Background: Exercise-induced left ventricular hypertrophy (LVH) has been extensively investigated in adolescent athletes using the conventional two-tiered classification (2TC). However, the four-tiered classification (4TC) allows further differentiation of LVH patterns by incorporating three-dimensional information on left ventricular (LV) geometry. This study aimed to compare LVH assessment using the two classification systems and characterize the reclassification patterns. Methods: A total of 121 adolescent athletes (mean age: 15.1 ± 1.6 years) and 114 adult athletes (mean age: 22.9 ± 3.7 years), all competing at the national level, underwent comprehensive echocardiographic and anthropometric evaluations. Results: The application of 4TC resulted in redistribution across LV geometric categories compared with conventional 2TC. Twenty-three (19.0%) adolescent and 25 (22%) adult athletes were reclassified, including seven (5.8%) and 17 (15%), respectively, who shifted from normal geometry under the 2TC to different LVH categories under the 4TC. Reclassification was observed across sex and sporting discipline subgroups, although the patterns varied. In runners and triathletes, the combined prevalence of eccentric non-dilated and eccentric dilated LVH was 22.7% using the 4TC versus 4.5% eccentric LVH under the 2TC classification. LVM was strongly associated with the combined contribution of cumulative training duration, lean body mass, and body surface area (r = 0.785, p < 0.001), whereas training duration alone was not significantly associated with the LVH parameters. Conclusions: The 2TC and 4TC approaches result in different assessments of LV geometry in highly trained athletes, with the 4TC providing additional characterization of LVH patterns by considering the presence or absence of LV dilatation. Reclassification patterns varied according to sex and sporting discipline, highlighting the importance of sport-related characteristics when interpreting exercise-induced LV remodeling in athletes.

This study investigates how empathic communication skills among medical and dental students can be effectively developed through simulation-based training that incorporates the Empathy Map as a structured reflective tool. Empathy, a key element of patient-centred care, is often difficult for students to apply in practice, particularly in emotionally charged or complex clinical situations. The course “Empathic and Assertive Communication in Clinical Practice,” delivered at the University of Pécs Medical School in 2023, combined theoretical instruction in clinical empathy, assertiveness, persuasive strategies, and breaking bad news with 23 simulated physician–patient encounters involving trained simulated patients and demonstrator peers. The Empathy Map was used to help students identify patients’ thoughts, emotions, prior knowledge, motivations, and barriers to cooperation. Both student-physicians and simulated patients completed the map after each encounter, providing comparable perspectives on the interaction. Additionally, the Patient–Professional Interaction Questionnaire (PPIQ) captured patient feedback on the quality of communication. The findings show that students consistently recognized patients’ thoughts and attitudes, while identifying emotions proved more difficult, reflecting the broader distinction between cognitive and affective dimensions of empathy. Patient feedback also highlighted strong performance in empathic communication behaviours, including active listening, attentiveness, calm tone, allowing time for questions, and creating a sense of trust and safety. Within the empathy-related items, patients rated “understood my feelings” higher than “was able to put themselves in my place,” aligning with the understanding of clinical empathy as primarily cognitive in nature. Students overwhelmingly found the Empathy Map to be useful for improving their communication skills, and its regular use supported the development of reflective practice and a deeper understanding of patients. However, some sections of the map remained incomplete, suggesting the need for further guidance and practice. Overall, the study demonstrates that integrating simulation-based learning with structured reflective tools can effectively enhance empathic competencies and support the development of patient-centred communication skills essential for modern healthcare.

