The protein participation in daily diet and nutritional status of medical students in Kraków.

PURPOSE: The assessment of protein participation in daily diet together with anthropometric estimation of nutritional status. MATERIAL AND METHODS: There were examined 150 students of Medical Faculty of Jagiellonian University. BMI and MAMC (Mid Arm Muscle Circumference) were examined in order to estimate the nutritional status. Quality of daily diet was estimated by the analysis of daily nutritional ratio (DNR). RESULTS: Underweight was more often observed among women (14.3% vs 5.8%), and overweight and obesity among men (13.4% vs 5.1%). Too low MAMC value was more often observed in the group of men (25% vs 2.4%). Correct MAMC value was represented by most women (86%) and with one exception they were also correct among female with underweight. Not acceptable diet showed 62.5% of male students and 46.8% of female students representing all BMI ranges. The low protein consumption frequency in every day diet showed 25% students with MAMC <5 percentile. CONCLUSIONS: The confirmed disturbances in nutrition among examined students did not find statistically important reflection in protein nutritional status represented by MAMC value. It may confirm short time of duration of nutritional disturbances (potential shortages--no physical symptoms) and may be connected with the lack of quantity estimation of nutrition.

The relation between antioxidative ability and the diet of young swimmers.

PURPOSE: The comparison of nutrition of children with high level of physical activity in dependence on antioxidative efficiency expressed in Ferric Reducing Ability of Plasma--FRAP adapted for saliva. MATERIAL AND METHODS: The group consisted of 74 pupils (43 boys and 31 girls) from swimming classes of Sport Championship School in Kraków. FRAP was measured in saliva with the use of colorimetric method and was presented in calculation per 1 gram of proteins. Three groups were separated on the basis of FRAP/ protein (g) values distribution of 15 and 85 percentile. In each group the comparison of particular nutritional components was done with taking into consideration the 24 hour nutritional recall. RESULTS: The statistically significant differences in nutrition were observed only in girls group in dependence on the FRAP values. These differences concerned energy and carbohydrates intake. Fats always provided more then 30% of energy, especially among children with high FRAP/ protein (g) value--34.3%. The shortage of proteins was not observed. The mean intake of calcium, and zinc was below and phosphorus, vitamin A and C intake was above the recommended level. CONCLUSIONS: Non-enzymatic mechanisms of antioxidative efficiency (FRAP) are partially being modified by nutritional factors.

An evaluation of breathing nervous regulation of opiate dependent patients during in 6 months' methadone maintenance treatment programme.

During the methadone maintenance treatment an individually specified doses of methadone should prevent a withdrawal syndrome and may stabilise the activity of respiratory centres of opiate dependent patients. The aim of the study was to evaluate the direction of changes in respiratory pattern parameters of 34 opiate dependent patients (14 women and 20 men) during 6 months' methadone maintenance treatment at the Kraków Department of Clinical Toxicology. Respiratory pattern parameters and occlusion pressure were measured by means of a computer spirometer using "on line" during unrestrained breathing with atmospheric air. Examination of respiratory pattern were performed three times: I--initial examination--before administration of methadone maintenance treatment; II--control examination after 3 months' methadone maintenance treatment; III--control examination after 6 months' methadone maintenance treatment. An increase in values of occlusion pressure and minute ventilation were observed. The times of expiration and total times of inspiration-expiration cycle were shorter in III examination than in the examination before methadone administration. The values for the breathing cycle neuromuscular drive (VT/Tin) were relatively stable, but they were higher than those obtained in the control group. It may be related to the anxiety states and mood alteration. The largest individual variation in consecutive examination were observed for Tin/Ttot index being the timing component of respiratory patterns characteristic for parasympathetic control of breathing.

The changes in spirometric measurements during 6 months' methadone maintenance treatment in opiate dependent patients.

