Avian Influenza

Hippokratia 2006; 10 (1):3-6

J Kavaliotis
Dpt of Paediatrics, Infectious Diseases Hospital, Thessaloniki, Greece

Abstract

Avian influenza is due to H5N1 type of influenza virus. It is hosted by birds, but may infect several species of mammals and specially the domestic poultry. The virus is transmitted by infectious droplets and droplet nuclei, by direct contact and, perhaps, by indirect contract. Two features of the current H5N1 outbreaks are striking: the predominance of children and young abults and the high mortality rate. The diagnosis needs a travel and epidemio-logic history as well as a close contact with patients or sick poultry. The management of avian flu include treatment and prevention. Oseltamivir is the drug of choice (75 mg twice daily for 5 days). Isolation precautions similar to thoce used for SARS - infected patients are recommended.

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Nanotechnology in Medicine: The Medicine of Tomorrow and Nanomedicine

Hippokratia 2006; 10(1): 7-21

S Logothetidis
Physics Dpt, Aristotle University of Thessaloniki
Lab for Thin Films - Nanosystems & Nanometrology, Thessaloniki, Greece

Abstract

Nanotechnology is an emerging technology with enormous potential in information and communication technology, biology and biotechnology, medicine and medical technology. Novel nano- and bio-materials, and nanodevices are fabricated and controlled by nanotechnology tools and techniques, which investigate and tune the properties, re-sponses and functions of living and non-living matter, at sizes below 100 nm. The current advances of nanotechnology in modern medicine are presented and discussed. The potential medical applications are predominantly in detection, diagnostics (disease diagnosis and imaging), monitoring, and therapeutics. The availability of more durable and better prosthetics, and new drug-delivery systems are of great scientific interest and give hope for cancer treatment and minimum invasive treatments for heart disease, diabetes and other diseases. Many novel nanoparticles and nanodevices are expected to be used, with an enormous positive impact on human health. The vision is to improve health by enhancing the efficacy and safety of nanosystems and nanodevices. Products based on nanotechnology in medicine and medical technology are reaching the market, with an anticipated enormous positive impact on human health, in the coming years. The development of specific guidance documents at a European level for the safety evaluation of nanotechnology products in medicine is strongly recommended and the need for further research in nanotoxicology, is identified. Ethical and moral concerns also need to be addressed in parallel with the new developments.

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Strategies for prenatal diagnosis today

Hippokratia 2006; 10(1):22-27

A Daniilidis, N Klearhou, M Mauromichali
3rd Dpt Obstetrics and Gynaecology, Hippokratio General Hospital, Thessaaloniki, Greece
Dpt of Paediatrics, "Gennimatas" General Hospital, Thessaloniki, Greece

Abstract

Prenatal diagnosis has become a standard part of modern obstetrics. There is always the risk for a diagnostic error, which could result in a loss of a normal pregnancy or in an avoidable birth of a handicapped child. The various available screening tests which are being used nowadays aim to detect with the highest possible sensitivity the high risk pregnancies. The first trimester screening test combines maternal age, nuchal translucency and the measurements of serum b-hCG, AFP, uE3 and inhibin A. Accurate prenatal diagnosis of chromosomal abnormalities is available by obtaining fetal cells through amniocentesis or chorionic villous sampling with an unavoidable though risk of miscarriage. Undoubtedly family history and also the improvement of ultrasound machines and skills play an important role in the detection of foetal abnormalities. The need of developing non invasive approaches for accurate prenatal diagnosis will become more and more desirable in the future.

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Anaesthesia for chronic spinal cord lesions

Hippokratia 2006; 10(1):28-31

Z Kanonidou
3rd Dpt Anaesthesiology, Hippokratio General Hospital, Thessaloniki, Greece

Abstract

Increasing numbers of patients with spinal cord injury present for surgery care. The most important perioperative risks are autonomic dysreflexia, bradycardia, hypotension, respiratory deficiency and muscle spasms. Patients with low, complete lesions, undergoing surgery below the level of injury, may safely do so without anaesthesia. An anaesthesiologist should be present to monitor the patient in this condition. General anaesthesia of sufficient depth is effective at controlling spasms and autonomic dysreflexia but hypotension and respiratory dysfunction are poten-tial risks. There is a growing consensus that techniques of regional anaesthesia are safe, effective and technically simple to perform in these patients.

