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This paper focuses on the erosion of the consensus around the Istanbul Convention due to the political obstacles to its ratification process in particular EU Member States. We warn that a black-and-white approach does not assist to understand the situation. Instead of conceptualising the rejection of the Convention as a “backlash” phenomenon, a more nuanced analysis is needed, especially in light of the ongoing EU legislative project in the field of combating gender-based violence. We first identify four main types of concerns regarding the Istanbul Convention on the international level: conservative, libertarian, “across-the-aisle” anti-feminist, and mainstream feminist concerns. Second, we consider the prevalence of these types of concerns in the Hungarian discourse, raised by the key political and civil society actors. Hungary provides an essential case study not only because of its role as a non-ratifying state and as an opponent of the EU-ratification plan but also due to the emergence of an additional (fifth kind of) concern related to the issue of migration (and asylum) in its discourse. Furthermore, the change in political situation in Europe since the adoption of the Convention in 2011 cannot be ignored. We believe that the analysis of the Hungarian discourse, may contribute to understanding the criticism towards the Convention and, as a consequential effect, facilitate the EU’s legislative efforts in the relevant fields.

The argumentation in this paper is based on the proposition that constitutions play a key role in defining the approach to women’s social status, not just by determining ordinary legislation and public policy, but also through constitutional review. The focus is on Hungary, a country that is not famous in Europe for a high level of equality between men and women, surrounded by a (liberal) international political discourse which asserts a backlash and claims that women’s equal rights are being curtailed even more during the era of Orbán’s illiberal government. Against this discursive backdrop, the paper highlights a counterintuitive phenomenon: since the democratic transition (1989–1990) all the key constitutional disputes related to equality between the sexes have been initiated by men claiming instances of discrimination against men, as if women were too privileged in Hungary. A relevant contextual feature is that while equal legal standing for the sexes is guaranteed (due partly to the heritage of state socialism, then to efforts related to EU integration), affirmative measures for women are also constitutionally ensured. The Constitutional Court has deployed surprisingly poor-quality reasoning in these disputes, suggesting that it never considered equality between the sexes to be an important issue. This leads us to claim that certain persistent features have characterized this field since the 1990s, not the dynamics of reversal since the 2010s. With our empirical findings, we aim to contribute to the academic discourse in a way that challenges the backlash narrative regarding developments in Hungary from a specific perspective.

There have been few clinical or scientific reports of autosomal dominant tubulointerstitial kidney disease due to REN mutations (ADTKD-REN), limiting characterization. To further study this, we formed an international cohort characterizing 111 individuals from 30 families with both clinical and laboratory findings. Sixty-nine individuals had a REN mutation in the signal peptide region (signal group), 27 in the prosegment (prosegment group), and 15 in the mature renin peptide (mature group). Signal group patients were most severely affected, presenting at a mean age of 19.7 years, with the prosegment group presenting at 22.4 years, and the mature group at 37 years. Anemia was present in childhood in 91% in the signal group, 69% prosegment, and none of the mature group. REN signal peptide mutations reduced hydrophobicity of the signal peptide, which is necessary for recognition and translocation across the endoplasmic reticulum, leading to aberrant delivery of preprorenin into the cytoplasm. REN mutations in the prosegment led to deposition of prorenin and renin in the endoplasmic reticulum-Golgi intermediate compartment and decreased prorenin secretion. Mutations in mature renin led to deposition of the mutant prorenin in the endoplasmic reticulum, similar to patients with ADTKD-UMOD, with a rate of progression to end stage kidney disease (63.6 years) that was significantly slower vs. the signal (53.1 years) and prosegment groups (50.8 years) (significant hazard ratio 0.367). Thus, clinical and laboratory studies revealed subtypes of ADTKD-REN that are pathophysiologically, diagnostically, and clinically distinct.

Abstract: Inherited errors of metabolism are rare genetic disorders characterized by diverse clinical and biochemical phenotypes. The complexity of signs and symptoms often presents a challenge for both clinicians and laboratory specialists. In many cases, prevention of permanent neurological symptoms or death in patients presenting these disorders is dependent on early diagnosis and introduction of appropriate therapy. For professionals it is indispensable to be familiar with the major clinical signs of inborn errors of metabolism and with the necessary and available laboratory studies to achieve an early diagnosis. The review tries to give a way of approach, diagnostic algorithm of laboratory measurements for the correct diagnosis in inherited errors of metabolism. The combination of biochemical and clinical signs, results of special metabolic investigations represent a portentous challenge in general practice. For the correct diagnosis of an inherited error of metabolism, the teamwork between clinicians and laboratory specialists is indispensable. Orv Hetil. 2017; 158(48): 1903–1907.

