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Fragkou PC, Karagiannis SP, Dimopoulou D, Kefala S, Fligou F, Gallos P, Jahaj E, Bellou A, Koukaki E, Magira E, Orfanos P, Papathanakos G, Papathanasiou A, Pediaditis E, Pontikis K, Rovina N, Vaporidi K, Xenikakis M, Theodorakopoulou M, Kotanidou A. Intensive Care Unit Mortality Trends during the First Two Years of the COVID-19 Pandemic in Greece: A Multi-Center Retrospective Study. Viruses 2024; 16:488. [PMID: 38675831 PMCID: PMC11054592 DOI: 10.3390/v16040488] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Data on COVID-19 mortality among patients in intensive care units (ICUs) from Eastern and/or Southern European countries, including Greece, are limited. The purpose of this study was to evaluate the ICU mortality trends among critically ill COVID-19 patients during the first two years of the pandemic in Greece and to further investigate if certain patients' clinical characteristics contributed to this outcome. We conducted a multi-center retrospective observational study among five large university hospitals in Greece, between February 2020 and January 2022. All adult critically ill patients with confirmed COVID-19 disease who required ICU admission for at least 24 h were eligible. In total, 1462 patients (66.35% males) were included in this study. The mean age of this cohort was 64.9 (±13.27) years old. The 28-day mortality rate was 35.99% (n = 528), while the overall in-hospital mortality was 50.96% (n = 745). Cox regression analysis demonstrated that older age (≥65 years old), a body mass index within the normal range, and a delay in ICU admission from symptom onset, as well as worse baseline clinical severity scores upon ICU admission, were associated with a greater risk of death. Mortality of critically ill COVID-19 patients was high during the first two years of the pandemic in Greece but comparable to other countries. Risk factors for death presented in this study are not different from those that have already been described for COVID-19 in other studies.
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Affiliation(s)
- Paraskevi C. Fragkou
- First Department of Critical Care and Pulmonary Diseases, Evangelismos General Hospital of Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece; (S.P.K.); (E.J.); (E.M.); (M.T.); (A.K.)
| | - Sotirios P. Karagiannis
- First Department of Critical Care and Pulmonary Diseases, Evangelismos General Hospital of Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece; (S.P.K.); (E.J.); (E.M.); (M.T.); (A.K.)
| | - Dimitra Dimopoulou
- Second Department of Pediatrics, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece;
| | - Sotiria Kefala
- Division of Anesthesiology and Intensive Care Medicine, School of Medicine, University of Patras, 26504 Patras, Greece; (S.K.); (F.F.); (A.B.)
| | - Fotini Fligou
- Division of Anesthesiology and Intensive Care Medicine, School of Medicine, University of Patras, 26504 Patras, Greece; (S.K.); (F.F.); (A.B.)
| | - Parisis Gallos
- Computational Biomedicine Laboratory, Department of Digital Systems, University of Piraeus, 18534 Piraeus, Greece;
| | - Edison Jahaj
- First Department of Critical Care and Pulmonary Diseases, Evangelismos General Hospital of Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece; (S.P.K.); (E.J.); (E.M.); (M.T.); (A.K.)
| | - Angeliki Bellou
- Division of Anesthesiology and Intensive Care Medicine, School of Medicine, University of Patras, 26504 Patras, Greece; (S.K.); (F.F.); (A.B.)
| | - Evangelia Koukaki
- Intensive Care Unit, First Department of Respiratory Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Chest Hospital, 11527 Athens, Greece; (E.K.); (K.P.); (N.R.)
| | - Eleni Magira
- First Department of Critical Care and Pulmonary Diseases, Evangelismos General Hospital of Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece; (S.P.K.); (E.J.); (E.M.); (M.T.); (A.K.)
| | - Philippos Orfanos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Georgios Papathanakos
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (G.P.); (A.P.); (M.X.)
| | - Athanasios Papathanasiou
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (G.P.); (A.P.); (M.X.)
| | - Emmanouil Pediaditis
- Department of Intensive Care Unit, University Hospital of Heraklion, School of Medicine, University of Crete, 70013 Heraklion, Greece; (E.P.); (K.V.)
| | - Konstantinos Pontikis
- Intensive Care Unit, First Department of Respiratory Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Chest Hospital, 11527 Athens, Greece; (E.K.); (K.P.); (N.R.)
| | - Nikoletta Rovina
- Intensive Care Unit, First Department of Respiratory Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Chest Hospital, 11527 Athens, Greece; (E.K.); (K.P.); (N.R.)
| | - Katerina Vaporidi
- Department of Intensive Care Unit, University Hospital of Heraklion, School of Medicine, University of Crete, 70013 Heraklion, Greece; (E.P.); (K.V.)
| | - Menelaos Xenikakis
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (G.P.); (A.P.); (M.X.)
| | - Maria Theodorakopoulou
- First Department of Critical Care and Pulmonary Diseases, Evangelismos General Hospital of Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece; (S.P.K.); (E.J.); (E.M.); (M.T.); (A.K.)
| | - Anastasia Kotanidou
- First Department of Critical Care and Pulmonary Diseases, Evangelismos General Hospital of Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece; (S.P.K.); (E.J.); (E.M.); (M.T.); (A.K.)
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2
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Andrianopoulos I, Kazakos N, Lagos N, Maniatopoulou T, Papathanasiou A, Papathanakos G, Koulenti D, Toli E, Gartzonika K, Koulouras V. Co-Administration of High-Dose Nebulized Colistin for Acinetobacter baumannii Bacteremic Ventilator-Associated Pneumonia: Impact on Outcomes. Antibiotics (Basel) 2024; 13:169. [PMID: 38391555 PMCID: PMC10886014 DOI: 10.3390/antibiotics13020169] [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: 01/18/2024] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
Acinetobacter baumannii (A. baumannii) is a difficult-to-treat (DTR) pathogen that causes ventilator-associated pneumonia (VAP) associated with high mortality. To improve the outcome of DTR A. Baumannii VAP, nebulized colistin (NC) was introduced with promising but conflicting results on mortality in earlier studies. Currently, NC is used at a much higher daily dose compared to the past. Nevertheless, there is little evidence on the effect of high-dose NC on the outcomes of A. baumannii VAPs, especially in the current era where the percentage of colistin-resistant A. baumannii strains is rising. We conducted a retrospective study comparing bacteremic A. baumannii VAP patients who were treated with and without NC co-administration and were admitted in the Intensive Care Unit of University Hospital of Ioannina from March 2020 to August 2023. Overall, 59 patients (21 and 38 with and without NC coadministration, respectively) were included. Both 28-day and 7-day mortalities were significantly lower in the patient group treated with NC (52.4% vs. 78.9%, p 0.034 and 9.5% vs. 47.4%, p 0.003, respectively). Patients treated with NC had a higher percentage of sepsis resolution by day 7 (38.1% vs. 13.5%, p 0.023) and were more likely to be off vasopressors by day 7 (28.6% vs. 8.1%, p 0.039). The addition of NC in the treatment regime of A. baumannii VAP decreased mortality.
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Affiliation(s)
| | - Nikolaos Kazakos
- Intensive Care Unit, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Nikolaos Lagos
- Intensive Care Unit, University Hospital of Ioannina, 45500 Ioannina, Greece
| | | | | | | | - Despoina Koulenti
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia
- Second Critical Care Department, Attikon University Hospital, Rimini Street, 12462 Athens, Greece
| | - Eleni Toli
- Intensive Care Unit, University Hospital of Ioannina, 45500 Ioannina, Greece
| | | | - Vasilios Koulouras
- Intensive Care Unit, University Hospital of Ioannina, 45500 Ioannina, Greece
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3
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Bose S, Papathanasiou A, Karkhanis S, Appleton JP, King D, Batra R, Mollan SP, Jacob S. Susac syndrome: neurological update (clinical features, long-term observational follow-up and management of sixteen patients). J Neurol 2023; 270:6193-6206. [PMID: 37608221 PMCID: PMC10632257 DOI: 10.1007/s00415-023-11891-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/24/2023]
Abstract
Susac syndrome is a likely autoimmune microangiopathy affecting the brain, retina and inner ear. Due to the rarity of this condition, diagnosis and treatment can be challenging. Diagnosis is based on the presence of the clinical triad of central nervous system dysfunction, branch retinal artery occlusions and sensorineural hearing loss. Typical MRI findings of callosal and peri-callosal lesions may assist in diagnosis. Clinical course can be monophasic, polycyclic or chronic continuous. It is important to look out for red flags to attain an accurate diagnosis and follow a therapeutic algorithm based on severity of the disease and response to treatment. Patients are treated with steroids and immunosuppressive agents with a variable response. Early aggressive treatment especially in severe cases, may help in preventing relapses and morbidity/disability. This study highlights important diagnostic features and proposes a treatment algorithm based on clinical experience from management of 16 patients from 2 neuroscience centres in the UK since 2007, who were followed up over a long period of 3-15 years.
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Affiliation(s)
- Smriti Bose
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | | | - Sameep Karkhanis
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Jason P Appleton
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
- Institute of Applied Health Research, College of Dental and Medical Sciences, University of Birmingham, Birmingham, UK
| | - Dominic King
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Ruchika Batra
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Susan P Mollan
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Saiju Jacob
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK.
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
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Agiannitopoulos K, Potska K, Katseli A, Ntogka C, Tsaousis GN, Pepe G, Bouzarelou D, Tsoulos N, Papathanasiou A, Ziogas D, Venizelos V, Markopoulos C, Iosifidou R, Karageorgopoulou S, Giassas S, Natsiopoulos I, Papazisis K, Vasilaki-Antonatou M, Psyrri A, Koumarianou A, Matthaios D, Zairi E, Blidaru A, Banu E, Jinga DC, Laçin Ş, Özdoğan M, Papadopoulou E, Nasioulas G. Only 32.3% of Breast Cancer Families with Pathogenic Variants in Cancer Genes Utilized Cascade Genetic Testing. Cancers (Basel) 2023; 15:5218. [PMID: 37958392 PMCID: PMC10649031 DOI: 10.3390/cancers15215218] [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: 09/19/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Hereditary cancer predisposition syndromes are responsible for approximately 5-10% of all diagnosed cancer cases. In order to identify individuals at risk in a cost-efficient manner, family members of individuals carrying pathogenic alterations are tested only for the specific variant that was identified in their carrier relative. The purpose of this study was to investigate the clinical use and implementation of cascade family testing (CFT) in families of breast cancer patients with pathogenic/likely pathogenic variants (PVs/LPVs) in cancer-related predisposition genes. METHODS Germline sequencing was carried out with NGS technology using a 52-gene panel, and cascade testing was performed by Sanger sequencing or MLPA. RESULTS In a cohort of 1785 breast cancer patients (families), 20.3% were found to have PVs/LPVs. Specifically, 52.2%, 25.1%, and 22.7% of patients had positive findings in high-, intermediate-, and low-penetrance breast cancer susceptibility genes, respectively. Although CFT was recommended to all families, only 117 families (32.3%) agreed to proceed with genetic testing. Among the first-degree relatives who underwent CFT, 70.3% were female, and 108 of 121 (89.3%) were cancer free. Additionally, 42.7%, 36.7%, and 20.6% were offspring, siblings, and parents of the subject, respectively. Our data suggest that CFT was mostly undertaken (104/117, 88.8%) in families with positive findings in high-risk genes. CONCLUSIONS Cascade family testing can be a powerful tool for primary cancer prevention by identifying at-risk family members. It is of utmost importance to implement genetic counseling approaches leading to increased awareness and communication of genetic testing results.
