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Tassopoulos A, Chalkias A, Papalois A, Karlovasiti P, Zanda JSA, Chatzidakis S, Gazouli M, Iacovidou N, Fanni D, Xanthos T. Assessment of Post-Resuscitation Intestinal Injury and Timing of Bacterial Translocation in Swine Anaesthetized With Propofol-Based Total Intravenous Anaesthesia. Cureus 2020; 12:e10362. [PMID: 33062485 PMCID: PMC7549874 DOI: 10.7759/cureus.10362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction and objectives Bacterial translocation (BT) is the passage of viable bacteria or endotoxins from the gastrointestinal lumen to extra-luminal tissues and is usually observed after intestinal ischaemia-reperfusion injury. The aim of this study was to investigate post-resuscitation BT after cardiac arrest and resuscitation in a swine anaesthetized with propofol-based total intravenous anaesthesia. Materials and methods Eighteen female Landrace/Large White piglets were randomly divided into control (CON), cardiac arrest (CA) and cardiac arrest-cardiopulmonary resuscitation (CA-CPR) groups. In the CON group, the animals were only monitored for two hours. In the CA group, the animals were not resuscitated and underwent necropsy immediately after cardiac arrest. In the CA-CPR group, the animals were resuscitated until the return of spontaneous circulation (ROSC) and were monitored for two hours. The animals of the CON and CA-CPR groups underwent necropsy 24 hours later. Bacterial translocation was assessed by blood and tissue cultures and endotoxin measurement in the portal and systemic circulation. Malondialdehyde content calculation and histological analysis of the intestine were performed in order to estimate ischemia and reperfusion (I/R) tissue damage. Results Malondialdehyde content, an indicator of oxidative stress, was significantly higher in the CA-CPR group compared to the CA in homogenized ileum (p=0.016). Malondialdehyde content in homogenized colon revealed significantly higher levels in the CA-CPR group compared to the CON (p=0.004) and the CA group (p=0.016). We found significantly higher levels of portal endotoxin in the CA-CPR group compared to the CON (p=0.026) and the CA group (p=0.026). The number of positive mesenteric lymph nodes cultures for E. coli was greater in the CA-CPR group, followed by the CA and CON groups, although the difference was not significant (67%, 33%, and 33%, respectively; p=0.407). Conclusions Malondialdehyde content and portal endotoxin levels do not increase during the cardiac arrest interval, but only after CPR and ROSC. Although the number of positive MLNs cultures was greater in the CA-CPR animals, no statistically significant differences were observed between the three groups due to the short monitoring period.
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Affiliation(s)
| | - Athanasios Chalkias
- Department of Anesthesiology, University of Thessaly, School of Health Sciences, Faculty of Medicine, Larisa, GRC
| | - Apostolos Papalois
- Translational Research and Training, ELPEN Research & Experimental Center, Athens, GRC
| | - Paraskevi Karlovasiti
- Department of Biopathology - Microbiology and Biochemistry, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | | | - Stefanos Chatzidakis
- Department of Medicine, European University Cyprus, School of Medicine, Nicosia, CYP
| | - Maria Gazouli
- Laboratory of Biology, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Nicoletta Iacovidou
- Department of Neonatology, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Daniela Fanni
- Division of Pathology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, ITA
| | - Theodoros Xanthos
- Department of Physiology and Pathophysiology, European University Cyprus, School of Medicine, Nicosia, CYP
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52
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Dimos A, Xanthopoulos A, Georgousi A, Eleftheriou M, Ekmektzoglou K, Iacovidou N, Kouskouni E, Papagiannis D, Chalkias A, Xanthos T, Skoularigis J, Triposkiadis F. Hellenic army recruits and change in tobacco use habits after entering military life. Hellenic J Cardiol 2020; 62:309-311. [PMID: 32846218 DOI: 10.1016/j.hjc.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/05/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Apostolos Dimos
- National and Kapodistrian University of Athens, Faculty of Medicine, Postgraduate Study Program (MSc) "Resuscitation", Athens, Greece; University General Hospital of Larissa, Department of Cardiology, Larissa, Greece
| | - Andrew Xanthopoulos
- University General Hospital of Larissa, Department of Cardiology, Larissa, Greece
| | - Anna Georgousi
- University of Patras, Department of Pharmacology, Patra, Greece
| | - Mavroudis Eleftheriou
- Aristotle University of Thessaloniki, Department of Mathematics, Thessaloniki, Greece
| | - Konstantinos Ekmektzoglou
- National and Kapodistrian University of Athens, Faculty of Medicine, Postgraduate Study Program (MSc) "Resuscitation", Athens, Greece; Army Share Fund Hospital (NIMTS), Department of Gastroenterology, Athens, Greece
| | - Nicoletta Iacovidou
- National and Kapodistrian University of Athens, Faculty of Medicine, Postgraduate Study Program (MSc) "Resuscitation", Athens, Greece; National and Kapodistrian University of Athens, Aretaieio Hospital, Department of Neonatology, Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - Evangelia Kouskouni
- National and Kapodistrian University of Athens, Faculty of Medicine, Postgraduate Study Program (MSc) "Resuscitation", Athens, Greece; National and Kapodistrian University of Athens, Aretaieio Hospital, Department of Biopathology, Athens, Greece
| | - Dimitrios Papagiannis
- University of Thessaly, School of Health Sciences, Department of Nursing, Larissa, Greece
| | - Athanasios Chalkias
- National and Kapodistrian University of Athens, Faculty of Medicine, Postgraduate Study Program (MSc) "Resuscitation", Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece; University of Thessaly - Faculty of Medicine, School of Health Sciences, Department of Anesthesiology and Perioperative Medicine, Larissa, Greece
| | - Theodoros Xanthos
- National and Kapodistrian University of Athens, Faculty of Medicine, Postgraduate Study Program (MSc) "Resuscitation", Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece; European University Cyprus, School of Medicine, Nicosia, Cyprus
| | - John Skoularigis
- University General Hospital of Larissa, Department of Cardiology, Larissa, Greece
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53
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Sokou R, Piovani D, Konstantinidi A, Tsantes AG, Parastatidou S, Lampridou M, Ioakeimidis G, Gounaris A, Iacovidou N, Kriebardis AG, Politou M, Kopterides P, Bonovas S, Tsantes AE. A Risk Score for Predicting the Incidence of Hemorrhage in Critically Ill Neonates: Development and Validation Study. Thromb Haemost 2020; 121:131-139. [PMID: 32838471 DOI: 10.1055/s-0040-1715832] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aim of the study was to develop and validate a prediction model for hemorrhage in critically ill neonates which combines rotational thromboelastometry (ROTEM) parameters and clinical variables. This cohort study included 332 consecutive full-term and preterm critically ill neonates. We performed ROTEM and used the neonatal bleeding assessment tool (NeoBAT) to record bleeding events. We fitted double selection least absolute shrinkage and selection operator logit regression to build our prediction model. Bleeding within 24 hours of the ROTEM testing was the outcome variable, while patient characteristics, biochemical, hematological, and thromboelastometry parameters were the candidate predictors of bleeding. We used both cross-validation and bootstrap as internal validation techniques. Then, we built a prognostic index of bleeding by converting the coefficients from the final multivariable model of relevant prognostic variables into a risk score. A receiver operating characteristic analysis was used to calculate the area under curve (AUC) of our prediction index. EXTEM A10 and LI60, platelet counts, and creatinine levels were identified as the most robust predictors of bleeding and included them into a Neonatal Bleeding Risk (NeoBRis) index. The NeoBRis index demonstrated excellent model performance with an AUC of 0.908 (95% confidence interval [CI]: 0.870-0.946). Calibration plot displayed optimal calibration and discrimination of the index, while bootstrap resampling ensured internal validity by showing an AUC of 0.907 (95% CI: 0.868-0.947). We developed and internally validated an easy-to-apply prediction model of hemorrhage in critically ill neonates. After external validation, this model will enable clinicians to quantify the 24-hour bleeding risk.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | | | - Andreas G Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Maria Lampridou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Georgios Ioakeimidis
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece
| | - Antonis Gounaris
- Neonatal Intensive Care Unit, University Hospital of Larissa, Larissa, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaeio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios G Kriebardis
- Department of Biomedical Science, Laboratory of Reliability and Quality Control in Laboratory Hematology, School of Health and Caring Science, University of West Attica, Egaleo, Greece
| | - Marianna Politou
- Department of Blood Transfusion, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Kopterides
- Intensive Care Unit, Excela Health Westmoreland Hospital, Greensburg, Pennsylvania, United States
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Argirios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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54
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Lampridou M, Sokou R, Tsantes AG, Theodoraki M, Konstantinidi A, Ioakeimidis G, Bonovas S, Politou M, Valsami S, Iliodromiti Z, Boutsikou T, Iacovidou N, Nikolopoulos G, Tsantes AE. ROTEM diagnostic capacity for measuring fibrinolysis in neonatal sepsis. Thromb Res 2020; 192:103-108. [DOI: 10.1016/j.thromres.2020.05.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/23/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023]
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55
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Tampakis K, Vogiatzakis N, Kontogiannis C, Spartalis M, Ntalianis A, Spartalis E, Siafaka I, Iacovidou N, Chalkias A, Xanthos T. Intravenous lipid emulsion as an antidote in clinical toxicology: a systematic review. Eur Rev Med Pharmacol Sci 2020; 24:7138-7148. [PMID: 32633409 DOI: 10.26355/eurrev_202006_21708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
OBJECTIVE Intravenous lipid emulsions (ILE) were developed many decades ago to supply nutritional requirements to patients unable to obtain adequate enteral nutrition. The utility of ILE was extended to therapeutics, facilitating the delivery of drugs. More recently, the potential for ILE to act as an antidote for inversion of drug toxicity has been recognized. This review aims to summarize the literature on ILE therapy as an antidote. Suggested mechanisms of action, safety profile, and recommendations on the administration of ILE in cases of drug intoxication are highlighted. MATERIALS AND METHODS A complete literature survey was performed using the PubMed database search to collect available information regarding mechanisms of ILE action as an antidote, ILE administration for drug toxicity, and presentation of adverse events. RESULTS A total of 102 studies met the selection criteria for inclusion in the review. Mainly used for local anesthetics toxicity, ILE therapy has been expanded in clinical toxicology involving overdose treatment of drugs other than local anesthetics. Partitioning in a lipid phase of fat droplets is a mechanism named the lipid sink phenomenon that has primarily been described to explain this action of ILE and remains the most widely accepted. At the same time, recent research has also revealed several molecular mechanisms that may contribute to ILE efficacy. CONCLUSIONS ILE therapy comprises a recognized approach in clinical toxicology. Due to the lack of randomized clinical trials, recommendations on administration are based on animal studies and published cases. Thus, the constantly increased knowledge about ILE therapy supports the need for a detailed appraisal.
