The use of fully articulating instruments has made significant advancements in minimally invasive surgery with their full spectrum of capabilities being integrated into contemporary robotic systems. Articulating laparoscopic instruments with a wide range of motion, when combined with three-dimensional (3D) laparoscopic imaging, create conditions that closely resemble those of a robotic platform. We present our initial experience with the combined use of these two technologies (3D visualization and HandX (TM)). An 82-year-old female patient underwent surgical repair of a large hiatal hernia due to severe symptoms of gastroesophageal reflux disease. Upper gastrointestinal endoscopy revealed a large sliding hiatal hernia with an incompetent gastroesophageal valve, classified as Hill grade IV. Chest computed tomography demonstrated herniation of a large part of the stomach into the mediastinum. Esophageal manometry showed normal lower esophageal sphincter pressure and adequate relaxation, but impaired esophageal peristalsis. The patient underwent three-dimensional laparoscopic repair of the hiatal hernia with crural approximation and a partial posterior fundoplication (Toupet), using a fully articulating laparoscopic HandX (TM) instrument. The postoperative course was uneventful, and the patient was discharged on the second postoperative day.
Necrotizing fasciitis is a severe, rapidly progressing acute bacterial infection of the soft tissues, with progressive necrosis of the subcutaneous tissue and fascia, often life-threatening. It is characterized by extension of the infection on the fascia level and ischemic necrosis of the overlying tissues. A pathognomonic sign is the marked pain of the affected area that is disproportionate to the external image of the skin corresponding to the area of the lesion. On the other hand, suppurative hidradenitis is a form of chronic obstructive skin disease with varying severity and complications. We present a 57-year-old patient, suffering from chronic hidradenitis suppurative, who presented to the emergency department in septic shock and with signs of necrotizing fasciitis in the perineum. The patient immediately underwent surgical debridement with simultaneously intravenous infusion of broad-spectrum antibiotics, followed by multiple surgical debridements. He remained intubated and hemodynamically unstable throughout his hospitalization and died after a long hospitalization. Necrotizing fasciitis is a diagnostic challenge for the clinician and is accompanied by an urgent need for immediate treatment, which is mainly the extensive surgical debridement without delay. Its coexistence with hidradenitis suppurativa is extremely rare and is an additional factor that worsens the already poor prognosis of this infection.
Background: During 2020, all attention was given to COVID-19, it remains to be assessed whether other factors contributed to the older people in-hospital mortality. Aim: To describe the main factors associated with all-cause in-hospital mortality in older patients with pneumonia. Methods: This cross-sectional study included a total of 332 records, which were collected from December 1, 2020, to January 5, 2021, from a hospital located in Nuevo Le & oacute;n, Mexico. Chi-squares and logistic regressions were performed to determine associations and predisposing factors for in-hospital mortality, respectively. Results: In the general population, an age above 76, having more than one comorbidity, a respiratory frequency > 29, COVID-19 infection, a BMI >30 and a saturation of oxygen/fraction of inspired oxygen ratio (SpO2/FiO2 ratio) <300 were associated with in-hospital mortality. For both, COVID-19 positive and COVID-19 negative, age >76, more than one comorbidity and an RF >29 were associated with in-hospital mortality whereas a BMI >29 and an SpO2/FiO2 ratio <300 was associated with in-hospital mortality only in COVID-19 positive patients. Conclusion: During COVID-19 pandemic, BMI and SpO2/FiO2 ratio marked the difference between COVID-19 and COVID-19 outcomes.
Invasive lobular breast cancer (ILC) is the second most often kind of breast cancer, after the invasive ductal breast carcinoma, with an incidence rate of 10% of all the kinds of invasive breast cancer. It is usually multifocal or bilateral and derives from the lobular breast cells. We present a 49 years old woman who was asymptomatic and who during a random blood test discovered high level of vitamin B12. Endoscopy of the colon showed two masses, one in the cecum and another one in the transverse colon. She underwent extended right colectomy and bilateral ovariectomy and the final biopsy revealed metastatic invasive lobular breast cancer. A recent mammogram before surgery was free of pathology.
Aim: Diabetes mellitus (DM) is one of the most common chronic metabolic diseases, with a steadily increasing prevalence worldwide. Its effective management largely depends on patients' adherence to pharmacological treatment and lifestyle recommendations. To investigate the level of adherence to treatment and lifestyle among individuals with DM and their association with the occurrence of chronic complications. Methods: A cross-sectional study was conducted using an anonymous online questionnaire, which included demographic and clinical characteristics, the 8-item Morisky Medication Adherence Scale (MMAS-8), as well as questions regarding lifestyle habits and chronic complications. Results: A total of 136 individuals with DM participated in the study. Low treatment adherence was recorded in 23.4% of participants, and low adherence was statistically significantly associated with the presence of chronic complications (p = 0.03). Conclusions: Inadequate adherence remains common and is associated with an increased risk of complications, highlighting the need for targeted interventions focused on patient education and support.
