Implementation of a Cardiogenic Shock Team in a Tertiary Academic Centre.

BACKGROUND: Observational studies have shown that the management of patients with cardiogenic shock (CS) by dedicated multidisciplinary teams improve clinical outcomes. Nevertheless, these studies reflect a specific organisational setting with most patients being transfers from referring hospitals, hospitalised in cardiac intensive care units (ICU), or treated with mechanical circulatory support (MCS) devices. The purpose of this study was to document the organisation and outcomes of a CS team offering acute care in all-comer population. METHODS: A CS team was developed in a large academic tertiary institution. The team consisted of emergency care physicians, critical care cardiologists, interventional cardiologists, cardiac surgeons, ICU physicians and heart failure specialists and was supported by predefined operating protocol, dedicated communication platform and regular team meetings. RESULTS: Over 12 months, 70 CS patients (69±13 years old, 67% males) were included. Acute myocardial infarction (AMI-CS) was the most common cause (64%); 31% of the patients presented post-resuscitated cardiac arrest and 56% needed invasive mechanical ventilation (IMV). Coronary angiography was performed in 70% and 53% had percutaneous coronary intervention. MCS was used in 10% and 6% were referred for urgent cardiac surgery. The in-hospital mortality in our centre was 40% with 39% of the patients dying within 24-hours from presentation. 76% of the alive patients were discharged home. CONCLUSIONS: Across an all-comer population, AMI was the most common cause of CS. A significant number of patients presented post cardiac arrest, and the majority required IMV. Mortality was high with a significant number dying within hours of presentation.

Acalculous Cholecystitis as a Complication of Primary Epstein-Barr Virus Infection: A Case-Based Scoping Review of the Literature.

Primary Epstein-Barr virus (EBV) infection manifests with diverse clinical symptoms, occasionally resulting in severe complications. This scoping review investigates the rare occurrence of acute acalculous cholecystitis (AAC) in the context of primary EBV infection, with a focus on understanding its prevalence, clinical features, and underlying mechanisms. The study also explores EBV infection association with Gilbert syndrome, a condition that potentially exacerbates the clinical picture. Additionally, a case report of an 18-year-old female presenting with AAC and ascites secondary to EBV infection enhances the review. A comprehensive literature review was conducted, analyzing reported cases of AAC secondary to EBV infection. This involved examining patient demographics, clinical presentations, laboratory findings, and outcomes. The search yielded 44 cases, predominantly affecting young females. Common clinical features included fever, cervical lymphadenopathy, tonsillitis/pharyngitis, and splenomegaly. Laboratory findings highlighted significant hepatic involvement. The review also noted a potential link between AAC in EBV infection and Gilbert syndrome, particularly in cases with abnormal bilirubin levels. AAC is a rare but significant complication of primary EBV infection, primarily observed in young females, and may be associated with Gilbert syndrome. This comprehensive review underscores the need for heightened clinical awareness and timely diagnosis to manage this complication effectively.

Synthesis and characterization of polysaccharide- and protein-based edible films and application as packaging materials for fresh fish fillets.

The rising packaging industry together with global demand for sustainable production has increased the interest in developing biodegradable packaging materials. The aim of the study was to develop edible films based on pectin, gelatin, and hydroxypropyl methylcellulose and evaluate their applicability as biodegradable packaging materials for gilthead seabream fillets. Mechanical properties, water barriers, wettability of the films through contact angle measurement, optical, and UV-Vis barrier properties were evaluated for food packaging applications. The effective blend of polysaccharide and protein film-forming solutions was confirmed by the produced films with excellent optical properties, acceptable mechanical properties and adequate barriers to water vapor. The contact angle for pectin based and gelatin based films were higher than 90° indicating the hydrophobic films, while HPMC based films had contact angle lower than 90°. The produced films were tested as alternative and environmentally friendly packaging materials for gilthead seabream fillets during refrigerated storage. All tested packaging conditions resulted in similar shelf-life in packed gilthead seabream fillets (i.e. 7-8 days at 2 °C). The results showed that the developed films may reduce the use of conventional petroleum-based food packaging materials without affecting the shelf-life of fish.

