Orvosi hetilap最新文献

{"title":"[Methods of regional analgesia during hepatopancreatobiliary surgeries].","authors":"Bánk Keczer, Balázs Varga, János Széll, Attila Szijártó, Katalin Darvas, Marcell Szabó","doi":"10.1556/650.2025.33314","DOIUrl":"10.1556/650.2025.33314","url":null,"abstract":"<p><p>Hepatopancreatobiliary surgeries are complex procedures associated with significant perioperative pain. Adequate pain relief improves patient comfort, contributes to faster recovery, and reduces the risk of complications. While thoracic epidural analgesia remains the first-line option for open pancreatic surgeries, its use in liver resections is debated. There is growing experience and increasing emphasis on alternative neuraxial and regional techniques. We aimed to perform a systematic review of randomized, controlled trials focused on neuraxial and regional anesthesia methods in hepatopancreatobiliary surgery. A structured PubMed® search was performed. We reviewed 47 randomized, controlled studies. Epidural analgesia continues to provide excellent pain relief, but there is a higher need for volume replacement and vasoactive agents. Intrathecal morphine administration is a viable alternative, particularly for laparoscopic procedures, though it is associated with a higher incidence of itching and nausea. Regional anesthesia techniques, such as erector spinae and transversus abdominis plane blocks, effectively reduce postoperative opioid requirements and related side effects, but their analgesic effects are inferior to epidural analgesia. Results from paravertebral and quadratus lumborum blocks are inconsistent, with their effectiveness not yet clearly established. Continuous wound infusion catheters are increasingly used to reduce opioid consumption. The optimal choice of technique is a multidisciplinary decision, considering patient risks, comorbidities, and surgical methods, with an increasing focus on novel approaches. Orv Hetil. 2025; 166(26): 1003–1016.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 26","pages":"1003-1016"},"PeriodicalIF":0.8,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529158","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":"[Correction of suboptimal outcomes after cataract surgery using secondarily implanted AddOn intraocular lenses].","authors":"Amanda Argay, Péter Vámosi, Zoltán Zsolt Nagy","doi":"10.1556/650.2025.33346","DOIUrl":"10.1556/650.2025.33346","url":null,"abstract":"<p><p>Introduction: Today, the expectation for cataract surgery is to achieve the best possible refractive outcome, but ultimately in many cases the visual outcome is suboptimal, which may require further surgical correction. Often the most optimal option for surgical correction is the implantation of a secondary supplementary lens in the ciliary sulcus. Aim: The aim of our study was to assess the long-term visual outcome after secondary implantation of the 1stQ AddOn® (Medicontur Medical Engeneering Ltd.) artificial lens in the sulcus, focusing on its stability and biocompatibility. Method: We analyzed the data of patients with suboptimal visual outcomes after cataract surgery who underwent implantation of a monofocal 1stQ AddOn lens as a corrective procedure. Pre- and postoperative evaluations included uncorrected and corrected distance vision, objective and subjective (manifest) refraction, corneal endothelial cell density, and complex slit-lamp ophthalmologic examination including applanation intraocular pressure measurement. The positions of the primary and secondary lenses were assessed via ultrasound biomicroscopy 1–4 years after implantation. Statistical comparisons were performed using an unpaired two-sample t-test or Wilcoxon test. The limit of significance was 5%. Results: 14 eyes from 12 patients (mean follow-up: 34,34 ± 16,13 months) were studied. The uncorrected logMAR visual acuity significantly improved at both 1 month (p = 0,0002) and 1–4 years (p = 0,0001) postoperatively, while the corrected acuity remained stable. Endothelial cell counts did not differ significantly from preoperative values. No increases in intraocular pressure, chronic inflammation, pigment dispersion, or other complications were observed. The secondary lenses remained stable, with a mean inter-lens distance of 0,38 ± 0,16 mm. Discussion: In patients with suboptimal visual outcome after cataract surgery, 1stQ AddOn lens implantation is well planned and provides a stable long-term outcome without complications. Conclusion: Secondary lens implantation is a suitable alternative for postoperative correction in cases of suboptimal visual outcome. Orv Hetil. 