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Panagiotis Kousiouris,1,&ast; Nikolaos Gouliopoulos,2,&ast; Anastasia Kourtesa,1,&ast; Georgios S Dimtsas,1 Klio Chatzistefanou,1 Nikolaos Bouratzis,2 Maria Kantzanou,3 Marilita M Moschos1 1 1st Department of Ophthalmology, University of Athens Medical School, G. Gennimatas Hospital, Athens, Greece; 2 2nd Department of Ophthalmology, University of Athens Medical School, Attikon Hospital, Athens, Greece; 3Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece&ast;These authors contributed equally to this workCorrespondence: Marilita M Moschos, 1st Department of Ophthalmology, University of Athens Medical School, G. Gennimatas Hospital, 154 Leof. Mesogeion, Athens, 115 27, Greece, Tel +30 6944887319, Email moschosmarilita@yahoo.frPurpose: To present the demographic and social characteristics of patients with ocular foreign bodies (OFB), who visit the Ophthalmological Outpatient Department of a tertiary hospital in Athens, Greece.Patients and Methods: During the period January-March 2019, 5181 patients presented to the Ophthalmological Outpatient Department of our hospital, and 543 of them were diagnosed with an ocular foreign body. Moreover, 106 of them were interviewed about their demographic and social factors, regarding among others data about their occupation, level of education, nationality, family, and insurance status.Results: The patients with ocular foreign bodies were significantly younger compared to the rest of the examined patients (49.5± 13.9 vs 56.3± 17 years, p< 0.001). Moreover, the ocular foreign bodies were more frequent in men compared to women (15.5% vs 5.0%, p< 0.001) and in non-Greek patients (23.7% vs 9.2%, p< 0.001). Regarding the social characteristics of the patients with ocular foreign bodies, we found that the majority of them were married, employed, insured, while their educational status was middle and high school. Furthermore, the vast majority of the patients practiced manual professions (73.1% of them).Conclusion: We documented that the introduction of an ocular foreign body is frequently encountered in the Outpatient Department of our tertiary hospital in Athens, Greece. We also demonstrated that these patients are younger, while they are more frequently men, of non-Greek origin, with an educational status of middle and high school, and their occupation is associated with manual labour.Keywords: ocular foreign body, ocular trauma, demographic characteristics, social characteristics

Panagiotis Kousiouris,1,&ast; Olga Klavdianou,1,&ast; Konstantinos AA Douglas,1 Nikolaos Gouliopoulos,2 Klio Chatzistefanou,1 Maria Kantzanou,3 Georgios S Dimtsas,1 Marilita M Moschos1 1 1st Department of Ophthalmology, National and Kapodistrian University of Athens, “G. Gennimatas” General Hospital, Athens, Greece; 2 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, “Attikon” General Hospital, Athens, Greece; 3Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece&ast;These authors contributed equally to this workCorrespondence: Marilita M Moschos 1st Department of Ophthalmology, National and Kapodistrian University of Athens, “G. Gennimatas” General Hospital, Leof. Mesogeion 154, Athens, 115 27, GreeceTel +30 6944887319Email moschosmarilita@yahoo.frAbstract: Globe injury is a serious worldwide public health issue frequently leading to permanent vision impairment. The plethora of different types of globe injuries is classified into categories, including open and closed globe injuries. Globe injury occurs mainly in the workplace and at home, affecting predominantly middle-aged working men. Socioeconomic status (SES) is defined by income level, educational attainment, and employment status. Low socioeconomic status has been associated with a higher incidence of globe injury and can be utilized to identify at-risk populations. For managing open and closed globe injuries, different strategies are applied and the implementation of adequate globe injury prevention measures is needed for reducing the occurrence of globe injury. The following article aims to provide an overview of globe injury characteristics and their correlation with socioeconomic status and to highlight the significance of considering SES as a variable in globe injury prevention.Keywords: eye injuries, occupational injuries, social class, educational status

Purpose: Our study aims to estimate the prevalence of lingual nerve injury following bilateral sagittal split osteotomy (BSSO)., Methods: Two reviewers independently conducted a systematic literature search in the Medline and Scopus databases. The pooled prevalence with 95% confidence intervals (CI) was estimated, and quality assessment, outlier analysis, and influential analysis were performed., Results: In total, eleven eligible studies comprising a total of 1,882 participants were included in this meta-analysis. One study was identified as critically influential. The overall prevalence of lingual sensory impairment was estimated to be as high as 0.1% (95% CI 0.0%-0.6%) with moderate heterogeneity observed between studies., Conclusion: It is important for healthcare professionals to be aware of this issue, despite the relatively low rate of lingual nerve deficit after BSSO. Additional research will provide a more comprehensive understanding of the underlying factors contributing to lingual nerve injury, leading to improved preventive measures and treatment strategies. Furthermore, insights gained from future studies will enable healthcare professionals to inform patients about the potential complications and manage their expectations before undergoing BSSO., (© 2024. The Author(s).)

