Hypertension and nephrology

[ACCREDITED CONTINUING TRAINING]

APRIL 29, 2021

Hypertension and nephrology - 2021;25(02)

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Hypertension and nephrology

[Current evidence on the accuracy and precision of non-invasive cardiac output monitoring]

VÉGH Anna, REUSZ S György

[Purpose of review: Assessing cardiac output (CO) is an important part of monitoring the hemodynamically unstable patients. Different non-invasive CO measurement devices are currently available, that can be useful in various clinical situations. The purpose of this article is to review current literature on commonly employed methods especially regarding their accuracy and precision. Results: Most of the devices, especially the non-invasive ones have the disadvantage of questionable accuracy and precision. Generally speaking, the more a method is based on assumptions and mathematical models, the less precise it will be. There is also significant heterogeneity between individual studies. Clinically it is important to consider the purpose of the measurement before choosing a method. In terms of accuracy the most reliable ones are, the ones that are based on simple physical principles and minimal assumptions, for example transthoracic echocardiography, and thermodilution. Conclusions: To have better comparability between individual studies it would be imperative to have standardized study protocols regarding the number of cardiac cycles assessed, the used method, the clinical environment, the age and clinical condition of the study population.]

Hypertension and nephrology

[Case report of supine hypertension and extreme reverse dipping phenomenon decades after kidney transplantation]

BATTA Dóra, KŐRÖSI Zita Beáta, NEMCSIK János

[Supine hypertension, a consequence of autonomic neuropathy, is a rarely recognized pathological condition. Reported diseases in the background are pure autonomic failure, multiple system atrophy, Parkinson’s disease, diabetes and different autoimmune disorders. In our case report we present a case of supine hypertension which developed in a patient decades after kidney transplantation. The patient was followed for 25 months and we demonstrate the effect of the modification of antihypertensive medications. At the time of the diagnosis supine hypertension appeared immediately after laying down (office sitting blood pressure (BP): 143/101 mmHg; office supine BP: 171/113 mmHg) and on ambulatory blood pressure monitoring (ABPM) extreme reverse dipping was registered (daytime BP: 130/86 mmHg, nighttime BP: 175/114 mmHg). After the modification of the antihypertensive medications in multiple times, both office supine BP (office sitting BP: 127/92 mmHg; office supine BP: 138/100 mmHg) and on ABPM nighttime BP improved markedly (daytime BP: 135/92 mmHg, nighttime BP: 134/90 mmHg). In conclusions, our case report points out that autonomic neuropathy-caused supine hypertension and extreme reverse dipping can develop in chronic kidney disease, after kidney transplantation. The modification of the antihypertensive medications can slowly restore this pathological condition.]

Hypertension and nephrology

[When should antihypertensive be taken: in the morning and/or evening? Chronopharmacotherapy of hypertension in practice]

SZAUDER Ipoly

[The circadian (24-hour) variability of blood pressure (BP) is influenced by constant and variable (external and internal) factors. With this in mind and by determining the type of hypertension with a 24-hour blood pressure monitoring (ABPM), individual chronopharmacological (chronopharmacotherapy) treatment can be planned. There are significant differences in the chronokinetics of antihypertensive drugs administered at different times. Their therapeutic range and efficacy depend significantly on their circadian timing. Although the most modern antihypertensives have a 24-hour effect, they are not able to lower blood pressure at all times. Morning intake of ACE inhibitors, ARB-s, alpha-blockers mainly affect the afternoon and early evening rise, while evening intake reduces nocturnal and morning rise. Calcium channel blockers, beta-blockers (except carvedilol and labetolol), do not affect the circadian blood pressure profile. Therefore, in nondipper hypertension or in the case of morning rise, the twice daily morning and evening administration is more effective than the single morning administration. (Usually a lower dose is sufficient in the evening.) Adequate control of nocturnal or morning blood pressure elevations can be achieved with medication taken in the evening. According to the relevant studies the conclusion is that there is no convincing evidence that the administration of BP-lowering drugs in the evening provides any significant advantage in terms of quality of BP control, prevention of target organ damage or reduction of cardiovascular events, so evening intake only is not recommended. In particular the administration of antihypertensive drugs at bedtime, especially in the case of elderly patients may cause excessive BP fall at night with increased risk of silent cerebral infarct and the myocardial ischemia in patients with coronary heart disease.]

