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The presence of prolonged symptoms after COVID infection worsens the workability and quality of life. 200 adults with long COVID syndrome were enrolled after medical, physical, and mental screening, and were divided into two groups based on their performance. The intervention group (n = 100) received supervised rehabilitation at Department of Pulmonology, Semmelweis University with the registration number 160/2021 between 01/APR/2021-31/DEC/2022, while an age-matched control group (n = 100) received a single check-up. To evaluate the long-term effects of the rehabilitation, the intervention group was involved in a 2- and 3-month follow-up, carrying out cardiopulmonary exercise test. Our study contributes understanding long COVID rehabilitation, emphasizing the potential benefits of structured cardiopulmonary rehabilitation in enhancing patient outcomes and well-being. Significant difference was found between intervention group and control group at baseline visit in pulmonary parameters, as forced vital capacity, forced expiratory volume, forced expiratory volume, transfer factor for carbon monoxide, transfer coefficient for carbon monoxide, and oxygen saturation (all p < 0.05). Our follow-up study proved that a 2-week long, patient-centered pulmonary rehabilitation program has a positive long-term effect on people with symptomatic long COVID syndrome. Our data showed significant improvement between two and three months in maximal oxygen consumption (p < 0.05). Multidisciplinary, individualized approach may be a key element of a successful cardiopulmonary rehabilitation in long COVID conditions, which improves workload, quality of life, respiratory function, and status of patients with long COVID syndrome., (© 2024. The Author(s).)

Objectives: The aim of this study was to analyze the modeling methodologies of fiscal policies on food with health or environmental outcomes., Background: Evidence suggests that fiscal policies on food can contribute to addressing the growing burden of noncommunicable diseases and climate change. These policies should be modeled in advance to see the implications for the environment and health., Methods: A systematic review was conducted of studies that modeled fiscal policies on the food groups targeted by the EAT-Lancet Commission and examined their health or environmental outcomes. The Scopus and PubMed databases were searched on November 30, 2021. The records were double-screened and data on modeling methods were extracted from the included studies., Results: A total of 55 studies were included in the review. The most frequently modeled interventions were fruit and vegetable subsidies (n = 19) and carbon taxes on food (n = 17). One study also included a consumer education campaign to enhance the effect of fiscal policy. The outcomes are highly sensitive to consumption change and price elasticities. None of the studies modeled the health effects of environmental outcomes., Conclusions: A model that covered all the relevant aspects of the issue was not found. Some parts were missing from all the included models. It is advisable to model the stability of the amount of diet consumed, either by keeping the amount of food in the diet stable or by taking a more conservative approach and keeping the consumed calories stable. It is preferable to keep the included diseases and environmental boundaries broad to have more valid outcome estimates on this complex issue. A more comprehensive understanding of fiscal policies would allow us to better anticipate the impact of our actions and inactions and thus could lead to more sophisticated measures taken by policymakers., Systematic Review Registration: PROSPERO registration no. 2022 CRD42022291945/., (© The Author(s) 2024. Published by Oxford University Press on behalf of the International Life Sciences Institute.)

Introduction: Mild cognitive impairment (MCI) is a prodromal stage of dementia. Understanding the mechanistic changes from healthy aging to MCI is critical for comprehending disease progression and enabling preventative intervention., Methods: Patients with MCI and age-matched controls (CN) were administered cognitive tasks during functional near-infrared spectroscopy (fNIRS) recording, and changes in plasma levels of extracellular vesicles (EVs) were assessed using small-particle flow cytometry., Results: Neurovascular coupling (NVC) and functional connectivity (FC) were decreased in MCI compared to CN, prominently in the left-dorsolateral prefrontal cortex (LDLPFC). We observed an increased ratio of cerebrovascular endothelial EVs (CEEVs) to total endothelial EVs in patients with MCI compared to CN, correlating with structural MRI small vessel ischemic damage in MCI. LDLPFC NVC, CEEV ratio, and LDLPFC FC had the highest feature importance in the random Forest group classification., Discussion: NVC, CEEVs, and FC predict MCI diagnosis, indicating their potential as markers for MCI cerebrovascular pathology., Highlights: Neurovascular coupling (NVC) is impaired in mild cognitive impairment (MCI). Functional connectivity (FC) compensation mechanism is lost in MCI. Cerebrovascular endothelial extracellular vesicles (CEEVs) are increased in MCI. CEEV load strongly associates with cerebral small vessel ischemic lesions in MCI. NVC, CEEVs, and FC predict MCI diagnosis over demographic and comorbidity factors., (© 2024 The Author(s). Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Significant regional variability in lifespan in Europe is influenced by environmental factors and lifestyle behaviors, including diet. This study investigates the impact of geographical region on the lifespan of European rulers spanning from the fourteenth century to the present day. By analyzing historical records and literature, we aim to identify region-specific dietary patterns and lifestyle factors that may have contributed to longer lifespans among rulers. The hypothesis to be tested is that rulers from Southern European countries, where the traditional Mediterranean diet is consumed by the local people, may exhibit longer lifespans compared to rulers from other regions, due to the well-documented health benefits associated with this dietary pattern. We extracted comprehensive information for each ruler, encompassing their sex, birth and death dates, age, age of enthronement, duration of rulership, country, and cause of death (natural vs. non-natural). To determine their nationality, we coded rulers based on their hypothetical present-day residence (2023). Utilizing the EuroVoc Geographical classification, we categorized the countries into four regions: Northern, Western, Southern, Central and Eastern Europe. While Cox regression models did not find significant differences in survival rates among regions, further analysis stratified by time periods revealed intriguing trends. Contrary to our initial predictions, the Northern region displayed better survival rates compared to the Southern region between 1354 and 1499, whereas survival rates were similar across regions from 1500 to 1749. However, after 1750, all regions, except the Southern region, exhibited significantly improved survival rates, suggesting advancements in healthcare and lifestyle factors. These findings underscore the dynamic influence of both region and time period on health and longevity. Interestingly, despite the prevalence of the Mediterranean diet in the Southern region of Europe, rulers from this region did not demonstrate longer lifespans compared to their counterparts in other regions. This suggests that additional lifestyle factors may have played a more prominent role in their longevity. In conclusion, our study sheds light on the intricate relationship between region, time period, and lifespan among European rulers. Although the Mediterranean diet is often associated with health benefits, our findings indicate that it alone may not account for differences in ruler longevity across regions. Further research is warranted to explore the impact of other lifestyle factors on the health and lifespan of European rulers throughout history., (© 2023. The Author(s).)

