Single OnabotulinumtoxinA Session Add-On to Carbamazepine or Oxcarbazepine in Treatment-Refractory Trigeminal Neuralgia: A Case Series with 24-Week Follow Up.

We sought to assess the efficacy of combining onabotulinumtoxinA (BoNTA) as add-on therapy to carbamazepine or oxcarbazepine in treatment-refractory patients with trigeminal neuralgia (TGN) who failed to respond (less than 30% response rate) to adequate monotherapy. We conducted a retrospective study on 15 patients with a definite diagnosis of TGN, according to the established criteria, and underwent BoNTA as part of their treatment plan. A single BoNTA session was administered subcutaneously, according to patients' perceived zone of pain, at different dosages ranging from 30 to 200 units (mean ± standard deviation: 87.3 ± 39.2). All patients (15/15; 100%) reported large reductions in the severity of their TGN-related neuropathic pain. The mean pain score on the VAS scale significantly decreased from 9.3 ± 1.1 to 3.7 ± 1.2 at 2 weeks after injecting BoNTA (p < 0.001) and remained stable at 4 and 24 weeks post-injection. Regarding the impact of BoNTA on patients' health-related quality of life, there were significant improvements in both the physical and mental health domains (p < 0.05) of SF-36 tool. BoNTA may be a safe and effective treatment option for patients with refractory TGN when added on to carbamazepine or oxcarbazepine. The use of a single BoNTA session for TGN treatment may be an alternative to surgical interventions and as add-on treatment to oral medications, providing patients with a minimally invasive, effective, safe and well-tolerated option.

Changes in Smoking Habits in Greece During the Lockdown Measures Due to COVID-19.

INTRODUCTION: During lockdown, people are experiencing higher than usual levels of stress related to social isolation, employment, and finances that may result in lifestyle changes. Here, we aim to assess whether smoking habits changed during the lockdown measures due to coronavirus disease 2019 (COVID-19). METHODS: For the purpose of the survey, an online questionnaire was distributed from the tenth of April to the second of May 2020, among a Greek population, by using an online platform. RESULTS: Two hundred smokers/vapers participated in the present survey (62.5% women, 44% of 36-45 years, 29% of 16-55 years, 15.5% 26-35 years). The daily number of cigarettes smoked before the onset of the COVID-19 pandemic is 15.06 ± 9.84, while during the restrictive measures due to COVID-19, the daily number of cigarettes smoked is 14.52 ± 10.13 (p > 0.05). Vapers consumed an average of 0.54 ± 2.43 mL vapor per day before the COVID-19 pandemic and 0.61 ± 2.81 mL during lockdown. Males smoked more cigarettes per day before (16.31 ± 11.87) and during the lockdown (15.33 ± 12.17) versus females (14.30 ± 8.36) and 14.04 ± 8.70, respectively) (p > 0.05 for both genders). Before versus during the restrictive measures, subjects that were primary school graduates smoked more cigarettes per day (28.00 ± 9.09 and 27.50 ± 9.57, respectively), followed by subjects that were high school graduates (16.90 ± 9.33 and 15.97 ± 9.50, respectively), university graduates (14.17 ± 10.14 and 13.93 ± 10.66, respectively), postgraduates (12.96 ± 9.52 and 12.25 ± 9.90, respectively) and middle school graduates (12.89 ± 8.22 and 14.22 ± 7.93, respectively).The self-reported reason for the change in the mL vaporized and the cigarettes smoked are confinement at home (36.3%), stress about COVID-19 (34.09%), free time (20.45%), boredom (4.54%), stress about the work status (2.27%), and participation in online lucky games (2.27%). DISCUSSION: We did not observe significant differences in the daily consumption of smoke/vaping during the lockdown measures. More studies are needed to assess the long-term effects of the pandemic in smoking habits.

Evaluation of Antibody Kinetics Following COVID-19 Vaccination in Greek SARS-CoV-2 Infected and Naïve Healthcare Workers.

