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Biomedical subjects

G Ternák

Publications and source records attributed to G Ternák.

At least 19 recordsLinked to original sources
PubMed2001

[Clinical aspects of the diagnosis and treatment of infectious mononucleosis in primary care and in departments of infectious diseases].

Medical documentation of the 342 patients hospitalised for infectious mononucleosis at the departments of infectious diseases of two county hospital was retrospectively reviewed between 1990 and 1996 and the most important clinical data were recorded. In order to document the effect of control measures, which were taken for the improvement diagnosis and therapy, data of the 105 infectious mononucleosis patients at one of the mentioned departments were also recorded in 1997 and 1998. The length of the time before the hospital admission (avg. 10.3 days), the length of the hospital stay (avg. 9.2 days) and the respectable amount of antibiotics taken for this indication show that this disease has great cost effect. High rate of classical clinical signs (fever, pharyngitis, lymphadenopathy, atypical cells) indicates, that the majority of the patients consulting their doctors presented the well-known signs of the disease. Only 43.6% of the patients were diagnosed as infectious mononucleosis by the G. P. s. Majority of the cases were treated for tonsillitis. 90.7% of the patients were given antibiotics before the hospital admission (avg. 1.6 antibiotics/person). 43.3% of the patients left the hospital without serologic diagnosis. After drowning lesson from the first part of this study, there was significant decrease in the rate of lack of serologic diagnosis and in the amount of consumption of antibiotics for this indication in the hospital, but there was no change at the level of G. P. s. The results of this paper demonstrate that the daily routine diagnosis and treatment of a well-known diseases differs remarkably from optimal practice. The fact is, that even if the physician has knowledge of a certain disease, does not necessarily mean that he uses it in his routine work. In order to reduce this failure, authors propose introduction of protocols and regular review of the practice.

Adolescent↗
PubMed1997

[Utilization of antibiotics according to most frequent indications at Hungarian hospitals and results of surveys].

Antibiotic utilisation of 8 Hungarian hospitals was analyzed examining the case histories of patients who were discharged between January 1 and 31, 1995. Usage of antibiotics in the most frequent indications is reported in this paper. Majority of the prescriptions for the treatment of upper and lower respiratory tract infections were broad spectrum beta lactams. Higher rate of penicillin usage was found only in tonsillitis cases. Besides II. generation cephalosporins (22.7% of 730 prescriptions), beta-lactamase inhibitor + aminopenicillin combinations (13.4%) and III. generation cephalosporins (9.5%) considerable quantity of aminoglycosides (14.9%) and quinolones (9.5%) were found in pneumonia. Relatively high rate of aminoglycosides in the treatment of lower respiratory infections is inconsistent with therapeutic guidelines in force. Co-trimoxazol and quinolones were most frequently prescribed for the treatment of lower urinary tract infections. Traditional urodesinficients were on the first place only at one hospital. Treatment of frequently occurring nosocomial infections was compared with those of community acquired at the same site. There was not significant difference in the utilisation rates of the most of antibiotic groups regarding place of disease acquisition. 44% of the 1373 prescriptions for perioperative profilaxis was indicated for clean operations where benefit of antibiotic administration is questionable. Duration of antibiotic profilaxis was more than 48 hours in 59% of prescriptions. Drugs most frequently used for perioperative profilaxis were II. generation cephalosporins (23.7%), metronidazol (16.7%), aminoglycosides (9.6%) and III. generation cephalosporines (9.6%). The authors compare their results to the literature. They suggest the setting up of "infection control committees" to organise the antibiotic policies in hospitals.

Anti-Bacterial Agents↗
PubMed1997

[Simple parameters of antibiotic utilization and diagnostic background of antimicrobial therapy in Hungarian hospitals in 1995].

This paper is published as second part of a survey on antibiotic utilisation of 8 Hungarian hospitals in January, 1995. The length of hospital stay of the patients receiving systemic antibiotic treatment was significantly higher (P < 0.0001) than those of not receiving such treatment. After exclusion of the patients suffering from nosocomial infections, average of the excess of hospital days was 4.65. Comparing the figures of patients receiving one or more antibiotic/one hospital stay and the rate of monotherapy and combined therapy and number of used antibiotics/100 discharged patients or/100 patients treated with antibiotics it was found that these indexes were most favourable in that hospital, where antibiotic policy was in function. Examining diagnoses (perioperative profilaxis 32.7%, pneumonia 13.3% of the 753 diagnoses) and drugs (metronidazol 26.3%, aminoglycosides 20% of the 1455 antibiotics) most frequently found in cases of combined antibiotic therapy it was concluded that parallel treatment with two or more antibiotic was often unjustified. Only 11% of antibiotics was used as directed against known bacteria. It was found that the rate of the achieved microbiological examinations and targeted therapy was low even if microbiological samples were easy to obtain. It was not the main purpose of the survey to get data of the clinical diagnostic background of antibiotic therapy, but indirect signs showed that these drugs were often used without sufficient clinical evidences (anamnesis, physical status, labor, X-ray and other tests) of infection. Authors recommend further survey in order to find out the causes of insufficiency of diagnoses. They also propose elaboration of diagnostic protocols.

