The ban on blood donation on men who have sex with men: time to rethink and reassess an outdated policy

During the 1980s the HIV/AIDS epidemic outbreak occurred. Due to the high prevalence of the disease on men who had sex with men (MSM) a lifetime ban on blood donations on men who had sex with men (MSM) was implemented. In the recent years, organizations like the European Union (EU) and the World Health Organization (WHO) have established new guidelines introducing the term of "risky sexual behavior" without any reference to the sex orientation of the potential donor, however many countries are hesitant to review the ban on men who had sex with men (MSM). Given the lack of screening methods for HIV back in the '80s the ban on men who had sex with men seemed like the only choice in order to limit the disease. However, nowadays the screening methods have advanced and the possibility of a transfusion related HIV infection is extremely low. Many countries, considering the new data available, have reformed their policies and moved from the lifetime ban to 5-year and 1- year deferrals but only a fraction of countries have adopted the guidelines for the "risky sexual behavior" assessment. The ban that forbid men who have sex with men from donating blood was implemented more than 30 years ago. During the '80s, the epidemiology was different and it seems not only hypocritical but also naïve to rely on guidelines that are far outdated and old-fashioned. The medical community has a duty to secure safe blood for every person who might need it, let us not waste safe potential donors and stigmatize them by focusing on outdated policies.Keywords: HIV, AIDS, donation, blood banks, homosexuality, risk assessmen

Drug allergy evaluation in children with suspected mild antibiotic allergy

BackgroundAdverse antibiotic reactions caused by an immunological mechanism are known as allergic reactions. The percentage of reported antibiotic allergies is likely to differ from the one validated after a drug provocation test (DPT) with the culprit antibiotic. This study aimed to compare the percentage of children who were thought to be allergic to a certain antibiotic with those who have a true allergy, as confirmed by DPTs. We also validated Skin Prick Tests (SPTs) and Intradermal Tests (IDTs) by assessing their sensitivity and specificity, in diagnosing antibiotic allergies using DPT as the gold standard. Furthermore, we investigated epidemiological risk factors such as personal and family history of atopic disease and eosinophilia.MethodsChildren with a history of possible allergic reaction to an antibiotic underwent a diagnostic procedure that included: (1) Eosinophil blood count, (2) SPTs, (3) IDTs and (4) DPTs. The parameters were compared with Pearson's Chi-Square and Fisher's Exact Test. Several risk factors that were found significant in univariate analysis, such as personal and family history of atopic disease, and positive SPTs and IDTs were examined with multiple logistic regression analysis to see if they were related to a higher risk for a positive DPT.ResultsSemi-synthetic penicillin was the most common group of antibiotics thought to cause allergic reactions in this study. Overall, 123 children with a personal history of an adverse reaction to a certain antibiotic, were evaluated. In 87.8% of the cases, the symptoms had occurred several hours after administration of the culprit antibiotic. Both SPTs and IDTs had low sensitivity but high specificity. Moreover, they had a high positive predictive value (PPV). In contrast, eosinophilia was not recognized as a risk factor. Seventeen patients (13.8%) had a true antibiotic allergy, as confirmed by a positive DPT. A positive IDT was a strong predictor of a positive DPT, along with a positive personal and family history of atopy.ConclusionSPTs and IDTs are very reliable in confirming antibiotic allergy when found positive. A negative result of a SPT highly predicts a negative DPT. A positive IDT and a positive personal and family history of atopy were recognized as significant risk factors for antibiotic allergy

The Biodiversity of the Mediterranean Sea: Estimates, Patterns, and Threats

The Mediterranean Sea is a marine biodiversity hot spot. Here we combined an extensive literature analysis with expert opinions to update publicly available estimates of major taxa in this marine ecosystem and to revise and update several species lists. We also assessed overall spatial and temporal patterns of species diversity and identified major changes and threats. Our results listed approximately 17,000 marine species occurring in the Mediterranean Sea. However, our estimates of marine diversity are still incomplete as yet—undescribed species will be added in the future. Diversity for microbes is substantially underestimated, and the deep-sea areas and portions of the southern and eastern region are still poorly known. In addition, the invasion of alien species is a crucial factor that will continue to change the biodiversity of the Mediterranean, mainly in its eastern basin that can spread rapidly northwards and westwards due to the warming of the Mediterranean Sea. Spatial patterns showed a general decrease in biodiversity from northwestern to southeastern regions following a gradient of production, with some exceptions and caution due to gaps in our knowledge of the biota along the southern and eastern rims. Biodiversity was also generally higher in coastal areas and continental shelves, and decreases with depth. Temporal trends indicated that overexploitation and habitat loss have been the main human drivers of historical changes in biodiversity. At present, habitat loss and degradation, followed by fishing impacts, pollution, climate change, eutrophication, and the establishment of alien species are the most important threats and affect the greatest number of taxonomic groups. All these impacts are expected to grow in importance in the future, especially climate change and habitat degradation. The spatial identification of hot spots highlighted the ecological importance of most of the western Mediterranean shelves (and in particular, the Strait of Gibraltar and the adjacent Alboran Sea), western African coast, the Adriatic, and the Aegean Sea, which show high concentrations of endangered, threatened, or vulnerable species. The Levantine Basin, severely impacted by the invasion of species, is endangered as well

