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The effects of the changing frequency and severity of drought events in Central Europe may become a growing concern for its forests. In this study, we looked into how Hungary's forests have been affected by the 2022 compound heatwave and drought, following an arid period from 2018 to 2021. We used our active intensive monitoring plots of the Forest Protection Measuring and Monitoring System (Level II in the ICP Forests) across the country between 2017 and 2022. We analyzed satellite images to support a survey of the large-scale drought utilizing moderate and high-resolution data. The health state of the forest calculated and mapped on the NDVI, ZNDVI, and NDWI indices showed damage and regeneration throughout the period studied. Overall, the forest stands observed tolerated the negative impacts of the drought (126–204 mm water deficit in 2022) based on our biomass data (the summer leaf loss was 14% in each monitoring plot). However, the classified Z-NDVI values of the Sentinel-2 satellite imagery for the period 2017–2022 showed a severe drought in 2022, which was followed by some improvement in 2023. [ABSTRACT FROM AUTHOR]

The Czech and Hungarian labour markets have undergone significant changes: European Union (EU) accession and various employment and job creation programmes that have all left their mark on employment. The authors analysed the two major economic crises -- the 2008 global economic crisis and Covid-19 pandemic -- and their impact on the labour markets of the examined countries from a regional perspective. The phases of change in the examined unemployment rates and the reasons for this change have shown that the crises have affected the employment situation in the regions of the countries in different ways, degrees and lengths of time. [ABSTRACT FROM AUTHOR]

Pikeperch (Sander lucioperca Linnaeus, 1758) is a wide-ranged percid predator fish characterised by a great ecological value in the Eurasian freshwater and brackish ecosystems. It is also one of the most famous fish species of Lake Balaton (Hungary), where a unique (genetically separated) pikeperch stock lives. However, until now, no detailed information was available about the pikeperch population genetic structure in Lake Balaton. In the present study, the population genetic structure of the pikeperch assemblages in the lake was revealed by using microsatellite markers. Commercial fishery and angler catch data going back more than 100 years verified that the pikeperch has always been a key element of Lake Balaton's fish stock utilization. Results of genetic data analyses showed that the pikeperch in the Lake Balaton forms a metapopulation system, in which only the westward stocks show certain separation. Moreover, it seems that the exploitation and mass fish kills that happened in the 1960s and 1970s may have had only a slight impact on the population genetic structure of Balaton pikeperch stocks. The information about genetic features and utilization changes of pikeperch stocks can help to develop area-specific management plans and ensure the long-term survival of this carnivore fish species characteristic of Lake Balaton. [ABSTRACT FROM AUTHOR]

Forest damage has become more frequent in Hungary in the last decades, and remote sensing offers a powerful tool for monitoring them rapidly and cost-effectively. A combined approach was developed to utilise high-resolution ESA Sentinel-2 satellite imagery and Google Earth Engine cloud computing and field-based forest inventory data. Maps and charts were derived from vegetation indices (NDVI and Z∙NDVI) of satellite images to detect forest disturbances in the Hungarian study site for the period of 2017–2020. The NDVI maps were classified to reveal forest disturbances, and the cloud-based method successfully showed drought and frost damage in the oak-dominated Nagyerdő forest of Debrecen. Differences in the reactions to damage between tree species were visible on the index maps; therefore, a random forest machine learning classifier was applied to show the spatial distribution of dominant species. An accuracy assessment was accomplished with confusion matrices that compared classified index maps to field-surveyed data, demonstrating 99.1% producer, 71% user, and 71% total accuracies for forest damage and 81.9% for tree species. Based on the results of this study and the resilience of Google Earth Engine, the presented method has the potential to be extended to monitor all of Hungary in a faster, more accurate way using systematically collected field-data, the latest satellite imagery, and artificial intelligence. [ABSTRACT FROM AUTHOR]

The land use sector is a crucial pillar in achieving the EU climate goals set for 2050. A significant part of the climate change mitigation potential of the land use sector is inherent to agroforestry. Windbreaks are important agroforestry elements of Hungarian agricultural landscapes. The new and improved agroforestry subsidy system may positively affect the extension of windbreaks in Hungary, making it relevant to assess their carbon sequestration potential. In our study, we examined the carbon sequestration of windbreaks at the country level and in two sample areas of 24,000 hectares based on National Forestry Database volume stock data, as well as information collected from the Hungarian Forest Cover Map using orthophoto interpretation. We estimated the total annual carbon sequestration realized in the aboveground biomass pool of Hungarian windbreaks to be −33.1 ktCO2/year, which is 0.67% of the total annual carbon sequestration of the aboveground biomass pool of all Hungarian forests, as reported by the Hungarian Greenhouse Gas Inventory. On the other hand, according to our estimate, the weighted mean annual carbon sequestration in the aboveground biomass of windbreaks was −2.4 tCO2/ha/year in the 2010–2020 period. This value is very close to the average mean annual carbon sequestration per hectare value of all forests, as reported by the Hungarian Greenhouse Gas Inventory. This means that planting a given area of windbreaks in between agricultural fields can have similar climate change mitigation effects as planting forests in the same given area. [ABSTRACT FROM AUTHOR]

Climate change and the growing number of forest damage demanded a response from forestry professionals. Satellite-based remote sensing enables an environment-friendly way of forest monitoring as part of sustainable forest management. A novel forest monitoring approach was created in Hungary to utilize high-resolution Sentinel-2 satellite imagery, Google Earth Engine (GEE) cloud computing for the detection of forest disturbances remotely. The processing, analysing, and visualization of vegetation index (NDVI and Z NDVI) maps derived from satellite imagery took place online, in the cloud, for the period 2017-2023. My results indicated that the satellite imagery and ground-based reports provided suitable input for sustainable forest damage monitoring. In the seven-year-long period, the annual index changes corresponded to the experienced weather extremes and the Z NDVI values captured both the negative and positive forest health changes. The image classification was proved to be useful to show deviations from normal forest state since 67 % of pixels were in the forest damage category in 2022 when a historic drought occurred. In 2023 the regeneration was visible. The promising results and the flexibility of the GEE made it possible to enhance sustainable management and this system could be extended to include urban forests as well. [ABSTRACT FROM AUTHOR]

Simple Summary: The authors' aim was to summarise the general concept and approach of the Hungarian National PRRS Eradication Program. However, limits on the length of the paper meant that many important points of the process could not be described in full detail. In some cases, previous publications were cited to guide the readers to a more detailed description of particular eradication parts. Porcine reproductive and respiratory syndrome (PRRS) is a widespread infectious disease that is currently a major cause of economic losses in pig production. In Hungary, a National PRRS Eradication Program has been introduced to attain a more efficient, economic, and competitive international market position. The program has been also approved by the EU, but the resulting legal obligations have imposed a burden on Hungarian producers to comply with EU competition rules. The implementation of the program has been carried out by the veterinary authorities with the consent of, continuous support from and monitoring conducted by organisations within the pig sector as well as a scientific committee. The PRRS eradication program in Hungary was based on a regional territorial principle and was compulsory for all pig holdings within the regions. In Hungary, large fattening farms operate as all-in/all-out or continuous flow systems. Large-scale breeding herds are predominantly farrow-to-finish types. Although its significance has decreased in recent decades, 20% of the Hungarian pig population is still kept on small (backyard) farms (<100 animals). All PRRSV-infected large-scale farms had to develop a unit-adapted eradication plan, including external and internal biosecurity measures, vaccinations, etc. It was crucial to render each fattening unit free of the disease, as fattening units play a significant role in spreading the virus within the country. The eradication efforts mainly implemented were depopulation–repopulation methods, but on some farms a testing and removal method has been used. As the eradication progressed over the years, the introduction of infected fattening pigs was restricted. Thanks to these measures, Hungarian large-scale fattening farms became PRRSV-free by the end of 2018. The PRRSV-free status of small-scale herds was achieved by the end of 2015 and was maintained between 2016 and 2021. By 31 December 2021, all breeding pigs in large-scale farms in Hungary were free of wild-type PRRS virus. By 31 March 2022, the total pig population of the country, including all backyard farms and fattening units, achieved PRRSV-free status. The future goal is to ensure and maintain the PRRSV-free status of Hungary via strict import regulations of live animals combined with the continuous and thorough screening of incoming and resident herds for the presence of the virus. [ABSTRACT FROM AUTHOR]

