bacteriophage therapy. Bacteriophages gained importance in biology in the 1950s, as model viruses in biological and genetic research. The decrease in the success of antibiotic therapy caused to renew efforts in experimental phage therapy. The author reviews the early studies carried out mainly on animals as well as human experiments with bacteriophages purified by genetic methods. According to the results, bacteriophage therapy may be effective under certain circumstances for the infections not treatable by antibiotics, and in the case of antiobiotic-susceptible bacteria it can supplement therapy.]

Lege Artis Medicinae

[Newly discovered molecules the chemokines]

KŐHIDAI László, DÉRFALVY Beáta

[Chemokine research in the last decade has provided new results in several areas of biomedicine. Investigation and characterization of chemokines resulted in better understanding and modeling complex pathophysiological and immunological processes. Chemokine research opened up entirely new aspects on the defense against pathogenic agents as well as on the processes of inflammation and angiogenesis. With the amount of clinical data growing steadily, it is clear that chemokines could play very important role not only in solving the problems of the oretical and experimental biology but also with their application in clinical diagnostics and therapy. ]

Lege Artis Medicinae

[Heparin in Acute Embolic Stroke Trial]

Lege Artis Medicinae

[Effect of calcium channel blocking drugs on the periodontal status of hospitalised patients]

KEGLEVICH Tibor, ZSIDRÓ Emese, BENEDEK Erika, BARNA István, SZEGEDI Zsolt, SCHWAB E. Richárd, GERA István

[Ca2+-channel blockers play crucial role in the chronic treatment of hypertension and cardiac arrhythmia. One of the side effects of the chronic nifedipine treatment is gingival enlargement. The pathomechanism of this side effect is not fully understood. The main objective of the present study was to evaluate the potential role of different factors in the development and severity of gingival hyperplasia. The incidence and severity of gingival enlargement were examined around the six surfaces of all fully erupted teeth in 243 hospitalized patients with the modified Angelopoulus-Goaz Gingival Hyperplasia Index. 172 patients in the study group were on Ca2+ channel blockers for at least three months prior to the examination while 71 inpatients served as controls. Gingival hyperplasia occurred in 87% of the test group and in 53% of the control group. Severe gingival enlargement occurred in 35% in the test group and only in 2% of the control group. The age and gender of the patient, the daily dose of the medication, the duration of the administration of the drug showed no correlation with the extent and severity of gingival hyperplasia. Only oral hygiene showed statistically significant correlation with the severity of gingival enlargement. The only clinical parameter influencing the extent and severity of gingival enlargement associated with Ca2+-channel blocker drugs was the quality of oral hygiene. ]

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Lege Artis Medicinae

[Second game, 37th move and Fourth game 78th move]

VOKÓ Zoltán

[What has Go to do with making clinical decisions? One of the greatest intellectual challenges of bedside medicine is making decisions under uncertainty. Besides the psychological traps of traditionally intuitive and heuristic medical decision making, lack of information, scarce resources and characteristics of doctor-patient relationship contribute equally to this uncertainty. Formal, mathematical model based analysis of decisions used widely in developing clinical guidelines and in health technology assessment provides a good tool in theoretical terms to avoid pitfalls of intuitive decision making. Nevertheless it can be hardly used in individual situations and most physicians dislike it as well. This method, however, has its own limitations, especially while tailoring individual decisions, under inclusion of potential lack of input data used for calculations, or its large imprecision, and the low capability of the current mathematical models to represent the full complexity and variability of processes in complex systems. Nevertheless, clinical decision support systems can be helpful in the individual decision making of physicians if they are well integrated in the health information systems, and do not break down the physicians’ autonomy of making decisions. Classical decision support systems are knowledge based and rely on system of rules and problem specific algorithms. They are utilized widely from health administration to image processing. The current information revolution created the so-called artificial intelligence by machine learning methods, i.e. machines can learn indeed. This new generation of artificial intelligence is not based on particular system of rules but on neuronal networks teaching themselves by huge databases and general learning algorithms. This type of artificial intelligence outperforms humans already in certain fields like chess, Go, or aerial combat. Its development is full of challenges and threats, while it presents a technological breakthrough, which cannot be stopped and will transform our world. Its development and application has already started also in the healthcare. Health professionals must participate in this development to steer it into the right direction. Lee Sedol, 18-times Go world champion retired three years after his historical defeat from AlphaGo artificial intelligence, be­cause “Even if I become the No. 1, there is an entity that cannot be defeated”. It is our great luck that we do not need to compete or defeat it, we must ensure instead that it would be safe and trustworthy, and in collaboration with humans this entity would make healthcare more effective and efficient. ]

Clinical Neuroscience

[Family planning in multiple sclerosis: conception, pregnancy, breastfeeding]

