Hypertension and nephrology

[Accredited Postgraduate Training]

SEPTEMBER 10, 2019

Hypertension and nephrology - 2019;23(04)

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Hypertension and nephrology

[Letter to our Readers]

ALFÖLDI Sándor, KÉKES Ede

Hypertension and nephrology

[Hungarian Hypertension Registry. Different methods and effects of increasing physician-patient cooperation on target blood pressure]

SZEGEDI János, KÉKES Ede, KISS István

[The life expectancy, the mortality and the development of complications of hypertensive patients are fundamentally influenced by the treatment, the effectiveness of care and physician-patient cooperation, the achievement of target blood pressure. Based on the database of the Hungarian Hypertonia Registry, we present three examples of the effect of different solutions for physician-patient cooperation on increasing the blood pressure target. During the two years between 2005 and 2007, we used a complex, versatile method of increasing the patient’s adherence in treated hypertensive patients (17,114 males and 21,772 women), with information, education, home-blood pressure diary, and continuous, regular physician- patient communication (sms, green phone line, website). The target blood pressure was significantly increased from 38.8% to 43.9%, and the rate of growth was higher in women. The increase was also significant in the elderly (over 70 years). In the first quarter of 2011, we launched a wide-ranging education and patient support campaign for 28,018 hypertensive patients under the ‘Everywhere Good, Best Home!’ subprogram for promoting of home blood pressure measurement and its use in therapy. 81.3% of the patients had completed the diaries under ther observation period, the full completion of the diaries was 91.3%. At the end of the third month, the target blood pressure of 135/85 mmHg for HBPM increased from baseline 21.2% to 48.8%. Growth was significant (P <0.001). In the year 2015-2016 we started a one-year, multicentric, prospective, observational study, in which 7735 patients aged 18-64 years were included from the database of Hungarian Hypertension Registry. In the non-active group (3313 people), treated hypertensive patients were controlled according to the traditional care program so far, while the active group members (4422) participated in an intensive care program with telemedicine (smart phone application) and other helping opportunities. The control was done at the end of 3, 6, 9, and 12 months after the start. In the active group, blood pressure dier was done by smart phone and every month, in the non-active group, paper logging was done every 3 months. In the active group, the blood pressure dieries were filled with smart phone every month and in nonactive group the paper dieries only every 3 months. Patient adherence was high in both groups (around 70%) and in the active group was greater than in the nonactive group. Target blood pressure (<140/90 mmHg) in the active group increased from 53.8% to 73.4% and in the non-active group from 49.9% to 68.1%. Studies have shown that patient interaction is determined by good communication between the care team and the patient, success of home blood pressure monitoring. The communicative ability of the care team (physician-nurse pharmacist) greatly influences the achievement of the therapeutic target. Modern telecommunications is another useful option.]

Hypertension and nephrology

[Role of IL-10 family of cytokines in kidney fibrosis]

PAP Domonkos, VERES-SZÉKELY Apor, SZEBENI Beáta, SZIKSZ Erna, KISS József Zoltán, TAKÁCS István Márton, REUSZ György, SZABÓ J. Attila, VANNAY Ádám

[Chronic renal failure is a major health problem, affecting 8 to 16% of the population. Regardless of the etiology the common hallmark of chronic renal failure is inflammation, leading to the activation of renal myofibroblasts. Chronic activation of myofibroblasts lead to abnormal accumulation of extracellular matrix, disruption of the architecture of the kidney and finally to reduced renal function. Although our knowledge is rapidly expanding about the pathomechanism of chronic renal failure, we still have no drug to treat or hinder the progression of the disease. In our present review article, we summarize the role of the cytokines of the IL-10 family in renal scarring.]

Hypertension and nephrology

[The prevalence of therapy resistant hypertension]

FEJES Imola, ÁBRAHÁM György, LÉGRÁDY Péter

[In our country as well as around the world the most common chronic disease is the hypertension, and it is also an important risk factor causing disability and premature death. Within this, getting to know the true prevalence of therapy- resistant hypertension is important also from a public health perspective, since the prognosis of it is worse than that of those who reaches goal blood pressure range. It usually comes with hypertension mediated organ damages and higher (2- 2.5 folder) cardiovascular risk. It is prevalence in the literature is from 5% to 30%. The knowledge of the true prevalence depends on many factors, like: there are many different definitions of resistant hypertension, what is the main profile of the data collecting study site and what level of the health care system it works, or for example a questionnaire of a multicenter trial cannot be used totally in each country and study site.]

