Lege Artis Medicinae

[The Faculty Library]

BUDA Béla, VASAS Lívia

APRIL 01, 2009

Lege Artis Medicinae - 2009;19(03)

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[Starvation and obesity on the verge of the 21st century]

FIGLER Mária

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[Anaemia of chronic disease: causes and therapeutic options]

EGYED Miklós

[Anemia observed in patients with infectious, inflammatory, or neoplastic diseases and persisting for more than one month is called anemia of chronic disease. The term anemia of chronic disease is far from perfect, the terms of anemia of inflammation, cytokine-mediated anemia, and anemia of defective iron reuse are also used. Anemia of chronic disease is more common than any other anemia syndrome - apart from anemia caused by iron deficiency secondary to blood loss. Erythrocytes usually are normocytic, but hypochromia and microcytosis may also be observed. In almost every case, this type of anemia is hypo-regenerative. Characteristic laboratory findings include hypoferremia, hyperferritinemia, and hypotransferrinemia. Cause of this anemia is complex; pathogenesis of this anemia includes moderate shortening of erythrocyte survival, blunted response to erythropoietin, reduced medullar erythropoiesis, and limited medullar iron availability. In addition to treating the underlying pathology, treatment opportunities are recombinant human erythropoietin, transfusions, and intravenous iron.]

Lege Artis Medicinae

[A holistic approach to neuropathic pain]

KISS Gábor

[Neuropathic pain is a chronic pain disorder due to a primary lesion and/or dysfunction of the peripheral or central nervous system. This tormenting condition causes a lot of distress to the patients, impairs their quality of life, and demands significant expenses. Chronic neuropathic pain is frequently under-diagnosed and mistreated. Explanations for these problems are the complex underlying pathomechanism, variability of symptoms, difficulties in diagnosis, and the differences between the treatment of this and other painful disorders. In addition, comorbid conditions such as anxiety, depression, and sleep disorders are often overlooked. Apart from the diagnostic difficulties, also treatment is usually unsatisfactory. Frequently NSAIDs are used, but they are usually not effective. Undoubtedly, even with the use of evidence-based treatment - such as duloxetine and pregabalin - complete pain relief is not always possible. Lack of proper medical education also contributes to problems in diagnosis and treatment. In western countries, diabetes is the most common cause of polyneuropathy. Painful diabetic neuropathy is the most intensely studied neuropathic pain condition; a lot of evidence comes from randomized controlled trials of this type of neuropathy. The same drugs as in the case of other neuropathic pain conditions are used for the symptomatic treatment of painful diabetic neuropathy. Etiological therapy is based on the best achievable glycemic control. A combination of etiological and symptomatic therapy can be a future treatment, but proving this will require further studies.]

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[Individual treatment of chronic hepatitis C based on virus kinetics at outpatient department of hepatology]

HUNYADY Béla, SZINKU Zsolt, HARAGH Attila

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[Correct judgment of skin lesions in older patients]

NAGY Éva

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[Education and psychological support of parents in cases of postnatally detected Down syndrome]

MÁTÉ Orsolya, KÍVÉS Zsuzsanna, OLÁH András, FULLÉR Noémi, PAKAI Annamária

[OBJECTIVE - Since the 60’s several publications dealt with the phenomenon how physicians inform parents of newborns about postnatal recognition of Down’s syndrome and the support they receive right after breaking the bad news. Howe - ver, the rest of these studies concentrated on surveying parental satisfaction, while relatively few international studies deal with the other side of the communicational situation, the opinion of the informer. Our study focused on the circumstances of parental information in Hungarian institutions of obstetrics in order to evaluate the possibilities for interventions. METHODS - The Down’s team operating at the University of Pécs Faculty of Health Sciences carried out a national survey in 2005 - an interview-based questionnaire filled by physicians of institutions of obstetrics - with the help of the National Register for Congenital Diseases of the National Centre for Epidemiology and Down’s Foun dation. RESULTS - The coverage of the survey reached 74%. Rest of the surveyed institutions did not have information protocol, however, 70% of them believes it would be necessary. Only 44% of the physicians received communication training and 81% of them believe they can manage communication, 33% have felt that the mother of a newborn with Down’s syndrome would expect special help that the institutions are unable to provide. CONCLUSION - There are serious problems with the circumstances of parental informing in Hungarian institutions of obstetrics. This situation would obviously require intervention. An aimed communicational training based on international experience and exploiting the openness of physicians, as well as the establishment of information protocol could be elements of such intervention.]

