Lege Artis Medicinae

[Supporting to quit tobacco smoking – evidence based options neglected – Comment to the article Telephone based supporting program to quit tobacco smoking in Hungary]

PÉNZES Melinda1

FEBRUARY 24, 2022

Lege Artis Medicinae - 2022;32(01-02)

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  1. Semmelweis Egyetem, Általános Orvostudományi Kar, Népegészségtani Intézet

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Further articles in this publication

Lege Artis Medicinae

[Non-alcoholic fatty liver disease]

BAFFY György

[Non-alcoholic fatty liver disease is estimated to affect 25% of the global population. It is often joining other metabolic disorders and features a heterogeneous natural history. Significant liver injury is unlikely to develop from steatosis, while a third of steatohepatitis cases will progress into cirrhosis and as a severe complication may lead to primary liver cancer. The probability of these severe outcome increases with the degree of liver fibrosis and with the prevalent type 2 diabetes and two or more metabolic risk factors. Regardless of its stage, non-alcoholic fatty liver disease is in­creasing the susceptibility for cardiovascular diseases, diabetes and all malignancies, and as a result is shortening the life expectancy. However, general awareness of the disease among healthcare professionals and their patients remains limited. Lack of approved medications for the disorder is likely a major contributor to this discrepancy. Since the disease primarily stems from sustained caloric excess, lifestyle modification including Mediterranean type diet, avoidance of alcohol consumption, and regular physical activity are the mainstay of management. Better education campaigns may improve patient compliance and enhance the recognition and acceptance of this condition within primary care, in parallel with the introduction of two-step fibrosis screening to achieve more efficient identification and management of the high-risk patients. ]

Lege Artis Medicinae

[Main features of cardiovascular rehabilitation in post-acute Covid-19]

JENEI Zoltán, HORVÁTH Judit

[The COVID-19 pandemic caused by SARS-CoV-2 is a significant challenge worldwide. Cornerstones of in-patient management of this pandemic which harms predominantly the respiratory system are the acute and intensive care. However, the rehabilitation plays a key role in improving the functional status and quality of life of survivors and reducing the impact of complications. As estimated, 40-50% of discharged patients require some form of medical support and 4-5% of them require inpatient rehabilitation. In addition to the respiratory system involvement, cardiovascular effects caused by COVID-19 (heart failure and myocarditis, acute coronary syndrome, arrhythmia, venous thromboembolism) are part of the ongoing systemic inflammatory processes and may affect 7-28% of hospitalized patients and lead to long-term deterioration in quality of life and loss of work capacity. Based on available scientific databases, expert consensus and the recommendations of European professional societies, this summary presents the recommended method, conditions and intensity of post-Covid cardiac rehabilitation including physical training exercises. The summary concerns also the recommended conditions for re­turn to work and sporting activities. Struc­tured exercise training is a very important and low-risk component of cardiac rehabilitation, reducing cardiovascular complications, thromboembolic complications, sys­temic inflammation and mortality, improving functional recovery and endothelial function. The planning of physical training should be preceded by a complex assessment of patients. Assessments of risk, capacity and function are needed to select the intensity, frequency and mode of indivi­dualized training. This should be combined with appropriate secondary preventive medication, monitoring, diet therapy and psychotherapy in accordance with respected principle of gradual progression. Finally, the consensus recommendations suggest that home-based and tele-rehabilitation should play a prominent role, considering the epidemiological and capacity constraints that also affect rehabilitation. ]

Lege Artis Medicinae

[Cardiovascular prevention 2021 – Guidelines of European Society of Cardiology 2021. Prevention at the population level And Disease specific cardiovascular prevention]

VÁLYI Péter, KÉKES Ede

[In our four-part publication we review the current state of cardiovascular prevention based on the European Society of Car­dio­logy Guidelines 2021. In part 1 we reviewed the risk factors, risk assessment, age-specificities, the influencing factors, including diabetes mellitus and chronic kidney disease. In part 2 we concerned comorbidities affecting the cardiovascular risk. In part 3 we reviewed the personalised cardiovascular prevention and the management of specific risk factors, including optimisation of life style factors, management of lipid levels and high blood pressure and anti­thrombotic therapy. This part 4, we review the community level preventive measures (physical activity, diet, smoking habits and alcohol consumption) and the importance of governmental and non-governmental interventions. We provide a brief summary about the principles of cardiovascular prevention in individuals with coronary artery disaese, heart failure, cerebrovascular dis­eases, lower extremity artery disaese, chronic kidney disease, atrial fibrillation, and in multimorbid patients.]

Lege Artis Medicinae

[Options for assessing the quality of postoperative pain relief: unidimensional scales]

LOVASI Orsolya, LÁM Judit, LÉBER Andrea, GAÁL Péter

[The measurement of the quality of postoperative pain relief receives increasing attention in clinical practice since the not properly treated pain has several negative consequences for both the patients and the health care providers. An important component of the evaluation of the quality of care is the measurement of patient outcomes, which needs regular pain assessments and reliable pain assessment tools. The main goal of our paper is to review the literature on scales and pain assessment tools for postoperative pain assessment, the systematic literature search of which was performed by the PICO (population, intervention, control, and outcomes) technique. We found 396 accessible and evaluable articles in total, and out of them we summarized the results of the most important 31 in English and 3 in Hungarian. Organisations in the field of pain relief recommend the regular assessment of postoperative pain by unidimensional and multidimensional scales. Among unidimen­sional scales, we compared the Numerical Rating Scale (NRS), the Visual Analogue Scale (VAS) and the Verbal Descriptor Scale (VDS) with one another by discussing their advantages and limitations in measuring the intensity of postoperative pain. Al­though in clinical practice NRS is the most widely used one, VAS is more sensitive in the detection of changes and the best for statistical analysis. The advantage of VDS is that no significant differences can be detected in the interpretation of its results. At the same time, the application of VAS is the most difficult and the least preferred by patients and not always applicable immediately after the operation. The VDS is the least sensitive measurement tool, whose results are influenced by differences of the patients’ verbal interpretation, thus it is not applicable among patients with a weak vocabulary. In general, the main advantage of unidimensional scales is that they are fast and easy to use, but they measure only one dimension of pain, namely its intensity, and the association between the in­tensity ratings, the patients' subjective ex­perience of pain and its observable consequences are not unequivocal in certain cases. Consequently, when the circumstances permit, the use of multidimensional measurement tools should be considered.]

Lege Artis Medicinae

[Paradigm shift in the treatment of osteoarthrosis and the importance of prevention today]

DÖMSE Eszter

[Osteoarthrosis is a major burden on our society, both in terms of health affairs and health economy. The increasing strain on joints by competitive sports and the grow­ing prevalence of sedentary lifestyle are coupled main factors behind the increas­ing occurence of osteoarthritis in younger generations. Its pathomechanism is re­cently recognised to be a combination of inflammatory and degenerative processes. Concerning the serious and even quality of life worsening outcomes and its growing and spreading prevalence, the role of prevention has become crucial. This study reviews the preventive options, emphasiz­ing the importance of recreational sport and physical activities, while presenting also the new generation of chondroprotective agents. ]

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

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

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

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]

Clinical Neuroscience

Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

Clinical Neuroscience

[The connection between the socioeconomic status and stroke in Budapest]

VASTAGH Ildikó, SZŐCS Ildikó, OBERFRANK Ferenc, AJTAY András, BERECZKI Dániel

[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. ]

Clinical Neuroscience

[The Comprehensive Aphasia Test in Hungarian]

ZAKARIÁS Lilla, RÓZSA Sándor, LUKÁCS Ágnes

[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]