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Acta Physiologica Hungarica
Authors:
Bernadett Borda
,
Cs. Lengyel
,
T. Várkonyi
,
É. Kemény
,
A. Ottlakán
,
A. Kubik
,
Cs. Keresztes
, and
Gy. Lázár

New-onset diabetes after transplantation (NODAT) is one of the frequent complications following kidney transplantation. Patients were randomized to receive cyclosporine A- or tacrolimus-based immunosuppression. Fasting and oral glucose tolerance tests were performed, and the patients were assigned to one of the following three groups based on the results: normal, impaired fasting glucose/impaired glucose tolerance (IFG/IGT), or NODAT. NODAT developed in 14% of patients receiving cyclosporine A-based immunosuppression and in 26% of patients taking tacrolimus (p = 0.0002). Albumin levels were similar, but uric acid level (p = 0.002) and the age of the recipient (p = 0.003) were significantly different comparing the diabetic and the normal groups. Evaluation of tissue samples revealed that acute cellular rejection (ACR) and interstitial fibrosis/tubular atrophy (IF/TA) were significantly different in the NODAT group. The pathological effect of new-onset diabetes after kidney transplantation can be detected in the morphology of the renal allograft earlier, before the development of any sign of functional impairment.

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Abstract

Purpose

Falls in older age are the result of the interaction of several modifiable and nonmodifiable risk factors. Risk factors for falls may vary in frequency not only in different economic and cultural contexts but also in different forms of care services among the older population. The aim of the present cross-sectional descriptive observational study was to assess the prevalence of risk factors for falls among older ambulant patients on a chronic inpatient ward in Hungary.

Material/Methods

Data associated with risk factors for falls, such as age, sex, chronic physical and mental illness, acute illness, incontinence, history of falls, balance and gait disorder, and visual impairment, were collected from 82 participants. The frequency of these risk factors in our sample was compared with their prevalence in the elderly population living at home — based on data available in the literature and statistical databases — using chi-square tests.

Results

Our results show that the prevalence of hypertension, cerebrovascular events, dementia and diabetes are significantly higher in the elderly population in chronic inpatient care than in the elderly population living at home. There is also a significantly higher prevalence of balance disorders and the use of sedatives/sleeping pills/neuroleptics in the studied population. Cardiovascular diseases, osteoporosis, and Parkinson's disease are equally prevalent in both populations.

Conclusions

In the case of many of the patients admitted to chronic inpatient care, there is a real chance that their physical condition will improve or stabilise to the point where they can return to their own homes or be moved to a nursing home. This kind of rehabilitation approach to chronic inpatient care would require many more qualified nurses, physiotherapists, occupational therapists, dietitians and social workers than are currently available.

Open access