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Journal of Nursing Theory and Practice

AUGUST 30, 2016

[Application of external circulatory assist device in cases of cardiac failure]

TAMÁS Csilla, BARATI Zoltán

[The Heart and Vascular Centre of Semmelweis University was the first institution in Hungary to routinely apply external mechanical circulatory support (Extracorporal Membrane Oxigenation, Ventricular Assist Device) as a new alternative to treat cardiogenic shock cases. The objective of our study was to assess how frequently certain therapeutic methods were applied, and to evaluate the demographic characteristics, the case historic and the mortality data of the patients treated, as well as to demonstrate the incidence rate of the most frequent complications. Our study was based on the data of patients suffering cardiogenic shocks treated with external circulatory assist devices between 1. June, 2012 and 31. January, 2016. The study has been carried out analytically and retrospectively after data collection from written and electronic patient documentation. Data analysis has been executed by SPSS software. The results revealed uneven gender distribution, over 60% of incidence in case of four examined complications, and an elevated mortality rate of patients over 60 years old. We found that there is a higher risk for complications if mechanical circulatory support is applied, and we made a suggestion to reconsider the application of this support for patients over certain ages. The study demonstrated that our results match the statistical data found in international medical literature. ]

Clinical Neuroscience

JANUARY 20, 2017

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

SONGUL Senadim, MURAT Cabalar, VILDAN Yayla, ANIL Bulut

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

DECEMBER 20, 2016

[Hypertension and atrial fibrillation]

SZŐKE Vince Bertalan, BARACSI-BOTOS Viktória, JÁRAI Zoltán

[Hypertension is the most important independent risk factor of atrial fibrillation, the most common clinically significant arrhythmia. Increased atrial wall tension, myocardium remodelling, activation of renin-angiotensin-aldosterone system (RAAS) and fibrotic remodelling are possible hypertension induced mechanisms which can contribute to developing atrial fibrillation. Knowing the relation of hypertension to atrial fibrillation is crucial in the need for effective and up-to-date therapeutic strategies. RAAS inhibitors and beta blockers prevent atrial fibrillation not only by lowering blood pressure but partly due to the inhibition of the above mentioned mechanisms. Complications of hypertension, such as left ventricular hypertrophy and hypertensive cardiomyopathy are substantially limiting the number of drugs that can be used for rhythm control. In most cases in the presence of hypertension initiation of anticoagulation therapy is necessary too.]

Lege Artis Medicinae

AUGUST 20, 2016

[Cardiovascular aging]


[The world population in both industrialized and developing countries is aging. The clinical and economic implications of this demographic shift are staggering because age is the most powerful risk factor for cardiovascular diseases. The incidence and prevalence of hypertension, coronary artery disease, congestive heart failure, and stroke increase steeply with advancing age. Although epidemiologic studies have discovered that some aspects of lifestyle and genetics are risk factors for these diseases, age, per se, confers the major risk. There is a continuum of age-related alterations of cardiovascular structure and function in healthy humans, however these alterations are not synonymous with diseases processes. Old age is not a disease. Although cardiovascular aging changes are considered “normative”, they lower the threshold for development of cardiovascular disease, and appear to influence the steep increases in hypertension, atherosclerosis, stroke, left ventricular hypertrophy, chronic heart failure, and atrial fibrillation with increasing age. Specific pathophysiologic mechanisms that underlie these diseases become superimposed on cardiac and vascular substrates that have been modified by an “aging process”, and the latter modulates disease occurrence and severity. Age-associated changes in cardiovascular structure and function become “partners” with pathophysiologic disease mechanisms, lifestyle, genetics, and other presently unknown factors in determining the threshold, severity, prognosis, and therapeutic response of cardiovascular disease in older persons. However, the role of specific age-associated changes in cardiovascular structure and function in such age-disease interactions has not been considered in most epidemiologic and clinical studies of cardiovascular disease. Quantitative information on age-associated alterations in cardiovascular structure and function in health is essential to unravel age-disease interactions and to target the specific characteristics of cardiovascular aging that render it such a major risk factor for cardiovascular diseases. Such information is also of practical value to differentiate between the limitations of an older person that relate to disease and those that might be expected, within limits, to accompany advancing age or a sedentary lifestyle.]

