Toldy Ferenc Kórház

Abstract Background The evolution of inflammatory bowel disease (IBD) occurs across four epidemiological stages: emergence, acceleration in incidence, compounding prevalence and prevalence equilibrium; as put forward by Kaplan. et al. (Nat Rev Gastroenterol Hepatol. 2021). Newly industrialized countries are in the acceleration in incidence stage, while the western world is in the compounding prevalence stage: stable incidence and rapidly increasing prevalence. The Veszprém IBD cohort is a well-established prospective, population based inception cohort. Our aim was to analyze total, age and gender specific incidence and prevalence rates of ulcerative colitis (UC) patients over the past four decades (1977-2018). Methods Data of 1,370 UC patients were analyzed. Patient inclusion was between January 1, 1977 and December 31, 2018. All patients in Veszprem county, a well-defined administrational area of Hungary, was included. Both in-hospital and outpatient records were collected and comprehensively reviewed at diagnosis and during clinical follow-up. The source of age- and gender-specific demographic data for statistical analysis was derived from the results of a national population census in 1980, 1990, 2001 and 2011 (source: Hungarian Central Statistical Office). Prevalence rates were calculated in 1991, 2001, 2011 and 2015. Results Adjusted mean incidence rate of UC increased from 4.06 (CI95%: 2.47-6.66) /105 person-years in 1977-1991 to 13.31 (CI95%: 10.71-17.50) /105 in 1997-2001. The following years show a plateau/ slight decrease in incidence: 11.16 (CI95%: 8.18-15.23) /105 in 2007-2011 and 10.92 (CI95%: 7.98-14.96) /105 in 2012-2018. see Figure 1/A. Age specific mean incidence rates in the total cohort show a peak of disease onset at the age of 20-29 years (16.54 /105 person-years), however incidence is only slightly lower at the age of 30-39 years (15.82 /105 person-years). The total prevalence of UC patients show a steady increase from 60.05 (CI95%: 52.07-68.42) /105 persons in 1991 to 317.62 (CI95%: 299.62-336.70) /105 in 2015. Age specific prevalence rates show similarly high prevalence rates among elderly patients (60-69y) compared to adult patients, meaning a saturation of age specific curves in the elderly. see Figure 1/B. Age specific prevalence of UC among the 60-69 years old is as high as 506.42 (CI95%: 443.23-578.56) /105 persons in 2015. Conclusion Incidence rates of UC patients plateaued around the 2000s and show slight decrease afterwards. Prevalence rates of UC show a steady increase, thus Hungary is well into the 3rd epidemiological phase of compounding prevalence. As we already see a saturation of prevalence rates among elderly UC patients, a transition to the 4th stage of prevalence equilibrium may began. Conflict of interest: Gonczi, Lorant: No conflict of interest Angyal, Dorottya: No conflict of interest Balogh, Fruzsina: No conflict of interest Golovics, Petra: No conflict of interest Akos, Ilias: No conflict of interest Pandur Baloghne, Tunde: No conflict of interest David, Gyula: No conflict of interest Erdélyi, Zsuzsanna: No conflict of interest Szita, Istvan: No conflict of interest Lakatos, Laszlo: No conflict of interest Lakatos, Péter Laszlo: No conflict of interest

The turnover intention of elderly care workers affects the quality and costs of social care, worker overload and associated health risks. Preventing the turnover and job-related stress of elderly care workers is essential to effectively support the elderly and ensure high-quality care. This study investigated the relationship between fear of COVID-19 and turnover intention, and job-related stress through burnout. A cross-sectional survey was conducted in Hungary with 269 elderly care workers. Data collection tools included a self-designed demographic questionnaire, the Turnover Intention Scale (TIS-6), Maslach Burnout Inventory (MBI-HSS), Effort-Reward Imbalance (ERI) and Fear of COVID-19 Scale (FCV-19). Indirect effects of fear of COVID-19 were observed on the turnover intention (B = 0.092, p = .008), ER ratio (B = 0.009, p = .007), effort (B = 0.070, p = .007), and overcommitment (B = 0.093, p = .006) via emotional exhaustion. Additionally, fear of COVID-19 negatively influenced overcommitment (B = - 0.043, p = .017) through depersonalization. The models explained 26.3% of the variance in effort (R² = 0.263), 3.4% in reward (R² = 0.034), 23.9% in overcommitment (R² = 0.239), and 25.8% in the ER ratio (R² = 0.258). The mediating role of emotional exhaustion and depersonalization in the relationship between pandemic-related fear and turnover intention and job-related stress underscores the need for targeted interventions in Hungary's elderly care sector. These should focus on early detection of burnout symptoms, especially emotional exhaustion, and implement systematic strategies such as regular monitoring, stress management training, supportive supervision, and team-based peer support to mitigate the impact of chronic occupational stress. The study protocol was registered on ClinicalTrials.gov before the start of the study, on 02/08/2022 (identifier: NCT05487157).

