Szent Imre Teaching Hospital

Budapest, Hungary

Szent Imre Teaching Hospital

Budapest, Hungary
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Denes M.,Gottsegen Gyorgy Hungarian Institute of Cardiology | Farkas K.,Szent Imre Teaching Hospital | Erdei T.,Gottsegen Gyorgy Hungarian Institute of Cardiology | Lengyel M.,Gottsegen Gyorgy Hungarian Institute of Cardiology
Echocardiography | Year: 2010

Background: Both systolic and diastolic tissue Doppler (TD) velocities have an important diagnostic and prognostic role in cardiology. We aimed to compare TD velocities between two different echocardiography systems. Patients: Thirty-one consecutive patients (mean age: 65.2 ± 17.5 years; 12 males) were enrolled. Methods: Systolic (Sa), early (Ea), and late (Aa) diastolic velocities were measured by TD at the lateral mitral annulus by a Sonos 2000 (Hewlett-Packard, Andover, MA, USA) and a Philips iE33 system. The E/Ea ratio was calculated. Results: Ea, Aa, and Sa velocities were higher when measured by the Sonos system (Ea: 13.2 ± 4.1 cm/s vs. 8.3 ± 3.6 cm/s; Aa: 14.8 ± 3.8 cm/s vs. 9.3 ± 2.3 cm/s; Sa: 15.2 ± 3.6 cm/s vs. 8.4 ± 2.0 cm/s; P < 0.0001 all). A significant correlation was found in Ea and in Ea/Aa (r = 0.84 and r = 0.85 resp; P < 0.0001 for both), and a weaker in Aa (r = 0.43; P = 0.02) between the machines. The Bland-Altman analysis showed broad limits of agreement between the measurements for Ea, Aa, and Sa (mean difference: 4.95 cm/s; 5.52 cm/s; 6.73 cm/s, respectively; limits: 0.64-9.25 cm/s; -1.39-12.39 cm/s; -0.37-13.83 cm/s, respectively). An E/Ea ratio >5.6 by the Sonos system showed 75% sensitivity and 79% specificity for elevated left ventricular filling pressure, defined as E/Ea >10 by the reference Philips system. Conclusions: Although diastolic TD velocities had excellent correlations between the two machines, there was a systematic overestimation by the Sonos system. Since the limits of agreement do not allow replacing the measurements, we suggest using the same echocardiographic equipment at patient follow-up. © 2010, Wiley Periodicals, Inc.

Simonyi G.,Szent Imre Teaching Hospital
CardioRenal Medicine | Year: 2014

Background: Various ECG abnormalities are commonly observed in obesity and in metabolic syndrome. Summary: Some of these abnormalities are caused by the pushed-up position of the diaphragm due to obesity and others occur as a result of the complications of the condition. The position of the R wave may change, various arrhythmias may develop or the QT interval may be prolonged, which increases the tendency to malignant arrhythmias. In obesity, the ECG signs of ventricular hypertrophy are less informative due to the accumulation of epicardial and subcutaneous adipose tissue. In general, it can be concluded that a microcirculation disorder is present in metabolic syndrome that may primarily be associated with ST-T wave abnormalities. Key Messages: Body surface potential mapping is a more sensitive method than traditional ECG with potentially greater use for diagnosis mainly in the early phase of non-ST elevation myocardial infarctions. © 2014 S. Karger AG, Basel.

Igaz P.,Semmelweis University | Igaz I.,Szent Imre Teaching Hospital | Nagy Z.,Semmelweis University | Nyiro G.,Hungarian Academy of Sciences | And 5 more authors.
Cellular and Molecular Life Sciences | Year: 2015

Several lines of evidence support the relevance of microRNAs in both adrenocortical and adrenomedullary (pheochromocytomas) tumors. Significantly differentially expressed microRNAs have been described among benign and malignant adrenocortical tumors and different forms of pheochromocytomas that might affect different pathogenic pathways. MicroRNAs can be exploited as markers of malignancy or disease recurrence. Besides tissue microRNAs, novel data show that microRNAs are released in body fluids, and blood-borne microRNAs can be envisaged as minimally invasive markers of malignancy or prognosis. MicroRNAs might even serve as treatment targets that could expand the rather-limited therapeutic repertoire in the field of adrenal tumors. In this review, we present a critical synopsis of the recent observations made in the field of adrenal tumor-associated microRNAs regarding their pathogenic, diagnostic, and potential therapeutic relevance. © 2014 Springer Basel.

