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
Dr. Steinberger Sarolta (1875–1966) és az ártatlanság vélelme
Sarolta Steinberger, MD (1875–1966) and the presumption of innocence
A virtuális valóság használatának lehetőségei gyermekek perioperatív ellátásában
The potentials of virtual reality in pediatric perioperative care
Each year, millions of children worldwide undergo general anesthesia for various surgical or diagnostic procedures. In Hungary, approximately 20,000 to 30,000 children are treated in pediatric surgical centers annually, and additional 5,000 to 10,000 children undergo operation in adult otolaryngology departments. Treating children is a challenge, as their cognitive and emotional development levels may pose difficulties for them in understanding the procedures ahead and may make the processing of the stressful experiences of the intervention uncertain. Preoperative anxiety can often lead to increased postoperative pain, confusion, extended hospital stays, and undesirable behavioral changes. Various methods are available to manage perioperative anxiety and pain (such as administering anxiolytics as premedication, allowing parental presence during anesthesia induction, and postoperative pain relief). Although distraction methods like music or cartoons have proven effective, pharmacological treatment remains the gold standard. The use of newer, alternative solutions (such as psychoeducation or virtual reality) has not yet become part of routine practice. Virtual reality is a new, innovative tool that offers an immersive, three-dimensional audiovisual experience, diverting children’s attention away from unpleasant experiences. The use of virtual reality in pediatric settings is particularly promising, as children’s attention can easily be engaged through virtual games, reducing the anxiety and pain caused by medical procedures. This article presents the pediatric applications of virtual reality and the possibilities of its use in procedural and perioperative environments based on literature data, in relation to the fact that personal experience with the method has begun at the Pediatric Center of Semmelweis University. Orv Hetil. 2025; 166(2): 50–59.
Abstract
Background and aims
Uncontrollable gaming behavior is a core symptom of Internet Gaming Disorder (IGD). Attentional bias towards game-related cues may contribute to the difficulty in regulating online gaming behavior. However, the context-specific attentional bias and its cognitive mechanisms in individuals with IGD have not been systematically investigated.
Methods
We compared individuals with IGD to healthy controls (HC) using a rapid serial visual presentation (RSVP) task to measure temporal attentional bias. By applying game-related and neutral stimuli as targets, we specifically assessed how attentional resources were allocated to game-related stimuli compared to neutral stimuli.
Results
The IGD group showed enhanced attentional blink effect when a game-related stimulus was the first target and a neutral target was the next, reflecting IGD's difficulty in disengaging from game-related stimuli. Both IGD and HC individuals exhibited decreased accuracy in identifying a neutral first target followed by a game-related second target at shorter lags, indicating increased attentional engagement with game-related stimuli in general.
Discussion
The results provide a cognitive basis for recurrent and uncontrollable gaming behaviors in individuals with IGD. Game cues have priority in the allocation of attentional resources in individuals with IGD. The results shed new light on the development of specific treatments for IGD.
Abstract
Background and aims
Internet gaming disorder (IGD) is a highly engrossing activity with the individual spending up to 10 h per day gaming, this causes issues in accomplishing their tasks and personal goals. Also, to generate in them increased anxiety, impulsivity and lack of social skills, this impacts the good personal development and individual's quality of life. Therefore, it is vital to better understand, in terms of treatment, which factors are associated with therapeutic outcomes (largely to achieve control over the use of video games and the lack of relapses) following a standardized Cognitive Behavioral Therapy (CBT) protocol. This study aimed to explore sociodemographic and personality variables and their relation to treatment outcome in patients with IGD.
Method
The sample included n = 105 patients with IGD, considered between January 2005 and December 2022 and recruited from the Behavioral Addictions Unit at the University Hospital of Bellvitge. Data at baseline was registered (sociodemographic and clinical measures), as well as the therapy outcomes (compliance with the guidelines, presence of relapses and dropouts).
Results
Patients were mainly males (n = 95) with a mean age of 24.97 (SD = 12.03). All patients included in this sample had individual CBT treatment in relation to their problematic gaming behavior. In terms of patients who relapsed, they had higher interpersonal sensitivity, hostility and persistence with lower self-directedness. Patients who dropped out were males with an older age of IGD onset. When looking at treatment noncompliance, it was related to higher psychoticism and reward dependence, and lower cooperation. Patients with IGD show higher levels of treatment noncompliance.
Conclusion
These findings evidence a positive and promising effect of CBT on IGT. The factors identified as predictors of good and poor treatment outcomes should be considered for developing new evidence-based interventions focused on learning healthier key coping strategies to manage both cravings and triggers.
Abstract
Background
During the development of addictive behaviors, theoretical models assume a shift from experience of gratification being a driver in early stages to experience of compensation which dominates at later stages of addiction development. Initial studies show a trend in this direction; however, this shift has not yet been investigated in clinical samples. We assume experienced gratification to be highest in individuals with risky use (indicating the beginning of the addiction process), and compensation to be highest in individuals with pathological use.
