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
ESBL-producing Escherichia coli strains threaten public health and obligate the use of last-resort antibiotics. This study identified 15 E. coli isolates through 16S rRNA and gyrB genes, specific to E. coli, in 120 egg samples (12.5%). Antibiotic resistance was detected according to the EUCAST and CLSI in E. coli isolates. 2 isolates were susceptible to all antibiotics, one isolate was resistant to one antibiotic, one isolate was resistant to 2 antibiotics, and 11 E. coli isolates (73.3%) had multidrug resistance. Most frequent antibiotic resistances were detected against ampicillin (80%), tetracycline (66.6%), and chloramphenicol (66.6%). A double-disc confirmation test was used to detect ESBL production, and bla TEM, bla SHV, bla CTX-M and bla OXA genes were searched by PCR. The bla TEM (100%) gene was found in all resistant E. coli isolates, and the bla CTX-M gene was detected in only 3 (20%) E. coli isolates. None of the E. coli isolates contained the genes responsible for carbapenem and colistin resistance. Our results show that multi-drug antibiotic resistance and the bla TEM gene are frequent in E. coli from table eggs in Istanbul. This is the first preliminary study on ESBL-producing E. coli isolates in table eggs in Türkiye.
Abstract
Background
Mycoplasma hyopharyngis is a commensal bacterium in the upper respiratory tract of swine. As it is recognized to be apathogenic, examinations regarding this species are scarce, compared to other swine mycoplasmas. However, in a few cases, M. hyopharyngis was detected in lesions of different organs. This report presents a case study in which M. hyopharyngis (along with other bacteria) was isolated from the joint of a pig showing lameness.
Case presentation
A Hungarian farm was repopulated with 250 gilts and 1,700 finishers after undergoing a complete depopulation and disinfection. Two days later, cases of diarrhoea and septicaemia caused by Salmonella enterica serovar typhimurium were seen in the finishers. At the same time, following the first farrowing, swollen joints were observed in 21–25 days old piglets. Joint samples were collected, and isolation of Mycoplasma sp. and other bacteria was attempted. Analysis of the joint samples revealed the presence of Staphylococcus haemolyticus, Staphylococcus hyicus, Aerococcus viridans, Trueperella pyogenes, Streptococcus agalactiae and M. hyopharyngis.
Conclusions
This is the second isolation of M. hyopharyngis from joints, which highlights the necessity of a better understanding the biology of this often-overlooked species, and its role in the progress of arthritis or other lesions.
Abstract
We report a nosocomial outbreak caused by a multidrug-resistant carbapenemase-producing Klebsiella pneumoniae (MDRCPKp), that was detected in six patients admitted to the medical intensive care unit between 20th of December 2023 and 15th of January 2024 in Ankara, Turkey. The investigation of this outbreak was started on 29th of December 2023. During the outbreak 11 samples were collected from the six patients with MDRCPKp. Pulsed-field gel electrophoresis (PFGE) was performed to determine the genetic relatedness and clonality of MDRCPKp strains. MDRCPKp was isolated in the tracheal aspiration culture, blood, urine, and screening samples. Five patients with MDRCPKp colonization developed healthcare-associated infection. In one patient MDRCPKp was isolated from tracheal aspirate and the screening cultures were considered as colonization not infection. PFGE analysis revealed that all isolates belonged to the same K. pneumoniae clone. MDRCPKp strain of this outbreak exhibited multidrug resistance and co-produced OXA-48 and NDM-1. This outbreak ended after application of strict infection control measures. An outbreak of MDRCPKp can occur in hospitals, especially in the intensive care units; thus, it should be detected early by infection control teams. A strong collaboration between infection control team and microbiology laboratory is essential to cope with MDR bacterial outbreaks in hospitals.
Abstract
A total of 490 diarrhoeic samples from calves aged between 0 and 6 months were screened for the presence of different G- and P-genotypes of rotavirus circulating in bovines in the Kashmir Valley. Of the 490 diarrhoeic samples, Group A rotavirus was detected in 68 (13.87%) samples by polymerase chain reaction (PCR) followed by RNA-PAGE. Genotyping analysis revealed G10, G6, G3, P[11] and P[5] to be the predominant types. The most common types of combinations detected were G10P[11] (27.90%) and G6P[11] (20.60%). The prevalence rate of G10 and P[11] decreased from 60% to 36.76% and 100%–69.11%, respectively. Genotypes G6, G3, P[1] and P[5], which were not previously reported, were detected and unusual combinations such as G6P[11], G3P[11], G10P[5], G3P[5], G6P[1], G6P[5], G6+G8P[11] were also observed for the first time. Fluctuations in the predominant types, emergence of new types and possible genetic reassortment events suggest an unstable epidemiological situation and the need for continuous surveillance of the circulating types to ensure the suitability of the vaccination programme. The present data suggests G10, G6, P[11] and P[5] genotypes could be incorporated in the polyvalent vaccine to offer increased protection against bovine rotavirus infection in India.
Abstract
Hospital acquired infections greatly affect recovery and survival in pediatric surgical patients. We evaluated prevalence and antimicrobial resistance of ESKAPE pathogens in neonates and infants subjected to cardiac surgery in a tertiary hospital in Central Kazakhstan between 2019 and 2023 (2,278 patients) using routine methods of microbiological detection. ESKAPE pathogens were found in 1,899 out of 2,957 samples (Staphylococcus aureus – 35.3%, Klebsiella pneumoniae – 27.8%, Acinetobacter baumannii – 14.5%, Pseudomonas aeruginosa – 12.4%, Enterobacter sp. – 8.8%, Enterococcus faecium – 1.2%). The total prevalence of ESKAPE increased significantly from 45.1 to 76.9% (P = 0.005) during the study period. The resistance significantly increased in methicillin-resistant S. aureus (MRSA, from 13.7 to 41.9%, P = 0.041) but decreased in carbapenem-resistant P. aeruginosa (from 64.3 to 37.7%, P = 0.037) and carbapenem-resistant A. baumannii (from 48.5 to 19.1%, P = 0.039). Gradual but non-significant changes were shown in third-generation cephalosporin resistant K. pneumoniae (from 63.6 to 45.2%) and carbapenem-resistant K. pneumoniae (from 0 to 8.3%). The relative prevalence of ESKAPE pathogens steadily increased in our pediatric cardiac surgery patients in 2019–2023. The most frequent were S. aureus, K. pneumoniae, and A. baumannii, with dramatically increasing tendencies for MRSA. Our results highlight the necessity for a well-designed infection control strategy and constant microbiological monitoring in pediatric cardiac surgery departments.
Hírek a hematológia világából
News from the world of hematology
Abstract
This interventional clinical trial aimed to assess the potential impact of Spirulina platensis supplementation on pregnant and lactating ewes living in a Moroccan endemic fluorosis area. Forty-eight ewes were divided into four equal groups: Groups I and II served as controls belonging respectively to fluorosis-free and endemic fluorosis areas, Groups III and IV received respectively 250 and 500 mg*kg−1 BW/day of S. platensis, during late pregnancy and early lactation. The results revealed that ewes reared in fluorosis-free areas exhibited significantly lower plasma fluoride and significantly higher haemoglobin levels compared to endemic fluorosis areas (P < 0.0001). However, supplementation with 500 mg*kg−1 BW*day−1 of S. platensis significantly improved these two parameters compared to Group II (P < 0.0001). Ewes in the endemic area also displayed increased oxidative stress (P < 0.05), characterized by decreased ascorbic acid levels and catalase activity, as well as elevated levels of reduced glutathione and malondialdehyde. Supplementation with 500 mg*kg−1 BW*day−1 of S. platensis enhanced the antioxidant status (P < 0.05) by increasing ascorbic acid levels and catalase activity and decreasing levels of reduced glutathione and malondialdehyde. Moreover, this dose yielded similar average daily gains compared to lambs of ewes living in fluorosis-free area. In conclusion, S. platensis may serve as a promising solution for addressing endemic fluorosis in pregnant and lactating ewes.