2025; 166(26): 1031–1037.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 26","pages":"1031-1037"},"PeriodicalIF":0.8,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529155","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":"[Injection laryngoplasty for the treatment of unilateral vocal fold paralysis].","authors":"Ágnes Szalenko-Tőkés, Zoltán Tóbiás, Andrea Ambrus, András Burián, László Rovó, Ádám Bach","doi":"10.1556/650.2025.33329","DOIUrl":"10.1556/650.2025.33329","url":null,"abstract":"<p><p>The effects of unilateral vocal fold paralysis on voice production and swallowing can lead to a significant deterioration in the quality of life. Isolated injury to the recurrent laryngeal nerve results in limited movement of the affected vocal fold and its fixation in a paramedian position. The leading symptom of paralysis is decreased vocal performance, less commonly aspiration and difficulty breathing on exertion. The selection of the optimal therapeutic method depends on the etiology of vocal fold paralysis, the position of the vocal folds, the prognosis of the disease, the time elapsed since the paralysis, the patient’s comorbidities and motivation. Several types of phonosurgical methods are available to solve the problem, the common goal of which is the medialization of the abnormally positioned, immobile vocal fold in order to optimize phonatory closure. Among the interventions, injection laryngoplasty stands out with its simplicity and versatility, which can correct the position of the paralyzed vocal fold, as well as its volume and, at the same time, its mass. Based on a review of the international literature and our own experiences, we present the methodology for applying the procedure, with particular attention to the different surgical techniques and the types of injectable materials. With the optimal choice of these factors, injection laryngoplasty is a safe, inexpensive, relatively easy to learn, and favorable solution for the treatment of mild to moderate glottic insufficiency due to various causes. Orv Hetil. 2025; 166(26): 1017–1024.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 26","pages":"1017-1024"},"PeriodicalIF":0.8,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529156","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":"[Treatment of hemorrhoids with rectal artery embolization].","authors":"Zsófia Sipos, Ákos Botos, Csaba Zsolt Oláh","doi":"10.1556/650.2025.33303","DOIUrl":"10.1556/650.2025.33303","url":null,"abstract":"<p><p>Introduction: Hemorrhoids are the most common anorectal diseases, with a prevalence of 4–35%. Endovascular treatment of hemorrhoid patients was first performed in 2014, and since then the evidence for this intervention has been confirmed by numerous reviews and meta-analyses. Objective: We were the first in Hungary to start using this treatment. In our publication, we present the arterial blood supply of hemorrhoids, the causes of their development, pathophysiology, conservative, surgical and endovascular treatment. We present the technical details of superior rectal artery embolization. In addition to the radiological and clinical results of our first 15 treated patients, we present the literature and evidence of the treatment procedure. Method: The analysis of our clinical study was performed based on a prospective clinical design and with ethical approval. According to Goligher classification, 20% of our patients were in stage 2 and 80% were in stage 3 of the disease before the intervention. 80% of our patients had pain, 80% had bleeding, and a third had itching and discomfort due to their hemorrhoids. One patient was treated for very severe anemia and one patient for severe anemia. In our angiography laboratory, we performed superselective embolization of the superior mesenteric artery branches with hairy coils under local anesthesia from a femoral puncture. Results: All our interventions were technically successful, and no complications were observed in any case. The average value on the basis of the hemorrhoidal bleeding scale during early control was 0.23 and the average value was 0.23 during the 12-week control. Out of 15 patients, 14 became completely asymptomatic and complaint-free, and 1 patient’s hemorrhoidal bleeding scale value decreased from 6 to 3 during the follow-up. Discussion: The advantage of endovascular intervention is that it is painless, complication-free and can be performed as a one-day procedure without anesthesia. Patients can live a full life from the day after the intervention. Our technical and clinical results achieved during the treatment of our first 15 patients show similar success rates to international results. Conclusion: Superior rectal artery embolization is a minimally invasive procedure that is considered an alternative to surgical procedures in the treatment of grade 2 and 3 hemorrhoidal disease. Orv Hetil. 