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Hypertension and nephrology

MARCH 20, 2018

[Trends in the treatment of hypertension]

BARNA István, GYURCSÁNYI András

[Use of drugs treating hypertension (and its associated diseases) supported by the National Health Insurance has changed spectacularly during the last 10 years. In December 2016 the turnover of drugs exceeds almost 2% the data of December 2007. Simultaneously the amount paid as a support decreased by 42.5%. Change in the categories of support resulted in an increase in the use of generics. In addition, the expansion in use of fixed combinations also brought a significant change in drug consumption. During the examined period the role of drugs used in the treatment of hypertension in most the groups has changed.]

Journal of Nursing Theory and Practice

OCTOBER 30, 2017

[Importance of the Hyponatraemia in the Emergency Care]

PÓHR Kitti, KÖCSE Tamás, MESTERHÁZI András, BIERER Gábor, KARAMÁNNÉ Pakai Annamária

[The aim of the study: Hyponatraemia is the most common electrolyte abnormality in hospitalized patients. Certain drugs (eg, diuretics, antidepressants, and antiepileptics) have been implicated as established causes of either asymptomatic or symptomatic hyponatraemia. Studies proved correlation between hyponatremia and hospital mortality. Hyponatraemia remains asymptomatic in most cases, but if left untreated, it can cause life-threatening situations. Our aim was to examine the frequency of hyponatraemia in our hospital and its impact on the emergency care. Methods: A total of 75 patients were enrolled in the study with purposive sampling. We used descriptive and mathematical statistics with SPSS 22.0 software package for processing non-parametric statistical data. Results: Patients transferred by ambulance or arriving at the ER department came with dizziness, vomiting / diarrhea symptoms. Admission causes, were characteristic symptoms of hyponatraemia as well as non-specific neurological symptoms (headache, dizziness, confusion, unconsciousness) were found (n = 29). In addition, a common complaint of vomiting / diarrhea (n = 12), abdominal pain (n = 10). In particular, the complaint leading to a significant proportion of patients with hyponatraemia was not typical, but it was kind of trauma (n = 12). Nearly half of the patients (n = 36) were revenant. The most common diagnosis was hypertension (34%). 52% were taking medication that typically cause hyponatraemia. There were significant increase in the incidence of hyponatraemia in cases where the patient was taking diuretics. Conclusions: The diagnosis of hyponatraemia is based on the recording history, physical examination, and laboratory tests. Preventive approach would reduce the number of hospital stays due to hyponatraemia, and this may indeed improve patients’ life expectancy. The disease itself is easily remedied, it can cause critical condition due to disregard.]

Clinical Oncology

SEPTEMBER 10, 2017

[Targeted therapy of the clear cell renal cancer ]

TORDAY László

[The renal cell cancer is among the ten most frequent cancers in developed countries. Its inci dence rate continuously increased until recently. On the other hand, survival parameters of renal cell cancer patients considerably improved in the last decade due to early diagnosis and developments in the treatment of irresectable disease. Huge progress had been made in understanding of the biological background of this chemo- and radiotherapy resistant disease, leading to the introduction of drugs in fi rst and further line treatment acting on VEGF and mTOR signal transduction pathways. Simultaneously, the era of widespread cytokine treatments had been ended. Recent studies had ensured the introduction of several drugs with new mechanism of action (MET, AXL; FGFR, PD-1 inhibition) into the therapy; these new advances completely changed the treatment landscape of RCC further improving progression free and overall survival. In this publication a review of data regarding the targeted treatment of clear cell renal cancer will be provided and as of our recent knowledge therapeutic positions of different drugs used will be discussed.]

Hypertension and nephrology

DECEMBER 10, 2017

[Place of rilmenidine therapy in reducing of sympathetic overactivity]

FINTA Ervin, KUN Edit, SIMONYI Gábor

[The sympathetic nervous system plays an important and widely investigated role in the pathogenesis of the hypertension and its concomitant diseases. Between the several types of antihypertensive drugs which can influence the sympathetic over activity, centrally acting agents, play an important role. Here some special aspects of the imidazoline I1 receptor agonist rilmenidine are reviewed.]

