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A palliatív ellátásban a hyponatraemia előfordulása rendkívül gyakori, melyre hirtelen jelentkező állapotromlás esetén gondolnunk kell. Az ionzavarral kapcsolatos diagnosztikus és kezelési lépéseket a beteg tünetei és életkilátása határozzák meg. A nem megfelelő indikációval végzett diagnosztika és kezelés a betegnek felesleges terhelést, a megfelelően végzett korrekció jelentős állapotjavulást eredményezhet. A palliatív ellátásban az akut hyponatraemia nagyon ritka. Leggyakrabban tünetmentes vagy enyhe tünetekkel járó krónikus hyponatraemiával találkozunk. A tünetmentes betegek ionzavara kezelést nem igényel. Enyhe tünetek esetén a legalább hónapokban mérhető várható túlélésű betegeknél a kiváltó ok korrekciója jön szóba. Középsúlyos-súlyos tünetek esetén a legalább hetekben mérhető várható életkilátású beteg ionzavarát az életminőség javítása céljából kezeljük. A néhány napos prognózisú, agonizáló betegek ionzavara kezelést nem igényel. A korai palliatív kezelésben részesülő, krónikus, súlyos fokú, középsúlyos tüneteket okozó hyponatraemiával észlelt nőbeteg esetbemutatása kapcsán javaslatot fogalmaztunk meg a leggyakrabban előforduló ionzavar korrekciójára a mindennapi palliatív ellátásban. Orv Hetil. 2023; 164(18): 713–717.

Bevezetés: A diabetes mellitus előfordulási gyakorisága világszerte növekedést mutat, Magyarországon 2014. évi adatok szerint a kórkép a lakosság 7,3%-át érinti. Az újonnan felfedezett daganatos betegek között a diabetes mellitus 8–18%-ban, egyes közlések szerint 30%-ban van jelen. A palliatív ellátásban részesülő betegek esetén a diabetes mellitus kezelési céljai, a kezelés és a vércukor-ellenőrzés módszerei jelentősen különböznek a kuratív ellátásban részesülő cukorbetegeknél megszokottaktól, aminek megértetése, elfogadtatása a beteggel, a családtagokkal és a beteget kezelő személyzettel elsődleges feladat. Célkitűzés: A közlemény célja, hogy megfogalmazza a palliatív ellátásban részesülő, cukorbetegséggel is kezeltek anyagcserezavarának a mindennapi orvoslásban használható ellenőrzési és kezelési módszerét. Módszer: A nemzetközi szakirodalomban fellelhető tanulmányok alapján a hazai gyakorlatban is alkalmazható javaslat került megfogalmazásra. Javaslatok: Az ajánlás egyéni, liberálisabb ellenőrzési és kezelési módszerek ismertetésével javíthatja e speciális betegcsoport életminőségét. Következtetés: A hazai palliatív ellátásban a cukorbetegek kezelésére alkalmazható javaslat megfogalmazása segíti a mindennapos minőségi betegellátást. Orv Hetil. 2022; 163(31): 1231–1236.

A diabetes mellitus előfordulási gyakorisága csaknem minden populációban növekszik. Az 1-es vagy 2-es típusú cukorbetegségben szenvedő páciensek akár 50–70%-ánál is észlelhető valamilyen gyomor-bélrendszeri rendellenesség, amely diagnosztikus és terápiás kihívást jelent. A szerzők összefoglaló közleményükben a cukorbetegség legfőbb emésztőrendszeri szövődményeit ismertetik, az előfordulás és a klinikum mellett kitérve a terápiás lehetőségekre. Összefoglalják a cukorbetegség kezelésére használt szerek leggyakoribb gyomor-bélrendszeri mellékhatásait, valamint ismertetik diabetológiai centrumukban a cukorbetegek endoszkópos vizsgálati előkészítésére bevált gyakorlatot.

Planting shelterbelts on agricultural fields has long traditions in Hungary. The biodiversityenhancing effect of this type of agroforestry is intensively researched, but most of the results concentrate on tree species diversity and specific animal communities such as insects and birds. The characteristics of herbaceous vegetation and soil mesofauna related to shelterbelts are understudied; however, both communities play key roles in agricultural productivity. This study aimed to explore the diversity and species composition of these groups in shelterbelts and adjacent grassy and cropped habitats. Samples were taken inside and adjacent to a native and a non-native shelterbelt in an agricultural landscape. The results highlight that shelterbelt edges are at least as important as tree stands in preserving soil-related diversity. Native tree species composition shows slightly more favorable conditions concerning the examined communities. While the positive impact of shelterbelts on the agricultural productivity and the diversity of several animal communities has been proven, the appearance of forest-related herbaceous species in tree stands planted on cultivated fields is not expected, even after decades have passed. The research was supported by the Blue Planet Climate Protection Foundation.

