A Rare Case of a Direct Incarcerated Inguinal Hernia Containing an Epiploic Appendage and a Literature Review

Inguinal hernias are a widespread condition, responsible for a large number of acute abdomen cases. Typically, indirect, rather than direct, hernias are the ones leading to complications, as a consequence of their narrower hernial defect. Our case concerns a rather rare incidence of a direct incarcerated hernia in a 71-year-old man who presented with acute pain in the left inguinal area. Upon clinical examination, an irreducible inguinal mass was palpated. Therefore, the existence of a complicated hernia was suspected. The patient underwent an emergency repair, during which it was established that the hernia was direct and incarcerated and that its sac contained an ischemic epiploic appendage. The hernia was successfully repaired with mesh, the patient recovered uneventfully and was discharged five days later. Despite the rarity of complicated direct inguinal hernias, they should always be included in the differential diagnosis of irreducible groin masses, because they can increase severe complications. Keywords: Direct inguinal hernia; Appendix epiploica

The diagnostic accuracy of carbon monoxide pulse oximetry in adults with suspected acute carbon monoxide poisoning: a systematic review and meta-analysis

IntroductionAcute carbon monoxide poisoning (COP) is one of the leading causes of intoxication among patients presenting to the emergency department (ED). COP symptoms are not always specific and may vary from mild to critical. In the last few years, COHb pulse oximeters have been developed and applied to the setting of suspected COP. The aim of this systematic review is to assess the diagnostic accuracy of CO pulse oximetry (SpCO) with carboxyhemoglobin (COHb) levels measured by blood gas analysis, used as a reference standard, in patients with suspected COP.MethodsWe developed our search strategy according to the PICOS framework, population, index/intervention, comparison, outcome, and study, considering the diagnostic accuracy of SpCO compared to COHb levels measured by blood gas analysis, used as a reference standard, in patients with suspected COP enrolled in cross-sectional studies in English. The search was performed on MEDLINE/PubMed and EMBASE in February 2022. Quality assessment was performed using the QUADAS-2 methodology. A COHb cutoff of 10% was chosen to test the sensitivity and specificity of the index test. A bivariate model was used to perform the meta-analysis. The protocol was registered on PROSPERO (CRD42022359144).ResultsA total of six studies (1734 patients) were included. The pooled sensitivity of the test was 0.65 (95% CI 0.44–0.81), and the pooled specificity was 0.93 (95% CI 0.83–0.98). The pooled LR+ was 9.4 (95% CI 4.4 to 20.1), and the pooled LR- was 0.38 (95% CI 0.24 to 0.62).ConclusionOur results show that SpCO cannot be used as a screening tool for COP in the ED due to its low sensitivity. Because of its high LR+, it would be interesting to evaluate, if SpCO could have a role in the prehospital setting as a tool to quickly identify COP patients and prioritize their transport to specialized hospitals on larger samples with a prospective design

Awareness of sex and gender dimensions among physicians: the European federation of internal medicine assessment of gender differences in Europe (EFIM-IMAGINE) survey

Sociocultural gender is a complex construct encompassing different aspects of individuals' life, whereas sex refers to biological factors. These terms are often misused, although they impact differently on individuals' health. Recognizing the role of sex and gender on health status is fundamental in the pursuit of a personalized medicine. Aim of the current study was to investigate the awareness in approaching clinical and research questions on the impact of sex and gender on health among European internists. Clinicians affiliated with the European Federation of Internal Medicine from 33 countries participated to the study on a voluntary basis between January 1st, 2018 and July 31st, 2019. Internists' awareness and knowledge on sex and gender issues in clinical medicine were measured by an online anonymized 7-item survey. A total of 1323 European internists responded to the survey of which 57% were women, mostly young or middle-aged (78%), and practicing in public general medicine services (74.5%). The majority (79%) recognized that sex and gender are not interchangeable terms, though a wide discrepancy exists on what clinicians think sex and gender concepts incorporate. Biological sex and sociocultural gender were recognized as determinants of health mainly in cardiovascular and autoimmune/rheumatic diseases. Up to 80% of respondents acknowledged the low participation of female individuals in trials and more than 60% the lack of sex-specific clinical guidelines. Internists also express the willingness of getting more knowledge on the impact of sex and gender in cerebrovascular/cognitive and inflammatory bowel diseases. Biological sex and sociocultural gender are factors influencing health and disease. Although awareness and knowledge remain suboptimal across European internists, most acknowledge the underrepresentation of female subjects in trials, the lack of sex-specific guidelines and the need of being more informed on sex and gender-based differences in diseases

