Knowledge and beliefs about HPV infection and the relevant vaccination in Greek young population

Background: Infection by HPV oncogenic subtypes is the causative agent of half a million cancer cases in developed countries every year. The objective of the present study was to assess: the knowledge and beliefs of young Greeks about HPV infection and potential factors that discourage them from HPV vaccination. Materials and Methods: The present group consisted of 825 individuals, 18-35-years-old, who voluntarily completed some questionnaires. Results: The attitude and consequent decision of women, considering HPV vaccination is associated with general vaccination attitude, mothers' beliefs, parents' educational level, family income, knowledge about HPV, the doctor's attitude, and individual's health beliefs. Conclusion: In Greece, as well as in other countries where HPV vaccination is neither a mandatory nor a school-based program, increased education of physicians and parents would substantially enhance HPV vaccination acceptance. Intervention strategies should focus more on providing adequate and reliable information to eliminate any doubts on HPV vaccine's safety and efficacy

Spread of subarachnoid block, intraoperative local anaesthetic requirements and postoperative analgesic requirements in Caesarean section and total abdominal hysterectomy

Background. Pregnancy is associated with a higher spread of subarachnoid anaesthesia and increased pain threshold. The study was designed to assess the spread of subarachnoid block and the intra- and postoperative analgesic requirements in pregnant vs non-pregnant women. Methods. We assessed the level of subarachnoid anaesthesia after 1.8 ml of hyperbaric lidocaine 5% and the postoperative analgesic requirements in women undergoing Caesarean section and undergoing abdominal hysterectomy (30 each group). Intraoperatively epidural ropivacaine was given as required. All patients received 10 ml of ropivacaine 0.2% epidurally 2, 10, and 24 h after operation and the VAS pain score was assessed. They also had access to patient controlled analgesia i.v. morphine. Results. Duration of surgery was 64 (13.7) vs 127 (33.8) min (P<0.0001) in the pregnant and non-pregnant groups. Ten minutes after subarachnoid injection, sensory block was higher by three dermatomes in the pregnant group (P<0.0001). Time to first ropivacaine dose was 37 (19.7) vs 19 (12.2) min (P<0.001) and the ropivacaine normalized for the duration of anaesthesia was 0.8 (0.6) vs 1.3 (0.5) mg(-1) (P=0.001) in the pregnant and non-pregnant groups, respectively. The time between the first and second ropivacaine dose was similar in the two groups (P=0.070). Fewer pregnant women (81 vs 100%) required ropivacaine intraoperatively (P=0.017). The VAS scores were similar but parturients consumed more i.v. morphine (33 (14) vs 24 (12) mg, P=0.016) during the first 24 h after operation. Conclusions. Pregnant patients exhibited a higher level of subarachnoid sensory block and required more i.v. morphine after operation

Uptake and metabolism of [H-3]anandamide by rabbit platelets - Lack of transporter?

Anandamide is an endogenous ligand for cannabinoid receptor and its protein-mediated transport across cellular membranes has been demonstrated in cells derived from brain as well as in cells of the immune system. This lipid is inactivated via intracellular degradation by a fatty acid amidohydrolase (FAAH). In the present study, we report that rabbit platelets, in contrast to human platelets, do not possess a carrier-mediated mechanism for the transport of [H-3]anandamide into the cell, i.e. cellular uptake was not temperature dependent and its accumulation was not saturable. This endocannabinoid appears to enter the cell by simple diffusion. Once taken up by rabbit platelets, [H-3]anandamide was rapidly metabolized into compounds which were secreted into the medium. Small amounts of free arachidonic acid as well as phospholipids were amongst the metabolic products. FAAH inhibitors did not decrease anandamide uptake, whereas these compounds inhibited anandamide metabolism. In conclusion, anandamide is rapidly taken up by rabbit platelets and metabolized mainly into water-soluble metabolites. Interestingly, the present study also suggests the absence of a transporter for anandamide in these cells

Anandamide amidohydrolase activity, released in the medium by Tetrahymena pyriformis. Identification and partial characterization

Anandamide, an endogenous cannabinoid receptor ligand, was rapidly metabolized by Tetrahymena pyriformis in vivo. Metabolic products were mainly phospholipids as well as neutral lipids, including small amounts of free arachidonic acid. Anandamide amidohydrolase activity was detected in the culture medium by the release of [H-3]arachidonic acid from [H-3]anandamide, in a time- and concentration-dependent manner. Kinetic experiments demonstrated that the released enzyme had an apparent K-m, of 3.7 muM and V-max 278 pmol/min/mg protein. Amidohydrolase activity was maximal at pH 9-10, was abolished by phenylmethylsulfonyl fluoride and was Ca2+- and Mg2+-independent. Thus, T. pyriformis is capable of hydrolyzing anandamide in vivo and releasing amidohydrolase activity. (C) 2001 Federation of European Biochemical Societies. Published by Elsevier Science B.V. All rights reserved

