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Gazdag G, Grenda Z, Takács R. Inpatient psychiatric care of COVID-19 infected patients in a Hungarian general hospital. Eur Psychiatry 2022. [PMCID: PMC9565879 DOI: 10.1192/j.eurpsy.2022.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction during the study period (08/02/2021 – 11/05/2021) the Centre of Psychiatry in the Jahn Ferenc South-pest Hospital (CP-JFSH) was one of the two psychiatric wards in Budapest, specialized for the treatment of COVID-19 infected psychiatric patients. Objectives the aim of the study was to survey the characteristics and evaluate the outcome of the COVID-19 infected psychiatric patients treated in the CP-JFSH. Methods retrospective analysis of the files of COVID-19 infected psychiatric patients admitted to the CP-JFSH in a 3 month period. In addition to demographic data, diagnostic distribution, co-morbidities, date of infection, method of detection of the virus, presence of pneumonia, severity of infection, outcome, treatment, vaccination data were evaluated. Results in the study period 124 COVID-19 infected psychiaric patients were admitted to the CP-JFSH. The gender distribution was aproximately equal, the mean age of the patients was 62.8+/-15.7 years. Majority of the patients suffered from major neurocognitive disorder followed by schizophrenia spectrum disorder. Most common co-morbidities were cardiovascular diseases and diabetes. Pneumonia was present in 41% of the patients. Majority of the patients were already infected at the time of admission, detected with the first PCR examination and haven’t been vaccinated yet. Thirty-one percent of the patients suffered from moderate to severe COVID-19 illness. COVID-19 specific therapy (favipiravir, remdesivir, fluvoxamin) was introduced in 57%. Mortality was 12% while the relaps rate 4%. Conclusions comparing with inpatient mortality rate published in the literature, mortality rate was higher among psychiatric patients, underlining the need for special attention of this population. Disclosure No significant relationships.
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Takács R, Asztalos M, Ungvari GS, Gazdag G. Catatonia in an inpatient gerontopsychiatric population. Psychiatry Res 2017; 255:215-218. [PMID: 28578181 DOI: 10.1016/j.psychres.2017.05.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 04/04/2017] [Accepted: 05/24/2017] [Indexed: 02/07/2023]
Abstract
There are limited data on the prevalence of catatonia in the elderly. The aim of this study was to determine the prevalence of catatonia in elderly patients (=/> 65 years) acutely admitted to the psychiatric unit of a general hospital. All patients aged 65 years and above admitted to a general hospital psychiatric unit over a 4-month period were screened for catatonia with the 14-item Bush-Francis Catatonia Screening Instrument (BFCSI). Patients with a minimum of 2 symptoms on the BFCSI were rated with the 23-item Bush-Francis Catatonia Rating Scale (BFCRS). Catatonia was simultaneously evaluated according to DSM-5 criteria. Clinical diagnoses were established using the validated Hungarian versions of the Structured Clinical Interview for DSM-IV Disorders, the Mini Mental State Examination and the Clock Drawing Test. Ninety-eight (28.1%) of the 342 patients admitted to the psychiatric unit during the study period were above 65 years of age; 11 (11.22%) and 6 (6.12%) patients were classified as having catatonia according to the BFCRS and DSM-5 criteria, respectively. The majority of the patients had catatonia due to a medical condition. A significant minority of gerontopsychiatric inpatients present with catatonia. Dementia was not a risk factor for catatonia.
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Affiliation(s)
- R Takács
- Centre for Psychiatry and Addiction Medicine, Szent István and Szent László Hospitals Budapest, Gyáli út 17-19, 1094 Budapest, Hungary; School of Doctoral Studies, Semmelweis University, Budapest, Hungary.
| | - M Asztalos
- School of Doctoral Studies, Semmelweis University, Budapest, Hungary.
| | - G S Ungvari
- University of Notre Dame, Australia/Marian Centre, 38 Henry Street, Fremantle, WA, Australia; School of Psychiatry & Clinical Neurosciences, University of Western Australia, 35 Stirling Highway Crawley, Perth, WA 6009, Australia.
| | - G Gazdag
- Centre for Psychiatry and Addiction Medicine, Szent István and Szent László Hospitals Budapest, Gyáli út 17-19, 1094 Budapest, Hungary; Department of Psychiatry and Psychotherapy, Semmelweis University Medical School, Balassa u 6, 1083 Budapest, Hungary.
