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Kounis NG. Cardiovascular Events After Coronavirus Disease 2019 Vaccinations: Hypersensitivity Myocarditis After Coronavirus Disease 2019 Vaccines, Diagnostic and Long-term Considerations. Anatol J Cardiol 2024. [PMID: 38686593 DOI: 10.14744/anatoljcardiol.2024.4400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Affiliation(s)
- Nicholas G Kounis
- Division of Cardiology, Department of Medicine, University Hospital of Patras, Patras, Greece
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Ceasovschih A, Șorodoc V, Covantsev S, Balta A, Uzokov J, Kaiser SE, Almaghraby A, Lionte C, Stătescu C, Sascău RA, Onofrei V, Haliga RE, Stoica A, Bologa C, Ailoaei Ș, Şener YZ, Kounis NG, Șorodoc L. Electrocardiogram Features in Non-Cardiac Diseases: From Mechanisms to Practical Aspects. J Multidiscip Healthc 2024; 17:1695-1719. [PMID: 38659633 PMCID: PMC11041971 DOI: 10.2147/jmdh.s445549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/10/2024] [Indexed: 04/26/2024] Open
Abstract
Despite the noteworthy advancements and the introduction of new technologies in diagnostic tools for cardiovascular disorders, the electrocardiogram (ECG) remains a reliable, easily accessible, and affordable tool to use. In addition to its crucial role in cardiac emergencies, ECG can be considered a very useful ancillary tool for the diagnosis of many non-cardiac diseases as well. In this narrative review, we aimed to explore the potential contributions of ECG for the diagnosis of non-cardiac diseases such as stroke, migraine, pancreatitis, Kounis syndrome, hypothermia, esophageal disorders, pulmonary embolism, pulmonary diseases, electrolyte disturbances, anemia, coronavirus disease 2019, different intoxications and pregnancy.
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Affiliation(s)
- Alexandr Ceasovschih
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Victorița Șorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Serghei Covantsev
- Department of Research and Clinical Development, Botkin Hospital, Moscow, Russia
| | - Anastasia Balta
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Jamol Uzokov
- Department of Cardiology, Republican Specialized Scientific Practical Medical Center of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan
| | - Sergio E Kaiser
- Discipline of Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Abdallah Almaghraby
- Department of Cardiology, Ibrahim Bin Hamad Obaidallah Hospital, Ras Al Khaimah, United Arab Emirates
| | - Cătălina Lionte
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Cristian Stătescu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Radu A Sascău
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Viviana Onofrei
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Raluca Ecaterina Haliga
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Alexandra Stoica
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Cristina Bologa
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Ștefan Ailoaei
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Yusuf Ziya Şener
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Nicholas G Kounis
- Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, Patras, Greece
| | - Laurențiu Șorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
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Kounis NG, Gogos C, de Gregorio C, Hung MY, Kounis SN, Tsounis EP, Assimakopoulos SF, Pourmasumi S, Mplani V, Servos G, Dousdampanis P, Plotas P, Michalaki MA, Tsigkas G, Grammatikopoulos G, Velissaris D, Koniar I. "When," "Where," and "How" of SARS-CoV-2 Infection Affects the Human Cardiovascular System: A Narrative Review. Balkan Med J 2024; 41:7-22. [PMID: 38173173 PMCID: PMC10767774 DOI: 10.4274/balkanmedj.galenos.2023.2023-10-25] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/26/2023] [Indexed: 01/05/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by the novel severe acute respiratory coronavirus-2 (SARS-CoV-2). Several explanations for the development of cardiovascular complications during and after acute COVID-19 infection have been hypothesized. The COVID-19 pandemic, caused by SARS-CoV-2, has emerged as one of the deadliest pandemics in modern history. The myocardial injury in COVID-19 patients has been associated with coronary spasm, microthrombi formation, plaque rupture, hypoxic injury, or cytokine storm, which have the same pathophysiology as the three clinical variants of Kounis syndrome. The angiotensin-converting enzyme 2 (ACE2), reninaldosterone system (RAAS), and kinin-kallikrein system are the main proposed mechanisms contributing to cardiovascular complications with the COVID-19 infection. ACE receptors can be found in the heart, blood vessels, endothelium, lungs, intestines, testes, neurons, and other human body parts. SARS-CoV-2 directly invades the endothelial cells with ACE2 receptors and constitutes the main pathway through which the virus enters the endothelial cells. This causes angiotensin II accumulation downregulation of the ACE2 receptors, resulting in prothrombotic effects, such as hemostatic imbalance via activation of the coagulation cascade, impaired fibrinolysis, thrombin generation, vasoconstriction, endothelial and platelet activation, and pro-inflammatory cytokine release. The KKS system typically causes vasodilation and regulates tissue repair, inflammation, cell proliferation, and platelet aggregation, but SARS-CoV-2 infection impairs such counterbalancing effects. This cascade results in cardiac arrhythmias, cardiac arrest, cardiomyopathy, cytokine storm, heart failure, ischemic myocardial injuries, microvascular disease, Kounis syndrome, prolonged COVID, myocardial fibrosis, myocarditis, new-onset hypertension, pericarditis, postural orthostatic tachycardia syndrome, pulmonary hypertension, stroke, Takotsubo syndrome, venous thromboembolism, and thrombocytopenia. In this narrative review, we describe and elucidate when, where, and how COVID-19 affects the human cardiovascular system in various parts of the human body that are vulnerable in every patient category, including children and athletes.
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Affiliation(s)
- Nicholas G. Kounis
- Department of Cardiology, University of Patras Medical School, Rio, Greece
| | - Christos Gogos
- Clinic of Cardiology, COVID-19 Unit, Papageorgiou General Hospital, Pavlos Melas, Greece
| | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, University of Messina Medical School, Messina, Italy
| | - Ming-Yow Hung
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | | | - Efthymios P. Tsounis
- Division of Gastroenterology, Department of Internal Medicine, Medical School, University Hospital of Patras, Rio, Greece
| | - Stelios F. Assimakopoulos
- Department of Internal Medicine, Division of Infectious Diseases, University of Patras Medical School, Rio, Greece
| | - Soheila Pourmasumi
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Virginia Mplani
- Intensive Care Unit, Patras University Hospital, Rio, Greece
| | - George Servos
- Pediatric Cardiology Unit, “P. & A. Kyriakou” Children’s Hospital, Athina, Greece
| | | | - Panagiotis Plotas
- Department of Cardiology, University of Patras Medical School, Rio, Greece
| | - Marina A. Michalaki
- Department of Internal Medicine, Division of Endocrinology, University of Patras, School of Health Sciences, Rio, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, University of Patras Medical School, Rio, Greece
| | | | - Dimitrios Velissaris
- Department of Internal Medicine, University of Patras Medical School, Rio, Greece
| | - Ioanna Koniar
- Electrophysiology and Device Department, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
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Kounis NG, Mplani V, Gogos C. Acute Myocardial Infarction and Emotional Distress: A Magnificent Biologic Pathway. Am J Cardiol 2023; 205:520. [PMID: 37633795 DOI: 10.1016/j.amjcard.2023.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/28/2023]
Affiliation(s)
| | - Virginia Mplani
- Intensive Care Unit, University Hospital of Patras, Patras, Greece
| | - Christos Gogos
- Department of Cardiology, Papageorgiou General Hospital, Nea Efkarpia, Thessaloniki, Greece; First University Cardiology Department, American Hellenic Educational Progressive Association General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Kounis NG, Mplani V, de Gregorio C, Koniari I. Attack the ATAK; A Challenging Contemporary Complex: Pathophysiologic, Therapeutic, and Preventive Considerations. Balkan Med J 2023; 40:308-311. [PMID: 37218727 PMCID: PMC10500137 DOI: 10.4274/balkanmedj.galenos.2023.2023-4-96] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/11/2023] [Indexed: 05/24/2023] Open
Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - Virginia Mplani
- Department of Intesive Care Unit, University of Patras Medical School, Patras, Greece
| | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, University of Messina Medical School, Messina, Italy
| | - Ioanna Koniari
- Department of Electrophysiology and Device, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
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Ferrazzo G, Perfetti S, Koniari I, Di Bella G, Kounis NG, de Gregorio C. [Ischemic heart scombroid syndrome: how to recognize what you know]. G Ital Cardiol (Rome) 2023; 24:653-660. [PMID: 37492873 DOI: 10.1714/4068.40534] [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] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Mistreated fish products ingestion can lead to a histaminergic illness known as scombroid syndrome. The disease usually causes cutaneous rash, gastrointestinal, breathing disorders, hypotension with further histamine-related symptoms. Although cardiac complications are infrequent, some patients experienced chest pain consistent with an acute coronary syndrome on admission to hospital. The pathomechanism seems related to a transient coronary artery vasospasm. We performed a literature search for all cases published in the literature from 1997 to 2022 with suspected ischemic heart scombroid syndrome. Overall, 18 studies describing 25 patients were recognized and the main pathophysiological, clinical, diagnostic, therapeutic and prognostic features are discussed. A simplified diagnostic flowchart has also been proposed. Even though this syndrome can lead to hemodynamic instability in the acute phase, also in the young, prognosis is rather good.
