Outcomes of iStent Inject Versus Kahook Dual Blade Surgery in Glaucoma Patients Undergoing Cataract Surgery.

PRCIS: iStent Inject implantation (iStent) or Kahook Dual Blade goniotomy (KDB) in combination with phacoemulsification have a similar IOP-lowering effect in all stages of glaucoma, and medications are significantly reduced, especially after KDB. PURPOSE: To compare the 2-year efficacy and safety of iStent or KDB in combination with phacoemulsification in eyes with mild to advanced open angle glaucoma. METHODS: A retrospective chart review of 153 patients that received iStent or KDB in combination with phacoemulsification at a single center between March 2019 and August 2020. The main outcome parameters at 2 years were: (1) intraocular pressure (IOP)-reduction ≥20%, with a postoperative IOP ≤18 mm Hg, and (2) a reduction of ≥1 medication. Results were stratified by glaucoma grade. RESULTS: After 2 years, mean IOP was reduced from 20.3±6.1 to 14.2±4.1 mm Hg in the phaco-iStent group ( P <0.001) and from 20.1±6.1 to 14.7±3.6 mm Hg in the phaco-KDB group ( P <0.001). The mean number of medications was reduced from 3.0±0.9 to 2.6±1.1 in the Phaco-iStent group ( P =0.001) and from 2.3±1.0 to 1.5±1.3 in the Phaco-KDB group ( P <0.001). Success regarding IOP-reduction ≥20% with a postoperative IOP ≤18 mm Hg was met by 46% in the phaco-iStent group and by 51% in the phaco-KDB group. A reduction of ≥1 medication was met by 32% in the phaco-iStent group and by 53% in the phaco-KDB group ( P =0.013). Eyes with mild to moderate and advanced glaucoma responded equally well to the success criteria. CONCLUSIONS: iStent and KDB, in combination with phacoemulsification, both lowered IOP effectively in all stages of glaucoma. More medications were reduced after KDB, suggesting that it may be a more effective procedure compared with iStent.

[The stigma of mental illness: Α historical overview and conceptual approaches].

The present article explores the concept of stigma from a historical and theoretical perspective. At first, the conceptual origin of the term "stigma" is presented as well as its subsequent course and incorporation in the scientific field. The term stigma originates from ancient Greek language and in particular from the verb «στίζω¼, which means "to carve, to mark as a sign of shame, punishment or disgrace". In contemporary thinking about stigma, the work of Erving Goffman is seminal. According to him, stigmatization is elicited by the presence of a socially undesirable characteristic, which signals otherness. When this characteristic becomes conspicuous during a social interaction, it may act in a disqualifying manner for the identity of the person who bears it. One of the first theories on social stigma which attracted increased scientific attention is labeling theory by Thomas Scheff. Later on, the conceptual model of Corrigan and Watson underscored the main constituents of stigma, namely stereotypes, prejudices and discrimination; whereas the theoretical framework of Link and Phelan stressed labeling, stereotyping, separation, status loss and discrimination as interconnected components in a power situation. During the last half of the previous century, the concept of stigma came to the fore and gained growing research attention, especially due to shedding light on the ways whereby people with mental disorders were treated socially. Most of the literature has focused on recording the general population's level of knowledge and lay beliefs about mental illness as well as on exploring social attitudes and desired social distance from people with mental disorders. Converging evidence indicates that stereotypical beliefs and discriminatory attitudes against people with mental illness prevail worldwide; while illness severity, poor therapeutic outcome, disturbances in patients' emotional expression during a social interaction, incidents of violent or dangerous behaviours and labeling have all been shown to influence public stigma. Regarding lay respondents' correlates of public stigma; male gender, older age, lower socio-economic status, lower educational attainment and residence in semi-urban or rural areas have been linked to unfavourable attitudes towards people with mental disorders; while of outmost importance is personal experience/ familiarity with mental illness.

[The impact of the recent financial crisis on the users' profile of a community mental health unit].

