Biomedical subjects

M Mokán

Publications and source records attributed to M Mokán.

At least 19 recordsLinked to original sources

PubMed2006

[Chronic renal disease and gravidity--case study].

Uremia, the result of renal failure, is a serious clinical problem. Rising azotemia during gravidity significantly increases perinatal morbidity and mortality. This study presents the case of 34 years old patient with 27-year medical history of diabetes mellitus type 1 with diabetic nephropathy and chronic renal insufficiency. The patient got pregnant in the stage of preterminal renal failure. During the first trimester, she showed hypertension and proteinuria. In her 25th week of pregnancy, she was hospitalized with progressive proteinuria, almost uncontrollable hypertension and increased azotemia. Intensive conservative therapy led to a slight decrease of azotemia and proteinuria levels which, however, remained high. In fact, we considered using elimination methods several times. Due to severe hypoxia of the foetus, the gravidity was terminated by section at 30 weeks. After the parturition, the newborn had to be resuscitated. In the first days, the newborn showed increased azotemia which decreased spontaneously after several days. In a month after the termination of gravidity, N-substances increased again and the patient was enrolled in the chronic dialysis programme.

Adult↗

PubMed2004

[Causes of hospitalization in patients on chronic hemodialysis].

UNLABELLED: Patients taking dialysis regularly form a group with higher morbidity and mortality compared with common population. The risk factors of the hospitalization in future in these patients are supposed to be: older age, history of cardiovascular disease, comorbidity, vascular access other than arterio-venous fistula, certain types of nephropathy and serum albumin level < 30 g/l. The number of patients in chronic dialysis treatment in Slovakia rises. Therefore we have performed a retrospective study. It's aim was to evaluate the main reasons and risk factors of hospitalizations in chronic haemodialysis patients in Turciansky region. METHODS: 80 patients undergoing regular haemodialysis treatment in 2 dialysis centres during 24 months were included. Following data were collected: age, gender, comorbidity, type of nephropathy, residual diuresis, some data connected with dialysis treatment, laboratory parametres and body mass index. RESULTS: During the given period of time 66 per cent of the patients of our sample required hospitalization. The main reasons of their hospitalization were complications of vascular access (13%), surgery (12%), the sepsis (9%) and serious bleeding (9%). Hospitalized patients showed significantly lower BMI and residual diuresis compared with non-hospitalized ones. They also suffered from greater amount of other diseases. As for gender prevailed men and patients with a history of cardiovascular disease, thrombosis and peptic ulcer. There was no connection between morbidity and age, type of vascular access and laboratory parameters observed.

Adolescent↗

PubMed2004

[Glomerulonephritides, histology forms, way of treatment and therapeutic effect in our patients].

Authors present a group of patients in the article who were monitored at a nephrology outpatient department of the University Hospital in Martin between years 1997 and 2001 for nephritic or nephrotic syndrome. Indications, contraindications and ways of histology examinations of kidneys in their department are discussed in the beginning of the work. Than prevalence of individual types of glomerulonephritides as well as way and length of therapy based on histology picture are discussed in the monitored group of patients. In the end results of therapeutic response are presented. Among other things, authors came to a conclusion that it is the least possible to manage the disease when histology results show sclerotisation of glomerules and in cases of frequent relapses in prolipherative forms of glomerulonephritides.

Adolescent↗

PubMed2004

[Pulmonary embolism, prolonged diagnosis in young man].

Despite progress in early detection and treatment, the rates of mortality and recurrences of pulmonary embolism remain high. Cardiovascular specialists must keep pulmonary embolism in mind when they evaluate patients with unexplained substernal or pleuritic chest pain, dyspnea and syncope because these symptoms constitute the cardinal clinical presentation of pulmonary embolism. Authors are presenting a case report of a patient with repeating pleuritic chest pain with pleural effusion. The patient was treated as suspected tuberculous pleuritis. Authors diagnosed pulmonary embolism as a cause of pleural effusion by elevated plasmatic D-dimer and perfusion lung scan. Thrombosis in left subclavian vein established by angiography was source of embolus. Patient was evaluated regarding primary risk factors for venous thromboembolism and Prothrombin 20210A mutation was detected. Subsequent adequate medical treatment led to significant clinical upturn in this patient.

Adult↗

PubMed2002

[Importance of determination of lymphocytes in intestinal mucosa biopsy specimens using flow cytometry in the evaluation of ulcerative colitis activity].

