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Mortality and Long-Term Outcome of Neonates with Congenital Heart Disease and Acute Perinatal Stroke:A Population-Based Case-Control Study

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Congenital Heart Disease 2022年第4期17卷 447-461页

作者： Eszter Vojcek vanna gyarmathy Rozsa Graf Anna M.Laszlo Laszlo Ablonczy Zsolt Prodan Istvan Seri First Department of Pediatrics Semmelweis UniversityMTA Centre of ExcellenceBudapestHungary Department of Pediatrics Saint John Hospital and North-Buda Unified HospitalsBudapestHungary Epiconsult BioMedical Consulting and Medical Communications Agency DoverUSA Department of Epidemiology Johns Hopkins UniversityBaltimoreUSA Department of Rehabilitation Saint John Hospital and North-Buda Unified HospitalsBudapestHungary Institute of Mathematics and Base Sciences Hungarian University of Agriculture and Life SciencesGödöllőHungary Gottsegen National Cardiovascular Center BudapestHungary Children’s Hospital Los Angeles University of Southern CaliforniaLos AngelesUSA

Objective:Neonates with congenital heart disease(CHD)and perinatal stroke have high mortality and survivors are at risk for poor long-term neurodevelopmental *** aim of this study was to assess the risk factors and outcome of neonates with both CHD and MRI-confirmed perinatal stroke(Study Group)and compare those to the risk factors and outcome of infants matched for CHD without stroke(Control-1)and of infants matched for MRI-confirmed stroke without CHD(Control-2).Methods:We conducted a population-based case-control study enrolling 28 term neonates with CHD and MRI-confirmed acute perinatal stroke born between 2007–2017 in the Central-Hungarian *** of the control groups included 56 *** Bayley Scales of Infant Development-II,the Brunet-Lézine test and the Binet Intelligence scales-V were used for neurodevelopmental follow-up at a median age of 61 ***:Mortality was highest in the Study Group(25%compared to 5%and 2%,respectively,p=0.001).Adverse neurodevelopmental outcome was prevalent in the Study(53%)and Control-2 Groups(52%,p=0.03).Significantly different parameters among the three groups included Apgar scores,mode of delivery,gestational age at birth,cardiac interventions and twin *** a multivariable regression analysis adjusted for clinically relevant parameters,patients in the Study Group had significantly higher odds for mortality compared to patients in the Control-1 Group(OR:6.595%CI:1.1–39.4).Conclusions:Neonates with perinatal stroke and CHD are at a higher risk for dying compared to neonates with CHD without *** addition,the stroke-associated direct insult to the brain likely plays an important role in the development of neurodevelopmental morbidity in these patients.

关键词： Congenital heart disease perinatal stroke neurodevelopmental outcome mortality

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HIV among people who inject drugs in Hungary

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Infectious Diseases of Poverty 2017年第1期6卷 1289-1293页

作者： Andras Ortutay vanna gyarmathy Zsuzsa Marjanek Karoly Nagy Jozsef Racz Istvan Barcs Anaesthesiology and Intensive Care Unit Javorszky Idon HospitalVácHungary Johns Hopkins Bloomberg School of Public Health BaltimoreMDUSA Faculty of General Medicine Institute of Medical MicrobiologySemmelweis UniversityBudapestHungary Institute of Psychology Eotvos Lorand UniversityBudapestHungary Faculty of Health Sciences Department of AddictologySemmelweis UniversityBudapestHungary Faculty of Health Sciences Department of EpidemiologySemmelweis UniversityBudapestHungary

Background:Before 2014(the year of closure of the two largest needle exchange programs in Hungary,which halved the number of available syringes in the country despite increased injecting risk practices)no HIV was reportedly acquired in Hungary among people who inject drugs(PWIDs)who were not also men who had sex with other men(MSM).In 2014,one and in 2015 two non-MSM PWIDs were newly diagnosed with HIV who supposedly became infected in Hungary,and both incident HIV cases in 2015 were diagnosed in the AIDS *** addition,two new(albeit supposedly imported)non-MSM PWID cases were also registered in the first three quarters of 2016,one of which subsequently was diagnosed with and then died of *** the same time,the prevalence of HCV doubled among PWIDs(from 24%to 49%in Hungary and from 34%to 61%in Budapest).Case presentation:The case that we discuss in this paper is a male PWID,who was diagnosed with HIV and AIDS in May of 2015 and then died of AIDS the next *** HIV infection status was detected with delay,and then appeared in the official statistics as an incident PWID HIV case and an incident PWID AIDS case,but not as an incident PWID AIDS *** contact tracing followed,even though it would have been relatively easy considering the *** our knowledge,no HIV post-exposure protocol exists in hospitals,in case of HIV exposure due to an eventual needle-stick ***:Our paper draws attention to recently published HIV and AIDS surveillance data,and shows the failure of the *** sounding the alarm based on three newly detected PWID HIV cases in the past 2 years may be premature,there are definitely serious problems in the HIV detection and tracing system among PWIDs in Hungary.

关键词： People who inject drugs HIV/AIDS Surveillance

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Lactate reloaded–reevaluation of the importance of lactate monitoring in the management of adult sepsis in the emergency department

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BIOCELL 2021年第3期45卷 445-449页

作者： GABOR XANTUS BALINT KISS GYULA MOLNAR CANDICE MATHESON V.A NNA gyarmathy PETER L.KANIZSAI Cardiff University CardiffCF103ATUK Semmelweis University Budapest1085Hungary Dalhuis University Halifax HalifaxNS B3H 4R2Canada EpiConsult Biomedical Consulting and Medical Communications Agency DoverDE 19901USA Pecs University Clinical CentrePecs7626Hungary

For about a quarter of a century,monitoring lactate levels and/or lactate clearance has been an unquestionable cornerstone in sepsis *** elevated lactate level appeared to be an independent predictor of mortality,and the consequent metabolic acidosis was thought to explain a number of pathophysiological changes seen in septic *** physiological and clinical findings seem to challenge the adverse role of lactic acidosis in *** suggests that lactate levels are not necessarily directly proportional to either tissue or cellular hypoxia,and conversely,despite high lactate levels,increased peripheral tissue oxygen pressure can be measured in adult patients with septic *** to the most recent understanding of in vitro and in vivo evidence,the elevated lactate level in sepsis might be a normal reaction due to adrenergic stress with potential beneficial/protective physiological effects,as *** the one hand,burning lactic may help fuel the body during critical illness,but on the other hand,with a slight drop in pH,the body may counteract certain deleterious changes during the dysregulated host response;reduce the chances of reperfusion myocardial injury,and improve tissue oxygenation by shifting the haemoglobin dissociation curve to the *** the pathophysiological process in sepsis resulting in elevated lactate levels may aid management in an emergency,medicine,and intensive care *** more in-depth physiological knowledge,physicians may inevitably surpass normalisation heuristics and deliver personalized rather than protocolised sepsis resuscitation.

关键词： Reevaluation Lactate Sepsis Resuscitation

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