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Hypertension and nephrology

MAY 20, 2017

[Prognostic significance of stiffness index determined by digital volume pulse method in polycystic kidney disease]

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

[Introduction: It is known from previous studies, that in chronic renal failure cardiovascular mortality and morbidity are more frequent than in the general population. The prognostic significance of arterial stiffness on cardiovascular outcomes trials was first demonstrated in end-stage renal disease patients by epidemiological longitudinal studies. Our aim was to assess the prognostic significance of arterial stiffness in polycystic kidney disease. Methods: 55 patients with polycystic kidney disease (PKD) were examined and followed in our clinic. Pulse wave velocity was determined by digital volume pulse (DVP) method, and a so-called stiffness index (SI DVP) was calculated. MDRD formula was used for estimating the glomerular filtration rate (eGFR, mL/min/1.73 m2) to determine renal function. Patients were observed regularly, in every 3-6 months, and we checked lab tests, which assessed the patient’s renal function and cardiovascular events occurred in patients were collected in our outpatient department. Results: Our study involved 55 patients, 21 were male, the mean age was 45±12 years. The average follow-up was 63±32 months. The average value of the stiffness index was 11.11±2.22 m/s. We divided the patients by 11 m/s as cut off point of SI values into two groups and analysed their outcome. In the increased arterial stiffness group (SI >11 m / s) the probability of the combined endpoint occurrence was signi - fi cantly higher than in the group with flexible arteries (χ-square: 4.571; p=0.033). Between the two groups we did not found significant difference in cardiovascular endpoint, but we found a statistically significant difference between the two groups in renal outcomes (χ-square: 5.591; p=0.018). Conclusion: In polycystic kidney disease the increased arterial stiffness may predict the onset of end-stage renal failure. Digital Pulse volume as determined by Pulse Trace system appears an appropriate method for making prognosis in chronic kidney disease.]

Hypertension and nephrology

APRIL 08, 2017

[Efficacy of a fixed-dose association of amlodipine and lisinopril in grade II and III hypertensive patients]

JOÃO Maldonado, TEIMO Pereira, MARGARIDA Carvalho

[We conducted an observational study, with ambulatory blood pressure monitoring (ABPM), to evaluate the efficacy of a fixed-dose combination of Amlodipine (5 mg) and Lisinopril (20 mg) in grade II and III hypertensive patients, over an 8 week intervention period. Thirty non-medicated hypertensive patients were enrolled, 36% female, with a mean age of 52.44±11.54 years, a body mass index of 28.73±4.54 kg/m2, and brachial office systolic (SBP) and diastolic (DBP) blood pressure of 174.43±15.06 mmHg and 102.83±10.67 mmHg, respectively. All patients performed a 24 hours ABPM at baseline and after a treatment period of 8 weeks with the fixed-dose association. Brachial office blood pressure and routine blood and urine samples were also obtained in both moments. A significant reduction in blood pressure was observed after the treatment with the fixed-dose association. The proportion of patients with controlled ambulatory blood pressure after the treatment was 69%, considering the normalization of the systolic and diastolic ambulatory pressures over the daytime, nighttime and 24 hours. Considering the brachial office blood pressures, the proportion of controlled hypertensive patients reached 79%. A significant improvement was also seen in microalbuminuria (reduction of 37.40 mg/24h; IC: 2.82-71.97; p=0.035) and fasting glycaemia (reduction of 11.53 mg/dl; IC: 3.46-19.61; p=0.007). No side effects were reported during the 8 week treatment period. The treatment of grade II and III hypertensive patients with a fixed-dose association of Amlodipine (5 mg) and Lisinopril (20 mg) during 8 weeks is effective controlling blood pressure. Furthermore, evidences indicate that the efficacy of the association is achieved quickly, safely and with good tolerability.]

