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1.
Orv Hetil ; 159(32): 1303-1309, 2018 Aug.
Artigo em Húngaro | MEDLINE | ID: mdl-30078359

RESUMO

The correlation between cholesterol and risk reduction is unique: no J curve is seen even at extreme low levels. According to PRECISE-IVUS, the effect of intensive cholesterol lowering on plaque regression is more pronounced post-myocardial infarction syndrome than in chronic coronary disease. The importance of LDL-C lowering with ezetimibe in IMPROVE-IT (1.4 mmol/L compared to 1.8 mmol/L in the statin monotherapy arm) is expressed in several international guidelines and the indication spectrum of combination cholesterol lowering has broadened and strengthened. There is a strong evidence that myalgia during statin treatment is generally not caused by statins and it is not related to type or dose of the drug. With patience, the majority of patients can be made to become statin takers even with good quality of life; for those who cannot, ezetimibe monotherapy can be an alternative. Even though intensive cholesterol lowering is safe, avoiding statin myopathy should be emphasized. Despite the outstanding efficacy and safety of cholesterol lowering, Hungarian statin sales have decreased recently, in which driven dilettante public climate around the products may be of utmost importance. Everyone of us should counteract this according to the possibilities. Orv Hetil. 2018; 159(32): 1303-1309.


Assuntos
Anticolesterolemiantes/uso terapêutico , Ezetimiba/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Placa Aterosclerótica/prevenção & controle , LDL-Colesterol/efeitos dos fármacos , Feminino , Humanos , Hungria , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino
2.
Orv Hetil ; 159(22): 878-884, 2018 Jun.
Artigo em Húngaro | MEDLINE | ID: mdl-29806478

RESUMO

INTRODUCTION AND AIM: The worldwide incidence of differentiated thyroid cancer (DTC) has markedly increased during the last few decades. According to the international guidelines, principles of DTC management are in transformation. The aim of our work was to evaluate patients' current likelihood of recovery. METHOD: Data of 380 patients treated between 1/Jan/2005 and 1/May/2016 at the PTE KK Ist Department of Internal Medicine were retrospectively analyzed. Female/male ratio was 306/74. Median age at diagnosis was 46 years (13-86 years), while median follow-up time was 55 months (0-144 months). Response to therapy was evaluable in 337 patients. Statistical analysis was done using SPSS (version 22.0). RESULTS: Based on the prevalence of papillary (PTC) and follicular (FTC) carcinomas (79/21%), moderate iodine deficiency has to be considered in this region. PTC patients were significantly younger and were diagnosed in earlier tumor stage. The ratio of lymph node and distant metastases was 35%/4% in PTC and 15%/14% in FTC. Radioiodine treatment was performed in a total of 542 times. 264 patients with PTC were followed up. 59% of patients were tumor-free, in 20% uncertain response, in 7% incomplete biochemical response, in 14% incomplete structural response were diagnosed and 6 patients died. Patients with FTC (n = 73) were tumor-free in 59%, uncertain response was found in 10%, incomplete structural response was diagnosed in 31%, while 10% of the patients died. CONCLUSIONS: In summary, although DTC has a favorable prognosis, in 31% of FTC patients and in 14% of PTC patients, tumor-free status was not achieved. During the median 55-month follow-up period, the disease-specific mortality was 10% in FTC and 2% in PTC. Orv Hetil. 2018; 159(22): 878-887.


Assuntos
Adenocarcinoma Folicular/terapia , Carcinoma Papilar/terapia , Neoplasias da Glândula Tireoide/terapia , Adenocarcinoma Folicular/patologia , Adulto , Carcinoma Papilar/patologia , Intervalo Livre de Doença , Feminino , Humanos , Hungria , Radioisótopos do Iodo/uso terapêutico , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Radioterapia Adjuvante , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia
3.
Endocr Pract ; 22(5): 523-32, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26684150

