Persefoni Talimtzi

Background: Optimal inhaler technique (IT) is essential for effective asthma management, yet skill retention among health care professionals (HCPs) remains inconsistent. Aim: To compare the long‐term effectiveness of intensive versus brief educational interventions on IT retention among HCPs in pediatric emergency departments (PEDs) across Northern Greece. Methods: We conducted a 12‐month prospective, multicenter intervention study in 20 PEDs. Pediatric consultants, residents, and nurses were allocated to either an intensive education group—receiving IT training every 4 months—or a brief education group—receiving a single training session. Blinded assessments of IT skills were performed alongside structured questionnaires on asthma crisis management and IT with both a facemask and a mouthpiece. Final evaluations were conducted at 12 months. Results: A total of 373 HCPs participated: 84 consultants, 178 residents, and 111 nurses. Post‐intervention scores improved significantly for consultants (asthma crisis management: 69.94 to 76.54, p = 0.006; IT with facemask: 37.5 to 50, p = 0.003; IT with mouthpiece: 50 to 75, p = 0.005) and residents (61.15 to 70.89, p = 0.004; 25 to 50, p = 0.005; 50 to 75, p = 0.01, respectively). Intensive education was associated with significantly greater improvements compared with brief education, particularly among consultants ( p = 0.003 for asthma crisis management). Nurses did not demonstrate statistically significant improvements. Conclusions: Intensive, repeated training produces superior long‐term retention of IT skills among HCPs in PEDs compared with a single educational session. Incorporating structured, ongoing educational strategies into routine practice may enhance asthma care delivery and reduce reliance on nebulizers in acute pediatric settings.

Background: The clinical relevance of circulating B-cell subpopulations during the early period after kidney transplantation remains incompletely understood. Methods: In this prospective single-center study, frequencies and absolute numbers of peripheral B-cell subpopulations were longitudinally assessed by flow cytometry in 71 kidney transplant recipients before transplantation (T0) and at 3 (T3), 6 (T6) and 12 months (T12) post-transplant. Associations with graft function, rejection episodes and clinical variables were explored. Results: During the first post-transplant year, relative frequencies of total and naïve B cells declined, whereas absolute counts showed modest increases. Memory B-cells expanded over time, driven by both class-switched (CSBC) and class-non-switched (CNSBC) subsets. Transitional regulatory B cells (tBregs) and plasmablasts decreased significantly, while memory regulatory B cells (mBregs) remained stable. Pre-transplant B-cell profiles did not differ between recipients experienced rejection and those with stable graft function. At T12, rejection was associated with a shift toward a memory-dominant peripheral profile, characterized by reduced naïve representation. tBregs showed modest positive associations with graft function during follow-up. Hierarchical clustering identified naïve- and memory-dominant phenotypes representing distinct post-transplant immune compositions. Conclusions: Early post-transplant peripheral B-cell landscapes are dynamic and heterogeneous. Peripheral B-cell phenotyping shows limited value as a standalone clinical monitoring tool.

Background: Reporting of COVID-19 prognostic models frequently falls short of established standards. The TRIPOD checklist and its 2024 AI extension (TRIPOD + AI) provide a comprehensive framework for assessing reporting quality. We therefore evaluated and compared reporting completeness in conventional versus machine-learning models. Methods: Studies reporting the development, and internal and external validation of prognostic prediction models for COVID-19 using either conventional or machine learning-based algorithms were included. Literature searches were conducted in MEDLINE, Epistemonikos.org, and Scopus (up to July 31, 2024). Studies using conventional statistical methods were evaluated under TRIPOD, while machine learning-based studies were assessed using TRIPOD + AI. Data extraction followed TRIPOD and TRIPOD + AI checklists, measuring adherence per article and per checklist item. The protocol was prospectively registered at the Open Science Framework ( https://osf.io/kg9yw ). Results: A total of 53 studies describing 71 prognostic models were identified. Overall, adherence to both guidelines was low, with significantly poorer compliance among machine learning-based studies (TRIPOD + AI) compared to conventional model studies (TRIPOD) (28.4% vs. 38.1%, 95% CI of difference: 4.1–15.4). No study fully adhered to abstract reporting requirements, and appropriate titles were included in only a minority of cases (29.0%, 95% CI: 16.1–46.6 for TRIPOD; 13.6%, 95% CI: 4.8–33.3 for TRIPOD + AI). Sample size calculations were not fully reported in any study. Reporting of methods and results sections was poor across both frameworks. Conclusion: Lower adherence among machine learning studies reflects the relatively recent publication of the TRIPOD + AI guidelines (April 2024), which postdate many of the included studies. Both conventional and machine learning-based prediction models showed insufficient reporting, with major gaps in model description and performance reporting. Greater compliance with reporting guidelines is critical to improving the clarity, reproducibility, and clinical value of prediction model research.

