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A kék szem elkülönítő kórismei értéke
Differential diagnostic significance of the blue eye
Szerző röviden áttekinti az ún. kék ínhártya („blue sclera”) lehetséges okait, s azok közül a súlyos vashiányra két rövid esetet mutat be. Az áttekintés célja a kórelőzmény felvétel és a fizikális vizsgálat fontosságára ráirányítani a figyelmet nemcsak a ritka kórképek, de az egyik leggyakoribb kórállapot – a vashiány, illetve vashiány anaemia – esetében is.
120 éve született Szodoray Lajos bőrgyógyászprofesszor (1904–1980)
Lajos Szodoray dermatologist professor was born 120 years ago (1904–1980)
A biztonságra törekvő radikalitás helye, szerepe és dilemmái a pajzsmirigysebészet mindennapjaiban
Safety-driven radical approaches in routine thyroid surgery: roles and challenges
Introduction: In thyroid surgery, the primary objectives are to facilitate effective hormone replacement therapy and to prevent recurrent diseases. Thyroid lobectomy is often the optimal approach to achieve these goals. Objective: This study aims to establish the criteria for safety-driven radicality and identify the appropriate surgical approaches. Methods: A total of 2215 thyroid surgeries were performed between 2001 and 2003. Among these, 86.1% were uni- or bilateral lobectomies, and 12.3% were near-total resections. Substernal extension was observed in 28.9% of cases, and recurrent disease was found in 5.3%. Partial sternotomy was required in 1.8% of cases. Results: Of the 2215 thyroid specimens analyzed, 27.9% were tumors, 19.6% showed hyperplasia, and 18.1% exhibited inflammation. Among the 216 cases of papillary carcinoma, the occult form was present in 42.1%, encapsulated form in 30.1%, multinodular form in 26.4%, bilateral involvement in 12.5%, and mixed appearance in 8.3%. Lymph node involvement in the central region was detected in 41% of cases. Co-occurrence of tumors with Hashimoto’s thyroiditis was significantly more common than with hyperplasia. Transient laryngeal nerve paresis occurred in 3.3% of cases, while permanent paresis was observed in 0.49%. Discussion: Radicality in thyroid surgery aims to minimize residual tissue while ensuring the functional integrity of nerves and parathyroid glands. These objectives are challenged by tissue inflammation, cancer, substernal extension, recurrent disease, and undetected metastases in the central paratracheal lymph nodes. Our analysis of routine lobectomies with meticulous nerve preparation revealed a significantly higher incidence of recurrent laryngeal nerve paresis in cases involving recurrent disease. Conclusion: Maintaining blood-free surgical conditions, cooling the nerves during preparation, meticulous dissection of nerves at the superior pole of the thyroid, and experience in excising non-inflammatory thyroid tissue are crucial for achieving safety-driven radicality. These practices are effective not only in cancer cases but also in the presence of hyperplasia, inflammation, and recurrent disease. Orv Hetil. 2024; 165(39): 1548–1557.
Myeloma multiplexben szenvedő betegek túlélési eredményei a Semmelweis Egyetem Belgyógyászati és Hematológiai Klinikáján
Survival of patients affected with multiple myeloma at the Department of Internal Medicine and Haematology of Semmelweis University
Introduction: Survival in multiple myeloma has improved over the past two decades, mostly due to the emergence of new treatment options. Results from clinical trials, however, may differ from real-world experiences, underscoring the importance of collecting “real-world” data as well. Objective and method: We examined the clinical and survival data of all myeloma patients diagnosed at the Department of Internal Medicine and Haematology (formerly the 3rd Department of Internal Medicine) of Semmelweis University, between 2008 and 2021. We evaluated survival depending on the date of diagnosis and additional factors including the International Staging System, karyotype, presence of bone lesions, renal failure, and first-line therapy. Since 2013, myeloma patients have been looked after in a subspecialty clinic, which may also affect outcomes. Results: Overall, we diagnosed 284 patients in this period, with the annual number of diagnoses tripling in recent years. Treatment strategies underwent significant changes, with novel drugs replacing chemotherapy, increasingly administered in triple or quadruple combinations. The median overall survival (OS) for the entire group was 54 months, but it significantly varied based on the era of diagnosis: it was 35 months for patients diagnosed between 2008 and 2011, 44 months between 2012 and 2015, and 50 months between 2016 and 2019, respectively, with the most recent period post-2020 yet to reach the median. Conclusion: Our study confirms that the introduction of new drugs nearly doubled the expected median survival in real life as well. This improvement can be attributed, in part, to a significant reduction in early mortality (related to refractoriness and septic complications) in comparison to prior periods and also to the availability of more options at relapse. Additionally, we consider the accumulated experience, the unified approach to treatment and monitoring, and the availability of clinical trials in our dedicated myeloma clinic non-negligible factors in this improvement. Orv Hetil. 2024; 165(39): 1539–1547
Szociális problémamegoldó készségek és öngyilkossági veszélyeztetettség fogvatartottak körében
Egy hazai multicentrikus vizsgálat eredményei
Social problem-solving and suicidality in prisoners
A multicenter study in Hungary
