125 results on '"Charalambos Gogos"'
Search Results
2. Mapping frailty in people living with <scp>HIV</scp> : A nationwide study in Greece
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Dimitra Tsakona, Anargyros Kapetanakis, Dimitrios Kyrou, Nikolaos Vrontaras, Aliki Xochelli, Simeon Metallidis, Olga Tsachouridou, Maria Chini, Maria Meliou, Mina Psichogiou, Dimitrios Basoulis, Anastasia Antoniadou, Konstantinos Protopapas, Periklis Panagopoulos, Vasilis Petrakis, Charalambos Gogos, Leonidia Leonidou, and Christina Karamanidou
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Infectious Diseases ,Health Policy ,Pharmacology (medical) - Abstract
Frailty is known to affect people living with HIV prematurely, compared to the ageing seronegative population. In this cross-sectional study, we aimed to assess frailty prevalence in people living with HIV in Greece and find associations of frailty criteria with clinical data.Demographic and clinical data were collected from 477 participants in six HIV clinics. Fried's frailty phenotype was used to assess frailty prevalence, and participants were classified as frail, pre-frail or robust. Associations of several factors with overall frailty phenotype, as well as with frailty criteria, were explored.The median age was 43 years old (IQR = 51.5) and 444/477 (93%) were men. Most of the participants (429/477, 93.5%) had an undetectable HIV viral load, and a CD4 cell count over 500 cells/μl (366/477, 76.7%). Frailty assessment classified 285/477 (62.1%) as robust, 155/477 (33.8%) as pre-frail and 19/477 (4.1%) as frail. Weakness in grip strength was the most prevalent criterion (128/477, 26.8%), followed by exhaustion (46/477, 9.6%). Lower CD4 cell count, history of AIDS diagnosis, CNS disorders, psychiatric diagnoses, and polypharmacy were strongly associated with frailty.Although the prevalence of frailty in people living with HIV in Greece is uncommon, when combined with pre-frailty over a third of people are affected, which requires attention in clinical practice. The physical and psychological aspects of frailty highlight the need for a holistic approach to prevent or counteract it. The diverse associations of frailty criteria with HIV-related and non-HIV-related factors suggest a possible variation in people's different healthcare needs.
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- 2022
3. Oral Antiviral Treatment for COVID-19: A Comprehensive Review on Nirmatrelvir/Ritonavir
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Karolina Akinosoglou, Georgios Schinas, and Charalambos Gogos
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Adult ,Infectious Diseases ,Ritonavir ,COVID-19 Vaccines ,SARS-CoV-2 ,Virology ,Humans ,Antiviral Agents ,COVID-19 Drug Treatment - Abstract
Despite the rapid development of efficient and safe vaccines against COVID-19, the need to confine the pandemic and treat infected individuals on an outpatient basis has led to the approval of oral antiviral agents. Taking into account the viral kinetic pattern of SARS-CoV-2, it is of high importance to intervene at the early stages of the disease. A protease inhibitor called nirmatrelvir coupled with ritonavir (NMV/r), which acts as a CYP3A inhibitor, delivered as an oral formulation, has shown much promise in preventing disease progression in high-risk patients with no need for supplemental oxygen administration. Real-world data seem to confirm the drug combination’s efficacy and safety against all viral variants of concern in adult populations. Although, not fully clarified, viral rebound and recurrence of COVID-19 symptoms have been described following treatment; however, more data on potential resistance issues concerning the Mpro gene, which acts as the drug’s therapeutic target, are needed. NMV/r has been a gamechanger in the fight against the pandemic by preventing hospitalizations and halting disease severity; therefore, more research on future development and greater awareness on its use are warranted.
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- 2022
4. Greek Remdesivir Cohort (GREC) Study: Effectiveness of Antiviral Drug Remdesivir in Hospitalized Patients with COVID-19 Pneumonia
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Vasilis Petrakis, Vasiliki Rapti, Karolina Akinosoglou, Constantinos Bonelis, Kalomoira Athanasiou, Vasiliki Dimakopoulou, Nikolaos K. Syrigos, Nikolaos Spernovasilis, Grigoris Trypsianis, Markos Marangos, Charalambos Gogos, Dimitrios Papazoglou, Periklis Panagopoulos, and Garyfallia Poulakou
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Microbiology (medical) ,Virology ,remdesivir ,COVID-19 ,SARS-CoV-2 ,pandemic ,retrospective study ,intubation ,discharge ,Microbiology - Abstract
In several randomized studies, remdesivir (RDV) has been reported to shorten the recovery period and improve clinical outcomes in COVID-19 patients, and thus, it is recommended as a standard of care. Nevertheless, controversial reports have been published. The aim of the present study is to evaluate the effectiveness of remdesivir in hospitalized patients with COVID-19 pneumonia at three Greek University Departments of Infectious Diseases with homogenous treatment protocols. From September 2020 to February 2021, we retrospectively analyzed adults hospitalized with confirmed SARS-CoV-2 infection and radiological findings of pneumonia, who received remdesivir once daily for five days. Exploratory end points were duration of hospitalization, time of intubation, and death. Overall, 551 patients were included in the study. The optimal cutoff point for the number of days needed after symptom initiation for drug administration associated with better clinical outcome was 7 days. Higher odds for discharge and lower for intubation were observed in patients with treatment initiation ≤7 days (p = 0.052 and p = 0.019, retrospectively) regardless of gender (p = 0.537), hypertension (p = 0.096), dyslipidemia (p = 0.221), diabetes mellitus (p = 0.306), and usage of immunomodulators (p = 0.408). Our study has demonstrated beneficial effects of early treatment with remdesivir (≤7 days from symptom onset) on rates of intubation and probability of discharge.
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- 2022
5. Remdesivir Use in the Real-World Setting: An Overview of Available Evidence
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Karolina Akinosoglou, Emmanouil Angelos Rigopoulos, Georgios Schinas, Georgia Kaiafa, Eleni Polyzou, Stamatia Tsoupra, Argyrios Tzouvelekis, Charalambos Gogos, and Christos Savopoulos
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Infectious Diseases ,Virology - Abstract
In the years of Coronavirus Disease 2019 (COVID-19), various treatment options have been utilized. COVID-19 continues to circulate in the global population, and the evolution of the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has posed significant challenges to the treatment and prevention of infection. Remdesivir (RDV), an anti-viral agent with in vitro efficacy against coronaviruses, is a potent and safe treatment as suggested by a plethora of in vitro and in vivo studies and clinical trials. Emerging real-world data have confirmed its effectiveness, and there are currently datasets evaluating its efficacy and safety against SARS-CoV-2 infections in various clinical scenarios, including some that are not in the SmPC recommendations according for COVID-19 pharmacotherapy. Remdesivir increases the chance of recovery, reduces progression to severe disease, lowers mortality rates, and exhibits beneficial post-hospitalization outcomes, especially when used early in the course of the disease. Strong evidence suggests the expansion of remdesivir use in special populations (e.g., pregnancy, immunosuppression, renal impairment, transplantation, elderly and co-medicated patients) where the benefits of treatment outweigh the risk of adverse effects. In this article, we attempt to overview the available real-world data of remdesivir pharmacotherapy. With the unpredictable course of COVID-19, we need to utilize all available knowledge to bridge the gap between clinical research and clinical practice and be sufficiently prepared for the future.
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- 2023
6. Association of Antiretroviral Therapy with Platelet Function and Systemic Inflammatory Response in People Living with HIV: A Cross-Sectional Study
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Karolina Akinosoglou, Martha Kolosaka, George Schinas, Anne-Lise Delastic, Stefania Antonopoulou, Angelos Perperis, Markos Marangos, Athanasia Mouzaki, and Charalambos Gogos
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Microbiology (medical) ,Virology ,HIV ,platelets ,inflammatory response ,cytokines ,P2Y12 ,GPIIb/IIIa ,antiretroviral therapy ,Microbiology - Abstract
People living with HIV (PLWHIV) present an increased risk of adverse cardiovascular events. We aimed to assess whether antiretroviral therapy (ART) pharmacologically enhances platelet reactivity and platelet activation intensity, and explore the potential association with underlying inflammatory status. This was a cross-sectional cohort study carried out among PLWHIV on diverse ART regimens. Platelet reactivity and activation intensity were assessed using the bedside point-of-care VerifyNow assay, in P2Y12 reaction units (PRU), measurements of monocyte-platelet complexes, and P-selectin and GPIIb/IIIa expression increase, following activation with ADP, respectively. Levels of major inflammatory markers and whole blood parameters were also evaluated. In total, 71 PLWHIV, 59 on ART and 22 healthy controls, were included in this study. PRU values were significantly elevated in PLWHIV compared to controls [Mean; 257.85 vs. 196.67, p < 0.0001], but no significant differences were noted between ART-naïve or ART-experienced PLWHIV, or between TAF/TDF and ABC based regimens, similar to systemic inflammatory response. However, within-group analysis showed that PRUs were significantly higher in ABC/PI vs ABC/INSTI or TAF/TDF + PI patients, in line with levels of IL-2. PRU values did not correlate strongly with CD4 counts, viral load, or cytokine values. P-selectin and GPIIb/IIIa expression increased following ADP activation and were significantly more prominent in PLWHIV (p < 0.005). Platelet reactivity and platelet activation intensity were shown to be increased in PLWHIV, but they did not appear to be related to ART initiation, similar to the underlying systemic inflammatory response.
