Orvosi hetilap最新文献

Based on our clinical observations, diabetic ketoacidosis, which is the most common acute life-threatening complication of insulin-deficient diabetes, does not develop in pancreatectomy patients. The diabetes developing after total pancreatectomy is extremely labile due to the complete lack of insulin, glucagon, and digestive enzymes. Our working group takes care of many patients after total pancreatectomy who, despite unstable diabetes and/or severe comorbidities from cancer treatment, do not develop diabetic ketoacidosis. In our opinion, the background to this is the lack of glucagon. The authors summarize the role of glucagon in diabetic ketoacidosis and the relationship between diabetes treatments that affect glucagon levels and the development of ketoacidosis. Orv Hetil. 2025; 166(43): 1683–1688.

Introduction: Mammography screening enabling early detection of breast cancer among women aged 45–65 has been available in Hungary since 2002. Objective: Our aim was to assess the effectiveness of the Hungarian mammography screening program based on the frequency of appearance and health outcomes of breast cancer patients. Method: Data on women aged 45–64 undergoing mammography screening between 2010 and 2021 was acquired from the National Health Insurance Fund. Frequency and regularity of screening was analyzed by age and place of residence. Patients receiving breast cancer treatment between 2013 and 2020 were identified and classified into molecular subtypes based on the provided care. The relationship between screening and lymph-node or other organ metastases and mortality was identified by univariate and multivariate analyses. Results: Screening rates are decreasing. Screening at least 5 times during the study period was the highest in the oldest cohort (19.7%), the lowest among the youngest (12.7%). There are significant differences by county, possibly partly due to coding problems. Between 2013 and 2020, 26,530 women aged 45–64 were diagnosed with breast cancer. Rate of participation in screening (30.2%) within six months before treatment increases with age: 29.1% (45–49-year-olds) to 36% (60–64-year-olds). The highest proportion of screen-detected breast cancer was observed in the luminal A molecular sub-group (41.3%), while it was only 18.4% among triple-negative cases. Known metastasis at the start of treatment was 3.7%, lymph-node metastasis 14.0% among screen-detected patients. Respective rates were 14.4% and 18.0% for those not screened. 1- and 3-year mortality rates for the 2 groups were 1.2%, 5.3% and 6.5%, 16.6%, respectively. Mortality was the highest in the triple-negative and HER2E groups. Discussion: Willingness to participate in screening is higher among the elderly, but it is decreasing overall. In the case of breast cancer, health benefits of screening are evident compared to the unscreened population. Conclusion: Screening participation should be improved as it allows earlier disease detection and better survival. The effectiveness of screening women with higher risks more frequently than 2 years requires further research. Coding practice of screenings requires improvement. Orv Hetil. 2025; 166(43): 1689–1705.

Introduction: For the proper development of children, a healthy diet is essential, as it can improve their performance, concentration, and prevent overweight and obesity. Objective: The aim of the study is to assess parents’ health-related attitudes and health behaviors in relation to personality dimensions and two types of schools (state- and church-maintained) as well as to examine how dietary habits influence the evaluation of school meals and the health behaviors of children. Method: The survey was conducted from July 6 to September 30, 2024, among the parents of students at the Bét Menachem Hebrew–Hungarian Bilingual Elementary School and the Hild József Elementary School. The questionnaire included self-formulated questions and a validated measurement tool. Research ethics approval number: BM/14826-3/2024. We used the JAMOVI statistical program for data processing and analysis (chi-square, Mann–Whitney, Fisher’s exact tests, analysis of variance, p<0.05). Results: A total of 166 parents completed the questionnaire (83 from public schools and 83 from Jewish religious schools). Based on our findings, it can be concluded that the parents of students attending religious schools have significantly higher health-related attitudes compared to the parents of students attending public schools (p = 0.002). The parents of students in public institutions are significantly more confident, exhibit better physical activity, and have healthier eating habits. Discussion: The catering for students attending Jewish religious schools requires greater attention and awareness, but it also means additional expenses for parents. Here, students have access to more carbohydrate-rich and varied foods, and fruit consumption is also more common. The development of healthy eating habits is more supported by the catering in Jewish religious schools, so it would be important to pay special attention to the education of students and parents in public schools, particularly tailored to their personality dimensions. A highly qualified school nurse is fully capable of performing this task. Orv Hetil. 2025; 166(43): 1706–1714.