Hypertension and nephrology

[Serum uric acid level in hypertension. Domestic experience based on the data of the Hungarian Hypertension Registry 2011., 2013. and 2015. Part III. - Relation of uric acid to clinical and laboratory characteristics]

KÉKES Ede, PAKSY András, ALFÖLDI Sándor

[2013. and 2015, we examined the correlation between the serum uric acid level and blood pressure, target blood pressure, prevalence of ISH and other diseases associated to high blood pressure used trend analysis and linear regression in 22,668 hypertensive men (mean age 60.8 years) and 24,684 hypertensive women (mean age 64.1 years). We have extended the correlation analysis to metabolic factors (BMI, abdominal circumference, lipid profile, blood sugar) and kidney function. Significant correlation was found between SH level and systolic and diastolic blood pressure as well as target blood pressure. There was a significant correlation between SH level and metabolic parameters (abdominal circumference, BMI, total cholesterol, HDL cholesterol, triglyceride, fasting blood sugar) and in hyperuricemia the prevalence of metabolic syndrome was higher. As the level of SH increases, the prevalence of hypertension-related KVB, ISZB and diabetes have increased. The closest correlation between uric acid levels and chronic kidney disease was in women and between the uric acid levels and ischemic heart disease in men. ur analysis supports the international declaration that hyperuricemia is an independent cardiovascular, metabolic and renal risk factor.]

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Lege Artis Medicinae

[Education and psychological support of parents in cases of postnatally detected Down syndrome]

MÁTÉ Orsolya, KÍVÉS Zsuzsanna, OLÁH András, FULLÉR Noémi, PAKAI Annamária

[OBJECTIVE - Since the 60’s several publications dealt with the phenomenon how physicians inform parents of newborns about postnatal recognition of Down’s syndrome and the support they receive right after breaking the bad news. Howe - ver, the rest of these studies concentrated on surveying parental satisfaction, while relatively few international studies deal with the other side of the communicational situation, the opinion of the informer. Our study focused on the circumstances of parental information in Hungarian institutions of obstetrics in order to evaluate the possibilities for interventions. METHODS - The Down’s team operating at the University of Pécs Faculty of Health Sciences carried out a national survey in 2005 - an interview-based questionnaire filled by physicians of institutions of obstetrics - with the help of the National Register for Congenital Diseases of the National Centre for Epidemiology and Down’s Foun dation. RESULTS - The coverage of the survey reached 74%. Rest of the surveyed institutions did not have information protocol, however, 70% of them believes it would be necessary. Only 44% of the physicians received communication training and 81% of them believe they can manage communication, 33% have felt that the mother of a newborn with Down’s syndrome would expect special help that the institutions are unable to provide. CONCLUSION - There are serious problems with the circumstances of parental informing in Hungarian institutions of obstetrics. This situation would obviously require intervention. An aimed communicational training based on international experience and exploiting the openness of physicians, as well as the establishment of information protocol could be elements of such intervention.]

Clinical Neuroscience

Relationship between Status Epilepticus Severity Score and etiology in adult NCSE patients

GENC Fatma, ERDAL Abidin, AKCA Gizem, KARACAY Ertan, GÖKSU Özaydın Eylem, KUTLU Gülnihal, GÖMCELI Bicer Yasemin

