[Evaluation of cardiovascular autonomic nervous system in ethanol withdrawal]. / Ocena ukladu autonomicznego sercowo-naczyniowego w zespole odstawiennym u chorych przewlekle uzaleznionych od alkoholu.

UNLABELLED: The aim of the study was to assess the risk factors and state of cardiovascular autonomic nervous system injury in ethanol dependent patients. The group examined consisted of 85 alcoholics (17 females and 68 males) aged from 27 to 68 y (45.7 +/- 8.82) hospitalized at the Ward of Toxicology and Environmental Diseases because of alcohol withdrawal. Ethanol dependence was diagnosed according to ICD -10 criteria, withdrawal syndrome was scored according to CIWA - A scale. A blood ethanol concentration, creatinine, urine, coagulation parameters and liver enzymes activity were measured on admission. Cardiovascular autonomic nervous system was evaluated by standard Ewing battery tests using VariaCardio TF5 system. The parasympathetic system was assessed by the heart rate response to forced breathing, the heart rate response to standing up, and to heart response to the Valsalva maneuver. The sympathetic system was evaluated by the blood pressure response to standing up. The original Ewing normal values were used. RESULTS: The mean duration of ethanol dependence was 13.7 +/- 8.2 y. In 92% of examined patients heavy and in 8% moderate ethanol withdrawal syndrome was diagnosed. The mean blood ethanol concentration was 1.07 +/- 1.21g/l. Liver injury was diagnosed in 43.5% of the examined group. No changes in autonomic battery tests were found only in 28.2% of the examined subjects. Early parasympathetic damage was stated in 23.5%, definite parasympa-thetic damage in 44.7%, combined para-sympathetic and sympathetic damage was diagnosed in 3.5% of patients examined. The relative risk for parasympathetic and sympathetic system injury rose together with CIWA - scoring, blood ethanol concentration on admission (OR = 1,4 95% CI: 0,81 +/- 2,4), and when GTP activity was three times greater than normal (OR = 1.2 95% CI: 0.92 +/- 1.7).

New forms of radionuclide therapy with (90)Y in oncology.

BACKGROUND: Currently, there is growing interest in the use of the beta emitter (90)Y in systemic therapy in oncology. For successful therapy, an appropriate ligand is chosen to carry the isotope to the place of its action. As well as performing this function, the type of the ligand influences both the course and the side effects of the treatment. For RIT of lymphomas, bone marrow becomes the critical organ; in NET patients treated with labelled somatostatin analogues, increased kidney irradiation can occur. The aim of this study was to evaluate the side effects of therapy using 90Y associated with different ligands, depending on the charge to critical organs after treatment in two groups of patients: those with neuroendocrine tumours and those with non-Hodgkin's lymphomas. MATERIAL AND METHODS: 32 patients with histopathologically confirmed NET treated with (90)Y-DOTATATE (7.4 GBq/m(2) cumulative dose) and 30 NHL patients treated with (90)Y-ibritumomab tiuxetan (1200 MBq max dose) were enrolled in the study. The kidney function and changes of blood indices were assessed during the course of the therapy. RESULTS: 59% of NET patients treated with (90)Y-DOTATATE displayed transient reduction of blood indices, the largest after cycles III and IV of therapy. After 5 months an increase in creatinine level was noticed, but no statistically important changes in creatinine level and GFR were observed. In the group of patients with NHL, the change of haematological indices after RIT concerned mainly PLT, ANC and WBC. The reduction of the average PLT and WBC values started in the first weeks after the treatment application, reaching nadir in the 6(th) week and 8(th) week, respectively. No life threatening infections were observed in either group of patients. CONCLUSIONS: After treatment with the use of the (90)Y radionuclide, no significant treatment toxicity, including disorders involving the critical organs for both types of therapies, was found in the groups of neuroendocrine tumour and non-Hodgkin's lymphoma patients.