Ropivacaine spinal anesthesia is not antagonized by ondansetron pretreatment

BACKGROUND:: We investigated a possible effect of ondansetron on the duration of sensory and motor block produced by ropivacaine. METHODS:: Fifty male patients undergoing transurethral surgery received either 8 mg oral ondansetron the evening before surgery plus IV 8 mg ondansetron 15 min before subarachnoid anesthesia or placebo. All patients received 2.2 mL of 0.75% plain ropivacaine intrathecally. Sensory and motor block were assessed 30 min after the intrathecal injection and every 30 min thereafter until recovery from the motor block. RESULTS:: Thirty minutes after spinal injection of ropivacaine, we first measured, in both groups, the time to maximum block for both sensory and motor modalities. The maximum level of the sensory block, defined as decreased sensation, was T8 in the control and T6 in the ondansetron group, and absence of sensation was defined as T11 and T9 for the control and the ondansetron groups, respectively. Regarding block duration, 180 min after spinal injection, sensory block was detected in 11 of 22 and 16 of 24 patients and motor block in 1 of 22 and 0 of 24 in the control and ondansetron groups, respectively. Sensory and motor block did not differ between groups at any measured time point. CONCLUSIONS:: Ondansetron had no effect on the subarachnoid sensory or motor block produced by ropivacaine. Copyright © 2009 International Anesthesia Research Society

Cancer pain relief by epidural PCA pump infusion through tunneled epidural catheters

Introduction. Seventy to eighty percent of terminally -ill cancer patients will experience moderate to severe pain at some stage of their illness. At present most of these will die in pain. The main reasons for failure to achieve control of this pain are inexperience and lack of knowledge of the simple principles of effective analgesic use, and in many countries the non-availability of strong opioid analgesics. Most of us accept that administering opioids orally is the best route because of simplicity and cost effectiveness. However, elementary gastrointestinal dysfunction is an indication that alternative routes of drug administration must be used. Subcutaneous, intraspinal, transdermal and transmucosal administrations are some of the more widely - accepted alternative routes. Spinal analgesia by epidural or intrathecal analgesic infusion has become a valuable tool in the treatment of cancer pain. We report here our results of 10 years experience in pain relief and palliative care at the university of Athens, using epidural PCA pump infusion through tunneled epidural catheters. Methods. One hundred and seventy - four patients with different kinds of abdominal cancer all experiencing from average to extreme pain were selected for pain relief with EPCA, using tunneled epidural catheters. The study took place after the approval of the University's Ethics Committee. All the patients had a routine epidural procedure using a standard nylon Portex epidural catheter 16 G that was tunneled subcutaneously and externalized in the umbilicus area. All also had a portable Pharmacia PCA pump. Micropore filters were employed in all cases and changed every five days. The analgesic mixture of preference was morphine, bupivacaine 0,5% and clonidine. The dose chosen to start the infusion depended on the previous dose of the oral morphine. The mean dose of initial morphine was 1.5-5 and the maximum dose 4.5 - 80mg/24h. For bupivacaine this was 60 - 70mg and for clonidine 75 - 600ug daily. The average number of catheter days per patient was 80.2 (2-875 days). All th'j patients were asked to answer the question whether the relief of pain and the patient's quality of life are synonymous. The VAS, the complications, the side-effects and the quality of life were assessed. Results Our results showed first that while the pain level before implanting the epidural catheter was 8-10 (x =8.8) the pain level following EPCA was 1-3 ( x =2.2). Secondly, regarding complications, only one patient (0.64%) suffered from epidural abscess and 8 patients (5.19%) experienced some form of infection in the catheter insertion site. This infection was treated successfully with antibiotics. Moreover, only 4 of the 154 catheters became occluded. The major side-effect was constipation in 32 patients (21.8%, while 22 patients (12.6%) suffered from nausea and vomiting. None of our patients showed respiratory depression. 90,8% of our patients answered that their quality of life depended completely on their pain relief. The rest answered that nursing care, psychological support and family support were as equally important as pain relief. Discussion The results suggest that EPCA pump infusion can offer good analgesia and an improved quality of life for terminally - ill cancer patients. We believe that further advances in producing drug delivery systems that are less invasive, more versa life and expensive will lead to the wider use of the PCA system

