Lege Artis Medicinae

[SCIENTIFIC DIGEST]

MARCH 20, 2004

Lege Artis Medicinae - 2004;14(03)

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Lege Artis Medicinae

[Global alliance against global threat - The anti-tobacco framework of the World Health Organisation]

VADÁSZ Imre

Lege Artis Medicinae

[DASH]

MATOS Lajos

Lege Artis Medicinae

[THE GENOMIC BACKGROUND OF ALLERGY]

SZALAI Csaba

[In this review we summarise the current results of the genomic investigation of allergic diseases. From the genetic point of view allergy is multifactorial, which means that the susceptibility to the disease is determined by the effect of one or more genes or the interactions between multiple genes and involves important nongenetic factors such as the environment for their expression. Among allergic diseases the genomic background of asthma was studied most thoroughly. Until now, using hundreds of DNA markers, located across all of the human chromosomes, 16 genome-wide screens for susceptibility genes for asthma or asthma related intermediate phenotypes in 12 different populations have been published and 20 chromosomal regions have been highlighted for further analysis. In genetic association studies more than 500 genes were identified as candidate genes for asthma. In this review, we selected those results which were consistently reported by several independent studies or appeared particularly important or interesting. According to the results of the human genome programs and association studies we discuss the possible roles of candidate genes found in these loci in the pathomechanism of allergy and atopy.]

Lege Artis Medicinae

[TRIPTAN THERAPY OF MIGRAINE]

UNGUREAN Aurélia, TAJTI János, VÉCSEI László

[Migraine sufferers in Hungary present a major epidemiological challenge with about 12% of the population affected. Authors have reviewed an extensive body of internationally published literature relative to the 5-hydroxi-triptamin receptor agonists such as the triptans. While summarising most relevant data with a view to enable physicians to choose the most effective therapy for an individual, the article also discusses the prevailing questions of efficacy, tolerability and safety. For those patients with differential-diagnostic difficulties referrals should be made to the specialized 'headache centers' of neurological departments.]

Lege Artis Medicinae

[PRESENTATION OF ACUTE ABDOMINAL SYMPTOMS WITH UNDERLYING MALIGNANT DISORDERS]

ZARÁND Attila, BESZNYÁK István, MERSICH Tamás

[Patients with different type of undiagnosed malignancy occasionally referred to emergency departments with acute disease-related symptoms as first signs of their underlying process. However, this broad spectrum of clinical signs and symptoms do not occur very often but may result in very poor outcome for these patients. It is therefore essential to establish correct diagnosis in time and provide appropriate care of patients with acute abdominal complaints. Cancer patients are frequently referred to doctor because of gastro-intestinal obstruction, perforation or bleeding and with symptoms of inflammation. In 3-5% of the cases an urgent operation is necessary. As the cure rate of the cancer patients is largely dependent on the stage of the tumour, it is important to make relevant staging, to set up diagnosis at the earliest phase and start the appropriate therapy in due time in a multidisciplinary way.]

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Related contents

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

[Personality development in East and West, and some clinical implications ]

PUREBL György

[Exploring human personality focused mainly on trait and state markers of behaviour so far. Nevertheless, the concept of the universal, culture-independent model of personality carries more disturbing difficulties: hardly understandable inter-cultural conflicts, culture-related mental disorders and scientific experiences with unexpected outcomes. It can be hypothesized, that beside personality concept represented by the Euro-Atlantic civilisation and mainstream psychology there is an alternative concept of personality. Opposed to the independent, autonomous ego concept of individualistic cultures, collectivistic (primarily far-eastern) cultures are providing an interdependent model. According to this model, the core element of personality are determined rather by social embedding instead of the person’s own characteristics, which are secondary to the personal traits and characteristics. This study attempts to briefly outline the concept of interdependent personality, with some illustrative clinical examples. ]

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. ]

Clinical Neuroscience

[The facets of creativity in the light of bipolar mood alterations]

SZAKÁCS Réka

[The link between creativity, as the highest expression form of human achievement, and bipolar disorder came into focus of scientific investigations and research. Accomplished writers, composers and visual artists show a substantially higher rate of affective disorders, prodominantly bipolar mood disorders, comparing to the general population. Then again, patients afflicted with bipolar II subtype (hypomania and depression), as well as persons presenting the mildest form of bipolar mood swings (cyclothymia) possess higher creative skills. It evokes therefore that certain forms and mood states of bipolar disorder, notably hypomania might convey cognitive, emotional/affective, and motivational benefits to creativity. The aim of this paper is to display expression forms of creativity (writing, visual art, scientific work) as well as productivity (literary and scientific work output, number of artworks and exhibitions, awards) in the light of clinically diagnosed mood states at an eminent creative individual, treated for bipolar II disorder. Analysing the affective states, we found a striking relation between hypomanic episodes and visual artistic creativity and achievement, as well as scientific performance, whereas mild-moderate depressed mood promoted literary work. Severe depression and mixed states were not associated with creative activities, and intriguingly, long-term stabilised euthymic mood, exempted from marked affective lability, is disadvantageous regarding creativity. It seems, thereby, that mood functions as a sluice of creativity. Nevertheless, it is likely that there is a complex interaction between bipolar mood disorder spectrum and psychological factors promoting creativity, influenced also by individual variability due to medication, comorbid conditions, and course of disorder.]