Our research aims to assess the prevalence of alveolar osteitis (AO) following impacted mandibular third molar extractions and investigate the impact of potential moderating factors on this occurrence. Two independent reviewers conducted a comprehensive systematic literature search across Medline, Scopus, and Google Scholar databases. The pooled prevalence, accompanied by 95 % confidence intervals (CI), was calculated. Quality assessments, outlier and influential analyses were performed. Subgroup and meta-regression analysis were conducted in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. Our meta-analysis included twenty-eight eligible studies, encompassing a total of 41,859 impacted mandibular third molar extractions. The overall prevalence of dry socket (DS) following impacted mandibular third molar extractions was estimated at 6.7 % (95 % CI 4.6-9.1 %), indicating considerable heterogeneity among the studies. No study was identified as critically influential, and meta-regression analysis did not pinpoint any potential sources of heterogeneity. This study highlights the imperative for future well-constructed prospective and retrospective investigations to deepen our understanding of the etiological nuances and refine management approaches for this prevalent postoperative complication., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Our research aims to assess the prevalence of surgical site infections (SSI) following impacted mandibular third molar extractions. Two independent reviewers conducted a comprehensive systematic literature search across Medline, Scopus and Cochrane Central databases. The pooled prevalence, accompanied by 95% confidence intervals (CI), was calculated. Quality assessments, outlier and influential analyses were performed. Our meta-analysis included seventeen eligible studies, encompassing a total of 37,585 impacted mandibular third molar extractions. The overall prevalence of SSI following impacted mandibular third molar extractions was estimated at 1.7% (95% CI 1%-2.6%), indicating considerable heterogeneity among the studies. No study was identified as critically influential. This study highlights the imperative for future well-constructed prospective and retrospective investigations to deepen our understanding of the etiological nuances and refine management approaches for this prevalent postoperative complication., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Our study seeks to provide a comprehensive assessment of leishmaniasis prevalence among blood donors, employing rigorous methodologies to inform public health initiatives and transfusion safety measures. A thorough literature search was conducted using electronic databases (Medline, Scopus, Web of Science, and Google Scholar) to identify the relevant studies reporting the prevalence of leishmaniasis among blood donors, gathering a wide range of studies encompassing different geographic locations and time periods. The pooled prevalence with a 95% confidence interval (CI) was estimated, and quality assessment, outlier analysis, and influential analysis were performed to ensure the robustness and validity of the findings. Our search and subsequent analyses led to the inclusion of thirty-five studies in our review. Using molecular diagnostic methods, the prevalence was estimated at 2.3% (95% CI 1-3.9%), while serological diagnostic methods indicated a higher prevalence rate of 4.5% (95% CI 2.8-6.7%). Notably, we observed significant heterogeneity among the included studies for each analysis. The observed heterogeneity highlights the need for future research to delve into the factors influencing leishmaniasis prevalence, with prospective and retrospective studies addressing the limitations identified in this review.

Aim: To study antimicrobial susceptibilities of genital mycoplasmas recovered from endocervical samples of reproductive-age, nonpregnant women ( n = 8,336). Materials & methods: For isolation and susceptibility testing, the Mycoplasma IST2 kit was used. Results: As many as 2093 samples were positive for mycoplasmas. The vast majority (>96%) of Ureaplasma urealyticum remained susceptible to tetracycline, doxycycline, josamycin and pristinamycin, whereas susceptibility rates to azithromycin and fluoroquinolones were significantly decreased. Mycoplasma hominis exhibited high susceptibility rates to doxycycline, pristinamycin and josamycin (98.1-100%), while susceptibilities to tetracycline and fluoroquinolones were considerably lower. Conclusion: Doxycycline remained highly potent for treating mycoplasmas; nevertheless, susceptibilities to other antimicrobials were significantly diminished.

