Cross-sectional survey on the nutritional and life-style habits of secondary school students in Hungary

INTRODUCTION: The national representative survey of secondary school students (age: 15-18 years) was undertaken between 1997 and 2000. The authors presented the data related to the nutritional and life-style habits. METHODS: The data for 6,347 students (48.4% boys and 51.6% girls) were evaluated. The anonymous questionnaire contained inquiries on nutritional rhythm, food frequency, use of vitamin and mineral supplements, smoking, alcohol and drug consumption habits, regular physical activity and family background (qualification, smoking, alcohol consumption). Within the frame of personal interviews the authors collected data on students' history with regard to occurrence of diabetes mellitus, other chronic diseases and in girls the time of the first menstruation. Concerning parents' history the authors collected information on the incidence of hypertension, myocardial infarction, diabetes mellitus, and stroke. STATISTICAL EVALUATION: Data were recorded in Data-Ease database system, in forms of individual records. The individual records were converted to be suitable for the statistical evaluation by SPSS for windows 9 statistical program pack. Data are presented as means and percent distribution. RESULTS: The nutritional rhythm of students was irregular. The daily consumption of milk, dairy products, fruits, fresh vegetables and vegetable dishes was insufficient. Eighty percent of students added extra salt to foods. More than 49% of students regularly consumed some forms of vitamin and/or mineral supplements. Thirty five percent of boys and 30% of girls smoked daily, 14.6% of boys and 5.9% of girls consumed alcohol at least once a week. Fifteen percent of boys and 11% of girls already tried taking drugs at least once. Only 50% of boys and 31% of girls were involved in a regular physical activity. Twenty two percent of fathers and 25% of mothers had university qualifications, whereas intermediate qualifications were recorded in 63 and 59%, lower qualifications occurred in 8 and 13% of parents, respectively. The incidence of smoking was 42% for fathers and 36% for mothers. Weekly alcohol consumption was recorded in 11%, daily consumption in 7% among fathers, the same figures for mothers were 4-4%, respectively. The incidence of hypertension, myocardial infarction, diabetes mellitus, and stroke was 26; 3.4; 5.4 and 1.5% in fathers and 32.9; 4.2; 6.6 and 1.5% in mothers. CONCLUSIONS: The data collected in the complex nutritional hygienic survey revealed serious deficiencies in the nutritional and life style habits of secondary school students. These factors considerably contribute to the unfavorable statistics of nutrition related non-infectious diseases in adulthood.     

Bioethics and the Hippocratic oath

Throughout the long centuries of medical activity, the Hippocratic Oath always had a distinguished place and role within the self definition of curative practice: it contains in a condensed form those ethical principles and moral norms that determine the doctors' behavior and their relationships with their patients and colleagues. The Hippocratic Oath is not the only oath but it is surely the best known and most famous one, that contains both timeless and age dependent norms. The ceremonial taking of the Oath is still a symbol of moral commitment for doctors. The millennia long adherence to the Oath perhaps suggests a timeless stature above all changes of society, but tracing its history, it becomes apparent that, though the text remained essentially the same, the interpretation is greatly influenced by the values and norms of the given age. Even so, the Oath's deontological, normative attribute has made it possible to fulfill its morally regulating role both of level of the profession and the individual, up to the middle of the 20. century. Today, however, classic, bipolar medicine has become complex and varied. Medicine and society have both undergone changes. Bioethics has appeared and become widely accepted. All this raises the question whether the Oath is still suitable for a modern statement of the moral identity of medical practitioners. Does it still have a compulsory force beyond keeping the tradition, and can its norms still be realized in practice? Both the study of texts used for the Oath in Hungarian universities, and the international proposal for modernization--together with the arguments that followed--indicate that if the traditional oath wishes to fulfill its function in the age of modern medicine, it has to adhere to the more up-to-date principles of bioethics, that better correlate with today's expectations.     

Novel biological therapies for the treatment of diabetic foot ulcers

Introduction: The number of people with diabetes mellitus (DM) is estimated to exceed 640 million by the year 2040. Diabetic foot ulcer (DFU) is a debilitating illness that affects more than 2% of DM patients. DFU is caused by DM-induced neural and vascular lesions leading to a reduced sensation and microcirculation. The increase in the prevalence of DFU has prompted researchers to find new therapies for the management of DFU.

Areas covered: This review presents the current status of novel biological therapies used in the treatment of DFU. Literature information and data analysis were collected from PubMed, the website of the American Diabetes Association, and ClinicalTrials.gov. The keywords used in the search were: DM, DFU, complications of DM.

