Lege Artis Medicinae

[The Survivor’s Shadow ]

NAGY Zsuzsanna

NOVEMBER 03, 2015

Lege Artis Medicinae - 2015;25(10)

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[The patient centered paradigm]

KAPÓCS Gábor

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[Current questions on Pneumococcus infections: cardiovascular complications, cardiotoxicity and new opportunities for prevention among elderly people]

LUDWIG Endre

[The respiratory tract infections, first of all severe pneumonia are associated with severe cardiovascular adverse events the significance of which that had not been recognised so far. Among the adverse events, the development of acute coronaria syndromes, heart failure, arrhythimias are the most important ones leading to significatly higher mortality even after several years. In the development of acute coronaria syndrome , the proinflammatory activites play the cenral role leading to the instability of coronaria plaques and plaque rupture associated with formation of platelet thrombi. The constriction of coronariae, peripherial vasodilatation and hypoxia also contribute to the deleterius complications. The role of pneumococci in this process seems to be especially significant since this pathogen exhibit a unique direct cardiotoxic effect, namely directly invades the myocardium and produce cardiotoxic substances. As a consequence, impairement of cardiomyocite function and contractility and formation of microscopic lesions in which later collagen deposition and long-term cardiac scarring can be detected. These pathological processes are developed despite of antibiotic treatment, consequently, vaccination against pneumococcal infection seems to be the only method for efficacious prevention of the myocardium damage and cardiovascular adverse events. According to the results of the CAPITA study, the conjugate polisaccharide vaccine decrease the number of pneumococcal pneumonia and invasive pneumococcal infections by 45 and 75% resp. in the elderly population. The recognition of the direct and indirect role of pneumococci in the development of early and late cardiovascluar adverse events gives a new aspect of the beneficial effect of efficacious vaccination.]

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[Insulin pump therapy in type 1 diabetes in the light of efficacy, safety, and quality of life]

HIDVÉGI Tibor, SZEPESI Gábor, LUKÁCS Andrea, BARKAI László

[The level of glycaemic control necessary to achieve optimal outcomes in subjects with type 1 diabetes mellitus typically requires intensified insulin therapy using multiple daily injections or continuous subcutaneous insulin infusion (CSII). For CSII, the insulins of choice are the rapid-acting insulin analogues: insulin aspart, insulin lispro and insulin glulisine. The advantages of CSII over multiple daily injections in adult and paediatric populations with type 1 diabetes include superior glycaemic control, lower insulin requirements and better health-related quality of life/patient satisfaction. An association between CSII and reduced hypoglycaemic risk is more consistent in children/adolescents than in adults. The use of CSII is widely recommended in both adult and pediatric type 1 diabetes mellitus populations, but is limited in pregnant patients. The review also discusses the result of the “A non-interventional trial to observe the effect of the use of Accu Chek Combo device on quality of life and metabolic control“(COM-1101-HU 1.3).]

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[The evaluation of statin adherence in patients from the village of Méhkerék]

HANYECZ Vince, DANI Győző, MÁRK László

[INTRODUCTION - One of the basic elements of cardiovascular prevention is lipid lowering therapy, the quality of which is indicated by the increasing rate of lipid target values achieved during recent years. Further improvement is needed and for this the enhancement of patient adherence to statin treatment is a possible way. PATIENTS AND METHODS - The prescription habits in 81 patients taking statins (41 atorvastatin and 40 rosuvastatin) from 392 randomly selected ones for another study were analysed from the database of general practitioner in the village called Méhkerék in Békés County, Hungary. RESULTS - The statin adherence of the patients was evaluated in two different ways: the estimation by the general practitioner and the determination of prescribed drug boxes during one year. There was no significant difference between the two methods. Similarly, no significant difference was found between the atorvastatin or rosuvastatin adherence. The reduction of total cholesterol was significantly greater in patients taking rosuvastatin (p=0.03). A significant correlation was found between the prescribed box numbers and the decrease of LDL- and total cholesterol. CONCLUSIONS - The patients’ adherence seems to be independent from the type of statin. For the evaluation of patient adherence the GP's simple estimation and determination of prescribed drug boxes during one year are equally appropriate. This suggests, that the GP would be able to select those patients whose education needs longer time. ]

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[Successfully applied fulvestrant treatment at patient with breast cancer]

CSEH József

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Hungarian Immunology

[Autoimmun thyroiditis presence in patient with Hodgkin’s disease in remission]

BÍRÓ Edit, BAKÓ Gyula, SZEGEDI Gyula, ILLÉS Árpád

[INTRODUCTION - It is known that the incidence of hypothyroidism is higher in long term survivor patients with Hodgkin's disease, and it is supposed to be the result of treatment, such as neck radiotherapy. The author believe that other etiologic factors may also play a role in the development of hypothyroidism. PATIENTS AND METHODS - Looking for the possible causes of hypothyroidism, the thyroid function of 151 patients treated for Hodgkin's disease since 1970 were examined. These patients with Hodgkin's disease in complete remission for at least one year and their data on thyroid autoantibody positivity [antithyroid peroxidase antibody (aTPO), antihuman thyroglobulin antibody (aHTG), TSH antireceptor antibody (TRAK)] were analysed. RESULTS - Among the patients with antibody positive 26 received ultrasound scanning and fine needle aspiration cytology of the thyroid, which confirmed autoimmun thyroiditis. There were no significant differences between the mean age, histologic subtypes and stage of the disease between the patients with antibody positive those with antibody negative. A significantly greater number of women in the group of antibody positive patients was found and thyroid dysfunction (two cases of hyper, and 13 cases of hyperthyroidism) was revealed in 53.6% of the patients. Though antibody positivity was more frequent in patients having been treated by neck irradiation, but no significant relationship was found between the form of Hodgkin’s disease treatment and the development of thyroiditis. Thus the authors cannot confirm the assumption according to which the autoantigens released from the thyroid gland damaged by neck irradiation for Hodgkin's disease would provoke the development of thyroiditis. Since - independently of the type of treatment received - the incidence of thyroiditis is higher in patients with Hodgkin's disease, it is probable that immune regulation disorders may also play a role in its development and thus hypothyroidism is the result of a multi-factor process. DISCUSSION - These results underline the importance of a regular control of thyroid hormones and thyroid autoantibodies in follow up Hodgkin’s disease patients. Levothyroxine administered as an isohormone treatment may inhibit the development of hypothyroidism in patients with thyroiditis may improve the quality of their life.]

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[In the Shadow of Death ]

FERENCZI Andrea

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[Interstitial Shadow in the Lung A Case Description in Images]

PÁPAY Judit, MOLDVAY Judit