The Challenging Evaluation of Patients with Severe Psoriasis for Latent Tuberculosis: An Important Indication for IGRA

It is well-established that tumour necrosis factor (TNF)-α-antagonist regimens are advisable for the control of moderate to severe psoriasis; however the application of these agents is associated with increased risk of TB reactivation. Screening for latent tuberculosis infection (LTBI) is indispensable prior to treatment inception in order to diminish the risk of active TB. Although tuberculin skin test (TST) still represents a useful tool for LTBI detection, it is difficult to be performed and read in patients with extensive psoriatic lesions. In this paper, we report the case of a 65-year-old male with severe psoriasis, who was evaluated by an interferon-gamma release assay (IGRA) for LTBI diagnosis prior to anti-TNF-α therapy. Furthermore, the physiological aspects of interferon-gamma release assays are discussed emphasizing the value of these novel immunodiagnostic tests (IGRAs) for presumable LTBI in all patients with extensive skin disorders

Prevalence of chronic HCV infection in EU/EEA countries in 2019 using multiparameter evidence synthesis

Publisher Copyright: © 2023 The Author(s)Background: Epidemiological data are crucial to monitoring progress towards the 2030 Hepatitis C Virus (HCV) elimination targets. Our aim was to estimate the prevalence of chronic HCV infection (cHCV) in the European Union (EU)/European Economic Area (EEA) countries in 2019. Methods: Multi-parameter evidence synthesis (MPES) was used to produce national estimates of cHCV defined as: π = πrecρrec + πexρex + πnonρnon; πrec, πex, and πnon represent cHCV prevalence among recent people who inject drugs (PWID), ex-PWID, and non-PWID, respectively, while ρrec, ρex, and ρnon represent the proportions of these groups in the population. Information sources included the European Centre for Disease Prevention and Control (ECDC) national operational contact points (NCPs) and prevalence database, the European Monitoring Centre for Drugs and Drug Addiction databases, and the published literature. Findings: The cHCV prevalence in 29 of 30 EU/EEA countries in 2019 was 0.50% [95% Credible Interval (CrI): 0.46%, 0.55%]. The highest cHCV prevalence was observed in the eastern EU/EEA (0.88%; 95% CrI: 0.81%, 0.94%). At least 35.76% (95% CrI: 33.07%, 38.60%) of the overall cHCV prevalence in EU/EEA countries was associated with injecting drugs. Interpretation: Using MPES and collaborating with ECDC NCPs, we estimated the prevalence of cHCV in the EU/EEA to be low. Some areas experience higher cHCV prevalence while a third of prevalent cHCV infections was attributed to PWID. Further efforts are needed to scale up prevention measures and the diagnosis and treatment of infected individuals, especially in the east of the EU/EEA and among PWID. Funding: ECDC.Peer reviewe

Analysis of the Major Probiotics in Healthy Women’s Breast Milk by Realtime PCR. Factors Affecting the Presence of Those Bacteria

Breast milk has been reported as a bacteria source that affects infant gut microbiota development. The present study utilizes a realtime PCR method to identify Lactobacillus and Bifidobacterium spp. in the breast milk of healthy women and attempts to identify factors affecting those human milk bacteria. Breast milk samples—both colostrum and mature milk—of 100 healthy women, were collected in Greece along with data about the demographic factors and nutritional habits of the volunteers. The colostrum samples were found to have higher percentages of either Bifidobacterium or Lactobacillus (76.9% and 48.6%, respectively) compared to the mature milk samples. For younger women, aged from 18 to 29 years, and women from rural areas, bacteria were detected in higher incidence than for older groups and women in urban areas, respectively. Moreover, for high-BMI women, bacteria were detected in lower incidence than for those with normal BMI. Probiotic supplements did not affect the composition of the breast milk-identified bacteria. Various factors such as lactation stage, maternal age, maternal weight, and residential location may contribute to the presence of those species in human milk. RT PCR has significant potential for the microbiological analysis of human milk

