Serum fetuin-A level is independent of Helicobacter pylori postinfection status in systemic lupus erythematosus.

Helicobacter pylori is a common pathogen causing gastric inflammation and malignancy. Fetuin-A is a multifunctional protein that is involved in the regulation of calcification, insulin resistance and inflammation. Reports on serum levels of fetuin-A in acute H. pylori infection are contradictory. We intended to see whether H. pylori post-infection status has a long-term effect on serum fetuin-A levels in a well-characterized series of systemic lupus erythematosus cases. In this cross-sectional study 117 patients with systemic lupus erythematosus were enrolled. Helicobacter infection status and serum fetuin-A concentration were determined by ELISA and radial immunodiffusion, respectively. H. pylori positive patients had higher serum fetuin-A concentration than negative ones: 517 (456-603) vs. 476 (408-544) mg L-1, median (25-75% percentiles), P = 0.020. No other parameters differed between these groups. During univariate regression analysis fetuin-A levels were associated with Erythrocyte sedimentation rate (ESR), White blood cell count (WBC), C-reactive protein (CRP), serum total protein, albumin, and the SLEDAI index at the time of diagnosis but only serum albumin remained a significant determinant in multivariate regression study.

[Examination of the health status and health behaviors of Hungarian family physicians]. / Magyar családorvosok egészségi állapotának, életmódjának vizsgálata.

Összefoglaló. Bevezetés: A családorvosok testi, lelki egészségi állapota hatással van a munkavégzésükre, a betegellátás minoségére, ezáltal a társadalom egészségmutatóira is. Az életmód pedig az egyik legjelentosebb, egészségi állapotot befolyásoló tényezo. Célkituzés: A vizsgálat célja a magyar háziorvosok egészségi állapotának és az azt befolyásoló életmódtényezoknek a felmérése. Módszer: Keresztmetszeti vizsgálat. Kvantitatív, papíralapú felmérés családorvosok körében (n = 569, életkor 54 ± 10 év, nok 42%). Eredmények: A háziorvosok 61%-a túlsúlyos vagy elhízott, 88%-ának a vércukorszintje ≤5,5 mmol/l. A résztvevok 50%-a legalább heti rendszerességgel végez testmozgást, 20%-uk egyáltalán nem. A háziorvosok 13%-a dohányzik jelenleg, 5%-a tekintheto nagyivónak. Enyhe fokú depressziós tünetegyüttes 19%-uknál, közepes fokú 6%-uknál, súlyos fokú 5%-uknál fordult elo. A súlyos fokú kiégés mindkét nemben, mindhárom dimenzióban 18­39% volt. Következtetés: A magyar háziorvosok általános egészségi állapota nem mondható jobbnak sem a hazai nem orvos populációénál, sem a külföldi orvoskollégákénál. A magyar háziorvosok dohányzási mutatói kedvezobbek a lakossági adatoknál, míg az alkoholfogyasztás terén kedvezotlenebb eredményeket kaptunk. Nemzetközi összehasonlításban, a káros szenvedélyek terén a hazai kollégák eredményei jónak tekinthetok. A depresszió és a kiégés gyakori elofordulása jelentos probléma a háziorvosok körében. Mentális egészségük monitorozása és gondozása a hatékony egészségügyi ellátórendszer kulcskérdése. Orv Hetil. 2021; 162(12): 449­457. Summary. Introduction: General practitioners' somatic and mental health status have an impact on their work and the quality of care they provide and thus influence the health indicators of the society. Lifestyle is one of the most important influencing factors of health. Objective: The study aims to assess the health status of Hungarian general practitioners and the lifestyle factors influencing it. Method: Cross-sectional study. Quantitative, paper-based questionnaire among general practitioners (n = 569, age 54 ± 10 years, female 42%). Results: 61% of family physicians are overweight or obese, 88% of them have blood glucose level ≤5.5 mmol/l. 50% of the participants do exercise at least once a week, 20% do not take any exercise at all. 13% currently smoke, 7% are considered heavy drinkers. Mild, moderate and severe depression symptoms occurred in 19%, 6% and 5% of them, respectively. A severe level of burnout syndrome was reported in 18­39% in both sexes, in all three dimensions. Conclusion: The health status of Hungarian general practitioners is not better than that of the non-medical Hungarian population or than that of foreign colleagues. The smoking indicators of Hungarian doctors are more favorable than the Hungarian population data, while we obtained worse results in the field of alcohol consumption. In international comparison, the results of Hungarian colleagues in the field of smoking and alcohol consumption are good. The frequent occurrence of depression and burnout is a significant problem among family physicians. Monitoring and caring for their mental health is a key factor in the effective health care system. Orv Hetil. 2021; 162(12): 449­457.