Background and aimWhite matter hyperintensities (WMHs), presented on T2-weighted or fluid-attenuated inversion recovery magnetic resonance imaging (MRI) sequences, are lesions in the human brain that can be observed in both migraine and multiple sclerosis (MS).MethodsSeventeen migraine patients and 15 patients with relapsing–remitting multiple sclerosis with WMHs, and 17 healthy subjects age-and sex-matched to the migraine group were prospectively enrolled and underwent conventional and advanced MRI studies with diffusion-and perfusion-weighted imaging and single voxel proton magnetic resonance spectroscopy.ResultsIn both disease groups, elevated T2 relaxation time, apparent diffusion coefficient (ADC) values, and decreased N-acetyl-aspartate levels were found in the intralesional white matter compared to the contralateral normal-appearing white matter (NAWM), while there was no difference between the hemispheres of the control subjects. Migraine patients had the lowest intralesional creatine + phosphocreatine and myo-inositol (mI) values among the three groups, while patients with MS showed the highest intralesional T1 and T2 relaxation times, ADC, and mI values. In the contralateral NAWM, the same trend with mI changes was observed in migraineurs and MS patients. No differences in perfusion variables were observed in any groups.ConclusionOur multimodal study showed that tissue damage is detectable in both diseases. Despite the differences in various advanced MRI measures, with more severe injury detected in MS lesions, we could not clearly differentiate the two white matter lesion types.

Bevezetés: Az orvosi kommunikációs készségek hatékony oktatásának széles körben elfogadott módszere a szimulációs betegek alkalmazásával végzett oktatás. A szimulációs betegek hozzájárulnak a klinikai készségek oktatásához és értékeléséhez is. Hazánkban intézményesített formában elsőként a Pécsi Tudományegyetem Általános Orvostudományi Karán indult 2019-ben a „Szimulációs Beteg” program a Kar mindhárom tannyelvű oktatásának támogatására. A program keretein belül laikus szimulációs betegek képzése és továbbképzése folyik magyar, angol és német nyelven. Célkitűzés: A program kari implementációjának fogadtatását négy évvel a program indulása után vizsgáltuk, magyar és nemzetközi hallgatóink körében. Tanulmányunkban a kutatás eredményeinek ismertetése mellett röviden bemutatjuk a program elméleti és gyakorlati vonatkozásait is. Módszer: Kutatásunk online kérdőíves felmérésre épült. A kérdőíves felmérés keresztmetszeti vizsgálattal, kényelmi mintavétellel történt a 2023. tavaszi szemeszterben. A kérdőív három skálája összesen 20 kérdésből áll. A zárt kérdéstípusok feleletválasztást, illetve rangsorolást tartalmaznak. A nyitott kérdések a pozitív tapasztalatok és a nehézségek szabad kifejtésére irányulnak. A vizsgálatot magyar, angol és német kommunikációs-szaknyelvi kurzusok hallgatói körében végeztük. A kutatásra 128 értékelhető válasz érkezett. Eredmények: Szignifikáns különbséget találtunk a három tannyelven tanuló csoportok értékelésében a szimulációs betegekkel folytatott konzultációk, valamint a visszajelzések megítélésében, illetve a szimulációs betegeket alkalmazó oktatás hatékonyságát illetően. A nyitott kérdésekre adott válaszokban a hallgatók a valós élethelyzetek gyakorlásának lehetőségét, a visszacsatolás jelentőségét, a magabiztosság növekedését, a szakmai fejlődést emelték ki. Következtetés: Korábbi kutatásokhoz hasonlóan a szimulációs betegeket alkalmazó módszertan bevezetését egyértelműen pozitívan fogadták hallgatóink. Jelen kutatásunk rámutatott ugyanakkor arra, hogy a különböző oktatási nyelven tanuló hallgatók eltérően súlyozzák a módszertan egyes elemeinek jelentőségét és kihatását a teljes tanulási folyamatra, illetve szakmai fejlődésükre nézve. Orv Hetil. 2024; 165(33): 1286–1294.

Medical communication skills are learned during undergraduate studies and residency programmes by future doctors through case presentations, medical interviews, and healthcare staff interactions. Approaches like peer tutoring, simulation-based education, and blended learning enhance these skills. Our study aims to draw attention to the significance of doctor-patient and doctor-doctor scenarios by presenting a course that facilitates sociopragmatic, pragmalinguistic, and code-switching skills that medical students need to successfully employ in future healthcare settings. We consider patient information, case presenting, and interviewing skills, as well as profound knowledge of medical language equally important elements. While highlighting the essential components of the doctor-patient discourse and revealing the students’ development of code-switching abilities, this article shares the results of a feedback survey completed by participants in a course entitled ‘History taking with actors; simulation practices in the mediskillslab’. We can see the gradual improvement in using medical terms, and the growing confidence of students presenting cases. The programme’s assessment approach, which provides constructive feedback from three perspectives—clinician, simulated patient, and communication instructor—helps the students pinpoint their areas for enhancement. Most students report no major difficulties in taking medical history by employing a simplified ‘patient-friendly’ language understandable to laypeople. However, when they intentionally choose a different code for reporting on their patients by using medical terms, younger students face challenges in creating a brief medical text. The most demanding task for senior participants proved to be delivering bad news; both emotionally and code-switch wise. Our study identifies these difficulties from history-taking simulations to case reports to raise awareness of levels of medical communication. As a conclusion, we believe that an early onset and gradual introduction of activities including history taking, case presentation, and breaking bad news should be incorporated into medical curricula to assist in the acquisition of highly professional, assertive, and empathetic communication skills by graduation.

