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Journal of Nursing Theory and Practice

APRIL 30, 2020

[The Effectiveness of Pain Control in Cancer]

BÖGYÖS Dorina Viola, KIRÁLY Edit

[Introduction: Cancer diseases pose a serious public health issue nowadays, as they are among the leading causes of death. As today it is possible to live with this disease for a long time, the quality of life, which is greatly affected by pain, becomes a very important factor. Objective: The purpose of the research is to investigate and explore potential existing problems in the field of cancer pain relief in Hungary and to propose solutions to these problems. In our questionnaire survey, we asked patients suffering from tumors who were in pain and living their lives at home. The research was an anonymous cross-sectional study using descriptive and comparative statistical methods. The average age of respondents was 55 and most of them were women. Answers showed that primary tumors appear mostly in breasts (n=25) or the lungs (n=13). Metastasis developed by almost 30% of the patients. 42% of the respondents experienced severe pain (VAS ≥7 point), which they estimated to last for 1-2 (n=40) or rather 4-5 hours daily (n=30). Almost two third of the respondents were using products containing NSAID (n=64). The number of mild (n=18) versus strong painkiller (n=15) users were almost equal. There was a significant difference between groups of patients experiencing “mild-medium” (p=0,01) versus “mild-strong” pains (p=0,004) due to the usage of medication containing stronger opioids. From this revealed that individuals with greater pain used potent analgetics. More than half of the patients use some sort of sleep or relax aid as a supplement to their medication. Patients with metastasis (n=28) use strong (n=7) as well as mild analgesics (n=10) in greater numbers than those without metastasis. The results reveal that in Hungary, relatively few patients with cancer diseases use strong opioid-containing drugs despite of the fact that their pains are severe. Therefore, a nearly precise estimate of pain levels would be important. Fear of side effects is often unjustified and cannot limit the choice of appropriate therapy. ]

Lege Artis Medicinae

DECEMBER 21, 2020

[The metamizole]

DUMELE Andreea

[Metamizole in use for almost 100 years, is reviving in our days since it has proved its efficiency and gained popularity during the past years. By its special triple effect (analgesic, antipyretic and spasmolytic) it has a wide range of indications. Among the non-opioid analgesics it is one of the most powerful painkillers. Metamizole is a prodrug, since it transforms into active metabolites within the human body. Its action mechanism is complex, not completely understood so far. Contrasted to classic non-steroidal anti-inflammatory drugs, metamizole has low anti-inflammatory effect. Its severe, but very rare side effect – i.e. the agranulocytosis - hindered its administration for years and even today it is under intense discussions. Based on international studies, it proved to be a well tolerable, safe medication. Its side effect profile differs from non-steroidal anti-inflammatory drugs, thus in NSAID contraindications it provides an excellent alternative. Its good water solubility makes metamizole suitable for both oral and parenteral administration. For its efficiency and good safety profile, metamizole has been correctly reintroduced to the supply of over-the-counter painkillers in our country.]

Lege Artis Medicinae

DECEMBER 21, 2020

[Risk of nonsteroidal antiinflammatory drugs. Focus on aceclofenac]


[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 Oncology

APRIL 30, 2020

[Tumor induction by chemotherapy]

[Without chemotherapy, the fi ve-year survival rate of detected cancers would be between 0 and 15%, depending on the tumor, and between 17 and 85% with current therapy. Several warnings call attention to the dangers of chemotherapy-induced side effects, most notably the potential for tumor-inducing ability, which can affect 5-10% of patients who have recovered beyond fi ve years. Some systematically applied drugs used in chemotherapy (alkylating agents, etoposide, arsenic trioxide) are able to cause mutations in healthy cells of the patients, increasing the likelihood that the mutated cells will start a later (secondary) tumor formation. In addition to mutagenic effects, some chemotherapeutic agents exert their effects on normal myeloid and epithelial cells of the body, which, by altering the tissue microenvironment, create the potential for malignant transformation. Tumor-associated macrophages (TAMs), which can alter gene expression patterns by tumor cell secreted factors and promote the survival and invasiveness of tumor cells by pro-carcinogenic signals, are very important in this process. It is of utmost importance that doctors, pharmacists, technicians and nurses working with cancer-causing materials do not come into direct contact with dangerous substances and wear appropriate protective equipment.]

