Ágnes Jermendy
Semmelweis University
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Featured researches published by Ágnes Jermendy.
Clinica Chimica Acta | 2008
Attila Molvarec; Ágnes Jermendy; Bálint Nagy; Margit Kovács; Tibor Várkonyi; Petronella Hupuczi; Zoltán Prohászka; János Rigó
BACKGROUND Preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome are multifactorial disorders with genetic and environmental components. Given that the tumor necrosis factor (TNF)-alpha G-308A single nucleotide polymorphism (SNP) affects TNF-alpha gene transcription and that preeclampsia and HELLP syndrome are characterized by a shift towards a Th1-type maternal immune response with increased TNF-alpha production, the aim of the current study was to investigate whether this SNP is associated with preeclampsia and HELLP syndrome in a Caucasian population from Hungary. Additionally, we aimed to examine whether TNF-alpha G-308A polymorphism can influence the risk for fetal growth restriction in preeclamptic patients, which issue none of the earlier studies dealt with. METHODS In a case-control study, we analyzed blood samples from 140 preeclamptic patients, 69 patients with HELLP syndrome and 144 normotensive, healthy pregnant women using the polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) method. We performed also a meta-analysis with our results and those of 8 previously published studies. RESULTS There were no significant differences in the genotype and allele frequencies of the TNF-alpha G-308A polymorphism between preeclamptic patients and normotensive, healthy pregnant women. However, the mutant (TNF2 or A) allele occurred significantly more frequently in preeclamptic patients with IUGR than in those without IUGR (18.5% versus 7.1%, p=0.003). In addition, the frequency of the mutant allele carriers was significantly higher among preeclamptic patients with IUGR compared to those without IUGR (30.6% versus 12.8%, p=0.010). The mutant allele carriers were found to have an increased risk of severe IUGR-complicated preeclampsia, which was independent of maternal age, prepregnancy BMI and primiparity (odds ratio (OR): 2.89, 95% confidence interval (CI): 1.16-7.22, p=0.023; adjusted OR: 2.78, 95% CI: 1.04-7.45, p=0.042). Nevertheless, no significant differences were detected in the genotype and allele frequencies of the TNF-alpha G-308A polymorphism between patients with HELLP syndrome and control subjects. In the meta-analysis, no association was observed between this SNP and preeclampsia (summary OR: 0.956, 95% CI: 0.693-1.319). CONCLUSIONS Although the meta-analysis demonstrated a lack of an overall association between TNF-alpha G-308A polymorphism and preeclampsia, our results suggest a role of this SNP in the risk of severe IUGR-complicated preeclampsia. However, further studies are required with a larger sample size to confirm our findings.
Hypertension Research | 2008
Attila Molvarec; Ágnes Jermendy; Margit Kovács; Zoltán Prohászka; János Rigó
Preeclampsia is a multifactorial disorder with genetic and environmental components. As Toll-like receptor 4 (TLR4) has an essential role in innate immune response, which is exaggeratedly activated in preeclampsia, our aim was to investigate whether two single nucleotide polymorphisms (SNPs) of the TLR4 gene—Asp299Gly (A896G) and Thr399Ile (C1196T)—are associated with preeclampsia in a Caucasian population from Hungary. In a case-control study, we analyzed blood samples from 180 preeclamptic patients and 172 normotensive, healthy pregnant women with the polymerase chain reaction (PCR)−restriction fragment length polymorphism (RFLP) method. The linkage disequilibrium (LD) profile of the TLR4 gene was investigated and tag SNPs were identified using data from the International HapMap Project. There were no significant differences in the genotype and allele frequencies of Asp299Gly and Thr399Ile polymorphisms between the two study groups. Additionally, no significant difference was found in the distribution of the estimated haplotypes created by the two polymorphisms between the preeclamptic and the control group. Furthermore, no significant differences were detected in the genotype, allele and haplotype frequencies of Asp299Gly and Thr399Ile TLR4 SNPs between patients with mild and severe preeclampsia, between patients with late and early onset of the disease, or between preeclamptic patients with and without fetal growth restriction. In conclusion, we did not find an association between TLR4 Asp299Gly and Thr399Ile gene polymorphisms and preeclampsia. As the Thr399Ile polymorphism is a highly informative tag SNP of the TLR4 gene, our results suggest that variations in this genomic region are not associated with preeclampsia. Nevertheless, further studies are required with determination of fetal TLR4 genotypes to explore the role of TLR4 gene polymorphisms in the risk of preeclampsia, especially in ethnically different populations.
