Quarterly scientific journal

Rostrum of Asclepius Vol 21, No. 1 (2022): January - March 2022

Vima AsklipiouRostrum of Asclepius Vol 21, No. 1 (2022): January - March 2022


Health care of other cultures – Cultural sensitivity | 1-2

Michael Kourakos


Clinical characteristics, risk factors and diagnostic methods of urinary tract infection: A literature review | 3-16

Vasileios Triantafyllou , Christos Triantafyllou , Maria Kallergi



Introduction: Urinary tract infection is the infection with the highest incidence per year. The frequency of its occurrence depends on gender and age, while the clinical situation of patients varies.

Aim: To present the clinical features, risk factors and diagnostic methods of urinary tract infection in children aged from 3 months to 5 years, as well as in adult males and females.

Materials and Methodology: A literature review of studies published in English language, from 01/01/2008 to 30/05/2019 in PubMed and Scopus databases was conducted, with the following key-words: “UTI”, “urinary tract infection”, “diagnostic method*”, “woman”, “man”, “children”, “dipstick”, “detection”, “home test” and “detection devices”. Exclusion criteria were animal studies, language expect for English and type of article (letter to publisher, editorial article and case study).

Results: Of all published studies, 28 met the inclusion criteria. The results showed that the clinical characteristics and risk factors depend on the patient's gender, age and clinical situation. Typical diagnostic methods are dipstick tests, urine culture and microscopy. Additional methods are flow cytometry, polymerase chain reaction (PCR) and in situ hybridization fluorescence.

Conclusions: Urinary tract infection is a worldwide problem on a yearly basis and should be promptly and correctly diagnosed in order to avoid unnecessary use of antibiotics.

Keywords: Urinary tract infection, diagnostic, methods, clinical characteristics, risk factors

Special Article

Environmental health management system. Requirements of ISO 14000 standard in Livadia General Hospital | 17-23

Elpiniki Biskanaki



The Environmental Management System focuses on recognizing the environmental  impact of any Organization in order to manage those impacts and ultimately to improve the Organization's performance in this area. Hospitals are predominantly Organizations with a strong environmental footprint, as significant amounts of material resources are spent on the production and delivery of services, and at the same time large quantities of waste are generated.

In this case, therefore, the standard focuses on the management of hazardous medical waste, their separation and recycling or re-use, where possible, reducing energy consumption and waste of resources, ensuring the quality of drinking water and the use of environmentally friendly materials.

In order to implement these good and efficient practices, it is essential to train staff and to engage in eco-conscious leadership.

Keywords: Environmental health, environmental management system, ISO 14001, Livadia General Hospital

Original Paper

The effect of consumption of legumes and cereals on the immune system, in the "era" of COVID-19: online epidemiological research in a sample of the Greek population | 24-33

Iliana Zamplakou , Demosthenes Panagiotakos



Background: Legumes and cereal are unappreciated food groups, when it comes to the defense of the public’s health. The aim of this study was to briefly review the role of the consumption of legumes and cereal on the enhancement of the immune system, as well as to investigate possible changes in their consumption during the COVID-19 pandemic.

Methods: An online, epidemiological study conducted in December 2020, by completing anonymous questionnaires. 2135 men and women, over 17 years old participated from all over Greece.

Results: 25% (n=531) of individuals stated that they increased the consumption of legumes and cereals during the COVID-19 pandemic, 12,54% (n= 265) decreased the consumption and 62,46% (n=1318) did not make any alterations in their habits. The 36,35% (n=776) of individuals stated that they improved their eating habits towards the healthiest. The 40,28% of those who stated an improvement in their diet, also stated that they increased their consumption of legumes and cereal (p<0,001). Data analysis showed no correlation between the change in the consumption of legumes and cereal and the infection of SARS-CoV-2 (COVID-19) (p=0,909).

Conclusions: The fact that just one third of the participants stated that they improved their nutritional habits, is both encouraging and disappointing. Encouraging due to the fact that some took this opportunity to improve their diet, and possibly to further been protected from severely infected, but disappointing as that percentage is not as high as one would expect.

Keywords: Nutritional habits, legumes, cereal, COVID-19, epidemiological study

Ιnvestigation of nurses’ perceptions regarding diversity in the health area | 34-55

Paschalis Tasoudis , Stefanos Digonis



Background: As nursing continues to promote healthcare in the 21st century, the current shift in demographics, combined with diversity in healthcare and continuing inequalities, will require our continued attention and action.

Aim: Measuring the diversity of nurses in the work environment based on three fundamental axes (origin, gender, sexual orientation) and how these dimensions can adversely affect patient health as well as staff relationships.