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Affiliation(s)
- K Tampakis
- National and Kapodistrian University of Athens, Medical School, Postgraduate Study Program (MSc) "Cardiopulmonary Resuscitation", Athens, Greece.
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56
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Konstantinidi A, Sokou R, Tsantes AG, Parastatidou S, Bonovas S, Kouskouni E, Gounaris AK, Tsantes AE, Iacovidou N. Erratum: Thromboelastometry Variables in Neonates with Perinatal Hypoxia. Semin Thromb Hemost 2020; 46:e1. [PMID: 32492714 DOI: 10.1055/s-0040-1713395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Rozeta Sokou
- Neonatal Intensive Care Unit, Nikaia General Hospital "Aghios Panteleimon," Piraeus, Greece
| | - Andreas G Tsantes
- First Department of Orthopaedics, National & Kapodistrian University of Athens School of Medicine, Attikon University Hospital, Athens, Greece
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, Nikaia General Hospital "Aghios Panteleimon," Piraeus, Greece
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Humanitas Clinical and Research Center, Milan University, Milan, Italy
| | - Evaggelia Kouskouni
- Biopathology Laboratory, National & Kapodistrian University of Athens Medical School, Aretaieion Hospital, Athens, Greece
| | - Antonios K Gounaris
- Neonatal Intensive Care Unit, University Hospital of Larissa, Larissa, Greece
| | - Argyrios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, National & Kapodistrian University of Athens School of Medicine, "Attiko" Hospital, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, National and Kapodistrian University of Athens School of Medicine, Aretaieion Hospital, Athens, Greece
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57
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Konstantinidi A, Sokou R, Tsantes AG, Parastatidou S, Bonovas S, Kouskouni E, Gounaris AK, Tsantes AE, Iacovidou N. Thromboelastometry Variables in Neonates with Perinatal Hypoxia. Semin Thromb Hemost 2020; 46:428-434. [PMID: 32438424 DOI: 10.1055/s-0040-1709473] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Perinatal hypoxia is associated with an increased risk of coagulation disorders by enhancing the consumption of platelets and some clotting factors due to the associated severe hypoxemia, acidemia, and compromised oxygen and blood supply to the neonatal liver and bone marrow. Thromboelastometry (TEM), which estimates the dynamics of blood coagulation, may represent an attractive tool for studying the coagulation status of these neonates. We aimed at assessing the hemostatic profile of neonates with perinatal hypoxia using the standard extrinsically activated TEM (ex-TEM) assay. In total, 164 hospitalized neonates with perinatal asphyxia and/or fetal distress comprised the study subjects, and 273 healthy neonates served as controls. Ex-TEM assay was performed, SNAPPE (Score for Neonatal Acute Physiology Perinatal Extension) was calculated, and clinical findings and laboratory results were recorded in all study subjects. Hypoxic neonates expressed a prolonged clotting time (CT) and clot formation time (CFT) and reduced amplitude at 10 minutes (A10), α-angle, and maximum clot firmness compared with healthy neonates. Furthermore, asphyxiated neonates had a significantly prolonged CT and CFT and reduced A10 and α-angle compared with neonates with fetal distress. Hypoxic neonates demonstrate a hypocoagulable ex-TEM profile relative to healthy neonates, indicating a potential role of TEM in the early detection of coagulation derangement in perinatal hypoxia.
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Affiliation(s)
| | - Rozeta Sokou
- Neonatal Intensive Care Unit, Nikaia General Hospital "Aghios Panteleimon," Piraeus, Greece
| | - Andreas G Tsantes
- First Department of Orthopaedics, National & Kapodistrian University of Athens School of Medicine, Attikon University Hospital, Athens, Greece
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, Nikaia General Hospital "Aghios Panteleimon," Piraeus, Greece
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Humanitas Clinical and Research Center, Milan University, Milan, Italy
| | - Evaggelia Kouskouni
- Biopathology Laboratory, National & Kapodistrian University of Athens Medical School, Aretaieion Hospital, Athens, Greece
| | - Antonios K Gounaris
- Neonatal Intensive Care Unit, University Hospital of Larissa, Larissa, Greece
| | - Argyrios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, National & Kapodistrian University of Athens School of Medicine, "Attiko" Hospital, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, National and Kapodistrian University of Athens School of Medicine, Aretaieion Hospital, Athens, Greece
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58
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Iliodromiti Z, Christou E, Vrachnis N, Sokou R, Vrachnis D, Mihopoulou G, Boutsikou T, Iacovidou N. Serum and Urinary N-Terminal Pro-brain Natriuretic Peptides as Biomarkers for Bronchopulmonary Dysplasia of Preterm Neonates. Front Pediatr 2020; 8:588738. [PMID: 33194922 PMCID: PMC7655774 DOI: 10.3389/fped.2020.588738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/14/2020] [Indexed: 11/13/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a common cause of respiratory illness in preterm newborns with high morbidity and mortality rates. At present, there are no early prognostic biomarkers that can be used in clinical practice to predict the development of BPD. In this review, we critically appraise evidence regarding the use of serum N-terminal pro-brain natriuretic peptide (NTproBNP) levels as a biomarker for BPD in neonates. Furthermore, we summarize studies assessing the feasibility of urinary NTproBNP levels as a non-invasive method to predict BPD in preterm infants. Multiple studies reported a strong association between NTproBNP serum levels and the onset of BPD. For urinary NTproBNP there is scarce evidence showing an association with BPD. Given the promising data obtained by preliminary studies, further assessment of this biomarker in both serum and urine is needed. Standardized reference values should be defined before conducting any further clinical studies.
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Affiliation(s)
- Zoi Iliodromiti
- Neonatal Department, Aretaieio Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Christou
- Neonatal Department, Aretaieio Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Vrachnis
- Third Obstetrics and Gynecology Department, Attikon Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece.,Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
| | - Rozeta Sokou
- NICU, "Agios Panteleimon" General Hospital of Nikaia, Piraeus, Greece
| | - Dionysios Vrachnis
- Endocrinology Unit, Second Obstetrics and Gynecology Department, Aretaieio Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Mihopoulou
- Second Obstetrics and Gynecology Department, Aretaieio Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, Aretaieio Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
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59
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Politou M, Mougiou V, Kollia M, Sokou R, Kafalidis G, Iliodromiti Z, Valsami S, Boutsikou T, Iacovidou N. High-Risk Pregnancies and Their Impact on Neonatal Primary Hemostasis. Semin Thromb Hemost 2019; 46:435-445. [PMID: 31858517 DOI: 10.1055/s-0039-3400258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Primary hemostasis, similar to other systems in the adjusting and transitioning neonate, undergoes developmental adaptations in the first days of life. Although platelets of neonates do not differ quantitatively compared with those of adults, they functionally present with major differences, thus supporting the theory of a "hypofunctional" phenotype that is counterbalanced by high hematocrit and more potent von Willebrand factor multimers. No clinical effect of bleeding tendency has hence been established so far for healthy term neonates. However, discrepancies in functionality have been noted, associated with gestational age, with more pronounced platelet hyporesponsiveness in preterm neonates. Multiple methods of in vitro platelet function evaluation such as PFA-100/200, platelet aggregometry, flow cytometry, and cone and platelet analyzer have been used for assessment of neonatal primary hemostasis. Several pregnancies are characterized as "high-risk" when risk factors preexist in maternal history or evolve during pregnancy. These pregnancies require specialized observation as they may have unpredictable outcome. High-risk pregnancies include clinical entities such as preeclampsia, pregnancy-induced smoking during pregnancy, gestational diabetes mellitus (GDM), autoimmune diseases, and other maternal hematological conditions. In some cases, like systemic lupus erythematosus, antiphospholipid antibody syndrome, and maternal immunologically based thrombocytopenia, neonatal thrombocytopenia is regarded as a prominent hemostasis defect, while in others, like pregnancy-induced hypertension and preeclampsia, both quantitative and qualitative disorders of neonatal platelets have been reported. In other pathologies, like GDM, neonatal primary hemostasis remains vastly unexplored, which raises the need for further investigation. The extent to which primary hemostasis is affected in neonates of high-risk pregnancies is the main objective of this narrative review.
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Affiliation(s)
- Marianna Politou
- Hematology Laboratory-Blood Bank, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Mougiou
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Kollia
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rozeta Sokou
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Kafalidis
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Serena Valsami
- Hematology Laboratory-Blood Bank, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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60
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Konstantinidi A, Sokou R, Parastatidou S, Lampropoulou K, Katsaras G, Boutsikou T, Gounaris AK, Tsantes AE, Iacovidou N. Clinical Application of Thromboelastography/Thromboelastometry (TEG/TEM) in the Neonatal Population: A Narrative Review. Semin Thromb Hemost 2019; 45:449-457. [PMID: 31195422 DOI: 10.1055/s-0039-1692210] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hemostasis is a dynamic age-related process, which gradually evolves from fetal life throughout childhood until adulthood. Although at birth there is a hemostatic deficit of most coagulation factors, studies have shown that this "hemostatic immaturity" is functionally counterbalanced in healthy term or preterm newborns. This delicate hemostatic balance is, however, deranged in sick neonates, resulting in an enhanced risk of hemorrhage and/or thrombosis. In critically ill neonates, conventional coagulation tests do not seem to provide reliable information or indications regarding the functional status of platelets or fibrinolysis. In contrast, viscoelastic tests, namely thromboelastography/thromboelastometry (TEG/TEM) hold promise for rapid assessment of the whole hemostatic potential, allowing immediate intervention should this be required. However, neonatal data are limited due to lack of reference values, especially in premature neonates. In this narrative review, we provide some insights around current knowledge regarding TEG/TEM applications in healthy and sick newborns. Overall, the use of viscoelastic tests in diagnosis and management of coagulation disorders in neonates is definitely worth further exploration. Consideration should be made to include these tests in the routine laboratory investigation of neonates and specific transfusion algorithms should also be developed in order to avoid treatment pitfalls.
