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Clinical Oncology

FEBRUARY 28, 2020

[Neoadjuvant and palliative drug therapy for bladder cancer]

MARÁZ Anikó

[The survival of patients with muscle-invasive localized bladder cancer is more favorable if they receive neoadjuvant or adjuvant cisplatin-based chemotherapy before or after cystectomy. Based on the meta-analyses, in case of neoadjuvant cisplatin-based chemotherapy, the 5-year survival benefi t is 5-16%. The outcome is even more favorable in case of patients who respond well to neoadjuvant chemotherapy (pathological complete remission rate 12–50%). More than 3 months delay of cystectomy does not signifi cantly reduce the survival if chemotherapy is performed before the operation. Results of adjuvant phase III studies and meta-analyses are not so unambiguous as neoadjuvant data, but chemotherapy seems to infl uence favorably PD-L1 expression the survival, especially in case of pT3/4 and/or N+ (and high grade or margin positivity) cases. According to the recent publications, outcome data of patients have been effective in case of progression after platinum therapy, in or after second-line and in fi rst-line therapies for cisplatin ineligible, PD-L1 positive patients, respectively. Survival and tumor response data are very promising; in particular stages, they seem to be more effective than the previously administered chemotherapies. Current and ongoing trials are investigating the combinations of new remedies with other immunotherapeutic agents or chemotherapies as well as trying to identify biomarkers in order to further increase effectiveness.]

Clinical Oncology

FEBRUARY 28, 2020

[Treatment sequencing in metastatic colorectal cancer]

MODEST D. P., PANT S., SARTORE-BIANCHI A.

[Metastatic colorectal cancer (mCRC) remains incurable in most cases, but survival has improved with advances in cytotoxic chemotherapy and targeted agents. However, the optimal use and sequencing of these agents across multiple lines of treatment is unclear. Here, we review current treatment approaches and optimal treatment sequencing across the fi rst-, second- and third-line settings in mCRC, including biological aspects affecting sequencing and rechallenge. Effective fi rst-line therapy is a key determinant of treatment outcomes and should be selected after considering both clinical factors and biological markers, notably RAS and BRAF. The second-line regimen choice depends on the systemic therapies given in fi rst-line. Anti-angiogenic agents (e.g. bevacizumab, ramucirumab and afl ibercept) are indicated for most patients, whereas epidermal growth factor receptor (EGFR) inhibitors do not improve survival in the second-line setting. Molecular profi ling is important in thirdline treatment, with options in RAS wild-type patients including EGFR inhibitors (cetuximab or panitumumab), regorafenib and trifl uridine/tipiracil. Immunotherapy with pembrolizumab or nivolumab ± ipilimumab may be considered for patients with high microsatellite instability disease. Targeting HER2/neu amplifi cation shows promise for the subset of CRC tumours displaying this abnormality. Sequencing decisions are complicated by the potential for any treatment break or de-escalation to evoke a distinct clinical progression type. Ongoing trials are investigating the optimal sequencing and timing of therapies for mCRC. Molecular profi ling has established new targets, and increasing knowledge of tumour evolution under drug pressure will possibly impact on sequencing.]

Clinical Oncology

DECEMBER 30, 2019

[Prevention and treatment of venous thromboembolism in cancer patients]

[Venous thromboembolism (VTE) is a common and severe complication of cancer. Deep vein thrombosis and pulmonary embolism are the second most common cause of death in cancer patients. Cancer, tumor-related factors as well as patient’s general condition and comorbidities are responsible for the increased risk of VTE. Chemotherapy is one of the most important risk factors for VTE, increasing incidence of VTE by 6.5-fold. In my paper, current guidelines for cancer VTE prevention and treatment are reviewed. Hospitalized patients with active tumor are at higher risk for VTE, and thrombosis prophylaxis is recommended in all cases. Extensive, routine prophylaxis for advanced cancer patients receiving chemotherapy is not recommended, but may be considered in high-risk ambulatory cancer patients (Khorana-score ≥ 3). Risk factors may change during the course of cancer disease, and the score should be continually reviewed and prophylactic treatment changed as necessary. LMWH is the recommended agent for both primary and secondary prophylaxis/treatment. Direct oral anticoagulants (DOACs) are knocking on our door, but results from further clinical trials are pending to determine their exact role.]

