Hippokratia最新文献

Background: Four waves of Coronavirus disease 2019 (COVID-19) occurred in France between March 2020 and September 2021. COVID-19 inpatient characteristics change because of the influence of numerous parameters, especially immunization and circulating severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) variants.

Methods: This retrospective single-center study analyzed patients with laboratory-proven COVID-19 admitted from 1/3/2020 to 30/6/2020 (wave one), 1/7/2020 to 31/12/2020 (wave two), 1/1/2021 to 30/6/2021 (wave three), and 1/7/2021 to 30/11/2021 (wave four). We compared the outcomes and baseline characteristics between these waves.

Results: In our center, 1,762 patients were hospitalized for COVID-19: 666 (37.8 %), 425 (24.1 %), 482 (27.3 %), and 189 (10.7 %) during waves 1, 2, 3, and 4, respectively. Patients during the first wave were hospitalized later after the onset of COVID-19 symptoms, had more severe disease conditions at baseline, and suffered higher intensive care unit (ICU) hospitalization rates. Most patients from waves 1-3 were >70 years old, with 88-93 % having ≥1 comorbidity, whereas those from wave four were younger (68.0 years) with less comorbidities. The first two waves showed higher mortality rates (16.8 % and 20.0 %) than the latter (16.6 % and 9.5 %).

Conclusion: Patients during the first wave had more severe disease conditions at baseline and higher mortality and ICU hospitalization rates. Despite the more virulent circulating Delta variant during wave four, the death and hospitalization rates were markedly decreased during wave four. HIPPOKRATIA 2023, 27 (1):1-6.

Background: Stroke has been associated with compromised patient outcomes, such as a decreased quality of life. We aimed in the present study to evaluate the health-related quality of life (HRQοL) of hospitalized Greek stroke patients during the sub-acute rehabilitation period and assess the effect of demographic and clinical characteristics mediated by depressive symptom severity on HRQοL.

Methods: In a prospective study, a cohort of adult patients hospitalized in the sub-acute phase of their first stroke episode were assessed in the Rehabilitation Clinic of the University Hospital of Ioannina in Greece. Patients' functional status, depressive symptom severity, and HRQοL were evaluated twice, using the Patient Health Questionnaire 9 (PHQ-9), the Barthel Index (BI), and the World Health Organization Quality of Life Brief Version (WHOQOL-BREF), respectively. All patients received physical, occupational, and speech therapy during their rehabilitation.

Results: Fifty consecutive adult stroke patients were enrolled. We detected a statistically significant (p <0.001) improvement in WHOQOL-BREF, especially in the "psychological health" and "environment" domains, BI, and PHQ-9 scores, between the initial and follow-up assessments. Mediation analysis revealed that baseline disability had both a significant direct (estimate =0.014, p <0.001) and indirect (estimate =0.010, p <0.001, PHQ-9 as mediator) effect on the total HRQoL score. Gender and stroke localization had significant direct effects on HRQoL total (estimate =-0.432, p =0.009, and estimate =0.395, p =0.031, respectively), while PHQ-9 mediation was insignificant. Antidepressant medications and stroke type did not play a substantial role in HRQoL.

Conclusion: By the end of the subacute rehabilitation phase, patients' HRQoL, functionality and depression severity improved. Additionally, baseline functionality, stroke localization, and gender directly or indirectly (mediated by initial depression severity) affected HRQoL, with male patients and patients with stroke non-involving the frontal lobe/basal ganglia showing a better HRQoL by the end of rehabilitation. HIPPOKRATIA 2023, 27 (1):12-17.

Background: Patients with psoriasis show an increased prevalence of depressive symptoms that worsen disease outcomes. This study investigated the effect of resilience and other sociodemographic/clinical variables on depressive symptoms' severity in patients with psoriasis.

Methods: This study included 58 psoriasis patients consecutively enrolled during the 14 months of the study. We evaluated psoriasis severity using the Psoriasis Area and Severity Index, Body Surface Area, and Physician Global Assessment. The psychometric assessment included the Resilience Scale and the Beck Depression Inventory-II (BDI-II). We divided participants into two subgroups based on the optimal BDI-II cut-off score (Group A: BDI-II ≤17; Group B: BDI-II >17). A stepwise regression analysis explored whether the variation in the BDI-II score could be predicted by a linear combination of sociodemographic and clinical variables.

Results: Psoriasis patients with more severe depressive symptoms (Group B patients) showed lower resilience levels than Group A patients (p <0.001). Moreover, depressive symptoms correlated only with resilience levels (p <0.001), with a negative correlation. The stepwise regression analysis revealed that resilience explained 37.1 % of the variance in BDI-II scores, whereas resilience, gender, and comorbidity with other physical illnesses combined explained 51.3 % of the variance.

Conclusion: Resilience may alleviate depressive symptoms in psoriasis patients. This study underscores the importance of resilience-building interventions for these patients. HIPPOKRATIA 2022, 26 (4):131-137.

