Acute Pain Management and Perceptions among Emergency Healthcare Workers: Feedback from Greece.

Background and Aims: Pain remains the most common reason patients seek assistance in emergency rooms. However, the level of pain management during emergencies, and subsequently during disasters and mass casualty incidents, remainsdisturbing. Methods: A cross-sectional study was conducted using a structured anonymous questionnaire among a random sample of doctors working in different tertiary hospitals of Athens and of rural regions. The data were analysed using descriptive statistics and statistical significance tests via R-Studio, version 1.4.1103. Results: The aforementioned sample yielded101 questionnaires. Results show suboptimal knowledge and attitudes regarding acute pain management among emergency healthcare providers in Greece. The majority of responders are unaware of the term multimodal analgesia (52%), of newer pain treatment methods (59%), they have not attended pain management seminars (84%), nor are they aware of pain treatment protocols in their workplace (74%). Participants appeared to disregard successful pain relief due to time constraints (58%), while leaving certain parts of the population (children under 3 years of age -75%, pregnant women-48%) significantly undertreated in terms of analgesia. Demographic correlations showed that clinical experience and pain management education were associated with older and more experienced emergency healthcare workers. Specialties with a previous core training containing pain education (anaesthesiologists, emergency physicians) again showed better results in the majority of the questions. Conclusions: Educational programs/seminars along with standardised algorithms should be developed in order to cover existing needs and misconceptions.

Demographic and clinical characteristics of refugees seeking primary healthcare services in Greece in the period 2015-2016: a descriptive study.

Background: In 2015-2016, more than a million refugees entered Greece. Along with other organizations, PRAKSIS, a local non-governmental organization, deployed mobile medical units on three islands and in temporary settlements in Athens. Methods: This is a descriptive cross-sectional study aimed at analysing the demographic and clinical characteristics of the population (n=6688) that received services from PRAKSIS between October 2015 and June 2016 in different locations (islands of Samos, Kos and Leros in the southeastern Aegean Sea and on the mainland at Athens-Piraeus Port Gate E) before and after the closure of European borders in March 2016. Results: The majority (88%) of the population came from Syria, Afghanistan and Iraq. Among them, 53% were women and children. Infectious diseases decreased as the population moved from the islands to the Athens-Piraeus Port, while all other disease categories increased in relative frequency, the difference being statistically significant (p<0.05). Among all consultations, dental and oral cavity health complaints also increased in the Athens-Piraeus Port, but failed to reach statistical significance (p=0.11). Referrals from the mobile health units to specialist care rose from 4.2% of all patients clinically examined on the islands to 9.9% in the Athens-Piraeus Port, and the difference was statistically significant (p<0.05). Conclusions: More research and systematic data collection are needed to inform appropriate policies for the humanitarian challenges posed by the recent refugee and migrant waves in Europe.

The invention of gonioscopy by Alexios Trantas and his contribution to ophthalmology.

Gonioscopy is a technique used to examine structures in the anterior chamber angle (the fluid filled space inside the eye between the iris and the innermost layer of the cornea, the endothelium). It is an essential tool in ophthalmic practice, particularly in the diagnosis of glaucoma. In 1899, the Greek ophthalmologist Alexios Trantas was the first to visualise the angle in vivo and coined the term 'gonioscopy'. He made a number of other important contributions to ophthalmology.

″I will not cut, even for the stone″: origins of urology in the Hippocratic Collection.

The Hippocratic Collection, including the most of ancient Greek medicine, remains still interesting, despite the recent advances that transformed definitely the urological healing methods. Considering the patient as a unique psycho-somatic entity and avoiding high risk surgical manipulations were the leading principles dictating the everyday practice. Contemporary physicians can still learn from the clinical observations in times of complete absence of laboratory or imaging aid, from the prognostic thoughts, the ethics, and the philosophical concepts, represented by the Hippocratic writings, tracing into them the roots of Rational Medicine in general and Urology in particular.

History of leucotomies in Greece.