[Quantitative analysis of heart scintigraphy (99mTc-MIBI GSPECT) with regional myocardial wall motion and thickening assessment for detecting myocardial injury in patients after acute paracetamol poisoning]. / Zastosowanie analizy ilosciowej badania 99mtc- MIBI GSPECT z ocena odcinkowej ruchomosci scian i grubienia skurczowego miesnia lewej komory w aspekcie oceny stopnia ogluszenia miesnia sercowego w ostrym zatruciu paracetamolem.

UNLABELLED: The aim of the study was to evaluate the myocardium function in acute paracetamol poisoning using 19mTc-MIBI GSPECT. MATERIAL AND METHODS: Under examination there were 25 acutely paracetamol poisoned patients (age: 24.5 +/- 6 years) treated at the Ward of Toxicology and Environmental Diseases. The control group necessary to perform quantitative analysis of myocardial scintigraphy consisted of 20 people examined in Nuclear Medicine Unit with normal results of 99mTc-MIBI GSPECT examination. RESULTS: The quantitative analysis of the heart scintigraphy (GSPECT) revealed that, the average value of left ventricle ejection fraction (EF) in examined women and men after paracetamol poisoning was lower than in control group, while end diastolic (EDV) and end systolic volumes (ESV) were higher; these differences were not statistically significant. Indicators of regional wall motion of the left ventricle were lower for the most of the heart segments. According to the control group, they were significantly lower for anterior and inferior LV segments. Wall thickening analysis revealed the impaired systolic thickening of majority of heart segments in examined group of patients; the wall thickening was the lowest for infero-lateral and septal segments in women and for inferior, infero-lateral and anterior segments in men. CONCLUSIONS: The quantitative analysis of myocardial perfusion scintigraphy (99mTc-MIBI GSPECT) with wall motion and wall thickening assessment, showed that the left ventricle function was usually diffusely depressed in paracetamol poisoned patients. The disturbances of regional wall motion of anterior and inferior wall (LV) were mainly visible.

[Evaluation of regional cerebral blood flow using 99mTc-ECD SPECT in ethanol dependent patients: pilot study]. / Ocena zaburzen regionalnego przeplywu mózgowego metoda tomografii emisyjnej Pojedynczego Fotonu z uiyciem 99mtc-ECD u pacjentów uzaleinionych od alkoholu: doniesienie wstepne.

UNLABELLED: The depressant actions of ethanol in the brain is known. SPECT is non invasive method to measure the regional cerebral blood flow (rCBF) and to evaluate indirectly the brain metabolism. The aim of the study is to evaluate morphologic and functional status of CNS using 99mTc-ECD SPECT in chronic alcoholics. MATERIAL AND METHODS: Examined group consisted of 18 male alcoholic patients aged from 28 to 52 years (x = 42.1 +/- 5.4) treated at the Ward of Toxicology and Environmental Diseaes (Detoxification Unit). Only patients without prior head injury, CNS inflammatory changes, epilepsy, migraine, diabetes mellitus or other systemic injury were included. Alcohol dependence was diagnosed according to ICD-10 criteria. The intensity of withdrawal syndrome was measured using CIWA-A scale. The regional cerebral blood flow (rCBF) was measured using 99mTc-ECD SPECT with the double head E.CAM Siemens gamma camera. The reference group, necessary to obtain a normal values for the gamma camera applied, consisted of 31 healthy subjects (33.32 +/- 10.99 y). RESULTS: The mean values of rCBF in all examined region of frontal and temporal lobes, and in basal ganglia bothsided were significantly lower in the group of alcoholic patients than in the control group. No significant difference between rCBF in occipital lobes except the occipital inferior region, and in parietal lobes except the parietal superior region. Symetrical hypoperfusion (rCBF-2SD) in the frontal lobes was stated in 11 (61.1%), in temporal lobes in 4 (22.2%), in parietal and occipital lobes in 3 (16.7%) of the patients examined. In 7 the patients examined rCBF disturbances in basal ganglia were found (bothsided in 4, leftsided in 2, and rightsided in 2 the patients). Focal rCBF changes in the parietal, frontal and temporal lobes localised mostly on the left hemisphere were stated in 27.8% of the alcoholics examined. In concusion, the metabolic disturbances and the brain morphological changes mostly in frontal and temporal lobes due to chronic alcoholism were detected in the pilot study. A further investigation on more numerous group of ethanol dependent patients and monitoring of the changes in alcoholics who maintain a long-term abstinence from alcohol is needed.