Introduction: Based on international studies, the risk of suicidality is higher in prisons than in the general population, which can have serious consequences for both the individuals concerned and the prison community. Low levels of problem-solving skills had been shown as a major risk factor for suicidal behaviour, along with depression and hopelessness. Objective: The aim of our study is to assess the social problem-solving skills by the Means End Problem Solving Inventory in a sample of incarcerated people as well as to examine the association of these skills with suicide risk factors in order to establish future intervention possibilities. Method: In our multicentre cross-sectional questionnaire study, we recruited prisoners (n = 363) from four prisons and, for comparison, we recruited volunteers (n = 234) from the general population by online convenience sampling. For comparative studies, we created a matched sample by gender and age (nprisoner = 174, ncontrol = 174). An independent samples t-test was used for the comparative analysis, and Cohen’s d-test was used to measure the effect size of differences. Pearson’s correlation was used to test the association of problem-solving skills with suicidal risk variables (suicidal ideation, depression, hopelessness, perceived stress, impulsivity, subjective well-being). Tests applied: Means End Problem Solving Test; Hopelessness Scale – short version; Paykel Suicide Scale; Beck Depression Inventory – short version; Perceived Stress Scale; Abbreviated Barratt Impulsivity Scale; WHO Well-Being Index-5 item – Hungarian version. Results: The prison sample has significantly worse mental health indicators of suicide risk than the matched control group. The findings show that the prison population has more serious level of depression, more intense suicidal ideation, higher level of perceived stress and impulsivity as well as lower level of social problem-solving skills and psychological well-being. There was no significant relationship between the frequency of suicidal ideation and the level of problem-solving skills neither on the matched sample (n = 174), nor on the full incarcerated sample (n = 363). However, the frequency of suicide thoughts, hopelessness, depression, the level of perceived stress and impulsivity showed moderately positive significant relationship on the full incarcerated sample. Conclusion: Based on our results, it seems that in order to reduce suicide vulnerability, hopelessness, perceived stress and impulsivity among incarcerated people mindfulness interventions might be more effective than problem-solving training. Orv Hetil. 2024; 165(39): 1529–1538.
Abstract
Background
We evaluated the capability of an AI application to independently detect, segment and classify intracranial tumors in MRI.
Methods
In this retrospective single-centre study, 138 patients (65 female and 73 male) with a mean age of 35 ± 26y were included. 97 were diagnosed with an intracranial neoplasm, while 41 exhibited no intracranial pathology. Inclusion criteria were a 1.5 or 3.0T MRI dataset with the following sequences: T2 axial, T1 axial pre- and post-contrast with a slice thickness between 3 and 6 mm and no previous brain surgery. Image analysis was performed by two human readers (R1 = 5 years and R2 = 10 years of experience in brain MRI) and a deep learning (DL)-based AI model. Sensitivity, specificity and accuracy of the AI model and the human readers to detect and correctly classify brain tumors were measured. Histological results served as the gold standard.
Results
The AI model reached a sensitivity of 93.81% [87.02–97.70] and a specificity of 63.41% [46.94–77.88], while human readers reached 100% [96.27–100.00] and 100% [91.40–100.00], respectively. Human readers provided a significantly higher accuracy rate with R1 0.93 (95% CI: 0.88–0.97) and R2 0.98 (95% CI: 0.94, 0.99) vs. 0.74 (95% CI: 0.66–0.81) for the AI model (P-value <0.001).
Conclusion
The underlying DL-based AI algorithm can independently identify and segment intracranial tumors while providing satisfactory results for establishing the correct diagnosis. Despite its current inferiority compared to experienced radiologists, it still experiences ongoing development and it is a step towards developing an artificial intelligence-augmented radiology workflow.
Az alapellátás és a rehabilitációs medicina közös útkeresése a fogyatékosság megelőzése és a rehabilitáció fejlesztése érdekében
Joint search of primary care and rehabilitation medicine to prevent disability and improve rehabilitation
World Health Organization has recognized the growing volume of unmet rehabilitation needs and has recently adopted a resolution on the importance of strengthening rehabilitation services. The paper first assesses the domestic situation, both from the side of primary care and rehabilitation specialist care and presents the significant limitations of resources and capacity in both areas. International publications of recent years point out, among other items, the need for integrated rehabilitation care, take account of possible solutions and present the challenges encountered during implementation. Some previous experiences and results important for integrated rehabilitation care in Hungary are also briefly presented in the paper. The improvement of the current situation and the planning of integrated care also presuppose the exploration of the extent of the limitations of functioning in Hungary. Additionally, it is intended that exploration of the data should allow the examination of the distribution by age, settlement and underlying diseases. To this end, we propose the introduction of a new primary care indicator based on self-assessment of functioning, furthermore, the implementation of possible methods and the conditions of implementation. Orv Hetil. 2024; 165(38): 1483–1492.
