Lege Artis Medicinae

[Treatment for simplex glaucoma, eye drops or early surgery?]

HOLLÓ Gábor

NOVEMBER 30, 1994

Lege Artis Medicinae - 1994;4(11)

[Primary open-angle glaucoma (simplex) occurs in -0.5-2% of the European population over 40 years of age and is one of the most common causes of blindness in countries with good public health. The visual field and visual impairment that has already developed with glaucoma is irreversible, so diagnosing the disease at an early stage and starting treatment at an early stage is a prerequisite for saving sight. Unfortunately, initiating treatment does not mean that retinal ganglion cell death and the resulting visual field loss will disappear. Although its rate slows down, progression can be detected in a significant proportion of eyes even with treatment. This is why the focus of glaucoma research today is to analyse the long-term efficacy of treatment.]

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Lege Artis Medicinae

[The use of in situ hybridization in basic biomedical research and clinical medicine]

MIHÁLY András

[The essential purpose of in situ hybridization is the histochemical and/or autoradiographic detection of specific nucleic acid sequences in cells, tissues or chromosomes. The method is based on the use of artificially manufactured DNA or RNA fragments which are label led with isotope, enzymes, biotin or digoxigenin. The specific attachment of these labelled single-stranded nucleic acid probes to intra nuclear or intracytoplasmic nucleic acids can be used for the study of gene expression, for the establishment of viral infections, for the diagnosis of specific tumours and for the detection of hereditary diseases and chromosomal aberrations. The present review discusses the molecular basis of the method, the possibilities of labelling and detection and various other applications.]

Lege Artis Medicinae

[The role of nutrition in the etiology and prevention of dental caries]

BÁNÓCZY Jolán

[Nutritional factors play an important role in the development of both dental caries and periodontal diseases. Dental caries is a multi factorial disease. The changes in the composition and accumulation of dental plaque, caused by physical and chemical components of the diet, are influenced by quantitative, qualitative and frequency factors of carbohydrate consumption. In the course of bacterial degradation of consumed sugars, acids are formed on the tooth by inherent dental plaque monosaccharides, and enamel demineralization occurs. Due to the multifactorial etiology of dental caries, prevention is a complex activity. In addition to fluoride prevention, appropriate oral hygiene measures, directives for a healthy diet, changes in life-style and behaviour are also important factors. For the elimination of the deleterious influence of carbohydrates, the decrease of between-meal snacks, and the use of non-acidogenic sugar substitutes (xylitol) is recommended, which might contribute to a decrease in the high caries prevalence rates in Hungary. ]

Lege Artis Medicinae

[Activated protein c response: a novel disorder causing thrombophilia]

PÁL András, SAS Géza, HAYNAL Imre, VAJDA Zoltán, KUNCZ Gabriella, MOHAMED A. Lateiwish, RÓNA Tas Ágnes

[In 1993 Dahlbäck described the so-called in vitro activated protein C response phenomena, according to which, the addition of activated protein C to citrated plasma samples prolongs the activated partial thromboplastin times. It was hypothesised that this phenomenon is the result of the action of a new protein C cofactor, and in 1994, Dahlbäck demonstrated that this phenomenon is linked to variations of the factor V, which surprisingly serves as a cofactor for protein C. In this study, forty-one highly selected thrombophilic patients and forty controls were investigated for the activated protein C response phenomenon. The response to activated protein C was expressed as the ratio of two activated partial thromboplastin times, the first in the presence of and the second in the absence of activated protein C. Eighteen patients demonstrated a decreased response, i. e. the ratio of the times was below 2.0 (mean 1.3). The average of the entire group was 1.86. The average ratio of the control group was 3.12, and there were 2 persons with ratios below 2.0. The results of this study correspond with the data in the literature. This newly recognised phenomenon may be responsible for the majority of the formerly unrecognised biochemical defects leading to the clinical picture of thrombophilia. ]

Lege Artis Medicinae

[News]

[MOTESZ is admitted to the European Union of Medical Specialists (UEMS); Hungarian-French medical education seminar; Smoking in the third trimester hinders foetal development; In Canada, cigarettes will only be sold in plain packaging in the future; Smoking during pregnancy can cause asthma in the unborn child; Smoking or health centre in NEVI; Smoking ban has not reduced restaurant sales in the US; Smoking during pregnancy can cause limb developmental abnormalities in the foetus; Dr. Zoltán Ajkay's five studies on health insurance reform; Diagnostic centre in Pécs; International meeting in Balatonszárszó; New information centre in Budapest;]

Lege Artis Medicinae

[Summary of the 1993 WHO and ISH guidelines on the management of mild hypertension]

[The World Health Organisation (WHO) and the International Society of Hypertension (ISH) have developed a new guidelines for the management of hypertension. The condition is a risk factor for cardiovascular disease in both young and older people, and treatment is essential. The guidelines include methods for dignostic and risk assessment, and options for treatment, including lifestyle modification.]

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We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Clinical Neuroscience

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

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Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Clinical Neuroscience

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Lege Artis Medicinae

[Diagnosis and treatment of microvascular coronary heart disease. Specialities of conditions in Hungary]

SZAUDER Ipoly

[Invasive investigations show that in two-thirds of patients the myocardial ischaemia persists without obstructive coronary disease and any other heart conditions (INOCA). The underlying cause may be microvascular dysfunction (CMD) with consecutive microvascular coronary disease (MVD) and microvascular or epicardial vasospastic angina (MVA). The modern practice of clinical cardiology while using the developed non-invasive cardiac imaging permits exact measuring of the coronary flow with its characteristic indices. All of these improve the diagnosing of CMD-induced myocardial ischemia and provide opportunity to determine primary MVD cases. Since the recognition and treatment of MVD is significantly underrep­resented in the Hungarian medical care, the primary stable microvascular angina (MVA) is described in detail below with its modern invasive and non-invasive differential diagnosis and treatment, concerning especially its frequency provoked by high blood pressure and female coronary heart diseases. There are highlighted all recommended diagnostic procedures available under domestic conditions.]

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[This consensus document is intended to provide guidance for the effective and efficient treatment of asymptomatic individuals with high uric acid levels and gout patients.]