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Hypertension and nephrology

APRIL 24, 2020

[Arterial hypertension and atrial fibrillation - the most important risk factors for stroke in clinical practice ]

LUDOVIT Gaspar, VESTENICKA Veronika, CAPRNDA Martin

[Vascular stroke is a very frequent cause of morbidity and mortality, and in patients who suffered stroke subsequent long-term neurological deficit of greater or lesser extent is an important factor. Numerous clinical and epidemiological studies confirmed that elevated systemic blood pressure is among the main risk factors of both ischemic and hemorrhagic vascular stroke, the effects of arterial hypertension being very complex including morphological and functional changes in vessels and vascular circulation. In our retrospective analysis of 218 patients hospitalized for stroke we found arterial hypertension in 91.2% of subjects and atrial fibrillation in 32.1% of subjects. 182 patients (83.5%) have been diagnosed with ischemic stroke and 36 patients (16.5%) with hemorrhagic stroke. In the group of patients with atrial fibrillation, only 33 patients (47.1%) were treated by anticoagulants, what points out an inadequate indication of anticoagulant treatment when considering the stroke risk calculation for atrial fibrillation (CHA2DS2- VASc Score) and bleeding risk (HAS-BLED Calculator for Atrial Fibrillation). It is also noteworthy that in the group of patients with anticoagulant therapy who have developed ischemic stroke in spite of this treatment, we found that in 48.5% the treatment was underdosed and therefore ineffective. Our work points to the need to improve the effective management of arterial hypertension and atrial fibrillation, the most common modifiable factors of vascular strokes.]

Clinical Neuroscience

MARCH 30, 2020

[Intracranial EEG monitoring methods]

TÓTH Márton, JANSZKY József

[Resective surgery is considered to be the best option towards achieving seizure-free state in drug-resistant epilepsy. Intracranial EEG (iEEG) is necessary if the seizure-onset zone is localized near to an eloquent cortical area, or if the results of presurgical examinations are discordant, or if an extratemporal epilepsy patient is MRI-negative. Nowadays, 3 kinds of electrodes are used: (1) foramen ovale (FO) electrodes; (2) subdural strip or grid electrodes (SDG); (3) deep electrodes (stereo-electroencephalographia, SEEG). The usage of FO electrode is limited to bitemporal cases. SDG and SEEG have a distinct philosophical approach, different advantages and disadvantages. SDG is appropriate for localizing seizure-onset zones on hemispherial or interhemispherial surfaces; it is preferable if the seizure-onset zone is near to an eloquent cortical area. SEEG is excellent in exploration of deeper cortical structures (depths of cortical sulci, amygdala, hippocampus), although a very precise planning is required because of the low spatial sampling. The chance for seizure-freedom is relatively high performing both methods (SDG: 55%, SEEG: 64%), beside a tolerable rate of complications.]

Lege Artis Medicinae

MARCH 10, 2020

[Primary care strategy of antihypertensive treatment of very elderly and frail patients]

TORZSA Péter, KALABAY László, CSATLÓS Dalma, HARGITTAY Csenge, MÁRKUS Bernadett, MOHOS András, SZIGETI Mátyás, FERENCI Tamás, MARJOLEIN Verschoor, ROZSNYAI Zsofia, JACOBIJN Gussekloo, ROSALINDE K. E. Poortvliet, SVEN Streit