Drug allergy evaluation with skin tests and drug provocation tests in children with reported allergy to antibiotics

Background: Adverse antibiotic reactions caused by an immunological mechanism are known as allergic reactions. The percentage of antibiotic allergies reported by caregivers, is likely to differ considerably from the one validated after a drug provocation test (DPT) with the culprit antibiotic. This study aims to compare the percentage of children who were thought to be allergic to a certain antibiotic with the percentage of those who have a true allergy, as confirmed by DPTs. The aim was also, to validate Skin Prick Tests (SPTs) and Intradermal Tests (IDTs) by assessing their sensitivity, specificity, and positive and negative predictive values in diagnosing antibiotic allergies using the DPT as the gold standard. Furthermore, we investigated several epidemiological risk factors regarding antibiotic allergy, personal and family history of atopic disease, eosinophilia, positive SPTs, and IDTs. Methods: Children with a history of possible allergic reaction to an antibiotic underwent a diagnostic procedure which included 1) Eosinophil blood count, 2) SPTs, 3) IDTs and 4) DPTs. The parameters were compared with Pearson’s Chi-Square and Fisher’s Exact Test. With multiple logistic regression analysis, several risk factors that were found significant in the univariate analysis, such as personal and family history of atopic disease, and positive SPTs and IDTs, were examined if they were related to a higher risk for a positive DPT. Results: A sample of 123 children, consisting of 73 boys and 50 girls with a mean age of 7.5 (SD± 4.5) years, with a personal history of an adverse reaction to a certain antibiotic, was evaluated. Semi-synthetic penicillin was the culprit antibiotic agent in 58.6% of the cases. In 87.8% of the cases, the symptoms had occurred several hours after administration of the culprit antibiotic, while in 12.2%, symptoms occurred in the first hour. Seventeen patients (13.8%) had a true antibiotic allergy, as confirmed with a positive DPT. SPTs had sensitivity 11.8%, specificity 100%, PPV: 100%, and NPV: 87. 6%. IDTs had sensitivity 23.5%, specificity 99.1%, PPV: 80%, and NPV: 89%. A positive IDT was a strong predictor of a positive DPT, along with positive personal and family history of atopy, while peripheral eosinophilia was not. Conclusion: Semi-synthetic penicillin was the most often group of antibiotics thought to cause allergic reactions in this study and the most often proven true allergy. Most allergic reactions that occurred during a positive DPT were of the delayed type of reaction, accounting for almost 90% of the cases. A DPT confirmed a true antibiotic allergy in 13.8% of the reported cases. SPTs and IDTs both had low sensitivity and high specificity. Moreover, they had a high PPV. Therefore, they are very reliable in confirming antibiotic allergy when found positive. However, their NPV is also high; thus, a negative result cannot help excluding drug allergies. A positive IDT and a positive personal and family history of atopy were recognized as significant risk factors for antibiotic allergy.