Care management of patients with high cardiovascular risk in Hungary an international and Hungarian longitudinal comparison of target level achievement.

BACKGROUND: Patients with high cardiovascular risk are usually cared for in primary care settings. Assessment of the effectiveness of long-time care was a subject of many European studies in the last two decades. This paper aims to present two Hungarian primary care cross sectional surveys and to compare their results to the primary care arms of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) III. and IV. METHODS: Between 2010 and 2011, 679 patients with high cardiovascular risk were recruited in 20 Hungarian primary care practices and 628 patients were selected in 40 practices between 2015 and 2016. The actual national recommendations were used for classification, all based on European guidelines. Achievements of target levels for blood pressure, total-, LDL-and HDL-cholesterols, triglyceride, and HbA1c (in diabetics) were recorded and analyzed. Further cardiovascular risk factors, such as smoking, BMI, waist-circumference were also evaluated. RESULTS: There was a statistically significant improvement in the management of blood-pressure and plasma LDL-cholesterol levels among high risk patients, while there was no change in the plasma triglyceride values. The effectiveness of diabetes care deteriorated. In international relation, the management of blood pressure and plasma LDL-cholesterol values were better in Hungary when compared to the results of EUROASPIRE III-IV. studies, while the previous advantage in diabetes care disappeared. A higher proportion of diabetic patients was above the target values in Hungary than the means of the European surveys. There was a higher proportion of smokers in the Hungarian samples, while the proportion of obese and overweight patients was similar to the European sample. CONCLUSIONS: Primary care has a unique role in cardiovascular prevention. Although many of the patients are managed appropriately, there is a need to improve primary care services in Hungary, giving more competences to GPs in prescription and introducing structural changes in the healthcare system.

The Diagnosis and Therapy of Helicobacter pylori Infection in Hungary: Comparison of Strategies Applied by Family Physicians and Internists.

BACKGROUND AIMS: Most patients with Helicobacter pylori infection are consulted for the first time by family physicians. We aimed to survey the adherence to the newest guidelines of the management of H. pylori infection in the primary and secondary care settings in Hungary. METHODS: From a total of 793 physicians, 94 trainees in family medicine, 334 family physicians without and 195 with board certification in internal medicine, 87 internists, 78 family paediatricians were invited to take part in the study. Diagnostic and therapeutic attitudes towards H. pylori infection were compared by a voluntary and anonymous questionnaire. RESULTS: Participants test for H. pylori infection in 92.8% of cases with a family history of peptic ulcer or 76.9% of gastric cancer, 68.9% of dyspepsia and 49.9% of non-specific abdominal complaints, before initiation of non-steroidal anti-inflammatory drug (NSAID; 17.3%) and antiplatelet treatment (14.5%), respectively. They confirm the success of eradication therapy in 88.1% mainly by urea breath test. Most of them initiate eradication therapy by themselves and only 22.4% refer their patients to a gastroenterologist. Clarithromycin-based standard triple therapy is the most preferred (62.1%) and only 3.7% choose quadruple combination with bismuth as first-line and 48.1% as second-line therapy. We found significant differences between groups with respect to the physicians' own infection, localization of practice, and sources of information on H. pylori infection. Internists are more likely to clarify H. pylori status before the initiation of NSAID and antiplatelet therapies, initiate second-line therapies and use bismuth compared to the other groups. Family physicians with board certification in internal medicine are also prone to start eradication therapy and less prone to refer patients to a gastroenterologist. Family paediatricians prefer stool antigen determination, screen family members and prefer gastroenterologist consultation more often, and use bismuth less frequently than the other groups. Family physicians with previous infection check for H. pyloriinfection more frequently before the initiation of NSAID treatment and are more likely to use histology to detect H. pylori. Postgraduate trainings were the most popular source of information. CONCLUSION: The adherence to the recent recommendations of current guidelines is moderate. There is a need to increase adherence to current recommendations by family physicians and internists.

Serum fetuin-A, tumor necrosis factor alpha and C-reactive protein concentrations in patients with hereditary angioedema with C1-inhibitor deficiency.