Journal of Pediatric Endocrinology and Metabolism | 2011
Ágnes Jermendy; Anna Körner; Margit Kovács; László Madácsy; Károly Cseh
Abstract Aim: The aim of the study was to investigate the association between PPAR-γ2 Pro12Ala polymorphism and laboratory characteristics of carbohydrate metabolism in children and adolescents with obesity. In addition, serum levels of tumor necrosis factor (TNF)-α, and soluble form of its receptors (sTNFR1 and sTNFR2) were assessed. Methods: In a cross-sectional study, 79 obese children and adolescents of Caucasian origin were investigated. PPAR-γ2 Pro12Ala polymorphism was determined using polymerase chain reaction – restriction fragment length polymorphism technique. Serum levels of TNF-α, sTNFR1 and sTNFR2 were measured by enzyme amplified sensitivity immunoassay. Results: The minor Ala allele frequency was found to be 14.56% in our cohort. No significant differences in age, BMI, waist circumference, blood pressure, serum lipid, uric acid, TNF-α, sTNFR1 and sTNFR2 values were found between carriers of the Ala allele (Pro/Ala and Ala/Ala; n=21) vs. homozygous carriers of the Pro allele (Pro/Pro; n=58). However, post-challenge (120 min) plasma glucose and insulin values were significantly lower in Ala allele carriers vs. homozygous Pro allele carriers (6.56±0.26 vs. 7.36±0.25 mmol/L and 65.9±13.8 vs. 111.8±20.7 μU/mL, respectively; p<0.05); while no significant differences were found at fasting state. Conclusions: The association between PPAR-γ2 Pro12Ala polymorphism and glucose metabolism is already present in children and adolescents with obesity who might be at the very beginning of the natural course of type 2 diabetes. At this stage, higher insulin sensitivity can be detected in Ala allele carriers compared to homozygous Pro subjects at post-challenge but not in fasting state; however, the TNF-system seems not to be involved in the alteration of glucose homeostasis due to PPAR-γ2 Pro12Ala polymorphism.
Biochemistry | 2014
Petra Rovó; Viktor Farkas; Pál Stráner; Mária Szabó; Ágnes Jermendy; Orsolya Hegyi; Gábor K. Tóth; András Perczel
Exendin-4 (Ex4) is a potent glucagon-like peptide-1 receptor agonist, a drug regulating the plasma glucose level of patients suffering from type 2 diabetes. The molecules poor solubility and its readiness to form aggregates increase the likelihood of unwanted side effects. Therefore, we designed Ex4 analogues with improved structural characteristics and better water solubility. Rational design was started from the parent 20-amino acid, well-folded Trp cage (TC) miniprotein and involved the step-by-step N-terminal elongation of the TC head, resulting in the 39-amino acid Ex4 analogue, E19. Helical propensity coupled to tertiary structure compactness was monitored and quantitatively analyzed by electronic circular dichroism and nuclear magnetic resonance (NMR) spectroscopy for the 14 peptides of different lengths. Both (15)N relaxation- and diffusion-ordered NMR measurements were established to investigate the inherent mobility and self-association propensity of Ex4 and E19. Our designed E19 molecule has the same tertiary structure as Ex4 but is more helical than Ex4 under all studied conditions; it is less prone to oligomerization and has preserved biological activity. These conditions make E19 a perfect lead compound for further drug discovery. We believe that this structural study improves our understanding of the relationship between local molecular features and global physicochemical properties such as water solubility and could help in the development of more potent Ex4 analogues with improved pharmacokinetic properties.
Pediatric Diabetes | 2018
Ágnes Jermendy; Ildikó Szatmári; Anna Körner; Attila J. Szabó; Péter Tóth-Heyn; Robert Hermann
Infections, mostly of viral origin, may contribute to the seasonal variation in the onset of type 1 diabetes mellitus (T1DM). The rs1990760 (A>G, Ala946Thr) polymorphism (GG genotype) of the interferon induced helicase (IFIH1), a virus recognition receptor, confers a modest protection for T1DM. The aim of our study was to evaluate a possible association between this IFIH1 polymorphism and the seasonal variation in the onset of T1DM.
