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Background High triglyceride levels are associated with increased cardiovascular risk, but whether reductions in these levels would lower the incidence of cardiovascular events is uncertain. Pemafibrate, a selective peroxisome proliferator-activated receptor α modulator, reduces triglyceride levels and improves other lipid levels. Methods In a multinational, double-blind, randomized, controlled trial, we assigned patients with type 2 diabetes, mild-to-moderate hypertriglyceridemia (triglyceride level, 200 to 499 mg per deciliter), and high-density lipoprotein (HDL) cholesterol levels of 40 mg per deciliter or lower to receive pemafibrate (0.2-mg tablets twice daily) or matching placebo. Eligible patients were receiving guideline-directed lipid-lowering therapy or could not receive statin therapy without adverse effects and had low-density lipoprotein (LDL) cholesterol levels of 100 mg per deciliter or lower. The primary efficacy end point was a composite of nonfatal myocardial infarction, ischemic stroke, coronary revascularization, or death from cardiovascular causes. Results Among 10,497 patients (66.9% with previous cardiovascular disease), the median baseline fasting triglyceride level was 271 mg per deciliter, HDL cholesterol level 33 mg per deciliter, and LDL cholesterol level 78 mg per deciliter. The median follow-up was 3.4 years. As compared with placebo, the effects of pemafibrate on lipid levels at 4 months were -26.2% for triglycerides, -25.8% for very-low-density lipoprotein (VLDL) cholesterol, -25.6% for remnant cholesterol (cholesterol transported in triglyceride-rich lipoproteins after lipolysis and lipoprotein remodeling), -27.6% for apolipoprotein C-III, and 4.8% for apolipoprotein B. A primary end-point event occurred in 572 patients in the pemafibrate group and in 560 of those in the placebo group (hazard ratio, 1.03; 95% confidence interval, 0.91 to 1.15), with no apparent effect modification in any prespecified subgroup. The overall incidence of serious adverse events did not differ significantly between the groups, but pemafibrate was associated with a higher incidence of adverse renal events and venous thromboembolism and a lower incidence of nonalcoholic fatty liver disease. Conclusions Among patients with type 2 diabetes, mild-to-moderate hypertriglyceridemia, and low HDL and LDL cholesterol levels, the incidence of cardiovascular events was not lower among those who received pemafibrate than among those who received placebo, although pemafibrate lowered triglyceride, VLDL cholesterol, remnant cholesterol, and apolipoprotein C-III levels. (Funded by the Kowa Research Institute; PROMINENT ClinicalTrials.gov number, NCT03071692.)

A cardiovascularis betegségek hazánkban amellett, hogy vezető halálokként szerepelnek, európai uniós összehasonlításban is kimagasló gyakorisággal fordulnak elő, így az emelkedett vérnyomással élő betegek azonosítását célzó szűrőprogramok jelentősége különösen fontos. A ”Május a vérnyomásmérés hónapja” (May Measurement Month – MMM) egy olyan évenként megrendezett kezdeményezés, amely 2017-ben indult és célkitűzése az emelkedett vérnyomású egyének felismerésének ösztönzése. Hazánk, a Magyar Hypertonia Társaság révén, a kezdetektől csatlakozott a szűrőprogramhoz. Közleményünkben a 2017-es és a 2019-es év eredményeit mutatjuk be. A keresztmetszeti felépítésű szűrőkampányba 18 év feletti alanyok kerültek bevonásra 2017 és 2019 májusában. A hypertonia definícióját ≥140 Hgmm-es szisztolés vagy ≥90 Hgmm-es diasztolés érték, vagy fennálló gyógyszeres kezelés jelentette, az eredmények elemzése a standard MMM-protokollt követte. 2017- ben 97, míg 2019-ben 55 helyszínen zajlottak a szűrések országszerte, háziorvosi rendelőkben, szakrendelőkben, gyógyszertárakban, bevásárlóközpontokban. Az első évben 3967, míg a második évben 2766 személy vett részt a programban. 2017-ben az alanyok 51,8%-a, míg 2019-ben 46,5%-a bizonyult hypertoniásnak. 2017-ben és 2019-ben hasonló arányban volt emelkedett vérnyomású a gyógyszeresen nem kezeltek között (22,4% és 20,8%) és az antihipertenzív kezelést alkalmazók között (44,5% és 46,8%). A szűrőprogramban résztvevők között minden másodiknak volt hypertoniája (kezelt és kontrollált, kezelt és nem kontrollált vagy nem kezelt). A nem kezelt résztvevők között minden ötödiknek volt emelkedett vérnyomása, míg a gyógyszeres kezelés alatt állóknál minden másodiknak volt nem kontrollált a hypertoniája. Azzal, hogy minden harmadik résztvevőnél felmerült a még nem diagnosztizált vagy nem megfelelően kontrollált hypertonia lehetősége, az MMM 2017-es és 2019-es eredményei megerősítik a vérnyomásmérési szűrőprogramok jelentőségét.

