Papp M.,Debrecen University |
Norman G.L.,INOVA Diagnostics Inc. |
Vitalis Z.,Debrecen University |
Tornai I.,Debrecen University |
And 14 more authors.
PLoS ONE | Year: 2010
Background: Bacterial translocation plays important role in the complications of liver cirrhosis. Antibody formation against various microbial antigens is common in Crohn's disease and considered to be caused by sustained exposure to gut microflora constituents. We hypothesized that anti-microbial antibodies are present in patients with liver cirrhosis and may be associated with the development of bacterial infections. Methodology/Principal Findings: Sera of 676 patients with various chronic liver diseases (autoimmune diseases:266, viral hepatitis C:124, and liver cirrhosis of different etiology:286) and 100 controls were assayed for antibodies to Saccharomyces cerevisiae(ASCA) and to antigens derived from two intestinal bacterial isolates (one gram positive, one gram negative, neither is Escherichia coli). In patients with liver cirrhosis, we also prospectively recorded the development of severe episodes of bacterial infection. ASCA and anti-OMP PlusTM antibodies were present in 38.5% and 62.6% of patients with cirrhosis and in 16% and 20% of controls, respectively (p<0.001). Occurrence of these antibodies was more frequent in cases of advanced cirrhosis (according to Child-Pugh and MELD score; p<0.001) or in the presence of ascites (p<0.001). During the median follow-up of 425 days, 81 patients (28.3%) presented with severe bacterial infections. Anti-microbial antibody titers (p = 0.003), as well as multiple seroreactivity (p = 0.036), was associated with infectious events. In logistic regression analysis, the presence of ascites (OR:1.62, 95%CI:1.16-2.25), co-morbidities (OR:2.22, 95%CI:1.27-3.86), and ASCA positivity (OR:1.59, 95%CI:1.07-2.36) were independent risk factors for severe infections. A shorter time period until the first infection was associated with the presence of ASCA (p = 0.03) and multiple seropositivity (p = 0.037) by Kaplan-Meier analysis, and with Child-Pugh stage (p = 0.018, OR:1.85) and co-morbidities (p<0.001, OR:2.02) by Cox-regression analysis. Conclusions/Significance: The present study suggests that systemic reactivity to microbial components reflects compromised mucosal immunity in patients with liver cirrhosis, further supporting the possible role of bacterial translocation in the formation of anti-microbial antibodies. © 2010 Papp et al.
Altorjay I.,Debrecen University |
Vitalis Z.,Debrecen University |
Tornai I.,Debrecen University |
Palatka K.,Debrecen University |
And 15 more authors.
Journal of Hepatology | Year: 2010
Background & Aims: Mannose-binding lectin (MBL) is a serum lectin synthesized by the liver and involved in innate host defense. MBL deficiency increases the risk of various infectious diseases mostly in immune-deficient conditions. Bacterial infections are a significant cause of morbidity and mortality in liver cirrhosis due to the relative immuncompromised state. Methods: Sera of 929 patients with various chronic liver diseases [autoimmune liver diseases (ALD), 406; viral hepatitis C (HCV), 185; and liver cirrhosis (LC) with various etiologies, 338] and 296 healthy controls (HC) were assayed for MBL concentration. Furthermore, a follow-up, observational study was conducted to assess MBL level as a risk factor for clinically significant bacterial infections in cirrhotic patients. Results: MBL level and the prevalence of absolute MBL deficiency (<100 ng/ml) was not significantly different between patients and controls (ALD: 14.5%, HCV: 11.9%, LC: 10.7%, HC: 15.6%). In cirrhotic patients, the risk for infection was significantly higher among MBL deficient subjects as compared to non-deficient ones (50.0% vs. 31.8%, p = 0.039). In a logistic regression analysis, MBL deficiency was an independent risk factor for infections (OR: 2.14 95% CI: 1.03-4.45, p = 0.04) after adjusting for Child-Pugh score, co-morbidities, gender, and age. In a Kaplan-Meier analysis, MBL deficiency was associated with a shorter time to develop the first infectious complication (median days: 579 vs. 944, pBreslow = 0.016, pLogRank = 0.027) and was identified as an independent predictor in a multivariate Cox-regression analysis (p = 0.003, OR: 2.33, 95% CI: 1.34-4.03). Conclusions: MBL deficiency is associated with a higher probability and shorter time of developing infections in liver cirrhosis, further supporting the impact of the MBL molecule on the host defense. © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Argay M.,Semmelweis University |
Koos I.,Borsod Abauj Zemplen County Hospital |
Mesko A.,Semmelweis University |
Zelko R.,Semmelweis University |
Hanko B.,Semmelweis University
International Journal of Clinical Pharmacology and Therapeutics | Year: 2013
