[Neurovascular compression of the medulla oblongata: a rare cause of secondary hypertension]. / Nyúltveloi neurovascularis kompresszió. A szekunder hypertonia ritka oka.

Compression of the rostral ventrolateral medulla oblongata is one of the rarely identified causes of refractory hypertension. In patients with severe, intractable hypertension caused by neurovascular compression, neurosurgical decompression should be considered. The authors present the history of a 20-year-old man with severe hypertension. After excluding other possible causes of secondary hypertension, the underlying cause of his high blood pressure was identified by the demonstration of neurovascular compression shown by magnetic resonance angiography and an increased sympathetic activity (sinus tachycardia) during the high blood pressure episodes. Due to frequent episodes of hypertensive crises, surgical decompression was recommended, which was performed with the placement of an isograft between the brainstem and the left vertebral artery. In the first six months after the operation, the patient's blood pressure could be kept in the normal range with significantly reduced doses of antihypertensive medication. Repeat magnetic resonance angiography confirmed the cessation of brainstem compression. After six months, increased blood pressure returned periodically, but to a smaller extent and less frequently. Based on the result of magnetic resonance angiography performed 22 months after surgery, re-operation was considered. According to previous literature data long-term success can only be achieved in one third of patients after surgical decompression. In the majority of patients surgery results in a significant decrease of blood pressure, an increased efficiency of antihypertensive therapy as well as a decrease in the frequency of highly increased blood pressure episodes. Thus, a significant improvement of the patient's quality of life can be achieved. The case of this patient is an example of the latter scenario.

Assessment of cardiometabolic risk among shift workers in Hungary.

AIM: Shift workers may be at risk of different diseases. In order to assess cardiometabolic risk in shift workers, a cross-sectional study was performed among active workers. METHODS: A total of 481 workers (121 men, 360 women) were investigated; most of them were employees in light industry (58.2%) or in public services (23.9%). Past medical history was recorded and physical examination was performed. Questionnaires were used to characterize daily activity. Fasting venous blood sample was collected for measuring laboratory parameters. Data from shift workers (n = 234, age: 43.9 ± 8.1 years) were compared to those of daytime workers (n = 247, age: 42.8 ± 8.5 years), men and women were analyzed separately. RESULTS: In men, systolic blood pressure was higher in shift workers compared to daytime workers (133 ± 8 vs 126 ± 17 mmHg; p < 0.05). In women, weight (73.6 ± 15.5 vs 67.7 ± 13.2 kg; p < 0.001), body mass index (27.5 ± 5.7 vs 25.0 ± 4.3 kg/m2; p<0.001) and the prevalence rate of hypertension in the past medical history (24.4 vs 13.4%; p < 0.01) were higher in shift workers compared to daytime workers. In addition, the proportion of current smokers was higher (37.7 vs 21.7%; p < 0.001) and HDL-cholesterol level was lower (1.56 ± 0.32 vs 1.68 ± 0.36 mmol/l; p < 0.01) in female shift workers than in female daytime workers. Both in men and in women, rotating shift workers spent less time sleeping both on working days and on non-working days, spent less time with sport activity, drank more coffee and they spent less time working per day, especially in light physical work, compared to daytime workers. In addition, low and middle educational levels were most frequently found among rotating shift workers as opposed to the daytime workers where high educational level was more common. CONCLUSION: Middle-aged active shift workers, especially women, have a less healthy lifestyle and are at higher cardiometabolic risk as compared to daytime workers. Our study highlights the importance of measures for identifying and preventing cardiometabolic risk factors in shift workers.

Prevalence rate of diabetes mellitus and impaired fasting glycemia in Hungary: cross-sectional study on nationally representative sample of people aged 20-69 years.

