Browse our Medical Journals - AKJournals
Among all scientific traditions alive, medical publishing has a good chance to be the oldest. The first fully peer reviewed academic journal, “Medical Essays and Observations” was launched in 1731 by the Royal Society in Edinburgh. Since then, hundreds of medical journals have been published worldwide. Medical publication in Hungary started in 1857 when the famous physician, Markusovszky founded “Orvosi Hetilap”, which has been published since then every week (with short breaks during the world wars). It is now a most prestigious piece in AKJournals’ portfolio, listed in Journal Citation Reports, with a remarkable impact factor.
Medical and Health Sciences
Abstract
We report a case of a female patient in her 40s who presented with right upper quadrant pain and abdominal discomfort. Surgical removal was not possible due to the location of the lesion. Between 2021 and 2022, the patient had four additional sessions of conventional transarterial embolization (TAE) with Lipiodol, but none succeeded in sufficiently reducing the hemangioma's size or permanently improving the symptoms. In November 2022, we used transarterial chemoembolization (TACE) with a Bleomycin-Lipiodol emulsion. Follow-up MRI scans showed a gradual reduction in the hemangioma volume, but the symptoms only improved partially. Hence, the patient underwent a second bleomycin TACE embolization in November 2023. By August 2024, control showed a total volume reduction of 409 cm³ (56%) and significant symptom improvement. This case demonstrates that Bleomycin-Lipiodol TACE can effectively reduce the size of giant liver hemangiomas, even after the failure of other interventional therapies.
Abstract
Background and aims
Online dating applications (ODAs) are gaining popularity, raising concerns about their potential addictive effects on users' health. The main objective of this study was to investigate the association between problematic ODA use and mental health, substance use, and sexual behavior outcomes in men-who-have-sex-with-men (MSM). To achieve this, we first validated a German version of the Problematic ODA Use Scale (PODAUS), which assesses problematic ODA usage patterns.
Methods
Problematic ODA use was assessed in 226 HIV-negative MSM counseling for HIV pre-exposure prophylaxis at baseline and 6-month follow-up (n = 164, Mage = 42, SD = 11). The German PODAUS was validated using confirmatory factor analyses (CFA) and correlational analysis. Multiple linear regression analyses were performed to investigate associations of PODAUS with mental, sexual health, and substance use outcomes.
Results
CFA supported PODAUS’ 6-item unidimensional structure, demonstrating excellent fit indices. Reliability analyses indicated good internal consistency (α = 0.79) and high test-retest reliability (r s = 0.68). Regarding mental health, significant positive associations were found between PODAUS and symptoms of depression, loneliness, anxiety, Attention Deficit Hyperactivity Disorder (ADHD), and impulsivity, with medium to large effect sizes. Regarding sexual health, significant negative associations of small to medium effect sizes were found between PODAUS and lifetime prevalence of sexually transmitted infections, body acceptance, and sexual fulfillment, while a significant positive association with trait sex motivation occurred.
Discussion and Conclusion
The German version of PODAUS emerges as a valid, reliable tool to assess problematic ODA use. In an MSM sample, problematic ODA use was associated with lower mental and sexual health.
Abstract
Background
There is a need to systemically diversify psychedelic clinical trials, considering the growing interest in in the therapeutic potential of psychedelics within Black, Indigenous, and Peoples of Color (BIPOC) and queer communities. Doing so contributes to a more inclusive foundation of evidence-based research and addresses ethical considerations surrounding anticipated demand for these treatments following regulatory approval. Cultural attunement may be key to facilitating effective research and ensuring equitable treatment.
Aims
Here, we introduce a primer for culturally attuned psychedelic clinical trials. We narratively review prevalent psychological and pragmatic barriers to diversity – as part of set and setting – in modern psychedelic trials. We also propose potential strategies for the culturally attuned recruitment, assessment, and retention of diverse participants.
Methods
This primer narratively synthesizes existing literature on barriers and potential strategies for culturally attuned psychedelic trials. Here, the scope is on classic psychedelics and other drugs with consciousness-altering effects (3,4-methylenedioxy-methamphetamine [MDMA], ketamine). The term ‘diversity’ focuses on BIPOC and sexual- and gender-diverse populations, primarily in the US.
Results
Psychological and pragmatic barriers include stigma, medical mistrust, history of psychedelic-assisted conversion therapy, income disparities, schedule inflexibilities, and transportation inaccessibility. Culturally attuned recruitment, assessment, and retention strategies include queering/diversifying the study team, debinarizing the therapist dyad, developing culturally attuned flyers, community outreach, using culturally attuned language, improving transportation-related access, diversifying room setup, and using culturally attuned assessments.
Conclusions
Psychedelic research groups are encouraged to adapt and enact these recommendations in their clinical trials, to improve accessibility to innovative mental health treatments for diverse populations.
Az akut szuicid veszély értékelése
A komplex rizikóbecslés lehetőségei a klinikai gyakorlatban
Assessment of acute suicide risk
Opportunities for comprehensive risk evaluation in clinical practice
Introduction: The identification of acute suicide risk is of paramount importance for the prevention of suicidal behavior. However, we currently lack sufficient data to reliably detect pre-suicidal mental states. Objective: Hungarian adaptation of the screening test and questionnaire developed by Galynker and colleagues based on the concept of the suicide crisis syndrome. Method: Acute Suicidal Risk Test, based on the suicide crisis syndrome, and Rihmer’s Short Suicide Scale were administered consecutively to all patients treated at our outpatient and inpatient clinic during the study period. In cases where the screening tests were positive, a more detailed questionnaire assessing the symptoms of suicide crisis syndrome was completed. Results: 99 patients completed a total of 150 questionnaires, with one-third (n = 35) being outpatients and two-thirds (n = 64) inpatients. The most frequent clinical diagnoses were depressive (44.7%), adjustment (34%), psychotic (33.3%), and substance use disorders (33.3%), with a high rate of comorbidities. The screening tests indicated suicide risk in 54.3% (n = 19) of outpatients and in 76.6% (n = 49) of inpatients. After inpatient treatment, this proportion significantly decreased (n = 17, 33.3%). The full diagnostic criteria for suicide crisis syndrome were the most frequently met in patients with a positive Acute Suicidal Risk Test, either alone (74.2%) or in combination with the Short Suicide Scale (87.1%). The presence of both positive Acute Suicidal Risk Test and Short Suicide Scale was associated with severe Suicide Crisis Syndrome symptoms (29%). Discussion: The short screening test, based on the suicide crisis syndrome, identified acute suicidal risk in a significant proportion of patients. One of the key advantages of the suicide crisis syndrome concept and method is its ability to detect suicide risk even in the absence of overt suicidal intents. The value of the acute screening test is further enhanced by Rihmer’s Short Suicide Scale, which primarily assesses lifetime suicidal risk. Conclusion: The combined use of these tests supports clinical decision-making for acute psychiatric admissions and helps prevent the premature discharge of patients, underscoring the relevance of this screening method in suicide prevention. Orv Hetil. 2025; 166(4): 146–153.
A korai elbocsátás kritériumainak és biztonságának vizsgálata anastomosissal járó elektív colorectalis műtétek során
Analysis of criteria and safety of early discharge after elective colorectal surgery with anastomosis
Introduction: Thanks to minimally invasive techniques and effective perioperative protocols, morbidity and hospital stay associated with colorectal surgery can be reduced. After elective colorectal procedures, some patients may be discharged within 72 hours. However, early discharge is not a routine practice, and its criteria are unclear. Method: A retrospective cohort study was conducted among patients who underwent elective colorectal surgery with anastomosis between March 2022 and May 2024. We analyzed the relationship between early discharge (<72 hours) and 30-day morbidity as well as unplanned hospital readmissions. To identify factors influencing successful early discharge, we examined demographic, medical history, intraoperative, and postoperative data. Results: A total of 109 patients underwent elective colorectal surgery. There were 85 laparoscopic, 8 robot-assisted, 4 open procedures and 12 stoma closures. The 30-day morbidity rate was 8.25% (n = 9), with severe morbidity (Clavien–Dindo 3b) at 4.6% (n = 5). Cases with complications within 72 hours (n = 9) were excluded. After an uncomplicated postoperative course, 30 patients were discharged early, while 70 patients had longer hospital stay (hospital stay: 67.5 ± 4.13 vs. 99.8 ± 2.06 hours; p = 0.0001). The groups were similar in age (57.17 ± 5.27 vs. 61.94 ± 2.75 years; p = 0.09), gender (p = 0.83), body mass index (p = 0.13), and performance status (p = 0.85). Bowel function recovery was comparable (31.0 ± 3.84 vs. 34.5 ± 3.49 hours; p = 0.26). Right- and left-sided resections were equally represented in both groups (p = 0.28), stoma closures were more frequent in the early discharge group (11 vs. 1; p<0.00001). There was no readmission, morbidity, or mortality within 30 days in either group. Conclusion: Following uncomplicated elective colorectal resections and stoma closures, early discharge within 72 hours is safe. Orv Hetil. 2025; 166(4): 139–145.