Igaz I.,Szent Imre Teaching Hospital | Igaz P.,Semmelweis University
Cellular and Molecular Life Sciences | Year: 2014

A growing body of experimental evidence supports the diagnostic relevance of circulating microRNAs in various diseases including cancer. The biological relevance of circulating microRNAs is, however, largely unknown, particularly in healthy individuals. Here, we propose a hypothesis based on the relative abundance of microRNAs with predominant tumor suppressor activity in the blood of healthy individuals. According to our hypothesis, certain sets of circulating microRNAs might function as a tumor surveillance mechanism exerting continuous inhibition on tumor formation. The microRNA-mediated tumor surveillance might complement cancer immune surveillance. © 2014 The Author(s).

In the majority of old and very old hypertensive patients, the reduction of abnormally high blood pressure has been proved to provide a strategic defense of target organs. In patients younger than 80 years, both initial and target blood pressure (BP) values are similar to those of younger age groups. In those older than 80 years, a a systolic blood pressure level >160 mmHg is the threshold of indication for antihypertensive treatment and the therapeutic target value is<150 mmHg. Both values are evidence-based (HYVET). The latest ACCF/AHA guidelines (USA 2011) advise to achieve a BP below 140 mmHg if the use of one or two antihypertensive agents result in sufficient BP reduction. However, this strategy is not yet supported by unequivocal evidence regarding complications in target organs. It is not recommended to aim for target levels lower than the above values (especially the value defined by the ESH guidelines) even in elderly hypertensive patients at high cardiovascular risk, as the results of several studies suggest a J-curve effect. In multimorbid elderly patients it is highly important to adapt antihypertensive treatment to individual needs, rather than to use schematic approaches. The number and progression of comorbid diseases can greatly influence, in certain cases attenuate the aimed BP reduction. A similar medical decision should be made if the target BP level could only be achieved by the combination of multiple antihypertensive medications, which can remarkably impair quality of life in elderly patients. Among non-comorbid elderly patients with hypertension, there seems to be no convincing difference in the efficiency of target organ protection between antihypertensive treatments that have different target sites but can achieve similar target levels. However, the majority of elderly hyperten-sive patients have comorbidities with variable rates of progression. In those at even low cardiometabolic risk the use of beta-receptor blockers (BRB) and especially a combination of BRB+diuretic (DIU) is not recommended. The adequate therapeutic tactic includes the use of only moderate drug-doses and their early combination. This approach has been convincingly proved mainly with early combinations of RAS inhibitors+CCB-s and RAS inhibitors+small doses of DIU-s. It is very important to monitor the treated patients, as the BP and circulatory response to the same antihypertensive treatment can markedly change in elderly patients when either the enviromental conditions change or a new pathologic process develops and/or is treated. Strict control is also necessary because it occurs quite often that the earlier optimal compliance of elderly patients in taking antihypertensive medicines rapidly deteriorates. The efficiency of statins and acetylsalicylic acid decreases over 80 years of age, but this does not indicate that the previously efficient approach should be suspended.

MicroRNAs as endogenous mediators of RNA interference and epigenetic regulation are involved in the regulation of numerous basic physiological processes. Both their expression and action is tissue specific, as microRNA target different messenger RNA molecules in different tissues and have various actions. MicroRNAs are major players in tumor development and act as oncogenes and tumor suppressors that also depend on the cellular context. MicroRNA are secreted and are present in the circulation, and circulating microRNA might affect gene expression in various cells. We present a hypothesis on the relevance of tissue specific microRNA action supposing that it might be a putative defense mechanism preventing secreted microRNA-mediated uniform gene expression changes (e.g. inducing cell proliferation or inhibiting apoptosis) and thus growth disorders, tumor development or progression that would occur if all cells and tissues would respond in the same way to circulating microRNA. © 2015 Elsevier Ltd.

Simonyi G.,Szent Imre Teaching Hospital
Experimental and Clinical Cardiology | Year: 2014

