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Árta, Greece

Pappas E.M.,University of Ioannina | Dounousi E.C.,University of Ioannina | Katopodis K.P.,General Hospital of Arta
Archives of Hellenic Medicine | Year: 2013

Metabolic acidosis (MA) is one of the main four disorders of acid-base balance. The pathophysiological mechanisms responsible for MA are exogenous administration or increased endogenous production of acids, decreased excretion of renal acids that are normally produced on daily basis, and increased renal loss of bicarbonates (HCO3 -). Apart from renal failure, diabetic ketoacidosis, rhabdomyolysis, etc., MA can also be observed during the administration of acids or acid precursors, such as sodium chloride (NaCl), ammonium chloride, bromide, valproic acid, acetate anion (through hemodialysis dialysate) and sulphuric acid, and during total parenteral nutrition (TPN). This review describes the main pathophysiological mechanisms of MA caused by the intravenous administration of NaCl and TPN. The understanding of the pathophysiological mechanisms responsible for the occurrence of MA in both cases is useful and increasingly necessary, considering the frequency of intravenous administration of these solutions in everyday clinical practice. © Athens Medical Society.

The process of involuntary psychiatric examination and/or hospitalization is a rare experience for the average modern man. As part of it, the citizen shall be subjected to a restriction of his freedom and forced hospitalization without himself having sought neither of the above situations.The rarity of this experience, assisted by the severity of the threat to individual freedom and dignity that leads to, impose the existence of a clear legal framework which will describe the permissive or non-implementation of procedures, the pious keeping on behalf of the stakeholders of these legal provisions and the operation of a reliable system of registration and control of these processes. In our country legal act nr.2071 for involuntary hospitalization in a psychiatric unit became the legal framework, which in 1992 was decided to be adopted, to describe the necessary conditions and requirements needed be fulfilled for the realization of involuntary examination and/or hospitalization in patients with mental illness, while respecting individual rights and freedoms. Although the replacement of previous relevant law with the adoption of this law was hailed by many sides, full implementation thereafter and, where applicable, "stumbled" because it never met with the full agreement of all parties involved. It is estimated that, in Greece, 40 to 50% of all hospitalizations taking place in public psychiatric units are involuntary hospitalizations. This percentage is extremely high, being nearly four times the European average. Therefore, it is now more than ever important to undertake initiatives towards re-testing the conditions under which the involuntary examination and/or treatment is realized in our country. The purpose of this short article is to present a case where the prosecutor and the psychiatrist disagreed on the interpretation of a paragraph of law nr. 2071/92 so the first to prosecute the second. Fortunately, the psychiatrist, who defended the view that only the judiciary has the power and authority to order involuntary hospitalization of a mentally ill patient, of course after the evidences based medical positive opinion of the psychiatrists, was acquitted by the court. In conclusion, we suggest that for the obscure points of interpretation of the law, professionals involved in its implementation (that is psychiatrists, prosecutors, police personnel etc.) must (a) adopt a spirit of conciliation and (b) establish measures and procedures that will allow continuous monitoring of the implementation of each case of involuntary examination and/or hospitalization.

Bilanakis N.,General Hospital of Arta | Kalampokis G.,University of Ioannina | Christou K.,University of Ioannina | Peritogiannis V.,University of Ioannina
International Journal of Social Psychiatry | Year: 2010

Background: Coercive physical measures are commonly used in psychiatric units throughout the world for the management of severe behaviourally disturbed patients. Aim: The aim of this study was to assess the rates of coercive physical measures (seclusion and restraint) used in psychiatric inpatients in the psychiatric unit of a general hospital in Greece. Methods: A retrospective chart review of all admissions to the psychiatric unit of the University General Hospital of loannina during a six-month period was conducted. Differences between patients who were subjected to coercion and patients who did not receive any coercive treatment were statistically analyzed and compared. Results: Of the total of 282 admissions during the study period, 31 (11.0%) cases had been subjected to some form of coercive physical measures: 9.55% and 1.76% were affected by seclusion and mechanical restraint, respectively (one patient had been subjected to both). The mean duration of any one seclusion and mechanical restraint was 64.9 hours and the mean number of seclusion and restraint per affected case was 3.58. Statistical analysis between the group subjected to coercive measures and the group who was not did not reveal any association with demographic data or diagnosis. Coercive measures were found to be associated only with the type of admission at intake. Conclusions: Involuntary admissions were associated with statistically significant higher levels of restraint and seclusion in this patient sample. Strategies that will enhance patients' follow-up are expected to prevent involuntary admissions and reduce the use of coercive measures. © 2010 The Author(s).

Pappas E.M.,University of Ioannina | Dounousi E.C.,University of Ioannina | Katopodis K.P.,General Hospital of Arta
Archives of Hellenic Medicine | Year: 2013

Rhabdomyolysis is defined as a syndrome which occurs after damage/breakdown (lysis) of skeletal muscle cells. The causes of rhabdomyolysis can be divided into natural and unnatural. Large quantities of breakdown products of damaged muscle cells, including proteins, especially myoglobin (Mb), phosphorus, potassium, uric acid, etc., are released into the bloodstream. These products may be harmful and are responsible for a number of clinical symptoms and disturbances in laboratory tests observed in rhabdomyolysis. Metabolic acidosis (MO), with an increased anion gap, is one of the main complications of rhabdomyolysis. The causes of MO are an increase in endogenous acid, hyperkalemia and acute renal failure (ARF). The latter is perhaps the most serious clinical consequence of rhabdomyolysis, the severity of which depends on the severity of the rhabdomyolysis. The main pathophysiological mechanisms responsible for ARF are renal vasoconstriction, tubular obstruction, the toxicity of Mb and lipid oxidation. © Athens Medical Society.

Pappa M.K.,General Hospital of Arta | Dounousi E.C.,University of Ioannina | Katopodis K.P.,General Hospital of Arta
Archives of Hellenic Medicine | Year: 2013

Diabetes mellitus (DM) is recognized as an epidemic in modern society. It is a syndrome characterized by impaired glucose metabolism, with either decreased or insufficient production of insulin, or increased resistance of the tissues to the action of insulin. The vascular complications of DM are classified as microvascular (diabetic retinopathy, nephropathy and neuropathy) and macrovascular (heart disease and hypertension, peripheral vascular disease and stroke). Diabetic nephropathy (DN) is a leading cause of chronic kidney disease (CKD) in both patients before initiation of dialysis (CKD stages II, III, IV), and those receiving dialysis (CKD stage V). Normochromic normocellular anemia is known to be a frequent complication of CKD, where the primary etiology is decreased production of erythropoietin by the kidney. The severity of anemia is proportional to the stage of CKD, but anemia may be observed before active renal involvement is apparent (i.e., proteinuria, impaired renal function). In addition, anemia in patients with DM and renal disease occurs earlier and in greater severity than in patients with CKD of the same stage but with a different primary renal disease. In addition to iron, vitamin B12 and folic acid deficiency, poor nutrition, secondary hyperparathyroidism, blood loss and malignancy may be involved in the pathogenesis of anemia in DM. Several other, less well known causes and interrelated mechanisms, such as ultrafiltration, proteinuria, chronic inflammation, damage of interstitial kidney tissue, autonomic neuropathy, the uremic toxins, the renin-angiotensin system, increased tubular sodium reabsorption and disorders of erythrocytes are also implicated in the pathogenetic process. This is an overview of the main mechanisms involved in the onset of anemia in these patients. © Athens Medical Society.

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