Vizuális analóg skála felhasználásával végzett postoperativ fájdalom vizsgálatának klinikai vonatkozásai thoracotomizált betegeken a Markusovszky Egyetemi Oktatókórház Mellkassebészeti Osztályán.

OBJECTIVE: The authors examined pain after thoracotomies in the Department of Thoracic Surgery, University Teaching Hospital Markusovszky and compared two analgetic methods. PATIENTS AND METHOD: The study was conducted for a period of 10 months, they have processed 268 patients details whose chest were open. The patients were divided in 2 groups: one of them got fentanyl containing plaster which absorbs transdermal as well as intraoperatively applied intercostal bupivacain blockade. The other group got anaesthetic to their epidural space (EDA). On the day of surgery and for two postoperative days they measured the pain with VAS. Time between premedication and surgery, the medications given before and after the surgery, doses and time of administration were all noted. Cases with rib fractures occurring during surgery were followed separately, and the number of broken ribs and the name of the operating surgeon were noted, too. RESULTS: The authors used linear regression and analysis of variance for the collected data. The results showed significant and close to significance relations. The dependent variables were the daily pain on day 0, 1, and 2. These data will be detailed later. CONCLUSIONS: The authors concluded that skin patch containing fentanyl applied around the same time of surgery with intercostal bupivacain injection were effective for pain relief, which was practical for the patient and the nursing staff too. It can be an alternative for the EDA.

Silent chorioamnionitis and associated pregnancy outcomes: a review of clinical data gathered over a 16-year period.

OBJECTIVE: To assess neonatal outcomes and associated findings in pregnant women identified after delivery as having had underlying subclinical chorioamnionitis by either histology or bacterial culture. METHODS: In 16 years, 8974 clinical, histological, and bacterial culture data were obtained retrospectively. RESULTS: Placental histology was analyzed in 4237 pregnancies (2785 term and 1452 preterm) and 4737 amniotic cavity cultures were obtained during 5446 cesarean deliveries (3268 term and 1469 preterm). Histological results and bacterial cultures were both available in 1270 of the preterm deliveries. Histology revealed inflammation, suggestive of infection, in 13.6% of placentas. Subclinical acute chorioamnionic inflammation was confirmed in 142 out of 2785 term pregnancies (5.1%) and in 436 out of 1452 preterm pregnancies (30.0%, P<0.001). Bacteriological culture of the intrauterine cavity was obtained from the lower uterine segment of the uterus during cesarean section. A positive culture was found in 19.9% of all cases (941/4737), this proportion was significantly higher in preterm deliveries (343/1273, 26.9%) than in term (17.3%, P<0.001). The lower the birth-weight or gestational age, the higher the frequency of silent infections in the uterine cavity. CONCLUSIONS: Our study findings support the association between intra-amniotic infections and preterm delivery.

Prevalence and psychosocial background of anxiety and depression emerging during the first trimester of pregnancy: data from a Hungarian population-based sample.

BACKGROUND: There are few surveys of antenatal depression and anxiety in Eastern-European countries. The aim of the present study was to gather prevalence data from a Hungarian sample and to search for associations between antenatal depression/anxiety and some psycho-social variables. SUBJECTS AND METHODS: A population-based monitoring system was created, covering every pregnant woman in the town of Szombathely, Western-Hungary for symptoms of depression and anxiety during the first trimester of pregnancy. Data were gathered in the period February 1, 2008 - February 1, 2010. Five-hundred and three pregnant women were included in the sample under survey. RESULTS: Mean age of our participants was 29.8 yr. (SD=4.94/). One fifth (19.9%; 95%CI = 16.6-23.6) of pregnant women were suffering from mild to severe depression as measured by the Beck Depression Inventory. Frequency of severe depression was low (1.4%). 14.2% of the sample (95%CI =11.5-17.6) showed signs of trait anxiety as measured by the Spielberger Inventory. Mean scores for depression and anxiety proved to be significantly higher among women who were unemployed, less than 20 years of age, having low educational or/and socio-economic status, and displaying higher level of social mistrust. Those living in common-law marriage had more depressive symptoms while reciprocity was associated only to anxiety. CONCLUSIONS: Except for prevalence of severe depression, our data did not differ from prevalence found in market economic countries. Teen age, unfavourable socio-economic conditions and high social mistrust were associated with the emergence of clinically meaningful depression and anxiety during the first trimester of pregnancy.

Screening pregnant women for group B streptococcus infection between 30 and 32 weeks of pregnancy in a population at high risk for premature birth.