Abstract
The Acidaminococcus genus is a part of the normal flora in gastrointestinal tract. It is a strictly anaerob Gram-negative coccus that is rarely pathogenic. We report the case of a 58-year-old man, who presented to surgery department A of the Charles Nicolle hospital, complaining of a wide inflammatory lesion in the anterior abdominal wall evolving for two weeks. Patient's anamnestic data included smoking, hypertension, and diabetes mellitus with poor compliance. The patient underwent flattening with excision of necrotic tissues and surgical drainage using a DELBET blade. Empirical antibiotic therapy with imipenem 1gx3/d, teicoplanin 400 mg 1 inj x2/d and gentamicin 400 mg 1 inj/d was administered pending bacteriological results. The bacteriological examination of a sample of necrotic tissue, after 72 h of incubation at 37 °C in anaerobic atmosphere, was able to detect a Gram-negative coccus, that the VITEK2 ANC system identified as Actinomyces canis with an accuracy of 80%. Whole genome sequencing was subsequently performed, that identified Acidaminococcus sp. AM33-14BH and demonstrated the following resistance genes: cfxa, tet(X) and tet(Q). An antibiogram for anaerobes was performed showing that the strain was resistant to amoxicillin but sensitive to amoxicillin-clavulanic acid, piperacillin-tazobactam, ertapenem, imipenem, meropenem and rifampin. Patient's condition improved after treatment with imipenem for 2 weeks, followed by oral amoxicillin-clavulanic acid for 16 days.
This work highlights the role of molecular biology in the diagnosis of infections caused by anaerobes. Although the Vitek 2 ANC card provides rapid and acceptable identification of the most common anaerobic bacteria, improvements are needed for the identification of bacteria in the genera Acidaminococcus and Actinomyces.
Abstract
Delftia acidovorans is an aerobic, non-fermenting Gram-negative bacterium (NFGNB), found in soil, water and hospital environments. It is rarely clinically significant, most commonly affecting hospitalized or immunocompromised patients. The present study aimed to explore the genomic characteristics of a Bulgarian clinical D. acidovorans isolate (designated Dac759) in comparison to all strains of this species with available genomes in the NCBI Genome database (n = 34). Dac759 was obtained in 2021 from the sputum of a 65-year-old female immunocompetent outpatient with bronchitis. Species identification using MALDI-TOF mass spectrometry, antimicrobial susceptibility testing, whole-genome sequencing (WGS), and phylogenomic analysis were performed. The isolate demonstrated high-level resistance to colistin (16 mg L−1); resistance to gentamicin; reduced susceptibility to piperacillin, piperacillin-tazobactam, ceftazidime, cefepime, ciprofloxacin, and levofloxacin; and susceptibility to imipenem, meropenem, amikacin, and tobramycin. The observed genome size (6.43 Mb) and GC content (66.76%) were comparable with the accessible data from sequenced D. acidovorans genomes. A limited number of resistance determinants were identified in the assembled genome as follows: bla OXA-459, emrE, oqxB, and mexCD-oprJ. The phylogenomic analysis indicated a high heterogenicity of the included D. acidovorans genomes. In conclusion, to the best of our knowledge, this is the first documented case of a clinically relevant D. acidovorans isolate in Bulgaria. Unlike the majority of reports in the literature, Dac759 affected a patient with no malignancies or other preexisting comorbidities. With this in mind, its genome sequence is a valuable resource for the fundamental study of uncommon bacterial pathogens of public health importance.
Abstract
Kettlebell as a sport has gained recognition worldwide. We characterized the physiological responses induced by a simulated kettlebell competition routine in experienced kettlebell athletes (n = 26) in a two-group, pre-post plus short-term follow-up, non-randomized experiment. The experimental group (EXP) included 13 kettlebell athletes, while the control group (CON) consisted of 13 individuals with prior recreational exposure to kettlebell activities. EXP performed a 10-minute-long, long-cycle kettlebell routine, whereas CON engaged in seated rest. Cardiovascular and neuromuscular outcomes were measured at rest, after warm-up, during exercise, at 0 (immediately post), 5 and 15 min into recovery. Group-by-time interactions revealed that the 10-minute-long, long-cycle kettlebell routine increased (P < 0.05) the levels of all outcomes (e.g. heart rate, blood pressure, blood lactate) (range of effect sizes: −0.9–8.9) with many outcomes remaining well above baseline at 5 and 15 min into recovery. A notable exception was a lack of change in maximal squat strength. Kettlebell experience and mass correlated with changes in oxygen uptake (ΔVO 2 ) and in ventilation (ΔVT) (r = −0.70, 0.64, −0.87, and 0.73, respectively, P < 0.05) in EXP. Kettlebell routine evoked significant changes in all physiological variables (respiratory and cardiovascular), out of which the heart rate (HR), diastolic blood pressure (DBP), rate pressure product (RPP), and blood lactate (BL) outlasted the routine for at least 15 min. Future studies should longitudinally examine physiological responses to kettlebell training throughout a season. Long-cycle kettlebell routine adds to the repertoire of evidence-based exercise options for high-intensity exercise.
II. Magyar Orvos-Egészségügyi Világtalálkozó, Budapest, 2024. augusztus 29–31.
Az orvostudomány dilemmái a XXI. században – Program és előadáskivonatok
2nd World Hungarian Medical and Health Meeting, Budapest, August 29–31, 2024
Program and abstracts
Javaslatok és megfontolások a magyarországi pertussisesetszám-növekedéssel összefüggésben
Proposals and recommendations due to the increased number of pertussis cases in Hungary
The number of pertussis cases is increasing dramatically across Europe. More confirmed cases were registered in the first three months of this year than last year. Hungary has recently experienced a favourable epidemiological pertussis situation. The median number of reported cases has been 2 over the last 5 years. However, an increasing incidence has also been observed in our country: 153 pertussis cases were reported between January 1, 2024 and July 14, 2024. In order to control the possible spread to the community, a change in the preventive attitude of health care workers is necessary, as well as an increase in diagnostic activity. Identification and treatment of contact persons are essential as soon as possible. The population most at risk are newborns and unvaccinated or partially vaccinated infants under 6 months of age. At this age, complications of pertussis (e.g., respiratory or cardiac arrest due to apnea) can sometimes be fatal. The main goal is to protect this vulnerable population. Vaccinating pregnant women, providing a safe environment (cocooning strategy), and immunizing infants early are the best strategies to avoid life-threatening complications of the disease. Vaccination of pregnant women against pertussis has been carried out safely and with high efficiency in many countries for decades. It can be offered between weeks 16 and 36 of gestation, but the best protection is provided by vaccination early in the third trimester. In this publication, we make recommendations for the diagnosis, treatment, and post-exposure chemoprophylaxis and active immunization of pertussis, based on current international guidelines. Our recommendations for clinical practice are valid only in the current domestic epidemiological situation, pending the publication of the current official national recommendation. Orv Hetil. 2024; 165(34): 1307–1318.
Prosztatarákban a vérkép a diagnózis időpontjában nem prediktív a túlélésre
Complete blood count at the time of diagnosis is not predictive to survival in prostatic cancer
Introduction: Numerous observations suggest that several elements of the complete blood count (CBC) predict disease survival in certain cancers. Objective: To evaluate the relationship between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), white blood cell count (WBC) and length of survival in prostate cancer patients. Method: We analyzed the relationship between clinical data (age at diagnosis, prostate-specific antigen [PSA] level, TNM score, Gleason score, comorbidities and CBC elements) and survival time in prostatic cancer patients diagnosed between 2000 and 2005 at the General Urology Department of Uzsoki Street Hospital using Cox regression. Results: In our analysis, we analyzed data from 97 prostate cancer patients; 82 of them died, 15 are still alive. No single element of CBC at the time of prostatic cancer diagnosis differed between the two groups (deceased or not deceased). Only patient age (p = 0.004), PSA level (p = 0.033) at the time of diagnosis and Gleason score (p = 0.033) had a significant effect on the length of survival. The analysis of subgroups created according to the length of survival (i.e., death within 1, 2, 5 and 10 years) revealed no difference in any of the hematological parameters either. Discussion: Besides the factors previously identified in the literature (PSA, Gleason score, age), CBC elements are not associated with survival in the general prostate cancer population. Conclusion: In prostate cancer, the elements of CBC cannot predict the length of survival or which patients will survive after an average of 20 years following the diagnosis of prostate cancer. Orv Hetil. 2024; 165(34): 1319–1324.
