64 research outputs found
Thrombocytopeniak.
Thrombocytopenia means low platelet count. This is the most frequent cause of bleeding abnormalities. Petechias, purpuras, mucosal bleeding are typical clinical findings. Severe, even life threatening gastrointestinal or intracranial bleeding may also occur. Diagnostic laboratory finding is the prolonged bleeding time. There are several causes of thrombocytopenia. The major mechanisms for a reduced platelet count are decreased production and increased destruction of platelets, or both. The major task is to reveal the underlying cause. Examination of the bone marrow and the peripheral blood smear can be helpful as well as special diagnostics of the assumed disease. Therapy targets the underlying disease, and also involves platelet transfusion. However, in case of diseases with increased platelet activation and consumption, platelet transfusion is forbidden because it may lead to aggravation of the pathologic process. Orv. Hetil., 2014, 155(8), 291-303
A klinikai epidemiológia beépítése a népegészségügyi ellenőr képzésbe
Az egészségügyi ellátással összefüggésben fellépő fertőzések olyan kihívást jelentenek, amelyekkel szemben a fellépés egyre több szakembert igényel. A közlemény összefoglalja a megelőző és követő tevékenységi körök rendszerét, az aktuális problémaköröket és a felsőoktatás előtt álló feladatokat
Antiphospholipid Syndrome and Thrombocytopenia
Antiphospholipid syndrome is characterised by arterial and venous thromboembolic events and pregnancy morbidity (mainly, recurrent foetal losses), in the presence of antiphospholipid antibodies. Diagnosis is based on the presence of at least one laboratory and at least one clinical manifestation of antiphospholipid syndrome. There are also so-called “non-criteria” clinical features, and thrombocytopenia is one of the most important among them. Thrombocytopenia has been reported with a prevalence between 30 and 46% among patients with antiphospholipid syndrome. The pathogenesis of thrombocytopenia related to antiphospholipid antibodies is not absolutely clear. Binding of antiphospholipid antibodies to platelets and the promotion of platelet activation and aggregation thus thrombus formation must be an important mechanism as well as the immune-mediated clearance of platelets. Thrombocytopenia in antiphospholipid syndrome is usually mild and does not require clinical intervention. The presence of thrombocytopenia in patients with antiphospholipid syndrome is typically associated not with haemorrhagic complications, rather it can trigger thrombotic events. Other causes of thrombocytopenia, such as TTP, SLE, MDS, and ITP should be excluded. As thrombocytopenia is usually mild and it predicts later thrombosis, patients may be given platelet aggregation inhibitors and/or anticoagulant therapy. Anti-thrombotic treatment should be stopped only in case of severe thrombocytopenia
Problémamegoldó ápolási-gondozási modell Parkinson-kórban
INTRODUCTION: Parkinson's disease affects more than 6,3 million people worldwide. Most patients and relatives are left alone to struggle with the symptoms associated with fluctuations in drug levels and the psychotic side effects of the anti-Parkinson's medications. Moreover, quite often even health providers may find difficult to interpret and manage the problems that have been encountered. AIM: The aims of the authors were to analyze systematically the biopsychosocial needs of Parkinson's patients, and to develop a complex, evidence-based Parkinson's-nursing-care model. METHOD: Patients' needs were assessed based on an observational study involving an old patient with Parkinson's disease for more than 28 years. The model has been specified as a multidisciplinary care framework adapted to the special characteristics of Parkinson's disease which transcends the limitations of different standard nursing models. RESULTS: The elaborated model contains a detailed description of cooperative problem solving, which is organized around individual patients along with recommendations for addressing various potential problems that might be encountered. CONCLUSIONS: Implementation of the presented model can improve the life quality of Parkinson's patients and can facilitate the life of affected families provided that these families are well aware about the potential benefits of the novel care delivery system. Orv. Hetil., 2016, 157(22), 855-868
AL-amyloidosis
Az AL-amyloidosis egy olyan szisztémás betegség, ahol kóros sejtek (malignus plazmasejtek) patogén fehérjét termelnek, amelyek lerakódnak a szervezetben. Az amyloidogen fehérjét monoklonális immunglobulin-molekula könnyű lánca alkotja, amely vízben oldhatatlanná válik, az extracelluláris térben kicsapódva a szövetekben lerakódik, szervkárosodás kialakulását eredményezve. A malignus plazmasejtbetegségek közé tartozik, illetve más, monoklonális B-sejtes betegséghez társulhat. A diagnózis – mint minden amyloidosistípusnál – a szövettani eredményre támaszkodik, de sokszor az amyloidogen fehérje azonosításához speciális vizsgálatokra is szükség van. A terápia alapvetően a malignus plazmasejtklón elpusztítására irányul. Az utóbbi évtizedekben a terápiás eszköztár igen jelentősen bővült, több, új hatásmechanizmusú gyógyszer is rendelkezésre áll (thalidomid, lenalidomid, bortezomib). Az arra alkalmas betegeknél ma a standard kezelést a nagy dózisú kemoterápiát követő autológ haemopoeticus őssejtátültetés jelenti, ezt azonban egy nagyon gondos rizikófelmérésnek kell megelőznie. A transzplantációra nem alkalmas betegeket kis dózisú alkilálószerrel, dexametazonnal, a kettő kombinációjával vagy valamelyik új gyógyszerrel lehet kezelni. Igen nagy jelentősége van a korai diagnózisnak és a terápia gyors megkezdésének, mert a parenchymás szervek kialakuló funkciózavara (elsősorban a szívelégtelenség) útját állja a hatékony kezelésnek. Mivel ritka betegségről van szó, a speciális centrumok tevékenységének jelentős szerepe van a klinikai vizsgálatok végzése terén.
