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Introduction: New variants of the SARS-CoV-2 coronavirus are constantly appearing, causing the COVID-19 pandemic. From November 2021, most infections were caused by the Omicron coronavirus variant., Objective: The aim of this prospective observational cohort study was to estimate the incidence of COVID-19 infections in the high-risk healthcare workers after two BNT162b2 mRNA Pfizer-BioNTech vaccines and the subsequent booster vaccine, as well as the effectiveness, the safety and the humoral immune response of the vaccines., Method: We started the two Pfizer-BioNTech ((BNT162b29) vaccinations of healthcare workers of the Polyclinic of the Hospitaller Brothers of St. John between January 07 and March 08, 2021. The choice of the type and timing of the third booster vaccination was voluntary. The workers were followed up between January 07, 2021 and June 29, 2022. The infection rate, adverse events of the vaccination, risk factors to infection and the kinetics of anti-spike (S) antibody and anti-nucleocapsid (N) antibody serum level were evaluated., Results: The data of 294 healthcare workers - 96 medical doctors, 127 nurses and 71 workers in hospital - who had at least three antibody level measurements were analyzed. The third booster vaccine was given to 280 workers, the distribution of the vaccines was the following: Pfizer-BioNTech (BNT162b29) vaccine (n = 210), Moderna COVID-19 (mRNA-1273) vaccine (n = 37), Sinopharm COVID-19 vaccine (n = 21), Janssen COVID-19 (n = 10), AstraZeneca (ChAdOx1 nCoV-19) vaccine (n = 2). Infection occurred in 121 cases (41%) during the observation period. The course of the COVID-19 infections was mostly mild (97%) and recovered within a week. During the observational period, 2 workers died: a 56-year-old woman died after two vaccinations for reason unrelated to COVID-19 infection, and a 58-year-old man died after the booster vaccination, following COVID-19 infection. The incidence of infection did not correlate with age, sex, comorbidities, smoking, occupation and BMI. The median titre of anti-S antibody serum level increased one month after the second vaccination of the basic immunization (1173.0 U/ml) and decreased slowly until the 8th month (678.5-625.8-538.0 U/ml) after the basic vaccination. One month after the booster vaccination, the median titre of anti-S antibody serum level increased significantly (16 535 U/ml), and showed a decreasing trend in the 3rd month after the booster vaccination (9697.7 U/ml). An exceptionally high S antibody serum level increasing after the basic (>10 000 U/mL) and booster (>60 000 U/m) vaccination showed a correlation with prior COVID-19 infection. The median cut-off index (COI) of anti-N antibody was not affected by vaccination, the increasing of the titre is related to the infection., Conclusion: The booster vaccination had less effect on the infection caused by Omicron variant, but the course of the infection was milder. Compared to the basic immunisation, the booster vaccination caused a significant increase in the S antibody level. An exceptionally high S antibody level correlated with prior COVID-19 infection. Orv Hetil. 2023; 164(5): 163-171.

