Lege Artis Medicinae

[The Painter’s Revolt against the Father, or Jesus Chastised ]

GEREVICH József

OCTOBER 20, 2018

Lege Artis Medicinae - 2018;28(10)

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Lege Artis Medicinae

[Hormesis: the importance of small doses in the modern medicine]

CSABA György

[The hormesis concept contains that high doses of some substances are harmful (toxic or inhibiting), at the same time small doses of these substances are adventageous and stimulating. The pretreatment with small doses helps to neutralize the later harmful or deleterious effects of large doses and this has therapeutical (clinical) importance in case of numerous diseases and treatments. The review use two examples for demonstrating the importance of hormesis: the effect of radiation and the effect to immunity, in addition general, evolutionary aspects are also highlighted. The importance of evolutionary aspects are discussed. It demonstrates the influence of hormesis to the human evolution and calls attention to the expected changes in human diseases (as inevitable consequences of hormesis in our chemically strongly infected world), which are transmitted to the progenies. Hormesis is a therapeutic possibility as well as a challenge for medicine, this means that it is advisable to use it in the therapy and must prepare ourselves to the challenges. ]

Lege Artis Medicinae

[A rebellion against the father - the chastened Jesus]

MARJAI Kamilla

Lege Artis Medicinae

[Gene modified T cells against cancer]

SZÖŐR Árpád

[Chimeric antigen receptor modified (CAR) T cells are hailed as a revolutionary breakthrough in the field of oncology. CAR T cells were first applied, with outstanding success, in the treatment of various leukaemias, yielding unprecedented antitumor activity and long periods of disease free survival. Following the success of CAR T cell therapy in leukaemias, solid tumors should now be targeted. These are more complex targets, therefore CAR T cell therapy needs to be further optimized for this purpose. Also, some unfortunate side effects, including the potentially deadly global inflammation called cytokine storm have to be minimized and possibly even eradicated. The next decade will be an exciting time to define whether this therapy which is yet exclusively used for cancer patients is also successful in the treatment of other diseases. In a recent study, T cells reengineered with CAR derived chimeric autoantibody receptors (CAAR) efficiently prevented disease progression in pre-clinical animal models simulating the serious autoimmune disorder, pemphigus vulgaris. Therapy was based on CAAR constructs which have the unique ability to selectively recognize and eliminate the B-cell clones secreting autoantibodies against a self-protein, thus playing a key role in disease pathogenesis and progression. In this review, we would like to give an overview about the history of the CAR T-cell concept, summarize briefly the currently running clinical trials, and discuss the challenges and future prospects of CAR T-cell therapy.]

Lege Artis Medicinae

[Does venous congestion decrease renal function - fiction or real?]

KOPITKÓ Csaba, MEDVE László, GONDOS Tibor

[Venous congestion can result in dysfunction of several organs. Although experimental data on renal dysfunction caused by venous congestion were already published about 90 years ago, those were difficult to extrapolate to humans, due to significant interracial differences. Acute pre-renal, or volume-sensitive kidney injury might respond to volume replacement; however, overt fluid resuscitation with or without right ventricular dysfunction can result in elevated central venous pressure. The glomerular capillary blood pressure, i. e. net filtration pressure in a single glomerulus is about 10 mmHg. Kidney dysfunction can both increase intra-abdominal pressure or elevate central venous pressure with or without decreased mean arterial pressure, can lead to renal dysfunction. In studies among patients with heart failure, or after cardiac or abdominal surgery, the increase of central venous pressure or intra-abdominal pressure above 8 mmHg resulted in impaired kidney function. This review summarizes both pre-clinical and clinical data on the role of intra-abdominal hypertension and venous congestion in the development of acute kidney injury.]

Lege Artis Medicinae

[On nursing in a different way - What are we talking about? ]

SÖVÉNYI Ferencné, PERKÓ Magdolna, FEDINECZNÉ Vittay Katalin

[Using an uncustomary approach to nursing history, authors review the intensive development process in the 1990s that resulted in the transition of nursing from an occupation to profession in Hungary. An occupa­tion attains professional status if its practitio­ners have access to education and training of a considerable duration, it has independent professional organisation, an ethical code of its own and is regulated by law. The article addresses these factors discussing at length the history and development of nurs­ing education and training in Hungary, subsequently it describes the process arching from practical nursing to the appearance of nursing science, an intrinsic part of which was the birth of a scientific nursing journal “Nővér”. The relevant and effective legislation on nursing and nursing practice is re­viewed comprehensively and the efforts to establish professional nursing organisations are described. It is maintained that framework conditions had to be established as a necessary precondition for nursing to professionalise itself on its own and become a vocation highly regarded by society. ]

