Prevalence and predictors of tuberculin skin positivity in Hellenic Army recruits

BACKGROUND: Tuberculosis (TB) remains one of the leading causes of death among infectious diseases worldwide. Despite its low incidence rates in countries of Western Europe and North America, the resurgence of TB in Eastern Europe and the increased immigration from high-incidence countries imply that extreme vigilance is required in order to detect early, treat, and isolate all new cases. In this study, we analyzed the prevalence and predictors of tuberculin skin testing positivity in Hellenic Army recruits. METHODS: The study population consisted of 953 Greek military recruits enlisted inthe Army during the period from November 2005 toFebruary 2006. Tuberculin skin testing was performed on all study subjects upon enrollment, according to the routine procedures. A tuberculin skin test reaction size >15 mm was considered positive for all study participants. Epidemiological data regarding age, repatriation status, geographic area of residence, smoking habits, and parental occupation were collected by means of personal interviews. In addition, body weight, height, and body mass index were measured. RESULTS: The mean age of the studied subjects (± SD) was 23.5 (± 6.4) years. The overall prevalence of tuberculin positivity was 3.9% (37/953), and bivariable analysis showed that it was associated with lower weight (p = 0.047) and repatriation status (p < 0.001). Tuberculin skin testing was positive in 2.6% of natives (24/900) and 24.5% of repatriates (13/53). A backward, stepwise multivariable logistic regression model showed that only repatriation status was independently associated with tuberculin positivity (p < 0.001; odds ratio [OR]: 14.1; 95% confidence interval [CI]: 6.5–30.3). CONCLUSION: While the incidence of tuberculosis in the native Greek population is low, and comparable to other Western European countries, the extremely high tuberculin positivity in repatriated persons underscores the importance of actively screening for TB in order to promptly identify, isolate, and treat cases of active and latent infection

Structural Modifications of the Brain in Acclimatization to High-Altitude

Adaptive changes in respiratory and cardiovascular responses at high altitude (HA) have been well clarified. However, the central mechanisms underlying HA acclimatization remain unclear. Using voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) with fractional anisotropy (FA) calculation, we investigated 28 Han immigrant residents (17–22 yr) born and raised at HA of 2616–4200 m in Qinghai-Tibetan Plateau for at least 17 years and who currently attended college at sea-level (SL). Their family migrated from SL to HA 2–3 generations ago and has resided at HA ever since. Control subjects were matched SL residents. HA residents (vs. SL) showed decreased grey matter volume in the bilateral anterior insula, right anterior cingulate cortex, bilateral prefrontal cortex, left precentral cortex, and right lingual cortex. HA residents (vs. SL) had significantly higher FA mainly in the bilateral anterior limb of internal capsule, bilateral superior and inferior longitudinal fasciculus, corpus callosum, bilateral superior corona radiata, bilateral anterior external capsule, right posterior cingulum, and right corticospinal tract. Higher FA values in those regions were associated with decreased or unchanged radial diffusivity coinciding with no change of longitudinal diffusivity in HA vs. SL group. Conversely, HA residents had lower FA in the left optic radiation and left superior longitudinal fasciculus. Our data demonstrates that HA acclimatization is associated with brain structural modifications, including the loss of regional cortical grey matter accompanied by changes in the white matter, which may underlie the physiological adaptation of residents at HA

Occupational chemical burns: a 2-year experience in the emergency department

Panagiotis Touzopoulos1, Paul Zarogoulidis2, Alexandros Mitrakas1, Michael Karanikas1, Panagiotis Milothridis1, Dimitrios Matthaios1, Ioannis Kouroumichakis3, Stella Proikaki3, Paschalis Pavlioglou3, Nikolaos Katsikogiannis4, Theodoros C Constantinidis511st University Surgical Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, 2Pulmonary Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, 32nd Internal Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, 4Surgical Department (NHS), University General Hospital of Alexandroupolis, 5Medical School, Laboratory of Hygiene and Environmental Protection, Democritus University of Thrace, Regional Laboratory of Public Health (Eastern Macedonia-Thrace), GreeceAbstract: Chemical burn injuries are a result of exposure to acid, alkali, or organic compounds. In this retrospective study, a total of 21 patients suffering occupational chemical burns, came to the emergency room at the University General Hospital of Alexandroupolis, from 2008 to 2010; 76.2% were workers, 19% were farmers, and 4.8% were desk officers. The majority of burns were due to exposure to acid (61.9%). Upper extremities were the most frequently injured area followed by the lower extremities and thorax. None of the patients needed further hospital care, but in the follow-up, four of the patients suffered keloid. Proper surgical treatment at the emergency room decreases the length of hospital stay for patients who suffer chemically induced burns.Keywords: chemical burns, surgical treatment, labor accident

