Western Attica General Hospital

Exposure index (EI) is a critical parameter in digital radiography, providing a quantitative measure of the radiation dose received by the detector. This review examines the significance of EI, methods for its determination, influencing factors, and clinical implications. Additionally, it explores challenges in standardization efforts and the role of emerging technologies, particularly artificial intelligence (AI), in optimizing exposure management. A comprehensive review of literature published over the last two decades was conducted using databases such as PubMed, ScienceDirect, and Google Scholar. Studies addressing EI measurement, clinical applications, and advancements in exposure monitoring technology were analyzed. Guidelines from the International Electrotechnical Commission (IEC), the American Association of Physicists in Medicine (AAPM), and the European Federation of Organizations for Medical Physics (EFOMP) were also reviewed to assess standardization efforts and best practices. Findings highlight the importance of EI in radiation dose optimization and quality control. Despite standardization initiatives, variations persist across manufacturers and imaging systems due to factors such as patient characteristics, beam energy, detector sensitivity, and post-processing algorithms. Artificial intelligence-driven exposure monitoring systems have shown promise in enhancing EI accuracy and enabling real-time dose adjustments. Artificial intelligence technologies have the potential to revolutionize EI utilization by enabling automated exposure optimization, real-time monitoring, and predictive analytics. Future efforts should focus on refining AI algorithms, ensuring cross-platform standardization, and enhancing radiographer training to fully integrate AI into EI-based radiation safety protocols.

ABSTRACTAimsTo estimate all-cause mortality in a cohort of people who inject drugs (PWID) over the period 2018–2022 in the two major cities of Greece (Athens and Thessaloniki).MethodsPWID were recruited from two community-based seek-test-treat programs for HCV and HIV infections in Athens and Thessaloniki. Participants provided information on sociodemographic characteristics, injection practices, social security number, access to harm reduction and treatment. Data on the vital status and date of death were identified from the national HCV treatment registry. All-cause mortality rates (CMR) were estimated as well as age-, gender- and calendar-year standardized mortality ratios (SMR). Determinants of mortality were assessed using a Cox proportional-hazards model.ResultsOf 2,433 PWID, 243 (10.0%) died over a total of 6,649 person-years (PYs) of follow-up. The CMR [95% confidence interval (CI)] was 3.50 (3.08–3.97) deaths per 100 PYs; 3.03 (2.58–3.57) in Athens and 4.56 (3.74–5.57) in Thessaloniki. An increasing trend in CMR was identified over the period 2018–2022 in Athens (p for trend=0.004). The overall SMR (95% CI) was 17.17 (15.14–19.47) per 100 PYs in the combined cohort; 15.10 (12.85–17.75) in Athens and 21.72 (17.78–26.53) in Thessaloniki. The SMR was particularly increased in younger ages, females, those injecting daily, and HIV-infected PWID. Older age, living in Thessaloniki, Greek origin, homelessness, daily injecting drug use, HIV, and HCV infections were independently associated with all-cause mortality.ConclusionAll-cause mortality among PWID in Greece during 2018–2022 is high with the population in Thessaloniki being particularly affected. The increasing trend in mortality in Athens might be the long-term impact of the pandemic on the health of PWID. Preventive programs such as take-home naloxone distribution and community involvement to increase harm reduction, screening, and uptake of antiretroviral and chronic hepatitis C treatment are urgently needed.

Sternal fractures are traumatic chest injuries, which relate primarily to road accidents. They were once considered to be high morbidity injuries, which has now been reversed, especially for isolated sternal fractures. This is a retrospective study that focuses on the clinical presentation of patients with isolated sternal fracture and their management. During the period of time 01/2009–01/2016, sixty two patients were examined in the emergency department with isolated sternal fracture. All patients had chest X-ray and sternum X-ray, blood tests and ECG and, according to the results and the symptoms, patients were admitted or discharged after observation in the short stay ward unit. Other parameters that have been studied were the cause of sternal fracture, age and sex. The average age of patients was 51.3 years, with age ranging from 17 to 79 years. There were 27 men and 35 women. The main cause of sternal fracture was traffic accidents (72.6%), followed by falls from height (21%) and assault (6.4%). Out of 62 patients, only four had to be admitted because of pathological ECG findings and increased CK-MB, while 58 were kept under observation for six hours and then discharged with oral analgesia, instructions and follow-up in the outpatient clinic. Isolated sternal fractures are considered benign injuries with a good prognosis, which require no special treatment except sufficient pain control, particularly in cases where there is no sign of displacement. Admission is required in patients with altered blood tests and abnormal ECG for monitoring for at least 48 hours.

