Plasma Somatostatin Levels Increase during Scoliosis Surgery, but Not Herniated Disc Operations: Results of a Pilot Study.

Somatostatin (SST) released from capsaicin-sensitive sensory nerves in response to stimulation exerts systemic anti-inflammatory, analgesic actions. Its elevation correlates with the extent of tissue injury. We measured plasma SST alterations during spine operations (scoliosis and herniated disc) to determine whether its release might be a general protective mechanism during painful conditions. Sampling timepoints were baseline (1), after: soft tissue retraction (2), osteotomy (3), skin closure (4), the following morning (5). Plasma SST-like immunoreactivity (SST-LI) determined by radioimmunoassay was correlated with pain intensity and the correction angle (Cobb angle). In scoliosis surgery, postoperative pain intensity (VAS 2.) 1 day after surgery significantly increased (from 1.44 SEM ± 0.68 to 6.77 SEM ± 0.82, p = 0.0028) and positively correlated with the Cobb angle (p = 0.0235). The baseline Cobb degree negatively correlated (p = 0.0459) with the preoperative SST-LI. The plasma SST-LI significantly increased in fraction 3 compared to the baseline (p < 0.05), and significantly decreased thereafter (p < 0.001). In contrast, in herniated disc operations no SST-LI changes were observed in either group. The VAS decreased after surgery both in the traditional (mean 6.83 to 2.29, p = 0.0005) and microdiscectomy groups (mean 7.22 to 2.11, p = 0.0009). More extensive and destructive scoliosis surgery might cause greater tissue damage with greater pain (inflammation), which results in a significant SST release into the plasma from the sensory nerves. SST is suggested to be involved in an endogenous postoperative analgesic (anti-inflammatory) mechanism.

Deconvolution Analysis of the Non-Ionic Iomeprol, Iobitridol and Iodixanol Contrast Media-Treated Human Whole Blood Thermograms: A Comparative Study.

To study the effect of non-ionic contrast media on anticoagulated and non-anticoagulated human whole blood samples, calorimetric measurements were performed. The anticoagulated plasma showed the greatest fall in the total ΔH after Iodixanol treatment. The plasma-free erythrocytes revealed a pronounced shift in the Tmax and a decrease in the ΔH of hemoglobin and transferrin. The total ΔH of Iodixanol treatment showed the highest decline, while Iomeprol and Iobitridol had fewer adverse effects. Similarly, the non-anticoagulated samples revealed a decrease both in the Tmax and the ΔH of albumin and immunoglobulin-specific transitions. The total ΔH showed that Iodixanol had more influence on the serum. The serum-free erythrocyte samples resulted in a significant drop in the Tmax of erythrocyte and transferrin (~5-6 °C). The ΔH of deconvolved hemoglobin and transferrin decreased considerably; however, the ΔH of albumin increased. Surprisingly, compared to Iomeprol and Iobitridol treatments, the total ΔH of Iodixanol was less pronounced in the non-anticoagulated erythrocyte samples. In sum, each non-ionic contrast medium affected the thermal stability of anticoagulated and non-anticoagulated erythrocyte proteins. Interestingly, Iodixanol treatment caused more significant effects. These findings suggest that conformational changes in blood components can occur, which can potentially lead to the increased prevalence of cardiovascular dysfunctions and blood clotting.

Developing intercultural competences for more effective patient care and international medical and research collaborations / Interkulturális kompetenciák fejlesztése a hatékonyabb betegellátás és a nemzetközi gyógyító és kutatói együttmuködések érdekében

Introduction: In our globalised world, the role of intercultural competence in healthcare is increasing as societies become multicultural. The development of this competence should start in medical education. Objective: In our qualitative study among Hungarian medical students, we sought to find out to what extent the multicultural student composition of our elective course contributes to the development of their intercultural competence. Method: In our action research, semistructured focus group interviews were conducted with 35 Hungarian medical students between April and November, 2021. The transcripts of the digitally recorded interviews were evaluated using qualitative methods. Results: After a thematic analysis of the interviews, the vast majority of the students' opinions could be classified into one of the following four thematic categories: 1) the benefits of studying together with international students, 2) the development of cultural awareness, 3) the development of an open mindset, and 4) the expected longterm impact of intercultural competence on medical work. Overall, Hungarian students evaluated their learning in the multicultural course positively. Based on the results of the focus group interviews, it can be claimed that by the end of the semester, the Hungarian students' perceived intercultural competence had improved due to the course and its multicultural composition. Conclusion: The course, with its multicultural student population, can contribute to and promote the acquisition of intercultural competence, which in the long run can be effectively used by future doctors both in patient care and in effective communication within healthcare teams as well as in international medical, research and scientific collaborations. Providing a multicultural student environment in the classroom, including interactive teaching methodologies and intercultural project work, have many potentials to make the learning-teaching process more effective and could be applied in the future when developing new courses.