Simple Summary: Habitat loss and nest predation significantly threaten European pond turtle (Emys orbicularis) populations. To reveal predation pressure in a protected area (Kis-Balaton marshland, Hungary) we conducted an artificial nests experiment. We used real nests which had been predated, and near each of them we created a new artificial nest. In each nest hole we put one quail egg, one plasticine egg and turtle egg shells and then covered them and sprayed the surface with water-diluted turtle urine. The majority of the nests were depredated in the first three nights, mostly by red foxes (Vulpes vulpes), confirmed by the bite marks preserved on the plasticine eggs, by footprints and excrements found near the nests and by camera recordings. Daily survival rates of quail eggs in artificial nests established in both real and in new nests were similar, suggesting that estimates obtained with artificial nests reflect the degree of predation pressure on real nests. Scattered nests had a lower survival rate than partly scattered and partly linear or only linearly arranged nests. We proved that spraying the nests with diluted turtle urine and marking them with a flag did not affect their survival. The results support turtle nest protection and selective predator control. Nest predation significantly impacts the population decline of the long-living European pond turtle (Emys orbicularis). Kis-Balaton is one of the most important habitats of this species in Hungary, and in May 2017 more than 400 damaged nests were counted. To reveal predation pressure, we conducted a study with artificial nests on three sites in this area. On each site, we used 11 depredated real nests, and near each of them, we created new artificial nests; then in every nest we put one quail egg, one plasticine egg and several turtle egg shells. After that, we sprayed the smoothed surface of the covered holes with water-diluted turtle urine, imitating the turtle's behaviour. Already in the first three nights, 94% of all nests were depredated by the red fox (Vulpes vulpes) and in one case by the European badger (Meles meles), which was confirmed by the bite marks preserved on the plasticine eggs, by the footprints and excrements found near the nests, as well as by camera recordings. Only 6% of the nests survived during the three weeks of our study. Daily survival rates of quail eggs in artificial nests established in both real (damaged) and in new nests were similar, suggesting that estimates obtained with artificial nests reflect the degree of predation pressure on real nests. On the site where the nests were scattered, their daily survival rate (33%) was significantly lower than on the sites where their arrangement was partly scattered, partly linear (83%), or only linear (76%). On two additional sites, by using simulated turtle nests we showed that spraying the nests with diluted turtle urine and marking them with a flag did not affect their survival, although further methodological testing is needed. The information obtained with artificial nests enables the organization of the protection of the nests of the European pond turtle and selective predator control. [ABSTRACT FROM AUTHOR]

Sopron mountains were affected by bark beetle (Ips typographus) damage between 2017 and 2020, which was surveyed on high-resolution ESA Sentinel-2 satellite images for the period 2017 and 2020 using Mosaic Hub, Anaconda, and Jupyter Notebook web-based computing environments. Biotic forest damage was detected based on vegetation (NDVI) and moisture (MSI, NDWI) indices derived from satellite images. The spatial and temporal change of damage was observed in the image series, resulting in information about the level of degradation and regeneration. In pursuance of GIS processing, 84 forest compartments were compared, which showed in most of the cases (97%) negative interannual change in the index mean values (MSI = - 0.14, NDWI = - 0.2, NDVI= - 0.19) when years compared to each other. The remote sensing-based survey was marked out and validated based on the forest database of the Hungarian Division of Forest of National Land Centre and forest protection damage reports of the Hungarian National Forest Damage Registration System. [ABSTRACT FROM AUTHOR]

Background: Porcine reproductive and respiratory syndrome virus (PRRSV) causes severe economic losses worldwide and only four countries in Europe are free from PRRSV. Complete depopulation–repopulation is the safest and fastest, but also the most expensive method for eradicating PRRSV from a population. Another possible way to eliminate an endemic PRRSV infection is to replace the infected breeding stock by gilts reared isolated and protected from PRRSV on an infected farm. With this method it is possible to maintain continuous production on the farm. The authors report the first successful elimination of PRRSV in a Hungarian large-scale pig farm by using an inactivated vaccine and performing segregated rearing of the offspring. Case presentation: The study was performed on a PRRSV infected farm (Farm A) with 1475 sows. The clinical signs of reproductive failure had been eliminated previously by using an inactivated vaccine (Progressis®, Ceva). At the beginning of the elimination programme, gilts intended for breeding were vaccinated at 60 and 90–100 days of age. After that, gilts selected for breeding were vaccinated at 6 months of age, on the 60–70th day of pregnancy and at weaning. Approximately 1200 piglets from vaccinated sows were transported at 7 weeks of age to a closed, empty farm (Farm B) after being tested negative for PRRSV by a polymerase chain reaction (PCR) method, and then were reared here until 14 weeks of age. At this age, all pigs were tested by PRRS ELISA. Seronegative gilts (n = 901) were subsequently transported from Farm B to a third, closed and empty farm (Farm C), and (having reached the breeding age) they were inseminated here after a second negative serological test (ELISA). At the same time, Farm A was depopulated, cleaned and disinfected. All pregnant gilts were transported from Farm C to Farm A after being re-tested negative for antibodies against PRRSV. Follow-up serology tests were performed after farrowing and results yielded only seronegative animals. Based on the subsequent negative test results, the herd was declared PRRSV free by the competent authority. Conclusions: The presented farm was the first during the National PRRS Eradication Programme of Hungary to eradicate PRRSV successfully by vaccinating the sows with an inactivated vaccine and performing segregated rearing of the offspring. Production was almost continuous during the whole process of population replacement. [ABSTRACT FROM AUTHOR]

Tench is a cyprinid fish that has undergone human-induced translocations. The natural populations of the species are on the decline due to habitat loss and spawning grounds degradation. The genetic diversity of seven natural populations was investigated to establish the genetic knowledge base for successful conservation efforts and for selective breeding. Twelve microsatellite markers, the sequencing of a 615 bp section of mtDNA (Cytb) and PCR-RFLP analysis of two nuclear markers (Act) and (RpS7) were used to analyze the genetic variation and structure among 175 individuals. All microsatellite loci were found to have moderate levels of polymorphism. The pairwise Fst values between population pairings were moderate; the populations were aligned to four clusters. The Cytb gene showed 20 haplotypes; 67.1% of individuals were categorized as Eastern, while 32.9% to the Western haplogroup. Analysis of the Act and RpS7 genes showed that the level of hybridization among the two haplogroups is high within the sampled populations. Hungarian Tench populations are genetically less diverse compared to natural populations in Western-Europe, but they still represent valuable genetic resources and Lake Fertő, Lake Kolon and Csörnöc-Herpenyő populations can be optimal candidates for future selective breeding programs. [ABSTRACT FROM AUTHOR]

