Lege Artis Medicinae

[Medicinal Geography?]

GRÉTSY Zsombor

DECEMBER 20, 2005

Lege Artis Medicinae - 2005;15(12)

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Lege Artis Medicinae

[“I See that it is Worth it...” An Interview with Professor Tamás Bender by Elemér Nemesánszky, LAM’s Editor-in-Chief]

NEMESÁNSZKY Elemér, GYIMESI Andrea

Lege Artis Medicinae

[LINKAGE OF POSTPRANDIAL LIPAEMIA AND GENES MUTATIONS IN FAMILIAL DYSLIPIDEMIA]

REIBER István

[The familial combined hyperlipidemia (FCH) is the most common form of heritable lipid disorder. The prevalence of FCH is 0.5 to 2.0% in the general population, and 15 to 20% in the survivors of myocardial infarction before the age of 60 years. Healthy people spend most part of their life in postprandial state, which is the sum of the 6-8 hours after each main meal spanning over 20 or 24 hour per day. After the ingestion of the fat rich meal the intestinal chylomicrons disturbs the balance of lipid metabolism. The disorder of the lipid transport does not always manifest itself in the fasting state when the lipid transport system is yet at poise. So, the measuring of fasting triglyceride does not reflect exactly the metabolic capacity and the true atherogen risk of the subject. The healthy FCH family members may have got abnormal higher and extended postprandial lipemia contrast of the normal fasting triglyceride levels. The distributions of PvuII and HindIII polymorphisms in FCH are different from normolipidemic controls. At the same time, there is significantly higher incidence of the apo e4 allele. The apo E4/3 genotypes have got higher and extended postprandial lipemia in FCH subjects. In the investigated international and Hungarian FCH groups have got the minor allele of apolipoprotein AV T/C polymorphism more frequently. The carrying status of the minor allele is accompanied with higher fasting lipid levels and associated with higher and extended postprandial lipemia. The Hungarian results suggest a decreased and extended catabolism of the remnants in FCH caused by apoAV T/C promoter variation that seems to have a more direct effect on the postprandial status than that of apoE 3/3-4/3 polymorphism. The knowledge of characteristics of postprandial lipemia influenced by the mutations of genes described by us are more useful as only the fasting triglyceride level and it is as effective as LDL- or HDL-cholesterol value in the measuring of prognosis of development of vascular disease with athero-thrombotic origin.]

Lege Artis Medicinae

[Against the Pharma Industry or for the More Reliable Knowledge?]

BÁNFALVI Attila

Lege Artis Medicinae

[PRECONDITIONING AND CARDIOPROTECTION WITH VOLATILE ANESTHETICS]

SZÉKELY Andrea, BREUER Tamás

[A rapidly growing body of experimental evidence indicates that volatile anesthetics protect the myocardium against reversible and irreversible ischemia and reperfusion injury. Volatile anesthetics exerted preconditioning effects, resembling to ischemic preconditioning in different animal models. This results in direct protection against ischemic damage, or an indirect enhancement of the ability of myocardial mitochondrial KATP channels to open in response to an agonist. In addition, volatile anesthetics also reduce the severity of reperfusion injury when administered only during reperfusion. These findings might expand our clinical possibilities in the perioperative management of ischemic cardiac dysfunction. Indeed, several recent publications reported on improved postoperative hemodynamic function and lowered level of ischemic cardiac biomarkers in patients anesthetized with volatile anesthetics during coronary artery bypass grafting. The potential applicability of these finding is subject of further research.]

Lege Artis Medicinae

[THE EFFECT OF BALNEOTHERAPY AND HIDROTHERAPY IN LOCOMOTOR DISEASES - AN OLD THERAPY REBORN]

BENDER Tamás

[Hungary is respected as an “Empire of thermal water” and balneotherapy has been an important part of health tourism. Recently, an increasing number of articles have been published which investigate the effect of thermal water on patients suffering from locomotor diseases. Balneotherapy has a beneficial painkiller effect and improves the quality of life in several cases of inflammatory and degenerative disorders of joint and bone diseases. The physical effect in its mechanism plays much greater role than the chemical one. A great number of evidence can be found in the medical databases proving the positive effect of balneotherapy in musculoskeletal diseases. Balneotherapy stands as an important factor in the National Development Plan of Hungary but we should like to emphasise that without basic research there is no effective balneotherapy.]

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Lege Artis Medicinae

[Original and generic drugs: Research, efficacy, utilization, and financing ]

NOSZÁL Béla

[Starting from the definition of medicinal drugs, this paper covers the terms of original, active principles, original and generic drugs, and their distinctive and identical properties. It also surveys the fundamentals of drug-marketing authorization, criteria of therapeutic and bioequivalence, pharmaceutical and pharmacokinetic equivalence, and development possibilities of generic drugs.]

