Lege Artis Medicinae

[What is the optimal diet for a civilized primate?]

FRECSKA Ede, SZABÓ Attila

FEBRUARY 15, 2015

Lege Artis Medicinae - 2015;25(01-02)

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Further articles in this publication

Lege Artis Medicinae

[Physician and Science 2. The Science of Schizophrenia... But Which One? ]

BÁNFALVI Attila

Lege Artis Medicinae

[New oral anticoagulant drugs - What must a GP know?]

MAGYAR Anna

Lege Artis Medicinae

[Five-year results of „Comprehensive Health Screening of Hungary 2010-2020”]

KISS István, BARNA István, DAIKI Tenno, DANKOVICS Gergely

[The „Comprehensive Health Screening of Hungary 2010-2020” have finished the 5th jubilee season. Int he past five year the program was working succesfully as a model for the primer and secondary prevention. The results of comprehensive screening have shown caracteristic picture about the health of population, and many people received education, informations about health protection, prevention and healthy lifestyle. More than 900 places, 7 millions of filled risk queries, 112 000 people’s comprehensive screening and 250 000 counsellings are the summary of activities. Some 200 000 people received the information pack. Significant is the familiar occurence of tumors and cardiovascular diseases, that means 20% of prevalence in test subjects. We are obese, smokers, physically inactive, our health behavior is poor. The improvement of the populational health care activity is among the strategical plans of health politics, and it is badly needed based on the results of MÁESZ Program.]

Lege Artis Medicinae

[Barbie’s Own Life ]

TÚRY Ferenc

Lege Artis Medicinae

[Amlodipine/atorvastatin fix combination in type 2 diabetes mellitus]

BÓTYIK Balázs

[INTRODUCTION - Type 2 diabetes mellitus is known to represent a major cardiovascular risk. In type 2 diabetes, hypertension and dislipidemy are often also present, increasing the vascular risk. In this case the use of both antihypertensive and lipid lowering therapies is needed. In our CASE REPORT, we discuss the data of a 43 years old diabetic man with BMI: 29.4 kg/m2, waist circumference of 101 cm, who had recently diagnosed hypertension and was given single pill amlodipine/ atorvastatine in addition to his original ACEI therapy. At the initiation of the therapy the mean blood pressure - measured during ABPM was 149/91 ± 14.99 Hgmm, his total cholesterol: 4.18 mmol/l, HDL cholesterol: 0.82 mmol/l, LDL cholesterol: 2.41 mmol/l, and triglicerid: 4.09 mmol/l. Three months later the results were the following: mean blood pressure: 121.66/ 82.79 ± 8.21 Hgmm, total cholesterol: 3.47 mmol/l, HDL cholesterol: 1.08 mmol/l, LDL cholesterol: 1.98 mmol/l, triglicerid: 1.44 mmol/l. There were no side effects. Using the therapy among several other diabetic patients we observed similar efficacy and tolerability, and the adherence of the patients was perfect. DISCUSSION - In type 2 diabetes the use of the fix combination of amlodipin/atorvastatin in addition to previous ACEI therapy is effective, well tolerated, and the long term compliance proves to be good.]

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Clinical Neuroscience

[Zonisamide: one of the first-line antiepileptic drugs in focal epilepsy ]

JANSZKY József, HORVÁTH Réka, KOMOLY Sámuel

[Chronic administration of antiepileptic drugs without history of unprovoked epileptic seizures are not recommended for epilepsy prophylaxis. Conversely, if the patient suffered the first unprovoked seizure, then the presence of epileptiform discharges on the EEG, focal neurological signs, and the presence of epileptogenic lesion on the MRI are risk factors for a second seizure (such as for the development of epilepsy). Without these risk factors, the chance of a second seizure is about 25-30%, while the presence of these risk factors (for example signs of previous stroke, neurotrauma, or encephalitis on the MRI) can predict >70% seizure recurrence. Thus the International League Against Epilepsy (ILAE) re-defined the term ’epilepsy’ which can be diagnosed even after the first seizure, if the risk of seizure recurrence is high. According to this definition, we can start antiepileptic drug therapy after a single unprovoked seizure. There are four antiepileptic drugs which has the highest evidence (level „A”) as first-line initial monotherapy for treating newly diagnosed epilepsy. These are: carbamazepine, phenytoin, levetiracetam, and zonisamide (ZNS). The present review focuses on the ZNS. Beacuse ZNS can be administrated once a day, it is an optimal drug for maintaining patient’s compliance and for those patients who have a high risk for developing a non-compliance (for example teenagers and young adults). Due to the low interaction potential, ZNS treatment is safe and effective in treating epilepsy of elderly people. ZNS is an ideal drug in epilepsy accompanied by obesity, because ZNS has a weight loss effect, especially in obese patients.]

Clinical Neuroscience

[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.]

Clinical Neuroscience

[Decisional collisions between evidence and experience based medicine in care of people with epilepsy]

RAJNA Péter

[Background – Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose – To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods – Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results – There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology – including genetic background –, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion – Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions. ]

Hypertension and nephrology

[“Diet” Soft Drinks Increase Blood Pressure More than Those with Added Sugar]

VÁLYI Péter

Lege Artis Medicinae

[Hypertension in the elderly - critical review of diagnostic-therapeutic guidelines and their background]

SZÉKÁCS Béla

[In the majority of old and very old hypertensive patients, the reduction of abnormally high blood pressure has been proved to provide a strategic defense of target organs. In patients younger than 80 years, both initial and target blood pressure (BP) values are similar to those of younger age groups. In those older than 80 years, a a systolic blood pressure level >160 mmHg is the threshold of indication for antihypertensive treatment and the therapeutic target value is<150 mmHg. Both values are evidence- based (HYVET). The latest ACCF/AHA guidelines (USA 2011) advise to achieve a BP below 140 mmHg if the use of one or two antihypertensive agents result in sufficient BP reduction. However, this strategy is not yet supported by unequivocal evidence regarding complications in target organs. It is not recommended to aim for target levels lower than the above values (especially the value defined by the ESH guidelines) even in elderly hypertensive patients at high cardiovascular risk, as the results of several studies suggest a J-curve effect. In multimorbid elderly patients it is highly important to adapt antihypertensive treatment to individual needs, rather than to use schematic approaches. The number and progression of comorbid diseases can greatly influence, in certain cases attenuate the aimed BP reduction. A similar medical decision should be made if the target BP level could only be achieved by the combination of multiple antihypertensive medications, which can remarkably impair quality of life in elderly patients. Among non-comorbid elderly patients with hypertension, there seems to be no convincing difference in the efficiency of target organ protection between antihypertensive treatments that have different target sites but can achieve similar target levels. However, the majority of elderly hypertensive patients have comorbidities with variable rates of progression. In those at even low cardiometabolic risk the use of beta-receptor blockers (BRB) and especially a combination of BRB+diuretic (DIU) is not recommended. The adequate therapeutic tactic includes the use of only moderate drug-doses and their early combination. This approach has been convincingly proved mainly with early combinations of RAS inhibitors+CCB-s and RAS inhibitors+small doses of DIU-s. It is very important to monitor the treated patients, as the BP and circulatory response to the same antihypertensive treatment can markedly change in elderly patients when either the enviromental conditions change or a new pathologic process develops and/or is treated. Strict control is also necessary because it occurs quite often that the earlier optimal compliance of elderly patients in taking antihypertensive medicines rapidly deteriorates. The efficiency of statins and acetylsalicylic acid decreases over 80 years of age, but this does not indicate that the previously efficient approach should be suspended.]