Attitudes and thoughts of medical practitioners towards their profession in the era of financial crisis in Greece

Introduction: The ongoing financial crisis occurring in Greece the last 8 years has affected the income of citizens in the country, their quality of life, as well as social and occupational relationships. Aim of this study assess attitudes towards working conditions and personal life and to explore quality of life, positive or negative attitudes, as well as disorders in sleep, mood, physical condition among doctors working or being trained in a tertiary hospital of NE Greece Methods: Included were 133 medical students and doctors of all ranks (61.7% males) practicing medicine in a University Tertiary Hospital in Greece. All of them answered a 31-item questionnaire regarding their working conditions, daytime activities and personal life, sleeping habits. Results: In general, the majority reported dissatisfaction with the work environment, the salary and they rated their quality of life worse than that of the general population. Weekly workload exceeded 60 hours for the majority. No difference between sexes was revealed, with the exception of use of energy drinks which was more prevalent in males (70.7% vs. 51%, p=0.022). Comparison between ranks revealed that medical students performed better in everyday activities and socialization, although prevalence of reported fatigue was higher in them. Finally, it was demonstrated that surgeons used more frequently medication to achieve sleep promotion (80.4% vs. 36%, p<0.001) and daily energy (78.4% vs. 44%, p<0.001). Conclusions: An overall dissatisfaction regarding workload, salary and quality of life is recorded among doctors of a tertiary hospital in Greece, with different coping strategies among subgroups. &nbsp

Esophageal and small bowel obstruction by occupational bezoar: report of a case

BACKGROUND: Phytobezoar may be a cause of bowel obstruction in patients with previous gastric surgery. Most bezoars are concretions of poorly digested food, which are usually formed initially in the stomach. Intestinal obstruction (esophageal and small bowel) caused by an occupational bezoar has not been reported. CASE PRESENTATION: A 70-year old male is presented suffering from esophageal and small bowel obstruction, caused by an occupational bezoar. The patient has worked as a carpenter for 35 years. He had undergone a vagotomy and pyloroplasty 10 years earlier. The part of the bezoar, which caused the esophageal obstruction was removed during endoscopy, while the part of the small bowel was treated surgically. The patient recovered well and was discharged on the 8(th )postoperative day. CONCLUSIONS: Since occupational bezoars may be a cause of intestinal obstruction (esophageal and/or small bowel), patients who have undergone a previous gastric surgery should avoid occupational exposures similar to the presented case

Current surgical status of thyroid diseases

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%–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

Outbreak of acute gastroenteritis in an air force base in Western Greece

BACKGROUND: On the 20(th )September 2005, soldiers and staff at the Air Force base in Western Greece experienced an outbreak of acute gastroenteritis. The purpose of this study was to identify the agent and the source of the outbreak in order to develop control measures and to avoid similar outbreaks in the future. METHODS: A case-control analytical approach was employed with 100 randomly selected cases and 66 controls. Patients completed standardized questionnaires, odds ratios were calculated and statistical significance was determined using χ(2 )test. In addition, to identify the source of the infection, we performed bacteriological examination of food samples (included raw beef, cooked minced meat, grated cheese and grated cheese in sealed package) collected from the cuisine of the military unit. RESULTS: More than 600 out of the 1,050 individuals who ate lunch that day, became ill. The overall attack rate, as the military doctor of the unit estimated it, was at least 60%. The overall odds ratio of gastroenteritis among those who had lunch was 370 (95% CI: 48–7700) as compared to those who didn't eat lunch. Among the symptoms the most prominent were watery diarrhoea (96%) and abdominal pain (73%). The mean incubation period was 9 h and the median duration of the symptoms was 21 h. In the bacteriological examination, Staphylococcus aureus was detected in a sample of raw beef (2,000 cfu per g) and in two samples of grated cheese; leftover cheese from lunch (7,800 cfu per g) and an unopened package purchased from the market (3,000 cfu per g). CONCLUSION: The findings of this study suggest that the aetiological agent of this outbreak was S. aureus. The food vehicle was the grated cheese, which was mixed with the beef and served for lunch in the military unit. This outbreak highlights the capacity of enterotoxin-producing bacteria to cause short term, moderately-severe illness in a young and healthy population. It underscores the need for proper food handling practices and reinforces the public health importance of timely notification of such outbreaks

Are there any differences in clinical and laboratory findings on admission between H1N1 positive and negative patients with flu-like symptoms?

