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Papazachariou A, Papadakis JA, Malikides V, Nikiforou A, Alexiadou D, Malikides O, Ioannou P, Ximeri M, Kofteridis DP. Monitoring anti-Xa levels in elderly medical patients undergoing thromboprophylaxis: A prospective cohort study. Geriatr Gerontol Int 2024. [PMID: 38705573 DOI: 10.1111/ggi.14891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Given the rising incidence of venous thromboembolism (VTE) and insufficient thromboprophylaxis dosing evidence in certain patients, the precise monitoring of anti-Xa (aFXa) levels is crucial. The aim of this study is to investigate the achievement of prophylactic aFXa levels in medical inpatients who were receiving parenteral anticoagulant and to evaluate the impact of various factors on aFXa levels. METHODS This is a single-center observational cohort study conducted on patients admitted to the Department of Internal Medicine at the University Hospital of Heraklion, Greece, from March to August 2023. These individuals received low-molecular-weight heparins thromboprophylaxis owing to an increased risk of VTE. Data regarding demographics, past medical history, and somatometric and laboratory findings were recorded. The established range for peak prophylactic aFXa levels was defined as 0.2-0.5 IU/mL. RESULTS In this study, we enrolled 150 individuals [91 (60.7%) women] with a mean age of 80.0 ± 14.1 years. Sixty-two (41.4%) patients exhibited non-prophylactic peak aFXa levels. Supratherapeutic levels were observed in all underweight patients and subtherapeutic levels in 12 of 13 obese patients in class II and III. A multivariate linear regression analysis revealed that body weight, cancer, and the Charlson Comorbidity Index (CCI) were independent factors influencing aFXa levels. CONCLUSIONS Our study reveals a substantial portion of medical elderly inpatients on thromboprophylaxis with non-prophylactic aFXa levels, with a notable prevalence among underweight and severely obese patients. Body weight, cancer, and CCI were identified as independent factors influencing aFXa levels, advocating for tailored thromboprophylaxis strategies. Further research is warranted to validate personalized dosing approaches and to enhance clinical decision-making. Geriatr Gerontol Int 2024; ••: ••-••.
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Affiliation(s)
- Andria Papazachariou
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - John A Papadakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Vironas Malikides
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Antigoni Nikiforou
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Dimitra Alexiadou
- Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | - Onoufrios Malikides
- Department of Cardiology, University Hospital of Heraklion, Heraklion, Greece
| | - Petros Ioannou
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Maria Ximeri
- Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
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Papazachariou A, Papadakis JA, Malikides V, Theodorakopoulou V, Vougiouklakis G, Malikides O, Kofteridis DP. The importance of intensive follow-up and achieving optimal chronic antithrombotic treatment in hospitalized medical patients with anemia: A prospective cohort study. Hellenic J Cardiol 2024:S1109-9666(23)00232-4. [PMID: 38176585 DOI: 10.1016/j.hjc.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/11/2023] [Accepted: 12/30/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Anemia is a global health concern, particularly among the elderly on chronic antithrombotic treatment. Close monitoring of hemoglobin (Hb) levels and achievement of an optimized treatment significantly enhance patients' quality of life. This study aimed to examine the impact of antithrombotic treatment on Hb levels and readmissions in hospitalized patients with anemia. METHODS This is a prospective cohort study of patients admitted to the Department of Internal Medicine of the University Hospital of Heraklion, Greece, from November 2021 to October 2022 with the diagnosis of anemia while receiving antithrombotic treatment. Data regarding demographics, past medical history, and laboratory and endoscopy findings were recorded. For those receiving inappropriate therapy according to international guidelines, antithrombotic treatment was optimized. Subsequent follow-ups occurred at one and six months post-discharge. Six- and twelve-month anemia-caused readmissions, as well as annual mortality, were evaluated. RESULTS In total, 104 patients were assessed. Among them, 34.6% were on antiplatelets, 56.7% were on anticoagulants, and 8.7% were on combination treatment. The mean age was 80 ± 8.2 years, and 54.8% were males. On admission, mean Hb levels were 6.86 ± 1.23 g/dL, while 56 (53.8%) patients had severe anemia. Gastroscopy and colonoscopy were performed in 75.0% and 41.4% of patients, respectively, confirming gastrointestinal bleeding in most of the cases. Treatment optimization was carried out for 56 patients. Follow-up revealed elevated Hb levels after one and six months post-discharge, while anemia-related readmissions stayed below 10%. CONCLUSIONS Most hospitalized anemic patients on antithrombotic treatment had endoscopic findings favoring gastrointestinal bleeding. Half received inappropriate antithrombotic therapy. Treatment optimization and regular follow-up improved Hb levels and reduced readmissions.
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Affiliation(s)
- Andria Papazachariou
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece.
| | - John A Papadakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Vironas Malikides
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | | | - George Vougiouklakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Onoufrios Malikides
- Department of Cardiology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Diamantis P Kofteridis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
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Mazokopakis EE, Papadomanolaki MG, Papadakis JA. The effects of folinic acid and l-methylfolate supplementation on serum total homocysteine levels in healthy adults. Clin Nutr ESPEN 2023; 58:14-20. [PMID: 38056998 DOI: 10.1016/j.clnesp.2023.09.002] [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: 10/31/2022] [Revised: 08/21/2023] [Accepted: 09/05/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND - AIM Hyperhomocysteinemia is recognized as a risk factor for several diseases and conditions. The aim of this study was to investigate and compare the efficacy of two total homocysteine (tHcy)-lowering treatments including folinic acid or l-methylfolate in healthy Greek adults. METHODS Two hundred and seventy-two healthy Greek adults (143 men, 129 women; mean age±SD: 43.0 ± 15.3 years), with serum tHcy levels ≥10 μmol/L received randomized folinic acid ("Folinic acid Group") or l-methylfolate ("l-methylfolate Group") orally for three months. All subjects with serum cobalamin (Cbl) levels <300 pg/mL additionally received 1 mg hydroxycobalamine intramuscularly twice a week for the first month only. Serum folate, Cbl and tHcy levels were determined using immunoassays methods at the beginning and the end of the study period. The MTHFR C677T and MTHFR A1298C gene polymorphisms were genotyped using polymerase chain reaction and reverse hybridization. RESULTS At the end of the 3-month intervention period, the levels of serum folate and Cbl increased significantly, whereas the levels of serum tHcy decreased significantly in the two groups. The individuals with MTHFR 677TT genotype had a significantly higher reduction in serum tHcy levels than the individuals with the MTHFR 677CC or MTHFR 677CT genotypes. Although the "Folinic acid Group" had a considerably higher increase in their serum folate levels (but not Cbl) than the "l-methylfolate Group", the reduction of serum tHcy levels between the two groups was not substantially different. The individuals with MTHFR 677CT genotype had a statistically significant higher reduction in serum tHcy levels when supplemented with folinic acid rather than l-methylfolate. CONCLUSIONS The administration of folinic acid compared to l-methylfolate caused a higher increase of serum folate levels but no difference in the reduction of serum tHcy levels. The reduction of serum tHcy levels was influenced by the existence of MTHFR C677T and not MTHFR A1298C gene polymorphisms. The individuals with MTHFR 677CT genotype appear to benefit more by folinic acid than l-methylfolate supplementation.
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Affiliation(s)
- Elias E Mazokopakis
- Department of Internal Medicine, Naval Hospital of Crete, Chania, Greece; Private Medical Office of Internal Medicine, Chania, Greece.
| | - Maria G Papadomanolaki
- School of Production Engineering and Management, Technical University of Crete, Chania, Greece
| | - John A Papadakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece
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Mazokopakis EE, Papadomanolaki MG, Papadakis JA. Associations of serum 25-hydroxyvitamin D with serum folate, cobalanin, and homocysteine concentrations and methylene tetrahydrofolate reductase (MTHFR) gene polymorphisms in healthy adults. Hormones (Athens) 2023; 22:491-499. [PMID: 37328700 DOI: 10.1007/s42000-023-00457-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/02/2023] [Indexed: 06/18/2023]
Abstract
AIM The aim of this study was to investigate the associations of serum 25-hydroxyvitamin D [25(OH)D] with various demographic, anthropometric, and genetic characteristics and biochemical parameters in healthy Greek adults. METHODS Demographic (age and sex), anthropometric (body mass index/BMI), and genetic (MTHFR gene polymorphisms) characteristics and biochemical parameters (serum folate, cobalamin/Cbl, and total homocysteine/tHcy concentrations), which had been recorded and measured, among others, in the framework of periodic medical examination (military personnel) or check-up (non-military personnel) of 383 healthy Greek adults (199 men and 184 women) were analyzed. Serum 25(OH)D, tHcy, folate, and Cbl levels were determined using immunoassay methods. The MTHFR C677T and A1298C gene polymorphisms were genotyped using polymerase chain reaction and reverse hybridization. RESULTS Serum 25(OH)D concentrations were correlated with Cbl levels and MTHFR C677T gene polymorphism, while they had a reverse correlation with serum tHcy levels, age, and BMI. There was no significant correlation between serum 25(OH)D concentrations and sex, serum folate levels, and smoking status. Individuals with the 677TT genotype had statistically significantly lower serum 25(OH)D levels than those with the 677CC or 677CT genotype, while individuals with the 1298CC genotype had statistically significantly higher serum 25(OH)D levels than those with 1298AA or 1298AC genotype. Moreover, the reverse correlation between the serum 25(OH)D and tHcy levels was statistically significant in all six MTHFR genotypes. CONCLUSIONS Serum 25(OH)D levels are associated with age, BMI, serum tHcy, and Cbl levels and MTHFR C677T gene polymorphism. The most significant finding of our study is the observed reverse correlation of serum 25(OH)D levels with serum tHcy levels. Considering that vitamin D deficiency and hyperhomocysteinemia (HHcy) are associated with an increased risk for cardiovascular diseases (CVDs), we suggest that individuals with high serum tHcy levels should be further investigated for, inter alia, their serum 25(OH)D levels.
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Affiliation(s)
- Elias E Mazokopakis
- Department of Internal Medicine, Naval Hospital of Crete, Chania, Greece.
- Private Medical Office of Internal Medicine, Chania, Greece.
| | - Maria G Papadomanolaki
- School of Production Engineering and Management, Technical University of Crete, Chania, Greece
| | - John A Papadakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece
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Alexiadou D, Panagiotakis S, Kontopodis N, Skiadas C, Nikiforou A, Vouyiouklakis G, Papadakis JA, Kofteridis D. Rapid Progression of Angiosarcoma in a Man with a Left Psoas Muscle Hematoma and a Recent EVAR of Abdominal Aorta. Maedica (Bucur) 2023; 18:519-522. [PMID: 38023756 PMCID: PMC10674126 DOI: 10.26574/maedica.2023.18.3.519] [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] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Angiosarcoma is a rare type of soft tissue cancer with several clinical presentations and a poor prognosis. We present a case of a 75-year-old man who was admitted due to anemia and fatigue. The patient had undergone an endovascular repair (EVAR) of a 9 cm infrarenal aneurysm of the abdominal aorta two months ago. A computed tomography (CT) scan of the abdomen on admission indicated a Type-II endoleak and a large hematoma of the left psoas muscle with multiple sites of intramuscular extravasation. Osseous metastases were found at the head of the left femoral head and at the iliac bones. A CT guided biopsy of the femoral head revealed an angiosarcoma of unknown primary site a few days after the patient had died from intra-alveolar hemorrhage caused by lung metastases.