The aquaculture industry is growing and includes the farming and breeding of more than 580 aquatic species worldwide. The rainbow trout (Oncorhynchus mykiss, Walbaum 1792) is the most commonly bred trout species in Hungary. As broodfish form the basis of most fish farms, investigation into tumours occurring in trout, although under‐researched, has proven to be a valuable and necessary field of study. During our investigation, we examined a broodstock of 3‐ to 6‐year‐old rainbow trouts (800) affected with idiopathic intestinal tumours (3%) which had consequentially led to ileus (40%). While performing necropsy, initial pathological observations showed intussusceptions. Tumours were discovered upon opening the body cavity, as well as metastasis forming in the livers and in the vessels of the gills. Histopathological and immunohistochemical tests allowed us to identify the neoplasms. The primary adenocarcinoma was found to have been developed within the intestines of the fish. The tumour tissue broke through the basal membrane and infiltrated the propria, protruding asymmetrically into the lumen of the mid‐intestines, causing it to narrow significantly. This subsequently led to passage disorders, invagination of the intestinal segment and finally the emaciation of the fish. Histopathological and immunohistochemical inspection of the tumour cells displayed a high mitotic index, confirming malignancy. [ABSTRACT FROM AUTHOR]

Introduction: The coronavirus disease 2019 (COVID-19) pandemic poses a challenge to healthcare. Staff and patients are at increased risk during an examination or intervention, so certain restrictions ought to be introduced. Hence, we aimed to measure the effect of the pandemic on endoscopy units in real-life settings. Methods: This was an observational, cross-sectional, questionnaire-based study, carried out between 7 April and 15 June 2020. Responds came from many countries, and the participation was voluntary. The survey contained 40 questions, which evaluated the effect of the COVID-19 pandemic on the endoscopy units and assessed the infection control. Results: A total of 312 questionnaires were filled, 120 from Hungary, and 192 internationally, and 54 questionnaires (17.3%) were sent from high-risk countries; 84.9% of the gastroenterologists declared that they read the European Society of Gastrointestinal Endoscopy (ESGE) statement, while only 32.1% participated in any advanced training at their workplace. Overall, 92.1% of gastroenterologists realized risk stratification, and 72.1% claimed to have enough protective equipment. In 52.6% of the endoscopy units, at least one endoscopist had to discontinue the work due to any risk factor, while 40.6% reported that the reduced staff did not affect the workflow. Gastroenterologists considered that the five most important examinations both in low and high-risk patients are the following: lower/upper gastrointestinal (GI) bleeding with hemodynamic instability, endoscopic retrograde cholangiopancreatography (ERCP) in obstructive jaundice, foreign body in the esophagus, ERCP in acute biliary pancreatitis, and iron deficiency anemia with hemodynamic instability, which correlates well with the ESGE recommendation. Significant correlation was found in the usage of the necessary protective equipment in high-risk patients depending on the countries (p < 0.001). Conclusions: The survey found weak correlation in preliminary training depending on countries; nevertheless, in Hungary during the examined period, endoscopists considered the recommendations more strictly than in other countries. Although many physicians left the endoscopy lab, the workflow was not affected, probably due to the reduced number of examinations. [ABSTRACT FROM AUTHOR]

Background: Health care professionals in endoscopic labs have an elevated risk for COVID-19 infection, therefore, we aimed to determine the effect of current pandemic on the workflow and infection prevention and control strategies of endoscopy units in real-life setting.Methods: All members of Hungarian Society of Gastroenterology were invited between 7 and 17 April 2020 to participate in this cross-section survey study and to complete an online, anonymous questionnaire.Results: Total of 120 endoscopists from 83 institutes were enrolled of which 35.83% worked in regions with high cumulative incidence of COVID-19. Only 33.33% of them had undergone training about infection prevention in their workplace. 95.83% of endoscopists regularly used risk stratification of patients for infection prior endoscopy. While indications of examinations in low risk patients varied widely, in high-risk or positive patients endoscopy was limited to gastrointestinal bleeding (95.00%), removal of foreign body from esophagus (87.50%), management of obstructive jaundice (72.50%) and biliary pancreatitis (67.50%). Appropriate amount of personal protective equipment was available in 60.85% of endoscopy units. In high-risk or positive patients, surgical mask, filtering facepiece mask, protective eyewear and two pairs of gloves were applied in 30.83%, 76.67%, 90.00% and 87.50% of cases, respectively. Personal protective equipment fully complied with European guideline only in 67.50% of cases.Conclusions: Survey found large variability in indications of endoscopy and relative weak compliance to national and international practical recommendations in terms of protective equipment. This could be improved by adequate training about infection prevention. [ABSTRACT FROM AUTHOR]

Porcine reproductive and respiratory syndrome (PRRS) causes significant losses to the swine industry worldwide, which leads to launching eradication programmes. The PRRS eradication programme in Hungary is based on the territorial principle, and it is obligatory for each swine farm irrespective of the number of animals kept there. Hungary has an exceptionally large herd size in large-scale pig farms. Large fattening farms operate as all-in/all-out or continuous flow systems. The large-scale breeding herds are predominantly farrow-to-finish types. In large-scale breeding farms, PRRS eradication was carried out by the depopulation-repopulation method in 33 farms, of which 23 received state compensation, 18 farm units either finished production or changed to producing fatteners only. Two farms used the test and removal method for eradication. One farm was classified as 'vaccinated free'. At this farm the breeding animals are vaccinated continuously but there is no vaccination of the progeny at any age, and the PRRS-free status of the farm is strictly controlled and monitored. By 31 December 2019, all pigs in five euroregions of Hungary had become free from PRRS virus, while the PRRS eradication process is still ongoing in the remaining two regions. [ABSTRACT FROM AUTHOR]

Background/aim: In Hungary, a nationwide colorectal screening program is about to be introduced in order to improve the high mortality rate of colorectal cancer (CRC). The aim was to summarize experiences from and assess short-term efficacy of the populationbased pilot colorectal screening program in 2015 in Csongrád county, Hungary. Materials and methods: Asymptomatic individuals between the ages of 50 and 70 with average risk of colorectal cancer participated in the program that was based on the two-step screening method: immune fecal blood test and colonoscopy. The short-term efficacy was assessed as the change in total CRC incidence and initial tumor stage in the screening year (2015). Results: 22,130 individuals were invited to participate, and the participation rate was 46.4%. Immune fecal blood test proved to be nonnegative in 1,343 cases (13%), screening colonoscopy was performed in 766 of them (7.5%). Total colonoscopy was performed in 711 individuals. Based on the reports, adenoma was detected in 358 (50.3%) and malignancy in 42 (5.9%) individuals. In the background population, the incidence of colon cancer was higher (183 vs. 228; P = 0.026) and was diagnosed at earlier stage (P = 0.002), while lymph node involvement was lower in 2015 (48.3% vs. 37.1%; P = 0.049). Conclusion: The Csongrád county population-based colorectal cancer screening was evidently successful on the short-term considering participation rate, and the changes in CRC incidence and stage, thus its national extension is necessary. [ABSTRACT FROM AUTHOR]

Background: The incidence and prevalence of ulcerative colitis (UC) varies geographically. The risk of colorectal cancer (CRC) and possibly some other malignancies is increased among patients with UC. It is still debated if patients with UC are at a greater risk of dying compared with the general population. Our aim was to describe the epidemiology and mortality of the Hungarian UC population from 2010 to 2016 and to analyze the associated malignancies with a special focus on CRC. Methods: This is an observational, descriptive, epidemiological study based on the National Health Insurance Fund social security databases from 2010 to 2016. All adult patients who had at least two events in outpatient care or at least two medication prescriptions, or at least one inpatient event with UC diagnosis were analyzed. Malignancies and CRC were defined using ICD-10 codes. We also evaluated the survival of patients suffering from UC compared with the general population using a 3 to 1 matched random sample (age, gender, geography) from the full population of Hungary. Results: We found the annual prevalence of UC 0.24–0.34%. The incidence in 2015 was 21.7/100 000 inhabitants. Annual mortality rate was 0.019–0.023%. In this subpopulation, CRC was the most common cancer, followed by non-melanotic skin and prostate cancer. 8.5% of the UC incident subpopulation was diagnosed with CRC. 470 (33%) of the CRC patients died during the course of the study (25% of all deaths were due to CRC), the median survival was 9.6 years. UC patients had significantly worse survival than their matched controls (HR = 1.65, 95% CI: 1.56–1.75). Summary: This is the first population-based study from Eastern Europe to estimate the different malignancies and mortality data amongst Hungarian ulcerative colitis patients. Our results revealed a significantly worse survival of patients suffering from UC compared to the general population. [ABSTRACT FROM AUTHOR]