The hospital environment is often quite complicated due to interdisciplinary workflow procedures and multitasking staff, which are exacerbated during periods of economic crisis. This study aimed to examine the motivation and job satisfaction factors of Greek National Healthcare Service (NHS) employees in relation to the Existence-Relatedness-Growth (ERG) theory of motivation during a period of severe financial constraints. A cross-sectional study was conducted in three public hospitals in Greece from 2018 to 2019, utilizing a survey tool to measure the factors of motivation and job satisfaction among Greek NHS employees. The study also aimed to identify the most relevant motivational theory applicable to the complex Greek hospital environment. Exploratory factor analysis (EFA) was employed to extract the structural factors of the survey tool, and analysis of variance (ANOVA) was used to identify statistical differences between the means of three or more independent groups. A sample of 363 Greek NHS employees participated in this study. Statistically significant differences were detected between hospital units and job satisfaction factors, as well as between the functions of hospital clusters and job positions. Specifically, managerial staff presented higher levels of job satisfaction, while nursing staff had the lowest scores in terms of psychological contracts when compared to medical and administrative staff. This study demonstrated that job satisfaction in Greek public hospitals, in a context of severe financial constraints, was mainly driven by strong interpersonal connections and employee trust in management, despite significant cuts in salaries, staff numbers, and hospital budgets., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. North Attica Hospital Cluster Ethics Committee (Sismanoglio-Amalia Fleming and Paidon Pentelis) issued approval 12813/14-6-18. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Koutalas et al.)

This study aimed to develop a scenario-based questionnaire for evaluating medium-level leadership behaviors within the Greek National Healthcare System (NHS), drawing upon the principles of servant leadership theory. Data for this pilot study were collected in the first quarter of 2019, using a sample of 33 (22.9% of all medium-level managerial positions) medium-level managers from the Greek NHS hospital cluster located in North Attica. To assess managerial behaviors, an ordinal scale was employed, revealing non-normal data distributions. Consequently, our analysis involved presenting descriptive statistics, utilizing non-parametric tests to explore distinctions in managerial behaviors, and conducting thematic analysis of responses to open-ended questions, with frequencies and relative frequencies of each theme meticulously recorded. Overall, our findings indicate that, in most cases, managers exhibited positive behaviors toward their employees, regardless of whether the outcomes were positive, negative, or unknown. Positive behaviors towards the administration were comparatively rare. Significant differences were observed, highlighting that managers were more inclined to exhibit positive behaviors when the outcome was known, particularly in scenarios involving employee management. Within each scenario, behavioral patterns varied, with managers demonstrating a propensity to take credit for employee success in positive outcomes but distancing themselves from negative outcomes when reporting to the administration. Furthermore, the survey responses underscored the prevalence of positive attitudes regarding accountability and stewardship, with stewardship showing a positive correlation with scenario-based behaviors. Finally, our study brought to light several challenges in the management of the Greek NHS, including the absence of comprehensive managerial evaluation, the lack of meritocracy, regulatory deficiencies, and a shortage of leadership skills among current managers. These findings emphasize the importance of scenario-based assessments for Greek hospital managers, as they can help connect managerial behaviors to stewardship, accountability, and skills, ultimately contributing to the enhancement of leadership within the Greek NHS., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Koutalas et al.)

Our study aimed to estimate the prevalence of total free flap failure following free flap reconstruction for mandibular osteoradionecrosis (mORN) and assess the impact of potential moderators on this outcome. A comprehensive systematic literature search was independently conducted by two reviewers using the Medline, Scopus, Web of Science and Cochrane Library databases. Quality assessment of the selected studies was performed, and prevalence estimates with 95% confidence intervals (CI) were calculated. Outlier and influential analyses were conducted, and meta-regression analyses was employed to investigate the effects of continuous variables on the estimated prevalence. Ultimately, forty-six eligible studies (involving 1292 participants and 1344 free flaps) were included in our meta-analysis. The findings of our study revealed a prevalence of 3.1% (95% CI 1.3-5.4%) for total free flap failure after reconstruction for mORN. No study was identified as critically influential, and meta-regression analysis did not pinpoint any potential sources of heterogeneity. These findings provide valuable insights for researchers and serve as a foundation for future investigations into the management of mandibular osteoradionecrosis and the prevention of free flap failure in this context., (© 2024. The Author(s).)