Background: Littre's hernia is the type of hernia where the sac contains Meckel's diverticulum, which is associated with various complications. Strangulation of Meckel's diverticulum and consequent rupture represents a serious and life-threatening condition. Methods: A 62-year-old female, with a 10-d history of abdominal pain, presented in the emergency department with abdominal pain in the past 48 h, accompanied by fever and vomiting. Clinical examination revealed diffuse abdominal pain and an inflamed mass on the right groin. Given the clinical and laboratory findings the patient was taken in the operating room. Results: Diagnostic laparoscopy revealed Littre's hernia accompanied by rupture of Meckel's diverticulum and abscess formation. Because of multiple adhesions and distension of the small bowel, the operation proceeded with open laparotomy, including a sub-umbilical midline incision. Enterectomy and side-to-side anastomosis was performed and the abscess was drained. The post-operative period was uneventful and the patient was symptom free at the two-month follow-up. Conclusions: An inguinal abscess can represent the first manifestation of a strangulated Meckel's diverticulum in Littre's hernia. It should be taken into account in the differential diagnosis of acute abdomen symptoms. Prompt diagnosis and therapy is essential. The preferred treatment is an operation consisting of enterectomy and primary anastomosis.

Abstract Background: The incidence of uterine fibroid entrapped in umbilical hernias during pregnancy is very low. Only 3 case reports of this kind have been published to date. Case: This article discusses the case of a 38-year-old woman in the 33rd week of gestation, who presented with an incarcerated umbilical hernia, and underwent emergency surgical repair. A pedicled uterine fibroid was found in the hernia sac, which was mobilized and resected. The hernia defect was repaired by the Mayo technique. Results: No complications were observed during the postoperative period and she subsequently delivered a full-term baby boy. Conclusions: The possibility of a fibroid entrapped in a hernia sac should be taken into consideration in the evaluation of incarcerated hernias during pregnancy. If the contents of the hernia sac cannot be reduced safely into the abdominal cavity by manual reduction, emergency surgical repair should be considered as a means to prevent further pregnancy-related complications. (J GYNECO...

The clinical relevance of mutations in the connection subdomain and the ribonuclease (RNase) H domain of HIV-1 reverse transcriptase (RT) is uncertain. The risk of virological failure to nonnucleoside RT inhibitor (NNRTI)-based antiretroviral therapy (ART) was evaluated in NNRTI-naive patients who started NNRTIs in the EuroSIDA study after July 1997 according to preexisting substitutions in the connection subdomain and the RNase H domain of HIV-1 RT. An observed association between A376S and virological failure was further investigated by testing in vitro NNRTI susceptibility of single site-directed mutants and patient-derived recombinant viruses. Enzymatic assays also determined the effects of A376S on nevirapine and template-primer binding to HIV-1 RT. Virological failure occurred in 142 of 287 (49%) individuals: 77 receiving nevirapine (67%) and 65 receiving efavirenz (38%) (P < .001). Preexisting A376S was associated with an increased risk of virological failure to nevirapine (relative hazard [RH] = 10.4; 95% confidence interval [CI], 2.0-54.7), but it did not affect efavirenz outcome the same way (RH = 0.5; 95% CI, 0.1-2.2) (P value for interaction = .013). A376S conferred selective low-level nevirapine resistance in vitro, and led to greater affinity for double-stranded DNA. The A376S substitution in the connection subdomain of HIV-1 RT causes selective nevirapine resistance and confers an increased risk of virological failure to nevirapine-based ART.