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Affiliation(s)
- Konstantinos Agiannitopoulos
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
| | - Kevisa Potska
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
| | - Anastasia Katseli
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
| | - Christina Ntogka
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
| | - Georgios N. Tsaousis
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
| | - Georgia Pepe
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
| | - Dimitra Bouzarelou
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
| | - Nikolaos Tsoulos
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
| | - Athanasios Papathanasiou
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
| | | | | | | | | | | | - Stylianos Giassas
- IASO, General Maternity and Gynecology Clinic, 15123 Athens, Greece; (S.K.); (S.G.)
| | | | | | | | - Amanta Psyrri
- Section of Medical Oncology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.P.); (A.K.)
| | - Anna Koumarianou
- Section of Medical Oncology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.P.); (A.K.)
| | | | - Eleni Zairi
- St. Luke’s Hospital, 55236 Thessaloniki, Greece;
| | - Alexandru Blidaru
- Alexandru Trestioreanu Bucharest Oncology Institute, 022328 Bucharest, Romania;
| | - Eugeniu Banu
- Saint Constantin Hospital, 500299 Brasov, Romania;
| | | | - Şahin Laçin
- Department of Medical Oncology, Koc University Faculty of Medicine, 34010 Istanbul, Turkey;
| | - Mustafa Özdoğan
- Division of Medical Oncology, Memorial Antalya Hospital, 07025 Antalya, Turkey;
| | - Eirini Papadopoulou
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
| | - George Nasioulas
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
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Papathanasiou A, Hibbert A, Tallantyre E, Harding K, Selvam AP, Morgan M, Quainton C, Talaei M, Arun T, Ingram G, Law GR, Evangelou N. Real-world annualized relapse rates from contemporary multiple sclerosis clinics in the UK: a retrospective multicentre cohort study. Neurol Sci 2023; 44:3629-3635. [PMID: 37208584 PMCID: PMC10198787 DOI: 10.1007/s10072-023-06838-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/02/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Annualized relapse rate (ARR) is used as an outcome measure in multiple sclerosis (MS) clinical trials. Previous studies demonstrated that ARR has reduced in placebo groups between 1990 and 2012. This study aimed to estimate real-world ARRs from contemporary MS clinics in the UK, in order to improve the feasibility estimations for clinical trials and facilitate MS service planning. METHODS A multicentre observational, retrospective study of patients with MS from 5 tertiary neuroscience centres in the UK. We included all adult patients with a diagnosis of MS that had a relapse between 01/04/2020 and 30/06/2020. RESULTS One hundred thirteen out of 8783 patients had a relapse during the 3-month study period. Seventy-nine percent of the patients with a relapse were female, the mean age was 39 years, and the median disease duration was 4.5 years; 36% of the patients that had a relapse were on disease-modifying treatment. The ARR from all study sites was estimated at 0.05. The ARR for relapsing remitting MS (RRMS) was estimated at 0.08, while the ARR for secondary progressive MS (SPMS) was 0.01. CONCLUSIONS We report a lower ARR compared to previously reported rates in MS.
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Affiliation(s)
- Athanasios Papathanasiou
- Nottingham Centre for Multiple Sclerosis and Neuroinflammation, Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Aimee Hibbert
- Nottingham Centre for Multiple Sclerosis and Neuroinflammation, Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Emma Tallantyre
- Helen Durham Centre for Neuroinflammatory Disease, University Hospital of Wales, Cardiff, UK
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Katharine Harding
- Department of Neurology, Aneurin Bevan University Health Board, Newport, UK
| | - Adithya Panneer Selvam
- Nottingham Centre for Multiple Sclerosis and Neuroinflammation, Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Matthew Morgan
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Charlotte Quainton
- Department of Neurology, Aneurin Bevan University Health Board, Newport, UK
| | - Maryam Talaei
- Department of Neurology, Morriston Hospital, Swansea, UK
| | - Tarunya Arun
- Department of Neurosciences, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Gillian Ingram
- Department of Neurology, Morriston Hospital, Swansea, UK
| | - Graham R Law
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Nikos Evangelou
- Mental Health and Clinical Neurosciences Academic Unit, University of Nottingham, Nottingham, UK
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Papathanakos G, Andrianopoulos I, Xenikakis M, Papathanasiou A, Koulenti D, Blot S, Koulouras V. Clinical Sepsis Phenotypes in Critically Ill Patients. Microorganisms 2023; 11:2165. [PMID: 37764009 PMCID: PMC10538192 DOI: 10.3390/microorganisms11092165] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/10/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Sepsis, defined as the life-threatening dysregulated host response to an infection leading to organ dysfunction, is considered as one of the leading causes of mortality worldwide, especially in intensive care units (ICU). Moreover, sepsis remains an enigmatic clinical syndrome, with complex pathophysiology incompletely understood and a great heterogeneity both in terms of clinical expression, patient response to currently available therapeutic interventions and outcomes. This heterogeneity proves to be a major obstacle in our quest to deliver improved treatment in septic critical care patients; thus, identification of clinical phenotypes is absolutely necessary. Although this might be seen as an extremely difficult task, nowadays, artificial intelligence and machine learning techniques can be recruited to quantify similarities between individuals within sepsis population and differentiate them into distinct phenotypes regarding not only temperature, hemodynamics or type of organ dysfunction, but also fluid status/responsiveness, trajectories in ICU and outcome. Hopefully, we will eventually manage to determine both the subgroup of septic patients that will benefit from a therapeutic intervention and the correct timing of applying the intervention during the disease process.
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Affiliation(s)
- Georgios Papathanakos
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (I.A.); (M.X.); (A.P.); (V.K.)
| | - Ioannis Andrianopoulos
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (I.A.); (M.X.); (A.P.); (V.K.)
| | - Menelaos Xenikakis
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (I.A.); (M.X.); (A.P.); (V.K.)
| | - Athanasios Papathanasiou
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (I.A.); (M.X.); (A.P.); (V.K.)
| | - Despoina Koulenti
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QL 4029, Australia;
- Second Critical Care Department, Attikon University Hospital, Rimini Street, 12462 Athens, Greece
| | - Stijn Blot
- Department of Internal Medicine & Pediatrics, Ghent University, 9000 Ghent, Belgium;
| | - Vasilios Koulouras
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (I.A.); (M.X.); (A.P.); (V.K.)
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7
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Andrianopoulos I, Maniatopoulou T, Lagos N, Kazakos N, Papathanasiou A, Papathanakos G, Koulenti D, Kittas C, Koulouras V. Acinetobacter baumannii Bloodstream Infections in the COVID-19 Era: A Comparative Analysis between COVID-19 and Non-COVID-19 Critically Ill Patients. Microorganisms 2023; 11:1811. [PMID: 37512983 PMCID: PMC10383443 DOI: 10.3390/microorganisms11071811] [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: 06/10/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic increased the incidence of severe infections caused by multidrug-resistant (MDR) pathogens among critically ill patients, such as Acinetobacter baumannii (AB), whose bloodstream infections (BSIs) have been associated with significant mortality. Whether there is any difference in outcome between COVID-19 and non-COVID-19 patients with AB BSI still remains unknown. We conducted a retrospective study comparing clinical characteristics and outcomes of COVID-19 versus non-COVID-19 critically ill patients with AB BSI. Overall, 133 patients with AB BSI (102 COVID-19, 31 non-COVID-19) were studied. The 28-day mortality rate was high and did not differ significantly (69.6% COVID-19 vs. 61.3% non-COVID-19, p = 0.275). Patients with septic shock had a higher mortality rate irrespective of their status with the majority of deaths occurring during the first 7 days. COVID-19 patients were more likely to have ventilator-associated pneumonia (VAP) as the source of BSI (55.8% vs. 22.3%, respectively, p = 0.0001) and were more likely to develop acute respiratory distress syndrome (ARDS) (78.4% vs. 48.4%, respectively, p = 0.001), sepsis (86.3% vs. 67.7%, respectively, p = 0.03), and septic shock (88.3% vs. 58.1%, respectively, p = 0.007) compared to the non-COVID-19 patient group. In conclusion, COVID-19 patients with A. baumannii BSI have a high rate of mortality and more often develop septic shock, while VAP is the main origin of their BSI.
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Affiliation(s)
| | | | - Nikolaos Lagos
- Intensive Care Unit, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Nikolaos Kazakos
- Intensive Care Unit, University Hospital of Ioannina, 45500 Ioannina, Greece
| | | | | | - Despoina Koulenti
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia
- Second Critical Care Department, Attikon University Hospital, Rimini Street, 12462 Athens, Greece
| | - Christos Kittas
- Department of Microbiology, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Vasilios Koulouras
- Intensive Care Unit, University Hospital of Ioannina, 45500 Ioannina, Greece
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Papadopoulou E, Bouzarelou D, Tsaousis G, Papathanasiou A, Vogiatzi G, Vlachopoulos C, Miliou A, Papachristou P, Prappa E, Servos G, Ritsatos K, Seretis A, Frogoudaki A, Nasioulas G. Application of next generation sequencing in cardiology: current and future precision medicine implications. Front Cardiovasc Med 2023; 10:1202381. [PMID: 37424920 PMCID: PMC10327645 DOI: 10.3389/fcvm.2023.1202381] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023] Open
Abstract
Inherited cardiovascular diseases are highly heterogeneous conditions with multiple genetic loci involved. The application of advanced molecular tools, such as Next Generation Sequencing, has facilitated the genetic analysis of these disorders. Accurate analysis and variant identification are required to maximize the quality of the sequencing data. Therefore, the application of NGS for clinical purposes should be limited to laboratories with a high level of technological expertise and resources. In addition, appropriate gene selection and variant interpretation can result in the highest possible diagnostic yield. Implementation of genetics in cardiology is imperative for the accurate diagnosis, prognosis and management of several inherited disorders and could eventually lead to the realization of precision medicine in this field. However, genetic testing should also be accompanied by an appropriate genetic counseling procedure that clarifies the significance of the genetic analysis results for the proband and his family. In this regard, a multidisciplinary collaboration among physicians, geneticists, and bioinformaticians is imperative. In the present review, we address the current state of knowledge regarding genetic analysis strategies employed in the field of cardiogenetics. Variant interpretation and reporting guidelines are explored. Additionally, gene selection procedures are accessed, with a particular emphasis on information concerning gene-disease associations collected from international alliances such as the Gene Curation Coalition (GenCC). In this context, a novel approach to gene categorization is proposed. Moreover, a sub-analysis is conducted on the 1,502,769 variation records with submitted interpretations in the Clinical Variation (ClinVar) database, focusing on cardiology-related genes. Finally, the most recent information on genetic analysis's clinical utility is reviewed.
