Search for exotic decays of the Higgs boson to a pair of pseudoscalars in the μμbb and ττbb final states

A search for exotic decays of the Higgs boson (H ) with a mass of 125Ge V to a pair of light pseudoscalars a 1 is performed in final states where one pseudoscalar decays to two b quarks and the other to a pair of muons or τ leptons. A data sample of proton-proton collisions at s = 13 Te V corresponding to an integrated luminosity of 138fb - 1 recorded with the CMS detector is analyzed. No statistically significant excess is observed over the standard model backgrounds. Upper limits are set at 95% confidence level (CL ) on the Higgs boson branching fraction to μ μ b b and to τ τ b b , via a pair of a 1 s. The limits depend on the pseudoscalar mass m a 1 and are observed to be in the range (0.17-3.3) × 10 - 4 and (1.7-7.7) × 10 - 2 in the μ μ b b and τ τ b b final states, respectively. In the framework of models with two Higgs doublets and a complex scalar singlet (2HDM+S), the results of the two final states are combined to determine upper limits on the branching fraction B ( H → a 1 a 1 → ℓ ℓ b b ) at 95% CL , with ℓ being a muon or a τ lepton. For different types of 2HDM+S, upper bounds on the branching fraction B ( H → a 1 a 1 ) are extracted from the combination of the two channels. In most of the Type II 2HDM+S parameter space, B ( H → a 1 a 1 ) values above 0.23 are excluded at 95% CL for m a 1 values between 15 and 60Ge V .

Observation of WWγ Production and Search for Hγ Production in Proton-Proton Collisions at sqrt[s]=13 TeV

The observation of WWγ production in proton-proton collisions at a center-of-mass energy of 13 TeV with an integrated luminosity of 138  fb^{-1} is presented. The observed (expected) significance is 5.6 (5.1) standard deviations. Events are selected by requiring exactly two leptons (one electron and one muon) of opposite charge, moderate missing transverse momentum, and a photon. The measured fiducial cross section for WWγ is 5.9±0.8(stat)±0.8(syst)±0.7(modeling)  fb, in agreement with the next-to-leading order quantum chromodynamics prediction. The analysis is extended with a search for the associated production of the Higgs boson and a photon, which is generated by a coupling of the Higgs boson to light quarks. The result is used to constrain the Higgs boson couplings to light quarks.

New Structures in the J/ψJ/ψ Mass Spectrum in Proton-Proton Collisions at sqrt[s]=13 TeV

A search is reported for near-threshold structures in the J/ψJ/ψ invariant mass spectrum produced in proton-proton collisions at sqrt[s]=13  TeV from data collected by the CMS experiment, corresponding to an integrated luminosity of 135  fb^{-1}. Three structures are found, and a model with quantum interference among these structures provides a good description of the data. A new structure is observed with a local significance above 5 standard deviations at a mass of 6638_{-38}^{+43}(stat)_{-31}^{+16}(syst)  MeV. Another structure with even higher significance is found at a mass of 6847_{-28}^{+44}(stat)_{-20}^{+48}(syst)  MeV, which is consistent with the X(6900) resonance reported by the LHCb experiment and confirmed by the ATLAS experiment. Evidence for another new structure, with a local significance of 4.7 standard deviations, is found at a mass of 7134_{-25}^{+48}(stat)_{-15}^{+41}(syst)  MeV. Results are also reported for a model without interference, which does not fit the data as well and shows mass shifts up to 150 MeV relative to the model with interference.

Search for Scalar Leptoquarks Produced via τ-Lepton-Quark Scattering in pp Collisions at sqrt[s]=13 TeV

The first search for scalar leptoquarks produced in τ-lepton-quark collisions is presented. It is based on a set of proton-proton collision data recorded with the CMS detector at the LHC at a center-of-mass energy of 13 TeV corresponding to an integrated luminosity of 138  fb^{-1}. The reconstructed final state consists of a jet, significant missing transverse momentum, and a τ lepton reconstructed through its hadronic or leptonic decays. Limits are set on the product of the leptoquark production cross section and branching fraction and interpreted as exclusions in the plane of the leptoquark mass and the leptoquark-τ-quark coupling strength.

Search for Inelastic Dark Matter in Events with Two Displaced Muons and Missing Transverse Momentum in Proton-Proton Collisions at sqrt[s]=13 TeV

A search for dark matter in events with a displaced nonresonant muon pair and missing transverse momentum is presented. The analysis is performed using an integrated luminosity of 138  fb^{-1} of proton-proton (pp) collision data at a center-of-mass energy of 13 TeV produced by the LHC in 2016-2018. No significant excess over the predicted backgrounds is observed. Upper limits are set on the product of the inelastic dark matter production cross section σ(pp→A^{'}→χ_{1}χ_{2}) and the decay branching fraction B(χ_{2}→χ_{1}μ^{+}μ^{-}), where A^{'} is a dark photon and χ_{1} and χ_{2} are states in the dark sector with near mass degeneracy. This is the first dedicated collider search for inelastic dark matter.

Luminosity determination using Z boson production at the CMS experiment

The measurement of Z boson production is presented as a method to determine the integrated luminosity of CMS data sets. The analysis uses proton-proton collision data, recorded by the CMS experiment at the CERN LHC in 2017 at a center-of-mass energy of 13Te V . Events with Z bosons decaying into a pair of muons are selected. The total number of Z bosons produced in a fiducial volume is determined, together with the identification efficiencies and correlations from the same data set, in small intervals of 20pb - 1 of integrated luminosity, thus facilitating the efficiency and rate measurement as a function of time and instantaneous luminosity. Using the ratio of the efficiency-corrected numbers of Z bosons, the precisely measured integrated luminosity of one data set is used to determine the luminosity of another. For the first time, a full quantitative uncertainty analysis of the use of Z  bosons for the integrated luminosity measurement is performed. The uncertainty in the extrapolation between two data sets, recorded in 2017 at low and high instantaneous luminosity, is less than 0.5%. We show that the Z boson rate measurement constitutes a precise method, complementary to traditional methods, with the potential to improve the measurement of the integrated luminosity.

