Background and aim: We conducted an equivalence trial of quadruple non-bismuth “concomitant” and “hybrid” regimens for H. pylori eradication in a high clarithromycin resistance area. Methods: There were 321 treatment-naïve H. pylori-positive individuals in this multicenter clinical trial randomized to either the hybrid (esomeprazole 40 mg/bid, amoxicillin 1 g/bid for 7 days, then 7 days esomeprazole 40 mg/bid, amoxicillin 1 g/bid, clarithromycin 500 mg/bid, and metronidazole 500 mg/bid) or the concomitant regimen (all medications given concurrently bid for 10 days). Eradication was tested using histology and/or a 13C-urea breath test. Results: The concomitant regimen had 161 patients (90F/71M, mean 54.5 years, 26.7% smokers, 30.4% ulcer) and the hybrid regimen had 160 (80F/80M, mean 52.8 years, 35.6% smokers, 31.2% ulcer). The regimens were equivalent, by intention to treat 85% and 81.8%, (p = 0.5), and per protocol analysis 91.8% and 87.8%, (p = 0.3), respectively. The eradication rate by resistance, between concomitant and hybrid regimens, was in susceptible strains (97% and 97%, p = 0.6), clarithromycin single-resistant strains (86% and 90%, p = 0.9), metronidazole single-resistant strains (96% and 81%, p = 0.1), and dual-resistant strains (70% and 53%, p = 0.5). The side effects were comparable, except for diarrhea being more frequent in the concomitant regimen. Conclusions: A 14-day hybrid regimen is equivalent to a 10-day concomitant regimen currently used in high clarithromycin and metronidazole resistance areas. Both regimens are well tolerated and safe.

Ticks are temporary ectoparasites that serve as vectors for a wide range of pathogens affecting both wildlife and humans. In Greece, research on the prevalence of tick-borne pathogens in wildlife is limited. This study investigates the presence of pathogens, including Anaplasma spp., Babesia spp., Bartonella spp., Rickettsia spp., as well as tick-borne encephalitis (TBE), and Crimean–Congo hemorrhagic fever (CCHF) viruses, in ticks collected from 28 wild animals across 10 different animal species. Ticks were manually harvested and identified using molecular methods, with sequencing confirming the presence of Hyalomma aegyptium, H. marginatum, H. anatolicum, Ixodes frontalis, and I. ventalloi. Among the pathogens detected, R. aeschlimannii was the most prevalent, particularly in H. aegyptium ticks from tortoises. Additionally, R. africae was identified in H. aegyptium from tortoises, marking the first report of this pathogen in this tick species in Greece. Hemolivia mauritanica, an apicomplexan parasite commonly found in Testudo tortoises, was also detected. No evidence of Babesia spp., Anaplasma spp., Bartonella spp., or viral nucleic acid was found. Phylogenetic analysis revealed close genetic relationships between the detected Rickettsia species and those previously reported in neighboring regions. These findings underscore the role of wildlife in the epidemiology of tick-borne pathogens in Greece and highlight the need for comprehensive surveillance to prevent future outbreaks.

Helicobacter species affect humans and animals, mainly causing gastrointestinal but also extra-gastrointestinal pathologies. Besides Helicobacter pylori, which is the main human pathogen, Non-Helicobacter pylori Helicobacters (NHPH) are also associated with human diseases, thus raising concern about their zoonotic potential. Veterinarians are considered a risk group for NHPH infections and act as first-line communicators to animal owners about their prophylaxis. Therefore, we aimed to assess the knowledge and perception of veterinarians working in Greece about Helicobacter pylori and NHPH by asking them to participate anonymously in an online 34-question survey. The questionnaire consisted of three sections regarding environmental exposure to Helicobacter spp.; know-how about clinical signs in various species, including personal human experience; and willingness to get updated information about NHPH. Of the 111 respondents, 41.4% had not heard of H. suis (NHPH), and 35.0% were unaware of the species that could be affected. Almost 60.0% of companion animal veterinarians rarely suspect and 20.0% never suspect Helicobacter spp. infections in the case of gastritis. Nevertheless, 41.0% of respondents considered Helicobacter as zoonotic, and 87.0% wanted to receive information via professional channels and brochures. Despite the limited number of respondents and the exploratory nature of our study, as with similar data from Portugal, we emphasize the need to train veterinarians to have a more targeted focus on the zoonotic potential of Helicobacter within a One Health approach.