Pharmacogenomic biomarker information differences between drug labels in the United States and Hungary: implementation from medical practitioner view.

Pharmacogenomic biomarker availability of Hungarian Summaries of Product Characteristics (SmPC) was assembled and compared with the information in US Food and Drug Administration (FDA) drug labels of the same active substance (July 2019). The level of action of these biomarkers was assessed from The Pharmacogenomics Knowledgebase database. From the identified 264 FDA approved drugs with pharmacogenomic biomarkers in drug label, 195 are available in Hungary. From them, 165 drugs include pharmacogenomic data disposing 222 biomarkers. Most of them are metabolizing enzymes (46%) and pharmacological targets (41%). The most frequent therapeutic area is oncology (37%), followed by infectious diseases (12%) and psychiatry (9%) (p < 0.00001). Most common biomarkers in Hungarian SmPCs are CYP2D6, CYP2C19, estrogen and progesterone hormone receptor (ESR, PGS). Importantly, US labels present more specific pharmacogenomic subheadings, the level of action has a different prominence, and offer more applicable dose modifications than Hungarians (5% vs 3%). However, Hungarian SmPCs are at 9 oncology drugs stricter than FDA, testing is obligatory before treatment. Out of the biomarkers available in US drug labels, 62 are missing completely from Hungarian SmPCs (p < 0.00001). Most of these belong to oncology (42%) and in case of 11% of missing biomarkers testing is required before treatment. In conclusion, more factual, clear, clinically relevant pharmacogenomic information in Hungarian SmPCs would reinforce implementation of pharmacogenetics. Underpinning future perspective is to support regulatory stakeholders to enhance inclusion of pharmacogenomic biomarkers into Hungarian drug labels and consequently enhance personalized medicine in Hungary.

[Risk adjusted capitation is the basis for general practitioners' renumeration]. / A korkorrigált fejkvóta (kapitáció) a háziorvosi (alapellátási) finanszírozás alapja.

The health care renumeration poses a great challenge for both politicians and policymakers. During the beginning of the 1990s, following the end of communism in Hungary, the reform of health care began with the introduction of the primary health care (PHC), specifically with general practitioner (GPP)/family medicine (FM) care. The basis of the renumeration was the age-adjusted capitation built upon the free choice of doctors, while social security renumeration was built on a mixed system. Several pros and cons have been highlighted, but the underlying principle has proved to be simple and effective. Comparison of the European and Hungarian characteristics, analysis of data in the present patient care report as well as in the years preceding the release of the aforementioned document, these confirm that the method of capitation-based remuneration is a fundamental, easy, and unmanipulable method. It places minimal weight on social security and comes with little costs. Orv Hetil. 2019; 160(27): 1057-1063.

[One-year persistence of fixed-dose combinations of angiotensin-converting enzyme inhibitor and calcium channel blocker in hypertensive patients]. / Az angiotenzinkonvertálóenzim-gátló/kalciumcsatorna-blokkoló fix gyógyszer-kombinációk egyéves perzisztenciája hypertoniában.

INTRODUCTION: The most recent European guidelines for the treatment of hypertension suggest the use of renin-angiotensin-aldosterone system antagonists (RAAS inhibitors) and calcium channel blockers (CCBs) or diuretics fixed-dose combinations (FDCs) as the first therapeutic option. In antihypertensive therapy, the patient's adherence is one of the most important factors in reducing unwanted cardiovascular events. AIM: Our aim was to assess the one-year persistence of angiotensin-converting enzyme inhibitor (ACEI) and CCB FDCs in hypertensive patients. METHOD: Authors have analysed the prescription database of the National Health Insurance Fund in Hungary on pharmacy claims between October 1, 2012 and September 30, 2013. Those patients were identified who filled prescriptions for FDCs of ACEI and CCBs prescribed for the first time for hypertensive patients and who had not received similar drugs during the year before. Apparatus of survival analysis was used, where 'survival' was the time to abandon the medication. RESULTS: 124 388 patients met the inclusion criteria. One-year persistence rate and hazard ratio (HR) of discontinuation in patients with ramipril/amlodipine FDC was 54% (HR = 1.00, reference), perindopril/amlodipine 47% (HR = 1.30, p<0.0001), lisinopril/amlodipine 36% (HR = 1.79, p<0.0001), ramipril/felodipine 26% (HR = 2.28, p<0.0001) and trandolapril/verapamil 12% (HR = 4.13, p<0.0001). The average survival time of drug limited to 360 days was 270.2 days for ramipril/amlodipine FDC, 242.7 days for perindopril/amlodipine FDC, 211.2 days for lisinopril/amlodipine FDC, 186.3 days for ramipril/felodipine FDC and 125.7 days for trandolapril/verapamil FDC. CONCLUSIONS: The authors demonstrated that the one-year persistence of ACEI/CCB FDCs was significantly different in hypertensive patients. Ramipril/amlodipine FDC was more advantageous for patient adherence. Orv Hetil. 2019; 160(9): 343-348.