Clinical Oncology

DECEMBER 30, 2019

[Treatment of cholangiocellular carcinoma]

ANDRÁS Csilla, ÁRKOSY Péter

[Tumors of the biliary tract are a rare entity, at the time of diagnosis most of the patients are in advanced stage and operation can’t be effectuated. After operation the risk of recurrence is high. The standard adjuvant therapy is capecitabin based on the results of BILCAP study. In advanced stage or in the presence of metastates the standard fi rst line treatment is gemcitabine and cisplatin therapy, there are noninferiority results from a Japan study with gemcitabin and S1 combination therapy. There was no evidence of second line treatment possibilities after gemcitabine and cisplatin therapy until 2019, but based on the results of ABC-06 study mFOLFOX could be the choice in the future. In the case of MSI-H/dMMR tumors immuntherapy should be considered. Personalised medicine with matched molecular targeted therapy is a new option. There are 2 new molecular targets, FGFR and IDH, the preliminary result are very promising.]

Clinical Neuroscience

NOVEMBER 30, 2020

The applications of transcranial Doppler in ischemic stroke

FINNSDÓTTIR Herdis, SZEGEDI István, OLÁH László, CSIBA László

Background: This overview provides a summary of the applications of transcranial Doppler (TCD) in ischemic stroke. Results: A fast-track neurovascular ultrasound protocol has been developed for detecting occlusion or stenosis. The technique is more reliable in the carotid area than in the posterior circulation. By monitoring the pulsatility index the in­crea­sed intracranial pressure can be diagnosed. TIBI score was developed for grading residual flow. TCD has been shown to accurately predict complete or any recanalization. Regarding recanalization, TCD has a sensitivity of 92%, a specificity of 88%, a positive predictive value of 96%, a negative predictive value of 78% and an overall accuracy of 91%, respectively. Sonothrombolysis seemed to be a promising application but randomized controlled trials have shown that it does not improve clinical outcome. TCD examination can detect microembolic signals (MES) which are associated with an increased risk of stroke. Micro­em­boli were detected in symptomatic and asymptomatic carotid artery stenosis and during carotid endarterectomy. The number of microemboli can be decreased by antithrombotic therapy. Contrast en­chan­ced examination and Valsalva maneuver with continuous TCD monitoring can accurately screen for right-to-left shunt.

Journal of Nursing Theory and Practice

DECEMBER 30, 2019

[Health awareness among nurses]

SZALÓCZY Nóra, VINGENDER István

[The purpose of this study is to demonstrate the dietary habits and health behaviors of nurses studying in SE-ETK. The study describes in a descriptive/informative manner the main characteristics of the target group mentioned above. In our research, and in our conclusions drawn and deduced from it, we sought answers to questions that have been addressed in the literature from other approaches so far. Our own research focused on nurses’ dietary habits and their health awareness. To explore whether occupational harm can only be considered, or whether the links here are much deeper and more complex. Based on the data, we can say that their theoretical knowledge of healthy eating is more complete, but in practice, their health awareness/behavior is not. Their answers to our eating and sports questions have an inverse relationship with their BMI data. This is probably because their workplace conditions (shifts) do not allow their health awareness to develop. ]

Hypertension and nephrology

NOVEMBER 04, 2020

[Hypertension and Covid-19 - part II.]

