Lege Artis Medicinae

[Masterpieces from the Kremer Collection ]

NÉMETH István

DECEMBER 20, 2014

Lege Artis Medicinae - 2014;24(12)

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Lege Artis Medicinae

[Artifacts of Mundane and Celestial Might ]

NAGY Zsuzsanna

Lege Artis Medicinae

[The complexity of hyper-lipidaemia’s follow-up in a polymorbid patient diagnosed with newfound Parkinson’s disease]

HANG Dóra

[The 73-year-old polymorbid man has been examined because of above normal blood pressure and increased serum lipid levels. From his already known diseases subclinic hypothyreosis should be highlighted. Because of increased serum cholesterol (6.7 mmol/l) and LDL levels (4.91 mmol/l) 40 mg atorvastatin has been adjusted besides 10 mg amlodipine against his high blood pressure. Subsequently selegiline and levodopa/benserazid therapy have been adjusted caused by newly diagnosed Parkinson’s disease. Parallel in time decreased dosage of atorvastatin (20 milli- gramms) has been enabled to adjust as well, the pill taken by the patient is combinated with 10 milligramms of amlodipine and called Amlator®. The improvement of lipid levels might be due to the trasformation of subclinic hypothyroidism to euthyroid state of the thyroid gland. Levodopa might plays role in this improvement resulting in an inhibition of TSH release because of demonstrated dopamine-receptors in the pituitary gland.]

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[How Much Time for the Patient? ]

ZELENA András

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[Fulvestrant therapy of breast cancer metastases with rare localization]

MOLNÁR Katalin

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[A Handbook of Cardiology and Angiology Assistant Training ]

SZENCZI Tóth Károly

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Clinical Neuroscience

Validation of the Hungarian version of Carlson’s Work-Family Conflict Scale

ÁDÁM Szilvia, KONKOLY THEGE Barna

Background and purpose - Work-family conflict has been associated with adverse individual (e.g., cardiovascular diseases, anxiety disorders), organizational (e.g., absenteeism, lower productivity), and societal outcomes (e.g., increased use of healthcare services). However, lack of standardized measurement has hindered the comparison of data across various cultures. The purpose of this study was to develop the Hungarian version of Carlson et al.’s multidimensional Work-Family Conflict Scale and establish its reliability and validity. Methods - In a sample of 557 employees (145 men and 412 women), we conducted confirmatory factor analysis to investigate the factor structure and factorial invariance of the instrument across sex and data collection points and evaluated the tool's validity by assessing relationships between its dimensions and scales measuring general, marital, and job-related stress, depressive symptomatology, vital exhaustion, functional somatic symptoms, and social support. Results - Our results showed that a six-factor model, similarly to that of the original instrument, fit the data best. Internal consistency of the six dimensions and the whole instrument was adequate. Convergent and divergent validity of the instrument and discriminant validity of the dimensions were also supported by our data. Conclusions - This study provides empirical support for the validity and reliability of the Hungarian version of the multidimensional Work-Family Conflict Scale. Deployment of this measure may allow for the generation of data that can be compared to those obtained in different cultural settings with the same instrument and hence advance our understanding of cross-cultural aspects of work-family conflict.

Hungarian Radiology

[Diagnostic pitfalls and artifacts of multislice CT]

BARANYAI Tibor

[There is a spectacular development in diagnostic radiology in the last one and a half decades. State-of-the-art US, CT and MR appliances and the dynamic software developments has improved diagnostic safety by order of magnitude, which resulted in the reduction of possible errors and misinterpretations. The advent of MSCT resulted in shorter scanning times, the submillimeter collimation and the subsecond scan time improves the spatial resolution of the image, the motion artifacts are reduced and the evaluation of the parenchymal organs improves. However, the new technology of MSCT raises new questions. Due to faster data collection the acquisition time decreases, that is why the tracing of the contrast material must be accurately timed. The high contrast material density that appears suddenly in pulsing vessels makes a disturbing effect on its environment, thus making way to erroneous interpretation. The performance of a secondary reconstruction (2D and 3D reconstructions) may diminish the possibility of diagnostic pitfalls and artifacts. Reconstruction increments made from appropriately overlapping thin slices are required for good image quality and spatial resolution, otherwise the image quality is deteriorating, some vessels might “disappear”, they are not depicted. We are struggling with several problems using MIP CTangiography. The proper elimination of the bones, the improper selection of VOI (volume of interest) might lead to false positive result, and the assessment of small vessels might become impossible. The differentiation of soft plaque and vessel thrombus can also be a problem, and the hard plaque may imitate a constriction. The knowledge of breath and pulsating motion artifacts, beam-hardening artifacts and flow-related artifacts is essential. Differentiating difficulties during virtual endoscopy, the partial volumen effect, the interpretation of various post-operative conditions, the disturbing effects of implants may cause diagnostic and differential diagnostic problems. The author gives a summary of possible errors, misinterpretations and artifacts that may occur with the application of MSCT even if examination protocols are followed.]

