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
De Winter-jel komplett atrioventricularis blokkal és jobb koszorúér-elzáródással ST-elevációval nem járó szívinfarktusban
De Winter sign with complete atrioventricular block and right coronary occlusion in non-ST-elevation myocardial infarction
The authors present a case where, in an 89-year-old female patient with atypical chest pain, complete atrioventricular block and junctional rhythm with De Winter sign were detected on the ECG. As De Winter pattern is a left anterior descending artery (LAD) occlusion sign in non-ST-elevation myocardial infarction, immediate coronary angiography was performed, which showed occlusion of the right coronary artery though. To our knowledge, two cases have been reported so far where De Winter’s signal was not caused by LAD occlusion. The authors consider it important to widely propagate this recently described, characteristic ECG signal, which helps in the recognition of acute coronary artery occlusions in patients who do not have ST elevation on the ECG. Orv Hetil. 2024; 165(45): 1794–1797.
Dr. Radványi Gáspár hematológus főorvos (1947–2024)
Dr. Gáspár Radványi chief regional hematologist (1947–2024)
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.
Kutyaharapás egy újszülöttben
Kérdések és válaszok az ellátás kapcsán
Dog bite in a newborn infant
Questions and answers for the management
Here we present the case of a 13-day-old newborn who was bitten by the family dog and arrived at our clinic by ambulance. In order to clarify the injury in the right parietal region of the head, a CT scan was performed, which did not confirm brain injury or bone damage, but penetrated through the coronal suture to the level of the dura mater. After his admission to the department, combined antibiotic therapy was commenced, wound treatment was managed openly. During the observation period, no systemic infection developed, and the child’s general condition and laboratory values improved. A control imaging study was not necessary. Based on infectious disease consultations, we administered Clostridium tetani prophylaxis, the administration of rabies post-exposure prophylaxis was not required by protocol. The purpose of our case report is to shed light on the complexity of this unusual case both in terms of surgical and infectious care and to hopefully provide assistance in the care of similar cases in the future. Orv Hetil. 2024; 165(45): 1788–1793.
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.
120 éve született Gömöri György, a modern hisztokémia magyar származású úttörője
George Gomori, the Hungarian pioneer of modern histochemistry, was born 120 years ago
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.
Exercise Addiction Inventory-3 (EAI-3): Psychometric properties of the Hungarian version
Testedzésfüggőség Kérdőív-3 (EAI-3): A magyar változat pszichometriai tulajdonságai
Background and aims: The Exercise Addiction Inventory (EAI), based on the components model addictions, is a 6-item instrument used to assess the risk of exercise addiction (REA). Its revised version (EAI-R) was published in 2019 but only differed from the original scale in the response rating range (using a 6-point rather than 5-point Likert scale). In 2023, the EAI-3 was released with two new items (guilt when missing training and exercising despite injury). We aimed to test the validity and reliability of the Hungarian EAI-3 (EAI-3-HU). Methods: We tested 507 regular exercisers (Mage = 38.7 years, SD age = 10.63 years, range age: 18–78 years; 62.7% females) who completed the EAI-3-HU, the obsessive passion subscale of the Passion Scale, and exercise habits questions on the online Qualtrics research platform during autumn/winter 2023–2024. Results: Confirmatory factor analysis resulted in a good model fit for the two factor EAI-3-HU (CFI = .96; TLI = .94; RMSEA = .07; SRMR = .04). However, the covariance between the latent factors was .97, indicating that they measure an identical concept. Thus, a single-factor solution was appropriate (CFI = .96; TLI = .94; RMSEA = .07; SRMR = .04). Testing measurement invariance revealed the partial scalar invariance across genders. The internal reliability of the scale was good (Cronbach’s α = .81). The scale had good convergent validity with obsessive passion (r = .72), and discriminant validity based on exercise frequency as well as exercise intensity (p < .001). Conclusion: The 8-item single factor EAI-3-HU adequately assesses the Hungarian samples’ REA. Nevertheless, it should be kept in perspective that the revised tool, like its predecessors, only assesses a level of ‘risk’, which does not imply morbidity, thus it has no clinical diagnostic value.
