Point-of-care diagnostics for sexually transmitted infections among migrants in Greece.

SETTING: Sexually transmitted infections (STIs) can impact individuals of any demographic. The most common pathogens causing STIs are Chlamydia trachomatis, Neisseria gonorrhea and Trichomonas vaginalis; these can be treated with specific antibiotics. OBJECTIVE: To compare the GeneXpert CT/NG test-and-treat algorithm to the syndromic approach algorithm and their impact on antibiotic prescription for gonorrhoea and chlamydia STIs. DESIGN: A retrospective observational study on women aged ≥18 years who accessed the Médecins Sans Frontières Day Care Centre in Athens with complaints related to urogenital infections between January 2021 and March 2022. Women with abnormal vaginal discharge, excluding clinically diagnosed candidiasis, were eligible for Xpert CT/NG testing. RESULTS: Of the 450 women who accessed care, 84 were eligible for Xpert CT/NG testing, and only one was positive for chlamydia, therefore resulting in saving 81 doses of ceftriaxone and azithromycin, and 19 doses of metronidazole. The cost of Xpert CT/NG testing, including treatment was €4,606.37, while full antibiotic treatment would have costed €536.76. CONCLUSION: The overall cost of the Xpert CT/NG test-and-treat algorithm was higher than the syndromic approach. However, quality of care should be weighed against the potential benefits of testing and syndromic treatment to determine the best option for each patient; we therefore advocate for decreasing the costs.

CONTEXTE: Les infections sexuellement transmissibles (STI, pour l'anglais « sexually transmitted infections ¼) touchent tous les individus. Les agents pathogènes les plus courants à l'origine des STI sont Chlamydia trachomatis, Neisseria gonorrhea et Trichomonas vaginalis, et ils peuvent être traités avec des antibiotiques spécifiques. OBJECTIF: Comparer l'algorithme test-and-treat du GeneXpert CT/NG à l'algorithme de l'approche syndromique et leur impact sur la prescription d'antibiotiques pour les STI à gonorrhée et à chlamydia. MÉTHODE: Une étude observationnelle rétrospective sur les femmes âgées de ≥18 ans qui ont accédé au centre de soins de jour de Médecins Sans Frontières à Athènes avec des plaintes relatives aux infections urogénitales entre janvier 2021 et mars 2022. Les femmes présentant des pertes vaginales anormales, à l'exclusion des candidoses cliniquement diagnostiquées, étaient éligibles pour le test GeneXpert CT/NG. RÉSULTATS: Sur les 450 femmes qui ont eu accès aux soins, 84 étaient éligibles au test GeneXpert CT/NG et une seule était positive à la chlamydia, ce qui a permis d'économiser 81 doses de ceftriaxone et d'azithromycine, et 19 doses de métronidazole. Le coût du test GeneXpert CT/NG, traitement compris, s'est élevé à €4 606,37, tandis qu'un traitement antibiotique complet aurait coûté €536,76. CONCLUSION: Le coût global de l'algorithme GeneXpert CT/NG test-and-treat était plus élevé que celui de l'approche syndromique. Cependant, la qualité des soins doit être mise en balance avec les avantages potentiels des tests et du traitement syndromique afin de déterminer la meilleure option pour chaque patient, et nous plaidons par conséquent en faveur d'une diminution des coûts.

Demographic and clinical characteristics of refugees seeking primary healthcare services in Greece in the period 2015-2016: a descriptive study.

Background: In 2015-2016, more than a million refugees entered Greece. Along with other organizations, PRAKSIS, a local non-governmental organization, deployed mobile medical units on three islands and in temporary settlements in Athens. Methods: This is a descriptive cross-sectional study aimed at analysing the demographic and clinical characteristics of the population (n=6688) that received services from PRAKSIS between October 2015 and June 2016 in different locations (islands of Samos, Kos and Leros in the southeastern Aegean Sea and on the mainland at Athens-Piraeus Port Gate E) before and after the closure of European borders in March 2016. Results: The majority (88%) of the population came from Syria, Afghanistan and Iraq. Among them, 53% were women and children. Infectious diseases decreased as the population moved from the islands to the Athens-Piraeus Port, while all other disease categories increased in relative frequency, the difference being statistically significant (p<0.05). Among all consultations, dental and oral cavity health complaints also increased in the Athens-Piraeus Port, but failed to reach statistical significance (p=0.11). Referrals from the mobile health units to specialist care rose from 4.2% of all patients clinically examined on the islands to 9.9% in the Athens-Piraeus Port, and the difference was statistically significant (p<0.05). Conclusions: More research and systematic data collection are needed to inform appropriate policies for the humanitarian challenges posed by the recent refugee and migrant waves in Europe.

