Clinical Neuroscience

MARCH 30, 2021

[Consensus statement of the Hungarian Clinical Neurogenic Society about the therapy of adult SMA patients]

BOCZÁN Judit, KLIVÉNYI Péter, KÁLMÁN Bernadette, SZÉLL Márta, KARCAGI Veronika, ZÁDORI Dénes, MOLNÁR Mária Judit

[ Background – Spinal muscular atrophy (SMA) is an autosomal recessive, progressive neuromuscular disorder resulting in a loss of lower motoneurons. Recently, new disease-modifying treatments (two drugs for splicing modification of SMN2 and one for SMN1 gene replacement) have become available. Purpose – The new drugs change the progression of SMA with neonatal and childhood onset. Increasing amount of data are available about the effects of these drugs in adult patients with SMA. In this article, we summarize the available data of new SMA therapies in adult patients. Methods – Members of the Executive Committee of the Hungarian Clinical Neurogenetic Society surveyed the literature for palliative treatments, randomized controlled trials, and retrospective and prospective studies using disease modifying therapies in adult patients with SMA. Patients – We evaluated the outcomes of studies focused on treatments of adult patients mainly with SMA II and III. In this paper, we present our consensus statement in nine points covering palliative care, technical, medical and safety considerations, patient selection, and long-term monitoring of adult patients with SMA. This consensus statement aims to support the most efficient management of adult patients with SMA, and provides information about treatment efficacy and safety to be considered during personalized therapy. It also highlights open questions needed to be answered in future. Using this recommendation in clinical practice can result in optimization of therapy.]

HUN 2021;74(3-4)

Hypertension and nephrology

FEBRUARY 24, 2021

[Prevention of polyuria during lithium treatment. Recent research and history]

[Renal toxicity of lithium is a highly important subject which may jeopardize the use of an agent needed by millions suffering from recurrent episodes of bipolar disorder. Lithium induced severe renal damage leading to end stage renal disease can be almost prevented today using lowered plasma lithium levels. But administration of medicines are necessary for the prevention of the lithium induced disturbance in renal concentrating operation and development of nephrogenic diabetes insipidus. Use of thiazides, non-steroid anti-inflammatory compounds (indomethacine) amiloride, high doses of desmopressin and their combinations are our present armamentarium. The present therapy for lithiuminduced nephrogenic diabetes insipidus in man is to counter anti-vasopressin action of lithium. The “future” treatment seems to be (on the basis of recent animal experiments) to enhance the sensitivity of the kidney to vasopressin action by administering pharmacologic blockade of the renal P2Y12 receptor by using clopidrogel or prasugrel.]

HUN 2021;25(1)

Journal of Nursing Theory and Practice

FEBRUARY 28, 2020

[Complication of the Metabolic Syndrome in Women with Polycystic Ovary Syndrome]

KOMLÓSI Kálmánné, KISS Sarolta, FERENCZY Mónika, MÁTÉ-PÓHR Kitti, PAKAI Annamária

[In our research we compared whether pregnant women with polycystic ovary syndrome or the mothers who were healthy through pregnancy has a higher risk to develop high BMI, metabolic syndrome, preeclampsia, polyhydramnion and macrosomia. Our research is a retrospective, cross-sectional study. In the random sampling within the target group, the target group was diagnosed with PCOS (n=50) and the control group was mothers who had undergone uninterrupted pregnancy (n=50). The exclusion criterion is the coexistence of other endocrine disease that may affect the parameters under consideration, in addition to the control group the diagnosis of PCOS. With IBM SPSS for Windows 22.0, we applied two-sample T-test and Khi2 test (p<0.05). The BMI values ​​measured in the PCOS study group are higher than in the control group (p<0,05). Pregnant women with PCOS has a higher risk of developing high blood pressure, and high cholesterol (p<0,05). The difference between the two groups can not be considered significant for the development of proteinuria and oedema. Emphasis should be placed on PCOS gravid care, early detection of metabolic disturbances, accurate documentation, and elimination of complications and illnesses associated with the disease.]