Clinical Oncology

MAY 10, 2017

[Combination of radiotherapy and immunotherapy]

HIDEGHÉTY Katalin, BRUNNER Szilvia, SZABÓ Zoltán Imre, SZABÓ Emília Rita, POLANEK Róbert, TŐKÉS Tünde

[Increasing experimental and clinical evidences demonstrated the synergic effect between the rapidly implemented immunotherapy and advanced forms of focal radiotherapy, not only on the elimination of the irradiated lesion, but also on the enhancement the immune-mediated systemic anti-tumoral activity. It is essential for gaining the most benefi t from the combination of the two modalities to select the appropriate patients, to defi ne the irradiation parameters, such as radiation quality (ie. particle) dosage, (total dose, fraction number) size of the target volume, the use of other supportive and anti-tumor drugs. In this review, we provide an update for the daily oncological practice on the data accumulated up to now on the molecular basis and patomechanism of enhancing radio-immune effect and clinical results, and highlight the most important parameters, which may increase the abscopal effect of ionizing radiation, thereby increasing the effectiveness of immunotherapy. However, development of clinical guidelines for benefi cial integration of immunotherapy and radiotherapy could be expected after evaluation the result of currently ongoing numerous (> 100) clinical trials. If the preclinical results will be confi rmed clinically, it could lead to paradigm shift in the use of ionizing radiation.]

Clinical Oncology

MAY 10, 2017

[Signaling pathways in cancer stem cells (Notch, Hedgehog, Wnt)]

KOPPER László, NAGY Noémi, SEBESTYÉN Anna

[OThe key regulators in the embryonic life, and later in the differentiation of tissues and organs are the evolutionary reserved signalling pathways, as Notch, Hedgehog and Wnt. Mutations of these pathways have been identifi ed in many tumor types, increasing the risk to the appearance of cancer stem cells (CSC), with very similar geno- and phenotype as normal stem cells have. Such CSCs with stemness functions can be developed not only from normal stem cells, but also from progenitor and differentiated cells. The main characteristics of CSC are the self maintenance, slow growth rate, very effective DNA-repair system, etc. All of these can contribute to the resistance. Further problems are the low number of CSC in the whole tumor mass, which makes rather diffi cult to achieve the effective drug concentration in CSC. The mentioned ancient pathways interact with many other pathways to form a network, which can infl uence the strategy of therapy. No doubt, that these pathways are promising targets, however, till now the clinical effectiveness is very low due to some reasons mentioned above. Nevertheless, some drugs are already in clinical use, either as monotherapy or part of the combinations. Little is known about the relationship between the pathways and the microenvironment, which has an outstanding role in the cellular activities, sometimes resulting opposite output. It is a great challenge to design effective drugs against CSC, similarly to fi nd reliable predictive biomarkers, which unfortunately still missing, since a reasonable drug-marker interactions would speed up the personalized treatment.]

Clinical Oncology

FEBRUARY 10, 2017

[Radiochemotherapy - questions/answers]

PIKÓ Béla, LACZÓ Ibolya

[During chemoradiotherapy the two main non-surgical anticancer methods are combined to improve the treatment outcomes. The theoretical possibilities of interactions and the most frequently used drugs will be presented here, emphasizing that although both the radiation therapy and the drugs need to be administered in full dose in practice considering the summarization of side effects we often have to make compromises. The treatments of the most frequent indications (brain, head and neck, oesophagus, lung, stomach, pancreas, rectum, bladder, cervix, soft tissue sarcoma) will be demonstrated. Since there are several drugs and drug combinations that are not included in the Hungarian registered anticancer therapies, for their off-label use the permission of the National Institute of Pharmacy and Nutrition is required. To choose the optimal treatment (during planning the optimal place of chemoradiotherapy, agents and doses) the opinion of a multidisciplinary team is necessary]

Clinical Oncology

FEBRUARY 10, 2017

[Cell cycle as therapeutic target – CDK4/6 inhibition]