A stratégiai gyógyszerlista szerepe a gyógyszerhiányok megelőzésében és kezelésében hazánkban
The potential impact of a critical medicines list on preventing and mitigating drug shortages in Hungary
Introduction: The impact of the stockpiling obligation of medicinal products imposed by Decree no. 16/2024. (III. 11.) of the Ministry of Interior on publishing the list of critical medicines on drug shortages has not been investigated. Objective: The aim of our study was to evaluate the appropriateness of this policy measure on tackling drug shortages by the partial use of quantitative methods. Method: The active pharmaceutical ingredients appearing on the list of critical medicines was compared to the ones identified using the public list of drug shortages covering the past year before the publication of the list of critical medicines. This was enriched with pharmaceutical consumption data, duration of the shortage, price increases and the availability of substitutional medicinal products to observe self-regulation mechanisms. Results: 605 active ingredients were reported to have a shortage in the time frame of our study; the number of active ingredients appearing on the list of critical medicines was 312; the number of active ingredients in both sets were 190. 415 active ingredients only appeared on the list of reported shortages; 99 active ingredients only appeared on the list of critical medicines. The median duration of shortages was 10 months and 11 months, respectively. Among those active ingredients reported to have a shortage and also appearing on the list of critical medicines, a substitutional medicine was authorized in 17.4% of the cases; a price increase was initiated for 5.3% of all cases; contingency arrangements were made in 7.4% of the cases. Discussion: Stockpiling obligations for wholesalers are common policy measures in the European Union. However, other member states use multiple policy tools (such as easing administrative and pricing procedures, maintaining a stakeholder forum) in parallel to mitigate drug shortages. Conclusion: The list of critical medicines might reduce the frequency of short-term drug shortages for a limited scope of medicinal products. Without appropriate self-regulation mechanisms, further policy interventions are needed to tackle shortages in a broader range of medicines, as well as to mitigate the risk of long-term drug shortages. Orv Hetil. 2024; 165(34): 1325–1331.
A tünetmentes hasiaorta-aneurysma szűrővizsgálata az alapellátásban
Screening of abdominal aortic aneurysm in primary care
Introduction: The prevalence of abdominal aortic aneurysm in Hungary is not precisely known, but given the similar (or slightly worse) prevalence of cardiovascular disease comparing to the Western countries, the estimated prevalence in the population over 65 years of age is expected to be between 1.3–3.3%, with a male predominance of 4 : 1. The gold standard screening method for this condition is the B-mode ‘abdominal’ ultrasound scan. In our country, there is currently no institutionalized screening program for this disease, which is most probably due to the scarce human resources in the outpatient care. Despite the theoretical availability of the skill base and equipment, the nearly 400,000 people in this risk group can not be screened. Objective: Due to the governmental procurement to improve primary care, B-mode ultrasound machines are now available in one-sixth of general practices in Hungary (1,000 ultrasound machines). Hopefully in the near future further 500 machines will be made available resulting in ultrasound machines in one quarter of the practices, or one third of practice groups. Using a prospective observational approach, we aim to investigate whether abdominal aortic aneurysm screening of men over 65 years of age can be safely incorporated into the daily adult care. Our model is based on the premise that the population of over 65 attending at the general practice surgeries has a significant overlap with the risk group for abdominal aneurysm. Method: Based on the consensus of the Hungarian Society of Radiology and the College of General Practitioners, we have prepared/conducted a bedside ultrasound educational course. Following accreditation, we trained 150 general practitioners and organized a skills test for the participants. A two-month pilot project was designed for 10 general practitioners who have passed the proficiency test and have a validated ultrasound machine. Examiners will perform focused abdominal aortic aneurysm screening of patients who meet the inclusion criteria in all morning/afternoon general practice surgeries in a crossover manner. Five practices would perform POCUS scans for one month either on a call-in basis (classical screening model) while in five practices only the ‘drop-in’ patients will be screened. The practices will swap in the next month. As a primary endpoint, we would look at the time spent in care, and thus patient safety, and as a secondary endpoint we would also measure provider’s resilience and patient satisfaction. Given the relatively low number of participants, the secondary endpoints will not include prevalence of the abdominal aortic aneurysm. Results: Our research is novel, no previous studies compared call-in and drop-in screening models of abdominal aneurysm in primary care. Discussion: If in our model the organized screening does not result in significantly higher adherence (higher number of examinations) than the so-called ‘drop-in’ model can easily be incorporated into the routine of practice without compromising patient safety. Furthermore, we can investigate the effects of general practitioners based abdominal aorta screening on provider resilience and patient satisfaction, too. Conclusions: We hope that the national economic gains of the potentially screened/saved lives, the obvious improvement of general practitioner skill sets and the expected positive patient experience can justify the resources invested. Orv Hetil. 2024; 165(34): 1332–1339.
Vegyi háború Vietnámban: utóhatások
Chemical war in Vietnam: late effects
Abstract
The present study explored the association between a point mutation (g.857G>A) in the IGF-1 gene and performance traits in Harnali Sheep. Genomic DNA was extracted from 110 Harnali sheep using an Automated Maxell RSC DNA/RNA purification system. A 294 bp fragment, covering the 5′ flanking region of the IGF-1 gene, was amplified with specific primers. The resulting PCR product, harboring the g.857G>A mutation, was digested with the Hae II enzyme to determine genotypes. The frequency of the A allele of the IGF-1 gene was higher (0.59) in the studied Harnali sheep population, with the GA genotype being the most prevalent (0.64). The presence of the A allele was associated with higher body weights, suggesting its potential as a selection criterion for improving flock performance. Furthermore, the GA genotype was linked to a lower average age at first lambing (727.93 days) compared to the GG genotype (753.08 days). The A allele was linked to higher body weights, while the GA genotype was associated with a lower age at first lambing. These findings highlight the potential of these genetic markers for improving breeding strategies and enhancing flock performance. However, validation on larger samples is warranted.
Abstract
Although the relationship between vaginal microorganisms and fertility has been well established, only few studies have investigated vaginal microorganisms in women undergoing in vitro fertilization (IVF). Our aim was to study the differences in vaginal microbiota between infertile women with repeated implantation failure (RIF) and those who achieved clinical pregnancy in their first frozen embryo transfer cycle. We compared the vaginal microbiota of patients with a history of RIF (n = 37) with that of the control group (n = 43). Following DNA extraction, metagenomic sequencing was employed for the analysis of alpha and beta diversities, distinctions in bacterial species, and the functional annotation of microbial genes. Furthermore, disparities between the two groups were revealed. Alpha diversity analysis revealed that the Shannon index was higher in the RIF group (P < 0.05). There were differences in the beta diversity between groups (P = 0.16). At the bacterial family level, the relative abundance of Actinomycetaceae (P = 0.013) and Ruminococcaceae (P = 0.013) were significantly higher in the RIF group. At the genus level, the abundances of Actinomyces (P = 0.028) and Subdoligranulum (P = 0.013) were significantly higher in the RIF group. At the species level, the abundances of Prevotella timonensis (P = 0.028), Lactobacillus jensenii (P = 0.049), and Subdoligranulum (P = 0.013) were significantly higher in the RIF group. Significant differences in family, genus, species, alpha and beta diversity were observed in the vaginal microbiota between groups. Notably, among these findings, the Subdoligranulum genus emerged as the most prominent correlating factor.
Abstract
The ectoparasitic copepod Lernaea cyprinacea (anchor worm) has more than 100 host species among teleost fishes and affects cyprinids both in fish farms and natural waters. In addition, while L. cyprinacea infection in amphibians has been recorded in Asia, North and South America, there is no data available in the literature on their presence in Europe. In this study, we first reported L. cf. cyprinacea parasitising an anuran tadpole in Europe. Specimens of L. cf. cyprinacea were observed attached to a tadpole of the agile frog (Rana dalmatina), which was caught during fishing of crucian carp fingerlings (Carassius carassius) from a small fish pond in Hungary during the summer of 2012. The infected tadpole was collected from a rearing pond, where juvenile crucian carps were kept. The tadpole was inspected in the laboratory, and digital photos were taken. The parasites were found attached to the body-tail junction and to the leg of the tadpole (at Gosner stage 41). The parasite species was identified as L. cf. cyprinacea based on morphological traits.
Abstract
Potential arrhythmias recorded by cardiac monitors using the built-in human algorithm are as follows: total number of episodes, ventricular tachycardia, asystole, bradycardia, atrial tachycardia, atrial fibrillation and the percentage of time spent in atrial tachycardia or atrial fibrillation. Long-term use of an insertable cardiac monitor (loop recorder) has been reported in one horse earlier, but its accurate role as a diagnostic tool is still unclear. The aim of the present study was to investigate the long-term applicability of the Reveal XT cardiac monitor for recording cardiac arrhythmias in adult horses. The Reveal XT cardiac monitor was implanted in 12 horses under sedation in standing position. Median duration of data recording calculated for the population was 1,169 days. The number of false positive detections of asystole and bradycardia was extremely high in all horses. For atrial fibrillation, false positive detection occurred in five and false negative detection occurred in one horse. The present study showed that the long-term use of the Reveal XT cardiac monitor is feasible, well-tolerated and the devices work reliably, without complications. The human algorithm could not be used for automatic detection of arrhythmic episodes in the study population. The device could detect atrial fibrillation in horses, but the recorded AF burden was inaccurate and the stored ECGs had to be manually interpreted. Because the human analyser algorithm of this cardiac monitor fails to identify bradyarrhythmias in horses based on our results, this instrument is not capable for accurately determining the aetiology of episodic collapse in this species.