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Orosz A, Baczkó I, Nyiraty S, Körei AE, Putz Z, Takács R, Nemes A, Várkonyi TT, Balogh L, Ábrahám G, Kempler P, Papp JG, Varró A, Lengyel C. Increased Short-Term Beat-to-Beat QT Interval Variability in Patients with Impaired Glucose Tolerance. Front Endocrinol (Lausanne) 2017; 8:129. [PMID: 28659867 PMCID: PMC5468431 DOI: 10.3389/fendo.2017.00129] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 05/29/2017] [Indexed: 01/02/2023] Open
Abstract
Prediabetic states and diabetes are important risk factors for cardiovascular morbidity and mortality. Determination of short-term QT interval variability (STVQT) is a non-invasive method for assessment of proarrhythmic risk. The aim of the study was to evaluate the STVQT in patients with impaired glucose tolerance (IGT). 18 IGT patients [age: 63 ± 11 years, body mass index (BMI): 31 ± 6 kg/m2, fasting glucose: 6.0 ± 0.4 mmol/l, 120 min postload glucose: 9.0 ± 1.0 mmol/l, hemoglobin A1c (HbA1c): 5.9 ± 0.4%; mean ± SD] and 18 healthy controls (age: 56 ± 9 years, BMI: 27 ± 5 kg/m2, fasting glucose: 5.2 ± 0.4 mmol/l, 120 min postload glucose: 5.5 ± 1.3 mmol/l, HbA1c: 5.4 ± 0.3%) were enrolled into the study. ECGs were recorded, processed, and analyzed off-line. The RR and QT intervals were expressed as the average of 30 consecutive beats, the temporal instability of beat-to-beat repolarization was characterized by calculating STVQT as follows: STVQT = Σ|QTn + 1 - QTn| (30x√2)-1. Autonomic function was assessed by means of standard cardiovascular reflex tests. There were no differences between IGT and control groups in QT (411 ± 43 vs 402 ± 39 ms) and QTc (431 ± 25 vs 424 ± 19 ms) intervals or QT dispersion (44 ± 13 vs 42 ± 17 ms). However, STVQT was significantly higher in IGT patients (5.0 ± 0.7 vs 3.7 ± 0.7, P < 0.0001). The elevated temporal STVQT in patients with IGT may be an early indicator of increased instability of cardiac repolarization during prediabetic conditions.
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Affiliation(s)
- Andrea Orosz
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - István Baczkó
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Szabolcs Nyiraty
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anna E. Körei
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Putz
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Róbert Takács
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Attila Nemes
- Second Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | | | - László Balogh
- Juhász Gyula Faculty of Education, Institute of Physical Education and Sport Science, University of Szeged, Szeged, Hungary
| | - György Ábrahám
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Péter Kempler
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Julius Gy. Papp
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
- MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
| | - András Varró
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
- MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
| | - Csaba Lengyel
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
- First Department of Medicine, University of Szeged, Szeged, Hungary
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Bailey TS, Takács R, Tinahones FJ, Rao PV, Tsoukas GM, Thomsen AB, Kaltoft MS, Maislos M. Efficacy and safety of switching from sitagliptin to liraglutide in subjects with type 2 diabetes (LIRA-SWITCH): a randomized, double-blind, double-dummy, active-controlled 26-week trial. Diabetes Obes Metab 2016; 18:1191-1198. [PMID: 27381275 PMCID: PMC5129465 DOI: 10.1111/dom.12736] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/01/2016] [Accepted: 07/02/2016] [Indexed: 12/15/2022]
Abstract