A familiáris hypercholesterinaemia (FH) a koleszterin-anyagcsere veleszületett zavarával járó kórkép, amelyet jelentősen emelkedett összkoleszterinszint (TC) és low density lipoprotein koleszterinszint (LDL-C), ennek következtében a szív- és érrendszeri betegségek korai megjelenése jellemez. A magas vérnyomás előfordulási gyakorisága FH-s betegekben nem tisztázott, de jelenléte független kockázati tényezője a cardiovascularis betegség kialakulásának. Megfelelő terápiája ezért kiemelt fontosságú ebben a nagy kockázatú betegcsoportban.Célul tűztük ki 86, szakrendelésünkön először megjelent, frissen diagnosztizált, lipidcsökkentő kezelésben még nem részesülő heterozigóta FH-s beteg (27 férfi, 59 nő, átlagéletkoruk 53,6±13,4 év) esetén a lipidszintek, valamint a dokumentáció alapján a magas vérnyomás előfordulásának és kezelésének értékelését. Az FH diagnózisát a Dutch Lipid Network kritériumrendszer alkalmazásával állítottuk fel.A betegek átlagos TC-szintje 8,49±1,7 mmol/l, átlagos LDL-C-szintje 6,11±1,5 mmol/l, átlagos high density lipoprotein koleszterin (HDL-C) szintje 1,62±0,5 mmol/l, míg a lipoprotein-(a)-szint mediánja 301 mg/l volt. Mindössze 33 beteg esetén diagnosztizáltak korábban magas vérnyomást (38,4%). Béta-blokkolót 23, ACE-gátlót 13, ARB-t 12, kalciumcsatorna-blokkolót 9, HCT-t 11 beteg kapott. 11 beteg részesült monoterápiában, 10 beteg kettős, 11 beteg hármas, míg 1 beteg négyes kombinált kezelést kapott.Az eredmények alapján a magasvérnyomás-betegség ebben a betegcsoportban valószínűleg aluldiagnosztizált, a javasolt kezelés pedig sem az alkalmazott szer típusát, sem annak módját tekintve nem felelt meg az aktuális terápiás irányelveknek. A magasvérnyomás-betegség szűrése és korszerű kezelése, tekintettel az FH esetén kialakuló korai érelmeszesedésre, jóval nagyobb figyelmet érdemel ebben a kiemelt kockázatú betegcsoportban.

