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Az acromegalia kezelésének nehézségei 12 év próbálkozás tükrében
Difficulties of treating acromegaly in the light of 12 years of experience
Acromegalic patients’ expected survival rate and quality of life are worse than those of the healthy population. This is due to delayed diagnosis and often persistent post-surgical residual hormonal activity of the disease. Therefore, early, effective and individualized endocrine treatment and care are especially important. Our female patient was born in 1965, and has required therapy for tension-type headaches since 2008. In 2012, sella MR examination confirmed a pituitary macroadenoma of 13 mm, which was completely removed by transsphenoidal neurosurgery. Histological examination verified a somatotroph adenoma. Based on the results of post-operative oral glucose load, biochemically active acromegaly was detected, along with a negative sella MR image, thus dopamine agonist treatment was started. Later, due to rising insulin-like growth factor 1 levels and increasing headaches, she was switched to first-generation somatostatin receptor ligand (SRL) therapy. Her developing diabetes mellitus required first biguanide, then later on insulin therapy. Due to progressive complaints, growth hormone-receptor antagonist treatment was started, which resulted in partial disease control. The persistent, severe headaches significantly worsened her quality of life. Therefore, after a decade of different therapeutic approaches, despite the existing diabetes mellitus, second-generation SRL treatment was advised. On pasireotide therapy, her headache stopped immediately, and complete disease control was achieved. The retrospective somatostatin receptor (SSTR) subtype evaluation of the adenoma confirmed dominant SSTR5 expression. Pasireotide could be an optimal choice of first-line therapy in cases of acromegaly complicated by diabetes mellitus, if the adenoma has dominant SSTR5 expression. Orv Hetil. 2024; 165(40): 1587–1593.
A derékfájdalom kezelési lehetőségei: a betegoktatás jelentősége
Treatment options for low back pain: the importance of patient education
Low back pain is the most common musculoskeletal problem worldwide. According to researches, it affected 619 million people globally in 2020. It is responsible for a large percentage of absences from the workplace and visits to the doctor. Since 1990, the number of years spent on disability due to low back pain has increased by more than 50%, largely due to the aging and growth of the population worldwide. The greatest increase can be seen in low- and middle-income countries, where adequate resources are not necessarily available to deal with the problem. Low back pain is now the leading cause of disability worldwide. In acute treatment, it is important to distinguish between specific and non-specific low back pain. Its general prognosis is good, but its prevalence is high, which makes it a significant public health problem. Preventing it from becoming chronic is extremely important. The aim of its treatment is to reduce pain, maintain physical activity and restore working capacity as soon as possible. There is often a wide gap between therapeutic methods based on available evidence and clinical practice. Recommendations include self-management, programs that include education and exercise to support the resumption of everyday activities, and psychological counseling. Treatment methods that include an exercise program and patient education are the most effective in the treatment of chronic low back pain. Orv Hetil. 2024; 165(40): 1562–1569.
Páciensspecifikus implantátumok használata arckoponya-rekonstrukció során
The use of patientspecific implants in maxillofacial reconstruction
The reconstruction of facial skull defects remains a challenging task in our days. In addition to its complex anatomy and multiple complex functions, this area is also of aesthetic importance. In all cases, reconstruction must aim to achieve anatomical or functionally equivalent reconstruction and to restore facial harmony. The advent of modern imaging tools, design software and 3D printers has led to the replacement of traditional titanium miniplates and screws used in maxillofacial traumatology by custom prostheses designed digitally, and manufactured using additive manufacturing technology to suit the patient’s individual circumstances. We carried out a total of 11 cases of facial skull and frontal bone reconstruction using patient-specific implants between 2010 and 2022. The design process and the potential for clinical application are presented through two case studies of our own. In all cases, the implants healed without complications, and no wound healing complication or rejection was observed. The reconstruction was aligned with the virtual plan, resulting in a significant aesthetic improvement. Our experiences to date indicate that patient-specific implants represent a reliable option for the reconstruction of maxillofacial defects. Orv Hetil. 2024; 165(40): 1594–1600.
A telemedicina alkalmazási lehetőségei az otthoni hospice-ellátásban, avagy mit tanultunk a COVID–19-pandémiából?
