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Background. Pharmaceutical care is currently an increasingly common tool facilitating the optimisation of pharmacology. Implementation of pharmaceutical care in collaboration with healthcare units, especially the Primary Health Care (PHC), will result in higher integration of the medical and pharmaceutical professions, resulting in tangible benefits for the patient. Due to this innovative approach, the scope of healthcare services provided by pharmacists has not been thoroughly researched. Objectives. This research investigates the issue of assessing the scope of the services provided within the framework of pharmaceutical care. The paper presents an original concept created by the Medical and Diagnostical Centre in Siedlice, Poland (MCD). Material and methods. The research methodology started with a literature analysis and systematic review. The second stage was brainstorming based on the current practical experiences of the MDC. The research and literature analysis were carried out in electronic databases to identify published studies on the scope of services provided within the framework of pharmaceutical care. Considering the practical and widely discussed nature of the subject, an Internet search was performed as a supplementary strategy to identify articles. The results were then analysed and brainstormed by the managing staff at the MDC. Results. In the research and analysis process, the authors found, named and stated seven types of pharmaceutical services: medication review, medication consultation, pharmaceutical assistance, prophylaxis diagnosis, intervention/urgent visit, patient digitisation, internal pharmaceutical consultation. The above services together comprise the coordinated pharmaceutical care process over a patient. It has been tested in the MDC and is now in the implementation phase. Conclusions. Identification and reinforcement of the scope of the services provided within the framework of pharmaceutical care may have a crucial influence on the quality and effectiveness of patient care. This care is provided by the pharmacy in close cooperation with the ambulatory medical facilities. [ABSTRACT FROM AUTHOR]

Background. The paper deals with the possibilities for implementation of professional competences of physical therapists working in different systems of education and health protection with regard to the holistic health concept, psychophysical education and interdisciplinary collaboration inside rehabilitation teams. Objectives. The main objective of the study was to compare the possibilities for implementation of professional competences of physical therapists working in rehabilitation teams of education and health protection systems. Material and methods. The survey encompassed 200 physical therapists working in the education (n = 98) and health protection (n = 102) systems of Lithuania. A questionnaire-based method employing closed-type questions was used, which was aimed at revealing whether implementation of professional competences of physical therapists working in different systems differed. Results. The competences of communication and collaboration, i.e. interdisciplinary activities inside rehabilitation teams, were more developed by physical therapists working in the education system (t = 23.483, df = 2, p = 0.001). In the process of physical diagnosis, physical therapists of the health system make a diagnosis of physical therapy independently. The same statistically significant difference was also noticed in the aspect of communication of groups of these specialists when psychosocial problems occur, specifically: t = 14.768, df = 3, p = 0.002. Physical therapists of the education system more actively participate in qualification development, delivery of talks at conferences and organising health promotion programmes, even though no statistically significant difference was found (t = 4.830, df = 3, p = 0.185). Conclusions. The competences of interdisciplinary collaboration are more developed by physical therapists working in the education system; whereas physical therapists working in the health system are more concerned with the making of a physical therapy diagnosis, design of a programme and application of more diverse methods. [ABSTRACT FROM AUTHOR]

Background. The current study aimed to investigate the rational drug use characteristics of physicians and the effect of a patient-centered approach on rational drug use. Material and methods. This cross-sectional and descriptive study was conducted with 182 assistant doctors from November 2020 to April 2021 in a university hospital. Rational drug use features are evaluated by World Health Organization (WHO) prescribing indicators. The patient-centered approach of physicians was measured by the Patent-Practitioner Orientation Scale (PPOS-14). Results. The mean number of drugs per prescription in the study was 3.0 ± 1.03. 66.5% of the doctors reported that they prescribed drugs to more than half of their patients. Physicians with high patient-centered approach scores were more likely to “call their patients by their names”, “use more from drug guides”, “follow their patients’ treatment processes”, and showed interest in “interest in rational drug use studies”, and “rational drug use training”. Physicians who prefer ready-to-use prescriptions for common conditions had lower patient-centered approach scores. There was a significant positive correlation between the PPOS-14 total score and the rational drug use score (r = 0.153, p = 0.039), and there was a significant negative correlation between PPSO share and care scores and the average number of drugs per prescription. Conclusions. Physicians with a patient-centered approach were more willing to use rational drugs, follow rational drug guidelines, and receive training on rational drug use. Bringing the patient-centered approach to physicians may improve rational drug use. [ABSTRACT FROM AUTHOR]

