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Mortality among people who inject drugs (PWID) is high, with overdose and HIV infection being the main causes of death. In Greece, there have been no data on mortality, and two HIV outbreaks have been recorded in this population in the past decade. In this study, we aim to estimate the all-cause crude mortality rate and the standardised mortality ratio in this population during 2018–2022. PWID recruited from two community-based programs in Athens and Thessaloniki during 2018–2021 were interviewed and tested for HIV/HCV. Data on vital status (deceased/alive) and date of death were obtained from death registries through December 31, 2022. All-cause crude mortality rates (CMR) and standardised mortality ratios (SMR) were estimated. Determinants of mortality were assessed using Cox proportional-hazards model. Of 2,530 participants, 301 died over 8,543 person-years (PYs) of follow-up. The CMR (95 % CI) was 3.52 (3.15–3.94) deaths per 100 PYs; 3.10 per 100 PYs (2.68–3.58) in Athens and 4.48 per 100 PYs (3.74–5.37) in Thessaloniki. An increasing trend in CMR was identified over 2018–2022 in Athens (from 2.90 to 4.11 per 100 PYs, 41.5 % increase, p = 0.018). The pooled SMR (95 % CI) was 15.86 (14.17–17.76) for both cities and was particularly increased in younger individuals, females, those injecting daily, not enrolled to opioid agonist treatment and HIV-infected individuals. Older age, living in Thessaloniki, Greek origin, homelessness, history of injection in the past 12 months, and HIV infection were independently associated with higher risk of death. Mortality among PWID in the two largest cities (Athens and Thessaloniki) in Greece in 2018–2022 was high, with the population in Thessaloniki being particularly affected. The increasing trend in mortality in Athens may reflect the long-term impact of the COVID-19 pandemic. Preventive programs such as take-home naloxone, screening and treatment for HIV, are urgently needed. [ABSTRACT FROM AUTHOR]

One of the World Health Organization's targets for the 2030 viral hepatitis elimination strategy is to reduce new hepatitis C (HCV) infections. In Athens, Greece, people who inject drugs (PWID) have a high HCV prevalence, with increasing trends since the 2000s. This analysis aims to assess primary HCV incidence among PWID during 2012–2020. Two community‐based interventions were implemented in 2012–2013 and 2018–2020 with repeated sero‐behavioural surveys in each period. Participants enrolled in multiple surveys were identified through linkage. To assess trends in HCV transmission, three indicators were estimated: (i) anti‐HCV prevalence among ‘new’ injectors (those injecting ≤2 years), (ii) indirect HCV incidence among ‘new’ injectors, assuming infection occurred at the midpoint between initiating injection and the first positive test, and (iii) HCV incidence from repeat participants. There were 431 and 125 ‘new’ injectors, respectively, in 2012–2013 and 2018–2020. Αnti‐HCV prevalence [95% CI] declined from 53.6% [48.8%, 58.3%] in 2012–2013 to 40.0% [31.3, 49.1%] in 2018–2020 (25.4% reduction, p = .007). The indirect estimate [95% CI] of HCV incidence among ‘new’ injectors decreased from 56.1 [49.3, 63.8] to 39.0/100 person‐years (PYs) [29.6, 51.5] (30.5% reduction, p = .020). HCV incidence [95% CI] based on seroconversions in repeat participants (16/63 in 2012–2013 and 9/55 in 2018–2020) declined from 64.6 [39.6105.4] to 13.8/100 PYs [7.2, 26.5], respectively (78.6% reduction, p < .001). Primary HCV incidence remains high among PWID in Athens. Consistent implementation of combined interventions, including high‐coverage harm reduction programs and initiatives tailored to increase access to HCV treatment, is essential to sustain the declining trends documented during 2012–2020. [ABSTRACT FROM AUTHOR]

Gastric carcinoid tumors (GCs) are rare lesions representing less than 10% of carcinoid tumors and less than 1% of all stomach neoplasms. There are three distinct types of gastric carcinoids; type I includes the vast majority (70-85%) of these neoplasms that are closely linked to chronic atrophic gastritis. Type II which accounts for 5-10 %, is associated with Zollinger-Ellison syndrome and often occurs in the context of multiple endocrine neoplasia type 1. Type III, finally, represents 15-25% of gastric carcinoids and is characterized by a far more aggressive course. The optimal clinical approach to GCs remains to be elucidated, depending upon type, size, and number of carcinoids. While there is universal agreement about the surgical treatment of type III GCs, current options for type I and II include simple surveillance, endoscopic polypectomy, surgical excision associated with or without surgical antrectomy, or total gastrectomy. Moreover, the introduction of somatostatin analogues could represent another therapeutic option. [ABSTRACT FROM AUTHOR]

