Vaccination coverage and predictors of influenza, pneumococcal, herpes zoster, tetanus, measles, and hepatitis B vaccine uptake among adults in Greece.

OBJECTIVES: Insufficient adult vaccination coverage rates remain an international challenge. This nationwide study aimed at exploring vaccination coverage and predictors of influenza, pneumococcal, herpes zoster, tetanus, measles, and hepatitis B vaccine uptake, following the recommendations of the National Immunization Program for adults. STUDY DESIGN: This was a multicenter, mixed-methods study conducted at 23 primary care units in six different regions of Greece. METHODS: A pretested questionnaire was administered to three randomly selected adults who visited each practice daily for 30 consecutive working days. RESULTS: Among the 1571 participants, vaccination coverage for influenza in the high-risk groups was 55%, 36% for pneumococcal disease, 12% for herpes zoster (HZ), 21% for tetanus, 33% for measles, and 11% for hepatitis B. Perception of low susceptibility to disease due to good health status, concerns about side-effects and vaccines' efficacy, and mistrust in pharmaceutical companies were among common factors associated with the vaccines uptake. The strongest factor associated with the participants' vaccination status was their doctor's recommendation (odds ratio [95% confidence interval] influenza: 6.06 [4.52-8.14], pneumococcal disease: 15.73 [10.98-22.52], HZ: 17.01 [9.05-31.96], tetanus: 23.93 [16.20-35.35], measles: 33.47 [16.85-66.47], and hepatitis B: 73.92 [17.47-312.74]). Being well-informed about each vaccine was also a predictor of its uptake. CONCLUSIONS: Vaccination coverage was suboptimal and especially low in tetanus, HZ, and hepatitis B immunization. Person-centered approach, with provision of appropriate information about vaccines' safety and efficacy, responding to each patient's needs, as well as physicians' strong recommendation for vaccination are considered crucial to advocate against the spread of vaccine misinformation and increase vaccination coverage.

Safety profile of chloroquine and hydroxychloroquine: a disproportionality analysis of the FDA Adverse Event Reporting System database.

OBJECTIVE: The present study aims to identify potential safety signals of chloroquine (CQ) and hydroxychloroquine (HCQ), over the period preceding their repurpose as COVID-19 treatment options, through the analysis of safety data retrieved from the FDA Adverse Event Reporting System (FAERS) pharmacovigilance database. MATERIALS AND METHODS: We performed a disproportionality analysis of FAERS data between the first quarter of 2004 and December 2019 using the OpenVigil2.1-MedDRA software. Disproportionality was quantified using the reporting odds ratio (ROR) and its 95% confidence interval (CIs). The reported mortality of CQ and HCQ was also investigated. RESULTS: The dataset contained 6,635,356 reports. Comparison of the RORs revealed significant differences between CQ and HCQ for the following adverse events: cardiomyopathy, cardiac arrhythmias, retinal disorders, corneal disorders, hearing disorders, headache, hepatic disorders, severe cutaneous reactions, musculoskeletal disorders, and cytopenia. Only CQ was associated with psychotic disorders, suicide, self-injury, convulsions, peripheral neuropathy, and decreased appetite. In multivariable logistic regression, death was more frequently associated with CQ use, advanced age, male sex, co-reported suicide and self-injury, cardiomyopathy, cardiac arrhythmias, and decreased appetite. CONCLUSIONS: Our results confirm previously published evidence and suggest that HCQ has a safer clinical profile compared to CQ, and thus could serve as the drug of choice for future therapeutic purposes.

Adherence to antiretroviral therapy among HIV seropositive patients in northern Greece. Major factors of influence.

BACKGROUND: Adherence to HIV antiretroviral therapy (ART) is of great importance for reducing viral load and the eventual treatment of the patients and minimizing infectivity. This study aimed to investigate adherence to ART among people living with HIV in northern Greece and investigate the factors influencing adherence to ART. METHODS: A correlational study was performed on a cohort of 112 seropositive individuals (100 men and 12 women) with a mean age of 37.14 years. The simplified medication adherence questionnaire (SMAQ) was used to assess adherence. In addition, the perceived available support questionnaire (PAS) for social support assessment was utilized to evaluate the perceived social support. RESULTS: Approximately 60% of patients were found to be nonadherent to ART. Important factors affecting adherence are educational level, social support, and use of substances. CONCLUSIONS: The results show that a significant proportion of the cohort of patients investigated from northern Greece does not show adherence to ART. Several factors were identified to be of significant influence, which should be taken into consideration by the Greek healthcare providers. HIPPOKRATIA 2020, 24(3): 114-119.

