Down regulation of the inverse relationship between parathyroid hormone and irisin in male vitamin D-sufficient HIV patients.

PURPOSE: Infection with the human immunodeficiency virus (HIV) predisposes to endocrine disorders, manifesting as a metabolic phenotype that affects the entire adipose-musculoskeletal unit (AMS). The present cross-sectional study aimed to investigate differences in irisin and adiponectin concentrations between people living with HIV and healthy controls, as well as to explore potential correlations between the levels of the aforementioned adipokines and markers of calcium homeostasis. METHODS: 46 HIV-infected individuals and 39 healthy controls (all men) were included in the study. Anthropometric data, adipokine levels, 25-hydroxyvitamin D [(25(OH)D)] and parathyroid hormone (PTH) concentrations were evaluated in the two groups. Correlations for the relationship between adiponectin, irisin, and PTH levels were examined. The results were adjusted for several confounders, including 25(OH)D levels, anthropometry, physical activity, bone mineral density, testosterone levels, and exposure to ultraviolet B radiation. RESULTS: Mean adiponectin concentrations were significantly lower in the HIV group compared to the control group: 5868 ± 3668 vs 9068 ± 4277 ng/mL, p = 0.011. The same was applicable to irisin concentrations: 8.31 ± 8.17 (HIV) vs 29.27 ± 27.23 (controls) ng/mL, p = 0.013. A statistically significant and negative correlation was observed between irisin and PTH in the control group (r = - 0.591; p = 0.033). In contrast, no significant correlation was observed between PTH and irisin in the HIV group (p = 0.898). CONCLUSION: Our results are the first to suggest a possible down regulation of the inverse relationship between PTH and irisin in HIV patients and to highlight that AMS dyshomeostasis could be involved in the development of skeletal and adipose HIV-related morbidities.

Relating SARS-CoV-2 shedding rate in wastewater to daily positive tests data: A consistent model based approach.

During the COVID-19 pandemic, wastewater-based epidemiology (WBE) has been engaged to complement medical surveillance and in some cases to also act as an early diagnosis indicator of viral spreading in the community. Most efforts worldwide by the scientific community and commercial companies focus on the formulation of protocols for SARS-CoV-2 analysis in wastewater and approaches addressing the quantitative relationship between WBE and medical surveillance are lacking. In the present study, a mathematical model is developed which uses as input the number of daily positive medical tests together with the highly non-linear shedding rate curve of individuals to estimate the evolution of global virus shedding rate in wastewater along calendar days. A comprehensive parametric study by the model using as input actual medical surveillance and WBE data for the city of Thessaloniki (~700,000 inhabitants, North Greece) during the outbreak of November 2020 reveals the conditions under which WBE can be used as an early warning tool for predicting pandemic outbreaks. It is shown that early warning capacity is different along the days of an outbreak and depends strongly on the number of days apart between the day of maximum shedding rate of infected individuals in their disease cycle and the day of their medical testing. The present data indicate for Thessaloniki an average early warning capacity of around 2 days. Moreover, the data imply that there exists a proportion between unreported cases (asymptomatic persons with mild symptoms that do not seek medical advice) and reported cases. The proportion increases with the number of reported cases. The early detection capacity of WBE improves substantially in the presence of an increasing number of unreported cases. For Thessaloniki at the peak of the pandemic in mid-November 2020, the number of unreported cases reached a maximum around 4 times the number of reported cases.

A physicochemical model for rationalizing SARS-CoV-2 concentration in sewage. Case study: The city of Thessaloniki in Greece.

