Lipid Disturbances in Breast Cancer Patients during Chemotherapy.

Breast cancer is the most common cancer in women. Cardiovascular diseases are common complications after chemotherapy due to the effect of the drug on lipid levels. This study aimed to explore the changes in lipid profiles in patients with breast cancer under chemotherapy. METHODS: In this prospective study, 50 patients with breast cancer participated. Three biochemical-lipid hematological tests were performed: total cholesterol (TC), triglycerides (TGs), High-Density Lipoprotein (HDL-C), and Low-Density Lipoprotein (LDL-C) before initiation (pre-chemotherapy), at the start (first follow-up), and at the completion (second follow-up) of the first cycle of chemotherapy. Statistical significance was set at p < 0.05. Analyses were conducted using SPSS Statistical Software (version 22.0). RESULTS: Mean TC values increased significantly at second follow-up. TGs values decreased significantly from first to second follow-up. HDL-C was significantly lower at first follow-up compared with pre-chemotherapy and was similar to the pre-chemotherapy levels at second follow-up. LDL-C values were significantly higher at second follow-up compared with pre-chemotherapy measurement. Significantly positive correlations of BMI with pre-chemotherapy LDL-C, first follow-up TC, first follow-up LDL-C, second follow-up TC, and second follow-up LDL-C were found. CONCLUSIONS: There is a statistically significant increase in the levels of TC and LDL-C in breast cancer patients during chemotherapy. This study was not registered.

Collective excitations of a bound-in-the-continuum condensate.

Spectra of low-lying elementary excitations are critical to characterize properties of bosonic quantum fluids. Usually these spectra are difficult to observe, due to low occupation of non-condensate states compared to the ground state. Recently, low-threshold Bose-Einstein condensation was realised in a symmetry-protected bound state in the continuum, at a saddle point, thanks to coupling of this electromagnetic resonance to semiconductor excitons. While it has opened the door to long-living polariton condensates, their intrinsic collective properties are still unexplored. Here we unveil the peculiar features of the Bogoliubov spectrum of excitations in this system. Thanks to the dark nature of the bound-in-the-continuum state, collective excitations lying directly above the condensate become observable in enhanced detail. We reveal interesting aspects, such as energy-flat parts of the dispersion characterized by two parallel stripes in photoluminescence pattern, pronounced linearization at non-zero momenta in one of the directions, and a strongly anisotropic velocity of sound.

Anxiety, insomnia and family support in nurses, two years after the onset of the pandemic crisis.

Introduction: The Covid-19 pandemic continues to cause serious physical and mental problems for health professionals, particularly nurses. Aim: To estimate the prevalence of anxiety and insomnia and to evaluate their possible association with family support received by nurses two years after the onset of the pandemic. Materials and methods: In total, the study participants were 404 nurses (335 females and 69 males) with a mean age of 42.88 (SD = 10.9) years and a mean of 17.96 (SD = 12) years working as nurses. Nurses from five tertiary hospitals in Athens constituted the study population who completed the questionnaires State-Trait Anxiety Inventory (STAI), Athens Insomnia Scale (AIS) and Family Support Scale (FSS), in the months of November and December 2021. Regarding demographic and occupational characteristics, gender, age and years of experience as nurses were recorded. Results: 60.1% of the nurses showed abnormal scores in state anxiety, with 46.8% in trait anxiety, and 61.4% showed insomnia. Women showed higher scores on the two subscales of anxiety and the insomnia scale compared to men (p < 0.01 and p < 0.05 respectively), while they showed a lower score on the FSS without statistical significance (p > 0.05). Positive correlations (p < 0.01) were found between the State Anxiety Inventory, Trait Anxiety Inventory and AIS, while all of them showed a high negative correlation with FSS (p < 0.01). Age showed a negative correlation with Trait Anxiety Inventory (p < 0.05). As shown by the mediation analysis, the relationship between state anxiety and insomnia was mediated by trait anxiety, whereas state anxiety appeared to be dependent on family support. Conclusions: Nurses continue to experience high levels of anxiety and insomnia and feel less supported by their families than in the first year of the pandemic. Insomnia appears to be dependent on state anxiety, with a significant indirect effect of trait anxiety, while family support seems to affect state anxiety.

