ObjectiveChildren with congenital heart disease are highly vulnerable to drug-related adverse effects due to the use of complex polypharmacy. This study aimed to develop and retrospectively evaluate a hybrid clinical decision support system for predicting drug-related adverse effects in this population.MethodsThis two-phase study combined machine-learning techniques and expert clinical rules. Phase 1 included a retrospective analysis of 4651 pediatric congenital heart disease reports from the Food and Drug Administration Adverse Event Reporting System to train and compare five machine-learning models. The best-performing model, Random Forest, was selected. In Phase 2, a hybrid clinical decision support system integrating the Random Forest model with an expert-validated rule-based engine was developed and retrospectively evaluated using 330 inpatient records of pediatric patients with congenital heart disease.ResultsThe Random Forest model achieved a mean area under the receiver operating characteristic curve of 0.902. During clinical validation, the hybrid clinical decision support system demonstrated a mean accuracy of 0.85 across 11 common drug-adverse effect pairs, outperforming standalone machine-learning- and rule-based approaches. This study demonstrated the feasibility and clinical fidelity of using a hybrid clinical decision support system for predicting drug-related adverse effects in pediatric patients with congenital heart disease, supporting safer and more personalized pharmacotherapy.ConclusionsThis study demonstrated the feasibility and clinical fidelity of using a hybrid clinical decision support system for predicting drug-related adverse effects in pediatric patients with congenital heart disease, supporting safer and more personalized pharmacotherapy.
Currently, utilized disease-modifying antirheumatic drugs (DMARDs) do not provide a complete cure for rheumatoid arthritis (RA) and are associated with side effects related to prolonged use. In contrast, natural products have demonstrated promising efficacy and low toxicity in treating various diseases. This study employed network pharmacology and virtual screening to identify natural products with potential therapeutic effects for RA, followed by molecular dynamics simulations and experimental validation. Through network pharmacology, we identified interleukin-1 beta (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) as RA-related targets, and subsequently prioritized neoprzewaquinone A (NEO) via virtual screening and molecular dynamics simulations for further validation. Subsequent experiments indicated that NEO could inhibit the binding of IL-1β, IL-6, and TNF-α to their respective receptors, reduce proliferation, and downregulate the migratory and invasive capacities of RA fibroblast-like synoviocytes (RA-FLS). Furthermore, NEO alleviated RA-related symptoms and diminished tissue damage in collagen-induced arthritis (CIA) mice. RNA sequencing suggested that the alleviative effect of NEO on RA may be attributed to the inhibition of the activation of the MAPK signaling pathway. Additionally, NEO appeared to reduce the phosphorylation levels of MEK and ERK. Importantly, safety evaluations did not reveal a clear increase in liver or kidney toxicity associated with NEO, within the scope of this study. Collectively, these findings suggested that NEO shows promise as a potential natural therapeutic option for RA and offers a new direction and theoretical foundation for future pharmacotherapy research in this area.