[A model, by making common task force out of scientific organisation, the academic sector and governmental institute, was realised in Hungary to support the specific family physician training and to implement research and development projects in the primary healthcare. Part I]. / Tudományos szakmai szervezet, az akadémiai szektor és országos intézet összefogásának modellje a családorvos-szakképzés, az alapellátás kutatás-fejlesztési színterein. I. rész.

It is internationally recognized that the best method for practicing general medical care is family medicine, based on the correct relationship between the physician and the patients/families, where the principles of disease prevention and patient care meet, and the cost-benefit rates are better. In Hungary, a major part of the health reform had been the advancement of a primary care system by the international standards of modern family medicine. The Scientific Association of the Hungarian General Practitioners (SAHGP), founded in 1967, has adviced - from its onset - to introduce a new, independent medical specialty named 'general practice' which was finally realised in 1974. That was followed, according to the Welfare Ministry Order No. 6/1993, by the specific training program for general practice which prescribed, also for the in-service GP-s, to complete an individual postgraduate training, to be ended by a state specialty exam in family practice, under conduction of the regional medical schools. Furthermore, for strengthening the primary healthcare, in 1998 the government established - uniquely in Europe - the National Institute of Primary Healthcare (NIPHC). So a unique task force has gained shape which included the academic sector, the professional NGO and the governmental background institution in order to manage: 1) human resource supply in PHC, 2) to implement statewide professional and public health goals as well as 3) to manage research and development projects. This paper takes a look back at the early events of this process as well as tries to offer an insight into the results and conclusions of the performed research projects, highlighting those which can be potentially usable in further professional development of the Hungarian PHC. Orv Hetil. 2018; 159(32): 1310-1316.

[Adverse effects of long-term proton-pump inhibitor therapy on adults]. / A hosszú távú protonpumpagátló kezelés következményei felnotteken.

In the last few decades, proton-pump inhibitors have become the mainstay of the treatment of acid-related disorders. Despite their efficacy, these drugs are not without risks. Recently several articles have been published on their long-term adverse effects. Among these adverse effects, the higher risk of bone fractures, the vitamin B12 and magnesium deficiencies and the higher risk of Clostridium difficile infection may be relevant. As these drugs are prescribed more and more frequently all over the world, the knowledge of the long-term adverse effects is very important not only for the specialists but for the general practitioners as well. In this review, the authors discuss the recent findings in this field, emphasising that the long-term use of these drugs must be based on an adequate and strong indication. Orv Hetil. 2018; 159(19): 735-740.

CYP2C9 and VKORC1 in therapeutic dosing and safety of acenocoumarol treatment: implication for clinical practice in Hungary.

The purpose of this work was to investigate the contribution of CYP2C9 and VKORC1 to acenocoumarol (AC) dose variability, bleeding events in Hungary. The study recruited 117 patients on long-term AC therapy (INR 2-3), and 510 healthy individuals to model the findings. Patients were genotyped for alleles proved to affect lower AC overdose CYP2C9*2, CYP2C9*3, VKORC1*2. Additionally, we tested VKORC1*3, VKORC1*4 to examine their effect in patients with higher AC requirements. Most impact on dose reduction is accountable for CYP2C9*2/*3 (59%) and for VKORC1*2/*2 (45.5%), and on dose increase for newly evaluated VKORC1*3/*4 (22.5%) diplotypes. VKORC1*3 and *4 alleles seem to balance the dose-reducing effect of VKORC1*2 allele. Being a carrier of combination of VKORC1*2 and CYP2C9*2,*3 polymorphisms, rather than of one of these SNPs, is associated with higher risk of over-anticoagulation (up to 34.3%) in long-term AC treatment. The pharmacogenetic dosing algorithm involving VKORC1, CYP2C9 diplotypes and age explains 30.4% of AC dosing variability (p<6.10×10-9). Correlation between the studied diplotypes and bleeding events could not be revealed.