Study of the effects of moxonidine on the levels of neuropeptide Y in hypertensive patients with or without obesity

Obesity is a multifactorial disease and its occurrence is associated with genetic and environmental factors. It is also, an important factor of morbidity and mortality and is associated with chronic diseases such as Arterial Hypertension, diabetes, dyslipidaimia and cardiovascular disease, constituting thereby an important public health problem that has modern epidemic characteristics.Obesity coexists with Arterial Hypertension, at a rate of 60-70%, while this coexistence increases the cardiovascular risk. The responsible mechanisms for the Arterial Hypertension in obesity are manifold, but one of the most important that has been shown that is the increased activity of Sympathetic Nervous System (SNS). The main regulator of food intake and energy balance is leptin, which interacts especially with the orexigenic NPY. The levels of leptin in obese patients are increased, while there is resistance to the metabolic actions of leptin. The SNS seems to be involved with the creation of Arterial Hypertension in obesity, through the main expressive of the SNS increased activity, NPY, which increase is parallel with the increase of leptin. In our study NPY was a key design parameter in order to relate the reduction of its levels after treatment with Moxonidine -a centrally acting antihypertensive agent and selective agonist of I1 of imidazoline receptors- with the decreasing of SNS activity and thus, with the reduction of blood pressure, body weight and BMI, and the improvement of glycaemic and lipid profile of patients.In our study, the levels of NPY in combination with the activity of SNS (secretion of catecholamines), were observed in hypertensive patients and they correlated with the body weight, by determining the levels of NPY, urine catecholamines and catecholamines’ metabolites (VMA), before and after treatment with moxonidine.Also, the antihypertensive action of Moxonidine was evaluated, especially according to the reduction of the SNS, with a corresponding effect on NPY, in order to confirm the role of NPY to the pathogenesis and a possible target for the treatment of Arterial Hypertension in obese.The study enrolled 90 patients from the outpatient clinic of the First Propedeutic Pathology Clinic of AHEPA Hospital – Internal medicine Clinic, Hypertension Center (Excellence Center), Obesity Center (Center of Obesity Management – COM) and Lipid outpatient- and patients hospitalized in the First Propedeutic Internal Medicine Clinic. The patients had mild and moderate Arterial Hypertension, according to the guidelines of JNC and ESH / ESC, videlicet first and second grade Arterial Hypertension, that required monotherapy.The patients, after 14 hours fasting, were bled for count of general blood and biochemical parameters (glucose, lipidaimic and renal parameters). Furthermore, in patients determined the levels of plasma NPY, with ELISA method (Enzyme-Linked Immunosorbent Assay) and the levels of urine adrenaline, noradrenaline and VMA in 24 hours measurement.The patients were subdivided according to the BMI in normal weight, overweight and obese, in respective groups by gender. They were treated for 12 weeks with moxonidine, in dose titrated up to 0,6 mg per day, to achieve the objective levels of blood pressure. At the end of this period, determined again the initial measurement of the predetermined markers.After analysis and statistical processing by descriptive (statistical indicators and graphical methods for quantitative description data) and inferential statistical analysis (control two means and analysis of variance), the results of our study are summarized as follows:A reduction was observed in SBP, DBP, heart rate, body weight and BMI, in all patients treated with Moxonidine, regardless of