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AimsTo estimate all-cause mortality in a cohort of people who inject drugs (PWID) over the period 2018–2022 in the two major cities of Greece (Athens and Thessaloniki).MethodsPWID were recruited from two community-based seek-test-treat programs for HCV and HIV infections in Athens and Thessaloniki. Participants provided information on sociodemographic characteristics, injection practices, social security number, access to harm reduction and treatment. Data on the vital status and date of death were identified from the national HCV treatment registry. All-cause mortality rates (CMR) were estimated as well as age-, gender- and calendar-year standardized mortality ratios (SMR). Determinants of mortality were assessed using a Cox proportional-hazards model.ResultsOf 2,433 PWID, 243 (10.0%) died over a total of 6,649 person-years (PYs) of follow-up. The CMR [95% confidence interval (CI)] was 3.50 (3.08–3.97) deaths per 100 PYs; 3.03 (2.58–3.57) in Athens and 4.56 (3.74–5.57) in Thessaloniki. An increasing trend in CMR was identified over the period 2018–2022 in Athens (p for trend=0.004). The overall SMR (95% CI) was 17.17 (15.14–19.47) per 100 PYs in the combined cohort; 15.10 (12.85–17.75) in Athens and 21.72 (17.78–26.53) in Thessaloniki. The SMR was particularly increased in younger ages, females, those injecting daily, and HIV-infected PWID. Older age, living in Thessaloniki, Greek origin, homelessness, daily injecting drug use, HIV, and HCV infections were independently associated with all-cause mortality.ConclusionAll-cause mortality among PWID in Greece during 2018–2022 is high with the population in Thessaloniki being particularly affected. The increasing trend in mortality in Athens might be the long-term impact of the pandemic on the health of PWID. Preventive programs such as take-home naloxone distribution and community involvement to increase harm reduction, screening, and uptake of antiretroviral and chronic hepatitis C treatment are urgently needed.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths worldwide [...]

Although central venous catheters (CVCs) provide reliable vascular access, there are several risks linked with their use, with the rates of central-line-associated bloodstream infections (CLABSIs) being the most important ones. CLABSIs have a big impact on mortality rates and health care costs. The aim of this study was to investigate the incidence of obesity in the development of central venous catheter infections.This is a prospective, observational study. The data were collected in the ICUs of three major hospitals in Greece, over a period of 18 months. Totally, 744 patients were included in the study.The study included 744 ICU patients aged 63.6 ± 16.6 years. The Apache II score and MODS score of patients were 23.3 ± 6.9 and 7.5 ± 3.8, respectively. Totally, 5.426 catheter-days were included in the study. Among the 722 CVCs, 178 (24.7%) were CLABSIs. The incidence rate of CVC-associated CLABSI was 22.48 infections per 1000 catheter-days. CLABSI was significantly predicted by the BMI (p = 0.001), by the diabetes mellitus as comorbidity (p = 0.013), by the doctors' experience (p = 0.001), by the type of CVC (p = 0.001) and CVC site (p = 0.001), by the number of efforts for CVC insertion (p = 0.009), by the catheterization's duration (p = 0.001) and by the MODS score (p = 0.001).Better staff training focused on care bundles preventing infections, better medical training focused on less efforts for CVC insertion, and the use of Ultrasounds during the CVC insertion may be the main factors that can lead to lower CLABSI rates in obese patients. Further research relating CLABSI rates in ICU patients and obesity is needed.

Healthcare workers are at high risk of acquiring hepatitis B and particularly haemodialysis staff. The aim of the study was to examine the prevalence of hepatitis B markers in haemodialysis nurses and to explore the determinants of the infection.Two hundred and sixteen haemodialysis nurses from 20 haemodialysis units in Athens completed an anonymous questionnaire, their blood samples were taken and tested for hepatitis B virus (HBV) markers.The prevalence of positive HBsAg among nurses was 0.5%. Anti-HBc positivity due to past exposure to HBV was 12.5%. A total of 87.5% of the participants had immunity to HBV. Multivariate analysis demonstrated that previous exposure to HBV was related positively with the age of the haemodialysis nursing staff [odd ratios (OR): 1.115, 95% CI: 1.014-1.226, P = 0.025].The prevalence of HBV in the haemodialysis nursing staff in Athens is low, the vaccination coverage and the immunity to HBV are high in comparison to previous reports.

The currently available genetic tests for identification of the RET proto-oncogene mutation offer the possibility of prospective successful therapy before the hyperplasia of C-cells evolve to Medullary Thyroid Carcinoma. We present our experience regarding the preventive thyroidectomy of family members with history of Medullary Thyroid Carcinoma, who were found to be heterozygote for mutant RET proto-oncogene. We have retrospectively reviewed 19 members of 6 families with history of Medullary Thyroid Carcinoma, who were heterozygote for mutant RET protooncogene and underwent prophylactic thyroidectomy. All patients included in this series were below twenty years of age. The Medullary Thyroid Carcinoma was asymptomatic and the mutation of RET protooncogene has been also documented pre-operatively in all of them. All patients had undergone total thyroidectomy, while 1 with pheochromocytoma had undergone also left epinephridectomy. Fourteen patients (73.68%) had undergone lymph-nodes resection (in 10 of them the resection was central, in 3 unilateral and in 1 bilateral). Although none of our patients suffered from hyperparathyroidism, 7 parathyroid glands have been also resected from 3 patients, while auto-transfusion has been performed in one. In all patients, preoperative measurement of the calcitonin blood levels before and after stimulation with pentagastrin has been performed.