Components that comprise our brain parenchymal and cerebrovascular structures provide a homeostatic environment for proper neuronal function to ensure normal cognition. Cerebral insults (e.g. ischaemia, microbleeds and infection) alter cellular structures and physiologic processes within the neurovascular unit and contribute to cognitive dysfunction. COVID-19 has posed significant complications during acute and convalescent stages in multiple organ systems, including the brain. Cognitive impairment is a prevalent complication in COVID-19 patients, irrespective of severity of acute SARS-CoV-2 infection. Moreover, overwhelming evidence from in vitro, preclinical and clinical studies has reported SARS-CoV-2-induced pathologies in components of the neurovascular unit that are associated with cognitive impairment. Neurovascular unit disruption alters the neurovascular coupling response, a critical mechanism that regulates cerebromicrovascular blood flow to meet the energetic demands of locally active neurons. Normal cognitive processing is achieved through the neurovascular coupling response and involves the coordinated action of brain parenchymal cells (i.e. neurons and glia) and cerebrovascular cell types (i.e. endothelia, smooth muscle cells and pericytes). However, current work on COVID-19-induced cognitive impairment has yet to investigate disruption of neurovascular coupling as a causal factor. Hence, in this review, we aim to describe SARS-CoV-2's effects on the neurovascular unit and how they can impact neurovascular coupling and contribute to cognitive decline in acute and convalescent stages of the disease. Additionally, we explore potential therapeutic interventions to mitigate COVID-19-induced cognitive impairment. Given the great impact of cognitive impairment associated with COVID-19 on both individuals and public health, the necessity for a coordinated effort from fundamental scientific research to clinical application becomes imperative. This integrated endeavour is crucial for mitigating the cognitive deficits induced by COVID-19 and its subsequent burden in this especially vulnerable population., Competing Interests: The authors report no competing interests., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Guarantors of Brain.)

Impaired cerebrovascular function contributes to the genesis of age-related cognitive decline. In this study, the hypothesis is tested that impairments in neurovascular coupling (NVC) responses and brain network function predict cognitive dysfunction in older adults. Cerebromicrovascular and working memory function of healthy young (n = 21, 33.2±7.0 years) and aged (n = 30, 75.9±6.9 years) participants are assessed. To determine NVC responses and functional connectivity (FC) during a working memory (n-back) paradigm, oxy- and deoxyhemoglobin concentration changes from the frontal cortex using functional near-infrared spectroscopy are recorded. NVC responses are significantly impaired during the 2-back task in aged participants, while the frontal networks are characterized by higher local and global connection strength, and dynamic FC (p < 0.05). Both impaired NVC and increased FC correlate with age-related decline in accuracy during the 2-back task. These findings suggest that task-related brain states in older adults require stronger functional connections to compensate for the attenuated NVC responses associated with working memory load., (© 2023 The Authors. Advanced Science published by Wiley-VCH GmbH.)

The Semmelweis Study is a prospective occupational cohort study that seeks to enroll all employees of Semmelweis University (Budapest, Hungary) aged 25 years and older, with a population of 8866 people, 70.5% of whom are women. The study builds on the successful experiences of the Whitehall II study and aims to investigate the complex relationships between lifestyle, environmental, and occupational risk factors, and the development and progression of chronic age-associated diseases. An important goal of the Semmelweis Study is to identify groups of people who are aging unsuccessfully and therefore have an increased risk of developing age-associated diseases. To achieve this, the study takes a multidisciplinary approach, collecting economic, social, psychological, cognitive, health, and biological data. The Semmelweis Study comprises a baseline data collection with open healthcare data linkage, followed by repeated data collection waves every 5 years. Data are collected through computer-assisted self-completed questionnaires, followed by a physical health examination, physiological measurements, and the assessment of biomarkers. This article provides a comprehensive overview of the Semmelweis Study, including its origin, context, objectives, design, relevance, and expected contributions., (© 2023. The Author(s).)

