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Acta Physiologica Hungarica
Authors:
G. Nyírő
,
G. Inczédy-Farkas
,
V. Reményi
,
A. Gál
,
Zs Pál
, and
Mária Molnár

Clopidogrel is an inhibitor of platelet-aggregation used in the prevention of secondary stroke. The molecule is activated by the cytochrome P450 2C19 (CYP2C19) enzyme. The frequent CYP2C19*2 point mutation causes loss of enzyme function, a decreased (heterozygous form) or blocked (homozygous form) formation of the active molecule. Thus, for a patient harboring a mutated allele, clopidogrel does not provide effective protection against stroke. Multiple drugs inhibit the CYP2C19 enzyme and their simultaneous use with clopidogrel is especially hazardous for patients with genetically decreased enzyme activity. Frequency of the CYP2C19*2 is variable in different populations, highest rates were detected in some Asian groups. In our study the CYP2C19 genotype was determined in one Hungarian sample of 354 stroke patients and 221 healthy controls. Frequency of the minor allele was found to be 12.87% (12.85% in stroke patients, 12.89% in healthy controls). The proportion of the homozygous CYP2C19*2 variant causing total loss of gene function was 1.74%, rate of the heterozygous allele causing reduced enzyme activity was 22.26% in the total population. Our results for the allele frequencies of the CYP2C19*2 gene are similar to those found in other Caucasian populations. In conclusion, the homozygous mutation, causing ineffectiveness of clopidogrel is relatively rare. However, the heterozygous form in which interaction of CYP2C19 inhibitors causes further decrease in the genetically impaired enzyme activity is present in every fifth drug-taking patient. Based on our findings, we would like to emphasize that it is important to adjust individually antiplatelet treatment in ischemic stroke patients and to take into consideration genetic factors as well as drugs taken for comorbid conditions.

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Purpose

Reduced functional mobility is a risk factor for falls. The Timed Up and Go test is a complex measurement tool for functional mobility. Our aims were to assess the functional mobility of: (a) community-living elderly who were participating in an exercise programme (n = 40; mean age = 73.7 years), (b) community-living elderly who were physically inactive (n = 40; mean age = 74.1 years), and (c) institutionalized elderly (n = 40; mean age = 73.5 years) and to compare the results with cut-off values for risk of fall.

Materials and methods

After measuring functional mobility, one-way independent ANOVAs and sample t-tests were used for analysis.

Results

The functional mobility of the active participants was better than that of the inactive (p < .001) and institutionalized participants (p < .001). There was no significant difference between the inactive and institutionalized participants (p = .990). The functional mobility of the active participants was better, whereas the functional mobility of the inactive participants was worse than the cut-off value of 13.5 s for risk of fall for community-living elderly. The functional mobility of the institutionalized participants did not differ from the 15-s reference value for predicting risk of fall.

Conclusion

The results indicate that regular physical activity has a positive effect on maintaining functional mobility among both community-living and institutionalized elderly individuals.

Open access

Abstract

Marfan syndrome is a genetic disorder of the connective tissue, including involvement of the lungs.

Pulmonary function test was performed in 32 asymptomatic adult Marfan patients using European Community for Coal and Steel (ECCS) and Global Lung Function Initiative (GLI) reference values.

Using GLI equations for reference, significantly lower lung function values were noted for forced vital capacity (FVC) (87.0 ± 16.6% vs. 97.1 ± 16.9%; P < 0.01) and forced expiratory volume in the first second (FEV1) (79.6 ± 18.9% vs. 88.0 ± 19.1%; P < 0.01) predicted compared to ECCS. Obstructive ventilatory pattern was present in 25% of the cases when calculating with GLI lower limit of normal (LLN), and it was significantly more common in men as compared to women (n = 6, 50% vs. n = 2, 10%; P = 0.03).

GLI is more suitable to detect early ventilatory changes including airway obstruction in young patients with special anatomic features, and should be used as a standard way of evaluation in asymptomatic Marfan population.

Open access