The aim of the study was to evaluate the respiratory system response to individually specified doses of methadone in opiate dependent patients during 6 months' methadone maintenance treatment at the Department of Clinical Toxicology CM UJ. There were 34 persons (14 women aged from 21 to 33 years and 20 men aged 21-46 years) under examination. Examinations were performed three times: I--initial examination--before administration of methadone maintenance treatment; II--control examination after 3 months--methadone maintenance treatment; III--control examination after 6 months--methadone maintenance treatment. Ventilation efficiency was assessed on the basis of the results from a "flow-volume" loop, spirometry and the measurements of the respiratory tract resistance (Rrs) in a computerised system. Rrs was determined by means of the flow-interruption method. The parameters obtained from a "flow-volume" loop and spirometry were stabile within opiate substitution with methadone, whilst the values of respiratory resistance were significantly different. Significant increase in respiratory resistance values between initial and control examination (after 3 months) was noted. The normalisation of respiratory resistance was proved after 6 months treatment. It can indicate the impact of nervous component on spastic reaction of central bronchi.

[The kind of dependence and estimation of body mass]. / Rodzaj uzaleznienia a skladowe masy ciala.

The aim of the study was to evaluate frequency of overweight and underweight, and estimation of components of body mass (body fat, lean body mass, body water) in 176 people: 61 men with aethanol dependency (group 1), 37 opiate addicted men (group 2), 32 men in control group (group 3), 14 opiate addicted women (group 4) and 32 women after first suicidal attempts who were treated in the Department of Clinical Toxicology (group 5). All of the patients had their Body Mass Index (BMI) calculated. The components of body mass were calculated using the method of bioelectrical impendance with Maltron. Statistical analysis was performed using the Statistica Software. The greatest differences were observed between group 2 and group 1. In both groups more underweight, less overweight with less total body fat was observed, with the increase in body water. In both women groups no overweight or obesity were observed, but there were significant differences between various body components masses. Deficiencies in body fat were observed in 86% women from group 4 and in 50% women from group 5. On the other hand excess of body water was observed in 93% from group 4 and only in 47% from group 5. Our studies shown that even among the persons with correct weight calculated using the BMI method some abnormalities can be observed in body fat, lean body mass and body water. We therefore conclude that only by measuring components of total body mass we may evaluate etiology of overweight and obesity.

Occurrence of pulmonary diseases in steel mill workers.

The 'Sendzimir' Steel Mill, Cracow, Poland, gives employment to approximately 17,000 workers. During the years 1994-98, 1396 compensation claims for diseases related to occupational hazards were registered. After a scrupulous investigation, 851 cases were certified as occupation-related diseases. Of this number, 481 cases (56.5%) were diagnosed as pulmonary diseases, including silicosis (n = 225, 46.7%); chronic bronchitis (n = 138, 28.7%); lung carcinoma (n = 59, 12.3%); epithelial cancer (n = 42); adenocarcinoma (n = 12); microcellular carcinoma (n = 5); asthma, 12 atopic and 24 non-atopic (n = 36, 7.5%); and asbestosis (n = 23, 4.8%). Chronic bronchitis was diagnosed in patients exposed to industrial dusts, containing SiO2, NOx, and SO2. Asthma occurred most frequently among those exposed mainly to Cr+6, Co and Ni containing dusts, and lung carcinoma in those exposed to policyclic aromatic hydrocarbons, including benz(a)pyren, asbestos, chromium, vapours of oils and lubricants. In 1994-96, chronic bronchitis and silicosis, and in 1997-98, lung carcinoma and asthma were most frequently diagnosed in the workers under study. It is likely that the diminishing frequency of chronic bronchitis and silicosis was the consequence of technological progress, and greater concern for hygiene standards. Increasing incidence of lung cancer reflects long latency characteristic of this illness.

[Comparison of ventilatory efficiency in alcohol and opiate abusers]. / Porównanie sprawnosci wentylacyjnej u osób przewlekle uzaleznionych od alkoholu i osób uzaleznionych od opiatów.

