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
Objective
2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ([18F]-FDG PET/CT) can be developed in association with contrast-enhanced CT (ceCT), specifically in oncologic patients. This study aimed to evaluate emergency cases incidentally detected in our clinical practice with [18F]-FDG PET/ceCT.
Method
We retrospectively evaluated 3661 [18F]-FDG PET/ceCT, developed between 2017 and 2023, collecting emergency cases needing prompt treatment.
Results
In 34/3661 patients (0.9%) an emergency case was recorded, in particular through contrast-enhanced CT, linked to a vascular (65%) or extravascular (35%) disease. The more frequent findings were pulmonary thromboembolism (0.5%). [18F]-FDG PET/CT was positive in 13/34 cases.
Conclusions
A significant minority of patients undergoing PET/ceCT present vascular or extravascular emergency diseases. The [18F]-FDG uptake improves confidence in diagnosing inflammatory findings. Properly trained diagnostic physicians approaching PET/ceCT can change the prognosis of a small but significant number of cancer patients through a life-saving approach. Future studies are needed to ensure the possibility of emergency findings with non-[18F]-FDG tracers.
Abstract
Psychedelic drugs show promising therapeutic potential; however, some users experience extended difficulties following their use. This study investigated the prevalence, severity, duration, and associated coping strategies of post-psychedelic difficulties. We conducted an online survey of 159 participants, all of whom reported experiencing difficulties lasting more than one day after psychedelic use within the past 2–10 years. Participants rated the severity and duration of 11 types of difficulties and indicated effective coping strategies. Results revealed that social disconnection (72%), anxiety and panic attacks (68%), and existential struggle (65%) were the most prevalent difficulties. Anxiety and panic attacks were rated as most severe, while existential struggle and diminished self-esteem persisted the longest, with mean durations exceeding 15 months. Derealization and depersonalization, despite being common, were consistently rated as less severe than other difficulties. Self-education emerged as the predominant coping strategy for multiple difficulties, including social disconnection and existential struggle. Professional therapy was most effective for depression and diminished self-esteem, while peer and family support were particularly beneficial for managing anxiety and panic attacks. These findings highlight the diverse nature of post-psychedelic difficulties and the varying effectiveness of different coping strategies. Our results contribute to the development of more nuanced, effective approaches to harm reduction and integration in psychedelic use, emphasizing the importance of multifaceted support systems that include professional, educational, and community-based resources.
Abstract
Background and aims
Deficits in emotion regulation (ER) are considered a key factor in the development of addiction, highlighting ER as a potential target for treatment. However, ER in problematic pornography use (PPU) remains poorly understood.
Methods
The current study investigated both spontaneous and instructed ER in male individuals at-risk for PPU (n = 35, average age = 20.40 ± 1.29) and in a control group (n = 33, average age = 20.06 ± 1.44). Initially, participants were evaluated with the Emotion Regulation Profile-Revised (ERP-R) to measure their spontaneous use of eight ER strategies across various negative emotion-eliciting scenarios. Subsequently, they completed an emotion reappraisal task, in which they were instructed to either observe or reappraise their reactions to negative images. Subjective emotional ratings (valence and arousal) and event-related potentials (ERPs) were recorded to examine the effects of deliberate ER on emotional processing.
Results
The results indicated that individuals at-risk for PPU reported less frequent spontaneous use of reappraisal compared to those in the control group. Furthermore, in both groups, reappraisal led to a decrease in the late positive potential (LPP) and the self-reported intensity of emotions elicited by negative images.
Discussion and conclusions
This indicates that both groups were able to effectively downregulate negative emotions through reappraisal when instructed. Our findings underscore the importance of incorporating ER skills, particularly reappraisal-based strategies, into the prevention and psychotherapy of PPU.
Abstract
Background
Gambling content on streaming platforms has gained popularity. Given their intense, cue-laden nature, watching gambling streams may trigger cravings among viewers. At the same time, people who gamble may be motivated to watch gambling streams in an attempt to regulate their cravings.
Methods
We tested these ideas across two preregistered online studies, recruiting i) people who gamble to compare a subgroup of gambling stream viewers with non-viewers (Study 1; n viewers = 221, n non-viewers = 642), and ii) a group of gambling stream viewers (Study 2; n viewers = 271).
Results
Gambling stream viewers were younger, tended to identify as men, and displayed higher levels of problem gambling and gambling cravings compared to non-viewers. Problem gambling severity was correlated positively with both the motivation to use gambling streams to regulate cravings and with cravings elicited by watching gambling streams.
Discussion
Our findings indicate that while viewers with higher levels of problem gambling may use gambling streams to regulate their cravings, doing so might evoke cravings.
Az orrmelléküregek mucormycosisa
Mucormycosis of the paranasal sinuses
Until nowadays, mucormycosis is the most aggressive fungal disease spreading in humans. Currently the Rhizopus, Lichtheimia and Mucor species are responsible for the development of diseases in the greatest number. The prevalence of mucormycosis appears to be much higher because in many cases achieving histological sample is difficult and the presence of risk factors is getting higher. While the classification systems, examination protocols, pharmaceutical and surgical treatment methods have developed, it is important to highlight that the continuous increase in the number of diabetes and the accompanying ketoacidosis, the recurrence of the COVID–19 epidemics in our overpopulated society had a high benefit factor in the spread of the disease, especially the one which affects the paranasal sinuses: the rhino-orbito-cerebral form. The purpose of this publication is to provide a detailed presentation of the disease, in which the effective treatment depends in many cases on the establishment of an accurate, early diagnosis, through a targeted drug therapy and, in several cases, an aggressive surgical debridement is indispensable. Orv Hetil. 2024; 165(48): 1878–1887.
A képi diagnosztikai adatmennyiség, esetszám, valamint a diagnosztikus munkaterhelés emelkedése egy magyar klinikai centrumban
Increase in the radiology imaging case volume and workload in a Hungarian university clinical center
Introduction: The number and complexity of radiological examinations (number of images, data volume) have significantly increased in the recent decades. Objective: We aimed to determine how the number of medical imaging examinations and their complexity, as well as the trends of radiology workforce have changed in the last decade in our clinical center. Method: We analyzed the number and characteristics of medical imaging studies archived in the picture archiving and communication system between 2012 and 2023. This analysis was compared with data on the radiologist resources of the department. Results: Compared to the base year, by 2023, there was a substantial increase in annual imaging data volume (200.7%), number of images (506.3%), and number of examinations (69.4%). Image number increased the most in angiography (3161%) and the least in conventional X-ray examinations (34.4%). Annual archived study volume showed the highest increase in ultrasound (447.9%) and the lowest in X-ray examinations (9.2%). CT examinations exhibited the largest increase in image numbers (50–140%) among specific, common examination types. Annual examinations (66.6%) and image numbers per consultant (496.3%) significantly increased. The COVID–19 pandemic caused a temporary decline in the number of studies. Discussion: During the studied period, significant growth was observed in cross-sectional imaging, ultrasound examinations, and interventional angiography but not in x-ray. This growth partly stems from technological advances and changing data archival practice. The substantial growth in examination numbers and image data was not matched by available human resources. The decline in examination numbers during the COVID–19 pandemic highlights reduced access to elective and screening diagnostics. Conclusion: Consistent with international trends, the period under review witnessed significant increases in the complexity and number of imaging examinations, resulting in considerable workload growth. Comprehensive, systemic solutions are needed to prevent compromising patient safety. Orv Hetil. 2024; 165(48): 1894–1903.