[The role of primary care professionals in preventive activitites during epidemics. Focus group assessment of the management of flu pandemic in 2009/2010]. / Az alapellátásban dolgozó orvosok és munkatársaik preventív szerepe járványok idején. Fókuszcsoportokra alapozott szakmapolitikai hatáselemzés a 2009/2010. évi H1N1 influenza-világjárvány tapasztalatairól.

INTRODUCTION: The experiences gained during the H1N1 flu pandemic in 2009/2010 could serve for a better planning and management of later outbreaks. AIM: The EU-sponsored TELL ME project aimed to provide evidence and develop models for improved risk communication during infectious disease crisis. Among its objectives was to develop original communication strategies regarding appropriate messages related to preventative behavior and advice based on uncertainties also addressing vaccine-resistant groups. METHOD: Focus groups involving family physicians (FPs) were called upon for assessing the main issues during the H1N1 pandemic, the possibilities for improving the preventative process and outcomes. RESULTS: The study demonstrated the key-role of family doctors during outbreaks; patients put their trust in their elected FP, he or she representing a personal example of health behavior. The evidence based information about effectiveness and safety of vaccines are needed in communication towards health professionals. CONCLUSIONS: Involvement of health care professionals in the communication provides validity, the communication routine of opinion leaders meant to be used for such purpose. The main media message should be: "For prevention go to see your family doctor". Orv. Hetil., 2017, 158(14), 523-532.

Role of health care professionals in preventative activities and vaccination programs during outbreaks.

PURPOSE: The general purpose of TELL ME study was to give an insight into the experiences of European family physicians with management of H1N1 pandemic flu. METHODS: Qualitative research methods (focus group discussions, one-to-one interviews, and online data collection) were used to explore family doctors' opinion and suggestions. Overall 158 family physicians took part in the study from six European countries. RESULTS: Family doctors' most important experience was that the official campaign was not able to compensate negative effects of the mass media. Due to the poor evidence-based information about new vaccines, it was difficult to convince the public and some health care professionals too. Lack of unified directives - under unclear circumstances - made the routine patient care more difficult and hampered the collaboration between different health care providers. Family physicians felt a pressure from health authorities to achieve high immunization rate, but got only a little support from them. Despite the difficulties, vaccination program was a success, mainly among high-risk population. For better handling of a future pandemic, Hungarian family physician made many general and practical suggestions.

[Palliative care in non-cancer, chronic, progressive diseases]. / Nem daganatos, krónikus progresszív betegségek palliatív ellátása.

Malignant and other chronic diseases cause the death of 2.5 million people in Europe annually. It is anticipated that this number will grow due to the aging of the European population. The death of a significant proportion of patients having progressive chronic disease is preceded by an extended end of life stadium. In this stage the patients have severe symptoms and pain that necessitate their symptomatic treatment and palliative care. The assessment of the life expectancy of patients, estimation of the prognosis of their illness and, therefore, selection of patients with a need of intensified palliative care often pose difficulties. This paper provides a summary on the basic elements of "good palliative care". It introduces the most frequent models for the procession of chronic diseases and those indicators that help practicing doctors to recognise easier patients with a need of intensified palliative care, and as a result provides more adequate medical attendance that is better suited to the specific needs of the patients.

Perceptions of quality in primary health care: perspectives of patients and professionals based on focus group discussions.

BACKGROUND: The EUprimecare project-team assessed the perception of primary health care (PHC) professionals and patients on quality of organization of PHC systems in the participating countries: Estonia, Finland, Germany, Hungary, Italy, Lithuania and Spain. This article presents the aggregated opinions, expectations and priorities of patients and professionals along some main dimensions of quality in primary health care, such as access, equity, appropriateness and patient- centeredness. METHODS: The focus group technique was applied in the study as a qualitative research method for exploration of attitudes regarding the health care system and health service. Discussions were addressing the topics of: general aspects of quality in primary health care; possibilities to receive/provide PHC services based on both parties needs; determinant factors of accessibility to PHC services; patient centeredness. The data sets collected during the focus group discussions were evaluated using the method of thematic analysis. RESULTS: There were 14 focus groups in total: a professional and a patient group in each of the seven partner countries. Findings of the thematic analysis were summarized along the following dimensions: access and equity, appropriateness (coordination, continuity, competency and comprehensiveness) and patient centeredness. CONCLUSIONS: This study shows perceptions and views of patients in interaction with PHC and opinion of professionals working in PHC. It serves as source of criteria with relevance to everyday practice and experience. The criteria mentioned by patients and by health care professionals which were considered determining factors of the quality in primary care were quite similar among the investigated countries. However, the perception and the level of tolerance regarding some of the criteria differed among EUprimecare countries. Among these dissimilar criteria we especially note the gate-keeping role of GPs, the importance of nurses' competency and the acceptance of waiting times. The impact of waiting time on patient satisfaction is obvious; the influence of equity and access to PHC services are more dependent on the equal distribution of settings and doctors in urban and rural area. Foreseen shortage of doctors is expected to have a substantial influence on patient satisfaction in the near future.

