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Lege Artis Medicinae

DECEMBER 10, 2019

[Why did I survived? Treatment of acute stress reaction after a road accident]

SZABÓ József, SIPOS Mária

[INTRODUCTION - Survivors and witnesses of traffic accidents often experience an acute stress reaction. Immediate or at least fast psychological support, relieving the subjective suffering is very important in the respect of preventing psychological crisis, post-traumatic stress disorder or depression and the associated increasing risk of suicide. CASE REPORT - We present the case of a 27-year-old male patient who was the victim of a traffic accident and was partly responsible for it. He lost his mother in the accident, his sister was injured, and there was a casualty in the other affected car. He applied for a psychiatric appointment one week after the accident. He complained of insomnia, loss of appetite, sadness, weakness, anxiety. The treatment consisted of low-dose anxiolytic therapy, recommended in case of need, and a psychological support via acute stress protocol (G-tep) of EMDR therapy. Both short-term feedback from his family doctor and psychiatry outpatient follow-up after three weeks showed significant symptomatic improvement. CONCLUSIONS - In the last one and a half year, he has not applied for psychiatrical treatment. According his general practitioner there were no new psychological problems during this time. Our work has been successful in terms of immediate relief of suffering and prevention of psychological crisis and PTSD.]

Lege Artis Medicinae

NOVEMBER 15, 2019

[Vascular biomarkers ]

BENCZÚR Béla

[While risk scores are invaluable tools for adapted preventive strategies, a significant gap exists between predicted and actual event rates. Additional tools to further refine the risk stratification of patients at an individual level are biomarkers. A surrogate endpoint is a biomarker that is intended as a substitute for and being realized earlier than a clinical hard endpoint. In order to be suitable as a surrogate endpoint of cardiovascular events, a biomarker should meet several well-defined criteria. It has been proposed that a plenty of potential vascular biomarkers would have a role in primary and secondary cardiovascular prevention. Most of the biomarkers examined fit within the concept of early vascular aging. The only biomarkers that fulfill most of the criteria and, therefore, are close to being considered a clinical surrogate endpoint are carotid ultrasonography, ankle-brachial index and carotid-femoral pulse wave velocity. ]

Journal of Nursing Theory and Practice

APRIL 30, 2019

[A Systematic Review of nurses knowledge of Incontinence-Associated Dermatitis ]

KÓSZÓ Lilla, NAGY Erika, PAPP Anita Tímea

[Background: Due to the growing incidence of incontinence, Incontinence-Associated Dermatitis (IAD) is one of the most important health problems nowdays. The most significant challange is the differentiation of IAD and ulcer pressure. Missclassification in practice causes suboptimal prevention and therapy. Thus, in order to provide optimal care, nurses need to be able to properly differentiate between the two illnesses. Objectives: The airm of this analysis was to identify how nurses can classify IAD from ulcer pressure, and how differentiation could be taught to nurses. Method: A systematic review was done wih ’pressure ulcer and ’classification’ and ’nurse’ search words using 3 databases, the Pubmed (NLM), the Science Direct and the Web of Science as basic sources. We relied on articles that were published before September 2018. From the total of 1268 records 7 studies met all the inclusion and exclusion criterias and were chosen for analysis. Results: We counted weighted arithmetic from the results of the studies. In total 4062 nurses participated in the clinical trials. Their weighted mean score was 33,2%. 2132 nurses got some types of education, The weighted mean score of their pre-test was 37%, while their post-test reached 66%. Conclusion: Differentional diagnosis between pressure ulcers and IAD is complicated. However, studies all agree that education in this field produces good results.. ]

Hypertension and nephrology

OCTOBER 23, 2019

[Blood pressure management for stroke prevention and in the acute stroke. The new guideline of European Society of Hypertension (ESH, 2018), European Society of Cardiology and Hungarian Society of Hypertension (HSH, 2018)]

JENEI Zoltán

[Hypertension is the leading modifiable risk factor for stroke. Its prevalence amongst stroke patient is about 60-70% and the benefit of blood pressure (BP) lowering therapy on stroke risk reduction is well established. However the optimal BP targets for preventing stroke and reducing stroke consequences have been controversial. The new European (ESC/ESH) and Hungarian (HSH) hypertension guideline published in 2018 highlighted the primary and secondary prevention of stroke and the BP management in the acute stroke care as well. According results from ACCORD, SPRINT, HOPE-3, and other metaanalysis the systolic blood pressure (SBP) lowering < 120 mmHg has not favourable effect, thus in hypertensive patients < 65 years the SBP should be lowered to a BP range of 120-129 mmHg. In older patients ≥ 65 years the SBP should be targeted to a BP range of 130-139 mmHg (IA). In patients with acute intracerebral haemorrhage careful acute BP lowering with iv. therapy, to <180 mmHg should be considered only in case of SBP ≥ 220 mmHg (IIaB). In patients with acute ischaemic stroke who are eligible for iv. thrombolysis, BP should be carefully lowered and maintained to < 180/105 mmHg for at least the first 24 h after thrombolysis (IIaB). If the patient is not eli gible for lysis and BP ≤ 220/110 mmHg, routine BP lowering drug therapy is not recommended inside 48-72 h (IA). In patients with markedly elevated BP > 220/110 mmHg who do not receive fibrinolysis, drug therapy may be considered, based on clinical judgement, to reduce BP by 15% during the first 24 h after the stroke onset (IIbC). After 72 h of acute stroke in case of hypertensive patients < 65 years the SBP should be lowered to a BP range of 120-129 mmHg (IIaB). In older patients ≥ 65 years the SBP should be targeted to a BP range of 130-139 mmHg (IA). If BP < 140/90 mmHg after stroke, the BP lowering should be considered (IIbA). It is recommended to initiate an antihypertensive treatment with combination, preferably single pill combination of renin-angiotensin system blockers plus a calcium channel blocker and/or a thiazide like diuretics (IA). Lowering SBP < 120 mmHg is not recommended due to advers events regardless of age and type of stroke either in primary or secondary stroke prevention.]