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Affiliation(s)
| | - Silvia Perfetti
- Dipartimento di Medicina Clinica e Sperimentale, Azienda Ospedaliera Universitaria di Messina, Università degli Studi, Messina
| | - Ioanna Koniari
- Division of Cardiology, Department of Internal Medicine, University Hospital of South Manchester, NHS Foundation Trust, Manchester, UK
| | - Gianluca Di Bella
- Dipartimento di Medicina Clinica e Sperimentale, Azienda Ospedaliera Universitaria di Messina, Università degli Studi, Messina
| | - Nicholas G Kounis
- Division of Cardiology, Department of Internal Medicine, University of Patras Medical School, Patras, Grecia
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Pourmasumi S, Kounis NG, Naderi M, Hosseinisadat R, Khoradmehr A, Fagheirelahee N, Kouni SN, de Gregorio C, Dousdampanis P, Mplani V, Michalaki MA, Plotas P, Assimakopoulos S, Gogos C, Aidonidis G, Roditis P, Matsas N, Velissaris D, Calogiuri G, Hung MY, Koniari I. Effects of COVID-19 Infection and Vaccination on the Female Reproductive System: A Narrative Review. Balkan Med J 2023; 40:153-164. [PMID: 37114907 PMCID: PMC10175880 DOI: 10.4274/balkanmedj.galenos.2023.2023-3-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Several studies and research papers have been published to elucidate and understand the mechanism of the coronavirus disease 2019 (COVID-19) pandemic and its long-term effects on the human body. COVID-19 affects a number of organs, including the female reproductive system. However, less attention has been given to the effects of COVID-19 on the female reproductive system due to their low morbidity. The results of studies investigating the relationship between COVID-19 infection and ovarian function in women of reproductive age have shown the harmless involvement of COVID-19 infection. Several studies have reported the involvement of COVID-19 infection in oocyte quality, ovarian function, and dysfunctions in the uterine endometrium and the menstrual cycle. The findings of these studies indicate that COVID-19 infection negatively affects the follicular microenvironment and dysregulate ovarian function. Although the COVID-19 pandemic and female reproductive health have been studied in humans and animals, very few studies have examined how COVID-19 affects the female reproductive system. The objective of this review is to summarize the current literature and categorize the effects of COVID-19 on the female reproductive system, including the ovaries, uterus, and hormonal profiles. The effects on oocyte maturation, oxidative stress, which causes chromosomal instability and apoptosis in ovaries, in vitro fertilization cycle, high-quality embryos, premature ovarian insufficiency, ovarian vein thrombosis, hypercoagulable state, women’s menstrual cycle, the hypothalamus-pituitary-ovary axis, and sex hormones, including estrogen, progesterone, and the anti-Müllerian hormone, are discussed in particular.
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Affiliation(s)
- Soheila Pourmasumi
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Nicholas G. Kounis
- Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, Patras, Greece
| | - Monavar Naderi
- Knowledge and Information Science, Vice Chancellor for Science and Technology, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Robabe Hosseinisadat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Arezoo Khoradmehr
- The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Niloofar Fagheirelahee
- Department of Anatomy, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, University of Messina Medical School, Messina, Italy
| | | | - Virginia Mplani
- Intensive Care Unit, Patras University Hospital, Patras, Greece
| | - Marina A. Michalaki
- Department of Internal Medicine, Division of Endocrinology, Fculty of Health Sciences, University of Patras, Patras, Greece
| | | | - Stelios Assimakopoulos
- Department of Internal Medicine, Division of Infectious Diseases, University of Patras Medical School, Patras, Greece
| | - Christos Gogos
- COVID-19 Unit, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | - Pavlos Roditis
- Department of Cardiology, Mamatsio Kozanis General Hospital, Kozani, Greece
| | | | | | - Gianfranco Calogiuri
- Pneumonology Department, Civil Hospital “Ninetto Melli”, Pietro Vernoti, Brindisi, Italy
- Department of Internal Medicine, Immunology and Infectious Diseases, Section of Allergology and Clinical Immunology, University of Bari Medical School, Bari, Italy
| | - Ming-Yow Hung
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Ioanna Koniari
- Departmentof Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
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Hung MJ, Yeh CT, Kounis NG, Koniari I, Hu P, Hung MY. Coronary Artery Spasm-Related Heart Failure Syndrome: Literature Review. Int J Mol Sci 2023; 24:ijms24087530. [PMID: 37108691 PMCID: PMC10145866 DOI: 10.3390/ijms24087530] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Although heart failure (HF) is a clinical syndrome that becomes worse over time, certain cases can be reversed with appropriate treatments. While coronary artery spasm (CAS) is still underappreciated and may be misdiagnosed, ischemia due to coronary artery disease and CAS is becoming the single most frequent cause of HF worldwide. CAS could lead to syncope, HF, arrhythmias, and myocardial ischemic syndromes such as asymptomatic ischemia, rest and/or effort angina, myocardial infarction, and sudden death. Albeit the clinical significance of asymptomatic CAS has been undervalued, affected individuals compared with those with classic Heberden's angina pectoris are at higher risk of syncope, life-threatening arrhythmias, and sudden death. As a result, a prompt diagnosis implements appropriate treatment strategies, which have significant life-changing consequences to prevent CAS-related complications, such as HF. Although an accurate diagnosis depends mainly on coronary angiography and provocative testing, clinical characteristics may help decision-making. Because the majority of CAS-related HF (CASHF) patients present with less severe phenotypes than overt HF, it underscores the importance of understanding risk factors correlated with CAS to prevent the future burden of HF. This narrative literature review summarises and discusses separately the epidemiology, clinical features, pathophysiology, and management of patients with CASHF.
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Affiliation(s)
- Ming-Jui Hung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital Keelung, Chang Gung University College of Medicine, Keelung City 24201, Taiwan
| | - Chi-Tai Yeh
- Department of Medical Research and Education, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Continuing Education Program of Food Biotechnology Applications, College of Science and Engineering, National Taitung University, Taitung 95092, Taiwan
| | - Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, 26221 Patras, Greece
| | - Ioanna Koniari
- Cardiology Department, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| | - Patrick Hu
- Department of Internal Medicine, School of Medicine, University of California, Riverside, Riverside, CA 92521, USA
- Department of Cardiology, Riverside Medical Clinic, Riverside, CA 92506, USA
| | - Ming-Yow Hung
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, No.291, Zhongzheng Rd., Zhonghe District, New Taipei City 23561, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei City 110301, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City 23561, Taiwan
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Kounis NG, Koniari I, Kouni S, Mplani V, Velissaris D, Plotas P, Tsigkas G. Rare acute hypersensitivity myocardial infarction (Kounis syndrome) and hypersensitivity myocarditis following COVID-19 vaccination. QJM 2023; 116:81-82. [PMID: 35134224 PMCID: PMC9383408 DOI: 10.1093/qjmed/hcac021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Indexed: 12/31/2022] Open
Affiliation(s)
- N G Kounis
- Address correspondence to N.G. Kounis, Department of Cardiology, University of Patras Medical School, Queen Olgas Square, 7 Aratou Street, Patras 26221, Greece.
| | - I Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - S Kouni
- From the Department of Cardiology, University of Patras Medical School, Queen Olgas Square, 7 Aratou Street, Patras 26221, Greece
| | - V Mplani
- Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - D Velissaris
- Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - P Plotas
- From the Department of Cardiology, University of Patras Medical School, Queen Olgas Square, 7 Aratou Street, Patras 26221, Greece
| | - G Tsigkas
- From the Department of Cardiology, University of Patras Medical School, Queen Olgas Square, 7 Aratou Street, Patras 26221, Greece
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Kagkelaris K, Mastronikolis S, Amasiadi N, Gerakaris A, Giorgalla V, Efthymiou P, Efstathiou I, Ziakas I, Katsifara A, Kitsos C, Kolios S, Konstantopoulou A, Kyprioti E, Papadopoulou MM, Razos N, Schinas I, Skourou K, Panayiotakopoulos G, Koniari I, Kounis NG, Georgakopoulos CD, Jelastopulu E, Plotas P. University faculty on student motivation to use medical education apps and barriers to their usage. Eur Rev Med Pharmacol Sci 2023; 27:852-858. [PMID: 36808330 DOI: 10.26355/eurrev_202302_31177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE University teachers, who primarily provide guidance and advice to their students, can play a significant role in educational process transformation. As there is no particular e-learning framework, it is important to understand the factors and variables that may impact both its effective usage and further successful implementation. The current study aims to outline the influence of university faculty, and possible barriers preventing medical students from using apps for learning purposes. SUBJECTS AND METHODS Α cross-sectional study was conducted with an online survey questionnaire. The population of the study included 1,458 students from all the seven Greek schools of medicine. RESULTS University faculty (51.7%), followed by fellow students and friends (55.6%), constitute the second most common source of information on adopting apps for medical education. 45.8% of students rated their educational guidance as insufficient/inadequate, 33.0% as moderate, 18.6% as quite good, and only 2.7% as sufficient/complete. University professors have proposed certain apps to 25.5% of students. PubMed (41.7%), Medscape (20.9%), and Complete Anatomy (12.2%) were the leading suggestions. The main barriers to app usage were the lack of knowledge of apps' benefits (28.8%), insufficient updates of their content (21.9%), their cost-effectiveness (19.2%), and financial reasons (16.2%). Most students preferred using free apps (51.4%) and 76.7% preferred universities to cover apps' expenses. CONCLUSIONS University faculty represent the main source of information regarding the adaptation of medical apps in the educational process. However, students need improved and enhanced guidance. The main barriers are ignorance about apps and financial reasons. The majority prefer free apps and universities to cover their cost.
