Hippokratia
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Hemoglobin Adana is a non-deletional alpha chain mutation, particularly rare, and to date, it is mostly described in coinheritance to other a-thalassemia mutations. Such interactions result in various phenotypes depending on the underlying genotype. Since routine hematological tests do not detect the aforementioned unstable variant, it is quite likely a diagnosis to be missed or delayed, with any complications this may have for a patient. Description of the case: A case report of late mutation identification in a 64-year-old woman of Greek origin is described. The importance of conducting not only molecular studies to confirm common mutations, such as the -a3.7 kb deletion, but also DNA studies in patients whose phenotype and results of standard tests are not consistent or who present with severe, late complications is highlighted. ⋯ The awareness of the necessity for accurate diagnosis is raised, especially in populations that thalassemia prevails and is attributed to numerous mutations. HIPPOKRATIA 2020, 24(1): 38-42.
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The postoperative supplementary motor area (SMA) syndrome may complicate unilateral surgery involving the SMA cortex and manifests as contralateral or global akinesia, mutism, or speech deficit, with complete or major recovery in weeks to months. ⋯ Prevention of SMA syndrome is not always possible in resective surgery. Given its favorable prognosis, it should be well known to the health professionals of different specialties engaged in such patients' postoperative care. The possibility of SMA should be preoperatively discussed with the patients and caregivers. HIPPOKRATIA 2020, 24(1): 38-42.
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Complicated cholecystitis (CC) is the severe form of acute cholecystitis (AC). Clinical, radiological, inflammatory, or biochemical parameters are used to predict presence of CC. We aimed to evaluate the Glasgow prognostic (GPS) and modified systemic inflammation scores (mSIS) that are used to predict presence of CC. ⋯ CRP, WBC, and NEU could be used to predict presence of CC. The combination of CRP or LMR with albumin could be a positive but weak predictor of CC, and it is quick, easy to use, and reliable. HIPPOKRATIA 2020, 24(1): 15-20.
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Multidrug-resistant (MDR) isolates of Acinetobacter spp. have been reported worldwide. This study aimed to analyze clinical features and outcomes of intensive care unit (ICU) patients with MDR Acinetobacter spp. bacteremia and to determine factors influencing survival by using 30-day mortality as the primary endpoint. ⋯ A case-control study included a total of 164 patients with MDR Acinetobacter spp. bacteremia hospitalized in ICUs in Vojvodina Province, Serbia, from January 2013 through March 2016. Medical records were reviewed, and patients' demographic and clinical characteristics were collected. Predictors of 30-day mortality were identified by logistic regression analysis. Results: The overall 30-day mortality rate was 48.2 % (79 of 164 patients). Multivariate logistic regression analysis revealed that independent predictors of 30-day mortality were two or more co-morbidities, diabetes mellitus, and inappropriate use of antimicrobials. Conclusion: Early implementation of appropriate antimicrobial therapy, particularly in critically ill ICU patients with MDR Acinetobacter spp. bacteremia, with two or more co-morbidities and diabetes mellitus, can be crucial for survival. HIPPOKRATIA 2020, 24(1): 21-26.
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The lack of standardized tools limits the diagnosis οf postoperative delirium (POD) in the Greek population. Our aim was the translation and the cultural adaptation of the confusion assessment method (CAM) diagnostic algorithm and the nursing delirium screening scale (nu-DESC) in the Greek surgical population, and the determination of their inter-rater reliability. ⋯ With the translation, the cultural adaptation, and the determination of their inter-rater agreement, the CAM diagnostic algorithm and the nu-DESC may serve as reliable instruments for the detection of POD in the Greek population. HIPPOKRATIA 2020, 24(1): 8-14.