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
Abszcizinsav – táplálkozási lánc és humán egészség
Abscisic acid – food chain and human health
Abscisic acid is an ancient, universal compound on different levels of phylogenetic development and helps organisms adapt to their environment. In the 1940s, attention was first given to a substance that inhibits the growth of plants, which in the mid-1960s turned out to be a phytohormone that regulates the dormant state of plants. Research conducted in the 2010s revealed the biosynthesis of abscisic acid. Bioactive abscisic acid, an oxygen-rich diterpene molecule, is the product of the degradation of xanthophylls synthesized from mevalonic acid as a starting compound. Abscisic acid, as a secondary metabolic product, affects many physiological processes in plants. In the last two decades, molecular-genetic, biochemical and pharmacological studies have discovered the universal signaling pathway of abscisic acid. In 1986, during animal experiments carried out in parallel with these studies, it was realized that abscisic acid is also produced in the animal body. After the turn of the millennium, more and more people became interested in the role of abscisic acid in animal organs, tissues, and cells (leukocytes, monocytes/macrophages, granulocytes, microglial cells, pancreatic cells, mesenchymal stem cells etc.). There is now an enormous amount of literature on the versatile physiological effects of this compound. It is proven that it is a human endogenous hormone. In both animals and humans, abscisic acid regulates many physiological functions in a manner very similar to the signaling pathway known in plants. It regulates cell growth, development and immune responses to various stimuli. It has also become known that abscisic acid, as a growth regulator, is not toxic to the animal body, but at the same time inhibits the growth of cancer cells. It has a favorable effect on carbohydrate metabolism and also has anti-inflammatory properties but its inflammatory effect has also been described. Currently, the possibility of its use in human medicine is being researched. Orv Hetil. 2025; 166(2): 43–49.
Az anaemia gyakoriságának felmérése, osztályozása, prediktív tényezői gyulladásos bélbetegségben szenvedő betegekben
Anemia classification, prevalence and predictive factors in inflammatory bowel disease
Introduction: Anemia is a common complication of inflammatory bowel disease and serves as an indicator of severe disease. Objective: This study aims to evaluate the prevalence, etiology, predictive factors, and treatment of anemia in patients with inflammatory bowel disease from two tertiary centers. Method: In this retrospective, cross-sectional study, we assessed the frequency of anemia among patients presenting within a specified calendar year (June 1, 2022, to May 31, 2023), focusing on the lowest hemoglobin levels recorded during this period. We collected demographic data, disease activity scores, treatment regimens, inflammatory markers, and laboratory parameters related to iron balance. Clinical disease activity was evaluated using the Crohn’s Disease Activity Index and the partial Mayo Score. The World Health Organization’s criteria were utilized for anemia classification and severity assessment. Absolute iron deficiency was defined as a serum ferritin level <30 µg/L, while anemia of chronic disease was defined as a ferritin level >100 µg/L in conjunction with clinical or biochemical evidence of active disease. Results: The study included 400 patients (277 with Crohn’s disease and 123 with ulcerative colitis). Among the Crohn’s disease patients, 17.7% exhibited complex disease behavior, and 40.7% of the ulcerative colitis patients had extensive colonic involvement. Biological treatments were administered to 75% of the participants. Anemia was identified in 32.5% (130) of the patient cohort, with 57% classified as mild, 35% as moderate, and 8% as severe. In the subset of non-macrocytic anemia (116 patients), iron status data were available for 51% (n = 66). Of these, 73% had iron deficiency anemia, 6% had anemia of chronic disease, and 17% had chronic disease with functional iron deficiency. Anemia predictors included steroid treatment (p<0.001; OR: 4.2), clinical disease activity (p<0.001, OR: 381), and laboratory markers of disease activity (p<0.001, OR: 2.9). Intravenous iron supplementation was administered to 43 patients, while 12 received oral iron supplementation. Conclusion: The findings highlight the high prevalence of anemia, predominantly iron deficiency anemia, among patients with inflammatory bowel disease, which is closely associated with clinical and laboratory markers of disease activity. This study underscores the importance of diagnosis, classification (through assessment of iron balance parameters), and treatment of anemia in patients with inflammatory bowel disease. Orv Hetil. 2025; 166(2): 60–66.
