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Introduction: This survey-based study investigates Greek patients' perceptions and attitudes towards generic drugs, aiming to identify factors influencing the acceptance and market penetration of generics in Greece. Despite the acknowledged cost-saving potential of generic medication, skepticism among patients remains a barrier to their widespread adoption. Methods: Between February 2017 and June 2021, a mixed-methods approach was employed, combining descriptive statistics with advanced machine learning models (Logistic Regression, Support Vector Machine, Random Forest, Gradient Boosting, and XGBoost) to analyze responses from 2,617 adult participants. The study focused on optimizing these models through extensive hyperparameter tuning to predict patient willingness to switch to a generic medication. Results: The analysis revealed healthcare providers as the primary information source about generics for patients. Significant differences in perceptions were observed across demographic groups, with machine learning models successfully identifying key predictors for the acceptance of generic drugs, including patient knowledge and healthcare professional influence. The Random Forest model demonstrated the highest accuracy and was selected as the most suitable for this dataset. Discussion: The findings underscore the critical role of informed healthcare providers in influencing patient attitudes towards generics. Despite the study's focus on Greece, the insights have broader implications for enhancing generic drug acceptance globally. Limitations include reliance on convenience sampling and self-reported data, suggesting caution in generalizing results. [ABSTRACT FROM AUTHOR]

Introduction: Dihydropyrimidine dehydrogenase (DPD), encoded by DPYD gene, is the rate-limiting enzyme responsible for fluoropyrimidine (FP) catabolism. DPYD gene variants seriously affect DPD activity and are well validated predictors of FPassociated toxicity. DPYD variants rs3918290, rs55886062, rs67376798, and rs75017182 are currently included in FP genetic-based dosing guidelines and are recommended for genotyping by the European Medicines Agency (EMA) before treatment initiation. In Greece, however, no data exist on DPYD genotyping. The aim of the present study was to analyze prevalence of DPYD rs3918290, rs55886062, rs67376798, rs75017182, and, additionally, rs1801160 variants, and assess their association with FP-induced toxicity in Greek cancer patients. Methods: Study group consisted of 313 FP-treated cancer patients. DPYD genotyping was conducted on QuantStudio ™ 12K Flex Real-Time PCR System (ThermoFisher Scientific) using the TaqMan® assays C__30633851_20 (rs3918290), __11985548_10 (rs55886062), C_;_27530948_10 (rs67376798), C_104846637_10 (rs75017182) and C__11372171_10 (rs1801160). Results: Any grade toxicity (1-4) was recorded in 208 patients (66.5%). Out of them, 25 patients (12%) experienced grade 3-4 toxicity. DPYD EMA recommended variants were detected in 9 patients (2.9%), all experiencing toxicity (p = 0.031, 100% specificity). This frequency was found increased in grade 3-4 toxicity cases (12%, p = 0.004, 97.9% specificity). DPYD deficiency increased the odds of grade 3-4 toxicity (OR: 6.493, p = 0.014) and of grade 1-4 gastrointestinal (OR: 13.990, p = 0.014), neurological (OR: 4.134, p = 0.040) and nutrition/metabolism (OR: 4.821, p = 0.035) toxicities. FP dose intensity was significantly reduced in DPYD deficient patients (β = -0.060, p <0.001). DPYD rs1801160 variant was not associated with FP-induced toxicity or dose intensity. Triple interaction of DPYD*TYMS*MTHFR was associated with grade 3-4 toxicity (OR: 3.725, p = 0.007). Conclusion: Our findings confirm the clinical validity of DPYD reduced function alleles as risk factors for development of FP-associated toxicity in the Greek population. Pre-treatment DPYD genotyping should be implemented in clinical practice and guide FP dosing. DPYD*gene interactions merit further investigation as to their potential to increase the prognostic value of DPYD genotyping and improve safety of FP-based chemotherapy. [ABSTRACT FROM AUTHOR]

