Fatal Left Ventricular Free Wall Rupture Complicating Acute Myopericarditis.

This is a case of a 59-year-old man presenting with myopericarditis. Over a 2-week period, he developed progressive symptoms and worsening pericardial effusion, leading to cardiac tamponade. Pericardiocentesis revealed hemopericardium, and multidetector computed tomography angiography showed left ventricular free wall rupture. The patient collapsed abruptly, and autopsy confirmed the findings.

Multiparametric ultrasound for upper extremity dialysis access evaluation.

The evolution of ultrasound (US) techniques has greatly improved the evaluation of many parameters in dialysis vascular access, which is typically achieved through an arteriovenous fistula (AVF) or graft (AVG). These techniques include grayscale B-mode, color Doppler, power Doppler, spectral Doppler, non-Doppler US flow imaging techniques, contrast-enhanced US, and elastography. In conjunction with a patient's medical history and physical examination, US provides crucial information about the native vascular bed prior to the surgical creation of an arteriovenous anastomosis. It also tracks the maturation progress of the newly created AVF or AVG and aids in diagnosing potential complications of the vascular access. These complications include thrombosis, steal syndrome, aneurysms, pseudoaneurysms, hematomas, infection, ischemic neuropathy, exacerbation of preexisting congestive heart failure, and stenosis.

Gastrointestinal Imaging Findings in the Era of COVID-19: A Pictorial Review.

The potentially fatal COVID-19 pandemic has been associated with a largespectrum of clinical presentations. Beyond the classical pulmonary manifestations, gastrointestinal tract-related symptoms suchas nausea, diarrhea, abdominal distention and pain have been observed in patients, as a consequence of the binding of SARS-CoV-19 to Angiotensin-converting Enzyme 2 (ACE2) receptors in the gastrointestinal (GI) tract. The early recognition ofspecific imaging features, including hepatobiliary involvement, pancreatic involvement, development of solid organ infarcts, ischemic bowel changes and vascular occlusion, plays a key role through the course of the disease. Also, suspicious symptoms, especially in critically ill patients with clinical and biochemical markers of hypovolemia, necessitate timely imaging for bleeding complications. The aim of this pictorial review is to illustrate the spectrum of the GIimaging findings in patients with COVID-19. Awareness of diagnostic imaging hallmarks is crucial to optimize the management of these patients.

COVID-19 related acute necrotizing encephalopathy presenting in the early postoperative period.

Besides respiratory and gastrointestinal symptoms, SARS-CoV-2 also has potential neurotropic effects. Acute hemorrhagic necrotizing encephalopathy is a rare complication of Covid-19. This article presents a case of an 81-year-old female, fully vaccinated, who underwent laparoscopic transhiatal esophagectomy due to gastroesophageal junction cancer. In the early postoperative period, the patient developed persistent fever accompanied by acute quadriplegia, impaired consciousness, and no signs of respiratory distress. Imaging with Computed Tomography and Magnetic Resonance revealed multiple bilateral lesions both in gray and white matter, as well as pulmonary embolism. Covid-19 infection was added to the differential diagnosis three weeks later, after other possible causes were excluded. The molecular test obtained at that time for coronavirus was negative. However, the high clinical suspicion index led to Covid-19 antibody testing (IgG and IgA), which confirmed the diagnosis. The patient was treated with corticosteroids with noticeable clinical improvement. She was discharged to a rehabilitation center. Six months later, the patient was in good general condition, although a neurological deficit was still present. This case indicates the significance of a high clinical suspicion index, based on a combination of clinical manifestations and neuroimaging, and the confirmation of the diagnosis with molecular and antibody testing. Constant awareness of a possible Covid-19 infection among hospitalized patients is mandatory.

Pneumocephalus; a rare cause of coma.

We report the case of an 84-years old female patient who developed cerebral air embolism in association with the indwelling hemodialysis central venous catheter. Pneumocephalus, even though rare, should be included in the differential diagnosis of acute manifestation of neurologic deficits, especially in association with central venous access, surgical interventions or trauma, and requests prompt management. Brain computed tomography scanning remains the investigation of choice.

Peridialytic and intradialytic blood pressure metrics are not valid estimates of 44-h ambulatory blood pressure in patients with intradialytic hypertension.

