Zsolt Abonyi-Tóth

Comparison of the pathogenicity of QX-like, M41 and 793/B infectious bronchitis strains from different pathological conditions

Five QX-like infectious bronchitis virus (IBV) strains, isolated from different field outbreaks and two reference IBV strains of known serotypes (M41 and 793/B), were used in the present study to investigate and compare their pathogenicity for 1-day-old specific pathogen free chickens. The ability of the strains to inhibit trachea epithelium ciliary activity, to induce immune response, to replicate and to cause histopathological lesions in designated organs was followed by repeated samplings during a period of 42 days post infection. Clear differences in pathogenicity and in organ distribution of the three serotypes were found. Strain 793/B had the least capacity to invade the investigated organs, while it produced a good humoral response as measured by enzyme-linked immunosorbent assay. The QX-like strains generally replicated to higher titres, although differences were found among the five strains in their pathogenicity and affinity for different organs. The Chinese isolate of QX-like virus caused the most severe lesions and induced the highest antibody titres. Severe kidney damage and dilatation of the oviduct were the prominent lesions that could be related to the QX-like IBV strains, although neither marked virus replication nor histopathological lesions were detected in the oviduct.

An exact confidence set for two binomial proportions and exact unconditional confidence intervals for the difference and ratio of proportions

An exact joint confidence set is proposed for two binomial parameters estimated from independent samples. Its construction relies on inverting the minimum volume test, a two-dimensional analogue of Sternes test for a single probability. The algorithm involves computer-intensive exact computation based on binomial probabilities. The proposed confidence set has good coverage properties and it performs much better than the likelihood-based confidence set for the same problem. Applying the principle of intersection-union tests, the method can be used to derive exact tests and confidence intervals for functions of the two binomial parameters. Based on this, new exact unconditional two-sided confidence intervals are proposed for the risk difference and risk ratio. The performance of the new intervals is comparable to that of certain well-known confidence intervals in small samples. Extension of the methods described to two hypergeometric or two Poisson variables is straightforward.

Persistence of initial oral antidiabetic treatment in patients with type 2 diabetes mellitus.

Summary Background Adequate persistence of oral antidiabetic treatment is highly important to achieve proper glycemic control in patients with type 2 diabetes. The aim of this study was to evaluate the persistence of initial treatment with metformin and/or sulphonylureas in patients with type 2 diabetes. Material/Methods The study was performed among diabetic patients (n=256,384) who were with newly prescribed oral antidiabetic drugs (metformin and/or sulphonylureas) between 2007 and 2009. For making comparison, patients with newly prescribed statin or clopidogrel therapy (with and without percutaneous coronary intervention) were investigated. The database of the Hungarian National Health Insurance Fund Administration was used. Results The 1-year persistence of initial treatment with metformin, sulphonylureas or metformin/sulphonylurea combination was 47.7%, 45.4% and 55.8%, respectively, which was significantly better than the persistence of statin therapy (26.3%) but worse than that of clopidogrel therapy in patients undergoing coronary intervention (73.2%). Within the sulphonylurea group there was a tendency of better persistence of treatment with the “modified-release” tablets at 12 months compared to the conventional sulphonylureas (47.8 vs. 42.2%). The persistence of therapy using metformin 1000 mg – 60 tablets was significantly better (60.4%) at 12 months than that of other forms of metformin therapy with lower doses and smaller boxes (with fewer tablets) analyzed together (47.7%). Conclusions The persistence of initial treatment with metformin and/or sulphonylureas is far from optimal. Better diabetic care and continuous patient education should be encouraged to achieve higher persistence of oral antidiabetic treatment in patients with type 2 diabetes.

Occurrence, clinical features and outcome of canine pancreatitis (80 cases)

Medical records of 80 dogs diagnosed with acute pancreatitis during a 4-year period were evaluated regarding history, breed predilection, clinical signs and additional examination findings. Cases were selected if compatible clinical symptoms, increased serum activity of amylase or lipase and morphologic evidence of pancreatitis by ultrasonography, laparotomy or necropsy were all present. Like in other studies, neutered dogs had an increased risk of developing acute pancreatitis. Although breed predilection was consistent with earlier reports, some notable differences were also observed. Apart from Dachshunds, Poodles, Cocker Spaniels and Fox Terriers, the sled dogs (Laikas, Alaskan Malamutes) also demonstrated a higher risk for pancreatitis according to our results. Concurrent diseases occurred in 56 dogs (70%), diabetes mellitus (n = 29, 36%) being the most common. Clinical signs of acute pancreatitis were similar to those observed in other studies. The study group represented a dog population with severe acute pancreatitis, having a relatively high mortality rate (40%) compared to data of the literature. Breed, age, gender, neutering and body condition had no significant association with the outcome. Hypothermia (p = 0.0413) and metabolic acidosis (p = 0.0063) correlated significantly with poor prognosis and may serve as valuable markers for severity assessment in canine acute pancreatitis.