Albuminuria is one of the most important biomarkers of chronic kidney disease and also a target that can be influenced by treatment. The amount of albumin excreted in the urine is an independent predictor of declining kidney function, cardiovascular events, and all-cause mortality. It is most easily determined based on the albumin-to-creatinine ratio (ACR) measured in the first morning urine sample; in the vast majority of cases, 24-hour urine collection is not required. The pathophysiology of albuminuria centers on damage to the glomerular filtration barrier - particularly podocytes - hemodynamic hyperfiltration, inflammation associated with tubular protein reabsorption, and activation of the renin-angiotensin-aldosterone system (RAAS). Modern four-pillar pharmacotherapy - RAS inhibitors (ACE inhibitors/ARBs), SGLT2 inhibitors, non-steroidal mineralocorticoid receptor antagonists (finerenone), and GLP1 receptor agonists in type 2 diabetes - acts on these processes through complementary mechanisms. When tailored to the degree of albuminuria and eGFR, this treatment significantly slows the progression of chronic kidney disease and reduces cardiovascular risk. Measuring and monitoring albuminuria must therefore be an essential part of daily clinical practice. Orv Hetil. 2026; 167(31): 1231-1237. Az albuminuria a krónikus vesebetegség egyik legfontosabb biomarkere és egyben terápiásan befolyásolható célpont. A vizelettel ürülő albumin mennyisége a vesefunkció-romlás, a cardiovascularis események és az összmortalitás önálló prediktora. Meghatározása a legegyszerűbben a reggeli első vizeletmintából meghatározott albumin/kreatinin hányados (ACR) alapján történik; az esetek túlnyomó hányadában nincs szükség 24 órás vizeletgyűjtésre. Az albuminuria patofiziológiájának középpontjában a glomerularis filtrációs barrier – különösen a podocyták – sérülése, a hemodinamikai hiperfiltráció, a tubularis fehérjereabszorpcióhoz kapcsolódó gyulladás és a renin-angiotenzin-aldoszteron rendszer (RAAS) aktivációja áll. A modern négypilléres farmakoterápia – RAS-gátló (ACE-gátló/ARB), SGLT2-gátló, nemszteroid mineralokortikoidreceptor-antagonista (finerenon) és 2-es típusú diabetesben GLP1-receptor-agonista – egymást kiegészítő mechanizmusokon keresztül hat ezekre a folyamatokra. A kezelés az albuminuria mértékéhez és az eGFR-értékhez igazítva érdemben lassítja a krónikus vesebetegség progresszióját, és csökkenti a cardiovascularis rizikót. Az albuminuria mérése és monitorozása ezért a mindennapi klinikai (egyben háziorvosi) gyakorlat elengedhetetlen része kell, hogy legyen. Orv Hetil. 2026; 167(31): 1231–1237.
Epilepsy remains a major neurological disorder characterized by unpredictable seizures and cumulative comorbidities that even endure with standard pharmacotherapy. Conventional antiepileptic drugs (AEDs) are constrained by two interrelated barriers: limited brain penetration due to the blood-brain barrier (BBB), which necessitates high systemic dosing and peripheral toxicity, and a narrow mechanistic focus on neuronal ion channels and synaptic receptors. This neuron-centric view overlooks non-neuronal drivers, such as neuroinflammation and BBB dysfunction, that sustain epileptogenesis and contribute to drug resistance in roughly one-third of patients. Nanomedicine addresses these limitations through a fundamentally different approach. Leveraging the unique advantages of nanocarriers, including facile synthesis, surface modification, and receptor-mediated BBB transcytosis, nanoparticles have evolved from passive delivery vehicles into intelligent, multifunctional therapeutic platforms that actively engage with disease biology. In this Perspective, we first delineate the inherent limitations of conventional AEDs in target selection. We then highlight how emerging nanomedicines are expanding the therapeutic target repertoire to include key non-neuronal nodes, with a focus on neuroinflammation and BBB repair. Finally, we offer a forward-looking perspective on two emerging frontiers: modulation of metabolic dysregulation and the microbiota-gut-brain axis, as well as the development of theranostic nanoplatforms that integrate real-time seizure monitoring with closed-loop intervention. Through this discussion, we aim to inspire a reorientation of nanomedicine strategies toward precision therapy for epilepsy.
Bipolar disorder is a chronic, episodic mood illness characterized by recurrent oscillations between mania, depression, and euthymia, affecting an estimated 2.4% of the global population. This pictorial review explores its pathophysiology through the case of a young individual presenting with a first manic episode with psychotic features. We examine the convergence of genetic loading (∼70-90% heritability), neurodevelopmental vulnerability, and environmental precipitants-including sleep restriction and antidepressant exposure-in unmasking this individual's illness. We review interconnected pathophysiological mechanisms underlying bipolar disorder, including fronto-limbic, reward, and cognitive control circuit dysfunction; opposing catecholaminergic-cholinergic imbalances driving mania vs depression; peripheral and central neuroinflammation; BDNF-mediated synaptic plasticity disruption; hypothalamic-pituitary-adrenal, thyroid, and gonadal axis dysregulation; and circadian rhythm disturbance. Recurrent episodes may drive progressive, heterogeneous brain changes that are potentially modifiable, reinforcing early intervention and adherence. Emerging biomarkers and phase-specific pharmacotherapy reflect progress toward personalized, multimodal treatment integrating mood stabilization with chronobiological and psychosocial optimization.