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Affiliation(s)
- Dimitra Alexiadou
- Internal Medicine Department, Heraklion University Hospital, Heraklion, Crete, Greece
| | - Symeon Panagiotakis
- Internal Medicine Department, Heraklion University Hospital, Heraklion, Crete, Greece
| | - Nikos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Heraklion University Hospital, Heraklion, Crete, Greece
| | - Christos Skiadas
- Department of Radiology, Heraklion University Hospital, Heraklion, Crete, Greece
| | - Antigoni Nikiforou
- Internal Medicine Department, Heraklion University Hospital, Heraklion, Crete, Greece
| | - George Vouyiouklakis
- Internal Medicine Department, Heraklion University Hospital, Heraklion, Crete, Greece
| | - John A Papadakis
- Internal Medicine Department, Heraklion University Hospital, Heraklion, Crete, Greece
| | - Diamantis Kofteridis
- Internal Medicine Department, Heraklion University Hospital, Heraklion, Crete, Greece
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Mazokopakis EE, Papadomanolaki MG, Papadakis JA. Association of methylene tetrahydrofolate reductase (MTHFR) gene polymorphisms with serum folate, cobalanin and homocysteine concentrations in Greek adults. Scand J Clin Lab Invest 2023; 83:69-73. [PMID: 36662122 DOI: 10.1080/00365513.2023.2167232] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Methylene tetrahydrofolate reductase (MTHFR) is a key enzyme of homocysteine metabolism participating in the folate cycle. The aim of this study was to investigate the association of MTHFR C677T and MTHFR A1298C gene polymorphisms with serum folate, cobalamin (Cbl) and homocysteine (Hcy) concentrations in healthy Greek adults. The MTHFR C677T and A1298C gene polymorphisms were genotyped in 383 healthy Greek adults (199 men and 184 women) using polymerase chain reaction and reverse hybridization. Serum folate, Cbl and total Hcy (tHcy) levels were determined using immunoassays methods. Among the 383 individuals, 73 (19.1%) were normal (CC), 202 (52.7%) were heterozygous (CT) and 108 (28.2%) were homozygous (TT) regarding the MTHFR C677T gene polymorphism, while 263 (68.7%) were normal (AA), 105 (27.4%) were heterozygous (AC) and 15 (3.9%) were homozygous (CC) regarding the MTHFR A1298C gene polymorphism. The overall C and T allele frequency for the MTHFR C677T gene polymorphism was 45.4% and 54.6%, respectively, while the overall A and C allele frequency for the MTHFR A1298C gene polymorphism was 82.3% and 17.6%, respectively. The MTHFR C677T and not the A1298C gene polymorphism had a significantly influence on serum folate and tHcy levels. The individuals with 677TT genotype had significantly lower serum folate and significantly higher serum tHcy levels than individuals with 677 CC or CT genotypes. Serum folate and tHcy levels are influenced by the existence of the MTHFR C677T gene polymorphism (mainly 677TT genotype). Individuals with low serum folate levels and/or high serum tHcy levels should be further investigated for a possible existence of MTHFR C677T and not A1298C gene polymorphisms, with aim to determine the suitable treatment.
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Affiliation(s)
- Elias E Mazokopakis
- Department of Internal Medicine, Naval Hospital of Crete, Chania, Greece.,Private Medical Office of Internal Medicine, Chania, Greece
| | - Maria G Papadomanolaki
- School of Production Engineering and Management, Technical University of Crete, Chania, Greece
| | - John A Papadakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece
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Matthiopoulou G, Ioannou P, Mathioudaki A, Papadakis JA, Daraki VN, Pappas A, Souris S, Maraki S, Stathopoulou C, Kofteridis DP. Asymptomatic Bacteriuria in Patients with Type 2 Diabetes Mellitus. Infect Dis Rep 2023; 15:43-54. [PMID: 36648859 PMCID: PMC9887587 DOI: 10.3390/idr15010005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/09/2023] Open
Abstract
Objectives: Asymptomatic bacteriuria (ASB) is a common finding in patients with diabetes. Moreover, patients with diabetes and ASB have a greater risk for symptomatic urinary tract infections and associated severe complications. The aim of this study was to estimate the prevalence of ASB, as well as to identify independent risk factors and related pathogens associated with ASB in female and male patients with type 2 diabetes mellitus (T2D). Methods: This prospective case-control study was performed at the University hospital, and the Venezeleion General Hospital, Heraklion, Greece between 2012 and 2019. All patients with T2D attending the diabetes and hypertension outpatient clinics at both hospitals were enrolled, and data regarding their medical history and clinical and laboratory profiles were recorded. Asymptomatic patients with positive urine cultures were assigned as cases while those with negative urine cultures were designated as controls. Results: A total of 437 adult patients of which 61% were female and 39% were male patients with a mean age of 70.5 ± 9.6 years, were enrolled. The prevalence of ASB was 20.1%, in total. ASB was noted in 27% of female participants and 9.4% of male participants. Higher glycated hemoglobin (OR = 3.921, 95%CI: 1.521−10.109, p < 0.001) and urinary tract infection within the previous year (OR = 13.254, 95%CI: 2.245−78.241, p < 0.001) were independently positively associated with ASB, while higher levels of vitamin B12 were independently negatively associated with ASB (OR = 0.994 per ng/mL, 95%CI: 0.989−0.999, p < 0.001). Conclusions: Development of ASB was associated with specific factors, some of which may be modifiable. Interestingly, high B12 was found to be negatively associated with ASB.
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Affiliation(s)
- Georgia Matthiopoulou
- First Department of Internal Medicine, Venezeleion General Hospital of Heraklion, 714 09 Heraklion, Greece
- School of Medicine, University of Crete, 700 13 Heraklion, Greece
| | - Petros Ioannou
- School of Medicine, University of Crete, 700 13 Heraklion, Greece
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 711 10 Heraklion, Greece
- Correspondence: (P.I.); (D.P.K.)
| | - Anna Mathioudaki
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 711 10 Heraklion, Greece
| | - John A. Papadakis
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 711 10 Heraklion, Greece
| | - Vasiliki N. Daraki
- Department of Endocrinology, University Hospital of Heraklion, 711 10 Heraklion, Greece
| | - Angelos Pappas
- Diabetes Unit, Venezeleion General Hospital of Heraklion, 714 09 Heraklion, Greece
| | - Sotiris Souris
- First Department of Internal Medicine, Venezeleion General Hospital of Heraklion, 714 09 Heraklion, Greece
| | - Sofia Maraki
- Department of Microbiology, University Hospital of Heraklion, 711 10 Heraklion, Greece
| | - Chrysoula Stathopoulou
- Laboratory of Rheumatology, Autoimmunity and Inflammation, Institute of Molecular Biology and Biotechnology, 700 13 Heraklion, Greece
| | - Diamantis P. Kofteridis
- School of Medicine, University of Crete, 700 13 Heraklion, Greece
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 711 10 Heraklion, Greece
- Correspondence: (P.I.); (D.P.K.)
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Mazokopakis EE, Papadomanolaki MG, Papadakis JA. Associations of Serum Total Homocysteine Levels with Various Demographic, Clinical and Genetic Characteristics in Healthy Greek Adults. Acta Medica (Hradec Kralove) 2023; 66:61-67. [PMID: 37930095 DOI: 10.14712/18059694.2023.17] [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] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
AIM The aim of this study was to investigate the association of serum total Hcy (tHcy) levels with various demographic, clinical and genetic characteristics in healthy Greek adults. METHODS Anthropometric characteristics (height, weight), systolic and diastolic blood pressure, complete blood count and biochemical assessments, were recorded and measured among 383 Greek adults (199 men). Serum folate, Cobalamin (Cbl) and tHcy levels were determined using immunoassays methods. The MTHFR C677T and A1298C gene polymorphisms were genotyped using polymerase chain reaction and reverse hybridization. RESULTS MTHFR C677T gene polymorphism, serum folate and Cbl levels were correlated with serum tHcy levels independently. The individuals with 677TT genotype had significantly higher serum tHcy levels than individuals with 677 CC or CT genotypes. Regarding the MTHFR C677T gene polymorphism, the existence of the T allele was associated with statistically significantly lower serum folate and higher serum tHcy levels than C allele. Regarding the MTHFR A1298C gene polymorphism, the existence of the C allele was associated with statistically significant lower serum tHcy levels than A allele. Furthermore, there was no significant correlation between the serum tHcy levels and demographic (except age) or clinical characteristics (sex, BMI, smoking status, SBP, DBP, HGB, HCT, TC, TG, HDL-C, LDL-C, TC/HDL-C). CONCLUSIONS Serum tHcy levels are influenced by the existence of MTHFR C677T gene polymorphism (mainly 677TT genotype), serum folate and Cbl levels. Individuals with hyperhomocysteinemia should be further investigated for the existence of MTHFR C677T gene polymorphism, with the aim to determine the suitable treatment.
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Affiliation(s)
- Elias E Mazokopakis
- Department of Internal Medicine, Naval Hospital of Crete, Chania, Greece.
- Private Medical Office of Internal Medicine, Chania, Greece.
| | - Maria G Papadomanolaki
- School of Production Engineering and Management, Technical University of Crete, Chania, Greece
| | - John A Papadakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece
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Papadakis JA, Ioannou P, Theodorakopoulou V, Papanikolaou K, Vrentzos G. Metabolic profile of patients with isolated systolic hypertension. Hormones (Athens) 2021; 20:377-380. [PMID: 33409906 DOI: 10.1007/s42000-020-00266-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE/OBJECTIVE While hypertension is an important contributor to cardiovascular disease (CVD) and its treatment has well-established mortality benefits, there is uncertainty as regards the management of isolated systolic hypertension (ISH). Furthermore, the association of ISH with CVD and mortality has been established, but the metabolic characteristics of the affected population have not as yet been adequately described. The aim of this study was to describe the metabolic profiles of patients with ISH. METHODS An observational study of patients attending the Hypertension Unit of the University Hospital of Heraklion, Crete, Greece, was performed. RESULTS In total, 809 hypertensive patients not on any antihypertensive treatment were identified. Among them, 44.7% were men, aged 55.6 ± 12.5 years, while 29.7% of both men and women were smokers. Systolic blood pressure was 161.3 ± 15.8 mmHg and diastolic blood pressure was 96.1 ± 11.3 mmHg. Body mass index (BMI) was 31 ± 5.3 kg/m2, while 9.6% had type 2 diabetes (T2D). A comparison of patients with ISH with those with hypertension, but not ISH, revealed that patients with ISH were older and had lower SBP and higher pulse pressure, while they also had lower total cholesterol and LDL and were more likely to have T2D, albeit they had a slightly lower BMI. On the other hand, they did not have any difference in terms of gender, smoking status, HDL, triglycerides, liver biochemistry, uric acid, or prevalence of impaired fasting glucose. CONCLUSION Patients with ISH were older, with lower SBP, total cholesterol, and LDL and higher pulse pressure and higher prevalence of diabetes.
