Subcutaneous and sublingual allergen-specific immunotherapy: a tale of two routes.

Summary: Specific immunotherapy is the only treatment acting on the causes and not only on symptoms of respiratory allergy. It was first introduced as subcutaneous immunotherapy (SCIT) with the aim to induce immunological tolerance to the administered allergen(s). In the 1980s, sublingual immunotherapy (SLIT) was developed, mainly to improve the safety, which was a critical issue at that time. This article reviewed the available literature, including a large number of randomized controlled trials, meta-analyses, and real-life studies as well, on the outcomes of SCIT and SLIT concerning the treatment critical issues of the two routes, that are efficacy, safety, cost-effectiveness, and compliance to treatment. The efficacy of SCIT and SLIT is similar in respiratory allergy, providing, based on the induction of typical changes in the immunologic response, an early control of symptoms that steadily increases during the treatment and its efficacy lasts after the recommended duration of three years. Such results are the reason why SCIT and SLIT have economic advantage over symptomatic drugs.

Asthma associated to rhinitis.

A large amount of data show that AR and asthma are associated both epidemiologically and clinically, introducing the definition of “united airway disease”. The mechanisms underlying such association were initially suggested to start from the nose, including the loss of the protective and homeostatic effects of nasal function, the activation of a naso-bronchial reflex and the spread of allergic inflammation from the nose to the lower airways. Later, other factors such as microbial stimuli and systemic inflammatory mechanisms, involving bloodstream and bone marrow, were advocated. The advance in knowledge made it clear that the link between asthma and AR is multifactorial, with particular importance for inflammatory cells and especially eosinophils. By the model of nasal challenge, important immunological responses were revealed, with particular importance for the increased expression of adhesion molecules (ICAM-1, VCAM-1 and E-selectin) and of cytokines such as interleukin (IL)-13, that was accompanied by a rise of eosinophils in blood and developement of bronchial hyper-responsiveness. The occurrence in AR of a concomitant sinusitis is frequently associated with worse asthma outcomes, as assessed by a lower pulmonary function, increased asthma symptoms and poorer quality-of-life compared to patients with asthma alone.

Sewer-mining: A water reuse option supporting circular economy, public service provision and entrepreneurship.

Water scarcity, either due to increased urbanisation or climatic variability, has motivated societies to reduce pressure on water resources mainly by reducing water demand. However, this practice alone is not sufficient to guarantee the quality of life that high quality water services underpin, especially within a context of increased urbanisation. As such, the idea of water reuse has been gaining momentum for some time and has recently found a more general context within the idea of the Circular Economy. This paper is set within the context of an ongoing discussion between centralized and decentralized water reuse techniques and the investigation of trade-offs between efficiency and economic viability of reuse at different scales. Specifically, we argue for an intermediate scale of a water reuse option termed 'sewer-mining', which could be considered a reuse scheme at the neighbourhood scale. We suggest that sewer mining (a) provides a feasible alternative reuse option when the geography of the wastewater treatment plant is problematic, (b) relies on mature treatment technologies and (c) presents an opportunity for Small Medium Enterprises (SME) to be involved in the water market, securing environmental, social and economic benefits. To support this argument, we report on a pilot sewer-mining application in Athens, Greece. The pilot, integrates two subsystems: a packaged treatment unit and an information and communications technology (ICT) infrastructure. The paper reports on the pilot's overall performance and critically evaluates the potential of the sewer-mining idea to become a significant piece of the circular economy puzzle for water.

Comparing the compliance to a short schedule of subcutaneous immunotherapy and to sublingual immunotherapy during three years of treatment.

BACKGROUND: Allergen immunotherapy (AIT) in its two forms of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) is an effective treatment of respiratory allergy, but is particularly concerned by the issue of compliance. OBJECTIVE: We aimed a real-life study at evaluating the compliance to SLIT and to SCIT administered by a short-course of four injections during a 3-year period of observation. METHODS: A group of 145 patients (79 males, 66 females, age ranging from 14 to 69 years), suffering from pollen-induced rhino-conjunctivitis with or without asthma, were included in the study. Following adequate education on AIT and according to patient's preference, 72 patients chose to be treated with short-course SCIT and 73 chose to be treated with SLIT. The latter was performed by allergen extracts from different manufacturers according to the suggested schedules. RESULTS: The rate of withdrawal was as follows: after one year, 15.6% for SCIT and 33.4 for SLIT; after two years, 25.6% for SCIT and 44.8% for SLIT; after three years, 26.7 for SCIT and 46% for SLIT. There was no significant difference in the rate of withdrawal between males and females. Regarding the safety, no systemic reaction requiring medical treatment was observed either in SCIT or SLIT group. CONCLUSION: The findings of this study confirm that involving the patient in the choice of the route of administration is associated to a satisfactory compliance to AIT. In particular, more than 70% of patients treated with a short schedule of SCIT completed the three-years course of treatment that is recommended for AIT, while this goal was reached by 54% of SLIT treated patients.