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Affiliation(s)
| | - Rozeta Sokou
- NICU Nikaia General Hospital "Agios Panteleimon", Piraeus, Greece
| | | | | | - George Katsaras
- NICU Nikaia General Hospital "Agios Panteleimon", Piraeus, Greece
| | - Theodora Boutsikou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaeio Hospital, Athens, Greece
| | | | - Argyrios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaeio Hospital, Athens, Greece
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61
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Sokou R, Konstantinidi A, Stefanaki C, Tsantes AG, Parastatidou S, Lampropoulou K, Katsaras G, Tavoulari E, Iacovidou N, Kyriakou E, Gounaris A, Bonovas S, Tsantes AE. Thromboelastometry: studying hemostatic profile in small for gestational age neonates-a pilot observational study. Eur J Pediatr 2019; 178:551-557. [PMID: 30707363 DOI: 10.1007/s00431-019-03331-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 12/23/2022]
Abstract
Scarce data exists about the hemostatic status of small for gestational age (SGA) neonates. We aimed at evaluating the hemostatic profile of SGA neonates, using thromboelastometry (TEM). This is an observational study performed in a Greek tertiary General Hospital during an 18-month period. Ninety-three neonates were included in the study: 48 appropriate for gestational age weight (AGA) neonates and 45 SGA neonates Extrinsically activated TEM (ex-TEM) parameters, such as clotting time, clot formation time, amplitude recorded at 5 and 10 min, a angle, maximum clot firmness, lysis index at 60 min, and also platelet count, were used for the evaluation of the hemostatic profile in all neonates. No statistically significant differences were noticed regarding all ex-TEM parameters between AGA and SGA neonates, while no event of hemorrhage or thrombosis was noticed in the study population.Conclusions: The coagulation system of SGA neonates seems to be fully functional, with no evident tendency toward coagulopathy or thrombosis, when compared with AGA neonates. TEM seems to provide a promising and valid assessment of coagulation and fibrinolysis systems and may be used as a valuable biomarker, in the future. Further studies, with large samples, are necessary to confirm our results. What is Known: • SGA neonates may present coagulation disorders mainly due to hepatic dysfunction, polycythemia, and thrombocytopenia owing to long-term intrauterine hypoxia. • In the literature, despite the statistically significant differences in laboratory results between SGA and AGA neonates, no clinical manifestations of significantly altered hemostasis were recorded. Data of TEM interpretation of hemostasis in SGA neonates are not available. What is New: • TEM seems to interpret coagulation mechanism of preterm and full-term SGA neonates and confirm previous relevant literature findings regarding hemostasis in these neonates.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, Nikaia General Hospital "Aghios Panteleimon", Piraeus, Greece.
| | | | - Charikleia Stefanaki
- Neonatal Intensive Care Unit, Nikaia General Hospital "Aghios Panteleimon", Piraeus, Greece
| | - Andreas G Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, Nikaia General Hospital "Aghios Panteleimon", Piraeus, Greece
| | - Katerina Lampropoulou
- Neonatal Intensive Care Unit, Nikaia General Hospital "Aghios Panteleimon", Piraeus, Greece
| | - George Katsaras
- Neonatal Intensive Care Unit, Nikaia General Hospital "Aghios Panteleimon", Piraeus, Greece
| | - Evagelia Tavoulari
- Neonatal Intensive Care Unit, Nikaia General Hospital "Aghios Panteleimon", Piraeus, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaeio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias Kyriakou
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Gounaris
- Neonatal Intensive Care Unit, University Hospital of Larissa, Larissa, Greece
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Humanitas Clinical and Research Center, Milan, Italy
| | - Argirios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Sidiropoulou EJ, Paltoglou G, Valsamakis G, Margeli A, Mantzou A, Papassotiriou I, Hassiakos D, Iacovidou N, Mastorakos G. Biochemistry, hormones and adipocytokines in prepubertal children born with IUGR evoke metabolic, hepatic and renal derangements. Sci Rep 2018; 8:15691. [PMID: 30356143 PMCID: PMC6200759 DOI: 10.1038/s41598-018-34075-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 10/08/2018] [Indexed: 12/15/2022] Open
Abstract
Children born with IUGR develop features of the metabolic syndrome and exhibit deranged markers of hepatorenal physiology. Metabolic and hepatorenal biochemistry and the rs9939609 FTO polymorphism were investigated in prepubertal children born with IUGR. Ninety-eight prepubertal children (46 IUGR and 52 AGA), subdivided in <5 years and >5 years old groups were included. Anthropometry; creatinine, eGFR, urea, AST, ALT, triglycerides, uric acid, total cholesterol, HDL-c, LDL-c, glucose, C-peptide, insulin and glucagon z-scores; HOMA-IR; leptin and adiponectin concentrations; rs9939609 FTO polymorphism frequency were measured. In males, weight and ALT were higher and adiponectin was lower, in IUGR < 5 years; C-peptide, insulin and leptin were higher in IUGR > 5 years; C-peptide was higher in all IUGR, than the respective AGA. In females, creatinine and triglycerides were higher in IUGR < 5 years old; creatinine was higher and eGFR was lower in all IUGR, than the respective AGA. In males and females, creatinine was higher in all IUGR, than the respective AGA; C-peptide, insulin and HOMA-IR were lower, and AST was higher in IUGR < 5 than in IUGR > 5 years old. FTO rs9939609 frequency did not differ between IUGR and AGA. In conclusion prepubertal males born with IUGR increased weight, insulin and leptin and decreased adiponectin, as compared to males born AGA, emerge as early metabolic syndrome characteristics. The concentrations of these hormones do not differ between prepubertal males and females born with IUGR. Weight control, healthy nutrition and physical exercise should be recommended to these children. The deranged renal (particularly evident in females below the age of 5) and liver biochemistry in prepubertal children born with IUGR suggests that hepatorenal derangements might commence in utero. Regular checkup of biochemical and lipid profile is recommended for all children born with IUGR.
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Affiliation(s)
- Elpida J Sidiropoulou
- Endocrine Unit, "Aretaieion" Hospital, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
| | - George Paltoglou
- Endocrine Unit, "Aretaieion" Hospital, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
- First Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
| | - George Valsamakis
- Endocrine Unit, "Aretaieion" Hospital, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
| | - Alexandra Margeli
- Department of Clinical Biochemistry, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Aimilia Mantzou
- First Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Dimitrios Hassiakos
- Second Department of Obstetrics and Gynecology, "Aretaieion" Hospital, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, "Aretaieion" Hospital, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
| | - George Mastorakos
- Endocrine Unit, "Aretaieion" Hospital, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece.
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63
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Kourek C, Greif R, Georgiopoulos G, Castrén M, Böttiger B, Opolski G, Makinen M, Zouganeli V, Iacovidou N, Tsekoura D, Dougenis D, Xanthos T. Comparing health care professionals’ CPR-knowledge between different specialties, departments and educational training in Europe. Resuscitation 2018. [DOI: 10.1016/j.resuscitation.2018.07.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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64
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Petta V, Perlikos F, Loukides S, Bakakos P, Chalkias A, Iacovidou N, Xanthos T, Tsekoura D, Hillas G. Therapeutic effects of the combination of inhaled beta2-agonists and beta-blockers in COPD patients with cardiovascular disease. Heart Fail Rev 2018; 22:753-763. [PMID: 28840400 DOI: 10.1007/s10741-017-9646-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major health problem worldwide, with co-morbidities contributing to the overall severity and mortality of the disease. The incidence and prevalence of cardiovascular disease among COPD patients are high. Both disorders often co-exist, mainly due to smoking, but they also share common underlying risk factors, such as aging and low-grade systemic inflammation. The therapeutic approach is based on agents, whose pharmacological properties are completely opposed. Beta2-agonists remain the cornerstone of COPD treatment due to their limited cardiac adverse effects. On the other hand, beta-blockers are administered in COPD patients with cardiovascular disease, but despite their proven cardiac benefits, they remain underused. There is still a trend among physicians over underprescription of these drugs in patients with heart failure and COPD due to bronchoconstriction. Therefore, cardioselective beta-blockers are preferred, and recent meta-analyses have shown reduced rates in mortality and exacerbations in COPD patients treated with beta-blockers.
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Affiliation(s)
- Vasiliki Petta
- Medical School, Postgraduate Study Program (MSc) "Cardiopulmonary Resuscitation", National and Kapodistrian University of Athens, Athens, Greece.
| | - Fotis Perlikos
- Pulmonary Division, Department of Critical Care, University of Athens Medical School, Evangelismos Hospital, Athens, Greece
| | - Stelios Loukides
- 2nd Department of Respiratory Medicine, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, Athens, Greece
| | - Petros Bakakos
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, Medical School, Sotiria University Hospital, Athens, Greece
| | - Athanasios Chalkias
- Medical School, Postgraduate Study Program (MSc) "Cardiopulmonary Resuscitation", National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - Nicoletta Iacovidou
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
- Department of Neonatology, National and Kapodistrian University of Athens, Medical School, Aretaieio University Hospital, Athens, Greece
| | - Theodoros Xanthos
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
- European University Cyprus, School of Medicine, Nicosia, Cyprus
| | - Dorothea Tsekoura
- Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Aretaieio University Hospital, Athens, Greece
| | - Georgios Hillas
- Pulmonary Division, Department of Critical Care, University of Athens Medical School, Evangelismos Hospital, Athens, Greece
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65
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Kontouli Z, Staikou C, Iacovidou N, Mamais I, Kouskouni E, Papalois A, Papapanagiotou P, Gulati A, Chalkias A, Xanthos T. Resuscitation with centhaquin and 6% hydroxyethyl starch 130/0.4 improves survival in a swine model of hemorrhagic shock: a randomized experimental study. Eur J Trauma Emerg Surg 2018; 45:1077-1085. [PMID: 30006694 DOI: 10.1007/s00068-018-0980-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 07/10/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE To investigate the effects of the combination of centhaquin and 6% hydroxyethyl starch 130/0.4 (HES 130/0.4) in a swine model of hemorrhagic shock. METHODS Twenty Landrace-Large White pigs were instrumented and subjected to hemorrhagic shock. The animals were randomly allocated in two experimental groups, the control (group CO, n = 10) and the centhaquin groups (0.015 mg/kg, n = 10, group CH). Acute hemorrhage was induced by stepwise blood withdrawal (18 mL/min) from the internal jugular vein until MAP decreased to 40-45 mmHg, whereas anesthesia remained constant. All animals received HES 130/0.4 solution in the resuscitation phase until their mean arterial pressure (MAP) reached 90% of the baseline. The animals were observed for 60 min, during which no further resuscitation was attempted. RESULTS The total amount of blood and the bleeding time did not differ significantly between group CO and group CH (120 ± 13 vs. 120 ± 14 mL, p = 0.6; 20 ± 2 vs. 20 ± 1 min, p = 0.62, respectively). During the hemorrhagic phase, only a difference in heart rate (97.6 ± 4.4 vs. 128.4 ± 3.6 beats/min, p = 0.038) was observed between the two groups. The time required to reach the target MAP was significantly shorter in the centhaquin group compared to controls (13.7 ± 0.4 vs. 19.6 ± 0.84 min, p = 0.012). During the resuscitation phase, a statistical significant difference was observed in MAP (75.2 ± 1.6 vs. 89.8 ± 2.1 mmHg, p = 0.02) between group CO and group CH. During the observation phase, a statistical significant difference was observed in SVR (1109 ± 32.65 vs. 774.6 ± 21.82 dyn s/cm5, p = 0.039) and cardiac output (5.82 ± 0.31 vs. 6.9 ± 0.78 L/min, p = 0.027) between the two groups. Two animals of group CO and seven animals of group CH survived for 24 h (p = 0.008). We observed a marked increase in microvascular capillary permeability in group CO compared to group CH, with the wet/dry weight ratio being significantly higher in group CO compared to group CH (4.8 ± 1.6 vs. 3.08 ± 0.6, p < 0.001). CONCLUSIONS The combination of centhaquin 0.015 mg/kg and HES 130/0.4 resulted in shorter time to target MAP, lower wet-to-dry ratio, and better survival rates after resuscitation from hemorrhagic shock.
