Use of cyclophosphamide and other immunosuppressive drugs in the treatment of patients with lupus nephritis.

UNLABELLED: Systemic lupus erythematosus (SLE) is a chronic relapsing systemic autoimmune disease; one of the most serious complications is renal involvement, which is occurring in almost 50% of all patients at the beginning of the disease. The aim of the present study was to compare renal function, proteinuria, activity markers and treatment regimen of active and inactive SLE patients with renal involvement. We analyzed the correlation of serum blood urea nitrogen, creatinine level, glomerular filtration rate, urine total protein/serum creatinine (uTP/creat), CRP to classic activity markers of SLE (serum complement 3, -4 level, anti-dsDNA antibody). Moreover we analyzed the treatment modalities of patients with lupus nephritis (LN). Data of 418 SLE patients were analyzed, out of these patients 128 had biopsy proven lupus nephritis or had more than 3 + proteinuria by urine dipstick analysis (30% of all cases). RESULTS: Data of 128 patients with lupus nephritis were analyzed (mean age 32.18 +/- 11.48 year, time between the diagnosis of SLE and LN was 2.78 +/- 4.59 year). 48% of patients had diffuse proliferative glomerulonephritis, 75% of them received cyclic cyclophosphamide treatment. UTp (total protein)/creatinine level was significantly higher in active LN group (p = 0.03), and correlated to erythrocyte sedimentation rate (p = 0.002, R = 0.52). Mean anti-dsDNA level of patients with active LN was significantly higher (p < 0.001). CONCLUSIONS: Patients with active lupus nephritis are at higher risk of developing renal failure, activity markers and urine protein are elevated in these patients as compared to inactive patients, early aggressive immunosuppressive treatment needs to be started to prevent end-stage renal failure.

Effect of drugs used in different type of myocardial infarction (STEMI or (NTEMI) on mortality.

We examined 416 patients with acute myocardial infarction. 249 patients had STEMI and 167 NSTEMI. 227 were men and 189 women. 142 men had STEMI and 85 men had NSTEMI. 107 women were diagnosed with STEMI and 82 with NSTEMI. 22.5% of patient with STEMI and 20.2% of patients with NSTEMI died (p = 0.58). We compared the effect of anticoagulant treatment, clopidogrel, salicylate, nitrate, beta-blocker, angiotensin-converting enzyme inhibitor, statin and trimetazidine therapy on mortality in function of the type of myocardial infarction. There were no differences between mortality of patients with STEMI and NSTEMI with respect of use of heparine, salicylate, nitrate, beta-blocker, ACE inhibitor, statin and trimetazidine. While examining the effect of clopidogrel, we observed a significantly lower mortality rate in patients with NSTEMI compared to the STEMI group (p = 0.005). These differences are due to the known variability in clopidogrel absorption and metabolism, which could be influenced by the type of myocardial infarction.

Serum and urinary cytokine levels of SLE patients.

Systemic lupus erythematosus (SLE) is a chronic, relapsing, polysystemic autoimmune disease with various clinical signs. The prognosis of SLE patients is influenced by neuropsychiatric and renal involvement. Lupus nephritis (LN) is present in 40-60% of patients. Classical laboratory parameters are not sensitive and specific in prediction renal flares, over the last few years there has been a growing interest in searching novel lupus biomarkers predicting future flares. Our goal was to detect serum and urinary level of cytokines in 36 patients with lupus nephritis (34 female and 2 male, mean age: 43.36 +/- 11.53 years), 23 patients with SLE without renal involvement (19 women and 4 men, mean age: 54 +/- 8.71) (both groups followed by the 3rd Department of Internal Medicine, Division of Clinical Immunology, University of Debrecen) and 30 healthy controls (23 female and 7 male, mean age: 45.5 +/- 12.4). Serum IL-1 (interleukin), IL-2 (both p < 0.05), IL-6, IL-13 and IFN-gamma (p < 0.001) levels were significantly higher in lupus nephritis patients, as compared to patients with SLE without renal involvement and healthy controls. Urinary level of IL-1 and TNF-alpha were significantly higher in SLE patients without renal disease (p = 0.012 and p < 0.001), while urinary IFN-gamma was significantly higher in LN patients (p = 0.002). Measurement of IL-6 level in SLE patients could help to predict future renal involvement of SLE patients.

