Lege Artis Medicinae

[Travel to the Antarctica]

KERESZTES Miklós

SEPTEMBER 21, 2009

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

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Lege Artis Medicinae

[Examination of the synergic effect between perindopril and calcium channel blockers - Post hoc analysis of the EUROPA study]

NAGY Viktor

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[Carcinoid tumours - various manifestations and possibilities of treatment]

IGAZ Péter, RÁCZ Károly

Lege Artis Medicinae

[Is there blue sky above beta-blockers again?]

NAGY Viktor

Lege Artis Medicinae

[Measurement of coronary artery calcification in adults with type 1 diabetes mellitus using dual-source, multi-slice computed tomography]

MAUROVICH-HORVAT Pál

[INTRODUCTION - Coronary artery calcification can be characterized non-invasively and numerically using computed tomography (CT). In adult patients with type 1 diabetes mellitus, coronary atherosclerosis may be present without clinical symptoms. PATIENTS AND METHODS - Asymptomatic adults with type 1 diabetes mellitus (n=46) were investigated. Coronary artery calcification was expressed in Agatston-scores using a dual source CT scanner. RESULTS - Twenty-one patients had a coronary artery calcification score of ≥1 (range 1-2353), while in 25 patients no detectable calcium (score 0) was observed. Patients with vs. without coronary artery calcification had a higher age (51.0±9.9 vs. 42.8±7.8 years; p=0.0045), a longer duration of diabetes (30.6±9.2 vs. 24.2± 8.6 years; p=0.0238), a higher waist circumference (87.9±11.5 vs. 79.7±9.4 cm; p=0.0146), and a higher BMI (26.2±2.9 vs. 23.8±3.1 kg/m2;p=0.0109). Moreover, patients with vs. without detectable coronary artery calcification had higher serum lipid levels (LDL-cholesterol, 3.35±0.32 vs. 3.01±0.68 mmol/l; p=0.0069) and higher serum uric acid levels (228.4±48.7 vs. 195.1±39.4 µmol/l; p=0.0437). Hypertension was more common (p=0.0144) in patients with coronary artery calcification than in patients without it. There was no significant difference between the groups in HbA1c (7.97±0.85 vs. 8.26±1.28%; p=0.7491), however, estimated insulin sensitivity was lower in patients with vs. without detectable coronary artery calcification (7.15±2.09 vs. 9.20±2.03 mg/kg/min; p=0.0017). CONCLUSION - Our results suggest that coronary artery disease in type 1 diabetic patients is associated with higher age, longer duration of diabetes, and cardiovascular risk factors rather than with long-term glucose control.]

Lege Artis Medicinae

[Do you have to die here?]

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

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[It is an old observation, that tumor cells can escape from the primary, travel with the circulation, and fi nally be arrested in distant places. To know the potential „advantage” of this phenomenon (circulating tumor cells, CTC) is very important. One of the key questions is the proper sensitivity of isolation and characterisation techniques being able to represent the heterogeneity of tumorous clones. There is no doubt that the time arrived for the application of minimal invasive markers in oncology, with the hope that the survival of the patients can be improved using real-time monitoring and more effective therapy. The analysis of CTCs/cfDNA and other markers (e.g. miRNA, exosomes) obtained from the blood will be, hopefully, rutine tool in designing therapeutic strategy, and monitoring tumor response.]

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[Red Star Line: Patients Could Not Travel ]

NÉMETH István

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[TRAVEL MEDICINE IN GP PRACTICE]

FELKAI Péter, KOVÁCS Erzsébet

[The authors describe the basic ideas of travel medicine, as a newly introduced interdiscipline of the medical science in Hungary. Recently, this segment is considered to be the part of Insurance Medicine, on the other hand the methods and the practice of the travel medicine is based on the other medical specialities’ knowledge. Due to the growing number of travellers in our country as well as the consequences of the joining Hungary to EU, travel medicine could play an important role in the improvement of the Hungarian travellers’ attitude to their health care status, the prevention against the emerged infectious diseases, and in the medical assistance for the international tourism. Travel medicine also a good guideline for the fit-for-travel considerations, made by the GPs. Hungary with its advantageous geographical position appears to be an excellent stopover for any medical evacuation from East European or other surrounding countries. That is why we would like to establish a first travel medicine facility in central Europe. It is expectable that the Hungarian travellers require more and more information regarding to their health care possibilities and prevention during their trip. The first authentic person is being asked by the patients’ are GPs. The GP’s tasks are: diagnosis and the treatment of travel related diseases, the pre-travel advices. All the mentioned factors are a new challenge for the GPs in Hungary.]