In order to present the social, scientific and institutional context which permitted the use of leucotomies in Greece, we have reviewed the Archives of the Medical Associations, the medical literature of the years 1946-56, a reader's dissertation and the memoirs of two psychiatrists. More than 250 leucotomies were done in the two public psychiatric hospitals in Athens from 1947 to 1954, as well as 40 leucotomies in the public psychiatric hospital in Thessaloniki. Although aware of the side effects, psychiatrists justified the use of the procedure. The performance of leucotomies in Greece declined because of reports of the dangers of the operation and its unpredictable outcome for the patients, but mainly because of the encouraging results with psychotropic drugs in the early 1950s.

“I will not cut, even for the stone”: origins of urology in the hippocratic collection

The Hippocratic Collection, including the most of ancient Greek medicine, remains still interesting, despite the recent advances that transformed definitely the urological healing methods. Considering the patient as a unique psycho-somatic entity and avoiding high risk surgical manipulations were the leading principles dictating the everyday practice. Contemporary physicians can still learn from the clinical observations in times of complete absence of laboratory or imaging aid, from the prognostic thoughts, the ethics, and the philosophical concepts, represented by the Hippocratic writings, tracing into them the roots of Rational Medicine in general and Urology in particular.

Medical, demographical and social aspects of syphilis: the case of infected sex workers in Greece during Interwar.

The aim of this research is to present syphilis among women described as "indecent" according to the records of the Venereal Diseases Hospital "Andreas Syggros", which is located in Athens, during the period 1931-1935. In impoverished Greece of the Interwar period, factors such as criminal ignorance, or lack of information on sexually transmitted diseases (STDs) along with inadequate health controls of sex workers, resulted in a dramatic spread of syphilis, whereas "Andreas Syggros" hospital accommodated thousands of patients. The inflow of 1.300.000 Greek refugees from Asia Minor, after the Greek defeat by the Turkish army in the war of 1922, resulted in a notable change in the demographics of the country, while the combination of miserable living conditions, unemployment, economic crisis of the Interwar period, political instability and dysfunction of the State led to an increased number of illegal sex workers and syphilis outbreaks. Despite the introduction of an ad hoc Act to control STDs since 1923, the State was unable to limit the transmissibility of syphilis and to control prostitution. Unfortunately, the value of this historical paradigm is borne out by a contemporary example, i.e. the scandal of HIV seropositive sex workers in -beset by economic crisis- Greece in May 2012. It turns out that ignorance, failure to comply with the law, change in the mentality of the citizens in an economically ruined society, and most notably dysfunction of public services during periods of crisis, are all risk factors for the spread of serious infectious diseases.

Holy fools: a religious phenomenon of extreme behaviour.

Monks in Byzantine times (330-1453 AD) often expressed their faith with extreme manifestations of behaviour, such as living on a high column (stylites), on a tree (dendrites) or in crowded urban centres of the empire pretending to be fools for Christ's sake. These Holy Fools exposed themselves to the ridicule and the mistreatment of the citizens, being protected, however, by their state of insanity to mock and violate moral codes and social conventions. The official Church barely tolerated these religious attitudes as promoting deviations from standard orthodoxy, and the Quinisext Ecumenical Council (592 AD) judged them as dangerous and formally denounced the phenomenon. The two most famous of them in Byzantium were Symeon of Emesa and Andrew of Constantinople, whose lives constitute unique testimonies to insanity and the simulation thereof. The survival and transplantation of the Holy Fools in Russia, called "yurodivye", where they met widespread acceptance, confirm their appeal in specific geographic areas and their endurance over time. We attempt to approach the symbolism of holy lunacy and to analyse the personality trends of these "eccentric" saints.

Penile representations in ancient Greek art.

OBJECTIVES: The presentation of the cult of phallus in ancient Greece and the artistic appearance of the phenomenon on vase figures and statues, as indicative of the significant role of the male genitalia in all fertility ceremonies. METHODS: The examination of a great number of penile representations from the ancient Greek pottery and sculpture and the review of the ancient theater plays (satiric dramas and comedies ). RESULTS: Phallus in artistic representation is connected either with gods of fertility, such as the goat-footed and horned Pan or the ugly dwarf Priapus or the semi-animal nailed figures Satyrs, devotees of the god Dionysus accompanying him in all ritual orgiastic celebrations. Phallus also symbolizes good luck, health and sexuality: people bear or wear artificial phalli exactly like the actors as part of their costume or carry huge penises during the festive ritual processions. On the contrary, the Olympic gods or the ordinary mortals are not imaged ithyphallic; the ideal type of male beauty epitomized in classical sculpture, normally depicts genitals of average or less than average size. It is noteworthy that many of these images belong to athletes during or immediately after hard exercise with the penis shrunk. The normal size genitalia may have been simply a convention to distinguish normal people from the gods of sexuality and fertility, protectors of the reproductive process of Nature. CONCLUSIONS: The representation of the over-sized and erected genitalia on vase figures or statues of ancient Greek art is related to fertility gods such as Priapus, Pan and Satyrs and there is strong evidence that imagination and legend were replacing the scientific achievements in the field of erectile function for many centuries.

