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We observed significantly reduced serum alpha 2-HS glycoprotein concentrations in patients with acute lymphocytic, acute nonlymphocytic, chronic granulocytic and chronic myelomonocytic leukemias, Hodgkin's and non-Hodgkin's lymphomas, myelofibrosis, and multiple myeloma, but not in patients with chronic lymphocytic leukemia and polycythemia vera, as compared with healthy controls. We followed the serum level of the protein for 18 months. Patients with infectious complications, those receiving cytostatic treatment, and those in the preterminal period had further reduced serum alpha 2-HS glycoprotein levels. The reduction of serum alpha 2-HS glycoprotein concentration was primarily due to decreased production caused by infiltration of the liver, a hepatotoxic effect of cytostatic treatment, and, to a lesser degree, to increased consumption. We found statistically significant negative correlations between serum alpha 2-HS glycoprotein concentration and erythrocyte sedimentation rate, serum aspartate aminotransferase and alkaline phosphatase activities, and IgG and IgM concentrations. The determination of the alpha 2-HS glycoprotein concentration is useful for the assessment and follow-up of the clinical status and therapy of patients with hematological malignancies and also has prognostic significance. [ABSTRACT FROM AUTHOR]

Abstract Background Lifestyle modifications including exercise are beneficial and fundamentally part of the therapy of metabolic syndrome, although in most of the cases medical interventions are also required to reach the target values in the laboratory parameters. Statin and fibrate combination therapy is considered to be safe and effective in dyslipidaemia and metabolic syndrome. However, increased physical activity can enhance the statin and fibrate-associated myopathy. Myositis and the rare but life-threatening rhabdomyolysis are causing a conflict between exercise and statin-fibrate therapy, which is yet to be resolved. Case presentation We present a case of a 43-year-old Caucasian man with metabolic syndrome who had the side-effect of exercise and drug-associated myositis. The patient had only transient moderate complaints and rhabdomyolysis could be avoided with the one-month creatine kinase control, a test which is not recommended routinely by the new guidelines. Conclusions We would like to turn the spotlight on the possible complications of statin-fibrate therapy and exercise, when strict follow-up is recommended. In this condition high number of patients can be affected and the responsibility of general practitioners is accentuated.

Abstract Background Serum concentration of fetuin A/α2HS-glycoprotein (AHSG) is a good indicator of liver cell function and 1-month mortality in patients with alcoholic liver cirrhosis and liver cancer. We intended to determine whether decreased serum AHSG levels are associated with long-term mortality and whether the follow-up of serum AHSG levels can add to the predictive value of the Child-Pugh (CP) and MELD scores. Methods We determined serum AHSG concentrations in 89 patients by radial immunodiffusion. Samples were taken at the time of enrolment and in the 1st, 3rd, 6th, and the 12th month thereafter. Results Forty-one patients died during the 1-year follow-up period, 37 of them had liver failure. Data of these patients were analysed further. Deceased patients had lower baseline AHSG levels than the 52 patients who survived (293 ± 77 vs. 490 ± 106 μg/ml, mean ± SD, p < 0.001). Of all laboratory parameters serum AHSG level, CP and MELD scores showed the greatest difference between deceased and survived patients. The cutoff AHSG level 365 μg/ml could differentiate between deceased and survived patients (AUC: 0.937 ± 0.025, p < 0.001, sensitivity: 0.865, specificity: 0.942) better than the MELD score of 20 (AUC: 0.739 ± 0.052, p < 0.001, sensitivity: 0.595, specificity: 0.729). Initial AHSG concentrations < 365 μg/ml were associated with high mortality rate (91.4%, relative risk: 9.874, 95% C.I.: 4.258–22.898, p < 0.001) compared to those with ≥ 365 μg/ml (9.3%). Fourteen out of these 37 fatalities occurred during the first month of observation. During months 1–12 low AHSG concentration proved to be a strong indicator of mortality (relative risk: 9.257, 95% C.I.: 3.945–21.724, p < 0.001). Multiple logistic regression analysis indicated that decrease of serum AHSG concentration was independent of all variables that differed between survived and deceased patients during univariate analysis. Multivariate analysis showed that correlation of low serum AHSG levels with mortality was stronger than that with CP and MELD scores. Patients with AHSG < 365 μg/ml had significantly shortened survival both in groups with MELD < 20 and MELD ≥ 20 (p < 0.0001 and p = 0.0014, respectively). Conclusion Serum AHSG concentration is a reliable and sensitive indicator of 1-year mortality in patients with alcoholic liver cirrhosis that compares well to the predictive value of CP score and may further improve that of MELD score.