Observation of the Rare Decay of the η Meson to Four Muons

A search for the rare η→μ^{+}μ^{-}μ^{+}μ^{-} double-Dalitz decay is performed using a sample of proton-proton collisions, collected by the CMS experiment at the CERN LHC with high-rate muon triggers during 2017 and 2018 and corresponding to an integrated luminosity of 101  fb^{-1}. A signal having a statistical significance well in excess of 5 standard deviations is observed. Using the η→μ^{+}μ^{-} decay as normalization, the branching fraction B(η→μ^{+}μ^{-}μ^{+}μ^{-})=[5.0±0.8(stat)±0.7(syst)±0.7(B_{2μ})]×10^{-9} is measured, where the last term is the uncertainty in the normalization channel branching fraction. This work achieves an improved precision of over 5 orders of magnitude compared to previous results, leading to the first measurement of this branching fraction, which is found to agree with theoretical predictions.

Analysis of the effectiveness and the cost of hospitalization of patients with atrial fibrillation

Introduction

Hospitalizations of patients with atrial fibrillation (AF) lead to an explosion of expenditure on the public health system or private health expenses in family budgets. This study aims to estimate the duration and the cost of hospitalization for the public health system or the private cost to patients hospitalized after an AF episode.

Material and Methods

Two hundred thirty-five consecutive patients (141 men and 94 women with an average age of 71.91 ± 12.2 years) who presented with AF to the Emergency Department of the General Hospital of Veroia during a single year were studied. We assessed the possible causes of arrhythmia, the duration and outcome of hospitalization, and the cost of hospitalization. We estimated the total cost by adding the price of the drugs used to cardiovert and the money spent on the patient's hospitalization.

Results

The average hospitalization time was 2.37 ± 1.17 days, and the average cost of hospitalization (total cost) was € 488.22 ± 170.34. There was a significant correlation between the severity of the episode and the total cost (r =0.78, p<0.0001), with 87.6 % of the total cost (€ 427.76 ± 135.86) being related to the cost of hospitalization (imaging, laboratory, hospitalization) and the rest to the drug therapy cost. Amiodarone (97 patients, 41.1 %), flecainide (52 patients, 22 %), propafenone (68 patients, 28.8 %), vernakalant (two patients, 0.8 %), and quinidine (eight patients, 3.4 %) were utilized.

Conclusion

The average cost of hospital care in patients with AF is significantly related to the severity of the episode. Effective drug therapy to reduce AF-provoking factors, such as antihypertensive therapy, combined with cardiovascular disease prevention in general, could reduce the morbidity and costs of AF-related hospitalizations. HIPPOKRATIA 2023, 27 (1):18-21.

Endothelial glycocalyx improvement after six months and one-year of antiretroviral therapy in treatment naive patients with human immunodeficiency virus

Background

Chronic inflammation induced by Human Immunodeficiency Virus (HIV) plays a key role in the development of early cardiovascular (CV) disease. The impact of currently recommended first line antiretroviral therapy (ART) on CV risk early after treatment initiation is still under investigation. We aimed to explore any treatment-induced changes in endothelial function through endothelial glycocalyx measurement (EG) in treatment naïve HIV patients' one year post HIV treatment initiation by different ART agents.

Methods

We estimated endothelial function by endothelial glycocalyx integrity measurement in 58 recently diagnosed and treatment naïve HIV patients (mean age=38+10 years, 91% males, 61% smokers) at baseline and at 1-year post ART initiation (integrase or protease inhibitors). Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (ranged from 5–25 micrometers) using Sideview Darkfield imaging (Microscan, Glycocheck) was measured as a non-invasive accurate index of reduced EG thickness.

Results

From a total population of 54 HIV patients, 35 patients were randomly treated by the newer integrase inhibitor Dolutegravir (Group A, mean age = 37±10 years, 89% males, 54% smokers) while 22 patients by the older protease inhibitor Darunavir/Cobicistat (Group B, mean age = 38±10 years, 95% males, 74% smokers). No differences were found between groups regarding age, weight, lipid profile (LDL-C, HDL-C, triglycerides), office (SBP, DBP) and central (cBP) blood pressure. We found that weight (76±14 vs. 81±16 kg, p&lt;0.001), SBP (125±12 vs. 130±14 mmHg, p=0.003) and cBP (116±12 vs. 121±12 mmHg, p=0.001) were increased in the entire HIV population, at 1 year post-treatment. At 6 months evaluation, PBR5–25 was decreased in the entire HIV population and Group A (2.18±0.3 μm vs. 2.05±0.3 μm, p=0.01 and 2.19±0.3 μm vs. 2.02±0.3 μm, p=0.02, respectively). However, at 1-year post treatment evaluation, PBR5–25 was decreased in all groups, total HIV population, Group A and Group B (2.18±0.3 μm vs. 1.96±0.3 μm, p&lt;0.001, 2.19±0.3 μm vs. 1.93±0.3 μm, p=0.003 and 2.17±0.3 vs. 1.99±0.3, p=0.04, respectively).

Conclusions

Endothelial function, estimated by endothelial glycocalyx integrity, is improved in newly diagnosed and treatment naïve HIV patients, evaluated at 6 and 12 months post-treatment initiation by integrase or protease inhibitors despite weight and blood pressure increase.

Funding Acknowledgement

Type of funding sources: None.