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- 2023
7. Cytokine production and outcome in MDR versus non-MDR gram-negative bacteraemia and sepsis
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Theologia Gkavogianni, Vasileios Karamouzos, Charalambos Gogos, Dimitrios Velissaris, and Evangelos J. Giamarellos-Bourboulis
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0301 basic medicine ,Microbiology (medical) ,General Immunology and Microbiology ,business.industry ,animal diseases ,medicine.medical_treatment ,Angiopoietin 2 ,030106 microbiology ,General Medicine ,medicine.disease ,Sepsis ,Multiple drug resistance ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,Cytokine ,Immunology ,medicine ,030212 general & internal medicine ,business ,Cytokine storm ,Susceptibility pattern ,Carbapenem resistance ,Gram - Abstract
Sepsis represents a life-threatening syndrome characterized by a cytokine storm. Whether cytokine levels are related to the susceptibility pattern of invasive micro-organism remains a matter of deb...
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- 2021
8. Assessment of HIV testing recommendations in Greek specialty guidelines: A missed opportunity and room for improvement for recommending testing
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Evangelia Georgia Kostaki, Karolina Akinosoglou, Charalambos Gogos, and Dimitrios Paraskevis
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Acquired Immunodeficiency Syndrome ,medicine.medical_specialty ,030505 public health ,Health (social science) ,Greece ,Social Psychology ,business.industry ,Public Health, Environmental and Occupational Health ,Specialty ,HIV Infections ,Hiv testing ,HIV Testing ,body regions ,03 medical and health sciences ,0302 clinical medicine ,Family medicine ,Prevalence ,Humans ,Medicine ,030212 general & internal medicine ,0305 other medical science ,business ,Missed opportunity - Abstract
HIV testing for individuals presenting with indicator conditions (ICs) including AIDS-defining conditions (ADCs) is explicitly recommended by European guidelines. We aimed to review specialty guidelines in Greece and assess if HIV was discussed and testing recommended. We reviewed European guidelines to produce a list of 25 ADCs and 48 ICs. We identified Greek guidelines for 11 of 25 (44%) ADCs and 30 of 48 (63%) ICs. In total, 47 guidelines were reviewed (range: 1-6 per condition); 11 (23%) for ADCs and 36 (77%) for ICs. Association with HIV was discussed in 7 of 11 (64%) ADC and 8 of 36 IC guidelines (22%), whereas HIV testing was appropriately recommended in two of 11 ADC (18%) and 10 of 36 IC guidelines (28%). Significant differences were found for the distribution of recommendations to test in both types of condition, with ICs having higher percentage of non-recommendation (50%
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- 2021
9. COVID-19 Pharmacotherapy in Pregnancy: A Literature Review of Current Therapeutic Choices
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Karolina Akinosoglou, Georgios Schinas, Emmanouil-Angelos Rigopoulos, Eleni Polyzou, Argyrios Tzouvelekis, George Adonakis, and Charalambos Gogos
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Infectious Diseases ,Virology - Abstract
The clinical management of COVID-19 in pregnant women, who are considered a vulnerable population, remains uncertain even as the pandemic subsides. SARS-CoV-2 affects pregnant individuals in multiple ways and has been associated with severe maternal morbidity and mortality, as well as neonatal complications. The unique anatomy and physiology of gestation make managing COVID-19 in this population a complex and challenging task, emphasizing the importance of spreading knowledge and expertise in this area. Therapeutic interventions require distinct clinical consideration, taking into account differences in pharmacokinetics, vertical transmission, drug toxicities, and postnatal care. Currently, there is limited data on antiviral and immunomodulating COVID-19 pharmacotherapy in pregnancy. Some medication has been shown to be safe and well tolerated among pregnant women with COVID-19; however, the lack of randomized clinical trials and studies in this patient population is evident. Available vaccines are considered safe and effective, with no evidence of harm to the fetus, embryo development, or short-term postnatal development. Pregnant women should be counseled about the risks of SARS-CoV-2 infection and informed of available ways to protect themselves and their families. Effective treatments for COVID-19 should not be withheld from pregnant individuals, and more research is needed to ensure the best outcomes.
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- 2023
10. Upraising Stenotrophomonas maltophilia in Critically Ill Patients: A New Enemy?
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George Dimopoulos, José Garnacho-Montero, Elisabeth Paramythiotou, Antonio Gutierrez-Pizarraya, Charalambos Gogos, Maria Adriansen-Pérez, Chrysa Diakaki, Dimitrios K. Matthaiou, Garyphalia Poulakou, and Karolina Akinosoglou
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Clinical Biochemistry ,Stenotrophomonas maltophilia ,carbapenem resistance ,cotrimoxazole ,ventilator-associated pneumonia ,emerging pathogens ,intensive care unit - Abstract
Stenotrophomonas maltophilia (S. maltophilia), an important pathogen in immuno-compromised patients, has recently gained attention in patients admitted in intensive care units (ICU). We sought to investigate clinical features of infections caused by S. maltophilia in ICU patients and identify risk factors for mortality. We conducted a retrospective study in two multivalent non-COVID-19 ICUs of tertiary-teaching hospitals in Greece and Spain, including patients with isolated S. maltophilia from at least one clinical specimen along with clinical signs of infection. A total of 103 patients (66% male) were analyzed. Median age was 65.5 (54–73.3) years and mean APACHE II and SOFA scores upon ICU admission were 18.36 (±7.22) and 18.17 (±6.95), respectively. Pneumonia was the predominant clinical syndrome (72.8%), while 22% of cases were among hemato/oncology patients. Crude 28-day mortality rate was 54.8%, even though, 14-day clinical and microbiological response was 96%. Age, APACHE II on ICU admission, hemato-oncologic disease, and multi-organ failure were initially identified as potential predictors of mortality. In the multivariable analysis, only increasing age and hemato-oncologic disease were shown to be independent risk factors for 28-day mortality. High all-cause mortality was observed in critically ill patients with predominantly respiratory infections by S. maltophilia, despite initial clinical and laboratory response after targeted treatment. The study elucidates a potentially worrisome emerging pathogen in the ICU.
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- 2023
11. Endotoxin Translocation and Gut Barrier Dysfunction Are Related to Variceal Bleeding in Patients With Liver Cirrhosis
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Christos, Triantos, Maria, Kalafateli, Stelios F, Assimakopoulos, Katerina, Karaivazoglou, Aikaterini, Mantaka, Ioanna, Aggeletopoulou, Panagiota I, Spantidea, Georgios, Tsiaoussis, Maria, Rodi, Hariklia, Kranidioti, Dimitrios, Goukos, Spilios, Manolakopoulos, Charalambos, Gogos, Dimitrios N, Samonakis, Georgios L, Daikos, Athanasia, Mouzaki, and Konstantinos, Thomopoulos
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General Medicine - Abstract
BackgroundBacterial infections are associated with the risk of variceal bleeding through complex pathophysiologic pathways.ObjectivesThe primary objective of the present case-control study was to investigate the role of bacterial translocation and intestinal barrier dysfunction in the pathogenesis of variceal bleeding. A secondary objective was to determine independent predictors of key outcomes in variceal bleeding, including bleeding-related mortality.MethodsEighty-four (n = 84) consecutive patients participated in the study, 41 patients with acute variceal bleeding and 43 patients with stable cirrhosis, and were followed up for 6 weeks. Peripheral blood samples were collected at patient admission and before any therapeutic intervention.ResultsChild-Pugh (CP) score (OR: 1.868; p = 0.044), IgM anti-endotoxin antibody levels (OR: 0.954; p = 0.016) and TGF-β levels (OR: 0.377; p = 0.026) were found to be significant predictors of variceal bleeding. Regression analysis revealed that albumin (OR: 0.0311; p = 0.023), CRP (OR: 3.234; p = 0.034) and FABP2 levels (OR:1.000, p = 0.040), CP score (OR: 2.504; p = 0.016), CP creatinine score (OR: 2.366; p = 0.008), end-stage liver disease model (MELD), Na (OR: 1.283; p = 0.033), portal vein thrombosis (OR: 0.075; p = 0.008), hepatocellular carcinoma (OR: 0.060; p = 0.003) and encephalopathy (OR: 0.179; p = 0.045) were significantly associated with 6-week mortality.ConclusionsBacterial translocation and gut barrier impairment are directly related to the risk of variceal bleeding. Microbiota-modulating interventions and anti-endotoxin agents may be promising strategies to prevent variceal bleeding.