Abstract
There is a developing dialogue between the psychoanalytic and psychedelic fields of psychotherapy. This paper contributes to this emerging collaboration by applying Winnicott's concept of transitional experience to psychedelic clinical work. By analyzing two Ketamine-Assisted Psychotherapy (KAP) cases, we explore in depth how transitional experience facilitates psychedelic transformation. We review clinical touch and introduce hand-holding as a transformational experience that can occur in the amplified relational field of the psychedelic space. Applying these ideas will deepen clinicians' theoretical understanding and experiential practice of KAP.
A diabétesz okozta distressz és az életminőség összefüggései 2-es típusú cukorbetegséggel élők körében – szisztematikus irodalmi áttekintés
Associations between diabetes distress and quality of life in type 2 diabetes patients – a systematic literature review
Háttér: Cukorbetegséggel élni megterhelő. Ezért, nem meglepő módon, ez a betegség nagyon gyakran érzelmi distresszt okoz, amelyet betegségre specifikusan diabétesz okozta distressznek hívunk. A cukorbetegséggel élők esetében a negatív érzelmi tünetek azonban nemcsak a pszichés jóllétre hatnak negatívan, hanem a magasabb distresszt megélő betegek alacsonyabb adherenciával jellemezhetőek, rosszabb glikémiás kontrollal rendelkeznek, és körükben magasabb a mortalitás is. A krónikus betegségek, így a cukorbetegség is nagymértékben rontja a szubjektív életminőséget, ráadásul a vonatkozó kutatások eredményei alapján a diabétesz okozta magasabb distressz rosszabb észlelt életminőséggel is együtt jár, és e két tényező külön-külön is, de együttesen is prediktora egyéb, a cukorbetegség önmenedzselésével kapcsolatos változóknak, mint amilyen például a glikémiás kontroll vagy az adherencia. Célkitűzés: Azonosítani néhány tényezőt és rizikófaktort amelyek a 2-es típusú cukorbetegséggel élő felnőttek körében befolyásolják a diabétesz okozta distresszt és az életminőséget. Módszerek: Tanulmányunkat a szisztematikus irodalomkutatás módszerével készítettük, angol nyelvű cikkeket keresve az EBSCO és az Embase adatbázisokban. Eredmények: A diabétesz distresszt és a betegséggel kapcsolatos életminőséget befolyásoló tényezők és rizikófaktorok egy része az ismertetett kutatások alapján beazonosítható, és általuk pontosabban meghatározhatók olyan beavatkozási pontok, amelyekkel a diabétesszel összefüggő distressz és annak következményei eredményesen csökkenthetőek.
A Harcolás, Menekülés, Lefagyás Kérdőív magyar változatának (FFFQ–HU) pszichometriai jellemzői
Psychometric properties of the Hungarian version of the Fight, Flight, Freeze Questionnaire (FFFQ–HU)
Elméleti háttér: Akut vagy krónikusan elnyúló fenyegetések esetén veleszületett, automatikusan aktiválódó védekezési reakciók jelennek meg: ezek között kiemelhető a harcolás, a menekülés és a lefagyás védekezési mechanizmusa. Ennek ellenére korábban nem volt elérhető magyar nyelven olyan mérőeszköz, amely specifikusan ezeket a reakciókat vizsgálta volna. Cél: A jelen vizsgálat célja a Fight, Flight, Freeze Questionnaire (FFFQ) magyarra történő adaptációja és a mérőeszköz pszichometriai jellemzőinek vizsgálata. Módszerek: A vizsgálatban kevert klinikai (183 szorongásos vagy hangulatzavarral diagnosztizált személy) és non-klinikai (311 egyetemi hallgató kontrollcsoportja) mintán konfirmatív faktorelemzéssel (CFA) vizsgáltuk meg az FFFQ–HU faktorszerkezetét. A mérőeszköz konvergens validitásának vizsgálata érdekében a résztvevők további, szorongást (Spielberger-féle Állapot- és Vonásszorongás Kérdőív Vonásszorongás Skála), depressziót (9 itemes Beck Depresszió Kérdőív), impulzivitást (Barratt Impulzivitás Skála módosított, 21 itemes magyar változata), viselkedésgátlást és aktivációt (Viselkedéses Gátló és Aktiváló Rendszer Skálák), valamint megküzdési módokat (Konfliktusmegoldó Kérdőív) mérő validált skálákat töltöttek ki. Eredmények: A CFA megfelelő modellilleszkedés mellett (RMSEA = 0,06; CFI = 0,96; TLI = 0,95) erősítette meg az FFFQ–HU elméleti, háromfaktoros szerkezetét. A konvergens validitás tekintetében a harcolás elsősorban az impulzivitással [r S(417) = 0,32; p < 0,001], a viselkedésaktiváció szórakozáskeresés dimenziójával [r S(417) = 0,26; p < 0,001], valamint a feszültségredukció [r S(417) = 0,46; p < 0,001] megküzdési módjával mutatott összefüggést. A menekülés elsődleges korrelátumai a depresszió [r S(417) = 0,64; p < 0,001], a viselkedésgátlás [r S(417) = 0,25; p < 0,001], valamint a feszültségredukció [r S(417) = 0,32; p < 0,001] voltak. A lefagyás leginkább a szorongással [r S(417) = 0,47; p < 0,001], a viselkedésgátlással [r S(417) = 0,52; p < 0,001], és a passzív megküzdéssel [r S(417) = 0,23; p < 0,001] mutatott jelentősebb együttjárást. A lineáris regresszió elemzések eredményei alapján a harcolás egyedüli szignifikáns és negatív magyarázó változója az iskolai végzettség volt (β = –0,19; p < 0,001), míg a menekülés és a lefagyás esetén a klinikai csoporttagság pozitív (β = 0,27; p < 0,001; β = 0,28; p < 0,001), míg az életkor negatív (β = –0,15; p < 0,01; β = –0,10; p = 0,04) prediktora volt a magasabb faktorátlagoknak. Következtetések: Az FFFQ– HU megfelelő pszichometriai jellemzői lehetővé teszik a mérőeszköz alkalmazását mind a kutatás, mind a klinikai gyakorlat területén. Az FFFQ–HU által mért védekezési reakciók fontos, potenciálisan a terápiás folyamatot is meghatározó információkat hordoznak.
A kontrollhely, a stressz és egyes mentális zavarok összefüggései a Sötét és Világos Hármas esetén
The relationship between locus of control, stress and certain mental disorders in the Dark and Light Triad
Elméleti háttér: A kontrollhely és a stressz, valamint egyes mentális zavarok (depresszió, szorongás) összefüggéseit számos kutatásban vizsgálták, azonban a proszociális Világos Hármas (humanizmus, kantianizmus, hit az emberiségben) és a szociálisan averzív Sötét Hármas (machiavellizmus, szubklinikai narcizmus, szubklinikai pszichopátia) hatása a kontrollhelyelvárás és a depresszió, a szorongás, valamint a stressz közötti összefüggésre nézve kevésbé kutatott terület. Célkitűzések: Mivel egyelőre nem tisztázott a kontrollhelyelvárás kapcsolata az említett mentális zavarokkal és a stresszel a két Hármas esetén, kutatásunk ezen összefüggéseket igyekszik feltárni. Módszerek: A keresztmetszeti kérdőíves vizsgálatban használt kérdőíveket (Világos Hármas Kérdőív, Rövidített Sötét Hármas Kérdőív, Rövidített Kontrollhely Kérdőív, DASS-21 Depresszió, Szorongás és Stressz Skála) 194 fő töltötte ki (148 nő, 46 férfi, átlagéletkor = 37 év, SD = 13,2 év). Eredmények: Eredményeink szerint a belsőkontrollhely-elvárás szignifikáns, mérsékelt erősségű, negatív irányú együttjárást mutat a szorongás, a depresszió és a stressz összesített értékével (r = –0,41; p < 0,001), és sem a Világos Hármas [F (3, 190) = 17,25; R 2 = 0,227; p < 0,001; B = 0,001; p = 0,927], sem a Sötét Hármas [F (3, 190) = 18,737; R 2 = 0,227; p < 0,001; B = 0,001; p = 0,916] összesített skálái nem mutatnak szignifikáns moderációs hatást a kontrollhelyelvárás és a mentális zavarok, valamint a stressz közötti összefüggések mentén. A Világos Hármas összessége (r = – 0,22; p = 0,002) és annak hit az emberiségben (r = – 0,18; p = 0,013) és kantianizmus alskálái (r = – 0,22; p = 0,002) szignifikáns, de enyhe, negatív irányú kapcsolatban vannak a mentális zavarok és a stressz mutatóival. Következtetések: Eredményeink alapján a depresszió, a szorongás és a stressz kialakulásában meghatározó jelentőségű a kontrollhely szerepe a vizsgált változókat tekintve. Ugyan a Világos Hármas összessége, és annak hit az emberiségben és kantianizmus alskálái mutatnak némi védelmet a mentális zavarok és a stressz megjelenésével szemben, ekkor is a belsőkontrollhely-elvárás szerepe fontosabb, azaz minél inkább belső kontrollos egy személy, annál kevésbé valószínű a vizsgált mentális zavarok és a stressz megjelenése, függetlenül attól, hogy a Világos vagy a Sötét Hármas tulajdonságai jellemzőek rá hangsúlyosabban.
