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Clinical Neuroscience

MAY 30, 2020

The etiology and age-related properties of patients with delirium in coronary intensive care unit and its effects on inhospital and follow up prognosis

ALTAY Servet, GÜRDOGAN Muhammet, KAYA Caglar, KARDAS Fatih, ZEYBEY Utku, CAKIR Burcu, EBIK Mustafa, DEMIR Melik

Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes. This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as <65 years old, 65-75 yo, 75-84 yo and> 85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups. A total of 1108 patients (mean age: 64.4 ± 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p<0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p<0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p<0.05). Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.

Lege Artis Medicinae

APRIL 18, 2020

[Interrelations between antidepressants and diabetes]

HARGITTAY Csenge, GONDA Xénia, MÁRKUS Bernadett, VÖRÖS Krisztián, TABÁK Gy. Ádám, KALABAY László, RIHMER Zoltán, TORZSA Péter

[Diabetes and depression are frequent comorbidities. They are a heavy burden by themselves, however, as comorbidities increase additionally the number of diabetes-related complications, morbidity, and mortality. In the background of interrelations, there are both well-known and hypothetical mechanisms. The aim of the present review is to outline these interrelations between antidepressants and diabetes and to discuss the effect of medications on carbohydrate metabolism respectively. Anti­depressant treatment on the one hand may improve mood, cognitive function and medication adherence leading to an improved glucose metabolism, on the other hand through their metabolic side effects, they may worsen carbohydrate metabolism. Concerning metabolic side effects, selec­tive serotonin reuptake inhibitors are the sa­fest, while tricyclic antidepressants and mo­noamine oxidase inhibitors should be administered under close monitoring. Se­rotonin and noradrenaline reuptake inhibitors may deteriorate gly­cae­mic control via increased noradre­nergic activation. Novel antidepressants, how­ever, have a neutral or positive impact on gly­caemic measures. Screening for and temporally adjusted treatment of depres­sion may decrease the risk of comorbidities ge­nerated complications. While caring for diabetic patients with depression, one should consider metabolic side effects of antidepressants and close monitoring of carbohydrate metabolism.]

Hypertension and nephrology

APRIL 24, 2020

[Arterial hypertension and atrial fibrillation - the most important risk factors for stroke in clinical practice ]

LUDOVIT Gaspar, VESTENICKA Veronika, CAPRNDA Martin

[Vascular stroke is a very frequent cause of morbidity and mortality, and in patients who suffered stroke subsequent long-term neurological deficit of greater or lesser extent is an important factor. Numerous clinical and epidemiological studies confirmed that elevated systemic blood pressure is among the main risk factors of both ischemic and hemorrhagic vascular stroke, the effects of arterial hypertension being very complex including morphological and functional changes in vessels and vascular circulation. In our retrospective analysis of 218 patients hospitalized for stroke we found arterial hypertension in 91.2% of subjects and atrial fibrillation in 32.1% of subjects. 182 patients (83.5%) have been diagnosed with ischemic stroke and 36 patients (16.5%) with hemorrhagic stroke. In the group of patients with atrial fibrillation, only 33 patients (47.1%) were treated by anticoagulants, what points out an inadequate indication of anticoagulant treatment when considering the stroke risk calculation for atrial fibrillation (CHA2DS2- VASc Score) and bleeding risk (HAS-BLED Calculator for Atrial Fibrillation). It is also noteworthy that in the group of patients with anticoagulant therapy who have developed ischemic stroke in spite of this treatment, we found that in 48.5% the treatment was underdosed and therefore ineffective. Our work points to the need to improve the effective management of arterial hypertension and atrial fibrillation, the most common modifiable factors of vascular strokes.]

Hypertension and nephrology

APRIL 24, 2020

[Cardiovascular risk assessment in chronic kidney disease, significance of left ventricular myocardial mass index]