Εισαγωγή: Οι ανεπιθύμητες αντιδράσεις των φαρμάκων, που προκαλούνται με συμμετοχή του ανοσολογικού μηχανισμού, είναι γνωστές ως αλλεργικές αντιδράσεις. Το ποσοστό της αναφερόμενης αλλεργίας σε αντιβιοτικά στα παιδιά, είναι πιθανό να διαφέρει σημαντικά από αυτό που επιβεβαιώνεται μετά από μια δοκιμασία πρόκλησης φαρμάκων (DPT) με το ύποπτο αντιβιοτικό. Αυτή η μελέτη, έχει ως στόχο τη σύγκριση του ποσοστού των παιδιών με αναφερόμενη αλλεργία σε ένα συγκεκριμένο αντιβιοτικό, με το ποσοστό εκείνων που έχουν αληθινή αλλεργία, όπως επιβεβαιώνεται από τη δοκιμασία πρόκλησης. Επιπρόσθετα, έγινε προσπάθεια εκτίμησης της αξιοπιστίας των δερματικών δοκιμασιών νυγμού (SPTs) και των ενδοδερμικών δοκιμασιών (IDTs) αξιολογώντας την ευαισθησία, την ειδικότητά τους και τις θετικές και αρνητικές προγνωστικές τους αξίες στη διάγνωση αλλεργιών στα αντιβιοτικά, χρησιμοποιώντας τη δοκιμασία πρόκλησης ως χρυσό κανόνα για τη διάγνωση φαρμακευτικής αλλεργίας. Επιπλέον, διερευνήσαμε αρκετούς επιδημιολογικούς παράγοντες κινδύνου σχετικά με την αλλεργία στα αντιβιοτικά, όπως την ηωσινοφιλία, τις θετικές δερματικές δοκιμασίες νυγμού τις θετικές ενδοδερμικές δοκιμασίες και το ατομικό και οικογενειακό ιστορικό ατοπικής νόσου. Μέθοδοι: Παιδιά με ιστορικό πιθανής αλλεργικής αντίδρασης σε ένα αντιβιοτικό υποβλήθηκαν σε διαγνωστική διαδικασία που περιελάμβανε 1) Προσδιορισμό ηωσινοφίλων στο περιφερικό αίμα, 2) δερματικές δοκιμασίες νυγμού, 3) ενδοδερμικές δοκιμασίες και 4) από του στόματος δοκιμασίες πρόκλησης. Οι παράμετροι συγκρίθηκαν με τις στατιστικές μεθόδους Pearson's Chi-Square και Fisher's Exact Test. Επίσης, πραγματοποιήθηκε ανάλυση πολλαπλής λογιστικής παλινδρόμησης, για τους παράγοντες κινδύνου που βρέθηκαν σημαντικοί στη μονοπαραγοντική ανάλυση, όπως το ατομικό και οικογενειακό ιστορικό ατοπικής νόσου και οι θετικές δερματικές δοκιμασίες νυγμού και ενδοδερμικές δοκιμασίες, και εξετάστηκε η συσχέτισή τους με την εμφάνιση υψηλότερου κινδύνου για θετική έκβαση δοκιμασίας πρόκλησης. Αποτελέσματα: Αξιολογήθηκε δείγμα 123 παιδιών, αποτελούμενο από 73 αγόρια και 50 κορίτσια με μέση ηλικία 7,5 έτη (SD± 4,5), με κλινική διάγνωση ανεπιθύμητης αντίδρασης σε ένα συγκεκριμένο αντιβιοτικό. Η ημισυνθετική πενικιλλίνη ήταν το ύποπτο αντιβιοτικό στο 58,6% των περιπτώσεων. Στο 87,8% των παιδιών που μελετήθηκαν, τα συμπτώματα εμφανίστηκαν αρκετές ώρες μετά τη χορήγηση του ύποπτου αντιβιοτικού, ενώ στο 12,2% τα συμπτώματα εμφανίστηκαν την πρώτη ώρα. Δεκαεπτά ασθενείς (13,8%) είχαν πραγματική αλλεργία στο αντιβιοτικό, όπως επιβεβαιώθηκε με θετική δοκιμασία πρόκλησης. Οι δερματικές δοκιμασίες νυγμού είχαν ευαισθησία 11,8%, ειδικότητα 100%, PPV: 100% και NPV: 87,6%. Οι ενδοδερμικές δοκιμασίες είχαν ευαισθησία 23,5%, ειδικότητα 99,1%, PPV: 80% και NPV: 89%. Η θετική ενδοδερμική δοκιμασία ήταν ισχυρός προγνωστικός δείκτης για θετική έκβαση δοκιμασίας πρόκλησης, καθώς και το θετικό ατομικό και οικογενειακό ιστορικό ατοπίας. Αντίθετα η περιφερική ηωσινοφιλία δεν αποτελούσε παράγοντα κινδύνου για τη θετική έκβαση δοκιμασίας πρόκλησης. Συμπέρασμα: Οι ημισυνθετικές πενικιλίνες ήταν η πιο συχνά ομάδα αντιβιοτικών που πιστεύεται ότι προκαλεί αλλεργικές αντιδράσεις σε αυτή τη μελέτη καθώς και η ομάδα αντιβιοτικών που επιβεβαιώθηκε πιο συχνά ως παράγοντας στις θετικές δοκιμασίες πρόκλησης. Οι περισσότερες αλλεργικές αντιδράσεις που εμφανίστηκαν κατά τη διάρκεια μιας θετικής δοκιμασίας πρόκλησης ήταν επιβραδυνόμενου τύπου, αντιπροσωπεύοντας σχεδόν το 90% των περιπτώσεων. Θετική δοκιμασία πρόκλησης, και επομένως πραγματική αλλεργία σε κάποιο αντιβιοτικό, σημειώθηκε στο 13,8% των αναφερόμενων περιπτώσεων. Οι δερματικές δοκιμασίες νυγμού και οι ενδοδερμικές δοκιμασίες είχαν και οι δύο χαμηλή ευαισθησία και υψηλή ειδικότητα. Ως εκ τούτου, είναι πολύ αξιόπιστες στην επιβεβαίωση της αλλεργίας στα αντιβιοτικά όταν βρεθούν θετικές. Ωστόσο, η αρνητική προγνωστική τους αξία τους είναι επίσης υψηλή. Επομένως, ένα αρνητικό αποτέλεσμα δεν μπορεί να βοηθήσει στον αποκλεισμό των αλλεργιών στα φάρμακα. Η θετική ενδοδερμική δοκιμασία καθώς και θετικό ατομικό και οικογενειακό ιστορικό ατοπίας βρέθηκαν ως σημαντικοί παράγοντες κινδύνου για αλλεργία στα αντιβιοτικά

