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

Faecal Matrix Metalloprotease-9 Is a More Sensitive Marker For Diagnosing Pouchitis Than Faecal Calprotectin – Results From a Pilot Study

Background. Potential non-invasive markers of pouchitis would have a great deal of significance within clinical practice. This study is aimed at assessing the diagnostic accuracy of faecal calprotectin and matrix metalloprotease-9 as potential markers in patients both with and without pouchitis. Patients and methods. Stool and blood samples were collected from 33 ileal pouch-anal anastomosis patients before a follow-up pouchoscopy. Biopsy samples were taken for histological purposes. The presence of cuffitis and stenosis was evaluated with an endoscopy. Calprotectin and matrix metalloprotease-9 were quantified with an enzyme-linked immunosorbent assay. Results. Pouchitis was detected in 30.3% of the patients. The levels of faecal calprotectin and matrix metalloprotease-9 increased significantly in patients with pouchitis. The sensitivity and specificity of matrix metalloprotease-9 was higher than that of faecal calprotectin. Only matrix metalloprotease-9 correlated significantly with the severity of pouchitis. Conclusions. Faecal matrix metalloprotease-9 has a high specificity in the diagnosis of pouchitis

Role of antispasmodics in the treatment of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a long-lasting, relapsing disorder characterized by abdominal pain/discomfort and altered bowel habits. Intestinal motility impairment and visceral hypersensitivity are the key factors among its multifactorial pathogenesis, both of which require effective treatment. Voltage-gated calcium channels mediate smooth muscle contraction and endocrine secretion and play important roles in neuronal transmission. Antispasmodics are a group of drugs that have been used in the treatment of IBS for decades. Alverine citrate, a spasmolytic, decreases the sensitivity of smooth muscle contractile proteins to calcium, and it is a selective 5-HT(1A) receptor antagonist. Alverine, in combination with simethicone, has been demonstrated to effectively reduce abdominal pain and discomfort in a large placebo-controlled trial. Mebeverine is a musculotropic agent that potently blocks intestinal peristalsis. Non-placebo-controlled trials have shown positive effects of mebeverine in IBS regarding symptom control; nevertheless, in recent placebo-controlled studies, mebeverine did not exhibit superiority over placebo. Otilonium bromide is poorly absorbed from the GI tract, where it acts locally as an L-type calcium channel blocker, an antimuscarinic and a tachykinin NK2 receptor antagonist. Otilonium has effectively reduced pain and improved defecation alterations in placebo-controlled trials in IBS patients. Pinaverium bromide is also an L-type calcium channel blocker that acts locally in the GI tract. Pinaverium improves motility disorders and consequently reduces stool problems in IBS patients. Phloroglucinol and trimethylphloroglucinol are non-specific antispasmodics that reduced pain in IBS patients in a placebo-controlled trial. Antispasmodics have excellent safety profiles. T-type calcium channel blockers can abolish visceral hypersensitivity in animal models, which makes them potential candidates for the development of novel therapeutic agents in the treatment of IBS