sex and dose. Similarly, there was a decrease of NPY, of urinary catecholamines, and of these urinary metabolite – VMA.Regarding the lipid profile, there was a statistically significant reduction in total cholesterol and in LDL, to all patients, treated with Moxonidine. When the analysis was sex specific, a statistically significant reduction in total and LDL cholesterol values, was seen before and after treatment, in women groups.For the HDL levels there was no statistically significant increase of the mean value after the treatment, but observed an increasing tendency of HDL levels ,before and after treatment, in the total patients and in both sexes.We observed a voltage reduction in triglycerides, in total patients, and in the individual groups, but the difference in their levels after treatment was statistically significant only in the group of obese.Regarding the effect of Moxonidine on glycaemic profile of patients, a clear downward trend was observed in overweight, in obese and in total patients and by gender.A decreasing trend was observed regarding the levels of uric acid, by the administration of Moxonidine, both in total and in separate groups, but this reduction was not able to reach statistical significance. Also, the renal function, as estimated using the biochemical markers of urea and creatinine, was not affected.Finally there was a significant reduction in the level of white blood cells after administration of Moxonidine, in the total patients, in the group of obese, obese men and obese women and there was an increasing tendency in overweigt, overweigt men and overweigt women. These finds also, reflects the reduction in the tone of SNS, by granting Moxonidine.When the groups were compared with each other, there was no statistically significant difference in mean reduction in SBP and DBP. In contrast, there was a difference in mean reduction of BMI and NPY, with the largest mean decrease in the group of obese and overweight compared with the group of normal weight. It was observed a reduction of the mentioned clinical and laboratory indices when the comparison was regard sex, with some individual variations, but with out clinical value.It is concluded, that the administration of Moxonidine, a centrally acting sympatholytic drug, in patients with Arterial Hypertension, obese or not, results in a significant reduction of blood pressure -SBP and DBP- and heart rate and affects favorably on metabolic, glycaemic and lipid profile of these patients. The decrease of NPY, which is the main biochemical exponent of SNS activity, causes a reduction in body weight, BMI and this makes the Moxonidine an antihypertensive agent with potential "pleiotropic" actions.Based on our stydy results, it may be revealed a new possible use of NPY, because this sensitive indicator is easy to measure and also, in daily clinical practice can be a therapeutic goal and simultaneously a prognostic factor of response of hypertensive obese patients in Moxonidine treatment.In particular, the detection of high levels of NPY before initiation of treatment, indicating the increased activity of SNS, as the main pathophysiological mechanism creation of Arterial Hypertension in the patients of the study, compared to other involved mechanisms (hyperinsulinemia, increased fluid retention, increased activity of cellular pumps, such as sodium-hydrogen, hypertrophy-hyperplasia of smooth muscle). Therefore, as a consequence, the inhibition of SNS activity, with a centrally acting drug, such as Moxonidine, which simultaneously has a neutral or favorable effect on metabolic profile of patients and can significantly reduce both blood pressure, and weight gain, that accords with the NPY reduction, obtains a particular indication.