2025; 166(26): 1025–1030.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 26","pages":"1025-1030"},"PeriodicalIF":0.8,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529159","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":"[Prevalence of ECG abnormalities in hypertrophic cardiomyopathy: who seeks will find].","authors":"Zsolt Forrai, Fanni Bánfi-Bacsárdi, Dávid Pilecky, Tamás G Gergely, Laura Fanni Hanuska, Pál Péter Schäffer, Ádám Kazay, Vivien Vértes, Máté Vámos, Péter Andréka, Zsolt Piróth, Noémi Nyolczas, Balázs Muk","doi":"10.1556/650.2025.33289","DOIUrl":"10.1556/650.2025.33289","url":null,"abstract":"<p><p>Introduction: The 2023 European Society of Cardiology Cardiomyopathy Guidelines emphasize the crucial role of a multiparametric approach in diagnosing. During the diagnostic workup of hypertrophic cardiomyopathy, besides echocardiography and cardiac magnetic resonance, ECG plays an important role. Based on literature data, only 4–18% of patients with hypertrophic cardiomyopathy have normal ECG, however, ECG deviations are often non-specific. Objective: To evaluate the ECG characteristics in a hypertrophic cardiomyopathy patient cohort followed-up at the Heart Failure Outpatient Clinic of Gottsegen National Cardiovascular Center. Method: We retrospectively analyzed the data and the first ECGs registered of patients with hypertrophic cardiomyopathy, diagnosed by cardiac magnetic resonance and/or genetic testing, followed-up between 01. 11. 2023 and 30. 09. 2024 at our Heart Failure Outpatient Clinic. Results: Data from 72 patients were evaluated, male: 58%, age: 49 (34–62) years, left ventricular ejection fraction: 63 (47–72)%, NYHA functional class: 2 (1–2), ICD/CRT-D: 47%. Based on the left ventricular outflow tract obstruction of ≥30 mmHg, 31% of the patients belonged to hypertrophic obstructive cardiomyopathy subgroup. Based on the ECGs analyzed, atrial fibrillation occurred in 6%. Interatrial conduction disturbances affected 29% of the patients. Atrioventricular and intraventricular conduction disturbances occurred in 50% (AV block: 20% [grade I: 18%, grade II: 2%, grade III: 0%], right bundle branch block: 14%, left bundle branch block: 16%, left anterior hemiblock: 13%, left posterior hemiblock: 3%, non-specific intraventricular conduction disturbance: 8%). The sensitivity of the Cornell, Sokolow–Lyon, and Peguero–Lo Presti “high voltage” criteria were low (23–14–25%). Pathological Q wave occurred in 42% of the patients, QRS fragmentation in 43% and corrected QT interval prolongation in 44%. T wave inversion was present in 94%, significant ST elevation in 21%, ST depression in 48%, while only 3% of patients had negative ECG. The only difference between hypertrophic obstructive cardiomyopathy and non-obstructive hypertrophic cardiomyopathy patients was the fulfillment of the Cornell criterion (45% vs. 15%, p = 0.044). Conclusions: A multimodal approach is essential in the diagnosis of hypertrophic cardiomyopathy. Based on our results, hypertrophic cardiomyopathy is often associated with heterogeneous ECG abnormalities. However, the early recognition of the ECG variations may help in the further diagnostic steps, contributing to the initiation of disease-modifying treatment. Orv Hetil. 2025; 166(25): 970–981.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 25","pages":"970-981"},"PeriodicalIF":0.8,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369129","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":"[Analysis of early language development delay in children survived neonatal hypoxic-ischemic encephalopathy without neurological impairment].","authors":"Anna Bolodár, Eszter Nagy, Dóra Luca Bodócs, Eszter Rusznyák, Ágnes Jermendy, Miklós Szabó, Zsuzsanna Varga","doi":"10.1556/650.2025.33323","DOIUrl":"10.1556/650.2025.33323","url":null,"abstract":"<p><p>Introduction: Data are limited about the detailed cognitive functions (e.g., language development) of children who survived neonatal hypoxic-ischemic encephalopathy without neurological impairment (quality survivors). Objective: A description of the prevalence of early language developmental delay and an examination of the differences in various linguistic indicators in quality survivors of hypoxic-ischemic encephalopathy. Method: Children who survived moderate to severe hypoxic-ischemic