[The significance of early diagnosis of cancer-related hypercalcaemia]. / Malignitáshoz társuló hypercalcaemia korai felismerésének jelentosége.

Cancer-related hypercalcaemia is one of the most common life-threatening metabolic disorders. It occurs in 20% to 30% of patients with cancer during the course of the disease, which depends on tumour type, too. There are two types of cancer-related hypercalcemia: humoral hypercalcemia and local osteolytic hypercalcaemia. Malignant hypercalcaemia is mediated by several circulating factors secreted by malignant cells. The biological actions of these factors are primarily stimulation of osteoclasts to resorb bone and, secondly, stimulation of calcium reabsorption at the renal tubules resulting in an elevation of serum calcium level. Diagnosis of hypercalcaemia is relatively difficult due to the non-specific clinical signs as well as the underlying malignancy and the side-effects of palliative medical treatment. Consequently, cancer-related hypercalcaemia is underdiagnosed quite often. Unrecognised malignant hypercalcaemia can lead to death. Nowadays 90% of hypercalcaemia can be treated with administration of intravenous saline containing fluids and bisphosphonates. Literature data suggest that hypercalcaemia is treated in less than 40% of hospitalized patients properly due to diagnostic errors and mismanagement.

Prevalence of undiagnosed abnormal glucose tolerance in adult patients cared for by general practitioners in Hungary. Results of a risk-stratified screening based on FINDRISC questionnaire.

BACKGROUND: The prevalence of type 2 diabetes mellitus is rapidly increasing, worldwide and also in Hungary. Timely diagnosis and early treatment could be aided by targeted screening. Recognizing this, the Hungarian Diabetes Association initiated a risk-stratified screening with the involvement of primary care physicians. MATERIAL/METHODS: In the first phase of screening, the FINDRISC questionnaire was completed, followed by an oral glucose tolerance test (OGTT) for those with a score of ≥12. Between September 1, 2010 and March 31, 2011, 70,432 non-diabetic adults, who visited their general practitioners for any reason, were involved in the screening. Of these, 68,476 questionnaires proved to be suitable for processing. RESULTS: From the questionnaires, 28,077 (41.0%) had a score of ≥12. A valid OGTT was performed in 22,846 cases; of this group 3,217 subjects (14.1%) had elevated fasting glucose levels, 5,663 (24.8%) had impaired glucose tolerance, and 1,750 (7.6%) had manifest, previously undiagnosed, diabetes mellitus. Overall, from the valid OGTT group, 46.5% subjects had some degree of glucose intolerance. CONCLUSIONS: Based on the FINDRISC questionnaire, the risk-stratified screening for diabetes mellitus proved to be simple and cost-effective method for the early detection of carbohydrate metabolism disorders. Using this method, the prevalence rate of previously undiagnosed abnormal glucose tolerance was high in adult patients cared for by general practitioners in Hungary.

The effect of sulphurous water in patients with osteoarthritis of hand. Double-blind, randomized, controlled follow-up study.

