Cardiovascularis betegségek szerepe csípőízületi endoprotézis beültetése utáni betegségérzet kialakulásában = Role of cardiovascular disorders in quality of life after total hip replacement

A váci Jávorszky Ödön Kórházban végzett retrospektív, utánkövetéses vizsgálatba a szerzők 109 teljes csípőízületi endoprotézis beültetésén átesett beteget vontak be. Módszer: Az alkalmazott kérdőíves módszer tartalmazta az EQ-5D életminőségi mutatókat, a betegségre jellemző Western Ontario and McMaster Universities Ostoearthritis Indexet (WOMAC) és a műtét előtti és a műtétet követő 5. év egészségi állapot jellemzőit. A társbetegségek súlyosságát a klinikai kép és a gyógyszeres terápia alapján rangsorolták. A betegek az 5. évben szubjektíven is értékelték globális egészségi állapotukat. Eredmények: Bár a WOMAC értéke szignifikánsan javult a vizsgált periódusban, azonban – szemben az EQ-5D változásával – ez nem befolyásolta a betegségérzetet. A társbetegségek közül kiemelkedő jelentőséggel bírtak a cardiovascularis betegségek, mivel előfordulási arányuk és progressziójuk szorosan összefüggött a betegek szubjektív egészségérzetével. Következtetés: A vizsgálat alapján számítani kell rá, hogy a jelentős mértékű hypertonia, ischaemiás szívbetegség vagy szívelégtelenség még sikeresen elvégzett csípőízületi protézis beültetése esetén is kedvezőtlen hatású a betegségérzetre. Orv. Hetil., 2011, 152, 464–468. | This cohort, retrospective study, in the Jávorszky Ödön Hospital, Vác, Hungary, involved 109 patients after total hip replacement. Methods: The applied questionnaires included the EQ-5D health-related quality of life scores, the Western Ontario and McMaster Universities Ostoearthritis Index (WOMAC) scores, the preoperative and the postoperative 5th year health characteristics. The severity of co-morbidities was graded in respect of clinical signs and pharmacological treatment. Results: The WOMAC values significantly improved in the examination period. However – in spite of the changes in EQ-5D –, it had no influence on adherence of feeling sick after total hip replacement. Among the co-morbidities, the cardiovascular diseases had a distinguished role because their prevalence and deterioration showed a close relationship with the subjective health-feeling of the patients. Conclusion: According to our study, we have to consider that in case of significant hypertension, ischemic heart diseases or chronic heart failure even the successful surgery will not improve the general sick-feeling of the patients. Orv. Hetil., 2011, 152, 464–468

A sarcopenia prevalenciája, valamint az egészség- és életmódbeli tényezőkkel való kapcsolata a tartós ellátást nyújtó intézményekben élő idősek körében.

INTRODUCTION: Earlier studies dealing with sarcopenia were conducted among community-living or hospitalized older adults; however, to date, study focusing on older adults living in institutions providing long-term care is lacking. AIM: The aim of this study was to describe the prevalence of sarcopenia and its associations with lifestyle and health factors among older people living in institutions providing long-term care. METHOD: Two hundred five individuals participated in the study. Sarcopenia was diagnosed based on muscle mass, muscle strength and functional performance. The independent variables were functional mobility, protein intake, smoking, current physical activity, and physical activity when middle-aged, multimorbidity, and falls in the previous year. Univariate models and a multivariate model were used to assess associations. RESULTS: In total 73 participants had sarcopenia. Sarcopenia was associated with smoking, multimorbidity, physically active lifestyle when middle aged, and functional mobility. CONCLUSION: This study showed that lifestyle factors and health condition have important roles in the prevalence of sarcopenia. Orv. Hetil., 2016, 157(46), 1847-1853

The effects of functional balance training on balance, functional mobility, muscle strength, aerobic endurance and quality of life among community-living elderly people

