Orvosi hetilap最新文献

Musculoskeletal diseases represent a major public health problem worldwide, as they are associated with pain, reduced musculoskeletal function, and diminished quality of life. They affect more than 1.7 billion people globally, and their prevalence continues to rise due to ageing, obesity, sedentary lifestyle, and psychosocial factors. Chronic pain is the most common complaint, which may appear as an independent condition or as a consequence of other diseases such as osteoarthritis, spondylosis, or rheumatoid arthritis. Pain and sleep disturbances are closely and mutually related: inadequate sleep increases pain sensitivity, reduces the efficiency of pain processing, and contributes to the persistence of chronic pain. The aim of this review study is to examine the relationship between pain, the most common symptom of degenerative joint and spinal diseases and sleep quality. Sleep disorders are highly prevalent in certain musculoskeletal diseases and predict a subsequent decline in functional status. Therapeutic options include balneotherapy and complex physiotherapy, both of which have been shown to reduce pain and improve musculoskeletal function. Several studies have reported long-term benefits of balneotherapy, mud therapy, and aquatic physiotherapy. In addition, regular moderate-intensity physical activity plays a key role in reducing pain and improving functional status and sleep quality. Monitoring physical activity using questionnaire-based methods and objective wearable devices enables a more accurate assessment, safe planning, and continuous tracking of physical activity levels. Overall, a multimodal, individualized therapeutic approach is the most effective in the management of musculoskeletal diseases, targeting the simultaneous improvement of pain, sleep, and lifestyle-related factors. Orv Hetil. 2026; 167(8): 300-308.

In their case study, the authors present the coexistence of delusional parasitosis and induced paranoid psychotic disorder: they observed the development of delusions induced in the partner of a psychotic patient suffering from vascular dementia. They discuss the main characteristics of the psychopathological manifestations of delusional parasitosis and induced psychosis. They also discuss psychopharmacological and supportive psychotherapeutic interventions that play an important role in the treatment of delusional symptoms and draw attention to the importance of prevention. Orv Hetil. 2026; 167(8): 324-328.

Merkel-cell carcinoma is a rare but very aggressive, neuroendocrine skin tumor with a poor prognosis. Its incidence is increasing with the aging of the population and increased ultraviolet exposure. Due to its featureless appearance, it is recognized late in most cases. It has a high recurrence and metastatic potential, therefore early diagnosis significantly increases the survival of patients. Its treatment is multidisciplinary, including surgical excision, radio- and chemotherapy, and immunotherapy in metastatic cases. Despite new treatment options, its mortality has not changed significantly in recent years, and its prognosis remains extremely poor. In our case, we describe a rare form of Merkel-cell carcinoma that metastasizes to the stomach and review the literature. Orv Hetil. 2026; 167(8): 317-323.

Introduction: Childhood injuries are among the leading causes of mortality worldwide and in Hungary. The quality of first aid provided by laypeople has a fundamental impact on survival rates.

Objective: To assess parents' knowledge of first aid, to explore their need for further practical training, and to determine whom they consider the most reliable source of such knowledge.

Method: During our quantitative research conducted in Győr-Moson-Sopron county, we used a self-designed, online, anonymous questionnaire (n = 545) and performed descriptive statistical analyses. Associations were examined using the chi-square test and binary logistic regression (p<0.05).

Results: The majority of parents (94.3%) possess basic, primarily theoretical first aid knowledge; however, this knowledge is often incomplete or outdated. The greatest deficiencies were in the practical application of cardiopulmonary resuscitation and in the airway obstruction caused by foreign bodies. The majority of respondents (93.4%) would be willing to learn from paramedics (84.9%), health visitor (60%), registered nurses (57.6%), physicians (56.4%). Based on the association analyses, first aid experience gained in real-life emergency situations was significantly associated with self-reported willingness to intervene (p = 0.012) as well as with a more favorable self-assessment of first aid competence (p<0.001). According to the results of the binary logistic regression, having an official, examination-based first aid qualification was an independent predictor of having provided first aid in a real-life emergency situation; among respondents without such qualification, the odds of providing first aid were reduced by approximately half (OR = 0.516; p = 0.001; 95% CI: 0.345-0.774).

Conclusion: The goal is to clarify the knowledge of parents and provide training in practical skills from professionals. Both formal first aid training and practical experience play a decisive role in shaping the willingness to intervene in real-life emergency situations as well as self-confidence. These findings support the need for structured, practice-oriented first aid education among parents. Orv Hetil. 2026; 167(7): 265-273.

Introduction: The professional quality of life of health visitors is a multidimensional construct. The emotionally demanding nature of the profession necessitates a comprehensive examination of both protective and risk factors.

Objective: The study aimed to explore the personal, job-related, and professional support factors determining the professional quality of life of health visitors, and to identify their positive and negative effects.

Method: A cross-sectional questionnaire-based study was conducted among health visitors (N = 286) who had been practicing for at least two years. Alongside self-developed items, the survey assessed multiple dimensions of professional quality of life using the standardized ProQOL instrument.

Results: Higher age was associated with greater work satisfaction and lower emotional overload. A higher level of education was related to a more favourable professional quality of life. Being in a stable relationship functioned as a protective factor. Among job-related characteristics, nurses working in mixed districts experienced greater emotional burden but also reported more positive helping experiences. Substitution increased compassion satisfaction, while prolonged substitution elevated secondary traumatic stress. Professional development activities and case discussions significantly enhanced positive indicators of professional quality of life, whereas limited availability of supervision provided strong protection against burnout and secondary traumatic stress.

Discussion: The findings confirm that personal resources, job characteristics, and professional support systems are all decisive for the mental well-being of health visitors. The regular presence of positive experiences and support mechanisms can mitigate the psychological burden arising from the profession.