An echocardiographic study of acute, progressive cardiac changes following a 246 km running race.

We describe the case of an ultra-marathon runner who finished first the "Spartathlon", a 246 km running race. The finishing time was the second fastest time ever in "Spartathlon". After finishing the race, the athlete suffered non-cardiac syncope and was administered intravenously 3 L of fluids for 5 hours. He underwent two echocardiographic assessments, one immediately after the finish of the race and the second 5 h later. Post-exercise fluid administration led to an increase in dimensions of all cardiac cavities, accompanied by a decrease in left ventricular (LV) end-diastolic interventricular septum thickness and posterior wall thickness of 0.1 cm. Dimensions and the respiratory profile of inferior vena cava improved after the race, reflecting alleviation of exercise-related hypovolaemia. Additionaly, LV global longitudinal strain improved, but right ventricular (RV) systolic function continued to deteriorate, mainly due to impairment of basal and medial RV free wall longitudinal strain. Study of this case offers a unique model for understanding the successive changes of cardiac structure and function following an ultra-marathon running race.

The Mediating Role of Depression and of State Anxiety οn the Relationship between Trait Anxiety and Fatigue in Nurses during the Pandemic Crisis.

The coronavirus pandemic (COVID-19) is a global health crisis with a particular emotional and physical impact on health professionals, especially nurses. The aim of this study was to investigate the prevalence of anxiety, depression and fatigue and their possible relationships among nurses during the pandemic. The study population consisted of nurses from five tertiary-level public hospitals in Athens who completed the Fatigue Assessment Scale (FAS), Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) questionnaires. Gender, age and years of work experience were recorded. The study was conducted from mid-November to mid-December 2021. The sample included 404 nurses (69 males and 335 females) with a mean age of 42.88 years (SD = 10.90) and 17.96 (SD = 12.00) years of work experience. Symptoms of fatigue were noted in 60.4% of participants, while 39.7% had symptoms of depression, 60.1% had abnormal scores on state anxiety and 46.8% on trait anxiety, with females showing higher scores on all scales (p < 0.05). High positive correlations (p < 0.01) were found between the FAS, BDI, State Anxiety and Trait Anxiety scales. Regression analysis showed that 51.7% of the variance in FAS scores can be explained by trait anxiety, an additional 6.2% by the BDI and 1.2% by state anxiety. Mediation analysis showed that state anxiety and BDI mediate the relationship between trait anxiety and FAS. Finally, BDI was found to exert a moderating role in the relationship between trait anxiety and fatigue. In conclusion, our study showed that nurses continue to experience high rates of anxiety, depression and fatigue. The variation in fatigue appears to be significantly dependent on trait anxiety. Depressive symptomatology and state anxiety exert a parallel positive mediation on the relationship between trait anxiety and fatigue, with depression exhibiting a moderating role in this relationship.

The development and validation of the pandemic medication-assisted treatment questionnaire for the assessment of pandemic crises impact on medication management and administration for patients with opioid use disorders.

Pandemic and the globally applied restriction measures mainly affect vulnerable population groups, such as patients with opioid use disorders. Towards inhibiting SARS-Cov-2 spread, the medication-assisted treatment (MAT) programs follow strategies targeting the reduction of in-person psychosocial interventions and an increase of take-home doses. However, there is no available instrument to examine the impact of such modifications on diverse health aspects of patients under MAT. The aim of this study was to develop and validate the PANdemic Medication-Assisted Treatment Questionnaire (PANMAT/Q) to address the pandemic effect on the management and administration of MAT. In total, 463 patients under ΜΑΤ participated. Our findings indicate that PANMAT/Q has been successfully validated exerting reliability and validity. It can be completed within approximately 5 min, and its implementation in research settings is advocated. PANMAT/Q could serve as a useful tool to identify the needs of patients under MAT being at high risk of relapse and overdose.

