[Hypertonology License]
KISS István
SEPTEMBER 20, 2014
Hypertension and nephrology - 2014;18(03-04)
KISS István
SEPTEMBER 20, 2014
Hypertension and nephrology - 2014;18(03-04)
Hypertension and nephrology
[Recently we have in vivo visualized glomerular filtration and fluid flow from the JGA portion of afferent arteriole into JGA using intravital multiphoton microscopy. Fluorescence of the extracellular fluid marker lucifer yellow appeared in the interstitium around the distal portion of afferent arteriole before the filtration into Bowman's capsule. In isolated microperfused JGA we demonstrated fluid movement from the glomerulus into the MD tubule. All these prove that there is a significant and dynamic fluid flow exists in the JGA. Angiotensin II similar to VEGF plays a role in regulation of permeability/fenestration formation. Angiotensin II acts through AT1 receptor and PV-1 protein synthesis.]
Hypertension and nephrology
[Myofibroblasts are the main effector cells of tissue fibrosis in chronic kidney disease. These cells are the main source of collagen rich extracellular matrix in the fibrous tissue. Recent hypotheses suggest that pericytes are the major progenitors of myofibroblasts. Platelet derived growth factor, transforming growth factor β and Wingless/Int signaling pathways play important role in pericyte activation. There are experimental evidences that blocking this pathways inhibits tissue fibrosis, therefore they might be targets for the development of antifibrotic drugs in the future.]
Hypertension and nephrology
[Hantaviruses are widespread infectious agents carried by different rodent species. The majority of them belongs to viral zoonotic pathogens, sometimes causing severe human infections. Hantaviruses inflict hemorrhagic fever with renal syndrome in Eurasia and supposedly in Africa, and hantavirus cardio-pulmonary syndrome in the Americas. The relationship between the virus and its host species is a result of a several million year co-evolution. Although virus replication is most intense in the infected rodents' lungs, these animals do not develop disease, instead they carry and spread the pathogens throughout their lifetime by body fluids. In the majority of infections, the virus gets into the human body by vaporization of rodent body fluids or by direct contact. In Europe, Puumala (PUUV) and Dobrava-Belgrade (DOBV) hantaviruses are the most abundant hantaviral infectious agents. There are numerous studies described the presence of different genotipes of hantaviruses circulating in Hungary. Although the number of clinical and epidemiolgical studies are limited, the medical importance - especially in a high risk population - of these viruses are unqustionable. There are a variety of methods to identify hantaviral infections. Molecular biological methods (RT-PCR) - also enabling genotyping - and virus neutralization tests proved to be the most reliable tools. The latter technique requires virus culturing, which can only be carried out in high-containment laboratories.]
Hypertension and nephrology
[The author summarizes knowledge about Reynolds risk assessment system based on data of references and own experiences. The first part of article is about how the results of study of pathogenesis of atherosclerosis were converted into new risk assessment systems. One result of this process is the Reynolds system wich is consisted of traditional riks factors, high sensitive C-reactive protein and the patients’ family medical history. He demonstrates essence of Reynolds system and process of it’s validity. The author deals with comparison of Reynolds system with other traditional risk assessment systems. The practical issues of application of Reynolds system are detailed in the conclusion of the article.]
Hypertension and nephrology
Clinical Neuroscience
[Lack of neurologists has become an obvious problem recently in Hungary, not only in small hospitals, but in major health care centers and also in university hospitals. With the current survey we set forth to estimate the number of board certified neurologists, and to evaluate the foreseeable changes in the next decade. In the beginning of 2010 there were 1310 physicians in Hungary with an official license to practice neurology. During 2009 neurological performance at least once during the year was claimed to the National Health Insurance Fund by 948 board certified neurologists. The number of those neurologists who are routinely involved in neurological patient care was estimated to be around 750. The lack of the young generation is characteristic for the age distribution of neurologists. In nine out of the 19 counties of Hungary the number of neurologists below the age of 35 is one or nil. In the ten-year period of 2000-2009 the annual mean number of new board certifications in neurology was 22. This number is much lower than that needed to replace those who get employed abroad and who leave the system for other reasons. The number of neurologists in the age range of 40-60 years will drop to 2/3 of the current number by 2020 even if emigration of neurologists will completely halt. If emigration will continue at the current rate and the number of those in neurological training will not increase considerably, then by 2020 only about 300 neurologists will have to cover neurological services throughout Hungary. As this number is insufficient for the task, and the tendency is clearly foreseeable, the health care government should urgently react to this situation to ensure an acceptable level of neurological services in the near future for the population of Hungary.]
Hypertension and nephrology
Hypertension and nephrology
Lege Artis Medicinae
[Diagnosis and treatment of sleep disorders play an increasingly important role in everyday clinical practice of family physicians. Obstructive sleep apnea syndrome (OSAS) is a significant disorder of this disease group due to its relatively high incidence rate and increasing risk of adverse medical outcomes in the course of time. The prevalence of OSAS is 2-4% in the general population. It is characterized by obstructive apneas and hypopneas mostly with desaturations and/or arousals caused by the repetitive collapse of the upper airway during sleep. Besides impairing sleep efficacy and daytime neurocognitive functions, OSAS increases cardiovascular risk as well. The typical clinical presentation is an excessive daytime sleepiness and loud snoring interrupted by brief pauses of breathing. It can be a risk factor for treatment-resistant and/or non-dipper hypertension, nocturnal cardiac arrhythmias, stroke, cognitive decline and depression. The importance of OSAS is presented by the fact that - according to the latest related Hungarian law reforms - risk evaluation of the disorder is part of the medical assessment of suitability for a driving license. The family physician’s tasks are to recognize the clinical symptoms, identify high-risk patients with potential complications who need adequate treatment and eventually guide them to sleep-diagnostic centers. ]
Hypertension and nephrology
[Prevalence of the isolated increase in systolic blood pressure ≥140 mmHg with normal or low diastolic blood pressure ≤80 mmHg, is defined as isolated systolic hypertension. Its prevalence increases with age up to >90% in patients aged >90 years. Isolated systolic hypertension is also found in the young and the clinical significance of it is still debated. For the therapy, those drugs should be used which have a license for use in children: angiotensin converting enzyme inhibitors, angiotensin AT-1 receptor antagonists, calcium channel blockers beta-blockers and diuretics and their combinations. The young adults with isolated systolic hypertension had a much higher risk of dying from coronary heart disease or cardiovascular disease, then the normotensive individuals, and should be treated to normalise their blood pressure. In the elderly and very elderly (>80 yrs), a wealth of data from large clinical trials are available, showing the necessity of treatment mostly with drug combinations - fix-combinations are preferred for increasing the adherence / persistence to therapy. Using diuretics, ACE-inhibitors / ARBs with calcium antagonists, and when needed diuretics and beta-blockers are suggested by recent European guidelines. The target is <140 mmHg, but in octogenarians <150 mmHg. Some studies are pressing for even lower SBP (to around 120 mm Hg), but it seems to be wise to balance advantages / disadvantages, so the optimal SBP may be around 130 mmHg.]
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Clinical Neuroscience
Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease3.
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Clinical Neuroscience
Cases of inborn errors of metabolism diagnosed in children with autism2.
Clinical Neuroscience
[The first Hungarian patient with Guillain-Barre syndrome after COVID-19]3.
Clinical Neuroscience
Retinal morphological changes during the two years of follow-up in Parkinson’s disease4.
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