AIM: To obtain correct evaluation of the prevalence rate of diabetes mellitus and impaired fasting glycemia (IFG) in Hungary. METHOD: The study was performed on a nationally representative sample covered by the Hungarian General Practitioners' Morbidity Sentinel Stations Program. The source population consisted of all persons aged 20-69 years who were registered with the participating centers. The prevalence rates were adjusted to age and sex distribution of the total Hungarian population. Fasting blood samples of 1803 participants were evaluated. Response rate was 90.7%. RESULTS: In addition to 130 (7.21%) patients with established diabetes, 26 participants with newly diagnosed diabetes were found, resulting in a total crude diabetes prevalence of 8.65% (men: 11.16%; women: 6.41%; P<0.001). After weighting for age and sex, the prevalence rate of diabetes in participants aged 20-69 years should be set at 7.47% (95% confidence interval [CI], 6.26-8.69) (men: 9.49%; 95% CI, 7.52-11.46; women: 5.58%; 95% CI, 4.12-7.04). In addition to 41 (2.27%) patients with established IFG (fasting blood glucose: 6.1-6.9 mmol/L), 47 participants with newly diagnosed IFG were found, resulting in a total crude IFG prevalence of 4.88% (men: 6.11%; women: 3.78%; P=0.022). After making corrections for weighting age and sex, the total IFG prevalence rate in participants aged 20-69 years should be set at 4.39% (95% CI, 3.44-5.34) (men: 5.52%; 95% CI, 3.99-7.06; women: 3.33%; 95% CI, 2.19-4.47). CONCLUSION: The prevalence rate of diabetes and IFG in Hungary is higher than previously estimated by experts and authorities. The present data may serve as a base for comparative investigations in the future.

[From the metabolic syndrome to the concept of global cardiometabolic risk]. / A metabolikus szindrómától a kardiometabolikus kockázat fogalmáig.

Although the clustering of cardiovascular risk factors is unquestionable, the clinical significance of the metabolic syndrome as a distinct entity has been debated in the past years. Recently, the term 'metabolic syndrome' has been replaced by 'global cardiometabolic risk' which implies cardiovascular risk factors beyond the metabolic syndrome. The metabolic syndrome can be frequently detected among people in western and developing countries affecting 25-30% of adult population, and its prevalence rate is increasing. Prospective studies show that the metabolic syndrome is a significant predictor of incident diabetes but has a weaker association with cardiovascular morbidity and mortality. At the same time the metabolic syndrome is inferior to established predicting models for either type 2 diabetes or cardiovascular disease.The underlying pathomechanism of the metabolic syndrome is still poorly understood. The role of insulin resistance--although not as a single factor--is still considered as a key component. In the last decade the importance of abdominal obesity has received increased attention but some studies, mainly in the Asian population, showed that central obesity is not an essential component of the syndrome. Regardless of the theoretical debates the practical implications are indisputable. The frequent clustering of hypertension, dyslipidaemia and glucose intolerance, that often accompanies central obesity, can not be ignored. Following the detection of one risk factor, the presence of other, traditional and non-traditional factors should be searched for, as the beneficial effect of intensive, target oriented, continuous treatment of metabolic and cardiovascular risk factors has been proven in both the short and long term.

Severe but preventable foot burn injury in diabetic patients with peripheral neuropathy.

BACKGROUND: Due to the sensory loss in the lower extremities, accidental foot injuries may develop in diabetic patients with distal sensorimotor polyneuropathy. Unusual etiologies of foot injury may be of interest. CASE REPORTS: Patient 1, a 51-year-old type 2 diabetic patient, was observed with a burn injury of the digits I-V of the right foot due to an unperceived thermal injury while working at a house construction site and wearing shoes. Patient 2, a 66-year-old type 2 diabetic patient, tried to treat a small dermal lesion caused by improper footwear by using a hot paraffin footbath, but during this unusual self-treatment a painless and unperceived burn injury developed. Bed rest, local disinfection, antibiotics, and minimal surgical intervention (partial amputation, debridement) were applied. After long healing periods, both patients recovered with acceptable residual findings. CONCLUSIONS: Severe clinical consequences of foot burn injuries of unusual etiology may occur in diabetic patients with neuropathy. To prevent severe foot burn injuries, continuous education should be provided for diabetic patients with sensory loss of the lower extremities due to neuropathic complications.

