Béta-laktám antibiotikumok terápiás gyógyszerszint-monitorozása kritikus állapotú felnőtt betegekben: egycentrumos, prospektív, obszervációs pilotvizsgálat
Therapeutic drug monitoring of beta-lactam antibiotics in critically ill adult patients.
A single-center prospective observational pilot study
Introduction: Beta-lactams are among the most commonly used antibiotics. Their efficacy is time-dependent, thus the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) recommends that their plasma concentrations should remain above the minimal inhibitory concentration (MIC) of the pathogenic bacteria throughout the dosing period (100%fT>MIC). However, according to several studies, it appears that the plasma concentrations of beta-lactam antibiotics can be suboptimal in critically ill patients. Objective: The aim of our study was to determine the pharmacodynamic target achievement of beta-lactam antibiotics (meropenem, piperacillin/tazobactam, and ceftriaxone) among critically ill adult patients admitted to an intensive care unit. Method: We conducted a prospective, observational single-centre study in a teaching hospital. Critically ill patients who were prescribed meropenem, piperacillin or ceftriaxone were enrolled. Trough antibiotic plasma concentration was measured using high-performance liquid chromatography (HPLC) and liquid chromatography–tandem mass spectrometry (LC–MS/MS) to assess the achievement of the pharmacodynamic target of 100%fT>MIC. The target concentration was determined based on the definitions of the European Committee on Antimicrobial Susceptibility Testing (EUCAST), depending on the pathogen. The primary endpoint was the proportion of patients not achieving therapeutic plasma concentrations. Results: A total of 60 antibiotic level measurements were performed in 28 patients. The median age of the patients was 64.5 ± 28,7 years, 80% (n = 22 patients) were male. The reason for admission was medical in 35.7% (n = 10), surgical/trauma in 53.5% (n = 15) and burns in 10.7% (n = 3) of patients. The therapeutic target was not achieved in 39.3% (n = 11) of patients, 66.6% (n = 6) in the meropenem group, 41.6% (n = 5) in the piperacillin group and 12.5% (n = 1) in the ceftriaxone group. Discussion: A significant proportion of critically ill patients receiving beta-lactam antibiotics did not achieve their target concentration, particularly piperacillin and meropenem. Conclusion: Our pilot study confirms the importance of therapeutic drug monitoring in critically ill patients receiving beta-lactam therapy. Orv Hetil. 2023; 164(48): 1904–1911.
A bölcsességfogak sebészete 2023-ban.
Változások, irányelvek
Wisdom tooth surgery in 2023.
Changes, guidelines
One of the most common dentoalveolar surgical procedures, with the most difficulties and complications, is the surgical removal of wisdom teeth. The topic is very topical, both because of its frequency and its diversity. It is diverse because its diagnostic evaluation in relation to the root canal mandibulae requires great expertise, the surgical technique is not standardised in the majority of the cases and the surgeon is often forced to improvise. The complications, the treatment of which is part of our daily tasks, are relatively frequent and sometimes require a strong institutional background. The literature on the subject is vast and the guidelines proposed often change from year to year. The authors review the indications, contraindications, diagnostics, surgical management, complications associated with the surgical removal of the wisdom teeth and their management. The authors present an overview of the protocols of the different international schools and formulate current recommendations for general practitioners, dentists and dentoalveolar surgeons in Hungary. Orv Hetil. 2023; 164(48): 1887–1894.
Húgyhólyag-schistosomiasis.
Az első hazai dokumentált eset
Schistosomiasis of the urinary bladder.
The first documented case in Hungary
Schistosomiasis, a worm infection known as bilharziasis or blood fluke, typically occurs in tropical regions. In temperate climates like Hungary, only imported cases are reported. The disease can affect the skin, gastrointestinal tract, or bladder, depending on the subtype of the worm. We present the case of a 32-year-old male of African origin who visited the urology clinic with macroscopic hematuria. Despite initial antibiotic therapy, the hematuria persisted. A cystoscopy revealed polyp-like lesions in the bladder, which were resected. Histological examination excluded bladder cancer and described a granulomatous and eosinophil granulocyte-rich inflammation. On top of that, the presence of Schistosoma haematobium eggs and sexually mature parasites in the venules was confirmed. After that, antihelmintic therapy was administered, leading to the resolution of symptoms. Notably, this case is the first documented instance of bladder schistosomiasis diagnosed in Hungary. Our paper aims to raise awareness of this rare condition while providing insights into its development, treatment, and potential complications. Orv Hetil. 2023; 164(48): 1920–1924.