The possible aromatic conjugation between 3D and 2D aromatic units is in the focus since the synthesis of benzocarborane. It has been showed that in the 3D aromatic icosahedral 1,2-dicarba-closo-dodecaborane systems fused with 2D aromatic rings a global 3D/2D aromaticity does not exist. Despite this fact during the last years several studies proposed interactions between 2D and 3D moieties. Herein, while tuning the size and the effective charge of the (car)borane systems, we demonstrate that global aromatic character can be excluded in any investigated cases, and the detectable conjugative properties can be explained the effect of the well-known negative hyperconjugation., (© 2024 The Author(s). Chemistry - A European Journal published by Wiley-VCH GmbH.)

Treating and caring for people with dementia is a complex task, which can be achieved through cooperation between primary and specialist healthcare, social care and specialist care services. General practitioners are key players in the prevention, screening, treatment and care of dementia. Our aim was to present the general practitioner's aspects of modern dementia care through different levels of prevention. Educating patients to lead a healthy lifestyle and optimising their cardiovascular status reduces the risk of developing dementia. Emphasis was placed on early screening and referral to a specialist, and the importance of timely, individualised therapy for modern care. General practitioner's care of patients with dementia includes monitoring the progression of the disease as well as co-morbidities so that the quality of life of both the patients and their family can be improved by reducing complications. Family doctors also have an important role to support family members who care for the patient. In addition to presenting the current possibilities in Hungary, we reviewed the international literature and national guidelines, which must be followed continuously to ensure quality patient care. Orv Hetil. 2023; 164(32): 1263-1270.

Introduction: Wilson's disease may lead to cirrhosis, but timely medical treatment could slow down its progression. Clinical markers helping early diagnosis are essential. Decreased fetuin-A concentration has been reported in cirrhosis of different etiologies. The aim of this study was to investigate whether decreased serum fetuin-A concentration could identify patients with Wilson's disease who developed cirrhosis., Materials and Methods: In this cross-sectional study we determined the serum fetuin-A concentration of 50 patients with Wilson's disease. We analyzed the data of patients with liver involvement, comparing cirrhotic and non-cirrhotic patients., Results: Among patients with liver involvement those with cirrhosis had significantly lower fetuin-A and albumin level, white blood cell and platelet count. Fetuin-A negatively correlated with disease duration, bilirubin level, positively with total protein and albumin concentration, but not with copper and ceruloplasmin concentrations or markers of systemic inflammation. In multivariate analysis with fetuin-A and the Nazer score or its parameters only fetuin-A was a significant determinant of having cirrhosis. In receiver operator curve analysis among patients with liver involvement the fetuin-A level of 523 μg/ml was associated with cirrhosis with 82% sensitivity and 87% specificity. The presence of the H1069Q mutation was not associated with alteration in fetuin-A concentration., Conclusions: The serum concentration of fetuin-A is a sensitive marker of liver cirrhosis in Wilson's disease, independently of the H1069Q mutation, ceruloplasmin concentration or systemic inflammation., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Vörös et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Helicobacter pylori is a common pathogen causing gastric inflammation and malignancy. Fetuin-A is a multifunctional protein that is involved in the regulation of calcification, insulin resistance and inflammation. Reports on serum levels of fetuin-A in acute H. pylori infection are contradictory. We intended to see whether H. pylori post-infection status has a long-term effect on serum fetuin-A levels in a well-characterized series of systemic lupus erythematosus cases. In this cross-sectional study 117 patients with systemic lupus erythematosus were enrolled. Helicobacter infection status and serum fetuin-A concentration were determined by ELISA and radial immunodiffusion, respectively. H. pylori positive patients had higher serum fetuin-A concentration than negative ones: 517 (456-603) vs. 476 (408-544) mg L-1, median (25-75% percentiles), P = 0.020. No other parameters differed between these groups. During univariate regression analysis fetuin-A levels were associated with Erythrocyte sedimentation rate (ESR), White blood cell count (WBC), C-reactive protein (CRP), serum total protein, albumin, and the SLEDAI index at the time of diagnosis but only serum albumin remained a significant determinant in multivariate regression study.

