Lege Artis Medicinae

[VIII. National Congress on Antibiotics]

SZÉKELY Éva

APRIL 20, 2003

Lege Artis Medicinae - 2003;13(03)

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Lege Artis Medicinae

[Severe acute respiratory syndrome]

BÁNHEGYI Dénes

Lege Artis Medicinae

[Proteomics - the new challenge]

HUDECZ Ferenc

[The term ”proteome” (proteome, PROTEin complement to a genOME) by now a generally accepted expression in biomedical science meaning a complete complements of proteins. The discipline ”proteomics”, coined after proteome, deals with the analysis of the complete set of proteins occurring in the living organism. This includes the identification and quantification of proteins, the determination of protein localisation, modifications, interactions, activities and function. Performing comparative studies is an important part of proteomics for the analysis of proteins in health and disease. The knowledge generated is already used for improved diagnostic procedures and development of new drugs and therapies. During the proteome analysis, as outlined in this paper, even very small quantities (concentrations) of proteins are measured, then the protein is identified and its structure is elucidated. This procedure is followed by functional studies. An important part of proteomics is the collection and validation of numerical databases suitable for data mining. There is a general understanding that methodology driven research (e.g. NMR, mass spectrometry, DNA chips) is also an integrated part of this discipline. It is already sensed that the analysis of proteome can lead to the discovery of new proteins proving targets for drug research and to the establishment of new procedures with a perspective of improved diagnosis and therapy.]

Lege Artis Medicinae

[Benefit of combined clopidogrel-aspirin platelet aggregation inhibition in acute coronary syndrome and after percutaneous coronary angioplasty]

KELTAI Mátyás

[Platelet aggregation inhibition is equally important both in conservative and interventional cardiological treatment of acute coronary syndrome. Recently, results from three important trial were published. All three proved the efficacy of the combined aspirin + clopidogrel treatment. The basic results of the three clinical trials (CURE, PCI-CURE, CREDO) are summarized in the article. In the CURE trial the combined primary endpoint was reached in 11.4% of the patients in the control group and in 9.3% in the clopidogrel group. The relative risk reduction was 20%. The combined primary endpoint included CV mortality, MI and stroke. The treatment effect was mostly detectable in the prevention of MI and stroke. In the PCI-CURE trial 2658 patients of the CURE trial were analysed. All of them were treated by coronary angioplasty. In this group the primary endpoint (CV death, nonfatal MI, urgent revascularisation) was reached in 6.4% of the aspirin treated and in 4.5% of the aspirin + clopidogrel treated patients. The relative risk reduction was 30%. The CREDO trial investigated patients after coronary angioplasty. The indication of angioplasty was either acute or chronic. All patients received combined aspirin + clopidogrel but only for four weeks in the control group or for one year in the treatment group. The combined primary endpoint was decreased by 26.9%. In all the 3 trials the risk of bleeding was slightly but significantly increased by the combined aspirin + clopidogrel treatment. Clinical application: based on the results of the 3 trials it is concluded that combined aspirin + clopidogrel treatment is indicated in all patients with acute coronary syndrome, independently from the treatment strategy. The treatment should be continued for one year. This is also applicable for all patients treated with coronary angioplasty.]

Lege Artis Medicinae

[Extraintestinal manifestations in inflammatory bowel diseases]

LAKATOS László

[Inflammatory bowel diseases (IBD) are systemic disorders. Bowel symptoms are the predominant manifestations, however during the course of the disease a lot of intestinal and extraintestinal complications may occur. Systemic complications are responsible for substantial co-morbidity and they have negative influence on the quality of life. A part of the extraintestinal symptoms seem to have common pathogenetic background with IBD, while others are the consequences of subsequent metabolic and endocrine abnormalities or may relate to local complications and adverse effects of treatment. Growing evidence is available on the role of genetic and immunologic factors in the pathogenesis of extraintestinal manifestations. Most important systemic complications are: peripheral and axial arthritides, osteoporosis, uveitis, erythema nodosum, pyoderma gangraenosum, primary sclerosing cholangitis, nonalcoholic steatohepatitis, different types of anaemia, thromboembolism, kidney stones and urinary complications. Cooperation with the specialists is very important in the diagnosis and treatment of these comlications. During followup of IBD patients special attention is needed to monitor possible extraintestinal manifestations.]

Lege Artis Medicinae

[Terbinafine (Lamisil) treatment of toenail onychomycosis in patients with insulin-dependent and non-insulin-dependent diabetes mellitus: a multicentre trial]

FARKAS Beatrix, PAUL C., DOBOZY Attila, HUNYADI J., HORVÁTH J. Attila, FEKETE Gy.

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Clinical Neuroscience

Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

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.

