bluuebunny/crossref_metadata_2025 huggingface dataset:
Reaching Therapeutic Goals Impacts on Estimated Cost of Illness for Patients with Type 2 Diabetes in Poland
Authors: Hałdaś Mateusz , Ziobro Maciej , Rutkowski Jakub , Szafaryn Małgorzata , Lis Joanna
Published: July 2023

Objective: To estimate savings for public payer and for society generated by reduction of diabetes mellitus complications through maintaining therapeutic goals set by Polish Diabetes Association (PDA). Methods: Diabetes progress in lifetime horizon was simulated in a Polish cohort of newly diagnosed adults with type 2 diabetes mellitus (T2DM) using the IMS Core Diabetes Model. The natural course of disease (Uncontrolled patients) was compared to situation where patients meet therapeutic goals in the first year and keep it in following years (Controlled patients). Direct medical costs from public payer and patients perspective were complemented with indirect costs estimated using friction costs approach (FCA) and human capital approach (HCA). Results: Mean life expectancy was higher for the Controlled vs Uncontrolled patients (11.3 vs 10.7 LYs). The average QALY was also higher for Controlled vs Uncontrolled patients (8.33 vs 7.87 QALYs). Uncontrolled patients generated during lifetime total costs respectively 2053 PLN, 2826 PLN and 4417 PLN higher than Controlled patients, depending whether direct costs only or direct costs and indirect costs (FCA or HCA) were considered. Adopting the estimated mean annual savings per patient to 1.1 million of Polish patients with uncontrolled T2DM (HbA1c>7%) would result in 192 million PLN of total annual savings, if only direct costs were considered and 264 or 412 million PLN, if indirect costs (FCA or HCA) were also included. Conclusion: Maintaining therapeutic goals in T2DM results in higher life expectancy and, through reduction of T2DM complications, reduces both direct and indirect costs per T2DM patient.
Real-life treatment patterns and medication costs in patients with hypertension treated with ramipril monotherapy or ramipril loose and fixed combinations in Poland
Authors: Czech Marcin , Krupa Dominika
Published: July 2023

Background: Real-World Evidence (RWE) provides insights into patient outcomes reflecting current practices under existing healthcare system conditions. Longitudinal patient data are a source of information that can be used to track treatments for anonymised individual patients over time. Arterial hypertension is one of the most common chronic diseases in Poland, leading to serious complications, especially if undiagnosed and not properly controlled. Fixed-dose combinations of antihypertensive drugs become more and more popular in the treatment of hypertension. The objective of this study was to analyze real-life treatment patterns and medication costs in patients with hypertension treated with the most popular ACEI in Poland - ramipril, in monotherapy, loose and fixed combinations. Methods: This analysis was based on the longitudinal prescription database (IMS “LRx”) of individual, anonymized patients structured by product, prescribing doctor specialty and patient age group and sex, sourced from dispensing transactions of 3367 chain and non-chain pharmacies, in the Polish open-care market. The period of analysis covers 20 months (January 2014 – August 2015). It is based on 1 488 053 patients and 9 023 582 prescriptions. Cost calculations were performed from payer’s and patient’s perspectives. Results: Owing to the availability of multiple treatment options, patterns in hypertension treatment in Poland are very complex, even when considered only at the molecule level. Furthermore, switching to fixed-dose combination therapy based on ramipril resulted in savings for patients as well as the public payer. Conclusion: Wider use of fixed-dose combinations is a cost saving option both for patients and the public payer.
Assessment of quality and clinical significance of endpoints in cancer immunotherapy
Authors: Miernik Katarzyna , Walczak Jacek
Published: July 2023

This review describes available immunotherapeutic agents approved for the treatment of prostate cancer (sipuleucel-T), advanced melanoma (ipilimumab, pembrolizumab, nivolumab) and NSCLC (nivoluamb) and underline that their specific mechanism of action require to use appropriate endpoints for the efficacy evaluation. The FDA and EMA guidelines on endpoints in clinical trials indicate the use of overall survival as a primary endpoints. However, there is a trend for using the time-to-event endpoints for drug approval since 1990. Oncological clinical trials utilize apart from OS also the endpoints based on tumor assessment – e.g. progression-free survival, disease-free survival or response rate. This review presents the differences in mechanism of actions between standard chemotherapy and immunotherapy which imply the significant differences in the kinetic of response and long-term effects. The WHO and RECIST response criteria were developed to estimate the effect of cytotoxic drugs on cancer and the new patterns of response observed after treatment with immunotherapeutic agents indicate the need for adopting novel criteria in the evaluation of tumor responses. The performed review of pivotal clinical trials assessing the efficacy of immunotherapy showed that the most commonly evaluated endpoints were: OS, PFS and RR. Prolonged survival with concomitant lack of benefit in PFS was explained by the need for applying irRC for evaluation of the efficacy of immunotherapeutic agents beyond the classical measurement. It could be concluded that trial design which takes into account disease characteristics and immunotherapeutic agents’ mechanism of action is the key to define appropriate endpoints and proper evaluation of the efficacy.
Asthma boundaries in a social security perspective
Authors: Radziwilska-Muc Anna , Pinkas Jarosław
Published: July 2023

