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
Objective
The association between depression and gambling disorder (GD) has been well-researched. However, prior research lacks consensus on the temporal association between depression and GD. Furthermore, the extant literature has not explored the nature of the aforementioned relationship using objective research methodology data and large-scale samples. The present study addressed these research gaps by investigating the longitudinal relationship between antidepressant prescriptions and the likelihood of developing GD using registry data over a period of 11 years (2008–2018).
Methods
Data were derived from the Norwegian Patient Registry (NPR) that was matched with data from the Norwegian Prescription Registry (NorPD). The dataset comprised 27,420 individuals, where 5,131 were diagnosed with GD. A binary logistic regression analysis was conducted where individuals with GD were compared with 22,289 individuals matched on age and gender from NPR.
Results
The results show that individuals with antidepressant prescriptions had higher odds of developing GD (OR = 2.80, 95% CI: 2.60–3.01, p < 0.001). Furthermore, males and older adults were found to have a higher likelihood of being diagnosed with GD.
Conclusions
Depression is known to be one of the most common mental health disorders. The findings show that prior antidepressant prescription is associated with GD, which would be in accordance with the escape hypothesis because some individuals gamble to escape dysphoric feelings, such as depression. The study findings add to the existing knowledge on the temporal association of depression and GD. Furthermore, the results also have significant practical implications.
Abstract
Background and aims
The Moral Incongruence Model of Pornography Use proposes that pornography-use-related problems may be present due to problematic pornography use (PPU) and/or moral disapproval (MD) of pornography use. Despite some supporting empirical evidence, no study has tested the presence of different pornography-use profiles based on individuals' behavioral dysregulation (i.e., PPU) and moral values concerning pornography use. The generalizability of previous findings to diverse populations has also been limited given the scarcity of studies conducted outside of Western countries.
Methods
Using data from the International Sex Survey (42 countries, N = 66,994; M age = 32.16 years, SD = 12.27), we conducted latent profile analysis to identify pornography-use profiles based on individuals' frequency of use, MD, and PPU. The profiles were compared along a wide range of pornography-use-related, sexuality-related, and psychological correlates.
Results
Six pornography-use profiles were identified, including two increased risk groups (i.e., Increased risk of PPU without MD and Increased risk of PPU with some MD). Several factors differentiated between the increased risk vs. no/low risk profiles (e.g., relatedness satisfaction) as well as between the two increased risk profiles (e.g., religiosity). Apart from behavioral dysregulation, moral values concerning pornography use played an important role in distinguishing pornography-use profiles and demonstrated the importance of inquiring about MD when working with individuals with pornography-use-related problems.
Conclusion
Findings also support recent calls for better-integrated sex therapy and sexual medicine perspectives into pornography-use-related problems research and care.
Abstract
Background and aims
Despite a growing body of research on pornography use among women, there is a lack of understanding of the problematic versus non-problematic nature. The current study aimed to investigate the relationship between women's motivations for pornography use and sexual wellbeing using a cross-sectional, self-report survey design among participants from 42 countries.
Methods
The total sample included 82,243 participants, of whom 46,874 (57.0%) identified as women and were analyzed. The participants' age averaged at M = 29.67 years, with a standard deviation of SD = 10.11. Participants were asked to complete a questionnaire assessing their motivations for pornography use, as well as measures of sexual functioning, sexual desire, and sexual satisfaction.
Results
Study results suggest that across cultures, women's motivations for pornography use are associated with their sexual wellbeing. Specifically, when women reported using pornography for their own pleasure or sexual curiosity, it was associated with fewer sexual functioning problems and higher sexual desire. Conversely, when women reported using pornography due to a lack of sexual satisfaction in their relationships, it was associated with more sexual functioning problems.
Discussion and conclusions
These findings highlight the need to consider the multifaceted nature of pornography use among women, including the usage motives, to fully understand associations with sexual wellbeing. Additionally, the study emphasizes the importance of conducting further research utilizing longitudinal designs, to establish the directionality between pornography use motivations and sexual wellbeing among women.
Abstract
Background and Aims
Nasal congestion is a prevalent symptom often alleviated with over-the-counter nasal sprays containing decongestants. Rhinitis medicamentosa (RM), caused by the overuse of decongestants leading to recurrent mucosal swelling, poses a significant challenge for specialists in managing patients. Despite advancements in understanding, research primarily consists of case series with limited data on its impact on quality of life. This qualitative study aimed to explore the effect of nasal spray overuse on quality of life and identify addiction components among individuals with RM.
Methods
Twenty participants with RM were interviewed by an otorhinolaryngologist and addiction counsellor. The study employed a qualitative approach utilising directed content analysis and revealed eleven categories, classified into addiction components and distinctive features of nasal spray addiction.
Results
The analysis revealed the presence of all Griffiths' addiction components in the identified themes. Additionally, sleep disorders, the feeling of suffocation, side effects, illness identity and psychological effects on nasal congestion significantly impair individuals' quality of life.
Conclusion
This qualitative study identified key components of addiction in nasal spray overuse and suggested that RM might be conceptualised in the DSM-5 category of “Other (or Unknown) Substance-Related Disorders”, considering the lack of psychoactive effects. Nevertheless, in view of the current findings, it also seems to be plausible to examine the phenomenon in the behavioural addiction framework. The study underscores the need for further research and intervention strategies to address the significant impact of RM on individuals' quality of life.
