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.

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Journal of Psychedelic Studies
Authors:
Sara G. Gloeckler
,
Julien Thibault Lévesque
,
Alexandre Lehmann
,
Houman Farzin
, and
Kyle T. Greenway

Abstract

Music is integral to Psilocybin-assisted psychotherapy (PAP), believed to enhance therapeutic outcomes by structuring experiences and facilitating emotional expression. However, the effects of conducting PAP without music are underexplored. This study examines the experiences of two breast cancer patients undergoing psilocybin therapy under Canada's compassionate access program, specifically focusing on sessions that incorporated intentional periods without music. Patients had previously experienced psychedelics in therapeutic contexts but only with continuous music, as is common practice. Here, each patient participated in a 30-min silent period involving mindfulness exercises and therapist discussions. These periods of relative silence resulted in both challenges and benefits. One patient found that the absence of music was difficult initially, but that the relative silence allowed for engagement with mindfulness exercises that were experienced as highly meaningful. The other patient reported that music had evoked challenging past memories early in the dosing session, which were then productively explored with her guides during the subsequent period without music. These findings suggest that integrating silent intervals in PAP can enhance mindfulness practices and therapist-patient interactions, potentially offering distinct therapeutic benefits. Further research is necessary to delineate the differential impacts of music, silence, and guided activities in PAP, given that these three common treatment activities can be understood as both complementary and competing. Finally, we emphasize the importance of more detailed reporting on session components in psychedelic research publications, particularly regarding the balance between patients listening to music and interacting with their guides, which is often not clearly detailed in existing studies.

Open access

Abstract

Musico-healing practices play a key role in indigenous and mestizo traditional medicine in the Amazon. The curative songs or icaros used by the curanderos (traditional healers) of the Peruvian Upper Amazon are administered alongside the psychoactive plant decoction ayahuasca in ritual settings. This Interpretive Phenomenological Analysis examines musical experiences of 6 participants attending an ayahuasca ritual for personal and spiritual development at the Takiwasi Center in Peru in 2018. Findings offer pointers towards a neurophenomenology of musico-healing experiences with ayahuasca, suggesting that the conjunction of icaros and ayahuasca may contribute to psycho-neurobiological mechanisms of healing such as self-referential processing, decentering, and facilitating access to beneficial introspective/meditative states. The study offers a medical ethnomusicological contribution to the phenomenological mapping of musico-healing experiences of Amazonian curative songs under the altered state of consciousness (ASC) produced by ayahuasca.

Open access

Abstract

The incidence of lower respiratory tract infections (LRTIs) caused by multidrug-resistant organisms (MDRO) has been high in recent years. However, traditional etiological detection methods have not been able to meet the needs for clinical diagnosis and prognosis of LRTIs. The rapid development of metagenomic next-generation sequencing (mNGS) provides new insights for diagnosis and treatment of LRTIs. We conducted a retrospective study on 95 patients with lower respiratory tract infections caused by MDRO admitted to our respiratory department from January 2022 to December 2023. These patients underwent mNGS testing and conventional culture testing. Additionally, 150 patients without lower respiratory tract infections caused by MDRO during the same period were included as the non-MDRO group. General information was collected, and Logistic regression analysis was performed to identify risk factors for MDRO infections in patients with lower respiratory tract infections. Our results show that the time to pathogen detection by mNGS was 50.76 ± 1.730 h, that is significantly shorter than 55.53 ± 2.782 h required for conventional culture testing. The pathogen detection rate by mNGS was 89.47% (85/95), higher than the 67.37% (64/95) identified by conventional testing. In terms of pathogen genus distribution, mNGS detected a total of 279 pathogens, while conventional testing detected 121 pathogens. Logistic multivariate regression analysis identified that the use of more than two antibiotics, invasive procedures, invasive mechanical ventilation for ≥7 days, and stay in the respiratory intensive care unit (RICU) for ≥7 days were the main influencing factors for lower respiratory tract infections caused by MDRO (P < 0.05).

