Centers In Hungary Research Articles

Clinical, functional and prognostic correlates of excess left ventricular force in hypertrophic cardiomyopathy

Abstract Background Excess force generation during myocardial contraction represents a cardinal feature of hypertrophic cardiomyopathy (HCM). Purpose To evaluate the anatomical, functional and prognostic correlates of left ventricular (LV) force in HCM. Methods We prospectively recruited a consecutive sample of 408 HCM patients with LV ejection fraction (EF) >50%, referred for baseline transthoracic echocardiography in 2 primary HCM centers in Hungary and Italy between 1999 and 2021. LV force was calculated as LV outflow tract gradient+systolic blood pressure/LV end-systolic volume. Patients were followed for a median of 107 months (IQ range, 58–158 months), the study endpoint was all-cause mortality. Results Mean LV force was 6.0±4.6 mm Hg/ml. Receiver-operating characteristic analysis identified 7.5 mm Hg/ml the best cut-off value to predict mortality. LV force >7.5 mm Hg/ml was present in 86 patients (21%), more frequently in women (58 vs 27%, p<0.0001), more often in patients with diabetes (16 vs 6%, p=0.003), beta-blocker (81 vs 58%, p<0.0001), calcium channel-blocker (19 vs 9%, p=0.012) and diuretic therapy (19 vs 8%, p=0.004), compared to patients with LV force ≤7.5 mm Hg/ml. Patients with excess LV force had more advanced NYHA class (1.8±0.7 vs 1.4±0.7, p=0.0001), greater left atrial diameter [(LAd), 46.7±6.6 vs 43.0±7.2 mm, <0.0001], LV maximal wall thickness (23.2±5.5 vs 21.6±5.5 mm p=0.01), LV EF (74.6±6.4 vs 67.0±6.8%, <0.0001), mitral regurgitation grade (1.2±0.7 vs 0.7±0.7, p<0.0001) and E/e' (10.3±5.0 vs 7.8±5.0, p=0.005). During follow-up 43 deaths occurred. All-cause death was more frequent in patients with excess LV force (21 vs 8%, p<0.0001). At multivariable Cox regression analysis, excess LV force was an independent predictor of mortality (HR 2.9, 95% CI 1.14–7.26, p=0.025) independent of age (HR 1.03, 95% CI 1.00–1.05, p=0.022) and LAd (HR 1.07, 95% CI 1.02–1.14, p=0.005). Conclusion LV force with a threshold of 7.5 mm Hg/ml, independently predicts adverse outcome in patients with HCM and preserved systolic function. Excess LV force generation is associated with female sex, diabetes, NYHA class, medications, LAd, LV wall thickness, EF, mitral regurgitation grade and E/e'. Funding Acknowledgement Type of funding sources: None.

The major stages in the development of a regional centre. The case of Pécs (Hungary)

The aim of the study is to provide an overview of the main milestones in the development of a regional centre in Hungary. Pécs is a centre of a depressed region. The Transdanubian region is among the 20 most disadvantaged regions of the European Union which shows a significant decline compared to previous years. This justifies the need for professional research directed at changing this situation by performing some tangible efforts. Pécs is a 2,000-years old city, acquiring various historical and mutually reinforcing central functions, by virtue of which it has developed into a regional centre. Of the historical drivers of the development of Pécs, the study is able to identify three groups of factors 1) centrality within its region, the regional functions it has fulfilled throughout its history, 2) culture and multiculturalism, and 3) industrial development. This study will analyse the relation of the cultural centre position and the other function of Pécs. The study is the first descriptive result of a research project1 that reviews the development and governance characteristics of a typical case of peripheral regions. Ongoing empirical analysis will allow the development of a development policy concept.

Effect of HEAT therapy in patiEnts with type 2 Diabetes mellitus (HEATED): protocol for a randomised controlled trial

IntroductionThe burden of type 2 diabetes mellitus (T2DM) is increasing worldwide. Heat therapy has been found effective in improving glycaemic control. However, to date, there is a lack of randomised...