Accepting cultural differences in the integration of foreign medical students / Kulturális különbözoségek elfogadása a külföldi orvostanhallgatók beilleszkedésében.

Összefoglaló. Bevezetés: A 21. századra a multikulturális társadalmi közegben az interkulturális tudás, mint készség, fokozott mértékben válik kulcskompetenciává. E társadalmi kompetencia elsajátításának egyik lehetséges területe a nemzetközi hallgatói mobilitás, mely világszerte, így hazánkban is, egyre nagyobb jelentoségu. Célkituzés: Magyar és külföldi hallgatók körében folytatott vizsgálatunk fókuszában a beilleszkedési folyamatoknak, valamint az interkulturális kompetencia és érzékenység kialakulásának és fejlodésének vizsgálata állt, a Pécsre érkezo mintegy 60 különbözo kultúra, valamint a magyar befogadó közeg vonatkozásában egyaránt. Kutatásunk során többek között arra kerestünk választ, hogy az eredeti és a befogadó kultúra közötti különbségek mely területeken nyilvánulnak meg a leginkább, illetve egy másik kultúrához történo alkalmazkodás során milyen beilleszkedést lassító vagy támogató tényezok tárhatók fel. Módszer: Kutatásunkban kvantitatív és kvalitatív módszereket alkalmaztunk, önkitöltéses kérdoíves felmérés, valamint fókuszcsoportos interjúk formájában. A PTE ÁOK német, angol és magyar nyelvu általánosorvos-képzésében részt vevo hallgatókat a 2010 és 2018 közötti idoszak tavaszi szemesztereiben saját fejlesztésu, anonim, önkéntesen kitöltheto kérdoívvel kerestük meg (a kitöltött kérdoívek száma: n = 13 084 kérdoív). A kérdoíveket három tanévben hét, félig strukturált fókuszcsoportos interjúval egészítettük ki (n = 92 fo). Eredmények: A hazánkba érkezo külföldi orvostanhallgatók számára a befogadó közeghez való alkalmazkodást tekintve a kapcsolódás elsosorban a szocializációs, nyelvi, kommunikációs különbségek miatt bizonyult kihívásnak. Megállapítható azonban, hogy a képzési ido elorehaladtával a különbözoségekbol fakadó nehézségek csökkentek, így a hallgatók egyre inkább képessé váltak az etnorelatív irányba történo elmozdulásra, valamint a multikulturális közeg pozitív aspektusainak értékelésére. Következtetések: A multikulturális környezetben folytatott tanulmányok alatt a kultúraközi kapcsolódási pontok és együttmuködések kialakulása és fejlodése lehetové teszi és támogatja az interkulturális kompetencia elsajátítását, annak minden résztvevoje számára, akár az egyetemi képzésen túlmutatóan, a késobbi orvosi pályát tekintve is. Orv Hetil. 2021; 162(25): 978-987. INTRODUCTION: In the increasingly multicultural social environment of the 21st century, intercultural knowledge as a social skill is gradually becoming a key competence. One of the possible areas of acquiring this competence is international student mobility, which is of increasing importance worldwide, including Hungary. OBJECTIVE: The focus of our study was to examine integration processes and the development and improvement of intercultural competence and sensitivity among Hungarian and international students, both in relation to the approximately 60 different cultures arriving in Pécs and in relation to the Hungarian host environment. In the course of our research, we sought - among other factors - areas, in which the differences between the original and the host culture are the most prominent, and we aimed at identifying those factors that are slowing down or supporting the integration during the adaptation period to another culture. METHOD: In our research, we used both quantitative and qualitative methods, in the form of a self-administered questionnaire and focus group interviews. General medical students of the University of Pécs studying in the German-, English- and Hungarian-language programmes participated in the survey during the spring semesters of the academic years between 2010 and 2018. We used our self-developed questionnaires (number of completed questionnaires: n = 13 084), which were filled in on a voluntary basis and anonymity was ensured. The questionnaires were supplemented with seven semi-structured focus group interviews over three academic years (n = 92 students). RESULTS: Regarding the adaptation to the host environment of foreign medical students studying in Hungary, relationship building arising from socialization, language and communication differences, proved to be a challenge. However, it can be stated that as the training time progressed, the difficulties arising from the differences decreased, so that the students gradually became more able to move towards an ethno-relative direction and evaluated the positive aspects of the multicultural environment. CONCLUSION: During studies in a multicultural university environment, the emergence and development of intercultural connections and collaborations enable and support the acquisition of intercultural competence for all of the students, which will be of great benefit for them, even beyond the university, in their future medical career. Orv Hetil. 2021; 162(25): 978-987.

