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[Both, mortality and morbidity of chronic heart failure are persistently high, thus its adequate disease management is of pre-eminent importance. For heart failure with reduced ejection fraction (HFrEF) numerous evidence are available to improve its prognosis, including reduction of mortality, sudden cardiac death, and hospitalizations. Large randomized clinical trials have been shown that angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin-receptor/neprilysin inhibitor (ARNI), B-blockers, mineralocotricoid receptor antagonists (MRAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) reduce both morbidity and mortality of HFrEF patients. Accordingly, the heart failure recommendation of the European Society of Cardiology (ESC) issued 2021, proposed the basic therapy for HFrEF in 4 pillars: ACEI/ARNI, BB, MRA and SGLT2 inhibitors.
Instead of the earlier approach of stepwise sequential therapy, the new recommendation advocates for simultaneous initiation of all four drug classes with rapid titration to the target dose. The STRONG-HF clinical trial aimed to compare the rapid titration with its conventional strategy. Concerning the primary composite endpoint of repeated heart failure in 180 days with rehospitalization and all-cause mortality compared with changes in quality of life and rehospitalization by heart failure as separate endpoints, the rapid titration was significantly more efficient solution.
When optimizing therapy, we have also to pay attention to the comorbidities of HFrEF patients, which may compromise the procedure of titration. The consensus document of the ESC Heart Failure Association recommends special patient profiling by comorbidities and specific hemodynamic parameters, followed by therapeutic recommendations on different patient profiles. Overall, SGLT2 inhibitors have the least limiting factors and contraindications, thus they can be used in all profiles without exception – as early as at initiating the therapy.]
[In patients with community acquired pneumonia associated sepsis, there are emerging frequently hematopoietic changes and disturbed haemostasis of varying severity as a part of the multiorgan dysfunctions. Between 2012 and 2020, we diagnosed community acquired pneumonia in 1826 patients. Among them, we recognised 218 cases of developing sepsis with typical symptoms and laboratory changes. In these septic patients, we registered the frequency and severity of anaemia, the quantitative and qualitative changes of leucocytes, the numerical abnormalities of platelets, and the pathologic haemostasis. The septic patients’ most frequent hematopoietic disorders were anaemia (n=159) and leucocytosis (n=151). Extremely severe leucocytosis (white blood cell count >50000/microlitre) was diagnosed in six patients. Decreased leucocyte count (leucopenia, agranulocytosis) was detected in 34 cases. There were three cases of leukemoid reaction: in prevalent leucocytosis we observed myelocytes, metamyelocytes and some atypical myeloid cells in the peripheral blood. In one patient crista biopsy was performed with Jamshidi technic, due to severe pancytopenia in the peripheral blood count. The histology of the crista biopsy revealed myelodysplastic bone marrow characteristics. In our patients with sepsis, concerning the number of platelets, the thrombocytopenia dominated (n=82). ]
Post-acute sequelae of COVID-19 (PASC) describes the occurrence of persistent symptoms following COVID-19 infection. Neurological and psychiatric symptoms may include fatigue, post-exertional malaise, cognitive complaints, sensorimotor symptoms, headache, insomnia. The aim of this study was to evaluate the long-term effects of COVID-19 infection on mental fatigue and cognitive flexibility in young adults.
[In Europe Hungary has the highest prevalence of oral cancer and mortality. That aforementioned case draws attention to the importance of oral screening tests because these types of tumors can be cured easily if we catch them in time. Stomato-oncology screening tests are one of the most painless and easiest examinations considering that it can be effectively done by non-professionals and healthcare workers outside of dentistry. This gives us the opportunity to filter out tumors in early states. This summary publication demonstrates the steps of extra- and intraoral examination and escalates to noticing periodontal deseases and oral cancer.]
[The continued high morbidity of cardiovascular diseases justifies the exploration of “residual” risk factors. During embryonic development, the cardiovascular organs, bones, muscles, kidney, and adipose tissue differentiate from the mesoderm, the remaining humoral and mechanical communication between cell lines partly explains the phenomenon of residual cardiovascular risk, and partly leads to the delineation of new therapeutic targets. Among the common factors in the pathogenesis of osteoporosis and atherosclerosis, inflammation can be highlighted, which makes the beneficial effects of biological therapy treatment understandable. The Klotho system and the AGE-RAGE axis are responsible for age-related systemic changes. Cardiokines, myokines, osteokines, adipokines, and hepatokines are molecular mediators of complex interactions between individual organs. In particular, the cardio-renoprotective effects of the GLP-1RA and SGLT2i drug classes already used in diabetology are part of the systemic beneficial effect. Similarly, blocking mineralocorticoid receptors with finerenone has a generalized anti-inflammatory, anti-oxidant and anti-fibrotic effects. Regular exercise has always been recommended for cardiovascular patients, but now more and more mechanisms are becoming known that highlight the role of skeletal muscle in regulating the entire metabolism. Simultaneous use with the diet, it can be a simple and effective method to control the progression of cardiovascular disease.]
[The inhibitors of RAAS (ACE-inhibitors and ARBs) are equally first-choice agents according to both the overseas and European (including the Hungarian) hypertension-guidelines. Nevertheless, medical practitioners prefer rather the ACE-inhibitors than the ARBs. This review aims to show the differences, the available direct comparisons, the meta-analyses as top evidences and the real-world experiences between the two drug classes. Based on these, there is no significant difference in the cardiovascular outcomes (myocardial infarction, heart failure, and stroke) of the groups treated with ACE-inhibitors or ARBs respectively. However, adverse events, which may interrupt the treatment, like cough or angioneurotic oedema joining sometimes the ACE-inhibitor therapy, were much more frequent than during the ARBs administration.]
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Clinical Neuroscience
[Headache registry in Szeged: Experiences regarding to migraine patients]2.
Clinical Neuroscience
[The new target population of stroke awareness campaign: Kindergarten students ]3.
Clinical Neuroscience
Is there any difference in mortality rates of atrial fibrillation detected before or after ischemic stroke?4.
Clinical Neuroscience
Factors influencing the level of stigma in Parkinson’s disease in western Turkey5.
Clinical Neuroscience
[The effects of demographic and clinical factors on the severity of poststroke aphasia]1.
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