Background. Clostridioides difficile infection is the most common diarrheal disease associated with antibiotic use. Treatment includes fidaxomicin, vancomycin, metronidazole, rifaximin, fecal flora transplants, and bezlotoxumab. There are numerous reports of the potential beneficial effects of using probiotics in Clostridioides difficile infection. Objectives. This study aimed to analyze the effects of the use of probiotics on patients with Clostridioides difficile infection who were hospitalized at the University Clinical Hospital in Wroclaw from 2016 to 2018. Material and methods. The study was conducted by analyzing the medical records of patients treated from 2016 to the end of 2018 at the University Clinical Hospital in Wroclaw. We examined the frequency of use of probiotics in Clostridioides difficile infection, differences in the use of probiotics by year of hospitalization, mortality among patients taking probiotics and not receiving this type of treatment, length of hospitalization by probiotic use, and the relationship between the gender of patients and the use of probiotics. Results. 313 patients were enrolled in the study, out of 319 patients total. Almost half of the patients (45.54%) received no probiotic during hospitalization. The most commonly administered probiotics were preparations containing Saccharomyces boulardii, which were received by 24.2% of patients. The use of probiotics did not affect mortality in Clostridioides difficile infection. Patients receiving probiotics were hospitalized longer. There was no significant statistical difference in probiotic use by patient gender. Conclusions. Probiotic use did not reduce the risk of death or shorten the length of hospitalization of patients with Clostridioides difficile infection [ABSTRACT FROM AUTHOR]

Background. Not only causing major implications on physical medicine, COVID-19 had changed the landscape in psychiatric medicine. The world is facing an impending surge of psychiatric disorders, and the early signs are now clearer than ever. These early signs might help psychiatrist and physicians, in general, to more accurately analyse, diagnose and treat these psychiatric disorders. Objectives. To report the epidemiological and clinical characteristics of COVID-19 patients who experience psychiatric symptoms. Material and methods. The data was collected by secondary data in the form of medical records from patients treated at Udayana University Hospital within the period April 2020 to March 2021. Results. Patients with psychiatric disorders admitted to this hospital (n = 94) had a mean age of 48.5 (SD ± 14.5) years of age, with males constituting 51.1%. The psychiatric diagnoses found were insomnia (44.7%), adjustment disorder (26.6%), anxiety disorder (16.0%), depression (6.4%), psychosis (4.3%), bipolar disorder (3.2%), as well as delirium, acute stress reaction and schizophrenia at 2.1% each. These patients had a mean duration of hospitalisation of 13.2 (SD ± 6.1) days. The hospital recorded a fatality rate of 7.4% in this particular element of patients, higher than the fatality rate observed in those of the whole population. Conclusions. The first year of the COVID-19 pandemic in Indonesia, though not directly implying, was a warning sign of the impending surge of the number of psychiatric diagnoses in the future. These psychiatric patients are not to be left alone and ignored, as they suggest a possible increase in fatality rate. [ABSTRACT FROM AUTHOR]

Background. Cardiovascular diseases (CVD) are chronic diseases that can be asymptomatic for a long time, and the first symptom may be sudden death. Objectives. This study was designed to draw attention to the frequency of both individual and occupational cardiovascular risk factors and to warn health professionals about variable risk factors. Material and methods. This research was conducted between 01.03.2022–01.09.2022. 160 participants were included in the study. The questionnaire form in which sociodemographic data was asked, the international physical activity questionnaire (short) form and the work stress scale form were directed to the participants. Blood pressure, height, weight and waist circumference were measured, and CVD risks were calculated using the SCORE (Systematic Coronary Risk Evaluation) 2 cardiovascular risk estimation algorithm. Results. Medium, high and very high CVD risks were determined in 41.8% of the employees. The risk was found to be significantly different among occupational groups (p < 0.001) and economic status (p = 0.036). Considering the relationship between shift work status and CVD risk, the risk was found to be significantly higher in those working only during day shifts compared to those working during alternating day and night shifts (p = 0.033). It has been shown that work stress does not increase the CVD risk of healthcare workers (HCW) (p = 0.857). However, it was observed that work stress significantly increases LDL and total cholesterol (p = 0.026 and p = 0.018). Conclusions. In this study, it is emphasised that work-related risks should be taken into consideration, as well as individual CVD risks. [ABSTRACT FROM AUTHOR]

