Fibroblast Growth Factor 23 in COVID-19: An Observational Study

INTRODUCTION

Fibroblast growth factor 23 (FGF23) belongs structurally to the endocrine FGF protein family, which also includes FGF19 and FGF21. In the past decade, FGF23 has emerged as a possible diagnostic, prognostic biomarker, and therapeutic target in several conditions. Data about COVID-19 and FGF23 is still limited, yet they suggest interesting interactions.

OBJECTIVE

In the present study, the levels of FGF23 were investigated in COVID-19 patients. These levels were also correlated with other inflammatory markers.

MATERIALS AND METHODS

In our prospective observational study, blood samples were collected from 81 patients admitted with COVID-19 (31 males and 50 females). We analyzed the relation of serum FGF23 levels with biochemistry, total blood count, coagulation parameters, and demographic data.

RESULTS

The distribution of FGF23 serum levels according to sex and age (n28-40=8, n41-60=28, n65-75= 25, n75+=20) was similar. No significant correlation between FGF23 and any other biochemistry, total blood count, and coagulation parameter was revealed in the whole sample. Nevertheless, there was a variation in the results among different age groups.

CONCLUSION

FGF23 levels seem to vary in symptomatic COVID-19 infection, but well-organized studies with larger numbers of patients in each group are needed to determine any reliable correlation between FGF23 and other laboratory parameters.

Complexity of Recent Earthquake Swarms in Greece in Terms of Non-Extensive Statistical Physics

Greece exhibits the highest seismic activity in Europe, manifested in intense seismicity with large magnitude events and frequent earthquake swarms. In the present work, we analyzed the spatiotemporal properties of recent earthquake swarms that occurred in the broader area of Greece using the Non-Extensive Statistical Physics (NESP) framework, which appears suitable for studying complex systems. The behavior of complex systems, where multifractality and strong correlations among the elements of the system exist, as in tectonic and volcanic environments, can adequately be described by Tsallis entropy (S_q), introducing the Q-exponential function and the entropic parameter q that expresses the degree of non-additivity of the system. Herein, we focus the analysis on the 2007 Trichonis Lake, the 2016 Western Crete, the 2021-2022 Nisyros, the 2021-2022 Thiva and the 2022 Pagasetic Gulf earthquake swarms. Using the seismicity catalogs for each swarm, we investigate the inter-event time (T) and distance (D) distributions with the Q-exponential function, providing the q_T and q_D entropic parameters. The results show that q_T varies from 1.44 to 1.58, whereas q_D ranges from 0.46 to 0.75 for the inter-event time and distance distributions, respectively. Furthermore, we describe the frequency-magnitude distributions with the Gutenberg-Richter scaling relation and the fragment-asperity model of earthquake interactions derived within the NESP framework. The results of the analysis indicate that the statistical properties of earthquake swarms can be successfully reproduced by means of NESP and confirm the complexity and non-additivity of the spatiotemporal evolution of seismicity. Finally, the superstatistics approach, which is closely connected to NESP and is based on a superposition of ordinary local equilibrium statistical mechanics, is further used to discuss the temporal patterns of the earthquake evolution during the swarms.

Strong Ground Motion Sensor Network for Civil Protection Rapid Decision Support Systems

Strong motion sensor networks deployed in metropolitan areas are able to provide valuable information for civil protection Decision Support Systems (DSSs) aiming to mitigate seismic risk and earthquake social-economic impact. To this direction, such a network is installed and real-time operated in Chania (Crete Island, Greece), city located in the vicinity of the seismically active south front of the Hellenic Subduction Zone. A blend of both traditional and advanced analysis techniques and interpretation methods of strong ground motion data are presented, studying indicative cases of Chania shaking due to earthquakes in the last couple years. The orientation independent spectral acceleration as well as the spatial distribution of the strong ground motion parameters such as the Peak Ground Acceleration (PGA), Peak Ground Velocity (PGV), Peak Ground Displacement (PGD) and Arias Ιntensity observed at the urban area of Chania are presented with the use of a Geographic Information System (GIS) environment. The results point to the importance of the strong ground motion networks as they can provide valuable information on earthquake hazards prior to and after detrimental seismic events to feed rapid systems supporting civil protection decisions for prevention and emergency response.

