Lege Artis Medicinae

[National game fund]

JULY 27, 1994

Lege Artis Medicinae - 1994;4(07)

[The list of applicants who have been awarded non-refundable or refundable grants from the Fund, based on a decision of the Minister of Finance, following a proposal by the National Games Council at its meeting in March 1994, is set out below.]

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Lege Artis Medicinae

[Ultrasonic signs of suspected fetal chromosomal aberration]

ÁDÁM Zsolt, NÉMET János, SZABÓ István, CSABAY László, TÓTH-PÁL Ernő, HAJDÚ Júlia

[The authors summarize the relevant ultrasonic findings in case of suspected fetal chromosomal aberration. Some of these signs are detectable during routine ultrasonic screening examinations. In high-risk cases, prenatal chromosomal analysis is recommended. The following ultrasonic findings indicate a situation of high risk: disturbances of the lymphatic and amniotic fluids (e.g. hydrops, hygroma colli, polyhydramnios, nuchal edema), certain skull and brain alternations, abnormalities of the thorax and abdomen, and „minor” findings such as a single umbilical artery, choroid plexus cyst, pyelectasy, or changes in the size or shape of the long tubular bones, if these signs are accompanied by other anomalies or growth retardation.]

Lege Artis Medicinae

[Advantages and limits of the open tube and flexible esophagoscopes]

TÓTA Julianna, IRÁS Béla

[The two types of endoscopes presently available for examination and treatment of the esophagus are the traditional open tube esophagoscope and the flexible endoscope. Despite the many advantages offered by the flexible endoscope, its limitations should not be forgotten. The open tube esophagoscope should not be thought of as out-of-date, since its new variations have important therapeutic applications. The authors examine the advantages and disadvantages of the two types of esophagoscopes as discussed in the literature. ]

Lege Artis Medicinae

[An update on obstructive sleep apnea]

METES Ágnes, HIRSCHBERG Andor

[Obstructive sleep apnea, which occurs in approximately 2% of the adult population, is the more common of the two major forms of sleep apnea. The conse quences and dangers of excessive daytime sleepiness are emphasized along with the other well-known characteristics of sleep apnea syndrome. Both the decreased upper airway muscle tone during sleep and the negative pressure due to breathing through the obstructed airways may cause upper air ways to collapse. The history has a very important role in the clinical assessment, while the role of the physical examination is limited. An exact and reliable diagnosis may be arrived at through laboratory evaluation, e. g. polysomnography (PSG), Multiple Sleep Latency Test (MSLT), or radiologic examinations. Among conservative treatments, reduction of the body weight is usually effective in mild to moderate cases. In severe apneas, nasal continuous positive airway pressure (nCPAP) is the current treatment of choice. The efficacy of surgical intervention is still controversial. According to most authors, uvulopalatopharyngoplasty (UPPP) has a 50% success rate. Most recently good results have been obtained with maxillo-facial surgery in a variety of selected patients. ]

Lege Artis Medicinae

[Electrophysiologic study versus electrocardiographic monitoring]

MATOS Lajos

[Both invasive electrophysiological techniques and Holter monitoring are used to assess and predict the efficacy of drug therapy in patients with ventricular arrhythmias. These two modalities were compared in this study, the largest of its kind to date. ]

Lege Artis Medicinae

[The role of echocardiography in the management of ventricular free wall rupture ]

PÁL Mátyás, LENGYEL Mária

[Our goal was to evaluate which diagnostic and therapeutic approaches could provide a better chance of survival. Between January 1, 1987, and December 7, 1992, 772 patients with acute myocardial infarction were treated in the Hungarian Institute of Cardiology. Cardiac rupture was investigated by the retrospective analysis of clinical data, electrome chanical dissociation, echocardiographic signs and autopsy findings. Ventricular free wall rupture was found in 28 cases. The diagnosis was confirmed by autopsy in 23, by intraoperative findings in 4 cases, and by echocardiography and pericardiocentesis in 1 case. Pericardial effusion was detected in 12 of 14 cases undergoing emergency echocardiography. Seven of these had pericardiocentesis and 2 patients underwent surgical pericardial fenestration. Following this 4 patients were referred to surgery. All 4 patients died: 2 during and 2 shortly after operation. The bleeding stopped in 1 case, after pericardiocen tesis and continous drainage and during the 12 month follow-up the patient is alive and well. In acute myocardial infarction, electromechanical dissociation or signs of tamponade are indications for emergency echocardiography, and if pericardial effusion can be visualized, pericardiocentesis should be performed. This can lead to a temporary haemodynamic improvement, providing sufficient time for emergency surgery.]

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Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Lege Artis Medicinae

[History of vaccine production in Hungary ]

ÓCSAI Lajos

[This study presents the complete history of the Hungarian vaccine production, partly in association with the process of fighting vaccine-preventable infectious diseases, and underlines the fact that every government actively contributed to the age-adjusted mandatory vaccination schedule of the past 140 years. It demonstrates the various achievements from the smallpox lymph production through the launch of diphtheria serum production at Phylaxia and the establishment of the National Public Health Institute (OKI) with its vaccine production and the later institutional transformation of OKI into Humán as economic corporation to its closure. Among all OKI’s vaccine production activities, this study focuses on the production of influenza vaccines, due to its international importance in the 1960s and 1970s. The vaccine production against diphtheria tetanus and pertussis stands out from Humán’s activities, and the tetanus component of this vaccine is still used in the products of a multinational vaccine manufacturer. ]

Lege Artis Medicinae

[Risk of nonsteroidal antiinflammatory drugs. Focus on aceclofenac]

FARSANG Csaba

[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deterio­rate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable.]

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. ]

Journal of Nursing Theory and Practice

[Hungarian Nurses Day]

TISÓCZKI Evelin, BALOGH Zoltán

[On February 19, 2022 We celebrate the 205th anniversary of the birth of the first national matronage (head nurse), Zsuzsanna Kossuth. Zsuzsanna Kossuth was characterized by a high degree of empathy, self-sacrifice, exemplary behaviour, and professionalism. She laid the foundation for the processes of nursing and patient care and performed outstanding professional work throughout his life. She made no distinction between man and man, she only saw the suffering patient, in every soldier and injured. She sacrificed his life for his profession. The Hungarian Nursing Association founded the Zsuzsanna Kossuth commemorative medal in 1998, the year of the 150th anniversary of the War of Independence, which is donated every year on February 19.]