RESUMO

OBJECTIVE: Hypoparathyroidism is characterized by inadequate parathyroid hormone (PTH), resulting in hypocalcemia, hyperphosphatemia, and bone abnormalities. Adults with hypoparathyroidism treated with recombinant human PTH, rhPTH(1-84), in the 24-week, phase III REPLACE study maintained serum calcium despite reductions in oral calcium and active vitamin D. This study assessed the long-term efficacy and safety of rhPTH(1-84) for hypoparathyroidism. METHODS: This was a 24-week, open-label, flexible-dose extension study of REPLACE (REPEAT) conducted in 3 outpatient centers in Hungary. Patients who previously completed or enrolled in REPLACE received 50 µg/day rhPTH(1-84), escalated to 75 and then to 100 µg/day, if needed, to reduce active vitamin D and oral calcium. The primary endpoint was ≥50% reduction in oral calcium (or ≤500 mg/day) and active vitamin D (or calcitriol ≤0.25 µg/day or alfacalcidol ≤0.50 µg/day) with normocalcemia. RESULTS: Twenty-four patients (n = 16 previously treated with rhPTH[1-84]; n = 8 rhPTH[1-84]-naïve) were enrolled and completed the study. At Week 24, 75% of patients (95% confidence interval [CI], 53.3-90.2%) achieved the study endpoint; 58% eliminated oral calcium and active vitamin D. Urinary calcium, serum phosphate, and calcium × phosphate (Ca × P) product decreased by Week 24. Mean serum bone turnover markers increased with rhPTH(1-84). Treatment-emergent adverse events (TEAEs) were reported by 92% of patients. No serious adverse events (AEs) occurred. CONCLUSION: This study used a simplified treatment algorithm intended to better mimic typical clinical practice and demonstrated the extended efficacy and safety of rhPTH(1-84) in patients with hypoparathyroidism and confirmed the REPLACE findings. Sustained rhPTH(1-84) efficacy up to 48 weeks was observed despite treatment interruption between studies.


Assuntos
Hipoparatireoidismo/tratamento farmacológico , Hormônio Paratireóideo/uso terapêutico , Adulto , Idoso , Densidade Óssea/efeitos dos fármacos , Cálcio/sangue , Cálcio/urina , Feminino , Humanos , Hungria/epidemiologia , Hipoparatireoidismo/sangue , Hipoparatireoidismo/epidemiologia , Hipoparatireoidismo/urina , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/efeitos adversos , Hormônio Paratireóideo/sangue , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêutico , Resultado do Tratamento
4.
Orv Hetil ; 157(31): 1242-7, 2016 Jul.
Artigo em Húngaro | MEDLINE | ID: mdl-27476520

RESUMO

The biological mechanisms, ecological and observational studies indicate increased morbidity and mortality in vitamin D deficiency, while the controlled, randomized supplementation trials - carried out mostly in vitamin D deficient patients - have shown no or some marginal benefits, mostly in preventing institutionalized elderly individuals' falls and fractures. Clarity is also disturbed by that the primary end points of intervention studies were generally not extraskeletal. The ideal serum 25-hydroxyvitamin D levels also considerably controversial: there is clearly a J-curve, but the optimal range is uncertain. All of these uncertainties appear also in the vitamin D guidelines which are, however, concordant in that they do not recommend (i) a population-wide screening and (ii) vitamin D supplementation with extraskeletal aim - beyond the prevention of falls. Certain studies suggest that calcium supplementation increases the incidence of cardiovascular events, while others show a neutral effect in this respect. There are several ongoing vitamin D studies directly designed for extraskeletal events. Orv. Hetil., 2016, 157(31), 1242-1247.


Assuntos
Cálcio/administração & dosagem , Cálcio/efeitos adversos , Suplementos Nutricionais , Deficiência de Vitamina D/tratamento farmacológico , Vitamina D/análogos & derivados , Vitamina D/sangue , Cálcio da Dieta/administração & dosagem , Humanos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Vitamina D/administração & dosagem , Deficiência de Vitamina D/sangue , Vitaminas/sangue
5.
Orv Hetil ; 157(21): 830-5, 2016 May 22.
Artigo em Húngaro | MEDLINE | ID: mdl-27177790

RESUMO

INTRODUCTION: The diagnostic algorithm of primary aldosteronism is burdened with uncertainties and, recently, it has been suggested that the sensitivity of the aldosterone/renin ratio used as a screening test - based on the suppression aldosterone - is low. AIM: The primary aim was to test the accuracy of aldosterone/renin ratio. METHOD: In a retrospective analysis of 309 hypertensive patients supine and ambulatory aldosterone levels were independently examined. RESULTS: Aldosterone/renin ratio was elevated in 99 patients of whom 31 exhibited elevated supine aldosterone, as well. In 34 cases supine aldosterone was increased without elevation of the aldosterone/renin ratio. However, only 3 of them had concomitant low renin levels indicating that primary aldosteronism could not be ruled out. Abnormally increased renin was found in 69 patients, but only 59% of them had increased aldosterone level. CONCLUSION: Sensitivity of aldosterone/renin ratio is high (91%) if used only in justified cases.


