Orvosi hetilap最新文献

{"title":"[Post-COVID-19 symptoms and sleep-wake abnormalities during the COVID-19 pandemic waves in Hungary].","authors":"Anna Réka Percze, Anna Boglárka Bardóczi, Alexandra Nagy, Szilvia Vasas, János Tamás Varga, Veronika Müller, Gábor Horváth","doi":"10.1556/650.2025.33282","DOIUrl":"10.1556/650.2025.33282","url":null,"abstract":"<p><p>Introduction: Mutations carried by SARS-CoV-2 variants in the spike protein and other regions influence the clinical presentation of COVID−19. However, the significance of SARS-CoV-2 variants concerning post-COVID−19 complications persisting beyond four weeks remains poorly understood. Objective: To assess post-COVID−19 symptoms and sleep-wake disorders induced by different SARS-CoV-2 variants. Method: We retrospectively analyzed hospital records of patients infected with SARS-CoV-2 during the third (February−July 2021; B.1.1.7, Alpha variant, n = 88), fourth (August−December 2021; B.1.617.2, Delta variant, n = 60), and fifth (January−June 2022; B.1.1.529, Omicron variant, n = 41) epidemiological waves in Hungary, and presented >4 weeks after the infection with post-COVID−19 symptoms at the Department of Pulmonology, Semmelweis University. Sleep-wake disturbances were assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. PSQI score >5 was considered as poor sleep quality. Results: Fatigue was the most common post-COVID−19 symptom for all three variants (61.7−64.8−65.9%). Over successive epidemiological waves, the occurrence of dyspnea decreased, whereas cough and palpitations increased. Comparing the subgroups based on the PSQI score, fatigue was more frequent in poor sleepers for the Alpha and Delta variants, and remained common (≥60%) for the Omicron variant, regardless of sleep quality. Cough and dyspnea were more frequent in poor sleepers for all three variants. Tachycardia was rare (<25%) for the Alpha variant, frequent (50%) among poor sleepers for the Delta variant, and consistently high (≥50%) for the Omicron variant, regardless of sleep quality. Our sleep-wake rhythms analysis revealed a delayed bedtime for the Omicron variant, an earlier wake-up time for the Alpha variant, and prolonged sleep latency with reduced sleep duration across all three variants in poor sleepers. Conclusion: Our study confirms the variant-dependent heterogeneity of post-COVID−19 symptoms and sleep-wake disturbances. Understanding the relationship between post-COVID−19 complications and viral variants may help elucidate the significance of SARS-CoV-2 genetic changes. Orv Hetil. 2025; 166(21): 817–825.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 21","pages":"817-825"},"PeriodicalIF":0.8,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Endometriosis in the sigmoid colon causing obstruction with lymph node involvement].","authors":"Viktor Nagy","doi":"10.1556/650.2025.33300","DOIUrl":"10.1556/650.2025.33300","url":null,"abstract":"<p><p>The case of a 50-year-old woman was presented, whose clinical examination first diagnosed subacute obstruction and then complete intestinal obstruction after several weeks of uncertain abdominal pain. Imaging examinations were inconclusive. An Hartmann’s resection of the sigmoid colon with end-stoma formation was performed as an emergency. The surgical specimen was processed as a malignant preparation, including searching for lymph nodes. The histological examination confirmed extensive endometriosis with lymph node involvement, which was also confirmed by immunohistochemistry, and other possible non-malignant, malignant, or metastatic processes were excluded. There are many theories about the etiology and pathogenesis of endometriosis associated with lymph node involvement, but the process is still not completely clear. Most often, the disease is only recognized during diagnostic laparoscopy. There are no coherent protocols for treatments either; in addition to surgical solutions, drug treatments are considered, the latter can be hormonal and non-hormonal preparations. The type of surgery should be planned based on the adequate anamnesis and diagnostic procedures, taking into account the long-term effects. Treatments should be tailored to the individuals and efforts should be made to avoid complications and recurrences. Orv Hetil. 2025; 166(21): 826–831.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 21","pages":"826-831"},"PeriodicalIF":0.8,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The effects of environmental factors on the embryonic and late postembryonic life through epigenetic mechanisms].","authors":"Vilmos Fülöp, László Kalmár, Attila Kiss, Kornél Lakatos, György Végh, Tamás Arányi","doi":"10.1556/650.2025.33305","DOIUrl":"10.1556/650.2025.33305","url":null,"abstract":"<p><p>It has long been known that, in addition to genetic factors, epigenetic effects fundamentally influence the functioning of the living organism. Although the genome of individual cells of the human body is almost identical, the access, transcription and expression of genetic information are influenced by epigenetic effects. The eukaryotic nuclear DNA is wrapped around histone