Hypertension and nephrology

[Scientific Programs of the Hungarian Society of Hypertension Characteristics of Hungarian Hypertensive Patients According to the Hungarian Society of Hypertension Registry and the Program “Live Below 140/90” ]

KÉKES Ede, KERKOVITS Lóránt, BÖDÖR Anikó, KISS István

MARCH 22, 2013

Hypertension and nephrology - 2013;17(01)

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Hypertension and nephrology

[Report on the 10th Regional Hypertension Day]

Hypertension and nephrology

[Paradigmal changes in renal replacement therapy. Dialysis and drug therapy of quality in chronic renal patients - Optimal and adequate opportunities of dialysis therapy]

KISS István, SZEGEDI János, FODOR Erzsébet, BARABÁS Noémi, REMPORT Ádám, AMBRUS Csaba, KULCSÁR Imre

[Researches over the past thirty years, many results have been related to acute and chronic renal failure pathophysiology, clinical characteristics and therapy. Can be more than just the uremic toxins and their characteristics of the regulation of salt and water balance, renal anemia treatment, uremic metabolic disorders, calcium phosphate and lipid metabolism dysfunction. Improve the quality of treatment and reduce mortality and options can be influenced by factors come to, therefore, execution and technique of dialysis therapy. We know the primary concern of the treatment period for reducing mortality. This is best for intermittent treatments increased (4.5-6 hours) treatment will help. Narrow scope is optional for the treatment several times a week treatment, the daily 8-hour long nightly therapy. The mortality of the patient significantly influenced by age, gender, co-morbidities, fluid balance and the CaxPO4. The technical side is the key factor influencing the dialysis fluid purity and membrane properties. The use of high-flux membranes is clearly improving the quality of treatment, the additional benefit of hemodiafiltration therapy, the mortality for those still controversial. For optimal dialysis adequacy, complexity may result in reducing mortality and improving the quality of life in chronic dialysis patients.]

Hypertension and nephrology

[ESH Advanced Course on Hypertension – St. Moritz, 3-10 March 2013]

Hypertension and nephrology

[Causes of and therapeutic opportunities in resistant hypertension]

SIMONYI Gábor, GENCSI Kristína

[Hypertension is an independent cardiovascular risk factor and one of the most frequent diseases in Hungary. In the treatment of hypertensive patients usually more than two drugs are needed for the appropriate blood pressure control. Resistant hypertension (RH) is defined when blood pressure remains above target value despite full doses of antihypertensive medications, which consist of at least three different classes of drugs including a diuretic administered in maximal doses. The frequency of RH can reach 20-30% among hypertensive patients. RH increases the cardiovascular risk because of the lack of target blood pressure. RH is multifactorial and it is important to exclude pseudo-resistant hypertension (e.g. poor compliance, white coat effect). In the background of RH we can find lifestyle factors (e.g. obesity, excessive salt intake, alcoholism, etc.) and a variety of drugs (e.g. non-steroids, corticosteroids, sympathomimetics). In the pathogenesis of RH the increased activity of the sympathetic nervous system has an important role. In the treatment of RH we should manage lifestyle factors and it is important to assess the drugs and diseases (e.g. sleep apnea, chronic kidney disease, diabetes mellitus) which may cause increased blood pressure. It is no exact recommendations for the treatment of RH. Therapy often consists of 4-5 various drugs in combination. An important role has the device therapy of RH in recent years (e.g. stimulation of the carotid baroreceptors and renal denervation) as well.]

Hypertension and nephrology

[Population based study of hypertension in Hungary - 2012 Comprehensive Health Protection Screening Program of Hungary 201-2020]

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

[Background: The year 2011 saw the continuation of Hungary’s greatest and to date most comprehensive health screening programme started in 2010. The aim of the screening programme established according to the directives of the European Union with the cooperation of more than forty professional organisations is the preservation of the health of the population, the prevention of illnesses and the improvement of the general health status. The programme contributes to the prevention of coronary diseases by passing on knowledge concerning healthy nutrition and guidelines to help the establishment of a health-conscious lifestyle. Partecipants and methods: In the Comprehensive Health Tests Programme of Hungary, the examinations, among them coronary examinations covering the fields of cardiology and hypertension, take place in a specially furnished lorry. The results of the examinations of the people who have presented themselves for the tests (n=19,814) have been evaluated. In the Comprehensive Health Tests Programme of Hungary a total of 10,444 (52.7%) women and 9,370 (47.3%) men were tested at 332 locations. Although the tests were free for all adults, predominantly persons between the ages of 26 and 55 presented themselves. The average age of women was 42 years and that of the men was 40 years. Results: Upon data processing with the help of a query, 28% of the participants reported suffering from hypertension disease. Measurement of the blood pressure was carried out in each case with validated equipment and by qualified medical staff. Based on the data, it can be observed that while among men hypertension tends to occur in larger numbers at a younger age, the tendency is reversed at ages above 45 years, where hypertension is more frequent among women. Among women, the state of normotonia was most frequent up to the age of 45 and stage 1 hypertension became most frequent from the age of 46 onwards. It must be noted, however, that stage 3 hypertension was already present in 1.7% of women of 26 years of age, and the frequency of this category increased to 6% from the age of 46 onwards. The average systolic blood pressure measured among men exceeded the upper limit of the normal range for all age groups. The average systolic blood pressure measured among women was in the normal range up to the age of 55 years and only moved to the pathological range from the age of 56 onwards. The diastolic blood pressure levels were in the normal range for both sexes (with the exception of the age group 46-55 of the men, where it exceeded the upper limit of the normal range by a minimal extent). Among the men, stage 1 hypertension was the most frequent status for all age groups; blood pressures above 140/90 were measured for 39% of the subjects from the age of 18 onwards. The distribution of this did not vary significantly with the increase of age. It must be mentioned here too, that stage 3 hypertension became more frequent with age, and that it was observed in more than 11% of the patients above 56 years of age. The correlation between abdominal circumference, total cholesterol, blood sugar level and the measured blood pressure values was unambiguously ascertainable. In case of simultaneous presence of diabetes and hypertension (women, n=344 and men, n=303), blood pressures above 140/90Hgmm were 2-3 times more frequent for both sexes than without the presence of diabetes. Discussion: Thanks to the vast information obtained through the programme, a comprehensive picture has been drawn up about Hungary’s present health status not only on a regional or cross sectional level, but as it was described in the programme, too. ]

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Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

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.

Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

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.

Hypertension and nephrology

[About the care of patients with hyperuricaemia and gout]

[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

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[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

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[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.]