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Hypertension and nephrology

JUNE 24, 2020

[Covid-19 and the kidney]

PATÓ Éva, DEÁK György

[Covid-19 pandemy has emerged from Wuhan, China in December 2019. The infection affects not only the lung but other organs such as the kidney, as well. The relation between Covid-19 infection and the kidney is bidirectional. On one hand, Covid-19 infection may cause kidney damage in 50-75% of the cases resulting in proteinuria, haematuria and acute kidney injury (AKI). The etiology of AKI is multifactorial. Main pathogenic mechanisms are direct proximal tubular cell damage, sepsis-related haemodinamic derangement, citokine storm and hypercoagulability. The virus enters proximal tubular cells and podocytes via the ACE2 receptor followed by multiplication in the lysomes and consequential cell lesion. Histopathology shows acute tubular necrosis and acute tubulointerstitial nephritis. AKI is a strong predictor of mortality in critically ill patients. On the other hand, the risk of Covid-19 infection and mortality is substantially increased in patients with chronic kidney disease – especially in those with a kidney transplant or on dialysis – due to their immunocompromised status. Among haemodialysis patients, infection may spread very easily due to the possibility of getting contacted in the ambulance car or at the dialysis unit. The mortality rate of patients on renal replacement therapy with Covid-19 infection is 20-35%. In order to avoid mass infection it is obligatory to employ preventive measures and implement restricions along with (cohors) isolation of infected patients. In Hungary, every dialysis or kidney transplant patient with Covid-19 infection should be admitted to dedicated Covid-19 wards.]

Clinical Neuroscience

MAY 30, 2020

Simultaneous subdural, subarachnoideal and intracerebral haemorrhage after rupture of a peripheral middle cerebral artery aneurysm

BÉRES-MOLNÁR Anna Katalin, FOLYOVICH András, SZLOBODA Péter, SZENDREY-KISS Zsolt, BERECZKI Dániel, BAKOS Mária, VÁRALLYAY György, SZABÓ Huba, NYÁRI István

The cause of intracerebral, subarachnoid and subdural haemorrhage is different, and the simultaneous appearance in the same case is extremely rare. We describe the case of a patient with a ruptured aneurysm on the distal segment of the middle cerebral artery, with a concomitant subdural and intracerebral haemorrhage, and a subsequent secondary brainstem (Duret) haemorrhage. The 59-year-old woman had hypertension and diabetes in her medical history. She experienced anomic aphasia and left-sided headache starting one day before admission. She had no trauma. A few minutes after admission she suddenly became comatose, her breathing became superficial. Non-contrast CT revealed left sided fronto-parietal subdural and subarachnoid and intracerebral haemorrhage, and bleeding was also observed in the right pontine region. The patient had leucocytosis and hyperglycemia but normal hemostasis. After the subdural haemorrhage had been evacuated, the patient was transferred to intensive care unit. Sepsis developed. Echocardiography did not detect endocarditis. Neurological status, vigilance gradually improved. The rehabilitation process was interrupted by epileptic status. Control CT and CT angiography proved an aneurysm in the peripheral part of the left middle cerebral artery, which was later clipped. Histolo­gical examination excluded mycotic etiology of the aneu­rysm and “normal aneurysm wall” was described. The brain stem haemorrhage – Duret bleeding – was presumably caused by a sudden increase in intracranial pressure due to the supratentorial space occupying process and consequential trans-tentorial herniation. This case is a rarity, as the patient not only survived, but lives an active life with some residual symptoms.

