Ankle Brachial Index is a strong predictor of mortality in hypertensive patients: results of a five-year follow-up study.

BACKGROUND: In the hypertensive population, the peripheral arterial disease (PAD) is considered one of the target organ damages. Ankle Brachial Index (ABI) measurement represents the widely accepted clinical method that may objectively detect the presence of PAD. The study aimed to assess how PAD revealed by ABI predicts mortality in patients with hypertension. METHODS: In the follow-up time (5 years period) of the Hungarian ERV Study, a large scale, multicenter observational study, recruiting hypertensive subjects between 50-75 years, the association of PAD with the survival time was analysed. Several multivariate, interval-censored survival models were developed to assess this association. RESULTS: Among the 21892 enrolled hypertensive patients, the prevalence of PAD (ABI≤0.9) was 14.4%. The crude death rate was 5.44% (1190 cases) over the available observational period. In multivariate models male sex, myocardial infarction in patients' history, diabetes, renal failure, PAD and cardiovascular risk (SCORE risk) were significantly associated with mortality. Lower ABI showed a continuous, close to linear association with worse survival. PAD was predictive for mortality risk in all SCORE patient groups. CONCLUSIONS: Low ABI is a strong predictor of mortality in hypertensive patients between the age 50-75, even after adjustment for several potential confounders. The association is linear, with no apparent cut-off, suggesting that ABI should be handled as a continuous variable. The detection of PAD in hypertensives may contribute to the determination of total cardiovascular risk in hypertensive population.

The combined effect of regular alcohol consumption and smoking on blood pressure and on the achievement of blood pressure target values in treated hypertensive patients / A rendszeres alkoholfogyasztás és a dohányzás hatása a vérnyomásra és a vérnyomáscélértékek elérési arányára kezelt hypertoniás betegekben

INTRODUCTION: The combined effect of alcohol consumption and smoking on hypertension in hypertensive patients is still not completely clear, although both are known to be cardiovascular risk factors. AIM: The aim of our study was to compare the blood pressure, the achievement of target blood pressure and heart rate of non-smokers and non-drinkers in the middle-aged hypertensive patients with those who smoke and drink regularly. METHOD: From the database of the Hungarian Hypertension Registry, 12 615 patients (6341 men and 6274 women) aged 45-64 years were included in the current analysis, who self-reported smoking habit and alcohol consumption. RESULTS: The mean age of the patients was 55.8 ± 5.7 years (males) and 56.1 ± 5.5 years (females). The percentage of regular smokers was 40.8% and 27.2% among men and women, respectively. 38.1% of males and 12.5% of females were regular alcohol drinkers. The ratio of patients reaching goal blood pressure values was higher in all investigated groups of females than males (p<0.001). Regular smokers and drinkers have lower percentage of reaching goal blood pressure values: 31.1% versus 46.6% in males (p<0.001) and 41.1% versus 49.8% in females (p<0.01), respectively. The average of pulse rate was higher in patients who are smokers and regular drinkers. CONCLUSION: Regular alcohol consumption and smoking decrease the chance of reaching blood pressure goal values in middle-aged, treated hypertensive patients. Orv Hetil. 2020; 161(30): 1252-1259.

Real-world adherence to oral anticoagulants in atrial fibrillation / [Orális antikoagulánssal kezelt pitvarfibrilláló betegek terápiahusége a mindennapokban]

Introduction: In the treatment of non-valvular atrial fibrillation (AF) with oral anticoagulant (OAC), the patients' adherence to therapy is a very important factor in stroke prevention. Aim: To investigate the one-year persistence of different OAC therapies (vitamin K antagonist [VKA] and new oral anticoagulants [NOAC]) in patients with AF. Method: The authors investigated the persistence of oral anticoagulant (OAC = VKA/NOAC) in atrial fibrillation using the National Health Insurance Fund of Hungary prescriptions database on pharmacy claims between June 1, 2016 and December 31, 2016. Results: 122 870 patients met the inclusion criteria. 18 650 patients started OACs therapy newly (therapy-naïve group), while 104 220 were already on one of the OACs. Among new patients, the one-year persistence of NOACs was 65.7% and that of VKA was 39.0% (p<0.001). The one-year persistence rate was 72.6% for NOAC and 53.9% for VKA (p<0.001) in patients already on OACs. In the therapy-naïve group, the one-year persistence to rivaroxaban was 65.7%. To apixaban it was 62.6%, and to dabigatran it was 59.2% (logrank p<0.001 in all comparisons except rivaroxaban vs. apixaban: p = 0.017, and dabigatran vs. apixaban: p<0.01). The one-year persistence rate of patients treated with NOACs was 73.4% to rivaroxaban, 68.0% to apixaban, and 68.4% to dabigatran (logrank p<0.001 in all comparisons except apixaban vs. dabigatran, NS). Conclusions: The one-year persistence of NOACs was significantly higher in AF compared to VKA therapy (in therapy-naïve and in already treated patients, too). Among the NOACs, rivaroxaban has the best one-year persistence in all patient populations. Orv Hetil. 2020; 161(20): 839-845.

