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Lege Artis Medicinae

OCTOBER 21, 2020

[Atherosclerosis: an ancient process in a new interpretation]

REIBER István

[The progress of atherosclerosis starts in childhood and lasts until the body dies. Most cardiovascular diseases and deaths can be traced back to atherosclerotic vascular changes. The process is thousands of years old, but its complex pathophysiology becomes recognized and realised only nowadays. Based on the evidence available today, atherosclerosis is such a chronic inflammatory disease of large- and medium-sized arteries, which is characterized by lipoproteins and immune cells transformed through oxidative and other changes and subendothelial accumulation of extracellular matrix. Innate and adaptive immunity provide a complex regulating system of atherogenesis, which while directing specifically the pro-atherogenic inflammatory and atheroprotective anti-inflammatory processes intensify plaque progression or even stabilize them respectively. With our growing knowledge about the pathology of atherogenesis, we can further improve the identification of cardiovascular risk conditions and apply more personalized therapeutic strategies.]

Lege Artis Medicinae

SEPTEMBER 30, 2020

[Analysis of factors influencing the efficacy of Hungarian acute cardiac care]

BECKER Dávid, SKODA Réka, BOKOR Laura, BÁRCZI György, VÁGÓ Hajnalka, MERKELY Béla, GAJDÁCSI József, BELICZA Éva, NEMES Attila, DINYA Elek, TÖRŐCSIK Klára

[Despite the modern invasive acute cardiac care available for all, as opposed to short-term mortality, the long-term mortality of Hungarian myocardial infarction patients exceeds significantly those of European patients getting similar treatment. In order to change this situation, it is necessary to assess and analyse exactly the factors behind. While analysing retrospectively the data of Hungarian acute myocardial infarction patients, we identified the influencing factors of short- and long-term mortality. This study processed data from 2003 to the present days from a number of registries (Heart- and Vascular Center of Semmelweis University VMAJOR I and VMAJOR II registry, Stent for Life I and II Programs of the European Society of Cardiology, National Public Health Service’s registry about Cardiac Care in Central Hungary, Budapest Modell database). According to our detailed examination, the proportion of primary per­cutaneous coronary intervention in ST-segment elevation myocardial infarction is at Western-European level, however the invasive treatment of acute coronary attack patients with Non-ST segment myocardial infarction is below the required. The so-cal­led hesitation span of Hungarian pa­tients with ST-segment myocardial infarc­tion is substantially longer than that of neighbouring countries thus the average cardiovascular risk of relevant Hungarian patients is significantly higher than those of the GRACE Register’s population. Based on our results a complex strategy can be developed which may have impact also on strategic health­care decisions in order to reduce the long-term mortality of patients surviving myocardial infarction.]

Journal of Nursing Theory and Practice

OCTOBER 30, 2019

[Biomonitoring of lead exposure among workers: the role of the occupational health nurse ]

SZOBOTA Lívia

[Biological monitoring (biomonitoring) in occupational safety and health is the detection of substances (biomarkers) in biological samples of workers, compared to reference values. This article is limited to Lead (Pb) exposures, as it is one of the most important models for biomonitoring of exposure, with the blood Pb concentration as a predominant choice in occupational health. This article examines the nature of and risk factors for lead exposure among workers, the scope of the problem, the legislative and regulatory framework relevant to biomonitoring, and the role of occupational health nurses in promoting a culture of safety to prevent exposures. ]

Clinical Neuroscience

JANUARY 30, 2021

[The first Hungarian patient with Guillain-Barre syndrome after COVID-19]

AL-MUHANNA Nadim, BÉRES-MOLNÁR Katalin Anna, JARECSNY Tamás, FOLYOVICH András

[Guillain-Barré syndrome (GBS) is a sporadic, relatively rare disease. In serious cases, it can lead to respiratory failure and death. The correlation between SARS-CoV-2 and the risk of GBS is not yet known. COVID-19-associated prolonged pulmonary complications could be worsened by the potential airway interference caused by GBS. The literature is inconsistent whether SARS-CoV-2 virus has direct or indirect effect on the onset of GBS. The authors describe the medical history of the first published GBS patient in Hungary with a preceding confirmed COVID-19 infection. The trigger role of COVID-19 infection is assumed because of the subsequent development of GBS after COVID-19 infection. So far none of the patients in the literature (including this patient) had positive PCR of SARS-CoV-2 virus from the cerebrospinal fluid.]

