Lege Artis Medicinae

[Trends of mortality amenable to health care in Hungary and in the Central Region, 1996-2006]

NAGY Csilla, JUHÁSZ Attila, PÁLDY Anna

NOVEMBER 20, 2010

Lege Artis Medicinae - 2010;20(11)

[INTRODUCTION - Despite of the decreasing trend of amenable mortality it is a significant contributor to social and economic loss due to premature death. This paper assesses the trends of amenable mortality over time, its contribution to the years of potential life lost (YPLL), furthermore reveals the spatial inequalities of the amenable mortality in the central region in relation to socioeconomic status and number of the inhabitants of municipalities. METHODS - This study describes the trend of the years of potential life lost due to amenable mortality during the period 1996-2006 in Hungary, in Pest county and in Budapest. The spatial epidemiological analysis of the amenable mortality was carried out by using smoothed indirectly standardised mortality ratio calculated by full hierarchical Bayesian methods at municipality level. The association between the spatial distribution of amenable mortality and socio-economic status was assessed by using a “Deprivation Index” elaborated by the authors. RESULTS - The years of potential life lost of males were 7207 (per 100 000) and respectively for females these value was 3870 (per 100 000) in Hungary in 2006. The amenable mortality is a significant contributor to years of potential life lost despite its decreasing trend. The amenable mortality accounted for approximately one third of the males’ and the females’ years of potential life lost. The risk of amenable mortality is higher in the less populated areas and the less-favoured socioeconomic situation coexists with high mortality risk. CONCLUSION - Approximately in average 32 000 persons died due to amenable mortality per year during the investigation period in Hungary. The results of the study provide essential information to the local policy-makers, and managing health professionals. The results can be used principally to inform planning healthcare development programs.]

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[In our case a 41-year-old man with following symptoms: non-productive coughing, fever, difficulty in breathing and weight loss was examined in February 2007, and on the basis of chest X-ray, CT and bronchoscopy, the possibility of neoplasm or tuberculosis cropped up. After the applied therapy (steroid, antibiotics, tuberculostatic drugs) the symptoms became more severe, i.e. hematuria and epistaxis were manifested. A tissue biopsy was carried out during bronchoscopy and the histological examination revealed granulomatous reaction. Meanwhile, the presence of c-ANCA was proved, and Wegener’s granulomatosis (WG) was diagnosed. In March 2007, sudden somnolence and left side hemiplegia developed, and a large haemorrhage was recognised on CT scan in the right fronto-temporal region, with regard to the haemorrhage, the patient had to undergo a neurosurgical operation. We started to treat him in April 2007 by intravenous steroid and 600 mg of cyclophosphamide (Cyc), and he regained the ability to walk again. In October 2007, the Cyc treatment was terminated, and we administered a maintenance therapy with methotrexat. During the regular medical check-up, a chest X-ray indicated a second attack in March 2008, which was confirmed by the chest CT, the clinical symptoms, increased anti-PR3 levels and c-ANCA positivity as well. The flair of the disease was established. Consequently, in April 2008 we decided on plasmapheresis therapy synchronised with Cyc. After that, we started an azathioprine maintenance therapy and he got rid of all the activation symptoms. We can say that with the adequate therapy started in good time and with the regular medical check up of the patient a good result can be achieved. It is true even in the case of WG disease associated by severe complication, for example central nervous hemorrhage.]

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[In vitro efficiency of doripenem, a new carbapenem against Gram-negative, aerob, problem bacteria - Prospective, multicentric, Hungarian study]

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[INTRODUCTION - Doripenem is a new carbapenem derivative, it’s chemical structure is similar to that of meropenem (substitution of one sulfamoxil-aminomethyl chain for the dimethylcarboxy chain) and has one 1-beta-methyl chain which provides resistance to dyhidropeptidase-I enzyme produced by the human kidney. It has a broad-spectrum of activity against multiresistant Gram-negative bacilli such as ESBL-producing Enterobacteriaceae and non-fermentative Gramnegativ bacilli including some strains of Pseudomonas aeruginosa that are resistant to other carbapenems. In 2010 between February and June a multi-centre comparative study was carried out including 5 Hungarian laboratories to investigate the in vitro activity of doripenem. MATERIAL AND METHODS - 1000 fresh, clinically relevant isolates were included both ESBLproducing and non-producing Enterobacteriaceae strains and resistant and multi-resistant Pseudomonas aeruginosa and Acinetobacter strains. The activity of doripenem and the comparator antibiotics (other carbapenems) were tested by the disc diffusion method. In the case of intermediate resistant strains the MIC of doripenem was also determined by the E-test methodology. RESULTS - All but one isolate belonging to the Enterobacteriaceae (592 isolates) were fully susceptible to doripenem. The only Enterobacter strain which proved to be intermediately susceptible to doripenem by the disc diffusion method was also found to be susceptible showing an MIC of 0.125 μg/ml. In the case of the 163 Pseudomonas aeruginosa and the 121 Acinetobacter spp isolates doripenem was the most active carbapenem compared with imipenem and meropenem (78.6% and 50.5% for doripenem versus 67.5% and 42.0% for imipenem and 68.7% and 30.2% for meropenem, respectively). CONCLUSION - According to our multi-centre study doripenem was highly active against both the ESBL-producing and ESBL-non-producing Enterobacteriaceae strains and against a great part of the Pseudomonas and Acinetobacter isolates often involved in nosocomial infections.]

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