Hypertonia és RAS-gátlók előfordulása SARS-Cov-2 fertőzés miatt intézeti ellátásra került 18 év feletti egyénekben = Effect of hypertension and RAS-inhibitors to adult patients (over 18 years old) with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection who were admitted to hospital

Célunk az volt, hogy az SZTE Belgyógyászati Klinika Nyugati telephely fekvőbeteg Járványellátó Központ részlegén felvételre került, 18 év feletti Covid-pozitív betegek között a kezelt hypertonia előfordulását, a szedett vérnyomáscsökkentők számát, a RAS-gátló vérnyomáscsökkentők (ACE-gátló és/vagy ARB) előfordulását felmérjük. A vizsgálatban véletlenszerűen kiválasztott 165 (94 férfi, 71 nő) gyorsteszttel vagy PCR-rel Covid-pozitív, 2021. február közepe és április vége között felvett betegek adatainak retrospektív elemzése történt. A betegek életkora 59,9±12,9 év volt (26–92), a BMI 30,7±6,6 kg/m2 (20,3–55,4). A betegek között felvételkor 103 (62,4%) már ismert hypertoniás egyén volt (56 férfi, 47 nő). A szedett vérnyomáscsökkentők száma felvételkor 1,6±1,6 darab (maximum hat), a kezelés végén 1,8±1,7 darab. Területen több mint három szert 23-an, éppen hármat 25-en szedtek. Monoterápiában felvételt megelőzően 20-an részesültek, a kezelés végén 25-en. A vérnyomáscsökkentők száma a kezelés végén 74 esetben nem változott, hat esetben csökkent, 31 esetben nőtt, ezek között 11 új indítás volt. Egy betegnél a csökkenés 100%-os volt, a monoterápiát el kellett hagyni, a többi öt esetben pedig 50%-os. A hypertoniás betegek több napot töltöttek intézetben, mint a nem hypertoniás egyének (10,9±6,8 vs. 9,2±6,3). A felvételkor mért spontán O2-szaturáció a hypertoniás beteg között alacsonyabb volt, mint a nem hypertoniás egyéneknél (92,6±4,8 vs. 89,6±9,7%), ARB-t szedők között volt a legalacsonyabb (87,5±8,5%, p=0,01 vs. nem hypertoniás). Az összes halálozás a hypertoniás betegek között 8,7%, a nem hypertoniás betegek között csak 1,6% volt. A hypertoniás betegeket vizsgálva, a RAS-gátlót szedők és nem szedők között az intenzív ellátás 16,3 vs. 13%. Az összes halálozás a RAS-gátlót szedők között 10%, a nem szedők között 4,3%, az ARB-t szedők között 13% és az ACE-gátlót szedők között 8,8% volt. Eredményeink alapján a hypertonia nagyobb kockázatot jelenthet a rosszabb Covid-kimenetel tekintetében. A RAS-gátló kezelésben részesültek nagyobb kockázatát észleltük a RAS-gátló kezelésben nem részesültekhez képest. = Our aim was to assess the prevalence of treated HT, the number of antihypertensive agents, especially ACE-inhibitors or ARBs among Covid-positive patients older than 18 years admitted to the Center for Disease Control of Department of Medicine of the University of Szeged. Data of 165 randomly selected patients (mean age 59.9±12.9 years, mean BMI 30.7±6.6 kg/m2) were analysed retrospectively. They were admitted between middle of February and end of April 2021. At the time of admission there were 103 (62.4% of all) HT patients (56 men, 47 women). The mean number of antihypertensive drugs were 1.6±1.6 pieces (max. 6) at the time of admission. 23 patients took more than 3 antihypertensives and 25 patients took exactly 3 drugs at home, and 20 patients had monotherapy. The antihypertensive therapy did not change in 74 cases, decreased in 6 cases and increased in 31 cases. In one case we could reduce therapy with 100%, monotherapy was finished, in the other 5 cases it was reduced by 50%. HT patients spent more days in hospital than non-HT patients (10.9±6.8 vs. 9.2±6.3). Spontaneous oxygen saturation (SatO2) was lower in HT patients compared to non-HTs at admission (89.6±9.7 vs. 92.6±4.8%) and patients who were on ARBs had the lowest SatO2 (87.5±8.5%, p=0.01 vs. non-HT). The total mortality rate was 8.7% in HT patients and it was just 1.6% in non-HT patients. 16.3% of HT patients with RAS-inhibitors and 13.0% without it required admission to the intensive care unit. The mortality rate was 10% of patients with RAS-inhibitors and 4.3% of them without it. This rate was 13% in patients with ARB and 8.8% with ACE-inhibitor. According to our results, HT may have higher risk for worse Covid-19 outcomes, including RAS-inhibitors also may have a higher risk

