10 research outputs found
Greek economic crisis: An understandable approach
No full textΔιπλωματική εργασία, η οποία εκπονήθηκε στην σχολή Μηχανικών Παραγωγής και Διοίκησης του Πολυτεχνείου Κρήτης, ως προαπαιτούμενο ολοκλήρωσης σπουδώνΠερίληψη: Η οικονομική κρίση που διήνυσε η Ελλάδα την τελευταία και πλέον δεκαετία, επηρέασε το σύνολο των Ελλήνων, συνεχίζει να επηρεάζει την καθημερινότητά τους μέχρι σήμερα και, αναμφίβολα, αποτελεί ένα ιδιαίτερα φορτισμένο ζήτημα. Στην παρούσα, λοιπόν, εργασία θα επιχειρηθεί μία κατανοητή ανάλυση των πραγματικών οικονομικών δεδομένων, που οδήγησαν στην κρίση και τον τρόπο με τον οποίο έγινε η προσπάθεια να αντιμετωπιστεί. Στην εργασία που ακολουθεί θα αναφερθούν τα οικονομικά δεδομένα και γεγονότα, δίχως πολιτικές ή ιδεολογικές αναφορές. Σαφώς, οικονομία και πολιτική είναι άρρηκτα συνδεδεμένες, ωστόσο, δε θα γίνει καμία προσπάθεια πολιτικής τοποθέτησης. Κάθε τέτοια αναφορά θα εξυπηρετεί αποκλειστικά σκοπούς οικονομικής ανάλυσης. Το αντίστοιχο, θα λάβει χώρα και όσον αφορά στις προσωπικές απόψεις του συγγραφέα, οι οποίες θα απουσιάζουν κατά το δυνατόν. Ο αναγνώστης, λοιπόν, δύναται από την ανάλυση αυτή, να δημιουργήσει τα δικά του συμπεράσματα.
Αρχικά, λοιπόν, παρουσιάζονται τα αίτια που οδήγησαν στην κρίση χρέους για την Ελλάδα. Ειδικότερα, γίνεται μία ανάλυση των δημοσιονομικών μεγεθών και ακολουθεί η διαχρονική ανάλυσή τους για 50 έτη πριν από την ένταξη της Ελλάδας στο πρόγραμμα των μνημονίων, με τα συμπεράσματα που προκύπτουν από αυτή.
Στη συνέχεια, πραγματεύεται η ένταξη της Ελλάδας στο πρόγραμμα του 1ου μνημονίου. Εξηγείται, πως η παγκόσμια χρηματοπιστωτική κρίση επηρέασε την βιωσιμότητα του ελληνικού χρέους και οδήγησε σε κατάσταση επικείμενης χρεοκοπίας. Ακολουθεί, η περίοδος κατά την οποία η Ελλάδα ζήτησε επισήμως την συνδρομή του Διεθνούς Νομισματικού Ταμείου και των Ευρωπαίων Εταίρων, καθώς και τα προγράμματα που έλαβαν χώρα ως 1ο μνημόνιο. Εξηγούνται τα αποτελέσματα αυτού, οι πραγματικοί του στόχοι και εξάγονται τα αναγκαία συμπεράσματα.
Ακολούθως, εξετάζεται η ένταξη της Ελλάδος στο 2ο μνημόνιο. Για την κατανόηση του προγράμματος αυτού, παρουσιάζονται κάποιες απαραίτητες γνώσεις όπως η ανακοίνωση του Deauville και η συνθήκη του Μάαστριχ. Στη συνέχεια, περιγράφεται το κούρεμα του ελληνικού χρέους, γνωστό ως PSI, για το χρέος προς τους ιδιώτες, τις ελληνικές τράπεζες και τα ασφαλιστικά ταμεία. Παρουσιάζεται ο απολογισμός του προγράμματος, καθώς καιτο υποπρόγραμμα που έλαβε χώρα λίγο αργότερα. Αναλύονται τα αποτελέσματα του προγράμματος για την Ελλάδα και ακολουθούν τα συμπεράσματα.
