Lege Artis Medicinae

[Modern antibiotic therapy - The antibiotic therapy of community acquired pneumonias in adults based on gudelines]

KOVÁCS GÁBOR

AUGUST 20, 2003

Lege Artis Medicinae - 2003;13(06)

[Most therapies in the treatment the community acquired pneumonia are empirical. There are several different guidelines helping to choose the right antibiotic. These guidelines contain the background of the epidemiology, diagnosis and microbiology. However the center of the interest is the therapeutic guide. The guidelines are worth as much as you make from those.]

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[Motor vehicle accident with complete loss of consciousness due to vasovagal syncope]

VARGA Emma, WÓRUM Ferenc, SZABÓ Zoltán, VARGA Mihály, BARTA Kitti, LŐRINCZ István

[INTRODUCTION - Vasovagal syncope is one of the most common causes of complete or partial loss of consciousness, causing harm to drivers or innocent bystanders. CASE REPORT - In our case, we report the case of a 60-year-old man who was admitted to hospital after a serious motor vehicle accident due to loss of consciousness. The process and results of complete cardiologic and neurological assessment are presented. The case report illustrates the importance of recognition of patients with a high risk for incapacitating symptoms due to vasodepressor type vasovagal syncope as well as the use of head-up tilt-table test to determine the diagnosis and also to guide combined management. CONCLUSION - As transient loss of consciousness during driving may cause potentially fatal accident, it has to be taken into consideration during decision making when issuing driving license for patients with vasovagal syncope.]

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BOSNYÁK Zsolt, STELLA Péter

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NÉMETH Éva

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REINDL Ildikó

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MAGYAR M. Tünde, EUN-MI Nam, CSIBA László, RITTER A. Martin, BERND E. Ringelstein, DIRK W. Droste

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[Traumatic brain injury (TBI) is recognized to be the main cause of death and disability in the first four decades representing a major socio-economical problem worldwide. Recent communications revealed a particularly worrying image about the quality of care for TBI in Hungary. For any improvement a systematic approach characterized by utilization of scientific evidence based guidelines forming the basis for close monitoring of the actual care are considered a prerequisite. In Hungary the first evidence based guidelines in the field of TBI have been issued by the National Society for Anesthesiology and Intensive Care more than two decades ago followed by joint guidelines of the Hungarian Neurosurgical Society and the Hungarian College of Neurosurgeons. These publications were primarily based on the work of the European Brain Injury Consortium as well as guidelines issued by the Brain Trauma Foundation. Recent renewal of the latter and a need to refresh the outdated national guidelines was met by a call from regulatory authorities to issue the updated version of the Hungarian TBI-guidelines. The present review is aimed to briefly summarize the most fundamental elements of the national head injury guidelines that would hopefully be officially issued in a far more detailed format soon.]

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[The lipid lowering therapy became one of the most important elements in the cardiovascular prevention, yet it is not appropriately evaluated neither by the doctors, nor by the patients. The lipid goal attainment should to be improved according to Hungarian and international data. Using a recommendation guided lipid lowering therapy the most benefit can be expected in the patients at very high risk who alrea­dy had a cardiovascular event, where the LDL-cholesterol goal is 1.8 mmol/L. Calculating upon the data of 170000 patients of Cholesterol Treatment Trialists’ Collaboration a decrease of LDL-cholesterol level from 2.5 mmol/L to 1.8 in 100 patients in 10 years would avoid 3 myocardial infarctions, strokes or death, lowering that from 3.5 mmol/L to the goal would prevent these 3 events within 5 years. Using the traditional LDL-cholesterol lowering medication, high dose statin and ezetimibe, if the attitude of doctors and the compliance of patients would be ideal, the 1.8 mmol/L goal attainment rate would be over 80%. Unfortunately, up to now the reimbursed administration of ezetimibe in Hungary is still bound to a specialist’s recommendation, adding it to any dose of any statin an additional 20% LDL-cholesterol can be expected. The reimbursed administration of PCSK9-inhibitors is possible only based on a special request to National Health Insurance Fund. To achieve a better national cardiovascular morbidity and mortality the attitude of the doctors and the adherence of the patients to the lipid lowering therapy should be improved (it’s the goal of the present paper as well).]

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[Beta-blockers are among the most widely used drugs for the treatment of cardiovascular diseases. In the mid-90’s, these drugs were recommended as first-line therapies of hypertension. With the introduction of new drugs, the list of first-choice drugs has been extended. The results of recently published major hypertension trials, which compared conventional agents (beta blockers and/or diuretics) with newer agents (angiotensin converting enzyme inhibitors, Caantagonists, angiotensin receptor blockers), raised concerns regarding the role of beta blockers in cardiovascular primary prevention. Subsequently, a metaanalysis of 13 trials has shown that compared with other drug types, beta-blocker therapy is less beneficial in patients with hypertension who do not have heart disease. Nevertheless, in cardiovascular indications other than hypertension (acute myocardial infarction, heart failure and arrhythmias), betablockers retain their dominant position.]

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