Streptococcus pyogenes okozta súlyos fertőzések halmozódása egy kórházi gyermekosztályra felvett betegek között
Accumulation of severe Streptococcus pyogenes infections among children admitted to the pediatric department of a county hospital
In one month, an unusually high rate of severe Streptococcus pyogenes infections occurred at the Children’s Department of the Bács-Kiskun County Hospital. The pathogen caused serious, sometimes life-threatening conditions. All but one of the patients were from the same municipality, raising the possibility of spread of the invasive clone in this community. Rapid clinical deterioration was observed in all our cases. International literature data support the periodic clustering of different invasive group A streptococcal (iGAS) infections with different clones responsible. The role of different viral coinfections has also been observed. The aim of this article is to raise awareness of the importance of iGAS infections, their symptoms, the importance of early recognition of sepsis and the timely transfer of patients to the right tertiary care centre. Orv Hetil. 2025; 166(4): 154–159.
A szomatosztatin és szisztémás felszabadulásának jelentősége gyulladásos, fájdalommal járó és egyéb állapotokban
The role of somatostatin and its systemic release in inflammatory, painful and other conditions
Somatostatin (SST) is a multifunctional peptide hormone of 14–28 amino acids, first discovered in the hypothalamus and later detected in other tissues, acting through different receptors (SST1–5). It has mainly inhibitory properties in endocrine and various nervous system processes. Its physiological properties and role go beyond the regulation of hormones, and it is involved in the modulation and regulation of neurogenic inflammation. During neurogenic inflammation, neuropeptides released from sensory neurons – such as substance P and the gene-related peptide calcitonin (CGRP) – trigger inflammatory responses. SST inhibits the release of these, other mediators and the associated inflammatory processes. The anti-inflammatory effect of SST has animportant clinical relevance in the treatment of neurological and inflammatory diseases (e.g., Alzheimer’s disease, migraine, chronic pain syndrome, neurodegenerative disorders, etc.). Synthetic derivatives (e.g., octreotide) can also be used in various clinical conditions, as well as in the treatment of neuroendocrine tumours (they inhibit excessive hormone production and tumour growth). Recent research has highlighted the importance of SST in pain perception. SST and its analogues are able to reduce nociceptive transmission and thus modulate pain sensation, especially in chronic and neuropathic pain. SST and its analogues represent a potential therapeutic target for modulating neurogenic and inflammatory pathophysiological processes, as a target for the treatment of pain and inflammatory diseases. Orv Hetil. 2025; 166(4): 123–129.
A testösszetétel meghatározásának módszerei a klinikai gyakorlatban
Body composition assessment methods in clinical practice
Body composition assessment might be an essential tool in clinical studies. Over the metabolic diseases, body composition assessment can play an important role in sports medicine and in old patient care. Numerous methods are available, including simpler and more cost-effective ones, as well as more expensive but complex procedures. Dual energy X-ray absorptiometry is considered the gold standard method for body composition assessment in clinical practice. However, the increasing precision of bioelectrical impedance-based devices might provide reliable alternatives. In our article, we summarized the basic characteristics of methods for determining body composition, with particular emphasis on the procedures most widely used in clinical practice. Orv Hetil. 2025; 166(4): 130–138.
Abstract
Objective
To explore the individual and interactive associations between mobile gaming addiction (MGA), excessive consumption of sugar-sweetened beverages (SSBs), and overweight/obesity among schoolchildren, and to investigate whether these interactions vary by gender or grade level.
Methods
Data were drawn from the Children's Growth Environment, Lifestyle, and Physical and Mental Health Development project (COHERENCE) conducted in Guangzhou, China, during the 2019/20 academic year. 418,197 children aged 6–12 years were included in the study. All participants were asked to complete an eligible questionnaire to provide details of their MGA over the past three months and SSBs consumption over the past week. Multiplicative and additive interaction models were performed to evaluate the interaction effects of MGA and excessive SSBs consumption on overweight/obesity, and variations by gender and grade level were also examined.
Results
Excessive SSBs consumption was identified as a risk factor for childhood overweight/obesity, but MGA was not. However, the combination of MGA and excessive SSBs consumption was associated with an increased risk of overweight/obesity. This multiplicative interaction was significantly stronger in girls than in boys, with no differences observed across grade levels. Additionally, the additive interaction effect between MGA and excessive SSBs consumption was present only in girls and children in the lower elementary grades.
Conclusions
This cross-sectional study found that the combination of MGA and excessive SSBs consumption is linked to an increased risk of childhood overweight/obesity, particularly in girls and children in lower elementary grades. These findings highlight the importance of addressing these factors together in targeted interventions.
Abstract
Background and aims
There are limited data regarding associations between gaming disorder and physical activity (PA). The present study investigated the direct association between these two variables and assessed the potentially mediating roles of PA avoidance and two types of weight stigma (i.e., internalized weight stigma and perceived weight stigma) in the association.
Methods
An online cross-sectional survey that assessed PA avoidance, two types of weight stigma, and PA level was completed in late 2023 by 884 Taiwanese young adults aged between 20 and 40 years (63.9% females). Multinomial logistic regression and structural equation modeling (SEM) were used to assess the associations between variables and perform the mediation analysis.
Results
Cognitive behavioral symptoms and negative consequences related to gaming disorder were more common among participants with lower PA than those with moderate to high PA. Individuals at risk of gaming disorder exhibited higher level of PA avoidance, internalized weight stigma, and perceived weight stigma. The SEM found a direct association between gaming disorder and PA, which was negatively mediated by PA avoidance. However, this direct effect was not present when the association was negatively mediated by serial mediations of weight stigma and PA avoidance.
Discussion and Conclusions
Higher gaming disorder was associated with higher levels of PA, but this association may not be present when taking into account the mediation effect of weight stigma and PA avoidance. The findings suggest complex relationships and further research is needed to examine individual differences and relationships among clinical groups.
Abstract
Background and aims
Behavioral addictions (BAs) represent complex and multifaceted disorders often associated with maladaptive neural alteration. To deepen our understanding of the essence of BAs, this study focuses on the neural mechanisms underlying its three stages: reward seeking, self-control, and decision-making. The aim of the current meta-analysis is to investigate the brain regions and neural networks involved in BAs.
Methods
Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched for relevant articles published before September 1, 2024, in the Web of Science and PubMed databases, and supplemented our search with Google Scholar. We conducted analyses using activation likelihood estimation (ALE) meta-analysis and meta-analytic connectivity modeling (MACM) analyses.
Results
A total of 50 functional magnetic resonance imaging studies involving 906 participants were included. The findings showed that individuals with BAs exhibited hyperactivation in the right inferior frontal gyrus (IFG), bilateral caudate and left middle frontal gyrus (MFG), and a high degree of connectivity was found between the right caudate, left caudate, and right IFG. These findings indicated that BAs were associated with the fronto-striatal circuits. Individuals with BAs demonstrate specific neural activation patterns in the reward seeking, self-control, and decision-making stages, characterized by differences in activation and functional connectivity of brain regions associated with these stages.
Discussion and conclusions
This study verifies the pivotal role of the fronto-striatal circuits in BAs and highlights the specific patterns of brain activity in different stages of addictive behavior. These findings expand our understanding of neural mechanisms underlying BAs and supports and provide partial support for the I-PACE model.
Abstract
Background
The Yaqui Intercultural Medicine Clinic was established in 2020 to provide accessible, culturally-attuned treatment for substance use and mental health disorders among an Indigenous Yaqui community in Mexico. The treatment program integrates ayahuasca ceremonies and psychotherapeutic support within a community-based outpatient treatment service. This observational pilot study was conducted to evaluate the safety, short-term symptom improvement, and cultural implications of the clinic's program.
Methods
Data from 37 patients who were diagnosed with depression, anxiety, complicated grief, or substance use disorder were included in the analysis. Patients were included in the study if they participated in at least one ayahuasca session with psychotherapeutic support. Data were collected using the Mini International Neuropsychiatric Interview (MINI), Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), Index for Complicated Grief (ICG), and the Post-Traumatic Stress Checklist for DSM-5 (PCL-5).
Results
Patients demonstrated marked reductions in scores of depression, anxiety, complicated grief, suicidality, and PTSD symptoms following ayahuasca ceremonies. After two ceremonies, mean BDI-II scores dropped from 15.7 to 5.1, mean BAI scores dropped from 16.6 to 6.3, and ICG scores reduced from 39.6 to 10.7. Among eight patients presenting suicide risk, seven cases resolved following a single ayahuasca ceremony. Safety assessment indicated that ayahuasca ceremonies were well-tolerated.