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Affiliation(s)
- J A Papadakis
- Hypertension Unit (ESH Excellence Center), Department of Internal Medicine, University Hospital of Heraklion, Stavrakia and Voutes Crossroads, 71110, Heraklion, Crete, Greece
| | - P Ioannou
- Hypertension Unit (ESH Excellence Center), Department of Internal Medicine, University Hospital of Heraklion, Stavrakia and Voutes Crossroads, 71110, Heraklion, Crete, Greece.
| | - V Theodorakopoulou
- Hypertension Unit (ESH Excellence Center), Department of Internal Medicine, University Hospital of Heraklion, Stavrakia and Voutes Crossroads, 71110, Heraklion, Crete, Greece
| | - K Papanikolaou
- Hypertension Unit (ESH Excellence Center), Department of Internal Medicine, University Hospital of Heraklion, Stavrakia and Voutes Crossroads, 71110, Heraklion, Crete, Greece
| | - G Vrentzos
- Hypertension Unit (ESH Excellence Center), Department of Internal Medicine, University Hospital of Heraklion, Stavrakia and Voutes Crossroads, 71110, Heraklion, Crete, Greece
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Stergiou GS, Menti A, Doumas M, Gkaliagkousi E, Grassos C, Kalaitzidis RG, Kallistratos MS, Katsi V, Krokidis X, Makris T, Manios E, Manolis A, Marketou M, Papadakis JA, Papadopoulos D, Protogerou A, Chatzopoulos M, Sarafidis P, Tsioufis C, Zebekakis P. Opportunistic screening for hypertension in the general population in Greece: International Society of Hypertension May Measurement Month 2019. Eur Heart J Suppl 2021; 23:B66-B69. [PMID: 34054365 PMCID: PMC8141958 DOI: 10.1093/eurheartj/suab024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Hypertension remains a major public health issue with inadequate control worldwide. The May Measurement Month (MMM) initiative by the International Society of Hypertension was implemented in Greece in 2019 aiming to raise hypertension awareness and control. Adult volunteers (≥18 years) were recruited through opportunistic screening in five urban areas. Information on medical history and triplicate sitting blood pressure (BP) measurements were obtained using validated automated upper-arm devices. Hypertension was defined as systolic BP ≥140 mmHg and/or diastolic ≥90 mmHg, and/or self-reported use of drugs for hypertension. A total of 5727 were analysed [mean age 52.7 (SD 16.6) years, men 46.5%, 88.3% had BP measurement in the last 18 months]. The prevalence of hypertension was (41.6%) and was higher in men and in older individuals. Among individuals with hypertension, 78.7% were diagnosed, 73.1% treated, and 48.3% controlled. Awareness, treatment, and control of hypertension were higher in women and in older individuals. Hypertensives had a higher body mass index (BMI) and were more likely to have diabetes, myocardial infarction and stroke, and less likely to smoke than normotensives (all P < 0.001). Among treated hypertensives, 65.1% were on monotherapy, and with increasing number of antihypertensive drugs the BP levels were higher and hypertension control rates lower. The prevalence of hypertension in Greece is high, with considerable potential for improving awareness, treatment, and control. Screening programmes, such as MMM, need to be widely implemented at the population level, together with training programmes for healthcare professionals aiming to optimise management and control.
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Affiliation(s)
- George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, Third Department of Medicine, Sotiria Hospital, 152 Mesogion Avenue, Athens 11527, Greece
| | - Ariadni Menti
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, Third Department of Medicine, Sotiria Hospital, 152 Mesogion Avenue, Athens 11527, Greece
| | - Michael Doumas
- Second Propedeutic Department of Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, 49 Konstantinoupoleos, Thessaloniki 54642, Greece
| | - Eugenia Gkaliagkousi
- Third Department of Medicine, Aristotle University of Thessaloniki, Papageorgiou Hospital, Ring Road N. Efkarpia, Thessaloniki 56403, Greece
| | - Charalampos Grassos
- Cardiology Department, General Hospital of Attica "KAT", 2 Nikis street, Athens 14561, Greece
| | - Rigas G Kalaitzidis
- Department of Nephrology, University Hospital of Ioannina, 1 Stavrou Niarchou Avenue, Ioannina 45500, Greece
| | - Manolis S Kallistratos
- Department of Cardiology, Asklepeion Hospital, 1 Vasileos Pavlou Avenue, Athens 16673, Greece
| | - Vasiliki Katsi
- Cardiology Department, Hippokration Hospital, 114 Vasilissis Sofias Avenue, Athens 11527, Greece
| | - Xenophon Krokidis
- Department of Medicine, Hospital of Kavala, Agios Syllas, Kavala 65500, Greece
| | - Thomas Makris
- Department of Cardiology, Helena Venizelou Hospital, 2 Elenas Venizelou Avenue, Athens 11521, Greece
| | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, 4-2 Lourou Avenue, Athens 11528, Greece
| | - Athanasios Manolis
- Department of Cardiology, Asklepeion Hospital, 1 Vasileos Pavlou Avenue, Athens 16673, Greece
| | - Maria Marketou
- Department of Cardiology, University Hospital, Panepistimiou Avenue, Heraklion 71500, Greece
| | - John A Papadakis
- Department of Medicine, University Hospital, Panepistimiou Avenue, Heraklion 71500, Greece
| | | | - Athanasios Protogerou
- Department of Pathophysiology, Cardiovascular Prevention & Research Unit, National & Kapodistrian University of Athens, 75 Mikras Asias street, Athens 11527, Greece
| | - Michail Chatzopoulos
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, Third Department of Medicine, Sotiria Hospital, 152 Mesogion Avenue, Athens 11527, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Aristotle University of Thessaloniki, Hippokration Hospital, 49 Konstantinoupoleos, Thessaloniki 54642, Greece
| | - Costas Tsioufis
- Cardiology Department, Hippokration Hospital, 114 Vasilissis Sofias Avenue, Athens 11527, Greece
| | - Pantelis Zebekakis
- First Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stylponos Kyriakidi, Thessaloniki 54636, Greece
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11
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Plataki MN, Vamvoukaki R, Samonis G, Bikis C, Gorgomiti M, Papadakis JA, Maraki S, Kofteridis DP. Vitamin D and Cathelicidin (LL-37) Status in Patients with Type 2 Diabetes and Staphylococcus aureus Nasal Carriage. Rev Diabet Stud 2021; 17:30-37. [PMID: 34289005 PMCID: PMC9380094 DOI: 10.1900/rds.2021.17.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Type 2 diabetes mellitus (T2D) is characterized by the dysregulation of innate immunity leading to higher rates of Staphylococcus aureus nasal carriage, an important risk factor for severe infections. 25-hydroxy vitamin D (25(OH) D) may contribute, via the production of the antimicrobial peptide cathelicidin (LL-37), to epithelial host defense against S. aureus. This study evaluated whether 25(OH)D and LL-37 levels determine S. aureus nasal carriage. METHODS Two consecutive nasal swabs were obtained from 118 T2D patients to determine S. aureus nasal carriage status. Serum levels of 25(OH)D and LL-37 were measured using chemiluminescence immunoassay and enzyme-linked immunosorbent assay, respectively. Supplementation of vitamin D by a number of participants was taken into account and evaluated. RESULTS Forty-two T2D patients (35.6%) were found to be colonized by S. aureus. Vitamin D deficiency was detected in sixty-nine patients (65.7%). Median value for LL-37 in T2D patients was 0.89 ng/ml (range 0.05-8.62 ng/ml). Circulating levels of LL-37 were higher in nasal carriers compared to non-carriers (1.25 ng/ml vs 0.72 ng/ml; p < 0.001). No difference was found in serum 25(OH) D levels between carriers and non-carriers. 25(OH)D and LL-37 serum levels correlated positively in non-carriers, while the relationship was inversed in the carrier group. Vitamin D supplementation was not associated with lower incidence of S. aureus nasal carriage (p = 0.706). CONCLUSIONS T2D patients presented decreased serum levels of 25(OH)D and LL-37, indicating a potential impairment of innate immunity. Expression of LL-37 may be induced by S. aureus nasal carriage among people with diabetes. Vitamin D supplementation did not influence S. aureus nasal colonization in T2D patients.
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Affiliation(s)
- Marina N Plataki
- Laboratory of Internal Medicine, Host Defense Unit, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Rodanthi Vamvoukaki
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - George Samonis
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Charalampos Bikis
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Maria Gorgomiti
- Department of Clinical Microbiology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - John A Papadakis
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Sofia Maraki
- Department of Clinical Microbiology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Diamantis P Kofteridis
- Laboratory of Internal Medicine, Host Defense Unit, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
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12
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Menti A, Kalpourtzi N, Gavana M, Vantarakis A, Voulgari PV, Hadjichristodoulou C, Gkaliagkousi E, Doumas M, Kalaitzidis RG, Kallistratos MS, Karakosta A, Katsi V, Krokidis X, Manios E, Marketou M, Ntineri A, Papadakis JA, Papadopoulos D, Sarafidis P, Trypsianis G, Chatzopoulos M, Chlouverakis G, Alamanos Y, Zebekakis P, Touloumi G, Stergiou GS. Opportunistic screening for hypertension: what does it say about the true epidemiology? J Hum Hypertens 2021; 36:364-369. [PMID: 33837294 DOI: 10.1038/s41371-021-00532-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/13/2021] [Accepted: 03/26/2021] [Indexed: 11/10/2022]
Abstract
This study aimed to assess the reliability of opportunistic screening programs in estimating the prevalence, treatment, and control rate of hypertension in the general population. Two recent epidemiological surveys obtained data on hypertension in the adult general population in Greece. The EMENO (2013-2016) applied a multi-stage stratified random sampling method to collect nationwide data. The MMM (2019) collected data through opportunistic (voluntary) screening in five large cities. Hypertension was defined as blood pressure (BP) ≥ 140/90 mmHg (single occasion; average of 2nd-3rd measurement; electronic devices) and/or use of antihypertensive drugs. Data from a total of 10,426 adults were analyzed (EMENO 4,699; MMM 5,727). Mean age (SD) was 49.2 (18.6)/52.7 (16.6) years (EMENO/MMM, p < 0.001), men 48.6/46.5% (p < 0.05) and body mass index 28.2 (5.7)/27.1 (5.0) kg/m2 (p < 0.001). The prevalence of hypertension in ΕΜΕΝΟ/MMM was 39.6/41.6% (p < 0.05) and was higher in men (42.7/50.9%, p < 0.001) than in women (36.5/33.6%, p < 0.05). Among hypertensive subjects, unaware were 31.8/21.3% (EMENO/MMM, p < 0.001), aware untreated 2.7/5.6% (p < 0.001), treated uncontrolled 35.1/24.8% (p < 0.001), and treated controlled 30.5/48.3% (p < 0.001). In conclusion, the prevalence of hypertension was similar with random sampling (EMENO) and opportunistic screening (MMM). However, opportunistic screening underestimated the prevalence of undiagnosed hypertension and overestimated the rate of hypertension treatment and control. Thus, random sampling national epidemiological studies are necessary for assessing the epidemiology of hypertension. Screening programs are useful for increasing awareness of hypertension in the general population, yet the generalization of such findings should be interpreted with caution.
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Affiliation(s)
- Ariadni Menti
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Natasa Kalpourtzi
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Magda Gavana
- Department of Primary Care, General Practice & Health Services Research, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | | | - Paraskevi V Voulgari
- Rheumatology Clinic, Department of Medicine, University of Ioannina, Ioannina, Greece
| | | | - Eugenia Gkaliagkousi
- Third Department of Medicine, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Michael Doumas
- Second Propedeutic Department of Medicine, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Argiro Karakosta
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Katsi
- Cardiology Department, Hippokration Hospital, Athens, Greece
| | | | - Efstathios Manios
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Marketou
- Department of Cardiology, Heraklion University Hospital, Iraklio, Greece
| | - Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - John A Papadakis
- Department of Medicine, Heraklion University Hospital, Iraklio, Greece
| | | | - Pantelis Sarafidis
- Department of Nephrology, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Grigoris Trypsianis
- Department of Medical Statistics, Medical Faculty, Democritus University of Thrace, Alexandroupolis, Greece
| | - Michail Chatzopoulos
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Grigoris Chlouverakis
- Division of Biostatistics, University of Crete, School of Medicine, Heraklion, Greece
| | - Yannis Alamanos
- Institute of Epidemiology Preventive Medicine and Public Health, Corfu, Greece
| | - Pantelis Zebekakis
- First Department of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece.