In the EU Member States with a traditionally significant pig industry, the prevalence of PRRS infections is high. Therefore, the Pig Strategy of the Government of Hungary prioritises eradication of PRRSV in Hungary. For the first time among the EU Member States, a National PRRS Eradication Programme was introduced in order to reach a more efficient, economical and competitive international market position. Although its significance has decreased in recent decades, 20% of the Hungarian pig population is still kept on small-scale (backyard) farms (< 100 animals). The prevalence of PRRSV in backyard farms was 3.9% at the beginning of the programme. The present paper details the measures applied during the different phases of the programme in backyard farms. During all the phases, serological testing of the breeding animals of the registered small-scale herds was performed, including the highest number of individual animals. Seropositive individuals were tested by PCR and were removed from the backyard farm within the framework of official measures. By sequencing the identified PRRS strains, the possible epidemic relationships between small-scale and large-scale farms were continuously monitored. As a result of the programme, PRRS-free status of the small-scale herds was achieved by the end of 2015, and this status was maintained in 2016-2018. [ABSTRACT FROM AUTHOR]

Eradication of porcine reproductive and respiratory syndrome virus (PRRSV) from the pig population of Hungary started in 2014 on the basis of the territorial principle. In order to reach this goal it was crucial to render each fattening unit free of this disease, since fattening units play a significant role in spreading the virus all over the country. In 2015, 188 out of 307 large-scale fattening farms (61.2%) kept PRRS-positive animals. The main source of infection of these farms was the import of PRRS-infected fattening pigs. The following methods were used during the eradication from 2017: (1) Only pigs coming from PRRS-free farms were allowed to be used for fattening in Hungary; (2) Quarantine of all herds for 60 days; (3) PCR test for PRRS 48 hours after the arrival of the prefattening animals; (4) Serological test for PRRS at the end of the quarantine period. If any diagnostic test gave even one positive result and the result was confirmed by another test, the stock had to be sold for slaughter within 15 days or placed outside Hungary, so that the infected stock would not compromise the PRRS status of that area. PRRSV eradication on large-scale fattening units applying all-in/all-out operation was relatively simple, using the depopulation-repopulation method. On permanently operating farms, the infected herd was sold from time to time, without having to be repopulated until the last delivery. After cleaning, disinfection and restocking, the repopulation was done with PRRS-free animals. As the eradication progressed over the years, a ban on the import of infected fattening pigs was imposed. As a consequence of these measures, by the end of 2018, Hungarian large-scale fattening farms became free of PRRS. Maintaining the national-level PRRS-free status of large-scale pig fattening units contributes to eliminating a significant cost factor from the Hungarian pork production industry, and opens the way for a significant reduction in antibiotic consumption as well. [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Volkers et al paper. To view this article, visit https://doi.org/10.1111/apt.17153 [ABSTRACT FROM AUTHOR]

Background and aims: To assess work disability (WD) rates in an inflammatory bowel disease (IBD) cohort involving patients with Crohn's disease (CD) or ulcerative colitis (UC) cohort and to identify possible clinical or demographic factors associated with WD. To our knowledge, this is the first study from Eastern Europe that has estimated indirect costs in IBD. Methods: Data from 443 (M/F: 202/241, CD/UC: 260/183, mean age: 35.5 (CD) and 40.5 (UC) years, biological drug exposure 31.2/11.5 %) consecutive patients were included. WD data were collected by questionnaire and the work productivity and activity impairment instrument. Disability pension (DP) rates in the general population were retrieved from public databases. Results: The overall DP rate in this IBD population was 32.3 %, with partial disability in 24.2 %. Of all DP events, 88.8 % were directly related to IBD. Overall, full DP was more prevalent in IBD (RR: 1.51, p < 0.001) and CD (RR: 1.74, p < 0.001) but not in UC compared to the general population and also in CD compared to UC (OR 1.57, p = 0.03). RR for full DP was increased only in young CD patients (RR: 9.4; RR: 9.4 and 5.6, p < 0.01 for both). In CD, age group, previous surgery, disease duration, frequent relapses, and the presence of arthritis/arthralgia were associated with an increased risk for DP. Among employed patients, absenteeism and presenteeism was reported in of 25.9 and 60.3 % patients, respectively, leading to a 28 % loss of work productivity and a 32 % activity loss, and was associated with disease activity and age group. Average cost of productivity loss due to disability and sick leave with a human capital approach was 1,450 and 430 €/patient/year in IBD, respectively (total productivity loss 1,880 €/patient/year), the costs of presenteeism were 2,605 (SD = 2,770) and 2,410 (SD = 2,970) €/patient/year in CD and UC, respectively. Conclusion: Risk of DP was highly increased in young CD patients (sixfold to ninefold). Previous surgery and presence of arthritis/arthralgia was identified as risk factors for DP. Work productivity is significantly impaired in IBD and is associated with high productivity loss. [ABSTRACT FROM AUTHOR]

A set of five polymorphic microsatellite markers developed in Emydoidea blandingii was characterized for crossspecies amplification in the European pond turtle, Emys orbicularis. The markers were tested for polymorphism in a total of 155 turtles sampled in four natural habitats in the Danube-Drava National Park, South-West Hungary in order to determine the genetic diversity of European pond turtle populations and to check the functionality of existing ecological corridors in the region. The number of alleles varied from 5 to 24. Observed heterozygosity was moderate (0.43-0.55), while the level for expected heterozygosity ranged from 0.76 to 0.80. Significant heterozygote deficit was found in the populations accompanied by a low degree of genetic differentiation (FST ranges from 0.0166 to 0.0652). Wahlund effect was demonstrated in two populations. The ecological corridor between two water catchment areas (Lake Balaton and Drava River) fulfils its role only partially. [ABSTRACT FROM AUTHOR]

Porcine reproductive and respiratory syndrome (PRRS) is a globally spread, highly infectious viral disease. Live, attenuated vaccines against PRRS virus (PRRSV) decrease virus excretion and evoke protective immunity reducing the economic damage caused by the disease. In a longitudinal molecular epidemiological study accompanying ongoing national eradication programme we evaluated the suitability of PRRSV ORF5 and ORF7 sequences to identify possible field strains of vaccine-origin. In total, 2342 ORF5 sequences and 478 ORF7 sequences were analysed. Vaccine strains were identified by sequence identity values and phylogenetic network analysis. Strains that shared greater than 98% nucleotide identity within ORF5 and/or ORF7 were considered to have originated from vaccine. A total of 882 (37.6%) ORF5 and 88 (18.4%) ORF7 sequences met these criteria. In detail, 618, 179 and 35 ORF5 and 51, 29 and 8 ORF7 sequences were related to Porcilis PRRS vaccine, Unistrain PRRS vaccine, and ReproCyc PRRS EU vaccine, respectively. Data showed that the Porcilis vaccine was genetically more stable. Whereas, the variability of the Unistrain and the ReproCyc strains was significantly higher. Given that ORF7 shares, in some instances, complete identity between a particular vaccine strain and some historic variants of field PRRSV strains, care must be taken when evaluating vaccine relatedness of a field isolate based on the ORF7. On the contrary, ORF5 sequences were more suitable to predict the vaccine origin making a distinction more robustly between field and vaccine strains. We conclude that ORF5 based molecular epidemiological studies support more efficiently the ongoing PRRS eradication programmes. The conclusions presented in this large-scale PRRS molecular epidemiological study provides a framework for future eradication programmes planned in other countries. [ABSTRACT FROM AUTHOR]