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Affiliation(s)
- K Kagkelaris
- Department of Public Health, Department of Ophthalmology, School of Medicine, University of Patras, Patras, Greece.
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Gogos C, Stamos K, Tsanaxidis N, Styliadis I, Koniari I, Kouni SN, de Gregorio C, Kounis NG. Blood Transfusion Components Inducing Severe Allergic Reactions: The First Case of Kounis Syndrome Induced by Platelet Transfusion. Vaccines (Basel) 2023; 11:vaccines11020220. [PMID: 36851100 PMCID: PMC9965342 DOI: 10.3390/vaccines11020220] [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: 12/28/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Kounis syndrome is a multisystem and multidisciplinary disease affecting the circulatory system that can be manifested as spasm and thrombosis. It can occur as allergic, hypersensitivity, anaphylactic, or anaphylactoid reactions associated with the release of inflammatory mediators from mast cells and from other interrelated and interacting inflammatory cells, including macrophages and lymphocytes. A platelet subset with high- and low-affinity IgE surface receptors is also involved in this process. Whereas the heart, and particularly the coronary arteries, constitute the primary targets of inflammatory mediators, the mesenteric, cerebral, and peripheral arteries are also vulnerable. Kounis syndrome is caused by a variety of factors, including drugs, foods, environmental exposure, clinical conditions, stent implantation, and vaccines. We report a unique case of a 60-year-old male with a past medical history of allergy to human albumin, alcoholic cirrhosis, and esophageal varices, who was admitted due to multiple episodes of hematemesis. Due to low hemoglobin levels, he was transfused with 3 units of red blood cells and fresh frozen plasma without any adverse reactions. On the third day of hospitalization, severe thrombocytopenia was observed and transfusion of platelets was initiated. Immediately following platelet infusion, the patient developed chest discomfort, skin signs of severe allergic reaction, and hemodynamic instability. The electrocardiogram revealed ST segment elevation in the inferior leads. Given the strong suspicion of Kounis syndrome/allergic coronary spasm, the patient was treated with anti-allergic treatment only, without any anti-platelet therapy. The clinical status of the patient gradually improved and the electrocardiographic changes reverted to normal. Based on these findings, Kounis hypersensitivity-associated acute coronary syndrome, specifically, type I Kounis syndrome, was diagnosed. Although platelet transfusion can be a life-saving therapy, each blood transfusion carries a substantial risk of adverse reactions. The aims of this report are to expand the existing knowledge of patient responses to blood transfusion and provide information on the incidence of various severe transfusion reactions to all blood components and especially to platelets. To the best of our knowledge, Kounis syndrome induced by platelet transfusionhas never been previously reported. Hypersensitivity to platelet external membrane glycoproteins in an atopic patient seems to be the possible etiology. Despite that Kounis syndrome remains an under-diagnosed clinical entity in everyday practice, it should always be considered in the differential diagnosis of acute coronary syndromes.
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Affiliation(s)
- Christos Gogos
- Department of Cardiology, Papageorgiou General Hospital, Nea Efkarpia, 56403 Thessaloniki, Greece
| | - Konstantinos Stamos
- Department of Cardiology, Papageorgiou General Hospital, Nea Efkarpia, 56403 Thessaloniki, Greece
| | - Nikolaos Tsanaxidis
- Department of Cardiology, Papageorgiou General Hospital, Nea Efkarpia, 56403 Thessaloniki, Greece
| | - Ioannis Styliadis
- Department of Cardiology, Papageorgiou General Hospital, Nea Efkarpia, 56403 Thessaloniki, Greece
| | - Ioanna Koniari
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| | | | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, University of Messina Medical School, 98122 Messina, Italy
| | - Nicholas G. Kounis
- Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, 26221 Patras, Greece
- Correspondence:
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12
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Calogiuri G, Savage MP, Congedo M, Nettis E, Mirizzi AM, Foti C, Vacca A, Kounis NG. Is Adrenaline Always the First Choice Therapy of Anaphylaxis? An Allergist-cardiologist Interdisciplinary Point of View. Curr Pharm Des 2023; 29:2545-2551. [PMID: 37877509 DOI: 10.2174/0113816128257514231019165809] [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: 04/23/2023] [Revised: 09/14/2023] [Accepted: 09/22/2023] [Indexed: 10/26/2023]
Abstract
Worldwide, adrenaline is considered the first choice therapy in the international guidelines for the management of anaphylaxis. However, the heart and cardiovascular apparatus are strongly involved in anaphylaxis; for that reason, there are some cardiac conditions and certain anaphylaxis patterns that make epinephrine use problematic without adequate heart monitoring. The onset of Kounis syndrome, takotsubo cardiopathy, or the paradoxical anaphylaxis require great attention in the management of anaphylaxis and adrenaline administration by clinicians, who should be aware of the undervalued evolution of anaphylaxis and the potential cardiologic complications of epinephrine administration. Numerous case reports and studies describe the unexpected onset of cardiac diseases following epinephrine treatment, despite the latter being the recommended therapy for anaphylaxis. Our review suggests that future anaphylaxis guidelines should incorporate cardiovascular specialists since the treatment of Kounis syndrome or takotsubo cardiopathy requires cardiologist skills.
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Affiliation(s)
| | - Michael P Savage
- Department of Medicine (Cardiology), Thomas Jefferson University Hospital, Philadelphia, USA
| | | | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergy and Clinical Immunology, University of Bari "Aldo Moro", Bari, Italy
| | | | - Caterina Foti
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine 'G. Baccelli', University of Bari "Aldo Moro", Bari, Italy
| | - Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras 26221, Greece
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13
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Perfetti S, Ferrazzo G, Andò G, Costa F, Pistelli L, Restelli D, Campanella F, Borgi M, Koniari I, Kounis NG, De Gregorio C. 57 ISCHEMIC HEART SCOMBROID SYNDROME: FURTHER EVIDENCE FROM ALL OVER THE WORLD. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Objective
Scombroid syndrome (SS) is a long-standing poisoning illness caused by ingestion of improperly stored fish food (usually tuna fish) contaminated by Gram-negative bacteria. The main pathogenetic feature is toxicity by the high histamine (and/or other toxin) levels within the fish muscle. Scombroid syndrome accounts for approximately 5% of food toxicities at emergency department in the USA. It consists of gastrointestinal symptoms, sickness, at times (head) rash or flushing, peppery taste, hypotension, and other symptoms. Cardiovascular complications are infrequent, but acute coronary syndromes (ACSs) have been described in some patients on admission to hospital. We identified those cases as with ischemic heart scombroid syndrome (IHSS).
Methods
An accurate literature search for IHSS in case series and single reports, published as by the end of July 2022, was performed. Herein main clinical features are summarized.
Results
From 1997 to 2022, 18 studies were found describing 25 patients aged 42±15 years, 14 women (56%), likely to have IHSS. Countries of origin are depicted in the Figure nearby. Apart from typical clinical presentation of SS, chest pain, oppression and hypotension were complained by almost all patents. Symptoms and signs of ACS started 10 to 180 minutes from the meal. Four patients (mostly before 2015) required advanced life support or mechanical ventilation. Widespread ST-depression (first in the inferior leads) was the most frequently reported ECG feature (approximately in 90% of cases). Hospitalization was required for unstable patients or those admitted for coronary angiography. However, this latter was performed only in 10 cases (40%), and only in 3 (12%) a culprit lesion was identified and treated. Therapy consisted with antihistamine drugs, fluids and circulatory support, symptomatic drugs, and steroids in some cases. All patients were discharged from hospital with uneventful follow-up.
Conclusions
To date, 25 published cases of IHSS have been recognized, mostly from Italy, but reports are from all over the world. As in typical SS, myocardial ischemia begins shortly after raw or cocked (tuna) fish ingestion. However, due to unfamiliarity with the syndrome, diagnostic misinterpretation is possible. IHSS can be classified as a transient (usually benign) ACS, caused by coronary vasospasm in response to a nitroxide-mediated histamine-induced tissue hypoperfusion, in a similar way to type-I Kounis syndrome. Based on current knowledge, coronary angiography is mandatory in patients with a history of coronary artery disease and/or allergic diathesis, persistent symptoms or unresponsive to emergency treatment.
