Hypothyroidism Induced Rhabdomyolysis in a Young Male after a Single Intramuscular Injection: A Case Report.

Hypothyroidism is a common endocrine disorder resulting from the inability of the thyroid gland to produce sufficient thyroid hormone for the metabolic demands of the body. Clinical symptoms and signs are often non-specific and subtle. Muscular symptoms are frequently reported. Rhabdomyolysis is a life-threatening condition caused by necrosis of muscles and leakage of toxic intracellular components into the blood circulation. Hypothyroidism induced rhabdomyolysis, represents an unusual clinical occurrence. This is a case of a middle-aged man, who presented with severe myalgias, following an intramuscular injection. After laboratory work-up, he was diagnosed with rhabdomyolysis. Laboratory and ultrasound tests disclosed primary hypothyroidism of auto-immune etiology.

COVID-19 pandemic and reasons to prioritize the needs of the health care system to ensure its sustainability: A scoping review from January to October 2020 (Review).

The worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led the World Health Organization to characterize the pandemic as a public health emergency of international concern. National health care systems in countries during the initial surge of the pandemic were unable to handle the sanitarian crisis that had emerged. Thus, the prevention and control of future global health emergencies must be a priority. The present scoping review aimed to retrieve articles that summarize the current experience on issues related to historical knowledge, and epidemiology, clinical features and overall burden of SARS-CoV-2 on health care services. In summary, a comprehensive overview of the information that has been learnt during this period is presented in the current review. Furthermore, taking into account the global experience, the need for planning cohesive and functional health services before similar pandemic events occur in the future is highlighted. The next public health issue should be prevented rather than treated. In spite of the vaccination benefits, a number of sporadic cases of SARS-CoV-2infections will persist. Information collected remains relevant for appraising how similar threats can be faced in the future. Overall, collaborative health care plans need to be rethought to increase preparedness.

Holly Sacrament: the medicine of spiritual immortality or a vehicle for contamination?

The Holy Communion is the oldest Christian practice, through which a gathered group of people partake bread and wine with a shared spoon. The pandemic of COVID-19 produced unexpected social instability and chaos. In Greece, a recent bishop's death from COVID-19 re-awaked the issue of infection transmission by using a common chalice and spoon. This review evaluates the available medical literature on this topic from the beginning of the pandemic until today.

Primary care and the COVID-19 pandemic: Schrödinger's cat.

The #COVID19 pandemic crisis requires the collaboration of all healthcare providers. Every contribution is welcome to gain time during the phase of "system state" superposition. https://bit.ly/3m4SBxY.

Burden of metabolic syndrome among primary care patients in Crete, Greece: A descriptive study.

BACKGROUND: Metabolic Syndrome (MetS) is a clustering of abdominal obesity, hypertriglyceridaemia, low HDL cholesterol, hyperglycaemia and hypertension. Early identification of MetS is important for preventing cardiovascular disease (CVD). MetS has not been systematically explored in Greek primary care. OBJECTIVES: To examine MetS frequency among primary care patients 40 years of age or older in Crete. METHODS: A descriptive study was conducted (July-December 2015). General practitioners, randomly selected from regional physician listings, recruited consecutive patients, 40 years of age or older, visiting their practice. Chart audits were completed for eligible patients using medical records, including demographics and cardiovascular risk factors (hypertension, dyslipidaemia, diabetes mellitus). MetS was defined using the revised NCEP ATP III criteria. Frequencies with 95% confidence intervals were calculated. Gender differences were explored using Chi-square and Mann-Whitney tests. RESULTS: Our sample consisted of 815 patients (55.7% female; mean age 65.2 years; range 40-98 years) from 44 GP practices. Overall, 73.6% (95% CI 70.4, 76.6) were identified with MetS, with a higher proportion of males (75.6%; 95% CI 71.0, 79.8) than females (72.0%; 95% CI 67.8, 76.0). Among the total sample, relatively high rates of hypertension (males: 64.5%; 95% CI 59.9, 70.0 and females: 61.1%; 95% CI 56.8, 65.8), dyslipidaemia (males: 69.3%; 95% CI 64.3, 74.1 and females: 63.5%; 95% CI 59.3, 68.0), diabetes mellitus (males: 46.9%; 95% CI 42.2, 52.4 and females: 36.5%; 95% CI 32.5, 41.6) and coronary heart disease (males: 21.2%; 95% CI 17.0, 25.2 and females: 6.2%; 95% CI 4.2, 8.6) were documented. CONCLUSION: MetS and CVD risk factors were encountered at high frequencies in the studied population of primary care patients in Crete.

Spontaneous Intra-Cerebral Haemorrhage Presenting with Chest Pain in a Healthy Young Man.