Purpose - Nonconvulsive status epilepticus (NCSE) is a heterogeneous, severe neurological disorder of different etiologies. In this study, the outcomes of NCSE episodes was assessed in a large series of adult patients. Our objective was to evaluate relationship between Status Epilepticus Severity Score (STESS) and etiology and the role of etiological factors on predicting the outcomes. Method - In this retrospective study, the medical records of 95 patients over 18 years of age who were diagnosed with NCSE between June 2011 and December 2015 were reviewed. Their treatment and follow-up for NCSE was performed at the Epilepsy Unit in Department of Neurology, Antalya Research and Training Hospital. Etiological factors thought to be responsible for NCSE episodes as well as the prognostic data were retrieved. The etiological factors were classified into three groups as those with a known history of epilepsy (Group 1), primary neurological disorder (Group 2), or systemic/unknown etiology (Group 3). STESS was retrospectively applied to patients. Results - There were 95 participants, 59 of whom were female. Group 1, Group 2, and Group 3 consisted of 11 (7 female), 54 (33 female), and 30 (19 female) patients, respectively. Of the 18 total deaths, 12 occurred in Group 2, and 6 in Group 3. The negative predictive value for a STESS score of ≤ 2 was 93.88% (+LR 2.05 95% CI: 1.44-2.9 and -LR 0.3 95% CI 0.10-0.84 ) in the overall study group. While the corresponding values for Group 1 (patients with epilepsy), Group 2 (patients with primary neurological disorder), and group 3 (patients with systemic or unknown etiology) were 100%, 92.59% (+LR 2.06 95%CI: 1.32-3.21 and -LR 0.28 95% CI 0.08-1.02 ) 83.33% (+LR 1.14 95%CI: 0.59-2.9 and -LR 0.80 95% CI 0.23-2.73). Conclusions - This study included the one of the largest patients series ever reported in whom STESS, a clinical scoring system proposed for use in patients with status epilepticus, has been implemented. Although STESS appeared to be quite useful for predicting a favorable outcome in NCSE patients with epilepsy and primary neurological disorders, its predictive value in patients with systemic or unknown etiology was lower. Further prospective studies including larger NCSE samples are warranted.

Clinical Neuroscience

Role of positioning between trunk and pelvis in locomotor function of ambulant children with and without cerebral palsy

SANZ-MENGIBAR Manuel Jose, SANTONJA-MEDINA Fernando

Purpose - To understand if children with and without cerebral palsy share the same lumbar postural control threshold on the sagittal plane for the transition between each walking locomotor stage. Method - Observational analysis of sagittal trunk-pelvis kinematics of 97 children with cerebral palsy and 73 with typical development, according to their locomotor stage. Results - Among children with typical development, all average and minimum measurements of the sagittal lumbar curve during the gait events were correlated with age and the locomotor stages of development. Among children with cerebral palsy, there were significant correlations between all average and minimum values of the sagittal lumbar curve and locomotor stages of development but not age. Conclusions - We conclude that, for the same locomotor level, there are no common postural patterns between children with typical development and those with spastic bilateral cerebral palsy for the position between trunk and pelvis in the sagittal plane. Maximal lordosis reduction between trunk and pelvis may change with age or even training, but does not make a positive effect on the locomotor level, while basal and maintenance capacities could explain locomotor function. Trials that failed to assess quality of movement may now have a better understanding of how different interventions improve posture towards the next functional level.

Lege Artis Medicinae

[Postgraduate conference on hepatology]

TELEGDY László

Journal of Nursing Theory and Practice

[Survey of patient education among patients with hip arthroplasty]

BÉKÉS Brigitta, KIRÁLY Edit, BALOGH Zoltán

[Aim of the study: To analyse the training level of patients underwent hip replacement therapy in different periods of their health care. Methods: Traumatology and orthopaedic departments, ambulances and musculoskeletal rehabi-litations took part in the research. A self-made questionnaire was distributed among doctors and health professionals who cured these patients directly. The received data was analysed with the IBM SPSS Statistics 20. program. ANOVA test, 2-sample T-test and Chi-squared test were applied to analyse the coherences. P<0,05 was defined as the value of the significance limit. Results: 86 health care professionals participated in the survey. The overwhelming majority of them (45%) reported that unstructured, postoperative patient education was characteristic. Their education was dominated by communication techniques (n=68), while among the instrumental methods the use of information leaflets was dominated (n=13). Their activity was limited by the time lag and work overload (76%). Analysing the training levels, it was found that information about lifestyle changes and post-operative mobilization was significantly underused. Conclusion: Significant insufficiency were found in the education of the patients in terms of organization, and in the teaching methods and topics which were further aggravated by the mentioned hindering factors. ]