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Affiliation(s)
- Silvia Perfetti
- Università Degli Studi Di Messina, Dip. Di Medicina Clinica E Sperimentale , Scuola Di Spec. Mal App. Cardiovascolare
| | - Giuseppe Ferrazzo
- Università Degli Studi Di Messina, Dip. Di Medicina Clinica E Sperimentale , Scuola Di Spec. Mal App. Cardiovascolare
| | - Giuseppe Andò
- Università Degli Studi Di Messina, Dip. Di Medicina Clinica E Sperimentale , Scuola Di Spec. Mal App. Cardiovascolare
| | - Francesco Costa
- Università Degli Studi Di Messina, Dip. Di Medicina Clinica E Sperimentale , Scuola Di Spec. Mal App. Cardiovascolare
| | - Lorenzo Pistelli
- Università Degli Studi Di Messina, Dip. Di Medicina Clinica E Sperimentale , Scuola Di Spec. Mal App. Cardiovascolare
| | - Davide Restelli
- Università Degli Studi Di Messina, Dip. Di Medicina Clinica E Sperimentale , Scuola Di Spec. Mal App. Cardiovascolare
| | - Francesca Campanella
- Università Degli Studi Di Messina, Dip. Di Medicina Clinica E Sperimentale , Scuola Di Spec. Mal App. Cardiovascolare
| | - Marco Borgi
- Università Degli Studi Di Messina, Dip. Di Medicina Clinica E Sperimentale , Scuola Di Spec. Mal App. Cardiovascolare
| | - Ioanna Koniari
- University Hosp. South Manchester Nhs. Found. Trust , Manchester (Uk)
| | | | - Cesare De Gregorio
- Università Degli Studi Di Messina, Dip. Di Medicina Clinica E Sperimentale , Scuola Di Spec. Mal App. Cardiovascolare
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14
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Kounis NG, Mplani V, Dousdampanis P, Plotas P, Koniari I. Encephalitis, myocarditis, and thrombocytopenia after COVID-19 mRNA vaccination: Clinical and pathophysiological considerations. J Neuroimmunol 2022; 373:577988. [PMID: 36272184 PMCID: PMC9576203 DOI: 10.1016/j.jneuroim.2022.577988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Nicholas G Kounis
- Department of Internal Medicice, Division of Cardiology, University of Patras Medical School, Patras, Greece.
| | - Virginia Mplani
- Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Periklis Dousdampanis
- Department of Renal Diseases, "Agios Andreas" Patras State General Hospital, Patras, Greece
| | - Panagiotis Plotas
- Department of Medicine, Division of Cardiology, University of Patras Medical School, Patras, Greece.
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
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Pourmasumi S, Nazari A, Ahmadi Z, Kouni SN, de Gregorio C, Koniari I, Dousdampanis P, Mplani V, Plotas P, Assimakopoulos S, Gogos C, Aidonisdis G, Roditis P, Matsas N, Velissaris D, Calogiuri G, Hung MY, Altay S, Kounis NG. The Effect of Long COVID-19 Infection and Vaccination on Male Fertility; A Narrative Review. Vaccines (Basel) 2022; 10:vaccines10121982. [PMID: 36560392 PMCID: PMC9783106 DOI: 10.3390/vaccines10121982] [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: 10/28/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
Earlier research has suggested that the male reproductive system could be particularly vulnerable to SARS-CoV-2 (COVID-19) infection, and infections involving this novel disease not only pose serious health threats but could also cause male infertility. Data from multi-organ research during the recent outbreak indicate that male infertility might not be diagnosed as a possible consequence of COVID-19 infection. Several review papers have summarized the etiology factors on male fertility, but to date no review paper has been published defining the effect of COVID-19 infection on male fertility. Therefore, the aim of this study is to review the published scientific evidence regarding male fertility potential, the risk of infertility during the COVID-19 pandemic, and the impact of COVID-19 vaccination on the male reproductive system. The effects of COVID-19 infection and the subsequent vaccination on seminal fluid, sperm count, sperm motility, sperm morphology, sperm viability, testes and sex hormones are particularly reviewed.
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Affiliation(s)
- Soheila Pourmasumi
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan 7717933777, Iran
- Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan 7717933777, Iran
| | - Alireza Nazari
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan 7717933777, Iran
- Department of Surgery, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan 7717933777, Iran
| | - Zahra Ahmadi
- Pistachio Safety Research Center, Rafsanjan University of Medical Sciences, Rafsanjan 7717933777, Iran
| | | | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, University of Messina Medical School, 98122 Messina, Italy
| | - Ioanna Koniari
- Department of Internal Medicine, Division of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester M23 9LT, UK
| | - Periklis Dousdampanis
- Department of Nephrology, Saint Andrews State General Hospital, 26221 Patras, Greece
| | - Virginia Mplani
- Intensive Care Unit, Patras University Hospital, 26500 Patras, Greece
| | - Panagiotis Plotas
- Department of Speech Therapy, University of Patras, 26500 Patras, Greece
| | - Stelios Assimakopoulos
- Department of Internal Medicine, Division of Infectious Diseases, University of Patras Medical School, 26500 Patras, Greece
| | - Christos Gogos
- COVID-19 Unit, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
| | | | - Pavlos Roditis
- Department of Cardiology, Mamatsio Kozanis General Hospital, 50100 Kozani, Greece
| | - Nikos Matsas
- Cardiology Private Practice, 30131 Agrinion, Greece
| | | | - Gianfranco Calogiuri
- Pneumonology Department, Civil Hospital “Ninetto Melli”, Pietro Vernoti, 72027 Brindisi, Italy
- Department of Internal Medicine, Immunology and Infectious Diseases, Section of Allergology and Clinical Immunology, University of Bari Medical School, 70121 Bari, Italy
| | - Ming-Yow Hung
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan
| | - Servet Altay
- Department of Cardiology, Faculty of Medicine Trakya University, Edirne 22030, Turkey
| | - Nicholas G. Kounis
- Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, 26500 Patras, Greece
- Correspondence:
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16
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Kounis NG, Mplani V, Koniari I. Bee sting-induced central retinal artery occlusion: A new manifestation of Kounis syndrome? Oman J Ophthalmol 2022; 15:429-430. [PMID: 36760950 PMCID: PMC9905887 DOI: 10.4103/ojo.ojo_264_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 09/14/2021] [Accepted: 09/27/2021] [Indexed: 02/11/2023] Open
Affiliation(s)
- Nicholas G. Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Greece,Address for correspondence: Dr. Nicholas G. Kounis, Department of Cardiology, University of Patras Medical School, Queen Olgas Square, Patras 26221, Greece. E-mail:
| | - Virginia Mplani
- Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
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17
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Kounis NG, Koniari I, Mplani V, Dousdampanis P, Plotas P. Significance of biopsy in SARS-CoV-2 mRNA vaccine-associated myocarditis: Paving the way toward precision vaccinology. Pathol Int 2022; 72:569-570. [PMID: 36263965 PMCID: PMC9874832 DOI: 10.1111/pin.13277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/17/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Nicholas G. Kounis
- Department of Medicine, Division of CardiologyUniversity of Patras Medical SchoolPatrasGreece
| | - Ioanna Koniari
- Department of CardiologyUniversity Hospital of South Manchester NHS Foundation TrustManchesterUK
| | - Virginia Mplani
- Intensive Care UnitUniversity of Patras Medical SchoolPatrasGreece
| | | | - Panagiotis Plotas
- Department of Medicine, Division of CardiologyUniversity of Patras Medical SchoolPatrasGreece
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18
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Kounis NG, Kouni SN, Mplani V, Koniari I. Corticosteroids for mild COVID-19 treatment: opening the floodgates of therapeutic benefits. QJM 2022; 115:701. [PMID: 34893902 PMCID: PMC9383071 DOI: 10.1093/qjmed/hcab312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- N G Kounis
- From the Division of Cardiology, Department of Internal
Medicine, University of Patras Medical School, Patras, Greece
- Address correspondence to Prof. Nicholas G. Kounis, Division of
Cardiology, Department of Internal Medicine, University of Patras Medical School, Queen
Olgas Square, 7 Aratou Street, 26221 Patras, Greece.
| | - S N Kouni
- Speech Therapy Clinic, Queen Olgas Square, Patras, Greece
| | - V Mplani
- Ιntensive Care Unit, University of Patras Medical School, Patras,
Greece
| | - I Koniari
- Department of Cardiology, University Hospital of South Manchester NHS
Foundation Trust, Manchester, UK
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19
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Kounis NG, Koniari I, Mplani V, Velissaris D, Plotas P. Letter by Kounis et al Regarding Article, "Biopsy-Proven Giant Cell Myocarditis Following the COVID-19 Vaccine". Circ Heart Fail 2022; 15:e009826. [PMID: 36214154 DOI: 10.1161/circheartfailure.122.009826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Greece. (N.G.K., P.P.)
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom (I.K.)
| | - Virginia Mplani
- Intensive Care Unit, University of Patras Medical School, Greece. (V.M.)
| | - Dimitrios Velissaris
- Department of Internal Medicine, University of Patras Medical School, Greece. (D.V.)
| | - Panagiotis Plotas
- Department of Cardiology, University of Patras Medical School, Greece. (N.G.K., P.P.)
