Journal of Nursing Theory and Practice

[Practice of the Hepatitis B vaccination with non-responder patients in our Centre]

GÓZ Lászlóné1, KÖRTVÉLYESINÉ Bari Krisztina2, BECS Gergely2, SZABÓ P. Réka2, BALLA József2, KÁRPÁTI István2, MÁTYUS János2, UJHELYI László2, BEN Thomas2

DECEMBER 25, 2015

Journal of Nursing Theory and Practice - 2015;28(06)

[Introduction: End-stage renal disease patients under dialysis have impaired immune system and are more susceptible to infection, even those infections that can be prevented by vaccination (e.g. hepatitis B). If the antibody titer (anti-HBs) remains <10 IU/ml after two consecutive vaccinations, patients are classified as non-responders. Reasons for unsuccessful vaccinations include technical, immunological (e.g. multigene haplotypes) reasons. They are often also associated with chronic diseases. Aim of the research: To re-vaccinate patients after unsuccessful intramuscular vaccination to achieve immunity. Research and sampling methods: Intracutaneous vaccination can be a viable alternative for successful immunity. 6 months after re-immunisation, anti-HBs titer>10 IU/mL indicate a successful immune response. Results: 22 haemodialysed patients received intracutaneous hepatitis B vaccination with the total dosage of 6 μg. An anti-HBs titer elevation (21-100 IU/ml) was observed in 15 cases (68.18%). In those cases, where we failed to achieve successful immunity, we identified malignancies, immunosuppression, amyloidosis, psoriasis diabetes mellitus, or coeliac disease as a possible reason. Conclusions: The rate of successful immunisations against HBV infections can be improved by means of intracutaneous vaccination. ]


  1. FMC-DEKK Debrecen Extracorporalis Szervpótló Centrum
  2. FMC Debrecen



Further articles in this publication

Journal of Nursing Theory and Practice

[One nurse, who influenced the flow of history - Edith Cavell (1865-1915)]


Journal of Nursing Theory and Practice

[The place and role of physiotherapy in total joint replacement surgery patients improve their quality of life]


[Aim of the research: The objective of investigation was to survey the efficiency of the rehabilitation of the patients operated with complete knee endoprosthesis (TKR) nursed in the Rehabilitation Centre and whether the bath course with the applied complex physiotherapy and the spring water of induce any change in the life quality of the patients and whether the efficiency of the physiotherapy can be measured. Research and sampling methods: prospective, quantitative, describing research, with non-random, convenience sampling method. 50 TEP-operated patients have filled in the self-filling questionnaires and participated in the examination of the walking time. The examination was performed between 03/01/2013-12/01/2013 in the Musculoskeletal Rehabilitation Centre of the Gunaras. The patients have filled in the WOMAC, SF-36, BDI, questionnaire compiled by us. Additionally we have measured the walking speed on flat ground and during climbing stairs. The patients have taken a bath in 36C spa for 3 weeks, 7-times a week for 20 minutes and 5-times a week they have received electrotherapy, physiotherapy and hydrotherapy. Results: The majority of the participants of the investigation belonged to the age group of 71-75. The patients avail themselves of the treatments regularly, once or twice a year, which are evaluated by women as more efficient than by men (p <0,001). After the treatments the extent of depression has significantly reduced (p <0,001). There was a significant improvement in the walking speed (p < 0,001), in the SF-36 (TF, PCS) dimensions and we have detected a significant relation between physical and mental health (p <0,001). The movement range of the patients has significantly improved (WOMAC, p=0,001). Between the result of the SF-36 and WOMAC questionnaires we have found also a significant relation (p=0,001), with the improvement of the physical function the life quality has also improved. Conclusions: The results have shown, that the application of the spring water and physiotherapy have proven as efficient treatment in the life quality improvement of the patients operated with complete knee prosthesis. ]

Journal of Nursing Theory and Practice

[Prevention of type-2. diabetes in the light of gestational diabetes mellitus (GDM)]


[Aim of the research: The main objective of the present study is to call women’s attention to the importance of preventive medical screenings and to increase the participation rate by emphasizing preconceptional care. Other aims include: Maintaining good health of pregnant and non-pregnant women; Ensuring a smooth antenatal period and the delivery of healthy infants; Primary prevention before the occurrence of GDM; Emphasizing the importance of secondary prevention for clients with already developed GDM; Highlighting the necessity of lifestyle change; Motivating patients to participate at follow-up checkups as tertiary prevention. Research and sampling methods: Questionnaire involving pregnant women of age 20-45 years (n=104) The questionnaires are uniform, each containing the same questions. Data collection was supported by antenatal care staff at Szent Margit Hospital where great emphasis is placed upon the early detection of GDM. Results: Age, body weight, education level and social background correlate with the occurrence of GDM as well as with the outcome of GDM-affected pregnancies. Due to the regular prenatal care including regular GDM care, the outcome of GDM-affected pregnancies is complaint-free, spontaneous delivery and postpartum period. Conclusions: It is essential that pregnant women receive adequate information about the importance of GDM prevention and its early diagnosis. The significance of educating pregnant women to adopt a healthy lifestyle must be given top priority. ]

