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Hypertension and nephrology

SEPTEMBER 21, 2012

[Protein-energy wasting and quality of life in kidney transplant recipients]

UJSZÁSZI Ákos, VÁRADY Tímea, CZIRA Mária Eszter, FORNÁDI Katalin, NOVÁK Márta, MUCSI István, MOLNÁR Miklós Zsolt

[Chronic kidney disease has profound effects on the health related quality of life (HRQoL) of patients with serious physiological, psychological and socio-economic implications. The co-occurrence of protein-energy wasting (PEW) and inflammation in end stage renal disease patients is associated with worse HRQoL and increased mortality. We designed this study to examine the relationship between nutritional and inflammatory status and HRQoL in kidney transplant recipients. Data from 100 randomly selected kidney transplant patients were analyzed in a crosssectional survey. Socio-demographic parameters, laboratory results, transplantation related data, co-morbidities, medication and malnutrition-inflammation score (MIS) (Kalantar Score) were tabulated at baseline. Patients completed the Kidney Disease Quality of Life-SF (KDQoL-SFTM) self-administered questionnaire. Mean age was 51±13 years, median (interquartile range, IQR) time since transplantation 66 (83) months, 57% were males and 19% had diabetes. The median (IQR) MIS was 3 (3). MIS significantly and negatively correlated with almost all HRQoL domains analyzed, and this association remained significant in multivariate linear regression analysis for the log-transformed scores on energy/fatigue (β=-0.059, p<0.001), bodily pain (β=-0.056, p=0.004), physical functioning (β=-0.029, p=0.022), and symptoms/problems (β=-0.023, p=0.005) domains after statistical correction for age, gender, eGFR, dialysis vintage, Charlson Comorbidity Index and occupational status. Additionally, cubic spline analyses revealed linearly increasing, “dose-response” relationship between almost all domains of KDQoL-SFTM and the MIS. Malnutrition Inflammation Score is independently associated with different dimensions of health related quality of life in kidney transplant recipients.]

Hypertension and nephrology

DECEMBER 22, 2011

[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.]

Clinical Neuroscience

NOVEMBER 30, 2011

[Theoretical and practical considerations of rational polytherapy in epilepsy]

RAJNA Péter

[Author analyses the consideration of rational polytherapy for epilepsy. Among the theoretical aspects he points the different effect of seizure inhibitory drugs on the epilepsy models but didn’t find data enough for the basis of any successful combination. Combinations of compounds having different way of action are more promising. Rational polytherapy can serve also the epileptic patients’ tailored therapy in the daily routine. There have already been some proved synergisms concerning drug interactions. Based on detailed analysis of side effects a possibility occurs for neutralization of side effects when anticonvulsants with side effects of opposite nature are combined. Considering both the side effect profiles and the different (somatic and psychic) habits of the patients we can create a special list of favourable combinations. Co-morbid states and their treatments play a significant role in the application of rational polytherapy. Combination of anticonvulsants of lower potential but without drug-interactions can be the choice in these cases. The non-epileptic indications of the anticonvulsants can also be utilized in polymorbid patients. Based on the theoretical and practical considerations the author defines the ten-step-cognitive-preparation-process in planning the optimal (poly)therapy. On speculative basis he suggests eight beneficial versions of seizure inhibitory rational polytherapy.]

Lege Artis Medicinae

FEBRUARY 21, 2008

[PSORIASIS TODAY]

SZEGEDI Andrea, KISS Flóra, GAÁL János

[Psoriasis is one of the most common dermatological disorders. It is an immune-mediated chronic inflammatory disease that primarily affects the skin and the joints, and substantially reduces the quality of life. It occurs worldwide, with a prevalence of about 2% in developed countries. Today numerous studies are continuously published on psoriasis. Important progress has been made especially on its genetics, pathomechanism and comorbidity. In the past few years, several efficient therapeutic approaches have been developed and applied. With the appearance of biological therapies, the inflammatory process can be targeted more selectively than before. The paper reviews most recent data on the pathogenesis, immunological background, comorbidity and reduced quality of life associated with psoriasis, and presents therapeutic approaches with special focus on recent advances. The increased knowledge allows of a more efficient treatment and care of patients with proriasis, thus significantly increasing their quality of life.]

Lege Artis Medicinae

JANUARY 20, 2005

[DEPRESSION IN SOMATIC ILLNESSES - THE NEED FOR CONSULTATION-LIAISON PSYCHIATRY]

VINCZE Gábor, TÚRY Ferenc, MURÁNYI István, KOVÁCS József

[INTRODUCTION - Affective disorders are widely prevalent causing a common health problem. They appear frequently as comorbid disorders in connection with somatic illnesses. In the Hungarian literature there are very little data available related to his topic. In this study the prevalence of depression was analyzed in different departments of general hospitals. PATIENTS AND METHODS - A questionnaire screening was performed in nine Hungarian hospitals among 2423 patients treated in general medical departments. The prevalence of depression and the use of antidepressants was measured. The Beck Depression Inventory was applied for the detection of depression. RESULTS - In the studied sample the mean score of depression was 12.9 on the Beck Depression Inventory. 46.4% of the patients reached a pathological score. The most prevalent depression was screened in the rheumatological, neurological and rehabilitation departments. The use of antidepressants was very low among the depressed patients (0-11.9%). CONCLUSION - Based on the data of the study it seems that screening and treatment of depression in general medical departments is of great importance, which stresses the practical significance of the consultation-liaison psychiatry.]

Clinical Neuroscience

MARCH 24, 2010

[Vertigo - comorbidity with psychiatric disorders]

FAZEKAS András

[Vertigo is one of the most common symptom and complaint in the clinical practice. The differential diagnosis can only be attained by a careful interdisciplinary way of thinking and activity, given the fact that the vestibular, neurological and psychiatric disorders - considered as pathogenic factors - are being present simultaneously in triggering the symptoms, and there can be overlaps between the certain pathological processes. The author deals with the co-morbidity of the vertigo and the psychiatric symptoms - anxiety, panic-disorder -, pointing out the common neurobiological and neurophysiological factors in the background of the symptoms, emphasizing the importance of the SSRI-s in the restoration of the serotonerg dysfunction.]

Clinical Neuroscience

JULY 20, 2011

[Combined evoked potentials in co-occuring attention deficit hyperactivity disorder and epilepsy]

MAJOR Zoltán Zsigmond

[Background and purpose - Evoked potentials, both stimulus related and event related, show disturbances in attention deficit-hyperactivity disorder and epilepsies, too. This study was designed to evaluate if these potentials are characteristically influenced by the presence of the two diseases, individually, and in the case of co-occurrence. Methods - Fourty children were included, and four groups were formed, control group, ADHD group, epilepsy group and a group with the comorbidity of epilepsy and ADHD. Epilepsy patients were under proper antiepileptic treatment; ADHD patients were free of specific therapy. Brainstem auditory evoked potentials, visual evoked potentials and auditory P300 evaluation were performed. Results - The latency of the P100 and N135 visual evoked potential components was significantly extended by the presence of epilepsy. If ADHD was concomitantly present, this effect was attenuated. Brainstem auditory evoked potential components were prolonged in the presence of the comorbidity, considering the waves elicited in the brainstem. P300 latencies were prolonged by the presence of co-occurring ADHD and epilepsy. Feedback parameters showed overall reduction of the tested cognitive performances in the ADHD group. Conclusion - Disturbances produced by the presence of ADHD-epilepsy comorbidity reveal hypothetically a linked physiopathological path for both diseases, and offers an approach with possible diagnostic importance, combined evoked potential recordings.]