Nicosia General Hospital

Stone heart syndrome (SHS) is a rare but catastrophic complication of cardiac surgery, characterized by irreversible ischemic myocardial contracture following prolonged global myocardial ischemia, and is almost uniformly fatal once established. We report the case of a 55-year-old woman with severe symptomatic aortic stenosis who underwent elective mechanical aortic valve replacement. Preoperative echocardiography showed preserved ventricular dimensions with low-normal systolic function. Due to technical difficulties during mini-sternotomy, a prolonged aortic cross-clamp time was required with repeated cardioplegia. Failure to wean from cardiopulmonary bypass was followed by complete left ventricular akinesia, immobile left-sided valves, and minimal right ventricular activity despite maximal support. Full sternotomy revealed a rigid, non-compliant myocardium consistent with SHS. Central veno-arterial extracorporeal membrane oxygenation was instituted without myocardial recovery. The patient died from multiorgan failure on postoperative day three. SHS results from profound myocardial ischemia, causing adenosine triphosphate depletion, calcium overload, and irreversible actin-myosin binding. Prevention, achieved through meticulous myocardial protection and strict minimization of ischemic time, remains the only effective strategy against this devastating and irreversible complication of cardiac surgery.

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that may be triggered by surgical trauma, often mimicking postoperative wound infection. Early recognition is essential to avoid unnecessary surgical interventions. Herein this report presents the case of a 71-year-old male with a history of acute myeloid leukemia in remission who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis. Despite initial postoperative recovery, he presented on postoperative day 12 with erythema and purulent discharge from a trocar site. Imaging suggested a postoperative collection, but cultures remained negative, and skin ulceration progressed despite broad-spectrum antibiotics. Two skin biopsies were required to establish the diagnosis of PG. The patient responded favorably to systemic corticosteroids. This case highlights the importance of considering postoperative PG in patients with rapidly progressive ulcerative lesions unresponsive to antibiotics, particularly in individuals with underlying hematologic disease. Early biopsy and multidisciplinary evaluation are crucial to timely diagnosis and appropriate management.

Pudendal neuralgia (PN) is a chronic neuropathic pain syndrome affecting the pudendal nerve, often presenting with perineal or pelvic pain exacerbated by sitting. The aim of this systematic review was to summarize the existing knowledge on the diagnosis and management of PN. A PubMed database search identified 475 articles, of which 35 met the inclusion criteria. Nine studies focused on diagnostic strategies, and 26 on management. Diagnosis of PN is largely clinical, with the Nantes criteria providing a widely adopted framework. Imaging modalities such as MRI and MR neurography, along with neurophysiological tests including quantitative sensory testing, have been explored as adjuncts, though their roles remain limited. Pudendal nerve blocks are both diagnostic and therapeutic, with response rates up to 94%. Management follows a stepwise approach, beginning with conservative therapies and progressing to nerve blocks, and extending to neuromodulation or surgery when necessary. Pulsed radiofrequency and nerve stimulation techniques demonstrate promising results, with reported pain reduction in up to 95% of refractory cases, though long-term durability remains uncertain. Surgical decompression remains the most common operative option, with several techniques described. Despite the established recognition of PN, there is a paucity of high-quality comparative studies and randomized controlled trials assessing diagnostic accuracy and treatment efficacy. Current evidence suggests conservative measures and nerve blocks are sufficient for most patients, with stimulation techniques and decompression surgery reserved for refractory cases. Emerging modalities may offer future therapeutic options, but require validation in larger cohorts.