We investigated the antibody kinetics after vaccination against COVID-19 in healthcare workers of a Greek tertiary hospital. Eight hundred and three subjects were included, of whom 758 (94.4%) received the BNT162b2 vaccine (Pfizer-BioNTech), eight (1%) mRNA-1273 (Moderna), 14 (1.7%) ChAdOx1 (Oxford-AstraZeneca) and 23 (2.9%) Ad26.COV2.S (Janssen). Before the second dose, at 2, 6 and 9 months after the second dose and at 2 and 6 months after the third dose, anti-spike IgG were quantified by the chemiluminescence microparticle immunoassay method. One hundred subjects were infected before vaccination (group A), 335 were infected after receiving at least one vaccine dose (group B), while 368 had never been infected (group C). Group A presented a greater number of hospitalizations and reinfections compared to group B (p < 0.05). By multivariate analysis, younger age was associated with an increased risk of reinfection (odds ratio: 0.956, p = 0.004). All subjects showed the highest antibody titers at 2 months after the second and third dose. Group A showed higher antibody titers pre-second dose, which remained elevated 6 months post-second dose compared to groups B and C (p < 0.05). Pre-vaccine infection leads to rapid development of high antibody titer and a slower decline. Vaccination is associated with fewer hospitalizations and fewer reinfections.

Analysis of SARS-CoV-2 Cases, COVID-19 Outcomes and Vaccinations, during the Different SARS-CoV-2 Variants in Greece.

Since the emergence of the SARS-CoV-2 Omicron variant, many issues have arisen. We report SARS-CoV-2 vaccinations, SARS-CoV-2 cases and COVID-19 outcomes in Greece during weeks 2-26 of 2021 (Alpha variant period), weeks 27-51 of 2021 (Delta variant period) and week 51 of 2021 to week 27 of 2022 (Omicron variant period). The average weekly cases were higher during the Omicron period vs. the Delta (25,354.17 cases/week) and Alpha periods (11,238.48 cases/week). The average weekly vaccinations were lower in the Omicron period (26,283.69/week) than in the Alpha and Delta period. Joinpoint regression analysis identified that the trend of SARS-CoV-2 cases increased by 88.5% during the rise of the Omicron wave in Greece. The trend of the intensive care unit (ICU) admissions related to COVID-19 decreased by 5.0% immediately after the rise of Omicron while the trend of COVID-19-related deaths decreased by 8.1% from the 5th week of the Omicron wave until the end of the study. For vaccinations, an increasing trend of 8.3% was observed in the first half of 2021 (weeks 18-25/2021), followed by a decreasing trend in weeks 26-43/2021. For the weeks before and during the early rise of Omicron (44/2021-1/2022), we identified an increasing trend of 10.7% and for weeks 2-27/2022 we observed a decreasing trend of 18.1%. Unfortunately, we do not have available data about the vaccination status of the SARS-CoV-2 cases, ICU admissions or deaths. Our findings suggest that the Omicron variant is associated with increased transmissibility and reduced morbidity and mortality despite the previous increase in the trend of SARS-CoV-2 vaccinations.

Efficiency of an Online Intervention in the Knowledge Concerning COPD in Nursing Students.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating respiratory disorder. Nurses play a major role in managing the disease. This study aimed to test the effect of a brief online intervention in increasing the knowledge of COPD in a sample of nursing students in Greece. Materials and Methods: The intervention entailed a combination of two ½ hour lectures focusing on the treatment and care of patients with COPD according to existing guidelines. Data were collected with a structured questionnaire specially designed for this study including questions regarding information on sociodemographic characteristics of the participants, and the Bristol COPD Knowledge Questionnaire (BCKQ) which is designed to assess the knowledge of 13 COPD-specific topics. The questionnaire was distributed three times and the one-way ANOVA test of repeated measures was applied to investigate the effect of the educational intervention by examining the periods before, immediately after, and one month after the intervention. Results: 125 nursing students participated in this study of which 13.6% were men (n=17) and 86.4% were women. According to the results of the repeated measures ANOVA test, there was a statistically significant improvement in gained knowledge about COPD. Conclusions: Short educational interventions can be effective in acquiring and cultivating nursing students concerning COPD. These short online tutorials seem to be cost-effective as they can be organized easily and with minimal financial resources.

Worldwide trends in mortality related to Parkinson's disease in the period of 1994-2019: Analysis of vital registration data from the WHO Mortality Database.

