A rare convergence: adult-onset Langerhans cell histiocytosis and HIV infection

While primarily described in children, adult-onset Langerhans cell histiocytosis (LCH) has been reported, albeit infrequently. In the present scenario, we unveil a unique case of adult-onset LCH in an HIV-infected individual. After the diagnosis was made, the patient was successfully treated and demonstrated total disease remission. This case illustrates the diagnostic challenge that rare clinical entities such as LCH pose, especially in the context of an untreated HIV infection. Furthermore, the complexity of treating adult-onset Langerhans cell histiocytosis in an HIV-positive patient is highlighted, with emphasis given on a multidisciplinary approach

Socio-psychological mechanisms of terror and uncertainty management: experimental investigation of new ways to cope with existential anxiety

This dissertation, which is comprised of four experimental studies and one correlational study, primarily aims at testing the effect of mortality and various types of uncertainty salience on core aspects of human social behavior. Study 1 (N=245) investigated the impact of mortality and financial bankruptcy reminders on subjects’ political beliefs. The results revealed that the threat of financial bankruptcy elicited the reduction of participants’ positive attitudes towards political authority and the intensification of disobedience to the latter, and thus highlighted the intergroup conflict between the group of the People on the one hand and the group of the established Authorities on the other. Study 2 (Ν=90) examined the effect of mortality and uncertainty salience on the accessibility of both death-related and uncertainty-related thoughts. In line with our expectations, mortality salience engendered indeed a remarkable increase in death-thought accessibility. Study 3 (Ν=144) investigated the effect of money reminders, and mortality and uncertainty salience, on the degree of identification with the Greek nation. Interacting with play money led participants to show a significant further decrease in the identification with their national in-group. Study 4 (Ν=135) examined the effect of mortality and specifically personal uncertainty salience on judgments of social transgressions, as well as on evaluations of political candidates as a function of leadership style. Under the mortality salience condition participants recommended more severe, harsher punishments for the individual who violates the law and deviates from cultural standards and values, made more negative evaluations of, and voted less for, the Relationship-oriented candidate, showed an increased global preference for the agentic ,“male” style of political leadership, and for the male gender as the ideal leadership gender, as well. Respectively, uncertainty salience similarly evoked more negative evaluations of, and fewer votes for, the Relationship-oriented political candidate, an increased global preference for the agentic ,“male” style of leadership, but also an increased preference for the female gender as the ideal leadership gender, solely for the case of the Relationship-oriented candidate and especially from women participants. Finally, study 5 (Ν=299) investigated, implementing a different methodological approach, the overall linkages among death anxiety, uncertainty for the future, attitudes towards money, political behavior and political orientation. The results showed that low-income city residents were more anxious about death than the high-income ones and that the more low-income participants recognized the positive symbolic power of money, the more exposed they were to existential anxiety per se. In the field of political leadership, the results do not contradict our previous findings from study 4 : young participants experiencing high uncertainty showed an increased preference for the Task-oriented candidate, but still a decreased preference for the Relationship-oriented. Furthermore, only among extremely low-income participants a significant positive correlation between right-wing political orientation, right self-placement in fact, and death anxiety was observed, while in the sample of strongly politicized participants both the left and the right ones were equally protected against anxiety about death. Results are discussed in relation to theories of Uncertainty and Terror Management Theory (TMT).