Conclusions
Preliminary data suggest that ayahuasca ceremonies integrated within a culturally-attuned community-based mental health program show promise for rapidly reducing mental health symptoms among a small group of Yaqui patients. These findings support further research of community-based ayahuasca-assisted therapeutic programs for mental health treatment within Indigenous communities.
Abstract
The spread of NDM-1-harboring Klebsiella pneumoniae is a worldwide concern. In this study the whole-genome sequence (WGS) of a carbapenem- and colistin-resistant K. pneumoniae 838Gr strain is presented. This strain was isolated from a urine sample of a patient in the Intensive Care Unit (ICU) at Volos Hospital, Greece. The initial assembly produced 224 contigs with a combined genome size of 5,561,803 bp and a GC content of 57.21%. The K. pneumoniae strain carried IncR, IncFIA, IncC, and repB (R1701) replicons. Multilocus sequence typing (MLST) analysis revealed that the isolate belonged to the sequence type 11 (ST11) and serogroup KL24 and O2a. The WGS analysis identified several beta-lactamase genes (bla TEM-1B , bla CTX-M-15 , bla NDM-1 , bla OXA-1 , bla VEB-1 , bla OXA-10, and bla SHV-11) alongside resistance genes for other antibiotic classes, including floR2, cmlA1, cmlA5, catB3, arr-3, aph(6)-Id, aadA2. Colistin resistance was attributed to specific point mutations in pmrB (R256G, T140P). This is the first report of a carbapenem- and colistin-resistant K. pneumoniae ST11 strain in Greece. The findings of this study highlight the urgent need for increased surveillance and stringent infection control.
Abstract
Background
Food addiction and an impulsive personality can increase overeating, which can lead to weight gain. The amygdala and nucleus accumbens (NAcc) are critical for regulating obesogenic behaviour. However, whether the amygdala or the NAcc acts as the neural basis for the regulation of food addiction, impulsive personality, and body weight remains unclear.
Methods
We examined the differences in the volume of the amygdala and NAcc, especially the lateralization index (LI), between 33 obese participants and 39 age- and sex-matched healthy controls. The associations of the LI of each brain region with clinical variables and body mass index (BMI) were identified using network analysis. Finally, we explored the relationships among the LIs of brain regions, impulsive personality, food addiction, and BMI through a multiple chain mediation model.
Results
We observed a significant decrease in the LI of the amygdala in the obese group compared with the healthy group (F = 20.276, p < 0.001), which indicates that the right amygdala was larger than the left amygdala in the obese group. Network analysis revealed that the LI of the amygdala was very closely associated with nonplanning impulsivity, food addiction and BMI. The results of the mediation analysis indicated that increased nonplanning impulsiveness could lead to weight gain through increased food addiction (β = 0.069, SE = 0.043, 95% CI [0.014, 0.184]). Moreover, in this symptom chain, the LI of the amygdala can mediate the relationship between food addiction and BMI (β = 0.018, SE = 0.014, 95% CI [0.002, 0.061]).
Conclusion
Our observations indicate a substantial reduction in the LI of the amygdala among individuals with obesity, suggesting a structural predisposition. The findings reveal a potential neural mechanism that can help explain the interplay between impulsivity, food addiction, and obesity.
Abstract
The anti-Müllerian hormone (AMH) is a granulosa cell-derived hormone that has been associated with female fertility and reflects the population of growing follicles. This study aimed to evaluate the average concentration of AMH in Lipizzaner mares, as well as to determine the relationship between AMH concentration and follicle number and size. We also investigated the relationship between the age of mares and their AMH levels. The possible effect of seasonality of AMH levels was also assessed. Twenty-three mares between 6 and 24 years of age were included in the experiment. Mares were divided into two groups: Group 1 included mares aged 6 – 15 years (n = 11), while Group 2 included individuals older than 15 years of age (n = 12). Venous blood was collected and ovarian activity was monitored parallelly by transrectal ultrasonography. Serum AMH concentrations varied widely between the two different groups. AMH concentrations were significantly lower in old mares than in younger animals. A positive relationship was detected between AMH concentration and the number of medium-sized follicles (P = 0.022), large follicles (P = 0.016) and the total follicle count (P = 0.026). No seasonal effect was detected.
Abstract
The discussion surrounding the necessity of acquiring personal experience of non-ordinary states of consciousness in the course of psilocybin-assisted therapy training is crucial, as it can affect treatment safety, effectiveness and accessibility. As such, the ethical and practical issues associated with such a training standard require timely consideration in jurisdictions where this intervention is endorsed and integrated into healthcare. We believe the most balanced and ethical approach is to make psilocybin legally available for professional training without making it a requirement.
Abstract
Aims
This study aimed to explore the brain activity characteristics of individuals with Internet Gaming Disorder (IGD) during mobile gameplay, focusing on neural responses to positive and negative game events. The findings may enhance our understanding of the neural mechanisms underlying IGD.
Methods
Functional near-infrared spectroscopy (fNIRS) was employed to measure hemodynamic responses (HbO/HbR) in the prefrontal cortex of both IGD participants and recreational gaming users (RGU), during solo and multiplayer mobile gameplay.
Results
In solo mode, IGD participants exhibited stronger activation in the dorsolateral prefrontal cortex (dLPFC), frontopolar area (FPA), orbitofrontal cortex (OFC) in response to positive events compared to RGU. Negative events led to reduced activation in the FPA among IGD participants. In multiplayer mode, IGD participants displayed lower activation in the dLPFC and ventrolateral prefrontal cortex (vLPFC), although overall brain response trends to positive and negative events were similar between IGD and RGU.
Conclusions
This study suggests that individuals with IGD exhibit heightened sensitivity to rewards and diminished sensitivity to losses, along with potential impairments in the executive control network. These results contribute to a better understanding of the neural mechanisms of IGD and offer insights for developing targeted interventions aimed at addressing abnormal reward and loss processing.
Abstract
Background and aims
Sexual trauma is associated with multiple negative health and social conditions, including compulsive sexual behavior. The present study examined network structures involving sexual trauma history, psychological distress (defined as depression and/or anxiety symptoms), substance use, transactional sex, and compulsive sexual behavior. Prior network analysis work in this area is limited.
Methods
We drew upon two samples of young adults (Sample 1: n = 1,884, 69.3% women; Sample 2: n = 2,337, 69.7% women) recruited from universities in the United States in 2020–2022.
Results
Findings support relationships between sexual trauma and compulsive sexual behavior. Relationships between elements of compulsive sexual behavior, timing of trauma, psychological distress, substance use, engagement in transactional sex, and gender differences were identified. Significant edge strength differences between men and women were observed; distress was a more central node for men, trauma was a more central node for women (Sample 1). When examining elements of CSB, significant gender differences in edge strength were also observed (e.g. connections between dissatisfaction and relapse for men, dissatisfaction and negative consequences for women).
Discussion and conclusions
Specific aspects of CSB closely related to sexual trauma history (e.g., dissatisfaction) and co-occurring psychopathology or clinical concerns (e.g., depression, anxiety, substance use, and engagement in transactional sex) and warrant further attention and study.
Előrehaladott Parkinson-kóros betegek kezelése levodopa-entakapon-karbidopa intestinalis géllel: az első két év tapasztalata
Two years’ experience with levodopa-entacapone-carbidopa intestinal gel treatment in advanced Parkinson’s disease
Introduction: In advanced Parkinson’s disease, oral or transdermal dopaminergic treatment is not effective enough and have significant side effects, so it may be necessary to use device-aided therapies for continuous dopaminergic stimulation. Objective: Our aim was to compare the clinical parameters of patients with advanced Parkinson’s disease treated with levodopa-entacapone-carbidopa intestinal gel before the start of the treatment and at the discharge from the hospital. Method: We retrospectively analyzed data from patients who started levodopa-entacapone-carbidopa intestinal gel treatment: the patients’ general and neurological condition, previous treatment, medication side effects, and complications of Parkinson’s disease. Results: Levodopa-entacapone-carbidopa intestinal gel treatment was initiated in 29 patients. The patients had an initial off state of 4.7 ± 0.8 hours/day. 20 patients suffered from moderately severe peak-dose dyskinesia (2.8 ± 1.2 hours/day) and 6 patients from severe dyskinesia (2.1 ± 1.0 hours/day). After treatment, the duration of the off state decreased significantly. There was a similar trend for mild or moderate dyskinesias, while severe dyskinesias disappeared completely. The sudden off states that occurred in 7 patients, were not present at discharge. After treatment, the early morning akinesia only occurred in 8 out of the initial 24. Discussion: The introduction of levodopa-entacapone-carbidopa intestinal gel proved to be effective, although our patients started the treatment later than recommended, and with serious motor complications. The mild, transient side effects related to treatment were comparable to literature. No entacapone-naive patient experienced gastrointestinal side effects. Conclusion: The effect of levodopa-carbidopa-entacapone intestinal gel on improving motor complications is similar to that of levodopa-carbidopa intestinal gel, with the advantage of lower daily levodopa dose and a smaller device. Further studies and longer clinical experience are necessary to recommend which of the two types of levodopa-containing enteral gel is more advantageous in individual cases. Long-term safety is also an important aspect in this decision, in order to improve the patients’ quality of life. Orv Hetil. 2025; 166(3): 90–97.