Absztrakt: Bevezetés és célkitűzés: Az előrehaladott, áttétes daganatos betegek megfelelő tüneti és életvégi ellátása, illetve ennek elérése komoly kihívás minden egészségügyi ellátó számára. A palliatív onkoteamrendszer kialakításával célunk a betegek időbeni palliatív ellátásba vonása és a konzekvencia nélküli sürgősségi kivizsgálások és ellátások számának lehetőség szerinti csökkentése volt. Módszer és eredmények: A palliatív onkoteam megbeszéléseit kéthetente tartottuk meg; a team állandó tagjai palliatív szakorvos, onkológus, belgyógyász, pszichiáter, szakápoló, pszichológus voltak, de időszakosan más szakemberek is csatlakoztak. 2019 májusa és 2020 januárja között 93, előrehaladott stádiumú daganatos betegnél 97 eseti megbeszélést tartottunk, egy-egy ülésen 6–10 beteg esetét tárgyaltuk végig. Minden esetben meghatároztuk a beteg további palliatív ellátásának formáját (szakrendelésen jelentkezés, otthoni szakellátás, intézeti elhelyezés) és azt, hogy adott esetben még szóba jön-e további aktív onkológiai ellátás. A megbeszélésre került betegek esetében pár hónap eltelte után a felesleges sürgősségi megjelenések számában egyértelmű csökkenés mutatkozott. Következtetés: A kezdeti, sokszor heves érzelmekkel is kísért megbeszélések rövid időn belül komoly operatív szakmai fórummá váltak. Úgy gondoljuk, hogy ez a rendszer is komolyan hozzájárulhat ahhoz, hogy az előrehaladott daganatos betegek időben palliatív szakellátáshoz jussanak, és ahhoz is, hogy a gyógyító onkológiai attitűd fokozatosan segítő orvosi hozzáállássá tudjon válni. Orv Hetil. 2020; 161(34): 1423–1430.

Intensive agricultural technologies lead to a simplification of landscape and a decrease in biodiversity. Besides economic benefits, alley cropping might increase species richness, improving pollination in agriculture. In this research, a traditional apricot plantation combined with crop fields was studied in Burgenland, focused on herbaceous diversity and species composition, which have a crucial role in promoting pollination. The vegetation of the grassy strips under the tree rows was compared to control grass and tree plantation habitats. The results show that the loose canopy layer of the fruit trees promotes the appearance of several herbaceous species, which results in a more diverse understory layer compared to the control tree plantation. However, the intensity of the management significantly impacts the species richness and composition of the understory vegetation., Az intenzív mezőgazdasági technológiák a táj és a biodiverzitás elszegényedéséhez vezetnek. Gazdasági előnyei mellett a köztes termesztés növelheti a fajgazdagságot, elősegítve a beporzást a mezőgazdaságban. Kutatásunkban megvizsgáltuk egy tradicionális, mezőgazdasági parcellákkal kombinált sárgabarack ültetvény lágyszárú diverzitását és fajösszetételét, amely kulcsfontosságú a beporzók számára. A fasorok alatti gyepes sávok növényzetét kontroll gyep és faültetvény vegetációjával is összevetettük. Az eredmények azt mutatják, hogy a fasorok laza lombkoronája lehetővé teszi számos lágyszárú faj megjelenését, ami a kontroll faültetvényhez képest diverzebb aljnövényzetet eredményez. Az alkalmazott kezelések intenzitása azonban erősen befolyásolja a lágyszárú szint fajgazdagságát és fajösszetételét.

Establishing shelterbelts for field protection is one of the rediscovered agroforestry practices in Europe and Hungary. Several studies have focused on the effects of these plantations on agricultural production. Prior scholarship reveals that shelterbelts enhance the diversity of bird and insect communities but generally fail to consider herbaceous cover. Our study aimed to describe the herbaceous vegetation in shelterbelts of different origins, tree species composition, and land management. We investigated surveys in four agricultural landscapes of North West Hungary, where the intensity of the landscape transformation is different. The diversity and species composition of the herbaceous vegetation were analyzed, including plant sociology and forest affinity. Our results highlight the importance of landscape history in herbaceous flora. Shelterbelts planted on cultivated without an immediate connection to former woody vegetation soil are not appropriate for the appearance of forest-related herbaceous species, regardless of tree species composition or the extent of the shelterbelt. On the contrary, the remnants of former woody vegetation are refuges for those herbaceous species that are very slow at colonizing new plantations. These findings expose that protecting existing woody areas is an essential task of agricultural land management.