RÓZSA Csilla

[Family planning is an exceptionally important question in multiple sclerosis, as women of childbearing age are the ones most often affected. Although it is proven that pregnancy does not worsen the long-term prognosis of relapsing-remitting multiple sclerosis, many patients are still doubtful about having children. This question is further complicated by the fact that patients – and often even doctors – are not sufficiently informed about how the ever-increasing number of available disease-modifying treatments affect pregnancies. Breastfeeding is an even less clear topic. Patients usually look to their neurologists first for answers concerning these matters. It falls to the neurologist to rationally evaluate the risks and benefits of contraception, pregnancy, assisted reproduction, childbirth, breastfeeding and disease modifying treatments, to inform patients about these, and then together come to a decision about the best possible therapeutic approach, taking the patients’ individual family plans into consideration. Here we present a review of relevant literature adhering to international guidelines on the topics of conception, pregnancy and breastfeeding, with a special focus on the applicability of approved disease modifying treatments during pregnancy and breastfeeding. The goal of this article is to provide clinicians involved in the care of MS patients with up-to-date information that they can utilize in their day-to-day clinical practice. ]

Hypertension and nephrology

[Monitoring of the blood pressure lowering effectiveness of ramipril-amlodipine fix combination – a non-interventional trial (RAMONA study)]

TOMCSÁNYI János

[Purpose: Monitoring the effectiveness and safety of the fix combination formulation Egiramlon® therapy containing ramipril and amlodipin in patients, suffering from mild or moderate hypertension despite antihypertensive treatment. Patients and methods: Open, prospective, phase IV clinical observational study, which involved 9169 patients (age >18) with mild or moderate hypertension [TUKEB No: 16927- 1/2012/EKU (294/PI/12.)]. Ramipril/Amlodipin 5/5, 5/10, 10/5, 10/10 mg combinations were administered/ titrated in three visits, during the four months period according to the physician’s decision Blood pressure was measured by validated blood pressure sphygmomanometry and ABPM (Meditech, Hungary). The dosis of the fix combination formulation was determined individually during the visits by the 923 doctors involved in the study. The target blood pressure value was 140/90 mmHg, but in case of high risk patients population (diagnosed cardiovascular disease, diabetes), 130/90 mmHg target value was determined. Results: In 70.1% of the patients had no protocoll deviation. Patients data and examination results were processed according to this 6423 patient population. The average age of the patients were 60.2 year, in 50-50% sex distribution. The average duration of the treated hypertension was 9.8 years and the average blood pressure value was 157/91 mmHg. Till the end of the study, systolic blood pressure has decreased with 26.4 mmHg and diastolic pressure with 11.8 mmHg. An average 5.5 bpm heart rate frequency decreasing was observed at the end of the study. As a result of the treatment 52.4% of the patient population has reached the target blood pressure value.]

Lege Artis Medicinae

[Cardiovascular prevention 2021 – Guidelines of European Society of Cardiology 2021. General principles]

VÁLYI Péter, KÉKES Ede

[On 31 August 2021, the European Society of Cardiology published its guideline “Prevention of cardiovascular disease in clinical practice”. This guideline provides a comprehensive review about risk factors of atherosclerotic cardiovascular disease, their assessment, potential modifiers, treatment and prevention of the cardiovascular disease itself at societal and individual levels respectively. The previous guideline issued 2016, had to be updated due to the recent significant advances in risk prediction of cardiovascular disease on atherosclerotic background and due to the beneficial effects of treatment, emerging new drugs and therapeutic targets. The risk assessment system has undergone a major overhaul and now predicts the risk of fatal and non-fatal cardiovascular events together over a 10-year horizon and over a lifetime. In the new guideline, age plays a more important role in risk classification than before. The risk assessment and staged management of apparently healthy people or patients with established atherosclerotic cardiovascular disease, diabetes mellitus and other specific diseases or conditions are detailed. The positive impact of influencing risk factors, the years of life gained can recently be presented in a lifetime perspective, which will help to make an individually tailored decision on the extent of interventions, taking into account also the patient'’s preferences.]

Clinical Neuroscience

Role of positioning between trunk and pelvis in locomotor function of ambulant children with and without cerebral palsy

SANZ-MENGIBAR Manuel Jose, SANTONJA-MEDINA Fernando

Purpose - To understand if children with and without cerebral palsy share the same lumbar postural control threshold on the sagittal plane for the transition between each walking locomotor stage. Method - Observational analysis of sagittal trunk-pelvis kinematics of 97 children with cerebral palsy and 73 with typical development, according to their locomotor stage. Results - Among children with typical development, all average and minimum measurements of the sagittal lumbar curve during the gait events were correlated with age and the locomotor stages of development. Among children with cerebral palsy, there were significant correlations between all average and minimum values of the sagittal lumbar curve and locomotor stages of development but not age. Conclusions - We conclude that, for the same locomotor level, there are no common postural patterns between children with typical development and those with spastic bilateral cerebral palsy for the position between trunk and pelvis in the sagittal plane. Maximal lordosis reduction between trunk and pelvis may change with age or even training, but does not make a positive effect on the locomotor level, while basal and maintenance capacities could explain locomotor function. Trials that failed to assess quality of movement may now have a better understanding of how different interventions improve posture towards the next functional level.