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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 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
Journal of Behavioral Addictions
Authors:
Jussi Palomäki
,
Tiina Latvala
,
Anne H. Salonen
,
Virve Marionneau
,
David Hodgins
,
Matthew M. Young
, and
Sari Castrén

Abstract

Background

The lower risk gambling guidelines (LRGG) represent an evidence-based collaborative effort to provide clear advice to people on the limits of safe gambling consumption. The guidelines are as follows: 1) Gamble no more than 1% of household income per month; and 2) Gamble no more than 4 days per month; and 3) Avoid regularly gambling at more than 2 types of games.

Methods

In an online survey study (N = 778), we evaluated the feasibility and acceptability of the LRGG among different subpopulations in Finland.

Results

We found that the guidelines were generally evaluated positively as understandable, sensible, clear, and “just right” in terms of their content. There were some notable differences between subpopulations: Individuals who were at risk of gambling problems evaluated the LRGG more negatively than others, while professionals working in the field of gambling prevention were the most optimistic about the guidelines. Thus, increased level of potentially harmful gambling engagement was linked with a somewhat more pessimistic attitude towards the guidelines. On the other hand, those who had not gambled in the past year viewed the guidelines as too permissive compared with those who had gambled, or those working in gambling prevention.

Discussion

Overall, our results show clear differences of opinion between the various subpopulations, which appear to be associated with the individuals' level and nature of gambling experience. We conclude that the LRGG can likely be adopted into wider use in Finland.

Open access

A mastocytosis ritka megbetegedés: kb. 10 új beteg megjelenésével lehet számolni évente 100 000 lakosra vonatkozóan. Ez annyit jelent, hogy ma Magyarországon ezres nagyságrendben kellene felismerésre és gondozásra kerüljenek, ami nem történik meg. A klinikánkon megalakult Semmelweis Mastocytosis hálózat elnyerte az európai, 21 ország szakembereit magában foglaló European Competence Network on Mastocytosis (ECNM) kiválósági központjaként történő elismerést. Évente 10–15 új beteget látunk és több mint 150 beteget gondozunk. Az egész országból érkeznek hozzánk. A hálózatban bőrgyógyász, hematológus, patológus működik együtt. Differenciáldiagnosztika tekintetében hálózatunkban HANO (örökletes angioneurotikus oedema) kivizsgálás is történik, triptázszintmérés is bevezetésre került, illetve lehetőség van a myeloid panelben vizsgálni a prognosztikus jelentőségű RUNX1, ASXL1 és SF3B1 mutációkat, valamint tervezzük a herediter alpha triptazaemia TPSAB1 gén mutációjának vizsgálatát. Ez utóbbi a következő WHO-klasszifikációban mint minor kritérium fog szerepelni. Alábbiakban az utóbbi években megjelent legfontosabb publikációk rövid ismertetésén túl az ECNM legutóbbi éves konferencián elhangzott a diagnosztikát és terápiát érintő újdonságokról számolok be.

Open access

Az epehólyag adenosquamosus daganata

Gallbladder adenosquamous carcinoma

Orvosi Hetilap
Authors:
Fanni Hegedűs
and
Anita Sejben

Adenosquamous carcinoma is a rare subtype of gallbladder tumours that often spreads to surrounding anatomical structures and, like malignant tumours of the gallbladder, is very aggressive. The 70-year-old female patient presented in this study was investigated due to abdominal pain, and thickened gallbladder wall was revealed with imaging techniques. The gallbladder was removed along with the surrounding liver parenchyma and the adjacent colon due to continuous spread. Histological examination confirmed primary adenosquamous carcinoma of the gallbladder. The squamous cell carcinoma component that revealed keratinization, was positive with p40 immunohistochemistry. In the 1 month since diagnosis, the patient was stable and is currently receiving adjuvant oncological treatment. According to the available literature, gallbladder adenosquamous carcinoma shows female predominance, and is occurring in the 6th–7th decade. Abdominal pain is the most common first symptom. The current WHO classification specifies a minimum of 25% squamous cell carcinoma component during the histological examination. Exclusion of metastatic process is necessary for a definitive diagnosis. Orv Hetil. 2024; 165(49): 1945–1950.

Open access