Lege Artis Medicinae

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JUNE 01, 2000

Lege Artis Medicinae - 2000;10(06)

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Lege Artis Medicinae

[Infectiosus diseases - Past, present, future]

SZALKA András

[The complex interactions between microorganisms and humans include the well known, traditional infectious diseases and also the symbiotic relationship with the human endogenous normal flora. Forty years ago everybody was convinced that medicine would soon be able to eradicate most of the infectious diseases. Perception of victory over infectious diseases has been blunted in recent years by nosocomial infections and by the new and re-emerging diseases. The spectrum of infectious diseases is expanding and many of those once thought conquered are increasing in numbers. Moreover, the problems of infection are present in all aspects of medicine and with the field turning more and more complex its challenge for practitioners has become increasingly demanding. It is now clear, that at the dawn of the new millennium infectious disease remains the number one killer in the world. ]

Lege Artis Medicinae

[Practical aspects of screening for microalbuminuria in diabetic patients]

JERMENDY György, FARKAS Klára, NÁDAS Judit, DARÓCZY Atilla, PÉTERFALI Éva

[INTRODUCTION - The importance of measuring microalbuminuria is well established, however, controversy still exists regarding the type of urine specimen to be used for detecting early renal impairment of diabetic patients. PATIENTS AND METHODS – To evaluate practical aspects, albumin concentration and albumin to creatinine ratio of first void urine samples as well as urinary albumin excretion in timed specimens were determined by immunoturbidimetric method 3 times within 3 weeks in 192 adult diabetic patients (136 men, 56 women; type 1/type 2: 90/102; age: 51.4=10.8 years; duration of diabetes: 15.3+9.1 years; body mass index: 27.9+4.6 kg/m2; HbA1c: 8.5+1.5 %; actual blood pressure: 13814/82+8 mmHg; serum creatinine: 94+20 umol/l; x+SD). RESULTS - According to the urinary albumin excretion values, one third of patients (31.2%-30.7%-34.4%) were normoalbuminuric (<30 mg/24 hours), more than half of the patients (55.8%-57.3%-53.6%) proved to be microalbuminuric (30-300 mg/24 hours), while the remaining group of patients (13.0%-12.0%–12.0%) was macroalbuminuric (>300 mg/24 hours). Comparing the results of successive measurements good correlation was found between the same laboratory values (urinary albumin excretion: K=0.64; K=0.67; urinary albumin concentration: K=0.60; K=0.62; albumin to creatinine ratio: K=0.54; K=0.61; first vs. second and second vs. third measurements, respectively). The percentage of patients being in the same range of albuminuria (i.e. normo-, micro-or macroalbuminuria) at successive measurements was 79.7-81.2% with urinary albumin excretion values, 77.1-77.6% with urinary albumin concentration and 74.5-78.6% with albumin to creatinine ratio. Good correlations were found between urinary albumin excretion and urinary albumin concentration (K=0.54; 0.54; 0.57) and nearly the same correlations were observed between urinary albumin excretion and albumin to creatinine ratio (K=0.49; 0.47;0.54) at different series. Using values of urinary albumin excretion for comparison at all measurements, 79.3% sensitivity and 69.5% specifity were found for urinary albumin concentration whereas 74.6% sensitivity and 68.8% specifity were documented for albumin to creatinine ratio. CONCLUSION - Beside the standard measurement of urinary albumin excretion in timed urine samples, the use of the more convenient morning urinary spot collection could also provide useful results (urinary albumin concentration or albumin to creatinine ratio) for detecting early renal involvement in diabetic patients. ]

Lege Artis Medicinae

[Hypertension And BPH Intervention Trial]

MATOS Lajos

Lege Artis Medicinae

[Postnatal development of the human hippocampal formation]

SERESS László

[Jean Piaget's theory suggests that cognitive development proceeds in discrete steps. The first is the sensorimotor period that happens in the first two years of life. In recent years it became clear, that it is necessary to have an intact and mature hippocampus for adequate memory formation, both in experimental animals and humans. In the present study, the morphological development of the human hip pocampus was correlated with the developmental changes of intellectual development. Our results suggest that neuronal cell formation of the human hippocampus terminates several weeks before birth. In the dentate gyrus, a small number (less than 1%) of granule cells are still formed around birth. Immature granule cells migrate through the hilar region to their final position in the granule cell layer during the first six postnatal months. Light microscope studies of individual neurons indicate that connections between granule cells and their target neurons are not yet formed at birth. Such connections develop during the third postnatal year. If the development of the synaptic connections is damaged in experimental animals, the hippocampal function will be permanently impaired. Newborns may have basic synaptic circuits for memory formation, but the postnatal morphological changes suggest the significant modification of the hippocampal circuits happening continuously from the newborn age until late childhood. These changes may cause the phenomenon of the "infantile amnesia". ]

Lege Artis Medicinae

[Pathophysiology of myocardial ischemia and reperfusion]

