Hypertension and nephrology

[Accredited continuing training]

DECEMBER 20, 2021

Hypertension and nephrology - 2021;25(06)

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Hypertension and nephrology

[Data on blood pressure over two years in resistant hypertensive patients with lett brain stem microvascular decompression]

FEJES Imola, VÖRÖS Erika, BARZÓ Pál, ÁBRAHÁM György, LÉGRÁDY Péter

[In the background of resistant hypertension (RHT) the neurovascular pulsatile compression (NVPC) of the left rostral ventrolateral medulla may play a role. In these cases a microvascular decompression (MVD) may decrease the blood pressure (BP). The aim of this work was to investigate how the BP has changed after the MVD in the operated patients recorded at the farthest time from the MVD up to maximum 31 December 2016. We have retrospectively collected data from 9 patients whose follow-up data fór 2 years has already been published earlier. Data collection was carried out from the patient register program of the University of Szeged Albert-Szent Györgyi Clinical Centre. The MVDs were performed between 2000 and 2004. The mean follow-up time was 11.1±4.6 years. Both the systolic and the diastolic BPs were significantly lower at the time of last record compared to the BPs at the time of MVD (systolic BP 211±40 vs. 135±20 mmHg, p=0.003; diastolic BP 116±17 vs. 81±14 mmHg, p=0.007). Last recorded BPs compared to the 24-month data alsó were lower bút nőt signffi- cantly (systolic BP 148±32 vs. 135±20 mmHg, p=0.25; diastolic BP 96 vs. 85 mmHg, p=0.11). The mean number of antihypertensives at the last Office visít was nőt sig- nificantly higher compared to MVD (5.9±1.4 vs. 6.3±1.5; p=0.5) bút signfficantly increased compared to MVD +1 month data (4.7±0.9vs. 6.3±1.5; p=0.03). These results confirmed our previous opinion that in severe RHT nőt respond- ing to conventional therapy an MVD of the left side NVPC could be a therapeutic option and may guarantee a long-lasting BP reduction. Evén if the number of antihypertensives increased in the meantime, as they still responded better to therapy. ]

Hypertension and nephrology

[Nonproteinuric diabetic kidney disease]

LENGYEL Zoltán, SCHANDL László

[Diabetic nephropathy is one of the most common causes of chronic kidney disease. In recent years, besides the classic phenotype with increased urinary albumin excretion, another phenotype showing Progressive kidney failure without albuminuria has been observed with increasing frequency. The histology, the pathophysiology and the course of non-proteinuric diabetic kidney disease differs from the classic phenotype in several respects. The former shows traits similar to atherosclerotic kidney disease with respect to association with cardiovascular disease and histological alterations and the progression is slower. This has important implications concerning the screening, treatment and prognosis of the disease. While the available data about non-proteinuric diabetic nephropathy is relatively scant, it deserves attention both in everyday clinical practice and in scientific research.]

Hypertension and nephrology

[Extrapulmonary multiple organ damage and dysfunction in Covid-19]

KÉKES Ede, NAGY Judit

[SARS-CoV-2 virus attacks nőt only the lungs bút alsó many other or- gans (heart, kidney, liver, pancreas, gastrointestinal tract, brain, hematopoiesis) and regulatory system (RAAS, immuné system) to different degrees and with dif- ferent pathomechanisms. Accordingly, cell death, tissue damage and dysfunction or failure of somé organs has been developed. Our paper provides a detailed analysis of the incidence of extrapulmonary lesions, clinical manifestations, and the underlying pathomechanisms. This multi-organ damages was detected dom- inantly in severe Covid cases, bút may occur in moderate or mild cases. It should alsó be taken intő account that the consequences may occur after the acute phase, in a seronegative State - months after the onset of infection. In particu- lar, the heart (myocarditis, coronary insufficiency, arrhythmia), the kidney (acute renal failure and then permanent GFR decrease), glucose metabolism disorder (diabetes worsening, ketoacidosis, new diabetes) are the biggest therapeutic challenge. Multi-organ damage is due to direct virus-induced cell death, endo- thelial cell damage in the vascular system, and thrombo-inflammation with the formation of microthrombi, imbalance in the RAAS regulatory system, and early and delayed abnormal immuné response (cytokine storm).]

Hypertension and nephrology

[Risk of drug-drug interactions in hemodialyzed patien]

SZABÓ Alexandra, HARIS Ágnes

[Hemodialysis patients usually need large number of medications fór treatment of their multiple comorbidities. Because of the polypharmacy we have to count on several drug-drug interactions, which might necessitate modification of types and dosages of drugs, based on the patient's actual condition and current treatment. The use of anticoagulants causes everyday problems, because these drugs have high pharmacokinetics potency, and on the other hand their administration is indispensable. In our investigation we aimed to analyze the drug therapy of chronic hemodialysis patients in the Szent Margit Hospital Taraba István Dialysis Unit, and present the clinical pharmacist's role in the hospital team.]

Hypertension and nephrology

[Changes in systolic blood pressure in the Hungárián aduit population between 2010 and 2018 based on public health screening data]

KÉKES Ede, BARNA István, DAIKI Tenno, DANKOVICS Gergely

[Using our mobile public health screening system, we examined the changes in systolic blood pressure averages and systolic pressure distribution between 2010 and 2018 by analyzing the data of 72,857 women (mean age 42.3±13.9 years) and 61,563 mén (mean age 42.2±13.9 years) in three consecutive time periods. The SBP averages have been gradually and significantly decreased since 2010 in all age groups. The parametric and non-parametric characteristics of the systolic distribution curves alsó showed a favorable change during the indicated period. The observed changes may indicate that the primary and secondary prevention, as well as the treatment of hypertension and the physician-patient cooperation in Hungarywere successful in the indicated period.]

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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.]

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. ]

Journal of Nursing Theory and Practice

[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.]

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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.