Abstract
Background and aims
Adolescent problematic gaming is a global public health issue, and is associated with numerous negative outcomes. The Big Two personality traits, neuroticism and extraversion, have been identified as significant predictors of problematic gaming in adolescents. However, most previous studies have been cross-sectional, limiting the ability to explore their mutual influences or causality inference. This study addresses this gap by employing a longitudinal design and utilizing the Random Intercept Cross-Lagged Panel Model (RI-CLPM) to examine the bidirectional relations between the Big Two personality traits and problematic gaming at the within-person level.
Methods
This study included 3,307 students (Mean age = 11.30, SD = 0.48, 43.6% being girls). Participants were assessed annually, completing a total of four assessments over the course of the study.
Results
The RI-CLPM analyses revealed that neuroticism and problematic gaming significantly predict each other. Extraversion acts as a protective factor against adolescent problematic gaming, whereas problematic gaming leads to a decrease in extraversion levels. Additionally, the longitudinal relations between neuroticism and problematic gaming exhibit significant sex differences.
Discussion and conclusions
This study provides insights into the interplay between the Big Two personality traits and problematic gaming in adolescents. These findings emphasize the need for prevention and intervention strategies that address personality traits as risk factors while recognizing how problematic gaming can influence personality, promoting a more holistic approach. The observed sex differences highlight the importance of integrating sex-specific considerations in interventions.
Abstract
Background
Sonographic risk patterns identified in established risk stratification systems (RSS) may not accurately stratify follicular carcinoma from adenoma, which share many similar US characteristics. The purpose of this study is to investigate the performance of a multimodal machine learning model utilizing radiomics and topological data analysis (TDA) to predict malignancy in follicular thyroid neoplasms on ultrasound.
Patients & Methods
This is a retrospective study of patients who underwent thyroidectomy with pathology confirmed follicular adenoma or carcinoma at a single academic medical center between 2010 and 2022. Features derived from radiomics and TDA were calculated from processed ultrasound images and high-dimensional features in each modality were projected onto their first two principal components. Logistic regression with L2 penalty was used to predict malignancy and performance was evaluated using leave-one-out cross-validation and area under the curve (AUC).
Results
Patients with follicular adenomas (n = 7) and follicular carcinomas (n = 11) with available imaging were included. The best multimodal model achieved an AUC of 0.88 (95% CI: [0.85, 1]), whereas the best radiomics model achieved an AUC of 0.68 (95% CI: [0.61, 0.84]).
Conclusions
We demonstrate that inclusion of topological features yields strong improvement over radiomics-based features alone in the prediction of follicular carcinoma on ultrasound. Despite low volume data, the TDA features explicitly capture shape information that likely augments performance of the multimodal machine learning model. This approach suggests that a quantitative based US RSS may contribute to the preoperative prediction of follicular carcinoma.
Abstract
This study aimed the identification of anaerobic bacteria isolated from blood cultures and the determination of antibacterial susceptibility of the isolates. The study material comprised of 5,282 blood samples taken between 2018 and 2020. The samples were incubated in a BacT/ALERT system. The species identification of the isolates was performed by three methods namely, BBL Crystal Anaerobe system, matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS), and 16S rRNA gene sequence analysis. Antibacterial susceptibility testing was performed using the disk diffusion method with benzylpenicillin, clindamycin, piperacillin-tazobactam, meropenem, and metronidazole disks. In the BacT/ALERT system, 45 anaerobic bacterial isolates were recovered from 39 (0.74%) of the samples that showed growth signs in blood culture bottles. The BBL Crystal Anaerobe system and 16S rRNA gene sequence analyses enabled the genus and species identification of all 45 isolates (100%), whereas with MALDI-TOF MS, only 37 (82.2%) of the isolates were able to be identified. Antibacterial resistance rates of the isolates to piperacillin/tazobactam, clindamycin, benzylpenicillin, meropenem, and metronidazole were detected as 100%, 73.8%, 40%, 9.8%, and 5.5%, respectively. MALDI-TOF MS showed a higher level of compatibility with 16S rRNA gene sequence analyses, compared to the BBL Crystal Anaerobe system. The high rates of susceptibility to meropenem and metronidazole suggested that these antibiotics are options for the empirical treatment of anaerobic bacterial infections.
Epidurolysis – egy régi-új eljárás
Epidurolysis – an old-new procedure
Epidural adhesions may be caused by inflammation of the surrounding spinal canal, disc degeneration (nucleus pulposus entering the epidural space as a result of damage to the disc), or scarring following spinal surgery (failed back surgery). The roots become stuck due to adhesions, which hinder their mobility. Furthermore, the richly innervated posterior longitudinal ligament and the dura mater are inhibited from “sliding” on each other. These patients develop chronic radicular and/or low back pain. The range of conservative treatments available is often limited, and the quality of life of patients is frequently impaired by severe pain and neurological deficits. Our goal is to introduce a cost-effective, minimally invasive therapeutic option in Hungarian public hospitals which can serve as a long-term solution for the treatment of the above-mentioned medical conditions. In our case report, we present epidurolysis as an innovative therapeutic option, which can be effectively used in the treatment of epidural adhesions. The 71-year-old lady underwent LIV–V flavotomy and discectomy in 2019. However, despite this intervention, the excruciating pain radiating to the left lower limb persisted. Based on the subsequent MRI of the lumbar spine and the physical examination, scarring was assumed around the previous surgical area, so lumbar epidurolysis was performed according to the one-day protocol. The patient reported a notable reduction in pain levels both immediately following the intervention and at the 6-week follow-up, with no requirement for the use of painkillers. The rationale for epidurolysis in postlaminectomy syndrome is level I evidence, and for the treatment of spinal pain due to disc herniation and spinal canal stenosis with or without radicular pain is level II evidence. Epidurolysis is a highly effective, safe and cost-effective procedure in experienced hands, especially when its social effects are taken into account. Orv Hetil. 2025; 166(6): 234–240.