Párkapcsolat és a személyiség működésmintázatai: A boweni szelf-differenciáció nyomán
Relationship and personality functioning patterns: Following Bowen’s self–differentiation
Elméleti háttér: A párkapcsolati elégedettség a párok romantikus kapcsolataira vonatkozó átfogó és általános szubjektív értékelését foglalja magában. A különböző nézőpontokat képviselő vizsgálati eredmények mind ugyanabban szolgálnak megerősítésül: a párkapcsolati működés alkotóelemeinek egyediségét, változatosságát támasztják alá. Az elégedettség szempontjából ugyanakkor ritkán vizsgálnak olyan transzgenerációs folyamatok eredményeként kialakuló jellemzőket, mint amilyen a szülőkről való érzelmi leválás. A kapcsolatok szempontjából azonban ennek szerepe kulcsfontosságú, hiszen meghatározhatja azok minőségét, sikerességét és egyben stabilitását is. Módszerek: Jelen kutatás a magyar lakosság tizennyolc év feletti, önbevallása alapján elkötelezett párkapcsolatban élő személyeit (n = 533) vizsgálta meg. Magyar mintán elsőként került feltárásra, hogy olyan jellegzetes, együttesen ritkán vizsgált változók mentén, mint az érzelmi leválás (szelf-differenciáció), az önegyüttérzés, a hála és a párkapcsolati elégedettség, az egyének vajon milyen működésmintázati modellek felállítását teszik lehetővé. Méréseinket az Érzelmi Leválás Kérdőív, a Hála Kérdőív, az Önegyüttérzés Skála és a Kapcsolati Elégedettség Skála felhasználásával hajtottuk végre. A személyiségek elkülönítését és szisztematikus csoportosítását pedig hierarchikus klaszterelemzés eljárással végeztük el. Eredmények: Az elemzés következtében a „fiatal – magasan differenciálatlan”, „a fiatal – differenciált” és az „idős – differenciálatlan” párkapcsolati működésmódok leírására nyílt lehetőség. A legnagyobb mértékű differenciáltságot, önegyüttérzést és hálakészséget mutató „fiatal – differenciált” klaszter (Mdn = 37), szignifikánsan különbözött a fiatal – magasan differenciálatlan (Mdn = 36; U = 15648; Z = –3,118; p = 0,002; r = 0,16) és az idős – differenciálatlan (Mdn = 31; U = 5162; Z = –7,556; p < 0,001; r = 0,44) klasztertől is, így egyben a párkapcsolatával leginkább elégedett klaszternek minősült. Következtetések: A három profil összehasonlítása során megállapíthattuk, hogy a legmagasabb szintű elégedettséget a leválás, az önegyüttérzés, és a hálakészség együttes intenzitása biztosíthatja. Általános érvényűnek bizonyult továbbá az a vizsgálati tapasztalat, hogy a szelf differenciáltsági állapota és az önegyüttérzés a párkapcsolati kiegyensúlyozottság szempontjából egyformán meghatározó lehet.
A Szabadidős Testedzés Motivációja Skála (PALMS) adaptációs vizsgálata magyar mintán
Validation of the Physical Activity and Leisure Motivation Scale (PALMS) on Hungarian sample
Háttér és célkitűzések: Jelen tanulmány célja a Szabadidős Testedzés Motivációja Skála (Physical Activity and Leisure Motivation Scale, PALMS) magyar változatának (PALMS–H) pszichometriai vizsgálata, a mérőeszköz reliabilitásának és validitásának ellenőrzése. Módszerek: 893 fő vett részt a vizsgálatban (nférfi = 428, átlagéletkor = 33,7 év; SD = 11,79 év). A PALMS–H mellett a Sportmotivációs Skála II-t (SMS-II) alkalmaztuk. Eredmények: A megerősítő faktoranalízis támogatta a PALMS–H nyolcdimenziós elméleti modelljét, megfelelő illeszkedési mutatókat kaptunk [χ 2(893) = 3427,77; p < 0,01; GFI = 0,95; TLI = 0,94; CFI = 0,94; RMSEA = 0,07]. Az alskálák belső konzisztenciája egy kivételével (Külső elvárások, Cronbach-α = 0,58) megfelelőnek bizonyult (Cronbach-α = 0,85–0,91). A skála invariánsnak mutatkozott a nemeket tekintve. A konstruktumvaliditás vizsgálata során szignifikáns, mérsékelt, illetve erős kapcsolatot mutatott az Elsajátítási cél és az Örömérzet az SMS-II-vel mért intrinzik motivációjával (r = 0,53–0,70), integrált (r = 0,41–0,47), identifikált (r = 0,32–0,60) és introjektált szabályozásával (r = 0,36–0,37). Gyenge, illetve közepes erősségű (r = 0,20–0,47) kapcsolatot találtunk a PALMS–H kérdőív többi alsklálája és az SMS-II öndeterminált viselkedésre utaló skálái között. Következtetés: A PALMS magyar nyelvű változata megfelelő, megbízható és érvényes mérőeszköznek bizonyult a testmozgás motivációs hátterének mérésére.
Az orvosi kommunikáció oktatásának fejlesztése a Pécsi Tudományegyetem Általános Orvostudományi Karán a „Szimulációs Beteg” program bevezetésével
Enhancing medical communication education through the implementation of the “Simulated Patient” program at the University Medical School of Pécs
Introduction: The use of simulated patients is a widely accepted method for effectively teaching medical communication skills. Simulated patients also contribute to the teaching and assessment of clinical skills. The first institutionalized “Simulated Patient” program in Hungary was launched at the University Medical School of Pécs in 2019 to support the education of medical students. The program provides training and education for lay simulated patients in Hungarian, English and German. Objective: We evaluated the perception of Hungarian and international students four years after implementing the program. In addition to presenting the research results, we briefly describe the theoretical and practical aspects of the program. Method: Research data were gathered with the help of an online cross-sectional questionnaire survey using convenience sampling in the spring semester of 2023. The three scales of the questionnaire consisted of a total of 20 questions. The closed question types included multiple choice questions and ranking. The open-ended questions focused on positive experiences and difficulties. The survey was conducted among Hungarian, English, and German program students. 128 students responded to the survey. Results: Significant differences were found between the students in the three language programs regarding the assessment of the simulated patient consultations and feedback and the method’s effectiveness. Analysis of responses to open-ended questions highlighted the opportunity to practice real-life situations, the importance of feedback, increased confidence, and professional development. Conclusion: Consistent with the results of other studies in the field, our students’ perceptions of the introduction of the new methodology were positive. However, our current study has pointed out that students learning in different languages of instruction weigh the significance and impact of some aspects of the simulation patient program differently on their overall learning process and professional development. Orv Hetil. 2024; 165(33): 1286–1294.
