Hellenic Society for the Study of Bone Metabolism

IntroductionPharmacists are among the most available and frequently consulted healthcare providers supporting older adults. They can actively contribute to thorough geriatric assessments and interventions and are often included in geriatric teams across different care settings. AimThis narrative review aims to compile current knowledge and practical approaches related to pharmacists’ roles in caring for older adults.MethodsWe searched in three databases and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Included studies were randomized clinical trials (RCTs) and systematic reviews, published between the years 2014 and 2024 in any language, reporting on the involvement of pharmacists in geriatric care, their interventions and results.ResultsFrom 306 identified different records, 32 studies were included in the final synthesis. The majority (22; 68.8%) were systematic reviews, ten were RCTs. The studies reported on the role of pharmacists in geriatric care in diverse settings including home, community, outpatient clinics, hospital, long-term care and residential facilities. While interventions were often multifaceted and complex, they more commonly comprised medication reviews and medication reconciliation. Positive outcomes resulting from pharmacists´ interventions were reported in 71.9% of the studies, mostly focused on medication appropriateness, deprescribing, medication safety and effectiveness.ConclusionOur narrative review highlights the growing evidence supporting the integration of pharmacists into geriatric care teams across diverse clinical settings. Despite heterogeneity among studies and limited high-certainty evidence, the findings underscore the potential of pharmacists to contribute meaningfully to person-centred, multidisciplinary care in this vulnerable population.

To explore the challenges and opportunities for the implementation of falls preventive services across Europe. An online cross-sectional survey among healthcare professionals was initiated by the European Geriatric Medicine Society (EuGMS) Special Interest Group on Falls and Fractures containing a Likert scale and multiple-choice questions on education and knowledge, current practices, barriers, and facilitators for falls prevention. Survey participation for healthcare professionals was encouraged by the EuGMS through an email invitation, website banner, and social media. National representatives from 24 countries further promoted it via societies, local networks, and hospital channels. A total of 1669 multidisciplinary healthcare professionals participated from 34 European countries (median 47 years; 75% female; 40.6% physicians (73.3% geriatricians/trainees), 36% physiotherapists, 23.4% other healthcare professionals). Only 26.9% believed their undergraduate education adequately prepared them for clinical practice in this area. A total of 75.8% of respondents reported opportunistically screening older adults for fall risk often or always during consultations. Gait and balance assessment was considered the most important and was the most frequently performed component of the multifactorial fall risk assessment. The top-five barriers were staffing issues, lack of time, older adults' non-adherence to recommended strategies, workload related to falls prevention, and prioritizing other tasks. The top-five facilitators were more time, easy-to-use guidelines, sufficient resources, increased education and training on falls prevention, and increased collaboration. We observed regional and country-level variation in these top barriers and facilitators. This survey highlights the need for improved undergraduate education in falls prevention across Europe. It is essential to educate and engage governmental bodies and insurers to secure their support and prioritization of falls prevention initiatives. Furthermore, enhancing education, addressing older adults' nonadherence, interdisciplinary collaboration and providing easy-to-use guidelines seem crucial for effective implementation. The falls prevention strategy should be tailored to the local context.

Predation of nests by a multitude of terrestrial predators is a major threat to sea turtle populations worldwide. Destruction of eggs decreases hatching success and reduces hatchling recruitment. The 43.5-km beach of Kyparissia Bay in Greece, hosting a large nesting population of loggerhead sea turtles (Caretta caretta), is subject to heavy nest predation by canids. Over 50% of nests were annually depredated in the 1980s and this triggered in 1992 an intensive long-term nest protection program through which the predation rate was reduced to about 13%. Continuous beach monitoring over decades revealed that nest numbers started to increase after 17-20 years from the onset of nest protection and in recent years reached exponential dimensions. Similarly, yearly tagging of nesting turtles showed, in the last decade, a significant increase in the percentage of neophyte turtles, i.e., those considered to be nesting for the first time. We attribute this extraordinary increase of nests largely to the maturing of hatchlings saved due to the intensive nest protection, since the time lag of 17-20 years falls within the boundaries of the maturation time of Mediterranean loggerheads. Our conclusion is further discussed in relation to the evolution of nest numbers at the nearby predator-free Zakynthos rookery that over the same time frame shows no significant increase of nests, although both populations share the same foraging habitats, and exhibit low nesting interchange, similar temperature regimes and female mortalities.

This phase IIb clinical trial evaluated the efficacy of a bimonthly treatment schedule (Q8W) with 4 subcutaneous doses of denosumab 120 mg among adults with Langerhans cell histiocytosis needing first-line systemic therapy for either multifocal single-system disease or multisystem disease without risk organ involvement. Two months after the last treatment administration, seven patients showed disease regression, one stable disease, one non-active disease, and one disease progression. One year after treatment, progression was evident in two patients, while the remaining exhibited either a regression (three patients) or non-active disease (five patients). No permanent sequalae developed during the study and no adverse events were adjudicated in treatment. In conclusion, four doses of denosumab 120 mg Q8W subcutaneously are an effective treatment option in Langerhans cell histiocytosis patients without risk organ involvement exhibiting a response rate of 80%. Further studies are needed to confirm its role as a disease modifying agent.