During previous financial crises as well as the recent global financial crisis, a strong impact of the crisis on the population mental health in many countries has been observed. Similarly, in Greece, a series of epidemiological studies pointed out the consequences of the economic crisis on the population mental health. However, there is limited data available, both in Greece and worldwide, regarding the impact of the economic crisis from the perspective of mental health services. The goal of the present study was to examine possible changes on the community mental health during the first years of the Greek financial crisis, as they are reflected on the operation of a community mental health unit with a specific catchment area within Athens (Byron and Kessariani). The demographic, social and clinical characteristics of adult users who were admitted for the first time at ByronKessariani Mental Health Community Center during the years 2008-2013 were analysed. The impact of the financial crisis on the workload of the center was also assessed during the same period. The sample of the study consisted of 1865 adult users and the data was collected with the use of an ad hoc structured questionnaire as well as from the users' case files. No significant differentiation on the number of clients admitted to the center per year after the beginning of the financial crisis was found. However, it is possible that an upper limit has been reached on the center's capacity to admit new clients, i.e. a ceiling effect, as it is shown from the increased number of provided sessions per year as well as from the increase in the mean waiting time for the intake of new patients during the same period. A constant increase in the number of women among the new clients of ByronKessariani Mental Health Community Center was found, but no significant differentiations were detected during the study period. Moreover, the study showed an upward trend in aggressive behavior as a reason for admission, a significant and continuous increase in the rate of unemployed individuals among the new clients, as well as a statistically significant increase in the number of referrals for psychotherapy during the study period. There was also an increase in the number of patients who had psychiatric history, even though they were admitted to Byron-Kessariani Mental Health Community Center for the first time. No significant differentiations were found in the remaining users' demographic and clinical characteristics assessed. Our study showed that during the crisis community mental health services are under pressure due to the increased needs of patients, especially the needs for psychotherapeutic intervention and psychological support. The increased unemployment rates affect the influx of new patients as well as the therapeutic management of many users. Reinforcement of the community mental health service network is an important strategy against the consequences of the crisis on the population mental health.

[Psychosocial rehabilitation and severe mental illness: Factors that influence patients' attendance in a support group].

Psychosocial rehabilitation for people with chronic-severe mental illness mainly aims to social integration by restoring independent functioning in the community, improving quality of life, and addressing risk factors that lead to social disability. Support groups (SG) are usually part of this multilevel mental health process. Given that non-adherence to treatment is a common phenomenon in people with chronic- severe mental illness, the aim of the current study was to identify which factors influence members' attendance in a support group in a vocational training Program of the Psychosocial Rehabilitation Unit of Byron-Kaissariani Community Mental Health Centre. The SG sessions were weekly, with 45-minute duration, opened to any new member of the Program and coordinated by two therapists. Members' demographic and psychiatric data were gathered from the medical records of the Center. Information about SG was obtained from the reports of the sessions. The sample consisted of 18 women, with mean age 38.56 (±6.92) years. Most of them were high school graduates (61.1%), unmarried (83.3%), with low socioeconomic status (55.5%), suffering from a schizophrenic spectrum disorder (61.1%) with a mean duration 15.22 (±8.44) years. Out of 83 sessions in total, twenty-two (26.5%) were in absence of a co-therapist, 11 (13.3%) after a member's entrance or withdrawal and 11 (13.3%) after a session cancellation. Furthermore, an average of four issues was discussed per session, with mental illness (62.7%) and interpersonal relationships (73.5%) being the most popular topics during the sessions. The statistical analysis demonstrated that members' demographic (age, education, marital status, residence, socioeconomic status, working experience) and psychiatric characteristics (diagnosis, illness duration, rehabilitation program experience) were not associated with the attendance rate in the SG. Similarly, the proportion of participants attending the sessions did not seem to be significantly related to the absence of a co-therapist, to a member's entrance or withdrawal and to a session cancellation. In contrast, attendance seemed to be significantly reduced when the topic of a session focused on members' future expectations/goals (having a family, further education, finding a job) (Beta=-0.32, p=0.006). This finding highlights the need for future research in order to incorporate interventions that promote and address future goals and expectations of people with chronic-severe mental illness in psychosocial rehabilitation services.

The impact of unemployment on mental health examined in a community mental health unit during the recent financial crisis in Greece.