Introduction: Patients in Poland, including asthmatics are beneficiaries of social security system in case of severe disease exacerbation. Usually sick leave due to uncontrolled asthma is enough to get better and come back to regular life, however some patients with permanent severe symptoms require invalidity pension to secure their social rights and life quality. Nowadays, the social security system is overloaded due to insufficiency of income versus expenditures, and asthma as disease might represent a significant part of this costs due to its prevalence. Objective of the study: In this article we have analysed trends in asthma management at the social insurance financial perspective, comparing the asthma social security costs to the overall social security system expenses. Material and methods: The study and analyses are based on the Polish Social Security Institution (ZUS) data publicised in years 2010-2014. Results: In year 2014 total ZUS and employers spendings on social benefits to ill patients were calculated at 32,5 billion of Polish Zloty. Respectively all respiratory system diseases social security costs accounted 2,2 billion of Polish Zloty, of which estimated asthma (J-45) 64 million of Polish Zloty, and status asthmatics (J-46) 580 thousands of Polish Zloty. Conclusions: Asthma social security costs represent 0,21% of all diseases social security costs and less than 3% of all respiratory diseases social security costs. Despite variability of the costs over years 2012-2014, there are no significant negative trends of asthma costs into the social security system.
Telemedicine - a miracle cure for everything?
Authors: Krzystanek Marek , Wojtuszek Magda , Wutke Joanna , Borkowski Mariusz , Krysta Krzysztof
Published: July 2023

Background: Telemedicine is an interesting area of modern treatment. It enables contact between patients and doctors at long distance. In this paper, we present the latest studies, conducted among Polish doctors about the utility of the telemedicine as a therapeutic tool. Methods: One of the methods was an anonymous questionnaire presented to psychiatrists from Poland (105 physicians). The second study was based on a questionnaire filled by participants (scale: 1-inappropriate to 5-very useful). It was part of the Polish Telemedical Project (grant no.POIG.01.04.00-04-219/12) conducted to assess medical Platform ‘Moneo’ in the therapy of the areas other than psychiatry. Results: All healthcare institutions noticed advantages of Medical Platform. The Platform’s functionalities, rated as the best by healthcare directors were: educational materials, appointment and therapy planning. Managers indicated parts which could be improved in e-prescribing system, the process of collecting information about hospitalizations, operations. Functionalities regarded by doctors as desirable in improving the platform include: e-prescribing system, reporting side effects, planning visits, educational materials. In the psychiatrists' study, they had confirmed the potential of telemedicine in psychiatry. They chose mood and neurotic disorders as the most adequate for that treatment. However, 60% of doctors would not widen the implementation of telepsychiatry in Poland. Probably it is due to their awareness for the need of new software, legal and refunding system.Conclusion: Telemedicine is a useful method for specialists and directors. It can improve quality of healthcare services. However, lots of improvements in telemedical services are needed to make it a miraculous cure for everything.
The problem of thresholds determination in ranking classifiers applied in medical diagnostics
Authors: Ameljańczyk Tomasz
Published: July 2023

The paper presents the opportunity for using multi-objective optimization for the development of ranking meta-classifiers being a synthesis of simple ranking domain functions. The method of threshold determination in the developed ranking classifiers applied in medical diagnostics was presented. Analysis was conducted of properties of medical diagnoses acquired with the application of thresholds for both simple and complex classifiers and for meta-classifiers.
Diabetic Macular Edema treatment limits in Poland
Authors: Pinkas Jarosław , Radziwilska-Muc Anna , Grabska-Liberek Iwona
Published: July 2023

Diabetic Macular Edema (DME) is a severe disease, related to Diabetic Retinopathy (DR). All diabetic patients are at risk of DME development. The disease severity may vary from mild to moderate, with a risk of loss of vision. Diabetic Retinopathy, including Diabetic Macular Edema patients in Poland, are treated within Diagnosis Related Groups (JGP) system, that allows settlement of costs of performed medical procedures, including vitreoretinal procedures, fotocoagulation, and administration of VEGF inhibitors. In this article authors tried to analyse what are the costs of treatment of DME patients within Diagnosis Related Groups (JGP) in Poland, what are the trends in expenditures of DME treatment, and what are the recommended steps to the decision makers in vision loss prevention amongst mellitus patients in Poland? The study and analyses in this article are based on Diagnosis Related Groups (JGP) statistical reports available for years 2009-2015, published by the Polish National Health Fund (NFZ). DME treatment spendings within the JGP groups in Poland, are notably low, vary from 1,2 MM PLN in 2009, achieving its maximum of 1,5MM PLN in 2010, and resulting in <1,1 MM PLN in year 2015. The number of treated patients decreased markedly from more than 800 in year 2009, achieving its minimum of 198 patients in year 2014. DME treatment in Poland within the public system is remarkably below needs, and it does not meet standards of vision loss prevention amongst mellitus patients. The situation is mainly caused by under-diagnosis at the primary healthcare outpatient clinics, long waiting time for an ophthalmologist consultations and treatment budget limits within JGP groups in hospitals.
Association between EQ-5D-3L population norms and gross domestic product based on purchasing power parity in European countries
Authors: Hołownia-Voloskova Malwina
Published: July 2023