BACKGROUND Adverse reaction to histamine found in food and beverages is still a debated entity. It presents with a diverse, multisystemic clinical picture and lacks objective diagnostic criteria. CASE REPORT We report a case of severe adverse reaction to histamine in food and beverages. The 36-year-old White man had diet-dependent problems for 17 years that involved periodic erythematous rash, fever, headaches, nausea, and upper respiratory symptoms. The symptoms developed in the same chronologic order each time. The course of the disease could be divided into a first (prodromal, gastrointestinal), a second (acute, dermal), and a third (subacute, respiratory) phase. The symptoms occurred every 3-6 weeks and lasted for 10-14 days. The differential diagnosis was time-consuming and very detailed. Family history, genetic testing, and oral histamine provocation testing supported the diagnosis of an adverse reaction to histamine in food and beverages. A low-histamine diet resulted in a symptom-free state. Follow-up lasted longer than 24 months. CONCLUSIONS This presentation of an adverse reaction to histamine in food and beverages can serve as a textbook example where a chronological, syndrome-like order of symptom appearance is described. To the best of our knowledge, this is the first report of a severe adverse reaction to histamine in food and beverages, where symptoms are described in 3 distinct recurring phases.

Összefoglaló. Bevezetés: A SARS-CoV-2-fertőzés elhúzódó tüneteit 4 héten túl poszt-COVID-19-tüneteknek nevezzük, és fennállási idő szerint csoportosítjuk. Célkitűzés: A vizsgálat célja egy háziorvosi körzet megközelítőleg állandó populációjában megfigyelni, hogy adott időintervallumon belül a SARS-CoV-2-fertőzöttek között milyen arányban, milyen jellegű poszt-COVID-19-tünetek alakulnak ki, és mennyi ideig tartanak. Módszer: 282 SARS-CoV-2-beteg tüneteit 2020. szeptember 1. és 2021. szeptember 1. között követtük, 4 hetente, 15-42 héten át - elhúzódó szaglászavar esetén 30-50 héten át -, elsősorban telefonos interjúk segítségével. Eredmények: Egy hónapon túli panaszok a betegek 67%-ában (170 fő) alakultak ki. A leggyakoribb tünet a fáradékonyság (79 fő, 29%) és a szaglászavar volt (74 fő, 27%). Az utóbbi jellemzően nem dohányzók körében lépett fel, és a COVID-19-fertőzöttek 2,5%-ában 43 héten túl is fennmaradt. A fáradékonyság panaszköre a poszt-COVID-19-betegek 46%-át érintette. Ezen betegek szignifikánsan hosszabb időt töltöttek keresőképtelenségi állományban, mint azok, akik nem voltak fáradékonyak (12,3 vs. 19,7 nap). Az enyhe SARS-CoV-2-fertőzést követő súlyos fáradékonysággal küzdő betegek a panaszaikat szindrómaszerűen írták le, melyre jellemző volt a palpitáció, a fáradékonyság, a terhelésre jelentkező légszomj, az alvászavar, a laza széklet és a posturalis panaszok. Ezek átlagosan 19 hét alatt múltak el. Megbeszélés: A poszt-COVID-19-tünetek kialakulása enyhe lefolyás mellett is gyakori, a lefolyás súlyossága sok esetben nincs arányban a poszt-COVID-19-fáradékonyság súlyosságával. A posztakut-COVID-19-fáradékony betegek kórházi kezelést nem igénylő csoportja számos tényező alapján elkülöníthető a posztakut-COVID-19-fáradékony betegek hospitalizált csoportjától. Következtetés: Az enyhe COVID-19-fertőzést is követheti elhúzódó fáradékonyság poszt-COVID-19-tünetként, mely spontán regrediál. SARS-CoV-2-fertőzést követően hosszú távon fennmaradhat szaglászavar, illetve a középsúlyos és súlyos COVID-19-eseteket követően fáradékonyság. Orv Hetil. 2022; 163(9): 335-342., Introduction: Extended symptoms may develop after a SARS-CoV-2 infection. We refer to these as post-COVID-19 symptoms and they are grouped according to time duration., Objective: The aim of the study was to follow all COVID-19 infected patients in a family practise, to observe all post-COVID-19 symptoms, symptom development rates and to document how long they last., Method: 282 SARS-CoV-2 patients were followed mainly through telephone interviews between 01. 09. 2020 and 01. 09. 2021. Post-COVID-19 symptoms were monitored for 15-42 weeks every 4 weeks (30-50 weeks in cases of delayed hypsomia)., Results: Symptoms lasting longer than a month developed in 67% of all patients (170 cases). The most frequent symptoms were fatigue (79 cases, 29%) and hyposmia (74 cases, 27%). The latter mainly developed in non-smokers, affecting 2,5% of all COVID-19 patients beyond 43 weeks. Fatigue affected 46% of all post-COVID-19 patients. Sick leave was significantly longer among these patients (19.7 vs. 12.3 days in patients with no fatigue). Severe post-COVID-19 fatigue in non-hospitalized patients presented in a sydrome-like appearance displaying palpitations, fatigue, dyspnoea, sleep disturbances, loose stools and postural complaints. These regrediated after 19 weeks., Discussion: Post-COVID-19 symptoms often develop after a mild COVID-19 infection. Severity of COVID-19 infection and severity of post-COVID-19 symptoms often do not correlate. Groups of hospitalized and non-hospitalized post-acute COVID patients with fatigue can be distinguished by many attributes., Conclusion: Mild COVID-19 infections may also be followed up by severe fatigue, but it spontenaously regrediates. Long-term effects of COVID-19 are permanent hyposmia and fatigue (the latter affect some hospitalized COVID-19 patients). Orv Hetil. 2022; 163(9): 335-342.