A policisztás ovárium szindróma (PCOS) pszichológiai következményei
Polycystic ovary syndrome (PCOS) and its psychological consequences
A policisztás ovárium szindróma (PCOS) egy genetikai prediszpozícióval rendelkező, összetett endokrin betegség, amely súlyos fiziológiai és pszichés komorbid szövődményekkel járhat. A tünetegyüttes természetéből adódóan a PCOS-sel élő nők úgy elsődleges (hormonális változások okozta), mint másodlagos (a betegséggel járó, teherként megélt tünetek által kialakult) pszichés szövődményekkel szembesülhetnek. Ennek ellenére a tünetegyüttes orvosi terápiája általában a betegség fiziológiai tüneteire korlátozódik, és a pszichés problémák feltárása és kezelése annak ellenére figyelmen kívül marad, hogy ezek sokszor a fiziológiai változókra (pl. inzulinrezisztenciára, cukorbetegségre, terméketlenségre) is visszahatnak, ezzel tovább súlyosbítva a kórképet. A tanulmány célja, hogy megismertesse ezt az összetett, többdimenziós és az egyes biológiai, pszichés és szociális tényezők cirkuláris egymásra hatásában alakuló betegséget és a vele való együttélés pszichés vonatkozásait. Elsőként bemutatjuk a PCOS szomatikus, illetve biomedikális vonatkozásait, a PCOS kórélettanának, diagnosztikus kritériumainak, fenotípusainak, patogenézisének és fiziológiai következményeinek tárgyalásával. Ezután részletesen ismertetjük a primer és szekunder pszichés szövődményeket, valamint a pszichés problémák megjelenését a PCOS fizikai tünetei mentén, többek között a depresszió, a szorongás, az életminőség, a szexuális funkcionalitás és a demográfiai változók hatásán keresztül, kiemelve a pszichés támogatás jelentőségét. Következtetéseink szerint a pszichológiai szövődmények megelőzése, szűrése és terápiája fontos része kell, hogy legyen a PCOS-sel élő nők kezelésének, ahogy fontos a betegek pontos tájékoztatása a betegség várható következményeiről is, a hosszú távon fenntartott életmódváltozás elérése céljából.
Psychometric evaluation and validation of the Hungarian version of the Physical Activity Affect Scale (PAAS-H)
A Fizikai Aktivitás Affektus Skála (PAAS-H) magyar változatának pszichometriai vizsgálata és validálása
Background: Feelings and emotions during sports and exercise determine commitment, adherence, and enjoyment of the activity. The Physical Activity Affect Scale (PAAS) combined two earlier instruments, the Exercise-Induced Feelings Inventory and the Subjective Exercise Experiences Scale, to investigate affective states generally characterizing post-exercise feelings based on the circumplex model of affect. Therefore, the PAAS measures positive affect, negative affect, fatigue, and tranquility on a five-point Likert scale having only 12 items. Aim: Its ease of administration and interpretation renders the PAAS a valuable tool in both research and practice, but it is unavailable to Hungarian scholars and sports and exercise professionals due to the lack of adaptation. Hence, this work aimed to develop and validate the Hungarian version of the PAAS. Methods: Three hundred sixty-two recreational exercisers (64.1% women), aged from 18 to 62 (mean of age: 27.0 [SD = 10.0]) years completed the questionnaires before and during their exercise (briefly interrupting activity). Measures: PAAS was used to measure positive affect, negative affect, fatigue and tranquility aspects of internal affective experience. Positive and Negative Affect Schedule (PANAS) was utilized to assess the actual mood state, consisting of positive affect and negative affect subscales. Arousal was measured with Felt Arousal Scale (FAS), while the pleasure–displeasure affective valence was assessed with the Feeling Scale (FS). Results: A confirmatory factor analysis indicated good fit of the four-factor model. The results also revealed configural, metric, and scalar measurement invariance between sexes. The internal reliabilities of the scales varied between (Cronbach’s α) .73 and .85 before and during exercise. PAAS scales largely showed the expected associations with other measures of positive and negative affect and activation. The lowest association was between Tranquility (PAAS) and Felt arousal (r = .14), followed by Tranquility and Feeling (r = .27). Feeling and Felt arousal correlated negatively with Fatigue (PAAS, r = –.42 and r = –.44), as well as with the Negative affect (PAAS, r = –.61 and r = –.40). Positive affect from PAAS (PAAS PA) had a positive correlation with Feeling and Felt arousal (r = .64, r = .54). PAAS PA and Positive affect from PANAS (PANAS PA) correlated strongly (r = .77), similar to the Negative affect from both inventories (r = .78; p < .01 for all cases). Conclusion: Therefore, the Hungarian PAAS could assess exercise-induced affect in a reliable and valid way in recreational exercisers. However, its validity in competitive sports remains to be tested.