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- 2022
12. The Prognostic Value of Endotoxemia and Intestinal Barrier Biomarker ZO-1 in Bacteremic Sepsis
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Stelios F Assimakopoulos, Anne-Lise de Lastic, Aikaterini Skintzi, Athanasia Mouzaki, Karolina Akinosoglou, and Charalambos Gogos
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Male ,medicine.medical_specialty ,Time Factors ,030204 cardiovascular system & hematology ,Fatty Acid-Binding Proteins ,Gastroenterology ,Disease-Free Survival ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Intestinal Mucosa ,Aged ,Aged, 80 and over ,APACHE II ,Gut barrier ,Receiver operating characteristic ,business.industry ,Organ dysfunction ,General Medicine ,Middle Aged ,medicine.disease ,Endotoxemia ,Pathophysiology ,Endotoxins ,Survival Rate ,Bacteremia ,Zonula Occludens-1 Protein ,Biomarker (medicine) ,Female ,medicine.symptom ,business ,Biomarkers - Abstract
Background Intestinal barrier dysfunction exerts a pivotal pathophysiological role in the development of multiple organ dysfunction in sepsis. The present study was undertaken to investigate the potential role of serum intestinal fatty acid-binding protein (I-FABP) and zonula occludens-1 (ZO-1) levels as biomarkers of intestinal barrier dysfunction in bacteremic sepsis. Methods Seventy-five patients with bacteremic sepsis of abdominal origin (n = 34) or nonabdominal origin (n = 41) and 12 healthy controls were retrospectively studied. Blood samples collected upon sepsis diagnosis were analyzed for serum ZO-1, I-FABP and endotoxin levels. Prognostic scores Sequential Organ Failure Assessment (SOFA), quickSOFA and Acute Physiology and Chronic Health Evaluation (APACHE-II) were determined over the first 24 hours after sepsis diagnosis and patients’ outcome in terms of 28-day mortality was recorded. Results Serum ZO-1 levels were significantly higher in bacteremic septic patients as compared to controls with no difference between patients with abdominal or extra-abdominal source of infection. Serum I-FABP levels were significantly lower in septic patients as compared to control and this reduction was more evident in patients with bacteremic abdominal sepsis. Serum ZO-1 and endotoxin concentrations were found significantly higher in patients who did not survive from sepsis. In receiver operating characteristic curve analysis, both endotoxin and ZO-1 predicted 28-day mortality. In addition, ZO-1 and endotoxin were correlated with the prognostic scores of qSOFA, SOFA and APACHE II. Conclusions The results of this study indicate that serum ZO-1 might be a reliable biomarker of gut barrier dysfunction in sepsis, not affected by the abdominal or extra-abdominal site of infection. ZO-1, measured early at sepsis diagnosis, might represent a valuable additional prognostic tool for patients’ outcome.
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- 2020
13. Vitamin D-related immunomodulation in patients with liver cirrhosis
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Maria Kalafateli, Venetsana Kyriazopoulou, Spilios Manolakopoulos, Christos Konstantakis, Georgia Diamantopoulou, Panagiota I. Spantidea, Ioanna Aggeletopoulou, Charalambos Gogos, Georgia Vourli, Athanasia Mouzaki, Marina Michalaki, Konstantinos Thomopoulos, Stelios F Assimakopoulos, and Christos Triantos
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Liver Cirrhosis ,Vitamin ,medicine.medical_specialty ,Cirrhosis ,Vitamin D-binding protein ,Gastroenterology ,vitamin D deficiency ,Immunomodulation ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,medicine ,Vitamin D and neurology ,Humans ,Vitamin D ,Hepatology ,biology ,business.industry ,Liver Neoplasms ,Hazard ratio ,Immunity ,Vitamin D Deficiency ,medicine.disease ,chemistry ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,biology.protein ,030211 gastroenterology & hepatology ,business ,Lipopolysaccharide binding protein - Abstract
Objective(s) Increasing evidence indicates that vitamin D status is linked to severity of liver cirrhosis and patients' survival. However, the potential role of vitamin D-related immunomodulation in hepatic decompensation and patients' mortality in relation to vitamin D deficiency remains unknown. The aim of the current study is to evaluate the association between vitamin D status and vitamin D binding protein (VDBP) levels with serum cytokine and lipopolysaccharide binding protein (LBP) and to examine their role on disease severity and cirrhotics' mortality. Methods One hundred consecutive Caucasian patients with liver cirrhosis were enrolled in the study. 25(OH)D, VDBP, and LBP concentrations were assessed by ELISA. Cytokine tumor necrosis factor-a (TNF-a), interleukin 6 (IL-6), IL-1β, IL-8, IL-10, and IL-12 levels were determined by Cytometric Bead Array. Results 25(OH)D levels were inversely correlated with CP score, MELD, IL-6, and CP stage and VDBP levels with CP score, MELD, IL-6, IL-8, LBP, and CP stage. Cirrhotics with 25(OH)D deficiency and severe deficiency had significantly higher CP score, increased IL-6 levels and lower VDBP levels. In the multivariate analysis, the independent prognostic factors associated with patients' survival were CP stage B [hazard ratio = 6.75; 95% confidence interval (CI) 1.32, 34.43; P = 0.022], CP stage C (hazard ratio = 7.39; 95% CI 1.41, 38.81; P = 0.018), the presence of hepatocellular carcinoma (hazard ratio = 4.50; 95% CI 1.54, 13.13; P = 0.006) and 25(OH)D levels (hazard ratio = 0.87; 95% CI 0.80, 0.95; P = 0.002). Conclusion The results show that vitamin D status and VDBP levels are associated with liver cirrhosis severity and patients' mortality, possibly through a proinflammatory immune response.
- Published
- 2019
14. An exploration of the quality of life of people living with HIV in Greece: Challenges and opportunities
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Nikolaos Vrontaras, Katerina Myrvali, Dimitrios Kyrou, Simeon Metallidis, Olga Tsachouridou, Maria Chini, Maria Meliou, Mina Psichogiou, Dimitrios Basoulis, Anastasia Antoniadou, Konstantinos Protopapas, Periklis Panagopoulos, Vasilis Petrakis, Charalambos Gogos, Lydia Leonidou, and Christina Karamanidou
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Stereotyping ,Multidisciplinary ,Cross-Sectional Studies ,Greece ,Quality of Life ,Humans ,HIV Infections ,Qualitative Research - Abstract
ObjectiveImproving the quality of life (QoL) of people living with HIV (PLWH) has been proposed as a new priority in HIV care. The objective of this cross-sectional, qualitative study was to explore the perspectives of PLWH in Greece regarding their QoL.DesignTwenty-four semi-structured interviews were conducted with PLWH receiving care across six HIV clinics in Greece. The thematic analysis of the transcribed interviews resulted in four themes and eleven subthemes.ResultsFirst, fear of repercussions (e.g., stigmatization) makes PLWH reluctant to disclose their diagnosis in public settings or disclose accounting for factors like the confidant’s discretion. Second, participants are challenged by HIV’s unique biopsychosocial facets (e.g., uncertainty about symptoms) and fear for the future (e.g., a confidant revealing their HIV status without consent). Third, support received by specialist services is satisfactory in contrast to non-HIV specialist services, where significant improvements are needed to reduce stigmatization. Finally, the experiences of PLWH include contrasting elements of post-traumatic growth and an inability to accept their seropositivity (e.g., avoiding social interactions).ConclusionsEmpowering PLWH in these QoL areas is greatly needed. Increasing the life expectancy of PLWH is only the initial step; their QoL needs to be secured as the next priority in HIV care.
