Lege Artis Medicinae

[Outrageous Nudity, or the Burden of Being Recognisable ]

GEREVICH József

DECEMBER 18, 2016

Lege Artis Medicinae - 2016;26(11-12)

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Lege Artis Medicinae

[Handicap in Movie ]

LENGYEL Dávid

Lege Artis Medicinae

[The cardiovascular risk of nonsteroidal antiinflammatory drugs]

AMBRUS Csaba, KISS István

[Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most common pain relief and anti-inflammatory medications all over the World, and many formulations are also available over-the-counter. Beyond the well-known gastrointestinal risks, emerging evidence supports increased incidence of cardiovascular events associated with the use of NSAIDs. This cardiovascular risk seems to be independent of the cyclooxygenase selectivity of these drugs. Distinct side effect profiles of various NSAIDs were summarized in a former issue of the Journal: LAM 2014;24(7): 327. In this paper, we aimed to summarize some of the yet unpublished results of a major research project of the European Medicines Agency (EMA), that was conducted in order to establish the relative risk of CV outcomes (myocardial infarction, ischaemic stroke and hospitalization for heart failure) associated with the use of various NSAIDs. In this epidemiological study, seven European healthcare databases on a source population of 35 million subjects were linked and analyzed. Most of the results are currently only available on the project homepage; however, analyses of heart failure data have already been published in a recent issue of The BMJ. ]

Lege Artis Medicinae

[Intravenous immunoglobulin immunotherapy in immune mediated habitual abortions]

FÜLÖP Vilmos, PETRÁNYI Győző

[INTRODUCTION - Based upon international and domestic research data authors summerize the humoral and cellular im­munregulatory disorders which can be found in the background of “immune me­diated abortions” (IMA). PATIENTS AND METHODS - Within the frame of a home research program a special examination protocol was elaborated in order to sepatare alloimmune habitual abortions from autoimmune and non immune backgrounds. After all other causes were excluded erythrocyte antibody inhibition assay (EAI) was used for measuring the serum level of FcgRII receptor blocking IgG antibody, because its lack an important diagnostic parameter. Among the cell mediated immunofuntional tests the mixed lymphocyte culture reaction (MLC) was the most useful. During the roughly last 16 years 67 out of 76 selected alloimmun IMA patients were administered Intratect IVIG treatment without any particular selection among them. IVIG treatment was first applied on the completed 5-6th week of pregnancy and doses of 0,3-0,4g/kg bodyweight per oc­casion were given 3 times with 3-week intervals. RESULTS - Altogether a significant rise in the serum level of blocking antibodies was shown after each IVIG treatment although a slight decrease was seen after every given dose. Of the 67 IMA patients 54 carried infants to term during the study period. In 4 cases of abortion no cause was identified with post hoc diagnosis. Thus the success rate of this type of IVIG therapy was 93.1% (58/54). Conclusion - In approprietly selected alloimmun IMA cases the IVIG generated immunoregulatory and antiimflammatory pathways may contribute to its net positive reproductive effect.]

Lege Artis Medicinae

[Philosophical café as therapeutic community]

NEMES László

[In this paper we examine the very possibility of integrating philosophical discussion groups into the practice of community psychiatry as a kind of therapeutic community. We summarize the history of the café-philo movement, the conception, methods and goals of the philosophical café. I present a detailed report on the experiences about the philosophical cafés going on at the Awakenings Foundation on a weekly basis for two years. I suggest group philosophy discussion as a useful additional form of activities usual in psychiatric rehabilitation. ]

Lege Artis Medicinae

[End-of-Life Decision Situations – Physician-Assisted Suicide in the Context of Hospice: Oregon and Washington (USA) ]

KŐMÜVES Sándor

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[Advanced Parkinson’s disease characteristics in clinical practice: Results from the OBSERVE-PD study and sub-analysis of the Hungarian data]

TAKÁTS Annamária, ASCHERMANN Zsuzsanna, VÉCSEI László, KLIVÉNYI Péter, DÉZSI Lívia, ZÁDORI Dénes, VALIKOVICS Attila, VARANNAI Lajos, ONUK Koray, KINCZEL Beatrix, KOVÁCS Norbert