Clinical Neuroscience

[Financing of medicines for treatment of rare diseases of the nervous system. orphan drugs in rare neurological diseases]

SZEGEDI Márta, KOSZTOLÁNYI György, BONCZ Imre, MOLNÁR Mária Judit

[Objectives – Nervous system involvement is expected up to 60-70% in case of rare diseases. This article aims to present the financial methods and expenditures of rare neurological diseases’ orphan medicinal products being financed in the frame of Hungarian social insurance system in 2012. Methods – The subsidized orphan medicines were selected on the Orphanet portal 2012 while orphans financed by compessionate use were provided by the Hungarian National Insurance Fund Administration (OEP) database. Three products exist without orphan designation, however those are intended for the treatment of rare neurological ailments. The medicines were categorized by financial methods and determined by costs. Results – Numerically, out of 36 pieces of subsidized orphan or orphan criteria fulfilled medicines 17 were authorized for the treatments of rare neurological diseases in the year of 2012. Most of the drugs (14 pieces) were to be financed in the frame of compassionate use by the reimbursement system. The cost amount of social insurance for 387 rare neurological disease patients reached more than 4.5 billion HUF (1.4% of the total pharmaceutical budget in outpatient care). Conclusions – In Hungary half of the subsidized orphans are intended for the treatments of rare neurological ailments. 30% of the total amount of social insurance for rare diseases’ medicinal treatments were used to subsidizing rare neurological disease patients in 2012. Most of the orphan medicines were to be financed in the frame of compassionate use by the reimbursement system for outpatient care. Consequently, a great deal of crucial problems occurred in relation with the unconventional subsidizing method. At the end of 2012 new financial methods have been elaborated and introduced in a pilot phase from 1 January 2013. In spite of the high cost commitment, nearly the entire diagnosed rare disease subpopulation have been provided with subsidized treatments in Hungary. In order to facilitate the acces to orphan medicines, collaboration shall be achieved by financing authority and professionals for identificating the descently sustainable, affordable and viable financial method. ]

Clinical Oncology

[First-line treatment of epithelial ovarian cancer]

RÉVÉSZ János, SZÁNTHÓ András

[The restructuration of Hungarian oncological attendance and medicinal fi nancing resulted in the more intensive participation of clinical oncologists in the therapy of patients with ovarian cancer. The aim of the authors was not to defi ne the taxative therapeutic recommendations, but to give an overview on the development of the therapy and to introduce the deliberation aspects and therapeutic alternatives. While the primary and secondary prevention have developed in case of cervical cancer - with the possibility of eradication - the improvement of surgical techniques and clinical oncological treatments may result in the decrease of mortality in ovarian cancer. It is important to emphasis that only the appropriately aligned application of the two therapeutic modalities can lead to the desired outcome. It has become clear by the end of the ‘90s, that paclitaxel-carboplatin combination is the standard chemotherapy against ovarian cancer. Alternative cytostatic treatments like intraperitoneal treatment and triplets were not breakthroughs. The dose intensive treatment increased the survival rates besides good tolerability, however the results require further confi rmation. Neoadjuvant therapy should be considered in case of patients with advanced and metastatic disease in selected cases. Recently, therapeutic use of angiogenesis inhibition comes with signifi cant improvement. Bevacizumab is the fi rst of targeted therapies, and studies on the effectiveness of similar compounds are under way.]

LAM KID

[Comment and reactions on the recommendations of EMA’s Committee for Medicinal Products for Human Use (CHMP) and Pharmacovigilance Risk Assessment Committee (PRAC) about strontium ranelate, April 2013]

POÓR Gyula, SZEKERES László, LAKATOS Péter

Lege Artis Medicinae

[CHEMOPREVENTION OF COLORECTAL CANCER]

LAKATOS László, LAKATOS Péter László

[Colorectal cancer is the second leading cause of cancer mortality in developed countries; in Hungary, the mortality has almost tripled in the past four decades. A decrease in mortality can only be expected from a consistently applied diagnostic and management strategy, including preventive measures. Primary prevention is defined as dietary, medicinal and lifestyle actions that can reduce the risk of developing cancer in people with average risk. Secondary prevention is the prophylactic treatment of high-risk patients or praecancerous lesions; tertiary prevention is the prevention of recurrence in patients cured of colorectal cancer. Drugs or dietary supplements used for chemoprevention block, delay or reverse the process of carcinogenesis. The most important drugs used for chemoprevention are aspirin and nonsteroidal anti-inflammatory drugs. Long-term administration of these drugs reduces the risk of developing colorectal cancer or adenoma both in the high-risk and in the average-risk population. The risk-lowering effect seems to be in positive correlation with the dose and the duration of use. Other chemoprophylactic drugs such as calcium, folate, oestrogen and antioxidants, as well as 5-aminosalicylates in patients with ulcerative colitis are also discussed in this review. Based on the current knowledge, chemoprophylaxis of colorectal cancer is recommended as secondary prevention in patients at high risk (e.g., familial adenomatous polyposis, extensive ulcerative colitis). In contrast, based on adverse event profile and cost-effectiveness analysis, primary prevention with chemopreventive drugs is currently not recommended in the averagerisk population.]