Lege Artis Medicinae

[The safety of rosiglitazone - Lessons from the RECORD study]

HALMOS Tamás

MARCH 20, 2010

Lege Artis Medicinae - 2010;20(03-04)

[The international RECORD study team evaluated the safety of the oral antidiabetic drug rosiglitazone, after contradictory reports of its unfavourable cardiovascular adverse effects, in combination with sulfonyureas and metformin. The drug didn’t increase cardiovascular morbidity and overall mortality compared with standard blood sugar lowering drugs. However, it increased the risk of heart failure, and, in women, the risk of limb fractures. Keeping in mind the strict contraindications, the drug can still be prescribed, as glitazones have effective blood sugar lowering and insulin-sensitizing effects.]

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Further articles in this publication

Lege Artis Medicinae

[A new era in the treatment of patients with type 2 diabetes - Significance of the incretin analogue liraglutide from an internist’s perspective]

FARSANG Csaba

[Therapy of patients with type-2 diabetes has two important features: in addition to the nonpharmacological approach (changes in lifestyle and diet, smoking cessation, physical exercise), pharmacological intervention is needed to reach the target level of blood sugar, and those of other cardiometabolic risk factors (blood pressure, body weight, lipids, uric acid). Unfortunately, it is a worldwide problem that only a small fraction of diabetic patients reach all these goals. This is why it is very important to have drugs which can not only decrease the blood sugar level, but have beneficial effect on several cardiometabolic factors. Antidiabetic drugs affecting incretin system, the GLP-1 analogues or -mimetics, and DPP-4 inhibitors open a new era in the treatment of diabetic patients, because in addition to the reduction of blood glucose level, they may have beneficial effects on blood pressure, blood lipids and body weight. Among these drugs the newly registered liraglutide has an important role, because it stimulates secretion of insulin in a glucose-independent manner, and it also reduces the secretion of glucagon which is a well known endogenous substance that increases blood glucose level. It is important to note that liraglutide decreases appetite, body weight and blood pressure of diabetic patients. Several clinical pharmacological studies has been completed with liraglutide. Of these the LEAD (Liraglutide Effect and Action in Diabetes) program is of outstanding value because it proved that either in monotherapy or in combination with other antidiabetics it effectively decreased blood sugar level, body weight, and had a beneficial effect on systolic blood pressure.]

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[Relaxing Close to the Nature – An Interview with Andrea Tóth, Marketing Director of Park Inn Sárvár]

NAGY Zsuzsa

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[The role of risk sharing in drug funding]

KALÓ Zoltán, VOKÓ Zoltán

[In order to make the pharmaceutical budget predictable, an internationally accepted approach of health insurance providers is to shift more and more financial risks to pharmaceutical companies. The major paradox of financial risk-sharing schemes is that increased mortality, poor therapeutic compliance, reduced access to healthcare services, decreasing quality of health care and lack of treatment reduce pharmaceutical spending. Consequently, payers have started to employ reimbursement schemes that enable them to guarantee health gain and quality of service. Introduction of a risk-sharing scheme based on outcome and compliance can be a major advancement in the strategy of the Hungarian National Health Insurance Fund (NHIF). Funding schemes that guarantee therapeutic benefit can help reduce the uncertainty in coverage decisions regarding high-value, innovative healthcare technologies. However, justification of the parallel use of financial and outcomebased risk-sharing on the micro level is questionable. Even if the primary objective of the NHIF is to ensure the sustainbility of the public pharmaceutical budget, financial risks should be managed on the macro level.]

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[Some thoughts about the motivatedness of the patient and the physician during treatment of hypertension - Advantages of modern, fixed-combinations drug therapies]

JOBBÁGY Lajos

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[A farewell to Róbert Frenkl]