Aim. The aim of this study was to investigate the effects of functional training on balance, functional mobility, muscle strength, aerobic endurance and quality of life among community-dwelling elderly people. Material and methods. Eighteen women were in the exercise group taking part in functional training program for 25 weeks; the control group did not participate in any exercise program. The Fullerton test for balance, Timed Up and Go test for functional mobility, Five-Times-Sit-to-Stand Test for lower limb strength, Two-Minute-Step-in-Place Test for endurance and the quality of life were measured at baseline and after 25 weeks. Results. After the training period in the exercise group the balance and the functional mobility improved more significantly than in the control group (p = 0.027; p = 0.0004, respectively). The quality of life showed a marginal significance (p = 0.083). In terms of lower limb muscle strength and aerobic endurance, the difference between the groups did not reach statistical significance (p = 0.276; p = 0.147). Conclusion. This 25-week functional training improves balance, functional mobility, as well as quality of life among community-living elderly adults; however functional training exercises might require to be completed with more tailored strength exercises. Clinical Rehabilitation Impact. Based on our results, functional training might be a promising exercise program for improving balance, functional mobility and quality of life for community-living elderly people

The value of combined hemodynamic, respiratory and intra-abdominal pressure monitoring in predicting acute kidney injury after major intraabdominal surgeries

Background: The incidence of postoperative acute kidney injury (AKI) is predominantly determined by renal hemodynamics. Beside arterial blood pressure, the role of factors causing a deterioration of venous congestion (intraabdominal pressure, central venous pressure, mechanical ventilation) has emerged. The value of combined hemodynamic, respiratory and intra-abdominal pressure (IAP) monitoring in predicting postoperative acute kidney injury has received only limited exploration to date. Methods: Data were collected for adult patients admitted after major abdominal surgery at nine Hungarian ICUs. Hemodynamic parameters were compared in AKI vs. no-AKI patients at the time of admission and 48 h thereafter. Regarding ventilatory support, we tested mean airway pressures (Pmean). Effective renal perfusion pressure (RPP) was calculated as MAP−(IAP + CVP + Pmean). The Mann–Whitney U and the chi-square tests were carried out for statistical analysis with forward stepwise logistic regression for AKI as a dependent outcome. Results: A total of 84 patients (34 ventilated) were enrolled in our multicenter observational study. The median values of MAP were above 70 mmHg, IAP not higher than 12 mmHg and CVP not higher than 8 mmHg at all time-points. When we combined those parameters, even those belonging to the ‘normal’ range with Pmean, we found significant differences between no-AKI and AKI groups only at 12 h after ICU admission (median and IQR: 57 (42–64) vs. 40 (36–52); p < .05). Below it’s median (40.7 mmHg) on admission, AKI developed in all patients. If above 40.7 mmHg on admission, they were protected against AKI, but only if it did not decrease within the first 12 h. Conclusions: Calculated effective RPP with the novel formula MAP−(IAP + CVP + Pmean) may predict the onset of AKI in the surgical ICU with a great sensitivity and specificity. Maintaining effective RPP appears important not only at ICU admission but during the next 12 h, as well. Additional, larger studies are needed to explore therapeutic interventions targeting this parameter

Az intravazális volumenstátusz elemzése = Analysis of intravascular blood volume status