AL amyloidosis is a systemic disease characterised by pathogenetic proteins produced by malignant plasma cells and
the deposition of them in different organs of the body. Amyloidogenic protein is the light chain of the monoclonal
immunoglobulin, which becomes water insoluble, precipitates and deposites in the extracellular space resulting damage of organ function. AL amyloidosis belongs to plasma cell dyscrasias or it can associate to other monoclonal B-cell diseases. Diagnosis – such as in case of other types of amyloidosis – is based on histology. Identification of the amyloidogenic protein often needs special examinations. The goal of the therapy is the eradication of the malignant cell
clone. Therapeutical armamentarium has been largely flared in the past few decades, several drugs with new mechanisms of action are available (thalidomide, lenalidomide, bortezomib). The standard treatment is high dose chemotherapy followed by autologous stem cell transplantation in case of eligible patients. Transplantation uneligible patients can be treated with a low dose alkylating agent with or without dexamethasone, or with the new agents. The therapeutical decision must be preceded by very thorough risk assessment. Early diagnosis and the prompt beginning of the treatment has great significance because the evolving functional abnormalities of parenchymal organs (mainly cardiac failure) prevents the effectivity of the treatment. Amyloidosis is an orphan disease, special centers play a signifi cant role in the field of clinical trials
Molecular laboratory tools for rapid diagnostics of systemic infections, and in clinical epidemiological practice
Antifoszfolipid-szindróma és a terhesség = Antiphospholipid Syndrome and Pregnancy
Az antifoszfolipid-szindrómára thromboemboliás események kialakulása mellett antifoszfolipid-antitestek jelenléte
jellemző. A szindróma további diagnosztikus kritériuma terhességi komplikációk jelenléte. Ez az egyik legkifejezettebb thrombosishajlamot fokozó kórállapot. Terhesség során és a gyermekágyi időszakban egészséges terhesség esetén is fokozott a thrombosishajlam, az anyai halálozás vezető oka a thromboembolia. Ha ehhez még más tényező is hozzájárul, az mind az anyára, mind a magzatra nézve komoly veszélyt jelent. A habituális vetélés, koraszülés, halvaszülés, eclampsia szintén jellemző klinikai megnyilvánulása a szindrómának. A megfelelően alkalmazott tromboprofilaxis segítségével egyrészt megelőzhetjük a jelentős morbiditást és mortalitást okozó thromboemboliás szövődmények kialakulását, másrészt hozzásegíthetjük a párokat egészséges gyermek világrahozatalához. Fontos az
antifoszfolipid-szindrómás betegeknek centrumba irányítása, ez a szakszerű ellátás mellett a komoly problémával szembesülő várandós édesanyák empatikus gondozását is szolgálja.
Antiphospholipid syndrome is characterized by arterial and venous thromboembolic events and persistent laboratory evidence of antiphospholipid antibodies. Obstetric complications such as recurrent miscarriage, early delivery, oligohydramnios, prematurity, intrauterine growth restriction, fetal distress, fetal or neonatal thrombosis, pre-eclampsia/eclampsia, and HELLP syndrome are also hallmarks of antiphospholipid syndrome. This syndrome is one of the diseases associated with the most severe thrombotic risk. Changes in the hemostatic system during normal pregnancy also result in a hypercoagulable state resulting in elevated thrombotic risk. Thromboembolic events are responsible of the vast majority of maternal and fetal deaths. Administration of appropriate thromboprophylaxis helps prevent thromboembolic complications during pregnancy in women with antiphospholipid syndrome and also give birth to healthy children. It is important to centralize the medication and management of these patients. It helps in the thoughtful care of these pregnant women encountering serious problems
40 years of education of diplomaed public health professionals in the Semmelweis University Faculty of Health Sciences and its predecessors
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