Conclusion: Strengthening professional support systems and ensuring broader and more accessible provision of continuing education, case discussions and clinical supervision are crucial for improving the professional quality of life and preserving the mental health of health visitors. Orv Hetil. 2026; 167(7): 274-285.

Introduction: Heart failure remains one of the leading causes of cardiovascular morbidity and mortality, impairing the quality of life. Based on randomized, controlled clinical trials, SGLT2 inhibitors significantly improve outcomes and reduce symptoms. However, real-world evidence is essential to better assess their effectiveness and safety in everyday clinical practice.

Objective: To evaluate the effects of empagliflozin therapy on the quality of life and functional status, as well as to assess its safety profile in the Hungarian cohort of the international Emp-Activity study, covering the full spectrum of heart failure.

Method: This prospective, non-interventional, multicenter, observational study involved symptomatic heart failure patients enrolled from 11 Hungarian centers. A total of 106 patients were enrolled, of whom 101 were assigned to the empagliflozin cohort and 5 to the non-empagliflozin cohort. Patients received empagliflozin as part of routine heart failure therapy and completed the Kansas City Cardiomyopathy Questionnaire (KCCQ-12) at baseline and after 24 weeks. Functional status was assessed using the New York Heart Association (NYHA) classification.

Results: 101 patients were enrolled to the empagliflozin cohort (median age 69 years, 28.7% female), primarily in NYHA class II and III. Among them, 57% had HFrEF, 19% HFmrEF, and 22% HFpEF. The most frequent etiology was ischemic heart disease (42%). The most common comorbidities included hypertension (58%), atrial fibrillation (33%), diabetes mellitus (26%), and hyperlipidemia (25%). A significant improvement was observed in the KCCQ-12 overall score (74.3 ± 19.5 vs. 67.1 ± 19.5, p<0.01), with clinically meaningful improvement (≥5-point increment) in 53% of patients. The NYHA class improved significantly. Systolic blood pressure decreased (131 ± 16 mmHg vs. 127 ± 17 mmHg, p = 0.02), while diastolic blood pressure, serum creatinine, and potassium levels remained stable during the 24-week follow-up.

Conclusion: In Hungarian patients with heart failure, 24-week empagliflozin treatment resulted in significant improvements in the quality of life and functional capacity, while being well tolerated. These findings support the effectiveness and safety of empagliflozin in routine clinical practice across the full spectrum of heart failure. Orv Hetil. 2026; 167(7): 257-264.

The technological advantages of minimally invasive surgery that has largely overwhelmed gynecological open surgery have also been shown to apply to the surgical treatment of early-stage cervical cancer. The decline in surgical morbidity, most apparently the decreasing blood-loss and wound healing disorders, shorter hospitalization and postoperative recovery have all been proven shortly after its introduction in the treatment of cervical cancer. However, the earliest large sample comparisons of overall survival results showed an alarming disadvantage of minimally invasive surgery to open surgery. Results of recently completed large comparative studies suggest that ablastic intraoperative measures and more stringent pathological tissue processing may succeed in eliminating this disadvantage in cure-rates. With the adherence to strict eligibility criteria, even systematic lymphadenectomy may be substituted safely with ultrastaging of sentinel lymph nodes to further reduce morbidity of surgical treatment of early-stage cervical cancer. It seems that the 2018's stalling of minimally invasive surgery in the treatment of early-stage cervical cancer was only temporary. Orv Hetil. 2026; 167(7): 251-256.

Congenital epulis is a rare, benign, neonatal tumor in the oral cavity. Its size can reach several centimeters, posing an obstruction to breathing and feeding. Prenatal diagnosis provides an opportunity to adequately prepare for delivery, including securing the airway, or even ex utero intrapartum treatment. The authors present the case of a newborn girl, whose postnatally discovered lesions suggested congenital epulis. The operation took place a few hours after birth, the histological examination of the excised tumor concluded the presumed diagnosis. Since its first description in 1871, less than 250 publications of congenital epulis have been reported. This is the first case report in Hungarian on the topic. The authors' goal is to exhibit this rare entity and raise awareness of questions that might arise during medical care. Orv Hetil. 2026; 167(6): 243-246.

Introduction: Using Global Burden of Disease 2023 data, this study examines the structure of health losses in Hungary, focusing on diseases, risk factors, and international comparisons.

Objective: To identify which diseases and risk factors contribute most to Hungary's health burden, how these relate to disability and premature mortality, and how patterns differ by gender and in comparison, with Central European countries.

Method: Age-standardized values per 100,000 inhabitants, broken down by gender and disease/risk category, were analyzed for Hungary and compared with Austria, the Czech Republic, Poland, and Slovakia.

Results: Cardiovascular diseases, cancers, and musculoskeletal disorders caused the largest losses. High blood pressure was the leading risk factor. Premature mortality was substantially higher in Hungary; men showed especially elevated levels due to smoking, diet, and hypertension. Morbidity-related losses were dominated by musculoskeletal and mental disorders.

Discussion: Hungary's burden stems not only from mortality but also from chronic disabling conditions. The mortality component is particularly unfavourable in international comparison.

Conclusion: Improving treatment quality, timely care, and early diagnosis is essential, while reducing morbidity requires stronger long-term care and rehabilitation. Effective policy should complement lifestyle-focused prevention with better access to high-quality curative care and gender-responsive interventions. Consistent use of objective burden-of-disease data can support decision-making. A systemic approach - combining prevention, supportive environments, and a strengthened healthcare system - is needed to reduce health losses in Hungary. Orv Hetil. 2026; 167(6): 232-242.