Cardiovascular diseases are still the leading cause of mortality due to increased atherosclerosis worldwide. In the background of accelerated atherosclerosis, the most important risk factors include hypertension, age, male gender, hereditary predisposition, diabetes, obesity, smoking and lipid metabolism disorder. Arterial stiffness is a firmly established, independent predictor of cardiovascular risk. Patients with familial hypercholesterolemia are at very high cardiovascular risk. Non-invasive measurement of arterial stiffness is suitable for screening vascular dysfunction at subclinical stage in this severe inherited disorder. Some former studies found stiffer arteries in patients with familial hypercholesterolemia compared to healthy controls, while statin treatment has a beneficial effect on it. If conventional drug therapy fails in patients with severe familial hypercholesterolemia, PCSK9 inhibitor therapy should be administered; if these agents are not available, performing selective LDL apheresis could be considered. The impact of recent therapeutic approaches on vascular stiffness is not widely studied yet, even though the degree of accelerated athero and arteriosclerosis correlates with cardiovascular risk. The authors provide an overview of the diagnosis of familial hypercholesterolemia and the findings of studies on arterial dysfunction in patients with familial hypercholesterolemia, in addition to presenting the latest therapeutic options and their effects on arterial elasticity parameters.

Develop individual discriminant models using clinical and psychosocial variables for physicians and patients with diabetes based on their perceptions of patient adherence.This was a cross-sectional research design utilizing a discriminant analysis approach. Type 2 patients on treatment for diabetes for at least 2 years prior to research were selected. Clinical data were obtained from patient records, and psychosocial variables were collected by survey instruments filled out by patients. A final sample of 200 patients was recruited.We found a positive correlation between patient and physician assessment of patient adherence behaviors. Greater adherence efforts were associated with lower HbA1c. Better quality of the patient-physician relationship was linked to better patient adherence. Increased HbA1c, longer therapy duration and higher BMI described low patient adherence for physicians. Lower HbA1c, female gender and fewer difficulties in marital adjustment characterized high adherence for patients. Dietary self-efficacy as well as emotional and social isolation discriminated mid-level adherers in both models.This research confirmed that patients and physicians perceived and judged patients' adherence behaviors differently. Physicians and patients associated different clinical and psychological factors with low and high adherence. Further research is recommended to clarify how the quality of the physician-patient as well as the patient-spouse relationship affect dietary efficacy and patient adherence. A randomized, controlled clinical trial approach is recommended to establish the effectiveness of interventions aiming to improve dietary self-efficacy on adherence outcomes.

Background and objectives The aim of our study was to assess systemic and cerebral hemodynamic changes as well as cerebral CO2-reactivity during propofol anesthesia. Methods 27 patients undergoing general anesthesia were enrolled. Anesthesia was maintained using the Target-Controlled Infusion (TCI) method according to the Schnider model, effect site propofol concentration of 4 μg.mL-1. Ventilatory settings (respiratory rate and tidal volume) were adjusted to reach and maintain 40, 35, and 30 mmHg EtCO2 for 5 minutes, respectively. At the end of each period, transcranial Doppler and hemodynamic parameters using applanation tonometry were recorded. Results Systemic mean arterial pressure significantly decreased during anesthetic induction and remained unchanged during the entire study period. Central aortic and peripherial pulse pressure did not change significantly during anesthetic induction and maintenance, whereas augmentation index as marker of arterial stiffness significantly decreased during the anesthetic induction and remained stable at the time points when target CO2 levels were reached. Both cerebral autoregulation and cerebral CO2-reactivity was maintained during propofol anesthesia. Conclusions Propofol at clinically administered doses using the Total Intravenous Anesthesia (TIVA/TCI) technique decreases systemic blood pressure, but does not affect static cerebral autoregulation, flow-metabolism coupling and cerebrovascular CO2 reactivity. According to our measurements, propofol may exert its systemic hemodynamic effect through venodilation. Trial registration The study was registered at http://www.clinicaltrials.gov , identifier: NCT02203097, registration date: July 29, 2014.