Ideggyogyaszati Szemle-clinical Neuroscience | 2018
Andrea Lakatos; Márton Kolossváry; Miklós Szabó; Ágnes Jermendy; Zsolt Bagyura; Péter Barsi; Gábor Rudas; Lajos R. Kozak
Background and purpose To develop an evidence-based, standardized structured reporting (SR) method for brain MRI examinations in neonatal hypoxic-ischemic encephalopathy (HIE) suitable both for clinical and research use. Methods SR template development was based on comprehensive review of the pertinent literature with the basic sections and subdivisions of the template defined according to MRI sequences (both conventional and diffusion-weighted, MR-spectroscopy (MRS), and T2*-weighted imaging), and the items targeted on age-related imaging patterns of HIE. In order to evaluate the usability of the proposed SR template we compared data obtained from the brain MR image analysis of 87 term and 19 preterm neonates with the literature. The enrolled 106 infants were born between 2013 and 2015, went through therapeutic hypothermia according to the TOBY criteria due to moderate to severe asphyxia and had at least one brain MRI examination within the first two weeks of life. Ethical approval was obtained for this retrospective study. Descriptive statistical analysis was also performed on data exported from the structured reporting system as feasibility test. Results The mean gestational age of the study population was 38.3±2.2 weeks; brain MRI was performed on 5.8±2.9 day of life, hence in 78% of our patients after the conclusion of therapeutic hypothermia. Our main imaging findings were concordant to the pertinent literature. Moreover, we identified a characteristic temporal evolution of diffusion changes. Interestingly 18% (n=19/106) of the clinically asphyxiated infants had isolated axial-extraaxial haemorrhage without any imaging sign of HIE. Conclusion In this article our approach of reporting HIE cases with our novel SR template is described. The SR template was found suitable for reporting HIE cases, moreover it uncovered time and location dependent evolution of diffusion abnormalities (and pseudonormalization, as well), suggesting its usefulness in clinical research applications. The high number of isolated intracranial haemorrhages, and the changing diffusion pattern emphasizes the importance of early imaging in HIE.
Early Human Development | 2018
Kata Kovacs; Eniko Szakmar; Unoke Meder; Anna Cseko; Attila J. Szabó; Miklós Szabó; Ágnes Jermendy
Abstract Background Hemodynamic instability due to cardiovascular insufficiency is a common complication in asphyxiated, cooled neonates. Hypotension is often resistant to volume and catecholamine administration, which could be related to low serum cortisol values. Relative adrenal insufficiency (RAI) has not been studied in detail in critically ill, hypotensive neonates with perinatal asphyxia between the 0 and 168th postnatal hours (during and immediately after hypothermia treatment). Aims To assess serum cortisol values in asphyxiated, hypotensive infants treated with hypothermia and examine the relationship between serum cortisol values and severity of illness. Methods We conducted a retrospective cohort study between 2007 and 2016, including term neonates with moderate-to-severe hypoxic-ischemic encephalopathy who underwent standard hypothermia treatment. Cortisol values were measured in 79 infants whenever hypotension occurred in the first week of life. Results Serum cortisol values displayed an exponential decay characteristic after birth with 89% of the measurements being p = 0.002). Eventually 57% of patients received low-dose hydrocortisone supplementation (HCS) at a median dose of 0.6 [0.5; 1.0] mg/kg due to hemodynamic instability and suspected RAI. Among those who were available for follow-up, patients with or without HCS scored similarly on the Bayley-II. Conclusions Our results suggest that asphyxiated, cooled infants presenting with hypotension were likely to have low serum cortisol values. Further studies are needed to test the efficacy and long-term safety of hydrocortisone administration in the treatment of hypotension in asphyxiated, cooled neonates.
Acta Paediatrica | 2018
Eniko Szakmar; Kata Kovacs; Unoke Meder; Géza Bokodi; Andras Szell; Zsolt Somogyvari; Attila J. Szabó; Miklós Szabó; Ágnes Jermendy
We investigated the association between active hypothermia and hypocapnia in neonates with moderate‐to‐severe hypoxic‐ischaemic encephalopathy (HIE) transported after birth.
