Orvosi hetilap最新文献

Introduction: B-cell acute lymphoblastic leukemia is one of the most common malignancies in children, but it is rare in adults. Based on our previous findings in pediatric patients, CD49f integrin was expressed on lymphoblasts in most cases and its intense expression at diagnosis was associated with the ETV6::RUNX1 fusion.

Objective: Adult-onset B-cell acute lymphoblastic leukemia is characterized by a poor prognosis, therefore investigating the background and mechanisms of the disease is an important task. Our goal was to determine CD49f expression at diagnosis and during treatment, and to compare it with the genetic background and clinical data of patients. We also planned to determine the activity of signal transduction pathways originating from CD49f.

Method: We examined CD49f expression by flow cytometry in bone marrow samples from children (n = 84) and adults (n = 24) with B-cell acute lymphoblastic leukemia, and examined the signaling molecules activated by CD49f by immunohistochemistry in bone biopsies (n = 10). We compared clinical and genetic data with expression.

Results: CD49f was detectable in 92% of diagnostic bone marrow samples from children and in 75% of samples from adult patients. We observed a significant increase in CD49f expression in samples from children with measurable residual disease, but no change in adults. In children, more intense CD49f expression at diagnosis predicted a higher rate of measurable residual disease, while in adults it correlated with weaker expression at diagnosis. In terms of genetic groups, we found more intense CD49f expression in the group with a better prognosis and reduced expression in lesions with a poor prognosis (KMT2A gene rearrangement) (P<0.001). When examining signaling pathways, intense CD49f expression was associated with increased Src and focal adhesion kinase staining, while integrin-linked kinase activation was not observed.

Discussion: CD49f proved to be a reliable measurable residual disease marker in both populations. In children, CD49f expression intensity at diagnosis was higher in patients belonging to the high-risk group than in those belonging to the low-risk group. In contrast, in adults, we observed weaker expression initially in measurable residual disease-positive patients. We found similar correlations between genetic groups and CD49f intensity values in pediatric and adult patient populations. CD49f expression was correlated with increased focal adhesion kinase-Src signaling activity.

Conclusion: Based on our results, the CD49f molecule can be used as a measurable residual disease marker in both pediatric and adult B-cell acute lymphoblastic leukemia patient groups, and its expression correlates with genetic abnormalities and focal adhesion kinase-Src pathway activation. Orv Hetil. 2025; 166(50): 1983-1992.

Introduction: Evaluation and management of markedly elevated blood pressure in the emergency department vary widely. Guidelines recommend repeated measurements in a calm setting and structured follow-up, discouraging acute interventions in asymptomatic patients without end-organ damage.

Objective: We retrospectively assessed blood pressure changes and laboratory parameters in older hypertensive patients during emergency care. The primary objective was to compare triage and discharge blood pressure and evaluate differences between discharge and prior renal function and electrolyte values. Secondary objectives included describing intravenous cannulation and length of stay.

Method: This single-center retrospective study included 158 patients treated in 2024 for primary hypertension in a county hospital emergency department. Triage and discharge blood pressures were compared using paired tests, discharge serum creatinine, estimated glomerular filtration rate, and potassium were compared to values from the previous 6 months.

Results: Systolic blood pressure decreased from a median of 190 to 150 mmHg (p<0.001), diastolic from 92 to 80 mmHg (p<0.001). Estimated glomerular filtration rate (63.5 vs. 61.0 mL/min/1.73 m²) and creatinine (81 vs. 83 µmol/L) showed no significant change. Serum potassium declined slightly (-0.15 mmol/L; p = 0.003) without clinical relevance. Intravenous cannula was inserted in 97.5% of patients, median stay was 6.0 hours.

Discussion: The observed decline likely reflects proper measurement and observation effects, in the absence of end‑organ damage a non‑invasive, outpatient‑oriented approach appears appropriate.