A kognitív érzelemszabályozás szerepe az evészavartünetekben egyes serdülőkori krónikus betegségekben
The role of cognitive emotion regulation in disordered eating among chronically ill adolescents
Introduction: The association of chronic diseases with eating disorders requires increased attention due to the potential for serious complications and increased risk of mortality. Eating disorders and sub-clinical eating disorders are associated with maladaptive emotion regulation, which may be both triggers and maintaining factors of the disease. To our knowledge, the role of cognitive emotion regulation in eating disorders in adolescents with inflammatory bowel disease and type 1 diabetes mellitus has not been investigated to date. Objective: We analysed the relationship between cognitive emotion regulation and symptoms of eating disorder in adolescents aged 14 to 18 years, focusing on young people with type 1 diabetes mellitus and inflammatory bowel disease. Our research aimed to identify the role of specific cognitive emotion regulation strategies in eating disorders in patient populations with chronic disease. Method: In our study, 300 adolescents completed the Cognitive Emotion Regulation Questionnaire and the Self Administrated Psychiatric Scales for Children and Adolescents after informed consent. The four study groups consisted of 157 physically healthy adolescents, 51 adolescents diagnosed with IBD, 61 adolescents diagnosed with type 1 diabetes mellitus and 31 adolescents diagnosed with anorexia nervosa. Results: The results of our study showed that rumination and positive reframing were significantly associated with symptoms of eating disorders in adolescents with inflammatory bowel disease, and self-blame and rumination were significantly associated with symptoms of eating disorders in adolescents with type 1 diabetes mellitus diagnosis, through an indirect pathway. Discussion: Our results suggest that cognitive emotion regulation strategies are indirectly related to symptoms of eating disorders among adolescents with the chronic illness studied. More frequent use of negative emotion regulation strategies of self-blame and rumination increases the incidence of eating disorder symptoms, and less frequent use is associated with fewer eating disorder symptoms. Greater use of positive reappraisal is associated with fewer eating disorder symptoms. Conclusion: We recommend the incorporation of cognitive emotion regulation strategies in the complex care of chronically ill adolescents, both in screening and in interventions. Orv Hetil. 2023; 164(48): 1895–1903.
Orvostanhallgatók sztereotípiái különböző társadalmi csoportokkal kapcsolatban
Stereotypes of medical students about different social groups
Introduction: Knowledge and prejudices of medical students regarding marginalised patient groups can influence their interactions with patients. Objective: The perceptions of medical students from the point of view of which social groups they would be less likely to accept as patients. Method: Medical students of the University of Szeged completed a voluntary, anonymous questionnaire (n = 410) in 2021, which included several groups of questions (sociodemographic characteristics, family background, career choice motivations, shaping of medical identity, future professional plans, working during university; warmth and competence, social distance, own experiences among 19 social groups). Results: Students were least likely to meet abusers, vaccine deniers and prisoners in their future work. Female medical students were more reluctant to meet abusers, while their male counterparts homeless, alcoholic, AIDS and psychiatric patients, and senior students the vaccine denial group and AIDS patients. Their experiences with different social groups also varied widely. Most of them personally knew Romani people, drug users, psychiatric patients and alcoholics. In clinical practice, they encountered Romani people, alcoholics and psychiatric patients the most. During their education, they heard most often about vaccine deniers, alcoholics, Romani people, homeless people, AIDS patients. Discussion: Overall, the students were accepting patients from different social groups. However, their personal and educational experiences behind their prejudices were very diverse. Conclusion: It would be important to strive to meet and get to know different social groups during university studies in behavioural sciences and public health as well as during clinical work, so that students can learn to communicate with them appropriately. Orv Hetil. 2023; 164(48): 1912–1919.
Abstract
This analysis of current and historical research and clinical reports observes that the relationship between psychedelics and schizophrenia is complex and there are reports of psychedelics benefiting this population. Specifically, lower doses of psychedelics (mostly LSD) appear to have a potential beneficial impact on the negative symptoms of schizophrenia.
Abstract
Accurate identification of Mitis group streptococci especially Streptococcus pneumoniae and Streptococcus pseudopneumoniae seems difficult due to the lack of specific and sensitive tests. We performed an approach for the identification of atypical pneumococci in pediatric Tunisian population. In this study, 49 streptococcal isolates that were considered as atypical S. pneumoniae were analyzed by: optochin susceptibility in ambient and 5% CO2 atmosphere, oxgall disk sensitivity, PCR targeting several genes and antimicrobial susceptibility.