Financial crisis has significant impact on the mental health of the population, resulting in increasing incidence of mental disorders and suicides. Specific social and financial factors mediate the effects of financial crisis on mental health, such as poverty, financial difficulties and unemployment. During the recent international financial crisis, studies in many countries have shown that the worsening of various mental health indicators was related to financial difficulties and unemployment. In Greece, which is one of the countries that experienced intense and prolonged economic and social burden due to the recent crisis, the epidemiological findings were similar and the increase of the prevalence of major depression and suicide was excessive. However, the information about the mental health of the population deriving from health services is limited. The aim of this study was to investigate the impact of the crisis on community mental health -more specifically the rates of mental disorders and suicide, as well as the role of unemployment- among the new cases of a community mental health unit. The sample consisted of 1,865 adult users, men and women, who came seeking for help to the Byron-Kessariani Community Mental Health Centre (CMHC) during the years 2008-2013, i.e. the early years of the current crisis. Regarding the rates of the diagnostic categories in the new cases of CMHC per year, no significant differentiation was observed. There was an increase in the proportion of the unemployed individuals in the total sample of new cases during the study, from 9.65% in 2008 to 26.17% in 2013 and a significant association between unemployment and the occurrence of anxiety and depressive disorders, as indicated by the increase in the proportion of unemployed individuals among new cases with disorders of these categories. There was an upward trend in the rate of new patients referred to CMHC after a suicide attempt, which was doubled during the first years of the crisis. There was also an increase in the rate of unemployed individuals among these cases, from 10% in 2008 to 41.7% in 2009, reaching the highest level in 2011 (53.3%). The findings of this study suggest that during economic crisis unemployment plays an important role in the development of anxiety and depressive disorders and is closely related to suicide attempts. Our results were derived from a specific catchment area and therefore they have high ecological validity.

Adolescents' mental health during the financial crisis in Greece: The first epidemiological data.

Greek financial crisis has incurred adverse effects on the mental health of the population; however existing research is constrained in the adult population. Therefore, the present study aims to shed light on the mental health state of adolescents during the recession. In this context 2,150 adolescents were recruited from a random and representative sample of public and private schools in the greater Athens area. Mental health problems were assessed with the selfreport Strengths and Difficulties Questionnaire while additional questions enquired about students' socio-demographic characteristics. Findings indicate that roughly one out of ten adolescents scored above the cut off point for the total difficulties score, with the higher prevalence been recorded for the conduct problems sub-scale. More specifically, 7.7% of the sample scored above the abnormal cut-off point for the total difficulties score, 10.9% for emotional symptoms, 11.9% for conduct problems, 10.6% for hyperactivity and 4.8% for peer problems. Furthermore, adolescents who reported that during the previous month there was not enough food in their house displayed higher odds of manifesting mental health problems than adolescents who replied negatively in the particular query. On the grounds of these results, there is indication about the adverse effects of the financial crisis in the development of psychiatric symptomatology in adolescents in the Greek society. This is the first study providing epidemiological data on the current state of adolescents' mental health amid the recession in Greece, showing that the crisis impinges disproportionately on the most vulnerable socio-economic groups.

[Patients coming back after interruption of care in a community mental health center: Associations with care provision and psychopathological features].

A large number of people with mental health problems do not receive any treatment and in a large number of patients under care the treatment is interrupted. Non-compliance to treatment, observed in many different settings, is a major challenge in providing mental health care. The aim of the present study was to assess the demographic, social and psychological characteristics of the patients coming back for help to community psychiatric services and to shed some light to the reasons of interrupting and coming back. Special emphasis was placed on the possible correlation with specific mental disorders and whether or not the treatment was completed. The survey was carried out at the Byron- Kessariani University Mental Health Center, in a middle-classes catchment area and offering free of charge services. During the years from 2012 to 2016: 346 patients interrupting treatment (PIT) came back, while 1643 new patients were registered. The PIT were assessed with a specific questionnaire consisting of 34 open and closed-ended questions on changes in socio-demographic data, diagnosis, reported causes of discontinuation of care, services provided, important life events, follow-up by other mental health services after interruption of care, medication, and hospitalizations. The data were collected by trainee psychologists through a structured interview lasting 15-30 minutes and also from patients' medical records. Out of the 525 PIT during the study period, we excluded 148 who asked only for a certificate and 31 with many missing values. The final sample consisted of 346 patients and the analysis has focused on 299 PIT falling into one of the following four basic diagnostic categories: (a) schizophrenia and other psychotic disorders (12.7%), (b) mood disorders (41.3%), (c) neurotic and stress-related disorders (22.0%), (d) family and couple problems (10.4%). 64.1% of the PIT considered that they had not completed their previous treatment in the center, 19% attributed the interruption of care to reasons related to the center operation, and 88.4% considered that their demand had been satisfied. The highest rate of patients coming back was observed in the first year (31.7%) and then in four or more years (43.4%) after interruption of care. 32.7% discontinued the medication, 21,4% continued the medication following previous prescription. 47.3% had no follow-up, while 52.7% had been followed-up (36.6% of them by a private psychiatrist and 30.7% by a psychiatrist in a public institution). 45.5% of people with schizophrenia and other psychotic disorders were hospitalized in the meantime. The relationships between diagnosis and follow-up status with unemployment were tested but these associations were not statistically significant. There was greater satisfaction by those who completed treatment, as expected. Reasons for interruption related to the center operation, such as the work shift, the frequent changes in stuff members and the quality of care, are of particular importance.