BACKGROUND AND AIMS: Hereditary angioedema with C1-inhibitor deficiency (C1-INH-HAE) is characterized by localized, non-pitting, and transient swelling of submucosal or subcutaneous region. Human fetuin-A is a multifunctional glycoprotein that belongs to the proteinase inhibitor cystatin superfamily and has structural similarities to the high molecular weight kininogen. Fetuin-A is also known a negative acute phase reactant with anti-inflammatory characteristics. In this study we aimed to determine serum fetuin-A, C-reactive protein (CRP) and tumor necrosis factor alpha (TNFα) concentrations in patients with C1-INH-HAE during symptom-free period and during attacks and compare them to those of healthy controls. Further we analyzed possible relationship among these parameters as well as D-dimer levels which was known as marker of HAE attacks. PATIENTS AND METHODS: Serum samples of 25 C1-INH-HAE patients (8 men, 17 women, age: 33.1 ± 6.9 years, mean ± SD) were compared to 25 healthy controls (15 men, 10 women, age: 32.5 ± 7.8 years). Serum fetuin-A and TNFα concentrations were determined by ELISA, CRP and D-dimer by turbidimetry. RESULTS: Compared to healthy controls patients with C1-INH-HAE in the symptom-free period had significantly decreased serum fetuin-A 258 µg/ml (224-285) vs. 293 µg/ml (263-329), (median (25-75% percentiles, p = 0.035) and TNFα 2.53 ng/ml (1.70-2.83) vs. 3.47 ng/ml (2.92-4.18, p = 0.0008) concentrations. During HAE attacks fetuin-A levels increased from 258 (224-285) µg/ml to 287 (261-317) µg/ml (p = 0.021). TNFα and CRP levels did not change significantly. We found no significant correlation among fetuin-A CRP, TNFα and D-dimer levels in any of these three groups. CONCLUSIONS: Patients with C1-INH-HAE have decreased serum fetuin-A concentrations during the symptom-free period. Given the anti-inflammatory properties of fetuin-A, the increase of its levels may contribute to the counter-regulation of edema formation during C1-INH-HAE attacks.

Licensing the first reduced, 6 µg dose whole virion, aluminum adjuvanted seasonal influenza vaccine - A randomized-controlled multicenter trial.

INTRODUCTION: Shortages of vaccine supplies repeatedly occur, limiting our abilities to prevent influenza. Therefore, increasing production volume remains a priority. The presently licensed seasonal influenza vaccines contain 15 µg of viral hemagglutinin per strain in adult, and up to 60 µg in elderly patients. Decreasing the amount of viral parts while maintaining efficacy is one way of increasing production capacity. METHODS: This was multicenter, stratified (18-60 years and >60 years of age), prospective, randomized, double-blind, active-controlled, parallel-arm, non-inferiority clinical trial, conducted in the European Union, involving 1206 patients. We used hemagglutination inhibition assay to assess the immunogenicity of a newly developed, whole virion, seasonal trivalent influenza vaccine, containing 6 µg hemagglutinin per strain (FluArt, Hungary) and to assess whether it is non-inferior to the presently licensed vaccine containing 15 µg hemagglutinin per strain. Safety and tolerability of both vaccines were assessed based on EMEA guidelines. RESULTS: The reduced dose vaccine containing 6 µg of hemagglutinin per strain was safe and non-inferior to the currently licensed 15 µg vaccine, not only in adult, but also in elderly patients, according to the immunogenicity criteria by the FDA and EMEA (seroconversion, seroprotection and post/pre vaccination GMT ratios), and it fulfilled all applicable licensing requirements for both age groups. CONCLUSIONS: Based on the results, the reduced dose vaccine was licensed in the EU member state Hungary and safely administered in over 1.5 million cases so far. The amount of viral hemagglutinin needed can be reduced by using a whole virion vaccine with aluminum phosphate adjuvants. REGISTRATION: This study was registered by the European Clinical Trials Database, EudraCT, number: 2011-003314-16.

Human Fetuin-A Rs4918 Polymorphism and its Association with Obesity in Healthy Persons and in Patients with Myocardial Infarction in Two Hungarian Cohorts.

