Prevalence of the metabolic syndrome in hypertensive and/or obese subjects.
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Biomedical subjects
Publications and source records attributed to L Bíró.
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The metabolic syndrome is characterised by hyperinsulinaemia (insulin resistance) leading to an increased risk of atherosclerotic cardiovascular diseases. Carotid intima-media thickness (IMT) can be easily measured to detect early atherosclerosis. In order to evaluate the clinical characteristics of the metabolic syndrome a screening procedure was performed and carotid IMT was determined by high-resolution B-mode ultrasonography in a cohort of middle-aged (40-60 years) subjects who proved to be hyperinsulinaemic [fasting plasma insulin >15 microU/ml and/or post-prandial (120 min) insulin > 45 microU/ml; n = 91; men/women: 35/56; homeostasis model assessment (HOMA)-index: 6.42 +/- 3.65; x +/- SD]. Subjects known to have diabetes were not involved. Subjects were divided into subgroups according to the stages of glucose intolerance (normal glucose tolerance, n = 46; impaired glucose tolerance, n = 26; diabetes mellitus, n = 19). As controls, age- and sex-matched non-diabetic and non-hyperinsulinaemic subjects (n = 20; HOMA-index: 2.09 +/- 0.85) were investigated. The values of IMT of the internal carotid arteries were higher in hyperinsulinaemic subjects than in controls (0.93 +/- 0.39 mm vs 0.57 +/- 0.13 mm,p < 0.001), whereas the lumen diameter proved to be smaller than in control subjects (5.04 +/- 0.75 mm vs 5.45 +/- 0.71 mm; p < 0.05). In hyperinsulinaemic subjects only a trend of increasing IMT values and that of decreasing lumen diameter of the internal carotid arteries were observed when subgroups classified according to the stages of glucose intolerance were compared. No significant changes in IMT or lumen diameter of the common carotid arteries were observed. Early and asymptomatic signs of atherosclerosis could be detected in middle-aged subjects who proved to be hyperinsulinaemic in a screening procedure. The prevention of clinically manifest cardiovascular diseases in these subjects could be of great importance.
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In order to study the effect of interferon alpha on the levels of acute phase complement proteins in vivo, serum concentrations of C9 and C1-inhibitor (C1-INH) were measured in patients with chronic hepatitis C before and 3 months after the beginning of interferon alpha2b therapy. Serum levels of the activation product of terminal complement pathway, C5b-9, HCV RNA and IL-6 were also determined. IFN alpha treatment significantly (P<0.0001) increased the serum concentrations of both complement proteins. C5b-9 levels were found to significantly decrease during the same period of time. When the patients were divided into responders or non-responders (more or less than 50% decrease in plasma HCV RNA concentrations) C9 and C1-INH levels were elevated only in the responder patients. There was no correlation between the changes of IL-6 levels or the amounts of IFN alpha administrated on one hand, and the changes in the complement protein levels on the other. These findings suggest that the marked increase in the serum concentrations of the acute phase complement proteins is a secondary phenomenon due to the IFN alpha-caused diminution of the viral load and the resulting immune complex-induced complement activation.
BACKGROUND: Available data and our observations suggest that elevated levels of interleukin (IL)-6 and -10 and some complement parameters may be associated with a poor response to IFN alpha. We evaluated how baseline levels of C5b-9, IL-6, and IL-10 influence the outcome of IFN alpha treatment. METHODS: Fifty-one patients with established chronic hepatitis C were enrolled and treated with IFN alpha-2b. Before and after a 12-week-IFN-treatment (3 MU or 5 MU tiw) serum levels of IL-6, IL-10, C5b-9 and RNA of hepatitis C virus (HCV) were assessed. Sera of 46 sex- and age-matched, healthy blood donors served as control. RESULTS: While two-thirds of patients was considered 'responder', 14 patients had no significant decrease either in HCV RNA or in ALT levels. In the responder's group lower baseline levels of IL-6 and C5b-9 were found than those in the 'non-responder' group. As a result of IFN therapy HCV RNA and C5b-9 levels significantly decreased. While the serum concentration of IL-6 increased during the follow-up period, regarding IL-10, no change was observed. In patients with 'low' baseline levels of C5b-9 (<2053 ng/ml) IFN alpha resulted in a significantly (P = 0.0005) higher decrease in HCV RNA level. Regarding 'low' IL-6 values (< 1.47 pg/ml) similar but somewhat less significant (P = 0.0039) difference was found if the change of HCV RNA was investigated. The odds ratio of patients with low IL-6 and/or C5b-9 to responding to IFN alpha treatment was almost 10 times (CI: 9.1 (1.8-50.9)) higher as compared with patients without 'low' levels of these parameters. CONCLUSION: Our data suggest that serum level(s) of IL-6 and/or C5b-9 taken prior to the initiation of IFN treatment may serve as surrogate marker(s) in evaluating patients with chronic hepatitis C whether to get IFN alpha in monotherapy or to consider having combination therapy in the form of IFN alpha-ribavirin.
