St Savas Hospital

Background/Objectives: Machiavellianism has long been associated with unethical tendencies and behaviors. High-Mach people have been stereotyped to choose business-related professions, contrary to low-Mach individuals choosing the helping professions. There has been a clear shift in scholarly focus, such as Machiavellian leadership and Machiavellian personality traits in healthcare. The objective of this narrative literature review was to provide a structured synthesis of empirical evidence on Machiavellianism within healthcare settings, focusing on its prevalence, manifestations, and organizational implications, while identifying conceptual and research gaps in the field. Methods: Literature research was conducted for articles published in PubMed, Scopus, and Google Scholar from 2014 until 2025. Articles written in English, examining Machiavellian traits in healthcare workers and students, were included in this review. Results: The search strategy produced 347 items, of which 11 original studies were included. Machiavellianism was described as a personality trait featuring emotional coldness and manipulativeness for the achievement of one's own ends; individuals exhibiting those traits may prioritize personal gain over collective welfare. Machiavellian tendencies manifesting in organizational culture often lead to a toxic work environment where manipulation might become normalized. Machiavellians show high commitment to their careers, but low commitment to their current organizations, supervisors, and teams. Conclusions: Machiavellianism emerges as a relevant but underexplored personality trait in healthcare, associated with unethical behaviors, reduced organizational commitment, and toxic work environments. Addressing its impact requires ethical leadership development, supportive organizational environments, and early identification during professional training to safeguard workforce well-being and patient safety.

Developmental venous anomalies (DVAs) are benign congenital veins that collect normal brain drainage into a single outlet. Cerebral cavernous malformations (CMs) are clusters of thin-walled capillary cavities prone to bleeding. When both lesions coexist, the DVA’s altered venous pressure and flow can promote CM formation or rupture. Detecting a DVA abutting an otherwise unexplained intracerebral hemorrhage can therefore raise suspicion of an occult CM as a likely cause, a clue which may be invaluable for daily clinical practice. The main focus of this review is to acknowledge the hallmark imaging appearances of DVAs and CMs, as well as their coexistence, explore the clinical consequences of mixed lesions, and emphasize that recognizing their partnership is vital for an accurate, timely diagnosis and appropriately targeted management.

After the implementations of Highly Active Antiretroviral Therapy (HAART) HIV infection became a chronic condition and the clinical focus on non-AIDS-related comorbidities such as hypertension and chronic kidney disease has increased. This study aims to investigate the prevalence and independent predictors of hypertension and albuminuria in a cohort of people with HIV (PWHIV) with high rates of viral suppression. This is a cross-sectional study of 183 HAART-experienced PWHIV. Hypertension, defined as office systolic blood pressure of ≥140 mmHg or diastolic blood pressure of ≥90 mmHg and albuminuria, was defined as a sex-based albumin-creatinine ratio (ACR) of >355 mg/g for females and >250 mg/g for males. Univariable and multivariable logistic regression was conducted to identify the association of hypertension and albuminuria with demographic, clinical, and HIV-specific factors. The prevalence of hypertension was 43.9% (n = 74) and albuminuria was 22.4% (n = 41). In the multivariable analysis, factors independently associated with prevalence of HTN were older age, overweight/obesity, and diabetes mellitus. TDF-based ART was explored as a potential factor but did not reach statistical significance (aRR = 1.85, p = 0.065). For albuminuria, older age, diabetes mellitus, and duration of HAART (aRR = 1.03 per year) were revealed as independent predictors. The results of this study demonstrate that the development of hypertension is primarily driven by traditional metabolic risk factors. However, the progression to albuminuria appears to be influenced not only by these comorbidities but also by long-term HIV disease and HAART exposure. These findings underline the critical need for the screening and management of hypertension and other comorbidities to mitigate the risk of long-term cardiovascular and renal complications in this aging population of PWHIV.

