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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.

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Hivatás az életért földön, vízen, levegőben – mentődolgozók egészségi állapotának vizsgálata

A vocation for life on land, sea and air – health assessment of ambulance workers

Orvosi Hetilap
Authors:
Emese Sánta
,
Krisztián Zelenák
,
Bálint Bánfai
,
József Betlehem
, and
Kitti Máté-Póhr

Bevezetés: A prehospitális betegellátás minden színtere más és más megterhelést ró a dolgozók testi és lelki egészségére. Célkitűzés: Vizsgálatunk célja volt összevetni a földi, a légi- és a vízimentők stresszterhelését és egyéb rizikófaktorait. Módszer: Keresztmetszeti vizsgálat történt a 2022. augusztus–októberi időszakban. Nem véletlenszerű, kényelmi mintaválasztást követően az adatgyűjtés önkéntes alapon, az Országos Mentőszolgálat Vas vármegyei mentőállomásain (n = 70), a Magyar Légimentő Nonprofit Kft. bázisain (n = 24) és a Vízimentők Magyarországi Szakszolgálatánál (n = 25) anonim, online kérdőív segítségével zajlott. A Rövid Stressz Kérdőív (Purebl és Rózsa, 2006) mellett szociodemográfiai mutatókra, munkavégzésre, káros szenvedélyekre, sportolásra és mentálhigiénés szokásokra kérdeztünk rá. Eredmények: A minta (n = 119) stresszterhelése alacsonynak volt mondható (átlag 9,79 ± 5,38), melyet nem befolyásolt a munkavégzés színtere (p = 0,064). A legjelentősebb stresszről a földi (10,17 ± 5,57 pont), míg a legcsekélyebbről a légimentők (9,08 ± 4,86 pont) számoltak be. A „nagy fokú” és az „igen jelentős” stresszkategóriába tartozott az Országos Mentőszolgálat dolgozóinak több mint 50%-a (p = 0,987). Nagyobb stresszterhelést mutattak a nők (p = 0,008), az egyedül élők (p = 0,006) és a gyermektelenek (p<0,001). Minél több esetet látott el egy műszak alatt (p = 0,008), minél megterhelőbbnek érezte a műszakokat (p<0,001), és minél kevésbé érezte magát szakmailag felkészültnek (p<0,001) egy válaszadó, annál nagyobb volt a stresszterhelése. Következtetés: A mentésben dolgozókat érő stressz mértékében és az előforduló rizikó-magatartások tekintetében nem volt ugyan számottevő különbség földön, vízen és/vagy levegőben, az eredmények rávilágítottak, hogy a munkaterhelés mértékét tekintve a földi mentésben tevékenykedők szoros nyomon követést igényelnek a stresszterhelés és a megküzdés szempontjából. Orv Hetil. 2024; 165(23): 900–907.

Open access

A JAK2 szomatikus génmutáció lehetséges betegségmódosító hatása a cardiovascularis kórképek kialakulásában

Somatic JAK2 gene mutation is an evolving risk factor in cardiovascular diseases

Orvosi Hetilap
Authors:
Eszter Magyar
,
Anikó Újfalusi
,
Marianna Czenke
, and
Gábor Méhes

A JAK-kináz működése egyes, sejtfelszíni receptorokhoz kötött jelátviteli útvonalak központi eleme (JAK/STAT útvonal), a fiziológiás sejtaktiváció közvetítője. Közvetítő hatása a myeloid eredetű sejtekben, elsősorban macrophagokban, neutrophil granulocytákban, illetve a thrombocytákban is szükséges a nem specifikus gyulladásos reakció elindításához. A jelátviteli útvonal kóros aktivációja a krónikus myeloproliferativ neoplasiákban az egyik leggyakoribb genetikai eltérés és a fokozott myelo- és thrombopoesis egyik jól ismert ’driver’ mechanizmusa. A myeloproliferativ neoplasiák diagnosztikájához a szerzett patogén JAK2-mutációk (elsősorban a V617F variáns) kimutatása is hozzátartozik. Ismertté vált ugyanakkor, hogy a génhiba – más, ritkább eltérések mellett – akár hosszú ideig fennállhat jelentős hematológiai eltérések nélkül. Ezt az állapotot klonális haemopoesisnek nevezik. A variáns JAK2 újabb megfigyelések szerint a myeloid eredetű sejtek funkciójára ebben a helyzetben is komoly aktiváló hatást fejthet ki, és meggyőző összefüggéseket mutattak ki a gyulladásos háttérrel rendelkező cardiovascularis szövődményekkel kapcsolatosan. A klonális JAK2-eltérés, valamint az ischaemiás szívbetegség, illetve a hasi aortaaneurysma kialakulása között is jelentős összefüggések mérhetők. Mára egyértelmű, hogy az atheromaképződés és a következményes coronariasclerosis kialakulása egy komplex thromboinflammatoricus folyamat következménye, és jelentős mértékben függ többek között a JAK2 mediálta szöveti macrophag–granulocyta interakcióktól. Közleményünkben a fokozott kockázat hátterében húzódó mechanizmusokat és a rendelkezésre álló legújabb ismereteket elemezzük. Orv Hetil. 2024; 165(23): 883–890.