Background: Albuminuria, arterial stiffening and left ventricular hypertrophy (LVH) constitute target organ damage. We estimated whether increased urinary albumin excretion, assessed by albumin-to-creatine ratio (ACR), and carotid to femoral pulse wave velocity (c-f PWV) were accompanied by augmented left ventricular (LV) mass index (LVMI) in hypertension. Methods: In 428 non-diabetic untreated hypertensives (257 men, mean age = 52 years, office blood pressure (BP) = 146/93 mm Hg) the distributions of ACR and c-f PWV were split by the median (8 mg/g and 7.8 m/s, respectively). Results: Age, male sex, 24 h systolic BP, ACR and c-f PWV were the independent predictors of LVMI (R² = 0.478, p < 0.0001). Among patients with low ACR (n = 198), those with high c-f PWV (n = 84) compared to those with low c-f PWV (n = 114) were characterized by increased LVMI (by 8.9 g/m², p = 0.012) and prevalence of LVH (30 vs. 14%, p = 0.015). Similarly among patients with high ACR (n = 230), those with high c-f PWV (n = 123) compared to those with low c-f PWV (n = 107) exhibited heightened LVMI (by 13.6 g/m², p = 0.001). Conclusions: Increased ACR in conjunction with pronounced arterial stiffness is accompanied by augmented LV mass and higher LVH rates. Furthermore, the interrelationships between albuminuria, c-f PWV and LVMI suggest parallel target organ damage progression.

Kikuchi-Fujimoto disease is a self-limited condition, characterized by benign lymphadenopathy. We describe a case of a 56-year-old male who presented with a node growth in the left axilla, without referring any other symptoms. The patient underwent excision and biopsy of the node and the histological examination established the diagnosis of Kikuchi-Fujimoto disease. After 3 days of hospitalization, the patient was released in a perfect condition and no medical treatment was prescribed. In a regular follow-up of 3 years the patient remains asymptomatic. Kikuchi-Fujimoto disease is an uncommon clinicopathological entity in Greece and it should always been taken under consideration in the differential diagnosis in patients presenting with lymphadenopathy. Surgical excision is the treatment of choice and the course of the disease is usually the spontaneous resolution.

Aggressive lymphomas can present with symptoms mimicking life-threatening infection. Flow cytometry (FC) is usually recommended for the classification and staging of lymphomas in patients with organomegaly and atypical cells in effusions and blood, after the exclusion of other possible diagnoses. FC may also have a place in the initial diagnostic investigation of aggressive lymphoma. Three cases are presented here of highly aggressive lymphomas in young adults, which presented with the clinical picture of fever of unknown origin (FUO) in patients severely ill. All followed a life-threatening clinical course, and two developed the hemophagocytic syndrome (HPS), but microbiological, immunological, and morphological evaluation and immunohistochemistry (IHC) failed to substantiate an early diagnosis. FC was the technique that provided conclusive diagnostic evidence of lymphoma, subsequently verified by IHC. Our experience with these three cases highlights the potential role of FC as an adjunct methodology in the initial assessment of possible highly aggressive lymphoma presenting with the signs and symptoms of life-threatening infection, although the definitive diagnosis should be established by biopsy. In such cases, FC can contribute to the diagnosis of lymphoma, independently of the presence of HPS.

The aim of this study was to evaluate the satisfaction of patients with chronic hepatitis C who used the pegylated interferon α-2b pen device. Patients from multiple centers in Greece were recruited to participate in this noninterventional, observational study. Patients received pen device training for at least 6 weeks before treatment and used questionnaires to provide feedback (rating scale: 1-4, negative; 5-7, positive) on training, medication preparation and injection, and appreciation of the device. Results were analyzed with standard statistical analysis and multivariate logistic regression. In total, 507 patients (mean age, 43.5 years), 77.4% of whom were treatment naive, participated in the study. Overall, 84.2% of patients rated training positively, 67.4% of patients rated medication preparation positively, and 88.3% of patients rated medication injection positively. Appreciation of the pen device treatment method was rated positively by 82.2% of patients. Intravenous drug users were more likely to rate medication injection positively (P=0.0284) and to appreciate this method of drug delivery (P=0.0328) than other patients. Patients with lower levels of education were less likely to rate training positively (P=0.0202) and showed less appreciation for this route of drug delivery (P=0.0341) than other patients. Treatment-naive patients were more likely to provide positive responses about the overall procedure than were treatment-experienced patients (odds ratio: 1.932; P=0.032). Adverse events were reported by 6.4% (29 of 453) of patients. Patients were satisfied with the pegylated interferon α-2b pen device; therefore, good treatment adherence is expected with its use.