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Ruzsa R, Benkő R, Hambalek H, Papfalvi E, Csupor D, Nacsa R, Csatordai M, Soós G, Hajdú E, Matuz M. Hospital Antibiotic Consumption before and during the COVID-19 Pandemic in Hungary. Antibiotics (Basel) 2024; 13:102. [PMID: 38275331 PMCID: PMC10812576 DOI: 10.3390/antibiotics13010102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
The aim of this study was to assess antibiotic use in the Hungarian hospital care sector during and before the pandemic. Aggregated systemic antibiotic (ATC: J01) utilisation data were obtained for the 2010-2021 period. Classifications and calculations were performed according to the WHO ATC/DDD index and expressed as DDD per 1000 inhabitants and per day (DID), DDD per 100 patient-days (DHPD) and DDD/discharge. A linear regression (trend analysis) was performed for the pre-COVID years (2010-2019) and a prediction interval was set up to assess whether the pandemic years' observed utilisation fit in. Antibiotic utilisation was constant in DID before and during the pandemic (2019: 1.16; 2020: 1.21), while we observed a substantial increase in antibiotic use when expressed in DDD per 100 patient-days (2019: 23.3, 2020: 32.2) or DDD/discharge (2019: 1.83, 2020: 2.45). The observed utilisation level of penicillin combinations; first-, third- and fourth-generation cephalosporins; carbapenems; glycopeptides; nitroimidazoles and macrolides exceeded the predicted utilisation values in both pandemic years. Before the pandemic, co-amoxiclav headed the top list of antibiotic use, while during the pandemic, ceftriaxone became the most widely used antibiotic. Azithromycin moved up substantially on the top list of antibiotic use, with a 397% increase (2019: 0.45; 2020: 2.24 DHPD) in use. In summary, the pandemic had a major impact on the scale and pattern of hospital antibiotic use in Hungary.
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Affiliation(s)
- Roxána Ruzsa
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Ria Benkő
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
- Department of Emergency Medicine, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Helga Hambalek
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Erika Papfalvi
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- Department of Emergency Medicine, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Dezső Csupor
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- Institute of Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Róbert Nacsa
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Márta Csatordai
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Gyöngyvér Soós
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
| | - Edit Hajdú
- Department of Internal Medicine Infectiology Unit, Albert Szent-Györgyi Health Centre, University of Szeged, 6725 Szeged, Hungary;
| | - Mária Matuz
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
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Engi Z, Matuz M, Soós G, Hajnal F, Szökő É, Viola R, Csupor D, Benkő R. [Deprescribing: an essential part of rational pharmacotherapy]. Orv Hetil 2023; 164:931-941. [PMID: 37330979 DOI: 10.1556/650.2023.32782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/06/2023] [Indexed: 06/20/2023]
Abstract
Deprescribing is a planned, systematic process supervised by a healthcare professional. It is considered to be a fundamental part of good prescribing. Deprescribing can be defined as the complete withdrawal of medications as well as dose reduction. The patient's health status, life expectancy, values, preferences and the therapeutic goals should be given serious consideration while planning the deprescribing process. The main objective of deprescribing may vary but reaching the patients' goals and improving their quality of life remain constant priorities. In our article, based on the international literature, we review potential deprescribing targets such as the characteristics of high-risk patients, medications that should prompt a therapy review and the ideal settings for deprescribing. We also cover the steps, risks and benefits of the process, and discuss the existing specific guidelines and algorithms. We provide information on the enablers and barriers of deprescribing among both patients and healthcare professionals, and discuss international initiatives as well as the future of deprescribing. Orv Hetil. 2023; 164(24): 931-941.
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Affiliation(s)
- Zsófia Engi
- 1 Szegedi Tudományegyetem, Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet Szeged, Szikra u. 8., 6725 Magyarország
| | - Mária Matuz
- 1 Szegedi Tudományegyetem, Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet Szeged, Szikra u. 8., 6725 Magyarország
| | - Gyöngyvér Soós
- 1 Szegedi Tudományegyetem, Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet Szeged, Szikra u. 8., 6725 Magyarország
| | - Ferenc Hajnal
- 2 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Családorvosi Intézet Szeged Magyarország
| | - Éva Szökő
- 3 Semmelweis Egyetem, Gyógyszerésztudományi Kar, Gyógyszerhatástani Intézet Budapest Magyarország
| | - Réka Viola
- 1 Szegedi Tudományegyetem, Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet Szeged, Szikra u. 8., 6725 Magyarország
| | - Dezső Csupor
- 1 Szegedi Tudományegyetem, Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet Szeged, Szikra u. 8., 6725 Magyarország
| | - Ria Benkő
- 1 Szegedi Tudományegyetem, Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet Szeged, Szikra u. 8., 6725 Magyarország
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Hambalek H, Matuz M, Ruzsa R, Engi Z, Visnyovszki Á, Papfalvi E, Hajdú E, Doró P, Viola R, Soós G, Csupor D, Benko R. Impact of the COVID-19 Pandemic on Ambulatory Care Antibiotic Use in Hungary: A Population-Based Observational Study. Antibiotics (Basel) 2023; 12:970. [PMID: 37370289 DOI: 10.3390/antibiotics12060970] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
The COVID-19 pandemic and related restrictions have potentially impacted the use of antibiotics. We aimed to analyze the use of systemic antibiotics (J01) in ambulatory care in Hungary during two pandemic years, to compare it with pre-COVID levels (January 2015-December 2019), and to describe trends based on monthly utilization. Our main findings were that during the studied COVID-19 pandemic period, compared to the pre-COVID level, an impressive 23.22% decrease in the use of systemic antibiotics was detected in ambulatory care. A significant reduction was shown in the use of several antibacterial subgroups, such as beta-lactam antibacterials, penicillins (J01C, -26.3%), and quinolones (J01M, -36.5%). The trends of antibiotic use moved in parallel with the introduction or revoking of restriction measures with a nadir in May 2020, which corresponded to a 55.46% decrease in use compared to the previous (pre-COVID) year's monthly means. In general, the systemic antibiotic use (J01) was lower compared to the pre-COVID periods' monthly means in almost every studied pandemic month, except for three months from September to November in 2021. The seasonal variation of antibiotic use also diminished. Active agent level analysis revealed an excessive use of azithromycin, even after evidence of ineffectiveness for COVID-19 emerged.
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Affiliation(s)
- Helga Hambalek
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Mária Matuz
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Roxána Ruzsa
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
| | - Zsófia Engi
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
| | - Ádám Visnyovszki
- Department of Internal Medicine Infectiology Unit, Albert Szent-Györgyi Health Centre, University of Szeged, Állomás Street 1-3, 6725 Szeged, Hungary
| | - Erika Papfalvi
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Department of Internal Medicine Infectiology Unit, Albert Szent-Györgyi Health Centre, University of Szeged, Állomás Street 1-3, 6725 Szeged, Hungary
| | - Edit Hajdú
- Department of Internal Medicine Infectiology Unit, Albert Szent-Györgyi Health Centre, University of Szeged, Állomás Street 1-3, 6725 Szeged, Hungary
| | - Péter Doró
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
| | - Réka Viola
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Gyöngyvér Soós
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
| | - Dezső Csupor
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Ria Benko
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
- Emergency Department, Albert Szent-Györgyi Health Centre, University of Szeged, Semmelweis Street 6, 6725 Szeged, Hungary
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Benkő R, Matuz M, Pető Z, Weist K, Heuer O, Vlahović-Palčevski V, Monnet DL, Galistiani GF, Blix HS, Soós G, Hajdú E. Trends in the hospital-sector consumption of the WHO AWaRe Reserve group antibiotics in EU/EEA countries and the United Kingdom, 2010 to 2018. Euro Surveill 2022; 27. [PMID: 36239173 PMCID: PMC9562808 DOI: 10.2807/1560-7917.es.2022.27.41.2101058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundIn 2019, the World Health Organization published the 21st Model list of Essential Medicines and updated the Access, Watch Reserve (AWaRe) antibiotics classification to improve metrics and indicators for antibiotic stewardship activities. Reserve antibiotics are regarded as last-resort treatment options.AimWe investigated hospital-sector consumption quantities and trends of Reserve group antibiotics in European Union/European Economic Area countries and the United Kingdom (EU/EEA/UK).MethodsHospital-sector antimicrobial consumption data for 2010-2018 were obtained from the European Centre for Disease Prevention and Control. Antibacterials' consumption for systemic use (Anatomical Therapeutic Chemical classification (ATC) group J01) were included in the analysis and expressed as defined daily doses (DDD) per 1,000 inhabitants per day. We defined reserve antibiotics as per AWaRe classification and applied linear regression to analyse trends in consumption of reserve antibiotics throughout the study period.ResultsEU/EEA/UK average hospital-sector reserve-antibiotic consumption increased from 0.017 to 0.050 DDD per 1,000 inhabitants per day over the study period (p = 0.002). This significant increase concerned 15 countries. In 2018, four antibiotics (tigecycline, colistin, linezolid and daptomycin) constituted 91% of the consumption. Both absolute and relative (% of total hospital sector) consumption of reserve antibiotics varied considerably (up to 42-fold) between countries (from 0.004 to 0.155 DDD per 1,000 inhabitants per day and from 0.2% to 9.3%, respectively).ConclusionAn increasing trend in reserve antibiotic consumption was found in Europe. The substantial variation between countries may reflect the burden of infection with multidrug-resistant bacteria. Our results could guide national actions or optimisation of reserve antibiotic use.