BACKGROUND Human fetuin A (AHSG) has been associated with the development of obesity, insulin resistance, type 2 diabetes mellitus, and atherosclerosis. Observations on the role of AHSG rs4918 single-nucleotide polymorphism are contradictory. We investigated the association between variants of rs4918 and parameters of obesity, lipid status, tumor necrosis factor-α (TNFα), adipokines (adiponectin, resistin, leptin), and insulin resistance in healthy persons and in patients with previous myocardial infarction. MATERIAL AND METHODS This was a cross-sectional study comprising cohort 1 (81 healthy individuals) and cohort 2 (157 patients with previous myocardial infarction). We used the allele-specific KASP genotyping assay to detect rs4918 polymorphism. RESULTS In cohort 1, G-nucleotide carriers had significantly lower serum TNFα, adiponectin, and higher leptin concentrations than in non-G carriers. These differences, however, were not observed in cohort 2. In cohort 2, G-carriers had lower BMI and waist circumferences than in non-G carriers. The G allele was more frequent among lean than obese patients (RR=1.067, 95%CI=1.053-2.651, p=0.015). An association between BMI and rs4918 polymorphism was observed among patients without diabetes (CC/CG/GG genotypes: p=0.003, G vs. non-G allele: p=0.008) but not in diabetics. In addition, a strong linearity between BMI and the CC/CG/GG genotypes (association value: 4.416, p=0.036) and the frequency of the G allele (7.420, p=0.006) could be identified. In cohort 2, non-obese, non-diabetic G-carriers still had lower BMI and waist circumferences than in non-G carriers. CONCLUSIONS The rs4918 minor variant is associated with lower TNFα and adiponectin, higher leptin levels in healthy persons, and more favorable anthropomorphic parameters of obesity in cohort 2.

[Hungarian Society for Sleep Medicine guideline for detecting drivers with obstructive sleep apnea syndrome]. / A Magyar Alvásdiagnosztikai és Terápiás Társaság módszertani ajánlása a közúti jármuvezetok egészségi alkalmasságának vizsgálatához az obstruktív alvási apnoe szindróma vonatkozásában.

Obstructive sleep apnea is the most frequent sleep-disordered breathing. The prevalence of sleep apnea in the general population is 2-4% and the main characteristics of the disease are the intermittent cessation or substantial reduction of airflow during sleep, which is caused by complete, or near complete upper airway obstruction. Decreased airflow is followed by oxygen desaturation and intermittent arousals. Untreated patients are 4-6 times more likely to cause traffic accidents than their healthy counterparts. The aims of the obstructive sleep apnea screening are to prevent and reduce the incidence of serious car accidents, which are often caused by one of the most dangerous sleep disorders. Since April 1, 2015 a modification of the 13/1992 regulation has been in force in Hungary which orders screening of obstructive sleep apnea during medical checkup of drivers. The Hungarian Society for Sleep Medicine made a guideline according to the regulation which was adapted to national circumstances and family doctors, occupational health specialists can more easily screen obstructive sleep apnea in suspected patients. In sleep ambulances the disease can be diagnosed and effective treatment can be started. Patients receiving appropriate treatment and with appropriate compliance can get their driving licence under regular care and control.

Association of human fetuin-A rs4917 polymorphism with obesity in 2 cohorts.

BACKGROUND: Previous studies have shown association of the multifunctional hepatic protein α2HS-glycoprotein/human fetuin A with insulin resistance, type 2 diabetes mellitus, metabolic syndrome, obesity, and atherosclerosis. Reports of contribution of α2HS-glycoprotein/human fetuin A rs4917 single-nucleotide polymorphism to the development of these pathologic processes are inconsistent. We aimed to investigate the association between variants of rs4917 and parameters of obesity, lipid status, the proinflammatory cytokine tumor necrosis factor α (TNF-α), adipokines (adiponectin, resistin), and insulin resistance in 2 cohorts. METHODS: Eighty-one healthy persons (cohort 1) and 157 patients with previous myocardial infarction (cohort 2) were included in this cross-sectional study. rs4917 Polymorphism was determined by the allele-specific KASP by design genotyping assays. RESULTS: In cohort 1, T-nucleotide carriers had lower low-density lipoprotein cholesterol levels compared with non-T carriers. The serum concentration of TNF-α was found to be higher carrying the non-T allele in cohort 1; however, this difference was not observed in cohort 2. In cohort 2, T carriers had lower body mass index and abdominal and waist circumferences than did non-T carriers. The T nucleotide was more frequent in nonobese than in obese patients (χ = 5.217, P = 0.022). Nonobese, nondiabetic T carriers still had lower body mass index and waist circumference than did non-T carriers. CONCLUSIONS: Our data suggest that the T nucleotide in rs4917 is associated with more favorable lipid status among healthy persons (i.e., lower low-density lipoprotein cholesterol) and anthropologic parameters of obesity in cohort 2. The protective role of the T allele may also be associated with lower TNF-α levels found in healthy individuals.