Tudatos jelenlét alapú kognitív terápia krónikus fejfájással élők számára
Mindfulness-based cognitive therapy for individuals with chronic headaches
Introduction: Chronic headache is one of the most common health issues leading to long-term disability, which results not only in a decline in the quality of life but also increases depressive and anxiety-related symptoms. In the case of chronic pain, the effectiveness of acute pain relief is limited. International research increasingly highlights the importance of modifying psychological and behavioral factors associated with pain. According to the literature, mindfulness-based cognitive therapy has been proven effective in reducing the burden of chronic headaches, primarily by improving the quality of life, enhancing self-efficacy, and reducing pain catastrophizing and depression. Objectives: Our primary goal was to make mindfulness-based cognitive therapy accessible for the first time in Hungary to individuals living with chronic headaches. Secondly, we aimed to measure the impact of this method on the quality of life, coping with pain, and depression. Method: We initiated 8-session groups following the structure developed by Melissa Day (2012) at the Department of Clinical Psychology, Semmelweis University. Measurement tools: Beck Depression Inventory, Pain Catastrophizing Scale, Comprehensive Headache-Related Quality of Life Questionnaire, Mindfulness Questionnaire, Perceived Stress Questionnaire, Self-Compassion Questionnaire. Results: After the group sessions, there was a significant reduction in the negative impact of pain on the quality of life (p<0.001, Cohen’s d = 0.92), pain catastrophizing (p<0.001, Cohen’s d = 0.76), and depression (p<0.01, Cohen’s d = 0.51). Additionally, there was an increase in mindfulness skills (p<0.001, Cohen’s d = –0.55) and self-compassion (p<0.001, Cohen’s d = –0.7). Discussion: Our clinical trial supports the effectiveness of mindfulness-based cognitive behavioral therapy in improving the quality of life for individuals living with chronic headaches. Conclusions: Since mindfulness-based cognitive therapy is a relatively brief psychological intervention, it can be easily implemented at various levels of care, including general practitioners’ offices or headache clinics. Orv Hetil. 2024; 165(48): 1904–1910.
Abstract
Background
In the international literature, several questionnaires measuring everyday activities are known with the aim of examining patients' quality of life. In the Hungarian language, few validated questionnaires focus on daily activities, examining both basic and moderately difficult physical activity, as well as mental health.
Objective
Our goal was to translate the Functional Status Questionnaire (FSQ) into Hungarian and examine its reliability and validity.
The validation of the questionnaire into Hungarian followed the six-step principle formulated in 2000. In our cross-sectional study, 376 participants took part. For convergent validity, we used the 36-Item Short Form Survey (SF-36) and the Functional Independence Measure (FIM) questionnaires. The examination of internal consistency was performed through Cronbach's alpha calculations. Test-retest reliability within the class was assessed with the intraclass correlation coefficient (ICC). We conducted discriminant validity for pain and general health.
Results
Internal consistency values demonstrated reliability. Participants' demographic data showed that the majority live in cities and have secondary education. The individuals included in the study exhibited unusually high levels of sports activity compared to the Hungarian average. Convergent validity examinations revealed significant relationships between dimensions of health-related quality of life of the different measurement tools.
Conclusions
The validated Hungarian questionnaire is valid and reliable. Similar to the original questionnaire, it is quickly and easily completed, allowing healthcare professionals in clinical settings to assess the patient's functional status before initiating examinations.
Abstract
Introduction
Smoking and alcohol consumption remain the two most important risk factors for the development of oropharyngeal tumours, but there is an increasing number of younger patients (age <50 years) with human papillomavirus (HPV) association origin, also known as positivity. The role of radiotherapy (RT) in the treatment of this disease is paramount.
Aim
To describe the radiotherapy results for oropharyngeal tumours and to search for prognostic parameters that influence the response of these malignant lesions to radio-chemotherapy.
Methods
95 patients underwent definitive radio- or radio-chemotherapy (RCT) for histologically squamous cell, oropharyngeal carcinoma at our Institute between 1 January 2019 and 31 December 2020, of which 51 (54%) received the latter. The mean age was 61.9 years (37–82 years) and the male-female ratio was 69:26. The average total dose was 69 Gy (range: 54–70 Gy).
Results
The 5-year local control (LC), cancer-specific survival (CCS), and overall survival (OS) calculated by the Kaplan-Meier method were 71, 69, and 58%, respectively. Forty-four cases (46%) were confirmed to have HPV involvement. HPV positive (+) tumours showed significantly better behaviour compared to HPV negative (−) cases in LC, CCS and OS. Smoking had a significant negative effect on cure rates: LC, CCS and OS were better in non-smokers. A significant negative effect of smoking on survival was also observed in HPV-associated cases. For HPV- lesions, RCT had a stronger effect on LC than RT alone (64 vs 43%, P = 0.03).
Conclusions
HPV-associated malignancies show better survival outcomes to radio ± chemotherapy than their HPV- counterparts. In all cases, smoking worsens the response to treatment. For HPV- tumours, chemotherapy with radiation, compared to irradiation alone, has a more significant effect on survival outcomes, whereas for HPV+ tumours this effect is less pronounced.
Abstract
In this publication various serum biochemistry and haematology parameters were determined from blood samples obtained from captive adult individuals of an exotic quail species, the mountain quail (Oreortyx pictus, Douglas, 1829). Venipuncture was performed in the second half of the breeding season from six roosters (males) and seven hens (females). During the examination, in addition to the haematological elements, basic parameters of serum enzyme levels, the products of protein metabolism, uric acid and the most important ions were monitored. The results are presented as a reference in future diagnostic tests for certain diseases. The blood parameters of the bird species examined in this study have not yet been published earlier.
Abstract
This study investigated a strain of Klebsiella pneumoniae, identified as GRTHES, which exhibited extensive antibiotic resistance. The strain was resistant to all beta-lactams, including combinations with newer agents such as meropenem/vaborbactam and imipenem/relebactam, as well as to aminoglycosides, fluoroquinolones, fosfomycin, trimethoprim-sulfamethoxazole and colistin. It remained susceptible to tigecycline. Whole-genome sequencing was performed by Ion Torrent platform on the K. pneumoniae strain. Genomic analysis revealed a genome length of 5,808,650 bp and a GC content of 56.9%. Advanced sequencing techniques and bioinformatic tools were used to assess resistance genes and plasmid replicons, highlighting the emergence of multidrug resistance and virulence traits. The strain carried bla NDM-1 and bla KPC-3 genes and was designated to KL107 O2afg type. Colistin resistance-associated mgrB/pmrB gene mutations were present, and the strain also harbored yersiniabactin-encoding ybt gene. Our findings provide insights into the genomic context of bla NDM-1 and bla KPC-3 carbapenemase-producing K. pneumoniae and emphasize the importance of continuous surveillance and novel therapeutic strategies to combat multidrug-resistant bacterial infections. It is the first time that an NDM-1 and KPC-3 co-producing strain of K. pneumoniae ST512 is identified in Greece. This study highlights the essential role of genomic surveillance as a proactive strategy to control the spread of carbapenemase-producing K. pneumoniae isolates, particularly when key antimicrobial resistance genes, such as bla NDM-1 and bla KPC-3, are plasmid-mediated. Detailed characterization of these isolates could reveal plasmid similarities that facilitate adaptation and transmission within and between hospitals. Although data on patient movements are limited, it is plausible that carbapenem-resistant isolate was selected to co-produce KPC and NDM through plasmid acquisition.
Abstract
Background
In the Compensatory-Dissociative Online Gaming (C-DOG; Giardina et al., 2024) model, we proposed a continuum from compensatory to dissociative gaming involvement. This continuum represents different degrees of integration between physical and virtual environments with three core processes – Active Escapism, Escape, and Dissociation – and two peripheral processes – Gaming-Related Relaxation and Body-Mind Detachment. Here, we developed and tested a multidimensional measure based on this model.
