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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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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
Orvosi Hetilap
Authors:
Heléna Safadi
,
Judit Lám
,
András Tislér
,
Katalin Keresztes
, and
Éva Belicza

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.

Open access

A mély neuromuscularis blokk szerepe a laparoszkópos műtétek során

Irodalmi összefoglaló

Deep neuromuscular block in laparoscopic surgical interventions

Orvosi Hetilap
Authors:
László Asztalos
,
Zsolt Kanyári
,
Zoltán Szabó-Maák
,
Orsolya Farkas
,
Dezső Tóth
, and
Béla Fülesdi

With the increasingly dynamic spread of laparoscopic surgical techniques and related robot-assisted surgery, interdisciplinary cooperation is becoming increasingly important for patient safety. In the last decade, more and more clinical observations have suggested that the use of a deep neuromuscular block for laparoscopic interventions can be beneficial because it enables the use of lower intra-abdominal pressures and does not adversely affect the surgical field of view. The lower intra-abdominal pressure applied during the procedure creates more favorable hemodynamic and respiratory mechanical conditions in the intraoperative period and also reduces the postoperative pain associated with the procedure. In our paper, we summarize the available evidence regarding the use of deep neuromuscular block and the conditions for its safe use. Orv Hetil. 2024; 165(52): 2039–2046.

Open access

Mesterséges intelligencia az egészségügyi oktatásban: áldás vagy átok?

Artificial intelligence in health education: blessing or curse?

Orvosi Hetilap
Authors:
Erzsébet Horváthné Kónya
,
Andrea Virág
,
Patrícia Lajkó
,
Ádám Attila Szűcs
,
Dorina Markovics
,
Klára Gadó
, and
Zoltán Balogh

Introduction: ChatGPT is a large language model developed by OpenAI that has brought significant advances in natural language processing. With GPT-4.0, the model is capable of human-level conversations, which is particularly useful in education and research. In healthcare education, students can practice patient admission in virtual situations, receiving real-time feedback. It also allows the personalisation of educational materials, tailored to the individual needs of students. Objective: The aim of this study is to demonstrate the potentials of ChatGPT, i.e., the application of artificial intelligence in health education. ChatGPT allows the creation of virtual patients and simulations, through which students can practice patient admission and communication with patients of different languages in a realistic environment. Method: ChatGPT was used to create various simulations in health education. During the simulations, students received feedback in real time, and we were able to adapt the learning materials to the individual needs of the students. With ChatGPT, students practiced in situations where they faced different language challenges. During the simulations, we fine-tuned the artificial intelligence’s responses to make them more realistic and integrated empathy into the system. Results: Throughout the research, educational simulations were created using ChatGPT that improved students’ skills and increased their confidence. Students were able to complete nursing documentation independently without interacting with real patients. Discussion: The use of ChatGPT in education offers significant benefits, particularly in bedside teaching. Virtual simulations allow students to practice their skills in a safe and controlled environment, which increases their confidence and reduces anxiety. The use of information and communication technology tools captures students’ attention and interest. Conclusion: The introduction of ChatGPT into health education allows the preparation and presentation of varied practical situations, improving the quality of patient care. Further research is currently underway, including the possibility of using ChatGPT in speech therapy and patient education. It is extremely important that the senior instructors and teachers participating in the training are able to relate to the younger generation already living in the digital world. Orv Hetil. 2024; 165(52): 2061–2064.

Open access

Multilocularis prostata-cystadenoma és incidentális alacsony rizikójú adenocarcinoma együttes előfordulása fiatal férfi betegben

Co-occurrence of multilocular prostatic cystadenoma and incidental low-risk adenocarcinoma in a young male patient

Orvosi Hetilap
Authors:
Péter Czétány
,
Dániel Bányai
,
Levente Kuthi
, and
Dávid Semjén