Post-Ischemic Renal Fibrosis Progression Is Halted by Delayed Contralateral Nephrectomy : The Involvement of Macrophage Activation

(1) Background: Successful treatment of acute kidney injury (AKI)-induced chronic kidney disease (CKD) is unresolved. We aimed to characterize the time-course of changes after contralateral nephrectomy (Nx) in a model of unilateral ischemic AKI-induced CKD with good translational utility. (2) Methods: Severe (30 min) left renal ischemia-reperfusion injury (IRI) or sham operation (S) was performed in male Naval Medical Research Institute (NMRI) mice followed by Nx or S one week later. Expression of proinflammatory, oxidative stress, injury and fibrotic markers was evaluated by RT-qPCR. (3) Results: Upon Nx, the injured kidney hardly functioned for three days, but it gradually regained function until day 14 to 21, as demonstrated by the plasma urea. Functional recovery led to a drastic reduction in inflammatory infiltration by macrophages and by decreases in macrophage chemoattractant protein-1 (MCP-1) and tumor necrosis factor-alpha (TNF-α) mRNA and most injury markers. However, without Nx, a marked upregulation of proinflammatory (TNF-α, IL-6, MCP-1 and complement-3 (C3)); oxidative stress (nuclear factor erythroid 2-related factor 2, NRF2) and fibrosis (collagen-1a1 (Col1a1) and fibronectin-1 (FN1)) genes perpetuated, and the injured kidney became completely fibrotic. Contralateral Nx delayed the development of renal failure up to 20 weeks. (4) Conclusion: Our results suggest that macrophage activation is involved in postischemic renal fibrosis, and it is drastically suppressed by contralateral nephrectomy ameliorating progression

Electrical atrial fibrillation induction affects the characteristics of induced arrhythmia.

Several methods are being used to induce atrial fibrillation (AF) in experimental investigations, which may affect the electrophysiologic parameters of the induced arrhythmia. The aim of our study was the investigation of temporal characteristics of AF during and after electrical induction. Direct current and high-frequency stimulation was used for induction in bipolar biatrial, right and left atrial appendage configurations in 6 dogs. Atrial and ventricular electrical activity was recorded near the bundle of His. Seven statistical parameters were calculated to analyze the temporal characteristics of electrical activity of both chambers. The induction method affected 5 atrial and no ventricular electrophysiologic parameters during stimulation, and the effect disappeared after ceasing induction, during the induced transient or persistent AF. Electrical stimulation affects the properties of the induced arrhythmia during the induction; thus, the investigation of AF is recommended only after ceasing the induction to avoid bias

Magnetic resonance imaging-based biventricular pacemaker upgrade

This report describes a patient with drug refractory severe chronic ischemic heart failure, atrial fibrillation with bradycardia, and left bundle branch block who had a failed implantation of a biventricular pacemaker because of a high left ventricular pacing threshold. VVI pacemaker implantation had not improved the patient's condition. MRI-guided biventricular pacemaker upgrade had been performed with a left ventricular epicardial lead at the lateral region where a 4-mm thickening during systole had been proven. After 6 months of effective resynchronization, the patient's functional class improved to NYHA II without further need of hospitalization

From Source to Tap: Tracking Microbial Diversity in a Riverbank Filtration-Based Drinking Water Supply System under Changing Hydrological Regimes

In drinking water supply, riverbank filtration (RBF) is an efficient and cost-effective way of eliminating pathogens and micropollutants using a combination of biotic and abiotic processes. Microbial communities in the hyporheic zone both contribute to and are shaped by these processes. Microbial water quality at the point of consumption is in turn influenced by the source water microbiome, water treatment and distribution system. Understanding microbial community shifts from source to tap and the factors behind them is instrumental in maintaining safe drinking water delivery. To this end, microbial communities of an RBF-based drinking water supply system were investigated by metabarcoding in a one-year sampling campaign. Samples were collected from the river, RBF wells, treated water, and a consumer’s tap. Metabarcoding data were analysed in the context of physicochemical and hydrological parameters. Microbial diversity as well as cell count decreased consistently from the surface water to the tap. While Proteobacteria were dominant throughout the water supply system, typical river water microbiome phyla Bacteroidota, Actinobacteria, and Verrucomicrobiota were replaced by Nitrospira, Patescibacteria, Chloroflexi, Acidobacteriota, Methylomicrobilota, and the archaeal phylum Nanoarcheota in well water. Well water communities were differentiated by water chemistry, in wells with high concentration groundwater derived iron, manganese, and sulphate, taxa related to iron and sulphur biogeochemical cycle were predominant, while methane oxidisers characterised the more oxic wells. Chlorine-resistant and filtration-associated taxa (Acidobacteria, Firmicutes, and Bdellovibrionota) emerged after water treatment, and no potentially pathogenic taxa were identified at the point of consumption. River discharge had a distinct impact on well water microbiome indicative of vulnerability to climate change. Low flow conditions were characterised by anaerobic heterotrophic taxa (Woesarchaeales, Aenigmarchaeales, and uncultured bacterial phyla MBNT15 and WOR-1), implying reduced efficiency in the degradation of organic substances. High flow was associated the emergence of typical surface water taxa. Better understanding of microbial diversity in RBF water supply systems contributes to preserving drinking water safety in the future changing environment