Method
We capitalized on existing items for measuring escapism and dissociation and we generated new items consistent with the hypothesized model dimensions. A total of 54 items were administered to 1,176 online gamers playing different game genres, together with measures of problematic gaming, passion for gaming, and other psychological distress indicators.
Results
Exploratory and confirmatory factor analyses yielded a six-factor, 36-item structure, with multiple hierarchical regression analyses highlighting unique associations with other psychological constructs assessed.
Discussion
The following factors were identified: (1) Emotional Displacement - redirection of negative emotion into the game with associated relaxation; (2) Absorption - detachment of the player from time and space while gaming; (3) Active Escapism - simulative use of the game to compensate for lack of self-confidence in reaching physical life objectives; (4) Virtual Withdrawal – maladaptive gaming to balance impaired social functioning, predicted by traumatic experiences and pervasive depression; (5) Dissociative Regulation - dysfunctional level of engagement associated with excessive anxiety; (6) Failure Escape - problematic avoidance via gaming related to fear of future failures.
Conclusions
The C-DOG factors identify critical psychological processes associated with problematic gaming, with relevant research and clinical implications.
A korai laboratóriumi vizsgálatok jelentősége hűtött asphyxiás újszülöttek kezelésében
Role of early laboratory parameters in treatment of cooled asphyxiated infants
Laboratory tests performed at a specific time point of the hypoxic injury may help the clinical care of neonates with hypoxic-ischemic encephalopathy and could provide additional information to determine the severity of the initial insult more precisely. Additionally, laboratory biomarkers may be useful to predict the neurodevelopmental outcome of these infants, which is especially important for parents and caregivers. Moreover, multi-organ dysfunction frequently complicates the clinical presentation of neonates with hypoxic-ischemic encephalopathy, and the appropriate treatment can also be facilitated by the analysis of laboratory tests. In our review article, we discuss the most important routinely measured and specific laboratory parameters, grouped by organ systems, hoping that we can thereby contribute to the improvement of the complex clinical care of asphyxiated, cooled neonates. Orv Hetil. 2024; 165(47): 1843–1853.
Változások a könnyűlánc-amyloidosis kezelésében – egy nagy budapesti centrum adatai
Changes in the treatment outcomes of light chain amyloidosis – findings of a large center in Budapest
Introduction: Primary or light chain amyloidosis is caused by monoclonal immunoglobulin fragments that accumulate in the organs, and the resulting amyloid deposits cause organ dysfunction. Objective and method: During our research, we examined the clinical and survival data of patients diagnosed with light chain amyloidosis between 2010 and 2024, at the Department of Internal Medicine and Hematology of Semmelweis University. We paid special attention to exploring what factors may affect the prognosis, therefore we reviewed the connection between survival and the date of diagnosis, the age of the patient, the cytogenetics, and different treatment schemes. Results: In the examined period, 56 patients were diagnosed with light chain amyloidosis. Based on the growing number of cases, we can see an increasing tendency in the recognition of the illness, however, the diagnosis was still mostly made in the advanced stages. The median overall survival of the group was 44 months, and it showed no significant improvement between the examined eras. The prognosis was considerably influenced by the age of the patients and the stage of the disease at the time of the diagnosis. The treatment of light chain amyloidosis went through considerable change in the past 15 years. The newer therapeutic agents – such as daratumumab and venetoclax – induce complete hematologic remission more often and offer a higher rate of organ response compared to previous treatment options. Conclusion: Due to the more favorable response rates to newer agents, in the future we can expect to see improvements in survival as well, although our study was not yet able to demonstrate this. Early stage remains the most important prognostic marker, which highlights the importance of early recognition of this condition. Orv Hetil. 2024; 165(47): 1860–1870.
Machine Learning(s) in gaming disorder through the user-avatar bond: A step towards conceptual and methodological clarity
Reply to: User-avatar bond as diagnostic indicator for gaming disorder: A word on the side of caution (2024)
Abstract
In response to our study, the commentary by Infanti et al. (2024) raised critical points regarding (i) the conceptualization and utility of the user-avatar bond in addressing gaming disorder (GD) risk, and (ii) the optimization of supervised machine learning techniques applied to assess GD risk. To advance the scientific dialogue and progress in these areas, the present paper aims to: (i) enhance the clarity and understanding of the concepts of the avatar, the user-avatar bond, and the digital phenotype concerning gaming disorder (GD) within the broader field of behavioral addictions, and (ii) comparatively assess how the user-avatar bond (UAB) may predict GD risk, by both removing data augmentation before the data split and by implementing alternative data imbalance treatment approaches in programming.
User-avatar bond as diagnostic indicator for gaming disorder: A word on the side of caution
Commentary on: Deep learning(s) in gaming disorder through the user-avatar bond: A longitudinal study using machine learning (Stavropoulos et al., 2023)
Abstract
In their study, Stavropoulos et al. (2023) capitalized on supervised machine learning and a longitudinal design and reported that the User-Avatar Bond could be accurately employed to detect Gaming Disorder (GD) risk in a community sample of gamers. The authors suggested that the User-Avatar Bond is a “digital phenotype” that could be used as a diagnostic indicator for GD risk. In this commentary, our objectives are twofold: (1) to underscore the conceptual challenges of employing User-Avatar Bond for conceptualizing and diagnosing GD risk, and (2) to expound upon what we perceive as a misguided application of supervised machine learning techniques by the authors from a methodological standpoint.
Az orvosi hivatásról – Magyar Imre belgyógyászprofesszor emlékére
Medical profession – in memory of the legendary professor of internal medicine, Magyar Imre
The author recalls the memory of the legendary professor of the 20th century, Magyar Imre, on the 40th anniversary of the professor’s death. He presents the characteristics of his teacher’s school of internal medicine, the features that have determined the behavior of internists for decades. The author also describes the expectations that made his medical profession and thinking credible and ethical, and which are sorely lacking in medical behavior nowadays. Orv Hetil. 2024; 165(46): 1803–1807.
Nők útja a diplomáig: az orvosnők képzésének első mérföldkövei hazánkban (1895–1946)
The way of women to diploma: first milestones of education of female physicians in Hungary (1895–1946)
Pápai Páriz Ferenc baseli egyetemi diplomamunkájának latinról magyarra fordítása védésének és orvossá avatásának 350. évfordulóján
Translation from Latin to Hungarian of the thesis of Ferenc Pápai Páriz at the 350th anniversary of his defense and medical inauguration at the University of Basel
This year we celebrate the 350th anniversary of the medical inauguration of the Transylvanian Hungarian physician, Ferenc Pápai Páriz at the University of Basel. In the 17th century, there was no medical training in Hungary, therefore visiting foreign universities (the peregrination) was the only option for students from Hungary and Transylvania to study protestant theology, law and medicine. In his Latin language thesis for inauguration in October 1674, Ferenc Pápai Páriz summarized three gynecological cases. Although several evaluations have been published of his dissertation, the text has not been translated to Hungarian before. This article presents the first complete Hungarian translation. As nowadays Latin is not generally spoken, and the medical dissertations written at foreign universities may include important and exciting observations, we suggest that Latin language further medical dissertations prepared during peregrination should be translated to Hungarian and be published in print or digital form. Orv Hetil. 2024; 165(46): 1808–1821.
Schulhof Vilmosra (1874–1944) emlékezünk
We remember Vilmos Schulhof (1874–1944)
Abstract
Background
Attention deficit hyperactivity disorder (ADHD) and behavioral addictions (BAs) are highly comorbid but little is known about the effect of anti-ADHD medications on behavioral addiction symptoms. Thus, the aim of this naturalistic prospective study was to investigate the long-term changes on BAs symptoms among methylphenidate-treated adults with a primary diagnosis of ADHD.