[BACKGROUND - When treating very el­der­ly and frail hypertensive patients, there have to be taken in account the general health condition and frailty of patients, the present cardiovascular diseases (CVD) and values of the systolic blood pressure (SBP). Goals - In a clinical study performed in 29 countries, we aimed to analyse differences in practical antihypertensive therapy of family doctors among patients older than 80 years; further we sought to answer how much was influenced their therapeutic choice by frailty of the old age. The other goal of our study was to compare Hungarian versus international outcomes. Methodology - As part of an online survey, family practitioners had to decide about necessity of starting antihypertensive treatment among very elderly patients according to different patterns of frailty, SBP and CVD. The ratio of specific cases with positive treatment decision of family practitioners was compared in all 29 countries. We used a logistic mixed model analysis to multivariately model the role of frailty. Results - 2543 family practitioners participated in the cross-national study; 52% were female; 51% practised in urban environment. In 61% of practices, there was the ratio higher than 10% of very elderly patients. Hungary participated with 247 family practitioners in the study; 52.3% were female; 63.1% practised in urban environment. In 48.8% of practices the ratio of very elderly patients was higher than 10%. In 24 out of the 29 countries (83%), frailty was associated with GPs’ negative decision about starting treatment even after adjustment for SBP, CVD, and GP characteristics (odds ratio [OR 0.53]), 95% CI: 0.48-0.59; ORs per country 0.11-1.78). The lowest treatment ratio was in the Netherlands (34.2%; 95% CI: 32.0-36.5%) and the highest one in Ukraine (88.3%; 95% CI: 85.3-90.9%). In Hungary’s treatment ratio ranged 50-59%. This country ranked on the 27th place since Hungarian family practitioners chose rather to start antihypertensive treatment despite the frailty of the patient (OR=1.16; 95% CI: 0.85-1.59). Hungarian family practitioners started pharmacotherapy of elderly patients more frequently if they were males (OR= 1.45; 95% CI: 0.81-2.61), were working in their practice for less than 5 years (OR=2.41; 94% CI: 0.51-11.38), and if they had many patients aged over 80 years in their practice (OR=2.18; 95% CI: 0.70-6.80), however these differences were sta­­tistically not significant. Among Hun­ga­rian family practitioners starting therapy was significantly influen­ced by cardiovascular disease (OR=3.71; 95% CI: 2.64-5.23) and a SBP over 160 mmHg (OR=190.39; 95% CI: 106.83-339.28). Conclusions - In our study, there was significant difference between countries in starting antihypertensive treatment for very elderly patients. However, Hungary was among the countries where family practitioners preferred to treat their frail patients. The patients’ frailty did not have any impact on starting the therapy; rather cardiovascular disease and a SBP over 160 mmHg decided. It is an important message of the study that there is continuous need to educate family practitioners and trainees about the treatment of frail, elderly hypertensive patients.]

Journal of Nursing Theory and Practice

AUGUST 30, 2019

[Meta-analysis about the Incontinence-associated dermatitis prevention ]

KÓSZÓ Lilla, NAGY Erika

[Background: The maintenance of tissue integrity is an essential part of qualitative nursing. There is a wide scale of products serving the prevention of Incontinence-associated Dermatitis (IAD). However, there is little evidence nurses know about them, making their choice of strategy difficult. Aim: To produce an evidence based publication about the preventive products of IAD, helping nurses in their choice of strategy. Method: In our meta analysis we examined the content of the Medline and Scopus database with special focus on English and Hungarian publications from the last ten years. From the 17459 articles relevant in this topic we analyzed and included 9 studies serving our criteria. Records: We found several methods of prevention; Washing without water, special absorbent pants, protocols and a study about the ’perineal pouch’. The studies were compared from the aspect of IAD prevalence, severity and cost effects. The 3in1 products and protokolls are should be used is the hungarian nursing practice.]

Lege Artis Medicinae

JANUARY 20, 2020

[History of Daytime Hospital of the Department of Psychiatry in the University of Debrecen ]

ÉGERHÁZI Anikó, CSERÉP Edina, MAGYAR Erzsébet

[In Hungary, there was a ward related psychotherapy already since the 1960s, yet without any national network to the 1980s. In Debrecen the spreading of the psychotherapeutic approach started in the psychiatric facilities since the 1990s. Daytime Hospital was founded first in the County Hospital and later on in the Department of Psychiatry of the University. The latter option was provided by separating the psychiatry from neurology. This study presents the development of the day care at the Psychiatric Department along the opportunities and shows the structure of the actually functioning system finally reports on our future plans respectively. Initially started the occupational therapy, gymnastics, community cooking and walking, which did not require any separate rooms. The 22-bed psychotherapeutic unit was established 2014 with its joined capacity for 11 persons in the Daytime Hospital. The County Hospital is engaged primarily in socio-therapy of psychotic psychiatry pa­tients, however the Psychiatric Department is rehabilitating mainly patients with affective spectrum disorders. Patients are treated in socio-therapy and psychotherapy small groups for a half or one year. Afterward they enter the outpatient program, may join the Patient Club or decide for therapeutic occupation aiming the best way of recovery. According to the feedback, there is a long-term change in the mental state of the patients leading to improvement in their quality of life, which we plan to prove by an efficacy research program. ]

Lege Artis Medicinae

JANUARY 20, 2020

[The Veszprém model, alias a different approach of psychiatric care]

BALCZÁR Lajos, ENGLERT Tímea

[This study describes an integration of a county-level psychiatric care unit with two elements of primary social care, namely the community psychiatric care and the daycare for psychiatric patients via mediation of a specific foundation. Adequate trainings make the connection and dual employment possible in the presented system. On the health care side development is characterized by extended psychiatric care with effective psychosocial interventions. Adding specialized group psychotherapies and sociotherapies to the activity of the social care also brought a quality change, extension of which provided self-help and the consumers' applicability as therapy leaders in sociotherapy group. Based on our ten years of practice we may declare that recovery-based psychiatric rehabilitation can be realized more effectively in this community-based biopsychosocial model of care. ]

