Lege Artis Medicinae

[County level mortality data of urogenital system in Hungary between 2010-2014]

KISS István, PAKSY András

MARCH 20, 2017

Lege Artis Medicinae - 2017;27(03)

[According to The International Statistical Classification of Diseases and Related Health Problems (10th Revision, ICD 10; XIV), urogenital diseases resulted in an average 910 yearly deaths in Hungary from 2010 through 2014, less than 1% of the cumulative mortality rate. Out of all urogenital conditions, kidney and bladder diseases were the leading cause of death, accounting for nearly 85 percent of all deaths in the examined period. It should be noted that mortality due to urogenital cancers, renovascular hypertonia, diabetic nephropathy, congenital malformations and pathologies related to childbirth and pregnancy are excluded from consideration in the present review. As the Hungarian Central Statistical Office does not disclose the causes of death by age and gender at its county-level data, this paper reports gender-specific mortality rates. Due to the fact that the county-level mortality rate of urogenital diseases is low and the yearly standard deviation is high, the five-year overall mortality rate of 2010-2014 is presented. Hungarian counties differ greatly in terms of mortality from urogenital diseases. The number of deaths per 100 000 population ranges between 6.74 in Békés county and 16.38 in Fejér county. Counties within the same region may exhibit substantially different mortality rates. An overall 7.01 deaths per 100 000 population was reported in Győr-Moson-Sopron county, whereas among residents of the neighbouring Vas county the rate was reported as 14.73 per 100 000 population. The observed variations prevail even when standardised mortality rates are compared and thus the differences in the counties’ age distributions are accounted for. Regional differences become more apparent when only the deaths caused by kidney diseases are analysed out of all urogenital pathologies. In this case, two- or threefold differences are observed between the respective Hungarian counties. Major disparities are still present between counties within the same region. For example, the number of deaths per 100.000 population is 3.74 in Hajdú-Bihar county, and 8.04 in Jász-Nagykun-Szolnok county, respectively. The diagnosis frequency of kidney diseases has a strong positive correlation with case fatality, but it may not fully account for all regional variations in mortality rates. Regional characteristics of dialytic care and the accessibility of dialytic facilities is not related to patient mortality. ]



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Lege Artis Medicinae

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Lege Artis Medicinae

[An analysis of the ankle-brachial index in patients with diabetes in general practice]

GALVÁCS Henrietta, HASITZ Ágnes, BALOGH Zoltán

[INTRODUCTION - Diabetic macroangiopathy is one of the most prevalent complications of chronic diabetes mellitus. In Hungary, diabetic foot diseases and atherosclerosis are the most common causes of lower limb amputations. In this paper, we aim to present the correlations between the ankle-brachial index in patients with diabetes mellitus, and risk factors such as HbA1c levels, smoking and gender, in order to prevent atherosclerosis and to facilitate its rapid diagnosis. PATIENTS AND METHODS - Ankle-brachial index (ABI) of diabetic patients was measured and statistically analysed. Our goal was to determine potential correlations between ABI and the three above mentioned risk factors. The study population consisted of patients with a known history of diabetes mellitus (n=65) who visited the general practitioner's office between July 2015 and September 2016. RESULTS - 47.69% of patients exhibited a pathological ankle-brachial index. The ankle-brachial index showed a statistically significant correlation with gender (p=0,054). There was no significant correlation between the ankle-brachial index and smoking (p=0.838) or between the ankle-brachial index and HbA1c levels (p=0.430). CONCLUSION - Our research suggests that primary care physicians should regularly assess the ankle-brachial index in diabetic patients as preclinical atherosclerosis is frequently present in this population. Regular screening can facilitate early diagnosis and reduce the risk of severe macrovascular complications.]

Lege Artis Medicinae

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Lege Artis Medicinae

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Lege Artis Medicinae

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Clinical Neuroscience

The evaluation of the relationship between risk factors and prognosis in intracerebral hemorrhage patients