Három intézet összefogása a központi régió magas színvonalú mellkassebészeti ellátásának érdekében
The cooperation between three institutions in favor of high-standard thoracic surgical care in the central region of Hungary
The cooperation between the Thoracic Surgery Department of the National Institute of Oncology, the Thoracic Surgery Clinic of the Semmelweis University, and the Thoracic Surgery Unit of the National Korányi Institute of Pulmonology shows an exemplary partnership. This cooperation includes patient care, education, and research, with some overlap in human resources. Robotic surgeries, lung transplants, and other oncological operations are carried out at the National Institute of Oncology, where thoracic surgery education for medical students is also provided in collaboration with Semmelweis University. The Semmelweis Thoracic Surgery Clinic’s research facility is located within the territory of the National Korányi Institute of Pulmonology. In addition to elective oncological surgeries, the Korányi Institute offers around-the-clock acute thoracic surgical care and manages thoracic trauma. During postgraduate education, residents rotate through each of the three units, allowing them to gain experience in various operations. This partnership does not establish a new entity but reflects a sensible cooperation of three independent organizations, collectively referred to as the Thoracic Center in this paper. This overview focuses on the surgical and scientific work at the Thoracic Center, emphasizing available surgical methods, minimally invasive procedures, and international collaborations. Each year, we conduct over 2,000 surgeries, including approximately 650–700 anatomical resections, 15–20 lung transplants, and numerous robot-assisted operations, which program started in 2023. The use of minimally invasive techniques has been on the rise, and by implementing advanced practices, we have decreased complication rates and reduced average hospital stays. Overall, the Thoracic Center has achieved international praise in thoracic surgery, committed to the ongoing and comprehensive enhancement of its services. By offering a complete range of care, we maintain a competitive edge in surgical, research, and educational aspects of our work. Orv Hetil. 2025; 166(6): 203–209.
Kis méretű insulinoma lokalizálása 68Ga-exendin-PET
CT segítségével/Localization of a small insulinoma with the aid of 68Ga-exendin PET/CT
The hyperinsulinemic hypoglycemic syndrome is typically caused by insulinoma, a neuroendocrine tumor of the pancreas. Beyond the diagnosis, the most difficult part is the accurate localization of the tumor, which is essential to the curative surgical therapy. A 36-year-old woman with several episodes of loss of consciousness was diagnosed with endogenous hyperinsulinemia causing hypoglycemia. The MRI raised the possibility of a 5-mm lesion in the tail of the pancreas, however, neither the CT, nor the endoscopic ultrasound was able to confirm it. The somatostatin-receptor scintigraphy was also negative. The 68Ga-exendin PET/CT showed tracer enhancement in the tail of the pancreas in the same region as in the MRI. Based on these results, a distal pancreas resection was made. After the surgery, the hypoglycemic episodes of the patient disappeared and histology confirmed the diagnosis. Conventional imaging techniques are often not sensitive enough for the localization of insulinoma, mostly in cases of small, hypovascularized tumors. Somatostatine-receptor targeted modalities which are widely used in the imaging of neuroendocrine tumors could be negative because of the lower expression of somatostatine receptors. In our case, the novel, functional imaging 68Ga-exendin PET/CT was efficiently used, which can localize insulinomas with high sensitivity. Orv Hetil. 2025; 166(6): 228–233.
A nem bináris nemi hovatartozás orvosi megítélésének szakirodalmi áttekintése
Review of medical perception of non-binary and transgender continuum
The physical and mental health of transgender and non-binary persons is a poorly researched area in our country. Diagnostic tools and awareness are limited, which makes the hidden client group particularly vulnerable. According to the International Classification of Diseases (ICD-11), ’gender incongruence’ is a permanent and significant discrepancy between the person’s lived and physical appearance. The lack of consistency alone does not indicate a diagnosis, but the more frequent occurrence of mental health difficulties and self-harming behavior justifies medical care in everyday general practice. Orv Hetil. 2025; 166(6): 210–218.