BACKGROUND: Ferritin is a storage protein for iron that can either represent a source of iron or perform a cytoprotective action as an iron sequestrant. OBJECTIVE: To compare the concentrations of ferritin in pericardial fluid of patients with valvular heart disease, serving as controls, and in patients with coronary artery disease. DESIGN: We studied a total of 59 consecutive male patients undergoing elective heart valve replacement (group 1: n = 22, mean +/- SD age 55 +/- 11 years) or elective coronary artery bypass grafting (group 2: n = 37, mean +/- SD age 59 +/- 9 years). METHODS: Iron status indicators, total protein and albumin concentrations, and lactate dehydrogenase activities were determined in pericardial fluid and serum samples obtained from patients during surgery. RESULTS: Pericardial fluid concentrations of ferritin in both patient populations were significantly (P < 0.001) greater than the concentrations in sera: group 1, 375 (107-2030) micrograms/l compared with 146.5 (21-407) micrograms/l; group 2, 1115 (226-2500) micrograms/l compared with 152.0 (16-398) micrograms/l (median (range)), respectively. Moreover, pericardial fluid ferritin concentration was significantly (P < 0.01) greater in patients undergoing coronary artery bypass grafting than in those undergoing heart valve replacement, whereas serum ferritin concentrations did not differ between the two patient populations. CONCLUSIONS: As pericardial fluid reflects the composition of the myocardial interstitium, we suggest that ferritin released can serve as a potential source of iron in the cardiac interstitium that may promote the generation of oxygen free radicals. Conversely, we presume that induction of ferritin synthesis, representing an important mechanism by which tissue adapts to hypoxic damage, can afford myocardial cytoprotection.
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BACKGROUND: Interleukin (IL) 6 has an important role in the regulation of acute-phase proteins (APPs) during an acute-phase response. We studied IL-6 and other cytokines to determine if they regulate serum APP levels in the same way under the condition of the aberrant, long-lasting 'acute-phase response' that occurs in patients with chronic inflammation and cancer. METHODS: Serum levels of nine positive APPs [CRP, SAA, C1-INH, Bf, C5, C8, C9, alpha 1-acidic glycoprotein (AGP) and haptoglobin] and two negative APPs [transferrin and alpha 2-HS glycoprotein (AHSG)] were measured using immunochemical methods in 59 multiple myeloma patients and in 72 healthy control subjects. Serum IL-6 and tumour necrosis factor (TNF) alpha levels were determined by bioassays. RESULTS: IL-6 was negatively correlated with five out of nine (C1-INH, C8, C9, AGP and haptoglobin) positive APPs but positively correlated with C-reactive protein (CRP). When patients with high and low IL-6 serum concentration were compared, CRP levels were higher, AGP and haptoglobin levels were lower in the high- than in the low-L-6 group, whereas no significant difference between the two groups was found in levels of the other positive and negative APPs. TNF-alpha levels were negatively correlated with transferrin and AHSG levels. No difference in the levels of positive APPs was observed between patients with low and high TNF-alpha serum concentration. By contrast, levels of both transferrin and AHSG were significantly lower in the high- than in the low-TNF-alpha group. CONCLUSIONS: These findings indicate that, except for regulation of the negative APPs by TNF-alpha, the mechanism of APP regulation is different under the conditions of the short-term and the chronic, long-lasting 'acute-phase reaction'.