Study of volatile compounds in Greek pistachio (Pistacia vera L. 'Aegina' cultivar) oils using Soxhlet and ultrasound assisted extraction.

Headspace solid-phase microextraction followed by gas chromatography-mass spectrometry (HS-SPME/GC-MS) represents the most used solvent-free methodology for the characterization of the complex and heterogeneous mix of volatile compounds. The present study investigates the differences in volatile profile of pistachio oils 'Aegina' cultivar extracted with two different techniques, ultrasound assisted extraction (UAE) and Soxhlet. Differences were observed both in the pistachio oil yield and the composition of the volatile compounds among these two groups of samples, which were significantly influenced due to the different thermal conditions. In terms of pistachio oil yield, the Soxhlet extraction technique was proven more efficient (52.5-68.2% w/w) than the UAE type (28.2-42.6% w/w). A total of 34 and 30 volatile compounds were identified for UAE and Soxhlet, respectively. The main ones associated with UAE were α-pinene, octane and decane, while the volatiles formed as a consequence of Soxhlet extraction were decane, nonanal and (E)-2-decenal. Terpenes' concentrations were found decreased in Soxhlet's samples, but hydrocarbons and aldehydes were significantly increased in these samples. Numerous studies concluded in common results. However, this article is the first to explore the influence of different extraction types on the volatile profile of the unique flavour and odor pistachio oil 'Aegina' cultivar.

Balloon Pulmonary Angioplasty in Patients with Chronic Thromboembolic Pulmonary Hypertension in Greece: Data from the Hellenic Pulmonary Hypertension Registry.

Balloon pulmonary angioplasty (BPA) is a novel and promising treatment option for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are ineligible for pulmonary endarterectomy (PEA) and for those with persistent or recurrent pulmonary hypertension after PEA. We present the results of BPA procedures in CTEPH patients included in the Greek Pulmonary Hypertension Registry, evaluating the real-life efficacy and safety. We analyzed data from 180 BPA procedures (2−17/patient, mean 8 ± 4/patient, 1248 dilated vessels, 0−18/session). Significant improvements were observed in mean pulmonary arterial pressure (a reduction by 44%, p < 0.001), pulmonary vascular resistance (reduction by 60%, p < 0.001), and NT-proBNP (decrease by >70%, p: 0.003), while cardiac index improved modestly (9% increase, p = 0.143). We had 37 BPA-related non-fatal complications (20.6% in all interventions), predominantly including hemoptysis. Overall survival was 91%, 75% and 62% at 3, 4 and 5 years, respectively. Therefore, BPA may be a promising therapeutic option in patients with CTEPH in Greece.

ST-elevation myocardial infarction in a 39-year-old patient with "normal" coronary arteries as a thrombotic complication of COVID-19.

We report the case of a 39-year-old male without traditional risk factors for coronary artery disease (CAD), i.e. smoking, hypercholesterolemia, hypertension, diabetes mellitus, familial history of premature CAD, admitted with anterior ST-segment elevation myocardial infarction and concurrent coronavirus disease-2019 infection. Coronary angiography showed high intracoronary thrombus burden and thrombotic occlusion of the proximal segment of left anterior descending artery, while optical coherence tomography revealed intact endothelium after thromboaspiration.

The application of right-angle fluorescence spectroscopy as a tool to distinguish five autochthonous commercial Greek white wines.