Seroprevalence and risk factors for hepatitis A, B, and C among Roma and non-Roma children in a deprived area of Athens, Greece.

The prevalence and risk factors of hepatitis A, B, and C (HAV, HBV, and HCV) markers were compared in non-Roma and Roma children who lived in a deprived suburb of Athens, Greece. The study included 216 children, 118 Roma and 98 non-Roma of 9 years median age (range 5-15 years). Among Roma children 98.3% had detectable antibodies to HAV, compared with 32.7% among non-Romas (P < 0.0001). Regarding HBV, 22% Roma children were identified with evidence of past infection (anti-HBc(+)), among whom five (4% of the total) were chronic carriers (HBsAg(+)), whereas no past infection was detected among the non-Romas (P < 0.0001). Markers of past HBV vaccination (anti-HBs(+), anti-HBc(-)) were detected in only 14% Roma but 96% non-Roma children (P-value < 0.0001). There was some indication for intrafamilial transmission of HAV and HBV in Roma school children. Unfavorable living conditions, frequent residency change, lack of child insurance and primary healthcare delivery were significantly associated with seroprevalence of HBV infection among Romas. No child in either group was found positive for HCV markers. These findings document high socioeconomic differentials with regards to preventable communicable diseases, such as HAV and HBV and underline the need for enhancing health policy action targeting pockets of minority childhood populations. Whereas, uptake of HBV vaccination is rather optimal in this general population, the high seroprevalence of HAV among Romas, also calls for implementing general vaccination for HAV, early in life.

Melanoma risk in association with serum leptin levels and lifestyle parameters: a case-control study.

BACKGROUND: Solar radiation has been identified as a principal factor for the causation of melanoma, whereas changing lifestyle patterns associated with obesity and diabetes might also contribute to the increasing incidence of the malignancy. No study has investigated the role of leptin, a hormone whose levels increase in obesity and which has also been related to cancer. PATIENTS AND METHODS: Fifty-five patients with incident melanomas and 165 age- and gender-matched healthy controls were interviewed on the basis of a questionnaire that covers phenotypic features, sociodemographic and medical history variables, lifestyle habits and frequency of consumption of major food groups. Anthropometrical measures were also recorded and blood samples were obtained for determination of serum leptin levels. Adjusted odds ratios (ORs) for melanoma risk were derived through multiple logistic regression analyses. RESULTS: An excess melanoma risk was observed for sun sensitive individuals and those with high circulating levels of leptin (OR: 1.56, 95% confidence interval 1.07-2.28, P = 0.02), after controlling for obesity indices, diabetes mellitus and education. Increased physical exercise, lower alcohol consumption and plant food consumption seem to play a protective role against melanoma development. CONCLUSIONS: Melanoma risk was found to be positively associated with serum leptin levels and inversely with healthy lifestyle factors. The findings need to be confirmed in prospective studies.

Breast cancer risk in relation to most prevalent IgE specific antibodies: a case control study in Greece.

BACKGROUND: This study aims to explore the debatable role of allergy in breast cancer (BC) by using country-specific biological markers, namely levels of the most prevalent allergen-specific immunoglobulin E in Greece. PATIENTS AND METHODS: Blood samples and clinical information were collected over a 30-month period from 103 women with histologically-confirmed BC and 103 controls from two university hospitals in Athens. Allergen-specific IgE, against the 12 prevailing allergens in Greece were determined; thereafter, a score comprising the sum of the individual values for this battery of serological IgE determinations was created. Bivariate and multiple logistic regression analyses were undertaken using case-control status as the outcome and IgE-scores as the predictor variable, controlling for socio-demographic, gynecological and lifestyle confounders. RESULTS: The serum IgE score seemed to be positively related to BC (OR: approximately 1.73; CI: 0.95-3.14; p-value: 0.07). A positive correlation between serological evidence and allergic history among controls was also found (p-value: 0.06). CONCLUSION: This investigation suggests an IgE-mediated allergic response among women with BC in comparison to their controls. The finding needs confirmation by immuno-epidemiological investigation to clarify the directionality of this association and whether laboratory-ascertained atopy can be considered as a risk-marker of susceptibility in the development of BC.