AIMS To confirm superiority on glycaemic control by switching from sitagliptin to liraglutide 1.8 mg/d versus continued sitagliptin. MATERIALS AND METHODS A randomized, multicentre, double-blind, double-dummy, active-controlled trial across 86 office- or hospital-based sites in North America, Europe and Asia. Subjects with type 2 diabetes who had inadequate glycaemic control (glycated haemoglobin [HbA1c] 7.5-9.5% on sitagliptin (100 mg/d) and metformin (≥1500 mg daily) for ≥90 days were randomized to either switch to liraglutide (n = 203) or continue sitagliptin (n = 204), both with metformin. The primary endpoint was change in HbA1c from baseline to week 26. Change in body weight was a confirmatory secondary endpoint. RESULTS Greater reduction in mean HbA1c was achieved with liraglutide than with continued sitagliptin [-1.14% vs. -0.54%; estimated mean treatment difference (ETD): -0.61% (95% CI -0.82 to -0.40; p < 0.0001)], confirming superiority of switching to liraglutide. Body weight was reduced more with liraglutide [-3.31 kg vs. -1.64 kg; ETD: -1.67 kg (95% CI -2.34 to -0.99; p < 0.0001)]. Nausea was more common with liraglutide [44 subjects (21.8%)] than with continued sitagliptin [16 (7.8%)]. Three subjects (1.5%) taking sitagliptin reported a confirmed hypoglycaemic episode. CONCLUSIONS Subjects insufficiently controlled with sitagliptin who switch to liraglutide can obtain clinically relevant reductions in glycaemia and body weight, without compromising safety. A switch from sitagliptin to liraglutide provides an option for improved management of type 2 diabetes while still allowing patients to remain on dual therapy.
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Affiliation(s)
| | - R. Takács
- First Department of MedicineUniversity of SzegedSzegedHungary
| | - F. J. Tinahones
- Department of Clinical Endocrinology and Nutrition, IBIMA, Hospital Virgen de la Victoria, CIBERobn, Instituto de Salud Carlos IIIUniversity of MálagaMálagaSpain
| | - P. V. Rao
- Kumudini Devi Diabetes Research CenterRamdevrao HospitalHyderabadTelanganaIndia
| | - G. M. Tsoukas
- Department of Endocrinology and MetabolismMcGill University Health CentreMontrealCanada
| | - A. B. Thomsen
- Global Development, Medical and Science, GLP‐1 and ObesityNovo Nordisk A/SSøborgDenmark
| | - M. S. Kaltoft
- Global Development, Medical and Science, GLP‐1 and ObesityNovo Nordisk A/SSøborgDenmark
| | - M. Maislos
- Atherosclerosis and Metabolism Unit, Soroka UMCBen‐Gurion University FOHSBe'er ShevaIsrael
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Boras D, Bailey TS, Takács R, Tinahones FJ, Rao PV, Tsoukas GM, Christensen SB, Kaltoft MS, Maislos M. Switching from Sitagliptin to Liraglutide in Subjects with Type 2 Diabetes (T2D): Analysis of Composite Endpoints from the LIRA-SWITCH Randomized Trial. Can J Diabetes 2016. [DOI: 10.1016/j.jcjd.2016.08.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Terzin V, Takács R, Lengyel C, Várkonyi T, Wittmann T, Pálinkás A, Czakó L. Improved glycemic control in pancreatic diabetes through intensive conservative insulin therapy. Pancreatology 2012; 12:100-3. [PMID: 22487518 DOI: 10.1016/j.pan.2012.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 01/08/2012] [Accepted: 01/24/2012] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effectivity and safety of insulin therapy in patients with DM secondary to underlying chronic pancreatitis with initially inappropriate glycemic control. METHODS Pancreatic DM patients treated with oral antidiabetics (OAD) or pre-mixed insulin (PMI) with HbA1c ≥7.0% were recruited. Intensive conservative insulin treatment (ICT) (Group A, n = 16) or PMI (Group B, n = 8) was introduced instead of OAD, or the initial PMI therapy was switched to ICT (Group C, n = 10). The changes in HbA1c, fasting plasma glucose, body weight and hypoglycemic events from baseline to 2 years were followed. RESULTS The patients in Group A and B had been treated with oral antidiabetics for 55 ± 68 months before switching to insulin therapy. The level of HbA1c had worsened from 8.3 ± 1.5% to 9.8 ± 1.7% during this period. The ICT had reduced HbA1c significantly from 9.7 ± 1.8% to 7.6 ± 1.4% after 12 weeks, in Group A, and five patients had HbA1c<7.0%. The introduction of PMI in Group B reduced HbA1c from 10.0 ± 1.4% to 9.0 ± 0.6% by 12 weeks. None of the patients had HbA1c<7.0%. By 12 weeks, the introduction of ICT in Group C had reduced the level of HbA1c from 8.8 ± 1.7% to 7.7 ± 1.2%. Two patients reached HbA1c<7.0%. There were two severe hypoglycemic episodes during the 2 years, one-one case in Group A and B. CONCLUSIONS Oral medication becomes insufficient early in pancreatic DM. Long-term improvement of glycemic control can be achieved through intensified insulin therapy and in selected cases through PMI with a low risk of hypoglycemia.