Journal of Nursing Theory and Practice

JUNE 30, 2019

[The role of nurses and their tasks in early sepsis management]

VÁRADI Annamária, FEHÉR Gábor, FÖMÖTÖR Péter

[The Surviving Sepsis Guideline (SSG) is a document that proposed new solutions in the diagnostics and treatment of sepsis. The methods identified were the 100% oxygen therapy, fluid resuscitation, blood culture and microbiological analysis, empiric combination antibiotic therapy, lactate monitoring, comparison of PCT and CRP, and surgical opening. Using the above mentioned methods has proven to improve the quality of sepsis treatment and the safety of patients. Sepsis -6 protocol has been highlighted by the authors as a process that is easy to implement in terms of cost while remaining highly beneficial. This recommendation should also be well known for nurses that do not work in emergency units. This will help recognise sepsis at an early stage, and provide guideline in the analytical examination and the possibilities within the competence. ]

Journal of Nursing Theory and Practice

DECEMBER 30, 2018

[Treatment and nursing of patients placed in prone position]

KISS Eszter

[Acute respiratory distress syndrome (ARDS) is a medical condition characterized by a high mortality rate. ARDS may be triggered by various pathologies such as sepsis and can have a significant impact on the overall outcome of primary disease. Prone positioning as a supportive strategy in the treatment of ARDS that has been investigated  since 1974. Lying face down has become more and more popular because it might have helped to improve oxygenisation in 70 percent of patients with ARDS. Occurence of ARDS did not change in the last 10 years in Europe and the syndrome is still associated with a quite high death rate between 40-50% despite of technologic and therapeutic improvement of last decades. It has already been investigated whether prone positioning may increase survival in patients with ARDS. However, approaches to the exact use of position are often occasional. Guideline development would be crucial to emphasize beneficial effect of prone positioning in patients suffering from ARDS and describe the process by which the manoeuvre may be performed. Primarily, it is substantial to improve oxygenation through the use of the prone position whilst promoting patient safety. Complications can be minimized by using a predefined strategy of placing patients in a prone position and a related checklist. ]

Journal of Nursing Theory and Practice

JUNE 30, 2015

[Practical role of nurses in early recognition in sepsis and curing process]

TÓTH Zoltánné

[Aim of the research: The aim of my research is to show detailed analysis of clinical categorizing of sepsis and clarifying its diagnostic difficulties. The study shows the elements of diagnostic and monitoring methodology during attendance including the importance of triage. Research and sampling methods: The research was done in a III progressive level hospital in the capital at the Emergecy Department emphasizing one group of illness: sepsis. 81 patients were analysed according to the 2013 data turnover. The method of the research is based on different document analysis and data gathering. In parallel with it, in the following parts of the study I was examining the competences of nurses with different qualifications at the department who were doing triage activity during attendance.Evaluation of the summarized results was created by SPSS 14.0 programme. Results: It was proved from the summarized data that triage activity done by nurses with septic patients was not influenced neither by professional experience nor by qualification of the nurses. More than half of the patients at the departments was not given the correct classification so they were not given the therapy in time. Conclusions: Nurses at the emergency department do not have the necessary knowledge on classification system of triage , that is why each nurse at the department must have the opportunity to improve their knowledge on triage or those not having it must acquire both theoretical and practical knowledge. ]

Clinical Neuroscience

JANUARY 30, 2015

[Assessment of severity and time course of critical illness neuropathy in septic patients: a prospective observational study]

NEMES Réka, FÜLEP Zoltán, LÁSZLÓ István, SÁRKÁNY Péter, FEKETE Klára, MECHLER Ferenc, FÜLESDI Béla

[Objective - In this prospective observational study we investigated electrophysiological alterations in the early phase of critical illness and correlated electrophysiological findings with the clinical picture and outcome. Methods - We enrolled 21 critically ill surgical patients having ≥12 Acute Physiology and Chronic Health Evaluation (APACHE) II scores on admission. Routine non-invasive bilateral electroneurography (ENG) examination of median and ulnar nerves was done on five consecutive days starting in two days after admission. Then weekly follow-up was performed. Motor and sensory nerve conduction indices were calculated and correlated with APACHE II and Simplified Acute Physiology Score II severity scores. Results - On the first examination 18/21 patients had >20% reduction in the motor and sensory nerve conduction indices. Severity score systems showed significant negative correlation with the daily change of CMAP and SNAP amplitudes and calculated nerve conduction indices (Spearman’s correlation, p<0,001). Mortality was higher in the patients with worse admission ENG and/or stagnant electrophysiological status or declining tendency in the first week. Conclusions - Electrophysiological alterations appeared soon after the development of critical illness. Early phase alterations showed a strong correlation with patients’ general condition and more severe electrophysiological alterations predisposed to higher mortality. In several cases early alterations proved to be reversible. ]