Objective: To obtain information on the main causatives of acute myocardial infarction (AMI), the background needs to be analyzed. Our aim was to identify those pharmaceutical aspects of this polymorbidity where the pharmacist can contribute. Earlier and recent European and Hungarian studies show similar results: cardiovascular (CV) death is still the leading cause of mortality. The quality of life is much lower and life expectancy is shorter in the investigated Borsod-Abaúj Zemplén county population compared to the whole of the country. After pharmaceutical care has been defined, its role should be established. Methods: A retrospective hospital-based survey was carried out. Medical records of 659 patients treated for myocardial infarction at the 1 st Department of Internal Medicine-Cardiology of Borsod-Abaúj- Zemplén County Hospital and University Hospital were analyzed. Data were obtained using the MedWorkS integrated hospital information system and were selected based on Social Security Number (TAJ) and The International Statistical Classification of Diseases and Related Health Problems (ICD). We focused on the therapy and medication of patients. Results: The obtained results are consistent with those of previous Hungarian studies (OLEF 2000) and statistical analyses. Based on the present study we suggest that pharmacists should work more closely with the medical staff. In studying the medication, we concentrated on antiplatelet therapy and studied the use of aspirin alone compared to aspirin plus clopidogrel. Of the 659 patients only 172 received aspirin as a preventive agent. We noticed that during this study only a low number of patients received ASA treatment and it could be seen in the outcome of the illness. We also found that dual antiplatelet therapy did not decrease the incidence of reinfarction in patients with AMI. Discussion: In this study the theory (guidelines, other studies) and the clinical practice of the therapy and medication of AMI were compared. ASA therapy did not produce any significant effect. Our results are similar to those studies which concluded that ASA did not decrease the risk of cardiovascular events. Conclusion: Most patients with AMI suffer from polymorbidity. Since the occurrence of underlying chronic diseases is high, not only AMI must be treated, but therapy and medication must be complex. Complex therapeutic management is the key to the success of pharmaceutical care in the community pharmacy following hospital treatment. © 2013 Dustri-Verlag Dr. K. Feistle.
Letrozol therapy of postmenopausal women with early-stage breast carcinoma after four-six years of tamoxifen therapy: Tolerability and quality of life [Korai stádiumú emlocarcinomában szenvedo posztmenopauzális korú nobetegek letrozolkezelése négy-hat éves tamoxifenterápia után: Tolerálhatóság és életminoség]
Toth E.K.,Semmelweis University |
Nemeskeri C.,Uzsoki Municipal Hospital |
Szabo B.,Borsod Abauj Zemplen County Hospital |
Urbancsek H.,Debrecen University |
And 6 more authors.
Lege Artis Medicinae | Year: 2013
INTRODUCTION: In patients with hormone-dependent breast cancer, five-year postoperative tamoxifen therapy is a standard treatment approach. Continuing this therapy for more than five years can increase the risk of recurrence of the disease. It has been shown that treatment with the third-generation aromatase inhibitor letrozol after discontinuation of tamoxifen therapy significantly improves disease-free survival. It is important to assess whether the substantial decrease of estrogen level shows a correlation with the occurrence of unwanted events/side effects or with changes in the quality of life. PATIENTS AND METHOD: Between 2005 and 2009, 921 women (mean age 63 years, age 40-94 years) with early-stage breast carcinoma were treated with expanded adjuvant letrozol therapy following tamoxifen treatment. Of these patients, 541 received previous tamoxifen therapy for 4-6 years. We studied relapses and quality of life - measured by the SF-36 survey - during letrozol therapy in the latter patient group and the occurrence of unwanted events and side effects in all 921 patients. The patients were examined eight times and completed the survey four times. RESULTS: At the check-ups, relapses were recorded in case of 20 patients. Quality of life scores significantly increased in two main categories - physical and mental health-, and within these in three subcategories, whereas decreasing scores were not recorded in any categories. In 921 patient taking letrozol, 73 experienced unwanted events/side effects, of which nine were severe and three patient died. The two most common side effects were joint and bone pain (18 patients) and heat rash (12 patients). CONCLUSION: Extended adjuvant therapy with letrozol efficiently decreased the number of relapses and the number of patients continuing therapy. On the basis of the SF-36 survey the patients' quality of life generaly improved. Letrozol therapy was well tolerated by most patients, which can have a favourable effect on the outcome of the therapy.
Dank M.,Semmelweis University |
Budi L.,Borsod Abauj Zemplen County Hospital |
Piko B.,Bekes County Pandy Kalman Hospital |
Mangel L.,University of Pécs |
And 4 more authors.