Assuntos
Aldosterona/sangue , Hiperaldosteronismo/diagnóstico , Hipertensão/sangue , Renina/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Humanos , Hiperaldosteronismo/sangue , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Decúbito Dorsal , Caminhada
6.
Orv Hetil ; 155(2): 62-8, 2014 Jan 12.
Artigo em Húngaro | MEDLINE | ID: mdl-24389322

RESUMO

Instead of LDL-cholesterol, non-HDL-cholesterol is proposed as a secondary lipid target when triglyceride level is above 2.3 mmol/L. Non-HDL-cholesterol target values are 0.8 mmol/L higher than those for LDL-cholesterol in the same cardiovascular risk category. Currently, the main issue of lipidology is the degree by which the cardiovascular risk can be reduced with the treatment of residual dyslipidemia that exists under statin therapy. In such a role the examined agents have essentially failed despite their more or less profound effect on HDL-cholesterol and/or non-HDL-cholesterol. The largest loser has been the nicotinic acid. The results of cardiovascular, otherwise controversial fish oil studies cannot be considered convincing because of the administered low doses. In a combination with statin (i) ezetimibe may have role if the LDL-cholesterol target cannot be reached with statin monotherapy, or (ii) fibrates, in case of large increase of triglyceride level, or in less severe hypertriglyceridemia if it is associated with considerable decrease in HDL-cholesterol level. Potential further possibilities are: (i) cholesterol ester transfer protein inhibitors that dramatically raise HDL-cholesterol, while reduce LDL-cholesterol, or (ii) proprotein convertase subtilisin/kexin 9 inhibitors that markedly decrease LDL-cholesterol even on the top of statin.


Assuntos
Proteínas de Transferência de Ésteres de Colesterol/antagonistas & inibidores , HDL-Colesterol/sangue , Dislipidemias/tratamento farmacológico , Dislipidemias/prevenção & controle , Ácidos Fíbricos/uso terapêutico , Hipolipemiantes/uso terapêutico , Niacina/uso terapêutico , Anticolesterolemiantes/uso terapêutico , Azetidinas/uso terapêutico , LDL-Colesterol/sangue , Dislipidemias/sangue , Ezetimiba , Óleos de Peixe/uso terapêutico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hiperlipoproteinemia Tipo II/tratamento farmacológico , Pró-Proteína Convertase 9 , Pró-Proteína Convertases/antagonistas & inibidores , Serina Endopeptidases
7.
Artigo em Inglês | MEDLINE | ID: mdl-39378147

RESUMO

BACKGROUND: The purpose of our work was to provide a data-driven perspective to APS, a complex autoimmune disorder, supplementing traditional clinical observations. METHODS: Medical records of 7559 patients were analyzed, autoimmune origin was proved in 3180 cases of which 380 (12%) had APS. Associations of component disorders were investigated by computational methods to reveal typical patterns of disease development. RESULTS: Twenty-eight distinct autoimmune disorders were diagnosed forming 113 combinations. The 10 most frequent combinations were responsible for 51,3% of cases. HT and GD were differentiated as main cornerstones of APS, sharing several comorbidities. HT was the most common manifestation (67.4%), followed by GD (26.8%) and T1D (20.8%). APS started significantly earlier in men than in women. Thyroid autoimmunity was frequently linked to gastrointestinal and systemic manifestations and these patterns of associations substantially differed from that of T1D, AD or CeD when present as first manifestations, suggesting the possibility of a common biological cause. CONCLUSION: APS is more frequent than reported. Classifying APS requires a shift of perspective towards disease associations rather than disorder prevalence.

8.
Orv Hetil ; 154(7): 243-7, 2013 Feb 17.
Artigo em Húngaro | MEDLINE | ID: mdl-23395787

RESUMO

From the evaluated ONTARGET, ALTITUDE, ACCOMPLISH, ROADMAP, and ACCORD-BP studies a conclusion can be drawn that though microalbuminuria/proteinuria is a strong epidemiological biomarker, in interventional studies it is not necessarily a reliable surrogate endpoint as actual renal function may change in an opposite way. Namely, some therapeutic measures improving microalbuminuria/proteinuria may actually worsen renal function. In case of procedures such as blood pressure lowering or measure of RAS blockade an optimum point on a J-curve may exist.


Assuntos
Anlodipino/farmacologia , Antagonistas de Receptores de Angiotensina/farmacologia , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Anti-Hipertensivos/farmacologia , Rim/efeitos dos fármacos , Substâncias Protetoras/farmacologia , Anlodipino/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Quimioterapia Combinada , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/metabolismo , Hipertensão/fisiopatologia , Rim/metabolismo , Rim/fisiopatologia , Substâncias Protetoras/uso terapêutico , Proteinúria/prevenção & controle , Renina/antagonistas & inibidores
9.
J Clin Med ; 12(14)2023 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-37510916

