Lege Artis Medicinae

[Neuroendocrine background of atherosclerosis and cardiovascular damages in durable stress]


MARCH 20, 2010

Lege Artis Medicinae - 2010;20(03-04)

[Chronic stress is associated with increased levels of cortisol and catecholamines as well as with an enhanced activity of the sympathico-sensory nervous system. These neuroendocrine events influence both directly and indirectly the lipid and glucose metabolism as well as inflammatory immune reactions. Stress effects directly cause vascular damage and atherosclerosis via the renin-angiotensin system (RAS). Besides RAS, activities of monocytes/macrophages and the sympathico-sensory nervous system lead to local cardiovascular inflammation and cell hypertrophy. Transactivation between G-protein coupled adrenoceptors and tyrosine kinase receptors as well as the switching between β1- and β2- adrenergic receptors play an important role in the development of cardiac hypertrophy and heart failure. In all chronic neuroendocrine diseases that are associated with increased activity of the sympathetic nervous system, the development of cardiovascular damages needs to be considered.]



Further articles in this publication

Lege Artis Medicinae

[A new era in the treatment of patients with type 2 diabetes - Significance of the incretin analogue liraglutide from an internist’s perspective]


[Therapy of patients with type-2 diabetes has two important features: in addition to the nonpharmacological approach (changes in lifestyle and diet, smoking cessation, physical exercise), pharmacological intervention is needed to reach the target level of blood sugar, and those of other cardiometabolic risk factors (blood pressure, body weight, lipids, uric acid). Unfortunately, it is a worldwide problem that only a small fraction of diabetic patients reach all these goals. This is why it is very important to have drugs which can not only decrease the blood sugar level, but have beneficial effect on several cardiometabolic factors. Antidiabetic drugs affecting incretin system, the GLP-1 analogues or -mimetics, and DPP-4 inhibitors open a new era in the treatment of diabetic patients, because in addition to the reduction of blood glucose level, they may have beneficial effects on blood pressure, blood lipids and body weight. Among these drugs the newly registered liraglutide has an important role, because it stimulates secretion of insulin in a glucose-independent manner, and it also reduces the secretion of glucagon which is a well known endogenous substance that increases blood glucose level. It is important to note that liraglutide decreases appetite, body weight and blood pressure of diabetic patients. Several clinical pharmacological studies has been completed with liraglutide. Of these the LEAD (Liraglutide Effect and Action in Diabetes) program is of outstanding value because it proved that either in monotherapy or in combination with other antidiabetics it effectively decreased blood sugar level, body weight, and had a beneficial effect on systolic blood pressure.]

Lege Artis Medicinae

[The Ferenczi Cult, the Therapeutic Technique and the “Dodo Hypothesis”]


Lege Artis Medicinae

[Nebivolol: the long-acting, vasodilatator beta-blocker]


[Nebivolol is a third-generation, long-acting, vasodilator beta-adrenoceptor-blocker with very high selectivity to beta-1 receptor. In addition to its efficient blood pressure lowering effect, results of previous trials have shown that nebivolol, which has a vasodilator effect and improves endothelial dysfunction, offers a safe, well-tolerable therapeutic option for elderly patients with heart failure, chronic pulmonary disease, diabetes, hyperlipidaemia and hypertension. It does not affect or improves lipid and carbohydrate metabolism, moreover, it can improve patients’ quality of life in multiple ways.]

Lege Artis Medicinae

[The role of risk sharing in drug funding]

KALÓ Zoltán, VOKÓ Zoltán

[In order to make the pharmaceutical budget predictable, an internationally accepted approach of health insurance providers is to shift more and more financial risks to pharmaceutical companies. The major paradox of financial risk-sharing schemes is that increased mortality, poor therapeutic compliance, reduced access to healthcare services, decreasing quality of health care and lack of treatment reduce pharmaceutical spending. Consequently, payers have started to employ reimbursement schemes that enable them to guarantee health gain and quality of service. Introduction of a risk-sharing scheme based on outcome and compliance can be a major advancement in the strategy of the Hungarian National Health Insurance Fund (NHIF). Funding schemes that guarantee therapeutic benefit can help reduce the uncertainty in coverage decisions regarding high-value, innovative healthcare technologies. However, justification of the parallel use of financial and outcomebased risk-sharing on the micro level is questionable. Even if the primary objective of the NHIF is to ensure the sustainbility of the public pharmaceutical budget, financial risks should be managed on the macro level.]

Lege Artis Medicinae

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[The effect of angiotensin receptor antagonists in diabetic nephropathy]

BÍBOK György

[Influencing the renin-angiotensin system through receptor blockade has become a new therapeutic approach toward the treatment of several morbidities, i.e. hypertension, cardiac failure and diabetic nephropathy. The current paper reviews the importance of diabetic nephropathy, the physiology of the renin-angiotensin system and specific effects of receptor blockade on different organs based on 3 new studies (published last year) using angiotensin-II receptor blockers. The paper gives a summary of the IRMA, IDNT and RENAAL studies, including their clinical and therapeutic significance in general practice as well as in specialized diabetes care. The new therapeutic approach (with an excellent safety profile, and infrequent side effects) could delay the progression or might even prevent the manifestation of diabetic nephropathy not only with lowering blood pressure but with its direct effects on target tissues as well. The angiotensin-II receptor blocking agents might be useful for the treatment of cardiac failure in hypertensive patients.]

Clinical Neuroscience

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


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.

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Lege Artis Medicinae

[The effect of chronic stress on defense mechanisms chronic inflammation and carcinogenesis]


[During stress, the activation of the hypothalamus- pituitary-adrenal axis and the sympathetic, sensory nervous system leads to an increased production of glucocorticoids, catecholamines and other active peptides. The specific receptors on immunocompetent and tissue cells for glucocorticoid, corticotropin-releasing hormone and histamine, substance-P, norepinephrine, calcitonin gene-related peptide can modify the cytokine production of macrophages, lymphocytes and tissue cells. Local hormonal effects have a role in the degranulation of mast cells and thus in histamine release and neurogenic inflammation. Long-term, chronic inflammations promote carcinogenesis, in which the tumourassociated macrophages have an important role. Carcinogenesis is associated with disturbed cooperation between the neuronal immune and endocrine systems.]