The importance of postoperative analgesia after major thoracic surgery interventions, protocols, applications, and the following evaluation of the patient's quality of life.

OBJECTIVES: Major thoracic surgery procedures constitute a standard method of diagnosis and/or therapy against lung, mediastinal cancer and other non-malignant manifestations of the respiratory system. Such patients' recovery and rehabilitation depend directly from the applied postoperative analgesia, with purpose to determine an optimum and long-term quality of life. BACKGROUND: Our database consists of 300 individuals, submitted to major thoracic surgery procedure during a 2 - year period of time (between December 2016 and December 2018) at the "Thoracic Surgery Department" of "Theageneio" Cancer Hospital, Thessaloniki. METHODS: Every operative method is accompanied with three different types of postoperative analgesia, depending on the demands of the surgical approach: Each patient's postoperative management and evaluation is performed via usage of three "Quality of Life" (QoL) Questionnaires and the "VAS-Visual Analog Scale" for pain, leading to the determination of the "QoL Index". RESULTS: Each patient answers the Questionnaires in 4 specific time intervals. The differentiation in their answers is the key point to extract important information about their postoperative health evolution. A detailed questionnaire evaluation follows, both individually and in groups, according to the subgroup of each patient's pain treatment, a combined study which is applied in this form for the first time. CONCLUSIONS: The measure of a "QoL" index is widely taken into account as one of the most accurate indicators of a patient's health evolution. The results supply us with significant information which is added to the initial management strategy, mainly regarding pain symptomatology and eventual complications and discomforts, while they indicate us towards a thorough realization of each patient's "follow up" individually and the achievement of an optimal Quality of Life level.

Prevalence of illicit drug use among medical students in Northern Greece and association with smoking and alcohol use.

AIM: The aim of this study was to estimate the prevalence of illicit drug use among medical students in Northern Greece, to identify the motivations for cannabis use and also to investigate the possible associations with smoking and alcohol misuse. METHODS: A sample of undergraduate students completed an anonymous, self-administered, web-based survey assessing lifetime and past-year illicit substance use. To further evaluate the motivation to use, the responders were classified into three subtypes (self-medication, recreational, and mixed). The CAGE questionnaire and a question assessing binge drinking were also used. Illicit substance use was correlated with age, gender, study year, CAGE and binge drinking. RESULTS: Five hundred and ninety-one undergraduate medical students completed the survey. The lifetime prevalence of illicit drug use was 24.7 %, while the most used drug was cannabis (22.2 %). The past-month prevalence of cannabis use was 8.1 %. Experimentation was the predominant reported motivation for its use, and the recreational subtype was the most prevalent. Binge drinking behavior was reported by 22.7 % of the sample, and the CAGE screening test was positive for 6.4 % of the students. Most students (80.4 %) characterized themselves as non-smokers. In the multivariate analysis, lifetime use of illicit drugs was significantly correlated with smoking and binge drinking. No associations were found with gender, age, study year or CAGE. CONCLUSION: Smoking and binge drinking were found to be risk factors for illicit drug use, whereas no association was found with gender, age, study year and CAGE. HIPPOKRATIA 2017, 21(1): 13-18.

Leptin increases luteinizing hormone secretion of fasting female rats.