Every revision of the seizure classification-most recently the 2025 International League Against Epilepsy (ILAE) update-refines terminology, yet it is worth asking whether patients are treated better because their seizures were renamed. The focal versus generalized dichotomy has organized epilepsy classification since the 1960 s and is grounded in a pharmacologic rationale, but head-to-head data from the SANAD trials show that efficacy differences between individual antiseizure medications frequently equal or exceed differences across the focal/generalized boundary. Meanwhile, the distinction that is genuinely transformative-whether an epilepsy is surgically remediable-produces seizure-freedom differences of an entirely different order of magnitude, and yet epilepsy surgery remains among the most underutilized evidence-based treatments in medicine. We argue that classification should elevate therapeutic trajectory over electroclinical phenomenology, and we propose an Interventional Axis built around three pathways: focal resection, neuromodulation, and palliative surgery, operating in parallel with pharmacotherapy rather than after its serial failure. Refining terminology improves communication, but the ultimate metric of a classification is outcome, not taxonomic elegance.
Neurodegenerative diseases including Alzheimer's disease (AD), Parkinson's disease (PD), and amyotrophic lateral sclerosis (ALS) pose an urgent global health challenge. Growing evidence establishes microglia-driven neuroinflammation as a key driver of disease onset and progression, with mitochondrial dysfunction emerging as an early trigger of microglial activation. This review comprehensively summarizes current progress on how mitochondrial alterations regulate microglial activation across AD, PD, and ALS. We identify conserved mechanisms including metabolic reprogramming, impaired mitophagy, and inflammatory signaling, though Aβ, α-synuclein, and TDP-43 engage these pathways through disease-specific molecular routes. Therapeutic strategies targeting microglial mitochondria, including cGAS-STING and NLRP3 inhibitors, TREM2 agonists, and mitochondrial transplantation, remain largely preclinical. Emerging targets such as OLFML3 and GPNMB require functional validation in microglia. Collectively, this review underscores that preserving microglial mitochondrial health represents a promising therapeutic frontier and identifies key priorities for translating these strategies toward clinical application.
Despite high efficacy and favorable safety profile in adults, Onabotulinumtoxin A (ONA) injections have not been Food and Drug Administration approved for pediatric migraine due to a lack of consistent data in children with chronic headaches. We prospectively surveyed 45 patients between 12 and 22 years of age with chronic migraine receiving ONA treatments using the Phase II Research Evaluating Migraine Prophylaxis Therapy protocol in our pediatric headache clinic. Subgroup analysis was performed on patients with daily chronic migraine. Headache frequency, pain scores, and disability were assessed at baseline and 6 weeks after each treatment. Forty-five patients were included for analysis; median age was 17 years, and 36/45 (80%) were female. Twelve out of forty-five (27%) patients had a greater than 50% reduction in headache days after one treatment (P < 0.005). Of the patients with available data following two treatments, 8/24 (33%) patients had a greater than 50% decrease in headache days (P = 0.004). In the subset of patients with daily chronic migraine, 6/27 (22%) patients had a greater than 50% reduction in headache days after the first treatment (P = 0.016). Mean headache disability as measured by the Headache Impact Test decreased after the first four treatments in the entire cohort and after the second and third treatments in the subset of patients with chronic daily migraine. These results suggest that ONA is effective in decreasing headache frequency and disability in pediatric patients with both chronic migraine and daily chronic migraine, which may improve quality of life.
