Evaluation of Sperm DNA Fragmentation Using Two Different Methods: TUNEL via Fluorescence Microscopy, and Flow Cytometry.

Background and Objectives: Sperm DNA fragmentation refers to any break in one or both of the strands of DNA in the head of a sperm. The most widely used methodologies for assessing sperm DNA fragmentation are the sperm chromatin structure assay (SCSA), the sperm chromatin dispersion assay (SCD), the single-cell gel electrophoresis assay (SCGE-comet), and the terminal-deoxynucleotidyl-transferase (TdT)-mediated dUTP nick end labelling (TUNEL) assay. The aim of this study was to compare the efficiency and sensitivity of the analysis of sperm DNA fragmentation using TUNEL via fluorescence microscopy, and flow cytometry. Materials and Methods: Semen samples were collected and analyzed for standard characteristics using light microscopy, and for sperm DNA fragmentation using both TUNEL via fluorescence microscopy, and flow cytometry. Results: There were no significant differences in the values of the sperm DNA fragmentation index (DFI) obtained when the analysis was performed using TUNEL or flow cytometry (p = 0.543). Spearman's correlation analysis revealed a significant negative correlation between sperm motility (%) and sperm DNA fragmentation (p < 0.01), as well as between sperm concentration and sperm DNA fragmentation (p < 0.05). The Mann-Whitney U test showed no significant difference in the DFI among couples with repeated implantation failure (RIF) and miscarriages (p = 0.352). Conclusions: Both methods (TUNEL via fluorescence microscopy, and flow cytometry) have a high efficiency and sensitivity in accurately detecting sperm DNA fragmentation, and can be effectively used to assess male fertility.

Sepsis-induced coagulopathy in preterm neonates with Gram-positive sepsis presents with hypercoagulation and reduced platelet activation compared with healthy preterm neonates.

Background: Neonatal sepsis is frequently accompanied by coagulopathy and thrombocytopenia attributed to the cross-link between inflammation and coagulation. However, sepsis-induced coagulopathy and platelet function in septic preterm neonates remain to be elucidated. In addition, there is no robust evidence for a causal relationship between thrombocytopenia and bleeding in preterm neonates with sepsis. Objective: This single-center prospective cohort study aimed to assess sepsis-induced coagulopathy and platelet function in preterm neonates during sepsis. Methods: We included 25 preterm neonates with Gram-positive sepsis born at gestational age 24 + 1 to 34 + 3 and studied in comparison to 30 healthy counterparts. Coagulation was assessed using conventional coagulation tests (CCTs) and rotational thromboelastometry (ROTEM). Platelet function was evaluated by flow cytometry. The study was conducted at 3-time points, at 1st, at 2nd to 3rd, and at 5th to 7th day of sepsis, respectively. Results: Compared with healthy controls, neonates with Gram-positive sepsis present in ROTEM a hypercoagulable state; a higher maximum clot firmness (MCF) and higher amplitudes of intrinsic rotational thromboelastometry (INTEM) (INTEM MCF: median, 71; P .004 and INTEM A10: median, 67; P .005, respectively), extrinsic rotational thromboelastometry (EXTEM) (EXTEM MCF: median, 70; P .02 and EXTEM A10: median, 67; P .02, respectively), and rotational thromboelastometry assay for fibrin formation (FIBTEM) (FIBTEM MCF: median, 25; P < .001 and FIBTEM A10: median, 23; P .002, respectively). Conversely, CCTs exhibited hypocoagulation. Thrombocytopenia in preterm neonates with Gram-positive sepsis is not associated with an increased bleeding risk. In Gram-positive sepsis, platelets display increased glycoprotein (GP) surface receptors' expression (GPIb: median, 2.8; P .03, GPIIb: median, 3.1; P .004, and GPIIIa: median, 3.9; P .008, respectively) and reduced activation (P-selectin: median, 1; P < .001). A higher expression of platelets GP and improved degranulation capacity were recorded in patients in higher gestational age groups of >32 weeks of gestation. Platelet GPIb expression is age-dependent in healthy neonates. Conclusion: Neonatal Gram-positive sepsis is characterized by a progressive hypercoagulation along with increased GP expression, reduced platelet activation, and thrombocytopenia without bleeding. Platelet GP expression and degranulation capacity are age-dependent among neonates with sepsis. Platelet GP expression is age-dependent among healthy counterparts.

