Complicated Gallstones after Laparoscopic Sleeve Gastrectomy

Background. The natural history of gallstone formation after laparoscopic sleeve gastrectomy (LSG), the incidence of symptomatic gallstones, and timing of cholecystectomy are not well established. Methods. A retrospective review of prospectively collected database of 150 patients that underwent LSG was reviewed. Results. Preoperatively, gallbladder disease was identified in 32 of the patients (23.2%). Postoperatively, eight of 138 patients (5.8%) became symptomatic. Namely, three of 23 patients (13%) who had evident cholelithiasis preoperatively developed complicated cholelithiasis. From the cohort of patients without preoperative cholelithiasis, five of 106 patients (4.7%) experienced complicated gallstones after LSG. Total cumulative incidence of complicated gallstones was 4.7% (95% CI: 1.3–8.1%). The gallbladder disease-free survival rate was 92.2% at 2 years. No patient underwent cholecystectomy earlier than 9 months or later than 23 months indicating the post-LSG effect. Conclusion. A significant proportion of bariatric patients compared to the general population became symptomatic and soon developed complications after LSG, thus early cholecystectomy is warranted. Routine concomitant cholecystectomy could be considered because the proportion of patients who developed complications especially those with potentially significant morbidities is high and the time to develop complications is short and because of the real technical difficulties during subsequent cholecystectomy

Elevated Bathing-Associated Disease Risks Despite Certified Water Quality: A Cohort Study

Bacteriological water quality criteria have been recommended to ensure bathers’ health. However, this risk-assessment approach is based mainly on routine measurements of fecal pollution indicator bacteria in seawater, and may not be adequate to protect bathers effectively. The aim of this study was to assess the risks of symptoms related to infectious diseases among bathers after exposure to seawater which was of excellent quality according to EU guidelines. This study is a cohort study recruiting bathers and non-bathers. Water samples were collected for estimating bacterial indicators. Univariable and multivariable analysis was performed to compare the risks of developing symptoms/diseases between bathers and non-bathers. A total of 3805 bathers and 572 non-bathers were included in the study. Water analysis results demonstrated excellent quality of bathing water. Significantly increased risks of symptoms related to gastrointestinal infections (OR = 3.60, 95% CI 1.28–10.13), respiratory infections (OR = 1.92, 95% CI 1.00–3.67), eye infections (OR = 2.43, 95% CI 1.27–4.63) and ear infections (OR = 17.21, 95% CI 2.42–122.34) were observed among bathers compared with non-bathers. Increased rates of medical consultation and medication use were also observed among bathers. There was evidence that bathers experienced increased morbidity compared with non-bathers though the bathing waters met bacteriological water quality criteria. These results suggest that risk assessments of recreational seawaters should not only focus on bacteriological water quality criteria

The importance of an active case detection (Acd) programme for malaria among migrants from malaria endemic countries: The greek experience in a receptive and vulnerable area

Greecehasbeenmalaria-freesince1974. InOctober2011,followinganoutbreakof36locally acquired malaria (LAM) cases in Evrotas Municipality, a Pro-Active Case Detection (PACD) program for malaria was implemented among migrants from malaria-endemic countries, to support early diagnosis and treatment of cases. We evaluated the PACD program for the years 2012–2017 using indicatorssuchasthenumberoflocallyacquiredcases,thedetectionrate/sensitivityandthetimeliness of diagnosis and treatment. We visited each migrant home every 7–15 days to screen migrants for malaria symptoms, performing Rapid Diagnostic Tests (RDTs) and blood smears on symptomatic patients. We estimated: (i) the number of malaria cases detected by the PACD, divided by the total number of reported malaria cases during the same period among the same population; (ii) the time betweenonsetofsymptoms,diagnosisandinitiationoftreatment. Thetotalnumberofmigrantswho were screened for malaria symptoms for the years 2012–2017 was 5057 with 84,169 fever screenings conducted, while 2288 RDTs and 1736 blood smears were performed. During the same period, 53 imported P. vivax malaria cases were detected, while incidence of malaria among migrants was estimated at 1.8% annually. Ten and one LAM cases were also reportedin 2012 and 2015, respectively. Sensitivity of PACD ranged from 86% to 100%; median timeliness between onset of symptoms and diagnosis decreased from 72 h in 2012 to 12 h in 2017 (83% decrease), while timeliness betweendiagnosis and treatment initiation was 0 h. The implementation of PACD could be considered an effective prevention and response tool against malaria re-introduction

Estimation of the incidence of infections by enterohemorrhagic Escherichia coli O157: H7 in the human population of central Greece: correlation of the frequency that the prevalence of the pathogen in the animal population, as well as animal and plant products