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Affiliation(s)
- Ria Benkő
- University of Szeged, Albert-Szent Györgyi Medical Centre, Emergency Department, Szeged, Hungary.,University of Szeged, Albert-Szent Györgyi Medical Centre, Central Pharmacy, Szeged, Hungary.,University of Szeged, Faculty of Pharmacy, Institute of Clinical Pharmacy, Szeged, Hungary
| | - Mária Matuz
- University of Szeged, Albert-Szent Györgyi Medical Centre, Central Pharmacy, Szeged, Hungary.,University of Szeged, Faculty of Pharmacy, Institute of Clinical Pharmacy, Szeged, Hungary
| | - Zoltán Pető
- University of Szeged, Albert-Szent Györgyi Medical Centre, Emergency Department, Szeged, Hungary
| | - Klaus Weist
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Ole Heuer
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Vera Vlahović-Palčevski
- Department of Clinical Pharmacology, University Hospital Rijeka/Medical Faculty and Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
| | - Dominique L Monnet
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Hege Salvesen Blix
- The research group for personalized pharmacotherapy and clinical pharmacy, Department of Pharmacy, University of Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway.,WHO Collaborating Centre for Drug Statistics Methodology, Oslo, Norway
| | - Gyöngyvér Soós
- University of Szeged, Faculty of Pharmacy, Institute of Clinical Pharmacy, Szeged, Hungary
| | - Edit Hajdú
- University of Szeged, Albert-Szent Györgyi Medical Centre, Internal Medicine Department, Infectious Disease Unit, Hungary
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- Members of the ESAC-Net AWaRe study group are listed under Collaborators
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Engi Z, Benkő R, Soós G, Szok D, Csenki M, Csüllög E, Balog A, Csupor D, Viola R, Doró P, Matuz M. Trends in Opioid Utilisation in Hungary, 2006-2020: A Nationwide Retrospective Study with Multiple Metrics. Eur J Pain 2022; 26:1896-1909. [PMID: 35848717 PMCID: PMC9541344 DOI: 10.1002/ejp.2011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/01/2022] [Accepted: 07/16/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Opioid use is well-documented in several countries: some countries struggle with overuse while others have almost no access to opioids. For Europe, limited data are available. This study analysed Hungarian opioid utilisation in ambulatory care between 2006 and 2020. METHODS We obtained national drug utilization data on reimbursed opioid analgesics (ATC code: N02A) from a national health insurance database for a 15-year period. We investigated utilisation trends, using three volume-based metrics (defined daily dose per 1000 inhabitants per day (DID), oral morphine equivalent per 1000 inhabitants per day, packages dispensed per 1000 inhabitants per year). We stratified data based on administration routes, analgesic potency and reimbursement categories. RESULTS Total opioid utilisation increased during the study period according to all three metrics (74% in DID) and reached 5.31 DID by 2020. Upward trends were driven by an increase both in weak and strong opioid use (79% vs. 53%). The most commonly used opioids were fentanyl (in the strong category; 0.76 DID in 2020) and tramadol (in the weak category; 2.62 DID in 2020). Overall, tramadol was also the most commonly used opioid throughout the study period. Oral administration of opioid medications was dominant. Based on reimbursement categories, musculoskeletal pain was becoming a more frequent indication for opioid use (1552% increase in DID), while opioid use for cancer pain declined significantly during the study period (-33% in DID). CONCLUSIONS Our low utilisation numbers might indicate underuse of opioid analgesia, especially for cancer pain.
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Affiliation(s)
- Z Engi
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary
| | - R Benkő
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary.,Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary.,Emergency Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary
| | - G Soós
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary
| | - D Szok
- Department of Neurology, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary
| | - M Csenki
- Department of Oncotherapy, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary
| | - E Csüllög
- Department of Anesthesiology and Intensive Care, Albert Szent-Györgyi Health Center, 6725, University of Szeged, Szeged, Hungary
| | - A Balog
- Department of Rheumatology and Immunology, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary
| | - D Csupor
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary.,Institute for Translational Medicine, Medical School, University of Pécs, 7624, Pécs, Hungary
| | - R Viola
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary
| | - P Doró
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary
| | - M Matuz
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary.,Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary
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6
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Matuz M, Soós G, Hajdú E, Papfalvi E, Visnyovszki Á, Viola R, Benkő R. Az antibiotikum ambuláns alkalmazásának jellemzői és tendenciái Magyarországon (2010–2019). Orv Hetil 2022; 163:140-149. [DOI: 10.1556/650.2022.32324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/30/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló.
Bevezetés: Az antibiotikumok észszerű alkalmazása
kulcsfontosságú a hatékonyságuk megőrzésében és a néhol kritikus méreteket öltő
antibiotikumrezisztencia visszaszorításában. Célkitűzés: A
hazai ambuláns antibiotikumfelhasználás jellemzőinek, trendjeinek bemutatása.
Módszer: A 2010 és 2019 közötti időszakra vonatkozó,
dobozszámban kifejezett ambuláns szisztémás antibiotikumfelhasználási adatokat –
a WHO 2019. évi indexe alapján – „defined daily dose” (DDD – napi átlagdózis)
egységbe konvertáltuk. Standardizált technikai egységünk a DDD/1000 fő/nap volt
(DID). Az antibiotikumfelhasználás értékelésére nemzetközileg elfogadott
minőségi indikátorokat alkalmaztunk. Eredmények: Az
antibiotikumfelhasználás mértéke kismértékű ingadozást mutatott (min.: 12,9 DID,
max.: 14,7 DID), viszont a szezonális ingadozás a teljes megfigyelt időszakban
jelentős mértékű volt. A széles versus szűk spektrumú
béta-laktámok és makrolidek felhasználási hányadosa évről évre tovább emelkedett
(2010: 13,3 vs. 2019: 71,6), a fluorokinolonok alkalmazási
aránya továbbra is meghatározó (2010: 14,3%, 2019: 14,5%). A vizsgált 12
minőségi indikátor közül a tanulmány nyitó évében 4, a tanulmány záró évében 6
indikátor esetében a legkedvezőtlenebbül teljesítő európai országok közé
tartoztunk. Megbeszélés: A hazai antibiotikumalkalmazás mértéke
európai mérce szerint nem magas, de csökkentésére látszik lehetőség; mintázata
szuboptimális, és az évek során kedvezőtlen irányba változott.
Következtetés: A kapott antibiotikumfelhasználási adatok s
azok értelmezése alapján rendkívül sürgető morális kötelesség a szakmai és
hatósági intervenciókra épülő hazai antibiotikumstratégia és -akcióterv mielőbbi
kidolgozása, implementálása. Orv Hetil. 2022; 163(4): 140–149.
Summary.
Introduction: Prudent antibiotic use is an important tool to
preserve their effectiveness as well as reverse and confine antibiotic
resistance. Objective: To evaluate the trends and
characteristics of Hungarian outpatient antibiotic use.
Methods: Crude, package level antibiotic sales data for the
period 2010–2019 were converted into DDD (defined daily dose) and were
standardized for 1000 inhabitants and per year (ATC-DDD index, version 2019).
Internationally validated drug-specific quality indicators were used to evaluate
antibiotic use. Results: The scale of antibiotic use was
stagnating with minimal fluctuation (min.: 12.9 DID, max.: 14.7 DID), and with
high intra-year seasonality index. The ratio of the consumption of broad to
narrow spectrum beta-lactams and macrolides increased gradually from year to
year (2010: 13.3 vs. 2019: 71.6) and the relative consumption
of fluoroquinolones is still remarkable (2010: 14.3%, 2019: 14.5%). Out of the
twelve surveyed drug-specific quality indicators in the first and last year of
analysis, we were ranked among the weakest European countries in the case of
four and six indicators, respectively. Discussion: The scale of
Hungarian outpatient antibiotic use is not high, in European comperison, but has
some reserve capacity for reduction. The pattern of Hungarian antibiotic use is
suboptimal and had further decreased quality through the years.
Conclusion: Based on the recorded data of antibiotic use
and their interpretation, the development of national antibiotic strategy
(including both professional and authority interventions) is a pressing moral
obligation. Orv Hetil. 2021; 163(4): 140–149.