[Alcohol consumption and the risk of insulin resistance--population based study]. / Spozywanie alkoholu i ryzyko wystqpienia insulinoopornosci--badanie populacyjne.

UNLABELLED: The aim of the study was to assess the relationship between alcohol consumption and insulin resistance in the adult Kraków's inhabitants. MATERIALS AND METHODS: 6000 subjects at age 35-75, participants of the Polish Multicenter Study on Diabetes Epidemiology, were randomized and invited to the study. Finally in 2838 participants the standardized questionnaire examination of the life style especially alcohol consumption was performed. In all persons anthropometric and blood pressure examination was performed. Fasting lipids, fasting and after glucose load glucose and insulin were determined. Glucose tolerance was determined in all study participants according WHO 1999 criteria. Insulin-resistance was defined as the highest quartile of the distribution of the HOMA-IR index assessed for population with normal glucose tolerance (NGT). RESULTS: In examined group 472 (29.2%) women and 150 (12.2%) men were abstainers. Alcohol consumption below 10 glday declared 68.4% of women and 54.9% of men, between 10 and 30 g/day--2.0% of women and 24.7% of men, above 30 g/day--8.2% of men and 0.4% of women. In men with normal glucose tolerance the lowest HOMA-IR we observed in the group drinking daily above 30 g of alcohol (2.05 +/- 1.3). In men with impaired glucose tolerance the lowest HOMA-IR was observed in the group drinking daily below 10 g of alcohol, the highest in the group of abstainers (2.81 +/- 2.04 vs. 3.23 +/- 1.72; ns). For men drinking between 10 and 30 g of alcohol daily decreased the risk of insulin resistance at 40% (OR = 0.6; 95% CI: 0.37-0.96), drinking above 30 g daily decreased the risk at 49% (OR = 0.51; 95% CI: 0.27-0.96). We didn't observed this relationship in the group of women. CONCLUSION: Our results confirm positive impact of daily alcohol intake above 10 g for the risk of insulin resistance in the group of men.

[Evaluation of pituitary-gonadal axis in alcohol dependent males]. / Ocena osi przysadkowo-gonadalnej u mezczyzn uzaleinionych od alkoholu.

UNLABELLED: Chronic alcoholism leads to organic damages of nervous system, the liver and the endocrine system. The aim of the study is to evaluate pituitary-gonadal axis in males chronically dependent with alcohol. MATERIAL AND METHODS: The study group consisted of 50 alcohol dependent men aged 27 to 53 years (40.7 +/- 6.6) treated at the Ward of Toxicology and Environmental Diseases (Detoxification Unit). Al-cohol dependence was diagnosed according to ICD-10 criteria. The intensity of withdrawal syndrome was measured using CIWA-A scale. In all the patients anthropometrical measurements and abdominal ultrasonography were performed as well as blood pressure was measured. Levels of gonadotropin, total testosteron, PRL were determined, thyroid and adrenal gland function were assessed and oral glucose tolerance test (OGTT) was performed in all patients. Activity of the liver enzymes, urea and creatine concentration were determined. Erectile dysfunction was assessed using IIEF. 5 questionnaire: in those patients who received < or =21 points an incidence of diabetes mellitus, thyroid gland and cardiovascular diseases was assessed using standardized questionnaire. RESULTS: Alcohol dependency longer than 15 years was stated in 25, longer than 10 years in 9, and longer than 5 years in 16 of examined patients. The moderate withdrawal syndrome was diagnosed in 22, severe withdrawal syndrome in 26 and very severe withdrawal syndrome in 2 of the patients. BMI ranged from 15.8 to 33.8 kg/m2 (mediane 24.67; +/- 0.54 kg/m2). In 24 men erectile dysfunction was diagnosed using IIEF5 questionnaire. No significant difference was noted between level of total testosterone and PRL in the group with or without erectile dysfunction (testosterone: 5.07 +/- 2.41 vs. 4.54 +/- 2.74; PRL: 330.2 +/- 214.2 vs. 307.4 +/- 258.2). Gonadropine level in the group of men with erectile dysfunction was significantly higher than that without erectile dysfunction (LH: 7.4 +/- 5.2 vs. 4.38 +/- 2.23, p < 0.01; FSH: 13.3 +/- 29.3 vs. 4.59 +/- 19.92, p < 0.05). CONCLUSION: The results obtained confirm that secondary stimulation of pituitary-gonadal axis in alcoholic men depends on liver function and ethanol toxic effect on gonads.