Αργότερα, παρουσιάζονται κάποιες θεμελιώδεις διαπιστώσεις, ώστε να πραγματοποιηθεί η σύνδεση μεταξύ του προηγούμενου και του επόμενου κεφαλαίου, το οποίο περιλαμβάνει την διαπραγμάτευση του 2015. Για την επίτευξη του σκοπού αυτού, αναλύεται η πορεία στην οποία είχε εισέλθει η Ελλάδα και η μεταχείριση της από την Ευρώπη, μαζί με τα αποτελέσματα αυτής. Εν συνεχεία, εξηγείται η ενδεδειγμένη λύση, με βάση τη διεθνή εμπειρία. Πρόσθετα, αναγνωρίζονται οι ευθύνες της Ελλάδας που οδήγησαν στην οικονομική δεινότητα. Στο σημείο αυτό, αναγκαία θεωρείται η αναφορά στην κερδοσκοπία των θεσμών έναντι της χώρας, καθώς και το κλίμα ρήξης που είχε δημιουργηθεί.
Το τελευταίο τμήμα της εργασίας ξεκινά με αναφορές στην περίοδο πριν την διαπραγμάτευση του 2015. Ακολουθεί, η ίδια η διαπραγμάτευση και οι βάσεις αυτής για την ελληνική πλευρά. Αργότερα, γίνεται μία σύντομη αναφορά στο δημοψήφισμα, τα capital controls και, εν τέλει, την συνθηκολόγηση. Αποτέλεσμα αυτής, αποτέλεσε το 3o μνημόνιο. Ακολουθούν οι υποχρεώσεις και οι απολαβές από αυτό. Τέλος, επιχειρείται μία προσέγγιση του κόστους της διαπραγμάτευσης αυτής για τη χώρα.
Η εργασία αυτή, ολοκληρώνεται παρουσιάζοντας τα γενικότερα συμπεράσματα για την Ελλάδα σε επίπεδο αριθμών, αλλά και σε κοινωνικό επίπεδο.Summarization: The economic crisis that Greece went through over the last decade, has affected all Greeks, continues to affect their daily lives to these days and, without a doubt, is a particularly emotional issue. In the present paperwork, a comprehensible analysis of the real economic data, which led to the crisis and the way in which the attempt was made to deal with it, will be attempted. The following analysis will refer to economic data and facts, without political or ideological references. Clearly, economics and politics are inextricably linked, however, no attempt will be made for a political position. Any report of this kind will serve the purposes of economic analysis. The same will take place in relation to the personal views of the author, which will be absent as possible. The reader, therefore, can extract his own conclusions, from this analysis.
At first, the causes that led to the debt crisis for Greece are presented. An analysis of the fiscal data is made, followed by an over time analysis, with the conclusions that emerge.
Subsequently, the introduction of Greece in the program of the 1st memorandum with be considered. It is explained how the global financial crisis affected the sustainability of the Greek debt and led to the impending bankruptcy. Following, the period during which Greece formally requested the assistance of the IMF and its European partners will be examined, as well as the programs that took place as the 1st memorandum. Its results, its real goals are explained and the necessary conclusions are drawn.
Next, Greece's accession to the 2nd memorandum is examined. To understand this program, some essential knowledge such as the Deauville doctrine and the Maastricht treaty are presented. After that, the Greek debt haircut in described, known as PSI, for debt to individual investors, Greek banks and insurance funds. The report of this program is presented, as well as the sub-program that took place later. The results of the program for Greece are analysed and the conclusions follow.
Later, some key knowledge in presented, as a link between the previous and the next chapter, which includes the negotiation in 2015. To achieve this goal, the course in which Greece had entered and its treatment by Europe are analysed, together with its results. Next, the appropriate solution is explained, based on international experience. In addition, the responsibilities of Greece that led to the impending bankruptcy are recognised. At this point, it is considered necessary to refer to the speculation of the European formals towards Greece, as well as the climate of rupture that had been created.
In the last part, references are made to the period before the negotiation in 2015. Furthermore, the negotiation itself and its bases for the Greek side are explained. Later, a brief reference is made to the referendum, capital controls and, finally, the capitulation. As result, the 3rd memorandum introduced. The obligations and the benefits from it, are referred. Finally, an approximation of the cost of this negotiation is attempted.