The aging population worldwide is facing a significant increase in age-related non-communicable diseases, including cardiovascular and brain pathologies. This comprehensive review paper delves into the impact of the exposome, which encompasses the totality of environmental exposures, on unhealthy aging. It explores how environmental factors contribute to the acceleration of aging processes, increase biological age, and facilitate the development and progression of a wide range of age-associated diseases. The impact of environmental factors on cognitive health and the development of chronic age-related diseases affecting the cardiovascular system and central nervous system is discussed, with a specific focus on Alzheimer's disease, Parkinson's disease, stroke, small vessel disease, and vascular cognitive impairment (VCI). Aging is a major risk factor for these diseases. Their pathogenesis involves cellular and molecular mechanisms of aging such as increased oxidative stress, impaired mitochondrial function, DNA damage, and inflammation and is influenced by environmental factors. Environmental toxicants, including ambient particulate matter, pesticides, heavy metals, and organic solvents, have been identified as significant contributors to cardiovascular and brain aging disorders. These toxicants can inflict both macro- and microvascular damage and many of them can also cross the blood-brain barrier, inducing neurotoxic effects, neuroinflammation, and neuronal dysfunction. In conclusion, environmental factors play a critical role in modulating cardiovascular and brain aging. A deeper understanding of how environmental toxicants exacerbate aging processes and contribute to the pathogenesis of neurodegenerative diseases, VCI, and dementia is crucial for the development of preventive strategies and interventions to promote cardiovascular, cerebrovascular, and brain health. By mitigating exposure to harmful environmental factors and promoting healthy aging, we can strive to reduce the burden of age-related cardiovascular and brain pathologies in the aging population., (© 2023. The Author(s).)

Introduction: Mild cognitive impairment (MCI) is a prodromal stage to dementia, affecting up to 20% of the aging population worldwide. Patients with MCI have an annual conversion rate to dementia of 15-20%. Thus, conditions that increase the conversion from MCI to dementia are of the utmost public health concern. The COVID-19 pandemic poses a significant impact on our aging population with cognitive decline as one of the leading complications following recovery from acute infection. Recent findings suggest that COVID-19 increases the conversion rate from MCI to dementia in older adults. Hence, we aim to uncover a mechanism for COVID-19 induced cognitive impairment and progression to dementia to pave the way for future therapeutic targets that may mitigate COVID-19 induced cognitive decline., Methodology: A prospective longitudinal study is conducted at the University of Oklahoma Health Sciences Center. Patients are screened in the Department of Neurology and must have a formal diagnosis of MCI, and MRI imaging prior to study enrollment. Patients who meet the inclusion criteria are enrolled and followed-up at 18-months after their first visit. Visit one and 18-month follow-up will include an integrated and cohesive battery of vascular and cognitive measurements, including peripheral endothelial function (flow-mediated dilation, laser speckle contrast imaging), retinal and cerebrovascular hemodynamics (dynamic vessel retinal analysis, functional near-infrared spectroscopy), and fluid and crystalized intelligence (NIH-Toolbox, n-back). Multiple logistic regression will be used for primary longitudinal data analysis to determine whether COVID-19 related impairment in neurovascular coupling and increases in white matter hyperintensity burden contribute to progression to dementia., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Owens 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.)

Cerebral small vessel disease (CSVD) is the leading cause of vascular cognitive impairment and is associated with COVID-19. However, contributing factors that often accompany CSVD pathology in COVID-19 patients may influence the incidence of cerebrovascular complications. Thus, a mechanism linking COVID-19 and CSVD has yet to be uncovered and differentiated from age-related comorbidities (i.e., hypertension), and medical interventions during acute infection. We aimed to evaluate CSVD in acute and recovered COVID-19 patients and to differentiate COVID-19-related cerebrovascular pathology from the above-mentioned contributing factors by assessing the localization of microbleeds and ischemic lesions/infarctions in the cerebrum, cerebellum, and brainstem. A systematic search was performed in December 2022 on PubMed, Web of Science, and Embase using a pre-established search criterion related to history of, or active COVID-19 with CSVD pathology in adults. From a pool of 161 studies, 59 met eligibility criteria and were included. Microbleeds and ischemic lesions had a strong predilection for the corpus callosum and subcortical/deep white matter in COVID-19 patients, suggesting a distinct CSVD pathology. These findings have important implications for clinical practice and biomedical research as COVID-19 may independently, and through exacerbation of age-related mechanisms, contribute to increased incidence of CSVD., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Currently, an increasing amount of evidence supports the notion that vitamins C, D and E, carotenoids, and omega-3 fatty acids may protect against the progression of chronic respiratory diseases. Although chronic obstructive pulmonary disease (COPD) primarily affects the lung, it is often accompanied by extrapulmonary manifestations such as weight loss and malnutrition, skeletal muscle dysfunction, and an excess of harmful oxidants, which can lead to a decline in quality of life and possible death. Recently, the role of various vitamins, minerals, and antioxidants in mitigating the effects of environmental pollution and smoking has received significant attention. Therefore, this review evaluates the most relevant and up-to-date evidence on this topic. We conducted a literature review between 15 May 2018 and 15 May 2023, using the electronic database PubMed. Our search keywords included COPD, chronic obstructive pulmonary disease, FEV 1 , supplementation: vitamin A, vitamin D, vitamin E, vitamin C, vitamin B, omega-3, minerals, antioxidants, specific nutrient supplementations, clinical trials, and randomized controlled trials (RCTs). We focused on studies that measured the serum levels of vitamins, as these are a more objective measure than patient self-reports. Our findings suggest that the role of appropriate dietary supplements needs to be reconsidered for individuals who are predisposed to or at risk of these conditions.