Abstract: Cardiac autonomic neuropathy (CAN) is a common complication in type 1 and 2 diabetes and is defined as the impairment of autonomic control of the cardiovascular system. CAN is strongly associated with increased mortality, and in some studies with morbidity of vascular complications, such as stroke, coronary artery disease and myocardial infarction. At the early stages, CAN can be subclinical and it becomes clinically evident as the disease progresses. Subclinically, the disease is defined by cardiovascular reflex testing, which may have prognostic implications. Clinically, the impairment in autonomic function is associated with resting tachycardia, exercise intolerance, orthostatic hypotension, syncope, intraoperative cardiovascular instability, silent myocardial infarction and ischemia, and increased mortality. Although very common and serious, CAN is a frequently overlooked complication of diabetes. Because the progression of cardiovascular denervation is partly reversible or can be slowed down in the early stages of the disease, recent guidelines strongly recommend screening for CAN in patients with diabetes. In this review we summarize the diagnostic tools suggested in the screening for diabetic CAN. Orv Hetil. 2019; 160(35): 1366–1375.

Abstract: Progranulin is a recently recognized multifunctional glycopeptide shown to be related to obesity and diabetes mellitus. Progranulin is an endogenous antagonist of tumor necrosis factor-α by competitively binding to its receptor, therefore, it exerts anti-inflammatory activity. Paradoxically, previous studies have shown that serum levels of progranulin were elevated in patients with diabetes and associated to its complications including micro- and macroangiopathies, macroalbuminuria or reduced renal function. Moreover, hyperprogranulinemia may be involved in the pathogenesis of obesity-associated insulin resistance. The review summarizes the currently available data on progranulin as a novel marker of the carbohydrate metabolism and inflammation. Orv Hetil. 2019; 160(25): 973–979.

Összefoglaló. A cardiovascularis megbetegedések kialakulását és progresszióját jelentősen befolyásolja az életmód, ezen belül a fizikai aktivitás. A rendszeres testmozgás csökkenti a szív- és érrendszeri kórképek kockázatát, többek között a magas vérnyomásra, a zsíranyagcsere-eltérésekre és az elhízásra gyakorolt kedvező hatásán keresztül, továbbá független tényező a cardiovascularis halálozás szempontjából is. Az artériás érfali merevség az elasztikus artériák falát alkotó extracelluláris mátrix degeneratív eltéréseinek következtében alakul ki a különböző kockázati tényezők hatására. Korábban, különböző populációkon már igazolták az érfali merevség prediktív értékét a cardiovascularis események kialakulásának tekintetében. A pulzushullám-terjedési sebesség mérése a leggyakrabban alkalmazott módszer az érfali merevség meghatározására. A pulzushullám-terjedési sebesség mérésének hasznát a cardiovascularis kimenetel és élettartam becslésében számos populációs szintű követéses vizsgálat igazolja. Jelen munkánkban áttekintjük a rendszeres fizikai aktivitás, az érfali merevség, az érelmeszesedés és a cardiovascularis események közötti összefüggéseket. Összefoglaljuk az edzésnek és az érfali merevség paramétereinek kapcsolatát egészséges populáción vizsgáló legfontosabb tanulmányok eredményeit. Megállapítjuk, hogy az érfali merevség figyelemre méltó, érdekes biomarker a cardiovascularis kockázat becslése során a rendszeresen sportoló személyek esetén is. Mindezek alapján, tekintve annak prognosztikai hasznát, felmerül a pulzushullám-terjedési sebesség mérésének beillesztése a klinikai döntéshozatali folyamatba mind amatőr, mind professzionális sportolók esetében. Orv Hetil. 2021; 162(16): 615-622. Summary. The development and progression of cardiovascular disorders is importantly dependent on lifestyle factors, including physical activity. Regular physical activity decreases cardiovascular morbidity by ameliorating risk factors such as hypertension, dyslipidemia and obesity, moreover, also independently affects cardiovascular mortality. Arterial stiffness results from a degenerative process affecting mainly the extracellular matrix of elastic arteries under the effect of risk factors. Previously, the independent predictive value of arterial stiffness for cardiovascular events has been demonstrated in various populations. Pulse wave velocity is the most commonly used method for the assessment of arterial stiffness. The value of measuring pulse wave velocity to predict cardiovascular health outcomes and longevity has been established in several population-based longitudinal studies. In this review, we summarize the main associations between regular physical exercise, arterial stiffness, atherosclerotic burden and incident cardiovascular events. We cite findings from the major studies focusing on the effect of training on arterial stiffness parameters in healthy subjects. We conclude that arterial stiffness is emerging as an interesting biomarker for cardiovascular risk stratification in subjects doing regular physical activity. Therefore, the incorporation of pulse wave velocity measurement into clinical decision-making could be indicated in the case of both amateur and professional athletes, given the prognostic information it provides. Orv Hetil. 2021; 162(16): 615-622.