The aim of this study was to evaluate the respiratory efficiency in alcohol and opiate abusers. There were 220 persons under examination: 144 alcohol abusers (group I), 36 opiate abusers (group II) and 40 healthy persons (control group). Both groups of dependent persons were treated in the Detoxication Unit of the Department of Clinical Toxicology CMUJ. During hospitalization the functional state of respiratory system was monitored. Ventilation efficiency was determined on the basis of the results from a "flow-volume" loop, spirometry and the measurements of the respiratory tract resistance in a computerised system Lungtest-MES company (Poland). In the examination performed directly after admission to the Clinic the normal respiratory efficiency was noted in 36.1% in ethanol abusers and 54.9% in opiate abusers. 63.9% of alcohol abusers (group I) and 45.1% of opiate abusers (group II) suffered from the bronchial obturation. In the examination performed after hospitalisation and 9 days of total abstinence in 33.3% of the alcohol dependent patients and in 38.5% of the opiate dependent patients respiratory obturation was observed. The values of respiratory tract resistance in both groups of dependent patients in examination on admission and after treatment were increased compared to controls. The changes of ventilatory parameters can be explained mainly by withdrawal syndrom revealing that it is connected with initial (9 days lasting) period of controlled and total abstinence.

[Comparison of respiratory regulation in alcohol and opiate abusers]. / Porównanie regulacji oddychania u osób przewlekle uzaleznionych od alkoholu i osób uzaleznionych od opiatów.

Opioid drugs and alcohol, both central nervous system depressants, may also have a depressive action on the brain stem centre responsible for breathing control. Disorders of breathing regulation are reflected in respiratory efficiency. The aim of this study was to evaluate the regulation of breathing by measuring the respiratory pattern and occlusion pressure of abusers of opiates and alcohol. There were 180 persons under examination: 84 alcohol abusers (group I), 36 opiates abusers (group II) and 40 healthy persons (control group). Both groups of dependent persons were treated in the Detoxication Unit of the Department of Clinical Toxicology CMUJ. Respiratory regulation was evaluated "on line" by means of synchronous measurements of the respiratory pattern (according to Milic-Emili assumptions) and occlusion pressure P 0.1 (according to Whitlaw assumptions). The central respiratory drive (VT/Tin) and the timing component of the breathing cycle (Tin/Ttot) were simillar in both groups of abusers. In comparison to the control group, in the group of opiates abusers, values of VT/Tin were higher during examination performed after treatment, and values of Tin/Ttot were elevated (in group I--only before treatment; in group II--before and after treatment). Examination of respiratory pattern and occlusion pressure is based on recording spontaneous breathing, which this can be performed even in unconscious patients in very early stage of poisoning.

[Occupational allergic diseases in the steel industry. Population studies]. / Alergiczne choroby zawodowe w hutnictwie. Badania populacyjne.

The aim of this study was to evaluate the occurrence of occupational allergic diseases of the respiratory system and skin. The study was carried out in a population of 17,600 employees of Huta im. T. Sendzimira (T. Sendzimir Steelworks) in 1992-96. During this period 543 employees were referred to the Occupational Diseases Department with a suspection of occupational allergy. Connection between the kind of occupation and disease was confirmed in 215 cases. 104 (48%) suffered from upper respiratory tract diseases or bronchial asthma and 111 patients (52%) suffered from allergic skin disease as contact dermatitis of the hand or generalized dermatitis. The analysis showed that allergic skin diseases occurred more frequently in 1992-94 and allergenic respiratory diseases were more frequent in 1995-96. Industrial dust containing metals (nickel, chrome, iron, cooper) turned out to be the main allergic factor. The highest prevalence was observed in the Rolling-Mill Department, Chemistry of Coke Department and Incombustible Materials Department. 33% of patients suffering from allergic respiratory diseases and 10% suffering from allergic skin diseases had a family predisposition to allergy (features of atopy).

Nervous regulation of breathing in opiate dependent patient. Part I. Respiratory system efficiency and breathing regulation in the first stage of controlled abstinence.

