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Among all scientific traditions alive, medical publishing has a good chance to be the oldest. The first fully peer reviewed academic journal, “Medical Essays and Observations” was launched in 1731 by the Royal Society in Edinburgh. Since then, hundreds of medical journals have been published worldwide. Medical publication in Hungary started in 1857 when the famous physician, Markusovszky founded “Orvosi Hetilap”, which has been published since then every week (with short breaks during the world wars). It is now a most prestigious piece in AKJournals’ portfolio, listed in Journal Citation Reports, with a remarkable impact factor.

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Az anaemia gyakoriságának felmérése, osztályozása, prediktív tényezői gyulladásos bélbetegségben szenvedő betegekben

Anemia classification, prevalence and predictive factors in inflammatory bowel disease

Orvosi Hetilap
Authors:
Fruzsina Balogh
,
Dorottya Angyal
,
Andor Áron Ecseki
,
Zsófia Veronika Sebeszta
,
Lóránt Gönczi
,
Livia Lontai
,
Pál Miheller
,
Péter Lakatos
, and
Ákos Iliás

Introduction: Anemia is a common complication of inflammatory bowel disease and serves as an indicator of severe disease. Objective: This study aims to evaluate the prevalence, etiology, predictive factors, and treatment of anemia in patients with inflammatory bowel disease from two tertiary centers. Method: In this retrospective, cross-sectional study, we assessed the frequency of anemia among patients presenting within a specified calendar year (June 1, 2022, to May 31, 2023), focusing on the lowest hemoglobin levels recorded during this period. We collected demographic data, disease activity scores, treatment regimens, inflammatory markers, and laboratory parameters related to iron balance. Clinical disease activity was evaluated using the Crohn’s Disease Activity Index and the partial Mayo Score. The World Health Organization’s criteria were utilized for anemia classification and severity assessment. Absolute iron deficiency was defined as a serum ferritin level <30 µg/L, while anemia of chronic disease was defined as a ferritin level >100 µg/L in conjunction with clinical or biochemical evidence of active disease. Results: The study included 400 patients (277 with Crohn’s disease and 123 with ulcerative colitis). Among the Crohn’s disease patients, 17.7% exhibited complex disease behavior, and 40.7% of the ulcerative colitis patients had extensive colonic involvement. Biological treatments were administered to 75% of the participants. Anemia was identified in 32.5% (130) of the patient cohort, with 57% classified as mild, 35% as moderate, and 8% as severe. In the subset of non-macrocytic anemia (116 patients), iron status data were available for 51% (n = 66). Of these, 73% had iron deficiency anemia, 6% had anemia of chronic disease, and 17% had chronic disease with functional iron deficiency. Anemia predictors included steroid treatment (p<0.001; OR: 4.2), clinical disease activity (p<0.001, OR: 381), and laboratory markers of disease activity (p<0.001, OR: 2.9). Intravenous iron supplementation was administered to 43 patients, while 12 received oral iron supplementation. Conclusion: The findings highlight the high prevalence of anemia, predominantly iron deficiency anemia, among patients with inflammatory bowel disease, which is closely associated with clinical and laboratory markers of disease activity. This study underscores the importance of diagnosis, classification (through assessment of iron balance parameters), and treatment of anemia in patients with inflammatory bowel disease. Orv Hetil. 2025; 166(2): 60–66.

Open access

Dr. Steinberger Sarolta (1875–1966) és az ártatlanság vélelme

Sarolta Steinberger, MD (1875–1966) and the presumption of innocence

Orvosi Hetilap
Authors:
Dalma Bóka
,
Brúnó Zsák
, and
Éva Göndör
Open access

A virtuális valóság használatának lehetőségei gyermekek perioperatív ellátásában

The potentials of virtual reality in pediatric perioperative care

Orvosi Hetilap
Authors:
Sarolta Haiyen Trinh
,
Melinda Kis-Tamás
,
János Pápai
,
Attila Kálmán
,
Melinda Cserép
,
Ágnes Jermendy
, and
Balázs Hauser

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.

Open access

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.

Open access
Journal of Behavioral Addictions
Authors:
Rocio-Elena Ayala-Rojas
,
Magda Rosinska
,
Iván Perales Cárdenas
,
Jorge Soldevilla-Morera
,
Roser Granero
,
Fernando Fernández-Aranda
, and
Susana Jiménez-Murcia

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.

Open access
Journal of Behavioral Addictions
Authors:
Elisa Wegmann
,
Stephanie Antons
,
Lasse David Schmidt
,
Lena Klein
,
Christian Montag
,
Hans-Jürgen Rumpf
,
Silke M. Müller
, and
Matthias Brand

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.

Open access
Journal of Behavioral Addictions
Authors:
Yong-Bo Zheng
,
Sheng-Nan Zhang
,
Hua-Da Tang
,
San-Wang Wang
,
Xiao Lin
,
Yan-Ping Bao
,
Yu-Mei Wang
,
Mark D. Griffiths
,
Jie Sun
,
Ying Han
, and
Lin Lu

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.

Open access

Belszervi perforációk IV-es típusú Ehlers–Danlos-szindrómában szenvedő gyermekben

Visceral perforations in a child with Ehlers–Danlos syndrome type IV

Orvosi Hetilap
Authors:
Csilla Nagy
,
Eszter Jávorszky
,
Violetta Antal-Kónya
,
Tímea Köles
,
Imre Kiss
,
Kálmán Tory
, and
Attila Kálmán

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.

Open access

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
Orvosi Hetilap
Authors:
Bálint Egyed
,
Kristóf Árvai
,
Erik Zajta
,
Lajos Hegyi
,
Blanka Andrássy
,
Árpád Ferenc Kovács
,
Anna Bekő
,
Borbála Péterffy
,
Dániel János Erdélyi
,
Judit Müller
,
Andrea Békési
,
Krisztián Kállay
,
Vera Goda
,
Gergely Kriván
,
Eszter Tuboly
,
Krisztina Csanádi
,
Gábor Ottóffy
,
István Szegedi
,
Csongor Kiss
,
Csaba Bödör
,
Donát Alpár
, and
Gábor Kovács

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.

Open access

Gyógyszerrezisztens epilepsziás betegek pszichológiai vizsgálata: affektív tényezők és társas támogatás

Psychological assessment of drug-resistant epilepsy patients: affective factors and social support

Orvosi Hetilap
Authors:
Orsolya Csabai
,
Orsolya Kalmár
,
Enikő Tóth
,
Délia Szok
, and
Tímea Tánczos

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.

Open access