Does COVID-19 Vaccination Warrant the Classical Principle "ofelein i mi vlaptin"?

The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic warrants an imperative necessity for effective and safe vaccination, to restrain Coronavirus disease 2019 (COVID-19) including transmissibility, morbidity, and mortality. In this regard, intensive medical and biological research leading to the development of an arsenal of vaccines, albeit incomplete preconditioned evaluation, due to emergency. The subsequent scientific gap raises some concerns in the medical community and the general public. More specifically, the accelerated vaccine development downgraded the value of necessary pre-clinical studies to elicit medium- and long-term beneficial or harmful consequences. Previous experience and pathophysiological background of coronaviruses' infections and vaccine technologies, combined with the global vaccines' application, underlined the obligation of a cautious and qualitative approach, to illuminate potential vaccination-related adverse events. Moreover, the high SARS-CoV-2 mutation potential and the already aggregated genetical alterations provoke a rational vagueness and uncertainty concerning vaccines' efficacy against dominant strains and the respective clinical immunity. This review critically summarizes existing evidence and queries regarding SARS-CoV-2 vaccines, to motivate scientists' and clinicians' interest for an optimal, individualized, and holistic management of this unprecedented pandemic.

EBV-related Cold Agglutinin Disease Presenting With Conjugated Hyperbilirubinemia: A Pediatric Case Report and Mini Review.

Hemolytic anemia occurs in only 1% to 3% of hospitalized patients with infectious mononucleosis. The authors describe an 8-year-old girl without cervical lymphadenopathy or splenomegaly, who presented with conjugated hyperbilirubinemia and was diagnosed with cold agglutinin disease caused by an immunoglobulin M autoantibody with anti-i specificity. Acute Epstein-Barr virus infection was confirmed by serologic and molecular methods. She recovered uneventfully after a 3-week course of methylprednisolone. Epstein-Barr virus infection should be considered in any case of hemolytic anemia associated with hepatic dysfunction, especially when direct antiglobulin test is positive for C3d. In these cases, a course of corticosteroids seems safe and may be beneficial.

A systematic review of reading tests.

Adequate near and intermediate visual capacity is important in performing everyday tasks, especially after the introduction of smartphones and computers in our professional and recreational activities. Primary objective of this study was to review all available reading tests both conventional and digital and explore their integrated characteristics. A systematic review of the recent literature regarding reading charts was performed based on the PubMed, Google Scholar, and Springer databases between February and March 2021. Data from 11 descriptive and 24 comparative studies were included in the present systematic review. Clinical settings are still dominated by conventional printed reading charts; however, the most prevalent of them (i.e., Jaeger type charts) are not validated. Reliable reading capacity assessment is done only by those that comply with the International Council of Ophthalmology (ICO) recommendations. Digital reading tests are gaining popularity both in clinical and research settings and are differentiated in standard computer-based applications that require installation either in a computer or a tablet (e.g., Advanced VISION Test and web-based ones e.g., Democritus Digital Acuity Reading Test requires no installation). It is evident that validated digital tests will prevail in future clinical or research settings and it is upon ophthalmologists to select the one most compatible with their examination routine.

Effect of spironolactone on pharmacological treatment of nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) was recently renamed to metabolic (dysfunction)-associated fatty liver disease (MAFLD) to better characterize its pathogenic origin. NAFLD represents, at least in western societies, a potential epidemic with raising prevalence. Its multifactorial pathogenesis is partially unraveled and till now there is no approved pharmacotherapy for NAFLD. A plethora of various choices are investigated in clinical trials, targeting an arsenal of different pathways and molecules. Since the mineralocorticoid receptor (MR) and renin-angiotensin-aldosterone system (RAAS) appear to be implicated in NAFLD, within this concise review, we focus on a rather classical and inexpensive pharmacological agent, spironolactone. We present the current lines of evidence of MR and RAAS-related preclinical models and human trials reporting an association with NAFLD. In conclusion, evidence about spironolactone of RAAS is commented, as potential future pharmacological management of NAFLD.

Diagnostic approach to Helicobacter pylori-related gastric oncogenesis.