Hypertension and nephrology

OCTOBER 23, 2019

[Non-invasive evaluation of cardiovascular risk in pediatric chronic kidney disease patients]

BÁRCZI Adrienn, DÉGI Arianna Amália, KIS Éva, REUSZ György

[Cardiovascular diseases are the leading cause of mortality and morbidity in children with chronic kidney disease (CKD). Similar to adults, children with CKD experience a high burden of traditional and uremia-associated risk factors. Recent years, several studies were published in connection with cardiovascular risk factors, patomechanism, and early markers of cardiovascular diseases. Early signs of cardiomyopathy, such as left ventricular hypertrophy or dysfunction, and markers of atherosclerosis, such as increased intima-media thickness of the carotid artery or increased wall stiffness of the aorta are frequently present in early stages of CKD in children. As prevention is important in pediatrics, the evaluation of subtle changes of the cardiovascular system provide opportunity for early treatment and that enables children to develop normally and have a better long-term quality of life. Recently, newer non-invasive cardiovascular imaging modalities have been emerged to diagnose subclinical alterations of the heart and vessels in this specific population with kidney disease. In this review, we provide an overwiev of the emerging imaging techniques used to detect early subclinical organ damage in pediatric chronic kidney disease patients.]

Lege Artis Medicinae

SEPTEMBER 10, 2019

[What may hurt the patient’s leg? Lower extremity ischaemia]

FENDRIK Krisztina, BIRÓ Katalin, KOLTAI Katalin, ENDREI Dóra, TÓTH Kálmán, KÉSMÁRKY Gábor

[Peripheral artery disease (PAD) is of high prevalence, and one of the most common clinical manifestations of the atherosclerosis beside ischaemic heart disease and cerebrovascular disease. PAD should be considered as a systemic disease, PAD patients have two times higher ten-year cardiovascular mortality than the normal population. For these reasons, the early recognition of the disease, the appropriate secondary preventive medical and non-medical therapy are of great importance. Risk stratification, proper physical examination, ankle pressure, ankle-brachial index, toe pressure, transcutaneous partial tissue oxygen pressure measurement and duplex ultrasound are the cornerstones to an early diagnosis. This summary aims at calling attention to the fact that lower extremity pain can not only be caused by musculo­sceletal diseases but limb and/or life-threatening limb ischaemia can be revealed in the background. ]

Lege Artis Medicinae

SEPTEMBER 10, 2019

[Treatment of painful diabetic polyneuropathy ]

KIS János Tibor

[Diabetic polyneuropathy can be present in up to 20-60% of diabetics, making it the most common complication of diabetes, but it is often undiagnosed. The diagnosis is mainly based on symptoms, but also several test options are available. For the prevention of neuropathy, long-term control of glycemic parameters is the most important. The pain caused by diabetic polyneuropathy affects 13-26% of diabetics. After the diagnosis, there are a number of treatment options that can be divided into causal and symptomatic therapy. The author summarizes therapeutic options from a practical point of view. ]

Lege Artis Medicinae

SEPTEMBER 10, 2019

[Anti-allergic agents and ICAM-1-antibodies for the control of upper respiratory infections]

SZABADKA Hajnalka

[Rhinoviruses are responsible for more than 50 percent of upper respiratory infections. It is well-established that the „Intercellular Adhesion Molecule 1” (ICAM-1) plays a crucial role in the adhesion of rhinoviruses and the relevant secondary bacterial pathogen Haemophilus influenzae to the epithelial cells of the respiratory tract. Both rhinoviruses and H. influenzae enhance the expression of ICAM-1 promoting their own attachment and mutually promoting that of the associated pathogen. It was experimentally shown that anti-ICAM-1 antibodies will inhibit infection by both rhinoviruses and H. influenzae. Since some anti-allergic agents - desloratadine and levocetirizine - also inhibit the expression of ICAM-1, their use may be beneficial in controlling some respiratory infections ]

Hypertension and nephrology

SEPTEMBER 10, 2019

[Kidney diet and the patient compliance issue ]

LADÁNYI Erzsébet

[There have been significant developments in the field of nephrology and dialysis as for the science and technology are concerned in the past decades. However, CKD patients still show high mortality and morbidity. From among the several factors determining the long-term outcome of CKD patients metabolic disorder and malnutrition play an important role. Malnutrition is often not diagnosed or is not paid enough attention to in the complex treatment of CKD patients. It is important to make both the patients and clinical staff more aware of proper nutrition and importance of prevention and treatment of malnutrition, respectively. The early diagnosis and treatment of malnutrition is of utmost importance in CKD patients. The long term renal failure and the accompanying malnutrition have a negative impact on their long term outcome and quality of life. Since the malnutrition causes a lot of complications, it is indispensable for dietitians and nephrologists to work closely together. Patient compliance is a determining factor in the successful implementation of renal diet.]