Therapeutic drug monitoring (TDM) is the clinical practice of measuring drug concentrations. TDM can be used to determine treatment efficacy and to prevent the occurrence or reduce the risk of drug-induced side effects, being, thus, a tool of personalized medicine. Drugs for which TDM is applied should have a narrow therapeutic range and exhibit both significant pharmacokinetic variability and a predefined target concentration range. The aim of our study was to assess the current status of TDM in Greek public hospitals and estimate its progress over the last 20 years. All Greek public hospitals were contacted to provide data and details on the clinical uptake of TDM in Greece for the years 2003 and 2021 through a structured questionnaire. Data from 113 out of 132 Greek hospitals were collected in 2003, whereas for 2021, we have collected data from 98 out of 122 hospitals. Among these, in 2003 and 2021, 64 and 51 hospitals, respectively, performed TDM. Antiepileptics and antibiotics were the most common drug categories monitored in both years. The total number of drug measurement assays decreased from 2003 to 2021 (153,313 ± 7794 vs. 90,065 ± 5698; p = 0.043). In direct comparisons between hospitals where TDM was performed both in 2003 and 2021 (n = 35), the mean number of measurements was found to decrease for most drugs, including carbamazepine (198.8 ± 46.6 vs. 46.6 ± 10.1, p < 0.001), phenytoin (253.6 ± 59 vs. 120 ± 34.3; p = 0.001), amikacin (147.3 ± 65.2 vs. 91.1 ± 71.4; p = 0.033), digoxin (783.2 ± 226.70 vs. 165.9 ± 28.9; p < 0.001), and theophylline (71.5 ± 28.7 vs. 11.9 ± 6.4; p = 0.004). Only for vancomycin, a significant increase in measurements was recorded (206.1 ± 96.1 vs. 789.1 ± 282.8; p = 0.012). In conclusion, our findings show that TDM clinical implementation is losing ground in Greek hospitals. Efforts and initiatives to reverse this trend are urgently needed. [ABSTRACT FROM AUTHOR]

The study concerns the quantitative evaluation of a satellite-based rain rate (RR) estimation algorithm using measurements from a network of ground-based meteorological stations across the Epirus Region, Greece, an area that receives among the maximum precipitation amounts over the country. The utilized version of the rain estimation algorithm uses the Meteosat-11 Brightness Temperature in five spectral regions ranging from 6.0 to 12.0 μm (channels 5–7, 9 and 10) to estimate the rain intensity on a pixel basis, after discriminating the rain/non-rain pixels with a simple thresholding method. The rain recordings of the meteorological stations' network were spatiotemporally correlated with the satellite-based rain estimations, leading to a dataset of 2586 pairs of matched values. A statistical analysis of these pairs of values was conducted, revealing a Mean Error (ME) of −0.13 mm/h and a correlation coefficient (CC) of 0.52. The optimal computed Probability of False Detection (POFD), Probability of Detection (POD), the False Alarm Ratio (FAR) and the bias score (BIAS) are equal to 0.32, 0.88, 0.12 and 0.94, respectively. The study of the extreme values of the RR (the highest 10%) also shows satisfactory results (i.e., ME of 1.92 mm/h and CC of 0.75). The evaluation statistics are promising for operationally using this algorithm for rain estimation on a real-time basis. [ABSTRACT FROM AUTHOR]

Hydrochemical and isotopic characteristics of fluids from major geothermal fields of middle/low temperature in N/NE Greece are examined [basins: Strymon River (SR), Nestos River Delta (ND), Xanthi–Komotini (XK), Loutros–Feres–Soufli (LFS) and Rhodope Massif]. The geodynamic context is reflected to isotopic/chemical composition of fluids, heat flow values and elevated CO2 concentrations in emitted fluids. B and Li are derived from leaching of the geothermal systems hosting rocks. δ18OH2O, δ18OSO4, δ13CCO2 values and chemical compositions of Cl, B and Li of geothermal discharges suggest two distinct source fluids. Fluids in SR exhibit high B/Cl and Li/Cl ratios, suggesting these constituents are derived from associated magmas of intermediate composition (andesitic rocks). Geothermal discharges in LFS exhibit low B/Cl and Li/Cl ratios, implying acid (rhyolitic) magmatism. δ13CCO2 and CO2/(CO2 + 105He) ratios in the west part, suggest fluids affected by addition of volatiles released from subducted marine sediments. For the eastern systems, these ratios suggest gas encountered in systems issued from mixing of crustal and mantle-derived volatiles. Isotopic geothermometers reflect, for the same direction, equilibrium processes more (LFS, XK) or less (SR) pronounced and discriminate the geothermal field from low to middle [SR, ND (Erasmio)] and middle to high enthalpy [ND (Eratino), LFS, XK]. [ABSTRACT FROM AUTHOR]