PURPOSE: In contrast to peridialytic blood pressure (BP), intradialytic and home BP measurements are accurate metrics of ambulatory BP load in hemodialysis patients. This study assessed the agreement of peridialytic, intradialytic, and scheduled interdialytic recordings with 44-h BP in a distinct hemodialysis population, patients with intradialytic hypertension (IDH). METHODS: This study included 45 IDH patients with valid 48-h ABPM and 197 without IDH. With 44-h BP used as reference method, we tested the accuracy of the following BP metrics: Pre- and post-dialysis, mean and median intradialytic, mean intradialytic plus pre/post-dialysis, and scheduled interdialytic BP (out-of-dialysis day: mean of 8:00am/8:00 pm readings). RESULTS: In IDH patients, peridialytic and intradialytic BP metrics showed at best moderate correlations, while averaged interdialytic SBP/DBP exhibited strong correlation (r = 0.882/r = 0.855) with 44-h SBP/DBP. Bland-Altman plots showed large between-method-difference for peri- and intradialytic-BP, but only + 0.7 mmHg between-method difference and good 95% limits of agreement for averaged interdialytic SBP. The sensitivity/specificity and κ-statistic for diagnosing 44-h SBP ≥ 130 mmHg were low for pre-dialysis (72.5/40.0%, κ-statistic = 0.074) and post-dialysis (90.0/0.0%, κ-statistic = - 0.110), mean intradialytic (85.0/40.0%, κ-statistic = 0.198), median intradialytic (85.0/60.0%, κ-statistic = 0.333), and intradialytic plus pre/post-dialysis SBP (85.0/20.0%, κ-statistic = 0.043). Averaged interdialytic SBP showed high sensitivity/specificity (97.5/80.0%) and strong agreement (κ-statistic = 0.775). In ROC analyses, scheduled interdialytic SBP/DBP had the highest AUC (0.967/0.951), sensitivity (90.0/88.0%), and specificity (100.0/90.0%). CONCLUSION: In IDH patients, only averaged scheduled interdialytic but not pre- and post-dialysis, nor intradialytic BP recordings show reasonable agreement with ABPM. Interdialytic BP recordings only could be used for hypertension diagnosis and management in these subjects.

Perceptions, Knowledge and Attitudes among Young Adults about Prevention of HPV Infection and Immunization.

INTRODUCTION: Human papilloma virus (HPV) is one of the most common sexually transmitted infections and is widely known as the main causative agent for cervical cancer. The aim of this study was to investigate the perceptions, knowledge and attitudes of young Greek adults concerning prevention of HPV infection and HPV immunization. MATERIAL AND METHODS: This constitutes a cross-sectional online survey. A convenience sample of young Greek adults (n = 883) residing in Greece, aged 17 to more than 35 years was surveyed from December 2020 to March 2021. Two validated questionnaires were used to collect data. RESULTS: Participants demonstrated moderate knowledge about HPV infection and vaccination, with a mean knowledge score of 53.26 (SD ± 20.65) and 38.92 (SD ± 17.58), respectively. Cronbach's alpha value was 0.77 and 0.80. Female participants were better informed than males. Approximately 52.3% of respondents had been vaccinated and 65.5% were willing to get vaccinated in the future. Vaccination rate was significantly associated with gender (OR = 11.99; 99% CI = 6.59-21.84), knowledge about the HPV vaccine (OR = 1.04; 99% CI = 1.03-1.04) and age (OR = 0.07; 99% CI = 0.03-0.15). Reasons for vaccine refusal were insufficient information (36.8%) and fear of side effects (19%). Correlates of positive vaccination intention were knowledge about HPV (OR = 1.02; 99% CI = 1.01-1.02). CONCLUSIONS: The findings suggest that the Greek government's continuing HPV promotion efforts and education on the risks of HPV infection among young people are likely to increase vaccination acceptance among this group.

Factors Affecting State and Trait Anxiety of Relatives of Hospitalized Patients.

