Emőke Kiss-Tóth

Factors influencing the diabetes-specific health-related quality of life in children and adolescents with type 1 diabetes mellitus

This study aimed to investigate the association of the anthropometric, clinical variables and maximal oxygen uptake (Vo 2max) with diabetes-specific health-related quality of life (HRQoL) in youths with type 1 diabetes mellitus (T1DM) and to find the predictors of HRQoL and blood glucose control. A total of 239 youths with diabetes (124 boys and 115 girls) were recruited from diabetes-based summer camps. HRQoL assessment was carried out with the Pediatric Quality of Life Inventory™ 3.0 Diabetes Module (Information Resources Centre, Mapi Research Trust, France); Vo 2max was evaluated by conducting the 20-m shuttle run test. Higher Vo 2max and the insulin pump therapy were significant predictors of the HRQoL in the multiple regression analysis; other clinical and anthropometric variables had no effect. The better blood glucose control was explained only by the higher Vo 2max. The good cardiorespiratory fitness (expressed by Vo 2max) has clinical and QoL benefits for paediatric patients with T1DM.

BENEFITS OF CONTINUOUS SUBCUTANEOUS INSULIN INFUSION ON QUALITY OF LIFE

PURPOSE The aim of this study was to compare the general health-related quality of life (HRQoL), the metabolic control (HbA1c), the anthropometric measurement, and the cardiorespiratory fitness (expressed by VO2max) in youths with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) to those receiving multiple daily injections (MDI). We looked for factors influencing the HRQoL and metabolic control. METHODS A total of 239 patients treated with CSII (51 girls and 53 boys) or MDI (64 girls and 71 boys) between ages 8 and 18 years were assessed with the Pediatric Quality of Life Inventory, Generic Core Scales, and Diabetes Module. VO2max was evaluated using the 20-meter shuttle run test. RESULTS CSII group had significantly better HRQoL according to both child self-report and parent proxy-report. Youths with CSII reported better physical, emotional, and school-related functioning, and had less diabetes-related fear and symptoms than the MDI group. There were no significant differences in body mass index z-scores, insulin doses, HbA1c, and VO2max between the groups. HRQoL was predicted by the CSII therapy (β = -0.220; p = .000) and the VO2max (β = 0.386; p = .000), other clinical and anthropometric parameters had no effect; the HbA1c was predicted only by VO2max (β = -0.353; p = .000). CONCLUSIONS Diabetic youths treated with CSII therapy have better HRQoL than those treated with MDI. There are no differences between the investigated groups in anthropometric data, glycated hemoglobin, and physical fitness. Moreover, good physical fitness has an important role in achieving better metabolic control and HRQoL, which underlines the importance of regular aerobic exercise in the treatment and care of type 1 diabetes in childhood.

Prevalence and possible causes of hypospadias

Hypospadias is the most common congenital malformation of the male external genitalia. After the heart and circulatory system, it is the second most common developmental disorder in males. It is due to a midline fusion defect of the male urethra, which results in a misplaced urethral meatus. Hypospadias may be distal, medial and proximal. It may occur as an isolated defect or it may develop together with other genital disorders (retention of testes in one or both sides, microphallus, bifid scrotum) or with malformation of other organs. In some cases syndromic forms may also occur. Genetic factors play a crucial role in the occurrence of early developmental defect, but endocrine and environmental factors may also be important in the aetiology of hypospadias. It may be associated with various sex and autosomal chromosomal abnormalities. Monogenic and chromosomal causes of hypospadias accounts for about in 30% of all cases, while genetic factors remain unknown in 70% of cases. The authors summarize the development of the male external genitalia, the prevalence and possible causes of hypospadias. They propose that better understanding of the pathogenesis of the disease may contribute to the prevention and decreased prevalence of the disease.