Background: Responsibility of general practitioners (GPs) in delivering safe and effective care is always high but during the COVID-19 pandemic they face even growing pressure that might result in unbearable stress load (allostatic overload, AO) leading to disease., Objectives: We aimed to measure AO of Hungarian GPs during the COVID-19 pandemic and explore their recreational resources to identify potential protective factors against stress load., Methods: In a mixed-method design, Fava's clinimetric approach to AO was applied alongside the Psychosocial Index (PSI); Kellner's symptom questionnaire (SQ) to measure depression, anxiety, hostility and somatisation and the Public Health Surveillance Well-being Scale (PHS-WB) to determine mental, social, and physical well-being. Recreational resources were mapped. Besides Chi-square and Kruskal-Wallis tests, regression analysis was applied to identify explanatory variables of AO., Results: Data of 228 GPs (68% females) were analysed. Work-related changes caused the biggest challenges leading to AO in 60% of the sample. While female sex (OR: 1.99; CI: 1.06; 3.74, p  = 0.032) and other life stresses (OR: 1.4; CI: 1.2; 1.6, p  < 0.001) associated with increased odds of AO, each additional day with 30 min for recreation purposes associated with 20% decreased odds (OR: 0.838; CI: 0.72; 0.97, p  = 0.020). 3-4 days a week when time was ensured for recreation associated with elevated mental and physical well-being, while 5-7 days associated with lower depressive and anxiety symptoms, somatisation, and hostility., Conclusion: Under changing circumstances, resilience improvement through increasing time spent on recreation should be emphasised to prevent GPs from the adverse health consequences of stress load.