Hypertension and nephrology

SEPTEMBER 10, 2016

[Hypertension and left ventricular hypertrophy]


[Left ventricular hypertrophy (LVH) is defined as an increase in the mass of the left ventricle. In addition to the absolute increase in mass, the geometric pattern of LVH also may be important. LVH can be secondary to an increase in wall thickness, an increase in cavity size, or both. LVH as a consequence of hypertension usually presents with an increase in wall thickness. This increase in mass predominantly results from a chronic increase in afterload of LV caused by the hypertension, although there is also a genetic component. A significant increase in the number and/or size of sarcomeres is the main pathologic mechanism, but hypertension may also result in interstitial fibrosis. The estimation of mass is commonly derived from measurements obtained by echocardiography. LVH is associated with increased incidence of systolic and/or diastolic dysfunction, heart failure, myocardial infarction, ventricular arrhythmias, sudden cardiac death, aortic root dilatation, and a cerebrovascular event. The cardiovascular risk is directly related to the degree of mass. The regression of LVH is associated with a reduction in cardiovascular risk and improved cardiac function. Regression of LVH is associated with weight loss, dietary sodium restriction, and use of ACE inhibitors, ARBs, some calcium channel blockers, and some sympatholytic agents.]

Hypertension and nephrology

SEPTEMBER 20, 2015

[Carvedilol therapy in hypertension]


[Author analyzed the properties and antihypertensive effect of one of the best beta blockers with vasodilative effects, the carvedilol on the base of the Hungarian and international literature . Author deals with this issue for many years and he presented his own experience. The beta blockers could never be missed on therapy of the endemic hypertension. They are equivalent to other drug family. This played a big role , that the new , strong beta-1 selective and -- especially 3. generation beta blockers (carvedilol and nebivolol) - came to the fore in the therapy of hypertension compared with conventional beta blockers. The carvedilol has many beneficial properties, as vasodilatation, antioxidant effect, beneficial effect on the vascular stiffness, regression of left ventricular hypertrophy, increasing coronary reserve. Carvedilol is able to stable success on the therapy of hypertension as monotherapy or combination with the other drugs. In Hungary the physicians applied beta blockers about 30-35% in the treatment of hypertension.]

Lege Artis Medicinae

JULY 20, 2015

[Treatment of chronic Pseudomonas aeruginosa lung infections in cystic fibrosis with inhaled tobramycin]


[BACKGROUND - Intermittent or chronic pulmonary infections caused by Pseudo­monas aeruginosa (Pa) deteriorate clinical status and worsen lung function in patients with cystic fibrosis (CF). The prognosis of the disease and life expectancy of patients are substantially dependent on lung infections and inflammation; therefore the primary goal of the treatment is the early termination of the infection. PATIENTS AND METHODS - Efficacy of tobramycin (TOBI® 300 mg/5 mL solution for inhalation, henceforth TOBI®) inhalation in Pa pulmonary infections was studied in a non-interventional, observational, open-label, single-arm trial in subjects with CF. Fifty-three patients aged six to 31 years (averaged 15.8 years) were enrolled into the study. Three treatment cycles of TOBI® inhalation (28 days on drug, 28 days off drug) plus 6 months observational period were evaluated. Primary endpoint was changing in the predictive values of forced expiratory volume in 1 sec (FEV1) compared to the initial values after three cycles of the treatment. Secondary endpoints were changing in the FEV1 predictive values at the end of the complete study compared to the initial values; ratios of patients with decreased density of originally Pa-positive result of sputum culture; as well as safety and tolerability of the TOBI® treatment. RESULTS - FEV1 and FEV1% results were unchanged comparing to the initial values at the end of the treatment and after the observational period in the whole study population. However, sputum cultures became negative in 47.2% of all subjects as a result of the treatment, and the FEV1 values were gradually increased in these patients: after the third treatment cycle plus 160 mL, and at the end of the study plus 110 mL comparing to the initial values. Similar considerable increase was detected in the predictive FEV1% in this sub-group: after the first cycle plus 5.2%, at the end of third cycle plus 7%, after the observational period above 3.8% considering the starting results. CONCLUSIONS - TOBI® inhalation proved to be effective in improvement of lung function results and eradication of infection in our patients with Pa positive CF. The treatment was well tolerated and safe.]

