Lege Artis Medicinae

[SCIENTIFIC DIGEST]

SEPTEMBER 18, 2004

Lege Artis Medicinae - 2004;14(08-09)

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Lege Artis Medicinae

[THE PUBLIC OPINION ON ORGAN DONATION IN HUNGARY]

SZÁNTÓ Zsuzsa, SUSÁNSZKY Éva, TÜTTŐ Gabriella

[INTRODUCTION - The aim of this study was to explore the common knowledge and the opinion of the Hungarian population on organ transplants as part of a larger international study about the reception of new achievements in biotechnology and medical science. METHODS - The basis of the study was a representative national survey conducted in 2003 on a sample of 1000 people. We analysed the significant differences in the attitudes towards organ donation using the background variables of gender, age, education, family situation, place of residence, self-rated health and religious beliefs. To explain the differences in the willingness to donate we applied the method of binomial regression. Logistic regression was used to analyse the strength and direction of the linear relationship between dependent and predictor variables. The probability of willingness in a given group was represented by odds ratios. RESULTS - The respondents’ knowledge level differed by gender, age and education. The greater part of the population was not knowledgeable about the legal regulations concerning the transplantation of cadaver organs but after they were properly informed they agreed with the regulations. The odds of the motivation to donate organs after death differed significantly by age, education, family situation and self-rated health. The motivation to be living donors was influenced by age, place of residence and the level of altruism. CONCLUSION - The concerns expressed on the decrease of donation willingness due to the increase of the knowledge level of the population seem to be unfounded.]

Lege Artis Medicinae

[FIXED-COMBINATION THERAPY IN ANTIHYPERTENSIVE TREATMENT]

BARNA István

[Target blood pressure and reduction in cardiovascular morbidity and mortality have to be accomplished always with the consideration of target organ lesion. Fixed-combination antihypertensive therapy has become accepted based on the recommendations of international and Hungarian medical associations that are aware of the results of evidence based medicine. The fix combinational treatment is more favorable for patients’ compliance. The daily dosage of drugs with 24 hour effect improves the patients’ cooperativeness. During fix combinational treatment higher efficiency, smaller dose and fewer side effects were observed. In combination, the effects of the drugs on blood pressure are additive without any increase in adverse effects. Last, but not least the cost of drugs of fixed combination are lower than buying the drugs separately. After careful consideration the fixed combination therapy can be recommended to the everyday practice.]

Lege Artis Medicinae

[Maybe I have not died in vain]

MATOS Lajos

Lege Artis Medicinae

[RISKS AND BENEFITS OF MEDICATION IN PREGNANT WOMEN]

CZEIZEL Endre

[The Hungarian Case-Control Surveillance System of Congenital Abnormalities can provide appropriate data for the evaluation of risk and benefits of drugs and pregnancy supplements in pregnant women. Among the main principles, the importance of time factor (the first trimester concept is outdated) and the explanation of frequent false teratogenic findings (e.g. recall bias, chance effect, etc.) are discussed. The main conclusion is that at present the exaggerated teratogenic risk of drugs is much more harmful for the fetus than the rare teratogenic effect of some drugs themselves. Medical doctors and other experts therefore need more education to know the principles and findings of modern human teratology because it may help us to have a better balance between the risks and benefits of drug use during pregnancy. On the other hand, the primary prevention of neural-tube defects and some other congenital abnormalities is demonstrated by periconceptional folic acid or folic acid-containing multivitamin supplementation. Unfortunately, this new method is used rarely and inappropriately (due to the late onset of supplementation) in Hungary.]

Lege Artis Medicinae

[THE VASCULAR BACKGROUND OF ERECTILE DYSFUNCTION]

TÓTH Károly

[With the new era of the medicaments, erectile dysfunction has become of great interest among sexual problems. Earlier, psychogenic origin was thought to be the main background, but today vasculogenetic reasons are have become equally important factors. Experimental data and clinical investigations demonstrate that erectile dysfunction is part and consequence of the same vascular process which is observed in aging and in atherosclerotic processes of the well-known arterial localisations (coronary arteries, cerebral arteries etc.). It was also common previously to associate erectile dysfunction with obliterative atherosclerotic disease but today endothel dysfunction, vascular remodelling and atherosclerosis are thought to be main pathogenetic factors affecting the whole arterial vascular system causing erectile dysfunction. Classic risk factors can also be observed in these patients, such as hypertension, dyslipidaemia, smoking and diabetes. Neurogenic factors are also involved in the development of erectile dysfunction. Based on this, erectile dysfunction is considered as the predictor of cardiovascular diseases preceding the general manifestation of the disease by 2-3 years.]

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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. ]

Lege Artis Medicinae

[Population-level QALY gain estimates with the use of cariprazine for patients with negative symptoms of schizophrenia in Hungary]

BENDES Rita, NÉMETH Bertalan, PITTER János György, KÓCZIÁN Kristóf, GÖTZE Árpád, KALÓ Zoltán

[INTRODUCTION - The loss in quality of life caused by mental illnesses has been growing in developed countries. This study aims to quantify the possible gains in quality of life by advantages of cariprazine therapy while treating patients with negative symptoms of schizophrenia in Hungary. Comparator therapy was defined as the currently available second-generation oral antipsychotic drugs. METHODS - In order to estimate the reachable gain in quality of life with cariprazine, an 8-state deterministic Markov cohort model was developed. Data was gathered from relevant scientific literature and public databases. The main assumptions regarding patient pathways have been validated by clinical experts, based on their real-life experience. The number of patients with negative symptoms of schizophrenia was estimated by the same methods as well. Sensitivity analyses were conducted on the input parameters. RESULTS - When compared with currently available second-generation oral antipsychotics, cariprazine generated an estimated increase of 0.05 quality-adjusted life years per patient in 2 years run. The deterministic sensitivity analysis confirmed the robustness of the results. Based on data of the National Health Insurance Fund and the scientific literature, a total gain of 450 quality-adjusted life years is expected at national level over a time horizon of 2 years. Even higher gains of QALY can be expected for longer time horizons. CONCLUSION - Based on conservative estimates significant health gain can be ge­ne­rated, if all patients with negative symp­toms of schizophrenia would receive the adequate cariprazine therapy in Hungary in­stead of the currently used se­cond-ge­ne­ration oral antipsychotic drugs. ]

Lege Artis Medicinae

[SCIENTIFIC DIGEST]

Hungarian Radiology

[Scientific presentations of pediatric radiology sections of ECR 2002]

KIS Éva