Background: Many patients with previous COVID-19 infection suffer from prolonged symptoms after their recovery: cough, dyspnea, chest pain, shortness of breath, fatigue, anxiety or depression, regardless of milder or severe coronavirus infection. Review of the literature demonstrates underrepresented complex cardiopulmonary rehabilitation of patients with post-COVID syndrome. The aim of our quasi-experimental study was to evaluate the effectiveness of complex cardiopulmonary rehabilitation and to assess the quality of life, functional parameters before and after a 14-day specific cardiopulmonary rehabilitation and two months later., Methods: Sixty-eight patients participated in rehabilitation at Semmelweis University's Department of Pulmonology. Respiratory function: forced expiratory volume in 1 second (FEV1%pred), 6-minute walk test (6MWT), chest kinematics (CK), quality of life [EuroQol-5D (EQ-5D), Post-COVID-19 Functional Status (PCFS)] and Modified Medical Research Council (mMRC) dyspnea scale were measured at the beginning and end of the programme and two months after the rehabilitation., Results: The 14-day rehabilitation programme resulted in significant improvement of 6MWT {492 [interquartile range (IQR), 435-547] vs. 523 (IQR, 477-580) m; P=0.031}, mMRC [1 (IQR, 0.25-1) vs. 0 (IQR, 0-1); P=0.003], EQ-VAS score [75 (IQR, 65-80) vs. 85 (IQR, 75-90); P=0.015], and PCFS [1 (IQR, 1-2) vs. 0.5 (IQR, 0-1); P=0.032]. Respiratory function and chest kinematics also improved, FEV1(%pred) [86 (IQR, 73-103) vs. 91 (IQR, 80-99); P=0.360], chest kinematics [3.5 (IQR, 2.75-4.25) vs. 4 (IQR, 1-5.25) cm; P=0.296], and breath-holding test (BHT) [33 (IQR, 23-44) vs. 41 (IQR, 28-58) s; P=0.041]., Conclusions: Complex cardiopulmonary rehabilitation improved workload, quality of life, respiratory function, complaints and clinical status of patients with post-COVID syndrome. Personalized complex pulmonary rehabilitation can be beneficial and recommended for patients suffer from post-COVID syndrome, who have good potential for recovery and are able to participate in the two weeks complex pulmonary rehabilitation.

Background: An increasing number of studies suggest that diet plays an important role in regulating aging processes and modulates the development of the most important age-related diseases., Objective: The aim of this review is to provide an overview of the relationship between nutrition and critical age-associated diseases., Methods: A literature review was conducted to survey recent pre-clinical and clinical findings related to the role of nutritional factors in modulation of fundamental cellular and molecular mechanisms of aging and their role in prevention of the genesis of the diseases of aging., Results: Studies show that the development of cardiovascular and cerebrovascular diseases, neurodegenerative diseases, cognitive impairment and dementia can be slowed down or prevented by certain diets with anti-aging action. The protective effects of diets, at least in part, may be mediated by their beneficial macro- (protein, fat, carbohydrate) and micronutrient (vitamins, minerals) composition., Conclusions: Certain diets, such as the Mediterranean diet, may play a significant role in healthy aging by preventing the onset of certain diseases and by improving the aging process itself. This latter can be strengthened by incorporating fasting elements into the diet. As dietary recommendations change with age, this should be taken into consideration as well, when developing a diet tailored to the needs of elderly individuals. Future and ongoing clinical studies on complex anti-aging dietary interventions translating the results of preclinical investigations are expected to lead to novel nutritional guidelines for older adults in the near future.

In laboratory mice, pituitary dwarfism caused by genetic reduction or elimination of the activity of growth hormone (GH) significantly extends lifespan. The effects of congenital pituitary dwarfism on human longevity are not well documented. To analyse the effects of untreated pituitary dwarfism on human lifespan, the longevity of a diverse group of widely known little people, the 124 adults who played "Munchkins" in the 1939 movie The Wizard of Oz was investigated. Survival of "Munchkin" actors with those of controls defined as cast members of The Wizard of Oz and those of other contemporary Academy Award winning Hollywood movies was compared. According to the Kaplan-Meier survival curves, survival of female and male "Munchkin" actors was shorter than cast controls and Hollywood controls of respective sexes. Cox regression analyses showed that female "Munchkin" actors had significantly higher risk ratios compared to both female cast controls (RR, 1.70; 95% CI, 1.05 to 2.77) and female Hollywood controls (RR, 1.52; 95% CI, 1.03 to 2.24). Similar trends were also discernible for men, albeit point estimates were not significant. The lack of lifespan extension in "Munchkin" actors does not support the hypothesis that hereditary GH deficiency regulates longevity in humans., (© 2022. The Author(s), under exclusive licence to American Aging Association.)

