Lege Artis Medicinae

[Possibilites of modern, evidence based prevention of recurrent cystitis]

GANYECZ Máté, KÖVES Béla, TENKE Péter

MARCH 20, 2016

Lege Artis Medicinae - 2016;26(03)

[Recurrent cystitis is a very common disease in women; every second women experiences at least one episode of acute cystitis during their lifetime, and in 20% of the cases it develops to recurrent cystitis. The disease also has a significant negative impact on quality of life. In 60% percent of the cases mild-severe depression can be shown, which can be reduced by 30-40% with the properly chosen prophylaxis. Therefore the up-to-date knowledge of the evidence based recommendations on disease management is mandatory to all clinicans dealing with this patient group. In case of a recurrent urinary tract infection treatment of the actual episode is not enough. Rather, emphasis has to be placed on appropriate prevention strategy. Alway non-antimicrobial methods has to be preferred as first choice, antibiotic prophylaxis should be considered only when the non-antimicrobials have been unsuccessful. In this review the authors summarise the evidence based management options of recurrent urinary tract infections in detail, based on the guideline recommendations of the European Association of Urology. ]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[End-of-Life Decision Situations Physician-Assisted Death: Quebec, Canada ]

KŐMÜVES Sándor

Lege Artis Medicinae

[Volcano Eruptions in Bohemia, or the Riots of a Shy Painter ]

GEREVICH József

Lege Artis Medicinae

[The Son of Saul Face to Face with Darkness ]

LENGYEL Dávid

Lege Artis Medicinae

[In Service of a Genius Giuseppina Strepponi ]

KÖVES Péter

Lege Artis Medicinae

[István Körmendi: The Practice of Family Practice–Family Medicine I-II ]

HANKISS János

All articles in the issue

Related contents

Hypertension and nephrology

[Infections associated to vesicoureteral reflux disease in children below 1 year of age: the infulence of continuous antibiotic prophylactic therapy on the prevalence of resistant pathogenic bacteria]

MÁTTYUS István, KENESEI Éva, VÁSÁRHELYI Barna

[Background: The primary goal when children with vesicoureteral reflux disease (VUR) are treated is the prevention of pyelonephritis and persisting renal damage. Continuous antibiotic prophylaxis (CAP) is usually applied to reach this aim. The selection of resisting pathogens is the major risk of CAP. The aim of our survey was to describe the patterns of pathogenic strains leading to pyelonephritis in patients treated with and without CAP. Patients and method: The pathogenic strains implicated in pyelonephritis were identified in 48 and 56 children below 1 year of age who were treated with or without CAP, respectively, between years 2006 and 2011. Results: Breakthrough urinary tract infections developing in the presence of CAP are more frequently (with about a double risk) caused by polyresistant bacteria compared to infections that emerged without CAP. Nevertheless, it should be noted that the prevalence of resistant pathogens was about 40% even in infants without CAP. Discussion: The pattern of pathogenic strains leading to pyelonephritis alters significantly even in the cohort of children below 1 year of age treated with CAP to prevent infections associated to VUR. The risk may be decreased through the rational use of antibiotics. To reach this goal national guidelines on VUR should be updated and the role of additional non-antibiotic treatment should be established.]

Lege Artis Medicinae

[Five nine year results of „Comprehensive Health Screening of Hungary 2010-2020-2030”]

BARNA István, DAIKI Tenno, KÉKES Ede, DANKOVICS Gergely

[2010 a new, complex screening program started in Hungary, named Nationwide Comprehensive Health Protection Screening Program in Hungary 2010-2020-2030. The screening was installed on a specially furnished lorry, which is able and will be able to get anywhere from big cities to the smallest villages. The Program as part of the “Heart and Vascular National Program” works with the support of 74 professional-scientific societies and companies. The screening program took place in a specially furnished lorry. The lorry has an easy access to the disabled, operation was performed with the quality control and permission of ÁNTSZ. Near the lorry there were activities for the preservation of health and prevention of illnesses. Within the framework of the Program in the largest mobile diagnostics center in Hungary 37 comprehensive surveys in free form. This enormous special screening station allows 5,100 tests to be performed at each of the 200 screening stations nationwide. The screening program for over 20 years provides 15 million trials on 3,000 scenes and 1 million adult visitors in free humanitarian. The European National Health Program and the National Program for the Prevention and Treatment of Car­dio­vascular Diseases co-ordinated by the Asso­ciation of Hungarian Medical Asso­ciations (MOTESZ) are implemented by con­sensual cooperation. Based on the results, it was re-confirmed that Hungarian population belonged to the high risk group in several aspects. Authors also outlined solution plans for general risk reduction and disease prevention. ]

Lege Artis Medicinae

[WAYS OF PREVENTION OF SEPTIC COMPLICATIONS IN ACUTE PANCREATITIS]