Accurate specimen marking is crucial during breast cancer surgery to avoid misorientation, which can lead to inadequate re-excision and tumor recurrence. We studied the marking methods at various breast cancer centers to create a tool that would prevent specimen misorientation. An online questionnaire was used to survey marking procedures at major breast cancer centers in Hungary, and a tool was developed using a troubleshooting method. Twelve out of twenty units responded (60%). Nine use an institutionally standardized marking system. Less than half of the surgical teams found specimen mammograms to be unambiguous. In more than 70% of departments, pathologists were uncertain about breast specimen orientation. Ambiguous marking methods caused orientation errors in half of the cases, while unclear marking directions caused the rest. Most pathologists (85%) and surgeons (75%) believed that coronal plane specimen mammography would help solve the problem. A plastic specimen plate has been developed to anchor breast tissue to a coronal breast scheme as seen in mammography images, providing clear localization information throughout the surgical process. There is a lack of standardization in breast specimen orientation and marking in Hungary. An optimized orientation toolkit is being developed to ensure consistent interpretation of specimen mammograms by surgeons and pathologists.

Objective: Stigma towards people with mental health problems is a growing issue across the world, to which healthcare providers might contribute. The aim of the present study was to explore psychiatrists' attitudes towards their patients and link them to psychosocial and professional factors., Methods: An online questionnaire was used to approach the in- and outpatient psychiatric services across Hungary. A total of 211 trainees and specialists in adult and child psychiatry participated in our study. Their overall stigmatizing attitudes were measured, with focus on attitude, disclosure and help-seeking, and social distance dimensions by using the self-report Opening Minds Stigma Scale for Health Care Providers (OMS-HC). Multiple linear regression analyses were performed to elucidate the dimensions of stigma and its association with sociodemographic, professional and personal traits., Results: Stigmatizing attitudes of close colleagues towards patients were statistically significant predictors of higher scores on the attitude [B = 0.235 (0.168-0.858), p = 0.004], the disclosure and help-seeking subscales [B = 0.169 (0.038-0.908), p = 0.033], and the total score of the OMS-HC [B = 0.191 (0.188-1.843), p = 0.016]. Psychiatrists who had already sought help for their own problems had lower scores on the disclosure and help-seeking subscale [B = 0.202 (0.248-1.925), p = 0.011]. The overall stigmatizing attitude was predicted by the openness to participate in case discussion, supervision or Balint groups [B = 0.166 (0.178-5.886), p = 0.037] besides the more favorable attitudes of their psychiatrist colleagues [B = 0.191 (0.188-1.843), p = 0.016]., Conclusions: The favorable attitudes of psychiatrists are associated with their own experiences with any kind of psychiatric condition, previous help-seeking behavior and the opportunity to work together with fellow psychiatrists, whose attitudes are less stigmatizing. The perception of fellow colleagues' attitudes towards patients and the openness to case discussion, supervision and Balint groups were the main two factors that affected the overall attitudes towards patients; therefore, these should be considered when tailoring anti-stigma interventions for psychiatrists., Competing Interests: The authors have declared that no competing interests exist.

In December 2019, a cluster of pneumonia cases of unknown origin occured in Wuhan, China. The identified infective agent is a novel corona virus called “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2) and the respiratory disease caused by this agent aquired the name “coronavirus disease 2019” (COVID-19). In March 2020, the World Health Organization (WHO) declared the novel coronavirus outbreak a pandemic. We reviewed the international literature regarding the novel coronavirus outbreak. Here below, we focus mainly on the diagnostic issues of COVID-19 and on the estimation of the prognosis. We detail the relevant anamnestic factors and initial examination results which serve as basics for the clinical suspicion of COVID-19. We also focus on the proper method of microbiological sampling and the relevant informations regarding diagnostic tests like the gold standard real-time reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2. We also cite the current national epidemiologic regulations of testing for novel coronavirus. In the last section, we emphasize the importance and the potential way of early identification of high-risk patients. The COVID-19 pandemic may cause substantial epidemiological and healthcare burden even in Hungary. In addition to the epidemiologic interventions aiming the deceleration of the outbreak, the early identification and the correct hospital treatment remain key issues since these may influence mortality. The chances of the critically ill patients could be improved solely by a high-quality and careful critical care. It is prudent to meet the experiences of colleagues working hard with these patients in the already heavily infected countries. Orv Hetil. 2020; 161(17): 667–671., (© Szerző(k)/The Author(s))

Background : Anti-TNF therapy is efficacious in the maintenance of remission in ulcerative colitis (UC); however, long-term data on real-life use of these agents are lacking. Methods : This observational, retrospective, epidemiological study using the National Health Insurance Fund social security database aimed to understand patient characteristics and therapeutic patterns of anti-TNF therapy. Data of adult Hungarian, UC patients treated with anti-TNF agents (IFX-infliximab, ADA-adalimumab) between 2012 and 2016 were analyzed. Results : Five hundred and sixty-eight UC patients were identified. Approximately 70-80% of the patients reached maintenance therapy. A large proportion of patients stopped therapy after 10 to 12 months due to the reimbursement policy. Corticosteroid use decreased significantly after the initiation of biological therapy. The dose-escalation rate was 19.8% for ADA and 10.9% for IFX, respectively, and was performed earlier along the treatment timeline for patients on ADA. In the present study, the rate of primary non-response (PNR) was 11.6% and the rate of secondary loss of response (LOR) was 36.5%. Summary : Treatment length is in correspondence with the Hungarian reimbursement policies. The mandatory stop of treatment in the reimbursement policy is suboptimal in UC patients requiring biological therapy. The corticosteroid-sparing effect of biological therapy was demonstrated.

Background: A significant percentage of patients receiving anti-tumor necrosis factor alpha (anti-TNFα) agents lose clinical response over time. This study aims to provide representative real-world data on anti-TNFα drug sustainability, prevalence and predictors of anti-TNFα dose escalation., Methods: In this nationwide, retrospective study, patients receiving infliximab or adalimumab therapy between 2013 and 2016 were included using the administrative claims database of the Hungarian National Health Insurance Fund. Demographic characteristics, drug sustainability, dose escalation, use of parallel medications were analyzed., Results: 476 infliximab and 397 adalimumab patients were included. Dose escalation was observed in 7%, 9% and 22% of patients receiving originator/biosimilar infliximab and adalimumab during the complete follow-up, respectively. Dose escalation was associated with shorter disease duration (OR = 1.75, p = 0.026) and corticosteroid use. Drug retention rates were 62.7%, 72.3%, 75.4% after 1 year follow-up for Remicade®, Inflectra® and Humira®, which decreased to 38.3% and 52.1% for Remicade® and Humira® at 3 years. Drug sustainability was affected by steroid use prior biologic initiation in adalimumab treated patients (HR = 2.04, p < 0.001), while in infliximab treated patients dose escalation (HR = 0.51, p = 0.02) and gender (HR = 1.39, p = 0.033) were predictors of treatment discontinuation., Conclusion: Dose escalation rates were lower in this real-world administrative database study for both adalimumab and infliximab compared to published data. Drug retention rates were overall satisfactory, with no apparent difference between the legacy and biosimilar infliximab., (Copyright © 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Background : GEMINI trials demonstrated the therapeutic efficacy of vedolizumab (VDZ) in Crohn's disease (CD) and ulcerative colitis (UC). Research design and methods : Aim of this study was to determine the real-life effectiveness of VDZ on endoscopic healing in the Hungarian nationwide cohort of inflammatory bowel disease (IBD) patients based on the changes on clinical and endoscopic scores. Every adult IBD patient in the country (121 UC and 83 CD) who completed the short-term VDZ therapy was enrolled, of which 72 UC and 52 CD patients could complete the long-term therapy. Results : The rates of endoscopic healing were substantially higher in UC compared with CD patients during the short- and long-term therapy (52.9% vs. 21.7%, p < 0.0001, and 51.4% vs. 21.2%, p = 0.015, respectively). In CD, the rate of endoscopic healing was lower at week 14 compared with week 22 (14.5% vs. 37.0%, p = 0.026). Prior anti-TNF-α therapy (88.73%) was not associated with a significant decrease in therapeutic response. The average disease duration was significantly lower in CD patients achieving endoscopic healing at week 52 (11.75 vs. 5.27 years, p = 0.007). Conclusions : VDZ therapy is an effective therapeutic option in anti-TNF-α refractory IBD. However, the endoscopic healing rate was substantially lower and showed a significant delay in CD compared with UC.