NATIONWIDE COMPREHENSIVE HEALTH PROTECTION SCREENING PROGRAM IN HUNGARY, 2010 2020 2030

Objective: From 2010 a new, complex screening program started in Hungary, named NATIONWIDE COMPREHENSIVE HEALTH PROTECTION SCREENING PROGRAM in HUNGARY MAESZ 2010 2020 2030. Design and method: Within the framework of the Program in the largest mobile diagnostics center in Hungary, the adult population has the opportunity to obtain 40 comprehensive surveys in free form. In the past nine years, the special screening lorry visited 1886 places Results: 228076 inhabitants had a complex screen and 561873 individuals received information packages about the right lifestyle, the prevention of illnesses, and preservation of health and we have received 14 million lifestyle question answers on sites. From 2018 2019 academic year officially started the child prevention program of the nationwide health prevention screening program of Hungary named Travel to Empire of the Health MAESZ provides free participation for about 75,000 children annually and assists in the development of children’s health knowledge. The nationwide comprehensive health protection screening program greatly contributes to improving students’ health knowledge. Within the framework of the program, students can gain insight into the program from the first grade of primary school to the university level. Based on data from 2010, the age of participants was 42 years for women and 40 years for men. 22% in women, 23% in men was the rate of known hypertension, and 5.1% and 4.5% was the proportion of known diabetics irrespectively. Myocardial infarction 26–22%, hype,rte,nsion disease 62–55%, stroke 19–14%, cancer 47–38%, and metabolic disease 42–34% occurred in the family history. BMI was increased in both genders, 45% in women and 59% in men. In both sexes, the proportion of smokers was over 24%. Conclusions: Based on the results, it has been repeatedly found that the Hungarian population has high risk.

Changes in the practice of electroconvulsive therapy at Semmelweis University before and during the COVID-19 pandemic

IntroductionThe Department of Psychiatry at Semmelweis University is the largest electroconvulsive therapy (ECT) centre in Hungary, where a total number of around 300 treatments are conducted every year. Certain changes were administered in 2018 and 2019 in our logistics and internal protocols that helped to increase the number of treated patients and improve quality of care. The COVID-19 pandemic caused serious disruptions in the Hungarian mental health care system , therefore there was a realistic fear that many patients who required ECT would not receive this form of tretament.ObjectivesOur goal was to assess the effects of the pandemic on our ECT service, and to analyse whether patients were able to receive treatment, despite the logistical difficulties.MethodsWe retrospectively gathered data from our internal documentation to compare the number of ECT treatments with the previous years. We also had to take into account the fluctuation in our general caseload of psychiatric patients, since our Department acted as a COVID-19 treatment centre for several months.ResultsTotal number of ECT treatments decreased in 2020 after a peak in 2019, however the numbers were not much lower compared to the years before changes in 2018. Unfortunately, we see a more direct effect of the 3rd wave of the pandemic.ConclusionsWe can conlude that there is a decrease in the number of ECT treatments due to the pandemic, however, the fact that we still provided service in most parts of 2020 and 2021 for patients with the most severe conditions is a serious achivement.DisclosureNo significant relationships.

The Impact of Diabetes Mellitus and Admission Hyperglycemia on Clinical Outcomes after Recanalization Therapies for Acute Ischemic Stroke: STAY ALIVE National Prospective Registry.

It was previously reported that diabetes mellitus (DM) and admission hyperglycemia (aHG) were associated with poor clinical outcomes in patients with acute ischemic stroke (AIS) who were treated with intravenous thrombolysis (IVT) or mechanical thrombectomy (MT). Our study aimed to assess the prognostic effect of DM and aHG (≥7.8 mmol/L) on clinical outcomes in patients treated with recanalization therapies (IVT and MT). Our multicentric study was based on data from the prospective STAY ALIVE stroke registry between November 2017 and January 2020. We compared the demographic data, clinical parameters and time metrics between recanalized DM and non-DM groups, and we analyzed the impact of DM and aHG on 90-day functional outcome, 90-day mortality, symptomatic intracranial hemorrhage (sICH), and successful recanalization. Statistical analyses were also performed in two subgroups: (1) patients treated with IVT alone and (2) patients treated with MT. Altogether, we included 695 patients from the three participating stroke centers in Hungary. Regarding the overall population, patients with diabetes were older (72 vs. 67 years, p < 0.001) and comorbidities were more frequent. There were significant differences in the 90-day good functional outcome (48.9% vs. 66.7%, p < 0.001), 90-day mortality (21.9% vs. 11.6%, p < 0.001) and the rate of symptomatic intracranial hemorrhaging (sICH) (7.8% vs. 2.2%, p < 0.001) between the groups. Diabetes and aHG were independently associated with a poor clinical outcome (OR 2.02, 95% CI 1.31–3.11, p = 0.001; OR 2.09, 95% CI 1.39–3.14, p < 0.001) and mortality at 3 months (OR 2.45, 95% CI 1.35–4.47, p = 0.003; OR 2.42, 95% CI 1.37–4.28, p = 0.002) and sICH (OR 4.32, 95% CI 1.54–12.09, p = 0.005; OR 4.61, 95% CI 1.58–13.39, p = 0.005) in the overall population. However, the presence of DM and aHG was not correlated with successful reperfusion (OR 0.39, 95% CI 0.09–1.67, p = 0.205; OR 0.42, 95% CI 0.09–1.97, p = 0.274) after MT. Our study revealed that diabetes and hyperglycemia on admission were correlated with poor clinical outcomes at 3 months in patients with acute stroke regardless of the recanalization method. In addition, the variables were also associated with sICH after recanalization therapies. However, successful recanalization was not associated with DM and aHG in patients who underwent MT.