In this clinical study, we have examined 10 patients with ulcerative colitis. The study group included 5 men and 5 women. The control group consisted of 6 patients with negative colonoscopic finding performed for differential diagnosis of the dyspeptic syndrome. Patients with ulcerative colitis were divided into two groups according to the clinical pattern, macroscopic endoscopic finding, and histological examination of the bioptic specimens. The Ist group of patients with active stage of ulcerative colitis, the IInd group of patients in remission, without clinical and endoscopic signs of disease activity. We have found that from the followed markers the greatest importance lies in the determination of the standard immunologic profile of the mucosa, the determination of activating markers HLA-DR+, CD69, CD122 and CD71 on T-lymphocytes and CD69 and CD71 on B-lymphocytes. The differences between the control group and the group of patients in active stage of the disease were statistically significant. Statistical significance was also found in some of the above-mentioned parameters when comparing the group of active disease and that one in remission (CD4/CD8 ratio, HLA-DR+, CD122 on T-lymphocytes). Our results imply that the changes in the target tissue contribute to more precise assessment and follow-up of therapeutic effect in non-specific inflammatory bowel disease.

Antigens, CD↗

PubMed2002

[Beta-blockers in the treatment of chronic heart failure].

The authors discuss in the submitted review the problem of therapeutic use of beta-blockers in the treatment of cardiac failure. n the introduction they emphasize the medical and societal consequences of this disease with emphasis on necessary prevention. In the subsequent part they present a review of the most important clinical studies (completed and under way) focused on the mentioned problem. In the discussion they analyze the role of the sympathetic nervous system in the pathogenesis of cardiac failure and the theoretical basis of the use of beta-blockers in its treatment. In the conclusion they present a summary of practical principles for the use of beta-blockers in this indication.

Adrenergic beta-Antagonists↗

PubMed2001

[The phenomenon of unawareness of hypoglycemia].

The incidence of hypoglycaemic episodes in patients with type 1 diabetes mellitus (DM1) is frequent. They experience 1-2 symptomatic hypoglycaemias per week. 10-20% of the patients suffer from at least one severe hypoglycaemia per year. The incidence of severe hypoglycaemia in a group of intensely treated patients is about three times as high as compared with standard treatment and 55% of all episodes occur during sleep. Prevention of hypoglycaemia, and restoration of euglycaemia resp. include disappearance of metabolic effects of insulin and activation of glucose contraregulating systems among which there is a certain hierarchy. The phenomenon of unaware hypoglycaemia (FNH) is defined as failure to diagnose autonomous warning symptoms, and their non-appearance before the development of neuroglycopenia. The incidence of FNH in the population with DM1 is frequent. Based on a standardized insulin diffusion test 26% of patients with DM1 suffer from it which means that every fourth patient is affected. In the pathogenesis of FNH various factors and mechanisms were suggested as predisposing. Most probably a defect at the level of the central nervous system is involved caused by: 1. a reduced ability to recognize the decline of the blood sugar level by the CNS (altered function of the hypothalamic glucostat and/or glucose transport across the haematoencephalic barrier), 2. reduced secretion of neurotransmitters, 3. reduced tissue response to adequate neurotransmitter secretion. The theory of etiopathogenesis must explain and define its association with the persistence of diabetes mellitus, strict metabolic control, autonomous neuropathy and repeated episodes of hypopglycaemia. The contemporary hypothesis of the pathogenesis of FNH is the mechanism of repeated frequent hypoglycaemia which leads to general adaptative changes at the level of the CNS by increased glucose transport across the haematoencephalic barrier which leads to reduced hormonal responses and reduction of symptoms. Thus a dangerous circulus vitiosus is created where hypoglycaemia induces unawareness of hypoglycaemia. This condition is at least partly reversible. The presence of FNH should influence the decision of the physician before using an intensified insulin regimen in diabetics.

Autonomic Nervous System↗

PubMed2001

[Respiratory disorders during sleep in patients with diabetes mellitus].

Respiratory disorders during sleep are a serious medical, economic and social problem. In the submitted review the authors discuss the possible relationship between sleep disorders and diabetes. In the introduction they make the reader familiar with basic information on sleep apnoea, incl. the definition, classification and basic pathomechanisms leading to this disorder. In the subsequent part the authors discuss possible relations between the two diseases, the possible participation of diabetic autonomous neuropathy in the pathogenesis of sleep apnoea, the possible influence of hypoglycaemia on sleep quality and the possible influence of sleep apnoea on the development or deterioration of insulin resistance. The objective of the paper is to provide the professional public, but in particular diabetologists, with an overall review of the problem based on most recent data from the literature and to draw attention to the fact that respiratory sleep disorders in diabetics are relatively frequent and that to this problem attention must be paid in practice and in medical research.