A szüléssel kapcsolatos attitűdök vizsgálata fiatal nők körében – személyorientált elemzés
The examination of birth attitudes in young women – a person-oriented study
Elméleti háttér: A szüléssel kapcsolatos kognitív és affektív viszonyulási módokat szülésattitűdöknek nevezzük. A szüléssel kapcsolatos attitűdök vizsgálata kiemelt jelentőségű, mivel azok nagyban meghatározzák a szülés preferált módját és később magát a szülésélményt is. Cél: Kutatásunk célja az volt, hogy a szüléssel kapcsolatos attitűdöket személyorientált statisztikai módszerekkel vizsgáljuk annak érdekében, hogy a szüléshez való személyes viszonyulásról differenciáltabb képet kapjunk. Módszerek: Keresztmetszeti kérdőíves kutatásunkban még nem szült és nem várandós nőket vizsgáltunk (n = 302). Hierarchikus klaszterelemzést végeztünk, majd a kapott klaszterstruktúrát megvizsgáltuk az egészségműveltség, a gyakorlati egészségértés, az élettel való elégedettség és a szüléssel kapcsolatos tudás vonatkozásában is. Eredmények: Az eredmények szerint azonosítható egy hét- és egy négyklaszteres struktúra. A továbbiakban a négyklaszteres (Önállóan közelítő, Elkerülő, Külső támaszkereső, Bizakodó) megoldást vizsgáltuk. Ez alapján találtunk szignifikáns különbséget az élettel való elégedettség, az egészségműveltség, valamint a szüléssel kapcsolatos tudás mentén is a klaszterek között. A Bizakodó profil magasabb szubjektív egészségértéssel jellemezhető, mint az Elkerülő [F(3; 298) = 2,51; p = 0,059; η 2 = 0,029], valamint magasabb az élettel való elégedettsége, mint a Külső támaszkereső, valamint az Elkerülő klaszterben [F Welch(3; 143,7) = 4,82; p = 0,003; F Brown-Forsythe (3;235,2) = 5,00; p = 0,002; η 2 = 0,054]. Az Önállóan közelítő csoport szüléssel kapcsolatos tudása szignifikánsan magasabb bármely más profilénál [χ 2(6) = 31,96; p < 0,001; Cramér-V = 0,188]. A profilok nem mutattak szignifikáns kapcsolatot a gyakorlati egészségértéssel. Következtetések: A szüléssel kapcsolatos attitűdök személyközpontú elemzése holisztikus képet adhat a fiatal nők szüléssel kapcsolatos elképzeléseiről és aggodalmairól. Emellett az eredmények megmutatják a szüléssel kapcsolatos attitűdök egyéni különbségeinek hátterét és más személyiségjellemzőkkel való kapcsolatát.
Abstract
Purpose
The determinants of aerobic capacity are oxygen delivery by the cardiopulmonary system and oxygen extraction by the skeletal muscles. However, the impact of the oxygen extraction capacity of the skeletal muscle is unclear. This study aimed to examine the associations between aerobic capacity; muscle strength, endurance, mass, and quality; and oxygen extraction capacity.
Methods
Twenty-seven healthy young men (mean age, 20.7 ± 0.8 years; body mass index, 21.6 ± 3.2 kg m−2) were recruited. The following parameters were determined: peak work rate (WR) and oxygen uptake (
Results
Multiple regression analysis with WR/kg peak as the dependent variable resulted in the adoption of SMI (β = −0.41, P = 0.036), muscle echo intensity (β = −0.45, P = 0.012) and ΔMOER (β = 0.73, P < 0.001) as significantly associated factors. Multiple regression analysis with
Conclusion
These findings suggest that muscle oxygen extraction rate is associated with aerobic capacity. MOER is a useful indicator because it is not affected by body mass.