It is well accepted that COVID-19-related mortality shows a strong age dependency. However, temporal changes in the age distribution of excess relative mortality between waves of the pandemic are less frequently investigated. We aimed to assess excess absolute mortality and the age-distribution of all-cause mortality during the second and third waves of the COVID-19 pandemic in Hungary compared to the same periods of non-pandemic years. Rate ratios for excess all-cause mortality with 95% confidence intervals and the number of excess deaths for the second (week 41 of 2020 through week 4 of 2021) and third waves (weeks 7-21 of 2021) of the COVID pandemic for the whole of Hungary compared to the same periods of the pre-pandemic years were estimated for 10-year age strata using Poisson regression. Altogether, 9771 (95% CI: 9554-9988) excess deaths were recorded during the second wave of the pandemic, while it was lower, 8143 (95% CI: 7953-8333) during the third wave. During the second wave, relative mortality peaked for ages 65-74 and 75-84 (RR 1.37, 95%CI 1.33-1.41, RR 1.38, 95%CI 1.34-1.42). Conversely, during the third wave, relative mortality peaked for ages 35-44 (RR 1.43, 95%CI 1.33-1.55), while those ≥65 had substantially lower relative risks compared to the second wave. The reduced relative mortality among the elderly during the third wave is likely a consequence of the rapidly increasing vaccination coverage of the elderly coinciding with the third wave. The hugely increased relative mortality of those 35-44 could point to non-biological causes, such as less stringent adherence to non-pharmaceutical measures in this population., (© 2022. The Author(s), under exclusive licence to American Aging Association.)

Background: The omega-3 polyunsaturated fatty acids (PUFAs) have an anti-inflammatory effect, beneficial for allergies, asthma, chronic obstructive pulmonary disease (COPD), reduce cholesterol and triglyceride levels and blood inflammatory parameters [C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-α)]. The aim of our cross-sectional study was to monitor omega-3 supplementation in patients with severe COPD and assess its association with quality of life, nutritional status, inflammatory parameters, lipid profile, comorbidities, exercise tolerance and inhaled medications., Methods: Our questionnaire on dietary supplement habits and our validated self-completion questionnaires were filled in by 400 patients with COPD at the National Koranyi Institute of Pulmonology, Hungary, mean age 67 [61-73] years; forced expiratory volume in one second (FEV1) (ref%): 46 [34-58]; 47.5% male, 52.5% female. We used the disease-specific COPD Assessment Test (CAT) questionnaire to measure quality of life., Results: More than half of the study participants (61%) did not consume fish or oilseeds at all. Nineteen patients (4.75%) took omega-3 supplementation regularly, mainly on medical advice (0.5 g/day). We observed significantly lower serum CRP levels [6.0 (1-7.3) vs. 9.7 (7.4-14.4); P=0.044], more favourable lipid profile [triglycerides, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol] with higher mean body mass index (BMI) [28.1 (22.0-35.3) vs. 24.7 (24.5-30.1); P=0.118], better quality of life {CAT: 25 [21-30.5] vs. 26 [20-31]; P=0.519}, lower inhaled short-acting bronchodilators use [short-acting beta-agonists (SABAs): 6 (31.58) vs. 209 (54.86); P=0.047], lower number of exacerbations in the previous half year [0 (0-1) vs. 1 (0-2); P=0.023], and higher 6-minute walking distance (6MWD) {300 [177-387] vs. 251 [150-345]; P=0.120} in the group with omega-3 supplementation., Conclusions: PUFAs are anti-inflammatory and affect the immune system. Our study shows that omega-3 intake of COPD patients is insufficient, and there is an urgent need to develop new anti-inflammatory strategies because only one drug (such as corticosteroids) cannot ease the chronically progressive inflammatory process of COPD.

Purpose: The purpose of current review is to conduct a systematic overview of articles published between 2019 and 2021 on the relationship of comorbidities and mortality due to Coronavirus Disease 2019 (COVID-19) among the elderly population., Methods: We conducted a systematic search on PubMed for articles published between 2019 and 2021 to identify any cohort and case-control studies that investigated the relationship of comorbidities and COVID-19 mortality among the elderly, defined as 60 years of age and above. Databases were searched independently by two authors. Disagreements were resolved by the inclusion of a third investigator. Reviews, systematic reviews, and meta-analyses were excluded from our systematic review., Results: A total of 15 studies were selected for our systematic review. Of the included studies, 3 were case-control, 3 were prospective cohort studies and 9 were retrospective cohort studies. As for size, 10 studies were conducted on populations of <1000 participants, 3 ranging from 1001 to 10,000, and 2 on populations of >10,000 individuals. The included studies found that the presence of certain conditions, such as cardiovascular, respiratory, renal diseases, malignancies, diseases of the nervous system and diabetes are associated to increased mortality in populations that consisted of elderly patients., Conclusion: Results of our systematic review suggest that comorbidities contribute to increased COVID-19 mortality among the elderly. The detrimental effect of comorbidities and advanced age on the immune response could lead to a more frequent occurrence of symptomatic and severe infections with COVID-19.

