Category Archives: Original Research

Evaluating demand of High Dependency Unit beds in a hospital with insights on return on capital investment

DOI: 10.2478/amma-2023-0033

Introduction: Hospital administration will have to constantly work around predicting demand of the critical care beds and evaluating the options of expanding the existing capacity. These expansions will be constantly requested by clinicians in private hospitals in India. It becomes imperative to infuse capital into such expansions predicting the utilisation pattern of the new beds. This study concentrates on factors considered for estimating the infrastructure enhancement in step down beds in progression of patient care.
Methodology: Retrospective measurement of past bed occupancy rates of existing critical care beds, number of patients denied admissions through emergency department due to lack of intensive care beds was counted during previous 1 year. Cost estimates of building, equipment, manpower was collected. The prices that can be charged per rack basis was estimated, for revenue calculation. Return on investment tool using annual revenues divided by annual investment was used to measure the outputs.
Results: For setting up a 34 bed HDU (High Dependency Unit), 4760 square feet of space was utilised, with USD 594,555 as investment, at a revenue of USD 527,425, which is 75% return in first year, provided occupancy is at 100%. At occupancy of 60%, which was seen within 6 months of commissioning new HDU, the breakeven can be achieved at 450 days. At 100% occupancy breakeven can be achieved in 290 days.
Conclusion: Demand estimation and Utilisation analysis is valuable tools for administration to make decisions on major capital investments.

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Iron metabolism and metabolic dysfunction-associated fatty liver disease

DOI: 10.2478/amma-2023-0031

Objective: The primary objective of this study was to investigate the association between biomarkers of iron metabolism and metabolic dysfunction-associated fatty liver disease in individuals with type 2 diabetes and non-diabetic individuals compared to a control group. We also examined the possible association between estimated liver fibrosis and serum ferritin levels in all three groups.
Methods: We conducted a descriptive, cross-sectional, comparative study involving subjects diagnosed with diabetes and/or metabolic dysfunction-associated fatty liver disease from an outpatient diabetology clinic and two general practices in Târgu Mureș. The patient population was divided into 3 groups: first group including diabetic patients suffering from fatty liver disease, second group including patients without fatty liver disease and third group with non-diabetic patients suffering from fatty liver disease. We compared the three groups based on specific laboratory tests.
Results: Patients with fatty liver disease had significantly higher ferritin and transferrin saturation levels than non-fatty liver disease sufferers (p<0.05). Transferrin saturation of the first group was significantly (p<0.05) higher compared to the non-diabetic fatty liver disease group. Ferritin correlated well with Fibrosis-4 index level (τ= 0.193, p<0.01) considering the whole sample and especially in the first group.
Conclusions: In our study, there was a clear association between higher ferritin levels and the presence of metabolic dysfunction-associated fatty liver disease. The higher transferrin saturation observed in diabetic patients suffering from metabolic dysfunction-associated fatty liver disease may indicate the possible etiological significance of iron overload. Higher ferritin levels in diabetes increase the risk of liver fibrosis.

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Knowledge, attitudes, and willingness of community pharmacy staff in Mures County, Romania, to provide the brief advice to stop smoking: A cross-sectional study

DOI: 10.2478/amma-2023-0030

Background and objective: Providing brief advice to stop smoking (BASS) can significantly increase motivation to quit, long-term smoking cessation rates, and substantially impact public health. The study aimed to evaluate knowledge, attitudes, and willingness of community pharmacy staff in Mures County, Romania, to provide BASS to smokers.
Methods: The observational, cross-sectional study included a sample of 96 professionals working in community pharmacies in Mures County, Romania. Data were collected using an online questionnaire. Descriptive statistics were calculated. Results: Generally, more than 90% of the respondents acknowledged that smoking is addictive, represents a health hazard, and increases the risk of lung and laryngeal cancer, chronic obstructive pulmonary disease, heart attack, and stroke. Up to 70% of the respondents recognized the most common scientifically proven quit medications, such as nicotine replacement therapy, bupropion, and varenicline. Most pharmacists agreed that they should regularly ask the patients about their smoking status and encourage smokers to quit. They also declared they should receive continual education regarding quit services, medications, and techniques. BASS was credited with very high efficacy by 17.1%, high efficacy by 26.8%, and moderate efficacy by 46.3% of the respondents. The most common perceived barriers to providing BASS in community pharmacies were lack of demand from smokers (78.0%), lack of time (73.2%), and lack of educational materials (39.0%). About 70% of the pharmacists received no formal training regarding quit services, but more than 75% were interested in earning such a qualification. About 65% of the respondents estimated they could dedicate 10-15 minutes of their daily working time to provide BASS to interested customers. Conclusions: Overall, the study found an acceptable level of knowledge and willingness of the participants in offering BASS, suggesting that a program to provide BASS in Mures County community pharmacies may be feasible and useful.