Helicobacter pylori (H. pylori) is a causative agent of peptic ulcer disease and plays an important role in the development of various other upper and lower gastrointestinal tract and systemic diseases; in addition to carcinogenesis and the development of mucosa-associated lymphoid tissue lymphoma, extragastric manifestations of H. pylori are increasingly being unraveled. Therefore, prompt and accurate diagnosis is essential. Within this narrative review we present an overview of the current trend in the diagnosis of H. pylori infection and its potential oncogenic sequelae, including gastric mucosa atrophy, intestinal metaplasia, dysplasia and gastric cancer. Signs of H. pylori-related gastric cancer risk can be assessed by endoscopy using the Kyoto classification score. New technology, such as optical or digital chromoendoscopy, improves diagnostic accuracy and provides information regarding H. pylori-related gastric preneoplastic and malignant lesions. In addition, a rapid urease test or histological examination should be performed, as these offer a high diagnostic sensitivity; both are also useful for the diagnosis of sequelae including gastric and colon neoplasms. Culture is necessary for resistance testing and detecting H. pylori-related gastric dysbiosis involved in gastric oncogenesis. Likewise, molecular methods can be utilized for resistance testing and detecting H. pylori-related gastric cancer development and progression. Noninvasive tests, such as the urea breath and stool antigen tests, can also be implemented; these are also suitable for monitoring eradication success and possibly for detecting H. pylori-related gastric malignancy. Serological tests may help to exclude infection in specific populations and detect gastric and colon cancers. Finally, there are emerging potential diagnostic biomarkers for H. pylori-related gastric cancer.

Determinants of compliance to the facemask directive in Greece: A population study.

PURPOSE: Primary objective of this study was to identify potential difficulties and/or discomfort when using a facemask. Moreover, to explore the impact of spectacles, contact lenses and visual acuity on the compliance to the facemask directive. METHODS: This is a prospective study that was conducted at the Department of Ophthalmology, University Hospital of Alexandroupolis, Greece between June 2020 and August 2020. Greek speaking citizens with permanent residency in Greece above 18 years old were included. A custom questionnaire (DeMask-20) was constructed and validated, which pertained to the perceived difficulty and discomfort when using a facemask. It contained 20 items grouped in 8 subscales (driving, near vision, distance vision, ocular discomfort, role limitation, collaboration, dependency on others, emotional stress). Perceived difficulty and discomfort when using a facemask, compliance and correlations of compliance with DeMask-20 scores, demographics, spectacle and/or contact lens use, and visual acuity were evaluated. RESULTS: The number of factors was determined through factor analysis. Cronbach's alpha ranged from 0.716 for the "Role limitation" subscale to 0.938 for "Ocular discomfort" subscale. 1,214 participants (402 men, 812 women, mean age 36.79±12.50 years) completed the DeMask-20 instrument. Mean DeMask-20 score of all study participants was 3.79±0.71. Significant differences in DeMask-20 score were detected in gender (p = 0.009), spectacle use (p = 0.034), contact lens use (p = 0.049), and binocular distance visual acuity (bDVA) (p = 0.001). Mean compliance of all participants was 4.05±0.96. Men, people <50 years and spectacle wearers showed significantly worse compliance (p<0.05). Moreover, professional workers and professional drivers demonstrated significantly better compliance (p = 0.008 and p = 0.047). Significant correlation was detected between compliance and DeMask-20 score (p<0.001, R2 = 0.471). Significant correlations were detected with driving, near vision, distance vision, collaboration, role limitation, emotional stress (p<0.05, R2: 0.386-0.493). CONCLUSIONS: Factor analysis suggested that the DeMask-20 instrument demonstrates adequate validity, while Cronbach's alpha indicated sufficient internal consistency of all subscales. This study provided the necessary methods that could evaluate compliance trends and the efficacy of healthcare interventions against COVID-19. Our outcomes suggest that young males who use spectacles should be targeted by Greek Healthcare authorities in order to improve compliance rates.

Iron Deficiency Anemia in Children Residing in High and Low-Income Countries: Risk Factors, Prevention, Diagnosis and Therapy.

Iron deficiency and iron-deficiency anemia (IDA) affects approximately two billion people worldwide, and most of them reside in low- and middle-income countries. In these nations, additional causes of anemia include parasitic infections like malaria, other nutritional deficiencies, chronic diseases, hemoglobinopathies, and lead poisoning. Maternal anemia in resource-poor nations is associated with low birth weight, increased perinatal mortality, and decreased work productivity. Maintaining a normal iron balance in these settings is challenging, as iron-rich foods with good bioavailability are of animal origin and either expensive and/or available in short supply. Apart from infrequent consumption of meat, inadequate vitamin C intake, and diets rich in inhibitors of iron absorption are additional important risk factors for IDA in low-income countries. In-home iron fortification of complementary foods with micronutrient powders has been shown to effectively reduce the risk of iron deficiency and IDA in infants and young children in developing countries but is associated with unfavorable changes in gut flora and induction of intestinal inflammation that may lead to diarrhea and hospitalization. In developed countries, iron deficiency is the only frequent micronutrient deficiency. In the industrialized world, IDA is more common in infants beyond the sixth month of life, in adolescent females with heavy menstrual bleeding, in women of childbearing age and older people. Other special at-risk populations for IDA in developed countries are regular blood donors, endurance athletes, and vegetarians. Several medicinal ferrous or ferric oral iron products exist, and their use is not associated with harmful effects on the overall incidence of infectious illnesses in sideropenic and/or anemic subjects. However, further research is needed to clarify the risks and benefits of supplemental iron for children exposed to parasitic infections in low-income countries, and for children genetically predisposed to iron overload.