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Affiliation(s)
- Viktória Terzin
- First Department of Medicine, University of Szeged, Szeged, P.O. Box 427, H-6701, Hungary
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Nemes A, Takács R, Gavallér H, Várkonyi TT, Wittmann T, Forster T, Lengyel C. Correlations between aortic stiffness and parasympathetic autonomic function in healthy volunteers. Can J Physiol Pharmacol 2011; 88:1166-71. [PMID: 21164563 DOI: 10.1139/y10-095] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cardiovascular autonomic dysfunction and alterations in vascular elasticity are known complications of several disorders, including diabetes mellitus, hypertension, hypercholesterolemia, aging, and chronic kidney disease. The current study was designed to test whether a relationship existed between pulse wave velocity (PWV), augmentation index (AIx), aortic elastic properties, and cardiovascular autonomic function in healthy volunteers. The study comprised 25 healthy volunteers, whose aortic strain, distensibility, and stiffness index were measured by echocardiography, whereas PWV and AIx were evaluated by Arteriograph (TensioMed, Budapest, Hungary) in all cases. Autonomic function was assessed by means of 5 standard cardiovascular reflex tests. We found that heart rate response to deep breathing, as the most reproducible cardiovascular reflex test to characterize parasympathetic function, showed low to moderate correlations with PWV (r = -0.431, p = 0.032), aortic strain (r = 0.594, p = 0.002), distensibility (r = 0.407, p = 0.043), and stiffness index (r = -0.453, p = 0.023). Valsalva ratio and autonomic neuropathy score (ANS) correlated with PWV (r = -0.557, p = 0.004 and r = -0.421, p = 0.036, respectively) and AIx (r = -0.461, p = 0.020 and r = -0.385, p = 0.057, respectively), while ANS correlated with even aortic stiffness index (r = -0.457, p = 0.022). Cardiovascular reflex tests mainly characterizing sympathetic function had no correlation with aortic stiffness parameters (p = NS for all correlations). Correlations exist between parameters characterizing aortic elasticity and parasympathetic autonomic function, as shown by standard cardiovascular reflex tests in healthy volunteers.
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Affiliation(s)
- Attila Nemes
- 2nd Department of Medicine and Cardiology Center, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.
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Nemes A, Takács R, Gavallér H, Várkonyi TT, Wittmann T, Forster T, Lengyel C. Correlations between Arteriograph-derived pulse wave velocity and aortic elastic properties by echocardiography. Clin Physiol Funct Imaging 2010; 31:61-5. [PMID: 21040403 DOI: 10.1111/j.1475-097x.2010.00980.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION There is an increased scientific interest on the evaluation of parameters characterizing aortic elasticity. The current study was designed to compare two characteristics of aortic distensibility: Arteriograph-derived pulse wave velocity (PWV) and augmentation index standardized to 80 per minutes heart rate (AIx80) and aortic elastic properties by echocardiography. METHODS The study comprised 21 adult healthy volunteers. In all cases, systolic and diastolic ascending aortic diameters were recorded during transthoracic echocardiography in M-mode at a level 3 cm above the aortic valve from a parasternal long-axis view. Using forearm blood pressure values, the following aortic elastic properties were calculated: aortic strain, distensibility and stiffness index. All patients were examined by Arteriograph at the same time, as well. RESULTS The Arteriograph-derived AIx80 and PWV correlated with aortic strain (R = -0·495, P = 0·023 and R = -0·527, P = 0·014, respectively) and aortic stiffness index (R = 0·454, P = 0·039 and R = 0·608, P = 0·003, respectively). Aortic distensibility did not correlated with AIx80 (R = -0·344, P = 0·127), only with PWV (R = -0·593, P = 0·005, respectively). DISCUSSION Low to moderate correlations could be demonstrated between Arteriograph-derived PWV and aortic elastic properties by echocardiography.