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Affiliation(s)
| | | | | | | | - Georgia Vogiatzi
- Third Department of Cardiology, Sotiria Hospital, Athens, Greece
| | - Charalambos Vlachopoulos
- Unit of Inherited Cardiac Conditions and Sports Cardiology, First Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Antigoni Miliou
- Unit of Inherited Cardiac Conditions and Sports Cardiology, First Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Efstathia Prappa
- Second Department of Cardiology, Arrhythmia Unit, Evangelismos General Hospital of Athens, Athens, Greece
| | - Georgios Servos
- Pediatric Cardiology Unit, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece
| | - Konstantinos Ritsatos
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Athens, Greece
| | - Aristeidis Seretis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Athens, Greece
| | - Alexandra Frogoudaki
- Second Department of Cardiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Dumitrescu L, Papathanasiou A, Coclitu C, Garjani A, Evangelou N, Constantinescu CS, Popescu BO, Tanasescu R. An update on the use of sphingosine 1-phosphate receptor modulators for the treatment of relapsing multiple sclerosis. Expert Opin Pharmacother 2023; 24:495-509. [PMID: 36946625 PMCID: PMC10069376 DOI: 10.1080/14656566.2023.2178898] [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] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Multiple sclerosis (MS) is an immune-mediated disorder of the CNS manifested by recurrent attacks of neurological symptoms (related to focal inflammation) and gradual disability accrual (related to progressive neurodegeneration and neuroinflammation). Sphingosine-1-phosphate-receptor (S1PR) modulators are a class of oral disease-modifying therapies (DMTs) for relapsing MS. The first S1PR modulator developed and approved for MS was fingolimod, followed by siponimod, ozanimod, and ponesimod. All are S1P analogues with different S1PR-subtype selectivity. They restrain the S1P-dependent lymphocyte egress from lymph nodes by binding the lymphocytic S1P-subtype-1-receptor. Depending on their pharmacodynamics and pharmacokinetics, they can also interfere with other biological functions. AREAS COVERED Our narrative review covers the PubMed English literature on S1PR modulators in MS until August 2022. We discuss their pharmacology, efficacy, safety profile, and risk management recommendations based on the results of phase II and III clinical trials. We briefly address their impact on the risk of infections and vaccines efficacy. EXPERT OPINION S1PR modulators decrease relapse rate and may modestly delay disease progression in people with relapsing MS. Aside their established benefit, their place and timing within the long-term DMT strategy in MS, as well as their immunological effects in the new and evolving context of the post-COVID-19 pandemic and vaccination campaigns warrant further study.
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Affiliation(s)
- Laura Dumitrescu
- Department of Clinical Neurosciences, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Department of Neurology, Colentina Clinical Hospital, Bucharest, Romania
| | - Athanasios Papathanasiou
- Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, UK
| | - Catalina Coclitu
- Department of Multiple Sclerosis and Neuroimmunology, CHU Grenoble, Grenoble, France
| | - Afagh Garjani
- Academic Clinical Neurology, Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nikos Evangelou
- Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, UK
- Academic Clinical Neurology, Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Cris S Constantinescu
- Academic Clinical Neurology, Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Neurology, Cooper Neurological Institute, Camden, NJ, USA
| | - Bogdan Ovidiu Popescu
- Department of Clinical Neurosciences, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Department of Neurology, Colentina Clinical Hospital, Bucharest, Romania
| | - Radu Tanasescu
- Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, UK
- Academic Clinical Neurology, Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK
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10
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Romanidou O, Apostolou P, Kouvelakis K, Tsangaras K, Eliades A, Achilleos A, Loizides C, Lemesios C, Ioannides M, Kypri E, Koumbaris G, Papadopoulou K, Papathanasiou A, Rigakos G, Xanthakis I, Fostira F, Kotoula V, Fountzilas G, Patsalis PC. Molecular profile and clinical features of patients with gliomas using a broad targeted next generation-sequencing panel. Oncol Lett 2022; 25:38. [PMID: 36589665 PMCID: PMC9773316 DOI: 10.3892/ol.2022.13624] [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: 09/13/2022] [Accepted: 11/02/2022] [Indexed: 12/13/2022] Open
Abstract
Gliomas are the most common malignant primary brain tumors characterized by poor prognosis. The genotyping of tumors using next generation sequencing (NGS) platforms enables the identification of genetic alterations that constitute diagnostic, prognostic and predictive biomarkers. The present study investigated the molecular profile of 32 tumor samples from 32 patients with high-grade gliomas by implementing a broad 80-gene targeted NGS panel while reporting their clinicopathological characteristics and outcomes. Subsequently, 14 of 32 tumor specimens were also genotyped using a 55-gene NGS panel to validate the diagnostic accuracy and clinical utility of the extended panel. The median follow-up was 19.2 months. In total, 129 genetic alterations including 33 structural variants were identified in 38 distinct genes. Among 96 variants (single nucleotide variants and insertions and deletions), 38 were pathogenic and 58 variants of unknown clinical significance. TP53 was the most frequently mutated gene, followed by PTEN and IDH1 genes. Glioma patients with IDH1 mutant tumors were younger and had significantly longer overall survival compared to patients with wild-type IDH1 tumors. Similarly, tumors with TP53 mutations were more likely observed in younger patients with glioma. Subsequently, a comparison of mutational profiles of samples analyzed by both panels was also performed. Implementation of the comprehensive pan-cancer and the MOL panels resulted in the identification of 37 and 15 variants, respectively. Of those, 13 were common. Comprehensive pan-cancer panel identified 24 additional variants, 22 of which were located in regions that were not targeted by the MOL panel. By contrast, the MOL panel identified two additional variants. Overall, the present study demonstrated that using an extended tumor profile assay instead of a glioma-specific tumor profile panel identified additional genetic changes that may be taken into consideration as potential therapeutic targets for glioma diagnosis and molecular classification.
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Affiliation(s)
- Ourania Romanidou
- Department of Medicine, Medical Oncology Unit, Giannitsa General Hospital, 58100 Giannitsa, Greece
| | - Paraskevi Apostolou
- Molecular Diagnostics Laboratory, InRASTES, National Centre for Scientific Research Demokritos, 15341 Athens, Greece
| | - Kyriakos Kouvelakis
- Section of Biostatistics, Hellenic Cooperative Oncology Group, Data Office, 11526 Athens, Greece
| | | | | | | | | | | | | | - Elena Kypri
- NIPD Genetics Ltd., 2409 Nicosia, Republic of Cyprus
| | | | - Kyriaki Papadopoulou
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, 54006 Thessaloniki, Greece
| | - Athanasios Papathanasiou
- Molecular Diagnostics Laboratory, InRASTES, National Centre for Scientific Research Demokritos, 15341 Athens, Greece
| | - Georgios Rigakos
- Third Department of Medical Oncology, Hygeia Hospital, 15123 Athens, Greece
| | - Ioannis Xanthakis
- Oncology Department, European Interbalkan Medical Center, 55535 Thessaloniki, Greece
| | - Florentia Fostira
- Molecular Diagnostics Laboratory, InRASTES, National Centre for Scientific Research Demokritos, 15341 Athens, Greece
| | - Vassiliki Kotoula
- Department of Pathology, School of Health Sciences, Faculty of Medicine, Aristotle University of Thessaloniki, 54006 Thessaloniki, Greece
| | - George Fountzilas
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, 54006 Thessaloniki, Greece,Aristotle University of Thessaloniki, 54006 Thessaloniki, Greece,Department of Medical Oncology, German Oncology Center, 4108 Limassol, Republic of Cyprus
| | - Philippos C. Patsalis
- NIPD Genetics Ltd., 2409 Nicosia, Republic of Cyprus,School of Medicine, University of Nicosia Medical School, 2417 Nicosia, Republic of Cyprus,Correspondence to: Professor Philippos C. Patsalis, NIPD Genetics Ltd., 31 Neas Engomis, Engomi, 2409 Nicosia, Republic of Cyprus, E-mail:
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11
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Karalidou V, Kalfakakou D, Papathanasiou A, Fostira F, Matsopoulos GK. MARGINAL: An Automatic Classification of Variants in BRCA1 and BRCA2 Genes Using a Machine Learning Model. Biomolecules 2022; 12:biom12111552. [PMID: 36358902 PMCID: PMC9687470 DOI: 10.3390/biom12111552] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/10/2022] [Accepted: 10/20/2022] [Indexed: 12/29/2022] Open
Abstract
Implementation of next-generation sequencing (NGS) for the genetic analysis of hereditary diseases has resulted in a vast number of genetic variants identified daily, leading to inadequate variant interpretation and, consequently, a lack of useful clinical information for treatment decisions. Herein, we present MARGINAL 1.0.0, a machine learning (ML)-based software for the interpretation of rare BRCA1 and BRCA2 germline variants. MARGINAL software classifies variants into three categories, namely, (likely) pathogenic, of uncertain significance and (likely) benign, implementing the criteria established by the American College of Medical Genetics and Genomics and the Association for Molecular Pathology (ACMG-AMP). We first annotated BRCA1 and BRCA2 variants using various sources. Then, we automatically implemented the ACMG-AMP criteria, and we finally constructed the ML model for variant classification. To maximize accuracy, we compared the performance of eight different ML algorithms in a classification scheme based on a serial combination of two classifiers. The model showed high predictive abilities with maximum accuracy of 92% and 98%, recall of 92% and 98% and specificity of 90% and 98% for the first and second classifiers, respectively. Our results indicate that using a gene and disease-specific ML automated software for clinical variant evaluation can minimize conflicting interpretations.
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Affiliation(s)
- Vasiliki Karalidou
- School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece
- Correspondence:
| | - Despoina Kalfakakou
- Molecular Diagnostics Laboratory, INRaSTES, National Center for Scientific Research NCSR Demokritos, 15341 Athens, Greece
| | - Athanasios Papathanasiou
- Molecular Diagnostics Laboratory, INRaSTES, National Center for Scientific Research NCSR Demokritos, 15341 Athens, Greece
| | - Florentia Fostira
- Molecular Diagnostics Laboratory, INRaSTES, National Center for Scientific Research NCSR Demokritos, 15341 Athens, Greece
| | - George K. Matsopoulos
- School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece
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12
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Liontos A, Biros D, Papathanasiou A, Papagiannopoulos C, Klouras E, Veliani C, Kolios NG, Pappa C, Liberopoulos E, Elisaf M, Milionis H, Liamis G. Comparative effect of 3 different fix-combination antihypertensive treatments in fasting glucose, fasting insulin, OGTT and HbA1c levels, in prediabetic hypertensive patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2204] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The effect of various antihypertensive drugs on the glucose homeostasis has been discussed extensively. Dual combination treatment is advised with current guidelines. We present comparative data of the effect of delapril/manidipine versus valsartan/amlodipine versus telmisartan/amlodipine combination treatments, in fasting glucose, fasting insulin, OGTT and HbA1c levels, before and after the 3-month treatment, in hypertensive prediabetic patients.
Methods
Data were collected from 154 patients from the outpatient clinic for patients with lipid disorders, hypertension and diabetes of our hospital, during the period 2014–2018. A number of 53 persons was randomized in the delapril/manidipine group 30/10 mg per day while 51 persons had been randomized in the group of telmisartan/amlodipine 80/5mg per day and 54 patients in the valsartan/amlodipine 160/5 mg per day. All patients successfully completed the study. Baseline characteristics are presented in Table 1A.
Results
The resulting alternations in glucose, insulin, OGTT and HbA1c levels, before and after the 3-month treatment are presented on Table 1B for the 3 groups of treatment.