Attitudes of psychology students to depression and its treatment: Implications for clinical practice.

Stigma and mental health literacy affect access to and quality of treatment of major depression. Though mental health professionals seem better able to recognize major depression than the general public, they often hold similarly stigmatizing attitudes towards people suffering from the disorder. These attitudes are shaped jointly by the public stigma attached to mental illnesses as well as by the content and delivery of mental health professionals' undergraduate training. In line with this, the present study aimed to explore psychology students' ability to recognize major depression, their attitudes towards the disorder, and their views surrounding helpfulness of various interventions. A random sample of 167 undergraduate students was recruited from the psychology department of one public university in Athens. During one university hour, students were administered a vignette describing a woman fulfilling the DSM-IV criteria for major depression. A self-report questionnaire exploring students' recognition abilities, attitudes to depression and views on the helpfulness of various treatment modes was also administered. In total, 80.2% of students correctly recognized major depression from the vignette. Concerning their attitudes, students were unsure about the illness and ambivalent towards the person who suffers from it. With regard to available treatments for depression, students considered discussion with a friend to be the most helpful intervention. Counseling, cognitive behavioural therapy and psychoanalysis were also viewed in a positive light. On the contrary, antidepressants were not deemed helpful by most students. Finally, recognition of as well as attitudes towards depression and its treatments seemed to improve during the second year of undergraduate study; however they remained unchanged thereafter. Consistent with these, psychology students seem to have only a rudimentary knowledge on depression, that cannot not be qualified as mental health literacy. The core misconception espoused pertains to the view that major depression is not a medical illness; a finding which can also be interpreted in light of the lingering controversy on the medicalization of normal sadness and human predicament. The clinical implications of these findings are substantial. Mental health professionals-educators should reflect on their own beliefs and attitudes towards depression, as they may convey stigmatizing messages to their students and thus perpetuate the stigmatization of the illness. Concomitantly, psychology students' attitudes to depression and its treatment might render them incapable of understanding their patients, responding to their needs and providing them with appropriate help, while they may hinder their effective collaboration with psychiatrists.

A 2-year prospective densitometric study on the influence of Fok-I gene polymorphism in young patients with thalassaemia major.

UNLABELLED: This study is to estimate the degree of genetic contribution of Fok-I gene polymorphism of Vitamin D receptor to bone mass in patients with thalassaemia. Results indicate a protective role of the f allele of the Fok-I gene polymorphism when found in homozygosity on bone mineral density of young thalassemic patients. INTRODUCTION: The purpose of this study is to estimate prospectively the degree of genetic contribution of Fok-I gene polymorphism of vitamin D receptor (VDR) to the evolution of bone mass in patients with beta-thalassemia major (b-TH). METHODS: Sixty-four children and young adults (33 males and 31 females) with mean decimal age of 23.20 ± 5.41 (range 9.25-32.41 years) were recruited in this study. All patients were genotyping for Fok-I gene polymorphism and were assessed with dual energy X-ray absorptiometry (DXA) at baseline and 2 years after. Z-scores were calculated based on normal age and sex matched Caucasian population. Metabolites of vitamin D, intact PTH, total calcium, inorganic phosphorous, and alkaline phosphatase were measured at the serum pre-transfusion. RESULTS: A moderate proportion of patients had decreased DXA Z-scores (Z-score ≤-2) predominately in total hip (31 %) and secondary in lumbar spine (15.6 %). Patients being homozygous for the f allele had apparently higher BMD Z-scores compared with those carrying the F allele in homo- or heterozygosity, however, with a difference that did not reached significance. Interestingly enough, a significant deterioration in BMD Z-scores measured at femur (FF: P = 0.004 Ff: P < 0.001, ff: P = 0.024) and total hip (FF: P = 0.022, Ff: P = 0.005) was recorded for all type of genotypes, except for ff genotype and with regard to the total hip DXA values. An increased prevalence of serum 25(OH)D3 deficiency (59.4 %) and 25(OH)D3 borderline (12.5 %) was recorded. CONCLUSION: Our study indicates a protective role of the f allele of the Fok-I gene polymorphism when found in homozygosity on bone mineral density of young patients with b-TM.