Influence of statin treatment on mortality of patients with myocardial infarction.

Dyslipidaemia is a major risk factor of cardiovascular diseases, the role of serum total cholesterol (Chol) especially LDL-Chol is well established in the pathogenesis of atherosclerosis and ischemic heart disease. Use of cholesterol lowering drugs within the first 24 h of hospitalization for acute myocardial infarction (AMI) is associated with a lower rate of cardiogenic shock, arrhythmias, cardiac arrest and recurrent myocardial infarction. We assessed data of 416 patients admitted to hospital with AMI in a 2 year period (2001-2003) focusing on statin therapy. We have not found a correlation between serum lipid parameters and mortality of patients with AMI. Chronic statin treatment used before AMI (in 36 patients) did not influence mortality of patients. Chol level of patients with ST-elevation myocardial infarction (STEMI) was significantly higher (p = 0,043). Mortality of patients who did not receive statin treatment after AMI was significantly higher. These data highlight the importance of early aggressive statin treatment in patients with AMI and necessity of statins in patients with hypercholesterolaemia.

Does impairment of renal and hepatic function influence the metabolism of thrombolytics in patients with myocardial infarction?

Thrombolytic agents activate plasminogen and induce a systemic fibrinolytic and anticoagulant state. Two thrombolytic drugs are used frequently in practice: streptokinase (SK) and alteplase (t-PA). Streptokinase mainly undergoes renal elimination with a half-life of 11-17 min, while alteplase is eliminating by the liver with a half-life of 4-6 min. Our goal was to examine whether renal and hepatic function influence the elimination and metabolism of thrombolytics and the efficacy of percutaneous coronary intervention (PCI) after using alteplase or streptokinase. 416 patients with myocardial infarction (MI) were treated from January 2001 to December 2003 (228 male and 189 female). Alteplase was used in 9 men and 6 women (mean age: 53.88 +/- 9.61 vs. 65.33 +/- 9.87 years, p = 0.07). Patients who underwent rescue PCI after administration of alteplase had slightly higher hepatic enzyme levels/alanine transaminase (ALT): 47.85 vs. 41.4 U/l; gamma-glutamyl transpeptidase (GGT): 69.5 vs. 44.8 U/l/. All patients treated with alteplase survived, rescue PCI was done in 8 cases. Streptokinase was used in 36 men and 28 women (mean age: 63.33 +/- 10.51 vs. 63 +/- 12.03 years, p = 0.9). We did not find a difference between serum creatinine levels of patients who received streptokinase and underwent PCI as compared to those who had not. Rescue PCI was done in 16 cases. 12 patients died in this group. In conclusion we have not found a significant correlation between the use of the thrombolytics and hepatic or renal function; this could indicate that such a slight impairment of liver and renal function does not influence pharmacokinetic properties of thrombolytics.

Evaluation of asthma knowledge and quality of life in Hungarian asthmatics.

BACKGROUND: The objective was to develop an educational instrument, to assess its impact as an intervention instrument and to examine quality of life (QoL). METHODS: 119 asthmatics were randomized (64 in the intervention and 55 in the reference group). The education instrument was developed based on the EuroPharm-Forum Guidelines and its impact assessed by a self-developed questionnaire. Patients' QoL, asthma knowledge was assessed twice, once before and after the education seminar, education was only provided for the intervention group. QoL was measured with the St George's Respiratory Questionnaire (SGRQ) and a visual analogue scale (VAS). RESULTS: We found significant differences in answers to the asthma questions, by 40% improvement, but no changes in the control group. In inhaler-use technique, we could not find significant changes neither in the intervention nor in the control group. There were no significant differences between the results of the two visits neither with the VAS nor with the SGRQ on the QoL data. CONCLUSION: The results indicate that asthmatics experience lower QoL. As the subjects were regularly controlled asthmatics they had better general knowledge and inhaler-use technique was expected. The results suggest that it is necessary to regularly refresh asthma knowledge, to assess patients' self-management plans to achieve long-term effectiveness of asthma management.

