West Nile virus is an RNA virus, member of the Japanese encephalitis serogroup of the genus Flavivirus, family Flaviviridae. First isolated in 1937, the virus has re-emerged after giving several outbreaks after the 1990 both in Europe and North America. Though severe neurological infection is only 1% of the total cases, mortality can reach 14% after CNS involvement. The present case report describes a case of WNV encephalitis with concomitant acute flaccid paralysis. Continue reading
Coronaviruses are a large family of viruses that cause illnesses ranging from the common cold to more severe diseases. SARS-CoV-2 is a new virus that has not been previously identified in humans. Patients with SARS-CoV-2 commonly develop acute respiratory distress syndrome (ARDS), myocardial injury, ventricular arrhythmias, and shock, all of which increase their risk of cardiac arrest. The main objective of this brief review is to raise the discussion on the possible indication of cardiopulmonary resuscitation in a patient with SARS-CoV-2 in prone position as a way to save time, since the entire process of decubitus change is complex and often slow, due to the number of devices used in these patients, such as catheters, infusion pumps and monitors. In addition to a price of high demand for stressed human resources. Continue reading
COVID-19 pandemic has created an unprecedented citation for the healthcare system; such that its effects are now started to become obvious. The main aim of this report is to describe the time trends of utilization of prehospital emergency medical system in a region of northern Greece from first confirmed case of the COVID-19 in the country, at 26/02/2020, till the first order for loosing lockdown at 04/05/2020. Use of data retrospectively collected for PEMS usage, in the regional unit of Thessaloniki, Northern Greece 26/02/2020, till the first order for loosing lockdown at 04/05/2020. The area of interest represents a little more than 10% of the total population of Greece. Daily cases of selected categories (suicides, assaults, animal bites, cardiac arrests, and car accidents) were recorded. Comparison with the daily cases in the previous 2 years (2019,2018), for the same period was performed. Continue reading
Intravesical bacillus Calmette-Guerin (BCG) therapy, recommended for superficial bladder tumors, triggers side effects in fewer than 5% of patients. Yet, when encountered, high level of suspition and early detection is essential for their succesfull management. In the present article, we present a case of severe sepsis and Steven Johnson syndrome in a male patient after intravesical BCG instillation. Intravesical instillation of Bacillus Calmette-Guérin (BCG) is frequently used as the treatment of choice for carcinoma in situ and non-invasive high-grade superficial tumor of the urinary bladder1. BCG is a live attenuated strain of Mycobacterium bovis and is the most widely used intravesical agent2. Adverse events occur in fewer than 5 % of cases, ranging from mild local symptoms to severe sepsis and death1-3. In the present article, we report a case of successful management of septic shock with concomitant Steven Johnson syndrome after intravesical BCG instillation and perform a short review of the relevant literature. Continue reading
Major disasters have always occurred, but their increasing frequency over the last years has raised the importance of disaster medicine. Knowledge visualisation techniques, such as bibliometric maps, along with expert judgement, can help us identify the “blind spots” and eventually better prepare for such catastrophic events. Continue reading
Though metformin is considered as first choice drug in type II diabetes, clinicians should be alert both for presence of potential contraindications to its use and to possible adverse reactions. Bad therapy compliance along and/or concomitant comorbidities may lead to serious toxicity. We hereby describe a case of extreme lactic acidosis- associated with metformin therapy- in an elder woman, managed with Continuous Renal Replacement Therapy in Intensive Care Unit environment. Short review of the literature about the place of renal replacement therapy in such cases is also discussed. Continue reading

We present a case report concerning fatal bacteremia caused by Pantoeaagglomerans in a critically ill patient.

Pantoea is a genus of Enterobacteriacae Gram-negative bacteria family that includes at least 20 species; mostly isolated in the ecological niches.

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The electrical properties of the skin, also known as electrodermal activity (EDA), are considered as an indirect measure of autonomous nervous system. Along with that, the effects of noise-induced stress in intensive care units, is well explored. This study explores the noise-induced acute electrodermal activity changes in adult critical care patients and to compare these changes with cardiovascular effects of the same stress (noise) stimulus. Skin conductance variability, noise level, selected hemodynamic and respiratory parameters were monitored during 4 hour routine daytime intensive care nursing and treatment in an adult Intensive Care Unit. Average ambient noise levels during the time window (4 min) before the stimulation were 54.33(2.65) dB for Group A and 55.65(3.31) dB, while the noise stimulation was on average for Group A 70.8 (1.98) dB, and for Group B: 71.31(3.31) dB. EDA changes to noise stimulus were more distinct than hemodynamic and respiratory parameters. Yet, a weak relation was found between all EDA parameters and the particular noise level changes. Noise-induce stress causes more distinct EDA changes when measured immediately post stimulus. In addition, sedation level seems to affect the intensity of these changes. However, further studies are needed in to order to reach a definite conclusion. Continue reading

This is the first study in Greece that aims prehospital care by Emergency Medical Services staff and the factors that affecting it. In a prospective 5 month survey study , 13 EMTs recorded data (45 variables) about 1450 cases;1010 of which were included for further analysis. Six (6%) of the cases were characterized as super-emergencies, 46% non-emergent and 35% as emergent. Fourty five (45%) of the cases were recorded in the 15.00-23.00 shift. Geographical distribution of the calls is very different from the pre-located ambulance bases and varies with the type (non-urgent/ urgent) of the call. In 152 the characterization of the call was changed after arrival on the spot.

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