Medical and Health Sciences

The overuse of antibiotics has led to the development of antimicrobial resistance. As a result, topical antiseptics may become more important in clinical practice. Unlike antibiotics, antiseptics are less likely to induce resistance due to their unspecific mode of action and high local concentrations. However, there are challenges associated with using antiseptics, such as tolerability, inactivation by organic matter, and potential side effects. This review focuses on the challenges of using antiseptics, with a detailed discussion on the antimicrobial properties and possible resistances of octenidine dihydrochloride, povidone-iodine, hydrogen peroxide, chlorhexidine, and isopropyl alcohol antiseptics. The review also explores and discusses their antimicrobial efficacy, resistance, wound-healing properties, skin tolerability, and side effects. Orv Hetil. 2024; 165(41): 1621–1627.

Introduction: In spite of the World Health Organisation’s recommendation of exclusive breastfeeding until 6 months of age, some of the mothers do not always provide this for their child for various reasons. In Hungary, breastfeeding is supervised by the health visitors so their role is crucial in this area. Objective: The aim of our research was to understand mothers’ knowledge and difficulties related to breastfeeding, and to explore their experiences about the activities of the health visitors. Method: Our cross-sectional survey was conducted between July 2023 and February 2024. Non-random, convenience sampling was used to target mothers who had started breastfeeding. Our exclusion criteria were insufficient breastfeeding experience, uninterpretable fulfilment of the questionnaire, and completion of breastfeeding more than 1 year ago (n = 287). Our survey was conducted anonymously online using a self-administered, self-completed questionnaire. The questions covered sociodemographic and breastfeeding data, knowledge level, and experiences and satisfaction with the health visitor. Data were analyzed using descriptive and mathematical statistics in Microsoft Excel. Results were presented with frequency and mean confidence intervals, considered significant at p<0.05. Results: 38% of our respondents exclusively breastfed their child until 6 months of age. These mothers had significantly higher levels of breastfeeding knowledge (p<0.001) than their counterparts who had exclusively breastfed for less time. 61% of mothers scored in the medium range on our knowledge test. Insufficient breast milk was the most common reason for stopping breastfeeding in 37%. 41% of mothers with one child did not receive any breastfeeding education by the health visitor during pregnancy, but this did not show a significant correlation with earlier stop of breastfeeding (p>0.05). 76% of our respondents were satisfied with the health visitor’s activities. The lowest rating in the satisfaction survey was given to questions on breastfeeding support, with a mean score of 2.65 on a scale of 4. Discussion: The proportion of mothers who exclusively breastfeed for up to 6 months is broadly in line with other international and national findings. The satisfaction rate in our study is significantly lower than the results of the study by Deutsch et al. in 2014 for all the same questions. Conclusion: Adequate knowledge transfer should be emphasised in health visitor’s caring. Respondents were not very satisfied with the breastfeeding support provided by health visitors, so this definitely needs to be improved, which would benefit from effective education and training of professionals. Orv Hetil. 2024; 165: 1628–1640.

Atopic dermatitis is one of the most common chronic inflammatory skin diseases. The complexity of the pathology has been known for a long time and in recent years we have gained a better understanding of the pathomechanism, the heterogeneity of the affected population and the clinical picture. Therapeutic options have also expanded with a better understanding of the disease background. At the Department of Dermatology, University of Debrecen, we have been studying the background of atopic dermatitis and looking after this group of patients for decades. The aim of this article is to summarize the results of our own research and the exponentially growing new data from the literature. Orv Hetil. 2024; 165(41): 1602–1612.

Angina and myocardial ischemia as detected by non-invasive modalities frequently occur in individuals without significant (obstructive) epicardial coronary artery disease. These are caused by microvascular coronary artery disease, coronary vasospasm, or a combination thereof. Patients suffering from these conditions have a poor quality of life, and prognosis, and frequently need rehospitalization which poses a significant burden on the healthcare system. It is now clear that the pathomechanism of these conditions can be objectively and quantitatively elucidated by invasive coronary thermodilution techniques and provocation tests. Recent publications and consensus documents have crystallized the diagnostic criteria of microvascular coronary artery disease and vasospastic angina. Systematic application of the diagnostic workup proposed by working groups makes it possible to identify individuals who benefit from medical therapies aimed at the pathomechanism thereby improving the quality of life of these patients. The present review summarizes the epidemiology, prognosis, and pathomechanism of microvascular coronary artery disease and vasospastic angina; provides a detailed, technical analysis of the invasive diagnostic modalities, the parameters of microvascular function applied in everyday practice, their background and caveats. The diagnostic aspects are complemented by pharmacologic approaches to treating these conditions available today and in the pipeline. Orv Hetil. 2024; 165(41): 1613–1620.