Hypertension and nephrology

[Covid-19 and peripheral arterial disease]

FARKAS Katalin

[Patients with peripheral vascular disease (PAD) are negatively affected by the coronavirus epidemic in several ways. Fewer-than-usual doctor-patient encounters make it more difficult to detect disease or disease progression. Outbreaks due to the epidemic reinforce a sedentary lifestyle that can mask the symptoms of PAD through lack of exercise. Another risk is that patients with cardiovascular disease are at risk for severe Covid-19 disease, and have a significantly increased risk of mortality. In the case of home treatment of Covid-19 infection in a patient with PAD, close observation is required to make a timely decision on the need for hospitalization. Vaccination, which is gradually available to all PAD patients, could be the solution to prevent the disease.]

Hypertension and nephrology

[At the doorstep of an attitude change: our novel knowledge on renal fibrosis in chronic kidney disease]

BUKOSZA Nóra Éva

[In spite of the diverse etiology, chronic kidney disease is finally leading to end-stage renal disease uniformly by the fibrotic transformation of the kidneys. In recent years – mainly due to experimental data – the explanation of this transformation changed profoundly: it has been revealed, that renal fibrosis is a dynamic, actively ongoing process involving many keyfactors. Influencing these factors, give us hope to prevent the progression of chronic kidney disease. This review summarizes the connection of renal fibrosis and chronic kidney disease, the results of the widely used different methods and the recently discovered mechanisms, which caused paradigm change in this topic]

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[Operational Efficiency Investigation from APN Perioperative Perspective]

MADARÁSZ Ildikó, VÁRADYNÉ HORVÁTH Ágnes, PUSZTAI Dorina, ROZMANN Nóra, BERTA Gábor, HARANGOZÓ Csilla, KOZMANN Krisztina

[In the healthcare system operating theatres have to put great emphasis on quality work, patient safety and efficiency as well, and to achieve this, optimal utilization of theatres is extremely important. The results of researches in this topic in Hungarian and international literature draw attention to a lot of aspects. The study of perioperative periods, and the evaluation of the analysed processes show that theatres could be operated more effectively. As a result of this, more operations could be carried out and waiting time would also reduce. In order to increase the efficiency of the processes, APNs can play a prominent role at several points. According to the experience, the number of people using health care and the number of people waiting for surgery is increasing, which is further increased by the development of the ongoing SARS-CoV-2 (COVID-19) epidemic. Thereby, patients are not satisfied with the service. The work of APNs would also help increasing the contentment of patients during the operation procedures. Taking advantage of the multifunctional role of the nurse due to her knowledge and training, she actively participates in the operation, in the smooth running of the scheduled daily surgical program and contributes to the reduction of the number of missed, planned surgeries.]

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[Assessing Nurses’ Knowledge of Surgical Wound Care, Complications and Knowledge of Bandages]

FERENCZY Mónika, BÁLINT Beáta, KOMLÓSI Kálmánné, KARÁCSONY Ilona

[Aim of our research was to assess the knowledge of nurses working in surgical departments about surgical wound treatment, phases of wound healing, its complications, and intelligent bandages. Our quantitative, cross-sectional, descriptive examination was carried out in a hospital in Transdanubia with non-random, expert sampling and a self-made questionnaire. Our target group was nurses working in the surgical departments of the hospital (N=85). During the data analysis, the descriptive statistical methods of MS Office Excel 2016 software were calculated: mean, standard deviation, frequency. A χ2-test was used to examine the relationship between variables (p <0.05). Knowledge of bandages was not affected by educational attainment (p>0.05). Those who perform wound care in their daily work have more knowledge about the wound treatment sequence of the wounds that are primarily healing, as well as about intelligent dressings (p<0.1). For the classes, there was a significance for the recognition of complicated wounds, knowledge of the benefit of the absorbable suture and the use of analgesic procedures (p<0.001). In the interests of patient safety, nurses’ knowledge of wound treatment needs to be continuously improved. It is necessary to provide an accessible source of information and further training.]