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20
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Kounis NG, Mplani V, Koniari I, Plotas P. Too Late Allergic Reaction in Patient with Permanent Pacemaker: Searching the Causality and Pathophysiology. Turk Kardiyol Dern Ars 2022; 50:472-473. [DOI: 10.5543/tkda.2022.22453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Karimabad MN, Hassanshahi G, Kounis NG, Mplani V, Roditis P, Gogos C, Lagadinou M, Assimakopoulos SF, Dousdampanis P, Koniari I. The Chemokines CXC, CC and C in the Pathogenesis of COVID-19 Disease and as Surrogates of Vaccine-Induced Innate and Adaptive Protective Responses. Vaccines (Basel) 2022; 10:vaccines10081299. [PMID: 36016187 PMCID: PMC9416781 DOI: 10.3390/vaccines10081299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 02/07/2023] Open
Abstract
COVID-19 is one of the progressive viral pandemics that originated from East Asia. COVID-19 or SARS-CoV-2 has been shown to be associated with a chain of physio-pathological mechanisms that are basically immunological in nature. In addition, chemokines have been proposed as a subgroup of chemotactic cytokines with different activities ranging from leukocyte recruitment to injury sites, irritation, and inflammation to angiostasis and angiogenesis. Therefore, researchers have categorized the chemotactic elements into four classes, including CX3C, CXC, CC, and C, based on the location of the cysteine motifs in their structures. Considering the severe cases of COVID-19, the hyperproduction of particular chemokines occurring in lung tissue as well as pro-inflammatory cytokines significantly worsen the disease prognosis. According to the studies conducted in the field documenting the changing expression of CXC and CC chemokines in COVID-19 cases, the CC and CXC chemokines contribute to this pandemic, and their impact could reflect the development of reasonable strategies for COVID-19 management. The CC and the CXC families of chemokines are important in host immunity to viral infections and along with other biomarkers can serve as the surrogates of vaccine-induced innate and adaptive protective responses, facilitating the improvement of vaccine efficacy. Furthermore, the immunogenicity elicited by the chemokine response to adenovirus vector vaccines may constitute the basis of vaccine-induced immune thrombotic thrombocytopaenia.
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Affiliation(s)
- Mojgan Noroozi Karimabad
- Molecular Medicine Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan 7717933777, Iran
| | - Gholamhossein Hassanshahi
- Molecular Medicine Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan 7717933777, Iran
| | - Nicholas G. Kounis
- Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, 26500 Patras, Greece
- Correspondence:
| | - Virginia Mplani
- Intensive Care Unit, Patras University Hospital, 26500 Patras, Greece
| | - Pavlos Roditis
- Department of Cardiology, Mamatsio Kozanis General Hospital, 50100 Kozani, Greece
| | - Christos Gogos
- COVID-19 Unit, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
| | - Maria Lagadinou
- Department of Internal Medicine, Division of Infectious Diseases, University of Patras Medical School, 26500 Patras, Greece
| | - Stelios F. Assimakopoulos
- Department of Internal Medicine, Division of Infectious Diseases, University of Patras Medical School, 26500 Patras, Greece
| | - Periklis Dousdampanis
- Department of Nephrology, Saint Andrews State General Hospital, 26221 Patras, Greece
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester, NHS Foundation Trust, Manchester M23 9LT, UK
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22
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Kounis NG, Mplani V, Kouni S, Plotas P, Koniari I. Hypersensitivity Lymphohistiocytic Myocarditis After Moderna mRNA-1273 Vaccine. Am J Clin Pathol 2022; 158:555-556. [PMID: 35938624 DOI: 10.1093/ajcp/aqac090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Sophia Kouni
- University of Patras Medical School, Patras, Greece
| | | | - Ioanna Koniari
- University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
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Kounis NG, Mplani V, Koniari I, Kouni S, Plotas P, Tsigkas G, Velissaris D. Hypersensitivity coronary myocardial infarction (Kounis syndrome) and COVID-19 vaccines. J Cardiol Cases 2022; 26:242-243. [PMID: 35611329 PMCID: PMC9119861 DOI: 10.1016/j.jccase.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nicholas G. Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Greece
- Corresponding author at: Department of Cardiology, University of Patras Medical School, Queen Olgas Square, 7 Aratou Street, Patras 26221, Greece.
| | - Virginia Mplani
- Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Sophia Kouni
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - Panagiotis Plotas
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, University of Patras Medical School, Patras, Greece
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25
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Kounis NG, Mplani V, Koniari I, Plotas P. Reader comments. Proc AMIA Symp 2022; 35:579-580. [DOI: 10.1080/08998280.2022.2057181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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26
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Kounis NG, Mplani V, Koniari I. Autopsy Histopathologic Cardiac Findings in Two Adolescents Following the Second COVID-19 Vaccine Dose: Cytokine storm, hypersensitivity, or something else. Arch Pathol Lab Med 2022; 146:924. [PMID: 35395083 DOI: 10.5858/arpa.2022-0102-le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology (Kounis), University of Patras Medical School, Patras, Greece
| | - Virginia Mplani
- Intensive Care Unit (Mplani), University of Patras Medical School, Patras, Greece
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK (Koniari)
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27
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de Gregorio C, Calcaterra G, Kounis NG, Bassareo PP, Mehta JL. Cerebral venous thrombosis after COVID-19 vaccines: Do we know the mechanism? Lancet Reg Health Eur 2022; 16:100387. [PMID: 35437521 PMCID: PMC9008443 DOI: 10.1016/j.lanepe.2022.100387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Cesare de Gregorio
- Department of Clinical and Experimental Medicine, Cardiology Unit. Outpatient Heart failure, Cardiomyopathy and Vascular Lab. University Hospital of Messina, Via Consolare Valeria, Messina 98125, Italy
- Corresponding author.
| | - Giuseppe Calcaterra
- University of Palermo, Adjunct Professor of Cardiology, Postgraduate Medical School of Cardiology, Palermo 90127, Italy
| | - Nicholas G. Kounis
- Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, Patras 26221, Greece
| | - Pier Paolo Bassareo
- Department of Cardiology, Mater Misericordiae University Hospital, University College of Dublin, School of Medicine, Dublin D07R2WY, Ireland
| | - Jawahar L. Mehta
- Department of Medicine, University of Arkansas for Medical Sciences and the Veterans Affairs Medical Center, Little Rock, AR 72205, USA
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28
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Kounis NG, Koniari I, Mplani V, Kouni S, Velissaris D, Plotas P, Tsigkas G. Rare Hypersensitivity Myocardial Reactions Following COVID-19 Vaccination: Hypersensitivity Myocardial Infarction (Kounis Syndrome) and Hypersensitivity Myocarditis. Anatol J Cardiol 2022; 26:245-246. [PMID: 35346918 PMCID: PMC9366403 DOI: 10.5152/anatoljcardiol.2022.1573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Virginia Mplani
- Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Sophia Kouni
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - Dimitrios Velissaris
- Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Panagiotis Plotas
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, University of Patras Medical School, Patras, Greece
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Kounis NG, Koniari I, Mplani V, Plotas P, Velissaris D. Hypersensitivity myocarditis and the pathogenetic conundrum of COVID 19 Vaccine Related Myocarditis. Cardiology 2022; 147:413-415. [PMID: 35316805 PMCID: PMC9393780 DOI: 10.1159/000524224] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Virginia Mplani
- Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Panagiotis Plotas
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - Dimitrios Velissaris
- Department of Internal Medicine, University of Patras Medical School, Patras, Greece
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Allam C, Kounis NG, Chlawit R, Saouma M, Badaoui G. Kounis syndrome following COVID-19 vaccination. Proc AMIA Symp 2022; 35:369-370. [DOI: 10.1080/08998280.2022.2034226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Chadi Allam
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Department of Cardiology, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Nicholas G. Kounis
- Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, Patras, Greece
| | - Roy Chlawit
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Department of Cardiology, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Marc Saouma
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Department of Cardiology, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Georges Badaoui
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Department of Cardiology, Hôtel-Dieu de France Hospital, Beirut, Lebanon
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Kounis NG, Mplani V, Koniari I, Plotas P. Rare cases of myocarditis after COVID-19 vaccination: searching for diagnosis, type, treatment and prevention. Revista Española de Cardiología (English Edition) 2022; 75:278-279. [PMID: 34838472 PMCID: PMC8542433 DOI: 10.1016/j.rec.2021.10.007] [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] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/11/2021] [Indexed: 11/19/2022]
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Kounis NG, Koniari I, Mplani V, Plotas P, Tsigkas G. First Identified Case of Fatal Fulminant Eosinophilic Myocarditis Following the Initial Dose of the Pfizer-BioNTech mRNA COVID-19 Vaccine (BNT162b2, Comirnaty): an Extremely Rare Idiosyncratic Necrotizing Hypersensitivity Reaction Different to Hypersensitivity or Drug-Induced Myocarditis. J Clin Immunol 2022; 42:736-737. [PMID: 35178640 PMCID: PMC8852986 DOI: 10.1007/s10875-022-01228-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/01/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, 7 Aratou Street, Queen Olgas Square, 26221, Patras, Greece.
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Virginia Mplani
- Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Panagiotis Plotas
- Department of Cardiology, University of Patras Medical School, 7 Aratou Street, Queen Olgas Square, 26221, Patras, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, University of Patras Medical School, 7 Aratou Street, Queen Olgas Square, 26221, Patras, Greece
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Del Rio-Pertuz G, Correa-Guerrero J, Abuabara-Franco E, Argueta-Sosa EE, Abohelwa M, Kounis NG, Nugent K. Acute coronary artery dissection after multiple bee stings. Proc AMIA Symp 2022; 35:86-87. [PMID: 34970046 DOI: 10.1080/08998280.2021.1958579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The occurrence of an acute coronary syndrome following an anaphylactic or anaphylactoid reaction is known as Kounis syndrome. Previous reports of Kounis syndrome described an acute coronary syndrome due either to vasospasm or atherosclerotic rupture of a coronary artery in the presence of cutaneous manifestation from the anaphylactic reaction. We report a case of a 33-year-old man who presented with anterior wall acute myocardial infarction immediately after honeybee stings without the presence of cutaneous manifestations other than the bee sting lesions. Emergent coronary arteriography revealed dissection of the proximal left anterior descending artery, which was treated with balloon dilation with an excellent outcome.