Mesenteric cysts often present with nonspecific symptoms. Preoperative diagnosis aims to locate best the position and the size of the cyst and the relation of the cyst with the surrounding structures. The initial diagnosis relies on a thorough assessment of the patient's symptoms and imaging studies, with MRI being the most accurate investigation. Surgical excision is the optimal approach for treating mesenteric cysts, with minimally invasive surgery being the preferred choice. We present a 45-year-old woman who complained about acute abdominal pain mainly at the right upper quadrant. The CT scan of the abdomen revealed a multilocular cyst at the right upper abdominal department measuring 8x6 cm in dimension and a lot of free liquid in the peritoneal cavity. She underwent an emergent exploratory laparotomy, which revealed a big lobulated and ruptured mesenteric cyst in close proximity with the superior mesenteric vessels. A partial excision of the cyst and marsupialization took place and the patient had an uneventful postoperative course. However, two years later the CT scan revealed recurrence of the cyst and the patient underwent another laparotomy where total excision of the cyst took place successfully.
Introduction. Chronic bacterial prostatitis is a persistent chronic infection whose treatment is difficult and relapse is not uncommon. The condition presents with a variety of symptoms (mainly local pain that is variable in origin and intensity). These symptoms often persist despite eradication of the bacteria. The aim of this study is to examine the role of acid-forming agents as adjunctive therapy in patients with bacterial prostatitis. Materials and Methods. The material consisted of individuals with reported pelvic discomfort and genital pain with or without lower urinary tract symptoms and sexual dysfunction who visited our department from 03/2025 to 01/2026. Patients in whom the diagnosis was confirmed by the Stamey-Meares test (or alternatively by the two-glass test) were randomized into two groups. The first group (11 patients) received appropriate antibiotics (according to susceptibility testing) for 30 days, while the second group (8 patients) received a combination of acidifying agents, in addition to conventional antibiotic treatment for 30 days. The response was monitored using laboratory and clinical criteria. Results. We found statistically significant differences between the two groups in terms of the percentage of bacterial presence and persistence of symptoms, as well as the burden of symptoms in patients who received combination therapy. Conclusions. Acidifying agents improve the outcome of prostatitis treatment. Further randomized, placebo-controlled studies are needed to document more secure conclusions.
Species of the Trichosporon fungus have been identified as opportunistic pathogens capable of causing life-threatening invasive infections, typically in immunocompromised patients and extremely rarely in individuals without an immunological defect or malignancy. Data on invasive Trichosporon infections, particularly meningitis, in children are limited. We present the case of an immunocompetent 5-year-old boy with Trichosporon mucoides meningitis. No specific antifungal treatment was administered, as the Cerebrospinal Fluid culture result was reported 20 days later, by which time the patient was asymptomatic. Transmission of the fungus to the child occurred from his parrots, with whom he had direct and daily contact, as Trichosporon mucoides also grew in six of their stool cultures.
Background: Workplace violence against healthcare professionals in Emergency Departments (EDs) has emerged as a growing global concern, affecting staff well-being, patient care quality, and institutional safety. This review synthesizes recent data on the prevalence, contributing factors, and consequences of ED violence and examines evidence-based strategies for its prevention and management. Methods: A systematic review of literature published between 2010 and 2024 was conducted using PubMed, Scopus, and Google Scholar. Keywords included 'workplace violence', 'emergency department', 'healthcare workers', and 'prevention'. Studies focusing on ED personnel and reporting quantitative or qualitative data on violence incidence were included. Results: Verbal abuse remains the most common form of violence (60-90% internationally, 70-85% in Greece), followed by psychological threats (40-60%) and physical assaults (15-30%). Contributing factors include long waiting times, overcrowding, substance abuse, and staff shortages. Consequences range from burnout and decreased job satisfaction to compromised patient safety. Conclusion: Addressing ED violence requires a multifaceted approach, including staff training, security reinforcement, institutional policy changes, and psychological support for affected employees.