In the background of the urinary symptoms of a young, 31-year-old male patient pelvic MRI revealed a multilocular cystic tumor measuring 7.6 cm in diameter on the right side of the pelvis. Given his symptoms and the possibility of malignancy, a transperitoneal laparoscopic resection was performed. Histological examination confirmed the diagnosis of prostatic cystadenoma, and an incidental finding of Gleason-grade 3 + 3 adenocarcinoma was also noted in a small focus. Postoperatively, the patient became completely asymptomatic, with neither urinary symptoms nor erectile/ejaculatory dysfunction. A follow-up MRI performed 3 months later showed no recurrence, and PSA levels showed significant regression. The patient continues to be monitored closely. The prostatic cystadenoma is an exceedingly rare benign tumor, with fewer than 50 cases reported to date. Preoperative diagnosis is challenging due to the nonspecific nature of its compressive urogenital and gastrointestinal symptoms. Basic investigations, such as physical examination, ultrasound and PSA testing, are often uninformative. More detailed diagnostic information can be obtained through higher-order imaging studies (CT, pelvic MRI) or cytological/histological sampling via fine needle or core biopsy. The treatment of prostatic cystadenoma is primarily surgical, involving resection or excision through various approaches (transurethral, laparoscopic, robotic, or open surgery). Complete removal of the tumor is crucial, as incomplete resection is associated with high rate of recurrence. Although prostatic cystadenomas typically exhibit indolent behavior, a case of concurrent high-grade prostatic intraepithelial neoplasia and a further description of conventional adenocarcinoma have been already published. This case is noteworthy as it represents the second documented co-occurrence of prostatic cystadenoma and adenocarcinoma (collision tumor), according to the current literature. Orv Hetil. 2024; 165(52): 2065–2071.

Open access
Open access

Dr. Jankó Albert Béla (1934–2024)

Dr. Albert Béla Jankó (1934–2024)

Orvosi Hetilap
Author:
Zoltán Papp
Open access

Epicutan próbák fogászati tesztsorokkal a COVID–19-járvány előtt és alatt a Közép-Magyarország régióban

Epicutaneous tests with dental materials before and during COVID–19 pandemic in the Central Hungary region

Orvosi Hetilap
Authors:
J. Mátyás Baló-Banga
,
Istvánné Szoboszlai
, and
Adrienne Vajda

Introduction: SARS-CoV-2 infection raids and the successive vaccination campaigns to combat them caused deep changes in the health status and the herd immunity of a given country or even in that of certain smaller geographical region’s population. Objective: The aim of these studies was the retrospective assessment of dental allergy testing by type IV in vivo cellular immune method, the epicutaneous tests. The question was raised in respect of pandemia-induced changes. Method: The 4 years’ period before COVID–19 pandemic was compared to the 3 years of COVID–19 burden based on numerous standard test series obtained from two central Hungarian sites. 45 patients before 2020 and 45 between March 2020 and September 2023 were enrolled in Budapest (capital city). There were 48 pre-COVID–19- and 55 COVID–19-related timely tested subjects in Fejér county (Székesfehérvár) involved as well. In both centers, every attending patient’s data were analyzed by Pearson’s correlation. Standard matching dentifrice-related test series (31 allergens) were used in both centers. In the North-Budapest area 11 781 test results were collected from the municipal hospital out-patient clinic of dermato-allergy and compared to 14 716 of a private clinic in Székesfehérvár. The data were analyzed by Pearson’s correlation. Results: In both centers and both timely intervals, the male to female ratio was about 1 : 5. All results have revealed that within those special target cohorts higher prevalence of positive results could be obtained as compared to standard general country-specific environmental test series, published for the area. Therefore, dental series followed more sensitively the changes emerging in the course of COVID–19 infection. Moreover, the results pointed to the increase of multiple sensitivities in both centers especially regarding metal allergies. Acrylate-related sensitization had shown similar outcome of lesser degree. Discussion: Out of the two centers, the Fejér county one was more prone to COVID–19-induced morbidity and mortality. At this site in addition, formaldehyde, a known constituent of facial masks and sensitivity to Myroxylon pereirae (Peruvian balm) widely used by the people in immune-enhancing natural products, teas and flavors yielded the highest sensitivity scores. Conclusion: During the COVID–19 pandemic, there was significant elevation of cellular hypersensitivity and polysensitization to dental materials. Hitherto no similar data in the literature accessible for us could be found. Orv Hetil. 2024; 165(51): 2015–2025.

