Hypertension and nephrology

[Quality of life: the effect of the environment - a European comparison]

REKETTYE Gábor, KÉKES Ede

MAY 20, 2017

Hypertension and nephrology - 2017;21(03)

[The present study analyses the natural and living environment of the European people. The survey made among the European citizens proved that the environment is a crucial factor in the quality of their life. They are worried firs of all about the air pollution. The paper deals in details with the causes and effects of air pollution. It shows how air pollution has changed (improved) in the European countries. The study ends with the analysis of how the satisfaction with the natural and living environment has developed in the European countries.]

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Hypertension and nephrology

[New agents in the therapy of hyperkalaemia]

PATÓ Éva, DEÁK György

[Serum potassium level higher than 5,5 mmol/l denotes hyperkalemia that becomes severe above 7,5 mmol/l being a potentially life threatening condition due to ventricular arrythmias. It may develop as a consequence of high potassium intake, decreased renal excretion, and extracellular potassium shift. Its treatment is a challenge even nowadays especially in the setting of chronic kidney disease, diabetes mellitus, and heart failure where RAAS inhibion is an essential component of the therapy. Sodium polystyrene sulfonate, an ion exchange resin is applied for more than fifty years. Recently new angents, patiromer and sodium zirconium cyclosylicate (ZS-9) were introduced and available results show a safer, more tolerable and predicatble effect. Efficiency of patiromer to reduce hyperkalemia is verified in clinical trials in patients with chronic kidney disease, or diabetes mellitus, or hypertension or heart failure on RAAS inhibitor therapy.]

Hypertension and nephrology

[Article Reports]

VÁLYI Péter

Hypertension and nephrology

[Systemic ANCA-associated vasculitis. Induction immunosuppression therapy, complications and outcome. Part 1]

HARIS Ágnes, POLNER Kálmán

[The present review is compiled of two parts, the first part aims to summarize the induction immunosuppressive therapy, the second part delineates the outcome and complications of ANCA-associated vasculitis. ANCA-associated vasculitis is a systemic disease, accompanied with rapidly progressive glomerulonephritis and severe, often life-threatening extrarenal complications. By early diagnosis and immediate initiation of immunosuppressive therapy, both patient and renal outcome have been substantially improved. The major aims of modern therapeutic protocols are, besides improving survival, to decrease immunosuppressive drug toxicity and avoid infections. Immunosuppression is based on the combination of large dose of corticosteroid and cyclophosphamide, which is advisable to supplement by plasma exchange. The B-cell depleting anti-CD20 monoclonal antibody rituximab, which has already been available in Hungary, has been proved to be similarly effective in newly diagnosed ANCA-vasculitis, and even more effective in a relapsing disease, compared to cyclophosphamide. Amongst rituximab’s further indications in this disease is the preservation of young women’s fertility, and it also has priority in some other special cases. Early diagnosis and prompt immunosuppressive treatment have resulted that ANCAvasculitis became a treatable disease with reasonably good clinical outcome, yet both the disease and the immunosuppressive medications frequently cause complications, which necessitate continuous alertness of the attending nephrologists.]

Hypertension and nephrology

[Report on the 5th Szeged Hypertension Days]

Hypertension and nephrology

[Prevalence of isolated systolic hypertension in our country]

KÉKES Ede, BARNA István, DAIKI Tenno, DANKOVICS Gergely, KISS István

[Prevalence of hypertension over the age of 56 is increasing in size and a significant proportion (60-80%) of isolated systolic hypertension. Within the population screening in the older age groups - in the light of economic development - 25-40% of the prevalence. We have an opportunity to analyse the prevalence and specificity of isolated systolic hypertension from age 36 to age 10 years on the base of 7 years data of the MÁESZ (Comprehensive Health Protection Screening Program of Hungary 2010- 2020) survey. Between 56-65 years 23.27-24.23% (male/female) 66-75 years 34,89-33,15% and over 76 years 44.04-41.5% occurrence was found. Divergence of systolic and diastolic pressure has begun since 36 years. Pulse pressure was used to separate individuals with varying degree of vascular disorders.]

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[Earlier and more efficiently: the role of deep brain stimulation for parkinson’s disease preserving the working capabilities]

DELI Gabriella, BALÁS István, KOMOLY Sámuel, DÓCZI Tamás, JANSZKY József, ASCHERMANN Zsuzsanna, NAGY Ferenc, BOSNYÁK Edit, KOVÁCS Norbert

[Background – The recently published “EarlyStim” study demonstrated that deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD) with early fluctuations is superior to the optimal pharmacological treatment in improving the quality of life and motor symptoms, and preserving sociocultural position. Our retrospective investigation aimed to evaluate if DBS therapy was able to preserve the working capabilities of our patients. Methods – We reviewed the data of 39 young (<60 years-old) PD patients who underwent subthalamic DBS implantation at University of Pécs and had at least two years follow-up. Patients were categorized into two groups based on their working capabilities: Patients with active job (“Job+” group, n=15) and retired patients (without active job, “Job-” group, n=24). Severity of motor symptoms (UPDRS part 3), quality of life (EQ-5D) and presence of active job were evaluated one and two years after the operation. Results – As far as the severity of motor symptoms were concerned, similar (approximately 50%) improvement was achieved in both groups. However, the postoperative quality of life was significantly better in the Job+ group. Majority (12/15, 80%) of Job+ group members were able to preserve their job two years after the operation. However, only a minimal portion (1/24, 4.2%) of the Job- group members was able to return to the world of active employees (p<0.01, McNemar test). Conclusion – Although our retrospective study has several limitations, our results fit well with the conclusions of “EarlyStim” study. Both of them suggest that with optimal timing of DBS implantation we may preserve the working capabilities of our patients.]

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[Impact of post hip-replacement motor functions on the patient’s subjective state of health and perception of surgical success]

KIRÁLY Edit, GONDOS Tibor

[Research aim: The authors analyse the extent to which the change in motor function infl uences the patients’ sense of illness fi ve years after the implantation of an artifi cial hip replacement. Methodology and sample: The retrospective follow-up survey was conducted in the Jávorszky Ödön Hospital in Vác through analysis of the electronic patient database and the returned questionnaires. A total of 109 patients who had received artifi cial hip replacements were included in the survey. The authors analysed the objective motor organ indicators (movement of the hip joint, use of mobility aids) based on the patients’ subjective sense of illness five years after the surgery, and the patients’ opinions about the operation. Results: In the 5th postoperative year the patients’ motor function had signifi cantly improved, and the use of mobility aids had signifi cantly decreased. In terms of the patients’ sense of illness, no signifi cant difference was found between the studied motor organ indicators of those who considered themselves to be healthy and of those who regarded themselves as ill. Conclusions: A successful hip replacement signifi cantly improves the patients’ motor function in the 5th postoperative year, but this has little bearing on the sense of illness. In this period the nursing staff should concentrate on other factors if they want to improve the patients’ quality of life.]

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[In the course of Parkinson’s disease, advanced and late stages can be distinguished. In the advanced stage, levodopa has good effect on motor symptoms, but patient care is often hindered by levodopa-induced complications such as motor fluctuation and dyskinesias. In the late stage levodopa response becomes poor, falls, dementia and psychotic symptoms appear and patients often need hospitalization. In the advanced stage, the quality of life may be improved better by device-aided therapy than by best oral medical treatment. The alternatives are apomorhin pump, levodopa carbidopa intestinal gel with pump and deep brain stimulation. The therapy plan should be based on the principle: “the right treatment, to the right patient, in the right time”.]