Η παχυσαρκία είναι πολυπαραγοντική νόσος, με την εκδήλωση της οποίας, σχετίζονται τόσο γενετικοί, όσο και περιβαλλοντικοί παράγοντες. Αποτελεί σημαντικό παράγοντα νοσηρότητας και θνησιμότητας, δεδομένου ότι συνδέεται με χρόνιες παθήσεις, και κυρίως με την ΑΥ, τον ΣΔ, την δυσλιπιδαιμία και την καρδιαγγειακή νόσο, αποτελώντας κατ’ επέκταση ένα σημαντικό πρόβλημα δημόσιας γείας, που προσλαμβάνει χαρακτηριστικά σύγχρονης επιδημίας.Συνυπάρχει με ΑΥ, σε ποσοστό 60-70%, ενώ η συνύπαρξη ΑΥ και παχυσαρκίας αυξάνει τον κίνδυνο νοσηρότητας και θνητότητας, από καρδιαγγειακή νόσο. Οι μηχανισμοί που είναι υπεύθυνοι για την ΑΥ της παχυσαρκίας είναι πολλαπλοί, ένας όμως από τους σημαντικότερους έχει αποδειχθεί ότι είναι η αυξημένη δραστηριότητα του ΣΝΣ. Ο κύριος ρυθμιστής της λήψης τροφής και της ενεργειακής ισορροπίας, είναι η λεπτίνη, η οποία αλληλεπιδρά κυρίως με το ορεξιογόνο NPY. Τα επίπεδα της λεπτίνης στους παχύσαρκους ασθενείς είναι αυξημένα, ενώ ταυτόχρονα παρατηρείται αντίσταση στις μεταβολικές δράσεις της λεπτίνης. Το ΣΝΣ φαίνεται να υπεισέρχεται στην πρόκληση ΑΥ στην παχυσαρκία, με κύριο εκφραστή της αυξημένης δραστηριότητάς του, το ΝΡΥ, το οποίο αυξάνεται παράλληλα με την αύξηση της λεπτίνης. Στη μελέτη μας το ΝΡΥ αποτέλεσε βασική παράμετρο της έρευνας, προκειμένου να συσχετισθεί η μείωση των επιπέδων του, μετά την αγωγή με Μοξονιδίνη -ένα κεντρικώς δρων αντιυπερτασικό και εκλεκτικό αγωνιστή των I1 υποδοχέων της ιμιδαζολίνης- με την μείωση της δραστηριότητας του ΣΝΣ και κατ’ επέκταση με την μείωση της ΑΠ, αλλά και ενδεχόμενη μείωση του σωματικού βάρους και του ΔΜΣ, καθώς και τη βελτίωση του γλυκαιμικού και λιπιδαιμικού προφίλ των ασθενών.Μελετήθηκαν τα επίπεδα του NPY σε συνδυασμό με την δραστηριότητα του ΣΝΣ (έκκριση κατεχολαμινών), σε υπερτασικούς ασθενείς και έγινε συσχέτισή τους με το σωματικό βάρος. Προσδιορίσθηκαν τα επίπεδα του NPY και των κατεχολαμινών ούρων και μεταβολιτών αυτών (VMA), πριν και μετά θεραπεία με Μοξονιδίνη. Εκτιμήθηκε η αντιυπερτασική δράση της Μοξονιδίνης και ειδικότερα μέσω μείωσης της δραστηριότητας του ΣΝΣ, με αντίστοιχη δράση στο NPY, με σκοπό την επιβεβαίωση του ρόλου του, τόσο στην παθογένεση, όσο και ως ενδεχόμενου στόχου στην θεραπεία της ΑΥ των παχύσαρκων.Στη μελέτη εντάχθηκαν 90 ασθενείς από τα εξωτερικά ιατρεία της Α’ Προπαιδευτικής Παθολογικής Κλινικής του Νοσοκομείου ΑΧΕΠΑ -Παθολογικό Ιατρείο, Ιατρείο Αριστείας Υπέρτασης (Excellence Center), Ιατρειο Παχυσαρκίας (Center of Obesity Management - COM) και Ιατρείο Λιπιδίων- καθώς και ασθενείς που νοσηλεύθηκαν στην Α’ Προπαιδευτική Παθολογική Κλινική. Οι ασθενείς είχαν ήπια και μέτρια ΑΥ, σύμφωνα με τις οδηγίες της JNC και του ESH/ESC, δηλαδή 1ου και 2ου βαθμού, που απαιτούσε μονοθεραπεία.Πέραν των γενικών αιματολογικών και βιοχημικών εξετάσεων, έγινε έλεγχος της γλυκόζης, των λιπιδαιμικών παραμέτρων και της νεφρικής λειτουργίας, ενώ στους ασθενείς προσδιορίσθηκαν τα επίπεδα NPY πλάσματος (με τη μέθοδο ELIZA - Enzyme-Linked Immunosorbent Assay) καθώς και η αδρεναλίνη, η νοραδρεναλίνη και το VMA ούρων/ 24 ώρου. Οι ασθενείς διακρίθηκαν ανάλογα με τον ΔΜΣ σε φυσιολογικού βάρους, υπέρβαρους, και παχύσαρκους, σε αντίστοιχες ομάδες και ανά φύλο ισομερώς. Έλαβαν αγωγή για 12 εβδομάδες με Μοξονιδίνη, σε δόση τιτλοποιούμενη μέχρι 0,6 mg ημερησίως, ώστε να επιτευχθούν τα επίπεδα ΑΠ- στόχου. Στο τέλος αυτής της περιόδου προσδιορίσθηκαν εκ νέου οι αρχικές μετρήσεις των προκαθορισμένων δεικτών.Μετά την ανάλυση και την στατιστική επεξεργασία με περιγραφική (στατιστικοί δείκτες και γραφικές μέθοδοι για περιγραφή ποσοτικών δεδομένων) και συμπερασματική στατιστική επεξεργασία (έλεγχος δύο μέσων τιμών και ανάλυση διασποράς), τα αποτελέσματα της μελέτης μας συνοψίζονται στα εξής:Παρατηρήθηκε στατιστικά σημαντική μείωση της ΣΑΠ, της ΔΑΠ, της καρδιακής συχνότητας, του σωματικού βάρους και του ΔΜΣ, σε όλες τις ομάδες των ασθενών που έλαβαν Μοξονιδίνη, ανεξάρτητα από το φύλο και τη δόση χορήγησης. Παρομοίως, παρατηρήθηκε στατιστικά σημαντική μείωση του ΝΡΥ, των κατεχολαμινών ούρων, καθώς και του μεταβολίτη αυτών - VMA - στα ούρα. Αναφορικά με το λιπιδαιμικό προφίλ, παρατηρήθηκε στατιστικά σημαντική μείωση της ολικής και LDL χοληστερόλης, στο σύνολο των ασθενών που έλαβαν Μοξονιδίνη, ενώ όταν η ανάλυση έγινε επιμέρους για τα δύο φύλα, μόνο στις γυναίκες διατηρήθηκε η ύπαρξη σημαντικότητας για την μείωση των μέσων τιμών ολικής και LDL χοληστερόλης, πριν και μετά τη χορήγηση.