Abstract
Hepatitis C virus (HCV) is a leading cause of chronic liver disease, cirrhosis, and hepatocellular carcinoma worldwide. HCV has 8 genotypes (GT) and 86 subtypes and distribution of GTs varies based on geographical regions, transmission routes and even in cultural groups. The determination of viral genotype is crucial in choosing antiviral treatment, determining the duration of therapy, and monitoring treatment respose. Since 2014, with the usage of direct-acting antiviral agents (DAAs) in the treatment of HCV infections, a cure rate over 95% could be possible. Epidemiological data are important to combat a chronic HCV infections. Due to its geographical location, Turkey is like a bridge connecting Asia and Europe. Istanbul is the biggest and most crowded city of Turkey and has received immigration from many different countries, especially from Syria, in recent years and immigration still goes on. In addition, the COVID-19 pandemic has had devastating effects in our country. In this study, we determined the HCV genotypes in Health Sciences University Ümraniye Training and Research Hospital, in Istanbul between 2016 and 2022. Of the 322 patients analyzed during this 7-year period, HCV GT1b was the most prevalent GT in 65.2%, followed by GT3 in 15.5%, GT1a in 10.6%. Our data serve as a great mirror for HCV epidemiology in Turkey and contribute to global data.
Abstract
Background and aims
Mobile phone bans in secondary schools are claimed to reduce student distraction and promote learning and face-to-face socializing. Currently, the evidence on phone bans is limited. The aim of this preregistered study was to evaluate the South Australian mobile phone ban's effects on students' problematic phone use, academic engagement, school belonging, and bullying. The study also sought to identify student variables that predict phone ban compliance.
Methods
As the ban was phased in over 2023, a 2 (phone ban: yes/no) × 2 (time: baseline, 1-month follow-up) repeated-measures design was employed. Students (n = 1,282 at baseline; n = 1,256 at follow-up) in Grades 7 to 12 were recruited from five public secondary schools. Surveys included measures drawn from the Longitudinal Study of Australian Children (LSAC) and the Programme for International Student Assessment (PISA).
Results
Problematic phone use was reported by 2.6% of the sample. Being older and a more frequent user of social media predicted lower phone ban compliance. Linear mixed models indicated that ban and no ban school groups did not differ significantly in terms of problematic phone use, academic engagement, and school belonging. There was slightly higher bullying in the ban group but bullying decreased significantly in both groups.
Discussion
Imposing access restrictions may not affect the underlying psychological mechanisms that drive problematic phone use. Although these results indicate limited to no short-term benefits of the ban, further evaluation with more sensitive methodologies is recommended.
Conclusions
Student-technology interactions in learning institutions should be continually monitored to determine the optimal balance to support student etiquette, learning, and wellbeing.
Influenzától a fehérállományig
From influenza to white matter
Acute disseminated encephalomyelitis is an inflammatory disease of the central nervous system. The authors present the case of a 16-year-old boy who was admitted to the Paediatric Emergency Department of the University of Pécs Clinical Centre with acute neurological symptoms. The tests carried out raised the suspicion of acute disseminated encephalomyelitis. Acute disseminated encephalomyelitis is a disease characterized by impaired consciousness and abnormal findings on MRI. Extensive microbiological sampling is important in differential diagnosis. The authors point out if neurological symptoms appear in connection with infections, acute disseminated encephalomyelitis should also be considered. Orv Hetil. 2024; 165(42): 1676–1679.
A lágyékhajlati feltárásból végzett érműtétek sebfertőzéseinek megelőzése negatív nyomású sebkezeléssel
Prevention of vascular surgical site infections in the groin with negative pressure wound therapy
Introduction: The role of negative pressure wound therapy in the treatment of chronic, difficult-to-heal, infected wounds is becoming increasingly significant. The site most susceptible to infection following vascular surgery is the longitudinal incision wound in the groin. The following factors are predisposing factors for the development of wound infection: diabetes, obesity, previous surgery in the region, lower limb gangrene and ulcers. Objective: The objective of this study was to investigate whether closed incision negative pressure wound therapy reduces the incidence of surgical site infections and wound healing disorders in high-risk patients and whether closed incision negative pressure wound therapy reduces septic graft formation. Method: A total of 38 patients who met at least one of the inclusion criteria (body mass index >30, previous surgery in the same region, wound necrosis) were included in the study. The control group (n = 19) was treated with conventional wound coverage (Cosmopor E). In the closed incision negative pressure wound therapy group (n = 19), the primarily closed wound was covered with polyvinyl alcohol foam (VivanoMed White Foam) intraoperatively, then sealed with an airtight foil. Once the port of the vacuum machine had been connected, wound suction was initiated immediately (continuous suction, 100 mmHg). The duration of treatment was 7 days. Patients were followed up postoperatively at 10, 30, and 60 days. Results: In the control group, 42.1% of patients (n = 8) developed wound healing defects, and 36.8% (n = 7) developed surgical site infection. One patient underwent reoperation for septic graft formation. In the closed incision negative pressure wound therapy group, 31.6% (n = 6) of the patients developed wound healing problem, and 26.3% (n = 5) developed infection; in one case reoperation was performed due to septic graft formation. Conclusion: Regarding the primary endpoint, no notable discrepancies were observed between the examined groups. The results of this study demonstrate that closed incision negative pressure wound therapy may be advantageous over conventional wound care in obese patients and in those who have undergone previous inguinal surgery. A potential avenue for further investigation would be to implement more rigorous inclusion criteria. Orv Hetil. 2024; 165(42): 1652–1658.