Hozzájárul-e a technológiai fejlődés (robotika) a nők nagyobb szerepvállalásához a sebészeti szakmákban?
Does the technological progress (robotics) contribute to women’s empowerment in surgical professions?
A nem szuicidális önsértési zavar mint lehetséges mentális betegségkategória és a mérésére kialakított kérdőív magyar adaptáció
Non-suicidal self-injury disorder as a possible mental illness category and the Hungarian adaptation of a questionnaire developed to measure
Introduction: Non-suicidal self-injury disorder is a severe form of non-suicidal self-injury, listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) as a condition in need of further study. The validity of this diagnostic category, which is still undergoing scientific testing, has been confirmed by a number of studies, highlighting that when it is associated with other mental disorders, more severe symptoms and psychosocial impairment are present. Objective: Our study tested the presence and characteristics of non-suicidal self-injury disorder in an adult clinical sample, while adapting a questionnaire designed to measure this syndrome. Method: In our cross-sectional questionnaire study, 101 psychiatric patients (66.3% female; mean age = 36.88 years; SD = 12.94) answered questions from the first part of the Inventory of Statements About Self-Injury, the Non-Suicidal Self-Injury Disorder Scale and the MMPI-2 (Minnesota Multiphasic Personality Inventory-2) clinical personality and psychopathology test. Results: Nearly 70% of the patients (n = 70) reported having experienced at least one episode of non-suicidal self-injury in their lifetime, but a much smaller proportion of the sample, 20.8% (n = 21), was affected by non-suicidal self-injury disorder, which was identifiable even without borderline personality disorder. Patients with non-suicidal self-injury disorder had significantly higher scores – in the pathological range – on the clinical scales (Hypochondriasis, Depression, Hysteria, Psychopathic Deviate, Paranoia, Psychasthenia, Schizophrenia, Social Introversion), on some personality psychopathology scales (Psychoticism, Neuroticism, Introversion) and on the suicidal scales of the MMPI-2 questionnaire. Hopelessness and engaging in multiple self-injurious methods significantly increase the risk of non-suicidal self-injury as a syndrome. Discussion: Non-suicidal self-injury disorder was also identified in a sample of Hungarian adult psychiatric patients without the presence of borderline personality disorder. The diagnostic level of non-suicidal self-injury was associated with more pronounced clinical symptoms and more severe psychosocial impairment. The psychometric validity of the Non-Suicidal Self-Injury Disorder Scale, designed to measure the syndrome, was also confirmed. Conclusion: Non-suicidal self-injury disorder can be interpreted as a distinct and clinically relevant diagnostic entity, and the scale introduced in the Hungarian test battery provides a reliable and valid measure to this symptomatology. Orv Hetil. 2025; 166(3): 98–108.
A Rövidített Sürgősségi Osztályos Betegelégedettségi Skála hazai validációja
Validation of the Brief Emergency Department Patient Satisfaction Scale in Hungary
Introduction: Measuring patient satisfaction is crucial for quality improvement processes. Due to the specific characteristics of emergency care, it is essential to use an adapted measurement tool. The Brief Emergency Department Patient Satisfaction Scale is an internationally validated questionnaire specifically developed to measure patient satisfaction in emergency care settings. Its reliability and validity have not yet been studied in Hungary. Objective: The aim of this study was to analyze the reliability and applicability of the Hungarian version of the survey, as well as to examine the components of patient satisfaction, based on data collected from a Hungarian emergency department. Method: Data collection took place between January 2023 and August 2024. A total of 683 non-traumatology patients and/or their relatives who visited the Semmelweis University Emergency Department completed the questionnaire. For the analysis, Cronbach’s alpha was calculated to assess reliability, a median test was used to analyze differences across satisfaction subscales, and factor analysis was conducted. Results: The overall and subscale Cronbach’s alpha values indicated excellent reliability and internal consistency (Cronbach’s alpha: 0.86–0.94). The median test showed significant differences between satisfaction with staff and overall patient satisfaction (χ² = 7.57, p = 0.006) and between satisfaction with staff and family satisfaction (χ² = 4.90, p = 0.027), while differences between satisfaction with staff and environment perception (p = 0.064) and between satisfaction with staff and medical care (p = 0.056) were not significant. According to Cliff’s delta, the largest effect size was observed between satisfaction with staff and overall patient satisfaction (Cliff’s delta = 0.17). Factor analysis identified five main factors explaining the total variance. Discussion: The questionnaire demonstrated high reliability in measuring various aspects of patient satisfaction. Strong correlations between subscales and the results of the factor analysis confirmed the complexity of the questionnaire, indicating that it effectively captures the essential dimensions of patient satisfaction. As expected, overall patient satisfaction was the most significantly influenced by satisfaction with the staff. Conclusion: The Hungarian adaptation of the questionnaire is a reliable tool with face validity for measuring patient satisfaction in emergency departments. Further studies are recommended for a more detailed statistical analysis with expanded demographic variables, potentially including multiple centers, to refine the findings. With a broader implementation, the tool could contribute to a deeper understanding of patient satisfaction across emergency care settings in Hungary. Orv Hetil. 2025; 166(3): 109–115.
A SPOCK1 fehérje szerepe a máj egészséges és kóros működéseiben
The role of the SPOCK1 protein in healthy and pathological liver processes
Diseases of the liver pose a significant global health challenge, often being diagnosed late and difficult to treat. Therefore, understanding the pathological processes of the liver and identifying new biomarkers and therapeutic targets are of paramount importance, as these efforts may contribute to early diagnosis, more effective treatment strategies, and better patient outcomes. The SPARC/Osteonectin CWCV and Kazal-like domains proteoglycan 1 (SPOCK1) protein, first described in 1992, may play a crucial role in healthy and pathological liver processes, particularly in liver cancer and liver fibrosis. SPOCK1 is a multi-domain protein located both in the extracellular matrix and intracellularly, especially near the mitochondria. It is present in small amounts in a healthy liver, but its expression increases significantly in pathological conditions, such as HCV infection, cirrhosis, and liver cancer. SPOCK1 promotes cell growth, migration, and invasion, while inhibiting apoptosis, thus contributing to tumor and fibrosis progression through the activation of multiple signaling pathways. SPOCK1 represents a potential biomarker and therapeutic target for liver cancer and other liver diseases. However, further research is needed to understand its clinical applications and significance, particularly regarding its functions and secretion mechanisms. Orv Hetil. 2025; 165(3): 82–89.
Abstract
Background
Non-face-to-face interventions offer promise, with cognitive training showing potential but inconsistent efficacy in problem gambling.
Methods
We conducted a non-face-to-face, parallel, randomized, controlled, single-blinded trial to evaluate training programs in adults with problem gambling (CPGI ≥5). Participants were randomized 1:1 to a web-based cognitive training program targeting inhibition unrelated to addiction cues or a control program on visuo-spatial functioning. Both programs benefited from weekly phone calls to support engagement and transferability to daily life. A mixed community and out-patient sample was recruited at the national-level. The primary outcome was change in CPGI at week 6. Secondary outcomes were change in impulsivity, gambling behavior and quality of life at 6 and 14 weeks.
Results
187 participants were screened, with 185 randomized: 93 to intervention and 92 to control. No significant differences were found between groups for any outcome. Mean PGSI change at 6 weeks was −2.75, 95% CI [−12.95; 7.44] in the experimental arm versus −2.44, 95% CI [−13.52; 8.64] in controls, p = 0.76. 34% of participants were classed as no longer problem gamblers at week 14. Intervention acceptability was moderate, with 21 participants (22.58%) in the experimental group, and 32 (34.78%) controls never accessing the platform (p = 0.07).
Conclusions
Further research is needed to optimize cognitive interventions in problem gambling, to improve engagement and to demonstrate their added value beyond minimal intervention. For a number of problem gamblers, minimal telephone interventions appeared to be sufficient to reduce gambling. Objective account-based gambling data will provide valuable insights into long-term and objective effects.
Abstract
Background and Aims
The widespread popularity of video games reflects their appeal to meet fundamental needs. This study aims to investigate the psychological factors of gaming use, identifying profiles ranging from healthy to gaming disorder.
Methods
In this cross-sectional study, 5,222 participants were surveyed. This international sample included adolescents and adults (16–69 years, M = 25.6 years, SD = 6.44), 48.66% men (n = 2,541; M = 26.4, SD = 7.03), 42.32% women (n = 2,210; M = 25.1, SD = 5.78), and 9.02% non-binary individuals (n = 471; M = 23.3, SD = 5.23), spanning from casual gamers to esports professional players. Latent Profile Analysis (LPA) was employed to identify distinct psychological profiles. The profile indicators included emotional regulation and motivations for playing video games. The profile correlates analysed included gaming disorder symptoms, time spent gaming and sociodemographics.
