Thanasis Alegakis

In Greece, primary care is still developing. The aim of this study was to define the epidemiologic profile of common otorhinolaryngological, head and neck disorders in order to help general practitioners to deal with them in a primary care future. A total of 6771 patients attended the Otorhinolaryngology emergency department of the University General Hospital of Heraklion (Crete), between January and December 2004. All cases were included in this retrospective study. The registry of the Otorhinolaryngology emergency department was analysed and age, sex, seasonality and clinical diagnosis were tabulated. All patients were evaluated by Otorhinolaryngologists. The classification of the cases was based on the main symptom or clinical sign that conditioned the reason for seeking care. Diagnoses were also coded according to the International Classification of Diseases (ICD-10). The male to female ratio was 1:1. The mean age for females was 36.3 years standard deviation (SD): 21.1 and for ...

To measure the prevalence of allergic rhinitis, atopy, and asthma among grape farmers, and to compare the respiratory and atopic status in grape farmers with those of nonexposed control subjects. Cross-sectional study. Malevisi region in northern Crete, Greece. One hundred twenty grape farmers and 100 control subjects living in the Malevisi region were examined. The protocol comprised a questionnaire, skin prick tests for 16 common allergens, measurement of specific IgE antibodies against 8 allergens, and spirometry before and after bronchodilation. Grape farmers were found to have an excess of respiratory symptoms. The comparison with the control group, after adjusting for age, sex, and smoking status, showed that the differences were statistically significant for rhinorrhea (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.5 to 5.1; p < 0.001), sneezing (OR, 2.2; 95% CI, 1.2 to 4.0; p < 0.01), and nasal itching (OR, 1.9; 95% CI, 1.0 to 3.6; p < 0.05), but were nonsignificant for asthma-related symptoms. In the multiple logistic regression model, grape farmers were found to have increased work-related symptoms, such as sneezing (OR, 2.9; 95% CI, 1.3 to 6.6; p < 01), rhinorrhea (OR, 2.9; 95% CI, 1.3 to 6.6; p < 0.01), cough (OR, 3.7; 95% CI, 1.2 to 11.4; p < 0.05), and dyspnea (OR, 3.8; 95% CI, 1.1 to 1.3; p < 0.05). The prevalence of allergic rhinitis was 40.8% in grape farmers and 26% in control subjects (OR, 2.0; 95% CI, 1.1 to 3.5; p < 0.02). Increased but statistically nonsignificant values of asthma prevalence were found in grape farmers (6.7%) compared with the control group (2.0%). The prevalence of atopy was 64.2% in grape farmers and 38.0% in the control group (OR, 2.2; 95% CI, 1.2 to 3.5; p < 0.01). Mean FEV1 was significantly lower in grape farmers than in control subjects (p < 0.05), after adjusting for age, sex, and smoking status. Bronchial obstruction was reversible in 23 grape farmers (19.2%) and in 6 control subjects (6%; p < 0.01). The study mainly demonstrated the high prevalence of allergic rhinitis and work-related respiratory symptoms in grape farmers compared to control subjects. It also suggested that grape farming is possibly associated with increased allergic sensitization to specific pollens, low baseline FEV1, and increased bronchial hyper-responsiveness. Further studies are needed to determine the potential risk factors for these disorders among the farming population.

Nine human acute poisonings due to intentional ingestion of organophosphorous pesticides are presented. Six of the victims died. Six patients were treated in the Intensive Care Unit (ICU) from 34 h to 45 d, while 3 were found dead by relatives. Two of the patients treated in the ICU fully recovered after 15 and 24 d while the third survivor developed delayed neuropathy. Organophosphate blood levels were determined on admission and during therapy, and in 1 case atropine and pralidoxime levels were also detected. Significant fluctuations of the plasma cholinesterase activity were observed during therapy. Postmortem analysis revealed higher levels of pesticides in organs (eg 23.1 micrograms fenthion/g kidney) and in fat (135.2 micrograms fenthion/g) than in blood (eg 4.8 micrograms fenthion/ml) and vitreous humor. Considerable pesticide was measured in testis (eg 5.8 micrograms fenthion/g, 0.8 micrograms methidathion/g) and uterus (170.5 micrograms malathion/g). Extracorporeal decontamination to enhance pesticide elimination is a therapeutic challenge.