Background. During the coronavirus disease 2019 (COVID-19) pandemic, most hospitals have faced a heavy load of patients. In this situation, it is very important to consider the resilience and endurance of medical staff, as well as to identify and investigate the relevant factors which can increase their resilience. Objectives. The aim of this study was to identify the factors affecting the resilience of hospital medical staff during the COVID-19 pandemic. Material and methods. The present study is a qualitative study using a semi-structured interview. Participants included doctors, nurses, clinicians and managers working in tertiary referral hospitals during the COVID-19 pandemic. Interviews were conducted as needed until data saturation was reached using the purposive sampling method. A total number of 20 people, including 6 physicians, 2 hospital managers, 7 nurses, 1 radiologist, 3 laboratory technicians and 1 clinical psychologist, were interviewed in 7 educational hospitals of the Kerman Province. Results. After data analysis and coding, 127 initial codes were identified. By reviewing the codes, 127 initial codes were merged by the research team, and 23 codes in 6 main categories, including Personal Factors (7 codes), Family-Related Factors (2 codes), Community Related Factors (2 codes), Virus-Related Factors (2 codes), Organisational Factors (7 codes) and Economical Factors (3 codes) were extracted. Conclusions. Paying attention to the identified factors on the maintenance of medical human resources in the form of the “Surge Capacity Programme” can increase the resilience of medical staff. Such measures pave the way for a better response to other threats similar to the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background. Smoking is the most dangerous modifiable risk factor all over the world and requires the lowest cost to quit. Objectives. In this study, we aimed to determine the relationship between the Fagerström Test for Nicotine Dependence (FTND) and carbon monoxide (CO) levels and neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR) and RDW, WBC, MPV values. Material and methods. 138 participants who applied to the Smoking Cessation Clinic of Bolu Izzet Baysal Training and Research Hospital between January 2022 and March 2022 were included in our study. After obtaining the necessary consent, the FTND test and CO levels in expiratory air were measured. The required haematological values of the participants were evaluated. Results. It was found that there was statistical significance between the CO levels of the participants and their FTND scores, and it was observed that the FTND scores increased as the CO level increased (p = 0.000). There was a statistically significant correlation between CO levels and PLR ratios and WBC levels (p = 0.024, p = 0.000). It was determined that as the CO level increased, the PLR ratios decreased, and the WBC values increased. Conclusions. In our study, a positive correlation was found between FTND levels and exhaled CO levels. We can say that CO levels can be a marker in predicting the level of addiction. In addition, it was observed that there was a significant relationship between exhaled CO levels and FTND levels, as well as PLR and WBC values. [ABSTRACT FROM AUTHOR]

Background. Primary health care physicians are at high risk of burnout. In addition, with the current conditions, they can have an effort-reward imbalance. However, studies on this topic concerning public primary health care (Puskesmas) physicians in Indonesia are still limited. Objectives. To assess whether the effort-reward imbalance among Puskesmas physicians is associated with two main burnout dimensions: emotional exhaustion and depersonalisation. Material and methods. This cross-sectional study surveyed physicians working in Puskesmas in Indonesia using the short version of the Effort-Reward Imbalance Questionnaire and Maslach Burnout Inventory-Human Services Survey questionnaires. Results. Of 226 physicians, 45.6% perceived high effort and low reward. A perceived effort-reward imbalance was higher among those working more than 40 hours weekly in work shifts and in urban areas. Significant predictors of emotional exhaustion included effortreward ratio (β = 0.426; p < 0.001), overcommitment (β = 0.393; p < 0.001) and working period at Puskesmas (β = - 0.122; p = 0.038). Predictors of depersonalisation include effort-reward ratio (β = 0.257; p -= 0.001), overcommitment (β = 0.170; p = 0.024), and night shift (β = 0.134; p -= 0.042). Conclusions. The effort-reward imbalance is significantly associated with emotional exhaustion and depersonalization. Therefore, it is important to set up the maximum working hours, balanced shift work arrangements, and standardized rewards for Puskesmas physicians. [ABSTRACT FROM AUTHOR]

Background. Students with poor sleep quality will undoubtedly disturb their daily activities, such as being absent from lectures due to illness and falling asleep during lectures. A further impact of poor sleep quality is decreased student academic achievement. Objectives. To analyse the relationship between sleep hygiene and the prevalence of insomnia in medical students during the COVID-19 pandemic at the Faculty of Medicine, Universitas Sumatera Utara. Material and methods. The research design was analytic with a cross-sectional approach. The study population was medical students in clinical clerkships, which amounted to 152 people using consecutive sampling methods. The data was collected using a Sleep Hygiene Index (SHI) and Insomnia Severity Index (ISI) questionnaire, conducted online via Google Forms. Data processing was carried out using SPSS and the Chi-square statistical test. Results. Most students, as many as 101 people (66.4%), had moderate sleep hygiene, and most students were without insomnia (approx. 61.8%). The results of the Chi-square test bivariate analysis showed a relationship between the degree of sleep hygiene and the prevalence of insomnia in the medical students of Universitas Sumatera Utara. Conclusions. Students are exposed to psychological impacts that can affect the quality of their sleep. Sleep hygiene and sleep cycles in students change due to changes in daily activities, such as physical activity, class schedules, assigned tasks and the use of electronic equipment. [ABSTRACT FROM AUTHOR]