A marosvásárhelyi serdülők dohányzási szokásai
Smoking habits of the adolescents from Tirgu-Mures
Introduction: Smoking remains a major concern globally, with significant consequences for public and individual health. Objective: We performed a survey about the smoking habits and the knowledge about the effects of smoking among young people in Tirgu-Mures. The aim of this study is to highlight the differences and similarities in the smoking behavior of young people, thus providing a wider perspective on this issue. Material and method: A questionnaire with 17 questions was distributed in the schools of Tirgu-Mures. We asked about the smoking habits of the subjects and their relatives. Results: 105 students filled in the questionnaire anonymously, of them 59.05% attends gymnasium, 15.24% theoretical high-school, and 25.71% vocational school. 54.29% of respondents are girls and 34.29% from rural area. 43.81% of the students had smoked before. 50% of the 9–10. grade students, and 75% of the 11–12. grades have smoked cigarettes. 40% of children are second-hand smokers at home, and these children are much more likely to become active smokers. Most of the students had smoked for the first time in the company of a friend, 4.34% of them before the age of 10 years, and 78.2% of them at 12–15 years old. 52.14% use electric cigarettes. 45 students had not received any information about smoking. Conclusion: The results show that, despite numerous campaigns, the majority of children do not receive authentic information about the effects of smoking. Young people start smoking cigarettes in a social environment, under the influence of their peers and parents, therefore, prevention strategies must be primarily based on the development of social skills. In addition to legislation ensuring the control of smoking, reducing the availability of tobacco products – especially for minors –, further tightening the direct and indirect advertising of tobacco products, and prevention programs such as extensive public information are also necessary. Orv Hetil. 2024; 165(42): 1669–1675.
A neonatális transzportszolgálat szerepe az extrém kis súlyú koraszülöttek korai ellátásában
The role of a neonatal transport service in the initial care of extremely low birth weight infants
Introduction: Delivery of an extremely low birth weight infant is unpredictable and in utero transfer to a hospital with tertiary neonatal intensive care unit (NICU) is not always possible. Postnatal transfer is often required. Data about their demographics and outcomes in Hungary is scarce, and the role of transport teams in their initial care has not been reported. Objective: To analyze resuscitation, initial care, transport, and outcome of extremely low birth weight infants requiring transport on the first day of life in the Central Region of Hungary. To present the results of definitive tertiary neonatal intensive care initiated at the place of birth. Method: In a retrospective observational study, data were analyzed from extremely low birth weight infants transferred on the first day of life by the Neonatal Emergency and Transport Service of the Peter Cerny Foundation between 20/03/2017 and 20/08/2022. Infants with major congenital malformations, transport time of <10 min or transfers between level III NICUs were excluded. Results: 55 infants were included, with a median gestational age of 25 (range: 21–31) weeks and median birth weight of 750 (range: 300–990) grams. 7 infants were born outside hospitals. The transport team was present at birth in 18 cases, while median postnatal age was 52 minutes at their arrival for the others. >50% were hypothermic upon the team’s arrival. Median transfer distance was 59 kilometers. Infants’ body temperature and blood gases have improved significantly during transport. 30 (55%) neonates survived to discharge from level III NICUs. However, no infants born before 24 weeks survived. Of those born outside hospital, 5 survived. Among all survivors, 7 infants had severe intraventricular hemorrhage. Discussion and conclusions: Extremely low birth weight infants transferred on the first day of life face high mortality rates. A mobile NICU service initiating definitive tertiary neonatal intensive care at birth can significantly improve initial care and ensure safe transfer. Orv Hetil. 2024; 165(42): 1643–1651.