This paper concludes by presenting the general conclusions for Greece in terms of numbers and societary impact
Pure ankle dislocation after modified Broström repair for chronic lateral instability: Case report and literature review
No full textAnkle dislocation with no concomitant malleolar fracture is an overwhelmingly rare injury, and only a relatively limited number of cases have been reported. Diligent management regarding the treatment of these injuries is requisite to attain an auspicious outcome. Lateral ankle instability is a frequent condition that can derive from recurrent sprains, predominantly at a young age. Broström repair, with its modifications and updates, has been established as the optimal solution when treating chronic lateral unsteadiness. We present a peculiar case of a posteromedial ankle dislocation without accompanying fracture in a patient operated on many years before the injury for chronic lateral instability with a modified Broström procedure. No similar case could be retrieved in the existing literature. After the initial clinical and radiological assessment, urgent closed reduction of the dislocation was achieved, and the foot was immobilized. Further imaging was carried out to evaluate the features of the injury. It was deduced that the repairs from the previous operation were intact. The patient was operated on to repair the distal tibiofibular syndesmosis. The postoperative course was uneventful, and absolute functional capacity was eventually accomplished. Demonstrating this rare case, we accentuate the role of implementing the modified Broström procedure in the surgical treatment of chronic lateral ankle instability. © 2023 The Author
Double Segmental Femoral Fracture: A Rare Injury Following High-Energy Trauma
No full textFemoral fractures are indubitably common injuries that can occur either from high-energy trauma in young patients or due to fragility in the geriatric population. Femoral fractures affecting two or more regions of the femur are exceedingly infrequent injuries, ordinarily caused by high-energy trauma and are considered segmental femoral fractures. We present a rare case of a 33-year-old male patient presented to our Emergency Department with multiple femoral fractures at the subtrochanteric, diaphyseal and supracondylar femoral regions, a condition regarded as double segmental femoral fracture. After assiduous consideration of treatment options, intramedullary nailing was employed for osteosynthesis. Fracture reduction was laborious, as an entirely separated femoral fragment was present between the fracture lines. The reaming process required paramount attentiveness as the middle femoral fragment was prone to rotational displacement by the reamer. Finally, the intramedullary nail was successfully placed, and the patient was discharged without complications after 11 days of hospitalization. Currently, the patient is capable of full weight-bearing without crutches. This paper underlines the challenges that double-segmental femoral fractures’ treatment can bring on to the orthopedic surgeon. © The author
Incidence of vertebral artery injury in patients undergoing cervical spine trauma surgery in correlation with surgical approach: A review
No full textSpinal cord injuries at the cervical spine level represent the most consequential of the related injuries at all levels of the spine. They can trigger permanent unilateral or bilateral damage with conspicuous disability. Regarding unstable injuries, the gold standard approach is open reduction and osteosynthesis, which can select between anterior and posterior surgical access. Each of the aforementioned approaches demonstrates both advantages and disadvantages; thus, it is up to the surgeon to determine the optimal option concerning the patient's safety. Diligent intraoperative control of anatomical reduction is pivotal to obtaining the best feasible postoperative outcomes. Literature data delineate copious complications following surgical intervention in the cervical spine. Indubitably, the most crucial intraoperative complication accounts for vascular injuries, with the most preponderant being the corrosion of the vertebral artery, as it is potentially life-threatening. This paper aims to provide a succinct and compendious review of the existing literature regarding cervical spinal cord injuries and to deduce many inferences concerning the incidence of iatrogenic vertebral artery injuries in relation to the surgical approach for fracture reduction. Copyright © 2023 the Author(s)
Single-center experience with Knee+™ augmented reality navigation system in primary total knee arthroplasty