encephalopathy and received hypothermia treatment and participated in the developmental follow-up examination at 2 years of age were included in the prospective study conducted between 2017 and 2020. Developmental follow-up assessments utilized the Bayley-II Developmental (Cognitive) Scale, with a score of ≤85 indicating unfavorable cognitive outcomes. Language development was assessed using the MacArthur–Bates Communicative Development Inventory: Words and Sentences Forms. Early language delay was defined as expressive vocabulary falling below the 20th percentile despite average cognitive performance. Results: 50 patients were included in the study. Unfavorable cognitive developmental outcomes were observed in 23/50 (46%) cases, while favorable outcomes occurred in 27/50 (54%) cases. Examination of language development revealed early language delay in 10 children, while 17 exhibited typical language development. The occurrence of early language delay was higher compared to the general population (20% vs. 10–15%). The median (IQR) vocabulary size was 30 [20; 70] words in children with delayed language development, compared to 250 [159; 565] words in those with typical language development (p<0.001). The two groups also differed across all language indicators (e.g., use of morphemes and word combinations). Discussion: Quality survivors of hypoxic-ischemic encephalopathy exhibit a higher prevalence of early language delay compared to the general population. Based on our results, it appears that different levels of language, including the lexical and grammatical levels, are affected in children with hypoxic-ischemic encephalopathy who exhibited early language developmental delay but achieved favorable cognitive developmental outcomes. Conclusion: Our findings highlight the importance of examining domain-specific functions such as language development, even in children with favorable cognitive outcomes, as average cognitive function does not necessarily imply intact language abilities. Orv Hetil. 2025; 166(25): 990–999.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 25","pages":"990-999"},"PeriodicalIF":0.8,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369126","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":"[Emergency care of patients with myocardial infarction: from the onset of symptoms until opening the vessel].","authors":"András Jánosi, Gábor Csató, Tamás Ferenci, György Pápai, Sándor Guti, Péter Vajer, Péter Andréka","doi":"10.1556/650.2025.33315","DOIUrl":"10.1556/650.2025.33315","url":null,"abstract":"<p><p>Introduction: The effectiveness of the treatment of patients with myocardial infarction and their life prospects are significantly influenced by the total ischemic time, which is calculated from the onset of the complaint to the opening of the vessel. Objective: In our study, we analyzed the length of the components of the total ischemic time and compared it with the results of the study five years earlier. Method: We analyzed the data of 8705 patients treated for acute myocardial infarction registered between 01. 07. 2022 and 30. 06. 2023 (4334 [49.8%] STEMI, 3428 [39.4%] women), for whom all data were available for the calculation of each time interval. In the case of times, the median values and notable quartiles (lower quartile, Q1 and upper quartile, Q3) were given, similarly to our previous study. The diagnosis was established during hospitalization, based on the valid criteria. We examined patient delay, i.e., the time elapsing from the complaint to the notification of the ambulance service, from the notification to the arrival at the scene, and from the scene to the arrival at the hospital. During hospital care, we examined the time between the admission of the patient and the opening of the vessel (door-to-needle time). The data were also provided in national and county breakdowns. Results: The median patient delay for STEMI patients nationwide was 140 minutes (Q1: 51; Q3: 458). The median ambulance arrival time was 13.2 minutes (Q1: 8.0; Q3: 21.1), the median on-site care time was 25.5 minutes (Q1: 17.6; Q3: 34.9), and the median on-site to hospital time was 31.0 minutes (Q1: 19.5; Q3: 43.7). The range of arrival time per county was 8.8–17.9 minutes. The median door-to-needle time for STEMI patients nationwide was 51.5 minutes (Q1: 28.7; Q3: 121.7). In the NSTEMI group, the median patient delay was 373 minutes (Q1: 106; Q3: 1184), and the time to arrival at the scene was 14.2 minutes (Q1: 8.5; Q3: 24.8). In the case of STEMI, the patient delay increased by almost 40 minutes compared to the previous period (101 vs. 140 minutes), and the median time to arrival of the ambulance at the scene (13.0 vs. 13.2 minutes) did not change significantly. The door-to-needle time in the present study was almost by 15 minutes longer than before (37.0 vs. 51.5 minutes). In the STEMI group, the vessel was opened within 2 hours in 4.1% of the patients and within 4 hours in 38.3% of the patients. Conclusion: The patient’s delay is the determining factor in terms of total ischemic time, therefore, in a significant proportion of treatments, revascularization did not take place at the optimal time. Orv Hetil. 