Conclusions
In the comparison between the groups, a statistically significant difference was found in the change in INS values from the beginning of treatment until 3 months, for the TEL/AMLO treatment group, where a statistically significant difference from the DEL/MANI treatment group (p-value<0.01) and a strong statistically significant difference from the VAL/AMLO treatment group (p-value<0.001) were noted. The TEL/AMLO group had the only decrease in insulin levels compared to the other treatment groups where an increase was observed, after the treatment. The change in OGTT levels showed a statistically significant difference (p-value<0.05) between the DEL/MANI treatment group (a decrease of 6.63%) compared to the TEL/AMLO treatment group (an increase of 1.53%) after 3 months of treatment.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Liontos
- University hospital of Ioannina, 1st Division of Internal Medicine and infectious Diseases Unit , Ioannina , Greece
| | - D Biros
- University hospital of Ioannina, 1st Division of Internal Medicine and infectious Diseases Unit , Ioannina , Greece
| | - A Papathanasiou
- University hospital of Ioannina, 1st Division of Internal Medicine and infectious Diseases Unit , Ioannina , Greece
| | | | - E Klouras
- University hospital of Ioannina, 1st Division of Internal Medicine and infectious Diseases Unit , Ioannina , Greece
| | - C Veliani
- University hospital of Ioannina, 1st Division of Internal Medicine and infectious Diseases Unit , Ioannina , Greece
| | - N G Kolios
- University hospital of Ioannina, 1st Division of Internal Medicine and infectious Diseases Unit , Ioannina , Greece
| | - C Pappa
- University hospital of Ioannina, 1st Division of Internal Medicine and infectious Diseases Unit , Ioannina , Greece
| | | | - M Elisaf
- University hospital of Ioannina, 2nd Division of Internal Medicine , Ioannina , Greece
| | - H Milionis
- University hospital of Ioannina, 1st Division of Internal Medicine and infectious Diseases Unit , Ioannina , Greece
| | - G Liamis
- University hospital of Ioannina, 2nd Division of Internal Medicine , Ioannina , Greece
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13
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Liontos A, Filippas-Ntekouan S, Biros D, Kolios NG, Papagiannopoulos C, Veliani C, Papathanasiou A, Samanidou V, Tsourlos S, Athanasiou L, Pappa C, Pargana E, Nasiou M, Zarachi A, Vagias I, Tsiakas I, Christaki E, Elisaf M, Liberopoulos E, Milionis H, Liamis G. Comparative effect of valsartan-amlodipine treatment versus telmisartan-amlodipine treatment in HOMA-IR, HOMA-B, HOMA-S and QUICKI indexes in prediabetic hypertensive patients. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.591] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Liontos A, Biros D, Papathanasiou A, Papagiannopoulos C, Klouras E, Tsourlos S, Athanasiou L, Filippas-Ntekouan S, Zarachi A, Kolios NG, Pappa C, Samanidou V, Christaki E, Liberopoulos E, Elisaf M, Milionis H, Liamis G. Comparative effect of valsartan-amlodipine treatment versus telmisartan-amlodipine treatment in fasting glucose, fasting insulin, OGTT and HbA1c levels, in prediabetic hypertensive patients. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.592] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Liontos A, Biros D, Papathanasiou A, Papagiannopoulos C, Klouras E, Athanasiou L, Tsourlos S, Filippas-Ntekouan S, Samanidou V, Kolios NG, Veliani C, Pappa C, Zarachi A, Christaki E, Liberopoulos E, Elisaf M, Milionis H, Liamis G. Comparative effect of delapril-manidipine treatment versus telmisartan-amlodipine treatment in fasting glucose, fasting insulin, OGTT and HbA1c levels, in prediabetic hypertensive patients. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.587] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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16
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Liontos A, Filippas-Ntekouan S, Biros D, Kolios NG, Veliani C, Papagiannopoulos C, Samanidou V, Papathanasiou A, Tsourlos S, Athanasiou L, Pappa C, Pargana E, Nasiou M, Zarachi A, Tsiakas I, Christaki E, Elisaf M, Liberopoulos E, Milionis H, Liamis G. Comparative effect of delapril-manidipine treatment versus telmisartan-amlodipine treatment in HOMA-IR, HOMA-B, HOMA-S and QUICKI indexes in prediabetic hypertensive patients. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.590] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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17
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Liontos A, Papathanasiou A, Biros D, Papagiannopoulos C, Tsourlos S, Athanasiou L, Zarachi A, Kolios NG, Pargana E, Nasiou M, Christaki E, Liberopoulos E, Elisaf M, Milionis H, Liamis G. Changes in TRG/ApoA-1 ratio, TRG/HDL-C ratio and lipid serum profile after combination therapy with telmisartan/amlodipine in prediabetic patients. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.094] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction-Purpose
The combination of telmisartan with amlodipine is a commonly administered combination of an agonist ATII (angiotensin receptor II) and CCB (calcium channel blocker) for the management of hypertension. The purpose of this study is to evaluate the effect of the fixed of combination telmisartan/amlodipine 80/5mg per day on the levels of serum lipids, as well as the levels of serum apolipoproteins and the TRG/ApoA-1, TRG/HDL-C ratios, in patients with stage 2 hypertension (systolic blood pressure (SBP) 160-180 mmHg and/or diastolic blood pressure (DBP) 100-110 mmHg) and with prediabetes (IFG/IGT), before and after the 3-month treatment.
Methods
Data from 51 patients who had visited our outpatient clinic for lipid metabolism disorders during the period 2014-2018 and had been randomized in the telmisartan/amlodipine group 80/5mg per day. The patients (35 male/16 female) had BMI: 29.32 [27.37-31.65]. The levels serum lipids and of apolipoproteins B, A1, Lp(a) and E were measured before the beginning of the treatment and 3-months after its administration.
Results
The resulting variations of SBP and DBP levels before and after the 3-month treatment, as well as the variations of serum lipid, apolipoprotein levels and TRG/ApoA-1, TRG/HDL-C ratios are presented on Table 1.
Conclusion
The 3-month telmisartan/amlodipine therapy seems to improved, statistically significant both SBP and DBP levels (decreased by -13.58 % and -13 % respectively, p<0.001, for both values). Serum lipid levels didn’t show any significant variation before and after treatment. Statistically significant changes were not present in apolipoprotein levels, also. Finally, there were no statistically significant variations in either TRG/ApoA-1 or TRG/HDL-C ratios.
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Affiliation(s)
- A Liontos
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - A Papathanasiou
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - D Biros
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | | | - S Tsourlos
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - L Athanasiou
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - A Zarachi
- University Hospital of Ioannina, ENT departement, Ioannina, Greece
| | - NG Kolios
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - E Pargana
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - M Nasiou
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - E Christaki
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - E Liberopoulos
- University Hospital of Ioannina, 2nd Division of Internal Medicine, Ioannina, Greece
| | - M Elisaf
- University Hospital of Ioannina, 2nd Division of Internal Medicine, Ioannina, Greece
| | - H Milionis
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - G Liamis
- University Hospital of Ioannina, 2nd Division of Internal Medicine, Ioannina, Greece
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18
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Liontos A, Papathanasiou A, Biros D, Papagiannopoulos C, Tsourlos S, Athanasiou L, Kolios NG, Pappa C, Veliani C, Zarachi A, Christaki E, Liberopoulos E, Elisaf M, Milionis H, Liamis G. Alternations in markers of insulin resistance: HOMA-IR, HOMA-B, QUICKI, after dual therapy combination with delapril/manidipine in prediabetic hypertensive patients. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.092] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Purpose
The administration of the 30mg hydrochloric delapril and 10mg hydrochloric manidipine formulation is indicated for patients with idiopathic hypertension whose arterial pressure cannot be sufficiently managed with monotherapy. The purpose of this study is to investigate the effect of the premade combination delapril/manidipine 30/10mg per day on the variation of HOMA-IR, HOMA-B and QUICKI values, in patients with stage 2 hypertension (systolic blood pressure (SBP) 160-180 mmHg and/or diastolic blood pressure (DBP) 100-110 mmHg) and with prediabetes (IFG/IGT) before and after the 3-month treatment with the fixed combination dual-therapy.
Methods
53 patients (30 male/23 female, from whom 12 smokers and 7 alcohol users) who visited our outpatient clinic for lipid metabolism disorders and fulfilled the study’s criteria joined the study’s sample. They were randomized in the delapril/manidipine group. The patients’ BMI was 28.73 [27.73-30.3] and the SBP and DBP values were: 156 [151-161] and 100 [88-101] mmHg respectively.
Results
The resulting variations of SBP and DBP levels, as well as the variations of glucose and insulin levels and HOMA-IR, HOMA-B and QUICKI are presented on Table 1.
Results
From the sampled patients it seems that the 3-month treatment with delapril/manidipine improved statistically significantly the levels of both SBP and DBP (reduction by -11.54% and -12% respectively, p<0.001 for both values). Glucose levels witnessed a 1.55% decrease with statistical significance while a notable increase in insulin by 4.65% was also observed after the 3-month treatment, albeit without any statistical significance. Concerning HOMA-IR and QUICKI, there were no significant variance, while HOMA-B values showed a statistically significant increase (7%, p=0.006)
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Affiliation(s)
- A Liontos
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - A Papathanasiou
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - D Biros
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | | | - S Tsourlos
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - L Athanasiou
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - NG Kolios
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - C Pappa
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - C Veliani
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - A Zarachi
- University Hospital of Ioannina, ENT departement, Ioannina, Greece
| | - E Christaki
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - E Liberopoulos
- University Hospital of Ioannina, 2nd Division of Internal Medicine, Ioannina, Greece
| | - M Elisaf
- University Hospital of Ioannina, 2nd Division of Internal Medicine, Ioannina, Greece
| | - H Milionis
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - G Liamis
- University Hospital of Ioannina, 2nd Division of Internal Medicine, Ioannina, Greece
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Liontos A, Papathanasiou A, Biros D, Papagiannopoulos C, Tsourlos S, Athanasiou L, Veliani C, Kolios NG, Pappa C, Zarachi A, Christaki E, Liberopoulos E, Elisaf M, Milionis H, Liamis G. Alternations in markers of insulin resistance: HOMA-IR, HOMA-B, QUICKI, after dual therapy combination with telmisartan/amlodipine in prediabetic hypertensive patients. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.091] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction-Purpose
The combination of telmisartan and amlodipine in tablet form indicated for patients whose arterial blood pressure cannot be fully managed with monotreatment. The purpose of this study was to investigate the effect of the fixed combination telmisartan/amlodipine 80/5mg per day on arterial pressure levels and the variation of HOMA-IR, HOMA-B and QUICKI values in patients with stage 2 hypertension (systolic blood pressure (SBP) 160-179 mmHg and/or diastolic blood pressure (DBP) 100-109 mmHg) and with prediabetes (IFG/IGT) before and after the 3-month treatment with the administration of the fixed combination.
Methods
Data collected from 51 patients who have visited our outpatient clinic for lipid metabolism disorders during the period 2014-2018. 51 persons with BMI: 29.32 [27.37-31.65] (25 male, 16 female) had been randomized in the group for telmisartan/amlodipine 80/5mg per day.
The median values for the study’s sample in SBP and DBP were: 163[158-168] and 100[95-106] mmHg, respectively. Their somatometric and demographic characteristics were recorded in the beginning of the study and are presented on Table 1Α.
Results
The results of the variations in SBP and DBP, as well as the variations in glucose, insulin, HOMA-IR, HOMA-B and QUICKI before and after the 3-month treatment are presented on Table 1B.
Conclusions
From the sampled patients it can be observed that the 3-month treatment with telmisartan/amlodipine statistically significantly improved (p=0.005) the HOMA-IR values while improving fasting glucose and insulin levels. Finally, there was a statistically significant reduction in QUICKI values and a statistically insignificant reduction in HOMA-B.