Open access
Journal of Behavioral Addictions
Authors:
Maja Friedemann
,
Celine A. Fox
,
Anna K. Hanlon
,
Daniel Tighe
,
Nick Yeung
, and
Claire M. Gillan

Abstract

Background and aims

Subjective confidence plays an important role in guiding behaviour, especially when objective feedback is unavailable. Systematic misjudgements in confidence can foster maladaptive behaviours and have been linked to various psychiatric disorders. In this study, we adopted a transdiagnostic approach to examine confidence biases in problem gamblers across three levels: local decision confidence, global task performance confidence, and overall self-esteem. The importance of taking a transdiagnostic perspective is increasingly recognised, as it captures the dimensional nature of psychiatric symptoms that often cut across diagnostic boundaries. Accordingly, we investigated if any observed confidence biases could be explained by transdiagnostic symptom dimensions of Anxiety-Depression and Compulsive Behaviour and Intrusive Thought. This approach allows us to gain a more comprehensive understanding of the role of metacognitive processes in problem gambling, beyond the constraints of traditional diagnostic categories.

Methods

Thirty-eight problem gamblers and 38 demographically matched control participants engaged in a gamified metacognition task and completed self-report questionnaires assessing transdiagnostic symptom dimensions.

Results

Compared to controls, problem gamblers displayed significantly elevated confidence at the local decision and global task levels, independent of their actual task performance. This elevated confidence was observed even after controlling for the heightened symptom levels of Anxiety-Depression and Compulsive Behaviour and Intrusive Thought among the problem gamblers.

Discussion

The results reveal a notable disparity in confidence levels between problem gamblers and control participants, not fully accounted for by the symptom dimensions Anxiety-Depression and Compulsive Behaviour and Intrusive Thought. This suggests the contribution of other factors, perhaps linked to gambling-specific cognitive distortions, to the observed confidence biases.

Conclusion

The findings highlight the intricate link between metacognitive confidence and psychiatric symptoms in the context of problem gambling. It underscores the need for further research into metacognitive biases, which could enhance therapeutic approaches for individuals with psychiatric conditions.

Open access

Abstract

The spread of antibiotic resistance is one of the biggest challenges of our time, making it difficult to treat bacterial diseases. Pasteurella multocida is a widespread facultative pathogenic bacterium, which causes a wide range of diseases in both mammals and birds. In the present study, antibiotic susceptibility of 155 P. multocida strains were tested using the broth microdilution method to obtain the minimum inhibitory concentration (MIC) values for 15 antibiotics. The most effective antibiotics against pasteurellosis were ceftiofur, tetracycline, doxycycline, florfenicol and tilmicosin. Of the strains, 12 proved to be multi-drug resistant (MDR). To combat antibiotic resistance, it is important to establish a pre-treatment antibiotic susceptibility profile. A well-chosen antibiotic would not only make the treatment more successful but may also slow down the spread of resistance and the evolution of MDR strains.

Open access
Journal of Behavioral Addictions
Authors:
Anna-Chiara Schaub
,
Maximilian Meyer
,
Amos Tschopp
,
Aline Wagner
,
Undine E. Lang
,
Marc Walter
,
Flora Colledge
, and
André Schmidt

Abstract

Background

Exercise dependence (ED) is characterised by behavioural and psychological symptoms that resemble those of substance use disorders. However, it remains inconclusive whether ED is accompanied by similar brain alterations as seen in substance use disorders. Therefore, we investigated brain alterations in individuals with ED and inactive control participants.

Methods

In this cross-sectional neuroimaging investigation, 29 individuals with ED as assessed with the Exercise Dependence Scale (EDS) and 28 inactive control participants (max one hour exercising per week) underwent structural and functional resting-state magnetic resonance imaging (MRI). Group differences were explored using voxel-based morphometry and functional connectivity analyses. Analyses were restricted to the striatum, amygdala, and inferior frontal gyrus (IFG). Exploratory analyses tested whether relationships between brain structure and function were differently related to EDS subscales among groups.

Results

No structural differences were found between the two groups. However, right IFG and bilateral putamen volumes were differently related to the EDS subscales “time” and “tolerance”, respectively, between the two groups. Resting-state functional connectivity was increased from right IFG to right superior parietal lobule in individuals with ED compared to inactive control participants. Furthermore, functional connectivity of the angular gyrus to the left IFG and bilateral caudate showed divergent relationships to the EDS subscale “tolerance” among groups.

