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BackgroundA growing number of online pharmacies have been established worldwide. Among them are numerous illegal websites selling medicine without valid medical prescriptions or distributing substandard or counterfeit drugs. Only a limited number of studies have been published on Internet pharmacies with regard to patient safety, professionalism, long-term follow-up, and pharmaceutical legitimacy verification. ObjectiveIn this study, we selected, evaluated, and followed 136 Internet pharmacy websites aiming to identify indicators of professional online pharmacy service and online medication safety. MethodsAn Internet search was performed by simulating the needs of potential customers of online pharmacies. A total of 136 Internet pharmacy websites were assessed and followed for four years. According to the LegitScript database, relevant characteristics such as longevity, time of continuous operation, geographical location, displayed contact information, prescription requirement, medical information exchange, and pharmaceutical legitimacy verification were recorded and evaluated. ResultsThe number of active Internet pharmacy websites decreased; 23 of 136 (16.9%) online pharmacies ceased operating within 12 months and only 67 monitored websites (49.3%) were accessible at the end of the four-year observation period. However, not all operated continuously, as about one-fifth (31/136) of all observed online pharmacy websites were inaccessible provisionally. Thus, only 56 (41.2%) Internet-based pharmacies were continuously operational. Thirty-one of the 136 online pharmacies (22.8%) had not provided any contact details, while only 59 (43.4%) displayed all necessary contact information on the website. We found that the declared physical location claims did not correspond to the area of domain registration (according to IP address) for most websites. Although the majority (120/136, 88.2%) of the examined Internet pharmacies distributed various prescription-only medicines, only 9 (6.6%) requested prior medical prescriptions before purchase. Medical information exchange was generally ineffective as 52 sites (38.2%) did not require any medical information from patients. The product information about the medicines was generally (126/136, 92.6%) not displayed adequately, and the contents of the patient information leaflet were incomplete in most cases (104/136, 76.5%). Numerous online operators (60/136, 44.1%) were defined as rogue Internet pharmacies, but no legitimate Internet-based pharmacies were among them. One site (0.7%) was yet unverified, 23 (16.9%) were unapproved, while the remaining (52/136, 38.2%) websites were not available in the LegitScript database. Contrary to our prior assumptions, prescription or medical information requirement, or the indication of contact information on the website, does not seem to correlate with “rogue pharmacy” status using the LegitScript online pharmacy verification standards. Instead, long-term continuous operation strongly correlated (P

In recent years, several changes have occurred in the management of chronic immunological conditions with the emerging use of targeted therapies. This two-phase cross-sectional study was conducted through structured in-person interviews in 2018–2019 and 2022. Additional data sources included ambulatory medical records and the itemized reimbursement reporting interface of the National Health Insurance Fund. Drug interactions were analyzed using the UpToDate Lexicomp, Medscape drug interaction checker, and Drugs.com databases. The chi-square test was used, and odds ratios (ORs) were calculated. In total, 185 patients participated. In 53% of patients (n = 53), a serious drug–drug interaction (DDI) was identified (mean number: 1.07 ± 1.43, 0–7), whereas this value was 38% (n = 38) for potential drug–supplement interactions (mean number: 0.58 ± 0.85, 0–3) and 47% (n = 47) for potential targeted drug interactions (0.72 ± 0.97, 0–5) in 2018. In 2022, 78% of patients (n = 66) were identified as having a serious DDI (mean number: 2.27 ± 2.69, 0–19), 66% (n = 56) had a potential drug–supplement interaction (mean number: 2.33 ± 2.69, 0–13), and 79% (n = 67) had a potential targeted drug interactions (1.35 ± 1.04, 0–5). Older age (>60 years; OR: 2.062), female sex (OR: 3.387), and polypharmacy (OR: 5.276) were identified as the main risk factors. Screening methods and drug interaction databases do not keep pace with the emergence of new therapeutics. [ABSTRACT FROM AUTHOR]

Background: The increasing distribution of Substandard and Falsified Medical Products is a well-known health risk. The quantity of these medicines sent to consumers is not known, and it can only be accurately estimated with a specific sample collection study. These consignments ordered via mail from illegal online sources pose a great health risk on the population. Methods: We used an observation-based cross-sectional study in order to obtain accurate data regarding the number of medicinal shipments from dubious origin. We collected data on-site to assess the number of Substandard and Falsified Medical Products arrived in Hungary via postal services in 2020. Results: The therapeutic category (according to the Anatomical Therapeutic Chemical Classification (ATC) system of the WHO) of the most frequently shipped products contained active ingredients for treating erectile dysfunction. These substances were sildenafil (G04BE03), tadalafil (G04BE08), and other analgesics and antipyretics, such as anilides (N02BE). In 2020 we estimated that the real Defined Daily Dose of SFMP was 1.2 DDD per 1000 inhabitants per day. This value is equivalent to one third of Hungary's opioid analgesic use. We also calculated that the average exposure was approximately 4 ampoules per day and 40 oral preparations per day (without DDD value) for 1000 people in Hungary. Conclusions: This study accurately estimates the number of consignments received by post containing Substandard and Falsified Medical Products, and determines the quantity per 1000 persons per day expressed in DDD. This parameter may be used as a benchmark that helps more detailed research in the future. [ABSTRACT FROM AUTHOR]