Neurotoxic properties of opioid drugs which are the central nervous system depressant may have also depressive action on the brain stem complex responsible for the breathing control. Disorders of breathing regulation are reflected in respiratory efficiency. The aim of this study was to evaluate the regulation of breathing by measuring of respiratory pattern parameters, occlusion pressure and also to estimate the respiratory efficiency in opiate abusers. There were 76 persons under examination: group I--36 opiates abusers (29 men and 7 women; mean age 22.6 years) treated in the Detoxification Unit of the Department of Clinical Toxicology; group II (control group)--40 healthy persons (25 men and 15 women; mean age 28 years) not dependent of opiates and never treated at the Department. During hospitalisation the functional state of respiratory system was monitored. Ventilation efficiency was determined on the basic of the results from a "flow-volume" curve, spirometry and the measurements of the respiratory tract resistance in a computerised system Lungtest-MES company (Poland). Respiratory regulation was evaluated by means of synchronic measurements of the respiratory pattern (according to the assumption of Milic-Emili) and occlusion pressure P 0.1 (according to Whitlaw assumptions). In the examination performed directly after admission to the Unit the normal respiratory efficiency was noted in 24 persons. 12 persons (33.3%) suffered from the bronchi obturation. In the examination performed after hospitalisation and 9 days of total abstinence the normal ventilatory efficiency was found in 23 persons. In 13 of the patients (38.5%) respiratory obturation was still observed. After treatment in group of opiate abusers compared to control group values of respiratory resistance, occlusion pressure, minute ventilation and VT/T(in) index describing the activity of the central breathing regulation were increased, while the time of expiration and time of total breathing cycle were shorter.

Nervous regulation of breathing in opiate dependent patient. Part II. Respiratory system efficiency and breathing regulation of persons classified to the methadone maintenance treatment.

The measurements of respiratory pattern parameters, occlusion pressure and respiratory tract resistance had never been performed in opiate dependent persons administered by the methadone maintenance treatment. The aim of this study was assessment of ventilatory efficiency and nervous regulation of 35 depended on opiates before starting the treatment. The presently examined opiate addicts classified to the methadone programme had intensified changes in nervous breathing regulation compared to the group of opiate dependent patients treated at the Department of Clinical Toxicology CMUJ in the first stage of controlled abstinence and to the control group. They had the higher values of minute ventilation, occlusion pressure and higher value of tidal volume to the inspiratory flow (VT/TIN) index which is the driving component of the breathing cycle and reflects the activity of the respiratory centres in the spinal cord and pons. A monitoring of respiratory patterns parameters, occlusion pressure and respiratory resistance, which are not disturbed or biased by lack of patient's cooperation, will allow to determinate the direction of changes in ventilatory efficiency in the course of methadone maintenance treatment programme.

[Nutritional problems of persons qualified for the methadone treatment. Part I. Nutritional status of opiate addicts]. / Problemy zywieniowe osób zakwalifikowanych do leczenia substytucyjnego metadonem. Czesc I. Stan odzywienia osób uzaleznionych od opiatów.

The aim of the study was assessment of the nutritional status of opiate addicted persons. The study was carried out on 44 opiate abusers (14 women aged from 21-33 years and 30 men aged from 21-46 years), who were classified to methadone maintenance treatment. Nutritional status was assessed by anthropometry methods and body composition was examined using bioelectric impedance. BMI (body mass index) of examined women ranged from 16.4 to 30.8, and BMI of examined men ranged from 17.1 to 44.9. 21% of women and 44% of men had BMI < 15th centile (this indicates undernutrition), 7% of women and 3% of men had BMI > 85th centile (this indicates overnutrition). The medium body fat content for women was 8.7 +/- 6.3 kg (14.7% of body weight), for men 9.5 +/- 8.5 kg (11.9% of body weight). 50% of women and 53% of men had body fat deficiency upper 5% of range adjusted for age and sex, body fat excess upper 5% of range revealed 14% of women and 17% of men. The water content for examined women was 35.5 +/- 6.9 L (62.8 of body weight), for men 47.4 +/- 8.4 L (58.8% of body weight). Water deficiency upper 5% of range revealed 7% of men, 86% of women and 53% of men had water excess upper 5% of range. The lean body mass for women was 48.2% +/- 7.2 kg (85.4% of body weight), for men 62.7 +/- 10 kg (88.4% of body weight). Anthropometry as well as examination of body composition indicate prevalence of energy protein malnutrition among opiate addicted.

The comparison of respiratory resistance and occlusion pressure in alcohol dependent patients who complain or not of the respiratory system disorders.