Robotasszisztált rádiófrekvenciás ablatio által létrehozott laesiók közbeni impedanciaesés vizsgálata
Investigation of impedance drop during lesions created by robot-assisted radiofrequency ablation
Introduction: The efficiency and safety of radiofrequency catheter ablation can be further improved using robotics. We can employ the objective data provided by the related sensors during the intervention. Objective: The aim of our research was to develop and implement a custom robotic measurement platform to investigate sensor-controlled ablation processes during in vitro experiments, ensuring stable catheter positioning. We then observed the impedance drop during lesion formation under varying temperature settings and ablation durations while maintaining a constant contact force. Method: Our experiments were carried out with a custom-developed equipment. The sizes of the lesions formed under different temperatures (60, 65, 70 °C) and ablation times (10, 20, 30 seconds) were investigated. Porcine heart tissue samples were ablated, creating a total of 186 lesions. After treatment, impedance drop were measured. A multivariate linear regression model was used to examine the effect of temperature and ablation duration on lesion impedance drop. Results: A robot-assisted radiofrequency ablation assisting in vitro device was set up using a proprietary designed and manufactured contact force measurement device. Our experiments have successfully generated accurate and repeatable ablation patterns, producing consistent and reliable results. The results of the multivariable regression analysis demonstrated that a temperature of 65 °C, compared to 60 °C, independently resulted in a 3.6 Ω reduction in impedance (95% confidence interval: –5.9 to –1.3; p = 0.026). Additionally, prolongation of the ablation duration had a significant impact on the decrease in impedance; for instance, at 20 seconds, the impedance value decreased by 4.1 Ω (95% confidence interval: –6.5 to –1.8; p = 0.0006). Conclusion: Robot-assisted ablation can significantly improve the precision and reproducibility of procedures, especially in in vitro experiments on porcine tissues. By setting optimal temperature and duration parameters, unwanted tissue damage can be minimised. Our observations indicate that higher temperatures result in a significantly greater reduction in impedance, and increasing the duration of ablation also significantly enhances the extent of impedance decrease. Orv Hetil. 2025; 166(6): 219–227.
Abstract
Background and aims
Exercise addiction in adults is increasingly recognized as a public health concern, carrying potentially harmful physical, psychological, and social consequences. Body image—encompassing cognitive, behavioral, affective, and perceptual elements—may be a key factor in this risk, yet comprehensive evidence remains scarce. This systematic review and meta-analysis aimed to (1) evaluate the overall relationship between multidimensional body image and the risk of exercise addiction in adults, and (2) identify key moderators (e.g., different elements of body image, gender, region).
Methods
A systematic search was conducted in PsycINFO, Medline, SPORT Discus, Web of Science, and Embase up to October 22, 2024. A three-level meta-analysis model was employed, and univariate and multivariate meta-regressions were used to explore potential moderating factors.
Results
A total of 38 eligible studies were identified, contributing 65 effect sizes. The meta-analysis revealed a moderate correlation (r = 0.26) between body image and risk of exercise addiction in adults. Moreover, the cognitive component of body image and the use of compulsive exercise measures in addiction assessments emerged as unique moderators, each further strengthening the observed relationship.
Discussion and conclusions
These findings underscore the central role of body image—particularly its cognitive dimension—in shaping the risk of exercise addiction in adults, especially when assessed via compulsive exercise measures. Incorporating these insights into research and practice may guide more effective interventions and improve public health strategies aimed at mitigating harmful exercise behaviors.
Abstract
Background and aims
Smartphones have been so widely adopted that many consider them essential for modern life. However, some people use their phone excessively, which can cause functional impairment or harm, termed problematic smartphone use (PSU). Smartphone use motives may help explain why users engage in general smartphone use and PSU, but existing measures may not capture certain motives which research suggests are important to smartphone use. To address this, across two studies, we constructed and validated a Motives for Smartphone Use Questionnaire (MSUQ) among young adults.
Methods and results
In Study 1, the Delphi method was used, whereby engagement with a panel of 23 international academic experts resulted in a pool of 62 smartphone use motives items that measure 11 proposed motives. In Study 2, the 62 items were administered to 680 young adults aged 18–25 years (M age = 22.50, SD = 2.16). Results from exploratory and confirmatory factor analyses found that the MSUQ has a seven-factor structure, assessing smartphone use to cope, pass time, socialize, obtain social comfort, feel safe, fulfil social obligations, and seek information. These motives differentially influenced PSU and smartphone usage.
Conclusions
The MSUQ is a valid measure of motives for smartphone use. It was developed specifically for smartphone use and it includes motives not captured in prior measures.
Abstract
Background and aims
Emotion dysregulation has been suggested to play a role in gambling-related harm, but past gambling research has typically assessed emotion dysregulation via self-report surveys rather than in a gambling context. Here, we sought to investigate how the severity of participants' hazardous gambling behavior was associated with their emotional reactivity and choice behavior within a simulated slot-machine task.
Methods
Participants (N = 100) recruited via Prolific completed a behavioral task involving repeated choices between two simulated slot-machines. When chosen, slot-machines could produce one of five outcome types (win/near-win/neutral/near-loss/loss). After each outcome, participants reported their subjective emotional valence. Emotion data were analysed using a beta-autoregressive computational model, allowing us to extract per-participant estimates of trial-by-trial emotional reactivity to different slot-machine outcomes.
Results
Correlation analyses revealed that people who engaged in more hazardous gambling behavior (higher PGSI scores) showed greater emotional reactivity to all slot-machine outcome types (all Spearman ρ > |0.31|, all p < 0.01, corrected for multiple comparisons). There were no significant associations between patterns of choice behavior and PGSI scores.