Increasing incidence of type 1 diabetes is supposed to be induced by environmental factors. Microbiome modulated by antibiotics seems to serve as one of the environmental factors which could influence the development of T1DM. Mitochondria, as autochthonous environmental bacteria living in our cells, and other bacteria share many common enzymes including beta-lactamases and it is supported by evidence that some beta-lactamase inhibitors are able to interact with counterpart enzymes. Thus, antibiotics may utilize two different pathways influencing the development of T1DM; one through modulation of microbiome and a second one via the interaction of mitochondrial enzymes. Data of consumption of penicillin (both narrow and broad spectrum) and beta-lactamase inhibitors in 30 European countries were collected from the database of the European Centre for Disease Prevention and Control. These data were correlated with the prevalence reported by the International Diabetes Federation (2019) referring to type 1 diabetes in Europe. No correlation was found between total penicillin consumption or use of broad spectrum penicillin and the prevalence of type 1 diabetes. Nevertheless, broad spectrum penicillin, in combination with beta-lactamase inhibitor, was in inverse correlation with the prevalence of type 1 diabetes (r = − 0.573, p = 0.001). On the other hand, narrow spectrum penicillin was in positive correlation with type 1 diabetes (r = 0.523, p = 0.003). Prevalence of type 1 diabetes showed an inverse correlation with the use of beta-lactamase inhibitors and a positive one with that of narrow spectrum penicillin. Such a detailed analysis has not so far been provided referring to the penicillin group. In the background of this association either microbiomal or direct mitochondrial effects can be supposed.

A special form of alley cropping system is the intercropping of forest, which is traditional and still used nowadays worldwide in afforestation. In Hungary this practice is used mostly on the non-protected areas of the Great Hungarian Plain. The aim of this study was to examine the extent to which intercropping modifies the development of seedlings compared to the current practice of reforestation. Measurements and observations have been proceeded in two trial sites: Hajduhadhaz and Kapuvar, and in both cases, control areas were also designated, close to the trial site, with similar parameters. The experimental areas have different ecological features, but in both cases intermediate cultivation has been applied. The Hajduhadhaz experimental area was established in 2015 and measurements were carried out until 2017, while in Kapuvar, the experiment started in 2019. At both sites, soil temperature, conductivity and growth parameter measurements were performed. The two examined areas are different regarding to tree species and plantation structure, but the main purposes of both forestry companies were to maximize the utilization of available space, protect seedlings and ensure the success of afforestation. The research results so far show that soil microclimate is more favourable in the intercropping system, which contributes to the better development of seedlings. By using maize as an intercrop in the alleys, fodder production for animal stock and game management was also feasible. Further investigations on yield and microclimate are planned in the area of Kapuvar Forest Office in the next three years.

The aim of the present research is to investigate the effect of a young alley cropping system (planted for experimental purposes) on the soil microclimate, compared with a control site. The trial system, involving the agroforestry plantation and a control site, has been implemented in 2013 in an intensive monoculture agricultural environment. Measurement of soil microclimatic parameters started in 2014. Based on the results of the examination carried out in an agroforestry and a monoculture production site, there is a clear difference between soil moisture and soil temperature of the two cultivation systems. This effect can be observed even from the second year of the fast growing tree (Paulownia) plantation.

Palliative, symptomatic and end-of-life care of advanced and metastatic cancer patients is a great challenge for every health care system. With the initiation and establishment of the multidisciplinary palliative tumor board (MPTB), our aims were the timely referral of patients to palliative care, and the avoidance of multiple unnecessary emergency visits and over-diagnostics without further treatment consequences.The MPTB meetings were held biweekly. The core members of the team were: palliative care consultant, medical oncologist, internal medicine physician, psychologist, psychiatrist, and oncology and palliative medicine nurses. From May 2019 till January 2020, we discussed the medical history of 97 cases of 93 cancer patients with advanced disease states; in one meeting the team usually discussed over 6-10 complex patient histories. In every case we determined the actual form of the necessary palliative care, e.g., outpatient clinic, home care, or institutional referral, and we decided on further possible and realistic oncology treatment regimes. A few months after the introduction of the new MPTB, we detected a decrease of the unnecessary emergency unit referrals considering the patients whose histories were discussed.Although the initial MPTB discussions had an intense emotional tone, they shortly became thoughtful and operational expert meetings. We believe that the MPTB system fully promotes the early and timely access of advanced cancer patients to appropriate palliative care and facilitates gradual changes in the medical oncologists' approach from the absolute curative determination to a supportive medical attitude. Orv Hetil. 2020; 161(34): 1423-1430.