Short-term effect of rate control on plasma endothelin levels of patients with tachyarrhythmias.

Radiofrequency catheter ablation or modification of the atrio-ventricular junction is an effective therapy of drug refractory supraventricular tachyarrhythmias (ST). Higher endothelin (ET) levels were observed during nonsustained STs. We aimed to examine the effect of sustained STs and the applied rate-control therapy on plasma ET levels. Twenty-two patients (12 men; mean age, 64.4 +/- 13.2 years; ejection fraction, 41.8 +/- 11.2%; New York Heart Association (NYHA) class I: 3 cases, NYHA II: 11 cases, and NYHA III: 8 cases) suffering of atrial fibrillation (n = 11), atrial flutter (n = 7), atrial paroxysmal tachycardia (n = 3), or sinus tachycardia (n = 1) were studied, having coronary artery disease (n = 8), dilative cardiomyopathy (n = 5), or no underlying diseases (n = 9). All groups went under catheter ablation (same protocol, duration: 35 +/- 10.3 mins; rate before ablation, 100-170/min in every case; after ablation, 70-80/min in Groups I and II and 70-90/min in Group III). A pacemaker (PM) was implanted 2 months before ablation in Group I (n = 9) and during ablation in Group II (n = 7). No PM was implanted in Group III (n = 6). A control group (n = 13; 7 men; mean age, 66.15 +/- 6.7 years) with sinus rhythm got a PM without ST and ablation. Blood samples were collected from the cubital vein immediately before (control), and 5 mins and 24 hrs after ablation. Plasma ET-1 and big ET-1 levels were measured after immunoprecipitation with Western blot analysis. There were no differences between plasma ET-1 levels in the ST groups and the control group (Groups I, II, and III vs. control group: 0.66 +/- 0.04 fmol/ml, 0.93 +/- 0.12 fmol/ml, and 0.68 +/- 0.05 fmol/ml vs. 0.50 +/- 0.05 fmol/ml, respectively; P < 0.05). Comparing the control, 5-min, and 24-hr samples, ET-1 levels decreased significantly after supraventricular tachycardia ablation in Groups I and III (control vs. Group I, 5 mins and 24 hrs: 0.66 +/- 0.04 fmol/ml vs. 0.50 +/- 0.04 fmol/ml and 0.29 +/- 0.05 fmol/ml; control vs. Group III, 24 hrs: 0.68 +/- 0.05 vs. 0.34 +/- 0.05 fmol/ml; P < 0.05). No plasma big ET-1 changes were measured in any of the groups. The rapid decrease of ET levels after catheter ablation suggests that a high ventricular rate can be a trigger of ET production. PM implantation procedure seems to interfere with the ET decrease in ST patients

Short-term effect of rate control on plasma endothelin levels of patients with tachyarrhythmias.

