63 research outputs found
A hosszú távú protonpumpagátló kezelés következményei felnőtteken
Absztrakt:
A protonpumpagátlók az utóbbi évtizedekben a savfüggő kórképek kezelésének
élvonalbeli gyógyszereivé váltak. Megkérdőjelezhetetlen hatékonyságuk ellenére
azonban ezek a szerek nem veszélytelenek, az utóbbi időszakban számos közlemény
született hosszú távú mellékhatásaikkal kapcsolatban. A felmerült lehetséges
mellékhatások között a csonttörések fokozott kockázata, a csökkent
B12-vitamin-, illetve magnéziumszint, valamint a
Clostridium difficile-fertőzés emelhető ki. Tekintettel
arra, hogy a protonpumpagátlók világszerte egyre nagyobb számban kerülnek
felĂrásra, nagyon fontos a tartĂłs szedĂ©sĂĽk következtĂ©ben fellĂ©pĹ‘ mellĂ©khatások
ismerete mind a szakorvosok, mind az alapellátásban dolgozó orvosok számára. A
szerzők ebben az összefoglaló közleményben a protonpumpagátlók hosszú távú
lehetséges mellékhatásait ismertetik, hangsúlyozva azt, hogy ezeket a szereket
csak megfelelő, szigorú indikációval szabad tartósan alkalmazni. Orv Hetil.
2018; 159(19): 735–740.
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Abstract:
In the last few decades, proton-pump inhibitors have become the mainstay of the
treatment of acid-related disorders. Despite their efficacy, these drugs are not
without risks. Recently several articles have been published on their long-term
adverse effects. Among these adverse effects, the higher risk of bone fractures,
the vitamin B12 and magnesium deficiencies and the higher risk of
Clostridium difficile infection may be relevant. As these
drugs are prescribed more and more frequently all over the world, the knowledge
of the long-term adverse effects is very important not only for the specialists
but for the general practitioners as well. In this review, the authors discuss
the recent findings in this field, emphasising that the long-term use of these
drugs must be based on an adequate and strong indication. Orv Hetil. 2018;
159(19): 735–740
The burden of Clostridium difficile infection between 2010 and 2013: trends and outcomes from an academic center in Eastern Europe
Modeling is now an essential ingredient in business process management and information systems development. The general usefulness of models in these areas is therefore generally accepted. It is also undisputed that the quality of the models has a significant impact on their usefulness. In the literature we can find any number of quality metrics, but hardly any study that investigates their relation with (perceived) usefulness and none that considers their relative impact on usefulness. We take a look at some of the most frequent quality dimensions and their relative impact on the perceived usefulness of models
A kĂĽlönbözĹ‘ Ă©rfali tágulĂ©konysági paramĂ©terek jelentĹ‘sĂ©ge a cardiovascularis mortalitás elĹ‘rejelzĂ©sĂ©ben hemodializált betegek között: prospektĂv kohorszvizsgálat = The consequence of arterial stiffness parameters to predict the cardiovascular mortality in hemodialysis patients: a prospective cohort study
Korábbi vizsgálatok eredmĂ©nyei alapján az Ă©rfali tágulĂ©konyság paramĂ©terei összefĂĽggĂ©st mutatnak a cardiovascularis mortalitással hemodializált betegekben. A kĂĽlönbözĹ‘ paramĂ©terek relatĂv prognosztikus Ă©rtĂ©kĂ©t ugyanakkor egy közös kohorszban eddig nem vizsgálták.
MĂłdszer:
DialĂzis elĹ‘tt Ă©s után 98 betegnĂ©l mĂ©rtĂĽk a carotis-femoralis pulzushullám terjedĂ©si sebessĂ©gĂ©t, a carotis augmentáciĂłs indexĂ©t, a carotis pulzusnyomását Ă©s a carotis-brachialis pulzusnyomás amplifikáciĂłját. A betegeket 29 hĂłnapig (medián) (tartomány 1–35) követtĂĽk, majd a cardiovascularis mortalitás Ă©s a kiinduláskor mĂ©rt tágulĂ©konysági paramĂ©terek közötti összefĂĽggĂ©st vizsgáltuk log-rank tesztek, illetve a korhoz, diabeteshez Ă©s korábban meglĂ©vĹ‘ cardiovascularis megbetegedĂ©shez illesztett Cox-fĂ©le regressziĂłs modellek alkalmazásával.
