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Lege Artis Medicinae

OCTOBER 21, 2020

[Epidemiology of diabetes mellitus and diabetes-related eye complications in Hungary]

TÓTH Gábor, NÉMETH János

[Diabetes mellitus is a disease of civilization and a leading cause of blindness among people of working age in developed countries. It’s prevalence is estimated to be 9.9% in the adult population in Hungary, based on this, the estimated number of people with diabetes mellitus was 807 000 in 2015 in our country. Almost every fifth people with diabetes mellitus has some form of diabetic retinopathy in Hungary. Among diabetic persons 0.3% is blind and 0.3% has serious visual impairment due to not adequately treated diabetes mellitus. The total prevalence-based diabetes retinopathy-associated economic burden was 43.66 billion HUF in 2018 in our country. The two major cost drivers were anti-VEGF injections and vitrectomies; they covered almost the four-fifths of the total cost among people with diabetes mellitus. We have to emphasize the importance of prevention, healthy nutrition and frequent sport activity in the fight against diabetes mellitus and overweight. With at least annually performed eye examinations in people with diabetes mellitus and timely treatment of diabetic retinopathy, visual impairment and blindness due to complications of diabetes mellitus can be prevented. ]

Hypertension and nephrology

SEPTEMBER 30, 2020

[Hyperkalaemia IV.]

DEÁK György, PATÓ Éva, KÉKES Ede

[The six-part summary presents the epidemiology, diagnosis, pathogenesis, and treatment of hyperkalaemia.]

Clinical Neuroscience

MARCH 30, 2020

[New applications of conventional EEG analysis ]

CLEMENS Béla, PUSKÁS Szilvia

[Neurophysiological research suggests that the so-called “standard” EEG analysis has been confronted with new diagnostic challenges. The findings mainly concern the occurrence, the neurophysiological and clinical significance of epileptiform EEG discharges in several neurological and psychiatric disorders. In addition to well-known interictal and ictal discharges, a growing number of recently recognized epileptiform phenomena have been described. The first reports suggested that they might be relevant for the comprehensive description of epileptic dysfunction and might contribute to diagnosis and treatment as well. However, considerable improvement of present-day “standard” EEG technique is necessary to give an appropriate answer to most challenges. Reliable registration and quantitative assessment of well-known epileptiform transients require extended electrode coverage of the head (high-density EEG) and long-term recordings including waking and sleep states to estimate frequency and dyna­mics of targeted activities. Computer-based automatic event detection is preferable to spare time and cost of the evaluation. The authors review recent progress concerning epidemiology, neurophysiology and clinical impact of well-known epileptiform transients and candidate epileptiform activities in neurological and psychiatric conditions. However, recent results need confirmation in large patient populations; therefore, research should not be restricted to a few central laboratories.]

Hypertension and nephrology

FEBRUARY 20, 2020

[Heart failure with mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF)]

NYOLCZAS Noémi

[reduced ejection fraction (HFrEF) is well-known. Physicians are well versed in diagnosing and treating the disease. At the same time, our knowledge is scarce about heart failure with preserved ejection fraction (HFpEF) and heart failure with mid-ranged ejection fraction (HFmrEF). We are diagnosing these cases in a much lower number than the actual ones, and we have no morbidity and mortality-reducing evidence for treating the disease. The summary is intended to provide an overview of the epidemiology, clinical characteristics, morbidity and mortality, treatment options, the importance of the etiological diagnosis and long-term follow- up of HFmrEF and HFpEF based on currently available literature.]

Lege Artis Medicinae

NOVEMBER 15, 2019

[The association between advanced age and peripheral arterial disease]

KOLOSSVÁRY Endre, FARKAS Katalin

[The high-income countries are characterized by the aging of the residents (epidemiological transition) and the change of the disease patterns that are recognized in the population (epidemiological transition). In that sense, considering the cardiovascular diseases in the last few decades, a decline of mortality of acute, fatal conditions (stroke, myocardial infarction) is notable. All these factors contributed to the recognition of the importance of peripheral arterial disease and related problems in the aging popula­tion of the affected people. The high prevalence, the decline of quality of life associated with compromised lower limb circula­tion, the risk of the limb loss, the challenge of rehabilitation and the high mortality represent a significant and increasing burden to the healthcare. The review aims to analyse the relation of the aging population and peripheral arterial disease, addressing the aspects of epidemiology, diagnostics, and therapy. ]

Lege Artis Medicinae

NOVEMBER 15, 2019

[Specialists’ opinions about the introduction of colorectal cancer screening ]

MAGDA Lilla, TEREBESSY András

[ INTRODUCTION - The number of new cases of colorectal cancer is over 10 000 and there are around 5000 deaths per year in Hungary. A nationwide colon cancer screening program was launched in 2018. AIMS - Concerning the upcoming national screening, our aim was to explore attitudes, preferences and knowledge of specialists (family medicine, gastroenterology, surgery, oncology, pathology) who will be engaged in screening, diagnosis and treatment of colorectal cancer. METHOD - Before the start of the program we conducted semi-structured interviews with 20 representatives of specialties mentioned above. Interview-questions focused on knowledge (epidemiology, screening methods, program-related), preferences (screening method, protocol) and impact of the program on medical practice. Quan­ti­ta­tive and qualitative methods were used for analysis. RESULTS - Incidence of colon cancer was well known but its mortality in Hungary was underestimated. The public health significance of colorectal cancer scored 7 on a 10-point Likert scale and all participants agreed with introduction of the program. 12 people knew the chosen protocol (two-stage), only a single person mentioned one-stage (colonoscopy), and 7 had no information. 16 people prefer colonoscopy as the best screening method. 11 support two-stage protocol, 5 do not support but accept it, 4 would only accept the one-stage approach. 13 people think their duties will increase considerably. CONCLUSIONS - Our review partners consider colorectal screening in Hungary as an initiative to be supported. They expect increase of workload in their everyday medical practice and assume that the current endoscopic capacity will be overburdened. The majority prefers two-stage protocol because of cost-effectiveness while arguing that the colonoscopy has a bad reputation among the general population, nevertheless they consider colonoscopy as the best method of screening. ]