Objective: Despite the progress in the management of patients with adult congenital heart disease (ACHD), a significant proportion of patients still develop pulmonary hypertension (PH). We aimed to highlight the rate of the complications in PH-ACHD and the predicting factors of cumulative mortality risk in this population.Methods: Data were obtained from the cohort of the national registry of ACHD in Greece from February 2012 until January 2018.Results: Overall, 65 patients receiving PH-specific therapy were included (mean age 46.1±14.4 years, 64.6% females). Heavily symptomatic (New York Heart Association (NYHA) class III/IV) were 53.8% of patients. The majority received monotherapy, while combination therapy was administered in 41.5% of patients. Cardiac arrhythmia was reported in 30.8%, endocarditis in 1.5%, stroke in 4.6%, pulmonary arterial thrombosis in 6.2%, haemoptysis in 3.1% and hospitalisation due to heart failure (HF) in 23.1%. Over a median follow-up of 3 years (range 1-6), 12 (18.5%) patients died. On univariate Cox regression analysis history of HF hospitalisation emerged as a strong predictor of mortality (HR 8.91, 95% CI 2.64 to 30.02, p<0.001), which remained significant after adjustment for age and for NYHA functional class.Conclusions: Long-term complications are common among patients with PH-ACHD. Hospitalisations for HF predict mortality and should be considered in the risk stratification of this population. [ABSTRACT FROM AUTHOR]

Background: Polypharmacy is a complex phenomenon with a number of negative effects. Objective: The aim of this study was to investigate the prevalence and characteristics of simple (6-10 medicines/person), major (> 11), and excessive (> 21) polypharmacy in patients aged ≥ 60 years in the suburban older age population of Greece. Methods: The prescribing records of 469 consecutive individuals, aged ≥ 60 years and with homogenous characteristics, who were clients of community pharmacies in two suburban areas of Greece (Athens and Thessaloniki) were examined over a period of 14 months. Medications used to treat chronic diseases were divided into 32 major categories and analyzed by age, sex, and medicine consumption. Results: Polypharmacy was identified in 56.5% of patient records, with 48.8% of records identifying simple polypharmacy and the remaining 7.7% identifying major polypharmacy, with no cases of excessive polypharmacy. An increased usage of chronic drug treatment was observed in the older age groups relative to younger age groups (70.8% of patients aged > 80 years received polypharmacy vs 52.8 and 47.6% of those aged 70-79 and 60-69 years, respectively). The use of polypharmacy did not differ significantly between sexes. The use of chronic disease medication was higher for polypharmacy patients in all drug categories. Conclusions: Polypharmacy in Greece, especially in older populations, still appears to be increasing, even in the era of e-prescriptions. [ABSTRACT FROM AUTHOR]