Background. Diabetic nephropathy is the main cause of impaired renal function and chronic kidney disease (CKD) in diabetic patients. Objectives. The aim of this study was to estimate the prevalence and characteristics of normal to mildly increased albuminuria in type 2 diabetes mellitus (T2DM) patients with chronic kidney disease. Material and methods. This retrospective study was performed on 310 patients diagnosed with T2DM and renal insufficiency (eGFR < 60 mL/min/1.73 m² ) referred to Ahvaz hospitals between 2014–2020. Demographic and clinical data, as well as laboratory parameters, were extracted from patients’ medical records. After considering the inclusion criteria (adult diabetic patients with renal failure (eGFR < 60 mL/min/1.73 m² ) and exclusion criteria (patients with hypertension, cardiovascular disease (ischemic heart disease, chronic heart failure, peripheral vascular disease, cerebrovascular disease), urinary tract infection, anatomical disorders of the urinary tract, kidney stones, benign prostatic hyperplasia, history of diuretic use, nephrotoxic drugs such as ACEI, ARB, NSAIDs, physiological causes of albuminuria such as prolonged standing and exercise, systematic disease (e.g. systemic lupus erythematosus) and dialysis patients), in terms of age, gender and duration of diabetes and lipid profile and retinopathy and neuropathy and HbA1C, patients were divided into three groups based on the severity of albuminuria (albumin-to-creatinine ratio): normal to mildly increased albuminuria (ACR < 30 mg/g), moderately increased (ACR: 30–300 mg/g) and severely increased (ACR > 300 mg/g). Results. A total of 310 T2DM patients with a mean age of 57.2 ± 9.5 years, including 164 women (52.9%) and 146 men (47.1%), participated in the study, of which 4 patients (1.3%) had normal albuminuria, 76 patients (24.5%) had mildly increased albuminuria, 142 patients (45.8%) had moderately increased albuminuria, and 88 patients (28.4%) had severely increased albuminuria. Individuals with normal to mildly increased albuminuria compared with moderate to severe albuminuria had lower duration of diabetes, age, creatinine, retinopathy, neuropathy, HbA1c, LDL, Tchol (p < 0.001), higher GFR (p < 0.001) and lower TG (p = 0.003), while HDL-c (p = 0.07) and patients’ gender (p = 0.2) were not significantly different. Examination of the odds ratio (OR) showed that retinopathy, high age and high HbA1c levels had the greatest effect on the development of moderate to severe albuminuria, whereas increased GFR and a small increase in LDL had a preventive effect on moderate to severe albuminuria. Conclusions. The results of the present study showed that although the majority of diabetic patients with renal insufficiency had moderate to severe albuminuria, a considerable proportion of patients with diabetes and renal insufficiency had normal to mildly increased albuminuria. This can limit the role of microalbuminuria as a screening tool to detect the onset of diabetic nephropathy. [ABSTRACT FROM AUTHOR]

Background. Patients with Chronic Kidney Disease (CK D), with an additional burden of cardiovascular disease, should be monitored, educated and treated through the close cooperation between multidisciplinary nephrology and cardiology teams. One of the elements by which this can be achieved is cardiac rehabilitation programs. Objectives. The aim of this study is to assess the effect of chronic kidney disease on exercise performance within cardiac patients. Material and methods. 92 patients qualified for stationary cardiac rehabilitation took part in a study conducted at the Cardiac Surgery Clinic of the SPSK 2 Pomeranian Medical University in Szczecin. Among them, a group with CK D (n = 24) and without (n = 68) was selected. Statistical analysis was performed on the basis of data from medical records and the results of the 6-minute walk test. Results. Patients with and without CK D improved the results of the 6-minute test. From an average result of 256.21 (± 138.99) at the beginning of the rehabilitation to an average of 385.96 (± 109.09) after that for patients with CK D and from average result of 281.01 (± 110.16) to an average result of 422.29 (± 96.39) for patients without CK D. Conclusions. Cardiac rehabilitation has a positive effect on physical fitness and exercise tolerance both in patients with CK D and without. However, the coexistence of CK D results in less satisfactory results compared to the control group. [ABSTRACT FROM AUTHOR]

