Πανεπιστημιακό Γενικό Νοσοκομείο Πατρών

The primary objective of this research essay is to critically examine the relationship between shock wave therapy usage and subsequent. Achilles tendon ruptures, with a specific focus on a case involving a 68-year-old patient with a history of Achilles tendinopathy, who experienced a perceptible pop and intense Achilles pain, after treatment with shock wave therapy. The assessment revealed typical rupture that was treated with surgical repair. By tracking the patient’s medical history and various treatment methods employed, the study aims to clarify the complex link between therapeutic actions and potential risks. Additionally, the case report seeks to review current literature on the adverse effects of repeated micro-trauma from percussive ultrasound therapy, suggesting that an inadequate understanding of biomechanical principles may have contributed to the unexpected complications. Ultimately, the aim of the study is to raise awareness among clinicians about appropriate treatment protocols to ensure patient safety and optimal recovery outcomes.

Background/Objectives: Low back pain (LBP) is a leading cause of disability worldwide. Diclofenac, a non-steroidal anti-inflammatory drug (NSAID), and thiocolchicoside, a muscle relaxant, are commonly combined to target inflammation and muscle spasm. However, the efficacy and safety of their combination remain under discussion. This systematic review evaluates the efficacy and safety of diclofenac-thiocolchicoside therapy for LBP and other musculoskeletal conditions. Methods: A systematic review was conducted following PRISMA guidelines. Eligible studies included randomized controlled trials (RCTs) and observational studies comparing diclofenac-thiocolchicoside combination with placebo, monotherapy, or alternative treatments. A search was performed in PubMed, Scopus, and relevant websites, identifying articles published up to 30 September 2024. Studies from trial registries were excluded. Risk of bias was assessed using Revised Cochrane Risk of Bias for randomized trials (RoB 2) for RCTs and the Newcastle-Ottawa Scale (NOS) for observational studies. Evidence certainty was evaluated with the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Results were visualized using Robvis, tables, and graphs. Results: Of 393 identified records, 9 studies (1097 patients) met the inclusion criteria. Seven RCTs reported significant pain reduction and functional improvement with combination therapy compared to placebo or active controls. However, study heterogeneity, dosage variations, and risk of bias limited comparability. Adverse events (AEs) included gastrointestinal (GI) discomfort and drowsiness, though no severe complications were consistently reported. Conclusions: Despite methodological limitations, the diclofenac-thiocolchicoside combination demonstrates promising efficacy for acute LBP and musculoskeletal pain management. However, there is no clear evidence of its clinical superiority over other available treatments, due to study heterogeneity and potential biases. Rigorous, standardized research with larger sample sizes and consistent methodologies is essential to definitively establish the efficacy and safety of diclofenac-thiocolchicoside, providing clearer guidance for clinical decision-making.

This study examined mortality rates among 2475 patients with thalassaemia and sickle cell disease (SCD) per year over 12 years in Greece, recording 335 deaths (27.92/year), with an overall mortality rate of 1.13% per year. The primary aim was to identify causes of death, comorbidities, treatment efficacy and iron overload prevalence. Of the deaths, 239 were attributed to thalassaemia and 96 to SCD. For thalassaemia patients, cardiac failure, hepatocellular carcinoma and sepsis were the leading causes of death, with no neoplasms observed in β+/β+ genotypes. In SCD, sepsis, liver failure and stroke were the predominant causes, with sepsis‐related deaths higher in frequently transfused patients. The median age of death was significantly lower in thalassaemia (50 years) compared to SCD (58.49 years, p < 0.001). Differences in comorbidities and treatment effectiveness highlight the need for improved management strategies. Addressing iron overload, optimizing chelation therapy and expanding hydroxyurea use in SCD patients could enhance survival and quality of life. Strengthening treatment protocols and monitoring may reduce mortality, emphasizing the importance of targeted interventions in haemoglobinopathies.

Vaccination strategies play a pivotal role in achieving broad and robust immune protection. With the advent of new technologies and challenges posed by emerging infectious diseases such as SARS-CoV-2, evaluating the efficacy of homologous (matching tracks) and heterologous (mixing paths) vaccination regimens is critical. This article explores mechanistic insights and empirical evidence on the benefits and limitations of these approaches.