The purpose of this study was to ultrasonographically evaluate spleen dimensions in healthy prematurely born neonates and infants during the first 3 months of life. Ninety-six neonates and infants aged from 2 to 90 days, with gestational ages from 25 to 35 weeks, were prospectively examined between 2001 and 2003. None had either infectious or other serious diseases or congenital disorders. The relationships between the ultrasonographically measured spleen size parameters and postmenstrual age, sex, gestational age, and somatometric parameters (height, weight, and body surface area) were studied with linear regression models with backward selection. Spleen dimension growth curves and upper/lower limits defined by the upper/lower 95% confidence interval were presented in graphs by height, weight, and body surface area. In addition, spleen length was compared with recently published data on term peers. All spleen dimensions were positively correlated with postmenstrual age and somatometric parameters. Sex did not influence the variability of spleen dimensions. Spleen length had lower values and a smaller rate of growth in preterm than term neonates and infants. We have provided ultrasonographic spleen volumetric values in preterm neonates and infants during the first 3 months of life, giving reference standards applicable for clinical practice or research purposes.

The regulation of arousal and pupillary functions may be intimately linked via activity in the nucleus locus coeruleus. In this preliminary study, we tested the validity of the gradual pupillary miosis during 5 minutes in darkness, as a quantitative physiologic index of the arousal state of the brain. Cross-sectional assessment of 2 groups with between-group comparison and correlational analyses within the patient group. Eleven unmedicated male patients recently diagnosed with obstructive sleep apnea (OSA) with no comorbid conditions who had undergone polysomnography to assess OSA severity and sleep variables, and 11 sex- and age-matched healthy controls. Sampling of the resting pupil diameter (RPD) over 5 minutes in darkness in the morning and in the afternoon hours, using an infrared video pupillometer. The RPD was smaller, indicating a lower level of arousal, in the patient group compared with controls in both the morning and the afternoon; the RPD showed a significant circadian ...

The electronic cigarette (e-cig) is an invention of the past few years and its popularity is rapidly growing all over the world. A rapid multicomponent analytical protocol for the analysis of the replacement liquids (e-liquids) of e-cig was developed using gas (GC) and liquid chromatography (LC)-mass spectrometry (MS). GC-MS-based methods were developed for the determination of the main humectants and polycyclic aromatic hydrocarbons (PAHs). For the determination and quantification of nicotine (NIC) and nitrosamines, appropriate LC-MS-based methods were developed. The approbated methods were applied for the analysis of 263 e-liquid samples obtained from the Greek market. The instruments response was linear; the limits of quantification ranged from 0.003 μg/mL for three PAHs to 1.187 μg/mL for glycerol. The precision was <16% for all analytes, while the mean accuracy ranged from 99.1% for NIC to 106.6% for the flavor 2,5-dimethylpyrazine. The measured concentrations of NIC were co...

The aim of this study was to develop and validate a method for the determination of buprenorphine (BUP), norbuprenorphine (NBUP) and naloxone (NAL) in fingernails and urine samples collected from former heroin users under suboxone substitution therapy. The analytes were extracted by solid-liquid or solid-phase extraction and were analyzed by liquid chromatography-mass spectrometry. The validation of the analytical methods developed included linearity, recovery, accuracy, precision, ion suppression, sensitivity of interfaces and limits of determination and quantification. The validated methods were applied to samples from 46 individuals. The majority of the urine samples were positive for all analytes (93.5% for BUP, 95.7% for NBUP and 84.8% for NAL). In nails, a higher detection rate was observed for NBUP and BUP (89.1%), compared with NAL (10.9%). The median values of the NBUP/BUP and the NAL/BUP ratio were 2.5 and 0.3 in urine and 0.8 and 0.3 in nails, respectively. A statisticall...

Fatal and non-fatal acute poisonings and other sudden deaths examined in the Toxicology Laboratory of University Hospital of Iraklion, Crete, from 1991 to 1996 mainly involved the abuse of drugs (heroin, flunitrazepam and other psychoactive substances), accidental poisonings or suicide attempts with pesticides (carbamates, organophosphates, paraquat), other chemicals (cyanide salts, paint thinner, chlorine), traffic accidents, drownings and violent deaths (gunshots). Many of the cases were related to poisonous gases or volatiles (carbon monoxide, methylbromide). Fatalities due to alcohol and methylene-dioxy-ethyl amphetamine were also examined. Amphetamine and alcohol-related deaths due to drowning were more recent. A significant number of cases were related to the accidental ingestion of alcohol, drugs or suicide attempts by children. Some of the cases were treated successfully in various Cretan hospitals, while others had fatal outcomes due to late hospital admission.