Background. Pemphigus vulgaris (PV) is a rare, life-threatening autoimmune disease and varies in its clinical profile and epidemiology in different regions of the world. Objectives. This study aimed to evaluate the demographic and clinical characteristics of oral PV patients in the lower north and northeast of Thailand. Material and methods. A retrospective study of PV patients who visited the Oral Medicine Clinic, Dental Hospital, Naresuan University and Khon Kaen University during the 2010–2020 period. Results. 21 oral PV patients were included. Among these, 16 (76.2%) were female, and 5 (23.8%) were male, with a female to male ratio of 3.2:1. The mean age of the patients was 47.7 ± 14.2 (range 25 to 74) years. 8 patients (38.1%) had a history of systemic diseases, and hypertension was predominant. The mean duration of the disease was 6 ± 3.42 (range 1 to 12) months. The most common complaint at presentation was oral ulceration with a burning sensation. The most affected sites were the buccal mucosa and gingiva (80.9%). Extraoral involvement was found in 14 patients (66.7%). Patients who had oral lesions before skin lesions found the mean duration was 4.63 ± 5.13 (range 1 to 16) months. Most of the patients (61.9%) were prescribed a combination of topical and systemic steroids. Conclusions. The present study illustrates the demographics and clinical characteristics of oral PV in Thai patients. Early diagnosis and timely treatment are critical for the patients. Since oral mucosa is often the first site of PV involvement, healthcare professionals must recognize the disease’s clinical characteristics and manage PV patients appropriately. [ABSTRACT FROM AUTHOR]

Background. Diabetes mellitus (DM) is a metabolic disorder caused by many factors and related to serious complications. Diabetes mellitus includes oxidative stress and inflammation, in addition to hyperglycemia and resistance to insulin. Objectives. This study aimed to evaluate the effect of supplementation with vitamin C on blood glucose control and body mass index in type 2 diabetic patients of the family medicine outpatient clinic in Suez Canal University, Ismailia, Egypt. Material and methods. This was a double-blind, randomized, controlled clinical trial. Sixty patients (n = 60) were distributed randomly into two groups: the intervention group (on 1 g of vitamin C orally for 12 weeks), and the control group (on a placebo for the same period). Only 55 patients completed the study (28 in the intervention group and 27 in the control group). Glycated hemoglobin (HbA1C%) and body mass index (BMI) were assessed at the beginning and after 12 weeks. Results. The HbA1C percentage significantly decreased in the intervention group, supplemented with vitamin C, after 12 weeks as compared to the placebo group. The body mass index did not change significantly after the intervention. The intervention group had 75% glycemic improvement, while only 33.3% of the subjects improved in the control group. Absolute risk reduction (ARR) was 42%, the number of patients in need of treatment (NNT) was 2.38, the relative risk (RR) was 0.37, and the relative risk reduction (RRR) was 62%. Conclusions. Patients with type 2 diabetes may benefit from adding vitamin C to their routine management to control blood glucose. [ABSTRACT FROM AUTHOR]

Background. Depression is one of the most common medical illnesses worldwide. Medical students during their training will be subjected to many stressors, both mentally and emotionally. Objectives. Assess the prevalence of depressive symptoms among medical students and to identify any association between depressive symptoms and some socio-demographic factors. Material and methods. A descriptive cross-sectional study was conducted in Baghdad city, and our study sample was 800 medical students from all six stages at Al-Kindy College of Medicine. Out of those sample students, only a convenient sample of 301 students was selected, and they agreed to take part in the current study. Data was collected using a self-administered questionnaire form. Results. The overall prevalence of depressive symptoms is 55.48% among students. The stage of the study, gender and social relationship were significantly associated with depression symptoms, with no significant association between chronic disease and monthly family income. The highest percentage of depressive symptoms was seen among students of the first, third, and fourth grade, being female, and social students with a p-value less than 0.05. Conclusions. A high level of depressive symptoms among students at Al-Kindy College of Medicine was reported, with females being more depressed than males, more than half of the participants showing symptoms and most students in the pre-clinical stage, whereas the lowest level appeared among stage six students. [ABSTRACT FROM AUTHOR]

Background. Today, the concept of health literacy is used to determine the health needs of the population in parallel with ever-increasing health knowledge. Objectives. The aim of the study is to evaluate the health literacy level of patients who apply to the Family Medicine preventive health services of Düzce University Hospital and to investigate the relevant factors that may be related to health literacy. Material and methods. This study was a cross-sectional study carried out between October 2018 and April 2019. The patients were evaluated utilizing the “Health Literacy Survey-European Union (HLS-EU)” scale. The study took place in Düzce Medical Faculty Hospital, Turkey. Results. A total of 816 patients, 48.5% (n = 396) of them male and 51.4% (n = 420) female, were included in the study. The general health literacy levels of the patients were as follows: 30.6% (n = 250) insufficient, 33.4% (n = 272) limited, 28.9% (n = 236) sufficient, 7.1% (n = 58) excellent. According to all subdimensions and matrix averages of the scale used in the study, the mean score that patients received in understanding and applying health information in the disease prevention dimension (8.45 ± 2.30, 8.10 ± 2.38, respectively) was found to be lower than health care (11.20 ± 2.72, 11.63 ± 3.01, respectively). Conclusions. The study results revealed a lower level of health literacy in terms of disease prevention rather than healthcare utilization. Initiatives to increase people’s knowledge of disease prevention should be planned. [ABSTRACT FROM AUTHOR]