WHEN LACK OF SLEEP TAKES ITS TOLL ON COMMUNICATION: AN ASSESSMENT OF PRAGMATIC ABILITIES IN TWO CHILDREN FOLLOWING SLEEP DEPRIVATION

Sleep deprivation affects numerous cognitive processes. Children populations have not been studied thoroughly, with regard to the effect of sleep deprivation on communication abilities. In this study, we investigate the pragmatic competence following acute sleep deprivation. Two eleven-year-old boys were evaluated on their pragmatic ability before and following sleep deprivation. The conversations were video-recorded, transcribed and analyzed using the CHAT conventions. The Pragmatic Evaluation Protocol Revised (PREP-R) was administered for the investigation of pragmatic ability. Both children demonstrated a significantly lower performance following acute sleep deprivation. Their specific pragmatic ability and grammatically-based pragmatic ability were impaired. The subjects were unable to use lexical, morphological and syntactic cohesion, and encountered difficulties in the interaction and the managing of pauses. Acute sleep deprivation affects pragmatic competence, mainly due to difficulties in alertness, attention, working memory, and executive dysfunction in general. Variability in the pragmatic ability of the two subjects implies that more studies, focused on the cognitive deficits after sleep deprivation can cast more light on the evaluation of pragmatic ability.

Systemic lupus erythematosus in a patient with multiple system atrophy: A case report

RATIONALE

Multiple system atrophy is a late-onset rare neurodegenerative movement disorder which results in debilitating disease. Fever frequently ensues in the context of infections which can be associated with significant morbidity and mortality, but among alternative diagnostic possibilities neoplasms and autoimmune disorders should be considered.

PATIENT CONCERNS

We describe a case of a prolonged febrile syndrome in a 55-year-old female patient with onset of multiple system atrophy two years before presentation. Patient history and symptoms were not contributive to guide the diagnostic work-up.

DIAGNOSIS

Initial evaluation provided no specific findings. Repeat testing of auto-antibodies revealed positive antinuclear and anti-ds DNA antibodies coupled with low complement which in conjunction with renal biopsy substantiated the diagnosis of systemic lupus erythematosus flare.

INTERVENTION

Pending the biopsy result, treatment with hydroxychloroquine and corticosteroids was initiated. Due to failure to achieve remission, azathioprine was added, but symptoms persisted. Following the diagnosis of lupus nephritis, azathioprine was discontinued and induction treatment with cyclophosphamide in accordance with the Euro-Lupus regimen was initiated and upon completion followed by maintenance therapy with mycophenolate mofetil.

OUTCOMES

The patient achieved remission after cyclophosphamide was added to treatment with corticosteroids and has not experienced new flares during the next two years. The neurological syndrome has remained stable during this period.

LESSONS

To our knowledge, we report the first case of concurrent systemic lupus erythematosus and multiple system atrophy. Prolonged fever presents unique challenges in patients with rare diseases.

Factors associated with delayed presentation at the emergency department in patients with acute ischemic stroke

Background and aims: Pre-hospital delay is a crucial factor that determines the eligibility for intravenous thrombolysis in patients with acute ischemic stroke. We aimed to evaluate the time to presentation at the emergency department (ED) and the factors that affect this time. Patients and methods: We prospectively studied 682 patients who were admitted with acute ischemic stroke (43.3% men, age 79.9 ± 6.6 years). Results: The median time to presentation at the ED was 2.1 h (range 0.15 to 168 h); 68.8% of the patients arrived within 4.5 h and 56.5% arrived within 3 h from the onset of symptoms. Independent predictors of presentation within 4.5 h were the use of emergency medical services (EMS) for transportation to the hospital (OR 2.61, 95% CI 1.38-4.94, p = .003), family history of cardiovascular disease (CVD)(OR 4.0 0,95%CI 1.61-12.23, p = .006) and the absence of history of smoking (OR 2.49, 95% CI 1.13-5.42, p = .021). Independent predictors of presentation within 3 h were the use of EMS for transportation to the hospital (OR 6.24, 95% CI 2.52-16.63, p = .0001), family history of CVD (OR 3.07, 95% CI 1.14-9.43, p = .03), and a moderately severe stroke at admission (OR vs. minor stroke 0.38, 95% CI 0.16-0.87, p = .02). Conclusions: A considerable proportion of patients with acute ischemic stroke arrives at the ED after the 4.5-h threshold for performing intravenous thrombolysis. Non-smokers, patients with a family history of CVD, with moderately severe stroke and those who use the EMS are more likely to arrive on time.

