Lege Artis Medicinae

[The Face of Impressionism]

NAGY Zsuzsanna

AUGUST 20, 2013

Lege Artis Medicinae - 2013;23(07-08)

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Lege Artis Medicinae

[The First Russian Physician who Won the Nobel Prize ]

MOLNÁR László

Lege Artis Medicinae

[ARBITER 6-HALTS]

MATOS Lajos

Lege Artis Medicinae

[“War of numbers” and the facts about pegylated interferon based treatment of chronic hepatitis C]

MAKARA Mihály, HUNYADY Béla

[Further to the traditional pegylated interferon and ribavirin products, used since 2001 in the treatment of chronic hepatitis C, two new direct antiviral protease inhibitors were licensed in 2011: telaprevir and boceprevir. Added to the traditional dual combination either of these drugs increase significantly the rate of sustained viral response. Discussions over the relative efficacy of two different bands of interferons with different pharmacokinetic properties as well as of the different protease inhibitors are arising regularly. After critical review of the relevant literature the authors did not identify any clinically meaningful differences in efficacy of the two pegylated interferons (α 2a or α 2b) neither in dual nor in triple combination therapies. There has been no convincing evidence found to support superiority of one protease inhibitor over the other, either: Generally both drugs can be recommended for patients previously or actually not responding to dual therapy. However, there is a tendency towards a potential difference between the relapse rates after treatments with the two pegylated interferons in dual therapy, attributable potentially to the difference of their pharmacokinetic profiles. In special cases the choice of protease inhibitors can be influenced by cost-effectiveness and side effect profile.]

Lege Artis Medicinae

[A Man of Spirit – Remembering Béla Buda]

KAPÓCS Gábor

Lege Artis Medicinae

[Legal status and regulation of complementary and alternative medicine in Europe]

HEGYI Gabriella, VINJAR Fønnebø, TORKEL Falkenberg, HÖK Johanna, SOLVEIG Wiesener

[OBJECTIVE - This study aims to review the current legal status of complementary and alternative medicine (CAM) in the 27 member states and 12 associated states of the European Union (EU). METHODS - We contacted national Ministries of Health and educational institutions of all participating countries, international, local and regional CAM associations and members of the EU project CAMbrella. Literature search was performed in governmental, scientific and popular science websites as well as the web sites/databases of health ministries and EU and Hungarian law documents. RESULTS - All 39 nations have different legislative frameworks and different regulations of CAM. CAM activities are regulated by health legislation in 17 member states, 11 of which have created a specific CAM law, and 6 of which include sections related to CAM in their general health laws. Some countries only regulate several CAM treatments. Preparations, agents and herbal products used in CAM are subject to similar authorization requirements in all countries, comparably to other medicinal products. One exception is the requirement for documentation of efficacy studies. The Directives, Regulations and Resolutions of the EU will affect the conditions that might influence CAM treatment(s) in Europe. CONCLUSION - We experienced an extraordinary diversity in EU countries with regard to the regulation and practice of CAM, but did not find differences in the regulation of herbal products and medicines used in CAM. This motivates patients, practitioners as well as researchers when crossing the borders of European countries. In the current legislative environment we think that harmonisation of law is possible within the EU: individual states within culturally similar regions should harmonise their CAM legislation and regulation. This would probably safeguard against inadequately justified, over- or underregulated practice at national levels. In Hungary, modifications of the decree regulating on CAM are currently being prepared following professional recommendations. This outdated decree needs to be reconsidered, as 17 years of practice have shown which practices are worthy to be maintainted, taught and applied within the healthcare system and which should be omitted.]

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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.]

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[INTRODUCTION - In this qualitative pilot study, our goal was to investigate the illness representation of gipsy cancer patients and to examine their attitudes toward medical treatment. SAMPLE AND METHODS - Deep interviews were made with 20 persons (60% female; Mage=39.2±15.1 years). The included participants approximately represented the group composition of the Hungarian Roma population. RESULTS - For most of our respondents, cancer is a frightening disease meaning some kind of punishment and the end of life. The potential causes of the disease usually remain completely incomprehensible. The participants proved to be very under-informed in relation to their treatment - even when compared to the low level of information among Hungarian cancer patients in general. In the face of the supporting presence of family members, our respondents often stated that there was nobody to share their deeper emotional problems with. About half of the patients reported on impolite and inefficient treatment attributed to prejudice against their Gipsy identity. However, deeper analyses revealed, that in most of these cases, mistreatment was a consequence of the general shortcomings of the health care system (e.g. lack of time) - being labelled as discrimination by our respondents. Almost every participant sees his/her only role in recovery merely in the participation in medical treatment - not attributing enough significance to life style changes and even less to alternative / complementary medicine. CONCLUSION - Special training to improve communication skills with gipsy patients is needed - especially for general practitioners. We also suggest preparing handouts to Roma cancer patients that provide easy-to-understand information on the medical treatments and health behaviours that serve the coping with cancer and their prevention.]