Detection of SARS-CoV-2 in sewage has been employed by several researchers as an alternative early warning indicator of virus spreading in communities, covering both symptomatic and asymptomatic cases. A factor that can seriously mislead the quantitative measurement of viral copies in sewage is the adsorption of virus fragments onto the highly porous solids suspended in wastewater, making them inaccessible. This depends not only on the available amount of suspended solids, but also on the amount of other dissolved chemicals which may influence the capacity of adsorption. On this account, the present work develops a mathematical framework, at various degrees of spatial complexity, of a physicochemical model that rationalizes the quantitative measurements of total virus fragments in sewage as regards the adsorption of virus onto suspended solids and the effect of dissolved chemicals on it. The city of Thessaloniki in Greece is employed as a convenient case study to determine the values of model variables. The present data indicate the ratio of the specific absorption (UV254/DOC) over the dissolved oxygen (DO) as the parameter with the highest correlation with viral copies. This implies a strong effect on viral inaccessibility in sewage caused (i) by the presence of humic-like substances and (ii) by virus decay due to oxidation and metabolic activity of bacteria. The present results suggest days where many fold corrections in the measurement of viral copies should be applied. As a result, although the detected RNA load in June 2020 is similar to that in April 2020, virus shedding in the city is about 5 times lower in June than in April, in line with the very low SARS-CoV-2 incidence and hospital admissions for COVID-19 in Thessaloniki in June.

The clinical course of smell and taste loss in COVID-19 hospitalized patients.

BACKGROUND: Recent studies have demonstrated an association between a new onset of smell or taste loss and COVID-19. We investigated the prevalence of smell and/or taste loss and the clinical characteristics and recovery in a comprehensive cohort of consecutive patients treated by two COVID-19 reference hospitals and evaluated late persistence of hyposmia. METHODS: A retrospective observational questionnaire study was conducted. All consecutive RT-PCR diagnosed patients who had been hospitalized in March-April 2020 in the COVID-19 care wards were contacted, excluding patients with cognitive disorders and severe deconditioning. The patients responded to a survey about the loss of smell and taste, nasal blockage, and rhinorrhea, rated the symptoms' severity from 0 to 4, and reported the recovery of smell and taste with time. Demographic and clinical characteristics were recorded. RESULTS: We contacted 117 patients. Ninety responded to the questionnaire; 38.9 % of them reported olfactory and 36.66 % gustatory disorders during their disease. Smell loss prior to other symptoms was reported by 42.86 %, and severe hyposmia/anosmia by 74.28 % of the hyposmic. Among the non-ICU treated patients, 43.75 % reported hyposmia. Only 8.89 % had nasal blockage, and 6.66 % rhinorrhea. Most of the patients (85.71 %) recovered their sense of smell in 3-61 days (median: 17; IQR: 24), but 8.57 % had persistent hyposmia. For one out of four, the olfactory loss lasted longer than a month. CONCLUSION: Smell and taste loss are highly prevalent and early symptoms in hospitalized COVID-19 patients. The great majority recover their smell, but nearly one out of ten have not recovered in two months.  HIPPOKRATIA 2020, 24(2): 66-71.

Nosocomial infections caused by Crimean-Congo haemorrhagic fever virus.

Crimean-Congo haemorrhagic fever (CCHF) is an acute febrile illness, often accompanied by haemorrhagic manifestations, with a high case fatality rate (CFR). The causative agent is CCHF virus (CCHFV), and is transmitted to humans mainly through tick bites or exposure to blood or tissues of viraemic patients or livestock. Human-to-human transmission usually occurs in hospital settings, and healthcare workers (HCWs) are mainly affected. A review on nosocomial CCHFV infections was performed to elucidate the routes and circumstances of CCHFV transmission in hospital settings. From 1953 to 2016, 158 published cases of CCHFV nosocomial infection in 20 countries in Africa, Asia and Europe were found. Almost all cases were symptomatic (92.4%), with an overall CFR of 32.4%. The majority of cases occurred in hospital clinics (92.0%) and 10 cases (8.0%) occurred in laboratories. Most cases occurred among HCWs (86.1%), followed by visitors (12.7%) and hospitalized patients (1.3%). Nursing staff (44.9%) and doctors (32.3%) were the most affected HCWs, followed by laboratory staff (6.3%). The primary transmission route was percutaneous contact (34.3%). Cutaneous contact accounted for 22.2% of cases, followed by exposure to aerosols (proximity) (18.2%), indirect contact (17.2%) and exposure to patient environment (8.1%). CCHFV can cause nosocomial infections with a high CFR. During the care and treatment of patients with CCHF, standard contact precautions, barrier precautions and airborne preventive measures should be applied. In order to improve patient safety and reduce healthcare-associated CCHFV exposure, there is a need for guidelines and education for HCWs to ensure that CCHF is appropriately included in differential diagnoses; this will enable early diagnosis and implementation of infection prevention measures.