The Hungarian government is dedicated to supporting a healthy and sporty life-style, thus in the past years the number of initiatives directed to publicizing and promoting sports has increased considerably. The new Law of Public Education has put the emphasis on physical education and on organizing other sport events in schools. This led to the introduction, in a phasing-out manner, of the every-day physical education (PE).We were interested to know the infrastructural background of PE including the number and size of sports halls available for the students, how many classes can they accommodate at the same time, and when were they constructed. To this end a survey was conducted through telephone, contacting 200 high schools in 19 counties of Hungary. Do the schools have their own swimming pools, or do they conduct after-hours sports events. Data were analyzed using the EvaSys program.The time of construction of the schools and their sports halls spans a wide range between the years 1530 and 2005. So do the number of students, between 150-1200. Nineteen of the schools have none, 67% has one, and 18.8% two sports halls. The size of these halls is also very variable, while in some schools it is only 25 m2, in others it can be as large as 2295m2. In most cases the halls can accommodate one or two classes in parallel. Afternoon classes are held in 87% of the schools, and include basketball, fencing, and soccer, among others. However, only eleven of the interviewed high schools have swimming pools. Research has called the attention to the fact that the exercise of Hungarian youth is too little. This puts the emphasis on the promotion of physical activity in schools. While there are large differences in the infrastructural background in the schools involved in the survey, they all strive to conduct after-hours sport events.

Elevated blood pressure remains the single biggest risk factor contributing to the global burden of disease and mortality. May Measurement Month is an annual global screening campaign aiming to improve awareness of blood pressure at the individual and population level. Adults ({greater than or equal to}18 years) recruited through opportunistic sampling were screened at sites in 92 countries during May 2019. Ideally three blood pressure readings were measured for each participant, and data on lifestyle factors and co-morbidities were collected. Hypertension was defined as a systolic BP {greater than or equal to} 140 mmHg, and/or a diastolic BP {greater than or equal to} 90 mmHg (mean of the second and third readings) or taking antihypertensive medication. When necessary, multiple imputation was used to estimate participants' mean blood pressure. Mixed-effects models were used to evaluate associations between blood pressure and participant characteristics. Of 1,508,130 screenees 482,273 (32.0%) had never had a blood pressure measurement before and 513,337 (34.0%) had hypertension, of whom 58.7% were aware and 54.7% were on antihypertensive medication. Of those on medication, 57.8% were controlled to

The aim of our study was to assess systemic and cerebral hemodynamic changes as well as cerebral CO27 patients undergoing general anesthesia were enrolled. Anesthesia was maintained using the Target-Controlled Infusion (TCI) method according to the Schnider model, effect site propofol concentration of 4 μg.mLSystemic mean arterial pressure significantly decreased during anesthetic induction and remained unchanged during the entire study period. Central aortic and peripherial pulse pressure did not change significantly during anesthetic induction and maintenance, whereas augmentation index as marker of arterial stiffness significantly decreased during the anesthetic induction and remained stable at the time points when target COPropofol at clinically administered doses using the Total Intravenous Anesthesia (TIVA/TCI) technique decreases systemic blood pressure, but does not affect static cerebral autoregulation, flow-metabolism coupling and cerebrovascular COThe study was registered at http://www.clinicaltrials.gov, identifier: NCT02203097, registration date: July 29, 2014.