Relating SARS-CoV-2 shedding rate in wastewater to daily positive tests data: A consistent model based approach

During the COVID-19 pandemic, wastewater-based epidemiology (WBE) has been engaged to complement medical surveillance and in some cases to also act as an early diagnosis indicator of viral spreading in the community. Most efforts worldwide by the scientific community and commercial companies focus on the formulation of protocols for SARS-CoV-2 analysis in wastewater and approaches addressing the quantitative relationship between WBE and medical surveillance are lacking. In the present study, a mathematical model is developed which uses as input the number of daily positive medical tests together with the highly non-linear shedding rate curve of individuals to estimate the evolution of global virus shedding rate in wastewater along calendar days. A comprehensive parametric study by the model using as input actual medical surveillance and WBE data for the city of Thessaloniki (~700,000 inhabitants, North Greece) during the outbreak of November 2020 reveals the conditions under which WBE can be used as an early warning tool for predicting pandemic outbreaks. It is shown that early warning capacity is different along the days of an outbreak and depends strongly on the number of days apart between the day of maximum shedding rate of infected individuals in their disease cycle and the day of their medical testing. The present data indicate for Thessaloniki an average early warning capacity of around 2 days. Moreover, the data imply that there exists a proportion between unreported cases (asymptomatic persons with mild symptoms that do not seek medical advice) and reported cases. The proportion increases with the number of reported cases. The early detection capacity of WBE improves substantially in the presence of an increasing number of unreported cases. For Thessaloniki at the peak of the pandemic in mid-November 2020, the number of unreported cases reached a maximum around 4 times the number of reported cases.

Osteochondral defects of the talus: radiological appearance and surgical candidate profiling - A retrospective analysis

BACKGROUND

Osteochondral defects of the talus (OCD) are a well-established pathology within the ankle. They are most commonly associated with ankle trauma and whilst many are asymptomatic, they can have a significant negative impact on the patient, most notably with regards pain and mobility. Treatment of these lesions remains variable across the diverse cohort of these patients.

AIMS

Evaluating the incidence of talus OCDs. Evaluating anatomic and morphologic data of the lesions against previous studies. Establishing if there was there any associated ligamentous injury. Determining the cohort of patients who were considered/underwent surgical intervention.

METHODS

A retrospective review was performed on patients presenting to a single Scottish Hospital with Talar OCDs between 2012-2016. Data collected included radiological appearance of the lesions (location and size), clinical history, associated ligament injury, treatment given and subsequent outcome. Categorical variables were presented as count and percentage while non-parametric variables were presented as median and interquartile range.

RESULTS

90 new cases that matched our inclusion criteria were identified. Using the Raikin classification, the majority of injuries are in the posteromedial (26%), centrolateral (21%), and centromedial (18%) segments of the talus. Of note, no lesions were identified in the posterocentral segment. 46% of patients had an associated ligamentous injury, either in the form of a sprain or tear. Most commonly the injury involved both ATFL and CFL (82%). 70% of patients that underwent surgery had radiological evidence of ligamentous injury. No statistically significant difference was identified between the management option and the involved segment according to Orr/Raikin classifications.

CONCLUSION

Talus osteochondral defects are a pathology which is more common than originally thought and their treatment remain a controversial topic. Little is known about the physical history of the condition as most cases are asymptomatic, thus poorly documented by definition. There is a clear opportunity and need for further research into developing evidence-based guidelines for their management. This study tried to correlate the management of OCDs with epidemiological and radiological data.

A physicochemical model for rationalizing SARS-CoV-2 concentration in sewage. Case study: The city of Thessaloniki in Greece

Detection of SARS-CoV-2 in sewage has been employed by several researchers as an alternative early warning indicator of virus spreading in communities, covering both symptomatic and asymptomatic cases. A factor that can seriously mislead the quantitative measurement of viral copies in sewage is the adsorption of virus fragments onto the highly porous solids suspended in wastewater, making them inaccessible. This depends not only on the available amount of suspended solids, but also on the amount of other dissolved chemicals which may influence the capacity of adsorption. On this account, the present work develops a mathematical framework, at various degrees of spatial complexity, of a physicochemical model that rationalizes the quantitative measurements of total virus fragments in sewage as regards the adsorption of virus onto suspended solids and the effect of dissolved chemicals on it. The city of Thessaloniki in Greece is employed as a convenient case study to determine the values of model variables. The present data indicate the ratio of the specific absorption (UV₂₅₄/DOC) over the dissolved oxygen (DO) as the parameter with the highest correlation with viral copies. This implies a strong effect on viral inaccessibility in sewage caused (i) by the presence of humic-like substances and (ii) by virus decay due to oxidation and metabolic activity of bacteria. The present results suggest days where many fold corrections in the measurement of viral copies should be applied. As a result, although the detected RNA load in June 2020 is similar to that in April 2020, virus shedding in the city is about 5 times lower in June than in April, in line with the very low SARS-CoV-2 incidence and hospital admissions for COVID-19 in Thessaloniki in June.

Where are we with pre-exposure prophylaxis use in Central and Eastern Europe? Data from the Euroguidelines in Central and Eastern Europe (ECEE) Network Group

OBJECTIVES

Pre-exposure prophylaxis (PrEP) for HIV infection is an important intervention for control of the HIV epidemic. The incidence of HIV infection is increasing in the countries of Central and Eastern Europe (CEE). Therefore, we investigated the change in PrEP use in CEE over time.

METHODS

The Euroguidelines in Central and Eastern Europe (ECEE) Network Group was initiated in February 2016 to compare standards of care for HIV and viral hepatitis infections in CEE. Data on access to PrEP were collected from 23 countries through online surveys in May-June 2017 (76 respondents) and in November 2018-May 2019 (28 respondents).

RESULTS

About 34.2% of respondents stated that tenofovir/emtricitabine (TDF/FTC) was licensed for use in their country in 2017, and 66.7% that it was licensed for use in 2018 (P = 0.02). PrEP was recommended in national guidelines in 39.5% of responses in 2017 and 40.7% in 2018 (P = 0.378). About 70.7% of respondents were aware of "informal" PrEP use in 2017, while 66.6% were aware of this in 2018 (P = 0.698). In 2018, there were 53 centres offering PreP (the highest numbers in Poland and Romania), whereas six countries had no centres offering PreP. The estimated number of HIV-negative people on PreP in the region was 4500 in 2018. Generic TDF/FTC costs (in Euros) ranged from €10 (Romania) to €256.92 (Slovakia), while brand TDF/FTC costs ranged from €60 (Albania) to €853 (Finland).

