Lege Artis Medicinae

[The Belief in Scientific Knowledge ]

BÁNFALVI Attila

FEBRUARY 05, 2016

Lege Artis Medicinae - 2016;26(01-02)

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Lege Artis Medicinae

[Visibility and quality of life: international literature review of the state of LMBTQ healers]

SZÉL Zsuzsanna, CSEKŐ Csilla, GYŐRFFY Zsuzsa

[BACKGROUND - Mental vulnerability is a well-known problem among healthcare professionals. In additional LGBT physicians’ discriminatory experiences and the exposure of minority stress appear to be a greater risk for health problems. METHODS - We collate researches in English by using search terms “LGBT doctors” “LGBT providers” “LGBT physicians”; “attitudes of nurses”; “attitudes of medical students”; “attitudes of doctors”; “LGBT practitioners”, “homophobia among doctors” „“homophobia among physicians”; “LGBT in medical curricula”, “sexual and gender minority”, “minority stress”. We reviewed findings highlighting the disclosure of orientation, experiences, mental and physical health of LGBT healthcare professionals, and physicians’, nurses’, medical students’ and patients’ attitudes towards LGBT students and physicians. RESULTS - At present conditions of LGBT individuals have gained international attention also in academic conversation. Based on the literature lack of safe, supporting environment seems to be the highest problem for LGBT physicians and medical students. Both in Canada and the USA several steps were made to improve attitudes of medical professionals, and decrease discrimination towards LGBT individuals in healthcare system such as creating more supportive environment by ‘Promoting pride’ and integrating LGBT-related content into medical universities’ curriculum. CONCLUSIONS - Our findings suggest that in Canada and the United States the rate of discrimination have decreased meanwhile transparency of LGBT professionals elevated as a result of antidiscrimination policies and the educational development.]

Lege Artis Medicinae

[Making the Female Face Ugly, or How Modern Painting was Born? ]

GEREVICH József

Lege Artis Medicinae

[Effect of rosuvastatin therapy’s introduction on lipid levels and on proportion of target values reaching in patients with familial hypercholesterolemia and familiarity]

SZTANEK Ferenc

[Familial hypercholesterolemia (FH) is a genetically heterogeneous disorders characterized by very high total cholesterol and low-density lipoprotein (LDL) cholesterol levels, and it accelerates the development of atherosclerosis and early cardiovascular disease. FH is most commonly caused by mutations in low-density lipoprotein receptor (LDLR) or apolipoprotein B-100 (APOB) genes. In rest of the cases the mutation is in the proprotein convertase subtilisin/kexin type 9 (PCSK9) gene. Previous studies have shown that rosuvastatin significantly reduces major cardiovascular events in high risk patients. The goal of our study was to investigate the lipid-altering efficacy of simvastatin or atorvastatin therapy compared with high-intensity rosuvastatin therapy in patients with FH and familiarity. Recent work has demonstrated the efficacy of high-intensity rosuvastatin therapy in enabling high-risk and very high-risk patients in lowering significantly plasma levels of total and LDL-cholesterol, which can subtantially affect major cardiovascular events in familial hypercholesterolemia.]

Lege Artis Medicinae

[The Revolution of Art – Russian Avantgarde in the 1910s and the 1920s ]

RÉVÉSZI Valéria

Lege Artis Medicinae

[When shall we choose fulvestrant treatment? Case report and some considerations]

RUBOVSZKY Gábor

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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

[Against the Pharma Industry or for the More Reliable Knowledge?]

BÁNFALVI Attila

Clinical Neuroscience

[Devic syndrome - case report, diagnostic and therapeutic principles]

ILJICSOV Anna, BARSI Péter, VÁRALLYAY György, TÁTRAI Erika, SOMFAI Gábor Márk, BERECZKI Dániel, RUDAS Gábor, SIMÓ Magdolna

[Neuromyelitis optica (NMO, Devic-syndrome) is a rare, relapsing autoimmun disease of the central nervous system, which is distinguished from other demyelinating disorders by a recently identified, specific autoantibody. By demonstrating the anti-aquaporin-4 IgG in the serum, a heterogenous group of syndromes can be defined, called NMO-spectrum. In the future, optical coherence tomography may support this diagnosis besides the clinical features, imaging examinations and presence of serum antibody. Early recognition and treatment can improve clinical outcome even in serious condition. Long-term immunosuppressive therapy is advised to prevent further relapses and to stabilize or improve clinical status. Hereby, we report a case of a 51-year-old woman, under treatment for 1.5 years. We summarize the up-to-date knowledge about the pathomechanism, diagnostic strategy and therapy of neuromyelitis optica. We review recent findings and the diagnostic value of a new, non-invasive ophtalmological examination, the optical coherence tomography. According to the first results, this method may be helpful in the early differential diagnosis of optic neuritis.]

Clinical Neuroscience

[Reversible hepatocerebral degeneration-like syndrome due to portovenous shunts]

SIBEL Güler, UFUK Utku, AHMET Tezel, ERCÜMENT Ünlü

[Ataxia and tremor are rare manifestations of hepatocerebral degeneration due to portovenous shunts. Ammonia is a neurotoxin that plays a significant role in the pathogenesis of hepatic encephalopathy. A 58-year old male patient was assessed with the complaints of gait disturbance, hand tremor, and impairment of speech. His neurological examination revealed dysarthric speech and ataxic gait. Bilateral kinetic tremor was noted, and deep tendon reflexes of the patient were hyperactive. Serum ammonia level was found to be 156.9 μg/dL. Cranial magnetic resonance (MR) imaging revealed increased signal intensity in bilateral globus pallidus on T1-weighted axial sections, and bilateral prominent hyperintense lesions in the middle cerebellar peduncles on T2-weighted axial sections. On his abdominal MR portography, multiple portohepatic venous collaterals were noted in the right and left lobes of liver parenchyma in 2D FIESTA axial MR sections. To our knowledge, we reported the first case of acquired hepatocerebral degeneration presenting with cerebral symptoms without any hepatic findings in which clinical improvement was noted, and hyperammonemia disappeared following medical treatment.]