Background and objectives: With the increasing use of laparoscopic and robotic approaches, accurate preoperative localization of colorectal cancer (CRC) is crucial for surgical planning. The present study aimed to compare the accuracy of colonoscopy, computed tomography (CT), and magnetic resonance imaging (MRI) for preoperative tumor localization in patients diagnosed with CRC.Methods: This single-center prospective study evaluated the accuracy of colonoscopy, CT, and MRI for rectal cancer as tools for preoperative tumor localization. Information from preoperative investigations was recorded prospectively and compared with intraoperative findings. All colonic segments were included.Results: Colonoscopy was the most accurate method, with an overall accuracy of 82.4%. However, it was less effective in the hepatic and splenic flexures, with failure rates of 88% and 100%, respectively. CT demonstrated an overall accuracy of 57%, which improved to 74% for visible lesions. MRI was highly accurate for localizing rectal cancers.Conclusions: Colonoscopy remains the gold standard for preoperative tumor localization despite its limitations in specific colonic segments. CT offers complementary information, but it was less accurate overall. MRI was a valuable tool for detecting rectal cancer. Future research should focus on improving localization methods, particularly in anatomically challenging areas.

Heart failure with preserved ejection fraction (HFpEF) is increasingly recognized in cancer patients and survivors, yet it remains underdiagnosed and its epidemiology largely unknown. This statement underscores the imperative need to include HFpEF in the cardiotoxicities identified during or after anticancer treatments. It also highlights the prognostic value of pre‐existing HFpEF for periprocedural and cardiotoxicity risk and it discusses the challenges in the diagnosis and treatment of HFpEF in cancer patients. It also explores the aetiologic role of anticancer therapies (chemotherapy, targeted and hormonal therapies and radiotherapy) in the pathogenesis of HFpEF. Special emphasis is given on the importance of considering HFpEF from cancer diagnosis throughout treatment and survivorship and provides useful insights for cardiologists and oncologists in the monitoring and management of these patients. Finally, it highlights the key gaps in current knowledge that require further investigation through well‐designed research trials to enhance our understanding and improve clinical outcomes.

Platelets play a central role in primary hemostasis and arterial thrombosis, and accumulating evidence suggests that physical exercise can modulate platelet function. Acute vigorous or exhaustive bouts commonly produce transient thrombocytosis, enhanced aggregation and degranulation (e.g., P-selectin, β-TG, and PF4), increased thromboxane generation, and short-lived shifts toward hypercoagulability; these responses seem to scale with exercise intensity, adrenergic drive, and shear stress and may be amplified in untrained or high-risk individuals. By contrast, repeated training across modalities (aerobic, resistance, and high-intensity interval) generally lowers resting platelet reactivity, augments endothelial nitric oxide (NO) bioavailability, improves redox balance, and strengthens fibrinolytic capacity. These favorable adaptations may diminish with detraining, suggesting that the platelet-modulating effects of exercise are dynamic and contingent on consistent training exposure. In this review, we examine the association between platelet function and distinct exercise modalities, including aerobic, resistance, and high-intensity training, influence. We compare exercise modalities, intensities, and fitness states and consider major methodological sources of heterogeneity (assay selection, sampling timing, exercise prescription, and inter-individual variability) that complicate interpretation. Clinically, regularly performed, appropriately progressed exercise appears net favorable for hemostatic balance, whereas unaccustomed extreme exertion in high-risk individuals should be approached with preparation and caution. Better-standardized protocols and biomarker-informed trials are needed to refine exercise prescriptions for reducing thrombotic risk.

Objective: ERAS protocols in major gynaecologic oncology surgery (MGOS), have established effectiveness in reducing complications, Length of Stay (LOS), and hospital costs. Their implementation appears to improve patient care compared to conventional perioperative practice. This study assessed the efficacy of ERAS protocol versus conventional postoperative care in the recovery of patients undergoing major gynaecological oncology surgery (MGOS). Methods: A prospective, randomized, single-centre study. A sample size of convenience included 101 patients with gynaecological cancer who underwent MGOS. Patients randomized into two groups: in group A (n=51, 50.5%), patients allocated to the ERAS protocol, and in group B (n=50, 49.5%), patients followed conventional care. Results: The mean age in group A was 52.8 years and in group B 56.7 years (p = 0.1). In the ERAS group the LOS was significantly lower compared to the control group, mean 3.9 versus 5.9 days (p < 0.001). All indicators of recovery, such as mobilisation, feeding, bowel motility , discontinuation of intravenous (IV) administration, catheter and drainage removal in the first 24 hours, were significantly improved in patients in the ERAS group. Furthermore complications in patients in the ERAS group, such as fever, urinary tract infection, and perioperative bleeding, were also significantly lower.Conclusion: Within the limitations of a small single centre RCT, ERAS protocol in MGOS appeared to promote early enteral feeding, discontinuation of IV fluids, early gastrointestinal motility , faster removal of drainage and bladder catheter, faster patient standing and mobilisation, fewer requirements for blood transfusion, lower rate of drowsiness and sedation and episodes postoperative fever and leukocytosis.