The association of affective temperaments with smoking initiation and maintenance in adult primary care patients.

BACKGROUND: Smoking behaviour and its course is influenced by personality factors. Affective temperaments could allow a more specific framework of the role trait affectivity plays in this seriously harmful health-behaviour. The aim of our study was to investigate if such an association exists in an ageing population with a special emphasis on gender differences. METHODS: 459 primary care patients completed the TEMPS-A, Beck Depression Inventory (BDI) and Hamilton Anxiety Rating Scale (HAM-A). Subjects were characterized according to their smoking behaviour as current, former or never smokers. Univariate analysis ANOVA and logistic regression were performed to analyse differences in the three smoking subgroups to predict smoking initiation and maintenance. RESULTS: Current smokers were younger and less educated than former or never smokers. Males were more likely to try tobacco during their lifetime and were more successful in cessation. Depressive, cyclothymic and irritable temperament scores showed significant differences between the three smoking subgroups. Irritable temperament was a predictor of smoking initiation in females whereas depressive temperament predicted smoking maintenance in males with a small, opposite effect of HAM-A scores independent of age, education, lifetime depression and BDI scores. Whereas smoking initiation was exclusively predicted by a higher BDI score in males, smoking maintenance was predicted by younger age and lower education in females. LIMITATIONS: The cross-sectional nature of the study design may lead to selective survival bias and hinder drawing causal relationships. CONCLUSIONS: Affective temperaments contribute to smoking initiation and maintenance independently of age, education, and depression. The significant contribution of depressive temperament in males and irritable temperament in females may highlight the role of gender-discordant temperaments in vulnerable subgroups.

[The role of fetuin-A in cardiovascular diseases]. / A fetuin-A szerepe cardiovascularis betegségekben.

Fetuin-A (also known as α2-Heremans-Schmid glycoprotein) is a multifunctional molecule secreted by the liver. It is a negative acute phase reactant with a debated role in subclinical inflammation. Fetuin-A is an inhibitor of the insulin receptor and its serum level correlates with insulin resistance. The protein has been implicated in adipocyte dysfunction and it is associated with obesity and non-alcoholic fatty liver disease. Although all these properties seem to promote atherosclerosis, the role of fetuin-A in cardiovascular diseases is more complex. As a natural inhibitor of tissue and vascular calcification, fetuin-A also acts as a protective factor in atherosclerosis. The potential role and prognostic value of fetuin-A in arterial calcification and cardiovascular diseases is discussed in this review, along with explanations for seemingly contradicting results in the literature and possible directions for future research.

Serum ghrelin level and TNF-α/ghrelin ratio in patients with previous myocardial infarction.

BACKGROUND AND AIMS: Studies investigating serum ghrelin level in atherosclerosis yielded contradictory results. Interaction of ghrelin with adipocytokines is obscure in cardiovascular diseases. We undertook this study to determine which molecules influence ghrelin level and to see whether post-myocardial infarction (MI) patients have decreased ghrelin levels. METHODS: In this cross-sectional study, acyl-ghrelin concentration was determined by radioimmunoassay in sera of 171 patients (ages 62 ± 6 years, mean ± SD) with previous MI and 81 age-matched referent subjects. We evaluated the associations of ghrelin with insulin, adiponectin, leptin, resistin, fetuin-A and tumor necrosis factor-alpha (TNF-α). RESULTS: Patients had lower ghrelin levels compared to referent subjects (240.55 ± 59.33 vs. 337.96 ± 30.75 pg/mL, p <0.001) even after excluding diabetic and obese patients (240.63 ± 54.08 vs. 337.96 ± 30.75, p <0.001). In multivariate analysis, insulin (ß = -0.327, p <0.001) and adiponectin (ß = 0.301, p <0.001) determined ghrelin level (R(2) = 0.199, p <0.001). There was no association between ghrelin and TNF-α levels. In discriminant analysis using ghrelin, adiponectin, leptin, fetuin-A, resistin and TNF-α, the structure matrix revealed ghrelin and TNF-α as strongest predictors for belonging to the patient group (0.760 and -0.569, respectively). Using these two parameters, 89.7% of cases were correctly classified. Subjects with high TNF-α/ghrelin ratio had 11.25 times higher chance for belonging to the patient group (95% CI 5.80-21.80; χ(2) (1) = 215.6, p <0.001) CONCLUSIONS: Acylated ghrelin levels are decreased in patients with coronary atherosclerosis, independently of body weight and the presence of type 2 diabetes mellitus. Ghrelin level is determined by elevated insulin and decreased adiponectin levels. Ghrelin alone or in combination with TNF-α may prove to be a novel indicator of coronary atherosclerosis.