MOSAICS FALL APART IN DIFFERENT WAYS: EXPLORING VARIATION IN COMMUNICATION BREAKDOWN PATTERNS IN THREE APHASIC PATIENTS

In addition to linguistic impairments, the cognitive underpinnings of pragmatic abilities in aphasic individuals can be severely compromised. Impairments include incoherent discourse and other speech organization deficits. At the same time, preserved pragmatic patterns reveal communicative abilities that can go unnoticed if only standardized screening tests are used. Conversational Partners also appear to play a role in mitigating compromised linguistic ability. Although some tools assessing the communicative abilities of neurological patients have been recently employed, the question of whether pragmatic performance declines in consistent patterns remains poorly understood. We applied the Pragmatic Evaluation Protocol – Revised (PREP-R) to video-recorded interviews of Greek individuals with aphasia, presented here as separate case studies. The tool offers a detailed account of pragmatic ability across 29 distinct categories and consists of three distinct subcomponents, namely enunciative pragmatics, textual pragmatics, and interactional pragmatics. Our results showed considerable variation in the performance of each patient and across our three aphasic patients. We also found that the role of the Key Conversational Partner was critical to effective communication, in line with previous research. As the communication repertoire of each of our participants was found to be highly idiosyncratic, we propose that further research should shift away from the mere evaluation of isolated verbal abilities.

A Complexity View into the Physics of the Accelerating Seismic Release Hypothesis: Theoretical Principles

Observational indications support the hypothesis that many large earthquakes are preceded by accelerating-decelerating seismic release rates which are described by a power law time to failure relation. In the present work, a unified theoretical framework is discussed based on the ideas of non-extensive statistical physics along with fundamental principles of physics such as the energy conservation in a faulted crustal volume undergoing stress loading. We define a generalized Benioff strain function Ω ξ ( t ) = ∑ i = 1 n ( t ) E i ξ ( t ) , where E_i is the earthquake energy, 0 ≤ ξ ≤ 1 . and a time-to-failure power-law of Ω ξ ( t ) derived for a fault system that obeys a hierarchical distribution law extracted from Tsallis entropy. In the time-to-failure power-law followed by Ω ξ ( t ) the existence of a common exponent m_ξ which is a function of the non-extensive entropic parameter q is demonstrated. An analytic expression that connects m_ξ with the Tsallis entropic parameter q and the b value of Gutenberg-Richter law is derived. In addition the range of q and b values that could drive the system into an accelerating stage and to failure is discussed, along with precursory variations of m_ξ resulting from the precursory b-value anomaly. Finally our calculations based on Tsallis entropy and the energy conservation give a new view on the empirical laws derived in the literature, the associated average generalized Benioff strain rate during accelerating period with the background rate and connecting model parameters with the expected magnitude of the main shock.

Interleukin-6 and interleukin-10 gene polymorphisms and the risk of further periodontal disease progression

Susceptible genotypes to periodontal disease are associated with disease onset and progression. The aim of this study was to examine the effect of gene polymorphisms on the risk of further disease progression and the need for further treatment among adults with chronic periodontal disease. Sixty-seven patients diagnosed with chronic periodontitis were grouped according to genotype status and risk of further progression of disease and tooth loss. All individuals were clinically evaluated for probing pocket depth, clinical attachment loss and bleeding on probing at baseline and 45 days after treatment. Blood samples were collected at baseline and genotyping of the polymorphisms in IL-6 (rs1800796) and IL-10 (rs1800872) genes were performed by PCR. Following DNA separation and genotyping, 65.7% of the patients were homozygous carriers of the IL-6 -572G and 49.3% were carriers of the IL-10 -592A allele. Individuals at risk of disease progression ranged from 7.5% to 62.7% based on the criteria used. Carriers of the IL-10 -592A allele were significantly associated with BOP ≥ 30% and therefore exhibited a higher risk of further periodontal breakdown (p = 0.018) with an odds ratio of 1.18. None of the other definitions of disease progression were significantly associated with the examined IL-6 and IL-10 genotypes (p > 0.05). IL-10 polymorphism was associated with an increased risk of further disease progression and the potential need for further treatment following non-surgical periodontal treatment. Susceptible IL-6 genotypes were not associated with the risk of persisting or recurrent disease activity.

Technical Quality and Associated Iatrogenic Errors of Endodontic Treatments Performed in Extracted Anterior Single-Rooted Teeth by Preclinical Undergraduate Students

Aim: To evaluate technical quality of root canal treatments performed in extracted anterior single-rooted teeth in an undergraduate dental clinic, and to record the associated iatrogenic errors.

Material and Method: 287 root canal treatments performed by 114 preclinical undergraduate students in extracted anterior teeth at the Department of Endodontology were radiographically evaluated, based on the following parameters: access cavity dimensions and direction, root canal instrumentation, and root canal filling quality.

Results: The access cavity was found of adequate dimensions in 28.9% and straight in direction in 71.1% of the material. Erroneous position, overextension of the access cavity and non-straight access were noted in 39.7 %, 21.6% and 28.9% of the cases, respectively. The frequency of ledged root canals was 10.1%, while 84.7% of the teeth had no instrumentation related iatrogenic errors. Regarding root canal filling, incomplete density apically and technical inadequacies in the middle and cervical thirds were observed in 76.3% and 82.3% of the cases. The percentage of flawless endodontic treatments was 3.1%.