Expert opinion: Many biological agents have been investigated in a bid to find an effective therapy for DFU. These include growth factors (platelet-derived growth factor, vascular endothelial growth factor etc), stem cells (epithelial progenitor-, adipose-derived stem cells etc), anti-diabetic drugs (insulin, exendin-4), herbs, urokinase, dalteparin, statins and bio-agents such as acid peptide matrix. Biological agents that can reduce hyperglycaemia, increase sensation, microcirculation and oxygenation and repair lost tissue are the most ideal for the treatment of DFU.     

Gene signature of the metastatic potential of cutaneous melanoma: too much for too little?

It was expected that with the advent of genomics, oncology may defeat the deadliest forms of cancer including malignant melanoma, but the past years have indicated that this is not the case. Despite the stunning success of genomics in defining markers or gene signatures for breast cancer prognosis and predicting therapies, there is virtually no progression in malignant melanoma. This is happening when experimental oncology or metastasis research is using several rodent and human melanoma models, when our knowledge on the metastatic cascade is actually derived from these models. Our critical analysis of these studies revealed several factors which might be responsible for this failure. First, it is evident, that these studies must be based on rigorous sample collection and basic pathological considerations, where divergent histological types of melanoma cannot be analysed universally. Secondly, without following basic consideration of metastasis biology, the majority of these studies were rarely based on primary tumors but frequently on various types of regional metastases. Third, successful expression profiling studies on other tumors such as breast cancer, provided evidences that the homogeneity of the patient cohort at least by clinicopathological stage is a critical element when defining prognostic signatures. Four studies attempted to define the prognostic signature of skin melanoma but only one based the study on the primary tumor resulting in heterogenous signatures with a minimal overlap (MCM3 and NFKBIZ). Four study attempted to define the invasiveness-signature in the primary tumor based on thickness or growth pattern discrimination identifying a 9-gene overlap which proved to be different from the prognostic signatures. On the other hand, seven studies analyzed various types of metastatic tissues (rarely visceral-, mostly cutaneous or lymphatic metastases) to define the metastasis-signatures, again with minimal overlap (AQP3, LGALS7 and SFN). Using seven GEO-based melanoma datasets we have performed a meta-analysis of the metastasis-gene signatures using normalization protocols. This analysis identified a 350-gene signature, the core of which was a 17-gene signature characterizing locoregional metastases where the individual components occurred in 3 studies: several members of this signature were extensively studied before in context of melanoma metastasis including WNT5A, EGFR, BCL2A1 and OPN. These data suggest that only efficient inter-disciplinary collaboration throughout genomic analysis of human skin melanoma could lead to major advances in defining relevant gene-sets appropriate for clinical prognostication or revealing basic molecular pathways of melanoma progression.     

Changing world of neutrophils

Neutrophilic granulocytes are no longer regarded as cells involved only in the last phase of the immune response with one single—although vitally important—task: engulfing and killing of microorganisms marked by immunoglobulin or complement fragments. In recent years, it was shown that neutrophils are actively involved in initiation and organization of the adaptive immune response by releasing various cytokines, interacting with all major types of immune cells, regulating their own lifespan, and participating in the anaphylactic reaction and in several classically nonimmune functions such as hemostasis, atherogenesis, and even insulin resistance. The antibacterial effect is no longer restricted to killing and destruction of microorganisms sequestered in the phagosomal space. Bacteriostasis also occurs at certain locations of the extracellular space, by formation of neutrophil extracellular traps (NETs) that were shown in the last 2 years to have a significant role in the prevention of dissemination of microorganisms. Extracellular vesicles represent a recently discovered form of intercellular communication carried out both by lipids, proteins, and nucleic acids. In this review, we also summarize the role of neutrophil-derived extracellular vesicles in modifying the function of other cell types as well as their direct antibacterial effect that differs significantly from mechanisms applied either by neutrophils or by the NETs.     

Macroprolactinemia: the consequences of a laboratory pitfall

The objective of this study was to assess the prevalence of macroprolactin, a macromolecule with reduced bioactivity, in hyperprolactinemic patients. Prolactin was measured before and after precipitation of macroprolactin by polyethylene glycol in 306 patients. Only patients with prolactin values >700 mIU/L (n = 270) entered the study. In 23% of the patients, macroprolactinemia was found. In women, the occurrence of macroprolactinemia increased with advancing age (< 30 yr: 16%; 30-45 yr: 28%; > 45 yr: 42%; p < 0.05). A priori clinical signs of hyperprolactinemia (morphological abnormalities in pituitary imaging, galactorrhea infertility) occurred significantly less frequently in macroprolactinemia than in true hyperprolactinemia. In eight females macroprolactinemia and true hyperprolactinemia appeared simultaneously. To avoid diagnostic and therapeutic pitfalls, the screening for macroprolactinemia of all patients with prolactin levels of > 700 mIU/ L is recommended.     