Acromegalic patients’ expected survival rate and quality of life are worse than those of the healthy population. This is due to delayed diagnosis and often persistent post-surgical residual hormonal activity of the disease. Therefore, early, effective and individualized endocrine treatment and care are especially important. Our female patient was born in 1965, and has required therapy for tension-type headaches since 2008. In 2012, sella MR examination confirmed a pituitary macroadenoma of 13 mm, which was completely removed by transsphenoidal neurosurgery. Histological examination verified a somatotroph adenoma. Based on the results of post-operative oral glucose load, biochemically active acromegaly was detected, along with a negative sella MR image, thus dopamine agonist treatment was started. Later, due to rising insulin-like growth factor 1 levels and increasing headaches, she was switched to first-generation somatostatin receptor ligand (SRL) therapy. Her developing diabetes mellitus required first biguanide, then later on insulin therapy. Due to progressive complaints, growth hormone-receptor antagonist treatment was started, which resulted in partial disease control. The persistent, severe headaches significantly worsened her quality of life. Therefore, after a decade of different therapeutic approaches, despite the existing diabetes mellitus, second-generation SRL treatment was advised. On pasireotide therapy, her headache stopped immediately, and complete disease control was achieved. The retrospective somatostatin receptor (SSTR) subtype evaluation of the adenoma confirmed dominant SSTR5 expression. Pasireotide could be an optimal choice of first-line therapy in cases of acromegaly complicated by diabetes mellitus, if the adenoma has dominant SSTR5 expression. Orv Hetil. 2024; 165(40): 1587–1593.

Low back pain is the most common musculoskeletal problem worldwide. According to researches, it affected 619 million people globally in 2020. It is responsible for a large percentage of absences from the workplace and visits to the doctor. Since 1990, the number of years spent on disability due to low back pain has increased by more than 50%, largely due to the aging and growth of the population worldwide. The greatest increase can be seen in low- and middle-income countries, where adequate resources are not necessarily available to deal with the problem. Low back pain is now the leading cause of disability worldwide. In acute treatment, it is important to distinguish between specific and non-specific low back pain. Its general prognosis is good, but its prevalence is high, which makes it a significant public health problem. Preventing it from becoming chronic is extremely important. The aim of its treatment is to reduce pain, maintain physical activity and restore working capacity as soon as possible. There is often a wide gap between therapeutic methods based on available evidence and clinical practice. Recommendations include self-management, programs that include education and exercise to support the resumption of everyday activities, and psychological counseling. Treatment methods that include an exercise program and patient education are the most effective in the treatment of chronic low back pain. Orv Hetil. 2024; 165(40): 1562–1569.

The reconstruction of facial skull defects remains a challenging task in our days. In addition to its complex anatomy and multiple complex functions, this area is also of aesthetic importance. In all cases, reconstruction must aim to achieve anatomical or functionally equivalent reconstruction and to restore facial harmony. The advent of modern imaging tools, design software and 3D printers has led to the replacement of traditional titanium miniplates and screws used in maxillofacial traumatology by custom prostheses designed digitally, and manufactured using additive manufacturing technology to suit the patient’s individual circumstances. We carried out a total of 11 cases of facial skull and frontal bone reconstruction using patient-specific implants between 2010 and 2022. The design process and the potential for clinical application are presented through two case studies of our own. In all cases, the implants healed without complications, and no wound healing complication or rejection was observed. The reconstruction was aligned with the virtual plan, resulting in a significant aesthetic improvement. Our experiences to date indicate that patient-specific implants represent a reliable option for the reconstruction of maxillofacial defects. Orv Hetil. 2024; 165(40): 1594–1600.

Introduction: Telemedicine has become increasingly essential in home hospice care, especially during the COVID–19 pandemic, as it was used to substitute for or support face-to-face home visits. Objectives: This retrospective pilot study aimed to investigate the use of telemedicine in home hospice care in Hungary during the pandemic and to explore whether home hospice services still use telemedicine after the end of the restrictions. Methods: An online survey was conducted among hospice coordinators and hospice nurses who worked in home hospice care during the pandemic. Statistical analysis was undertaken using IBM SPSS Statistics for Windows software. Descriptive analysis was performed on the data. Results: Telephone contact was the most used method in home hospice care to reduce the number of face-to-face visits during the COVID–19 pandemic, and the pulse oximeter with an app was the only tool for monitoring the patients’ condition. Telephone consultation replaced face-to-face consultation with doctors for advice. Most respondents considered telemedicine helpful, mainly in reducing the staff workload. According to the respondents’ experience, half of the home hospice patients and their caregivers were welcomed to use telemedicine, and most had no problems using it. Some telemedicine-related solutions are still applied in home hospice care, and the staff would like to continue using them. Conclusion: Telemedicine was applied in home hospice care in Hungary during the COVID–19 pandemic, and there is still a demand for the use of it. Telemedicine could also be a solution to reduce differences in accessibility to home hospice care in Hungary. Orv Hetil. 2024; 165(40): 1579–1586.