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13
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Andrianaki AM, Koutserimpas C, Kafetzakis A, Tavlas E, Maraki S, Papadakis JA, Ioannou P, Samonis G, Kofteridis DP. Diabetic foot infection and osteomyelitis. Are deep-tissue cultures necessary? Germs 2020; 10:346-355. [PMID: 33489950 DOI: 10.18683/germs.2020.1227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/17/2020] [Accepted: 12/01/2020] [Indexed: 11/08/2022]
Abstract
Introduction Diabetic foot infections (DFIs) are common and difficult to treat. The objective of this study was to compare swab and tissue cultures as indicators of appropriate treatment of DFIs. Methods This is a prospective study conducted during a 4-year period. All patients with DFIs and/or diabetic foot osteomyelitis (DFO) admitted to the University Hospital of Heraklion, Greece, were included. Clinical data were collected, while cultures taken with swabs and/or tissue biopsies were used as indicators of the microbiological cause and the appropriate treatment. Results In total, 83 individuals (62.7% males) with mean age of 72 years, were enrolled. Coexisting osteomyelitis was present in 18.1%. From tissue and pus cultures, 131 and 176 pathogens, respectively, were isolated. Gram-positive aerobes were the most common microorganisms, followed by Gram-negatives. Infection was polymicrobial in 40 (70.2%) out of 57 patients with tissue culture and in 54 (75.0%) out of 72 with pus culture. Microbiological results from tissue cultures were compatible with those from pus at a rate of 80%, while in cases of osteomyelitis concordance reached 100%. Multidrug-resistant organisms (MDROs) were isolated from 32 (24.4%) tissue and 44 (25%) pus cultures (p=0.910). Initial empirical antimicrobial treatment was considered inappropriate in 44.6% of cases. Conclusions A high concordance between easily taken swab cultures and those taken by biopsy was noted, especially in DFO. This was helpful for early change to appropriate treatment in cases where MDROs were isolated and empirical treatment was inappropriate. Further research is needed to confirm this observation in clinical practice.
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Affiliation(s)
- Angeliki M Andrianaki
- MD, PhD, Department of Internal Medicine, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - Christos Koutserimpas
- MD, Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, PC 11525, Greece
| | - Alexandros Kafetzakis
- MD, Department of Vascular Surgery, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - Emmanouil Tavlas
- MD, Department of Vascular Surgery, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - Sofia Maraki
- MD, PhD, Department of Microbiology, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - John A Papadakis
- MD, PhD, Department of Internal Medicine, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - Petros Ioannou
- MD, MSc, PhD, Department of Internal Medicine, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - George Samonis
- MD, PhD, Department of Internal Medicine, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - Diamantis P Kofteridis
- MD, PhD, Department of Internal Medicine, University Hospital of Heraklion, Crete, PC 71110, Greece
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14
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Moschou A, Ioannou P, Maraki S, Koutroumpakis F, Mamaloukaki M, Bikis C, Samonis G, Papadakis JA, Kofteridis DP. A prospective study of epidemiology characteristics and outcomes of bloodstream infections in older patients. Australas J Ageing 2020; 40:e182-e189. [PMID: 33174381 DOI: 10.1111/ajag.12881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 09/24/2020] [Accepted: 10/11/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to investigate the characteristics of bloodstream infections (BSIs) in older patients and describe the differences between community-acquired, hospital-acquired and health care-associated BSIs. METHODS A prospective observational study was conducted at the University Hospital of Heraklion, Crete, Greece. Epidemiology, clinical characteristics and outcomes of BSIs were recorded. RESULTS During a four-year period, 113 BSIs were recorded. Of them, 42% occurred in male patients; patients' mean age was 80 years. BSIs were community-acquired in 76% of patients, hospital-acquired in 12% and health care-associated in 12%. The most commonly isolated bacteria were E coli and K pneumoniae. Thirty-day mortality from detection of BSIs was 27%. Patients with fever, without septic shock and with appropriate empirical treatment were less likely to die. CONCLUSION Community-acquired, health care-associated and hospital-acquired BSIs had different presentation, microbiology and outcomes. Older patients had a high mortality. The absence of fever, inappropriate empirical treatment and septic shock were independent mortality predictors.
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Affiliation(s)
- Aikaterini Moschou
- Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece
| | - Petros Ioannou
- Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece
| | - Sofia Maraki
- Department of Clinical Microbiology, University Hospital of Heraklion, Crete, Greece
| | | | - Maria Mamaloukaki
- Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece
| | - Charalampos Bikis
- Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece
| | - George Samonis
- Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece
| | - John A Papadakis
- Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece
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15
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Fragkiadakis K, Ioannou P, Papadakis JA, Hatzidakis A, Gikas A, Kofteridis DP. Cytomegalovirus Pneumonitis in a Patient with Homozygous β-Thalassemia and Splenectomy. Jpn J Infect Dis 2018; 71:370-372. [PMID: 29848843 DOI: 10.7883/yoken.jjid.2018.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cytomegalovirus (CMV) rarely causes disease in immunocompetent individuals but may cause severe disease in immunocompromised patients. We report the case of a young woman who had undergone multiple transfusions and splenectomy for homozygous β-thalassemia. She presented with prolonged fever and respiratory distress. Although broad-spectrum antibiotic therapy had initially been administered, the patient had clinically deteriorated. Serology and molecular blood testing established CMV infection and viremia. Computed tomography of the chest demonstrated pneumonitis and she was successfully treated with a 3-week administration of ganciclovir. In β-thalassemia patients who undergo splenectomy necessitating multiple blood transfusions, CMV infection should be considered as a differential diagnosis.
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Affiliation(s)
| | - Petros Ioannou
- Department of Internal Medicine, University Hospital of Heraklion
| | - John A Papadakis
- Department of Internal Medicine, University Hospital of Heraklion
| | | | - Achilleas Gikas
- Department of Internal Medicine, University Hospital of Heraklion
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16
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Velegraki M, Ioannou P, Theodorakopoulou V, Papadakis JA. A case of pheochromocytoma crisis simulating acute coronary syndrome and multiple organ dysfunction syndrome. Hellenic J Cardiol 2018; 59:370-372. [PMID: 29452308 DOI: 10.1016/j.hjc.2018.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/22/2018] [Accepted: 01/27/2018] [Indexed: 10/18/2022] Open
Affiliation(s)
- Magdalini Velegraki
- Hypertension Unit (ESH Excellence Centre), Internal Medicine Department, University Hospital of Heraklion, Stavrakia and Voutes, Heraklion, Crete, Greece.
| | - Petros Ioannou
- Hypertension Unit (ESH Excellence Centre), Internal Medicine Department, University Hospital of Heraklion, Stavrakia and Voutes, Heraklion, Crete, Greece.
| | - Vasiliki Theodorakopoulou
- Hypertension Unit (ESH Excellence Centre), Internal Medicine Department, University Hospital of Heraklion, Stavrakia and Voutes, Heraklion, Crete, Greece.
| | - John A Papadakis
- Hypertension Unit (ESH Excellence Centre), Internal Medicine Department, University Hospital of Heraklion, Stavrakia and Voutes, Heraklion, Crete, Greece.
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17
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Ioannou P, Tsagkaraki E, Andrianaki AM, Papadakis JA. Unnecessary hospitalizations for DVT in the era of NOACs. Eur J Intern Med 2017; 44:e40-e41. [PMID: 28739351 DOI: 10.1016/j.ejim.2017.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/11/2017] [Accepted: 07/17/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Petros Ioannou
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece.
| | - Emmanouela Tsagkaraki
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece.
| | - Aggeliki M Andrianaki
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece.
| | - John A Papadakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece.
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18
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Marketou ME, Kontaraki JE, Papadakis JA, Vrentzos GE, Patrianakos A, Fragkiadakis K, Tsiverdis P, Lempidakis D, Chlouverakis G, Vardas PE, Parthenakis FI. Increased platelet alpha 2B-adrenergic receptor gene expression in well-controlled hypertensives: the effect of arterial stiffness. ACTA ACUST UNITED AC 2017; 11:762-768. [PMID: 28923554 DOI: 10.1016/j.jash.2017.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/07/2017] [Accepted: 08/18/2017] [Indexed: 11/16/2022]
Abstract
Catecholamines play a major role in atherothrombotic mechanisms in essential hypertension. Alpha2B-adrenergic receptors (α2B-ARs) are implicated in the pathophysiology of platelet aggregation. In this study, we evaluated platelet α2B-AR gene expression levels in patients with well-controlled essential hypertension compared with normal individuals and investigated their association with increased arterial stiffness. Fifty-nine patients with well-controlled essential hypertension (34 men, mean age 65 ± 9 years) and 26 normotensives (19 men, mean age 64 ± 8 years) were included in the study. For each patient, carotid-femoral pulse wave velocity (PWV) and carotid-radial PWV were evaluated. In addition, blood samples were obtained and platelets were isolated. The α2B-AR gene expression levels in platelets were examined by real-time polymerase chain reaction for each participant. Well-controlled hypertensive patients showed significantly higher gene expression levels of α2B-Rs in platelets compared with normotensives (34.7 ± 29.5 vs 17.6 ± 12.5, respectively, P = .005). Interestingly, we found that carotid-femoral PWV and carotid-radial PWV were positively correlated with platelet α2B-R gene expression levels (r = 0.59, P < .001, and r = 0.39, P = .002, respectively).Platelet α2B-R gene expression levels are increased in patients with well-controlled essential hypertension compared with normotensives and are correlated with increased PWV in those patients. Our data indicate an association of arterial stiffness and platelet α2B-Rs gene expression and indicate the need for further research.
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Affiliation(s)
- Maria E Marketou
- Department of Cardiology, Heraklion University Hospital, Heraklion, Crete, Greece.
| | - Joanna E Kontaraki
- Division of Biostatistics, Department of Social Medicine, Molecular Cardiology Laboratory, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - John A Papadakis
- Department of Internal Medicine, Heraklion University Hospital, Crete, Heraklion, Crete, Greece
| | - George E Vrentzos
- Department of Internal Medicine, Heraklion University Hospital, Crete, Heraklion, Crete, Greece
| | | | | | - Panagiotis Tsiverdis
- Department of Cardiology, Heraklion University Hospital, Heraklion, Crete, Greece
| | - Dimitris Lempidakis
- Department of Cardiology, Heraklion University Hospital, Heraklion, Crete, Greece
| | - Gregory Chlouverakis
- Division of Biostatistics, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Panos E Vardas
- Department of Cardiology, Heraklion University Hospital, Heraklion, Crete, Greece
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19
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Papakonstantinou PE, Theodoraki E, Koulentaki M, Papadakis JA. New-onset severe hypercholesterolemia in a patient with cholestatic liver disease. Should we treat the lipids? Hellenic J Cardiol 2017; 58:300-302. [DOI: 10.1016/j.hjc.2016.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/12/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022] Open
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20
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Kofteridis DP, Giourgouli G, Plataki MN, Andrianaki AM, Maraki S, Papadakis JA, Zacharioudaki ME, Samonis G. Community-Acquired Pneumonia in Elderly Adults with Type 2 Diabetes Mellitus. J Am Geriatr Soc 2016; 64:649-51. [PMID: 27000342 DOI: 10.1111/jgs.14011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Diamantis P Kofteridis
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece
| | - Giannoula Giourgouli
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece
| | - Marina N Plataki
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece
| | - Angeliki M Andrianaki
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece
| | - Sofia Maraki
- Department of Clinical Microbiology, University Hospital of Heraklion, Crete, Greece
| | - John A Papadakis
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece
| | - Maria E Zacharioudaki
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece
| | - George Samonis
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece
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21
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Ganotakis ES, Gazi IF, Papadakis JA, Jagroop IA, Nair DR, Mikhailidis DP. The Relationship Between Circulating Fibrinogen and Lipoprotein (a) Levels in Patients With Primary Dyslipidemia. Clin Appl Thromb Hemost 2016; 13:35-42. [PMID: 17164494 DOI: 10.1177/1076029606296256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The correlation between 2 predictors of vascular events, plasma fibrinogen and serum lipoprotein (a), was evaluated in patients referred to a specialist clinic because of primary hyperlipidemia. A significant correlation existed between fibrinogen and lipoprotein (a) in nonsmokers but not in smokers. Plasma fibrinogen concentration correlated positively and significantly with serum lipoprotein (a) levels in men nonsmokers without cardiovascular disease and in women nonsmokers with cardiovascular disease. Nonsmoker women without cardiovascular disease had significantly higher plasma fibrinogen (3.63 g/L versus 3.07 g/L, P < .0001) than the corresponding men. Nonsmoker women with and without cardiovascular disease had significantly higher lipoprotein (a) levels than the corresponding groups of men (0.36 versus 0.18 g/L; P = .0015 and 0.40 versus 0.26 g/L; P = .008), respectively. The relationship between fibrinogen and lipoprotein (a) levels alters markedly depending on the population selected. This relationship is influenced by gender, the presence of cardiovascular disease and smoking status.