Methods
37 consecutive adult ADHD outpatients completed a baseline and follow-up assessment of ADHD, mood and BAs symptoms (internet, shopping, food, sex addictions and gambling disorder) after one year of methylphenidate (flexible dose) treatment.
Results
Internet addiction test scores pre-treatment were significantly higher than post-treatment scores (p < 0.001). The same trend was seen for the shopping addiction (p = 0.022), food addiction scores (p = 0.039) and sex addiction scores (p = 0.047). Gambling disorder scores did not differ pre and post treatment since none of the included patients reported significant gambling symptoms at baseline. The rate of ADHD patients with at least one comorbid BA was reduced after methylphenidate treatment (51.4% vs 35.1%). The correlation analyses showed a moderate positive correlation between the changes in sluggish cognitive tempo symptoms, cognitive impulsivity, mood and anxiety symptoms and changes in internet addiction symptoms.
Conclusions
This is the first study showing that after one-year of treatment with methylphenidate, adult ADHD patients show a significant reduction on internet, food, shopping and sex addiction symptoms. Further controlled studies with larger samples should replicate these preliminary results and elucidate the role of methylphenidate and other moderator factors (such as concomitant psychological treatments or lifestyle habits changes) on BAs improvements.
Abstract
Long COVID-19 syndrome increases the risk of cardiovascular events. Although rare in young people, acute coronary syndromes occur more often in those recently infected with COVID-19. This report discusses a rare case of myocardial infarction in a 28-year-old male with no prior medical issues, occurring four weeks after a mild COVID-19. Initially, the patient refused invasive coronary angiography, so a coronary computed tomography angiography (CCTA) was conducted during an ST-elevation myocardial infarction (STEMI). The CCTA, using fat attenuation index (FAI) technology, revealed significant inflammation at the culprit lesion. This CCTA and FAI analysis were done shortly after the STEMI onset, before revascularization, highlighting the case's uniqueness. In patients with recent COVID-19, CCTA combined with FAI analysis of perivascular inflammation can help identify those at risk for acute coronary events. In this case, FAI analysis detected high inflammation, suggesting a potential cause for STEMI in a young patient with long COVID-19.
Korai tapasztalatok az Advanced Bionics cochlearis implantátummal
Early experiences with the Advanced Bionics cochlear implant
Introduction: The first cochlear implantation was performed in 1995 at the Department of Otorhinolaryngology and Head and Neck Surgery of the Albert Szent-Györgyi Medical School at the University of Szeged. On August 11, 2022, our clinic had the opportunity to insert the HiRes Ultra 3D implant, distributed by Advanced Bionics, a company that is less known in Hungary but internationally well-recognized. Objective: Currently, patients at our clinic are rehabilitated with devices from Cochlear Ltd. and MED-EL GmbH. To broaden this range of services, the first Advanced Bionics cochlear implantation surgery was performed at our clinic. Method: In our study, a HiRes Ultra 3D implant was implanted. During the operation, electrophysiological measurements (electrically evoked stapedius reflex threshold [ESRT], neural response telemetry [NRT], and impedance) were performed. The results were recorded using the Active Insertion Monitoring system. Hereinafter, we would like to review our initial experience. Results: The impedance thresholds were adequate, and both the neural response and the electrical stapedius reflex were responsible included . In accordance with the clinical protocol, after the immediate wound closure, the position of the electrode within the cochlea was also checked with low-dose fluoroscopic imaging. Discussion: Our short-term experience indicates that Advanced Bionics implant is fully suitable for serve sensorineural hearing loss. Conclusion: Based on our results, the implant offers the possibility of preserving residual hearing. From a surgical technique perspective, it provides a construction similar to the other two manufacturers’ current devices in the clinical portfolio. Orv Hetil. 2024; 165(45): 1772–1778.
A poszttraumás stressz-zavar előfordulása mentődolgozók körében a COVID–19-járvány idején
Prevalence of post-traumatic stress disorder among ambulance officers during the COVID-19 pandemic
Introduction: The coronavirus epidemic in 2019 put ambulance officers’ health at risk in all areas. Objective: The aim of the study was to assess the occurrence of post-traumatic stress disorder among ambulance officers after the pandemic. Data and method: After obtaining the necessary permits, we conducted our cross-sectional, quantitative survey online among the employees of the National Ambulance Service between February and May 2023, using a non-random convenience sample. In addition to John Brier’s Trauma Symptom Checklist-33, our questionnaire included questions about sociodemographic data, work and the coronavirus epidemic. The survey included those who reached the age of 18, had at least 1 year of employment as paramedic or medic, and were active during the pandemic. Data analysis was done with SPSS 26.0 program, using descriptive (average, frequency, confidence range) and mathematical-statistical procedures (chi2-test, T-test, ANOVA, correlation). The results were considered significant at p<0.05. Results: The sample consisted of 237 people (n = 237), 84% of whom were men, the average age was 39.65 ± 10.48 years. Most of them (24.1%) worked in the Budapest rescue service as rescue officers (25.7%). 73.7% of the respondents got infected with COVID–19. On a 5-point Likert scale (where 1 is the least, 5 is the most), the quarantine affected them at an average value of 2.21 ± 1.32, and they feared for their family’s safety from the coronavirus at a value of 3.49 ± 1.29. The average score measured on the post-traumatic stress disorder test (between 0–99 points) was 26.52 ± 19.36, 25.7% of the respondents scored above 40 points, who were the most at risk of the disease. The disease affected more women (p = 0.028), more people living in social relationships (p = 0.013), those who were more affected emotionally by the quarantine (r = 0.296, p<0.001), those who were physically more affected by overwork due to the coronavirus (r = 0.307, p<0.001), and more mentally stressed (r = 0.776, p<0.001). For those whose post-traumatic stress disorder proved to be more severe based on their score, a greater proportion used the help of a mental health specialist provided by the National Ambulance Service (p = 0.002). Conclusion: Special attention should continue to be paid to the mental health care of paramedics, especially in the identified risk groups. Orv Hetil. 2024; 165(45): 1779–1787.
A szuicid búcsúlevelek struktúrája
Új elemzési szempontok és előzetes eredmények bemutatása
The structure of suicide notes
Presentation of new analysis aspects and preliminary results
Introduction: This research aims to analyze the structure of suicide notes. Based on our results, suicide notes consist of seven main, consecutive structural elements. We named these elements functions. The order of variations of the functions may change, but their consecutive nature shows constancy. With the help of these functions, every suicide note can be written with a simple formula. Method: For the analysis, we used the qualitative analysis method and coding technique of grounded theory on 160 complete suicide notes published in the Hungarian press. In this catalog of suicide notes, we collected data based on the age, gender, year, method and place of the suicide(s), as well as the functions we developed for the analysis. Results: With our method, we were able to write down and analyze all suicide notes. The functions of suicide notes show a gender difference: the most used functions for men are different from the most used functions for women. Conclusion: Every suicide note can be written with a simple formula. Based on our results, we discovered a potentially significant difference in the structure of farewell letters for fatal and non-fatal suicides. The structure of farewell letters for non-fatal suicides does not necessarily follow the rule of consecutive nature of functions: in our view, there is a demonstrable structural difference between the suicide notes of parasuicides and completed suicides. Orv Hetil. 2024; 165(45): 1763–1771.
Abstract
Background and Aim
The anatomy and function of different areas within the intraconal fat remain poorly understood. A potential difference between nasal and temporal orbital fat densities in normal eyes may assist clinicians and radiologists in more accurately interpreting computerized tomographic (CT) scans and making more informed diagnostic and therapeutic decisions for patients with orbital pathologies.