CONCLUSIONS

Although the process of licensing TDF/FTC use for PrEP has improved, this is not yet reflected in the guidelines, nor has there been a reduction in the "informal" use of PrEP. PrEP remains a rarely used preventive method in CEE countries.

Comparison of Triflusal with Aspirin in the Secondary Prevention of Atherothrombotic Events; Α Randomised Clinical Trial

BACKGROUND

Triflusal has demonstrated an efficacy similar to aspirin in the prevention of vascular events in patients with acute myocardial infarction (ΜΙ) and ischaemic stroke but with less bleeding events.

OBJECTIVE

We performed a randomised, multicentre, phase 4 clinical trial to compare the clinical efficacy and safety of triflusal versus aspirin, administered for 12 months in patients eligible to receive a cyclooxygenase-1 (COX-1) inhibitor.

METHODS

Patients with stable coronary artery disease or with a history of non-cardioembolic ischaemic stroke were randomly assigned to receive either triflusal 300 mg twice or 600 mg once daily or aspirin 100 mg once daily for 12 months. The primary efficacy endpoint was the composite of: (a) ΜΙ, (b) stroke (ischaemic or haemorrhagic), or, (c) death from vascular causes for the entire follow-up period. The primary safety endpoints were the rate of bleeding events as defined by Bleeding Academic Research Consortium (BARC) criteria.

RESULTS

At 12-month follow-up, an equivalent result was revealed between the triflusal (n=559) and aspirin (n=560) in primary efficacy endpoint. Specifically, the combined efficacy outcome rate (i.e. MI, stroke or death from vascular causes) difference was equal to -1.3% (95% confidence interval -1.1 to 3.5) and lied within the a-priori defined equivalence interval (p<0.001). Regarding the primary safety endpoints, patients on triflusal treatment were 50% less likely to develop bleeding events according to the BARC criteria, and especially any clinically overt sign of haemorrhage that requires diagnostic studies, hospitalisation or special treatment (BARC type 2).

CONCLUSION

The efficacy of triflusal in the secondary prevention of vascular events is similar to aspirin when administered for 12 months. Importantly, triflusal significantly reduced the incidence of ΜΙ and showed a better safety profile compared with aspirin. (ASpirin versus Triflusal for Event Reduction In Atherothrombosis Secondary prevention, ASTERIAS trial; Clinical Trials.gov Identifier: NCT02616497).

Stress in people at high risk for psychosis

Background

Stress is a key feature of many aetiological models of psychosis and there is considerable empirical evidence implicating stress in the development of psychosis. This paper investigates the role of psychosocial stress in the onset of psychosis by examining the relationship between current and lifetime exposure to traumatic experiences and psychosocial stressors, HPA axis function, and psychopathology in people at high risk of developing psychosis.

Methods

Sixty ‘high risk’ (HR) participants were compared with 50 healthy control (HC) participants on measures of exposure to psychosocial stressors. Subgroups of HR and HC participants which provided saliva samples were compared regarding measures of HPA axis function.

Results

HR participants were exposed to greater levels of psychosocial stress than HC participants. Specifically, HR participants were more likely to have been separated from their parents (p = .003), report severe parental antipathy (p = .011), and have been bullied while growing up (p = .024). HR participants experienced greater levels of perceived stress than HC participants (p = .001) and were more likely to have had a negative life event in the previous 6 months (p < .001). Positive correlations were found between current stress and number of life events and attenuated psychotic symptoms (r = .585, p < .001, and r = .384, p = < .001, respectively) in the HR participants.

Discussion

This study shows that people at high risk of developing psychosis experience greater levels of psychosocial stress than matched healthy control participants throughout the lifetime, from early childhood to the present day, and that current stress is strongly associated with psychotic symptomatology.

The identification, assessment and management of difficult-to-treat depression: An international consensus statement

BACKGROUND

Many depressed patients are not able to achieve or sustain symptom remission despite serial treatment trials - often termed "treatment resistant depression". A broader, perhaps more empathic concept of "difficult-to-treat depression" (DTD) was considered.

METHODS

A consensus group discussed the definition, clinical recognition, assessment and management implications of the DTD heuristic.

RESULTS

The group proposed that DTD be defined as "depression that continues to cause significant burden despite usual treatment efforts". All depression management should include a thorough initial assessment. When DTD is recognized, a regular reassessment that employs a multi-dimensional framework to identify addressable barriers to successful treatment (including patient-, illness- and treatment-related factors) is advised, along with specific recommendations for addressing these factors. The emphasis of treatment, in the first instance, shifts from a goal of remission to optimal symptom control, daily psychosocial functional and quality of life, based on a patient-centred approach with shared decision-making to enhance the timely consideration of all treatment options (including pharmacotherapy, psychotherapy, neurostimulation, etc.) to optimize outcomes when sustained remission is elusive.

LIMITATIONS

The recommended definition and management of DTD is based largely on expert consensus. While DTD would seem to have clinical utility, its specificity and objectivity may be insufficient to define clinical populations for regulatory trial purposes, though DTD could define populations for service provision or phase 4 trials.

CONCLUSIONS

DTD provides a clinically useful conceptualization that implies a search for and remediation of specific patient-, illness- and treatment obstacles to optimizing outcomes of relevance to patients.

Hair cortisol and childhood trauma predict psychological therapy response in depression and anxiety disorders

OBJECTIVE

Around 30-50% of patients with depression and anxiety disorders fail to respond to standard psychological therapy. Given that cortisol affects cognition, patients with altered hypothalamic-pituitary-adrenal (HPA) axis functioning may benefit less from such treatments. To investigate this, reliable pretreatment cortisol measures are needed.