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The digital presence of the leading brands in the
category of Food for Special Medical Purposes

DOI: 10.2478/amma-2023-0029

Objective: Food for Special Medical Purposes (FSMP) is a niche area in the food and healthcare industries that produces foods to meet the dietary requirements of people with specific medical conditions. These products provide specific nutrient amounts and ratios, which can be used as a supplement to a conventional diet, part of an entire medical treatment plan, or as a sole source of Nutrition. The market is expected to generate revenues of $19.67 billion in 2028. Most FSMPs products are purchased individually by patients or caregivers. Although these products are not advertised directly to the public might be bought online from pharmacies and other online shops. This research aims to evaluate the online presence of the most important brands within the FSMPs category and how the patients get to the online shops without direct-to-consumer advertisement.
Methods: This exploratory qualitative research study examines the online presence of FSMP products and key brands using SEO as the main digital technique. Data sources included Romanian websites, Google SERPs, Brandmentions.com, Semrush, and Ubersuggest.
Results: The findings showed that these websites received only a small amount of direct traffic, with only a few hundred monthly visits. To increase organic visibility, businesses must follow regulatory requirements, collaborate with medical experts, engage with potential clients, and exhibit their products at medical events and fairs. Content marketing is crucial for FSMP brands to engage with their target audience and deliver valuable information.
Conclusions: FSMP brands cannot advertise directly to consumers. Instead, they should focus on SEO, reputable online pharmacies, e-commerce shops, and content marketing. This research applies to FSMP brands, digital marketers, and online pharmacies to effectively connect with target demographics, promote products, navigate regulatory constraints, and enhance online presence, improving accessibility and awareness.

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Differences in literacy, education level, and healthcare attendance in two different Roma subgroups from Transylvania, Romania

DOI: 10.2478/amma-2023-0028

Background: Literacy and education levels were demonstrated to be low in the Roma population. The outcomes after the implementation of different educational policies, in different countries, were not properly assessed for Roma subgroups until now.
Aims: We aimed to study literacy, education level, and healthcare attendance in two well-defined Roma subgroups, compared to the majority population, in a specific Transylvanian rural region.
Material and methods: A non-interventional, cross-sectional comparative survey was conducted in 2016-2017 between two Roma subgroups and the general population, from a rural region in Transylvania regarding their literacy, education level and healthcare attendance.
Results: Illiteracy was 33.3%, 66.6%, and 4.2% in the Gabor, Lovari Roma, and general population (p < 0.001). 29.5% of the Gabors and 45.6% of the Lovari Roma did not attend any school, compared to 2.7% of the general population. Almost none of the Roma population attended school after finishing 8 classes. Healthcare service attendance was significantly lower for the Roma subgroups, and directly related to their education level. 32.7% of the Gabors, 28.3% of the Lovari Roma, comparing to 7.3% of the general population never attended the general practitioner (p < 0.001).
Conclusions: Gabor Roma population had a significantly lower proportion of illiteracy and a higher school attendance than Lovari Roma group, but still illiterate by a high percentage. The Roma’s healthcare attendance was far lower than the general population’s, having been even worse in the Gabor group. Healthcare counseling was directly correlated with education level.