Patients and Methods
Data from randomly selected patients who underwent orbital CT scans at Sheba Medical Center in 2022 were analyzed. Patients with abnormal imaging findings in either orbit were excluded. Intraconal orbital fat density was measured in six nasal and temporal sites by means of Hounsfield units (HU).
Results
The study included 54 patients (mean age 45.3 ± 25.5 years, 29 [54%] females) who were scanned for ophthalmologic etiologies unrelated to the orbit. Non-contrast-enhanced (NCE)-CT scans were available for 36 patients (67%), CE-CT scans for 31 patients (57%), and both CE and NCE scans for 13 patients. HU values were significantly higher in the nasal orbit compared to the temporal orbit on both NCE-CT (−75.8 ± 7.5 nasal vs. −78.1 ± 8.4 temporal, P < 0.001) and CE-CT (−72.7 ± 6.7 nasal vs. −74.6 ± 8.6 temporal, P = 0.02). Age, sex, and laterality had no effect on the HU values.
Conclusions
The density of nasal intraconal fat is higher compared to temporal intraconal fat, as observed on both CE and NCE-CT scans of normal eyes.
These results suggest the presence of anatomical differences between these compartments and could have significant clinical implications in the diagnosis of various orbital pathologies.
Abstract
We present the case of a 64-year-old man who was incidentally found to have a left atrial mass in the vicinity of the left atrial appendage. Despite adequate anticoagulation for suspected thrombus for 6 months, the appearances of the mass remained unchanged. Surgical resection was recommended to reduce the risk of embolisation and to establish a histopathological diagnosis. Despite our initial suspicions of this being a myxoma the mass was ultimately confirmed to represent a rare papillary fibroelastoma occurring on the endocardial surface of the left atrium. The current report details the multimodality imaging of this phenomenon along with the diagnostic dilemma this unusual left atrial mass initially posed.
Abstract
Purpose
Our objective was to quantitatively investigate metamorphopsia in patients who had undergone pars plana vitrectomy for rhegmatogenous retinal detachment at the Department of Ophthalmology of the University of Szeged. We aimed to compare our findings with perioperative clinical data, and in particular the patients' optical coherence tomography (OCT) results.
Materials/Methods
Our study is a retrospective analysis of data from 23 patients who had undergone surgery for retinal detachment. We evaluated best corrected visual acuity (BCVA), metamorphopsia (MM) using M-CHARTS, and macular morphological abnormalities using OCT images in patients who attended regular follow-up visits 1–6 months after the surgery.
Results
The mean preoperative BCVA of the patients was 0.4, while the mean postoperative BCVA was 0.6, indicating a significant improvement (P = 0.03). We observed a negative correlation between preoperative BCVA and postoperative MM (Pearson's r = −0.27), indicating that lower preoperative BCVA was associated with higher postoperative MM. Additionally, we noted a strong trend between disintegration of the ellipsoid zone (EZ), abnormality of the external limiting membrane (ELM), and MM (P = 0.051 and 0.072 respectively).
Conclusions
While no significant correlation was found between MM and specific perioperative factors, we observed a notable trend between EZ disintegrity and MM, as well as abnormal ELM and MM. This trend is anticipated to become significant with higher numbers of patients.
Molekuláris klasszifikáció a diffúz nagy B-sejtes limfómában: egy multiomikai tanulmány összegzése
Molecular classification in diffuse large B-cell lymphoma: Summary of a multiomics Study
A diffúz nagy B-sejtes limfóma (DLBCL) a leggyakoribb non-Hodgkin limfóma, amely az újonnan felfedezett esetek 35–40%-át adja. A betegség klasszifikációja intenzív kutatások tárgyát képezi, egyik legújabb tanulmányban Wenzl és mtsai. sikeresen azonosítottak egy korai stádiumban is felfedezhető molekuláris mintázatot, amely segítséget nyújthat a kétéves eseménymentes túlélés előrejelzésére. RNS-expresszió és DNS-alapú vizsgálatok által kifejlesztettek egy klasszifikációs rendszert, amely alacsony, közepes és magas rizikójú csoportokba sorolja a betegeket. A mutiomikai, innovatív rizikóbecslés hasznos információval szolgálhat mind a klinikum, mind a további kutatások szempontjából.
Mainland China's 2021 restrictions on under-18s' video game time were imposed when older 2019 restrictions already applied: Omitting the historical regulatory context is misleading
Commentary on: Compliance and alternative behaviors of heavy gamers in adolescents to Chinese online gaming restriction policy (Zhou et al., 2024)
Abstract
Investigating the impacts of addiction policymaking following implementation is important. Effective policies should be considered for emulation elsewhere, whilst ineffective policies should be repealed. Zhou et al. (2024) reported how Mainland Chinese under-18s responded to the 2021 restrictions on their online videogame playtime, which were intended to curb online gaming addiction. However, Zhou et al. failed to mention that Mainland China had previously tried to achieve the same regulatory aim by imposing rules in 2019 that were more lenient than the 2021 rules but nonetheless restricted under-18s' gameplay time. These 2019 restrictions were neither acknowledged as crucial background in the introduction section nor accounted for by Zhou et al. when interpreting their results, thus giving readers the incorrect impression that the 2021 rules were the first ones introduced and that under-18s' gameplay time was not restricted at all prior to 2021. Importantly, Zhou et al.’s entire sample of young people therefore consisted not merely of ‘heavy gamers’ as they euphemistically described them as, but ‘counterplayers’ who actively contravened the 2019 rules. The misleading omission of this context is a major limitation and misrepresentation. The results should be interpreted accordingly and not overgeneralised.
Myeloma multiplex és emlőcarcinoma társulása egy hazai hematológiai centrum adatai alapján
Association of multiple myeloma and breast cancer based on data from a Hungarian Haematology Centre
A myeloma multiplex (MM) javuló túlélése mellett egyre gyakrabban találkozunk másodlagos primer malignitásokkal (MPM). Az emlőcarcinoma (EC) a leggyakoribb malignitás a nők körében. A két malignus betegség együttes előfordulása a kórtörténetben egyre gyakoribb, ami különleges kihívások elé állítja a klinikusokat. A DEKK Hematológiai Tanszékén az elmúlt tíz évben MM-mel diagnosztizált 624 beteg közül 6 esetben fordult elő EC társulása, ami 0,96%-os incidenciát jelent. Az esetek felében az MM, a másik felében az EC alakult ki először. Az EC elsődleges kezelései közé tartozott a sugár- és hormonkezelés, míg az MM kezelésében minden esetben történt autológ haemopoietikus őssejttranszplantáció, és gyakori volt a lenalidomid alkalmazása. Az MM-mel kapcsolatos kezelések, különösen az alkilálószerek és a lenalidomid növelhetik az MPM kockázatát. A betegeknél a kombinált kezelések során gyakran fordultak elő csontléziók, és szükség volt antireszorptív kezelésre. Az MM és EC együttes fennállása esetén a terápiás döntések és gondozás a két szakma szoros együttműködésén alapul. Az esetek elemzése során fontosnak tartottuk, hogy a két malignitás társulásának klinikai és terápiás kihívásait megértsük, és a betegellátás során figyelembe vegyük.
