Open Lobectomies and Cardiac Biomarkers : vol.17 No1 (2022)

Objective: Troponin is a sensitive biomarker for cardiovascular injury. In lobectomies, perioperative analgesia can be performed with either a combination of thoracic epidural anesthesia and general anesthesia or general anesthesia alone. We wish to demonstrate that patients who receive the former tend to have lower levels of troponin. Method: In this prospective observational study, we included patients who underwent open lobectomy. Cardiovascular markers were recorded postoperatively, in order to correlate the fluctuation of these markers with the application or not of thoracic epidural anesthesia. Results: Forty eight (48) patients were enrolled, 15 (31.3%) received a combination of thoracic epidural anesthesia with general anesthesia, while 33 (68.7%) received general anesthesia alone. Patients with epidural anesthesia were found to have significantly lower levels of troponin 12-24 hours after surgery (8.9±4.1 versus 16.8±10.5, p <0.05), while 48 to 72 hours postoperatively, the troponin values of the two groups did not appear to differ (10.7±6.9 vs. 14.8±8.3, p 0.103). Age, sex and body mass index were not found to be significantly associated with the fluctuation of troponin values in this setting. Conclusion: Patients who undergo open lobectomy receiving a combination of general and thoracic epidural anesthesia appear to maintain lower troponin levels in the immediate postoperative period than patients receiving general anesthesia alone

A Retrospective Study of 120 Patients with Eczema in Greece: Eczema in an Allergic Department in Greece

Object ives: Eczema is a common chronic and troublesome disease for the patients and the parents. The knowledge of the process of disease and management of treatment and comorbidities is important.Methods: This is a retrospective study of 120 patients.Results : A significant number of patients had sensitization of no clinical importance.Most of them responded well to hydration treatment and they did not need more sophisticated drugs.Conclusions: Eczema is a chronic disease with exacerbations and remissions. However,environmental factors rather than foods and aeroallergens contribute to exacerbations.Educating parents and patients properly about the hydration of epidermis and the use of anti-inflammatory drugs could help in long term remissions.

Hartmann’s Procedure for Left Side Large Bowel Emergencies

Background: Colonic emergency situations which need an intervention in emergency are quite common, especially in the left side of the abdomen. The aim of this study is to investigate the importance of Hartmann’s procedure, which has been used for years in such cases. Method: One hundred and fifty-six cases which underwent Hartmann’s procedure due to a left side emergency, either malignant or benign, during over a 15-year period. Results: One hundred and fifty-six patients met the inclusion criteria in the final analysis. Fifty one point nine percent were operated due to malignancy, most of them at an advanced stage (65,4%). Half of them were treated for colonic perforation. Conclusion: Left sided large bowel emergencies are mainly caused by complicated cancer and diverticulitis of the left colon. Hartmann’s procedure remains a safe, simple and fast operation with an acceptable percentage of morbidity and mortality. Also, it continues to play a vital role in elderly and severely ill patients

Cough in Children and Antitussive Drugs in the Office and in Practice

Acute cough is a frequent complaint in pediatric practice. However, there is no acceptable treatment with current knowledge and parents’ common practice is to ask advice from not professional personnel and to use over the counter regimes. This is also a common practice in chronic cough, although the disease has more complex investigation. There are provided data according the etiology and treatment of acute and chronic cough as well as recent literature for anti-tussive medications

The Role of Levocarnitine in the Management of Valproic Acid Intoxication: A Case-Based Review

The administration of L-carnitine to patients with VPA intoxication and CNS depression with normal ammonia concentrations has a rationale, on the grounds that it is a safe compound with no severe adverse effects reported. Herein, we present a case of valproate poisoning with normal ammonia levels and discuss about the therapeutic as well as the prophylactic potential of L-carnitine administration in such cases

Diagnostic Value of Assessment Tools for Sciatica in Clinical Practice: A Systematic Review and Narrative Synthesis