[Screening of depression in primary care in Hungary and its importance in suicide prevention]. / A depresszió szurése az alapellátásban Magyarországon és ennek jelentosége az öngyilkosság megelozésében.

The current prevalence of DSM-IV depressive disorders were surveyed among 984 primary care attendees in 6 PCPs in Hungary, using the Beck Depression Inventory (BDI) and the PRIME-MD screening instrument. The current prevalence rate of any DSM-IV depressive disorders, including symptomatic major depressive episode (MDE) were 18.5% and 7.3% respectively. BDI identified any current depressive disorders with 95% sensitivity and 56% specificity and the same figures for MDE were 83% and 23%, respectively. Current MDE was found 50% of patients with positive family history of suicide, comparing to the 14.3% of those without. The BDI and the PRIME-MD are useful screening tools for detecting depressive disorders in PCPs. Family history of completed suicide as a clinical marker could improve suicide prevention through the more effective management of MDE in primary care.

Psychometric properties and construct validity of the brief Wisconsin inventory of smoking dependence motives in an Internet-based sample of treatment-seeking Hungarian smokers.

INTRODUCTION: Both full and brief versions of the Wisconsin Inventory of Smoking Dependence are promising new measurement tools for studying tobacco dependence. We assessed the psychometric properties and construct validity of the Wisconsin Inventory of Smoking Dependence Motives (WISDM)-68 and WISDM-37. METHODS: Participants were adult, treatment-seeking Hungarian daily smokers (N = 720) with Internet access who were also registered on a smoking cessation Web site. Using confirmatory factor analyses (CFAs), we tested the measurement models of both WISDM-68 and WISDM-37, internal consistency of subscales of WISDM-37, and gender invariance. We tested the associations between heaviness of smoking, tobacco dependence symptoms, smoking environment, and subscales of WISDM-37. RESULTS: Although the measurement model of WISDM-68 did not fit adequately, the measurement model of WISDM-37, including 11 correlating factors (affiliative attachment, automaticity, loss of control, cognitive enhancement, craving, cue exposure/associative processes, social/environmental goads, taste, tolerance, weight control, affective enhancement), satisfactorily represents the data. Latent structures are equal in both genders. Internal consistency of subscales of WISDM-37 ranges between 0.67 and 0.90. Tobacco dependence symptoms were significantly linked with all motives, heaviness of smoking was related significantly only to affiliative attachment, automaticity, loss of control, cognitive enhancement, craving, and tolerance, while tobacco dependence symptoms and gender were controlled. Gender was associated only with the weight control motive. CONCLUSIONS: Concurring with previous reports using other types of sample, WISDM-37 has sufficient psychometric properties and good construct validity to make it useful in measuring the multidimensional nature of tobacco dependence even in Internet-based research. Without precedent, gender equality of WISDM-37 is also supported.

Serum fetuin-A in metabolic and inflammatory pathways in patients with myocardial infarction.

