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Összefoglaló. Nemzetközi kutatások szerint a deréktáji fájdalom 2019-ben 568 millió embert érintett világszerte. Magyarországon a lakosság 20%-a él krónikus derékfájdalommal, ami nemcsak egészségügyi, de szociális és ökonómiai krízist is jelent. A probléma aktualitását jól mutatja az is, hogy a Nemzetközi Fájdalomkutatási Társaság a 2021. évet a derékfájdalomról szóló globális évnek kiáltotta ki. A derékfájdalmak megfelelő kezelése és a krónikussá válás megelőzése tehát kiemelten fontos. Ebben nyújthatnak segítséget az evidenciákon alapuló irányelvek. Magyarországon azonban jelenleg nincs hatályos, egységes irányelv, mely a derékfájdalmakkal, azon belül is a krónikus derékfájdalom kezelésével foglalkozna. A jelen közleményben a krónikus derékfájdalom evidenciákon alapuló diagnosztikai és kezelési lehetőségeinek áttekintését tűztük ki célul. Az irodalomkutatást követően, a jelenleg is hatályos, AGREE II. rendszer szerinti magas minőségű besorolást elérő, krónikus deréktáji fájdalomra vonatkozó, angol nyelvű nemzetközi irányelvek ajánlásainak összehasonlítását végeztük el. Tanulmányunkban hét irányelvet dolgoztunk fel (négy európai, kettő amerikai, egy kanadai), melyek mindegyikében a következő közös ajánlások kerültek megfogalmazásra: a súlyos patológiák kizárása az alarm tünetek alapján, a pszichoszociális tényezők figyelembevétele, a szükségtelen képalkotó vizsgálat visszaszorítása, az elsősorban aktív, nem gyógyszeres terápiák preferálása és a nemszteroid gyulladáscsökkentők körültekintő felírása. Az európai irányelvekben új elemként szerepelt a krónikussá válás korai rizikóbecslése. Orv Hetil. 2021; 162(49): 1951-1961. Summary. In 2019, low back pain caused the highest burden globally, among musculoskeletal disorders, affecting 568 million people. According to Hungarian sociodemographic data, 20% of the Hungarian adults live with chronic low back pain that is a global health priority. Therefore, the International Association for the Study of Pain announced 2021 as the global year about back pain. Evidence-based guidelines about the appropriate treatment of acute low back pain and prevention of chronic low back pain are therefore of paramount importance. However, there are currently no valid, uniform treatment guidelines in Hungary about acute and chronic lower back pain. In this paper, we aimed at summarizing up-to-date, evidence-based diagnostic and treatment recommendations for chronic low back pain. Using a literature review, we identified seven international treatment guidelines (four from Europe, two from the United States and one from Canada) in English for the management of chronic low back pain that were previously assessed by the AGREE II quality assessment tool. We found consistent recommendations in the guidelines such as exclusion of alarm symptoms, assessment of psycho-social factors, reduction of unnecessary imaging, initialization of primarily active, non-pharmacological therapies, and careful and cautious prescription of non-steroidal anti-inflammatory medications. A new recommendation in the European guidelines is the early risk assessment of low back pain becoming chronic. Orv Hetil. 2021; 162(49): 1951-1961.