SÁGI Balázs, KÉSŐI István, VAS Tibor, CSIKY Botond, NAGY Judit, KOVÁCS Tibor

[Introduction: Earlier studies have shown that cardiovascular (CV) mortality and morbidity in chronic kidney disease (CKD) often exceed their average population, and left ventricular hypertrophy (LVH) is an independent risk factor for CV disease. However, in CKD, the relationship between LVH, arterial stiffness (AS) and renal function has not yet been fully elucidated. Little data is available on their prognostic role. Aims of our study a) cross-sectional examination of the relationship between left ventricular mass index (LVMI), arterial vascular stiffness, and renal function, b) in our follow-up study, clarification of the LVMI, the prognostic role of AS in patients with CKD, IgA nephropathy (IgAN). Methods: In our cross-sectional study, 79 IgAN patients were examined in our clinic. The myocardial mass index (LVMI) was determined using an estimation formula after echocardiographic measurements. Arterial stiffness was measured using a photoplethizmography technique (PulseTrace) and characterized by the stiffness index (SI). The MDRD formula was used to estimate renal function (GFR) (eGFR, ml/min/1.73 m2). In the prognostic study the primary combined endpoint was total mortality, the most important CV events (stroke, myocardial infarction or cardiovascular interventions such as revascularization) and end stage renal disease. Secondary endpoints were CV and renal endpoints separately. Results: Of the 79 patients included in our cross-sectional study, 50 were men, with an average age of 46 ± 11 years. The mean value of LVMI was 106.66 ± 22.98 g/m2. Patients were divided into groups of 115 g/m2 for males considered to be abnormal and 95 g/m2 for women. LVMI is closely correlated with SI and inversely with eGFR (corr. coeff: 0.358; p <0.05 or -0.526; p <0.001). In case of LVH, SI was significantly higher in both sexes (p = 0.005 in males, p = 0.04 in females). In case of higher LVMI, renal function was significantly lower (p = 0.002 in males, p = 0.01 in females). Metabolic syndrome occurred in several cases in both sexes with LVH, but the difference was only significant in male patients (males 6 vs. 10, p = 0.008; females 2 vs. 4, p = 0.29). In our follow-up study, the presence of LVH in men significantly reduced survival in both primary and secondary endpoints, whereas in women there was no significant difference. Conclusion: In IgAN decreasing of renal function is closely related to left ventricular hypertrophy and vascular stiffness, as well as a close relationship was found between LVMI and AS. Reduced renal function is associated with an increase in LVMI and an increase in AS, which may result in a worse prognosis for both CV and renal outcomes. The underlying role of all these can be assumed to be a common vascular and myocardial pathological remodeling.]

Hypertension and nephrology

FEBRUARY 20, 2020

[Heart failure with mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF)]

NYOLCZAS Noémi

[reduced ejection fraction (HFrEF) is well-known. Physicians are well versed in diagnosing and treating the disease. At the same time, our knowledge is scarce about heart failure with preserved ejection fraction (HFpEF) and heart failure with mid-ranged ejection fraction (HFmrEF). We are diagnosing these cases in a much lower number than the actual ones, and we have no morbidity and mortality-reducing evidence for treating the disease. The summary is intended to provide an overview of the epidemiology, clinical characteristics, morbidity and mortality, treatment options, the importance of the etiological diagnosis and long-term follow- up of HFmrEF and HFpEF based on currently available literature.]

Hypertension and nephrology

FEBRUARY 20, 2020

[Thinking globally - the significance of the joint treatment of risk factors]

BENCZÚR Béla

[Hypercholesterolemia and hypertension - as the key risk factors of ischemic heart disease - are strongly linked to the increasing prevalence of cardiovascular mortality and morbidity. These risk factors are related to each other and half of the hypertensive patients have elevated cholesterol, as well. The recent European hypertension guidelines recommend statin treatment in dyslipidemic and/or subjects at high risk including diabetic or CKD-patients. Reaching blood pressure target if we can hold the patient under 1.8 mmol/l LDL-level results in 60% reduction of the risk of CAD and 17% reduction of stroke. This aim can only be reached if patients regularly take their prescribed medications although statinadherence is the poorest in our country. One of the main tools of improving adherence beyond education is the use of fix-dosed combination.]

Hypertension and nephrology

DECEMBER 12, 2019

[Predictive factors for ischemic heart disease, diabetes mellitus and chronic kidney disease among hypertensive patients based on the data of the Hungarian Hypertension Registry 2011-2013-2015. Part I. Hypertensive population aged 35 to 64 years]

