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1.
Orv Hetil ; 161(46): 1939-1943, 2020 11 15.
Artigo em Húngaro | MEDLINE | ID: mdl-33190124

RESUMO

Összefoglaló. Bevezetés: A COVID-19-járvány világszerte hónapokra átalakította a járóbeteg-ellátás muködését is. Magyarországon a 2020. március 11-tol 2020. június 17-ig fennálló egészségügyi veszélyhelyzeti rendelkezések szabták meg az új kereteket. Célkituzés: Az elso veszélyhelyzeti periódus második felében, 2020. április 22. és 2020. május 5. között mértük fel az epilepsziaellátásban részt vevo orvosok véleményét, hogy milyen mértékben változott a betegek ellátása, és hogyan élték meg a változásokat személyesen. Módszer: Internetes kérdoíves véleményfelmérés történt, a Magyar Epilepszia Liga 2020. április 16-17-re tervezett, de a COVID-19-járvány miatt elhalasztott XV. kongresszusára regisztrált neurológusok között. Kilenc egyszeres vagy többszörös feleletválasztós kérdés és 'szabad kommentár' mezok álltak rendelkezésre. Eredmények: A megkeresett 116 neurológus közül 33-an válaszoltak (28%), összesen 30 kommentár került rögzítésre. 73%-uk szerint a változások komoly nehézséget okoztak, 15%-uk gondolta, hogy ennek súlyos következményei lesznek. Új betegek fogadása 53%-ban leállt, 25%-ban nagy nehézségekbe ütközött. A gondozott betegek problémáit 49%-ban a távvizit lehetoségeivel élve meg tudták oldani, de 24%-ban ez nem sikerült. A beteg távollétében lebonyolított vizitek 68%-a dokumentált telefonbeszélgetések formájában zajlott. Az orvosok kétharmada veszélyeztetve érezte magát, hogy elkapja a vírust, ebbol 40% úgy érezte, nem kap elegendo védelmet, 6% (2 fo) kapta el a fertozést. Következtetés: A COVID-19-járvány a leginkább az új szakvélemények kiadását érintette, de a gondozási feladatokat sem mindig lehetett megfeleloen megoldani. A károkat jelentosen enyhítette az ellátószemélyzet rugalmassága. A telefonvizitek, szükség esetén, az epileptológiában pótolhatják a személyes orvos-beteg találkozásokat. A járvány visszatérésének veszélye miatt a távvizit-alkalmazások technikai fejlesztése és ezek dokumentálási kérdéseinek megoldása fontos. A járványidoszakban a személyzet védelmére nagy figyelmet kell fordítani a fertozodés elkerülése és az orvosok biztonságérzetének fokozása érdekében. Orv Hetil. 2020; 161(46): 1939-1943. INTRODUCTION: COVID-19 pandemic has transformed the operation of outpatient care worldwide for months. The new framework was set in Hungary by the health emergency regulations that existed from 11. 03. 2020 to 17. 06. 2020. OBJECTIVE: In the second half of the emergency period, between 22. 04. 2020 and 05. 05. 2020, we surveyed the opinion of physicians involved in epilepsy care about the extent to which patient care had changed and how they experienced the changes in person. METHOD: An internet questionnaire survey was conducted among neurologists registered for the annual congress of the Hungarian Chapter of the International League Against Epilepsy. Nine single- or multiple-choice questions and 'free comment' fields were available. RESULTS: Of 116 neurologists contacted, 33 responded (28%), and a total of 30 comments were recorded. 73% said the changes caused a serious difficulty, 15% thought it would have serious consequences. Reception of new patients was stopped in 53%, and 25% encountered great difficulties. In 49%, the problems of the cared patients could be solved using remote visits, but 24% could not solve them properly. 68% of outpatient visits took the form of documented telephone conversations. Two-thirds of doctors feared catching the virus, 40% of whom felt they were not getting enough protection. 6% caught the infection. CONCLUSION: The COVID-19 pandemic has mostly affected the issuance of new expert opinions, but care tasks have not always been adequately addressed. The damage was significantly mitigated by the flexibility of the care staff. Telephone visits, if necessary, can replace personal doctor-patient encounters in epileptology. The technical development of remote visit applications and their documentation issues are important. During the pandemic period, great care must be taken to protect staff in order to avoid infection and increase the sense of safety of doctors. Orv Hetil. 2020; 161(46): 1939-1943.


Assuntos
Infecções por Coronavirus , Epilepsia , Pandemias , Pneumonia Viral , Infecções por Coronavirus/epidemiologia , Epilepsia/terapia , Pesquisas sobre Serviços de Saúde , Humanos , Hungria/epidemiologia , Pneumonia Viral/epidemiologia
2.
Oral Health Prev Dent ; 18(1): 991-998, 2020 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-33215490