In Greece, Shiga toxin-producing Escherichia coli (STEC) have only been sporadically reported. The objective of this study was to estimate the prevalence of Escherichia coli O157:H7 in farm animals, vegetables and humans in Greece. A total number of 1010 fecal samples were collected from farm animals (sheep, goats, cattle, chickens, pigs), 667 diarrheal samples from humans and 60 from vegetables, 30 raw meat products και 30 milk samples for the detection of STEC using ELISA and, subsequently, the toxin-producing colonies were subjected to a multiplex PCR for genes stx1, stx2, eae, O157 and H7. In animal samples, 80 strains (7.9%) were found to produce Shiga toxin by ELISA, while by PCR, E. coli O157:H7 strains were detected from 8 (0.8%) and non-O157 STEC strains from 43 (4.2%) samples. STEC strains were isolated mainly from sheep and goats, rarely in cattle and not in pigs and chickens, suggesting that small ruminants constitute a potential risk for human infections. However, from the 667 human specimens only three (0.5%) were positive for the detection of Shiga toxins and all were PCR negative. Similarly, colorless colonies from all 60 vegetable samples were examined using ELISA for toxin production and PCR for toxin genes and were all negative, but colonies from 3 samples (two roman rockets and one spinach) were positive by PCR for O157 and H7. E. coli O157:H7 was not detected in meat and milk samples examined. These findings indicate that sheep, goats, cattle and leafy vegetables can be a reservoir of STEC and E. coli O157:H7 in Greece and the consumption of unpasteurized goat and sheep milk, undercooked meat or inadequately washed vegetables may serve as vehicle for STEC transmission to humans.Εως σήμερα στην Ελλάδα δεν αναφέρονται εξάρσεις κρουσμάτων που να οφείλονται σε STEC (Shiga toxin-producing Escherichia coli) και οι περιπτώσεις λοίμωξης από STEC που έχουν καταγραφεί αποτελούν σποραδικές περιπτώσεις. Σκοπός της μελέτης αυτής είναι η εκτίμηση της επίπτωσης της E. coli O157:H7 στους ανθρώπους και η συσχέτισή της με τον επιπολασμό του παθογόνου στο ζωικό πληθυσμό καθώς και με τον επιπολασμό του σε προϊόντα ζωικής και φυτικής προέλευσης στην περιοχή της κεντρικής Ελλάδας. Συνολικά, συλλέχθηκαν 1010 δείγματα κοπράνων ζώων (πρόβατα, αίγες, βοοειδή, όρνιθες, χοίροι), 667 δείγματα κοπράνων από ασθενείς με διάρροια, 60 δείγματα από λαχανικά, 30 δείγματα ωμού κρέατος και 30 δείγματα ωμού γάλακτος. Από τις καλλιέργειες των δειγμάτων αυτών, αποικίες συμβατές με E. coli που παράγουν Shiga toxin (άχρωμες αποικίες σε θρεπτικό υλικό SMAC) εξετάστηκαν για την απομόνωση των STEC μέσω της χρήσης ELISA και ακολούθως οι αποικίες που ήταν θετικές για Shiga τοξίνη εξετάστηκαν με PCR για την ανίχνευση των παθογόνων γονιδίων stx1, stx2, eae, O157 και H7. Στα δείγματα που προέρχονταν από τα κόπρανα των ζώων, απομονώθηκαν 80 (7.9%) στελέχη που παρήγαγαν Shiga τοξίνη μέσω της ELISA, ενώ μέσω της PCR, E. coli O157:H7 στελέχη απομονώθηκαν από 8 (0.8%) και non-O157 STEC στελέχη από 43 (4.2%) δείγματα. Τα STEC στελέχη απομονώθηκαν κυρίως από πρόβατα και αίγες, μικρός αριθμός απομονώθηκε από βοοειδή και κανένα από τα κόπρανα χοίρων και όρνιθων. Τα αποτελέσματα υπογραμμίζουν την παρουσία των STEC στα μικρά μηρυκαστικά και φαίνεται ότι τα ζώα αυτά μπορούν να αποτελέσουν παράγοντες κινδύνου για τη μετάδοση της λοίμωξης στους ανθρώπους. Από τα 667 δείγματα κοπράνων από διαρροϊκούς ασθενείς που εξετάστηκαν, μόνο τρία (0.5%) ήταν ασθενώς θετικά για την απομόνωση της Shiga τοξίνης και όλα ήταν PCR αρνητικά. Ομοίως, και τα 60 δείγματα λαχανικών ήταν αρνητικά για την παραγωγή Shiga τοξίνης. Οι άχρωμες αποικίες από τα λαχανικά εξετάστηκαν όλες με PCR και βρέθηκαν αρνητικές για λοιμογόνα γονίδια, αποικίες από τρία όμως δείγματα (δυο δείγματα ρόκας και ένα σπανάκι) ήταν θετικές για τα γονίδια Ο157 και Η7. Η E. coli O157:H7 δεν απομονώθηκε σε κανένα από τα δείγματα κρέατος και γάλακτος που εξετάστηκαν. Τα αποτελέσματα αυτά, αποδεικνύουν ότι τα πρόβατα, οι αίγες, τα βοοειδή και τα φυλλώδη λαχανικά μπορούν να αποτελέσουν πηγές μετάδοσης των STEC και της Ε. coli O157:H7 στους ανθρώπους στην Ελλάδα, μέσω της κατανάλωσης μη καλά ψημένου κρέατος, μη παστεριωμένου γάλακτος ή μη κατάλληλα πλυμένων λαχανικών