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Affiliation(s)
- Zinais Kontouli
- Postgraduate Study Program (MSc) "Cardiopulmonary Resuscitation", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Chryssoula Staikou
- Department of Anesthesiology, Medical School, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicoletta Iacovidou
- Postgraduate Study Program (MSc) "Cardiopulmonary Resuscitation", Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neonatology, Medical School, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - Ioannis Mamais
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Department of Health Sciences, European University Cyprus, Nicosia, Cyprus
- Department of Life Sciences, European University Cyprus, Nicosia, Cyprus
| | - Evaggelia Kouskouni
- Postgraduate Study Program (MSc) "Cardiopulmonary Resuscitation", Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Department of Biopathology, Medical School, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Anil Gulati
- Department of Pharmaceutical Sciences, Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, USA
| | - Athanasios Chalkias
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.
- Department of Anesthesiology and Perioperative Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece.
- , Larisa, Greece.
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66
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Miaris N, Samantas E, Siafaka I, Logothetis E, Iacovidou N, Chalkias A, Xanthos T. Views of cancer patients regarding cardiopulmonary resuscitation in Greece. Eur J Cancer Care (Engl) 2018; 27:e12850. [PMID: 29672984 DOI: 10.1111/ecc.12850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 11/28/2022]
Abstract
Cardiopulmonary resuscitation (CPR) in patients with cancer is an ethical issue of worldwide interest. A questionnaire-based study was carried out in a Greek oncology hospital aiming to explore the attitude of Greek cancer patients towards CPR. Overall, 200 patients (94 male, 106 female) of a mean age of 62.8 years took part in the study. Only 42 (21%) patients indicated that they knew what CPR really involves and only 20 (10%) patients thought that CPR has serious side effects, while the mean estimated in-hospital CPR survival rate to hospital discharge was 56.6% (minimum = 2%, maximum = 99%, standard deviation [SD] = 25.16) and 42.1% (minimum = 0%, maximum = 90%, SD = 24.56%) in case of unselected and cancer patients respectively. Despite their poor knowledge, 177 (88.5%) patients were willing to undergo CPR in case of an in-hospital arrest, 127 (63.5%) thought that they had the right to choose their CPR status and 141 (70.5%) believed that they should be asked about it when they enter the hospital. Most patients (36%) wanted their CPR status to be decided by themselves, their family and their doctor jointly. These findings indicate that specific measures should be applied to clinical practice in order to best manage this ethical issue, and consequently, improve cancer care.
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Affiliation(s)
- N Miaris
- Postgraduate Study Program (MSc) "Cardiopulmonary Resuscitation", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Third Department of Medical Oncology, "Agioi Anargyroi" General Oncology Hospital of Kifisia, Athens, Greece.,Department of Cardiology, "Tzaneio" General Hospital of Piraeus, Piraeus, Greece
| | - E Samantas
- Third Department of Medical Oncology, "Agioi Anargyroi" General Oncology Hospital of Kifisia, Athens, Greece
| | - I Siafaka
- Pain Relief and Palliative Care Unit, Department of Anesthesiology and Pain Therapy, First Anesthesiology Clinic, Medical School, Aretaieio University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - E Logothetis
- Department of Biopathology, Aretaieio University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - N Iacovidou
- Postgraduate Study Program (MSc) "Cardiopulmonary Resuscitation", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neonatology, Aretaieio University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - A Chalkias
- Postgraduate Study Program (MSc) "Cardiopulmonary Resuscitation", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - T Xanthos
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.,Medical School, European University Cyprus, Nicosia, Cyprus
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67
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Kollia M, Sokou R, Patsouras G, Panagiotounakou P, Iacovidou N, Konstantinidi A. Congenital diaphragmatic hernia and double-outlet right ventricle: elements of trisomy 18? Case Reports in Perinatal Medicine 2018. [DOI: 10.1515/crpm-2017-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
We present a case of a term male neonate born with congenital diaphragmatic hernia (CDH), double-outlet right ventricle (DORV) and a “picture of genetic syndrome”, antenatally diagnosed, without any confirmation of a particular syndrome as no amnioparacentesis was performed. The postnatal chromosomal analysis revealed trisomy 18.
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Affiliation(s)
- Maria Kollia
- Department of Neonatology , National and Kapodistrian University of Athens , Medical School, Aretaieion Hospital , Athens , Greece
| | - Rozeta Sokou
- NICU, “Aghios Panteleimon”, Nikaia General Hospital , Piraeus , Greece
| | - George Patsouras
- NICU, “Aghios Panteleimon”, Nikaia General Hospital , Piraeus , Greece
| | | | - Nicoletta Iacovidou
- Department of Neonatology , National and Kapodistrian University of Athens , Medical School, Aretaieion Hospital , Athens , Greece
| | - Aikaterini Konstantinidi
- NICU, “Aghios Panteleimon” Nikaia General Hospital , Mantouvalou 3, Nikaia, PO Box: 18454 , Piraeus , Tel : 00306977242274 Greece
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68
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Adamos G, Iacovidou N, Xanthos T. Medical Therapy for Long QT Syndrome. Mini Rev Med Chem 2018; 18:495-506. [DOI: 10.2174/1389557517666170707110000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 10/10/2016] [Accepted: 05/11/2017] [Indexed: 11/22/2022]
Affiliation(s)
- Georgios Adamos
- National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nicoletta Iacovidou
- National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theodoros Xanthos
- European University Cyprus, Nicosia 6, Diogenis Street, 2404 Engomi, Nicosia, Cyprus
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69
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Sokou R, Giallouros G, Konstantinidi A, Pantavou K, Nikolopoulos G, Bonovas S, Lytras T, Kyriakou E, Lambadaridis I, Gounaris A, Douramani P, Valsami S, Kapsimali V, Iacovidou N, Tsantes AE. Thromboelastometry for diagnosis of neonatal sepsis-associated coagulopathy: an observational study. Eur J Pediatr 2018; 177:355-362. [PMID: 29255948 DOI: 10.1007/s00431-017-3072-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/01/2017] [Accepted: 12/08/2017] [Indexed: 01/01/2023]
Abstract
UNLABELLED Our aim was to evaluate the potential role of standard extrinsically activated thromboelastometry (EXTEM) assay in the early detection of neonatal sepsis. We studied 91 hospitalized neonates categorized in two groups: group A included 35 neonates with confirmed sepsis, while group B included 56 neonates with suspected sepsis; 274 healthy neonates served as controls. Whenever sepsis was suspected, EXTEM assay was performed, Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE) and Tοllner score were calculated, and clinical findings and laboratory results were recorded. Septic neonates had significantly prolonged clotting time (CT) and clot formation time (CFT), and reduced maximum clot firmness (MCF), compared to neonates with suspected sepsis (p values 0.001, 0.001, and 0.009, respectively) or healthy neonates (p values 0.001, 0.001, and 0.021, respectively). EXTEM parameters (CT, CFT, MCF) demonstrated a more intense hypocoagulable profile in septic neonates with hemorrhagic diathesis than those without (p values 0.021, 0.007, and 0.033, respectively). In septic neonates, CFT was correlated with platelet count, SNAPPE, Tollner score, and day of full enteral feeding (p values 0.01, 0.02, 0.05, and 0.03, respectively). CONCLUSIONS A ROTEM hypocoagulable profile at admission seems promising for the early detection of sepsis in neonates while the degree of hypocoagulation may be associated with sepsis severity. What is Known: • The early phase of septicemia might be difficult to be recognized in neonates. In adult septic patients, the diagnostic and prognostic role of thromboelastometry (ROTEM) have been extensively investigated. • Limited data are available on the role of ROTEM as an indicator of early neonatal sepsis. What is New: • ROTEM measurements indicate an early appearance of hypocoagulability in neonatal sepsis, while the degree of hypocoagulation might be associated with severity of sepsis. • ROTEM could be a useful tool in the early detection of sepsis in neonates.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikaia, Piraeus, Greece
| | | | | | | | | | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Humanitas Clinical and Research Center, Milan, Italy
| | - Theodore Lytras
- Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Elias Kyriakou
- Laboratory of Haematology and Blood Bank Unit, School of Medicine, "Attiko" University Hospital, National and Kapodistrian University of Athens, 1 Rimini Str, 12462, Athens, Greece
| | - Ioannis Lambadaridis
- Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikaia, Piraeus, Greece
| | - Antonis Gounaris
- Neonatal Intensive Care Unit, University Hospital of Larissa, Larissa, Greece
| | - Panagiota Douramani
- Laboratory of Haematology and Blood Bank Unit, School of Medicine, "Attiko" University Hospital, National and Kapodistrian University of Athens, 1 Rimini Str, 12462, Athens, Greece
| | - Serena Valsami
- Department of Blood Transfusion, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Violetta Kapsimali
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaeio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Argirios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, School of Medicine, "Attiko" University Hospital, National and Kapodistrian University of Athens, 1 Rimini Str, 12462, Athens, Greece.