Corneal Graft Success Rates in HSV Keratitis: A Systematic Review.

Herpes Simplex Virus (HSV) has worldwide prevalence. The primary objective of this systematic review was to compare penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) regarding the efficacy and complications of the treatment of corneal scarring caused by herpes simplex keratitis. Out of the 469 articles identified during the combined search of the literature based on the PubMed and Cochrane libraries, 10 retrospective and 2 prospective studies published from January 2010 to December 2019 were included. The study outcomes indicated that both surgical approaches resulted in a comparable improvement of visual acuity (VA). However, DALK demonstrated fewer complications in the majority of studies. Higher graft survival rates were associated with higher acyclovir (ACV) doses (above 800 mg/day), topical steroid and antibiotic drops. In conclusion, in terms of postoperative VA, both PK and DALK demonstrate comparable efficacy. However, DALK, which is applied in less severe HSK cases, is associated with fewer complications and better graft survival rates. High dosages of ACV, topical steroids and antibiotics contribute significantly to improved postoperative outcomes.

Introduction of a digital near-vision reading test for normal and low vision adults: development and validation.

BACKGROUND: MNREAD is an advanced near-vision acuity chart that has already been translated and validated in Greek language. Considering that no validated Greek digital near-vision test exists, our primary objective was to develop and validate a digital near-vision reading test based on the fundamental properties of the Greek printed MNREAD (MNREAD-GR). METHODS: This is a prospective, comparative study. A digital near-vision chart was developed (Democritus Digital Acuity Reading Test - DDART) with text size calibration, audio recording for automatic reading timing, as well as automatic calculation of reading acuity (RA), maximum reading speed (MRS), critical print size (CPS) and reading accessibility index (ACC). Normal and low vision subjects participated in the validation process, responding to MNREAD-GR and DDART at the same day, at a 40 cm viewing distance. Differences in all parameters between the charts were compared with t-test and intraclass correlation coefficients (ICCs). Within 15 days, all participants responded again to DDART in a different set of sentences to assess its test-retest reliability. RESULTS: One hundred patients (normal vision group - NVG: 70 patients; low vision group - LVG: 30 patients) responded to both reading tests. Non-significant differences were detected for all parameters between DDART and MNREAD-GR except for MRS and ACC that were significantly higher in MNREAD-GR in NVG (p <  0.01). NVG participants demonstrated sufficient ICCs that ranged from 0.854 to 0.963, while LVG demonstrated ICCs for RA, ACC, MRS and CPS equal to 0.986, 0.894, 0.794 and 0.723, respectively. All parameters calculated with DDART demonstrated excellent test-retest reliability (ICCs: 0.903 - 0.956). CONCLUSIONS: The proposed reading test presented comparable validity and repeatability to MNREAD-GR suggesting that it can be used both in normal and low vision Greek patients. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04242836. Registered 24 January 2020 - Retrospectively registered.

Ten Years of Experience in Contraception Options for Teenagers in a Family Planning Center in Thrace and Review of the Literature.

Abstract: Introduction: The goal of our study was to investigate and evaluate the contraceptive behavior in teenagers from our family planning centre that services two different religious and socioeconomic populations living in the Thrace area. Methods: During the last 10 years 115 Christian Orthodox (group A) and 53 Muslim teenagers (group B) were enrolled in our retrospective study. Contraceptive practice attitudes were assessed by a questionnaire. Religion, demographics, socio-economic characteristics were key factors used to discuss contraception and avoid unplanned pregnancy in each group and to compare with the contraceptive method used. Results: The most used contraceptive method-about two times more frequently-among Christian Orthodox participants was the oral contraceptive pill (p = 0.015; OR = 1.81, 95% CI = 1.13-2.90), while in the other group the use of condoms and IUDs was seven and three times more frequent, respectively. Our family planning centre was the main source of information for contraception. Conclusions: During adolescence, the existence of a family planning centre and participation in family planning programs plays a crucial role to help the teenagers to improve their knowledge and choose an effective contraception method.