Background One of the of health-related quality of life (HRQoL) measurement methods is the EQ-5D questionnaire. Population norms of the EQ-5D can be used to compare profiles for patients with specific conditions with data for the general population or to compare countries to each other. The aim of this review is to see whether the gross domestic product based on purchasing-power-parity (GDP PPP) per capita influence the HRQoL, measured by EQ-5D-3L questionnaire in Europe. Methods We have searched the databases in order to identify population norms based on EQ-5D-3L from European countries and extracted data of EQ-VAS and percentage of patients with no problems in all five dimensions of the EQ-5D and compared it to GDP PPP per capita, based on 2015 International Monetary Fund data. Results Population norms from 16 countries were found: Belgium, Denmark, Finland, France, Germany, Greece, Hungary, Italy, Netherlands, Poland, Portugal, Slovenia, Spain, Sweden Switzerland and the United Kingdom. Subjective HRQoL measured by the EQ-VAS and anxiety and depression dimension were strongly correlated with GDP PPP (R²=0.66 and 0.53, respectively), while the mobility and usual daily activities dimensions were weakly correlated (R²=0.41 and 0.29, respectively). There was no association between self-care, nor pain/discomfort dimensions and GDP PPP per capita (R² = 0.02 and 0.01, respectively). Conclusion There is a strong correlation of subjective HRQoL measured by the EQ-VAS and anxiety and depression dimension with GDP PPP. There are only 3 CEE countries and only one former USSR country with published population norms for the EQ-5D questionnaire.
Severe allergic asthma treatment in Poland
Authors: Kucharczyk Aleksandra , Jahnz-Różyk Karina
Published: July 2023

Severe asthma is a heterogeneous disease, which, as it is now believed, requires a personalized therapy dependent on phenotype. Omalizumab, a humanized monoclonal antibody that specifically binds to free immunoglobulin E, proved to be particularly effective in the treatment of allergic asthma. Because this treatment is very expensive, in Poland it is reimbursed under the drug program: “Omalizumab treatment of severe, allergic, IgE-dependent asthma”. One of the main features of drug programs is precise defining the group of patients, which may be subject to treatment. The current experience shows that it significantly increase the efficacy of the therapy. On the other hand, however, may adversely affect the possibility of treating patients with difficult access to specialized centres.
Drug policy as an integral part of state health policy - international examples
Authors: Różalska Anna
Published: July 2023

Medicines policy plays a major role in protecting, maintaining and restoring people’s health and is an integral part of state health policy. It embraces brand and generic drugs, biologics, vaccines and natural health products. Drug policy ensures an access to safe and effective medicines while reducing patient participation in treatment costs. Medicine policy includes among others, patent law, licensing, prescribing, pricing, reimbursement, formulary management, eligibility, pharmacy, funding of research in the life sciences services[1] The national pharmaceuticals policy is the one based on drug use where patients receive medications according to their clinical needs, in the individual required doses, in the right time, at the lowest possible cost [3]. In this article national medicine policies in Australia, United Kingdom, Sri Lanka, South Africa and Poland were presented from the viewpoints of drugs’ spending, regulations and practice. The general policy framework addresses the inherent tensions within the objectives of attaining affordable access to medicines, while maintaining a viable pharmaceutical industry, and achieving quality medicines and healthcare systems. In Poland development of medicine policy is under creation.
Healthcare needs maps – evidence informed healthcare policy
Authors: Więckowska Barbara
Published: July 2023

The healthcare system in Poland suffers from some inefficiency in its organization, functioning and financing. In order to implement comprehensive change management in healthcare sector, the Polish Ministry of Health has been working for the last three years on the “Healthcare needs maps”, that aim at creating a tool and a process appropriate to develop public policies at national and regional level based on evidence coming from reliable data. The stochastic analysis and projection of healthcare needs will be a basis for contracting process of National Healthcare Fund and public investments. The Healthcare needs maps are a condition sine qua non for receiving the EU funding for healthcare sector. Healthcare needs maps enable identification of inefficiencies in the system and planning of prevention actions, healthcare services provision and investments adjusted to demographic and epidemiologic trends. To implement evidence-based policy making and enable modelling system performance and optimum shape of delivery net it is crucial to extract, count and present the data in an appropriate way and give it an appropriate meaning, what can be achieved only in cooperation with medical experts. Maps present values for over 1000 input, output and outcome indicators, separately for individual hospitals and concerns nearly 300 disease groups. Ministry leads the project to better coordinate the wide range of stakeholders but have never been meant to be institutionalized and forced down by the central administration. This is why so many concerned parties are involved in the process and the results are being consulted so widely.
Neoadjuvant treatment of HER2-positive breast cancer – pathological complete response (pCR) as a surrogate of long term outcomes in the context of regulatory guidelines and reimbursement recommendations.
Authors: Panasiuk Anna , Budasz-Świderska Małgorzata , Kaczor Marcin
Published: July 2023

Background: The vast heterogeneity of breast cancer (BC) patients, together with relatively long survival in the early stages of the disease, leads to methodological issues in designing clinical trials, particularly in case of therapies targeted for narrow patients subsets. That situation led to the need and search for early, reliable predictors of long-term outcomes.However, in countries adopting HTA methodology to reimbursement decisions non-final (“surrogate”) endpoints may not be accepted as a measure of clinical benefit. Methods: We searched PubMed and EMBASE for meta-analyses investigating association of pathologic complete response to BC neoadjuvant therapy with longer-term clinical outcomes. To be eligible analyses had to pool primary studies identified in a systematic manner. The results of the included studies were discussed in the context of current regulatory and reimbursement recommendations. Results: The 4 included meta-analyses varied in methodological approaches, eligibility criteria and number of included patients. Three of them assessed predictive value of pCR in overall non-metastatic BC population and two – in HER2-positive subgroup. The existing differences in conclusions are consistent with the variability in methodological assumptions. Conclusion: Significant heterogeneity of BC population and low number of studies showing substantial treatment effect on pCR could bias the results of “trial-level” analyses. In contrast, studies consistently show significant patient-level association of pCR with clinical outcomes, particularly strong for aggressive tumour subtypes. The existing EMA and FDA guidelines show how to make use of the existing evidence, in spite of its limitations, in a pursuit of satisfying the unmet medical needs.
The access to an ophthalmic treatment in Poland on the example of the ocular complications in the course of diabetes mellitus
Authors: Muc Rafał , Grabska-Liberek Iwona
Published: July 2023