Acute renal failure following intravenous immunoglobulin therapy in a HIV-infected patient.

Acute renal failure is a rare complication following the administration of intravenous immunoglobulin (IVIG). Only 114 cases have been reported in the literature. The exact mechanism of IVIG-associated acute renal failure remains unclear. Hereby we describe the first case of ARF in a HIV-infected patient, who received IVIG stabilized with maltose for the treatment of HIV-related thrombocytopenic purpura.

Leishmaniases in Northern Greece: seroprevalence of the infection and incidence of the disease during the period 2001-2006.

Increasing risk factors are making leishmaniases a growing public health concern for many countries around the world. The aim of this study was to assess the seroprevalence of Leishmania infantum infection in the general population and in HIV infected subjects of Northern Greece, bordering the Mediterranean basin where leishmaniasis is endemic. The clinical cases of the disease during the last 6 years (2001-2006) are also presented. A low frequency of L. infantum antibodies was found by IFA and ELISA in 1,525 healthy individuals (2.8%), aged 18-80 years, living in the 16 prefectures of Northern Greece (Macedonia and Thrace regions), and in 167 HIV positive subjects (0.6%). Fifty-seven clinical cases were diagnosed in the same area and an approximate annual incidence of 0.34/100,000 was estimated. No endemic foci were identified and the cases of the disease were sporadic. Most presented with the visceral form (VL), few with the cutaneous, and one with VL-HIV co-infection. A significant shift in the age of people at risk was observed, with children less affected than adults (children/adults ratio: 0.36). No relevant data from previous studies are available to demonstrate a possible change of the infection in Northern Greece. The results of this study could be used as a reference for leishmaniasis surveillance in the area.

Single use of fentanyl in colonoscopy is safe and effective and significantly shortens recovery time.

BACKGROUND: Colonoscopy remains an uncomfortable examination and many patients prefer to be sedated. The aim of this study was to evaluate the efficacy and safety of intravenous administration of fentanyl in titrated doses compared with intravenous administration of the well-known midazolam in titrated doses. METHODS: One hundred twenty-six patients scheduled for ambulatory colonoscopy were randomly assigned to receive either 25 mcg fentanyl (Fentanyl group, n = 66, 35 females, mean age = 61.5 years) and titrated up to 50 mcg or 2 mg midazolam (Midazolam group, n = 60, 33 females, mean age = 63.2 years) and titrated up to 5 mg. Patients graded discomfort on a scale from 0 to 4 and pain on a scale from 0 to 10. Success of the procedure, time to cecum, complications, and recovery time for each patient were independently recorded. RESULTS: Mean discomfort scores were 0.4 in the Fentanyl group and 1.0 in the Midazolam group (p = 0.002). Similarly, mean scores for pain and anus to cecum time were lower in the Fentanyl group than in the Midazolam group [2.59 vs. 4.43 (p = 0.002) and 8.7 vs. 12.9 min (p = 0.012), respectively]. No adverse events were reported in the Fentanyl group, while in the Midazolam group a decrease in oxygen saturation was noted in 23/60 (35%) patients. Mean recovery time was 5.6 min in the Fentanyl group and 16 min in the Midazolam group (p = 0.014). Mean dosage was 36 mcg for fentanyl and 4.6 mg for midazolam. CONCLUSION: Administration of fentanyl in low incremental doses is sufficient to achieve a satisfactory level of comfort during colonoscopy.