Suicidal behaviour in the ancient Greek and Roman world.

OBJECTIVE: We attempt to present and analyze suicidal behaviour in the ancient Greek and Roman world. METHODS: Drawing information from ancient Greek and Latin sources (History, Philosophy, Medicine, Literature, Visual Arts) we aim to point out psychological and social aspects of suicidal behaviour in antiquity. RESULTS: The shocking exposition of suicides reveals the zeitgeist of each era and illustrates the prevailing concepts. Social and legal reactions appear ambivalent, as they can oscillate from acceptance and interpretation of the act to punishment. In the history of these attitudes, we can observe continuities and breaches, reserving a special place in cases of mental disease. The delayed emergence of a generally accepted term for the voluntary exit from life (the term suicidium established during the 17th century), is connected to reactions triggered by the act of suicide than to the frequency and the extent of the phenomenon. CONCLUSIONS: The social environment of the person, who voluntary ends his life usually dictates the behaviour and historical evidence confirms the phenomenon.

Representaciones fálicas en el arte griego antiguo / Penile representations in ancient Greek art

OBJETIVO: La presentación del culto del falo en la Grecia antigua y la aparición artística del fenómeno en figuras de ánforas y estatuas, como indicativo del papel significativo de los genitales masculinos en todas las ceremonias de fertilidad. MÉTODOS: La examinación de un gran número de representaciones fálicas en la cerámica y escultura griega antigua y la revisión de las antiguas obras teatrales (dramas satíricos y tragedias). RESULTADOS: El falo en las representaciones artísticas está conectado a los dioses de fertilidad, como Pan, el dios con pies de chivo y cuernos, o el enano feo Príapo, o los Sátiros, figuras con uñas parecidas a las de los animales, devotos del dios Dioniso que lo acompañan en todas las celebraciones rituales orgiásticas. El falo también simboliza la buena suerte, la salud y la sexualidad: la gente se pone falos artificiales exactamente como los actores, como parte de sus trajes, o lleva penes enormes durante las procesiones rituales festivas. Al contrario, los dioses del Olimpo o los mortales comunes no están representados como itifálicos; el tipo ideal de la belleza masculina resumida en la escultura clásica, normalmente representa genitales de tamaño mediano o aún más pequeño. Es notable que muchas de estas imágenes pertenecen a atletas durante o inmediatamente después de ejercicios duros con el pene reducido. Quizás los genitales de tamaño regular hayan sido sencillamente una convención para distinguir entre la gente común y los dioses de sexualidad y fertilidad, protectores del proceso reproductivo de la naturaleza. CONCLUSIONES: La representación de genitales de gran tamaño o en erección en figuras de ánforas y estatuas en el arte griego antiguo está relacionada con dioses de fertilidad como Príapo, Pan y los Sátiros, y existe una gran evidencia de que la imaginación y la leyenda estaban sustituyendo los logros científicos conseguidos durante muchos siglos en el campo de la función eréctil (AU)