Background: Mortality due to Parkinson's disease (PD) and its long-term trends worldwide in recent decades remain unknown. No previous studies have simultaneously studied age- and sex-specific mortality trends at a population level worldwide. Insights gained from this study can help identify high-risk populations and inform healthcare service requirements for managing Parkinson's disease globally. Objectives: The aim of the study was to examine trends in mortality from Parkinson's disease by age-group and sex across countries all over the world. In this study, we used worldwide registry data to examine the temporal trends in PD mortality across most counties of the world from 1994 to 2019 using joinpoint regression. Results: In data from vital registration systems, huge variations in the patterns of deaths due to Parkinson's disease were observed both over time and between countries. Between 1994 and 2019, there was a significant increase in mortality rates globally in both men and women. In more detail, the mortality rate (per 100,000) in 1994 was 1.76 and reached 5.67 in 2019. Greater increases in mortality were seen in men than in women; and in older than in younger people. Conclusions: There has been a striking rising trend in Parkinson's disease mortality globally. Persistent age and sex disparities are found in Parkinson's disease mortality trends. Our findings may have important implications for future research, healthcare planning, and provision.

Association of SARS-CoV-2 Vaccinations with SARS-CoV-2 Infections, ICU Admissions and Deaths in Greece.

The available coronavirus disease 2019 (COVID-19) vaccines have shown their effectiveness in clinical trials. We aimed to assess the real-world effects of SARS-CoV-2 vaccinations in Greece. We combined national data on vaccinations, SARS-CoV-2 cases, COVID-19-related ICU admissions and COVID-19-related deaths. We observed 3,367,673 vaccinations (30.68% of the Greek population), 278,821 SARS-CoV-2 infections and 7401 COVID-19-related deaths. The vaccination rate significantly increased from week 2 to week 6 by 85.70%, and from week 7 to 25 by 15.65%. The weekly mean of SARS-CoV-2 cases, COVID-19 ICU patients and COVID-19 deaths markedly declined as vaccination coverage accumulated. The rate of SARS-CoV-2 cases increased significantly from week 2 to week 13 by 16.15%, while from weeks 14-25 the rate decreased significantly by 13.50%. The rate of COVID-19-related ICU admissions decreased significantly by 7.41% from week 2 to week 4, increased significantly by 17.22% from weeks 5-11, then decreased significantly from weeks 17-20, by 11.99%, and from weeks 21-25, by 16.77%. The rate of COVID-19-related deaths increased significantly from week 2 to week 15 by 12.08% and decreased significantly by 16.58% from weeks 16-25. The data from this nationwide observational study underline the beneficial impact of the national vaccination campaign in Greece, which may offer control of the SARS-CoV-2 pandemic.

Peripheral Inflammatory Markers TNF-α and CCL2 Revisited: Association with Parkinson's Disease Severity.

One of the major mediators of neuroinflammation in PD is tumour necrosis factor alpha (TNF-α), which, similar to other cytokines, is produced by activated microglia and astrocytes. Although TNF-α can be neuroprotective in the brain, long-term neuroinflammation and TNF release can be harmful, having a neurotoxic role that leads to death of oligodendrocytes, astrocytes, and neurons and, therefore, is associated with neurodegeneration. Apart from cytokines, a wide family of molecules with homologous structures, namely chemokines, play a key role in neuro-inflammation by drawing cytotoxic T-lymphocytes and activating microglia. The objective of the current study was to examine the levels of the serum TNF-α and CCL2 (Chemokine (C-C motif) ligand 2), also known as MCP-1 (Monocyte Chemoattractant Protein-1), in PD patients compared with healthy controls. We also investigated the associations between the serum levels of these two inflammatory mediators and a number of clinical symptoms, in particular, disease severity and cognition. Such an assessment may point to their prognostic value and provide some treatment hints. PD patients with advanced stage on the Hoehn-Yahr scale showed an increase in TNF-α levels compared with PD patients with stages 1 and 2 (p = 0.01). Additionally, the UPDRS score was significantly associated with TNF-α levels. CCL2 levels, however, showed no significant associations.

Temporal trends in pulmonary embolism prevalence in Greece during 2013-2017.

