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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Abstract

Background and Aims

Nasal congestion is a prevalent symptom often alleviated with over-the-counter nasal sprays containing decongestants. Rhinitis medicamentosa (RM), caused by the overuse of decongestants leading to recurrent mucosal swelling, poses a significant challenge for specialists in managing patients. Despite advancements in understanding, research primarily consists of case series with limited data on its impact on quality of life. This qualitative study aimed to explore the effect of nasal spray overuse on quality of life and identify addiction components among individuals with RM.

Methods

Twenty participants with RM were interviewed by an otorhinolaryngologist and addiction counsellor. The study employed a qualitative approach utilising directed content analysis and revealed eleven categories, classified into addiction components and distinctive features of nasal spray addiction.

Results

The analysis revealed the presence of all Griffiths' addiction components in the identified themes. Additionally, sleep disorders, the feeling of suffocation, side effects, illness identity and psychological effects on nasal congestion significantly impair individuals' quality of life.

Conclusion

This qualitative study identified key components of addiction in nasal spray overuse and suggested that RM might be conceptualised in the DSM-5 category of “Other (or Unknown) Substance-Related Disorders”, considering the lack of psychoactive effects. Nevertheless, in view of the current findings, it also seems to be plausible to examine the phenomenon in the behavioural addiction framework. The study underscores the need for further research and intervention strategies to address the significant impact of RM on individuals' quality of life.

Open access

Abstract

Background and aims

Adolescent problematic gaming is a global public health issue, and is associated with numerous negative outcomes. The Big Two personality traits, neuroticism and extraversion, have been identified as significant predictors of problematic gaming in adolescents. However, most previous studies have been cross-sectional, limiting the ability to explore their mutual influences or causality inference. This study addresses this gap by employing a longitudinal design and utilizing the Random Intercept Cross-Lagged Panel Model (RI-CLPM) to examine the bidirectional relations between the Big Two personality traits and problematic gaming at the within-person level.

Methods

This study included 3,307 students (Mean age = 11.30, SD = 0.48, 43.6% being girls). Participants were assessed annually, completing a total of four assessments over the course of the study.

Results

The RI-CLPM analyses revealed that neuroticism and problematic gaming significantly predict each other. Extraversion acts as a protective factor against adolescent problematic gaming, whereas problematic gaming leads to a decrease in extraversion levels. Additionally, the longitudinal relations between neuroticism and problematic gaming exhibit significant sex differences.

Discussion and conclusions

This study provides insights into the interplay between the Big Two personality traits and problematic gaming in adolescents. These findings emphasize the need for prevention and intervention strategies that address personality traits as risk factors while recognizing how problematic gaming can influence personality, promoting a more holistic approach. The observed sex differences highlight the importance of integrating sex-specific considerations in interventions.

Open access
Imaging
Authors:
Andrew M. Thomas
,
Ann C. Lin
,
Grace Deng
,
Yuchen Xu
,
Gustavo Fernandez Ranvier
,
Aida Taye
,
David S. Matteson
, and
Denise Lee

Abstract

Background

Sonographic risk patterns identified in established risk stratification systems (RSS) may not accurately stratify follicular carcinoma from adenoma, which share many similar US characteristics. The purpose of this study is to investigate the performance of a multimodal machine learning model utilizing radiomics and topological data analysis (TDA) to predict malignancy in follicular thyroid neoplasms on ultrasound.

Patients & Methods

This is a retrospective study of patients who underwent thyroidectomy with pathology confirmed follicular adenoma or carcinoma at a single academic medical center between 2010 and 2022. Features derived from radiomics and TDA were calculated from processed ultrasound images and high-dimensional features in each modality were projected onto their first two principal components. Logistic regression with L2 penalty was used to predict malignancy and performance was evaluated using leave-one-out cross-validation and area under the curve (AUC).

Results

Patients with follicular adenomas (n = 7) and follicular carcinomas (n = 11) with available imaging were included. The best multimodal model achieved an AUC of 0.88 (95% CI: [0.85, 1]), whereas the best radiomics model achieved an AUC of 0.68 (95% CI: [0.61, 0.84]).