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Affiliation(s)
- Mária Matuz
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet Szeged
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, Központi Gyógyszertár Szeged, Szikra u. 8., 6725
| | - Gyöngyvér Soós
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet Szeged
| | - Edit Hajdú
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, I. Belgyógyászati Klinika, Infektológia Osztály Szeged
| | - Erika Papfalvi
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, I. Belgyógyászati Klinika, Infektológia Osztály Szeged
| | - Ádám Visnyovszki
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, I. Belgyógyászati Klinika, Infektológia Osztály Szeged
| | - Réka Viola
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet Szeged
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, Központi Gyógyszertár Szeged, Szikra u. 8., 6725
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Idegsebészeti Klinika Szeged
| | - Ria Benkő
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet Szeged
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, Központi Gyógyszertár Szeged, Szikra u. 8., 6725
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, Sürgősségi Betegellátó Önálló Osztály Szeged
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Tuula A, Volmer D, Jõhvik L, Rutkovska I, Trečiokienė I, Merks P, Waszyk-Nowaczyk M, Drozd M, Tatarević A, Radovanlija M, Pacadi C, Meštrović A, Viola R, Soós G, Rais C, Táerel AE, Kuzelova M, Zare M, Peymani P, Oona M, Scott M. Factors Facilitating and Hindering Development of a Medication Use Review Service in Eastern Europe and Iran-Cross-Sectional Exploratory Study. Healthcare (Basel) 2021; 9:healthcare9091207. [PMID: 34574981 PMCID: PMC8468572 DOI: 10.3390/healthcare9091207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/29/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
Polypharmacy is a common issue in patients with chronic diseases. Eastern-European countries and Iran are exploring possibilities for implementing the Medication Use Review (MUR) as a measure for optimizing medication use and ensuring medication safety in polypharmacy patients. The aim of this study was to gain insights into the development of the community pharmacy sector and map facilitators and barriers of MUR in Eastern Europe and Iran. The representatives of the framework countries received a questionnaire on community pharmacy sector indicators, current and future developments of pharmacies, and factors encouraging and hindering MUR. To answer the questionnaire, all representatives performed document analysis, literature review, and qualitative interviews with key stakeholders. The socio-ecological model was used for inductive thematic analysis of the identified factors. Current community pharmacist competencies in framework countries were more related to traditional pharmacy services. Main facilitators of MUR were increase in polypharmacy and pharmaceutical waste, and access to patients’ electronic list of medications by pharmacists. Main barriers included the service being unfamiliar, lack of funding and private consultation areas. Pharmacists in the framework countries are well-placed to provide MUR, however, the service needs more introduction and barriers mostly on organizational and public policy levels must be addressed.
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Affiliation(s)
- Anita Tuula
- Institute of Pharmacy, University of Tartu, 50411 Tartu, Estonia;
- Correspondence: ; Tel.: +372-7375-286
| | - Daisy Volmer
- Institute of Pharmacy, University of Tartu, 50411 Tartu, Estonia;
| | - Liisa Jõhvik
- Hospital Pharmacy, Tartu University Hospital, 50406 Tartu, Estonia;
| | - Ieva Rutkovska
- Faculty of Pharmacy, Riga Stradins University, LV-1007 Riga, Latvia;
| | - Indre Trečiokienė
- Pharmacy Center, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
| | - Piotr Merks
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, 01-938 Warsaw, Poland;
| | - Magdalena Waszyk-Nowaczyk
- Department of Pharmaceutical Technology, Pharmacy Practice Division, Poznan University of Medical Sciences, 60-780 Poznan, Poland;
| | - Mariola Drozd
- Department of Humanities and Social Medicine, Medical University of Lublin, 20-093 Lublin, Poland;
| | | | | | - Carmen Pacadi
- Mandis Pharm Community Pharmacies, 10000 Zagreb, Croatia;
| | | | - Réka Viola
- Faculty of Pharmacy, University of Szeged, H-6720 Szeged, Hungary; (R.V.); (G.S.)
| | - Gyöngyvér Soós
- Faculty of Pharmacy, University of Szeged, H-6720 Szeged, Hungary; (R.V.); (G.S.)
| | - Cristina Rais
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 020956 Bucharest, Romania; (C.R.); (A.-E.T.)
| | - Adriana-Elena Táerel
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 020956 Bucharest, Romania; (C.R.); (A.-E.T.)
| | - Magdalena Kuzelova
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, 83232 Bratislava, Slovakia;
| | - Marziyeh Zare
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz 7134845794, Iran;
| | - Payam Peymani
- Rady Faculty of Health Sciences, College of Pharmacy, University of Manitoba, Winnipeg, MB R3E 0T5, Canada;
| | - Marje Oona
- Institute of Family Medicine and Public Health, University of Tartu, 50411 Tartu, Estonia;
| | - Michael Scott
- Medicines Optimisation Innovation Centre, Antrim BT41 2RL, UK;
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Matuz M, Benkő R, Engi Z, Schváb K, Doró P, Viola R, Szabó M, Soós G. Use of Proton Pump Inhibitors in Hungary: Mixed-Method Study to Reveal Scale and Characteristics. Front Pharmacol 2020; 11:552102. [PMID: 33013389 PMCID: PMC7506043 DOI: 10.3389/fphar.2020.552102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/14/2020] [Indexed: 12/11/2022] Open
Abstract
Background Due to their efficacy and tolerability, utilization of proton pump inhibitors (PPI) has significantly increased worldwide. Parallel to the clinical benefits, potential long-term side effects have been observed, which, along with increasing medical expenses and potential drug interactions, justifies the analysis of the trends of utilization. Objective The aim of the present study was to show the level, pattern, and characteristics of PPI use. Methods We assessed the nationwide use of proton pump inhibitors in ambulatory care based on aggregated utilization data from the National Health Insurance database. The annual PPI utilization was expressed as the number of packages and as number of DDDs per 1,000 inhabitants and per year. For 2018, we estimated PPI exposure as the number of packages and as the number of DDDs per user per year. The annual reimbursement costs of proton pump inhibitors were also calculated. Moreover, three patient-level surveys were carried out in non-gastroenterological inpatient hospital departments to reveal characteristics of proton pump inhibitor use, namely dose, duration, and indication. Results The PPI utilisation increased from 5867.8 thousand to 7124.9 thousand packages and from 41.9 to 50.4 DDD per 1,000 inhabitants and per day between 2014 and 2018. Nationwide data showed that 14% of the adult population was exposed to proton pump inhibitors in 2018, while among hospitalized patients, the prevalence of proton pump inhibitor use was between 44.5% and 54.1%. Pantoprazole was the most frequently used active ingredient, both in the nationwide data and in the patient-level surveys. In the patient-level survey in majority of patients (71.5%-80.0%) proton pump inhibitors were prescribed for prophylaxis. Many inpatients (29.4%-36.9%) used 80 mg pantoprazole per day. The average number of PPI packages per user was 6.5 in 2018 in the nationwide data. The duration of PPI therapy was typically between 1 and 5 years in the patient-level surveys and nearly 20% of the inpatients had been taking proton pump inhibitors for more than 5 years. Conclusions Our data suggests that Hungarian patients receive proton pump inhibitors in high doses and for a long time. Use of proton pump inhibitors beyond their recommended indications was also found.
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Affiliation(s)
- Mária Matuz
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Ria Benkő
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Zsófia Engi
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Krisztina Schváb
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Péter Doró
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Réka Viola
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Mária Szabó
- Department of Surgery, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
| | - Gyöngyvér Soós
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
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Abstract
INTRODUCTION Growing bacterial resistance threatens public health, which can be tempered by prudent antibiotic use. AIM To quantify systemic antibacterial use in Hungarian hospitals. METHOD Consumption data were analysed using the Anatomical-Therapeutic-Chemical - Defined Daily Dose (ATC/DDD) methodology. Data were standardized for patient turnover and also for population to enable international benchmarking. RESULTS Hospital antibiotic use was quite constant (22.4 ± 1.5 DDD/100 patient-days), but its composition changed substantially. The use of parenteral products rose gradually (in 1996 26.4% and in 2015 41.6%). The pattern of use was homogenised due to the headway of co-amoxiclav use. A substantial increase of fluoroquinolone (2.3 vs. 4.2 DDD/100 patient-days) and third generation cephalosporin (1.0 vs. 2.9 DDD/100 patient-days) use was detected. In parallel the use of narrow spectra penicillins diminished. CONCLUSION Hungarian hospital antibiotic use is low. The causes and the justification of this low use together with the internationally outstanding use of certain antibacterials should be addressed in future studies. Orv. Hetil., 2016, 157(46), 1839-1846.
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Affiliation(s)
- Ria Benkő
- Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet, Szegedi Tudományegyetem Szeged, Szikra u. 8., 6725
| | - Mária Matuz
- Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet, Szegedi Tudományegyetem Szeged, Szikra u. 8., 6725
| | - Edit Hajdú
- Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, I. Belgyógyászati Klinika, Infektológia Osztály, Szegedi Tudományegyetem Szeged
| | - Andrea Bor
- Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, I. Belgyógyászati Klinika, Infektológia Osztály, Szegedi Tudományegyetem Szeged
| | - Péter Doró
- Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet, Szegedi Tudományegyetem Szeged, Szikra u. 8., 6725
| | - Réka Viola
- Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet, Szegedi Tudományegyetem Szeged, Szikra u. 8., 6725
| | - Gyöngyvér Soós
- Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet, Szegedi Tudományegyetem Szeged, Szikra u. 8., 6725
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Bor A, Matuz M, Csatordai M, Szalai G, Bálint A, Benkő R, Soós G, Doró P. Medication use and risk of falls among nursing home residents: a retrospective cohort study. Int J Clin Pharm 2017; 39:408-415. [PMID: 28188510 DOI: 10.1007/s11096-017-0426-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 01/09/2017] [Indexed: 02/08/2023]
Abstract
Background Geriatric falls are leading causes of hospital trauma admissions and injury-related deaths. Medication use is a crucial element among extrinsic risk factors for falls. To reduce fall risk and the prevalence of adverse drug reactions, potentially inappropriate medication (PIM) lists are widely used. Objective Our aim was to investigate the possible predictors of geriatric falls annualized over a 5-year-long period, as well as to evaluate the medication use of nursing home residents. Setting Nursing home residents were recruited from the same institution between 2010 and 2015 in Szeged, Hungary. Method A retrospective epidemiological study was performed. Patient data were analysed for the first 12 months of residency. Chi-squared test and Fisher's-test were applied to compare the categorical variables, Student's t test to compare the continuous variables between groups. Binary logistic regression analysis was carried out to determine the association of falls with other variables found significant in univariate analysis. Microsoft Excel, IBM SPSS Statistics (version 23) and R (3.2.2) programs were used for data analysis. Main outcome measure Falls affected by age, gender, number of chronic medications, polypharmacy, PIM meds. Results A total of 197 nursing home residents were included, 150 (76.2%) women and 47 (23.8%) men, 55 fallers (annual fall prevalence rate was 27.9%) and 142 non-fallers. Gender was not a predisposing factor for falls (prevalence in males: 23.4 vs 29.3% in females, p > 0.05). Fallers were older (mean years ± SD; 84.0 ± 7.0) than non-fallers (80.1 ± 9.3, p < 0.01). The age ≥80 years was a significant risk factor for falls (p < 0.001). The number of chronic medications was higher in male fallers (12.4 ± 4.0) than in non-fallers (6.9 ± 4.2, p < 0.001). Polypharmacy (taking four or more chronic medications) was a significant risk factor of falls (p < 0.01). Those PIMs carrying fall risk were taken by 70.9% of fallers and 75.3% of non-fallers (p > 0.05). Taking pantoprazole, vinpocetine or trimetazidine was a significant risk factor for falls. Conclusion Older age, polypharmacy and the independent use of pantoprazole, vinpocetine, and trimetazidine were found to be major risk factors for falls. Further real-life epidemiological studies are necessary to confirm the role of particular active agents, and to help professionals prescribe, evaluate and review geriatric medication use.
