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Lege Artis Medicinae

MAY 20, 2019

[Perinatal faulty hormonal imprinting: early impact, late consequences]

CSABA György

[The description and basic study of hormonal imprinting were the first in the series of research, which led to the recognition of the role of perinatal chemical effects in the late (adult age) manifestation of some diseases and inclination to diseases. Today it is clear, that certain pathological states, as obesity or diabetes, hypo- or hyperactivity (autoimmunity and allergy) of immune system can be deduced to perinatal (hormonal or metabolic) imprinting. The perinatal hormonal (chemical) imprinting takes place at the first encounter between the developing hormone receptor and the target hormone which sets the binding capacity of the receptor for life. In the critical periods of ontogeny (in addition to the perinatal imprinting) it can be developed at weaning, in adolescence and in continuously dividing and differentiating cells during the whole life. It is provoked by considerable quantitative differences of the physiological hormone or the presence of strange target-hormone-like molecules. The faulty hormonal imprinting leads to the adult-age diseases at any time of life and is inherited epigenetically to the progeny generations. Faulty hormonal imprinting always could be present in earlier times however, at present, because of the erroneous multiplication of endocrine disruptors in the environment, nutrition and medicine, its importance is continuously growing. The effects of faulty hormonal imprinting seem to be dangerous however, it can be imagined in the far future also a positive effect by the transformation of the human endocrine system at an evolutionary route. In the metabolic or immunological imprinting as well, as in the DOHaD (Developmental Origins of Health and Disease) the foremost recognized hormonal (chemical) imprinting is materialized.]

Clinical Neuroscience

MAY 30, 2019

Population-based stroke screening days in the 12th district of Budapest in 2011 and 2016 - What have and what have not changed?

FOLYOVICH András, BOTOS Nóra, BALOGH Erzsébet, BAKOS Mária, HERTELENDY Anna, BÉRES-MOLNÁR Anna Katalin

Introduction - Population-based screening is an option to identify persons at high risk for stroke. However it is associated with rather high expenses, necessitating the selection of effective methods that take local characteristics into account. The 12th district of Budapest has a long tradition of population-based screening for frequent and preventable diseases. The Szent János Hospital hosts an annual stroke screening day. In the present study, previously published data from the 2011 screening were compared with those obtained in 2016, looking for changes and tendencies throughout the examined period. Subjects and methods - The screening day was conducted in a generally similar way in 2011 and 2016. Similarly to the previous event, the program was organized on a Saturday, the call for the event was spread by the local newspaper. The crew composition was the same. As regards the components of the screening (currently including general history taking, risk status assessment, blood pressure measurement, BMI assessment, cholesterol and blood glucose tests, carotid duplex ultrasonography, and ophthalmological examination), the only difference was the absence of cardiologic examination (it was conducted on an independent day). The anonymous data sheet was the same. Results - The number of participants in the 2016 event was 33, to provide more comfortable conditions. The female predominance was slightly less pronounced but was still present in 2016 (60.6% vs. 72.9%). The mean age became substantially higher (71.2 y vs. 62.9 y). The ratios of participants with higher level of education (97% vs. 94%) and those who are married were still remarkable. The most frequent risk factors were the same; however the ratio of participants with hypertension, ‘other heart disease’, and diabetes increased, whereas that of with hyperlipidemia and obesity decreased. The incidence of atrial fibrillation was unaltered. None of the participants in 2016 admitted smoking (previously this ratio was 20.8%) or drinking heavily. The findings of the carotid ultrasonography revealed a more favorable vascular status. Ophthalmological assessments (predominantly hypertensive alterations on fundoscopy) revealed that the pathological vs. physiological ratio switched to 1:2 from 2:1. The final evaluation of the screening program likewise demonstrated an improved overall state of health of the population. Conclusions - We observed a more favorable stroke risk status of the population in 2016. Whether it is indeed a tendency unknown at present. The role of the local media in calling for screening is still decisive, and the cohesive power of the family is important.

Hypertension and nephrology

MAY 10, 2019

Hypertension and nephrology

MAY 10, 2019

[Diabetology in dialysis]

MÁCSAI Emília, HALMAI Richárd, NEMERE Éva, BRASNYÓ Pál, KISS István

[According to epidemiological data, the number of diabetic patients requiring dialysis is increasing. Burnt-out diabetes, new onset diabetes during chronic dialysis treatment and new onset diabetes after transplantation diabetes are new types of diabetes compared to the traditional division forms. It is utmost important to evaluate education ability and acceptance the core values of lifestyle changes. Clear guidelines for oral anti-diabetic and insulin therapy have not yet been developed since this group of patients did not participate in previous major surveys. In order to formulate individualized therapeutic recommendations, it is imperative to perform regular glucose self-monitoring, which is also the cornerstone of solving unexpected situations. Both in hemodialysis and peritoneal dialysis, special considerations should be applied to the diabetic patient group, this review focuses on the current understanding of available relevant knowledge and summarizes presumably extrarenal diabetic complications as well.]

