Hypertension and nephrology

[Whole Grains and Health]

VÁLYI Péter

SEPTEMBER 10, 2016

Hypertension and nephrology - 2016;20(04)

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Hypertension and nephrology

[Letter to our Readers]

KÉKES Ede, KISS István

Hypertension and nephrology

[Hypertension and cognitive feature]

KÉKES Ede, KISS István

[Around authors of the literature data and our own experience of the relationship between hypertension and cognitive function. The age progresses, more and more of the dysfunction and vascular dementia. This plays a significant role in hypertension. Simple methods, tests you should regard the practice and also check this function, considering that the aging population is an unstoppable process. The effective antihypertensive treatment, blood pressure variability reduction positively affected by the deterioration of the cognitive function, especially if treatment is started as soon as possible.]

Hypertension and nephrology

[Prevalence of overweight and obesity in hypertensive patients]

KISS István, PAKSY András, KÉKES Ede

[Authors had performed an anthropometric analysis using a database of 2011-2013 of Hungarian Hypertension Register. They analyzed overweight and obesity in relation of age. The results were compared with similar analysis conducted in the total population 2015. They analyzed the prevalence of visceral obesity as well using the waist circumference measurement categories and these were also compared with screening data of total population. The prevalence of overweight and obesity was very high in both genders, co-occurrences exceeded 70% between 45-70 years. The prevalence was significantly higher in hypertensives, than in the total population. The prevalence of visceral obesity measured by waist circumference was also high, especially in women whose reached 50% of cases. They observed a significant difference between hypertensive and total populations In category „danger” of visceral obesity]

Hypertension and nephrology

[Therapy resistant hypertension in clinical practice]

FEJES Imola, ÁBRAHÁM György, LÉGRÁDY Péter

[Around 57% of Hungarian hypertensive patients did not reach the goal blood pressure. According to a paper in 2011, the prevalence of resistant hypertension is 2.9-43%. Analyzing only the therapy of hypertensive patients of an Hypertension Outpatient Clinic of the University of Szeged authors wanted to answer these main questions. How many patients were therapeutically resistant by definition? How many patients were taking 3 or more antihypertensive drugs? How many of these patients reached the goal systolis blood pressure values? How many fold drug combinations were used generally? Data were retrospectively collected from 01/01/2011 to 31/08/2011 from the electronic files of the hypertensive patients. Altogether 310 patients’ data were analyzed, of all cases only one visit. If someone returned more times during this period, only the first visit was considered. Means of two measurements were calculated. The goal SBP was 140/ mm Hg. By the definition 234/310 (76%) patients had resistant hypertension in this population (158±17/97±8 mm Hg). Three or more antihypertensive drugs were taken by 257/310 (83%) patients (136±20 mm Hg) and 134 of them (52% of 257 patients) reached the goal. A fourfold combination of antihypertensive agents was the most frequent in this population. It is advised to use multiple drug combinations to reach the goal blood pressure and it is recommended to spend enough but not longer than necessary time to find the most effective combination in every case. In resistant cases it is always necessary to investigate the background of it.]

Hypertension and nephrology

[The comparative analysis of quality of life in the european countries]

REKETTYE Gábor, KÉKES Ede

[The well-being of the citizens is a determining factor of the social development in every country. The well-being is expressed in the notion of quality of life. Quality of life consists of lots of components and it is more than just being healthy, so its terrain extends far beyond the medicine. Based on a comprehensive research carried out by Eurostat the statistical office of the European Union the study intends to report about the components of the quality of life and about the findings of the survey made with the aim to map the opinions and views of the citizens about it in the different European countries. The paper deals with the relations among these components and with the comparison of the views of the countries.]

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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.

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.]

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.]