Hamstring Muscle Cramp Visualized on Bone Single-Photon Emission Computed Tomography/Computed Tomography Hybrid Imaging.

ABSTRACT: It is well recognized that bone-seeking radiotracers localize in muscles sustaining an injury from various causes (e.g., strenuous physical activity, trauma, hereditary myopathies, inflammatory myositides, medications, electrical burns, etc.). This report presents the case of an active 50-yr-old man (body mass index = 29) that was recently referred to our nuclear medicine department for bone scintigraphy, for the skeletal staging of a newly diagnosed prostate adenocarcinoma. The scan findings were unremarkable for its oncological indication but revealed extraosseous radiotracer absorption in the medial region of the hamstrings bilaterally. Hybrid scintitomography (single-photon emission computed tomography) with computed tomography indicated that this uptake involved the semitendinosus muscle. On a more meticulous repeat history questioning, he recalled experiencing muscle cramps on both posterior thighs 5 days earlier, during intense work-related physical activity (plumbing) under warm environmental conditions. The combination of strenuous exercise with likely dehydration contributed to bilateral self-limiting heat cramps of the hamstrings, leading to an inconsequential localized minor rhabdomyolysis that was discovered coincidentally a few days later during a bone scan. Although extraskeletal absorption of bone-seeking radiotracers in muscles is widely documented as a result of exertion or injury, this is the first report of radiotracer absorption induced by cramping.

Burnout, Depression and Sense of Coherence in Nurses during the Pandemic Crisis.

During the COVID-19 pandemic, the risk to nurses' mental health has increased rapidly. The aim of the study was to investigate the prevalence of depression and burnout and to evaluate their possible association with the sense of coherence in nursing staff during the pandemic crisis. The Copenhagen Burnout Inventory questionnaire, Beck's Depression Inventory, and the Sense of Coherence questionnaire were completed by 101 male and 559 female nurses. Individual and demographic data were recorded. Regarding depression, 25.5% of respondents exhibited mild depression, 13.5% moderate depression and 7.6% severe depression. In the burnout scale, 47.1% had a pathological value. Female nurses had higher burnout (t test p < 0.01, 49.03 vs. 38.74) and depression (t test p < 0.01, 11.29 vs. 6.93) scores compared to men and lower levels in the sense of coherence (p < 0.05, 59.45 vs. 65.13). Regression evidenced that 43.7% of the variation in the BDI rating was explained by the CBI, while an additional 8.3% was explained by the sense of coherence. Mediation analysis indicated a partial mediation of burnout in the correlation between sense of coherence and depression. The sense of coherence acted as a negative regulator between burnout and depression.

Validation of the Trauma and Injury Severity Score for Prediction of Mortality in a Greek Trauma Population.