A tanulói korpuszok egy adott nyelvet idegen nyelvként tanulók produktumainak szisztematikus, elektronikus gyűjteményei, melyek fontos szerepet játszhatnak egy nyelvet idegen nyelvként tanulók nyelvelsajátításának vizsgálatában. A jelen tanulmány célja a modalitás vizsgálata a „UPMS Learner Corpus of Official Letters” korpuszban. A korpusz angol nyelvet idegen nyelvként tanuló, B2 szinten lévő orvostanhallgatók által angol nyelven megírt hivatalos leveleket tartalmaz. A vizsgálat a Sketch Engine szoftver segítségével történt. Az eredmények azt mutatták, hogy a hallgatók a modalitás kifejezésére főként segédigéket használtak. Az eredményekből arra lehet következtetni, hogy a hallgatók B2 szinten a modalitást elsősorban modális segédigét tartalmazó betanult kifejezések segítségével fejezik ki, és ezeket helyesen használják, jól elsajátították. Azonban kevesebb figyelmet fordítanak más modalitást kifejező eszközökre, pl. modális jelzők, határozók, „köntörfalazási” technikák használatára.

Medical education and communication training has been undergoing substantial changes recently in our globalized environment.Multidisciplinary simulation-based methods worldwide focus on improving effective clinical skills including history taking, physical examination, diagnostic skills, critical thinking, therapeutic skills, and others via interactions between medical students, trainees, and patients.Recently, Hungary has joined such global trends.The first simulated patient program in Hungary was developed at the University of Pécs Medical School in 2019 to aid effective patient-interviewing skills in language and communication classes.Under the supervision of linguists, communication specialists and medical professionals, the multidisciplinary program uses lay people to perform as simulated patients while using the languages of Hungarian, German, and English.Our simulated patient program plays a specific role in supporting students to learn languages for medical purposes, aiming to prepare them for handling the medical, linguistic, at the same, time emotional and sociocultural difficulties encountered while taking patient histories.Medical and linguistic experts evaluate student performance, provide feedback, and give tailored instruction so that students can advance their communicative and professional skills.This study discusses working formats and the role of constructive feedback exploring potential advantages and disadvantages, sharing ideas, and proposing recommendations on language-and communicationbased integration of simulated patients.In our elective communication courses, undergraduate medical students learn to cope with a variety of patient situations through practicing medical emergencies, misunderstandings, and disagreements in a safe atmosphere provided by the MediSkillsLab.Among the benefits, we should emphasize that any course with a growing number of students can be accommodated by carefully designing the program, which allows for interprofessional collaboration.This program contributes to higher-quality medical education, promoting more skilled and compassionate healthcare specialists.