Discussion and conclusions
Within a simulated slot-machine task, individuals who engaged in more hazardous gambling behavior showed greater emotional reactivity in general (more positive emotional reactions to wins and more negative emotional reactions to unpleasant events such as losses and near-wins). These results are consistent with a model in which emotion dysregulation is a risk factor for gambling-related harm, and serve to validate this model in a more naturalistic setting.
Abstract
Objective
Hallucinogen Persistent Perception Disorder (HPPD) is a condition where the effects of hallucinogenic drugs reoccur long after the acute effects have stopped. No established risk factors or mechanisms for HPPD have been identified. However, reports have suggested a risk phenotype for HPPD due to associations with other perceptual disturbances. With recent increases in therapeutic psychedelic drug use, it is essential to consider the existence of HPPD risk factors. Therefore, exploring potential links between HPPD and other perceptual disturbances, such as tinnitus and migraine with aura, is a necessary first step. This study aimed to investigate the association between HPPD and other perceptual disorders.
Methods
One hundred thirty-eight individuals with HPPD and 116 controls participated in a survey assessing the prevalence of various perceptual disturbances: photosensitivity, phonosensitivity, tinnitus, migraine with aura, vertigo, paraesthesia, and synaesthesia.
Results
The survey results showed a significant association between HPPD and photosensitivity (OR = 10.65), phonosensitivity (OR = 8.00), and the number of perceptual disturbances (OR = 1.59) in the HPPD group compared to the control group. The study also observed trends of dual prevalence between HPPD and tinnitus, migraine with aura, vertigo, paraesthesia, and synaesthesia. Participants with both HPPD and other perceptual disturbances were likelier to experience additional perceptual disturbances after the onset of HPPD.
Conclusions
These findings suggest a common vulnerability or pathophysiological mechanism among these perceptual disturbances. Given the increasing therapeutic use of hallucinogens, the results of this study provide essential considerations for HPPD risk profiles. Moreover, they may guide future investigations into HPPD's pathophysiology and management options.
Abstract
[68Ga]Ga-PSMA-11 PET/CT (Gallium prostate-specific membrane antigen positron emission tomography/computed tomography) is an established molecular imaging technique for identifying the spread of prostate cancer in patients with biochemical recurrence (BCR) and for initial staging. Penile metastases from prostate cancer are very rare and can be easily misdiagnosed as noncancerous nodules as part of Peyronie's disease. Most cases of penile metastases occur in patients with disseminated disease and are typically diagnosed at advanced stages. In this case, a 74-year-old patient with prostate cancer underwent a successful prostatectomy, ADT, and radiation therapy to the prostate bed, achieving a PSAnadir of 0.01 ng mL−1. Three and a half years after surgery, biochemical recurrence occurred, and the patient was referred to our clinic for a [68Ga]Ga-PSMA-11 PET/CT scan. PET/CT revealed pathological PSMA expression in a proximal part of the penile root, later confirmed by pathohistological analysis as prostate cancer metastasis. Notably, our patient had a PSA value of only 0.53 ng mL−1, one of the lowest serum PSA values reported in the literature for penile metastasis. This case underscores the critical role of [68Ga]Ga-PSMA-11 PET/CT in differentiating benign conditions like Peyronie's disease from metastatic lesions and in detecting rare and unusual metastatic sites.
Abstract
Physical activity can provide health benefits if done regularly and of sufficient duration and intensity. The World Health Organization recommends adults do 150–300 min of moderate-intensity activity per week, 75–150 min of vigorous-intensity activity, or an equivalent combination.
Physical inactivity is the fourth leading cause of early death globally, with 31% of the world's population not getting enough physical activity. Aging is defined by rapid decline in physical activity, loss of mobility, and premature morbidity.
Low testosterone levels in men decline from 30 to 40 years of age, and this continues until death. Antiaging strategies, such as caloric restriction, balanced diet, regular exercise, weight management, diabetes control, and smoking cessation can prevent and treat aging-related diseases. Exercise significantly boosts testosterone production, with levels varying based on type, frequency, volume, intensity, and duration. It increases muscle steroidogenesis, total testosterone, and free testosterone in the elderly. Testosterone replacement therapy in elderly men improves physical function, strength, protein synthesis, cholesterol, bone density, sexual desire, erectile function, and overall cognition. However, some studies suggest dehydroepiandrosterone supplementation may provide health improvements without negative effects, potentially reversing arterial aging and reducing the risk of cardiovascular diseases. Senolytic therapeutics focus on cellular senescence, and stem cell transplantation investigates the therapeutic potential of older stem cells.
Abstract
The study was conducted in the microbiology laboratory of the First Affiliated Hospital of Hainan Medical University, Haikou, China, from January 2019 to December 2023. A total of 316 consecutive non-duplicate isolates were collected and identified, that belonged to the Bacteroides fragilis group. Identification of the isolated strains was performed by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The minimum inhibitory concentration (MIC) of seven antibiotics was determined by agar dilution method. The presence of cfiA, ermF, and nim genes was determined by polymerase chain reaction (PCR). Correlations between the presence of resistance genes and the MIC values of antibiotics were determined using the Pearson correlation coefficient. In the identification process, 214 isolates (67.7%) were identified as B. fragilis, 52 (16.4%) as Bacteroides thetaiotaomicron, 17 (5.4%) as Bacteroides ovatus, 12 (3.8%) as Bacteroides uniformis, 10 (3.2%) as Phocaeicola vulgatus (=Bacteroides vulgatus), 7 (2.2%) as Bacteroides stercoris, and 4 (1.3%) as Parabacteroides distasonis. The presence of cfiA gene moderately correlated with the MIC of imipenem and meropenem (r = 0.34 and r = 0.42, respectively), while resistance to clindamycin and the presence of ermF gene exhibited a very strong correlation (r = 0.72). In the current study, the most active antimicrobial agents against B. fragilis group bacteria were found to be meropenem, imipenem, metronidazole, and piperacillin/tazobactam; however, resistance to clindamycin renders its empirical use inappropriate.