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Hyperkalemia, self-medication, and over-the-counter drug usage in patients with cardiovascular disease in the perspective of polypragmasy

DOI: 10.2478/amma-2023-0003

Cardiovascular disease is a leading cause of death globally. 40 percent of the adult Romanian population is hypertensive, and only three out of seven patients are getting the appropriate treatment. Hyperkalemia is in a close relationship with certain cardiovascular diseases, although the influence of a certain medical treatment on hyperkalemia is not yet established. The aim of our study was to evaluate the pharmacotherapy of a group of patients with cardiovascular disease, representative for the adult population of our are and to analyze the administered drug therapy regarding polypragmasy (the concomitant usage of more than five different classes of substances), over-the-counter drugs and usage of drugs used without medical – physician prescribed – indication, and to evaluate serum potassium levels. The cross-sectional, observational, prospective, pharmaco-epidemiological study targets the observation, recording and analysis of 301 adult patients’ pharmacotherapy and laboratory findings. Based on the demographic data we found that the study group is representative for the adult population of our region. Hypertension was observed in 173 cases, and more than 60 percent of the patients were older than 65 years of age. Other comorbidities, such as ischemic cardiac disease, heart failure, arrhythmias, other cardiovascular diseases as well as chronic kidney failure and diabetes mellitus were positively associated with hypertension. In 50.8 percent of the cases usage of drugs without prescription was present. Likewise, multiple drug combinations were frequent with high rates of polypragmasy. Multiple drug combinations were observed, and self-medication rates were very high, which should be reduced substantially to obtain a more successful pharmacotherapy and a reduced drug interaction-induced side effect.

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Multiorgan morphological changes caused by
hyperthermia: Case study on experimental model

DOI: 10.2478/amma-2023-0026

Morphologic changes in organs vary from nonspecific to specific ones, depending on causes of sudden death, e.i whether it is an acute, subacute or chronic event. The aim of this pilot study was to observe the appearance and occurrence of morphological characteristics on organs that were exposed to long-term effects of hyperthermia. A sample of 7 rats was exposed to a water temperature of 41°C, which is defined in the literature as “heat stroke temperature”, both sexes, weighing 250 to 300 g were used. Tissue samples, obtained by dissection of rats, were fixed in 10% buffered neutral formalin, at room temperature, then incorporated into paraffin blocks, cut at 4-5 microns, mounted and stained with standard hematoxylin-eosin (HE) method. In order to prove/exclude lipid and glycogen accumulation in hepatocytes we did additional histochemical staining, using Sudan black and Periodic Acid Shiff (PAS) method, respectively. We obtained samples from kidney, liver, pancreas, spleen, lung and brain. Analyzing tissue samples of different organs obtained from seven Wistar rats, we gained insight into morphological changes caused by induced hyperthermia. All sampled organs showed congestion and some degree of oedema. The most prominent changes were observed in liver and lung samples. Tissue samples of the lung of all seven rats showed signs of acute bronchitis and bronchiolitis, together with signs of initial bronchopneumonia. We also noticed signs of focal acute emphysema as well as focal accumulations of foamy macrophages. Our study suggests that changes in the vascular bed occur soon after hyperthermia and while some organs are more tolerant to heat stroke than others, most organs show similar changes consisting of capillary dilation, congestion and interstitial extravasation, observed after 30 minutes at a temperature of 40.5°C, with the most significant changes observed in liver and lung samples.

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Correlation between diabetic nephropathy and diabetic retinopathy as a long term complications of diabetes mellitus

DOI: 10.2478/amma-2023-0024

Background/aim: Diabetes mellitus is a metabolic disorder of multiple etiologies characterized by a lack of insulin, with a consequent disordered metabolism of glucose, fats, and proteins. A number of complications, such as diabetic nephropathy and retinopathy, may develop as a result of long-term diabetes. The aim of this study aimed to determine the correlation between diabetic nephropathy and diabetic retinopathy as long-term complications of diabetes mellitus.
Materials and methods: Retrospective, descriptive, and analytical research was conducted at the department of Endocrinology, Clinical Center, University of Sarajevo. The study included 158 patients hospitalized in time between 1st of January and 31st of December 2012.
Results: New-onset diabetes was found in 38%, and diabetes type 2 patients 132 (83.5%), female 105 (66.5%) while older than 60 years were 100 (63.3%). Upon discharge from hospital 83,7% of patients were discharged with glycemia <10 mmol / l. We found that 47,5% of patients had HbA1c> 10%. Reduced kidney function, different degrees of failure was at 66.5%. More than half (62.7%) patients had proteinuria as a sign of diabetic nephropathy. Diabetic retinopathy was diagnosed with different types in 54.4%.
Conclusion: Diabetes leads to an increase in nitrogen compounds, and the development of diabetic nephropathy manifests as various degrees of renal insufficiency. The duration of diabetes and occurrence of diabetic retinopathy were significantly interrelated. The correlation between the degree of renal failure and changes in the ocular fundus has not been proven, but more severe renal insufficiency is associated with a higher incidence of diabetic retinopathy compared to patients with less impaired renal function.