PURPOSE: To investigate whether leptin acts directly on the anterior hypophysis by influencing gonadotropin secretion in vivo. MATERIALS AND METHODS: Cycling female rats were catheterised for frequent blood sampling and were either fasted or allowed free access to food. Stereotactic lesion of the medial preoptic area (MPOA) of the hypothalamus was performed in order to eliminate gonadotropin releasing hormone (GnRH) production. Leptin was administered at a dose of one mg/kg i.v. and blood samples were taken just before leptin administration and then after 30, 60, 90, 120, and 180 minutes. Plasma gonadotropin levels were determined. With completion of sampling, the brains were removed and the localisation of the lesions was verified histologically. RESULTS: Leptin at one mg/kg induced an increase in luteinizing hormone (LH) secretion in fasting rats, both in those with a lesion and those with intact medial preoptic area with a peak occurring 90 minutes after infusion. The augmenting effect was more prominent when the hypothalamus was intact. There was no effect in fed animals with or without lesion. Similarly, no effect was observed on follicle stimulating hormone (FSH) levels in any of the experimental groups. CONCLUSIONS: Leptin acts directly on the hypophysis enhancing LH but not FSH secretion. Nutritional state influences leptin's effect on the hypothalamus and the hypophysis.

Effect of ropivacaine infiltration on muscle regeneration: a morphometric analysis.

BACKGROUND/AIM: Local anaesthetic myotoxicity is a well described phenomenon resulting in reversible muscle damage. Considering that in previous studies microscopic images were evaluated without quantification of morphologic characteristics, the aim of the present study was evaluate muscle regeneration after local anaesthetic infiltration. MATERIALS AND METHODS: Wistar rats underwent injection of the left tibialis anterior muscle with ropivacaine (0.75%, group HC or 0.375%, group LC), while the contralateral muscle was injected with saline (group SL). Six weeks later, the muscles were dissected, stained using acid ATPase and examined under light microscope coupled with a computer imaging system for morphometric analysis. Sections were evaluated regarding the content of different muscle fibre types (type I, IIa and IIb), fibre cross-section area and perimeter. RESULTS: Groups were comparable regarding the ratio of different muscle fibre types. Regenerated type I fibres of both HC and LC groups had significant greater mean cross-sectional area and perimeter, compared to SL fibres. No signs of necrosis or inflammation were observed. Type IIa and IIb fibres didn't show significant differences. CONCLUSIONS: Regenerated muscles, following local anaesthetic application, showed long-term morphological differences, which could lead to impaired function. Further studies are needed, in order to clarify the underlying cellular mechanisms and the subsequent possible functional impairment.

Efficacy, safety and tolerability of green tea catechins in the treatment of external anogenital warts: a systematic review and meta-analysis.

BACKGROUND: External anogenital warts (EGWs) are non-malignant skin tumours caused by human papillomavirus. They are one of the fastest growing sexually transmitted diseases. Current treatments are unsatisfactory. Green tea sinecatechin Polyphenon E ointment is a botanical extract from green tea leaves exhibiting anti-oxidant, anti-viral and anti-tumour properties. OBJECTIVE: The aim of this study was to integrate valid information and provide basis for rational decision making regarding efficacy and safety of green tea extracts in the treatment of EGWs. METHODS: A systematic search in electronic databases was conducted using specific key terms. Main search was performed independently by two reviewers. The accumulated relevant literature was subsequently systematically reviewed and a meta-analysis was conducted. RESULTS: Three randomized, double-blind, placebo-controlled studies evaluating efficacy and safety of Polyphenon E 15% and 10% in the treatment of warts were included in the systematic review and meta-analysis. A total of 660 men and 587 women were enrolled. Regarding primary outcome, both Polyphenon E 15% and 10% demonstrated significantly higher likelihood of complete clearance of baseline and baseline and new warts compared with controls. No significant heterogeneity was detected. Recurrence rates were very low. Commonest local skin sign was erythema and local skin symptom was itching. CONCLUSIONS: Efficacy of Polyphenon 15% and 10%, at least for the primary endpoint, is clearly indicated. Polyphenon E treatment exhibits very low recurrence rates and appears to have a rather favourable safety and tolerability profile. Recommendations for future studies should include evaluation of the efficacy of green tea catechins in the treatment of internal anogenital warts and direct comparison with its principal comparator, imiquimod.

Gabapentin and pregabalin in the treatment of fibromyalgia: a systematic review and a meta-analysis.