Emerging trends in domestic homicide/femicide in Greece over the period 2010-2021.

Temporal trends in epidemiological parameters of domestic homicide and femicide in Greece over the last decade have not yet been studied. We conducted this study to fulfill this purpose. Specifically, we conducted a retrospective epidemiological study using 11-year data from the official nationwide Hellenic Police Archives and statistically analyzed data regarding domestic homicide and femicide. Overall, 1370 records of homicides among which 236 domestic homicides were identified. The pattern emerging from the statistical results of the present study highlighted the phenomenon of femicide as the gravest current issue to be interpreted and addressed. Nationally, the average number of homicides was 114.2/year, among which 19.7 domestic homicides. However, in 2021, while a decrease was recorded in homicides in general to 89 incidents per year, domestic homicides skyrocketed to 34 cases, reaching the highest annual number ever nationally recorded. On average, domestic homicides account for 18.2% of all homicides in Greece. In 2021, however, this percentage rose to 38.2%. The number of male victims of domestic homicide has declined over the years, with a further decline in 2021, in stark contrast to the number of women escalating over time and even more sharply in 2021. The proportion of female victims of domestic homicides in Greece was fourfold higher on average. The fact that cases of domestic homicide and femicide have received a lot of media attention, the recent Greek financial crisis, as well as increased alcohol and drug consumption due to the COVID-19 pandemic constitute possible aggravating factors.

Psychosis and conduct disorder in Greek forensic patients found not guilty by reason of insanity: Differences between patients with and those without a history of conduct disorder in childhood or adolescence.

Much epidemiological evidence converges in identifying distinct types of individuals suffering from schizophrenia who exhibit aggressive behavior: those with and those without a history of conduct disorder (CD) in childhood or adolescence. In this study a sample of Greek forensic patients suffering from psychotic disorders was examined regarding demographic, clinical, legal and psychometric characteristics. All patients had committed a crime and were found not guilty by reason of insanity (NGRIs) in a court of law. This study aims to clarify whether history of conduct disorder leads to greater violence or shapes the index offense in some way. It also aims to examine new parameters, such as psychopathology, personality traits, substance abuse and risk assessment, not included in the relevant literature so far, and whether they are relevant and why in this specific group of patients. The sample was divided in two groups depending on the history of CD or not, and subsequently statistically significant differences were explored between the groups. The research aimed to highlight specific characteristics of both groups with the ultimate goal of making more accurate prognosis regarding risk assessment, as well as determining different needs for treatment in each group (e.g. drug abuse). Overall, 78 forensic psychiatric records of NGRI offenders were identified throughout a five-year period in the Psychiatric Hospital of Thessaloniki (January 2015 to January 2020), who were divided into two groups depending on the history of conduct disorder in childhood or adolescence (N = 30) or not (N = 48). The two groups were compared regarding hostility and aggression (with the Hostility and Direction of Hostility Questionnaire-HDHQ and the Aggression Questionnaire), personality traits (with the Zuckerman- Kuhlman Personality Questionnaire-ZKPQ), dangerousness (with the Historical, Clinical and Risk Management 20- HCR-20 scale), addiction (with the Addiction Severity Index-ASI), previous violent behavior or convictions (with a semi-structured tool), and psychopathology current and at the time of the index (with the Positive And Negative Syndrome Scale-PANSS). Comparing the two groups (with CD history vs. without CD history) we found that patients with a history of conduct disorder had significantly higher compulsory hospitalization rates up to the time of the perpetration of the offense and a significantly higher rate of illicit drug use. While they were more likely to exhibit violent behavior before the index offense, it was noted that they committed fewer crimes against life. They were younger at the index offense and they presented with more severe positive symptomatology at the time of the research and a steadily high risk assessment score. Our findings underline the importance of diagnosing CD in early life and subsequently raising awareness when this individual develops schizophrenic disorder, thus emphasizing the need for appropriately targeted interventions in each case. Our research also illustrates that forensic patients with both schizophrenia and a history of conduct disorder before the age of 15 exhibit more severe psychopathology after the index crime even after long hospitalization and treatment. Our findings illustrate that the diagnosis of CD in psychotic offenders found not guilty by reason of insanity affects their dangerousness in general, but not the severity of the crimes committed.