Background Corneal diseases are the fourth most common cause of blindness worldwide. In the majority of these diseases, vision reduction is reversible and can be restored to a large extent by replacing the cornea through specific surgery and, in particular, transplantation. In Greece, due to a lack of organized eye banks as well as donors, the grafts intended for corneal transplantation usually come from eye banks abroad. This study focuses on the dynamics of cost versus value in the decision-making process for the procurement of corneal grafts, ultimately investigating the safety that the procured grafts provide to patients. Methodology A total of 267 patients with severe vision problems who underwent 301 corneal and amniotic membrane transplants from years 2020 to 2023 at the Transplant Unit of the Athens General Hospital "Georgios Gennimatas" were included in this study. All patients who were deemed appropriate to undergo corneal transplant operations, the diagnosis that led to the specific surgery, and other relevant data were recorded and evaluated. Results There was no significant difference in the ratio between males and females (51.3% male and 48.7% female). The mean age of the patients was 66.5 years (SD = 13.7 years). Graft problems were faced by 13.9% of the patients, with the amniotic membrane by 1.5% (in the total number of surgical operations) and both eyes by 4.5% of patients. The majority of the patients had undergone only one surgery (88.8%). Reoperation was needed in 14% of the cases, and 7.6% of the cases were surgeries that occurred due to graft rejection or non-functioning grafts from surgeries performed at another hospital or clinic. In the majority of surgeries (60.8%), a Descemet's stripping automated endothelial keratoplasty graft was used. The mean cost was 3,167 euro (SD = 960.3 euro). Furthermore, in 35.8% of the surgeries, the graft was preserved with amphotericin. Conclusions The present study draws useful conclusions about the effectiveness of surgical interventions through the correlation of cost and safety of the grafts that are approved and finally used in corneal transplants, as well as the submission of proposals to improve the procedures and lead to patient benefits., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Kousiouris et al.)

Aim: To determine the prevalence of ocular toxoplasmosis among people living with HIV through a systematic review and meta-analysis. Materials & methods: A literature search was conducted, estimating pooled prevalence and performing quality assessment, outlier, influential and meta-regression analyses. Results: Twenty-nine studies were included in the analysis, revealing that the rate of ocular toxoplasmosis among people living with HIV was 0.37% (95% CI: 0.2-0.6). Substantial heterogeneity was observed among the studies. Despite analyzing continuous variables, including year of publication, proportion of males, mean age and proportion of patients receiving antiretroviral therapy, no statistically significant associations were found. Conclusion: This study provides an overview of the prevalence of ocular toxoplasmosis in people living with HIV, emphasizing the need for further research to uncover factors contributing to its development.

Purpose: To estimate the prevalence of carpal tunnel syndrome (CTS) among dental surgeons and the effect of possible moderators on it. Methods: A systematic literature search (Medline and Scopus databases) was conducted independently by two reviewers. Only observational studies that examined specifically the prevalence rates of CTS among dentists were included. Quality assessment was performed. The pooled prevalence with 95% confidence intervals (CI) was estimated. Outlier and influential analysis were conducted. Moderator analysis was performed in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. Results: In total, ten eligible studies (3,547 participants) were finally included in this meta-analysis. Two of them were estimated as high quality (low risk of bias) and the remaining ones as moderate quality (moderate risk of bias). The overall prevalence of CTS among dental surgeons was estimated as 9.87% (95%CI 6.84%-14.03%) with significant heterogeneity between studies. No study was identified as influential. Potential sources of heterogeneity were not identified through meta-regression analysis. In the subgroup analysis the prevalence was 12.47% (95%CI 6.38%-22.95%) for the group identified as having CTS through medical history and at least clinical examination or electrodiagnostic testing and 8.56% (95%CI 5.53%-13.01%) among those who identified solely through questionnaire. Conclusions: Our findings are important to provide the pooled prevalence of CTS among dentists. Our results were based on highly heterogeneous studies. Our study reports a considerable prevalence, consequently, significance of awareness among dental surgeons regarding the etiology of this issue is more than necessary. More studies need to be conducted that could guide researchers in order this issue to be fully investigated., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Kostares E et al.)

Our study aims to estimate the prevalence of surgical site infections (SSI) following open reduction and internal fixation (ORIF) for mandibular fractures and to determine the effect of potential moderators on it. A systematic literature search (Medline and Scopus databases) was conducted independently by two reviewers. The pooled prevalence with 95% confidence intervals was estimated. Quality assessment as well as outlier and influential analysis were performed. Additionally, subgroup and meta-regression analysis were conducted in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. In total, seventy-five eligible studies (comprising a sum of 5825 participants) were included in this meta-analysis. The overall prevalence of SSI following ORIF for mandibular fractures was estimated as high as 4.2% (95% CI 3.0-5.6%) with significant heterogeneity between studies. One study was identified to be critically influential. In the subgroup analysis, the prevalence was 4.2% (95% CI 2.2-6.6%) among studies conducted in Europe, 4.3% (95% CI 3.1-5.6%) among studies conducted in Asia and higher among those conducted in America (7.3%) (95% CI 4.7-10.3%). It is important for healthcare professionals to be aware of the etiology of these infections, despite the relatively low rate of SSI in these procedures. However, further, well-designed prospective and retrospective studies need to be conducted in order this issue to be fully clarified., (© 2023. The Author(s).)