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Affiliation(s)
- A Liontos
- University hospital of Ioannina, Ioannina, Greece
| | - A Papathanasiou
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - D Biros
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | | | - S Tsourlos
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - L Athanasiou
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - C Veliani
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - NG Kolios
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - C Pappa
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - A Zarachi
- University Hospital of Ioannina, ENT departement, Ioannina, Greece
| | - E Christaki
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - E Liberopoulos
- University Hospital of Ioannina, 2nd Division of Internal Medicine, Ioannina, Greece
| | - M Elisaf
- University Hospital of Ioannina, 2nd Division of Internal Medicine, Ioannina, Greece
| | - H Milionis
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - G Liamis
- University Hospital of Ioannina, 2nd Division of Internal Medicine, Ioannina, Greece
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Liontos A, Papathanasiou A, Biros D, Papagiannopoulos C, Athanasiou L, Tsourlos S, Veliani C, Kolios NG, Pappa C, Zarachi A, Christaki E, Liberopoulos E, Elisaf M, Milionis H, Liamis G. Alternations in markers of insulin resistance: HOMA-IR, HOMA-B, QUICKI, after dual therapy combination with valsartan/amlodipine in prediabetic hypertensive patients. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.090] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction-Purpose
The combination of valsartan with amlodipine is more effective than monotherapy for managing HT. The purpose of this study was to investigate the effect of the fixed combination of valsartan/amlodipine 160/5 mg per day on HOMA-IR (homeostatic model assessment for insulin resistance), HOMA-B (HOMA for β cell function) and QUICKI (quantitative insulin-sensitivity check index) values in patients with stage 2 hypertension (systolic arterial pressure 160-179 mmHg and/or diastolic pressure 100-109 mmHg) and prediabetes (IFG/IGT) before and after 3 months of treatment with the dual therapy.
Methods
Data from 54 patients who visited our outpatient clinic for lipid metabolism during the period 2014-2018. 54 persons were randomized in the valsartan/amlodipine group 160/5 mg per day (33 males/21 females from whom 14 were smokers and 8 were alcohol consumers) with BMI: 28.09[26.81-29.89], all of whom successfully completed the study. The median values of systolic and diastolic arterial pressure for the study population: 162 [159.25-165] and 100 [92-103.75] mmHg, respectively.
Results
The resulting variations of systolic and diastolic arterial pressure as well as the variations of HOMA-IR, HOMA-B and QUICKI are presented on Table 1.
Conclusions
From the studied group it is concluded that the 3-month treatment with valsartan/amlodipine improved with statistical significance the values of both systolic and diastolic arterial pressure (reduction by -13.58% and -13% for systolic and diastolic arterial pressure, respectively, p<0.001, for both values). Regarding glucose levels, there has also been a reduction by -0.04%, without statistical significance, while the increase of insulin levels (+16.13%) by the end of the 3-month period was also deemed statistically insignificant. Additionally, there have been noted statistically insignificant increases in HOMA-IR (+12.65%) and HOMA-B (+17%). Finally, no change has been observed in QUICKI values.
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Affiliation(s)
- A Liontos
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - A Papathanasiou
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - D Biros
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | | | - L Athanasiou
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - S Tsourlos
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - C Veliani
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - NG Kolios
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - C Pappa
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - A Zarachi
- University Hospital of Ioannina, ENT departement, Ioannina, Greece
| | - E Christaki
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - E Liberopoulos
- University Hospital of Ioannina, 2nd Division of Internal Medicine, Ioannina, Greece
| | - M Elisaf
- University Hospital of Ioannina, 2nd Division of Internal Medicine, Ioannina, Greece
| | - H Milionis
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - G Liamis
- University Hospital of Ioannina, 2nd Division of Internal Medicine, Ioannina, Greece
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Liontos A, Papathanasiou A, Biros D, Papagiannopoulos C, Tsourlos S, Athanasiou L, Zarachi A, Pargana E, Nasiou M, Veliani C, Christaki E, Liberopoulos E, Elisaf M, Milionis H, Liamis G. Changes in TRG/ApoA-1 ratio, TRG/HDL-C ratio and lipid serum profile after combination therapy with valsartan/amlodipine in prediabetic patients. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.093] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction-Purpose
The combination of valsartan with amlodipine is a commonly administered combination of an agonist ATII (angiotensin receptor II) and CCB (calcium channel blocker) for the management of hypertension. There is already data from different studies that describe the effect of each of those medications in the lipidemic profile. Ratios TRG/ApoA-1, TRG/HDLC are useful markers of insulin resistance. The purpose of this study is to investigate the effect of the fixed combination of valsartan/amlodipine 160/5mg per day on the levels of serum lipids, as well as the levels of serum apolipoproteins and the TRG/ApoA-1, TRG/HDLC ratios, in patients with stage 2 hypertension (systolic blood pressure (SBP) 160-179 mmHg and/or diastolic blood pressure (DBP) 100-109 mmHg) and prediabetes (IFG/IGT), before and after the 3-month treatment.
Methods
Data from 54 patients who were referred to our outpatient clinic for lipid metabolism disorders during the period 2014-2018 and had been randomized in the valsartan/amlodipine group 160/5mg per day. Those patients (33 male/21 female from whom 14 were smokers and 8 alcohol users) all completed the study successfully with mean BMI: 28.09[26.81-29.89]. The median values of SBP and DBP for the sample group were: 162 [159.25-165] και 100 [92-103.75] mmHg, respectively. The levels of apolipoproteins B, A-1, Lp(a) and E were measured prior to the beginning of treatment and 3-months after its administration.
Results
The resulting alternations of SBP and DBP levels before and after the 3-month treatment, as well as the changes of serum lipid, apolipoprotein levels and TRG/ApoA-1, TRG/HDL-C ratios are presented in Table 1.
Conclusions
From the sample group it seems like that the 3-month therapy with valsartan/amlodipine improved statistically significant both SBP and DBP levels (decreased by -13.58% and -13% respectively, p<0.001 for both values). Concerning lipid levels, no significant variation was observed across the board. Finally, no significant change was observed in apolipoprotein levels and TRG/ApoA-1, TRG/HDL-C ratios.
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Affiliation(s)
- A Liontos
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - A Papathanasiou
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - D Biros
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | | | - S Tsourlos
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - L Athanasiou
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - A Zarachi
- University Hospital of Ioannina, ENT departement, Ioannina, Greece
| | - E Pargana
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - M Nasiou
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - C Veliani
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - E Christaki
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - E Liberopoulos
- University Hospital of Ioannina, 2nd Division of Internal Medicine, Ioannina, Greece
| | - M Elisaf
- University Hospital of Ioannina, 2nd Division of Internal Medicine, Ioannina, Greece
| | - H Milionis
- University Hospital of Ioannina, 1st Division of Internal Medicine, Ioannina, Greece
| | - G Liamis
- University Hospital of Ioannina, 2nd Division of Internal Medicine, Ioannina, Greece
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Dumitrescu L, Papathanasiou A, Coclitu C, Constantinescu CS, Popescu BO, Tanasescu R. Beta interferons as immunotherapy in multiple sclerosis: a new outlook on a classic drug during the COVID-19 pandemic. QJM 2021; 114:691-697. [PMID: 33486513 PMCID: PMC7928608 DOI: 10.1093/qjmed/hcaa348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/22/2020] [Indexed: 12/16/2022] Open
Abstract
Beta interferons (IFN-β) are pleiotropic cytokines with antiviral properties. They play important roles in the pathogenesis of multiple sclerosis (MS), an incurable immune-mediated disorder of the central nervous system. The clinical expression of MS is heterogeneous, with relapses of neuroinflammation and with disability accrual in considerable part unrelated to the attacks. The injectable recombinant IFN-β preparations are the first approved disease-modifying treatments for MS. They have moderate efficacy in reducing the frequency of relapses, but good long-term cost-efficacy and safety profiles, so are still widely used. They have some tolerability and adherence issues, partly mitigated in recent years by the introduction of a PEGylated formulation and use of 'smart' autoinjector devices. Their general impact on long-term disability is modest but could be further improved by developing accurate tools for identifying the patient profile of best responders to IFN-β. Here, we present the IFN-β-based immunomodulatory therapeutic approaches in MS, highlighting their place in the current coronavirus disease (COVID-19) pandemic. The potential role of IFN-β in the treatment of COVID-19 is also briefly discussed.
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Affiliation(s)
- L Dumitrescu
- From the Department of Clinical Neurosciences, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Department of Neurology, Colentina Hospital, Bucharest, Romania
| | - A Papathanasiou
- Department of Neurology, Queen’s Medical Centre, Nottingham University Hospitals, Nottingham, UK
| | - C Coclitu
- Department of Multiple Sclerosis and Neuroimmunology, CHU Grenoble, Grenoble, France
| | - C S Constantinescu
- Department of Neurology, Queen’s Medical Centre, Nottingham University Hospitals, Nottingham, UK
- Academic Clinical Neurology, Division of Clinical Neuroscience, C Floor, South Block, Queen's Medical Centre, Derby Road, NG7 2UH, Nottingham, UK
| | - B O Popescu
- From the Department of Clinical Neurosciences, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Department of Neurology, Colentina Hospital, Bucharest, Romania
| | - R Tanasescu
- Department of Neurology, Queen’s Medical Centre, Nottingham University Hospitals, Nottingham, UK
- Academic Clinical Neurology, Division of Clinical Neuroscience, C Floor, South Block, Queen's Medical Centre, Derby Road, NG7 2UH, Nottingham, UK
- Address correspondence to Dr Radu Tanasescu, c/o Division of Clinical Neuroscience, Section of Clinical Neurology, University of Nottingham, Queen’s Medical Centre, C Floor South Block, Nottingham NG7 2UH, UK.
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Papathanasiou A, Tanasescu R, Tench CR, Rocha MF, Bose S, Constantinescu CS, Jacob S. Age at onset predicts outcome in aquaporin-4-IgG positive neuromyelitis optica spectrum disorder from a United Kingdom population. J Neurol Sci 2021; 431:120039. [PMID: 34715481 DOI: 10.1016/j.jns.2021.120039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/26/2021] [Revised: 09/29/2021] [Accepted: 10/19/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND There are few studies exploring the prognostic factors in patients with aquaporin-4 (AQP4)-IgG positive neuromyelitis optica spectrum disorder (NMOSD). OBJECTIVE To assess the predictors of outcome in patients with AQP4-antibody positive NMOSD from a United Kingdom (UK) population. METHODS A retrospective study of 52 patients from 2 neuroscience centres in the UK Midlands. RESULTS The most common initial presentations were acute myelitis and optic neuritis, with 22/52 cases (42.3%) each. Relapsing course was seen in 32 patients (61.5%) with mean annualised relapse rate of 0.43 (standard deviation 0.45) and a mean interval time to first relapse of 31 months (range 2-108). The median Expanded Disability Status Scale (EDSS) score at the last follow up was 4 (range 1-9). Age at onset was an independent predictor of disability in the whole cohort of patients with NMOSD. For every 10-year increase in age at disease onset, the risk of developing an EDSS score of ≥4 increased by 34%. Patients who presented initially with a longitudinally extensive transverse myelitis (LETM) showed a higher risk to develop disability, compared to other clinical presentations (median time of 4 years versus 13 years). Late onset (LO-NMOSD) patients were likely to reach an EDSS score of 4 more quickly, compared to early onset (EO-NMOSD) (median time of 7 years versus 13 years). Higher median EDSS score at last follow up was observed in LO-NMOSD compared to EO-NMOSD (6 versus 2). CONCLUSION Increasing age at onset and LETM predict disability in AQP-4-IgG positive NMOSD patients.