Results
The LPA revealed four profiles labelled as avoidant (20.16%), engaged (38.95%), relational (26.01%), and dysregulated (15.78%). Results suggested that the dysregulated profile had the most emotional regulation difficulties, a low level of general motivation, and less interest in recreational gaming, presenting the highest risk for gaming disorder.
Discussion and Conclusions
This study's findings present the first profiles encompassing key detailed psychological factors affecting gamers' behaviour across all game genres, considering three genders. These profiles can aid researchers and clinicians in developing further research on targeted prevention and intervention programs tailored to each profile's characteristics to promote healthy gaming habits and mitigate the risks and harm associated with gaming disorder.
Abstract
Background and Aims
The study of stigma contributes greatly to our understanding of individuals' experiences of mental disorders. Addictive disorders are often associated with public misconceptions of the disorder, which can contribute to shame, discrimination, and reticence to seek help. This review aimed to: (1) evaluate the nature, frequency, and prevalence of addiction stigma; (2) identify the correlates of addiction stigma; and (3) examine the psychometric qualities of addiction stigma measures.
Methods
A search of Web of Science, PubMed, Scopus, PsycINFO, and PsycNet, had 5,515 results which were screened for eligibility using Covidence. Eligible papers were quantitative, peer-reviewed studies, which reported an outcome variable of stigma related to an addiction.
Results
A total of 99 studies were included in the review, including 70 studies of substance-based addictions, 19 studies of behavioral addictions, and 10 studies which examined both. Thirteen of the 20 studies examining the impact of familiarity with addiction reported that greater familiarity was associated with lower public stigma. Studies comparing substance and behavioral addictions (n = 5) typically reported greater public stigma towards vignettes depicting substance-based addictions than for behavioral addictions. Between 22% and 40% of individuals with an addictive disorder identified stigma as a significant barrier to seeking help; however, the relative importance of stigma among other barriers was unclear.
Discussion and Conclusions
Evidence for countermeasures to prevent and/or reduce stigma is currently limited. Further research on the nature and prevalence of addiction stigma is needed to inform the development of effective clinical and public health countermeasures.
Abstract
Background
While psychedelic substances are extensively studied through the lens of various academic disciplines, their impact on the therapeutic practice of mental health professionals is yet to be explored. This firsthand experience is deemed crucial for effectively assisting patients in the process of integrating a psychedelic experience.
Aims
The aim of this study was to explore the psychological and spiritual dimensions of psychedelic integration among mental health professionals, focusing on understanding how transformation and insights influence their clinical work.
Methods
Utilizing a phenomenological methodology, interviews with eight mental health professionals with substantial first-person experience with psychedelics were conducted.
Results
Our findings indicate a potential, enduring, positive impact of psychedelic meta-integration on the practice of mental health clinicians. The data analysis yielded a multi-faceted model encompassing key aspects of human life including interpersonal and emotional development, relationship with death and nature, concepts of love, meaning, and spirituality, along with elements pertinent to therapeutic work. This comprehensive model integrates these diverse dimensions, offering a holistic understanding of the impact of psychedelics on both personal and professional realms.
Conclusions
The findings of this study lend support to the notion that health professionals involved in clinical work encompassing psychedelic integration should themselves have undergone induced altered states of consciousness, not only for a better empathetic understanding. This might be also predicated on the intrinsic positive transformative effects on their human capacities and as therapists. This dual benefit underscores the importance of personal experience in the effective facilitation of psychedelic integration in clinical settings.
Abstract
Background and aims
The recent resurgence of psychedelic research has led to increased interest in extra-pharmacological factors shaping drug effects (set and setting). Habitually discussed in the context of psychedelic therapy, the relevance of set and setting to determining the outcome of non-psychedelic psychiatric interventions receives strong theoretical and empirical support in the literature. Unfortunately, there has been little research on the subject. The current study addresses this lacuna and investigates the potential of using non-pharmacological interventions to improve the outcomes of psychiatric care including safety, satisfaction, efficacy, and non-habituation.
Methods
110 participants (patients prescribed with psychiatric medication) took part in workshops focused on 1) Relaxation (Anxiolytics) 2) [n = 70] Focus (Stimulant ADHD Medication) [n = 40]. Workshops included a) an educational section designed to increase participants' understanding of their medical conditions and prescribed medications b) an experiential section that included the guided, mindful ingestion of the prescribed drug in a supportive setting including reinforcing cues and the practice of non-pharmacological techniques for coping with underlying medical conditions.
Results
Survey questionnaires (n = 33) indicated a significant improvement in participants' understanding of their medical conditions and the properties of their prescribed medication. Semi-structured interviews demonstrated a strong interest in the idea of mindful use of medication, benefit from the communal setting of ingestion, as well as recurring themes of greater satisfaction with- and improved ability to derive benefit from the use of prescribed drug.
Conclusions
The results of this pilot study demonstrate the impressive potential of providing patients with extra-pharmacological tools to improve the outcomes of prescription drug use and supports the need for further study.
Abstract
In silico, we modelled the possible docking conformation of human WNT16B and the human ERBB2 TMD homodimer, resulting in a mutant complex. The ribbon structure and the C-terminal, N-terminal, and GG4-like motif structures are similar in HER2 TMD and HER TMD: we modelled the possible docking conformation of WNT16B to the HER1 TMD (ErbB), which also resulted in a mutant complex. If a strong relationship exists between TMD mutations that improve the active dimer interface or stabilizing an activated conformation and the potency with which HER2 (and possibly also HER), then the dimerization part of the TMD seems to be the ideal reagent target. The agent we tested –4-(Furan-2-yl)hepta-1,6-dien-4-ol (AKOS004122375) – can connect directly into human ERBB2 TMD (HER2), to the ErbB TMD (HER1) dimer bilayer motif, and human WNT16B, ERBB2 TMD (HER2) and WNT16B ErbB TMD (HER1) mutant complex residues. We tested the agent ligand in vitro and in vivo in several tumor models, which highlighted that targeting the EGFR's TMD with an agent not only reduced treatment-induced metastasis but also radically decreased tumor growth. Because of the analogous structure of HER2 TMD and HER TMD, this dimerization motif targeting can also be successful in HER and HER2 EGFR signalling. In vitro, we reached an antiproliferation rate of 80%–94% in different tumor models, while in vivo we reached a rate of 35%–61% tumor suppression in different tumor models. The metastasis inhibition effect of the compound was between 82% and 87% in different tumor models. The referenced experiments took place in 2015 in Hungary.
Abszcizinsav – táplálkozási lánc és humán egészség
Abscisic acid – food chain and human health
Abscisic acid is an ancient, universal compound on different levels of phylogenetic development and helps organisms adapt to their environment. In the 1940s, attention was first given to a substance that inhibits the growth of plants, which in the mid-1960s turned out to be a phytohormone that regulates the dormant state of plants. Research conducted in the 2010s revealed the biosynthesis of abscisic acid. Bioactive abscisic acid, an oxygen-rich diterpene molecule, is the product of the degradation of xanthophylls synthesized from mevalonic acid as a starting compound. Abscisic acid, as a secondary metabolic product, affects many physiological processes in plants. In the last two decades, molecular-genetic, biochemical and pharmacological studies have discovered the universal signaling pathway of abscisic acid. In 1986, during animal experiments carried out in parallel with these studies, it was realized that abscisic acid is also produced in the animal body. After the turn of the millennium, more and more people became interested in the role of abscisic acid in animal organs, tissues, and cells (leukocytes, monocytes/macrophages, granulocytes, microglial cells, pancreatic cells, mesenchymal stem cells etc.). There is now an enormous amount of literature on the versatile physiological effects of this compound. It is proven that it is a human endogenous hormone. In both animals and humans, abscisic acid regulates many physiological functions in a manner very similar to the signaling pathway known in plants. It regulates cell growth, development and immune responses to various stimuli. It has also become known that abscisic acid, as a growth regulator, is not toxic to the animal body, but at the same time inhibits the growth of cancer cells. It has a favorable effect on carbohydrate metabolism and also has anti-inflammatory properties but its inflammatory effect has also been described. Currently, the possibility of its use in human medicine is being researched. Orv Hetil. 2025; 166(2): 43–49.
