Lege Artis Medicinae

[The diversity of desire in arts]

CZIGLÉNYI Boglárka

NOVEMBER 30, 2021

Lege Artis Medicinae - 2021;31(11)

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Lege Artis Medicinae

[Relationship of adolescents’ eating behavior and motivations with self-control and risk perception]

SZABÓ Katalin, PIKÓ Bettina

[Obesity and related diseases caused by unhealthy eating form a serious public health problem already in youth. In terms of prevention, it is essential to explore adolescents’ eating behaviors and factors influencing their diet. Our study aimed to explore adolescents’ eating behaviors, its motivations and their relation to self-control and risk perception related to eating behavior. Participants were 374 high school students (48% males; mean age: 16 years, S.D.=1.5) from Szeged and Bu­da­pest. Self-administered questionnaire was used for data collection which assessed socio-demographics, eating behaviors, mo­ti­vation, eating behavior related risk perception and self-control. Using factor analysis, we categorized eating behaviors (“junk food/drink consumption”; “health-oriented nutrition”; and “snacking and habit-oriented nutrition”), and eating motivations (“social, emotional and external motives”; “traditions and internal motives”; and “health motives”). According to correlation analysis, self-control was positively related to health-oriented nutrition and health motives and negatively to junk food/drink consumption and social, emotional and external motives. These two latter factors were associated with an increased risk perception as well. Our results draw the attention to strengthen self-control and explore the role of risk perception and eating motivations in school health education programs. ]

Lege Artis Medicinae

[Cardiovascular prevention 2021 – Guidelines of European Society of Cardiology 2021. Special considerations]

VÁLYI Péter, KÉKES Ede

[On 31 August 2021, the European Society of Cardiology published its guideline “Prevention of cardiovascular disease in clinical practice”. This guideline provides a comprehensive review about risk factors of atherosclerotic cardiovascular disease, their assessment, potential modifiers, treatment and prevention of the cardiovascular dis­ease itself at societal and individual levels respectively. The previous guideline issued 2016, had to be updated due to the recent significant advances in risk prediction of cardiovascular disease on atherosclerotic background and due to the beneficial effects of treatment, emerging new drugs and therapeutic targets. The risk assessment system has undergone a major overhaul and now predicts the risk of fatal and non-fatal cardiovascular events together over a 10-year horizon and over a lifetime. In the new guideline, age plays a more important role in risk classification than before. The risk assessment and staged management of apparently healthy people or patients with established atherosclerotic cardiovascular disease, diabetes mellitus and other specific diseases or conditions are detailed. The positive impact of influencing risk factors, the years of life gained can recently be presented in a lifetime perspective, which will help to make an individually tailored decision on the extent of interventions, while taking into account also the patient’s preferences.]

Lege Artis Medicinae

[The history of acute stroke care in Hungary ]

BERECZKI Dániel

[Stroke is one of the most frequent causes of death and the most important cause of permanent disability worldwide and also in Hungary. The Hungarian medical literature has mentioned this disease and has been giving recommendations for its treatment since 1690. Initially folk medicines, herbal preparations and phlebotomy were used as standard therapy. Later, cooling the head joined these methods. Pharmacy preparations emerged at the middle of the 19th century. From the middle of the 20th century, products of the pharmaceutical industry like blood flow enhancers and neuroprotective drugs were in the frontline of the acute care. Anti­hy­per­ten­sive, antithrombotic and lipid-lowering medications became part of stro­ke prevention. Imaging techniques – mainly computer tomography of the brain and ultrasound examination of the cervical large arteries – have radically changed the diagnostics of cerebrovascular diseases from the middle of the 1980s. Since the 1990s, diagnostic and therapeutic decisions are based on reliable evidence from good quality clinical trials. Since the beginning of the 21st century, reperfusion treatments (intravenous thrombolysis and mechanical thrombectomy) re­present the most effective emergency care. The current direction is the extension of the therapeutic time-window of reperfusion treatments based on sophisticated neruoimaging. This review provides a brief summary of the development of stroke care in the last three and a half centuries as reflected in the Hungarian medical literature. ]

Lege Artis Medicinae

[New approach in the treatment of elevated lipoprotein(a)]