RESUMO

PURPOSE: This study aimed to explore self-reported oral hygiene practices (OHPs) among Hungarian adult e-cigarette-only (former smokers who switched completely to e-cigarette use or vaping) and dual users (smokers who use e-cigarettes and combustible tobacco cigarettes concomitantly). MATERIALS AND METHODS: A cross-sectional, web-based survey of 930 adult Hungarian e-cigarette users was conducted in 2015. Participants reported 10 OHPs, which were included in analyses as separate binary variables and as a composite variable of the 10 OHP items (inadequate/adequate). Chi-square test was used to explore whether separate OHPs differ by vaping status, and to examine the relationship between inadequate OHPs and past combustible or e-cigarette use characteristics. Associations between separate OHPs and vaping status, and between inadequate OHPs and vaping status were tested by multiple logistic regression analyses. RESULTS: More dual users reported toothbrushing twice a day or more than e-cigarette-only users (73.6% vs 65.3%, respectively, p = 0.041) and using sugar-free chewing gum (57.7% vs 45.8%, respectively, p = 0.006) while adequacy of other OHPs did not differ statistically significantly by vaping status. Inadequate OHPs were more typical in the sample (63.7%) than adequate OHPs, however, inadequate OHPs did not differ statistically significantly among dual users and e-cigarette-only users (62.0% vs 64.0%, respectively, OR = 1.20, p = 0.400), controlling for age, gender, education, past combustible and current e-cigarette use characteristics. CONCLUSION: In this study, both e-cigarette-only and dual users demonstrated similarly high prevalence of inadequate OHPs. Therefore dentists should educate them about effective OHPs and the role of tobacco and e-cigarette use in the development of oral diseases.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Produtos do Tabaco , Adulto , Estudos Transversais , Humanos , Hungria/epidemiologia , Higiene Bucal
3.
Orv Hetil ; 161(45): 1914-1919, 2020 11 08.
Artigo em Húngaro | MEDLINE | ID: mdl-33161390

RESUMO

Összefoglaló. A malignus csonttumorok sebészi ellátása során kialakuló szegmentális csontdefektusok pótlása fontos szempont a végtagmegtartó sebészetben. Felnottkorban a megoldás rendszerint tumorprotézis beültetése, 10 évesnél fiatalabb gyermekeknél azonban ez nehezen alkalmazható módszer a kis csontméret és az igen magas várható szövodményarány miatt. A bemutatott, hazánkban még ritkán alkalmazott beavatkozás, a tumoros csontszegmentum mutét alatti sugárkezelése, visszaültetése megfelelo rekonstrukciós lehetoség a végtag funkciójának megtartása mellett, csökkentve a késobbi reoperációk, protézisrevíziók számát. Célkituzés: A hazánkban eddig az ismertetett módon végzett mutétek bemutatása, az eredmények összevetése nemzetközi irodalmi adatokkal. Módszer: Magyaroszágon eddig 12 alkalommal végeztünk végtagmegtartó mutétet malignus csonttumor miatt 12 évesnél fiatalabb gyermekeknél, és e mutétek során biológiai rekonstrukciós módszerként extracorporalis irradiatiót, autograft-reimplantatiót (ECRT, ECI) végeztünk. A mutétek mindegyike primer malignus csonttumor (Ewing-sarcoma 7 esetben, osteosarcoma 4 esetben, chondrosarcoma 1 esetben) miatt történt. Betegeink átlagéletkora 9 (3-12) év volt, az átlagos utánkövetési ido 32,5 (2-73) hónap. A felmérés során fizikális vizsgálat, valamint minden alkalommal röntgenfelvételek készítése történt, szükség esetén szövettani mintavétellel, vérelemzéssel vagy egyéb képalkotással kiegészítve. Eredményeinket nemzetközi irodalmi adatokkal hasonlítottuk össze. Eredmények: Lokális tumorkiújulást egyetlen esetben sem észleltünk, másik csontot érinto skip ('ugró') metastasis miatt egy alkalommal amputatiót végeztünk. A szövodmények tekintetében eredményeink megfelelnek a nemzetközi irodalomban leírtaknak. Két esetben jelentkezett szeptikus szövodmény (16,7%). A resectiós sík radiológiai átépülése 3-9 hónap alatt történt meg az esetek 60%-ában. Álízület, grafttörés, graft részleges elhalása miatt 3 esetben végeztünk reoperációt, kétszer újabb allograft felhasználásával, egy esetben pedig tumorprotézis beültetésével. Betegeink szubjektív véleménye a módszerrol pozitív, a legtöbb esetben megorizték jó fizikai aktivitásukat, az esetleges reoperációk ellenére végtagjukat terhelik, akár sporttevékenységet is végeznek. Következtetések: Vizsgálatunk alapján az extracorporalis irradiatio hasznos biológiai rekonstrukciós módszer 12 évesnél fiatalabb gyermekek esetében szegmentális csontdefektusok pótlására tumoros indikációval. A felmerülo szövodmények aránya alatta marad a hasonló korban beültetett tumorprotézisek szövodményarányainak, ideális esetben pedig több, további kiterjesztett mutét elkerülheto vele. Szövodmény esetén a késobbiekben tumorprotézis-beültetés mint végtagmegtartó vészmegoldás még mindig elvégezheto. Orv Hetil. 2020; 161(45): 1914-1919. INTRODUCTION: Reconstruction of massive segmental bone defects is a crucial point of limb salvage surgeries after malignant bone tumor resections. Megaendoprostheses implantation is a commonly used method for adult patients, but hardly usable for children below 12 years old, because of the small size of the host bone and multiple mechanic complications. OBJECTIVE: Extracorporeal irradiation and allograft reimplantation (ECRT, ECI) are promising methods for these young children for limb salvage, reducing the number of prostheses revisions, reoperations. METHOD: In Hungary, we performed limb salvage surgery for malignant bone tumor in 12 cases in children under 12 years old, using extracorporeally irradiated autografts as biological reconstruction. All cases were primary bone tumors (Ewing's sarcoma: 7, osteosarcoma: 4, chondrosarcoma: 1). The average age of our patients was 9 (3-12) years, the average follow-up was 32.5 (2-73) months. At follow-up, we performed physical examination, X-ray, and other imaging methods if they were necessary. Our results were compared to international publications. RESULTS: We observed no local recurrence, but in one case we had to perform above-knee amputation, due to a skip metastasis in the proximal tibia. The complication rates were similar to those reported in other papers. Septic complications were treated in two cases (16.7%). Total union of the resection lines was observed at 3-9 months in 60% of all cases. Reoperations were performed due to nonunion, or allograft fracture/partly desorganization in 3 cases, twice with new allograft, and with prostheses in one case. The subjective opinion of our patients is positive, they walk with full weightbearing, some of them do even light sporting activities. CONCLUSIONS: We found extracorporeal irradiation a useful and safe method for children under 12 years old for biological reconstruction after malignant bone tumor resection. Complication rate stays under the rate of growing prostheses complications, in optimal cases further radical, and extensive surgeries may be avoided. In the case of major complications, megaendoprostheses implantation later on is still an option as salvage procedure with limb salvage. Orv Hetil. 2020; 161(45): 1914-1919.