Soil-transmitted helminth (STH) infections affect approximately 1.5 billion people globally. Although the World Health Organization (WHO) aims for 75% mass drug administration (MDA) coverage by 2030, the long-term population benefit remains debated. This review aims to describe the characteristics of recent mass deworming studies, synthesize parasitologic and coverage outcomes, and identify programmatic themes. Search was conducted across Scopus, PubMed, and EBSCO CINAHL, restricted to studies reporting both parasitologic efficacy outcomes and MDA coverage. Following a risk of bias assessment in Review Manager 5.4, qualitative data were processed in Taguette 1.5.1 through a hierarchical thematic analysis to generate basic, organizing, and global themes and supplemented by VOSviewer 1.6.20 overlay visualization. Thirteen eligible studies primarily featured African countries and cross-sectional study designs. While overall risk of bias was low, lack of blinding revealed high performance bias. Thematic analysis, supported by bibliographic visualization, identified four global themes on delivery, compliance, equity and impact. Findings indicate that annual dosing is often insufficient and requires bi-annual schedules and WASH integration. Compliance is hindered by temporal inaccessibility and unreliable decentralized monitoring while equity gaps persist for out-of-school children and pregnant women. Although drug efficacy is confirmed, risks of resistance and diagnostic underreporting via the Kato-Katz method remain critical concerns. This review identifies four interrelated pillars of delivery, compliance, equity, and impact that shape the effectiveness of mass deworming programs and have direct implications for achieving WHO 2030 targets.
Antibody-drug conjugates (ADCs) are a powerful form of targeted therapy that can deliver drugs with a high level of selectivity towards a specific cell type, reducing off-target effects and increasing the therapeutic window compared to small-molecule therapeutics. However, creating ADCs that are stable, homogeneous, and with a controlled drug-to-antibody ratio (DAR) remains a significant challenge. Divinyl pyrimidine (DVP) reagents were developed as a method to irreversibly conjugate linker-payloads onto native antibodies to generate stable ADCs and antibody-probe systems with a precise drug-to-antibody ratio (DAR) of 4. This protocol describes how to conjugate DVPs to antibodies and methods for ADC characterization.
Dapagliflozin shows variable renoprotective efficacy in patients with type 2 diabetic kidney disease (T2DKD). A retrospective clinical analysis confirmed marked interindividual variability in its urinary protein-lowering effects. To investigate the mechanism, drug affinity responsive target stability (DARTS) combined with quantitative proteomics was applied for target identification. Subsequent in vivo and in vitro validation suggested that GSK3β acts as a mediator of dapagliflozin-associated nephroprotection. Dapagliflozin directly bound and partially inhibited GSK3β, and GSK3β activity influenced podocyte protection. To translate findings into clinical relevance, a prospective trial was conducted. The GSK3B rs60393216 polymorphism was associated with urinary albumin-to-creatinine ratio (UACR) reduction after dapagliflozin therapy. These findings suggest that GSK3β contributes to the renoprotective effects of dapagliflozin and that GSK3B polymorphisms may influence therapeutic responses in T2DKD.
BACKGROUND Hip fractures cause severe perioperative pain, increased opioid use, and delayed recovery. The ultrasound-guided pericapsular nerve group (PENG) and suprainguinal fascia iliaca (SIFI) blocks are regional techniques targeting hip innervation. This study aimed to compare the effects of ultrasound-guided PENG and SIFI blocks on perioperative analgesia and clinical outcomes in hip fracture surgery. MATERIAL AND METHODS This prospective observational study included patients undergoing hip fracture surgery under spinal anesthesia. Patients received either an ultrasound-guided PENG block or a suprainguinal fascia iliaca block as part of routine clinical practice. The primary outcome was perioperative pain intensity measured using the numerical rating scale (0-10), including baseline pre-block assessments, pain during spinal positioning, and postoperative pain scores. All other variables, including ease of spinal positioning, hemodynamic parameters, cumulative 24-hour postoperative tramadol consumption, time to first analgesic requirement, range of motion of the affected limb, patient satisfaction, and adverse events, were evaluated as secondary outcomes. RESULTS A total of 67 patients were included (PENG, n=34; SIFI, n=33). The SIFI group had significantly lower pain scores in the neutral position (P=0.004), during limb elevation (P<0.001), and at 2 to 8 hours postoperatively (P<0.001). The 24-hour consumption of tramadol was lower (P=0.011), and active hip flexion at 8 hours was greater (P=0.001) in the SIFI group. Other outcomes were similar. CONCLUSIONS Both the PENG and SIFI blocks provided effective perioperative analgesia. SIFI was associated with lower pain scores at selected intervals and reduced opioid consumption; however, these findings represent time-specific associations rather than definitive superiority.