[Effectiveness of cardiometabolic risk reduction in patients with type 1 diabetes mellitus]. / A kardiometabolikus kockázati tényezôk kezelésének eredményessége 1-es típusú diabetesben szenvedôk körében.

UNLABELLED: The attainment and maintenance of therapeutic goal of cardiovascular risk factors are of great clinical importance. The effectiveness of cardiovascular risk management is not well characterized during regular care of patients with type 1 diabetes mellitus. AIM: The aim of the study was to estimate the effectiveness of cardiovascular risk management in type 1 diabetic patients. METHODS: Adult patients with type 1 diabetes mellitus (n = 533; 256 men, 277 women; age: 35.6 +/- 11.6 years; duration of diabetes: 18.0 +/- 11.1 years; x +/- SD) were consecutively enrolled from 11 diabetes outpatient departments. Data on medical history, actual treatment, anthropometric and laboratory parameters as well as actual blood pressure were registered, while eating and smoking habits, education level and physical activity were evaluated by standardized questionnaires. The treating goal was set according to the national guideline which corresponds to the current international task force. RESULTS: Of 533 patients, the body mass index target level (< 25 kg/m 2 ) was achieved by 295 (55.5%) patients. Ideal waist circumference (< 80 cm for women and < 94 cm for men) was measured in 140 (50.5%) and in 165 (63.7%) patients, respectively. Optimal glycaemic control (HbA 1c level < 6.5%) was documented in 45 (8.4%) patients. Lipid lowering drugs (statins, fibrates or ezetimibe) were used by 130 patients, among which 53.1% reached the target triglyceride level, 71.5% the target HDL-cholesterol and 27.8% the target LDL-cholesterol levels. Taking the lipid target values together, only 23 (17.7%) patients were at goal. Antihypertensive drugs were used by 173 patients among which 29.5% reached the systolic and 34.8% the diastolic target values (< 130/80 mmHg). Regarding smoking habits, 94 (17.7%) patients were current smokers and 102 (19.2%) ex-smokers. CONCLUSIONS: The attainment of therapeutic goal of cardiovascular risk factors proved to be difficult in a substantial part of patients. Further efforts are needed for attaining and maintaining the established goal of cardiovascular risk management during regular care of adult patients with type 1 diabetes mellitus.

Intraobserver and interobserver variability of measuring waist circumference.

BACKGROUND: The measurement of waist circumference for assessing abdominal obesity has become widely accepted. MATERIAL/METHODS: To evaluate the reliability of measuring waist circumference, anthropometric parameters were measured in 150 adult patients by two diabetes educators on two consecutive days. The intraobserver difference was defined as the difference in the measurements made by the same educator on different days and the interobserver difference as the difference in the measurements made by the two educators on the same days. RESULTS: The correlation coefficients (r values) of the measurements were >0.99 for the educators and days. The interobserver difference was statistically significant for waist circumference (96.23 cm vs. 97.08 cm, p<0.0001). Although the %Delta values (percent difference in the two means) for waist circumference proved to be 2.5-6.3 times higher and the% absolute Delta values (percent average difference) 1.5-2.8 times higher than those for body mass index, the absolute values of the differences (Delta, the difference of the two means, and absolute delta, the average difference) were small (waist circumference Delta: 0.17 cm and 0.85 cm, absolute Delta: 1.51 cm and 2.15 cm; body mass index Delta: 0.02 kg/m(2) and 0.04 kg/m(2), absolute Delta: 0.292 kg/m(2) and 0.226 kg/m(2); intraobserver and interobserver differences, respectively). CONCLUSIONS: The intraobserver and interobserver variability for waist circumference were higher than those for body mass index. Nevertheless, the differences in repeated measurements of waist circumference were small when expressed in absolute values. The reliability of waist circumference should be considered in the clinical practice.