Abstract: Classical galactosemia is an inherited disorder of the carbohydrate metabolism, most often caused by the deficient activity of the enzyme galactose-1-phosphate-uridyltransferase. Classical galactosemia presents in the neonatal period with life threatening illness after galactose is introduced in the diet. Symptoms and signs include poor feeding, vomiting, and diarrhea, weight loss, jaundice, hypotension, cataracts, hepatosplenomegaly, hepatocellular insufficiency, and encephalopathy. Since 1975 the testing for galactosemia is part of the neonatal screening program in Hungary. Affected newborns are recognized in the first days of their life, and special diet is introduced immediately. The therapy of galactosemia is the lactose-free and galactose-poor diet for life. As a result of the nationwide newborn screening and the lifelong medical therapy, early treatment with galactosemia can achieve a normal life without serious complications. Orv Hetil. 2017; 158(47): 1864–1867.

Abstract: We report the case of a 46-year-old female patient with recurrent rhabdomyolysis. In the background of her metabolic myopathy an inherited metabolic disorder of the fatty acid oxidation, very long-chain acyl-coenzyme A-dehydrogenase deficiency was diagnosed. The diagnosis was based on abnormal acyl-carnitine- and urine organic-acid profile in addition to low residual enzyme activity, and was confirmed by genetic testing. After introduction of dietotherapy metabolic crisis necessitating hospital admission has not occurred neither have fixed myopathic changes developed. We present here the differential diagnosis of rhabdomyolysis and exertional muscle complaints, with the metabolic myopathies in focus. The main features of fatty acid oxidation disorders are highlighted, acute and chronic managements of very long-chain acyl-coenzyme A-dehydrogenase deficiency are discussed. Metabolic myopathies respond well to treatment, so good quality of life can be achieved. However, especially in fatty acid oxidation disorders, a metabolic crisis may develop quickly and can be fatal, albeit rarely. Some of these disorders can be identified by newborn screening, but occasionally the symptoms may manifest only in adulthood. With the presentation of this case we would like to point out that in the differential diagnosis of recurrent rhabdomyolysis inherited metabolic disorders should be considered regardless of the patient’s age. Orv Hetil. 2017; 158(46): 1873–1882.

We report on a sibling pair with the EPG5 c.1007A > G mutation who developed a severe form of Vici syndrome and died in infancy. The c.1007A > G (p.Gln336Arg) mutation, affecting the penultimate nucleotide and the splicing of exon 2 is the most common mutation of EPG5 and is typically associated with a less devastating prognosis: cardiomyopathy and cataract are less frequent consequences and the median survival time is 78 months compared to an overall median survival of 42 months. The less severe course related to c.1007A > G was formerly explained by the preserved canonical splicing in 25% of the transcripts. In contrast, we found the messenger RNA encoded by the c.1007A > G allele to be absent, explaining the severe course of the disease. This family provides another example of phenotypic variability related to a differential splicing.

Hyperinsulinemic hypoglycemia (HH) is one of the most common causes of persistent hypoglycemic episodes in neonates. Current pharmacologic treatment of neonatal HH includes diazoxide and octreotide, whereas for diffuse, unresponsive cases a subtotal pancreatectomy may be the last resort, with questionable efficacy. Here we report a case of congenital diffuse neonatal HH, first suspected when severe hypoglycemia presented with extremely high serum insulin levels immediately after birth. Functional imaging and genetic tests later confirmed the diagnosis. Failure to respond to a sequence of different treatments and to avoid extensive surgery with predictable morbidity prompted us to introduce a recently suggested alternative therapy with sirolimus, a mammalian target of rapamycin inhibitor. Glucose intake could be reduced gradually while euglycemia was maintained, and we were able to achieve exclusively enteral feeding within 6 weeks. Sirolimus was found to be effective and well tolerated, with no major adverse side effects attributable to its administration.

The chapter is aimed at presenting and analyzing the dynamics among civil society actors as relevant to Roma women’s rights in Hungary. The author concludes that, quite sensibly, the Roma women’s movement chooses to avoid confrontational approaches towards gender inequalities within Roma communities, and this may very well be interpreted as an attempt to reduce the risk of fragmentation within the Roma rights movement at the cost of not putting intersectional issues high on the agenda.

Inherited errors of metabolism are rare genetic disorders characterized by diverse clinical and biochemical phenotypes. The complexity of signs and symptoms often presents a challenge for both clinicians and laboratory specialists. In many cases, prevention of permanent neurological symptoms or death in patients presenting these disorders is dependent on early diagnosis and introduction of appropriate therapy. For professionals it is indispensable to be familiar with the major clinical signs of inborn errors of metabolism and with the necessary and available laboratory studies to achieve an early diagnosis. The review tries to give a way of approach, diagnostic algorithm of laboratory measurements for the correct diagnosis in inherited errors of metabolism. The combination of biochemical and clinical signs, results of special metabolic investigations represent a portentous challenge in general practice. For the correct diagnosis of an inherited error of metabolism, the teamwork between clinicians and laboratory specialists is indispensable. Orv Hetil. 2017; 158(48): 1903-1907.