Background: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a life-threatening healthcare-associated infection affecting especially patients with immunosuppression and comorbidities. We investigated the association between the incidence of CRPA bacteremia, antibiotic consumption, and infection control measures in a hospital during 2013-2018., Methods: We prospectively recorded the incidence of CRPA bacteremia, antibiotic consumption, use of hand-hygiene solutions, and isolation rates of multidrug-resistant (MDR) carrier patients., Findings: The consumption of colistin, aminoglycosides, and third-generation cephalosporins decreased significantly in the total hospital and its divisions ( p -value < 0.001 for all comparisons) while the consumption of carbapenems decreased significantly in the adults ICU ( p -value = 0.025). In addition, the incidence of CRPA significantly decreased in the total hospital clinics and departments ( p -values = 0.027 and 0.042, respectively) and in adults clinics and departments ( p -values = 0.031 and 0.051, respectively), while in the adults ICU, the incidence remained unchanged. Increased isolation rates of MDR carrier patients, even two months before, significantly correlated with decreased incidence of CRPA bacteremia (IRR: 0.20, 95% CI: 0.05-0.73, p -value = 0.015) in the adults ICU. Interestingly, when the use of hand-hygiene solutions (alcohol and/or scrub) increased, the consumption of advanced, nonadvanced, and all antibiotics decreased significantly., Conclusion: In our hospital, multimodal infection control interventions resulted in a significant reduction of CRPA bacteremia, mostly due to the reduction of all classes of antibiotics.

The prognosis of children with neuroblastoma (NBL) can be dismal with significant variations depending on the stage and biology of the tumor. We assessed the event-free (EFS) and overall (OS) survival using harmonized data from three Southern-Eastern European (SEE) countries. Data for 520 incident NBL cases (2009-2018) were collected from Greece, Slovenia and Russia. Kaplan-Meier curves were fitted, and EFS/OS were derived from Cox proportional models by study variables including the protocol-based risk-group (low/observation, intermediate, high). Over one-third of cases were coded in the high-risk group, of which 23 children (4.4%) received treatment with anti-ganglioside 2 (GD2) mAb. Survival rates were inferior in older (OS 5-year; 1.5-4.9 years: 61%; EFS 5-year; 1.5-4.9 years: 48%) compared to children younger than 1.5 years (OS 5-year; <1.5 years: 91%; EFS 5-year; <1.5 years: 78%). Predictors of poor OS included stage 4 (hazard ratio, HR OS : 18.12, 95% confidence intervals, CI: 3.47-94.54), N-myc amplification (HR OS : 2.16, 95% CI: 1.40-3.34), no surgical excision (HR OS : 3.27, 95% CI: 1.91-5.61) and relapse/progression (HR OS : 5.46, 95% CI: 3.23-9.24). Similar unfavorable EFS was found for the same subsets of patients. By contrast, treatment with anti-GD2 antibody in high-risk patients was associated with decreased risk of death or unfavorable events (HR OS : 0.11, 95% CI: 0.02-0.79; HR EFS : 0.19, 95% CI: 0.07-0.52). Our results confirm the outstanding prognosis of the early NBL stages, especially in children <1.5 years, and the improved outcomes of the anti-GD2 treatment in high-risk patients. Ongoing high-quality clinical cancer registration is needed to ensure comparability of survival across Europe and refine our understanding of the NBL biology., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