Open access

A megromlott egészség okozta munkaidő-veszteség Magyarországon 2021-ben

Lost working time due to ill health in Hungary in 2021

Orvosi Hetilap
Author:
József Vitrai

Introduction: Deteriorating of workers’ health means reduced performance for the employers, lower incomes for workers and increased health care costs for the country. Objective: Examination of the loss of working time due to ill health in 2021, its gender differences and changes compared to 2019, and the differences of the Hungarian data compared to other countries. Methods: Working time loss in the 30–64 years age group was analyzed by the number of working days lost in 2021 due to disability and ‘premature’ deaths in the 30–64 years age group, and by the number of future working days lost by the deceased until retirement age. Data on disability and mortality were taken from the Global Burden of Disease Study database, and population and mortality data from the National Statistical Office and Eurostat. Hungarian data were compared with the corresponding figures for the Visegrad countries and Austria. Results: In the year 2021, 30–64-year-old workers lost one in seven working days, meaning they could not work at all for 37 working days. In addition, more than 117,000 years that could be worked until retirement were lost. For women, the loss of working time was due to disability, for men more to mortality. Compared to 2019, the number of working days lost per capita increased by 7% and the future loss of working days due to mortality by 40%. Hungary was similar to other countries in the number of days lost per capita due to limitation, but the number of deaths was much higher than in the others. Discussion: The female excess of disability and the male excess of mortality are assumed to be due to different attitudes towards disease: men perceive their health better and therefore use health care less often. The higher mortality in Hungary compared to other countries reflects the lower effectiveness of prevention and medical care. The high rate of deaths that can be prevented or avoided with medical intervention is largely due to deficiencies in the health system, and not to a low willingness to seek medical care. Conclusions: The results show that reducing time lost to work requires a different approach by gender. To mitigate losses, improvements in the effectiveness of public health and medical interventions are needed. Measures to promote healthy lifestyles and create an enabling environment are also essential to increase the country’s competitiveness. Orv Hetil. 2024; 165(51): 2026–2032.

Open access

A nagyérocclusióval járó ischaemiás stroke endovascularis ellátásának anesztéziája

Anesthesia of the endovascular treatment of ischemic strokes due to large vessel occlusion

Orvosi Hetilap
Authors:
Zoltán Szabó-Maák
,
Viktória Molnár
,
Balázs Kis
,
Ivett Belán
, and
Béla Fülesdi

Endovascular therapy for ischemic stroke with large vessel occlusion can be performed with either sedation without intubation or general anesthesia with intubation. According to current guidelines, decision should be made on individual basis, depending on clinical situation. Both methods have advantages and disadvantages, however, anesthetic practice varies from center to center and the nomenclature is often not uniform. In recent years, the term Monitored Anesthesia Care has been used worldwide in neurointervention to denote sedation and stabilization in urgent situations in a potentially unstable stroke patient. Since the introduction of endovascular therapy, studies comparing the two anesthetic techniques have yielded contradictory results so far, and in the meantime, the importance of anesthesia has been reassessed. In the years surrounding the introduction of mechanical thrombectomy in 2015, observational and retrospective studies have associated general anesthesia with worse functional stroke outcomes compared to sedation, mainly due to the associated time delay and more frequent hypotensive periods. Later randomized controlled trials designed to compare anesthetic methods showed no difference in outcome between general anesthesia and sedation. Moreover, concordant results of different trials showed that mechanical thrombectomy with general anesthesia had better recanalization rates, and some studies also reported better functional outcome. The true benefit of general anesthesia can only be realised in stroke centers where a neuroanesthesia team is continuously available, and also intrahospital care coordination and hemodynamic protocols are in place to minimize time delay and hypotensive period rates during general anesthesia. Orv Hetil. 2024; 165(51): 1997–2007.

Open access

A Streptococcus pneumoniae (pneumococcus-) infekciók megelőzése felnőttkorban

Prevention of Streptococcus pneumoniae infections in adults

Orvosi Hetilap
Authors:
Zsófia Mészner
,
Botond Lakatos
, and
Endre Ludwig

The authors believe that the renewal of the position paper, published 10 years ago, is justified for two reasons. Firstly, as a consequence of the global implementation of vaccination strategies and the coronavirus 2019 (COVID–19) pandemic, there has been a significant serotype shift in the distribution of Streptococcus pneumoniae infection epidemiology worldwide as well as in Hungary. On the other hand, new 15- and 20-valent conjugate vaccines have become available for prevention. Among respiratory tract infections, invasive pneumococcal infections continue to represent a significant burden of disease, typically among the youngest children under 5 years of age and older people, especially among those with other chronic underlying conditions. Furthermore, adults with certain chronic diseases and immunocompromised patients regardless of age are also more susceptible to invasive disease. The present position paper proposes prevention strategies for adults taking into account the epidemiological changes and recent international recommendations (World Health Organization [WHO], Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices [CDC–ACIP], Ständige Impfkomission, Standing Committee on Vaccination [STIKO]), in the light of currently available vaccines for the prevention of pneumococcal infections. Orv Hetil. 2024; 165(51): 2008–2014.

Open access