HUN 2020;33(1)

Hypertension and nephrology

DECEMBER 19, 2020

[Possibility of ARNI (angiotensin receptor-neprilysin inhibitor) treatment in hypertension]

KÉKES Ede

[The natriuretic peptide (NP) is an important endocrine, autocrine and paracrine system that is in constant interaction with RAAS and the sympathetic nervous system in order to ensure a continuous cardio-renal homeostasis. In abnormal conditions – if the pressure/volume load develops in the heart or there are some disorder in the vascular tone or in sodium-water balance, the NP system triggers the body’s defense mechanism. The neutral endopeptidase (NEP) inactivates the vasodilator NPs, bradykinin and vasoconstrictor angiotensin II and endothelin I as well. From this knowledge, the idea that inhibition of the effect of NEP (NEPg) offers a potentially beneficial option in the treatment of heart failure and hypertension was initiated, only the stimulatory effect of angiotensin II needs to be blocked. After a lengthy search, they arrived at a dualacting molecule with a beneficial effect of NEP inhibition (secubitrile) and the angiotensin II AT1 receptor antagonist valsartan (ARNI). Several clinical studies have shown that ARNI alone and in combination with other antihypertensive agents significantly reduces SBP and DBP in hypertensive patients. Its effect is also present in isolated systolic hypertension and in chronic kidney disease with high risk. Do not administer with an ACE inhibitor. Based on clinical experience to date, there is a logic expectation that ARNI will also be classified as a useful antihypertensive agent in the near future.]

HUN 2020;24(6)

Hypertension and nephrology

DECEMBER 19, 2020

[The efficiency of angiotensin receptor blocker/neprilysin inhibitor (ARNi) treatment in heart failure 2020 ARNI, VIDI, VICI…]

VÁRALLYAY Zoltán

[A new compound ARNi (valsartan/sacubitril) – as a member of a new pharmacoterapeutic group – has several clinical evidences almost in the whole spectrum of heart failure, especially in case of reduced left ventricular ejection fraction and hypertension. The most important and essential evidence based studies and the efficiency of the treatment with ARNi in heart failure have been demonstrated in this overview. Due to the favorable results of the studies the recommendations of ARNi indication are increasingly dominant in the clinical guidelines. The usage provides effective, safe therapeutic help for the poor life expectancy heart failure patients in the everyday clinical practice. The treatment is already available in Hungary.]

HUN 2020;24(6)

Clinical Neuroscience

NOVEMBER 30, 2020

The applications of transcranial Doppler in ischemic stroke

FINNSDÓTTIR Herdis, SZEGEDI István, OLÁH László, CSIBA László

Background: This overview provides a summary of the applications of transcranial Doppler (TCD) in ischemic stroke. Results: A fast-track neurovascular ultrasound protocol has been developed for detecting occlusion or stenosis. The technique is more reliable in the carotid area than in the posterior circulation. By monitoring the pulsatility index the in­crea­sed intracranial pressure can be diagnosed. TIBI score was developed for grading residual flow. TCD has been shown to accurately predict complete or any recanalization. Regarding recanalization, TCD has a sensitivity of 92%, a specificity of 88%, a positive predictive value of 96%, a negative predictive value of 78% and an overall accuracy of 91%, respectively. Sonothrombolysis seemed to be a promising application but randomized controlled trials have shown that it does not improve clinical outcome. TCD examination can detect microembolic signals (MES) which are associated with an increased risk of stroke. Micro­em­boli were detected in symptomatic and asymptomatic carotid artery stenosis and during carotid endarterectomy. The number of microemboli can be decreased by antithrombotic therapy. Contrast en­chan­ced examination and Valsalva maneuver with continuous TCD monitoring can accurately screen for right-to-left shunt.

ENG 2020;73(11-12)