The coronavirus disease-2019 (COVID-19) pandemic has raised the stakes for planetary health diagnostics. Because pandemics pose enormous burdens on biosurveillance and diagnostics, reduction of the logistical burdens of pandemics and ecological crises is essential. Moreover, the disruptive effects of catastrophic bioevents impact the supply chains in both highly populated urban centers and rural communities. One "upstream" focus of methodological innovation in biosurveillance is the footprint of Nucleic Acid Amplification Test (NAAT)-based assays. We report in this study a water-only DNA extraction, as an initial step in developing future protocols that may require few expendables, and with low environmental footprints, in terms of wet and solid laboratory waste. In the present work, boiling-hot distilled water was used as the main cell lysis agent for direct polymerase chain reactions (PCRs) on crude extracts. After evaluation (1) in blood and mouth swabs for human biomarker genotyping, and (2) in mouth swabs and plant tissue for generic bacterial or fungal detection, and using different combinations of extraction volume, mechanical assistance, and extract dilution, we found the method to be applicable in low-complexity samples, but not in high-complexity ones such as blood and plant tissue. In conclusion, this study examined the doability of a lean approach for template extraction in the case of NAAT-based diagnostics. Testing our approach with different biosamples, PCR settings, and instruments, including portable ones for COVID-19 or dispersed applications, warrant further research. Minimal resources analysis is a concept and practice, vital and timely for biosurveillance, integrative biology, and planetary health in the 21st century.

Leishmaniasis is a parasitic infection expressing different clinical phenotypes. Visceral leishmaniasis (VL) is considered an opportunistic infection among people with human immunodeficiency virus (HIV). The objective of this review was to identify published data on the prevalence of Leishmania spp. infection among PWH and to define particular determinants that affect critically the epidemiological characteristics of VL-HIV coinfection and, potentially, its burden on public health. Two independent reviewers conducted a systematic literature search until June 30, 2022. Meta-analyses were conducted using random-effects models to calculate the summary prevalence and respective 95% confidence intervals (CI) of leishmaniasis among PWH. Meta-regression analysis was performed to investigate the impact of putative effect modifiers, such as the mean CD4 cell count, on the major findings. Thirty-four studies were eligible, yielding a summary prevalence of 6% (95%CI, 4-11%) for leishmaniasis (n = 1583) among PWH (n = 85,076). Higher prevalence rates were noted in Asia (17%, 95%CI, 9-30%) and America (9%, 95%CI, 5-17%) than in Europe (4%, 95%CI, 2-8%). Prevalence rates were significantly mediated by the age, sex, and CD4 cell count of participants. Heterogeneity remained significant in all meta-analyses (p < 0.0001). In the majority of included studies, people were coinfected with HIV and Leishmania species associated with VL, as opposed to those associated with cutaneous leishmaniasis. No sign of publication bias was shown (p = 0.06). Our summary of published studies on leishmaniasis among PWH is important to provide prevalence estimates and define potential underlying factors that could guide researchers to generate and further explore specific etiologic hypotheses., (© 2022. The Author(s).)

Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Urine catheters are often reservoirs of multidrug-resistant (MDR) bacteria and sources of pathogens transmission to other patients. The current study was conducted to investigate the correlation between CAUTIs, MDR bacteremia, and infection control interventions, in a tertiary-care hospital in Athens, from 2013 to 2018. The following data were analyzed per month: 1. CAUTI incidence; 2. consumption of hand hygiene disinfectants; 3. incidence of isolation of MDR carrier patients, and 4.incidence of bacteremia/1000 patient-days [total resistant a.Gram-negative: carbapenem-resistant Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae; b.Gram-positive: vancomycin-resistant Enterococci and methicillin-resistant Staphylococcus aureus]. The use of scrub disinfectant solutions was associated with decreased CAUTI rate in Total Hospital Clinics (OR: 0.97, 95% CI: 0.96−0.98, p-value: <0.001) and in Adults ICU (OR: 0.79, 95% CI: 0.65−0.96, p-value:0.018) while no correlation was found with isolation rate of MDR-carrier pathogens. Interestingly, an increase in total bacteremia (OR: 0.81, 95% CI: 0.75−0.87, p-value:<0.001) or carbapenem-resistant bacteremia correlated with decreased incidence of CAUTIs (OR: 0.96, 95% CI: 0.94−0.99, p-value: 0.008). Hand hygiene measures had a robust and constant effect on infection control, reducing the incidence of CAUTIs.