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Affiliation(s)
- Gaspar Del Rio-Pertuz
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Jose Correa-Guerrero
- Department of Internal Medicine, Hospital Universitario del Caribe, Universidad de Cartagena, Cartagena, Colombia
| | | | - Erwin E Argueta-Sosa
- Division of Cardiology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Mostafa Abohelwa
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Nicholas G Kounis
- Department of Cardiology, Patras University School of Medicine, Patras, Greece
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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Roumeliotis A, Davlouros P, Anastasopoulou M, Tsigkas G, Koniari I, Mplani V, Hahalis G, Kounis NG. Allergy Associated Myocardial Infarction: A Comprehensive Report of Clinical Presentation, Diagnosis and Management of Kounis Syndrome. Vaccines (Basel) 2021; 10:vaccines10010038. [PMID: 35062699 PMCID: PMC8781167 DOI: 10.3390/vaccines10010038] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/25/2021] [Accepted: 12/26/2021] [Indexed: 12/12/2022] Open
Abstract
Kounis syndrome (KS) has been defined as acute coronary syndrome (ACS) in the context of a hypersensitivity reaction. Patients may present with normal coronary arteries (Type I), established coronary artery disease (Type II) or in-stent thrombosis and restenosis (Type III). We searched PubMed until 1 January 2020 for KS case reports. Patients with age <18 years, non-coronary vascular manifestations or without an established diagnosis were excluded. Information regarding patient demographics, medical history, presentation, allergic reaction trigger, angiography, laboratory values and management were extracted from every report. The data were pulled in a combined dataset. From 288 patients with KS, 57.6% had Type I, 24.7% Type II and 6.6% Type III, while 11.1% could not be classified. The mean age was 54.1 years and 70.6% were male. Most presented with a combination of cardiac and allergic symptoms, with medication being the most common trigger. Electrocardiographically, 75.1% had ST segment elevation with only 3.3% demonstrating no abnormalities. Coronary imaging was available in 84.8% of the patients, showing occlusive lesions (32.5%), vascular spasm (16.2%) or normal coronary arteries (51.3%). Revascularization was pursued in 29.4% of the cases. In conclusion, allergic reactions may be complicated by ACS. KS should be considered in the differential diagnosis of myocardial infarction with non-obstructive coronary arteries.
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Affiliation(s)
- Anastasios Roumeliotis
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA 02138, USA;
| | - Periklis Davlouros
- Division of Cardiology, Department of Internal Medicine, Medical School, University of Patras, 26500 Patras, Greece; (P.D.); (M.A.); (G.T.); (G.H.)
| | - Maria Anastasopoulou
- Division of Cardiology, Department of Internal Medicine, Medical School, University of Patras, 26500 Patras, Greece; (P.D.); (M.A.); (G.T.); (G.H.)
| | - Grigorios Tsigkas
- Division of Cardiology, Department of Internal Medicine, Medical School, University of Patras, 26500 Patras, Greece; (P.D.); (M.A.); (G.T.); (G.H.)
| | - Ioanna Koniari
- Manchester Heart Institute, Manchester University Foundation Trust, Manchester M23 9LT, UK;
| | - Virginia Mplani
- Intensive Care Unit, Medical School, University of Patras, 26500 Patras, Greece;
| | - Georgios Hahalis
- Division of Cardiology, Department of Internal Medicine, Medical School, University of Patras, 26500 Patras, Greece; (P.D.); (M.A.); (G.T.); (G.H.)
| | - Nicholas G. Kounis
- Division of Cardiology, Department of Internal Medicine, Medical School, University of Patras, 26500 Patras, Greece; (P.D.); (M.A.); (G.T.); (G.H.)
- Correspondence:
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35
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Kounis NG, Mplani V, Koniari I, Plotas P. [Rare cases of myocarditis after COVID-19 vaccination: searching for diagnosis, type, treatment and prevention]. Rev Esp Cardiol 2021; 75:278-279. [PMID: 34876771 PMCID: PMC8639393 DOI: 10.1016/j.recesp.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Grecia
| | - Virginia Mplani
- Intensive Care Unit, University of Patras Medical School, Patras, Grecia
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, Reino Unido
| | - Panagiotis Plotas
- Department of Cardiology, University of Patras Medical School, Patras, Grecia
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Kounis NG, Mplani V, Koniari I, Velissaris D. Hypersensitivity myocarditis and COVID-19 vaccines. Kardiol Pol 2021; 80:109-110. [PMID: 34856634 DOI: 10.33963/kp.a2021.0166] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Greece.
| | - Virginia Mplani
- Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
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Kounis NG, Koniari I, Mplani V, Velissaris D, Tsigkas G. The pathogenesis of potential myocarditis induced by COVID-19 vaccine. Am J Emerg Med 2021; 56:382-383. [PMID: 34799207 PMCID: PMC8585566 DOI: 10.1016/j.ajem.2021.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Greece.
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Virginia Mplani
- Intensive care Unit, University of Patras Medical School, Patras, Greece
| | | | - Grigorios Tsigkas
- Department of Cardiology, University of Patras Medical School, Patras, Greece
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Yamashita T, Oguma Y, Kounis NG. Kounis Syndrome: Kill Two Birds With One Stone. J Invasive Cardiol 2021; 33:E920-E921. [PMID: 34735359] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A 59-year-old man with a 95% stenosis in his diagonal branch and no stenosis in the right coronary artery (RCA) or left circumflex artery was scheduled for PCI. After exhibiting symptoms consistent with type I Kounis syndrome (KS), nitroglycerin was administered. While giving him intravenous epinephrine to maintain his hemodynamics, the ST level recovered, and he became fully conscious. When he complained of chest pain, a new ST elevation was noticed in the lateral leads, with ST levels in the inferior leads turning into depression. Repeat angiography demonstrated neither spasm nor occlusion in the RCA, while the diagonal branch was completely occluded at the proximal portion, which was considered to be responsible for ST elevation in the lateral leads. This is the first reported case that combined 2 variants of KS in a single event.
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Affiliation(s)
- Takehiro Yamashita
- Cardiology, Cardiovascular Center, Hokkaido Ohno Memorial Hospital, 2-1-16-1, Miyanosawa, Nishiku, Sapporo, Hokkaido 063-0052, Japan.
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Kounis NG, Mplani V, Koniari I. Aortic dissection type 1, windsock sign, neglected lead, and Kounis syndrome: What a coincidence! Anatol J Cardiol 2021; 25:747-748. [PMID: 34622792 DOI: 10.5152/anatoljcardiol.2021.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras-Greece
| | - Virginia Mplani
- Intensive Care Unit, University of Patras Hospital, Patras-Greece
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust; Manchester-UK
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de Gregorio C, Ferrazzo G, Koniari I, Kounis NG. Acute coronary syndrome from scombroid poisoning: a narrative review of case reports. Clin Toxicol (Phila) 2021; 60:1-9. [PMID: 34396875 DOI: 10.1080/15563650.2021.1959605] [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: 10/20/2022]
Abstract
BACKGROUND Scombroid syndrome constitutes a toxic illness caused by ingestion of improperly stored fish, usually contaminated by Gram-negative bacteria producing histamine and other toxins. Scombroid currently accounts for approximately 5% of food toxicities in the United States. Though cardiovascular complications are infrequent, some patients experienced acute coronary syndrome (ACS) on admission to hospital. This article focuses on the main pathophysiology, clinical features, therapy, and outcomes in scombroid-related ACS. METHODS Starting from the consolidated knowledge on histaminergic syndromes, we performed a literature search for studies describing patient series and single cases presenting at emergency department with scombroid toxicity complicated by myocardial ischemia. RESULTS After a pathophysiological overview on histaminergic syndromes, we carefully analyzed a dataset of 19 patients from 13 studies, published from 1997 to December 2020. Electrocardiographic, echocardiographic, angiographic features, clinical course, hospital complications, and therapeutic approach were described. Shared and differential aspects of scombroid ACS with typical atherosclerotic ischemia, Kounis, MINOCA and Takotsubo syndromes are also discussed. CONCLUSION An ischemic heart scombroid syndrome may occur in some patients after the eating of improperly stored fish food. Currently available studies indicate this as a benign condition, except for patients with history of coronary artery disease, previous ACS, or anaphylaxis. Of clinical concern, there is a potential of hemodynamic failure in the acute stage, even in apparently healthy people.