Long-term response in biochemical markers of bone turnover during enzyme replacement therapy in a case-series of patients with Gaucher disease type I from Northern Greece.

BACKGROUND: Gaucher disease (GD) is a lysosomal storage disorder characterized by severe skeletal complications. Bone complications are an important cause of morbidity of GD and are thought to result from imbalance in bone remodeling. The objective of this case series was to analyze the long-term effect of enzyme replacement therapy on chemokines MIP-1a and MIP-1b, cytokines IL-3, IL-6, IL-10, and IL-12, osteoprotegerin (OPG) and osteocalcin (BGP), chitotriosidase, quantitative ultrasound sonography (QUS), bone magnetic resonance imaging (MRI) and dual-energy X-ray absorptiometry (DXA) in patients with GD in Northern Greece. In addition, the study aimed in investigating possible relationship between the above mentioned parameters. PATIENTS AND METHODS: Seven patients with GD type I (three males and four females) were included in the study. Mean age was 26.29 ± 15.34 years (range 7-47 years). Six patients were receiving enzyme replacement therapy (ERT), with 40-60 IU/kg of imiglucerase weekly, for a mean period of 36 months prior to study initiation. One patient started ERT after his inclusion in the study. The levels of MIP-1a, MIP-1b, IL-3, IL-6, IL-10, IL-12, OPG, BGP, chitotriosidase, bone imaging parameters assessed with two different techniques (QUS and DXA) and MRI data were estimated at baseline (T0) and after two years on ERT. RESULTS: Chitotriosidase, MIP-1a, and IL-6 levels decreased in all patients after two years of ERT (p =0.05). In contrast, OPG and BGP levels increased (p =0.04 and p =0.02, respectively). Bone mineral density (BMD) demonstrated a progressive improvement with regards to the Z-score in all patients (p =0.05). The decrease in the plasma levels of MIP-1a strongly correlated with a decrease in the plasma levels of chitotriosidase. Additionally, decreased plasma levels of IL-6 were correlated with increased Z-score both at baseline (T0) as well as two years later, in all patients. There was no correlation between MRI findings and any inflammatory biomarker. CONCLUSIONS: Measurement of serum markers in patients with GD under ERT could be used as an auxiliary tool in the monitoring of bone involvement, in combination with MRI imaging and BMD. However, larger studies involving higher numbers of GD patients are needed to confirm these conclusions. Hippokratia 2016, 20(2): 153-159.

[Group psychoeducational intervention in relatives of patients suffering from schizophrenia].

The present research paper aims at assessing the effectiveness of a psychoeducational intervention in relatives' groups of patients with schizophrenia or schizoaffective disorder. It examines the possible influence of the intervention on family members as well as on the course of the patient illness. Of a total of 131 relatives, 83 consisted the experimental group and 48 the control group. The relatives of the experimental group were divided into 5 groups and attended 18 psychoeducational sessions. Their patients as well s the patients and the relatives of the control group attended no specific intervention and continued their routine care. The psychoeducational intervention included education about the illness, communication skills training and training in problem-solving. It combined educational and psychotherapeutic techniques. The psychometric tools administered were: The Family Burden Scale, The Family Rituals Scale, The General Health Questionnaire GHQ-28, the Center for Epidemiological studies - Depression Scale (CES-D), the Opinions about Mental Illness Scale OMI, two scales concerning the knowledge about the illness, two questionnaires concerning expectations and feedback about the group process and questionnaires regarding sociodemographic characteristics of the sample and information about the illness. The number of hospitalizations of patients (n=91) during the research year was investigated. An interaction between group and measurement was found. While patient hospitalizations of both research groups did not differ significantly at the year before the study with X2=0.54, p=0.46), they differed when measured a year after the intervention, where patients in the intervention group had statistically significant fewer hospitalizations compared to the patients in the control group (x2=4.58, significant at p=0.032). As to the "compliance" in the medication, two statistical tests were conducted, taking into consideration that "compliance" by patients starting with a "very good" one can't be improved, while by those beginning with poor compliance can't be worsened. In the first investigation, which involved patients with possibility of amelioration or deterioration of "compliance", an improvement of patients (n=12) in the intervention group was recorded. This finding is statistically significant (p=0.0005). The second statistical test included all patients who were giving as an initial reply for the 'compliance' any value below "very good". In the intervention group there were 32 patients, 14 of whom showed improved "compliance" during the research year. This change is statistically significant (p=0.0014). The findings verify that the participation of relatives in psychoeducational groups leads to statistically significant improvement in the course of patient illness, as evident by the reduction in hospitalization rates and the improvement in adherence to pharmacotherapy. The study shows that relatives' psychoeducation constitutes a useful tool in improving the course of illness and empowering the family. The widespread implementation of relatives' psychoeducation in Greece is both necessary and challenging.