Smoking has no impact on survival and it is not associated with ACE gene I/D polymorphism in hemodialysis patients.

INTRODUCTION: The relationship between smoking and mortality in patients on hemodialysis is controversial. Earlier studies showed that the insertion/deletion (I/D) polymorphism of the ACE gene might have an effect on mortality. The aim of this study was to test the impact of smoking on survival and whether this association was influenced by ACE gene I/D polymorphism in patients on maintenance hemodialysis. PARTICIPANTS AND METHODS: In this prospective, multicenter cohort study we analyzed 709 prevalent patients on maintenance hemodialysis. Patients were allocated into groups based on their smoking habit. Outcome data were collected during the 144-month follow-up period. Outcomes of current smokers and lifelong non-smokers were compared. In order to control for interactions between predictor variables, we also identified 160 matched pairs for further sub-analysis. RESULTS: The vast majority of patients (67%) were non-smokers, followed by current smokers (22.2%) and ex-smokers (9.8%). Smoking had no impact on survival in the matched pair analysis ( p = 0.99). After adjustment for ACE I/D polymorphism and other co-variates, smoking had no effect on survival. CONCLUSION: Our data suggest that smoking has no impact on survival; neither is it associated with ACE gene I/D polymorphism in hemodialysis patients.

[Public health issues of the Roma and non-Roma unemployed in the Ózd microregion of Hungary]. / Roma és nem roma munkanélküliek közegészségügyi helyzete az Ózdi kistérségben.

INTRODUCTION: In their previous studies authors of the present work showed that public health situation and socioeconomic position of unemployed Roma persons in the Ozd microregion were well below the average of the whole Hungarian population. AIM: To continue these previous studies, the authors wanted to determine whether the greater proportion of the unemployed Roma persons in the Ózd microregion compared to the country average could contribute to the worse public health situation and the poor hygienic situation of the living environment of unemployed persons hardly or not suitable for learning. METHOD: Data from 400 unemployed Roma (96 males, 97 females) and caucasian non-Roma subjects (114 males, 93 females) obtained in 2012 and 2013 using self-completed and interview questionnaires were analysed. In addition, occupational medical examination methods were applied and the results were analysed. RESULTS: It was found that all studied parameters (public health and epidemiological safety, in-door living environmental hygiene, conditions for learning) indicated significantly disadvantaged situation of the Roma compared to the non-Roma unemployed persons. There was a clear relationship between these examined parameters and other factors adversely influencing the quality of life of Roma persons (unemployment, deep poverty, lower level of education, shorter life span). Finally, the results showed that the quality of life conditions of the lowest 1/10, 1/5 of the non-Roma unemployed persons were comparable to those found in the average of Roma unemployed persons. CONCLUSIONS: The authors conclude that i) the greater proportion of unemployed Roma persons in the Ozd microregion contributes to the worse public health, epidemiological safety and the worse living conditions of unemployed persons in this regions of the country; ii) It would be essential to provide Roma persons with conditions appropriate for learning, which could enable them to get qualification necessary for employment.

Fermented Wheat Germ Extract Reduces Chemotherapy-Induced Febrile Neutropenia in Pediatric Cancer Patients.