Összefoglaló. A tudomány jelenlegi állása szerint - csoportok összehasonlítására épülő matematikai-statisztikai eszközökkel - a leginkább hatékonynak és hatásosnak vélt kezelési módszerek szisztematikus elemzése mentén, a bizonyítékokon alapuló irányelveken nyugvó gyógyító munkát tekintjük követendőnek. A nyaki verőérszűkület ellátása esetén az utóbbi években elkészült mind a hazai, mind az európai irányelv, mindemellett a társszakmák irányelveiben is megjelentek kezelési javaslatok. Közleményünkben összehasonlítottuk a témában publikált magyar, angol, német és olasz nyelvű, valamint az európai társaságok által kiadott irányelveket. Az irányelvek alapelveikben hasonlóak, formailag és tartalmilag azonban jelentős (időnként egymásnak ellentmondani látszó) különbségeket találhatunk. Az ellentmondások három leggyakoribb oka: 1) az egyes irányelvek által kitűzött célok különbözősége, 2) az aszimptomatikus és szimptomatikus betegcsoport definíciói, valamint 3) az eltérő evidenciaszintek. Az irányelvek összevetése alapján a tünetes, szignifikáns nyaki verőérszűkületek sebészi ellátása evidenciának tekinthető. A szimptomatikus nyaki verőérszűkület a definíció szerint ellenoldali cerebralis ischaemia okozta, tranziens vagy definitív plegia, paresis, aphasia és az azonos oldali arteria centralis retinae embolisatiója miatti amaurosis fugax. A tünetmentes nyaki verőérszűkületek ellátása tekintetében az európai és a nemzeti irányelvek nem azonosak, ezen esetek terápiás döntése egyéni mérlegelést igényel. Tünetmentes, 70%-os stenosis esetén vascularteam-konzílium javasolt. Orv Hetil. 2020; 161(51): 2139-2145. Summary. The correct practice is the one that is proven to be the most effective based on systematic statistical analyses of different treatment methods, and is applied according to evidence-based principles. In recent years, not only has the European Society of Vascular Surgery created a guideline about the management of supra-aortic steno-occlusive disease, but some nations' vascular surgical societies and related disciplines have also developed their own guidance. In this paper, the guidelines by the European societies on the clinical care of patients with carotid artery luminal narrowing is compared to national guidelines published in Hungarian, English, German, and Italian. Although the fundamental points of the guidelines are similar, there are some important differences among them both in presentation and in content; as a result, they sometimes appear to be contradictory. The three main sources of inconsistency are the various goals, the discrepancy in the definition of symptomatic and asymptomatic carotid artery stenosis, and the bias arising from the use of distinct evidence levels. A comparison of guidelines suggests that the treatment of symptomatic significant carotid artery stenosis with surgery can be considered evidence. Symptomatic carotid artery stenosis is defined as transient or definite plegia, paresis, aphasia due to cerebral ischemia, and monocular blindness caused by embolism in the central retinal artery. However, in the case of asymptomatic 70% or greater carotid artery stenosis, the guidelines are quite heterogeneous, and these patients require individual consideration and a vascular team decision is recommended. Orv Hetil. 2020; 161(51): 2139-2145.

International migration is a current and growing phenomenon, which has become an increasingly critical issue in Europe since 2013 and this has posed new challenges to the healthcare systems of the European Union (EU). The need for 'culturally competent' healthcare systems that can adapt and respond to the needs of a changing population while taking into account cultural, religious, linguistic and gender diversity, has become more and more an agenda across Europe. Nowadays, it is widely accepted that inequalities in health conditions are mainly due to socio-economic factors, and disparities are particularly evident among certain ethnic and cultural minority groups. Additionally, minorities often face difficulties during their attempts in accessing healthcare, including linguistic and cultural barriers. These barriers are primarily manifested in communication and other interactions between the patient and the healthcare provider. Communication difficulties and misunderstandings may lead to frustration and prejudice among caregivers and also to a lack of cooperation from patients, and consequently, may contribute to poorer health outcomes. Therefore, in order to ensure the highest quality of care for migrants, ethnic or other minority populations in our increasingly diverse societies, it is of crucial importance to overcome the difficulties arising from linguistic, cultural and religious differences. To achieve these goals, an important step is the development of intercultural competences within the healthcare system. Our paper discusses the concept, content and opportunities for the development of intercultural competence in clinical and healthcare settings. Orv Hetil. 2020; 161(32): 1322-1330.

Sudden cardiac death is one of the leading causes of mortality in developed countries. When happens only immediate action can save the patient's life. A rather simple sequence of interventions (CPR - cardiopulmonary resuscitation) by the bystander witnessing the collapse could significantly increase the chance of survival yet it happens less than in half of the cases. One of the most important initiatives of the last decade was the simplification of basic life support guidelines and its trainings along with widely publicising its simplicity, importance and its effect on survival. The success of the initiative has been published by several studies showing an increasing number of bystander CPR worldwide, in Europe and in Hungary, too. Survival data have also increased moderately but by far not as much as it could be expected under ideal circumstances. This paper reviews the potential issues to be considered for increasing the numbers and improving the quality of bystander resuscitation. Orv Hetil. 2019; 160(46): 1810-1815.