Background Diabetic Retinopathy (DR) is the severe disease, that develops as a result of diabetes complication. All diabetic patients are at risk of DR development and the National Health Fund (NHF) estimates that there are 2 million people suffering from diabetes in Poland. Thus, around 692,000 Poles may exhibit DR traits, of which up to 139,000 have a severe form of it - proliferative, threatening the loss of vision in the absence or an incorrect treatment. Objective The aim of this study is to discuss the quality of the healthcare system in Poland, through the prism of access to highly specialized treatment for patients with ocular complications in the course of diabetes. Material and Methods The study in this article is based on the statistical data and reports by the Central Statistical Office in Poland, the European Statistical Office, the National Health Fund, as well as the Polish Chamber of Physicians and Dentist. Data collection and analysis concerning the period between years 2010 and 2018. All information has been reviewed thoroughly, compared and juxtaposed with each other to allow concluding. Results There are 4,617 ophthalmologist in Poland, which results in a 1 ophthalmologist per 8,324 inhabitants in Poland. Comparing Poland to major EU countries, access to an ophthalmic treatment just based on number of ophthalmologists is almost as poor as in the United Kingdom, especially comparing to the benchmark countries like Spain, France and Germany. In Poland, patients waiting for a treatment in an ophthalmic clinic account for 5% of all patients. 34% ophthalmology patients had to wait 3 months and more for the specialist consultation, which is contrasting with the DR guidelines, where each DR patient has to be reviewed every 3 months regularly. A one statistical ophthalmologist, in a specialist care clinic, gives 11 consultations per working day. Conclusion Patients with Diabetic Retinopathy in Poland have insufficient access to the specialized diagnostics and treatment. They have much lower access for quick diagnostics and treatment in comparison to the major western European countries. It might result in increased expenditures on ocular complications treatment in the course of Diabetes Mellitus. Therefore a strategic assessment of the DM and DR patients’ access to the specialized diagnostics and treatment as well as development of a holistic approach and diseases comprehensive management strategy is recommended, including change of the healthcare system processes related to ocular complications in the course of diabetes mellitus.
Cost-utility analysis and budget impact analysis of pegvisomant for the treatment of adult patients with acromegaly in Poland
Authors: Borowiack Ewa , Nowotarska Anna , Policht Katarzyna , Snarska Katarzyna , Konopka-Pliszka Małgorzata , Jarosz Joanna , Borowiack Monika
Published: July 2023

Background: The aim of this publication was to evaluate the cost-effectiveness and financial consequences of pegvisomant (PEG) in the treatment of adult patients with acromegaly, who have had an inadequate response to surgery and/or radiation therapy and in whom an appropriate medical treatment with somatostatin analogues (SSA) did not normalize IGF-1 concentrations or was not tolerated compared with SSA continuation. Methods: The Markov model constructed in TreeAge Pro with 45-year time horizon was used in the cost-utility analysis (CUA). Quality adjusted life years (QALY) were used as the measure of effectiveness. CUA was conducted from the perspective of the public payer for health services (Polish National Health Fund, PNHF) and from the patient’s and PNHF’s perspective. Budget impact analysis was performed in a 3-year time horizon from PNHF’s perspective. Two scenarios were compared: “present”, without reimbursement of PEG; “new”, after reimbursement of PEG. Results: The cost of gaining an additional QALY by replacing SSA with PEG is equal 742,724 PLN/ 714,800 PLN (172 470 €/ 165 986 €) from PNHF/PNHF+patient perspective. The annual expenditure of the PNHF’s budget in the first three years would increase by approximately 11.95 million PLN in the first, 26.39 million PLN in the second and 26.5 million in the third year of PEG reimbursement. Conclusion: The creation of drug program for acromegalic patients, in which reimbursement of PEG will be provided, will significantly influence the prognosis, course of the disease and improve the patient’s quality of life.
The cost of macro- and microvascular diseases in patients with diabetes mellitus in selected Central and Eastern European countries
Authors: Grelewska Justyna , Jakubczyk Michał , Niewada Maciej , Lipka Izabela , Petrova Guenka , Tcharaktchiev Dimitar , Mitkova Zornitza , Tsonev Svetlin , Verkauskiene Rasa , Popovic Pejicic Senzjana , Vulic Dusko , Seranic Alen , Pana Adrian , Bodgan-Vasile Ileanu , Došenović Bonča Petra , Janša Karmen , Valov Vasil , Jokubauskiene Giedre , Hałdaś Mateusz , Jusufovic Rasim , Ciocirlan Razvan , Stariha Jurij , Russel-Szymczyk Monika
Published: July 2023

