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
Background and Aim
Issues in patient positioning during chest X-ray (CXR) acquisition impair diagnostic quality and potentially increase radiation dose. Automated quality assessment was proposed to address this. Our objective is to determine thresholds on some quality control metrics following international guidelines, that represent expert knowledge and can be applied in a comprehensible and explainable AI approach for such an automatic quality assessment.
Materials and Methods
An AI-method estimating collimation distance to the ribcage, balancing between both clavicle heads, and number of ribs above the diaphragm as metrics for collimation, rotation, and inhalation quality was applied on 64,315 posteroanterior CXR images from a public dataset (ChestX-ray8). From this set 920 CXR images were sampled and manually annotated to gain additional trusted reference metrics. Seven readers from different institutions then classified the acquisition quality of these images independently into okay, inadequate, or unacceptable following the criteria of international guidelines. Optimal thresholds on the metrics were determined to reproduce these classes using the metrics only.
Results
A fair to moderate agreement between the experts was found. When disregarding all inadequate rates a classification on the metrics was able to separate okay rated cases from unacceptable cases for collimation (AUC
Conclusion
Suitable thresholds were determined to reproduce expert opinions in the assessment of the most important quality criteria in CXR acquisition. These thresholds were finally applied on the AI-method's estimates to automatically classify image acquisition quality comprehensibly and according to the guidelines.
Abstract
Background
This study contributes to the understanding of the efficacy, safety, and experience of ketamine-assisted therapy. The paper documents how individuals describe the effects of a protocolized and personalized use of ketamine (‘the relational dose’) in the context of group couples therapy based on Imago Relationship Therapy (IRT). Little is known about simultaneously administering ketamine to both members of a couple in this context, and no research to date has been published on whether ketamine facilitates couples to better engage in and benefit from the therapeutic process. The paper includes both qualitative and quantitative results.
Method
The study utilized a mixed methods approach. One approach was an inductive content analysis that produced overarching themes gleaned from participants' check-ins pre and post their weekly ketamine sessions. Transcripts were examined to better understand ketamine's effects on couples' ability to engage in therapeutic dialogue and resolve challenging relationship issues, as well as themes related to the non-ordinary-state-of-consciousness (NOSC) experience. The second approach involved the analysis of pre-test, post-test, and follow-up data from the Couples Satisfaction Index (CSI).
Results
The couples described a wide range of effects that ketamine produced in the context of their relational dialoguing including: empathogenic effects, mystical/spiritual/psychedelic experiences, anxiolytic and antidepressant effects. They also affirmed ketamine's ability to generate alternative perspectives, promote insight, heighten awareness, enhance vulnerability and communication, lower defenses, and produce novel somatic experiences. Participants' description of ketamine effects included its short duration, rapid onset, idiosyncratic sensitivity to dose, cumulative effects, as well as transient and mild side-effects. Several t-tests were statistically significant, and indicated improved relationship satisfaction following the treatment.
Conclusion
In the context of couples therapy, ketamine produced a wide range of therapeutic effects and possessed unique pharmacological properties as a rapid-acting novel psychoactive molecule. The drug may have profound therapeutic benefits when administered in the context of couples therapy, under clinical supervision, however more research should be carried out.