METHOD

N = 89 outpatients with depression and anxiety disorders were recruited before undergoing therapy within an Improving Access to Psychological Therapies (IAPT) service. Three-month hair cortisol was determined, and the Childhood Trauma Questionnaire was administered. Patients were classified as responders if they showed significant decreases in depression (>= 6 points on the Patient Health Questionnaire) or anxiety (>= 5 points on the Generalised Anxiety Disorder Scale).

RESULTS

Non-responders in terms of depression (57%) had lower pretreatment hair cortisol concentrations (P = 0.041) and reported more physical abuse (P = 0.024), sexual abuse (P = 0.010) and total trauma (P = 0.039) when compared to responders. Non-responders in terms of anxiety (48%) had lower pretreatment hair cortisol (P = 0.027), as well as higher levels of emotional abuse (P = 0.034), physical abuse (P = 0.042) and total trauma (P = 0.048).

CONCLUSION

If future research confirms hair cortisol to be a predictor of psychological therapy response, this may prove a useful clinical biomarker which identifies a subgroup requiring more intensive treatment.

Short-term and long-term measures of cortisol in saliva and hair in atypical and non-atypical depression

BACKGROUND

Atypical depression may show lowered rather than raised short-term cortisol levels. Atypical major depressive episodes (A-MDE) may also be more closely linked to environmental factors and show overlap with somatic symptom disorders. Hair specimens allow measuring long-term cortisol levels.

METHODS

Twenty-seven A-MDE and 44 NA-MDE patients and 40 matched controls were tested. Measures of hair cortisol concentration [HCC] covering the previous 3 months and short-term cortisol parameters (six saliva specimens to assess the cortisol awakening response [CAR] and total daily cortisol output calculated as the area under the curve [AUCg]) were taken alongside measures of environmental factors and clinical variables.

RESULTS

There were no differences in HCC between the three groups (P = 0.8), and no difference in the CAR (P = 0.95). However, A-MDE showed lowered short-term cortisol output (AUCg) compared to controls (P = 0.04). A-MDE patients also reported a higher number of daily hassles, and higher levels of fatigue and impaired concentration than NA-MDE.

CONCLUSIONS

Normal long-term (HCC) and reduced short-term (AUCg) cortisol levels in A-MDE could suggest a disrupted long-term cortisol rhythm, perhaps affected by environmental factors or by certain symptoms, such as mid-nocturnal insomnia. However, other underlying explanations for these findings should also be investigated in the future.

Prevalence of drug resistance among HIV-1 treatment-naive patients in Greece during 2003-2015: Transmitted drug resistance is due to onward transmissions

BACKGROUND

The prevalence of HIV-1 drug resistance among treatment-naïve patients ranges between 8.3% and 15% in Europe and North America. Previous studies showed that subtypes A and B were the most prevalent in the Greek HIV-1 epidemic. Our aim was to estimate the prevalence of resistance among drug naïve patients in Greece and to investigate the levels of transmission networking among those carrying resistant strains.

METHODS

HIV-1 sequences were determined from 3428 drug naïve HIV-1 patients, in Greece sampled during 01/01/2003-30/6/2015. Transmission clusters were estimated by means of phylogenetic analysis including as references sequences from patients failing antiretroviral treatment in Greece and sequences sampled globally.

RESULTS

The proportion of sequences with SDRMs was 5.98% (n=205). The most prevalent SDRMs were found for NNRTIs (3.76%), followed by N(t)RTIs (2.28%) and PIs (1.02%). The resistance prevalence was 22.2% based on all mutations associated with resistance estimated using the HIVdb resistance interpretation algorithm. Resistance to NNRTIs was the most common (16.9%) followed by PIs (4.9%) and N(t)RTIs (2.8%). The most frequently observed NNRTI resistant mutations were E138A (7.7%), E138Q (4.0%), K103N (2.3%) and V179D (1.3%). The majority of subtype A sequences (89.7%; 245 out of 273) with the dominant NNRTI resistance mutations (E138A, K103N, E138Q, V179D) were found to belong to monophyletic clusters suggesting regional dispersal. For subtype B, 68.1% (139 out of 204) of resistant strains (E138A, K103N, E138Q V179D) belonged to clusters. For N(t)RTI-resistance, evidence for regional dispersal was found for 27.3% and 21.6% of subtype A and B sequences, respectively.

CONCLUSIONS

The TDR rate based on the prevalence of SDRM is lower than the average rate in Europe. However, the prevalence of NNRTI resistance estimated using the HIVdb approach, is high in Greece and it is mostly due to onward transmissions among drug-naïve patients.

Implementation of the Needs Assessment Tool for patients with interstitial lung disease (NAT:ILD): facilitators and barriers

A Needs Assessment Tool (NAT) was developed previously to help clinicians identify the supportive/palliative needs of people with interstitial lung disease (ILD) (NAT:ILD). This letter presents barriers and facilitators to clinical implementation. Data from (1) a focus group of respiratory clinicians and (2) an expert consensus group (respiratory and palliative clinicians, academics, patients, carers) were analysed using Framework Analysis. Barriers related to resources and service reconfiguration, and facilitators to clinical need, structure, objectiveness, flexibility and benefits of an ‘aide-memoire’. Identified training needs included communication skills and local service knowledge. The NAT:ILD was seen as useful, necessary and practical in everyday practice.

emoval of malachite green dye from aqueous solutions by diasporic Greek raw bauxite

Raw bauxite from Klisoura mine (Prefecture of Fokida, Greece) containing 72 wt.% diaspore, 16 wt.% hematite, 6 wt.% quartz, 4 wt.% anatase and 2 wt.% calcite, has been used for the removal of malachite green dye from aqueous solutions. The batch type experiments were conducted with 10 ml of solution, at pH = pHZPC = 6.7 and contact time 1 h. The initial concentration of malachite green dye was 10 mg/l, the bauxite quantity was 0.02 g, 0.04 g, 0.06 g, 0.1 g and 0.2 g. The highest adsorption capacity achieved was 4.5 mg/g (90% removal) using 0.02 g bauxite. The removal capacity of raw bauxite is comparable to other non-conventional adsorbents, such as neem sawdust, sugar cane dust and cane root carbon.