Abstract
Background and Aims
Networks of so-called underground, or illegal, psilocybin mushroom practitioners are popularly known to exist, though few systematic investigations of their practices have been conducted. We sought to uncover the experiences of a hidden community of psilocybin practitioners in order to inform scientific and policy dialogues about safe and effective practices in this area.
Methods
An academic-community partnered research team used snowball sampling to recruit 17 underground psilocybin practitioners in a western U.S. state for in-depth individual interviews focused on training, protocols, practices, and policy priorities. Combined deductive and inductive analysis with three independent coders was completed using NVivo v12.
Results
Practitioners were white (76.5%), female-identified (64.7%), aged 31 to 50 (64.7%), non-therapists by training (58.8%), and moderately to highly experienced facilitators. All described multiple years of often difficult personal inner-directed work with psilocybin before guiding others. Benefits ranged from reduction in symptoms of depression, obsessive-compulsive disorder, and addictions to greater self-knowledge, reduced death anxiety, and a greater ability to experience joy. Client screening protocols revealed precautions for persons with severe trauma backgrounds, personality disorders, or lacking social support. Moving too quickly into a high dose mushroom session without adequate preparation or internal resourcing was perceived as a significant risk for harm. Practitioners' direct personal relationship with mushrooms was highlighted as critical to safe practice. Policy priorities centered on respectful reciprocity, defined as an ethos of giving back rather than extraction, and equitable access.
Conclusions
While some psychedelic research actively examines the role of the mystical-type experience in clients' positive outcomes, findings from underground practitioners suggest an even greater role of mysticism, relationality, and expanded concepts of holistic healing that can inform the development of best practice paradigms of an emerging profession.
Abstract
Thoracoabdominal aneurysms with extent I and II usually represent a challenge for endovascular aortic repair, given the absent proximal landing zone for a standard thoracic endovascular aortic repair. We report a successful endovascular treatment of such an aneurysm with a staged complex repair incorporating a total of eight branches, without the need of a surgical bypass.
Abstract
A longstanding challenge in the behavioral addictions field has been determining the point at which gaming involvement becomes clinically significant problematic use. Gaming disorder (GD) and hazardous gaming as recent ICD-11 diagnoses have attracted polarized perspectives due in part to the global popularity of recreational gaming and gaming culture. The broad continuum of gaming can often be perceived differently by different parties, including gamers themselves; what might be seen as regular, harmless, and normative to some, may be considered risky and problematic by others. The ICD-11 guidelines provide some clarity by advising that gaming disorder should not be diagnosed based on persistent gaming alone; that gaming as part of a routine, developing skills, changing mood or relieving boredom, or facilitating social interaction is not sufficient for a diagnosis; and that cultural and peer group norms should be considered in diagnosis. In this paper, we examine gaming normality-disorder boundary issues in the areas of conceptualization, assessment, and interventions. Some examples of the complex personal, social, and cultural considerations that arise in gaming diagnoses are provided. We call for researchers in the addiction and health disciplines to grapple with conceptual controversy and conduct the empirical and clinical research needed to ensure that normal recreational gaming is always clearly distinguished from harm and disorder.
Fejlett technológiák és innovatív megközelítések a neuromusculoskeletalis rehabilitációban
Advanced technologies and innovative approaches in neuromusculoskeletal rehabilitation
In recent years, advanced technology-based devices have become increasingly important in rehabilitation. Modern devices such as virtual and augmented reality, exoskeletons, end-effectors and weight-assisted gait training can be of great benefit in restoring mobility and cognitive function when used as a complement to traditional therapies. The development and implementation of protocols and guidelines are needed to ensure that modern rehabilitation technologies are regulated and based on scientific evidence. Advanced technology-based devices require specially trained therapists who are skilled in their use. Therapists play a crucial role not only in selecting the appropriate device, developing the therapeutic plan and delivering treatments based on the principles of traditional physiotherapy but also in motivating patients, which is important during longer treatment processes. Further research is needed to better understand the effectiveness of the devices and how they are used and to develop new guidelines to support their practical application. Improving the cost-effectiveness of the devices is also important, as this can ensure wider availability of the technology, including their home use. Overall, the widespread availability and adoption of modern technology-based solutions by health professionals could offer new long-term rehabilitation perspectives. Orv Hetil. 2025; 166(5): 175–182.