Összefoglaló. Bevezetés: A SARS-CoV-2 koronavírus okozta COVID-19 általános egészségügyi és gazdasági krízist idézett elő. Célkitűzés: A megfigyeléses vizsgálat célja a BNT162b2 mRNS-Pfizer-BioNTech-vakcina hatásosságának, biztonságosságának és immunogenitásának igazolása a Budai Irgalmasrendi Kórház dolgozóin. Módszer: A vakcina adása után elemeztük a COVID-19-fertőzés előfordulását, az oltások utáni reakciókat, valamint a "spike" (S-) protein és a nukleokapszid (N)-protein elleni ellenanyag szintjének változását. Eredmények: A felmérésben részt vevő 295 dolgozó közül az oltást megelőzően 36 dolgozó esett át COVID-19-fertőzésen (COVID-19-pozitív csoport). A második oltás után a megfigyelési időszak három hónapjában COVID-19-fertőzés nem alakult ki a felmérésben részt vevő oltott dolgozók körében. Az oltási reakciók enyhék voltak. A COVID-19-pozitív csoportban az N-antitestek medián küszöbértékindexe az első vakcina után 4 héttel mérve szignifikánsan magasabb volt (28,37), mint a COVID-19-negatív (0,085) csoportban (p<0,0001). Az első vakcina után 4 héttel az S-antitestek medián értéke (8015 U/ml) a COVID-19-pozitív csoportban szignifikánsan magasabb volt (p<0,0001), mint a COVID-19-negatív csoportban (23,18 U/ml). A COVID-19-negatív csoport S-antitest-középértéke a második vakcina után szignifikáns (p<0,0001), mintegy 500×-os emelkedést mutatott (23,18 U/ml ről 1173 U/ml-re). Egy vakcina hatásosságát a fertőzések terjedésének megakadályozása igazolja. Következtetések: A második vakcina utáni megfigyelési időszakban új COVID-19-fertőzés nem volt az oltott dolgozók körében. A fertőzésen át nem esett COVID-19-negatív egyének esetén az S-antitest emelkedése mérsékelt az első oltás után, míg a második oltás után lényegesen emelkedik. A COVID-19-fertőzésen átesett egyének csoportjában már az első vakcina is jelentős S-antitest-termelődést vált ki. Orv Hetil. 2021; 162(39): 1551-1557., Introduction: The coronavirus disease 2019 (COVID-19) pandemic caused global public health and economic crises., Objective: The aim of this observation study was to estimate the effectiveness, safety and elicited immune response of the BNT162b2 mRNA Pfizer-BioNTech vaccine in healthcare workers of the Buda Hospital of the Hospitaller Order of St. John of God., Method: After vaccination, the infection rate, adverse events and the kinetics of anti-SARS-CoV-2 spike (S) protein and anti-SARS-CoV-2 nucleocapsid (N) protein antibodies were evaluated., Results: Before vaccination, from the 295 healthcare workers 36 recovered from prior COVID-19 infection (COVID-19-positive group). After the second vaccination, there was no COVID-19 infection during the three-month follow-up period. The adverse events were mild. In the COVID-19-positive group, the median cut-off index of anti-N antibodies measured at 4 weeks after the first vaccination were significantly (p<0.0001) higher (28.37) than in the COVID-19-negative group (0.085). After the first vaccine, the median titer of anti-S antibodies was significantly higher (p<0.0001) in the COVID-19-positive group (8015 U/ml) compared to the COVID-19-negative group (23.18 U/ml). In the COVID-19-negative group, the median titer of anti-S antibodies increased significantly (p<0.0001) after the second vaccine (from 23.18 U/ml to 1173 U/ml), showing an increase of 500×., Conclusions: After the second vaccination, there was no COVID-19 infection during the follow-up. In the COVID-19-negative group, the anti-S antibody titer is moderate after the first vaccination and increases significantly after the second vaccine. In the COVID-19-positive group, the first vaccine induces significant anti-S antibody production. Orv Hetil. 2021; 162(39): 1551-1557.

In this review the available evidences regarding the most frequently applied medication (peroral and transdermal non-steroidal anti-inflammatory agents) for the most frequent musculoskeletal complaints (regional pain syndromes) have been collected for the appropriate medical professionals who are most frequently faced with these conditions (general practitioners, rheumatologists, orthopedics, occupational and sports medicine experts). The special population at risk (with repeated and high energy overuse because of occupational or sport activities) and the pathology of their syndromes are identified. Mode of action, pharmacological properties of the non-steroidal anti-inflammatory drugs and the unwanted effects of their application especially in infants and elderly are highlighted. Recommendations of the general and specific pain management guidelines have been selected and listed in the review. Orv Hetil. 2017; 158(Suppl. 3): 3-30.

Physiotherapy lacks studies performed with the use of the modern research methodology and, therefore, its use based on empirical considerations. International practice guidelines do not recommend unequivocally the use of all kinds of physiotherapy with the exception of exercise therapy, but Hungarian guidelines support its use in the treatment of several different conditions. National health insurance in Hungary provides financial support for the use of physiotherapy in the fields of home care, out- and inpatient care and spa treatment. In 2011 national health insurance in Hungary supported spa treatments with 4 billion HUF, and the most frequently used treatment was thermal bath in about 2 million occasions. National health insurance in Hungary spent about 1 billion HUF for physiotherapy used in outpatient care; both ultrasound and interference treatments were financed in 2 million occasions in 2011.