Abstract Conservation actions for endangered species often require detailed data over large temporal and spatial scales, which are usually hard to obtain from traditional scientific surveys that operate at localized scales. In contrast to the terrestrial conservation world where citizen science has become nowadays a highly relevant and useful tool to overcome such difficulties, Marine Citizen Science is still highly underrepresented. Using a dataset of 20 years of citizen science data and appropriate statistical modelling, we developed a methodological approach to monitor the presence of the endangered, notoriously elusive Mediterranean monk seal Monachus monachus. We used sighting data collected in Greece from 2000 to 2020 and fitted dynamic occupancy models that allow inferring range dynamics whilst accounting for species imperfect detectability to estimate species occupancy. The occurrence of Mediterranean monk seals of all age categories combined, and pups separately, increased during the study period. Mediterranean monk seal occurrence increased also spatially: the distribution of the species in Greece increased by approximately 12.5% for seals of all age categories and by approximately 185% for monk seal pups. Most of this distribution (i.e. 67 and 72% of the distribution of seals of all age categories and of pups, respectively) was located within the boundaries of the network of protected areas in the country. These results indicate a significant range recovery of the Mediterranean monk seal in Greece over the last two decades and facilitate the prioritization of conservation actions for the species in the country. We demonstrate how occupancy modelling and citizen science can be used to evaluate the distribution of an endangered species and become a highly relevant and reliable tool in marine mammal conservation. We advocate the increased use of citizen science in the conservation of the Mediterranean monk seal in the eastern Mediterranean Sea.

Purpose Gastric cancer is the fifth most common neoplasm worldwide with high rates of mortality. Afatinib, a low molecular, irreversible potent inhibitor of ErbB trans-membrane receptor family, has shown promising results according to preclinical and phase I clinical trial data when combined with chemotherapy. We aimed at evaluating the safety and efficacy of the combination of cisplatin, 5FU with afatinib in molecularly unselected patients with advanced gastric cancer. Methods Patients with locally advanced or metastatic gastric/gastroesophageal junction adenocarcinoma received first line combination therapy of cisplatin, 5FU and afatinib every 21 days, followed by afatinib maintenance monotherapy. The primary endpoint was the Objective Response Rate (ORR); secondary endpoints included Overall Survival (OS), Progression Free Survival (PFS) and the safety profile. Unplanned exploratory analysis of HER2 and tumor mutational profile was performed. Results Among 55 patients (ITT population) enrolled, 19 (34.5%) achieved an objective tumor response; stable disease was observed in 16 patients (29.1%) and progressive disease in 10 patients (18.2%). The ORR in the per protocol population (PP) was 42.9%. Within a median follow-up of 56 months, the median PFS and OS in the ITT population was 5.0 and 8.7 months, respectively. Seven of the 47 HER2 informative cases carried HER2 positive tumors while TP53, BRCA2 and SMAD4 were the most frequently mutated genes. The most common toxicities were neutrophil count and white blood cell decrease occurring in 56.4% of patients, followed by anemia (50.9%), hyperglycemia (40%), and diarrhea (38.2%). Conclusions The combination of cisplatin/5FU with afatinib did not surpass the benchmarks of efficacy of the contemporary therapeutic regimens that are being applied for the treatment of patients with advanced gastric cancer. However, the observed efficacy and the improved safety profile support that our administration schedule may be further investigated to overcome toxicity problems when integrating afatinib to cytotoxic chemotherapy. Clinical trial registration NCT01743365

Although acupuncture was first introduced to Greece in about 1938, it was not until 1973 that an institution was created to teach it, where its study was limited to medical doctors (MDs). Traditional Chinese medicine (TCM) was not taught to non-MDs until 2004. Even today, TCM has not been integrated into the Greek health system, and in a few exceptions, TCM was mainly associated with pain management. A few private schools teach TCM theory and practice in the fields of acupuncture, moxibustion, herbology, gua sha, and tui na (Chinese massage). This study examines the use of Chinese single herbs and formulas for prevention or treatment during the COVID-19 pandemic in Greece, as well as issues with the availability of Chinese herbs and proposals for substitutes from the traditional Greek medicine point of view.

Over the last few years, mismatch repair deficiency (MMR-D)/microsatellite instability (MSI) has been recognized as an indicator of colon carcinomas potentially susceptible to immunotherapy (1,2). To date, two strategies of identifying mismatch repair defects in tumor tissue have been employed: lack of immunohistochemical staining for mismatch repair proteins, in which case the term “mismatch repair deficiency” (MMR-D) is used, and detection of instability of microsatellite DNA tandem repeats in the tumor tissue DNA as compared to germline host DNA, in which case the term “microsatellite instability” (MSI) is used.

Mediterranean monk seals Monachus monachus are classified as Critically Endan- gered on the IUCN Red List, with <600 individuals split into 3 isolated sub-populations, the largest in the eastern Mediterranean Sea. Canine teeth collected during the last 2 decades from 45 dead monk seals inhabiting Greek waters were processed for age estimation. Ages were best estimated by counting growth layer groups (GLGs) in the cementum adjacent to the root tip using un - processed longitudinal or transverse sections (360 µm thickness) observed under polarized light. Decalcified and stained thin sections (8 to 23 µm) of both cementum and dentine were inferior to unprocessed sections. From analysing patterns of deposition in the cementum of known age- maturity class individuals, one GLG was found to be deposited annually in M. monachus. Ages ranged from 0.5 to 36 yr for females, 0.5 to 21 yr for males and 0.5 to 25.5 yr for individuals of un - known sex. The majority of seals (65%) were considered adults (≥4 yr), followed by juveniles (20%, <1 yr) and sub-adults (15%, 1�3.9 yr). Thirty percent of the aged sample had died from human-related causes, such as accidental entanglement in fishing gear and direct killings. A sin- gle-Gompertz growth curve was generated for both sexes using standard length data, resulting in asymptotic values of 212.3 cm for females and 221.8 cm for males. This study represents the first quantitative glimpse of sex-specific growth in monk seals and the age structure of dead individu- als in this rare species' core range.