Methods
Data from 834 participants from a multi-center study (FOR2974) investigating specific Internet-use disorders (IUDs) including gaming, buying-shopping, pornography use, and social-network use disorders were analyzed about Experience of Gratification (EGS) and Experience of Compensation (ECS), symptom severity, use expectancies, and usage motives. A diagnostic interview based on DSM-5 criteria for gaming disorder was used to classify individuals into either non-problematic, risky, or pathological use group.
Results
The groups (non-problematic, risky, pathological) differed significantly regarding EGS and ECS. Individuals with pathological use reported highest experiences of compensation but equally high experienced gratification as individuals with risky use. Effects vary with respect to the specific behavior. All measures correlated significantly. Symptom severity was most strongly associated with facets of compensation.
Conclusion
The experience of gratification and compensation appear to be crucial for addiction-like Internet use. Experienced gratification is already high in individuals experiencing first negative consequences and appear to be stable in individuals with pathological use indicating the relevance of both positive and negative reinforcement during the addiction processes.
Abstract
Background and aims
The inclusion of gaming disorder as a new diagnosis in the 11th revision of the International Statistical Classification of Diseases (ICD-11) has caused ongoing debate. This review aimed to summarise the potential neural mechanisms of gaming disorder and provide additional evidence for this debate.
Methods
We conducted a comprehensive literature review of gaming disorder, focusing on studies that investigated its clinical characteristics and neurobiological mechanisms. Based on this evidence, we further discuss gaming disorder as a psychiatric disorder.
Results
The present review demonstrated that the brain regions involved in gaming disorder are related to executive functioning (e.g., anterior cingulate cortex and dorsolateral prefrontal cortex), reward systems (e.g., striatum and orbitofrontal cortex), and emotional regulation (e.g., insula and amygdala). Despite the inclusion of gaming disorder in the ICD-11, the debate remains on the benefits and harms of classifying it as a mental health disorder. Opponents argue that the current manifestations that support gaming disorder as a psychiatric disorder remain inadequate, it could cause moral panic among healthy gamers, and that the label of gaming disorder is stigmatising.
Discussion
Evidence suggests that gaming disorder shares similar neurobiological alterations with other types of behavioural and substance-related addictions, which further supports gaming disorder as a behavioural addiction. Ongoing debates on whether gaming disorder is a psychiatric disorder push for further exploring the nature of gaming disorder and resolving this dilemma in the field.
Belszervi perforációk IV-es típusú Ehlers–Danlos-szindrómában szenvedő gyermekben
Visceral perforations in a child with Ehlers–Danlos syndrome type IV
The vascular type IV of Ehlers–Danlos syndrome is an autosomal dominant connective tissue disorder, the diagnosis of which is often delayed. Severe complications: arterial rupture or colon perforation may rarely occur already in childhood. We present a five-year-old child who developed bowel and bladder ruptures. He was admitted with severe abdominal pain and muscle defense. He had a history of chronic constipation, recurrent complaints of dysuria and suffusions. Based on clinical signs and imaging, acute surgery was indicated. A 3 mm perforation was found at the rectosigmoid part of the bowel. Weakness of the bowel due to chronic constipation, Hirschsprung’s disease, abuse, inflammatory bowel disease and connective tissue disorder have been raised as possible diagnoses. The excessive connective tissue fragility in several family members raised the possibility of Ehlers–Danlos syndrome. Indeed, a missense COL3A1 variant (p.Arg449Leu) was identified that segregated with the disease in the family. Six months later, a bladder diverticulum was found by cystoscopy. Spontaneous bladder rupture occurred on the fourth postoperative day. After suturing the defect, the child completely recovered. Ehlers–Danlos syndrome may present as a life-threatening condition already in childhood. It is important to recognize this rare genetic disorder and follow up the patient. Patients should avoid exertion. Colonoscopy and cystoscopy are relatively contraindicated. Orv Hetil. 2025; 166(1): 27–32.