RESUMO

BACKGROUND: The adrenocortical system and copeptin as prognostic markers were intensively investigated in critical illness. The potential predictive power of apelin-13 as a biomarker is largely unknown. We aimed to investigate the prognostic role of apelin-13 in relation to free cortisol, aldosterone, CRH, and copeptin in critically ill patients. METHODS: In this prospective observational study, 124 critically ill patients (64 men, 60 women, median age: 70 (59-78) years) were consecutively enrolled at the time of admission. All routinely available clinical and laboratory parameters were evaluated and correlated to hormonal changes. RESULTS: Serum apelin-13 was 1161 (617-2967) pg/mL in non-survivors vs. 2477 (800-3531) pg/mL in survivors (p = 0.054). The concentrations of apelin-13 and CRH had strong positive correlations (r = 0.685, p < 0.001) and were significantly higher in surviving non-septic patients (Apelin-13 (pg/mL): 2286 (790-3330) vs. 818 (574-2732) p < 0.05; CRH (pg/mL) 201 (84-317) vs. 89 (74-233) p < 0.05). Apelin-13 and free cortisol were independent determinants of survival in the multivariate Cox regression analysis, while copeptin, CRH, or aldosterone were not. CONCLUSIONS: Beyond free cortisol, serum apelin-13 may also help refine prognostic predictions in the early phase of critical illness, especially in non-septic patients.

10.
Orv Hetil ; 153(51): 2041-7, 2012 Dec 23.
Artigo em Húngaro | MEDLINE | ID: mdl-23248059

RESUMO

The discovery of cardiac hormone production significantly changed the evaluation of the function of the heart, which is rather regarded as a determining factor of the electrolyte and hemodynamic homeostasis cooperating with other organ systems instead of a mechanical pump. The most important hormones produced by the heart are the natriuretic peptides that have the primary role of protection against volume overload through natriuretic, diuretic, vasodilator and antiproliferative effects. They are integrative markers of the cardiac, vascular and renal functions and marking cardiorenal distress. Brain natriuretic peptide and the N-terminal pro-hormone (NT-proBNP) became generally accepted markers of heart failure exceeding traditional pathophysiological significance of those. They are useful in the diagnosis, estimation of prognosis and therapy guidance and their therapeutic administration is also available. Although the detection of extraadrenal aldosterone production is an exciting new discovery, intracardial aldosterone production is not significant in human beings. The intracardial thyroid hormone production is regulated by deiodinase activity. The role of elevated T3 concentration was suggested in the development of cardiac hypertrophy, while low T3 is assumed to be important in adaptation to hypoxia. An unexpected, complex relation can be determined between epicardial adipose tissue and coronary artery diseases, cytokine and adipokine production of adipocytes might be a part of the self-enhancing process of atherosclerosis.


Assuntos
Doença da Artéria Coronariana/metabolismo , Insuficiência Cardíaca/metabolismo , Gordura Intra-Abdominal/metabolismo , Miocárdio/metabolismo , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Adipócitos/metabolismo , Adipocinas/biossíntese , Aldosterona/metabolismo , Biomarcadores/sangue , Cardiomegalia/sangue , Cardiomegalia/induzido quimicamente , Citocinas/biossíntese , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Humanos , Pericárdio , Tri-Iodotironina/efeitos adversos , Tri-Iodotironina/sangue
11.
Front Endocrinol (Lausanne) ; 13: 981891, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36187132

RESUMO

Objective: This study aimed to investigate the complex interactions of thyroid hormone, apelin, and copeptin in the fluid-ion homeostasis of patients with severe transitory hypothyroidism. Methods: In this prospective observational study, 39 patients (ECOG: 0; 11 men, 28 women, mean age: 50.3 ± 14.9 years) were investigated during short-term severe hypothyroidism due to surgical removal of the thyroid gland and after adequate thyroid replacement therapy. In addition to the routinely available lab tests, copeptin and apelin levels were determined using ELISA. Results: In the hypothyroid state, apelin concentration was lower, while copeptin levels did not differ compared to the euthyroid condition. Apelin showed a positive correlation with copeptin (p = 0.003), sodium (p = 0.002), NT-proBNP (p < 0.001), and fT4 (p < 0.001) and a negative correlation with thyroid-stimulating hormone (TSH) (p < 0.001). In multivariate linear regression models, copeptin and TSH proved to be significant independent predictors of apelin levels, of which TSH had an explanatory power of 48.7%. Aside from apelin, copeptin only correlated with sodium (p = 0.046). Sodium levels were negatively associated with TSH (p = 0.004) and positively with ACTH (p = 0.002) and cortisol (p = 0.047), in addition to copeptin. None of the parameters were independent predictors of serum sodium levels in a multivariate regression model. Conclusions: In short-term severe hypothyroidism, serum apelin level is markedly decreased, which may predispose susceptible patients to hyponatremia, while the level of copeptin is unchanged. TSH and copeptin are independent predictors of apelin concentration, of which TSH is stronger.