The leadership of the Semmelweis University as a leading institution of higher education in Hungary and the Central Eastern European region within the area of medicine and health sciences has decided to reflect on the unfavorable public health situation in the country as well as the deteriorating health behavior and health status indicators in the Hungarian population by the development of an occupational setting-based personalized public health model program targeting its about 8500 employees. Based on its infrastructure and human resources the core element of the program is the establishment of the Center of Preventive Services (CPS) with units providing health risk assessment for each employee, and whenever necessary consultation with medical specialist in preventive medicine and public health, as well as counseling with dietician, physiotherapist and/or health psychologist. The service providers are the staff members of the relevant faculties in collaboration with partner primary and occupational care physicians. The units of the CPS can also serve as practical training sites for students at various levels of medical and health sciences training, and strongly contribute to the development and improvement of their skills to be able for working as a team in service provision. The employees are not only beneficiaries of health risk assessment and screening repeated on a regular basis and adequate interventions at the right time, but they also serve as a sample for a longitudinal cohort study and further ad hoc surveys for defining and implementing interventions to support health protection, disease prevention and healthy aging among them., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor declared a past co-authorship with one of the authors RÁ., (Copyright © 2021 Ungvári, Ádány, Szabó, Dörnyei, Moizs, Purebl, Kalabay, Varga, Torzsa, Kellermayer and Merkely.)

Összefoglaló. A cukorbetegség és a depresszió kapcsolatáról számos tanulmány született. A szorongás és a diabetes közti összefüggést már kevesebben vizsgálták, pedig jelentős szerepük van a szorongásos kórképeknek is, hiszen nagyon gyakori a két betegség együttes előfordulása. A diabetes már önmagában is nagy betegségterhet jelent a betegek számára, a társuló pszichiátriai kórképek pedig tovább rontják a kezelés minőségét, ezért fontos a korai felismerésük és kezelésük. Jelen összefoglaló közleményünk célja a szorongásos kórképek és elsősorban a 2-es típusú cukorbetegség közti összefüggés feltárása. Több elmélet született a köztük lévő kapcsolat magyarázatára. Egyesek szerint szerepet játszhat benne a közös etiológiai háttér, mások szerint a cukorbetegség diagnózisa és a gondozásával kapcsolatos feladatok vezetnek szorongáshoz. Megint mások pedig ellentétes irányból vizsgálva a köztük lévő kapcsolatot, arra a megállapításra jutottak, hogy a szorongás különböző fiziológiai mechanizmusokon keresztül vezethet cukorbetegséghez. A szorongás és a diabetes közti kapcsolat irányától függetlenül javasolt a depresszió mellett a szorongásnak a szűrése és minél korábbi kezelése a cukorbetegek körében, így csökkennének a komorbiditásból származó szövődmények, a kezelési nehézségek, javulna a betegek életminősége és a terápiával való együttműködésük. Orv Hetil. 2021; 162(31): 1226-1232. Summary. The relationship between diabetes and depression has been evaluated in numerous studies. The association between diabetes and anxiety was less investigated, although the importance of anxiety disorders is underlined by its frequent co-occurrence with diabetes. Diabetes alone carries a significant disease burden for patients. Comorbidity with psychiatric disorders deteriorates the quality of care, therefore early treatment and diagnosis of these conditions are essential. The aim of the present review is to outline the relationship between anxiety and mainly type 2 diabetes. There are several theories to explain the relationship between them. Some researchers suggest that common etiological background may play a role in their co-occurrence, some believe that the diagnosis of diabetes and the burden of self-management lead to anxiety, while others - investigating the relationship from the opposite direction - suggest that anxiety leads to diabetes through physiological mechanisms. Independently of the direction of the relationship, screening for anxiety and timely treatment among diabetic patients may decrease the risk of complications, the difficulty in treatment arising from the co-occurrence of these two conditions and may improve patients' quality of life and adherence to therapy. Orv Hetil. 2021; 162(31): 1226-1232.

