Orvosi hetilap最新文献

Oncology clinical trials play a pivotal role in the development of new therapeutic options; however, their implementation remains an extremely costly and time-consuming process. Artificial intelligence can open new horizons in the design and conduct of clinical trials, particularly in early phases, where safety, dose planning, and patient recruitment efficiency are critical. This paper aims to explore the potential applications of artificial intelligence in various stages of early-phase oncology trials, including biostatistical design, patient enrollment, and quality assurance aspects. Based on case studies and examples from the literature, it can be concluded that artificial intelligence can assist with precise protocol design, shorten recruitment timelines, and improve predictive performance in dose planning and patient selection, thereby reducing the number of adverse events. At the same time, regulatory, ethical, and data protection challenges remain significant barriers to the widespread adoption of artificial intelligence. Integrating artificial intelligence into clinical trials requires not only technological but also strategic-level modernization, from the industrial companies and authorities as well. The reliable and validated application of artificial intelligence could represent a major advancement in clinical research, particularly in increasing the success rate of early-phase trials. Orv Hetil. 2025; 166(47): 1857-1868.

Introduction: Newborn hearing screening plays a crucial role in the early detection and treatment of hearing loss.

Objective: This study presents a database developed by Hungarian software engineers, designed for the collection and analysis of data on hearing screening and subsequent care. The National Newborn Hearing Screening Registry has been collecting data since September 1, 2019, on mandatory objective hearing screening conducted in neonatal units and neonatal intensive care centres, along with confirmations from five designated verification centres. The aim of the study is to describe the structure of the database and to analyze the data collected.

Method: The registry aggregates data from screening devices performing brainstem-evoked response audiometry (BERA) via machine-to-machine communication. Indicators were defined and analyzed using registry data collected over a five-year period (2020-2024) and evaluated annually.

Results: During the study period, hearing screening data for a total of 345,945 newborns were recorded in the database. According to the registry data, screening coverage was 80.16%. Among screened newborns, 6.14% were referred due to suspected hearing loss. Only 16.81% of those who had a positive screening result underwent audiological evaluation at a verification centre, according to the transferred data.

Discussion: Data reported to the registry indicate that newborn hearing screening is not yet comprehensive. The high rate of suspected cases places an increased burden on the health care system and affected families. There is a low rate of data transfer to verification centres, raising concerns regarding access to adequate audiological diagnostics and treatment for screened children.

Conclusion: These findings underscore the importance of standardized data collection for effective hearing rehabilitation. The results provide insight into care pathways and highlight critical deficiencies in the system that require improvement. Data collection alone is insufficient; continuous data and patient follow-up are essential. Enhancing the involvement and awareness of health visitors and pediatricians is also key, which constitutes one of the main objectives of this study. Orv Hetil. 2025; 166(47): 1869-1876.

Sleeve gastrectomy has been the most commonly performed metabolic surgical procedure in recent years. One of its rare but serious postoperative complications is staple line leak. Due to the high intraluminal pressure within the gastric sleeve, its management is technically challenging. Over time, treatment strategies have shifted from surgical approaches toward interventional radiologic and endoscopic techniques. In this case report, we present a 37-year-old female patient who underwent sleeve gastrectomy for morbid obesity. Postoperatively, she developed abdominal symptoms prompting a CT scan, which initially revealed a perigastric hematoma. This was drained by interventional radiology. Following drain removal and a brief period of clinical improvement, her symptoms recurred. A repeat CT scan demonstrated contrast extravasation and a collection adjacent to the staple line. A new percutaneous drain was inserted via interventional radiology. She was then referred to our bariatric unit, where the defect was definitively closed using endoscopic suturing system under general anesthesia, followed by placement of a self-expanding metal stent. The stent was well tolerated, with no migration. After 5 weeks, it was successfully removed. A subsequent CT scan showed no further contrast leak. The patient is currently asymptomatic, satisfied with her weight loss trajectory and quality of life. This case highlights that the management of staple line leaks after sleeve gastrectomy has evolved, with less invasive methods – such as interventional radiology and endoscopy – and their combination now playing a central role in treatment. Orv Hetil. 2025; 166(46): 1827–1832.

Introduction: Voluntary bans on smoking inside the home reduce exposure to secondhand smoke, prevent smoking uptake, and support cessation. In Hungary, limited data are available on the temporal changes and correlates of smoke-free household rules. Objective: To examine the prevalence, temporal trend, and sociodemographic correlates of voluntary bans on traditional tobacco smoking inside the home. Method: We conducted a secondary analysis of data from two surveys in 2009 and one in 2022. The unit of analysis was the household. We applied Z-tests, Cochran–Armitage trend tests, and binomial logistic regression with calculation of average marginal effects (AMEs). Results: The proportion of households with a complete ban on smoking inside the home increased in Hungary from 60.6% in 2009 to 75.1% in 2022 (h = 0.3; p<0.01). Nevertheless, in 2022, 25.2% (95% CI: 22.5–28.0%) of children under the age of 18 still lived in households where smoking inside the home was allowed. Financial difficulties (AME ≈ –0.09 to –0.01) and the presence of a smoker in the household (AME ≈ –0.42 to –0.30) had a negative association in all models. The presence of a child under 18 years slightly increased the likelihood of a complete ban (AME ≈ 0.02 to 0.10). Discussion: Although there has been improvement, minors are still not adequately protected from indoor tobacco smoke in all Hungarian households. Conclusion: Our findings highlight the need for targeted health communication and intervention programmes, particularly among disadvantaged households with children and at least one smoker. Orv Hetil. 2025; 166(46): 1818–1826.