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Affiliation(s)
- Andrea Bor
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikra utca 8, Szeged, 6725, Hungary
| | - Mária Matuz
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikra utca 8, Szeged, 6725, Hungary
| | - Márta Csatordai
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikra utca 8, Szeged, 6725, Hungary
| | - Gábor Szalai
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikra utca 8, Szeged, 6725, Hungary
| | - András Bálint
- Ősz Nursing Home of Szeged, Zákány utca 25, Szeged, 6724, Hungary
| | - Ria Benkő
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikra utca 8, Szeged, 6725, Hungary
| | - Gyöngyvér Soós
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikra utca 8, Szeged, 6725, Hungary
| | - Péter Doró
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikra utca 8, Szeged, 6725, Hungary.
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Bor A, Soós G, Csatordai M, Gyimesi N, Csonka A, Doró G, Gárgyán I, Doró P. CP-117 Risks of surgical intervention in patients taking oral anticoagulants. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Csontos D, Soós G, Higyisán I. PS-102 Can the patient bring medicine to the hospital? – the use and risk of brought in medicines. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Gyimesi N, Soós G, Matuz M, Benko R, Szabó M, Bor A, Doró P. PS-104 Initiative for improving medicines safety in surgical inpatients. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bor A, Matuz M, Gyimesi N, Biczók Z, Soós G, Doró P. Gender inequalities in the treatment of osteoporosis. Maturitas 2014; 80:162-9. [PMID: 25433654 DOI: 10.1016/j.maturitas.2014.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 10/27/2014] [Accepted: 11/03/2014] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Our aim was to perform both gender- and age-specific analysis regarding the utilisation of anti-osteoporotic drugs in Hungary, between 2007 and 2011, and to compare our results with other European countries. METHODS The database of the Hungarian National Health Insurance Fund was screened for anti-osteoporotic medications, covering 100% of the Hungarian population (10 million people). ICD coding system (International Classification of Diseases) and WHO ATC/DDD methodology were used for medication screening and analysis. RESULTS In Hungary, the total bisphosphonate use was 6.66 DDD/TID (Defined Daily Dose/1000 inhabitants/day) in 2007, and 6.22 DDD/TID in 2011; the rate of bisphosphonate combinations slightly increased from 1.60 to 2.81 DDD/TID. The total vitamin D use almost doubled (13.73 DDD/TID in 2011), while the calcium supplementation tripled (4.47 DDD/TID in 2011), and so did the strontium ranelate utilisation (0.70 DDD/TID in 2011) within the investigated time period. Denosumab consumption was marginal. Male patients were disproportionately, 10-20 times undertreated in all age groups, and treatment choice was restricted among men. Several differences were seen in our results compared to those in Baltic countries, Finland and in Norway. CONCLUSIONS Men were significantly undertreated in all age groups, compared to women. The 10 to 20-fold difference calls attention to this unrecognised problem.
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Affiliation(s)
- Andrea Bor
- University of Szeged, Faculty of Pharmacy, Department of Clinical Pharmacy, Szikra utca 8, 6725 Szeged, Hungary.
| | - Mária Matuz
- University of Szeged, Faculty of Pharmacy, Department of Clinical Pharmacy, Szikra utca 8, 6725 Szeged, Hungary
| | - Nóra Gyimesi
- University of Szeged, Faculty of Pharmacy, Department of Clinical Pharmacy, Szikra utca 8, 6725 Szeged, Hungary
| | - Zsuzsanna Biczók
- University of Szeged, Faculty of Pharmacy, Department of Clinical Pharmacy, Szikra utca 8, 6725 Szeged, Hungary
| | - Gyöngyvér Soós
- University of Szeged, Faculty of Pharmacy, Department of Clinical Pharmacy, Szikra utca 8, 6725 Szeged, Hungary
| | - Péter Doró
- University of Szeged, Faculty of Pharmacy, Department of Clinical Pharmacy, Szikra utca 8, 6725 Szeged, Hungary
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Abstract
INTRODUCTION Urinary tract infections are one of the common diseases in the primary health care. AIM To analyse patterns of ambulatory antibiotic use in acute cystitis. METHOD Antibiotic use data was based on national-level prescription turnovers. Patterns of antibiotic use were evaluated by prescribing quality indicators. The content of different national guidelines for treatment of acute cystitis and adherence to these guidelines were also evaluated. RESULTS For the treatment of acute cystitis quinolones were used predominantly. Norfloxacin (26%) and ciprofloxacin (19%) were prescribed most commonly. The use of internationally recommended agents such as sulphonamides, nitrofurans and fosfomycin shared 15%, 7% and 2%, respectively. The average adherence rate to national guidelines was 66% and certain weak points (e.g. controversial content) of the national guidelines were also identified. CONCLUSIONS Antibiotic use in acute cystitis seems to be suboptimal in Hungary. Considering actual local antibiotic resistance patterns, a new national guideline should be worked out for acute cystitis treatment.
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Affiliation(s)
- Zoltán Juhász
- Szegedi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika, Infektológiai Osztály Szeged Kálvária sugárút 57. 6725
| | - Ria Benkő
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar Klinikai Gyógyszerészeti Intézet Szeged
| | - Mária Matuz
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar Klinikai Gyógyszerészeti Intézet Szeged
| | - Réka Viola
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar Klinikai Gyógyszerészeti Intézet Szeged
| | - Gyöngyvér Soós
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar Klinikai Gyógyszerészeti Intézet Szeged
| | - Edit Hajdú
- Szegedi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika, Infektológiai Osztály Szeged Kálvária sugárút 57. 6725
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Anda A, Illés B, Soós G. Effect of cadmium pollution of atmospheric origin on field-grown maize in two consecutive years with diverse weather conditions. Acta Biol Hung 2013; 64:476-89. [PMID: 24275593 DOI: 10.1556/abiol.64.2013.4.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aim of the study was to analyse the effect of atmospheric cadmium (Cd) pollution of atmospheric origin in maize compared to a control without Cd pollution. The plant parameters investigated were the timing of phenological phases, leaf area index (LAI) and yield, while radiation and water regime parameters were represented by albedo (reflection grade) and evapotranspiration, respectively. In treatments with and without irrigation, Cd caused a significant reduction in LAI, accompanied by lower evapotranspiration. The mean annual albedo in the Cd-polluted treatment only rose to a moderate extent in 2011 (in 2010 there was hardly any change), but changes within the year were more pronounced in certain phases of development. Cd led to greater reflection of radiation by plants during the vegetative phase, so the radiation absorption of the canopy was reduced leading to a lower level of evapotranspiration. In the dry, hot year of 2011 maize plants in the non-irrigated treatments showed a substantial reduction in grain dry matter, but maize yield losses could be reduced by irrigation in areas exposed to Cd pollution.
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Affiliation(s)
- Angéla Anda
- University of Pannonia Dept. of Meteorology and Water, Georgikon Faculty Keszthely Hungary
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Matuz M, Benkő R, Hajdú E, Viola R, Soós G. [Evaluation of ambulatory antibiotic use in Hungary using drug-specific quality indicators]. Orv Hetil 2013; 154:947-56. [PMID: 23752050 DOI: 10.1556/oh.2013.29632] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Rational use of antibiotics is an important tool in combating antibiotic resistance. AIM The aim of the authors was to evaluate the quality of ambulatory antibiotic use in Hungary. METHOD Crude antibiotic sales data for the period between 1996 and 2010 were converted into DDD (Defined Daily Dose) per 1000 inhabitants and per year. The recently developed and validated drug-specific quality indicators were used to evaluate antibiotic use. RESULTS Beside constant quantity (18.0±1.8 DDD/1000 inhabitants/day), the authors detected major changes in the composition of antibiotic use. Ratios of the consumption of broad to narrow spectrum beta-lactams and macrolides increased eight-fold (1996: 2.2 vs. 2010: 15.8) and consumption of fluoroquinolones tripled. Out of the ten surveyed drug-specific quality indicators, Hungary belonged to the European elite in case of three, while considering the remaining seven, Hungary ranked among the weak or weakest European countries. CONCLUSION In quantity Hungary an ambulatory antibiotic use resembles to Scandinavian countries while it mimics antibiotic consumption patterns of southern countries.
