Lege Artis Medicinae

[S.O.S.! Hospital in critical condition]

BEDE Zsóka

JUNE 30, 1993

Lege Artis Medicinae - 1993;3(06)

[According to reports from health and economic experts, of the slightly more than 100,000 hospital beds in the country, only 70,000 can be maintained by social security. 30,000 beds will have to be cut. The hospitals throughout the country are in a difficult financial situation, with the counties in the lowlands, especially the hospital in Békéscsaba, being in a critical situation. ]

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Lege Artis Medicinae

[The role of angiotenzin converting enzyme inhibitors in the treatment of hypertension]

FARSANG Csaba

[The role of the renin-angiotensin system in the regulation of blood pressure is outlined. The mechanism of action as well as the role of angiotensin converting enzyme inhibitors (ACEI) in the treatment of various forms (primary, secondary, uncomplicated, complicated) of hypertension is discussed. The individualized , stepped care" approach is detailed, therefore the advantages of the therapeutic combinations of ACEi-s are emphasized. Interactions with other antihypertensive agents and with other drugs are also described, and side effects are also briefly addressed]

Lege Artis Medicinae

[Postmenopausal hormone replacement therapy]

H S Jacobs, F E Loeffler

[Over the past year, a number of summary publications on postmenopausal hormone replacement therapy have been published in the UK (1-3). Therefore, in this review we focus on areas that, although often controversial, may be of interest to practitioners. We will discuss the effects of postmenopausal hormone therapy on the risk of ischaemic heart disease, osteoporosis and cancer and present some observations on the concept of oestrogen tachifilaxis and dependence. Our conclusions are summarised in our recommendations on hormone therapy in menopause.]

Lege Artis Medicinae

[Immunohistochemistry of atherosclerotic lesions]

ILLYÉS Gyula, KÁDÁR Anna

[Cellular interactions within the arterial wall are considered to be essential in the development and progression of atherosclerotic lesions. This paper is a review of the actual knowledge about the role of the macrophages in the process of atherogenesis. The cellular composition of atherosclerotic changes – aligned in a possible consecutive order in which they may progress – are presented and discussed from the author's own immunohistochemical investigation. 108 aortic specimens obtained at autopsy performed within 12 hours following death from young people (20–34 ages) were examined. The Factor VIII positive endothelial lining was well preserved, no desmin content could be demonstrated. In contrary the presence of vimentin was noted in almost all the cells of the aortic wall. The foam cells reacted with different anti-macrophage antibodies, and most of the non-reacting cells of the different lesions proved to be smooth muscle cells. A considerable part of the intimal cells showed HLA-DR positivity as well. The quantity of the T helper lymphocytes in the lesions did not bear any significance. There was relationship between clinical data and types of (early) atherosclerotic lesions in the aorta. It is suggested, that the atherogenetic process starts in the intima with the appearance of smooth muscle cells and an increase in the lipid content. Thereafter macrophages accumulate and lead to the development of foam cells and at the same time they cause tissue damages leading to further smooth muscle proliferation and to classic atherosclerotic changes within the arterial wall.]

Lege Artis Medicinae

[Genetic counselling service at the congenital diaphragmatic defect]

GÖRBE Éva, FEKETE Zoltán, JEAGER Judit, TÓTH-PÁL Ernő, PAPP Csaba

[Recurrence risk of congenital diaphragmatic defect in a genetic counselling service has been investigated. Based on the investigation of 78 cases the risk of recurrence proved not significant. The families who have already had a newborn with congenital diaphragmatic defect may be suggested to bear subsequent pregnancies with the support of genetic counselling and intermittent ultrasonography. ]

Lege Artis Medicinae

[Studies of left ventricular dysfunction]

MATOS Lajos

[510 patients (39.7%) in the placebo group and 452 patients (35.2%) in the enalapril group died. The reduction in cardiac mortality was mainly due to a reduction in progressive heart failure (placebo: 251, enalapril: 209; risk reduced by 22%). There was no appreciable reduction in mortality from arrhythmias without pump failure. However, fewer patients died or were hospitalised due to worsening of circulatory failure (placebo: 736, enalapril: 613; risk reduction 26%; p<0.001).]

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Lege Artis Medicinae

[Risk of nonsteroidal antiinflammatory drugs. Focus on aceclofenac]

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[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deterio­rate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable.]

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[Association between cyclothymic affective temperament and hypertension]

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[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

Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

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We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Clinical Neuroscience

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