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Objective - Patients were assessed in terms of risk factors, hematoma size and localization, the effects of spontaneous intracerebral hemorrhage (ICH) on mortality and morbidity, and post-stroke depression. Materials and methods - The present study evaluated the demographic data, risk factors, and neurological examinations of 216 ICH patients. The diagnosis, volume, localization, and ventricular extension of the hematomas were determined using computed tomography scans. The mortality rate through the first 30 days was evaluated using ICH score and ICH grading scale. The Modified Rankin Scale (mRS) was used to determine the dependency status and functional recovery of each patient, and the Hamilton Depression Rating Scale was administered to assess the psychosocial status of each patient. Results - The mean age of the patients was 65.3±14.5 years. The most common locations of the ICH lesions were as follows: lobar (28.3%), thalamus (26.4%), basal ganglia (24.0%), cerebellum (13.9%), and brainstem (7.4%). The average hematoma volume was 15.8±23.8 cm3; a ventricular extension of the hemorrhage developed in 34.4% of the patients, a midline shift in 28.7%, and perihematomal edema, as the most frequently occurring complication, in 27.8%. Over the 6-month follow-up period, 57.9% of patients showed a poor prognosis (mRS: ≥3), while 42.1% showed a good prognosis (mRS: <3). The mortality rate over the first 30 days was significantly higher in patients with a low Glasgow Coma Scale (GCS) score at admission, a large hematoma volume, and ventricular extension of the hemorrhage (p=0.0001). In the poor prognosis group, the presence of moderate depression (39.13%) was significantly higher than in the good prognosis group (p=0.0001). Conclusion - Determination and evaluation of the factors that could influence the prognosis and mortality of patients with ICH is crucial for the achievement of more effective patient management and improved quality of life.

Hypertension and nephrology

[Terciary hyperparathyreosis or not? ? You cannot solve it alone: combined treatment in severe osteitis fibrosa cystica]

HERSZÉNYI Eszter, PATÓ Éva, SZALAY László, BÍRÓ Zsolt, György Andrea, DEÁK György

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Lege Artis Medicinae


VOKÓ Zoltán, SZÉLES György, KARDOS László, NÉMETH Renáta, ÁDÁNY Róza

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Hypertension and nephrology

[Plasma ortho-tyrosine/para-tyrosine ratio predicts hyporesponsiveness to erythropoiesis-stimulating agents in dialyzed patients]

KUN Szilárd, MIKOLÁS Esztella, MOLNÁR Gergő Attila, SÉLLEY Eszter, LACZY Boglárka, CSIKY Botond, KOVÁCS Tibor, WITTMANN István

[Objectives: Patients suffering from end-stage renal failure (ESRF) are mostly treated with erythropoiesis-stimulating agents (ESAs). They often show hyporesponsiveness to ESA, which condition is associated with elevated production of free radicals. Phenylalnine (Phe) is converted into para- and ortho-tyrosine (p- and o- Tyr) by hydroxyl free radical. o-Tyr is produced exclusively in this way. However, physiological isomer p-Tyr is formed in significantly higher amounts by phenylalaninehydroxylase, mainly in the kidney. It has been shown that p-Tyr production is decreased in ESRF. As a result, p-Tyr can be replaced by o-Tyr in proteins, e.g. in proteins playing part in signal transduction of erythropoietin. We aimed to study the association of different Tyr isoforms with ESA-responsiveness. Methods: Four groups of volunteers were involved in our cross-sectional study: healthy volunteers (CONTR; n=16), patients on hemodialysis without ESA-treatment (non-ESA-HD; n=8), hemodialyzed patients with ESA-treatment (ESA-HD; n=40) and patients on continuous peritoneal dialysis (CAPD; n=21). Plasma p-, o-Tyr and Phe levels were detected using a high performance liquid chromatography (HPLC)-method, with fluorescence detection. ESA-demand was expressed as ESA-dose, ESAdose/ body weight and erythropoietin resistance index1 (ERI1, weekly ESA-dose/body weight/hemoglobin). Multivariate regression models were used to examine predictors of ESA-demand. In these models, most of the known predictors of ESA-hyporesponsiveness were included. Results: Lower p-Tyr levels were found in dialyzed patients compared with control subjects. In contrast, o-Tyr levels and o-Tyr/p-Tyr ratios were higher in dialyzed patients. Regarding dialyzed patients, o-Tyr level and o-Tyr/p-Tyr ratio were higher in ESA-HD than in non-ESA-HD and CAPD groups. Weekly ESA-dose/body weight and ERI1 correlated with o-Tyr/p-Tyr ratio (r=0.441, p=0.001; r=0.434, p=0.001, respectively). Finally, o-Tyr/p-Tyr ratio proved to be an independent predictor of ERI1 (β=0.330, p=0.016). Discussion: Our results suggest that elevation of o-Tyr/p-Tyr ratio could be responsible for ESA-hyporesponsiveness in dialyzed patients.]