Clinical Neuroscience

JANUARY 30, 2021

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Journal of Nursing Theory and Practice

APRIL 30, 2020

[Survey of Medication Habits in Hypertensive Adults]

VARGA Bernadett, FUSZ Katalin, CSIMA Melinda, LUKÁCS-HORVÁTH Marianna, DEÁK András, STROMAJER-RÁCZ Tímea

[Hypertension is the best known risk factor in development of cardiovascular diseases and stroke. Survey has assessed –in hypertensive patients over 40, - the illness representation, lifestyle and medicine taking habits. Quantitative, cross-section descriptive research was conducted in 2017 with online questionnaire among hypertensive people over 40 (n=267) using shortened version of Brief Illness Perception Questionnaire, Morisky Medication Adherence Scale (8-item) and our questionnaire. Therapy adherence is typical for older individuals in surveyed population. (r= 0,26; p<0,001). Who were advised by general practitioners (GP) to implement lifestyle changes show more inclination following therapy. (p=0,032). Those with higher blood pressure (r-0,18; p=0,003) has harder time living with hypertension. (r=0,15; p=0,014). Quality of living with hypertonia and therapy adherence can be influenced by health behaviour and the information provided by general practitioners (GP). Beside the, general practitioners (GP) advanced practice nurse can have significant role in increasing the level of health behaviour and therapy adherence. ]

Journal of Nursing Theory and Practice

FEBRUARY 28, 2020

[Complication of the Metabolic Syndrome in Women with Polycystic Ovary Syndrome]

KOMLÓSI Kálmánné, KISS Sarolta, FERENCZY Mónika, MÁTÉ-PÓHR Kitti, PAKAI Annamária

[In our research we compared whether pregnant women with polycystic ovary syndrome or the mothers who were healthy through pregnancy has a higher risk to develop high BMI, metabolic syndrome, preeclampsia, polyhydramnion and macrosomia. Our research is a retrospective, cross-sectional study. In the random sampling within the target group, the target group was diagnosed with PCOS (n=50) and the control group was mothers who had undergone uninterrupted pregnancy (n=50). The exclusion criterion is the coexistence of other endocrine disease that may affect the parameters under consideration, in addition to the control group the diagnosis of PCOS. With IBM SPSS for Windows 22.0, we applied two-sample T-test and Khi2 test (p<0.05). The BMI values ​​measured in the PCOS study group are higher than in the control group (p<0,05). Pregnant women with PCOS has a higher risk of developing high blood pressure, and high cholesterol (p<0,05). The difference between the two groups can not be considered significant for the development of proteinuria and oedema. Emphasis should be placed on PCOS gravid care, early detection of metabolic disturbances, accurate documentation, and elimination of complications and illnesses associated with the disease.]

Hypertension and nephrology

DECEMBER 19, 2020

[Possibility of ARNI (angiotensin receptor-neprilysin inhibitor) treatment in hypertension]

KÉKES Ede

[The natriuretic peptide (NP) is an important endocrine, autocrine and paracrine system that is in constant interaction with RAAS and the sympathetic nervous system in order to ensure a continuous cardio-renal homeostasis. In abnormal conditions – if the pressure/volume load develops in the heart or there are some disorder in the vascular tone or in sodium-water balance, the NP system triggers the body’s defense mechanism. The neutral endopeptidase (NEP) inactivates the vasodilator NPs, bradykinin and vasoconstrictor angiotensin II and endothelin I as well. From this knowledge, the idea that inhibition of the effect of NEP (NEPg) offers a potentially beneficial option in the treatment of heart failure and hypertension was initiated, only the stimulatory effect of angiotensin II needs to be blocked. After a lengthy search, they arrived at a dualacting molecule with a beneficial effect of NEP inhibition (secubitrile) and the angiotensin II AT1 receptor antagonist valsartan (ARNI). Several clinical studies have shown that ARNI alone and in combination with other antihypertensive agents significantly reduces SBP and DBP in hypertensive patients. Its effect is also present in isolated systolic hypertension and in chronic kidney disease with high risk. Do not administer with an ACE inhibitor. Based on clinical experience to date, there is a logic expectation that ARNI will also be classified as a useful antihypertensive agent in the near future.]

Hypertension and nephrology

DECEMBER 19, 2020

hirdetés

[Arrhythmias in hypertension]

ZÁMOLYI Károly

[Hypertension has been recognized as the principal and most common risk factor and underlies many cardiovascular (CV) conditions, including heart failure, coronary artery disease, stroke, and chronic renal failure. Different cardiac arrhythmias have been recognized as clinical manifestations of hypertensive heart disease, related to structural and functional pathophysiological changes of the myocardium, which may predispose to arrhythmias, most commonly atrial fibrillation. Both supraventricular arrhythmias and ventricular arrhythmias may occur in the hypertensive patients, especially when associated with left ventricular hypertrophy or heart failure.]

Lege Artis Medicinae

DECEMBER 21, 2020

[Risk of nonsteroidal antiinflammatory drugs. Focus on aceclofenac]

FARSANG Csaba

[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deterio­rate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable.]