Assuntos
Hidrocortisona , Hipotireoidismo , Hormônio Adrenocorticotrópico , Adulto , Idoso , Apelina , Feminino , Glicopeptídeos , Humanos , Masculino , Pessoa de Meia-Idade , Sódio , Hormônios Tireóideos , Tireotropina
12.
Orv Hetil ; 163(31): 1243-1249, 2022 Jul 31.
Artigo em Húngaro | MEDLINE | ID: mdl-35908216

RESUMO

Paragangliomas are mostly benign tumors originating from the sympathetic or parasympathetic ganglions, but malignant forms are also known. They are in the region of the head and neck, in the glomus caroticum, intra-abdominally as well as in the thorax. The investigation of the 39-year-old male patient began due to extremely high blood pressure, night sweats and a 10 kg weight loss. Chest CT scan described a huge mass in the right hilum, bronchoscopic sampling was inconclusive. Tumor biopsy was performed through right thoracotomy, but complete resection was not possible due to tissue adhesions and cardiac involvement. Histological examination verified paraganglioma, which was also confirmed by laboratory tests. Accordingly, somatostatin analog therapy was initiated, followed by I-131-MIBG treatment with good clinical effect. Coronary angiography confirmed that the right coronary artery contributed with two marginal branches to the blood supply of the thoracic mass. The tumor was successfully removed and after the cardio-thoracic surgery, the patient's antihypertensive therapy was stopped. There was no sign of relapse during follow-ups. During the medical investigation of severe blood pressure elevations, the possibility of paraganglioma should be considered. In these cases, invasive procedures, if not preceded by proper medication, can be fatal. By taking advantage of the ever-expanding therapeutic options and the cooperation between institutions, even patients with a giant paraganglioma can become tumor-free.


Assuntos
Radioisótopos do Iodo , Paraganglioma , 3-Iodobenzilguanidina , Adulto , Humanos , Radioisótopos do Iodo/uso terapêutico , Masculino , Recidiva Local de Neoplasia/tratamento farmacológico , Paraganglioma/diagnóstico , Paraganglioma/cirurgia
13.
J Am Coll Nutr ; 30(5): 333-9, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22081619

RESUMO

OBJECTIVE: The prevalence of obesity is increasing in adult and child populations throughout the world. Childhood obesity has a great impact on adult cardiovascular morbidity and mortality; treatment of this pathological state is important given the significant health consequences. We investigated the effect of short-term lifestyle changes on the alteration of human serum paraoxonase-1 (PON1) activities, leptin, adiponectin, E-selectin, and asymmetric dimethylarginine (ADMA) as atherogenic and antiatherogenic factors in obese children. PON1 protects lipoproteins against oxidation by hydrolyzing lipid peroxides in oxidized low density lipoprotein (LDL) and therefore may protect against atherosclerosis. METHODS: A total of 23 white obese and overweight children (age, 11.43 ± 1.78 years; 8 girls, 15 boys) participated in a 2-week-long lifestyle camp based on a diet and exercise program. Overweight and obesity were defined according to the national body mass index (BMI) reference tables for age and sex. RESULTS: After a 2-week-long supervised diet and aerobic exercise program, obese children had significantly lower leptin (55.02 ± 33.42 ng/ml vs 25.37 ± 19.07 ng/ml; p < 0.0001), ADMA (0.68 ± 0.15 µmol/l vs 0.55 ± 0.16 µmol/l; p < 0.01), and E-selectin levels (67.19 ± 30.35 ng/ml vs 46.51 ± 18.40 ng/ml; p < 0.0001), whereas they had significantly higher PON1 paraoxonase activity (110.48 ± 72.92 U/l vs 121.75 ± 93.48 U/l; p < 0.05) besides the antiatherogenic alteration of the lipid profile and significant weight change (70.32 ± 19.51 kg vs 67.01 ± 18.75 kg, p < 0.0001; BMI, 28.95 ± 5.05 kg/m(2) vs 27.43 ± 4.82 kg/m(2), p < 0.0001). Adiponectin and PON1 arylesterase activity did not change significantly. CONCLUSIONS: Our investigation suggests that modifications in dietary habits and physical activity induce antiatherogenic changes in childhood obesity. These findings emphasize the major role of primary prevention and nonpharmaceutical treatment of childhood obesity through lifestyle changes based on diet and increased physical activity.


Assuntos
Adipocinas/sangue , Arildialquilfosfatase/sangue , Comportamento Alimentar , Estilo de Vida , Obesidade/epidemiologia , Obesidade/terapia , Adiponectina/sangue , Adolescente , Arginina/análogos & derivados , Arginina/sangue , Índice de Massa Corporal , Criança , Dieta , Selectina E/sangue , Feminino , Humanos , Leptina/sangue , Lipídeos/sangue , Masculino , Atividade Motora , Fatores de Risco
14.
Ideggyogy Sz ; 64(5-6): 151-6, 2011 Mar 30.
Artigo em Húngaro | MEDLINE | ID: mdl-21692273

RESUMO

Despite that hypercholesterinemia is not a risk factor of stroke, treatment with statins is able to reduce these events in a clinically relevant degree. Intervention trials suggest that while for primary prevention, statins are effective in conventional dose, after stroke or TIA this is true only if LDL-cholesterol is reduced below 1,8 mmol/L. To reach this goal, usually intensive antilipid treatment is necessary. There are studies showing beneficial impacts of other lipid drugs, beyond statins, i.e. fibrates and fish oil (among the settings of primary, and secondary preventions, respectively). Against cerebro-vascular events, pleiotropic effects of some antihypertensive and antidiabetic medications can also be established.