Implicit bias against the Romas in Hungarian healthcare: taboos or unrevealed areas for health promotion?

The Roma or Gipsy population is the largest ethnic minority both in Europe and Hungary with a 10-15 years lower life expectancy and significantly worse health indicators than majority populations. The purpose of this exploratory study was to investigate a sensitive and controversial topic: the perspectives of healthcare staff about the presence and impacts of implicit bias in the Hungarian healthcare system towards Roma patients. Therefore, between June 2017 and May 2018 semi-structured interviews were conducted involving 13 healthcare professionals. Interview transcripts were coded and thematically analysed. The presence and occasional manifestation of prejudices against the Romas were noted by the interviewees, most commonly in the form of longer waiting time, comments or other meta-communicative tools. Study participants appeared to exclude a direct relationship between health providers' implicit bias and the lower quality of health services or the worse health status of Roma patients. However, as reported, indirect negative effects may occur in cases where a patient refrains from seeking care due to previous perceived or experienced discrimination. As barriers to effective patient-provider communication and cooperation, differences in culture, health-seeking behaviour and gaps between health literacy levels were emphasized. In terms of prevention, enhancing anti-discriminatory attitudes from early childhood within the families, the role of media in conveying unbiased information, increasing health awareness of the Roma people as well as educating healthcare providers on culture-related issues may be beneficial. Stress and burnout of healthcare professionals also need to be addressed as these may impact on the enactment of unconscious biases.

Intercultural competence in healthcare / Interkulturális kompetenciák az egészségügyi ellátásban

International migration is a current and growing phenomenon, which has become an increasingly critical issue in Europe since 2013 and this has posed new challenges to the healthcare systems of the European Union (EU). The need for 'culturally competent' healthcare systems that can adapt and respond to the needs of a changing population while taking into account cultural, religious, linguistic and gender diversity, has become more and more an agenda across Europe. Nowadays, it is widely accepted that inequalities in health conditions are mainly due to socio-economic factors, and disparities are particularly evident among certain ethnic and cultural minority groups. Additionally, minorities often face difficulties during their attempts in accessing healthcare, including linguistic and cultural barriers. These barriers are primarily manifested in communication and other interactions between the patient and the healthcare provider. Communication difficulties and misunderstandings may lead to frustration and prejudice among caregivers and also to a lack of cooperation from patients, and consequently, may contribute to poorer health outcomes. Therefore, in order to ensure the highest quality of care for migrants, ethnic or other minority populations in our increasingly diverse societies, it is of crucial importance to overcome the difficulties arising from linguistic, cultural and religious differences. To achieve these goals, an important step is the development of intercultural competences within the healthcare system. Our paper discusses the concept, content and opportunities for the development of intercultural competence in clinical and healthcare settings. Orv Hetil. 2020; 161(32): 1322-1330.

Prejudices and their healthcare implications. Lessons learnt from a national survey. / [Eloítéletek és hatásaik az egészségügyi ellátásban. Egy felmérés tanulságai].

Introduction: The presence and recognition of prejudice during care were examined among healthcare professionals towards the Roma population, the largest ethnic minority in Hungary. Aim: The aim of this study was to explore the extent to which prejudice in the Hungarian healthcare system might affect the quality of care and, thereby, the health of the Roma patients. Method: Semi-structured interviews were conducted between June 2017 and May 2018 with 13 interviewees. Qualitative methods were applied to analyse the transcripts. Results: Our respondents generally confirmed the presence of prejudices in the healthcare system. Prejudicial attitudes and discriminatory behaviour are less common in wards where the prevalence of disadvantaged patients (HIV-positive, homeless) is high (e.g., infectology). Prejudice is not specifically directed at the Roma ethnic minority, but also extends to populations living under poor socio-economic conditions, or with underlying self-destructive behaviour (alcoholism, drug use). In the opinion of our interviewees, occasional prejudicial behaviour does not lead to sub-standard care, but, on the contrary, to positive discrimination. Prejudice does not directly lead to poorer health, but it cannot be ruled out that it may indirectly contribute to it, in the case if the patient does not seek medical attention due to a former negative experience within healthcare. Conclusion: Our results confirmed the occasional presence of prejudice against the Romas in the healthcare system, however, this may not directly contribute to Romas' poorer health status. Our results also highlighted the importance of prevention, including the education of both parties and the prevention of the burnout of care providers. Orv Hetil. 2020; 161(19): 789-796.