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Affiliation(s)
- Emmanuel S Ganotakis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Hampstead NHS Trust and Royal Free and University College Medical School, London, United Kingdom
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Charalampakis V, Daskalakis M, Bertsias G, Papadakis JA, Melissas J. Validation of the Greek Translation of the Obesity-Specific Moorehead–Ardelt Quality-of-Life Questionnaire II. Obes Surg 2012; 22:690-6. [PMID: 22411571 DOI: 10.1007/s11695-012-0628-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Vasileios Charalampakis
- Bariatric Unit, Department of Surgical Oncology, Heraklion University Hospital, University of Crete, 164 Erythreas St, 71409 Heraklion, Crete, Greece
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Lioudaki E, Vrentzos GE, Mavrogeni H, Zeniodi MH, Ganotakis ES, Mikhailidis DP, Papadakis JA. Prevalence of Metabolic Syndrome According to Different Definitions in a Hypertensive Population. Angiology 2011; 63:39-47. [DOI: 10.1177/0003319711407303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Aims: The metabolic syndrome (MetS) is associated with increased risk of cardiovascular disease (CVD) and diabetes mellitus (DM). Several definitions of MetS have been proposed. The aim of the present study was to estimate and compare the prevalence of MetS according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), American Heart Association-National Heart Lung and Blood Institute (AHA-NHLBI), International Diabetes Federation (IDF) and the more recent Joint Interim Statement (JIS) definitions in patients attending a hypertension clinic. Methods: The records of patients referred to the hypertension clinic at the University Hospital (Heraklion, Crete) from January 2001 to June 2009 were screened retrospectively. A total 384 patients (146 men) were included in the study. Results: The prevalence of MetS according to the IDF and JIS definitions was significantly higher compared with that of the NCEP ATP III in both genders (IDF: P = .009 and P = .002, JIS: P = .002 and P = 0.001 for men and women, respectively); this was the case for the AHA-NHLBI definition only among women ( P = .03). All MetS components differed significantly ( P from < .0001 to .02) between patients with and without MetS for all definitions. Conclusions: The prevalence of MetS varies considerably depending on the definition used in a hypertensive population in a Mediterranean country. These differences will influence risk assessment.
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Affiliation(s)
- Eirini Lioudaki
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
- Department of Internal Medicine, University of Crete and School of Medicine, Heraklion, Crete, Greece
| | - George E. Vrentzos
- Department of Internal Medicine, University of Crete and School of Medicine, Heraklion, Crete, Greece
| | - Helen Mavrogeni
- Department of Internal Medicine, University of Crete and School of Medicine, Heraklion, Crete, Greece
| | - Maria-Helen Zeniodi
- Department of Internal Medicine, University of Crete and School of Medicine, Heraklion, Crete, Greece
| | - Emmanuel S. Ganotakis
- Department of Internal Medicine, University of Crete and School of Medicine, Heraklion, Crete, Greece
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
| | - John A. Papadakis
- Department of Internal Medicine, University of Crete and School of Medicine, Heraklion, Crete, Greece
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Kourbeti IS, Papadakis JA, Neophytou C, Filippou M, Ioannou A, Karabetsos DA, Bertsias G, Anastasaki M, Vakis AF. Infections in patients with traumatic brain injury who undergo neurosurgery. Br J Neurosurg 2010; 25:9-15. [DOI: 10.3109/02688697.2010.500411] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Kofteridis DP, Papadimitraki E, Mantadakis E, Maraki S, Papadakis JA, Tzifa G, Samonis G. Effect of Diabetes Mellitus on the Clinical and Microbiological Features of Hospitalized Elderly Patients with Acute Pyelonephritis. J Am Geriatr Soc 2009; 57:2125-8. [DOI: 10.1111/j.1532-5415.2009.02550.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Kofteridis DP, Christofaki M, Mantadakis E, Maraki S, Drygiannakis I, Papadakis JA, Samonis G. Bacteremic community-acquired pneumonia due to Pasteurella multocida. Int J Infect Dis 2009; 13:e81-3. [DOI: 10.1016/j.ijid.2008.06.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 06/10/2008] [Indexed: 10/21/2022] Open
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Papadakis JA, Sidiropoulos PI, Karvounaris SA, Vrentzos GE, Spanakis EK, Ganotakis ES, Kritikos HD, Mikhailidis DP, Boumpas DT. High prevalence of metabolic syndrome and cardiovascular risk factors in men with ankylosing spondylitis on anti-TNFalpha treatment: correlation with disease activity. Clin Exp Rheumatol 2009; 27:292-298. [PMID: 19473571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Ankylosing spondylitis (AS) may be associated with an increased risk for cardiovascular diseases (CVD). We investigated the prevalence of cardiovascular risk factors and metabolic syndrome (MetS) in men with AS and assessed any correlation with AS-related factors. METHODS This was a cross-sectional study of 63 men with AS, median age 40 (19-69) years, and 126 age-matched controls. Patients were on anti-TNFalpha treatment because of considerable disease activity at some time during the course of the disease. MetS was assessed according to the modified National Cholesterol Education Program Adult Treatment Panel III criteria. The risk for CVD event within the next 10 years was estimated using the Framingham equation. RESULTS Patients had lower high-density lipoprotein cholesterol (HDL-C) (p<0.001), higher systolic (p=0.001) and diastolic (p<0.01) blood pressure compared with controls. The prevalence of the MetS was higher in patients compared to controls (34.9% vs. 19.0%; p<0.05). AS patients with MetS were older (p<0.01), with higher Framingham risk score (p=0.001), had longer disease duration (p<0.05) and higher BASDAI (5.1 vs. 3.7; p<0.05) than those without MetS, while both BASFI and CRP had an inverse correlation with HDL-C levels. CONCLUSIONS Men with AS have a higher prevalence of cardiovascular risk factors and MetS compared with controls. The presence of MetS was associated with increased 10 year CVD risk in these patients. The association of AS disease activity with MetS suggests that CVD in AS patients may, at least in part, be attributed to the inflammatory burden of the disease.
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Affiliation(s)
- J A Papadakis
- Department of Internal Medicine, Clinical Immunology and Allergy, University Hospital, Heraklion, Greece
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Melissas J, Daskalakis M, Koukouraki S, Askoxylakis I, Metaxari M, Dimitriadis E, Stathaki M, Papadakis JA. Sleeve gastrectomy-a "food limiting" operation. Obes Surg 2008; 18:1251-6. [PMID: 18663545 DOI: 10.1007/s11695-008-9634-4] [Citation(s) in RCA: 184] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Accepted: 06/30/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG), which, thus far, is showing good resolution of comorbidities and good weight loss, shows increasing popularity among bariatric surgeons. The aim of this study was to evaluate clinical outcome and the gastric emptying of solid foods, 24 months after SG. METHODS Fourteen morbidly obese patients, four males and ten females, median age 41 years (range 29-65), median body mass index (BMI) 49.46 kg/m(2) (range 41.14-55.63), who underwent SG for weight loss, were studied prospectively. Nine patients underwent gastric emptying studies, using radioisotopic technique before, 6 months and 24 months after the operation. The remaining five patients underwent gastric emptying studies, 6 months and 24 months after the operation. RESULTS A significant reduction in patients' weight and BMI was evident at 6, 12 and 24 months postoperatively. In the nine patients who underwent gastric emptying studies pre-, 6 and 24 months postoperatively, the T-lag phase duration significantly decreased, following the SG, from 17.30 (range 15.50-20.90) min, to 12.50 (range 9.20-18.00) min at 6 months and 12.16 (range 10.90-20.00) min at 24 months postoperatively (P < 0.05). The gastric emptying half time (T1/2) accelerated significantly postoperatively from 86.50 (range 77.50-104.60) min, to 62.50 (range 46.30-80.00) min at 6 months and 60.80 (range 54.80-100.00) min at 24 months after SG (P < 0.05). The percentage of gastric emptying (%GE) increased significantly postoperatively, from 52 (range 43-58) % to 72 (range 57-97) % at 6 months and 74 (range 45-82) % at 24 months, following SG (P < 0.05). No differences in gastric emptying were observed, when values at 24 months were compared to those at 6 months postoperatively. When the whole group of 14 patients was studied, there were also no significant changes in T-lag, T1/2 and %GE between 6 and 24 months postoperatively. CONCLUSIONS Our study indicates the constant effect of SG in the acceleration of gastric emptying of solids, which occurs faster, not only in short but also in long-term postoperatively. Such effects on gastric motility, in combination with the reported alterations in gut hormones, may explain how this 'food limiting' operation results in weight loss.
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Affiliation(s)
- John Melissas
- Bariatric Unit Department of Surgical Oncology, Heraklion University Hospital, Medical School, University of Crete, 15 Delaporta St., Herarklion 71409, Crete, Greece.
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Vrentzos GE, Papadakis JA, Ganotakis ES, Paraskevas KI, Gazi IF, Tzanakis N, Nair DR, Mikhailidis DP. Predicting coronary heart disease risk using the Framingham and PROCAM equations in dyslipidaemic patients without overt vascular disease. Int J Clin Pract 2007; 61:1643-53. [PMID: 17877651 DOI: 10.1111/j.1742-1241.2007.01527.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIM To compare the Framingham and Prospective Cardiovascular Munster (PROCAM) risk calculations. METHODS We calculated the risk in 234 dyslipidaemic patients without overt vascular disease and in different subgroups. For example, the proportion of patients with coronary heart disease (CHD) risk >or= 20%, the effect of including the family history (FaHist) and of adjusting raised triglyceride (TG) levels. RESULTS The Framingham risk was significantly (p < 0.0001) higher than the PROCAM risk (with and without including the FaHist) in different subgroups and when the TGs were adjusted to 1.7 mmol/l. The percentage of patients with CHD risk >or= 20% calculated by the Framingham (based on systolic or diastolic blood pressure) and PROCAM equations was 21.4% or 23.1% and 16.2% respectively. In the tertile with the highest PROCAM risk, the Framingham score was significantly greater than the PROCAM risk only when the FaHist was included in the Framingham calculation. When we analysed risk by gender, the Framingham score did not differ but the PROCAM risk was significantly (p < 0.0001) greater in men. When TG values were adjusted to 1.7 mmol/l, the predicted risk using PROCAM changed by 0% to -2% in all subgroups. CONCLUSIONS In dyslipidaemic patients without overt vascular disease the Framingham model predicted a higher risk than PROCAM. Thus, the Framingham equation probably leads to substantial overtreatment compared with PROCAM. However, according to the literature, even the PROCAM equation may overestimate risk. This has considerable cost implications. New more accurate risk engines are needed to calculate risk in dyslipidaemic patients without overt vascular disease.