Assuntos
Isquemia Encefálica/prevenção & controle , Circulação Cerebrovascular/efeitos dos fármacos , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Acidente Vascular Cerebral/prevenção & controle , Anti-Hipertensivos/farmacologia , Isquemia Encefálica/etiologia , Estenose das Carótidas/complicações , Estenose das Carótidas/tratamento farmacológico , Hemorragia Cerebral/induzido quimicamente , Hemorragia Cerebral/complicações , Interações Medicamentosas , Ácidos Fíbricos/farmacologia , Óleos de Peixe/farmacologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipoglicemiantes/farmacologia , Hipolipemiantes/farmacologia , Prevenção Secundária , Acidente Vascular Cerebral/etiologia
15.
Magy Seb ; 64(6): 289-93, 2011 Dec.
Artigo em Húngaro | MEDLINE | ID: mdl-22169342

RESUMO

INTRODUCTION: Many factors contribute to the pathogenesis of morbid obesity, and the central nervous system - as one of those - also has an important role. Numerous studies focus on the central regulation of eating and metabolism, since associated problems like obesity, anorexia, diabetes or metabolic syndrome put an increasing burden on the health system of modern societies. Neither the pathophysiologic changes, nor the normal regulation of these systems are known adequately. Functional MR (fMRI) imaging, which has certainly gained popularity recently, aims to better understand these mechanisms. In this series we studied the brain fMRI activity changes of normal and obese persons, triggered by gustatory stimulation. METHODS: 10 obese and 10 normal weight healthy volunteers took part in the study, with comparable age and sex distribution. Gustatory stimulation was performed by 0.1 M sucrose (pleasant), 0.5 mM quinine HCl (unpleasant) and complex vanilla flavored (Nutridrink) solutions, which were administered through 0.5 mm PVC tubes, in 5-5 ml portions. For rinsing distilled water with neutral flavor was used. Imaging was performed in a 3T MRI, applying standard EPI sequences. Post processing of data was accomplished by FSL software package. RESULTS: Brain activation for gustatory stimuli was characteristically different between the two groups. There were high intensity activations in more cortical and subcortical regions of the obese volunteers compared to the normal ones. CONCLUSIONS: Our current fMRI investigations revealed different activations of numerous brain regions of normal and obese individuals, triggered by pleasant and unpleasant gustatory stimulation. Based on these results this method can help to recognize the role of the central nervous system in obesity, and may contribute to develop new therapies for weight loss.


Assuntos
Encéfalo/fisiopatologia , Imageamento por Ressonância Magnética , Obesidade Mórbida/fisiopatologia , Paladar , Adulto , Tonsila do Cerebelo/fisiopatologia , Índice de Massa Corporal , Peso Corporal , Encéfalo/metabolismo , Estudos de Casos e Controles , Núcleo Caudado/fisiopatologia , Feminino , Lobo Frontal/fisiopatologia , Humanos , Masculino , Obesidade Mórbida/metabolismo , Extratos Vegetais/administração & dosagem , Putamen/fisiopatologia , Quinina/administração & dosagem , Sacarose/administração & dosagem , Vanilla
16.
Cancers (Basel) ; 13(2)2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33467717

RESUMO

Thyroglobulin (Tg) is the most important tumor marker in differentiated thyroid cancer (DTC). The aim of this study was to assess the diagnostic and prognostic roles of postoperative stimulated and postablative lowest, highest, and one-year non-stimulated Tg values obtained during the follow-up of patients with DTC. In this retrospective study, 222 radioiodine-treated, anti-thyroglobulin antibody (TgAb)-negative DTC patients having at least 9 months' follow-up time were included (172 papillary and 50 follicular cancers; median age: 48 (from 15 to 91) years; female-male ratio: 158/64; median (quartiles) follow-up time: 54 (22-97) months). The 2015 American Thyroid Association guidelines were applied as criteria of the therapeutic response. Postoperative stimulated Tg values had significantly lower diagnostic accuracy than any of the non-stimulated postablative Tg values. One-year non-stimulated Tg had excellent prognostic value for structural disease: a cut-off value of 0.85 ng/mL had an 88.1% diagnostic accuracy. If the Tg value did not decrease below 0.75 ng/mL at any time during follow-up, the risk of residual disease was 25 times higher. The highest non-stimulated Tg during follow-up was the best predictor of residual disease (e.g., a Tg value exceeding 7.7 ng/mL indicated a 30-fold increase in risk). Non-stimulated Tg values measured during follow-up have excellent diagnostic accuracy to predict structural disease in DTC patients. The risk classification of a patient can safely be modified based on even a single Tg measurement.