Prevalence of Electronic Cigarette Use and Its Determinants among 13-to-15-Year-Old Students in Greece: Results from the 2013 Global Youth Tobacco Survey (GYTS)

Electronic cigarette use has increased over the past decade. Its potential role in smoking cessation, in addiction and as a ‘gateway’ to tobacco smoking is subject to intense research. This cross-sectional study, carried out in 2013, aims to present the habits of students aged 13–15 in Greece with regard to e-cigarettes and investigate potential risk factors and the relationship between e-cigarettes, tobacco smoking and other nicotine products. It is the first such study to be carried out in Greece. The survey was based on the standardized methodology of the Global Youth Tobacco Survey. All potential associations were investigated using multiple logistic regression. In total 2.8% of the 4096 participating students were current e-cigarette users and 12.3% of them were ever users. E-cigarette use was associated with male gender, being older, current use of combustible tobacco products and e-cigarette use in the family. Ever e-cigarette use, being older, female gender and higher pocket money were associated with an increased susceptibility to tobacco smoking. E-cigarette prevalence in Greece in 2013 was similar to that of other, developed countries. The smoking and vaping habits of adolescents must be monitored in order to assess trends over time and whether any policy alterations are necessary

Introducing New Paths towards Public Primary Healthcare Services in Greece: Efforts for Scaling-Up Mental Healthcare Services Addressed to Older Adults

The exponential growth in the aging population challenges the Primary Care Providers (PCPs) who provide health care services to older adults who are considered highly vulnerable and are in need of specialized healthcare services. The development of new policies and the adoption of appropriate health strategies by PCPs may improve the early detection and prevention of mental disorders in older adults. This reduces both queuing and costs in outpatient clinics while preventing stigma for patients and families. To this end, specialized training for PCPs at the Local Primary Health Care Unit (LPHCU) was provided in order to conduct efficient assessments of older adults (65 and above years old, without previously diagnosed depression or dementia, and willing to participate). The assessment is based on the Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS). Older adults identified with MMSE <20 and GDS >5 were referred to the psychiatric outpatient clinic. The aim of this study is to discuss evidence-informed policymaking in Greece with a focus on advancing mental health practices and scaling up quality primary healthcare services for older adults

Wastewater monitoring as a supplementary surveillance tool for capturing SARS-COV-2 community spread. A case study in two Greek municipalities

A pilot study was conducted from late October 2020 until mid-April 2021, aiming to examine the association between SARS-CoV-2 RNA concentrations in untreated wastewater and recorded COVID-19 cases in two Greek municipalities. A population of Random Forest and Linear Regression Machine Learning models was trained and evaluated incorporating the concentrations of SARS-CoV-2 RNA in 111 wastewater samples collected from the inlets of two Wastewater Treatment Plants, along with physicochemical parameters of the wastewater influent. The model’s predictions were adequately associated with the 7-day cumulative cases with the correlation coefficients (after 5-fold cross validation) ranging from 0.754 to 0.960 while the mean relative errors ranged from 30.42% to 59.46%. Our results provide indications that wastewater-based predictions can be applied in diverse settings and in prolonged time periods, although the accuracy of these predictions may be mitigated. Wastewater-based epidemiology can support and strengthen epidemiological surveillance

Field Application of SD Bioline Malaria Ag Pf/ Pan Rapid Diagnostic Test for Malaria in Greece Field Application of SD Bioline Malaria Ag Pf/ Pan Rapid Diagnostic Test for Malaria in Greece

Abstract Greece, a malaria-free country since 1974, has experienced re-emergence of Plasmodium vivax autochthonous malaria cases in some agriculture areas over the last three years. In early 2012, an integrated control programme (MALWEST Project) was launched in order to prevent re-establishment of the disease. In the context of this project, the rapid diagnostic tests (RDT) of SD Bioline Malaria Ag Pf/Pan that detects hrp-2 and pan-LDH antigens were used. The aim of this study was to assess the field application of the RDT for the P. vivax diagnosis in comparison to light microscopy and polymerase chain reaction (PCR). A total of 955 samples were tested with all three diagnostic tools. Agreement of RDT against microscopy and PCR for the diagnosis of P. vivax was satisfactory (K value: 0.849 and 0.976, respectively). The sensitivity, specificity and positive predictive value of RDT against PCR was 95.6% (95% C.I.: 84.8-99.3), 100% (95% C.I.: 99.6-100.0) and 100% (95% CI: 91.7-100.0) respectively, while the sensitivity, specificity and positive predictive value of RDT against microscopic examination was 97.4% (95% C.I.: 86.1-99.6), 99.4% (95% C.I.: 98.6-99.8) and 86.1% (95% CI: 72.1-94.7), respectively. Our results indicate that RDT performed satisfactory in a non-endemic country and therefore is recommended for malaria diagnosis, especially in areas where health professionals lack experience on light microscopy

Flow chart of all samples collected for malaria in Greece (2012).

<p>Flow chart of all samples collected for malaria in Greece (2012).</p