Lege Artis Medicinae

[SCIENTIFIC DIGEST]

NOVEMBER 21, 2004

Lege Artis Medicinae - 2004;14(11)

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Lege Artis Medicinae

[Amongst the guilty, the silent is a pander - Consequences of research and publication misdemeanours]

VARRÓ Vince

Lege Artis Medicinae

[THE ROLE OF ORAL ANTIDIABETIC AGENTS AND ACE INHIBITORS IN THE PREVENTION OF TYPE 2 DIABETES MELLITUS]

KEMPLER Péter

[Nowadays Type 2 diabetes is considered as a cardiovascular disease,. The cause of death among 80% of people with Type 2 diabetes is of cardiovascular origin, with the most common cause of death of myocardial infarction. Optimal solution would be the prevention of the disease and there are also some possibilities for intervention. The present paper summarises the role of antidiabetic agents and ACE inhibitors in the prevention of Type 2 diabetes mellitus. The incidence rate of Type 2 diabetes decreased by 36% using acarbose in the STOP NIDDM Trial and by 31% using metformin in the Diabetes Prevention Program. The rate of risk reduction regarding the incidence of Type 2 diabetes during the ALLHAT Study compared the subjects treated with thiazid diuretics among those treated with amlodipine was 25% by the end of the second year and 16% by the end of the fourth year, while the corresponding data for patients treated with lisinopril were 40% and 30%, respectively. The action of lisinopril on the better bioavailability of Insulin like growth factor I. (IGF-I) probably contributes to the beneficial effect of lisinopril on insulin sensitivity.]

Lege Artis Medicinae

[MAGNETIC RESONANCE IMAGING IN MUSCULOSKELETAL DIAGNOSTICS]

MESTER Ádám

[The aim of the author is present a practical MRI guideline for partners clinicians working in general or specialist patient care related to musculoskeletal diseases. The evidence based diagnostic decision-making process requires specific and realistic expectations related to MRI in daily practice. The focus message of the article is that the more exact and specific clinical question arrives, the more accurate and precise answer of the radiologist is achieved. The importance of detailed clinical information based optimal planning is emphasized versus “general” studies based on poor clinical information. It is not less important for the referring physician to prepare and inform the patient prior to the MRI study, with the exclusion criteria and contrast agent application all explained. Very few technical details are presented, only as little as possible to understand the clinically relevant properties of the imaging process.]

Lege Artis Medicinae

[LIPID-LOWERING THERAPY BASED ON RISK ASSESSMENT]

PARAGH György, BALOGH Zoltán

[The authors’ brief review follows the changes made to therapeutic guidelines based on primary and secondary prevention trials. They describe the main characteristics of National Cholesterol Education Program Adult Treatment Panel-I (NCEP ATP-I), ATP-II and ATP-III, and the decisions of the Hungarian Consensus Conference with respect to the lowering of lipids. The authors highlight the clinical importance of the evaluation of cardiovascular risk factors before the commencement of lipid-lowering therapy. They emphasize the significance of achieving the target values for low-density lipoprotein. Current dyslipidemia treatment guidelines focus on determining coronary heart disease risk status and matching the intensity of plasma LDL-C reduction to that perceived risk. Adding plasma C-reactive protein measurement to current risk assessment techniques may improve the identification of patients in the primary prevention population who may require more aggressive lipid-lowering therapy.]

Lege Artis Medicinae

[The 46th Congress of the Hungarian Society of Gastroenterology]

ABONYI Margit

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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

[Decisional collisions between evidence and experience based medicine in care of people with epilepsy]

RAJNA Péter

[Background – Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose – To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods – Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results – There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology – including genetic background –, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion – Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions. ]

Hypertension and nephrology

[The 27th Great Assembly of the Hungarian Society of Nephrology – Scientific Program]

Lege Artis Medicinae

[SCIENTIFIC DIGEST]

Lege Artis Medicinae

[The significance of statin pleiotropy]

KOLOSSVÁRY Endre

[Application of statins in the primary and secondary prevention of atherosclerosis is of great importance. Attenuation of cardiovascular risk by statin therapy is primarily related to a decrease in serum cholesterol levels. Scientific data published in the past few years highlight the importance of the beneficial effects of statins that are not related to cholesterol-lowering. These effects are known as pleiotropic effects. This review aims to present the current view of statins’ pleiotropic effects.]