Cardiac autonomic neuropathy (CAN) is a common complication in type 1 and 2 diabetes and is defined as the impairment of autonomic control of the cardiovascular system. CAN is strongly associated with increased mortality, and in some studies with morbidity of vascular complications, such as stroke, coronary artery disease and myocardial infarction. At the early stages, CAN can be subclinical and it becomes clinically evident as the disease progresses. Subclinically, the disease is defined by cardiovascular reflex testing, which may have prognostic implications. Clinically, the impairment in autonomic function is associated with resting tachycardia, exercise intolerance, orthostatic hypotension, syncope, intraoperative cardiovascular instability, silent myocardial infarction and ischemia, and increased mortality. Although very common and serious, CAN is a frequently overlooked complication of diabetes. Because the progression of cardiovascular denervation is partly reversible or can be slowed down in the early stages of the disease, recent guidelines strongly recommend screening for CAN in patients with diabetes. In this review we summarize the diagnostic tools suggested in the screening for diabetic CAN. Orv Hetil. 2019; 160(35): 1366-1375.Absztrakt: A cardialis autonóm neuropathia (CAN) az 1-es és 2-es típusú diabetes mellitus gyakori szövődménye, melyet a cardiovascularis rendszer autonóm szabályozásának zavaraként definiálnak. A CAN szoros összefüggést mutat a halálozási adatokkal, és bizonyos vizsgálatok szerint a vascularis szövődmények, köztük a stroke, a koszorúér-betegség és a szívinfarktus okozta halálozással is. Korai stádiumban a CAN tünetmentes lehet, majd a betegség előrehaladtával megjelennek a klinikai tünetek is. A tünetmentes periódusban a cardiovascularis reflextesztek segítségével azonosítható, melyek prognosztikai értékkel is bírnak. A tünetek megjelenését követően az autonóm működési zavar a nyugalmi tachycardia, csökkent fizikai terhelhetőség, ortosztatikus hipotónia, syncope, intraoperatív cardiovascularis instabilitás, néma szívizominfarktus vagy ischaemia okozta megnövekedett halálozás alapján diagnosztizálható. Bár a CAN nagyon gyakori és előrehaladott esetekben súlyos diabeteses szövődmény, gyakran nem kerül felismerésre. Mivel a betegség korai stádiumában a cardiovascularis denerváció részlegesen visszafordítható, vagy progressziója lelassítható, a legújabb irányelvek határozottan ajánlják a CAN szűrését diabeteses betegekben. Az alábbiakban összefoglaljuk a diabeteses CAN szűrésére alkalmas diagnosztikai lehetőségeket. Orv Hetil. 2019; 160(35): 1366–1375.

Progranulin is a recently recognized multifunctional glycopeptide shown to be related to obesity and diabetes mellitus. Progranulin is an endogenous antagonist of tumor necrosis factor-α by competitively binding to its receptor, therefore, it exerts anti-inflammatory activity. Paradoxically, previous studies have shown that serum levels of progranulin were elevated in patients with diabetes and associated to its complications including micro- and macroangiopathies, macroalbuminuria or reduced renal function. Moreover, hyperprogranulinemia may be involved in the pathogenesis of obesity-associated insulin resistance. The review summarizes the currently available data on progranulin as a novel marker of the carbohydrate metabolism and inflammation. Orv Hetil. 2019; 160(25): 973-979.Absztrakt: A progranulin egy újonnan felfedezett multifunkcionális glikoprotein, amely összefüggésben van az elhízás és a cukorbetegség kialakulásával. A progranulin a tumornekrózisfaktor-α endogén antagonistája, kompetitíven kötődik annak receptorához, így antiinflammatoricus aktivitással rendelkezik. Érdekes módon korábbi tanulmányok kimutatták, hogy a progranulin szérumszintje emelkedett a cukorbetegekben, és összefüggésbe hozták a cukorbetegség bizonyos komplikációival, beleértve a micro- és macroangiopathiát, a macroalbuminuriát és a csökkent vesefunkciót. Továbbá a hyperprogranulinaemia közrejátszhat az elhízáshoz társuló inzulinrezisztencia patogenezisében. A cikkben összefoglaljuk a jelenleg elérhető adatokat a progranulinnak – mint új markernek – a szénhidrát-metabolizmusban és a gyulladásban betöltött szerepére vonatkozóan. Orv Hetil. 2019; 160(25): 973–979.