Post-exposure prophylaxis after non-occupational exposure to HIV in Greece.

AIM: To assess the use of post-exposure prophylaxis after a non-occupational exposure to HIV in Greece. METHODS: We analysed the data that were reported to the Hellenic Centre for Disease Control and Prevention by physicians who requested non-occupational post-exposure to HIV prophylaxis (NONOPEP). RESULTS: During the period January 1996-June 2005 inclusive, 159 persons received NONOPEP (116 males, 42 females and 1 unknown). Fifty-three per cent of the males sought NONOPEP because of an exposure to sperm and vaginal secretions, while 35.7% of the females were exposed to sperm. Unprotected sex was the main reported cause of exposure to HIV (38.36%) followed by condom rupture (35.85%). For 110 (69.18%) persons, it was the first time they were prescribed NONOPEP. CONCLUSION: The current surveillance system in Greece should be further developed to include the documentation of potential drug-toxicity, side effects and adherence to the prophylaxis. The health educational role of the nurse in HIV prevention in Greece should be developed.

Adsorption at the air-water interface and emulsification properties of grain legume protein derivatives from pea and broad bean.

Functional properties of native and modified (through induced autolysis) pea (Pisum sativum L.) and broad bean (Vicia faba L.) protein derivatives are studied. In specific, protein solubility and behavior at the air-water interface through surface pressure measurements are investigated. Furthermore the ability of the protein products to act as emulsifying agents and to stabilize emulsions is studied through oil droplet size distribution measurements and by the protein adsorbed at the oil-water interface. The data reveal that the ability of the proteins to act as surfactants and build up a rigid film around the oil droplets, mainly depends on their suitable molecular configuration and structure. Hydrolysis did not promote the functionality of the legume proteins. Broad bean exhibited better functionality than pea, before and after hydrolysis. Some comparisons were also made with lupin (Lupinus albus L.) protein isolate.

Occult hepatitis B virus infection in Greek patients with chronic hepatitis C and in patients with diverse nonviral hepatic diseases.

Occult hepatitis B virus (HBV) infection has been reported in patients with chronic hepatitis C who are negative for HBV surface antigen (HBsAg). However, the significance of 'silent' HBV in hepatitis C virus (HCV) infection is unknown. We investigated 540 subjects for the presence of occult HBV in Greek HCV patients, patients with nonviral liver diseases and healthy donors in an attempt to determine the frequency and importance of this phenomenon. One hundred and eighty-seven anti-HCV(+)/HBsAg(-) patients' sera were investigated for the presence of HBV-DNA by polymerase chain reaction. Two hundred and eighty-two selected blood donors (positive for antibodies to HBV core antigen) and 71 patients with various nonviral hepatic diseases consisted the control groups [both controls were anti-HCV(-)/HBsAg(-)]. HBV-DNA was detected in 26.2% of HCV-infected patients vs 8.5% of patients with nonviral diseases (P = 0.003) and 0/282 of donors (P = 0.0000). HBV-DNA was neither associated with HBV markers, nor with the clinical status of HCV and nonHCV patients. Neither epidemiological, histologic and virologic data nor the response to therapy were associated with the HBV-DNA detection. Hence one quarter of HCV-infected patients had occult HBV infection. Similar findings were not found in both control groups. Occult HBV infection in Greek patients with chronic hepatitis C does not seem to modify the progression of chronic liver disease. Further studies of longer duration are needed in order to clarify the role of 'silent' HBV infection in HCV-infected patients.

Bringing community involvement into a Cretan primary/hospital care center: an evaluation of population habits and attitudes toward health care.

In a small Cretan township hospital combining secondary and primary care, a questionnaire was distributed to a consecutive visitor sample. The questionnaire requested information on the participants' personal smoking and other life habits, perceptions and expectations of the delivery of the health care services, and attitudes toward their own doctors and others who provide various health services. Three hundred and one individuals of both sexes who were 15 years and older participated in the study (participation rate, more than 97%). An interesting and varied response was recorded, covering a wide range of perceptions, opinions, and attitudes not only toward the services, but also toward the staff. Although a high confidence in and appreciation of both the primary care and hospital sections appeared in the study results, these attitudes should not be allowed to deteriorate. Therefore, specific actions should be undertaken: constant upgrading of the existing organizational context, implementation of promotional and educational programs, and use of the questionnaire as an effective tool for periodically assessing the population's attitudes, experiences, and expectations.