octamers to form the nucleosome, the basic unit of the chromatin structure. The covalent modifications of the histone proteins cause epigenetic changes. Human conception, followed by the division and implantation of the fertilized egg into the maternal decidua, is a complex process that requires the coordinated functioning of embryological, immunological processes and anatomical structures. The steps of these processes are genetically determined and the coarse- and fine-tuning of these effects occurs at the epigenetic level by external effects such as hormones, toxins, changes in diet, infections, or cell differentiation. The most significant rearrangements occur in the embryonic period after the fertilization of the egg. In our paper, we review the literature to present the effects that influence the fine-tuning of genome function at the epigenetic level. Disturbances of these mechanisms are the basis of several pathologies that threaten conception, implantation and successful pregnancy, such as recurrent miscarriage, preeclampsia, fetal growth restriction or premature birth. In addition, epigenetic alterations acting during the period of plasticity of individual development can cause diseases that appear in the young, adult and even old age of the offspring, which can even be inherited through generations. Orv Hetil. 2025; 166(21): 799–807.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 21","pages":"799-807"},"PeriodicalIF":0.8,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Comparison of therapy adherence in patients suffering from atrial fibrillation treated with direct oral anticoagulants based on data from years 2015-2018].","authors":"Gábor Simonyi, András Paksy, Mihály Medvegy, Kristína Gencsiová, Erzsébet Evelyn Sipos, Gergő Csitári, Roland Gasparics, Ervin Finta","doi":"10.1556/650.2025.33286","DOIUrl":"10.1556/650.2025.33286","url":null,"abstract":"<p><p>Introduction: Direct oral anticoagulants are playing a significant role in the treatment of non-valvular atrial fibrillation for stroke prevention. Previous studies have demonstrated that adherence to direct anticoagulant therapy is better than that of vitamin K antagonists, however, it remains suboptimal. Objective: The authors aimed to examine the persistence of direct anticoagulant therapy in patients with atrial fibrillation by analyzing the National Health Insurance Fund Administration database. Method: We analyzed data from patients receiving direct anticoagulant therapy between 2015 and 2018 using the database of the National Health Insurance Fund Administration. The study considered both newly treated patients and those previously receiving direct anticoagulant therapy. Patients’ medication refills were tracked for 14 months, and persistence changes were evaluated using Kaplan–Meier analysis. The average duration of drug intake and its 95% confidence interval were determined for each active substance. Results: The one-year persistence of newly initiated direct anticoagulant therapy was 63.4% on average, while it was 71.1% among previously treated patients. The one-year average persistence was 7.7 percentage points higher in previously treated patients compared to those newly initiated on direct anticoagulant therapy. This advantage was +4.9 percentage points for apixaban, +9.5 percentage points for dabigatran, and +9.4 percentage points for rivaroxaban. The best one-year persistence in both groups was observed in 2017 (65.7% and 72.5%, respectively). Among newly treated patients, the average persistence rates were 61.5% for apixaban, 57.7% for dabigatran, and 62.9% for rivaroxaban. In previously treated patients, the one-year average persistence rates were 66.4% for apixaban, 67.4% for dabigatran, and 72.3% for rivaroxaban. The mean duration of drug intake over a 360-day period was 299 days for new patients and 322 days for previously treated patients. Conclusion: Differences were observed in one-year persistence among the various direct anticoagulants. However, in general, therapy adherence to direct anticoagulants has increased since 2016. Nonetheless, significant efforts are required to further improve persistence rates. Orv Hetil. 2025; 166(21): 808–816.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 21","pages":"808-816"},"PeriodicalIF":0.8,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Relation of metabolic-associated fatty liver disease to the complications of diabetes mellitus].","authors":"Brigitta Kozma, Anna Egresi, Géza Nagy, Anikó Somogyi, Anna Blázovics, Krisztina Hagymási","doi":"10.1556/650.2025.33294","DOIUrl":"10.1556/650.2025.33294","url":null,"abstract":"<p><p>Fatty liver has become one of the most common chronic liver diseases worldwide. During its progression, steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma may develop. Fatty liver disease of metabolic origin occurs in nearly 30% of adults, it affects people with diabetes mellitus to a greater extent. Its incidence is 70% in type 2 diabetes mellitus, and 30–40% in type 1 diabetes mellitus. The global health burden of fatty liver disease of metabolic origin means an increased risk not only of hepatic (e.g., cirrhosis, liver failure or hepatocellular carcinoma) but also of extrahepatic (e.g., cardiovascular, and neoplastic diseases) complications. Both type 1 and type 2 diabetic patients with fatty liver disease have a higher mortality rate. These patient groups are exposed to an increased risk not only of cardiovascular diseases, but also of diabetic retinopathy and nephropathy, compared to diabetics not associated with fatty liver disease. In our summary, we review how the coexistence of fatty liver and type 1 and type 2 diabetes mellitus affects the frequency of diabetic macro- and microvascular complications. Orv Hetil. 