BACKGROUND: Pulmonary embolism (PE) epidemiological data about the disease prevalence in the general population are unclear. The present study aims to investigate the prevalence of PE in Greece and the associated temporal trends for the years 2013-2017. METHODS: Data on medical prescriptions for PE in the years 2013-2017 were provided by the Greek National Health Service Organization (EOPYY). Data on age, gender, specialty of the prescribing physician and prescription unit were provided as well. RESULTS: The total number of medical prescriptions for PE for the study period was 101,426. Of the total prescriptions, 51% were issued by the Public Sector and 48% by the Private Sector. In 2013 the prevalence of PE was 5.43 cases per 100,000 citizens and increased constantly until 2017 with 23.79 cases per 100,000 population. Prevalence was higher in all years studied in the age group of 70-80 years. For the year 2017, we observed 69.35 cases per 100,000 population for subjects 70-80 years, followed by the ages 80-90 (60.58/100,000) and 60-70 years (56.47 /100,000). Females displayed higher PE prevalence than males and higher increasing trend. CONCLUSION: PE prevalence has an increasing trend throughout the years 2013-2017 while prevalence in females is higher than males and displays a higher increasing trend. Our results may be used to appropriately organize nationwide health care campaigns aiming at the diagnosis, treatment and prevention of PE.

Association of Psychopathology Symptoms, Self-Compassion, and Forgiveness in Patients With Pulmonary Embolism.

Background Pulmonary embolism (PE) is a potentially life-threatening disease with both physical and psychological impacts. The psychological distress in the early phase of the disease has not been previously studied in the literature.  Methods The study sample included patients with PE with or without deep vein thrombosis. All subjects included in the study prospectively completed the Symptom Checklist-90-R (SCL-90-R) questionnaire, the Heartland Forgiveness Scale (HFS), and the Self-Compassion Scale (SCS) during their hospitalization for PE. Results Forty-four PE patients were included in the study (59.1% males). The mean age was 62.27±15.03 years. The majority (77.3%) had at least one comorbidity with 9.1% previously diagnosed with depression. The Total Global Severity Index (GSI) score for SCL-90-R was 82.42±49.70 while 36.4% of subjects had a high "Obsessive-compulsive" score, 22.7% had a high "Depression" score, and 22.7% presented a high "Hostility" score. The total HFS score was 45.54±40.42 with 54.5% of patients classified as "usually forgiving." The mean SCS score was 2.05±0.65 with 59.1% of patients presenting moderate self-compassion while 18.2% had low self-compassion. The total SCS score was correlated with the total GSI score (p=0.005, r=-0.576) and total HFS score (p=0.005, r=0.675). The SCS Self-kindness score correlated with interpersonal sensitivity (p=0.024, r=-0.479), depression (p=0.008, r=-0.551), and GSI score (p=0.049, r=-0.425). Self-judgement correlated with paranoid ideation (p=0.044, r=-0.467), hostility (p=0.007, r=-0.597), and GSI (p=0.027, r=-0.505). Isolation correlated with interpersonal sensitivity (p=0.026, r=-0.509), anxiety (p=0.014, r=-0.553), hostility (p=0.032, r=-0.494), paranoid ideation (p=0.026, r=-0.509), and GSI (p=0.015, r=-0.548). The total SCS score correlated with anxiety (p=0.041, r=-0.438). SCS Self-kindness score correlated significantly with total HFS score (p=0.002, r=0.613), forgiveness of self (p=0.011, r=0.528), forgiveness of others (p=0.008, r=0.550), and forgiveness of situations (p=0.004. r=0.587). Common humanity was significantly correlated with total HFS score (p=0.023, r=0.481), forgiveness of others (p=0.033, r=0.456), and forgiveness of situations (p=0.016, r=0.507). Mindfulness was positively correlated with HFS total score (p=0.009, r=0.544), forgiveness of self (p=0.049, r=0.424), forgiveness of others (p=0.012, r=0.525), and forgiveness of situations (p=0.013, r=0.520). Conclusions We report for the first time that patients acutely hospitalized for PE present symptoms of obsessive-compulsive disorder, depression, and hostility and exhibit moderate self-compassion. The marginal majority of PE patients are "usually forgiving" during the acute phase of the disease. Self-compassion is positively associated with forgiveness and negatively associated with psychiatric symptoms. Further studies are warranted in order to assess longitudinal differences in psychometric scores and the possible result of targeted mental health interventions at PE-specific clinical outcomes.