Assuntos
Neoplasias Ósseas , Condrossarcoma , Adulto , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/cirurgia , Transplante Ósseo , Criança , Pré-Escolar , Condrossarcoma/radioterapia , Condrossarcoma/cirurgia , Humanos , Hungria , Salvamento de Membro , Recidiva Local de Neoplasia , Resultado do Tratamento
4.
Orv Hetil ; 161(44): 1858-1871, 2020 11 01.
Artigo em Húngaro | MEDLINE | ID: mdl-33130602

RESUMO

Összefoglaló. A székletmikrobiota-transzplantáció (faecalismikrobiota-transzplantáció - FMT) a Clostridioides difficile fertozés (CDI) kezelésében nemzetközileg széles körben elfogadott, megfelelo szakmai háttér mellett végezve biztonságos, potenciálisan életmento, költséghatékony, valamint a hospitalizációs ido és az orvos-beteg találkozások jelentos redukálására képes eljárás. Az FMT elvégzésére egyes országokban magas szintu minoségirányítási háttérrel muködo, célfeladatra szervezodött donor- és székletbankok rendezkedtek be. Máshol, így például hazánkban, az eljáráshoz az egyértelmu jogi szabályozási környezet, a standardizált technológiai háttér és a finanszírozás hiánya miatt nem egységes a hozzáférés. Régóta idoszeru továbbá, hogy a heterogén, nemegyszer háztartási eszközökkel elokészített beavatkozások helyett a nemzetközi és legújabban már a hazai ajánlásokban is megfogalmazott, a betegbiztonságot legjobban garantáló elvárások mellett történjen a széklettranszplantáció. Az új koronavírus (SARS-CoV-2) okozta pandémia megjelenése eroteljes szakmai érv országos szinten az FMT minoségirányítási környezetének és technológiai hátterének újragondolására, mert a SARS-CoV-2 egyszerre jelent kockázatot a CDI miatt kórházban kezelt sérülékeny betegpopulációnak, és egyben veszélyezteti az FMT biztonságosságát mind a recipiens, mind pedig az eljárást végzo egészségügyi személyzet tekintetében. Ezekre a szakmai és társadalmi kihívásokra reagálva, a széles köru beteghozzáférés és a legmagasabb szintu betegbiztonság garantálására, a Debreceni Egyetemen új eljárásrendet dolgoztunk ki az FMT végzésére. Ezen eljárásrendnek a COVID-19-pandémia miatt módosított, a fagyasztottgraftbank üzemeltetése és a rendszerszemlélet tekintetében releváns elemeit ismertetjük. Javasolt, hogy országos szinten hasonló, megfelelo minoségirányítási és technológiai környezettel, a SARS-CoV-2-fertozés kizárását is integráló donorszurési rendszerrel, továbbá fagyasztottgraft-banki háttérrel muködo laboratóriumok vegyenek részt a széklettranszplantációk végzésében. Felmerül továbbá, hogy az eljárást a számos analógia és a donor-recipiens koncepció alapján a sejt- és szövettranszplantációkra vonatkozó szabályozórendszer keretei közé ajánlott beágyazni. Orv Hetil. 2020; 161(44): 1858-1871. Summary. Stool transplantation (faecal microbiota transplantation - FMT) is a widely accepted, potentially life-saving, cost-effective medical intervention for the treatment of Clostridioides difficile infection (CDI), which has an acceptable safety profile if performed with an appropriate professional background. FMT can significantly reduce hospitalization time and the number of patient visits. National donor and stool banks with high-standard quality management systems were established in certain countries for supporting the procedures. In other regions, including Hungary, patient access is not uniform due to the lack of clear legal regulations, standardized technology or financial reimbursement. It has been expected for a long time to replace the heterogenous techniques, occasionally utilizing household equipment with a technology providing improved patient safety and fulfilling international and recently published local FMT guidelines. The emergence of the novel coronavirus (SARS-CoV-2) pandemic is a very powerful argument in favour of urgently reconsidering the quality management and technological background of FMT procedures. SARS-CoV-2 is a major threat to the vulnerable patients suffering from CDI and also impose risks for the recipient and healthcare personnel involved in carrying out the transplantation. New FMT guidelines were implemented at the University of Debrecen to address these professional and public challenges, to provide wide patient access and to guarantee the highest achievable patient safety. Relevant elements of this new protocol are presented, focusing on a systemic quality management approach, on the operation of a frozen stool bank and on a modified donor screening algorithm taking the risks of COVID-19 into consideration. We suggest that laboratories with proper quality assurance and technological conditions, implementing SARS-CoV-2 donor screening and operating a frozen graft bank should participate in faecal microbiota transplantations. It is also recommended that, based on the analogies and the similar donor-recipient concept, FMT should be embedded under the organ tissue and cell transplantation polices in Hungary. Orv Hetil. 2020; 161(44): 1858-1871.