KAPÓCS Gábor

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Clinical Neuroscience

Hyperhomocysteinemia in female migraineurs of childbearing ages

ALEMDAR Murat, SELEKLER Macit Hamit

Background and purpose - Migraine is a risk factor for ischemic stroke in women of childbearing ages. Previous researches revealed a higher prevalence of hyperhomocysteinemia in migraineurs. Possible differences on the frequencies of hyperhomocysteinemia between migraine with aura and migraine without aura could contribute the established variances in stroke risk between these migraine types. Therefore, we aimed to search if the frequency of hyperhomocysteinemia was different between these subtypes of migraine or not. Methods - We analyzed the findings of serum homocysteine levels in female migraineurs of 16-49 years old who admitted to our outpatient clinic. Results - Homocysteine level was elevated in 13.3% of study population. There were not any significant differences on median serum homocysteine levels between migraine with aura (8.0 mikromol/L) and without aura (8.5 mikromol/L). (p=0.426) The frequencies of hyperhomocysteinemia were also similar (9.1% versus 16.7%, respectively; p=0.373). Correlation analyses did not reveal any linear correlation between ages and homocysteine levels either in group of migraine with aura or in group of migraine without aura (p=0.417 and p=0.647, respectively). Similarly, any linear correlation between disease ages and homocysteine levels either in group of migraine with aura or in group of migraine without aura was not detected (p=0.359 and p=0.849, respectively). Conclusion - The median serum homocysteine levels and the frequencies of hyperhomocysteinemia are similar between migraine with aura and without aura in women of childbearing ages. Therefore, the variances on stroke risk ratios between these types of migraine are probably not originated from the differences of serum homocysteine status.

LAM Extra for General Practicioners

[Advantages of fixed Combinations in the treatment of Hypertensive patients ]

FARSANG Csaba

[In 60-70% of patients with hypertension, a significant decrease in blood pressure can only be achieved by a combination of antihypertensive drugs. International as well as national guidelines emphasise the numerous advantages and the importance of combination treatment. Fixed combinations are particularly advantageous, as their use improves patients’ compliance. This paper summarises the available information on the possible combinations of the nine major antihypertensive drug groups distributed in Hungary, and for details the results published on the recently approved and introduced fixed combination of telmisartan and amlodipine.]

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[COMPLEX TREATMENT OF OROPHARYNGEAL DYSPHAGIA]

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[The authors focus on the rehabilitation of patients with dysphagia caused by surgical and/or irradiative treatment of head and neck tumors as well as neurogenic diseases. The complex rehabilitation includes treatment of the oropharyngeal swallowing dysfunction as well as the therapy of communicative disabilities. The home care of patients with dysphagia, which can not only be life threatening, but also causes social isolation, is an important task for the general practitioner.]

Clinical Neuroscience

[Dissections of the supraaortic arteries]

CSEH Tamás, SZUKITS Sándor, SZAPÁRY László

[Dissection of the cervical and intracranial vasculature is a rare but important cause of ischaemic stroke especially in young adults. In the majority of cases it affects the extracranial vessels, mostly the internal carotid artery. It might be categorized as spontaneous or traumatic, causing diverse clinical symptoms. Dissection might lead to ipsilateral stroke mainly by artery-to-artery embolisation. Due to its relative rarity compared to the classic ischaemic stroke of the elderly, there are much less clinically relevant information for the clinician to rely on. Several large, randomised, multicentered, prospective studies and some smaller, retrospective analyses have been published recently concerning the genetic background, epidemiology, acute care and secondary prevention of supraaortic arterial dissection which helps the neurologist to provide evidence-based care for his patient. Our aim is to give a short, up-to-date overview of arterial dissections with two case reports.]

Clinical Neuroscience

Alteration of mean platelet volume in the pathogenesis of acute ischemic stroke: cause or consequence?

AYAS Özözen Zeynep, CAN Ufuk

Introduction - Platelets have a crucial role on vascular disease which are involved in pathogenesis of ischemic stroke. Platelet size is measured as mean platelet volume (MPV) and is a marker of platelet activity. Platelets contain more dense granules as the size increases and produce more serotonin and tromboglobulin (b-TG) than small platelets. In this study, the alteration of MPV values were investigated in patients with acute stroke, who had MPV values before stroke, during acute ischemic stroke and 7 days after the stroke. The relationship between this alteration and risk factors, etiology and localization of ischemic stroke were also investigated. Methods - Sixty-seven patients with clinically and radiologically established diagnoses of ischemic stroke were enrolled into the study and stroke etiology was classified by modified Trial of Org 10 172 in Acute Stroke Treatment (TOAST) classification and, modified Bamford classification was used for localization and stroke risk factors were also evaluated. The platelet counts and MPV values from patient files in patients who had values before stroke (at examination for another diseases), within 24 hours of symptom onset and after 7 further days were analysed. Results - MPV values increased after stroke (10.59±2.26) compared with acute stroke values (9.84±1.64) and the values before stroke (9.59±1.72) (p<0.0001); this alteration of MPV values occured 7 days after stroke (p<0.016). There was a positive correlation between age and MPV values during acute stroke (r=0.270; p<0.05). Patients with atrial fibrillation had higher alteration in the time of MPV compared with patients without atrial fibrillation (p>0.006). We assessed for gender, men (n=38) had a higher alteration in the time of MPV compared with women (n=29) (p=0.013). Conclusion - Although there was no alteration of platelet counts, MPV values were increased 7 days after stroke in patients with acute ischemic stroke.