Aseptic Meningitis Linked to Borrelia afzelii Seroconversion in Northeastern Greece: An Emerging Infectious Disease Contested in the Region.

Borreliosis (Lyme disease) is a zoonosis, mediated to humans and small mammals through specific vectors (ticks), with increasing global incidence. It is associated with a variety of clinical manifestations and can, if not promptly recognized and left untreated, lead to significant disability. In Europe, the main Borrelia species causing disease in humans are Borrelia burgdorferi s.s., Borrelia afzelii, Borrelia garinii, and Borrelia spielmanii. The Ixodes ricinus tick is their principal vector. Although Lyme disease is considered endemic in the Balkan region and Turkey, and all three main Lyme pathogens have been detected in ticks collected in these countries, autochthonous Lyme disease remains controversial in Greece. We report a case of aseptic meningitis associated with antibody seroconversion against Borrelia afzelii in a young female patient from the prefecture of Thasos without any relevant travel history. The patient presented with fever and severe headache, and the cerebrospinal fluid examination showed lymphocytic pleocytosis. Serum analysis was positive for specific IgG antibodies against Borrelia afzelii. In the absence of typical erythema migrans, serological evidence of infection is required for diagnosis. Although atypical in terms of clinical presentation, the seasonality and geographical location of potential disease transmission in the reported patient should raise awareness among clinicians for a still controversial and potentially underreported emerging infectious disease in Greece.

Pneumocephalus; a rare cause of coma.

We report the case of an 84-years old female patient who developed cerebral air embolism in association with the indwelling hemodialysis central venous catheter. Pneumocephalus, even though rare, should be included in the differential diagnosis of acute manifestation of neurologic deficits, especially in association with central venous access, surgical interventions or trauma, and requests prompt management. Brain computed tomography scanning remains the investigation of choice.

Self-management and self-efficacy of women with gestational diabetes mellitus: a systematic review.

BACKGROUND: Gestational diabetes mellitus (GDM) is a temporary form of diabetes induced by pregnancy and is potentially harmful to both the mother and fetus The impact of GDM diagnosis on pregnant women needs to be taken into account. This is related to the capacity for self-management of GDM, for which quality evidence is still lacking. OBJECTIVE: to identify several aspects of self-management and self- efficacy for women with GDM. METHOD: Electronic databases were searched for studies related to the self-management, self-efficacy, and glycemic control of women with GDM, from January 2012 to January 2021. The extraction of study features was based on study location, reported research aims, study design, methodology, and the analytical approach, using Endnote Version X7.7.1. The Critical Appraisal Skills Program Qualitative Checklist (CASP) was used to assess quality, as recommended by the Cochrane Qualitative Research Methods Group. RESULTS: Ten out of 70 studies were identified as meeting the established criteria and including a diverse population. The synthesis revealed seven major themes: preliminary psychological impact, communicating the diagnosis, knowledge of GDM, self-efficacy and self-management of GDM, risk perception, the burden of GDM, and gaining control. The benefits of a diagnosis were behavioral and were mostly crystalized if a particular level of self-management and self-efficacy was reached and women were able to have specific control over their diet and body weight. On the other hand, women reported that the diagnosis increased their responsibility, as they had to take extra precautions regarding their dietary regimen. CONCLUSION: Self-management and self-efficacy for GDM management are possible, despite the psychological hurdles that most women confront. There is still potential for improvement in terms of developing a healthy lifestyle that not only manages GDM for the best pregnancy result, but also prevents diabetes after pregnancy.

Depression, anxiety, and quality of life in a large cohort of patients with rheumatic diseases: common, yet undertreated.

A growing amount of literature has explored mainly the role of depression (and/or anxiety) in patients with rheumatic disorders. We aimed at determining the prevalence of depression, anxiety, and their association with quality of life among patients attending a rheumatology clinic, focusing on data regarding concomitant psychiatric treatment. Depression, anxiety, and quality of life were assessed using the Zung Self-Rating Depression Scale, the Hamilton Anxiety Scale, and the Health Assessment Questionnaire, respectively. Overall, 514 rheumatologic patients were studied. Depression and anxiety were documented in 21.8 and 30.8 % of the population, respectively, and correlated significantly with quality of life. Only 13.4 % of patients with depressive symptoms and 12.1 % of patients with anxiety symptoms were receiving antidepressant or antianxiety medication. Given the wide therapeutic armamentarium available nowadays for the management of depression and anxiety, an increased awareness among physicians dealing with rheumatologic patients is warranted in order to integrate detection and effective treatment of anxiety and depression into the routine clinical practice. Special attention should be paid to female patients, patients with longer disease duration, and/or those with established disability.

Association between mental health disorders and sexual dysfunction in patients suffering from rheumatic diseases.

INTRODUCTION: Sexual functioning may be notoriously affected in patients suffering from rheumatic diseases, yet the extent to which physical and/or psychological factors contribute to sexual dysfunction in this particular group of patients remains underinvestigated. AIM: This cross-sectional study aimed at investigating whether an association exists between psychological status (anxiety, depression) and sexual dysfunction, independently of other physical factors, in patients with rheumatic disorders. METHODS: A total of 509 consecutive rheumatologic patients, aged 54.7 ± 14.2 years, 423 female and 86 male, were studied. Female and male sexual function was evaluated with the Female Sexual Dysfunction Index (FSFI) and the International Index of Erectile Function (IIEF) questionnaire, respectively. The Hamilton Anxiety Scale and the Zung Self-Rating Depression Scale were used to detect presence of anxiety and depression, respectively. MAIN OUTCOME MEASURES: Sexual dysfunction affected 69.9%, anxiety 37.5%, and depression 22% of our patients. RESULTS: A strong and negative correlation was found between anxiety and both FSFI (r = -0.169, P < 0.001) and IIEF score (r = -0.304, P = 0.004). Similarly, depressive symptomatology was strongly and negatively correlated with both FSFI (r = -0.178, P < 0.001) and IIEF score (r = -0.222, P = 0.04). In the logistic regression analysis, apart from increasing age and female sex, depression (P = 0.027) and anxiety (P = 0.049) were identified as the only predictors of sexual dysfunction, even after adjustment for a variety of physical factors. CONCLUSIONS: Mental distress and sexual dysfunction are extremely common in rheumatologic patients. Sexual dysfunction is significantly associated with anxiety and depression in both men and women and may be independently predicted by their presence in this group of patients. Physicians dealing with rheumatologic patients should be aware of these results and incorporate screening and treatment of the above comorbidities in the global assessment of their patients, in order to alleviate the disease-emerging mental and physical burden and improve their quality of life.

Vascular disease in systemic lupus erythematosus.

Vascular disease, either as a direct complication of the disease or developing as an accompanying comorbidity impairs significantly the quality of life of patients with SLE and represents the most frequent cause of death in established lupus. This paper aims to give an overview of the prevalence of the different forms of vasculopathy that can be encountered in a lupus patient, describe their pathogenesis, and address their impact on disease severity and outcome.