Opportunities for the use of telemedicine in home hospice care: lessons learned from the COVID–19 pandemic
Introduction: Telemedicine has become increasingly essential in home hospice care, especially during the COVID–19 pandemic, as it was used to substitute for or support face-to-face home visits. Objectives: This retrospective pilot study aimed to investigate the use of telemedicine in home hospice care in Hungary during the pandemic and to explore whether home hospice services still use telemedicine after the end of the restrictions. Methods: An online survey was conducted among hospice coordinators and hospice nurses who worked in home hospice care during the pandemic. Statistical analysis was undertaken using IBM SPSS Statistics for Windows software. Descriptive analysis was performed on the data. Results: Telephone contact was the most used method in home hospice care to reduce the number of face-to-face visits during the COVID–19 pandemic, and the pulse oximeter with an app was the only tool for monitoring the patients’ condition. Telephone consultation replaced face-to-face consultation with doctors for advice. Most respondents considered telemedicine helpful, mainly in reducing the staff workload. According to the respondents’ experience, half of the home hospice patients and their caregivers were welcomed to use telemedicine, and most had no problems using it. Some telemedicine-related solutions are still applied in home hospice care, and the staff would like to continue using them. Conclusion: Telemedicine was applied in home hospice care in Hungary during the COVID–19 pandemic, and there is still a demand for the use of it. Telemedicine could also be a solution to reduce differences in accessibility to home hospice care in Hungary. Orv Hetil. 2024; 165(40): 1579–1586.
A vérlemezkében gazdag fibrin alkalmazása a parodontalis sebészetben
Use of platelet-rich fibrin in periodontal surgery
Periodontal disease as a chronic inflammation of multifactorial origins causes the destruction of the supporting tissues of the teeth. Due to intraosseal defects, the prognosis of the affected teeth is questionable. Comprehensive periodontal therapy intends to stop the destruction of the attachment apparatus and reach the regeneration of lost tissues. Periodontal intrabony defects have shown improved regenerative potential due to their morphology. Interest in the use of biological agents to promote periodontal regeneration, including growth factors, has increased significantly in recent decades. Autologous platelet concentrates have been successfully applied in various fields of medicine for more than two decades. Autologous platelet concentrates are being used in more and more areas of medicine. Application of platelet-rich fibrin is the most topical among these therapeutic options. As main advantages, it can be prepared without the addition of anticoagulants, requires only one centrifugation, its high concentration of growth factors is highly supportive for wound healing and can be used in various forms. The application of platelet-rich fibrin may facilitate the successful treatment of periodontal defects. A new generation of platelet-rich fibrin may open up further opportunities, including those in periodontal wound healing. Orv Hetil. 2024; 165(40): 1570–1578.
Abstract
Background and aims
The South Oaks Gambling Screen (SOGS) is a commonly used tool for screening potential gambling problems. The SOGS score has been found to be correlated with the DSM-5 criteria for Gambling Disorder (GD). However, one of its main limitations is the high rate of false positives. The objective of this study was to establish more accurate cutoff points for the SOGS based on the DSM-5 criteria and severity levels, taking into account sex-specific samples. Additionally, we aimed to validate these cutoff points using external measures.
Methods
The study sample comprised 4.516 patients (398 women and 4,118 men) who sought treatment for GD. Of these patients, 4.203 met the DSM-5 criteria for GD, while 313 did not meet the threshold for GD diagnosis.
Results
The recommended cutoff value for the SOGS is eight for men (Sensitivity (Se): 82.9%, Specificity (Sp): 86.2%) and seven for women (Se: 85.6%, Sp: 77.4%). For moderate severity of GD, the cutoff points are nine for men (Se: 82.1%, Sp: 82.0%) and eight for women (Se: 86.3%, Sp: 73.3%), while for severe cases of GD, the cutoff point is ten for both sexes (Se: 83.0%, Sp: 56.7% for men; Se: 80.0%, Sp: 77.4% for women). These cutoff values are validated by evidence of worse psychopathological states, more dysfunctional personality traits, and risky behaviours commonly associated with GD.