Introduction: Hospitalization is a stressful event for both patients and relatives. The aim of the study was to explorefactors affecting state and trait anxiety of relatives of hospitalized patients. Methods: In this cross-sectional study, was enrolled a convenience sample of 222 relatives of hospitalized patients in a public hospital in Athens, Greece. Data were collected by the completion of State-Trait Anxiety Inventory (STAI) which also included participants' characteristics. Data were analyzed using SPSS version 25, while the statistical significance level was P < 0.05. Results: Of the 222 relatives, 72 were men and 150 women. The average state and trait anxiety score was 45.6 and 42, respectively, within the possible range of scores (20-80) thus indicating moderate levels of anxiety. Moreover, state and trait anxiety was statistically significantly associated with gender, degree of information of patient's health, whether they had readjusted family responsibilities, whether they had financial worries, whether they experienced uncertainty about future and finally whether they were anxious about their ability to respond to patients care. Conclusion: Factors associated with relatives' anxiety were gender, information regarding patient's health, family responsibilities, financial worries, uncertainty and anxiety to respond to patients' care. These factors need to be evaluated when planning psychological intervention to alleviate this emotional burden.

An unusual cause of epigastric pain and diaphoresis.

The median arcuate ligament, or celiac artery compression syndrome is a rare syndrome, caused by extrinsic compression of the celiac trunk by the median arcuate ligament. Its symptomatology mainly comprises of visceral angina. Differential diagnosis includes cardiovascular angina, other vascular events and causes of vagotonia. The case reported here refers to a middle aged male patient who presented with intermittent epigastric pain and diaphoresis after a long drive. Diagnosis was made radiologically, during computed tomography scan angiography, which revealed a hook-like appearance of the celiac artery partially loosened during inspiration. Careful history and cautious reviewing of the imaging may refrain from further, unnecessary, diagnostic investigations.

Fulminant cryptococcal meningoencephalitis after successful treatment of primary cutaneous cryptococcosis.

INTRODUCTION: Cryptococcal meningoencephalitis is a life-threatening disease affecting mainly immunocompromised hosts. CASE REPORT: We present a case of a 64-year-old immunocompetent patient, who initially developed a traumatic scalp skin infection due to Cryptococcus neoformans. The patient received oral fluconazole and subsequently liposomal amphotericin B due to the development of resistance with resolution of the infection. Two years later, during chemotherapy for newly diagnosed gastric and lung cancer, he developed fulminant cryptococcal meningoencephalitis, which did not respond to liposomal amphotericin B and flucytosine. CONCLUSIONS: To our knowledge, this is the first case of fulminant cryptococcal meningoencephalitis following long latency after adequately treated primary cutaneous infection.

Complete early regression of asymptomatic hindbrain herniation caused by minor head trauma.

Very few cases of cerebellar tonsillar herniation resulting from head trauma have previously been reported. We present a case of an 11-month-old girl who suffered a minor head trauma. Computed tomography (CT) scan of the head showed an occipital bone fracture and blood in the fourth ventricle. Magnetic resonance imaging (MRI) scan of the brain 2 days later revealed cerebellar edema and displacement of the cerebellar tonsils 6 mm below the foramen magnum. She was discharged from the hospital without neurological deficits. Repeat brain MRI scan, 1 month after trauma, demonstrated complete regression of the hindbrain herniation. During the hospital stay and at follow-up, no symptoms and signs related to posterior fossa involvement were noted.

Epiploic appendagitis: pathogenesis, clinical findings and imaging clues of a misdiagnosed mimicker.

Primary epiploic appendagitis (PEA) is a rare and frequently underdiagnosed cause of acute abdominal pain. PEA most commonly affects obese, male patients in the 4th and 5th decade of life. Clinical presentation includes acute, localized, non-migrating pain without fever, nausea, vomiting or diarrhea and the laboratory workup is usually within normal limits. PEA is commonly mistaken as other more severe causes of acute abdominal pain, such as diverticulitis, acute appendicitis or cholecystitis and thus patients undergo unnecessary diagnostic and therapeutic procedures. The emergence of computerized tomography (CT) as the gold standard imaging test in diagnostic dilemmas of acute abdominal pain has resulted in increased recognition and diagnosis of PEA. Upon confirmation, PEA is considered a self-limiting disease and is managed conservatively with analgesics, occasionally combined with nonsteroidal anti-inflammatory drugs (NSAIDS). Persistence of symptoms or recurrence mandate the consideration of surgical management with laparoscopic appendage excision as the definitive treatment. We review the current literature of PEA, with a focus on clinical and imaging findings, in order to raise awareness about this frequently misdiagnosed entity.

Pancreatic Cystosis in Two Adolescents with Cystic Fibrosis.