Assuntos
Infecções por Clostridium/terapia , Infecções por Coronavirus/prevenção & controle , Coronavirus , Transplante de Microbiota Fecal/normas , Pneumonia Viral/prevenção & controle , Betacoronavirus , Clostridium difficile , Infecções por Coronavirus/epidemiologia , Transplante de Microbiota Fecal/métodos , Humanos , Hungria , Pandemias , Pneumonia Viral/epidemiologia , Melhoria de Qualidade , Resultado do Tratamento
5.
Ideggyogy Sz ; 73(9-10): 311-316, 2020 Sep 30.
Artigo em Húngaro | MEDLINE | ID: mdl-33035417

RESUMO

Background and purpose: This research focused on the knowledge and attitude toward to electroconvulsive therapy (ECT) in the general population of Hungary. There are only a few studies in the international literature focusing on the public's attitude towards ECT, and no such study has been published from Hungary. Methods: Participants were reached through social media and asked to fill out a semi-structured questionnaire on internet that comprised seventeen questions. Participation in the survey was entirely voluntary and anonymous. Participants of the survey were not working in health care; their answers to the questionnaire were compared to those of health-care workers. Results: The result showed a significant difference between healthcare workers' and lay people's knowledge and attitude towards ECT. Two third of lay participants have never heard about ECT. Those familiar with ECT were relatively well-informed about its certain aspects yet rejection of ECT was significantly higher in the group of lay participants than in health-care workers. Conclusion: Lay people's incomplete knowledge and negative attitude towards ECT was confirmed by this survey. The dissemination of reliable information - which should be the shared responsibility of mental health professionals and the media - would be vitally important to disperse the prejudices and doubts about ECT.


Assuntos
Eletroconvulsoterapia , Conhecimentos, Atitudes e Prática em Saúde , Opinião Pública , Esquizofrenia/terapia , Atitude , Humanos , Hungria , Internet , Esquizofrenia/diagnóstico , Inquéritos e Questionários
7.
PLoS One ; 15(9): e0238849, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32898177

RESUMO

Investigation into the genetic diversity of certain endangered native breeds of domestic animals has been in common practice for several decades. The primary objective of these investigations has been to reveal the exceptional genetic value of such breeds, both for their conservation and also to gain insight into their current genetic status, as they have been undergoing a progressive decrease in population size and general diversity; this has been compounded by the general lack of an optimal breeding scheme. In this study, we have investigated changes in the genetic diversity of six Hungarian local chicken breeds based on 29 microsatellite loci over a period of 15 years. In terms of the basic diversity measures, populations sampled in 2017 generally exhibited a lower heterozygosity and mean number of alleles and thus, experienced a higher degree of inbreeding. Although the effective population size increased, the estimates of populations sampled over different periods indicated comparatively low values, suggesting overall lower genetic variance. Pairwise FST estimates were higher in the populations sampled in 2017, showing a larger genetic distance between them. Considerable differences exist between the populations of the same breeds, which can most likely be attributed to genetic drift. STRUCTURE results have shown a clear separation between the Hungarian populations, which is in agreement with the principal coordinate analysis. The most likely clustering was found at K = 6, classifying the populations of the same breed as one group. No considerable allele loss was found in the Hungarian indigenous chicken breeds after 15 years of conservation. In general terms, after 15 years, the level of inbreeding within the populations was, in fact, higher, although this could be effectively reduced through the use of an improved mating system. Consequently, the breed management applied in the case of Hungarian local chicken breeds was found to be effective at adequately conserving their genetic variability.


Assuntos
Cruzamento/métodos , Galinhas/genética , Conversão Gênica , Deriva Genética , Variação Genética , Repetições de Microssatélites , Animais , Feminino , Hungria , Masculino , Densidade Demográfica , Fatores de Tempo
8.
Leg Med (Tokyo) ; 47: 101780, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32882537

RESUMO

New psychoactive stimulants appeared in Hungary in 2010 as in several other European countries. We present our findings from cases where new psychoactive and conventional stimulants (we listed amphetamine, methamphetamine and MDMA as conventional drugs) have been detected in biological specimens between 2010 and 2019. MATERIALS: Biological samples (including urine, blood and body tissues), sent to the Department of Forensic Medicine, University of Pécs, South-West Hungary, in the period 2010-2019. METHOD: High performance liquid chromatography coupled with diode array detection (HPLC-DAD); supercritical fluid chromatography coupled to tandem mass spectrometry (SFC-MS/MS). RESULTS: During the nine-year period between 2010 and 2019, we found new stimulants in 973 (21.1%) cases, and conventional stimulants in 658 (14.2%) cases (out of 4604 analyses -100%- of samples sent to the laboratory for toxicology screening). 594 (12.9%) of all cases were post mortem analyses. The new drugs we've detected could be classified into three groups based on their chemical structure: cathinones (in 960 from our cases), substituted phenethylamines (8), and tryptamines (5). The most frequently identified new psychoactive stimulants were (in the order of decreasing frequency): pentedrone (262), mephedrone (188), N-ethylhexedrone (126), methylenedioxypyrovalerone (MDPV; 98), α-pyrrolidinopentiophenone (alpha-PVP; 93), 4-CMC (35). CONCLUSION: The new substances were detected in highest proportion in 2011; by 2018, the number of conventional drugs exceeded the new stimulants in our cases. According to the data of the Hungarian seizures, the decrease was predictable: from 2015, the seizures of traditional stimulants exceeded the seizures of new stimulants. In 2019 the new stimulants were dominated again among the detected substances in the samples.