KÉKES Ede, PAKSY András, SZEGEDI János, JÁRAI Zoltán

[The association of hypertension with ischemic heart disease, diabetes and chronic kidney disease is the greatest therapeutic challenge because these associations significantly increase mortality and deteriorate life expectancy. It is important for the clinician to clarify the predictive factors of each association for successful prevention or slowing the progression of diseases. According to the database of the Hungarian Hypertension Registry 2011-2013-2015, 11,137 men and 11,112 women with hypertension and comorbidities (CHD, diabetes, CKD) aged between 35 and 64 were analyzed for the purpose of assessing the predictive value of the traditional risk factors in co-morbidity. We analyzed the predictive weight of each variable with single- and multi-variable stepwise logistic regression, and reported Odds ratio (OR, odds ratio). In patients with hypertension aged 35-64 (male / female), the prevalence of CHD was 41.6% / 35.8%, diabetes 27.1% / 23% and KVB 16.2% / 33.8%, respectively. The chance of developing CHD is highest in hypertensive individuals (male/female) who have diabetes (OR 1.30/1.48), who are obese (OR 1.22/1.21), who smoke (OR 1.50/1.51), and whose blood pressure >140/90 mmHg (OR 1.23/1.29). The dominant predictive factors of type 2 diabetes are obesity (visceral obesity) (OR 1.46/1.49), low HDL cholesterol (OR 1.32/1.35), and high triglyceride levels (OR 1.20/1.42); in women the uric acid level also showed high odds ratio (OR 1.39). There is a significant chance of developing chronic kidney disease in hypertension in both sexes, if abnormal uric acid levels (OR 1.73/1.46) and inadequate treatment of high blood pressure (>140Hgmm SBP) (OR 1.43/1.19) are present. In women, the abnormal triglyceride level) also showed a high odd (OR 1.81).]

Journal of Nursing Theory and Practice

APRIL 30, 2019

Socioeconomic status and health status: mortality and morbidity

DABES Meshik Alphonsus, PAPP Katalin

There is no situation that the individual’s socioeconomic status (SES) play a huge role in the individual’s health outcomes and the health care they receive. Socioeconomic status is mostly measured by education, income and occupation. People of higher SES tend to have more knowledge on health and health behaviours, and that determined their accessibility, acceptability and affordability of health care services. Arpey et al 2017, opined that people of lower SES are more likely to have worse self-reported health, lower life expectancy, and suffer from more chronic conditions when compared with those of higher SES. In this study, I want to analyse the relationship between socioeconomic status and health status considering mortality and morbidity among people of lower SES and higher SES using current literatures review. Base on this study it is clearly understood that there is a clear disparity in health status between lower socioeconomic status and higher socioeconomic status population. This health inequality is as a result of differences in economic, social and cultural factors. Health inequalities is avoidable and unfair because it is as a result of an unjust distribution of the underlying social determinants of health such as, unequal opportunities in education and/or employment which are the core determinants of persons socioeconomic status. Therefore, in order to reduce the inequality in health among higher and lower SES group, there should be equal distribution and opportunity for both groups to access education and employment.

Hypertension and nephrology

OCTOBER 23, 2019

[Non-invasive evaluation of cardiovascular risk in pediatric chronic kidney disease patients]

BÁRCZI Adrienn, DÉGI Arianna Amália, KIS Éva, REUSZ György

[Cardiovascular diseases are the leading cause of mortality and morbidity in children with chronic kidney disease (CKD). Similar to adults, children with CKD experience a high burden of traditional and uremia-associated risk factors. Recent years, several studies were published in connection with cardiovascular risk factors, patomechanism, and early markers of cardiovascular diseases. Early signs of cardiomyopathy, such as left ventricular hypertrophy or dysfunction, and markers of atherosclerosis, such as increased intima-media thickness of the carotid artery or increased wall stiffness of the aorta are frequently present in early stages of CKD in children. As prevention is important in pediatrics, the evaluation of subtle changes of the cardiovascular system provide opportunity for early treatment and that enables children to develop normally and have a better long-term quality of life. Recently, newer non-invasive cardiovascular imaging modalities have been emerged to diagnose subclinical alterations of the heart and vessels in this specific population with kidney disease. In this review, we provide an overwiev of the emerging imaging techniques used to detect early subclinical organ damage in pediatric chronic kidney disease patients.]

Clinical Neuroscience

SEPTEMBER 30, 2019

[The role of epigenetic regulations in early childhood diseases]

TORY Vera

[With the acceptance of “The developmental origins of health and disease” concept in the 1990s, it became clear that epigenetic inheritance, which do not involve changes in the DNA sequence has important role in the pathogenesis of diseases. Epigenetic regulation serves the adaptation to the changing environment and maintains the reproductive fitness even on the drawback of increased risk of diseases in later life. The role of epigenetic mechanisms in chronic non-communicable diseases has been well established. Recent studies have revealed that epigenetic changes have also causal role in certain pediatric diseases. The review evaluates the recent epigenetic findings in the pathomechanism of common pediatric diseases. The wide range and long-lasting duration of epigenetic regulations give importance to the subject. Methods are already available to evaluate a part of the epigenetic changes in the clinical practice, presently aiming primarily the estimation of the disease risk or definition of diagnosis. Furthermore, there are already available limited means to influence the epigenetic regulation. ]