Material and Method: The sample (N=106) consisted of nurses working in clinics, care units and public and private health centers, while a research tool was a non-standard questionnaire according to the needs of the study with influences from the English version of the Transcultural Self-Efficacy Tool (TSET).

Results: The research questions were answered by men where they constituted 17.9% of the respondents while women by 82.1%. 45.3% of the respondents stated that in the hospital / clinic where they work, the differences in ethnicity are supported, followed by disability with a percentage of 29.2% and gender (17.9%), while sexual orientation is the least supported difference with a percentage of 7.5 %. Also, 58.5% of the respondents stated that they have never felt criticized because of their gender, while 25.5% answered that this has happened. At the same time, 92.5% of them stated that equal opportunities should be given between the sexes in the workplace. When asked about collaboration, 89.6% of respondents said they do not feel embarrassed about working with people of different backgrounds than their own. Regarding sexual orientation, 80.2% stated that their sexuality does not affect to any extent his daily life as a health professional. Finally, the internal consistency coefficient of Cronbach's alpha questionnaires was 0.859.

Conclusions: Diversity brings new ideas and experiences and people can learn from each other. Attracting different ideas and perspectives leads to better problem solving, opens dialogue and promotes creativity. This increased need to enhance diversity in nursing is not new to the profession. The value of diversity also applies to our culture.

Keywords: Diversity, nurses, equality, healthcare, workplace

The influence of determinants of the knowledge for the hypertension in the community | 56-72

Evgenia Karathanasi , Anna Kavga , Ourania Govina , Eugenia Vlachou , Ioannis Kalemikerakis



Background: Hypertension is one of the greatest challenges of our times and knowledge regarding hypertension could help to prevent and treat this disease. Several factors mediate and affect individuals’ knowledge regarding hypertension, especially demographic characteristics and medical history.

Aim: To investigate the level of knowledge regarding hypertension and the mediators affecting the knowledge regarding hypertension among individuals in the community.

Methods: A cross-sectional study with a convenience sample of 230 people was conducted in the Health Centers of the First Regional District of Attica. We used the Hypertension Knowledge-Level Scale (HK-LS) to measure knowledge regarding hypertension which takes value 22 as maximum. We investigated as possible mediators of knowledge the following characteristics: gender, age, family status, educational level, job, assurance, personal and family medical history, pressure measurement, and financial status. Data analysis was performed with SPSS v.25.

Results: Mean knowledge score was 17.60±2.49. Bivariate analysis showed that, on a large scale, those with a family history of hypertension (p <0.001), a family history of cardiovascular disease (p = 0.04) and those who were graduates of higher education (p <0.001) had higher scores. Multiple linear regression showed that family history of hypertension and higher education predict a statistically significant overall score. In contrast, irregular blood pressure measurement is a predictor of a negative score. The model seemed to explain 15% of the total variability (R2 = 0.15, p = 0.007).

Conclusions: The level of knowledge concerning hypertension was quite high. According to our results, those with low educational level, without family history of hypertension and cardiovascular diseases and the older ones had less knowledge about hypertension. For that reason, educational programs should be focused on increasing the knowledge of individuals belonging to the abovementioned groups.

Keywords: Hypertension, knowledge, intermediary factors, community

Factors associated with delayed hospital arrival among patients with acute myocardial infarction | 73-89

Anisa Kozmai , Georgios Vasilopoulos , Georgia Toylia , Antonia Kalogianni



Introduction: Cardiovascular diseases are the main cause of mortality and morbidity worldwide. Prehospital delay is the most significant obstacle for effective AMI management despite efforts in public and patients’ education.

Aim: The purpose of this study was to identify the sociodemographic, personal and clinical predictors of prehospital delay in care seeking among patients with AMI.

Methods: A cross sectional study among 119 AMI patients was carried out during a three months’ period in two large hospitals in Athens. Data were recorded by a face to face interview. The patients were analyzed in two groups according to symptoms onset -to-door time ( short delay time group < 2 hours vs long delay group > 2 hours ).

Results: The median delay time was 4 hours and 41 minutes and only 17,8% (n21) of patients were admitted to hospital within the first 2 hours of symptoms onset. The main factors that were found to be correlated with longer prehospital delay (>2hours), were the long distance more than 10km away from the hospital (p=<0.001), The absence of company during the incident (p= 0.003), and not living in Athens (p= 0.049). Having high level education, more than 9 years (p= 0.008), arrival by ambulance (p= 0.001), family history of coronary artery disease (0.015) and self-perceived cardiac symptoms (p= 0.025) were associated with shorter prehospital delay. In multivariate logistic regression analysis, distance from hospital (b 0.301, p 0.044), smoking (b 3.135, p 0.048) and family history heart disease (b 3.782, p 0, 021) were independent predictors of prolonged prehospital delay.