2025; 166(25): 963–969.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 25","pages":"963-969"},"PeriodicalIF":0.8,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369128","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":"[Changes in infertility-related quality of life in relation to personality traits].","authors":"Zsaklin Zsuzsa Kántor, Hajnalka Makó","doi":"10.1556/650.2025.33321","DOIUrl":"10.1556/650.2025.33321","url":null,"abstract":"<p><p>Introduction: Experiencing infertility comes with a significant psychological burden, making the assessment of quality of life and the identification of influencing factors important considerations alongside treatment. Objective: To identify factors related to infertility that affect the quality of life among women with organic and functional infertility. Method: A total of 179 Hungarian women participated in the questionnaire study, including 58 fertile women, 46 with organic infertility, and 75 with infertility of unknown origin. The questionnaire package included the Fertility-Specific Quality of Life Questionnaire (FertiQol), the Hewitt–Flett Multidimensional Perfectionism Scale (HF-MPS), the Connor–Davidson Resilience Scale, the Big Five Inventory (BFI), as well as sociodemographic questions. Results: Women with functional infertility exhibited a poorer quality of life compared to those with organic infertility. Moreover, among the variables we measured (e.g., neuroticism, resilience, socially prescribed perfectionism), the most were closely related to the quality of life. The two infertility groups were characterized by different correlations. Conclusion: Due to the adverse effects of infertility on mental and social health, assessing fertility-specific quality of life and examining the influencing factors are both crucial tasks alongside somatic treatment, contributing to the development of adequate prevention and intervention programs. Orv Hetil. 2025; 166(25): 982–989.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 25","pages":"982-989"},"PeriodicalIF":0.8,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369127","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":"[Workplace violence at the Heim Pál National Institute of Pediatrics].","authors":"Gergely Fliegauf, Dóra Eszter Várnai, Tünde Guti, Krisztina Baranyi, Gabriella Ráczkevy-Deák, Zsófia Mészner","doi":"10.1556/650.2025.33324","DOIUrl":"10.1556/650.2025.33324","url":null,"abstract":"<p><p>Introduction: Violence against healthcare workers is a frequently researched topic because of its impact on hospital quality. However, studies focusing specifically on children’s hospitals are rarer. Workplace violence reduces the effectiveness of hospital services and the perception of aggression is a social psychological process that becomes particularly complex when a sick child is involved in the interaction. In addition to the behavioral patterns exhibited by patients and their relatives, workplace aggression is also present among healthcare workers in the form of harassment. Objective: Beyond detailed descriptive statistics, our study examines the relationship between demographic characteristics of healthcare workers and perceived workplace violence. We also explore staff’s assessments of their work environment and the specific characteristics of emergency care. Method: Our exploratory cross-sectional study involved 266 healthcare workers (81.2% female, mean age: 42 years). Our research team designed an online questionnaire that included demographic and work-related questions, as well as items from the Open Aggression Scale, which has been used previously in Hungary. The questionnaire was adapted to the specific circumstances of the centrally located children’s hospital where the study was conducted. It also included the findings of a previous study on workplace violence conducted in the same hospital. Prior to the survey, orientation meetings were held in all 32 departments of the hospital. Results: In line with international research, we found