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. The cardiovascular mortality rate in Hungary is twice as high as the European Union average. In a recent Hungarian screening programme, among those volunteers who claimed to be healthy, BP was above 140/90 mmHg in 24% and 39% in women and men, while the control rate was 45% and 36% in women and men, respectively. May Measurement Month (MMM) is a global initiative by the International Society of Hypertension aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. BP measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. In Hungary, 97 sites were set-up in primary and secondary care facilities, in pharmacies and in malls. All regions, both cities and villages were involved. A total of 3967 individuals were screened. After multiple imputation, 2052 subjects (51.8%) had hypertension. 553 (22.4%) of untreated individuals had hypertension, and 666 (44.5%) of treated individuals had uncontrolled BP. More than 50% of the screened cohort had hypertension (treated and controlled, treated and uncontrolled or untreated). By identifying almost one-third of the screened cohort with the possibility of newly diagnosed or uncontrolled hypertension, the Hungarian part of MMM17 suggest that opportunistic screening can identify significant numbers with raised BP.

Active screening for resistant multidrug strain carriers remains an important component of infection control policy in any healthcare setting indifferent of financial and logistical costs. The objective of our study was to determine the spectrum of bacterial colonization individually among intensive care unit patients. A retrospective observational study was performed in the Intensive Care Unit of Emergency Clinical County Hospital of Oradea during 2017. Medical records of the patients were used for evaluation of source of ICU admission, previous antibiotic therapy, comorbidities, and length of hospital stay. Nasal and groin swabs for MRSA detection and rectal swabs for ESBL, VRE, and CRE detection were collected upon ICU admission of all patients in the first 24 hours and after 7 days. Swab samples were processed for isolation and identification of these resistant multidrug strains. Bacterial colonization on admission was detected in a quarter of patients included in the study. Carbapenemase-producing bacteria were the most common colonizers (21.16%). On admission, 12.06% of patients have been colonized by ESBL-producing members of the family Enterobacterales. Risk factors for colonization on admission to the ICU were chronic liver diseases and chronic renal failure for ESBL infection and chronic liver disease for CRE in male patients. Evaluation of Carmeli’s score for male patients showed association only with CRE colonization. Chronic renal failure was found as risk factor for ESBL colonization in female patients. The prevalence of MRSA was 5.23% and less than 1% for VRE. There was no association between any risk factors studied and the presence of S. aureus or VRE upon admission. The 7-day ICU stay also proved to be an increased risk for ESBL and CRE infection.

Lowering elevated blood pressure in children and adolescents has significant impact. In these ages, non-pharmacological treatment, that is, comprehensive lifestyle changes, is preferred. Most hypertensive youth are often overweight or obese. Loss of body weight therefore not only lowers blood pressure but also has favorable effects for other cardiovascular risk factors. Changes in eating habits, mainly restricted calorie intake and the addition of DASH diet, should hold great potential in decreasing elevated blood pressure. Increased physical activity has a strong and positive effect on lowering blood pressure as well, but the focus should be on regularity of exercise and not its intensity. Decline of daily salt intake should also contribute to achieving target blood pressure levels. Other factors, such as motivational interviewing and stress management, hold promise for reaching regulated blood pressure outcomes in adolescents. Best results may be achieved by combining these lifestyle-modifying methods for long-term success.