Anti-Bacterial Agents↗
PubMed1997

The serological signs of the Epstein-Barr virus (EBV) activity in the elderly.

The authors determined the IgM and IgG anti-Epstein-Barr virus (EBV)-VCA and anti-EBNA levels in single serum samples of 1882 patients with diagnose except infectious mononucleosis. The serological results were divided into four groups according to different serological patterns: the seronegative group, the IgM anti-VCA positive group (supposedly having actual EBV infection), the IgG (only) anti-VCA group (probably recent EBV infection or not sufficiently functioning cellular immunity) and IgG anti-VCA antibodies together with anti-EBNA (past EBV infection). The presence of heterophil antibodies was detected too. The incidence rates of the serological patterns were classified according to different age groups. It has been observed that the EBV seropositivity rapidly increases with age and over 60 years of age it is over 96%. At the same time the incidence rate of the IgM anti-VCA has gradually increased with age and from 3.66% in the age group of 0-10 years reached 11.98% in patients over 60 years of age. Significantly higher titres of IgG anti-VCA were found in the elderly group of patients as well. The distribution of heterophil antibody positive samples failed to show any significant distribution.

Adolescent↗
PubMed1996

[Usage of antibiotics in hospitals].

The authors publish the results of a survey conducted among hospital records of patients discharged from eight inpatient's institutes between 1-31st of January 1995 to gather information on the indications and usage of antibiotics. The institutes were selected from different part of the country to represent the hospital structure as much as possible. Data from the 13,719 documents were recorded and analysed by computer program. It was found that 27.6% of the patients (3749 cases) received antibiotic treatment. 407 different diagnosis and 365 different surgical procedures (as profilaxis) were considered as indications of antibiotic treatment (total: 4450 indications for 5849 antibiotic treatment). The largest group of patients receiving antibiotics was of antibiotic profilaxis (24.56%, 1093 cases), followed by lower respiratory tract infections (19.89%, 849 cases), uroinfections (10.53%, 469 cases) and upper respiratory tract infections. Relatively large group of patients belonged to those who had fever or subfebrility without known reason (7.35%, 327 cases) and to those who did not have any proof in their document indicating the reasons of antibiotic treatment (6.4%, 285 cases). We can not consider the antibiotic indications well founded in those groups of patients (every sixth or every fifth cases). The most frequently used antibiotics were of [2-nd] generation cefalosporins. The rate of nosocomial infections were found as 6.78% average. The results are demonstrated on diagrams and table.

Anti-Bacterial Agents↗
PubMed1996

[Serologic signs of Epstein-Barr-virus infections in various patients without infectious mononucleosis].

The authors detected Epstein-Barr virus (EBV) virus capsid (VCA) antibodies of IgM and IgG type together with EBNA and heterophil antibodies in the sera collected from 1882 unselected patients without infectious mononucleosis. Out of them IgM type antibodies were found in 123 cases and in an additional group of 30 patients heterophil antibodies were detected together with EBV specific virus markers. Altogether 153 patients were considered as cases of primary EBV infection, or reinfection. Comparing the distribution of age groups of the 1729 and the 153 patients, the author observed the increased incidence of elderly cases among patients with actual EBV infection, particularly above 60 years of age (P < 0.001). The 1729 patients were composed of 141 main diagnostic groups and the 153 patients with actual EBV infection consisted of 30 main diagnostic groups of which more than one third (53 cases) were of alcoholic liver diseases and patients of HBsAg carriers. The authors suppose, that in the cases of alcoholic liver diseases and of HBsAg carriers the suspected "immunocompromised" condition of those patients resulted the actual EBV infection, or reinfection. In other cases, like virus infection or meningitis serosa, it is suspected that the EBV can be responsible producing the symptoms.

Adult↗
PubMed1996

[Serologic signs of Epstein Barr virus activity in acute viral hepatitis, symptomless HbsAg carriers as well as in alcoholic liver diseases].

The authors, based on their previous observations, analysed the serological incidence of the EBV infection in patients with viral hepatitis, HBsAg carriers and alcoholic liver diseases compared to control group. For the better statistical comparison they have selected the patients of 20-60 years of age and by using Khi-square probe, compared the incidence of IgM and IgG type antibodies against EBV in the samples. Significantly higher incidence (P < 0.05) of IgM antibodies were found in the samples of patients with alcoholic liver disease and of HBsAg carriers compared to the patients of viral hepatitis and control group. No similar distribution was observed related to the IgG type antibodies. Certain degree of "immunocompromised" condition is suspected in the cases of patients with HBsAg carrier state and with alcoholic liver disease known from the literature as the main reason behind the relatively more frequent Epstein-Barr virus infection.