BackgroundAdvances in cancer care require ongoing monitoring of patient satisfaction using rigorous questionnaires. The EORTC Quality of Life Group has cross-culturally developed a patient satisfaction core questionnaire (PATSAT-C33) to be used in any hospital cancer care settings and an outpatient satisfaction module (OUT-PATSAT7) to address specific aspects of ambulatory care. This multi-center international prospective study aimed to validate the PATSAT-C33 and OUT-PATSAT7, including assessing its acceptability.MethodsPatients (N = 690) affected by any cancer site or stage equally distributed by age and gender, were enrolled in in- and out-patient cancer settings from 20 institutions, 12 countries and 5 geographic/cultural areas. Among them, 675 completed the PATSAT-C33 alongside the EORTC QLQ-C30, Oberst’s perception of care quality 5-item, and ‘intention to recommend the hospital’ 1-item. Among the 532 outpatients, 526 also completed the OUT-PATSAT7. A subset completed a two-week retest (N = 120 & 96 for the PATSAT-C33 & OUT-PATSAT7, respectively) or one-year responsiveness-to-change assessment (RCA) (N = 166 & 155). Comprehensive psychometric testing was performed.ResultsFull item completion was high (85% & 88%), 83% of patients took ≤ 20 min to complete both questionnaires (40 items); 5% of patients required help with understanding questionnaire items. Confirmatory factor analyses evidenced satisfactory fit on the eleven PATSAT-C33 and two OUT-PATSAT7 multi-item scales (CFI/TLI > 0.90; RMSEA < 0.10 and = 0.108, respectively). Internal consistency was good to excellent (all ≥ 0.80); test–retest reliability was fair (0.48, 1 scale), good (0.60–0.74, 11 scales) to excellent (≥ 0.75, 7 scales). Convergent validity was supported by correlations of ≥ 0.40 with related Oberst’s scales and < 0.30 with unrelated QLQ-C30 scales. Known-groups differences was shown for comorbidity, toxicity, global health, care expectations and intention to recommend the hospital. Change over time was captured in groups defined based on change in global health, cancer care setting, and the receipt of supportive care over the past year.ConclusionsThis study supports the psychometric robustness of the EORTC PATSAT-C33 and OUT-PATSAT7 and their promising usefulness in monitoring cancer care within and across cancer care settings from different cultures and cancer patient populations.Trial registrationClinicalTrials.gov ID: NCT05989191, August 2, 2023.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12885-025-15119-3.

Abstract Background/Introduction Apelin, an endogenous peptide involved in regulating cardiovascular function, has been implicated in various cardiovascular diseases, including acute myocardial infarction (AMI). Some studies suggest that plasma apelin upon admission is decreased early after ST-elevation AMI (STEMI) indicating the inverse correlation of apelin with the presence and severity of coronary artery disease (CAD). However, other studies demonstrated a positive correlation of upon admission apelin with mortality at 6 months post-STEMI. The role of sustained high apelin levels in the post-STEMI period remains underexplored. Purpose The INFINITY study (INFlammatIoN amI sTudY) evaluates the role of a selected panel of inflammatory biomarkers in predicting long-term outcomes after AMI. This sub-study specifically investigates the prognostic value of plasma apelin in STEMI patients, examining its association with short-term (in-hospital, M0) and long-term (1, M1 and 6 months, M6) clinical outcomes, including cardiac death, noncardiac death, heart failure, and major adverse cardiovascular events (MACEs). MACEs were defined post hoc as non-fatal MI, unplanned revascularization, new-onset heart failure, angina or recurrent ACS requiring rehospitalization, and major bleeding. Methods Apelin levels were measured at three time points: upon admission (H0), 24 hours post-MI (H24), and 30 days post-MI (D30). Patients were followed for six months and categorized based on apelin levels at each time point, as well as the Area Under the Trapezoid (AUC) for apelin. Primary in-hospital endpoints included major bleeding (per BARC classification), new-onset heart failure (LVEF &amp;lt;40%), and MACEs (non-fatal MI, unplanned revascularization, recurrent ACS, heart failure, major bleeding). Long-term outcomes at 1 and 6 months included cardiac death, heart failure, and hospital readmission for ACS or heart failure. Cox proportional hazards regression models were applied to evaluate the association between apelin levels and clinical outcomes. Results Among 69 STEMI patients, high apelin levels upon admission associated with a statistically increased risk of in-hospital bleeding (p = 0.011). Those with sustained high apelin levels at 30 days post-MI had a significantly higher risk of hospital re-admission for heart failure or ACS (p = 0.006). Finally, elevated plasma apelin area under trapezoid (AUC) was strongly associated with a higher risk of hospital readmission for heart failure or ACS (p = 0.042). Conclusion Persistently high apelin levels 30 days post-STEMI are strongly associated with an increased risk of hospital readmission for heart failure or ACS. These findings suggest that apelin may serve as a valuable biomarker for identifying high-risk patients, potentially guiding early interventions. Targeting apelin signalling pathways could offer novel therapeutic strategies to improve long-term post-STEMI outcomes.Table 1 and 2 Figure 1

