Lege Artis Medicinae

[Recommendation of the Public Relation Committee of the Hungarian Association of Pharmaceutical Manufacturers]

JUNE 30, 1992

Lege Artis Medicinae - 1992;2(06)

[The paragraphs of the forthcoming new Medicines Act dealing with information and information on medicines.]

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Lege Artis Medicinae

[Immunological aspects of granuloma formation]

DANKÓ Katalin, SZEGEDI Gyula

[The process of inflammation can be classified as acute, subacute and chronic, as well as the special category of granulomatous inflammation. Classification of granulomatous inflammation based on morphologic criteria. These are epitheloid, histiocytic, foreign-body, necrobiotic and mixed inflammatory granuloma. The current knowledge suggests the following sequences for the mechanisms of granuloma formation in sarcoidosis (Fig 2): 1. T-cells are locally activated and proliferating 2. These activated T-cells release lymphokines that recruit and activate monocytes/macrophages 3. These activated monocytes/macrophages may differentiate into granuloma cells such as epithelioids cells and multinucleated giant cells and release pro-inflammatory profibrotic mediators that modulate the granulomatous and fibrotic process. It is hoped that further studies in sarcoidosis will help not only in clarifying the pathogenic mechanisms leading to granuloma formation, but also in eventually revealing the etiology of sarcoidosis. ]

Lege Artis Medicinae

[Transvaginal ultrasound examination of embryo development in early pregnancy (sono-embryology) II. central nervous system]

CSABAY László, SZABÓ István, NÉMET János, PAPP Zoltán

[In the second part of their paper, the authors look over the most important phases of the development of the central nervous system during the first trimester of pregnancy - especially considering the stages, which can be differentiated with a high resolution transvaginal transducer. The closed neural tube is developing at days 40 to 44 by the closure of the posterior neuropore, however at this time no brain structures can be detected by ultrasound. During the 7th week the three primary brain vesicles (prosencephalon, metencepha lon, myelencephalon) can be identified – a single ventricle can be seen by ultrasound. During the 8th week the secondary brain vesicles (telencephalon, diencephalon, mesencephalon, metencephalon, myelencephalon) can be separated. During the 9th week the lateral ventricles are filled out by the choroid plexus, which are retracted to the occipital horn by the 13th week. The appearance of the brain structures also takes place according to an accurate „calendar". The structures recognized by ultrasound can be compared to those of the central nervous system known from embryology. The problem of the primary prevention of the cerebrospinal malformations, which are among the most frequent congenital disorders, is not yet solved; therefore the early prenatal diagnosis of the structural anomalies has great importance. ]

Lege Artis Medicinae

[Laparoscopic varicocelectomy]

HOLMAN Endre, TÓTH Csaba, PÁSZTOR Imre, FICSÓR Ervin, PAPP Ferenc

[ With the spreading use of the laparoscope in the urological surgery laparoscopic varicocelectomy may become an alternative treatment of varicocele. The method can be advantageous mainly for patients with bilateral cases compared to the open operation. The authors report on two cases that have been the first urological laparoscopic operations in Hungary.]

Lege Artis Medicinae

[Vascular surgical aspects of small bowel ischaemia]

DÓBI István

[A brief account is given of acute and chronic diseases underlying the disorders of blood supply to the small bowel. In cases of acute disorders, considering the diagnostic difficulties involved, the author stresses the importance of commencing of a vasodilatator treatment immediately after the tentative diagnosis has been reached based on the first suspicious symptomes, and also requiring angiography to render the accurate diagnosis. This is the only possibility to increase (without irreversible tissue damages) the number of successful early vascular reconstructions which are the prerequisites to reducing in lethality. Finally, based on his own extensive experimental work, the author proposes to make allowances for the augmented local postischaemic vasoconstrictor trends of vascular reactivity in the complex therapeutic regimen of these diseases. ]

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[Cardiovascular effects of sleep-related breathing disorders, a review]

VÁRDI Visy Katalin

[The acute and chronic cardiovascular effects of sleep related breathing disorders are summarized in this review. Obstructive sleep apnoea syndrome is characterized by recurrent upper airway collapse during inspiration. The resulting asphyxia causes hypoxia and arousal. The vigorous inspiratory efforts produce falls in blood pressure coinciding with each effort (pulsus paradoxus). A rise in blood pressure is seen concurrently with each termination of apnoea and arousal. Bradycardia induced by hypoxia in each obstructive period and increased frequency at time of arousals could lead to arrhythmias. This may result in a high prevalence of hypertension, acute myocardial infarction and arrhythmias in sufferers of obstructive sleep apnoea syndrome have. ]

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We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

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Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

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[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]