Autonomic Nervous System Diseases↗

PubMed2000

[Adrenomyeloneuropathy as the cause of Addison's disease].

The authors describe adrenoleukodystrophy and adrenomyeloneuropathy found in one family. This disease is a less frequent cause of Addison's disease, but it is very serious from the prognostic aspect. The authors recommend therefore to examine very long chain fatty acid plasma levels in patients with adrenal insufficiency.

Addison Disease↗

PubMed1999

[A multicompartmental and multifactorial model of production of plasminogen activator inhibitor (PAI-1). II. Clinical study in patients with insulin resistance].

PAI-1 levels are closely associated with insulin resistance (IR) syndrome, including patients with obesity, hypertension, hypertriglyceridaemia and type 2 diabetes mellitus (DM). Clinical studies demonstrated PAI-1 correlations with insulin (IRI), triglycerides (TG) and body mass index (BMI) values, but these relations have not been confirmed in all studies. In obesity PAI-1 levels correlate with IRI and BMI in the relation to increased adipocyte PAI-1 production, which is dependent on stimulative insulin action. In the case of endothelial hyperproduction in patients with IR elevated PAI-1 levels correlate with TG values. Insulin inhibits induced endothelial PAI-1 production. PAI-1 levels in patients with IR represent cumulative production in described tissues.

Adipocytes↗

PubMed1999

[Latent autoimmune (Type-1) diabetes mellitus in adults. Part. I. Serologic markers of autoimmune involvement of pancreatic beta-cells: GADA, ICA, IA-2 a IA-A].

AIM OF STUDY: To assess the prevalence of markers of autoimmune destruction of pancreatic beta-cells (AIDbeta) in patients classified initially as Type-2 diabetes mellitus (Type-2 DM). SUBJECTS: 250 patients subdivided according to the: 1. BMI and C-peptide, 2. type of treatment. Measured parameters: age, BMI, C-peptide, autoantibodies directed against: glutamic acid decarboxylase (GADA), islet cells (ICA), thyrosinphosphatase (IA-2) and insulin (IA-A). RESULTS: GADA (and other AIDbeta markers) positivity varied from < 5% in patients with overweight/obesity (> 27 kg.m(-2)) and normal/increased C-peptide (> 0.32 nmol/l) to > 30% in non-obese patients with low C-peptide. CONCLUSION: Proportion of diabetics classified initially as having Type-2DM have had in fact slowly evolving autoimmune (Type-1) diabetes mellitus (LADA). In some patients both AID and insulin resistance may coexist in parallel. Pitfalls in interpretation of results of GADA, such as border positivity and similar, are discussed.

Aged↗

PubMed1999

[Latent autoimmune (type I) diabetes mellitus in adults. Part. II. Association of HLA antigens, status of cellular immunity and occurrence of other autoimmune diseases].

AIM OF STUDY: To assess some immunological and immunogenetic aspects in patients with latent autoimmune (Type-1) diabetes mellitus (DM) of adults (LADA). SUBJECTS: 24 patients with LADA, 11 patients with Type-2 DM and 20 healthy volunteers (Pilot study). PARAMETERS TESTED: HLA-DRB1* and HLA-DQB1* alleles, parameters of cellular immunity (CD4+, CD8+, CD3/HLA-DR+, CD8/HLA-DR+, CD45RA+[CD4], CD16+CD56), CD19+, IL-4, INF-gamma and organ specific (OSA) autoantibodies (against thyroid gland, gastric parietal cells, tubuli, basal membranes of glomerulus, AMA and ABBA). RESULTS AND DISCUSSION: Type-1 DM HLA-DRB1* and HLA-DQB1* risk alleles have been found in a majority of patients with LADA. The most frequent were HLA-DRB1*0301 and DQB1*0201. Assessement of parameters of cellular immunity and cytokine profiles (IL-4 a INF-gamma) in peripheral blood did not reveal any contribution to a differentiation between Type-1 and Type-2 DM). We confirmed increased occurence of OSA in patients with LADA, what stress importance of routine screening for OSA in patients with LADA.

Aged↗

PubMed1998

Endogenous digoxin-like immunoactivity in subjects with diabetes mellitus and hypertension.