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- 2021
15. Dexamethasone in COVID‐19: Should we consider a 'golden hour' practice?
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Karolina Akinosoglou and Charalambos Gogos
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2019-20 coronavirus outbreak ,Letter ,Coronavirus disease 2019 (COVID-19) ,SARS-CoV-2 ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,General Medicine ,Virology ,Dexamethasone ,Hypoglycemia ,COVID-19 Drug Treatment ,Infectious Diseases ,LETTERS ,medicine ,Golden hour (medicine) ,Humans ,business ,medicine.drug - Published
- 2021
16. Tixagevimab/Cilgavimab in SARS-CoV-2 Prophylaxis and Therapy: A Comprehensive Review of Clinical Experience
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Karolina Akinosoglou, Emmanouil-Angelos Rigopoulos, Georgia Kaiafa, Stylianos Daios, Eleni Karlafti, Eleftheria Ztriva, Georgios Polychronopoulos, Charalambos Gogos, and Christos Savopoulos
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Infectious Diseases ,Virology - Abstract
Effective treatments and vaccines against COVID-19 used in clinical practice have made a positive impact on controlling the spread of the pandemic, where they are available. Nevertheless, even if fully vaccinated, immunocompromised patients still remain at high risk of adverse outcomes. This has driven the largely expanding field of monoclonal antibodies, with variable results. Tixagevimab/Cilgavimab (AZD7442), a long-acting antibody combination that inhibits the attachment of the SARS-CoV-2 spike protein to the surface of cells, has proved promising in reducing the incidence of symptomatic COVID-19 or death in high-risk individuals without major adverse events when given as prophylaxis, as well as early treatment. Real-world data confirm the antibody combination’s prophylaxis efficacy in lowering the incidence, hospitalization, and mortality associated with COVID-19 in solid organ transplant recipients, patients with immune-mediated inflammatory diseases and hematological malignancies, and patients in B-cell-depleting therapies. Data suggest a difference in neutralization efficiency between the SARS-CoV-2 subtypes in favor of the BA.2 over the BA.1. In treating COVID-19, AZD7442 showed a significant reduction in severe COVID-19 cases and mortality when given early in the course of disease, and within 5 days of symptom onset, without being associated with severe adverse events, even when it is used in addition to standard care. The possibility of the development of spike-protein mutations that resist monoclonal antibodies has been reported; therefore, increased vigilance is required in view of the evolving variants. AZD7442 may be a powerful ally in preventing COVID-19 and the mortality associated with it in high-risk individuals. Further research is required to include more high-risk groups and assess the concerns limiting its use, along the SARS-CoV-2 evolutionary trajectory.
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- 2022
17. COVID-19 Vaccination in Patients with Chronic Liver Disease
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Georgios Schinas, Eleni Polyzou, Fevronia Mitropetrou, Aristotelis Pazionis, Charalambos Gogos, Christos Triantos, and Karolina Akinosoglou
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Liver Cirrhosis ,COVID-19 Vaccines ,Infectious Diseases ,SARS-CoV-2 ,Liver Diseases ,Virology ,Vaccination ,Humans ,COVID-19 - Abstract
Vaccination against SARS-CoV-2 has become a central public health issue, primarily for vulnerable populations such as individuals with Chronic Liver Disease (CLD). Increased COVID-19-related mortality and disease severity has been noted in this subgroup of patients. Severe COVID-19 tends to further deregulate liver function in patients with chronic liver failure or cirrhosis and even reactivate hepatitis in people living with HBV or HCV. In addition, impaired hepatic function leads to several limitations in possible therapeutic interventions. Chronic hepatic dysregulation, along with the underlying cirrhosis-associated immune dysfunction (CAID), leads to a decreased immune response to vaccination that, in turn, may result in reduced efficacy rates and lowered lasting protection. According to current guidelines, timely vaccination and frequent booster shot administration are deemed necessary in this context. Vaccination-related adverse events are mostly mild in nature and similar to those reported in the general population, whereas the incidence of liver injury following vaccination is relatively rare. We aimed to review available evidence and recommendations associated with COVID-19 vaccination in patients with chronic liver disease, and provide insight to current issues and future directions.
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- 2022
18. Changes in Body Mass Index after Initiation of Antiretroviral Treatment: Differences by Class of Core Drug
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Nikos Pantazis, Vasilios Papastamopoulos, Anastasia Antoniadou, Georgios Adamis, Vasilios Paparizos, Simeon Metallidis, Helen Sambatakou, Mina Psichogiou, Maria Chini, Georgios Chrysos, Periklis Panagopoulos, Nikolaos V. Sipsas, Emmanouil Barbunakis, Charalambos Gogos, and Giota Touloumi
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Adult ,Infectious Diseases ,HIV ,antiretroviral therapy ,integrase strand transfer inhibitors ,body mass index ,weight ,obesity ,Anti-Retroviral Agents ,Virology ,Humans ,HIV Infections ,HIV Integrase Inhibitors ,Obesity ,Weight Gain ,Body Mass Index - Abstract
Recent research on antiretroviral treatment (ART) for HIV suggests that integrase strand transfer inhibitors (INSTIs) cause faster weight gain compared to other drug classes. Here, we investigated changes in body mass index (BMI) and obesity prevalence after treatment initiation and corresponding differences between drug classes. Data were derived from a large collaborative cohort in Greece. Included individuals were adults who started ART, in or after 2010, while previously ART naïve and achieved virologic response within the first year of ART. Data were analysed using mixed fractional polynomial models. INSTI regimens led to the more pronounced BMI increases, followed by boosted PI and NNRTI based regimens. Individuals with normal initial BMI are expected to gain 6 kg with an INSTI regimen compared to 4 kg with a boosted PI and less than 3 kg with a NNRTI regimen after four years of treatment. Prevalence of obesity was 5.7% at ART initiation and 12.2%, 14.2% and 18.1% after four years of treatment with NNRTIs, PIs, and INSTIs, respectively. Dolutegravir or Raltegravir were associated with marginally faster BMI increase compared to Elvitegravir. INSTIs are associated with faster weight gain. INSTIs’ increased risk of treatment emergent obesity and, possibly, weight-related co-morbidities should be judged against their improved efficacy and tolerability but increased clinical attention is required.
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- 2022
19. Cytokine production and outcome in MDR
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Vasileios, Karamouzos, Evangelos J, Giamarellos-Bourboulis, Dimitrios, Velissaris, Theologia, Gkavogianni, and Charalambos, Gogos
- Subjects
Male ,Tumor Necrosis Factor-alpha ,Sepsis ,Cytokines ,Humans ,Bacteremia ,Female ,Prospective Studies ,Prognosis - Abstract
Sepsis represents a life-threatening syndrome characterized by a cytokine storm. Whether cytokine levels are related to the susceptibility pattern of invasive micro-organism remains a matter of debate. The purpose of this study is to investigate the immune response in multidrug resistant (MDR) and non-MDR sepsis patients by measuring cytokine levels, compare the outcome and determine predictors of mortality.A total of 128 septic patients, treated in intensive care unit (ICU) were enrolled in the study. Epidemiological and ICU data were recorded. Plasma concentrations of angiopoietin-2 (Ang-2), interleukin (IL)-6, IL-10, tumour necrosis factor-α (TNF-α) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) were measured on admission.A total of 90 patients suffered from non-MDR and 38 from MDR gram-negative sepsis. Levels of TNF-α were significantly higher (Sepsis evolution and outcome are influenced by multiple factors. Although MDR pathogens induced a weaker immune response characterized by lower TNF-α levels this was not accompanied by better survival. Increased Ang-2 levels, APACHE II score and carbapenem resistance are important factors associated with higher mortality.
- Published
- 2021
20. The Role of Macrolides for the Management of Community-Acquired Pneumonia and Pneumonia by the Novel Coronavirus SARS-CoV-2 (COVID-19): A Position Paper by Four Medical Societies from Greece
- Author
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Evangelos J. Giamarellos-Bourboulis, Marios Lazanas, George L. Daikos, Charalambos Gogos, Panagiotis Gargalianos, Helen Sambatakou, Michael Samarkos, Periklis Panagopoulos, and Garyphallia Poulakou
- Subjects
0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Community-acquired pneumonia ,030106 microbiology ,Azithromycin ,medicine.disease_cause ,Immunomodulation ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Clarithromycin ,medicine ,030212 general & internal medicine ,Coronavirus ,business.industry ,COVID-19 ,medicine.disease ,Pneumonia ,Infectious Diseases ,Commentary ,Position paper ,Severe acute respiratory syndrome coronavirus ,business ,medicine.drug - Abstract
In light of the accumulating evidence for survival benefit coming from the use of macrolides for community-acquired pneumonia (CAP), a group of experts from the field of internal medicine and infectious diseases frame a position statement on the use of macrolides for the management of bacterial CAP and for infection by the novel coronavirus (COVID-19). The statement is framed taking into consideration existing publications and own research experience. The main content of this statement is that the combination of one β-lactam and a macrolide should be the first treatment of choice for patients with severe bacterial CAP. Severity is assessed as scoring 2 or more points on the CURB65 scoring system of severity or as pneumonia severity index III to V or C-reactive protein more than 150 mg/l; the suggested macrolide is either azithromycin or clarithromycin. The experts also suggest that in COVID-19 pneumonia, the combination of one β-lactam and a macrolide should be reserved only when there is strong suspicion of bacterial co-infection.
