Lege Artis Medicinae

[Remission’s Culture – Reserves in Alcohol Politics]

KELEMEN Gábor

NOVEMBER 20, 2009

Lege Artis Medicinae - 2009;19(11)

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Lege Artis Medicinae

[Wolf or lamb?]

NEMESÁNSZKY Elemér

Lege Artis Medicinae

[In wine, the truth?]

FEHÉR János

Lege Artis Medicinae

[Diabetes mellitus and cancer risk]

BECHER Péter, PATAI Árpád, MÁJER Katalin

[In the past decades, the prevention of micro- and macrovascular complications has been the main target of diabetes treatment. On the basis of the latest publications that have created a storm we have to highlight the associations between diabetes mellitus, its treatment protocols and tumours. Analysing the often controversial human results, in the absence of relevant prospective studies, we have to consider preclinical observations to choose a safe treatment method.]

Lege Artis Medicinae

[Cirrhosis and its complications: diagnostic and treatment options]

PÁR Alajos

[During the past two decades, the management of complications of cirrhosis has dramatically changed, which substantially improved the patients’ survival. The present paper provides an overview of the diagnosis, treatment and prevention of cirrhosis and its complications including portal hypertension, variceal bleeding, ascites, hepatorenal and hepatopulmonary syndromes, encephalopathy and bacterial infection. Besides noninvasive diagnostic methods, pharmacological and endoscopic treatment modalities are discussed, with emphasis of the importance of nonselective beta-blockers, vasoactive therapy, antibiotic and albumin medication. Prevention and early diagnosis of cirrhosis as well as new pharmacological agents under development presumbaly result in further development in the management of patients with advanced, chronic liver disease.]

Lege Artis Medicinae

[Treatment of severe infections: principles of therapy and problems of resistance]

LUDWIG Endre

[The basic principles of the treatment of severe infections have recently been delineated : after having samples for microbiological tests, empiric therapy based on local resistance patterns should be introduced immediately, possibly within 1 hour in severe sepsis or in septic shock, the empiric therapy should be simplified according to the results of microbiological tests and/or improvement of the condition of patient , the antibiotics should be applied according to their pharmacodynamic properties, the duration of therapy should be shortened to the minimum time, in case of well responding non-complicated infection to 5-7 days., The most frequent problem pathogens in Hungary are the MRSA and ESBL-producing Gram-negatives. In severe infections with MRSA bacteremia, the therapy sholud be based on the vancomycin MIC of the pathogen. If MIC is below 1,5 mg/l, vancomycin is probably effective with a serum minimum concentration of 15 mg/l, while in case of less sensitive pathogens the administration of an alternative agent, such as linezolid, tigecyclin or daptomycin should be considered. In severe infections due to ESBL-producing pathogens, the carbapenems are the firts line antibiotics, while tigecyclin seems to be a promising alternative agent. The treatment of severe infections requires thorough care of the patient and skillnes in antimicrobial therapy in the period of multiresistant pathogens]

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[The connection between the socioeconomic status and stroke in Budapest]

VASTAGH Ildikó, SZŐCS Ildikó, OBERFRANK Ferenc, AJTAY András, BERECZKI Dániel

[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. ]

Clinical Neuroscience

Matrix metalloproteinases and their tissue inhibitors in relapsing remitting multiple sclerosis: Possible markers and treatment agents

SANLI Arzu, OZTURK Musa, SOYSAL Aysun, DOVENTAS Yasemin, BASOGLU Fulya, GOZUBATIK-CELIK R. Gokcen, BAYBAS Sevim

Matrix metalloproteinases (MMPs), which are synthesized by many cell groups and responsible for the destruction of matrix proteins, and endogen tissue inhibitors of MMPs (TIMPs) have a role in the pathogenesis of Multiple Sclerosis (MS) by affecting the blood-brain barrier. We aimed to investigate the role of MMPs and TIMPs in the immunopathogenesis and in the course of multiple sclerosis (MS). We enrolled 25 relapsing remitting MS patients, who had a definite MS diagnosis according to McDonald criteria and 25 healthy subjects similar for age and gender as control group. MMP-9- and TIMP-1 levels were measured twice in patient group (one time during an attack and one in remission) and once in healthy subjects. MMP-9- and TIMP-levels of patients during attack and remission period and MMP-9/TIMP-1 ratio were found significantly higher than in the control subjects. In patient group MMP-9 and TIMP-1 levels and MMP-9/TIMP-1 ratio during attacks were not significantly different than during remission period. However, when subdivided according to their number of attacks, patients with 2 attacks had significantly higher levels during attack period comparing to remission period (p<0.05); in case of patients with more than 2 attacks did not have a statistically significant difference in attack and remission periods. Matrix metalloproteinases are important actors in MS immunopathogenesis, particularly in the early period and inhibitor agents for these enzymes can be used as a treatment option.