Introduction: Ischemic stroke accounts for approximately 80% of all stroke cases and remains a major cause of morbidity and mortality among adults. At the beginning of the 21st century, the age-standardized incidence of stroke in Europe ranged from 95 to 290 cases per 100,000 population. Objective: Our aim was to examine trends in the incidence of ischemic stroke in Europe between 1991 and 2021, by country group, gender, and age group. Method: In our retrospective, quantitative study, we analyzed data from 44 countries in three European country groups (Eastern, Central, and Western Europe) per 100 000 people based on the Global Burden of Disease 2021 database. Descriptive statistics, time series analysis and Kruskal–Wallis test were performed. Results: Between 1991 and 2021, the age-standardized incidence per 100 000 population in men decreased from 206.7 to 147.1 (−28.8%) in Eastern Europe, from 172.1 to 123.8 (−28.1%) in Central Europe, and from 120.7 to 62.3 (−48.4%) (p<0.05) in Western Europe. In women, during the same period, it decreased from 169.8 to 113.9 (−32.9%) in Eastern Europe, from 142.4 to 106.0 (−25.6%) in Central Europe, and from 89.5 to 47.2 (−47.3%) in Western Europe (p<0.05). Significant differences were found between Eastern and Western European countries and between Central and Western European countries for both sexes (1991, 2001, 2011, 2021: p<0.05). The incidence was higher in men than in women every year, especially in the age groups over 55. The largest decrease for both sexes was observed in the 65–69 age group. Based on the analysis by country, the largest decrease was in Portugal (men: –71.1%; women: –69.9%), while in Montenegro, increases of +4.1% for men and +6.3% for women were observed. Conclusion: During the study period, the incidence of ischemic stroke decreased in all three country groups, but the improvement was greater in the Western European country group, which had lower (more favorable) baseline values, than in Central or Eastern Europe. Nevertheless, in 2021, the incidence in Eastern and Central Europe still exceeded the level measured in Western European countries in 1991. Orv Hetil. 2025; 166(42): 1642–1652.

Introduction: Heart failure is one of the leading causes of death worldwide. Optimizing prognosis requires appropriate therapy. Administrative health databases enable large-scale assessments of clinical outcomes and pharmacological treatment patterns. Objective: This study aimed to examine short-term mortality and its associations with therapeutic strategies among patients diagnosed with heart failure. Method: We analyzed data from the Hungarian National Health Insurance Fund (NEAK) between 2012 and 2020. Patients were classified as having heart failure if they received an ICD-10 I50 code within two months following an echocardiography. Based on whether they were hospitalized within 60 days of diagnosis, patients were divided into two groups. Descriptive statistics were used to assess demographic characteristics, comorbidities, prescription medication use, and 90-day mortality rates. Multivariable analyses were conducted to evaluate the relationship between mortality and medication use. Results: More than 250,000 patients met the inclusion criteria. Female sex was associated with a 10% lower risk of short-term mortality, while patients aged 80–89 had more than a fivefold risk compared to those aged 40–49. Among outpatients who filled prescriptions for guideline-recommended medications prior to diagnosis, all therapeutic groups were associated with significantly reduced 90-day mortality. In contrast, longer hospital stays during the year preceding diagnosis were linked to a threefold increase in mortality. Compared to the reference county, certain regions exhibited up to 25% higher mortality risk. Discussion: The distribution of comorbidities and mortality rates was consistent with international findings. Our results suggest that heart failure management in Hungary is heterogeneous, with marked regional disparities in patient outcomes. Early initiation of evidence-based pharmacotherapy for high-risk comorbidities appears to reduce short-term mortality more effectively than post-diagnosis treatment alone. Conclusion: Retrospective administrative data can provide valuable insights into heart failure mortality, but results should be interpreted with caution. Our findings emphasize the importance of adherence to treatment guidelines and suggest that the potential benefits of pre-diagnostic use of guideline-recommended medications warrant further clinical investigation, alongside more detailed analyses to understand regional differences. Orv Hetil. 2025; 166(42): 1653–1665.