Real-world effectiveness of vortioxetine in outpatients with major depressive disorder: functioning and dose effects.

BACKGROUND: Functional recovery is an important treatment goal in major depressive disorder (MDD). This study assessed the real-world effectiveness of vortioxetine in patients with MDD, with particular focus on functioning; dose-response was also assessed. METHODS: This was a non-interventional, prospective, multicenter study conducted in Greece. Adult outpatients with MDD (n = 336) initiating vortioxetine (5-20 mg/day flexible dosing) as treatment for a current major depressive episode were followed for 3 months. Analyses were stratified according to vortioxetine dosage at 3 months: 5-10 mg/day versus 15-20 mg/day. Functioning was assessed using the Sheehan Disability Scale (SDS). RESULTS: Mean ± standard error SDS total score decreased (improved) from 18.7 ± 0.3 at baseline to 12.9 ± 0.3 after 1 month of vortioxetine treatment and 7.8 ± 0.4 after 3 months (p < 0.001 vs. baseline for all comparisons). Functional recovery (SDS score ≤ 6) was achieved in 14.6% of patients after 1 month of treatment and 48.4% of patients after 3 months. Improvement from baseline in SDS total and domain scores at 3 months was more pronounced in patients receiving vortioxetine 15-20 mg/day than in those receiving vortioxetine 5-10 mg/day. The mean ± standard error change in SDS total score from baseline was 9.2 ± 0.8 in the 5-10 mg/day group and 12.1 ± 0.4 in the 15-20 mg/day group (p < 0.001). Limitations of this study include its non-interventional study design and lack of a control group or active comparator. CONCLUSIONS: Statistically significant and clinically relevant improvements in functioning were seen in patients with MDD treated with vortioxetine in a real-world setting. Higher doses of vortioxetine were associated with significantly greater improvements in functioning.

The Effects of Use of Long-Term Second-Generation Antipsychotics on Liver and Kidney Function: A Prospective Study.

(1) Background: The second-generation antipsychotics (SGAPs) induce metabolic and inflammatory side effects, but documentation of their effects on the liver and kidneys is scarce. Aim: To study the three-year fluctuation of selected markers of renal and hepatic function in forensic psychiatric patients receiving SGAPs for more than five years. (2) Methods: Thirty-five forensic psychiatric patients (N = 35) were classified into two groups according to the type of SGAPs used for their treatment and the relevant risk of weight gain and metabolic complications. The three-year medication history, anthropometric data and biochemical data relevant to renal and hepatic function were retrieved from the individual medical files, specifically: serum levels of urea, uric acid, creatinine, alkaline phosphatase and amylase; the liver function enzymes, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT) and gamma-glutamyl transpeptidase(γ-GT), and also the inflammatory index C-reactive protein (CRP). (3) Results: The patients receiving the SGAPs with a low risk for weight gain showed no significant fluctuation in the biochemical markers over the three-year period. The patients receiving the SGAPs with a high risk for weight gain showed significant differences between at least two measurements of uric acid (p = 0.015), SGOT (p = 0.018) and SGPT (p = 0.051). They showed significantly higher levels of creatinine in the third year compared to the second year (p = 0.029), and SGOT in the second year compared to the first (p = 0.038), and lower levels of SGPT in the third year compared to the second (p = 0.024). (4) Conclusion:In addition to consideration of possible metabolic and inflammatory complications, the choice of an antipsychotic drug for long-term treatment should also take into account the risk of hepatotoxicity and kidney damage.

The phenomenon of overkill in northern Greece: A descriptive forensic psychiatric study between 2015 and 2020 on criminal offenders found not guilty by reason of insanity.