Background Macro- and microvascular diseases (MMVDs) in diabetes mellitus (DM) are important clinical and economic burdens. Reimbursement decisions require substantiated information; however, for Central and Eastern European (CEE) countries cost data are lacking. Our aim was to estimate the direct public-payer medical costs of MMVDs in adult DM (regardless of the type of DM) patients in Bulgaria, Lithuania, Poland, Republic of Srpska/Bosnia and Herzegovina, Romania, and Slovenia. Methods The MMVDs considered were diabetic foot, end-stage renal disease (ESRD), heart failure (HF), painful neuropathy, peripheral vascular disease, retinopathy, stable angina pectoris, myocardial infarction (MI), stroke, transient ischemic attack, and unstable angina (UA). They were split into complications (the first seven) and events; prevalence and incidence-based approaches, respectively, were used. Experts in participating countries provided information via a unified questionnaire. Results The total cost of DM-related MMVDs (EUR per annum) amounted to 1,165 million (m) in Poland, 581m in Romania, 103m in Bulgaria, 76m in Slovenia, 47m in Republic of Srpska/Bosnia and Herzegovina, and 29m in Lithuania (some categories omitted). The cost per DM patient was similar for most included countries (range 586–759), and lower in Lithuania (301) and Bulgaria (219). The largest individual contributor was HF (20.9%), followed by 13% for MI, UA, stroke, and ESRD. Conclusions DM-related MMVDs impose a significant financial burden in CEE countries; our results can aid economic assessments of treatments for DM. Collecting data for several countries is challenging as available information differs; however, a unified methodology allow quality checks. The results are consistent between the countries, which supports the credibility.
Evaluation of thrombocytopenia symptoms influence on patients' daily activities using TSIDAV adapted to Ukrainian language
Authors: Boretska Olga , Nastyukha Yuliya , Kaiser Lidiya , Drozd Mariola
Published: July 2023

Background: The aim was to study the results of the impact of thrombocytopenia on patients’ daily activities using the TSIDAV adapted to Ukrainian language. Methods: The assessment was performed using the TSIDAV vignette (thrombocytopenia Symptoms and their Impact on patients Daily Activities assessment Vignette), which was translated into Ukrainian language to obtain information on how the daily activities of adult patients with thrombocytopenia are affected by the disease symptoms. Patients (n=49) from one of the Lviv clinics participated in the study. The tool consists of two parts: first part identified the symptoms that cause particular concern to the patients; second part provides a self-assessment regarding the intensity of the specific symptoms influencing patients’ daily activities. The quantitative assessment was based on the Likert scale. Results: 49 patients with thrombocytopenia were interviewed. Bleeding episodes were of particular concern in case of the majority of the patients (22.4%). 30.6% of patients did not indicated any symptoms at all, 18.4% of respondents marked weakness and excessive tiredness. The most significant impact on the performance of daily activities, both for men, and for women, was related to “nose and /or gums bleeding” (40.0% of men and 29.2% of women). None of the respondents indicated “menstrual bleeding” as “significant impact” on their daily activities. Conclusion: The Ukrainian-language TSIDAV has confirmed its function as an instrument for assessing the impact of the thrombocytopenia symptoms on patients’ daily activities, it can be used for individualized support clinical and/or pharmaceutical intervention.
SGLT2 inhibitors and cardioprotection. Literature review and real-world data from Poland
Authors: Seweryn Michał , Augustyńska Joanna
Published: July 2023

Background Sodium-glucose cotransporter-2 (SGLT2) has been demonstrated to reduce cardiovascular events in randomized controlled settings. This group of drugs has been reimbursed for a selected group of patients in Poland since 2019. A decision to extend the reimbursement would be considered after analyzing the real-world data of the SGLT2 in Polish conditions. The aim of this study was the assessment of current evidence, both from the literature and real data from the health care system. Methods The targeted literature review was made based on high-quality articles on the topic of interest. Randomized clinical trials and publications based on real-world data were collected. Collaterally, data from the Polish third-party payer, National Health Fund (NHF), for 2020 was gathered. Results Ten publications were included in the final analysis. They showed that the use of cardioprotectors in the treatment reduces cardiovascular events and lowers the rate of hospitalization for heart failure, regardless of pre-existing CVD or diabetes. Having regard the NHF data from Lesser Poland, in SGLT2 group, there were 196 out of 5,332 patients hospitalized due to cardiovascular incidents (3.68%). This percentage is lower than in the whole insulin group (5.06%) and close to the subgroup who started therapy in a similar period as SGLT2 group (5.07%). Conclusions SGLT2 significantly affects the treatment of cardiovascular events across the countries reported in the literature. Our study, the first real-world evidence from Poland, proves the cardioprotective effect of these groups of drugs as well. The main limitation is data restricted to one region, thus future studies with whole country coverage are needed.
Decoding the genetic and chemical basis of sexual attractiveness in parasitic wasps
Authors: Sun Weizhao , Lange Michelle Ina , Gadau Jürgen , Buellesbach Jan
Published: July 2023