Conclusions

We demonstrate that inclusion of topological features yields strong improvement over radiomics-based features alone in the prediction of follicular carcinoma on ultrasound. Despite low volume data, the TDA features explicitly capture shape information that likely augments performance of the multimodal machine learning model. This approach suggests that a quantitative based US RSS may contribute to the preoperative prediction of follicular carcinoma.

Open access

Abstract

This study aimed the identification of anaerobic bacteria isolated from blood cultures and the determination of antibacterial susceptibility of the isolates. The study material comprised of 5,282 blood samples taken between 2018 and 2020. The samples were incubated in a BacT/ALERT system. The species identification of the isolates was performed by three methods namely, BBL Crystal Anaerobe system, matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS), and 16S rRNA gene sequence analysis. Antibacterial susceptibility testing was performed using the disk diffusion method with benzylpenicillin, clindamycin, piperacillin-tazobactam, meropenem, and metronidazole disks. In the BacT/ALERT system, 45 anaerobic bacterial isolates were recovered from 39 (0.74%) of the samples that showed growth signs in blood culture bottles. The BBL Crystal Anaerobe system and 16S rRNA gene sequence analyses enabled the genus and species identification of all 45 isolates (100%), whereas with MALDI-TOF MS, only 37 (82.2%) of the isolates were able to be identified. Antibacterial resistance rates of the isolates to piperacillin/tazobactam, clindamycin, benzylpenicillin, meropenem, and metronidazole were detected as 100%, 73.8%, 40%, 9.8%, and 5.5%, respectively. MALDI-TOF MS showed a higher level of compatibility with 16S rRNA gene sequence analyses, compared to the BBL Crystal Anaerobe system. The high rates of susceptibility to meropenem and metronidazole suggested that these antibiotics are options for the empirical treatment of anaerobic bacterial infections.

Restricted access

Epidurolysis – egy régi-új eljárás

Epidurolysis – an old-new procedure

Orvosi Hetilap
Authors:
Anett Kiss
,
Anna Udvarhelyi
,
István Zátroch
, and
Csaba Kopitkó

Epidural adhesions may be caused by inflammation of the surrounding spinal canal, disc degeneration (nucleus pulposus entering the epidural space as a result of damage to the disc), or scarring following spinal surgery (failed back surgery). The roots become stuck due to adhesions, which hinder their mobility. Furthermore, the richly innervated posterior longitudinal ligament and the dura mater are inhibited from “sliding” on each other. These patients develop chronic radicular and/or low back pain. The range of conservative treatments available is often limited, and the quality of life of patients is frequently impaired by severe pain and neurological deficits. Our goal is to introduce a cost-effective, minimally invasive therapeutic option in Hungarian public hospitals which can serve as a long-term solution for the treatment of the above-mentioned medical conditions. In our case report, we present epidurolysis as an innovative therapeutic option, which can be effectively used in the treatment of epidural adhesions. The 71-year-old lady underwent LIV–V flavotomy and discectomy in 2019. However, despite this intervention, the excruciating pain radiating to the left lower limb persisted. Based on the subsequent MRI of the lumbar spine and the physical examination, scarring was assumed around the previous surgical area, so lumbar epidurolysis was performed according to the one-day protocol. The patient reported a notable reduction in pain levels both immediately following the intervention and at the 6-week follow-up, with no requirement for the use of painkillers. The rationale for epidurolysis in postlaminectomy syndrome is level I evidence, and for the treatment of spinal pain due to disc herniation and spinal canal stenosis with or without radicular pain is level II evidence. Epidurolysis is a highly effective, safe and cost-effective procedure in experienced hands, especially when its social effects are taken into account. Orv Hetil. 2025; 166(6): 234–240.

Open access

Három intézet összefogása a központi régió magas színvonalú mellkassebészeti ellátásának érdekében

The cooperation between three institutions in favor of high-standard thoracic surgical care in the central region of Hungary

Orvosi Hetilap
Authors:
Márton Csaba
,
Áron Kristóf Ghimessy
,
Péter Radeczky
,
Zsolt Megyesfalvi
,
Ákos Kocsis
,
László Agócs
,
Balázs Döme
,
Csaba Fehér
,
Klára Török
,
László Mészáros
,
Levente Bogyó
,
Balázs Gieszer
,
Kristóf Csende
,
Dóra Nagy
,
Hanna Tihanyi
,
Gábor Tarsoly
,
Sára Lality
,
K. István Hartyánszky
,
József Kass
,
Attila Vágvölgyi
,
Victor Lungu
,
Róbert Szegedi
,
Evelin Yu
,
Bernát Gyenge
,
Dániel Afari
,
Arnold Köllő
,
Ildikó Madurka
, and
Ferenc Rényi-Vámos