The purpose of this descriptive study was to investigate overkill in a representative sample of Greek psychiatric patients found not guilty by reason of insanity (NGRIs) from a forensic psychiatric - criminological standpoint and explore possible correlations of the phenomenon with socio-cultural or psychiatric factors. Overall, 24 forensic psychiatric records of overkill offenders were identified throughout the 5-year records of the national forensic psychiatric service in northern Greek mainland. The pattern that has emerged from the statistical results of the present study on the victims of overkill within the Greek borders was generally in line with global literature on homicide perpetrators. The mean age of overkill offenders (at the time of enactment of the crime) was estimated at 36.3 years ranging from 19 to 55 years (variance = 146.72; standard deviation = 12.11). The number of male single-offence killers was ten-times larger compared to their female counterparts, while the number of male multiple-offence killers were three-times larger compared to their female counterparts. Male offenders were averagely 15 years younger (mean 33.7; variance = 81.69; standard deviation = 9) in comparison to female offenders, and single-offence killers were averagely ten years younger compared to multiple-offence killers (mean 40.2; variance = 185.19; standard deviation = 13.6). The phenomenon correlated more strongly with homicides in the context of schizophrenia spectrum disorders (80-100%) as well as domestic violence. Overall, males outnumbered females both as offenders (approximately five-times) and victims (approximately three-times), but regarding domestic violence, the sad majority of overkill victims stood for females murdered by their male relatives. Close female relatives (especially mothers and grandmothers) were most often victimized. Female-perpetrated overkill was directed against male individuals with whom offenders shared a relationship (intimate partners and minors). An important finding was the fact that three-quarters of the overall perpetrator sample were under prescribed medication at the time of offence, but with a very low compliance rate (5.6%). This last particular finding of the present study demonstrated that mental health services within community in Greece may unfortunately have been ineffective in addressing issues requiring risk assessment and timely intervention.

Effects of Different Drug Therapies and COVID-19 mRNA Vaccination on Semen Quality in a Man with Ankylosing Spondylitis: A Case Report.

Background and Objectives: Ankylosing spondylitis (AS) is a condition that affects 0.1% to 0.5% of the adult population. The aim of this case report was to investigate the possible effects of the drugs taken for treatment of AS as well as mRNA vaccination for COVID-19 on semen quality by performing a highly detailed analysis. Materials and Methods: Sperm characteristics were examined by light microscopy, DNA fragmentation (DFI) was analysed by flow cytometry and morphology was evaluated by transmission electron microscopy (TEM). Results: Semen analysis under therapy with (1) celecoxib and sulphasalazine showed: concentration 47 million/mL, 53% progressive motility, 7% normal morphology and 9.6% DFI, (2) Golimumab and before mRNA Vaccination showed: concentration 108 million/mL, 82% progressive motility, 1% normal morphology and 7.6% DFI, and (3) Golimumab and after 3 doses of mRNA Vaccination showed: concentration 142 million/mL, 85% progressive motility, 1% normal morphology and 6.8% DFI. TEM revealed head, neck and tail abnormalities, as well as the presence of cells with incomplete spermiogenesis white cells and phagocytes in the sample under therapy with celecoxib and sulphasalazine. Golimumab treatment lead to an increased incidence of elongated heads but in general reduced inflammation as no white cells were evident in TEM. Conclusion: The anti-inflamatory drugs celecoxib and sulphasalazine had no adverse effect on sperm quality as all parameters were within normal limits and the patient achieved under that treatment 2 pregnancies following natural conception that lead to the birth of a healthy boy and girl respectively. Anti-TNFa treatment with Golimumab exerted a negative effect on morphology but not on concentration, motility and DFI. After 3 doses of mRNA Vaccination, sperm concentration increased while motility, morphology and DFI remained similar to the values before vaccination suggesting no negative effect of the mRNA vaccine for COVID-19 on sperm quality.

Long Term Metabolic and Inflammatory Effects of Second-Generation Antipsychotics: A Study in Mentally Disordered Offenders.