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[Treatment and nursing of patients placed in prone position]

KISS Eszter

[Acute respiratory distress syndrome (ARDS) is a medical condition characterized by a high mortality rate. ARDS may be triggered by various pathologies such as sepsis and can have a significant impact on the overall outcome of primary disease. Prone positioning as a supportive strategy in the treatment of ARDS that has been investigated  since 1974. Lying face down has become more and more popular because it might have helped to improve oxygenisation in 70 percent of patients with ARDS. Occurence of ARDS did not change in the last 10 years in Europe and the syndrome is still associated with a quite high death rate between 40-50% despite of technologic and therapeutic improvement of last decades. It has already been investigated whether prone positioning may increase survival in patients with ARDS. However, approaches to the exact use of position are often occasional. Guideline development would be crucial to emphasize beneficial effect of prone positioning in patients suffering from ARDS and describe the process by which the manoeuvre may be performed. Primarily, it is substantial to improve oxygenation through the use of the prone position whilst promoting patient safety. Complications can be minimized by using a predefined strategy of placing patients in a prone position and a related checklist. ]

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[Increasing cerebral perfusion pressure in serious cranial injury - contradictory effects of dopamine]

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[Background - Management of cerebral perfusion pressure is an important element of the treatment of traumatic brain injury. Vasopressors are accepted as a method of choice to increase mean arterial blood pressure and thus cerebral perfusion pressure in the face of rising intracranial pressure. There are, however, some unresolved issues and potential risks to this therapy. Matherial and methods - This study therefore examines the effects of dopamine on physiological changes as well as on brain edema and water content that can be readily assessed by MRI/MRS in 1. a rodent model of rapidly rising intracranial pressure, caused by diffuse injury with secondary insult and 2. a model of cortical contusion. Results - Dopamine was capable of restoring cerebral perfusion pressure in the model of rapidly rising intracranial pressure. However, this was associated with only a partial restoration of cerebral blood flow. In the brain tissue two profiles of change in the apparent diffusion coefficient of water (ADCw) were seen; one in which ADCw recovered to baseline, and one in which ADCw remained persistently low. Despite that dopamine did not alter these profiles, MRI-assessed tissue water content was increased four hours after injury and dopamine increased cerebral water content in both subgroups of injury, especially in the subgroup with a persistently low ADCw (p<0,01). In the contusion group dopamine significantly worsened the edema both in the injured and in the contralateral area of hippocampus and temporal cortex even though the ADCw values did not change, except for the contralateral hippocampus, where both water content and ADCw values rose with treatment, suggesting extracellular accumulation of water. Conclusion - The results suggest that dopamine has a double effect - while it temporarily and partially restores cerebral blood perfusion, at the same time it induces an increase in brain swelling and thus an increase in intracranial pressure in some cases. It is possible that in a subgroup of patients vasopressor treatment leads to an opposite effect several hours later. Vasopressor therapy in the clinical setting therefore should be cautiously applied.]

Lege Artis Medicinae

[The changing face of carrier choice: Chances and opportunities in Hungary]

GYŐRFFY Zsuzsa, SUSÁNSZKY Éva, SUSÁNSZKY Anna, SZÁNTÓ Zsuzsa

[BACKGROUND - In the 21st century, medicine has changed. As a part of this transformation we observe the phenomenon of deprofessionalisation, change of the recruitment and alteration of the carrier motivation. METHODS - The quantitative study included 733 medical students of four Medical Universities in Hungary. Data for the qualitative study was collected from interviews of 45 medical students. RESULTS - Both research methods confirmed the changing of the medical profession. Besides, the number of medical school applicants are decreasing, and the number of women students are increasing. The impact of the doctor parents showed a decrease. Students reported late carrier choice and that they don’t become exclusively clinicians. The most important factor of carrier choice is altruism, but scientific interest and controllable lifestyle also appears as a motivation factor. CONCLUSIONS - Results suggest challenge of the „feminization of medical profession”. The medical curriculum and the conditions of work environment need to respond to these „metamorphoses”.]