Orvostanhallgatók stresszterheltsége és mentális jólléte a testtömegindex és az étkezési magatartás tükrében
Klaszterelemzés
Medical students’ perceived stress and mental well-being in light of body mass index and eating behavior
A cluster analysis
Introduction: Maintenance of medical students’ mental health is a big challenge worldwide: due to the increased level of their perceived stress, there is a high frequency of anxiety, depression, suicidal ideation and burnout. Objective: The aim of our study has been to investigate levels of stress, ways of coping, eating behavior and features of mental health in a sample of medical students and to identify their groups in terms of their vulnerability by means of cluster analysis. Method: Participants of the online survey were medical students from the University of Szeged (n = 153, aged between 18 and 30 years, 77.1% females). Besides the Perceived Stress Scale and the Ways of Coping Questionnaire, we applied the following scales: Three-Factor Eating Questionnaire, Rosenberg Self-Esteem Scale, General Self-Efficacy Scale, Body Appreciation Scale and the Self Regulation of Eating Behavior Questionnaire. Results: According to Student’s t-test, there was no significant difference between those with normal/subnormal BMI and the overweight/obese group in the level of perceived stress. However, the second group shows higher scores on the subscales of emotional and uncontrolled eating which may propose the risk of eating disorders. The three clusters possess different levels of vulnerability: those with “high levels of stress and BMI, and low level of competence in psychological immunity” were characterized by risky ways of coping and a greater risk of disordered eating, while the risk was comparatively less when the high level of stress goes together with normal BMI and healthy body appreciation. Those with “lower level of stress and normal BMI, and high level of competence in psychological immunity” are in the most favorable position. Conclusion: Results of this study can be applied in the development of preventive and health education programs so as to improve the medical students’ quality of life and precede deterioration of their mental health. Orv Hetil. 2024; 165(42): 1659–1668.
Abstract
The aim of this study was to investigate some biochemical and tissue changes associated with Salmonella gallinarum infection in laying hens (LHs), and the complicities of oxidative stress (OS). Fifty LHs were assigned to two groups of 25 LHs infected with S. gallinarum (109 cfu*mL−1 of S. gallinarum) and 25 uninfected controls. Biochemical assays and histopathology were carried out following standard procedures. There was a significant loss of body weight, drop in egg production, as well as 28% mortality in the infected group. Serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and superoxide dismutase (SOD) activities, as well as serum total protein, globulin, total cholesterol, total bilirubin, uric acid, creatinine and malondialdehyde (MDA) levels were significantly higher, whereas serum albumin levels were significantly lower in infected LHs. There were inflammatory, degenerative and necrotic changes observed in the affected organs. Considering the significant elevation in MDA levels coupled with elevated SOD activity in the infected LHs, OS may play a significant role in the pathology of fowl typhoid and may suggest a possible treatment of infected layers with antioxidants.
Abstract
Objective
We aimed to study the possible factors influencing visualisation of brown adipose tissue (BAT) on FDG PET/CT at diagnosis in children.
Method
A total of 92 children or adolescents were included (63 patients with Hodgkin lymphoma (HL) and 29 patients with sarcoma). We examined FDG PET/CT images obtained at diagnosis and searched for FDG uptake in BAT. We analysed the relationship between BAT activation and different possible influencing factors, such as age, sex, outside temperature or season, histological type of malignancy (HL or sarcoma), and volumetric and metabolic values of the tumour tissue. Mann-Whitney, Chi-2 and Fischer's exact tests, and logistic regression analysis were used.
Results
We found no significant difference in the BAT activation frequency between patients with HL and those with sarcoma (P = 0.12). BAT visualization on FDG PET/CT in the HL subgroup showed a trend towards lower TMTV (P = 0.06) and TLG (P = 0.09).
The logistic regression analysis did not show a significant correlation between BAT visualisation on FDG PET/CT and TMTV values.
In terms of age, we found a slightly significant correlation for the whole group (P = 0.06) and for the subgroup of HL patients (P = 0.04) in logistic regression. In terms of seasons, the majority (45%) of BAT positive cases were found in autumn.
Conclusions
BAT visualisation may be associated with a low HL tumour mass. Multivariate analysis revealed a correlation between BAT activation and age in paediatric patients. BAT visualisation do not differ between boys and girls.