Current surgical status of thyroid diseases

Panagiotis Touzopoulos1, Michael Karanikas1, Paul Zarogoulidis2, Alexandros Mitrakas1, Konstantinos Porpodis2, Nikolaos Katsikogiannis3, Vasilis Zervas2, Ioannis Kouroumichakis4, Theodoros C Constantinidis5, Dimitrios Mikroulis6, Konstantinos E Tsimogiannis71First Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Alexandroupolis, Greece; 2Pulmonary Department, &amp;quot;G. Papanikolaou&amp;quot; General Hospital, Aristotle University of Thessaloniki, Greece; 3Surgery Department (NHS), University General Hospital of Alexandroupolis, Greece; 4Second Internal Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; 5Medical School, Laboratory of Hygiene and Environmental Protection, Democritus University of Thrace, Regional Laboratory of Public Health, Eastern Macedonia-Thrace, Greece; 6Cardiothoracic Surgery Department, General University Hospital of Alexandroupolis, Democritus University of Thrace, Greece; 7Surgery Department, &amp;quot;G. Hatzikosta&amp;quot; General Hospital of Ioannina, GreeceAbstract: Thyroid nodules are a common clinical problem for surgeons. The clinical importance of nodules is the need to exclude thyroid cancer, which occurs in 5%&amp;ndash;15% of patients. If fine needle aspiration cytology is positive, or suspicious for malignancy, surgery is recommended. During the past decade, with the tendency to develop smaller incisions, an endoscopic approach has been applied to thyroid surgery, called minimally invasive video-assisted thyroidectomy. This approach was immediately followed by other minimally invasive or scarless neck techniques, such as the breast approach, axillary-breast approach, and robot-assisted method. All these techniques follow the same principles of surgery and oncology. This review presents the current surgical management of the thyroid gland, including the surgical techniques and compares them by describing benefits and drawbacks of each one.Keywords: thyroidectomy, surgical techniques, thyroid cance

Clinical differences between influenza A (H1N1) virus and respiratory infection between the two waves in 2009 and 2010

Paul Zarogoulidis,1,2 Dimitrios Glaros,1 Ioannis Kioumis,2 Eirini Terzi,1 Konstantinos Porpodis,2 Anastasios Tsiotsios,2 Anastasios Kallianos,3 Georgia Trakada,4 Nikolaos Machairiotis,1 Aikaterini Stylianakil,1 Antonis Sakas,1 Ageliki Rapti,3 Nikolaos Courcoutsakis,5 Theodoros C Constantinidis,6 Efstartios Maltezos,1 Konstantinos Zarogoulidis21Unit of Infectious Diseases, General University Hospital of Alexandroupolis, Democritus University of Thrace, Komotini, 2Pulmonary Department, &amp;quot;G Papanikolaou&amp;quot; General Hospital, Aristotle University of Thessaloniki, Thessaloniki, 3Second Pulmonology Clinic, Hospital of Chest Diseases &amp;quot;Sotiria&amp;quot;, Athens, 4Pulmonary Department, &amp;quot;Alexandra&amp;quot; General Hospital, University of Athens, Athens, 5Radiology Department, University General Hospital of Alexandroupolis, 6Laboratory of Hygiene and Environmental Protection, Occupational Medicine Section, Democritus University of Thrace, Komotini, GreeceBackground: The purpose of the present retrospective study was to examine the clinical differences between patients hospitalized with H1N1 virus and those hospitalized with nonvirus respiratory tract infection in 2009 and 2010.Methods: Adult patient data were collected from three tertiary hospital centers. Real-time reverse transcriptase polymerase chain reaction testing was used to confirm the diagnosis. We included 106 H1N1-positive patients (52 from 2009 and 54 from 2010). These data were compared with those from 108 patients with H1N1-negative respiratory tract infection (51 patients from 2009 and 57 from 2010).Results: In 2009, the mean age was 36.4 years for H1N1-positive patients versus 46.4 years for H1N1-negative patients, and mean body mass index (BMI) was 26.4 kg/m2 patients and 28.1 kg/m2, respectively. In 2009, seven patients required intubation, six of whom were H1N1-positive. In 2010, the mean age was 43.8 years for H1N1-positive patients versus 60.2 years for H1N1-negative patients, and mean BMI was 32.3 kg/m2 and 26.9 kg/m2, respectively. In 2010, six patients required intubation, three of whom were H1N1-positive. Abnormal chest x-ray findings were found significantly more frequently in H1N1-negative patients than in H1N1-positive patients.Conclusion: In comparison with 2009, H1N1-positive patients in 2010 were older, were more likely to be obese, and had more severe clinical and laboratory perturbations. However, this did not affect their outcomes. H1N1-negative patients were older in comparison with those who were H1N1-positive, and had more severe clinical and laboratory perturbations.Keywords: clinical characteristics, influenza A, H1N1, respiratory infectio