Systemic Lupus Erythematosus (SLE) is a disease primarily targeting fertile women. The odds of spontaneous miscarriage, preeclampsia, intrauterine growth restriction is higher in pregnant women with SLE as well as there are increased risks of preterm delivery and perinatal fetal death. The occurrence of spontaneous abortion is closely related to the presence of antiphospholipid antibodies. The disease on its own is not a contraindication of pregnancy but at least a six-month remission is suggested prior conception. The physiological changes in the course of pregnancy might have close resemblance to the symptoms of lupus, therefore these changes should be differentiated from symptoms caused by lupus. For mothers suffering from SLE, regular visits not only to their obstetricians but also to a rheumatologist are also recommended in order to allow at proper time recognition of potential complications and their appropriate treatment. Thorough check of the maternal disease is of high importance not only during but also prior to and following pregnancy. An overview is given of the opportunities of recent diagnosis and opportunities of therapeutic approaches including biological as well as stem cell treatments. The antithrombotics treatment increases the chance of survival and healthy child birth in the case of pregnant women suffering from antiphospholipid syndrome. Although occurring rarely, neonatal SLE has significantly higher morbidity and mortality compared to healthy births. Recent studies show positive results in the case of prophylactic treatment of neonatal lupus. Prenatal care is recommended to be conducted at an institute where the obstetrician is experienced in the possible complications of lupus and where consultation with a rheumatologist, and the treatment of neonates with low birth weight are ensured.

Introduction: Biologic treatments are newly used in rheumatoid arthritis. Three tumornecrosis factor alfa (TNF-alpha) inhibitors--adalimumab, etanercept and infliximab--have been licensed for rheumatoid arthritis in Hungary. B-cell targeted treatment with rituximab is the next biologic treatment. Rituximab was used earlier for the treatment of non-Hodgkin's lymphoma. Rituximab was registered to be used in patients with rheumatoid arthritis who have had an inadequate response or an intolerance to one or more TNF-alpha blocking agents., Aim: Systematic review in the literature of efficacy of rituximab in rheumatoid arthritis. To assess the efficacy and safety of rituximab treatment in patients with rheumatoid arthritis., Methods: MEDLINE and Cochrane database were searched for randomized controlled trials with rituximab in rheumatoid arthritis. A meta-analysis of trial data was conducted., Results: Three randomized controlled trials were identified including 1145 patients. 54% of patients with inadequate response to TNF-alfa inhibitors and severe disease-activity have reached American College of Rheumatology 20 criteria. This ratio is larger with 33% (95% CI, 25-41%) than without treatment, and patients have almost five times (relative risk = 4.77 95% CI, 3.12-7.31) chance to improve. Functional status represented by Health Assessment Questionnaire score improves significantly (p < 0.001) in rituximab arms (-0.4 scores) compared with placebo arms (-0.1 scores). EULAR moderate and good responses in the rituximab group were significant (p < 0.00001) compared with the placebo group, rate difference is 38% (95% CI, 32-44%). Rituximab improves also radiological symptoms of rheumatoid arthritis., Conclusions: New therapeutic options, rituximab is efficacious in patients with rheumatoid arthritis. Rituximab can improve symptoms of patients with inadequate response to or intolerance of TNF-alpha inhibitors.

Ankylosing spondylitis is a chronic, inflammatory rheumatic disease which etiology and pathogenesis are not yet fully understood. The inflammation involves the spine and also the peripheral joints might be affected in some cases resulting in a progressive ankylosis, restricted mobility, significant disability, loss of productivity and decreased quality of life. Gene technology based new drugs of the past decade, the biologic agents, offer an alternative opportunity for the treatment of ankylosing spondylitis in comparison with the previous drugs with doubtful efficiency. In Hungary infliximab and etanercept has been registered for ankylosing spondylitis. The aim of this study was to evaluate the efficacy of infliximab and etanercept by the available randomised controlled trials. A systematic search of the literature was performed from 01. 01. 2000 to 08. 31. 2005. and the relevant publications were analysed following the concepts of evidence based medicine. 7 double blind, randomised, placebo controlled trials were identified, three for infliximab (n = 389) and four for etanercept (n = 431). Although the inclusion criteria, the duration of the trials and the primary endpoints were different, the results confirm that both drugs significantly decrease symptoms and disease activity, and this effect is sustained during the therapy, nevertheless half of the patients did not achieve the standardised criteria of 50% decrease in disease activity. Both agents are well tolerated by patients. The outcomes of long-term therapy are reassuring by open extension studies of three years. Guidelines for biologic therapy has been developed in Hungary determining the target patient group, the conditions of the therapy and also an arthritis centre network has been established. Though individual admission is feasible, biologic drugs are not under reimbursement in Hungary. High drug costs makes the implementation of this new therapeutic opportunity difficult in the daily medical practice.