A dentin-túlérzékenység és kezelése
Dentin hypersensitivity and its treatment
Nowadays, the occurrence of dentin hypersensitivity affects almost every person during their lifetime. Various stimuli – such as cold, heat, osmotic effects – can cause intense pain if the external structure of the tooth, enamel or cement layer are damaged or the anatomy of the enamel–cement border provides free dentin surface. Pain can trigger symptoms similar to tooth decay and its consequent diseases, so it is unclear to the patient what is causing the pain. The determination of dentin hypersensitivity is the task of the practising dentist. The prevention of the main root causes and the solution of the already existing problem cannot be managed without the knowledge of today’s modern treatment options. This review describes dentin hypersensitivity’s causes and effects and possible therapeutic solutions. Orv Hetil. 2024; 165(44): 1723–1727.
A medullaris pajzsmirigyrák diagnosztikája és kezelése négy magyarországi egyetemi centrumban (2000–2023)
Diagnosis and treatment of medullary thyroid cancer in four Hungarian university centers (2000–2023)
Introduction: Medullary thyroid carcinoma is a rare malignancy originating from the calcitonin-secreting parafollicular C-cells. Despite distinct histological and biochemical markers, diagnosing and managing of medullary thyroid carcinoma remain complex. Objective and method: Our study retrospectively analyzed medullary thyroid carcinoma cases from four Hungarian university centers diagnosed between 2000 and 2023. Demographic data, serum calcitonin and calcitonin doubling time, disease stage, therapeutic interventions and disease progression were investigated. Results: Out of 171 cases, 156 patients were eligible for inclusion. Lymph node involvement was seen in 37.5% of cases at diagnosis. Preoperative calcitonin levels were recorded in 84.2% of cases, and fine-needle aspiration biopsy was performed in 72%. Preoperative cytology confirmed medullary thyroid carcinoma in 67.4% of cases. Nearly one-third of the patients were diagnosed with stage IV. Total thyroidectomy with lymph node dissection was performed in 53.8% of cases, with a higher rate after 2015 (p<0.05). Based on postoperative serum calcitonin measurements, 44 patients were considered cured. Disease progression occurred in 47.8% of patients. In the first postoperative year, calcitonin measurements were available for 75% of patients. A postoperative calcitonin doubling time (Ct-DT) of less than two years was associated with significantly lower progression-free survival than a Ct-DT of more than two years (p<0.05). Discussion: Genetic testing identified germline receptor tyrosine kinase (RET) mutations in 34.2% of patients, predominantly at codon 634. Tyrosine kinase inhibitors were used in 35 advanced cases. Treatment with selpercatinib was associated with less frequent disease progression and fewer adverse events than with the use of multi-kinase inhibitors (p<0.05). Conclusion: Despite recent advances, medullary thyroid carcinoma management remains challenging. Although the routine screening is debated, calcitonin measurement remains crucial for preoperative diagnosis. Fine-needle aspiration biopsy alone often fails to provide an accurate preoperative diagnosis; immunohistology or calcitonin measurement from washout fluid enhances sensitivity. Surgery can cure localized diseases, while advanced cases require personalized approaches. Germline and somatic RET mutation analyses are essential for selecting targeted therapies for medullary thyroid carcinoma. Orv Hetil. 2024; 165(44): 1735–1745.
Optimalizált lipidcsökkentéssel és thrombocytaaggregáció-gátló kezeléssel elérhető potenciális cardiovascularis nyereség akut coronaria szindrómán átesett betegekben – szimulációs elemzés
Potential cardiovascular benefit of optimized lipid-lowering and antiplatelet therapy in patients with acute coronary syndrome – a simulation analysis
Introduction: Lipid lowering therapy – despite the accumulated clinical trial evidence behind it and its significant preventive role reflected in the guidelines – does not have its rightful place in the value system of patients or doctors, there is a great gap between practice and principles. Objective: In order to increase the prestige of lipid-lowering therapy, the potential benefit of lowering LDL cholesterol was compared with antiplatelet therapy, which is generally more accepted. Method: We processed the data of 531 patients of the Bekes County Central Hospital Pandy Kalman Branch in Gyula who underwent percutaneous coronary intervention for acute coronary syndrome for one year starting on April 1, 2020. A simulation study was conducted during which, based on the results of large clinical studies, the cardiovascular prevention effect of optimal lipid reduction and platelet aggregation inhibition for one year was estimated. Results: In all 531 patients treated for acute coronary syndrome, if LDL cholesterol levels had remained at the mean level of 3.37 mmol/L found at admission, 59 major cardiovascular events could have occurred within one year after the index event. If LDL-cholesterol levels were to be reduced to 1.4 mmol/L, which is the very high-risk target value in the lipid recommendations of the European Society of Cardiology, the number of events would be 13, and 16 if the theoretical, very low, non-target value of 0.5 mmol/L was reached. Lowering LDL cholesterol levels is therefore expected to avoid 13 and 16 major cardiovascular events, respectively. If aspirin alone was given for antiplatelet aggregation, 14 events could be prevented over a year, 17 events could be prevented using aspirin and clopidogrel combination, and 20 events with aspirin and prasugrel or aspirin and ticagrelor. Discussion: Based on the low rates of achieving LDL cholesterol targets, there is a considerable potential for optimizing lipid-lowering treatment worldwide. In patients with acute coronary syndrome, one of the most vulnerable patient groups in cardiology practice, the study results suggest that lipid reduction and platelet aggregation inhibition could achieve a similar reduction in the number of major cardiovascular events. Conclusion: The simulation study confirms the comparable cardiovascular benefit of the two interventions. Since the attainment rate of LDL cholesterol targets set in the guidelines is very poor – with physicians’ therapeutic inertia playing a major role –, we hope our findings will convince colleagues that more attention should be paid to more optimal lipid reduction. Orv Hetil. 2024; 165(44): 1746–1752.
Szükséges-e a subarachnoidealis vérzésen átesett betegek pszichológiai követése?
Pszichológiai megvalósíthatósági tanulmány a szegedi Idegsebészeti Klinikán
Is psychological follow-up of patients with subarachnoid haemorrhage necessary?
Psychological pilot study at the Department of Neurosurgery, Szeged
Introduction: After aneurysmal subarachnoid haemorrhage (SAH), even apparently fully recovered patients often report serious psychological problems (anxiety, depression, mood swings, loss of concentration, memory impairment). Objective: Our aim is to assess, in a pilot study, the effectiveness of available and commonly used psychological tests in assessing the condition of patients after SAH and to start the development of a post-SAH psychological care system. Methods: From May 2023 to January 2024, a total of 52 patients with aneurysmal subarachnoid haemorrhage who had a good outcome, i.e., were asymptomatic or mildly symptomatic but still self-sufficient (modified Rankin scale <2), were included in our study. In addition to general patient data (age, sex, education), we recorded the treatment modality and excluded patients with significant deterioration as a complication of aneurysm treatment. According to the main aim of our study, we used the following psychological tests: Montreal Cognitive Assessment (MoCa), Spielberger State/Trait Anxiety Questionnaire (STAI-S/T), Beck Depression Questionnaire (short version; BDI-R). Results: According to the above criteria, a total of 38 women and 14 men with a mean age of 53 years (SD = 7.14) were included in our study. Psychological examination revealed cognitive impairment in 1/3 of the patients, 74% with some degree of depression, 10% with high levels of depression, and 42% with above average anxiety. There is a correlation between the level of anxiety, the severity of depression and the likelihood of developing cognitive impairment. Discussion and conclusion: Our results so far suggest that even in somatically almost asymptomatic patients, moderate to severe psychological problems occur regularly after SAH, which requires psychological care. Our study has shown that the psychological tests available in Hungarian are not suitable for accurate mapping the condition of patients with SAH and then tracking changes due to the learning effect. Furthermore, it became clear that the modified Rankin scale used to classify the outcome of the disease is not sufficient information on the psychological state of the patients, as it does not differentiate well in terms of symptoms, and therefore a new, complementary SAH-specific test needs to be applied, adopted and localised, which our institution has started to do. Orv Hetil. 2024; 165(44): 1753–1759.