Conclusion: Most older adults presenting with hypertension did not have a true hypertensive emergency. Blood pressure dropped in many cases just by monitoring and without acute organ damage. The emphasis of the treatment should be on the correct measurement of blood pressure, managing the reversible causes, starting oral antihypertensive therapy, and making an outpatient follow-up appointment. Routine invasive interventions are generally not warranted in asymptomatic cases. Orv Hetil. 2025; 166(50): 1975-1982.

Introduction: Inhibition of the calcitonin gene-related peptide (CGRP) pathway offers a novel therapeutic option in the prevention of migraine attacks.

Objective: The aim of this guideline is to provide practical recommendations for the safe, effective, and personalized use of CGRP inhibitors in episodic and chronic migraine within Hungarian clinical practice.

Method: The recommendations were developed based on international guidelines and current clinical trial evidence. The guideline takes into account drug efficacy, side-effect profiles, contraindications, as well as considerations for specific patient populations.

Results and recommendations: CGRP antagonists - including monoclonal antibodies and gepants - may be applied even as first-line acute or preventive treatments owing to their efficacy and favorable safety profiles, particularly when the patient's clinical status, preferences, or comorbidities justify their use. Adverse events are mostly mild, and overall safety is favorable. Therapeutic decisions should be followed by a three-month evaluation period, and in the case of insufficient response, drug switching or combination therapy should be considered.

Conclusion: According to international evidence, a structured therapeutic algorithm and a patient-tailored approach may have a beneficial effect and are expected to contribute to improved quality of life in patients with migraine. Orv Hetil. 2025; 166(50): 1963-1974.

The manuscript addresses the social, clinical, and institutional dimensions of attention-deficit/hyperactivity disorder (ADHD), with particular emphasis on the problem of medicalization and controversies surrounding pharmacological treatment. It briefly summarizes the discrepancies in epidemiological literature across countries and age groups and critically analyzes selected aspects of DSM-5 criteria (e.g., the undefined threshold for "often"). The paper highlights that the expansion of diagnoses is partly driven by institutional, economic, and cultural factors, including educational expectations, access to healthcare, and pharmaceutical interests. It provides a detailed discussion of the benefits and risks of methylphenidate, the issue of misuse, and the role of atomoxetine as an alternative. Shortages of system capacity, lack of specialists, and pressures on primary care are emphasized. Illustrative clinical vignettes are presented, though the author underscores their anecdotal nature and cautions against overgeneralization. The concluding section offers consistent recommendations: avoiding liberalization of methylphenidate prescribing and/or introducing stricter centralized control, concentrating the management of severe cases in designated centres, and strengthening psychosocial interventions as well as school- and young adult-related support systems. The paper is intended as a position piece and a contribution to a possible ongoing debate. Orv Hetil. 2025; 166(49): 1935-1942.

With the replacement of predominantly traditional, frontal teaching methods, the aim is to introduce individually paced and experience-based instruction into healthcare simulation training including the theoretical education of first aid. To date, there has been no comprehensive or coordinated national study comparing conventional courses with those conducted in virtual environments. The educational system must adapt to the information acquisition and learning habits of younger generations. Virtual reality may have a significant impact on the individuals' willingness to provide first aid. Learners can encounter various scenarios (e.g., bleeding control, resuscitation) for the first time in a safe environment, which can be simulated an unlimited number of times across different adapted settings. This not only enhances professional first aid delivery but also allows for the replication of environmental and emotional influences that are essential for realistic visualization, skill development, and shaping a helping attitude. Moreover, virtual reality enables the identification of key components that contribute to effective education and learning processes such as the element of problem-solving. It is crucial for first aid providers to be able to assess the safety of a scene, examine the patient, and make sound decisions in response to changing conditions. Experiential and gamified learning plays a pivotal role in the long-term retention of knowledge, potentially activating relevant skills in real-life situations. Virtual reality can offer added value in understanding critical aspects of first aid such as evaluating the safety of the environment, recognizing changes in patient condition, and mastering the correct sequence of actions. Through immersion in simulation, virtual reality can foster focused attention. From an instructional perspective, it may also support more objective and precise student assessment by making the recognition of key aid related observations more tangible. It is presumed that the application of virtual reality in first aid education can become a cost-effective method by optimizing individual learning. Orv Hetil. 2025; 166(49): 1927-1934.