Background: In recent years, more and more numerical tools have been utilized in medicine in or-der to assist the evaluation and decision-making processes for complex clinical cases. Towards this direction, Finite Element Models (FEMs) have emerged as a pivotal tool in medical research, particularly in simulating and understanding the complex fluid and structural behaviors of the circulatory system. Furthermore, this tool can be used for the calculation of certain risks regarding the function of the blood vessels. Methods: The current study developed a computational tool utilizing the finite element method in order to numerically evaluate stresses in aortas with abdominal aneurysms and provide the necessary data for the creation of a patient-specific digital twin of an aorta. More specifically, 12 different cases of aortas with abdominal aneurysms were examined and evaluated. Results: The first step was the 3D reconstruction of the aortas trans-forming the DICOM file into 3D surface models. Then, a finite element material model was developed simulating accurately the mechanical behavior of aortic walls. Conclusions: Through the results of these finite element analyses the values of tension, strain, and displacement were quantified and a rapid risk assessment was provided revealing that larger aneurysmatic regions elevate the risk of aortic rupture with some cases reaching an above 90% risk.

This systematic review explores the integration of machine learning (ML) with augmented reality (AR) and virtual reality (VR) technologies in cognitive therapies for mental health disorders. Analyzing 141 studies following PRISMA guidelines, the findings reveal that ML-driven AR/VR therapies offer significant advancements in personalization, real-time adaptation, and treatment efficacy. VR-based interventions demonstrate strong effectiveness in reducing symptoms of PTSD, anxiety disorders, and phobias, with ML algorithms—such as neural networks (NNs), supervised learning, and reinforcement learning (RL)—further optimizing therapy through predictive analytics and dynamic adjustments. These technologies enhance patient engagement, improve treatment adherence, and sustain therapeutic benefits for up to six months. This review highlights the transformative impact of ML-enhanced AR/VR therapies in delivering immersive, scalable, and highly personalized interventions, redefining the future of mental health treatment. As AI-powered therapeutic frameworks are poised to evolve further, such advancements have enormous potential to revolutionize cognitive therapies, enhancing their accessibility and optimizing patient outcomes worldwide.

Human echinococcosis (hydatidosis or hydatid) disease is a worldwide neglected zoonotic larval infection typically caused by cestodes of the Echinococcus genus. It affects 1 million people worldwide, predominantly reported in Central Asia, the Middle East, and South America. In this paper, we report a patient who underwent a successful laparoscopic partial pericystectomy and omentoplasty with simultaneous cholecystectomy in the treatment of cystic echinococcosis and cholelithiasis, respectively. There are many challenges to treating complicated hepatic hydatid cysts. It is crucial for surgeons to have knowledge of the range of possibilities of each surgical modality and its expanding advancements that can reduce complication risks and increase a patient’s quality of life. The art of sharing techniques and management possibilities between professionals in this field provides a bridge in further crafting the best-tailored treatment plan for patients. This report illustrates the successful usage of laparoscopy in the management of a section IV hydatid cyst with simultaneous cholecystectomy. This case aims to expand the knowledge and prospects of laparoscopic surgery in cystic echinococcosis.

BACKGROUND Hair has long held cultural and psychosocial significance, symbolizing health, status, and identity. Hair loss impacts quality of life, self-esteem, and psychological well-being. While treatments like minoxidil and finasteride exist, they often yield limited results. Hair transplantation (HT), first demonstrated by Johann Friedrich Dieffenbach in 1822, has evolved into the most effective hair restoration method. Since its inception in 1975, Dermatologic Surgery has been a main source for groundbreaking publications from major players in the field, while also playing a pivotal role in documenting the history of HT. OBJECTIVE This mini review examines the historical evolution of HT techniques over the past 200 years, highlighting their advantages and limitations. MATERIALS AND METHODS A literature search was conducted using PubMed and Google Scholar with the term “hair transplantation techniques.” Relevant sources were reviewed to extract information on technique development and historical origins. RESULTS Key pioneers such as Dieffenbach, Menahem Hodara, and Shoji Okuda laid the groundwork for modern HT. Milestones include punch grafting, follicular unit transplantation (FUT), and follicular unit extraction (FUE). FUT emphasized natural follicular grouping, while FUE introduced minimally invasive methods with faster recovery and better aesthetics. Recent advancements include robotic-assisted procedures and bioengineered follicles, reflecting a shift toward precision and patient-centered care. CONCLUSION The continuous evolution of HT techniques underscores its position as the most effective method for hair restoration, particularly in androgenetic alopecia cases.