[Carbohydrate metabolism in acute poisoning with xenobiotics]. / Zaburzenia gospodarki weglowodanowej w ostrych zatruciach ksenobiotykami.

UNLABELLED: The aim of the study was to evaluate carbohydrate metabolism in patients hospitalised because of acute intoxication with xenobiotics. MATERIAL AND METHODS: An analysis of 3628 patients (1553 females and 2075 males; age: 40.6 +/- 15.9 y) hospitalized at the Ward of Toxicology and Environmental Diseases because of acute poisoning in 2004-2006 was done. The patients with diabetes mellitus diagnosed prior to hospitalisation were excluded from the analysis. The blood ethanol concentration was measured, medication drugs and/or psychoactive substance screening test were performed in all patients on admission. Fasting glucose level on admission and control level on second or third day of hospitalisation were determined. Risk ratio of hyperglycaemia according to toxic agent was assessed using multiple regression model considering age, gender, and the patient education. RESULTS: In 18.2% (398 males and 254 females) of the patients the blood glucose level on admission was > or = 7.8 mmol/l; in u 3.6% (78 males and 50 females) > or = 11.1 mmol/l. In 24 (0.6%) of the patients glycaemia on admission was < or = 3.5 mmol/l. Control fasting glucose level of > or = 7.0 mmol/l was determined in 115 males and 76 female patients. 42% elevation in risk of hyperglycaemia was noted in acute carbon monoxide poisoning (OR = 1.42; 95% PU: 1.11-1.82). In ethanol intoxicated patients 12% drop in risk of hyperglycaemia was noted (OR = 0.88; 95% PU: 0.72-1.07). Benzodiazepine poisoning diminished risk of hyperglycaemia in 36% (OR=0.64; 95%PU: 0.48-0.84). Risk of hyperglycaemia in poisoning by medicines co-ingested with ethanol was always lower compared to poisoning with the single agent. CONCLUSION: A higher risk of hyperglycaemia was related to acute carbon monoxide poisoning whereas lower risk of hyperglycaemia was attributed to benzodiazepines and alcohol. A frequency of hypoglycaemia in the group of poisoned patients was much more lower compared to hyperglycaemia.

Nontraditional atherosclerotic risk factors and extent of coronary atherosclerosis in patients with combined impaired fasting glucose and impaired glucose tolerance.