Conclusions: Most of the endodontic treatments evaluated were classified unacceptable. Inadequate root canal filling density in the middle and cervical third and ledge formation were the most common faults.

Oral health conditions of older people: Focus on the Balkan countries

Oral health plays a pivotal role in general health, especially in older people. Oral diseases may affect the development of systemic conditions, such as diabetes mellitus, cardiovascular disease, stroke and hypertension. The most important oral health conditions that have been recorded in dental literature for older population include tooth loss, dental caries, periodontal diseases, xerostomia (dry mouth) and oral cancer. Edentulism influences social life, either causing aesthetic problems or affecting functional abilities, such as speaking, chewing and eating. Dental caries in older people is similar to that in people in their thirties. Socio-economic status and living area play a key role in the development of dental caries. In addition, the accumulation of several risk factors, such as plaque or systemic diseases, acts synergistically in the onset of periodontal disease in seniors. Furthermore, older people, mainly due to their medications, exhibit a reduced amount of saliva. Xerostomia causes difficulties in chewing, speaking and swallowing, and it has a substantial impact on older people's lives. The prevalence of oral cancer is 1-10 per 100,000 patients, and several factors (smoking, alcohol, education, economic status) play crucial role. Limited data exists today that evaluates oral health conditions of seniors in the Balkan countries. Aging and socio-economic status of seniors in the Balkans are significantly associated with oral health problems.

Molecular basis of human enamel defects

During eruption of teeth in the oral cavity, the effect of gene variations and environmental factors can result in morphological and structural changes in teeth. Amelogenesis imperfecta is a failure which is detected on the enamel of the teeth and clinical picture varies by the severity and type of the disease. Classification of the types of amelogenesis imperfecta is determined by histological, genetic, clinical and radiographic criteria. Specifically, there are 4 types of amelogenesis imperfecta (according to Witkop): hypoplastic form, hypo-maturation form, hypo-calcified form, and hypo-maturation/hypoplasia form with taurodontism and 14 subcategories. The diagnosis and classification of amelogenesis imperfecta has traditionally been based on clinical presentation or phenotype and the inheritance pattern. Several genes can be mutated and cause the disease. Millions of genes, possibly more than 10,000 genes produce proteins that regulate synthesis of enamel. Some of the genes and gene products that are likely associated with amelogenesis imperfecta are: amelogenin (AMELX, AMELY genes), ameloblastin (AMBN gene), enamelin (ENAM gene), enamelysin (MMP20 gene), kalikryn 4 (KLK 4 gene), tuftelins (Tuftelin gene), FAM83H (FAM83H gene) and WDR72 (WDR72 gene). Particular attention should be given by the dentist in recognition and correlation of phenotypes with genotypes, in order to diagnose quickly and accurately such a possible disease and to prevent or treat it easily and quickly. Modern dentistry should restore these lesions in order to guarantee aesthetics and functionality, usually in collaboration with a group of dentists.

Oral hygiene and nutrition habits of young people in Greece aged 18 to 25 and review of the literature

Purpose: The aim of this paper is to document the oral hygiene and nutrition habits of young people (aged 18 to 25) in Greece. Material and Methods: In a random sample of 100 people in Greece aged 18 to 25, a questionnaire including 23 questions (4 demographical and 19 other) was given. The frequency, the usual reason for visiting the dentist, the frequency of brushing, the type of toothbrush and the criteria for choosing toothbrush and toothpaste were searched. The nutrition habits were recorded as frequency in receiving sugar or no sugar meals during the day. The statistical analysis included frequencies and the use of chi-square test for interrelation with the demographical questions. Results: 72% of the sample visits the dentist at least once a year, while the reason for visiting was prevention in 69%. 85% brushes at least twice a day, and the same percentage uses medium hardness toothbrush. The choice of the toothpaste is based on flavour and fragrance in 25%. The frequency of receiving sugar meals was recorded as 45% once daily and 43% in 2 or 3 times daily (p<0.05 between smokers and non smokers). 78% of the young people receives less than 5 meals and snacks per day. There was no statistically significant difference between different available monthly budgets in the sample for the oral hygiene and nutrition habits. Conclusion: More than 1/3 of young people in Greece aged 18 to 25 visits the dentist at least once yearly for prevention and uses medium hardness toothbrush. The frequency of sugar consumption was significantly higher in smokers when compared to non smokers. Statistically significant differences were not observed between males and females except for the frequency in brushing (p<0.05). A review of the literature was performed for issues related to this project:.