BACKGROUND Laboratory markers are essential tools in the follow-up of patients with Crohn's disease (CD). Our aim was to investigate urinary concentrations of orosomucoid in relation to the inflammatory activity of CD and to compare it with clinical indices and conventional laboratory parameters. MATERIALS AND METHODS Blood and urine samples of 86 patients (55 adults and 31 children) with CD and 68 healthy individuals (38 adults and 30 children) as controls were analysed. Patients were categorized according to their clinical scores (Harvey-Bradshaw Index [HBI] or Pediatric Crohn's Disease Activity Index [PCDAI]). Urinary orosomucoid (u-ORM) was determined by automated immune turbidimetric assay, and values were referred to urinary creatinine (u-ORM/u-CREAT, mg/mmol). RESULTS U-ORM/u-CREAT values were seven times higher in children with active CD (0.50 vs 0.07 mg/mmol, P

A szerzők egy 75 éves nőbeteg esetét ismertetik, akinek jelentős felső gastrointestinalis vérvesztése hátterében egy nagyméretű hyperplasticus polypust, valamint egy kisebb inflammatoricus fibroid polypust találtak, melyeket endoszkópos úton sikeresen eltávolítottak. Az eset kapcsán irodalmi adatok felhasználásával összefoglalják a gyomor polipjainak endoszkópos képét, szövettani jellemzőiket, etiológiájukat, a Helicobacter pylorival való kapcsolatukat, malignizálódási hajlamukat, valamint kezelésüket.

IgA-nephropathy is the most common primary chronic glomerulonephritis worldwide. Beside the primary IgA-nephropathy (IgA-nephropathy with an unknown origin), there are more and more cases, which are associated with diseases of other organs. Although the causality is often not obvious, these forms are called secondary IgA-nephropathy. In this study, the authors cover only the secondary forms of IgA-nephropathy with relation to gastroenterology in a broader sense that includes the liver. They would like to draw the attention to the necessity of analyzing also the associate occurrence of gastrointestinal diseases (principally liver diseases, coeliac disease, Crohn's disease, ulcerative colitis) in patients with IgA-nephropathy, as well. They think that it would be expedient to organize a nationwide clinical analysis that would search the frequency of occurrence of IgA-nephropathy in the above mentioned gastrointestinal diseases.

Measurement of the immunoreactive urinary albumin (ir-uAlb) concentration by immunological methods was found to be an effective method to identify disease activity in Crohn's disease (CD). Recently a size-exclusion (SE) high performance liquid chromatography (HPLC) method was developed to measure both ir-uAlb and non-immunoreactive urinary albumin (total, t-uAlb). We aimed to follow-up one of our CD patients with frequent remissions and exacerbation phases comparing the changes of disease activity parameters and the concentration of ir-uAlb and t-uAlb. The surprising results led us to perform measurements in greater depth.Concentration of ir-uAlb was measured by immunoturbidimetry (IT) and t-uAlb by SE-HPLC. Albumin peak of SE-HPLC was collected and applied to a reversed-phase (RP) HPLC and to gel-electrophoresis. Eluted peaks of RP-HPLC and identified bands of gel-electrophoresis were analyzed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF/MS).The concentration of t-uAlb was 15 times higher than that of the ir-uAlb during active state. The RP-HPLC and the gel-electrophoresis separation proved that albumin peak by size-exclusion consists of three different peaks. MALDI-TOF/MS measurements identified α1-acid-glycoprotein and Zn-α2-glycoprotein as major, and albumin as minor protein.Peak of albumin of SE-HPLC contains a significant amount of glycoprotein during the active phase of CD, which could not be detected in remission. Urinary α1-acid-glycoprotein and/or Zn-α2-glycoprotein could be an ideal disease activity biomarker of CD.