Peanut-allergic patients in the MIRABEL survey: characteristics, allergists' dietary advice and lessons from real life

BACKGROUND

The MIRABEL survey is an observational study on peanut allergy in France, Belgium and Luxemburg. The objectives are to provide data on a large population, to analyse the consumer behaviour, to study the presence of peanut traces in pre-packed foods with/without precautionary allergen labelling (PAL), and to combine these data to quantify allergic risk and produce a cost/benefit analysis. This paper reports a real-life observatory of 785 patients (< 16y: 86%): medical characteristics, eliciting doses (ED) in real life and in oral food challenges (OFC), factors associated with severe reactions, allergist dietary advice and patients' anxiety regarding their allergy.

METHODS

Age and symptoms at diagnosis, route of exposure, comorbidities, allergy tests, ED (OFC/real life; mg peanut protein), dietary advice about PAL, and anxiety score were recorded.

RESULTS

Median age was 3 years; 85% were declared allergic. Severe/potentially severe reactions were reported in 30% of the allergic patients: serious systemic reaction (15%), laryngeal angioedema (8%), shock (4%) and acute asthma (3%); 66% had atopic dermatitis, 58% asthma. Median ara h 2 sIgE level was 11.5 kUA/L. Of the 278 OFCs, 225 were positive (median ED: 67.3 mg). Real-life ED was < 100 mg in 44.3%. Severe reactions were significantly more frequent in teenagers and adults (P = 0.004), asthmatic patients (P = 0.033), and patients who reacted to inhalation (P < 0.001). No significant association was found for OFC ED or ara h 2 sIgE. Factors associated with strict avoidance advice including PAL were OFC ED < 100 mg (P < 0.001), but not severe reaction history (P = 0.051) or asthma (P = 0.34). Anxiety was significantly associated with strict avoidance (P < 0.001).

CONCLUSION AND CLINICAL RELEVANCE

Severe/potentially severe reactions, allergic comorbidities, and low EDs in real life are frequent in peanut-allergic patients. Asthma, teenage/adulthood and reaction to inhalation are associated with severe symptoms. PAL and criteria guiding dietary advice need to be improved.

Assessment of gamma radiation exposure of beach sands in highly touristic areas associated with plutonic rocks of the Atticocycladic zone (Greece)

This study aims to evaluate the activity concentrations of ²³⁸U, ²²⁶Ra, ²³²Th, ²²⁸Th and ⁴⁰K along beaches close to the plutonic rocks of the Atticocycladic zone that ranged from 15 to 628, 12-2292, 16-10,143, 14-9953 and 191-1192 Bq/kg respectively. A sample from island of Mykonos contained the highest ²³²Th content measured in sediments of Greece. The heavy magnetic fraction and the heavy non-magnetic fraction as well as the total heavy fraction, were correlated with the concentrations of the measured radionuclides in the bulk samples. The heavy fractions seem to control the activity concentrations of ²³⁸U and ²³²Th of all the samples, showing some local differences in the main ²³⁸U and ²³²Th mineral carrier. Similar correlations have been found between ²³⁸U, ²³²Th content and rare earth elements concentrations. The measured radionuclides in the beach sands were normalized to the respective values measured in the granitic rocks, which at least in most cases are their most probable parental rocks, so as to provide data upon their enrichment or depletion. Since the Greek beaches are among the most popular worldwide the annual effective dose equivalent received due to sand exposure has been estimated and found to vary between 0.002 and 0.379 mSv y^-1 for tourists and from 0.018 to 3.164 mSv y^-1 for local people working on the beach. The values corresponding to ordinary sand samples are orders of magnitude lower than the limit of 1 mSv y^-1, only in the case of heavy minerals-rich sands the dose could reach or exceed the recommended maximum limit.

The Role of the New Imaging Modalities in the Investigation of Menière's Disease

Thirty one patients with Menière's disease investigated with HRCT and MRI of the inner ear are presented. The parameters evaluated were:

a) Pneumatization of the petrous bone, b) Width of the vestibular aqueduct (VA) in its postisthmic segment, c) Visualization of the endolymphatic duct (ELD).

A similar survey was performed in other 50 patients with no previous history of ear disease which served as controls. There was evidence of statistically significant differences in the pneumatization of the petrous bones (p<0.05), as well as the width of the vestibular aqueducts (p<0.001) between the two groups of patients. Also the percentage of the visualized endolymphatic ducts was higher in the control group as compared to the patients with Menière's disease (p<0.05).

Prevalence of late potentials on signal-averaged ECG in patients with psychiatric disorders

BACKGROUND

Sudden cardiac death (SCD) occurs three times more often in psychiatric patients than in the general population. QRS fragmentation (QRSfr) and signal-averaged electrocardiography (SAECG) are simple, inexpensive, readily available tools for detecting the presence of abnormal depolarization and late potentials (LPs) in these patients, a result of either the underlying disease or treatment.

METHODS

Frequency of LP detection by SAECG and QRSfr was studied in 52 psychiatric patients and compared with 30 healthy (without known structural heart disease or occurrence of ventricular arrhythmia) controls. Patients were then prospectively followed up and incidence of SCD was recorded.