Intraoperative complication rates in cataract surgery performed by resident trainees and staff surgeons in a tertiary eyecare center in Hungary.

To compare the incidence of intraoperative complications during primary phacoemulsification (phaco) surgery between resident surgeons (residents) and staff surgeons (specialists) and to objectively determine the difficulty of stages in phaco surgery. This retrospective study included cases of phaco cataract surgery performed between January and December 2019. There were no exclusion criteria. For each patient, demographics, clinical history, case complexity, type of surgeon, and operative details were reviewed. Primary outcomes included intraoperative complication rates and the objective measure of difficulty in the steps of the surgery performed by residents and specialists. A total of 3272 cases were included; 7.4% (n=241) of cases were performed by residents. The overall complication rate was 5.4% (n=177). The intraoperative complication rate was significantly higher (P<0.001) in residents (n=33, 13.7%) than in specialists (n=144, 4.8%). The most frequent complications were posterior capsule tear (n=85, 2.6%), anterior capsule tear (n=50, 1.53%), zonular fiber loss (n=45, 1.38%), and dropped nucleus (n=15, 0.46%). Objectively, the most difficult steps during surgery were phaco in 66 (60.0%), capsulorhexis in 21 (19.1%), irrigation/aspiration in 13 (11.8%), hydrodissection in 9 (8.2%), and intraocular lens (IOL) implantation in 1 (0.9%) case. Intraoperative complication rates are higher in residents than in specialists. The order of objective difficulty in phaco surgery steps is in line with the subjective findings of other surveys, revealing that the most challenging parts of phaco surgery are phaco and capsulorhexis.

Assessment of cognitive function in long-term Hodgkin lymphoma survivors, results based on data from a major treatment center in Hungary

IntroductionNowadays, more than 80% of newly diagnosed classical Hodgkin lymphoma (HL) patients can be cured and become long-term survivors due to risk and response-adapted treatment strategies. A well-known side effect is cognitive dysfunction that appears in HL patients after chemotherapy. In the present study, we aimed to measure cognitive dysfunction in our HL patients in this study and to find potential correlations between patient-related factors, the signs and symptoms of their diseases, or therapeutic factors.MethodsWe carried out a computer-assisted assessment (CANTAB) of cognitive dysfunction in 118 patients. We examined the domains of visual memory, attention, working memory, and planning.ResultsThe median age of 64 females and 54 males at diagnosis was 29 (13–74) and 41 (21–81) years at the completion of CANTAB. Fifty-two percent of all patients showed cognitive impairment. Attention was impaired in 35% of patients, the working memory and planning were impaired in 25%, while visual memory was affected in 22%. All the three functions showed a significant association with inactive employments status. A close correlation was found between visual memory/working memory and planning, higher age at HL diagnosis or the completion of CANTAB test, and disability pensioner status.DiscussionOur investigation suggests that patients with inactive employment status and older age require enhanced attention. Their cognitive function and quality of life can be improved if they return to work or, if it is not possible, they receive a cognitive training.