Alcohol abusers often complain of respiratory symptoms. The aim of the study was to analyse the respiratory pattern parameters and occlusion pressure in chronic alcoholics who complained of respiratory symptoms vs. those who did not suffer from any symptoms before the admission. Also dynamics in changes of spirometry parameters and respiratory pattern parameters during controlled, absolute abstinence while hospitalisation in the Detoxification Unit of the Department of Clinical Toxicology was evaluated. There were 124 study patients: 84 ethanol dependent patients and 40 healthy subject not dependent on ethanol (control group). Ethanol dependency was diagnosed using ICD-10 criteria. The questionnaire according to Fletcher was gathered for each of the subject. The positive results of Fletcher questionnaire (chronic cough + chronic expectoration) was obtained in 43 of the ethanol abusers-group I. The rest of abusers who did not complain of any respiratory symptoms was included to the group II. Respiratory tract resistance was significant the differential factor between the patients with positive results of Fletcher questionnaire and patients who did not suffer any symptoms before admission. Significant differences in occlusion pressure values, were noted between the group of abusers with and without the respiratory symptoms both in the first and control examination.

Assessment of nutritional state of alcohol abusers and drug poisoned patients.

Beside the primary illness and environmental factors also alcohol addiction, similarly to another kind of dependency, is being considered as the causative factor of nutritional disorders. Alcohol and drug dependent people due to distorted eating behaviour are predisposed not only to eating disorders (anorexia, bulimia) but also to eating abuse (obesity, overweight, habitual eating). The aim of the study was to assess the nutritional state of alcohol abusers and drug poisoned patients. 113 patients treated at the Department of Clinical Toxicology in Kraków including 65 chronic alcoholics (85% men) and 48 drug poisoned patients (75% young women) were examined anthropometricaly. The measures were performed twice: on admission and on discharge from the Clinic. Nutritional state was unsatisfactory in 76.1% of examined patients and malnutrition or risk of malnutrition was more prevalent than overnutrition. Proportions of subjects qualified to specific groups of nutriture were different in alcohol abusers compared to drug poisoned patients. Also etiology of malnutrition was different. Irregular lifestyle and improper nutrition mode in the group of alcohol abusers (mainly men) and a phenomenon of "slimness terror" in the group of young woman with incidence of suicide attempt should be understood as significant factors of malnutrition. There was no detectable change in nutriture within the nine days long hospitalisation. Only slight, not significant, increase in values of anthropometric parameters was observed in the group of alcohol dependent patients.

Obstruction of the small airways in the spirometric diagnosis of occupational bronchial asthma.

The aim of this study was to evaluate spirometric changes after inhalation challenge in steel and tobacco factory workers suffering from bronchial asthma suspected to be of occupational origin. In 49 patients the spirometric changes were analyzed immediately after and 24 h (delayed reaction) after inhalation challenge at work. A decrease in spirometric parameters of 20% compared to baseline was considered significant. The suspicion of occupational bronchial asthma was based on anamnesis and skin patch tests. The atopy features in examined patients were evaluated according to anamnesis, skin prick tests with aeroallergens, as well as total IgE serum level and blood eosinophils. The significant decrease in spirometric parameters after the inhalation challenge at work was confirmed in 25 (51%) patients. In 16 of them (64%), the decrease of FEV1 value together with the decrease of the MEF 25-75% VC values were noted. A significant isolated decrease in the FEV1 was observed in only four (16%) patients. However, in five (20%) patients a significant decrease in MEF 25-75% VC values was only found as a confirmation of airways obstruction. The studies emphasize the diagnostic value of small airways obstruction in the evaluation of inhalation challenge tests in patients suspected of occupational bronchial asthma.

The influence of acute poisoning with an organophosphate compound on the regulation of breathing and the respiratory system efficiency.

The female patient, aged 40, was admitted to the Department of Toxicology about fifteen hours after she had drunk 50 ml Basudin 25 EC (diazinon contents 25%) in a suicidal attempt. On admission the patients state was described as moderately severe (9 points). Starting with the first day after the poisoning, the functional state of the respiratory system was monitored. Ventilation efficiency was determined on the basis of the results from a flow-volume curve, spirometry and the measurements of the respiratory tract resistance (Rrs) in a computerised system Lungtest-MES company (Poland). Respiratory regulation was evaluated by means of synchronic measurements of the respiratory pattern and occlusion pressure. The results obtained from a respiratory pattern and P 0.1 were refereed to normal values. In the examination carried out directly after the poisoning slight obturation of the central bronchi and elevation in resistance of respiratory tract was noted. After a week, obturation was not noted and the resistance value was better. Also the respiratory pattern parameters and value of occlusion pressure were better. It seems that in this case the increase in resistance values in the respiratory tract should be related to the increased activity in the parasympathetic system. Basic, traditional spirometric even in the examination on the first day after the poisoning, were within normal limits, while the parameters of respiratory pattern, occlusion pressure and respiratory resistance were beyond the norm. The results obtained from the measurements of respiratory pattern parameters correlated well with the clinical condition of the patient and with the results of biochemical and enzymatic measurements.