Introduction: Alcohol consumption poses a significant global public health and economic burden. In Hungary, it has long been a major contributor to health losses and health inequalities.

Objective: The objective is to quantify alcohol-related health losses in Hungary using various indicators and social cost estimates, and to present these findings within an international context.

Method: We utilized data from the WHO Global Health Estimates for the period 2000-2019, stratified by sex and age. Hungarian data were compared with the average for Central and Western Europe. Social costs were estimated for the 30-64 years age group based on unit costs from our previous studies, with subsequent correction applied to estimate the cost for the total population.

Results: Alcohol consumption in Hungary decreased during the study period, stabilizing below the Central European average after 2011. Concurrently, health losses diminished: mortality losses by over 40%, years of life lost by half, and years lived with disability by 20%. Nevertheless, approximately 300,000 disability-adjusted life years were attributable to alcohol in 2019. The main causes of loss of mortality were malignant neoplasms and cirrhosis, while the causes of disability were primarily injuries and mental disorders. The estimated total social cost in 2019 was approximately 800 billion HUF, equivalent to 1.68% of the GDP.

Discussion: Despite the reduction in health losses, data for Hungary and Central Europe remain significantly higher (mortality losses are half the magnitude) than Western European values. The magnitude of the estimated 800 billion HUF social cost, compared to the estimated 250 billion HUF in state revenue from alcohol sales, clearly demonstrates the economic imbalance associated with alcohol distribution.

Conclusion: The observed decrease in consumption indicates the effectiveness of current interventions. However, due to the high health and social burden, continued restrictive policies and improved treatment success rates for alcohol-related diseases (especially neoplasms and digestive diseases) are warranted. Orv Hetil. 2025; 166(49): 1949-1955.

Introduction: Alopecia areata is an autoimmune disease presenting with non-scarring hair loss. In Hungary, the JAK inhibitors baricitinib and ritlecitinib are approved for the treatment of severe alopecia areata, with their efficacy supported by the results of multicenter clinical trials.

Objective: We retrospectively evaluated the efficacy and safety of baricitinib therapy in patients treated for severe alopecia areata, as well as factors influencing hair regrowth.

Method: We analyzed demographic data, medical history, disease duration, and severity in patients with severe alopecia areata treated with baricitinib at the Department of Dermatology and Allergology, University of Szeged. Disease severity was assessed using the Severity of Alopecia Tool (SALT). We examined the time to initial and complete hair regrowth, and the proportion of patients achieving a SALT≤20 score at months 3, 6, 9, and 12 of treatment.

Results: 30 patients (20 women and 10 men) were included, with a mean age of 33 years (range 9-56). Clinical subtypes included patchy (n = 13), diffuse (n = 1), ophiasis (n = 2), alopecia totalis (n = 4), and alopecia universalis (n = 12) forms, with a mean baseline SALT score of 74. The mean follow-up duration was 14 months (range 3-24). Initial hair regrowth was observed after a mean of 4 months (range 1-15), and complete hair regrowth (n = 16) after a mean of 10 months (range 2-19) of therapy. A SALT≤20 score was achieved by 23% of patients after 3 months, 46% after 6 months, 46% after 9 months, and 63% after 12 months. Reported adverse events included laboratory abnormalities, headache, herpes simplex, acne, weight gain, and mild infections. Treatment was discontinued in 6 patients: due to pregnancy planning (n = 3), lack of efficacy (n = 1), mild side effects (n = 1), and loss to follow-up (n = 1).

Conclusion: Our findings support the efficacy of baricitinib in the treatment of severe alopecia areata. Hair regrowth was observed in a substantial proportion of patients as early as the 3. month of therapy, with further improvement by month 12. Adverse events were mostly mild, leading to treatment discontinuation in only one case. Baricitinib appears to be an effective and safe therapeutic option for severe alopecia areata. Orv Hetil. 2025; 166(49): 1943-1948.