Partially inconsistent data exist on mutual relations between nontraditional atherosclerotic risk factors, including the magnitude of insulin resistance (IR), as well as on their relevance for atherogenesis in the metabolic syndrome. Subjects exhibiting combined impaired fasting glucose and impaired glucose tolerance (IFG/IGT) are exposed to an exceptionally high risk for atherogenesis and development of type 2 diabetes mellitus. Because of islet Beta-cell dysfunction, the usefulness of commonly used indices of IR is limited in IFG/IGT. Our aim was to assess the relationship between extent of angiographic coronary artery disease (CAD) and nontraditional atherosclerotic risk factors (including IR by a clamp-based golden standard method) in IFG/IGT. Fifty-three subjects (32 men, 21 women; mean age, 55 +/- 11 years) with stable angina, preserved left ventricular systolic function, and IFG/IGT were divided into 3 groups: group A (no coronary stenoses >50%, n = 22), group B (1-vessel CAD, n = 15), and group C (2/3-vessel CAD, n = 16). Insulin sensitivity was quantified by a hyperinsulinemic euglycemic clamp technique and expressed as M. M value, plasma homocysteine (Hcy) level, and asymmetric dimethyl-L-arginine (ADMA)/L-arginine ratio were independent determinants of CAD extent as shown by forward stepwise discriminant function analysis. Compared with group A (M = 32.7 +/- 9.3 micromol/kg fat-free mass [FFM] per minute; Hcy, 8.1 +/- 1.4 micromol/L), lower M and higher Hcy levels were found in group B (M = 16.9 +/- 8.2 micromol/kg FFM per minute, P < .001; Hcy, 11.2 +/- 2.9 micromol/L, P = .003) and C (M = 16.4 +/- 7.8 micromol/kg FFM per minute, P < .001; Hcy, 12.8 +/- 3.9 micromol/L, P < .001). The ADMA/L-arginine ratio was increased in group C (0.0078 +/- 0.0011) compared with group A (0.0063 +/- 0.0013, P = .03) and B (0.0058 +/- 0.0012, P = .01). Multivariate correlates (P < .05) of plasma Hcy concentrations were M (beta = -.34 +/- .12, P = .008), creatinine clearance (beta = -.23 +/- .10, P = .03) and fasting insulin (beta = .25 +/- .12, P = .04). This indicates an additive contribution of IR, plasma Hcy, and elevated ADMA/L-arginine ratio to the extent of angiographic CAD in combined IFG/IGT.

[Higher incidence of type 1 diabetes in males--a study in teenagers and young adults in Krakow region in 1987-1999]. / Wieksza zapadalnosc na cukrzyce typu 1 u plci meskiej--badania u nastolatków i mlodych doroslych w Krakowie i okolicy w latach 1987-1999.

Numerous reports of increasing incidence of type 1 diabetes worldwide, and similar tendency in children population in Poland prompted the study aiming at evaluating the incidence of type 1 diabetes in a population aged 15-29 years in Krakow area (voivodeship) in 1987-1999. The type 1 diabetes registry established in Chair and Department of Endocrinology CMUJ in 1986 was continued. To improve ascertainment two independent data sources were used: hospital departments and outpatient diabetic clinics. Definite inclusion criteria were assigned and data verified. Incidence rates and trends of incidence were calculated for gender and age groups, differences between the groups were analyzed. Incidence rates were standardized for the European population. The seasonality of disease occurrence was calculated. Registry ascertainment was assessed using "capture-recapture" method. Incidence of type 1 diabetes showed a significant increase in the whole group (0.32 new cases/100,000/year), mainly due to marked incidence increase observed in males (0.53). The oldest age group (25-29 years) showed the most rapid increase in diabetes type 1 incidence (1.07). Seasonality of disease occurrence was found in females. Mean ascertainment was 81%, with the lowest values in 1996-1999. The results obtained indicate that the increase of type 1 diabetes incidence in the age group 15-29 years in Krakow region was due to rapidly increasing incidence in males, especially those aged 25-29 years. Lack of disease occurrence seasonality in this group may indicate a role of other factors (associated with lifestyle or hormonal) responsible for such marked increase in young males, not seen in females. The study was terminated in 1999 due to new administrative division of the country and problems with data collection from the area of non-longer existing Krakow voivodeship.

[Prevalence of the glucose metabolism disturbances in screening of adult inhabitants of Krakow]. / Czestosc wystepowania zaburzen tolerancji weglowodanów wsród doroslych mieszkanców Krakowa--badania przesiewowe.