A case of enterobiasis presenting as post-traumatic-stress-disorder (PTSD): a curious case of the infection with predominant mental health symptoms, presenting for the first time in the settings of a refugee camp

Enterobiasis (oxyuriasis) is a common infection in human caused by Enterobius vermicularis (E. vermicularis), a human intestinal helminth. Because of the easy way of its transmission among people, it has an extremely high prevalence in overcrowded conditions, such as nurseries and primary schools. Oxyuriasis's symptoms are extremely diverse in children, ranging from nausea, diarrhea, insomnia, irritability, recurrent cellulitis, loss of appetite, nightmares and endometritis. Here we report a curious case of oxyuriasis in the settings of a refugee camp in Greece. The patient was a 10-year old Syrian female, who presented with unusual and vague symptoms like insomnia and irritability. Given the violent background of the Syrian warzone that the patient had escaped, she was firstly diagnosed with post traumatic stress disorder (PTSD) before eventually getting correctly diagnosed with enterobiasis. This infection is the first documented case of enterobiasis in the settings of a refugee camp and can highlight the unsanitary living conditions that refugees have to endure in those camps.Keywords: Enterobiasis, oxyuriasis, enterobius vermicularis, helminth, refugee

Psychological Aspects and Depression in Patients with Symptomatic Keratoconus

Purpose. To assess the psychological status of keratoconus sufferers and to determine the relationship between depression and visual impairment in this group of patients. Methods. Fifty-six patients with keratoconus and forty-seven age- and gender-matched healthy control subjects were retroprospectively analyzed. Every participant underwent a complete ophthalmological examination. Keratoconus diagnosis was confirmed with corneal topography and tomography. Zung Depression Inventory Questionnaire and Patient Health Questionnaire-9 (PHQ-9) were completed by everyone. Results. Visual acuity (logMAR 0.53 ±0.30 versus 0.11 ± 0.16), PHQ-9 score (10.20 ± 4.00 versus 5.40 ± 5.01), and Zung score (46.52 ± 8.70 versus 38.53 ± 8.41) showed a statistically significant difference between keratoconus patients and healthy controls (p<0.001 for all). Worse visual acuity was strongly correlated with older individuals (rho = 0.339, p=0.011) and higher PHQ-9 (rho = 0.765, p<0.001) and Zung score (rho = 0.672, p<0.001). Conclusion. Depressive disorders appear to be directly associated with keratoconus, both in frequency and intensity. Worse visual acuity and older age could be identified as predictive factors for their emotional status. Moreover, the disease itself could be recognized as an independent risk factor for depression development, underlying the need for close monitoring and supportive management. To the best of our knowledge, our study is the first in the literature to elaborate the association between keratoconus and depression, by assessing two different questionnaires simultaneously

Psychological aspects and depression in patients with symptomatic keratoconus

Purpose. To assess the psychological status of keratoconus sufferers and to determine the relationship between depression and visual impairment in this group of patients. Methods. Fifty-six patients with keratoconus and forty-seven age- and gender-matched healthy control subjects were retroprospectively analyzed. Every participant underwent a complete ophthalmological examination. Keratoconus diagnosis was confirmed with corneal topography and tomography. Zung Depression Inventory Questionnaire and Patient Health Questionnaire-9 (PHQ-9) were completed by everyone. Results. Visual acuity (logMAR 0.53 +/- 0.30 versus 0.11 +/- 0.16), PHQ-9 score (10.20 +/- 4.00 versus 5.40 +/- 5.01), and Zung score (46.52 +/- 8.70 versus 38.53 +/- 8.41) showed a statistically significant difference between keratoconus patients and healthy controls (p &lt; 0.001 for all). Worse visual acuity was strongly correlated with older individuals (rho = 0.339, p = 0.011) and higher PHQ-9 (rho = 0.765, p &lt; 0.001) and Zung score (rho = 0.672, p &lt; 0.001). Conclusion. Depressive disorders appear to be directly associated with keratoconus, both in frequency and intensity. Worse visual acuity and older age could be identified as predictive factors for their emotional status. Moreover, the disease itself could be recognized as an independent risk factor for depression development, underlying the need for close monitoring and supportive management. To the best of our knowledge, our study is the first in the literature to elaborate the association between keratoconus and depression, by assessing two different questionnaires simultaneously