Penetration of moxifloxacin and levofloxacin into cancellous and cortical bone in patients undergoing total hip arthroplasty.

Penetration of levofloxacin and moxifloxacin into cancellous and cortical bone was studied using high-performance liquid chromatography (HPLC) in 16 patients who underwent routine total hip arthroplasty. Our results demonstrate a good degree of penetration into bone for both quinolones. The mean cancellous penetration was 53.86% for moxifloxacin and 54.13% for levofloxacin. The penetration into cortical bone was 41.59% and 34.26% respectively. The concentrations for both quinolones were above the minimum inhibitory concentration (MIC(90s)) for the most common pathogens, so they can be used for the treatment of osteomyelitis.

West Nile virus meningitis in a patient with human immunodeficiency virus type 1 infection.

The emergence of West Nile virus lineage 2 in central Macedonia, Greece, in 2010 resulted in large outbreaks for 5 consecutive years. We report a case of viral meningitis in an individual infected with human immunodeficiency virus type 1, which preceded the recognition of the outbreak and was confirmed retrospectively as West Nile virus neuroinvasive disease.

Occurrence of Bartonella henselae and Bartonella quintana among human immunodeficiency virus-infected patients.

The purpose of this study was to determine the seroprevalence against Bartonella henselae and Bartonella quintana among a risk group, patients with HIV infection, and to identify the epidemiological factors involved. Our data indicate that the prevalence of Bartonella infection among HIV-infected patients is much greater than that in the healthy population of the same area and that Bartonella infection should be considered in the differential diagnosis for patients with HIV disease.

Epidemiologic characteristics of hypertension in the civilians of Kosovo after the war.

34th Greek regimen, which was part of the NATO forces, provided medical services to the civilians of Kosovo. We studied epidemiologic data in the population of Kosovo regarding hypertension in order to determine the prevalence and characteristics of hypertension. 830 patients (281 - 33.86% male, 62 +/- 26 yrs and 549 - 66.14% female, 49 +/- 28 yrs) were examined for different diseases. We identified 254 (30.6%) patients with hypertension (188 female and 66 male). According to the international criteria used for the classification of the severity of hypertension, more than half of the patients (51.2%) had severe hypertension, 31.5% modest and 17.3% mild. Statistically significant relation between the severity of hypertension and age or sex was not found out. Increased BMI as well as the presence of proteinuria and rheumatic diseases were significantly related to the severity of the hypertension while the coexistent heart disease, diabetes mellitus and chronic obstructive pulmonary disease (COPD) wasn't. The use of non-steroid anti-inflammatory agents (NSAIDs) was related to the severity of hypertension with a borderline significance. 31.4% of the patients were on treatment with NSAIDs and/or cortisone because of rheumatic disease or obstructive pulmonary disease. Overfunction of the sympathetic system was present in 62.99%. The mean heart rate was greater in women (84/min) than in men (72/min). 28.35% of the patients had secondary hypertension, including the patients on a drug that can elevate the blood pressure and patients with increased activity of the sympathetic nervous system. So, 8.6% of the patients had usual causes of secondary hypertension and 19.6% hypertension secondary related to the use of NSAIDs or cortisone, or due to the increased activity of the sympathetic nervous system. Antihypertensive treatment was started in 248 patients, i.e. in all of them except the ones already on treatment having their blood pressure well controlled. For antihypertensive treatment beta-blockers or central adrenergic inhibitors either as monotherapy or in combination with other agents were used most frequently combined with diuretics and Ca antagonists and ACE inhibitors. In conclusion the diagnosis and treatment of hypertension in the population of Kosovo during the post war period had certain particularities.

