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Lege Artis Medicinae

APRIL 20, 2014

[Switching from human basis-bolus insulin treatment to analog insulins, from clinical aspects]

KIS János Tibor

[During treatment of patients with type 2 diabetes, early insulin treatment improves beta cell function, slows the progression of the disease and improves glycaemic values in the long term. In these cases, the strictest glycaemic target values can be achieved by basal-bolus insulin treatment. Furthermore, the development of chronic complications can be halted most effectively by normoglycaemia. It is a special task to switch from human basal-bolus insulin treatment to analog insulins. The author presents practical, clinical aspects of this switching through a case study.]

Lege Artis Medicinae

NOVEMBER 20, 2013

[Therapeutic strategies in rheumatoid arthritis]

VÁNCSA Andrea, SZEKANECZ Zoltán

[In this review, we follow the consecutive steps of the internationally accepted therapeutic strategy of rheumatoid arthritis (RA). We summarise in brief the current European recommendations, and provide some advice on methotrexate (MTX) therapy. The initiation, maintenance and, if needed, switch of biological therapy is also discussed. Having reached remission or low disease activity (LDA), tapering or discontinuation of biologics may be considered. Finally, we review the possibilities and the most important biomarkers of personalised treatment.]

LAM KID

OCTOBER 04, 2013

[Is a paradigm shift possible in the clinical practice of preventing recurrent fractures?]

TAKÁCS István

[Recurrent osteoporotic bone fractures are less and less considered “natural”, due to the immense variety of products available for treatment. In order to prevent recurrent fractures, treatment should be started in time, and a careful approach is needed to choose the appropriate treatment, and, if needed, to switch therapy. When choosing the therapeutic approach, we have to decide whether it corresponds to the severity of the osteoporosis and the risk of fracture. In order to do this, we have to consider bone quality, previous fractures, the condition of cortical bones and the mode of action of the selected treatment, in addition to the easily evaluated density value. The aim of this article is to provide practical help for the above mentioned decisionmaking process.]

Clinical Neuroscience

NOVEMBER 30, 2006

[MOVEMENT-RELATED BETA RESPONSES IN ESSENTIAL TREMOR AND PARKINSON’S DISEASE]

GERTRÚD Tamás, PÁLVÖLGYI László, TAKÁTS Annamária, SZIRMAI Imre, KAMONDI Anita

[Objective - To investigate the pathomechanism of essential (ET) and parkinsonian tremor (PT) by studying the correlation between tremor severity and movement-related beta rhythm changes of the human electroencephalogram. Patients and methods - We recorded the electroencephalogram of 10 patients with essential tremor, 10 with Parkinsonian tremor and 10 controls. In a preliminary session we determined the side with lower and higher tremor intensity (T+, T++ respectively), using accelerometry. Subjects pressed an on-off switch in a self-paced manner with left and right thumb. After digitalization of the EEG from Cz, C3, C4 electrodes, the movement reactive beta frequency (MRBF), its minimum/maximum peak power values and their latencies triggered to movement offset were determined. Results - The time course and amplitude of movement related beta desynchronization (ERD) were similar in each group regardless of tremor intensity. In ET tremor severity did not influence post-movement beta synchronization (PMBS) amplitude (PMBSET+=100.98±48.874%, PMBSET++=135.1±92.87%; p=0.231), however it was significantly delayed after the movement of the more tremulous hand (latPMBSET+=1.26±0.566 s, latPMBSET++= 1.57±0.565 s, p=0.003). In the PT group on the side of pronounced tremor the amplitude of PMBS decreased but it was not delayed, compared to the less affected hand (PMBSPT+=115.19±72.131%, PMBSPT++= 77.84±53.101%, p=0.0028; latPMBSPT+=1.4±0.74 s, latPMBSPT++=1.25±0.797 s, p=0.191). In controls the power and latency of PMBS was similar on both sides. Conclusions - The results suggest that neuronal mechanisms underlying PMBS generation are differently affected by ET and PT. Investigation of PMBS might be used for the differential diagnosis of essential tremor and Parkinson's disease.]

Lege Artis Medicinae

NOVEMBER 30, 2006

[THERAPY WITH TRIMETAZIDINE IN DIABETIC PATIENTS WITH CORONARY DISEASE]

NAGY András

[In the diabetic heart the efficacy of haemodynamic agents is limited due to vascular stiffness. Metabolic drugs such as trimetazidine switch energy production from fatty acid oxidation typical to diabetes to the more efficient glycolysis. The improved energy production increases contractility. Three studies have been conducted with trimetazidine in patients with comorbid diabetes and coronary artery disease. In these, trimetazidine improved left ventricular function without modifying heart rate or blood pressure. Markers of glycaemic control also improved. Trimetazidine also reduced the levels of circulating endothelin-1. In conclusion, trimetazidine is a safe and effective drug that improves both myocardial function and glycaemic control in patients with coexisting diabetes and coronary artery disease.]