Transcatheter aortic valve replacement – 10 years experience at Gottsegen György National Cardiovascular Center in Hungary

Transcatheter aortic valve implantation (TAVI) is an alternative treatment to surgical aortic valve replacement for elderly, high surgical risk patients. The aim of this study was to evaluate the short- and long-term outcomes of those 463 patients who underwent TAVI during the first 10 years in our TAVI program. We compare the first 200 patients' results with the further 263 patients' results. Between 11th November 2008 and 31st December 2018, 463 patients underwent TAVI. The average age of the patients was 79.6 years, the average logistic EuroSCORE was 19.0%, the average STS score was 5.2%. 72% of the patients were in NYHA III or IV stage before TAVI. 92% of TAVIs were performed from femoral arteries. Average mean gradient was 50.0 mmHg and aortic valve area was 0.55 cm2, respectively. In 2% of the cases, "valve-in-valve" intervention was performed because of the restenosis of former aortic valve prosthesis. 30-day mortality was 5.2% and the 1-year mortality was 16.4% after TAVI. Post-TAVI complications were evaluated according to the VARC-2 definitions. Major stroke occurred in 2.2% after TAVI. The most common complication was pacemaker implantation (19.9%), but their incidence was significantly reduced between the 2 groups (26.5% vs. 14.8% [p = 0.002]). The incidence of vascular access site complications was significantly higher between the 2 groups (10% vs. 20.2% [p = 0.016]), but it did not affect the mortality. Based on our results, TAVI is a safe alternative treatment for patients with severe, symptomatic aortic stenosis in our institute as well. Orv Hetil. 2022; 163(6): 229-235.

Vascular procedures during the COVID-19 pandemic in a high volume Eastern European interventional radiology department

Abstract Aim To assess the impact of the COVID-19 outbreak on trends in hospital admissions and number of diagnostic and therapeutic procedures in the largest tertiary vascular center in Hungary. Patients and Methods A retrospective analysis was carried out. The first wave of the COVID-19 pandemic occurred approximately from March 15 until June 1 in Hungary. We have compared the same period of 2020 to 2019. Electronic medical records were reviewed for the clinical status of the patients and treatment-related information. Results The total number of diagnostic angiographies and therapeutic interventions in 2020 (N = 233) decreased significantly (P = 0.046) compared to 2019 (N = 373). The ratio of Fontaine stage I–II cases to Fontaine stage III–IV cases for both diagnostic angiographies and therapeutic interventions was significantly lower (OR, 2.11; 95% CI, 1.26–3.59; P = 0.007 and OR, 3.22; 95% CI, 1.67–6.52; P &lt; 0.001) in 2020 (0.36 and 0.27) than in 2019 (0.77 and 0.89). There was also a negative but not significant change in the number of supra-aortic (including internal carotid artery stenting) (P = 0.128) and other vascular therapeutic interventions (superior vena caval stenting, hemodialysis access percutaneous transluminal angioplasty [PTA], visceral artery/vein PTA/stenting, embolization) (P = 0.452) in 2020 (N = 16 and N = 21) compared to 2019 (N = 39 and N = 37). Conclusion The first wave of the COVID-19 pandemic had a negative effect on the total number of endovascular procedures in the largest tertiary vascular center in Hungary.

Invasive fungal infections among critically ill adult COVID-19 patients: First experiences from the national centre in Hungary

IntroductionData suggests that invasive fungal infections (IFI) might complicate COVID-19. Our goal was to describe characteristics of IFI among critically ill COVID-19 adults. MethodsA retrospective observational case-series analysis was done between March–July 2020. Consecutive patients with critical COVID-19 were eligible, and have been included when proven or putative/probable IFI could be confirmed during their course. For COVID-19 diagnosis, ECDC definitions and WHO severity criteria were followed. Candidaemia was diagnosed according to the ESCMID 2012 guideline. Invasive pulmonary aspergillosis (IPA) was defined following EORTC/MSG, ECMM/ISHAM and modified AspICU criteria. Outcome variables were rates of IFIs, in-hospital all-cause mortality, rate and time to negative respiratory SARS-CoV-2 PCR. ResultsFrom 90 eligible patients, 20 (22.2%) fulfilled criteria for IFI. Incidence rate for IFI was 2.02 per 100 patient-days at ICU. Patients were mostly elderly males with significant comorbidities, requiring mechanical ventilation because of ARDS. IFI could be classified as candidaemia in 7/20 (40%), putative/probable IPA in 16/20 (80.0%). Isolated species of candidaemia episodes were Candida albicans (4/9, 44.4%), Candida glabrata (3/9, 33.3%), Candida parapsilosis (1/9, 11.1%), Candida metapsilosis (1/9, 11.1%). Mold isolates from lower respiratory tract were Aspergillus fumigatus, BAL galactomannan positivity was prevalent (16/20, 80.0%). Mortality was 12/20 (60.0%) with a median time to death of 31.0±37.0 (5–89) days. Only 9/20 (45.0%) patients reached SARS-CoV-2 PCR negativity after a median time of 20.0±12.0 (3–38) days. ConclusionIn this small cohort of critically ill COVID-19 adults, morbidity and mortality related to invasive fungal infections proved to be significant.