The cooperation between the Thoracic Surgery Department of the National Institute of Oncology, the Thoracic Surgery Clinic of the Semmelweis University, and the Thoracic Surgery Unit of the National Korányi Institute of Pulmonology shows an exemplary partnership. This cooperation includes patient care, education, and research, with some overlap in human resources. Robotic surgeries, lung transplants, and other oncological operations are carried out at the National Institute of Oncology, where thoracic surgery education for medical students is also provided in collaboration with Semmelweis University. The Semmelweis Thoracic Surgery Clinic’s research facility is located within the territory of the National Korányi Institute of Pulmonology. In addition to elective oncological surgeries, the Korányi Institute offers around-the-clock acute thoracic surgical care and manages thoracic trauma. During postgraduate education, residents rotate through each of the three units, allowing them to gain experience in various operations. This partnership does not establish a new entity but reflects a sensible cooperation of three independent organizations, collectively referred to as the Thoracic Center in this paper. This overview focuses on the surgical and scientific work at the Thoracic Center, emphasizing available surgical methods, minimally invasive procedures, and international collaborations. Each year, we conduct over 2,000 surgeries, including approximately 650–700 anatomical resections, 15–20 lung transplants, and numerous robot-assisted operations, which program started in 2023. The use of minimally invasive techniques has been on the rise, and by implementing advanced practices, we have decreased complication rates and reduced average hospital stays. Overall, the Thoracic Center has achieved international praise in thoracic surgery, committed to the ongoing and comprehensive enhancement of its services. By offering a complete range of care, we maintain a competitive edge in surgical, research, and educational aspects of our work. Orv Hetil. 2025; 166(6): 203–209.

Open access

Kis méretű insulinoma lokalizálása 68Ga-exendin-PET

CT segítségével/Localization of a small insulinoma with the aid of 68Ga-exendin PET/CT

Orvosi Hetilap
Authors:
Nóra Garam
,
Nikolette Szücs
,
Ildikó Tünde Bálint
,
Gergely Huszty
,
András Budai
,
Beatrix Kerecsen
,
Ildikó Schmidt
,
Marcus Hacker
, and
Péter Igaz

The hyperinsulinemic hypoglycemic syndrome is typically caused by insulinoma, a neuroendocrine tumor of the pancreas. Beyond the diagnosis, the most difficult part is the accurate localization of the tumor, which is essential to the curative surgical therapy. A 36-year-old woman with several episodes of loss of consciousness was diagnosed with endogenous hyperinsulinemia causing hypoglycemia. The MRI raised the possibility of a 5-mm lesion in the tail of the pancreas, however, neither the CT, nor the endoscopic ultrasound was able to confirm it. The somatostatin-receptor scintigraphy was also negative. The 68Ga-exendin PET/CT showed tracer enhancement in the tail of the pancreas in the same region as in the MRI. Based on these results, a distal pancreas resection was made. After the surgery, the hypoglycemic episodes of the patient disappeared and histology confirmed the diagnosis. Conventional imaging techniques are often not sensitive enough for the localization of insulinoma, mostly in cases of small, hypovascularized tumors. Somatostatine-receptor targeted modalities which are widely used in the imaging of neuroendocrine tumors could be negative because of the lower expression of somatostatine receptors. In our case, the novel, functional imaging 68Ga-exendin PET/CT was efficiently used, which can localize insulinomas with high sensitivity. Orv Hetil. 2025; 166(6): 228–233.

Open access

A nem bináris nemi hovatartozás orvosi megítélésének szakirodalmi áttekintése

Review of medical perception of non-binary and transgender continuum

Orvosi Hetilap
Author:
Noémi Somorjai

The physical and mental health of transgender and non-binary persons is a poorly researched area in our country. Diagnostic tools and awareness are limited, which makes the hidden client group particularly vulnerable. According to the International Classification of Diseases (ICD-11), ’gender incongruence’ is a permanent and significant discrepancy between the person’s lived and physical appearance. The lack of consistency alone does not indicate a diagnosis, but the more frequent occurrence of mental health difficulties and self-harming behavior justifies medical care in everyday general practice. Orv Hetil. 2025; 166(6): 210–218.