Introduction: Patients with chronic obstructive pulmonary disease (COPD) are a vulnerable group in terms of the outcome of coronavirus infection in relation to their disease or its treatment, with a higher risk of developing serious complications compared to the healthy population., Aim: The aim of our summary study is to review the background and health outcomes of chronic obstructive pulmonary disease and COVID-19 infection in the presence of both diseases., Methods: Review of national and international medical databases (PubMed, MEDLINE, and MOB) with keywords COPD, COVID-19, disease risk, cause, prevention, complications, and prognosis., Results: Meta-analyses show that COPD is one of the most common underlying conditions in patients hospitalized for COVID-19. Such patients are five times more likely to develop a serious complication due to oxygen supply problems therefore they are more likely to be admitted to intensive care units, where they may require mechanical ventilation. In the case of underlying COPD, the usual care plan for COVID-19 infection should be followed, as well as all public health recommendations to minimize the risk of developing and transmitting COVID-19., Conclusion: Coronavirus infection is especially dangerous for COPD patients, who are much more likely to become seriously ill, so increased surveillance, prevention, early detection, adequate treatment and rehabilitation of the disease group are of paramount importance.

Purpose: The goal of our review was to gather information on the most important community-acquired and hospital-acquired co-infections among coronavirus disease 2019 (COVID-19) patients, and to examine not only the effect of these co-infections on disease outcomes but also to identify the possible risk factors that predispose COVID-19 patients to co-infections., Methods: Medline (PubMed) and Google Scholar were searched for relevant articles published between January 1st, 2020, and September 31st, 2021, on the topic of co-infections among COVID-19 patients., Results: Among community-acquired and hospital-acquired co-infections, bacterial and fungal co-infections are equally frequent, followed by viral co-infections that affected a relatively smaller portion of patients. Overall, co-infections were more frequent in the hospital than at the community level. Risk factors for acquiring co-infections include male gender, longer length of hospital stay, presence of supportive treatment, such as ventilation, the admission to intensive care units, the administration of medications, such as steroids or antibiotics, and certain blood parameters, such as high C-reactive protein or lymphopenia. The presence of co-infections could aggravate the COVID-19 disease severity, prolong the healing time of patients, and lead to worse disease outcomes overall., Conclusion: Co-infections may increase the mortality of COVID-19 patients, especially in the hospital setting. Paying closer attention to hygiene, adhering to diagnostic and therapeutic protocols, implementing antimicrobial stewardship programs could decrease the occurrence of co-infections and lead to improved outcomes for COVID-19 patients.

Összefoglaló. A COVID-19-fertőzésen átesett betegek közül többen elhúzódó panaszokról számolnak be a felépülést követően, sokaknál tartósan fennáll a köhögés, a nehézlégzés, a mellkasi fájdalom, a légszomj attól függetlenül, hogy enyhe vagy súlyosabb tüneteket okozott a koronavírus. A betegek erőtlennek érzik magukat, erős fáradtságérzetre panaszkodnak, míg mások gyomor-bél rendszeri panaszokra, fejfájásra, depresszióra, a szaglás- és ízérzékelés elvesztésére. Számtalan kutatás leírja, hogy a fertőzés még akár hónapokkal később is hatással lehet a tüdő működésére, és korábban egészséges tüdőn is látható a koronavírus-fertőzés a gyógyulás után három hónappal készült kontroll-mellkas-CT-leleten. Éppen ezért szükség van a fertőzés lezajlását követően tüdőgyógyászati kivizsgálásra, ha a betegnek elhúzódó panaszai vannak, vagy ha a betegség tüdőgyulladást okozott. Szükség van a jelenleg működő fekvőbeteg-légzőszervi rehabilitáció mellett a kezelés ambuláns kiterjesztésére is, melynek célja újabb kórházi ápolás nélkül a teljes gyógyulás elérése a betegeknél. A COVID-19-fertőzésen átesett betegeknél a komplex rehabilitáció hatására javul a terhelhetőség, az életminőség, javulnak a légzésfunkciós értékek, csökkennek a panaszok, javul a betegek fizikai és pszichikai állapota. Összefoglaló kutatásunk célja áttekinteni, hogy milyen COVID-19 ambuláns rehabilitációs programok indultak el a koronavírus-fertőzésen átesett betegek esetében nemzetközi és hazai színtereken. Orv Hetil. 22021; 162(42): 1671-1677. Summary. Several patients with COVID-19 infection report prolonged complaints after recovery and many of them suffer from persistent cough, dyspnea, chest pain and shortness of breath regardless of whether the coronavirus caused mild or more severe symptoms. They complain of severe fatigue and weakness while others grizzle about gastrointestinal complaints, headache, depression, loss of sense of smell and taste. Numerous studies describe that the infection can affect lung function even in months and coronavirus infection can be detectable in previously healthy lungs by taking a control chest CT scan three months after recovery. Therefore, chest follow-up is required after the infection if the patient has prolonged complaints or if the disease has caused pneumonia. In addition to the currently operating inpatient respiratory rehabilitation, there is also a need for an outpatient extension of treatment to achieve complete recovery in patients without further hospitalization. For those patients who have had the COVID-19 infection complex rehabilitation can improve their workload, quality of life, improves their respiratory function values, reduces their complaints and also improves their physical and mental condition. The aim of our summary research is to review what COVID-19 outpatient rehabilitation programs have been initiated for patients who went through coronavirus infection on international and domestic scenes. Orv Hetil. 2021; 162(42): 1671-1677.