An Opto-electronic Sensor-ring to Detect Arthropods of Significantly Different Body Sizes.

Arthropods, including pollinators and pests, have high positive and negative impacts on human well-being and the economy, and there is an increasing need to monitor their activity and population growth. The monitoring of arthropod species is a time-consuming and financially demanding process. Automatic detection can be a solution to this problem. Here, we describe the setup and operation mechanism of an infrared opto-electronic sensor-ring, which can be used for both small and large arthropods. The sensor-ring consists of 16 infrared (IR) photodiodes along a semicircle in front of an infrared LED. Using 3D printing, we constructed two types of sensor-ring: one with a wider sensing field for detection of large arthropods (flying, crawling, surface-living) in the size range of 2-35 mm; and another one with a narrower sensing field for soil microarthropods in the size range of 0.1-2 mm. We examined the detection accuracy and reliability of the two types of sensor-ring in the laboratory by using particles, and dead and living arthropods at two different sensitivity levels. For the wider sensor-ring, the 95% detectability level was reached with grain particles of 0.9 mm size. This result allowed us to detect all of the macroarthropods that were applied in the tests and that might be encountered in pest management. In the case of living microarthropods with different colors and shapes, when we used the narrower sensor-ring, we achieved the 95% detectability level at 1.1 mm, 0.9 mm, and 0.5 mm in the cases of F. candida, H. nitidus, and H. aculeifer, respectively. The unique potential of arthropod-detecting sensors lies in their real-time measurement system; the data are automatically forwarded to the server, and the end-user receives pest abundance data daily or even immediately. This technological innovation will allow us to make pest management more effective.

Detection of pregnancy in sheep using an ELISA for pregnancy-specific protein B.

The early detection of pregnancy and the determination of fetal numbers have economic benefits in sheep production because of the seasonal breeding patterns where missing a breeding opportunity means the loss of one productive year. The purpose of this study was to evaluate the efficacy of the B6-HRP ELISA for ovine pregnancy-specific protein B (oPSPB) measurement in the detection of pregnancy and estimation of fetal numbers in different sheep breeds. BioPRYN® ELISA assay kit was used for the detection of pregnancy in the experimental animals. Ninety-three ewes of three breeds (British Milksheep - BM, Lacaune - L and Transylvanian Racka - TR), each from three farms in Hungary, were included in the study. BM and L ewes were artificially inseminated (AI). Thirty-five days after AI, all ewes were examined by transabdominal ultrasound. The TR flock was mated naturally over a six-week period. At the end of the mating period, the ewes were similarly examined by ultrasound. Blood samples were taken from all pregnant ewes twice (35 and 65 days after AI), and serum samples were assayed by the BioPRYN test. It can be concluded that the detection of serum PSPB by ELISA is a much easier, safer, less expensive and highly accurate method for the detection of ovine pregnancy. Although some breed-related differences were detectable at 35 and 65 days post breeding, no differences in oPSPB levels were found in pregnant ewes carrying different numbers of fetuses.

Plasma somatostatin-like immunoreactivity increases in the plasma of septic patients and rats with systemic inflammatory reaction: experimental evidence for its sensory origin and protective role.

Alterations of somatostatin-like immunoreactivity (SST-LI) in the plasma of 11 systemic inflammatory response syndrome (SIRS) patients were investigated in correlation with cytokines, adhesion molecules and coagulation markers repeatedly during 4 days. The origin and role of SST were studied in the cecum ligation and puncture (CLP) rat SIRS model. Capsaicin-sensitive peptidergic sensory nerves were defunctionalized by resiniferatoxin (RTX) pretreatment 2 weeks earlier, in a separate group animals were treated with the somatostatin receptor antagonist cyclo-somatostatin (C-SOM). Plasma SST-LI significantly elevated in septic patients compared to healthy volunteers during the whole 4-day period. Significantly decreased Horowitz score showed severe lung injury, increased plasma C-reactive protein and procalcitonin confirmed SIRS. Soluble P-selectin, tissue plasminogen activator and the interleukin 8 and monocyte chemotactic protein-1 significantly increased, interleukin 6 and soluble CD40 ligand did not change, and soluble Vascular Adhesion Molecule-1 decreased. SST-LI significantly increased in rats both in the plasma and the lung 6h after CLP compared to sham-operation. After RTX pretreatment SST-LI was not altered in intact animals, but the SIRS-induced elevation was absent. Lung MPO activity significantly increased 6h following CLP compared to sham operation, which was significantly higher both after RTX-desensitization and C-SOM-treatment. Most non-pretreated operated rats survived the 6h, but 60% of the RTX-pretreated ones died showing a significantly worse survival. This is the first comprehensive study in humans and animal experiments providing evidence that SST is released from the activated peptidergic sensory nerves. It gets into the bloodstream and mediates a potent endogenous protective mechanism.