Open access

A D-vitamin-hiány mint a cerebrovascularis betegségek kockázati tényezője

Vitamin D deficiency as a risk factor for cerebrovascular diseases

Orvosi Hetilap
Authors:
Éva Pál
,
Zoltán Ungvári
,
Szabolcs Várbíró
,
Dániel Bereczki
, and
Zoltán Benyó

Vitamin D is a lipid-soluble steroid hormone whose role has been well-known in calcium and bone metabolism for a long time. In the last decades, vitamin D deficiency, which affects approximately 24% to 40% of the population, has been linked to the pathogenesis of cardiovascular disorders including cerebrovascular diseases, one of the leading causes of death worldwide. According to epidemiological studies, vitamin D deficiency is associated with an increased risk and more severe outcome of ischemic stroke, vascular cognitive impairment, and cerebral cavernous malformations. Although several consequences of vitamin D deficiency, such as endothelial dysfunction, increased oxidative stress, vascular permeability, and inflammation, are implicated in the pathogenesis of cerebrovascular disorders; the exact molecular pathomechanisms have not yet been fully elucidated. In addition, further research is needed to clarify the preventive and therapeutic potential of vitamin D supplementation in cerebrovascular diseases. This brief overview focuses on the effects of vitamin D on cerebral circulation and summarizes the molecular and functional changes characteristic of vitamin D deficiency, which may play a role in the development of cerebrovascular diseases. Furthermore, the role of vitamin D deficiency in the pathogenesis and progression of ischemic stroke, vascular cognitive impairment, and cerebral cavernous malformations is discussed in more detail. Understanding the complex role of vitamin D deficiency in these disorders may be important in the prevention and treatment of cerebrovascular diseases as vitamin D deficiency might be an easily modifiable cerebrovascular risk factor. Orv Hetil. 2024; 165(50): 1958–1968.

Open access

Idős emberek és gondozóik számára fejlesztett okosóra-alapú távgondozó rendszer terepvizsgálata és digitális naplóadatokra fókuszáló értékelése

Pilot-testing and log data focused evaluation of a smartwatch-based telecare system developed for older adults and their caregivers

Orvosi Hetilap
Authors:
Gabriella Tónay
,
Zoltán Dénes
,
András Tóth
,
Tamás Pilissy
,
Babett Tóth
, and
Gábor Fazekas

Introduction: As long as it is safely feasible, older adults should receive care assistance at home and during their life activities. In our research project, a telecare system (environmental sensors, smartwatch with custom application, web-based cloud service) developed for older adults and their caregivers was pilot-tested. Objective: We aimed to evaluate how much older adults and their caregivers can make telecare services a part of their lifestyle. We investigated whether digital log data correlates with the well-being and usability questionnaires. Method: The used telecare systems were installed in the homes of older adults over 65 living alone (care recipients) and their caregivers’ smart devices for 21 days. A questionnaire survey was conducted three times, while the log data were continuously recorded. Results: 25 care recipients, 25 caregivers, and one care organiser completed the pilot-test, all of whom reported a positive change in the sense of safety. In relation to the log data, the daily maximum averages of the heart rate in the age group over 76 years increased significantly (p = 0.025, r = 0.573), and the daily heart rate range also increased significantly (p = 0.023, r = 0.580). Among the correlations between the log data and the responses to the questionnaires, the strongest significant positive correlation was found in the results of the age group over 76 years, between the median change in the daily steps and the evaluation scale of the User Experience Questionnaire (p = 0.001, r = 0.732). Discussion: The log data characterized the changes in the lifestyle (activity, load capacity) of the care recipients over 76 years. Caregivers and care organisers found the telecare system useful. Conclusion: A limitation is that the 21-day test period is short to correlate the log data with all well-being and usability questionnaires. At the same time, through the log data, conclusions can be drawn regarding the change in the condition of the participants. Participants over 76 years had improved cardiac states; therefore, information and communication technology-based assistive technology services are also worth using for very old adults. Orv Hetil. 2024; 165(50): 1985–1996.

Open access

Szenvedélybetegek traumainformált ellátása

Indokoltság, elméleti háttér és nemzetközi kitekintés

Trauma-informed addiction care

Rationale, theoretical background and international perspectives
Orvosi Hetilap
Authors:
Sejla Gubucz-Pálfalvi
,
Tamás Kurimay
, and
Ildikó Danis

The links between adverse childhood experiences and trauma in later life and the development of addiction are well known and documented in the international literature. In many ways, the research of the past decades has clarified the neurobiological consequences of trauma, as well as the effects behind substance use disorders, and their close connections. The reform of addiction treatment and care, which would integrate this knowledge and follow international trends, seems to be still to come. A paradigm shift is needed both in prevention and in treatment. Service providers and professionals need to adapt treatment guidelines to the needs of the clients who are often traumatized while struggling with substance use disorders. In this way, re-traumatization can be avoided and the likelihood of relapse can be reduced. After presenting the theoretical background, our publication provides a comprehensive picture of trauma-informed care, and also presents a number of international good practices as examples. Orv Hetil. 2024; 165(50): 1975–1984.

