Introduction: Hospitals account for the largest share of health care expenditures, which are mainly financed by public funds. In healthcare, it is of paramount importance that the management focus not on reducing costs at the expense of patient health, but on improving the value and thus the healthcare outcomes. In addition to the economic factors used to determine a hospital's cost efficiency, non-economic or soft factors should be considered. The aim of this study was to elucidate the influence of non-financial factors on a hospital's cost-efficiency. Method: An online survey was conducted among the staff of a typical Slovenian general hospital (N = 150). Results: Self-assessment of cost-efficiency was influenced by communication in the hospital, satisfaction and cooperation within the multidisciplinary team, willingness of employees to innovate, cooperation with external providers and evaluation of the quality of healthcare. Communication with the patient had the greatest impact, followed by communication with external providers and communication with the management. Conclusion: In order to reduce costs while maintaining or even improving the healthcare outcomes, communication with patients is extremely important.

BACKGROUND: The extent of the resection, whether clamped or non-clamping resection is factor that influences the operating time and intraoperative bleeding, the development of modern techniques for vascular control and resection, and determine of lesser blood loss, morbidity, and mortality. AIM: The aim of this study was to determine the experience of General and Hepatobiliary Surgery Clinic at Aleksandrovska Hospital Sofia, Republic of Bulgaria in the treatment of patients with colorectal metastases in the liver and to compare literature reports on the influence of the extent of resection and Pringle maneuver (IPM) on operating time and perioperative bleeding. MATERIALS AND METHODS: This retrospective study covers the time period from January 01, 2006, until December 31, 2015. A total of 239 patients were included, from which: 179 patients were treated with radical surgery, 5 with palliative intervention, and 55 were subjected on operability exploration. RESULTS: The use of the IPM for vascular control insignificantly influenced the prolonged operative time, while intraoperative blood loss was significantly lower in patients with Pringle <15 min. There was no association between IPM and resection type, while intraoperative blood loss and operating time were significantly greater in patients with major resection.

Introduction: Non-Hodgkin’s lymphoma (NHL) consists of several hematologic malignancies arising from B, T lymphocytes or natural killer lymphocytes, and nearly 85–90% originates from B lymphocytes. This current study illustrates frequency of diagnosed NHL cases, age-standardized incidence rate (ASIR) and crude incidence rate (CIR) by age group, year of diagnosis and administrative regions for identifying the distribution, pattern and real condition of NHL in Saudi Arabia. Methodology: In this study, an epidemiological analysis of NHL cases is conducted on registered cases between 2006 and 2016 from Saudi cancer registry (SCR). For statistical analysis, t-test, sex ratio, Kruskal–Wallis and descriptive statistics were performed by SPSS version 20.0. Results: A total of 8019 NHL cases were documented from reported from January 2006 to December 2016. Among males, Riyadh region had the highest overall ASIR at 7.9 followed by Eastern region at 6.9 per 100,000 males and lowest overall ASIRs were observed in Jazan and Hail region at 3.5, and the Northern region at 3.9 per 100,000 males. The highest overall ASIR among females was reported in the Riyadh region at 6.9 and Eastern region at 5.2 per 100,000 females and lowest overall ASIR was documented in the Jazan region at 2.2, followed by Hail at 2.4. The overall age-standardized incidence sex ratio of NHL was found to be 1.3 per100,000 in Saudi Arabia. Conclusion: This study concluded an increase in crude incidence rates and age-standardized incidence rates NHL among Saudi population. Highest overall ASIRs for NHL among males and females from 2006 to 2016 were documented in Riyadh and Eastern region. While, lowest overall ASIRs among males and females were documented in the Jazan and Hail region.

