Multidrug-resistant strains of Neisseria gonorrhoeae in Greece.

Eighty-seven out of 575 gonococci isolated in Greece from 1991 to 1998 belonged to serovar Bropyst and exhibited resistance to penicillin, tetracycline, erythromycin, and chloramphenicol. Conventional and molecular typing showed three clusters, A, B, and C, that were associated with networks of high- frequency transmitters (cluster A with homosexuals and clusters B and C with refugees from Eastern Europe). Study of one isolate revealed mutations in the penA, mtrR, and porB genes that may explain the multidrug-resistant phenotype.

Seroprevalence of hepatitis B surface antigen (HBsAg) among first-time and sporadic blood donors in Greece: 1991-1996.

Hepatitis B surface antigen (HBsAg) seroprevalence among three major groups of sporadic voluntary blood donors in Greece was studied and compared to the seroprevalence in regular donors. These three groups share many characteristics with the general population. A 6-year retrospective seroepidemiological study was carried out (1991-1996). The study population consisted of donors who were (i) military recruits (n = 80 302), (ii) enlisted military personnel (n = 86 920) and (iii) directed family donors (n = 75403). A specimen was considered as HBsAg positive when found repeatedly reactive by a 3rd-generation immunoassay and confirmed by RIA. The Mantel-Haenszel chi2 procedure was used for stratified analysis of the prevalence rates and Greenland/Robins confidence intervals of the respective weighted relative risk (MHRR) were calculated. The 6-year overall HBsAg seroprevalence among the three sporadic donor groups was 0.84%; this was twice the seroprevalence among a sample of regular donors (n = 45504) in Greece. Seroprevalence was higher among enlisted personnel (1.21 < MHRR = 1.34 < 1.50), during years prior to 1995. Directed family donors had the same overall seropositivity rate as recruits and enlisted personnel. After 1995, all groups had a seroprevalence below 1%, possibly indicating a shift towards lower endemicity in the Greek population.

Lack of reactivation of cytomegalovirus retinitis in an AIDS patient, during and after stopping long-term cidofovir treatment: case report.

The case of an AIDS patient with cytomegalovirus (CMV) retinitis who was treated with cidofovir for 17 consecutive months, without any adverse effect, is presented. In the context of antiretroviral therapy, cidofovir therapeutic regimen was 5 mg/kg of body weight for 2 weeks and 5 mg/kg thereafter every other week. Probenecid, hydration and monitoring for proteinuria were also used to prevent nephrotoxicity. The patient stopped maintenance therapy for CMV retinitis after the permanent rise of CD4+ cells above 100 c/mm3. For more than 10 months after drug withdrawal the patient remains free of retinitis.

HIV-1 infection-associated risk factors among sexually transmitted disease patients in Athens, Greece: 1990 to 1996.

OBJECTIVE: To determine trends in HIV seroprevalence and related risk factors among patients with sexually transmitted diseases (STDs) and to report the respective epidemiologic history characteristics. METHODS: A cross-sectional seroepidemiologic study conducted from 1990 to 1996 among 5,669 symptomatic STD cases was carried out. RESULTS: The overall HIV test acceptance was 98.9%, and 1.2% patients (n = 66) were seropositive. Highest rates were detected among those who were born or resided in Sub-Saharan Africa. Seropositivity fluctuates significantly by age, and is excessive in persons 45 years and older (2.6%). A significant decreasing trend in STD incidence and HIV seroprevalence among patients younger than 25 years was detected. Male homosexuals and bisexuals (MSM) exhibited the highest overall rate of infection (5.8%) followed by intravenous drug users (2%). Highly promiscuous STD patients (ie, those who had more than 10 partners during the past 6 months) presented a significantly increased HIV seroprevalence when compared with patients of the same sexual orientation. STD patients infected with HIV mostly belonged to notable risk categories of AIDS (men who have sex with men, 72.7%). Awareness of serostatus was low (13.6%). In male patients, the HIV seropositivity rate was significantly higher among early syphilis and proctitis cases, whereas in females this higher rate occurred with herpes genitalis. CONCLUSIONS: Promiscuity and sexual orientation significantly influence the seroprevalence rate. Exposure to HIV remained stable despite the above declining time trends, which implies the need for additional preventive interventions targeted to the real health and illness behavior of the partner.

Experience with low-dose thalidomide therapy in chronic discoid lupus erythematosus.

BACKGROUND: Low-dose thalidomide therapy (median dose 100 mg/day, 50-200 mg/day) in chronic discoid lupus erythematosus was studied with regard to efficacy, tolerance, and toxicity in 22 patients. Intense contraceptive precautions were taken in women patients of childbearing age. METHODS: An open uncontrolled trial was conducted. Age, the total drug intake, disease duration, extent/severity, and adverse reactions were studied with regard to the final clinical outcome. The follow-up duration was 1.8 years (range 1 month to 3 years). RESULTS: With the exception of age (inverse correlation, P < 0.01), the parameters studied did not influence the final clinical amelioration: complete responders numbered 54.5%, partial responders 22.7%, and 13.6% were withdrawn from the trial with complaints of intolerance. The initial (first month) clinical response correlated significantly with the final one (P < 0.01). Drowsiness (40.9%) and somnolence (18.2%) were the most common side-effects, without affecting seriously the daily life of the participants. No case of real neurotoxicity was confirmed. Relapses occurred within 39.4 +/- 21.4 days after drug withdrawal, presenting a milder clinical picture. CONCLUSIONS: In the context of a predictable final outcome, low-dose thalidomide therapy is effective as an alternative choice in cases resistant to the usual treatment.