Στην HDL δεν παρατηρήθηκε στατιστικά σημαντική αύξηση της μέσης τιμής, μετά τη θεραπεία, αλλά μία αυξητική τάση της HDL, πριν και μετά την αγωγή, τόσο στο σύνολο, όσο και στα δύο φύλα.Παρατηρήθηκε τάση μείωσης στα τριγλυκερίδια, τόσο στο σύνολο, όσο και στις επιμέρους ομάδες, ωστόσο η διαφορά των επιπέδων τους μετά την αγωγή, κατέστη στατιστικά σημαντική μόνο στο σύνολο των παχύσαρκων.Αναφορικά με την επίδραση της Μοξονιδίνης στο γλυκαιμικό προφίλ των ασθενών, παρατηρήθηκε σαφής τάση μείωσης, στους υπέρβαρους και στους παχύσαρκους, αλλά και στο σύνολο, όσο και ανά φύλο.Τάση μείωσης παρατηρήθηκε και αναφορικά με τα επίπεδα του ουρικού οξέος με τη χορήγηση Μοξονιδίνης, τόσο στο σύνολο, όσο και στις επιμέρους ομάδες, χωρίς ωστόσο η μείωση αυτή να φθάσει σε επίπεδα στατιστικής σημαντικότητας. Επίσης, δεν επηρεάσθηκε η νεφρική λειτουργία, όπως εκτιμήθηκε με τους βιοχημικούς δείκτες ουρίας και κρεατινίνης.Τέλος παρατηρήθηκε στατιστικά σημαντική μείωση του αριθμού των λευκών αιμοσφαιρίων, μετά τη χορήγηση Μοξονιδίνης, στο σύνολο, στην ομάδα των παχύσαρκων, στην ομάδα των παχύσαρκων ανδρών και των παχύσαρκων γυναικών, ενώ τάση μείωσης στους υπέρβαρους, τόσο στο σύνολο, όσο και ανά φύλο. Το παραπάνω εύρημα αντικατοπτρίζει επίσης την μείωση του τόνου του ΣΝΣ, με τη χορήγηση Μοξονιδίνης.Κατά τη σύγκριση των ομάδων μεταξύ τους, δεν παρατηρήθηκε στατιστικά σημαντική διαφορά στη μέση μείωση της ΣΑΠ και ΔΑΠ. Αντίθετα, παρατηρήθηκε διαφορά στη μέση μείωση του ΔΜΣ και του ΝΡΥ, με τη μεγαλύτερη μέση μείωση να παρατηρείται στην ομάδα των παχύσαρκων και υπέρβαρων σε σχέση με αυτή των νορμοβαρών. Παρατηρήθηκε μείωση των προαναφερθέντων κλινικών και εργαστηριακών δεικτών και όταν η σύγκριση αφορούσε το κάθε φύλο ξεχωριστά, με κάποιες επιμέρους διαφοροποιήσεις, χωρίς κλινική σημασία.Συμπεραίνεται, ότι η χορήγηση Μοξονιδίνης, σε ασθενείς με ΑΥ, παχύσαρκους και μη, ως κεντρικώς δρων συμπαθολυτικό, επιφέρει σημαντική μείωση της ΑΠ –ΣΑΠ και ΔΑΠ-, αλλά και της καρδιακής συχνότητας, ενώ επιδρά ευμενώς και στο μεταβολικό, το γλυκαιμικό και το λιπιδαιμικό προφίλ των ασθενών αυτών. Μέσω δε της μείωσης του ΝΡΥ, που αποτελεί και κύριο βιοχημικό εκφραστή της δραστηριότητας του ΣΝΣ, προκαλεί και μείωση του σωματικού βάρους και του ΔΜΣ επιβεβαιώνοντας με τον τρόπο αυτό την υπόθεση ότι αποτελεί ένα αντιυπερτασικό με δυνητικές «πλειότροπες» δράσεις.Με βάση τα αποτελέσματα της μελέτης μας, δίνεται μία νέα προοπτική χρήσης του ΝΡΥ, διότι ο ευαίσθητος αυτός δείκτης, είναι σχετικά εύκολα μετρήσιμος, δυνατόν δε στην καθημέρα κλινική πράξη να αποτελεί θεραπευτικό στόχο και ταυτόχρονα προγνωστικό δείκτη ανταπόκρισης των παχύσαρκων υπερτασικών ασθενών στην αγωγή με Μοξονιδίνη.Συγκεκριμένα, η ανεύρεση υψηλών επιπέδων του ΝΡΥ πριν την έναρξη της αγωγής, υποδηλώνει την αυξημένη δραστηριότητα του ΣΝΣ, ως τον κύριο παθοφυσιολογικό μηχανισμό πρόκλησης ΑΥ στην πληθυσμιακή αυτή ομάδα, σε σχέση με άλλους μηχανισμούς που υπεισέρχονται (υπερινσουλιναιμία, αντίσταση στην ινσουλίνη, αυξημένη κατακράτηση υγρών, αυξημένη δραστηριότητα κυτταρικών αντλιών, όπως νατρίου- υδρογόνου, υπερτροφία- υπερπλασία αγγειακών λείων μυϊκών ινών). Έτσι και κατά συνέπεια, η αναστολή της δραστηριότητας του ΣΝΣ μ΄ ένα κεντρικώς δρων φάρμακο, όπως η Μοξονιδίνη, που ταυτόχρονα έχει ουδέτερη ή ευμενή επίδραση στο μεταβολικό προφίλ των ασθενών, αποκτά ιδιαίτερη ένδειξη, με δυνατότητα σημαντικής μείωσης, τόσο της ΑΠ, όσο και του σωματικού βάρους, ανάλογης και με προκαλούμενη μείωση του ΝΡΥ