Background. Pregnancy is one of the most sensitive periods in a woman's life, causing great changes and emotional instability. Pregnancy, apart from the pleasure of being a mother, is the most stressful period of the life of women. Objectives. This study aimed to investigate the relationship between mothers' personality types and their perceived stress. Material and methods. This cross-sectional descriptive-analytic study was conducted on 210 eligible mothers in three hospitals affiliated with the Shiraz University of Medical Sciences. Personality and Perceived Stress Questionnaires were completed by the mothers. Data analysis was performed with Pearson and Spearman statistical tests, using SPSS software (version 22). Results. The highest score of the personality type belonged to the conscientiousness, with an average score of 39.68 ± 6.09. The highest frequency was also related to conscientiousness personality type (48.1%). Mothers in the study had a moderate perceived stress level, with a mean score of 26.98. Using the Pearson correlation test, we found there was a significant positive relationship between the two variables of neuroticism and perceived stress (r = 0.149, p = 0.031). There was also a significant relationship between openness to experience and perceived stress (r = 0.265, p = 0.001). Conclusions. According to the results, personality types are related to the level of perceived stress in mothers, and maternal stress can be predicted through personality traits. Therefore, identifying the personality types, training of mothers and holding psychotherapy sessions can be very important. [ABSTRACT FROM AUTHOR]

Background. Long-term exercise contributes to the inhibition of osteoblast cell activity and to the decrease of bone resorption. Objectives. The research objective was to analyze the chronic effect of regular, long-term physical activity and physical inactivity on carboxyterminal collagen cross-linking telopeptide levels (CTx) and calcium levels in healthy adults. Material and methods. This study was a prospective cohort study. Fifty-four men and women, aged 17-26 years, were divided into 2 groups of 27 people each: exercise and non-exercise. This research was carried out from April 2015 to April 2016 at the Faculty of Medicine, Syiah Kuala University, Aceh, Indonesia. Bone resorption can be determined by measuring the carboxyterminal cross-linking telopeptide of collagen (CTx). The data were analyzed using Student's t-test and regression correlation analysis with a significance level of 5%. Results. The highest levels of CTx were found in the non-exercise group; the lowest levels of CTx were in the exercise group (1.6 ng/mL and 0.30 ng/mL, respectively). This difference in CTx levels between groups was statistically significant (0.52 ± 0.22 ng/mL vs 0.72 ± 0.28 ng/mL; p = 0.005). Calcium was significantly higher in the exercise group than in the non-exercise one (9.67 ± 0.30 vs 9.01 ± 0.21 mg/dl; p = 0.006). There was a negative correlation between calcium levels and CTx in the exercise group (r = 0.038; p = 0.001). Conclusions. Regular exercise led to lower CTx levels and increased calcium levels. The increase in calcium is an effect of the decrease in CTx in healthy adults. Regular exercise decreases bone resorption and increases bone calcium deposition in healthy adults. Regular exercise has the potential to prevent and treat osteoporosis non-pharmacologically. [ABSTRACT FROM AUTHOR]

Background. A stapedectomy or stapedotomy is known as the best treatment option for patients with otosclerosis. Otosclerosis is a primary disease of the bony labyrinth capsule, which is characterized by one or more localized foci, where bone deposition occurs repeatedly. The best and most effective treatment option is a stapedectomy or stapedotomy. Objectives. The present study evaluated the short-term hearing results in patients with otosclerosis after primary stapes surgery. Material and methods. In this retrospective study, the short-term hearing results of all patients with otosclerosis after a primary stapedotomy admitted to the Ahvaz Emam hospital from 2007 to 2017 was evaluated. Improvement in hearing was evaluated according to the pre- and post-audiometry results. Air Conduction (AC), Bone Conduction (BC) and Air-Bone Gap (ABG) thresholds were recorded at 500, 1 000, 2 000 and 4 000 Hz. SPSS software (Version 22.0) was used for statistical analysis. Results. Of the 413 cases, 231 (55.93%) and 182 (44.07%) were females and males, respectively. The mean age of patients was 39.06 ± 11.29 years. The disease in 131 (31.72%) was bilateral. The mean ABG in 341 patients (82.63%) ≤ 10 dB and in 52 patients (12.47%) was 10-20 dB. Conclusions. The results of the study showed that a primary stapedotomy is a successful and effective way to improve short-term hearing results in adults with otosclerosis. [ABSTRACT FROM AUTHOR]