Measles is one of the most serious preventable infectious diseases, which in our country were among the rare diseases in the last 10 to 20 years. One of the reasons for this is that the Hungarian population born after 1969 was vaccinated in almost 99 percent. The other reason is that in the period prior to vaccination era, the often-occurring measles epidemics left life-long immunity in the affected persons. Thus, natural and artificial immunizations provided extensive herd immunity. However, the ongoing measles epidemics in Europe have highlighted the fact that the symptoms and differential diagnosis related to measles have been relegated to the negligible category for the last 20 years. In addition to reviewing the consequences of the European measles pandemics in Hungary, the purpose of this paper is to revise and summarize the clinical and laboratory knowledge required to establish a definitive epidemiological control of measles. Orv Hetil. 2019; 160(20): 767-773.

This analysis is based on papers published in periodicals, in the period 1975-2013 with title words referring to diagnosis or therapy. The literature of both topics is growing dynamically and in an ever accelerating pace. At the same time, the two topics appear to get more and more separated, except for a part of the German-language literature. The share of therapy-oriented literature is increasing and its citation rate is higher, although 9 of the 10 most cited papers are from the topic of diagnostics. The Hungarian literature (papers having at least one Hungarian author) appeared to be proportional and balanced.

This paper presents the history, the achievements and the current status in the research performed by family physicians in Hungary and makes suggestions for the future. The comparative analysis of research domains, results infrastructural differences and perspectives between Hungary and other European countries is also performed. A wide range of primary care bibliography is also offered for readers who are interested in this topic.

The Bologna Declaration aims at harmonizing the European higher education structure. In accordance with the Declaration, biomedical engineering will be offered as a master (MSc) course also in Hungary, from year 2009. Since 1995 biomedical engineering course has been held in cooperation of three universities: Semmelweis University, Budapest Veterinary University, and Budapest University of Technology and Economics. One of the latter's faculties, Faculty of Electrical Engineering and Informatics, has been responsible for the course. Students could start their biomedical engineering studies - usually in parallel with their first degree course - after they collected at least 180 ECTS credits. Consequently, the biomedical engineering course could have been considered as a master course even before the Bologna Declaration. Students had to collect 130 ECTS credits during the six-semester course. This is equivalent to four-semester full-time studies, because during the first three semesters the curriculum required to gain only one third of the usual ECTS credits. The paper gives a survey on the new biomedical engineering master course, briefly summing up also the subjects in the curriculum.

Surgical robotics is one of the most dynamically advancing areas of biomedical engineering. In the past few decades, computer-integrated interventional medicine has gained significance internationally in the field of surgical procedures. More recently, mechatronic devices have been used for nephrectomy, cholecystectomy, as well as in orthopedics and radiosurgery. Estimates show that 70% of the radical prostatectomies were performed with the da Vinci robot in the United States last year. Robot-aided procedures offer remarkable advantages in neurosurgery both for the patient and the surgeon, making microsurgery and Minimally Invasive Surgery a reality, and even complete teleoperation accessible. This paper introduces surgical robotic systems developed primarily for brain and spine applications, besides, it focuses on the different research strategies applied to provide smarter, better and more advanced tools to surgeons. A new system is discussed in details that we have developed together with the Johns Hopkins University in Baltimore. This cooperatively-controlled system can assist with skull base drilling to improve the safety and quality of neurosurgery while reducing the operating time. The paper presents the entire system, the preliminary results of phantom and cadaver tests and our efforts to improve the accuracy of the components. An effective optical tracking based patient motion compensation method has been implemented and tested. The results verify the effectiveness of the system and allow for further research.