Eredmények:
A követĂ©s alatt 40 beteg halt meg (mortalitási ráta 20,7/100 betegĂ©v), köztĂĽk 25-en cardiovascularis ok következtĂ©ben. A dialĂzis elĹ‘tt Ă©s után mĂ©rt pulzushullám-terjedĂ©si sebessĂ©get tercilisei, illetve a dialĂzis elĹ‘tt mĂ©rt pulzusnyomás-amplifikáciĂł tercilise szignifikáns összefĂĽggĂ©st mutattak a cardiovascularis mortalitással (log-rank p-Ă©rtĂ©kek 0,012 Ă©s 0,011 a pre- Ă©s posztdialĂzis pulzushullám-terjedĂ©si sebessĂ©g, illetve <0,001 Ă©s 0,321 a pre- Ă©s posztdialĂzis pulzusnyomás-amplifikáciĂł esetĂ©n). Az augmentáciĂłs indexek, illetve a carotispulzusnyomás-Ă©rtĂ©kek nem álltak összefĂĽggĂ©sben a cardiovascularis mortalitással. Cox-modellben az 1 m/s-mal gyorsabb pre- Ă©s posztdialĂzis pulzushullám-terjedĂ©si sebessĂ©gĂ©hez tartozĂł relatĂv rizikĂł 1,24 (1,07–1,44) Ă©s 1,17 (1,06–1,28) volt. 10%-kal kisebb predialĂzispulzusnyomás-amplifikáciĂłval járĂł rizikĂłnövekedĂ©s 41% (3–92%) volt. Egy közös modellben vizsgálva mind a predialĂzispulzushullám-terjedĂ©si sebessĂ©g, mind a pulzusnyomás-amplifikáciĂł szignifikáns összefĂĽggĂ©st mutatott a cardiovascularis tĂşlĂ©lĂ©ssel [relatĂv rizikĂł: 1,23 (1,07–1,42) Ă©s 1,39 (1,02–1,89)].
Következtetés:
Hemodializált betegekben az Ă©rfali tágulĂ©konyságot leĂrĂł kĂĽlönbözĹ‘ paramĂ©terek közĂĽl a pulzushullám-terjedĂ©si sebessĂ©g a mĂ©rĂ©s idejĂ©tĹ‘l fĂĽggetlen, konzekvens összefĂĽggĂ©st mutat a cardiovascularis mortalitással. Ugyanakkor a predialĂzispulzusnyomás-amplifikáciĂłs Ă©rtĂ©k további prognosztikus informáciĂłt hordoz.
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Previous studies demonstrated that different parameters of arterial stiffness are related to cardiovascular mortality in hemodialysis patients. The relative prognostic value of these parameters has not previously been evaluated in one cohort.
Patients and Methods:
: Carotid-femoral pulse wave velocity, carotid augmentation index, carotid pulse pressure and carotid-brachial pulse pressure amplification were measured in 98 patients before and after hemodialysis. Patients were followed for a median of 29 months (1–34) and the association of these parameters with cardiovascular mortality was assessed using log-rank tests and Cox proportional hazards regressions.
Results:
During follow-up, 40 patients died (mortality rate 20.7/100 patient-year), of which 25 died of cardiovascular causes. Increasing pre- and postdialysis pulse wave velocity tertiles and decreasing predialysis pulse pressure amplification tertiles were significantly related to cardiovascular mortality (p-values are 0.012 and 0.011 for pre- and postdialysis pulse wave velocity, and <0.001 and 0,321 for pre- and postdialysis pulse pressure amplification, respectively). Neither the carotid augmentation index nor carotid pulse pressure was related to cardiovascular mortality. In the Cox-regression, the adjusted hazard ratios for 1 m/s higher pre- and postdialysis pulse wave velocity were 1.24 (1.07–1.44) and 1.17 (1.06–1.28), respectively. The hazard ratio for 10% lower predialysis pulse pressure amplification was 1.41 (1.03–1.92). When included in the same model, both predialysis pulse wave velocity and pulse pressure amplification remained significantly associated with cardiovascular mortality (relative risk: 1.23 [1.07–1.42] and 1.39 [1.02–1.89]).
Conclusion:
Among different stiffness parameters, pulse wave velocity is consistently related to cardiovascular mortality, irrespective of the timing of measurement. Predialysis pulse pressure amplification seems to provide additional prognostic information
A csonttörĂ©s kockázatának megĂtĂ©lĂ©se osteoporosisban [Evaluation of fracture risk in osteoporosis]
Osteoporotic fractures are associated with excess mortality. Effective treatment options are available, which reduce the risk of vertebral and non-vertebral fractures, but the identification of patients with high fracture risk is problematic. Low bone mineral density (BMD) - the basis for the diagnosis of osteoporosis - is an important, but not the only determinant of fracture risk. Several clinical risk factors are know that operate partially or completely independently of BMD, and affect the fracture risk. These include age, a prior fragility fracture, a parental history of hip fracture, use of corticosteroids, excess alcohol intake, rheumatoid arthritis, and different types of diseases which can cause secondary bone loss. The FRAX® tool integrates the weight of above mentioned clinical risk factors for fracture risk assessment with or without BMD value, and calculates the 10-year absolute risk of hip and major osteoporotic (hip, vertebral, humerus and forearm together) fracture probabilities. Although the use of data is not yet uniform, the FRAX® is a promising opportunity to identify individuals with high fracture risk. The accumulation of experience with FRAX® is going on and it can modify current diagnostic and therapeutic recommendations in Hungary as well
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