Active leprosy in Greece: a 20-year survey (1988-2007).

A retrospective study (1988-2007) of all newly detected (n = 26) and relapsed (n = 51) Greek cases of leprosy was carried out. Multibacillary types prevailed in both patient groups (n = 68, 88.3%). Seven immigrants from endemic areas were also referred with multibacillary leprosy. Newly detected Greek cases resided more frequently in rural areas. Incident and relapsed multibacillary disease cases did not differ by age. Diagnosis was mainly made on the basis of skin lesions rather than leprosy reactions. Leprosy in Greece (total population, ten million) has the epidemiological characteristics of a disease that is dying out, without gender inequalities.

Calcium antagonists in dermatology: a review of the evidence and research-based studies.

Calcium antagonists (CAs) or calcium-channel blockers are a common group of antihypertensive medications. These drugs have the property of blocking the calcium channels of vascular and cardiac smooth muscle fibers. Some of these drugs may inhibit the growth and proliferation of vascular smooth muscle cells and fibroblasts, and inhibit the synthesis of extracellular-matrix proteins (collagen, fibronectin, proteoglycans). Other CAs also have immunomodulatory or dysregulatory effects on lymphocytes and can suppress superoxide generation and phagocytic action of neutrophils. Moreover mast cell degranulation and platelet aggregation may also be impaired. On account of these properties, calcium antagonists have also been used for the prevention and treatment of various dermatologic diseases such as erythromelalgia, idiopathic- or CREST-related calcinosis cutis, primary and secondary Raynaud phenomenon, chilblains, chronic anal fissures, keloids, and burn scars. They are also used for prevention of skin flap necrosis in experimental models. Calcium antagonists, apart from their well known and established antihypertensive action, should also be considered as possible therapy for several dermatologic diseases.

Epidemiologic determinants of herpes genitalis case detection rates among STD clinic attendees.

BACKGROUND AND OBJECTIVE: to report significant sociodemographic and behavioural outpatient characteristics in Greeks and foreign immigrants associated with the diagnosis of symptomatic herpes genitalis. METHODS: A cross sectional hospital-based study (1990-96). RESULTS: In the context of an STD reference population (n = 5,831), herpes genitalis (n = 831) represents the second leading sexually transmitted disease (14.2%), more often affecting Greek outpatients. Immigrant women were found five times more infected than Greek. In Greek heterosexuals low partner change rate was the main characteristic at the moment of health seeking behaviour (median: 1 partner in the past six months). Homo/bisexual orientation in males resulted in lower detection rate. Injecting drug use history was not associated with an increased relative incidence. CONCLUSIONS: low risk behaviour in heterosexuals constitutes a background for further preventive interventions to reduce complications.

Prevalence and titre of antibodies against Hepatitis A virus in HIV-infected men having sex with men in Greece.

Hepatitis A remains a serious vaccine-preventable disease for HIV patients. We tested 897 HIV-infected men having sex with men (MSM) for antibodies against hepatitis A virus (anti-HAV) and measured the geometric mean antibody titres (GMTs) in a group of patients who received a hepatitis A vaccine and in patients with immunity to HAV due to infection in childhood. In all, 320 patients (35%) had positive anti-HAV antibodies. Multivariate analysis showed that only age (p 0.001) and ethnic origin (OR 20.029, p 0.001) had a statistically significant effect on the presence of antibodies. In addition, age was a fairly sensitive (68.4%) and specific (64.2%) marker, patients being separated by the 36.5 years cut-off point. The response rate of patients who get vaccinated (n 383), one month following the administration of the second dose of the vaccine, was 76%. The GMT of the vaccinated patients was 305 mIU/ml versus 7105 mIU/ml of patients with past infection. The vast majority of HIV-infected MSM patients in Greece is susceptible to HAV. Immunity to HAV in newly vaccinated patients, unlike patients with natural immunity, is low and probably requires monitoring.

Hallmarks in history of syphilis therapeutics.

At the end of the 15th century syphilis appeared in Europe as a devastating epidemic. For nearly four centuries mercury was regarded as a remedy of first-rate importance along with guaiac and potassium iodide. In the early 20th century, two new substances were added to syphilis therapeutics, namely arsenobenzol and bismuth. The absence of treponemal serum tests and the erroneous attribution of the positive Wassermann reaction exclusively to Treponema pallidum infection resulted in prolonged and non-proven effective treatments. In 1943 John Mahoney introduced penicillin, revolutionizing the treatment of syphilis.

