Lege Artis Medicinae

[The Nobel Prize in Medicine 2018 ]

KOVÁCS Ferenc

DECEMBER 10, 2018

Lege Artis Medicinae - 2018;28(11-12)

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Lege Artis Medicinae

[Identity formation of novel psychoactive substance users. Thematic content analysis of life narratives ]

ERDŐS Márta, SZIJJÁRTÓ Linda, VOJTEK Éva, KÁRPÁTI Tamás, ROZGONYI Róbert, KELEMEN Gábor

[Authors rely on Susan Greenfield’s identity theory to explore life narratives of novel psychoactive substance users in a Hunga­rian sample (n=24). Main nodes of the conceptual network identified in the computer-aided content analysis were personal and institutional relational networks, processing of emotions and sensory experi-ence seeking.]

Lege Artis Medicinae

[Saluting Semmelweis on the 200th Anniversary of his Birth ]

GAZDA István

Lege Artis Medicinae

["Nowadays we know a great deal about the microscopic detail" - but do we know more about Axolotl than Antal Szerb?]

GÁCS ZSÓFIA

[In Antal Szerb’s novel, The Pendragon Legend, which was first published in 1934 (its first English translation came out in 1963), the excentric Earl of Gwynedd experiments with strange creatures. Rea­ding the book based on mystic elements as well as their mockery, the reader gets quite a bizarre knowledge of axolotls. In this re­view, a detailed history of this amphi­bian (Ambystoma mexicanum) in Western scientific research is offered; beside the scientific data, of which presumably Antal Szerb was aware, the main trends in the axolotl studies of the recent decades, both their successes and failures, are also de­fined.]

Lege Artis Medicinae

[Mastitis and breastfeeding]

UNGVÁRY Renáta, MIKÓ-BARÁTH Eszter, KISS Eleonóra

[Various degrees of mastitis affect a significant percentage of breastfeeding mothers. Prevention and effective treatment are important public health issues due to the severe pain, malaise, high fever, and possible complications. Among other causes for early termination of breastfeeding, the most prominent reasons are the pain, prolonged healing, abscess due to mastitis and the frequent recurrence of the disease. Proper management of mastitis and alleviating the symptoms influence the length of breastfeeding and hence leads to a positive outcome for both the mother’s and her child’s long term health. Nevertheless, there are inconsistencies worldwide regarding the diagnosis, cure and prevention of mastitis. The treatments are done mostly on empirical basis. Even though numerous articles have been published on the subject, the unequivocal results are yet to come. This overview summarizes the current knowledge and the dilemmas about mastitis as well as the prevention opportunities and therapies. It also discusses the new results on breastmilk microbiome research, which might change the approach towards mastitis treatment.]

Lege Artis Medicinae

[Type 2 diabetes: what is the role of a General Practitioner in the treatment of diabetes?]

TORZSA Péter, OLÁH Ilona, HARGITTAY Csenge, KALABAY László

[The 2017 National Guidelines of the Hun­garian Diabetes Association emphasize the individual treatment of diabetic patients and the strong, goal-oriented regulation of carbohydrate metabolism from recogni­tion on. Beside monotherapy, primary dual or triple combination therapy may be applied in the treatment of patients. In primary care it’s the treatment of patients with type 2 diabetes where there is a lot to be done. We hope that the everyday use of the Professional Guidelines will contribute to a more successful diabetic care by General Practitioners (GPs). The holistic care of the GP’s team plays an important role in the primary, secondary and tertiary prevention of Type 2 diabetes, which accounts for more than 90% of all diabetic cases. ]

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Clinical Neuroscience

A case with reversible neurotoxicity induced by metronidazole

EREN Fulya, ALDAN Ali Mehmet, DOGAN Burcu Vasfiye, GUL Gunay, SELCUK Hatem Hakan, SOYSAL Aysun