Assuntos
Líquidos Corporais/química , Estimulantes do Sistema Nervoso Central/análise , Crime , Usuários de Drogas/estatística & dados numéricos , Drogas Ilícitas/análise , Psicotrópicos/análise , Detecção do Abuso de Substâncias/métodos , Cromatografia Líquida de Alta Pressão/métodos , Humanos , Hungria/epidemiologia , Espectrometria de Massas em Tandem/métodos , Fatores de Tempo
9.
Orv Hetil ; 161(36): 1506-1513, 2020 09.
Artigo em Húngaro | MEDLINE | ID: mdl-32886625

RESUMO

INTRODUCTION: The number of organ transplants is being on the rise. State-of-the-art immunosuppressive therapies and modern peri- and postoperative care have significantly increased life expectancy of transplanted patients, therefore, dentists and oral surgeons may encounter these patients more frequently. Although the number of successful transplants in Hungary has recently exceeded ten thousand; there is still no dental treatment protocol for these patients. AIM: The authors aimed to review and analyse the international literature about the perioperative dental care of transplanted patients based on good practice and evidence-based care protocols. MATERIAL AND METHOD: A review and comparative analysis of the English and Hungarian literature between 2010 and 2019 was conducted in relation to the objective pursued. RESULTS: The number of scientific papers in this topic is limited and their level of evidence is low. In our paper, the risk factors of transplantation and the cornerstones of perioperative, early and late postoperative dental management are described. Organ-specific considerations and possible oral manifestations of the applied medications are also presented. CONCLUSION: Lifelong administered immunosuppressive medications and the resulting artificially weakened immune system require increased attention from dentists and other healthcare professionals during patient aftercare. Close cooperation between the treating physician/surgeon and the dentist is essential to maintain patient safety. Moreover, inflammatory disorders may put the patients at increased risk, so maintaining good oral hygiene is essential. Regular dental check-ups, early detection and adequate therapy can be the cornerstones of long-term uncomplicated survival. Orv Hetil. 2020; 161(36): 1506-1513.


Assuntos
Assistência Odontológica , Transplante de Órgãos , Protocolos Clínicos , Humanos , Hungria
10.
Orv Hetil ; 161(36): 1522-1533, 2020 09.
Artigo em Húngaro | MEDLINE | ID: mdl-32886627

RESUMO

INTRODUCTION: Health disorders may affect negatively work productivity of individuals, leading to absence from work (absenteeism) and/or decreased functioning in the workplace (presenteeism). AIM: To assess the health-related work productivity of the adult population in Hungary by the Work Productivity and Activity Impairment questionnaire (WPAI). METHOD: A cross-sectional survey was performed in 2019 involving a sample (n = 2023) representative for the adult population of Hungary. Socio-demographic characteristics were recorded. Health-related productivity of the participants was assessed by the WPAI questionnaire, health status was measured by the EQ-5D-3L measurement tool and the Minimum European Health Module (MEHM). STATISTICAL ANALYSES: Descriptive statistics were performed, subgroups were compared by Mann-Whitney and Kruskal-Wallis tests. Spearman's rank correlation was applied to analyze the relationship between WPAI, age and EQ-5D-3L index score. RESULTS: Among those in a paid job (n = 1194, 59%), altogether 70 respondents (6%) were absent from work during the week before the survey, which resulted in an average 1.9 (SD = 8.5) work hours loss per week. Presenteeism occurred in 166 (14%) cases. The average absenteeism was 3.6%, presenteeism was 4.4%, and activity impairment in the total sample was 9.5%. Absenteeism did not correlate with age and did not differ significantly across socio-demographic subgroups. Presenteeism was the highest among actively working retired people, disability pensioners and part-time employees. Presenteeism correlated moderately (r = -0.379), absenteeism weakly (r = -0.113) with EQ-5D-3L index. Correlation was significant between activity impairment and age (r = 0.412) as well as the EQ-5D-3L index score (r = -0.592). All WPAI items showed significant worsening across MEHM status levels. CONCLUSION: This is the first study in Hungary to present population reference values with the WPAI. Productivity loss due to presenteeism deserves special attention from the employers as well as from decision makers in the labour, health and social sectors. Orv Hetil. 2020; 161(36): 1522-1533.


Assuntos
Absenteísmo , Eficiência , Presenteísmo/estatística & dados numéricos , Trabalho/estatística & dados numéricos , Adulto , Estudos Transversais , Humanos , Hungria , Inquéritos e Questionários
11.
Orv Hetil ; 161(37): 1545-1553, 2020 09.
Artigo em Húngaro | MEDLINE | ID: mdl-32894734

RESUMO

Human red blood cell concentrate and platelet suspension are unstable preparations, therefore, they are not part of the international pharmaceutical market for biological and economic reasons. Consequently, they cannot be replaced by external sources. Human allogeneic erythrocyte and platelet preparations should therefore be considered as part of the common national wealth. The amount of transfused red blood cell concentrate has been declining in countries with advanced health systems in recent years. The changes were initially driven by the spread of the concept and practice of liberal and restrictive transfusion triggers. A complex, thoughtful system of perioperative blood utilization, the Patient Blood Management has later emerged, and a paradigm shift in the delivery of life-threatening perioperative bleeding has developed. At the same time, clinical practitioners are facing a new challenge of reducing willingness to donate blood worldwide. The rationalization of the use of human red blood cell concentrate and platelet suspension is essential in Hungary. As a health care measure, the currently rigidly earmarked financial resources available for allogeneic preparations and stable factor concentrates for the treatment of life-threatening haemorrhages need to be changed to be interoperable. The perioperative blood use could additionally be reduced by the widespread dissemination of the Patient Blood Management requiring complex coordinated educational interdisciplinary and logistical work. Orv Hetil. 2020; 161(37): 1545-1553.