Using Receiver Operating Characteristic Curve to Define the Cutoff Points of Voice Handicap Index Applied to Young Adult Male Smokers

Voice performance is an inextricable key factor of everyday life. Obviously, the deterioration of voice quality can cause various problems to human communication and can therefore reduce the performance of social skills (relevant to voice). The deterioration could be originated from changes inside the system of the vocal tract and larynx. Various prognostic methods exist, and among them is the Voice Handicap Index (VHI). This tool includes self-reported questionnaires, used for determining the cutoff points of total score and of its three domains relevant to young male Greek smokers. The interpretation of the calculated cutoff points can serve as a strong indicator of imminent or future evaluation by a clinician. Consistent with previous calculation, the VHI can also act as a feedback for smokers’ voice condition and as monitoring procedure toward smoking cessation. Specifically, the sample consisted of 130 male nondysphonic smokers (aged 18–33 years) who all participated in the VHI test procedure. The test results (through receiver operating characteristic analysis) concluded to a total cutoff point score of 19.50 (sensitivity: 0.838, 1-specificity: 0). Also, in terms of constructs, the Functional domain was equal to 7.50 (sensitivity: 0.676, 1-specificity: 0.032), the Physical domain was equal to 7.50 (sensitivity: 0.706, 1-specificity: 0.032), and the Emotional domain was equal to 6.50 (sensitivity: 0.809, 1-specificity: 0.048). © 2018 The Voice Foundatio

How Does an Undergraduate Pain Course Influence Future Physicians' Awareness of Chronic Pain Concepts? A Comparative Study

Objective: Pain is one of the most undertreated medical complaints, with barriers to effective pain management lying in poor education of health professionals and misconceptions regarding patients in pain. The aim of this study was to assess whether an elective undergraduate course on chronic pain offered in Greek medical schools influences knowledge and attitudes of medical undergraduates about chronic pain and helps them clarify pain-related concepts. Methods: An electronic questionnaire with 6 demographic and 21 pain-related items was uploaded on SurveyMonkey. The questionnaire was open to medical students in every Greek medical school for 1 month. Students were asked to respond to questions regarding various aspects of pain taught in the aforementioned course. In specific, they were asked to respond to questions regarding the definition, types, and adequacy of treatment of chronic cancer and non-cancer pain. They were queried about their knowledge of pain clinics, health practitioners who run them, and types of treatment available there. There were also questions about opioid use in cancer and non-cancer chronic pain patients and regarding the likelihood of opioid addiction. Results: According to their responses, medical students had good knowledge about the definition and consequences of pain, and those who attended the pain course had greater knowledge regarding the adequacy of treatment of chronic pain and were more familiar with the recent classification of types of pain. Students who did not have exposure to the undergraduate pain course had little information regarding pain clinics and had poor knowledge regarding the use of opioids in cancer and in nonmalignant chronic pain. All students expressed concerns regarding addiction to opioids. Conclusions: Although students enter medical school with little knowledge about pain issues, pain awareness can be positively influenced by education. A curriculum about pain should not only teach the basic science of pain but also present treatment strategies available and address the socio-emotional dimensions of pain. Additionally, if misconceptions about opioid use and addiction are properly elucidated early in medical education, the future health practitioners will be one step forward in achieving the goal of alleviating suffering patients' pain. © 2015 American Academy of Pain Medicine

Comparison of Voice Handicap Index Scores Between Female Students of Speech Therapy and Other Health Professions

Students' groups (eg, teachers, speech language pathologists) are presumably at risk of developing a voice disorder due to misuse of their voice, which will affect their way of living. Multidisciplinary voice assessment of student populations is currently spread widely along with the use of self-reported questionnaires. This study compared the Voice Handicap Index domains and item scores between female students of speech and language therapy and of other health professions in Greece. We also examined the probability of speech language therapy students developing any vocal symptom. Two hundred female non-dysphonic students (aged 18–31) were recruited. Participants answered the Voice Evaluation Form and the Greek adaptation of the Voice Handicap Index. Significant differences were observed between the two groups (students of speech therapy and other health professions) through Voice Handicap Index (total score, functional and physical domains), excluding the emotional domain. Furthermore, significant differences for specific Voice Handicap Index items, between subgroups, were observed. In conclusion, speech language therapy students had higher Voice Handicap Index scores, which probably could be an indicator for avoiding profession-related dysphonia at a later stage. Also, Voice Handicap Index could be at a first glance an assessment tool for the recognition of potential voice disorder development in students. In turn, the results could be used for indirect therapy approaches, such as providing methods for maintaining vocal health in different student populations. © 2017 The Voice Foundatio