We present pancreatic cystosis in two adolescents with cystic fibrosis, a 13-year-old girl and an 18-year-old boy. In pancreatic cystosis, which is a rare manifestation of CF, the pancreatic parenchyma is replaced with multiple cysts of different sizes. Pancreatic cystosis is mainly an imaging based diagnosis and frequent follow-up should be recommended.

Can balance trampoline training promote motor coordination and balance performance in children with developmental coordination disorder?

The present study aimed to examine movement difficulties among typically developing 8- to 9-year-old elementary students in Greece and to investigate the possible effects of a balance training program to those children assessed with Developmental Coordination Disorder (DCD). The Body Coordination Test for Children (BCTC; Körperkoordinationstest fur Kinder, KTK, Kiphard & Schilling, 1974) was chosen for the purposes of this study and 20 children out of the total number of 200, exhibited motor difficulties indicating a probable DCD disorder. The 20 students diagnosed with DCD were equally separated into two groups where each individual of the experimental group was paired with an individual of the control group. The intervention group attended a 12-week balance training program while students of the second - control group followed the regular school schedule. All participants were tested prior to the start and after the end of the 12-week period by performing static balance control tasks while standing on an EPS pressure platform and structured observation of trampoline exercises while videotaping. The results indicated that after a 12-week balance training circuit including a trampoline station program, the intervention group improved both factors that were examined. In conclusion, balance training with the use of attractive equipment such as trampoline can be an effective intervention for improving functional outcomes and can be recommended as an alternative mode of physical activity.

Effects of a trampoline exercise intervention on motor performance and balance ability of children with intellectual disabilities.

Balance and motor impairments are most evident among inactive individuals with ID that might be particularly susceptible to a loss of basic functioning and further limit the person's autonomy in activities of daily living. The aim of the study was to assess the effect of a 12-week trampoline exercise intervention program on motor and balance ability of school aged children with intellectual disability (ID). Eighteen healthy schools aged children (mean age=10.3 ± 1.6 years) with moderate ID were assigned either to an experimental group (n=9) or a control group (n=9). The experiment group attended a 12 weeks trampoline training intervention program consisting of daily individualized 20-min sessions, while the control group followed the regular school schedule. Balance was assessed using three tasks of increased difficulty (double-leg stance with eyes opened or closed, and one-leg stance with eyes opened) performed while standing on an electronic pressure platform (EPS). Motor performance of all participants was tested using sit and reach test and long and vertical jump tests all derived from the Eurofit Test Battery of physical fitness. Trampoline intervention resulted in significant improvements of participants' performance in all motor and balance tests. In conclusion, trampoline training can be an effective intervention for improving functional outcomes and can be recommended as an alternative mode of physical activity programming for improving balance and motor performance. Furthermore, it also supports the idea that individuals with ID require enjoyable and interesting intervention programs such as the trampoline program used in this study so as to remain active and consequently to facilitate their overall development and promote a more active and healthier way of life.

The effect of institutionalization on psychomotor development of preschool aged children.

Development can be altered by several factors which can either facilitate or obstruct development. The aim of the current study was the examination and the detection of differences in the developmental profiles of preschool aged children living in conventional institution facilities (N=28), in SOS villages (N=20) and in natural family environment (N=48). The psychomotor development of the 96 children, aged 4-6 years old, was assessed using the six scales of the Griffiths Test No II. Two-way analysis of variance designs showed that family reared children had better performance in all scales of the Griffiths test compared with children of the other two groups and that children living in a SOS village had better scores on all domains of development examined compared to children living in a conventional institution (p<.05). The findings reinforce the need to transform institution environments into more supportive ones for the most benefit of children's development and mental health.

Incidence of exercise-induced asthma in adolescent athletes under different training and environmental conditions.