Factors affecting HCV vertical transmission

Objective: To determine the rate of mother-to-infant transmission of hepatitis C virus (HCV) and identify risk factors associated with HCV transmission. Methods: We prospectively studied 84 infants born to anti-HCV positive mothers and 66 infants born to HIV/HCV co infected mothers. HCV infection was verified in all mothers before delivery and their HCV viral load was measured at or near delivery using reverse transcription polymerase reaction (Amplicor, HCV Monitor). For HCV genotyping the INNO-Lipa II probe assay was used. Possible risk factors for vertical transmission were recorded. The children were followed up for evidence of HCV infection at the age of 0, 1, 3 months, every 3 months during the first year of their life and every 6 months thereafter. HCV infection was determined by persistent presence of HCV antibodies after 18 months and/or detection of HCV-RNA in more than 2 samples after the 3rd month of life. Results: 9 infants (6%) had HCV antibodies after the 18th month of age and those had detectable HCV-RNA in their serum during their first year. HCV transmission rate was associated with HCV maternal viral load (p=0,02). The HIV-infected mothers and those using drugs intravenously were more likely to transmit HCV to their children. The infected children had the same genotype as their mother. The transmission rate was not influenced by the mode of delivery or by the type of child’s feeding. All non-infected infants had anti-HCV antibodies at birth, progressively disappearing within 12 months. Conclusion: Our data confirm that HCV transmission rate was 6% and was associated with HCV maternal viral load, HIV co-infection and/or active drug abuse during pregnancy. The transmission rate was not influenced by the mode of delivery or by the type of child’s feedingΣκοπός: Εκτίμηση της συχνότητας της κάθετης μετάδοσης του ιού της ηπατίτιδας C (HCV) από μητέρα σε παιδί και προσδιορισμός παραγόντων που την επηρεάζουν. Μέθοδος: Η μελέτη περιέλαβε 84 νεογνά των οποίων οι μητέρες είχαν ηπατίτιδα C (θετικά αντί-HCV αντισώματα), χωρίς ταυτόχρονη λοίμωξη από HIV και 66 νεογνά των οποίων οι μητέρες είχαν συλλοίμωξη HCV και HIV. Η HCV λοίμωξη είχε επιβεβαιωθεί στις μητέρες πριν τον τοκετό και το ιικό τους φορτίο μετρήθηκε με PCR (AMPLICOR, HCV Monitor) κατά την περιγεννητική περίοδο. Σε κάθε μητέρα ή παιδί με επιβεβαιωμένη ΗCV λοίμωξη ελέγχθηκε ο γονότυπος του ιού με μέθοδο INNO-Lipa II (INNOGENETICS N.V., Belgium). Tα παιδιά παρακολουθούνταν προοπτικά για παρουσία HCV λοίμωξης σε ηλικία 0, 1, 3 μηνών, ανά τρίμηνο στη διάρκεια του πρώτου χρόνου της ζωής και μετά ανά εξάμηνο. Καταγράφονταν παράγοντες που έχουν συσχετιστεί με την κάθετη μετάδοση της ηπατίτιδας C. Η διάγνωση HCV λοίμωξης στα παιδιά ετίθετο με: ανίχνευση HCV RNA σε περισσότερα από 2 δείγματα ορού μετά τον τρίτο μήνα της ζωής και/ή παρουσία αντί- HCV αντισωμάτων μετά τον 18ο μήνα της ζωής. Αποτελέσματα: Αρχικά όλα τα παιδιά είχαν θετικά αντί- HCV αντισώματα, ενώ μετά την ηλικία των 18 μηνών μόνο 9 παιδιά παρέμειναν HCV οροθετικά. Τα 9 αυτά παιδιά είχαν θετικό HCV- RNA κατά τον πρώτο χρόνο της ζωής τους. Η κάθετη μετάδοση ήταν συχνότερη στα παιδιά των μητέρων που παρουσίαζαν υψηλό ιικό φορτίο για HCV (p=0.02), HCV-HIV συλλοίμωξη (p=0.01), ή έκαναν ενδοφλέβια χρήση εξαρτησιογόνων (p=0.0035). Τα μολυνθέντα βρέφη είχαν τον ίδιο γονότυπο με τις μητέρες τους. O γονότυπος δεν βρέθηκε να σχετίζεται με τη κάθετη μετάδοση της λοίμωξης. Συμπεράσματα: Τα ευρήματά μας δείχνουν ότι η κάθετη μετάδοση της ηπατίτιδας C ήταν 6% και σχετιζόταν με το ιικό φορτίο της μητέρας, την ενδοφλέβια χρήση ναρκωτικών και την HIV συλλοίμωξ

