[Personalized medicine and healthcare: where are we now, where should we go?] / Személyre szabott orvoslás és egészségügy: hol tartunk, merre menjünk?

The authors of this manuscript are representatives of different subdisciplines of medicine, all of them are experienced researchers. As of their origin, they are practicing doctors from the primary care and from the clinical/hospital setting, diagnostics experts, researchers from healthcare management, health economics, representatives of patients' rights and patient organizations. They are all devoted to the implementation of personalized medicine and personalized healthcare in Hungary. The current manuscript - also meant to be a keynote message provoking further discussion in the medical community - is devoted to correcting for two false ideas. One is that personalized medicine is not yet ready for practical applications, it is merely a research area of futurologists. The other false idea is that only (or mainly) the lack of financial resources hinders the introduction of personalized healthcare in Hungary. Orv Hetil. 2023; 164(6): 202-209.

Intraarticular Injection of a Cross-Linked Sodium Hyaluronate Combined with Triamcinolone Hexacetonide (Cingal) to Provide Symptomatic Relief of Osteoarthritis of the Knee: A Randomized, Double-Blind, Placebo-Controlled Multicenter Clinical Trial.

OBJECTIVE: To evaluate the efficacy and safety of an intraarticular injection of Cingal (Anika Therapeutics, Inc., Bedford, MA) compared with Monovisc (Anika Therapeutics, Inc., Bedford, MA) or saline for the treatment of knee osteoarthritis. DESIGN: This multicenter, double-blind, saline-controlled clinical trial randomized subjects with knee osteoarthritis (Kellgren-Lawrence grades I-III) to a single injection of Cingal (4 mL, 88 mg hyaluronic acid [HA] plus 18 mg triamcinolone hexacetonide [TH]), Monovisc (4 mL, 88 mg HA), or saline (4 mL, 0.9%). The primary efficacy outcome was change in WOMAC (Western Ontario and McMaster Universities Arthritis Index) Pain Score through 12 weeks with Cingal versus saline. Secondary outcomes included Patient and Evaluator Global Assessments, OMERACT-OARSI Responder index, and WOMAC Total, Stiffness, and Physical Function scores through 26 weeks. RESULTS: A total of 368 patients were treated (Cingal, n = 149; Monovisc, n = 150; saline, n = 69). Cingal improvement from baseline was significantly greater than saline through 12 weeks ( P = 0.0099) and 26 weeks ( P = 0.0072). WOMAC Pain was reduced by 70% at 12 weeks and by 72% at 26 weeks with Cingal. Significant improvements were found in most secondary endpoints for pain and function at most time points through 26 weeks. At 1 and 3 weeks, Cingal was significantly better than Monovisc for most endpoints; Cingal and Monovisc were similar from 6 weeks through 26 weeks. A low incidence of related adverse events was reported. CONCLUSIONS: Cingal provides immediate and long-term relief of osteoarthritis-related pain, stiffness, and function, significant through 26 weeks compared to saline. Cingal had similar immediate advantages compared with HA alone, while showing benefit comparable to HA at 6 weeks and beyond.

Balneotherapy in elderly patients: effect on pain from degenerative knee and spine conditions and on quality of life.

BACKGROUND: Balneotherapy is an established treatment modality for musculoskeletal disease, but few studies have examined the efficacy of spa therapy in elderly patients with degenerative spine and joint diseases. OBJECTIVES: To assess the effects of balneotherapy on chronic musculoskeletal pain, functional capacity, and quality of life in elderly patients with osteoarthritis of the knee or with chronic low back pain. METHODS: The 81 patients in the study group underwent a 1 day course of 30 minute daily baths in mineral water. Changes were evaluated in the following parameters: pain intensity, functional capacity, quality of life, use of non-steroidal anti-inflammatory or analgesic drugs, subjective disease severity perceived by the patients, investigator-rated disease severity, and severity of pain perceived by the patients. We analyzed the results of 76 subjects as 5 did not complete the study. RESULTS: Compared to baseline, all monitored parameters were significantly improved by balneotherapy in both investigated groups. Moreover, the favorable effect was prolonged for 3 months after treatment. CONCLUSIONS: This study showed that balneotherapy is an effective treatment modality in elderly patients with osteoarthritis of the knee or with chronic low back pain, and its benefits last for at least 3 months after treatment.

[Assessment of cerebrovascular reactivity using the breath-holding test in hypertensive and normotensive adolescents--preliminary results]. / A cerebrovascularis reaktivitás vizsgálata légzés-visszatartásos teszttel hypertoniás és egészséges serdülókben (elózetes eredmények).

AIM: Authors report on preliminary results of cerebral vasoreactivity-tests performed in frame of the Debrecen Hypertension Study among hypertensive and healthy adolescents. METHODS: Investigators measured blood flow velocities before and after 30 seconds of breath holding using transcranial Doppler sonography. RESULTS: Blood flow velocities at rest were significantly higher in the hypertensive that in the healthy adolescent group. Breath holding induced less intensive cerebral vasoreactivity response in the hypertensive than in the normotensive group. CONCLUSION: It is concluded that altered arteriolar function of the cerebral arterioles can be detected already in this early stage of hypertension.

Comparison of different methods evaluating the functional and structural abnormalities in hypertension.

Functional and morphological abnormalities due to hypertension could be detected in neurologically symptom-free patients by CT, MRI, transcranial Doppler ultrasound, PET and SPECT. Neuropsychological tests also provide useful information. Single or combined application of these techniques reveals different aspects of parenchymal or vascular impairment in hypertension. The advantages and disadvantages of the different imaging techniques are reviewed and compared. The relatively simple, non-invasive transcranial Doppler (alone or combined with neuropsychological observations) could be recommended for screening and follow-up of hypertensive patients and seems to be a promising ancillary tool for evaluation of efficacy of antihypertensive therapy, but cannot replace the prospective controlled trials with hard endpoints.

[Treatment of migraine in patients with hypertension and ischemic heart disease]. / A migrén kezelése hypertoniás és ischaemiás szívbetegek esetében.

Migraine is a common disorder with a prevalence of 9-10% in Hungary. Migraine can be accompanied by hypertension and/or ischemic heart disease sometimes in younger patients, but more frequently in the elderly, which is important for therapeutical considerations. The article reviews the literature with special focus on hypertension and coronary heart disease. In the second part, the authors summarize their experiences on headache patients.