Introduction: The relationship between human emotions and their bodily expressions has been receiving increasing attention in psychology and cognitive sciences. Emotions are not only expressed through verbal and facial cues but also through posture, gestures, and movement patterns. Motion analysis is one of the possible methods for identifying emotions; however, there is currently no clear consensus on which method is the most suitable for this purpose. Objective: The aim of this study is to systematically review motion analysis methods used for emotion recognition and to compare human-based and artificial intelligence-based approaches. Method: This study follows a systematic literature review using the PRISMA protocol. The initial search identified 7699 scientific articles from various databases. After applying inclusion and exclusion criteria, 16 relevant studies were selected for detailed analysis. The research examines different motion analysis techniques, their applicability, and their accuracy. Results: A total of 9 different motion analysis methods were identified in the literature, of which 4 utilized artificial intelligence for emotion recognition. These methods differ in terms of data processing techniques, applied technologies, and accuracy in detecting emotions. Discussion: Motion analysis is a promising tool for studying emotions; however, no universally applicable technique currently exists. Artificial intelligence plays an increasing role in emotion recognition, yet challenges remain in algorithm development and handling individual differences in emotional expression. Conclusion: Currently, there is no single, universally accepted motion analysis technique for emotion identification. Artificial intelligence can be a useful tool, but it has limitations when used alone. The most reliable approach appears to be the application of multidisciplinary methods, which combine human observation, classical motion analysis, and machine learning techniques. Orv Hetil. 2025; 166(46): 1803–1809.

Introduction: Epilepsy is a chronic neurological disease with a significant burden worldwide, often associated with comorbidities, particularly depression. Depression does not only impair quality of life but also affects the effectiveness of epilepsy treatment. The NDDI-E (Neurological Disorders Depression Inventory for Epilepsy) is a short, targeted questionnaire developed to rapidly identify depression in people with epilepsy. Objective: The aim of our study is to prepare the ground for the validation and adaptation of the NDDI-E questionnaire in Hungarian. Method: 83 epilepsy patients (54 women and 29 men) with a mean age of 47.253 years (SD = 14.613) were included in our study. The NDDI-E questionnaire was compared with the Beck Depression Questionnaire (BDI) and other psychometric instruments (Quality of Life in Epilepsy [QOLIE-31], Patient Health Questionnaire-9 [PHQ-9]). The methodological process included a back-and-forth translation of the questionnaires and expert validation. Results: The internal reliability of the NDDI-E was Cronbach’s α = 0.8, which increased to 0.885 during retest. The results of the confirmatory factor analysis showed that the one-dimensional structure of the NDDI-E matched the data well. The analysis confirmed the presence of a single component, with each item contributing a corresponding factor weight; the lowest factor weight was 0.440 and the highest was 0.762. Total questionnaire scores showed a significant positive correlation with BDI scores (r [81] = 0.574; p<0.001). NDDI-E scores predicted changes in the quality of life (QOLIE-31). Maximum sensitivity and specificity showed optimal predictive value in diagnosing depression. The external validity of the questionnaire was supported by the strong correlation with PHQ-9 and BDI scores. Discussion: The results support the applicability of the NDDI-E in a Hungarian-speaking epilepsy population, and the questionnaire may serve as a reliable tool for the rapid screening of depression. Conclusion: Future studies with a larger number of items are needed to further confirm the validity and reliability of the questionnaire. Orv Hetil. 2025; 166(46): 1810–1817.

Population ageing, increasing prevalence of chronic diseases and multimorbidity – and the associated healthcare costs – require a multidisciplinary approach in health care. Major nutrition-related geriatric challenges such as anorexia of ageing and malnutrition, dysphagia, sarcopenia, frailty, sarcopenic obesity, metabolic syndrome, as well as drug–nutrient interactions and iatrogenia form vicious circles that define the main focus areas of nutritional therapy. In 2023, the European Society for Clinical Nutrition and Metabolism provided a new guideline on the nutrition of multimorbid hospitalized patients, followed in 2024 by a concise summary containing practical algorithms. The guideline presents 32 recommendations grouped according to 15 clinically relevant questions on malnutrition screening, personalized nutritional support and its indications, timing, procedure of interventions and monitoring. The nutrition plan is described in detail, covering energy, protein and micronutrient intake and disease-specific considerations. Two-thirds of the recommendations are based on low- to moderate-quality evidence, expert consensus or clinical experience, because the highly heterogeneous population of multimorbid older adults is usually excluded from clinical trials; further research is therefore essential. The international guideline aligns with the Hungarian guidance on the care of multimorbid geriatric patients, with the overarching aim of improving current quality of life and functional capacity through individualized nutritional therapy rather than restrictive diets. All conditions and treatments of multimorbid patients – their present functional performance and activity – must be considered and assessed, while respecting patients’ preferences and the characteristics of the healthcare system. Orv Hetil. 2025; 166(45): 1769–1776.