Open access

Abstract

Klebsiella pneumoniae is a major pathogen associated with hospital-acquired infections, particularly those involving multidrug-resistant strains. Carbapenem resistance, often driven by carbapenemases such as KPC, VIM, OXA-48, and NDM, poses a significant challenge in clinical settings. This study reports on K. pneumoniae strain A165, isolated from a blood culture of a 51-year-old female patient hospitalized for respiratory distress post-SARS-CoV-2 infection. This K. pneumoniae strain exhibited resistance to several antibiotics, including carbapenems, cephalosporins, aminoglycosides, and fluoroquinolones, but remained susceptible to gentamicin, colistin, and trimethoprim-sulfamethoxazole. Next-generation sequencing was performed on Ion torrent platform, that revealed a genome size of 5,676,404 bp, including a chromosome and six plasmids. The strain was classified as sequence type 11 (ST11), a high-risk lineage associated with carbapenem resistance. The resistome of A165 included multiple β-lactamase genes, such as bla NDM-1 and bla OXA-48, as well as genes conferring resistance to other antibiotic classes. The virulome analysis identified genes involved in iron acquisition (yersiniabactin operon genes: ybtE, ybtT, irp1, irp2; aerobactin receptor: iutA), adhesion (mrkA-J, fimA-K), capsule and biofilm formation (rcsA, rcsB, ompA) and resistance to complement (traT) contributing to its pathogenic potential. The mobilome analysis revealed nine insertion sequences, including ISKpn1, ISKpn18, ISKpn43, ISKpn28, ISKpn14, ISEcp1, and IS6100. The strain also harbored six replicons: Col440II, ColRNAI, IncFIA(HI1), IncFIB(K), IncFII(K), and IncR, which are associated with the horizontal transfer of resistance and virulence genes. Comparative analysis with global isolates demonstrated the widespread dissemination of carbapenemase-producing K. pneumoniae, with notable occurrences in Europe, Asia, and the Americas. This study highlights the growing concern of multidrug-resistant K. pneumoniae in hospital settings and emphasizes the need for robust surveillance and infection control measures.

Open access

Abstract

Purpose

The aim of our study was to compare intraoperative complication rates in cataract surgeries performed by women and men surgeons and to analyse the possible impact of surgeon–patient gender difference on intraoperative complication rates in a tertiary eye care centre in Hungary.

Materials/Methods

This retrospective study looked at cases of cataract surgery involving phacoemulsification performed between January and December 2019. There were no exclusion criteria. In each case, patient demographics, patient clinical history, surgeon gender, case complexity, and operative details were reviewed. Primary outcomes included intraoperative complication rates.

Results

A total of 2,156 operations were included in the study, 1,295 (60.1%) of which were performed by men surgeons and 861 (39.9%) by women surgeons. The overall complication rate was 4.7% (n = 101). There was no significant difference (P = 0.728) in the intraoperative complication rate between the surgeries performed by women (n = 42, 4.9%) and men (n = 59, 4.6%) in either the simple (P = 0.214) or the complex (P = 0.508) cataract cases. Intraoperative complication rates were analysed in the two surgeon gender groups among both women and men patients. No significant difference was found in any of the compared groups.

Conclusions

Intraoperative complication rates were similar in the surgeries performed by women and men specialists. Our study showed that neither surgeon–patient gender difference nor surgeon–patient gender concordance had a significant impact on complication rates during phacoemulsification cataract surgery.

Open access

Abstract

Background and aims

Video games are a common form of entertainment in adolescents, which may result in gaming habits characterized by impairment to reward-related decision-making. The aim of the current study was to investigate the relationship between reward processing and symptoms of gaming addiction in adolescents.

Methods

Data from three consecutive follow-up years (years 2, 3 and 4) of the Adolescent Brain Cognitive Development (ABCD) Study were analyzed (n = 6,143, total observations = 12,745, mean age at year-2 = 12 years). Participants completed the Video Game Addiction Questionnaire (VGAQ) at each visit. Discrete stages of reward processing were measured at the year-2 visit using the Monetary Incentive Delay task while the participant completed a functional magnetic resonance imaging (fMRI) scan. Bayesian hierarchical linear models were employed to examine the longitudinal association between reward processing in regions of interest at year-2 and VGAQ scores over time.

Results

Lower activation in the bilateral caudate during the anticipation of a large reward (β = −0.87, 95% CI: −1.68, −0.07) was associated with greater VGAQ scores over time. This implies that for each one-unit increase in brain activity in the caudate, there was an associated 0.87-point decrease in symptoms of gaming addiction as measured by the VGAQ. No association was found between reward feedback and VGAQ scores.

Discussion and Conclusions

The findings suggest that abnormal reward processing in the caudate nucleus is associated with symptoms of gaming addiction in adolescents. These results provide a clearer understanding of the brain mechanisms involved in gaming addiction, which could inform future preventive and therapeutic strategies.

Open access