Clinical Neuroscience

Different work schedules of nurses in Hungary and their effects on health

FUSZ Katalin, TÓTH Ákos, VARGA Bernadett, ROZMANN Nóra, OLÁH András

Introduction - The shift work is burdensome for nurses and may lead to health problems. Aims - The purpose of the study was to examine the nursing shift system types and to analyse the effects on nutritional status, subjective state of physical and mental health in case of different shift schedules. Method - In the first phase of the research 326 nurses working in changing shifts filled out the Bergen Shift Work Questionnaire after adaptation into Hungarian. 518 nurses participated in our second study in hospitals of the South-Danubian Region, in clinics of University of Pécs and at trainings organized by the Faculty of Health Sciences of the University of Pécs. Results - Based on the psychometric characteristics of Bergen Shift Work Questionnaire technically it is suitable for the examination of sleeping disorders associated with shift work. Sleeping quality is worse in those working in irregular work shifts compared to those working in regular and flexible work schedules (p<0.001). The irregular work schedule is worse than the regular work schedule according to 76.6% of the nurses. According to 63.8% of the respondents the following regular work schedule is the best: after one 12-hour day shift one 12-hour night shift, followed by two days of rest. The average Body Mass Index (BMI) is 26.16 kg/m2. Since the nurses work in shift work 47.7% of them reported weight gain. Among the psychosomatic symptoms the most frequent is back pain (78.4%) related elevated BMI (p=0.013). The nurses’ sense of coherence on average is 61.76 points. In case of full-time employees the sense of coherence is better than those who work in shifts (t=2.933, p=0.004). The nurses working irregular shift work asses their health worst (mean rank: 166.61; p=0.019), and their sense of coherence is lower (p=0.04). Conclusion - The irregularity of work schedules is stressful for nurses. Due to the health of nurses it would be useful to establish the least exhausting work schedules.

Clinical Neuroscience

Restless leg syndrome frequency in health workers

ÖCAL Ruhsen, ATGÜDEN Gizem, AYCAN Cagri, BALABAN Zeynep, SENAR Seran, YAVUZ Sena

Introduction - Restless Leg Syndrome (RLS) is a disease, primarily composed of sensational symptoms, caused by the urge to move lower extremities especially at night, and characterized by undesired feelings of the legs. Decreasing of the dopaminergic effect at night is thought to be responsible from these symptoms. RLS patients suffer from low quality of sleep affecting their daily life activities even causing socio-economic loss. Although RLS is a common and treatable disease, it can not be diagnosed easily due to the variability of symptoms. Aim - The purpose of this study is to determine the frequency of RLS among health workers and to define the disease causing factors. Method - A questionnaire was applied to 174 randomly selected health workers at Baskent University Medical Faculty (KA17/285). The demographic information, history of illnesses or usage of drugs, socioeconomic status, working hours and daytime sleepiness were questioned. Included in the questionnaire were diagnostic criteria for RLS, frequency assessment scale, and survey of sleep quality. We used “the diagnostic criteria of international RLS working group” for the diagnosis, and “Pittsburgh sleep quality index survey” to determine the quality of sleep. Reliability and validity studies were performed on both tests. Results - A significant relationship between socio-economic status and RLS was found (p<0.05) as an increase of RLS frequency in parallel with decreased socio-economic status. RLS was found to be common among health workers. We suggest that health workers should be checked regularly, and they should be informed about the disease in order to raise an awareness and hence increase their quality of life.

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[CONTROVERSIAL EFFECTS OF NITRIC OXIDE: INTEGRITY AND TOXICITY]

KISS Róbert Gábor, BÉRES Bernát János

[Nitric oxide is a key molecule of the human body. Since its discovery, a library of books and papers have been published on its physiological and pathophysiological role. It is involved in almost all pathological processes. In healthy individuals nitric oxide plays a crucial role in the vascular regulation by protecting against atherosclerosis, myocardial infarction and stroke. In the central nervous system, nitric oxide in its function as a neurotransmitter is responsible for synaptic plasticity, long-term potentiation, memory and a number of neuroendocrine control mechanisms. Furthermore, during inflammation and host defense, macrophages and neutrophils produce nitric oxide that has antibacterial, antiviral, and tumour cell killing activity. In pathologic conditions, however, nitric oxide reacts with superoxide anion to form peroxynitrite that damages the enzymes of the mitochondrial respiratory chain, superoxide-dismutase, reduced glutathion and activates or inactivates signalling molecules. During ischaemia- reperfusion, nitric oxide and peroxynitrite contribute to nitrative/nitrosative stress, DNAfragmentation and consequent polyADP-ribosepolymerase- 1 enzyme activation both in coronary thrombosis and ischaemic stroke.]

Hungarian Radiology

[A Neuroradiology Postgraduate and Specialist Training Workgroup is Formed at the Radiology Clinic of the University of Szeged Faculty of Medicine]

PALKÓ András