Lege Artis Medicinae

MARCH 20, 2017

[An analysis of the ankle-brachial index in patients with diabetes in general practice]

GALVÁCS Henrietta, HASITZ Ágnes, BALOGH Zoltán

[INTRODUCTION - Diabetic macroangiopathy is one of the most prevalent complications of chronic diabetes mellitus. In Hungary, diabetic foot diseases and atherosclerosis are the most common causes of lower limb amputations. In this paper, we aim to present the correlations between the ankle-brachial index in patients with diabetes mellitus, and risk factors such as HbA1c levels, smoking and gender, in order to prevent atherosclerosis and to facilitate its rapid diagnosis. PATIENTS AND METHODS - Ankle-brachial index (ABI) of diabetic patients was measured and statistically analysed. Our goal was to determine potential correlations between ABI and the three above mentioned risk factors. The study population consisted of patients with a known history of diabetes mellitus (n=65) who visited the general practitioner's office between July 2015 and September 2016. RESULTS - 47.69% of patients exhibited a pathological ankle-brachial index. The ankle-brachial index showed a statistically significant correlation with gender (p=0,054). There was no significant correlation between the ankle-brachial index and smoking (p=0.838) or between the ankle-brachial index and HbA1c levels (p=0.430). CONCLUSION - Our research suggests that primary care physicians should regularly assess the ankle-brachial index in diabetic patients as preclinical atherosclerosis is frequently present in this population. Regular screening can facilitate early diagnosis and reduce the risk of severe macrovascular complications.]

Journal of Nursing Theory and Practice

OCTOBER 30, 2016

[Empathy research among nurses - comparison of the scales empathy: Jefferson Scale of Physician Empathy (JSPE) and the Interpersonal Reactivity Index (IRI)]

NAGY Ivett Klára, ÖREG Zsolt

[Aim of the research: comparison of the two internationally validated self-administered questionnaire (Jefferson Scale of Physician Empathy (JSPE) (Hojat et al., 2001, 2002a, 2002b, 2003) and the Interpersonal Reactivity Index (IRI) (Davis, 1983) - during empathy research among nurses. Research and sampling methods: a quantitative cross-sectional study applying two internationally validated self-administered questionnaire (Interpersonal Reactivity Index (IRI), Jefferson Scale of Physician Empathy (JSPE)), as well as home-made socio-demographic survey, shared online. The online questionnaires have been completed by 101 nurses in different age, having different qualification levels and working currently in Hungary in different areas of health care. The sample consists of 91 women and 10 men nurses. 89 nurses work in hospitals in the sample, 7 of them work in health centre one of them is ambulance officer and 4 of them are home nurse. Results: The applied questionnaire is acceptable based on the reliability statistical analysis (Cronbach’s  0.798 and 0.817). The results of IRI show in scale exploiting the professional specificity. In case of Perspective taking the used scale range is 11-28, while in the case of personal distress it shrank to 2-22 interval (as long as the total range is 1-28). Average and standard deviation in each dimension are (s): EC = 19.4 (s = 4.26); PT = 18.5 (s = 4.26); FS = 17.23 (s = 5.32), and PD = 10.85 (s = 4.66). In the total range of JSPE scale the mean empathy level is 98.5 and the standard deviation is 14.425. The same correlation relationship turned up between these two questionnaires as the developer published. These underline profession specific dimensions with direct association of the patient care (r factor EC=0,507, PT=0,447). Most of the questions related to socio-demographic factors have not been verified. Relationship emerged between the gender and the IRI personal distress dimension and the empathy value of JSPE according to the assumption for the benefit of women. It appears in scale of JSPE in perspective taking factor primarily. The extra working time had no show link with empathy, but private sector workers’ empathic concern was higher. The religion as a sociological characteristics was represented in the fantasy scale dimension of the IRI with a significantly higher value. It failed to detect any connection between the empathy and satisfaction of needs. Conclusion: Based on the study the JSPE questionnaire is admissible in Hungary. Next to the IRI it can reveal the empathy dimensions major from the patient’s view and it can make so comparable the empathy levels in other similar research projects. The women’s higher emphatic level was verified, but the length of the practice, the qualification and other socio-demographic aspects need further investigation, their effect aren’t discovered even in the research literature. Researchers steady emphasize how important is the empathy in the patient care to improve the efficacy of which would be accounted in Hungarian postgraduate courses as well. ]

Clinical Neuroscience

MARCH 30, 2017

[A családorvosok alvási apnoéval kapcsolatos ismeretei és attitűdjei. Megvalósul-e az OSAS szűrése a járművezetők egészségi alkalmasságának vizsgálata során?]