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Iacovidou N, Kollia M, Nana E, Boutsikou T, Savvidis C, Kattamis A, Kyriakopoulou D, Ladis V. Spontaneous Fertility in a Male Thalassemic Patient after Allogeneic Hematopoietic Cell Transplantation. Thalassemia Reports 2017. [DOI: 10.4081/thal.2017.7090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patients with thalassemia major who received allogeneic hematopoietic cell transplantation are at increased risk of gonadal insufficiency and reduced fertility due to the toxicity of both the transfusional iron overload and the gonadotoxic effects of drugs used in the conditioning regimen. We present a case of an ex-thalassemic patient with spontaneous recovery of spermatogenesis that fathered a healthy, term male neonate. Maternal hemoglobin electrophoresis was within normal limits. At the age of 9.5 years the patient underwent hematopoietic cell transplantation. The conditioning therapy included busulfan (16 mg/kg) and cyclophosphamide (200 mg/kg). No irradiation was administered. Thirty-two days after the hematopoietic cell transplantation the patient developed acute graft-versus-host disease needing long-term treatment with methylprednisolone, cyclosporine and immunoglobulin. Although consecutive semen analyses after the hematopoietic cell transplantation revealed azoospermia, the last semen analysis before conception, at the age of 33 years, was improved and normal follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone (Te) levels were detected. The current pregnancy was the result of physical conception. In this case, it seems that thalassemia major along with the respective treatment prior to- and posthematopoietic cell transplantation did not irreparably impair spermatogenesis, probably due to the pre-pubertal time frame they were implemented.
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Galatianou I, Karlis G, Apostolopoulos A, Intas G, Chalari E, Gulati A, Iacovidou N, Chalkias A, Xanthos T. Body mass index and outcome of out-of-hospital cardiac arrest patients not treated by targeted temperature management. Am J Emerg Med 2017; 35:1247-1251. [DOI: 10.1016/j.ajem.2017.03.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/17/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022] Open
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Sokou R, Foudoulaki-Paparizos L, Lytras T, Konstantinidi A, Theodoraki M, Lambadaridis I, Gounaris A, Valsami S, Politou M, Gialeraki A, Nikolopoulos GK, Iacovidou N, Bonovas S, Tsantes AE. Reference ranges of thromboelastometry in healthy full-term and pre-term neonates. ACTA ACUST UNITED AC 2017; 55:1592-1597. [DOI: 10.1515/cclm-2016-0931] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/27/2016] [Indexed: 11/15/2022]
Abstract
AbstractBackground:Rotational thromboelastometry (ROTEM) is an attractive method for rapid evaluation of hemostasis in neonates. Currently, no reference values exist for ROTEM assays in full-term and pre-term neonates. Our aim was to establish reference ranges for standard extrinsically activated ROTEM assay (EXTEM) in arterial blood samples of healthy full-term and pre-term neonates.Methods:In the present study, EXTEM assay was performed in 198 full-term (≥37 weeks’ gestation) and 84 pre-term infants (<37 weeks’ gestation) using peripheral arterial whole blood samples.Results:Median values and reference ranges (2.5th and 97.5th percentiles) for the following main parameters of EXTEM assay were determined in full-term infants: clotting time (seconds), 41 (range, 25.9–78); clot formation time (seconds), 70 (range, 40–165.2); maximum clot firmness (mm), 66 (range, 41–84.1); lysis index at 60 min (LI60, %), 97 (range, 85–100). The only parameter with a statistically significant difference between full-term and pre-term neonates was LI60 (p=0.006). Furthermore, it was inversely correlated with gestational age (p=0.002) and birth weight (p=0.016) in pre-term neonates.Conclusions:In conclusion, an enhanced fibrinolytic activity in pre-term neonates was noted. For most EXTEM assay parameters, reference ranges obtained from arterial newborn blood samples were comparable with the respective values from studies using cord blood. Modified reagents, small size samples, timing of sampling, and different kind of samples might account for any discrepancies among similar studies. Reference values hereby provided can be used in future studies.
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Niforopoulou P, Iacovidou N, Lelovas P, Karlis G, Papalois Α, Siakavellas S, Spapis V, Kaparos G, Siafaka I, Xanthos T. Correlation of Impedance Threshold Device use during cardiopulmonary resuscitation with post-cardiac arrest Acute Kidney Injury. Am J Emerg Med 2017; 35:846-854. [PMID: 28131602 DOI: 10.1016/j.ajem.2017.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 01/16/2017] [Accepted: 01/21/2017] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To assess whether use of Impedance Threshold Device (ITD) during cardiopulmonary resuscitation (CPR) reduces the degree of post-cardiac arrest Acute Kidney Injury (AKI), as a result of improved hemodynamics, in a porcine model of ventricular fibrillation (VF) cardiac arrest. METHODS After 8 min of untreated cardiac arrest, the animals were resuscitated either with active compression-decompression (ACD) CPR plus a sham ITD (control group, n=8) or with ACD-CPR plus an active ITD (ITD group, n=8). Adrenaline was administered every 4 min and electrical defibrillation was attempted every 2 min until return of spontaneous circulation (ROSC) or asystole. After ROSC the animals were monitored for 6 h under general anesthesia and then returned to their cages for a 48 h observation, before euthanasia. Two novel biomarkers, Neutrophil Gelatinase-Associated Lipocalin (NGAL) in plasma and Interleukin-18 (IL-18) in urine, were measured at 2 h, 4 h, 6 h, 24 h and 48 h post-ROSC, in order to assess the degree of AKI. RESULTS ROSC was observed in 7 (87.5%) animals treated with the sham valve and 8 (100%) animals treated with the active valve (P=NS). However, more than twice as many animals survived at 48 h in the ITD group (n=8, 100%) compared to the control group (n=3, 37.5%). Urine IL-18 and plasma NGAL levels were augmented post-ROSC in both groups, but they were significantly higher in the control group compared with the ITD group, at all measured time points. CONCLUSION Use of ITD during ACD-CPR improved hemodynamic parameters, increased 48 h survival and decreased the degree of post-cardiac arrest AKI in the resuscitated animals.
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Affiliation(s)
- Panagiota Niforopoulou
- National and Kapodistrian University of Athens, Medical School, 3A Parou st, Melissia, Athens 15127, Greece.
| | - Nicoletta Iacovidou
- National and Kapodistrian University of Athens, Medical School, 3 Pavlou Mela st, Athens 16233, Greece.
| | - Pavlos Lelovas
- National and Kapodistrian University of Athens, Medical School, Laboratory of Research of the Musculoskeletal System, 10 Athinas st, Kifissia, Athens 14561, Greece.
| | - George Karlis
- National and Kapodistrian University of Athens, Medical School, 45-47 Ypsilantou st, Athens 10676, Greece.
| | - Αpostolos Papalois
- Experimental-Research Centre, ELPEN Pharmaceutical Co. Inc., 95 Marathonos Ave, Pikermi, Athens 19009, Greece.
| | - Spyros Siakavellas
- National and Kapodistrian University of Athens, Medical School, Academic Department of Gastroenterology, Laikon General Hospital, 17 Aghiou Thoma st, Athens 11527, Greece.
| | - Vasileios Spapis
- Hippokrateion General Hospital of Athens, 114 Vassilissis Sofias Ave, Athens, 11527, Greece.
| | - George Kaparos
- Aretaieion University Hospital, Biopathology Department, 76 Vassilissis Sofias Ave, Athens 11528, Greece.
| | - Ioanna Siafaka
- National and Kapodistrian University of Athens, Medical School, Aretaieion University Hospital, 76 Vassilissis Sofias Ave, Athens 11528, Greece.
| | - Theodoros Xanthos
- European University of Cyprus, School of Medicine, 6 Diogenis str, Engomi, Nicosia 1516, Cyprus.
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Tassopoulos A, Chalkias A, Papalois A, Iacovidou N, Xanthos T. The effect of antioxidant supplementation on bacterial translocation after intestinal ischemia and reperfusion. Redox Rep 2016; 22:1-9. [PMID: 27734759 DOI: 10.1080/13510002.2016.1229893] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The intestine is highly sensitive to ischemia/reperfusion (I/R) injury. Intestinal I/R may cause local tissue injury and disruption of the intestinal mucosal barrier, allowing the passage of viable bacteria and endotoxins from the gastrointestinal lumen to distant organs. This phenomenon, known as bacterial translocation (BT), may lead to systemic disorders with high morbidity and mortality. Oxidative stress mediators such as reactive oxygen species, polymorphonuclear neutrophils and nitric oxide are believed to contribute to the intestinal I/R injury. Many antioxidants have shown protective effects against I/R injury of various organs. The present article provides an overview of studies investigating the effect of antioxidant supplementation on BT after intestinal I/R.
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Affiliation(s)
- A Tassopoulos
- a National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - A Chalkias
- b Hellenic Society of Cardiopulmonary Resuscitation , Athens , Greece.,c National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - A Papalois
- f Experimental-Research Centre ELPEN Pharmaceutical Co. Inc. , Athens , Greece
| | - N Iacovidou
- e Department of Neonatology, Aretaieio Hospital , National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - T Xanthos
- d European University Cyprus , School of Medicine , Nicosia , Cyprus
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Karlis G, Iacovidou N, Lelovas P, Niforopoulou P, Papalois A, Siafaka I, Mentzelopoulos S, Xanthos T. Nifekalant Versus Amiodarone in the Treatment of Cardiac Arrest: an Experimental Study in a Swine Model of Prolonged Ventricular Fibrillation. Cardiovasc Drugs Ther 2016; 29:425-31. [PMID: 26145169 DOI: 10.1007/s10557-015-6604-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of the experiment was to compare the effects of nifekalant and amiodarone on the return of spontaneous circulation (ROSC), survival, as well as on the hemodynamic parameters in a swine model of prolonged ventricular fibrillation (VF). METHODS After 8 min of untreated VF, bolus doses of epinephrine (adrenaline) and either nifekalant, or amiodarone, or saline (n = 10 per group), were administered after randomization. Cardiopulmonary resuscitation (CPR) was commenced immediately after drug administration and defibrillation was attempted 2 min later. CPR was resumed for another 2 min after each defibrillation attempt and the same dose of adrenaline was given every 4th minute during CPR. RESULTS Forty-eight hour survival was significantly higher with nifekalant compared to amiodarone (p < 0.001) and saline (p = 0.02), (9/10 vs. 0/10 vs. 3/10, respectively). Systolic aortic pressure, diastolic aortic pressure and coronary perfusion pressure were significantly higher with nifekalant during CPR and immediate post-resuscitation period (p < 0.05). The animals in the amiodarone group had a slower heart rate at the 1st and 45th min post-ROSC (p < 0.001 and p = 0.006, respectively). The number of electric shocks required for terminating VF, time to ROSC and adrenaline dose were significantly higher with amiodarone compared to nifekalant (p < 0.001). CONCLUSIONS Nifekalant showed a more favorable hemodynamic profile and improved survival compared to amiodarone and saline in this swine model.