- Published
- 2021
21. Patterns, price and predictors of successful empiric antibiotic therapy in a real-world setting
- Author
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Christos Davoulos, Foteini Kosmopoulou, Christina-Panagiota Koutsouri, Anne-Lise deLastic, Karolina Akinosoglou, Spyridoula Theodoraki, Martha Kolosaka, Charalambos Gogos, Vasiliki Niarou, and Dimitrios Ziazias
- Subjects
Male ,medicine.medical_specialty ,medicine.drug_class ,Urinary system ,Antibiotics ,Comorbidity ,030226 pharmacology & pharmacy ,Tazobactam ,Drug Administration Schedule ,Sepsis ,Tertiary Care Centers ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Antibiotic therapy ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Formulary ,Aged ,Retrospective Studies ,Pharmacology ,Aged, 80 and over ,Greece ,business.industry ,Drug Administration Routes ,Age Factors ,Bacterial Infections ,Length of Stay ,Middle Aged ,medicine.disease ,Drug Utilization ,Anti-Bacterial Agents ,Hospitalization ,Cohort ,Practice Guidelines as Topic ,Female ,Health Expenditures ,business ,medicine.drug ,Piperacillin - Abstract
WHAT IS KNOWN AND OBJECTIVE Prompt and appropriate empiric antibiotic therapy (EAT) remains the cornerstone of successful outcomes, while the majority of blood cultures do not identify pathogen. We aimed to report patterns of EAT and its impact on outcomes and associated medical costs, while exploring predictors of its success in a real-world setting. METHODS We retrospectively utilized the prospective registry of the medical unit of a tertiary university hospital, including patients admitted with diagnosis of infection between 1st May 2016 and 1st May 2018. Costs of hospitalization and unit of antibiotic regimen were retrieved from a database regarding Greek hospitals containing hospitalization-cost data for each ICD-10 code and the national formulary, respectively. RESULTS A total of 489 patients were included in this study. Mean age was 61.3 years, 53% were males, while intra-abdominal infections predominated (55%). The most commonly administered EAT included quinolones (48%), followed by piperacillin/tazobactam (18%), or other regimens alone or in combination. EAT was successful in 67% and failed in 33% of cases. Fourteen patients died of the infection before EAT was switched, while among 55 patients that EAT had to be modified, mortality was 22%. Presence of urinary tract infection and use of quinolones, least predicted for failure of EAT [OR:0.15 (0.07-0.35), p
- Published
- 2021
22. Patient-reported outcomes in HIV clinical trials evaluating antiretroviral treatment: a systematic review
- Author
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Stefania Antonopoulou, Charalambos Gogos, Ioannis Katsarolis, and Karolina Akinosoglou
- Subjects
medicine.medical_specialty ,Health (social science) ,Social Psychology ,Anti-HIV Agents ,education ,MEDLINE ,Scopus ,Human immunodeficiency virus (HIV) ,HIV Infections ,medicine.disease_cause ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Antiretroviral treatment ,Humans ,030212 general & internal medicine ,Patient Reported Outcome Measures ,Intensive care medicine ,Acquired Immunodeficiency Syndrome ,030505 public health ,business.industry ,Public Health, Environmental and Occupational Health ,Antiretroviral therapy ,Clinical trial ,Anti-Retroviral Agents ,0305 other medical science ,business - Abstract
We aimed to assess patterns of patient-reported outcomes (PRO) instruments' utilization in HIV clinical trials in relation to antiretroviral therapy (ART). PubMed/MEDLINE, Scopus, and EMBASE were searched using the terms "Patient-Reported Outcomes" and "HIV/AIDS" or "Antiretroviral Treatment" or "ART" or "Antiretroviral Therapy" from 1 January 1990 until 1 December 2019. In total, 173 studies were identified and 26 were directly related to ART. Study population included treatment-naïve patients (
- Published
- 2020
23. SARS‐CoV‐2 persistence and non‐protective immunity in infected haematological patients
- Author
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Karolina Akinosoglou, Leonidas G. Alexopoulos, Foteini Paliogianni, Markos Marangos, Alexandra Kouraklis-Symeonidis, Argiris Symeonidis, Alexandros Spyridonidis, Dimitrios Ziazias, and Charalambos Gogos
- Subjects
2019-20 coronavirus outbreak ,Protective immunity ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,persistence ,Hematology ,immunity ,Virology ,SARS‐CoV‐2 ,Persistence (computer science) ,COVID‐19 ,Immunity ,Correspondence ,Medicine ,business - Published
- 2020
24. A Nationwide Study about the Dispersal Patterns of the Predominant HIV-1 Subtypes A1 and B in Greece: Inference of the Molecular Transmission Clusters
- Author
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Vasileios Bolanos, Dimitra Paraskeva, Dimitrios Basoulis, Maria Gova, Simeon Metallidis, Anastasia Antoniadou, Dimitrios Chatzidimitriou, Maria Giovanna Chini, Evrikleia Kantzilaki, Marios Lazanas, Sofia Kourkounti, Georgios Xylomenos, Georgios Chrysos, Helen Sambatakou, Stelios Drimis, Lemonia Skoura, Charalambos Gogos, Nikos Mangafas, Apostolos Beloukas, Olga Tsachouridou, Emmanouil Barbounakis, Angelos Hatzakis, Malvina Lada, Georgios Adamis, Vasileios Papastamopoulos, Dimitrios Paraskevis, Mina Psichogiou, Ifigeneia Papageorgiou, Evangelia Georgia Kostaki, Vasileios Paparizos, Eleni Kakalou, Periklis Panagopoulos, Nikolaos V. Sipsas, Antonios Papadopoulos, Dimitrios Pilalas, and Vasilis Petrakis
- Subjects
0301 basic medicine ,Adult ,Male ,Younger age ,Genotype ,lcsh:QR1-502 ,Human immunodeficiency virus (HIV) ,HIV Infections ,phylogeographic analysis ,Biology ,medicine.disease_cause ,molecular epidemiology ,lcsh:Microbiology ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Risk groups ,law ,Virology ,medicine ,Prevalence ,Cluster Analysis ,Humans ,030212 general & internal medicine ,Men having sex with men ,Phylogeny ,Genetics ,local transmission ,Molecular epidemiology ,Phylogenetic tree ,Greece ,phylogenetic analysis ,Middle Aged ,Phylogeography ,human immunodeficiency virus (HIV) ,030104 developmental biology ,Infectious Diseases ,Transmission (mechanics) ,DNA, Viral ,Epidemiological Monitoring ,HIV-1 ,Biological dispersal ,Female ,dispersal patterns ,transmission clusters - Abstract
Our aim was to investigate the dispersal patterns and parameters associated with local molecular transmission clusters (MTCs) of subtypes A1 and B in Greece (predominant HIV-1 subtypes). The analysis focused on 1751 (28.4%) and 2575 (41.8%) sequences of subtype A1 and B, respectively. Identification of MTCs was based on phylogenetic analysis. The analyses identified 38 MTCs including 2&ndash, 1518 subtype A1 sequences and 168 MTCs in the range of 2&ndash, 218 subtype B sequences. The proportion of sequences within MTCs was 93.8% (1642/1751) and 77.0% (1982/2575) for subtype A1 and B, respectively. Transmissions within MTCs for subtype A1 were associated with risk group (Men having Sex with Men vs. heterosexuals, OR = 5.34, p <, 0.001) and Greek origin (Greek vs. non-Greek origin, OR = 6.05, p <, 0.001) and for subtype B, they were associated with Greek origin (Greek vs. non-Greek origin, OR = 1.57, p = 0.019), younger age (OR = 0.96, p <, 0.001), and more recent sampling (time period: 2011&ndash, 2015 vs. 1999&ndash, 2005, OR = 3.83, p <, 0.001). Our findings about the patterns of across and within country dispersal as well as the parameters associated with transmission within MTCs provide a framework for the application of the study of molecular clusters for HIV prevention.