Background: Structural spine changes are the frequent musculoskeletal disorders occurring in the human body in the form of scoliosis, hypo- or hyper-kyphosis, hypo- or hyper-lordosis, or a combination of the above.

Methods: In this retrospective, observational-comparative study, we included 240 third- and fifth-grade primary school pupils of both sexes and different daily life habits from four schools in the South and North of Montenegro. Data collected included children's posture examination conducted by a qualified professional. The testing procedure included standing position inspection, elasticity test application for the iliopsoas muscle, Adam's test, and the curve rigidity test. To analyze the differences between individual groups for categorical and continuous variables, we used the chi-square test and Student's t-test for independent samples, respectively.

Results: We did not observe a significantly higher prevalence of suspected scoliosis among male participants who did not engage in sports activities. The presence of suspected scoliosis in participants from the South is significantly higher than in their peers from the North of Montenegro. A significantly higher prevalence of suspected scoliosis was observed among female participants who did not engage in sports activities. Suspected spinal variations are significantly more frequent among participants from the South of Montenegro (p <0.001, Cramer's V= 0.319) and significantly more frequent in females with lower sports engagement (χ² =3.941, p =0.042). This fact could be attributed to the slower development of the central nervous system and motor control in girls in combination with their engagement in less physical activity.

Conclusion: The findings of this study impose doubt that multifactorial etiology, including gender, child's age, engagement in sports activities, and the manner of conducting daily activities, is crucial for developing spinal deformities and may facilitate future studies and support preventive and therapeutic procedures in treating postural changes. HIPPOKRATIA 2022, 26 (4):147-151.

Background: The classification of vascular anomalies includes terms of nomenclature that are not based on histogenesis resulting in confusion among health professionals of different specialties. Ongoing efforts to classify them properly have taken place. This literature review aimed to identify erroneous nomenclature of vascular anomalies and to investigate their continued use over the past four years after the last International Society for the Study of Vascular Anomalies (ISSVA) update.

Methods: Literature research was based on pertinent classifications (ISSVA, WHO) and books related to vascular anomalies and soft tissue pathology. After identifying twelve entities with confusing terminology, new research in the Pubmed database was conducted to verify their continued use in the last four years.

Results: The literature review highlighted terms referring to vascular malformations as neoplasms. In addition, terms used as equivalents represent entirely different entities. On the other hand, different terms to characterize the same entity were also recorded. Furthermore, regardless of the last ISSVA update in 2018, terms that are only descriptive or do not correspond to vascular anomaly histogenesis are consistently used.

Conclusion: Despite intensive efforts in the last decades for correct terminology and classification of vascular anomalies, modifications are still required. A common and broadly accepted scientific terminology should be applied, accurately representing histogenesis or pathogenesis, to obtain a common language among medical specialists, given that a multidisciplinary approach is crucial for managing vascular anomalies. HIPPOKRATIA 2022, 26 (4):126-130.

Background: Excessive bleeding is common and can be life-threatening in patients undergoing coronary artery bypass grafting (CABG) surgery. Existing conventional methods for preventing bleeding are ineffective or impractical; thus, additional strategies are required. This study used the autologous platelet-rich plasma fibrin-glue (PRP-FG) as a topical hemostatic and tissue regenerative agent to evaluate its preventive effect in postoperative bleeding in off-pump CABG surgery anastomosis.

Methods: Patients undergoing elective off-pump CABG were randomly allocated into control (16 males and ten females) and case (19 males and seven females) groups. In the control group, hemostasis was accomplished exclusively using electrocautery and overcharging. In contrast, in the case group, PRP-FG was applied in the place of distal and proximal coronary graft anastomosis and sternotomy at the end of the operation and after surgical homeostasis. Patients were closely monitored for 48 hours in the intensive care unit (ICU), and the drainage volume was estimated based on blood accumulation in the chest tube bottle. Mean hemoglobin, platelet count, international normalized ratio (INR), time of surgery, bleeding volume in the operating room, and bleeding (drainage) volume in ICU after 48 hours were documented for both case and control groups.

Results: There were no meaningful differences between the two groups regarding sex, age, mean hemoglobin, platelet count, INR, time of surgery, and bleeding volume in the operating room. A significant decrease in the postoperative bleeding volume was observed in ICU after 48 hours for the case group compared to the control group.

Conclusion: Topical application of autologous PRP-FG significantly reduces postoperative bleeding volume after CABG surgery without adding extra risks to the patient. HIPPOKRATIA 2022, 26 (4):143-146.

Background: The prevalence of thyrotropin-secreting pituitary adenomas, most being macroadenomas, is one to two cases per million inhabitants. Their differential diagnosis may be challenging, especially for microadenomas.