<p>Abstract</p> <p>Background</p> <p>The World Health Organization alert for the H1N1 influenza pandemic led to the implementation of certain measures regarding admission of patients with flu-like symptoms. All these instructions were adopted by the Greek National Health System. The aim of this study was to retrospectively examine the characteristics of all subjects admitted to the Unit of Infectious Diseases with symptoms indicating H1N1 infection, and to identify any differences between H1N1 positive or negative patients. Patients from the ED (emergency department) with flu-like symptoms (sore throat, cough, rhinorhea, or nasal congestion) and fever >37.5°C were admitted in the Unit of Infectious diseases and gave pharyngeal or nasopharyngeal swabs. Swabs were tested with real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR).</p> <p>Findings</p> <p>Patients were divided into two groups. Group A comprised 33 H1N1 positive patients and Group B (control group) comprised of 27 H1N1 negative patients. The two groups did not differ in terms of patient age, co-morbidities, length of hospitalization, temperature elevation, hypoxemia, as well as renal and liver function. There were also no significant differences in severity on admission. C-reactive protein (CRP) (mean 12.8 vs. 5.74) and white blood count (WBC) (mean 10.528 vs. 7.114) were significantly higher in group B than in group A upon admission. Obesity was noted in 8 patients of Group A (mean 31.67) and 14 patients of Group B (mean 37.78). Body mass index (BMI) was lower in H1N1 positive than in H1N1 negative patients (mean 31.67 vs. 37.78, respectively; p = 0.009).</p> <p>Conclusions</p> <p>The majority of patients in both groups were young male adults. CRP, WBC and BMI were higher among H1N1 negative patients. Finally, clinical course of patients in both groups was mild and uneventful.</p

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Frontal lobe dysfunction in amyotrophic lateral sclerosis

Fifty-one patients with Amyotrophic Lateral Sclerosis and twenty eight age and education matched controls, participated in the following ocular motor tasks: (1) a three-choice task and (2) a remembered saccade task. Eye movements recorded using an infrared oculagraphic system. The patients un-derwent a clinical and laboratory examination to confirm the diagnosis, accor-ding to El Escorial criteria of the World Federation of Neurology. An exten-sive neuropsychological evaluation performed. Wechsler Adult Intelligence Scale(WAIS) administered and Verbal IQ calculated. Global IQ calculation avoided due to impaired motor function of the patients, resulting in false IQ e-stimation. Subjects with a VIQ score of less than 70 excluded from the study. Wisconsin Card Sorting test and Stroop test, recognized as sensitive in the de-tection of frontal lobe dysfunction, as well as Rey Complex Figure Recall test also administered. Beck's depression inventory also administered and a cut-off point of 16 used to exclude moderately and severely depressed subjects. One-third of ALS patients presented with signs of frontal dysfunction, as determi-ned by their high distractibility factors (DF) in the three-choice task and their performances in both the Wisconsin and Stroop tests. ALS patients exhibi-ted longer latencies to eye movements than controls in the performance of the remembered saccade task, specifically in performance of both remembe-red and delayed saccades, but saccade accuracy was not impaired. Finally, performance indices of the ocular motor tasks, in particular the DF, was cor-related only with the degree of dysarthria.Πενήντα ένα ασθενείς με Πλαγία Μυατροφική Σκλήρυνση και είκοσι οκτώ μάρτυρες, παρόμοιας ηλικίας και μόρφωσης, συμμετείχαν στα ακόλου-θα οφθαλμοκινητικά παραδείγματα: (1)παράδειγμα τριών επιλογών (2)παρά-δειγμα απομνημονευμένων σακκαδικών. Οι οφθαλμικές κινήσεις καταγρά-φηκαν με τη χρήση συστήματος υπέρυρθρης οφθαλμογραφίας. Οι ασθενείς υποβλήθηκαν σε κλινικοεργαστηριακό έλεγχο για την τεκμηρίωση της διά-γνωσης, σύμφωνα με τα κριτήρια του El Escorial της Παγκόσμιας Ομοσπον-δίας Νευρολογίας. Νευροψυχολογική εκτίμηση έγινε κατ’ αρχήν με τη χρήση της κλίμακας Wechsler, μέτρησης του δείκτη νοημοσύνης(ΔΝ). Υπολογίσθη-κε μόνο ο λεκτικός ΔΝ, για να αποφευχθεί ο υπολογισμός ψευδώς χαμηλών ΔΝ, λόγω των κινητικών ελλειμμάτων των ασθενών. Ασθενείς ή μάρτυρες με λεκτικό ΔΝ16. Το ένα τρίτο των ασθενών παρουσίαζε μετωπιαία δυσλειτουργία, όπως αυτή ανιχνεύεται με τα υψηλά ποσοστά λαθών στη δο-κιμασία τριών επιλογών και τις αποδόσεις τους στις δοκιμασίες Wisconsin και Stroop. Επιπλέον οι ασθενείς εκτελούσαν απομνημονευμένες και απλές σακκαδικές με μεγαλύτερους λανθάνοντες χρόνους, στο παράδειγμα των α-πομνημονευμένων κινήσεων. Τέλος η μόνη στατιστικά σημαντική συσχέτι-ση, ήταν μεταξύ ποσοστού λαθών των αντισακκαδικών και της δυσαρθρίας