Σκοπός αυτής της διατριβής, η οποία συνίσταται σε τέσσερις πειραματικές απόπειρες και μία συσχετιστική έρευνα, υπήρξε, κατά κύριο λόγο, ο έλεγχος της επίδρασης της ευκρίνειας της προσωπικής θνητότητας και διαφορετικών ειδών αβεβαιότητας σε ένα σύνολο όψεων της ανθρώπινης συμπεριφοράς. Η έρευνα 1 (Ν=245) διερεύνησε την επίδραση της υπενθύμισης της απειλής του θανάτου και της απειλής της χρεοκοπίας στις ιδεολογικοπολιτικές πεποιθήσεις των υποκειμένων. Τα ευρήματα έδειξαν πως η οικονομική απειλή της χρεοκοπίας προκάλεσε τη μείωση των θετικών στάσεων των συμμετεχόντων για την εξουσία και την επίταση της ανυπακοής τους προς αυτήν, κι ως εκ τούτου ανέδειξαν τη διομαδική σύγκρουση μεταξύ της ομάδας του Λαού και της ομάδας της κατεστημένης Εξουσίας. Η έρευνα 2 (Ν=90) εξέτασε την επίδραση της ευκρίνειας της θνητότητας και της αβεβαιότητας στην προσβασιμότητα των έμμεσων σκέψεων του θανάτου και της αβεβαιότητας. Όπως αναμενόταν, η ευκρίνεια της θνητότητας προκάλεσε σημαντική αύξηση στην προσβασιμότητα των σκέψεων που σχετίζονται με την έννοια του θανάτου. Η έρευνα 3 (Ν=144) διερεύνησε την επίδραση της υπενθύμισης του συμβόλου του χρήματος, και της ευκρίνειας της θνητότητας και της αβεβαιότητας, στον βαθμό της ταύτισης των υποκειμένων με το ελληνικό έθνος. Η επαφή με πλαστά, μη έγκυρα χαρτονομίσματα οδήγησε συνολικά τους συμμετέχοντες στην περαιτέρω μείωση της ταύτισής τους με την ενδο-ομάδα του έθνους. Η έρευνα 4 (Ν=135) εξέτασε, εκτός άλλων, την επίδραση της ευκρίνειας της θνητότητας και, συγκεκριμένα, της προσωπικής αβεβαιότητας στις αντιδράσεις των συμμετεχόντων απέναντι στον δράστη μίας παραβατικής πράξης, αλλά και στις αξιολογήσεις τριών πολιτικών υποψηφίων, διαφορετικού ύφους πολιτικής ηγεσίας. Τα υποκείμενα στα οποία κατέστη πρόδηλη η θνητότητά τους πρότειναν αυστηρότερες και βαρύτερες ποινές για τον παραβάτη του νόμου και των κοινωνικών αξιών, αξιολόγησαν λιγότερο θετικά, και ψήφισαν σε μικρότερο βαθμό ως πρωθυπουργό τον Συνεργάσιμο πολιτικό υποψήφιο, προτίμησαν περισσότερο το εξουσιαστικό ή αλλιώς «ανδρικό» στυλ ηγεσίας, αλλά και το ανδρικό φύλο ως ηγετικό φύλο. Αντιστοίχως, η ευκρίνεια της προσωπικής αβεβαιότητας προκάλεσε την αρνητικότερη αξιολόγηση, και τη μείωση των ψήφων υπέρ, του Συνεργάσιμου υποψήφιου, την ισχυρότερη προτίμηση προς το εξουσιαστικό, «ανδρικό» στυλ ηγεσίας, αλλά και την επιλογή, εκ μέρους ειδικά των γυναικών, του θηλυκού φύλου ως ηγετικού, αποκλειστικά για την περίπτωση του Συνεργάσιμου υποψηφίου. Τέλος, η συσχετιστική έρευνα 5 (Ν=299) διερεύνησε μ’ έναν διαφορετικό μεθοδολογικά τρόπο τις σχέσεις του άγχους του θανάτου, της αβεβαιότητας για το μέλλον, των στάσεων έναντι του χρήματος, της πολιτικής συμπεριφοράς και της πολιτικής αυτοτοποθέτησης των συμμετεχόντων. Τα ευρήματα έδειξαν πως οι κάτοικοι των πόλεων που λαμβάνουν χαμηλά εισοδήματα ανέφεραν μεγαλύτερο άγχος του θανάτου σε σύγκριση με αυτούς που λαμβάνουν υψηλότερα εισοδήματα, και επιπλέον, πως οι πρώτοι όσο περισσότερο αναγνώριζαν τη θετική συμβολική δύναμη του χρήματος, τόσο περισσότερο ήταν εκτεθειμένοι στο άγχος του θανάτου αυτό καθεαυτό. Στο πεδίο της πολιτικής ηγεσίας τα ευρήματά μας δεν είναι ασύμβατα με τα αποτελέσματα της έρευνας 4 : οι υψηλά αβέβαιοι νεαροί συμμετέχοντες προτίμησαν μεν σε μεγαλύτερο βαθμό τον Αποτελεσματικό πολιτικό υποψήφιο, αλλά προτίμησαν, ταυτόχρονα, και σε μικρότερο βαθμό τον Συνεργάσιμο. Επιπροσθέτως, η θετική συνάφεια μεταξύ δεξιού πολιτικού προσανατολισμού, δεξιάς πολιτικής αυτοτοποθέτησης για την ακρίβεια, και άγχους του θανάτου καταγράφηκε αποκλειστικά στην κατηγορία των συμμετεχόντων που λαμβάνουν εξαιρετικά χαμηλά εισοδήματα, ενώ, απεναντίας, στο δείγμα των υψηλά πολιτικοποιημένων ερωτώμενων εξίσου από το άγχος του θανάτου φάνηκε πως προστατεύονται τόσο οι αριστεροί, όσο και οι δεξιοί. Τα αποτελέσματα ερμηνεύονται και προσεγγίζονται μέσω θεωριών της Αβεβαιότητας και της Θεωρίας Διαχείρισης του Τρόμου (ΤΜΤ)

Primary HHV 6 infection after liver transplantation with acute graft rejection and multi-organ failure: successful treatment with a 2.5-fold dose of cidofovir and reduction of immunosuppression