Chronic myeloproliferative neoplasms and risk of osteoporotic fractures; a nationwide population‐based cohort study

Patients with systemic mastocytosis have an increased risk of osteoporosis, however, the risk of osteoporotic fractures among the classic chronic myeloproliferative neoplasms (CMPN), including essential thrombocythaemia (ET), polycythaemia vera (PV) and chronic myeloid leukaemia (CML), is unknown. We conducted a population‐based cohort study to determine the risk of osteoporotic fractures among three cohorts of patients with newly diagnosed ET, PV, and CML. Patients were identified in medical registers including all Danish hospitals during 1980–2010 and were followed until first osteoporotic fracture. Fracture risk was compared to cohorts from the general population matched on age, sex and calendar year. We followed 7595 CMPN patients and 338 974 comparison cohort members. We found that the risk of femoral fracture after 5 years was consistently higher than the general population, being 3·01% (95% confidence interval (CI): 2·20–4·10), 4·74% (95%CI: 4·06–5·52) and 4·64% (95%CI: 3·29–6·53) among ET, PV, and CML patients respectively. Adjusted hazard ratio for femoral fracture was increased 1·19‐fold (95% CI: 0·94–1·51) for ET patients, 1·82‐fold (95% CI: 1·62–2·04) for PV patients, and 2·67‐fold (95% CI: 1·97–3·62) for CML patients. We conclude that CMPN patients are at higher risk of osteoporotic fractures than the general population.     

A Population-Based Case-Control Study on the Effect of Bronchial Asthma During Pregnancy for Congenital Abnormalities of the Offspring

Bronchial asthma is one of the most common maternal diseases complicating pregnancy. We assessed the risks of congenital abnormalities in a case-control population-based analysis using the dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities between 1980 and 1996. Of the 22,843 cases with congenital abnormalities, 511 (2.2%) had mothers with bronchial asthma, while of the 38,151 matched control subjects without congenital abnormalities 757 (2.0%) had mothers with bronchial asthma (unadjusted prevalence odds ratios [POR] 1.2; 95% CI: 1.0-1.3). In all mothers with bronchial asthma, a higher incidence of respiratory tract infections and higher drug intake could be observed. In the case group of medically recorded bronchial asthma, a slightly increased risk for club foot has been revealed. However, this weak association could be explained by the higher proportion of preterm births in this group. The main limitation of the analysis was that at the time of data collection only a small proportion of pregnant mothers were using anti-asthma medications recommended by the actual guidelines.     

A population-based case-control teratologic study of oral dipyrone treatment during pregnancy.

OBJECTIVE: To study the possible human teratogenic effect of oral dipyrone, an antipyretic and analgesic drug treatment during pregnancy. DESIGN AND SETTING: The analysis of cases with different congenital abnormalities and their matched population controls without congenital abnormalities, in addition to a comparison between cases and malformation controls (Down's syndrome) in the population-based, large data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980-1996. STUDY PARTICIPANTS: 22 843 neonates or fetuses with congenital abnormalities (cases), 38 151 matched newborns without congenital abnormalities (population controls) and 834 neonates or fetuses with Down's syndrome (malformation controls). MAIN OUTCOME MEASURES: 25 congenital abnormality groups. RESULTS: 1382 (6%) cases, 1911 (5%) population controls and 74 (8.9%) malformation controls were born to mothers treated with dipyrone during pregnancy. The case-matched population control analysis showed a higher rate of diaphragmatic defect (adjusted prevalence odds ratio [POR] 2.7; 95% CI 1.0, 6.8), cardiovascular malformations (POR 1.3; 95% CI 1.0, 1.7) and other isolated congenital abnormalities (POR 1.8; 95% CI 1.1, 2.9) after oral dipyrone treatment during the second and third months of gestation, i.e. in the critical period for most major congenital abnormalities. However, the evaluation of only medically recorded dipyrone use did not confirm these possible associations. The comparison of dipyrone treatment between 25 congenital abnormalities groups and malformation controls as the referent group also did not show any difference in the dipyrone use during the second and third months of gestation. CONCLUSIONS: The higher occurrence of dipyrone treatment in the case mothers compared with population control mothers can be explained by recall bias and/or chance. However, the higher rate of diaphragmatic congenital abnormalities can be considered as a signal and merits further investigation.