17.
Front Med (Lausanne) ; 8: 671951, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34950676

RESUMO

Background: The prevalence of hyponatremia is highly variable among patients with lung cancer. However, its prevalence and prognostic significance in subgroups of patients with lung cancer have not yet been evaluated in a meta-analysis. Methods: We have registered our meta-analysis and review protocol to the PROSPERO International Prospective Register of Systematic Reviews, with the following registration number: CRD42020167013. A systematic search was done in the following sources: MEDLINE, Embase, CENTRAL, Web of Science, ClinicalTrials.gov, a WHO Global Health Library. Results: We identified a total of 8,962 potentially eligible studies, and we included 31 articles in our evaluation. The prevalence of hyponatremia in patients with lung cancer varied between 3 and 94.8% with an average of 25% without any significant differences between the following subgroups: histotype, gender, age, Eastern Cooperative Oncology Group (ECOG) state, and the extent of disease. The overall survival (OS) was significantly lower in hyponatremic compared to normonatremic patients at 10 months [RR.59 (95% CI.47-0.74), p < 0.001] and at 20 months [RR.44 (95% CI.33-0.59), p < 0.001], with worse survival rates in non-small cell lung cancer (NSCLC) [RR.27 (95% CI.12-0.44), p < 0.001] than in small cell lung cancer (SCLC) [RR.42 (95% CI.27-0.57), p < 0.001]. If hyponatremia was corrected, OS at 10 months was significantly higher than in the uncorrected hyponatremia group [RR 1.83 (95% CI 1.37-2.44), p < 0.001], but, at 20 months, no statistically significant difference could be found between these subgroups [RR 2.65 (95% CI.94-7.50), p = 0.067]. Conclusions: Patients with lung cancer diagnosed with hyponatremia, especially patients with NSCLC, seem to have significantly lower survival rates than normonatremic patients. If hyponatremia remains uncorrected, the mortality rates might be even higher.

18.
Pediatr Res ; 67(3): 309-13, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19915520

RESUMO

Childhood obesity is a predisposing factor for adult cardiovascular diseases. Human serum paraoxonase (PON1) may protect against atherosclerosis by hydrolyzing lipid peroxides in oxidized LDL. Alterations and potential correlations of PON1 activities, leptin and adiponectin levels in childhood obesity were studied. We measured PON1 paraoxonase and arylesterase activities, anthropometric parameters, leptin and adiponectin levels in 59 white, obese (obese group-OB: BMI corrected for age: 95.1 +/- 3.5 percentile, age: 11.9 +/- 1.6 y) and 51 normal-weight children (control group-C: BMI corrected for age: 64.1 +/- 8.4 percentile, age: 12.0 +/- 3.9 y). Obese children had significantly lower PON1 paraoxonase (OB: 84.80 (64.33/144.74) U/L versus. C: 99.42 (83.33/152.05) U/L; p < 0.05) and arylesterase activities (OB: 94.40 (82.20/108.70) U/L versus. C: 115.20 (93.70/126.00) U/L; p < 0.01), higher leptin (OB: 37.05 (24.33/53.87) ng/mL versus. C: 4.62 (2.52/17.6) ng/mL; p < 0.0001) and lower adiponectin levels (OB: 7.56 (5.69/12.06) microg/mL versus. C: 11.51 (8.84/14.49) microg/mL; p < 0.001) compared with the normal-weight group. PON1 arylesterase activity showed inverse univariate correlation with leptin (r = -0.29; p < 0.05) and positive correlation with adiponectin levels (r = 0.39; p < 0.01). In multiple regression analysis adiponectin was strongly associated with PON1 arylesterase activity in obese children (beta = 0.45, p < 0.02). Our results emphasize the importance of the investigated metabolic alterations which may have further effects on cardiovascular morbidity and mortality in later adulthood. Altered levels of leptin, adiponectin and PON1 activities may be useful markers beside the general risk factors in childhood obesity.