Background. The use of over-the-counter (OT C) medications without consulting a doctor has become increasingly common. Objectives. To compare the scale of self-treatment in a population of students of the Medical University of Bialystok in 2012 and 2017. Material and methods. The study included 217 students in 2012 and 220 students in 2017, and used a proprietary questionnaire. Results. A total of 78.8% of students in 2012 and 86.4% in 2017 were familiar with the meaning of the abbreviation OT C. When using an OT C drug for the first time, most students consulted a nurse (66.4%) in 2012, while in 2017, students usually consulted a family member (68.8%). Headache was the main reason for using OT C drugs (89.4% in 2012, and 92.7% in 2017). The use of analgesics (87.1%) and the use of OT C medicines in accordance with the leaflet (47%) predominated in 2012, while vitamin therapy (83.2%) took first place in 2017. When purchasing OT C medications, students usually based their decision on their own experience (63.1% in 2012 and 84.1% in 2017). A total of 35.5% of the students in 2012 and 39.1% in 2017 always read the leaflet. Conclusions. Self-medication was practiced by most students in both years, with lack of time for a medical appointment being the main reason. Over the last 6 months, the students most often used prescription and non-prescription drugs simultaneously. [ABSTRACT FROM AUTHOR]

Background. Acute otitis media in children is one of the most common causes of patients reporting to the family doctor and pediatrician. In rare cases, the inflammatory process spreads deeper into the temporal bone despite proper treatment, resulting in mastoiditis. Objectives. The aim of this article is to present the most common complication of inflammation of the middle ear. This is mastoiditis. The authors describe mastoiditis by means of its characteristics, the most common symptoms, incidence and treatment. Material and methods. Data about the patients hospitalized in the Pediatric Otolaryngology Department of the Poznan University of Medical Sciences from January 2017 to April 2018 was analyzed and subjected to a retrospective study. Statistical analysis of the results was performed. Results. Based on the analyzed medical documentation, the incidence of mastoiditis was evaluated. In addition, the parameters characterizing the diagnostic procedure, along with the treatment methods and the effectiveness of the applied therapies in the hospital conditions, were assessed. The number of outpatient ambulatory visits and the frequency of necessary hospitalizations for patients with uncomplicated otitis media were additionally subjected to evaluation. Conclusions. The number of cases of inflammation of the middle ear requiring hospitalization in the Pediatric Otolaryngology Department Poznan University of Medical Sciences is minimal, although the complications may present severe health consequences. Uncomplicated acute otitis media may be successfully treated in ambulatory conditions by family physicians and pediatricians. Early detection of the potential complication is essential in the practice of the family doctor. [ABSTRACT FROM AUTHOR]

Background. The average waiting time for cataract treatment in Poland is 441 days - the longest for any surgical procedures in the country. Objectives. The aim of the study was to examine the availability of surgical cataract treatment among older Polish patients. Material and methods. Using data from 25,970 hospitalizations at the Ophthalmology Ward of the University Clinical Hospital in Wrocław, Poland in years 2012-2017, we analyzed the demographic structure of the patients, the duration of hospital stay, and the average cost; the level of statistical significance was taken to be p < 0.05. Results. Patients 65 years of age or older made up 78% of patients receiving surgical cataract treatment. This treatment required significantly shorter hospitalization time in 2017 than in 2012 (an average of 1.89 vs. 2.19 patient-days, respectively). The average hospital stay length among the older patients was significantly shorter than among younger patients (2.3 vs 3.2 patient-days, respectively) and the average hospitalization cost for patients aged 65 years or older was significantly lower (2105.63 PLN vs 2929.57 PLN , equivalent of 495.44 EUR vs 689.31 EUR , respectively). Conclusions. The duration of the average hospital stay in the ophthalmology ward was shorter, and the average hospitalization cost was lower, for patients aged 65 years or older than for younger patients because older patients mostly undergo modern standardized less-invasive cataract treatment. As more ophthalmological medical staff, infrastructure, and financial assets are available for cataract treatment and have not yet been assigned or spent, Polish hospitals should introduce newer medical technology, process adjustments, and organizational innovations to fully utilize their potential and improve the availability of cataract treatment. [ABSTRACT FROM AUTHOR]