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Monitoring of patients with sustained virological response treated with standard or pegylated interferon in combination with ribavirin for chronic hepatitis C

Hippokratia 2006; 10(1):32-34

M Raptopoulou, M Sinakos, H Orfanou, Th Lalla, H Gigi
2nd Dpt Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

Abstract

Background-Aims: Sustained virological response (SVR) is defined as undetectable HCV-RNA at the end of 24 weeks of follow-up after treatment. This study aimed to determine the durability of this response beyond this time period and the long term management of patients with chronic hepatitis C.
Methods: We retrospectively analyzed viral response to treatment with either standard or pegylated interferon in combination with ribavirin in 63 patients followed-up for 3-65 months after the completion of 6 months follow-up. HCV-RNA was determined by polymerase chain reaction at baseline, week 12, end of treatment and every 3 months thereafter.
Results: End of treatment virologic response (ETVR) was achieved in 43/63 patients. Concerning sustained response 6 patients were lost during follow-up and 11 / 37 - 10 / 11 with genotype 1- relapsed at week 12. No more patient relapsed until the end of the 24-week follow-up. All patients with SVR (n=26) (8 with genotype 1, 1 with genotype 2, 15 with genotype 3 and 1 with genotype 4) retained the SVR during the long term follow-up except for one with genotype 3 who relapsed two years after cessation of treatment.
Conclusions: Our findings suggest that patients with chronic hepatitis C receiving combination therapy usually re-lapse during the first 12 weeks of follow-up. Relapse is extremely rare there after. Thus, measurement of HCV-RNA at week 12 of follow-up can safely predict persistent virologic response to treatment.

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Lipid status, inflammatory markers and vascular complications in patients on haemodialysis.

Hippokratia 2006; 10(1):35-38

D Yonova, S Dobrev
Dialysis Clinic, Central Clinical Lab, Medical University Hospital, Sofia, Bulgaria

Abstract

The protective role of high density lipoproteins (HDL) on the delopment of vascular calcifications with atheromatous and medial forms of calcium deposits have been recently suggested. Vascular calcification shares several features with skeletal bone formation at the cellular and molecular levels. Lack or decreasing of serum HDL leads to higher vascular calcification in general population and perhaps even more severely it happens to patients with chronic renal failure where the lipid metabolism is frequently disturbed. Another supposed factor for arterial calcification is the presence of inflammation. The high rate of cardiovascular morbidity and mortality in haemodialysis (HD) patients and the special impor-tance of presence of vascular calcification in that pathology initiates this study, which has set a goal to establish whether there is a relation between: a). lipid profile and inflammation, accounting C-reactive protein as one of its typical markers, and: b). both lipid profile and inflammation and vascular calcification rate in a group of HD patients, comparing HD group with a group of healthy volunteers.

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Amikacin - treatment of an urinary tract infection in a hemodialysis patient - what may be eventualy missed?

Hippokratia 2006; 10(1):39-40

D Yonova, E Vazelov, V Papazov, I Trendafilov, A Simeonov
Dialysis Clinic, Medical University Hospital "Alexandrovska", Sofia, Bulgaria

Abstract

The study is presenting a clinical case of a diabetic patient on regular haemodialysis treatment with an exacerbated urinary infection, demonstrated by fever, microhematuria, disuria and significant bacteriuria. The urinary bacterial infection (Pseudomonas aeruginosa >10 5 , sensitive to amikacin) was treated ineffectively by an aminoglucoside (amikacin) until pH of the urine was changed to slight alkaline level – the appropriate media in which aminoglucosides are effective and reasonably applied. The successful treatment after alkalization proved that pH of the media is of great mportance for aminoglucoside’s therapy and must not be neglected.

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A rare complication of a permanent venous catheter implantation to a patient on regular haemodialysis

Hippokratia 2006; 10(1):41-43

V Papazov, D Yonova, D Terziev, M Lubih
Dialysis Clinic, Medical University Hospital "Alexandrovska", Sofia, Bulgaria

Abstract

Central venous catheters for hemodialysis play an important role in the treatment of acute renal failure, for immediate vascular access in cases of urgently needed hemodialysis in chronic renal failure or for patients having problems with their permanent vascular access ??? arteriovenous anastomosis or prothesis. Some kinds of central venous catheters are named ???permanent??? catheters, as they are surgically implanted up to v.v. cava superior and inferior to provide higher blood flow and can be used longer time ??? a number of months or years. Two types of risk are associated with vascular access devices: those occurring during or shortly after placement and delayed risks that occur simply because the device is in your body.The different positions of the venous catheters are related to different level of risks of complications what is shortly described in this brief review.

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