Comparative evaluation of the prolonged use of the cuffed oropharyngeal airway and the laryngeal mask airway in spontaneously breathing anaesthetized patients.

The cuffed oropharyngeal airway (COPA) was compared with the laryngeal mask airway (LMA) with respect to airway quality and respiratory adverse events in 140 spontaneously breathing patients undergoing procedures of duration more than 1 h. Patients were allocated randomly to receive either a COPA (n = 72) or a LMA (n = 68) for airway management during anaesthesia induced with propofol and maintained with sevoflurane, nitrous oxide and oxygen. Groups were similar when comparing the first-time successful insertion rates (COPA: 94.5%, LMA: 95.6%), but airway manipulations (head tilt, chin lift, jaw thrust) were reported more frequently in the COPA group, 27.8% vs. LMA, 4.4%; P = 0.0005. During the post-induction apnoeic period, all patients were ventilated manually and although, mean (SD) leak pressure was lower in the COPA group (18 (4) cm H2O vs. LMA, 22 (3) cm H2O; P < 0.0001), the tidal volumes achieved did not differ in both groups: COPA, 9.5 (4) mL kg-1 vs. LMA, 10.5 (4.5) mL kg-1. The incidences of intra-operative coughing, gagging, laryngospasm, oxygen desaturation and hypercarbia were similar in both groups. Although both devices are equivalent with respect to the overall respiratory problems during spontaneous breathing anaesthesia of intermediate or prolonged duration, the LMA was associated with fewer airway quality problems, suggesting that it is more efficacious in securing the airway.

Epidemiologic aspects of male gonococcal infection in Greece.

OBJECTIVE: To report male gonorrhea incidence trends between the years 1974 and 1996 and compare the epidemiologic characteristics of the affected population during periods of high and low incidence of the disease. STUDY DESIGN: Retrospective study of all available data for male gonorrhea cases recorded annually in a major STD hospital in Greece since 1974. RESULTS: An abrupt drop in gonorrhea relative incidence occurred in 1986, followed by low rates thereafter. In the context of the overall decline in the incidence of the disease, a shift to older ages, longer time elapsed before seeking medical assistance, and higher proportion of disease repeaters was noticed among the patients. Infections caused by penicillinase-producing gonococci were strongly associated with contacts outside the country or with foreigners and their incidence presented erratic time fluctuations, indicating that they have not been established as endemic in the Greek population. CONCLUSION: The core group hypothesis in terms of nighttime sociosexual activity can be used to interpret most of the findings.

PIP: Trends in Neisseria gonorrhoeae incidence rates in men presenting to a major sexually transmitted disease hospital (Andreas Sygros) in Athens, Greece, in 1974-96 were evaluated and gonorrhea risk factors during periods of low and high incidence were compared. An abrupt drop in the relative incidence of gonorrhea occurred in 1986, followed by low rates thereafter. A comparison of the periods 1974-85 (high incidence) and 1986-96 (low incidence) revealed a 1.27-fold decrease in total attendance to the hospital and a 5-fold decrease in the number of gonorrhea cases detected. Observed over time was a shift to older ages, longer time elapsed before seeking medical assistance, and a higher proportion of disease repeaters. Infections caused by penicillinase-producing gonococci were strongly associated with contacts outside the country or with foreigners and their incidence was characterized by erratic time fluctuations, suggesting that they have not become endemic in the Greek population. Changes observed in the features of the affected population indicate a trend toward increased risk in sexual behavior.

Re-evaluation of the natural course of bullous pemphigoid. A prospective study.

BACKGROUND: Few studies of prospectively collected data regarding the natural course of bullous pemphigoid have been performed. METHODS: The following factors were combined both quantitatively and qualitatively to obtain results: gender, clinical activity based on the estimation of the body area involvement, disease duration, relapses, coexistence with other disease states, and serology Twenty-seven consecutive patients were followed up for 1 year. RESULTS: Most disease activity (85.2%) is exhibited in the first year after onset. There is a lack of parameters with clear predictive significance. The extent and severity of skin involvement are equally distributed between the sexes and not affected by the disease duration. The generalized form of the disease is predominant (86.5%). The average clinical activity in relapses within the year of follow-up is 48% of the initially observed attack. The probability for recurrence is higher in seropositive patients (overall 37%). Coexistence with other disease states seems to be a random chance event. CONCLUSIONS: The lack of parameters with predictive importance underlines the necessity of a thorough follow-up to prevent treatment-related complications in elderly patients.