Background. Long-term care (LTC ) services involve long-lasting continuous supervision, care, nursing, therapy, and rehabilitation of patients who do not qualify for acute medical care. Demand for LTC services is on the rise, because of the aging of society and increasing number of dependent young and middle-aged people. Objectives. The aim of the study was to examine the dysfunction of LTC services in Poland, taking the phenomenon of prolonged hospitalization as an example. Material and methods. We examined data on patients at the University Clinical Hospital in Wroclaw, Poland, who were waiting for transfer from hospital to LTC facilities in the years 2012-2017. The statistical threshold of significance was p < 0.05. Results. There were 1006 cases of hospital stays prolonged by waiting for transfer to LTC facilities; 77% of patients affected were 65 years or older. This age group saw a large increase in the total number of patients transferred from hospital to LTC facilities. Patients 65 years and older made up the majority of patients on transfer waiting lists, but their average waiting time was significantly shorter than that of younger patients (38.7 vs 69.6 days, respectively). Conclusions. The demonstrated forced prolonged hospitalizations, which result from a lack of capacity on the part of LTC facilities to accept patients who have undergone hospital treatment, confirmed the dysfunction of the Polish LTC system. This results in a lack of adequate medical care continuity, increased total costs of medical care, and a shifting of expenses from the LTC facilities to the acute treatment facilities, which are most often hospitals. [ABSTRACT FROM AUTHOR]

Background. Women in some social groups of the population may be less supported by their partners and may be more reliant on their employees. Objectives. This study was designed to investigate the impact of paternal-attachment training skills on the extent of maternal neonatal attachment in primiparous women referred to the hospitals affiliated with the Shiraz University of Medical Sciences. Material and methods. A randomized controlled trial was done in hospitals affiliated with the Shiraz University of Medical Sciences from October 2012 to September 2013. The present clinical trial was conducted on 150 husbands of qualified pregnant women. The intervention group took part in 90-minute sessions of maternal-fetal attachment training held once a week. On the other hand, the control group received routine pregnancy care. Both groups filled out Avant's checklist after the intervention to determine maternal-neonatal attachment. The data was then analyzed in SPSS using the independent t-test, chi-square test and Fisher's exact test. A rating of p < 0.05 was considered as statistically significant. Results. The median score in the total maternal-neonatal attachment group was [84; IQR,70-103], and in the control group it was [66; IQR, 49-86; p < 0.001]. The Mann-Whitney U test showed a significant difference between the median of the groups. In the five aspects of the checklist, Avant included dimensions such as mothers' emotional behavior, maternal-infant proximity behavior, maternal-infant caring behavior and maternal-infant attention. The relationship between the attachment and control groups was significant (p < 0.001). Conclusions. Paternal attachment behavior training skills increased the score of maternal-neonatal attachment. Thus, there is a need to educate fathers on prenatal care. [ABSTRACT FROM AUTHOR]

Background. Toxoplasmosis is caused by infection from a ubiquitous obligate intracellular parasite known as Toxoplasma gondii, which can infect both human and warm-blooded animals. This infection is commonly prevalent in developing country. Objectives. The purpose of this study is to report on a 7-year review of ocular toxoplasmosis patients that presented to the Universiti Sains Malaysia Hospital. Material and methods. This is a retrospective review of cases. The demographic data, ocular manifestations, clinical and laboratory profiles, treatment and disease outcome were collected from the patients' medical records from January 2010 to December 2016. Results. A total of 16 patients with a diagnosis of ocular toxoplasmosis were identified. The mean age was 43.2, with standard deviation ± 15.4 years old. The percentage was 62.5% (10 patients) females and 37.5% (6 patients) male. The majority of patients were Malay (93.4%, 15 patients). The most common classification of uveitis was panuveitis (56.3%, 9 patients), followed by posterior uveitis (25%, 4 patients), anterior uveitis (12.5%, 2 patients) and intermediate uveitis (6.2%, 1 patient). Keratic precipitate (75%, 12 patients) and vitritis (75%, 12 patients) were the most common ocular manifestation of ocular toxoplasmosis. A serological test for toxoplasmosis found only 1 patient with positive serum immunoglobulin M, while all patients displayed non-reactive serum immunoglobulin G (except 1 missing data). All ocular toxoplasmosis patients were treated with oral Azithromycin 500 mg daily for 6 weeks, 81.3% (13 patients) were given an instillation of a steroid eye drop, while 25% (4 patients) required administration of an oral steroid. All of the patients responded well to treatment, but 25% (4 patients) suffered from recurrence, which required a second course of treatment. Conclusions. Ocular toxoplasmosis is a serious and depilating disease that can cause serious ocular morbidities. This review shows a diverse presentation of ocular toxoplasmosis as a result of toxoplasmosis infection. [ABSTRACT FROM AUTHOR]