Introduction: The use of simulated patients is a widely accepted method for effectively teaching medical communication skills. Simulated patients also contribute to the teaching and assessment of clinical skills. The first institutionalized “Simulated Patient” program in Hungary was launched at the University Medical School of Pécs in 2019 to support the education of medical students. The program provides training and education for lay simulated patients in Hungarian, English and German. Objective: We evaluated the perception of Hungarian and international students four years after implementing the program. In addition to presenting the research results, we briefly describe the theoretical and practical aspects of the program. Method: Research data were gathered with the help of an online cross-sectional questionnaire survey using convenience sampling in the spring semester of 2023. The three scales of the questionnaire consisted of a total of 20 questions. The closed question types included multiple choice questions and ranking. The open-ended questions focused on positive experiences and difficulties. The survey was conducted among Hungarian, English, and German program students. 128 students responded to the survey. Results: Significant differences were found between the students in the three language programs regarding the assessment of the simulated patient consultations and feedback and the method’s effectiveness. Analysis of responses to open-ended questions highlighted the opportunity to practice real-life situations, the importance of feedback, increased confidence, and professional development. Conclusion: Consistent with the results of other studies in the field, our students’ perceptions of the introduction of the new methodology were positive. However, our current study has pointed out that students learning in different languages of instruction weigh the significance and impact of some aspects of the simulation patient program differently on their overall learning process and professional development. Orv Hetil. 2024; 165(33): 1286–1294.

Educational feedback is a facilitating tool in improving medical interviewing skills through simulation practices. The simulated patient (SP) programme at the University of Pécs Medical School aims to provide efficient help for educators and students alike in language for medical purposes, communication and clinical courses. The constructivist feedback methodological approach ensures that students in history taking classes learn from role-playing in simulated scenarios and the feedback offered from the simulated patient. Effective assessment includes the learners’ own reflection and the patients’ non-judgmental observation on perceived interpersonal communication skills, observed professional misconduct, students’ ability to cope in emotionally challenging situations, and suggestions for improvement. Giving feedback has to be offered regularly to enable improvement in medical communication and nurture self-confidence. Our questionnaire survey of the students who attended history taking courses involved both self-reflection and instructor feedback based on their performance during simulated scenarios. The results of the study demonstrated substantial developments in relationship-building skills and self-confidence for students in post-course clinical practice.

Background/aimMigraine is a disabling headache with clinical and radiological complications. The aim of this study was to investigate the volume of the thalamus and hippocampus in migraineurs, the role of white matter lesions (WMLs), and the migraine characteristics in volume changes.MethodsBrain MRIs of 161 right-handed female episodic migraine patients and 40 right-handed, age-related, healthy women were performed. Left and right thalamus segmentation was performed on the 3D MPRAGE images using the Freesurfer 5.3 image analysis suite. Hippocampal subfield segmentation was based on a novel statistical atlas built primarily upon ultra-high-resolution ex vivo MRI data.ResultsThe left hippocampus had a smaller and the left thalamus had a larger total volume than the right one in both the control (p < 0.001) and migraine groups (p <0.001). Patients with white matter lesions (L+) showed smaller right thalamus and right hippocampal tail volumes than patients without lesions (L–) (p = 0.002 and p = 0.015, respectively) and controls (p = 0.039 and p = 0.025, respectively). For the right hippocampal body, we found significantly smaller volume in L+ patients when compared to L– patients (p = 0.018) and a similar trend when compared to the control group (p = 0.064). Patients without aura (A–) showed a larger right hippocampus (p = 0.029), right hippocampal body (p = 0.012), and tail volumes (p = 0.011) than patients with aura (A+). Inverse correlations were found between attack frequency and the volumes of the left and right hippocampal tails (p = 0.018 and p = 0.008, respectively).ConclusionThese findings indicate that WMLs may influence the volume of the right thalamus and hippocampus, while migraine aura and attack frequency may lead to volume changes in different parts of the hippocampi in migraine patients. These data support the necessity of effective migraine management to limit subcortical volume loss in migraineurs.

Assertive communication is a powerful communication skill in everyday clinical practice among staff members and in doctor-patient encounters. It has an important role in eliciting relevant information during patient interviewing, similarly, in shared decision-making or convincing patients of certain therapy options. The skills are also needed in delegating tasks or giving feedback to colleagues. Through simulated medical encounters, culturally appropriate assertive communication skills can be improved to tackle challenges in hierarchical healthcare contexts. Our comparative study analyses the results of a questionnaire survey of two simulation-based communication courses, where one explicitly aims to use assertive skills in clinical settings while the other implicitly encourages students to defend their opinions in doctor-patient scenarios. Blended-learning methods, support from clinicians and mentors in promoting self-confidence and self-esteem, constructive feedback from both simulated patients and the observers (linguists, psychologists), teamwork skills training and assertive communication techniques were applied to ensure the effectiveness of the courses. The article shares the verbal and non-verbal tools of assertive communication evaluated by the observers, and the self-evaluations of students, which focused on their own behavioural changes in terms of sense of responsibility, sense of failure and navigating between assertiveness and empathy.