Objective: This diagnostic study aims to determine the expression of salivary IEX-1 as a predictor of malignancy in epithelial ovarian tumors. Methods: Samples were obtained from ovarian cancer patients who were scheduled for elective surgery. Patients' saliva was collected before surgery and used as the study's research material. Research subjects who met the inclusion and exclusion criteria were divided into two groups based on the post-operative histopathological results, benign and malignant epithelial ovarian tumors. The salivary IEX-1 expression was examined using the Real Time qPCR method. We compared and analyzed the salivary IEX-1 expression ​​in benign and malignant epithelial ovarian tumors. Results: The results of this study were obtained from 47 epithelial ovarian tumors subjects, 22 malignant tumors and 27 benign tumors. The mean salivary IEX-1 expression in benign epithelial ovarian tumors was higher (1.976) than the malignant tumors (0.554) (p<0.001). The AUC value of IEX-1 expression was 0.949 (95% CI 0.894-1,000), cut off point of salivary IEX-1 is ≥ 0,9115 with sensitivity 84%, specificity 86,4%, positive predictive value 82.6% and negative predictive value 87.5%. There was a significant correlation between salivary IEX-1 expression and malignant epithelial ovarian tumors with an OR 5.031 (95% CI 2.039-12.4; p<0,001) Conclusion: Salivary IEX-1 expression declines in tandem with the development of malignant epithelial ovarian tumors, providing a very sensitive and specific indicator of the presence of these malignant tumors. Keywords: Expression of IEX-1, Malignant epithelial ovarian tumor, Salivary IEX-1, Tumor Marker.

The article discusses the use of transcranial pulse stimulation (TPS), a treatment method that uses ultrasound to penetrate the brain up to 8 cm. The article aims to review published studies on the effects of TPS on Alzheimer’s disease and to link the mechanism of the treatment with the pathophysiology of the disease. The discussion highlights the pathological triad of senile plaques, neurofibrillary tangles, and granular degeneration that causes Alzheimer’s disease. Patients with diabetes mellitus are predisposed to degenerative diseases, and the overlap between Alzheimer’s disease and obesity may be explained by the use of streptozotocin, which generates reactive oxygen species leading to DNA damage and cell death. The accumulation of beta-amyloid in the brain, mitochondrial malfunction, decreased production of ATP, and energy insufficiency is also discussed. The article concludes that TPS is a potential treatment for Alzheimer’s disease and that it can boost the expression of growth factors, enhance the flow of blood to the brain, trigger the creation of novel blood vessels, and promote the regeneration of nerves.

Introduction: According to the International Society for Quality in Healthcare, accreditation is a process in which "trained external peer reviewers evaluate a healthcare organisation's compliance with pre-established performance standards. Unlike licensure, accreditation focuses on continuous improvement strategies and achievement of optimal quality standards, rather than adherence to minimal standards intended to assure public safety".^1,2 This study aims to observe and identify gaps in adherence to Facility Management and Safety Standards as prescribed by the Joint Commission International (JCI). Methodology: A time-bound single-centre observational study was carried out using the JCI Accreditation Standards for Hospitals (Sixth Edition). Questionnaires were shared with 20 purposively and conveniently (based on consent) selected participants after obtaining signed informed consent. Following the questionnaire examination, one-on-one interviews with management were held to acquire the necessary data for the study, including the reasons for non-compliance with specific requirements. This research closely examined JCI-recommended policies (Chapter: Facility Management and Safety) and the hospital's compliance with them. Results and Conclusion: Based on the study, it can be concluded that the hospital has complied with most of the standards on Facility Management and Safety Standards of the Sixth Edition of JCI. However, the clauses FMS.2:ME.3, FMS.6:ME.4, FMS.9.2.1:ME.3, and FMS.9.2.1:ME.4 were not met.

BACKGROUND: Kidney disease in human immunodeficiency virus (HIV) is often overlooked. The types of kidney disease in HIV consist of glomerulopathy and tubulointerstitial nephritis. Hypertension, diabetes mellitus, and the use of tenofovir increase the risk of kidney disease. AIM: The purpose of this study is to analyze the type of kidney disease in person living with HIV using the urine albumin-protein ratio. METHODS: This research is an analytic observational study. Data were collected using the consecutive sampling. The urine albumin-protein ratio was carried out to differentiate glomerulopathy from tubulointerstitial nephritis. RESULTS: Screening with dipstick proteinuria in 1148 person living with HIV, total of 189 subjects (16.5%) with proteinuria were obtained, with a urinary protein-creatinine ratio over 150 mg/g in 101 persons (8.7%). The proportion of tubulointerstitial nephritis (73.3%) was higher than glomerulopathy (26.7%). Kidney disease mostly occurs at glomerular-filtration rate ≥90 ml/minute/1.73 m2, specifically glomerulopathy (66.7%), and tubulointerstitial nephritis (52.7%). The risk stratification of cardiovascular complications and worsening of kidney function was mostly at moderate risk (60%), there were 6.9% of study subjects with a glomerular-filtration rate ≥90 ml/min/1.73 m2 with high-risk stratification. There was no significant difference in the proportion of glomerulopathy and tubulointerstitial nephritis based on comorbidities.

