[Measurement Options of Overweight and Obesity and their Levels of Usefulness]
KISS István, KÉKES Ede
DECEMBER 10, 2015
Hypertension and nephrology - 2015;19(06)
KISS István, KÉKES Ede
DECEMBER 10, 2015
Hypertension and nephrology - 2015;19(06)
Hypertension and nephrology
[In cases where a definitive diagnosis of a renal disease cannot be established on the basis of the clinical and laboratory data as well as imaging techniques the histological examination of the renal biopsy can be useful for establishing a pathological diagnosis, assessing the prognosis and can give etiopathogenetic information to guide the further management. The description and the degree of the active and chronic changes may influence the rationale treatment and the likelihood of the response. However, discussion between the nephrologist and the nephropathologist is indispensable at the decision to take the biopsy and at the evaluation of the result of the histological examination.]
Hypertension and nephrology
[Hypertension is a risk factor of cardiovascular and renal diseases. Although high blood pressure usually does not show symptoms, it can lead to serious health problems such as stroke or cardio and renal insufficiency. Globally 40% of adults over the age of 24 suffer from hypertension, and the risk increases with age. The incidence is more than 70% over 65 years of age. Environmental and genetic effects are jointly responsible for the onset of hypertension, thereby determining predisposing genes is extremely difficult. Genetic variations of several genes have been identified to increase the risk of hypertension. The most common hypertension susceptibility polymorphisms occur in AGT, AGTR1, ACE, NOS3 and CYP4A11 genes. Learning about polymorphisms has clinical importance both in prevention and therapeutic processes. Therapeutic and lifestyle recommendations can be individualized by using molecular genetic tests such us PCR, microarrays, real-time PCR.]
Hypertension and nephrology
[Due to the a large number of antihypertensive drugs on the Hungarian market, in the light of the constantly updated recommendations for therapy, seemed to be worth to consider the traffic data provided by the National Health Insurance. We analysed the turnover of the centrally-acting and direct vasodilator antihypertensive, using the data of The National Health Insurance Fund (NHIF) between 2007 and 2014. Every year the December data were comparesed, the turnover of the month did not substantially different from other month, an average of 5-6 million boxes of cardiovascular products are prescribed. Over the past seven years it was fluctuating, but overall there was almost 19% increase in the turnover of centrally acting medicinal products. The prescription number of guanfacine decreased almost one-third, moxonidine orders fell 37%, while the turnover of rilmenidine doubled during that same period. A significant expansion of the centrally acting rilmenidine became clear in the domestic market. The minimal side effects, the favourable profile of applications, the number of international and domestic studies make it an excellent second-third additional agent. The use of vasodilators overall increased of a small degree (15%), mainly due to a 53% increase of doxazosin. Considering the domestic prescribing habits they follow very well the international and domestic recommendations. The observed differences in each group are the effects of the positive results of recent studies.]
Hypertension and nephrology
Hypertension and nephrology
Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.
Clinical Neuroscience
Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithymia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share common pathology of neuroanatomical structures. We hypothesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship between WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.
Hypertension and nephrology
[This consensus document is intended to provide guidance for the effective and efficient treatment of asymptomatic individuals with high uric acid levels and gout patients.]
Clinical Neuroscience
[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmelweis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]
Clinical Neuroscience
[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]
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Clinical Neuroscience
Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease3.
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Journal of Nursing Theory and Practice
[Examination of the Strength of Core- and Perineal Muscles in Case of Different Movements]2.
Journal of Nursing Theory and Practice
[Examination of Parental Treatment among Outgoing Ambulance Workers]3.
Journal of Nursing Theory and Practice
[BLS Quality Assessment – The Effectiveness of Telephone Cardiopulmonary Resuscitation Instruction]4.
Journal of Nursing Theory and Practice
[The History of the Founding of the first State School of Nursing ]5.
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