Orvosi Hetilap | 2017
Kata Kovacs; Enikő Szakmár; Ünőke Méder; Márton Kolossváry; Zsolt Bagyura; Lilla Lamboy; Zsuzsanna Élő; Attila Szabo; Miklós Szabó; Ágnes Jermendy
Absztrakt: Bevezetes es celkitűzes: A hypothermias kezelesben reszesult hypoxias-ischaemias encephalopathias ujszulottek osszegyűjtott vizsgalati adatait elemeztuk a Semmelweis Egyetem, I. Gyermekgyogyaszati Klinika harmas szintű Perinatalis Intenziv Centrumaban. Modszer: Retrospektiv kohorszvizsgalatunkban a 2013–2015 kozott szuletett, erett, hypoxias-ischaemias encephalopathia kovetkezteben hypothermias kezelesben reszesult 97 beteg adatait ertekeltuk, sajat fejlesztesű regiszter segitsegevel. Eredmenyek: A gyermekek 59,8%-a csaszarmetszessel szuletett, az első vergazvizsgalat soran eszlelt pH 7,0 ± 0,2, pCO2 55,9 ± 27,3 Hgmm, bazishiany 16,7 ± 7,2 mmol/l, illetve laktatszint 13,3 ± 4,7 mmol/l (x ± SD) volt. A hypothermias kezeles 93,7%-ban mar a neonatalis transzport alatt megkezdődott, atlagosan 2,5 ± 0,3 oras eletkorban. Az asphyxiahoz gyakran tarsulo sokszervi elegtelenseg betegeink 83,2%-anal volt jelen. Az intenziv terapiaval toltott median idő 10,8 nap volt. Betegeink 61,3%-a az intenziv terapiat...INTRODUCTION AND AIM We aimed to analyze patient characteristics of term neonates with hypoxic-ischemic encephalopathy treated with hypothermia at the 3rd level Neonatal Intensive Care Unit of the 1st Department of Pediatrics, Semmelweis University. METHOD We conducted a retrospective cohort analysis between 2013-2015, including 97 asphyxiated neonates with HIE who received hypothermia treatment, using our in-house developed novel registry database. RESULTS 59.8% of neonates were born with Cesarean section and the first blood gas analysis showed a pH of 7.0 ± 0.2, pCO2 55.9 ± 27.3 mmHg, base deficit 16.7 ± 7.2 mmol/l, and lactate levels of 13.3 ± 4.7 mmol/l (x ± SD). Hypothermia treatment was started during neonatal transport in 93.7% of the cases, at 2.5 ± 0.3 hours of age. Multiorgan failure associated with the perinatal asphyxia was present in 83.2% of the patients. Patients received intensive therapy for a median of 10.8 days, 61.3% of neonates were discharged home directly, 32.2% required further hospital treatment, and 6.5% died. CONCLUSION Our novel registry database allowed for a quick, user-friendly and time-efficient analysis of patient characteristics in neonates with HIE. This registry could aid institutional audit work and prospective clinical data collection. Orv. Hetil., 2017, 158(9), 331-339.
Archives of Disease in Childhood | 2014
Hajnalka Barta; Ágnes Jermendy; Márton Kolossváry; Gábor Rudas; Miklós Szabó
Background and aims Neonatal hypoxic-ischaemic encephalopathy (HIE) can lead to neurodevelopmental impairment, raising a need for early prognostic tools to guide therapy. The prognostic value of HMRS performed between 5–30 days of life has been extensively studied, although few studies focus on earlier periods. Therefore, we investigated the prognostic performance of HMRS during the first 96 h of life. Methods 55 consecutive hypothermia-treated HIE neonates were examined by HMRS at three echo-times (TE = 35 ms, 144 ms, 288 ms) between 6–96 h of age, depending of clinical stability. Patients were divided into favourable (n = 38) and unfavourable (n = 17) outcome groups based on Bayley II MDI and PDI scores (≥70 vs <70 or death, respectively) assessed at 18–26 months of age. Associations between 36 routinely measured metabolite ratios (MROs) and outcome were studied. The prognostic performance of MROs was evaluated by ROC analysis. Time-dependent changes of MROs in whole patient population were also assessed. Results 6 MROs showed significant difference between outcome groups after correction for multiple testing (p < 0.0014). ROC analysis revealed that Myo-inositol/N-Acetyl-Aspartate (TE = 35) gives best prediction for outcome with 85.71% sensitivity and 91.30% specificity. Assessment of time-dependency showed that 4 of 6 MROs stay constant during the first 96 h of life, all containing Myo-inositol. Conclusions Our findings suggest that during the first 96 h of life HMRS could be a useful early prognostic tool in predicting the outcome of asphyxiated neonates. Myo-inositol/N-Acetyl-Aspartate ratio was found to be the best and time-independent predictor.