Lege Artis Medicinae

[GENDER ASSOCIATED DIFFERENCES IN THE PROGRESSION OF RENAL DISEASES]

MÜLLER Veronika, SZABÓ Attila

JANUARY 21, 2004

Lege Artis Medicinae - 2004;14(01)

[Increasing evidence suggests an important role of gender in the incidence, progression and different therapeutic possibilities of several diseases. Recent data demonstrated gender associated differences in the development and progression of chronic renal diseases. Present work reviews sexual dimorphism in different chronic renal diseases, summarizes underlying pathophysiological processes and therapeutic possibilities focusing on the role of gender. New evidences may present the base of gender based therapies in the future.]

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Lege Artis Medicinae

[LOCAL INEQUALITIES IN THE UTILIZATION OF SPECIAL HOME NURSING IN THE SOUTH-TRANSDANUBIAN REGION]

BONCZ Imre, SÁNDOR János, OLÁH András, BETLEHEM József, SEBESTYÉN Andor, KISBENEDEKNÉ Gulyás Kinga, DÓZSA Csaba

[INTRODUCTION - The aim of this study is to analyse the local inequalities in the access and utilization of special home nursing within Hungary focusing on the South-Transdanubian Region. DATA AND METHODS - In the first part of the study we compared the indicators of the access and utilizations of special home nursing at national and county level. In the second part of the analyses we made a detailed analyses of utilization data of home nursing in the three counties (Baranya, Somogy, Tolna) of the South- Transdanubian Region of Hungary. Data is derived from the financial database of the National Health Insurance Fund of Hungary for the period 1998-2002. RESULTS - The access of population to the special home nursing increased from 83,8% (1998) to 95,1% (2002). The utilization rate increased from 74,8% (1998) to 84,1% (2002). Within the South-Transdanubian Region we found significant local inequalities in the utilization of services (number of cases, number of visits), which were represented by the tools of geographical information system. CONCLUSIONS - There have been significant differences in the access and utilization of home nursing with remarkable within country inequalities.]

Lege Artis Medicinae

[Cardiovascular aspects of impaired glucose tolerance: A review through the STOP-NIDDM Trial]

BOSNYÁK Zsolt, KERÉNYI ZSUZSA

Lege Artis Medicinae

[A NEW DISCIPLINE IN THE CENTER OF MEDICAL RESEARCH AND CLINICAL PRACTICE - THOUGHTS ON BIOINFORMATICS]

FALUS ANDRÁS, BERKE Tamás, ORTUTAY Csaba Péter, SUHAI György

[Bioinformatics is one of the most important element of genomic research revolutionising biomedical science. This review describes the phenomena of genomic variance and comparative genomics. Briefly, the review summarises the identification procedure of new genes and gene expression patterns highly important in diagnostics. Bioinformatic procedures make possible the rapid detection of pathogens and have principal role in molecular drug design technologies.]

Lege Artis Medicinae

[THE METABOLIC SYNDROME CLINICAL APPEARANCE, DIAGNOSIS, PATHOMECHANISM]

KÉKES Ede, CZURIGA István

[The metabolic syndrome has gone by several names over the past two decades. The diagnostic criteria were proposed by the ATP III of NCEP in 2001 and were accepted by European Society of Cardiology and European Society of Hypertension in 2003. The criteria (abnormal waist rate, HDLcholesterol, triglyceride, blood pressure and fasting glucose) are listed and the presence of any three of these factors is considered sufficient for diagnosis. The prevalence of syndrome affects about a quarter of the Hungarian population with hypertension. The metabolic syndrome is associated with premature cardiovascular morbidity and mortality including an excess of sudden deaths. According to the recent literature data the main component of the syndrome, the obesity, especially with abdominal fat distribution is associated with hypertension, hyperinsulinemia and insulin resistance with related abnormalities of carbohydrate and lipid metabolism. The low HDL cholesterol, high triglyceride level and the small, dense LDL cholesterol particles are the parts of lipid component of syndrome. A variety of environmental (obesity, smoking, physical inactivity) and genetic factors (genetic mutations of lipoprotein lipase, hepatic lipase, CETP and PPA receptors) and the impaired FFA metabolism have all been related to lipid abnormalities. Sympathetic hyperfunction participates in the pathogenesis and complications of metabolic syndrome. Possible factors augmenting sympathetic activation include alterations of insulin, leptin, FFA, cytokines, sleep apnoe. Other important factors as the endocrin concept, the hypothalamus-hypophysis- adrenal axis, endothelial dysfunction are discussed. The impaired muscle insulin stimulated glycogen synthesis (FFA induced GLUT-4 inhibition) is the major cellular factor of insulin resistance. There is a continuous process from the insulin resistance state (with hyperinsulinemia) into the 2T diabetes mellitus (with hypoinsulinemia).]