Introduction: Access to obstetric health services is essential for ensuring safe, high-quality care for all pregnant women, regardless of their place of residence. This study examines the extent to which pregnant women in Greece travel from their permanent domicile to other regions for childbirth Material and Methods: Statistical analysis was conducted using national data on live births from the Hellenic Statistical Authority for the year 2017. Indicators of population-level mobility and obstetric coverage were estimated by calculating both the absolute and relative differences in the number of live births between the region where the birth occurred and the mother's permanent residence. The analysis was performed at both the prefecture and regional levels, with stratification by age group. Results: In 2017, Greece recorded a total of 88,553 live births. Pregnant women relocated from 40 prefectures for childbirth. In these prefectures, obstetric care coverage was limited to 53.7%, while 46.3% of births to women residing permanently in these areas took place in other prefectures. In 20 prefectures, obstetric facilities met less than 50% of the demand. The proportion of births requiring maternal mobility increased with maternal age, from 12.0% in women under 20 years of age to 18.4% in women aged 40 years and older. At the prefecture level, 14,578 births (16.5%) were due to maternal mobility, while 10,596 births (12.0%) resulted from movement at the regional level. Conclusions: The majority of prefectures in the country had insufficient obstetric coverage, leading to a significant proportion of pregnant women traveling from their permanent residence for childbirth. These findings have significant implications for the planning of public health policies and the organization of maternity health services nationwide.
Purpose: The research aimed to evaluate the current situation regarding medical liability in Ophthalmology in Greece, the impact of court cases and decisions and the total litigation time. Methods: Published court decisions of criminal, civil, administrative and disciplinary content related to malpractice in ophthalmology were searched in legal information banks, from 1985 to 2021. Results: A total of 36 court decisions were retrieved, related to 11 civil cases and 6 criminal ones, while 7 of them were acquittals. The average duration of cases from the date of filing of the complaint to the final decision was 5.25 years. An average compensation of 26.227 Euros was imposed in 5 civil cases. Conclusion: Ophthalmology cases represent a small percentage of reported complaints of medical negligence in Greece. The majority of litigation cases involved complications after cataract and corneal surgery. There is a need for judicial-legislative reform and education of doctors in the legal aspects of medical liability.
Dog bites represent a significant public health issue worldwide, leading to soft tissue trauma, infections, and occasionally life-threatening complications such as sepsis or rabies transmission. This retrospective study reviews 120 cases of dog bite injuries managed in the Emergency Department of [Hospital Name] over a twoyear period (2023-2025). Demographic data, anatomical distribution, clinical severity, management strategies, and outcomes were analyzed. Most victims were children and young adults, with extremities and the face being the most affected sites. Secondary wound infections occurred in 30% of cases, and 15% required surgical intervention. All patients received appropriate wound care, tetanus prophylaxis, and rabies vaccination when indicated. Our findings underscore the importance of prompt management and standardized protocols, while also emphasizing preventive measures such as community education, responsible pet ownership, and vaccination programs for dogs.
Background: It is known that hepatic steatosis is quite common in people with type 2 diabetes mellitus (T2DM). The aim of this study is to estimate the prevalence of hepatic fibrosis (FIB-4>1.3) and its association with cardiovascular risk factors in people with T2DM. Methods: The study included and retrospectively evaluated 184 people with T2DM (42% men, HbA1c: 6.97 +/- 1.28%, T2DM duration 11.54 +/- 5.15 years) who came to our center in the six-month period June-December 2024. Demographic, medical data as well as recent laboratory tests were recorded in all study subjects. Results: The mean value of FIB-4 was 1.35 +/- 0.57. 91 individuals with type 2 diabetes (49.5%) had FIB-4 <= 1.3 and 93 (50.5%) had FIB-4>1.3. 57 individuals (31%) had coronary artery disease (CAD), 10 (5.4%) had heart failure (HF),18 (9.8%) had chronic kidney disease (CKD), 11 (1.1%) had a history of stroke (CVA),15 (1.5%) had diabetic neuropathy, and 8 (0.8%) had retinopathy. Log-rank analysis showed that FIB-4>1.3 was associated only with age (relative risk: 1.11, 95% confidence limits: 1.05-1.16). No statistically significant correlations were observed between FIB-4>1.3 and duration of T2DM, HbA1c, presence of CHD, HF, stroke, CKD, diabetic neuropathy and retinopathy. Conclusions The results of the present study showed that a significant proportion of individuals with T2DM had FIB-4>1.3. The only statistically significant correlation observed was between FIB-4>1.3 and age.