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Affiliation(s)
- G E Vrentzos
- Department of Clinical Biochemistry, Vascular Disease Prevention Clinic, Royal Free Hospital and Royal Free University College Medical School, London, UK
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Mazokopakis EE, Papadakis JA, Papadomanolaki MG, Batistakis AG, Giannakopoulos TG, Protopapadakis EE, Ganotakis ES. Effects of 12 months treatment with L-selenomethionine on serum anti-TPO Levels in Patients with Hashimoto's thyroiditis. Thyroid 2007; 17:609-12. [PMID: 17696828 DOI: 10.1089/thy.2007.0040] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We studied the effects of selenium (Se) treatment on serum anti-thyroid peroxidase (TPO) levels in Greek patients with Hashimoto's thyroiditis (HT). DESIGN We prospectively studied 80 women with HT, median age 37 (range 24-52) years, for 1 year. All patients received 200 microg Se in the form of l-selenomethionine orally for 6 months. At the end of the 6-month period, 40 patients continued taking 200 microg Se (Group A) and 40 patients stopped (Group B). Serum thyrotropin (TSH), free triiodothyronine (FT(3)), free thyroxine (FT(4)), anti-TPO, and anti-thyroglobulin (Tg) levels were measured at baseline and at the end of each 3-month period. MAIN OUTCOME There was a significant reduction of serum anti-TPO levels during the first 6 months (by 5.6% and 9.9% at 3 and 6 months, respectively). An overall reduction of 21% (p < 0.0001) compared with the basal values was noted in Group A. In Group B, serum anti-TPO levels were increased by 4.8% (p < 0.0001) during the second 6-month period. CONCLUSIONS Our study showed that in HT patients 6 months of Se treatment caused a significant decrease in serum anti-TPO levels, which was more profound in the second trimester. The extension of Se supplementation for 6 more months resulted in an additional 8% decrease, while the cessation caused a 4.8% increase, in the anti-TPO concentrations.
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Affiliation(s)
- Elias E Mazokopakis
- Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece.
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Ganotakis ES, Vrentzos GE, Gazi IF, Papadakis JA, Jagroop A, Paraskevas KI, Nair DR, Mikhailidis DP. Fibrinogen, lipoprotein (a), albumin and bilirubin (F-L-A-B) levels and cardiovascular risk calculated using the Framingham equation. In Vivo 2007; 21:685-94. [PMID: 17708367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVES To determine the correlation between cardiovascular risk calculated using the Framingham equation and the circulating levels of 4 'emerging'predictors of vascular events: fibrinogen (Fib), lipoprotein (a) (Lp(a)), albumin (Alb) and bilirubin (Bil) (F-L-A-B). PATIENTS AND METHODS A retrospective survey was carried out using patients referred to a specialist university-based clinic. A total of 376 patients with primary dyslipidaemia (209 men), without overt vascular disease, had their cardiovascular risk estimated using the Framingham equation. RESULTS Among the men, smokers (n=45) were significantly younger (p =0.014) than non-smokers (n=164). Smokers when compared with non-smokers had significantly higher median Fib levels (3.84 (1.15-5.87) vs. 3.08 (1.44-5.47) g/l; p<0.0001) and lower median Bil levels (8 (3-17) vs. 10 (1-28) micromol/l; p=0.016). When non-smoker men without clinically evident vascular disease were considered, there was a significant positive Fib and negative Alb correlation with calculated risk, whether the family history was considered or not. Moreover in smokers, the only significant correlation was a negative one between Bil and cardiovascular disease risk. Lp(a) correlated with risk for stroke in women non-smokers whether the family history was considered or not, while Alb correlated with risk for stroke in women non-smokers without family history. CONCLUSION Fib, Lp(a), Alb and Bil (F-L-A-B) may be predictors of vascular events in high-risk populations. Prospective studies should evaluate whether the F-L-A-B markers are useful in the assessment of cardiovascular risk load. Such an advantage would make treatment more cost effective by improving patient targeting. The F-L-A-B markers could eventually become targets for new drugs.
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Affiliation(s)
- Emmanuel S Ganotakis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinic), Royal Free Hospital and Royal Free University College Medical School, London NW3 2QG, UK
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Abstract
We report five cases with unusual causes of intrahepatic cholestasis, including consumption of Teucrium polium (family Lamiaceae) in the form of tea, Stauffer’s syndrome, treatment with tamoxifen citrate for breast cancer, infection with Coxiella Burnetii (acute Q fever), and infection with Brucella melitensis (acute brucellosis).
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Affiliation(s)
- Elias E Mazokopakis
- Department of Internal Medicine, University Hospital of Heraklion Crete, Iroon Polytechniu 38A, Chania 73 132, Crete, Greece.
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Vrentzos GE, Papadakis JA, Malliaraki N, Zacharis EA, Mazokopakis E, Margioris A, Ganotakis ES, Kafatos A. Diet, serum homocysteine levels and ischaemic heart disease in a Mediterranean population. Br J Nutr 2007; 91:1013-9. [PMID: 15182405 DOI: 10.1079/bjn20041145] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Homocysteine (Hcy) is recognised as a risk factor for IHD. Serum Hcy is negatively correlated with serum folate levels, the main sources of which are fruits, vegetables and legumes. The present case–control study was designed to examine the relationship between serum Hcy levels and IHD and to assess the role of dietary factors in the southern Mediterranean population of Crete, Greece. Serum Hcy, folate, vitamin B12, creatinine and glucose levels and a full lipid profile were measured in 152 patients with established IHD, median age 64 (range 33–77) years, and 152 healthy control subjects, age- and sex-matched. Dietary data were assessed using a 3 d food intake record. Compared with controls, patients with IHD had significantly higher daily intakes of vitamin B12and MUFA and significantly lower intakes of carbohydrate, fibre, folate, cholesterol,n-3 fatty acids and totaltransunsaturated fatty acids. Moreover, patients had significantly higher serum Hcy, vitamin B12and creatinine levels, but significantly lower folate. Serum folate concentrations in both groups had a significant positive correlation with dietary fibre consumption and a significant inverse correlation with vitamin B12intake. IHD patients should be encouraged to increase their daily dietary intake of fibre, folate andn-3 fatty acids, which are significant components of the traditional Cretan Mediterranean diet. Where dietary folate intake is inadequate, folate supplements are recommended to reduce elevated Hcy levels.
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Affiliation(s)
- George E Vrentzos
- Department of Internal Medicine, University Hospital of Crete, Crete, Greece
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Melissas J, Mouzas J, Filis D, Daskalakis M, Matrella E, Papadakis JA, Sevrisarianos N, Charalambides D. The intragastric balloon - smoothing the path to bariatric surgery. Obes Surg 2006; 16:897-902. [PMID: 16839490 DOI: 10.1381/096089206777822188] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Intragastric balloon placement in association with diet for weight reduction is steadily gaining popularity. However, long-term follow-up studies on the effect of this method in maintaining weight loss are lacking. This study evaluated the long-term outcome following balloon removal in morbidly obese patients who had selected this method for weight loss. METHODS 140 morbidly obese patients who refused bariatric surgery because of fear of complications and mortality, underwent intragastric balloon placement and were followed over a 6- to 30-month period (mean 18.3 months) after balloon extraction. The 34 males and 106 females, with median age 38 years (range 16-62), median weight 122 kg (range 85-203), median BMI 42.3 kg/m(2) (range 35-61.3) and median excess weight (EW) 59 kg (range 29-132), received a Bioenterics Intragastric Balloon (BIB). Excess weight loss (EWL) > or =25% when the BIB was removed was considered a success. Weight fluctuations and any further interventional therapy requested by the patients after balloon removal were recorded. RESULTS 100 patients (71.4%) lost > or =25% of their EW on balloon extraction and were categorized as successes, while 40 patients (28.6%) did not achieve that weight loss and were categorized as failures of the method. During the follow-up period, 44 of the originally successful patients (31.4%) regained weight and were categorized as recurrences, while the remaining 56 patients (40%) maintained their EWL of > or =25% and were considered long-term successes. During follow-up, 45 patients (32.1%) requested and underwent bariatric surgery for their morbid obesity (21 Adjustable Gastric Band, 11 Laparoscopic Sleeve Gastrectomy, 13 Laparoscopic Gastric Bypass). Of these, 13 (32.5%) were from the group of 40 patients categorized as failures on BIB removal, 28 (63.6%) were from the group of 44 patients whose obesity recurred, and 4 (7.1%) were from the 56 patents who although they maintained successful weight loss requested further weight reduction. CONCLUSIONS The BIB served as a first step and a smooth introduction to bariatric surgery for morbidly obese patients who initially refused surgical intervention. The incidence of surgical intervention was double in patients who initially experienced the benefits of weight loss and then had obesity recurrence, compared with patients in whom the method failed. Indeed, a significant number of patients were assisted in their efforts to lose and maintain an acceptable weight loss over a 6- to 30-month follow-up period.
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Affiliation(s)
- John Melissas
- Bariatric Unit, Department of Surgical Oncology, Heraklion University Hospital, Crete, Greece.
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Vrentzos GE, Papadakis JA, Malliaraki N, Bampalis DE, Repa A, Lemonomichelaki V, Petinellis EG, Ganotakis ES. Serum homocysteine concentration as a marker of nutritional status of healthy subjects in Crete, Greece. J Hum Nutr Diet 2006; 19:117-23. [PMID: 16533373 DOI: 10.1111/j.1365-277x.2006.00678.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dietary habits are an important determinant of serum homocysteine (tHcy), which may be a marker rather than a cause of progression of the atherosclerotic process. The aim of the present study was to evaluate the nutritional status, and to determine the serum tHcy concentrations in healthy subjects who live in rural areas of Crete, and who theoretically follow a contemporary Mediterranean-style diet. METHODS Serum tHcy, folate, vitamin B(12), creatinine, glucose, and the lipid profile, were measured in 203 (141 men and 62 women) healthy subjects, aged 33-78 years. The major risk factors for cardiovascular disease such as age, gender, cigarette smoking, obesity were recorded and dietary data were assessed using a 3-day weighed food intake record. RESULTS Our population had high serum tHcy, low serum folate concentrations and lower than the traditional Cretan dietary folate intake [median (range): 12.0 (3.6-44.7) micromol L(-1), 7.9 (1.9-15.5) ng mL(-1) and 241 (68-1106) microg, respectively]. Dietary intake of fibre, omega-3, and mono- or/ polyunsaturated fatty acids was also low. An inverse relation was observed between serum tHcy concentrations and serum folate (r = -0.28; P < 0.01) and vitamin B(12) levels (r = -0.33; P < 0.001). CONCLUSIONS Nowadays, the Cretan diet has changed towards a more westernized eating pattern. Given the analytic difficulties in determining the amount of folate in food and the inverse correlation between serum tHcy and folate levels, serum tHcy concentrations may be a useful marker for nutritional status, especially folate deficiency, in healthy subjects.