Az elhízás anyagcsere-szövődményei serdülőkorban, különös tekintettel az emelkedett húgysavszintek előfordulására

Absztrakt Bevezetes: Az elhizas tarsadalmi problemat jelent vilagszerte, amely elvezet tobb betegseghez, beleertve a metabolikus szindromat, hypertoniat es a cardiovascularis betegsegeket. Ismert teny, hogy a hyperurikaemia felnőttkorban osszekapcsolodhat e betegsegekkel. Celkitűzes: A metabolikus szindroma es a hyperurikaemia gyakorisaganak es ezek osszefuggesenek vizsgalata elhizott serdulők koreben. Modszer: A szerzők keresztmetszeti tanulmanyukban 162 (100 fiu, 62 lany) tulsulyos vagy elhizott serdulő adatait elemeztek, akiket korabban a gyermekgyogyaszati endokrinologiakonzultacion kivizsgaltak. Antropologiai es metabolikus parametereket ertekeltek valamennyi szemelynel. Kontrollkent egeszseges, azonos eletkoru, nem elhizott 20 leany es 26 fiu adatait hasznaltak. A betegek eletkora fiuknal 12±2,1 ev, lanyoknal 11±2,5 ev, a kontrollfiuk eletkora 12,9±2,5 ev, a lany kontrollcsoport eletkora 13,2±1,6 ev volt. A szerzők linearis regressziot alkalmaztak a hugysavszint es a metabolikus szindroma egyes klin...

Questions and dilemmas in the management of hypospadias

Hypospadias is the second most common congenital malformation in males. Etiology remains unknown in about 70% of the cases. Distal hypospadias is considered not only developmental abnormality of the urethra in males, but it may also constitute a mild form of sexual development disorder in 46,XY males. Most urologists and endocrinologists consider that it is necessary to perform a detailed investigation of children presenting with proximal hypospadias associated with a small phallus or poorly developed scrotum and undescended testes. Currently, there is no generally accepted recommendation for the preoperative evaluation of hypospadias and, therefore, masculinizing surgery without preoperative evaluation is performed in these children. The authors summarize the international literature data and their own experience for the assessment and management of hypospadias concerning questions and problems related to preoperative investigation, masculinizing surgery and additional surgery. A detailed algorithm is presented for preoperative evaluation of both proximal and distal hypospadias.

Role of genetic and environmental factors in the development of polycystic ovary syndrome

Polycystic ovary syndrome is the most common heterogeneous endocrine abnormality in women in the reproductive age. The syndrome remains an enigmatic disorder because the aetiology is still unclear. Familial aggreagation is relatively common among patients with polycystic ovary syndrome suggesting a significant genetic component, although the way of inheritance has not been established firmly. The authors review the relevant medical literature and suggest that genetic and environmental factors play a role in the development of polycystic ovary syndrome. To date, no gene has been identified that causes or contributes substantially to the development of a polycystic ovary syndrome phenotype. Polycystic ovarian syndrome is considered to be an oligogenic disorder in which the interaction of a number of genetic and environmental factors determines the heterogeneous clinical and biochemical phenotype. To summarize current evidence the authors conclude, that when we are able to identify and then modify environmental determinants, then we will be able to safeguard better the health of those patients who are predisposed to disease development due to genotype or previous environmental effects.

A pubertas fejlődését szabályozó neuroendokrin mechanizmusok. Irodalmi áttekintés

: Puberty is the stage of development in human life, when the hypothalamus-hypophysis-gonad axis is re-activated after quiescence. Humanity has long been concerned with the idea of exogenous and endogenous factors and mechanisms that influence the temporal course of puberty neuroendocrine events. Recent discoveries have helped to understand the functioning of the neuroendocrine system. It has been clarified that kisspeptin plays a key role in puberty and regulation of fertility. However, in the function of the gonadotropin-releasing hormone (GnRH) pulse secretion, besides kisspeptin, neurokinin B, dynorphin neurons other positive and negative signals are involved, guiding the release of hormones of hypophysis gonadotropin. The knowledge of these nerves further enhanced the understanding of GnRH pulsation modulation by endocrine, metabolic and environmental impacts. The authors point out the risk of endocrine disruptors in the physiological course of puberty. The aim of the review is to provide a comprehensive picture of the research results of the physiology of kisspeptin, as the manipulation of kisspeptin signaling has the potential for novel therapies in patients with pathologically low or high luteinizing hormone (LH) pulsatility. Orv Hetil. 2018; 159(29): 1175-1182.