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Affiliation(s)
- Athanasios Papathanasiou
- Nottingham Centre for Multiple Sclerosis and Neuroinflammation, Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, UK.
| | - Radu Tanasescu
- Nottingham Centre for Multiple Sclerosis and Neuroinflammation, Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, UK; Division of Clinical Neuroscience, University of Nottingham, UK
| | - Chris R Tench
- Division of Clinical Neuroscience, University of Nottingham, UK
| | - Maria Francisca Rocha
- Nottingham Centre for Multiple Sclerosis and Neuroinflammation, Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, UK
| | - Smriti Bose
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, UK
| | - Cris S Constantinescu
- Nottingham Centre for Multiple Sclerosis and Neuroinflammation, Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, UK; Division of Clinical Neuroscience, University of Nottingham, UK
| | - Saiju Jacob
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, UK; Institute of Immunology and Immunotherapy, University of Birmingham, UK
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Kalfakakou D, Fostira F, Papathanasiou A, Apostolou P, Dellatola V, Gavra IE, Vlachos IS, Scouras ZG, Drosopoulou E, Yannoukakos D, Konstantopoulou I. CanVaS: Documenting the genetic variation spectrum of Greek cancer patients. Hum Mutat 2021; 42:1081-1093. [PMID: 34174131 DOI: 10.1002/humu.24249] [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: 03/15/2021] [Revised: 05/13/2021] [Accepted: 06/14/2021] [Indexed: 11/08/2022]
Abstract
National genetic variation registries vastly increase the level of detail for the relevant population, while directly affecting patient management. Herein, we report CanVaS, a Cancer Variation reSource aiming to document the genetic variation of cancer patients in Greece. CanVaS comprises germline genetic data from 7,363 Greek individuals with a personal and/or family history of malignancy. The data set incorporates approximately 24,000 functionally annotated rare variants in 97 established or suspected cancer susceptibility genes. For each variant, allele frequency for the Greek population, interpretation for clinical significance, anonymized family and segregation information, as well as phenotypic traits of the carriers, are included. Moreover, information on the geographic distribution of the variants across the country is provided, enabling the study of Greek population isolates. Direct comparisons between Greek (sub)populations with relevant genetic resources are supported, allowing fine-grain localized adjustment of guidelines and clinical decision-making. Most importantly, anonymized data are available for download, while the Leiden Open Variation Database schema is adopted, enabling integration/interconnection with central resources. CanVaS could become a stepping-stone for a countrywide effort to characterize the cancer genetic variation landscape, concurrently supporting national and international cancer research. The database can be accessed at: http://ithaka.rrp.demokritos.gr/CanVaS.
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Affiliation(s)
- Despoina Kalfakakou
- Department of Genetics, Development & Molecular Biology, School of Biology, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Molecular Diagnostics Laboratory, Institute of Nuclear & Radiological Sciences and Technology, Energy & Safety, National Center for Scientific Research "Demokritos", Athens, Greece
| | - Florentia Fostira
- Molecular Diagnostics Laboratory, Institute of Nuclear & Radiological Sciences and Technology, Energy & Safety, National Center for Scientific Research "Demokritos", Athens, Greece
| | - Athanasios Papathanasiou
- Molecular Diagnostics Laboratory, Institute of Nuclear & Radiological Sciences and Technology, Energy & Safety, National Center for Scientific Research "Demokritos", Athens, Greece
| | - Paraskevi Apostolou
- Molecular Diagnostics Laboratory, Institute of Nuclear & Radiological Sciences and Technology, Energy & Safety, National Center for Scientific Research "Demokritos", Athens, Greece
| | - Vasiliki Dellatola
- Molecular Diagnostics Laboratory, Institute of Nuclear & Radiological Sciences and Technology, Energy & Safety, National Center for Scientific Research "Demokritos", Athens, Greece
| | - Ioanna E Gavra
- Molecular Diagnostics Laboratory, Institute of Nuclear & Radiological Sciences and Technology, Energy & Safety, National Center for Scientific Research "Demokritos", Athens, Greece
| | - Ioannis S Vlachos
- Department of Pathology, Cancer Research Institute, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA.,Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Zacharias G Scouras
- Department of Genetics, Development & Molecular Biology, School of Biology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Drosopoulou
- Department of Genetics, Development & Molecular Biology, School of Biology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Drakoulis Yannoukakos
- Molecular Diagnostics Laboratory, Institute of Nuclear & Radiological Sciences and Technology, Energy & Safety, National Center for Scientific Research "Demokritos", Athens, Greece
| | - Irene Konstantopoulou
- Molecular Diagnostics Laboratory, Institute of Nuclear & Radiological Sciences and Technology, Energy & Safety, National Center for Scientific Research "Demokritos", Athens, Greece
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Papathanakos G, Andrianopoulos I, Papathanasiou A, Koulenti D, Gartzonika K, Koulouras V. Pandrug-resistant Acinetobacter baumannii treatment: still a debatable topic with no definite solutions. J Antimicrob Chemother 2021; 75:3081. [PMID: 32596722 DOI: 10.1093/jac/dkaa264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Georgios Papathanakos
- University Hospital of Ioannina, Intensive Care Unit, Stavros Niarchos Avenue, 45500 Ioannina, Greece
| | - Ioannis Andrianopoulos
- University Hospital of Ioannina, Intensive Care Unit, Stavros Niarchos Avenue, 45500 Ioannina, Greece
| | - Athanasios Papathanasiou
- University Hospital of Ioannina, Intensive Care Unit, Stavros Niarchos Avenue, 45500 Ioannina, Greece
| | - Despoina Koulenti
- Burns, Trauma and Critical Care Research Centre, UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Herston Campus, Brisbane QLD 4029, Australia.,2nd Critical Care Department, Attikon University Hospital, Rimini Street, 12463 Athens, Greece
| | - Konstantina Gartzonika
- Laboratory of Immunology and Microbiology, School of Medicine, University of Ioannina, Stavros Niarchos Avenue, 45500 Ioannina, Greece
| | - Vasilios Koulouras
- University Hospital of Ioannina, Intensive Care Unit, Stavros Niarchos Avenue, 45500 Ioannina, Greece
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26
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Papathanakos G, Andrianopoulos I, Papathanasiou A, Lepida D, Koulouras V. Adapting in the COVID-19 Era. Indian J Crit Care Med 2020; 24:1286-1287. [PMID: 33446990 PMCID: PMC7775942 DOI: 10.5005/jp-journals-10071-23689] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Papathanakos G, Andrianopoulos I, Papathanasiou A, Lepida D, Koulouras V. Adapting in the COVID-19 Era. Indian J Crit Care Med 2020;24(12):1286–1287.
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Affiliation(s)
- Georgios Papathanakos
- Department of Intensive Care Unit, University Hospital of Ioannina, Ioannina, Epirus, Greece
| | - Ioannis Andrianopoulos
- Department of Intensive Care Unit, University Hospital of Ioannina, Ioannina, Epirus, Greece
- Ioannis Andrianopoulos, Department of Intensive Care Unit, University Hospital of Ioannina, Ioannina, Epirus, Greece, Phone: +3026510992012, e-mail:
| | | | - Dimitra Lepida
- Department of Intensive Care Unit, University Hospital of Ioannina, Ioannina, Epirus, Greece
| | - Vasilios Koulouras
- Department of Intensive Care Unit, University Hospital of Ioannina, Ioannina, Epirus, Greece
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27
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Papathanasiou A, Mawal N. The risk of poor ovarian response during repeat IVF. Reprod Biomed Online 2020; 42:742-747. [PMID: 33487556 DOI: 10.1016/j.rbmo.2020.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/26/2020] [Revised: 10/27/2020] [Accepted: 12/04/2020] [Indexed: 11/28/2022]
Abstract
RESEARCH QUESTION What are the incidence and risk factors for poor ovarian response (POR) during repeat IVF? DESIGN A retrospective analysis of 1224 consecutive patients who underwent at least two IVF stimulations in a single centre over a 6-year period. Risk factors from the initial treatment were assessed for association with POR during repeat IVF using logistic regression analysis. A simple, practical predictive model was constructed and evaluated for accuracy and calibration, based on the factors that demonstrated significant association with subsequent POR. POR during repeat IVF was defined as ≤3 retrieved oocytes or cancellation before retrieval following recruitment of ≤3 mature follicles. RESULTS The risk of POR during repeat IVF was approximately 11.5%. A higher POR risk during repeat IVF is associated with a reduced oocyte yield during the initial treatment (≤3 oocytes: odds ratio [OR] 14, 95% confidence interval [CI] 6.42-30.24; 4-9 oocytes: OR 4.13, 95% CI 2.00-8.54; 10-15 oocytes: OR 1) and low ovarian reserve (anti-Müllerian hormone [AMH] <5.4 pmol/l: OR 3.54, 95% CI 2.24-5.59; AMH 5.4-25 pmol/l: OR 1). Women with low ovarian reserve who experience POR during the initial IVF have the highest risk of suffering POR again during repeat IVF (57% within 1 year). Other groups, such as women with unexpected POR or expected poor responders with suboptimal ovarian response during the initial IVF, are also at risk of exhibiting POR during a subsequent treatment (28% within 1 year). CONCLUSIONS As there is a clear association between POR and lower live birth rates, this practical model may help manage patients' expectations during repeat IVF treatment.
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Affiliation(s)
| | - Nausheen Mawal
- Bourn Hall Clinic, High Street, Bourn Cambridge CB23 2TN, UK
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28
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Kostara CE, Ferrannini E, Bairaktari ET, Papathanasiou A, Elisaf M, Tsimihodimos V. Early Signs of Atherogenic Features in the HDL Lipidomes of Normolipidemic Patients Newly Diagnosed with Type 2 Diabetes. Int J Mol Sci 2020; 21:ijms21228835. [PMID: 33266469 PMCID: PMC7700318 DOI: 10.3390/ijms21228835] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease (CVD) is the major cause of death in patients with type-2 diabetes mellitus (T2DM), although the factors that accelerate atherosclerosis in these patients are poorly understood. The identification of the altered quantity and quality of lipoproteins, closely related to atherogenesis, is limited in routine to a pattern of high triglycerides and low HDL-cholesterol (HDL-C) and in research as dysfunctional HDLs. We used the emerging NMR-based lipidomic technology to investigate compositional features of the HDLs of healthy individuals with normal coronary arteries, drug-naïve; recently diagnosed T2DM patients with normal coronary arteries; and patients with recent acute coronary syndrome. Patients with T2DM and normal serum lipid profiles even at diagnosis presented significant lipid alterations in HDL, characterized by higher triglycerides, lysophosphatidylcholine and saturated fatty acids; and lower cholesterol, phosphatidylcholine, phosphatidylethanolamine, sphingomyelin, plasmalogens and polyunsaturated fatty acids, an atherogenic pattern that may be involved in the pathogenesis of atherosclerosis. These changes are qualitatively similar to those found, more profoundly, in normolipidemic patients with established Coronary Heart Disease (CHD). We also conclude that NMR-based lipidomics offer a novel holistic exploratory approach for identifying and quantifying lipid species in biological matrixes in physiological processes and disease states or in disease biomarker discovery.
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Affiliation(s)
- Christina E. Kostara
- Laboratory of Clinical Chemistry, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece; (C.E.K.); (E.T.B.)
| | | | - Eleni T. Bairaktari
- Laboratory of Clinical Chemistry, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece; (C.E.K.); (E.T.B.)
| | - Athanasios Papathanasiou
- Department of Internal Medicine, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece; (A.P.); (M.E.)
| | - Moses Elisaf
- Department of Internal Medicine, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece; (A.P.); (M.E.)
| | - Vasilis Tsimihodimos
- Department of Internal Medicine, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece; (A.P.); (M.E.)
- Correspondence: ; Tel.: +30-2651007362
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Papathanasiou A. COVID-19 screening during fertility treatment: how do guidelines compare against each other? J Assist Reprod Genet 2020; 37:1831-1835. [PMID: 32656589 PMCID: PMC7354356 DOI: 10.1007/s10815-020-01885-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/08/2020] [Indexed: 12/28/2022] Open
Abstract
Various fertility scientific societies have published pathways and recommendations for COVID-19 screening during fertility treatments. As there is currently very limited research evidence on how to best deliver this screening, it is not surprising that there are noticeable differences between their recommendations. This paper compares the screening pathways recommended by these guidelines, in the light of the emerging evidence. It proposes the more liberal use of viral testing for improving detection of asymptomatic or mildly symptomatic fertility patients. It also argues that a negative test result on symptomatic individuals should not be over-relied upon for allowing the treatment to proceed. In these cases, a low threshold for cancellation may still need to be maintained.