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Affiliation(s)
- G E Vrentzos
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
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Mazokopakis EE, Starakis IK, Papadomanolaki MG, Batistakis AG, Papadakis JA. Changes of bone mineral density in pre-menopausal women with differentiated thyroid cancer receiving L-thyroxine suppressive therapy. Curr Med Res Opin 2006; 22:1369-73. [PMID: 16834835 DOI: 10.1185/030079906x115612] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We studied the effect of levothyroxine (L-T(4)) suppressive therapy on bone mineral density (BMD) in pre-menopausal women with total thyroidectomy and radioactive iodine ((131)I) ablation therapy post-operatively for differentiated thyroid cancer (DTC). PATIENTS AND METHODS We prospectively studied 26 athyroid pre-menopausal women (median age 39 years, range 28-48 years) receiving suppressive L-T(4) therapy postoperatively for 48 months. BMD was measured by dual energy X-ray absorptiometry (DEXA) at the femoral neck, femoral trochanter and Ward's triangle, before (basal) and during (12th and 48th month) the follow-up period. None of the women gave a medical history that could possibly affect bone metabolism. Patients were free of thyroid cancer in clinical and laboratory examinations at the time of the study. Paired t-test was used for comparisons among BMD measurements during the suppressive therapy. RESULTS There were statistically significant decreases of BMD at all measured regions during (12th and 48th month) L-T(4) suppressive therapy. The overall decreases in BMD at the femoral neck, femoral trochanter and Ward's triangle were 7.5%, 10.9% and 3.4%, respectively, at the end of the follow-up period. The coefficient of variation (CV) of all BMD measurements was around 10%, showing a rather homogenous group of patients. Our patients had a statistically significant decrease in their body mass index (BMI) and weight at the end of the follow-up period. However, there was no significant correlation between the decrease in BMI and BMD. Patients did not experience significant adverse effects from L-T(4) suppressive therapy during the study. CONCLUSION L-T(4) suppressive therapy for at least 1 year in pre-menopausal women with DTC causes a reduction in BMD of the femoral neck, femoral trochanter and Ward's triangle.
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Affiliation(s)
- Elias E Mazokopakis
- Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece.
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Karvounaris SA, Sidiropoulos PI, Papadakis JA, Spanakis EK, Bertsias GK, Kritikos HD, Ganotakis ES, Boumpas DT. Metabolic syndrome is common among middle-to-older aged Mediterranean patients with rheumatoid arthritis and correlates with disease activity: a retrospective, cross-sectional, controlled, study. Ann Rheum Dis 2006; 66:28-33. [PMID: 16793841 PMCID: PMC1798406 DOI: 10.1136/ard.2006.053488] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Patients with rheumatoid arthritis have an increased risk for cardiovascular disease (CVD). The prevalence of metabolic syndrome (MetS)-a major contributor to CVD-in a cohort of patients with rheumatoid arthritis and its relationship with rheumatoid arthritis related factors is investigated here. METHODS 200 outpatients with rheumatoid arthritis (147 women and 53 men), with a mean (standard deviation (SD)) age of 63 (11) years, and 400 age and sex-matched controls were studied. MetS was assessed according to the adult treatment panel III criteria and rheumatoid arthritis disease activity by the disease activity score of 28 joints (DAS28). A standard clinical evaluation was carried out, and a health and lifestyle questionnaire was completed. RESULTS The overall prevalence of MetS was 44% in patients with rheumatoid arthritis and 41% in controls (p = 0.5). Patients with rheumatoid arthritis were more likely to have low high-density lipoprotein cholesterol compared with controls (p = 0.02), whereas controls were more likely to have increased waist circumference or raised blood pressure (p = 0.001 and 0.003, respectively). In multivariate logistic regression analysis adjusting for demographics and rheumatoid arthritis treatment modalities, the risk of having moderate-to-high disease activity (DAS28>3.2) was significantly higher in patients with MetS compared with those with no MetS components (OR 9.24, 95% CI 1.49 to 57.2, p = 0.016). CONCLUSION A high, albeit comparable to the control population, prevalence of MetS was found in middle-to-older aged patients with rheumatoid arthritis. The correlation of rheumatoid arthritis disease activity with MetS suggests that the increased prevalence of coronary heart disease in patients with rheumatoid arthritis may, at least in part, be attributed to the inflammatory burden of the disease.
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Affiliation(s)
- S A Karvounaris
- Division of Rheumatology, Clinical Immunology and Allergy, University of Crete, Medical School, Voutes 71500, Heraklion, Greece
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Melissas J, Malliaraki N, Papadakis JA, Taflampas P, Kampa M, Castanas E. Plasma antioxidant capacity in morbidly obese patients before and after weight loss. Obes Surg 2006; 16:314-20. [PMID: 16545163 DOI: 10.1381/096089206776116444] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Oxidative stress may play a critical role in the pathogenesis and development of obesity-associated co-morbidities. Reactive oxygen and nitrogen species are produced as a consequence of normal aerobic metabolism and removed and/or inactivated in vivo by both endogenous (uric acid, bilirubin, thiols) and diet-derived (exogenous) antioxidants. The purpose of this study is to measure the total plasma antioxidant capacity (TAC), as well as the corrected TAC (cTAC, an index of exogenous provided antioxidants) in morbidly obese patients before and after surgical weight reduction. METHODS 16 morbidly obese (5 male and 11 female) candidates for surgical intervention, median age 34 (range 22-56) years, median weight 128 (range 96-186) kg, median excess weight 62 (range 28-115) kg and median BMI 44.4 (range 33.7-60.1) kg/m2 were evaluated before and 6 months after implantation of an intragastric balloon. 15 healthy blood donors (4 male and 11 female) on a normal diet, median age 35 (range 21-52) years, median weight 64.3 (range 46-78) kg and median BMI 24.2 (range 23.7-25.2) kg/m2 were also evaluated. Blood samples for routine clinical chemistry, TAC and cTAC determination were drawn, and weight and BMI calculation were performed once in the control group, and in the morbidly obese patients (MO) before and 6 months after the balloon implantation. RESULTS 6 months after balloon placement, weight and BMI of the MO patients were statistically significantly reduced from the preoperative values (P<0.001). Plasma TAC and cTAC values in the MO group were significantly lower preoperatively, compared to the control group (P<0.05 and P<0.001 respectively). cTAC values in the MO patients increased significantly following weight loss (P<0.001) and were restored to normal. However, the postoperative TAC values in the MO group did not change significantly and remained lower than in the normal controls. A significant decrease (P<0.001) in uric acid values was also noticed in the MO group after weight loss. CONCLUSION Plasma TAC and cTAC values are impaired in morbidly obese patients. Weight loss from an intragastric balloon is associated with significant increase in plasma cTAC values. Plasma TAC values, after the weight loss remain unchanged, possibly due to a decrease in uric acid, an important endogenous antioxidant.
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Affiliation(s)
- John Melissas
- Bariatric Unit, Department of Surgical Oncology, University of Crete, Heraklion, Crete, Greece.
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Samonis G, Kofteridis DP, Maraki S, Alegakis D, Mantadakis E, Papadakis JA, Gikas AH, Falagas ME, Falagas M. Levofloxacin and moxifloxacin increase human gut colonization by Candida species. Antimicrob Agents Chemother 2006; 49:5189. [PMID: 16304202 PMCID: PMC1315982 DOI: 10.1128/aac.49.12.5189.2005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mazokopakis E, Kalikaki A, Stathopoulos E, Vrentzos G, Papadakis JA. Acute febrile neutrophilic dermatosis (Sweet's syndrome) with erythema nodosum and anterior scleritis. A case report. Int J Dermatol 2006; 44:1051-3. [PMID: 16409276 DOI: 10.1111/j.1365-4632.2004.02278.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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] [Indexed: 11/25/2022]
Affiliation(s)
- Elias Mazokopakis
- Division of Internal Medicine, University General Hospital of Heraklion, Crete, Greece.
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Papadakis JA, Mikhailidis DP, Vrentzos GE, Kalikaki A, Kazakou I, Ganotakis ES. Effect of antihypertensive treatment on plasma fibrinogen and serum HDL levels in patients with essential hypertension. Clin Appl Thromb Hemost 2005; 11:139-46. [PMID: 15821820 DOI: 10.1177/107602960501100203] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The influence of hypertension, and its treatment, on circulating lipid and fibrinogen (Fib) concentrations in patients with essential hypertension was investigated. The lipid profile and Fib levels were measured in 353 patients (131 men) with essential hypertension. Their median age was 60 years (range: 18-85 years). All patients had normal results from liver, renal, and thyroid function tests. There were 162 patients (45.9%) who were not receiving antihypertensive treatment. Of the remaining patients, 117 were taking 'lipid-hostile' beta-blockers, thiazide diuretics) antihypertensives and 74 were taking 'lipid-neutral' (angiotensin-converting enzyme inhibitors, calcium channel blockers, angiotensin-II receptor blockers) agents. Patients who were taking 'lipid-hostile' antihypertensive drugs had significantly higher plasma Fib concentrations when compared with those taking 'lipid-neutral' antihypertensives or those not receiving antihypertensive treatment. These differences were not attributable to established factors that influence plasma Fib levels, since when smokers and patients with diabetes mellitus and/or vascular disease were excluded, the difference remained significant. In addition, in these more homogeneous groups, patients receiving 'lipid-neutral' treatment had significantly higher serum high-density lipoprotein (HDL) cholesterol levels when compared with both those taking 'lipid-hostile' antihypertensives and untreated ones. There were no significant differences in the other lipid variables, independently of the presence/absence or the type of antihypertensives. These results suggest that antihypertensive drugs have additional effects, beyond lowering blood pressure, on other vascular risk factors, like Fib and HDL. These effects may depend on the type of drug used.
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Affiliation(s)
- John A Papadakis
- Department of Internal Medicine, University Hospital of Crete, Greece
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Mazokopakis EE, Kofteridis DP, Papadakis JA, Gikas AH, Samonis GJ. First case report of Streptococcus suis septicaemia and meningitis from Greece. Eur J Neurol 2005; 12:487-9. [PMID: 15885057 DOI: 10.1111/j.1468-1331.2005.00998.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mazokopakis EE, Papadakis JA, Papadomanolaki MG, Vrentzos GE, Ganotakis ES, Lionis CD. Overweight and obesity in Greek warship personnel: prevalence and correlations. Eur J Public Health 2005; 14:395-7. [PMID: 15542876 DOI: 10.1093/eurpub/14.4.395] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of obesity among the personnel of a Greek warship and to highlight the potential relationship of the body-mass index (BMI). METHODS Data on behavioural and demographic characteristics, among 274 men of a Greek warship, aged between 19 and 38 years, were analysed. RESULTS 26.5% of participants were overweight and 4.7% obese. BMI was correlated with age, and cigarette pack-years, and inverse correlated with the aerobic exercise. No significant associations were found between BMI and alcohol consumption. CONCLUSION A relatively high proportion of obesity was found in a Greek military population. Intervention and prevention measures should be targeted at the promotion of physical activity and the reduction of the smoking behaviour of personnel.