In 2010-2012, new outpatient service locations were established in poor Hungarian micro-regions. We exploit this quasi-experiment to estimate the extent of substitution between outpatient and inpatient care. Fixed-effects Poisson models on individual-level panel data for years 2008-2015 show that the number of outpatient visits increased by 19% and the number of inpatient stays decreased by 1.6% as a result, driven by a marked reduction of potentially avoidable hospitalization (PAH) (5%). In our dynamic specification, PAH effects occur in the year after the treatment, whereas non-PAH only decreases with a multi-year lag. The instrumental variable estimates suggest that a one euro increase in outpatient care expenditures produces a 0.6 euro decrease in inpatient care expenditures. Our results (1) strengthen the claim that bringing outpatient care closer to a previously underserved population yields considerable health benefits, and (2) suggest that there is a strong substitution element between outpatient and inpatient care.

Introduction: Transfer is a planned movement of patients and their medical records from one provider to another. Only a few data are available from real life in inflammatory bowel disease patients in this topic., Aim: Our aim was to retrospectively evaluate the results of the transfer of our patients without longitudinal transition., Method: Data of the transferred patients at the University of Szeged were analysed. Patients were diagnosed in paediatric care. Transfer strategy at our departments was detailed medical summary., Results: 59 patients were enrolled in this study. 28.8% of the patients had mild to moderate disease activity and 71.2% was in remission at the time of transfer. Steroid therapy was initiated in 58% of the patients within an average of 9.1 months after the transfer. Anti-tumor necrosis factor therapy was given to 24% of the patients during the paediatric care and to an additional 23% in the adult care within an average of 28 months. Almost 70% of the patients received immunosuppressive therapy during paediatric and adult care. Surgery was required in 17% of the patients within an average 10.7 months after the transfer., Conclusion: Our results revealed that one-third of the paediatric patients have been transferred to adult care in active stage of disease. Shortly after the transfer 58% of the patients required corticosteroids and 17% surgery. Every fifth patient needed biological therapy to be initiated after the transfer. Longitudinal transition may have a potential to decrease the need for therapeutic change and the relatively high rate of surgery. Orv Hetil. 2018; 159(44): 1789-1793.

Inflammatory bowel diseases (IBD) [Crohn's disease (CD) and ulcerative colitis (UC)], are chronic relapsing disorders of unknown etiology. The aim of this study was to determine demographic features, disease phenotypes, medical and surgical therapies in our IBD patients and to identify which parameters are in association with the need of surgery and/or biologic therapy. Data on demographic and clinical characteristics of the patients were analyzed from the IBD registry of the 1st Department of Medicine, University of Szeged. The study period was between January 2007 and March 2015. Data of 911 IBD patients (428 CD, 483 UC) were analyzed. The median lag time between onset of symptoms and diagnosis proved to be significantly longer in UC than in CD (4.6 years vs. 2.1 years, p = 0.01). 40% of the patients received biological therapy, 301 patients underwent surgery required more frequently for CD than UC. Surgery was more common in CD patients with ileal location and penetrating behaviour. In UC, more severe disease onset predicted to unfavourable disease course. Higher proportion of surgery was shown in patient aged above 40 years in both CD and UC. Diagnostic delay of more than 1 year and appendectomy predicted to unfavourable disease outcome of both CD and UC. This analysis revealed that more than 1 year of diagnostic delay, disease activity at diagnosis in UC, CD, ileal location and penetrating behaviour are factors that may influence disease outcome. Use of thiopurines seemed to be protective in UC., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Adalimumab was approved for the treatment of ulcerative colitis refractory to conventional therapy several years later than infliximab in Europe. Due to the relatively low remission rate observed in Ultra trials, data on the efficacy of adalimumab in ulcerative colitis are really helpful in the daily practice., Aim: The aim of this study was to prospectively collect data on induction and maintenance adalimumab therapy in patients with ulcerative colitis treated in Hungarian centres., Method: This prospective study collected data of all patients with ulcerative colitis treated with adalimumab in 10 Hungarian centres. The primary endpoints of the study were rates of remission, response and primary failure at week 12, and the rate of continuous clinical response, remission and loss of response at weeks 30, and 52. Secondary endpoints were endoscopic outcome at week 52 and comparison of the efficacy of adalimumab between treatment naive and infliximab-experienced patients., Results: 73 patients with active ulcerative colitis were enrolled in the study. 75.3% of the patients exhibited clinical response after the induction at week 12. The probability of maintaining adalimumab treatment was 48.6% at week 52 with a continuous clinical response in 92% of these patients. Mucosal healing was achieved in 48.1% of the patients at week 52. Dose intensification was performed in 17.6% of the patients. Minor side effects developed in 4% of the patients and 5.4% of the patients underwent colectomy during the 1-year treatment period., Conclusions: These results coming from the real clinical setting demonstrate a favourable efficacy of adalimumab induction and maintenance therapy in patients with ulcerative colitis.

Background and Aim: Adalimumab [ADA] was approved for the treatment of ulcerative colitis [UC] refractory to conventional therapy in 2012 in Europe. Due to the observed discrepancies between clinical trials and practice, data on the outcome of ADA therapy are really needed from the real life. The aim of this study was to estimate the short- and long-term efficacy and safety of ADA in UC patients from each Hungarian biological centre., Patients and Methods: This prospective study consisted of UC patients treated with ADA in 10 Hungarian inflammatory bowel disease centres. The primary endpoints of the study were rates of continuous clinical response, remission, non-response and loss of response at Weeks 12, 30, and 52.The secondary endpoints included mucosal healing at Week 52 and the comparison of the efficacy of ADA between biological naive and infliximab [IFX]-treated groups. Colonoscopy was performed before starting the therapy and at Week 52., Results: In all, 73 active UC patients were enrolled in the study: 67.1% of the patients received previous IFX therapy; 75.3% of the patients showed short-term clinical response at Week 12. The probability of maintaining ADA was 48.6% at Week 52 with a continuous clinical response in 92% of these remaining patients. Mucosal healing was achieved in 48.1% of the patients at Week 52. Escalation of ADA was performed in 17.6%, and minor side effects developed in 4% of the patients; 5.4% of the patients underwent colectomy during the 1-year treatment period., Conclusion: UC is a progressive disease that may need early aggressive therapy to prevent structural and functional complications. The results of our study demonstrated the favourable efficacy of short- and long-term ADA treatment for patients with UC., (Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: For the surgical treatment of ulcerative colitis, laparoscopy is used more widely, but less data are available on long-term results in Hungary., Aim: The aim of the authors was to compare the mean 47.8-month follow-up results of patients treated with conventional and minimally invasive surgical methods., Method: Between January 1, 2005 and December 31, 2014, 56 patients were treated with surgery (20 emergencies, and 36 elective cases). Laparoscopy was used in 33 and conventional method in 23 cases., Results: There was no difference between the two groups in hospital and intensive care unit stay, bowel function recovery, need for transfusion, and complications during the perioperative period. Regarding long-term complications, the occurrence of intestinal obstruction, septic condition and other complications were significantly fewer in the laparoscopy group. The quality of life improved in both groups after the surgery., Conclusions: Laparoscopy can be used safely; it provides good quality of life and better cosmetic results, and the long-term rate of complications is lower as compared to open surgery.