Assuntos
Arildialquilfosfatase/sangue , Leptina/sangue , Obesidade/enzimologia , Adiponectina/sangue , Adiposidade , Adolescente , Biomarcadores/sangue , Glicemia/metabolismo , Pressão Sanguínea , Índice de Massa Corporal , Estudos de Casos e Controles , Criança , Feminino , Humanos , Insulina/sangue , Lipídeos/sangue , Masculino , Obesidade/sangue , Obesidade/fisiopatologia , Análise de Regressão , Medição de Risco , Fatores de Risco , Circunferência da Cintura
19.
Adv Exp Med Biol ; 660: 129-42, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20221876

RESUMO

Obesity as a pathogenic disorder is a predisposing factor for cardiovascular diseases and shows an increasing incidence in the industrialized countries. Adipokines such as leptin, adiponectin and resistin have a great impact on the development of atherosclerosis in obesity. Elevated levels of leptin have been found to be atherogenic whereas decreased levels of adiponectin have been proved to be anti-atherogenic in recent studies. The exact role of resistin in the process of atherosclerosis has so far remained uncertain and controversial. In our recent work, we studied the alteration in human paraoxonase-1 (PON1) activity and adipokine levels; furthermore, we also aimed at identifying the potential correlation between these parameters in this metabolic disorder. We investigated the above-mentioned parameters both in adults and in children, with regard to the emerging role of childhood obesity and to get a clearer view of these factors during a whole lifetime. Investigating the adult population with a broad range of body mass index (BMI) we found significantly increased leptin and significantly decreased adiponectin and resistin levels and PON1 activity in the obese group compared to the lean controls. Adiponectin and resistin levels showed significantly positive correlation, while leptin and BMI showed significantly negative correlation with PON1 activity. Our findings were similar in childhood obesity: leptin showed significantly negative correlation, while adiponectin showed significantly positive correlation with PON1 activity. We found gender differences in the univariate correlations of leptin and adiponectin levels with PON1 activity in the adult population. In multiple regression analysis, adiponectin proved to be an independent factor of PON1 activity both in childhood and adult obesity, furthermore thiobarbituric acid-reactive substances (TBARS) also proved to be an independent predictor of the enzyme in adults, reflecting the important role of oxidative stress in obesity. Investigating PON 192 Q/R polymorphism by phenotypic distribution (A/B isoenzyme) in obese children, we found a significant correlation of PON1 arylesterase activity with leptin and adiponectin levels, and of body fat percentage with PON1 192 B isoenzyme. According to our studies, these metabolic changes in obesity predispose to the early development of atherosclerosis throughout our whole lifetime. Decreased activity of PON1 and alterations in adipokine levels in childhood obesity could contribute to an early commencement of this process, detected only later in adulthood by increased cardiovascular morbidity and mortality. Changed levels of leptin, adiponectin, resistin and PON1 activity at all ages, just like 192 Q/R polymorphism determined by phenotypic distribution, may be useful markers beside the general risk factors.


Assuntos
Adipocinas/metabolismo , Arildialquilfosfatase/metabolismo , Regulação Enzimológica da Expressão Gênica , Obesidade/metabolismo , Adulto , Animais , Aterosclerose , Criança , Humanos , Leptina/metabolismo , Peroxidação de Lipídeos , Modelos Biológicos , Fenótipo , Polimorfismo Genético , Substâncias Reativas com Ácido Tiobarbitúrico
20.
Kidney Blood Press Res ; 32(5): 360-5, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19887823

RESUMO

BACKGROUND/AIMS: In hemodialyzed (HD) patients, adiponectin and sE-selectin levels are elevated, while antioxidant paraoxonase 1 activity (PON1) is decreased. We determined if the hyperadiponectinemia in HD patients has a protective effect on the decrease in PON1 and elevation in sE-selectin in kidney failure. METHODS AND DESIGN: Predialysis serum adiponectin, PON1 and sE-selectin as well as other metabolic variables were measured in 70 HD patients. RESULTS: Adiponectin had (1) no association with PON1 or sE-selectin, (2) a positive association with dialysis efficiency and HDL-C, and (3) an inverse association with BMI, waist circumference, HOMA IR, triglyceride, hsCRP, fibrinogen, and albumin. Moreover, albumin, BMI, and HOMA-IR were independent negative predictors of adiponectin. CONCLUSIONS: In kidney failure, in contrast to normal renal function, higher adiponectin levels had no correlation with PON1 activity or the sE-selectin level. However, adiponectin has an association with dialysis efficiency and, similar to individuals with preserved kidney function, traits of metabolic syndrome. In addition to BMI and HOMA-IR, the serum albumin concentration is also one of the independent negative predictors of the serum adiponectin level. Collectively, these findings may add details to the understanding of the role that adiponectin plays in chronic renal disease related to 'reverse epidemiology'.


Assuntos
Adiponectina/sangue , Arildialquilfosfatase/sangue , Selectina E/sangue , Nefropatias/sangue , Diálise Renal , Insuficiência Renal/sangue , Insuficiência Renal/terapia , Idoso , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Estudos Transversais , Feminino , Fibrinogênio/metabolismo , Humanos , Nefropatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Análise de Regressão , Triglicerídeos/sangue
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