OBJECTIVES: In Poland, similarly like in the other European countries type 2 diabetes screening and prevention projects have been run. In Krakow, Krakow's Municipality had undertaken a decision of financing a prevention program directed to adult inhabitants of the city. The aim of the study was to assess the prevalence of the glucose metabolism disturbances in adult inhabitants of Krakow city. MATERIAL AND METHOD: The study was conducted in 2004-2005 in 42 Krakow's primary health care units in patients aged over 25, not treated due to the diabetes type 2 and/or coronary artery disease, with no history of myocardial infarction or stroke. In all study participants anthropometric examination, blood pressure and fasting glucose were measured. Diabetes risk score (DRS) and fasting glyceamia were used to classify patients to receive oral glucose tolerance test (OGTT). RESULTS: 40989 people (67.2% women and 32.8% men) aged 25 to 97 were examined. 12495 people received OGTT, in 1858 fasting glycaemia measurement was repeated. In 15.1% of men and 12.7% of women impaired glucose metabolism was found (p < 0.01). IFG was found in 5.9% men and 4.7% women (p < 0.01). The prevalence of IGT was the same in men and women (3.7% vs 3.8%, ns). Newly diagnosed diabetes type was found in 5.5% men and 4.2 % of women (p < 0.01). The prevalence of impaired glucose metabolism was increasing with age in men and women, in all categories of glucose disturbances, age related trends were statistically significant. Overweight was more frequent in men than in women (50.3% vs 36.8%, p < 0.0001), while obesity was more frequent in women compared to men (20.7% vs 19.5%, p < 0.02). Obesity was statistically more frequent in people with impaired glucose metabolism compared to those with normal glucose tolerance. Overweight was more frequent in women with impaired glucose metabolism compared to women with normal glucose metabolism, no relation with overweight was observed in men. CONCLUSIONS: The prevalence of newly diagnosed type 2 diabetes is increased in people aged over 55, what confirms the necessity of screening in this group of age. Due to more prevalent newly diagnosed type 2 diabetes and IFG in men, in all age groups implementation of routine screening for impaired glucose metabolism in men aged over 35 should be considered. Results of the study confirm the importance of the implementation of early prevention programs focused on lifestyle modification, especially addressed to men.

[Prevalence of the metabolic syndrome and its components in adult inhabitants of Krakow]. / Czestosc wystepowania zespolu metabolicznego i jego skladowych w populacji doroslych mieszkanców Krakowa.

OBJECTIVES: There are only few studies on the prevalence of the metabolic syndrome in Polish population. The aim of the study was to assess the prevalence of the metabolic syndrome according to NCEP definition in adult inhabitants of Krakow. MATERIAL AND METHOD: The study was conducted in 2004-2005 in 42 Krakow's primary health care units in patients aged over 25, not treated due to the diabetes type 2 and/or coronary artery disease, with no history of myocardial infarction or stroke. In all study participants anthropometric examination, blood pressure, fasting total cholesterol and fasting glucose were measured. In those with total cholesterol > 5.2 mmol/l additional triglicerides and HDL-cholesterol were measured. RESULTS: 40989 people (67.2% women and 32.8% men) aged 25 to 97 (54.1 +/- 14.1 years) were examined. In 19,4% of the examined population the MS was diagnosed (20.9% women and 16.2% men). In age group below 55 years the MS was more frequent in men than in women. Impaired glucose tolerance was found in 5394 study participants (3239 women and 2155 men). Mean systolic blood pressure was higher in men than in women (131.5 +/- 16,1 vs 127.0 +/- 17.5, p < 0.0001), the same was found for diastolic blood pressure (81.5 +/- 0.3 vs 78.6 +/- 9.6 p < 0.0001). 33.5% of women and 34.9% of men (p < 0.01) were treated from hypertension. In age group below 55 years men were more frequently treated due to hypertension than women (p < 0.001). In 8.7% of women and 14.1% of men (p < 0.001) newly diagnosed hypertension was found. In all age groups untreated hypertension was more frequent among men than in women. In 26.1% women and 33.5% men hypertriglicrdymia was found. In age group below hypertiglicerydemia was more frequent in men than in women (p < 0.001). Low HDL-cholesterol was found in 20.9% of women and 10.1% of men (p < 0.001). Visceral fat distribution was found in 19.9% of men and 33.3% of women. CONCLUSIONS: The MS was found in 20% of examined inhabitants of Krakow. Special attention should be paid to high prevalence of the MS among men younger than 45 years, as well as high prevalence of hypertriglicerydemia and newly diagnosed hypertension present in this group of men. The study results confirm the necessity of implementation of screening and early prevention of cardiovascular disease programs especially focused on younger men.

