Lege Artis Medicinae

[Successfulness of Antituberculotic Treatment in Hungary]

BÖSZÖRMÉNYI Nagy György1

OCTOBER 20, 2009

Lege Artis Medicinae - 2009;19(10)

AFFILIATIONS

  1. Tüdôgyógyászati Szakmai Kollégium, Budapest

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[Beta-blockers are among the most widely used drugs for the treatment of cardiovascular diseases. In the mid-90’s, these drugs were recommended as first-line therapies of hypertension. With the introduction of new drugs, the list of first-choice drugs has been extended. The results of recently published major hypertension trials, which compared conventional agents (beta blockers and/or diuretics) with newer agents (angiotensin converting enzyme inhibitors, Caantagonists, angiotensin receptor blockers), raised concerns regarding the role of beta blockers in cardiovascular primary prevention. Subsequently, a metaanalysis of 13 trials has shown that compared with other drug types, beta-blocker therapy is less beneficial in patients with hypertension who do not have heart disease. Nevertheless, in cardiovascular indications other than hypertension (acute myocardial infarction, heart failure and arrhythmias), betablockers retain their dominant position.]

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[Antibiotic treatment of intra-abdominal infections, focusing on secondary peritonitis]

PULAY István, KONKOLY THEGE Marianne

[The morbidity and lethality of intra-abdominal infections are still high. Their first-line therapies include surgical or image-guided interventions. Adjuvant therapy with a broad-spectrum antibiotic is crucial for the treatment of polymicrobial infections. As initiation of the therapy is urgent, the antibiotic must be chosen empirically. Pathogens of community-acquired and nosocomial intra-abdominal infections are greatly different. The type of microbes, the general status of the patients, and the severity of their disease determine the choice of antibiotic or antibiotic combination. Using an adequate initial antibiotic decreases postoperative mortality and morbidity. Emerging new pathogens and the resistance of known germs against multiple antibiotics complicates the selection of the antiinfective therapy. Tigecycline is a new tetracyclin-derivative that offers a novel therapeutic option owing to its broad spectrum and efficiency against “problematic bacteria”. The current guidelines facilitate the selection of an empirical therapy, but they do not replace the individualised therapeutic approach.]

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[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

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