For chronic disease and oncology new drug developments, it is crucial to demonstrate whether the experimental drugs are effective induction therapies and maintenance therapies. Many designs have been proposed for trials with binary and continuous endpoints. For these endpoints, the evaluation of an induction therapy can be based on only the data of the induction phase. Nonetheless, for time to event endpoint (e.g., mortality) treatment may need time to manifest effect and the assessment of an induction therapy may need long-term data beyond data of only the induction phase. A two-stage re-randomized design has been advocated for time to event endpoint to address this in the literature. For this design, patients are initially randomized to one of two induction therapies. Then induction responders are re-randomized to one of the two maintenance therapies. An inverse probability weighting approach is used for the analysis. To simplify trial operation, we propose the use of a one-randomization, two-stage and four-treatment-regimen design. As maintenance therapies are not administrated and have no effects during the induction phase, a time dependent covariate proportional hazards model is applied to data analysis. To increase power, a weighted combination test is used for overall between-treatment assessment. A multiple imputation tipping point sensitivity analysis is considered for handling informative censoring issue. Simulations are conducted to evaluate the performances of the methods, and an example is used to illustrate the applications of the methods.
Autism Spectrum Disorder (ASD) is associated with neuroinflammation and oxidative stress that disrupt neurodevelopmental processes. Resveratrol (RSV) is a polyphenol with antioxidant and anti-inflammatory properties, but its poor bioavailability limits therapeutic use. This study investigated whether PEGylated liposomes encapsulating RSV (LipRSV) could modulate oxidative and behavioral alterations in a valproic acid (VPA)-induced rat model of ASD. PEGylated LipRSV were synthesized, characterized as hemocompatible, and administered to offspring from postnatal day (PND) 6 to 27. Behavioral tests included developmental milestones, olfactory discrimination, negative geotaxis, open field, and three-chamber social interaction. Oxidative stress markers and neurotrophins (BDNF, NGF) were quantified in the following brain regions: hippocampus, hypothalamus, striatum, cerebellum, frontal and posterior cortex. LipRSV exerted limited and region-dependent redox effects, reducing ROS levels only in the hippocampus, cerebellum, and posterior cortex, while failing to improve behavioral outcomes and being associated with unfavorable neurochemical alterations, including reduced BDNF and NGF levels. Importantly, LipRSV also induced behavioral deficits, redox imbalance, and neurochemical alterations in control animals, indicating treatment-related effects in the absence of VPA exposure. LipRSV modulated oxidative stress in a region-dependent manner without improving behavioral deficits in the VPA model and was associated with reduced BDNF and NGF levels. This study provides evidence that modulation of oxidative stress alone is insufficient to rescue behavioral phenotypes in the VPA model of ASD. These findings highlight the partial neurochemical efficacy and translational limitations of this formulation, suggesting the need for optimized nanocarrier design and dosing strategies in ASD pharmacotherapy.