that the most common type of hospital violence was 60.1% by patients, 78.7% by relatives and 53.8% by colleagues over a one-year period. In all three categories, verbal aggression was the most common form. The four most frequently perceived aggressive behaviors – shouting, insulting, swearing and derogatory threats – occurred in all three groups of respondents. The highest-risk profile was among registered healthcare professionals with nursing qualifications, working permanent day shifts or alternating day and night shifts, caring mainly for inpatients, working second jobs and speaking English beyond their mother tongue. In terms of job evaluation, 23% of the 149 respondents perceived a worsening trend, 70% saw no change and 7% saw an improvement in the six months prior to the survey. 100% of emergency care workers reported experiencing some form of verbal aggression from relatives, a higher proportion than those working in other departments (82%). Discussion: A study conducted at the Heim Pál National Institute of Pediatrics found an association between perceptions of workplace violence among healthcare workers and demographic variables. Particular attention should be paid to understanding the unique communication dynamics between children, their relatives and healthcare providers. Conclusion: In general, lower-ranking healthcare workers are more likely to interact with patients and relatives","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 24","pages":"930-941"},"PeriodicalIF":0.8,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302700","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":"[Association between serum cortisol levels and multiple organ dysfunction in neonates with perinatal asphyxia].","authors":"Ramóna Kerekes, Marianna Dobi, Ágnes Jermendy, Miklós Szabó, Kata Kovács","doi":"10.1556/650.2025.33317","DOIUrl":"10.1556/650.2025.33317","url":null,"abstract":"<p><p>Introduction: Therapy-resistant hypotension is observed in 16% of neonates with perinatal asphyxia undergoing therapeutic hypothermia. Relative adrenal insufficiency, defined by an inadequate cortisol response to stress, is a potential etiological factor. Hydrocortisone supplementation may be the causal treatment; however, optimal dosing during hypothermia remains unknown. Serum cortisol levels may serve as a useful marker for monitoring treatment, although these levels are likely influenced by multiorgan dysfunction secondary to the hypoxic injury and by the effects of hypothermia on drug metabolism. Objective: The aim of our research was to evaluate serum cortisol levels in cooled neonates with perinatal asphyxia before and during hydrocortisone supplementation, and to investigate the association between these levels and the severity of multiorgan dysfunction. Method: This retrospective cohort study included neonates with perinatal asphyxia treated with therapeutic hypothermia and hydrocortisone supplementation at the Neonatal Intensive Care Unit, Pediatric Center, Semmelweis University between January 2007 and December 2022. We assessed serum cortisol levels and parameters indicating the severity of multiorgan dysfunction. Results: Data from 44 neonates (126 cortisol samples) were analyzed. Two-thirds of the endogenous serum cortisol levels were below the diagnostic threshold for relative adrenal insufficiency (15 µg/dl), with a median of 4.6 µg/dl [IQR 2.8; 17.1]. Hydrocortisone supplementation resulted in a significant elevation in cortisol levels (median 61.2 µg/dl [30.6; 93.4], p<0.001), which continued to rise during therapy (median 77.6 µg/dl [46.1; 171.3], p = 0.002). Newborns with more severe multiorgan dysfunction had significantly higher cortisol levels before and after hydrocortisone supplementation. Discussion: In neonates undergoing therapeutic hypothermia after perinatal asphyxia, low serum cortisol levels can be increased by hydrocortisone supplementation in cases of suspected relative adrenal insufficiency. The higher cortisol levels observed in cases of severe multiorgan dysfunction may result from increased hormone secretion, as well as reduced drug metabolism and excretion. Conclusion: Optimizing hydrocortisone therapy is crucial in the management of cooled neonates with perinatal asphyxia. Prospective pharmacokinetic studies considering the severity of multiorgan dysfunction should be conducted. Orv Hetil. 2025; 166(24): 942–952.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 24","pages":"942-952"},"PeriodicalIF":0.8,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302697","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}