No full textBACKGROUND Computer-assisted systems obtained an increased interest in orthopaedic surgery over the last years, as they enhance precision compared to conventional hardware. The expansion of computer assistance is evolving with the employment of augmented reality. Yet, the accuracy of augmented reality navigation systems has not been determined. AIM To examine the accuracy of component alignment and restoration of the affected limb’s mechanical axis in primary total knee arthroplasty (TKA), utilizing an augmented reality navigation system and to assess whether such systems are conspicuously fruitful for an accomplished knee surgeon. METHODS From May 2021 to December 2021, 30 patients, 25 women and five men, underwent a primary unilateral TKA. Revision cases were excluded. A preoperative radiographic procedure was performed to evaluate the limb’s axial alignment. All patients were operated on by the same team, without a tourniquet, utilizing three distinct prostheses with the assistance of the Knee+™ augmented reality navigation system in every operation. Postoperatively, the same radiographic exam protocol was executed to evaluate the implants’ position, orientation and coronal plane alignment. We recorded measurements in 3 stages regarding femoral varus and flexion, tibial varus and posterior slope. Firstly, the expected values from the Augmented Reality system were documented. Then we calculated the same values after each cut and finally, the same measurements were recorded radiologically after the operations. Concerning statistical analysis, Lin’s concordance correlation coefficient was estimated, while Wilcoxon Signed Rank Test was performed when needed. RESULTS A statistically significant difference was observed regarding mean expected values and radiographic measurements for femoral flexion measurements only (Z score = 2.67, P value = 0.01). Nonetheless, this difference was statistically significantly lower than 1 degree (Z score = -4.21, P value < 0.01). In terms of discrepancies in the calculations of expected values and controlled measurements, a statistically significant difference between tibial varus values was detected (Z score = -2.33, P value = 0.02), which was also statistically significantly lower than 1 degree (Z score = -4.99, P value < 0.01). CONCLUSION The results indicate satisfactory postoperative coronal alignment without outliers across all three different implants utilized. Augmented reality navigation systems can bolster orthopaedic surgeons’ accuracy in achieving precise axial alignment. However, further research is required to further evaluate their efficacy and potential. © The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved
The correlation between transient osteoporosis of the hip and pregnancy: A review
No full textTransient osteoporosis of the hip is indubitably a comparatively infrequent entity affecting both men and women worldwide. Its occurrence in the course of pregnancy, specifically in the third trimester, and lactation are of paramount concernment. The exact association between transient hip osteoporosis and pregnancy is precarious. Etiology and potential pathophysiological mechanisms behind this correlation are still to be utterly defined. Magnetic resonance imaging is highly regarded as the gold standard imaging method for assiduous assessment of this disorder. Physicians of copious medical specialties should practice scrupulous techniques for early and pertinent diagnosis when pregnant women are presented with persistent hip pain, as differential diagnosis with femoral head avascular necrosis can be exceedingly arduous. Treatment is predominantly conservative with protected weight-bearing and analgesic medication in the first line of management. In terms of prognosis, the disease ordinarily resolves spontaneously after a few months. Further research is required in order to elucidate the ambiguity surrounding the establishment of globally approved diagnosis and treatment guidelines for pregnancy-associated transient hip osteoporosis. This paper aims to accentuate the significance of this particular disorder by providing a succinct review of the existing literature, augmenting clinicians' knowledge about the features of pregnancy-related transient proximal femur osteoporosis. Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc
Intraoperative transfusion practices in Europe
No full text© 2016 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.Background: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. Methods: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. Results: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl-1 and increased to 9.8 (1.8) g dl-1 after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Conclusions: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl-1), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold
Decoding the historical tale: COVID-19 impact on haematological malignancy patients—EPICOVIDEHA insights from 2020 to 2022