Conclusions: The delay time from symptoms onset to hospital admission was high in patients with AMI. Factors such as distance from the hospital, negative family history and absence of smoking are associated with prehospital delay.

Keywords: Acute myocardial infarction, prehospital delay, treatment delay, symptoms onset

Systematic Review

Topical agents and dressings in care of burns | 90-107

Dimitrios Arikas , Georgios Vasilopoulos , Antonia Kalogianni , Ioannis Kalemikerakis



Introduction: Topical antimicrobial agents and dressings for the burn wounds, aim to protect the wound surface, maintain a moist environment, enhance wound healing and prevent wound progression, minimize the patient's discomfort.

Aim: The review of the literature to investigate the effectiveness of local agents and dressings,on healing and infectionsof burns.

Method: The literature was searched in the PUBMED database with the terms (burn) AND (topical therapy OR topical agents OR topical antiseptics). The search involved randomized clinical trials over a decade and included a total of 11 studies.

Results: Aquacel® Ag dressings, honey dressings, Vaseline gel, Ectoderm cream and Aloe Vera gel were associated with a shorter healing time and/ or shorter re-epithelialization of the burn wound compared to other dressings or cream silver sulfadiazine. Also, Moist Exposed Burn Ointment, Fifing Aurelian Burn Ointment, rhyme-CSF hydrogen and topical treatment with heparin have been found to be effective in healing burns. In radiation burns found, topical honey pentoxifylline has been found to be associated with faster healing, less pain and improved mobility versus usual treatment. Factors associated with a significantly lower incidence of burn infections than the control group were honey, hydrogen GM-CSF and Ectoderm.

Conclusions: Although silver sulfadiazine is the gold standard in the treatment of second-degree burns, it seems that there are other factors that have been shown to be effective and are associated with promoting re-epithelialization and healing and protecting against infections by increasing treatment options.

Keywords: Βurn, topical agents, topical antiseptics, topical therapy

Anxiety, depression, social isolation and quality of life in patients with diabetic foot syndrome: A systematic review | 108-129

Eirini Petidou , Ioannis Kalemikerakis , Eugenia Vlachou , Georgia Fasoi



Introduction: Diabetes mellitus is a chronic disease associated with serious complications such as diabetic foot syndrome. The main purpose of this study was to investigate the relationship between the existence of diabetic foot syndrome and the social life of patients, their quality of life and stress / depression.

Methodology: The systematic review was considered as the most appropriate type for the answer of the set goals. For its implementation, a thorough search was conducted in the Pubmed and Google Scholar databases, using specific keywords: "diabetic foot", "social isolation", "anxiety", "depression" in all possible combinations. The selected papers were published in English, and should have been published after 2015, and all surveys and meta-analyzes were rejected. Of the 689 surveys that met the initial criteria, only 11 were used.

Results: 4 studies were found and analyzed related to social isolation, 4 related to quality of life, and 3 related to stress and depression. Patients with diabetes develop numerous serious complications due to their disease. Also, people with higher levels of social isolation are significantly more likely to develop foot ulcers, while ulcer development and social isolation are associated with a higher mortality rate, especially among patients with type 2 diabetes.

Conclusions: Diabetic foot syndrome is a serious complication of diabetes with impending low quality of life, increased levels of anxiety and depression, and increased long-term mortality. At the same time, social isolation seems to be an independent predictor of long-term mortality and diabetic foot syndrome.

Keywords: Diabetic foot, social isolation, anxiety, depression, quality of life

Heterogeneity in sepsis: Subtypes of sepsis - Systematic review | 130-163

Ioannis Mitrou , Antonia Koutsoukou , NIkoletta Rovina , Ioannnis Vasileiadis



Introduction: It is widely known that the high heterogeneity in sepsis is an obstacle to the research efforts, causing great confusion in the medical community concerning the results interpretation. This is why it is of outstanding significance to categorize sepsis into subtypes (of patients) which share the same characteristics.

The purpose of this article was to provide a systematic review of subcategories of patients with sepsis, which are highlighted in the literature as subtypes, subcategories, subgroups and endotypes in order to see if this categorization improves the final outcome in sepsis.

Methods: A research at the MEDLINE (Pubmed) database was made using all the possible combinations of the word sepsis with the words subtypes, subphenotypes, phenotypes, subclasses, subgroups, clusters and endotypes.

Results: The research yielded 13 articles, 9 out of which were about subtypes of sepsis based on clinical and laboratory variables and 4 referred to sepsis subtypes through genomic and transcriptomic analysis.

Conclusions: Sepsis is characterized by great diversity, so the research is oriented to sub-classify the disease in subtypes. The aim of the subclassification is to have a greater understanding of the pathophysiology of the disease and recommend more targeted therapies.

Keywords: sepsis, heterogeneity, subtypes, endotypes

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