Hypertension and nephrology

[The uremic toxin indoxyl sulfate reflects cardio-renal risk and intestinalrenal relationship]

KISS István

DECEMBER 22, 2011

Hypertension and nephrology - 2011;15(06)

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Hypertension and nephrology

[Management of hypertensive crises]

JÁRAI Zoltán, ÁCS Tamás, FARSANG Csaba

Hypertension and nephrology

[The importance of white-coat hypertension in adolescents]

LENGYEL Szabolcs, SZÁNTÓ Ildikó, KATONA Éva, PARAGH György, FÜLESDI Béla, PÁLL Dénes

[The importance of adolescent hypertension is that there is tight correlation between blood pressure data in adolescents and in adulthood. In case of sustained adolescent hypertension increase of the left ventricular mass and the intima-media thickness of the carotid artery is also detected. The prevalence of adolescent hypertension is about 1-4%. Among them 1-41% is the frequency of white-coat hypertension. Diagnosis can be set up with repeated measurements at home, or with ambulatory blood pressure monitoring. In the background of adolescent white-coat hypertension the increased sympathetic activity has outstanding importance, which causes endothel dysfunction and increased arterial stiffness. There are growing evidence, that adolescent white coat hypertension is not a harmless condition, because sustained hypertension can develop in the future. In its case risk survey, start of non-pharmacological treatment, and follow-up has major importance.]

Hypertension and nephrology

[Salt consumption and hypertension]

KISS István, MARTOS Éva

Hypertension and nephrology

[Association between sleep disorders and inflammation among kidney transplant recipients]

FORNÁDI Katalin, LINDNER Anett, CZIRA Mária Eszter, SZENTKIRÁLYI András, LÁZÁR S. Alpár, ZOLLER Rezső, TURÁNYI Csilla, VÉBER Orsolya, NOVÁK Márta, MUCSI István, MOLNÁR Miklós Zsolt

[In patients on dialysis, the results of studies examining the association of sleep disorders and inflammation are controversial. We assessed the association between inflammatory markers and different sleep disorders in a large sample of kidney transplant recipients. In the cross-sectional study 100 randomly selected kidney transplanted patients underwent one-night polysomnography [“SLeep disorders Evaluation in Patients after kidney Transplantation (SLEPT) Study”] to diagnose obstructive sleep apnea (OSA) and periodic limb movement is sleep (PLMS). Athens Insomnia Scale (AIS) was used to assess the prevalence of insomnia. Socio-demographic information, data on medication, comorbidity and laboratory parameters were collected. Inflammatory markers such as Creactive protein (CRP), serum albumin, white blood cell count, interleukine-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were measured. The mean age was 51±13 years (43% female) and the prevalence of diabetes 19%. We found no significant difference in the levels of inflammatory markers between patients with OSA and PLMS versus (vs) patients without such disorders. Apnea-hypopnea index showed a significant association with white blood cell count (rho=0.23), and weak, non significant correlations with the other inflammatory markers (rho<|0.15|). PLM index showed weak, non significant correlations with all markers of inflammation (rho<|0.15|). The serum IL-6 level was significantly higher in patients with insomnia (AIS≥10) than in non-insomniacs [median (IQR): 3.2 (2.6-5.1) vs. 1.7 (1.2- 2.9) ng/l; p=0.009]. The levels of other inflammatory markers were similar between insomniacs and non-insomniacs. We did not find any association between the presence of objectively assessed sleep disorders and inflammatory markers in kidney transplant patients.]

Hypertension and nephrology

[The advantages of a fixed combination of lisinopril with amlodipine in patients with primary hypertension]

GAHRAMANOVA SM, BAKHSHALIYEV AB

[Background: The aim of the study was to examine the effect of amlodipine, lisinopril and a fixed low-dose combination of amlodipine + lisinopril on the performance of the daily profile, blood pressure variability and heart rate variability in patients with PH stage I-II, 1-2 degrees. The diagnosis of PH was made in accordance with the classification of JNC USA in 2003, ESH, ESH 2007 on the basis of careful clinical and instrumental investigations. Methods: The study included 75 PH patients who were divided into three groups depending on the medication received. The first group included 23 patients treated with lisinopril, the second included 27 patients treated with amlodipine, and the third included 25 patients receiving a fixed combination of amlodipine + lisinopril. Drugs were administered once daily with dose titration for lisinopril effective for 10 to 20 mg (mean 15.6±2.2 mg), for amlodipine 5 to 10 mg (mean 7.8±1.1 mg), and Lisonorm administered in a standard fixed dose (lisinopril 10 mg, amlodipine 5 mg), once in the morning. Controlled treatment lasted for 12 weeks. The study used daily blood pressure monitoring and ECG Holter monitoring methods. Results: A comparison of side effects found that combined therapy significantly reduced the number of adverse reactions. For all three groups, treatment resulted in a significant decrease in the average daily, daytime and night-time BP values and in the variability of systolic and diastolic BP. With combined therapy, these changes were more significant. Conclusion: These positive changes appear to be due to the fact that combination therapy can affect several parts of the pathogenetic development of hypertension, compared with the effects of monotherapy, with superior results. In the combination therapy, lisinopril levelled the sympathetic stimulation of amlodipine by blocking the activity of the sympathoadrenal and renin-angiotensin-aldosterone system.]

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Lege Artis Medicinae

[THE POSSIBILITIES OF USING PROBIOTICS IN DIGESTIVE DISEASES]

DEMETER Pál

[The mammalian intestinal tract contains a complex, dynamic and diverse society of microorganisms. The beneficial effects of developing a normal bacterial flora are: colonic resistance against pathogens, immunmodulation and intact intestinal barrier. Probiotics are live microbial supplements which beneficially affect the host by improving its intestinal microbial balance after oral administration. The health benefits of probiotics have been the subject of increased research interests. This paper gives a review of the literature that study the roles of probiotics in the prevention and treatment of antibiotic-associated diarrhea, traveller's diarrhea, irritable bowel syndrome, inflammatory bowel disease, Helicobacter pylori infection and hepatic encephalopathy. In human studies the examined probiotics are safe, tolerable and seem to be effective in conditions of diarrhea caused by antibiotics, traveller's diarrhea and pouchitis. In other above-mentioned conditions further randomized and controlled clinical trials are needed to evaluate their efficacy. Based on these results, in the research and manufacturing of genetically-engineered probiotic bacteria a major leap is expected.]

Clinical Neuroscience

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.

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.]