Engagement of T cell receptors by antigen-presenting cells or stimulation by cytokines determine whether the cell will become activated, anergic or die via apoptosis or necrosis. Ca2+ is a key second messenger that delivers signal from the cell surface, reactive oxygen intermediates and nitric oxide are recently recognized as important mediators of T cell activation. Nitric oxide is a multifunctional intracellular and intercellular messenger induces mitochondrial biogenesis in many cell types, such as lymphocytes. Mitochondria produce reactive oxygen intermediates and store and release Ca2+ in response to activation and death signals. Rapid Ca2+ fluxing is increased while sustained Ca2+ signaling is decreased in lupus T cells. Lupus T cells contain increased numbers and mass of mitochondria. Serum nitric oxide levels and production of nitric oxide by monocytes is increased in patients with systemic lupus erythematosus. Lupus T cells exhibit mitochondrial hyperpolarization and increased mitochondrial mass, which confer predisposition to necrosis rather than apoptosis in response to repetitive activation and death signals. Exposure of normal T cells to nitric oxide dose-dependently increase the mitochondrial mass and mimic rapid and sustained Ca2+ signal abnormalities observed in lupus T cells. Thus increased mitochondrial biogenesis may account for altered Ca2+ handling and represents novel targets for pharmacological intervention in SLE.

Articular cartilage damaged by disease or trauma has a limited capacity for regeneration. The end stage of cartilage loss frequently leads to osteoarthritis resulting in a significantly decreased quality of life in millions of people. The surgical treatment of articular cartilage injury has always posed difficult problems for orthopedic surgeons and regarding long-term outcomes the currently available methods are unsatisfactory. The main lack of the applied methods is the appearance of the mechanically inadequate resident fibrocartilage instead of hyalin cartilage in the place of the cartilage defect. To find reliable methods for early repair of cartilage injuries seems of huge importance. Using techniques of tissue engineering, artificial cartilage fabricated in vitro has been applied for the repair and regeneration of damaged cartilage. Mesenchymal stem cells provide a source of cells for the repair of musculoskeletal tissue. Mesenchymal stem cells are multipotent cells that are capable of differentiating into cartilage, tendon, muscle, cartilage or hematopoiesis supporting marrow stroma. To ensure the successful durable integration and function of the engineered tissue requires suitable biomechanical and biochemical circumstances, and poses the challenge of handling in vitro culture of human cells, cell biology and molecular biology.

Introduction: Measuring quality of life has growing importance in the field of health technology assessment. It is especially true for chronic diseases, like ankylosing spondylitis, which results in significant impact on patients' quality of life through the intensity and duration of the disease., Objectives: To measure the reliability and validity of the Hungarian version of Ankylosing Spondylitis Quality of Life instrument with the intention of its use in clinical and health economic trials and burden of disease studies in Hungary via the introduction of a certain validation process., Methods: One of the most important criteria for the validity of quality of life instruments is the standard method used for adapting the questionnaire to foreign languages. The dual method was applied for the Hungarian adaptation of the Ankylosing Spondylitis Quality of Life questionnaire, which was followed by psychometric testing., Results: High test-retest correlation (0.85) indicated an acceptable degree of reliability with no evidence of excessive random measurement error. The internal consistency of the measure was confirmed (Cronbach's alpha coefficients were 0.87 and 0.91 at Time 1 and Time 2 respectively), with strong evidence that all items were adequately inter-related. The correlations with the NHP at both time points were at the expected levels, providing evidence of convergent and divergent validity., Conclusion: On the basis of results shown above, it is concluded that the Hungarian Ankylosing Spondylitis Quality of Life questionnaire is a reliable and valid measure of quality of life.

Hereditary multiple exostoses is an autosomal dominant disorder. Three different chromosomal loci have been implicated in this genetically heterogeneous disease. The authors describe a family in which 3 generations were affected, there were data about the disease of an already died grandmother, the father and his daughter were investigated by conventional X-ray and the disease was proved. The disease caused only minor complaints. The exostosis of the father's pelvis showed increased isotope uptake during bone scintigraphic examination, the same region exhibited malignant degeneration on MR examination. Regular check-up of the patients is necessary because of the possibility to a malignant transformation in 1-27% of the cases.