Fetal hemoglobin as a possible marker of susceptibility to working conditions for certain men exposed to industrial pollutants.

In 43 from 222 men (19.4%) employed in a coking plant a higher than normal concentration of fetal hemoglobin (HbF) was found, whereas an elevated level of HbF was detected in only two from 87 persons (2.3%) working in the cold rolling mill of the steel mill 'Huta Sendzimira', Krakow, Poland. Subjects employed in the coking mill worked in a much more polluted atmosphere than those in the cold rolling mill. It is speculated that synthesis of HbF may be a marker of the effect of unfavorable working conditions on some susceptible persons.

Regulation of breathing in cases of acute carbon monoxide poisoning.

The contribution of the central and peripheral nervous system to the regulation of breathing in acute carbon monoxide poisoning was evaluated through the analysis of respiratory pattern parameters, mainly the values of tidal volume to the inspiratory flow (VT/T(in)--driving component), and the relation of inspiratory time to the total cycle time (T(in)/T(tot)--timing component). In the examination performed as soon as possible after poisoning, an increase in the value of the VT/T(in) parameter and a diminishing of T(in)/T(tot) value were noted. Lightly poisoned subjects showed higher dynamics of changes in the regulation of breathing than the medium and severely poisoned patients. Both respiratory pattern components, measured after treatment, were in the lightly poisoned group comparable to the healthy subjects, whereas in the medium and severely poisoned group the value of VT/T(in) was elevated, and the value of T(in)/T(tot) was lessened in comparison to the control counterpart. Both respiratory pattern components significantly correlated to the blood lactace level, and to the degree of poisoning estimated in a complex way.

Humoral immunosuppression in men exposed to polycyclic aromatic hydrocarbons and related carcinogens in polluted environments.

We evaluated humoral immunity by measuring IgG, IgA, IgM, and IgE concentrations in 274 male workers in an iron foundry in Cracow, Poland. There were two groups: 199 coke oven workers and 76 cold-rolling mill workers. The groups were similar with respect to age, length of work (average 15 years), and smoking habits. Exposure to polycyclic aromatic hydrocarbons (PAHs), assessed by personal and area monitoring, ranged from 0.2 to 50 micrograms/m3 benzo[a]pyrene in coke plant workers and was of 3-5 magnitudes higher than in the cold-rolling mill employees. Comparison of the two groups revealed a marked depression of mean serum IgG and IgA in coke oven workers (p < 0.001, Student's unpaired t-test). In the same subjects, serum IgM had a tendency to decrease, whereas serum IgE showed a trend toward higher values. Thus, workers exposed chronically to complex mixtures of air pollutants, composed primarily of PAHs, develop immunosuppression. It remains to be established whether the immunosuppression described here is related to the frequent development of lung cancer reported in coke plant employees. Workers exposed chronically to PAHs should have serum immunoglobulins monitored regularly.

The effect of acute carbon monoxide poisoning on the respiratory system efficiency. I. Values of spirometric parameters in different degrees of poisoning.

The examination of 91 patients, performed as soon as possible after CO poisoning, revealed that the values of ventilatory parameters obtained from the flow-volume loop recorded by a computer-aided spirometer were significantly lower then those after treatment. Ventilatory efficiency closely related with the degree of poisoning, was assessed according to age, COHb concentration, blood lactate level, and neurological symptoms. Ventilatory parameters in 48 persons with medium and acute poisoning were significantly lower than in the group of slightly poisoned patients. The strong relationship between the major spirometric parameters, blood lactate level and duration of exposure to carbon monoxide was noted. However, the correlation between ventilatory parameters and the degree of poisoning taken as a total of all mentioned parameters was strongest.