Background and Aims: To assess work disability (WD) rates in an inflammatory bowel disease (IBD) cohort involving patients with Crohn's disease (CD) or ulcerative colitis (UC) cohort and to identify possible clinical or demographic factors associated with WD. To our knowledge, this is the first study from Eastern Europe that has estimated indirect costs in IBD., Methods: Data from 443 (M/F: 202/241, CD/UC: 260/183, mean age: 35.5 (CD) and 40.5 (UC) years, biological drug exposure 31.2/11.5%) consecutive patients were included. WD data were collected by questionnaire and the work productivity and activity impairment instrument. Disability pension (DP) rates in the general population were retrieved from public databases., Results: The overall DP rate in this IBD population was 32.3%, with partial disability in 24.2%. Of all DP events, 88.8% were directly related to IBD. Overall, full DP was more prevalent in IBD (RR: 1.51, p < 0.001) and CD (RR: 1.74, p < 0.001) but not in UC compared to the general population and also in CD compared to UC (OR 1.57, p = 0.03). RR for full DP was increased only in young CD patients (RR<35 year olds: 9.4; RR36-40 year olds: 9.4 and 5.6, p < 0.01 for both). In CD, age group, previous surgery, disease duration, frequent relapses, and the presence of arthritis/arthralgia were associated with an increased risk for DP. Among employed patients, absenteeism and presenteeism was reported in of 25.9 and 60.3% patients, respectively, leading to a 28% loss of work productivity and a 32% activity loss, and was associated with disease activity and age group. Average cost of productivity loss due to disability and sick leave with a human capital approach was 1,450 and 430 €/patient/year in IBD, respectively (total productivity loss 1,880 €/patient/year), the costs of presenteeism were 2,605 (SD = 2,770) and 2,410 (SD = 2,970) €/patient/year in CD and UC, respectively., Conclusion: Risk of DP was highly increased in young CD patients (sixfold to ninefold). Previous surgery and presence of arthritis/arthralgia was identified as risk factors for DP. Work productivity is significantly impaired in IBD and is associated with high productivity loss.

Background: Surgical Site Infection (SSI) is the third most frequent nosocomial infection, and accounts for 14-16% of all infections. While the treatment of SSI can be very costly, previous results indicated that triclosan may reduce SSI rate. Therefore, we carried out a prospective randomised trial to further evaluate the effect of triclosan after elective colorectal surgery., Methods: Seven surgical units in Hungary were involved in a prospective, randomised, multicentric clinical trial to compare triclosan coated (PDS plus®) and uncoated (PDS II®) sutures for abdominal wall closure in elective colorectal surgery. Pre- and perioperative variables were recorded in an online database. The primary aims of the study were to determine the incidence of SSI and the pathogens associated with it, as well as evaluation of additional cost of treatment., Results: 485 patients were randomised. SSI occurred in 47 cases (12.5%), of those 23 (12.23%) from the triclosan group (n = 188) and 24 (12.18%) from the uncoated group (n = 197, p = 0.982). In 13 (27.66%) cases late appearance of SSI was detected, of those 4 patients with triclosan coated suture (8.51%) and 9 patients with uncoated suture (19.15%, p = 0.041). There was no difference between the type of incisions or elective colon and rectal resections in terms of incidence of SSI., Conclusion: Beneficial effect of triclosan against Gram positive bacteria could not be confirmed in our study due to the relatively low number of patients with SSI. Furthermore, triclosan did not influence the incidence of SSI due to Gram negative bacteria. SSI rate decreased by 50% compared to our previous study, however, it was regardless of the use of coated or uncoated PDS loop. Finally, operative factors were more important than patient's risk factors in terms of incidence of SSI. In case SSI developed, delayed discharge from hospital as well as special wound care significantly increased overall cost of treatment.

Background and Aims: A severe flare-up develops in approximately 15% of patients with ulcerative colitis (UC). It is questionable whether the response to the first parenteral corticosteroid therapy decreases the risk for colectomy. Our aim was to evaluate the association between long-term colectomy rate and the efficacy of steroids in the first few days of the therapy and to assess other predictive factors for colectomy in our patients hospitalized because of the first severe attack of UC., Patients and Methods: The records of the first hospitalization of a total of 183 UC patients with severe exacerbation were reviewed. Every patient had received parenteral corticosteroid treatment. Colectomy was performed in refractory UC or in the case of intolerable side-effects of the rescue therapy. We compared different laboratory and clinical parameters between patients undergoing colectomy and those who avoided surgery., Results: Clinical response to steroid therapy was achieved in 110 of the 183 patients with acute severe UC; 14.5% of steroid responder patients were operated on during the follow-up period. 39.7% of patients in the steroid-refractory group required either urgent or late colectomy. The overall colectomy rate was 24.6%. Unresponsiveness to intravenous steroid therapy, anemia, and the need for blood transfusion proved to be the major predictors for colectomy., Conclusion: The colectomy rate was 2.5 times higher in our patients with acute severe UC not responding to the intensive steroid therapy, suggesting that the response to the therapy of the first 3-5 days of hospitalization may determine the long-term outcome and colectomy rate in UC.

Unlabelled: Adalimumab is a fully human monoclonal antibody targeting tumor necrosis factor with proven efficacy in the treatment of Crohn's disease in clinical trials. The aim of the present study was to investigate the predictors of medium term clinical efficacy and mucosal healing during adalimumab therapy in patients with Crohn's disease in specialized centers approved for biological therapy in Hungary., Methods: Data of 201 Crohn's disease patients were prospectively captured (male/female: 112/89, median age: 24 years, duration: 8 years). Previous infliximab therapy was given in 97 (48.3%) patients, concomitant steroids in 41.3% and azathioprine in 69.2% (combined: 26.4%) of patients., Results: Overall clinical response and remission rates at 24 and 52 weeks were 78% and 52%, and 69.4% and 44.4%, respectively. Endoscopic improvement and healing was achieved in 43.1% and 23.6%, respectively. In a logistic regression model, clinical efficacy and normalized C-reactive protein at week 12, need for combined immunosuppression at induction, shorter disease duration and smoking were identified as independent predictors for 12-month clinical outcome, while normalized C-reactive protein at week 12, clinical remission at week 24, frequency of previous relapses and smoking were associated to endoscopic improvement/healing. Dose intensification to weekly dosing was needed in 16.4%. Parallel azathioprine therapy and clinical remission at week 12 was inversely associated to dose escalation to weekly dosing., Conclusion: Clinical efficacy and normalized C-reactive protein at week 12, need for combined immunosuppression, luminal disease and smoking are predictors for medium term clinical efficacy/mucosal healing during adalimumab therapy, while parallel azathioprine therapy may decrease the probability for dose escalation.

