Healthcare access for refugees in Greece: Challenges and opportunities.

The arrival of more than one million refugees and migrants in Europe in 2015, most of whom transited through Greece, has placed significant strains on local health systems and demonstrated the need for preparedness to meet the immediate and longer-term health needs of arrivals in EU countries. Population movements will continue to occur and the need for cost effective, appropriate provision of both primary and secondary health services to meet these needs is key. The Global Compact on Migration was ratified in 2018 and forms an overarching, international agreement to address safe, orderly and regular migration which benefits refugees and migrants as well as host communities; however, it did not give due emphasis to health. In this manuscript, we explore the evolution of the health response for refugees in Greece over the last three years, the challenges faced at different times of the response and the efforts to integrate refugees into Greece's health system.

Leading article: Use of smartphones to pass on information about patients - what are the current issues?

Many doctors now use mobile devices such as smartphones to communicate with one another about their patients, and sometimes this is without the knowledge and approval of their employer. We know of little information about the use of texting and other web-based messaging services by doctors in hospitals, so we reviewed relevant published studies to assess the safety and usefulness of current methods of digital communication.

Cytoglobin is upregulated by tumour hypoxia and silenced by promoter hypermethylation in head and neck cancer.

BACKGROUND: Cytoglobin (Cygb) was first described in 2002 as an intracellular globin of unknown function. We have previously shown the downregulation of cytoglobin as a key event in a familial cancer syndrome of the upper aerodigestive tract. METHODS: Cytoglobin expression and promoter methylation were investigated in sporadic head and neck squamous cell carcinoma (HNSCC) using a cross-section of clinical samples. Additionally, the putative mechanisms of Cygb expression in cancer were explored by subjecting HNSCC cell lines to hypoxic culture conditions and 5-aza-2-deoxycitidine treatment. RESULTS: In clinically derived HNSCC samples, CYGB mRNA expression showed a striking correlation with tumour hypoxia (measured by HIF1A mRNA expression P=0.013) and consistent associations with histopathological measures of tumour aggression. CYGB expression also showed a marked negative correlation with promoter methylation (P=0.018). In the HNSCC cell lines cultured under hypoxic conditions, a trend of increasing expression of both CYGB and HIF1A with progressive hypoxia was observed. Treatment with 5-aza-2-deoxycitidine dramatically increased CYGB expression in those cell lines with greater baseline promoter methylation. CONCLUSION: We conclude that the CYGB gene is regulated by both promoter methylation and tumour hypoxia in HNSCC and that increased expression of this gene correlates with clincopathological measures of a tumour's biological aggression.

An implant periapical lesion leading to acute osteomyelitis with isolation of Staphylococcus aureus.

A case of an implant periapical lesion (IPL) proceeding to acute osteomyelitis is presented, most likely due to surface contamination of the implant. Five weeks post placement of two anterior mandibular implants, symptoms of acute pain from one implant presented. This symptom and later swelling were unresponsive to antibiotics. On removal of the implant, there was a purulent discharge which, following microbial analysis, proved to be a pure growth of Staphylococcus aureus. A replacement implant was positioned in the site of the previously lost implant ten weeks later, with no recurrence of infection. Staphylococcus aureus can be isolated commonly from the mouths of denture wearers. When an IPL affects a recently placed implant its removal should be accepted but its replacement also considered.

Variable presentation of temporalis hypertrophy--A case report with literature review.

A case of painful, initially bilateral, and then unilateral temporalis hypertrophy in a 33-year-old Caucasian woman is presented in a primary care setting; the aetiology of the hypertrophy was considered reactive in nature. Medical and supportive treatment was successful in providing symptomatic relief. Further treatment including an intramuscular botulinum injection was considered by the patient with a view to reduction of the chronic enlargement of her temporalis and masseter musculature. A review of the literature and previous treatment regimes is also presented.