How healthy are ambulance personnel in Central Europe?

The health status of ambulance personnel (AP) has an important impact on the quality of patient care. The aim of this study is to analyze the self-fperceived health of AP. A cross-sectional survey was conducted among Hungarian AP, in which anonymous data (n = 364 subjects) were evaluated by descriptive statistics and multivariate logistic regression analyses. Those AP who reported engaging in any amount of exercise experienced better self-rated health (odds ratio [OR]: 1.7 confidence interval [CI] 95% [1.2, 2.7]) and self-rated physical fitness (OR: 2.0 CI 95% [1.2, 2.9]), and reported less limitation in daily activities due to health problems (OR: 2.4 CI 95% [1.4, 4.0]). Those AP who reported feeling more overall stress reported 2.1 times (CI 95% [1.3, 3.2]) worse health and 1.9 (CI 95% [1.2, 2.8]) times worse self-rated physical fitness. Possibly, physical fitness protocols should be implemented and required or advised for all AP.

Cell death mechanisms and potentially cytotoxic natural immune cells in human pregnancies complicated by preeclampsia.

Preeclampsia, which occurs in about 2% to 3% of all pregnancies, is a severe multisystem disorder showing symptoms in the second half of human pregnancy. Its prevention, early diagnosis, and treatment are insufficient, since etiology and pathogenesis of the disease are still not totally understood. Recent studies confirm that preeclampsia is the extreme end of a normal inflammatory reaction, which also occurs in healthy pregnancies. This review focuses on maternal immune changes during preeclampsia leading to altered cytotoxic responses. The potential role of perforin/granzyme-, Fas/Fas-ligand-, tumor necrosis factor α (TNF-α)- or TNF-related apoptosis-inducing ligand-mediated apoptotic mechanisms in the pathomechanism is analyzed. The frequency and function of effector cytotoxic cells of natural immunity itself such as natural killer (NK) cells, NKT cells, and γδT cells are also changed both in the periphery and locally in the uterus influencing the outcome of pregnancy. Here, authors conclude that beside exaggerated inflammatory responses, apoptotic and killing mechanisms also seem to be implicated in the pathogenesis of preeclampsia.

Surgery and sepsis increase somatostatin-like immunoreactivity in the human plasma.

We have previously shown in animals that somatostatin released from capsaicin-sensitive afferents in response to inflammation and tissue damage exerts systemic anti-nociceptive and anti-inflammatory actions. Since peptidergic sensory innervation of the airways and the joints are particularly dense, we aimed at investigating the alterations of plasma somatostatin-like immunoreactivity (SST-LI) in response to thoracic and orthopedic surgery, as well as sepsis. Thoracotomy, video-assisted thoracoscopy, hip and knee endoprosthesis were performed under general anesthesia. Blood was taken before, during and after the surgical procedures, as well as at admission and every consecutive morning from septic patients receiving exclusively total parenteral nutrition. SST-LI was determined from the plasma with specific and sensitive radioimmunoassay developed in our laboratory. Plasma SST-LI in healthy volunteers and preoperatively was 8-12fmol/ml. Both thoracotomy and thoracoscopy significantly increased SST-LI by 55-60% at the end of the procedures when the thoracic cavity and the skin were closed. Hip endoprosthesis implantation elevated SST-LI by 30% after skin incision, which increased further to 55% by the time the surgery was completed. In contrast, knee operations performed under tourniquet did not alter SST-LI in the systemic circulation. SST-LI was almost 3-fold higher in the plasma of septic patients than in healthy volunteers. This human study revealed that thoracic/hip surgery and sepsis elevate SST-LI in the systemic circulation, presumably by inducing its release from sensory fibres. It is concluded, that the endogenous protective mechanism mediated by neural somatostatin, which has been evidenced in animals, is likely to operate in patients.