The serum concentrations of digoxin-like immunoactivity (DLIA) were measured in 99 patients: 20 healthy volunteers (HV), 15 patients with insulin-dependent diabetes mellitus (IDDM), 14 patients with non-insulin-dependent diabetes mellitus without hypertension taking oral hypoglycemic (OHA) agents (NIDDM/-HT), 11 patients with NIDDM without hypertension taking insulin (NIDDM/-HT+INS), 12 NIDDM patients with hypertension taking OHA (NIDDM/+HT), nine NIDDM patients with hypertension taking insulin (NIDDM/+HT/+INS), 10 patients with essential hypertension with normal insulin levels (HT/-HI), and in eight patients with essential hypertension with hyperinsulinemia (HT/+HI). The numbers (%) of subjects with DLIA levels above the detection limit of the assay used (> 0.1 nmol/L) were, in the NIDDM/-HT group, 12/14 (85.7%) and in the NIDDM/+HT group, 9/12 (75%), significantly higher (P < .05) than in the HV (7/20; 35%), IDDM (3/15; 20%), and HT/-HI groups (2/10; 20%). The number and percentage of subjects with DLIA levels above the detection limit in the HT/+HI group was six of eight (75%), significantly (P < .05) higher than in the IDDM and HT/-HI groups, and tended to be higher than in the HV group (P < .055). Means and SD of serum DLIA levels (nmol/L) in the NIDDM/-EH (0.18/0.09) and NIDDM/+EH (0.19/0.15) groups were significantly higher (P < .05) than in the HV (0.09/0.07), IDDM (0.05/0.05), and EH/-HI (0.06/0.06) groups. DLIA levels in the HT/+HI group (0.15/0.12) were significantly higher (P < .05) than in the IDDM and HT/-HI groups. The percentage of DLIA levels above the detection limit, as well as the mean and SD of DLIA in the NIDDM group taking OHA, did not differ from those in subjects taking insulin. In all subjects studied (n = 99), DLIA correlated with C-peptide (r = 0.30; P < .01) and glomerular filtration (GF) (r = -0.21; P < .05). After exclusion of insulin-treated patients, DLIA correlated significantly with plasma glucose (PG; r = 0.25; P < .05), immunoreactive insulin (IRI; r = 0.41; P < .001), C-peptide (r = 0.27; P < .05), and GF (r = -0.26; P < .05) (n = 64). Correlation of DLIA with IRI (r = 0.33; P < .05; n = 38) also persisted after exclusion of patients taking insulin and those with DLIA levels below the detection limit. Similarly, DLIA also correlated with C-peptide (r = 0.64; P < .05) and IRI (r = 0.70; P < .05) in the subgroup of 10 patients with the highest levels of DLIA (> 0.25 nmol/L). None of the sera (n = 15) with different DLIA concentrations (0.0-0.38 nmol/L) exhibited K-pNPPase (Na+-K+-ATPase) inhibitory activity. In conclusion, this work demonstrated elevated serum DLIA in NIDDM and HT/+HI patients, and its correlation with IRI and GF. However, due to the fact that the chemical nature and biologic properties of DLIA are still a matter of debate, it is too early to speculate whether the elevation of DLIA is just a secondary result associated with HI and reduced GF, or whether it also has pathophysiologic consequences. Nevertheless, in both cases the elevated concentrations of substances with DLIA and their interference with antidigoxin antibodies may affect therapeutic monitoring of digitalization in NIDDM and HT/+HI patients. Also, the elevated DLIA could subclassify these patients. The significance of such subclassifications (pathophysiologic, therapeutic, or prognostic), however, will need further investigation.

Adult↗

PubMed1998

[Insulin antibodies in patients with type 2 diabetes mellitus].

AIM OF STUDY: To assess the prevalence of insulin antibodies (IA-A) and their binding capacity (c%IA-A) in Type-2 diabetic patients and relation of IA-A/c%IA-A to duration of diabetes, type of therapy, kind/dosage of administered insulin, glycaemic control and to appearance of hypoglycaemic episodes. SUBJECTS: 196 hospitalised patients with type-2 diabetes mellitus (negative for antiGAD-Ab). Assessed parameters: age, duration of diabetes mellitus, duration of insulin-therapy, BMI, glycaemic profile, IRI, C-peptide, IA-A and antiGAD-Ab (Cis bio international, distr. fy Solupharm). RESULTS: Prevalence of IA-A and their c%IA-A were related to treatment with insulin. c%IA-A correlated significantly with fasting plasma glucose and IRI concentrations. c%IA-A did not correlate with insulin dosages, C-peptide, BMI, nor with age. CONCLUSION: Prevalence of IA-A and their c%IA-A in patients with Type-2 diabetes affects levels of total plasma insulin, insulin kinetic and consequently the quality of glycaemic compensation. Prevalence of IA-A is related to duration of insulin therapy, but independent on dosage of administered insulin.