A csökkent ejekciós frakciójú szívelégtelenség gyógyszeres kezelésének változása és a prognózisra gyakorolt hatása a hazai gyakorlatban
The changes in the pharmacotherapy of heart failure with reduced ejection fraction and its effect on prognosis: experience in the Hungarian clinical practice
Introduction: According to the 2021 ESC Heart Failure (HF) Guidelines (GLs), the conventional triple therapy (TT) (RASi + βB + MRA) has been supplemented with the SGLT2i dapa-/empagliflozin as the fourth pillar of the quadruple therapy (QT) recommended for all patients with heart failure with reduced ejection fraction HFrEF. Objective: To assess the implementation and impact on the prognosis of the HFrEF QT (TT + SGLT2i) in the light of the 2021 HF GLs. Method: A retrospective data analysis of a consecutive cohort of HFrEF patients hospitalized for HF from 04/01/2021 to 12/31/2023 at our Institute was performed. The patients were classified into two groups: those hospitalized before and those after the publication of the 2021 ESC HF GLs. Differences in the implementation of the drug therapy were analyzed by the Fisher test. 1-year mortality was compared using Kaplan–Meier analysis and log-rank test. Results: A cohort of 346 patients (male: 76%, age: 61 [50–70] years, coronary artery disease: 46%, diabetes: 36%, atrial fibrillation/flutter: 42%, LVEF: 25 [20–30]%, estimated glomerular filtration rate: 57 [45–73] ml/min/1.73 m2; NT-proBNP: 4848 [2389–9307] pg/ml) was treated with a high proportion of TT (83%) and QT (51%) at discharge. After the publication of the 2021 ESC HF GLs, the proportion of patients on SGLT2i-s improved (19% vs. 60%, p<0.001; before vs. after the publication of the GLs), resulting in an increased proportion of patients on QT (19% vs. 54%, p<0.001). There was no significant difference between the groups regarding the use of TT (0% vs. 3%) or QT (0% vs. 2%) at target doses. 1-year mortality was more favourable in those receiving QT (12% vs. 13% vs. 32%, p<0.001; QT vs. TT vs. non-TT/non-QT). Conclusions: In the light of the 2021 ESC HF GLs, the introduction of SGLT2-s and the use of QT were feasible even in the everyday practice among HFrEF patients requiring hospitalization and were accompanied by better prognosis compared to those without TT/QT. Orv Hetil. 2024; 165(18): 698–710.
Diagnosztikus kihívások gastrointestinalis tünetekkel járó szisztémás mastocytosisban
Diagnostic challenges in systemic mastocytosis with gastrointestinal symptoms
Mastocytosis is a rare disease. The yearly incidence is 1/100,000 in the general population. The diagnosis is relatively simple when cutaneous manifestations are present, but there are cases when just the mastocyte activation syndromes might call attention on the disease. Symptoms might be diverse, varying case to case, involving different organs and are often considered as allergy. Symptoms come suddenly like flush, collapse, headache, pyrosis, watery diarrhoea that influence the life quality, but sting anaphylaxis might be life threatening if not treated immediately. With this case report, authors aimed to call attention to the importance to take bowel biopsy in cases of watery diarrhoea of non-infective origin even when the macroscopic picture of the bowel looks normal, as histological evaluation of the specimen might prove mastocytic infiltration. Orv Hetil. 2024; 165(18): 717–720.
Monogénesen öröklődő és szerzett autoinflammatoricus betegségek
Monogenic and acquired autoinflammatory diseases
Autoinflammation is a disorder of natural (innate) immunity, which can be monogenic, or acquired. Monogenic autoinflammatory diseases include inflammasomopathies, actinopathies, endoplasmic reticulum stress mutations, NFκB-associated diseases, interferonopathies, mutations in endogenous antagonist genes, and DADA2. Acquired autoinflammatory diseases include numerous inflammatory rheumatological diseases, intestinal, skin and bone diseases, as well as other conditions (e.g., VEXAS, IgG4-related disease, recurrent pericarditis, type 2 diabetes, interstitial lung disease). In this summary, we review the concept and main mechanisms of autoinflammation, the most important monogenic and acquired autoinflammatory conditions, the role of inborn errors of immunity in autoinflammation, as well as the possible therapeutic options. Orv Hetil. 2024; 165(18): 683–697.
Abstract
Introduction
Problematic usage of the internet (PUI) is an umbrella term for a range of uncontrolled, excessive, and potentially harmful online behaviors. Recently, numerous studies have examined the potential of mindfulness programs (MPs) for reducing PUI. We conducted a comprehensive systematic review and meta-analysis in this emerging field.