Lege Artis Medicinae

[CURE]

MATOS Lajos

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[The reason of the unfavourable life expectancy of patients with chronic kidney disease (CKD) is not only the development of end-stage renal failure but the frequent appearance of cardiovascular diseases (CVD). Chronic kidney damage itself is a cardiovascular risk state and the occurrence of CVD/associated diseases is significantly higher in chronic kidney failure. Beside risk stratification and valid treatment of CVD (hypertension, diabetes mellitus, ischemic heart disease e.g.) we and the international nephrological community have left the cerebrovascular diseases of CKD patients out of consideration. However, up to 50% of patients suffering a stroke will die immediately, only 10% of stroke survivors can continue his/her profession, but the others will be permanently disabled. High blood pressure is a strong predictor of stroke and of other CVD in most of the patients. In stroke risk reduction it is particularly important to reach the target blood pressure values. The main object of the “Live under 140/90 mmHg” programme of the Hungarian Society of Hypertension is to familiarize with target blood pressure itself and how to reach target blood pressure. In 2010, prevention, early diagnosis and management of stroke are the most important challenges of this programme (The Brain Control Programme). We think it is advisable to prepare and publish a clinical practice guideline in collaboration with stroke societies which is similar to the guidelines of international societies and of the Hungarian Society of Stroke but specific for CKD patients. This guideline would help to give a uniform, up-to-date treatment for the cerebrovascular diseases of CKD patients.]

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[Gender differences in sport-adaptation of intramural coronary resistance arteries]

TÖRÖK Marianna

[Biomechanical and functional remodeling of coronary resistance arteries in physiological left ventricular hypertrophy has not been analyzed yet, and the possible sex differences are unknown. We aimed to study the biomechanics and function of these arteries during an exercise intervention. Wistar rats were divided into four groups: male and female sedentary controls (MSe and FSe) and male and female animals undergoing a 12-week intensive swim training programme (MEx and FEx). After the training sessions, LV morphology and function were checked by echocardiography, the coronary artery biomechanics and function were examined by pressure arteriography. Elastica remodeling was studied in resorcin-stained histological sections. The female animals had enhanced heart weight/body weight ratio compared to male rats. A similar outer radius and reduced inner radius resulted in an elevated wall-to-lumen ratio in the MEx and FEx animals compared to the sedentary controls. The wall elastic moduli increased in the MEx and FEx rats. The spontaneous tone and TxA2 agonist-induced tone was raised only in ExF animals, whereas the endotheliumdependent relaxation became more effective in ExM rats. Arteries of ExF rats had stronger contraction, whereas arteries of ExM animals had improved dilation. Range of coronary vascular reactivity increased in both exercised male and female rats, but its mechanism was different depending on sex. According to our results the coronary arterioles adapted to an elevated load during long-term exercise and this adaptation depended on sex. The observed sex differences in the biomechanics and function of the coronary resistance arteries of rats may contribute to better understanding of the physiological and pathological function of these arteries in active and retired athletes.]

Lege Artis Medicinae

[The relationship between premature mortality and marital status in hungary]

HAJDÚ Vargáné Piroska, BOJÁN Ferenc

[The relationship between mortality and the marital status of Hungarians aged 30–64 was analyzed for the period 1970–1990. The lowest mortality rate was found among married men and women, independent of age. The risk of mortality among unmarried men and women is greater in the age group 30–49 than in the age group 50–59. In both age groups the relative mortality risk of widowed and divorced men is higher than that of the corresponding women. As compared with the married population, the relative mortality risk of men and women who never married is less pronounced, especially in the age group 50– 59. From the late 1970s, the relative mortality risk of divorced men has increased to the greatest extent. As a consequence, in 1980s, the divorced men proved to be the group at greatest risk. ]

Clinical Neuroscience

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VALIKOVICS Atilla, OLÁH László, FÜLESDI Béla, MUNKÁCSY Csaba, CSIBA László

[Transcranial Doppler (TCD) was used to measure the effect of 1 g acetazolamide (Diamox, Lederle) on blood flow velocity in the middle cerebral artery of 50 healthy volunteers (aged 20-70 years). Parameters of blood flow, blood pressure, heart rate and blood gas values were determined before and after intravenous administration of Diamox. The reserve capacity was expressed as a percentage change of baseline values. The acetazolamide did not result in significant blood pressure and blood gas changes. The mean velocity of blood flow before Diamox administration was 59.8+14.4 cm/s. The velocity of flow significantly increased after acetazolamide, peaking after 10 minutes. The extent of reserve capacity was the greatest in the age group of 31-40 years and the smallest in the 61-70 years group. The reaction was longer lasting in age groups over 50 years. Significantly higher flow parameters and greater reserve capacity was found in women than in men at each measuring time point. The reserve capacity depended on age and gender.]