The aim of the study was to demonstrate the effectiveness of sulphurous water in patients with osteoarthritis of the hand. Forty-seven patients with osteoarthritis of the hand were enrolled into the double-blind, randomized, controlled study, satisfying ACR criteria. One group of the patients (n = 24) received balneotherapy, bathing in sulphurous thermal water for 20 min per occasion, 15 times in all during a period of 3 weeks. The control group (n = 21) had a bath exclusively in warm tap water. Assessments were carried out in both groups on four occasions: at the beginning and at the end of the treatment, and 3 and 6 months after the beginning of the treatment. The parameters studied were the following: pain in the hand, morning stiffness in the joints, grip strength of both hands, and Health Assessment Questionnaire Disability Index (HAQ) and AUSCAN Hand Osteoarthritis Index and EuroQol quality of life questionnaire. At the end of treatment, the improvement was more pronounced in the patient group treated with the sulphurous water. After 3 months, significant improvement could be detected in all parameters, except the morning stiffness and EQ5D. After 6 months, the values of pain, HAQ and AUSCAN continued to be significantly better in comparison with the baseline values. The improvement in quality of life was significant only at the end of the treatment, 6 months later not any longer. The difference between the two groups was significant after 3 months in point of pain and EQVAS. Balneotherapy and within this the sulphurous spa water alone may be effective for the attenuation of pain in patients with hand osteoarthrosis.

Correlations between prescription of anti-hypertensive medication and mortality due to stroke.

BACKGROUND: One of the most important risk factors for stroke is hypertension. A number of studies have attempted to identify the most effective anti-hypertensive therapeutic group for stroke prevention. Using an epidemiologic approach we aimed to find correlations based on Hungarian data on stroke-mortality and on prescription routine of anti-hypertensive therapeutics in three different counties, showing significant difference in stroke mortality. METHODS: We have used the official yearly reports on stroke-mortality for the period 2003-2008. Based on the significant differences in the change in mortality due to stroke three counties were selected: Baranya, Bekes and Hajdu-Bihar. The usage of antihypertensive therapeutic groups was analyzed. The correlation of stroke mortality difference and different antihypertensive treatment habits was analyzed by using normality test, time series analyses, correlation coefficient, paired samples test, one sample test and chi-square test. RESULTS: For the year 2003 stroke-mortality standardized with the county population number was highest in county Bekes, followed by county Baranya and county Hajdu-Bihar. For each year stroke mortality has shown significant (p < 0.0001) difference between the three counties and the ranking/order of the counties has been preserved over time. During the period of our study, an increase in the number of days of treatment was observed for most of the anti-hypertensive drugs listed. We have observed that the increased use of high-ceiling diuretics resulted in a mortality advantage, and the reduction in use of calcium channel blockers with direct cardiac effect had negative consequences. CONCLUSIONS: The authors acknowledge that by limiting the study to three counties the findings cannot be generalized to the whole Hungarian population. Two trends can still be identified:i) increased number of days of treatment (and therefore the probable use) of high-ceiling diuretics is associated with reduction in mortality due to stroke and its immediate complications; ii) reduction in the use of non-dihidropiridin CCBs does not seem justified, as their use appears to be advantageous in stroke prevention. Authors put emphasis on the importance of the adherence of the patients to the preventive therapies. Health care professionals could provide an important added value to the life long preventive therapies by improving the compliance of their patients, giving personalized care and advice.

Recurrent arterial thrombosis associated with the antithrombin basel variant and elevated lipoprotein(a) plasma level in an adolescent patient.

Both myocardial infarction and ischemic stroke are rare in the young. Yet a 15-year-old male patient suffered a myocardial infarction and later an ischemic stroke despite uninterrupted antiplatelet therapy. His medical history involved the surgical correction of an incomplete atrioventricular canal defect at the age of 13 years. No cardiovascular risk factors other than elevated lipoprotein(a) level could be identified. His antithrombin (AT) activity was decreased and DNA sequence analysis revealed heterozygosity for AT Basel (p.Pro41Leu), a variant with impaired heparin binding. This report supports a possible additional pathophysiological role for AT Basel and elevated lipoprotein(a) level in arterial thrombogenesis.

Effect of glutathione-S-transferase M1 and T1 allelic polymorphisms on HPV-induced cervical precancer formation.

AIM: The effect of GSTM1 and GSTT1 allelic polymorphisms was studied on the HPV-induced cervical carcinogenesis. PATIENTS AND METHODS: Two hundred and fifty-three women with persistent high-risk HPV infection were involved in the study; 117 of them developed cervical high-grade dysplasia and/or cervical intraepithelial neoplasia grade III during the 7-year follow-up period. Occurrence of GSTM1 and GSTT1 null genotypes was compared between women with and without dysplasia. RESULTS: Presence of GSTM1 (OR=1.78, 95% CI=1.06-2.97; p=0.028) and GSTT1 (OR=1.89, 95% CI=1.10-3.26; p=0.022) null genotypes was statistically significantly more frequent among women with cervical dysplasia than in the group without dysplasia. Participants with dual null genotype had an even more elevated risk of precancerous lesion (OR=2.35, 95% CI=1.17-4.73; p=0.017). CONCLUSION: Our study demonstrated the role of both GSTM1 and T1 null genotypes in the development of high-grade cervical dysplasia in a Caucasian population.