A transzplantált szív kilökődésének előrejelzése endomyocardialis biopsziás minták mesterségesintelligencia-alapú patológiai vizsgálatával
Pathology of transplanted heart rejection using artificial intelligence-based image analysis of endomyocardial biopsies
Introduction: Technologies based on digital image analysis are becoming an increasingly prominent feature of pathological diagnostics. The application of artificial intelligence to data analysis has the potential to offer a more objective and detailed morphological characterization than that achievable through visual inspection. This could lead to a reduction in the time necessary for a diagnosis to be reached. Objective: The aim of this study was to optimize the nuclear recognition and nuclear separation capabilities of the image analysis software BIAS (Single-Cell Technologies). Method: To this end, the recognition and morphological characteristics (distance, density) of five to five Gr0R, Gr1R, Gr2R stage endomyocardial biopsies of hematoxylin-eosin stained, digitized sections of lymphocytes, myocytes, and other tissue structures were investigated. Results: The data demonstrated a clear increase in lymphocyte density averages during the progression of histological signs of graft rejection (Gr0R: 127.02/mm² < Gr1R: 324.03/mm² < Gr2R: 686.49/mm²), with the results for Gr0R showing a significant difference compared to Gr1R. The mean distance between lymphocytes exhibited a corresponding variation (Gr0R: 32.44 µm > Gr1R: 19.37 µm > Gr2R: 11.63 µm), with the latter two values being significantly below the Gr0R cases. The mean myocyte–lymphocyte distances of the first ten lymphocytes in order of distance from the myocytes were found to be similar (Gr0R: 55.32–193 µm > Gr1R: 35.16–109.96 µm > Gr2R: 32.46–92.95 µm). This indicates that the mean distance of lymphocytes from myocytes in Gr0R cases was significantly greater than in the other groups. In 1 mm² of myocardium, the mass of intramyocardial connective tissue exhibited a notable decline following a substantial increase (Gr0R: 1013.72 µm², Gr1R: 1942.65 µm², Gr2R: 1686.79 µm²). Conversely, the prevalence of intramyocardial oedema demonstrated an appreciable surge subsequent to a moderate decline (Gr0R: 202.42 µm², Gr1R: 181.56 µm², Gr2R: 273.91 µm²) throughout the progression of the rejection process. Discussion: The results of our study indicate that our artificial intelligence-based method, when adequately trained, is suitable for objective pathological analysis of lymphocyte, myocyte and connective tissue volume, as well as the extent of oedema and morphological parameters (distance, density) that are important from the perspective of rejection in endomyocardial biopsies of transplanted hearts. Conclusion: Complex digital image analysis may prove to be a valuable tool for the efficient pathological evaluation of organ rejection in heart transplant recipients. Orv Hetil. 2024; 165(44): 1728–1734.
Abstract
Background and aims
Conflicting findings have been reported for the longitudinal course of behavioral addictions, especially for social media addiction (SMA) and work addiction (WA). Therefore, evaluating whether these constructs are more trait-like or state-like might be informative. The aim of the present study was to examine the proportion of variance of SMA and WA symptoms (as defined by the components model of addiction) explained by trait and occasion-specific factors in addition to exploring cross-lagged relationships between SMA and WA.
Methods
Young adults from a representative sample who continuously used social media and worked at least 40 hours a week during the first three waves of the Budapest Longitudinal Study were included (N = 1,551; Females: 50.6%; Age: M = 27.7 years [SD = 4.40]). The Bergen Social Media Addiction Scale and the Bergen Work Addiction Scale were administered in all three waves.
Results
A latent state-trait model with a general trait factor was considered for both SMA and WA. Symptomatic variability in SMA was explained approximately equally by trait and state-like factors, while WA-related symptom variability was mostly attributed to state-like factors. SMA negatively predicted WA over time, while WA showed a positive cross-lagged effect on SMA.
Discussion and Conclusions
While the symptoms of WA were more state-like, the trait-like effects were stronger in SMA. Situational influences and previous symptom severities might have to be considered in the screening process.
Abstract
Interest in psychedelic research in the West is surging, however, clinical trials have almost exclusively studied synthetic compounds such as MDMA, ketamine, DMT, LSD, ibogaine, and psilocybin. To date, few clinical trials have utilized whole mushroom/plant material like Psilocybe mushrooms, Iboga, or Ayahuasca. Individuals participating in the Roots To Thrive Psilocybin-Assisted Therapy for End of Life Distress program were administered synthetic psilocybin, whole Psilocybe cubensis, and mycological extract on separate occasions and post-treatment interview transcripts were qualitatively analyzed to discern themes and patterns. There was broad consensus that all three forms were helpful and similar, all generating visual and perceptual distortions, emotional and cognitive insight, and mystical experiences. However, synthetic psilocybin was said to feel less natural compared to organic forms, and the overall quality of experience of synthetic psilocybin was inferior to the organic forms. Research should be conducted with whole psychedelic mushrooms and extract in addition to synthetic psilocybin given this preliminary data, especially when considering that medicine keepers around the world have utilized whole mushrooms and plant material for millennia.
Abstract
Clostridioides difficile infection (CDI) is one of the most significant causes of diarrhea in hospitalized patients. The aim of this study was to investigate the incidence and epidemiology of CDI after the COVID-19 pandemic in hospitalized patients in a rehabilitation center in Thessaloniki, Greece. Α retrospective observational cohort study was performed in inpatients diagnosed with diarrhea of all ages (January 2023 - December 2023) who were initially screened for CDI. From the total cohort of patients with proven CDI, some patients were randomly selected based on their monthly isolation incidence throughout the study period, to investigate their epidemiological data and clinical characteristics. Laboratory diagnosis of CDI was performed by enzyme immunoassay, followed by specific anaerobic culture and molecular testing for detection of toxigenic C. difficile. The isolated C. difficile strains were further characterized by PCR ribotyping. The annual incidence of CDI during the study period was 27.1% (130/480). The linear trend of CDI incidence decreased from 32.5% to 18.2% (P = 0.024). The all-cause mortality rate was 5.0% (3/60). A positive correlation was observed between the length of hospital stay and the number of recurrences (r = 0.546, P < 0.001), while 28 patients (46.7%) experienced recurrence of the infection. Seven different PCR ribotypes were identified in this study. C. difficile tcdA+, tcdB+, cdtA+, cdtB+ PCR ribotype 181 (RT181) was the predominant (76.6%, 46/60), followed by toxin A-negative PCR RT017 (11.6%, 7/60). The annual incidence of CDI decreased after the COVID-19 pandemic. Our study demonstrates predominance of C. difficile RT181 with tcdA+, tcdB+, cdtA+, cdtB+ toxin gene profile after COVID-19 pandemic in Northern Greece.