Abstract Introduction Right ventricular (RV) assessment must be a part of the baseline cardiovascular (CV) assessment of patients diagnosed with cancer according to 2022 ESC guidelines on cardio-oncology. This facilitates the calculation of cardiotoxicity risk and enables cardiologists to serially assess RV during and after anticancer treatment. Aim We aimed to assess longitudinal strain of the RV in patients diagnosed with solid and hematological cancers before initiation of any anticancer therapy and compare them with patients without cancer. Patients and Methods This prospective study included 261 patients diagnosed with cancer and 130 patients without cancer (control group). All patients during their baseline CV assessment, had a standard echocardiogram, an electrocardiogram and blood tests as per standard clinical care. Left and right ventricular structure and systolic function, as well as global longitudinal strain of the left ventricle (LVGLS) and of the RV (RVGLS) and global longitudinal strain of the free wall of the RV (RVFWLS) were assessed in all patients. Results Baseline characteristics of the study population are presented in Table 1. The cancer cohort included predominantly female patients, with older age, smaller body surface area (BSA), and higher rates of hypertension and diabetes compared to the control group. In the total study population, the assessment of LVGLS was not possible in 8 patients, while of RVGLS and RVFWLS in 18 patients due to suboptimal echocardiographic images. The majority of patients had breast cancer (76,9%), followed by colon cancer. Patients with and without cancer had no significant difference in the systolic function assessed by the conventional echocardiographic parameters (LVEF, TAPSE, RV S’) and in the LVGLS (Table 2). However, cancer patients had significantly impaired longitudinal strain of the RV compared to the control group (RVGLS -18.57% ± 5.36% vs -20.94% ± 3.67%, p &amp;lt; 0.001 and RVFWLS -21.3% ± 5.93% vs -23.42% ± 5.97%, p &amp;lt; 0.001), independently of the assessed CV risk factors. From the blood tests, platelets-to-lymphocytes ratio, that is a prognostic marker of survival in cancer patients, is correlated with RVGLS (rho = -0.152, p=0.04). Conclusion Right ventricular strain is impaired in patients diagnosed with cancer, even before any cancer treatment and independently of CV risk factors. The findings of our study highlight the need to assess meticulously the RV at the baseline CV evaluation as suggested by the 2022 ESC cardio-oncology guidelines. Impaired RV longitudinal strain being associated with platelets-to- lymphocytes ratio may be indicative of prognosis too, but prospective studies are need to assess this hypothesis.

Tomato is steadily the most produced and consumed vegetable in the world during the last decade. The wide availability of data produced by the worldwide industrial tomato cultivation efforts, in combination with the power of machine learning algorithms, allows the identification of patterns and hidden variable correlations that allows the creation of accurate prediction models. These models can be used to accurately predict the yield of cultivations under various conditions and environments. In the present study, a machine learning platform was developed, able to predict the yield of industrial tomato crops during their cultivation period, based on historical data (yield, the hybrid cultivated and the environmental conditions of the area). These data were extracted from 302 different fields in six regions of western Peloponnese, Greece. They include data from 2019 to 2021 with 26 different tomato hybrids being cultivated during three cultivation periods, one per year. A correlation study was conducted on the dataset confirming that most of the variables are correlated to some degree to the crop yield. In order to find the optimal algorithm for this dataset, 12 different algorithms were tested and ranked using 14 different metrics. In addition, a hyper-parameter optimization process ensured that each tested algorithm is optimized for the dataset under examination. The presented solution is using the Ridge algorithm as it was deemed the most appropriate. The model was tested on open field cultivations, predicting the yield of tomato crops within the cultivation period, using real time weather data for 11 fields during the 2022 cultivation period. The observed prediction error ranged from just 6 up to 6,674 kg/ha, which was considered as acceptable by the producers. The uniqueness of the presented study lies in the fact that the model was both trained and tested in open field cultivations using in-season environmental data. • The dataset contained 636 records from 302 fields with 26 different tomato hybrids. • The model was trained and tested in open field cultivations using only raw data. • The prediction error ranged from just 6 kg/ha. • In-season weather data used for yield prediction in 11 open-field farms. • The predictions of the model improve as monthly data is added, approaching zero deviation.