Item does not contain fulltextHHV type 6 has been reported with enhanced pathogenicity in immunocompromised patients. Herein, we report about a two-yr-old girl who experienced primary HHV 6 infection after liver transplantation. She clinically presented with graft rejection and necrotic hepatitis as well as high fever, pneumonitis with respiratory failure and a rash. Therapy with cidofovir of 5 mg/kg per wk did not show improvement, so that a full pharmacokinetic profile of cidofovir was performed. It demonstrated enhanced body weight normalized clearance of cidofovir and cidofovir dosage was augmented to 12 mg/kg per wk to reach adequate drug exposure. With additional reduction of immunosuppression, the patient dramatically improved and liver function stabilized

Dating the Origin and Estimating the Transmission Rates of the Major HIV-1 Clusters in Greece: Evidence about the Earliest Subtype A1 Epidemic in Europe

Our aim was to estimate the date of the origin and the transmission rates of the major local clusters of subtypes A1 and B in Greece. Phylodynamic analyses were conducted in 14 subtype A1 and 31 subtype B clusters. The earliest dates of origin for subtypes A1 and B were in 1982.6 and in 1985.5, respectively. The transmission rate for the subtype A1 clusters ranged between 7.54 and 39.61 infections/100 person years (IQR: 9.39, 15.88), and for subtype B clusters between 4.42 and 36.44 infections/100 person years (IQR: 7.38, 15.04). Statistical analysis revealed that the average difference in the transmission rate between the PWID and the MSM clusters was 6.73 (95% CI: 0.86 to 12.60; p = 0.026). Our study provides evidence that the date of introduction of subtype A1 in Greece was the earliest in Europe. Transmission rates were significantly higher for PWID than MSM clusters due to the conditions that gave rise to an extensive PWID HIV-1 outbreak ten years ago in Athens, Greece. Transmission rate can be considered as a valuable measure for public health since it provides a proxy of the rate of epidemic growth within a cluster and, therefore, it can be useful for targeted HIV prevention programs

HIV continuum of care: Bridging cross-sectional and longitudinal analyses

Objective: The aim of this study was to propose a unified continuum-of-care (CoC) analysis combining cross-sectional and longitudinal elements, incorporating time spent between stages. Design: The established 90-90-90 target follows a cross-sectional four-stage CoC analysis, lacking information on timing of diagnosis, antiretroviral therapy (ART) initiation, and viral suppression durability. Methods: Data were derived from the Athens Multicenter AIDS Cohort Study (AMACS). In the cross-sectional CoC, we added stratification of diagnosed people with HIV (PWH) by estimated time from infection to diagnosis; of those who ever initiated ART or achieved viral suppression by corresponding current status (in 2018); and cumulative incidence function (CIF) of ART initiation and viral suppression, treating loss-to-followup (LTFU) as competing event. Viral suppression was defined as viral load less than 500 copies/ml. Viral suppression durability was assessed by the CIF of viral load rebound. Findings: About 89.1% of PWH in 2018 were diagnosed (range of diagnoses: 1980 - 2018). Median time to diagnosis was 3.5 years (IQR: 1.1 - 7.0). Among diagnosed, 89.1% were ever treated, of whom 86.7% remained on ART. CIF of ART initiation and LTFU before ART initiation were 80.9 and 6.0% at 5 years since diagnosis, respectively. Among treated, 89.4% achieved viral suppression, of whom 87.4% were currently virally suppressed. The CIF of viral load rebound was 24.2% at 5 years since first viral suppression but substantially reduced in more recent years. Interpretation: The proposed analysis highlights time gaps in CoC not evident by the standard cross-sectional approach. Our analysis highlights the need for early diagnosis and identifies late presenters as a key population for interventions that could decrease gaps in the CoC. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved

Dating the Origin and Estimating the Transmission Rates of the Major HIV‐1 Clusters in Greece: Evidence about the Earliest Subtype A1 Epidemic in Europe

Our aim was to estimate the date of the origin and the transmission rates of the major local clusters of subtypes A1 and B in Greece. Phylodynamic analyses were conducted in 14 subtype A1 and 31 subtype B clusters. The earliest dates of origin for subtypes A1 and B were in 1982.6 and in 1985.5, respectively. The transmission rate for the subtype A1 clusters ranged between 7.54 and 39.61 infec-tions/100 person years (IQR: 9.39, 15.88), and for subtype B clusters between 4.42 and 36.44 infections/100 person years (IQR: 7.38, 15.04). Statistical analysis revealed that the average difference in the transmission rate between the PWID and the MSM clusters was 6.73 (95% CI: 0.86 to 12.60; p = 0.026). Our study provides evidence that the date of introduction of subtype A1 in Greece was the earliest in Europe. Transmission rates were significantly higher for PWID than MSM clusters due to the conditions that gave rise to an extensive PWID HIV‐1 outbreak ten years ago in Athens, Greece. Transmission rate can be consid-ered as a valuable measure for public health since it provides a proxy of the rate of epidemic growth within a cluster and, therefore, it can be useful for targeted HIV prevention programs. © 2022 by the authors. Licensee MDPI, Basel, Switzerland