Nationwide comprehensive health protection screening program in Hungary, 2010-2020-2030 (MAESZ).

Background and Aims: From 2010 a new, complex screening program started in Hungary, named NATIONWIDE COMPREHENSIVE HEALTH PROTECTION SCREENING PROGRAM in HUNGARY 2010-2020-2030. Within the framework of the Program in the largest mobile diagnostics center in Hungary the adult population has the opportunity to obtain 40 comprehensive surveys in free form.

Clinical Review of Ocular Traumas Resulting in Enucleation or Evisceration in a Tertiary Eye Care Center in Hungary.

Purpose To analyse the demographic and clinical characteristics of ocular traumas resulting in enucleation/evisceration in a large tertiary referral center in a developed country (Hungary) over a period of 15 years. Patients and Methods. A retrospective review of enucleated/eviscerated eyes that underwent surgery between 2006 and 2020 at the Department of Ophthalmology of Semmelweis University, Budapest, Hungary, due to ocular trauma as the primary indication for enucleation/evisceration. For each subject, clinical history, B-scan ultrasound report, and histopathology results were reviewed. Results There were 124 enucleated/eviscerated eyes from 124 patients (91 males (73.4%)). The mean age at the time of trauma was 37.3 ± 26.0 years while the mean age at the time of enucleation/evisceration was 46.9 ± 20.3 years. The main clinical diagnoses after ocular trauma were open globe injury (n = 96; 77.4%), ocular burns (n = 6; 4.8%), traumatic optic neuropathy (n = 4; 3.2%), bulbar avulsion (n = 3; 2.4%), traumatic cataract (n = 2; 1.6%), retinal ablation (n = 1; 0.8%), and traumatic carotid-cavernous fistula (n = 1; 0.8%). Among the 124 patients, 98 (79.0%) underwent enucleation and 26 (21.0%) evisceration. Patients who underwent primary enucleation/evisceration (n = 24 19.4%) were significantly older at the time of the injury (57.7 ± 22.7 years) than people who underwent secondary eye removal (32.4 ± 24.4 years) (p < 0.0001). The mean time interval between trauma and enucleation/evisceration was 114.9 ± 163.5 months. The main clinical indications for anophthalmic surgery were atrophia/phthisis bulbi (n = 56, 45.2%), acute trauma (n = 25, 20.2%), painful blind eye due to glaucoma (n = 17, 13.7%), endophthalmitis (n = 10, 8.1%), and cosmetic reasons (n = 7, 5.6%). One patient (0.8%) had sympathetic ophthalmia. Conclusions Primary enucleation/evisceration was performed in one-fifth of all ocular trauma-related anophthalmic surgeries in our tertiary eye care center with enucleation being the most common procedure. Atrophia/phthisis bulbi was the most frequent immediate clinical indication for enucleation/evisceration.

Pathologic Complete Response Rates After Neoadjuvant Pertuzumab and Trastuzumab with Chemotherapy in Early Stage HER2-Positive Breast Cancer - Increasing Rates of Breast Conserving Surgery: A Real-World Experience.