PURPOSE: An open-label, matched-pair (by diagnosis, stage of disease, age, and gender) pilot clinical trial was conducted to test whether the combined administration of the medical nutriment MSC (Avemar) with cytotoxic drugs and the continued administration of MSC on its own help to reduce the incidence of treatment-related febrile neutropenia in children with solid cancers compared with the same treatments without MSC. METHODS: Between December 1998 and May 2002, 22 patients (11 pairs) were enrolled in this study. At baseline, the staging of the tumors was the same in each pair (mostly pTNM = T2N0M0), with the exception of two cases in which patients in the MSC group had worse prognoses (metastasis at baseline). There were no significant differences in the average age of the patients, the length of treatment time (MSC) or follow-up, the number of patients with central venous catheters, the number of chemotherapy cycles, the frequency of preventive counterneutropenic interventions, or the type and dosage of antibiotic and antipyretic therapy used in the two groups. RESULTS: During the treatment (follow-up) period, there was no progression of the malignant disease, whereas at end-point the number and frequency of febrile neutropenic events significantly differed between the two groups: 30 febrile neutropenic episodes (24.8%) in the MSC group versus 46 (43.4%) in the control group (Wilcoxon signed rank test, P < 0.05). CONCLUSIONS: The continuous supplementation of anticancer therapies with the medical nutriment MSC helps to reduce the incidence of treatment-related febrile neutropenia in children with solid cancers.

Fermented wheat germ extract reduces chemotherapy-induced febrile neutropenia in pediatric cancer patients.

PURPOSE: An open-label, matched-pair (by diagnosis, stage of disease, age, and gender) pilot clinical trial was conducted to test whether the combined administration of the medical nutriment MSC (Avemar) with cytotoxic drugs and the continued administration of MSC on its own help to reduce the incidence of treatment-related febrile neutropenia in children with solid cancers compared with the same treatments without MSC. METHODS: Between December 1998 and May 2002, 22 patients (11 pairs) were enrolled in this study. At baseline, the staging of the tumors was the same in each pair (mostly pTNM = T2N0M0), with the exception of two cases in which patients in the MSC group had worse prognoses (metastasis at baseline). There were no significant differences in the average age of the patients, the length of treatment time (MSC) or follow-up, the number of patients with central venous catheters, the number of chemotherapy cycles, the frequency of preventive counterneutropenic interventions, or the type and dosage of antibiotic and antipyretic therapy used in the two groups. RESULTS: During the treatment (follow-up) period, there was no progression of the malignant disease, whereas at end-point the number and frequency of febrile neutropenic events significantly differed between the two groups: 30 febrile neutropenic episodes (24.8%) in the MSC group versus 46 (43.4%) in the control group (Wilcoxon signed rank test, P < 0.05). CONCLUSIONS: The continuous supplementation of anticancer therapies with the medical nutriment MSC helps to reduce the incidence of treatment-related febrile neutropenia in children with solid cancers.

[Mini-Cog: a simple method for very brief screening of mental decline]. / Mini-cog: a mentális hanyatlás "ultrarövid" és egyszerú szúrésének lehetósége.

INTRODUCTION: Physicians do not detect majority of the demented people, and many patients appear only in an advanced stage of their mental decline at the first medical visit. Role of general practitioner is crucial; a brief and effective screening method can basically change the present situation. Borson et al (2000) has investigated a new, very brief method named Mini-Cog that consists of the combination of the 3-word recall and the clock-drawing test. AIM: of the present study was to evaluate this method in Hungarian patient population. METHODS: Authors have analysed the charts of patients examined by the first author in the outpatient part of the Memory clinic of the National Institute of Psychiatry and Neurology in a 2-year interval (between 11.01. 1999 and 31.10.2001). Data of 186 patients were analysed. From the Mini-Mental State the total score, score of three-word recall (possible scores between 0-3), serial counting backward with 7 from 100 were taken into consideration; the clock-drawing test was analysed quantitatively (1 = failure, 2 = borderland, 3 = acceptable solution). RESULTS: The algorithm which considers the patient demented if she or he does not remember of any word, or remembers only of 1-2 and the clock-drawing is pathologic, has a high sensitivity (100%) and specificity (80.9%) in cases using the < or = 24 Mini-Mental State value, while the sensitivity and specificity is 98.8% and 88.0% respectively if drawing the limit at < or = 26 points. Combination of the two tests (word-recall, clock drawing) gives a better value than either of them alone. Based on their experiences they propose to apply in a short test the serial backwards with seven from 100 too, while patients with very high Mini-Mental State scores (29-30) not infrequently can not perfectly solve this subtest (7/11 = 64 p.c.). CONCLUSION: In agreement with the Hungarian Protocol for diagnosing and treating dementias (1999) authors stress the importance of the consultation with a specialist (neurologist or psychiatrist) in cases of suspected dementia to reveal the underlying disease.