The combined results of biochemical and molecular methods showed the presence of 23 S. pneumoniae, 7 S. pseudopneumoniae, and 19 other mitis group. Among S. pseudopneumoniae, all isolates were collected from respiratory tract samples and showed a high level of resistance to β-lactams with a MIC90 of 32 mg L−1. Two isolates of S. pseudopneumoniae showed the typical phenotype of optochin resistance described in the literature. All isolates could be identified only by molecular tests. Among Streptococcus pneumonaie, all strains harbored the lytA gene and the Spn9802 fragment. But only 14 strains were encapsulated.
This study describes several assays for the identification of atypical pneumococci in order to gain insights on the nature of isolate and raise alert about the presence of these strains in the pediatric Tunisian community.
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is an increasingly common consequence of antiresorptive treatment, which often leads to the development of necrotic exposed bone surfaces with inflammatory processes affecting the jawbone. Although the development of MRONJ is often associated with the inflammatory response or infections caused by the colonizing members of the oral microbiota, the exact pathogenesis of MRONJ is still not fully understood. In the present paper, we aimed to provide additional, microbiological culture-supported evidence, supporting the “infection hypothesis” that Actinomyces spp. and related organisms may play an important pathogenic role in the development of MRONJ and the resulting bone necrosis. In our case series, all patients presented with similar underlying conditions and anamnestic data, and have received antiresorptive medications (bisphosphonates or a RANK ligand (RANKL) inhibitor) to prevent the occurrence or progression of bone metastases, secondary to prostate cancer. Nevertheless, a few years into antiresorptive drug therapy, varying stages of MRONJ was identified in the mentioned patients. In all three cases, quantitative microbiological culture of the necrotic bone samples yielded a complex microbiota, dominated by Actinomyces and Schaalia spp. with high colony counts. Additionally, our followed-up case series document the treatment of these patients with a combination of surgical intervention and long-term antibiotic therapy, where favourable clinical responses were seen is all cases. If the “infection hypothesis” is valid, it may have significant consequences in the preventative and therapeutic strategies associated with this disease.
Abstract
Purpose
The aim of the study was to analyse the use of digital devices among children.
Materials/Methods
A specially designed questionnaire was distributed to 249 schoolchildren to assess their use of digital devices both in school and outside school. The questionnaire was used before the start of the COVID-19 pandemic. The children were asked about the extent of their use of digital devices, as well as about ophthalmic and general health complaints. Their responses were assessed statistically.
Results
Regarding age distribution, 145 children were between seven and 10 years old when they started to use digital devices. Most of the children used a digital device for between one and two hours a day. The majority preferred using smartphones. The second most popular devices were laptops and tablets, and the third most popular was the desktop computer. Fifty-six children wore glasses, 14 to correct hyperopia and 42 to correct myopia. 97 children spent between one and two hours a day outdoors; 99 children spent more than two hours outdoors; and 51 spent less than one hour outdoors. 71 children reported eye problems; 48 reported other general health problems (back and neck pain); and 43 mentioned blurred vision while using a digital device.
Conclusions
The use of digital devices can be regarded as general among schoolchildren, and most children use a digital device for longer than the recommended time. Excessive use of digital devices may contribute to an increase in the prevalence of myopia and other general eye and back problems.
Abstract
The soaking step of dry pulse products' – e.g. chickpeas' – food processing is a time consuming process. Soaking time can be significantly reduced by ultrasonic treatment or using higher processing temperatures. The effect of ultrasonic treatment can be investigated by examining the soaking water characteristics. Ultrasound-assisted soaking of chickpeas was performed at 25, 35 and 45 °C, respectively. Additionally, control samples were also prepared without ultrasonic treatment at the same temperatures. The dynamics of the fitted curve clearly shows the relationship namely the higher the treatment temperature, the faster the hydration of the raw material for both untreated and treated groups. In contrast to control group, swelling rate of 2.00 – except the group 45 °C – is not achieved during ultrasound-assisted soaking. In case of treated group, the swelling rate was about 1.90 for all temperatures applied. The ANOVA test shows that the color of the ultrasonically treated samples was significantly different compared to the control (F (5;12) = 207.86; P < 0.001). Average dry matter content and °Brix value were significantly higher in the ultrasound treated group compared to the control in case of all temperatures. This may indicate the destructive effect of ultrasound, which may cause more components to dissolve out of the raw material by the end of the soaking process.