CSATLÓS Dalma, FERENCI Tamás, KALABAY László, LÁSZLÓ Andrea, HARGITTAY Csenge, MÁRKUS Bernadett, SZAKÁCS ZOLTÁN, TORZSA Péter

[Objective - Obstructive sleep apnea syndrome (OSAS) without treatment can cause serious cardiovascular, cardiorespiratory, neurological and other complications. Family physicians have an important role in recognizing the disease. The aim of the study is to assess the knowledge and attitude of family physicians related to sleep apnea. Whether OSAS screening is realized during the general medical checkup for drivers. Methods - In the cross-sectional study we used a validated OSAKA questionnaire in mandatory continuous medical education courses, supplemented with four additional questions. Results - 116 family physicians and 103 family medicine residents filled out the questionnaire. Hungarian family physicians, especially male doctors lack the adequate knowledge of sleep apnea. The average score of female physicians was significantly higher than that of males (13.4±1.8 vs. 11.7±2.6, p=0.005). The more sprecializations the doctor has, the higher the score. Zero or one special examination holders reached 12.5±2.3 points, two special examination holders 12.7±2.2 points. three or four special examination holders reached 14.0±2.1 (p=0.05). Residents’ average score was 12.1±2.4 points, which is higher than that of family doctors (p=0.012). Female residents also had higher average points than male residents (12.6±2.0 vs. 11.3±2.7; p=0.008). The size, location and type of the practice or the doctor’s age did not show any statistically significant correlation with the number of points achieved. According to our regression analysis, corrected to variables in the model, we found correlation between gender and medical knowledge, but there was no correlation between age, number of specialities, body mass index and the theoretical knowledge of the doctors. In terms of attitude female GPs had higher average scores than male GPs (3.5±0.6 vs. 2.9±0.6, p<0.001). Despite the modification of the 13/1992 regulation only 39% of the practices carried out regularly the required OSAS screening as part of the medical examination for a driving licence. Conclusions - Despite the high prevalence and clinical importance of OSAS, GPs often do not recognize sleep apnea and they have difficulty in treating their patients for this problem.]

Clinical Neuroscience

MARCH 30, 2017

Different work schedules of nurses in Hungary and their effects on health

FUSZ Katalin, TÓTH Ákos, VARGA Bernadett, ROZMANN Nóra, OLÁH András

Introduction - The shift work is burdensome for nurses and may lead to health problems. Aims - The purpose of the study was to examine the nursing shift system types and to analyse the effects on nutritional status, subjective state of physical and mental health in case of different shift schedules. Method - In the first phase of the research 326 nurses working in changing shifts filled out the Bergen Shift Work Questionnaire after adaptation into Hungarian. 518 nurses participated in our second study in hospitals of the South-Danubian Region, in clinics of University of Pécs and at trainings organized by the Faculty of Health Sciences of the University of Pécs. Results - Based on the psychometric characteristics of Bergen Shift Work Questionnaire technically it is suitable for the examination of sleeping disorders associated with shift work. Sleeping quality is worse in those working in irregular work shifts compared to those working in regular and flexible work schedules (p<0.001). The irregular work schedule is worse than the regular work schedule according to 76.6% of the nurses. According to 63.8% of the respondents the following regular work schedule is the best: after one 12-hour day shift one 12-hour night shift, followed by two days of rest. The average Body Mass Index (BMI) is 26.16 kg/m2. Since the nurses work in shift work 47.7% of them reported weight gain. Among the psychosomatic symptoms the most frequent is back pain (78.4%) related elevated BMI (p=0.013). The nurses’ sense of coherence on average is 61.76 points. In case of full-time employees the sense of coherence is better than those who work in shifts (t=2.933, p=0.004). The nurses working irregular shift work asses their health worst (mean rank: 166.61; p=0.019), and their sense of coherence is lower (p=0.04). Conclusion - The irregularity of work schedules is stressful for nurses. Due to the health of nurses it would be useful to establish the least exhausting work schedules.