Background: Primary health care provision in terms of quality, equity, and costs are different by countries. The Quality and Costs of Primary Care (QUALICOPC) study evaluated these domains and parameters in 35 countries, using uniformized method with validated questionnaires filled out by family physicians/general practitioners (GPs).This paper aims to provide data of the Hungarian-arm of the QUALICOPC study and to give an overview about the recent Hungarian primary care (PC) system., Methods: The questionnaires were completed in 222 Hungarian GP practices, delivered by fieldworkers, in a geographically representative distribution. Descriptive analysis was performed on the data., Findings: Financing is based mostly on capitation, with additional compensatory elements and minor financial incentives. The gate-keeping function is weak. The communication between GPs and specialists is often insufficient. The number of available devices and equipment are appropriate. Single-handed practices are predominant. Appointment instead of queuing is a new option and is becoming more popular, mainly among better-educated and urban patients. GPs are involved in the management of almost all chronic condition of all generations. Despite the burden of administrative tasks, half of the GPs estimate their job as still interesting, burn-out symptoms were rarely found. Among the evaluated process indicators, access, continuity, comprehensiveness, and coordination were rated as satisfactory, together with equity among health outcome indicators. Financing is insufficient; therefore, many GPs are involved in additional income-generating activities. The old age of the GPs and the lack of the younger GPs generation contributes to a shortage in manpower. Cooperation and communication between different levels of health care provision should be improved, focusing better on community orientation and on preventive services. Financing needs continuous improvement and appropriate incentives should be implemented. There is a need for specific PC-oriented guidelines to define properly the tasks and competences of GPs.

Összefoglaló. Bevezetés: A családorvosok testi, lelki egészségi állapota hatással van a munkavégzésükre, a betegellátás minőségére, ezáltal a társadalom egészségmutatóira is. Az életmód pedig az egyik legjelentősebb, egészségi állapotot befolyásoló tényező. Célkitűzés: A vizsgálat célja a magyar háziorvosok egészségi állapotának és az azt befolyásoló életmódtényezőknek a felmérése. Módszer: Keresztmetszeti vizsgálat. Kvantitatív, papíralapú felmérés családorvosok körében (n = 569, életkor 54 ± 10 év, nők 42%). Eredmények: A háziorvosok 61%-a túlsúlyos vagy elhízott, 88%-ának a vércukorszintje ≤5,5 mmol/l. A résztvevők 50%-a legalább heti rendszerességgel végez testmozgást, 20%-uk egyáltalán nem. A háziorvosok 13%-a dohányzik jelenleg, 5%-a tekinthető nagyivónak. Enyhe fokú depressziós tünetegyüttes 19%-uknál, közepes fokú 6%-uknál, súlyos fokú 5%-uknál fordult elő. A súlyos fokú kiégés mindkét nemben, mindhárom dimenzióban 18–39% volt. Következtetés: A magyar háziorvosok általános egészségi állapota nem mondható jobbnak sem a hazai nem orvos populációénál, sem a külföldi orvoskollégákénál. A magyar háziorvosok dohányzási mutatói kedvezőbbek a lakossági adatoknál, míg az alkoholfogyasztás terén kedvezőtlenebb eredményeket kaptunk. Nemzetközi összehasonlításban, a káros szenvedélyek terén a hazai kollégák eredményei jónak tekinthetők. A depresszió és a kiégés gyakori előfordulása jelentős probléma a háziorvosok körében. Mentális egészségük monitorozása és gondozása a hatékony egészségügyi ellátórendszer kulcskérdése. Orv Hetil. 2021; 162(12): 449–457. Summary. Introduction: General practitioners’ somatic and mental health status have an impact on their work and the quality of care they provide and thus influence the health indicators of the society. Lifestyle is one of the most important influencing factors of health. Objective: The study aims to assess the health status of Hungarian general practitioners and the lifestyle factors influencing it. Method: Cross-sectional study. Quantitative, paper-based questionnaire among general practitioners (n = 569, age 54 ± 10 years, female 42%). Results: 61% of family physicians are overweight or obese, 88% of them have blood glucose level ≤5.5 mmol/l. 50% of the participants do exercise at least once a week, 20% do not take any exercise at all. 13% currently smoke, 7% are considered heavy drinkers. Mild, moderate and severe depression symptoms occurred in 19%, 6% and 5% of them, respectively. A severe level of burnout syndrome was reported in 18–39% in both sexes, in all three dimensions. Conclusion: The health status of Hungarian general practitioners is not better than that of the non-medical Hungarian population or than that of foreign colleagues. The smoking indicators of Hungarian doctors are more favorable than the Hungarian population data, while we obtained worse results in the field of alcohol consumption. In international comparison, the results of Hungarian colleagues in the field of smoking and alcohol consumption are good. The frequent occurrence of depression and burnout is a significant problem among family physicians. Monitoring and caring for their mental health is a key factor in the effective health care system. Orv Hetil. 2021; 162(12): 449–457.