Az anaemia gyakoriságának felmérése, osztályozása, prediktív tényezői gyulladásos bélbetegségben szenvedő betegekben
Anemia classification, prevalence and predictive factors in inflammatory bowel disease
Introduction: Anemia is a common complication of inflammatory bowel disease and serves as an indicator of severe disease. Objective: This study aims to evaluate the prevalence, etiology, predictive factors, and treatment of anemia in patients with inflammatory bowel disease from two tertiary centers. Method: In this retrospective, cross-sectional study, we assessed the frequency of anemia among patients presenting within a specified calendar year (June 1, 2022, to May 31, 2023), focusing on the lowest hemoglobin levels recorded during this period. We collected demographic data, disease activity scores, treatment regimens, inflammatory markers, and laboratory parameters related to iron balance. Clinical disease activity was evaluated using the Crohn’s Disease Activity Index and the partial Mayo Score. The World Health Organization’s criteria were utilized for anemia classification and severity assessment. Absolute iron deficiency was defined as a serum ferritin level <30 µg/L, while anemia of chronic disease was defined as a ferritin level >100 µg/L in conjunction with clinical or biochemical evidence of active disease. Results: The study included 400 patients (277 with Crohn’s disease and 123 with ulcerative colitis). Among the Crohn’s disease patients, 17.7% exhibited complex disease behavior, and 40.7% of the ulcerative colitis patients had extensive colonic involvement. Biological treatments were administered to 75% of the participants. Anemia was identified in 32.5% (130) of the patient cohort, with 57% classified as mild, 35% as moderate, and 8% as severe. In the subset of non-macrocytic anemia (116 patients), iron status data were available for 51% (n = 66). Of these, 73% had iron deficiency anemia, 6% had anemia of chronic disease, and 17% had chronic disease with functional iron deficiency. Anemia predictors included steroid treatment (p<0.001; OR: 4.2), clinical disease activity (p<0.001, OR: 381), and laboratory markers of disease activity (p<0.001, OR: 2.9). Intravenous iron supplementation was administered to 43 patients, while 12 received oral iron supplementation. Conclusion: The findings highlight the high prevalence of anemia, predominantly iron deficiency anemia, among patients with inflammatory bowel disease, which is closely associated with clinical and laboratory markers of disease activity. This study underscores the importance of diagnosis, classification (through assessment of iron balance parameters), and treatment of anemia in patients with inflammatory bowel disease. Orv Hetil. 2025; 166(2): 60–66.
Dr. Steinberger Sarolta (1875–1966) és az ártatlanság vélelme
Sarolta Steinberger, MD (1875–1966) and the presumption of innocence
Újszerű bariátriai bypassműtéttel (SASI) szerzett tapasztalataink
Experiences with a novel bariatric bypass procedure (SASI)
Introduction: Obesity is a problem of endemic proportions, which is not simply an aesthetic problem, but rather a systemic disease. Regarding its treatment, surgery is more effective than conservative methods. Laparoscopic „single anastomosis sleeve ileal” (SASI) bypass is a novel bariatric procedure not yet broadly in practice that combines advantageous features of restrictive and malabsorptive techniques. SASI can be effective for both „amount eaters” and „sweet eaters”, while the risk of impaired absorption remains minimal. Objective: In this report, we present the results of SASI bypass procedures performed by our team between August 1, 2022 and September 1, 2024. Methods: Regarding criteria of qualification and conducting the study, the protocol of the international bariatric society was followed. After creating a gastric sleeve in the first stage, an anastomosis with a maximal width of 4 cm was created between the ileum and remaining stomach. Follow-ups were carried out 3 and 6 months after surgery. Gastric emptying was examined with isotopic method in two voluntary patients. Results: A group of 25 patients (17 women, 8 men) who underwent SASI bypass surgery were evaluated in the study (mean age 40.1 ± 11.3 years). Mean preoperative BMI was 43.7 ± 6.7 kg/m2. Postoperative BMI decreased by 6.1 ± 3.4 kg/m2 (13.9 ± 6.3%) at 3 months and 11.6 ± 6.2 kg/m2 (26.1 ± 12.0%) at 6 months. Hypertension resolved in 9 out of 11 cases, prediabetes normalized in 2 out of 2 cases. We observed postoperative reflux in 6, sleep disorder in 1, fatigue in 5, hair loss in 9 cases. Lasting diarrhea did not occur. With isotopic examination we found that 90% of gastric content empties into the efferent ileum and 10% goes into the duodenum. Discussion: SASI bypass combines advantages of restrictive and malabsorptive bariatric procedures effectively, while – according to our experience so far – the risk of impaired absorption, vitamin- and mineral-deficiency remains minimal. A significant regression can be expected regarding comorbidities and required medications in the first 6 months after surgery. Conclusions: SASI bypass is a safe procedure that achieves effective weight loss and quick resolution of comorbidities, thus it may become the leading bariatric procedure in the near future. Orv Hetil. 2025; 166(2): 67–76.
A virtuális valóság használatának lehetőségei gyermekek perioperatív ellátásában
The potentials of virtual reality in pediatric perioperative care
Each year, millions of children worldwide undergo general anesthesia for various surgical or diagnostic procedures. In Hungary, approximately 20,000 to 30,000 children are treated in pediatric surgical centers annually, and additional 5,000 to 10,000 children undergo operation in adult otolaryngology departments. Treating children is a challenge, as their cognitive and emotional development levels may pose difficulties for them in understanding the procedures ahead and may make the processing of the stressful experiences of the intervention uncertain. Preoperative anxiety can often lead to increased postoperative pain, confusion, extended hospital stays, and undesirable behavioral changes. Various methods are available to manage perioperative anxiety and pain (such as administering anxiolytics as premedication, allowing parental presence during anesthesia induction, and postoperative pain relief). Although distraction methods like music or cartoons have proven effective, pharmacological treatment remains the gold standard. The use of newer, alternative solutions (such as psychoeducation or virtual reality) has not yet become part of routine practice. Virtual reality is a new, innovative tool that offers an immersive, three-dimensional audiovisual experience, diverting children’s attention away from unpleasant experiences. The use of virtual reality in pediatric settings is particularly promising, as children’s attention can easily be engaged through virtual games, reducing the anxiety and pain caused by medical procedures. This article presents the pediatric applications of virtual reality and the possibilities of its use in procedural and perioperative environments based on literature data, in relation to the fact that personal experience with the method has begun at the Pediatric Center of Semmelweis University. Orv Hetil. 2025; 166(2): 50–59.
Abstract
Background and aims
Uncontrollable gaming behavior is a core symptom of Internet Gaming Disorder (IGD). Attentional bias towards game-related cues may contribute to the difficulty in regulating online gaming behavior. However, the context-specific attentional bias and its cognitive mechanisms in individuals with IGD have not been systematically investigated.
Methods
We compared individuals with IGD to healthy controls (HC) using a rapid serial visual presentation (RSVP) task to measure temporal attentional bias. By applying game-related and neutral stimuli as targets, we specifically assessed how attentional resources were allocated to game-related stimuli compared to neutral stimuli.
Results
The IGD group showed enhanced attentional blink effect when a game-related stimulus was the first target and a neutral target was the next, reflecting IGD's difficulty in disengaging from game-related stimuli. Both IGD and HC individuals exhibited decreased accuracy in identifying a neutral first target followed by a game-related second target at shorter lags, indicating increased attentional engagement with game-related stimuli in general.
Discussion
The results provide a cognitive basis for recurrent and uncontrollable gaming behaviors in individuals with IGD. Game cues have priority in the allocation of attentional resources in individuals with IGD. The results shed new light on the development of specific treatments for IGD.
Abstract
Background and aims
Internet gaming disorder (IGD) is a highly engrossing activity with the individual spending up to 10 h per day gaming, this causes issues in accomplishing their tasks and personal goals. Also, to generate in them increased anxiety, impulsivity and lack of social skills, this impacts the good personal development and individual's quality of life. Therefore, it is vital to better understand, in terms of treatment, which factors are associated with therapeutic outcomes (largely to achieve control over the use of video games and the lack of relapses) following a standardized Cognitive Behavioral Therapy (CBT) protocol. This study aimed to explore sociodemographic and personality variables and their relation to treatment outcome in patients with IGD.
Method
The sample included n = 105 patients with IGD, considered between January 2005 and December 2022 and recruited from the Behavioral Addictions Unit at the University Hospital of Bellvitge. Data at baseline was registered (sociodemographic and clinical measures), as well as the therapy outcomes (compliance with the guidelines, presence of relapses and dropouts).
Results
Patients were mainly males (n = 95) with a mean age of 24.97 (SD = 12.03). All patients included in this sample had individual CBT treatment in relation to their problematic gaming behavior. In terms of patients who relapsed, they had higher interpersonal sensitivity, hostility and persistence with lower self-directedness. Patients who dropped out were males with an older age of IGD onset. When looking at treatment noncompliance, it was related to higher psychoticism and reward dependence, and lower cooperation. Patients with IGD show higher levels of treatment noncompliance.
Conclusion
These findings evidence a positive and promising effect of CBT on IGT. The factors identified as predictors of good and poor treatment outcomes should be considered for developing new evidence-based interventions focused on learning healthier key coping strategies to manage both cravings and triggers.