Mentally disordered offenders provided with forensic psychiatric care are often treated with second generation antipsychotic (SGA) medication and experience metabolic and inflammatory side effects. AIM: In this paper, we monitored the three-year fluctuation of selected anthropometric, biochemical, and inflammatory indices in forensic psychiatric patients receiving antipsychotic (AP) medication for more than five years, according to the type of AP. METHODS: Thirty-five patients with psychotic disorders were classified into two groups based on the type of AP. Specifically: AP1, related to a lower risk, and AP2, related to an increased risk of weight gain (WG) and metabolic complications. Biochemical, hematological, anthropometric, blood pressure (BP), and medication data were retrieved from the individual medical files. Statistical analysis was performed with SPSS 23. RESULTS: No significant differences in weight and glucose and cholesterol levels were observed, but patients taking AP2 more often needed drugs to control diabetes mellitus (DM), lipidemia, and cardiovascular disease (CVD). In those taking AP1, the mean HDL level decreased significantly over time (p < 0.05) and a higher proportion developed higher BP (52.9% of AP1 vs. 16.7% AP2). In the AP2 group the median level of C-reactive protein (CRP) (p < 0.001) and the white blood cell count (WBC) increased over the three years (p < 0.001). CONCLUSIONS: The proposed sub-classification of SGAs into AP1 and AP2, depending on their potential for metabolic and inflammatory effects, might facilitate study of their long-term side-effects but also help in personalized prevention or treatment measures to counteract these side-effects.

Investigating the phenomenon of overkill in Greece: A forensic psychiatric autopsy study between 2005 and 2020.

The purpose of this study was to investigate overkill in the Greek population from a criminological and victimological point of view and explore possible correlations of the phenomenon with socio-cultural or psychiatric factors. Overall, 158 autopsies of overkill victims were identified throughout the 15-year records of the national forensic laboratories throughout the northern Greek mainland. The pattern that has emerged from the statistical results of the present study on the victims of overkill within the Greek borders was generally in line with global statistics on homicide victims, but also presented differences. The phenomenon correlated more with homicides in the context of mental disorders (within schizophrenia spectrum), other crimes (such as burglary) as well as domestic violence. Overall, males outnumbered females both as victims (approximately threefold) and as perpetrators in overkill homicide cases, but regarding domestic violence, the sad majority of overkill victims stood for females murdered with excessive violence by male relatives. Close female relatives (especially mothers and grandmothers) were also victimized by psychiatrically ill offenders. Female perpetrators tended to attack male individuals with whom they shared a relationship (intimate partners). An important finding was the fact that less than half the offenders' population with major mental disorders were diagnosed at the time of the offense. Overkill victims were found, on average, to be older than average homicide victims, being probably associated with the entailed difference in the physical strength ratio between the victim and the perpetrator.

Self-immolation Suicide in Greece: A Forensic Psychiatric Autopsy Study between 2011 and 2019.

Self-immolation is a rare suicide method in the developed countries of the western world (0.06-1%); however, it has relatively higher prevalence rates in the developing countries of Asia and Africa (6-57%). The present study aims to examine self-immolation suicides within the Greek mainland (Attiki, Thrace, and Peloponnese) over a period of 9 years (2011-2019) in order to investigate the phenomenon in the Greek population forensically, identify the characteristics and motivations of suicide victims, explore its associations to socio-cultural or psychiatric factors, and describe a fatal case of suicide by self-immolation that was partially recorded on camera. The medical files (autopsy reports) of cases performed at the Departments of Forensic Medicine of the National and Kapodistrian University of Athens, Democritus University of Thrace, and the Forensic Service of Messinia-Peloponnese were retrospectively examined yielding 19 cases of suicides by self-immolation. A 3.7% prevalence of suicide by self-immolation among suicide fatalities within the Greek population was estimated. A distinctive feature of the Greek population regarding self-immolation was disclosed that it is being practiced predominantly by the elderly (mean age 2-3.5 decades higher than other countries). The phenomenon correlated strongly with poorly controlled mental disorders (mostly affective and adjustment disorders). Unlike other countries, there was no significant association with domestic or sexual violence, social or political protest, or religious issues. Therefore, the suicide victims preferred secluded or private outdoor locations (not public). Findings deriving from the examined variables localize Greek population culturally between the Western European and Asian African countries, but with its own idiosyncrasies.

In fear of the most loved ones. A comprehensive review on Capgras misidentification phenomenon and case report involving attempted murder under Capgras syndrome in a relapse of a schizophrenia spectrum disorder.