[Representations of mental illness in the Greek Press: 2001 vs 2011].

The media seem to have played a prominent role in shaping the contemporary social image of people with mental illness, by perpetuating the stigma attached to it. Worldwide, a vast amount of research findings converge to the stigmatizing representation of people with mental illness by the media, with reference to the dominant stereotype of violence. The present study aims to explore the representations of mental illness in the Greek Press using a quantitative and qualitative approach. Potential changes in the media portrayal of mental illness during the last decade are also being examined: findings are compared to those of a previous research that took place in 2001, following the same methodology. The sample consisted of press articles referring to mental illness, that were indexed daily from the Greek newspapers during the period July-November 2011. The items were categorized into thematic categories and further analyzed taking in account the use of stigmatizing vocabulary, the reproduction of common myths concerning mental illness, the overall valence of each article (stigmatizing, neutral or anti-stigmatizing) towards people with mental illness, as well as the contextual implications conveyed in the use of psychiatric terms as a metaphor. The largest thematic category that emerged from the sample was that referring to the repercussions of the economic crisis to mental health, followed by the category of articles where psychiatric terms are used as a metaphor. The comparisons made between 2001 and 2011 revealed an improved representation of mental illness in terms of stigma, especially regarding schizophrenia. The public expression of stigma has decreased, with fewer stigmatizing articles and notably more neutral in valence articles. The findings of this study suggest a decline of the media propensity for emotionally charged descriptions and a shift towards objective journalism regarding mental illness. This is most likely to be attributed to the anti-stigma campaigns, targeting media workers, that have been implemented during the last decade in Greece. Nevertheless, the public expression of stigma remains present by taking more subtle forms. Such examples are demonstrated by the semantic context of articles in which psychiatric terms are used as a metaphor, or by the recurrent reference of (unspecified) mental illness on the occasion of violent crime.

Safety and efficacy of hydroxyurea in children and adolescents with sickle/beta-thalassemia: two-year experience.

BACKGROUND: Hydroxyurea is a cytotoxic and myelosuppressive drug that has been used during recent years in the treatment of children with severe sickle cell disease. Nevertheless, questions remain regarding its role in young patients with no severe course, like sickle/beta-thalassemia (S/b-thal) patients often present. The aim of the present study was to evaluate the safety and efficacy of hydroxyurea in young patients with S/b-thal, which is the commonest form of the disease in Greece. PATIENTS-METHODS: Hydroxyurea was given in thirteen children with S/b-thal for 24 months and for that period clinical and laboratory evaluation of the children was performed. RESULTS: A reduction in pain crises and rate of hospitalization was noted. None of the patients presented with a severe clinical event, related to the disease during the study period. A significant increase in hemoglobin, hemoglobin F, mean corpuscular volume, and mean corpuscular hemoglobin and a decrease in reticulocyte count, white blood cell and platelet count, and total bilirubin level was noted. With regards to adverse events, these were transient, short-term and dose-dependable. CONCLUSIONS: To the best of our knowledge, this is the first study to specifically assess the effect of hydroxyurea therapy in young patients with S/b-thal and the results indicate is safe and efficacious in this patient cohort. Hippokratia 2015; 19 (2):172-175.

Myocarditis after administration of clozapine.

OBJECTIVE: Clozapine is an atypical antpsychotic medication with established efficacy in patients diagnosed of resistant schizophrenia. However, clozapine has multiple side effects. Cardiac complications such as myocarditis and cardiomyopathy have always been related with treatment with clozapine. METHODS: A 42 year old Caucasian male, with history of schizophrenia developed a acute myocarditis after commencement of clozapine. RESULTS: The patient recovered with intensive medical support. The symptoms occurred approximately 20 days after starting clozapine. CONCLUSIONS: Myocarditis is an ingreasingly recognized complication associated with clozapine. Use of clozapine must be based on a balance of its risks and benefits on an individual basis which for the most part defines its use in treatment refractory schizophrenia. Appropriate monitoring of adverse events is an essential part of the clinical usage of clozapine and should be charted for at least two years.