With the explosion of insurance contracts in the last two hundred years both in Europe and around the rest of the world, there is a temptation to think that the financing and insuring on projects on limited or non-recourse terms is a relatively novel concept. This is, however, far from being true. Indeed, there is an early evidence of project financing techniques and insurance contracts being actively used during the ancient times. The first examples come from the Roman law but there are similar legal institutions even in the ancient Greek legal system. - The essay analyses the legal history of assurances on lives and health in the Roman law, especially the question of the collegium tenuiorum and the collegium funeraticium. In the centre of the studies are the analyses of their legal personality, the changes in the regulation concerning their foundation, the purpose and the internal organisation. The treatment of the main topics begins with fragments from the material of the Corpus Iuris Civilis by Justinian. After that the views of the most important authors and the contemporary investigations in the Roman law found the statements of the paper. As a result of these analyses we can see the process of development in the ancient legal systems, especially in the Roman law. And although these results have no immediate influence on the present legal regulation, it can demonstrate original tendencies in the field of insurances. This way we can prove that the Roman law is a still existing basis for the development in contractual law.

The significant growth of the online literature usage, and the conspicuously differing interest of publishers, procurers and users raise the question whether the electronic or the paper journals will be the primary information sources in the future. The price of the scientific literature has gotten out of control in the last two decades. At the same time websites showed up providing open access, and this may make all participants of the market to change their marketing policy. Instead of the extra-profit accumulation strategy, publishers should take individual users' interests into consideration. Although the technical conditions of value-added option-enriched online services to surpass the paper journals are given already, there is still a demand for the latter, due to ingrained user habits. At the same time, the electronic version is attracting the users with e-versions, three-dimensional images, video records, sound, hypertext, content and relation analysis, which are limited only by the imagination. According to the authors, the development of information media is unstoppable, and the main challenge in the future will be still to find the most effective way of processing information, make it available for professional research and preserve it for the scientific heritage.

Babesia microti and Anaplasma phagocytophilum was recently reported with a minimum prevalence of 0.9 and 1.3% in Hungary based on the PCR-sequencing analysis of 452 European sheep ticks (Ixodes ricinus). These results and the epidemiological data of the neighbouring countries indicate that human cases caused by these pathogens may occur in the country. The aim of the present paper is to summarise the current knowledge on the morphology, life cycle and distribution of B. microti and A. phagocytophilum, and the epidemiology, clinical features, diagnosis, treatment and control of babesiosis and granulocytic anaplasmosis.

Background: Meta-analyses evaluated several aspects of Helicobacter pylori eradication based on the randomised controlled trials., Aim: to perform a meta-analysis of the papers presented at the European Helicobacter Pylori Study Group and United European Gastroenterology Week meetings from 1997 to 2002., Methods: Abstracts dealing with the eradication of Helicobacter pylori have been reviewed and the randomised, controlled studies from European countries were included. The studies were classified into groups based on eradication schedules, antibiotics used and country of provenience. The pooled eradication rates were calculated and the differences were assessed by multiple variance analysis., Results: One-hundred and two studies were accepted comprising 25,644 cases and 398 treatment arms. The eradication rate of proton pump inhibitor-based first line triple therapies was 80.4% (confidence interval: 78.9-81.8); no difference was observed between the five proton pump inhibitors (p > 0.05). Ranitidine bismuth citrate based regimens were efficient in 79.9% (75.7-84.0) (p = 0.95 vs PPI). H2 blockers-based therapies achieved 68.6% (59.0-78.1) (p = 0.0007 vs proton pump inhibitor and p = 0.005 vs ranitidine bismuth citrate-based regimens). Proton pump inhibitor-based double combinations were efficient in 47.1 (31.9-62.4) (p = 0.001 vs triple regimens). Clarithromycin+amoxicillin/nitroimidazole combinations achieved rates of 79.6% and 84.1%, respectively, while amoxicillin-nitroimidazole regimens were less efficient (72.5%, 66.6-78.5) (p = 0.006). The pooled eradication rate of second-line triple regimens was 75.5% (69.9-86.4)(p = 0.08 vs primary treatment). Quadruple therapies were successful in 81.1% (76.6-85.6) of cases as first-line and 73.8% (61.2-86.4) as second-line regimens (p = 0.77 and p = 0.02 vs triple regimens). The pooled eradication rates varied from 58% to 92% in the European countries., Conclusions: The pooled eradication rate of the primary proton pump inhibitor/ranitidine bismuth citrate-based triple regimens are comparable with the results of meta-analyses. H2 blocker-based triple and proton pump inhibitor-based double regimens are of lower efficacy. Quadruple regimens were not better than triple therapies. The eradication rates per country varied, approaching 80% in most places. The results confirm in part post-hoc the validity of the Maastricht consensus recommendations.

