Hippokratia最新文献

Background: The long-term studies for femoral neck fractures (FNFs) in young patients treated with closed reduction and internal fixation (CRIF) are limited. This study aimed to evaluate the long-term outcomes of a group of young patients (<65 years) with FNFs treated with CRIF at our department during the last decade. We estimated treatment failure rates and identified risk factors for poor outcomes.

Methods: This retrospective cohort study included patients under 65 with a unilateral FNF treated with CRIF using partially threaded cannulated screws (CSs) between 2011 and 2021. During the latest follow-up visit, we recorded the patients' complications, re-admissions, reoperations, functional outcomes, and quality of life scores.

Results: We included 52 patients with a mean age of 53.04 years and a mean follow-up of 5.3 (range: 1.3-11) years. No non-union was recorded. Nine patients (17.3 %) underwent total hip arthroplasty (THA) due to femoral head avascular necrosis (AVN) at an average of 1.68 years following the index operation (THA group). The mean age (p =0.96), trauma type (p =0.290), sex prevalence (p =0.989), Garden classification (p =0.187), CSs number (p =0.751), and comorbidities (p =0.516) were comparable between THA and non-THA groups. Time from trauma to index surgery was significantly shorter for the THA than the non-THA group (p =0.03).

Conclusions: During a mid-to-long follow-up, 17.3 % of patients under 65 years who were treated with CRIF and CSs for FNFs developed AVN. Age, trauma type, comorbidities, time from trauma to treatment, and the number of screws did not affect the outcomes. HIPPOKRATIA 2024, 28 (1):29-34.

Background: The kidney is the organ of the human body with the most common congenital anomalies in either development or vascular supply. Although the presence of a second feeding artery arising from a different level of the aorta is not uncommon, the occurrence of a feeding renal artery arising from the contralateral common iliac artery is an infrequent finding.

Case description: We present a case bearing significant abnormalities, including malrotation of the right kidney, the presence of two feeding arteries arising from very uncommon sites, and the presence of two main renal veins with anomalous drainage.

Conclusion: Awareness of such defects is essential in treatment planning in cases of endovascular surgery for abdominal aneurysm repair, as well as in cases of renal tumors where partial nephrectomy or embolization is contemplated or in the case of kidney transplantation. HIPPOKRATIA 2024, 28, 1: 35-37.

Background: Patient-reported outcome measures (PROMs) assess how individuals perceive the disease and its impact on quality of life, representing an important complement to the metabolic evaluation in type 1 diabetes mellitus (T1DM). This study aimed to assess the PROMs and their association with metabolic control.

Methods: A cross-sectional study of adults with T1DM was conducted in the outpatient Endocrinology department between October 2022 and May 2023. Clinical, demographic, and continuous glucose monitoring (CGM) data were collected. Three PROMs were applied: the diabetes psychological adjustment scale (ATT18), the World Health Organization well-being index (WHO-5), and the patient health questionnaire (PHQ-9). Descriptive and bivariate statistical analyses were performed.

Results: We included 56 participants, aged 41.2 ± 14.6 years, 58 % female, and 64 % of medium-high socioeconomic class. The disease duration of the cohort was 21 ± 14.6 years, with 44.6 % on continuous subcutaneous insulin infusion (CSII) and 39.3 % presenting microvascular complications. Glycated hemoglobin of the cohort was 8.0 ± 1.4 %, time in range (TIR) 52 ± 22 %, coefficient of variation (CV) 37 ± 8 %, and median time below range (TBR) 2 %. Individuals on CSII had higher TIR (p =0.03). CV was related to TBR (ρ =0.643, p <0.001). The majority had satisfactory psychological adjustment to diabetes (ATT18 ≥60), which correlated directly with WHO-5 (r =0.511, p <0.001) and inversely with depression symptoms (r =-0.676, p <0.001). No relationships were identified between metabolic control and PROMs (p =0.63).

Conclusions: Including PROMs alongside detailed metabolic evaluation allows for individualized decision-making and active patient participation in diabetes management. These results underscore the importance of preventing depression, promoting well-being, and enhancing diabetes psychological adjustment in these patients, aiming to improve their quality of life. HIPPOKRATIA 2024, 28 (1):17-21.

Background: Trisomy 13 is a chromosomal defect with high prenatal and postnatal mortality that may reach 87 % during the first year of life. More than 90 % of cases of fetuses with trisomy 13 may be detected by first-trimester ultrasound based on severe fetal structural malformations together with increased nuchal translucency thickness.

Case description: We report a case of a fetus with trisomy 13 mosaicism with only anomalous findings on prenatal ultrasound of a single umbilical artery and increased nuchal translucency in the absence of major structural abnormalities.

Conclusion: This case highlights the importance of performing first-trimester fetal ultrasound by specialists in Fetal Medicine to avoid misdiagnosis. Trisomy 13 should be included in the differential diagnosis and prenatal counseling in cases with a single umbilical artery and increased fetal nuchal translucency, even in the absence of major anatomic anomalies. HIPPOKRATIA 2024, 28 (1):38-40.

Background: Detecting liver dysfunction/failure in the intensive care unit poses a challenge as individuals afflicted with these conditions often appear symptom-free, thereby complicating early diagnoses and contributing to unfavorable patient outcomes. The objective of this endeavor was to improve the chances of early diagnosis of liver dysfunction/failure by creating a predictive model for the critical care setting. This model has been designed to produce an index that reflects the probability of severe liver dysfunction/failure for patients in intensive care units, utilizing machine learning techniques.

