Temporal trends in stroke incidence and case-fatality rates in Arcadia, Greece: A sequential, prospective, population-based study.

BACKGROUND: Stroke incidence and case-fatality are reported to decline in high-income countries during the last decades. Epidemiological studies are important for health services to organize prevention and treatment strategies. AIMS: The aim of this population-based study was to determine temporal trends of stroke incidence and case-fatality rates of first-ever stroke in Arcadia, a prefecture in southern Greece. METHODS: All first-ever stroke cases in the Arcadia prefecture were ascertained using the same standard criteria and multiple overlapping sources in three study periods: from November 1993 to October 1995; 2004; and 2015-2016. Crude and age-adjusted to European population incidence rates were compared using Poisson regression. Twenty-eight days case fatality rates were estimated and compared using the same method. RESULTS: In total, 1315 patients with first-ever stroke were identified. The age-standardized incidence to the European population was 252 per 100,000 person-years (95% CI 231-239) in 1993/1995, 252 (95% CI 223-286) in 2004, and 211 (192-232) in 2015/2016. The overall age- and sex-adjusted incidence rates fell by 16% (incidence rates ratio 0.84, 95% CI: 0.72-0.97). Similarly, 28-day case-fatality rate decreased by 28% (case fatality rate ratio = 0.72, 95% CI: 0.58-0.90). CONCLUSIONS: This population-based study reports a significant decline in stroke incidence and mortality rates in southern Greece between 1993 and 2016.

Treatment Failure of Active Vitamin D Therapy in Chronic Kidney Disease: Predictive Factors.

BACKGROUND: In patients with chronic kidney disease (CKD), impaired renal function leads to decreased vitamin D levels, which causes an increase in parathyroid hormone (PTH) production and contributes to the development of secondary hyperparathyroidism (SHPT). This may result in adverse clinical effects such as bone disorders, vascular calcification, cardiovascular disease, and increased mortality. Current treatment practices and associated outcomes with active vitamin D treatment in patients with CKD were reviewed with the objective to assess parameters (such as PTH and serum calcium levels) that may be used to define the failure of vitamin D treatment. SUMMARY: Reports based on observational data have noted improved outcomes with active vitamin D treatment (calcitriol, paricalcitol, alfacalcidol, or doxercalciferol) in patients with CKD. Criteria for the identification of active vitamin D treatment failure are unclear from current guidelines, although up to 50% of patients may experience treatment failure eventually because of development of hypercalcemia or resistant SHPT, characterized by an elevated intact PTH (iPTH) level despite treatment. We propose a definition of vitamin D treatment failure as iPTH >600 pg/ml after 6 months of intravenous active vitamin D treatment and corrected total calcium serum levels >10.2 mg/dl, and review factors that may predict the response to vitamin D treatment. Key Message: Active vitamin D treatment failure is an important challenge in clinical practice. The aim of the proposed definition is to suggest a possible framework for hypothesis generation and to encourage further research into this common problem.

Multicenter epidemiological study to assess the population of CKD patients in Greece: results from the PRESTAR study.

BACKGROUND: Chronic Kidney Disease (CKD) is a relatively common condition not only associated with increased morbidity and mortality but also fuelling End Stage Renal Disease (ESRD). Among developed nations, Greece has one of the highest ESRD incidence rates, yet there is limited understanding of the epidemiology of earlier stages of CKD. METHODS: Cross-sectional survey of pre-dialysis CKD outpatients in nephrology clinics in the National Health Care system between October 2009 and October 2010. Demographics, cause of CKD, blood pressure, level of renal function, duration of CKD and nephrology care, and specialty of referral physician were collected and analyzed. Different methods for estimating renal function (Cockroft-Gault [CG], CKD-Epi and MDRD) and staging CKD were assessed for agreement. RESULTS: A total of 1,501 patients in 9 centers were enrolled. Diabetic nephropathy was the most common nephrologist assigned cause of CKD (29.7%). In total, 36.5% of patients had self-referred to the nephrologist; patients with diabetes or serum creatinine above 220 µmol/l (eGFR<40 ml/min/1.73 m2) were more likely to have been referred by a physician. Agreement between MDRD and CKD-Epi, but not between CG, the other estimating equations, was excellent. There was substantial heterogeneity with respect to renal diagnoses, referral patterns and blood pressure among participating centers. CONCLUSIONS: In this first epidemiologic assessment of CKD in Greece, we documented delayed referral and high rates of self-referral among patients with CKD. eGFR reporting, currently offered by a limited number of laboratories, may facilitate detection of CKD at an earlier, more treatable stage.