OBJECTIVE To identify patients with upper gastrointestinal symptoms and explore their clinical management in the primary care setting. METHOD The study population consisted of all patients who attended 5 rural health centers in the areas of Central Macedonia and Crete in Greece on 10 consecutive days. In total 992 patients were evaluated for upper gastrointestinal symptoms using questionnaires validated for Greek use: IDGP concerning dyspepsia and RDQ for Gastroesophageal Reflux Disease (GERD). All patients with positive indications were referred for upper endoscopy. Those patients who refused upper endoscopy were further evaluated for Helicobacter pylori (HP) infection with the urea breath test (UBT). RESULTS Of the 992 participants, 160 (16.12%) were found positive for dyspepsia according to the IDGP, while in 156 (15.72%) there were also symptoms of GERD. Twenty patients were found positive for HP through endoscopy and 65 through UBT. An increased frequency of upper gastrointestinal symptoms was observed in these two rural areas of Greece. CONCLUSIONS The use of specific questionnaires appears to contribute to the early identification and better clinical management of patients with upper gastrointestinal symptoms in primary care. [ABSTRACT FROM AUTHOR]

New sandstone petrology and petrostratigraphy provide insights on Palaeogene (Middle Eocene to Oligocene) clastics of the Thrace Basin in Greece, which developed synchronously with post-Cretaceous collision and subsequent Tertiary extension. Sandstone petrofacies are used as a tool to unravel complex geodynamic changes that occurred at the southern continental margin of the European plate, identifying detrital signals of the accretionary processes of the Rhodope orogen, as well as subsequent partitioning related to extension of the Rhodope area, followed by Oligocene to present Aegean extension and wide magmatic activity starting during the Early Oligocene. Sandstone detrital modes include three distinctive petrofacies: quartzolithic, quartzofeldspathic and feldspatholithic. Major contributions are from metamorphic basement units, represented mostly by low to medium-grade lithic fragments for the quartzolithic petrofacies and high-grade metamorphic rock fragments for the quartzofeldspathic petrofacies. Volcaniclastic sandstones were derived from different volcanic areas, with a composition varying from dominantly silicic to subordinate intermediate products (mainly rhyolitic glass, spherulites and felsitic lithics). Evolution of detrital modes documents contributions from three key source areas corresponding to the two main crystalline tectonic units: (i) the Variegated Complex (ultramafic complex), in the initial stage of accretion (quartzolithic petrofacies); (ii) the Gneiss-Migmatite Complex (quartzofeldspathic petrofacies); and (iii) the Circum-Rhodope Belt. The volcaniclastic petrofacies is interbedded with quartzofeldspathic petrofacies, reflecting superposition of active volcanic activity on regional erosion. The three key petrofacies reflect complex provenance from different tectonic settings, from collisional orogenic terranes to local basement uplift and volcanic activity. The composition and stratigraphic relations of sandstones derived from erosion of the Rhodope orogenic belt and superposed magmatism after the extensional phase in northern Greece provide constraints for palaeogeographic and palaeotectonic models of the Eocene to Oligocene western portions of the Thrace Basin. Clastic detritus in the following sedimentary assemblages was derived mainly from provenance terranes of the Palaeozoic section within the strongly deformed Rhodope Massif of northern Greece and south-east Bulgaria, from the epimetamorphic units of the Circum-Rhodope Belt and from superposed Late Eocene to Early Oligocene magmatism related to orogenic collapse of the Rhodope orogen. The sedimentary provenance of the Rhodope Palaeogene sandstones documents the changing nature of this orogenic belt through time, and may contribute to a general understanding of similar geodynamic settings. [ABSTRACT FROM AUTHOR]

In this study, modern, eco-friendly and cost-efficient ideas to enhance the competitiveness and to promote Green Ports are presented by taking into account the current situation of the ports, as well as the current legislation regarding the protection of the environment. This study is based on a bibliography survey, examining two Greek ports as case studies and investigating the integration and adaptation of the environmental legislation, national, international and European, in order to suggest improvements to move towards the idea of the perfect Green Port.This paper first introduces the idea of the green port. Then, the main legislation in force in Greece and Europe is briefly described aiming to answer the question if existent legislation leads to green ports or not. The existent situation in two Greek ports, the actions, and the measures that need to be made and taken in order to turn the Greek ports into Green ports are examined as case studies. The two Greek ports are the port of Igoumenitsa and the port of Patras This paper presents the main characteristics that feature a Green port. [ABSTRACT FROM AUTHOR]