Lege Artis Medicinae

[Health risk awareness among healthcare professionals]

SZOBOTA Lívia, BALOGH Zoltán

[INTRODUCTION - The aim of our study was to assess how aware healthcare professionals are of the risks and dangers they are faced with while performing their jobs. MATERIAL AND METHOD - Data collection was done quantitatively with a survey filled out by the subjects themselves from among medical/healthcare professionals who are currently working multiple shifts or medical professionals who are in leadership positions and are currently continuing their higher education beside their employment. Data analysis was done with the help of Microsoft Excel and SPSS using the Pearson chi-squared test and the Mann Whitney test (p<0.05) as well as descriptive statistical methods. RESULTS - The 134 healthcare professionals taking part in the study were not fully aware of the health risks they are faced with. CONCLUSION - The people who provided answers were not clear on workplace dangers and risks. On the whole, it can be determined that the cooperation of occupational health and workplace safety is necessary in order to avoid damage to the health of healtcare professionals.]

LAM Extra for General Practicioners

[TREATMENT OF ACUTE PANCREATITIS, WITH SPECIAL REGARD TO PHARMACEUTICAL THERAPY]

DÖBRÖNTE Zoltán

[Treatment of acute pancreatitis is mainly supportive, including the correction of any factors causing or sustaining the disease process, efforts to limit complications, as well as treatment of complications. Pharmaceutical efforts to influence the pathophysiological events with protease inhibitors or by influencing the release of the pro-inflammatory cytokine cascade did not prove to be effective, so there is no known effective and specific drug therapy for clinical use. Adequate pain control is an important component of pharmaceutical management, and - although yet controversial - early antibiotic prophylaxis and effective antimicrobial treatment of the inflammatory complications (infected necrosis or fluid collection, SIRS, sepsis) have probably a determining role in the outcome of severe necrotizing pancreatitis. Carbapenems proved to be the most potent antibiotics. For the prevention of the not infrequent fungal superinfection in acute pancreatitis, early administration of fluconasole can also decrease mortality. Surgery is indicated in the first stage of infected necrosis and infected pancreatic and peripancreatic fluid collections. In certain patients with a high operative risk, endoscopic or percutaneous drainage with lavage can also be worth trying. Optimal conditions for the treatment of severe necrotizing pancreatitis, as well as adequate management of multiple organ failure can only be warranted at an intensive care unit. In the chemoprevention of pancreatitis complicating endoscopic retrograde cholangiopancreatography (ERCP), non-steroidal anti-inflammatory drugs promise a new therapeutic option. There are insufficient data about the beneficial effects of the protease inhibitor ulinastatin, and results with nitroglycerin are contradictory.]

Lege Artis Medicinae

[Feeding and eating in infancy and early childhood part II. - Breastfeeding, complementary feeding and weaning in the Large-sample of the “For Healthy Offspring” project]

NÉMETH Tünde, VÁRADY Erzsébet, DANIS Ildikó, SCHEURING Noémi, SZABÓ László

[INTRODUCTION - Complementary feed-ing is the transitional period from exclusive breastfeeding to family foods, while breastfeeding is continued. It should be started, when breastmilk itself no longer meets the infant’s nutritional requirements, ideally at the age of around 6 months. SUBJECTS AND METHODS - In the Healthy Offspring project self reported questionnaires were received from 1133 parents of 0-3 year old children. Comple­mentary feeding practices and issues of weaning were analyzed. RESULTS - In our sample complementary feeding was started at the age of 5.5±1.8 months. 6% of infants younger than 4 months and about two third of infants at the age between 4 and 6 months were started on complementary feeding. 32% of the 7-12 month old infants were continued on breastfeeding. The proportion of breastfed infants and young children in the 12-24 and 25-36 month age group was 24% and 5.5% respectively. The daily feeding frequency of breastfed infants was 6.7±1.6. The infants and young children, who were breastfed along with complementary feeding were feeding 5.6±1.5 times/day. After completed weaning the range of feeding frequency was limited to 4.9±0.9 occasions/day. 60.4% of mothers regarded their feeding style on demand, while 39.6% on set schedule. 16% of mothers reported that their child had feeding difficulties. CONCLUSIONS - Complementary feeding indicators should be part of infant feeding data collection, such as time of introduction of complementary food, feeding frequency, food consistency, energy density of food and safe preparation. Responsive feeding is part of responsive parenting and should be promoted, along with continuing breastfeeding at least till one year of age, and for as long as mother and infant wish to continue. ]