A mocsári kockásliliom (Fritillaria meleagris L.) természetvédelmi helyzete indokolja az állományok monitoring jellegű vizsgálatát, a tövek számának nyomon követését. A virágzó egyedek számának rendszeres megállapítását nehezíti, hogy a faj csak rövid ideig észlelhető, és nagy kiterjedésű réteken fordul elő. Míg a korábban rendelkezésre álló megoldások idő- és költségigénye nem tette lehetővé az évenkénti teljes körű adatgyűjtést, a légi felmérés költséghatékony segítséget nyújthat az állományok aktuális virágzó egyedszámának becslésében. Ennek a modern módszernek is vannak fizikai korlátai: az ortofotó-mozaik geometriai megbízhatóságát 10 cm alatti értéken kell tartani, a felvételeket nagy átfedéssel készíteni (legalább 80% sorok közötti, legalább 90% soron belüli átfedések), a terepi felbontást pedig 0,7 mm körülire szükséges tervezni.

Introduction: The importance of artificial nutrition in critical illness is well known; the lack of it can cause delayed wound healing and increase in ventilator days. Objective: The objective of the previously published EuroPN study was to assess the nutritional practice across Europe amongst the participating intensive care units and examine the effect of calory and protein intake in weaning from mechanical ventilation and 90-day mortality. This manuscript will analyze the Hungarian data out of the EuroPN study. Method: We included all patients with length of stay >5 days during the screening month. Clinical and nutritional data were collected retrospectively for the first 5 days and prospectively thereafter until day 15 (or discharge/death). Patient outcome data were collected on day 15, 30 and 90. Results: There were 111 patients included from 6 Hungarian intensive care units. The analysis of cumulative calory and protein intake of these patients showed that the ESPEN target was achieved at a much higher proportion in Hungary compared to the European patients: 92% of calory target was reached (95% CI 68; 118) vs. 83% in European patients (95% CI 59; 107). The protein target showed even higher difference: patients in Hungary reached the target in 83% (95% CI 57; 121), compared to 65% in European patients (95% CI 41; 91). Discussion and conclusion: The higher cumulative calory and protein intake significantly reduced the number of ventilator days in the EuroPN study. The Hungarian patients reached this target earlier, by day 3; this was achieved by using the supplementary parenteral nutrition earlier. Orv Hetil. 2024; 165(14): 531–537.

Survival of in-hospital cardiac arrests is still as low as 15-35%. Healthcare workers should closely monitor patients' vital signs, notice any deterioration, and initiate the necessary actions to prevent cardiac arrest. The introduction of early warning sign protocols (including the monitoring of respiratory rate, oxygen saturation, pulse, blood pressure, consciousness, etc.) can improve the recognition of periarrest patients during hospital stay. However, when a cardiac arrest occurs, healthcare workers should also be able to work in team and follow the relevant protocols delivering good quality chest compressions and early defibrillation. To achieve this goal, regular trainings, appropriate infrastructure and system-wide teamwork are needed. In this paper, we discuss the challenges of the first phase of in-hospital resuscitation and its integration into the hospital-wide medical emergency response system. Orv Hetil. 2023; 164(12): 449-453.