A petefészek-krioprezerváció és -autotranszplantáció mint a termékenység megőrzésének új lehetősége
Ovarian cryopreservation and autotransplantation as a new method for fertility preservation
Ovarian cryopreservation and autotransplantation offer a promising opportunity for preserving fertility in patients undergoing gonadotoxic treatment of malignant diseases. The aim of the procedure is to restore ovarian function following treatment and prevent premature ovarian failure. The aim of this case study is to present the method of ovarian cryopreservation and autotransplantation and to review the current scientific literature on the subject. A 25-year-old female patient diagnosed with acute lymphoblastic leukemia underwent ovarian tissue cryopreservation prior to myeloablative treatment. Following her remission, the ovarian tissue was orthotopically autotransplanted, after which the patient was monitored through weekly hormone level assessments (FSH, LH, estradiol, progesterone) and transvaginal ultrasounds. Gonadotropin and ovarian hormone levels showed no significant changes between postoperative days 7 and 63. By day 145, ovarian endocrine function was restored as indicated by decreased gonadotropin levels and normalized estradiol levels. In the literature, the 5-year survival rate of ovarian grafts during long-term follow-up was reported at 55%, with restoration of reproductive function and spontaneous pregnancies occurring in some cases. The method has proven effective in restoring both endocrine and reproductive functions, with the highest likelihood of achieving pregnancy shortly after the procedure. Previous studies have reported live birth rates as high as 41% following ovarian cryopreservation and autotransplantation. Ovarian cryopreservation and autotransplantation provide a valuable opportunity for preserving fertility in patients undergoing gonadotoxic treatments. Although our experience is limited to a single case, the results are encouraging. Further research is needed to optimize the procedure and expand its clinical application. Orv Hetil. 2025; 166(5): 195–200.
Stresszkezelési stratégiák és prevenciós lehetőségek hatékonysága a magyar sürgősségi betegellátásban
Effectiveness of stress management strategies and preventive measures in Hungarian emergency medical care
Introduction: Professionals working in emergency medical services frequently face intense physical and mental stress, significantly impacting their health and the quality of their work. Objective: This study aims to assess the effectiveness of stress management strategies among Hungarian emergency medical service professionals and the available preventive measures. Method: The study is a cross-sectional investigation conducted between January 2023 and March 2024 in the Southern Transdanubian Region. The data of 202 emergency medical professionals were analyzed, including physiological parameters recorded at various time points (blood pressure, heart rate), the level of subjective stress perception, and cortisol values measured from saliva and hair samples. Mann–Whitney U test, χ2 test, Wilcoxon test, Kruskal–Wallis test, and repeated measures ANOVA were applied. Data processing was performed using IBM SPSS Statistics 26.0, G*Power 3.1, and Matplotlib 3.9.1 software. Results: Most participants work long shifts, often at night, and hold secondary jobs. Emergency departments experienced patient load five times that of prehospital settings, with more mentally demanding cases. Participants mainly rely on family, colleagues, and friends, but only a few seek the help of mental health professionals (7.4%). During emergencies, ambulance workers experienced a 10.7% increase in blood pressure, a 15.3% rise in heart rate, and a 1.7-fold increase in tension (p<0.001). In emergency departments, blood pressure increased by 8.5%, heart rate by 11.9%, and tension by 2.5-fold (p<0.001). The workplace environment and patient care processes in both settings elevated the cortisol levels of healthcare professionals (p<0.001). Hair sample measurements were higher among emergency department workers, reflecting the accumulation of long-term stress. Among ambulance workers, those serving at central stations exhibited higher cortisol levels than those at peripheral stations. Conclusion: Distress is significantly present among domestic emergency care professionals, particularly in work environments characterized by high patient volume and long shifts, posing long-term health risks. Mental health preservation and stress management practices must be integrated into daily routines, and communication efficiency should be improved through multichannel information and personal consultations. Systematic development of social support and workplace mental health services is essential to prevent chronic stress and burnout. Orv Hetil. 2025; 166(5): 183–194.
Új irányelvek az infektív endocarditis megelőzésében és ezek fogászati és szájsebészeti vonatkozásai
New guidelines in infective endocarditis and its dental and surgical aspects
Infective endocarditis is one of the most severe potential complications associated with dental procedures. The mortality of infective endocarditis is still high, but with application of prophylactic measures, the risk can be reduced. It is strongly recommended to be up-to-date with the new (2023) international guidelines and follow its recommendations. Several great works have been published previously in Hungary, now we would like to update them. The previous guideline from the European Society of Cardiology (ESC) was published in 2015. Since then, several new data have come out, resulting in the revision of the guideline. The main changes regarding oro-dental procedures include the more detailed specification of the group of patients with cardiovascular diseases who are recommended to use antibiotic prophylaxis. These affect the patients who live with congenital heart disease. Another major change is in the recommended list of antibiotics. Clindamycin was ruled out, the guideline now includes azithromycin and clarithromycin instead. Our guideline provides a detailed, yet simplified chair-side guide for infective endocarditis prophylaxis. This includes the indication of prophylaxis, antibiotic choice and dosage, available original medications, their dosage and contraindications. We also provide recommendations for the most common problems related to drug intake, like difficulty in swallowing and allergies. Orv Hetil. 2025; 166(5): 163–174.
Abstract
Objective
To identify associations between the occurrence of sacrocaudal fusion and the potential morphology of certain hind limb bones in actively racing greyhounds.