Levél a szerkesztőhöz
Letter to the editor
Noninvazív rejekció utánkövetése szolid szervek átültetését követően: a donoreredetű sejtmentes DNS vizsgálata
Noninvasive rejection surveillance after solid organ transplantations: analysis of the donor-derived cell-free DNA
Solid organ transplant rejection is a major etiological factor of graft dysfunction, hospitalisation, and death. Invasive biopsy is still considered the gold standard method of monitoring rejection; however, besides the need for hospitalisation, common concerns are its complications and the high interobserver variability. Thus, noninvasive methods for monitoring allograft injury are of paramount importance. Donor-derived cell-free DNA (dd-cfDNA) characterizes graft injury, and it can be isolated from the recipient’s sera. Elevated dd-cfDNA levels precede the diagnosis of rejection on biopsy and possess high negative predictive value. We aimed to analyze the role of dd-cfDNA testing after solid organ (kidney, liver, heart, lung, and pancreas) transplantation and to present the first Hungarian results with the dd-cfDNA-based routine heart allograft rejection surveillance programme. Since October 2022, dd-cfDNA testing has been performed on 264 occasions in 46 heart transplant recipients. The amount of dd-cfDNA is measured relative to the total amount of cell-free DNA derived from a plasma sample. A dd-cfDNA level of ≥0.20% indicates injury, while severe injury threshold is at ≥0.35%. 80% of dd-cfDNA data points were below the injury threshold. Meanwhile, elevated dd-cfDNA values indicated 20 for-cause endomyocardial biopsies (EMB). Six heart allograft rejection episodes were diagnosed. Based on the dd-cfDNA levels, 232 EMBs, i.e., 88% of routine surveillance biopsies that would have otherwise been performed over 16 months were safely avoided. Since it has the potential to detect early signs of graft injury, it opens the door to earlier and more personalized titration of immunosuppressive therapy, thus avoiding its toxicities, more severe allograft rejection, and irreversible graft dysfunction. Orv Hetil. 2024; 165(33): 1275–1285.
A poszt-COVID–19-szindróma (long-COVID) tünetei és a rehabilitáció lehetőségei
Symptoms and options in rehabilitation of post-COVID–19 syndrome (long-COVID)
Today we live in the age of epidemics. More and more serious epidemics are appearing. Coronavirus disease 2019 (COVID–19) is a highly contagious disease caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2). The virus probably spread from bats to humans. One virus of Rhinolophus sinicus showed 80% similarity, while the virus strain of Rhinolophus affinis showed 96% similarity with SARS-CoV-2. Human-to-human transmission of the COVID–19 infection has led to the isolation of patients. Due to globalized travel, it has spread worldwide, the World Health Organization (WHO) declared it a pandemic, and today it is considered a major public health problem. Besides the acute symptoms after infection, patients and society are also being challenged by long-term health complications associated with COVID–19 including the post-COVID–19 syndrome, also known as long-COVID. Within the post-acute COVID–19 syndrome, two stages are distinguished: subacute COVID–19 between 4 and 12 weeks after acute infection and post-COVID–19 syndrome characterized by symptoms that persist beyond 12 weeks. It is characterized by a wide range of symptoms that affect several organ systems. Treatment of complaints consists primarily of symptomatic treatment and multidisciplinary rehabilitation. Vaccination against COVID–19 is one of the most important means of mitigating the pandemic. Extensive research in recent years has confirmed the effectiveness of the COVID–19 vaccines. International studies have shown that the vaccine has proven to be a protective factor against long-lasting COVID symptoms. In this review, the symptoms, epidemiology, transmission, pathogenesis of COVID–19 as well as the effects of the post-COVID–19 syndrome on certain organ systems, its rehabilitation, and the effect of vaccines on the development of symptoms are highlighted. Orv Hetil. 2024; 165(33): 1266–1274.
Pszichiátriai osztályon diagnosztizált, AIDS talaján kialakult progresszív multifokális leukoencephalopathia
Case report and literature review of AIDS-related progressive multifocal leukoencephalopathy diagnosed in a psychiatric department
Progressive multifocal leukoencephalopathy is caused by the reactivation of the John Cunningham virus, which occurs almost exclusively in immunocompromised patients. The symptoms of the disease are primarily determined by the localization of demyelinating lesions. In the early stages, the disease could be asymptomatic, and neurological symptoms appear later. Diagnostic methods primarily include imaging studies and the detection of viral DNA from cerebrospinal fluid. There is no specific therapy known; the goal is to restore immune system function. In our case study, we present the medical history of a patient observed in a psychiatric department, whose case was confirmed to be AIDS-related right hemispheric progressive multifocal leukoencephalopathy. Early differential diagnostic difficulties included pathological personality traits observed in the patient as well as a crisis state arising from situational difficulties and relationship loss. With this case, we aim to highlight the importance of psychiatric symptoms in immunocompromised patients. Orv Hetil. 2024; 165(33): 1295–1302.
Abstract
Background
Fertilization check performed at the 18th hour following classic in vitro fertilization procedure (IVF) or intracytoplasmic sperm injection (ICSI) is a critical stage in assisted reproduction. The success of the treatment is significantly reliant on the quantity of zygotes exhibiting two pronuclei. Consequently, low fertilization rates or complete fertilization failure are highly undesirable outcomes for both patients and reproductive specialists. Applying additional calcium ionophore for oocyte activation subsequent to ICSI may offer benefits and potentially enhance treatment outcomes, particularly for patients who have experienced low or absent fertilization rates (FR) in previous treatment cycles. The aim of the study is to evaluate the efficacy of Ca2+ ionophore application for oocyte activation.
Methods
A retrospective analysis of 924 oocytes obtained from 120 patients who underwent ICSI cycles with a history of low or no fertilization as a result of previous unsuccessful treatment rounds. The next ART cycle followed with additional oocyte Ca2+ ionophore activation applied in 57 of the cases in order to optimize the treatment process (Group 1), and 63 patients were included and their outcomes followed as a control group (Group 2).
We conducted a comparative analysis of results in both groups. The study's primary outcomes encompassed fertilization, cleavage embryo quality, blastocyst rate, and established clinical pregnancies.
Results
At day 1 fertilization check we had 274/386 zygotes (71%FR) in group 1 and 132/410 in group 2 (32.2%FR), (P < 0.0001). Twenty-two (34.9%) cycles in group 2 resulted in total fertilization failure (TFF). At the cleavage stage top-quality embryos from group 1 were significantly higher (P = 0.0021) in comparison to group 2. Forty-eight embryo transfers (ET) were performed in group 1 resulting in 41.67% clinical pregnancies versus 33 ET and only 4 pregnancies (12.12%) for group 2 (P = 0.0044).
Conclusions
The results confirm the appropriateness of assisted oocyte activation as an additional method in cases of previous fertilization failure cycles.
Abstract
Background
Psychedelic use and its impact on well-being is garnering a lot of research attention, however, little has been done to understand the potential associations between multiple characteristics of the psychedelic experience and psychological flexibility (PF), which encompasses a conscious awareness of thoughts and behavior, allowing individuals to adapt to new experiences and perceive multiple explanations or solutions for life events.
Aims
The current study examines the psychedelic correlates of PF. It was hypothesized that intention, comfort and safety during the experience, decentering, mystical experiences, ego-dissolution, and insight would be significantly associated with greater reports of PF.
Methods
Data used for the regression analysis were from 114 participants who had used one of the classic psychedelics (LSD, Psilocybin, Mescaline, DMT, Ayahuasca, 5MeO-DMT) and were recruited from postings on Twitter (now X) and within psychedelic-based groups on Facebook and Reddit to fill out an online survey. Standard assessments used include the Experiences Questionnaire, Mystical Experience Questionnaire, Ego-Dissolution Inventory, Cognitive Flexibility Inventory, Psychological Insight Questionnaire, and Religious Salience Scale.
Results
After controlling for sociodemographics (age, income, religious salience, number of psychedelic experiences), self-perceived meaningful intention and decentering remained significantly associated with greater psychological flexibility.
Conclusions
These results expand upon existing literature on psychedelic use and its impact on well-being by exploring specific characteristics of the psychedelic experience. Understanding the importance of intention and decentering can provide a pathway by which psychedelic users, guides, and researchers can further understand the psychedelic experience and its effects.
Abstract
Background and aims
Cognitive control and reward-related abnormalities are centrally implicated in addiction. However, findings from longitudinal studies addressing neurocognitive predictors of addictive behaviors are mixed. Further, little work has been conducted predicting non-substance-related addictive behaviors. Our study aimed to assess predictors of substance and non-substance addictive behaviors in a community sample, systematically evaluating each neurocognitive function's independent influence on addictive behavior.
Methods
Australians (N = 294; 51.7% female; M[SD] age = 24.8[4.7] years) completed online neurocognitive tasks and surveys at baseline and 3-month follow-up. Self-report scales assessed problematic alcohol use, addictive eating (AE), problematic pornography use (PPU), and problematic internet use (PUI) at 3- and 6-month follow-ups. Linear regressions with bootstrapping assessed neurocognitive predictors for each addictive behavior across a 6-month period.