Introduction: Chat Generative Pre-Trained Transformer (ChatGPT) is a recently developed artificial intelligence (AI)-based language model that has become an increasingly common source of health-related information due to its accessibility. However, there is limited evidence regarding the accuracy and reliability of its responses. Objective: This study aimed to assess ChatGPT’s usability in otolaryngology by analyzing its answers to common patient questions. Method: 24 patient-oriented questions were created across 10 otolaryngological disease categories and submitted sequentially to ChatGPT version 4.0. The generated responses were evaluated from a linguistic perspective and 6 board-certified otolaryngologists using a three-point scale: incorrect (1), correct but incomplete (2), and correct (3). Results: Language evaluations indicated that the responses were generally clear, well-structured, and of good quality for further medical evaluations. ChatGPT’s medical accuracy scores ranged from 2.00 to 2.83. Three specific questions (Q4, Q9, Q24) received significantly lower ratings. Four raters (R1, R2, R4, R6) showed strong agreement in their evaluations, while significant differences emerged between the scores of R3 and R5 (p<0.001). Conclusion: ChatGPT’s responses in otolaryngology were coherent and well-structured, but the accuracy of medical content varied by topic. While the tool may be beneficial for basic patient education, it is not currently reliable enough to support clinical decision-making. Future development of validated, specialty-specific artificial intelligence systems based on trustworthy medical sources will be crucial for safe implementation in healthcare. Orv Hetil. 2025; 166(42): 1666–1674.

In our study, we present two cases of schizophrenia and obsessive-compulsive disorder according to DSM-5 criteria. In both patients, obsessive-compulsive symptoms preceded the onset of psychotic symptoms and influenced the therapeutic response. Pathophysiological research suggests that in the case of schizophrenia, we can consider schizo-obsessive-compulsive disorder as a separate subtype. Proper diagnosis and differentiation is crucial, as both the interpretation of symptoms and the therapeutic response may differ significantly. Orv Hetil. 2025; 166(42): 1675–1680.

Identifying the underlying cause of pancytopenia can be challenging, as there is a wide range of etiologies, including drugs, autoimmune conditions, malignancies, infections, hemophagocytosis and hereditary conditions. The authors present the case of a 3-year-old girl who was admitted for a prolonged febrile condition. Laboratory investigations revealed pancytopenia, increased inflammatory activity, and malignancy was excluded as the underlying cause of the symptoms. A diagnosis of hemophagocytic lymphohistiocytosis (HLH) was made on the basis of clinical signs and characteristic laboratory findings. She received combined immunosuppressive therapy as intravenous steroid, interleukin-1 antagonist, cyclosporine. Her condition stabilized and she was transferred to the Centre for Pediatric Immunology at the University of Milan. Additional investigations confirmed Leishmania infection. Therapy was supplemented with amphotericin B. The treatment resulted in a rapid improvement of the child’s condition and laboratory parameters. Persistent remission was observed even after the end of treatment. Our case study aims to highlight the rare pathology underlying pancytopenia. The treatment of this disease requires the use of different immunosuppressive therapies depending on the extent of the organ manifestations and the treatment of the underlying cause. Orv Hetil. 2025; 166(41): 1628–1633.

Introduction: The goal of medical training is to ensure that new generations of doctors are not only knowledgeable, but have the emotional, intellectual and practical capabilities to treat patients safely. Workplace-based learning can facilitate this process effectively. Objective: The aim of our study was to explore the components of real patient learning among medical students in their preclinical years. Method: This cross-sectional survey was conducted between 2019 and 2024 at Semmelweis University, with small groups of medical students in their preclinical (1st, 2nd) years during a semester-long practical in primary care practices with 48 general practitioner preceptors. The aim was to learn taking the medical history of patients. The Manchester Clinical Placement Index was applied to measure the influence of the learning environment. We undertook latent construct analysis on free-text answers provided by students. Results: A total of 883 answers were analyzed. Three key themes emerged, the welcoming social environment created by the preceptor, facilitated active involvement of students. Observation of the implementation of tasks, and forward looking, personalized feedback provided for students were key elements of the learning process. Transition from childhood to adulthood and from layperson to professional were key sources of tension during the practical, just like the blurring of the differences between the routine of patient care and the role as preceptor. Discussion: Early clinical experience has been shown to strengthen the vocation of foundational year medical students by enabling them to put their theoretical knowledge into clinical context and enriching it with personal meaning. The preceptors’ commitment and humanity served as a role model that contributes to commitment to the medical profession and lays the foundation for humane, person-centered approach to healing. Conclusion: Preceptor-led workplace learning facilitates professional identity formation through enabling participation in practice and role-modelling; while their theoretical knowledge is placed into clinical settings. Orv Hetil. 2025; 166(41): 1611–1621.