Health costs from hospitalization with H1N1 infection during the 2009&amp;ndash;2010 influenza pandemic compared with non-H1N1 respiratory infections

Paul Zarogoulidis1, Dimitrios Glaros2,3, Theodoros Kontakiotis1, Marios Froudarakis4, loannis Kioumis1, loannis Kouroumichakis3, Anastasios Tsiotsios1, Anastasios Kallianos5, Paschalis Steiropoulos4, Konstantinos Porpodis1, Evagelia Nena6, Despoina Papakosta1, Aggeliki Rapti5, Theodoros C Constantinidis6, Theodora Kerenidi7, Maria Panopoulou8, Georgia Trakada9, Nikolaos Courcoutsakis10, Evangelia Fouka11, Konstantinos Zarogoulidis1, Efstratios Maltezos2,31Aristotle University of Thessaloniki, Pulmonary Department, &amp;quot;G Papanikolaou&amp;quot; Hospital, Exochi, Thessaloniki, 2Unit of Infectious Diseases, General University Hospital of Alexandroupolis, 3Second Department of Internal Medicine, 4Pulmonary Department, General University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, 52nd Pulmonology Clinic, Hospital of Chest Diseases &amp;quot;SOTIRIA,&amp;quot; Athens, 6Laboratory of Hygiene and Environmental Protection, Occupational Medicine Section, Teaching Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Greece, Alexandroupolis, 7Pulmonary Department, University of Larissa, Larissa, 8Microbiology Department, General University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, 9Pulmonary Department, University of Athens, Athens, 10Radiology Department, General University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, 111st Pulmonary Department, &amp;quot;G Papanikolaou&amp;quot; Hospital, Exochi, Thessaloniki, GreeceBackground: The first positive patient with influenza A (H1N1) was recorded in March 2009 and the pandemic continued with new outbreaks throughout 2010. This study&amp;#39;s objective was to quantify the total cost of inpatient care and identify factors associated with the increased cost of the 2009&amp;ndash;2010 influenza A pandemic in comparison with nonviral respiratory infection.Methods: In total, 133 positive and 103 negative H1N1 patients were included from three tertiary care hospitals during the two waves of H1N1 in 2009 and 2010. The health costs for protective equipment and pharmaceuticals and hospitalization (medications, laboratory, and diagnostic tests) were compared between H1N1 positive and negative patients.Results: The objective of the study was to quantify the means of daily and total costs of inpatient care. Overall, cost was higher for H1N1 positive (&amp;euro;61,0117.72) than for H1N1-negative patients (&amp;euro;464,923.59). This was mainly due to the protection measures used and the prolonged hospitalization in intensive care units. In H1N1-negative patients, main contributors to cost included additional diagnostic tests due to concern regarding respiratory capacity and laboratory values, as well as additional radiologic and microbial culture tests. The mean duration of hospitalization was 841 days for H1N1 positive and 829 days for negative patients.Conclusion: Cost was higher in H1N1 patients, mainly due to the protection measures used and the increased duration of hospitalization in intensive care units. An automated system to monitor patients would be desirable to reduce cost in H1N1 influenza.Keywords: cost effect, H1N1, health care resource utilization, respiratory infectio