Introduction: There is uncertainty regarding the optimal timing for initiation of oral anticoagulation in patients with acute ischemic stroke (AIS) due to atrial fibrillation (AF). Methods: We performed a systematic review and meta-analysis of randomized-controlled clinical trials (RCTs) and prospective observational studies to assess the efficacy and safety of early anticoagulation in AF-related AIS (within 1 week versus 2 weeks). A second comparison was performed assessing the efficacy and safety of direct oral anticoagulants (DOACs) versus vitamin-K antagonists (VKAs) in the two early time windows. The outcomes of interest were IS recurrence, all-cause mortality, symptomatic intracerebral haemorrhage (sICH) and any ICH. Results: Eight eligible studies (6 observational, 2 RCTs) were identified, including 5616 patients with AF-related AIS who received early anticoagulation. Patients that received anticoagulants within the first week after index stroke had similar rate of recurrent IS, sICH and all-cause mortality compared to patients that received anticoagulation within two weeks (test for subgroup differences p = 0.1677; p = 0.8941; and p = 0.7786, respectively). When DOACs were compared to VKAs, there was a significant decline of IS recurrence in DOAC-treated patients compared to VKAs (RR: 0.65; 95%CI: 0.52-0.82), which was evident in both time windows of treatment initiation. DOACs were also associated with lower likelihood of sICH and all-cause mortality. Conclusions: Early initiation of anticoagulation within the first week may have a similar efficacy and safety profile compared to later anticoagulation (within two weeks), while DOACs seem more effective in terms of IS recurrence and survival compared to VKAs.

Ventilator-associated pneumonia (VAP) occurs more than 48h after mechanical ventilation and is associated with a high mortality rate. The current hospital-based study aims to investigate the association between VAP rate, incidence of bacteremia from multidrug-resistant (MDR) pathogens, and infection control interventions in a single case mix ICU from 2013 to 2018. Methods: The following monthly indices were analyzed: (1) VAP rate; (2) use of hand hygiene disinfectants; (3) isolation rate of patients with MDR bacteria; and (4) incidence of bacteremia/1000 patient-days (total cases, total carbapenem-resistant cases, and carbapenem-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae cases separately). Results: Time trends of infection control interventions showed increased rates in isolation of patients with MDR pathogens (p <0.001) and consumption of hand disinfectant solutions (p =0.001). The last four years of the study an annual decrease of VAP rate by 35.12% (95% CI: −53.52 to −9.41; p =0.01) was recorded, which significantly correlated not only with reduced trauma and cardiothoracic surgery patients (IRR:2.49; 95% CI: 2.09−2.96; p <0.001), but also with increased isolation rate of patients with MDR pathogens (IRR: 0.52; 95% CI: 0.27−0.99; p = 0.048), and hand disinfectants use (IRR: 0.40; 95% CI: 0.18−0.89; p =0.024). Conclusions: Infection control interventions significantly contributed to the decrease of VAP rate. Constant infection control stewardship has a stable time-effect and guides evidence-based decisions., Competing Interests: The authors declare no conflict of interest.

Background: To investigate the association between Clostridioides difficile infection (CDI), antibiotic use, and infection control interventions, during an antibiotic stewardship program (ASP) implemented in a tertiary-care hospital in Greece from 2013 to 2018., Methods: Analysis was applied for the following monthly indices: 1. consumption of antibiotics; 2. use of hand hygiene disinfectant solutions; 3. percentage of isolations of patients either with multidrug-resistant (MDR) bacteria, or CDI, or admitted from another hospital; and 4. percentage of patients with CDI divided into two groups: community-acquired CDI (CACDI) and hospital-associated CDI (HACDI) (onset ≤72 h and >72 h after admission, respectively)., Results: During the study, a significant reduction in CACDI rate from 0.3%/admissions [95% CI 0.1-0.6] to 0.1%/admissions [95% CI 0.0-0.3] (p-value = 0.035) was observed in adults ICU, while CDI rates were stable in the rest of the hospital. Antibiotic consumption showed a significant reduction in total hospital, from 91.7 DDDs [95% CI 89.7-93.7] to 80.1 DDDs [95% CI 79.1-81.1] (p-value<0.001), except adults ICU. Non-advanced antibiotics correlated with decreased CDI rates in Adults Clinic Departments and ICU. Isolation of patients one and two months earlier correlated with decreased CACDI rates per 20% [95% CI 0.64-1.00, p-value = 0.046] and HACDI per 23% [95% CI 0.60-1.00, p-value = 0.050] in Adults Clinic Departments. Consumption of disinfectant solutions current month correlated with decreased rate for CACDI per 33% [95% CI 0.49-0.91, p-value = 0.011] and HACDI per 38% [95% CI 0.40-0.98, p-value = 0.040] in total Hospital Clinics., Conclusion: Rational antibiotic prescribing during ASP along with multipronged intervention strategy focusing on hand hygiene and patient isolation measures prevent and control CDI outbreaks in the hospital setting., (Copyright © 2022 Australasian College for Infection Prevention and Control. Published by Elsevier B.V. All rights reserved.)

