Jaundice-Should "yellow" be a red code?

Objective: Jaundice is the clinical manifestation, of hyperbilirubinemia. It is considered as a sign of either a liver disease or, less often, of a hemolytic disorder. It can be divided into obstructive and non obstructive type, involving increase of indirect (non-conjugated) bilirubin or increase of direct (conjugated) bilirubin, respectively, but it can be also manifested as mixed type. Methods: This article updates the current knoweledge concerning the jaundice's etiology, pathophysiological mechanisms, and complications ant treatment by reviewing of the latest medical literature. It also presents an approach of jaundice's treatment and pathogenesis, in special populations as in neonates and pregnant women. Results: The treatment is consistent in the management of the subjective diseases responsible for the jaundice and its complications.The clinical prognosis of the jaundice depends on the etiology. Surgical treatment of jaundiced patients is associated with high mortality and morbidity rates. Studies have shown that the severity of jaundice and the presence of malignant disease are importan risk factors for post-operative mortality. Conclusions: Early detection of jaundice is of vital importance because of its involvement in malignancy or in other benign conditions requiring immediate treatment in order to avoid further complications

Methylene tetrahydrofolate reductase gene polymorphisms and their association with methotrexate toxicity: a meta-analysis

Objective A systematic review and a meta-analysis were conducted, to investigate the possible association of methylene tetrahydrofolate reductase (MTHFR) gene polymorphisms with adverse effects related to methotrexate (MTX). Methods A systematic literature search in PubMed retrieved a total of 44 studies (42 unique articles). Two polymorphisms were included in the meta-analysis: C677T and A1298C. Random effect models were used in the analysis. Odds ratios along with their 95% confidence intervals were computed to compare the distribution of alleles and genotypes between cases and controls. Results The analysis highlighted a significant association of C677T polymorphism with overall MTX toxicity, hepatotoxicity, hematological toxicity, and neurotoxicity. It also revealed an association with MTX toxicity in patients with rheumatoid arthritis. In contrast, a protective effect of C677T MTHFR polymorphism on acute graft-versus-host disease and on patients treated with hematopoietic cell transplantation was found. As for the A1298C polymorphism, a statistically significant association with overall MTX toxicity and a protective role of the polymorphism in rheumatoid arthritis patients was detected. Conclusion These results indicate the association of MTHFR polymorphisms with MTX toxicity. However, further studies are needed to reveal the underlying biological mechanism of the association. Pharmacogenetics and Genomics 22: 117-133 (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins

Containing Carbapenemase-producing Klebsiella pneumoniae in an endemic setting

Background: Carbapenemase-producing K. pneumoniae (CP-Kp) has been established as important nosocomial pathogen in most tertiary care hospitals in Greece. The aim of the present study was to examine the impact of an enhanced infection control program on the containment of CP-Kp in a haematology unit where the incidence of CP-Kp infections was high. Methods: The study was conducted from June 2011 to December 2014 in a haematology unit of a tertiary-care 500-bed hospital located in Athens, Greece. A bundled intervention (active surveillance cultures, separation of carriers from non-carriers, assignment of dedicated nursing staff, contact precautions, environmental cleaning, and promotion of hand hygiene) was tested whether would reduce colonization and infection caused by CP-Kp. Results: A total of 2507 rectal swabs were obtained; 1199 upon admission from June 2011 to June 2013 and 1307 during hospitalization from June 2011 to December 2012. During intervention the admission prevalence of CP-Kp colonization (p < 0.001 for linear trend), the hospitalization prevalence (p = 0.001 for linear trend) and the incidence rate of CP-Kp colonization (p = 0.072 for linear trend) were declining. Application of segmented linear regression revealed that both the change in the level of CP-Kp BSI incidence rates (p = 0.001) as well as the difference between pre- and post-intervention slopes were statistically significant (p < 0.001). Conclusions: A bundled intervention including active surveillance cultures on admission can attain maximum containment of CP-Kp colonization and infection in endemic acute healthcare settings. © 2020 The Author(s)

KPC-producing, multidrug-resistant klebsiella pneumoniae sequence type 258 as a typical opportunistic pathogen