Lege Artis Medicinae

[Successful treatment of chronic hepatitis C infection accompanied by rare but reversible adverse effects]

ERŐSS Bálint Mihály, NEMESÁNSZKY Elemér

[INTRODUCTION - In absence of signs and symptoms characteristic of chronic hepatic disease caused by hepatitis C viral infection, its diagnosis is generally suggested by abnormal liver function tests. If viral serological activity is confirmed, combined antiviral treatment (pegylated interferon plus ribavirin) has to be considered. Antiviral treatment is accompanied by several, usually reversible adverse effects. CASE REPORT - The 62 year-old woman has had waveringly abnormal liver function results for decades. Her anamnesis included transfusions for polytraumatization that resulted in a hepatitis C virus infection. We started treatment with interferon alpha-2a plus ribavirin. At week 4 of therapy, a significant decrease in virulence and at week 12, viral negativity was confirmed, accompanied by a normalization of hepatic function markers. Because of a gradually developing anemia, beginning from month 4, the former optimal dose of ribavirin had to be reduced. At the end of week 42, severe dermatitis with fever, muscle weakness and malaise (Sweetsyndrome) developed, and antiviral therapy had to be discontinued and steroids had to be given. During a short travel abroad, the patient suffered a collaptiform episode caused by extremely high blood glucose (28.0 mmol/l). She received temporarily fractioned insulin and then combined oral antidiabetic treatment. Then, dermatosis symptoms rapidly resolved, glycemic status gradually improved, and could be controlled by low-dose metformin. Liver function tests were normal. At the end of antiretroviral treatment and 6 months later, HCV-RNA by PCR proved negative, meaning that hepatitis C virus has been eradicated successfully. CONCLUSION - Treatment with pegylated interferon alpha-2a plus ribavirin rendered viral replication undetectable at 3 months, which is - together with the normalization of abnormal liver function tests - the strongest predictor of a good outcome. The patient’s exemplary good compliance contributed to successful treatment of hepatitis C and control of these rare but reversible adverse effects.]

Lege Artis Medicinae

[Summary data of Hungary's comprehensive health screening program (MAESZ) 2010-2019]

BARNA István, KÉKES Ede, HALMY Eszter, BALOGH Zoltán, KUBÁNYI Jolán, SZŐTS Gábor, NÉMETH János, PÉCSVÁRADY Zsolt, MAJOROS Attila, DAIKI Tenno, ERDEI Ottilia, DANKOVICS Gergely

[The comprehensive screening program of Hun­gary (MAESZ) 2010-2020-2030 is a unique initiative in Hungary and worldwide too. This largest humanitarian program provides by the latest technology free scree­ning tests for all residents in Hungary. The program developed by 76 pro­fessional organizations offers 38 scree­ning tests to every participants free of charge, in a special designed screening truck. Screening program performed by MAESZ includes cardiovascular, ophthalmologic, dermatologic, gynecologic, and neurologic investigations, lab tests, audiometry, blood pressure and arterial stiffness measurements, and venous Doppler ultrasound examinations. More­over, screening tests for lactose intolerance, colon malignancy, inflammatory bowel disease, reflux disease, urine incontinency, prostatic cancer and physical activity level were evaluated. Starting 2020, a dental screening station will be added to the mobile unit for early detection of oral cancers. Beyond screening tests, special attention is paid to assess health threatening risk factors, such as smoking, alcohol con­sumption, physical inactivity, un­healthy nutrition, and obesity. The program demonstrates the key elements of first aid from reanimation to bandage of burns in cooperation with professional and civil organisations. Furthermore, during the waiting time, participants get lifestyle recommendations and a health booklet with a bar code enabling the immediate computer analysis of test outcomes. Since the 2018/2019 school year the official prevention program for children entitled “Travel around the Empire of Health” was started. During its 10 years, the MAESZ performed 7 million free of charge screening tests on 1,886 scenes, enrolled 560,000 participants, invested 16,000 hours for prevention, handed out 1,200,000 health booklets and 391,000 prevention info packages to thousands of fami­lies. More than 20,000 health professionals (GPs, nurses, dietetics, health development agents, public health government officials, Accident Prevention Committee of National Police Headquarters, General Directorate of Social Affairs and Child Protection and non-governmental organizations) have been participated. The program designed to improve social health aims to help more and more Hun­garian citizens to be informed about their health status and to reminds them of the importance of prevention. ]