Background: Multidrug-resistant (MDR) bacteremia is a serious health care-associated infection with significant morbidity and excess hospitalization costs. Our aim is to study the association between incidences of MDR bacteremia, antibiotic consumption, and infection control measures in a hospital from 2013 to 2018. Methods: We analyzed the following indices: (1) incidence of bacteremia (carbapenem-resistant Acinetobacter baumanii , Pseudomonas aeruginosa , and Klebsiella pneumoniae , methicillin-resistant Staphylococcus aureus , vancomycin-resistant Enterococci ); (2) use of antibiotics; (3) consumption of disinfectant solutions for hand hygiene; and (4) isolation rates of MDR carrier patients. Findings: The use of advanced antibiotics ( p  = 0.001) and carbapenems ( p  = 0.008) decreased significantly in all hospital departments but the incidence of total MDR bacteremia did not change significantly. Increased use of hand disinfectant solutions was statistically associated with decreased incidence of total MDR bacteremia (incidence rate ratio [IRR]: 0.94, confidence interval [95% CI]: 0.90-0.99, p : 0.020) in all hospital. Also, increased isolation rates of MDR carrier patients 2 months before correlated with decreased incidence of bacteremia due to carbapenem-resistant gram-negative pathogens (IRR: 0.35, 95% CI: 0.18-0.66, p : 0.001) in adults intensive care unit. Conclusion: In our hospital, hand hygiene and isolation of MDR carrier patients controlled MDR bacteremia.

Central nervous system (CNS) cystic echinococcosis (CE) is a rare disease caused by Echinococcus which especially exists in agricultural endemic areas. This condition is more frequent in the pediatric and adolescent population and it can be associated with hydatid cyst in other localizations. A literature search was conducted up to April 28, 2021 by two independent reviewers. This study focused on clinical, imaging, therapeutic features as well as on complications of CNS CE among children and adults. Fifteen studies from seven different countries were included. A significant prevalence in males (ranging from 51% to 100%) was observed with an average rate of 60%. CNS CE was mainly single and located in the parietal region. The predominant symptoms were those of increased intracranial pressure. All patients were treated surgically, and the most common post-surgical complication was cyst rupture (prevalence: [3.3-37.5%], average: 12.9%). Furthermore, the outcomes were worse amongst patients with cyst ruptures and multiple recurrences. The average proportion of deaths due to CNS CE was 5.6% (range: 2.5-14.8%). This review highlights the necessity of including CNS CE in the differential diagnosis of patients with cystic lesions, especially in those residing in endemic areas. Early gross total cyst removal is the mainstay of treatment yielding the best outcomes., Competing Interests: Conflicts of interest: All authors – none to declare., (GERMS.)

Background and Objectives: To explore the association between blood pressure (BP) levels after endovascular thrombectomy (EVT) and the clinical outcomes of patients with acute ischemic stroke (AIS) patients with large vessel occlusion (LVO)., Methods: A study was eligible if it enrolled patients with AIS >18 years of age with an LVO treated with either successful or unsuccessful EVT and provided either individual or mean 24-hour systolic BP values after the end of the EVT procedure. Individual patient data from all studies were analyzed with a generalized linear mixed-effects model., Results: A total of 5,874 patients (mean age 69 ± 14 years; 50% women; median NIH Stroke Scale score on admission 16) from 7 published studies were included. Increasing mean systolic BP levels per 10 mm Hg during the first 24 hours after the end of the EVT were associated with a lower odds of functional improvement (unadjusted common odds ratio [OR] 0.82, 95% confidence interval [CI] 0.80-0.85; adjusted common OR 0.88, 95% CI 0.84-0.93) and modified Rankin Scale score ≤2 (unadjusted OR 0.82, 95% CI 0.79-0.85; adjusted OR 0.87, 95% CI 0.82-0.93) and a higher odds of all-cause mortality (unadjusted OR 1.18, 95% CI 1.13-1.24; adjusted OR 1.15, 95% CI 1.06-1.23) at 3 months. Higher 24-hour mean systolic BP levels were also associated with an increased likelihood of early neurologic deterioration (unadjusted OR 1.14, 95% CI 1.07-1.21; adjusted OR 1.14, 95% CI 1.03-1.24) and a higher odds of symptomatic intracranial hemorrhage (unadjusted OR 1.20, 95% CI 1.09-1.29; adjusted OR 1.20, 95% CI 1.03-1.38) after EVT., Discussion: Increased mean systolic BP levels in the first 24 hours after EVT are independently associated with a higher odds of symptomatic intracranial hemorrhage, early neurologic deterioration, 3-month mortality, and worse 3-month functional outcomes., (© 2021 American Academy of Neurology.)