Classical galactosemia is an inherited disorder of the carbohydrate metabolism, most often caused by the deficient activity of the enzyme galactose-1-phosphate-uridyltransferase. Classical galactosemia presents in the neonatal period with life threatening illness after galactose is introduced in the diet. Symptoms and signs include poor feeding, vomiting, and diarrhea, weight loss, jaundice, hypotension, cataracts, hepatosplenomegaly, hepatocellular insufficiency, and encephalopathy. Since 1975 the testing for galactosemia is part of the neonatal screening program in Hungary. Affected newborns are recognized in the first days of their life, and special diet is introduced immediately. The therapy of galactosemia is the lactose-free and galactose-poor diet for life. As a result of the nationwide newborn screening and the lifelong medical therapy, early treatment with galactosemia can achieve a normal life without serious complications. Orv Hetil. 2017; 158(47): 1864-1867.

In Hungary the Roma constitute the largest minority (the estimated number of the Roma population is 700 000,1 which is approximately 7% of Hungary’s total population), and practically the Roma are the only “visible” minority (given the small proportion of migrants in the population).2 Given that the Roma are often used as scapegoats for social and economic problems, and prejudices and negative attitudes against Roma are pervasive in the mainstream Hungarian society, hate crimes or hate speech as an issue might come up rst of all in the context of anti-Roma tensions in Hungary. Anti-Semitism is to be considered as a prevalent phenomenon in Hungary (including the political discourse), and there are numerous cases of attacks against the members of the Jewish community, which is estimated to be between 80 000 and 100 000,3 or vandalism against Jewish property. Other racist manifestations are not signi cant. The only known Islamophobic incident in 2009, when civil protesters, supported by local politicians, opposed the opening of a Muslim cultural centre in Budapest, might not be considered as an example for hate crime. Manifestations of hate crimes are reported against LGBT people in Hungary. Allegedly, a large proportion of homophobic hate crimes (including violent attack against persons and verbal abuses) is committed around the time of the annual Gay Pride March in Budapest. This trend started in 2007, and there was an enormous amount of violent attacks against the Pride March in 2008.

Smith-Lemli-Opitz syndrome (SLOS), a multiple congenital anomaly with severe mental retardation, is caused by decreased activity of 7-dehydrocholesterol reductase. Fifteen Hungarian patients were diagnosed with SLOS on the basis of clinical symptoms, serum cholesterol, 7-dehydrocholesterol, and molecular genetic testing. Their age at the time of diagnosis in mild SLOS (n = 4, clinical score20) was 0.5-18 years, cholesterol was 2.37 ± 0.8 mmol/L, and 7DHC was 0.38 ± 0.14 mmol/L. In the group of typical SLOS (n = 7, score 20-50), the diagnosis was set up earlier (age of 0.1-7 years); t-cholesterol was 1.47 ± 0.7 mmol/L, and 7DHC was 0.53 ± 0.20 mmol/L. Patients with severe SLOS (n = 4, clinical score50) died as newborns and had the lowest t-cholesterol (0.66 ± 0.27 mmol/L), and 7DHC was 0.47 ± 0.14 mmol/L. Correlation coefficient with clinical severity was 0.74 for initial t-cholesterol and 0.669 for Cho/7DHC. Statistically significant difference was between the initial t-cholesterol of mild and severe SLOS (p = 0.01), and between the Cho/7DHC ratios of groups (p = 0.004). In severe SLOS, the percentage of α-lipoprotein was significantly lower than in typical (p = 0.003) and mild SLOS (p = 0.004). Although serum albumin, total bilirubin, and hemostasis parameters remained in the reference range during cholesterol supplementation (n = 10) combined with statin therapy (n = 9), increase of aspartate aminotransferase and alanine aminotransferase in 50 % of the patients probably refers to a reversible alteration of liver function; therefore, statin therapy was suspended.life expectancy is fundamentally determined by the initial t-cholesterol, but dehydrocholesterol and α-lipoprotein have prognostic value. Accumulation of hepatotoxic DHC may inhibit the synthesis of α-lipoproteins, decreasing the reverse cholesterol transport. During statin therapy, we suggest monitoring of lipid parameters and liver function.

The case of a 2-year-old boy with associated anomalies of the limbs and the urinary system is reported. Similar to cases reported earlier he presented a split hand and foot syndrome, but differed from previously reported cases by the presence of bilateral renal hypoplasia leading to end stage renal failure. Renal histology disclosed oligomeganephronia.