Human alveolar echinococcosis, caused by the metacestode stage of Echinococcus multilocularis, is one of the most dangerous zoonoses in the temperate and arctic areas of northern hemisphere. The mortality of the disease exceeds 95% in untreated or inadequately treated patients. In the past three decades, the spread of this parasite was observed in Europe as a consequence of human interventions resulting in the population size increase of foxes. The authors demonstrated the presence of E. multilocularis in foxes in all northern counties of Hungary and the existence of hyperendemic regions in the Counties Nógrád and Gyor-Moson-Sopron. The aim of the present paper is to summarize the current knowledge on the life cycle and distribution of E. multilocularis, and the epidemiology, clinical features, diagnosis, treatment and control of human alveolar echinococcosis.

Hungary joined the Ovideo Treaty (a bioethical health agreement signed by EU countries in 1997), as declared by Law Nr. VI in 2002. In July 1 2002 two departmental orders were enacted: departmental order Nr. [23/2002 (V. 9.)] about the biomedical research in humans and departmental order Nr. [24/2002 (V. 9.)] about the human use and clinical trials of investigational products and the adaptation of Good Clinical Practice (GCP). Both were based on the Health Law. The departmental order on the Medical Research Council [(16/2001 (IV. 28.)] together with these two orders contains the national rules of biomedical research performed in Hungary and also the Hungarian adaptation of various, bioethical principles and directives published by EU or other internationally accepted organisations. According to these regulations from 2002 biomedical research in Hungary could be in agreement with the Oviedo Treaty. Ethical approval and supervision can be obtained from research ethical committees of three types: central, regional and local superimposed upon one another. There are three, central, ethical committees within the frames of the Medical Research Council with national responsibility: Scientific and Research Ethical Committee, Clinical Pharmacological Ethical Committee, Human Reproduction Committee. In some cases regional research ethical committees are entitled to hand out ethical approval and ethical supervision. In those research sites, where the regional research ethical committee is not existent a local committee should be organized for the local ethical control of the research investigations and experiments. This way the ethical requirements and clinical practice by the GCP can be performed in clinical research in Hungary with a special respect to the vulnerable persons possibly involved. The paper gives an overview on recent developments and major ethical principles of the Hungarian biomedical research.

The European Society of Cardiology, the European Atherosclerosis Society and the European Society of Hypertension published in 1994 a joint statement and recommendation on prevention of coronary heart disease in clinical practice. The EUROASPIRE study intended to investigate the present clinical practice in this respect in 9 European countries. The present paper deals with the Hungarian leg of the collaborative study. Hospital data of 546 patients below the age of 70 were reviewed of whom 29% were women. Consecutive patients were identified retrospectively with the following discharge-diagnoses: coronary bypass grafting, PTCA, acute myocardial infarction and angina pectoris. Minimum 6, in the average 18 month after the index event, patients were interviewed and examined. The participation rate was 77%. During the index hospitalisation an incomplete documentation of the main risk factors was found: blood pressure values were missing in 12%, lipid values in 48%, smoking status in 34%, body weight in 22% and family history in 46% of the cases, with wide variation between diagnostic categories. At follow-up 23% of the patients were obese (BMI > or = 30 kg/m2), 49% had elevated blood pressure (140/90 > or = Hgmm), 46% had total cholesterol above 5.5 mmol/l, 23% smoked and 27% were diabetic. 75% of the patients were on antiplatelet, 14% on anticoagulant, 58% on beta-blocking, 22% on lipid lowering, 32% on ACE-inhibitor and 44% on calcium channel blocking medication. The screening of first degree relatives was recommended in only 18% of the patients. The results speak for a substantial neglect of secondary prevention of coronary patients in the Hungarian clinical practice. However without complex detection, evaluation and management of risk factors it is impossible to reduce the recurrence and high mortality of coronary heart disease.