Hypertension and nephrology

JUNE 25, 2015

[The use of beta-blockers in Hungary 2007-2014 based on data from National Health Insurance]


[disease, various rhythm disturbances, migraine, essential tremor case, addition to the treatment of endocrine disorders caused tachycardia and also may be used in the treatment of systolic and diastolic heart failure. Using the National Health Insurance Fund (NHIF) database, we analyzed changes in the turnover of beta-blockers used domestically between 2007 and 2014. At the beginning of the period more than 50% was metoprolol as the used active ingredient, the end of the period, nebivolol became the most frequently assigned active agent betablocker (29%). Besides nebivolol the use of bisoprolol and carvedilol increased, among the “old” beta-blockers the use of pindolol, bopindolol continuously decreases, propranolol and sotalolol consumption stagnant after the initial small decrease. Metabolic syndrome, disorders of carbohydrate metabolism, in case of sleep apnea the advantage of nebivolol is accompanied by the status of enhanced sympathetic activity and consequent reduction of RAS activation. Vasodilation, inhibition of plaque formation, reduction of platelet aggregation and anti-proliferative effects of nebivolol are its unique characteristics in the beta-blocker group. Improves insulin sensitivity, thus it is not characterized by a long-term side effects that cause diabetes. Effective reduction in the central blood pressure with nebivolol is likely to reduce the risk of complications in stroke and other related central blood pressure. Therefore, if the recommendations of the international and domestic support for considering it is not surprising that the use of metoprolol reduced such a large extent and how nebivolol covered the significant majority of the entire domestic beta-blockers market. Carvedilol was before the second and currently has become the 3rd or 4th most frequently used beta blocker. The decrease in the use of metoprolol undoubtedly caused by change in the recommendations, getting out of the subsidized products, and the appearance of the above known, new effective drugs.]

Hypertension and nephrology

MARCH 20, 2015

[Effects of peripheral resistance lowering and elevating beta-blockers on central blood pressure - nebivolol in focus]


[Central blood pressure, that is, blood pressure (BP) in the ascending aorta, is considered an important physiologic parameter as it reflects the hemodynamic relationship between the heart and the aorta, both in systole and in diastole. In the systolic phase, central BP represents the pressure against which the left ventricle has to eject blood during systolic contraction. Thus, central arterial pressure reflects both left ventricular stroke volume and afterload, defines cardiac work, and contributes to the development of left ventricular hypertrophy in hypertensive individuals. In the diastolic phase, central BP is a key determinant of the blood flow delivery to the myocardium. Despite the increasing knowledge regarding the importance of central blood pressure and the availability of non-invasive measurement technics it couldn’t spread in everyday clinical practice and rarely or not mentioned in the therapeutic guidelines. The different antihypertensiv drugs significantly differs based on their effects on central blood pressure particularly β-blockers. The so-called ’classical’ β-blockers have un - favourable effect on central blood pressure due to increasing peripherial vascular resistance. In the opposit the vasodilating β-blockers including nebivolol markedly decrease central blood pressure which could explain their beneficial effects.]

Hypertension and nephrology

DECEMBER 20, 2014

[Epidemiology of hypertension in Hungary]


[The most important aspects of Hungarian hypertension epidemiology are demonstrated. The prevalence of hypertension is continuously increasing and in 2011 from the nearly 10 million population exceeded 3 million. Its occurrence rises in parallel with the increase in of systolic blood pressure and the progression of age, and exceeds 60% in those aged over 65 years. The average blood pressure is increasing in children and adolescents, and isolated systolic hypertension is often observed in those over 65-70 years. The situation is closely related to overweight in the young, while in elderly the atherosclerotic process results in low diastolic blood pressure. The prevalence is significantly different in some regions with the highest incidence in South-Transdanubia and North- Hungary. Overall, there is a higher incidence in women. Among known hypertensive patients, the ratio of men is greater till 40-45 years; thereafter, there will be an equilibration and in elderly women the incidence will be higher. It is interesting, that the morbidity and mortality have significantly increased in hypertension and diabetes since 2004, while the incidence of myocardial infarction and stroke has significantly decreased. As concerns organ damage, an increase in occurrence of left ventricular hypertrophy and microalbuminuria has been observed. Metabolic syndrome, diabetes mellitus and ischemic heart disease were the most frequent comorbidities.]