2025; 166(20): 759–767.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 20","pages":"759-767"},"PeriodicalIF":0.8,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Diagnostic testing practices of patients with early stage bowel cancer - without organ metastasis and synchronous cancer - between 2012 and 2020 within the publicly funded Hungarian healthcare].","authors":"Zsolt Horváth, Viktor Dombrádi, György Surján, Fruzsina Mária Sinka, Cecília Surján, Éva Belicza","doi":"10.1556/650.2025.33270","DOIUrl":"10.1556/650.2025.33270","url":null,"abstract":"<p><p>Introduction: Early detection and investigation of bowel cancers is crucial in order to increase the patients’ chances of survival, as failure and delay in diagnostic steps worsen survival results. Objective: To understand and characterize the diagnostic process of patients with early malignant bowel cancers, those having no organ metastasis and synchronous cancer, based on the analysis of patient visit data. Method: For our research, we used data of the outpatient care and hospital utilization provided by the National Health Insurance Fund for the period 2010–2021, of the demographics of the population with a social security identification number, and of the CT/MR examinations. Among the patients with ICD C17–C19 coded small, large bowel and ICD C20 coded rectal cancer, we assessed the examinations required to establish the diagnosis in the six months prior to the first therapeutic intervention: 1. faecal blood test; 2. ultrasound and/or X-ray; 3. biopsy, histology; 4. CT and/or PET/CT; 5. MR. In our analysis, we included patients with early-stage bowel cancer aged 30–89 years who were treated between 2012 and 2020. In addition to the demographic characteristics of the patients, descriptive statistical methods were used to measure the rate of examinations, the time elapsed between the first and last examination, the time between the last examination and the start of the first treatment, and the change over time. Results: Between 2012 and 2019, the proportion of patients without organ metastases and synchronous cancer improved from 63.2% to 68.4% in the C17–C19 group, and from 59.6% to 65.6% in the C20 group. In the small intestine-colon group, CT increased from 64.6% to 72.3%, and among rectal cancer patients, the proportion of those receiving MR examination increased from 9% to 33.5%. During the period, the proportion of patients receiving treatment within 14 days of the last diagnostic examination decreased moderately, by 8 percentage points. 6% of the treated patients had no previous documented diagnostic tests. Discussion: During the analysis period, we observed further improvements in imaging practice in line with international guidelines. Although more than half of the patients received care within 14 days of the last diagnostic step, the patient care pathway, which mostly consists of 2–4 steps, can be further shortened with appropriate support and coordination. Conclusion: Clinically relevant results can be generated from the patient visit data, which can be used by those involved in the field as well as in health policy and care management. The improvement of coding practices, the creation of domestic clinical guidelines, and the investigation and management of delays in the diagnostic steps are recommended. Orv Hetil. 2025; 166(20): 768–782.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 20","pages":"768-782"},"PeriodicalIF":0.8,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Addressing the feasibility of abdominal aortic aneurysm screening in Hungarian primary care].","authors":"Róbert Kiss-Kovács, Szabolcs Fábián-Nagy, Blanka Morvai-Illés, Zsolt Palásthy, Rita Váradi, Endre Szabó, Zsigmond Tamás Kincses, Albert Varga, Gergely Ágoston","doi":"10.1556/650.2025.33291","DOIUrl":"10.1556/650.2025.33291","url":null,"abstract":"<p><p>In Hungary, there is currently no institutionalised, organised, invitation-based screening programme for the detection of abdominal aortic aneurysms. In contrast, an increasing number of countries are developing and launching their own pilot abdominal aortic aneurysm screening programmes, as was recently the case in the Czech Republic on the first of January 2025. In Hungary, a validation pilot study was initiated in the autumn of 2023, in which a subset of general practitioners – who previously participated in point-of-care ultrasound training and demonstrated proficiency in the abdominal aortic aneurysm