OBJECTIVES: The presentation of the cult of phallus in ancient Greece and the artistic appearance of the phenomenon on vase figures and statues, as indicative of the significant role of the male genitalia in all fertility ceremonies. METHODS: The examination of a great number of penile representations from the ancient Greek pottery and sculpture and the review of the ancient theater plays (satiric dramas and comedies). RESULTS: Phallus in artistic representation is connected either with gods of fertility, such as the goat-footed and horned Pan or the ugly dwarf Priapus or the semi-animal nailed figures Satyrs, devotees of the god Dionysus accompanying him in all ritual orgiastic celebrations. Phallus also symbolizes good luck, health and sexuality: people bear or wear artificial phalli exactly like the actors as part of their costume or carry huge penises during the festive ritual processions. On the contrary, the Olympic gods or the ordinary mortals are not imaged ithyphallic; the ideal type of male beauty epitomized in classical sculpture, normally depicts genitals of average or less than average size. It is noteworthy that many of these images belong to athletes during or immediately after hard exercise with the penis shrunk. The normal size genitalia may have been simply a convention to distinguish normal people from the gods of sexuality and fertility, protectors of the reproductive process of Nature. CONCLUSIONS: The representation of the over-sized and erected genitalia on vase figures or statues of ancient Greek art is related to fertility gods such as Priapus, Pan and Satyrs and there is strong evidence that imagination and legend were replacing the scientific achievements in the field of erectile function for many centuries (AU)

Epidemic waves during Justinian's plague in the Byzantine Empire (6th-8th c. AD).

The aim of the present study is to collect the epidemic outbreaks and the epidemic waves of the bubonic plague of the Byzantine Empire during the first pandemic (541-751 AD). Human activities, such as trade and military movements have been speculated as underlying factors for the causation of the pandemic. Historical data combined with geographical spreading of the plague, allows an alternative speculation of suspicious enzootic areas in the Middle East. We conclude that the possible existence of enzootic areas in that region might have been responsible for the causation of the numerous outbreaks of the bubonic plague in the Eastern provinces of the Byzantine Empire during the 6th-8th century period.

The lack of a child, the loss of a throne: the infertility of the first royal couple of Greece (1833-62).

The first dynasty in Greece after its independence in 1830 was founded in 1833 with Otto, the son of Ludwig I of Bavaria. In 1836 Otto married Amalia, the daughter of the Grand Duke of Oldenburg. The people of Greece anticipated that the marriage would result in an heir to the throne, establishing the new dynasty. The failure of the royal couple to produce an heir was a major reason for their subsequent abdication. For many years both were subjected to repeated examinations by Greek and German physicians, especially Amalia, who was considered to be largely responsible for the infertility. In this paper we discuss possible diagnoses and describe the various treatments suggested for, and applied to, the infertility. We also review the consequent political controversies and the problems created among the royal families of Europe who wanted to replace the Wittelsbach dynasty with another royal line--a situation that led, in 1863, to the succession of the Danish Schleswig-Holstein-Sonderburg-Glücksburg dynasty to the Greek throne.

Historical consequences of the infertility of Otto (1815-67) and Amelia (1818-75), first Royal couple of Greece.

After the Greek Independence (1830), the first King, Otto from the Wittelsbach dynasty (Bayer), was married to Amelia from the House of Oldenburg (1836). Their failure to produce an heir to the throne, eagerly expected by the people, contributed much to their abdication in 1862, as an additional factor at the general, opposition to their way of governing. The responsibility for the couples sterility became a matter of political controversies among their families, their countries and the other European thrones after the unsuccessful medical diagnoses and treatments of the most eminent Greek and German physicians. This paper examines their failure to continue the throne, the medical circumstances, and the historical and political consequences.

Lycanthropy in Byzantine times (AD 330-1453).

In this paper, the original Greek language texts of the Byzantine medical literature about lycanthropy are reviewed. The transformation of a human being into a wolf and the adoption of animal-like behaviour, which were already known from mythology and had been presented in the scientific works of ancient Greek and Roman physicians, were examined by six Byzantine physicians and explained as a type of melancholic depression or mania. In spite of the influence of Byzantine medicine, its rationality in the interpretation of lycanthropy was forgotten in medieval and Renaissance times when it was replaced by explanations based on demonic possession and witchcraft. More recently psychiatry has treated the phenomenon as a subject of medical inquiry and has again explained the condition in terms of mental disorder.

Methods of lithotripsy in ancient Greece and Byzantium.

PURPOSE: In this article we present the medical methods of lithotripsy applied by ancient Greek and Byzantine physicians, and their influence on the development of surgery after that time. MATERIALS AND METHODS: Study and analysis of the original texts of the Byzantine medical writers, written in Greek and containing the knowledge of the ancient Greek, Hellenistic and Roman periods, were performed. RESULTS: The Byzantine method of lithotripsy was the result of the eternal knowledge of the spasmolytic, analgesic and lithotriptic effect of various herbs, together with ancient surgical techniques of stone removal from Hellenistic and Roman periods. No operation was attempted for the extraction of stones from kidneys. Rather the idea was to drop the stones to the bladder or into the urethra, or dilute them into smaller pieces with various herbs. CONCLUSIONS: Ancient Greek and Byzantine physicians described conservative and surgical methods, derived from the texts of early surgeons, to which they added their own observations.