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Effects of vitamin D3 (cholecalciferol) supplementation on diabetic polyneuropathy in patients diagnosed with diabetes mellitus

DOI: 10.2478/amma-2023-0023

Introduction: Peripheral sensorimotor polyneuropathy is present in nearly half of the patients diagnosed with diabetes mellitus. Over the past 10 years, animal and human studies have suggested that vitamin D3 treatment may have a role in preventing or reducing neuropathic complaints and symptoms.
Material and method: Our clinical, prospective, interventional, placebo-controlled study investigated the therapeutic effect of 2.000 IU oral cholecalciferol administered for three months on diabetic polyneuropathy. Patients treated with vitamin D and B, thioctic acid, and other analgesics were excluded. Using the single-blind technique, they were randomly assigned into vitamin D-treated and placebo-treated groups. In addition to recording anamnestic data, the study included – a Toronto Clinical Neuropathy Scoring System and Michigan Neuropathy Screening Instrument based – questionnaire to assess subjective symptoms and a physical examination including sensory tests (fine touch-, temperature awareness, pain-, vibration perception). Vitamin D levels were measured. After three months of therapy, the examination was repeated.
Results: Most of the patients were found to have vitamin D deficiency (36% of the total population) or insufficiency (43%). In the cholecalciferol-treated group, but not in the control group, subjective symptoms decreased in intensity and/or frequency, and a significant improvement in the overall complaint scale was observed (p = 0.006), but no change regarding the sensory tests (p > 0.05).
Conclusions: Our results show that oral administration of cholecalciferol for three months significantly reduced subjective symptoms and neuropathic pain as assessed by our questionnaire, however, there was no significant change in the results of the sensory tests. Vitamin D deficiency/insufficiency was common in diabetic patients (79% in our population), therefore screening is recommended.

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Detection of serum telomerase and fibronectin as precursor markers of cervix cancer in patients with a positive Pap test

DOI: 10.2478/amma-2023-0021

Introduction: Cervical cancer is a type of cancer that appears in cervical cells, in the lower part of the uterus, being characterized by the proliferation of atypical cancerous cells, which can spread rapidly, representing a serious disease, with significant medical and social impact among affected individuals, and a severe evolution particularly when detected in advanced stages. The aim of this study was to evaluate the alterations found in cervical cells, caused by persistent HPV infection, using inflammatory protein biomarkers such as fibronectin and telomerase.
Material and method: This study included a total of 169 women, both asymptomatic and symptomatic, aged between 30 and 64 years. Those women underwent routine gynecological consultations or were referred to a gynecologist because of their symptoms. After selecting the patients, a Pap test and blood samples (5 ml) were taken. Using a questionnaire, information regarding sexual characteristics and behaviors, as well as personal medical history, were collected.
Results: The median value for telomerase was 0.1 ng/ml, with a minimum of 0.01 ng/ml and a maximum of 30.09 ng/ml. Based on the telomerase results, 66 (39.1%) patients had positive results (more than 0.215 units) and 103 (60.9%) had negative results. The median value for fibronectin was 3.72 ng/ml with a minimum of 0.55 ng/ml and a maximum of 89.9 ng/ml. Of all women included in the study, 36 (21.3%) had positive results (more than 10 ng/ml), and 133 (78.7%) had negative results. Also, 15.2% of patients with positive telomerase and 16.7% with positive fibronectin presented Atypical Squamous Cells of Undetermined Significance. Mature squamous metaplasia and inflammatory cells have been identified among positive and negative results of fibronectin and telomerase.
Conclusions: Positive and negative results for fibronectin and telomerase were similar in correlation with cytological results and information about HPV infection or sexual practices/characteristics were similar.

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