Background - Metronidazole is a synthetic antibiotic, which has been commonly used for protozoal and anaerobic infections. It rarely causes dose - and duration - unrelated reversible neurotoxicity. It can induce hyperintense T2/FLAIR MRI lesions in several areas of the brain. Although the clinical status is catastrophic, it is completely reversible after discontinuation of the medicine. Case report - 36-year-old female patient who had recent brain abscess history was under treatment of metronidazole for 40 days. She admitted to Emergency Department with newly onset myalgia, nausea, vomiting, blurred vision and cerebellar signs. She had nystagmus in all directions of gaze, ataxia and incompetence in tandem walk. Bilateral hyperintense lesions in splenium of corpus callosum, mesencephalon and dentate nuclei were detected in T2/FLAIR MRI. Although lumbar puncture analysis was normal, her lesions were thought to be related to activation of the brain abscess and metronidazole was started to be given by intravenous way instead of oral. As lesions got bigger and clinical status got worse, metronidazole was stopped. After discontinuation of metronidazole, we detected a dramatic improvement in patient’s clinical status and MRI lesions reduced. Conclusion - Although metronidazole induced neurotoxicity is a very rare complication of the treatment, clinicians should be aware of this entity because its adverse effects are completely reversible after discontinuation of the treatment.

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. ]

Hypertension and nephrology

[First experiences with percutaneous renal denervation in management of resistant hypertension]

SCHULCZ Domonkos, NAGY Ferenc Tamás, THURY Attila, BAJCSI Dóra, FEJES Imola, LETOHA Annamária, CONSTANTINOU Kypros, UNGI Imre, ÁBRAHÁM György, LÉGRÁDY Péter

[Percutaneous transluminal radiofrequency renal denervation is a promising new therapeutic method for the treatment of primary resistant hypertension. The intervention decreases the systemic sympathetic over activation and thus arterial blood pressure. In the 1st Department of Medicine of the University of Szeged, 9 resistant hypertensive patients (2 male, 7 female; mean age: 55.0±4.0 years) had all the conditions were required for renal denervation at the time of interventions were performed. We measured the blood pressure together with the heart rate of the patients on the day preceding the intervention, right after the intervention, at discharge from hospital, then at months 6, 9 and 15. The mean blood pressure was 178/107±7/5 mmHg before the intervention. After denervation mean blood pressure decreased right after the intervention, at discharge from hospital, as well as at months 6, 9 and 15, respectively -15/-17 mmHg; -36/-16 mmHg; -19/-9 mmHg; -27/-21 mmHg and -15/- 16 mmHg. Besides decreasing of blood pressure, the antihypertensive drug therapy also decreased, however, it was not the primary aim of the intervention. No denervation- related intra- or perivascular complications were detected. The findings of our study proved the efficacy and safety of renal denervation in the treatment of primary resistant hypertension, of course with an appropriate patient selection. Our study was not relevant to determine whether this method is accompanied with a significant decrease of cardiovascular morbidity and mortality. Answers may come only based on randomized sham controlled studies with great case numbers.]

Lege Artis Medicinae

[Errors and mistakes in laboratory medicine]

ENDRŐCZI Elemér

[The unacceptable results of laboratory testing derive from the insufficient preanalytical, analytical and postanalytical processes. In addition to the analytical errors, there are inappropriate testing orders which reflect the failures of diagnostic strategy, and either result in excess testing orders without additional new informations, or in the lack of testing order that would be necessary for efficiency of patient's care. An increasing number of study demonstrate that in majority of cases the cause of erroneous results can be traced back to mistakes in the preanalytical phase (preparation of patient, sample collection). The total quality of the diagnostic strategy depends both on the compliance of tests according to the health condition of patient and the quality performance of laboratory processes. The elimination of the preanalytical errors and the formulation of proper diagnostic strategy requires a close cooperation between physicians and the diagnostic workplaces as well as the application of multidisciplinary guidelines which specify the quality requirements of the whole diagnostic process. Such guidelines are not prepared for specific professional activities and do not replace lower-level professional standards (e.g. for test procedures). Based on evidence-based medicine and the recommendations of international experts such guidelines should cover all elements of quality assurance necessary to achieve efficient diagnostic strategy and testing. There is little doubt that such recommendations will also be useful for rational financing of the health care system.]

Lege Artis Medicinae

[Female Physicians in the Early History of European Medicine]

KÖLNEI Lívia