Assuntos
Transfusão de Sangue , Transfusão de Eritrócitos , Plaquetas , Hemorragia , Humanos , Hungria
12.
Orv Hetil ; 161(37): 1554-1568, 2020 09.
Artigo em Húngaro | MEDLINE | ID: mdl-32894735

RESUMO

The perioperative Patient Blood Management (in Hungary National Blood Donation and Blood Saving Program) is an individualized clinical practice based on a multidisciplinary consensus with a comprehensive and complex approach. It supports the rational and judicious utilization of blood products and abolishes irrational transfusion policy. Its practical implementation is based upon three pillars: 1. anemia management without transfusion, if possible; restrictive transfusion strategy; 2. minimization of blood loss; 3. enhancement of anemia tolerance. Early detection, clarification of etiology and appropriate treatment are the most important tools for the management of preoperative anemia before surgeries with a high risk of bleeding. Minimization of blood loss can be achieved by identifying patients with congenital or acquired bleeding disorders, preparing them appropriately for surgery, discontinuing anticoagulants and antiplatelet drugs for a sufficient time in the preoperative phase of surgery and reversing their effects to comply with current guidelines. Minimal-invasive approaches are preferable. Intraoperatively, atraumatic technique and accurate topical haemostasis should be provided by surgeons. Autologous blood salvage techniques and controlled hypotension in lack of contraindications can also reduce the amount of blood loss. In cases of perioperative bleeding, protocols based on international guidelines but adapted to local circumstances must be used. Ideally, it should be managed by viscoelastic test-guided, goal-directed, individualized and factor concentrate-based algorithm. Perioperatively, an ideal oxygen demand/supply ratio must be ensured to avoid oxygen debt. Restoration and maintenance of homeostasis are essential for both the effectively functioning haemostatic system and the avoidance of oxygen deficit. Implementation of the Patient Blood Management improves patient safety, reduces the cost of medical care and facilitates the national blood product supply. Its successful introduction is our common interest. Orv Hetil. 2020; 161(37): 1554-1568.


Assuntos
Anemia , Perda Sanguínea Cirúrgica , Hemostáticos , Assistência Perioperatória , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Hemorragia , Humanos , Hungria
13.
Orv Hetil ; 161(37): 1606-1616, 2020 09.
Artigo em Húngaro | MEDLINE | ID: mdl-32894741

RESUMO

INTRODUCTION AND AIM: In the last decade, guidelines and trainings promoted haemostasis point-of-care tests, availability and application of factor products, while they led to a decrease in blood product consumption. The aim of this study is to examine protocols, conditions in terms of facilities, equipment, personnel of anaesthesia-intensive care units (A-ICU) to improve healthcare services and patient safety. METHOD: In 2019, self-reported questionnaires were sent in e-mail to A-ICUs. Application of guidelines and local protocols, education, haemostasis diagnostic tools, availability of allogeneic transfusion products, stable factor and drug products for restoring haemostasis were evaluated. RESULTS: 49% of A-ICUs filled out 46 questionnaires. 91.3% applied guidelines, 43.5% had local protocols. The lack of haemostasis and Patient Blood Management (PBM) trainings was indicated by 6 and 17 A-ICUs, respectively. Applying MAITT guidelines decreased red blood cell concentrate (RBC), fresh frozen plasma (FFP) and thrombocyte consumption by 65.1%, 67.4% and 30.2%. The availability of laboratory and viscoelastic tests is limited except for blood count, INR, APTI, fibrinogen. Where viscoelastic tests were available, RBC 2.9, FFP 1.7, thrombocyte 2.5 times more physicians per A-ICU beds participated in haemostasis trainings. 32% of A-ICUs can provide the required amount of factor products in the case of massive bleeding. CONCLUSION: Haemostasis and PBM trainings improve the quality of healthcare services if necessary equipment, factor and haemostasis drug products are provided. In order to promote PBM programmes and to improve patient safety, rearrangement of service and financing structure is needed, which must be accompanied by consulting perioperative professionals, general practitioners, and other related experts. Orv Hetil. 2020; 161(37): 1606-1616.


Assuntos
Doadores de Sangue , Recuperação de Sangue Operatório , Segurança do Paciente , Hemostasia , Humanos , Hungria
14.
PLoS One ; 15(9): e0238526, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915829

RESUMO

Archaeologists use differences in metals from burial contexts to identify variation in social inequalities during the European Bronze Age. Many have argued that these social inequalities depended on access to, and control of, trade routes. In this paper, I model critical gateways in the Tisza river-a river system in the Carpathian Basin that might have enabled privileged access to metal in some areas but not others. I then evaluate the concentration of metal on different topological nodes of the river network in an attempt to understand what best explains the distribution of metals across this landscape. I do this by describing Bronze Age metal consumption and display in cemeteries from four micro-regions of the Tisza, and compare them with network 'betweenness centrality' values for locations along the river. I find support for the argument that favourably located river nodes had better access to metal in the earlier part of the Bronze Age.


Assuntos
Cemitérios , Metais/análise , Rios/química , Poluentes Químicos da Água/análise , Artefatos , Geografia , Hungria
15.
Toxicon ; 187: 181-187, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32920016