Background and Aims Despite the recent spread of hepatitis C virus genotype 4 (HCV-4) into European countries, very little is known about the influence of ethnicity on treatment outcomes in patients with HCV-4. The aim of this study was to compare the virologic response (VR) rates of: rapid virologic response (RVR), early virologic response (EVR), VR at 24 weeks of treatment, at end of treatment (EoT), and sustained virologic response (SVR) of European and Egyptian HCV-4 patients. Methods Sixty (30 Europeans – Group A; and 30 Egyptians – Group B) chronic HCV-4 subtype A adult patients with elevated baseline viral load (>800 000 IU/m L) were treated for a fixed period of 48 weeks with pegylated interferon α2a (PEG-IFN- α2a) and ribavirin. During the study, HCV-RNA levels were measured at weeks 4,12,24,48 and 72. Results Baseline characteristics, including liver histology, were similar in the two groups. RVR, EVR and HCV-RNA at week 24 in Groups A and B were (RVR 26.7% vs. 30.0%) (EVR 23.3% vs. 16.7%) (in week 24 13.3% vs. 16.7%). Overall SVR rates were 36.7% (11/30) for Group A and 26.7% (8/30) for Group B (P = 0.59). For group B, RVR was the weakest indicator for SVR as compared with RVR of group A, where RVR was the best SVR indicator Conclusions The overall response to treatment was similar, but ethnic origin or previous history and treatment of schistosomiasis may influence intermediate response rates of chronic HCV-4a infected patients with elevated baseline HCV-RNA.

Biotinidase activity is closely related to liver function.To evaluate whether maternal chronic hepatitis B virus (HBV) infection affects neonatal biotinidase activity.Twenty-three asymptomatic pregnant women with HBV (group A) and 28 healthy pregnant women (controls) in the delivery room and their newborns (cord blood) underwent laboratory examinations. Serological HBV and liver function tests were performed with standard techniques, while biotinidase activity was measured with an HPLC method.Serological HBV tests and HBV DNA showed chronic HBV (precore mutant G1896A) in group A, whereas anti-HBc and anti-HBe were detected in their neonates. Liver function chemistry was found normal in controls and both groups of newborns. Moderately increased transaminases were found in the infected mothers. Interestingly, albumin levels did not differ among the studied groups. Biotinidase activity in HBV mothers (5.76+/-0.6 nmol/min/mL) was significantly decreased (p0.001) as compared to controls (8.43+/-0.65 nmol/min/mL). The enzyme activity did not differ among the neonates. Biotinidase activity inversely correlated with transaminases but not with albumin or with HBV-DNA levels.Decreased biotinidase activities were evaluated in mothers with HBV and normal in their neonates. Biotin supplementation in the diseased mothers may prevent possible symptoms due to biotin recycling impairment.

Primary (AL) amyloidosis is the most common form of systemic amyloidosis seen in current clinical practice. The symptoms of the disease are usually vague, special features are seen in fewer than one fifth of patients, and the combination of organs and systems involved provides a clue for the diagnosis. We describe a patient in whom asymptomatic hepatomegaly, cardiomegaly, hyperlipidaemia and elevated serum alkaline phosphatase level were found during routine examination; the final diagnosis was primary systemic AL amyloidosis with severe cardiomyopathy, resulting in a fatal outcome within eight months from the diagnosis.

To evaluate the significance of induction with high doses of pegylated interferon -2b (Peg-IFNalpha-2b) and the predictability of sustained virologic response (SVR) in naïve patients with chronic hepatitis C.188 consecutive naïve patients with chronic hepatitis C were enrolled in a randomised controlled clinical trial. Patients were randomised to receive either Peg-IFN -2b 3.0 mcg/kg QW x 12 weeks followed by 1.5 mcg/kg QW x 36 weeks plus 800-1200 mg ribavirin (Arm A) or Peg-IFNalpha-2b 1.5 mcg/kg QW x 48 weeks plus 800-1200 mg ribavirin (Arm B). HCV-RNA was obtained at 0, 4, 8, 12, 16, 24, 48 and 72 weeks. Differences between schemes were evaluated by Kaplan-Meier curves. Predictability of SVR was assessed by two-way contingency table analysis and ROC curve analysis.From 176 patients, 75 had genotype 1, 15 genotype 2, 75 genotype 3 and 11 genotype 4. No statistical significance emerged in HCV-RNA positivity, side effects and withdrawals between schemes. Patients with genotype 1 achieved lower SVR (46.6%) in comparison to patients with genotypes 2/3 (94.1%, p0.001) and 4 (90.9%, p = 0.002). The most appropriate time for estimation of SVR for genotype 1 is week 8 (accuracy = 0.84, AUC = 0.90) while predictability increases with time in genotypes 2/3, reaching maximum accuracy = 0.93 and AUC = 0.76 at week 16.Induction with high doses of Peg-IFNalpha-2b does not preclude better outcome and rapid virologic response at 4 weeks of treatment sufficiently predicts SVR. These findings might be useful in an attempt to gain supportive evidence for decision making in difficult-to-treat patients.

A 32-year-old man with chronic hepatitis B who was treated with pegylated interferon alpha-2b once a week, developed widespread psoriasis 4 weeks after the beginning of the treatment. There was no history of psoriasis. The treatment was stopped and gradually the eruption vanished. Thereafter, the patient was treated with lamivudine successfully without dermatological or other sequelae.