BACKGROUND: Although multifunctional glycoprotein α2HS-glycoprotein/human fetuin-A (AHSG) is involved in atherosclerosis, it is not clear whether high or low concentrations are more important. We studied the correlation of serum AHSG with adiponectin, leptin, resistin, C-reactive protein (CRP) and tumour necrosis factor-α (TNF-α) to see whether its metabolic effects or its involvement in subclinical inflammation are dominant in patients with established coronary disease. MATERIALS AND METHODS: In this cross-sectional study, AHSG concentration was determined in sera of 171 patients (age: 62 ± 6 years, mean ± SD) with previous myocardial STEMI infarction and normal renal function and 81 age-matched healthy controls by radial immunodiffusion. Results Patients had increased AHSG levels (673 ± 103 vs. 619 ± 96 mg L(-1), P < 0·001) compared to controls. Obese and diabetic patients had higher AHSG concentration than those with normal BMI or without diabetes but even the latter group had elevated AHSG levels (667 ± 101 mg L(-1), n = 88) compared to controls (P = 0·002). Serum AHSG correlated negatively with adiponectin (r = -0·236, P = 0·006) even after adjusting for BMI (r = -0·177, P = 0·043). AHSG determined adiponectin levels independently from BMI, age and other adipocytokines (P = 0·014). The correlation between leptin and AHSG (r = 0·321, P = 0·021) weakened following adjustment for BMI (r = 0·209, P = 0·072). Serum AHSG did not correlate significantly with CRP, resistin and TNF-α concentrations. BMI and resistin but not AHSG determined TNF-α levels independently. CONCLUSIONS: AHSG is elevated in sera of patients with previous myocardial infarction. Association with adipokines favours the concept that AHSG is involved in atherosclerosis more likely through metabolic pathways (insulin resistance, obesity and adipocyte dysfunction) than by inflammation in patients with post-myocardial infarction.

Fetuin-A serum levels in patients with aortic aneurysms of Marfan syndrome and atherosclerosis.

BACKGROUND: Fetuin-A is a glycoprotein that inhibits extraosseous and vascular calcification. Its serum level is lower in patients with atherosclerosis compared with healthy controls, but its role is unknown in aneurysmal diseases. The aim of our study was to investigate the association of serum fetuin-A levels with aortic aneurysms of different aetiology: Marfan syndrome and atherosclerosis. MATERIAL AND METHODS: In a single centre cross-sectional observational study, 105 patients (30 with atherosclerotic aortic aneurysm, 15 with Marfan syndrome, 30 with peripheral arterial disease and 30 healthy controls) were examined; sera were analysed for fetuin-A, standard markers of possible inflammation, lipid profile, kidney and hepatic disease and diabetes. Systemic atherosclerosis was assessed by carotid intima-media thickness (IMT) measurement and arterial calcification score of cardiac valves, carotids, aorta and femoral arteries determined by ultrasound. RESULTS: Serum fetuin-A levels (median and IQR) were significantly lower in the atherosclerotic aneurysm cohort than in patients with Marfan syndrome: 708 µg mL⁻¹ (612-780) and 756 µg mL⁻¹ (708-816), respectively, (P = 0·0428). Fetuin-A levels were 754 µg mL⁻¹ (713-777) in the control group and 654 µg mL⁻¹ (600-756) in patients with peripheral arterial disease. Mean and maximum IMT, ACS values and homocysteine levels were significantly higher in patients with atherosclerosis: P < 0·0001, P < 0·0001, P < 0·0001 and P = 0·0034, respectively. There was no significant difference between aneurysm groups analysing the results of lipid profile and acute-phase markers. CONCLUSIONS: The significantly lower serum level of fetuin-A in the atherosclerotic aneurysm group supports the protective role of fetuin-A in the evolution of arterial calcification.

Socio-demographic characteristics, health behaviour, co-morbidity and accidents in snorers: a population survey.

OBJECTIVE: We assessed the socio-demographic correlates of snoring and also the patterns of health behaviour and co-morbidity associated with different types of snoring in the Hungarian population. We wanted to study whether different types of snoring are associated with high-risk health behaviour, chronic illnesses, daytime consequences of poor sleep, and with frequent accidents compared with non-snoring individuals. METHOD: This is a cross-sectional study. Interviews were carried out in the homes of 12,643 people. This was the largest nationally representative study in Central Europe about health behaviour. In the Athens Insomnia Scale, questions about snoring and sleep behaviour, life-style factors and health behaviour, as well as questions on their history and current medical treatment were included in the questionnaire. RESULTS: Thirty-seven percent of males and 21% of females reported loud snoring with breathing pauses. We found a significant increasing trend for the consumption of alcohol and coffee as well as smoking among non-snorers, habitual snorers and loud snorers, respectively. In an ordinal regression model male gender, the presence of smoking, the presence of three or more co-morbid conditions and alcohol consumption were independent predictors of snoring (OR [95% CI], 1.99 [1.85-2.1], 1.76 [1.60-1.92], 1.45 [1.30-1.62] and 1.22 [1.04-1.43], respectively, P < 0.001) after controlling for multiple socio-demographic and clinical variables. The frequency of accidents was higher in the loud snoring group than among non-snoring individuals (24% vs 17%, P < 0.0001). CONCLUSIONS: Snoring is common in the Hungarian adult population. Snoring, especially loud snoring with breathing pauses, is strongly associated with high-risk health behaviour, higher co-morbidity and a higher frequency of accidents.