BACKGROUND: Although the Trauma and Injury Severity Score (TRISS) has been extensively used for mortality risk adjustment in trauma, its applicability in contemporary trauma populations is increasingly questioned. OBJECTIVE: The study aimed to evaluate the predictive performance of the TRISS in its original and revised version and compare these with a recalibrated version, including current data from a Greek trauma population. METHODS: This is a retrospective cohort study of admitted trauma patients conducted in two tertiary Greek hospitals from January 2016 to December 2018. The model algorithm was calculated based on the Major Trauma Outcome Study coefficients (TRISSMTOS), the National Trauma Data Bank coefficients (TRISSNTDB), and reweighted coefficients of logistic regression obtained from a Greek trauma dataset (TRISSGrTD). The primary endpoint was inhospital mortality. Models' prediction was performed using discrimination and calibration statistics. RESULTS: A total of 8,988 trauma patients were included, of whom 854 died (9.5%). The TRISSMTOS displayed excellent discrimination with an area under the curve (AUC) of 0.912 (95% CI 0.902-0.923) and comparable with TRISSNTDB (AUC = 0.908, 95% CI 0.897-0.919, p = .1195). Calibration of both models was poor (Hosmer-Lemeshow test p < .001), tending to underestimate the probability of mortality across almost all risk groups. The TRISSGrTD resulted in statistically significant improvement in discrimination (AUC = 0.927, 95% CI 0.918-0.936, p < .0001) and acceptable calibration (Hosmer-Lemeshow test p = .113). CONCLUSION: In this cohort of Greek trauma patients, the performance of the original TRISS was suboptimal, and there was no evidence that it has benefited from its latest revision. By contrast, a strong case exists for supporting a locally recalibrated version to render the TRISS applicable for mortality prediction and performance benchmarking.

Nursing staff fatigue and burnout during the COVID-19 pandemic in Greece.

INTRODUCTION: The coronavirus pandemic (COVID-19) is an unprecedented global health crisis with emotional and physical impact on health care workers. OBJECTIVE: The purpose of this study was to investigate the levels of fatigue and burnout in nursing staff during the pandemic. METHODS: The present study involved nursing staff from hospitals in Greece in February 2021, who completed the Fatigue (FAS) and Burnout (CBI) questionnaires. Gender, age, years of work experience, workplace (COVID-19 or non-COVID-19 wards) and SARS-CoV-2 infection status were recorded. RESULTS: The sample included 593 women and 108 men, with a mean age ± SD: 42.9 ± 9.9 years and 18.14 ± 10.8 years work experience. Slightly more than half, (367, 52.4%) worked in COVID-19 departments. Fifty-six (8%) tested positive for SARS-CoV-2 and 14 of them needed to be treated. The mean ± SD FAS and CBI scores were 25.6 ± 7.4 and 46.9 ± 18.8, respectively (67.9% and 42.9% had scores suggestive of fatigue and burnout, respectively). Women showed higher values in both scales (p < 0.01). Subjects working in COVID-19 wards scored significantly higher on both the FAS and CBI scales; they were also younger and with less work experience (p < 0.01). Staff treated for COVID-19 scored higher on the burnout scale (p < 0.01) than the uninfected staff. Fatigue showed a strong positive correlation with burnout (p < 0.01, r = 0.70). Stepwise multiple regression showed that the variation of fatigue was explained by 47.0% and 6.1% by the scores on the subscales of personal and work-related burnout, respectively. CONCLUSION: In conclusion, high rates of fatigue and burnout were found in the studied population. Nurses working with COVID-19 patients had higher rates of fatigue and burnout compared to those working elsewhere. There was a strong positive correlation (r = 0.70) between burnout and fatigue. Particular attention should be paid to staff who became ill and need to be treated.

External validation of International Classification of Injury Severity Score to predict mortality in a Greek adult trauma population.