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Kousta E, Sdogou T, Papathanasiou A. Paraganglioma syndrome type 4 presenting as hypertensive encephalopathy in an 8-year-old boy. Hippokratia 2020; 24:143. [PMID: 34239293 PMCID: PMC8256786] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- E Kousta
- Department of Pediatric Endocrinology, University of Athens, "P & A Kyriakou" Children's Hospital, Athens, Greece
| | - T Sdogou
- Second Department of Pediatrics, University of Athens, "P & A Kyriakou" Children's Hospital, Athens, Greece
| | - A Papathanasiou
- Department of Pediatric Endocrinology, University of Athens, "P & A Kyriakou" Children's Hospital, Athens, Greece
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Papathanasiou A, Yeo JM, Humberstone M, Hosseini AA. MOG-antibody-associated hypertrophic pachymeningitis. Mult Scler Relat Disord 2020; 42:102074. [PMID: 32361264 DOI: 10.1016/j.msard.2020.102074] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/22/2020] [Accepted: 03/25/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The clinical spectrum of myelin oligodendrocyte glycoprotein (MOG)-antibody-associated disease is expanding. OBJECTIVE To describe an unusual case of MOG-antibody-associated hypertrophic pachymeningitis (HP). METHODS Case study. RESULTS A 57-year-old female presented with a generalised seizure on a background of 3 months history of progressive cognitive decline and behavioural changes. Brain Magnetic Resonance Imaging (MRI) revealed widespread pachymeningeal enhancement and hyperintense signal in both hippocampi. Cerebrospinal Fluid (CSF) examination was normal. The patient was found positive for MOG-antibody. She clinically improved with steroids and the MRI abnormalities completely resolved. CONCLUSIONS Clinicians might consider testing for MOG-antibody in cases with HP.
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Affiliation(s)
- Athanasios Papathanasiou
- Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
| | - Jing-Ming Yeo
- Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Miles Humberstone
- Department of Neurology, Queen's Medical Centre, United Lincolnshire Hospitals NHS Trust, Nottingham, UK
| | - Akram A Hosseini
- Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
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Papathanakos G, Andrianopoulos I, Zikou X, Papathanasiou A, Koulouras V. Tracheostomy in the COVID-19 Era: The Apneic Approach. Otolaryngol Head Neck Surg 2020; 163:1283-1284. [PMID: 32600179 DOI: 10.1177/0194599820940652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Andrianopoulos I, Papathanasiou A, Papathanakos G, Chaidos A, Koulouras V. Tocilizumab's efficacy in patients with Coronavirus Disease 2019 (COVID-19) is determined by the presence of cytokine storm. J Med Virol 2020; 93:120-121. [PMID: 32568411 PMCID: PMC7361556 DOI: 10.1002/jmv.26209] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 11/13/2022]
Affiliation(s)
| | | | | | - Aristeidis Chaidos
- Department of Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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Papathanasiou A, Abdel-Fahim R, Gilmore C, Evangelou N. Venous thromboembolism in multiple sclerosis: a report of two cases with pulmonary embolism on dimethyl fumarate and available data from adverse event reporting systems. Time to include disease modifying drugs in the equation? Clin Neurol Neurosurg 2020; 192:105726. [DOI: 10.1016/j.clineuro.2020.105726] [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] [Received: 06/07/2019] [Revised: 01/20/2020] [Accepted: 02/05/2020] [Indexed: 10/25/2022]
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Papathanakos G, Andrianopoulos I, Papathanasiou A, Priavali E, Koulenti D, Koulouras V. Colistin-Resistant Acinetobacter Baumannii Bacteremia: A Serious Threat for Critically Ill Patients. Microorganisms 2020; 8:microorganisms8020287. [PMID: 32093299 PMCID: PMC7074815 DOI: 10.3390/microorganisms8020287] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 01/28/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 01/31/2023] Open
Abstract
The prevalence of acinetobacter baumannii (AB) as a cause of hospital infections has been rising. Unfortunately, emerging colistin resistance limits therapeutic options and affects the outcome. The aim of the study was to confirm our clinically-driven hypothesis that intensive care unit (ICU) patients with AB resistant-to-colistin (ABCoR) bloodstream infection (BSI) develop fulminant septic shock and die. We conducted a 28-month retrospective observational study including all patients developing AB infection on ICU admission or during ICU stay. From 622 screened patients, 31 patients with BSI sepsis were identified. Thirteen (41.9%) patients had ABCoR BSI and 18/31 (58.1%) had colistin-susceptible (ABCoS) BSI. All ABCoR BSI patients died; of them, 69% (9/13) presented with fulminant septic shock and died within the first 3 days from its onset. ABCoR BSI patients compared to ABCoS BSI patients had higher mortality (100% vs. 50%, respectively (p = 0.001)), died sooner (p = 0.006), had lower pH (p = 0.004) and higher lactate on ICU admission (p = 0.0001), and had higher APACHE II (p = 0.01) and Charlson Comorbidity Index scores (p = 0.044). In conclusion, we documented that critically ill patients with ABCoR BSI exhibit fulminant septic shock with excessive mortality. Our results highlight the emerging clinical problem of AB colistin resistance among ICU patients.
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Affiliation(s)
- Georgios Papathanakos
- University Hospital of Ioannina, Intensive Care Unit, Stavros Niarchos Avenue, 45500 Ioannina, Greece; (I.A.); (A.P.); (V.K.)
- Correspondence: ; Tel.: +30-2651-099-353
| | - Ioannis Andrianopoulos
- University Hospital of Ioannina, Intensive Care Unit, Stavros Niarchos Avenue, 45500 Ioannina, Greece; (I.A.); (A.P.); (V.K.)
| | - Athanasios Papathanasiou
- University Hospital of Ioannina, Intensive Care Unit, Stavros Niarchos Avenue, 45500 Ioannina, Greece; (I.A.); (A.P.); (V.K.)
| | - Efthalia Priavali
- Department of Microbiology, Medical School, University of Ioannina, 45110, Ioannina, Greece
| | - Despoina Koulenti
- Burns, Trauma and Critical Care Research Centre, UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Herston Campus, Brisbane QLD 4029, Australia;
- 2nd Critical Care Department, Attikon University Hospital, Rimini Street, 12463, Athens, Greece
| | - Vasilios Koulouras
- University Hospital of Ioannina, Intensive Care Unit, Stavros Niarchos Avenue, 45500 Ioannina, Greece; (I.A.); (A.P.); (V.K.)
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Sakalis VI, Sfiggas V, Vouros I, Salpiggidis G, Papathanasiou A, Apostolidis A. Subtle errors of bladder wall thickness measurement have a significant impact on the calculation of ultrasound-estimated bladder weight. A pilot study. Med Ultrason 2018; 20:292-297. [PMID: 30167581 DOI: 10.11152/mu-1369] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIMS Ultrasound-estimated bladder weight (UEBW), is an emerging diagnostic tool, which has been used in both males and females with lower urinary tract dysfunction. The currently acknowledged UEBW calculation methods rely on the accurate measurement of bladder wall thickness (BWT). We aim to identify if subtle errors in BWT measurement have a significant impact on UEBW calculations. MATERIALS AND METHODS Twenty patients were randomly selected from an overactive bladder patient cohort. The primary endpoint was to identify the range of false BWT measurements outside which significant changes in UEBW calculation occur. We used the Kojima method and a semi-automatic 3-D model that is based on Chalana's principle. Measurements were performed using the correct BWT and a series of faulty calculations from +0.5 mm to -0.5 mm using steps of 0.05 mm from true BWT. The effect of a fixed 0.5 mm BWT error was checked in bladder volumes above and below 250 ml and in three UEBW groups (<35 gr; 36-50 gr; >51gr). RESULTS BWT measurement errors above 0.25 mm cause statistically significant changes in UEWB calculation when a 3-D model is used and errors above 0.15 mm when Kojima's method is used. At a fixed BWT error of 0.5 mm and bladder volume <250 ml, there is a 23.76% deviation from true UEBW, while at volumes >250 ml the deviation is 32.72%. The deviation is inversely proportional to the UEBW result, and heavier bladders deviate less. CONCLUSIONS UEBW is a promising diagnostic tool, but small errors in BWT measurement might cause significant deviation from the true values. A 3-D calculation model appears to minimize such risks.
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Affiliation(s)
- Vasileios I Sakalis
- Department of Urology, General Hospital of Thessaloniki 'Agios Pavlos', Thessaloniki, Greece.
| | - Vasileios Sfiggas
- Department of Urology, General Hospital of Thessaloniki, Hippokrateion, Thessaloniki, Greece.
| | - Ioannis Vouros
- Department of Urology, General Hospital of Thessaloniki, Hippokrateion, Thessaloniki, Greece.
| | - Georgios Salpiggidis
- Department of Urology, General Hospital of Thessaloniki, Hippokrateion, Thessaloniki, Greece.
| | | | - Apostolos Apostolidis
- Department of Urology, 2nd University Hospital of Thessaloniki, Papageorgiou, Thessaloniki, Greece.
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Sakalis V, Sfiggas V, Vouros I, Salpiggidis G, Papathanasiou A, Apostolidis A. Combination of solifenacin with tamsulosin reduces prostate volume and vascularity as opposed to tamsulosin monotherapy in patients with benign prostate enlargement and overactive bladder symptoms: Results from a randomized pilot study. Int J Urol 2018; 25:737-745. [DOI: 10.1111/iju.13721] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 05/22/2018] [Indexed: 01/10/2023]
Affiliation(s)
| | | | - Ioannis Vouros
- Department of Urology; Hippokration Hospital; Thessaloniki Greece
| | | | | | - Apostolos Apostolidis
- 2nd Department of Urology; Papageorgiou General Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
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Papathanasiou A, Abdel-Fahim R, Evangelou N. Dual infectious brainstem encephalitis with Aspergillus flavus and Haemophilus influenza in an immunocompetent patient. Neurol Sci 2018; 39:1795-1796. [PMID: 29948465 DOI: 10.1007/s10072-018-3469-0] [Citation(s) in RCA: 1] [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: 02/05/2018] [Accepted: 06/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Athanasios Papathanasiou
- Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
| | - Rasha Abdel-Fahim
- Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Nikos Evangelou
- Division of Clinical Neurology, University of Nottingham, Nottingham, NG7 2UH, UK
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Lepida D, Papathanasiou A, Galiatsou E, Nakos G, Goudevenos I, Koulouras V. The contribution of left heart disease in COPD patients with pulmonary hypertension. Hellenic J Cardiol 2018; 59:160-165. [DOI: 10.1016/j.hjc.2018.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 02/02/2018] [Accepted: 02/06/2018] [Indexed: 10/18/2022] Open
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Karahaliou A, Papathanasiou A, Andrianopoulos I, Kostanti E, Papathanakos G, Goudevenos I, Nakos G, Koulouras V. Thrombolysis through a Swan-Ganz catheter in two patients with high-risk pulmonary embolism and absolute contraindication for systemic thrombolysis. Hellenic J Cardiol 2017; 59:296-297. [PMID: 29169986 DOI: 10.1016/j.hjc.2017.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 10/31/2017] [Accepted: 11/09/2017] [Indexed: 01/22/2023] Open
Affiliation(s)
- Aggeliki Karahaliou
- University Hospital of Ioannina, Intensive Care Unit, 45500, Ioannina, Greece
| | | | | | - Eleonora Kostanti
- University Hospital of Ioannina, Intensive Care Unit, 45500, Ioannina, Greece
| | | | - Ioannis Goudevenos
- University Hospital of Ioannina, Cardiology Department, 45500, Ioannina Greece
| | - George Nakos
- University Hospital of Ioannina, Intensive Care Unit, 45500, Ioannina, Greece
| | - Vasilios Koulouras
- University Hospital of Ioannina, Intensive Care Unit, 45500, Ioannina, Greece.