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Affiliation(s)
- George Karlis
- 2nd Department of Internal Medicine, Sismanoglio General Hospital, Athens, Greece. .,Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.
| | - Nicoletta Iacovidou
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.,2nd Department of Obstetrics and Gynecology, Neonatal Division, Aretaieio Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Pavlos Lelovas
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | | | | | - Ioanna Siafaka
- 1st Anesthesiology Clinic, Pain Relief and Palliative Care Unit, Aretaieio Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Spyros Mentzelopoulos
- 1st Department of Intensive Care Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theodoros Xanthos
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.,MSc "Cardiopulmonary Resuscitation", National and Kapodistrian University of Athens, Medical School, Athens, Greece.,Midwestern University of Chicago, Chicago, IL, USA
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Stofa M, Xanthos T, Ekmektzoglou K, Chalkias A, Barouxis D, Pantazopoulos I, Iacovidou N. Jakość życia u dorosłych chorych na mukowiscydozę — doświadczenia greckie. Adv Respir Med 2016. [DOI: 10.5603/arm.48476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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77
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Stofa M, Xanthos T, Ekmektzoglou K, Chalkias A, Barouxis D, Pantazopoulos I, Iacovidou N. Quality of life in adults with cystic fibrosis: the Greek experience. Pneumonol Alergol Pol 2016; 84:205-11. [PMID: 27435346 DOI: 10.5603/piap.2016.0025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Recent developments in treatment have steadily raised the median predicted age of survival for people with Cystic Fibrosis (CF). We report the health-related quality of life (HRQoL) in CF adult patients and correlate our findings with the patients' demographic characteristics. MATERIAL AND METHODS The Cystic Fibrosis Quality of Life (CFQoL) questionnaire was answered by 77 CF adult patients. The questionnaire included questions pertaining to age, sex and level of education and covered eight sections of functioning. RESULTS The highest score was reported in the "Social Functioning" section, while the lowest in the "Concerns for the Future" section. When different age groups were compared, statistical significances were reported in "Physical Functioning", "Interpersonal Relationships", and the "Career Concerns" section, with older patients reporting statistically higher HRQoL scores than younger ones (p < 0.005). No statistically significant difference was reported amongst the scoring between male and female CF patients. When different educational levels were compared, patients that had received a higher educational training scored statistically higher in all but one sections of the questionnaire when compared with patients of a lower educational level (p < 0.005). CONCLUSION More than half Greek adult CF patients report that they are capable to participate in social activities but most of them are worried about the outcome of their disease and its effect on their lives.
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Xanthos T, Psichalakis N, Russell D, Papalois A, Koutsovasilis A, Athanasopoulos D, Gkiokas G, Chalkias A, Iacovidou N. Intralipid™ administration attenuates the hypotensive effects of acute intravenous amiodarone overdose in a swine model. Am J Emerg Med 2016; 34:1389-93. [PMID: 27131633 DOI: 10.1016/j.ajem.2016.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To investigate whether a lipid emulsion could counteract the hypotensive effects of amiodarone overdose after an acute intravenous administration and improve 4 h survival in an established model of swine cardiovascular research. METHODS Twenty pigs were intubated and instrumented to measure aortic pressures and central venous pressures (CVP). After allowing the animals to stabilize for 60 minutes, amiodarone overdose (1 mg/kg/min) was initiated for a maximum of 20 minutes. Afterwards, the animals were randomized into 2 groups. Group A (n = 10) received 0.9% Normal Saline (NS) and Group B (n = 10) received 20% Intralipid® (ILE). A bolus dose of 2 ml/kg in over 2 min time was initially administered in both groups followed by a 45 min infusion (0.2 ml/kg/min) of either NS or ILE. RESULTS All animals survived the overdose and all animals survived the monitoring period of 4 hours. Systolic aortic pressure (SpthAorta) (6.90 vs 14.10 mmHg, P = .006) and mean arterial pressure (MAP) (6.10 vs 14.90 mmHg, P = .001) were higher in the ILE group 2 min after the bolus ILE infusion. This difference was maintained for 15 min after ILE infusion for both SpthAorta (7.85 vs 13.15 mmHg, P = .044) and MAP (7.85 vs 13.15 mmHg, P = .042). Animals that received ILE had higher CVP (11.6 vs 15.7 mmHg, P = .046), an effect which was attenuated 2 and 4 hours post administration. Animals receiving ILE were more acidotic (7.21 vs 7.38, P = .048) in the monitoring period compared to animals receiving NS. CONCLUSIONS Intralipid attenuated the hypotensive effects of amiodarone toxicity for a period of 15 minutes compared to animals receiving NS.
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Affiliation(s)
- Theodoros Xanthos
- European University Cyprus, School of Medicine, Nicosia, Cyprus; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | | | | | | | | | | | - Georgios Gkiokas
- National and Kapodistrian University of Athens, Medical School, Aretaieion University Hospital, 2nd Department of Surgery
| | - Athanasios Chalkias
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece; National and Kapodistrian University of Athens, Medical School, Postgraduate Study Program (MSc) "Cardiopulmonary Resuscitation", Athens, Greece.
| | - Nicoletta Iacovidou
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece; National and Kapodistrian University of Athens, Medical School, Postgraduate Study Program (MSc) "Cardiopulmonary Resuscitation", Athens, Greece
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Mavri M, Rellos K, Pantazopoulos I, Kampolis C, Floros I, Iacovidou N, Xanthos T, Pantazopoulos C. Comparison between dexmetomidine and midazolam on early extubation and hemodynamic profile. a randomized double-blind study. Intensive Care Med Exp 2015. [PMCID: PMC4798284 DOI: 10.1186/2197-425x-3-s1-a327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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80
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Locci E, Varvarousi G, Scano P, Noto A, Ferino G, Rosa F, Finco G, Iacovidou N, d’Aloja E, Xanthos T. A metabolomics approach in asphyxial cardiac arrest. Resuscitation 2015. [DOI: 10.1016/j.resuscitation.2015.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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81
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Galatianou I, Karlis G, Apostolopoulos A, Intas G, Iacovidou N, Gulati A, Xanthos T. The obesity paradox is associated with admission to intensive care units, but not with hospital discharge. Resuscitation 2015. [DOI: 10.1016/j.resuscitation.2015.09.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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82
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Mavri M, Rellos K, Pantazopoulos I, Kampolis C, Floros I, Iacovidou N, Xanthos T, Pantazopoulos C. Dexmetomidine, fentanyl and esmolol on prevention of the hemodynamic effects of laryngoscopy and endotracheal intubation. a prospective, randomized, double-blind study. Intensive Care Med Exp 2015. [PMCID: PMC4798263 DOI: 10.1186/2197-425x-3-s1-a210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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83
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Konstantogianni E, Tsalkidou V, Dimou P, Stroumpoulis K, Palgimezi A, Chalkias A, Iacovidou N, Xanthos T. Comparative study of Supreme, Cobra, and i-gel during spontaneous and controlled mechanical ventilation: a case series. Am J Emerg Med 2015; 33:1524-5. [PMID: 26189957 DOI: 10.1016/j.ajem.2015.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - Panagiota Dimou
- General Hospital of Nikaia, Department of Anesthesiology, Athens, Greece
| | - Konstantinos Stroumpoulis
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation," Athens, Greece
| | | | - Athanasios Chalkias
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation," Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.
| | - Nicoletta Iacovidou
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece; National and Kapodistrian University of Athens, Medical School, 2nd Department of Obstetrics & Gynecology, Neonatal Division, Athens, Greece
| | - Theodoros Xanthos
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation," Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
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Drakou E, Kanakis MA, Papadimitriou L, Iacovidou N, Vrachnis N, Nicolouzos S, Loukas C, Lioulias A. Changes in Simple Spirometric Parameters After Lobectomy for Bronchial Carcinoma. J Cardiovasc Thorac Res 2015; 7:68-71. [PMID: 26191395 PMCID: PMC4492181 DOI: 10.15171/jcvtr.2015.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 05/25/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction: The purpose of this study was to describe the postoperative changes in lung function after pure open lobectomy for lung carcinoma.
Methods: 30 patients (mean age 64 ± 7 years old, 16 men and 14 women) underwent a left or right lobectomy. They underwent spirometric pulmonary tests preoperatively, and at 1 and 6 months after the operation.
Results: The average preoperative forced expiratory volume in 1 second (FEV1) was 2.55±0.62lt and the mean postoperative FEV1 at 1 and 6 months was 1.97 ± 0.59 L and 2.15±0.66 L respectively. The percentage losses for FEV1 were 22.7% and 15.4% after 1 and 6 months respectively. An average percentage increase of 9.4% for FEV1 was estimated at the time of 6 months in comparison with this of 1 month after the operation. The average preoperative forced vital capacity (FVC) was 3.17 ± 0.81 L and the mean postoperative FVC at 1 and 6 months after the operation was 2.50 ± 0.63 L and 2.72 ± 0.67 L respectively. The percentage losses for FVC were 21.1% and 14.2% after 1 and 6 months respectively. An average percentage increase of 8.7% was observed at the time period of 6 months in comparison with this of 1 month after the operation.
Conclusion: Although, we observed a significant decrease in FEV1 and FVC after the operation, all patients were in excellent clinical status. FEV1 and FVC of 6 months were increased in comparison with the respective values of 1 month after the operation, but did not reach the preoperative values in any patient.
