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Clinical Neuroscience

MARCH 30, 2021

hirdetés

[Consensus statement of the Hungarian Clinical Neurogenic Society about the therapy of adult SMA patients]

BOCZÁN Judit, KLIVÉNYI Péter, KÁLMÁN Bernadette, SZÉLL Márta, KARCAGI Veronika, ZÁDORI Dénes, MOLNÁR Mária Judit

[Background – Spinal muscular atrophy (SMA) is an autosomal recessive, progressive neuromuscular disorder resulting in a loss of lower motoneurons. Recently, new disease-modifying treatments (two drugs for splicing modification of SMN2 and one for SMN1 gene replacement) have become available. Purpose – The new drugs change the progression of SMA with neonatal and childhood onset. Increasing amount of data are available about the effects of these drugs in adult patients with SMA. In this article, we summarize the available data of new SMA therapies in adult patients. Methods – Members of the Executive Committee of the Hungarian Clinical Neurogenetic Society surveyed the literature for palliative treatments, randomized controlled trials, and retrospective and prospective studies using disease modifying therapies in adult patients with SMA. Patients – We evaluated the outcomes of studies focused on treatments of adult patients mainly with SMA II and III. In this paper, we present our consensus statement in nine points covering palliative care, technical, medical and safety considerations, patient selection, and long-term monitoring of adult patients with SMA. This consensus statement aims to support the most efficient management of adult patients with SMA, and provides information about treatment efficacy and safety to be considered during personalized therapy. It also highlights open questions needed to be answered in future. Using this recommendation in clinical practice can result in optimization of therapy.]

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.]

Clinical Neuroscience

JULY 30, 2018

[Strategies of using the new antiepileptic drugs for epilepsy in adults]

NIKL János

[The new antiepileptic drugs have not changed the basic pharmacological treatment principles of epilepsy, but they have given greater choice in focal and in generalized epilepsies as well. The new drugs are not necessarily more effective than traditional drugs, but they have favourable pharmacokinetic characteristics, fewer interactions and better adverse effect profile in the acute and chronic phase of the treatment. They generally show a lower teratogenicity risk than the standard antiepileptics, although carbamazepine, one of the standard drugs can be used and zonisamide, a new one must be avoid in pregnancy. Due to characteristics mentioned above they are not only effective as add-on therapy, but in monotherapy as well. On the basis of the international and national recommendation lamotrigine and levetiracetam belong to the first line antiepileptics. The favourable tolerability of the new antiepileptics may improve the patient’s compliance and adherence to the given treatment. The low teratogenicity makes them especially suitable for the treatment of women of childbearing age. The new antiepileptic drugs can succesfully used for the treatment of special patients’ groups as for the post stroke, poszttraumatic epilepsies, for the epilepsies accompanied with brain tumours as well as for epilepsies in the elderly. The new drugs are advantageous for the treatment of such patients who have psychiatric symptoms or signs of cognitive decline and high risk of these symptoms respectively.]

Lege Artis Medicinae

MAY 01, 2000

[Reiter-syndrome]

GÉHER Pál

[The Reiter-syndrome is the complex of sterile arthritis, urethritis and conjunctivitis and involvement of other organs (skin, mucosal membranes, cardiac conducting system) following bacterial enteric or urogenital infec tion. Systemic signs can also occur with polyarthritis. This syndrome belongs to the reactive arthritis group. In each year there are 30 40 new cases among 100 000 citizens. The disease can occur at any age, but most of the patients are 20-40 years old. It is the patient's genetic background and the type of invading microbes that play a leading role in the pathomechanism of the disease. The exact pathomechanism is yet unknown, therefore our treatment is symptomatic. It is advised to immobilize the involved joint and aspirate the excess fluid and to take non-steroidal antiinflammatory drugs. The patient's medical history is most important to diagnose the disease, because laboratory tests may show signs of inflammation, the serology can only prove antecedent infection, viable organism can not be cultured from the involved organs and the imaging procedures and histology shows non-specific inflammation only. The importance of diagnostic procedures is to exclude the presence of other diseases. Other causes of monarticular inflammation (infection, crystal induced arthritis, sarcoid arthritis) and rheumatic fever should be excluded. The disease lasts for 3-6 months. 2 to 18% of the patients develop chronic arthritis and 12 to 26% of the patients develop ankylosing spondylitis. ]