Lege Artis Medicinae

JANUARY 20, 2020

["Punishment-therapy” - chances of psycho-rehabilitation for mentally ill offenders under forced medical treatment]

BACSÁK Dániel, KRÁMER Lili

[When examining the life course of mentally disordered offenders it is unavoidable to take into consideration the legal definition of in­sanity that exempts an individual from ordinary punishment in the given context of criminal law. As technical as it is, legal language describes and prescribes institutional responses on how to deal with mentally disordered offenders - not being independent from the everyday societal stereotypes on mental illness. In Hungary, the definition of criminal liability consists of medical and legal elements. Thus, in practice court appointed psychiatric experts are solely relied upon in determining whether or not the accused are criminally liable - the formal decision is in the hands of the court. If no criminal liability is determined by the experts, the court has to acquit the accused. In some special cases this acquittal opens the way to criminal psychiatric detention that is maintained by the Hungarian Prison Service. The aims of criminal psychiatric detention are twofold: rehabilitation and punishment. We suggest that it is nearly impossible to serve both of the aforementioned aims simultaneously. Furthermore, our article argues that the philosophy of care is focused on punishment and biomedical treatment nowadays, rather than rehabilitation and holistic bio-psycho-social treatment. The approach of treatment in operation makes successful recovery of patient-detainees difficult. Moreover, there are systemic issues as well: limited effects of review proceedings, holes in the psychiatric-social institutional care system and the general societal stigmatisation of people with mental illnesses can unreasonably prolong discharging “guilty patients”, thus, they stay detained 4-5 years longer. ]

Lege Artis Medicinae

JANUARY 20, 2020

[American-Hungarian forerunners of humanistic psychology and medicine: Andras Angyal and Bela Mittelmann ]

KELEMEN Gábor

[The fact that there are two significant Hungarian pioneers in humanistic psycho­therapy is still not recognised in the Hungarian academic community. In order to redress this omission the author compares and considers the careers of András Angyal and Béla Mittelmann. Both individuals left Hungary in 1920, settling first in Europe and subsequently in America, where they separately enjoyed successful careers. According to the author the trajectory of their lives is quite representative of many Hungarian emigrants during this period in history. This study examines the course of their life and explores their main achievements in the context of their contemporary relevance and enduring legacies. In the case of Angyal, it is the holistic-organismic theory of personality and influence on Maslow, which are his paramount achievements. As regards Mittelmann his topical contribution has been to the practice of “coaching” on the one hand and the application of dance and body therapy to recovery on the other. ]

Clinical Oncology

FEBRUARY 20, 2019

[The role of the microbiome in the etiology and treatment of neoplastic diseases]

SCHWAB Richárd, BACSUR Emese, TORDAI Attila, PETÁK István

[Experimental data on the role of the microbiome in the onset and progression of infl ammatory diseases and cancer have been accumulated for years. An important milestone in this respect was the discovery that APC mutant mice in sterile conditions do not develop colon cancer of the FAP type. The direct role of the Enterobacteriaceae and Fusobacteriaceae bacterial families were also shown in the pathomechanism of the same experimental model. The toxic effect of chemotherapy on the gut fl ora has been well documented, but it may very well be that this putative side effect is part of the effi cacy, primarily in the case of adjuvant chemotherapy. The fi rst reproducible methods of microbiome molecular diagnostics are already available today. In addition to standard large clinical studies, we can increasingly rely on evidence of molecular pathomechanism and „real-world” clinical experience in the clinical interpretation of the microbiome. The overview summarizes the results of the fi eld research and its translation possibilities in terms of routine clinical practice.]

Clinical Oncology

FEBRUARY 20, 2019

[The role of artifi cial intelligence in precision medicine]

MESKÓ Bertalan

[The essence of practicing medicine has been obtaining as much data about the patient’s health or disease as possible and making decisions based on that. Physicians have had to rely on their experience, judgement, and problem-solving skills while using rudimentary tools and limited resources. With the cultural transformation called digital health, disruptive technologies have started to make advanced methods available not only to medical professionals but also to their patients. These technologies such as genomics, biotechnology, wearable sensors, or artifi cial intelligence (AI) are gradually leading to three major directions. They have been (1) making patients the point-of-care; (2) created a vast amount of data that require advanced analytics; and (3) made the foundation of precision medicine. Instead of developing treatments for populations and making the same medical decisions based on a few similar physical characteristics among patients, medicine has shifted toward prevention, personalization, and precision. In this shift and cultural transformation, AI is the key technology that can bring this opportunity to everyday practice.]