INTRODUCTION: The International Classification of diseases- based Injury Severity Score (ICISS) obtained by empirically derived diagnosis-specific survival probabilities (DSPs) is the best-known risk-adjustment measure to predict mortality. Recently, a new set of pooled DSPs has been proposed by the International Collaborative Effort on Injury Statistics but it remains to be externally validated in other cohorts. The aim of this study was to externally validate the ICISS using international DSPs and compare its prognostic performance with local DSPs derived from Greek adult trauma population. MATERIALS AND METHODS: This retrospective single-center cohort study enrolled adult trauma patients (≥ 16 years) hospitalized between January 2015 and December 2019 and temporally divided into derivation (n = 21,614) and validation cohorts (n = 14,889). Two different ICISS values were calculated for each patient using two different sets of DSPs: international (ICISSint) and local (ICISSgr). The primary outcome was in-hospital mortality. Models' prediction was performed using discrimination and calibration statistics. RESULTS: ICISSint displayed good discrimination in derivation (AUC = 0.836 CI 95% 0.819-0.852) and validation cohort (AUC = 0.817 CI 95% 0.797-0.836). Calibration using visual analysis showed accurate prediction at patients with low mortality risk, especially below 30%. ICISSgr yielded better discrimination (AUC = 0.834 CI 95% 0.814-0.854 vs 0.817 CI 95% 0.797-0.836, p Ë‚ .05) and marginally improved overall accuracy (Brier score = 0.0216 vs 0.0223) compared with the ICISSint in the validation cohort. Incorporation of age and sex in both models enhanced further their performance as reflected by superior discrimination (p Ë‚ .05) and closer calibration curve to the identity line in the validation cohort. CONCLUSION: This study supports the use of international DSPs for the ICISS to predict mortality in contemporary trauma patients and provides evidence regarding the potential benefit of applying local DSPs. Further research is warranted to confirm our findings and recommend the widespread use of ICISS as a valid measure that is easily obtained from administrative data based on ICD-10 codes.

Impact of a 246 Km ultra-marathon running race on heart: Insights from advanced deformation analysis.

Although previous studies suggest that prolonged intense exercise such as marathon running transitorily alters cardiac function, there is little information regarding ultramarathon races. Aim of this study was to investigate the acute impact of ultra-endurance exercise (UEE) on heart, applying advanced strain imaging. Echocardiographic assessment was performed the day before and at the finish line of "Spartathlon": A 246 Km ultra-marathon running race. 2D speckle-tracking echocardiography was performed in all four chambers, evaluating longitudinal strain (LS) for both ventricles and atria. Peak strain values and temporal parameters adjusted for heart rate were extracted from the derived curves. Out of 60 participants initially screened, 27 athletes (19 male, age 45 ± 7 years) finished the race in 33:34:27(28:50:38-35:07:07) hours. Absolute values of right (RV) and left ventricular (LV) LS (RVLS -22.9 ± 3.6 pre- to -21.2 ± 3.0% post-, p=0.04 and LVLS -20.9 ± 2.3 pre- to -18.8 ± 2.0 post-, p=0.009) slightly decreased post-race, whereas atrial strain did not change. RV and LV LS decrease was caused mainly by strain impairment of basal regions with apical preservation. Inter-chamber relationships assessed through RV/LV, LV/LA, RV/RA and RA/LA peak values' ratios remained unchanged from pre to post-race. Finally, UEE caused an extension of the systolic phase of cardiac cycle with concomitant diastole reduction (p<0.001 for all strain curves). Conclusively, ventricular LS strain as well as effective diastolic period slightly decreased, whereas atrial strain and inter-chamber relationships remained unchanged after running a 246-km-ultra-marathon race. These changes may be attributed to concomitant pre- and afterload alterations following UEE.

Arterial Function after a 246 km Ultra-marathon Running Race.

There is little research about the effects of ultra-endurance exercise on arterial morphological and functional properties. The aim was to assess the acute changes of the carotid-femoral pulse wave velocity and carotid doppler-derived parameters following an ultra-marathon race as well as the intima-media thickness of the carotid artery in ultra-marathon runners. Twenty athletes were examined at baseline and within 10 mins after a 246 km running race. Measurements included carotid-femoral pulse wave velocity, peak-systolic and end-diastolic velocities of carotid artery blood flow, pulsatility and resistivity indices and blood biochemical parameters. The intima-media thickness of the right and left carotid artery was measured before the race. Arterial stiffness and carotid artery intima media thickness at rest remained within known normal limits. The ultra-marathon race significantly increased carotid-femoral pulse wave velocity by 22.6% and pulsatility index by 10.2%. There was a decrease in body weight by 3.35% and an increase of all biochemical markers of muscle damage after the race. Additionally, C-reactive protein was correlated with both pulsatility and resistivity indices post-race. This study shows that immediately after a 246 km ultra-marathon running race, acute increase of arterial stiffness and vascular resistance were evident. The carotid artery thickness of ultra-marathon runners was within normal range.