Discussion and Conclusions
These findings support adjusting the reference values for the SOGS to eight in males and seven in females to enhance the classification of individuals potentially experiencing GD. The use of higher cutoff values has significant implications for clinical and research purposes, enabling a more precise assessment of the diagnosis and severity of GD.
Malignus pleurális mezotelióma, hajas sejtes leukémia és szplenikus marginális zóna limfóma társulása – esettanulmány
Malignant pleural mesothelioma associated with simultaneous hairy cell leukemia and splenic marginal zone lymphoma – a case report
A visszatérő pleurális folyadék okának megállapítása problémás lehet. Ha egy betegnél korábban diagnosztizálták a rosszindulatú daganatot, akkor ennek a daganatnak és a hidrotoraxnak az összefüggése nyilvánvalónak tűnhet, de ez félrevezetheti a diagnosztikai eljárásokat. Közleményünkben egy idős betegről számolunk be, aki két indolens B-sejtes lép limfómában szenvedett, nevezetesen hajas sejtes leukémiában és szplenikus marginális zóna limfómában. Négy évvel később visszatérő pleurális folyadékgyülem alakult ki, és a kiváltó okként rosszindulatú pleurális mezoteliómát diagnosztizáltak. Tudomásunk szerint az azbesztmentes rosszindulatú pleurális mezotelióma és léplimfóma együttes előfordulását még nem publikálták.
Abstract
Craving is a central feature of substance use disorders and disorders due to addictive behaviors. Considerable research has investigated neural mechanisms involved in the development and processing of craving. Recently, connectome-based predictive modeling, a data-driven method, has been used in four studies aiming to predict craving related to substance use, addictive behaviors, and food. Studies differed in methods, samples, and conceptualizations of craving. Within the commentary we aim to compare, contrast and consolidate findings across studies by considering conceptual and methodological features of the studies. We derive a theoretical model on the functional connectivity-craving relationships across studies.
Abstract
Background and Aims
Gaming disorder (GD) is a prevalent and complex issue that has recently been recognized as a condition that impairs mental health, underscoring the urgent need for early prevention measures. This evaluation study examined the effectiveness of the Digital Netizen Alliance (D.N.A.) program, a new multicomponent positive psychology program for preventing GD and bolstering mental wellness among Chinese children.
Methods
Drawing on gamification and positive psychology principles, the program builds four key positive skills collectively referred to as the P-A-G-E framework: psychological resilience, active coping, growth mindset, and emotion regulation. A randomized controlled trial was conducted with 264 primary school pupils attending fourth, fifth, or sixth grade in Hong Kong (63% female; mean age = 10.83, SD = 1.18).
Results
The findings revealed that participation in the program effectively promoted active coping, a growth mindset, and emotion regulation. Moreover, program participation alleviated GD symptoms and reduced negative affect. These desirable changes were fully explained by the P-A-G-E framework.
Discussion and Conclusions
The new D.N.A. program, which cultivates the positive psychology skills specified in the P-A-G-E framework, facilitates favorable psychological changes among children. These results emphasize the importance of using multicomponent frameworks for interventions targeting GD prevention.
A Hemophilia, s kiemelten a haemophilia A (HA) kezelése az elmúlt évtizedben jelentős változáson megy át. Az ígéretes hosszított hatású (EHL/UHL) PEGylált/Fc-fúziós készítmények, a bispecifikus-antitest terápia, a klinikai vizsgálatokban jól teljesítő nem-faktoralapú készítmények átrendezik a jelenlegi kezelési ajánlásokat. A legtöbb beteg azonban továbbra is a hatékony standard féléletidejű készítménnyel (SHL) folytatott profilaxist kapja, mely kezelés hátrányait az elmúlt évtizedben jelentősen javította a pharmakokinetikai alapú (PK), személyre szabott kezelés bevezetése. A mára rutinná vált PK meghatározások módszereit, a fontosabb klinikai vonatkázásokat, saját betegeink vizsgálatainak tanulságát tekintem át e rövid összefoglalóban elsősorban a haemophilia A tekintetében. A PK-meghatározás módszere, a személyreszabott kezelés az időközben jelentős teret nyerő hosszított hatású készítmények esetében is kiemelt jelentőséggel fog bírni.