The authors report on the successful pregnancy and permanent symptom-free condition of a young woman who underwent operation for pituitary microadenoma. At the time of submitting the publication mother and child are healthy. According to the available literature this is the first such case reported in Hungary.

Description of history data, course of the disease and therapy is given of WPW syndrome diagnosed in neonatal age. In connection with the case the authors deal in details with the etiology, pathomechanism, course and complications of the disease. Problems of differential diagnostics and therapy are discussed. A relatively infrequent case is presented; the importance of pre- and postnatal observation and diagnosis being in close connection with the way of therapy and prognosis is emphasized.

During their clinical studies on human endometric tissue in normal and pathologic condition authors attempt to determine morphologic changes occurring to the effect of progestagens. Klt is established that progestagens cause typical morphologic changes which are manifested in regression of endometrium on varying scale. The most striking effect is exerted on mitochondria among respective cell organelles; it means the damage of these structures. Decrease of enzymatic processes linked to mitochondrea, caused by effect of progestagens, presumably inhibits cell proliferation. Inhibition of cellular oxidation in pathologic conditions, like in endometric hyperplasia and in highly differentiated cases of endometric cancer, can be of therapeutic effect. Their studies provide opportunity to interpretation of morphologic changes performed in hormone dependent tissues and to better understanding of its role in carcinogenesis of sexual hormones.

Characteristic morphologic alterations of endometrium following corpus luteum insufficiency are described. It is emphasized that in the majority of cases insufficiency of corpus luteum--which in 22 per cent of cases lies on the basis of functional sterility--brings about decreased output of progesterone in the luteal phase of the cycle and induces "disturbed secretion" i. e. hypoluteal transformation of endometrium. Another variant may also take place: normal function of the corpus luteum may last over a too short period inducing the shortening of the secretory phase and the early breakdown of the endometrium. Both, above mentioned mechanisms may inhibit the implantation of the fertilized ovum and lead to functional sterility.

Authors have applied Danazol-treatment to 15 sexually mature patients because of beningn, menorrhagic bleeding disturbances. Three months after daily 400 to 600 mg Danazol an amenorrhea ensued. Steroid determinations during drug administration were complemented by endometrial biopsy in the amenorrheal state. Samples were studied light and electron microscopically. Upon Danazol-treatment the endometrium showed a patterns resembling that in atrophy or in early proliferations stage of the menstrual cycle. This corresponded to estrogen values obtained. In 3 out of 15 cases the pseudosecretory transformation of the endometrium was observed which is explained by the interaction between Danazol and progesterone receptors.

Electron micrographs and scanning electron micrographs of well differentiated and anaplastic carcinoma of endometrium have been compared. It was established, that the grade of malignancy could be correctly estimated by studying the surface pattern of them. Comparison of the surface pattern of cells with the ultrastructure of the intracellular elements has shown that they represent functional unit. The surface pattern of cells may characterize intracellular processes and indicate the grade of differentiation.

Occurrence of glomerular-bodies or nucleolus-like bodies in the cytotrophoblast cells of the human placenta in praeeclampsia is described. Structural details and intra-cytoplasmatic localization of nucleolus-like-bodies are discussed. Function of this structure is recently unknown but it is remarkable that it occurs in great number at one of the most serious pathological process in pregnancy--at praeeclampsia.

As a first part of their series, authors discuss the clinicopathological problems of the tissue effects of copper-containing IUDs. They stress the possibilities of local injury caused by copper ions which play a role in enhancing the contraceptive effects.

During progestogen treatment, nickel ions were detected in the human endometrial tissue of patients with endometrial carcinoma by the dimethyloxime cytochemical method. In this paper, the mechanism of action of nickel is dealt with and, because nickel ions have earlier not be detected in human endometrial carcinomatous tissues, the question arises as a result of what kind of cell biological processes, nickel ions appear in the cells of endometrial carcinoma. It is still to be answered whether the progestogen treatment applied can be correlated with the appearance of the trace element in the carcinomatous cell.

Author studied the effect of prolonged--6-8 month--treatment with Hormofort on the cells of adenocarcinoma of the endometrium. Light- and electronmicroscopic studies show, that after the treatment with progestative hormones cells of the adenocarcinoma seems significantly regrediate and simultaneously clinical remission can be observed. These data suggest, that progestative-norsteroids seems to elicit "cytostatic" effect on the endometrical tumour cells.

Scanning electron microscopic study of endometrium in premalignant hyperproliferative conditions has been carried out. Scanning and transmission electron micrographs have been correlated. It has been established that changes of the surface pattern of cells within limits indicate the process of dedifferentiation. First of all formation of cilia can be regarded as a phenomenon demonstrating malignant transformation of cells. Surface pattern of cells and intracellular processes seems to show a certain degree of parallelism. To reveal morphologic criteria evidencing malignant transformation of cells further study of the problem is needed.