Lege Artis Medicinae

JULY 20, 2019

[Epidemiology, comorbidity, etiology of depression and cardiovascular diseases]

PÉTER László, RIHMER Zoltán

[Psychiatric problems are a common comorbid condition in patients with cardiovascular disease. Depression is a well-known risk factor for the development of cardiovascular disease and mortality too. Psychiatric and cardiovascular diseases are prevalent public health problems in the western world. Depression is associated with endo­thelial dysfunction and increased platelet aggregation, which may explain the consequent cardiovascular complications. Specific affective temperaments may be associated with special cardiovascular diseases. Antidepressant therapy does not only reduce depression but also cardiac mortality.]

Hypertension and nephrology

MAY 10, 2019

[Hungarian dialysis statistics: changing trends in the renal epidemiology]

KULCSÁR Imre, KISS István, SZEGEDI János

[In the last 30-35 years, dialysis care in Hungary has been a major development: both the incidence and prevalence of patients have increased year by year. Over the last decade, growth has slowed and is becoming more and more stabilized (similar trends can be seen in dialysis statistics in developed countries). Behind the dialysis indication the acute kidney injury (AKI) is more common than the end-stage renal disease (ESRD). The latter incidence has been stable for last 6 years (200-230 patient/million population). The annual average growth rate of prevalent dialysis patients was only 0.9%/year in the last 6 years. Among prevalent dialysis patients, the proportion of diabetic patients has remained unchanged for 10 years (26-27%), but those have increased who had hypertension nephropahty. The average age of incident and prevalent dialyzed patients has decreased gradually over the past 8 years (between 2009 and 2017 incident rate was from 67.1 to 63.0 years, prevalent rate was from 65.6 to 61.8 years). Unfortunately, just over half of the patients who dialyzed due to chronic kidney disease (CKD) have reached dialysis day 91. This is due to the high proportion of patient who was in urgent need of dialysis. In chronic hemodialysis (HD) program, the proportion of patients treated with arterovenous fistulas (AVF) decreases, while the rate of central venous catheter (CVC) users increases. The Hungarian peritoneal dialysis program in Europe is very good. The number of prevalent patients receiving renal replaement therapy (RRT) in Hungary in 2017 was 1005 for 1 million inhabitants.]

Clinical Neuroscience

MARCH 30, 2019

[Epidemiology, cost and economic impact of cerebral palsy in Hungary]

FEJES Melinda, VARGA Beatrix, HOLLÓDY Katalin

[Objective - The purpose of our communication was to determine the total cost of cerebral paretic patients in Hungary between 0 and 18 years and to assess their impact on the national budget. Methods - Based on the data of Borsod county we calculated the CP characteristics. The cost of CP was determined by routine care of individuals. Lost Parental Income and Tax were calculated on the basis of average earnings. The ratio of GDP, Health and Social Budget and Health Budget to CP is based on CP annual average cost and frequency. We have developed a repeatable computational model. Results - Of the risk groups, premature birth (30.97%), low birth weight (29.64%), perinatal asphyxia (19.47%) were the most common. Source is unknown of 37.61% of the cases. CP prevalence was 2.1‰. The two-sided (59.7%) and the one-sided (19.0%) spastic pareses dominated. The most serious form is the two-sided spastic paresis (42.5% GMFCS 3-5 degrees). Epilepsy was 22.0%, incontinence was 27%, mental involvement was 46%. Care for one child up to 18 years of age costs an average of 73 million HUF (€ 251,724). The lost family income was 27.36 million HUF (€ 94,345), and lost tax and health care contributions were 14.46 million HUF (€ 49,862). Additionally, 0.525% of the GDP, 0.88% of the full health and social budget and 1.83% of direct medical costs were spent for CP families. Conclusion - The cost of CP disease is significant. Costs can be reduced by improving primary prevention. From the perspective of the family and government, it is better to care for families so they can take care of their disabled children.]

Lege Artis Medicinae

DECEMBER 10, 2018

[IgG4-related gastropathy mimicking malignancy]

NAGY Pál, KASZÁS Ilona, PÁK Gábor, TIBA Imre, FELFÖLDI Éva, HAMVAS József, BAGDI Enikő, KRENÁCS László

[The Immunoglobulin G4-related disease (IgG4-RD) along with its synonyms is recently a popular topic in the medical literature. This illness can affect almost every organ in the body therefore it is frequently discussed in any type of interdisciplinary forums. We presented an instructive case of IgG4-RD with gastric involvement in 2016. Hereby we share our pertinent experiences. We are not dealing with the IgG4-RD in general including its terminology problems, epidemiology, pathogenesis, detailed clinical/pathological appearances, diagnostic criteria and treatment. A 63-year-old male presented with symp­toms of pylorus stenosis. The endoscopic findings and CT images were interpreted as those of a malignant tumour in the antrum of the stomach. So a subtotal resection was performed although the biopsy showed reactive proliferation of plasma cells without evidence of malignancy. Pathological examination of the surgical specimen confirmed an IgG4- associated sclerosing inflammation. The patient had an uneventful recovery. Our case is an example of rare, isolated formof IgG4-RD. ]