No full textBackground: The COVID-19 pandemic heightened risks for individuals with hematological malignancies due to compromised immune systems, leading to more severe outcomes and increased mortality. While interventions like vaccines, targeted antivirals, and monoclonal antibodies have been effective for the general population, their benefits for these patients may not be as pronounced. Methods: The EPICOVIDEHA registry (National Clinical Trials Identifier, NCT04733729) gathers COVID-19 data from hematological malignancy patients since the pandemic's start worldwide. It spans various global locations, allowing comprehensive analysis over the first three years (2020–2022). Findings: The EPICOVIDEHA registry collected data from January 2020 to December 2022, involving 8767 COVID-19 cases in hematological malignancy patients from 152 centers across 41 countries, with 42% being female. Over this period, there was a significant reduction in critical infections and an overall decrease in mortality from 29% to 4%. However, hospitalization, particularly in the ICU, remained associated with higher mortality rates. Factors contributing to increased mortality included age, multiple comorbidities, active malignancy at COVID-19 onset, pulmonary symptoms, and hospitalization. On the positive side, vaccination with one to two doses or three or more doses, as well as encountering COVID-19 in 2022, were associated with improved survival. Interpretation: Patients with hematological malignancies still face elevated risks, despite reductions in critical infections and overall mortality rates over time. Hospitalization, especially in ICUs, remains a significant concern. The study underscores the importance of vaccination and the timing of COVID-19 exposure in 2022 for enhanced survival in this patient group. Ongoing monitoring and targeted interventions are essential to support this vulnerable population, emphasizing the critical role of timely diagnosis and prompt treatment in preventing severe COVID-19 cases. Funding: Not applicable. © 2024 The Author(s
Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study
No full textBackground: The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes. Methods: LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January?December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien?Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141). Results: A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/ 2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively. Conclusions: This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives. © Copyright 2023 The Author(s)
Nirmatrelvir/ritonavir in COVID-19 patients with haematological malignancies: a report from the EPICOVIDEHA registry
No full textBackground Nirmatrelvir/ritonavir treatment decreases the hospitalisation rate in immunocompetent patients with COVID-19, but data on efficacy in patients with haematological malignancy are scarce. Here, we describe the outcome of nirmatrelvir/ritonavir treatment in a large cohort of the latter patients. Methods This is a retrospective cohort study from the multicentre EPICOVIDEHA registry (NCT04733729) on pa-tients with haematological malignancy, who were diagnosed with COVID-19 between January and September 2022. Patients receiving nirmatrelvir/ritonavir were compared to those who did not. A logistic regression was run to determine factors associated with nirmatrelvir/ritonavir administration in our sample. Mortality between treatment groups was assessed with Kaplan-Meier survival plots after matching all the patients with a propensity score. Additionally, a Cox regression was modelled to detect factors associated with mortality in patients receiving nirmatrelvir/ritonavir. Findings A total of 1859 patients were analysed, 117 (6%) were treated with nirmatrelvir/ritonavir, 1742 (94%) were treated otherwise. Of 117 patients receiving nirmatrelvir/ritonavir, 80% had received >= 1 anti-SARS-CoV-2 vaccine dose before COVID-19 onset, 13% of which received a 2nd vaccine booster. 5% were admitted to ICU. Nirmatrelvir/ritonavir treatment was associated with the presence of extrapulmonary symptoms at COVID-19 onset, for example anosmia, fever, rhinitis, or sinusitis (aOR 2.509, 95%CI 1.448-4.347) and 2nd vaccine booster (aOR 3.624, 95%CI 1.619-8.109). Chronic pulmonary disease (aOR 0.261, 95%CI 0.093-0.732) and obesity (aOR 0.105, 95%CI 0.014-0.776) were not associated with nirmatrelvir/ritonavir use. After propensity score matching, day-30 mortality rate in patients treated with nirmatrelvir/ritonavir was 2%, significantly lower than in patients with SARS-CoV-2 directed treatment other than nirmatrelvir/ritonavir (11%, p = 0.036). No factor was observed explaining the mortality difference in patients after nirmatrelvir/ritonavir administration. Interpretation Haematological malignancy patients were more likely to receive nirmatrelvir/ritonavir when reporting extrapulmonary symptoms or 2nd vaccine booster at COVID-19 onset, as opposed to chronic pulmonary disease and obesity. The mortality rate in patients treated with nirmatrelvir/ritonavir was lower than in patients with targeted drugs other than nirmatrelvir/ritonavir. Funding EPICOVIDEHA has received funds from Optics COMMIT (COVID-19 Unmet Medical Needs and Asso-ciated Research Extension) COVID-19 RFP program by GILEAD Science, United States (Project 2020-8223). Copyright (c) 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