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Papathanasiou A, Messinis L, Zampakis P, Papathanasopoulos P. Corpus callosum atrophy as a marker of clinically meaningful cognitive decline in secondary progressive multiple sclerosis. Impact on employment status. J Clin Neurosci 2017; 43:170-175. [PMID: 28601572 DOI: 10.1016/j.jocn.2017.05.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 02/12/2017] [Accepted: 05/22/2017] [Indexed: 11/16/2022]
Abstract
Cognitive impairment in Multiple Sclerosis (MS) is more frequent and pronounced in secondary progressive MS (SPMS). Cognitive decline is an important predictor of employment status in patients with MS. Magnetic Resonance Imaging (MRI) markers have been used to associate tissue damage with cognitive dysfunction. The aim of the study was to designate the MRI marker that predicts cognitive decline in SPMS and explore its effect on employment status. 30 SPMS patients and 30 healthy participants underwent neuropsychological assessment using the Trail Making Test (TMT) parts A and B, semantic and phonological verbal fluency task and a computerized cognitive screening battery (Central Nervous System Vital Signs). Employment status was obtained as a quality of life measure. Brain MRI was performed in all participants. We measured total lesion volume, third ventricle width, thalamic and corpus callosum atrophy. The frequency of cognitive decline for our SPMS patients was 80%. SPMS patients differed significantly from controls in all neuropsychological measures. Corpus callosum area was correlated with cognitive flexibility, processing speed, composite memory, executive functions, psychomotor speed, reaction time and phonological verbal fluency task. Processing speed and composite memory were the most sensitive markers for predicting employment status. Corpus callosum area was the most sensitive MRI marker for memory and processing speed. Corpus callosum atrophy predicts a clinically meaningful cognitive decline, affecting employment status in our SPMS patients.
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Affiliation(s)
- Athanasios Papathanasiou
- Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; Neuropsychology Section, Department of Neurology, University of Patras Medical School, Patras 265 04, Greece.
| | - Lambros Messinis
- Neuropsychology Section, Department of Neurology, University of Patras Medical School, Patras 265 04, Greece
| | - Petros Zampakis
- Department of Radiology, University of Patras Medical School, Patras 265 04, Greece
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Elsalem L, Fotopoulos A, Papathanasiou A, Allison S, Moreb J, Cournia Z, Pors K. Human aldehyde dehydrogenase 7A1 (ALDH7A1) expression affects cancer cell proliferation, migration and cell protection against oxidative stress. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61361-8] [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: 10/21/2022]
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Koulouras V, Papathanakos G, Papathanasiou A, Nakos G. Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review. World J Crit Care Med 2016; 5:121-136. [PMID: 27152255 PMCID: PMC4848155 DOI: 10.5492/wjccm.v5.i2.121] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [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: 11/27/2015] [Accepted: 03/09/2016] [Indexed: 02/06/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a syndrome with heterogeneous underlying pathological processes. It represents a common clinical problem in intensive care unit patients and it is characterized by high mortality. The mainstay of treatment for ARDS is lung protective ventilation with low tidal volumes and positive end-expiratory pressure sufficient for alveolar recruitment. Prone positioning is a supplementary strategy available in managing patients with ARDS. It was first described 40 years ago and it proves to be in alignment with two major ARDS pathophysiological lung models; the “sponge lung” - and the “shape matching” -model. Current evidence strongly supports that prone positioning has beneficial effects on gas exchange, respiratory mechanics, lung protection and hemodynamics as it redistributes transpulmonary pressure, stress and strain throughout the lung and unloads the right ventricle. The factors that individually influence the time course of alveolar recruitment and the improvement in oxygenation during prone positioning have not been well characterized. Although patients’ response to prone positioning is quite variable and hard to predict, large randomized trials and recent meta-analyses show that prone position in conjunction with a lung-protective strategy, when performed early and in sufficient duration, may improve survival in patients with ARDS. This pathophysiology-based review and recent clinical evidence strongly support the use of prone positioning in the early management of severe ARDS systematically and not as a rescue maneuver or a last-ditch effort.
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Papathanasiou A, Searle BJ, King NMA, Bhattacharya S. Trends in 'poor responder' research: lessons learned from RCTs in assisted conception. Hum Reprod Update 2016; 22:306-19. [PMID: 26843539 DOI: 10.1093/humupd/dmw001] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [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: 09/29/2015] [Accepted: 01/11/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A substantial minority of women undergoing IVF will under-respond to controlled ovarian hyperstimulation. These women-so-called 'poor responders'-suffer persistently reduced success rates after IVF. Currently, no single intervention is unanimously accepted as beneficial in overcoming poor ovarian response (POR). This has been supported by the available research on POR, which consists mainly of randomized controlled trials (RCTs ) with an inherent high-risk of bias. The aim of this review was to critically appraise the available experimental trials on POR and provide guidance towards more useful-less wasteful-future research. METHODS A comprehensive review was undertaken of RCTs on 'poor responders' published in the last 15 years. Data on various methodological traits as well as important clinical characteristics were extracted from the included studies and summarized, with a view to identifying deficiencies from which lessons can be learned. Based on this analysis, recommendations were provided for further research in this field of assisted conception. RESULTS We selected and analysed 75 RCTs. A valid, 'low-risk' randomization method was reported in three out of four RCTs. An improving trend in reporting concealment of patient allocation was also evident over the 15-year period. In contrast, <1 in 10 RCTs 'blinded' patients and <1 in 5 RCTs 'blinded' staff to the proposed intervention. Only 1 in 10 RCTs 'blinded' ultrasound practitioners to patient allocation, when assessing the outcome of early pregnancy. The majority of trials reported an intention-to-treat analysis for at least one of their outcomes, with an improving trend in the recent years. Substantial variation was noted in the definitions used for 'poor responders', the most popular being 'low ovarian response at previous stimulation'. The preferred cut-off value for defining previous low response has been 'less or equal to three retrieved oocytes'. The most popular tests used for diagnosing diminished ovarian reserve have been antral follicle count and FSH. Although the Bologna criteria for POR were only recently introduced, they are expected to become a popular definition in future 'poor responder' trials. Numerous interventions have been studied on 'poor responders'. Most of these have been applied before/during controlled ovarian hyperstimulation. The antagonist protocol, the microdose flare protocol and the long down-regulation protocol have been among the most popular interventions. The analysis of outcomes revealed a clear improving trend in reporting live birth. In contrast, only 10% of RCTs reported significant improvement in reproductive outcomes among tested interventions. Twelve 'significant' interventions were reported, each supported by a single 'positive' RCT. Finally, trials of higher methodological quality were more likely to have been published in a high-impact journal. CONCLUSIONS Overall, the majority of published trials on POR suffer from methodological flaws and are, thus, regarded as being high-risk for bias. The same trials have used a variety of definitions for their poor responders and a variety of interventions for their head-to-head comparisons. Not surprisingly, discrepancies are also evident in the findings of trials comparing similar interventions. Based on the identified deficiencies, this novel type of 'methodology and clinical' review has introduced custom recommendations on how to improve future experimental research in the 'poor responder' population.
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Papathanasiou A, Roustanis E, Zikou X, Galiatsou E, Papathanakos G, Zilis G, Saranti M, Koulouras V, Karachaliou A, Nakos G. The burden of new onset atrial fibrillation in the intensive care unit (ICU). an observational, prospective, single-center study. Intensive Care Med Exp 2015. [PMCID: PMC4797372 DOI: 10.1186/2197-425x-3-s1-a212] [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: 11/28/2022] Open
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Papathanasiou A, Nakos G. Why there is a need to discuss pulmonary hypertension other than pulmonary arterial hypertension? World J Crit Care Med 2015; 4:274-277. [PMID: 26557477 PMCID: PMC4631872 DOI: 10.5492/wjccm.v4.i4.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/25/2015] [Revised: 08/11/2015] [Accepted: 09/16/2015] [Indexed: 02/06/2023] Open
Abstract
Pulmonary hypertension (PH) is a condition characterized by the elevation of the mean pulmonary artery pressure above 25 mmHg and the pulmonary vascular resistance above 3 wood units. Pulmonary arterial hypertension (PAH) is an uncommon condition with severe morbidity and mortality, needing early recognition and appropriate and specific treatment. PH is frequently associated with hypoxemia, mainly chronic obstructive pulmonary disease and DPLD and/or left heart diseases (LHD), mainly heart failure with reduced or preserved ejection fraction. Although in the majority of patients with PH the cause is not PAH, a significant number of published studies are still in regard to group I PH, leading to a logical assumption that PH due to other causes is not such an important issue. So, is there a reason to discuss PH other than PAH? Chronic lung diseases, mainly chronic obstructive lung disease and DPLD, are associated with a high incidence of PH which is linked to exercise limitations and a worse prognosis. Although pathophysiological studies suggest that specific PAH therapy may benefit such patients, the results presented from small studies in regard to the safety and effectiveness of the specific PAH therapy are discouraging. PH is a common complication of left heart disease and is related to disease severity, especially in patients with reduced ejection fraction. There are two types of PH related to LHD based on diastolic pressure difference (DPD, defined as diastolic pulmonary artery pressure - mean PAWP): Isolated post-capillary PH, defined as PAWP > 15 mmHg and DPD < 7 mmHg, and combined post-capillary PH and pre-capillary PH, defined as PAWP > 15 mmHg and DPD ≥ 7 mmHg. The potential use of PAH therapies in patients with PH related to left heart disease is based on a logical pathobiological rationale. In patients with heart failure, endothelial dysfunction has been proposed as a cause of PH and hence as a target for treatment, supported by the presence of increased endothelin-1 activity and impaired nitric oxide-dependent vasodilation. Unfortunately, so far, there is no evidence supporting the use of specific PAH therapies in patients with PH related to left heart disease. In conclusion, the presence of PH in patients with conditions other than PAH contributes to the severity of the disease, affecting the outcome and quality of life. The disappointing results regarding the effectiveness of specific PAH therapies in patients with chronic lung diseases and LHD underline the need for seeking new underlying mechanisms and thus novel therapies targeting PH due to left heart disease and/or lung diseases.
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Papathanasiou A, Messinis L, Zampakis P, Panagiotakis G, Gourzis P, Georgiou V, Papathanasopoulos P. Thalamic atrophy predicts cognitive impairment in relapsing remitting multiple sclerosis. Effect on instrumental activities of daily living and employment status. J Neurol Sci 2015; 358:236-42. [DOI: 10.1016/j.jns.2015.09.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 08/31/2015] [Accepted: 09/01/2015] [Indexed: 11/30/2022]
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Affiliation(s)
- Athanasios Papathanasiou
- Bourn-Hall Clinic Norwich, Unit 3, The Apex, Gateway 11, Farrier Close, Wymondham, Norwich NR18 0WF, UK
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Papathanasiou A, Zouvelou V, Breen DP, Phillips TJ, Misbahuddin A, Chawda S, de Silva R. Reversible cerebral vasoconstriction syndrome as a cause of thunderclap headache: a retrospective case series study. Am J Emerg Med 2015; 33:859.e3-6. [DOI: 10.1016/j.ajem.2014.12.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 12/12/2014] [Accepted: 12/12/2014] [Indexed: 11/27/2022] Open
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