Persistence with statin therapy in Hungary

Introduction Persistence with lipid-lowering drug therapy by cardiovascular patients in Hungary has not been studied previously. This study was designed to determine the rate with which Hungarian patients with hyperlipidemia persist in taking lipid-lowering agents, and to compare this with rates reported from other countries. Material and methods This was a retrospective study that utilized data from the Institutional Database of the National Health Insurance Fund to analyze persistence rates with statins and ezetimibe. The study included data for patients who started lipid-lowering therapy between January 1, 2007, and March 31, 2009. Variables included type of lipid-lowering therapy, year of therapy start, and patient age. Main outcome measures were medians of persistence in months, percentages of patients persisting in therapy for 6 and 12 months, and Kaplan-Meier persistence plots. Results The percentage of patients who persisted with overall statin therapy was 46% after 1 month, 40.3% after 2 months, 27% after 6 months, and 20.1% after 12 months. Persistence was slightly greater for statin therapy started during 2008 than during 2007. Older patients were more persistent with therapy than younger patients. Persistence with the combination of ezetimibe-statin therapy was greater than with statin or ezetimibe monotherapy. Conclusions Persistence with statin therapy by patients in Hungary was low compared with other countries. Low persistence may have negated potential clinical benefits of long-term statin therapy.

Seasonal fertility differences in synchronised dairy cows: ultrasonic, metabolic and endocrine findings.

The aim of this study was to identify relationships among seasonal differences of fertility, metabolic parameters and appearance of irregular luteal forms in high-yielding dairy cows. Holstein-Friesian cows were put on the Provsynch regimen in winter (n = 10) and in summer (n = 10). Blood sampling (starting 35 days post partum) and rectal ultrasound examinations (starting post insemination) were carried out once a week in each examination period. Metabolic [plasma nonesterified fatty acid (NEFA) and beta-hydroxybutyrate (BHB) levels, ferric reducing ability of plasma (FRAP) and serum beta-carotene] and endocrine parameters [plasma thyroxine (T4), triiodothyronine (T3), insulin-like growth factor (IGF-I) and insulin levels] were measured. In summer, two cows were excluded from the study because of metritis and none of the remaining animals became pregnant, but 6 of the 8 cows had irregular luteal forms (ILF) on their ovaries. In winter, one cow was excluded because of metritis and 6 of the 9 cows became pregnant, while 2 of the 3 open cows had irregular luteal forms. In summer the mean plasma NEFA and BHB concentrations were significantly higher, while serum carotene and plasma IGF-I concentrations were significantly lower than in winter. The high plasma NEFA concentration found in summer seemed to be in association with the lower body condition score (BCS) caused by depressed appetite. In conclusion, statistical analysis supports the hypothesis that increased plasma NEFA and BHB and decreased plasma IGF-I concentrations may result in reduced fertility in summer. These changes may be associated with the more frequent appearance of ILFs and probably have a negative effect on ovarian function and/or oocyte quality.

Hematologic and Plasma Biochemistry Values in White Storks (Ciconia ciconia)

Abstract Hematologic and plasma biochemistry parameters of the white stork (Ciconia ciconia) were studied. Blood samples were taken from a total of 80 adult white storks kept in captivity in Hungarian zoos and bird repatriation stations, between 2002 and 2006. Hematologic (packed cell volume, 46.3% ± 5.3%; hemoglobin concentration, 127.8 ± 20.4 g/L; red blood cell counts, 2.28 ± 0.35 1012/l/l; white blood cell counts, 21.6 ± 4.2 109/l/l; heterophils, 61.0% ± 9.8% [13.1 ± 3.2 × 109/L]; lymphocytes, 34.3% ± 9.1% [7.4 ± 2.5 × 109/L]; monocytes, 3.44% ± 2.3% [0.78 ± 0.57 × 109/L]; eosinophils 0.75% ± 0.91% [0.16 ± 0.21 × 109/L]; basophils 0.38% ± 0.56% [0.04 ± 0.07 × 109/L]) and plasma biochemistry values (aspartate aminotransferase, 267.5 ± 145.8 U/L; L-γ-glutamyltransferase, 47.6 ± 49.3 U/L; lipase, 70.3 ± 60.6 U/L; creatine kinase, 443.9 ± 182.2 U/L; lactate dehydrogenase, 880.4 ± 293.6 U/L; alkaline phosphatase, 177.5 ± 116.6 U/L; amylase, 917.6 ± 314.3 U/L; glutamate dehydrogenase, 7.3 ± 4.0 U/L; total protein, 45.2 ± 8.1 g/L; uric acid, 459.2 ± 254.3 µmol/L; and bile acids, 46.3 ± 20.5 µmol/L) were determined. The results obtained can be used as reference values, because there are no established values previously reported for adult white storks.

