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Lege Artis Medicinae

MARCH 10, 2020

[Summary data of Hungary's comprehensive health screening program (MAESZ) 2010-2019]

BARNA István, KÉKES Ede, HALMY Eszter, BALOGH Zoltán, KUBÁNYI Jolán, SZŐTS Gábor, NÉMETH János, PÉCSVÁRADY Zsolt, MAJOROS Attila, DAIKI Tenno, ERDEI Ottilia, DANKOVICS Gergely

[The comprehensive screening program of Hun­gary (MAESZ) 2010-2020-2030 is a unique initiative in Hungary and worldwide too. This largest humanitarian program provides by the latest technology free scree­ning tests for all residents in Hungary. The program developed by 76 pro­fessional organizations offers 38 scree­ning tests to every participants free of charge, in a special designed screening truck. Screening program performed by MAESZ includes cardiovascular, ophthalmologic, dermatologic, gynecologic, and neurologic investigations, lab tests, audiometry, blood pressure and arterial stiffness measurements, and venous Doppler ultrasound examinations. More­over, screening tests for lactose intolerance, colon malignancy, inflammatory bowel disease, reflux disease, urine incontinency, prostatic cancer and physical activity level were evaluated. Starting 2020, a dental screening station will be added to the mobile unit for early detection of oral cancers. Beyond screening tests, special attention is paid to assess health threatening risk factors, such as smoking, alcohol con­sumption, physical inactivity, un­healthy nutrition, and obesity. The program demonstrates the key elements of first aid from reanimation to bandage of burns in cooperation with professional and civil organisations. Furthermore, during the waiting time, participants get lifestyle recommendations and a health booklet with a bar code enabling the immediate computer analysis of test outcomes. Since the 2018/2019 school year the official prevention program for children entitled “Travel around the Empire of Health” was started. During its 10 years, the MAESZ performed 7 million free of charge screening tests on 1,886 scenes, enrolled 560,000 participants, invested 16,000 hours for prevention, handed out 1,200,000 health booklets and 391,000 prevention info packages to thousands of fami­lies. More than 20,000 health professionals (GPs, nurses, dietetics, health development agents, public health government officials, Accident Prevention Committee of National Police Headquarters, General Directorate of Social Affairs and Child Protection and non-governmental organizations) have been participated. The program designed to improve social health aims to help more and more Hun­garian citizens to be informed about their health status and to reminds them of the importance of prevention. ]

Clinical Oncology

FEBRUARY 10, 2015

[Oncological management of gastro-entero-pancreatic neuroendocrine neoplasias]

PETRÁNYI Ágota, UHLYARIK Andrea, RÁCZ Károly, BODOKY György

[Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are unusual and relatively rare neoplasms. They characteristically synthetize, store and secrete a variety of peptides and neuroamines, which can lead to development of disctinct clinical syndromes. Clinical symptoms and presentations vary depending on the location and hormones produced by the tumor. The diagnosis of NETs is established by histological examination and the immunohistochemical detection of general neuroendocrine markers, such as chromogranin A (CgA) and synaptophysin. An update of the WHO classifi cation has resulted in a new classifi cation dividing neuroendocrine neoplasms into neuroendocrine tumors (NETs) including G1 (Ki67 index ≤2%) and G2 (Ki67 index 3-20%) tumors and neuroendocrine carcinomas (NECs) with Ki67 index >20%, G3. The different available therapeutic approaches, including surgery, liver-directed ablative therapies, peptide receptor radionuclide therapy, and systemic hormonal, cytotoxic or targeted therapy, are discussed in this overview.]

Hypertension and nephrology

FEBRUARY 20, 2012

[Infections associated to vesicoureteral reflux disease in children below 1 year of age: the infulence of continuous antibiotic prophylactic therapy on the prevalence of resistant pathogenic bacteria]

MÁTTYUS István, KENESEI Éva, VÁSÁRHELYI Barna

[Background: The primary goal when children with vesicoureteral reflux disease (VUR) are treated is the prevention of pyelonephritis and persisting renal damage. Continuous antibiotic prophylaxis (CAP) is usually applied to reach this aim. The selection of resisting pathogens is the major risk of CAP. The aim of our survey was to describe the patterns of pathogenic strains leading to pyelonephritis in patients treated with and without CAP. Patients and method: The pathogenic strains implicated in pyelonephritis were identified in 48 and 56 children below 1 year of age who were treated with or without CAP, respectively, between years 2006 and 2011. Results: Breakthrough urinary tract infections developing in the presence of CAP are more frequently (with about a double risk) caused by polyresistant bacteria compared to infections that emerged without CAP. Nevertheless, it should be noted that the prevalence of resistant pathogens was about 40% even in infants without CAP. Discussion: The pattern of pathogenic strains leading to pyelonephritis alters significantly even in the cohort of children below 1 year of age treated with CAP to prevent infections associated to VUR. The risk may be decreased through the rational use of antibiotics. To reach this goal national guidelines on VUR should be updated and the role of additional non-antibiotic treatment should be established.]