WHAT IS KNOWN AND OBJECTIVES: Fibromyalgia (FBM) is a common chronic pain disorder affecting up to 2% of the general population. Current treatment options are mostly symptom-based and limited both in efficacy and number. Two promising alternatives are gabapentin (GP) and pregabalin (PB). We aimed to estimate the efficacy and safety/tolerability of the two compounds in FBM through a systematic review and a meta-analysis of relevant randomized double-blind placebo-controlled (RCT) were performed. DATA SOURCES, EXTRACTION AND ANALYSIS: A literature search was conducted through MEDLINE, EMBASE, Cochrane CENTRAL and the reference lists of relevant studies. Responders to treatment (>30% reduction in mean pain score) and dropouts due to lack of efficacy were used as primary outcome measures. Dropout rates and incidence of common adverse outcomes were also investigated. Four RCTs, reporting data on 2040 patients, were reviewed and three of them using PG were included in the meta-analysis. RESULTS: Pregabalin at a dose of 600, 450 and 300 mg per day is effective in FBM compared to placebo (NNT: 7, upper 95% CI: 12, 450 mg). A number of adverse events (AE), such as dizziness, somnolence, dry mouth, weight gain, peripheral oedema, is consistently associated with treatment at any dose and could lead one out of four patients to quit treatment (NNH: 6, lower 95% CI: 4, 600 mg). Indirect comparison meta-analysis suggests that PB at a dose of 450 mg per day could result in more responders than at 300 mg, but this result needs to be interpreted with caution as there were no significant differences between 600 and 300 mg or between 600 and 450 mg. Data on GP is limited. WHAT IS NEW AND CONCLUSIONS: The analysis indicates that PB at a dose of 450 mg per day is most likely effective in treating FBM, although AE are not negligible. Further evidence is necessary for more conclusive inferences.

A2delta ligands gabapentin and pregabalin: future implications in daily clinical practice.

Gabapentin (GP) and pregabalin (PB) are structurally related compounds and their predominant mechanism of action is the inhibition of calcium currents via high-voltage-activated channels containing the a2d-1 subunit. A2delta ligands are approved for the treatment of pain of diabetic neuropathy and post-herpetic neuralgia in adults and as adjunctive therapy of partial seizures in children. Recently, pregabalin has been approved for treatment of anxiety disorders in Europe. Besides their already approved indications both drugs are promising treatment options for a number of different serious and debilitating diseases, as fibromyalgia, neuropathic pain of spinal cord injury, hot flushes, and essential tremor. In the present review, the unique mechanism of action of the above drugs is critically analyzed and evidence for their future use is provided. Gabapentin and pregabalin can be treatment options for these disorders, however, a clear comparison between the two drugs can not be performed, since there is no direct comparison study. The most common side effects are dizziness and somnolence which are also the most frequent reasons for withdrawal. Recommendations for future studies should include assessment of ideal titration period for GP and PB to reduce incidence of somnolence and dizziness and increase tolerability, cost-effectiveness and dose-response analysis of PB and GP and direct comparison of the two drugs.

PDE5 inhibitors: in vitro and in vivo pharmacological profile.

PDE5 inhibitors have been clearly established as first-line therapy for the treatment of erectile dysfunction (ED). Three PDE5 inhibitors--sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis)--are currently approved by the FDA and the EMEA for use in ED, whereas sildenafil is also marketed under a different proprietary name (Revatio) for the treatment of pulmonary arterial hypertension (PAH). A forth PDE5 inhibitor, udenafil (Zydena), is currently marketed. In the present review the molecular basis and the mechanism of action of PDE5 inhibitors is discussed. In addition experimental and clinical data concerning their effects on different tissues, organs and systems is systematically reviewed and their possible beneficial action in numerous disorders is presented.

Age of pubertal stages including menarche in Greek girls.

The age at the different stages of pubertal development, including menarche, was assessed by the status quo method in 1366 middle-class girls living in Athens. The initial pubertal event in the average Athenian girl was the appearance of pubic hair along the labiae (P10:8.85, P50:10.47), followed shortly by breast budding (P10:9.39, P50:10.62), and later on by axillary hair growth (P10:10.55, P50:11.63). The age at menarche was 12.58 +/- 0.07 years. It seems tht Athenian girls of 1979 have one of the earliest ages of menarche reported. Recollected age data on menarche when compared to previous data from the Greek population show a decrease of 0.46 years/decade from 1935 to 1964 and no appreciable change from 1964 to 1979. Although these data are not absolutely comparable from the methodological point of view, they may indicate that the trend in menarcheal age in Athens is levelling off.