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Affiliation(s)
- Elias E Mazokopakis
- Department of Internal Medicine, School of Medicine, University of Crete, Greece
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Kofteridis DP, Papadakis JA, Bouros D, Nikolaides P, Kioumis G, Levidiotou S, Maltezos E, Kastanakis S, Kartali S, Gikas A. Nosocomial lower respiratory tract infections: prevalence and risk factors in 14 Greek hospitals. Eur J Clin Microbiol Infect Dis 2005; 23:888-91. [PMID: 15558346 DOI: 10.1007/s10096-004-1245-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nosocomial lower respiratory tract infections (NLRTIs) are associated with significant morbidity and mortality. The aim of this study was to investigate the epidemiological features of NLRTIs in Greece, where knowledge about these infections is limited. Two point-prevalence studies of hospital-acquired infections were carried out in 14 Greek hospitals located throughout the country, one in 1999 and one in 2000. NLRTIs were diagnosed in accordance with the Centers for Disease Control and Prevention (CDC) definitions. Among the 7,120 hospitalized patients registered during the two studies, 610 (8.6%) cases of hospital-acquired infections were identified, of which 200 (32.8%) were NLRTIs. Sixty-nine (34.5%) patients had pneumonia, and the remaining 131 (65.5%) patients had bronchitis. The greatest prevalence of NLRTI was found in the adult ICUs (30.4%). Male gender, age >65 years, mechanical ventilation, tracheostomy, an intravenous central line, and an indwelling urethral catheter were the main risk factors. There was no significant difference in the incidence of NLRTI among hospital-acquired infections between the 1999 study and the 2000 study. The causative microorganism was identified in 78 of 200 (39%) cases, and 103 strains were isolated. The majority of strains (67%) were gram-negative bacteria. The most frequently isolated microorganisms were Pseudomonas aeruginosa (22.3%), Acinetobacter spp. (19.4%), Klebsiella pneumoniae (12.6%), and Staphylococcus aureus (10.7%). There was no difference between the two prevalence studies in the frequency of isolation of the microorganisms. NLRTI was the leading cause of morbidity and mortality among hospitalized patients with hospital-acquired infections in Greek hospitals. Gram-negative microorganisms were the most frequently isolated pathogens.
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Affiliation(s)
- D P Kofteridis
- Department of Clinical Bacteriology, Parasitology, Zoonosis and Geographical Medicine, University Hospital of Heraklion, PO Box 1352, Heraklion, 71110, Crete, Greece
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Mazokopakis EE, Vrentzos GE, Papadakis JA, Babalis DE, Ganotakis ES. Wild chamomile (Matricaria recutita L.) mouthwashes in methotrexate-induced oral mucositis. Phytomedicine 2005; 12:25-27. [PMID: 15693704 DOI: 10.1016/j.phymed.2003.11.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Oral mucositis is a known complication of methotrexate (MTX) therapy, but a single efficacious intervention or agent for prophylaxis or management of this side effect has not yet been identified. We report a case of MTX-induced oral mucositis in a patient with rheumatoid arthritis, who was successfully treated with Wild chamomile mouthwashes.
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Affiliation(s)
- E E Mazokopakis
- Department of Internal Medicine, University General Hospital of Heraklion Crete, P.O. Box 1352, 71110 Heraklion, Crete, Greece
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Vrentzos G, Papadakis JA, Malliaraki N, Zacharis EA, Katsogridakis K, Margioris AN, Vardas PE, Ganotakis ES. Association of serum total homocysteine with the extent of ischemic heart disease in a Mediterranean cohort. Angiology 2004; 55:517-24. [PMID: 15378114 DOI: 10.1177/000331970405500507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
High total homocysteine (tHcy) concentrations increase coronary disease risk. Therefore, the authors examined the relation between tHcy concentrations and the number of stenotic arteries in patients with ischemic heart disease (IHD). They enrolled 155 patients with IHD (135 men) who had undergone selective coronary angiography during the previous 2 years. These patients were divided into 4 groups according to the number of vessels (0, 1, 2, and 3) with > or = 70% stenosis. They also reviewed the major coronary risk factors for each patient (age, gender, hypertension, diabetes mellitus, dyslipidemia, cigarette smoking, obesity), and measured serum concentrations of tHcy, folate, vitamin B12 and lipids. There was a significant positive correlation (rs = 0.19; p = 0.017; n = 155) between tHcy serum concentration and the extent of coronary atherosclerosis, expressed by the number of coronary arteries with significant stenosis. Moreover, the number of affected vessels displayed a significant positive correlation with the presence of diabetes mellitus (rs = 0.30; p < 0.0001; n = 155) and serum concentrations of lipoprotein (a) (rs = 0.25; p < 0.05; n = 67) and a negative correlation with apolipoprotein A-I serum concentration (rs = -0.27; p < 0.01; n = 67). In this study, the serum concentrations of tHcy correlated with the extent of coronary atherosclerosis, independently of other classical risk factors, with the exception of diabetes mellitus.
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Affiliation(s)
- George Vrentzos
- Department of Internal Medicine, University Hospital of Crete, Greece
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Abstract
There is extensive trial-based evidence showing that antihypertensive drugs reduce the risk of vascular events (e.g. stroke and myocardial infarction) as well as target organ damage (e.g. left ventricular hypertrophy and microalbuminuria). However, some of these benefits appear to be, at least partially, independent of the extent of blood pressure (BP) lowering. It is also evident that in certain clinical situations some antihypertensive drugs are more effective than others. In this review we discuss the effects of antihypertensive drugs on the endothelium, platelets, fibrinolysis and coagulation. These properties may account for the observed BP-independent actions. Antihypertensive drugs exert multiple effects on the vascular endothelium. These include effects on nitric oxide (NO) and angiotensin II-mediated actions. Many BP lowering drugs can inhibit platelet activity, although the relevance of this property is unknown, especially if patients are also taking platelet inhibitors (e.g. aspirin). Antihypertensive drugs also influence fibrinolysis and coagulation. These effects may be mediated by a variety of mechanisms, including altering insulin sensitivity. The haemostatic actions of antihypertensive drugs deserve greater recognition and further investigation.
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Affiliation(s)
- E S Ganotakis
- Department of Internal Medicine, University of Crete, Greece
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Vrentzos GE, Papadakis JA, Vardakis KE, Maliaraki N, Stilianou K, Arvanitis A, Sratigis S, Alivanis P, Margioris AN, Ganotakis ES. Intravenous administration of vitamin B12 in the treatment of hyperhomocysteinemia associated with end-stage renal disease. J Nephrol 2003; 16:535-9. [PMID: 14696755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND High serum levels of total homocysteine (tHcy) are common in dialysis patients with end-stage renal disease (ESRD). We assumed that these patients may have decreased response to conventional folic acid (FOL) and vitamin B12 (B12) administered orally. This study aimed to evaluate the efficacy of an intravenous (i.v.) B12 regimen in ESRD patients and compare it with the conventional regimen. METHODS We designed an open label, crossover, non-randomized study of 72 ESRD patients. Our patients were hemodialyzed in two hospitals (HOSP1 and HOSP2). In HOSP1, patients were on 1 mg of FOL and 600 micog of B12 orally for 3 months, and then switching to 1 mg of B12 i.v. for 3 additional months, while the FOL dosage was constant. In HOSP2, patients received the same treatment in reverse. RESULTS Patients in HOSP1 (n = 37) after i.v. B12 treatment, had significantly lower tHcy (p < 0.001) and FOL (p < 0.05) serum levels, compared with those at the end of oral B12 treatment. On the contrary in HOSP2 patients, serum tHcy levels increased significantly (n = 35, p < 0.0001) when i.v. was switched to oral treatment. There was a significant inverse correlation between tHcy and B12 (p < 0.0001) at the end of the i.v. treatment period; while treatment there was no correlation between tHcy and FOL serum levels. At the end of the oral treatment period, there was no significant correlation between tHcy and B12 serum levels, while tHcy and FOL serum levels had a significant inverse correlation (p = 0.002). CONCLUSIONS Our results suggest that ESRD patients on dialysis have 'B12 resistance', and that they should have, in addition to their FOL therapeutic regimen, i.v. B12 treatment to reduce their elevated tHcy levels.
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Affiliation(s)
- George E Vrentzos
- Department of Internal Medicine, University Hospital of Crete, Crete, Greece
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Gikas A, Pediaditis J, Papadakis JA, Starakis J, Levidiotou S, Nikolaides P, Kioumis G, Maltezos E, Lazanas M, Anevlavis E, Roubelaki M, Tselentis Y. Prevalence study of hospital-acquired infections in 14 Greek hospitals: planning from the local to the national surveillance level. J Hosp Infect 2002; 50:269-75. [PMID: 12014899 DOI: 10.1053/jhin.2002.1181] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A prevalence study of hospital-acquired infections (HAI) was carried out in 14 of 112 Greek hospitals (15.7%), scattered throughout Greece. Five of seven Greek university hospitals and nine regional hospitals participated in the one-day study, and 3925 hospitalized patients (10.5% of the total hospital beds in Greece) were recorded. The aim of this project was to organize a surveillance of HAI with the participation of the greatest possible number of Greek hospitals, transferring the experience from the local Cretan infection control network in an effort to create a nationwide network. Special attention was paid to recruit all Greek university hospitals in our attempt to expand the study base. Co-ordination of the participating centres, education of the infection control teams on surveillance methods, preparation of agreed definitions, and elaboration of the protocol for the collection of the data were the major objectives of this study. The difficulties, however, were limited resources and the lack of skilled personnel. The overall prevalence of HAI was found to be 9.3%. The most common HAI recorded involved lower respiratory tract infections (30.3%), followed by urinary tract infections (22.7%), bloodstream infections (15.8%), and surgical site infections (14.8%). The greatest prevalence rate was found in the adult ICU (48.4%), followed by the neonatal ICU (30.3%). The duration of hospitalization, the number of operations, the total number of used devices and invasive procedures were significantly correlated with HAI. Positive cultures were found in 51.5% of the cases. The most frequently isolated micro-organisms were: Pseudomonas aeruginosa (16.6%), Escherichia coli (10.8%), Klebsiella pneumoniae (10.3%), Staphylococcus epidermidis (8.1%) and Staphylococcus aureus (7.6%). The administration of antibiotics was also recorded. The prevalence of antibiotic use was 51.4%.
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Affiliation(s)
- A Gikas
- Universiy Hospital of Heraklion, Greece.
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Krijgsman B, Papadakis JA, Ganotakis ES, Mikhailidis DP, Hamilton G. The effect of peripheral vascular disease on the serum levels of natural anti-oxidants: bilirubin and albumin. INT ANGIOL 2002; 21:44-52. [PMID: 11941273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Bilirubin and albumin may act as antioxidants. Their circulating levels are lower in those patients with ischemic heart disease (IHD) and could be further reduced by more extensive atherosclerosis, i.e. peripheral vascular disease (PVD). METHODS Serum bilirubin and albumin were measured in 456 patients classified into 3 groups: 1) no clinically evident cardiovascular disease (CVD), 2) IHD present and 3) PVD present. Smoking status and gender (which affect bilirubin and albumin levels in healthy individuals) were considered separately. RESULTS Bilirubin was lower in smoking men without CVD or with PVD than in non-smokers (p=0.02 and p=0.04, respectively) in the same groups. Non-smoking women without CVD had significantly (p=0.004) lower bilirubin levels than the corresponding group of men. Frequency analysis of male non-smokers revealed significantly (p=0.04) more patients with a lower bilirubin (<6.5 mmol/l) in the PVD compared with the no CVD group. Albumin levels showed the same trends. CONCLUSIONS Prospective studies should consider smoking and gender when assessing the relevance of bilirubin and/or albumin levels in patients with vascular disease. Our findings support those of other studies that show that low serum bilirubin and albumin levels are associated with the presence of vascular disease.
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Affiliation(s)
- B Krijgsman
- Department of Surgery at the Royal Free Campus, Royal Free and University College Medical School, University College London, London, UK
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