Authors investigated the effect of high dose progestogen in endometrium carcinomatous tissue on the distribution of calcium depots, as well as on the chemically detectable activity of cytochrome oxidase and succinate dehydrogenase. By means of electron microscopy no characteristic destructive effect could unequivocally be demonstrated; cytochemical examinations showed a very significant activity of cytochrome oxidase, and in the activity of succinate dehydrogenase a considerable decrease was observed. They found distributional alterations in plasma membranes, in mitochondria and in the ground cytoplasm. Changes between Ca depots are thought to have an effect on tumour cells also in a protective way, and can be regarded as compensatory phenomena.

Ultrastructural changes of the placenta in toxemia of pregnancy and in diabetes are described. In toxemia of pregnancy in the placenta definite morphological changes were observed; marked atrophy of the syntitial layer was followed by hyperplasia of the cytotrophoblastie cells. The most expressed changes occurred in the vessel wall: swelling of the endothelium, narrowing of the vessel-lumen, deposition of filamentous material in the cytoplasma. Morphological changes in the placenta in diabetes are moderate as compared to those observed in toxemia. Thickening of the basal membrane seems to be most characteristic. Ultrastructural changes are almost identical to those observed in toxemia. Morphological changes revealed may be responsible for the insuffiziency of the placenta and the intrauterine damage to the foetus.

The clinicopathological problems of the tissue effect of copper-containing IUDs are discussed. In the third part of their series, authors present the cytochemical analysis of the endometrial scrapings. For the investigations, dithizone, salicylaldoxime, rubeanic acid as well as dimethylglyoxime were used. The reaction precipitate, the copper dithizone complex, could be visualized partly intracellularly and intramitochondrially and partly interstitially. The technical problems of copper demonstration are also dealt with.

The authors studied electron microscopically the effect of a large dose of medroxyprogesterone acetate (Depo-Provera) on the fine structure of endometrial carcinoma, with special regard to the annulate lamellae of the cells. Following treatment in one-third of their cases of highly-differentiated endometrial carcinoma the glandular epithelial cells were found to show a marked regression. After using a large dose of progestogen, the oestrogen-dependent annulate lamellae 'disappeared' from the cytoplasm of the cells. This phenomenon may be one of the morphological manifestations of subcellular oestrogen-progesterone antagonism.

In the blood of 39 women with endometrial carcinoma the FSH, LH, estrone, androstendion, estradiol and dehydroepiandrosterone were determined by the RIA method. Compared to the control group the estrone (303.3 +/- 44.3 pmol/l), estradiol (165.2 +/- 29.4 pmol/l) and the androstendion (5.24 +/- 0.44 nmol/l) were significantly higher. The source of the increased estrogen levels was mainly of adrenal origin. The peripheral conversion, i.e. aromatization of androstendion into estrone was particularly marked in the case of adipose patients. The unbalanced estrogen effect in the absence of progesterone is one of the decisive factors in the etiology of endometrial carcinoma.

According to our experience, the after-loading procedure can successfully be applied in the majority of endometrial cancer cases. Primarily, in those where corpus parameters can be accurately judged and these correspond to the doses to be applied. By devising individual doses, a tumour dose can be planned and administered which in the vesical and rectal wall is amply below the threshold value. (According to our calculations, the posterior wall of the bladder received, on an average, a dose of 5 to 30, while the anterior wall one of 15 to 35 Gy.) The relatively long time of treatment--occasionally 40 to 60 hours--are well tolerated by the patients receiving mild sedatives. The considerable protection of the small intestine is due to the protracted method of a low R/min. The lack of complications in the small intestine can be attributed to this fact. Beside all these results, application, localization and nursing can be made in a radiation-free environment. For examining the effectivity of after-loading treatment, light- and electron microscopic studies were performed in patients with endometrial carcinoma (in 6 and 8 cases, respectively) to support also morphologically the favourable results of clinical practice.

Scanning electron microscopic examination revealed conspicuous superficial changes in endometrial carcinoma, primarily in highly differentiated cases, after treatment with high doses of a progesterone compound (Depo-Provera). The most important changes included decrease of superficial structure, distruction of microvilli, loosening of intercellular connection and disintegration of the glandular substance. In consequence a barren, poorly structured, "devastated" pattern was seen, which points to the regressive processes on intracellular plane occurring on the effect of progestagens. Results confirmed the hypothesis of the close relationship between intracellular and cell surface processes.

For assessment of the tissue effect of copper-containing IUDs routine electron microscopic study was made of the endometrial scrapings. It was established that there was evidence of severe, degenerative changes not only on the IUD but also in the endometrial cells and, occasionally, also in the muscle layer of the uterus. These were characterized by pyknosis of the endometrial cells and alterations of the intracellular components. In this material of the study of 22 endometrial specimens obtained from beside IUDs, relatively few microtubuli were found in the endometrial cells. The changes seemed to be too severe to be ascribed to a sterile inflammation. The sporadic changes in the endothelial cells were found to be non-specific.

Effect of progestagen-norsteroids on the cells of endometrial carcinoma was studied. It was established that as an effect of treatment with large doses of progestagen (100 mg/day) in about 4--6 weeks carcinoma cells show a peculiar increased secretory activity. It seems likely, that this secretory activity proceeds on the account of the growth-potencial of tumour cells. Thus, as a result the growth of the tumour ceases, or in optimal cases stops.