Background and Aim: Brainstem descending modulatory circuits have been postulated to be involved in migraine. Differences in brainstem volume between migraineurs and healthy controls have been demonstrated in previous research, nevertheless, the effect of migraine aura on brainstem volume is still uncertain. The aim of this study was to investigate the brainstem volume in migraineurs and examine the effect of migraine aura on brainstem volume. Methods: Our study included 90 female migraine patients without white matter lesions. (29 migraine patients with aura (MwA) and 61 migraine patients without aura (MwoA) and 32 age-matched female healthy controls (HC). Using the FreeSurfer image analysis suite, the volumes of the entire brainstem and its subfields (medulla, pons, and midbrain) were measured and compared between migraine subgroups (MwA vs. MwoA) and the healthy control group. The possible effects of migraine characteristics (i.e., disease duration and migraine attack frequency) on brainstem volume were also investigated. Results: Migraineurs had greater medulla volume (MwoA 3552 +/- 459 mm3, MwA 3424 +/- 448 mm3) than healthy controls (3236 +/- 411 mm3). Statistically, MwA vs. HC p = 0.040, MwoA vs. HC p = 0.002, MwA vs. MwoA p = 0.555. A significant positive correlation was found between disease duration and the volume of medulla in the whole migraine group (r = 0.334, p = 0.001). Neither the whole brainstem nor its subfields were significantly different in volume between migraine subgroups. Conclusion: Brainstem volume changes in migraine are mainly localized to the medulla and not specific to the presence of aura.

Az empátia kiemelt szerepet játszik az orvos–beteg együttműködésben, ezért elengedhetetlen, hogy az empatikus kommunikáció fejlesztése már az orvostanhallgatók képzése során megvalósuljon. Ehhez a leghatékonyabb módszer a valódi orvos–beteg szituációhoz hasonló helyzetek szimulációs gyakorlása. Az interakciók során alkalmazott empatikus kommunikáció nagymértékben elősegíti a terápiás együttműködést, a megértést. Ezért esett választásunk olyan érzelmileg komoly kihívást jelentő helyzetek vizsgálatára, amelyekben nagy szerepe van az empátiának, így a meggyőzést, ellenállást, valamint a rossz hír közlését gyakoroltató szituációkra. Az „Empatikus és asszertív kommunikáció a klinikai gyakorlatban” kurzust 2021 tavaszán a pandémia miatt online formában tudtuk megvalósítani. Tanulmányunkban arra keressük a választ, hogy ha a konzultáció az orvos–beteg között személyes jelenléttel kivitelezhetetlen és a kommunikációs csatorna az online formára korlátozódik, milyen nyelvi eszközei, lehetőségei vannak egy orvosnak, hogy a sikeres terápia érdekében az empatikus kommunikációt maximálisan megvalósíthassa. Kérdésként merül fel, hogy vajon csökken-e a kommunikáció hatékonysága vagy újabb lehetőségeket adhat az online tér. Gyakorlataink során azt vizsgáltuk, hogy az orvostanhallgatók milyen nyelvi eszközökkel tudják megvalósítani az empatikus kommunikációt, milyen nem-verbális és verbális interakció jöhet létre egy ilyen speciális helyzetben.

Cow's milk protein allergy is one of the most common pediatric food allergies. It poses a significant socioeconomic burden in industrialized countries and has a profound effect on the quality of life of affected individuals and their families. Diverse immunologic pathways can lead to the clinical symptoms of cow's milk protein allergy; some of the pathomechanisms are known in detail, but others need further elucidation. A comprehensive understanding of the development of food allergies and the features of oral tolerance could have the potential to unlock more precise diagnostic tools and novel therapeutic approaches for patients with cow's milk protein allergy.