Lege Artis Medicinae

MARCH 20, 2019

[How can we reach more effective antihypertensive treatment in diabetic patients with hypertension?]

BENCZÚR Béla, TORZSA Péter

[Hypertension is the leading “silent killer” accounting for 10 million deaths worldwide. It frequently occures together with other metabolic risk factors, including type-2 diabetes mellitus and dyslipidemia augmenting the global cardiovascular risk of patients. Their treatment and reaching target blood pressure means a real challenge for practising physicians. According to the recent hypertension guidelines RAAS-inhibitors are the first choice agents which can be excellently combined with diuretics. RAAS-inhibitor based therapy frequently needs to be completed with Ca-antagonist to which statin should be added in the presence of metabolic risk factors. The benefits of amlodipin/atorvastatin fixed combination are multiple: both agents are capable to inhibit the progression of atherosclerosis and to reach blood pressure and LDL target values. In addition the well-known poor statin-adherence can be improved with fixed combination which can contribute to the reduction of risk of these high-risk subjects. ]

Hypertension and nephrology

FEBRUARY 20, 2019

[Carvedilol in chronic kidney disease]

CSIKY Botond

[Chronic kidney disease (CKD) is endemic affecting 850 million people worldwide. Adequate antihypertensive treatment slows the progression of the kidney disease and also decreases the mortality of this population. Because of the comorbidities and the high cardiovascular risk beta-blockers have to be administered frequently in these patients. Carvedilol is a 3rd generation non-selective beta-blocker with alpha- 1 receptor blocking and antioxidant properties. It is metabolically neutral, it does not increase the risk of new onset diabetes and it does not increase the patients’ body weight. In some animal models of CKD and in several human CKD studies carvedilol has shown to have nephroprotective properties and it also decreased the cardiovascular risk in combination therapies.]

Hypertension and nephrology

FEBRUARY 20, 2019

[Statins for elderly people, in primary prevention?]

BAJNOK László

[In a recent, retrospective cohort study, statin usage in primary prevention was found being not beneficial for patients (i) without diabetes over 75 years of age, and (ii) with diabetes over 85 years of age (75-84 years total mortality of diabetics was also lower). These findings are in sharp contrast to the two outstanding, double-blind, placebo controlled, randomized, a primary prevention studies done with rosuvastatin. Of these, 50% reduction in LDL-C in JUPITER was associated with a 50% reduction in risk and 25% reduction in LDL-C in HOPE-3 with 25% reduction in risk. Furthermore, subgroup analyzes did not indicate lower efficacy for the elderly. The recommendation of the European Atherosclerosis Society for primary preventions of the elderlies recommending consideration of statin use in these cases (Class IIa) is particularly relevant, especially in the presence of other risk factors such as hypertension. In the primary prevention lipid treatment, we can see quite clearly till 75 years of age and hopefully, we will even further after learning about the results of STAREE, a study that is designed to elderly and in which 40 mg atorvastatin is applied.]

Hypertension and nephrology

DECEMBER 10, 2018

[Hypertension and atrial fibrillation. Part 2. Basic methods of screening atrial fibrillation]

KÉKES Ede

[Early detection of PF, especially short-term “paroxysmal aritmia”, is very important primarily in older individuals (over 65 ys), especially those with heart disease, hypertension or diabetes. Two methods are known for the early detection of PF: In one (regular screening) making 12-lead ECG examination for individuals over the age of 65 at fix times. The other (opportunistic screening) means that every person over the age of 65, whenever he or she percieves any complains, the physician will experience the pulse of the patient and in case of arrhythmia the EKG is made.]

Lege Artis Medicinae

DECEMBER 10, 2018

[Type 2 diabetes: what is the role of a General Practitioner in the treatment of diabetes?]

TORZSA Péter, OLÁH Ilona, HARGITTAY Csenge, KALABAY László

[The 2017 National Guidelines of the Hun­garian Diabetes Association emphasize the individual treatment of diabetic patients and the strong, goal-oriented regulation of carbohydrate metabolism from recogni­tion on. Beside monotherapy, primary dual or triple combination therapy may be applied in the treatment of patients. In primary care it’s the treatment of patients with type 2 diabetes where there is a lot to be done. We hope that the everyday use of the Professional Guidelines will contribute to a more successful diabetic care by General Practitioners (GPs). The holistic care of the GP’s team plays an important role in the primary, secondary and tertiary prevention of Type 2 diabetes, which accounts for more than 90% of all diabetic cases. ]