Does tourism affect the long term course of COVID-19 pandemic in a country of destination? Evidence from a popular Greek island in 2020 where control measures were implemented.

Greece opened its points of entry on July 1, 2020, with specific guidelines for travellers arriving by sea, air or land. The aim of this article is to examine the effect of tourism on the long term course of the Coronavirus Disease 2019 (COVID-19) pandemic during the pre-vaccination era (June to December 2020) on the popular Greek island of Crete. To achieve this, a cross-sectional serosurvey, repeated at monthly intervals, was conducted to compare the seroprevalence in Crete with seroprevalence in the mainland of Greece. Crete welcomed nearly 2,000,000 travellers during the 2020 summer season. Left-over serum samples were collected and obtained from public and private laboratories located in Greece, including the island of Crete. These samples were tested for the presence of anti-SARS-CoV-2 IgG antibodies. A total of 55,938 samples were collected, 3,785 of which originated from Crete. In Crete, the seroprevalence ranged between 0% (June 2020) and 2.58% (December 2020), while the corresponding seroprevalence in Greece was 0.19% and 10.75%, respectively. We identified 4.16 times lower seropositivity in Crete (2.58%) in comparison with the mainland of Greece (10.75%) during December 2020. Moreover, the monthly infection fatality rate (IFR) in Crete was calculated at 0.09%, compared with 0.21% in mainland Greece for December 2020. The island of Crete presented more than four times lower seroprevalence than the mainland of Greece, despite being a highly attractive tourist destination. This evidence supports the idea that tourism may not have affected the long term course of the COVID-19 pandemic in Greece. However, due to contradicting results from previous studies, further investigation is needed.

Synthesis and antimicrobial activity of chloramphenicol-polyamine conjugates.

A series of chloramphenicol (CAM) amides with polyamines (PAs), suitable for structure-activity relationship studies, were synthesized either by direct attachment of the PA chain on the 2-aminopropane-1,3-diol backbone of CAM, previously oxidized selectively at its primary hydroxyl group, or from chloramphenicol base (CLB) through acylation with succinic or phthalic anhydride and finally coupling with a PA. Conjugates 4 and 5, in which the CLB moiety was attached on N4 and N1 positions, respectively, of the N(8),N(8)-dibenzylated spermidine through the succinate linker, were the most potent antibacterial agents. Both conjugates were internalized into Escherichia coli cells by using the spermidine-preferential uptake system and caused decrease in protein and polyamine content of the cells. Noteworthy, conjugate 4 displayed comparable activity to CAM in MRSA or wild-type strains of Staphylococcus aureus and Escherichia coli, but superior activity in E. coli strains possessing ribosomal mutations or expressing the CAM acetyltransferase (cat) gene. Lead compounds, and in particular conjugate 4, have been therefore discovered during the course of the present work with clinical potential.

The need for intra aortic balloon pump support following open heart surgery: risk analysis and outcome.

BACKGROUND: The early and intermediate outcome of patients requiring intraaortic balloon pump (IABP) was studied in a cohort of 2697 adult cardiac surgical patients. METHODS: 136 patients requiring IABP (5.04%) support analysed over a 4 year period. Prospective data collection, obtained. RESULTS: The overall operative mortality was 35.3%. The "operation specific" mortality was higher on the Valve population.The mortality (%) as per time of balloon insertion was: Preoperative 18.2, Intraoperative 33.3, postoperative 58.3 (p < 0.05).The incremental risk factors for death were: Female gender (Odds Ratio (OR) = 3.87 with Confidence Intervals (CI) = 1.3-11.6), Smoking (OR = 4.88, CI = 1.23- 19.37), Preoperative Creatinine>120 (OR = 3.3, CI = 1.14-9.7), Cross Clamp time>80 min (OR = 4.16, CI = 1.73-9.98) and IABP insertion postoperatively (OR = 19.19, CI = 3.16-116.47).The incremental risk factors for the development of complications were: Poor EF (OR = 3.16, CI = 0.87-11.52), Euroscore >7 (OR = 2.99, CI = 1.14-7.88), history of PVD (OR = 4.99, CI = 1.32-18.86).The 5 years survival was 79.2% for the CABG population and 71.5% for the valve group. (Hazard ratio = 1.78, CI = 0.92-3.46). CONCLUSIONS: IABP represents a safe option of supporting the failing heart. The need for IABP especially in a high risk Valve population is associated with early unfavourable outcome, however the positive mid term results further justify its use.

Histologic-type specific role of cell cycle regulators in non-small cell lung carcinoma.