SZÉKÁCS Béla, KÉKES Ede, NAGY Judit, KOVÁCS Tibor

[The authors review those components and mechanisms in the two major regulatory systems of circulation and inflammation-coagulation whose internal balance and interactions are pathologically altered during SARS-CoV-2 infection, thereby enhancing lung and systemic inflammation threatening to enter into severe clinical condition. They examine the question of how – in addition to potentially promoting the coronavirus cellular entry and penetration – the RAS inhibitor therapy affects these changes and whether can be supposed difference between the anti-/pro-inflammatory influence of ACEi and ARB treatment of old hypertensive patients representing a remarkably high proportion of victims in COVID-19 epidemic. The paper is focussing to the pathomechanical background of inflammation beyond the direct immunological response to the infection: to the significance of immunological alterations characterizing old hypertensive patients also in basic condition, and to the key components as angiotensin II, ACE2, angiotensin1-7, bradykinin, ARB and ACEi. In conclusion a consideration on optimal point of action is offered in RASi treated and SARS-CoV-2 infected (old) hypertensive patients.]

Hypertension and nephrology

NOVEMBER 04, 2020

[The role of stress management in the care of hypertension and the treatment of cardiovascular disease]

SOMOGYI Éva, KISS Zoltán, STAUDER Adrienne

[The aim of this paper is to give an overview of the relationship between stress and hypertension and cardiovascular diseases, furthermore to introduce an evidence based stress management intervention available in Hungary. The correlation between cardiovascular disease and psychosocial factors (including concomitant mental disorders as well as personality traits or the effect of social environment) has been established in numerous studies aimed at investigating pathogenesis or various clinical endpoints. The 2016 Guidelines of the European Society of Cardiology include the assessment and the management of psychosocial problems with behavioral medicine interventions as a I.A level recommendation. The implementation of these guidelines in everyday clinical practice is crucial to decrease cardiovascular risk. This involves the training of health care professionals, the facilitation of multidisciplinary collaboration and the integration of behavioral intervention into everyday care. The Williams Life Skills (WLS) program is an evidence based behavioral medicine intervention aiming to improve stress management and communication skills which implemented internationally and also available all over Hungary. It involves the learning of simple coping strategies that facilitate the successful management of every day psychosocial stress situations and the self-conscious reduction of bodily and psychological tensions. In cardiovascular disease, this improves quality of life and survival. The WLS program is especially recommended for healthcare workers to decrease the negative health consequences of their high stress load and to prevent burnout. Stress may affect both doctors and patients during their interactions. Bálint groups have a positive impact on the physician-patient collaboration and help to reduce burnout by improving the understanding of the diseases from a more complex approach.]

Hypertension and nephrology

NOVEMBER 04, 2020

[Covid-19 and the diabetes mellitus]

SIMONYI Gábor

[In late 2019 the epidemic of new coronavirus disease (Covid-19) from Wuhan, China, posed major challenges to the health systems of even the most developed countries. High mortality of the disease has been observed mainly in the elderly and in those with various cardiovascular and metabolic comorbidities. In this summary, the relationship between diabetes mellitus]

Lege Artis Medicinae

OCTOBER 21, 2020

[Similarities and differences of the most significant international guidelines for the treatment of hypertension]

KÉKES Ede, VÁLYI Péter

[Guidelines of diagnosing and treating hypertension play pre-eminent role in maintaining health in our World. Based on reliable estimates we have to take in ac­count more than 1.6 billion individuals suffering from hypertension by 2025. Ad­he­rence to the guidelines is a vital issue for all high blood pressure patients, however, also the economically developed countries have a disappointing share of well-controlled hypertension. Unfortunately, on the 5 continents of the world, the guidelines provide different or very different recommendations for measuring blood pressure, making diagnosis, estimating cardiovascular risk, and setting a target value, although an attempt has been made in the recent years for developing “consensus” in specific issues. This study presents the different opinions and resolutions by analysing the ACC/AHA, ESC/ESH, NICE, Canadian and Australian guidelines. WHO and ISH resolutions were also concerned. We describe the mutual ad­justment in theoretical and practical terms of the guidelines and the consensus that have already been estab­lished.]