OBJECTIVE: To assess the benefits of a chemoprophylaxis program based on screening women for group B streptococcus (GBS) infection between 30 and 32 weeks of pregnancy in a population with a high rate of premature births. METHODS: From 1995 to 2011, 24 950 women were screened for GBS infection between 30 and 32 weeks of pregnancy at Markusovszky Teaching Hospital, Szombathely, Hungary. Those who tested positive, and those who tested negative but were at risk of infecting their newborns, underwent intrapartum prophylaxis. Neonatal outcomes were compared with those of a historical cohort that underwent no screening or treatment, and with those published in CDC/ACOG guidelines recommending screening closer to term. RESULTS: There were 63 infected newborns (0.2%) in the study cohort, and 1 of 8 with sepsis died. There were 149 infected newborns (0.7%) in the historical cohort, and 29 of 31 with sepsis died. CONCLUSION: Screening women early in a population with a high rate of premature births may simplify preterm labor management. It results, however, in a higher incidence of early onset neonatal GBS disease than when screening is done closer to term.

Metabolic syndrome in normal and complicated pregnancies.

BACKGROUND: The aim of our study was to elucidate the association of the metabolic syndrome with the risk of unsuccessful pregnancy. METHODS: This was a retrospective observational study conducted at Markusovszky Teaching Hospital, Szombathely, Hungary, a tertiary health care center. During the study period of 2007-2011 (5 years), 7373 pregnancies were followed. Pregnant women who were suffering from metabolic syndrome in the first trimester of gestation during the study period were compared to all other pregnant women without the syndrome. Retrospectively, 219 (2.9%) patients met the criteria of metabolic syndrome during the first trimester. Our goal was to evaluate the prevalence of the metabolic syndrome in normal pregnancies and in those complicated by either premature birth, or intrauterine growth retardation (IUGR), pregnancy-induced hypertension, and preeclampsia. RESULTS: The rate of preterm birth was 15.2% [32/219 in the metabolic syndrome group vs. 11.1% (p=0.051) in the control group]. Within the affected group, 40 pregnancies were complicated with IUGR (18.4%) versus 3.3%, in the unaffected group (p<0.001). In 58 cases, we observed preeclampsia during pregnancy [26.7% vs. 5.2% (p<0.001)] in the control group. Among the patients affected by the metabolic syndrome, 83 patients (38.2%) had more then one pregnancy complication during pregnancy, and only 59 cases (27.2%) had no adverse events during pregnancy and delivery (p<0.001). CONCLUSIONS: Our study demonstrated a higher rate of complicated pregnancies in association with metabolic syndrome compared to the control group.

Association of lean and fat body mass, bone biomarkers and gonadal steroids with bone mass during pre- and midpuberty.

BACKGROUND/AIMS: The association of bone mass with body composition, bone turnover markers and gonadal steroids was examined in Hungarian children during pre- and midpuberty. METHODS: Two hundred and thirty-seven 7- to 16-year-old subjects (56% girls) were investigated. Bone mineral density (BMD), fat mass and total and appendicular lean mass were estimated with dual-energy X-ray absorptiometry (Lunar Prodigy). The fat mass index and appendicular lean mass index (LMI) were calculated. Serum bone markers, parathyroid hormone, estradiol and testosterone were analyzed. Associations between variables were evaluated by multiple regression analysis. RESULTS: During prepuberty, bone biomarkers, gonadal steroids and appendicular LMI were associated with bone mass in both genders (p < 0.05). During midpuberty, girls' bone turnover markers were negatively associated with bone mass (p < 0.001). In prepuberty, appendicular LMI and ß-crosslaps were predictors of bone mass in both genders. During midpuberty, appendicular LMI and gonadal steroids positively contributed to bone mass in both genders, while osteocalcin exerted a negative influence on total and L1-L4 spine BMD in girls and on L1-L4 BMD in boys (all p < 0.001). CONCLUSIONS: Predictors for bone development varied according to Tanner stage and gender. The most significant determinants of bone mass were appendicular LMI and estradiol.

Histological chorioamnionitis is associated with cerebral palsy in preterm neonates.