[The majority of patients with advanced Parkinson’s disease are treated at specialized movement disorder centers. Currently, there is no clear consensus on how to define the stages of Parkinson’s disease; the proportion of Parkinson’s patients with advanced Parkinson’s disease, the referral process, and the clinical features used to characterize advanced Parkinson’s disease are not well delineated. The primary objective of this observational study was to evaluate the proportion of Parkinson’s patients identified as advanced patients according to physician’s judgment in all participating movement disorder centers across the study. Here we evaluate the Hungarian subset of the participating patients. The study was conducted in a cross-sectional, non-interventional, multi-country, multi-center format in 18 countries. Data were collected during a single patient visit. Current Parkinson’s disease status was assessed with Unified Parkinson’s Disease Rating Scale (UPDRS) parts II, III, IV, and V (modified Hoehn and Yahr staging). Non-motor symptoms were assessed using the PD Non-motor Symptoms Scale (NMSS); quality of life was assessed with the PD 8-item Quality-of-Life Questionnaire (PDQ-8). Parkinson’s disease was classified as advanced versus non-advanced based on physician assessment and on questions developed by the Delphi method. Overall, 2627 patients with Parkinson’s disease from 126 sites were documented. In Hungary, 100 patients with Parkinson’s disease were documented in four movement disorder centers, and, according to the physician assessment, 50% of these patients had advanced Parkinson’s disease. Their mean scores showed significantly higher impairment in those with, versus without advanced Parkinson’s disease: UPDRS II (14.1 vs. 9.2), UPDRS IV Q32 (1.1 vs. 0.0) and Q39 (1.1 vs. 0.5), UPDRS V (2.8 vs. 2.0) and PDQ-8 (29.1 vs. 18.9). Physicians in Hungarian movement disorder centers assessed that half of the Parkinson’s patients had advanced disease, with worse motor and non-motor symptom severity and worse QoL than those without advanced Parkinson’s disease. Despite being classified as eligible for invasive/device-aided treatment, that treatment had not been initiated in 25% of these patients.]

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[Experiences acquired in our department with endoscope assisted microsurgical transsphenoidal pituitary surgery encouraged us to expanded the endoscopic approach to skull base lesions. The endoscopic endonasal transsphenoidal approach proved to be less traumatic to the traditional microsurgical approaches, yet very effective. The endoscopic transsphenoidal technique was applied in a patient havin anterior skull base tumor. The patient was a 49-year-old woman with several months history of left visual defect. The magnetic resonance (MR) scans of the skull revealed a midline anterior fossa space-occupying lesion measuring 21×16×22 mm located on planum sphenoidale, tuberculum sellae and intrasellar. The tumor compressed both optic nerves and optic chiasm. Total resection of the tumor was achieved by use of endoscopic transnasal, transsphenoidal technique. This is the first reported case of an anterior fossa meningeoma being treated by an endoscopic transsphenoidal technique in Hungary.]

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[Statins represent the most important drug among antilipidemic therapy modalities playing dominant roles against atherosclerotic burden. Statin’s outstanding importance is due partly to cholesterol lowering capacity, however their anti-inflammatoric, antiproliferative, antioxidant and vasodilatative efficacies as a pleiotropic potential indicates much more impact on prompt retardation of atherosclerotic progression. The results concerning statin pleiotropic influence are reviewed which are in association with their new indication in ACS management. The second part of this review delineates suspected side effects of statin use. Only one concern brings safety information: it is a fact that patients being treated with statins may have a small increased risk of increased blood sugar levels and of being diagnosed with type 2 diabetes mellitus, but the cardiovascular and mortality benefits of statin therapy exceed the diabetes hazard.]

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[This paper presents the situation and perceptions of nurses regarding sexuality related to disabled patient care in hospital. The nurses have difficulty dealing with issues of sexuality, and the reasons for this were complex and interrelated. Patient care is influenced by nurses’ perceptions of sexuality. Nurses basically could discuss of sexuality with their patients however, the sexuality is a fundamental part of being human. A person’s sexuality or sexual health can be temporarily or permanently altered by illness or treatment. Nurses are well suited to deal with patients’ needs regarding sexuality, because nurses are in constant contact with patients and because of the intimate nature of care that nurses could provide the sexual care, information’s and education on this field. Professional boundaries are the spaces between the nurse’s “power” and the patient’s vulnerability. The power of the nurse comes from the nurse’s professional position and access to sensitive personal information. Nurses should make every effort to respect the power imbalance and ensure a patient- centered relationship.]

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[Background and purpose - Data on disease burden of multiple sclerosis from Eastern-Central Europe are very limited. Our aim was to explore the quality of life, resource utilisation and costs of ambulating patients with multiple sclerosis in Hungary. Methods - Cross-sectional questionnaire survey was performed in two outpatient neurology centres in 2009. Clinical history, health care utilisation in the past 12 months were surveyed, the Expanded Disability Status Scale and the EQ-5D questionnaires were applied. Cost calculation was conducted from the societal perspective. Results - Sixty-eight patients (female 70.6%) aged 38.0 (SD 9.1) with disease duration of 7.8 (SD 6.7) years were involved. Fifty-five (80.9%) had relapsing-remitting form and 52 (76.5%) were taking immunomodulatory drug. The average scores were: Expanded Disability Status Scale 1.9 (SD 1.7), EQ-5D 0.67 (SD 0.28). Mean total cost amounted to 10 902 Euros/patient/year (direct medical 67%, direct nonmedical 13%, indirect costs 20%). Drugs, disability pension and informal care were the highest cost items. Costs of mild (Expanded Disability Status Scale 0-3.5) and moderate (Expanded Disability Status Scale 4.0-6.5) disease were 9 218 and 17 634 Euros/patient/year respectively (p<0.01), that is lower than results from Western European countries. Conclusion - Our study provides current inputs for policy making and contributes to understanding variation of costof- illness of multiple sclerosis in Europe.]