The prevalence of atrial fibrillation in Hungary

UNLABELLED To estimate the prevalence and incidence of atrial fibrillation in the entire population of Hungary. METHODS Analysis of the National Health Insurance Fund Administration database between 2007 and 2009 considering data from 2002. We assumed that patients with atrial fibrillation would turn to health care providers at least once either as outpatients or inpatients in a 5-year period. The National Health Insurance Patient Registry was used to assess the true number of patient visits. RESULTS The prevalence of atrial fibrillation in Hungary is between 2.37-2.67%. Each year, only about half of these patients seek medical advice. CONCLUSIONS Our survey seems to be the first epidemiological study that aims at estimating the prevalence of atrial fibrillation in the total population of our country. Using a time frame of five to seven years, the prevalence of atrial fibrillation in the total population is significantly higher than it was estimated earlier. However, by using a mathematical model, an even higher prevalence rate of atrial fibrillation (2.95%) was calculated for the total population of Hungary.

Pitfalls associated with the therapeutic reference pricing practice of asthma medication

BackgroundTherapeutic reference pricing (TRP) based on the WHO daily defined dose (DDD) is a method frequently employed for the cost-containment of pharmaceuticals. Our objective was to compare average drug use in the real world with DDD and to evaluate whether TRP based on DDD could result in cost savings on maintenance medication and the total direct health expenditures for asthma patients treated with Symbicort Turbuhaler (SYT) and Seretide Diskus (SED) in Hungary.MethodsReal-world data were derived from the Hungarian National Health Insurance Fund database. Average doses and costs were compared between the high-dose and medium-dose SYT and SED groups. Multiple linear regressions were employed to adjust the data for differences in the gender and age distribution of patients.Results27,779 patients with asthma were included in the analysis. Average drug use was lower than DDD in all groups, 1.38-1.95 inhalations in both SED groups, 1.28-1.97 and 1.74-2.49 inhalations in the medium and high-dose SYT groups, respectively. Although the cost of SED based on the DDD would be much lower than the cost of SYT in the medium-dose groups, no difference was found in the actual cost of the maintenance therapy. No significant differences were found between the groups in terms of total medical costs.ConclusionsCost-containment initiatives by payers may influence clinical decisions. TRP for inhalation asthma drugs raises special concern, because of differences in the therapeutic profile of pharmaceuticals and the lack of proven financial benefits after exclusion of the effect of generic price erosion. Our findings indicate that the presented TRP approach of asthma medications based on the daily therapeutic costs according to the WHO DDD does not result in reduced public healthcare spending in Hungary. Further analysis is required to show whether TRP generates additional expenditures by inducing switching costs and reducing patient compliance. Potential confounding factors may limit the generalisability of our conclusions.

Survival of rapidly frozen hatched mouse blastocysts

The objective of the present study was to examine the effect of rapid freezing on the in vitro and in vivo survival of zona-pellucida-free hatched mouse blastocysts. Hatched blastocysts were rapidly frozen in a freezing medium containing either ethylene glycol (EG) or glycerol (G) in 1.5 M or 3 M concentration. Prior to freezing, embryos were equilibrated in the freezing medium for 2 min, 10 min, 20 min or 30 min at room temperature. To freeze them, embryos were held in liquid nitrogen vapour [approximately 1 cm above the surface of the liquid nitrogen (LN2)] for 2 minutes and then immersed into LN2. After thawing, embryos were transferred either to rehydration medium (DPBS + 10% foetal calf serum +0.5 M sucrose) for 10 minutes or rehydrated directly in DPBS supplemented with foetal calf serum. In vitro survival of embryos frozen with EG was higher than those frozen with G. The highest survival was obtained with 3 M EG and 2 min or 10 min equilibration prior to freezing, combined with direct rehydration after thawing. Frozen blastocysts developed into normal foetuses as well as unfrozen control ones did, with averages of 30% (control), 26% (EG) and 15% (G). The results show that hatching and hatched mouse blastocysts can be cryopreserved by a simple rapid freezing protocol in EG without significant loss of viability. Our data indicate that the mechanical protection of the zona pellucida is not needed during freezing in these stages.