Clinical Neuroscience

JANUARY 20, 2017

Combination of severe facial and cervical vascular malformation with obstructive sleep apnea syndrome: diagnostic and therapeutic approaches

FALUDI Béla, IMRE Marianna, BÜKI András, KOMOLY Sámuel, LUJBER László

The combination of obstructive sleep apnea syndrome and vascular malformation within the head and neck region is a rare condition, and interestingly, only a few cases have recently been published. Propagation of the vascular mass to the larynx and pharynx can cause breathing and swallowing difficulties. Due to these sypmtoms, examination and initiation of appropriate therapy for such patients are indeed challenging. We reviewed the literature available and present our case of a 64 year old woman emphasizing the complaints of sleep apnea syndrome and vascular malformation of the face and neck region. Polygraphic examination detected severe obstructive sleep apnea syndrome. The MR examination of the neck revealed extensive vascular mass narrowing the pharyngo-laryngeal region, thereby causing temporal bone destruction on the right side with intracranial propagation. ENT examination demonstrated significant narrowing of the pharyngeal lumen and the laryngeal aditus caused by multiple hemangiomas. CPAP titration showed the minimalization of the apnea-hypopnea index on the effective pressure level. Regular CPAP usage resulted in diminishing a majority of the patient’s complaints. Our examination clearly demonstrates, obstructive sleep apnea syndrome coupled with significantly obstructing vascular malformation in the head and neck region can be effectively treated safely with a CPAP device, if surgical therapy is not possible. We summarized our findings and the data available in the literature to set up recommendations for the appropriate examination and therapy (including mask fit, etc.) of vascular malformations and hemangiomas causing pharyngo-laryngeal obstruction.

Journal of Nursing Theory and Practice

JUNE 30, 2016

[Associated factors of independency in older adults with cognitive impairment living in a long term care institute]

KOVÁCS Éva, JÓNÁSNÉ SZTRUHÁR Izabella, KARÓCZI Csilla Kata, VASS Zsolt, FARKAS Lilla

[Aim of the research: Functional independence determines the elderly’s health and quality of life. In them cross-sectional study the authors analysed the associations between functional abilities (balance, gait, functional mobility, cognitive abilities), age, BMI and comorbidities and independency in older adults with cognitive impairment. Research and sampling methods: 110 elderly people were measured. Self-sufficiency was measured by the Katz-index, balance, and gait by the Tinetti Test and functional mobility by the Timed Up and Go Test. Correlations between variables were analysed with the Spearman’s rank-order correlation. Results: There was strong association between balance (r=0,557), gait (r=0,515), functional mobility (r=-0,647), and independency. It means the better the balance, gait, and functional mobility is, the higher the independency is. There was weak association between age, BMI, cognitive abilities, comorbidities and independency. Conclusion: Results show that preserving of the functional independence in older adults with cognitive impairment is a multidisciplinary task: physiotherapists and nurses should work together to complete doctors’ curative work of chronic diseases.]