Clinical Neuroscience

NOVEMBER 28, 2014

[Critical illness associated neuromuscular disorders - Keep them in mind]

NEMES Réka, MOLNÁR Levente, FÜLEP Zoltán, FEKETE Klára, BERHÉS Mariann, FÜLESDI Béla

[Neuromuscular disorders complicating sepsis and critical illness are not new and scarce phenomena yet they receive little attention in daily clinical practice. Critical illness polyneuropathy and myopathy affect nearly half of the patients with sepsis. The difficult weaning from the ventilator, the prolonged intensive care unit and hospital stay, the larger complication and mortality rate these disorders predispose to, put a large burden on the patient and the health care system. The aim of this review is to give an insight into the pathophysiological background, diagnostic possibilities and potential preventive and therapeutic measures in connection with these disorders to draw attention to their significance and underline the importance of preventive approach.]

Journal of Nursing Theory and Practice

AUGUST 30, 2013

[The role of nurses in the early recognition and treatment of sepsis]

BABARCI Ágnes

[Aim of the study: The aim of the research was to gain a complex assessment of nurses’ skills related to sepsis. Sample and method: The survey was conducted at the University of Szeged, among nurses at four departments of the Anaesthesia and Intensive Care Institute, and at the Cardiac Surgery Post-operative Unit. The survey sample consisted of the specialist nurses at the aforementioned intensive-care departments. The nurses had to complete a questionnaire consisting of 37 questions, concerning the topics of sepsis, hand disinfection and continuous training. The answers were evaluated through a statistic analysis using the SPSS 21 program (Kruskal-Wallis test, binomial test, one-sample T-test and regression analysis), with a significance level of p =0.05. Results: Based on the results, 28.6% of the surveyed sample is capable of differentiating sepsis, severe sepsis and septic shock on the basis of the listed symptoms (p <0.001). The answers given to questions relating to the treatment and nursing of septic patients revealed that the level of knowledge is not satisfactory (p <0.001). No correlation could be demonstrated between the number of years spent working in the intensive-care department and the level of sepsis related knowledge (p =0.138). Conclusions: Based on the research results it can be concluded that there is a real need and demand for continuous training in relation to sepsis. ]

Lege Artis Medicinae

FEBRUARY 22, 2013

[Infectious diseases associated with biological therapy]

KÁDÁR János

[The use of biological therapeutic agents increases the risk of certain infectious diseases. The greatest hazards are the reactivation of tuberculosis or hepatitis B infection and the development of sepsis. The degree of risk is comparable to that experienced with the use of routine DMARD therapy: in case of an adequate choice of treatment the risk is equal to or slightly higher than that of conventional treatment. However, this hazard is definitely smaller than that associated with the use of corticosteroids at doses necessary to reach the required immunosuppressive effect. This article provides a brief summary of potential infectious illnesses on the basis of the literature.]

LAM KID

SEPTEMBER 20, 2012

[Vitamin D deficiency and infections]

LUDWIG Endre, KRIVÁN Gergely

[Studies performed in the past few years have confirmed that vitamin D is essential for maintaining the optimal immune defense, and its immunomodulatory effect has a role in the defense against infections as well. A lot of data suggest that low serum 25-(OH)-D concentration is associated with an increased frequency of certain infections and it adversely influences pathological processes. Data on this adverse effect are available mostly in case of Mycobacterium tuberculosis, respiratory viral infections in general, HIV, hepatitis C and sepsis. The outcomes of severe infections are usually influenced by a number of factors and it seems that vitamin D deficiency is one of those factors that shift the process towards an unfavourable outcome. Further studies should evaluate the significance of this role and the influence of vitamin D supplementation on pathological processes.]