White wine is among the most widely consumed alcoholic beverages. Varietal discrimination of wines has received increasing attention. Today's consumers require a sense of authenticity and are deterred by falsehood or misrepresentation in product marketing. However, wine can involve various types of frauds, which directly affects the distribution of wine in national and international markets. Right-angle fluorescence spectroscopy is a simple and rapid analytical technique that in combination with chemometric algorithms, constitutes a novel method for wine authentication. In this study, the stepwise-Linear Discriminant Analysis algorithm was applied in three representative spectral regions related to phenolic compounds for the purpose of distinguishing white wines according to the grape variety. The wavelength at 310 nm attributed to the hydroxycinnamic acids and stilbene provided a higher classification rate (95.5%) than the λex 280 and 295 nm regions (79.8%), suggesting that these compounds are highly related to the botanical origin of samples. The chemometric models were validated utilizing cross-validation and an external validation set to enhance the robustness of the proposed methodology. The above-mentioned methodology constitutes a powerful tool for the varietal discrimination of white wines and can be used in industrial setting. The ultimate goal of this study is to contribute to the efforts towards the authentication of Greek white wine which will eventually support producers and suppliers to remain competitive and simultaneously protect the consumers from fraudulent practices.

Unifloral Autumn Heather Honey from Indigenous Greek Erica manipuliflora Salisb.: SPME/GC-MS Characterization of the Volatile Fraction and Optimization of the Isolation Parameters.

For long heather honey has been a special variety due to its unique organoleptic characteristics. This study aimed to characterize and optimize the isolation of the dominant volatile fraction of Greek autumn heather honey using solid-phase microextraction (SPME) followed by gas chromatography-mass spectrometry (GC-MS). The described approach pointed out 13 main volatile components more closely related to honey botanical origin, in terms of occurrence and relative abundance. These volatiles include phenolic compounds and norisoprenoids, with benzaldehyde, safranal and p-anisaldehyde present in higher amounts, while ethyl 4-methoxybenzoate is reported for the first time in honey. Then, an experimental design was developed based on five numeric factors and one categorical factor and evaluated the optimum conditions (temperature: 60 °C, equilibration time: 30 min extraction time: 15 min magnetic stirrer velocity: 100 rpm sample volume: 6 mL water: honey ratio: 1:3 (v/w)). Additionally, a validation test set reinforces the above methodology investigation. Honey is very complex and variable with respect to its volatile components given the high diversity of the floral source. As a result, customizing the isolation parameters for each honey is a good approach for streamlining the isolation volatile compounds. This study could provide a good basis for future recognition of monofloral autumn heather honey.

GC-MS, FTIR and Raman spectroscopic analysis of fatty acids of Pistacia vera (Greek variety "Aegina") oils from two consecutive harvest periods and chemometric differentiation of oils quality.

Pistacia vera oil is a rich source of unsaturated fatty acids, whose presence is associated with high quality and nutritional value. According to the literature, fatty acid oil composition is not constant every harvest year, but varies mainly depending on climate conditions. Therefore, the knowledge of oil composition in fatty acids is necessary to assess both its quality and its nutritional value. Twenty-two samples (11 samples from the harvest year 2017 and 11 samples from 2018) of the Greek variety "Aegina" were collected from four different Greek regions, from producers following the same cultivation and post-harvest cares. Extraction oil yields were found to be similar (61.7% w/w, 2017; 60.8% w/w, 2018). A reduction of the saturated fatty acids content was determined in 2018 (mean values 12.2% w/w against 13.8% w/w in 2017) by Gas Chromatography-Mass Spectrometry, accompanied by an increase of the unsaturated ones (mean values 87.9% w/w against 86.2% w/w in 2017). These results indicate that the harvest year 2018 may be considered superior to 2017 in terms of quality and nutritional value and may be correlated with an increased mean rain rate in 2018 and a slight decrease of the mean temperature. Fourier transform infrared (FTIR) and Raman spectroscopic studies of the oils were also performed. Three chemometric models were developed for the two consecutive harvest years of pistachio oil and the discrimination was based on GC-MS analysis, FTIR and Raman spectroscopic data combined with cross-validation techniques and comparison among them. The most successful chemometric model was that based on FTIR spectroscopy, which has the advantage of speed, simplicity and economy. Such a chemometric model may help in estimating the quality of Pistacia vera oils.