Chemoresistance remains a major obstacle in bladder cancer therapy, driven by the interplay among P-glycoprotein (P-gp)-mediated drug efflux, mitochondrial metabolic reprogramming, and impaired apoptotic signaling. Here, we present a TME-responsive nanoplatform (DR@MPDA@M) composed of MPDA core shielded by manganese dioxide (MnO2) shell, enabling sequential co-delivery of doxorubicin and resveratrol for chemo-/chemodynamic/photothermal therapy. The MnO2 layer selectively degrades under the acidic and glutathione-rich TME, enabling controlled drug release while simultaneously generating Mn2+ that catalyze Fenton-like reactions to produce cytotoxic hydroxyl radicals (•OH). Notably, this design strategically targets the mitochondria-P-gp axis that resveratrol potently downregulates P-gp expression to suppress drug efflux, while the Mn2+-induced oxidative stress disrupts mitochondrial function, depleting intracellular ATP and inhibiting heat shock protein 90. The resultant energy crisis synergistically impairs P-gp-mediated efflux and sensitizes cancer cells to doxorubicin-induced apoptosis. Upon 808 nm laser irradiation, the MPDA core mediates photothermal conversion, further accelerating the Fenton-like reaction and potentiating chemotherapy. Both in vitro and in vivo bladder tumor models demonstrate that DR@MPDA@M achieves favourable tumor inhibition. This work provides a mitochondria-P-gp axis-targeted strategy that integrates chemo-/chemodynamic/photothermal therapy, offering a promising paradigm for overcoming chemoresistance in bladder cancer.
Nivolumab and other immune checkpoint inhibitors (ICIs) have improved survival in advanced gastric cancer. However, optimal management after progression on ICI-containing therapy remains uncertain. We report a case of HER2-negative esophagogastric junction (EGJ) cancer that showed a marked radiological and metabolic response to second-line ramucirumab plus paclitaxel (RAM + PTX) after nivolumab-based chemotherapy, allowing conversion-intent surgery, after which pathological complete response (pCR) was confirmed in the resected specimen. A 76-year-old woman was diagnosed with advanced HER2-negative EGJ adenocarcinoma with para-aortic lymph node metastases (cT3N3bM1[Lym], Stage IVB according to the 15th edition of the Japanese Classification of Gastric Carcinoma). The tumor was classified as Siewert type III with minimal esophageal invasion. First-line SOX plus nivolumab was administered, but disease progression with mediastinal lymph node enlargement and suspected pulmonary metastases was observed after five cycles. Second-line RAM + PTX was subsequently initiated and resulted in marked regression of the primary tumor and metastatic lesions on computed tomography and endoscopy, with metabolic complete response on positron emission tomography-computed tomography. Although chemotherapy was temporarily interrupted because of immune-related type 1 diabetes mellitus, metabolic complete response was maintained after glycemic control with insulin therapy. Following multidisciplinary evaluation of treatment response and resectability, robot-assisted proximal gastrectomy with D2 lymphadenectomy and double-flap reconstruction was performed. Histopathological examination demonstrated no residual viable tumor cells (ypT0N0), consistent with pCR. The postoperative course was uneventful, and the patient remains clinically recurrence-free 10 months after surgery. This case suggests that RAM + PTX after nivolumab-based chemotherapy may achieve substantial tumor regression in selected patients with advanced EGJ cancer and may provide an opportunity for conversion surgery. Robot-assisted proximal gastrectomy with double-flap reconstruction was feasible after successful systemic therapy. Careful multidisciplinary assessment and accumulation of further clinical evidence are needed to clarify the role of sequential systemic therapy and surgical intervention in this setting.
Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder requiring multi-target therapeutic strategies. Traditional Chinese medicine offers potential multi-component interventions, yet the material basis and molecular mechanisms of novel formulations often remain incompletely defined. This study developed an integrated formula (FSV) combining a modified Baihu Jia Renshen Decoction with Sanghuangporus vaninii extract and explored its anti-hyperglycemic potential using chemical profiling, network pharmacology, in vitro α-glucosidase inhibition, and an STZ/HSHFD-induced hyperglycemic mouse model. A total of 2,413 database-matched features were annotated, most of which should be regarded as putative rather than standard-confirmed identifications. Mangiferin and several flavonoids were retained as plant/fungus-compatible candidate constituents, whereas implausible xenobiotic matches were excluded from biological interpretation. Network pharmacology predicted the involvement of inflammation- and insulin-resistance-related targets, including TNF, AKT1, IL6, NFKB1, and MAPK3 (also known as ERK1), whereas ALB was treated as a high-connectivity carrier protein rather than a direct druggable mediator. FSV inhibited α-glucosidase in vitro and was associated with improvements in hyperglycemia, insulin-sensitivity indices, dyslipidemia, and tissue morphology in the mouse model. These phenotypic findings are presented as experimental support accompanying the pathway predictions, while direct pathway validation is left for future mechanistic studies. Overall, the results provide a preliminary basis for further chemical validation and mechanistic investigation of FSV in diabetes-related metabolic dysfunction.
Traditional cancer therapy has limitations due to a lack of specificity and efficiency in tumor-targeting, toxicity issues, and biological barriers, which affect the clinical efficacy of traditional agents as well as synthetically designed carriers. Exosomes have gained popularity as excellent biological carriers owing to their inherent biocompatibility, capability to overcome biological barriers, and ability to transport cargoes between cells naturally. This review discusses how engineering of exosomes, hybrid exosomes, and exosome mimics could be employed to deliver therapies, enhance tumor penetration, and enable multimodal treatment of cancers, including chemotherapy, gene therapy, immunotherapy, and theranostics. The biomimetic and hybrid platforms may overcome key limitations of native exosomes, particularly low production yield, heterogeneity, limited drug-loading efficiency, and scalability constraints, while preserving desirable biological functionality. Moreover, the review also emphasizes that the standardization in manufacturing, reproducibility in cargo, safety evaluation, and regulatory approval are the major obstacles to clinical application. Unlike many earlier reviews that were mainly centered on native exosomes, the current review discusses the engineering aspects of exosome-like nanoplatforms from a translational viewpoint.
The main objective of the study is to evaluate the performance of the FilmArray® Pneumonia Plus (FA-PP) panel in critically ill patients with suspected pneumonia compared to conventional culture, in both pandemic and pospandemic periods, and its impact on therapeutic decision-making. Observational study including 225 patients (314 samples) during COVID-19 pandemic and post-pandemic periods. FA-PP and culture results were compared assessing sensitivity (Se), specificity, predictive values, level of concordance between them and the impact on antibiotic prescription. FA-PP detected 133% more bacterial targets than culture and 48% more positive samples. Excluding off-panel bacteria, the panel showed high sensitivity of up to 100% in patients with pneumonia and a negative predictive value (NPV) of over 98%. In the post-pandemic period, the overall Se (78.6%) and Se in patients with pneumonia (81%), as well as the overall NPV and in pneumonia (94%), were higher than in the pandemic period, with significant differences (p<0.05). Twenty-six per cent of pneumonia episodes involved bacteria not included in the panel. The positive concordance between the two tests was 72%. In 56% of cases with pneumonia, antibiotic was modified after the results. During the pandemic period, the panel served to modify treatment towards initiation or escalation. The FA-PP is a valuable tool for optimizing the diagnosis and management of pneumonia in the ICU, with a clinical impact on the appropriateness of antibiotic treatment. There were differences in the impact of the panel between the pandemic and post-pandemic periods.
