Rostrum of Asclepius Vol 19, No. 3 (2020): July - September 2020

Introduction: Cardiovascular disease (CVD) is the main cause of mortality worldwide and an important public health issue with a serious social and economic impact. Cardiovascular risk assessment models (long and short term) have been developed since 1950, which are based on the examination of various risk factors. Aim: To present indicative models of cardiovascular risk, to compare and apply them in clinical practice. Methodology: A review of the literature was performed on the databases of Google Scholar, Scopus, Science Direct, and PubMed. The search was done in a simple, complex and combined way to identify studies and tools for cardiovascular risk assessment. Results: The review resulted in 24 models of cardiovascular risk assessment. CVDs are a consequence of multiple risk factors. More than 80% of patients with established CVD have a history of at least one of the major modifiable risk factors: smoking, hypertension, and dyslipidemia. The best risk assessment tools are those that provide total cardiovascular risk and allow professionals to manage them accordingly. Conclusions: The use of these algorithms can form the basis for developing modern strategies for predicting cardiovascular disease and therefore early diagnosis and treatment in clinical practice.

Keywords: Risk, risk assessment, cardiovascular disease, model, algorithm

Even today, myocarditis remains a disease that often occurs in young and middle-aged people, but unfortunately its diagnosis is difficult to confirm. Diagnosis of viral myocarditis is a challenge as the diagnostic tools used until recently lacked high sensitivity and specialty. Proper history, detailed clinical examination, hematological and serological examinations, electrocardiogram and imaging tests including echocardiogram and cardiac magnetic resonance have so far helped to diagnose patients with potential myocarditis. Nevertheless, the introduction of new immunohistological and molecular techniques in the diagnostic approach of patients with possible myocarditis helps significantly not only in the precise diagnosis but also in the setting of a treatment plan based on the exact etiology of myocarditis. However, endomyocardial biopsy and the application of the above techniques require a high degree of specialization and experience. Important questions remain, in particular, about which patients and to what extent will be benefit from immunosuppressive therapy. Also, more research is needed in the field of targeted treatment of viral myocarditis. It is clear that in order to achieve effective treatment of myocarditis, medical science needs to fully analyze and understand the pathophysiological pathways activated in the course of a myocarditis.

Keywords: Myocarditis, virus, endomyocardial biopsy

The rise of social media created by Internet users and hosted by popular sites such as Facebook, Twitter, YouTube and Wikipedia, and blogs - has brought several new risks to medical professionalism. First, many doctors may find it fascinating, in specific contexts, to apply principles of medical professionalism to the internet environment. Secondly, doctors may not consider the possible impact of their online content on their patients and the public. Thirdly, an instant lag in the judgment of an individual doctor to create non-professional online content may inappropriately reflect the entire profession. To overcome these challenges, individual doctors are encouraged to realize that as they "walk" through the Web, they leave behind a "footprint" that can have undesirable negative consequences for them and the profession in general. It also recommends that institutions adopt an active approach to attracting social media users to establish consensus standards for the 'internet professional'. Finally, since professionalism involves more than avoiding negative behaviors, examples of more positive applications for this technology are presented. Like a mirror, social media can reflect the best and worst aspects of the content that has been put before it so that everyone can see it.

Keywords: Professionalism, internet use, medical ethics, health policy

Financial crisis in Greece has brought many changes in health care, not only in population level but also in financial level. There have been investigated the changes in the Greek citizens’ health level, by the presentation of the changes in values of the healthy life indicator in the last decade. It is presented a significant decline, in contrast with the equivalent indicator in Sweden and the European average where it is presented a rapid rise. In financial level, the adjustment programme which has been applied resulted the recession of Greek economy and the consequent reduction of public funding in health, the support of private expenditure so as the rise of the indicator of the citizens’ unmet needs for health care. The use of generic drugs constitutes a mean of saving health resources. However, its pervasiveness in Greece is presented low, in contrast with the other European countries. It occurs that there have been many changes in the health field of our country the last decade, with consequences in citizens, especially the socioeconomic sensitive groups. The question that is been raised is how the meta- memorandum policies will manage to reverse the current data so as our country will succeed to return to growth rates and development.

Keywords: Financial crisis, healthy life years, health expenditure, unmet needs generic drugs

Introduction: The identification of occult sources of infection is of paramount importance to improve the outcomes of patients with sepsis. Aim: The investigation of the clinical impact of computed tomography (CT) scans in patients with sepsis of unknown origin. Methods: A systematic review of studies published up to December 2016 in PubMed and Scopus databases was conducted, with the following key-words: “'sepsis”, “severe sepsis”, “septic shock”, “unknown origin”, “computed tomography” and “CT”. The keywords were searched in the title and abstract of the studies, while the filters "human" and "English language" were used. The inclusion criteria in this review were: studies should concern patients sepsis or severe sepsis or septic shock of unknown origin, as well as patients having undergone CT or positron emission tomography (PET/CT). Results: Of the published studies, 5 met the inclusion criteria. The results of the studies showed that in all of the 75 and 89 patients underwent PET/CT and CT, true positive findings showed in 50 (66.66%) and in 29 (35%) patients, respectively, while in 23 out of 50 (46%) and in all of the 29 (100%) patients, findings led to the selection of the appropriate therapeutic intervention or led to a change in the initial chosen treatment. Conclusions: CT and PET/CT are valuable tools in identifying occult sources of infection in patients with sepsis or severe sepsis or septic shock, contributing to the selection of the appropriate therapeutic intervention and leading to higher rates of survival.

Keywords: Computed Tomography, sepsis, unknown origin