Materials and methods: This effort used comprehensive open-access patient databases to build and validate machine learning-based models for predicting the likelihood of severe liver dysfunction/failure. Two artificial neural network model architectures that derived a novel 0-100 Liver Failure Risk Index were developed and validated using the comprehensive patient databases. Data used to train and develop the models included clinical (patient vital signs) and laboratory results related to liver function which included liver function test results. The performance of the developed models was compared in terms of sensitivity, specificity, and the mean lead time to diagnosis.

Results: The best model performance demonstrated an 83.3 % sensitivity and a specificity of 77.5 % in diagnosing severe liver dysfunction/failure. This model accurately identified these patients a median of 17.5 hours before their clinical diagnosis, as documented in their electronic health records. The predictive diagnostic capability of the developed models is crucial to the intensive care unit setting, where treatment and preventative interventions can be made to avoid severe liver dysfunction/failure.

Conclusion: Our machine learning approach facilitates early and timely intervention in the hepatic function of critically ill patients by their healthcare providers to prevent or minimize associated morbidity and mortality. HIPPOKRATIA 2024, 28 (1):1-10.

Background: Births from adolescent mothers account globally for 10 % of all births and 23 % of maternal morbidity and mortality. Adolescence is a period of rapid biological changes; therefore, teens have a risk of developing iron deficiency anemia. The present study aimed to determine the hematological profile and compare the distribution and the severity of anemia among pregnant adolescents (12-19 years old) over ten years in Northern Greece.

Material and methods: We conducted a retrospective study of pregnant adolescents' medical records and laboratory data recorded during their first prenatal consultation. The laboratory workout was performed in the Thalassemia Prevention Unit of the Hippokration Hospital of Thessaloniki, Greece, from 2013 to 2022.

Results: Two hundred nine of the adolescents were of Greek Nationality (88.3 %) (86 Greek natives of the general population; 41.1 %, 112 members of the Roma community; 53.5 %, 11 members of the Muslim minority of Thrace; 5.2 %) and 29 (11.6 %) were immigrants from the Balkans, Middle East, and Asia. The mean age (± standard deviation) of the 238 pregnant women in our study's cohort was 16.67 ± 1.67 years, and the majority of them (90 %) were approximately between 15-19 years, and 10 % were between 12-14 years. Half of the cohort were Greek Roma (47 %) and were our study's youngest (15.9 ± 1.3 years old) adolescent pregnant women. All registered pregnant adolescents had abandoned school. Our data shows anemia in 33.6 %, iron deficiency anemia in 28.5 %, and iron deficiency in 54.6% of these pregnant adolescents. Migrants and Roma had the lowest hemoglobin levels in the second and third trimesters of pregnancy, respectively, while we found the lowest ferritin levels in Roma and Muslims of Thrace.

Conclusions: Despite existing knowledge regarding adolescent pregnancy prevalence and its adverse effects, it nonetheless remains a socio-medical problem and a matter of concern in our country. HIPPOKRATIA 2024, 28 (1):11-16.

Background: Gastrointestinal (GI) bleeding is common among hemodialysis (HD) patients. Endoscopic examination of the upper and lower GI tract often fails to identify hemorrhagic lesions in anemic HD patients. The study aims to evaluate lesions of the small bowel mucosa in HD vs non-HD patients with suspected small-bowel bleeding (SSBB) using capsule endoscopy (CE) after negative upper and lower GI endoscopies.

Methods: This prospective cross-sectional study included all consecutive patients presenting with occult GI bleeding at the Dialysis Unit (HD patients) and the Gastroenterology Outpatient Clinic (non-HD patients) of the University Hospital of Alexandroupolis. Within a pre-specified period of 13 months (01/07/2022 to 31/07/2023), we collected all relevant demographic data, laboratory parameters, comorbidity records, treatment profiles, and endoscopic findings. We used univariate and optimal scaling multivariate analyses to evaluate all parameters correlating with CE findings and Rhemitt score.

Results: The study included 100 patients (25 HD and 75 non-HD). Considering any lesion (oozing blood, red spots, angiodysplasias, and erosive/ulcerative lesions) at any site (duodenum, jejunum, and ileum) as separate binary variables, the prevalence per patient was superior in HD patients (3.8 ± 1.6 vs 1.3 ± 1.4; p <0.001). More specifically, endoscopic capsule findings in HD vs non-HD patients identified oozing blood (28 % vs 15 %; p =0.133), red spots (96 % vs 44 %; p <0.001), angiodysplasias (32 % vs 9 %; p =0.006), and erosive/ulcerative lesions (64 % vs 24 %; p <0.001). In 25 non-HD patients, no findings were observed (p =0.001). The number of total endoscopic findings was independently correlated with dialysis (p <0.001), male sex (p =0.048), dyslipidemia (p =0.004), liver disease (p =0.001), and mean corpuscular volume (MCV) (p =0.015). Lastly, we found that HD patients rebleed more often (Rhemitt score 6.5 ± 1.4 vs 2.9 ± 2.1; p <0.001). The Rhemitt score was independently correlated with dialysis (p <0.001), body mass index (p =0.024), MCV (p <0.001), smoking (p <0.001), dyslipidemia (p =0.007), GI bleeding (p <0.001), Calcium channel blockers (p =0.023), and preparation (p =0.001).

Conclusion: Compared with non-HD patients, HD patients who were investigated for potential GI bleeding demonstrated more severe and frequent small intestinal lesions with a higher probability of rebleeding. HIPPOKRATIA 2024, 28 (1):22-28.