The virulence of a KPC-producing Klebsiella pneumoniae sequence type 258 (ST258) strain representing those circulating in Greece was assessed in a mouse septicemia model. The strain was virtually avirulent (50% lethal dose,>108 and 5×107 CFU for immunocompetent and neutropenic animals, respectively). Also, it was highly susceptible to serum killing, rapidly phagocytosed in vitro, and classified as K41, which is not among the virulent capsular types. The findings indirectly support the notion that high ST258-associated mortality is largely due to inefficient antimicrobial treatment. Copyright © 2013, American Society for Microbiology. All Rights Reserved

Myocarditis in a pediatric patient with campylobacter enteritis: A case report and literature review

Myocarditis represents a potential complication of various infectious and noninfectious agents and a common diagnostic challenge for clinicians. Data regarding Campylobacter-associated myocarditis are limited. Here, a case of a 13-year-old female with Campylobacter jejuni gastroen-teritis complicated by myocarditis is presented, followed by a literature review in order to retrieve information about Campylobacter-associated carditis in the pediatric population. A search on MED-LINE/PubMed yielded 7relevant cases in the last 20 years. Most of them (six/seven) were males and the mean age was 16.1 years. All patients presented with gastrointestinal symptoms followed in six/seven cases by chest pain within two to seven days. Campylobacter was isolated from stool cultures in six patients; abnormal electrocardiographic findings were detected in six; and abnormal echocardiographic findings in three of the cases. Five patients were treated with antibiotics. Full recovery was the clinical outcome in six patients, whereas one patient died. Concerning the nonspecific symptoms of patients with myocarditis, high clinical suspicion of this complication is necessary in cases where patients with a recent infection present with chest pain and elevated cardiac biomarkers. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Assessing multiple sources of data to detect illegal fishing, trade and mislabelling of elasmobranchs in Greek markets

Elasmobranchs, extremely charismatic and threatened animals, still are an important economic source for fishers in many parts of the world, providing significant income through trade. Even though Greek seas host at least 67 elasmobranch species, our knowledge about their biology and ecology is to a large extent unknown. In the present study the integration of conventional (legislation, official data from fisheries landings and fish market value and import/export data) and unconventional (social media) sources of data, accompanied with the use of genetics, aim at outlining the elasmobranch fisheries and trade in Greece and identifying “weak spots” that sabotage their conservation. Results revealed that: (a) about 60% of the 68 specimens collected in fish markets were mislabelled, with that being very common for Prionace glauca and Mustelus spp., (b) Illegal fishing is a reality, c) Greece represents one of the top-three European Union southern countries in terms of elasmobranch market size, (d) Aegean Sea and especially its Northern part (Thermaikos Gulf and Thracian Sea) contributed to more than half of the M. mustelus Greek fisheries landings and (e) wholesale prices of elasmobranchs have remained stable during the last decade. Mislabelling and illegal trade of elasmobranchs are common ground in Greece. This context stems from incoherent and complex fisheries legislative framework due to institutional decoupling, discrepancies in the collection and analysis of fisheries-related data, thus substantially reducing the efficiency of the fisheries management in Greek seas

An Updated Greek National Checklist of Chondrichthyans

Accurate checklists of species are essential for evaluating their conservation status and for understanding more about their distribution, biology and ecology and, therefore, the first step in order to effectively protect them. According to the existing literature, the Greek seas are rich in chondrichthyan biodiversity and herein, we update the most recent chondrichthyan checklist for the country regarding the species that are present in the Greek waters, correct unvalidated miscellaneous sightings and observations and provide guidelines about future research to improve their conservation. In total, 330 sources were collected from which 276 were used for further analysis, resulting in 1485 records of 67 species, among which 61 are confirmed by experts, including 34 sharks, 26 batoids and one chimaera. We are further listing six species as “Questionable/Not Confirmed”

An Updated Greek National Checklist of Chondrichthyans

Accurate checklists of species are essential for evaluating their conservation status and for understanding more about their distribution, biology and ecology and, therefore, the first step in order to effectively protect them. According to the existing literature, the Greek seas are rich in chondrichthyan biodiversity and herein, we update the most recent chondrichthyan checklist for the country regarding the species that are present in the Greek waters, correct unvalidated miscellaneous sightings and observations and provide guidelines about future research to improve their conservation. In total, 330 sources were collected from which 276 were used for further analysis, resulting in 1485 records of 67 species, among which 61 are confirmed by experts, including 34 sharks, 26 batoids and one chimaera. We are further listing six species as “Questionable/Not Confirmed”