Acute appendicitis during pregnancy is the most common non-obstetric cause requiring surgical exploration of the abdomen and is associated with increased risk for both the mother and the fetus, especially when diagnosis is delayed. Hereby, we report a case of a pregnant woman who presented with atypical abdominal pain and initially non-specific laboratory findings. The persistence of symptoms and imaging evaluation led to the decision for surgical exploration via laparotomy and appendicectomy. Despite the increasing use of laparoscopy as a therapeutic option, open surgical access still has a role in specific situations. Timely recognition of the condition and prompt collaboration between obstetricians and surgeons remain crucial for a favorable outcome for both mother and fetus.
Background: The most prevalent type of cancer in women globally is breast cancer, with an estimated 1.3 million new cases and 465,000 fatalities per year. In 2024, it is projected that approximately 310,720 new cases of invasive breast cancer will be diagnosed in women in the United States. An estimated 42,250 women are expected to die from breast cancer in the same year. Objectives: the main objective of this work was to extract the variations in shape, size and count of WBCs, RBCs (10(6)/L), WBCs (10(3)/L), Platelets(10(3)/L), HGB(g/dl), RDW(%), PDW(fL), MCV(fL), MPV(fL), HCT(%), and PCT(%) for five concentrations of Neurobion (0-20) mMol with an interval of 5 mMol. Materials and Methods: Neurobion has been used as analyte in this experiment. A complete blood count and blood smear of both normal and cancerous blood samples were investigated using optical techniques. Outcomes/Measures: This manuscript compares the histo-pathological effects of neurobion on the morphology, physiology, and state of blood constituents and parameters. Sample Size: Three milliliters (3 mL) of blood from both samples were used to assess the comparative health impacts of neurobion. Results: There was a 1.1x10(3)/mu L factor increase for normal WBCs and a 0.9x10(3)/mu L factor increase for cancerous WBCs, reaching optimal levels from their inherent counts. For platelets, there was an 18x10(3)/mu L factor increase for normal and a 39x10(3)/mu L factor increase for cancerous samples. RBCs showed a 0.39x10(6)/mu L factor decrease for cancerous samples. Conclusions: Neurobion can cause severe negative health effects if used for an extended period.
Introduction: The application of artificial intelligence (AI) in the health sector is a challenge for health professionals who are called upon to integrate it into daily clinical practice. The purpose of this study is to record the existing perceptions on the use of AI by health professionals in our country. Methodology: An anonymous questionnaire on attitudes, perceptions and use of AI was distributed electronically to 259 health professionals (78.8% women, with 78.4% belonging to the age groups between 35-64 years, 66.8% university educated, 37.5% doctors and 33.6% health visitors). Results: A percentage of 72.6% knows what AI is, however only 19.7% feel familiar with its use and 23.2% use it in their work. 24.3% reported using AI for general interest issues, 17.8% for searching for scientific articles and 10.8% for educational purposes. 3 in 10 reported using AI for case management, however only 14% used it to make therapeutic decisions. As for its disadvantages, the lack of empathy (35.9%), the reliability of information (27%) and the time required for training in its use (23.2%) were reported as the main problems of AI with 62.6% confirming the information they receive from other sources. At the same time, 71% question the ability of AIto reduce workload and 25.5% the prospect of AI replacing part of healthcare professionals. Finally, 70.7% expressed the belief that AI should now be taught in schools and 54.9% expressed their desire to receive even more training in its use. Conclusions: The use of AI in the healthcare sector is at an early stage with limited application in daily clinical practice. More knowledge and training of healthcare professionals is required for its constructive and beneficial use in therapeutic decision-making.
Introduction/Purpose: The term overactive bladder (OAB) describes a set of symptoms that are common to various conditions rather than a single disease, as no clear cause is identified in most cases. These symptoms include a sudden, difficult-to-control urge to urinate, frequent urination-with or without nocturia-and involuntary urine loss (urge incontinence). Treatment depends on the underlying cause. When no underlying disease is diagnosed, symptomatic treatment is necessary. However, options are limited, and the available pharmaceuticals often have serious side effects that can make their use prohibitive for certain patients. Recently, cannabinoids have been used successfully to treat these symptoms in patients with neurogenic bladder. In this pilot study, cannabinoids were tested in otherwise healthy patients with OAB who could not use conventional treatments. Material and Methods: Patients with overactive bladder symptoms who visited the outpatient clinic between 01/01/24 and 31/12/24 were examined to determine the cause of their suffering. Only patients with idiopathic overactive bladder were included in the study. Medical histories were reviewed, and cannabinoid treatment was offered to those for whom conventional treatment was contraindicated. Participants were divided into two groups: one receiving conventional treatment and the other receiving cannabinoid treatment. Before treatment, participants completed the OAB-8 questionnaire, both before and at the end of the study. The patients recorded any side effects experienced throughout the treatment. Total questionnaire scores were compared before and after treatment. Results: No significant differences were observed between groups 1 and 2 when comparing OAB-8 scores either before treatment (p=0.15) or after (p=0.24). A comparison of pre-and post-treatment scores showed a statistically significant reduction in OAB-8 in group 2 (p=0.014) and a highly significant reduction in group 1 (p=0.00009). No significant adverse events were reported. None of the participants discontinued treatment. Conclusions: Cannabinoids seem effective and safe for treating patients with overactive bladder in whom conventional treatment is contraindicated.