A genetikai eredetű gyermekkori krónikus cytopeniák felismerése a molekuláris medicina érájában
Klinikai ajánlás és metodikai útmutató
Identification of genetically determined chronic childhood cytopenia in the era of molecular medicine
Clinical recommendation and methodical considerations
The vast majority of childhood cytopenias are transient, mostly secondary, and not the consequence of primary bone marrow processes. Yet, every few months we see patients in the pediatric hematology centers of the Hungarian Pediatric Oncology Network in whom repeated bone marrow sampling and extensive laboratory hematological investigations do not lead to a diagnosis and the cytopenia persists chronically. In these cases, the identification or exclusion of genetically determined benign or premalignant hematological conditions – such as congenital neutropenia, hereditary hemolytic or dyserythropoietic anemia, inherited thrombocytopenia, congenital bone marrow failure syndrome – is essential for modern therapy planning. In correctly selected pediatric patients with chronic cytopenia, modern high-throughput molecular genetic testing by next-generation sequencing is the most cost-effective diagnostic option, and its early use avoids many invasive interventions and inappropriate therapeutic attempts. At the initiative of Semmelweis University, a national molecular genetic diagnostics program was launched to map the etiology, epidemiology and prognosis of hereditary chronic cytopenias in children in Hungary. In the present work, we summarize the technical details of the testing modality and the indications we propose to apply in clinical practice. As a proof of concept, we present a discovery cohort of 30 patients selected according to these indications: 67% of them were identified with a gene variation that at least partially explained the phenotype, 47% with a variation that revised the diagnosis initially assumed by the treating physician, and 43% with a variation that determined the next substantive therapeutic decision. Of these, 45% were likely pathogenic or pathogenic aberrations and 55% were variants of unknown clinical significance. We propose to consider and apply this high-throughput molecular genetic modality, which generates significant clinical benefit and has a high diagnostic success rate according to our own and international data presented, as a priority element of the hematological diagnostic workflow in our country, within a regulated, professional framework. Orv Hetil. 2025; 166(1): 3–19.
Gyógyszerrezisztens epilepsziás betegek pszichológiai vizsgálata: affektív tényezők és társas támogatás
Psychological assessment of drug-resistant epilepsy patients: affective factors and social support
Introduction: Epilepsy is a chronic brain disease, which is basically treated with antiepileptic drugs. Objectives: The aim of our study was to map the social support of drug-resistant epilepsy patients and to examine and compare affective factors, including depression and anxiety, with healthy controls. Methods: A total of 34 subjects (22 women and 12 men; age range: 21–66 years [M = 43.1, SD = 14.0]) were included in our study. 17 drug-resistant epilepsy patients (13 women and 4 men; age range: 21–66 years [M = 46.6, SD = 13.5]) and 17 matched control subjects (9 women and 8 men; age range: 23–59 years [M = 39.6, SD = 14.1]) participated in the study. Questionnaires used were Hospital Anxiety and Depression Scale (HADS), Caldwell’s Social Support Questionnaire (SDS). Results: In the study sample, the level of depression and the level of social support showed an inverse correlation. Higher levels of depression were significantly related to lower levels of social support: difficult life situation (rs [15] = –0.498, p<0.003), practical support (rs [15] = –0.622, p<0.001), and the number of people the subject was in contact with (rs [15] = –0.513, p<0.002). There was a significant difference in the HADS total score between people with drug-resistant epilepsy and controls (t [24.4] = 3.40, p = 0.002, d = 1.16). Discussion: The maintaining and helping role of the social environment is essential in chronic drug-resistant epilepsy. In the absence of social support, the rate of depression increases significantly, which further deteriorates the quality of life of patients. Conclusion: The results of the present pilot study highlight the relevance of this problem, which may facilitate a detailed neuropsychological diagnosis of drug-resistant epilepsy patients, thereby increasing therapeutic efficacy. Orv Hetil. 2025; 166(1): 20–26.
A felnőtt korú cukorbetegek laboratóriumi vizsgálatainak elemzése hazánkban
Retrospektív kohorszvizsgálat a 2014–2021 közötti igénybevételi adatok alapján
Analysis of laboratory tests in adults with diabetes in Hungary
A retrospective cohort study based on administrative data from 2014 to 2021
Introduction: Diabetes remains a significant healthcare burden despite declining incidence. However, a systematic, nationwide assessment of the care routine is lacking. Objective: To evaluate diabetes care practice in Hungary using laboratory test completion data as reflected in available administrative data. Methods: Using administrative data from the National Health Insurance Fund (2010–2021), we performed a retrospective cohort study to analyze the completion rates of laboratory tests, as recommended by clinical guidelines, among diabetes patients in 4 cohorts over a 4-year follow-up period. Multivariate logistic regression analysis was used to identify factors associated with test completion. Results: 128,115 patients were included. Over 70% had blood glucose and serum creatinine tests in at least 3 different years over the 4-year period, while HbA1c, urinary glucose, and urinary ketone tests were performed in 50–60%. LDL-cholesterol or urinary albumin testing was <30% within the 4 years following the first antidiabetic medication initiation. Testing rates declined during the pandemic (2020–2021). Testing was less likely among men, younger age groups, and those on metformin and/or sulfonylurea only. Results showed a declining trend over time. Discussion: Our findings highlight the need for clearer roles and responsibilities in diabetes care, the provision of information technology tools, reminder systems, and sufficient capacity to facilitate laboratory testing and better patient education. Limitations include lack of access to test results, private and point-of-care testing data. Conclusions: In light of the current national clinical guidelines, an examination of relevant laboratory tests alone reveals that there are areas for improvement in the functioning of domestic diabetes care and the underlying data provision. The establishment of integrated care, the clear definition of tasks and responsibilities, the inclusion of point-of-care tests and laboratory tests results in data provision can significantly contribute to the development of diabetes care in our country. Orv Hetil. 2024; 165(52): 2047–2060.
