Hypertension and nephrology

[Accredited Postgraduate Training]

OCTOBER 20, 2018

Hypertension and nephrology - 2018;22(05)

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Hypertension and nephrology

[The importance of recognition and proper treatment of hypertension and the maintenance of adherence in hypertension care]

NEMCSIK János, PÁLL Dénes, JÁRAI Zoltán

[Hypertension is the leading cause of death and disability-adjusted life years. In the United States hypertension accounts for more cardiovascular (CV) deaths than any other modifiable CV disease risk factor and was second only to cigarette smoking as a preventable cause of death for any reason. In our country the situation is similar. In Hungary the number of subjects with hypertension is approximately 3.5 million and this high prevalence contributes markedly to the poor Hungarian CV morbidity and mortality figures. The recognition of hypertension, the initiation of drug therapy and the long-term follow- up of the patients is mainly the task of primary care. Besides that it inheres high responsibility, this is also a grateful commitment, as hypertension in most of the cases can be treated properly with lifestyle-changes and medications leading to a marked decrease of CV complications, especially stroke. In our review article we would like to focus on the high prevalence of hypertension worldwide as well as in our country, the exact implementation of screening, the risk reduction potential of the proper treatment and the importance of the long-term maintenance of treatment adherence.]

Hypertension and nephrology

[Letter to our Readers]

KÉKES Ede

Hypertension and nephrology

[Significance of the Extracellular Matrix, Collagens and their Biomarkers in the Development and Prediction of Hypertension According to the Latest Literature Data]

LELBACH Ádám, KÁNTOR Márk, DÖRNYEI Gabriella, KOLLER Ákos

Hypertension and nephrology

[Hungarian Vasculitis Registry – results of the first five years]

HARIS Ágnes, TISLÉR András, ONDRIK Zoltán, FILE Ibolya, MÁTYUS János, ZSARGÓ Eszter, DEÁK György, AMBRUS Csaba

[Launching the Hungarian Vasculitis Registry aimed to collect information about prevalence and outcome of our patients with ANCA-associated vasculitis, and treatment protocols of the disease. The on-line data collection has been developing dynamically since its initiation five years ago, presently 278 patients’ files are available. Patients’ mean age is 58.2±14.5 years, 62% are women; their disease is associated with c-ANCA positivity in 51% and p-ANCA in 49%. At diagnosis GFR was 24.6±21.6 ml/min/1,73 m2, that time 29%, during the total follow up 39% of the registered subjects needed dialysis. Renal replacement therapy could be discontinued in 23% of them. In cases with focal histological changes, also with upper respiratory tract and skin involvement dialysis was significantly less frequently necessary, which underlines the importance of early diagnosis. In induction therapy steroid was administered for 94% of the patients, 85% of them got cyclophosphamide, 59% was treated by plasmapheresis, 11% got rituximab. Maintenance treat ment contained steroid in 80%, per os cyclophosphamide in 23%, parenteral cyclophosphamide in 22%, furthermore 40% of the patients got azathioprin, 8 subjects got mycophenolate and 6 got methotrexate. Median follow up was 30 months (IQR 6-78), during which period 20% of the patients died, 5% got kidney transplantation, and 5% were lost to follow up. Median survival was 14.8 years, five years survival was 85%, and ten years survival was 70%. Long term survival in patients with c-ANCA vasculitis seemed better comparing to p-ANCA vasculitis, but when correcting by age this difference disappeared. Predictors of death were age and dialysis dependent renal failure. Relapses developed in 27% of patients, 28% of them presented in the first year, 21% suffered it after five years of care. Collected data by the Hungarian Vasculitis Registry shows our society’s successful professional activity. Our results are comparable to the published data in the literature, yet there are several areas in our care where further improvements are warranted in order to increase our patient’s survival and quality of life.]

Hypertension and nephrology

[Relationship between the Mediterranean Diet and the Prevention of High Blood Pressure and Cardiovascular Diseases]

DOLGOS Szilveszter

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[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.

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TELEGDY László

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[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. ]