Introduction:The most prevalent food allergy in younger children is cow's milk protein allergy (CMPA), a hypersensitivity reaction to cow's milk protein and its most common clinical manifestation is allergic colitis. The goal of our recent study was to assess somatic symptoms of CMPA and to prospectively observe the effects of a dairy elimination diet using objective parameters and questionnaires.Methods:The County Hospital in Szekszárd, Hungary, investigated children aged 1 to 18 who had clinical signs that might indicate CMPA. Stool samples were taken and analyzed using a fecal calprotectin (FC) rapid test (Quantum Blue fCAL, Bühlmann Laboratories, Switzerland) at the time of the diagnosis and following 3 months of an elimination diet. At the baseline visit as well as the first and second follow-up, questionnaires were filled out. Patients were divided into two subgroups according to dietary guidelines based on the results of the questionnaires.Results:A total of 47 patients participated in the study [42.55% female, mean age: 7.36 (SD 4.22) years]. There was no significant difference in FC levels between baseline and after 3-month elimination diet [73.98 (71.12) μg/g and 68.11 (74.4) μg/g, respectively, p = 0.331]. After three months, there was a significant decrease in FC levels among patients who adhered to the strict diet [84.06 (79.48) μg/g and 41.11 (34.24) μg/g, respectively, p = 0.001].Conclusion:The findings of our study suggest that FC can be an objective marker in confirming the diagnosis of CMPA. Significant improvement in clinical symptoms and in FC levels can only be expected after a strictly followed elimination diet.

Empathy plays an essential role in communication between doctor and patient, which can facilitate treatment. Therefore, it is crucial to develop communication and empathic skills of medical students through experiential role-playing at the Medical School. This study focuses on methods improving empathy of medical students in doctor (student) - patient (actor) simulated role-plays. The purpose of our research was to identify factors that promote the development and expression of empathy in medical encounters. We aim to investigate the language of clinical empathy: how medical students can use the language to build empathetic communication. The authentic case-based role-plays provide sociolinguistic tools for interactions and for expressing empathy as well as reassuring the patient’s emotions. Our study demonstrates how empathic communication skills form a more effective doctor-patient relationship, leading to greater patient satisfaction and better patient compliance. Keywords: empathy training, the language of empathetic communication, medical education, simulation, verbal and non-verbal clinical communication

Abstract Endurance training-induced changes in left ventricular diastolic function and right ventricular parameters have been investigated extensively in adolescent athletes. Our aim was to examine the parameters for adolescent athletes (n=121, 15.1±1.6 years) compared to adult athletes and age-matched non-athletes. We explored the effects of influencing factors on the echocardiographic parameters. Significantly higher E/A (p<0.05) and e’ values (p<0.001) were detected in adolescent athletes compared to age-matched non-athletes’ and also adult athletes’ parameters. Significantly lower structural and functional right ventricular parameters (p<0.05) were detected in adult athletes. In adolescent athletes significantly higher right ventricular diameters, tricuspid S wave, right ventricular end-diastolic and end-systolic area values (p<0.05) were found compared to the matching parameters of non-athletes. We found significantly higher corrected tricuspid annular plane systolic excursion values (p<0.001) in athletes compared to the non-athletes. Based on multivariate analysis lean body mass, body surface area, age and cumulative training time were proved as strong predictive factors of both left ventricular diastolic and right ventricular parameters. Supernormal left ventricular diastolic function and significantly higher right ventricular parameters are indicative of cardiac adaptation. Well-defined cut-off values should be applied to discriminate pathological conditions in the relation of the influencing factors.

Medical terminology is a specific code, also labelled as the language of medical communication. Methods including simulation-based doctor-patient encounters enable students to start using that language already during their undergraduate years, often prior to or parallel to their clinical practices. Yet, one party in the conversation – mainly the patient – is most often unable to use that code. The simulation-based history taking course at the University of Pécs facilitates the students’ improvement of awareness in code-switching from a doctor-patient scenario to a doctor-doctor or health personnel scene. Focusing on fundamental elements of the specific language use, students have a chance to revise medical and/or more precisely, clinical terminology by simplifying, defining terms to lay patients – simulated by actors –, as well as present the term-loaded case history to a fellow colleague. Thus, by awareness raising, theoretical knowledge of previous years may be activated. The paper introduces how history taking simulations and case presentations in the English programme empower medical students in the confident use of medical terminology.