Composition, seasonal abundance, and public health importance of mosquito species in the regional unit of Thessaloniki, Northern Greece.

Mosquitoes (Diptera: Culicidae) are the largest group of blood-feeding insects that disturb not only humans but also other mammals and birds. This study reports the presence of native mosquito species in the regional unit of Thessaloniki and the monitoring of their population. In total, 13 mosquito species belonging to four genera were identified. The most dominant species was Culex pipiens, followed by Aedes caspius. In the present study, we report for the first time the presence of Ae. vittatus in Greece and of Anopheles plumbeus in the regional unit of Thessaloniki. Regarding the seasonal variation, species of the genus Aedes were the ones that first appeared in late March, followed by Culex species at the end of April and finally species of the genus Anopheles in July. Species of the Aedes genus were found to be the most abundant in the first quarter of the year (late March to early April). Population of Cx. pipiens remained at high levels from late April to late September. Species of the genus Anopheles were found in high densities from early August to October. The current study contributes to the knowledge of the mosquito species composition and their relative abundance in an area where West Nile virus caused severe epidemic outbreaks.

Authentication of the Botanical and Geographical Origin and Detection of Adulteration of Olive Oil Using Gas Chromatography, Infrared and Raman Spectroscopy Techniques: A Review.

Olive oil is among the most popular supplements of the Mediterranean diet due to its high nutritional value. However, at the same time, because of economical purposes, it is also one of the products most subjected to adulteration. As a result, authenticity is an important issue of concern among authorities. Many analytical techniques, able to detect adulteration of olive oil, to identify its geographical and botanical origin and consequently guarantee its quality and authenticity, have been developed. This review paper discusses the use of infrared and Raman spectroscopy as candidate tools to examine the authenticity of olive oils. It also considers the volatile fraction as a marker to distinguish between different varieties and adulterated olive oils, using SPME combined with gas chromatography technique.

The Use of SPME-GC-MS IR and Raman Techniques for Botanical and Geographical Authentication and Detection of Adulteration of Honey.

The aim of this review is to describe the chromatographic, spectrometric, and spectroscopic techniques applied to honey for the determination of botanical and geographical origin and detection of adulteration. Based on the volatile profile of honey and using Solid Phase microextraction-Gas chromatography-Mass spectrometry (SPME-GC-MS) analytical technique, botanical and geographical characterization of honey can be successfully determined. In addition, the use of vibrational spectroscopic techniques, in particular, infrared (IR) and Raman spectroscopy, are discussed as a tool for the detection of honey adulteration and verification of its botanical and geographical origin. Manipulation of the obtained data regarding all the above-mentioned techniques was performed using chemometric analysis. This article reviews the literature between 2007 and 2020.

Chemometric Study of Fatty Acid Composition of Virgin Olive Oil from Four Widespread Greek Cultivars.

Virgin olive oil (VOO) is one of the key components of the Mediterranean diet owing to the presence of monounsaturated fatty acids and various bioactive compounds. These beneficial traits, which are usually associated with the cultivar genotype, are highlighting the demand of identifying characteristics of olive oil that will ensure its authenticity. In this work, the fatty acid (FA) composition of 199 VOO samples from Koroneiki, Megaritiki, Amfissis, and Manaki cultivars was determined and studied by chemometrics. Olive cultivar greatly influenced the FA composition, namely, oleic acid (from 75.36% for Amfissis to 65.81% for Megaritiki) and linoleic acid (from 13.35% for Manaki to 6.70% for Koroneiki). Spearman's rho correlation coefficients revealed differences and similarities among the olive oil cultivars. The use of the forward stepwise algorithm identified the FAs arachidonic acid, gadoleic acid, linoleic acid, α-linolenic acid, palmitoleic acid, and palmitic acid as the most significant for the differentiation of samples. The application of linear and quadratic cross-validation discriminant analysis resulted in the correct classification of 100.00% and 99.37% of samples, respectively. The findings demonstrated the special characteristics of the VOO samples derived from the four cultivars and their successful botanical differentiation based on FA composition.