Clinical Oncology

DECEMBER 30, 2019

[Sequential therapy of metastatic renal cell carcinoma]


[The incidence of renal carcinoma is on the rise in developed countries, with the tumor being among the 10 most common malignancies. However, the survival of patients with irresecable renal carcinoma has improved signifi cantly in recent years, mainly due to signifi cant advances in oncology treatment. The use of agents acting on the VEGF and mTOR signaling pathways is widespread and has become a standard clinical practice in fi rst and later line therapy. Recent clinical trials have provided many new drugs with new targets (cMET and AXL, FGFR, PD-1/PD-L1, CTLA-4) and combinations thereof, and have completely redrawn the treatment landscape of metastatic renal carcinoma and signifi cantly improved clinical results. This report reviews data on targeted drug therapy of renal cell carcinoma and discusses the therapeutic position of various drugs and combinations to our knowledge.]

Clinical Oncology

AUGUST 30, 2019


KIS Erika Gabriella

[Tumors with standard electrochemotherapy (ECT) has raised over the past decade from skin cancers to locally advanced or metastatic tumors. The procedure became a reliable alternative of other local tumor ablation methods, because of its patient tolerability, effi cacy across histotypes, and repeatability. ECT is based on the physical phenomenon of reversible electroporation; short electric pulses are applied to tumor nodules to achieve transient cell membrane permeabilization to otherwire poorly permeant chemotherapy drugs, which consequently increases cytotoxicity. At present recognized indications include superfi cial metastases of malignant melanoma, breast cancer, head and neck skin tumors, Kaposi sarcoma, primary and recurrent nonmelanoma skin cancers, and in well-selected patients mucosal oropharyngeal cancers. Emerging applications include skin metastases from visceral or hematological malignancies, vulvar cancer, certain benign skin lesions, and the combination of ECT with systemic immunotherapy. Thanks to the technical developments, the new ECT indications are deep-seated tumors, including bone metastases, liver malignancies, pancreatic and prostate cancers with the use of long needle variable geometry electrodes. Herein we review the present status of ECT from the basic principles to emerging applications, and report the effi cacy of standard ECT across histotypes.]

Clinical Oncology

AUGUST 30, 2019

[Prevention of drug-related neuropathy in the clinical practice]


[There was a revolution of oncological treatments in the last fi ve years caused by introduction of immuncheckpoint inhibitors. Platinum and taxane based chemotherapies are the standard of care of the most frequent malignancies such as colon and breast cancer. Signifi cant improvement was achieved concerning side effects of chemotherapy in the few past decades. Preventive treatment of vomiting, neutropenia, aneamia are now based on clinical evidences. Meanwhile, there remained side effects (including chemotherapy induced neuropathy) which are diffi cult to treat. This article provides overwiev of the pharmacological therapies, vitamins and non-pharmacological procedures aimed to prevent chemotherapy induced neuropathy. Unfortunately still there are no drugs that are highly effective of preventing of chemotherapy induced periferial neuropathy validated in randomized clinical trials.]