Lege Artis Medicinae

[History of vaccine production in Hungary ]

ÓCSAI Lajos

[This study presents the complete history of the Hungarian vaccine production, partly in association with the process of fighting vaccine-preventable infectious diseases, and underlines the fact that every government actively contributed to the age-adjusted mandatory vaccination schedule of the past 140 years. It demonstrates the various achievements from the smallpox lymph production through the launch of diphtheria serum production at Phylaxia and the establishment of the National Public Health Institute (OKI) with its vaccine production and the later institutional transformation of OKI into Humán as economic corporation to its closure. Among all OKI’s vaccine production activities, this study focuses on the production of influenza vaccines, due to its international importance in the 1960s and 1970s. The vaccine production against diphtheria tetanus and pertussis stands out from Humán’s activities, and the tetanus component of this vaccine is still used in the products of a multinational vaccine manufacturer. ]

Lege Artis Medicinae

[Risk of nonsteroidal antiinflammatory drugs. Focus on aceclofenac]

FARSANG Csaba

[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deterio­rate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable.]

Clinical Neuroscience

[Rehabilitation possibilities and results after neurosurgical intervention of brain tumors ]

DÉNES Zoltán, TARJÁNYI Szilvia, NAGY Helga

[Objectives - Authors examined the rehabilitation possi­bi­lities, necessities, and results of patients after operation with brain tumor, and report their experiences. Method - Retrospective, descriptive study at the Brain Injury Rehabilitation Unit, in National Institute for Medical Rehabilitation. Patients - Patients were admitted consecutively after rehabilitation consultation, from different hospitals, following surgical intervention of brain tumors, between 01 January 2001 and 31 December 2016. Patients participated in a postacute inpatient rehabilitation program, in multidisciplinary team-work, leaded by Physical and Rehabilitation Medicine specialist included the following activities: rehabilitation nursing, physical, occupational, speech, psychological and neuropsychological therapy. Results - At the rehabilitation unit, in the sixteen-year period 84 patients were treated after operation with brain tumor. Patients arrived at the unit after an average of 41 days to the time of the surgical intervention (range: 10-139 days), and the mean length of rehabilitation stay was 49 days (range: 2-193 days). The mean age of patients was 58 years (20-91), who were 34 men and 50 women. The main symptoms were hemiparesis (64), cognitive problems (26), dysphagia (23), aphasia (16), ataxia (15), tetraparesis (5), and paraparesis (1). The mean Barthel Index at the time of admission was 35 points, whereas this value was 75 points at discharge. After the inpatient rehabilitation, 73 patients improved functionally, the status of 9 patients did not show clinically relevant changes, and 2 patients deteriorated. During the rehabilitation 10 patients required urgent interhospital transfer to brain surgery units, 9 patients continued their oncological treatment, two patients continued rehabilitation treatment at another rehabilitation unit, and after rehabilitation 73 patients were discharged to their homes. Conclusions - Inpatient rehabilitation treatment could be necessary after operation of patients with brain tumor especially when functional disorders (disability) are present. Consultation is obligatory among the neurosurgeon, rehabilitation physician and the patient to set realistic rehabilitation goals and determine place and method of rehabilitation treatment, but even at malignancies cooperation with oncological specialist also needed. Authors’ experience shows benefits of multidisciplinary rehabilitation for patients after brain tumor surgery. ]

Lege Artis Medicinae

[Tobacco use habits and cessation support tasks in Hungary. PART 1.]

CSELKÓ Zsuzsa, FÉNYES Márta, CSÁNYI Péter, BOGOS Krisztina, KISS Judit, DEMJÉN Tibor

[Today, non-communicable diseases and their underlying main risk factors, namely tobacco use, physical inactivity, excessive alcohol intake and unhealthy diet are responsible for almost 70% of the mortality worldwide. The Global Ac­tion Plan issued for the preven­tion and control of non-communicable diseases aims among others to reduce smoking rates by 30% as compared to the 2010 prevalence. The aim of the World Health Or­ga­ni­zation (WHO) in ac­cor­dance with the United Nations Sus­tai­nable Development Goals (UN SDG 2030) proposes to achieve a 23% target rate in Hun­gary by 2025. Based on the current smo­king prevalance (29%) and preliminary estimates this goal will not be accomplished. It is highly concerning that while the con­sumption of traditional tobacco products does not decrease at the expected rate in Hungary, novel nicotine and tobacco products are spreading worldwide and in Hungary as well. Thus in order to curb tobacco use, more ro­bust actions are needed in Hungary. More emphasis should be laid on the provisions of the WHO Fra­mework Con­vention on Tobacco Control (FCTC). This document re­com­mends to in­crease the tax rate of to­bacco products, declares to halt the spread of novel nicotine and tobacco products, and urges health care requirements to support smokers in quit­ting. The present summary describes the smoking cessation support related tasks of the health care in­dust­ry, taking into ac­count current national smoking habits. ]