It is well known and it has been proved that the increased low density lipoprotein (LDL)-cholesterol, has played an outstanding role in the formation and risk of cardiovascular diseases. That's why according to European and American lipid offers, the most important role of the lipid diminishing therapy is the moderation of the LDL-cholesterol level. The statins, among lipid lowering drugs, are known to moderate the best the cardiovascular risk. According to some widespread statin surveys-even in the case of aggressive strategies- a strong residual cardiovascular risk can be pre-calculated. One of its main factors is the non-high density lipoprotein (HDL)-cholesterol. The non-HDL-cholesterol contains numerous atherogenic lipoproteins (very low density lipoprotein (VLDL), intermediate density lipoprotein (IDL), LDL and lipoprotein(a)). On the other hand the lipoproteins containing apoB (LDL, IDL and VLDL) have an important atherogenic effect, that is why they can signal much more stronger than the LDL-cholesterol, the risk of coronary diseases. Taking into consideration that the co-relation between apoB and non-HDL-cholesterol is quite strong, and the apoB measurements have serious impedimets (standardization, expenses), this is why the non-HDL-cholesterol is a much more useful parameter and therapeutic target, especially in the case of those having a triglycerides level above 2.26 mmol/ l. In spite of the fact that the non-HDL-cholesterol is an important cardiovascular risk factor, we do not have randomized, clinically proved examinations of the importance of minimalizing its target value. This can be the reason that the latest AHA/ACC recommendation, opposed to the ATPIII and the EAS/ESC recommendations do not contain non-HDL-cholesterol targets.

Farsang C.,Szent Imre Teaching Hospital | Tulassay Z.,Semmelweis University
Lege Artis Medicinae | Year: 2015

Cardiovascular preventive drugs (nonsteroidal antiinflammatory drugs, aspirin, inhibitors of platelet aggregation, anticoagulants) are among the most frequently used medicines all over the world. Gastrointestinal (GI) complications (hemorrhage, ulceration, perphoration) are among the most frequent side effects of these drugs, however, differences in their pharmacodynamics properties and other pleiotropic effects may substantially modify these unwanted events. Authors, based on international and Hungarian guidelines, summarize the most important data for GI protection, focusing on the use of H-2 receptor blockers and proton pump inhibitors.

MicroRNAs are short non-coding RNA molecules involved in the posttranscriptional epigenetic regulation of gene expression. Recent data show that microRNAs can be found in body fluids, and these microRNAs might enter cells giving rise to a hormone like way of action. MicroRNAs released in body fluids might affect other individuals, and there are some data of potential cross-species action of microRNAs, as well. Here, the authors discuss hypotheses concerning the potential pathogenic relevance of interindividual and cross-species action of microRNAs including food-derived microRNAs. Supposing that microRNAs might traverse the gastrointestinal tract, microRNAs might wander via the food-chain and even master regulatory microRNAs might be envisaged that could influence gene expression in a wide range of species and might thereby link different species via common gene expression signatures. Since many microRNA genes are located in the non-protein coding "dark matter" of the genome, a novel function of this "dark matter" is raised regarding interindividual and cross-species epigenetic communication via information transfer by gene products coded by the non-protein coding part of the genome. © 2014 Elsevier Ltd.

PubMed | Szent Imre Teaching Hospital, Eötvös Loránd University, University of Szeged, Semmelweis University and Medical University of Vienna
Type: Journal Article | Journal: PloS one | Year: 2017

Genetic variation in human maternal DNA contributes to the susceptibility for development of gestational diabetes mellitus (GDM).We assessed 77 maternal single nucleotide gene polymorphisms (SNPs) for associations with GDM or plasma glucose levels at OGTT in pregnancy.960 pregnant women (after dropouts 820: case/control: m99WHO: 303/517, IADPSG: 287/533) were enrolled in two countries into this case-control study. After genomic DNA isolation the 820 samples were collected in a GDM biobank and assessed using KASP (LGC Genomics) genotyping assay. Logistic regression risk models were used to calculate ORs according to IADPSG/m99WHO criteria based on standard OGTT values.The most important risk alleles associated with GDM were rs10830963/G of MTNR1B (OR = 1.84/1.64 [IADPSG/m99WHO], p = 0.0007/0.006), rs7754840/C (OR = 1.51/NS, p = 0.016) of CDKAL1 and rs1799884/T (OR = 1.4/1.56, p = 0.04/0.006) of GCK. The rs13266634/T (SLC30A8, OR = 0.74/0.71, p = 0.05/0.02) and rs7578326/G (LOC646736/IRS1, OR = 0.62/0.60, p = 0.001/0.006) variants were associated with lower risk to develop GDM. Carrying a minor allele of rs10830963 (MTNR1B); rs7903146 (TCF7L2); rs1799884 (GCK) SNPs were associated with increased plasma glucose levels at routine OGTT.We confirmed the robust association of MTNR1B rs10830963/G variant with GDM binary and glycemic traits in this Caucasian case-control study. As novel associations we report the minor, G allele of the rs7578326 SNP in the LOC646736/IRS1 region as a significant and the rs13266634/T SNP (SLC30A8) as a suggestive protective variant against GDM development. Genetic susceptibility appears to be more preponderant in individuals who meet both the modified 99WHO and the IADPSG GDM diagnostic criteria.

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