RESUMO

The Fusarium mycotoxins deoxynivalenol (DON) and zearalenone (ZEA) frequently contaminate grain crops, especially maize, the basis of poultry's feed. Mycotoxins enter the food chain and induce pathological changes in edible tissues. Milk thistle (Silybum marianum) has been used for the treatment of liver disease in humans because of its antioxidant and hepatoprotective effects, but its utility in veterinary use is poorly examined. To investigate possible protective properties against mycotoxin caused oxidative stress in poultry, pressed form of milk thistle seed (0.5%) was tested in white, female, Hungarian ducks over a feeding period of 47 days. Ducks were separated into 3 groups. The first group was fed with normal diet. The second group was fed with normal diet contaminated with DON (4.9 mg/kg) and ZEA (0.66 mg/kg). The third group received mycotoxin contaminated feed with milk thistle supplementation. Histological examination, markers of the redox status and metal element concentration measurements were carried out. The results showed alterations in the histological examination and in the redox homeostasis markers as a short-term effect by strengthening the antioxidant system. Acute exposure of mycotoxins caused an oxidative stress, which induced an effective antioxidant defensive response of the organism indicated by the free sulfhydryl group content (from 0.72 ± 0.06 to 0.77 ± 0.11) and the reducing power (0.49 ± 0.06 to 0.52 ± 0.08) elevation. The short-term free radical injury may be compensated by the liver resulting in decreased lipid peroxidation markers (malondialdehyde concentration: from 16.86 ± 0.49 to 0.94 ± 0.15, conjugated diene concentration: from 0.21 ± 0.07 to 0.17 ± 0.03). Silymarin further strengthtened the antioxidant defense by the elevation of sulfhydryl groups concentration and reducing power property resulted in decreased total scavenger capacity. However the concentration of lipid peroxidation markers were further elevated by the used antioxidant treatment (MDA: 5.2 ± 0.35, DC: 0.26 ± 0.08). In conclusion, the mycotoxin-contamination activated effectively the antioxidant system. The milk thistle supplementation has cytoprotective effects according to the histological findings, activated the antioxidant system, however the elevation of lipid peroxidation products need further explanation.


Assuntos
Contaminação de Alimentos , Cardo-Mariano , Micotoxinas , Ração Animal , Animais , Patos , Flavonoides , Homeostase , Hungria , Fígado , Oxirredução , Estresse Oxidativo
16.
Orv Hetil ; 161(38): 1619-1622, 2020 09.
Artigo em Húngaro | MEDLINE | ID: mdl-32924965

RESUMO

INTRODUCTION: In Hungary, SARS-CoV-2 was first detected in the swab samples of two Iranian patients on March 4, 2020. After finding the first positive cases, the question arose whether the virus had entered Hungary and caused infections before this date. Before March 4, 2020, except for the two above-mentioned samples, none of the 224 swab samples received specifically for SARS-CoV-2 tested positive. AIM: The National Reference Laboratory for Respiratory Viruses of the National Public Health Center aimed to carry out a retrospective study of the swab and other samples taken for testing respiratory virus infections between January 1, and April 19, 2020 sent by sentinel physicians within the influenza surveillance for diagnostic purposes. METHOD: For the study, we used swab samples taken weekly by sentinel physicians of the influenza surveillance service, and other samples received for diagnostic purposes. Tests were performed using real-time PCR. RESULTS: All the 465 swab samples sent by sentinel physicians were found to be SARS-CoV-2 negative. Also, of the 551 samples collected for diagnostic reasons of other respiratory viruses, no SARS-CoV-2 positive was found among those taken before March 4. CONCLUSION: Based on our data, it is very likely that prior to the first cases diagnosed on March 4, 2020, SARS-CoV-2 did not cause clinically symptomatic infections in Hungary. Orv Hetil. 2020; 161(38): 1619-1622.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Pandemias , Pneumonia Viral/diagnóstico , Vigilância da População/métodos , Betacoronavirus/genética , Técnicas de Laboratório Clínico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Humanos , Hungria/epidemiologia , Irã (Geográfico) , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Reação em Cadeia da Polimerase em Tempo Real , Estudos Retrospectivos
17.
Value Health ; 23(9): 1235-1245, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940242

RESUMO

OBJECTIVES: The wording of the Hungarian EQ-5D-3L and EQ-5D-5L descriptive systems differ a great deal. This study aimed to (1) develop EQ-5D-3L and EQ-5D-5L value sets for Hungary from a common sample, and (2) compare how level wording affected valuations. METHODS: In 2018 to 2019, 1000 respondents, representative of the Hungarian general population, completed composite time trade-off tasks. Pooled heteroscedastic Tobit models were used to estimate value sets. Value set characteristics, single-level transition utilities from adjacent corner health states, and mean transition utilities for all possible health states were compared between the EQ-5D-3L and EQ-5D-5L. RESULTS: Health utilities ranged from -0.865 to 1 for the EQ-5D-3L and -0.848 to 1 for the EQ-5D-5L. The relative importance of the 5 EQ-5D-5L dimensions was as follows: mobility, pain/discomfort, self-care, anxiety/depression, and usual activities. A similar preference ranking was observed for the EQ-5D-3L with self-care being more important than pain/discomfort. The EQ-5D-5L demonstrated lower ceiling effects (range of utilities for the mildest states: 0.900-0.958 [3L] vs 0.955-0.965 [5L]) and better consistency of mean transition utilities across the range of scale. Changing "confined to bed" (3L) to "unable to walk" (5L) had a large positive impact on utilities. Smaller changes with more negative wording in the other dimensions (eg, "very much anxious/feeling down a lot" [3L] vs "extremely anxious/depressed" [5L]) had a modest negative impact on utilities. CONCLUSION: This study developed value sets of the EQ-5D-3L and EQ-5D-5L for Hungary. Our findings contribute to the understanding of how the wording of descriptive systems affects the estimates of utilities.


