Holter ECG diagnosis of nicotine-spray induced ventricular fibrillation. An unusual case of Prinzmetal variant angina.

We report on an interesting case of resuscitated sudden cardiac death (SDC) in a 51-year-old with hypertension and positive family history for SDC. The patient was resuscitated and an emergency angiogram ruled out coronary artery disease. Cardio-MRT ruled structural disease or infection. Holter and telemetry monitoring revealed premature ventricular complexes and transient ST-changes followed by anginaepisodes in correlation with the use of the nicotine-replacement-spray. The patient was urged to quit smoking and smoking-substitutes. Medical therapy with calcium-channelblocker and a long acting nitrate was administered. One-month follow up reported no arrhythmic or angina events.

Old age mental health services in Southern Balkans: Features, geospatial distribution, current needs, and future perspectives.

BACKGROUND: Healthcare services are increasingly confronted with challenges related to old age mental disorders. The survey aimed to provide an overview of existing psychogeriatric services in Albania, Bulgaria, Greece, and North Macedonia. METHODS: After identification of psychogeriatric units across the four countries, their head physicians were asked to provide data on their clinical, teaching, and research activity, as well as staff composition. Moreover, the attitudes of head physicians to current needs and future service development were explored. RESULTS: A total of 15 psychogeriatric units were identified (3 in Bulgaria, 8 in Greece, and 4 in North Macedonia). Results show wide variation regarding the location, team size and composition, service availability, numbers of patients attending, and inpatient treatment length. Most head physicians underscored the urgent need for breakthroughs in the graduate and postgraduate education in psychogeriatrics of medical and nonmedical professionals, as well as in the interconnection of their units with community primary healthcare services and long-term care facilities for seniors via telemedicine. They would welcome the development of national standards for psychogeriatric units, potentially embodying clear pointers for action. A number of head physicians advocated the development of nationwide old age mental health registries. CONCLUSIONS: Regional disparities in resources and services for seniors' mental health services were unveiled. These data may enrich the dialogue on optimizing psychogeriatric services through planning future cross-border collaborations mainly based on telemedicine services, especially in the era of the novel coronavirus pandemic, and training/education in psychogeriatrics of mental health professionals.

Implementation of tunneled versus not tunneled peripherally inserted central catheters.

Tunneled peripherally inserted central catheters (PICCs) offer several advantages such as an exit site at the green zone no matter where the puncture point is and a long subcutaneous route, which is considered a shield against infections and provides comfort to the patient. Clinicians could choose the proper exact exit site so as to avoid blood leakage from the exit point. The aim of the study was to assess the value of the tunneled PICCs versus normal PICCs with no long subcutaneous route. Sixty patients were randomly divided into two groups and underwent a PICC placement procedure between August 2014 and November 2014 and were then observed until February 2015. Thirty of them (group A) underwent a PICC placement procedure, after proper ultrasound scan and under local anesthesia, of the veins of the upper limb, internal jugular and axillary veins. The mean (±standard deviation) age of patients was 54.8 ± 9.2 years (range, 18-80 years). The primary success rate was 100% for all patients in both the groups. The procedure was not painful for the patients. In group A, after 3 months of surveillance, 7 devices were removed because the patients' therapy came to an end, and only in one incident, the catheter was removed due to soft tissue infection. Tunneled PICCs seem to be a safe option and an easy alternative to perform in contrast to placement without a tunnel. It is an easy, cheap procedure that allows us to catheterize the vein with a larger caliber and create an exit point at any preselected point on the upper limb.

Daily dose of itraconazole 100 mg to treat allergic bronchopulmonary aspergillosis (ABPA) related eosinophilia: a case report.

BACKGROUND: Itraconazole can be used in the treatment of allergic bronchopulmonary aspergillosis (ABPA), as add-on therapy to antiasthmatic medications. Description of the case: The case of an 83-year-old male with asthma, newly diagnosed with ABPA, is presented. A daily itraconazole dose of 100 mg managed to efficiently control eosinophilia and reduce his total IgE count, while these laboratory findings relapsed three months after stopping itraconazole. When the dose was reduced to 100 mg of itraconazole every other day, it was proved insufficient to control eosinophilia. Moreover, one year later, he is being efficiently treated with 100 mg itraconazole daily. CONCLUSIONS: The dose of itraconazole 100 mg can effectively treat some cases of ABPA with asthma. HIPPOKRATIA 2017, 21(3): 144-146.

Effective treatment of secondary hyperparathyroidism in hemodialysis patients by titration of intravenous calcitriol dosage.

AIM: Effective treatment of secondary hyperparathyroidism (HPTH) with intravenous (i.v.) administration of calcitriol in hemodialysis patients. PATIENTS AND METHODS: The current study evaluates the use of i.v. calcitriol dosing in relation to the severity of the HPTH in 35 hemodialysis patients with serum phosphate < 6.5 mg/dl. Arbitrarily, patients with plasma IPTH levels (intact PTH) between 288 and 576 pg/ml (288 pg/ml = four-fold the upper normal limit) were given initially 1 microg i.v. calcitriol at the end of each dialysis (group A, n = 15). Patients with IPTH between 577 and 864 pg/ml received 2 microg i.v. calcitriol (group B, n = 10) and patients with IPTH more than 865 pg/ml were given 3 - 4 microg i.v. calcitriol (group C, n = 10). As IPTH levels decreased, the dose of i.v. calcitriol was also decreased gradually. Patients were followed-up for 4 months after the end of calcitriol treatment. RESULTS: During the i.v. calcitriol treatment period, the observed plasma IPTH concentrations compared with the baseline values were significantly lower (p < 0.01 for A and B group and p < 0.05 for C group) from the sixth month onwards in group A and C and from the third month onwards in group B. At the 12th month of follow-up, all patients being off i.v. calcitriol treatment for four months, a sharp and significant increase (p < 0.01 for group A and B and p < 0.05 for group C) of plasma IPTH was recorded in all three groups of patients. Alkaline phosphatase was also gradually decreased in all studied groups. Serum Ca and P remained unchanged in most patients. CONCLUSION: In conclusion, the study presented here demonstrates that the titration of i.v. calcitriol dosage according to the severity of HPTH is an effective and safe treatment of HPTH in chronic hemodialysis patients. It also shows that parathyroidectomy could be avoided in the majority of patients with severe HPTH, if an appropriate dose of calcitriol not aggravating hyperphosphatemia is administered.