Lege Artis Medicinae

[Waiting for a saviour - to the margin of a working paper]

KAPÓCS Gábor

NOVEMBER 20, 2010

Lege Artis Medicinae - 2010;20(11)

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Further articles in this publication

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[On the screening for prostate cancer]

ROMICS Imre

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[It is Hard to Scoop out the Sea with a Net]

FERENCZI Andrea

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[Diagnostic informativeness of a finding]

VOKÓ Zoltán

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[Robert Schumann, the Romantic Composer ]

KÖVES Péter

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

NAGY Erzsébet, SAQQA Muhammad, SZABÓ Judit, MESTYÁN Gyula, SZIKRA Lenke, KONKOLY THEGE Marianne

[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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The prevalence of sarcopenia and dynapenia according to stage among Alzheimer-type dementia patients

YAZAR Tamer, YAZAR Olgun Hülya

Aim - In this study, the aim was to identify the prevalence of sarcopenia and dynapenia according to disease stage among Alzheimer-type dementia (AD) patients and collect data to suggest precautions related to reducing the disease load. Method - The study was completed with 127 patients separated into stages according to Clinical Dementia Rating Scale (CDR) criteria and 279 healthy volunteers aged 18-39 years and 70-80 years abiding by the exclusion criteria who agreed to participate in the research. Our prospective and cross-sectional study applied the CDR and mini mental test (MMSE) to patients with disorder in more than one cognitive area and possible AD diagnosis according to NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association) diagnostic criteria. The patient and control groups had skeletal muscle mass index (SMMI), muscle strength and physical performance assessed with sarcopenia diagnosis according to European Working Group on Sarcopenia in Older People (EWGSOP) diagnostic criteria. Results - In our study, in parallel with the increase in disease stage of AD patients, the prevalence of sarcopenia (led by severe sarcopenia) and dynapenia was higher compared to a control group of similar age. Conclusion - In chronic, progressive diseases, like AD, identification of changes in parameters, like muscle mass and strength and reductions in physical performance in the early period, is important for identification and to take precautions in the initial stages considering the limitations of the preventive effects of treatment applied after diagnosis of AD.

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[Earlier and more efficiently: the role of deep brain stimulation for parkinson’s disease preserving the working capabilities]

DELI Gabriella, BALÁS István, KOMOLY Sámuel, DÓCZI Tamás, JANSZKY József, ASCHERMANN Zsuzsanna, NAGY Ferenc, BOSNYÁK Edit, KOVÁCS Norbert

[Background – The recently published “EarlyStim” study demonstrated that deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD) with early fluctuations is superior to the optimal pharmacological treatment in improving the quality of life and motor symptoms, and preserving sociocultural position. Our retrospective investigation aimed to evaluate if DBS therapy was able to preserve the working capabilities of our patients. Methods – We reviewed the data of 39 young (<60 years-old) PD patients who underwent subthalamic DBS implantation at University of Pécs and had at least two years follow-up. Patients were categorized into two groups based on their working capabilities: Patients with active job (“Job+” group, n=15) and retired patients (without active job, “Job-” group, n=24). Severity of motor symptoms (UPDRS part 3), quality of life (EQ-5D) and presence of active job were evaluated one and two years after the operation. Results – As far as the severity of motor symptoms were concerned, similar (approximately 50%) improvement was achieved in both groups. However, the postoperative quality of life was significantly better in the Job+ group. Majority (12/15, 80%) of Job+ group members were able to preserve their job two years after the operation. However, only a minimal portion (1/24, 4.2%) of the Job- group members was able to return to the world of active employees (p<0.01, McNemar test). Conclusion – Although our retrospective study has several limitations, our results fit well with the conclusions of “EarlyStim” study. Both of them suggest that with optimal timing of DBS implantation we may preserve the working capabilities of our patients.]

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Clinical Neuroscience

[Effect of two month positive airway pressure therapy on the structure of sleep, cognitive function and anxiety]

CSÁBI Eszter, VÁRSZEGI Mária, SEFCSIK Tamás, NÉMETH Dezsõ

[Obstructive sleep apnea is a common disorder, characterized by repeated episodes of upper airway obstruction during sleep, resulting intermittent hypoxia and disruption of the normal sleep pattern, which caused cognitive dysfunction in these patients. Nasal continuous positive airway pressure is the treatment of choice for this disorder. The aim of the study is to evaluate the effect of short-term positive airway pressure on sleep pattern (polisomnographic measures), cognitive function and anxiety. Twenty four newly diagnosed and previously untreated patients with obstructive sleep apnea were evaluated a battery of neuropsychological tests before and after 2 and a half months of the treatment. We focused on working memory, short and long-term episodic memory, executive functions, anxiety and subjective sleepiness. Our results showed that the two and half month of treatment improved the respiration during sleep, sleep pattern and the subjective sleepiness. We found improvement in short- and long-term verbal memory, and complex working memory. Despite of treatment we did not find improvement in visuospatial learning. These results reveal that 2 and a half months of positive airway pressure treatment restored not only the normal respiration during sleep and normal sleep pattern, but also the cognitive functions. Our study suggests that cognitive dysfunction is at least partial reversible in obstructive sleep apnea patients after positive airway pressure treatment.]

Clinical Neuroscience

Restless leg syndrome frequency in health workers

ÖCAL Ruhsen, ATGÜDEN Gizem, AYCAN Cagri, BALABAN Zeynep, SENAR Seran, YAVUZ Sena

Introduction - Restless Leg Syndrome (RLS) is a disease, primarily composed of sensational symptoms, caused by the urge to move lower extremities especially at night, and characterized by undesired feelings of the legs. Decreasing of the dopaminergic effect at night is thought to be responsible from these symptoms. RLS patients suffer from low quality of sleep affecting their daily life activities even causing socio-economic loss. Although RLS is a common and treatable disease, it can not be diagnosed easily due to the variability of symptoms. Aim - The purpose of this study is to determine the frequency of RLS among health workers and to define the disease causing factors. Method - A questionnaire was applied to 174 randomly selected health workers at Baskent University Medical Faculty (KA17/285). The demographic information, history of illnesses or usage of drugs, socioeconomic status, working hours and daytime sleepiness were questioned. Included in the questionnaire were diagnostic criteria for RLS, frequency assessment scale, and survey of sleep quality. We used “the diagnostic criteria of international RLS working group” for the diagnosis, and “Pittsburgh sleep quality index survey” to determine the quality of sleep. Reliability and validity studies were performed on both tests. Results - A significant relationship between socio-economic status and RLS was found (p<0.05) as an increase of RLS frequency in parallel with decreased socio-economic status. RLS was found to be common among health workers. We suggest that health workers should be checked regularly, and they should be informed about the disease in order to raise an awareness and hence increase their quality of life.