Az infektív endocarditis epidemiológiája és időbeli változása 2006 és 2018 között egy tercier centrumban
Epidemiology and temporal trends of infective endocarditis between 2006 and 2018 at a tertiary referral center
Introduction: Despite modern diagnostics, targeted antibiotic therapy and surgical treatment, the mortality rate of infective endocarditis remains high. In developed countries, both the risk factors and pathogens have changed. Objective and method: In our retrospective single-center study, we analyzed the clinical and microbiological characteristics, short- and long-term all-cause mortality, and temporal trends of patients admitted with infective endocarditis before COVID–19 pandemic, between 2006 and 2018. Results: We included 537 consecutive cases in our study, the mean age was 56 years (73% male). 339 (63%) cases were native valve infective endocarditis, 130 (24%) cases were prosthetic valve infective endocarditis, 62 (12%) cases were intracardiac device-related infective endocarditis and 6 (1%) other cases. The most common microorganisms were Staphylococci (n = 175; 33%), including 104 cases of methicillin-sensitive Staphylococcus aureus, 27 cases of methicillin-resistant Staphylococcus aureus and 44 cases of coagulase-negative Staphylococci. Streptococcus species were identified in 141 cases (26%), Enterococcus species in 88 cases (17%) and 72 cases (13%) were classified as blood culture-negative infective endocarditis. In-hospital all-cause mortality was 14%, mortality at 6 months was 27%, at 1 year was 31%, and at 5 year was 44%. The incidence of methicillin-sensitive S. aureus infections increased over time (p<0.05), while coagulase-negative Staphylococci (p<0.001), and Streptococci (p<0.05) infections decreased. None of the observed mortality rates showed significant change over the study period. Predictors of mortality were advanced age (HR: 1.37 [1.23–1.51]; p<0.001), impaired renal function (HR: 1.03 [1.01–1.04]; p<0.001), reduced ejection fraction at admission (HR: 1.38 [1.25–1.52]; p<0.001), cerebral embolism (HR: 1.74 [1.25–2.42]; p = 0.001), and methicillin-resistant S. aureus infection compared to Streptococcal infection (HR: 2.56 [1.39–4.7]; p = 0.002) based on multivariate Cox-regression. Conclusion: During the observed 13 years, Staphylococci were the most common pathogens with an increasing incidence of methicillin-sensitive S. aureus infection in our tertiary center. The mortality rate of infective endocarditis remained high and showed no improvement over time. Orv Hetil. 2024; 165(38): 1500–1508.
Abstract
Background and aims
Unemployment rates are elevated among individuals with disordered gambling, yet the directionality of the relationship remains unclear. The present study investigated paid and unpaid unemployment as risk factors for future gambling disorder (GD).
Methods
The study employed a case-control design, including all adult Norwegians receiving a GD diagnosis within specialist health services from January 2008 to December 2018 (n = 5,131). These individuals were compared with age- and sex-matched controls from the general population (n = 30,164), as well as controls with somatic and psychiatric diagnoses (n = 30,476).
Results
Logistic regressions showed that those in the highest quartile of unpaid unemployment days had more than double the odds (odds ratio [OR] 2.23 (95% CI [1.96, 2.52]) of developing GD compared to those with no unpaid unemployment days. Similarly, higher levels of paid unemployment were also found to increase the odds for GD, with those in the highest quartile having an OR of 1.86 (95% CI [1.50, 2.28]) compared to those with no paid unemployment days. Moreover, an interaction analysis indicated that the association between paid unemployment days and GD was significantly stronger among men compared to women.
Conclusions
The present study suggests that both paid and unpaid unemployment constitute risk factors for GD. Programs aiming at obtaining and sustaining work have been found to improve health and future studies should examine if the risk for GD can be similarly mitigated.
Abstract
Background and Aims
Many jurisdictions are experiencing opioid epidemics. Opioid use disorder (OUD) often co-occurs with other psychiatric disorders including behavioral addictions like gambling disorder. However, little is known regarding the frequency and correlates of problematic pornography use (PPU) among people seeking treatment for OUD. Here we aimed to investigate PPU and its correlates in people seeking OUD treatment.
Method
From October 2018 to March 2020, 1,272 individuals seeking OUD treatment were screened for PPU by completing the Brief Pornography Screen (BPS), a 5-item instrument validated for assessing PPU. Self-reported data were used.
Results
Among the sample there were 707 (60%) males and 565 (40%) females. The mean age of participants was 37.9 ± 10.5 years (range 18–73), there were 707 (60%) males and 565 (40%) females, 14.4% (n = 183) exhibited low positive BPS scores (1 ≤ score ≤4), and 4.5% of the sample (n = 57) screened positive for PPU (BPS score ≥4). Individuals screening positive for PPU versus negative were mostly male (77%), scored higher on measures of impulsivity in the domains of positive urgency, negative urgency, and sensation-seeking and demonstrated more psychopathology on measures of substance use, psychotic symptoms, emotional lability, depression/functioning and self-harm.
Discussion and Conclusion
A minority of individuals seeking treatment for OUD screened positive for PPU. Among individuals with OUD, those screening positive (versus negative) for PPU were more impulsive and experienced more psychiatric symptoms, suggesting the need for additional investigation and screening for and addressing PPU in people with OUD.