BACKGROUND: Sciatica is one of the most common reasons for seeking healthcare for musculoskeletal pain and can be a challenge to healthcare providers to diagnose and treat. In view of the variability of sciatica symptoms, a great range of patient reported outcome measures (PROMs) and performance-based measures (PBOs) have been developed for its assessment and management, with however, often poor or controversial results in their reliability and discriminative ability.  Accurate diagnosis of sciatica is crucial to ensure appropriate intervention is given. However, to date there is no gold standard to diagnose sciatica. There has been no systematic review conducted to compare the diagnostic validity of assessment tools of sciatica. OBJECTIVE: To evaluate the diagnostic value of tools (PROMs and PBOs) used to assess patients presenting with sciatica. METHODS: This review informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Protocols. PubMed, Science Direct, Cochrane Library, CINAHL, MEDLINE, EMBASE, key journals and grey literature searched rigorously to find diagnostic accuracy studies investigating patient with sciatica. Two independent reviewers conducted the search, extracted the data and assessed risk of bias for included studies using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. The overall quality of included studies evaluated using Grading of Recommendations, Assessment, Development and Evaluation guidelines.  RESULTS: From 8347 studies, 11 studies were included. Nine studies out of the 11 were at risk of bias. Very low level evidence supports the use of dermatomal patterns and low level evidence supports the use of 7 tools (neurological examination, Βragard test, S-LANSS, ID Pain, PDQ, S-DN4, SQST) for diagnosing sciatica. Moderate level evidence supports a cluster of eight signs (age, duration of disease, paroxysmal pain, pain worse in leg than back, typical dermatomal distribution, worse on coughing/sneezing/straining, finger to floor distance and paresis), twenty items of patient history, self-reported items (pain below knee,  which pain worst, numbness pins and needles), question «worsening of pain during sneezing coughing and straining» and Slump test for diagnosing sciatica. Also, moderate level evidence supports the use of the StEP tool for diagnosing lumbar radicular pain, demonstrating high sensitivity (92%) and specificity (97%) values. SLR showed moderate level evidence in one study and high level evidence in another study in diagnosing sciatica with sensitivity 63.46% and specificity 45.88%. CONCLUSIONS: Overall low-moderate level evidence supports the diagnostic utility of the tools examined in this review in diagnosing sciatica.  The weak evidence base is largely due to methodological flaws and indirectness regarding applicability of the included studies. The most promising diagnostic tools include a cluster of 8 patient history/clinical examination signs, the StEP tool and the SLR test. From these results it is easily understood that history taking has a major role as assessment tool of sciatica in clinical practice. Low risk of bias and high level of evidence diagnostic utility studies are needed, in order for stronger recommendations to be mad

Psychosocial Effects of Iron Chelation on Thalassemia Patients

Introduction: Hemodialysis is a serious consequence of transfusions in the treatment of b-thalassemia major. Iron deficiency burdens the psychology of patients and due to the complexity and long process can be abandoned as a treatment. Aim: To study the perceptions and limitations experienced by patients undergoing iron deficiency, as well as the psychological effects. Methodology: The study was conducted in the Mediterranean Anemia Unit of Evangelismos Hospital. The study included patients with b-Mediterranean anemia, who were informed about the purpose of the study and gave signed consent. The research is a qualitative study with semi-structured interviews. Results: The analysis of 70 patient interviews (32 men - 38 women) showed that the majority of patients (54 participants) are regular in iron deficiency therapy, as they find that it improves survival expectancy. Six participants are not regular, as they feel that it limits them significantly, while the rest try to be regular, as they recognize its benefits. 41 participants have a positive attitude towards treatment, of which 13 state that treatment improves their quality of life, while the remaining 29 have a negative attitude towards treatment. Regarding the existence of a supportive environment, 47 participants state that they have a supportive family environment, while 11 participants state that they hide from the family environment and 12 participants have experienced or are still experiencing the stigma due to the disease. Conclusions: It is important to facilitate patients with iron deficiency treatments, which do not limit their daily life. Also, the psychological support of patients with thalassemia is important, so that they overcome the obstacles of the disease and live a life with fewer obstacles