Background and Aims: The human immunodeficiency virus (HIV) outbreak among people who inject drugs (PWID) in Athens, Greece in 2011–13 was the largest recent epidemic in Europe and North America. We aimed to assess trends in HIV prevalence, drug use and access to prevention among PWID in Athens to estimate HIV incidence and identify risk factors and to explore HIV‐1 dispersal using molecular methods during 2014–20. Methods: Two community‐based HIV/hepatitis C programmes on PWID were implemented in 2012–13 (n = 3320) and 2018–20 (n = 1635) through consecutive respondent‐driven sampling (RDS) rounds. PWID were uniquely identified among rounds/programmes. We obtained RDS‐weighted HIV prevalence estimates per round for 2018–20 and compared them to 2012–13. We assessed changes in HIV status, behaviours and access to prevention in PWID participating in both periods. We estimated HIV incidence in a cohort of seronegative PWID as the number of HIV seroconversions/100 person‐years during 2014–20 and used Cox regression to identify associated risk factors. Molecular sequencing and phylogenetic analysis were performed in HIV seroconverters. Results: HIV prevalence per round ranged between 12.0 and 16.2% in 2012–13 and 10.7 and 11.3% in 2018–20 with overlapping 95% confidence intervals (95% CI). Among PWID participating in both programmes, HIV prevalence (95% CI) increased from 14.2% (11.7–17.1%) in 2012–13 to 22.0% (19.0–25.3%) in 2018–20 (P < 0.001). There was a deterioration in socio‐economic characteristics such as homelessness [from 16.2% (95% CI = 13.5–19.2%) to 25.6% (22.3–29.0%)], a shift in cocaine use [16.6% (13.9–19.6%) versus 28.1% (24.7–31.7%], reduced access to free syringes [51.8% (48.0–55.7%) versus 44.5% (40.7–48.3%)] and a decrease in daily injecting [36.2% (32.6–39.9%) versus 28.5% (25.2–32.1%)]. HIV incidence (95% CI) in 2014–20 was 1.94 (1.50–2.52) new cases/100 person‐years and younger age, lower educational level, larger injection network and daily injecting were risk factors. Almost 9% of HIV seroconversions occurred within a newly expanding phylogenetic cluster. Conclusions: In Athens, Greece, compared with the period 2012–13, in the period 2018–20 there was a deterioration in socio‐economic conditions among people who inject drugs, an increase in the use of cocaine, reduced access to needle and syringe programmes and stable low levels of human immunodeficiency virus testing. Ongoing human immunodeficiency virus transmission was documented during 2014–20 in existing as well as new transmission clusters. [ABSTRACT FROM AUTHOR]

Introduction: Bacille Calmette–Guérin (BCG) vaccination has shown promising therapeutic effects for type 1 diabetes (T1D). According to recent studies, immunometabolism modification and regulation of T lymphocytes constitute the proposed mechanisms by which BCG vaccination may delay T1D onset. Clinical trial evidence from Turkey supports that two to three doses of the BCG vaccine in childhood, with the first dose administered in the first year of life, may prevent T1D. In the same study, one or zero vaccinations appeared to have no effect in T1D onset prevention. In Greece, the BCG vaccine was administered in a single dose at the age of 9 years in elementary school. BCG vaccination was not performed on a mandatory basis, creating one BCG vaccinated and one non-vaccinated population. The aim of our study was to investigate the possible effect of a single dose of BCG vaccine, at the age of 9 years, on the time of T1D onset, in a population of BCG vaccinated and non-vaccinated patients with diagnosed T1D. Methods: To test this hypothesis, a survey through the Pan-Hellenic Federation of People with Diabetes (PFPD) was performed. In this observational, retrospective study, participating patients provided information regarding age, gender, time of diagnosis, and BCG vaccination status. Patients diagnosed with T1D before the age of 9 years were excluded from the analysis. Results: The final sample included 196 patients (73 male and 123 female) with a mean age of 42.2 ± 14.3 years and a mean duration of diabetes of 16.8 ± 12.9 years. Mean age of T1D diagnosis in the BCG vaccinated group was 24.0 ± 19.0 years, while the mean age of T1D diagnosis in the BCG non-vaccinated group was 21.5 ± 14.3 years (p = 0.03). No interaction was found between gender and the age of diagnosis for BCG vaccinated and unvaccinated patients (p = 0.86). Conclusion: The results of our study suggest that a single dose of BCG vaccine, performed at the age of 9 years, may delay the onset of T1D by 2.5 years. Additional studies of children receiving multiple doses of BCG should be conducted to possibly prove prolongation of the disease-free interval. [ABSTRACT FROM AUTHOR]

Background Peptic ulcer disease (PUD) is more prevalent in cirrhotics and this may aggravate prognosis. We investigated the prevalence of PUD in cirrhotics and its potential association with Helicobacter pylori (H. pylori) infection, the underlying etiology and severity of liver disease, and other manifestations of portal hypertension (PH). Methods We enrolled consecutive asymptomatic cirrhotic patients who underwent screening endoscopy in a tertiary hospital during a 12-month period. We recorded the presence of PUD and the endoscopic findings associated with PH. H. pylori infection was documented through either histology or CLO-test. The diagnosis of cirrhosis was based on elastography, liver biopsy or a combination of clinical, biochemical and imaging data. Results One hundred patients (M/F: 54/46, mean age: 61±14 years) were included in the analysis. Viral hepatitis (37%) and alcohol (22%) were the most common causes of cirrhosis. Child-Pugh stage was A/B/C: 60/35/5. PUD was found in 19 patients (14 gastric, 5 duodenal). H. pylori infection was diagnosed in 54%. Varices were detected in 59% (39% needed treatment). PH gastropathy was present in 81% (severe in 33%). The presence of PUD was unrelated to the etiology and the severity of liver disease or to other endoscopic manifestations of PH. No correlation was found between PUD and H. pylori infection. Conclusions A high prevalence of PUD was observed in our cirrhotic patients, although they were asymptomatic and had no known risk factors of ulcerogenicity. The value of screening endoscopy for the early diagnosis and treatment of PUD in cirrhotics deserves further investigation. [ABSTRACT FROM AUTHOR]