Abstract
The establishment of a well-adapted and accurate feeding regimen is a fundamental determining factor in the maintenance of shark species in captivity. Replicating the natural diet in captivity is commonly accepted and recommended. Given the diverse nutritional composition of prey, supplementation may become necessary. The captive environment poses unique challenges, making sharks susceptible to an array of health issues, including numerous diseases. Mitigating these risks demands detailed husbandry practices, an appropriate physical environment and a balanced diet. Supplementation, encompassing vitamins and minerals, becomes imperative for the provision of essential nutrients. This complexity has rendered the formulation of an adapted feeding plan for aquarists exceptionally challenging. The scarcity of information in these species adds to the issue, mandating extrapolation from various shark groups and to species with analogous characteristics. This literature review concentrates predominantly on benthic and pelagic shark species prevalent in contemporary aquariums. The central argument posits that dietary choices in captivity rely on factors such as availability, quality and consistency of supply. The advocated approach highlights the importance of a balanced, diverse feeding that closely mirrors natural diets. It is then crucial to emphasize that these are general guidelines, and the specific dietary requisites may diverge between shark species. Collaborating with experts in marine biology, shark husbandry and veterinary care is imperative for the formulation and perpetuation of an adapted diet for captive sharks.
Abstract
Background
Compulsive buying-shopping is recognised as a significant mental health concern, yet its aetiology is largely understudied. A known risk factor for compulsive buying-shopping is adverse childhood experiences (ACEs). ACEs are also associated with greater problems regulating emotions, as well as depression and anxiety. These factors are also known to be associated with compulsive buying-shopping problems. In this study, we aimed to test a serial mediation model in which ACEs were associated with compulsive buying-shopping problems via emotion dysregulation, and then emotional psychopathology (depression, anxiety).
Methods
We tested this model cross-sectionally in two large samples (N = 1,868 & 4,742) to evaluate the robustness of the model. Both samples completed self-report measures of ACEs, emotional dysregulation, compulsive buying, depression, and anxiety symptoms.
Results
We found support for indirect effects, and all results were consistent for both samples. ACEs predicted greater emotion dysregulation, which then predicted greater depression and anxiety. In turn, anxiety (but not depression) predicted compulsive buying symptoms.
Discussion and conclusions
Emotion dysregulation and anxiety consistently mediated the relationship between ACEs and compulsive buying symptoms. Both emotion dysregulation and anxiety represent malleable targets in clinical interventions for compulsive buying-shopping problems. Our findings also suggest that anxiety may be a stronger predictor of compulsive buying compared to depression, which may be an important avenue for future researchers to investigate.
Abstract
Background and Aims
Electronic gaming machines (EGMs) are a significant source of gambling spend due to their widespread use. Skill-based gambling machines (SGMs) represent an innovative adaptation, merging EGMs' chance-based rewards with video game-like skills. This study aimed to explore the appeal and behavioural consequences of playing SGMs in comparison to traditional reel-based EGMs, particularly focusing on illusions of control, betting behaviour, and the subjective experience of gamblers.
Methods
Participants (N = 1,260) were recruited online and engaged in an online task simulating either an SGM or a reel-based EGM, with outcomes represented to influence their survey compensation. The study examined the effect of SGMs relative to EGMs on bet size, persistence, enjoyment, illusions of control, game immersion, and the influence of demographic and gambling problem severity.
Results
SGMs particularly appealed to younger adults, regular EGM players, and people with more gambling problems. Despite identical payout structures, people assigned to play SGM showed greater illusions of control, believing in the influence of skill on game outcomes and that practice could improve results. However, there was no significant difference in overall betting intensity between SGM and EGM players, although specific demographic groups showed faster betting speeds in SGMs.
Discussion and Conclusions
SGMs, despite not inherently encouraging higher betting intensity, attract vulnerable groups and create illusions of control, posing new regulatory challenges. The visual and interactive features of SGMs, while appealing, might contribute to these perceptions, indicating a need for careful regulation and further research on their long-term impacts on gambling behaviour and harm.
Az antibiotikumok alternatívájaként egyre gyakrabban ajánlott, helyileg alkalmazható antiszeptikumok összehasonlítása
A comparison of locally acting antiseptics, increasingly recommended as an alternative to antibiotics
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.
Az édesanyák tapasztalatai a védőnői szoptatástámogatással kapcsolatban hazánkban
Mothers’ experiences of breastfeeding support by health visitors in Hungary
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.