Assuntos
Atividades Cotidianas , Limitação da Mobilidade , Qualidade de Vida , Adulto , Idoso , Doença Crônica/epidemiologia , Feminino , Nível de Saúde , Humanos , Hungria/epidemiologia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
18.
Trials ; 21(1): 809, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993779

RESUMO

BACKGROUND: Early reports indicate that COVID-19 may require intensive care unit (ICU) admission in 5-26% and overall mortality can rise to 11% of the recognised cases, particularly affecting the elderly. There is a lack of evidence-based targeted pharmacological therapy for its prevention and treatment. We aim to compare the effects of a World Health Organization recommendation-based education and a personalised complex preventive lifestyle intervention package (based on the same WHO recommendation) on the outcomes of the COVID-19. METHODS: PROACTIVE-19 is a pragmatic, randomised controlled clinical trial with adaptive "sample size re-estimation" design. Hungarian population over the age of 60 years without confirmed COVID-19 will be approached to participate in a telephone health assessment and lifestyle counselling voluntarily. Volunteers will be randomised into two groups: (A) general health education and (B) personalised health education. Participants will go through questioning and recommendation in 5 fields: (1) mental health, (2) smoking habits, (3) physical activity, (4) dietary habits, and (5) alcohol consumption. Both groups A and B will receive the same line of questioning to assess habits concerning these topics. Assessment will be done weekly during the first month, every second week in the second month, then monthly. The composite primary endpoint will include the rate of ICU admission, hospital admission (longer than 48 h), and mortality in COVID-19-positive cases. The estimated sample size is 3788 subjects per study arm. The planned duration of the follow-up is a minimum of 1 year. DISCUSSION: These interventions may boost the body's cardiovascular and pulmonary reserve capacities, leading to improved resistance against the damage caused by COVID-19. Consequently, lifestyle changes can reduce the incidence of life-threatening conditions and attenuate the detrimental effects of the pandemic seriously affecting the older population. TRIAL REGISTRATION: The study has been approved by the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (IV/2428- 2 /2020/EKU) and has been registered at clinicaltrials.gov ( NCT04321928 ) on 25 March 2020.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Comportamento de Redução do Risco , Ensaios Clínicos Adaptados como Assunto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/efeitos adversos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Exercício Físico , Comportamento Alimentar , Feminino , Nível de Saúde , Interações Hospedeiro-Patógeno , Humanos , Hungria , Masculino , Saúde Mental , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Ensaios Clínicos Pragmáticos como Assunto , Fatores de Proteção , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos
19.
Orv Hetil ; 161(34): 1395-1399, 2020 08.
Artigo em Húngaro | MEDLINE | ID: mdl-32804669

RESUMO

INTRODUCTION: Early international observations report decreased number of acute ischemic stroke admissions and prolonged onset-to-treatment times during COVID-19 pandemic. AIM: Our goal was to assess the effect of COVID-19 pandemic on Hungarian acute ischemic stroke care. METHOD: We compared demographical and clinical characteristics, rate of intravenous and endovascular therapies and therapeutic time parameters of acute ischemic strokes admitted to a university stroke centre in a COVID-epidemic period (01/03/2020-30/04/2020) and an identical period of 2019. RESULTS: 86 patients were admitted during the COVID-period and 97 in the control period. Demographical and clinical characteristics of these periods were well-balanced. In the COVID-period, the proportion of patients arriving beyond 24 hours after onset increased by 13% (p = 0.046), the rate of endovascular interventions remained unchanged (8%), the rate of intravenous thrombolysis decreased from 26% to 16%, the mean onset-to-treatment time of thrombolysis increased by 20 minutes, while the mean door-to-treatment time increased by only 5 minutes. Behind the shift of arrival time categories, multivariable (year of examination, NIHSS, age) logistic regression shows that the year of examination might play a leading role (p = 0.096). CONCLUSION: In the COVID-period, admissions for acute ischemic strokes decreased by 11% and the proportion of cases certainly untreatable by reperfusion therapies (arriving beyond 24 hours after onset) increased significantly. While the rate of endovascular interventions remained unchanged, the absolute rate of intravenous thrombolysis decreased by 10% and the mean onset-to-treatment time showed a tendency to increase. In these changes, the COVID-epidemic itself and related out-of-hospital factors might play a leading role. Orv Hetil. 2020; 161(34): 1395-1399.


Assuntos
Isquemia Encefálica/terapia , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Acidente Vascular Cerebral/terapia , Humanos , Hungria/epidemiologia , Admissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Tempo para o Tratamento/estatística & dados numéricos
20.
Orv Hetil ; 161(34): 1400-1413, 2020 08.
Artigo em Húngaro | MEDLINE | ID: mdl-32804670

RESUMO

INTRODUCTION: During a 36-year period (between January 1, 1983 and December 31, 2018), 5159 adult patients with newly diagnosed haematological malignancy were registered in the leukaemia/lymphoma registry of Szabolcs-Szatmár-Bereg county. AIM: The review of the incidence of different haematological malignancy in the authors' county, and the changes of incidence from time to time, the associated haematological malignancies, and familial occurrence of malignant haematological diseases. METHOD: Detailed analysis of the data of the registry, with statistical analysis of incidence. RESULTS: The incidence of Hodgkin disease and non-Hodgkin's lymphoma (1.49 and 7.12 new cases, respectively/100 000 inhabitants/year) was a little smaller, that of essential thrombocythaemia was larger than in the published data. The incidence of all other haematological malignancies corresponded to the data of the literature. The change of incidence of all malignant haematological diseases was similar to the published data. In the registry, there were 35 patients with two different malignant haematological diseases appearing simultaneously or successively. During the 36-year period, 88 families with haematological malignancies were recorded in the registry. CONCLUSION: With the exception of Hodgkin disease, non-Hodgkin's lymphoma, and essential thrombocythaemia, the incidence of other haematological malignancies corresponded to the data of the literature. The change of incidence in all entities was similar to that observed by other authors. The authors in their country do not know other published data related to associated malignant haematological diseases. The observed anteposition in familial haematological diseases of uncle/aunt and nephew/cousin, and anteposition in malignant haematological diseases of siblings are equally new in the literature. Orv Hetil. 2020; 161(34): 1400-1413.


Assuntos
Neoplasias Hematológicas/epidemiologia , Adulto , Humanos , Hungria/epidemiologia , Incidência
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