OBJECTIVE: To determine the interaction between histological chorioamnionitis and unexplained neonatal cerebral palsy among low birth weight infants. STUDY DESIGN: We studied 141 preterm infants below 1500 g delivered between 2000 and 2010. Clinical data, neonatal neuroimaging, laboratory results, the histopathological features of the placenta and gastric smear within the first hour of delivery, were evaluated. RESULTS: Cerebral palsy was detected in 11 out of 141 preterm newborns (7.8%). The incidence of silent histological chorioamnionitis was 33.6% (43 of 128 cases). Chorioamniontis was significantly associated with the risk of unexplained cerebral palsy (p=0.024). There were also significant correlations between maternal genital infections and chorioamnionitis (p=0.005), and between maternal infections and a positive smear of neonatal gastric aspirates (p=0.000). The rate of cesarean section was 67.4% (95 out of 141 deliveries), and elective cesarean section was performed in 68 cases. CONCLUSION: Intrauterine exposure to maternal infection was associated with a marked increase in the risk of cerebral palsy in preterm infants.

Effects of depression, anxiety, self-esteem, and health behaviour on neonatal outcomes in a population-based Hungarian sample.

OBJECTIVE: To investigate possible associations of maternal antenatal depression, anxiety and self-esteem with negative neonatal outcomes controlling for the effects of demographic covariates and health behaviour in a Hungarian sample. STUDY DESIGN: A population-based monitoring system was established in 10 districts of health visitors in Szombathely, Hungary, covering every woman registered as pregnant between February 1, 2008 and February 1 2009. Three hundred and seven expectant women in the early stage of their pregnancy were surveyed using the Short Form of Beck Depression Inventory for the measurement of depression and the Spielberger Trait-Anxiety Inventory for the measurement of anxiety. Self-esteem was evaluated by the Rosenberg's Self-Esteem Scale. At the end of the follow-up period, data on 261 mothers and their singleton neonates were available. The relationship between the explanatory and outcome variables (birth weight, length, chest circumference, gestational age, and 1- and 5-min Apgar score) was tested in girls and boys separately by multiple linear regression analysis (Forward method). Categorical variables were used as "dummy variables". RESULTS: Maternal depression, anxiety and health behaviour did not show any association with neonatal outcomes. Higher level of maternal self-esteem was associated with higher birth weight and birth length in boys and higher birth length in girls. Maternal education positively correlated with birth length, gestational age and chest circumference in boys, and with birth length in girls. In girls, maternal socioeconomic status showed a positive association with birth weight and gestational age, while common law marriage had a negative effect on birth weight and chest circumference. CONCLUSIONS: Lower level of maternal self-esteem possibly leads to a higher level of maternal stress which may reduce fetal growth via physiologic changes. Gender differences in associations between demographic factors and neonatal outcome measures indicate differences in fetal development between boys and girls.

Association between health beliefs and health behavior in early pregnancy.

Folate-supplementation significantly reduces the risk of neural tube defects. The aim of this research was to reveal associations between health beliefs and folate -supplementation as well as other elements of health behavior among Hungarian women early in their pregnancy. Three-hundred and seven women in early pregnancy completed the second part of Health and Illness Scale. Factor structure of health beliefs was established and associations of factors with pregnancy planning, folate-intake, vitamin-intake, smoking-habits and alcohol-consumption were tested. A six factor health model was formulated; the factor named 'mental capacities and abilities' was associated with greater chance on folate-intake, vitamin-intake and prepared pregnancy, as well as a reduced chance of smoking. The factors 'destiny', 'measures aiming at prevention', and 'relatives and acquaintances' related to lower chance on folate-intake. The health belief factor representing Internal Health Locus of Control was associated with more than one component of healthy behavior, while factors of external dimensions (Powerful Others Health Locus of Control and Chance Health Locus of Control) were predictive on unhealthy behavioral tendencies. New approaches aiming to shift one's health beliefs and health locus of control from external causes to internal dimensions are needed in order to reach greater openness towards health-improving interventions.

[Effect of demographic factors on folate-supplementation and health-behavior of pregnant women]. / Demográfiai tényezôk hatása a várandósok folsavbevitelére és egészség-magatartására.

UNLABELLED: The aim was to scrutinize associations between folate-supplementation and other elements of health-behavior and demographic factors in pregnant women. METHODS: A population-based monitoring system was established in 10 districts of health visitors in Szombathely, Hungary. The system covered every woman registered as pregnant between 1st February 2008 and 1st February 2009. RESULTS: Young age and lower educational level is associated with less preparation for pregnancy. Those who were prepared for pregnancy, folate-intake was more than twofold, vitamin-intake was threefold higher, while prevalence of smoking was the 50% less, compared to non-prepared women . Older age, higher educational and socio-economic level was positively, while number of siblings was negatively associated with folate-supplementation. Pregnant women with low level of education (OR = 4.72; 95% CI = 2.34-9.51), and living in common-law relationships had higher chance to smoke (OR = 2.74; 95% CI = 1.54-4.89). CONCLUSIONS: Pregnant women who do not receive folate-supplementation are younger, have lower educational and socio-economical status and show other unhealthy behavioral tendencies.