Quality of life of patients with epilepsy (Hungarian survey).

We assessed the quality of life (QOL) of patients with epilepsy using the Quality of Life in Epilepsy Inventory (QOLIE-31). As the first step we compared our results with the data from an American survey in order to validate the test in Hungary. The results show that the Hungarian values were lower but that they followed the same trends as the American data. There was only one controversial result in the question-group of the 'the effects of treatment', which could be explained by the differences in habits and conventions, opportunities and expectations between Hungarian and American epileptic patients. We found significant differences in many aspects of quality of life with respect to (a) gender (general quality of life, seizure worry), (b) pharmacological treatment form (cognitive functions, medication effects, total score and social and role functioning) and (c) economic activity of patients (cognitive functions, emotional well-being, energy/fatigue, medication effects, overall quality of life, overall scores, seizure worry, social and role functioning). We have tried to explain the differences found by taking either the characteristics of epilepsy or the social background of the epileptic patient into consideration. Based on previous knowledge we have tried to define the situations where the assessment of quality of life for people with epilepsy, may be beneficial to their core.

[Therapeutic aspects of HIV/AIDS infected patients and evaluation of therapeutic protocols]. / HIV/AIDS betegek gyógyszeres kezelésének lehetóségei és a terápiás módszerek értékelése.

The first HIV-infected patients were treated in 1986, however, at that time medicines inhibiting HIV replication were not available. Solely the complications of AIDS and opportunistic infections could be treated. The HIV replication inhibition capacity of antiretroviral nucleoside and ribavirin were tested in Hungary in 1987, an early date even in international practice. The first nucleoside reverse transcriptase inhibitor (NRTI), azidothymidine, presently called zidovudine (ZDV), was introduced in 1989. By giving patients the appropriate dosage of this, the progression of the disease could be delayed by approximately 6 months to one year. In 1991, the application of two new NRTI was commenced, namely zalcitabine (DDC) and didanosine (DDI). These medicines were applied partly in case of ZDV intolerance and as a part of the sequential monotherapy. In 1994 and 1995 two new NRTI's were introduce, namely stavudine (d4T) and lamivudine (3 TC). At that same time, to obtain a more effective replication inhibition method, a double NRTI combination became part of the therapeutic protocol. The year 1996 resulted in significant changes. At the beginning of the year, two compounds belonging to two new therapeutic procedures. These are saquinavir (SQV) and delavirdine (DLV) belonging to the groups of protease inhibitors and non-nucleoside reverse transcriptase, respectively. The so-called virus cocktails and the effective active antiretroviral therapy (HAART) were applied and, later, to monitor the efficiency of the treatment, the opportunity was provided to measure the copy number of HIV-RNS. The treatment of the HIV disease entails a number of unanswered questions. The maximum result that can be achieved by using today's therapeutic methods is to prolong that particular phase of the HIV disease, which secures the patient a fairly good quality of life. The new combination of the antiretroviral compounds produced by the pharmaceutical industry provides better changes to prolong said period by years, sometimes decades. However, the real solutions to the problem are only theoretically known treatment procedures (gene therapy, cytokins) today.

[Analysis of antibiotic usage]. / Antibiotikum-felhasználás költségeinek elemzése.

