Lege Artis Medicinae

[The Message of the Invisible Exhibition]

NAGY Zsuzsa

SEPTEMBER 21, 2009

Lege Artis Medicinae - 2009;19(08-09)

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Lege Artis Medicinae

[Do you have to die here?]

VITRAI József, FÜZESI Zsuzsanna, KAPOSVÁRI Csilla, KAPÓCS Gábor, RÁCZ József, SINKÓ Eszter

Lege Artis Medicinae

[The importance of vitamin D deficiency in practice]

TAKÁCS István

[The effects of vitamin D in bone health have been known since the 1920s. Recently, it has been proven that its role in the body is much more complex. Activated vitamin D is a steroid hormone that regulates transcription of more than 200 human genes through its receptor that is detectable in almost all types of cells. In contrast to the former conceptions, it can be activated not only in the kidneys; moreover, local 1-α-hydroxylation plays a greater role in its extraskeletal effects. Vitamin D deficiency, currently defined as serum levels of <30 ng/ml, is caused by the lack of ‘effective’ sunlight exposition. Thus, vitamin D deficiency is one of the most frequent deficiencies in the developed world that plays a role not only in the development of skeletal conditions but many other diseases, as well. A low vitamin D level causes a reduced calcium absorption, a higher bone remodelling rate and increased bone loss. It also reduces muscle strength and increases the risk of falling. Normal vitamin D status is required for the effectiveness of drugs for osteoporosis treatment; however vitamin D treatment in itself is not effective in osteoporosis. An increasing number of studies show the benefits of vitamin D supplementation and treatment in extraskeletal conditions. Vitamin D plays an important role in the prevention of several auto-immune diseases, infections, cardiovascular diseases, and cancers. Therefore, all UV-B radiation-deprived adults require an intake of vitamin D to maintain a level of >30 ng/ml. Vitamin D3 treatment is safe. The necessary dose can be reliably approximated by the calculation that an incremental consumption of 100 IU/day raises serum vitamin levels by 1,0 ng/ml. Clinical trials suggest that for the vast majority of individuals, a prolonged intake of 10,000 IU/day does not pose any risk.]

Lege Artis Medicinae

[Up-to-date management of systemic sclerosis]

SZŰCS Gabriella

[Systemic sclerosis is a chronic autoimmune disease characterized by three major features: widespread fibrosis in the skin and internal organs, a non-inflammatory small vessel obliterative vasculopathy and immunological activation with disease-specific autoantibodies. It is necessary to take a systematic approach to the diagnosis and evaluation of each case in order to provide appropriate treatment. Disease-modifying approaches can be classified according to the underlying pathogenic process. Thus vascular therapies include agents used for Raynaud’s phenomenon, critical digital ischaemia and organ-based vascular complications such as scleroderma renal crisis and pulmonary hypertension. Immunosuppressive drugs are used in lung involvement or rapid skin progression. The results of different anti-fibrotic therapies are controversial. Finally in managing organ-based manifestations and complications a multidisciplinary approach to the therapy is useful with patient education as an integral component of successful management.]

Lege Artis Medicinae

[The role of neurohormonal regulation in the development of insulin resistance in chronic stress]

MOLNÁR Ildikó

[The effects of the chronic stress could not be avoided recently. The pathognomic regulation of the neurohormonal events is responsible for the manifestation of diseases such as obesity, cardiovascular diseases, diabetes mellitus type 2, depression, tumors, inflammations, allergy. Two major regulatory systems are involved in the neuroendocrine alterations caused by stress: the hypothalamus-pituitary-adrenal (HPA) axis and the sympathetic nervous systems. The chronic activation of the adrenocortical system leads to insulin resistance and obesity associating with vascular, arteriosclerotic and inflammatory symptoms. The revealing of the pathognomic events on time and the enhanced physical activity may provide the effective prevention of these frequent diseases.]

Lege Artis Medicinae

[Side effects of long-term treatment with proton pump inhibitors]

PAP Ákos

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[I hold in my hand LAM issue 5-6. My sincere congratulations to both the previous issues and this double issue. The "outside" and the "inside" are equally valuable. It is a journal with a very fine exhibition. No country much richer than ours can boast of anything like it. The content is also impeccable. The exhibition stands up to all criticism.]

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Lege Artis Medicinae

[We heard in forums]

ANDRÁS László

[The 1993 Social Security Budget Act and, as part of it, a series of provisions setting out the way forward for the reform of primary care and initiating the reform of specialised care. However, the government and ministerial decrees implementing the provisions and setting out the technical details are not yet known. Health professionals are still full of uncertainty and doubt. The time has come once again for forums in which the leaders of health policy - the authors of the laws and the drafters of the expected regulations - give presentations explaining and justifying what has already happened and informing about expected developments. At the same time, of course, they "sound out public opinion". The huge interest that greeted the speakers at the first forum of the "season" of the complementary event of the International Medical Technology Exhibition in the Theoretical Block of the SOTE Oradea Square, was not so much a sign of the organisers' success as of the doctors' lack of information, their uncertainty and their hunger for information.]