BACKGROUND: Lung cancer is the most lethal type of cancer in humans. Cell cycle alterations have commonly been encountered in lung cancer and may have prognostic value. MATERIALS AND METHODS: This study investigates the immunohistochemical expression of the important cell cycle regulators phosphatase and tensin homolog deleted on chromosome 10 (PTEN), p27, Cks1, and Skp2 in 128 non-small cell lung carcinomas (64 adenocarcinomas, 46 squamous cell carcinomas, and 18 large cell undifferentiated carcinomas) and adjacent non-neoplastic lung tissue. RESULTS: PTEN and p27 were always highly expressed in non-neoplastic lung whereas Cks1 and Skp2 were not expressed in normal tissue. Decreased PTEN expression was noted in 19/64 adenocarcinomas, 15/46 squamous cell carcinomas, and 7/18 undifferentiated large cell carcinomas. Reduced expression of p27 was noted in 28/64, 19/46, and 6/18 of the tumors, respectively. Increased expression of Cks1 was seen in 38/64, 26/46, and 11/18 and increased expression of Skp2 in 29/64, 30/46, and 14/18 of the tumors, respectively. An inverse relationship between p27 and Skp2 levels was found in adenocarcinomas and between p27 and Cks1 levels in squamous cell carcinomas. Decreased PTEN and p27 expression were associated with advanced tumor stage in squamous cell carcinomas. Univariate analysis showed that high p27 and PTEN and low Cks1 expression correlated with increased survival in patients with squamous cell carcinoma independently of tumor stage. CONCLUSIONS: Aberrant expression of PTEN, p27, Cks1, and Skp2 is a common feature of all three major types of non-small cell lung cancer NSCLC, but seems to be involved in the progression of squamous cell carcinoma alone.

Comparative analysis and outcomes of sleeve resection versus pneumonectomy.

To compare the outcome of sleeve resection or complex sleeve resection versus (Vs) pneumonectomy for lung cancer in a single unit. Between 1998 and 2006, 664 lung resections were carried out. There were 129 (19.4%) pneumonectomies and 79 (11.9%) sleeve resections; Twenty one patients (26.5%) underwent a complex sleeve resection. Operative mortality for the sleeve resections (SR) was 2.5% and for the pneumonectomies 8.53%. Overall 5-year survival after SR was 46.8% and after pneumonectomy 37.1%. The survival curves for the 2 procedures after adjusting for risk factors are different. The area under the curve is higher for the SR (Hazard ratio 1.78 C.I.: 0.92-3.46). The 5-year survival for early stages favors SR. The survival for the complex SR was not influenced by the complexity of the procedure but from the TNM stage of each individual case. Multivariate analysis of risk factors affecting survival after surgery showed: male sex Hazard ratio (HR) 1.19, 0.63-2.27(95%CI), Age >63 1.38(HR), 0.78-2.48, Pneumonectomy 1.78(HR), 0.92-3.46 and stage III 4.44(HR), 1.94-10.16(95% CI). For comparative stages survival appears to be better after sleeves, moreover male sex, sleeve resection, age younger that 63 and early TNM stage are positive predictors for survival.

Bronchial asthma, chronic obstructive pulmonary disease and NF-kappaB.

Respiratory diseases place a considerable burden on global health. Bronchial asthma describes many heterogeneous clinical phenotypes that result in chronic bronchial inflammation. Chronic obstructive pulmonary disease (COPD) is one of the most common adult respiratory disorders characterized by chronic airflow limitation that is not fully reversible and is associated with an abnormal inflammatory response of the lungs to noxious particles and gases. Recognition of the global importance and rising prevalence of these diseases and the absence of effective treatments has led to concerted efforts to improve the efficacy of the existing drugs and develop new ones that target cellular and molecular mechanisms that underlie disease pathogenesis. The transcription factor nuclear factor kappa B (NF-kappaB) regulates the expression of a wide array of genes that are involved in the molecular pathobiology of the lung by regulating cellular immune responses, cell adhesion, differentiation, proliferation, angiogenesis and apoptosis. In this work, we review published clinical and experimental studies that link the inhibition of NF-kappaB activity with the treatment of asthma and COPD. Our end point is to help identify pathway-specific inhibitors of NF-kappaB that can be used for the treatment of specific human ailments.

Rarity of bacterial and viral meningitis in areas of Western Greece with fewer than 2,000 inhabitants.

The purpose of the present study was to compare the incidence of childhood meningitis in regions with fewer than 2,000 inhabitants (rural regions) and regions with more than 2,000 inhabitants (urban regions) in the prefecture of Achaia in Western Greece during 1991-2005. Included were all 555 children hospitalized for meningitis. The criteria for bacterial meningitis were (i) positive blood/cerebralspinal fluid (CSF) culture, Gram stain, or latex agglutination and/or (ii) increased beta-glucuronidase in CSF. In case of suspected bacterial meningitis, the following findings were considered: compatible clinical and laboratory findings, and whether or not a cure was achieved with antibiotic treatment and finally resulted in negative cultures. In cases of suspected viral meningitis, compatible clinical and laboratory findings were considered, together with observation of a cure without antibiotic treatment. Only 28 of 555 meningitis patients were from rural regions. The incidence per 10,000 children in rural and urban regions, respectively, was as follows: meningitis, 1.13 and 8.99; bacterial meningitis, 0.16 and 2.40; suspected bacterial meningitis, 0.52 and 3.00; and viral meningitis, 0.44 and 3.58. The incidence ratio for bacterial, suspected bacterial, and viral meningitis in urban versus rural regions was 14.85, 5.72, and 8.10, respectively. Only 2 of the 79 cases with a confirmed causative pathogen came from rural regions. In conclusion, compared to those living in urban regions, children living in rural regions are relatively spared from bacterial and viral meningitis.