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Affiliation(s)
- Cesare de Gregorio
- Department of Clinical and Experimental Medicine, University of Messina Medical School, Messina, Italy
| | - Giuseppe Ferrazzo
- Department of Clinical and Experimental Medicine, University of Messina Medical School, Messina, Italy
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester, NHS Foundation Trust, Manchester, United Kingdom
| | - Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Greece
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Lin YK, Yeh CT, Kuo KT, Yadav VK, Fong IH, Kounis NG, Hu P, Hung MY. Pterostilbene Increases LDL Metabolism in HL-1 Cardiomyocytes by Modulating the PCSK9/HNF1α/SREBP2/LDLR Signaling Cascade, Upregulating Epigenetic hsa-miR-335 and hsa-miR-6825, and LDL Receptor Expression. Antioxidants (Basel) 2021; 10:antiox10081280. [PMID: 34439528 PMCID: PMC8389247 DOI: 10.3390/antiox10081280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/27/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 12/14/2022] Open
Abstract
Proprotein convertase subtilisin/kexin type 9 (PCSK9) can promote the degradation of low-density lipoprotein (LDL) receptor (LDLR), leading to hypercholesterolemia and myocardial dysfunction. The intracellular regulatory mechanism by which the natural polyphenol pterostilbene modulates the PCSK9/LDLR signaling pathway in cardiomyocytes has not been evaluated. We conducted Western blotting, flow cytometry, immunofluorescence staining, and mean fluorescence intensity analyses of pterostilbene-treated mouse HL-1 cardiomyocytes. Pterostilbene did not alter cardiomyocyte viability. Compared to the control group, treatment with both 2.5 and 5 μM pterostilbene significantly increased the LDLR protein expression accompanied by increased uptake of LDL. The expression of the mature PCSK9 was significantly suppressed at the protein and mRNA level by the treatment with both 2.5 and 5 μM pterostilbene, respectively, compared to the control. Furthermore, 2.5 and 5 μM pterostilbene treatment resulted in a significant reduction in the protein hepatic nuclear factor 1α (HNF1α)/histone deacetylase 2 (HDAC2) ratio and sterol regulatory element-binding protein-2 (SREBP2)/HDAC2 ratio. The expression of both hypoxia-inducible factor-1 α (HIF1α) and nuclear factor erythroid 2-related factor 2 (Nrf2) at the protein level was also suppressed. Pterostilbene as compared to short hairpin RNA against SREBP2 induced a higher protein expression of LDLR and lower nuclear accumulation of HNF1α and SREBP2. In addition, pterostilbene reduced PCSK9/SREBP2 interaction and mRNA expression by increasing the expression of hsa-miR-335 and hsa-miR-6825, which, in turn, increased LDLR mRNA expression. In cardiomyocytes, pterostilbene dose-dependently decreases and increases the protein and mRNA expression of PCSK9 and LDLR, respectively, by suppressing four transcription factors, HNF1α, SREBP2, HIF1α, and Nrf2, and enhancing the expression of hsa-miR-335 and hsa-miR-6825, which suppress PCSK9/SREBP2 interaction.
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Affiliation(s)
- Yen-Kuang Lin
- Biostatistics Research Center, Taipei Medical University, Taipei 110, Taiwan;
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan City 33301, Taiwan
| | - Chi-Tai Yeh
- Department of Medical Research and Education, Taipei Medical University-Shuang Ho Hospital, New Taipei City 23561, Taiwan; (C.-T.Y.); (V.K.Y.); (I.-H.F.)
- Department of Medical Laboratory Science and Biotechnology, Yuanpei University of Medical Technology, Hsinchu 300, Taiwan
| | - Kuang-Tai Kuo
- Department of Surgery, Division of Thoracic Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan;
- Department of Surgery, Division of Thoracic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Vijesh Kumar Yadav
- Department of Medical Research and Education, Taipei Medical University-Shuang Ho Hospital, New Taipei City 23561, Taiwan; (C.-T.Y.); (V.K.Y.); (I.-H.F.)
- Department of Medical Laboratory Science and Biotechnology, Yuanpei University of Medical Technology, Hsinchu 300, Taiwan
| | - Iat-Hang Fong
- Department of Medical Research and Education, Taipei Medical University-Shuang Ho Hospital, New Taipei City 23561, Taiwan; (C.-T.Y.); (V.K.Y.); (I.-H.F.)
- Department of Medical Laboratory Science and Biotechnology, Yuanpei University of Medical Technology, Hsinchu 300, Taiwan
| | - Nicholas G. Kounis
- Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, 26221 Patras, Greece;
| | - Patrick Hu
- Department of Cardiology, University of California, Riverside, CA 92521, USA;
- Department of Cardiology, Riverside Medical Clinic, Riverside, CA 92506, USA
| | - Ming-Yow Hung
- Department of Internal Medicine, Division of Cardiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan
- Department of Internal Medicine, Division of Cardiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Correspondence: ; Tel.: +88-62-2249-0088; Fax: +88-62-8262-2010
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42
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Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, Patras University School of Medicine, Patras, Greece
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, University of Messina Medical School, Messina, Italy
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43
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Gogos C, Sachpekidis V, Moschovidis V, Styliadis I, Kounis NG. Kounis syndrome in a Covid-19 patient following intravenous azithromycin administration. J Investig Allergol Clin Immunol 2021; 32:75-76. [PMID: 34156959 DOI: 10.18176/jiaci.0723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C Gogos
- Covid -19 Unit, Department of Cardiology, Papageorgiou General Hospital, Thessaloniki, Greece
| | - V Sachpekidis
- Covid -19 Unit, Department of Cardiology, Papageorgiou General Hospital, Thessaloniki, Greece
| | - V Moschovidis
- Covid -19 Unit, Department of Cardiology, Papageorgiou General Hospital, Thessaloniki, Greece
| | - I Styliadis
- Covid -19 Unit, Department of Cardiology, Papageorgiou General Hospital, Thessaloniki, Greece
| | - N G Kounis
- Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, Patras, Greece
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Fanni D, Gerosa C, Nurchi VM, Suri JS, Nardi V, Congiu T, Coni P, Ravarino A, Cerrone G, Piras M, Cau F, Kounis NG, Balestrieri A, Gibo Y, Van Eyken P, Coghe F, Venanzi Rullo E, Taibi R, Orrù G, Faa G, Saba L. Trace elements and the carotid plaque: the GOOD (Mg, Zn, Se), the UGLY (Fe, Cu), and the BAD (P, Ca)? Eur Rev Med Pharmacol Sci 2021; 25:3772-3790. [PMID: 34109586 DOI: 10.26355/eurrev_202105_25945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Multiple epidemiological studies have suggested that industrialization and progressive urbanization should be considered one of the main factors responsible for the rising of atherosclerosis in the developing world. In this scenario, the role of trace metals in the insurgence and progression of atherosclerosis has not been clarified yet. In this paper, the specific role of selected trace elements (magnesium, zinc, selenium, iron, copper, phosphorus, and calcium) is described by focusing on the atherosclerotic prevention and pathogenesis plaque. For each element, the following data are reported: daily intake, serum levels, intra/extracellular distribution, major roles in physiology, main effects of high and low levels, specific roles in atherosclerosis, possible interactions with other trace elements, and possible influences on plaque development. For each trace element, the correlations between its levels and clinical severity and outcome of COVID-19 are discussed. Moreover, the role of matrix metalloproteinases, a family of zinc-dependent endopeptidases, as a new medical therapeutical approach to atherosclerosis is discussed. Data suggest that trace element status may influence both atherosclerosis insurgence and plaque evolution toward a stable or an unstable status. However, significant variability in the action of these traces is evident: some - including magnesium, zinc, and selenium - may have a protective role, whereas others, including iron and copper, probably have a multi-faceted and more complex role in the pathogenesis of the atherosclerotic plaque. Finally, calcium and phosphorus are implicated in the calcification of atherosclerotic plaques and in the progression of the plaque toward rupture and severe clinical complications. In particular, the role of calcium is debated. Focusing on the COVID-19 pandemia, optimized magnesium and zinc levels are indicated as important protective tools against a severe clinical course of the disease, often related to the ability of SARS-CoV-2 to cause a systemic inflammatory response, able to transform a stable plaque into an unstable one, with severe clinical complications.
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Affiliation(s)
- D Fanni
- Department of Medical Sciences and Public Health, Division of Pathology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - University Hospital San Giovanni di Dio, University of Cagliari, Cagliari, Italy.