Kidolgoztunk egy pulzatilis fizikai modellt a humán artériás keringés vizsgálatára. A modellen mérhetők különböző pontokban a nyomások és az áramlás. Elemeztük az ICG-vel mért vértérfogat paraméterek (BV) és a PiCCO monitorral mért keringési változók közötti összefüggéseket. Szoros korrelációt tudtunk kimutatni a BV és a globális vég-diasztolés térfogat (GEDVI) között, ezért a vizsgálat további részében a GEDVI-t használtuk referenciaként. Megvizsgáltuk a perctérfogat- (CI) és a GEDVI mérés pontosságát. 30 betegen igazoltuk, hogy már 2 mérés átlaga is <5% hibát eredményez, ezért felhasználható tudományos célokra. A megfigyelés klinikai jelentősége az, hogy hemodinamikai mérések során nem kell kitenni a beteget felesleges folyadékterhelésnek. Elemeztük a CI-GEDVI összefüggés matematikai kapcsolódásának lehetőségét (n=122). Kimutattuk, hogy a CI-(MTt-DSt)-GEDVI kapcsolatban létezik egy matematikai kapcsolódás, ami azonban csak 3 összetevőjű modellben érvényesül. 2 paraméter kiragadása az összefüggésből téves következtetések levonására vezethet. Elemeztük, hogy az artériás nyomásgörbe mely paramétereiből lehet jó hatásfokkal következtetni a GEDVI-re (n=122). A parciális pulzusnyomás, a szisztolés csúcsnyomás görbülete, az augmentációs index, a szívfrekvencia valamint a kor bevonásával jó hatásfokkal meg lehetett becsülni a GEDVI értékét. Jelentős különbséget észleltünk férfiak (r=0,779) illetve nők között (r=0,530), melynek tisztázására további vizsgálatokra van szükség. | We have developed a pulsatile physical model to examine the human arterial circulation, enable us to measure pressure and flow in the different parts of the model. We have analyzed the relationship between blood volume parameters (BV) and the other components of circulation (n=26) using PiCCO monitoring technique. Strong correlation was found between BV and end-diastolic volume (GEDVI) therefore GEDVI was used as a reference in the latter part of the study. We have analyzed the precision of cardiac index (CI) and GEDVI measurements. It was proved (n=30) that the error is <5% - fulfilling the criterion of scientific precision -when the mean is calculated from 2 measurements. Any further repeated measurements may be unnecessary, and may contribute to volume overloading. The potential mathematical coupling between CI and GEDVI was analyzed (n=122). We could prove a mathematical coupling among CI-(MTt-DSt)-GEDVI but it works only in a 3-compartment model. Focusing only 2 parameters from this relationship may cause errors. We tried to calculate the GEDVI values from the different components of the arterial pressure curve (n=122). Putting the partial pulse pressure, the curve of the systolic peak pressure, the augmentation index, the heart rate and the age into an equation we could estimate GEDVI values with a good agreement. However, a significant difference was found between male (r=0.779) and female (r=0.530) patients, whose explanation needs further examination

Hemo- és hidrodinamikai rendszerek numerikus és kísérleti vizsgálata = Numerical and Experimental Investigation of Hemodynamic and Hydrodynamic Systems

A pályázatban megfogalmazott kutatási céllal összhangban egy olyan moduláris felépítésű programcsomagot készítettünk el, mely alkalmas különböző fizikai hátterű, de hasonló logikai felépítésű áramlástechnikai hálózatok dinamikus vizsgálatára. A programcsomagot Matlab környezetben kódoltuk. Jelenleg az alábbi elemkönyvtárak állnak rendelkezésre: (1) érhálózatok elemei (viszkoelasztikus cső, szív, stb.), (2) olajhidraulikus hálózatok (munkahenger, volumetrikus szivattyú, útváltó, nyomáshatároló szelep, térfogatáram állandósító szelep, stb.), (3) nyomottvizes ivóvízhálózat elemek (szivattyú, lineárisan rugalmas anyagú cső, visszacsapó szelep, nyomásszabályzó, légüst, stb.) és (4) szennyvíz- és csatornahálózatok elemei (nyíltfelszínű prizmatikus csatorna, akna, stb.). Az artériás és vénás véráramlás modellezése során kifejlesztettünk egy viszkoelasztikus anyagmodellt, amelyet beépítettünk a számítógépes programcsomagba. Megépítettünk egy mérőberendezést a viszkoelasztikus csőszakaszok összeroppanásának vizsgálatára. Orvos kollégákkal együttműködve megfigyeltük a véráramlást patkányvénákban. Kidolgoztunk egy módszert a véráramlás sebességének becslésére. Modelleztük a vénás billentyűk működését három dimenziós kapcsolt áramlástani szimulációk végrehajtásával. | A modular software package has been developed, which makes it possible to easily add hydraulic system elements with different physical background but similar logical build-up. The following libraries were developed: (1) arterial systems (viscoelastic pipe, heart, etc.), (2) power transmission systems (hydraulic cylinder, positive displacement pump, directional valve, pressure relief valve, flow control valve, etc.), (3) pressurized water distribution systems (pump, linearly elastic pipe, check valve, pressure control valve, air vessel, etc.) and (4) wastewater system elements (open-surface prismatic channel, weir, etc.). The software package is continuously used and developed by the colleagues at the Dept. and students. In the project of modeling of the elements of the artery system (heart, artery, vein, etc.) a viscoelastic material model was developed and inserted into the software package used for simulating unsteady 1D flow in pipe networks. A test rig was designed and manufactured for the investigation of collapsing viscoelastic tubes. In cooperation with medical researchers we carried out in vivo measurements on rat veins. A method was developed for the estimation of blood velocity. The operation of venous valves was investigated using fluid-structure interaction methods

