Hypertension and nephrology

[Accredited Postgraduate Training]

JUNE 20, 2019

Hypertension and nephrology - 2019;23(03)

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Hypertension and nephrology

[Letter to our Readers]

ALFÖLDI Sándor, KÉKES Ede

Hypertension and nephrology

[Overview of a 10 years kidney biopsies data from the Nephrological and Blood Pressure Center Szeged]

[The authors retrospectively analyzed the data of kidney biopsies performed between 01/01/2007 and 31/12/2016 performed in the Center. During this period 452 biosies were performed. Mean age of patients was 48.7±15.0 years, of them, 43.5% were man and 56.5% women. The nephrotic syndrome was the most common (38.8%) clinical indications for a biopsy. The mos common histological diagnoses were the membranous nephropathy (16.7%), the IgA nephropathy (11.6%) and the FSGS (10.9%). The most common suggestions by nephrologists were the FSGS (17.4%), the membranous nephropathy (16.1%) and the IgA nephropathy (10.3%). These percentages of diabetic nephropathy were 7.5% and 12.2%. Minor complications not requiring any interventions occured in 98 cases (21.7%), major ones in 13 cases (2.9%). By the results FSGS seems to be overrated by nephrologists, but it is among the 3 most common histological findings. Diabetic nephropathy is a similarly excessive clinical diagnosis, sithence the histologically confirmed diagnoses are only a little more than half of it. Regular meetings of pathologists and nephrologists about clinical suggestions and real histological diagnoses may help to improve the ratio of more accurate suggestions.]

Hypertension and nephrology

[Experimental models of renal fibrosis]

KÖKÉNY Gábor

[The high incidence of chronic kidney diseases and, regardless of the etiology, their progression to renal fibrosis with end-stage renal failure rise the urgent need to reveal the pathomechanisms. As the disease leads to complex changes in the body, it is essential to use in vivo model systems for these investigations. Animal experiments choosing the appropriate model system helps to develop more sensitive early diagnostic markers and new therapeutic approaches. Several animal experimental model descriptions can be found in the literature, which mimic specific or more general human diseases in order to help the better understanding of the pathomechanisms. Using these model systems, we are able to analyze the detailed pathophysiology of glomerulonephritis, tubulointerstitial fibrosis, glomerular scarring or generalized renal fibrosis. The most commonly used model systems for renal fibrosis are presented and discussed.]

Hypertension and nephrology

[Hyperuricemia in hypertension. Domestic experience based on the data of the Hungarian Hypertonia Register 2011., 2013., 2015. Part II.]

ALFÖLDI Sándor, PAKSY András, KÉKES Ede

[Asymptomatic hyperuricemia is frequent in hypertension and its prevalence is increasing. Authors studied the incidence of serum uric acid levels and its correlation with age, risk factors, anthropological, metabolic characteristics, blood pressure, blood pressure target, organ damage, age-related co-morbidity in 47,372 hypertensive patients (22,688 males, 24,694 women). In the second part of their analysis the prevalence of hyperuricemia was 13.8% in hypertensive men and 21.6% in women. The age, BMI, waist diameter, systolic and diastolic blood pressure and onset of hypertension, serum cholesterol, triglyceride, blood glucose and serum creatinine were slightly higher, but serum HDL cholesterol and eGFR were slightly lower in hyperuricemic hypertensive patients, independently of their gender. Among hypertension mediated organ damage ischemic and left ventricular hypertensive ECG alterations, mild chronic kidney disease and proteinuria, among hypertension associated diseases diabetes associated ischemic heart disease, chronic kidney disease associated diabetes and both ischemic and chronic kidney disease associated diabetes were significantly more frequent in hyperuricemic hypertensive patients.]

Hypertension and nephrology

[Proposed Methods for Reducing LDL Cholesterol Levels in Atherosclerotic Cardiovascular Disease for Secondary Prevention in American and European Recommendations]

KÉKES Ede

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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. ]