Results
Neurocognition at baseline did not predict AE or PUI severity at 6-month follow-up. Less delay discounting at baseline predicted higher PPU at 6-month follow-up (β = −0.16, p = 0.005). Poorer performance monitoring at baseline predicted higher AE at 3-month follow-up (β = −0.16, p = 0.004), and more reward-related attentional capture at 3-months predicted higher AE at 6-month follow-up (β = 0.14, p = 0.033). Less reward-related attentional capture (β = −0.14, p = 0.003) and less risk-taking under ambiguity (β = −0.11, p = 0.029) at baseline predicted higher PUI at 3-month follow-up. All findings were of small effect size. None of the neurocognitive variables predicted problematic alcohol use.
Discussion and conclusions
We were unable to identify a core set of specific neurocognitive functions that reliably predict multiple addictive behavior types. However, our findings indicate both cognitive control and reward-related functions predict non-substance addictive behaviors in different ways. Findings suggest that there may be partially distinct neurocognitive mechanisms contributing to addiction depending on the specific addictive behavior.
Abstract
Background and aims
Neurobiological models of addiction posit that addiction manifests through an amplified salience towards addiction-associated stimuli and a diminished responsiveness to non-addiction-related incentives. However, existing research on reward processing in individuals with problematic pornography use (PPU) has primarily been limited to sexual cue reactivity.
Methods
In this event-related potential (ERP) study, we employed a risky decision-making task involving 30 individuals with PPU and 33 healthy controls (HCs) to examine the effects of PPU on non-pornographic (money) reward valuation.
Results
Compared to HCs, individuals with PPU exhibited compromised sensitivity to monetary rewards. Specifically, while the HC group demonstrated a differential response in late positive potential (LPP) amplitude to various expected value (EV) levels, this pattern was absent in the PPU group. This impairment was associated with poorer adaptive decision-making, as evidenced by PPU participants' inability to adjust risk choices based on changes in EV, leading to a propensity for riskier decisions in disadvantageous situations.
Discussion and conclusions
The findings of impaired monetary evaluation in individuals with PPU may potentially explain why they continually pursue pornographic rewards while showing insensitivity to other rewards in daily life. Consequently, treatment development strategies may prioritize improving sensitivity to non-pornographic rewards within this population.
Abstract
Background
Although family history of psychiatric disorders has often been considered potentially useful in understanding clinical presentations in patients, it is less clear what a positive gambling family history means for people with gambling disorder. We sought to understand the clinical impact of having a first-degree relative with gambling disorder in a sample of adults with gambling disorder.
Methods
Data from 455 participants (aged 18–65 years) who had participated in previous pharmacological and psychotherapeutic clinical trials for gambling disorder were pooled in a secondary analysis. Demographic and clinical variables were compared between those who did versus did not have one or more first-degree relative(s) with gambling disorder. Additionally, we examined whether a family history of gambling disorder was associated with treatment outcome.
Results
223 (49.0%) participants had at least one first-degree family member(s) with gambling disorder. In terms of clinical variables, family history of gambling disorder was significantly associated with being female, having an earlier age of gambling onset, longer duration of untreated gambling illness, a greater likelihood of developing legal problems secondary to gambling, and higher rates of alcohol use disorder in family members. Family history of gambling disorder was also associated with a greater gambling symptom improvement from pharmacotherapy.
Conclusions
These results indicate that gamblers with a first-degree family member with a gambling disorder may have a unique clinical presentation and better response to treatment interventions.
Abstract
There are increasing number of clinical cases with physician-modified endograft (PMEG) endograft for urgent reconstruction of large pararenal aneurysms to reduce the perioperative complication risks of fragile patients, but the risk of spinal cord ischemia due to the coverage of longer segment of thoracic aorta is relatively high.
We demonstrate an expedited endovascular treatment of an 88 mm pararenal aneurysm by performing a 4-vessel fenestrated endovascular aortic repair. A prominent Adamkiewicz artery, ectatic supraceliac aortic segment, median arcuate ligament compression of the celiac artery and severe tortuosity of the common iliac arteries made the endovascular repair more challenging. A PMEG was implanted with simultaneous deployment technique to achieve a short proximal landing zone to preserve the Adamkiewicz artery.
The proper risk assessment and preparation of the patient based on the clinical evaluation and procedure planning is essential for the clinical success of PMEG in urgent indication.
Abstract
Selenium (Se) is an essential trace element. Depending on concentration, Se can manifest both beneficial and harmful effects on the cell and can have both oxidative and antioxidant effects. Because the therapeutic index for Se is very narrow and it can depend on the form of Se used, we aimed to investigate the potential safety and side effects of inorganic Se on kidney function and structure in rats. After 8 days of treatment, no detectable signs of microscopic changes or oxidative stress in kidney tissue were observed. We detected a moderate increase in urea and creatinine levels in the blood as a sign of a slight decrease in kidney function. The most notable changes in our study were morphometric alterations in proximal tubules and glomeruli, both of which were considerably enlarged. The short-term application of inorganic Se to rats in a supratherapeutic dose induced mild functional and ultrastructural changes in the kidneys. The dose of inorganic Se used could be considered relatively safe for short-term application in situations where Se could be beneficial to the organism, such as the usage of known nephrotoxicants or high levels of oxidative stress in the body.
Abstract
Objective
Corpus luteum is a transient structure which plays an important role by producing crucial hormones required for conception and pregnancy maintenance. The objective of this study was to compare grey scale morphological appearances and Doppler indices of corpus luteum in normal and abnormal pregnancies during first trimester.
Methodology
A comparative study was carried out after getting approval from Institutional Research Ethical Committee. A total of 156 pregnant women, 78 with normal and abnormal pregnancies each, with gestational age between 5 and 8 weeks were included in the study. Out of the abnormal pregnancies 52 (66.66%) were cases of threatened while 26 (33.33%) had missed abortion. Transvaginal ultrasound was used to assess the corpus luteum on gray scale and Doppler ultrasound.
Results
There was no significant difference between gray-scale sonographic appearances of normal and cases of missed and threatened abortion on Chi-square test. However, PI, RI and SD ratio showed significant difference between normal and cases of missed and threatened abortion on Kruskal- Wallis test.
Conclusion
Doppler indices recorded from the vasculature of corpus luteum can serve as an important indicator of the pregnancy outcome during early pregnancy.
Abstract
True aneurysms involving the branches of the subclavian arteries are rare clinical entities and often manifest with vague symptoms or incidental findings. Early diagnosis and treatment are imperative to prevent aneurysm rupture, which could result in life-threatening bleeding. Definitive diagnosis is established through computed tomography angiography or magnetic resonance angiography. In this case report, we present two cases: a right internal thoracic artery aneurysm and a right costocervical trunk aneurysm, both of which were successfully treated with endovascular procedures using vascular plugs via transradial access. Transradial access is notable for its lower rate of access-site complications compared to the traditionally used transfemoral access. Consequently, it allows for quicker patient mobilization and discharge. These cases underscore the feasibility and efficacy of endovascular treatment for such aneurysms, providing a safe alternative to surgical intervention. Individualized therapy and adequate follow-up are essential due to the rarity of these conditions.
Az intervertebralis porckorong degenerációja és diagnosztikai megközelítése – a kvantitatív MRI által kínált lehetőségek
Degeneration of the intervertebral disc and its diagnostic approach – the possibilities offered by quantitative MRI
Az ágyéki derékfájdalom világszerte a munkaképes korú populáció fogyatékosságának egyik fő oka, jelentős költségeket róva az egészségügyi rendszerekre. A fájdalom eredete a leggyakrabban az intervertebralis discus degenerációjára vezethető vissza. Ennek ellenére a fájdalom eredetének meghatározása az egyik legnagyobb kihívás a mindennapi orvosi gyakorlatban. Az intervertebralis porckorong morfológiája pontos jellemzésének képességével a mágnesesrezonancia-képalkotás (MRI) a leggyakrabban javallt és legfontosabb képalkotó diagnosztikai vizsgálat a derékfájásban szenvedő betegeknél. A derékfájás okának meghatározása azonban bonyolult. Számos különböző képi jellemző társulhat a derékfájáshoz, melyek gyakran derékfájás nélkül is jelen lehetnek. Az elmúlt években több MRI-szekvenciát fejlesztettek ki a deréktáji fájdalom eredetének diagnosztizálására. Közleményünkben áttekintjük a legújabb MRI-módszereket, amelyek képesek az intervertebralis discusok összetételében bekövetkező biokémiai változások jellemzésére. Ezek az eljárások segítséget jelenthetnek a discus degenerációjának és az ágyéki gerincfájdalom kapcsolatának pontos felderítésében. Orv Hetil. 2024; 165(32): 1227–1236.