PAPP Zoltán, ÉDES István

[Complete and long lasting loss of coronary circulation results in myocardial cell death (ischemic necrosis). Short lasting ischemia (few minutes) is well tolerated and it may bring certain protection against recurrent ischemia (ischemic preconditioning). Contractile force promptly diminishes following the onset of ischemia and the changes in the intracellular ATP or Ca2+ concentration do not explain this phenomenon. With the progression of ischemia, myocardial relaxation ceases and hypertonic muscle activation appears (ischemic contracture). During myocardial reperfusion following short-term ischemia, arrhythmias often develop and pump function is regularly depressed transiently (myocardial stunning). Permanent reduction in coronary blood supply results in sustained ventricular dysfunction (hibernation). It has been established, that pathologic processes leading to ischemic injury are distinct from those of reperfusion injury. Cellular events are complicated (Ca2+-overload, free radical injuries, activation of proteolytic processes, energy loss, membrane damage, hypercontracture, etc.), and complete understanding of the background of ischemic/reperfusion disorders is still awaited. ]

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Lege Artis Medicinae

[Vaccines against COVID-19 pandemic]

FALUS András, SZEKANECZ Zoltán

[The rapidly spreading SARS-CoV2 respiratory virus has evoked an epidemic with serious aftermath around the world. In addition to the health effects, the global economic damage is actually unpredictable. At the same time, the pandemic has launched a series of unprecedented collaborative scientific research, including the development of vaccines. This study summarizes up-to-date information on vaccines, immune memory, and some emerging clinical effects.]

Lege Artis Medicinae

[A short chronicle of three decades ]

KAPRONCZAY Katalin

[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]

Lege Artis Medicinae

[Focus on Lege Artis Medicinae (LAM)]

VASAS Lívia, GEGES József

[Three decades ago, LAM was launched with the goal of providing scientific information about medicine and its frontiers. From the very beginning, LAM has also concerned a special subject area while connecting medicine with the world of art. In the palette of medical articles, it remained a special feature to this day. The analysis of the history of LAM to date was performed using internationally accepted publication guidelines and scientific databases as a pledge of objectivity. We examined the practice of LAM if it meets the main criteria, the professional expectations of our days, when publishing contents of the traditional printed edition and its electronic version. We explored the visibility of articles in the largest bibliographic and scientific metric databases, and reviewed the LAM's place among the Hun­ga­rian professional journals. Our results show that in recent years LAM has gained international reputation des­pite publishing in Hungarian spoken by a few people. This is due to articles with foreign co-authors as well as references to LAM in articles written exclusively by foreign researchers. The journal is of course full readable in the Hungarian bibliographic databases, and its popularity is among the leading ones. The great virtue of the journal is the wide spectrum of the authors' affiliation, with which they cover almost completely the Hungarian health care institutional sys­tem. The special feature of its columns is enhanced by the publication of writings on art, which may increase Hungarian and foreign interest like that of medical articles.]

Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]

NEMCSIK János, BATTA Dóra, KŐRÖSI Beáta, RIHMER Zoltán

[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

Clinical Neuroscience

[Tracing trace elements in mental functions]

JANKA Zoltán

[Trace elements are found in the living organism in small (trace) amounts and are mainly essential for living functions. Essential trace elements are in humans the chromium (Cr), cobalt (Co), copper (Cu), fluorine (F), iodine (I), iron (Fe), manganese (Mn), molybdenum (Mo), selenium (Se), zinc (Zn), and questionably the boron (B) and vanadium (V). According to the biopsychosocial concept, mental functions have biological underpinnings, therefore the impairment of certain neurochemical processes due to shortage of trace elements may have mental consequences. Scientific investigations indicate the putative role of trace element deficiency in psychiatric disorders such in depression (Zn, Cr, Se, Fe, Co, I), premenstrual dysphoria (Cr), schizophrenia (Zn, Se), cognitive deterioration/de­mentia (B, Zn, Fe, Mn, Co, V), mental retardation (I, Mo, Cu), binge-eating (Cr), autism (Zn, Mn, Cu, Co) and attention deficit hyperactivity disorder (Fe). At the same time, the excess quantity (chronic exposure, genetic error) of certain trace elements (Cu, Mn, Co, Cr, Fe, V) can also lead to mental disturbances (depression, anxiety, psychosis, cognitive dysfunction, insomnia). Lithium (Li), being efficacious in the treatment of bipolar mood disorder, is not declared officially as a trace element. Due to nutrition (drinking water, food) the serum Li level is about a thousand times less than that used in therapy. However, Li level in the red cells is lower as the membrane sodium-Li countertransport results in a Li efflux. Nevertheless, the possibility that Li is a trace element has emerged as studies indicate its potential efficacy in such a low concentration, since certain geographic regions show an inverse correlation between the Li level of drinking water and the suicide rate in that area. ]