Journal of Nursing Theory and Practice

[Patients with type-1 and type-2 diabetes mellitus in the program of peritoneal dialysis]


[Aim of the research: To evaluate the efficacy of the treatment and incidence of complications in diabetes type 1 and 2 patients treated with peritoneal dialysis. Research and sampling methods: During a retrospective study with 85 diabetic PD patients (19 type 1 patients and 66 type 2 patients) was compared data of 22 years with regard to the following parameters: Glucose metabolism, body weight, changes in residual urine clearance values, distribution of quantity and glucose content of the solutions used, incidence of infections, and average duration in PD programme before transferring to haemodialysis. Results: All patients, irrespective of their type of diabetes: spend the same time in PD on average, gained body weight during PD. Diabetes type 1 patients: had a lower residual urine clearance, had HbA1c values decreasing during PD, reported peritonitis less frequently, had a higher incidence of catheter-related infections. Diabetes type 2 patients: had a better glucose metabolism, had a higher body weight from the beginning of therapy, required PD solution with higher glucose concentration. Conclusions: Diabetes patients, irrespective of the type of diabetes, can successfully be treated with PD, but require more attention because of their underlying disease and associated complications. ]

All articles in the issue

Related contents

LAM Extra for General Practicioners

[Polyneuropathy as a first sign of microscopic polyangiitis]

ZÖLD Éva, HORVÁTH Ildikó Fanny, TARJÁN Péter, BARTA Zsolt, ZEHER Margit

[INTRODUCTION - Microscopic polyangiitis (MPA) is a systemic autoimmun disease characterized by necrotizing small vasculitis. MPA belongs to the ANCA-associated vasculitides. The disease can affect many of the body’s organ systems. Major organs involved are kidneys, skin, peripheral nerves and lungs. In addition, generalized symptoms such as fever and weight loss are very common. CASE REPORT - In January 2013 a 56-year old woman presented with weight loss, lower leg numbness, walking difficulty and petechiae on the lower legs. One month later, laboratory examinations showed progressive kidney dysfunction, anemia, hypersedimentation and elevated C reactive protein level, but further tests and investigations for potential bacterial infection and tumors were all negative. In sum, clinical signs and symptoms suggested systemic vasculitis, which was proved by the kidney biopsy and ENG examination. From these findings, microscopic polyangiitis was diagnosed with polyneuropathy and glomerulonephritis. The patient was a Hepatitis B (HBV) virus carrier, which can be provoking factor for vasculitis. Corticosteroid and six treatment cycles of intravenous pulse cyclophosphamide were performed for induction of remission. After treatment her symptoms improved and kidney function was normalized. Antiviral treatment was started because of HBV reactivation in October 2013. As a new manifestation of MPA, pulmonary symptoms were appeared in November 2013 and the patient was treated with synchronization of plasmapheresis and pulse cyclophosphamide with good clinical effectivity. Now, she is treated with methotrexate as immunosuppressive treatment and control examinations indicate the remission of the disease with proper renal function. CONCLUSION - We draw attention to a rare case of vasculitis and underline the importance of both the early diagnosis and the early and effective immunosuppressive therapy. Peripheral neuropathy may occur as a result of having systemic vasculitis. Nevertheless, the exploration and elimination of provoking factors are also must be part of the management and the regular follow-up is essential to recognize the disease relapses, thus avoid permanent organ damage.]

Lege Artis Medicinae

[Efficiency and safety of the vaccination against H1N1 influenza virus in inflammatory bowel disease]

FARKAS Klaudia, JANKOVICS István, MELLES Márta, NAGY Ferenc, SZEPES Zoltán, WITTMANN Tibor, MOLNÁR Tamás