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Affiliation(s)
- Attila Nemes
- 2nd Department of Medicine and Cardiology Center, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.
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Lengyel C, Baczkó I, Orosz A, Takács R, Várkonyi T, Wittmann T, Gy J. Increased short-term QT variability in patients with type 1 diabetes mellitus: Implications for repolarization reserve. J Mol Cell Cardiol 2008. [DOI: 10.1016/j.yjmcc.2008.02.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Várkonyi TT, Börcsök E, Tóth F, Fülöp Z, Takács R, Rovó L, Lengyel C, Kiss JG, Janáky M, Hermányi Z, Kempler P, Lonovics J. Severity of autonomic and sensory neuropathy and the impairment of visual- and auditory-evoked potentials in type 1 diabetes: is there a relationship? Diabetes Care 2006; 29:2325-6. [PMID: 17003316 DOI: 10.2337/dc06-1174] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Nemes A, Lengyel C, Forster T, Várkonyi TT, Takács R, Nagy I, Kempler P, Lonovics J, Csanády M. Coronary flow reserve, insulin resistance and blood pressure response to standing in patients with normoglycaemia: is there a relationship? Diabet Med 2005; 22:1614-8. [PMID: 16241931 DOI: 10.1111/j.1464-5491.2005.01681.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To establish the relationships between coronary flow reserve, cardiovascular autonomic function, and insulin resistance characterized by the homeostasis model assessment insulin resistance score in patients with normal carbohydrate metabolism according to the World Health Organization (WHO) and American Diabetes Association (ADA) criteria, and with morphologically normal epicardial coronary arteries. METHODS Twenty-five patients [12 women and 13 men, mean (sd) age: 53 +/- 11 years] with normal coronary angiography were enrolled into the study. Coronary flow reserve was measured during stress transoesophageal echocardiography. Autonomic dysfunction was assessed by means of five standard cardiovascular reflex tests. The fasting serum glucose and insulin levels were determined and the homeostasis assessment model insulin resistance score was calculated. RESULTS In patients with normal carbohydrate metabolism, negative correlations were observed between the coronary flow reserve and both the serum insulin level (r = -0.445, P = 0.026) and the homeostasis assessment model insulin resistance score (r = -0.449, P = 0.024). The systolic blood pressure response to standing also correlated with the coronary flow reserve (r = -0.519, P = 0.011). The heart rate response to deep breathing, the Valsalva ratio, the 30/15 ratio and the sustained handgrip test results were not correlated with the coronary flow reserve. CONCLUSIONS Our data suggest the possible role of insulin resistance and early sympathetic nerve dysfunction in the development of decreased coronary flow reserve in patients without diabetes mellitus or impaired glucose tolerance.