Continued improvement of cardiovascular mortality in Hungary--impact of increased cardio-metabolic prescriptions.

BACKGROUND: During the last 35 years the poor ranking of Hungary on the list of life expectancy at birth among European countries, has not changed. In 1970 our lag behind the leading European countries was the smallest. The gap was growing between 1970 and 1993 but from 1994 onwards the life expectancy at birth in Hungary has increased continuously and somewhat faster than in other European countries. The aim of this study was to analyze the association between decreasing cardiovascular mortality rates, as a main cause of death and the increase in cardio-metabolic prescriptions and possible changes in lifestyle behavior. METHODS: Analyses were conducted on national data concerning cardiovascular mortality and the number of cardio-metabolic drug prescription per capita. The association between yearly rates of cardiovascular events and changes in antihypertensive, antilipidemic and antidiabetic prescription rates was analyzed. The changes in other cardiovascular risk factors, like lifestyle were also considered. RESULTS: We observed a remarkable decline of mortality due to stroke and acute myocardial infarction (AMI). The fall was significantly associated with all prescription rates. The proportion of each treatment type responsible for suppression of specific mortality rates is different. All treatment types comparably improved stroke mortality, while antilipidemic therapy improved AMI outcome. CONCLUSIONS: These results emphasize the importance of a comprehensive strategy that maximizes the population coverage of effective treatments. Hungary appears to be at the beginning of the fourth stage of epidemiologic transition, i.e. it has entered the stage of delayed chronic noninfectious diseases.

Determinants of health-promoting lifestyle behaviour in the rural areas of Hungary.

Today chronic non-communicable diseases are the major cause of death and disability worldwide. Chronic diseases are determined by common risk factors (e.g. smoking). The purpose of this study was to develop a health-promoting behaviour index, and to evaluate the impact of the social and the demographic characteristics of the individuals, self-rated health and certain features of settlements on the score of this index. A population-based, cross-sectional health survey was conducted. Altogether 91 settlements with various sizes of population, and at various stages of social, economic and infrastructural development took part in the survey. The survey was based on interviewer-administered questionnaires, 3380 subjects filled in the questionnaires correctly, and the response rate was 82.4%. Questions on lifestyle factors referred to smoking, nutritional habits and physical activity. Low level (5.5%) of people have achieved the 'complete' health-promoting behaviour, including non-smoking, healthy nutrition and physical activity. There were significant associations between health-promoting behaviour and demographic, social and economic characteristics of the individuals and their dwelling place. The lower prevalence of healthy lifestyle activities among lower educated, lower income and aged people living in small settlements call the attention to the higher risk of these people. On planning interventions, special attention should be paid to the geographically, infrastructurally, socially and demographically disadvantaged population groups to provide equal opportunities for them, to live a healthy way of life. The application of the health-promoting index might be used to monitor the effects of interventions to alter lifestyle at community level.

The effect of balneotherapy on C-reactive protein, serum cholesterol, triglyceride, total antioxidant status and HSP-60 levels.

An increasing body of evidence substantiating the effectiveness of balneotherapy has accumulated during recent decades. In the present study, 42 ambulatory patients (23 males and 19 females, mean age 59.5 years) with degenerative musculoskeletal disease were randomised into one of two groups-bathing in tap water or in mineral water at the same temperature-and subjected to 30-min balneotherapy sessions on 15 occasions. Study parameters comprised serum levels of sensitised C-reactive protein (CRP), plasma lipids, heat shock protein (HSP-60) and total antioxidant status (TAS). In both groups, CRP levels followed a decreasing tendency, which still persisted 3 months later. At 3 months after balneotherapy, serum cholesterol levels were still decreasing in patients who had used medicinal water, but exhibited a trend towards an increase in the control group. Triglyceride levels followed a decreasing trend in both patient groups. TAS showed a declining tendency in both groups. No changes of HSP-60 levels were observed in either group. Balneotherapy with the thermal water from Hajdúszoboszló spa had a more pronounced physiological effect compared to that seen in the control group treated with tap water in a 3 month period.