KARÁDI István

[Lipoprotein(a) is a genetic trait, resembling the structure of low density lipoprotein (LDL). Due to its high atherogenicity it is an independent risk factor for atherosclerotic vascular diseases. External impacts (as dietary and lifestyle measurements) do not decrease its plasma level thus the primary and secondary cardiovascular prevention prefers primarily the drug therapy. How­ever, widely used lipid lowering agents do not have any impact on its plasma level. Recently, the PCSK9 inhibitor monoclonal antibodies (evolocumab and alirocumab), the small interfering mRNA inclisiran, and particularly the antisense oligonucleotide targeting the LPA mRNS, further the clinical use of pelacarsen produced significant lipoprotein(a) lowering effect. Beyond the atherosclerotic vascular diseases, lipoprotein(a) plays an important role in the pathogenesis of the calcific aortic valvular stenosis, as well. The usage of the above-men­tioned biological therapies in this condition is also promising. ]

Lege Artis Medicinae

[A practical demonstration of critically assessing health economic analyses]

MERÉSZ Gergô, DÓCZY Veronika, HÖLGYESI Áron, NÉMETH Gergely

[During the critical assessment of health economic analyses, it is useful to present their uncertainties within a standardized framework. The aim of this research is to demonstrate how to use the procedural framework to identify, quantify and interpret such uncertainties through the examples of cell and gene therapies. Based on the review of methodological documents used by the Di­vi­sion of Health Technology Assessment at the National Institute of Pharmacy and Nutrition of Hungary (NIPN), and formalizing the current practice in its own framework, first we identify the uncertainty factors of the analysis and then examine their quantification in the submitted health economic model. Subsequently, we interpret their impact on the cost-effectiveness conclusion and determine the significance of all uncertainty factors. By applying the framework on the cost-effectiveness analysis of tisagenlecleucel as our example, we identified the following uncertainty factors. Although it is challenging to quantify, there is significant uncertainty related to the effectiveness of comparator procedure, which is due to single-arm clinical trials and the use of secondary data sources. The discount rate had a quantifiable and significant impact on both health gains and costs. Methods used to estimate relative effectiveness are also quantifiable but have less of an impact on the conclusions. The presented framework proved to be appropriate, with some li­mitations to document and arranging uncertainties of health economic analyses. It is advised to use this framework for reimbursement decisions for public financing. A possible subject of methodological development is the further formalization of identifying factors of uncertainty.]

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OSVÁTH Péter

[Nowadays, the focus of genetic, neurobiological, neuropsychological and psychosocial research is on a more accurate discovery of the etiology of mental illnesses, especially with regard to the role and complex interactions of certain risk factors. It is increasingly challenging to interpret the results of different aspects and methodologies in a coherent theoretical framework, as this can only lead to a more accurate understanding of the complexity and mechanism of the psychiatric disorders. The main aim of this paper to overview recent studies on etiological background of mental disorders and to present the most important aspects of the Research Domain Criteria (RDoC) system. Review of reports from comprehensive studies published in the most important psychiatric journals over the past five years summarizing new findings on the etio­logy of mental disorders. Although current classifications indicate that mental disorders are strictly distinct diagnostic categories, new findings suggest that these marked differences in symptomatic, genetic, and neurobiological backgrounds are not detectable, as many mental disorders have been identified as having common molecular genetic risk factors, which may indicate common neurobiological pathomechanisms. Research results support the need for a rethinking of psychiatric nosology on an etiological basis and represent an important step forward in the more accurate exploration of the neurobiological background factors of mental disorders and thus in the development of more targeted therapeutic approaches. The development of the RDoC system can be a great help in this, as this dimensional approach offers the possibility of integrating the - often diffuse or even contradictory - neuroscientific research findings into a unified theoretical framework for the etiology, nosology and treatment of mental disorders. ]

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[The aldosterone-producing adenoma, aldosteronoma, the actual Conn syndrome, is a relatively well-defined entity, while the separability of idiopathic hyperaldosteronism and low-renin primary hypertension appears to be inherently uncertain according to our current knowledge. In this way, the diagnosis of primary aldosteronism (PA) is in fact more or less probabilistic and this also contributes fundamentally to the uncertainty of prevalence data. These are confirmed by a recent study in which PA was evaluated in the form of 24- hour urinary aldosterone excretion measured with oral salt loading instead of the standard technique. The paper has contributed to the change of paradigm by which the chair of the most widely accepted PA guideline, renewed in 2016, called to be jettisoned much of it.]

Lege Artis Medicinae

[I Had Neither Mood, Desire, Impulse or Condom – Curiosities about the Practice of Géza Csáth as a Bath Physician]

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Lege Artis Medicinae

[The World of Toulouse-Lautrec – Lithographs in the Museum of Fine Arts ]

NAGY Zsuzsanna

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[Diabetes in the fine arts]

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