Open access

Robotasszisztált rádiófrekvenciás ablatio által létrehozott laesiók közbeni impedanciaesés vizsgálata

Investigation of impedance drop during lesions created by robot-assisted radiofrequency ablation

Orvosi Hetilap
Authors:
Hilda Zsanett Marton
,
Pálma Emese Inczeffy
,
Attila Kardos
, and
Tamás Haidegger

Introduction: The efficiency and safety of radiofrequency catheter ablation can be further improved using robotics. We can employ the objective data provided by the related sensors during the intervention. Objective: The aim of our research was to develop and implement a custom robotic measurement platform to investigate sensor-controlled ablation processes during in vitro experiments, ensuring stable catheter positioning. We then observed the impedance drop during lesion formation under varying temperature settings and ablation durations while maintaining a constant contact force. Method: Our experiments were carried out with a custom-developed equipment. The sizes of the lesions formed under different temperatures (60, 65, 70 °C) and ablation times (10, 20, 30 seconds) were investigated. Porcine heart tissue samples were ablated, creating a total of 186 lesions. After treatment, impedance drop were measured. A multivariate linear regression model was used to examine the effect of temperature and ablation duration on lesion impedance drop. Results: A robot-assisted radiofrequency ablation assisting in vitro device was set up using a proprietary designed and manufactured contact force measurement device. Our experiments have successfully generated accurate and repeatable ablation patterns, producing consistent and reliable results. The results of the multivariable regression analysis demonstrated that a temperature of 65 °C, compared to 60 °C, independently resulted in a 3.6 Ω reduction in impedance (95% confidence interval: –5.9 to –1.3; p = 0.026). Additionally, prolongation of the ablation duration had a significant impact on the decrease in impedance; for instance, at 20 seconds, the impedance value decreased by 4.1 Ω (95% confidence interval: –6.5 to –1.8; p = 0.0006). Conclusion: Robot-assisted ablation can significantly improve the precision and reproducibility of procedures, especially in in vitro experiments on porcine tissues. By setting optimal temperature and duration parameters, unwanted tissue damage can be minimised. Our observations indicate that higher temperatures result in a significantly greater reduction in impedance, and increasing the duration of ablation also significantly enhances the extent of impedance decrease. Orv Hetil. 2025; 166(6): 219–227.

Open access
Journal of Behavioral Addictions
Authors:
Shuai Guo
,
Agata Kamionka
,
Qinbo Xue
,
Bernadetta Izydorczyk
,
Małgorzata Lipowska
, and
Mariusz Lipowski

Abstract

Background and aims

Exercise addiction in adults is increasingly recognized as a public health concern, carrying potentially harmful physical, psychological, and social consequences. Body image—encompassing cognitive, behavioral, affective, and perceptual elements—may be a key factor in this risk, yet comprehensive evidence remains scarce. This systematic review and meta-analysis aimed to (1) evaluate the overall relationship between multidimensional body image and the risk of exercise addiction in adults, and (2) identify key moderators (e.g., different elements of body image, gender, region).

Methods

A systematic search was conducted in PsycINFO, Medline, SPORT Discus, Web of Science, and Embase up to October 22, 2024. A three-level meta-analysis model was employed, and univariate and multivariate meta-regressions were used to explore potential moderating factors.

Results

A total of 38 eligible studies were identified, contributing 65 effect sizes. The meta-analysis revealed a moderate correlation (r = 0.26) between body image and risk of exercise addiction in adults. Moreover, the cognitive component of body image and the use of compulsive exercise measures in addiction assessments emerged as unique moderators, each further strengthening the observed relationship.

Discussion and conclusions

These findings underscore the central role of body image—particularly its cognitive dimension—in shaping the risk of exercise addiction in adults, especially when assessed via compulsive exercise measures. Incorporating these insights into research and practice may guide more effective interventions and improve public health strategies aimed at mitigating harmful exercise behaviors.

Open access