Adult↗
PubMed1995

[Sero-epidemiologic study of Epstein-Barr virus markers in patients without mononucleosis at a department for infectious diseases].

The authors have screened sera samples of 1817 unselected patients of not having infectious mononucleosis, admitted to their department, for Epstein-Barr virus (EBV) viruscapsid (VCA) IgM and IgG type antibody to detect the actual situation of EBV infection. The results were evaluated in age groups and in serological patterns. Their results indicated, that 80% of children became seropositive by 5-10 years of age and after 20 years, the rate of seropositivity was over 90% comparable to the reports from "developing" countries. IgM VCA antibodies were found in 103 samples (5.66%). The relatively high rate of only IgG VCA antibody-containing samples (480 cases, 26.41%) might indicate a previous EBV infection or the weakness of the cellular immunity of the given subject. Further studies are necessary to elucidate the problem.

Adolescent↗
PubMed1995

[Indications for antimicrobial treatment in immunocompromised granulocytopenic patients].

The authors, based on the reviewed literature, call the attention to the main guidelines of the antimicrobial treatment of patients with impaired immunity with particular consideration to the patient with granulocytopenia. Individual evaluation is necessary in each of the cases according to tha nature and severity of the immunocompromised status, the localization of the infection and the type of the microorganism. The antimicrobial protocol in granulocytopenic, immunocompromised patients is extremely important in the cases of patients with fever of unknown origin. The main trends of the bacterial infections with emphasis on the reappearance of the gram positive cocci are evaluated. They describe the main types of the antimicrobial prophylaxis and the particular features of the organ-manifestations of the infections in the immunocompromised patients.

Acquired Immunodeficiency Syndrome↗
PubMed1995

[Comparative study of antibiotic use at hospital departments in 7 Hungarian hospitals 1989-1991].

In their present work, authors, referring to their previous paper, wanted to compare the antibiotic consumption of the special medical fields in different hospitals. Computer database were utilised from different hospitals to obtain the necessary figures concerning antibiotic consumption. The amount of antibiotic consumption was expressed in Defined Daily Dose/1000 hospital day. The great differences found between hospitals in quality of antibiotic consumption related to the same subspeciality can be due to the different therapeutical approach in the respective departments. Quality of drug utilisation did not meet the expectations of the modern antibiotic therapy. Relatively low consumption was found in departments of ophthalmology, neurology, psychiatry and rehabilitation. Medium amount of antibiotic consumption was recorded in departments of internal medicine, general surgery, traumatology, obstetrics and gynecology, E. N. T. and dermatology. High antibiotic consumption was observed at the departments of urology, intensive care, infectology, pediatrics and pulmonology. Authors emphasise the importance of the education of the usage of antibiotics both at the medical universities and in postgraduate training as well.

Anti-Bacterial Agents↗
PubMed1995

[Comparative study of antibiotic consumption in Hungarian hospitals during 1989-1991].

The data of case histories of the year of 1989 of seven Hungarian hospitals and also the 1990 and 1991 data of two hospitals were collected and integrated in a database. Consumption of antibiotics were represented in DDD (Defined Daily Dose)/1000 hospital day. These data were compared with the data of the drugs delivered by the hospital pharmacy in one of the mentioned hospitals between 1989 and 1992. It was concluded that data based on case histories represent better the real antibiotic consumption than those of the hospital pharmacy. Reason of this phenomenon is the fact, that considerable amount of drug supply gets out of institutions. Great differences were observed between the seven hospitals in the total amount of antibiotic consumption and between the different antibiotic groups as well. Drugs most frequently used were tetracyclines, broad spectrum penicillins, sulfonamides and aminoglycosides. Consumption of penicillins was decreasing. Regarding new drugs only utilisation of quinolones was increasing. It was concluded, that structure of antibiotic selection did not follow the recommendations of the medical literature. The authors suggest that "antibiotic policy" should be introduced in Hungarian hospitals so as to imporve antibiotic utilisation.

Aminoglycosides↗
PubMed1992

[Differential diagnosis in patients with fever at the department for infectious diseases of a county hospital].

Between the 1st of January 1985 and the 31st of december 1989 101 patients were admitted for fever. Their data were analysed retrospectively. The patients were divided into three groups according to the diagnostic procedures. 32 patients belonged to the first group. The causes of their fever were diagnosed within 24 hours by simple clinical and laboratory means. The second group held 42 patients whose diagnosis were made within one week after detailed laboratory and clinical examinations. The third group (21 patients) fulfilled the criteria of FUO (Fever of Unknown Origin), and the authors analyse this group of patients. Most of the FUO group, 11 patients were diagnosed as infectious origin, 1 tumor, 4 autoimmune. In three cases the diagnosis remained unknown. Authors conclude that patients coming to hospital with fever should deserve more attention of specialist infectologists.

Autoimmune Diseases↗