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Affiliation(s)
- Mária Matuz
- Szegedi Tudományegyetem, Gyógyszerész-tudományi Kar, Klinikai Gyógyszerészeti Intézet, Szeged.
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Bor A, Doró P, Matuz M, Biczók Z, Viola R, Soós G. CPC-036 Connection Between Bone Fractures, Vitamin D Level and Low-Energy Falls in Hospitalised Elderly Patients. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
The aging population in developed countries is a growing problem nowadays. The burden on healthcare is particularly high, since the prevalence of the diseases, especially chronic diseases increases with age. Prevalence of polypharmacy is common among elderly patients. While comorbidities require usage of several active agents with evidence based indication, polypharmacy increases the likelihood of interactions and adverse drug reactions, reduces patient compliance, affects quality of life and puts a significant financial burden on the patient and society. In order to reduce drug-related problems among the elderly, different lists of potentially inappropriate drugs and doses were created. One of the earliest known lists is the “Beers criteria”. The use of listed drugs is risky and not recommended for elderly patients. Following foreign examples, a list was compiled and adapted to the Hungarian drug spectrum based on the main concerns and alternative therapeutic suggestions. Orv. Hetil., 2012, 153, 1926–1936.
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Affiliation(s)
- Andrea Bor
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar Klinikai Gyógyszerészeti Intézet Szeged Szikra u. 8. 6725
| | - Mária Matuz
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar Klinikai Gyógyszerészeti Intézet Szeged Szikra u. 8. 6725
| | - Péter Doró
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar Klinikai Gyógyszerészeti Intézet Szeged Szikra u. 8. 6725
| | - Réka Viola
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar Klinikai Gyógyszerészeti Intézet Szeged Szikra u. 8. 6725
| | - Gyöngyvér Soós
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar Klinikai Gyógyszerészeti Intézet Szeged Szikra u. 8. 6725
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Benko R, Matuz M, Peto Z, Bogár L, Viola R, Doró P, Soós G, Hajdú E. Variations and determinants of antibiotic consumption in Hungarian adult intensive care units. Pharmacoepidemiol Drug Saf 2011; 21:104-9. [PMID: 21796720 DOI: 10.1002/pds.2192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 04/18/2011] [Accepted: 05/25/2011] [Indexed: 01/18/2023]
Abstract
PURPOSE The aim of this work was to study the use of systemic antibacterials and its possible determinants in Hungarian intensive care units (ICUs). METHODS Hospital pharmacy. departments provided package level dispensing data for their corresponding ICU (2006). Data were converted into defined daily doses (DDDs) and expressed as DDD per 100 patient-days and DDD per 100 admissions. Antibiotics were ranked by volume of DDDs, and the agents responsible for 90% of total use (DU90%) were noted. To explore differences and relationships between antibiotic use and antibiotic policy elements/ICU characteristics, the analysis of variances or the Pearson correlation analysis was performed. RESULTS Valid data were obtained for 44 ICUs. Antibiotic use varied widely (from 27.9 to 167.8 DDD per 100 patient-days and from 104.7 to 1784.6 DDD per 100 admissions). In total, 11-34 different antibacterials per ICUs were used, of which, 5-15 were in the DU90% segment. The proportional use of parenteral agents ranged from 46.2 to 98.3%. The mean of overall antibiotic use was highest for penicillins with beta-lactamase inhibitors, followed by quinolones and third-generation cephalosporins. Of the studied factors, only the ICU category (i.e., level of care) showed significant association with total antibacterial use. CONCLUSIONS The striking differences in total antibiotic use and the extensive use of the oral agents in some ICUs may indicate room for improvement. As none of the antibiotic policy elements were accompanied by lower antibiotic use in the pooled analysis, it suggests that--beside the ICU category--other unrevealed factors determine antibiotic use.
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Affiliation(s)
- Ria Benko
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary.
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21
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Abstract
Az intenzív osztályon az infekciók hatékony kezeléséhez elengedhetetlen a megbízható mikrobiológiai háttér, a mikrobiológiai leletek értékeléséhez infektológus vagy mikrobiológus szakember. A hazai felnőtt intenzív osztályok antibiotikum-politikájáról, mikrobiológiai hátteréről, infektológiai/mikrobiológiai konzultációs lehetőségeiről 97 kérdést tartalmazó kérdőív alapján készült felmérés. Az intenzív osztályok 62%-a (60/96) küldte vissza a kitöltött kérdőívet. A kérdésekre válaszoló osztályok 55%-ában működik az anyaintézetben mikrobiológiai laboratórium. Az antibiotikum-választáshoz a mikrobiológiai lelet szolgáltat elsősorban információt, míg a gyakori nosocomialis pneumoniák kórokozójának kimutatására szolgáló pozitív tenyésztésű alsó légúti minta eredménye hét közben 50%-ban, hétvégén <20%-ban érkezik optimális időben vissza az osztályokra. Az eredmények értelmezését segítő infektológus-mikrobiológus konzíliumra munkaidőben >90%-ban, munkaidőn kívül infektológus 70%-ban, mikrobiológus 55%-ban érhető el. Az osztályok közel fele veszi igénybe az infektológus, kevesebb mint egyharmada a mikrobiológus segítségét. A mikrobiológiai laboratóriumi diagnosztikai háttér messze nem optimális a magyarországi intenzív osztályok esetében, ezt a működési minimumfeltételek sem írják elő. Nagyon kevés a személyes szakmai konzultáció lehetősége is.
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Affiliation(s)
- Edit Hajdú
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ Klinikai Mikrobiológiai Diagnosztikai Intézet Szeged Semmelweis u. 6. 6725
| | - Ria Benkő
- 2 Szegedi Tudományegyetem, Gyógyszerésztudományi Kar Klinikai Gyógyszerészeti Intézet Szeged
| | - Mária Matuz
- 2 Szegedi Tudományegyetem, Gyógyszerésztudományi Kar Klinikai Gyógyszerészeti Intézet Szeged
| | - Zoltán Pető
- 3 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ Aneszteziológiai és Intenzív Terápiás Intézet, Újklinika Intenzív Osztály Szeged
| | - Ágnes Hegedűs
- 4 Dr. Diósszilágyi Sámuel Kórház Intenzív Terápiás Osztály Makó
| | - Gyöngyvér Soós
- 2 Szegedi Tudományegyetem, Gyógyszerésztudományi Kar Klinikai Gyógyszerészeti Intézet Szeged
| | - Lajos Bogár
- 5 Pécsi Tudományegyetem, Általános Orvostudományi Kar Aneszteziológiai és Intenzív Terápiás Intézet Pécs
| | - Erzsébet Nagy
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ Klinikai Mikrobiológiai Diagnosztikai Intézet Szeged Semmelweis u. 6. 6725
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Benko R, Matuz M, Hajdú E, Peto Z, Hegedus A, Bogár L, Soós G. [The participation of pharmacist in antibiotic related activities of Hungarian hospitals and intensive care units]. Acta Pharm Hung 2009; 79:57-62. [PMID: 19634635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The present paper describes the antibiotic related activities of Hungarian adult intensive care units (ICUs) and their parent hospitals, specially focusing on the role of hospital pharmacists. Information was gathered by a structured questionnaire, which was sent to the head of ICU departments by post and by email. The multidisciplinary team of authors developed and validated the questions. Results were compared to recommendations set up by the Antibiotic Resistance Prevention And Control (ARPAC) project. Minimal requirements appointed by the ARPAC have not been fulfilled by many aspects: multidisciplinary hospital commitees were not realized and the activity of these committees in antibiotic guideline developments was not satisfactory. Continuous education and calculation of standardized antibiotic use was rarely performed at ICUs. The role of pharmacist remained marginal in every field. All these findings suggest the need for appointment of a responsible, multidisciplinary antibiotic manamement team including also a pharmacist.
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Affiliation(s)
- Ria Benko
- Szegedi Tudományegyetem, Klinikai Gyógyszerészeti Intézet, Szeged.
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Matuz M, Benko R, Doró P, Hajdú E, Soós G. [Analysis and interpretation of non-reimbursed antibiotic use data in Hungary]. Acta Pharm Hung 2009; 79:70-74. [PMID: 19634637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The present paper describes one special field of the Hungarian ambulatory care antibiotic consumption: it focuses on the non-reimbursed antibiotic use and interprets it by using different measurement units, including the WHO recommended DDD per 1000 inhabitants and per day. The most commonly dispensed active agents belonged to the penicillin, tetracycline or sulfonamide antibacterial groups. Although the non-reimbursed antibiotic use increased during the study period, it was still low in 2004, representing approximately 2% of total Hungarian ambulatory care antibiotic use. Our study also revealed interregional differences in the non-reimbursed antibiotic use, which was outstanding in some western Hungarian counties.
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Affiliation(s)
- Mária Matuz
- Szegedi Tudományegyetem, Klinikai Gyógyszerészeti Intézet, Szeged.