Dr. Steinberger Sarolta (1875–1966) és az ártatlanság vélelme
Sarolta Steinberger, MD (1875–1966) and the presumption of innocence
Újszerű bariátriai bypassműtéttel (SASI) szerzett tapasztalataink
Experiences with a novel bariatric bypass procedure (SASI)
Introduction: Obesity is a problem of endemic proportions, which is not simply an aesthetic problem, but rather a systemic disease. Regarding its treatment, surgery is more effective than conservative methods. Laparoscopic „single anastomosis sleeve ileal” (SASI) bypass is a novel bariatric procedure not yet broadly in practice that combines advantageous features of restrictive and malabsorptive techniques. SASI can be effective for both „amount eaters” and „sweet eaters”, while the risk of impaired absorption remains minimal. Objective: In this report, we present the results of SASI bypass procedures performed by our team between August 1, 2022 and September 1, 2024. Methods: Regarding criteria of qualification and conducting the study, the protocol of the international bariatric society was followed. After creating a gastric sleeve in the first stage, an anastomosis with a maximal width of 4 cm was created between the ileum and remaining stomach. Follow-ups were carried out 3 and 6 months after surgery. Gastric emptying was examined with isotopic method in two voluntary patients. Results: A group of 25 patients (17 women, 8 men) who underwent SASI bypass surgery were evaluated in the study (mean age 40.1 ± 11.3 years). Mean preoperative BMI was 43.7 ± 6.7 kg/m2. Postoperative BMI decreased by 6.1 ± 3.4 kg/m2 (13.9 ± 6.3%) at 3 months and 11.6 ± 6.2 kg/m2 (26.1 ± 12.0%) at 6 months. Hypertension resolved in 9 out of 11 cases, prediabetes normalized in 2 out of 2 cases. We observed postoperative reflux in 6, sleep disorder in 1, fatigue in 5, hair loss in 9 cases. Lasting diarrhea did not occur. With isotopic examination we found that 90% of gastric content empties into the efferent ileum and 10% goes into the duodenum. Discussion: SASI bypass combines advantages of restrictive and malabsorptive bariatric procedures effectively, while – according to our experience so far – the risk of impaired absorption, vitamin- and mineral-deficiency remains minimal. A significant regression can be expected regarding comorbidities and required medications in the first 6 months after surgery. Conclusions: SASI bypass is a safe procedure that achieves effective weight loss and quick resolution of comorbidities, thus it may become the leading bariatric procedure in the near future. Orv Hetil. 2025; 166(2): 67–76.
A virtuális valóság használatának lehetőségei gyermekek perioperatív ellátásában
The potentials of virtual reality in pediatric perioperative care
Each year, millions of children worldwide undergo general anesthesia for various surgical or diagnostic procedures. In Hungary, approximately 20,000 to 30,000 children are treated in pediatric surgical centers annually, and additional 5,000 to 10,000 children undergo operation in adult otolaryngology departments. Treating children is a challenge, as their cognitive and emotional development levels may pose difficulties for them in understanding the procedures ahead and may make the processing of the stressful experiences of the intervention uncertain. Preoperative anxiety can often lead to increased postoperative pain, confusion, extended hospital stays, and undesirable behavioral changes. Various methods are available to manage perioperative anxiety and pain (such as administering anxiolytics as premedication, allowing parental presence during anesthesia induction, and postoperative pain relief). Although distraction methods like music or cartoons have proven effective, pharmacological treatment remains the gold standard. The use of newer, alternative solutions (such as psychoeducation or virtual reality) has not yet become part of routine practice. Virtual reality is a new, innovative tool that offers an immersive, three-dimensional audiovisual experience, diverting children’s attention away from unpleasant experiences. The use of virtual reality in pediatric settings is particularly promising, as children’s attention can easily be engaged through virtual games, reducing the anxiety and pain caused by medical procedures. This article presents the pediatric applications of virtual reality and the possibilities of its use in procedural and perioperative environments based on literature data, in relation to the fact that personal experience with the method has begun at the Pediatric Center of Semmelweis University. Orv Hetil. 2025; 166(2): 50–59.