Attracting and securing potential mating partners is of fundamental importance for reproduction. Therefore, signaling sexual attractiveness is expected to be tightly coordinated in communication systems synchronizing senders and receivers. Chemical signaling has permeated through all taxa of life as the earliest and most widespread form of communication and is particularly prevalent in insects. However, it has been notoriously difficult to decipher how exactly information related to sexual signaling is encoded in complex chemical profiles. Similarly, our knowledge of the genetic basis of sexual signaling is very limited and usually restricted to a few case studies with comparably simple pheromonal communication mechanisms. The present study jointly addresses these two knowledge gaps by characterizing two fatty acid synthase genes that most likely evolved by tandem gene duplication and that simultaneously impact sexual attractiveness and complex chemical surface profiles in parasitic wasps. Gene knockdown in female wasps dramatically reduces their sexual attractiveness coinciding with a drastic decrease in male courtship and copulation behavior. Concordantly, we found a striking shift of methyl-branching patterns in the female surface pheromonal compounds, which we subsequently demonstrate to be the main cause for the greatly reduced male mating response. Intriguingly, this suggests a potential coding mechanism for sexual attractiveness mediated by specific methyl-branching patterns in complex cuticular hydrocarbon (CHC) profiles. So far, the genetic underpinnings of methyl-branched CHCs are not well understood despite their high potential for encoding information. Our study sheds light on how biologically relevant information can be encoded in complex chemical profiles and on the genetic basis of sexual attractiveness.
Colestasis intrahepática por Treponema pallidum en paciente inmunocompetente
Authors: Orozco-Sebá Beatriz E. , Viasus Diego , Meléndez Esperanza , Fuentes Jairo , Tovar José , Amado Elkin A. , Loaiza Daniela
Published: July 2023

La hepatitis por Treponema pallidum es una entidad poco frecuente y su diagnóstico representa un reto clínico. Treponema pallidum debe considerarse como etiología presuntiva en todo paciente con enfermedad hepática aguda, en el cual se hayan descartado otras causas más frecuentes.Se presenta el caso de un paciente joven,  inmunocompetente, quien presentó elevación de los valores de las pruebas hepáticas con patrón colestásico y lesiones maculopapulares en palmas y plantas. Dado su cuadro clínico, las pruebas diagnósticas y la respuesta a la terapia antimicrobiana instaurada, se estableció el diagnóstico de colestasis por una sífilis secundario sifilítiao. Es importante incluir la sífilis secundaria entre las posibles causas de enfermedad hepática aguda.
The Effect of Aerobika Device and Acapella Device on Rehospitalisation and Pulmonary Functions in Patients with Chronic Obstructive Pulmonary Disease-A Systematic Review
Authors: Tayade Vishakha , Vardhan Vishnu
Published: July 2023

Introduction: Controlling and preventing symptoms of exacerbations, shortness of breath, cough and mucus in the lungs are important goals of Chronic Obstructive Pulmonary Disease (COPD) treatment. Oscillating Positive Expiratory Pressure (OPEP) devices have been shown to improve clinical results. The conservation of energy and oxygen, as well as, the prevention of lung infections and reducing rehospitalisation may be facilitated by clearing the lungs. There are several airway clearance devices, that can be used to help clear excessive sputum. Aim: To identify the effect of aerobika device versus acapella device on rehospitalisation and lung functions in COPD patients. Materials and Methods: This systematic review was conducted in the Department of Physiotherapy at Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, Maharashtra, India. The duration of the study was three months, from march 2022 to june 2022. Five databases (PubMed, scopus, web of science, google scholar) were searched from 2012 to 2022. Inclusion criteria consisted of studies on the effect of aerobika device and acapella device on rehospitalisation and lung functions only in COPD patients. Data extraction included baseline features, treatment intervention, training frequency, supervision level, breathlessness, acute exacerbation, and outcomes. High quality experimental trials and comparative studies were chosen for the study. Results: A total of 20 articles were extracted; five were utilised for the purpose of writing the review, emphasising the effect of aerobika device versus acapella device on rehospitalisation and lung functions in COPD patients. Studies had showed inconsistent results on the effect of aerobika device versus acapella device on rehospitalisation and lung functions in COPD patients. Conclusion: Rehospitalisation, readmission and length of the stay can be reduced by using both, aerobika and acapella devices. Both devices are effective in improving lung function in COPD patients.
Prosthetic Rehabilitaion of an Exenterated Defect with a Magnet Retained, Customised Stock Eye Two-piece Hollow Orbital Prosthesis: A Case Report
Authors: Taneja Sukrit , Khalikar Arun , Wankhede Sattyam , Deogade Suryakant , Dutta Vinay
Published: July 2023

Loss of the eye results in a functional impairment, disfigurement of the face and long-term psychological effects on the patient. Coronavirus Disease-2019 (COVID-19) pandemic was accompanied by an increase in the number of patients reporting with mucormycosis. The treatment often involves widespread excision of the involved area, leading to gross facial deformity. Rehabilitation of the orbital defect is a complex task and requires a thorough treatment planning. It has always been challenging for a prosthodontist to create an orbital prosthesis for an exenterated defect brought on by post-COVID mucormycosis because it is difficult to meet the patient’s expectations. It is a time-consuming process requiring multiple appointments with every appointment being an important one. The advent of Computer-Aided Design/Computer-Aided Manufacturing (CAD-CAM) technology has made the fabrication simple, but not all have access to the required infrastructure. The conventional and economical silicone prosthesis still is a popular choice among clinicians. A 52-year-old male patient reported to the Department of Prosthodontics for an artificial substitute of his missing left eye, which was exenterated in the surgical treatment of mucormycosis. The present case report describes the fabrication of a two-piece magnet retained hollow orbital prosthesis with a “customised stock eye”. The prosthesis is designed in such way that, it utilises the natural undercut in the defect and a magnet between the conformer and the prosthesis. This yields in better maintenance and limiting the contact of silicon with the body fluids, thereby, enhancing the long-term use.
Investigating the Usefulness of Wild Dioscorea esculenta (Wild Yam) Flour as Substrate for Citric Acid Biosynthesis
Authors: Ezea Ifeanyi Boniface , Ewoh Anthonia Ngozi , Ezugwu Roseline  Ifeyinwa
Published: July 2023

Background and Objective: The cost of substrate represents a significant percentage of the total biosynthesis cost of citric acid. There is need to continue searching for better and cheap underutilize starchy raw material for citric acid biosynthesis. Therefore, the objective of this research was to biologically synthesis citric acid in submerged fermentation of Aspergillus niger using wild Dioscorea esculenta (wild yam) tubers.