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Clinical Neuroscience

[Zonisamide: one of the first-line antiepileptic drugs in focal epilepsy ]

JANSZKY József, HORVÁTH Réka, KOMOLY Sámuel

[Chronic administration of antiepileptic drugs without history of unprovoked epileptic seizures are not recommended for epilepsy prophylaxis. Conversely, if the patient suffered the first unprovoked seizure, then the presence of epileptiform discharges on the EEG, focal neurological signs, and the presence of epileptogenic lesion on the MRI are risk factors for a second seizure (such as for the development of epilepsy). Without these risk factors, the chance of a second seizure is about 25-30%, while the presence of these risk factors (for example signs of previous stroke, neurotrauma, or encephalitis on the MRI) can predict >70% seizure recurrence. Thus the International League Against Epilepsy (ILAE) re-defined the term ’epilepsy’ which can be diagnosed even after the first seizure, if the risk of seizure recurrence is high. According to this definition, we can start antiepileptic drug therapy after a single unprovoked seizure. There are four antiepileptic drugs which has the highest evidence (level „A”) as first-line initial monotherapy for treating newly diagnosed epilepsy. These are: carbamazepine, phenytoin, levetiracetam, and zonisamide (ZNS). The present review focuses on the ZNS. Beacuse ZNS can be administrated once a day, it is an optimal drug for maintaining patient’s compliance and for those patients who have a high risk for developing a non-compliance (for example teenagers and young adults). Due to the low interaction potential, ZNS treatment is safe and effective in treating epilepsy of elderly people. ZNS is an ideal drug in epilepsy accompanied by obesity, because ZNS has a weight loss effect, especially in obese patients.]

Clinical Oncology

[Adjuvant treatment of breast cancer]

PAJKOS Gábor

[Choice of optimal adjuvant treatment has been based on present debates, doubts and commit offence against processing or existing evidences. Clinical research has been resulted changes and renewal of practice decisions continuously. 3rd Breast Cancer Consensus Conference held on Kecskemét last year corresponded by Hungarian experts of the fi eld has given up to date and well-defi ned guideline. Present paper try to give a summary of adjuvant treatment courses for early breast cancer in consideration of last results of research since then.]

LAM KID

[New approaches to the treatment of osteoporosis]

LAKATOS Gergely

[Osteoporosis is a significant health care problem, and its treatment is of major interest. Despite of the wide spectrum of therapeutical modalities, the effective cure for all forms of this condition has not yet been developed. For this reason, the focus is on the development of new pharmacological approaches. The RANK/RANKL/OPG system discovered one and a half decades ago provides a tool for the neutralization of the osteoclast-stimulating RANKL by the use of monoclonal antibodies. Catepsin-K inhibitors offer another pathway for the inhibition of bone degradation. Anti-sclerostin and anti-Dkk-1 antibodies may stimulate bone formation by the release of Wnt signal transduction system. Other administration methods for PTH analogs, new generations of selective estrogen receptor modulators and antibodies against vitronectin receptors as well as potential new drug targets will enable us to fight bone loss more efficiently.]

Lege Artis Medicinae

[THE POSSIBILITIES OF USING PROBIOTICS IN DIGESTIVE DISEASES]

DEMETER Pál

[The mammalian intestinal tract contains a complex, dynamic and diverse society of microorganisms. The beneficial effects of developing a normal bacterial flora are: colonic resistance against pathogens, immunmodulation and intact intestinal barrier. Probiotics are live microbial supplements which beneficially affect the host by improving its intestinal microbial balance after oral administration. The health benefits of probiotics have been the subject of increased research interests. This paper gives a review of the literature that study the roles of probiotics in the prevention and treatment of antibiotic-associated diarrhea, traveller's diarrhea, irritable bowel syndrome, inflammatory bowel disease, Helicobacter pylori infection and hepatic encephalopathy. In human studies the examined probiotics are safe, tolerable and seem to be effective in conditions of diarrhea caused by antibiotics, traveller's diarrhea and pouchitis. In other above-mentioned conditions further randomized and controlled clinical trials are needed to evaluate their efficacy. Based on these results, in the research and manufacturing of genetically-engineered probiotic bacteria a major leap is expected.]

Lege Artis Medicinae

[A rebellion against the father - the chastened Jesus]

MARJAI Kamilla