Spontaneous, non-traumatic intra-cerebral haemorrhage is the second most common type of stroke and is associated with significant morbidity and mortality. It is defined as the presence of blood within the cerebral parenchyma without prior injury or surgery. The purpose of this work is to describe an atypical presentation of spontaneous intra-cerebral haemorrhage in a healthy young adult. A literature review was also carried out. LEARNING POINTS: Spontaneous intra-cerebral haemorrhage is a challenge in daily practice due to the wide range of clinical symptoms on presentation.Chest pain mimicking acute myocardial infarction is an atypical presentation of intra-cerebral haemorrhage.In the primary care setting, misdiagnosis of a patient with spontaneous cerebral haemorrhage with chest discomfort suggesting cardiac aetiology and prompting antiplatelet/aspirin therapy could result in disaster.Taking a detailed history and conducting a thorough neurological examination is important in every clinical encounter and may trigger diagnostic suspicion.

An Elderly Woman with Pyrexia of Unknown Origin.

Pyrexia of unknown origin represents a diagnostic challenge in the daily practice. Clinical features are often subtle or inadequate to recognize the etiology of prolonged fever. Endocrine etiology of pyrexia of unknown origin is not common. Here we present a case of an elderly female seeking medical advice from her general practitioner due to a four-week history of moderate fever, malaise and loss of appetite. Initial outpatient diagnostic workup was negative. During repeated examination a slight enlargement of thyroid gland was noticed. Thyroid function tests revealed a very low level of thyroid stimulated hormone along with elevated free T4 suggesting subacute thyroiditis. Low dose administration of corticosteroids led to clinical improvement and fever remission. Physicians involved must be aware about this unusual presentation of thyroiditis and include the condition in the differential diagnosis of prolonged unexplained fever. In the absence of clinical signs and symptoms, an abnormal thyroid function test may prevent from unnecessary investigations and inefficient hospital admission.

Religiosity, Well-Being and 'Slowing Down' Ageing Damage: A Literature Review.

Telomere length (TL) represents an important marker of cellular aging. Its shortening affects human health and longevity by inducing senescence, apoptosis, and oncogenesis. Advanced ageing and negative behavioral and lifestyle factors decrease TL. The relationship between positive psycho-social factors and longer telomeres has given rise to a growing number of research efforts. Among these, religiosity poses a particular interest since it is associated with a wide range of favorable health outcomes. In this direction, recent literature reports, suggest a positive link between religiosity and TL. Underlying mechanisms for this association are not yet clarified. In this review, we would like to summarize the current knowledge on the link between religiosity and TL. Taking this opportunity, we recall findings from a cohort study in rural Crete, Greece that adds evidence on the discussion of potential psycho-social mediators which some may prevent shortening of TL.

Diabetic neuropathy and restless legs syndrome: can a known chronic condition slow down our diagnostic way of thinking? A case report and a short literature overview.

Restless legs syndrome is a common lifelong neurological disorder with a negative impact on the patients' sleep and quality of life. Despite its common occurrence in the general population, the condition usually remains undiagnosed. Patients with diabetes run at a higher risk to suffer from restless legs syndrome. Diabetic neuropathy, in particular, shares similar clinical characteristics with restless legs syndrome and reduces significantly the patients' quality of life. Our aim was to report on an interesting case of restless legs syndrome in a patient with diabetes seeking medical advice for a ten-year long insomnia. Sleep deprivation was falsely attributed to diabetic neuropathy. A literature overview of the up-to-date knowledge was performed in order to summarize available information and provide primary care physicians with a comprehensive way of clinical thinking to differentiate peripheral neuropathy and restless legs syndrome manifestations.

Holy Communion and Infection Transmission: A Literature Review.

The Holy Communion originated in the Last Supper of Jesus Christ, nearly 2,000 years ago. According to the Bible, the night before his crucifixion, Jesus Christ shared with his 12 apostles a meal of bread and wine. During the meal, Christ instructed his disciplines to eat and drink in his memory, saying that bread is his body and wine is his blood. Today, faithful people worldwide share the consecrated bread and wine retracted from a chalice with a Holy Communion spoon. The novel coronavirus that emerged in December 2019 recorded a rapid exponential spread across space and time. The ongoing pandemic of coronavirus disease has affected people from all cultures and religions. In Greece, the pandemic concurred with the Easter celebration. Measures of social distancing have been implemented. Among others, churches have closed their doors to the public in order to avoid religious mass gatherings. The issue of the novel coronavirus transmission by partaking Holy Communion has received much criticism. In this review, we aimed to retrieve articles that summarize the current knowledge on the selected topic. In order to offer a balanced analysis of the subject, we have also assessed the theological framework of the Holy mystery.

Rectal Lipoma in an Elderly Male: A Case Report.