Abstract
Background
During the development of addictive behaviors, theoretical models assume a shift from experience of gratification being a driver in early stages to experience of compensation which dominates at later stages of addiction development. Initial studies show a trend in this direction; however, this shift has not yet been investigated in clinical samples. We assume experienced gratification to be highest in individuals with risky use (indicating the beginning of the addiction process), and compensation to be highest in individuals with pathological use.
Methods
Data from 834 participants from a multi-center study (FOR2974) investigating specific Internet-use disorders (IUDs) including gaming, buying-shopping, pornography use, and social-network use disorders were analyzed about Experience of Gratification (EGS) and Experience of Compensation (ECS), symptom severity, use expectancies, and usage motives. A diagnostic interview based on DSM-5 criteria for gaming disorder was used to classify individuals into either non-problematic, risky, or pathological use group.
Results
The groups (non-problematic, risky, pathological) differed significantly regarding EGS and ECS. Individuals with pathological use reported highest experiences of compensation but equally high experienced gratification as individuals with risky use. Effects vary with respect to the specific behavior. All measures correlated significantly. Symptom severity was most strongly associated with facets of compensation.
Conclusion
The experience of gratification and compensation appear to be crucial for addiction-like Internet use. Experienced gratification is already high in individuals experiencing first negative consequences and appear to be stable in individuals with pathological use indicating the relevance of both positive and negative reinforcement during the addiction processes.
Abstract
Background and aims
The inclusion of gaming disorder as a new diagnosis in the 11th revision of the International Statistical Classification of Diseases (ICD-11) has caused ongoing debate. This review aimed to summarise the potential neural mechanisms of gaming disorder and provide additional evidence for this debate.
Methods
We conducted a comprehensive literature review of gaming disorder, focusing on studies that investigated its clinical characteristics and neurobiological mechanisms. Based on this evidence, we further discuss gaming disorder as a psychiatric disorder.
Results
The present review demonstrated that the brain regions involved in gaming disorder are related to executive functioning (e.g., anterior cingulate cortex and dorsolateral prefrontal cortex), reward systems (e.g., striatum and orbitofrontal cortex), and emotional regulation (e.g., insula and amygdala). Despite the inclusion of gaming disorder in the ICD-11, the debate remains on the benefits and harms of classifying it as a mental health disorder. Opponents argue that the current manifestations that support gaming disorder as a psychiatric disorder remain inadequate, it could cause moral panic among healthy gamers, and that the label of gaming disorder is stigmatising.
Discussion
Evidence suggests that gaming disorder shares similar neurobiological alterations with other types of behavioural and substance-related addictions, which further supports gaming disorder as a behavioural addiction. Ongoing debates on whether gaming disorder is a psychiatric disorder push for further exploring the nature of gaming disorder and resolving this dilemma in the field.
Belszervi perforációk IV-es típusú Ehlers–Danlos-szindrómában szenvedő gyermekben
Visceral perforations in a child with Ehlers–Danlos syndrome type IV
The vascular type IV of Ehlers–Danlos syndrome is an autosomal dominant connective tissue disorder, the diagnosis of which is often delayed. Severe complications: arterial rupture or colon perforation may rarely occur already in childhood. We present a five-year-old child who developed bowel and bladder ruptures. He was admitted with severe abdominal pain and muscle defense. He had a history of chronic constipation, recurrent complaints of dysuria and suffusions. Based on clinical signs and imaging, acute surgery was indicated. A 3 mm perforation was found at the rectosigmoid part of the bowel. Weakness of the bowel due to chronic constipation, Hirschsprung’s disease, abuse, inflammatory bowel disease and connective tissue disorder have been raised as possible diagnoses. The excessive connective tissue fragility in several family members raised the possibility of Ehlers–Danlos syndrome. Indeed, a missense COL3A1 variant (p.Arg449Leu) was identified that segregated with the disease in the family. Six months later, a bladder diverticulum was found by cystoscopy. Spontaneous bladder rupture occurred on the fourth postoperative day. After suturing the defect, the child completely recovered. Ehlers–Danlos syndrome may present as a life-threatening condition already in childhood. It is important to recognize this rare genetic disorder and follow up the patient. Patients should avoid exertion. Colonoscopy and cystoscopy are relatively contraindicated. Orv Hetil. 2025; 166(1): 27–32.
A genetikai eredetű gyermekkori krónikus cytopeniák felismerése a molekuláris medicina érájában
Klinikai ajánlás és metodikai útmutató
Identification of genetically determined chronic childhood cytopenia in the era of molecular medicine
Clinical recommendation and methodical considerations
The vast majority of childhood cytopenias are transient, mostly secondary, and not the consequence of primary bone marrow processes. Yet, every few months we see patients in the pediatric hematology centers of the Hungarian Pediatric Oncology Network in whom repeated bone marrow sampling and extensive laboratory hematological investigations do not lead to a diagnosis and the cytopenia persists chronically. In these cases, the identification or exclusion of genetically determined benign or premalignant hematological conditions – such as congenital neutropenia, hereditary hemolytic or dyserythropoietic anemia, inherited thrombocytopenia, congenital bone marrow failure syndrome – is essential for modern therapy planning. In correctly selected pediatric patients with chronic cytopenia, modern high-throughput molecular genetic testing by next-generation sequencing is the most cost-effective diagnostic option, and its early use avoids many invasive interventions and inappropriate therapeutic attempts. At the initiative of Semmelweis University, a national molecular genetic diagnostics program was launched to map the etiology, epidemiology and prognosis of hereditary chronic cytopenias in children in Hungary. In the present work, we summarize the technical details of the testing modality and the indications we propose to apply in clinical practice. As a proof of concept, we present a discovery cohort of 30 patients selected according to these indications: 67% of them were identified with a gene variation that at least partially explained the phenotype, 47% with a variation that revised the diagnosis initially assumed by the treating physician, and 43% with a variation that determined the next substantive therapeutic decision. Of these, 45% were likely pathogenic or pathogenic aberrations and 55% were variants of unknown clinical significance. We propose to consider and apply this high-throughput molecular genetic modality, which generates significant clinical benefit and has a high diagnostic success rate according to our own and international data presented, as a priority element of the hematological diagnostic workflow in our country, within a regulated, professional framework. Orv Hetil. 2025; 166(1): 3–19.
Gyógyszerrezisztens epilepsziás betegek pszichológiai vizsgálata: affektív tényezők és társas támogatás
Psychological assessment of drug-resistant epilepsy patients: affective factors and social support
Introduction: Epilepsy is a chronic brain disease, which is basically treated with antiepileptic drugs. Objectives: The aim of our study was to map the social support of drug-resistant epilepsy patients and to examine and compare affective factors, including depression and anxiety, with healthy controls. Methods: A total of 34 subjects (22 women and 12 men; age range: 21–66 years [M = 43.1, SD = 14.0]) were included in our study. 17 drug-resistant epilepsy patients (13 women and 4 men; age range: 21–66 years [M = 46.6, SD = 13.5]) and 17 matched control subjects (9 women and 8 men; age range: 23–59 years [M = 39.6, SD = 14.1]) participated in the study. Questionnaires used were Hospital Anxiety and Depression Scale (HADS), Caldwell’s Social Support Questionnaire (SDS). Results: In the study sample, the level of depression and the level of social support showed an inverse correlation. Higher levels of depression were significantly related to lower levels of social support: difficult life situation (rs [15] = –0.498, p<0.003), practical support (rs [15] = –0.622, p<0.001), and the number of people the subject was in contact with (rs [15] = –0.513, p<0.002). There was a significant difference in the HADS total score between people with drug-resistant epilepsy and controls (t [24.4] = 3.40, p = 0.002, d = 1.16). Discussion: The maintaining and helping role of the social environment is essential in chronic drug-resistant epilepsy. In the absence of social support, the rate of depression increases significantly, which further deteriorates the quality of life of patients. Conclusion: The results of the present pilot study highlight the relevance of this problem, which may facilitate a detailed neuropsychological diagnosis of drug-resistant epilepsy patients, thereby increasing therapeutic efficacy. Orv Hetil. 2025; 166(1): 20–26.