The most common surgical intervention in childhood is inguinal hernioplasty. The aim of the authors was to evaluate the learning curve of PIRS (percutaneous internal ring suturing). A prospective observational cohort was studied including patients under the age of 18 years with planned PIRS between 2018 and 2019. Patients with urgent intervention (incarceration) or other surgical procedures performed simultaneously were excluded. The incidence of metachronous hernia, surgical time, number of conversions and complications were analyzed. The postoperative follow-up time was 1-4 weeks. A phone call check-up was performed in 2022. PIRS was performed in 126 patients (57 boys, 69 girls) with an average age of 4.6 years. The average surgical time was 26.5 min, in the case of experts it was reduced to 22.9 min. The surgeries were longer in boys than in girls (30.5 vs. 23 min). Unilateral surgeries were faster than bilateral ones (23.7 vs. 33.6 min). Initially, girls were operated with PIRS, the surgical time decreased. When trainees started to learn the procedure, the surgical time increased, then decreased again. The same trend was observed in boys. 28 metachronous hernias were found. 3 conversions and 3 intraoperative complications were observed. During the postoperative follow-up, 1 recurrence, 4 postoperative complications were observed. The phone call check-up with 92/126 patients revealed 1 more recurrence and 6 chronic complaints. PIRS is a good laparoscopic "teaching" procedure during the training, but the open procedure has still place in the treatment. PIRS is a safe procedure in childhood and can be easily learned. It is an excellent method in basic laparoscopic training by use of which metachronous hernia can be recognized. Orv Hetil. 2023; 164(7): 260-264.

Abstract Background The number of epidemiological population-based studies on unclassified inflammatory bowel disease (IBD-U) patients are very limited. The present study is a continuation of the Veszprem IBD population based cohort with a follow-up of the incidence and disease course of IBD-U since 1977. Our aim was to evaluate incidence, prevalence, disease course, time to biological therapy and surgery rates in a prospective population-based database of incident IBD-U patients diagnosed between 1977 and 2018, with follow-up until 2020. Methods Both in-hospital and outpatient records were collected. The source of age- and gender-specific demographic data was derived from the Hungarian Central Statistical Office. Medical therapy, time to first biological therapy, disease progression, and colectomy was registered. Results Data of 119 incident IBD-U patients were analyzed (male/female: 55/64; median age at diagnosis: 34 years(y) (IQR: 24-47)). Adjusted mean incidence rate was 0.76 (CI95%: 0.63-0.9) /105 person-years in the total study period, and 0.96 (CI95%: 0.79-1.16) /105 person-years between 1990-2018. Disease extent at diagnosis was proctitis in 7.6%, one-sided colitis (left-sided colitis, or isolated right-sided colitis) in 36.1%, and extensive (pancolitis) in 56.3%. The probability of progression in colonic disease extent was 6.7% (SE:2.3) at 3 years, 10.3% (SE:2.8) at 5 years and 15.3% (SE:3.4) at 10 years. Figure 1. The probability of developing terminal ileitis, thus disease classification change – Crohn’s disease was 2.6% (SE:1.5) at 5 years and 3.5% (SE:1.7) at 10 years. Figure 2. Perianal disease developed in 5% (n=6) of all patients during the total follow-up. The probability of receiving biological therapy in patients diagnosed after the year 2000 (n=62), was 15.5% (SE:4.8) at 5 years, and 19.4% (SE:5.3) at 10 years. Figure 3. The overall resective surgery rate was 16.8% at the end of follow-up. Segment resection was performed in 5.0% of the patients, and 11.8% underwent subtotal- or total colectomy. The cumulative probability of resective surgery was 7.6% (SE:2.4) at 1 year, 9.3% (SE:2.7) at 5 years, 13.5% (SE:3.3) at 10 years, and 18.5% (SE:3.9) at 20 years. Figure 4. Conclusion Initial disease phenotype was severe in most cases of IBD-U and colonic progression is substantial over time. Disease classification change to Crohn’s disease with development of terminal ileitis or perianal disease was low. High rates of biological therapy and surgery are suggestive of a severe disease course of IBD-U.