Physical activity and physical fitness as protective factors of adolescent health

Abstract Objective This quantitative correlational design study aimed to examine the variation in adolescent health and lifestyle characteristics across self-reported physical activity (PA) and physical fitness (PF) levels. Methods Data were collected from 422 students (50.2% males) (16.33 SD = 1.66 y/o) attending a high school. An online questionnaire was used to gather data on the following characteristics: self-reported well-being, overall life satisfaction, depression (including self-harm and suicidal ideation), perceived health status, eating disorders, sleepiness, substance use (alcohol, tobacco and illicit drug use), body mass index, PA participation and PF levels. Results Of the participants, 42.4% reported at least 5 days of PA a week for 60 min per day. These high active individuals had significantly better well-being, health status, life satisfaction, PF and consumed fewer alcohol beverages. High PA and better PF inversely correlated with depression. Conclusions It seems that high PA and better PF have a positive impact on adolescent perceived health, health-risk behaviors and mental health. Increased levels of PA can play a vital role in the primary care, prevention of health risks and in adolescent health promotion. Accordingly, educational institutions are an excellent setting to promote and provide sport facilities and encourage students to be more physically active.

A csecsemőkori táplálás összefüggése a gyermekkori elhízással. Irodalmi áttekintés

Absztrakt: A gyermekkori elhizas egyre novekvő gyakorisaga komoly kozegeszsegugyi problema. Ma mar elfogadott teny, hogy a csecsemőtaplalasnak az emberi fejlődes korai, kritikus időszakaiban (első 1000 nap) hosszu tavu hatasa lehet a kesőbbi egeszsegre. A szerzők a fogantatastol szamitott első 1000 nap csecsemőkorra eső időszakaval foglalkoznak, irodalmi tallozas alapjan. 2010 ota nagyszamu kozlemeny jelent meg, amelyben a csecsemőtaplalas, korai sulygyarapodas es a kesőbbi elhizas kozotti osszefuggest vizsgaltak. Tobbsegukben azt igazoltak, hogy a szoptatas jelentősen befolyasolja a korai novekedest, es hosszu tavon csokkenti az obesitas rizikojat. A szoptatas egeszsegugyi előnyei a tapszeres etetessel szemben elfogadottak, de a csecsemőtaplalas es a kesőbbi elhizas kozotti osszefuggesről nincs teljes egyetertes a szakirodalomban. A szerzők az ellentmondas okat kerestek az irodalomban az utobbi evekben fellelhető kozlemenyek alapjan. Osszegzeskent megallapitjak, hogy a legalabb negy honapig tarto kizarol...

Elkülöníthetőek-e egymástól az eltérő kockázatkereső magatartásformák, a szenzoros élménykeresés, rezíliencia, teljesítménymotiváció valamint a temperamentum- és karakterfaktorok alapján?

The purpose of our study was to find out whether groups of people with different forms of risk-seeking behavior can be clearly differentiated from each other on the basis of sensation seeking, resilience, performance motivation, and temperament and character factors. Altogether 435 subjects participated in our research; 170 pro-social risk-takers (firemen), 194 anti-social risk-takers (perpetrators of violent crime) and 71 people exercising extreme sports. We assessed sensation seeking with the Brief Sensation Seeking Scale (BSSS-8). For the assessment of resilience we used Neill and Dias’ (2001) 15-item version of the originally 25item self-administered questionnaire, Resilience Scale (RS) by Wagnild and Young. We used the Achievement Motives Scale (AMS-R), developed by Jonas W.B Lang and Stefan Fries in 2006, to assess performance motivation. Measuring temperament and character factors took place with the Hungarian adapted version (Rózsa and co, 2005) of Cloninger’s Temperament and Character Inventory (TCI). Our results point out that although showing major differences, groups with different forms of risk-seeking behavior can not be clearly differentiated from each other with all of the scales used in this research.