Thermia_ landscape intervention at Loutra, Kythnos

Η τοπιακή παρέμβαση στα Λουτρά Κύθνου αφορά τη συμπλήρωση των λουτρικών χρήσεων που στεγάζονται στο Υδροθεραπευτήριο(σχέδια C.Hansen), ιδιοκτησίας ΕΟΤ και τη δημιουργία χώρων αναψυχής σε επαφή με τη φύση, μέσα από μία πρόταση σε αρμονία με το τοπίο. Σκοπός ήταν η δημιουργία ενός υπερτοπικού πόλου έλξης στον οικισμό, χωρίς να διαταράσσονται οι ισορροπίες του νησιού, να δημιουργηθεί ένας «ευγενής» τουρισμός. Η συστηματική μελέτη του φυσικού και δομημένου περιβάλλοντος του οικισμού αποτελεί βασικό στοιχείο για να διερευνηθούν τα περισσότερο ισχυρά χαρακτηριστικά του τόπου και να αποτελέσουν αφορμή για τη συνθετική ιδέα. Μελετήθηκε ευρύτερα το κυκλαδίτικο τοπίο, αλλά και τα επιμέρους στοιχεία του οικισμού, καθώς και η ίδια η χρήση των ιαματικών νερών και από την πλευρά της αναψυχής για πολλούς και διαφορετικούς χρήστες. Η μελέτη αυτή οδήγησε στην επιλογή της τοποθέτησης χρήσεων σχετικών με την αγροτική ύπαιθρο και τη συμπλήρωση των λουτρικών χρήσεων. Αξιοποιήθηκε η διαμόρφωση που έχει επέλθει φυσικά στην περιοχή παρέμβασης και βασικά στοιχεία από τη γειτνίαση με το κτισμένο περιβάλλον. Τοποθετείται ένα σύγχρονο κτίριο λουτρών, ένα παραδοσιακό πατητήρι, ένα παραδοσιακό λιοτρίβι, ένα wine bar και ένα πωλητήριο τοπικών προϊόντων. Δημιουργείται μία θεματική διαδρομή, πάνω στην οποία τοποθετούνται οι χρήσεις.The landscape intervention in village Loutra, Kythnos is about completion of baths uses, at the moment housed in Spa (drawings C.Hansen), property of EOT and create recreational areas in contact with nature, through a motion in harmony with the landscape. The aim was to create a magnet to the village, without disturbing the balance of the island, creating a "gentle" tourism. The systematic study of the natural and built environment of the village is a key element to explore the most powerful features of the site and have prompted the basic idea. We studied the Cycladic landscape, but also the components of the settlement, and the very use of the hot water from the side of recreation for many different users. This study led to the selection of placing uses about the island countryside and the baths. We used the configuration that has occurred naturally in the intervention area and key elements of its proximity to the built environment. We decided to place a modern building of baths, a traditional wine press, a traditional olive press, a wine bar and a gift shop of local products. We created a thematic route, on which we placed the different uses.Ευαγγελία Σ. Νικολάου-ΑλαβάνουΓεωργία Α. Νικολοπούλο

Cerebrospinal Fluid Anti-Neuronal Autoantibodies in COVID-19-Associated Limbic Encephalitis with Acute Cerebellar Ataxia and Myoclonus Syndrome: Case Report and Literature Review

Since the outbreak of coronavirus (COVID-19) in 2019, various rare movement disorders and cognitive changes have been recognized as potential neurological complications. The early treatment of some of these allows rapid recovery; therefore, we must diagnose these manifestations in a timely way. We describe the case of a 76-year-old man infected with severe acute respiratory syndrome coronavirus-2 who presented with confusion and hallucinations and was admitted to our hospital 14 days after the onset of symptoms. One day later, he developed generalized myoclonus, dysarthria and ataxia, and tonic clonic seizures and was admitted to the intensive care unit. A diagnosis of COVID-19-associated autoimmune encephalitis with characteristics of limbic encephalitis and immune-mediated acute cerebellar ataxia and myoclonus syndrome was supported by alterations in the limbic system shown in magnetic resonance imaging, lateralized discharges shown in electroencephalography, a slightly elevated protein level in the cerebrospinal fluid (CSF), and indirect immunofluorescence in the CSF with autoantibody binding to anatomical structures of the cerebellum and hippocampus. The patient improved with 2 weeks of corticosteroid treatment and four sessions of plasmapheresis. Our current case study describes a rare case of COVID-19-related limbic encephalitis with immune-mediated acute cerebellar ataxia and myoclonus syndrome (ACAM syndrome) and strengthens the need for tissue-based assays (TBAs) to screen the serum and/or CSF of patients highly suspected to have autoimmune encephalitis. We believe that the timely diagnosis and targeted aggressive immunotherapy were mainly responsible for the patient’s total recovery