Laboratory investigation of platelet function in patients with thalassaemia.

The aim of this study was to investigate platelet function in patients with thalassaemia and to detect any relation to chelation treatment (deferasirox or deferiprone/deferiprone plus desferioxamine). Thirty-three transfusion-dependent patients with thalassaemia were included. The investigation consisted of aggregation testing of platelet-rich plasma by light transmission aggregometry (LTA) with the use of 5 agonists as well as the global test of haemostasis by means of the PFA-100 platelet function analyser. In 66.67% of the patients, there was reduced LTA to at least one agonist and in 18.18% there was reduced LTA to two or more agonists. The PFA-100 test was prolonged in 60.6% of the cases. An abnormal LTA and a prolonged PFA-100 time were recorded in 33.3% of the patients and 27.4% had a normal aggregation and PFA-100 test. No correlation between chelation regimen and either LTA or PFA-100 test was found. The abnormal LTA can be explained either by the release of ADP from the haemolysed red blood cells, which leads to defective platelet aggregation, or by the presence of two platelet populations. An in vitro effect without an in vivo impact could be an alternative explanation. In patients with thalassaemia, the reduced LTA and the prolonged PFA-100 closure time could be an in vitro effect and has a close correlation to the bleeding phenotype of each patient.

Cyclosporine therapy during pregnancy in a patient with ß-thalassemia major and autoimmune haemolytic anemia: a case report and review of the literature.

Recent advances in the management of hemoglobinopathies offer an improved potential for safe pregnancy with favourable outcome in patients with ß-thalassemia major. Autoimmune diseases that are common in women at reproductive age might be fulminant and hardly manageable in pregnant women with thalassemia. Thus immunosuppressant drugs like cyclosporine A could be necessary in order to maintain good maternal and foetal health. We present a case report of a 35-year-old woman with ß-thalassemia major, splenectomy, autoimmune hemolytic anemia and insulin treated diabetes mellitus who was treated with cyclosporine A during her pregnancy, and delivered a healthy male infant. First line therapy with steroids was ineffective, due to deregulation of diabetes mellitus.

Impact of HLA alleles and cytokine polymorphisms on inhibitors development in children with severe haemophilia A.

Human Leucocyte Antigen (HLA) alleles, cytokine polymorphisms and the type of factor VIII (FVIII) gene mutation are among predisposing factors for inhibitors (inh) development in children with severe haemophilia A (HA). The aim was to investigate the correlations among (i) FVIII gene intron-22 inversion, (ii) HLA alleles and haplotypes and (iii) certain cytokine polymorphisms, with the risk for FVIII inhibitors development in 52 Greek severe HA children, exclusively treated with recombinant concentrates. We performed Long-Range PCR for detection of intron-22 inversion and PCR-SSP, PCR-SSO for genotyping of HLA-A, B, C, DRB1, DQB1 alleles and also for cytokine polymorphisms of TNF-α, TGF-ß1, IL-10, IL-6 and IFN-γ. Chi-squared test and Fischer's exact test were used for statistical analysis. A total of 28 children had developed inhibitors (Group I), 71.4% high responding, while 24 had not (Group II). No statistically increased intron-22 inversion prevalence was found in Group I compared with Group II (P = 0.5). Comparison of HLA allele frequencies between the two groups showed statistically significant differences in the following genotypes (i) promoting inhibitors development: DRB1*01(P = 0.014), DRB1*01:01(P = 0.011) and DQB1*05:01 (P = 0.005) and (ii) possibly protecting from inhibitors development: DRB1*11 (P = 0.011), DRB1*11:01 (P = 0.031), DQB1*03 (P = 0.004) and DQB1*03:01 (P = 0.014). Analysis of cytokines revealed a higher incidence of inhibitor detection only in homozygotes of the haplotypes ACC and ATA for IL-10 polymorphisms (P = 0.05). There is evidence that HLA alleles and cytokine polymorphisms play an important role in FVIII inh development. On the contrary, no statistically significant results were obtained for intron-22 inversion and its impact on FVIII inhibitors formation.

[Economic crisis and mental health: effects on the prevalence of common mental disorders].