270 éve, 1754-ben avatták az első diplomás orvosnőt, Dorothea Erxlebent
270 years ago, in 1754 the first female medical graduate, Dorothea Erxleben was inaugurated
A jól és a dedifferenciált liposarcomák morfológiai és immunhisztokémiai jellegzetességei
Evaluation of morphological patterns and immunohistochemical characteristics of well-differentiated and dedifferentiated liposarcomas
Introduction: Liposarcomas represent a morphologically diverse group among mesenchymal malignancies. During the diagnostic process of soft tissue tumors, the possibility of well-differentiated and dedifferentiated liposarcoma should always emerge. So far, the most robust immunohistochemical (IHC) marker for these neoplasms is MDM2, however, liposarcomas can show a large variety of positivity with other markers. Methods: In our study, all cases of well-differentiated and dedifferentiated liposarcomas from 2017 to 2022 at the University of Szeged were re-examined, and if necessary, additional IHC was performed, including MDM2, CDK4, p16, and STAT6. Results: Our cohort included 7 cases of well-differentiated, and 11 of dedifferentiated liposarcomas. All morphological patterns were registered and photographed. In more than half of the cases, the tumor was localized to the retroperitoneum (n = 11), and 8 patients presented with T4 stage disease. All cases were focally or diffusely positive with MDM2 IHC (n = 18), while CDK4 and p16 proved to be diffuse in almost every case (n =17). Despite morphological diversity, all dedifferentiated liposarcomas (n = 11) were positive for MDM2, CDK4, and p16 as well. STAT6 showed multifocal nuclear positivity in 3 dedifferentiated liposarcoma cases. Conclusions: Based on our results, MDM2, CDK4, and p16 IHC reactions, and MDM2 fluorescence in situ hybridization should be performed to establish the proper diagnosis of liposarcoma. A small, but significant minority of our dedifferentiated liposarcoma cases showed multifocal positivity for STAT6, hence performing MDM2 IHC for small samples of solitary fibrous tumours is highly recommended to exclude the possibility of liposarcoma. Our study is the first to include all well-known morphological patterns of liposarcomas. Orv Hetil. 2024; 165(43): 1700–1706.
A kivonuló mentődolgozók egészsége a COVID–19-érában
Health status of Hungarian ambulance workers in the COVID–19 era
Objective: The study aimed to assess the physical and mental health status of active ambulance workers concerning the additional workload they are facing due to the coronavirus pandemic. Data and methods: A cross-sectional survey was conducted with 130 Hungarian National Ambulance Service employees (n = 130) in the first quarter of 2023, using an online questionnaire on a voluntary, anonymous basis. After convenience sampling, physical and mental health were assessed using the SF-36 questionnaire, along with questions on musculoskeletal status and experience of the COVID–19 pandemic. SPSS was used for data analysis, with descriptive and mathematical statistical tests. The results were significant at p<0.05. Results: The ambulance workers considered their “Physical functioning” to be the best (mean 90.7 ± 13.2 points) and their “General health” to be the worst (55.4 ± 9.5 points). The dimensions were correlated (p<0.001). 73.1% of the sample had a musculoskeletal complaint in the last 5 years, with the highest proportions in the back area (56.8%) and spine (51.5%). These ambulance workers rated their “Physical Functioning” significantly worse (p = 0.002). 95 persons were registered as COVID–19-infected, 50% of whom were only slightly or not at all affected by the pandemic (mean 2.6 ± 1.2). The experience of the coronavirus had a negative impact on the dimensions “Vitality” (r = –0.204, p = 0.020), “Emotional role” (r = –0.317, p<0.001) and “Mental health” (r = –0.283, p = 0.001). Persons with residual symptoms of COVID–19 rated their “Physical functioning” (p = 0.015), “Physical pain” (p = 0.010), “Social functioning” (p = 0.001), and “Mental health” (p = 0.023) dimensions worse. Conclusion: The sudden increase in workload caused by the pandemic makes it essential to monitor ambulance workers’ health closely. Residual symptoms of the coronavirus and concomitant musculoskeletal disorders can compromise the quality of patient care. Orv Hetil. 2024; 165(43): 1707–1713.
A testmozgás mint az életmódorvoslás alappillére
Physical activity as the basic pillar of lifestyle medicine
Physical inactivity is an important public health problem all over the world and one of the leading risk factors for noncommunicable diseases mortality. Sedentary lifestyle is responsible for the premature death of 5.3 million people worldwide. Obesity is an endemic affecting nearly one-third of the adult population in Hungary and combining it with overweight people, means half of the population. In Europe, one in three children is obese. Unhealthy lifestyle is a risk factor for numerous noncommunicable chronic diseases, negatively affecting both physical and mental health, limiting the quality of life, and reducing life expectancy. Lifestyle medicine, particularly regular physical activity, plays a very important role as a low-intensity intervention. Regular physical activity is a widely accessible and effective tool for both prevention and therapy, significantly contributing to the improvement and long-term maintenance of physical and mental health. It also enhances the quality of life and increases life expectancy. Numerous physical and mental diseases remain undiagnosed and therefore untreated. This fact makes exercise particularly important for disease prevention at all stages of life. Despite the long-recognized benefits of regular physical activity, it is seldom mentioned in medical literature and, with few exceptions, it is almost absent from treatment protocols as a targeted therapeutic intervention. The scope of the summary is to introduce how regular physical activity, as one of the pillars of lifestyle medicine, and targeted exercise programs can be used in primary, secondary, and tertiary prevention as low-intensity interventions. Orv Hetil. 2024; 165(43): 1683–1693.
A testvíztartalom változása a tápláltsági állapot és az életkor függvényében
Change of total body water dependent on age and nutritional status
Introduction: A healthy fluid balance is necessary to maintain normal vital functions. Detecting the amount of body water is important both in clinical practice and in sports in assessing dehydration and/or fluid overload. Among the methods used to determine the amount and distribution of body water, devices operating on the principle of bioelectrical impedance are becoming more common. Their use is simple, fast and the results obtained are reliable. Objective: The aim of our study was to determine the relative body water content changing dependent on age in men and women of normal weight, overweight and obese, using a device that works on the principle of bioelectrical impedance. Method: The data of a total of 2,354 persons between the ages of 7 and 81 are included in the study conducted with the InBody 720 type device. Normal body weight, overweight and obesity were determined using the body mass index. Results: There were significant differences between gender in body weight, body mass index between normal weight and overweight/obese participants in all age groups. The differences between relative body water content of men and women in normal body weight are significant in all age groups. The averages have not changed until the 3rd age group (21–50 years), then decreased in the 4th age group (above 51 years) in the normal body weight men. In the case of normal body weight women, the averages decreased linearly dependent on age. The relative body water contents in overweight/obese subjects were significantly lower by gender and age group than the averages of those with normal body weight. The relative water contents in overweight/obese men and women have not changed dependent on age. Discussion: Although bioelectrical impedance method is less commonly used, it is suitable for measuring total body water content. The reliability of the data obtained by the method is confirmed by more and more studies in the case of people of normal body weight, overweight and obese people as well. Conclusion: The bioelectrical impedance procedure can help prognosis and diagnosis in many areas. After presenting our data, we hope that our study will contribute to the spread of the bioelectrical impedance method. Orv Hetil. 2024; 165(43): 1694–1699.
Az affektív érintés (simogatás) pszichofiziológiája. Narratív összefoglaló
Psychophysiology of affective touch (stroking). A narrative review
Elméleti háttér: Az affektív érintés (azaz a szőrös bőrfelület lassú simogatása) humán hatásaival kapcsolatos pszichológiai és pszichofiziológiai tudásanyag az elmúlt két évtizedben megtöbbszöröződött. Cél: Narratív összefoglalónk célja e friss empirikus tudásanyag, valamint az azt magyarázó elméletek bemutatása. Eredmények: Az empirikus eredmények az affektív érintés akut fájdalomcsillapító és stresszcsökkentő hatását sugallják. Az érintést közvetítő receptorok aktivitása emellett hozzájárulhat a testséma fenntartásához. Jelentős egyéni különbségek mutatkoznak az affektív érintésre való fogé- konyságban (az érintés észlelt kellemességében), ezek mögött részben a kötődési stílus különbségei húzódhatnak meg. Következtetések: Evolúciós szempontból az affektív érintés a homeosztázis fenntar- tásának szociális eszközeként közelíthető meg, csecsemőkortól egészen felnőttkorig.