Estimation of the severity of breathlessness in the emergency department: a dyspnea score

BACKGROUND: Dyspnea is a frequent complaint in emergency departments (ED). It has a significant amount of subjective and affective components, therefore the dyspnea scores, based on the patients' rating, can be ambiguous. Our purpose was to develop and validate a simple scoring system to evaluate the severity of dyspnea in emergency care, based on objectively measured parameters. METHODS: We performed a double center, prospective, observational study including 350 patients who were admitted in EDs with dyspnea. We evaluated the patients' subjective feeling about dyspnea and applied our Dyspnea Severity Score (DSS), rating the dyspnea in 7 Dimensions from 0 to 3 points. The DSS was validated using the deterioration of pH, base-excess and lactate levels in the blood gas samples (Objective Classification Scale (OCS) 9 points and 13 points groups). RESULTS: All of the Dimensions correlated closely with the OCS values and with the subjective feeling of the dyspnea. Using multiple linear regression analysis we were able to decrease the numbers of Dimensions from seven to four without causing a significant change in the determination coefficient in any OCS groups. This reduced DSS values (exercise tolerance, cooperation, cyanosis, SpO2 value) showed high sensitivity and specificity to predict the values of OCS groups (the ranges: AUC 0.77-0.99, sensitivity 65-100%, specificity 64-99%). There was a close correlation between the subjective dyspnea scores and the OCS point values (p /=7 points without correction factors) can be useful at the triage or in pre-hospital care

Epidemiology of acute kidney injury in Hungarian intensive care units: a multicenter, prospective, observational study

<p>Abstract</p> <p>Background</p> <p>Despite the substantial progress in the quality of critical care, the incidence and mortality of acute kidney injury (AKI) continues to rise during hospital admissions. We conducted a national, multicenter, prospective, epidemiological survey to evaluate the importance of AKI in intensive care units (ICUs) in Hungary. The objectives of this study were to determine the incidence of AKI in ICU patients; to characterize the differences in aetiology, illness severity and clinical practice; and to determine the influencing factors of the development of AKI and the patients' outcomes.</p> <p>Methods</p> <p>We analysed the demographic, morbidity, treatment modality and outcome data of patients (n = 459) admitted to ICUs between October 1^st, 2009 and November 30^th, 2009 using a prospectively filled in electronic survey form in 7 representative ICUs.</p> <p>Results</p> <p>The major reason for ICU admission was surgical in 64.3% of patients and medical in the remaining 35.7%. One-hundred-twelve patients (24.4%) had AKI. By AKIN criteria 11.5% had Stage 1, 5.4% had Stage 2 and 7.4% had Stage 3. In 44.0% of patients, AKI was associated with septic shock. Vasopressor treatment, SAPS II score, serum creatinine on ICU admission and sepsis were the independent risk factors for development of any stage of AKI. Among the Stage 3 patients (34) 50% received renal replacement therapy. The overall utilization of intermittent renal replacement therapy was high (64.8%). The overall in-hospital mortality rate of AKI was 49% (55/112). The ICU mortality rate was 39.3% (44/112). The independent risk factors for ICU mortality were age, mechanical ventilation, SOFA score and AKI Stage 3.</p> <p>Conclusions</p> <p>For the first time we have established the incidence of AKI using the AKIN criteria in Hungarian ICUs. Results of the present study confirm that AKI has a high incidence and is associated with high ICU and in-hospital mortality.</p