Economic crises have been found to bring adverse repercussions on physical and mental health internationally through various pathways. Research corroborates a link between financial distress and common mental disorders. In this context, the University Mental Health Research Institute conducted epidemiological nationwide surveys in an endeavour to gauge the impact of the ongoing financial crisis on the mental health of the Greek population. The purpose of the present analysis pertains to investigating changes in the prevalence of common mental disorders in the population as a whole as well as in various population sub-groups between years 2009 and 2011. In addition, the association of financial strain with common mental disorders was also explored. For investigating the particular research objectives, two cross-sectional surveys following the same methodology were conducted. A random and representative sample of 2192 respondents in 2009 and 2256 respondents in 2011 took part in telephone interviews. Generalized anxiety disorder and major depression were assessed with the germane modules of Structured Clinical Interview, while financial difficulties with the Index of Personal Economic Distress (IPED), an original scale developed for the purposes of the particular surveys. All measures displayed good psychometric properties. Between the two years, a noteworthy, albeit non-significant, increase in one-prevalence of major depression was documented. On the other hand, the prevalence of generalized anxiety disorder remained largely unchanged. Statistically significant differences in the prevalence of both disorders were reported for particular population subgroups, with married persons and employed people emerging as the most afflicted individuals. Regarding financial distress, it was found to bear a statistically significant association with major depression but not with generalized anxiety disorder. For mitigating the mental health effects of the crisis on the general population, study findings underline the necessity of implementing targeted interventions, tailored to the needs and difficulties of each population sub-group.

[Depression telephone helpline: help seeking during the financial crisis].

Mental health telephone help-lines usually play a significant role in mental health services system. Their importance is substantiated during periods of financial crisis, where the mental health of the population is gravely inflicted. Media reports have documented a large increase in calls made to mental health telephone help-lines around the world as a corollary to the global economic crisis; however, a systematic investigation of this observation is still lacking. In this context, the present study endeavours to fill this gap in the literature, while it adds strength to the handful of studies which have empirically supported the impact of the financial crisis on mental health in Greece. Data were extracted from information gleaned during the calls made to the Depression Telephone Helpline of the Greek University Mental Health Research Institute. The information entailed the reason for calling, the socio-demographic and clinical profile of the person with mental health problems, his/her previous and current contacts with mental health professionals and the treatment he/she might be receiving. The results showed a steep increase in calls with direct or indirect reference to the economic crisis during the first half of 2010 and onwards. The callers who referred to the economic crisis manifested depressive symptomatology of clinical significance to a greater degree than callers who made no such reference. The latter exhibited increased levels of distress and agitation as well as drug/alcohol misuse. Concomitantly, a higher frequency of depressive symptomatology was discerned among the unemployed, whereas employed people were found to experience anxiety symptoms to a higher degree. The impact of the financial crisis on the mental health of the Greek population has been considerable, underscoring in this way the importance of mental health help-lines as emotional buffers and as guides for timely and appropriate service use in response to the emerging mental health problems.

Low serum high-density lipoprotein cholesterol in childhood is associated with adolescent asthma.

BACKGROUND: Whilst emerging evidence from animal and cell experiments has shown high-density lipoprotein cholesterol to have anti-inflammatory effects consistent with a protective role in asthma, human studies investigating the relationship of high-density lipoprotein cholesterol with asthma have produced conflicting results. OBJECTIVE: To examine the association between serum lipids among Cypriot children aged 11-12 years and prevalence of asthma at age 15-17 years. METHODS: In 3982 children, we assessed serum lipids, body mass index and maximal oxygen consumption at baseline (2001-2003) and explored associations with respiratory health at follow-up (2007) using multiple logistic regression models. RESULTS: Lower levels of high-density lipoprotein cholesterol at age 11-12 years were found in subjects who reported ever asthma (58.2 vs. 60.0 mg/dL, P = 0.005) and active asthma (57.5 vs. 59.9 mg/dL, P = 0.010) in adolescence, in comparison with their respective reference groups. Total cholesterol, low-density lipoprotein and triglycerides had no association with any of the asthma outcomes. In contrast, with estimated odds ratios of 1.89 (95% CI 1.19-3.00) and 1.89 (95% CI 1.02-3.53), ever asthma and active asthma respectively appeared particularly pronounced among those who at baseline had high-density lipoprotein cholesterol <40 mg/dL, even after adjusting for potential confounders including body mass index and maximal oxygen consumption. CONCLUSIONS & CLINICAL RELEVANCE: Low-serum high-density lipoprotein cholesterol in childhood is associated with an increased risk for asthma in adolescence, suggesting a potential role of this lipoprotein in the pathogenesis of paediatric asthma.