Discussion

The findings suggest that ED may be accompanied by alterations in cognition-related brain structures, but also functional changes that may drive compulsive habitual behaviour. Further prospective studies are needed to disentangle beneficial and detrimental brain effects of ED.

Open access

Abstract

Carbapenem-resistant Enterobacterales (CRE) have become a major public health problem worldwide. The aim of this study was to investigate efficacy of ceftazidime/avibactam and plazomicin on carbapenem-resistant Klebsiella pneumoniae and Escherichia coli isolates. Susceptibility of imipenem, meropenem, ertapenem, ceftazidime/avibactam and plazomicin was investigated by broth-microdilution method. Major carbapenemases NDM, VIM, IMP, KPC, OXA-48 as well as other β-lactamases namely, TEM, SHV, OXA-1-like, CTX-M, ACC, FOX, MOX, DHA, CIT, EBC, VEB, GES, PER were investigated by PCR. A total of 120 carbapenem-resistant isolates (60 E. coli and 60 K. pneumoniae) were included in this study and bla OXA-48-like was found in 78.33%, bla NDM in 26.66%, bla KPC in 7.5%, bla IMP in 5.83%, and bla VIM in 5%. Among 94 isolates with the bla OXA-48-like gene, 22.3% were resistant to ceftazidime/avibactam and 51.1% were resistant to plazomicin. Of 32 isolates with bla NDM, 31 (96.9%) were resistant to ceftazidime/avibactam and 30 (93.75%) were resistant to plazomicin, and both antibiotics had limited effects against bla NDM carriers (P < 0.001). Of the 12 isolates with bla NDM+OXA-48 combination, 11 (91.7%) were resistant to ceftazidime/avibactam and plazomicin. The effect of both antibiotics was significantly lower in strains with bla NDM+OXA-48 combination (P < 0.005).

The most common carbapenemase genes in this study were bla OXA-48-like and bla NDM. Ceftazidime/avibactam demonstrated a good efficacy among OXA-48 producing K. pneumoniae and E. coli, however, plazomicin had a significantly lower antibacterial effect in our study. Both antimicrobial agents should be considered as an option by evaluating combined susceptibility results and gene patterns obtained by regional and global molecular data in the treatment of CRE infections.

Restricted access
Acta Microbiologica et Immunologica Hungarica
Authors:
Nadia El mrimar
,
El Mehdi Belouad
,
Elmostafa Benaissa
,
Fatna Bssaibis
,
Mohammed Jazouli
,
My abdelaziz El alaoui
,
Adil Maleb
, and
Mostafa Elouennass

Abstract

The rate of pandrug-resistant Acinetobacter baumannii strains is on the rise in all continents. This bacterium can acquire resistance to all antibiotics, even to colistin. Alterations in the lipid A or/and the two-component pmrAB were earlier detected in colistin resistance. We investigated and analyzed two strains of A. baumannii (ABRC1 and ABRC2) isolated from two patients admitted to intensive care unit with a septic shock. Both strains were resistant to all tested antibiotics including colistin with a MIC >256 mg L−1. Colistin resistance genes (pmrA, pmrB, lpxA, lpxC, lpxD, and lpsB) of two strains (ABRC1 and ABRC2) were investigated by PCR and sequencing. Obtained nucleic acid sequences were aligned with reference sequences of ATCC 19606 and 17987. In this study two amino acid mutations, N287D in the lpxC gene and E117K in the lpxD gene, were detected in both ABRC1 and ABRC2 strains. ABRC1 had an additional H200L mutation in the pmrA gene. Both colistin resistant strains harbored the same A138T mutation in the pmrB gene. The ABRC2 strain also had an alteration in the kinase domain, specifically an R263S substitution of the histidine kinase domain. Three identical mutations were found in the lpsB gene of both A. baumannii strains: Q216K + H218G + S219E. As a result, a newly deduced protein sequence in both ABRC1 and ABRC2 strains differed from those described in ATCC 17978 and 19606 strains was determined. Colistin resistance is multifactorial in A. baumannii. In our study we detected novel mutations in colistin resistant A. baumannii clinical isolates.