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Doró P, Grant WB, Benko˝ R, Matuz M, Tóth T, Soós G. Vitamin D and the seasonality of type 2 diabetes. Med Hypotheses 2008; 71:317-8. [DOI: 10.1016/j.mehy.2008.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 03/05/2008] [Accepted: 03/06/2008] [Indexed: 10/22/2022]
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Makó S, Lepesi-Benko R, Marschalkó M, Soós G, Kárpáti S. [Diagnostic methods for confirming drug-allergy--the lymphocyte transformation test in dermatology]. Orv Hetil 2008; 149:1107-14. [PMID: 18539577 DOI: 10.1556/oh.2008.28215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Recognizing the adverse drug reactions and confirming the role of the drug causing the symptoms is a great challenge for a medical team. The aim of this article is to review the diagnostic methods for confirming drug-allergy and to evaluate the lymphocyte transformation test according to dermatological aspect. Lymphocyte transformation test relies on the observation that specific T-cells divide and expand after encountering the antigen. T-cell sensitization is measured by 3H-thymidine uptake in dividing cells. The main advantage of this test is its applicability with many different drugs in different immune reactions, as drug-specific T-cells are almost always involved in drug hypersensitivity reactions. Its disadvantage is that the test is cumbersome and technically demanding. The method is not unequivocally accepted, it is necessary to carry out a systematic evaluation of its sensitivity and specificity to make the test more widely appreciated. Despite of its deficits, the lymphocyte transformation test plays an important role in diagnosing drug-hypersensitivities.
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Affiliation(s)
- Sarolta Makó
- Semmelweis Egyetem, Altalános Orvostudományi Kar Bor-, Nemikórtani és Boronkológiai Klinika, Budapest.
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Viola R, Benko R, Nagy G, Soós G. National trend of antidepressant consumption and its impact on suicide rate in Hungary. Pharmacoepidemiol Drug Saf 2008; 17:401-5. [PMID: 18314926 DOI: 10.1002/pds.1574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE The aim of this study was to analyse the changes in the amount and structure of Hungarian antidepressant consumption at national and regional level, furthermore to investigate the possible relationship between antidepressant sales and trends in suicide rates using regional data. METHOD Retrospective analysis of antidepressant sales data was performed on a 12 years period (1993-2004), applying the ATC/DDD methodology developed by WHO. Linear regression model was set up to investigate the trends in antidepressant utilisation. The association between antidepressant consumption and suicide rates was measured by Pearson correlation. RESULTS The nationwide utilisation of antidepressants revealed more than five-fold increase in the studied 12 year period. The usage of tricyclic antidepressants (N06AA) decreased to one third of the previous value, while the usage of selective serotonin reuptake inhibitors (N06AB) multiplied by 21. The consumption of 'other antidepressants' (N06AX) was found very low (3.66 DDD/1000 inhabitants/day in 2004). There was not found any significant correlation between increased antidepressant consumption and decreased suicide rates at regional level by our statistical analysis (r (min) = -0.160; r (max) = -0.314). CONCLUSION Further investigation is required to identify determinants that have contributed to recent decline in suicide rate in Hungary.
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Affiliation(s)
- Réka Viola
- Department of Clinical Pharmacy, University of Szeged, Hungary.
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Viola R, Lovas K, Szabó Z, Czenner Z, Meads D, McKenna S, Soós G. [Hungarian adaptation of a questionnaire for determining depression-specific quality of life]. Orv Hetil 2007; 148:603-8. [PMID: 17383954 DOI: 10.1556/oh.2007.27972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The Quality of Life in Depression Scale (QLDS) is a widely used outcome measure available in a large number of languages. No measure of quality of life was available for use with depressed patients in Hungary and a decision was taken to adapt the QLDS for this purpose. The adaptation of a questionnaire for use in a new language involves three stages; translation, testing for face and content validity and assessment of the translated measure's psychometric properties. OBJECTIVES To adapt the QLDS for use in Hungary and to evaluate its psychometric properties. METHOD The dual panel method was used to translate the QLDS into Hungarian. The translation was tested for face and content validity by interviews conducted with depressed patients. Finally, a test-retest postal survey was conducted to determine internal consistency, reproducibility and construct validity. RESULTS Interviews conducted with 25 patients indicated that the QLDS was an appropriate measure and that it was well accepted and completed. The postal survey ( n = 50) showed that the measure had good internal consistency (Cronbach's alpha-coefficients were 0.95 at both administrations) and that the test-retest reliability (0.89) indicated good reproducibility with limited random measurement error. Correlations of QLDS scores with those for the Nottingham Health Profile sections were as expected, providing evidence of convergent and divergent validity. CONCLUSION Given the acceptability of the Hungarian version of QLDS to depressed patients and the excellent psychometric properties of the adapted questionnaire it is concluded that the adaptation was successful. The measure is suitable for use in clinical practice and studies involving depressed patients in Hungary.
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Affiliation(s)
- Réka Viola
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet, Szeged, Hungary.
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Benko R, Matuz M, Doró P, Hajdú E, Nagy G, Nagy E, Soós G. [Antibiotic consumption between 1996 and 2003: national survey and international comparison]. Orv Hetil 2006; 147:1215-22. [PMID: 16898083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
AIMS To describe the qualitative and quantitative changes of antibiotic consumption in Hungarian hospitals and in the primary care setting between 1996 and 2003. METHODS Sales data relating to community and hospital care antibiotic consumption were obtained for the 8 years period of 1996-2003. The 2003 version of the world health organisation (WHO) anatomical therapeutic chemical (ATC)/ defined daily dose (DDD) system was used for calculations and the 2005 version for classifications. The final expression units were DDD/100 bed-days and DDD/1000 inhabitants/day for hospital and community care utilization, respectively. Trend analysis was applied to assess the annual changes in antimicrobial consumption. RESULTS The total antibiotic consumption in the community setting and in the hospitals remained relatively stable during the study period. The average antibiotic consumption in the community setting (20.20 +/- 1.42 DDD/1000 inhabitants/day was in line with the European average, while the national average hospital antibiotic consumption (24.81 +/- 1.69 DDD/ 100 bed-days) was very low in international benchmark. Changes in the pattern of antibiotic consumption was observed in both settings. Internationally outstanding consumption of penicillins plus beta-lactamase inhibitor combinations (J01CR) and sulphonamides and extremely low utilisation of beta lactamase resistant penicillins (J01CF) were detected. The hospital antibiotic consumption was characterized by extended use of sulphonamides, tetracyclines, and second generation cephalosporins. CONCLUSIONS The low hospital consumption of antibiotics and the internationally extreme usage of certain antibiotic groups needs further pharmacoepidemiologic analysis.
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Affiliation(s)
- Ria Benko
- Szegedi Tudományegyetem, Szent-Györgyi Albert Orvos- es Gyógyszerésztudományi Centrum, Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet, Szeged. (vezet6: So6s Gy6ngyv6r dr.)'
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Doró P, Benko R, Matuz M, Soós G. Seasonality in the incidence of type 2 diabetes: a population-based study. Diabetes Care 2006; 29:173. [PMID: 16373925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Doró P, Benko R, Kosik E, Matuz M, Tóth K, Soós G. Utilization of oral antihyperglycemic drugs over a 7–year period (1998–2004) in a Hungarian population and adherence to drug therapy. Eur J Clin Pharmacol 2005; 61:893-7. [PMID: 16328320 DOI: 10.1007/s00228-005-0031-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Accepted: 08/24/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To describe the quantitative and qualitative changes in the utilization of oral antihyperglycemic drugs (OAHDs) between 1998 and 2004 and to analyze patients' adherence to OAHD therapy. METHODS We conducted a retrospective analysis of the electronic database of the Hungarian National Health Fund Administration for the years 1998 through 2004. All 912,620 prescriptions for OAHDs dispensed for the 38,855 patients in Csongrád County (430,000 inhabitants) were retrieved and analyzed according to the ATC/DDD (World Health Organization) methodology. Nonadherence was set as medication possession ratio <80%. RESULTS The number of patients using OAHDs significantly increased (P<0.001); the yearly prevalence of 2.88% in 1998 increased to 4.32% in 2004. The overall consumption of OAHDs increased by 76%, from 20.85 defined daily doses per 1,000 inhabitants per day (DDD/TID) in 1998 to 36.83 DDD/TID in 2004. While in 1998 glibenclamide was the most often prescribed agent, received by 61.7% of patients, its share dropped to 16.1% in 2004, and metformin became the leading agent prescribed for 43.0% of patients. During the study period, the adherence rate varied between 47.9% and 49.2%. Women had a significantly better (P<0.001) adherence rate than men, 51.3% vs. 45.5%. The adherence rate peaked in patients between 60 and 79 years and was lowest in patients in their 30s. CONCLUSIONS The utilization pattern of OAHDs considerably changed, but there were no significant changes in patients' adherence. The significant increase in the utilization of OAHDs is not the result of increased adherence but of increased patient number.
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Affiliation(s)
- Péter Doró
- Department of Clinical Pharmacy, University of Szeged, Szikra u.8., H-6725 Szeged, Hungary.