Purpose: The neoadjuvant use of pertuzumab and trastuzumab with chemotherapy improves the pathologic complete response (pCR) in early HER2+ breast cancer. The aim of this study was to determine the pCR rate obtained with dual HER2 blockade in routine clinical practice. The secondary and tertiary objective was to investigate the impact of neoadjuvant systemic therapy (NST) on performing breast-conserving surgery and survival data. Methods: This was a multicentre, retrospective, observational study in patients with stage II and III HER2+ early breast cancer who received pertuzumab and trastuzumab-based NST. Data were collected from patients’ medical records. Results: Eighty-two patients were included in the study treated in 8 cancer centers in Hungary between March 2015 and January 2020. The study included women with a median age of 50.3 years. The majority of the patients (95%) received a sequence of anthracycline-based chemotherapy followed by docetaxel. pCR was achieved in 54% of the cases. As a result of NST a significant increase of conservative breast surgeries (33% vs. 3.6% planned, p = 0.0001) was observed. Ki67 expression and neutrophil-to-lymphocyte ratio (NLR) significantly predicted pCR. None of the variables were independent predictors of DFS. Conclusion: The pCR rate achieved in our study demonstrates the reproducibility of trial data in a real-world population. The rate of breast-conserving surgery was significantly increased.

Combining Social Media and Mobile Positioning Data in the Analysis of Tourist Flows: A Case Study from Szeged, Hungary

Despite the growing importance of mobile tracking technology in urban planning and traffic forecasting, its utilization in the understanding of the basic laws governing tourist flows remains limited. Knowledge regarding the motivations and spatial behavior of tourists has great potential in sustainable tourism studies. In this paper, we combine social media (Twitter) and mobile positioning data (MPD) in the analysis of international tourism flows in Szeged, a secondary urban center in Hungary. First, the content of geotagged and non-geotagged Twitter messages referring to Szeged in a six-month period of 2018 was analyzed. In this way specific events attracting foreign tourists were identified. Then, using MPD data of foreign SIM cards, visitor peaks in the investigated period were defined. With the joint application of the social media and mobile positioning analytical tools, we were able to identify those attractions (festivals, sport and cultural events, etc.) that generated significant tourism arrivals in the city. Furthermore, using the mixed-method approach we were also able to analyze the movements of foreign visitors during one large-scale tourism event and evaluate its hinterland. Overall, this study supports the idea that social media data should be combined with other real-time data sources, such as MPD, in order to gain a more precise understanding of the behavior of tourists. The proposed analytical tool can contribute to methodological and conceptual development in the field, and information gained by its application can positively influence not only tourism management and planning but also tourism marketing and placemaking.

Fibrinogen level at hospital admission after multiple injury correlates with BMI and is negatively associated with the need for transfusion and early multiple organ failure

IntroductionBleeding and coagulopathy are leading causes of morbidity and lethal outcome after multiple injuries. The pathophysiology of traumatic coagulopathy is under extensive investigations and recent results highlighted the central role of fibrinogen and the fibrin polymerisation process. Our goal was to investigate the factors influencing fibrinogen level and the consequences of hypofibrinogenaemia with clinical importance. MethodsWe conducted a retrospective analysis enrolling adult patients admitted to the shock room of a tertiary trauma centre in Hungary. Beside coagulation values, demographic data, injury related, transfusion and outcome parameters were collected from the hospital electronic charts. Only patients with complete e-chart were involved into final analysis. Multivariate linear and proportional odds logistic regression models were used to model outcomes – admission fibrinogen and SOFA score – controlling for age, sex, BMI, ISS and lactic acidosis. Results54 patients were enrolled in final analysis. Among the parameters analysed, BMI was positively associated with fibrinogen level at admission (+0.23 g/l for every 5 unit of increase in BMI, 95% CI: 0.09-0.37, p=0.0021). Increased risk of transfusion was observed, if fibrinogen at admission was about 1.8 g/l or lower. Beside age and ISS, fibrinogen concentration was also a determinant of early organ failures as it negatively correlated with SOFA scores within 24 hours or care (OR=2.42, 95% CI: 1.05-5.62, for 1 g/l decrease, p=0.0388). ConclusionsIn our trauma cohort BMI seems to significantly influence fibrinogen level at admission. This result draws our attention to the possible differences of haemostasis process, and consequently different diagnostic and therapeutic thresholds in the management of obese trauma patients. Moderate hypofibrinogenaemia increases transfusion risk and beside ISS might be a prognostic factor of early MOF after multiple injuries.