- Published
- 2020
25. Hospital factors associated with SARS-CoV-2 infection among healthcare personnel in Greece
- Author
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Maria Tseroni, Androula Pavli, Angelos Pefanis, Evangelos Kostis, Charalambos Gogos, Anastasios Chrysochoou, Kalliopi Papadima, Vasilios Raftopoulos, Nikolaos V. Sipsas, Efthalia Randou, Georgios Adamis, Xanthi Dedoukou, Paraskevi Tsonou, and Helena C. Maltezou
- Subjects
Microbiology (medical) ,medicine.medical_specialty ,Infectious Disease Transmission, Patient-to-Professional ,Coronavirus disease 2019 (COVID-19) ,Referral ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Health Personnel ,Short Report ,030501 epidemiology ,03 medical and health sciences ,Risk Factors ,Health care ,occupational risk ,Medicine ,Infection control ,Humans ,Personal protective equipment ,Personal Protective Equipment ,0303 health sciences ,Infection Control ,Greece ,SARS-CoV-2 ,030306 microbiology ,business.industry ,Risk of infection ,virus diseases ,COVID-19 ,General Medicine ,Continuous training ,Hospitals ,Hospitalization ,Infectious Diseases ,Emergency medicine ,0305 other medical science ,business ,Delivery of Health Care ,healthcare personnel - Abstract
Summary Healthcare workers (HCWs) have been recognized as a high-risk group for infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This study estimated their risk of infection based on hospital characteristics. Factors significantly associated with increased risk for SARS-CoV-2 infection were: working in a non-referral hospital compared with a coronavirus disease 2019 (COVID-19) referral hospital, working in a hospital with a high number of employees, and working in a hospital with an increased number of patients with COVID-19. This study revealed gaps in infection control in the non-referral hospitals. There is an urgent need for continuous training in infection control practices. Compliance of HCWs with the use of personal protective equipment should also be addressed.
- Published
- 2020
26. Biomarkers in pediatric sepsis: a review of recent literature
- Author
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Karolina Akinosoglou, Despoina Gkentzi, Mariza Z Oikonomakou, and Charalambos Gogos
- Subjects
medicine.medical_specialty ,Clinical Biochemistry ,Procalcitonin ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Pediatric sepsis ,Drug Discovery ,medicine ,Diagnostic biomarker ,Humans ,030212 general & internal medicine ,Precision Medicine ,Intensive care medicine ,Child ,Cause of death ,business.industry ,Septic shock ,Biochemistry (medical) ,030208 emergency & critical care medicine ,medicine.disease ,Biomarker (medicine) ,business ,Biomarkers ,Pediatric population - Abstract
Sepsis remains the leading cause of death in infants and children worldwide. Prompt diagnosis and monitoring of infection is pivotal to guide therapy and optimize outcomes. No single biomarker has so far been identified to accurately diagnose sepsis, monitor response and predict severity. We aimed to assess existing evidence of available sepsis biomarkers, and their utility in pediatric population. C-reactive protein and procalcitonin remain the most extensively evaluated and used biomarkers. However, biomarkers related to endothelial damage, vasodilation, oxidative stress, cytokines/chemokines and cell bioproducts have also been identified, often with regard to the site of infection and etiologic pathogen; still, with controversial utility. A multi-biomarker model driven by genomic tools could establish a personalized approach in future disease management.
- Published
- 2020
27. Evidence for increased circulating procoagulant phospholipids in patients with COVID-19 pneumonia and their prognostic role
- Author
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Asimina Tsimeka, Andreas Emmanuil, Stelios F Assimakopoulos, Charalambos Gogos, Theodora Chalkidi, and Markos Marangos
- Subjects
Male ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Clinical Biochemistry ,MEDLINE ,Medicine ,Humans ,In patient ,Prospective Studies ,Blood Coagulation ,Phospholipids ,business.industry ,SARS-CoV-2 ,Biochemistry (medical) ,Anticoagulants ,COVID-19 ,General Medicine ,Heparin, Low-Molecular-Weight ,Middle Aged ,medicine.disease ,Prognosis ,Thrombosis ,Blood Coagulation Factors ,Pneumonia ,C-Reactive Protein ,Immunology ,Ferritins ,Disease Progression ,Female ,business ,Pulmonary Embolism - Published
- 2020
28. Severe COVID-19 and interleukin-6 receptor antagonist tocilizumab: Some notes of concern
- Author
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Charalambos Gogos and Karolina Akinosoglou
- Subjects
Pulmonary and Respiratory Medicine ,Reply ,2019-20 coronavirus outbreak ,chemistry.chemical_compound ,Tocilizumab ,chemistry ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Immunology ,Interleukin-6 Receptor Antagonist ,Medicine ,business - Abstract
See related letter
- Published
- 2020
29. Prognosis of COVID-19: Changes in laboratory parameters
- Author
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Maria, Lagadinou, Elena E, Salomou, Nicholas, Zareifopoulos, Markos, Marangos, Charalambos, Gogos, and Dimitrios, Velissaris
- Subjects
Adult ,Male ,Pneumonia, Viral ,Comorbidity ,Fibrin Fibrinogen Degradation Products ,Leukocyte Count ,Risk Factors ,Neoplasms ,Humans ,Lymphocyte Count ,Pandemics ,Aged ,Retrospective Studies ,Greece ,L-Lactate Dehydrogenase ,beta-Thalassemia ,COVID-19 ,Fibrinogen ,Middle Aged ,Prognosis ,C-Reactive Protein ,Cardiovascular Diseases ,Ferritins ,Female ,Coronavirus Infections ,Biomarkers - Abstract
Since December 2019, an outbreak of coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome - Coronavirus 2 (SARS-CoV-2) emerged in China and has become a global threat. Comparison of hematological parameters between mild and severe cases of SARS-CoV 2 is so far limited, but significant differences in parameters such as interleukin-6, d-dimers, glucose, fibrinogen and C-reactive protein have been already reported.In this study we analyzed the changes observed in easily measured blood biomarkers in the patients and provided evidence of how these markers can be used as prognostic factors of the disease.Demographic characteristics, detailed medical history, and laboratory findings of all enrolled SARS-CoV 2 infection positive patients who were referred to Patras University Hospital from the period of March 4th 2020 (when first confirmed case in Greece appeared in our hospital) until April 4th 2020 were extracted from electronic medical records and analyzed.We provided evidence that some very common laboratory values can be used as independent predictive factors in SARS-CoV 2 infection. Despite the retrospective nature of this study and the small number of subjects analyzed, we showed that NLR, LDH, d-dimers, CRP, fibrinogen and ferritin can be used early at the patient's first visit for SARS-CoV 2 infection symptoms and can predict the severity of infection.More studies are warranted to further objectively confirm the clinical value of prognostic factors related to SARS-CoV 2 and establish an easy-to-get panel of laboratory findings for evaluating the disease severity.
- Published
- 2020
30. High flow nasal cannula oxygen therapy in adults with COVID-19 respiratory failure. A case report
- Author
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Dimitrios Velissaris, Charalambos Gogos, Fotini Fligou, and Vasileios Karamouzos
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,Critical Care ,medicine.medical_treatment ,Pneumonia, Viral ,lcsh:Medicine ,medicine.disease_cause ,Intensive care ,Oxygen therapy ,medicine ,Cannula ,Humans ,Continuous positive airway pressure ,Pandemics ,Mechanical ventilation ,Noninvasive Ventilation ,SARS-CoV-2 ,business.industry ,lcsh:R ,Oxygen Inhalation Therapy ,high flow nasal cannula ,COVID-19 ,Treatment Outcome ,Respiratory failure ,Anesthesia ,Breathing ,Coronavirus Infections ,Respiratory Insufficiency ,Cardiology and Cardiovascular Medicine ,business ,Nasal cannula - Abstract
The novel corona virus (SARS-CoV-2) continuous to spread around the globe causing high mortality, tremendous stress on healthcare systems and an unprecedented disruption of everyday life with unpredictable socioeconomic ramifications. The diseaseis typically affecting the respiratory system and some patients will develop refractory hypoxemic respiratory insufficiency requiring mechanical ventilation. The role of non-invasive ventilation (NIV), high flow nasal cannula (HFNC) or continuous positive airway pressure devices (C-PAP) in the treatment of the 2019 corona virus disease (COVID-19) is not yet clear. We hereby report a case of a 44-year-old COVID-19 positive male patient suffering from hypoxic respiratory failure that was successfully treated with high flow nasal cannula oxygen therapy in a negative pressure intensive care room. Although specific criteria for the use of high flow nasal canula devices COVID-19 are not available at this time, clinicians could use this non-invasive modality as analternative method of respiratory support in selected patients presenting with respiratory failure.