[Theories and cures of the rheumatic diseases during the byzantine period (330-1453 a.D.)]. / Teorie e trattamento delle malattie reumatiche nel periodo bizantino (330-1453 d.C.).

Most Byzantine medical texts described the rheumatic diseases. The Byzantine physicians, based on the ancient Greek texts, explained the causes of rheumatic diseases, described their symptoms and proposed certain treatments. The Byzantine medical sources described various types of rheumatic diseases, as inflammatory arthritis, chronic deformans polyarthritis, and gout. As it can be concluded by the available medical sources, during the Byzantine period rheumatic diseases constituted a serious medical and social problem, representing a remarkable cause of disability, and this complaint was part of the epidemiological interest of the Byzantine physicians.

Immunological treatment of superficial bladder carcinoma.

PURPOSE: To determine the effect of intravesical bacillus Calmette-Guerin (BCG) therapy in relation to recurrence of superficial bladder cancer after transurethral resection (TUR). PATIENTS AND METHODS: During the period 1996-2001 patients who underwent TUR were randomized to have adjuvant BCG treatment (intravesically and subcutaneously) (43 patients) or TUR alone (43 patients). Eighteen patients of the latter group were crossed-over to BCG group because of frequent recurrences. These 61 BCG-treated patients were the focus of this report. All of them presented with papillary noninvasive (stage Ta) or superficially invasive (stage T1) tumours (grades 2 and 3), with or without associated carcinoma in situ (Tis). RESULTS: A total of 19 (31%) patients remain free of tumor, 17 (28%) had superficial recurrences and 25 (41%) had disease progression, first identified as muscle invasion in 12, prostatic involvement in 8 and metastasis in 5. Most tumors recurred or progressed within the first 5 years. Of the 61 patients 33 (54%) are disease-free and with intact bladder, 13 (21%) are disease-free after cystectomy, 2 (3%) died of other causes, 1 (2%) is alive with metastasis and 12 (20%) died of metastatic urothelial cancer. CONCLUSION: BCG has been shown to be effective for prophylaxis against tumor recurrence and appears to be more useful in the treatment of patients with Tis. Intravesical BCG in conjunction with TUR may be effective in the treatment of patients with Tis involving the prostatic urethral mucosa. The mechanism by which BCG exerts its antitumor effect seems to be immunologically-mediated. Based upon our current data we believe the potential for long-term bladder preservation, progression-free and overall survival justifies the risk and cost of BCG therapy and frequent follow-up evaluations for most patients with superficial bladder cancer.

Measurements of nuclear size in collecting tubules of the kidney of rats during prolonged hypokinesia and ambulatory conditions.

Hypokinesia (decreased motor activity) induces significant morphological changes in the kidneys, but little is known about the effect of hypokinesia (HK) on the collecting duct nuclei of the kidney. The aim of this study was to measure the effect of prolonged HK on the nuclear size in the inner meduallary collecting ducts on the kidney of rats. Studies were done on one hundred ninety-two 13-week-old male rats (370 to 390 g) during 15 days pre HK period and 90 days HK period. Rats were equally divided into two groups: vivarium control rats (VCR) and hypokinetic rats (HKR). The HKR group kept in small individual cages. Nuclear size in renal collecting tubules, fluid excretion, sodium (Na) and potassium (K) in plasma and urine, plasma aldosterone (PA) and antidiuretic hormone (ADH) and body weight were measured. A significant (p < or = 0.01) increase in size of the collecting duct nuclei of the kidney, PA, plasma and urinary Na and K and fluid loss, and a significant (p < or = 0.01) decrease of body weight and plasma ADH observed in the HKR group when compared with the VCR. The measured parameters did not change significantly in the VCR group when compared with their baseline control values. It was concluded that prolonged HK induces a significant increase of the nuclear size in the inner meduallary collecting ducts of the kidney of hypokinetic rats when compared with the control rats.