The incidence of atrial fibrillation is increased during hemodialysis (HD); however, the effects of hemodiafiltration (HDF) on atrial arrhythmias have not been evaluated. The prolongation of the P wave and P dispersion (Pd) can predict atrial arrhythmias. Data from 30 patients receiving HDF over a period of 3 months were collected; the same group of patients was then evaluated during treatment with conventional HD for at least another 3 months. Electrolyte values were obtained, and surface electrocardiograms (ECG), echocardiography, and Holter ECGs were performed. The duration of the P wave and Pd increased significantly during HD. The left atrial diameter decreased significantly only during HDF. During HDF, the left atrial cross diameter measured at the beginning of the session was positively correlated with the incidence of supraventricular premature beats (p = 0.011, r = 0.4556). The decrease in left atrial diameter during HDF was negatively correlated with the incidence of supraventricular premature beats (p = 0.016, r = −0.43). During HDF, the changes in sodium and Pd were significantly positively correlated (p

Previous studies showed that plasma levels of high-density lipoprotein (HDL) cholesterol are inversely related to risk of cardiovascular diseases. However, in the last few decades it became obvious that beyond its plasma level, HDL structure and function have a critical role in its anti-atherogenic efficacy. Apolipoprotein M (ApoM) is an HDL-associated plasma protein affecting HDL metabolism and exhibits various anti-atherosclerotic functions, such as protection against oxidation and regulation of cholesterol efflux. Sphingosine 1-phosphate (S1P) is a potent sphingolipid mediator that regulates numerous cellular responses including cell differentiation and migration, apoptosis and vascular inflammation. The majority of S1P is associated to ApoM containing HDL particles. Therefore, ApoM and S1P content of HDL have an impact on the atherosclerotic process. Moreover, HDL-ApoM and S1P content can be altered in several pathologic conditions such as coronary artery disease. This review covers the currently available data on the contribution of ApoM and S1P to HDL function in health and cardiovascular diseases. Orv Hetil. 2018; 159(5): 168-175.

We evaluated the efficacy and safety of ertugliflozin, an SGLT2 inhibitor, in type 2 diabetes mellitus (T2DM) inadequately controlled (HbA1c, 7.0%-10.5%) with metformin monotherapy (≥1500 mg/d for ≥8 weeks).This was a double-blind, 26-week, multicentre study with ongoing 78-week extension (ClinicalTrials.gov identifier: NCT02033889). A total of 621 participants were randomized 1:1:1 to placebo, or ertugliflozin 5 or 15 mg/d. The primary endpoint was change from baseline at week 26 in HbA1c. Secondary efficacy endpoints were change from baseline at week 26 in fasting plasma glucose (FPG), body weight, systolic/diastolic blood pressure (SBP/DBP) and number of participants with HbA1c7.0% (53 mmol/mol). Pre-specified adverse events (AEs) of special interest and percent change from baseline in bone mineral density (BMD) were also assessed at week 26.At week 26, the placebo-adjusted least-squares mean change from baseline HbA1c (8.1%) was -0.7% and -0.9% for ertugliflozin 5 and 15 mg, respectively (both P .001), to final means of 7.3% and 7.2%, respectively. The odds of HbA1c7.0% were significantly greater in both ertugliflozin groups vs placebo. Ertugliflozin significantly reduced FPG, body weight, SBP and DBP vs placebo. The incidence of genital mycotic infections was higher in the ertugliflozin groups (female subjects: placebo, 0.9%; ertugliflozin 5 mg, 5.5%; ertugliflozin 15 mg, 6.3% [P = .032]; male subjects: 0%; 3.1%; 3.2%, respectively), as was the incidence of urinary tract infections and symptomatic hypoglycaemia. The incidence of hypovolaemia AEs was similar across groups. Ertugliflozin had no adverse impact on BMD at week 26.Ertugliflozin added to metformin in patients with inadequately controlled T2DM improved glycaemic control, reduced body weight and BP, but increased the incidence of genital mycotic infections.