Lege Artis Medicinae

OCTOBER 21, 2020

[Teleconsultations in general practice during coronavirus epidemiological emergency]

PAPP Renáta, OBERFRANK Ferenc, BALOGH Sándor

[Modifications of operating the health care belong to the preventive measures of the COVID-19 epidemic. Their priority period was the time interval between March 21, and May 3, 2020. Teleconsultation played an emphasized and dedicated role among General Practitioners (GPs) and the range of health services available through telemedicine was published by the legislation. In the present study, we evaluated the experiences of GPs according to the mandatory family practice guidelines in this period using electronically administered questionnaires sent back by the GPs themselves. 83% of respondents considered that the number of patients consulted by teleconsultations increased significantly if contrasted to the pre-epidemic period. Of the tools used in teleconsultation, all respondents mentioned the telephone, 85.5% mentioned e-mail, while 40% also included social media applica­tions. Prescribing drugs to known chronic patients and documentation were most feasible without face-to-face ap­pointment. 96.5% of GPs responded that they are ready to use teleconsultation even after the epidemiological emergency. We conclude that the GPs met the requirements and responded quickly to the introduction of telemedicine in the epidemiological emergency, which reduced effectively personal contacts in the health care, and according to the feedbacks, “remote” cases got solved successfully. Additionally, telemedicine has also its place in the GP offices in terms of patient care and specialist consultations as well. The implementation of telemedicine is expected to provide opportunities for more rational patient care and management. The development of telemedicine protocols is necessary and actual to support patient safety and medical responsibility.]

Lege Artis Medicinae

NOVEMBER 30, 2020

[GLP-1 receptor agonists in the elderly]


[According to current guidelines of type 2 diabetes, treatment, glucagon-like pep­tide (GLP) -1 receptor agonists (RAs) are primary suggested drugs of the early antidiabetic medication, just after the first an­ti­­diabetic metformin. However, more and more arguments support their optional application in old age diabetes. These include multi-target strong glycemic ef­fects, low risk of hypoglycaemia, proven cardio- and nephroprotective nature of long- and ultra long-acting derivatives, multifaceted be­neficial pleiotropic effects, as well as the appearence of their fixed combinations with analogue basal insulins effective in weight loss and lowering the blood pressure. This study reviews specific aspects of blood sugar lowering treatment in the elderly and the potential benefits of choosing GLP-1 RAs in this age group. While presenting data of relevant literature and own experiences it is emphasized, that these preparations can be used safely in long term also in this age group.]

Clinical Neuroscience

MAY 30, 2020

[The long-term follow-up of enzyme replacement treatment in late onset Pompe disease]

MOLNÁR Mária Judit, BORSOS Beáta, VÁRDI Visy Katalin, GROSZ Zoltán, SEBÕK Ágnes, DÉZSI Lívia, ALMÁSSY Zsuzsanna, KERÉNYI Levente, JOBBÁGY Zita, JÁVOR László, BIDLÓ Judit

[Pompe disease (PD) is a rare lysosomal disease caused by the deficient activity of acid alpha-glucosidase (GAA) enzyme due to mutations in the GAA gene. The enzymatic deficiency leads to the accumulation of glycogen within the lysosomes. Clinically, the disease has been classically classified in infantile and childhood/adult forms. Presently cc. close to 600 mutations distributed throughout the whole gene have been reported. The c.-32-13T>G splice mutation that is very common in patients of Caucasian origin affected by the childhood/adult form of the disease, with an allelic frequency close to 70%. Enzyme replacement treatment (ERT) is available for the patients with Pompe disease (Myozyme). In this paper, we are presenting the long term follow up of 13 adult onset cases treated more than 5 years. The longest follow up was 15 years. To evaluate the treatment efficacy, the 6 minutes walking test (6MWT) and the respiratory functions were monitored annually. The analysis revealed that at the beginning of ERT for 3-4 years the 6MWT had been generally increasing, then it declined, and after 10 years it was lower in 77% of the cases than it had been at the start of the treatment. In 23% of the cases the 6MWT increased during the follow up time. Only one of the patients become wheelchair dependent during the follow-up period. The respiratory function showed similar results especially in supine position. A high degree of variability was observed among patients in their responses to the treatment, which only partially associated with the antibody titer against the therapeutic protein. The efficacy of the ERT was associated with the type of the disease causing mutation, the baseline status of the disease, the lifestyle and the diet of the patient. The long-term follow up of the patients with innovative orphan drugs is necessary to really understand the value of the treatment and the need of the patients.]