Integrative medicine is a new approach in the 21st century healthcare system, which integrates conventional medicine and evidence-based, safe and efficient complementary therapies into a unified biomedicine. Medical doctors and complementary therapists work together in partnership with patients to help them recover and live a whole life. Equally important is the maintenance and enhancement of health and well-being in which therapists become role-models. In this article, the authors introduce a proposal for the concept and major elements of a two-year integrative medicine postgraduate training for specialist doctors in Hungary and summarize international progress in the field. Orv Hetil. 2020; 161(27): 1122-1130.

Background: Patients with high cardiovascular risk are usually cared for in primary care settings. Assessment of the effectiveness of long-time care was a subject of many European studies in the last two decades. This paper aims to present two Hungarian primary care cross sectional surveys and to compare their results to the primary care arms of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) III. and IV., Methods: Between 2010 and 2011, 679 patients with high cardiovascular risk were recruited in 20 Hungarian primary care practices and 628 patients were selected in 40 practices between 2015 and 2016. The actual national recommendations were used for classification, all based on European guidelines. Achievements of target levels for blood pressure, total-, LDL-and HDL-cholesterols, triglyceride, and HbA 1c (in diabetics) were recorded and analyzed. Further cardiovascular risk factors, such as smoking, BMI, waist-circumference were also evaluated., Results: There was a statistically significant improvement in the management of blood-pressure and plasma LDL-cholesterol levels among high risk patients, while there was no change in the plasma triglyceride values. The effectiveness of diabetes care deteriorated. In international relation, the management of blood pressure and plasma LDL-cholesterol values were better in Hungary when compared to the results of EUROASPIRE III-IV. studies, while the previous advantage in diabetes care disappeared. A higher proportion of diabetic patients was above the target values in Hungary than the means of the European surveys. There was a higher proportion of smokers in the Hungarian samples, while the proportion of obese and overweight patients was similar to the European sample., Conclusions: Primary care has a unique role in cardiovascular prevention. Although many of the patients are managed appropriately, there is a need to improve primary care services in Hungary, giving more competences to GPs in prescription and introducing structural changes in the healthcare system.

Background and Aims: Hereditary angioedema with C1-inhibitor deficiency (C1-INH-HAE) is characterized by localized, non-pitting, and transient swelling of submucosal or subcutaneous region. Human fetuin-A is a multifunctional glycoprotein that belongs to the proteinase inhibitor cystatin superfamily and has structural similarities to the high molecular weight kininogen. Fetuin-A is also known a negative acute phase reactant with anti-inflammatory characteristics. In this study we aimed to determine serum fetuin-A, C-reactive protein (CRP) and tumor necrosis factor alpha (TNFα) concentrations in patients with C1-INH-HAE during symptom-free period and during attacks and compare them to those of healthy controls. Further we analyzed possible relationship among these parameters as well as D-dimer levels which was known as marker of HAE attacks., Patients and Methods: Serum samples of 25 C1-INH-HAE patients (8 men, 17 women, age: 33.1 ± 6.9 years, mean ± SD) were compared to 25 healthy controls (15 men, 10 women, age: 32.5 ± 7.8 years). Serum fetuin-A and TNFα concentrations were determined by ELISA, CRP and D-dimer by turbidimetry., Results: Compared to healthy controls patients with C1-INH-HAE in the symptom-free period had significantly decreased serum fetuin-A 258 μg/ml (224-285) vs. 293 μg/ml (263-329), (median (25-75% percentiles, p = 0.035) and TNFα 2.53 ng/ml (1.70-2.83) vs. 3.47 ng/ml (2.92-4.18, p = 0.0008) concentrations. During HAE attacks fetuin-A levels increased from 258 (224-285) μg/ml to 287 (261-317) μg/ml (p = 0.021). TNFα and CRP levels did not change significantly. We found no significant correlation among fetuin-A CRP, TNFα and D-dimer levels in any of these three groups., Conclusions: Patients with C1-INH-HAE have decreased serum fetuin-A concentrations during the symptom-free period. Given the anti-inflammatory properties of fetuin-A, the increase of its levels may contribute to the counter-regulation of edema formation during C1-INH-HAE attacks.