Gestational Diabetes, Colorectal Cancer, Bariatric Surgery, and Weight Loss among Diabetes Mellitus Patients: A Mini Review of the Interplay of Multispecies Probiotics

Diabetes mellitus has been steadily increasing over the past decades and is one of the most significant global public health concerns. Diabetes mellitus patients have an increased risk of both surgical and post-surgical complications. The post-surgical risks are associated with the primary condition that led to surgery and the hyperglycaemia per se. Gut microbiota seems to contribute to glucose homeostasis and insulin resistance. It affects the metabolism through body weight and energy homeostasis, integrating the peripheral and central food intake regulatory signals. Homeostasis of gut microbiota seems to be enhanced by probiotics pre and postoperatively. The term probiotics is used to describe some species of live microorganisms that, when administered in adequate amounts, confer health benefits on the host. The role of probiotics in intestinal or microbial skin balance after abdominal or soft tissue elective surgeries on DM patients seems beneficial, as it promotes anti-inflammatory cytokine production while increasing the wound-healing process. This review article aims to present the interrelation of probiotic supplements with DM patients undergoing elective surgeries

What Do Cancer Surgery and orthopedic Surgery Elderly Patients Have in Common? A Long-term Postoperative Cognitive Dysfunction in Orthopedic and Cancer Patients Original Research