Abstract
Background and aims
Uncontrollable gaming behavior is a core symptom of Internet Gaming Disorder (IGD). Attentional bias towards game-related cues may contribute to the difficulty in regulating online gaming behavior. However, the context-specific attentional bias and its cognitive mechanisms in individuals with IGD have not been systematically investigated.
Methods
We compared individuals with IGD to healthy controls (HC) using a rapid serial visual presentation (RSVP) task to measure temporal attentional bias. By applying game-related and neutral stimuli as targets, we specifically assessed how attentional resources were allocated to game-related stimuli compared to neutral stimuli.
Results
The IGD group showed enhanced attentional blink effect when a game-related stimulus was the first target and a neutral target was the next, reflecting IGD's difficulty in disengaging from game-related stimuli. Both IGD and HC individuals exhibited decreased accuracy in identifying a neutral first target followed by a game-related second target at shorter lags, indicating increased attentional engagement with game-related stimuli in general.
Discussion
The results provide a cognitive basis for recurrent and uncontrollable gaming behaviors in individuals with IGD. Game cues have priority in the allocation of attentional resources in individuals with IGD. The results shed new light on the development of specific treatments for IGD.
Abstract
Background and aims
Internet gaming disorder (IGD) is a highly engrossing activity with the individual spending up to 10 h per day gaming, this causes issues in accomplishing their tasks and personal goals. Also, to generate in them increased anxiety, impulsivity and lack of social skills, this impacts the good personal development and individual's quality of life. Therefore, it is vital to better understand, in terms of treatment, which factors are associated with therapeutic outcomes (largely to achieve control over the use of video games and the lack of relapses) following a standardized Cognitive Behavioral Therapy (CBT) protocol. This study aimed to explore sociodemographic and personality variables and their relation to treatment outcome in patients with IGD.
Method
The sample included n = 105 patients with IGD, considered between January 2005 and December 2022 and recruited from the Behavioral Addictions Unit at the University Hospital of Bellvitge. Data at baseline was registered (sociodemographic and clinical measures), as well as the therapy outcomes (compliance with the guidelines, presence of relapses and dropouts).
Results
Patients were mainly males (n = 95) with a mean age of 24.97 (SD = 12.03). All patients included in this sample had individual CBT treatment in relation to their problematic gaming behavior. In terms of patients who relapsed, they had higher interpersonal sensitivity, hostility and persistence with lower self-directedness. Patients who dropped out were males with an older age of IGD onset. When looking at treatment noncompliance, it was related to higher psychoticism and reward dependence, and lower cooperation. Patients with IGD show higher levels of treatment noncompliance.
Conclusion
These findings evidence a positive and promising effect of CBT on IGT. The factors identified as predictors of good and poor treatment outcomes should be considered for developing new evidence-based interventions focused on learning healthier key coping strategies to manage both cravings and triggers.
Abstract
Background
During the development of addictive behaviors, theoretical models assume a shift from experience of gratification being a driver in early stages to experience of compensation which dominates at later stages of addiction development. Initial studies show a trend in this direction; however, this shift has not yet been investigated in clinical samples. We assume experienced gratification to be highest in individuals with risky use (indicating the beginning of the addiction process), and compensation to be highest in individuals with pathological use.