Case description: We present the case of a 50-year-old male with progressive neck enlargement, hot sudorific hands, anorexia, diarrhea, and weight loss over the preceding three months. Laboratory evaluation revealed high thyroid hormones, predominantly high free triiodothyronine of 7.74 pg/mL (reference range 2.3-4.2), with a non-suppressed thyroid stimulating hormone (TSH) of 1.73 µIU/mL (reference range 0.55-4.78). A high level of suspicion directed additional evaluation that revealed a high total alpha-subunit of glycoprotein hormones (αGS) and αGS/TSH ratio. Magnetic resonance imaging revealed a six mm pituitary lesion. A microthyrotropinoma was diagnosed, and long-acting octreotide was initiated before surgery for symptomatic control. Endoscopic transnasal transsphenoidal tumor resection was performed months later. The patient was in remission one year after surgery with no pituitary deficits.

Conclusions: Reaching an accurate diagnosis on time is crucial for deciding the optimal therapeutic approach and preventing and decreasing the frequency of endocrine and neurological complications. HIPPOKRATIA 2022, 26 (4):157-160.

Background: Following the global pandemic of coronavirus disease 2019 (COVID-19), the long COVID or post-COVID syndrome refers to a relatively complex novel clinical entity. We conducted this study to assess the primary epidemiological features, main symptoms, and comorbidities probably related to this syndrome in patients referred to our long/post-COVID primary care unit during the initial months of its operation.

Methods and material: This single-center prospective observational study was conducted between April 2022 and December 2022 and enrolled 71 patients (33 men, 38 women) who were examined due to persisting symptoms after recovering from COVID-19 infection, with the mean time of the first visit estimated at 3.12 ± 2.41 months from their acute COVID-19 illness. A thorough medical history, clinical examination, laboratory, and any other tests were performed on all patients when necessary.

Results: The most common symptoms of long/post-COVID reported were fatigue (63.4 %), a persistent cough (45.1 %), stress manifestations (42.3 %), arthralgia or myalgia (33.8 %), tachycardia (32.4 %), depression manifestations (29.6 %), exertional dyspnea (28.2 %), and sleep disorders (25.4 %). Hypertension (in about 40 %) and the presence of five or more symptoms during the acute COVID-19 illness (in approximately 52 %) could be regarded as factors increasing the long/post-COVID appearance. The long/post-COVID syndrome affects even patients not experiencing severe COVID-19 illness. Unvaccinated patients are at higher risk of severe COVID-19 (p =0.014), higher risk of hospitalization (p =0.002), and in higher need of respiratory support with high flow (p =0.017) when compared to vaccinated ones. Hospitalized patients appear to be older than outpatients (59 ± 12.42 vs 52.78 ± 11.48 years of age; p =0.032.

Conclusion: The long/post-COVID syndrome is an established clinical entity, and several clinical features, symptoms, and patient profiles have to be assessed from the initial medical contact in primary care to exclude early any other clinical conditions and offer guided therapeutic strategies to those patients. HIPPOKRATIA 2022, 26 (4):138-142.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) was first applied in 1976 in children for diagnosing and treating pancreaticobiliary diseases based on experience with adult patients. Its application was limited initially but has become widespread in recent years with technical developments. This study evaluated the efficacy, indications, and complications of the ERCP's diagnostic and therapeutic use in pediatric patients.

Case series: We evaluated retrospectively the files of 16 pediatric patients aged 5-18 years who underwent ERCP between January 2015 and June 2022 in the Endoscopy Unit of Prof. Dr. Cemil Taşçıoğlu City Hospital. We recorded and analyzed the demographic data, admission complaints, pre-procedure diagnostic tests, ERCP findings, and early and late post-procedure complications. Five of the 16 patients (31 %) who underwent ERCP were male, 11 (69 %) were female, and their mean age was 12.7 ± 5.44. We utilized as a diagnostic tool the Fujifilm ED-580XT duodenoscope with a 13.4 mm outer diameter and a 4.4 mm diameter channel connected to a Fujinon Eluxeo 6000 light source, not specifically designed for children but in use for adult patients. While biochemistry and ultrasonography were conducted for all patients before the procedure, only ten patients (62 %) underwent magnetic resonance cholangiopancreatography. Indications for performing ERCP included suspected biliary pathology (8 patients, 50 %), pancreatitis attack (6 patients, 38 %), bile leakage after cholecystectomy (one patient, 6 %), and mass lesion in the ampulla (one patient, 6 %). Seven patients (44 %) underwent cholecystectomy for cholelithiasis 4-6 weeks after the ERCP (one cholecystectomy was performed in another center). In one of the patients, ERCP was performed for diagnostic-only purposes, while in fifteen patients was performed for diagnostic and therapeutic purposes (partial sphincterotomy and stent placement). While none of the patients had complications in the early post-procedure period, one experienced an acute pancreatitis episode in the late post-procedure period.

Conclusion: With the increase in endoscopists' experience and technological developments in different age groups, ERCP is a safe and effective method for diagnosing and treating pancreaticobiliary diseases in children. HIPPOKRATIA 2022, 26 (4):152-156.