Gender differences in antidepressant use-related seasonality change in suicide mortality in Hungary, 1998-2006.

OBJECTIVES: Studies show that the seasonality of suicide (spring/early summer peak, winter low) is mainly the consequence of the seasonal incidence of depression-related suicides. The aim of the present study was to analyse the relationship between increasing antidepressant utilization and national suicide rate of Hungary between 1998 and 2006, with particular regard to seasonal patterns and gender differences. METHODS: Time trend analysis (ARIMA) had been applied to investigate the correlation between the trend of antidepressant prescription and both of suicide rates and seasonality index. RESULTS: During the 9 years of the study period there was a significant (P<0.001) correlation between the steadily increasing antidepressant prescription (113%) and continuous decline in total national suicide rate (23%) as well as both in females and males (21 and 23%, respectively), but this relationship was 8-fold stronger in males. Increasing antidepressant utilization was associated with significantly decreased seasonality of suicides only among males. CONCLUSIONS: The results suggest that decreasing seasonality of suicides could be a good marker of lowering rate of depression-related suicides in the population particularly among males.

Barriers of antenatal folate-supplementation: The role of depression and trait-anxiety on periconceptional folate-intake.

Abstract Objective. The aim of the research was to reveal the effect of antenatal depressive symptoms and trait-anxiety on folate supplementation. Higher levels of depression, and trait-anxiety were hypothesized to be associated with insufficient folate intake among pregnant women in early pregnancy. Methods. Level of depressive symptoms, trait-anxiety, self-esteem, social capital, self-related health, and demographic factors (age, number of siblings, marital, educational, employment, and socioeconomic-status) were established among 185 Hungarian women in the first trimester of their pregnancies. Depressive symptoms and trait-anxiety were evaluated with the Short Hungarian Version of the Beck Depression Inventory and the Hungarian version of the Spielberger State-Trait Anxiety Inventory form Y (STAI-Y). Results. The higher levels of both trait-anxiety and self-esteem decreased the folate-intake significantly, OR=0.925 (95%CI=0.863-0.991; P=0.026) and OR=0.897 (95%CI=0.808-0.996; P=0.041) while depressive symptoms did not have an effect on it. The lower level of education (less than 8 elementary years) had similar effects (OR=0.228 [95%CI=0.064-0.817], P=0,023). The lack of trust had a significant role too (P=0.043): those, who were distrustful with other people, also had a lower chance of supplementation (OR=0.620; 95%CI=0.390-0.986). Conclusions. The way to increase the openness towards folate-supplementation leads through the treatment of psychological disturbances and the restoration of social trust.

[Investigation of adolescents' bone metabolism in the western part of Transdanubia]. / Serdülôk csontanyagcsere-markereinek vizsgálata a nyugat-dunántúli régióban.

UNLABELLED: Childhood reference range based on the age is not available in Hungary, therefore the diagnosis and therapy of bone metabolic diseases of childhood are subject to difficulties. The aim of this work is to provide information about the adolescents' results of bone mineral density and bone biomarkers. SUBJECTS AND METHODS: Measurements were performed in 169 healthy adolescents (98 girls, 71 boys, age: 17.0+/-1.2 years). Bone mineral content (BMC) and bone mineral density (BMD) of the lumbar spine were measured using Double X-ray Absorptiometry (DXA, LUNAR, GE Health Care, USA) and Z-score values were analyzed using different reference population. In the serum, bone biomarkers osteocalcin (OC) and beta-crosslaps (beta-Cl) were measured by a fully automated, electrochemiluminescence immunoassay method (Elecsys-2010, Roche). Data were analyzed according to gender and the Tanner stage and grade system. Associations between body mass index (BMI), calcium intake, consumption of soft drinks and coke, and physical exercise were investigated. RESULTS: BMC values for both age groups were significantly elevated in boys of the Tanner stage V. (15-16 years: 62.9+/-14.3 g; 17-19 years: 69.8+/-9.3g) than in girls (58.1+/-10.4; 61.6+/-8.5 g) (p<0.001). BMD values were higher in girls, than in boys (1.17+/-0.12 g/cm 2 vs. 1.13+/-0.11 g/cm 2) (p<0.05). OC and beta-Cl levels showed negative correlation with age in both gender (p<0.01), while OC and beta-Cl levels were higher in boys, than in girls (p<0.001). Elevation of BMC and BMD values were associated with increase of BMI in both gender (p<0.05), but the biomarkers in thin girls were higher, than in overweight girls (p<0.05). Authors obtained excellent correlations between the BMD-Z-score values compared to the German standard and to their own population (girls: r=0.97, boys: 0.88), but the absolute values significantly differed from one another. 80% of adolescents are on a diet with insufficient calcium intake, while 38% of them do not play sport regularly. Excessive intake of soft drinks was determined in 60% of adolescents. In the case of insufficient calcium intake (4.7%, 6/127), low bone mass was measured using the Z-score of the German reference values. Among children with adequate calcium intake, BMD assessed by DXA was normal. CONCLUSION: These data help to determine normal reference values among healthy high school students. Further studies are needed in wider range of young population for the establishment of Hungarian reference values of bone markers.