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Abstract
INTRODUCTION Increasing attention has recently been focused on polypharmacy, which is often referred to as an indicator of irrational drug consumption. Although polypharmacy is an important risk factor for problems arising from drug therapies, certain health concerns and conditions or patient-specific factors may justify the need for polypharmacy. In recent years there no data have been published regarding polypharmacy in Hungary. OBJECTIVE The authors examined the frequency of polypharmacy among psychiatric patients. The study also looked at the extent to which comorbidity and demographic characteristics (age, gender) were responsible for the multiple drug use. METHODS An inpatient database of the year 2001 at the psychiatric department was analysed. Based on the standard definition of polypharmacy the authors enrolled into the polypharmacy group those patients who were on more than five drugs as part of chronic and simultaneous therapy. The data were analysed with the SPSS 9.0 statistics program package. RESULTS Among the psychiatric patients included in the study (N = 984) the frequency of polypharmacy was 33.6%. Significant correlation was found between the investigated factors (age, gender, comorbidity) and polypharmacy. On the basis of OR-values, comorbidity was the strongest inducer of polypharmacy. CONCLUSION Polypharmacy cannot be fundamentally regarded as unnecessary drug use. Numerous facts prove that in certain diseases and conditions adequate polypharmacy is necessary.
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Affiliation(s)
- Réka Viola
- University of Szeged, Faculty of Pharmacy, Department of Clinical Pharmacy, University of Szeged, Szikra u. 8., H-6725 Szeged, Hungary.
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Benkó R, Bácskai T, Hajdú E, Matuz M, Soós G. [Analysis of antibiotic consumption of five different clinical departments, especially considering the features of hematology departments]. Acta Pharm Hung 2003; 72:245-51. [PMID: 12812044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
The importance of antibiotic consumption and bacterial resistance analysis is unquestionable. Although the WHO has been recommending the use of ATC/DDD method for the analysis of drug utilization for about 20 years, only limited numbers of publications are available considering the antibiotic consumption of in-patients. In the present study--with the help of the mentioned method--we analysed the utilization of antibiotics in 5 clinical departments. We also investigated the connection between antibiotic consumption, bacterial resistance and enterococcal sepsis at the haematologic department. We could follow the successful impact of the implementation of the new guideline.
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Affiliation(s)
- Ria Benkó
- SZTE-GYTK Klinikai Gyógyszerészeti Intézet, Szeged, Szikra u. 8.-6725
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Soós G. [Importance of drug utilization studies as a pharmaceutical tool for the practice of evidence-based medicine]. Acta Pharm Hung 2003; 72:252-6. [PMID: 12812045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Application of the theory of the Evidence-based Medicine into the every day practice means critically appraising the evidence for validity and clinical usefulness. The real therapeutic value & place of different drugs could be determined only according to the internationally standardised drug statistics. The method for drug consumption analysis recommended by WHO is the ATC/DDD methodology. The basic features of this method will be summarised by the author as well as the usefulness of the data given by utilization researches especially regarding the validation of evidence-based practice and the basis of decision making processes.
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Affiliation(s)
- Gyöngyvér Soós
- SZTE Klinikai Gyógyszerészeti Intézet, Szeged, Szikra u. 8.-6725
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Preisz K, Temesvári E, Podányi B, Soós G, Kárpáti S, Horváth A. [Contact dermatitis after topical use of ketoprofen gel]. Orv Hetil 2001; 142:2841-4. [PMID: 11828933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Authors present 5 cases of generalized contact and photocontact dermatitis due to topically applied ketoprofen, a non-steroidal anti-inflammatory drug. They investigated the sensitisation and photosensitisation to the drug and also the possible cross-reactivity.
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Affiliation(s)
- K Preisz
- Altalános Orvostudományi Kar, Bór- és Nemikórtani Klinika, Semmelweis Egyetem, Budapest
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Abstract
Twenty temporal bones (TBs) were removed from autopsy cases and prepared for immunohistochemical examination. Ten TBs were free of ear disease whereas the other ten TBs showed the signs of chronic otitis media. Expression of markers for monocyte-macrophages (25F9, 27E10) and natural killer cells (anti-Leu-11) was examined immunohistochemically. There were no specific positive stainings with 25F9 or anti-Leu-11 antibodies in any of the specimens. Staining for 27E10 was found to be negative in each section obtained from normal cochlea. However, 27E10 positivity was detected in three of ten TBs with signs of chronic ear inflammation. This positivity can be explained by two theories: (1) activated monocytes can enter the inner ear from the systemic circulation as a consequence of chronic antigen challenge; (2) mesothelial cells could become activated as a result of a cross-reaction, with resultant positivity. Development of sensorineural hearing loss in some cases of chronic otitis media may be due to these immunological reactions.
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Affiliation(s)
- I Jókay
- Clinic of Otorhinolaryngology, University of Debrecen and Health Science Center Medical School, Hungary.
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Abstract
Endocarditis is an uncommon complication of invasive candidiasis. We present a fatal case of endocarditis caused by Candida albicans in a very low birth weight infant. The 780-g male infant did not have any structural heart disease and a central venous catheter was not placed. Endocarditis developed in spite of parenteral fluconazole treatment. Echocardiography was a valuable tool in making the diagnosis. The infant died on the 40th day of life. The development of Candida endocarditis in a premature infant who was treated with fluconazole had not been previously reported. In the case of systemic candidiasis, premature infants require very careful monitoring for the progression of the disease, even if antifungal therapy is administered.
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Affiliation(s)
- G Mogyorósy
- Department of Pediatrics, University of Debrecen, Debrecen, Hungary.
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Abstract
We assessed the quality of life (QOL) of patients with epilepsy using the Quality of Life in Epilepsy Inventory (QOLIE-31). As the first step we compared our results with the data from an American survey in order to validate the test in Hungary. The results show that the Hungarian values were lower but that they followed the same trends as the American data. There was only one controversial result in the question-group of the 'the effects of treatment', which could be explained by the differences in habits and conventions, opportunities and expectations between Hungarian and American epileptic patients. We found significant differences in many aspects of quality of life with respect to (a) gender (general quality of life, seizure worry), (b) pharmacological treatment form (cognitive functions, medication effects, total score and social and role functioning) and (c) economic activity of patients (cognitive functions, emotional well-being, energy/fatigue, medication effects, overall quality of life, overall scores, seizure worry, social and role functioning). We have tried to explain the differences found by taking either the characteristics of epilepsy or the social background of the epileptic patient into consideration. Based on previous knowledge we have tried to define the situations where the assessment of quality of life for people with epilepsy, may be beneficial to their core.
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Affiliation(s)
- J Lám
- Semmelweis University, University Pharmacy, Institute of Pharmacy Administration, Hungary
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Németh Z, Soós G. [Care of patients with oral cavity tumors in the hospital and at home]. Fogorv Sz 2000; 93:277-85. [PMID: 11057026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
This study reports on experience acquired during the care of patients who could not participate in surgery, chemotherapy or radiation therapy because of the extent of the primary, recurrent or metastatic tumour, or because of the deterioration of the general condition or (in the event of recurrence), intervention with a curative aim could not be performed for the mentioned reasons. In these cases, improvement or preservation of the quality of life is the fundamental goal to be achieved at all times, for these patients must receive the best possible supportive treatment for the remainder of their lives, Unfortunately, the quaranteeing of this often tends to become mainly a financial question rather than a professional one. The medical staff has very little chance to influence the financial aspects, and must therefore do everything possible to ensure the highest possible level of care during hospitalization. Attention is drawn to the significant roles to be played by the family, the family doctor, the various home-care services and the hospice.
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Szarka K, Veress G, Juhász A, Kónya J, Sápy T, Soós G, Hernádi Z, Gergely L. Integration status of virus DNA and p53 codon 72 polymorphism in human papillomavirus type 16 positive cervical cancers. Anticancer Res 2000; 20:2161-7. [PMID: 10928171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND The aim of this study was to determine the physical state of HPV16 DNA and to reveal any association between the physical state of virus DNA and pathologic or prognostic factors in HPV16 positive cervical cancers. The other aim was to estimate the role of p53 codon 72 polymorphism in disease progression. MATERIALS AND METHODS The presence and physical state of HPV16 DNA was analysed by Southern blot hybridisation and E1-E2 specific PCRs in the primary tumours and pelvic lymph nodes of 85 cervical carcinoma patients. Results Integrated HPV16 DNA was found in 32 out of 41 (78%) primary tumours and 2 out of 22 (95%) lymph nodes carrying HPV16 DNA. No significant association was found between integration of virus DNA and course of the disease. There was a trend towards an association between disease recurrence and the presence of the p53 codon 72 arginine homozygous genotype (OR = 3.41, p = 0.23). CONCLUSION The physical state of HPV16 DNA does not seem to play a major role as a prognostic indicator in Hungarian cervical cancer patients, while the p53 codon 72 genotype may have an impact on the clinical outcome of the disease.
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Affiliation(s)
- K Szarka
- Department of Microbiology, University Medical School of Debrecen, Hungary.
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Major T, Jókay I, Soós G, Gergely L, Czeglédy J. [Virologic aspects of juvenile laryngeal papillomatosis]. Orv Hetil 1999; 140:405-9. [PMID: 10083813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Juvenile laryngeal papillomatosis is the most common benign tumor of the larynx in childhood. The specific etiological factors are non-oncogenic human papillomavirus types 6 and 11. In the present study two cases (a 6-year-old male and a 5 and a half-year-old female) operated five times each and harbouring type 11 DNA in papillomas excised in the first operations are analysed from the following virological aspects: 1. the examination of vertical transmission by general primer-polymerase chain reaction of maternal cervical exfoliation; 2. sites of papilloma predilections in the larynx; 3. histopathology; 4. viral DNA detection from the formalin-fixed and paraffin-embedded archive tissues and from a fresh papilloma tissue in one case by polymerase chain reaction applying type-specific primers. We did not find any signs of maternofoetal transmission in the anamnesis and the maternal cervix proved to be negative for viral DNA. However, the vertical route of transmission can not be excluded due to the special natural history of papillomavirus infections. Papillomas usually localised in normal squamociliary junctions of the larynx. The histopathologic review did not reveal any signs of malignancy. Koilocytosis referring to productive viral infection and the signs of abnormal keratinisation were present in each tissue. All tissues of the patients proved to be positive for the short amplimer deriving from the genome of human papillomavirus type 11.