- Published
- 2020
31. Fecal Microbiota Transplantation and Hydrocortisone Ameliorate Intestinal Barrier Dysfunction and Improve Survival in a Rat Model of Cecal Ligation and Puncture-Induced Sepsis
- Author
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Anne-Lise de Lastic, Athanasia Mouzaki, Stelios F Assimakopoulos, Maria Rodi, Ioannis Maroulis, Vasiliki Zolota, Dimitra Bantouna, Iliana Papadopoulou, and Charalambos Gogos
- Subjects
Male ,medicine.medical_specialty ,Hydrocortisone ,Punctures ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Occludin ,digestive system ,Gastroenterology ,Sepsis ,Random Allocation ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Animals ,Rats, Wistar ,Cecum ,Ligation ,Lamina propria ,business.industry ,Organ dysfunction ,030208 emergency & critical care medicine ,Fecal Microbiota Transplantation ,Apoptotic body ,medicine.disease ,Pathophysiology ,Rats ,Intestines ,Survival Rate ,Disease Models, Animal ,medicine.anatomical_structure ,Paneth cell ,Emergency Medicine ,medicine.symptom ,business ,medicine.drug - Abstract
INTRODUCTION Sepsis is a life-threatening syndrome which can progress to multiple organ dysfunction with high mortality. Intestinal barrier failure exerts a central role in the pathophysiological sequence of events that lead from sepsis to multiple organ dysfunction. The present study investigated the role of hydrocortisone (HC) administration and fecal microbiota transplantation (FMT) in several parameters of the gut barrier integrity, immune activation, and survival, in a model of polymicrobial sepsis in rats. METHODS Forty adults male Wistar rats were randomly divided into four groups: sham (group I), cecal ligation and puncture (CLP) (group II), CLP + HC (2.8 mg/kg, intraperitoneally single dose at 6 h) (group III), and CLP + FMT at 6 h (group IV). At 24 h post-CLP, ileal tissues were harvested for histological and immunohistochemical analyses while endotoxin, IL-6, and IL-10 levels in systemic circulation were determined. In a second experiment the same groups were observed for 7 days for mortality, with daily administration of hydrocortisone (group III) and FMT (group IV) in surviving rats. RESULTS HC administration and FMT significantly reduced mortality of septic rats by 50%. These interventions totally reversed intestinal mucosal atrophy by increasing villous density and mucosal thickness (μm, mean ± SD: Group I: 620 ± 35, Group II: 411 ± 52, Group III: 622 ± 19, Group IV: 617 ± 44). HC and FMT reduced the apoptotic body count in intestinal crypts whereas these increased the mitotic/apoptotic index. Activated caspase-3 expression in intestinal crypts was significantly reduced by HC or FMT (activated caspase-3 (+) enterocytes/10 crypts, mean ± SD: Group I: 1.6 ± 0.5, Group II: 5.8 ± 2.4, Group III: 3.6 ± 0.9, Group IV: 2.3 ± 0.6). Both treatments increased Paneth cell count and decreased intraepithelial CD3(+) T lymphocytes and inflammatory infiltration of lamina propria to control levels. In the sham group almost the total of intestinal epithelial cells expressed occludin (92 ± 8%) and claudin-1 (98 ± 4%) and CLP reduced this expression to 34 ± 12% for occludin and 35 ± 7% for claudin-1. Administration of HC significantly increased occludin (51 ± 17%) and claudin-1 (77 ± 9%) expression. FMT exerted also a significant restoring effect in tight junction by increasing occludin (56 ± 15%) and claudin-1 (84 ± 7%) expression. The beneficial effects of these treatments on gut barrier function led to significant reduction of systemic endotoxemia (EU/mL, mean ± SD: Group I: 0.93 ± 0.36, Group II: 2.14 ± 1.74, Group III: 1.48 ± 0.53, Group IV: 1.61 ± 0.58), while FMT additionally decreased IL-6 and IL-10 levels. CONCLUSION Fecal microbiota transplantation and stress dose hydrocortisone administration in septic rats induce a multifactorial improvement of the gut mechanical and immunological barriers, preventing endotoxemia and leading to improved survival.
- Published
- 2020
32. Continuous positive airway pressure in the treatment of COVID-19 patients with respiratory failure. A report of six cases with excellent outcome
- Author
-
Dimitrios Velissaris, Charalambos Gogos, Konstantinos Tsiotsios, Diamanto Aretha, and Vasileios Karamouzos
- Subjects
Pulmonary and Respiratory Medicine ,Male ,Oxygen inhalation therapy ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Continuous Positive Airway Pressure ,Greece ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,medicine.medical_treatment ,Oxygen Inhalation Therapy ,COVID-19 ,Middle Aged ,Respiratory failure ,Anesthesia ,Medicine ,Humans ,Female ,Continuous positive airway pressure ,business ,Respiratory Insufficiency ,Aged - Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently considered a significant threat to global health and global economy. This new rapidly spreading virus causes enormous stress to healthcare systems as large number of patients present with respiratory failure, needing intubation and mechanical ventilation. While the industry is racing to meet the rising demand for ventilators, all the alternative respiratory support modalities are employed to save lives in hospitals around the globe. We hereby report 6 patients who were diagnosed with SARS-CoV-2 and treated with continuous positive airway pressure in a negative pressure isolated room in a tertiary center in western Greece. The rapid progression of mild flu-like symptoms to respiratory failure in all patients was controlled with the use of continuous positive airway pressure making this strategy a reasonable alternative to respiratory failure due to SARS-CoV-2 as it may avert intubation and mechanical ventilation.
- Published
- 2020
33. Gut-origin sepsis in the critically ill patient: pathophysiology and treatment
- Author
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Christos Triantos, Fotini Fligou, Konstantinos Thomopoulos, Ioannis Maroulis, Markos Marangos, Stelios F Assimakopoulos, and Charalambos Gogos
- Subjects
Microbiology (medical) ,Critical Illness ,Multiple Organ Failure ,Proinflammatory cytokine ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Animals ,Humans ,Lung ,Intestinal permeability ,business.industry ,Zonulin ,030208 emergency & critical care medicine ,General Medicine ,medicine.disease ,Pathophysiology ,Gastrointestinal Microbiome ,Systemic inflammatory response syndrome ,Intestinal Diseases ,Infectious Diseases ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Immunology ,Multiple organ dysfunction syndrome ,business ,Biomarkers - Abstract
Gut permeability is increased in critically ill patients, and associated with the development of the systemic inflammatory response syndrome and multiple organ dysfunction syndrome (MODS). The pathogenetic link(s) and potential therapies are an area of intense research over the last decades. We thoroughly reviewed the literature on gut-origin sepsis and MODS in critically ill patients, with emphasis on the implicated pathophysiological mechanisms and therapeutic interventions. Intestinal barrier failure leading to systemic bacterial translocation associated with MODS was the predominant pathophysiological theory for several years. However, clinical studies with critically ill patients failed to provide the evidence of systemic spread of gut-derived bacteria and/or their products as a cause of MODS. Newer experimental data highlight the role of the mesenteric lymph as a carrier of gut-derived danger-associated molecular patterns (DAMPs) to the lung and the systemic circulation. These substances are recognized by pattern recognition receptor-bearing cells in diverse tissues and promote proinflammatory pathways and the development MODS. Therefore, the gut becomes a pivotal proinflammatory organ, driving the systemic inflammatory response through DAMPs release in mesenteric lymph, without the need for systemic bacterial translocation. There is an emerging need for application of sensitive non-invasive and easily measured biomarkers of early intestinal injury (e.g., citrulline, intestinal fatty acid protein, and zonulin) in our everyday clinical practice, guiding the early pharmacological intervention in critically ill patients to restore or prevent intestinal injury and improve their outcomes.
- Published
- 2018
34. Reduced circulating B cells and plasma IgM levels are associated with decreased survival in sepsis - A meta-analysis
- Author
-
Sarah L. Maier, Maximilian Brunner, Christian Krautz, Evangelos J. Giamarellos-Bourboulis, Georg F. Weber, Robert Grützmann, Apostolos Armaganidis, Charalambos Gogos, Frank Kunath, and Melanie Langheinrich
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Critical Care ,Inflammation ,Critical Care and Intensive Care Medicine ,Gastroenterology ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Web of knowledge ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,B cell ,B-Lymphocytes ,biology ,business.industry ,030208 emergency & critical care medicine ,medicine.disease ,Confidence interval ,030104 developmental biology ,medicine.anatomical_structure ,Immunoglobulin M ,Meta-analysis ,biology.protein ,Antibody ,medicine.symptom ,business ,Biomarkers - Abstract
Background B cell function and antibody production are crucial factors in host protection during inflammation. We aimed to synthesize the available evidence on the association between the reduction of circulating B cells and plasma immunoglobulin (IgM) levels and decreased survival during sepsis. Methods We performed a systematic search in PubMed, Embase, ISI Web of Knowledge, Cochrane Central Register of Controlled Trials, BioMed Central, and Science Direct. We selected studies with data on circulating B cells and plasma IgM levels within the initial 24 h after sepsis onset. Results In total nine studies (n = 992 patients) were identified. Circulating B cells were reduced in septic patients as compared to non-septic patients (mean difference [MD] −88.2 cells/μl; 95% confidence interval [CI] −148.6–−27.9). Sepsis non-survivors showed a significant reduction of circulating B cells and IgM levels compared to sepsis survivors (MD −77.1 cells/μl; 95% CI −111.4–−42.7 and MD −20.9 mg/dl; 95% CI −33.8–−8.0, respectively). Conclusions Our results suggest that a reduction of circulating B cells and IgM levels at sepsis onset are associated with decreased sepsis survival. However, due to methodological limitations and the risk of bias, we need further prospective studies to confirm this association. Registration The protocol was registered (PROSPERO 2016:CRD42016053184).