Methods
The calcaneus, talus and patella from each hind limb were collected from 94 male and 77 female mature greyhound cadavers and grouped into four groups; right or left bones from greyhounds with a standard or fused sacrum. The measurements were recorded for the following parameters: body mass of the greyhound, mass, length, and width of the right and left calcanei, tali and patellae.
Results
A fused sacrum (4 sacral vertebrae) was present in 41% of specimens. The right and left calcanei, tali and patellae in greyhounds with a standard or fused sacrum were anatomically similar. Overall, left to right asymmetry was found, in the width of calcaneus (P < 0.01) and the talus (P < 0.05) and the length of calcaneus (P < 0.001) all these being larger in bones from the left hind limbs. Comparing bones from dogs with a fused or unfused sacrum showed that the right calcaneus length (P < 0.05) was significantly less than the left in those greyhounds with standard sacrum; the right calcaneus width was significantly less (P < 0.01) than the left in those with a fused sacrum. There were no significant differences in the means of measurements of bones between greyhounds with a standard and those with a fused sacrum except for the mass of the right (95% CI 0.22 to 1.10, P < 0.01) and left (95% CI 0.18 to 1.04, P < 0.01) calcaneus which were heavier in greyhounds with a fused sacrum than those with a standard sacrum.
Conclusion
In a population of greyhounds that race on anticlockwise tracks, the left calcaneus was wider and longer than the right and the left talus was wider. This asymmetry was more significant in dogs with sacrocaudal fusion and those dogs had more massive calcanei than dogs with standard sacrums, suggesting a difference in the way these bones were loaded in dogs with sacrocaudal fusion compared to dogs with the standard sacral anatomy.
Abstract
Background and aims
There is a lack of research on the impact of acute stress on the interaction of affective and cognitive processes in online compulsive buying-shopping disorder (CBSD). Therefore, this project addressed stress response, cue reactivity, attentional bias, and implicit associations in individuals with online CBSD.
Methods
Women with CBSD (n = 63) and women with non-problematic online buying-shopping (n = 64) were randomly assigned to the Trier Social Stress Test or a non-stress condition. After the stress/non-stress induction, participants performed a cue-reactivity paradigm, a dot-probe paradigm, and an implicit association task, each with addiction-related (online buying-shopping) and control (social networks) cues.
Results
Individuals with CBSD showed stronger affective responses towards the addiction-related and control cues than the control group and rated the addiction-related pictures with higher ‘arousal’ and ‘urge’ than the control images. No group differences emerged in the dot-probe paradigm and implicit association task. Acute stress showed no effect on performance in the behavioural tasks. Regression models investigating the impact of craving on the relationship between stress response and implicit cognitions within the group with CBSD were not significant.
Discussion
The findings demonstrate the involvement and generalization of cue reactivity in online CBSD, but do not provide support for effects of acute stress on cue reactivity, attentional bias and implicit associations.
Conclusions
Future studies should not be restricted to women and combine laboratory and naturalistic study designs to investigate the complex psychological mechanisms in online CBSD.
Abstract
Oral nerve blocks are an indispensable technique for pre-emptive pain management in various veterinary procedures, including tooth extractions. Local anaesthetic drugs are considered the safest and the most effective agents to inhibit oral pain. Recently, tramadol was used as an adjuvant to local anaesthetics to increase the duration of analgesia. The aim of this study was to compare the effect of maxillary nerve block induced by lidocaine or lidocaine-tramadol on perioperative pain in dogs undergoing upper fourth premolar extraction. A randomized blinded clinical study was conducted over five months involving sixteen animals divided into two groups, Group L (8 animals, Group Lidocaine) and Group LT (8 animals, Group Lidocaine-Tramadol). Both drugs provided effective pain control during and after surgical intervention, but lidocaine-tramadol resulted in longer analgesia than lidocaine alone. These findings suggest that the maxillary nerve block with lidocaine-tramadol can ensure adequate and prolonged pain control in dogs undergoing dental extraction. Although these are preliminary results, tramadol showed promising effects as a potential drug to use during oral surgery in association to local anaesthetics.
Abstract
This article critically addresses one of the most pressing questions of the current moment of the psychedelic wave: Is mainstreaming psychedelics a good thing? Our aim is not to provide a simple “yes” or “no” as an answer but to explore the tensions, controversies, disparities, inequalities, and risks that have risen in the last decades. We discuss the limits of psychedelic science as the paradigm leading this movement and the risks of an overemphasis on biomedicalization to the detriment of the social sciences, humanities, and traditional knowledge. We also examine policy considerations, the dangers of commodification, and the ecological burdens that the expansion of the use of psychedelics is causing. Additionally, the article reflects on the tendency to prioritize the psychotherapeutic approach to care, a topic that has been neglected in the field. The authors put forward the need for inclusion, ethics, and reciprocity to balance the inequalities that risk recreating the psychedelic movement as another expression of mainstream capitalist endeavors. Given the Food and Drug Administration's delay in approval of MDMA for PTSD and the hurdles for regulating access to psychedelics in ceremonial and therapeutic contexts, such as Colorado and Oregon, there is an urgent need to engage in an informed conversation about the future of the psychedelic movement. It is important to avoid the tendency to romanticize this landscape and to do a proper assessment of the contemporary challenges and ethical risks that we face in the future.
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.