Anticancer Research | Year: 2014
Background: First-line bevacizumab-paclitaxel therapy demonstrated a median progression-free survival (PFS) of 11 months in three randomized phase III trials on metastatic breast cancer (mBC) (E2100, TURANDOT and CALGB 40502). We assessed the efficacy and safety of bevacizumab-paclitaxel in a routine oncology practice study. Patients and Methods: Patients with previously untreated mBC received bevacizumab-paclitaxel according to the approved indication in Hungary. The primary end-point was PFS. Secondary end-points included time-to-treatment discontinuation, 1-year survival rate, PFS in patients with triple-negative breast cancer (TNBC) and safety. Results: Median PFS in the 220 treated patients was 9.3 (95%CI 7.8- 10.8) months. The 1-year survival rate was 68%. In patients with TNBC (N=106), median PFS was 8.3 months (95%CI 7.8-8.8). Adverse events were consistent with the established safety profile of bevacizumab-paclitaxel. Conclusion: Bevacizumab-paclitaxel is an active and well-tolerated firstline treatment for mBC, with notable activity in TNBC.
Gerlinger I.,University of Pécs |
Bako P.,University of Pécs |
Piski Z.,University of Pécs |
Revesz P.,University of Pécs |
And 3 more authors.
European Archives of Oto-Rhino-Laryngology | Year: 2013
The aim of this study was an evaluation of the mid-term hearing results after the implantation of a self-crimping heat memory Nitinol piston in stapes surgery. The 12-month postoperative results were compared with those at a minimum of 3 years (maximum 6.7, average 4.4 years). The medical records of all 44 patients who underwent surgery with a Nitinol piston for stapes fixation between November 2005 and January 2007 were evaluated retrospectively. The prostheses used in all cases measured either 4.5 or 4.75 × 0.6 mm. We hypothesized that the 12-month postoperative hearing results would be permanent after an average follow-up of 4.4 years. Thirty-two of the 44 consecutive patients were females and 12 were males. Their mean age was 40.4 years (range 27-69). All underwent a 12-month postoperative audiometric evaluation. 38 (30 females, 8 males, average age 45, range 28-77 years) of the 44 were available for mid-term 4.4-year (minimum 3 years, maximum 6.7 years) postoperative audiometric evaluation. The mean air-bone gap (ABG) for the frequencies 0.5, 1, 2 and 3 kHz at the 12-month postoperative follow-up was 11 dB (SD 4.1) and that after an average 4.4-year postoperative evaluation was 6.4 dB (SD 3.6). The mean decrease in ABG after 12 months was 19.5 dB, and that after the average 4.4 years was 21.3 dB. ABG closure within 10 dB was achieved in 77.2 % after 12 months and in 89.5 % after the average 4.4 years. No patient with an ABG > 20 dB was recorded after the average 4.4 years. The mean air conduction threshold at 4 kHz was examined pre and postoperatively so as to indicate any possible inner ear damage. At the 12-month follow-up, the difference between the pre and postoperative values was -2.5 dB, whereas after the average 4.4 years the difference was surprisingly +13 dB. The individual AC improvements were also demonstrated with the use of Amsterdam Hearing Evaluation Plots (AHEPs). The Nitinol prosthesis allowed excellent intraoperative handling and no postoperative complication was reported. As compared with conventional stapes prostheses, the Nitinol-based SMart prosthesis is a safe and reliable stapes prosthesis. Our mid-term audiometric evaluations revealed that the audiometric parameters demonstrated a hearing improvement between the postoperative 12-month and average 4.4-year examinations. We consider the elimination of manual crimping and the use of a "non-touch" hand-held laser technique has a positive impact on the mid-term audiometric results. Most of the previous studies presented only relatively short-term (from 6 weeks up to 6-12 months) audiometric evaluations. Complications are rare, but a longer follow-up is needed to establish the long-term stability. © 2013 Springer-Verlag Berlin Heidelberg.
Koszo R.,University of Szeged |
Santha D.,University of Szeged |
Budi L.,Borsod Abauj Zemplen County Hospital |
Erfan J.,Szabolcs Szatmar Bereg County Josa Andras Hospital |
And 9 more authors.
Pathology and Oncology Research | Year: 2016
Due to the limited experience with capecitabine plus docetaxel (XT) combination in the first-line treatment of metastatic breast cancer in Hungary, the main objective of the study was to analyze the effectiveness and tolerability of XT therapy. A prospective, open-label, non-randomized, single-arm, multicenter, observational study was designed. All female patients were eligible whose metastatic breast cancer could be treated with the XT protocol according to the summary of product characteristics of the drugs. The median progression free survival was 9.9 ± 3.0 months. Time to treatment failure was 4.6 ± 5.1 months on average. The overall response rate was 28.9 %, the clinical benefit rate was 73.3 %. The treatment was discontinued in 35.6 % of patients due to disease progression and in 20.0 % due to adverse events (AE). 33 patients with a total of 73 AEs have been reported, and 13 of them had serious adverse events (SAE). The efficacy and the safety profile of XT chemotherapy proven in the study are consistent with the results demonstrated in randomized trials. First-line XT chemotherapy effectively improves the PFS in metastatic breast cancer. © 2016 Arányi Lajos Foundation
Gal A.,Semmelweis University |
Komlosi K.,University of Pécs |
Maasz A.,University of Pécs |
Pentelenyi K.,Semmelweis University |
And 7 more authors.