Introduction: Recognition of potentially harmful drug interactions is one of the duties of healthcare. However, solutions involving databases are fraught with contradictions due to the lack of standardized principles and data., Aim: The aims of the authors were to perform a comparative evaluation of Hungarian and international databases and to explore ambiguities and contradictions in order to develop more standardized criteria for screening interactions., Method: Four Hungarian and two English-language websites and software, and the summaries of product characteristics were compared. The authors analyzed 40 drug-drug and 8 drug-supplement interactions and looked at 8 cases, which represent 28 pairs of interacting substances., Results: The databases warn about most interactions, but these warnings were rarely helpful in preventing undesired consequences. The authors found discrepancies between the databases in 70% of interactions. When looking at different products with the same active ingredients, discrepancies cropped up in 0-66.7% of the cases. Up to 80% of searches for supplementary product interactions did not produce satisfactory results., Conclusions: In the present situation mapping these ambiguities and creating a standardized classification system would be advantageous.

In the management of spinal metastases bringing about neurological symptoms and signs, palliative surgical treatment plays an important role. The goals of surgery are preservation of neurological function especially that of the mobility, pain relief and local tumor control. Many of spinal metastases are hypervascularised, accordingly, preoperative embolisation offers logically improvement in technical realisation of surgery by means of reduction of intraoperative profuse bleeding. To prove this working hypothesis a retrospective analysis was performed. Results of preoperative transarterial embolisation of hypervascularised spinal tumours were worked up from 2000 to 2012. By means of 2 case presentations - to our knowledge, first in the Hungarian literature - the techniques of transarterial spinal embolisation of spinal metastases are described. Indications, complications and effect on intraoperative bleeding events of the embolisation procedure in these oncological cases are presented on the basis of literature search and of our own experience. The case analyses, based mainly on qualitative retrospective data, support the notion that histologically known spinal hypervascularised metastases or those found to be hypervascularised by MRI can be treated effectively by means of preoperative superselective embolisation without major risks of morbidity or mortality.

As internet is now available to nearly everyone in Hungary, the accessibility of websites offering pharmaceutical products is also increasing. The national and international regulation of these sites is currently an unsolved problem worldwide, thus potentially harmful, counterfeit and prescription only medicines are easily accessible on the market. We aimed to measure and estimate the current situation of the ordering of online medicines. In 5 Hungarian cities 434 self-administered questionnaires were collected in community pharmacies. Our results show that 6.2% of the respondents have already ordered drugs or dietary supplements online and approximately same amount of people are considering this option in the near future. Based on our survey mostly the educated, the 30-49 year old people and women are likely to buy drugs online. Every fifth respondent reported willingness to buy drugs online from abroad if lower prices were offered. Most people do not know that the quality of medicines purchased online could be different from the ones purchased from community pharmacies. We would like to draw attention of healthcare professionals to the rising popularity and potential risks of drugs available online.

Amphotericin B can be determined by chemical (HPLC, spectrophotometry) and microbiological (bioassay) methods. The utilization of both during a stability test can give more detailed information about the activity and concentration change of amphotericin B solutions. Previously published HPLC methods do not lay stress on the separation of by-constituents present in the substance. We have also observed that the bioassay conditions described in the Ph. Eur. 6. are not suitable for the measurement of concentration change experienced during a stability test. The aim of our study was to optimize the chemical and microbiological methods. We have improved the eluent system based on earlier HPLC methods for the separation of the main heptaene and the minor tetraene by-constituents in Fungizone (Bristol-Myers Squibb). The most optimal bioassay conditions were determined where a relatively wide concentration range can be measured. With the improved methods both chemical and microbiological changes can be more accurately measured in our future stability tests.

Recent studies have shown that the presence of fungal cells in the nasal mucosa may play an important role in the development of chronic rhinosinusitis with nasal polyps. In 2006 a pilot clinical trial was organized by the Department of Otorhinolaryngology, Head and Neck Surgery and the Pharmaceutical Institute of the Medical University of Pécs for the treatment of patients with chronic rhinosinusitis with nasal polyps. In our study we investigated the stability of the 5 mg/ml amphotericin B solutions (Fungizone) with chemical (spectrophotometry) and biological (bioassay) detection. The effect of storage temperature and the addition of 5% glucose was evaluated on the stability of the solutions for three months. The two detection methods showed different results. According to the chemical analysis the samples are considered relatively stable under all observed conditions (loss of concentration is: 14.2% at 20 degrees C and 4.5% at 4 degrees C). The bioassay shows complete loss of antifungal activity after 35 days of storage at room temperature and notable decrease can be observed at 4 degrees C (glucose containing solution 17.6%; glucose free solution 37.2%). Storage temperature had significant effect (p < 0.05), while 5% glucose had no significant effect (p > 0.05) on the stability of the examined solutions. Bioassay is considered to be the official quantitative analytical method for the analysis of amphotericin B recommended by the European Pharmacopoeia 4. Thus we estimated the shelf life of the glucose-free solutions, being stored at 4 degrees C, to be 30 days in accordance with our bioassay results.