Objectives-background: Postoperative cognitive dysfunction (POCD) involves decline in several cognitive domains after surgery and is particularly common after cardiac surgery, while also common among other types of surgery. Given the potential effects of such cognitive dysfunction on the quality of life, it is important to study it in multiple populations in order to limit its occurrence. Study design: We present the long-term neuropsychological outcome of 200 patients, 100 of whom had orthopedic surgery and 100 oncological surgery. Methods: We administered a series of neuropsychological tests assessing attention, complex scanning, verbal working memory, executive functioning, short-term and long-term memory, and visuospatial perception before surgery, prior to discharge, at 3-month follow-up and 6 years after surgery. We compared the performance of these patients to normative datasets. Results: Despite equivalent levels of pre-surgery performance between patients, oncology patients exceeded their preoperative neurocognitive levels, suggesting less postoperative cognitive dysfunction in orthopedic patients overall, in all neuropsychological domains at a 6-year follow-up, except short-term retention. In contrast, orthopedic patients showed no improvement, and, instead, showed some cognitive decline, which remained consistent over time. Conclusions: Our findings highlight the critical role of the type of surgery utilized in the development of POCD and have implications for clinical management and patients’ quality of life in the very long term. Health policy professionals should be aware that patients’ low POCD may persist in the long term, and this is useful from a clinician’s point of view

The Diagnostic Accuracy of SARS-CoV-2 Nasal Rapid Antigen Self-Test: A Systematic Review and Meta-Analysis

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of coronavirus disease 2019 (COVID-19), a disease that quickly spread into a pandemic. As such, management of the COVID-19 pandemic is deemed necessary, and it can be achieved by using reliable diagnostic tests for SARS-CoV-2. The gold standard for the diagnosis of SARS-CoV-2 is a molecular detection test using the reverse transcription polymerase chain reaction technique (rt-PCR), which is characterized by various disadvantages in contrast with the self-taken nasal rapid antigen tests that produce results faster, have lower costs and do not require specialized personnel. Therefore, the usefulness of self-taken rapid antigen tests is indisputable in disease management, facilitating both the health system and the examinees. Our systematic review aims to access the diagnostic accuracy of the self-taken nasal rapid antigen tests. Methods: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to assess the risk of bias in the included studies. All the studies included in this systematic review were found after searching the two databases, Scopus and PubΜed. All but original articles were excluded from this systematic review, while all the studies concerning self-taken rapid antigen tests with a nasal sample and using rt-PCR as a reference test were included. Meta-analysis results and plots were obtained using RevMan software and the MetaDTA website. Results: All 22 studies included in this meta-analysis demonstrated a specificity of self-taken rapid antigen tests greater than 98%, which exceeds the minimum required yield for the diagnosis of SARS-CoV-2, according to the WHO. Notwithstanding, the sensitivity varies (from 40% to 98.7%), which makes them in some cases unsuitable for the diagnosis of positive cases. In the majority of the studies, the minimum required performance set by the WHO was achieved, which is 80% compared with rt-PCR tests. The pooled sensitivity of self-taken nasal rapid antigen tests was calculated as 91.1% and the pooled specificity was 99.5%. Conclusions: In conclusion, self-taken nasal rapid antigen tests have many advantages over rt-PCR tests, such as those related to the rapid reading of the results and their low cost. They also have considerable specificity and some self-taken rapid antigen test kits also have remarkable sensitivity. Consequently, self-taken rapid antigen tests have a wide range of utility but are not able to completely replace rt-PCR tests

The Diagnostic Accuracy of SARS-CoV-2 Nasal Rapid Antigen Self-Test: A Systematic Review and Meta-Analysis