BACKGROUND: Colorectal cancer (CRC) is the world’s third most common type of cancer. Case studies have shown an inverse correlation between serum Vitamin D levels and the incidence of human colorectal cancer. AIM: This study aims to assess Vitamin D levels in patients who underwent colonoscopy for diagnostic colorectal cancer. METHODS: This research is a cross-sectional study. This study’s subjects were patients who visited the Digestive Surgery polyclinic and underwent a colonoscopy to diagnose colorectal cancer. Level of Vitamin D was collected before the colonoscopy examination and categorized into three groups: Vitamin D with a value of < 20 ng/mL indicates a deficiency, a level of 20–30 ng/mL as an insufficiency level, and a value > 30 ng/mL as a sufficient value. A colonoscopy examination was performed to obtain a diagnosis of colorectal cancer based on anatomical pathology examination. RESULTS: Examination of Vitamin D levels from 120 subjects showed that the average vitamin level was 16.36 ng/mL, which indicates Vitamin D deficiency levels. A total of 85 (70.8%) subjects showed Vitamin D deficiency, as many as 24 (20%) showed Vitamin D insufficiency levels, and only 11 (9.2%) study subjects showed sufficient Vitamin D levels. The colonoscopy showed 60 (50%) subjects with colorectal cancer. The relationship between Vitamin D levels and the diagnosis of CRC showed a value of p = 0.60 (p > 0.05).

BACKGROUND: The older population is at high risk for vitamin B12 deficiency, leading to various significant and chronic health problems. AIM: This study aimed to determine the association between sociodemographic characteristics, nutritional knowledge and overall vitamin B12 intake among older persons. METHODS: An observational study with a cross-sectional design was directed to 69 older women aged > 50 years. Data was collected from subject responses to various questions on the google platform, guided by professional assistance. RESULT: The study showed an inversed association between employment status (p<0.05), income level (p<0.001) and overall vitamin B12 intake, including dietary and supplement intake. The results provided new insights on monthly income level playing a crucial role in VB12 rich food consumption patterns in older persons, which were mostly unemployed.

One of the cognitive processes most damaged by aging and thought to be the system most susceptible to neurodegenerative illnesses is episodic memory. Recently, episodic memory function has been linked to a single nucleotide polymorphism (rs17070145) in the ninth intron of the KIBRA gene (kidney and brain expressed gene). This study looked at the relationship between the KIBRA polymorphism (rs17070145) and the episodic memory abilities assessed by the Rey Auditory Verbal Learning Test and Rey Complex Figure Test at various time points (20-minute, 30-minute, 24-hours and 6-month). 112 healthy adult Jordanians between the ages of 18 and 45 were included in the study, and the genotypes at the KIBRA (rs17070145) polymorphic site were identified using the PCR-RFLP method. The outcomes did not reveal any statistically significant any assessment of verbal and visual episodic memory tests and the KIBRA polymorphism. The findings also indicated that KIBRA polymorphism had no statistically significant impact on short-term memory or learning capacity, indicating that KIBRA had no effect on a person's ability to pay attention or concentrate. Additionally, in the Jordanian population, the genotype percentages for KIBRA rs17070145 were: 10.7% for TT, 43.8% for TC, and 45.5% for CC, and the percentage of the T allele was 0.326. The current investigation discovered no statistically significant differences between the Jordanian population and either the European or the South Asian populations in terms of the percentages of alleles and genotypes of the KIBRA rs17070145 gene.