Comparative in vitro activity of quinupristin/dalfopristin and seven other antimicrobials against methicillin-susceptible and methicillin-resistant nosocomial Staphylococcus aureus bloodstream isolates.

Staphylococcus aureus strains resistant to a variety of antimicrobial agents are often found in the hospital environment and are responsible for many life-threatening infections. The activity of quinupristin/dalfopristin against 84 Staphylococcus aureus bloodstream isolates (both methicillin resistant and methicillin sensitive) was compared to the activity of vancomycin, teicoplanin, erythromycin, oxacillin, clindamycin, gentamicin, rifampicin. The Minimum Inhibitory Concentrations of these agents was evaluated with the Epsilometer Test. Quinupristin/dalfopristin inhibited all methicillin-sensitive strains at 1mg/L, and 75% of methicillin-resistant strains at 1.5mg/L. According to these results, quinupristin-dalfopristin shows promising in-vitro activity and may be a welcome alternative treatment for methicillin-resistant staphylococcal infections, resulting in reduced use of glycopeptides.

In-vitro activity of clinafloxacin compared to ciprofloxacin against Acinetobacter baumannii strains isolated from intensive care unit patients.

The activity of clinafloxacin was compared to that of ciprofloxacin against 154 Acinetobacter baumannii strains isolated from patients treated in Intensive Care Units. Minimum inhibitory concentrations (MICs) were determined by the Epsilometer test method. The majority (87.6%) of the A. baumannii strains tested were resistant to ciprofloxacin (MIC range 0.125->32, MIC50 = >32, MIC90 = >32). On the contrary, only 9.7% of the strains tested were resistant to clinafloxacin (MIC range 0.023->4, MIC50 = 0.75, MIC90 = 2). Due to its superior activity shown against A. baumannii strains, compared to ciprofloxacin, clinafloxacin may be added to the therapeutic armamentarium for hospital-acquired infections caused by A. baumannii in Intensive Care Units.

Comparative in vitro activity of linezolid and five other antimicrobials against nosocomial isolates of methicillin-resistant Staphylococcus aureus, methicillin-resistant Staphylococcus epidermidis and vancomycin-resistant Enterococcus faecium.

The activity of linezolid in comparison to vancomycin, teicoplanin, oxacillin, clindamycin and gentamicin was tested against 60 strains of methicillin-resistant Staphylococcus aureus, 60 strains of methicillin-resistant Staphylococcus epidermidis isolated from patients with nosocomial infections and 24 strains of vancomycin-resistant Enterococcus faecium isolated from feces of hospitalized patients. Minimum Inhibitory Concentrations (MICs) were determined by the Epsilometer test method. All tested strains were sensitive to linezolid and specifically all methicillin-resistant S. aureus had MIC range 0.25-3.00, MIC50 = 0.75, MIC90 = 1.5, all methicillin-resistant S. epidermidis had MIC range 0.125-1.5, MIC50 = 0.5, MIC90 = 1 and all vancomycin-resistant E. faecium had MIC range 0.5-1.5, MIC50 = 1, MIC90 = 1. Linezolid is the first of a novel antimicrobial class, the oxazolidinones, which is a promising treatment for serious Gram-positive infections, including multiresistant strains.

High rates of transmitted drug resistance among newly-diagnosed antiretroviral naïve HIV patients in Northern Greece, data from 2009-2011.

We conducted a retrospective study on the prevalence and correlates of transmitted drug resistance among newly-diagnosed antiretroviral naive human immunodeficiency virus (HIV) patients in Northern Greece, during the period 2009-11. Transmitted drug resistance was documented in 21.8% of patients enrolled, affecting approximately 40% of subtype A HIV-1-infected individuals. Overcoming challenges due to the ongoing financial crisis, effective preventive measures should be implemented to control further dissemination of resistant HIV strains.

A method for calculating the dose length product from CT DICOM images.