Objectives/Background: B lymphocytes are involved in both graft function and rejection. The role of double-negative (DN) and marginal zone B (MZB) lymphocytes in transplantation remains unclear. This study aims to investigate their role one year after transplant. Methods: The frequency and absolute numbers of DN and MZB cells were determined by flow cytometry before transplantation and at 3, 6 and 12 months after transplant. They were correlated with graft function and rejection. Results: Both the frequency and absolute number of MZB and DN cells increased 12 months after transplantation. Variations were observed in the populations studied at different time points. The observed decrease in the frequency of MZB lymphocytes in kidney recipients with rejection at 12 months, the end of follow-up, was associated with rejection episodes. On ROC curve analysis, a cut-off value of <20.6% could be a predictor of rejection risk in the first 12 months after transplantation (sensitivity 72.7%, specificity 69.6%). No relationship was found between the frequencies and absolute numbers of cell populations and graft function at any time point. Conclusions: The kinetics of B cells (DN and MZB) were determined over the course of 12 months after kidney transplantation. The frequency of MZ B cells was associated with rejection episodes.

Background: To investigate the correlation of colour vision, visual acuity, contrast sensitivity, and photostress recovery time test scores in visually impaired patients. Materials and methods: A total of 133 subjects were enroled and 133 eyes were examined. The pathological group consisted of 76 (57.1%) males with an average age of 68.0 (SD=13.2) and 57 (42.9%) females, with an average age of 68.1 (SD=15.2), Mann–Whitney U test was used to evaluate the differences in K-colour tests, HRR, visual acuity, Contrast Sensitivity test and photostress recovery time test between two different groups of severity. Results: Correlations were found among colour vision tests, visual acuity, contrast sensitivity, and photostress recovery time scores in eyes with age-related macular degeneration, with diabetic retinopathy, with optic nerve diseases, and various other retinal diseases (P<0.05). In patients with moderate-visual impairments. Conclusions: The colour vision test scores correlate with the scores of visual acuity, contrast sensitivity, and photostess recovery time test. It may be a useful clinical surrogate for functional vision.

Background: The Inflammatory Bowel Disease-Disk (IBD-Disk) is a physician-administered tool that evaluates the functional status of patients with Inflammatory Bowel Disease (IBD). The aim of our study was to validate the content of the IBD-Disk in a Greek cohort of IBD patients. Methods: Two questionnaires [the IBD Disk and the IBD-Disability Index (IBD-DI)] were translated into Greek and administered to IBD patients at baseline visit, after 4 weeks and 6 months. Validation of the IBD Disk included measuring of concurrent validity, reproducibility, and internal consistency. Results: A total of 300 patients were included at baseline and 269 at follow-up. There was a good correlation between the total scores of the IBD-Disk and IBD-DI at baseline (Pearson correlation 0.87, p < 0.001). Reproducibility of the total IBD-Disk score was very good [intra-class correlation coefficient (ICC), 95% confidence interval (CI) 0.89 (0.86–0.91)]. Cronbach’s coefficient alpha for all items achieved 0.90 (95%CI 0.88–0.92), demonstrating a very good homogeneity of the IBD-Disk items. Female gender and extraintestinal manifestations were significantly associated with a higher IBD-Disk total score. Conclusions: The Greek version of the IBD-Disk proved to be a reliable and valid tool in detecting and assessing IBD-related disability in a Greek cohort of IBD patients.

RRH: Rural and Remote Health. Published article number: 6985 - Perceived risk and pandemic response awareness in low-capacity public primary health care in Greece

This study aims to provide an up-to-date meta-analysis of data from studies investigating the risk of bearing a child with autism spectrum disorder (ASD) after being conceived by assisted reproductive technology (ART). The study was conducted according to the PRISMA Statement. PubMed and Scopus databases were searched up to August 2, 2020. Observational studies using a type of conception of assisted reproductive technology and examined as outcome offspring with ASD were included. A random effect model was applied due to the heterogeneity of the studies. Statistical analysis was performed with Stata 13 software. The Newcastle–Ottawa scale was used to assess the methodological quality of the included studies. The search strategy identified 587 potentially relevant studies. A total of 15 studies provided adequate data for statistical comparisons and, therefore, were included in the meta-analysis. Analysis of the subset of studies that examined all offspring and controlled for confounder factors revealed that the use of ART is associated with a higher risk of ASD (RR = 1.11, 95% CI = 1.03–1.19, p < 0.009), while in the case of studies that focused on singletons, a statistically significant association between ART and ASD was not observed (RR = 0.96, 95% CI = 0.82–1.13, p = 0.654). Conclusion: The present meta-analysis confirmed the existing positive correlation between ART and ASD in offspring, suggesting that ART is correlated with a higher risk for bearing a child with ASD. In contrast, this relationship is not confirmed in singletons. High quality prospective studies with a larger number of participants are still required. What is Known: • Studies that investigated the association between ART and ASD in offspring have shown conflicting results. • A previous meta-analysis showed that offspring conceived by ART are 1.35 times more likely to develop ASD than offspring spontaneously conceived. What is New: • This investigation separately considered studies with and without adjustment for confounders. • The findings from the two analyses were similar.