RESULTS

LP prevalence was significantly higher in patients than in controls (16/52-31% vs 2/30-7%, p=0.012), while QRSfr was similar between these two groups (p=0.09). Of the LP presence criteria, the root mean square value at terminal 40msec of the QRS (RMS40) was significantly lower in patients (32μV, SD=19μV, vs 46μV, SD=32μV, p=0.015). Among patients, no differences were noted between the LP positive and negative groups regarding age, sex, number of medications, class of antipsychotics and defined daily doses. Mean follow-up was 46months (SD=11) and during it 3 patients suffered SCD. Although 2 SCD victims had both LPs and QRSfr concurrently present, neither of them, nor their simultaneous presence could definitely account for the events.

CONCLUSIONS

LP prevalence in psychiatric patients was significantly higher than in controls. SAECG performance was feasible in all cases and constitutes a readily available tool for assessing myocardial electrophysiological alterations in this patient group.

Development of a tiered framework for public health capacity in Canada

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Select SARS reports were qualitatively analyzed for usage of “capacity”/“capacities”.

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Public health capacity can be sub-divided into 17 individual capacity components.

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These components can be organized into five tiers to build a capacity framework.

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This framework can be used to guide capacity assessment and building efforts.

Transmission of HIV Drug Resistance and the Predicted Effect on Current First-line Regimens in Europe

Transmitted human immunodeficiency virus drug resistance in Europe is stable at around 8%. The impact of baseline mutation patterns on susceptibility to antiretroviral drugs should be addressed using clinical guidelines. The impact on baseline susceptibility is largest for nonnucleoside reverse transcriptase inhibitors.

Background. Numerous studies have shown that baseline drug resistance patterns may influence the outcome of antiretroviral therapy. Therefore, guidelines recommend drug resistance testing to guide the choice of initial regimen. In addition to optimizing individual patient management, these baseline resistance data enable transmitted drug resistance (TDR) to be surveyed for public health purposes. The SPREAD program systematically collects data to gain insight into TDR occurring in Europe since 2001.

Methods. Demographic, clinical, and virological data from 4140 antiretroviral-naive human immunodeficiency virus (HIV)–infected individuals from 26 countries who were newly diagnosed between 2008 and 2010 were analyzed. Evidence of TDR was defined using the WHO list for surveillance of drug resistance mutations. Prevalence of TDR was assessed over time by comparing the results to SPREAD data from 2002 to 2007. Baseline susceptibility to antiretroviral drugs was predicted using the Stanford HIVdb program version 7.0.

Results. The overall prevalence of TDR did not change significantly over time and was 8.3% (95% confidence interval, 7.2%–9.5%) in 2008–2010. The most frequent indicators of TDR were nucleoside reverse transcriptase inhibitor (NRTI) mutations (4.5%), followed by nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations (2.9%) and protease inhibitor mutations (2.0%). Baseline mutations were most predictive of reduced susceptibility to initial NNRTI-based regimens: 4.5% and 6.5% of patient isolates were predicted to have resistance to regimens containing efavirenz or rilpivirine, respectively, independent of current NRTI backbones.

Conclusions. Although TDR was highest for NRTIs, the impact of baseline drug resistance patterns on susceptibility was largest for NNRTIs. The prevalence of TDR assessed by epidemiological surveys does not clearly indicate to what degree susceptibility to different drug classes is affected.

Reported consent processes and demographics: a substudy of the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial

OBJECTIVES

Efforts are needed to improve informed consent of participants in research. The Strategic Timing of AntiRetroviral Therapy (START) study provides a unique opportunity to study the effect of length and complexity of informed consent documents on understanding and satisfaction among geographically diverse participants.

METHODS

Interested START sites were randomized to use either the standard consent form or the concise consent form for all of the site's participants.

RESULTS

A total of 4473 HIV-positive participants at 154 sites world-wide took part in the Informed Consent Substudy, with consent given in 11 primary languages. Most sites sent written information to potential participants in advance of clinic visits, usually including the consent form. At about half the sites, staff reported spending less than an hour per participant in the consent process. The vast majority of sites assessed participant understanding using informal nonspecific questions or clinical judgment.

CONCLUSIONS

These data reflect the interest of START research staff in evaluating the consent process and improving informed consent. The START Informed Consent Substudy is by far the largest study of informed consent intervention ever conducted. Its results have the potential to impact how consent forms are written around the world.

Inflammation and clinical response to treatment in depression: A meta-analysis

The depressive state has been characterised as one of elevated inflammation, which holds promise for better understanding treatment-resistance in affective disorders as well as for future developments in treatment stratification. Aiming to investigate alterations in the inflammatory profiles of individuals with depression as putative biomarkers for clinical response, we conducted meta-analyses examining data from 35 studies that investigated inflammation before and after treatment in depressed patients together with a measure of clinical response. There were sufficient data to analyse IL-6, TNFα and CRP. Levels of IL-6 decreased with antidepressant treatment regardless of outcome, whereas persistently elevated TNFα was associated with prospectively determined treatment resistance. Treatment non-responders tended to have higher baseline inflammation, using a composite measure of inflammatory markers. Our findings suggest that elevated levels of inflammation are contributory to treatment resistance. Combining inflammatory biomarkers might prove a useful tool to improve diagnosis and detection of treatment refractoriness, and targeting persistent inflammation in treatment-resistant depression may offer a potential target for the development of novel intervention strategies.

High prevalence of the UGT1A1*28 variant in HIV-infected individuals in Greece

Hyperbilirubinaemia with or without jaundice is one of the side effects of atazanavir boosted with low-dose ritonavir (ATV/rit) related to the drug plasma levels, as a result of its metabolism by UGT1A1 – uridine diphosphate-glucuronosyl transferase. Genotyping for UGT1A1*28 before initiation of antiretroviral therapy containing atazanavir may aid in identifying individuals at risk of hyperbilirubinaemia. Our objective was to estimate the prevalence of the UGTA1A1*28 polymorphism in HIV-infected individuals in Greece and to determine its potential association with hyperbilirubinaemia in patients receiving ATV/rit. The prevalence of the UGTA1A1*28 variant was estimated in 79 HIV-infected patients prior to the administration of the first-line treatment. The UGTA1A1*28 variant was detected in 46 out of 79 individuals (58.2%). Antiretroviral therapy was administered to 64/79 patients (81%). Among them, 26/64 (40.6%) received ATV/rit. Of the ATV/rit-treated patients, 14 were found to be carriers of the UGT1A1*28 variant (54%), and maximum serum bilirubin levels were significantly higher in the carrier population (4.71 vs. 2.69 mg/dL, p = 0.026). In 50% of the population, maximum levels were recorded in the first month of follow-up. Although carriage of UGT1A1 is linked with the development of hyperbilirubinaemia, the implementation of a pharmacogenomic approach in clinical practice cannot yet be recommended as a standard of care.