Radiofrequency catheter ablation or modification of the atrio-ventricular junction is an effective therapy of drug refractory supraventricular tachyarrhythmias (ST). Higher endothelin (ET) levels were observed during nonsustained STs. We aimed to examine the effect of sustained STs and the applied rate-control therapy on plasma ET levels. Twenty-two patients (12 men; mean age, 64.4 +/- 13.2 years; ejection fraction, 41.8 +/- 11.2%; New York Heart Association (NYHA) class I: 3 cases, NYHA II: 11 cases, and NYHA III: 8 cases) suffering of atrial fibrillation (n = 11), atrial flutter (n = 7), atrial paroxysmal tachycardia (n = 3), or sinus tachycardia (n = 1) were studied, having coronary artery disease (n = 8), dilative cardiomyopathy (n = 5), or no underlying diseases (n = 9). All groups went under catheter ablation (same protocol, duration: 35 +/- 10.3 mins; rate before ablation, 100-170/min in every case; after ablation, 70-80/min in Groups I and II and 70-90/min in Group III). A pacemaker (PM) was implanted 2 months before ablation in Group I (n = 9) and during ablation in Group II (n = 7). No PM was implanted in Group III (n = 6). A control group (n = 13; 7 men; mean age, 66.15 +/- 6.7 years) with sinus rhythm got a PM without ST and ablation. Blood samples were collected from the cubital vein immediately before (control), and 5 mins and 24 hrs after ablation. Plasma ET-1 and big ET-1 levels were measured after immunoprecipitation with Western blot analysis. There were no differences between plasma ET-1 levels in the ST groups and the control group (Groups I, II, and III vs. control group: 0.66 +/- 0.04 fmol/ml, 0.93 +/- 0.12 fmol/ml, and 0.68 +/- 0.05 fmol/ml vs. 0.50 +/- 0.05 fmol/ml, respectively; P < 0.05). Comparing the control, 5-min, and 24-hr samples, ET-1 levels decreased significantly after supraventricular tachycardia ablation in Groups I and III (control vs. Group I, 5 mins and 24 hrs: 0.66 +/- 0.04 fmol/ml vs. 0.50 +/- 0.04 fmol/ml and 0.29 +/- 0.05 fmol/ml; control vs. Group III, 24 hrs: 0.68 +/- 0.05 vs. 0.34 +/- 0.05 fmol/ml; P < 0.05). No plasma big ET-1 changes were measured in any of the groups. The rapid decrease of ET levels after catheter ablation suggests that a high ventricular rate can be a trigger of ET production. PM implantation procedure seems to interfere with the ET decrease in ST patients

Hypertonia és RAS-gátlók előfordulása SARS-Cov-2 fertőzés miatt intézeti ellátásra került 18 év feletti egyénekben

Célunk az volt, hogy az SZTE Belgyógyászati Klinika Nyugati telephely fekvőbeteg Járványellátó Központ részlegén felvételre került, 18 év feletti Covid-pozitív betegek között a kezelt hypertonia előfordulását, a szedett vérnyomáscsökkentők számát, a RAS-gátló vérnyomáscsökkentők (ACE-gátló és/vagy ARB) előfordulását felmérjük. A vizsgálatban véletlenszerűen kiválasztott 165 (94 férfi, 71 nő) gyorsteszttel vagy PCR-rel Covid-pozitív, 2021. február közepe és április vége között felvett betegek adatainak retrospektív elemzése történt. A betegek életkora 59,9±12,9 év volt (26–92), a BMI 30,7±6,6 kg/m2 (20,3–55,4). A betegek között felvételkor 103 (62,4%) már ismert hypertoniás egyén volt (56 férfi, 47 nő). A szedett vérnyomáscsökkentők száma felvételkor 1,6±1,6 darab (maximum hat), a kezelés végén 1,8±1,7 darab. Területen több mint három szert 23-an, éppen hármat 25-en szedtek. Monoterápiában felvételt megelőzően 20-an részesültek, a kezelés végén 25-en. A vérnyomáscsökkentők száma a kezelés végén 74 esetben nem változott, hat esetben csökkent, 31 esetben nőtt, ezek között 11 új indítás volt. Egy betegnél a csökkenés 100%-os volt, a monoterápiát el kellett hagyni, a többi öt esetben pedig 50%-os. A hypertoniás betegek több napot töltöttek intézetben, mint a nem hypertoniás egyének (10,9±6,8 vs. 9,2±6,3). A felvételkor mért spontán O2-szaturáció a hypertoniás beteg között alacsonyabb volt, mint a nem hypertoniás egyéneknél (92,6±4,8 vs. 89,6±9,7%), ARB-t szedők között volt a legalacsonyabb (87,5±8,5%, p=0,01 vs. nem hypertoniás). Az összes halálozás a hypertoniás betegek között 8,7%, a nem hypertoniás betegek között csak 1,6% volt. A hypertoniás betegeket vizsgálva, a RAS-gátlót szedők és nem szedők között az intenzív ellátás 16,3 vs. 13%. Az összes halálozás a RAS-gátlót szedők között 10%, a nem szedők között 4,3%, az ARB-t szedők között 13% és az ACE-gátlót szedők között 8,8% volt. Eredményeink alapján a hypertonia nagyobb kockázatot jelenthet a rosszabb Covid-kimenetel tekintetében. A RAS-gátló kezelésben részesültek nagyobb kockázatát észleltük a RAS-gátló kezelésben nem részesültekhez képest