Lege Artis Medicinae

DECEMBER 16, 2006

[CLINICAL ASPECTS OF NOCTURNAL GASTRO-OESOPHAGEAL REFLUX]

DEMETER Pál

[Gastro-oesophageal reflux that occur at night has special clinical features and thus require extra attention. During sleep most anti-reflux mechanisms diminish, which results in prolonged contact between gastric acid and oesophageal mucosa compared to reflux during the day. Nighttime reflux symptoms adversely affect quality of life, vitality, physical and mental health. A further important consequence is the potential exacerbation of respiratory disorders such as asthma and sleep apnea. There is increasing interest in the association between nocturnal reflux and certain extra-oesophageal symptoms, including reflux laryngitis and chronic cough. An increased risk of erosive damage and adenocarcinoma of the oesophagus are also observed among patients who report nocturnal reflux symptoms. The primary goal of treatment is to improve quality of life and reduce the risk of complications by decreasing the time of acid contact with oesophageal mucosa. Nighttime reflux symptoms are much more difficult to control than daytime symptoms. Treatment guidelines generally recommend lifestyle changes as the initial approach in managing nocturnal symptoms, however, this is successful in only a small proportion of patients. Evidence-based reviews and meta-analyses favour the use of proton pump inhibitors in the treatment of gastro-oesophageal reflux disease and reflux-oesophagitis. Proton pump inhibitors are the most efficient acid-suppressing agents and thus diminish the harmful effect of acidic gastric reflux on the oesophageal mucosa. In addition, by decreasing the volume of gastric acid, they reduce the tendency to reflux.]

Hungarian Radiology

FEBRUARY 20, 2004

[Candida esophagitis]

SZÁNTÓ Dezső, SZŰCS Gabriella, DITRÓI Edit

[INTRODUCTION - 97-98 percent of upper gastrointestinal mycoses are caused by candida albicans infections. Two cases of candida oesophagitis is reported in female patients with bronchial asthma. CASE REPORT - The patients were treated with steroid drugs due to the asthma. Esophageal barium study in a 48 year old female showed fine multiple rounded radiolucent aphthoid lesions, which fused after six weeks and resulted an aphthoid-shaggy esophagus. In a 55 year old patient double-contrast plain films presented cobblestone, alias snakeskin esophagus and foamy cardia. CONCLUSION - Radiographic signs of candida esophagitis are not pathognomic but correctly demonstrate extension of fungal infection into esophageal wall. Definitive diagnosis can be proved by histological and microbiological examinations.]

LAM Extra for General Practicioners

OCTOBER 12, 2009

[CHRONIC COUGH - THE OTOLARYNGOLOGISTS’ POINT OF VIEW]

GERLINGER Imre

[Chronic cough can have a profound impact on the psychosocial function of patients. Most studies agree that post-nasal drip syndrome (PNDS), asthma, gastro-esophageal reflux disease (GERD), and laryngo-pharyngeal reflux (LPR) are the most common causes of chronic cough in immunocompetent, non-smoking patients who are not taking angiotensin-converting enzyme (ACE) inhibitors and present with a negative chest x-ray. No diagnostic test has yet been found to define those who have PNDS other than the response to a first-generation antihistamine. Examination of the available evidence suggests that the theory of mechanical stimulation of the pharynx by mucus does not explain the occurrence of cough. Inflammatory mediators’ levels in the lower airways are higher in PNDS, cough variant asthma, and GERD, and the theory that an inflammatory process is affecting “one airway” is a plausible one. Nasal disease is more likely to result in cough from the co-existing involvement of the lower airways through a yet undefined pathway. Mediation by eosinophil and mast cells appears to be a likely mechanism. In this paper, the author summarizes all potential pulmonological, otolaryngological and other reasons of chronic cough, suggesting a systematic therapeutic algorithm.]

