A simple score for early risk stratification in acute heart failure.

INTRODUCTION: The use of many acute heart failure (AHF) risk scores is cumbersome. We therefore developed a simple AHF risk score (AHFRS) for early risk stratification. METHODS: The study consisted of a prospective derivation cohort (PDC; N=104; age, 77[21] years; LVEF (%), 35[29]) and a retrospective validation cohort (RVC; N=141; age, 76[15] years; LVEF (%), 35[25]). Clinical, echocardiography and laboratory assessment was performed at admission. The study end-point was death from any cause or HF-rehospitalization at 1year. RESULTS: In the PDC 46 (44.2%) patients experienced the end-point. Independent prognostic factors of outcome were hypertension (HTN) history, myocardial infarction (MI) history, and admission red cell distribution width (RDW). Multivariate logistic regression indicated 8-, 4-, and 3-times higher odds ratio for development of study end-point in patients without a HTN history, with MI history, and RDW≥15% (median) respectively. Thus in AHFRS, 2 points were assigned for absence of HTN history, 1 point for presence of MI history, and 1 point for RDW values ≥15% (0 best possible, whereas 4 worst possible score). The AHFRS identified patients who developed the end-point in the PDC with an area under the ROC curve (AUC) of 0.80 [95% C.I.: (0.71, 0.87)] denoting a high discriminative ability. These findings were confirmed in the RVC, in which the endpoint occurred in 52 (36.9%) patients and the AUC for the AHFRS was 0.82 [95% C.I.: (0.73, 0.89)]. CONCLUSIONS: AHFRS is easily obtained at admission and accurately risk stratifies AHF patients.

Spontaneous intracranial hypotension: clinical and neuroimaging findings in six cases with literature review.

Spontaneous intracranial hypotension (SIH) is an uncommon but increasingly recognized syndrome. Orthostatic headache with typical findings on magnetic resonance imaging (MRI) are the key to diagnosis. Delayed diagnosis of this condition may subject patients to unnecessary procedures and prolong morbidity. We describe six patients with SIH and outline the important clinical and neuroimaging findings. They were all relatively young, 20-54 years old, with clearly orthostatic headache, minimal neurological signs (only abducent nerve paresis in two) and diffuse pachymeningeal gadolinium enhancement on brain MRI, while two of them presented subdural hygromas. Spinal MRI was helpful in detecting a cervical cerebrospinal fluid leak in three patients and dilatation of the vertebral venous plexus with extradural fluid collection in another. Conservative management resulted in rapid resolution of symptoms in five patients (10 days-3 weeks) and in one who developed cerebral venous sinus thrombosis, the condition resolved in 2 months. However, this rapid clinical improvement was not accompanied by an analogous regression of the brain MR findings that persisted on a longer follow-up. Along with recent literature data, our patients further point out that SIH, to be correctly diagnosed, necessitates increased alertness by the attending physician, in the evaluation of headaches.

Perspectives for integrated municipal solid waste management in Thessaloniki, Greece.

Local authorities need updated and reliable data on the quantity and the quality of the waste generated in their area, in order to establish an integrated solid waste management system capable of fulfilling regional and national waste management targets. This paper presents information about the quantity and the characteristics of the municipal solid waste generated in Thessaloniki, which is the second largest city in Greece. It is based on the results of three research programs investigating the evolution of municipal solid waste. The investigations were carried out over the last 20 years at the landfill of Thessaloniki by the same research group using statistically acceptable practices for sampling and hand sorting. The results show a great increase in the incoming quantities during the last years and a significant increase of the per capita generation. There is also a significant change in the composition, demonstrated mainly by a decrease in the organic fraction followed by an increase of packaging materials (paper and plastic).

Cervix cancer screening among Greek and immigrant women: the experience of a Greek District Hospital.

PURPOSE: To explore whether there are differences in Papanicolaou (Pap) smear screening between native and immigrant women that attended our outpatient clinic. METHODS: In this retrospective study, from January 2002 until December 2003 we examined age, nationality, marital status, economic status (self-reported family income per year) and previous Pap test screening frequency; 3,316 women were included in the study. RESULTS: The average age was 41.95 years. The majority of the women who had had a Pap test (58.4%) were Greeks and 41.6% immigrants. Regarding marital status a percentage of 61.2% were married, 13.7% were single and 24.9% were divorced. Regarding economic status 71.0% of the women had a low-income, 25.1% a middle-income and 3.8% a high-income. Of the women 24.99% had never had a Pap test in their lives. DISCUSSION/CONCLUSION: The possibility of having easy access to a clinic and to routine health care has a critical influence on the cancer screening habits of immigrant women. Opportunistic Pap smear screening as part of a pregnancy or family-planning checkup in local clinics is an acceptable strategy for poor immigrant women.

A process model basis for evolving hospital information systems.

Hospitals often invest significant resources in the development of large and complex information systems that must be modified and extended to respond to changing requirements and to exploit the capabilities offered by modern technologies. A disciplined approach of managing the evolution of hospital information systems is then required so that to meet the increasing demands for effective and efficient use of scarce resources. This paper takes a process oriented view of the hospital and presents an approach based on hospital process modeling which aims at assessing the current status of computer support within a hospital and at identifying new opportunities for automation. The approach is illustrated by an example taken from a major Greek hospital.

Amoxicillin and clavulanic acid combination: clinical and laboratory evaluation in pulmonary infections.

Twenty-four patients with pulmonary infections (7 pneumoniae, 17 exacerbations of chronic bronchitis) were treated with a combination of 250 mg of amoxicillin and 125 mg of clavulanic acid supplemented by 500 mg of amoxicillin every eight hours. All patients showed good clinical, roentgenological, and bacteriological response. Bacteria were cleared from sputum by the third day of treatment in half of the patients and by the end of treatment in all but one of the others. Pathogens eradicated from sputum, with concurrent clinical cure, included gram-negative bacteria producing cephalosporinases shown to be resistant to the combination drug by both disk and minimal inhibitory concentration determinations.