Lege Artis Medicinae

[Polydactylic Human Figures on North American Stone Paintings]

NAGY Gyula

APRIL 22, 2008

Lege Artis Medicinae - 2008;18(04)

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Lege Artis Medicinae

[From Research Subject to a Co-Creator]

SÁNDOR Judit

Lege Artis Medicinae

[Facts and myths in the management of acute stroke]

CSIBA László, KOVÁCS Katalin Réka

Lege Artis Medicinae

[Satisfaction]

HANKISS János

Lege Artis Medicinae

[RECENT ADVANCEMENTS IN THE DIAGNOSIS AND TREATMENT OF AGE-RELATED MACULAR DEGENERATION]

SERES András István

[Age-related macular degeneration is the leading cause of blindness in developed countries. In the last few years, new therapeutic approaches such as photodynamic therapy and intravitreal injections of vascular endothelial growth factor antagonists were introduced that do not only prevent disease progression but also give the hope of vision improvement. Of the new diagnostic methods, the use of optical coherence tomography improves diagnosis and also permits the qualitative measurement of therapeutic effects. Given the current high price of the new drugs and the need for frequent re-treatments, a significant increase in the economic burden of the disease is foreseeable.]

Lege Artis Medicinae

[A Must-Have Scientific Book György Jermendy (editor): Hypertension from a Diabetologist’s Perspective]

NAGY Judit

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Clinical Neuroscience

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]

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[Prevention of invasive meningococcal infection, recognition and first treatment of the disease in primary care]

KOVÁCS Ákos, KULCSÁR Andrea, KALABAY László, TORZSA Péter

[In this article, based on a short case report, the authors summarise what you must do and must not do as a primary care physician when suddenly meeting a young patient suspected of having meningococcus infection. Neisseria meningitidis, the meningococcus, is a Gram-negative diplococcal bacterium that is only found naturally in humans. The meningococcus is part of the normal microbiota of the human nasopha-rynx and is commonly carried in healthy individuals. In some cases systemic invasion occurs, which can lead to meningitis and/or septicemia. Invasive disease caused by Neisseria meningitidis is potentially de­vastating, with a high case fatality rate and high rates of significant sequelae among survivors after septicaemia or meningitis. Between 2006 and 2015 every year there were 34 to 70 cases of the registered invasive disease caused by Neisseria meningitidis, the morbidity rate being 0.02-0.07‱. Half of the diseases (50.7%) were caused by serotype B N. meningitidis, 23.2% were serotype C. ]

Lege Artis Medicinae

[The treatment of chronic hepatitis C with peginterferon - Peginterferon alfa-2a or alfa-2b?]

TORNAI István

[The main purpose of the treatment of patients with chronic hepatitis C is to achieve a sustained virologic remission (SVR), which means that no hepatitis C virus ribonucleic acid (HCV RNA) is detectable 24 weeks after the cessation of treatment. In patients infected by genotype 1 virus, the chance of achieving SVR by a combination treatment with peginterferon alfa-2a or alfa-2b plus ribavirin is about 40-50%. The pharmacokinetic properties of the two peginterferons are significantly different from each other. A number of clinical trials have been performed in the past eight years to clarify whether this difference influences the clinical efficiency or safety of these drugs. Several prospective, comparative studies have been completed recently. Among these, the American IDEAL study is the largest and most important one, however, the results of numberous smaller studies are also available. More than 3000 patients with genotype 1 HCV were treated in the IDEAL study and no significant difference was found in SVR rates between the peginterferon alfa-2a and alfa-2b treatment arms. However, the doses of ribavirin used in this study raise several questions in this study. In two smaller Italian studies, significantly higher SVR was achieved with peginterferon alfa-2a plus ribavarin treatment. According to a Cochrane metaanalysis, in which reviewed data of 4335 patients from eight randomized trails have been reviewed, treatment with peginterferon alfa-2a is significantly more effective. Besides efficiency, the cost/effectiveness of the two therapies were also compared in a large American study, which also showed that peginterferon alfa-2a treatment was superior to peginterferon alfa-2b treatment.]