Assessment of daily nutrition ratios of opiate-dependent persons before and after 4 years of methadone maintenance treatment.

The aim of the study was the evaluation of the changes in nutritional habits of opiates dependent persons during 4 years of attendance in methadone maintenance treatment conducted by the Department of Toxicology of CMUJ in Kraków. These criteria were fulfilled by 30 persons (23 males and 7 females). They were examined before the methadone treatment and after 4 years of treatment. During Initial and final examinations for each of examined person the 24-hour recall had been performed three times. The information about daily supply of main nutrients (proteins, fats, fatty acids, carbohydrates, dietary fibre, cholesterol), minerals (calcium, iron, phosphorus, zinc, sodium) and vitamins (vitamin A, B1, B2, niacin, C) were obtained. The results were compared with daily norms (N) recommended on the safe level of intake. The normal range was established on the level +/-10% of normal values (+/-10% N). The changes between the results of following examinations were tested by using the t-student test. After 4 years of methadone treatment an increase in energy, vitamins, minerals and main nutritional ingredients intake was noted in women group. In men group a decrease in energy, proteins and carbohydrates intake was noted and fats intake, mainly unsaturated fatty acids, was increased. Vitamins were consumed in lower amounts and among minerals lower consumption in case of iron and sodium was noticed. In comparison with the recommended values in the initial examination in women group too low intake concerned fibre and vit. A, B,, calcium, iron, zinc and magnesium was noticed. In group of men too low intake (below recommended values) of energy, carbohydrates, fiber, vit. B1, B2, C, niacin, calcium and magnesium was noticed. After 4 years of methadone maintenance treatment in group of women too low intake only of vit. B1 and iron was noticed. In group of men it concerned vit. B1, B2, C, niacin and minerals such as calcium, iron, magnesium and zinc.

Nutritional status of the opiate dependent persons after 4 years of methadone maintenance treatment.

The aim of the study was to evaluate the nutritional status of opiate dependent patients before and after 4 years of participation in the methadone maintenance treatment. The examinations were performed in 30 opiates addicted persons (7 women and 23 men). The initial examination (exam 1) was done during the patients qualification for the methadone program, preceding methadone administration and final examination (exam 2) after 4 years of the treatment. In order to estimate the nutritional status body mass, the height, the arm circumference and the thickness of the triceps and subscapular fat-skin folds were measured. On the basis of them the BMI and mid arm muscle circumference (MAMC) were counted. The measurements of the body composition (using the bioimpedance method) were performed. The changes between the results of subsequent examination were tested using the t-Student test. In the examination that took place after 4 years of follow-up, body weight loss in the group of women was observed (mean--1.7 kg). It was followed by the decrease of BMI value (from 20.3 to 19.8 kg/m2). In both examinations the percentage of fatty tissue in general body mass was significantly below recommended values (10.7% in both examinations--the recommended values are 20%-22%). In the group of men an increase in body weight (mean--8.8 kg) and BMI value (from 23.3 to 25.9 kg/m2) was noticed. Arm circumference, muscle arm circumference and fat-skin folds values were increased. The analysis of particular body components showed increased fatty body mass (11.9% in the first and 18.5% in the second examination--the recommended values 16-19%) together with the decrease of lean body mass and body water.

The changes in taste preferences during 4 years period of methadone maintenance treatment.

The aim of the study was the analysis of the changes in the kind and the frequency of particular nutritional products consumption by opiate addicted persons during 4-year lasting methadone programme. There were 30 opiate addicted patients under examination (23 men and 7 women). Food consumption quality was estimated with the use of the Intake Frequency of Food Products Questionnaire. The examinations were performed before methadone administration had started, after 9 months and after 4 years of methadone maintenance treatment. Three categories of consumption frequency were established: rarely, moderately and often. The classification of different products was done with the use of hierarchic cluster analysis. For general illustration of the data the consumed products were compared by the means of hierarchical cluster analysis (this was done with the help of Euclidean distances and the Ward's algorithm). Then the k-means (with k=3) method was used in order to identify groups of products that were similarly often consumed. Each k-means analysis was performed separately for each examination. This was done in order to find out the products that change the cluster from one examination to another. Twenty labile products were identified. The examined products were moving between the adherent categories. This means that the consumption pattern undergoes some changes over the course of methadone therapy. Additionally, the analysis of the diet of this group of people shows improper and unhealthy nutritional behaviours: too big intake of sweets and too low intake of complex carbohydrates, fish and vegetable fats. This was especially visible at the beginning of the therapy, later this unfavourable diet habits changed but not to the desired level.