Prevalence and clinical course of hepatitis delta infection in Greece: A 13-year prospective study

Background & Aims: Hepatitis D virus (HDV) has decreased in Europe, but recent reports indicate a rising trend. We report the epidemiological changes, clinical progress, and effect of treatment on the natural course of HDV infection in Greece during the last 13 years. Methods: Prospective data were extracted from the Hep-Net. Greece Cohort-Study. Results: Since 1997, 4673 chronic HBV (CHB) cases (4527 adults, 146 children) have been followed prospectively. Two thousand one hundred thirty-seven patients were tested for anti-HDV [101 (4.7%) positive]. Anti-HDV testing in Greece decreased significantly (57.0% before 2003, 35.3% thereafter; p < 0.001). Anti-HDV prevalence among HBsAg-positives was 4.2%; lower in native Greeks (2.8%) than in immigrants (7.5%) or in children (15.3%; p < 0.001). Within 2.3 years of follow-up, HDV occurred in 11/2047 HBsAg-positive patients (2.2 new delta-infected adults and 8.7 children per 1000 HBsAg-positive annually). HDV-positive compared to CHB adults were younger (p = 0.035) and had more active and advanced disease at baseline, as indicated by laboratory indices and the higher prevalence of cirrhosis at younger age. During a 4.2-year median observation, significantly more anti-HDV-positive than CHB adults developed a liver-related first event (20.0% vs. 8.5%, p(Log-rank) = 0.014). Treatment was received by 46/90 (51.1%) patients, 40 of them interferon-based. In multivariable analysis, interferon significantly decreased disease progression in HDV-positive patients [HR = 0.14 (95% CI: 0.02-0.86; p = 0.033)]. Conclusions: In Greece, HDV serology is currently tested in only one-third of HBsAg-positive patients. HDV prevalence is lower in native Greeks compared to immigrants, who may contribute >50% of the HDV infection burden in Greece. Data show that HDV infection is a rapidly progressive disease, but interferon-based treatment may alter its course. (C) 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved

Prevalence and Prognostic Factors of Stress Hyperglycemia in a Pediatric Population with Acute Illness in Greece—A Prospective Observational Study

Background: stress hyperglycemia (SH) is a relatively frequent finding in pediatric patients. The purpose of this prospective observational study was to identify the prevalence of pediatric SH and its associated risk factors in Greece. Methods: A total of 1005 patients without diabetes who were admitted consecutively for acute illness in a Pediatric Emergency Department were included in the study. Medical history, anthropometric measurements, blood glucose levels, and the medication administered were recorded. A questionnaire was distributed to parents regarding medical and perinatal history and sociodemographic characteristics. Results: There were 72 cases of SH on admission (7.2%) and 39 (3.9%) during hospitalization. Mean age was 6.4 years; 50.3% were male. SH on admission was associated with oral corticosteroid therapy (21.1% vs. 4.7%, p < 0.001), inhaled corticosteroids (12.7% vs. 3%, p < 0.001), and inhaled β2-agonists (30.6% vs. 10.7%, p < 0.001). In-hospital hyperglycemia was associated with oral corticosteroids (adjusted OR = 3.32), inhaled corticosteroids (OR = 10.03) and inhaled β2-agonists (OR = 5.01). Children with asthma were 5.58 and 7.86 times more likely to present admission and in-hospital hyperglycemia, respectively. Conclusions: This is the first report of SH prevalence in pediatric patients in Greece. Asthma, corticosteroids, and β2-agonists significantly increase the risk of SH. No parental factors seem to predispose to SH