Restricted access

Abstract

Despite growing interest in psychedelic-assisted therapy (PAT) research, there remains a lack of consensus about key issues relevant to difficulties in predicting acute drug effects, and the role of therapeutic support in clinical trials. In the absence of a clear theoretical model to conceptualize multifaceted components in PAT research, dialogue across contexts (e.g., popular media, peer reviewed journals, conference settings) is becoming increasingly polarized and siloed. This has even contributed to somewhat unusual recommendations by the FDA and others that removing critical aspects of psychological and medical safety could enhance our ability to investigate the impact of these drugs on clinical outcomes. Considering the importance of determining and maximizing safety in ongoing PAT research, this commentary suggests that an ecological systems theory (EST) approach provides a structure to make contextual and practical factors a more explicit and testable component of research. Utilizing systems theory and Bronfenbrenner’s EST approach adapted for healthcare settings, we propose that a more detailed conceptual model in PAT research would enable more explicit consideration of contextual factors informing and influencing outcomes. This commentary is accompanied by a custom figure that illustrates application of this model for psychedelic research and highlights the limitations of current measurement of acute subjective experience.

Open access
Journal of Behavioral Addictions
Authors:
Nirav Saini
,
Cam Adair
,
Daniel L. King
,
Daria J. Kuss
,
Douglas A. Gentile
,
Hyoun S. Kim
,
Jeremy Edge
,
Joël Billieux
,
John Ng
,
Juliana P. S. Yun
,
Lisa Henkel
,
Linda Faulcon
,
Michelle Nogueira
,
Rune K. L. Nielsen
,
Shannon Husk
,
Shawn Rumble
,
Trey R. Becker
,
Zsolt Demetrovics
, and
David C. Hodgins

Abstract

Background and Objectives

As the gaming industry experiences exponential growth, concerns about gaming disorder (GD) also grow. It is crucial to understand the structural features of games that can interact with individual characteristics of gamers to promote GD. This research consolidates the views of an international body of panelists to create an assessment tool for gauging the addictive potential of distinct games.

Methods

Utilizing the iterative and structured Delphi method, an international panel of researchers, clinicians, and people with lived experience were recruited to offer a multifaceted viewpoint on the addictive risk associated with specific structural elements in games. Two rounds of surveys facilitated consensus.

Results

The panel initially included 40 members—ten from research, eight from clinical settings, and 22 with lived experiences. The second round included 27 panelists—seven from research, eight from clinical settings, and 11 with lived experiences. The study identified 25 structural features that contribute to potentially addictive gaming patterns.

Discussion and Conclusions

Consensus was found for 25 features, which were distilled into a 23-item evaluation tool. The Saini-Hodgins Addiction Risk Potential of Games Scale (SHARP-G) consists of five overarching categories: ‘Social,’ ‘Gambling-Like Features,’ ‘Personal Investment,’ ‘Accessibility,’ and ‘World Design.’ SHARP-G yields a total score indicating level of addiction risk. A case study applying the scale to three games of differing perceived risk levels demonstrated that that score corresponded to game risk as expected. While the SHARP-G scale requires further validation, it provides significant promise for evaluating gaming experiences and products.

Open access

A diffúz nagy B-sejtes limfóma osztályozása és kezelési lehetőségei

Classification and Treatment of Diffuse Large B-Cell Lymphoma

Hematológia–Transzfuziológia
Authors:
Lajos Gergely
and
Zsolt Nagy

A diffúz nagy B-sejtes limfóma (DLBCL) a leggyakoribb agresszív non-Hodgkin limfóma. Az első vonali kezelésre nem reagáló vagy visszaeső betegek (r/r DLBCL) nagy kihívás a kezelőorvos számára. A betegséget ma a WHO2022 felosztás alapján csoportosítjuk, és rendelkezésre állnak génexpressziós profil és újgenericáiós szekvenálás (NGS) alapú felosztások, melyek segítenek az egyes esetek pontos karakterizálásában. Az első vonali kezelésben közel 20 év után a polatuzumab-vedotin alkalmazása hozta az első pozitív eredményt, több mint 6%-kal növelve a hatást. Az r/r DLBCL kezelésében forradalom ment végbe, számos CAR-T-kezelés (axi-cel, liso-cel, tisa-cel) érhető el már 2. vonaltól. Az elért eredmények lényegesen jobbak, mint eddig bármi más kezeléssel. A bispecifikus antitestek (glofitamab, epcoritamab) alkalmazásával 3. vonaltól szintén nagyon kedvező hatást tudunk elérni, úgy, hogy a kezelést bármely hematológiai kezelő centrum tudja alkalmazni. Idősebb betegeken nagyon hatásos és biztonságos a loncastuximab-teserine monoterápia, mely szignifikánsan meg tudja nyújtani ezen betegek túlélést. A tafasitamab+lenalidomid kombináció alkalmazása is jelentősen kedvezőbb eredményt adott, mint a korábbi salvage kezelések.

A cikkben a szerzők igyekeznek összefoglalni mindezen újdonságokat, segítve az olvasót, hogy tájékozódni tudjon a DLBCL kezelésében elérhető legújabb kezelések között.

Open access