[Diagnosis and therapy of depression in family practice]. / A depresszió diagnosztikája és kezelése a családorvosi gyakorlatban.

Depression is one of the most prevalent mental disorders, according to Hungarian and international data. In Western- Europe, lifetime prevalence of major depression is 13%, while one-year prevalence is 4%. The prevalence of severe depressive symptoms is similar in Hungary: approximately 5 to 8% of all patients seen by primary care physicians suffer from some kind of depressive disorders. Depression is more prevalent in women and in the elderly. According to the World Health Organization, depression is the third most common disabling disorder. Patients with depression experience impaired quality of life, anxiety, sleep disturbances, alcohol and drug abuse, and different somatic disorders. Furthermore, depression is the most important risk factor for suicide. Primary care physicians have a crucial role in the screening and diagnosing of depressive disorders. Depressive disorders can exist not only in patients complaining about depressed mood, but also in patients with "medically unexplained symptoms" (headache, fatigue, abdominal pain, gastrointestinal symptoms, weight change). Primary care physicians should have appropriate knowledge about the different therapeutic options (including various psychotherapies, antidepressant medications and other treatment options) to be able to treat their patients properly. We review the literature about the significance and epidemiology of depression and summarize the diagnostic and therapeutic options of depressive disorders in primary care practice.

[Morbidity, demography and life style of Hungarian medical doctors 25 years after graduation]. / Magyar orvosok életmódja, egészségi állapota és demográfiai adatai 25 évvel a diplomaszerzés után.

UNLABELLED: The health status and social circumstances of medical professionals have been studied worldwide. However, there are only a few published studies pertaining to these topics in the countries of the former Eastern block. The present paper aimed at charting the state of health, the medical career path and some sociological factors of Hungarian medical doctors who graduated in 1979. The results were analysed for differences between genders and professional specialty groups (primary, surgical, non-surgical, and diagnostic), respectively. MATERIALS AND METHOD: Two-hundred and twenty-eight doctors who graduated in 1979 at Semmelweis Medical University in Budapest, Hungary, were asked to fill out a questionnaire on these topics. RESULTS: More men were in surgical professions, whereas a larger proportion of women became primary specialists. Women had to modify their specialty or place of work more often than men. The average number of children was 2.26 for men and 1.87 for women. The highest increases in body weight were registered in primary specialist men and non-surgical women. Hypertension and failure to attend regular screenings were more common in males and they were not always treated properly. Physical exercise, typically sports, were reduced after graduation, furthermore the preferred types of activity also changed after graduation. Female physicians considered regular exercise more important. Smokers were mainly amongst surgical specialist men and women working in primary care. Surgical professionals and women in non-surgical specialties consumed more alcoholic beverages. As patients, male physicians followed medical advice more faithfully. Doctors judged their own health status to be better than that of their patients. The knowledge of foreign languages was higher in men. Ten percent of physicians received a postgraduate degree in research.

[The role of family physicians in the recognition and screening of obstructive sleep apnea]. / A családorvos szerepe az obstruktív alvási apnoe szurésében, felismerésében.

Obstructive sleep apnea is the most frequent sleep disorder. The prevalence of sleep apnea in the general population is 2-4% and the main characteristic of the disease is the intermittent cessation or substantial reduction of airflow during sleep, caused by complete, or near complete upper airway obstruction. Decreased airflow is followed by oxygen desaturation and intermittent arousals. The clinical presentation of the disorder is complex. Loud snoring with breathing pauses and daytime sleepiness should raise the suspicion of sleep apnea, but we have to consider this disease if the patient has therapy resistant hypertension, heart failure, arrhythmias, stroke, depression or memory problems. Family physicians have an important role in recognizing sleep apnea. High risk patients can easily be identified by the main symptoms and using the Berlin sleep apnea questionnaire. These patients should be referred to a sleep laboratory for polysomnographic assessment and, if necessary, for further treatment.