Methods
We searched eight databases from inception to October 18, 2022, with no language restrictions. We included randomized controlled trials (RCTs) and nonrandomized trials (NRTs). The primary outcome was change in self-reported PUI, the secondary outcome was change in screen time.
Results
Of 3,473 identified records, 19 RCTs and 20 NRTs with a total of 1,549 participants were included. Participation in an MP was associated with large reductions in PUI in between-group analysis in RCTs (k = 19; g = −1.67; 95% CI −2.15, −1.19) and in within-group pre-post analysis in all studies (k = 35; g = −1.67; 95% CI −1.99, −1.36). Screen time showed a medium reduction in within-group pre-post analysis (k = 10; g = −0.65; 95% CI −0.90, −0.41). The effects for PUI remained significant in a series of sensitivity analyses, such as excluding low quality studies, excluding outliers, adjusting for publication bias, or using follow-up data. Heterogeneity between studies was high and the overall quality of evidence was rated low.
Discussion and conclusions
MPs are probably effective in reducing PUI and might be effective in reducing screen time. Shortcomings in the quality of evidence highlight the need for high-quality controlled trials with long-term follow-ups to confirm results.
Abstract
Type 2 diabetes is a frequent chronic disease. Given its strong positive association with older age, it is a significant public health issue in elderly populations. Furthermore, the aging of the population, driven by increasing life expectancy in high and middle-income countries leads to an increasing prevalence of diabetes.
Although the same diagnostic criteria apply to the elderly and to younger people, there are unique aspects to the care for elderly type 2 diabetes patients. Both treatment goals and preferred medications, as well as non-pharmacological approaches should be adjusted in the elderly. For example, increasing the amount of physical activity may encounter difficulties, while introducing an appropriate diet may be more challenging. The patients' therapeutic adherence requires special attention due to cognitive and physical limitations. The most important treatment goal is to avoid hypoglycemia. Frailty, social and economic issues, comorbidities and the consequent polypharmacy frequently causing drug-drug interactions, as well as the increased danger of drug toxicity due to renal failure are only some of the problems that make the health care for old diabetes patients extremely difficult. Adequate care requires cooperation from a multidisciplinary team of health care professionals.
Acute diabetes complications have a higher mortality in the elderly, thus close attention must be paid to avoid them. Family members should be involved in the care of elderly diabetes patients, and it is recommended to educate them on clinical signs of complications. Regular care for the patients including feedback on quality of life and early signs of health issues are essential.
A COVID–19 elleni védőoltással kapcsolatos hiedelmek egészségkommunikációs szempontú elemzése a felnőtt magyar lakosság körében
Analysis of beliefs about COVID–19 vaccines among the adult Hungarian population from a health communication perspective
Bevezetés: A magyar lakosság az európai uniós átlaghoz képest kisebb arányban vette fel a COVID–19 elleni védőoltást. A hazai deprivált települések lakosainak körében az oltás felvétele pedig 38,2%-kal volt kisebb arányú az országos átlaghoz képest. Az oltási program egyik legfőbb akadálya a lakossági bizalmatlanság volt. Célkitűzés: A COVID–19-védőoltással kapcsolatos lakossági hiedelmek feltárása és a járvánnyal kapcsolatos tájékozódásra használt tömegmédiumok azonosítása. Módszer: Az elemzett adatok egy 2022. november 15–26. között zajlott keresztmetszeti, online kérdőíves felmérésből származnak. Az anonim adatfelvétel effektív mintaelemszáma 1222 fő volt. A COVID–19 elleni védőoltás elutasítását, szociodemográfiai változókat, 5 pozitív és 5 negatív, a védőoltással és a COVID–19-cel kapcsolatos attitűdállítást, valamint a járvánnyal kapcsolatos tájékozódásra használt tömegmédiumokra vonatkozó kérdéseket vontunk be a vizsgálatba. Frekventista statisztikai eszközöket és Hornik–Woolf-becslést alkalmaztunk. Eredmények: „A beoltottak védik a környezetükben élők egészségét is” állítással való egyetértés sikeres megerősítése érhette volna el a legnagyobb átoltottságnövekedést a magyar felnőtt lakosság körében. A válaszadók a tömegmédiumok közül a televíziót, az online hírportálokat, a kormányzati online kommunikációt, valamint a rádiót jelölték meg mint elsődleges információforrást. A zárt Facebook-oldalakon és a YouTube-on szignifikánsan több oltáselutasító tájékozódott, mint oltáselfogadó. Következtetés: A nemzetközi eredményekkel összhangban Magyarországon is a közösségi érdek és a felelősség hangsúlyozása lehetett volna a szerencsés általános megközelítés a COVID–19 elleni védőoltás felvételének tömegkommunikációjában. Jövőbeli átfogó lakossági oltási kampány előkészítéséhez többszintű egészségkommunikációs felmérés, tervezés és tesztelés ajánlható. Orv Hetil. 2024; 165(17): 664–671.