Patient Knowledge, Adherence to the Therapeutic Regimen, and Quality of Life in Hemodialysis : Knowledge, Adherence, and Quality of Life in Hemodialysis.

The aim of this study was to investigate the effect of patients' knowledge on adherence to the hemodialysis regimen and Quality of Life (QoL) of patients undergoing hemodialysis as well as the effect of adherence on QoL. Also, the effect of demographic and clinical characteristics on the above three variables was studied. In this cross-sectional study conducted between March and May 2017, 321 patients on hemodialysis from six hemodialysis units completed the Kidney Disease Questionnaire, the GR-Simplified Medication Adherence Questionnaire and the Missoula Vitas Quality of Life Index-15 to measure the patient knowledge, the adherence to hemodialysis regimen, and the QoL, respectively. The statistical analysis was performed via the Statistical Program SPSS 19.0. The statistical significance level was set up at 0.05. The knowledge was independently associated with the overall QoL and its dimension-transcendence-with total adherence and its dimension-diet/fluid adherence. The total adherence was independently associated with overall QoL and its dimensions-symptoms and interpersonal. The educational level, the type of vascular access, and the daily number of pills were independently associated with the total adherence and the overall QoL. Patient knowledge may have an important effect on adherence and QoL. Adherence may have an important effect on QoL. Demographic and clinical characteristics play, also, a crucial role in the above variables. The findings can help nephrology nurses to quantify the extent of non-adherence in hemodialysis and poor quality of life.

Increased serum levels of fibroblast growth factor 23 after an ultradistance run.

OBJECTIVES: Healthy bones need to be loaded on a regular basis. However, overstrenuous exercise causes uncoupling of bone metabolism. Thus, it is important to be aware of exercise-induced alterations in bone metabolism. The aim of this observational study was to determine whether participation in an ultradistance run has an impact on the phosphaturic hormone fibroblast growth factor 23 (FGF23), which is produced by osteocytes and suppresses osteoblast differentiation as well as matix mineralization. DESIGN: Observational study. METHODS: Nine participants of the Spartathlon (246km) had venous blood samples taken before and within 15min after finishing the race as well as during recovery. Serum levels of FGF23, phosphate, and blood urea nitrogen were determined. RESULTS: FGF23 increased 6.5-fold from pre-race to post-race (2.2pmol/L [IQR: 0.4; 3.2pmol/L] to 14.4pmol/L [IQR: 4.7; 20.0pmol/L]; p=0.001). Thereafter, serum levels of FGF23 fell to 1.4pmol/L [IQR: 0.5; 1.7pmol/L] (p<0.0001). The differences in FGF23 levels between pre-race and recovery (3 days after the start) did not achieve statistical significance (p=0.614). Serum levels of phosphate and blood urea nitrogen also did not change significantly. CONCLUSIONS: Since FGF23 plays a central role in mineral homeostasis, the transient overexpression of FGF23 may be an important contributor to the short-term uncoupling of bone metabolism induced by overstrenuous exercise.

The Importance of an Active Case Detection (ACD) Programme for Malaria among Migrants from Malaria Endemic Countries: The Greek Experience in a Receptive and Vulnerable Area.