Visszaemlékezés Fornet Béla belgyógyászprofesszorra (1890–1966), a debreceni Belklinika legendás igazgatója születésének 135. évfordulóján
Remembering Béla Fornet (1890–1966), professor of internal medicine, on the 135th anniversary of the birth of the legendary director of the University Department of Internal Medicine in Debrecen
A felnőtt korú cukorbetegek laboratóriumi vizsgálatainak elemzése hazánkban
Retrospektív kohorszvizsgálat a 2014–2021 közötti igénybevételi adatok alapján
Analysis of laboratory tests in adults with diabetes in Hungary
A retrospective cohort study based on administrative data from 2014 to 2021
Introduction: Diabetes remains a significant healthcare burden despite declining incidence. However, a systematic, nationwide assessment of the care routine is lacking. Objective: To evaluate diabetes care practice in Hungary using laboratory test completion data as reflected in available administrative data. Methods: Using administrative data from the National Health Insurance Fund (2010–2021), we performed a retrospective cohort study to analyze the completion rates of laboratory tests, as recommended by clinical guidelines, among diabetes patients in 4 cohorts over a 4-year follow-up period. Multivariate logistic regression analysis was used to identify factors associated with test completion. Results: 128,115 patients were included. Over 70% had blood glucose and serum creatinine tests in at least 3 different years over the 4-year period, while HbA1c, urinary glucose, and urinary ketone tests were performed in 50–60%. LDL-cholesterol or urinary albumin testing was <30% within the 4 years following the first antidiabetic medication initiation. Testing rates declined during the pandemic (2020–2021). Testing was less likely among men, younger age groups, and those on metformin and/or sulfonylurea only. Results showed a declining trend over time. Discussion: Our findings highlight the need for clearer roles and responsibilities in diabetes care, the provision of information technology tools, reminder systems, and sufficient capacity to facilitate laboratory testing and better patient education. Limitations include lack of access to test results, private and point-of-care testing data. Conclusions: In light of the current national clinical guidelines, an examination of relevant laboratory tests alone reveals that there are areas for improvement in the functioning of domestic diabetes care and the underlying data provision. The establishment of integrated care, the clear definition of tasks and responsibilities, the inclusion of point-of-care tests and laboratory tests results in data provision can significantly contribute to the development of diabetes care in our country. Orv Hetil. 2024; 165(52): 2047–2060.
A mély neuromuscularis blokk szerepe a laparoszkópos műtétek során
Irodalmi összefoglaló
Deep neuromuscular block in laparoscopic surgical interventions
With the increasingly dynamic spread of laparoscopic surgical techniques and related robot-assisted surgery, interdisciplinary cooperation is becoming increasingly important for patient safety. In the last decade, more and more clinical observations have suggested that the use of a deep neuromuscular block for laparoscopic interventions can be beneficial because it enables the use of lower intra-abdominal pressures and does not adversely affect the surgical field of view. The lower intra-abdominal pressure applied during the procedure creates more favorable hemodynamic and respiratory mechanical conditions in the intraoperative period and also reduces the postoperative pain associated with the procedure. In our paper, we summarize the available evidence regarding the use of deep neuromuscular block and the conditions for its safe use. Orv Hetil. 2024; 165(52): 2039–2046.
Mesterséges intelligencia az egészségügyi oktatásban: áldás vagy átok?
Artificial intelligence in health education: blessing or curse?
Introduction: ChatGPT is a large language model developed by OpenAI that has brought significant advances in natural language processing. With GPT-4.0, the model is capable of human-level conversations, which is particularly useful in education and research. In healthcare education, students can practice patient admission in virtual situations, receiving real-time feedback. It also allows the personalisation of educational materials, tailored to the individual needs of students. Objective: The aim of this study is to demonstrate the potentials of ChatGPT, i.e., the application of artificial intelligence in health education. ChatGPT allows the creation of virtual patients and simulations, through which students can practice patient admission and communication with patients of different languages in a realistic environment. Method: ChatGPT was used to create various simulations in health education. During the simulations, students received feedback in real time, and we were able to adapt the learning materials to the individual needs of the students. With ChatGPT, students practiced in situations where they faced different language challenges. During the simulations, we fine-tuned the artificial intelligence’s responses to make them more realistic and integrated empathy into the system. Results: Throughout the research, educational simulations were created using ChatGPT that improved students’ skills and increased their confidence. Students were able to complete nursing documentation independently without interacting with real patients. Discussion: The use of ChatGPT in education offers significant benefits, particularly in bedside teaching. Virtual simulations allow students to practice their skills in a safe and controlled environment, which increases their confidence and reduces anxiety. The use of information and communication technology tools captures students’ attention and interest. Conclusion: The introduction of ChatGPT into health education allows the preparation and presentation of varied practical situations, improving the quality of patient care. Further research is currently underway, including the possibility of using ChatGPT in speech therapy and patient education. It is extremely important that the senior instructors and teachers participating in the training are able to relate to the younger generation already living in the digital world. Orv Hetil. 2024; 165(52): 2061–2064.
Multilocularis prostata-cystadenoma és incidentális alacsony rizikójú adenocarcinoma együttes előfordulása fiatal férfi betegben
Co-occurrence of multilocular prostatic cystadenoma and incidental low-risk adenocarcinoma in a young male patient
In the background of the urinary symptoms of a young, 31-year-old male patient pelvic MRI revealed a multilocular cystic tumor measuring 7.6 cm in diameter on the right side of the pelvis. Given his symptoms and the possibility of malignancy, a transperitoneal laparoscopic resection was performed. Histological examination confirmed the diagnosis of prostatic cystadenoma, and an incidental finding of Gleason-grade 3 + 3 adenocarcinoma was also noted in a small focus. Postoperatively, the patient became completely asymptomatic, with neither urinary symptoms nor erectile/ejaculatory dysfunction. A follow-up MRI performed 3 months later showed no recurrence, and PSA levels showed significant regression. The patient continues to be monitored closely. The prostatic cystadenoma is an exceedingly rare benign tumor, with fewer than 50 cases reported to date. Preoperative diagnosis is challenging due to the nonspecific nature of its compressive urogenital and gastrointestinal symptoms. Basic investigations, such as physical examination, ultrasound and PSA testing, are often uninformative. More detailed diagnostic information can be obtained through higher-order imaging studies (CT, pelvic MRI) or cytological/histological sampling via fine needle or core biopsy. The treatment of prostatic cystadenoma is primarily surgical, involving resection or excision through various approaches (transurethral, laparoscopic, robotic, or open surgery). Complete removal of the tumor is crucial, as incomplete resection is associated with high rate of recurrence. Although prostatic cystadenomas typically exhibit indolent behavior, a case of concurrent high-grade prostatic intraepithelial neoplasia and a further description of conventional adenocarcinoma have been already published. This case is noteworthy as it represents the second documented co-occurrence of prostatic cystadenoma and adenocarcinoma (collision tumor), according to the current literature. Orv Hetil. 2024; 165(52): 2065–2071.
A száz éve született, az első magyarországi vesetranszplantációt végző Németh András nyelvújítási kísérlete a transplantatum szó magyar fordítására
The hundred years ago born and in Hungary the first kidney transplantation performing András Németh’ language renewal attempt for the Hungarian translation of transplant
Dr. Jankó Albert Béla (1934–2024)
Dr. Albert Béla Jankó (1934–2024)
Epicutan próbák fogászati tesztsorokkal a COVID–19-járvány előtt és alatt a Közép-Magyarország régióban
Epicutaneous tests with dental materials before and during COVID–19 pandemic in the Central Hungary region
Introduction: SARS-CoV-2 infection raids and the successive vaccination campaigns to combat them caused deep changes in the health status and the herd immunity of a given country or even in that of certain smaller geographical region’s population. Objective: The aim of these studies was the retrospective assessment of dental allergy testing by type IV in vivo cellular immune method, the epicutaneous tests. The question was raised in respect of pandemia-induced changes. Method: The 4 years’ period before COVID–19 pandemic was compared to the 3 years of COVID–19 burden based on numerous standard test series obtained from two central Hungarian sites. 45 patients before 2020 and 45 between March 2020 and September 2023 were enrolled in Budapest (capital city). There were 48 pre-COVID–19- and 55 COVID–19-related timely tested subjects in Fejér county (Székesfehérvár) involved as well. In both centers, every attending patient’s data were analyzed by Pearson’s correlation. Standard matching dentifrice-related test series (31 allergens) were used in both centers. In the North-Budapest area 11 781 test results were collected from the municipal hospital out-patient clinic of dermato-allergy and compared to 14 716 of a private clinic in Székesfehérvár. The data were analyzed by Pearson’s correlation. Results: In both centers and both timely intervals, the male to female ratio was about 1 : 5. All results have revealed that within those special target cohorts higher prevalence of positive results could be obtained as compared to standard general country-specific environmental test series, published for the area. Therefore, dental series followed more sensitively the changes emerging in the course of COVID–19 infection. Moreover, the results pointed to the increase of multiple sensitivities in both centers especially regarding metal allergies. Acrylate-related sensitization had shown similar outcome of lesser degree. Discussion: Out of the two centers, the Fejér county one was more prone to COVID–19-induced morbidity and mortality. At this site in addition, formaldehyde, a known constituent of facial masks and sensitivity to Myroxylon pereirae (Peruvian balm) widely used by the people in immune-enhancing natural products, teas and flavors yielded the highest sensitivity scores. Conclusion: During the COVID–19 pandemic, there was significant elevation of cellular hypersensitivity and polysensitization to dental materials. Hitherto no similar data in the literature accessible for us could be found. Orv Hetil. 2024; 165(51): 2015–2025.