Association of coronary atherosclerosis with insulin resistance in patients with impaired glucose tolerance.

OBJECTIVES: The purpose of the study was to evaluate the role of insulin resistance (IR) in the development of coronary atherosclerosis in patients with impaired glucose tolerance. METHODS AND RESULTS: The study group consisted of 42 patients with impaired glucose tolerance. Based upon coronary angiography the patients were divided into group A--with prior myocardial infarction and critical coronary stenosis (n=20) and group B--without prior myocardial infarction and without critical coronary stenosis (n=22). In each patient glucose disposal rate (GDR) during metabolic clamp, insulinaemia in the fasting state and during the clamp, glycaemia during oral glucose tolerance test (OGTT), BMI and body mass composition were measured. The groups did not differ in age, BMI, percent fat content and distribution, and blood pressure. Fasting insulinaemia (56.7 microU/ml) was higher in group A than in group B (22.3 microU/ml). GDR in group A (2.96 mg/kg b.m./min) was lower than in group B (5.36 mg/kg b.m./min). There was a negative correlation between the number of critically narrowed coronary vessels and GDR in group A. GDR below 3.97 mg/kg b.m./min was found, based on regression analysis, to be a powerful risk factor for myocardial infarction. CONCLUSIONS: The relationship between IR and severity of coronary atherosclerosis implies its unfavourable role in the development of atherosclerosis. The present findings indicate a negative role of IR in the development of myocardial infarction and suggest that it is an independent risk factor, which identifies high-risk patients requiring treatment that would increase tissue insulin sensitivity.

[Insulin resistance indices in population-based study and their predictive value in defining metabolic syndrome]. / Wskazniki insulinoopornosci w badaniu populacyjnym i ich wartosc predykcyjna w okresgleniu zespllu metabolicznego.

UNLABELLED: In clinical studies insulin resistance, the main factor of the Metabolic Syndrome (MS), is determined directly by metabolic clamp technique, while in epidemiological studies is estimated on the basis of indices calculated from oral glucose tolerance test glycemia and insulinemia. The aim of the study was to find out which insulin resistance indicator best predicts the risk of the MS. MATERIAL AND METHODS: The study population consisted of 2673 inhabitants of Kraków, aged 35-75 years, who participated in the "Polish Multicenter Study on Diabetes Epidemiology". Fasting insulin, HOMA-IR, QUICKI and Matsuda's index were determined for all subjects. Insulin resistance was defined as the cutoff values for the population with normal glucose tolerance and with BMI < 25 kg/m2. RESULTS: All insulin resistance indices were closely correlated (r=0.78-0.98), and the frequency of insulin resistance in the general population was similar (47%-54%), however the highest prevalence of insulin resistance was observed when Matsuda index was used. The risk of insulin resistance, increased with the category of glucose tolerance, and was the highest when Matsuda index was used. The MSWHO was observed in 42% to 45% of the studied population and the predictive value of insulin resistance indices were similar when using WHO criteria. The highest sensitivity in the MSNCEP identification was observed when Matsuda index was used. Matsuda index had also the highest sensitivity to diagnose MSNCEP as compared with the remaining insulin resistance indices. CONCLUSIONS: The study insulin resistance indices have a similar value in predicting the MSWHO while Matsuda index predicts best the MSNCEP. Matsuda index as well predicts best the risk of insulin resistance. This argues in favor of using oral glucose tolerance test to estimate risk for diabetes mellitus and cardiovascular disease.