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Kounis NG, Koniari I. Bleeding risk during anticoagulation: do all patients with non valvular atrial fibrillation need long-term anticoagulation? Acta Cardiol 2021; 77:664-665. [PMID: 34006196 DOI: 10.1080/00015385.2021.1923889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Nicholas G. Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
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Kounis NG, Koniari I, Tzanis G, Soufras GD, Velissaris D, Hahalis G. Anaphylaxis-induced atrial fibrillation and anesthesia: Pathophysiologic and therapeutic considerations. Ann Card Anaesth 2021; 23:1-6. [PMID: 31929239 PMCID: PMC7034217 DOI: 10.4103/aca.aca_100_19] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Atrial fibrillation is the most common cardiac arrhythmia in western society affecting more than 35 million individuals worldwide annually. It is a common postoperative complication and may also occur spontaneously during general and local anesthesia administration. Aging, diabetes mellitus, hypertension, and cardiovascular diseases including cardiomyopathies, congenital cardiac anomalies, heart failure, myocardial ischemia, pericarditis, previous cardiac surgery, vascular disease, and valvular heart disease are some correlated factors. Beyond age, increased incidence of atrial fibrillation has been correlated to autoimmune system activation as it is the underlying mechanism of persistent atrial fibrillation development. Current research supports an association between the complement system activation and lymphocyte-pro-inflammatory cytokines release with the cardiac conduction system and atrial fibrosis. The loss of CD28 antigen from CD4+ CD28+ T lymphocytes seems to play a major role in atrial fibrillation development and prognosis. Except atrial fibrillation, a variety of additional electrocardiographic changes, resembling those with digitalis intoxication may accompany anaphylaxis and particularly Kounis syndrome. Histamine is one well-known mediator in allergic and inflammatory conditions as physiologically regulates several cardiovascular and endothelial functions with arrhythmogenic potential. The increased oxidative stress, measured by the redox potentials of glutathione, has been correlated with atrial fibrillation incidence and prevalence. The use of antazoline, a first-generation antihistamine agent used for rapid conversion of recent-onset atrial fibrillation in patients with preserved left ventricular function and for rapid atrial fibrillation termination during accessory pathway ablation denotes that anaphylaxis-induced histamine production could be the cause of atrial fibrillation at least in some instances. The anaphylaxis diagnosis in anesthesia can be challenging owing to the absence of cutaneous manifestetions such as flushing, urticaria, or angioedema. Anticoagulation for stroke prevention, rate and rhythm control medications, invasive methods such as radiofrequency ablation or cryoablation of pulmonary veins as well surgical ablation constitute the treatment basis of atrial fibrillation. Understanding the underlying mechanisms of atrial fibrillation by cardiologists, anesthesiologists and surgeons, as well as potential treatments, to optimize care is of paramount importance.
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Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, Patras University School of Medicine, Patras, Greece
| | - Ioanna Koniari
- Electrophysiology and Device Department, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - George Tzanis
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - George D Soufras
- Department of Cardiology, Patras State General Hospital, Patras, Greece
| | - Dimitrios Velissaris
- Department of Internal Medicine, Patras University School of Medicine, Patras, Greece
| | - George Hahalis
- Department of Cardiology, Patras University School of Medicine, Patras, Greece
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Chang NC, Yeh CT, Lin YK, Kuo KT, Fong IH, Kounis NG, Hu P, Hung MY. Garcinol Attenuates Lipoprotein(a)-Induced Oxidative Stress and Inflammatory Cytokine Production in Ventricular Cardiomyocyte through α7-Nicotinic Acetylcholine Receptor-Mediated Inhibition of the p38 MAPK and NF-κB Signaling Pathways. Antioxidants (Basel) 2021; 10:antiox10030461. [PMID: 33809417 PMCID: PMC8000018 DOI: 10.3390/antiox10030461] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 01/28/2021] [Revised: 02/27/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022] Open
Abstract
Garcinol, a nicotinic acetylcholine receptor (nAChR) antagonist, has recently been established as an anti-inflammation agent. However, the molecular mechanism by which garcinol suppresses inflammation in the context of acute myocardial infarction (AMI) remains unclear. Hypothesis: We hypothesized that the administration of physiological doses of garcinol in mice with isoproterenol-induced AMI decreased the effect of lipoprotein(a) (Lp(a))-induced inflammation both in vivo and in vitro via the α7-nAChRs mediated p38 mitogen-activated protein kinase (MAPK)/nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) signaling pathway. We analyzed altered reactive oxygen species (ROS) generation, the production of superoxide by mitochondria, cytokine expression patterns, and the role of the p38 MAPK/NF-κB signaling pathway after Lp(a)-stimulated human ventricular cardiomyocyte AC16 cells were treated with increasing doses of garcinol. C-reactive protein (CRP), interleukin (IL)-1β, IL-6, or tumor necrosis factor (TNF)-α production were detected by enzyme-linked immunosorbent assay. The Cell Counting Kit-8 assay was used to evaluate drug cytotoxicity. Western blots and confocal fluorescence microscopy were used to determine altered expression patterns of inflammatory biomarkers. We also examined whether the therapeutic effect of garcinol in AMI was mediated in part by α7-nAChR. Lp(a)-induced inflammatory cardiomyocytes had increased expression of membrane-bound α7-nAChRs in vitro and in vivo. Low-dose garcinol did not affect cardiomyocyte viability but significantly reduced mitochondrial ROS, CRP, IL-1β, IL-6, and TNF-α production in Lp(a)-stimulated cardiomyocytes (p < 0.05). The Lp(a)-induced phosphorylation of p38 MAPKs, CamKII, and NFκB, as well as NFκB-p65 nuclear translocation, was also suppressed (p < 0.05) by garcinol, while the inhibition of p38 MAPK by the inhibitor SB203580 decreased the phosphorylation of extracellular signal-regulated kinase (ERK) and p38 MAPK. Garcinol protected cardiomyocytes by inhibiting apoptosis and inflammation in mice with AMI. Furthermore, garcinol also enhanced the expression of microRNA-205 that suppressed the α7-nAChR-induced p38 MAPK/NF-κB signaling pathway. Garcinol suppresses Lp(a)-induced oxidative stress and inflammatory cytokines by α7-nAChR-mediated inhibition of p38 MAPK/NF-κB signaling in cardiomyocyte AC16 cells and isoproterenol-induced AMI mice.
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Affiliation(s)
- Nen-Chung Chang
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan
| | - Chi-Tai Yeh
- Department of Medical Research and Education, Taipei Medical University—Shuang Ho Hospital, New Taipei City 23561, Taiwan; (C.-T.Y.); (I.-H.F.)
- Department of Medical Laboratory Science and Biotechnology, Yuanpei University of Medical Technology, Hsinchu City 30015, Taiwan
| | - Yen-Kuang Lin
- Biostatistics Center, Office of Data Science, Taipei Medical University, Taipei 110, Taiwan
- Graduate Institute of Data Science, Taipei Medical University, Taipei 110, Taiwan
- Research Center of Big Data, College of Management, Taipei Medical University, Taipei 110, Taiwan;
| | - Kuang-Tai Kuo
- Division of Thoracic Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan;
- Division of Thoracic Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Iat-Hang Fong
- Department of Medical Research and Education, Taipei Medical University—Shuang Ho Hospital, New Taipei City 23561, Taiwan; (C.-T.Y.); (I.-H.F.)
- Department of Medical Laboratory Science and Biotechnology, Yuanpei University of Medical Technology, Hsinchu City 30015, Taiwan
| | - Nicholas G. Kounis
- Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, 26221 Patras, Greece;
| | - Patrick Hu
- Department of Cardiology, University of California, Riverside, CA 92521, USA;
- Department of Cardiology, Riverside Medical Clinic, Riverside, CA 92506, USA
| | - Ming-Yow Hung
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Correspondence: ; Tel.: +886-2-22490088
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Abstract
A 69-year-old woman with a history of allergic reactions to unknown metals who presented 1 year prior with acute coronary syndrome complicated by acute stent thrombosis (ST) was admitted due to new-onset chest pain during mild exercise. She electively underwent coronary angiography, revealing a newly developed stenosis in the fourth branch of the posterior descending artery, treated with an everolimus-eluting stent. One hour later, she reported of sudden chest tightness and nausea; ECG revealed significant ST-segment elevation in the II, III and aVF leads. We suspected ST-segment elevation myocardial infarction resulting from an allergic reaction (ie, Kounis syndrome type III) and managed it properly by eliminating other potential causes. The tentative diagnosis was confirmed by pathological examination of aspirated materials. Kounis syndrome type III may be a frequently undiagnosed clinical entity, emphasising the importance of pathological examination of aspirated materials when implanting coronary stents and history-taking of allergies to stent metals.
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Affiliation(s)
- Shiro Miura
- Department of Cardiology, Hokkaido Ono Memorial Hospital, Sapporo, Japan
| | - Takehiro Yamashita
- Department of Cardiology, Hokkaido Ono Memorial Hospital, Sapporo, Japan
| | - Masaki Murata
- Department of Surgical Pathology, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - Nicholas G Kounis
- Department of Cardiology, University of Patras School of Medicine, Patras, Greece
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Kounis NG, Koniari I, Gogos C, Assimakopoulos SF. Ηypercoagulation and myocardial injury as risk factors for mortality in patients with COVID-19 pneumonia. Am J Emerg Med 2021; 47:313-314. [PMID: 33494959 PMCID: PMC7816584 DOI: 10.1016/j.ajem.2021.01.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 01/29/2023] Open
Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Greece.
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Christos Gogos
- Department of Cardiology, Papageorgiou General Hospital, Thessaloniki, Greece
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Kounis NG, Koniari I, Plotas P, Argyriou A, Soufras GD, Tsigkas G, Davlouros P, Hahalis G. Bee Sting-Induced Acute Ischemic Stroke: A New Manifestation of Kounis Syndrome? Ann Indian Acad Neurol 2021; 24:118-120. [PMID: 33911404 PMCID: PMC8061506 DOI: 10.4103/aian.aian_54_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 02/12/2020] [Accepted: 02/21/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Nicholas G. Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - Ioanna Koniari
- Department of Electrophysiology and Device, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Panagiotis Plotas
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - Andreas Argyriou
- Department of Neurology, “Saint Andrews” State General Hospital, Patras, Greece
| | - George D. Soufras
- Department of Cardiology, “Saint Andrews” State General Hospital, Patras, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - Periklis Davlouros
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - George Hahalis
- Department of Cardiology, University of Patras Medical School, Patras, Greece
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