Greece has been malaria-free since 1974. In October 2011, following an outbreak of 36 locally acquired malaria (LAM) cases in Evrotas Municipality, a Pro-Active Case Detection (PACD) program for malaria was implemented among migrants from malaria-endemic countries, to support early diagnosis and treatment of cases. We evaluated the PACD program for the years 2012-2017 using indicators such as the number of locally acquired cases, the detection rate/sensitivity and the timeliness of diagnosis and treatment. We visited each migrant home every 7-15 days to screen migrants for malaria symptoms, performing Rapid Diagnostic Tests (RDTs) and blood smears on symptomatic patients. We estimated: (i) the number of malaria cases detected by the PACD, divided by the total number of reported malaria cases during the same period among the same population; (ii) the time between onset of symptoms, diagnosis and initiation of treatment. The total number of migrants who were screened for malaria symptoms for the years 2012-2017 was 5057 with 84,169 fever screenings conducted, while 2288 RDTs and 1736 blood smears were performed. During the same period, 53 imported P. vivax malaria cases were detected, while incidence of malaria among migrants was estimated at 1.8% annually. Ten and one LAM cases were also reported in 2012 and 2015, respectively. Sensitivity of PACD ranged from 86% to 100%; median timeliness between onset of symptoms and diagnosis decreased from 72 h in 2012 to 12 h in 2017 (83% decrease), while timeliness between diagnosis and treatment initiation was 0 h. The implementation of PACD could be considered an effective prevention and response tool against malaria re-introduction.

Exploring the determinants of the cardiac changes after ultra-long duration exercise: The echocardiographic Spartathlon study.

AIM: The investigation of the pathophysiological determinants of cardiac changes following ultra-long duration exercise. METHODS: Twenty-seven runners who finished a 246 km running race were examined both before and after the finish of the race. Examinations included echocardiography and measurement of body weight and blood biochemical parameters. RESULTS: Exercise increased left ventricular end-diastolic interventricular septum thickness (LVIVSd) (p < 0.001) and posterior wall thickness (LVPWTd) (p = 0.001) and right ventricular end-diastolic area (p = 0.005), while reduced tricuspid annular plane systolic excursion (TAPSE) (p = 0.004). A minor decrease in the peak absolute values of both left ventricular (from -20.9 ± 2.3% to -18.8 ± 2.0%, p = 0.009) and right ventricular (from -22.9 ± 3.6% to -21.2 ± 3.0%, p = 0.040) global longitudinal strains occurred. There was decrease in body weight (p < 0.001) and increase in both circulating high-sensitivity troponin I (p = 0.028) and amino-terminal pro-B type natriuretic peptide (NT-proBNP) (p = 0.018). The change in the sum of LVIVSd and LVPWTd correlated negatively with percentage change of body weight (r = -0.416, p = 0.049). The only independent determinant of post-exercise NT-proBNP was pulmonary artery systolic pressure (r = 0.797, p = 0.002). Post-exercise NT-proBNP correlated positively with percentage changes of basal (RVbas) (r = 0.582, p = 0.037) and mid-cavity (RVmid) (r = 0.618, p = 0.043) right ventricular diameters and negatively with percentage change of TAPSE (r = -0.720, p = 0.008). Similar correlations with RVbas, RVmid and TAPSE were found for pulmonary artery systolic pressure. Post-exercise high-sensitivity troponin I correlated negatively with percentage change of body weight (r = -0.601, p = 0.039), but was not associated with any cardiac parameter. CONCLUSION: The main cardiac effects of ultra-long duration exercise were the decrease in left ventricular end-diastolic dimensions and increase in left ventricular wall thickness, as well as minimal dilatation and alteration in systolic function of right ventricle, possibly due to the altered exercise-related right ventricular afterload.

The Effect of Fatigue and Pain Self- Efficacy on Health-Related Quality of Life Among Patients with Multiple Sclerosis.