Methodology: Submerged fermentation was conducted and the effect of Dioscorea esculenta concentrations, combined pretreatment and membrane permeability induction on citric acid biosynthesis were carried out.

Results: Citric acid concentration increased as the concentration of the wild yam increased with maximum citric acid production of 10.5 ± 0.9 g/ l after 96 hours of fermentation. The overnight combined pretreatment with 0.3 % NaOH before pretreatment at 121oC for 20 minutes as one time combined pretreatment yielded 15. 0 ±1.2 g/l citric acid. Calcium chloride membrane induction produced 24.5 ± 1.3 g/l citric acid concentration respectively after 96 hours of fermentation.

Conclusion: The result showed that wild Dioscorea esculenta tubers can be used as a substrate for the biosynthesis of citric acid. The biosynthesis of citric acid from Dioscorea esculenta tubers was enhanced by increased in concentration, combined pretreatment and membrane permeability induction.
Factors Militating against Community Policing in Curbing Kidnapping in Anambra State, Nigeria
Authors: Darl Ochiagha, Chibuike , Uzoamaka Chuke, Ngozi , Elizabeth Okoye, Onyinyechi
Published: July 2023

The purpose of the study was to determine the factors militating against community policing in curbing kidnapping in Anambra State. The study was guided by two research questions and two hypotheses. The design used in the study was a descriptive research design. The population for the study was 1,620 members of the vigilantee group in Anambra State. The sample size was 321  members of the vigilantee group in Anambra State and was arrived at using Taro Yamane sample size formula. Muti-stage sampling technique was used. The instrument for the study was 11 items sructured questionnaire titled “Factors Militating against Community Policing in Curbing Kidnapping Questionnaire” (FMCPCK). Using Cronbach Alpha, a reliability coefficient of 0.81 was obtained on the ICPCKQ instrument. The two research questions that guided the srudy were responded to using mean and standard deviation. T-test was used for Ho1, while Analysis of Variance (ANOVA) was used for Ho2. It was found out that some factors such as inadequate funding, lack of fire arms, lack of patrol vehicles, little or no training and development of police staff, illiteracy, use of outdated and insufficient technology among the police, lack of cooperation between the police and the masses, poor initiative and administrative frame work in police system, wide spread corruption and harassment among the police, poor access to vital information are affecting community policing in curbing kidnapping. Based on the findings, The state government should provide the security force with adequate firearms, funding and patrol vehicles.
Hereditary Spherocytosis in a Neonate with a New Frameshift Deletion- A Case Report
Authors: Kasula Lingareddy , Lingaldinna Swapna , Kotha Rakesh , Madireddi Alimelu
Published: July 2023

Introduction: Hemolytic anaemias often occur in neonates, often presenting with jaundice or encephalopathy. Hereditary spherocytosis is the most common cause, followed by glucose-6-phosphate-dehydrogenase deficiency and ABO isoimmunization. Early diagnosis and laboratory evaluation are crucial for effective interventions and preventing complications. This case report helps to recognise the clinical signs of hereditary spherocytosis early. And to emphasise the importance of the HS ratio in the diagnostic approach to hereditary spherocytosis.

Case Report: A 20-day-old first-born female baby presented with progressive pallor and jaundice since 7 days of life. The baby was treated with phototherapy and discharged home. On the 20th day, the parents noticed increasing jaundice and pallor, leading to a provisional diagnosis of hemolytic anaemia with splenomegaly. The baby had anaemia and unconjugated hyperbilirubinemia with normal liver enzymes. Hemolysis was found, and the mother's blood group was A-positive. The baby had an HS Ratio of 0.43, suggesting hereditary spherocytosis. Clinical exome sequencing confirmed hereditary spherocytosis type 2. The baby is currently 9 months old and growing normally.

Conclusion: The HS ratio is more useful to diagnose hereditary spherocytosis. This study further expanded the mutation spectrum of the SPTB gene. Reaffirms the diagnostic value of gene detection in neonatal HS type 2.
On-Farm Study on the Efficacy of Weed Management Treatments on Wheat under Irrigated Agro-Ecosystem of Jharkhand, India
Authors: Singh Amitesh Kumar , Shanker Ravi , Kumar Rakesh , Singh Nikhil Kumar , Singh Amit Kumar , Raghubanshi Narendra
Published: July 2023