Response Surface Methodology to Optimize the Isolation of Dominant Volatile Compounds from Monofloral Greek Thyme Honey Using SPME-GC-MS.

This study aimed at an experimental design of response surface methodology (RSM) in the optimization of the dominant volatile fraction of Greek thyme honey using solid-phase microextraction (SPME) and analyzed by gas chromatography-mass spectrometry (GC-MS). For this purpose, a multiple response optimization was employed using desirability functions, which demand a search for optimal conditions for a set of responses simultaneously. A test set of eighty thyme honey samples were analyzed under the optimum conditions for validation of the proposed model. The optimized combination of isolation conditions was the temperature (60 °C), equilibration time (15 min), extraction time (30 min), magnetic stirrer speed (700 rpm), sample volume (6 mL), water: honey ratio (1:3 v/w) with total desirability over 0.50. It was found that the magnetic stirrer speed, which has not been evaluated before, had a positive effect, especially in combination with other factors. The above-developed methodology proved to be effective in the optimization of isolation of specific volatile compounds from a difficult matrix, like honey. This study could be a good basis for the development of novel RSM for other monofloral honey samples.

Hyperhomocysteinemia as the only risk factor in a young man presenting with ST-elevation myocardial infarction.

Hyperhomocysteinemia has been established as a risk factor for cardiovascular events. This case of a 23-year-old male, presenting with acute coronary thrombosis and unremarkable past medical history, highlights the importance of measuring homocysteine levels in young individuals with acute coronary syndromes, especially those without conventional risk factors. .

Rapid screening on aflatoxins' presence in Pistachia vera nuts using diffuse reflectance infrared Fourier transform spectroscopy and chemometrics.

Aflatoxin contamination in pistachios has been analyzed in this work, using Diffuse Reflectance Infrared Spectroscopy (DRIFTS) with chemometrics. Forty-nine Greek pistachio samples of different aflatoxin concentrations were classified into aflatoxin and non-aflatoxin groups using the 3035-2821, 1770-1721, 1570-1481 and 1260-1061 cm-1 spectral regions in Kubelka-Munk conversion and first derivative form. A chemometric model was developed using twenty-eight samples as calibration, 11 as validation and 10 as test set. The discrimination analysis separated correctly the 100% of the calibration and the validation set and the 80% of the test set. The proposed chemometric model is simple, rapid, economical and environmentally friendly since it does not require chemical pre-treatment of the samples. It is expected that the present method may be proved useful in food industry and the inspection authorities as a rapid decision-making tool to detect batches that must be rejected and enhance consumers' protection from aflatoxin contaminated pistachios.

Botanical origin discrimination of Greek honeys: physicochemical parameters versus Raman spectroscopy.

BACKGROUND: The authenticity of honey is of high importance since it affects its commercial value. The discrimination of the origin of honey is of prime importance to reinforce consumer trust. In this study, four chemometric models were developed based on the physicochemical parameters according to European and Greek legislation and one using Raman spectroscopy to discriminate Greek honey samples from three commercial monofloral botanical sources. RESULTS: The results of physicochemical (glucose, fructose, electrical activity) parameters chemometric models showed that the percentage of correct recognition fluctuated from 92.2% to 93.8% with cross-validation 90.6-92.2%, and the placement of test set was 79.0-84.3% successful. The addition of maltose content in the previous discrimination models did not significantly improve the discrimination. The corresponding percentages of the Raman chemometric model were 95.3%, 90.6%, and 84.3%. CONCLUSION: The five chemometric models developed presented similar and very satisfactory results. Given that the recording of Raman spectra is simple, fast, a minimal amount of sample is needed for the analysis, no solvent (environmentally friendly) is used, and no specialized personnel are required, we conclude that the chemometric model based on Raman spectroscopy is an efficient tool to discriminate the botanical origin of fir, pine, and thyme honey varieties. © 2020 Society of Chemical Industry.