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of coronavirus disease 2019 (COVID-19), a disease that quickly spread into a pandemic. As such, management of the COVID-19 pandemic is deemed necessary, and it can be achieved by using reliable diagnostic tests for SARS-CoV-2. The gold standard for the diagnosis of SARS-CoV-2 is a molecular detection test using the reverse transcription polymerase chain reaction technique (rt-PCR), which is characterized by various disadvantages in contrast with the self-taken nasal rapid antigen tests that produce results faster, have lower costs and do not require specialized personnel. Therefore, the usefulness of self-taken rapid antigen tests is indisputable in disease management, facilitating both the health system and the examinees. Our systematic review aims to access the diagnostic accuracy of the self-taken nasal rapid antigen tests. Methods: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to assess the risk of bias in the included studies. All the studies included in this systematic review were found after searching the two databases, Scopus and PubΜed. All but original articles were excluded from this systematic review, while all the studies concerning self-taken rapid antigen tests with a nasal sample and using rt-PCR as a reference test were included. Meta-analysis results and plots were obtained using RevMan software and the MetaDTA website. Results: All 22 studies included in this meta-analysis demonstrated a specificity of self-taken rapid antigen tests greater than 98%, which exceeds the minimum required yield for the diagnosis of SARS-CoV-2, according to the WHO. Notwithstanding, the sensitivity varies (from 40% to 98.7%), which makes them in some cases unsuitable for the diagnosis of positive cases. In the majority of the studies, the minimum required performance set by the WHO was achieved, which is 80% compared with rt-PCR tests. The pooled sensitivity of self-taken nasal rapid antigen tests was calculated as 91.1% and the pooled specificity was 99.5%. Conclusions: In conclusion, self-taken nasal rapid antigen tests have many advantages over rt-PCR tests, such as those related to the rapid reading of the results and their low cost. They also have considerable specificity and some self-taken rapid antigen test kits also have remarkable sensitivity. Consequently, self-taken rapid antigen tests have a wide range of utility but are not able to completely replace rt-PCR tests

Exploring the Role of ACE2 as a Connecting Link between COVID-19 and Parkinson’s Disease

Coronavirus disease 2019 (COVID-19) is frequently accompanied by neurological manifestations such as headache, delirium, and epileptic seizures, whereas ageusia and anosmia may appear before respiratory symptoms. Among the various neurological COVID-19-related comorbidities, Parkinson’s disease (PD) has gained increasing attention. Some cases of PD disease have been linked to COVID-19, and both motor and non-motor symptoms in Parkinson’s disease patients frequently worsen following SARS-CoV-2 infection. Although it is still unclear whether PD increases the susceptibility to SARS-CoV-2 infection or whether COVID-19 increases the risk of or unmasks future cases of PD, emerging evidence sheds more light on the molecular mechanisms underlying the relationship between these two diseases. Among them, angiotensin-converting enzyme 2 (ACE2), a significant component of the renin-angiotensin system (RAS), seems to play a pivotal role. ACE2 is required for the entry of SARS-CoV-2 to the human host cells, and ACE2 dysregulation is implicated in the severity of COVID-19-related acute respiratory distress syndrome (ARDS). ACE2 imbalance is implicated in core shared pathophysiological mechanisms between PD and COVID-19, including aberrant inflammatory responses, oxidative stress, mitochondrial dysfunction, and immune dysregulation. ACE2 may also be implicated in alpha-synuclein-induced dopaminergic degeneration, gut–brain axis dysregulation, blood–brain axis disruption, autonomic dysfunction, depression, anxiety, and hyposmia, which are key features of PD

Pyogenic Liver Abscess Complicating Acute Cholecystitis: Different Management Options

Acute cholecystitis, which is usually associated with gallstones is one of the most common surgical causes of emergency hospital admission and may be further complicated by mural necrosis, perforation and abscess formation. Perforation of the gallbladder is a relatively uncommon complication of acute cholecystitis (0.8–3.2% in recent reviews). The intrahepatic perforation causing a liver abscess is an extremely rare condition, anecdotally reported in the scientific literature, even in the rare types of subacute or acute perforation. Liver abscess caused by gallbladder perforation can be a life-threatening complication with a reported mortality of 5.6%. The treatment of synchronous pyogenic liver abscess and acute cholecystitis may be challenging. We reported three cases of liver abscess due to acute cholecystitis in which different therapeutical approaches were employed. The first case was treated with antibiotics and interval laparoscopic cholecystectomy; the second case was treated with emergency cholecystectomy; and the third case with percutaneous aspiration of the abscess only. The appropriate therapeutical method in these cases depends on the patient’s clinical condition, the on-site expertise that is available in the hospital, and the experience of the surgeon