Lipomas of the gastrointestinal tract are uncommon, benign non-epithelial tumors detected incidentally during surgery or endoscopy. Rectal lipomas are extremely rare. Patients may be asymptomatic or present with rectal bleeding, constipation, tenesmus and signs of intestinal obstruction. Preoperative diagnosis is challenging. Management consists of simple observation, endoscopic or laparoscopic removal, and open surgery. We present a case of an elderly male admitted to the Department of Surgery of a general hospital in Crete, complaining of a protruding rectal mass during defecation. CT raised the diagnostic suspicion. The mass was removed by trans-anal excision. Histopathology of the resected specimen confirmed the diagnosis. The patient had an uneventful postoperative course and was discharged home at the second postoperative day.

A Young Male With Anorexia, Abdominal Complaints and Marked Blood Eosinophilia.

Peripheral blood eosinophilia represents a frequent finding in routine clinical practice when absolute eosinophil count is found to be greater than 0.5 x 109/L (500/µL). Common causes include parasitic infections, allergic reactions, and hyper-eosinophilic syndrome. Eosinophilia secondary to malignancy represents an uncommon presentation. Here we report an atypical case of a 47-year-old previously healthy male who presented to a primary care setting complaining of fatigue and anorexia for the last two weeks. The evaluation revealed leucocytosis and peripheral hypereosinophilia with an absolute eosinophil count of 14.13×109/L (37%). Following an extensive diagnostic work in a secondary care centre he was finally diagnosed with rectal carcinoma. This case highlights that solid malignancy should be considered in patients with marked peripheral eosinophilia.

R on T Phenomenon and Long QTc Syndrome due to Moxifloxacin in a Healthy Female.

Long QT syndrome is characterized by prolongation of the corrected QT interval and is associated with fatal arrhythmias. R on T phenomenon is the coincidence of a premature ventricular complex with a T wave and may result to syncope and sudden cardiac death. Here we present a case of a 59-year-old woman with no previous history of medication, receiving moxifloxacin for community-acquired pneumonia. She was admitted complaining for thoracic pain and shortness of breath. Electrocardiogram showed both R on T phenomenon and QT prolongation. After discontinuation of the antibiotic symptoms and electrocardiography features were resolved. Physicians should always be vigilant about this rare and potentially fatal adverse drug reaction especially in high risk patients. General practitioners in particular being the first point of access in care have to carefully assess and detect high risk patients before the administration of moxifloxacin.

Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study: a WSES observational study.

Background: Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted. Methods: This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018. Results: A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28-66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4-10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO2) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0-1, 22.7% for those who had scores of 2-3, 46.8% for those who had scores of 4-5, and 86.7% for those who have scores of 7-8. Conclusions: The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.

Multiorgan paradoxical embolism in an elderly female with a patent foramen ovale: a case report.

Paradoxical embolism is an uncommon cause of arterial occlusion with a high mortality burden. Current evidence suggests that patent foramen ovale is the most important etiological factor of paradoxical embolism, by acting as a pathway for a thromboembolic material originating from the peripheral veins, passing through the lungs and entering the systemic circulation. Here we present a case of paradoxical embolism in the mesenteric and renal arteries associated with pulmonary embolism and deep vein thrombosis in an elderly woman with no predisposing risk factor. A diagnosis of paradoxical embolism was considered and the presence of a patent foramen ovale was consequently confirmed with a transesophageal echocardiography. Urgent thrombolysis saved the life of the patient. Paradoxical embolism represents an emergency and therefore prompt diagnosis and initiation of therapy may prevent adverse outcomes.

Insisting Pain on the Mid-scapular Line.

Neoplastic diseases are commonly paired with a wide range of non-specific clinical symptoms. Even the most alarming complaints pose a low positive predictive value making diagnosis of an underlying malignancy a major detective challenge for the primary care physician. Therefore, although cancer may be suspected for not be missed, as management failure within primary care, diagnosis usually occurs in the context of a secondary care setting. Here we present a case of a patient seeking medical advice from his general practitioner due to a two-week history of back thoracic pain. Following investigations, the patient was early diagnosed with myeloma. Current notion of target-driven laboratory tests utility that may be used as possible clues for the detection of multiple myeloma at a primary care level is also discussed to enhance capacity.

A fatal case of cytomegalovirus disease in an immunocompetent young woman: a case report.

Cytomegalovirus can cause severe disease with adverse outcome in immunocompromised patients. Severe cytomegalovirus infection in previously healthy individuals is rare. Here we present an unusual case of cytomegalovirus infection with neurological and pulmonary involvement in a previously healthy young woman with no history of immuno-suppression. Unfortunately, the disease followed a malignant course and despite the efforts of the medical staff the patient died. CMV infection should be considered in the diagnostic work-up of immunocompetent patients with fever and unexplained neurological or pulmonary manifestations. Although uncertainty exists regarding the optimal treatment of CMV in healthy individuals, early recognition and administration of ganciclovir may prevent a fatal outcome.

Prospective Observational Study on acute Appendicitis Worldwide (POSAW).

Background: Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments. Methods: This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study. Results: A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%. Conclusions: The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.