Economic analysis is founded on the assumption that resources are limited and that should be used in a way that maximizes the benefits gained. Pharmacoeconomics extends these assumptions to drug treatment. Therefore, a full pharmacoeconomic analysis must consider two or more alternative treatments and should be founded on measurement of incremental cost, incremental efficacy, and the value of successful outcome. Antibiotic policy based only on administrative restrictions is failed, instead of it disease formularies and infectologist consultation system are needed. Equally important are various programmes that encourage the cost-conscious use of the antibiotics chosen. Some of the methods evaluated in the literature include: streamlining from combination therapy to a single agent, early switching from parenteral to oral therapy, initiating treatment with oral agents, administering parenteral antibiotic at home from outset of therapy, and antibiotic streamlining programmes that are partnered with infectious disease physicians. The solution is the rational and adequate use of antibiotics, based on the modern theory and practice of antibiotic policy and infection control, that cannot be carried out without the activities of experts in this field.

[Quality of life in asthmatics]. / Az asthmás betegek életminóségének vizsgálata.

UNLABELLED: Despite the availability of effective treatments asthma is increasing in both prevalence and severity specially in the well developed countries. As a consequence of this a large part of population is affected and the disease has a significant burden to the society. Evaluation of therapeutic effectiveness can be determined by measuring the quality of life. OBJECTIVE: As asthma has a major impact on the patients everyday life, we examined the quality of life of adult asthmatics with a disease specific questionniare (St. George's Respiratory questionniare SGRQ) and a visual analogue scale (VAS). We wanted to find out if the quality of life scores are significant with the results of clinical tests. METHODS: We examined 321 adult asthmatic patients. Patients were randomly selected. The influence of three factors age, sex, and FEV1 on quality of life was investigated. The data was analysed with user SPSS system. RESULTS: The results of the visuala analog scale were the following in female asthmatics 61.38%, in males 63.86%, the VAS results were the following according to the disease severity: mild intermittant 76%, mild 69%, moderate 60%, sever 49%. From the St. George questionniare three component scores were calculated: symptom (304.15 +/- 11.01), activity (580.71 +/- 19.57), impact (842.18 +/- 31.53) and the total score (1727.05 +/- 57.24). When we examined the different scores according to the age we found significant differences with the activity, impact and total score, but could not find significant differences with the symptom scores. The relationship between spirometry and quality of life is not as strong (coefficient of correlation: 0.37) but the majority of patients have high SGRQ scores even those patients whose FEV1 lies within the normal range. CONCLUSIONS: For patients with asthma it is common that one might see improvement in the FEV1 and yet not see an improvement in patients feelings or functioning. It was interesting to see that in spite of their bad conditions patients do accept the chronic nature of asthma, a degree of impairment and regard that as normal, limits in their everyday life, as they adjust their activity so that they can avoid the asthma attacks.

The study of asymmetric carrier transport phenomena in living systems.

The paper presents a probability model of carrier mechanism. The formation of a carrier-substrate complex is considered to happen with a variable probability as a stochastic model. The characterization of this process from a mathematical point of view is achieved. The mathematical description embeds the carrier mechanism into the general theory of transport processes. It is proved that the carrier transport mechanism is only the one of asymmetric transport phenomena.

The study of asymmetric transport phenomena in living systems through second-order phenomenological equations.

In this study we approach the transport phenomena by second-order phenomenological equations. If the condition of Onsager is not accepted, then it results that in the living system there is asymmetrical transport. The experimental investigations proved that the exchange between Na+-Ca2+ is asymmetric, as there takes place the transport of three ions of Na+ to one ion of Ca2+. This is an instance of concordance between theory and experimental research.

Drug utilization study of antiepileptics in Hungary.

This paper describes drug utilization review activities on anticonvulsant drugs in Hungary. Data on the use of phenytoin, carbamazepine, primidone, and sulthiam in the 20 administrative regions of the country are presented. From 1971 to 1980, consumption of these anticonvulsants doubled, and most of them were used in combination therapy. Estimates of the numbers of epileptics in the country were calculated from data on the international incidence of epilepsy and from total drug consumption data in Hungary.