A gyermekkori alvászavarok háttértényezői: a szülők közötti konfliktusok, a szülő-gyermek kötődés, a nevelési stílus és a szülő-gyermek kapcsolat minősége
Background factors of childhood sleep disorders: interparental conflicts, parent-child attachment, parenting style and the quality of parent-child relationship
A szakirodalmi adatok szerint az egészségesen fejlődő gyermekek 20–30%-a megtapasztal valamilyen alvásproblémát gyermekkorban. Csecsemőknél és kisebb gyermekeknél az alváshiány és a fiziológiás alvási ritmus felborulása a nappali nyűgösség mellett hosszú távon hatással van a fejlődés minden területére (a mozgás-, a kognitív, a nyelvi készségekre és az emocionális fejlődésre is). Nagyobb gyermekeknél és serdülőknél ez rövid távon nappali fáradtsághoz és figyelemzavarhoz vezet, idővel azonban súlyosabb hatások is lehetnek, a szellemi és a fizikai teljesítmény csökkenésén át a hangulatingadozásig, sőt depressziós és szorongásos tünetek megjelenéséig. Ezért különösen nagy jelentősége van minden olyan környezeti tényező ismeretének, amelyet összefüggésbe hozhatunk a gyermekkorban megjelenő alvásproblémák kialakulásával. A jelen szakirodalmi összefoglaló célja átfogó képet adni azokról a kutatásokról, amelyek a gyermekek alvászavarait családi kontextusban vizsgálják, hiszen gyermekkorban a család funkcionalitása meghatározó tényező a gyermekek alvásának minőségét illetően. Az alvásproblémák megjelenésében a szülők közötti kapcsolat minősége, a szülők konfliktusmegoldó stratégiái, a szülői szerepükben való funkcionalitás, a szülők mentális egészsége, a gyermekkel kialakult kötődés minősége, a szülők nevelési stílusa, az esti, elalvási rituálék mind fontos szerepet játszanak. Figyelembe véve az alvásproblémák hosszú távú negatív következményeit, érdemes számba venni a hatékony intervenciós lehetőségeket. Elmondható, hogy amennyiben a szülő a gyermeke alvásproblémájával keresi fel orvosát, úgy érdemes nagyító alá venni a család funkcionalitását, a szülők párkapcsolati minőségét, a szülő-gyermek kapcsolat minőségét is. Ha ezeken a területeken derül fény problémára, akkor a szakorvosi kezelés mellett érdemes javasolni számukra a szülő-csecsemő/kisgyermek konzultációt, szülőkonzultációt, esetleg párterápiás, családterápiás lehetőségeket, a probléma teljes körű és hosszú távú megoldása érdekében. Orv Hetil. 2024; 165(17): 652–663.