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Affiliation(s)
- Eleni Drakou
- Department of Thoracic Surgery, Sismanoglio General Hospital of Athens, Athens, Greece
| | - Meletios A Kanakis
- Department of Thoracic Surgery, Sismanoglio General Hospital of Athens, Athens, Greece
| | | | - Nicoletta Iacovidou
- Department of Neonatology, Aretaieio Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Nikolaos Vrachnis
- 2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Stefanos Nicolouzos
- Department of Thoracic Surgery, Sismanoglio General Hospital of Athens, Athens, Greece
| | - Constantinos Loukas
- Medical Physics Laboratory, School of Medicine, University of Athens, Athens, Greece
| | - Achilleas Lioulias
- Department of Thoracic Surgery, Sismanoglio General Hospital of Athens, Athens, Greece
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Varvarousis D, Varvarousi G, Iacovidou N, D'Aloja E, Gulati A, Xanthos T. The pathophysiologies of asphyxial vs dysrhythmic cardiac arrest: implications for resuscitation and post-event management. Am J Emerg Med 2015; 33:1297-304. [PMID: 26233618 DOI: 10.1016/j.ajem.2015.06.066] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/30/2015] [Accepted: 06/30/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cardiac arrest is not a uniform condition and significant heterogeneity exists within all victims with regard to the cause of cardiac arrest. Primary cardiac (dysrhythmic) and asphyxial causes together are responsible for most cases of cardiac arrest at all age groups. The purpose of this article is to review the pathophysiologic differences between dysrhythmic and asphyxial cardiac arrest in the prearrest period, during the no-flow state, and after successful cardiopulmonary resuscitation. METHODS The electronic databases of PubMed/Medline, Scopus, and Cochrane were searched for relevant literature and studies. RESULTS/DISCUSSION Significant differences exist between dysrhythmic and asphyxial cardiac arrest regarding their pathophysiologic pathways and affect consequently the postresuscitation period. Laboratory data indicate that asphyxial cardiac arrest leads to more widespread postresuscitation brain damage compared with dysrhythmic cardiac arrest. Regarding postresuscitation myocardial dysfunction, few studies have addressed a comparison of the 2 conditions with controversial results. CONCLUSIONS Asphyxial cardiac arrest differs significantly from dysrhythmic cardiac arrest with regard to pathophysiologic mechanisms, neuropathologic damage, postresuscitation organ dysfunction, and response to therapy. Both conditions should be considered and treated in a different manner.
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Affiliation(s)
- Dimitrios Varvarousis
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.
| | - Giolanda Varvarousi
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nicoletta Iacovidou
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Ernesto D'Aloja
- Forensic Science Unit, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, 09042 Monserrato, Italy
| | - Anil Gulati
- College of Pharmacy, Midwestern University, Downers Grove, IL
| | - Theodoros Xanthos
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; College of Pharmacy, Midwestern University, Downers Grove, IL
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Papapanagiotou P, Xanthos T, Gulati A, Chalkias A, Papalois A, Kontouli Z, Alegakis A, Iacovidou N. Centhaquin improves survival in a swine model of hemorrhagic shock. J Surg Res 2015. [PMID: 26216751 DOI: 10.1016/j.jss.2015.06.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hemorrhage is a frequent event in hospital and prehospital settings. The aim of the present study was to investigate whether centhaquin improves 24-h survival and reduces the total volume of required fluids in an established model of swine hemorrhagic shock. MATERIAL AND METHODS Twenty-five pigs were instrumented and subjected to hemorrhagic shock. The animals were randomly allocated in two experimental groups, the control (vehicle) (n = 10) and the centhaquin groups (0.015 mg/kg, n = 10); all animals received lactated Ringer solution in the resuscitation phase until their mean arterial pressure reached 90% of the baseline. A sham group (n = 5) was added a posteriori to mimic the hemodynamic profile of the centhaquin group. RESULTS A statistically significant difference was observed in the time required for the three groups to reach their target mean aortic pressure, 36.88 ± 3.26 min for the control group versus 9.40 ± 1.01 min for the sham group and 7.10 ± 0.97 min for the centhaquin group (P < 0.001). The total amount of fluids in the control and the sham groups was significantly higher when compared with that of the centhaquin-treated animals (P < 0.001). All 10 animals in the centhaquin group survived for 24 h, whereas only three animals survived in the control group and one animal in the sham group (P = 0.002). CONCLUSIONS Centhaquin 0.015 mg/kg administered in the fluid resuscitation phase resulted in lower volume of fluids and better survival compared with control and sham-operated animals.
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Affiliation(s)
- Panagiotis Papapanagiotou
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - Theodoros Xanthos
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - Anil Gulati
- Chicago College of Pharmacy, Department of Pharmaceutical Sciences, Midwestern University, Downers Grove, Illinois
| | - Athanasios Chalkias
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.
| | | | - Zinais Kontouli
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece
| | | | - Nicoletta Iacovidou
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece; National and Kapodistrian University of Athens, Medical School, Aretaieio Hospital, Department of Neonatology, Athens, Greece
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87
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Gerosa C, Iacovidou N, Argyri I, Fanni D, Papalois A, Aroni F, Faa G, Xanthos T, Fanos V. Histopathology of renal asphyxia in newborn piglets: Individual susceptibility to tubular changes. World J Nephrol 2015; 4:313-318. [PMID: 25949946 PMCID: PMC4419142 DOI: 10.5527/wjn.v4.i2.313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 09/08/2014] [Accepted: 02/12/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the effects on the kidney of hypoxia-reoxygenation in an experimental model of normocapnic asphyxia.
METHODS: To this end, 40 newborn Landrace/Large-White piglets aged 1-4 d were studied in this work. Hypoxia was induced by decreasing the inspired fiO2 to 0.06-0.08. Animals were resuscitated with different fiO2 and subdivided into 4 groups: group 1, 2, 3 and 4 received 18%, 21%, 40% and 100% O2 respectively. Macroscopic examination was carried out to evidence possible pathological features. Tissue sample were obtained from both kidneys. Four or five micron paraffin sections were stained with H-E and PAS stain and examined under an optical microscope.
RESULTS: Pathological changes, mainly affecting tubular cells, were observed in the vast majority of kidneys of asphyxiated piglets. The most frequent tubular changes were: tubular casts (95%), tubular dilatation (87.5%), tubular vacuolization (70%), tubular eosinophilia (52.5%), sloughing (50%), fragmentation of the brush border (50%), oedema (32.5%), apoptosis (15%) and glomerular changes (meningeal cell proliferation, capsular adhesion between the flocculus and Bowman’s capsule, glomerulosclerosis and fibrous or cellular crescents associated with collapse of the glomerular tuft). Statistical analysis was carried out on changes observed when the animals were allocated in the 4 groups (χ2-test 0.05). The statistical analysis showed no evidence of differences regarding kidney lesions among the animals groups.
CONCLUSION: Our data show that renal pathology in newborn piglets is characterized by interindividual variability to hypoxia and is not associated with oxygen concentration.
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88
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Bassareo PP, Bassareo V, Iacovidou N, Mercuro G. Antihypertensive therapy in children: differences in medical approach between the United States and Europe. Curr Med Chem 2015; 21:3121-31. [PMID: 24606510 DOI: 10.2174/0929867321666140304093848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 05/14/2013] [Accepted: 06/24/2013] [Indexed: 11/22/2022]
Abstract
Similarly to a series of chronic diseases, essential arterial hypertension (HTN) may be manifested during childhood as a blood pressure (BP) reading which repeatedly rises above the 95(th) percentile of population-specific standards. Since BP tends to track along the same percentiles throughout life, children with higher BPs are more likely to become hypertensive adults. When healthy measures aimed at reducing BP (i.e. body weight reduction, aerobic physical exercise, low sodium intake) have failed, pharmacological treatment is usually required. This paper aims to undertake a review of antihypertensive pharmacological therapy in children, examining the drugs used in chronic treatment as well as those administered to treat hypertensive crisis (i.e. a BP major than 99(th) percentile of paediatric normograms). Moreover, several important differences registered in the therapeutic approach to paediatric HTN between US and European Guidelines will be underlined.
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Affiliation(s)
| | | | | | - G Mercuro
- Department of Medical Sciences "M.Aresu", University of Cagliari, Policlinico Universitario, S.S. 554, bivio di Sestu - 09042, Monserrato (Cagliari), Italy.
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89
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Barouchos N, Papazafiropoulou A, Iacovidou N, Vrachnis N, Barouchos N, Armeniakou E, Dionyssopoulou V, Mathioudakis AG, Christopoulou E, Koltsida S, Bassiakou E. Comparison of tumor markers and inflammatory biomarkers in chronic obstructive pulmonary disease (COPD) exacerbations. Scand J Clin Lab Invest 2015; 75:126-32. [PMID: 25598350 DOI: 10.3109/00365513.2014.992944] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of the present study was: (a) to measure levels of the tumor markers, Carcinoembryonic antigen (CEA), Cancer antigen 19-9 (CA19-9), Cancer antigen 125 (CA125), Neuron specific enolase (NSE) and Cytokeratin fragments 19 (CYFRA21-1); (b) to investigate any correlation between them and the inflammatory biomarkers C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR) and white blood cells count (WBC), in patients with chronic obstructive pulmonary disease (COPD) exacerbation, who belong in groups of severity C and D, as classified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD); (c) and finally, to compare these results in these two groups. MATERIAL AND METHODS Fifty-two patients with COPD exacerbation [35 male/17 female, mean age (± SD) 68.3 ± 6.4 years] were the study subjects, and were classified in severity groups C (n = 27) and D (n = 25), based on the spirometric classification, the number of exacerbations in the preceding year and the assessment of their symptoms by GOLD. Results. CEA and CA125 were increased in group D. In group C, there was a significant correlation between CRP and CA125 (p = 0.05). In group D, there was a significant correlation between WBC and NSE (p = 0.02), between CRP and CA19-9 (p = 0.02) and NSE (p < 0.001), and between the ESR and NSE (p = 0.03). CA125 (p = 0.01) and CA19-9 (p = 0.01) were significantly higher in group D compared to group C. In contrast, there was no significant difference in two groups for NSE, CEA and CYFRA21-1. CONCLUSION Certain tumor markers were increased and were associated with increased levels of inflammatory biomarkers and with the disease severity. Inflammation might have a key pathogenetic role linking the above tumor markers with the severity of COPD.
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90
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Pantazopoulos C, Floros I, Archontoulis N, Xanthis D, Barouxis D, Iacovidou N, Xanthos T. Comparative study between fluidless resuscitation with permissive hypotension using the impedance threshold device versus aggressive fluid resuscitation with Ringer lactate in a swine model of hemorrhagic shock. Crit Care 2015. [PMCID: PMC4472914 DOI: 10.1186/cc14254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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91
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Pantazopoulos C, Floros I, Archontoulis N, Xanthis D, Barouxis D, Iacovidou N, Xanthos T. Prospective nonrandomized observational study of the use of an impedance threshold device in patients with spontaneous respiration and hemodynamic instability. Crit Care 2015. [PMCID: PMC4471410 DOI: 10.1186/cc14224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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92
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Pantazopoulos C, Floros I, Mega A, Rigas C, Pavleas I, Vernikos P, Archontoulis N, Xanthis D, Iacovidou N, Xanthos T. 1036. Comparison of the hemodynamic parameters of two external chest compression devices (LUCAS versus AUTOPULSE) in a swine model of ventricular fibrillation. Intensive Care Med Exp 2014. [PMCID: PMC4798117 DOI: 10.1186/2197-425x-2-s1-p83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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93
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Pantazopoulos C, Floros I, Mega A, Rigas C, Pavleas I, Vernikos P, Archontoulis N, Xanthis D, Iacovidou N, Xanthos T. 0391. Comparison of the histopathologic effects on the lungs of two external chest compression devices (lucas versus autopulse) in a swine model of ventricular fibrillation. Intensive Care Med Exp 2014. [PMCID: PMC4797847 DOI: 10.1186/2197-425x-2-s1-p24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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94
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Abstract
Despite recent advances in perinatal medicine and in the art of neonatal resuscitation, resuscitation strategy and treatment methods in the delivery room should be individualized depending on the unique characteristics of the neonate. The constantly increasing evidence has resulted in significant treatment controversies, which need to be resolved with further clinical and experimental research.