examination technique – are screening patients belonging to the target population in their own practices, under radiological validation, to detect abdominal aortic aneurysms. The aim of our ongoing study is to determine whether ultrasound-based abdominal aortic aneurysm screening is justified in Hungarian primary care. During the study, a positive screening result requiring vascular surgical intervention was obtained within a short timeframe by one of the participating general practitioners, despite the relatively low number of patients screened at the time of detection. The purpose of our case report is to highlight that, after a simple and brief training period, general practitioners can perform accurate, radiologically evaluable, and standardised examinations, enabling the timely detection of this potentially life-threatening condition through a screening process that takes only a few minutes. By doing so, the elective surgical treatment of mostly asymptomatic abdominal aortic aneurysms can be life-saving, preventing rupture of the aortic wall. Orv Hetil. 2025; 166(20): 788–794.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 20","pages":"788-794"},"PeriodicalIF":0.8,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Korszerű gyermeksebészet. Rákóczy György, Vajda Péter, Cserni Tamás (szerk.), Semmelweis Kiadó, Budapest, 2025.","authors":"Attila Szijártó","doi":"10.1556/650.2025.20M","DOIUrl":"https://doi.org/10.1556/650.2025.20M","url":null,"abstract":"","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 20","pages":"795"},"PeriodicalIF":0.8,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A case of hyponatremia due to central hypothyroidism associated with senile hypopituitarism].","authors":"Gyula Tomasics, Anna Czégeni, László Schandl, Ádám Csatáry, János Kis, Gábor Winkler","doi":"10.1556/650.2025.33296","DOIUrl":"10.1556/650.2025.33296","url":null,"abstract":"<p><p>Hyponatremia is one of the most common ion disorders encountered in everyday practice. It is usually caused by sodium loss or hypervolemic dilution, and side effects of drugs may also contribute. Less well known is the hyponatremia associated with hypothyroidism. The mechanism of its development is not well understood, but it is mainly explained by a decrease in myocardial pump function and secondary arginine vasopressin stimulation-induced fluid retention as wells as a decrease in renal fluid excretion. Although hyponatremia is not a typical and uncommon symptom of hypothyroidism, it may be important to be aware of the possibility of hypothyroidism underlying ion imbalance. In our case report, an elderly patient with hyponatremia was found to have pituitary insufficiency, which caused hypothyroidism and consequent hyponatremia by a central mechanism. Thyroid-stimulating hormone levels in the normal range did not initially raise suspicion of the disease, but free hormone determination revealed an underlying hypothyroidism, the central origin of which was confirmed by imaging. Our case may serve as a useful lesson for everyday practice. Orv Hetil. 2025; 166(20): 783–787.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 20","pages":"783-787"},"PeriodicalIF":0.8,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Signet ring cell carcinoma in the terminal ileum in the background of Crohn's disease].","authors":"Viktor Nagy","doi":"10.1556/650.2025.33283","DOIUrl":"10.1556/650.2025.33283","url":null,"abstract":"<p><p>Adenocarcinoma occurs less frequently in the small intestine than in the large intestine. Occasionally, it develops on the background of Crohn’s disease, due to long-term chronic inflammation. A case of a young man with Crohn’s disease who had not been treated for years is presented. The histological examination confirmed signet ring cell carcinoma in the terminal ileum. The carcinoma formed in the surroundings of a deep fissure area where dysplastic glands were confirmed, confirming the local development. The tumor also infiltrated the muscularis propria with perineural and vascular spread. Great care must be taken when processing this type of surgical preparation, and in all similar cases, the possibility of a malignant process should be considered. Macroscopically the tumor could not be clearly identified so the entire suspected area was processed. There are no specific immunophenotype to identify the small intestinal origin, however, CK7, CK20, CDX2, SATB2, EMA (MUC1), MUC5AC, MUC6, Villin reactions may be helpful. In addition to long-term chronic inflammation, other etiological factors may include ileal conduits, reservoirs, acid exposure, gluten-sensitive enteropathy, significant alcohol consumption, sugar or processed carbohydrate consumption, and smoking. In addition to curative surgical solutions, adjuvant chemo- and radiotherapy are considered as treatments. The 5-year survival rate of signet ring cell carcinoma complicated by Crohn’s disease is barely 20–30%. Orv Hetil. 2025; 166(19): 744–749.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 19","pages":"744-749"},"PeriodicalIF":0.8,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}