Urinary albumin is now measured by high-performance liquid chromatography (HPLC) which also detects albumin missed by traditional immunochemical methods. A predictive effect of HPLC-detected albuminuria on mortality has just been reported in the AusDiab study, measuring albuminuria with HPLC after 7 years of -80 degrees C storage. However, there are already some data suggesting that HPLC-detected albuminuria is affected by -80 degrees C storage. We aimed to measure changes in HPLC-detected albuminuria after 2.5 years and find the factors which may be responsible for this alteration.Urinary albumin was measured by the US Food and Drug Administration approved HPLC Accumin kit. Total free sulfhydryl groups (TFSG) of urine samples were measured by Ellman's reagent.We found a significant 24% average decrease in HPLC-detected albuminuria and a correlation between the magnitude of decrease and urinary pH. We found a correlation between changes of urinary albumin dimeric to monomeric ratio of stored urine and pH; however, only changes of monomeric form were found to be significant. A correlation was also found between the TFSG of fresh urine samples and pH. Less TFSG could be detected, and a correlation between TFSG and pH was absent in stored urine.We conclude that measurement of albuminuria by HPLC in long-term -80 degrees stored urine gives unreliable results. Decrease of HPLC-detected albuminuria is pH-dependent and may be due to the reducing capacity of urine. Prospective studies need to decide whether the predictive properties of HPLC-detected albuminuria decrease during longterm storage.

Background/Aims: Proteinuria, hypoproteinaemia, hypoalbuminaemia and oedema are major characteristics of nephrotic syndrome. Aims of this study were to detect serum total LDH activity and its isozymes in nephrotic syndrome. Methods: In a cross-sectional study, clinical parameters were compared in three cohorts, namely kidney patients with or without nephrotic syndrome and hypoalbuminaemic controls (NEPHR, NON-NEPHR, CONTR, respectively). Results: Serum total LDH activity in the NEPHR group was increased compared with the NON-NEPHR and CONTR groups (p < 0.001) and correlated with serum total protein (r = –0.549, p < 0.001), serum albumin (r = –0.596, p < 0.001), proteinuria (r = 0.456, p < 0.001) and serum total cholesterol (r = 0.523, p < 0.001). LDH isozyme pattern was analysed in three subgroups of the patients. Serum LDH-2 activity was higher in the NEPHR subgroup compared with the NON-NEPHR and CONTR subgroups (p < 0.001). Serum LDH-2 activity correlated with serum total protein (r = –0.665, p < 0.001), serum albumin (r = –0.615, p < 0.001), proteinuria (r = 0.694, p < 0.001), and serum total cholesterol (r = 0.723, p < 0.001). Linear regression analysis revealed that serum total protein proved to be an independent predictor of serum total LDH activity, while serum total protein and proteinuria were predictors of LDH-2. Conclusions: These findings suggest that serum total LDH activity might be a marker of the activity of the nephrotic syndrome.

Hiccups are intermittent, involuntary spasmodic contractions of the diaphragm and the intercostal muscles leading to the cessation of inspiration due to an abrupt closure of the glottis. Hiccups are usually innocuous phenomena, which could easily be terminated by simple manoeuvres but sometimes they become permanent and intractable causing significant decline in the patient's quality of life. Besides a number of provoking exogenous factors hiccups are caused by organic or psychical disorders. This why in cases of permanent hiccups detailed investigations are important. Beyond physical manoeuvres, pharmacotherapy, surgical intervention and some other therapeutic measures may be effective forms of treatment. In the present report the authors give a review of two patients, whose permanent hiccups were successfully treated with combined medical therapy. They review the causes and therapy of permanent hiccups and call the attention to the therapeutic value of baclofen, a gamma-aminobutyric acid analog compound.

A 57-year-old female patient presented with a long history of overlapping autoimmune disease, including limited cutaneous systemic sclerosis, Sjogren's syndrome and primary biliary cirrhosis. Another unusual finding was that the mild skin involvement (limited cutaneous systemic sclerosis, subcutaneous calcinosis) was combined with serious internal organ involvement, including honeycombing and finally scleroderma renal crisis. The most important finding was, that two decades later she developed severe telangiectasia of the gastrointestinal and urinary tract. Furthermore, a specific type of vascular malformation, i.e. gastric watermelon stomach was also found. The chronic gastrointestinal bleeding primarily derived from a watermelon stomach caused protein overload, which provoked the onset of the scleroderma renal crisis that finally led to the patient's death.