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Affiliation(s)
- A Nemes
- First Department of Medicine, Medical Faculty, Albert Szent-Györgyi Medical and Pharmaceutical Centre, University of Szeged, Korányi fasor 10, H-6720 Szeged, Hungary
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Czakó L, Tiszlavicz L, Takács R, Baradnay G, Lonovics J, Cserni G, Závodná K, Bartosova Z. [The first molecular analysis of a Hungarian HNPCC family: a novel MSH2 germline mutation]. Orv Hetil 2005; 146:1009-16. [PMID: 15945244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Hereditary nonpolyposis colorectal cancer is an inherited disease characterized by onset at an early age, an excess of synchronous and metachronous large bowel tumors and a variety of extracolorectal malignancies. Basal and squamous cell carcinomas of the skin are not customarily included in the tumor spectrum of the syndrome. The disease is caused by a germline mutation in one of the DNA mismatch repair genes, most commonly MSH2 or MLH1, and typically presents with microsatellite instability and frequent loss of mismatch repair protein expression in the tumor tissue. PATIENT The case of a 62-year old woman who had a history of colon cancer at the age of 46 years, endometrial cancer at the age of 56 years, baso-squamous, and squamous cell cancer of the face at the ages of 53, 54, 62 and 58 years, respectively, and rectal cancer at 60 is reported. Her family fulfills the Amsterdam criteria for the diagnosis of hereditary nonpolyposis colorectal cancer. The baso-squamous cell, the squamous cell, the endometrial and the rectal cancers were assessed for the microsatellite instability status and the expression of the MSH2 and MLH1 mismatch repair proteins, and the p53 tumor suppressor protein by immunohistochemistry. Mutational screening using an automated capillary DNA sequencer was performed by the direct genomic sequencing of 17 fragments of the MSH2 gene, which covers promoter, all exons and flanking intronic regions. RESULTS All cancers displayed microsatellite instability and were positive for the p53 protein. The immunohistochemical staining in the baso-squamous cell, the squamous cell, the rectal and endometrial cancers were negative for MSH2 and positive for MLH1 proteins. DNA sequencing analysis revealed a mutation c.2292G > A in exon 14 of the MSH2 gene, which is altering the 764. amino acid, the tryptophan to STOP codon (p.W764X). Thus the MSH2 protein is presumably truncated by 171 aminoacids. CONCLUSION To the best of authors' knowledge, this is the first molecular characterization of a Hungarian hereditary nonpolyposis colorectal cancer family. According to the Human Mutation Database and International Collaborative Group of HNPCC Database, this mutation is novel, has not been reported previously. Cutaneous baso-squamous and squamous cell cancers may present as part of the HNPCC phenotype. Detection of the loss of mismatch repair protein expression and mismatch repair gene mutation mapping, represents a significant improvement of the diagnosis of this syndrome in Hungary. These examinations identify the mutation carriers who are at an increased risk of developing cancers.
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Kovács L, Papós M, Takács R, Róka R, Csenke Z, Kovács A, Várkonyi T, Pajor L, Pávics L, Pokorny G. Autonomic nervous system dysfunction involving the gastrointestinal and the urinary tracts in primary Sjögren's syndrome. Clin Exp Rheumatol 2003; 21:697-703. [PMID: 14740447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVE Antibodies reacting with the m3 subtype muscarinic acetylcholine receptor appear to be an important pathogenic factor in primary Sjögren's syndrome (pSS). As this receptor subtype is functionally important in the gastrointestinal and urinary tracts, and very little is known about the autonomic nervous system function in these organs in pSS patients, the occurrence and clinical significance of an autonomic nervous system dysfunction involving the gastrointestinal and urinary tracts were investigated. METHODS Data on clinical symptoms attributable to an autonomic dysfunction were collected from 51 pSS patients. Gastric emptying scintigraphy and urodynamic studies were performed on 30 and 16 patients, respectively, and the results were correlated with patient characteristics and with the presence of autonomic nervous system symptoms. RESULTS Gastric emptying was abnormally slow in 21 of the 30 examined patients (70%). Urodynamic findings, compatible with a decreased detrusor muscle tone or contractility were found in 9 of the 16 patients tested (56%). Various symptoms of an autonomic nervous system dysfunction were reported by 2-16% of the patients. CONCLUSION Signs of an autonomic nervous system dysfunction involving the gastrointestinal and the urinary systems can be observed in the majority of pSS patients. This high occurrence is rarely associated with clinically significant symptoms. The authors presume a role of autoantibodies reacting with the m3 muscarinic acetylcholine receptor in the elicitation of the autonomic dysfunction.
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Affiliation(s)
- L Kovács
- Department of Rheumatology, University of Szeged, Faculty of Medicine, Szeged.
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