Central European Journal of Medicine | Year: 2010
The A3243G mutation in the mitochondrial tRNALeu (UUR) gene is one of the most common causes of mitochondrial DNA related disorders. Originally it was described in MELAS syndrome (Mitochondrial Encephalomyopathy, Lactic acidosis, Stroke-like episodes), later it had been found to be associated with various phenotypes. In our study the mutation frequency of the A3243G mtDNA mutation was investigated in patients with maternal sensoneural hearing loss, stroke-like episodes, ataxia and myopathy with undetermined etiology. We screened 631 Hungarian patients in North-East, South-West and Central Hungary between 1999 and 2008 for this mutation. The mtDNA analysis was performed from blood and/or muscle tissue. The A3243G substitution was present in 6 patients in heteroplasmic form. The segregation analysis detected 8 further cases. The frequency of the A3243G mutation was 2.22% in the investigated patients. The A3243G mutation frequency in Hungary does not differ significantly from other countries using similar patient selection criteria, however in Finland a higher mutation rate was found. In studies investigated the mutation frequency of this mutation in diabetes mellitus similarly wide variety was detected as well. We conclude that the study design has a huge impact on the result of the genetic epidemiological investigation analyzing the mutation frequency of the A3243G mutation due to the broad clinical phenotype and the different mutation load in different tissues. © 2010 Versita Warsaw and Springer-Verlag Berlin Heidelberg.
Sikorszki L.,Borsod Abauj Zemplen County Hospital |
Kalmar K.,University of Pécs |
Pavlovics G.,University of Pécs |
Papp A.,Borsod Abauj Zemplen County Hospital |
And 3 more authors.
European Surgery - Acta Chirurgica Austriaca | Year: 2012
Background: During the surgical treatment of corrosive oesophageal strictures, one of the most important decisions to make is, whether the injured and scarred oesophagus should be removed or bypassed. Resectional approach is justified by the high frequency of scar cancer developing in the injured oesophagus. On the other hand, according to advocators of bypass surgery, the risk of malignant transformation in the oesophagus excluded from the food passage is negligible, when bypass is performed within few years of injury. There are very few data on the risk of cancer in the remaining oesophagus following resection, and in the replacement organ in case of bypass. Case report: On three cases - one skin tube cancer in the replacement organ 21 years following injury, one colon cancer in the replacing colon 44 years following injury and one oesophageal scar cancer in the remnant oesophagus 28 years following injury - three different types of late malignisation in the remaining oesophagus as well as in different organs used for oesophageal replacement are demonstrated. Results: Malignant transformation is rarely but equally occurs in the remnant oesophagus following caustic injury and in the different organs used for replacement. Conclusion: In this debate, there are more controversies than consensus. © Springer-Verlag Wien 2012.
Feher L.Z.,Hungarian Academy of Sciences |
Pocsay G.,Pandy Kalman County Hospital |
Krenacs L.,Laboratory of Tumour Pathology and Molecular Diagnostics |
Zvara A.,Hungarian Academy of Sciences |
And 7 more authors.
Pathology and Oncology Research | Year: 2012
Papillary thyroid carcinoma (PTC) is the most common well-differentiated thyroid cancer. Although the great majority of the cases exhibit an indolent clinical course, some of them develop local invasion with distant metastasis, and a few cases transform into undifferentiated/anaplastic thyroid carcinoma with a rapidly lethal course. To identify gene copy number alterations predictive of metastatic potential or aggressive transformation, arraybased comparative genomic hybridization (CGH-array) was performed in 43 PTC cases. Formalin-fixed and paraffinembedded samples from primary tumours of 16 cases without metastasis, 14 cases with only regional lymph node metastasis, and 13 cases with distant metastasis, recurrence or extrathyroid extension were analysed. The CGH-array and confirmatory quantitative real-time PCR results identified the deletion of the EIF4EBP3 and TRAK2 gene loci, while amplification of thymosin beta 10 (TB10) and Tre-2 oncogene regions were observed as general markers for PTC. Although there have been several studies implicating TB10 as a specific marker based on gene expression data, our study is the first to report on genomic amplification. Although no significant difference could be detected between the good and bad prognosis cases in the A-kinase anchor protein 13 (AKAP13) gene region, it was discriminative markers for metastasis. Amplification in the AKAP13 region was demonstrated in 42.9% and 15.4% of the cases with local or with distant metastasis, respectively, while no amplification was detected in nonmetastatic cases. AKAP13 and TB10 regions may represent potential new genomic markers for PTC and cancer progression. © Arányi Lajos Foundation 2011.