Cardiac implantable electronic device (CIED) infections caused by Gram-negative bacteria are uncommon but potentially life-threatening. This study examined patients with Gram-negative CIED infections, investigating the clinical characteristics of patients harboring multidrug-resistant (MDR), versus non-MDR, isolates. A retrospective observational analysis was conducted at two tertiary Greek University Hospitals from 2015 to 2020. Patients were identified through microbiological cultures from device-related sites (pocket, lead, generator), with infections classified as MDR or non-MDR based on antimicrobial susceptibility profiles. Comprehensive data were collected, including demographic characteristics, clinical parameters, procedural details—on both the last device procedure and subsequent extraction procedure—infection-related findings, and microbiological profiles. In total, 18 patients were identified, with an equal distribution of 9 MDR and 9 non-MDR cases. The study population had a median age of 78 years, with 33.3% female patients, and a median Charlson Comorbidity Index of four. Pseudomonas aeruginosa was the most prevalent isolated species. Comparative analysis revealed that MDR patients had higher median SOFA (Sequential Organ Failure Assessment) scores (2 vs. 0, p = 0.07), longer time to device extraction (50% vs. 88.9% extracted within one month, p = 0.079), and higher blood culture positivity (80% vs. 37.5%, p = 0.135). Despite similar demographic characteristics, MDR infections demonstrated more complex clinical profiles, with a trend towards increased disease severity.

Traumatic tracheobronchial injuries (TTBIs) are rare but potentially life-threatening complications of high-energy thoracic trauma, most commonly associated with road traffic accidents. These injuries demand prompt diagnosis and a multidisciplinary approach for effective management. We present the case of a 16-year-old male patient who sustained a spiral rupture of the right main bronchus following a motorcycle accident. Upon presentation to the emergency department (ED), the patient demonstrated severe hypoxemia and respiratory acidosis. Imaging confirmed the presence of a pneumothorax, necessitating the placement of bilateral chest tubes. Despite the intervention, a persistent air leak was observed. Fiberoptic bronchoscopy was used to confirm the diagnosis and stabilize the patient by isolating the unaffected left lung. Definitive surgical management via right thoracotomy revealed a complex spiral lesion in the right main bronchus, which was deemed irreparable. A right pneumonectomy was performed, and the bronchial stump was secured with 4-0 pledgeted sutures reinforced with fibrin glue. The patient’s postoperative course was uneventful, and he was discharged in good health 15 days later. Further follow-up demonstrated excellent health and no complications. This case highlights the critical role of fiberoptic bronchoscopy in the diagnosis and initial stabilization of TTBIs and emphasizes the importance of meticulous surgical techniques for managing complex bronchial injuries. The combination of prompt airway management and careful surgical planning ensured a successful outcome, even in the context of a severe, life-threatening, and technically challenging injury.

Immune checkpoint inhibitors like pembrolizumab represent a modern approach to the management of various malignancies, including non-small cell lung cancer. The therapeutic activity of immunotherapy is exerted by the activation of immune cells against the tumor cells. However, systemic activation of the immune system can lead to the development of autoimmune complications known as immune-related adverse events. A combination of rare immune-related adverse events is occasionally observed simultaneously in the same patient. We present the case of a 66-year-old male with squamous non-small cell lung carcinoma who presented to the emergency department with dyspnea and respiratory failure. Imaging findings were consistent with pulmonary embolism and nonspecific interstitial pneumonitis. One month before this event, he was diagnosed with bullous pemphigoid following 21 cycles of treatment with pembrolizumab. The radiological findings, the lack of response to antibiotics, the negative microbiological workup, and the excellent response to corticosteroids established the diagnosis of pembrolizumab-induced pneumonitis. The combination of bullous pemphigoid and pneumonitis secondary to pembrolizumab is rare; only a few case reports exist in the literature. Hence, this case highlights the possibility of multiple immune-related adverse events in the same patient. The exclusion of infectious diseases and other immunologic disorders with a similar clinical presentation is necessary to make the final diagnosis of immune-related adverse events and start the appropriate treatment. Serology, histopathology, and direct immunofluorescence aid to the diagnosis of immune-related bullous pemphigoid; the differential diagnosis includes other pemphigoid or lichenoid diseases, Stevens-Johnson syndrome/toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms. Imaging, microbiological testing, and bronchoscopy (if possible) confirm the diagnosis of immune-related pneumonitis, which should be differentiated from acute coronary syndrome, cardiogenic pulmonary edema, pulmonary embolism, tumor progression, and lower respiratory tract infections (especially Pneumocystis jirovecii pneumonia in immunocompromised patients). An interdisciplinary approach is necessary for the management of these cases.