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[Evaluation of clinical practices among academic nursing students]

NAGY-GÁL Anetta

[Purpose: Establishing a balance between theoretical and practical training is essential in the training of college nursing students. The aim was to assess the students’ experiences of clinical practice and the problems they indicate in the component, which plays an important role in preparing the training for professional competencies. The study sample consisted of 3rd and 4th grade students (N=96) participating in nursing training at the Faculty of Health Sciences of Semmelweis University. The method of data collection was based on the completion of a quantitative online questionnaire, which also included qualitative elements in the form of three open-ended questions. Among the statements measured on the Likert scale, the balance of theory-practice, the role of participants in education, and the time spent on practical tasks received lower average ranks from both grades. Logistic regression is suitable for estimating the probability of a positive/negative impression of a practice as a combined effect of several explanatory variables. Compared to the results of a previous (2009) study, the problems with field clinical training remain unresolved.]

Clinical Neuroscience

[Is the implementation of Vojta therapy associated with faster gross motor development in children with cerebral palsy? ]

SANZ-MENGIBAR Jose Manuel , MENENDEZ-PARDIÑAS Monica , SANTONJA-MEDINA Fernando

[Vojta therapy has been reported as clinically beneficial for strength, movement and gross motor activities in individual cases and is being included within the second of three levels of evidence in interventions for cerebral palsy. The goal of this study is to understand the effect of Vojta therapy on the gross motor function. Our clinical trial followed a one group, pre-post design to quantify rates of changes in GMFM-88 after a two-months period undergoing Vojta therapy. A total of 16 patients were recruited. Post-intervention acceleration rates of GMFM-88-items acquisition (0.005; p<0.001) and Locomotor Stages (1.063; p<0.0001) increased significatively following Vojta the­rapy intervention. In this study, Vojta therapy has shown to accelerate the acquisition of GMFM-88-items and Loco­motor Stages in children with cerebral palsy younger than 18 months. Because functional training was not utilised, and other non-Vojta therapy intervention did not influence the outcome, Vojta therapy seems to activate the postural control required to achieve uncompleted GMFM-88-items. ]

Clinical Neuroscience

Comparison of pramipexole versus ropinirole in the treatment of Parkinson’s disease

GENCLER Onur Serdar , OZTEKIN Nese , OZTEKIN Fevzi Mehmet

Parkinson’s disease is a progressive neurodegenerative disease characterized by motor and non-motor symptoms. Levodopa is the most effective drug in the symptomatic treatment of the disease. Dopamine receptor agonists provide sustained dopamin-ergic stimulation and have been found to delay the initiation of levodopa treatment and reduce the frequency of various motor complications due to the long-term use of levodopa. The primary aim of this study was to compare the efficacy of potent nonergoline dopamine agonists pramipexole and ropinirole in both “dopamine agonist monotherapy group” and “levodopa add-on therapy group” in Parkinson’s disease. The secondary aims were to evaluate the effects of these agents on depression and the safety of pramipexole and ropinirole. A total of 44 patients aged between 36 and 80 years who were presented to the neurology clinic at Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey and were diagnosed with idiopathic Parkinson’s disease, were included into this randomized parallel-group clinical study. Dopamine agonist monotherapy and levodopa add-on therapy patients were randomized into two groups to receive either pramipexole or ropinirole. The maximum daily dosages of pramipexole and ropinirole were 4.5 mg and 24 mg respectively. Patients were followed for 6 months and changes on Unified Parkinson’s Disease Rating Scale, Clinical Global Impression-severity of illness, Clinical Global Impression-improvement, Beck Depression Inven­tory scores, and additionally in advanced stages, changes in levodopa dosages were evaluated. Drug associated side effects were noted and compared. In dopamine agonist monotherapy group all of the subsections and total scores of Unified Parkinson’s Disease Rating Scale and Clinical Global Impression-severity of illness of the pramipexole subgroup showed significant improvement particularly at the end of the sixth month. In the pramipexole subgroup of levodopa add-on therapy group, there were significant improvements on Clinical Global Impression-severity of illness and Beck Depression Inventory scores, but we found significant improvement on Clinical Global Impression-severity of illness score at the end of the sixth month in ropinirole subgroup too. The efficacy of pramipexole and ropinirole as antiparkinsonian drugs for monotherapy and levodopa add-on therapy in Parkinson’s disease and their effects on motor complications when used with levodopa treatment for add-on therapy have been demonstrated in several previous studies. This study supports the effectiveness and safety of pramipexole and ropinirole in the monotherapy and levodopa add-on therapy in the treatment of Parkinson’s disease.