Novel influenza A (H1N1) infection vs. common influenza-like illness: a prospective study.

BACKGROUND: On June 11th, 2009 the World Health Organization (WHO) declared the first influenza pandemic of the 21st century. Data regarding the clinical characteristics and course of this viral infectious disease are still being assessed. The aim of this study was to investigate and compare the possible differences in clinical course and outcome between H1N1-positive [H1N1(+)] and negative [H1N1(-)] patients. MATERIAL/METHODS: This prospective study was conducted between July 2009 and January 2010 in a regional hospital in Greece. The study population consisted of 165 patients aged 14 years or older, with influenza-like illness (ILI) who, according to CDC recommendations, fulfilled the criteria for diagnostic influenza testing. Enrolled patients underwent a detailed diagnostic work-up. Infection by the H1N1 virus was diagnosed using real-time reverse transcriptase polymerase chain reaction, from pharyngeal swab specimens. RESULTS: We identified 81 H1N1 (+) (49%) patients. Statistical analysis revealed that H1N1(+) patients were significantly younger (median age 27 vs. 35 years, p<0.05), had a decreased white blood cell count (median 7.200 vs. 8.415, p<0.05) and an increased percentage of monocytes (55.6% vs. 27.4%, p<0.05) compared to the H1N1(-) patients. The clinical presentation at the emergency department, as well as the hospital admission and disease complication rate, were not significantly different between the 2 groups. CONCLUSIONS: The clinical characteristics of the new influenza virus appear to be mild and to resemble those of common influenza-like illnesses (ILI). The patients who tested positive for the H1N1 virus were younger and had an increased percentage of monocytes compared to the H1N1-negative patients.

Hypothyroidism as a protective factor in acute stroke patients.

OBJECTIVE: It has been reported that hypothyroidism is associated with better survival in elderly persons. We investigated possible associations of thyroid status with clinical outcome in patients with acute stroke. DESIGN: Retrospective analysis. PATIENTS: Consecutive patients (median age 70 years) admitted for acute stroke. MEASUREMENTS: Total T3, T4 and TSH levels. Stroke severity evaluation using the Scandinavian Stroke Scale (SSS) and the Glasgow Coma Score (GCS). Handicap and survival assessment over 12 months. RESULTS: Of 744 patients where thyroid function tests were available within the first 24 h of stroke, 13 had elevated TSH (>or= 10 microU/ml; range 10-42 microU/ml) (hypo-group), 51 had mildly elevated TSH (3.3-9.9 microU/ml) and 680 had nonelevated TSH < 3.3 microU/ml. In the hypo-group transient ischaemic attacks (TIA's) were more prevalent (46.2%) compared to the groups of mildly elevated TSH (11.8%) and nonelevated TSH (12.4%, P < 0.002). Hypo-group had more frequently an adequate level of consciousness (GCS 14-15 = fully alert): 92.3%vs 74.5% and 63.7% (P = 0.033), a milder neurological deficit (SSS score 45-58) 76.9%vs 39.2% and 38.7% (P = 0.02) compared to the other two groups, respectively, and a tendency for lower glucose levels on admission. One year outcome tended to be better with respect to survival and handicap. CONCLUSIONS: Acute stroke patients with laboratory findings compatible with pre-existing hypothyroidism on admission, appear to have better clinical presentation and outcome; we speculate that a reduced response to stress and previous TIA's, possibly related to endogenous 'preconditioning', may contribute to this phenomenon.