In the management of patients with Barrett's Esophagus (BE) the definition of a sub-group of patients at high risk for malignant transformation of the metaplastic epithelium is important. Undoubtedly, the histological evaluation of dysplasia is the most important and objective parameter to identify a malignant transformation of BE. In order to obtain additional data a group of cell proliferation markers was applied in dysplastic lesions. We studied PCNA in a selected group of patients with BE. One hundred six biopsies were examined, referring to fifty five patients with BE, who were followed up for a period of at least one year (1-5 years). All patients showed one or more biopsies positive for dysplasia. PCNA was detected immunohistochemically on formalin fixed and paraffin embedded biopsies, and positive cells were evaluated in a crude percent count. Our results showed a remarkable number of PCNA positive cells in high grade dysplasia and a variable amount of PCNA positive cell...

Angiogenesis is an essential process for the expansion of multiple myeloma (MM). Angiopoietin-2 (Ang-2), Ang-1 and their receptor possess important roles in this procedure. The aim of the study was to measure serum levels of Ang-2 along with known markers of angiogenesis and to estimate their prognostic impact on the survival. Bone marrow microvascular density (MVD), estimated by CD31, and circulating levels of known angiogenic factors Ang-2, interleukin-6, soluble CD105 and platelet-derived growth factor-AB, measured by ELISA, were measured in 77 newly diagnosed patients with active MM and in 57 of them who responded to chemotherapy. All measured parameters were increased in MM patients, were also increasing in advanced disease and decreased after effective treatment. Ang-2 correlated positively with the other angiogenic factors and MVD. Moreover, Ang-2 values above the median were accompanied by worse survival. Ang-2 correlates strongly with the angiogenic process and its serum levels are importantly prognostic for survival, highlighting the role of angiopoietins pathway in the biology of MM.

Post-operative nausea and vomiting (PONV) are common complications related to surgery and anaesthesia. The aim of this study was to assess whether sevoflurane, with or without the use of an antiemetic such as ondansetron, increases or not the incidence of PONV in children. One hundred and ten children, 2 months to 14 years undergoing inguinal hernia, hypospadias and penile deformity repair, were randomly allocated into one of two groups, according to whether they received ondansetron or placebo (47 vs. 63). Induction and maintenance of anaesthesia was with Sevoflurane in both groups. Regional anaesthesia was performed on all children (inguinal nerve, penile or caudal block). No opioids were used. In post-operative period, children were assessed for PONV, every 4 h for the first 24 h. Vomiting was very low in both groups (8 cases: 7.3%). No significant statistical difference of post-operative nausea (p = 0.296) and vomiting (p = 0.462) (Fisher's exact test) was found between the ...

Euthanasia has become a prominent social and ethical issue in which nurses play an important role. This study evaluated, for the first time in Greece, the acceptance and enactment of passive euthanasia among Greek nursing staff, measured in relation to the type of patients cared for. Passive euthanasia, illegal in Greece, is defined as either withdrawing or withholding life-sustaining treatment. Fifty-one per cent responded that they would not be willing to withhold life-sustaining treatment if legalized, while almost 30% responded that they had withheld life-sustaining treatment from a patient at least once in the past; specifically 47.7% of intensive care unit nurses (OR 8.2; 95% CI: 1.6-41.3), 20% of cancer ward nurses (OR 2.7; 95% CI: 0.5-15.6) and 8.3% of other nurses from other wards (P = 0.001). Age, gender and self-reported levels of religiosity among Greek nurses were not found to affect statistically any variable regarding euthanasia and its enactment.

Paraoxonases and cytochromes P450 constitute two major classes of xenobiotic-metabolizing enzymes involved in the detoxification of pesticide chemicals. In this study, we examined the distribution of two common genetic polymorphisms of the paraoxonase 1 gene and one common polymorphism of the CYP1A1 gene, in relation to pathological diseases occurring in a rural population. Blood and hair samples were collected from 220 participants of an agricultural cohort in the south of Greece for genotype and pesticide analysis. Demographic information and disease status of the participants was obtained by questionnaire, medical examination and medical record. Organochlorine pesticides and metabolites (DDTs, HCHs) were extracted from hair and analyzed using gas chromatography combined with mass spectrometry techniques. Our results indicate exposure of the rural population of Amaliada to organophosphate and past exposure to organochlorine pesticides. Genotypic analysis of PON1Q192R, PON1L55M and CYP1A1*2A MspI polymorphisms was performed using PCR-RFLP. The PON1 192R and 55M alleles absence was significantly associated with hypertension (OR: 2.59; 95% CI: 1.10-6.09) and hepatitis (OR: 21.43; 95% CI: 2.53-181.50), respectively, as indicated from backward logistic regression. Although the presence of PON1 192R allele significantly affected the occurrence of prostate hyperplasia (OR: 0.35; 95% CI: 0.03-0.40), no associations were obtained between the paraoxonase serum activity or the CYP1A1 genotype and the disease status.