Aged↗

PubMed1998

[Tissue plasminogen activator and diabetes mellitus].

tPA has been the independent risk factor of the thrombosis associated with atherosclerosis. There are increased tPA levels in type 1 diabetic patients with vascular complications and tPA is endothelial injury marker in this case. In type 2 diabetes mellitus elevated tPA antigen levels in early disease stage are caused by increased production of complexes with inhibitor (PAI-1) and tPA or fibrinolytic activity has been decreased.

Diabetes Mellitus↗

PubMed1998

[A new model of hemostasis].

Haemostasis is a complexly controlled process which takes place in two stages. The first initial stage leads to the formation of a small amount of thrombin. The crucial step of initiation is the bond between the activated factor VIIa and the tissue factor. It is regulated by interaction between factors promoting and inhibiting the process of thrombogenesis. The initiation of haemostasis must be associated with the formation of the thrombus and for effective fibrinogenesis the second stage, amplification of haemostasis, is necessary. A new two-stage model of coagulation imitates the process of haemostasis in vivo as the classical MacFarlan cascade model and makes it possible to explain the pathogenesis of prothrombotic conditions.

Hemostasis↗

PubMed1998

[A multicomparmental and multifactorial model of production of plasminogen activator inhibitor (PAI-1). I. Experimental studies].

Hypofibrinolysis caused by increased PAI-1 levels in patients with insulin resistance (IR) is one of the most common acquired prothrombotic states with higher risk of arterial thrombosis associated with atherosclerosis. Increased PAI-1 levels are caused by PAI-1 hyperproduction in various compartments owing to various factors (multicompartmental and multifactorial model). Metabolic compartment, including visceral adipocytes and hepatocytes, is sensitive on stimulative action of insulin, proinsulin and some cytokines. This pool is responsible for elevated PAI-1 levels in obesity. Vascular compartment, including mainly endothelium, is sensitive on thrombin, angiotensin IV, cytokines, biological active lipids and oxidative stress effect, while insulin inhibits cytokine induced PAI-1 production on contrary. This compartment is responsible for elevated PAI-1 levels in patients with type 2 diabetes mellitus and hypertension with endothelial dysfunction. PAI-1 levels in patients with IR represent cumulative production in described compartments.

Adipocytes↗

PubMed1998

[Glutamic acid decarboxylase autoantibodies (antiGAD-Ab) in patients with non-insulin dependent diabetes mellitus (NIDDM)].

AIM OF STUDY: To assess the prevalence of markers of autoimmune destruction of pancreatic beta-cells in patients with non-insulin dependent diabetes mellitus (NIDDM). SUBJECTS: 127 hospitalized NIDDM patients subdivided to the following subgroups: non-obese with C-peptide < 0.3 nmol/l (NIDDM-(-)), non-obese with C-peptide > 0.3 nmol/l (NIDDM-(+)), obese with C-peptide < 0.3 nmol/l (NIDDM+(-)) and obese with C-peptide > 0.3 nmol/l (NIDDM2+). METHODS AND MEASURED PARAMETERS: Age, BMI, C-peptide, autoantibodies to glutamic acid decarboxylase (antiGAD-Ab), autoantibodies to islet cells (ICA), markers of specific cellular immunity CD4, CD8, CD19, CD4/CD8, CD4/CD45/RA+, CD4/CD45/RA-, NK (CD16+56), CD3/HLADR, organ specific/non-specific autoantibodies. RESULTS: AntiGAD-Ab were positive in 5/15 (33.3%) NIDDM-(-), 1/32 (3.1%) NIDDM-(+), 2/9 (22.2%) NIDDM+(-) and in 3/71 (4.2%) NIDDM2+. The positivity of antiGAD-Ab in NIDDM-(-) and NIDDM+(-) was significantly higher (p < 0.05) than in NIDDM-(+) and NIDDM2+. CONCLUSION: Some patients with manifestation of diabetes in older age initially classified and treated as having NIDDM may have in fact slowly evolving autoimmune insulin-dependent diabetes mellitus (LADA). These patients can be identified by measurement of antiGAD-Ab or other markers (ICA, IA-2) of autoimmune destruction of pancreatic beta-cells (AID). Moreover, in some patients both AID and insulin resistance may coexist in parallel.

Adult↗