OBJECTIVE: The dosimetric calculations in CT examinations are currently based on two quantities: the volume weighted CT dose index (CTDI(vol)) and the dose-length product (DLP). The first quantity is dependent on the exposure factors, scan field of view, collimation and pitch factor selections, whereas the second is additionally dependent on the scan length. METHODS: In this study a method for the calculation of these quantities from digital imaging and communication in medicine (DICOM) CT images is presented that allows an objective audit of patient doses. This method was based on software that has been developed to enable the automatic extraction of the DICOM header information of each image (relating to the parameters that affect the aforementioned quantities) into a spreadsheet with embedded functions for calculating the contribution of each image to the CTDI(vol) and DLP values. The applicability and accuracy of this method was investigated using data from actual examinations carried out in three different multislice CT scanners. These examinations have been performed with the automatic exposure control systems activated, and therefore the tube current and tube loading values varied during the scans. RESULTS: The calculated DLP values were in good agreement (±5%) with the displayed values. The calculated average CDTI(vol) values were in similar agreement with the displayed CTDI(vol) values but only for two of the three scanners. In the other scanner the displayed CTDI(vol) values were found to be overestimated by about 25%. As an additional application of this method the differences among the tube modulation techniques used by the three CT scanners were investigated. CONCLUSION: This method is a useful tool for radiation dose surveys.

Linezolid penetration into cerebrospinal fluid and brain tissue.

The aim of the study was to evaluate the penetration of linezolid into cerebrospinal fluid (CSF) and brain tissue after a single i.v. dose of 600 mg. The penetration of linezolid into cerebrospinal fluid and brain tissue was studied in 18 patients undergoing a neurosurgical procedure. Linezolid 600 mg i.v. was given with the induction of anesthesia. Mean concentrations of linezolid 2h after the final dose, in serum, cerbrospinal fluid and brain tissue were assayed by HPLC. CSF/serum and brain/serum ratios were 69.57% and 44.66% respectively. Concentrations of linezolid were above the MIC(90s )for staphylococci and streptococci. The concentrations obtained indicate good penetration of linezolid into CSF and brain tissue and support its use in the management of multidrug-resistant Gram-positive CNS infections.

Endothelial nitric oxide synthase (eNOS) is not upregulated in gastric mucosa of Helicobacter pylori (H. pylori)-positive patients with type 2 diabetes mellitus.

AIM: To evaluate the expression of eNOS and CD34 in gastric mucosa of Helicobacter pylori (H. pylori) positive diabetic patients, in correlation with glycaemic control and diabetic autonomic neuropathy (DAN). METHODS: We prospectively studied 49 diabetic type 2 patients (29 women, mean age 65.32+/-8.56 years) and 30 control subjects (15 women, mean age 58.47+/-12.40) that underwent endoscopy. Biopsies from the body and antrum were evaluated for H. pylori-gastritis, eNOS and angiogenic marker CD34 expression. Statistical analysis in correlation with mean glycosylated haemoglobin (HbA1c) of the last 3 years, and DAN was performed. RESULTS: The two groups were matched for age (p=0.144), sex (p=0.335), H. pylori-infection (p=0.617) and degree of gastritis (p=0.78). eNOS and CD34 attenuated expression correlated with diabetes mellitus (DM) in the corpus (p=0.009 and 0.02, respectively). eNOS and CD34 expression was upregulated in H. pylori-positive controls but not in H. pylori-positive diabetic patients (p=0.010 and 0.007 for the corpus and p=0.036 and 0.047 for the antrum, respectively). eNOS expression correlated with good glycaemic control (GGC) in the gastric corpus (p<0.001) and antrum (p=0.0037) and with absence of DAN (p=0.009 and 0.036, respectively for the corpus and antrum). CONCLUSION: Chronic glycaemic control affects eNOS expression and angiogenesis in the gastric mucosa of patients with type 2 DM. eNOS expression is not upregulated in H. pylori-positive diabetic patients.