The present paper aims to describe a case of a schizophrenia spectrum disorder relapse leading to attempted murder, review literature, and investigate the epidemiological data and expression of violent behavior among Capgras-related incidents. 109 case reports deriving from various scientific areas dating from 1971 to 2017 were evaluated and juxtaposed with an equivalent comparison group of random psychiatry inpatients, who were examined for the same variables. Quantitative and qualitative differences were observed between samples. High level of interpersonal violence was disclosed among Capgras-related incidents, especially towards the main care-givers, with higher propensity among male patients. Homicidal behavior was also expressed in higher levels among male patients experiencing the Capgras delusion. A multidisciplinary approach is vital for the optimal management of these incidents. Further research on the pathophysiology of Capgras delusion with the utilization of functional imaging techniques is of exceptional significance for the understanding of issues of neuroscience.

Prepartum Psychosis and Neonaticide: Rare Case Study and Forensic-Psychiatric Synthesis of Literature.

Peripartum psychosis is a rare but serious psychiatric disorder characterized by the presence of a mood episode with psychotic features. Although controversy surrounds the nosological status of peripartum mental disorders, these conditions continue to be of exceptional interest to the medical and forensic mental health communities. The aim of this study was to report a rare case of prepartum psychosis which escalated to the endpoint of neonaticide and summarize literature on peripartum mental disorders and infanticide. A 30-year-old mother murdered her newborn with the spike of her serum delivery system and planned to commit suicide while in hospital after hallucinating due to an acute puerperal psychotic disorder with a prepartum onset and postpartum deterioration. Her disorder was not managed until neonaticide. Throughout this paper, the significance of a multidisciplinary approach for the optimal management of these incidents is highlighted and diagnostic as well as therapeutic issues are addressed.

Neuroleptic malignant syndrome without fever after addition of oxcarbazepine to long-term treatment with amisulpride.

OBJECTIVE: Our goal was to report a case of malignant neuroleptic syndrome in a patient administered with both oxcarbazepine (OXCBZ) and amisulpride (AM). METHOD: We present a case of a young man who presented with symptoms of malignant neuroleptic syndrome after progressive titration of OXCBZ (1,200 mg) added to the long-term treatment with AM (800 mg). RESULTS: After discontinuation of AM and administration of dopaminergic drugs, his clinical symptoms improved gradually. CONCLUSION: This case suggests that clinicians should consider the risk of neuroleptic malignant syndrome when OXCBZ is coadministered to patients undergoing long-term treatment with neuroleptics.

Relationship of age and psychosocial factors with biological ratings in patients with end-stage renal disease undergoing dialysis.

BACKGROUND AND AIMS: Dialysis is a time-consuming procedure and may cause psychological distress. The aim of the present study was to investigate the relationship between age, emotional state, life satisfaction, sexual functioning and the method of dialysis in patients suffering from end-stage renal failure. METHODS: Eighty-two patients of 97 with end-stage chronic renal failure entered the study; 56 were under hemodialysis (HD), and 26 were under continuous ambulatory peritoneal dialysis (CAPD). Zung Depression Rating Scale (ZDRS), the Life Satisfaction Inventory (LSI), the Lasry Sexual Functioning Scale (LSFS), and a protocol aiming to register sociodemographic variables and variables considering the physical disorders were used. RESULTS: No significant differences between groups were found in the ZDRS (HD patients: 40.7 +/- 8.2, CAPD patients: 41.88 +/- 10.44; p = 0.57), LSI scores (HD patients: 87.9 +/- 14.7, CAPD patients: 87.03 +/- 5.25; p = 0.7) and LSFS scores. Multiple linear regression analysis showed that LSI scores depended only on gender (females were less satisfied) and individual items on level of albumins and the presence of other physical disorders; ZDRS individual items depended on leukomatine level, gender, diabetes mellitus, albumins, age, creatinine and duration of disease; sexual functioning on age, and urea and sleep on albumin level (all with p < 0.001). DISCUSSION: No statistically significant differences were detected in depressive symptomatology, sexual function and life satisfaction between patients undergoing HD or CAPD. Some aspects of depressive symptomatology, sexual functioning and life satisfaction may be influenced by age, the kind of treatment and its effectiveness. Age was positively related with satisfaction from general quality of life, frequency of sexual activity, tiredness and feelings of usefulness.