Lege Artis Medicinae

[In vitro efficiency of doripenem, a new carbapenem against Gram-negative, aerob, problem bacteria - Prospective, multicentric, Hungarian study]

NAGY Erzsébet, SAQQA Muhammad, SZABÓ Judit, MESTYÁN Gyula, SZIKRA Lenke, KONKOLY THEGE Marianne

[INTRODUCTION - Doripenem is a new carbapenem derivative, it’s chemical structure is similar to that of meropenem (substitution of one sulfamoxil-aminomethyl chain for the dimethylcarboxy chain) and has one 1-beta-methyl chain which provides resistance to dyhidropeptidase-I enzyme produced by the human kidney. It has a broad-spectrum of activity against multiresistant Gram-negative bacilli such as ESBL-producing Enterobacteriaceae and non-fermentative Gramnegativ bacilli including some strains of Pseudomonas aeruginosa that are resistant to other carbapenems. In 2010 between February and June a multi-centre comparative study was carried out including 5 Hungarian laboratories to investigate the in vitro activity of doripenem. MATERIAL AND METHODS - 1000 fresh, clinically relevant isolates were included both ESBLproducing and non-producing Enterobacteriaceae strains and resistant and multi-resistant Pseudomonas aeruginosa and Acinetobacter strains. The activity of doripenem and the comparator antibiotics (other carbapenems) were tested by the disc diffusion method. In the case of intermediate resistant strains the MIC of doripenem was also determined by the E-test methodology. RESULTS - All but one isolate belonging to the Enterobacteriaceae (592 isolates) were fully susceptible to doripenem. The only Enterobacter strain which proved to be intermediately susceptible to doripenem by the disc diffusion method was also found to be susceptible showing an MIC of 0.125 μg/ml. In the case of the 163 Pseudomonas aeruginosa and the 121 Acinetobacter spp isolates doripenem was the most active carbapenem compared with imipenem and meropenem (78.6% and 50.5% for doripenem versus 67.5% and 42.0% for imipenem and 68.7% and 30.2% for meropenem, respectively). CONCLUSION - According to our multi-centre study doripenem was highly active against both the ESBL-producing and ESBL-non-producing Enterobacteriaceae strains and against a great part of the Pseudomonas and Acinetobacter isolates often involved in nosocomial infections.]

Lege Artis Medicinae

[The clinical importance of HER2 expression in breast cancer]

KAHÁN Zsuzsanna

[HER2 (neu/c-erbB-2) is a member of the EGF receptor family. It is activated without binding a specific ligand that leads to malignant transformation and tumor progression. Overexpression of HER2 is detected in approximately one quarter of human breast cancers. Immunohistochemistry and in situ hybridization (FISH) are the most widely used techniques in studying HER2 expression. HER2 positivity indicates worse outcome in node positive breast cancer and increasing number of studies show unfavourable prognosis in node negative cases as well. Recent data indicate that the knowledge of HER2 status may promote therapeutic decision. The generally applied cyclophosphamide- methotrexate-5-fluorouracil (CMF) polychemotherapy seems to provide no benefit in HER2 positive cases in contrast with HER2 negative breast cancer patients. Interestingly, doseintensive doxorubicin based chemotherapy gives better results in HER2 positive than in HER2 negative tumors. Determination of HER2 expression has great importance before therapeutic application of the humanized antibody trastuzumab (Herceptin). HER2 overexpression usually correlates well with estrogen and progesterone receptor negativity and hormone-resistance, therefore hormonal therapy is not justified for these patients. Some experimental and clinical data indicate that in case of simultaneous HER2 and ER positivity tamoxifen worsens treatment results which may be prevented by the coadministration of tamoxifen and trastuzumab. Emerging experimental and clinical data about HER2 has led to a new stage of individual treatment of breast cancer patients. The knowledge of HER2 status promotes antitumor intervention based on molecular characteristics of breast cancers. Therefore, reliable HER2 tests are needed in the everyday practice.]