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Weekly patterns of suicide and the influence of alcohol consumption in an urban sample

SAPOZHNIKOV Sergey , GOLENKOV Andrei , RIHMER Zoltán , UNGVARI S Gabor , GAZDAG Gábor

The weekly fluctuation in suicide rates is influenced by several factors including sex, psychiatric illness and alcohol dependence. The purpose of this study is to explore the impact of current alcohol use on suicid Data on sex, date of death, results of blood and/or urine alcohol tests and history of alcohol dependence in suicide victims over the 1997-2002 period were retrieved from a forensic database in two cities in Chuvash Republic. Over the six-year study period, 1,379 suicides were committed, 59% of them under the influence of alcohol. The peak incidence for men and women regardless of previous alcohol consumption was on Wednesdays and Mondays, respectively. The overall suicide rate was highest on Mondays and lowest on Thursdays. Both sexes were less likely to commit suicide during holidays than on weekends or workdays while intoxicated with alcohol. In this urban sample, the distribution of suicide across weekdays only partly followed the international pattern. The peak incidence of suicide showed sex difference, with the highest incidence for women on Mondays and for men on Wednesdays. The higher suicide rate on workdays might be accounted for by work-related stress, while the lower rate on weekends could be explained that people usually drink alcohol in the comforting company of family or friends, which reduces psychological tension and suicidal ideation. The majority of men consumed alcohol before committing suicide, regardless of the day of the week, while this observation was true for women only on Fridays and Sundays. Alcohol consumption greatly contributes to suicidal behavior in Chuvash Republic.

Lege Artis Medicinae

[Non-alcoholic fatty liver disease]

BAFFY György

[Non-alcoholic fatty liver disease is estimated to affect 25% of the global population. It is often joining other metabolic disorders and features a heterogeneous natural history. Significant liver injury is unlikely to develop from steatosis, while a third of steatohepatitis cases will progress into cirrhosis and as a severe complication may lead to primary liver cancer. The probability of these severe outcome increases with the degree of liver fibrosis and with the prevalent type 2 diabetes and two or more metabolic risk factors. Regardless of its stage, non-alcoholic fatty liver disease is in­creasing the susceptibility for cardiovascular diseases, diabetes and all malignancies, and as a result is shortening the life expectancy. However, general awareness of the disease among healthcare professionals and their patients remains limited. Lack of approved medications for the disorder is likely a major contributor to this discrepancy. Since the disease primarily stems from sustained caloric excess, lifestyle modification including Mediterranean type diet, avoidance of alcohol consumption, and regular physical activity are the mainstay of management. Better education campaigns may improve patient compliance and enhance the recognition and acceptance of this condition within primary care, in parallel with the introduction of two-step fibrosis screening to achieve more efficient identification and management of the high-risk patients. ]

Lege Artis Medicinae

[Tobacco use habits and cessation support tasks in Hungary. PART 1.]

CSELKÓ Zsuzsa, FÉNYES Márta, CSÁNYI Péter, BOGOS Krisztina, KISS Judit, DEMJÉN Tibor

[Today, non-communicable diseases and their underlying main risk factors, namely tobacco use, physical inactivity, excessive alcohol intake and unhealthy diet are responsible for almost 70% of the mortality worldwide. The Global Ac­tion Plan issued for the preven­tion and control of non-communicable diseases aims among others to reduce smoking rates by 30% as compared to the 2010 prevalence. The aim of the World Health Or­ga­ni­zation (WHO) in ac­cor­dance with the United Nations Sus­tai­nable Development Goals (UN SDG 2030) proposes to achieve a 23% target rate in Hun­gary by 2025. Based on the current smo­king prevalance (29%) and preliminary estimates this goal will not be accomplished. It is highly concerning that while the con­sumption of traditional tobacco products does not decrease at the expected rate in Hungary, novel nicotine and tobacco products are spreading worldwide and in Hungary as well. Thus in order to curb tobacco use, more ro­bust actions are needed in Hungary. More emphasis should be laid on the provisions of the WHO Fra­mework Con­vention on Tobacco Control (FCTC). This document re­com­mends to in­crease the tax rate of to­bacco products, declares to halt the spread of novel nicotine and tobacco products, and urges health care requirements to support smokers in quit­ting. The present summary describes the smoking cessation support related tasks of the health care in­dust­ry, taking into ac­count current national smoking habits. ]