BackgroundWhile triggering by physical activity is a criterion for the diagnosis of migraine, evaluations regarding fear of movement related to physical activity are lacking in the literature. This study aimed to investigate the validity and reliability of the Turkish version of the Tampa Scale of Kinesiophobia, adapted to headache (TSK-H), in patients with episodic migraine (EM) and chronic migraine (CM). This questionnaire is a newly developed version adapted for headache, based on but different from the original TSK used in low back pain, and has not been previously validated in Turkish for headache.MethodsPatients between the ages of 18–70 were included in the study. Demographic-clinical information was obtained after expert committee evaluation and cross-cultural adaptation of the questionnaire. Numerical Pain Rating Scale (NPRS), Migraine Disability Assessment (MIDAS), Headache Impact Test-6 (HIT-6), Hospital Anxiety and Depression Scale (HADS) and TSK-H were evaluated for structural validity. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were performed. Intraclass Correlation Coefficient (ICC) and Cronbach’s α values ​​were analyzed for reliability.ResultsA total of 329 patients (n = 148 EM, n = 181 CM) with a mean age of 37.2 ± 10.6 years for EM and 39.8 ± 13.1 years for CM were included in the study. Headache intensity on NPRS was 6.89 ± 1.86 for EM and 7.56 ± 2.10 for CM. Item-total correlations ranged from − 0.030 to 0.758. Cronbach’s α was 0.925. TSK-H had good test-retest reliability (ICC = 0.866, n = 151) and high internal consistency (Cronbach’s α = 0.928). TSK-H was associated with NPRS, MIDAS, HIT-6 and HADS (p < 0.000 for each one). EFA identified a four-factor structure explaining 58.64% of the variance. CFA remained within acceptable limits.ConclusionThe Turkish version of the 23-item TSK-H is a valid and reliable tool for assessing kinesiophobia in patients with migraine and is significantly associated with physical, functional and psychosocial factors.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12883-025-04471-3.

Background/Objectives: Ventricular fibrillation (VF) is the most common shockable rhythm in cardiac arrest, yet refractory VF (RVF), defined as persistent VF after ≥three failed defibrillation attempts, poses a significant challenge. Two alternative strategies, double sequential external defibrillation (DSED) and vector change (VC) defibrillation, aim to enhance defibrillation success where conventional methods fail. This review evaluates the clinical feasibility, safety, and implementation barriers of DSED and VC in RVF cases. Methods: A systematic review was conducted following PRISMA 2020 guidelines. PubMed, Scopus, and CINAHL databases were searched for studies published between January 2015 and August 2025. Eligible studies included adult RVF patients treated with DSED or VC. Outcomes assessed included implementation barriers, safety concerns, and methodological limitations. Study quality was evaluated using the Newcastle–Ottawa Scale and the Cochrane RoB 2 tool. Results: Sixteen studies met the inclusion criteria. Identified barriers were grouped into practical and methodological categories. Practical barriers included the need for dual defibrillators and pads, delays in shock coordination, inconsistent protocols, equipment compatibility issues, and dependence on trained personnel. Methodological barriers included small sample sizes, retrospective designs, inconsistent RVF definitions, and incomplete reporting of neurological outcomes. Conclusions: DSED and VC defibrillation may offer potential benefits in managing RVF, but their use is hindered by significant practical and methodological barriers. Due to the limited number of randomized trials, further high-quality studies with standardized definitions and safety endpoints are needed to clarify their clinical utility and inform implementation.