[INTRODUCTION - Inactivated influenza and H1N1 vaccination is recommended yearly for patients with inflammatory bowel disease receiving immunosuppressive therapy; however, immunomodulator and biological therapy might impair the immune response to the vaccination. In our study, we assessed whether immunity can develop in response to H1N1 influenza vaccination in patients receiving immunomodulator and/or biological therapy. We also assessed the occurrence of side effects after the immunisation in these patients. PATIENTS AND METHODS - In our prospective study, blood samples were obtained from 24 patients (12 Crohn’sdisease, 12 ulcerative colitis) one month after immunisation against influenza A/California/ 07/2009 (H1N1) virus. At the time of vaccination, all patients have been receiving immunomodulator and/or biological therapy for at least three month. Antiviral antibodies were detected by using microneutralisation assay. The safety of the vaccination was assessed by questionnaires. RESULTS - Every patient developed complete immunity against influenza A (H1N1) virus, independently from the type of immunosuppressive therapy. Regarding side effects, local symptoms occurred in six patients and systemic symptoms in another six patients. Mild diarrhea occurred in five patients. Moderate exacerbation of the disease was observed in 2 patients with Crohn’s disease and in one patient with ulcerative colitis. CONCLUSIONS - According to our results, immunocompromised patients with IBD can be safely advised to receive the vaccination. In our study, all patients developed adequate immunity according to microneutralisation titers.]

Hypertension and nephrology

[Dialysis in Hungary: 2003-2009]

KULCSÁR Imre, SZEGEDI János, LADÁNYI Erzsébet, TÖRÖK Marietta, TÚRI Sándor, KISS István

[The authors show the data of Hungarian dialysis statistics from 2003 to 2009. The questionnaire-based data collection was made by the Dialysis Committee of the Hungarian Society of Nephrology. The number of all patients entered in the dialysis program increased by 45.2% over six years (an average of 7.5% per year) and the number of new ones increased by 51.2% (8.5% per year). The increase in number of patients treated with haemodialysis was 39% (6.5% per year) in this period. The increase in the number of patients in the peritoneal dialysis program was extremely high: 80.6% (an average of 13.4% per year). The population incidence of new dialysed patients was 332/1 million in 2003 and 483/1 million in 2009. The population point prevalence at the end of the year was 437/1 million in 2003, but 607/1 million in 2009. The penetrance of peritoneal dialysis was 12.8% in 2009. Differences exist among the regions of Hungary in the number of patients, the penetrance of peritoneal dialysis and the prevalence of renal replacement therapies. Among patients suffering in conditions which lead to end stage renal disease the proportion of patients with diabetic or hypertensive nephropathies is increasing and the proprtion of patients with glomerular or tubulointerstitial damage is decreasing. The number (and rate) of the elderly people is growing continuously year by year. The rate of patients on waiting list for renal transplantation is decreasing (the rate was 20% in 2003, but only 10.7% in 2009). There is also a slow decrease in the number of the annual renal transplantations. The mortality rate of chronically dialysed patients shows a little increase. Five dialysis centres for paediatric patients and 58 for adults have been functioning in Hungary by the end of 2009. In average 106 patients have been treated by each Hungarian dialysis centre in contrast to the optimal of 60 persons. The number of nephrologists increased between 2003 and 2007, but slightly decreased since then. The case is similar regarding nephrological nurses.]

Journal of Nursing Theory and Practice

[Does the optimal attention has preserving of the our health during organizing of the our travell?]

TÓTH Ildikó, BEKE Szilvia

[The study aims to show the relationship between health and travel. Most people do not even count during the journey the possibility of disease, which was confirmed during the research. The study shows the most common illnesses and vaccinations. Henceforth we review the travel health tasks. During the authors’s research questionnaire survey was carried out by 164 persons filled out. The responses confirmed that during our travels our health in need background. Our aim was to raise awareness of what individuals and health care are important. ]

Journal of Nursing Theory and Practice

[The importance of serum albumin level in patients with chronic renal disease on maintenance dialysis]

TÓTH Csitkovicsné Tünde, SZAKÁCS Gyuláné, KULCSÁR Imre

[The aim of the study: Evaluation of changes in serum albumin levels and their effects on mortality in chronic haemodialyzed (HD) population. Material and Methods: We analysed the serum albumin values and survival in 253 HD patients, in a retrospective observational study. Data were analyzed using Spearman-correlation, Cox-modell, endpoint analysis and Kaplan-meier analysis. Results: We did not find any significant correlation between serum albumin levels and gender or basic diseases, but the median serum albumin level was lower in patients with ages 65 years or older than in younger ones, and had decreased until observational period (5.4±3.0 years). Lower the serum albumin level the risk of mortality was higher (if the serum albumin level was <35 g/L versus >40 g/L), the HR was 5.69. Conclusions: The serum albumin level is a main indicator of the nutrition in dialyzed patients, but the target level would be different in older and younger patients. The serious malnutrition (lower serum albumin level) increases the risk of mortality in haemodialyzed patients.]