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Lászlóffy M, Keszei N, Kákosy T, Soós G, Hudák A, Náray M. [Severe lead poisoning caused by an ingested fishing weight]. Orv Hetil 1998; 139:963-5. [PMID: 9595931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Authors describe the case-history of a 17 year old male who accidentally ingested a fishing weight that was retained in the stomach and caused a serious lead poisoning. It is worth mentioning that beside the wellknown symptoms and signs of lead intoxication also the liver was seriously affected. The histologically verified toxic lesion of the liver presumably can be attributed to the large quantities of lead absorbed within a short period. This also explains the appearance of symptoms and signs indicating to encephalopathy beside the young age of the patient. The foreign body could not be removed by means of gastroscopy, therefore a gastrotomy was carried out followed by chelating treatment with i.v. CaNa2EDTA that resulted in complete clinical and laboratory recovery. The case history draws the attention to the importance of the quick removal of the retained lead containing objects out of the gastrointestinal tract.
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Affiliation(s)
- M Lászlóffy
- Országos Munka-és Uzemegészségügyi Intézet, Budapest
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Abstract
The aim of this study was to obtain baseline data on the recently described special form of single cell death, apoptosis, in normal human inner ears. For this purpose, in situ end-labeling of the fragmented DNA was applied, in conjunction with apoptosis-related markers, to detect cellular elements showing programmed cell death in decalcified and paraffin-embedded tissues. Over 20 specimens were analyzed which were obtained from autopsy cases with no history of acoustic lesions confirmed by histopathology. Based on staining results, we saw no apoptotic signs in the majority of normal adult inner ears. An apoptotic cell captured in the Reissner's membrane of the cochlea from an old patient may, however, indicate an age-related subtle cell loss with the process of apoptosis. Nevertheless, the fact that more apoptosis was not found in our cases suggests that this phenomenon does not contribute significantly to the tissue homeostasis in the adult inner ear under normal conditions. These data are in accordance with our immunohistochemical findings on the p53 nucleoprotein, and proliferating cell nuclear antigen expression since there was no staining in any of the cellular elements, including the mesenchymal cells. This reflects a stationary and stable condition of cells of the vestibular and the cochlear structures, probably to maintain their integrity and the fine sensory functions. As opposed to the above findings, during inner ear development, the epithelial cells lining the cochlear lumen, the ossifying cartilage of the temporal bone, and the mesenchymal cells show different degrees of proliferation in combination with single cell death as signs of maturation of the vestibular and the cochlear apparatus. In addition, apoptosis has been demonstrated in cells of the cochlear stria vascularis from an adult patient treated with high doses of cisplatin, vinblastine and bleomycin prior to death. Furthermore, a wide range of apoptosis could be induced experimentally in a normal ear by an external perfusion of actinomycin D (ActD), which is known to produce programmed cell death in many cell types of different origins. The potential role of cytostatic agents in the apoptotic process of the inner ear needs, however, to be confirmed in large-scale specimens from patients treated with genotoxins. The fact, however, that apoptotic cells are also seen in association with ActD indicates that the fine sensory structure of the cochlea may also be a target for certain chemotherapeutic agents when administered in high doses.
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Affiliation(s)
- I Jókay
- Department of Otolaryngology, University Medical School of Debrecen, Hungary
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Soós G, Debiec-Rychter M, Jones RF, Zukowski K, Haas GP, Wang CY. Maintenance of human hyperplastic prostate implants at different sites in athymic mice. Anticancer Res 1995; 15:2007-11. [PMID: 8572593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The present study determined the influence of implantation sites, androgens, and the graft's fibrovascular elements on the maintenance of epithelial elements of human benign hyperplastic prostate tissue (BPH) in the nude mouse. BPH fragments prepared from fresh surgical specimens were implanted subcutaneously (s.c.), intraperitoneally (i.p.), or under the renal capsules (r.c.) into male Beige nude mice, which had been implanted s.c. with a Silastic tube filled with 4-dihydrotestosterone (DHT) or cholesterol. Two weeks later the BPH tissues were removed from the mouse and examined microscopically. The implants from all three sites maintained a comparable morphology, with epithelial and/or angio-leiomyomatous stromal hyperplastic appearance, without striking signs of atrophy, irrespective of supplementation with DHT. Expression of proliferating cell nuclear antigen in the implants was comparable, indicating that there was no significant influence of implantation site on the proliferative ability of either epithelia or the stromal fibroblasts. The PCNA-positive cells in the implants, including the vascular and myofibrous elements, hybridized in situ to a human-specific repeated-sequence DNA probe, indicating that these proliferating cells were of human origin. Our data suggest that during the early phases of the adaptation and maintenance of BPH implants, survival of epithelial cells is actively supported by fibro-vascular mesenchymal elements of the prostate grafts in a manner apparently unaffected by DHT supplements.
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Affiliation(s)
- G Soós
- Michigan Cancer Foundation, Detroit 48201-1379, USA
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Kákosy T, Soós G. [An undying civilization damage: lead poisoning]. Orv Hetil 1995; 136:1091-7. [PMID: 7539117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The authors summarise the history, the sources, the pathophysiology, the symptoms and signs, the diagnostic methods, the differential-diagnostic possibilities, the therapy and prevention of the lead poisoning. They suggest that besides the classical professional and alimentary sources the environmental pollution caused first of all by leaded petrol plays a more and more important role in the lead exposure of the people. They draw the attention of the physicians to the lead intoxication as a possible cause of abdominal pain and/or anemia.
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Affiliation(s)
- T Kákosy
- Országos Munka- és Uzemegészségügyi Intézet, Budapest
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Kónya J, Veress G, Hernádi Z, Soós G, Czeglédy J, Gergely L. Correlation of human papillomavirus 16 and 18 with prognostic factors in invasive cervical neoplasias. J Med Virol 1995; 46:1-6. [PMID: 7622999 DOI: 10.1002/jmv.1890460102] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Forty-seven patients with cervical carcinoma were examined in order to correlate human papillomavirus (HPV) types with prognostic factors in invasive cervical neoplasias. Age, clinical stage, histological type, and grade and parity were analysed with respect to HPV status as determined by a general primer mediated polymerase chain reaction (PCR) or a type specific PCR. All but one sample (98%) harboured HPV sequences: HPV 16 was found in 26 cases (55%), HPV 18 in 19 cases (40%), and HPV 31 in 1 case. The presence of HPV 18 DNA was significantly associated with cancers developed below 40 years of age (P = 0.029). HPV 18 detection was associated with poor differentiation malignancy (P = 0.045) and histological types of poor prognosis (adenocarcinoma or nondifferentiated carcinoma; P = 0.006). HPV 18 positivity was also correlated with advanced clinical stages (FIGO II and III; P = 0.032). Parity and HPV status proved to be independent of each other (P approximately 0.99). Eighty-seven percent (27/31) of pelvic lymph nodes from HPV positive patients contained HPV DNA. The virus types found in lymph nodes were identical with those of the primary tumours in all cases. Virological results were compared to those obtained by routine histological examination. Only 6 of 27 patients with HPV positive lymph nodes had any histological evidence of metastasis. Nevertheless, the lack of metastasis as detected by histology does not exclude the possibility of relapses. Follow-up of the clinical prognostic significance of PCR detection of HPV in the possible sites of early metastases.
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Affiliation(s)
- J Kónya
- Department of Microbiology, University Medical School of Debrecen, Hungary
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Marschalkó M, Knobler R, Soós G, Berecz M, Pálóczy K, Rácz I. [Extracorporeal photopheresis in the therapy of Sézary syndrome]. Orv Hetil 1993; 134:1253-7. [PMID: 8332344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
50 year old patient with advanced stage Sézary syndrome was treated with extracorporeal photochemotherapy. During extracorporeal photochemotherapy the photoactivable agent 8-methoxypsoralen was administered orally. After 2 h a leucocyte enriched blood fraction was irradiated with UVA extracorporeally and reinfused to the patient. Besides the extracorporeal photochemotherapy Prednisolone and Leukeran were administered. Slow but permanent improvement was observed, the erythroderma, pruritus disappeared, lymph nodes, liver, spleen enlargement reduced, the number of CD4 positive lymphocytes decreased, that of CD8 positive lymphocytes increased.
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Affiliation(s)
- M Marschalkó
- Semmelweis Orvostudományi Egyetem Bör és Nemikórtani Klinika, Budapest
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Affiliation(s)
- E Temesvári
- Department of Dermatology, University School of Medicine of Budapest, Hungary
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Affiliation(s)
- M Marschalkó
- Department of Dermatology, Semmelweis Medical School, Budapest, Hungary
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49
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Temesvári E, Rácz I, Szatlóczky E, Soós G. [Treatment of chronic urticaria with Corontin forte]. Orv Hetil 1980; 121:1145-6. [PMID: 6997799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Török I, Soós G, Podányi B, Várkonyi V, Király K. [Model for the objective evaluation of antimycotic topical agents]. Dermatol Monatsschr 1979; 165:783-7. [PMID: 160873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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