Hanaoka Seishu (1760–1835) és a világ első, általános érzéstelenítésben végzett emlőeltávolítása Japánban, 1804-ben
Seishu Hanaoka (1760–1835) and the first mastectomy performed under general anesthesia in Japan, in 1804
Mesterséges intelligencia alkalmazása fogászati cone-beam számítógépes tomográfiás felvételek automatikus szegmentációjára
Automatic segmentation of dental cone-beam computed tomography scans using a deep learning framework
Bevezetés: A ’cone-beam’ (kúpsugaras) számítógépes tomográfiás (CBCT) felvételek szegmentációja során a síkbeli képekből álló adatokat három dimenzióban (3D) rekonstruáljuk. A szájsebészetben és a parodontológiában a digitális adatfeldolgozás lehetővé teszi a műtéti beavatkozások 3D tervezését. A leggyakrabban alkalmazott határérték-alapú szegmentáció gyors, de pontatlan, míg a félautomatikus módszerek megfelelő pontosságúak, de rendkívül időigényesek. Az utóbbi években a mesterséges intelligencián alapuló technológiák elterjedésével azonban mostanra lehetőség van a CBCT-felvételek automatikus szegmentációjára. Célkitűzés: A klinikai gyakorlatból vett CBCT-felvételeken betanított mélytanulási szegmentációs modell bemutatása és hatékonyságának vizsgálata. Módszer: A vizsgálat három fő fázisa volt: a tanuló adatbázis felállítása, a mélytanulási modell betanítása és ezen architektúra pontosságának tesztelése. A tanuló adatbázis felállításához 70, részlegesen fogatlan páciens CBCT-felvételeit alkalmaztuk. A SegResNet hálózati architektúrára épülő szegmentációs modellt a MONAI rendszer segítségével fejlesztettük ki. A mélytanulási modell pontosságának ellenőrzéséhez 15 CBCT-felvételt használtunk. Ezeket a felvételeket a mélytanulási modell segítségével, valamint félautomatikus szegmentációval is feldolgoztuk, és összehasonlítottuk a két szegmentáció eredményét. Eredmények: A mélytanulásos szegmentáció és a félautomatikus szegmentáció közötti hasonlóság a Jaccard-index szerint átlagosan 0,91 ± 0,02, a Dice hasonlósági együttható átlagos értéke 0,95 ± 0,01, míg a két modell közötti átlagos Hausdorff- (95%) távolság 0,67 mm ± 0,22 mm volt. A mélytanulásos architektúra által szegmentált és a félautomatikus szegmentációval létrehozott 3D modellek térfogata nem mutatott statisztikailag szignifikáns különbséget (p = 0,31). Megbeszélés: A vizsgálatunkban használt mélytanulási modell az irodalomban található mesterségesintelligencia-rendszerekhez hasonló pontossággal végezte el a CBCT-felvételek szegmentációját, és mivel a CBCT-felvételek a rutin klinikai gyakorlatból származtak, a mélytanulási modell relatíve nagy megbízhatósággal szegmentálta a parodontalis csonttopográfiát és az alveolaris gerincdefektusokat. Következtetés: A mélytanulási modell nagy pontossággal szegmentálta az alsó állcsontot dentális CBCT-felvételeken. Ezek alapján megállapítható, hogy a mélytanulásos szegmentációval előállított 3D modell alkalmas lehet rekonstruktív szájsebészeti és parodontalis sebészeti beavatkozások digitális tervezésére. Orv Hetil. 2024; 165(32): 1242–1251.
Mi állhatott a német labdarúgó-válogatott „berni csodája” mögött?
Az 1954. évi világbajnokság döntőjének orvosi vonatkozásai
What could be behind the “Bernese miracle” of the German national football team?
Medical aspects of the world cup final in 1954.
Az otosclerosis egy máig tisztázatlan eredetű csontanyagcsere-betegség, amely csakis humán temporalis csontban alakít ki apró csontátépüléssel járó gócokat. Ezek az elváltozások a leggyakrabban az ovális ablakfülke elülső részén és a stapestalpban alakulnak ki, és mechanikailag fixálják a hallócsontláncolatot, következményes vezetéses halláscsökkenést okozva ezzel. Az otosclerosis kezelésével kapcsolatban természetes igény, hogy különféle gyógyszeres terápiás lehetőségekkel próbáljuk visszafordítani a betegséget, ez idáig azonban csupán a csontátépülést sikerült lelassítani. A nátrium-fluorid- és a biszfoszfonátkezelés igen ígéretesnek mutatkozott, súlyos mellékhatásaik miatt azonban alkalmazásuk csak kivételes esetekben jöhet szóba. A célzott (biológiai) terápiákhoz nagy reményt fűznek, ezeket azonban Magyarországon még nem engedélyezték. Az otosclerosis terápiájának „gold standard” eljárása a sebészi megoldás, mely nem a betegséget gyógyítja meg, pusztán a halláscsökkenés vezetéses komponensét küszöböli ki. A régebbi műtéti technikát, a stapedectomiát egyre inkább felváltja a technikailag egyszerűbb stapedotomia, ám mindmáig szinte ekvivalens eljárásnak tekinti őket a szakirodalom. A szokványos mikroszkópos stapessebészet mellett külön bemutatjuk a legmodernebb endoszkópos stapedotomiát is. Orv Hetil. 2024; 165(32): 1237–1241.
Terápiás kihívások nehezen kezelhető, penetráló Crohn-betegségben – multidiszciplináris megoldás
Therapeutic challenges in difficult-to-treat, penetrating Crohn’s disease – a multidisciplinary approach
A rectovaginalis fistula a penetráló Crohn-betegség ritka szövődménye, jelenléte esetén a gyógyszeres kezelés és a sebészeti beavatkozás együttes alkalmazása javasolt. Habár perianalis sipollyal szövődött Crohn-betegség esetén a TNFα-blokkolók hatékonyak lehetnek, rectovaginalis fistula esetén kisebb hatékonyság mutatkozik, feltehetően anatómiai okok, valamint a gyulladás talaján megváltozott szövetekbe történő csökkent penetrációs készség miatt. Az újabb biologikumok és kis molekulájú szerek hatékonyságáról és biztonságosságáról penetráló Crohn-betegségben kevés adat áll rendelkezésünkre. Esetünk egy fiatal penetráló Crohn-beteg nőről szól, aki közepesen súlyos/súlyos betegségaktivitás és kiújuló rectovaginalis fistula miatt több vonalbeli biológiai kezelésben részesült. Ultimum refugiumként deviáló ileostoma képzése történt, illetve upadacitinib indult ötödik terápiás vonalként. 12 hetes indukciót követően a rectovaginalis sipoly teljes bezáródását, valamint a vastagbél teljes szakaszán komplett nyálkahártya-gyógyulást tapasztaltunk. Az ileostoma zárását aktivitásfokozódás vagy fistulakiújulás nem követte. A szelektív JAK1-gátló upadacitinib hatékonynak mutatkozott stomaképzést követően, nehezen kezelhető, közepesen súlyos-súlyos luminalis aktivitást mutató, recidív rectovaginalis fistulával szövődött Crohn-betegségben. Orv Hetil. 2024; 165(32): 1252–1257.
Myeloma multiplex: a jelen kihívásai és a korszerű ellátás feltételei II.
A hazai myelomaellátás értékelése egészségpolitikai és egészség-gazdaságtani szempontok szerint
Multiple myeloma: Current challenges and prerequisites for modern healthcare II.
Assessment of myeloma care in Hungary from a health policy and health economics perspective
A myeloma multiplex kezelése az elmúlt években számottevően változott köszönhetően a diagnosztikai eljárások fejlődésének, az indikációban törzskönyvezett korszerű készítményeknek. A betegség kezelésében tapasztalható folyamatos innováció, a legújabb klinikai vizsgálati eredmények és valós életbeli adatok, továbbá a nemzetközi irányelvek követése ugyanakkor Európa-szerte kihívás elé állítja a finanszírozókat, döntéshozókat.
A Myeloma multiplex: a jelen kihívásai és a korszerű ellátás feltételei áttekintő tanulmány elkészítésével célunk egy rendszerszemléletű javaslati anyag kidolgozása volt, amely az ellátás minden területét érintve átfogó értékelést nyújt, kitérve a lehetséges beavatkozási pontokra.
Jelen közlemény a myeloma multiplex korszerű kezelési elvei, a Magyarországon elérhető terápiák és kielégítetlen szükséglet továbbá a magyarországi betegellátásban mutatkozó főbb kihívások, szűk keresztmetszetek alapján elemzi a hazai myelomaellátást, amely alapján széles körű javaslatok készültek a magyarországi ellátás fejlesztésére.