[Prevalence of depression and anxiety in early pregnancy on a population based Hungarian sample]. / Várandósság alatti depresszió és szorongás gyakorisága az elso trimeszterben hazai mintán.

UNLABELLED: In Hungary, no survey has been conducted so far concerning of the incidence of depression and anxiety during pregnancy. AIM: Besides determining missing data, the aim was to scrutinize their socio-demographic relations. METHODS: A population-based monitoring system was established in 10 districts of health visitors in Szombathely. The system covered every woman who was registered as pregnant between 1st February 2008 and 1st February 2009. 307 expectant women in the early stage of their pregnancy were surveyed using the Short Form of Beck Depression Inventory, which enabled the measurement of depression whereas the Spielberger Trait-Anxiety Inventory was used for the measurement of anxiety. RESULTS: 17.9% (95%CI: 13.0-21.5%) of pregnant women showed signs of depression, 1.0 % of whom had severe depression. 14.6% of them showed signs of anxiety (95%CI: 10.7-18.6%), moreover, 4.2 % of them had explicit angst. Depression and anxiety proved to be significantly more prevalent among unskilled workers, those with low incomes and unemployed women. Depression turned out to be significantly more prevalent among women under the age of 18, and those living in common-law relationships. CONCLUSIONS: In the examined sample, prevalence of depression and anxiety during early pregnancy basically coincides with the situation in developed countries.

[The metabolic syndrome and the risks of unfavourable outcome of pregnancy]. / Metabolikus tünetegyüttes és egyes szülészeti szövodmények kapcsolata.

UNLABELLED: The metabolic syndrome is defined by abdominal obesity, elevation of blood pressure, fasting glucose and triglycerides and low levels of high-density lipoprotein cholesterol. The metabolic syndrome may play an important role in the pathogenesis of unsuccessful pregnancy, by including a pro-inflammatory and prothrombotic state. Some authors have suggested that in case of metabolic syndrome the LMW heparin therapy given from the time of conception has a favourable effect. The aim of our study was to elucidate the association of the metabolic syndrome with the risk of unsuccessful pregnancy. DESIGN AND METHODS: During the study period 2005-2008 (4 years) we followed 5869 pregnancies. Retrospectively, 172 (2.9%) patients met the criteria of metabolic syndrome at the time of the first trimester. RESULTS: The rate of premature birth was 15.1% [26/172 in the metabolic syndrome group vs. 11.7%; OR: 1.52 (95% CI: 0.996-2.33) p=0.051], in control group. Within the affected group 32 pregnancies were complicated with intrauterine grow retardation (18.6%); versus 3.6%, in the unaffected group; OR: 6.38 (95% CI: 4.24-9.61 p<0.001). In 47 cases we observed preeclampsia during pregnancy [27.3%; vs. 4.7%; OR: 7.93 (95% CI: 5.54-11.33) p<0.001] in the control group. Among the patients affected by the metabolic syndrome 67 patients (38.2%) had more then one pregnancy complications during pregnancy, and only 47 cases (27.3%) were lacking adverse events during pregnancy and delivery [OR: 3.11 (2.27-4.26) p<0.001]. CONCLUSIONS: Our study demonstrated higher rate of complicated pregnancies in association with metabolic syndrome compared to the control group. In addition, we started a prospective study in 2007, using LMWH therapy to prevent thromboplastic and atherosclerotic effects of the metabolic syndrome. The study is planned to be reported in 2010 to assess the effect of LMWH therapy on the outcome of pregnancies.