ObjectivesThe aim of the SIMPACT study was to evaluate the efficacy and safety of MTX-free s.c. tocilizumab (TCZ) therapy in RA patients.MethodsSIMPACT was an open-label, non-controlled, non-randomized, non-interventional study, in which RA patients for whom the treating physicians ordered s.c. TCZ were observed during a 24-week treatment period in Hungarian centres. Although the use of MTX was avoided during the study period, other conventional synthetic DMARDs, oral CSs and NSAIDs were allowed. Study endpoints included the change in DAS28 and clinical activity index (CDAI) scores, the proportion of patients achieving remission in the whole population and in subgroups defined based on prior RA treatment history, and age, weight or biological sex post hoc. The extent of supplementary medication use was monitored.ResultsThree hundred and thirty-seven RA patients were enrolled in 18 study centres. TCZ therapy significantly decreased the disease activity measured by both DAS28 (P = 0.0001) and CDAI (P = 0.0001). Clinical response was more pronounced in biologic-naïve patients and was lower in patients >75 years of age. In the whole population, DAS28 ESR or CRP and CDAI remission rates were 70.10%, 78.95% and 33.59%, respectively. In patients <45 years of age, the CDAI remission rate doubled (67.86%). A significant decrease in the frequency of co-administered medication was reported, including oral CSs and DMARDs.ConclusionReal-world clinical evidence on s.c. TCZ reported here is in line with the efficacy outcomes of randomized clinical trials. Subgroup analysis revealed that TCZ was more effective in biologic-naïve patients and in those <75 years old.Trial registrationClinicalTrials.gov, http://www.clinicaltrials.gov, NCT02402686.

Abstract Introduction Cardiopulmonary exercise testing (CPET) is an important diagnostic method to evaluate athletes and non-athletes, however we do not have widely accepted normal values for correct evaluation and interpretation in the young. Goals Our aim was to compare CPET parameters of young athletes and non-athletes and determine reference values. Methods Exercise tests were performed in young non-athletes, aged &lt;18 years between 2011 to 2016 at Mayo Clinic. Athletes underwent detailed sports cardiology screening including CPET at Semmelweis University Heart and Vascular Center between 2016 and 2018. Individuals with cardiovascular disease were excluded. We created 2 subgroups in both sexes: 12–14 years (Group 1), 15–17 years (Group 2). Statistical analysis was performed using SAS with analysis of variance under the general linear model adjusting for age, body mass index and test effort based on peak respiratory exchange ratio (RER). Results A total of 212 athletes (92% male, 15.5±0.6ys) and 207 non-athletes (68% male, 15.0±0.7ys) were included in the analysis. In Group 1 boys, athletes have higher peak HR (200.0±9.2 vs 188.5±16.8 bpm, p&lt;0.0001), HR reserve (117.1±14.5 vs 108.9±19.8 bpm p&lt;0.05), VO2 max (53.7±6.6 vs 44.7±9.1 mL/kg/min p&lt;0.0001), ventilation (VE) (120.3±25.0 vs 70.7±21.6 L/min p&lt;0.0001) and RER (1.12±0.0 vs 1.07±0.08, p &lt;.001) compared to controls. In Group 2 boys, there was no difference in peak HR and HR reserve, but athletes have higher VO2 max (57.2±4.7 vs 45.3±9.3 mL/kg/min, p&lt;0.0001) and VE (150.7±23.7 vs 104.1±25.9 L/min, p&lt;0.0001), similarly as Group 2 girls: VO2 max (46.3±3.6 vs 34.9±8.5 mL/kg/min p&lt;0.0001), VE (118.7±12.5 vs 68.4±20.6 L/min, p&lt;0.0001). In male athletes, peak HR (200.6±9.2 vs 196.5±7.4 bpm p&lt;0.05) and HR recovery (34.2±9.8 vs 29.8±11.1 bpm p&lt;0.05) decreases with age, while VO2 max (53.7±6.6 vs 57.2±4.7 mL/kg/min, p&lt;0.001) and VE (120.3±24.9 vs 150.7±23.7 L/min, p&lt;0.0001) increases. Lower cut-off values were determined in each group (Figure). Lower-cut off values Conclusion We created a unique Mayo-Semmelweis database of young athletes and non-athletes. As a result of intensive training, athletes show higher levels of CPET variables vs non-athletes. Our study provides CPET reference values in the pediatric age group, applying them could contribute to correct evaluation and interpretation of CPET, increasing its diagnostic potential.