Does better availability mean better accessibility? Spatial inequalities in the care of acute myocardial infarction in Hungary

The availability of health care services is an important issue, however, improving availability of health care services does not necessarily mean better accessibility for everybody. The main aim of this study is to find out how better availability in the care of acute myocardial infarction vary with accessibility of patients’ geographical location within Hungary. We applied statistical analysis and interview techniques to unfold the role of spatiality in the conditions of access to health care. Results of statistical analysis indicate significant health inequalities in Hungary. Decreasing national mortality rates of acute myocardial infarction, has been coupled by increasing spatial inequalities within the country especially at micro-regional level. According to in-depth interviews with local health care stakeholders we defined factors that support access to health care as well as important barriers. The supporting factors are related to the improvement of availability (i.e. infrastructural developments), while geographical distance, lack of material and human resources, or low level of health literacy proved to be the most relevant barriers. Main conclusion is that barriers to accessibility and availability are not only spatial but are also based on individual stages of acute myocardial infarction care. The development of cardiac catheter centres in Hungary has improved the short-term chances of infarction survival, but long-term survival chances have worsened in recent years due to deficiencies in rehabilitation care as well as low level of health literacy.

Subjective expectations regarding longevity and future health: a cross-sectional survey among patients with Crohn's disease.

The aim was to explore the subjective health expectations (sHE) of patients with Crohn's disease (CD) for both the near future and the elderly. A cross-sectional survey was performed in four gastroenterology centres in Hungary. Consecutive outpatients with CD with age ≥18 were recruited. Socio-demographic and disease characteristics were recorded and the Crohn's Disease Activity Index (CDAI), Perianal Disease Activity Index, Patients' Global Assessment (PGA) and current pain visual analogue scale (VAS) were assessed. Subjective life expectancy (sLE) was explored and compared to statistical life expectancy. Current health and sHE for 1year ahead and for ages 60/70/80/90 were assessed using the descriptive system of the EQ-5D-3L. In all, 206 patients (54.9% men) with a mean age of 34.7 (SD 10.5years) and disease duration of 10.5 (SD 6.3) years were studied. The CDAI score was 110.5 (SD 77.0) and 66% were treated by biologic drugs. Mean current EQ-5D-3L score was 0.80 (SD 0.17) and patients expected a 0.05 (SD 0.15) improvement within a year (P<0.05). For ages 60/70/80/90, a mean EQ-5D-3L score of 0.59, 0.38, 0.10 and -0.12 respectively was provisioned. Age, current health status, sLE, PGA and pain VAS showed significant correlation with both 1-year and older age sHE (P<0.05). Long-term sHE and sLE were negatively affected by the presence of extraintestinal manifestations but not by previous CD-related surgery. Patients with CD expect severe deterioration in health in later life. Given that unrealistic sHE may affect patients' current quality of life and health behaviour, we encourage physicians to explore and consider CD patients' sHE in clinical care.

Prognostic factors and overall survival in patients with adrenocortical cancer: Experiences of a single tertiary referral endocrine centre in Hungary (1974–2019)

Prognostic factors and overall survival in patients with adrenocortical cancer: Experiences of a single tertiary referral endocrine centre in Hungary (1974–2019)

Cardamine occulta Hornem. in Hungary, and other stowaways of the ornamental plant trade

During the study of the weed flora of garden centers in Hungary (among 2017–2020), remarkable populations of Cardamine occulta Hornem., a new alien for the Hungarian flora were found. C. occulta was present altogether in 51 of the 53 visited sites. Dominantly the regularly irrigated and continuously moist microhabitats (pots, containers, muddy surfaces of geotextile-covered beds etc.) were colonized. During the revision of our recently collected specimens, deposited in JPU and DE herbaria as Cardamine hirsuta L., further individuals proved to identical with this till overlooked species. One of them (27.08.2004., Heves county: Eger [8088.3; 8188.1], coll. by A. Schmotzer, deposited in DE collection) proved to the third documented occurrence in Europe, comparing to the accessed literature data. Eclipta prostrata (L.) L. and Urtica membranacea Poir. are also new aliens for the Hungarian flora. Several introduced individuals of these taxa were found in containers of imported thermophilous woody ornamentals at 4 and 2 sites, respectively. Tens of individuals of Eclipta prostrata were also found in a sapling-bed at another site. New populations of scarce or rare Euphorbia prostrata Aiton, E. serpens Kunth and Veronica peregrina L. were also documented.