Adherence to antiretroviral therapy among HIV-infected prisoners.

Adherence, the act of following a course of medication in exactly the manner prescribed, is critical for the success of therapy. Adherence is influenced by many behavioural and social factors and incarceration might be one such factor. This study determined the level of adherence and reasons for non-adherence to antiretroviral therapy among 93 HIV-infected prisoners. Up to 56% of these patients had poor adherence. A similar rate of adherence was detected in prisoners after release. Problems with antiretroviral adherence among prisoners appear to be mostly linked to their deviant behaviour. Inmates with poor adherence had higher HIV-related morbidity and mortality. Age and country of origin were also associated with adherence.

Antimicrobial susceptibility of Neisseria gonorrhoeae in Greece: data for the years 1994-2004.

OBJECTIVES: Surveillance data concerning antimicrobial susceptibilities of Neisseria gonorrhoeae isolated in Greece during the 11 year period 1994-2004 are presented. METHODS: Antimicrobial susceptibilities of all gonococcal isolates received by the Greek National Reference Center for N. gonorrhoeae during the study period were determined in terms of MICs using Etest. Trends in yearly isolation frequencies by susceptibility category were estimated for defining significant changes in overall susceptibility figures. RESULTS: Cefotaxime and spectinomycin retained undiminished activity against all isolates throughout the study period. High rates of resistance and intermediate susceptibilities were noticed for penicillin, tetracycline and erythromycin, and even for norfloxacin and ciprofloxacin. A substantial portion (16.5%) of the gonococcal samples consisted of multiresistant strains exhibiting resistance to two or more agents of different antibiotic classes. Although annual rates of low-level chromosomal resistance decreased, high-level resistance owing to the presence of penicillin- and tetracycline-resistance plasmids increased. Fluoroquinolone resistance also showed a significant increasing trend after 1996, reaching a peak rate of 11.3% in 2004. CONCLUSION: Third-generation cephalosporins and spectinomycin should be considered as first-choice drugs for the empirical treatment of gonorrhoea in Greece.

Determinants of genital wart case detection rates among STD clinic attendees in Athens, Greece.

BACKGROUND AND OBJECTIVE: To report significant sociodemographic and behavioral outpatient characteristics associated with the diagnosis of genital warts. METHODS: Cross-sectional hospital-based study (1990-96). RESULTS: Genital warts (n = 2988, 51.2%) represent the leading sexually transmitted disease (STD) among 5831 consecutive symptomatic Greek and foreign immigrant STD outpatients. In Greek heterosexuals a low rate of partner change was the main patient characteristic at diagnosis (median: one partner in the past 6 months). Lower detection rate and riskier behavior characterized immigrants. Although associated with risky behavior, homo/bisexual orientation in males and injecting drug use were not significantly associated with condyloma diagnosis in the context of STDs. CONCLUSION: Broader health education and secondary prevention are needed to control this infection, whereas low-risk behavior in Greek heterosexuals with condylomata facilitates further preventive interventions.

Incidence determinants of gonorrhea, chlamydial genital infection, syphilis and chancroid in attendees at a sexually transmitted disease clinic in Athens, Greece.

OBJECTIVE: To determine the specific impact on the incidence rate of some demographic and behavioral characteristics in outpatients with four bacterial sexually transmitted diseases (STDs). STUDY DESIGN: A cross-sectional hospital outpatient-based study was conducted from 1990 to 1996 on 1064 consecutive symptomatic STD cases (Chlamydia trachomatis, n = 375; gonorrhea, n = 369; early symptomatic syphilis, n = 288, and chancroid, n = 32) using a standardized questionnaire. RESULTS: In a reference STD population of 5831 symptomatic outpatients, the relative incidence of gonorrhea, syphilis and chancroid was found to be increased among immigrants. Low educational/socioeconomic level was also a significant incidence predictor. Older age characterized homo/bisexuals. The chlamydial infection detection rate was not affected by nationality, injecting drug use history or sexual orientation in males. CONCLUSION: Innovative preventive and control strategies are needed among immigrants, older men having sex with men and injecting drug users, apart from those targeting the general population.