Hippokratia最新文献

Background: Medical education was widely affected by the Coronavirus disease 2019 (COVID-19) pandemic. Long-distance learning was implemented over the traditional educational paradigm. Clinical clerkships were canceled, and evaluation methods were altered. This study aims to assess this multifaceted impact on the Greek undergraduate medical community.

Methods: A cross-sectional survey study was conducted. All undergraduate medical students at Greek Universities were addressed using social media. The data were post-stratified according to the population's male-to-female ratio and underwent descriptive and inferential statistical analysis. Associations were determined using chi-square and Fisher's exact test. A linear regression model was developed to investigate the factors that contributed to the overall impact of the pandemic on medical education.

Results: A total of 905 responses were analyzed, representing 9.8 % of Greece's medical students. Most reported decreased duration of laboratory (n =711, 78.5 %) and clinical (n =526, 96.7 %) practice. The majority stated that their ability to perform practical skills was affected negatively (n =805, 89.0 %). The impact on student's education was positively associated with their psychological impact. Therefore, a more negative effect on the student's education was observed on those whose psychology was affected more negatively [β =0.49, 95 % confidence interval (CI): 0.40, 0.58, p <0.001). Additionally, the pandemic's overall impact on medical education was much more unfavorable for the clinical than the pre-clinical students (β =-0.30, 95 % CI: -0.40, -0.20, p <0.001).

Conclusions: This study's findings agree that the COVID-19 pandemic has severely impacted the education and personal life of medical students, especially in the advanced years. An insight into their specific needs to overcome the impact on their education is provided. The necessity of future mitigating actions is underlined. Emphasis should be given to clinical skills and enhancing the students' adaptive behavior to attenuate the consequences on their psychology, social life, and future healthcare provider careers. HIPPOKRATIA 2022, 26 (2):55-61.

Objective: To comprehensively evaluate the primary performance regarding the task of detecting thrombomodulin (TM), thrombin-antithrombin complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC), and tissue plasminogen activator/plasminogen activator inhibitor-1 complex (t-PAIC) by Sysmex HisCL5000 high sensitivity chemiluminescence analyzer.

Methods: The performance of the chemiluminescence analyzer was evaluated according to the Clinical and Laboratory Standards Institute (CLSI) documents for in-batch precision, daytime precision, carryover rate, linearity, and reference range.

Results: The intra-batch and inter-day variation coefficients of the test items were all less than 5 %, and the contamination rate of each index was less than 10 %. The linear verification analysis showed that the correlation coefficients of TM, TAT, PIC, and t-PAIC were 0.9968, 0.9988, 0.9981, and 0.9930, respectively. The project recommended reference range was applicable to our laboratory.

Conclusion: The high-sensitivity chemiluminescence analyzer has good performance in the detection of TM, TAT, PIC, and t-PAIC and is suitable for the detection of clinical specimens. HIPPOKRATIA 2022, 26 (2):78-82.

Background: Multisystem inflammatory syndrome in children (MIS-C) is a rare complication after infection with Coronavirus disease 2019 (COVID-19), and the differential diagnosis from Kawasaki disease is predominantly based on patients' older age and positive anti-SARS-CoV-2 antibodies in most cases.

Case description: We report an "atypical" case of MIS-C in a 3.5-year-old child, with relatively low levels of inflammatory markers, persistent hyponatremia, and hypoalbuminemia, along with exceptionally high levels of brain natriuretic peptide (BNP) and myocardial dysfunction. Persistent hyponatremia was mainly related to natriuresis, while BNP elevation was a marker of the disease severity, reflecting abnormal cardiac function.

Conclusion: Low inflammatory markers in children under the age of five years should not exclude a possible diagnosis of MIS-C. HIPPOKRATIA 2022, 26 (2):83-85.

Background: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic disease leading to renal complications of pauci-immune focal and segmental necrotizing crescentic glomerulonephritis (PI-NCGN).

Case description: We present a 57-year-old female patient with rapidly progressive glomerulonephritis, multiple systemic infections [candidiasis and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)], severe weight loss, arthralgia, positive myeloperoxidase ANCA, acute deterioration of cardiac function and NCGN with heavy deposition of immunoglobulin (Ig) A and complement 3 (C3) in kidney biopsy. After two months of follow-up and appropriate treatments [methylprednisolone (60 mg/day), cyclophosphamide (15 mg/kg)], our patient recovered from multiple life-threatening infections, including candidiasis treated by fluconazole and SARS-CoV-2 treated by methylprednisolone and acute cardiac failure. In addition, she was saved from dialysis despite all poor prognostic factors.

Conclusion: AAV might lead to immune complex deposition in kidneys due to different pathogenetic mechanisms like complement activation and immune complex formation, apart from losing tolerance to neutrophil proteins. HIPPOKRATIA 2022, 26 (2):86-88.

Background: As hand osteoarthritis (HOA) is a highly prevalent disease, the purpose of the present study was to examine the relationship between structural damage of the hand in HOA patients and assess its impact on their hand function, pain, and satisfaction.

Methods: This prospective cross-sectional study included 60 postmenopausal women aged 60-70 years, all of whom underwent structural damage assessments using the Kellgren-Lawrence scale and the Altman Atlas, as well as completed the Michigan Hand Outcomes Questionnaire (MHQ) to assess their hand function, pain, and satisfaction. To examine the influence of HOA grade on these outcomes, patients were segregated into three groups (grade II-IV), and their average MHQ subscale scores were compared.

Results: The three groups differed in terms of scores achieved on all MHQ subscales: overall hand function-right hand (H =35.42, p <0.001), overall hand function-left hand (H =29.94, p <0.001), activities of daily living-right hand (H =39.88, p <0.001), activities of daily living-left hand (H =33.82, p <0.001), activities of daily living-both hands (H =30.93, p <0.001), activities of daily living-total (H =37.81, p <0.001), work performance (H =32.33, p <0.001), pain-right hand (H =27.94, p <0.001), pain-left hand (H =24.63, p <0.001), appearance-right hand (H =26.28, p <0.001), appearance-left hand (H =23.82, p <0.001), satisfaction-right hand (H =22.40, p =0.001), and satisfaction-left hand (H =26.71, p <0.001).

Conclusion: The study findings reveal that respondents with more severe structural damage experienced more significant pain, reported greater functional and work-related limitations, and were more dissatisfied with the function and appearance of their hands. HIPPOKRATIA 2022, 26 (1):7-12.

Background: The minimal residual disease (MRD) level in patients with B-precursor acute lymphoblastic leukemia (B-ALL) is the strongest independent predictor of relapse and survival. Assessment of MRD plays a crucial role in the treatment of B-ALL.

Case report: We performed long-term monitoring of a 30-year-old woman with B-ALL of standard risk for MRD using multiparametric flow cytometry (MFC). After five years of monitoring, molecular relapse of the disease was confirmed.

Conclusion: This case illustrates that more extended monitoring for MRD, even by only MFC when other newer sophisticated diagnostics are not available, is essential in detecting early relapse in patients with B-ALL of standard risk. HIPPOKRATIA 2022, 26 (1):38-40.