Objective: There is limited data on pregnancy outcome in inflammatory bowel diseases (IBD) (Crohn's disease [CD] and ulcerative colitis [UC]) from Eastern Europe. The aim of our multicenter study was to compare the pregnancy outcomes and the data of infants in pregnancies before and after the diagnosis of IBD., Patients and Methods: 97 pregnancies in women with IBD (36 CD and 61 UC) and 70 pregnancies in the same women before the diagnosis of IBD (24 CD and 46 UC) were compared. The influence of disease activity and medical treatment during pregnancy on gestational age at birth, birth weight, health status of the newborns and the frequency of childhood diseases were analyzed., Results: Preterm birth and low birth weight were more common in IBD compared to those pregnancies delivered before the diagnosis of the disease (p = 0.008, p = 0.048). The occurrence of congenital abnormalities was not influenced by IBD, whereas childhood diseases occurred more frequently in the offspring of mothers with active UC. Disease activity in CD and UC during pregnancy did not predispose to abnormal birth outcome, compared to inactive disease. The type of medical treatment did not affect the pregnancy outcome in IBD., Conclusion: Preterm birth and low birth weight were more common in IBD. The medical treatment of the active disease during pregnancy did not increase the frequency of abnormal birth outcomes. Medical maintenance treatment should be continued during pregnancy to avoid relapses, although IBD seems to be an independent risk factor for low birth weight and preterm birth.

Background: Infliximab (IFX) has proven to be an effective addition to the therapeutic arsenal for refractory, fistulizing, and steroid dependent Crohn's disease (CD), with efficacy in the induction and maintenance of clinical remission of CD. Our objective in this study is to report the nationwide, multicenter experience with IFX induction therapy for CD in Hungary., Methods: During a 6-year-period, beginning in 2000, a total of 363 CD patients were treated with IFX as induction therapy (5 mg/kg IFX infusions given at week 0, 2 and 6) at eleven centers in Hungary in this observational study. Data analysis included patient demographics, important disease parameters and the outcome of IFX induction therapy., Results: Three hundred and sixty three patients (183 women and 180 men) were treated with IFX since 2000. Mean age was 33.5 +/- 11.2 years and the mean duration of disease was 6.7 +/- 6.1 years. The population included 114 patients (31.4%) with therapy-refractory CD, 195 patients (53.7%) with fistulas, 16 patients (4.4%) with both therapy-refractory CD and fistulas, and 26 patients (7.2%) with steroid dependent CD. Overall response rate was 86.2% (313/363). A higher response rate was observed in patients with shorter disease duration (p = 0.05, OR:0.54, 95%CI:0.29-0.99) and concomitant immunosuppressant therapy (p = 0.05, OR: 2.03, 95%CI:0.165-0.596). Concomitant steroid treatment did not enhance the efficacy of IFX induction therapy. Adverse events included 34 allergic reactions (9.4%), 17 delayed type hypersensitivity (4.7%), 16 infections (4.4%), and 3 malignancies (0.8%)., Conclusion: IFX was safe and effective treatment in this cohort of Hungarian CD patients. Based on our experience co-administration of immunosuppressant therapy is suggested in patients receiving IFX induction therapy. However, concomitant steroid treatment did not enhanced the efficacy of IFX induction therapy.

Cases of equine abortion and perinatal foal losses were investigated in Hungary during a three-year period (1998-2000). Samples from aborted equine fetuses and newborn foals (total n = 96) were examined using bacteriological, virological, pathological, immunohistochemical (IHC), molecular biological and serological methods. The cause of abortion and perinatal foal loss was identified in 67/96 cases (70%); viral infection was found in 22 (23%), viral and bacterial coinfection in 1 (1%), bacterial infection in 23 (24%), protozoan infection in 1 (1%) and fungal infection in 2 cases (2%). Morphological lesions suggestive of infection were recorded in 2 (2%) and non-infectious causes in 16 cases (17%).

Background: A recent study reported that the c.30T>A (p.Cys10Ter; rs2043211) variant, in the CARD8 (TUCAN) gene, is associated with Crohn's disease (CD). The aim of this study was to analyze the frequency of p.C10X in 3 independent European (IBD) cohorts from Germany, Hungary, and the Netherlands., Methods: We included a European IBD cohort of 921 patients and compared the p.C10X genotype frequency to 832 healthy controls. The 3 study populations analyzed were: (1) Germany [CD, n = 317; ulcerative colitis (UC), n = 180], (2) Hungary (CD, n = 149; UC, n = 119), and (3) the Netherlands (CD, n = 156). Subtyping analysis was performed in respect to NOD2 variants (p.Arg702Trp, p.Gly908Arg, c.3020insC) and to clinical characteristics. Ethnically matched controls were included (German, n = 413; Hungarian, n = 202; Dutch, n = 217)., Results: We observed no significant difference in p.C10X genotype frequency in either patients with CD or patients with UC compared with controls in all 3 cohorts. Conversely to the initial association study, we found a trend toward lower frequencies of the suggestive risk wild type in CD from the Netherlands compared with controls (P = 0.14). We found neither evidence for genetic interactions between p.C10X and NOD2 nor the C10X variant to be associated with a CD or UC phenotype., Conclusions: Analyzing 3 independent European IBD cohorts, we found no evidence that the C10X variant in CARD8 confers susceptibility for CD.

Unlabelled: Recently mutations of the NOD2/CARD15 gene were identified as genetic markers for Crohn's disease (CD). It has also been suggested that the presence of mutation may influence the phenotype of the disease. The aim of this study was to determine the frequency of common NOD2/CARD15 mutations in Hungarian Crohn's patients., Patients and Methods: DNA was obtained from 142 pts with Crohn's disease (70 male and 72 female, mean age: 36.2 yrs) and of 115 healthy subjects. Clinical data were obtained by filling in a questionnaire by the physician. DNA was screened for possible mutations by denaturing HPLC (WAVE Nucleic acid fragment analysis systems, Cheshire, UK) using published primers (Lesage et al, Am J Hum Gen 2002) for SNP's 8, 12, and 13. Mutations were then confirmed by direct sequencing on a ABI Prism 310 Genetic Analyzer (Perkin Elmer; Norwalk, USA)., Results: Mutations of NOD2/CARD15 were significantly more frequent in patients (n = 42, 29.6%) than in controls (11.3%, p = 0.0007, OR = 3.3, 95% CI = 1.7-6.5). R702W and 3020insC mutations were significantly more common in IBD compared to controls (4.3% and 2.6%); 18 patients had the R702W mutation (12.7%, p = 0.001, 13 homozygous, one homozygous for R703C) and 22 the 3020insC (15.9%, p = 0.001, 4 homozygous). 7 patients (4.9%) were heterozygous for the G908R, which was not different from the controls (4.3%). 5 patients were compound heterozygous. The allele frequency of R702W (11.6% vs. 4.3%, p = 0.0026, OR = 5.9, 95% CI: 2.3-14.9) and 3020insC (9.1% vs. 2.6% p = 0.004, OR = 7.6, 95% CI = 2.4-24.0) was significantly higher in Crohn's disease compared to the controls. Age at presentation was not different between carriers and non-carriers (26.7 +/- [SD] 10.3 yrs vs. 27.7 +/- 11.8 yrs). There was a tendency of ileal location to be more common in carriers of the mutation (40.5% vs. 29.0%), while colonic location was less frequent (16.7% vs. 44%). The presence of the mutation did not affect disease behaviour (carrier: inflammatory: 30.9%, stenosing: 26.2%, penetrating: 42.9%, non-carrier: inflammatory: 36%, stenosing: 27%, penetrating: 37%). Among the extraintestinal manifestations arthritis (30.1% vs. 47%, p = 0.05) and primary sclerosing cholangitis (0% vs. 9%, p = 0.047%) was significantly less frequent in carriers of the mutation., Conclusions: In concordance with European data we found a high number of NOD2/CARD15 R702W and 3020insC mutations in Hungarian patients with Crohn's disease. The G908R mutation was uncommon in Hungarian Crohn's patients. The presence of the mutation was associated with ileal but not with fibrostenosing disease and extraintestinal manifestations were less common in carriers of the mutation.