The aim of this study was to establish if there were differences in the incidence of exercise-induced bronchospasm between athletes in different sports, which take place under different environmental conditions such as open places, closed courses, and swimming pools with similar exercise intensity (football, basketball, water polo) using the free running test. The study included 90 adolescents (3 groups of 30) aged 14-18 years recruited from academies in northern Greece. All the participants were initially subjected to (a) a clinical examination and cardiorespiratory assessment by a physician and (b) free running test of a 6-minute duration and measurement with a microspirometer of the forced expiratory volume in 1 second (FEV1). Only the participants who had measured a decrease in FEV1 ≥ 10% were reevaluated with the microspirometer during a training session. The examination of all the participants during the free running test showed that 22 athletes, that is, 9, 8, and 5 of football, basketball, and water polo athletes, respectively, demonstrated an FEV1 ≥ 10 drop. Reevaluation of the 22 participants during training showed that 5 out 9 (55%) football athletes, 4 out of 8 basketball athletes (50%), and none of the 5 athletes of the water polo team displayed a drop of FEV1 ≥ 10%. Despite the absence of any significant statistical differences between the 3 groups, the analysis of variances did show a trend of a lower incidence of EIA in the water polo athletes. It was found that a football or basketball game can induce EIA in young athletes but to a lesser degree than the free running test can induce. The water polo can be a safer sport even for participants with a medical history of asthma or allergies.

The effect of a traditional dance training program on dynamic balance of individuals with mental retardation.

The purpose of this study was to evaluate the influence of a Greek traditional dance training program on the dynamic balance of individuals with mental retardation (MR). A total of 17 individuals participated in this study. Ten individuals with mild or moderate MR and 7 individuals with mild or moderate MR who studied in special schools were assigned to intervention (MR-I) and control (MR-C) groups, respectively. Pretraining and posttraining exercise tests were performed to determine the dynamic balance ability. Dynamic balance ability was measured by means of a balance deck (Lafayette, Lafayette, IN, USA) in 30-, 45-, and 60-second intervals. The MR-I group underwent a 16-week Greek traditional dance training program at a frequency of 3 times per week and for a duration of 45 minutes per season. Posttraining results showed that the individuals with MR in the MR-I group improved during treatment, from their baseline scores on dynamic balance measurements (30 seconds: p < 0.01, 45 seconds: p < 0.05, 60 seconds: p < 0.05). The MR-C group did not show any improvement between the 2 measurements. In conclusion, individuals with MR may be able to improve their dynamic balance when performing a systematic and well-designed Greek traditional dance training program.

The effect of a rhythmic gymnastics program on the dynamic balance ability of individuals with intellectual disability.

The purpose of this study was to examine the effect of a rhythmic gymnastics program on the dynamic balance ability of a group of adults with intellectual disability (ID). The sample consisted of 18 adults with ID. The control group consisted of 8 adults and an intervention group of 10. The subjects were assigned to each group according to their desire to participate or not in the intervention program. Both groups were comparable in terms of age, weight, height, IQ, and socioeconomic background. The intervention group received a 12-week rhythmic gymnastics program at a frequency of 3 lessons per week, of 45 minutes. The methods of data collection included pre/post-test measurements of the dynamic balance for all subjects of both groups. The dynamic balance ability was measured by means of a balance deck (Lafayette) and was determined by the number of seconds the subject could remain standing on the platform of the stabilometer in durations of 30-, 45-, and 60-second intervals. As the results indicated, the intervention group showed a statistically significant improvement (p < 0.05) in terms of dynamic balance ability in each interval after the application of the rhythmic gymnastics program when compared with the control group. It is concluded that adults with ID can improve their balance ability with the application of a well-designed rhythmic gymnastics program.

The effect of interval training in children with exercise-induced asthma competing in soccer.

A lot of emphasis has been placed in screening individuals with exercise-induced bronchospasm in order to avoid persistence bronchial hyperactivity and consequent chronic silent inflammation of the respiratory tract. The purpose of this study was to evaluate the effect of interval training on the respiratory function and endurance in children with exercise-induced asthma (EIA) participating in the sport of soccer. Twenty-nine boys ages 10-14, who developed EIA after a 6-minute free running test (decline in forced expiratory volume in 1 second: FEV(1)10%), participated in the study. They were divided into 2 groups (experimental: n = 18, and control: n = 11), fulfilling the same criteria (i.e., age, body height and weight, and severity of asthma). The experimental group exercised with the interval training method for a period of 8 weeks, (3 sessions per week), whereas the control group exercised with the usual football program. Measurements were made for FEV(1) and endurance in both groups, before and after the application of training (8 weeks). Following the implementation of the training program, a significant improvement in FEV(1) and endurance was documented in the experimental group, as well as significant differences between the 2 groups. In conclusion, duration and aerobic training via the interval method seems to be beneficial to soccer players with EIA.