The way the intra-aortic balloon catheter moves within the aorta as a possible mechanism of balloon associated morbidity.

This study set off to investigate which mode of weaning of an intra-aortic balloon pump (IABP) produces more aortic trauma. With the use of a perfusion pump, an intact porcine aorta with an IABP in situ, was studied. Angioscopic images of the interior of the aorta were obtained. Whilst keeping steady blood pressure and flow, an 'aortic impact score' was calculated. Endoscopically there is a 'whipping' effect of the balloon shaft on the lateral aortic wall, which appears to be prominent in 1:3 mode. The aortic impact score at 0.5, 6 and 12 h during the experiments was: (1) When weaning by mode: a) 1:1 3.3+/-0.6, 4.0+/-1.0 and 4.3+/-0.6; b) 1:2 4.7+/-0.6, 6.7+/-0.6 and 7.0+/-0.0; c) 1:3 8.7+/-0.6, 11+/-1.0 and 11.7+/-0.6. (2) Weaning by augmentation: a) 75% 2.3+/-0.6, 2.7+/-0.6 and 3.0+/-0.0; b) 50% 1.3+/-0.6, 1.3+/-0.6 and 1.7+/-0.6. An increasing score was observed while weaning by mode (P<0.05). The 1:3 mode produces marked intimal disruption that worsens with time.

A novel study investigating the therapeutic outcome of patients with lytic, mixed and sclerotic bone metastases treated with combined radiotherapy and ibandronate.

PURPOSE: To investigate the therapeutic response of patients with different types of bone metastases treated with combined radiotherapy and bisphosphonates. PATIENTS AND METHODS: By using computed tomography 52 patients were grouped into groups of lytic, mixed and sclerotic bone lesions. All patients were treated with concomitant radiotherapy and ibandronate (10 monthly cycles) and underwent clinical and radiological evaluations prior to therapy and at 3, 6 and 10 months of follow up. RESULTS: At baseline there were statistically significant differences between the three groups for all the evaluated parameters. From 3 months onwards differences were leveled out. Statistically significant improvements were noted at all time points of evaluation for all groups in parameters such as pain (0-10), quality of life (QOL-physical functioning, 0-100) and Karnofsky performance status (KPS). The average pain score for the lytic group was reduced from 8.1 to 1.5 points at 3 months. The corresponding reductions for the mixed and sclerotic groups were from 6.2 to 0.5 and from 4.4 to 0.3 points respectively. Complete pain responses were >76.4% at all time points for all groups. Opioid consumption was also markedly reduced. Overall, the highest clinical response was noted for the lytic group, even though the mean values of pain, QOL and KPS were worse than those of the two other groups at all time points (apart from pain score at 10 months). The percentage of patients of the lytic group experiencing a complete pain response was the least of the three groups during follow up. At 10 months bone density was almost tripled for the lytic and almost doubled for the mixed group. CONCLUSIONS: Even though the therapeutic outcome for the three groups was similar, the degree of clinical response and reossification differed.

Clinical and radiological evaluation of patients with lytic, mixed and sclerotic bone metastases from solid tumors: is there a correlation between clinical status of patients and type of bone metastases?

PURPOSE: To investigate the association between the clinical status of patients with metastatic bone disease and the type of bone metastases. PATIENTS AND METHODS: 80 patients with skeletal metastases underwent both clinical and radiological assessments. Bone lesions were evaluated with computed tomography (CT), and patients were separated into three groups: lytic, mixed, sclerotic. Bone density of each lesion was measured in Hounsfield units (HU). RESULTS: Patients with osteolytic lesions had the highest mean pain score with 8.1 +/- 2.2 points, the least mean scores for quality of life (QoL) and performance status (PS) with 31.4 +/- 14.6 and 58.6 +/- 9.7 points respectively, the highest percentage and mean opioid consumption (100% and 220.9 mg of oral daily morphine equivalent respectively), and the least mean bone density (116.3 +/- 40.4 HU). On the contrary, the group with sclerotic metastases had the least mean pain score with 4.6 +/- 1.3 points, the highest mean scores of QoL and PS (61.1 +/- 15.5 and 66.6 +/- 10 points respectively), the least percentage and mean opioid requirement (55.5% and 170.6 mg respectively), and the highest mean bone density (444 +/- 86.6 HU). The differences between the three groups were statistically significant for all parameters evaluated, apart from performance status between the sclerotic and mixed groups. The correlation coefficients were statistically significant between all parameters investigated. Bone density had a strong negative correlation with pain. CONCLUSION: Our results show a clear correlation between the type of bone metastases and the clinical status of patients. Patients with excessive bone resorption suffer the most, and may be given priority in treatment. CT proved to be a practical and efficient method to investigate and classify metastatic bone lesions.