Clinical Neuroscience

SEPTEMBER 30, 2016

Cerebral vasomotor reactivity in fibromyalgia patients and its relationship to central neuropathic pain

GULER Sibel, KURTOGLU S. Hakan, KEHAYA Sezgin, PAMUK Nuri, CELIK Yahya

Background - Cerebral vasomotor reactivity, defined as the cerebral vasculature response to hypoxia, is not wellunderstood in fibromyalgia (FM) patients. This study investigated the difference in the cerebrovascular reactivity (i.e., responsiveness to hypercapnia was evaluated by use of breath- holding index) to the breath-holding index (BHI) between patients with fibromyalgia and a group of normal controls. Methods - The study included 40 FM patients and 40 healthy subjects. Cerebrovascular reactivity was evaluated using the BHI, which is a nonaggressive, well-tolerated, real-time, reproducible screening method to study cerebral haemodynamics. Insonation depth and basal velocity were symmetrical and not significantly different between the two groups (p>0.05). All patients completed the Revised Fibromyalgia Impact Questionnaire (FIQR), Hospital Anxiety and Depression Scale (HADS), visual analogue scale (VAS), and the somatization subscale of the SCL-90-R symptom checklist. Results - The BHI ranged from 0.30 to 2.20 (mean 1.11±0.45) in the FM patients and 1.10 to 2.80 (mean 1.90±0.35) in the control group (p<0.001). Disease duration and right BHIaverage and left BHIaverage values exhibited a significant negative correlation (r=-0.877; p<0.001, r=-0.842; p<0.001, respectively). As pain and fatigue scores increased, the right BHIaverage and left BHIaverage values decreased (r=-0.431; p=0.005, r=-0.544; p<0.001, r=-0.341; p=0.031, r=-0.644; p<0.001, respectively). Conclusions - BHI values showed that cerebrovascular reactivity in FM patients decreased in comparison to healthy individuals. BHI decreased as disease duration and severity increased. Cerebrovascular reactivity decreased in FM patients, and this phenomenon should be accepted as an abnormality. Additionally, this outcome may have been the result of a mechanism responsible for central neuropathic pain.

Clinical Neuroscience

SEPTEMBER 30, 2016

Frequency and types of headaches in patients with metabolic syndrome

DEMIRYÜREK Enes Bekir, EMRE Ufuk, KORUCU Osman, BARUT Özen Banu, TASCILAR Nida Fatma, ATASOY Tugrul Hüseyin, DEMIRYÜREK Esra, YAYLACI Selcuk, GENC Bilal Ahmet

Background - Metabolic Syndrome (MetS) and headaches are common public health problems in whole world. The relationship between headaches and the MetS isn’t understood clearly. Purpose - The aim of this study is to determine the prevalence and types of headaches, and evaluate the relationship between headache characteristics and clinical and laboratory parameters analyzed in patients diagnosed with MetS. Materials and methods - Of the patients diagnosed with MetS in Endocrinology outpatient clinics between July 2011 and July 2012, 202 patients were included in the study. Hemoglobin, fasting blood glucose (FBG), total cholesterol, triglyceride, HDL and LDL cholesterol, thyroid function tests and HbA1c values of all patients were recorded. Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were applied to all patients. The headache severity was assessed by Visual Analog Scale (VAS). Results - The prevalence of headache in patients with MetS was found to be 61.4%. The incidence of headache was higher in female patients (F: 86.4%, M: 13.6%). The distribution of the subtypes of headaches was as follows: Episodic Tension-Type Headaches (ETTH) 24.8%, Episodic Migraine 14.4%, Chronic Tension-Type Headaches (CTTH) 11.3%, Episodic Tension-Type Headaches (ETTH) and Episodic Migraine 7.9%, and other types of headaches (Cervicogenic Headache and Cluster Headache) 3%. No statistically significant relationship was found between headache and non-headache groups in terms of body mass index, waist circumference, and the laboratory parameters (p>0.05). The mean BDI and BAI scores were higher in the headache group (p<0.001 and p<0.001). No significant difference was found between the mean MIDAS scores in the subtypes of headaches (p=0.35). In the headache group, there was a significant relationship only between triglyceride levels and attack frequency, duration and severity. Conclusion - Prevalence of headache in patients with MetS was 61.4%. The incidence of subtypes of headaches was similar to those in the general population. A relationship was found between triglyceride levels and attack frequency and severity. The result may be important to draw attention to the evaluation of triglyceride levels for reducing the frequency and severity of attacks in patients with headaches.