KOPPER László

[One of the most important decision of a cell: to live or die. If survival is the choice, there are three options: proliferate, to stay in sleeping state for a while, or differentiate in order to perform its specifi c function. These decisions are under a very strict molecular regulation infl uenced by internal and external factors. Tumor cells more and more disregard the regulations, and move into independency for a continuous proliferation, which has a very similar program in normal and tumor cells. The main route towards mitosis is the cell cycle, under the supervision of positive and negative regulators, forming checkpoints, telling to the cell - under the infl uence of mitogenic signals - to go or to stop. The most critical checkpoint is at the border of G1 and S phases where the main players are cyclinD, CDK4/6 and RB1. It turned out that the best targets to inhibit cell proliferation are the CDKs, but this approach, when used unselected targets, was unsuccessful due to the toxicity. To improve the clinical results, the selection of CDK4/6 as a therapeutic target seems to fulfi l most of the hopes. Today three drugs are the most promising: palbociclib (with an acceptance by FDA and EMA to treat breast cancer patients), abemaciclib and ribociclib (underclinical trials). Now, most of the data concern breast cancer, especially the combinations of CDK4/6 inhibitors and endocrine therapy, but many other malignancies are studied (e.g. liposarcoma, mantel cell lymphoma, melanoma, renal cancer, lung cancer, pancreatic cancer, ovarian cancer, teratomas etc.). The key points are the side-effects, the most frequently observed is neutropenia, but so far it is managed without serious toxicity.]

Journal of Nursing Theory and Practice

APRIL 30, 2017

[Handling hazardous drugs during bladder instillation: epirubicin contamination with and without a closed system]

BOGNÁR Krisztina, ZRÍNYI Miklós, JUHÁSZ Ákos, BATKA Gábor

[The aim of the study: Assess epirubicin contamination during bladder instillation with or without the use of a closed system drug transfer device (CSTD). Material and Methods: Four hospital sites participated in an experimental wipe study (3 used, 1 did not use a CSTD [control]). Samples were frozen and transported to Germany for liquid chromatography analysis. Samples were taken from seven surfaces following drug reconstitution and patient administration. Group differences were analyzed by one way ANOVA. Results: There was a major difference in contamination between CSTD and non-CSTD use (F = 7,63; p < 0,001); the workflow without the use of a CSTD showed much greater amounts of epirubicin left behind. There wasn’t any difference in contamination across sites using a CSTD. Conclusions: Without a CSTD epirubicin contamination was high. The CSTD was shown to be effective to minimize the health risk of nurses. We recommend that CSTD be implemented in routine nursing practice.]

Clinical Neuroscience

JULY 30, 2017

[Valproate in the treatment of epilepsy and status epilepticus]

JANSZKY József, TÉNYI Dalma, BÓNÉ Beáta

[According to Hungarian guidelines, valproate - with the exception of infants and small children as well as fertile women - is the first drug of choice in generalized and unclassified epilepsies because it is effective in most seizure types and epilepsy syndromes. It is highly effective in juvenile myoclonic epilepsy. Even though it is not the first-line drug in focal epilepsies, if the first-line therapy is ineffective, it is a plausible alternative as second choice therapy, owing to its different mechanism of action. If the type of epilepsy can’t be surely established, valproate is the drug of choice, as it possesses the broadest-spectrum among antiepileptic drugs. After administration of benzodiazepines, intravenously applied valproate can be a first choice therapy in all types of status epilepticus, owing to its broad-spectrum and efficacy. Valproate is the first-choice therapy in patients with glioblastoma - independently of the seizure type -, as it is likely to improve the survival rate with 2-10 months and the effectivity of chemo- and radiotherapy. Valproate is generally not suggested for fertile women, but - as it is the most effective therapy in some epilepsy syndromes -, the patient has the right to choose valproate therapy, thus undertaking the elevated risk of developmental abnormalities, for higher safety regarding seizures. If only valproate therapy owns the ability to obtain seizure freedom, then stopping its administration is not suggested, but a low dosage has to be aimed (500-600 mg/day, but not more than 1000 mg/day): according to some studies, most idiopathic generalized epilepsies can be controlled by low valproate dosage. Stopping valproate therapy in case of an ongoing pregnancy is not suggested. ]