Hypertension and nephrology

APRIL 29, 2021

[When should antihypertensive be taken: in the morning and/or evening? Chronopharmacotherapy of hypertension in practice]

SZAUDER Ipoly

[The circadian (24-hour) variability of blood pressure (BP) is influenced by constant and variable (external and internal) factors. With this in mind and by determining the type of hypertension with a 24-hour blood pressure monitoring (ABPM), individual chronopharmacological (chronopharmacotherapy) treatment can be planned. There are significant differences in the chronokinetics of antihypertensive drugs administered at different times. Their therapeutic range and efficacy depend significantly on their circadian timing. Although the most modern antihypertensives have a 24-hour effect, they are not able to lower blood pressure at all times. Morning intake of ACE inhibitors, ARB-s, alpha-blockers mainly affect the afternoon and early evening rise, while evening intake reduces nocturnal and morning rise. Calcium channel blockers, beta-blockers (except carvedilol and labetolol), do not affect the circadian blood pressure profile. Therefore, in nondipper hypertension or in the case of morning rise, the twice daily morning and evening administration is more effective than the single morning administration. (Usually a lower dose is sufficient in the evening.) Adequate control of nocturnal or morning blood pressure elevations can be achieved with medication taken in the evening. According to the relevant studies the conclusion is that there is no convincing evidence that the administration of BP-lowering drugs in the evening provides any significant advantage in terms of quality of BP control, prevention of target organ damage or reduction of cardiovascular events, so evening intake only is not recommended. In particular the administration of antihypertensive drugs at bedtime, especially in the case of elderly patients may cause excessive BP fall at night with increased risk of silent cerebral infarct and the myocardial ischemia in patients with coronary heart disease.]

Hypertension and nephrology

DECEMBER 12, 2019

[Serotoninergic drugs for weight loss. A review of efficacy and cardiovascular safety of lorcaserin]

SIMONYI Gábor

[Complex therapy of obesity consist the medical treatment. Several weight lowering drugs are available in the United States, one of which is 5-HT2c agonist lorcaserin. After failures with former non-selective serotoninergic agents (fenfluramine, dexfenfluramine), there was great anticipation and more questions about the release of lorcaserin, which proved its effectiveness and safety in several phase 3 studies. Lorcaserin is a selective agonist of 5-HT2c receptors, therefore free form adverse effects of former non-selective serotoninergic drugs on valvulopathy or pulmonary hypertension. The results of the recently published CAMELLIATIMI 61 study confirmed the cardiovascular safety of lorcaserin.]

Hypertension and nephrology

SEPTEMBER 12, 2018

[Treatment of hypertension in kidney transplant patients]

KOVÁCS Tibor, WAGNER László

[Most of the renal transplant recipients suffer from hypertension. Hypertension substantially contributes to the high cardiovascular mortality in this population. The recommendation of the Hungarian Society of Hypertension and the international guidelines suggest to achieve less than 130/80 mmHg as target blood pressure in these patients. Several factors may be in the background of hypertension after kidney transplantation, which can be summarized as factors from the recipient-side, the donorside and factors provoked by transplantation itself. In most of the cases early after transplantation high doses of immunosuppressive drugs (especially calcineurin inhibitors and steroids) are responsible for the increased blood pressure. There are some further special methods apart from the general recommendations which are needed during the examination of hypertension of kidney transplant patients: e.g. measurement of blood trough-level of immunosuppressive drugs, investigation of bone-mineral disorder, screening for the level and causes of anaemia, check-up of the renal graft circulation. Kidney transplant patients suffering from hypertension usually need more than two antihypertensive drugs beyond the use of non-pharmaceutical antihypertensive methods. In the early posttransplantation period calcium channel blockers are preferred antihypertensive medications, because they counterbalance the vasoconstrictive effect of calcineurin inhibitors. The administration of renin-angiotensin-aldosterone inhibitors are rather suggested after the stabilization of renal function (from the 1-3 months posttransplantation). When designing antihypertensive strategy, comorbidities and special factors should be regarded as well, especially volume overload, proteinuria, allograft function (GFR), diabetes, other cardiovascular risk factors, previous cardiovascular events. The setup of an individual therapeutical strategy is advised in view of all these factors, which is different according to the timing after transplantation: the perioperative, the early postoperative phases and from 1-3 months after transplantation have special focuses.]