According to epidemiological data from Hungary, cardiovascular diseases cause the greatest loss of health among the population and are responsible for a significant proportion of premature deaths. This reinforces the health policy position that cardiovascular prevention, including improving medication adherence, must be given top priority in patient care. Long-term survival in patients who have experienced acute coronary syndrome depends heavily on medication adherence, particularly regarding statins and anticoagulants; however, domestic surveys indicate deficiencies in the use of preventive medications. The aim of our study was to compare the attitudes and beliefs regarding antiplatelet agents and cholesterol-lowering drugs among patients in the secondary prevention group who underwent percutaneous coronary intervention and those in the primary prevention control group, using the Beliefs about Medicines Questionnaire (BMQ). A cross-sectional, questionnaire-based study included 162 secondary prevention patients and 136 primary prevention patients who had undergone percutaneous coronary intervention. Medication attitudes were measured using the specific and general dimensions of the BMQ, and SPSS 27.0 was used for statistical analysis. Among patients in the secondary prevention group, both drug groups were characterized by lower levels of concern and more accepting attitudes, whereas in the primary prevention group, sceptical (p<0.05) and ambivalent attitudes were more common (p<0.001). Based on the analysis of respondents by attitude group and the examination of the BMQ's general subscales, percutaneous coronary intervention significantly influenced beliefs regarding medications. This change was clinically significant in terms of treatment adherence (p<0.001) Discussion and conclusion: Patients who have undergone percutaneous coronary intervention have more favourable attitudes toward medication, which highlights the role of targeted education and psychoeducation in improving adherence in the non-intervention population. However, adherence in the secondary prevention group cannot be considered optimal either, therefore further targeted education is warranted in this patient group as well. Orv Hetil. 2026; 167(31): 1238-1247. Bevezetés: Magyarországi epidemiológiai adatok alapján a cardiovascularis betegségek okozzák a legnagyobb egészségveszteséget a lakosság körében, és az idő előtti halálozás jelentős részéért is felelősek. Ez megerősíti azt az egészségpolitikai álláspontot, hogy a cardiovascularis prevenciónak, beleértve a gyógyszeres terápiahűség javítását, kiemelt prioritást kell kapnia a betegellátásban. Az akut coronaria szindrómán átesett betegek hosszú távú túlélése nagymértékben függ a gyógyszeres terápiahűségtől, különösen a sztatinok és véralvadásgátlók tekintetében, ugyanakkor hazai felmérések a preventív gyógyszerek szedésének hiányosságaira utalnak. Célkitűzés: Vizsgálatunk célja a percutan coronariaintervención átesett másodlagos prevenciós és a kontrollcsoportba tartozó elsődleges prevenciós betegek thrombocytaaggregáció-gátlókkal és koleszterinszint-csökkentőkkel kapcsolatos hozzáállásának és hiedelmeinek összehasonlítása volt a Beliefs about Medicines Questionnaire (BMQ) segítségével. Módszerek: Keresztmetszeti, kérdőíves vizsgálatban 162 percutan coronariaintervención átesett másodlagos prevenciós és 136 elsődleges prevenciós beteg vett részt. A gyógyszerattitűdök mérése a BMQ speciális és általános dimenziói mentén történt, a statisztikai elemzéshez az SPSS 27.0 programcsomagot alkalmaztunk. Eredmények: A másodlagos prevenciós betegek esetében elmondható, hogy mindkét gyógyszercsoport esetében kisebb aggodalomszint és elfogadóbb hozzáállás volt jellemző, míg az elsődleges prevenciós csoportban gyakoribb volt a szkeptikus (p<0,05) és az ambivalens hozzáállás (p<0,001). A válaszadók attitűdcsoportok szerinti elemzése, valamint a BMQ általános alskáláinak vizsgálata alapján a percutan coronariaintervencióhoz társulóan szignifikáns különbségek voltak megfigyelhetők a gyógyszerekkel kapcsolatos hiedelmeket illetően. Ez a változás a gyógyszeres terápiahűséggel összefüggő attitűdök szempontjából jelentős volt (p<0,001). Megbeszélés és következtetés: A percutan coronariaintervención átesett betegek kedvezőbb gyógyszerattitűdökkel rendelkeznek, ami kiemeli a célzott edukáció és pszichoedukáció szerepét a nem intervención átesett populáció terápiahűségének javításában. Ugyanakkor a terápiahűség a másodlagos prevenciós csoportban sem tekinthető optimálisnak, ezért ebben a csoportban is indokolt a további célzott betegoktatás alkalmazása. Orv Hetil. 2026; 167(31): 1238–1247.