Introduction: Shortages of vaccine supplies repeatedly occur, limiting our abilities to prevent influenza. Therefore, increasing production volume remains a priority. The presently licensed seasonal influenza vaccines contain 15 µg of viral hemagglutinin per strain in adult, and up to 60 µg in elderly patients. Decreasing the amount of viral parts while maintaining efficacy is one way of increasing production capacity., Methods: This was multicenter, stratified (18-60 years and >60 years of age), prospective, randomized, double-blind, active-controlled, parallel-arm, non-inferiority clinical trial, conducted in the European Union, involving 1206 patients. We used hemagglutination inhibition assay to assess the immunogenicity of a newly developed, whole virion, seasonal trivalent influenza vaccine, containing 6 µg hemagglutinin per strain (FluArt, Hungary) and to assess whether it is non-inferior to the presently licensed vaccine containing 15 µg hemagglutinin per strain. Safety and tolerability of both vaccines were assessed based on EMEA guidelines., Results: The reduced dose vaccine containing 6 µg of hemagglutinin per strain was safe and non-inferior to the currently licensed 15 µg vaccine, not only in adult, but also in elderly patients, according to the immunogenicity criteria by the FDA and EMEA (seroconversion, seroprotection and post/pre vaccination GMT ratios), and it fulfilled all applicable licensing requirements for both age groups., Conclusions: Based on the results, the reduced dose vaccine was licensed in the EU member state Hungary and safely administered in over 1.5 million cases so far. The amount of viral hemagglutinin needed can be reduced by using a whole virion vaccine with aluminum phosphate adjuvants., Registration: This study was registered by the European Clinical Trials Database, EudraCT, number: 2011-003314-16., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background Aims: Most patients with Helicobacter pylori infection are consulted for the first time by family physicians. We aimed to survey the adherence to the newest guidelines of the management of H. pylori infection in the primary and secondary care settings in Hungary., Methods: From a total of 793 physicians, 94 trainees in family medicine, 334 family physicians without and 195 with board certification in internal medicine, 87 internists, 78 family paediatricians were invited to take part in the study. Diagnostic and therapeutic attitudes towards H. pylori infection were compared by a voluntary and anonymous questionnaire., Results: Participants test for H. pylori infection in 92.8% of cases with a family history of peptic ulcer or 76.9% of gastric cancer, 68.9% of dyspepsia and 49.9% of non-specific abdominal complaints, before initiation of non-steroidal anti-inflammatory drug (NSAID; 17.3%) and antiplatelet treatment (14.5%), respectively. They confirm the success of eradication therapy in 88.1% mainly by urea breath test. Most of them initiate eradication therapy by themselves and only 22.4% refer their patients to a gastroenterologist. Clarithromycin-based standard triple therapy is the most preferred (62.1%) and only 3.7% choose quadruple combination with bismuth as first-line and 48.1% as second-line therapy. We found significant differences between groups with respect to the physicians' own infection, localization of practice, and sources of information on H. pylori infection. Internists are more likely to clarify H. pylori status before the initiation of NSAID and antiplatelet therapies, initiate second-line therapies and use bismuth compared to the other groups. Family physicians with board certification in internal medicine are also prone to start eradication therapy and less prone to refer patients to a gastroenterologist. Family paediatricians prefer stool antigen determination, screen family members and prefer gastroenterologist consultation more often, and use bismuth less frequently than the other groups. Family physicians with previous infection check for H. pyloriinfection more frequently before the initiation of NSAID treatment and are more likely to use histology to detect H. pylori. Postgraduate trainings were the most popular source of information., Conclusion: The adherence to the recent recommendations of current guidelines is moderate. There is a need to increase adherence to current recommendations by family physicians and internists., (© 2019 S. Karger AG, Basel.)