Lege Artis Medicinae

NOVEMBER 30, 2004

[FROM ASPIRIN TO COXIBS - JANUS-FACE OF THE NONSTEROIDAL ANTI-INFLAMMATORY THERAPY]

NEMESÁNSZKY Elemér

[Since the introduction of aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) proved to be the most commonly used drugs in the world. One of the major factors limiting their use is gastrointestinal toxicity. It has long been recognised that NSAID use is associated with serious, sometimes life-threatening adverse effects, like gastrointestinal ulcers, bleeding and perforation. Recent studies have indicated that the combination of NSAID and aspirin significantly increases the risk of complications. Aspirin is like a two-edged sword, balancing cardiovascular prevention with the risk of gastrointestinal side effects. Past history of ulcer carries the highest individual risk and other contributing factors include age, concurrent anticoagulation, cortocisteroid therapy, as well as high-dose or multipleforms of NSAID use. The mechanism of action of NSAID is to inhibit prostaglandin production through cyclooxygenase (COX). The inhibition of COX-2 isoenzyme reduces inflammatory-mediated prostaglandins, while the inhibition of COX-1 reduces the level of prostaglandins needed for normal protecting mechanism of the gastric mucosa. Non-selective NSAID has impact on both COX-enzymes, while selective COX-2-inhibitors (such as coxibs) exert their effects without affecting mucosal defence significantly. It is important to note that the risk of complications can not be reduced to zero by any therapeutic approach. The most appropriate treatment modality is to administer PPI co-therapy for the sake of gastro-protection, especially in high-risk cases. Histamine-2-receptor antagonists are not effective in reducing ulcer and complication in that particular group of patients. It has turned out that the inhibition of the synthesis of COX-2 by rofecoxib increases the risk of developing thromboembolic events and myocardial infaction. This has led to the withdrawal of Vioxx from the market on 30. 09. 2004. Studies conducted in recents years shed new light on numerous beneficial effects of NSAID other than alleviate pain, cure inflammatory processes and diminish higher temperature. The incidence of colon polyps and adenomas as well as cancers is reduced among people who are on maintanance NSAID therapy. The process of stone formation in the biliary tract is also reduced in patients who are on NSAID treatment. Development of Alzheimer's disease seems to be hindered, however, this finding can not yet be considered as evidence based.]

AUGUST 15, 2011

USE OF DRUGS FOR GASTRIC ACID REDUCTION IN GENERAL PRACTICE

HAJNAL Ferenc

In order to facilitate (general) practitioner’s therapeutic decisions, this overview reviews advantages and disadvantages of three drug classes used for acid reduction, as to antacids, histamine 2-receptor antagonists (H2RAs), and proton pump inhibitors (PPIs). The possibilities and mechanisms of gastric acid reduction are detailed. This can be achieved either by neutralization of gastric acid by systemic or non-systemic antacids, or by inhibiting acid secretion by H2RAs and PPIs. PPIs are the strongest acid reducing agents indispensable in gastro-esophageal reflux disease (GERD), eradication therapy for Helicobacter pylori ulcers and Zollinger- Ellison syndrome, and they are first choice in non-steroidal anti-inflammatory drug (NSAID) induced gastropathy, epigastric pain syndrome, and functional upper GI dyspepsia. Nonetheless, antacids and H2RAs are faster in relieving pain in the latter pain syndrome and in acute heartburn. Contraindications and adverse effects of these three drug classes are also detailed. The author has concluded that physicians’ up-to-date awareness of these compounds’ pharmacological properties contributes to their ability to tailor acid reduction therapy to patients’ individual needs. Refreshing and expanding this knowledge will finally benefit patients seen in everyday practice.

Lege Artis Medicinae

NOVEMBER 19, 2006

[TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE]

PAPP János

[In the acidic type of gastroesophageal reflux disease treatment is based on the use of proton pump inhibitors. Efficiency of the treatment is primarily assessed by the changes in symptoms. A long-term, continuous drug use is invariably necessary. In typical cases an increased dose or combination therapy is rarely required, however, in the presence of extraesophageal symptoms, the use of higher doses has been found to be beneficial. The minimum efficient drug amount is usually determined by gradually decreasing the dose. Surgery is mainly recommended for young patients, but it is indispensable in the management of complications or in volume reflux. Endoscopic antireflux therapy is still considered a clinical trial. Treatment of Barrett’s oesophagus by drugs or antireflux surgery does not decrease the incidence of Barrett’s cancer - the mostly recommended approach is endoscopic ablation.]