INTRODUCTION: Health-related quality of life is a major issue among patients with Multiple sclerosis (MS). AIM: To explore the effect of fatigue and pain self-efficacy on health-related quality of life among patients with MS. METHODS: Between March and May 2018, 85 MS patients from a large Hospital of Athens region completed the questionnaires: a) Missoula-VITAS Quality of Life Index-15, which examines 5 dimensions of quality of life, b) Pain Self Efficacy Questionnaire which measures the pain self-efficacy that an individual perceives, c) Fatigue Assessment Scale (FAS) which measures fatigue, d) a questionnaire about the sociodemographic elements. Statistical analysis was performed using the IBM SPSS Statistics version 21. The significance level was set up to 0.001. RESULTS: Fatigue might predict the dimension of quality of life "Function" while Pain Self-Efficacy might, also, predict the dimension of quality of life "Interpersonal". A strong correlation was found between the dimensions of quality of life "Well-being" and "Transcendent" and between "Interpersonal" and Pain Self-Efficacy. The total score of fatigue was strongly correlated with Physical Fatigue and very strongly correlated with Mental Fatigue. CONCLUSION: Fatigue and Pain Self-Efficacy are important predictors of the dimensions of quality of life among patients with MS. Pain in MS has to be taken into serious consideration in every patient with MS.

The impact of education on knowledge, adherence and quality of life among patients on haemodialysis.

PURPOSE: The purpose of the study was to assess the impact of an educational intervention on the level of knowledge, quality of life (QoL) and adherence to the treatment regimen among haemodialysis (HD) patients as well as to describe the association between these variables. METHODS: In this quasi-experimental interventional study, 50 HD patients at a HD centre in Western Attica were randomly assigned into intervention (N = 25, received education and a booklet) and control (N = 25, received only the booklet) groups. Knowledge, adherence and quality of life were measured pre- and post-intervention using the Kidney Disease Questionnaire, the GR-Simplified Medication Adherence Questionnaire-HD and Missoula Vitas Quality of Life Index-15, respectively. The statistical analysis of the data was performed with the help of the Statistical Program SPSS version 19.0. The statistical significance level was set up at 0.05. RESULTS: The increase of knowledge, adherence and QoL levels in the intervention group was significantly higher compared to the control group. There was no significant correlation between knowledge and adherence scores after the intervention. However, a significant positive correlation was found between the change in the overall QoL and the changes in the total adherence score as well as the adherence to the fluids and dietary behaviour. CONCLUSIONS: An educational intervention can improve knowledge, adherence and QoL among HD patients. The increase of knowledge level is not associated with increased adherence. However, the increase of adherence may improve some dimensions of QoL.

Correlation of Dietary Advanced Glycation End Products with the Hematological and Biochemical Markers of Patients with Chronic Kidney Disease Undergoing Hemodialysis.

Aim The advanced glycation end products (AGEs) are among the mechanisms responsible for the pathogenesis and development of chronic kidney disease. The aim of this study was to estimate the dietary AGE intake and to assess its correlation with hematological and biochemical markers of patients with end-stage renal disease (ESRD) undergoing hemodialysis. Materials and methods For this study, a structured questionnaire of the exogenous AGEs was developed, whose reliability and validity were evaluated in the pilot phase of the study including 50 participants. The questionnaire was issued to 605 participants (305 ESRD patients undergoing hemodialysis and 300 controls), and a blood sample was obtained through which hematological and biochemical markers were analyzed. Results It was noted that patients with ESRD consume large quantities of dietary AGEs not only in absolute values but also in comparison with control subjects (p = 0.001), attributed mainly to the methods of product processing as well as cooking. It was also ascertained that dietary AGEs were correlated (p < 0.005) with fasting glucose and glycated hemoglobin (HbA1c) and with lipidemic profile markers, such as triglyceride, as well as inflammation markers, such as erythrocyte sedimentation rate, ferritin, and C-reactive protein. All the aforementioned markers show abnormally increased levels in patients with ERSD and diabetes compared with healthy subjects. Conclusion Patients with ESRD consuming foods favoring AGE formations combined with increased endogenous AGE burden the body with their harmful action. If the specific group of patients adopt dietary habits contributing to the containment or the inhibition of AGE formation, then this would lead to the improvement of their hematological and biochemical markers and in terms of the effects of AGEs on their health is deemed imperative through the creation of consulting and prevention programs.