An on-farm trial was conducted during rabi (winter) seasons of 2019-20 and 2020-21 at the farmers’ field. To test the OFT on weed management technology in wheat developed by the Bihar Agricultural University, Sabour, Bhagalpur. The efficacy of post-emergence application (PoE) of metsulfuron-methyl @ 4 g/ha, 2, 4-D ethyl ester 0.75 kg/ha followed by (fb) one manual hand weeding at 45 days after sowing (DAS) and 2, 4-D ethyl ester @ 0.75 kg /ha in managing weeds and improving productivity and economics of irrigated wheat was studied in comparison with the farmer’s practice (one hand weeding at 40 DAS). The metsulfuron methyl @ 4g/ha PoE had significantly reduced the density of broad-leaved weeds (BLWs) and sedges and resulted in higher grain yield (34.4%), gross returns (INR 97.6×103/ha), net returns (INR 50.1× 103/ha), benefit: cost ratio (2.05), economic efficiency (INR 385.9/day/ha) and production efficiency (28.8 kg/ha/day) in comparison to farmer’s practice. Thus, it may be concluded metsulfuron methyl @ 4g/ha PoE is effective and economically feasible practice in wheat of tribal farming community under the irrigated agro-ecosystem of Jharkhand.
Influence of Seed Invigoration with Organic Kunapajala on Seed Quality and Biochemical Activity in Late Sown Wheat
Authors: Devi Okram Ricky , Verma Omvati , Laishram Bibek , Raj Akarsha , Supriya  , Singh Shubham , Gaurav Kumar
Published: July 2023

A laboratory experiment was conducted at GBPUA&T, Pantnagar during rabi season of 2020-2021 to study the influence of seed invigoration with organic kunapajala on germination and biochemical activity in wheat variety UP-2526. The experiment was laid in completely randomized design which consisted of five treatments viz; no seed priming (control), Hydropriming for 16 hours, kunapajala seed priming @10%, 25% and 50% for 16 hours. Results revealed that germination percentage in hydro primed seeds and 25% kunapajala primed seeds jointly recorded maximum germination percentage (99.7%) which was statistically at par with 10% kunapajala priming (99.3%). Seed reserve mobilization efficiency after 4th day and 8th day of incubation was significantly affected by seed invigoration treatments. 25% kunapajala primed seeds recorded significantly higher dehydrogenase activity (0.68 OD) which was at par with hydroprimed seeds and 10% kunapajala primed seeds (0.63 and 0.62 OD, respectively). So, seed priming with either 10% or 25% organic kunapajala is an effective method to bring about improvement in germination of wheat and predict its field performance.
Evaluation of Growth and Yield of Maize (Zea mays L.) Hybrids under Agro-climatic Conditions of Prayagraj, U. P., India
Authors: Akhil Golla , Singh Vikram , George Shruti G.
Published: July 2023

At the Crop Research Farm (CRF), Department of Agronomy, SHUATS, Prayagraj (UP), a field experiment was carried out in the Kharif season of 2022 to examine the "Evaluation of Maize (Zea mays L.) hybrids under agro-climatic conditions of Prayagraj, U.P." Ten hybids make up the course of treatment. Ten treatments were reproduced three times, and the experiment was set up using a randomised block design. Compared to other hybrids, hybrid M-400 had the largest plant height (196.65 cm), dry weight (157.25 g/plant), number of cobs / plant (2.65), cob length (19.87 cm), number of grains / row (31.73/row), seed yield (8.64 t/ha), stover output (19.45 t/ha), and biological yield (28.09 t/ha).
Field Efficacy and Economics of Selected Insecticides and Bio-pesticides against Chickpea Pod Borer [Helicoverpa armigera (Hubner)] on Chickpea (Cicer arietinum L.) at Prayagraj
Authors: Phani Avala Venkata Naga , Kumar Ashwani
Published: July 2023

At the Central Research Farm of Sam Higginbottom University of Agriculture, Technology And Sciences, Prayagraj, an experiment on chickpea was carried out to test the "Field efficacy and economics of selected insecticides and bio-Pesticides against chickpea pod borer [Helicoverpa armigera (Hubner)] on chickpea (Cicer arietinum L.) at Prayagraj" during rabi season of 2022-2023. Effectiveness of biopesticides and insecticides viz., T1 Chlorantraniliprole 18.5% SC 0.5ml ml/lit of water, T2 Emamectin benzoate 5% SG 0.4 gm/lit of water, T3 Novaluron 10% EC 1.5 ml/lit of water, T4 Spinosad 45% SC 0.5 ml/lit of water, T5 Beauveria bassiana WP 5 gm/lit of water, T6 Nisco sixer plus 1ml/lit of water and T7 Neem oil 5% @ 5 ml/lit of water and treatment of T8 Untreated control were tested against chickpea pod borer Helicoverpa armigera (Hubner). The different insecticides and biopesticides treatments revealed that all the treatments were superior over control, T1 Chlorantraniliprole 18.5% SC (0.66) which found most effective followed by T2 Emamectin benzoate 5% SG (0.87), T4 Spinosad 45% SC (0.98), T3 Novaluron 10% EC (1.11), T6 Nisco sixer plus (1.30), T5 Beauveria bassiana WP (1.48), T7 Neem oil 5% (2.15) and T8 Untreated control (6.02). The crop with the highest average yield, T1 Chlorantraniliprole 18.5% SC, produced 22.01 q/ha, and its cost-benefit ratio was 1:2.26. followed by T2 Emamectin benzoate 5% SG (21.09 q/ha) with 1:2.55 C:B ratio, T4 Spinosad 45% SC (19.75 q/ha) with 1:2.32 C:B ratio, T3 Novaluron 10% EC (17.5 q/ha) with 1:2.14 C:B ratio, T6 Nisco sixer plus (16.16 q/ha) with 1:2.02 C:B ratio, T5 Beauveria bassiana WP (13.29 q/ha) with 1:1.72 C:B ratio, T7 Neem oil 5% (13.03 q/ha) with 1:1.67 C:B ratio and T8 Control   (9.5 q/ha) with 1:1.29 C:B ratio.