The blood samples of 229 volunteers (100 men, aged 35-59 y and 129 women, aged 35-54 y) were randomly selected and analysed for serum lipids (triglyceride, total, HDL- and LDL-cholesterol), apolipoproteins (apolipoprotein A1, A2 and B) and Lp(a). The mean serum level of triglyceride was in the high risk category in males (2.50 +/- 2.27 mmol/L) and in normal range in females (1.31 +/- 0.82 mmol/L). Concentrations of total cholesterol (male: 5.93 +/- 1.16, female: 5.66 +/- 0.99 mmol/L) and LDL-cholesterol (male: 3.72 +/- 0.94, female: 3.55 +/- 0.81 mmol/L) were in the borderline risk category, and up to the 75th percentiles both total cholesterol (male: > 6.71, female: > 6.25 mmol/L) and LDL-cholesterol (male: > 4.38, female: > 4.10 mmol/L) were in the high risk categories. The mean values of HDL-cholesterol and apolipoprotein A1, A2 and B were in the desirable range in both sexes, but apolipoprotein B in males and females (male: > 1.3, female: > 1.29 g/dl) were in the high risk category up to the 75th and 90th percentiles, respectively. The mean levels of serum Lp(a) were 19.5 +/- 25.0 and 21.0 +/- 25.2 mg/dl for men and women, respectively, and up to the 75th percentiles were in the high risk category (> 30 mg/dl) both in males and females.
Amantadine prophylaxis was performed in 91 patients during influenza A epidemics. It was used for patients with chronic heart, pulmonary and metabolic disease, for immundeficienty and elderly patients. Patients with gravidity, lactation, epilepsy, peptid ulcer or serious liver disorder were excluded from prophylaxis. The daily dose was 200 mg, which was reduced to 100 mg in people over 65. The chemoprophylaxis was combined with killed influenza vaccine in 6 patients. No influenza-like illness occurred among patients with prevention. Light side-effect was observed in 5 patients. Ten peoples who were excluded from prophylaxis caught serologic proven influenza. Amantadine prophylaxis is appropriate for prevention of nosocomial influenza among high-risk patients in institutions because of other diseases.
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The 60 year old man was admitted because of aphasia and hemiparesis. After cranial computed tomography 15 ml parietal hematoma was removed by stereotaxic biopsy. The patient had hyperpyrexia, combined mitral vitium and atrial fibrillation. There was no symptom of gastroenteritis. Salmonella enteritidis was cultured from blood three times. The vegetation was proved by transoesophageal echocardiography. Ampicillin + gentamycin, amoxicillin-clavulanate + amikacin therapy was ineffective, respectively. During ciprofloxacin therapy of usual dose ceased the toxicosis and hyperpyrexia, but remained fever to 38.5 degrees C. During 750 mg ciprofloxacin t. i. d. intravenous followed 750 mg t. i. d. per os plus 1.5 g cefuroxin t. i. d. intravenous for 46 days became the patient afebrile and the vegetation was disappeared. No side effect was observed with ciprofloxacin of unusual high daily dose.
Five days' ciprofloxacin treatment resulted quick clinical improvement in all of the 45 patients with salmonella gastroenteritis and stool cultures of 35 patients became negative. The advantages of ciprofloxacin treatment are analysed in comparison with previous antibiotics. Indications for new quinolones in the treatment of salmonella gastroenteritis are summarized. It is emphasized that antibiotic therapy is unnecessary in mild cases of salmonella gastroenteritis. This is demonstrated on the basis of case reports of 12 patients with symptomatic treatment too.
The authors reviewed data of 137 patients with purulent meningitis treated in the period of 10 years. Attention was paid to the frequency of predisposing and associated diseases, to the factors helping and delaying the diagnosis and to those altering the prognosis. The importance of effective supportive care, particulary covering pressure of the CNS as well as specific therapy was stressed. The circumstances and the conditions of management depending on the condition of the patient was emphasized. Thirty eight of patients (27%) has died.
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