Introduction/Aim: Recent studies suggest that organisms not culturable by standard methods but detectable by molecular techniques, as well as previously considered nonpathogenic bacteria, are involved in the development of chronic bacterial prostatitis (CBP). In this work, we investigate the frequency and nature of unusual organisms found in urine and/or prostatic secretions or semen cultures of patients with suspected CBP. Materials and Methods: The material of this retrospective study consisted of bacterial isolates from urine and/or prostatic secretions or semen cultures (whole ejaculate cultures) obtained from subjects with symptoms of chronic prostatitis and from patients with febrile relapses of CBP who visited our department from March 2008 to December 2025. Eligible patients underwent the Meares-Stamey "four-glass" test or ejaculate culture, while cases with false-negative cultures underwent quantitative polymerase chain reaction. Patients who were unable to provide prostatic secretions underwent the "two-glass" test, evaluating only the VB2 and VB3 samples. Simple midstream culture was used to investigate patients presenting with febrile chronic prostatitis. Results: Five hundred and three bacterial isolates were identified as causative agents of CBP. A significant proportion (12.52%, or 63/503) of unusual pathogens were found. In these, the pathogens were found in polymicrobial isolates (usually coagulase-negative staphylococci or Enterococcus faecalis). Conclusions: Unusual organisms and rare bacteria are more frequently identified in current studies than in the past. The reason for this epidemiological shift is largely unknown. However, these "rare" pathogens may represent temporal trends in bacterial colonisation of the prostate due to increasing bacterial resistance worldwide.
HELLP syndrome without hypertension, occurring in the second trimester of pregnancy, is an extremely rare obstetric complication, with significantly increased rates of maternal and perinatal morbidity and mortality. The case report concerns a pregnant second-time mother, aged 24 years, who, in the 25th week of pregnancy, was presented to the Emergency Department of the General Hospital of Trikala, Greece, in a state of distress and with signs of preterm labor. After the ultrasound examination of the negative fetal heart function, the patient was admitted to the maternity ward, where she gave birth by vaginal delivery. While awaiting delivery, clinical and laboratory testing combined with the later exclusion of other pregnancy-related pathological conditions of atypical thrombocytopenia and microangiopathic hemolytic anemia definitively established the diagnosis of HELLP syndrome without hypertension. In this case report, we describe the rare manifestation of HELLP syndrome without hypertension in the second trimester of pregnancy, the presence of which was associated with fetal loss. After the description of the case, a brief bibliographic review is made regarding the pathogenesis, diagnosis and treatment of this rare nosological entity, the correct management of which can improve the prognostic outcome for both the mother and the fetus and the newborn.
Introduction: There is evidence of an association between sexual intercourse and the development of chronic prostatitis. To investigate the above association and to explore the conditions favouring such an association, we retrospectively reviewed the medical records of patients who visited a prostatitis clinic between 01/2008 and 10/2025 and had symptoms of chronic bacterial prostatitis (CBP) and a history of microbiologically proven sexually transmitted diseases (STDs). Material and methods: The study group included a total of ninety-two patients. Most were evaluated with the four-glass test (Meares-Stamey), while some cases underwent the two-glass test. Depending on the presence or absence of specific symptoms, additional samples of ejaculate, urethral smear and urethral discharge were obtained from 34 patients. Results: A statistically significant association was found between STDs and a history of prostatitis and acute or chronic epididymitis. The rate of concurrent urethritis among men with CKD was high but not statistically significant. A significant association was found between multiple sexual partners and CKD. The type of sexual intercourse and the use or non-use of a condom were not associated with CKD. The most common causes of coexisting urethral infection were Chlamydiae trachomatis and Gonococcus. Both were also found in the 81.8% of these patients upon RTPCR analyses of total ejaculate and/or prostatic fluid. The most common pathogens isolated from prostatic secretion and urine after prostate massage were Escherichia coli and Enterococcus faecalis. Conclusions: According to our analyses, sexual intercourse is one of the main modes of transmission of pathogens to the prostate gland.