OLÁH Attila

[Similarly to other acute inflammatory responses, the mortality curve of acute pancreatitis has two distinct peaks. The first one, which coincides with a hyperinflammatory phase, is due to the development of an overwhelming systemic inflammatory response syndrome and subsequent multi-organ failure. The second peak of mortality is detected much later, after 14 days from the onset of the disease, when the compensatory antiinflammatory phase results in the infection of the necrotising pancreatic glandular substance. Since no therapy has been shown to efficiently prevent the activation of inflammatory and proteolytic cascades that evoke and sustain the disease, the treatment of acute pancreatitis is basically symptomatic. Beside adequate fluid and volume replacement and pain relief, medical and mechanical support may become necessary if organ failure develops. Recent studies suggest that there are ways to decrease the incidence of infection in pancreatic necrosis, which is usually due to bacterial translocation from the gut. The results of attempts to decrease the frequency of septic complications are controversial. A number of studies support the need of antibiotic prophylaxis but the evidence is weak. Furthermore, the increasingly observed infections by multi-resistant strains of Gram-positive bacteria and Candida species are due to long-term antibiotic use, which strongly questions the grounds for prophylactic antibiotic treatment. Recently, various clinical studies aimed to decrease bacterial translocation in other ways, including probiotic use and enteral feeding. This paper provides a systematic review of the data available in the evidence-based literature on the use of antibiotics and the role of alternative and adjuvant therapy in the treatment of severe acute pancreatitis.]

Hypertension and nephrology

[Association between the genetic polymorphism of heat-shock protein 72 and pediatric kidney diseases]

BÁNKI Nóra Fanni, RUSAI Krisztina, KÁROLY Éva, SZEBENI Bea, VANNAY Ádám, SALLAY Péter, REUSZ György, TULASSAY Tivadar, SZABÓ J. Attila, FEKETE Andrea

[Recurring urinary tract infections (UTI) in childhood may result in chronic- and end-stage-renal-disease (ESRD), which leads to the initiation of dialysis and renal transplantation (NTx). Heat shock protein (HSP) 72 protects the kidney, whereas it refolds destroyed proteins and cells, and helps regenerating the renal tissue. The HSPA1B (1267)G allele is associated with lower HSP72 expression. This study assesses the role of HSPA1B A(1267)G polymorphism using PCR-RFLP in 103 children treated because of recurrent UTI, 26 children after NTx and 235 healthy controls. Clinical data were also evaluated. HSPA1B (1267)GG genotype and HSPA1B (1267)G allele occurred more frequently in the UTI (p=0.0001; CI: 1.378-2.68) and in the NTx (p=0.014; CI: 2.29-187.7) patient group than in the controls group, and were associated with a higher risk for scarring (p=0.012; CI: 0.33-1.00) and renal malformation (p=0.0072; CI: 1.623- 140.6). Our data indicate a relationship between the carrier status of HSPA1B (1267)G allele and the development of recurrent UTI and ESRD, raising further questions about the clinical and therapeutic relevance of these polymorphism.]

Hypertension and nephrology

[Change in the approach of the treatment of hypertension in Hungary. Five years results of the „Live below 140/90!” Program]

KISS István, PÁL László, SCHANBERG Zsolt, BARNA István, ALFÖLDI Sándor, FARSANG Csaba, CHÁTEL de Rudolf, KÉKES Ede

[One of the potentials of the effective fight against endemic diseases is their exposition and the recognition of their dangers and risk factors. The other possibility is to increase the professional knowledge of the medical and healthcare employees along with the patients’ co-operation. For the prevention of complications and the adequate treatment of hypertension an extensive compliance program, called „Live below 140/90!” was initiated by the Hungarian Society of Hypertension in 2005. The mission was to give knowledge to the non-professional public about the symptoms of the disease and how to get information about it while helping patients’ relatives. The first message was the “Hit the target blood pressure value!”. With careful planning, treatment and taking of medicines the next phase could begin. The ratio of the patients who reached the target blood pressure increased by 5% during the two years of the Program between 2005 and 2007 therefore the message changed to “Hold the blood pressure there!”. The next step in the Program was to prevent the forming of complications and to treat the co-morbidities effectively among patients with pre-diabetes or diabetes and hypertension in 2008. The slogan was “Prevent the complications!”. As part of the Program we organized a roadshow named the “Day of caring!” and we announced the “Conscious Care” substudy focused on the public summoning about the stroke which is the most dangerous complication of hypertension. The year of 2011 is an absolutely new beginning in the communication of the Program since we started to use some very modern tools of the 21st century including YouTube, Facebook and others for the better education of the people. Based on the results of the initial Program we got to know the risks, co-morbidities, complications and the characteristics of the Hungarian hypertensive patients. We have recognized that most of the patients belong to the high and very high risk hypertensive category. Also more than 30 percent of them have a pre-diabetes condition. We have found that increased caring helps to build up the patients’ co-operation which in return improves the decrease of their blood pressure significantly. The Program therefore continues in 2011! Our intention is to enlarge the Hungarian Hypertension Register database and to get to know more and more epidemiologic and therapeutic features of the hypertension disease.]