Lege Artis Medicinae

OCTOBER 01, 2000

[Diabetes mellitus and hypertension - Facts, questions and thoughts]

KERÉNYI Zsuzsa, STELLA Péter, TAMÁS Gyula

[Using the new diagnostic criteria by WHO/ISH, the frequency of hypertension in type 1 diabetic patients is 15-61%, reaching 51-73% in type 2 cases. The combination of diabetes mellitus with hypertension increases the risks of stroke and cardiovascular diseases further compared to non-diabetic hypertensive patients. Authors review new recommendations concerning the diagnosis and treatment goals of hypertension in different types of diabetes mellitus. Most recent studies supporting these recommendations are also critically analysed. Theoretical advantages of new drugs and drug combinations in the therapy of hypertensive diabetics are reviewed. The strategy of treatment according to the cardiovascular riskprofile of diabetic patients is discussed in detail in the report. For the prevention of target-organ damage, the evidence based combination of ACE inhibitors and long-acting calcium channel blockers was strongly recommended. In about 70% of diabetic patients a combination of two drugs, in one-third of the cases a combination of three or four preparations seemed to be necessary, including low-dose diuretics and/or cardioselective beta-blockers. ]

Lege Artis Medicinae

SEPTEMBER 01, 2000

[Effect of calcium channel blocking drugs on the periodontal status of hospitalised patients]

KEGLEVICH Tibor, ZSIDRÓ Emese, BENEDEK Erika, BARNA István, SZEGEDI Zsolt, SCHWAB E. Richárd, GERA István

[Ca2+-channel blockers play crucial role in the chronic treatment of hypertension and cardiac arrhythmia. One of the side effects of the chronic nifedipine treatment is gingival enlargement. The pathomechanism of this side effect is not fully understood. The main objective of the present study was to evaluate the potential role of different factors in the development and severity of gingival hyperplasia. The incidence and severity of gingival enlargement were examined around the six surfaces of all fully erupted teeth in 243 hospitalized patients with the modified Angelopoulus-Goaz Gingival Hyperplasia Index. 172 patients in the study group were on Ca2+ channel blockers for at least three months prior to the examination while 71 inpatients served as controls. Gingival hyperplasia occurred in 87% of the test group and in 53% of the control group. Severe gingival enlargement occurred in 35% in the test group and only in 2% of the control group. The age and gender of the patient, the daily dose of the medication, the duration of the administration of the drug showed no correlation with the extent and severity of gingival hyperplasia. Only oral hygiene showed statistically significant correlation with the severity of gingival enlargement. The only clinical parameter influencing the extent and severity of gingival enlargement associated with Ca2+-channel blocker drugs was the quality of oral hygiene. ]

Lege Artis Medicinae

SEPTEMBER 01, 2000

[The treatment of life-threathening ventricular tachyarrhythmias in coronary artery disease - Antiarrhythmic drug or implantable cardioverter-defibrillator?]

BORBOLA József

[Sudden cardiac death due to sustained ventricular tachyarrhythmias accounts for approximately 50% of all cardiovascular deaths. From the major therapeutic options currently available, antiarrhythmic drug therapy and implantation of automatic car dioverter-defibrillators could be applied to the great majority of patients. Both early observations on automatic implantable cardioverter-defibrillator devices and more recent prospective, randomized, multicenter trials with long-term outcome data uniformly document sudden cardiac death recurrence rates of 1% to 2% annually, compared with recurrences rates of 15% to 25% without the device. There is now compelling evidence from studies suggesing that these devices are superior to antiarrhythmic drugs (Class I and III), both in terms of effectivity and life-saving effects. The implantation of the automatic cardioverter-defibrillator device is currently the first choice therapy for cardiac arrest survivors based on the AHA/ACC guideline (1998), and has to be considered in each case. In the future, the common, hybride treatment with antiarrhythmic device and drugs is expected. ]