Lege Artis Medicinae

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


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. ]



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[A relative cardiovascular risk reduction of 25-35% has been reported in patients with high cardiovascular risk that have started statins directly after the cardiovascular events. A lot of patients fail to consistently take these medications as directed. In order to obtain further success, it is very important to improve the actual routine, especially because in the field of lipid-lowering we have new data and guidelines that strongly support our efforts in the right direc­tion. We report the results of our ten patients treated with rosuvastatin after myocardial infarction from our ALADDIN Study. In the period of six month of treatment with 40 mg rosuvastatin LDL-cholesterol decreased 55% (from 3.55±1.1 to 1.58±0.6 mmol/l, p<0.01), non-HDL-cholesterol decreased 52% (from 4.15±1.23 to 2.0±0.8 mmol/l, p<0.01), triglycerides -26% (from 1.63± 0.41 to 1.2±0.4 mmol/l) and hsCRP level decreased 61% (from 5.47±3.8 to 2.1±1.0 mg/l, p<0.01). The two years persistence in these patients were 100%. Our experience confirms that the daily use of a highly-efficient statin (rosuvastatin) has a beneficial effect on lipid parameters and also facilitates the attainment of target lipid levels and significant cardiovascular risk reduction. ]

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[Clinical trials for evaluating cardiovascular safety of SGLT-2- inhibitor drugs in patients with type 2 diabetes]


[SGLT-2-inihibitors are considered as a new class among oral antidiabetic drugs. The first derivatives of this class became available in the last couple of years in Hungary. According to the requirements from regulatory bodies, randomized, controlled clinical trials have been initiated in order to evaluate the cardiovascular safety of nearly all new antidiabetic drugs in patients with type 2 diabetes. Among SGLT-2-inhibitors, only one trial with empagliflozine has been completed so far. Based on the endpoints of the EMPA-REG OUTCOME trial a significant decrease in different cardiovascular events and total mortality was observed in type 2 diabetic patients with elevated cardiovascular risk. The exact pathomechanism of this beneficial effect has not been clearly understood. Currently, the position statements and scientific guidelines clearly describe the place of SGLT-2-inhibitor drugs in the treatment algorithm; the beneficial effect of empagliflozine on cardiovascular events should seriously be considered when making therapeutic decision. Together with the results of ongoing studies with SGLT-2-inhibitors (dapagliflozine: DECLARE, canagliflozine: CANVAS), these data will provide a more robust evidence about the cardiovascular safety of this new class of oral antidiabetic drugs. ]

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[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.]

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

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[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.]

Lege Artis Medicinae


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.]

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[In the past 10 years, a number of screening programs with various goals have been started in Hungary, with varying degrees of success. The „Comprehensive Health Screening of Hungary 2010-2020” program has been touring the country (with a screening truck), either joining organised events or as an independent screening, collaborating with local healthcare centers (primary care, occupational healthcare etc). The screening program has been conducted in a special truck, in which various examinations were performed in a set time. Those who participated in the screening received a prevention information pack (for studying and reading at home) and the official publication of the program (Health Book), in which the program and the screening results were described. In the past four years the screening truck has been to 725 places in Hungary and travelled 83,145 kilometers. 87,935 people have participated in comprehensive screening. 194,549 visitors received lifestyle counseling and 142,319 received Prevention Packs. In total 2,901,855 examinations have been performed, which required 6711 hours of work of 1132 healthcare professionals. 5,856,114 answers were given to queries of the survey related to the health status of the Hungarian population. The program has already overfulfiled its original goals to visit 1500 locations and perform 8 million examination during this period. It is of particular significance that the average age of participants was 40 years. As cardiovascular risk is still the leading health risk, screening for such risk factors has to be part of all general and complex screening programs. In this program, an increasing number of validated, rapid and effective risk-estimation tests were used. It is remarkable that 20% of the tests related to colorectal cancer risk has positive results. Also of importance are the test results for hearing loss (7% positive) and various degrees of visual impairment (over 50%). Both results have significant social and economical implications for both individuals and the society. Unfortunately, the general level of health consciousness is still low. This might be improved not only by the screening itself but the opportunity to inform the public and provide organised counselling and printed materials, for which the activity and expertise of professional healthcare worker is essential. ]

Lege Artis Medicinae

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