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Affiliation(s)
- Athanasios Chalkias
- Medical School, National and Kapodistrian University of Athens , Athens , Greece
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95
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Chantzara G, Stroumpoulis K, Alexandrou N, Kokkinos L, Iacovidou N, Xanthos T. Influence of LMA cuff pressure on the incidence of pharyngolaryngeal adverse effects and evaluation of the use of manometry during different ventilation modes: a randomized clinical trial. Minerva Anestesiol 2014; 80:547-555. [PMID: 24226490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Pharyngolaryngeal discomfort is a significant complication following the use of laryngeal mask airway (LMA). The present study aimed to investigate the relation of LMA cuff pressure and the occurrence of pharyngolaryngeal discomfort during spontaneous ventilation (SV), pressure support (PSV) and pressure control ventilation (PCV). METHODS A hundred and twenty patients, ASA I-III, were included in this study. Originally the patients were divided into three groups: the 1st group was left to breath spontaneously, the 2nd group was placed under PSV while PCV was used in the 3rd group. Each group was divided into two subgroups: A) intervention group (maintaining cuff pressure at 60 cmH2O, measurement in 10 min intervals) and B) observation group (no intervention in cuff pressure, measurement in 10 min intervals). Anesthesia was induced with propofol and fentanyl and maintained with sevoflurane in air/oxygen. Patients were assessed 2 and 24 hours post-surgery, for sore throat, dysphonia or dysphagia. RESULTS A and B subgroup comparison at 24 hours revealed a statistically significant difference in the presence of pharyngolaryngeal discomfort in the PSV group (10% versus 55% respectively, P=0.006). Furthermore, when assessing the effect of maintaining a constant cuff pressure regardless of mode of ventilation, significantly fewer adverse effects were observed (8.3% vs. 35%, P=0.001) when compared to the non-intervention subgroup. CONCLUSION Maintaining LMA cuff pressure in values which do not exceed 60 cmH2O probably contributes in decreasing pharyngolaryngeal discomfort independently of ventilation mode. The ventilation mode which leads to the highest incidence of pharyngolaryngeal morbidity when cuff pressures are not closely monitored is PSV.
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Affiliation(s)
- G Chantzara
- Department of Anesthesiology, "Elpis" General of Athens, Greece -
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96
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Fanni D, Ambu R, Gerosa C, Nemolato S, Iacovidou N, Van Eyken P, Fanos V, Zaffanello M, Faa G. Aluminum exposure and toxicity in neonates: a practical guide to halt aluminum overload in the prenatal and perinatal periods. World J Pediatr 2014; 10:101-7. [PMID: 24801228 DOI: 10.1007/s12519-014-0477-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND During the last years, human newborns have been overexposed to biologically reactive aluminum, with possible relevant consequences on their future health and on their susceptibility to a variety of diseases. Children, newborns and particularly preterm neonates are at an increased risk of aluminum toxicity because of their relative immaturity. DATA SOURCES Based on recent original publications and classical data of the literatures, we reviewed the aluminum content in mother's food during the intrauterine life as well as in breast milk and infant formula during lactation. We also determined the possible role of aluminum in parenteral nutrition solutions, in adjuvants of vaccines and in pharmaceutical products. A special focus is placed on the relationship between aluminum overexposure and the insurgence of bone diseases. RESULTS Practical points of management and prevention are suggested. Aluminum sources that infants may receive during the first 6 months of life are presented. In the context of prevention of possible adverse effects of aluminum overload in fetal tissues during development, simple suggestions to pregnant women are described. Finally, practical points of management and prevention are suggested. CONCLUSIONS Pediatricians and neonatologists must be more concerned about aluminum content in all products our newborns are exposed to, starting from monitoring aluminum concentrations in milk- and soy-based formulas in which, on the basis of recent studies, there is still too much aluminum.
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Affiliation(s)
- Daniela Fanni
- Department of Pathology, University Hospital San Giovanni di Dio, AOU Cagliari and University of Cagliari, Cagliari, Italy
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97
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Vasileiou P, Xanthos T, Barouxis D, Pantazopoulos C, Papalois A, Lelovas P, Kotsilianou O, Pliatsika E, Kouskouni E, Iacovidou N. Administration of Erythropoietin in a swine model of prolonged cardiac arrest. Resuscitation 2014. [DOI: 10.1016/j.resuscitation.2014.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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98
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Vasileiou PVS, Xanthos T, Barouxis D, Pantazopoulos C, Papalois AE, Lelovas P, Kotsilianou O, Pliatsika P, Kouskouni E, Iacovidou N. Erythropoietin administration facilitates return of spontaneous circulation and improves survival in a pig model of cardiac arrest. Am J Emerg Med 2014; 32:871-7. [PMID: 24857249 DOI: 10.1016/j.ajem.2014.04.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/12/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND In addition to its role in the endogenous control of erythropoiesis, recombinant human erythropoietin (rh-EPO) has been shown to exert tissue protective properties in various experimental models. However, its role in the cardiac arrest (CA) setting has not yet been adequately investigated. AIM The aim of this study is to examine the effect of rh-EPO in a pig model of ventricular fibrillation (VF)-induced CA. METHODS Ventricular fibrillation was electrically induced in 20 piglets and maintained untreated for 8 minutes before attempting resuscitation. Animals were randomized to receive rh-EPO (5000 IU/kg, erythropoietin [EPO] group, n = 10) immediately before the initiation of chest compressions or to receive 0.9% Sodium chloride solution instead (control group, n = 10). RESULTS Compared with the control, the EPO group had higher rates of return of spontaneous circulation (ROSC) (100% vs 60%, P = .011) and higher 48-hour survival (100% vs 40%, P = .001). Diastolic aortic pressure and coronary perfusion pressure during cardiopulmonary resuscitation were significantly higher in the EPO group compared with the control group. Erythropoietin-treated animals required fewer number of shocks in comparison with animals that received normal saline (P = .04). Furthermore, the neurologic alertness score was higher in the EPO group compared with that of the control group at 24 (P = .004) and 48 hours (P = .021). CONCLUSION Administration of rh-EPO in a pig model of VF-induced CA just before reperfusion facilitates ROSC and improves survival rates as well as hemodynamic variables.
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Affiliation(s)
- Panagiotis V S Vasileiou
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.
| | - Theodoros Xanthos
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - Dimitrios Barouxis
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - Charalampos Pantazopoulos
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | | | - Paulos Lelovas
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece
| | | | - Paraskevi Pliatsika
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece
| | - Evaggelia Kouskouni
- National and Kapodistrian University of Athens, Medical School, Aretaieio Hospital, Department of Biopathology-Microbiology, Athens, Greece
| | - Nicoletta Iacovidou
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece; National and Kapodistrian University of Athens, Medical School, Aretaieio Hospital, 2nd Department of Ob&Gyn, Athens, Greece
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Giotakis E, Chalkias A, Tarantinos K, Castrén M, Papadopoulos G, Iacovidou N, Xanthos T. Pretest-based group forming in advanced cardiovascular life support courses increases acquisition and retention of resuscitation knowledge. Am J Emerg Med 2014; 32:478-9. [PMID: 24612596 DOI: 10.1016/j.ajem.2014.01.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 01/26/2014] [Accepted: 01/26/2014] [Indexed: 11/26/2022] Open
Affiliation(s)
- Efthymios Giotakis
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece
| | - Athanasios Chalkias
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.
| | - Kyriakos Tarantinos
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece
| | - Maaret Castrén
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset and Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden
| | - Georgios Papadopoulos
- Department of Anesthesiology, University of Ioannina, Medical School, Ioannina, Greece
| | - Nicoletta Iacovidou
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece; 2nd Department of Obstetrics and Gynecology, Neonatal Division, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theodoros Xanthos
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
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Chalkias A, Fanos V, Noto A, Castrén M, Gulati A, Svavarsdóttir H, Iacovidou N, Xanthos T. 1H NMR-metabolomics: can they be a useful tool in our understanding of cardiac arrest? Resuscitation 2014; 85:595-601. [PMID: 24513156 DOI: 10.1016/j.resuscitation.2014.01.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/12/2013] [Accepted: 01/26/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This review focuses on the presentation of the emerging technology of metabolomics, a promising tool for the detection of identifying the unrevealed biological pathways that lead to cardiac arrest. DATA SOURCES The electronic bases of PubMed, Scopus, and EMBASE were searched. Research terms were identified using the MESH database and were combined thereafter. Initial search terms were "cardiac arrest", "cardiopulmonary resuscitation", "post-cardiac arrest syndrome" combined with "metabolomics". RESULTS Metabolomics allow the monitoring of hundreds of metabolites from tissues or body fluids and already influence research in the field of cardiac metabolism. This approach has elucidated several pathophysiological mechanisms and identified profiles of metabolic changes that can be used to follow the disease processes occurring in the peri-arrest period. This can be achieved through leveraging the strengths of unbiased metabolome-wide scans, which include thousands of final downstream products of gene transcription, enzyme activity and metabolic products of extraneously administered substances, in order to identify a metabolomic fingerprint associated with an increased risk of cardiac arrest. CONCLUSION Although this technology is still under development, metabolomics is a promising tool for elucidating biological pathways and discovering clinical biomarkers, strengthening the efforts for optimizing both the prevention and treatment of cardiac arrest.
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Affiliation(s)
- Athanasios Chalkias
- MSc "Cardiopulmonary Resuscitation", Medical School, National and Kapodistrian University of Athens, Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, AOU and University of Cagliari, Cagliari, Italy
| | - Antonio Noto
- Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, AOU and University of Cagliari, Cagliari, Italy
| | - Maaret Castrén
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset and Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden
| | - Anil Gulati
- Midwestern University, Downers Grove, IL, USA
| | | | - Nicoletta Iacovidou
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece; 2nd Department of Obstetrics and Gynecology, Neonatal Division, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Xanthos
- MSc "Cardiopulmonary Resuscitation", Medical School, National and Kapodistrian University of Athens, Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
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