Heavy smoking and lung cancer: are women at higher risk? Result of the ICARE study

Background:

Whether women are more or equally susceptible to the carcinogenic effects of cigarette smoke on the lungs compared with men is a matter of controversy. Using a large French population-based case–control study, we compared the lung cancer risk associated with cigarette smoking by gender.

Methods:

The study included 2276 male and 650 female cases and 2780 male and 775 female controls. Lifetime smoking exposure was represented by the comprehensive smoking index (CSI), which combines the duration, intensity and time since cessation of smoking habits. The analysis was conducted among the ever smokers. All of the models were adjusted for age, department (a regional administrative unit), education and occupational exposures.

Results:

Overall, we found that the lung cancer risk was similar among men and women. However, we found that women had a two-fold greater risk associated with a one-unit increase in CSI than men of developing either small cell carcinoma (OR=15.9, 95% confidence interval (95% CI) 7.6, 33.3 and 6.6, 95% CI 5.1, 8.5, respectively; P<0.05) or squamous cell carcinoma (OR=13.1, 95% CI 6.3, 27.3 and 6.1, 95% CI 5.0, 7.3, respectively; P<0.05). The association was similar between men and women for adenocarcinoma.

Conclusion:

Our findings suggest that heavy smoking might confer to women a higher risk of lung cancer as compared with men.

Natural radioactivity and radiation index of the major plutonic bodies in Greece

The natural radioactivity of the major plutonic bodies in Greece, as well as the assessment of any potential health hazard due to their usage as decorative building materials is studied. One hundred and twenty one samples from every major plutonic body in Greece, including various rock-types from gabbro to granite, have been measured for their natural radioactivity using γ-spectrometry methodology. According to the experimental results, the natural radioactivity levels were ranged up to 315 Bq kg(-1) for (226)Ra, up to 376 Bq kg(-1) for (232)Th and up to 1632 Bq kg(-1) for (40)K, with arithmetic mean values and standard deviations of 74 (±51), 85 (±54) and 881 (±331) Bq kg(-1) respectively, which are below the international representative mean values for granite stones. The excess on the effective dose received annually indoors due to granite tiles usage is estimated considering a standard room model where granite tiles with 1.5 cm in thickness cover only the floor of the room. The increment on the external γ-radiation effective dose rate shows a Gaussian distribution well dispersed below 0.3 mSv y(-1), presenting a mean value of 0.14 (±0.06) mSv y(-1). In case of the internal α-radiation a log-normal distribution is appeared scattering below 0.5 mSv y(-1) with a mean value 0.19 (±0.13) mSv y(-1), for a well-ventilated living environment. In case of a poor-ventilated room the increment on internal effective dose rate is estimated with a mean value 0.27 (±0.19) mSv y(-1) scattering below 0.8 mSv y(-1). The majority of the samples increase the external as well as the internal dose less than 30% of the maximum permitted limit of the effective dose rate. Therefore, at least from radiological point of view, the plutonic rocks of Greece could be safely used as decorative building materials.

The incidence of AIDS-defining illnesses at a current CD4 count ≥ 200 cells/μL in the post-combination antiretroviral therapy era

BACKGROUND

Few studies consider the incidence of individual AIDS-defining illnesses (ADIs) at higher CD4 counts, relevant on a population level for monitoring and resource allocation.

METHODS

Individuals from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) aged ≥14 years with ≥1 CD4 count of ≥200 µL between 1998 and 2010 were included. Incidence rates (per 1000 person-years of follow-up [PYFU]) were calculated for each ADI within different CD4 strata; Poisson regression, using generalized estimating equations and robust standard errors, was used to model rates of ADIs with current CD4 ≥500/µL.

RESULTS

A total of 12 135 ADIs occurred at a CD4 count of ≥200 cells/µL among 207 539 persons with 1 154 803 PYFU. Incidence rates declined from 20.5 per 1000 PYFU (95% confidence interval [CI], 20.0-21.1 per 1000 PYFU) with current CD4 200-349 cells/µL to 4.1 per 1000 PYFU (95% CI, 3.6-4.6 per 1000 PYFU) with current CD4 ≥ 1000 cells/µL. Persons with a current CD4 of 500-749 cells/µL had a significantly higher rate of ADIs (adjusted incidence rate ratio [aIRR], 1.20; 95% CI, 1.10-1.32), whereas those with a current CD4 of ≥1000 cells/µL had a similar rate (aIRR, 0.92; 95% CI, .79-1.07), compared to a current CD4 of 750-999 cells/µL. Results were consistent in persons with high or low viral load. Findings were stronger for malignant ADIs (aIRR, 1.52; 95% CI, 1.25-1.86) than for nonmalignant ADIs (aIRR, 1.12; 95% CI, 1.01-1.25), comparing persons with a current CD4 of 500-749 cells/µL to 750-999 cells/µL.

DISCUSSION

The incidence of ADIs was higher in individuals with a current CD4 count of 500-749 cells/µL compared to those with a CD4 count of 750-999 cells/µL, but did not decrease further at higher CD4 counts. Results were similar in patients virologically suppressed on combination antiretroviral therapy, suggesting that immune reconstitution is not complete until the CD4 increases to >750 cells/µL.