Methods
Data from 834 participants from a multi-center study (FOR2974) investigating specific Internet-use disorders (IUDs) including gaming, buying-shopping, pornography use, and social-network use disorders were analyzed about Experience of Gratification (EGS) and Experience of Compensation (ECS), symptom severity, use expectancies, and usage motives. A diagnostic interview based on DSM-5 criteria for gaming disorder was used to classify individuals into either non-problematic, risky, or pathological use group.
Results
The groups (non-problematic, risky, pathological) differed significantly regarding EGS and ECS. Individuals with pathological use reported highest experiences of compensation but equally high experienced gratification as individuals with risky use. Effects vary with respect to the specific behavior. All measures correlated significantly. Symptom severity was most strongly associated with facets of compensation.
Conclusion
The experience of gratification and compensation appear to be crucial for addiction-like Internet use. Experienced gratification is already high in individuals experiencing first negative consequences and appear to be stable in individuals with pathological use indicating the relevance of both positive and negative reinforcement during the addiction processes.
Abstract
Background and aims
The inclusion of gaming disorder as a new diagnosis in the 11th revision of the International Statistical Classification of Diseases (ICD-11) has caused ongoing debate. This review aimed to summarise the potential neural mechanisms of gaming disorder and provide additional evidence for this debate.
Methods
We conducted a comprehensive literature review of gaming disorder, focusing on studies that investigated its clinical characteristics and neurobiological mechanisms. Based on this evidence, we further discuss gaming disorder as a psychiatric disorder.
Results
The present review demonstrated that the brain regions involved in gaming disorder are related to executive functioning (e.g., anterior cingulate cortex and dorsolateral prefrontal cortex), reward systems (e.g., striatum and orbitofrontal cortex), and emotional regulation (e.g., insula and amygdala). Despite the inclusion of gaming disorder in the ICD-11, the debate remains on the benefits and harms of classifying it as a mental health disorder. Opponents argue that the current manifestations that support gaming disorder as a psychiatric disorder remain inadequate, it could cause moral panic among healthy gamers, and that the label of gaming disorder is stigmatising.
Discussion
Evidence suggests that gaming disorder shares similar neurobiological alterations with other types of behavioural and substance-related addictions, which further supports gaming disorder as a behavioural addiction. Ongoing debates on whether gaming disorder is a psychiatric disorder push for further exploring the nature of gaming disorder and resolving this dilemma in the field.
Belszervi perforációk IV-es típusú Ehlers–Danlos-szindrómában szenvedő gyermekben
Visceral perforations in a child with Ehlers–Danlos syndrome type IV
The vascular type IV of Ehlers–Danlos syndrome is an autosomal dominant connective tissue disorder, the diagnosis of which is often delayed. Severe complications: arterial rupture or colon perforation may rarely occur already in childhood. We present a five-year-old child who developed bowel and bladder ruptures. He was admitted with severe abdominal pain and muscle defense. He had a history of chronic constipation, recurrent complaints of dysuria and suffusions. Based on clinical signs and imaging, acute surgery was indicated. A 3 mm perforation was found at the rectosigmoid part of the bowel. Weakness of the bowel due to chronic constipation, Hirschsprung’s disease, abuse, inflammatory bowel disease and connective tissue disorder have been raised as possible diagnoses. The excessive connective tissue fragility in several family members raised the possibility of Ehlers–Danlos syndrome. Indeed, a missense COL3A1 variant (p.Arg449Leu) was identified that segregated with the disease in the family. Six months later, a bladder diverticulum was found by cystoscopy. Spontaneous bladder rupture occurred on the fourth postoperative day. After suturing the defect, the child completely recovered. Ehlers–Danlos syndrome may present as a life-threatening condition already in childhood. It is important to recognize this rare genetic disorder and follow up the patient. Patients should avoid exertion. Colonoscopy and cystoscopy are relatively contraindicated. Orv Hetil. 2025; 166(1): 27–32.