- Published
- 2018
35. Renal vein thrombosis complicating severe acute pyelonephritis with renal abscesses and associated bacteraemia caused by extended-spectrum beta-lactamase producing Escherichia coli
- Author
-
Stelios F Assimakopoulos, Charalambos Gogos, Markos Marangos, and Pantelis Kraniotis
- Subjects
Nephrology ,medicine.medical_specialty ,Carbapenem ,business.industry ,030232 urology & nephrology ,Renal vein thrombosis ,Case Report ,General Medicine ,biochemical phenomena, metabolism, and nutrition ,Fosfomycin ,bacterial infections and mycoses ,medicine.disease ,Meropenem ,Gastroenterology ,Thrombosis ,Renal Abscess ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,030212 general & internal medicine ,Renal vein ,business ,medicine.drug - Abstract
Acute pyelonephritis might be complicated by the formation of renal and perirenal abscesses and very rarely by renal vein thrombosis, which is a life-threatening condition. The main causative agents of acute pyelonephritis are enterobacteriaceae with the incidence of extended-spectrum beta-lactamase (ESBL)-producing strains increasing worldwide. We present the case of a 71-year-old Greek man with history of diabetes mellitus and recent hospitalization, who suffered from severe pyelonephritis with renal abscesses formation and associated bacteraemia caused by ESBL-producing Escherichia coli, complicated by extensive thrombosis of the ipsilateral renal vein and its branches, protruding also in the inferior venal cava. Our patient was effectively treated with anticoagulants and targeted antibiotic therapy, respectively, consisted of low molecular weight heparin transitioned to oral acenocoumarol for 3 months and 2-week course of intravenous meropenem followed by oral fosfomycin for additional 3 weeks as quidded by clinical and computed tomographic follow-up. In conclusion, in complicated urinary infections, caused by ESBL-producing enterobacteriaceae, oral fosfomycin might represent an effective option for step-down therapy of carbapenems, allowing the shortness of the duration of patient’s hospitalization and carbapenem use.
- Published
- 2018
36. Ketamine in COVID‐19 patients: Thinking out of the box
- Author
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Athanasios Gogos, Charalambos Gogos, Charalambos Papageorgiou, Karolina Akinosoglou, and Elias Angelopoulos
- Subjects
2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Mental Disorders ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,COVID-19 ,Virology ,COVID-19 Drug Treatment ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,Humans ,Medicine ,Ketamine ,030211 gastroenterology & hepatology ,030212 general & internal medicine ,business ,Letter to the Editor ,Depression (differential diagnoses) ,medicine.drug - Published
- 2020
37. Coronavirus disease 2019 pandemic in Greece, February 26 – May 3, 2020: The first wave
- Author
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Andreas Mentis, Ioanna Magaziotou, Angelos Pefanis, Charalambos Gogos, Symeon Metallidis, Antonia Koutsoukou, Anastasia Andreopoulou, Kassiani Gkolfinopoulou, Elisavet Mouratidou, Athanasios Tsakris, Theano Georgakopoulou, Anastasia Stathakarou, Androula Pavli, George Ferentinos, Anna Papa, Markos Marangos, Anastasios Chrysochoou, Nikolaos V. Sipsas, Anastasia Antoniadou, Helena C. Maltezou, Kalliopi Papadima, Kassiani Mellou, Anastasia Kotanidou, Rengina Vorou, and Angeliki Karaiskou
- Subjects
Male ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Comorbidity ,Correspondence ,Pandemic ,Epidemiology ,Humans ,Medicine ,Pandemics ,Greece ,SARS-CoV-2 ,business.industry ,pandemic ,Public Health, Environmental and Occupational Health ,COVID-19 ,Virology ,Hospitalization ,co-morbidities ,Infectious Diseases ,Female ,Co morbidity ,Contact Tracing ,business ,Contact tracing - Published
- 2021
38. Lactate serum concentrations during treatment with nucleos(t)ide analogues in hepatitis B with or without cirrhosis
- Author
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Konstantinos Thomopoulos, Georgia Vourli, Giorgos Tsiaoussis, Charalambos Gogos, Dimitra Taprantzi, Christos Triantos, Martha Mandellou, Maria Kalafateli, Ioanna Aggeletopoulou, Evangelos D. Anastassiou, Paraskevi Tselekouni, Stelios F Assimakopoulos, and Chrisoula Labropoulou-Karatza
- Subjects
Adult ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,Guanine ,Time Factors ,Cirrhosis ,Organophosphonates ,Antiviral Agents ,Gastroenterology ,Young Adult ,03 medical and health sciences ,Hepatitis B, Chronic ,Sex Factors ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Lactic Acid ,Prospective Studies ,030212 general & internal medicine ,Tenofovir ,Prospective cohort study ,Aged ,Acidosis ,Aged, 80 and over ,Hepatology ,business.industry ,Adenine ,Lamivudine ,Entecavir ,Middle Aged ,Hepatitis B ,medicine.disease ,Up-Regulation ,Treatment Outcome ,Hepatocellular carcinoma ,Lactic acidosis ,Acidosis, Lactic ,Drug Therapy, Combination ,Female ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Biomarkers ,medicine.drug - Abstract
Objective The aim of this study is to evaluate the clinical implications of lactate concentrations in patients with hepatitis B with or without cirrhosis during treatment with nucleos(t)ide analogues. Patients and methods One hundred and seven consecutive patients with chronic hepatitis B and median age 57 (24-85) years were prospectively included. Lactate concentrations were measured at baseline and at 12, 24, 36, 48, and 60 months following the baseline measurements. Eight (n=8, 7.5%) patients received lamivudine, 38 (n=38, 35.5%) patients received tenofovir, 34 (n=34, 31.8%) patients received entecavir, and 27 (n=27, 25.2%) patients received combined therapy. Results None of the patients developed lactic acidosis during follow-up [median: 58 (6-155) months]. Overall, no trends of the lactic acid evolution were observed over time; however, there was a nonsignificant increasing trend in patients with cirrhosis up to 24 months of treatment. This increasing trend was significant in female patients with cirrhosis (P=0.016). The age of the patients, the presence of cirrhosis, and hepatocellular carcinoma were strongly associated with the survival of all patients. In the group of cirrhotic patients, the only independent prognostic factor that was associated with patients' survival was the Child-Pugh class. Conclusion None of the patients developed lactic acidosis. There is an indication of an increasing trend of lactic acid levels up to 24 months of therapy in female cirrhotic patients.
- Published
- 2017
39. Prognostic Models for Survival in Patients with Stable Cirrhosis: A Multicenter Cohort Study
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Georgia Diamantopoulou, Cristina Rigamonti, Konstantinos Zisimopoulos, Aikaterini Georgiou, Georgia Vourli, Christos Triantos, Maria Kalafateli, Charalambos Gogos, Spilios Manolakopoulos, Evangelos Akriviadis, Chryssoula Lambropoulou-Karatza, Emmanuel Tsochatzis, John Goulis, Emanuel K. Manesis, Giota Touloumi, and Konstantinos Thomopoulos
- Subjects
Liver Cirrhosis ,Male ,medicine.medical_specialty ,Cirrhosis ,Physiology ,Models, Biological ,Gastroenterology ,Cohort Studies ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,In patient ,Internal validation ,Prognostic models ,Aged ,business.industry ,Proportional hazards model ,Middle Aged ,Hepatology ,Prognosis ,medicine.disease ,Survival Analysis ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,business ,Cohort study - Abstract
Two models are mostly used to predict survival in cirrhosis: the Child–Pugh score (CP score) and the model for end-stage liver disease score (MELD score). The aim of this study is to evaluate the CP score and the MELD score for short- and long-term prognosis in cirrhosis, as well as CP-creatinine score, MELD-Na score, and UKELD score. One thousand and forty-seven patients from five referral centers were included: men/women: 620/427, median age: 58 years (IQR 48–66), median follow-up: 33 months (IQR 12–74), CP (A/B/C): 493/357/147, CP score: 7 (IQR 5–9), MELD score: 12 (IQR 9–16). The performance of each score was evaluated by the Cox hazard model in terms of their: discrimination ability (C-index and Somer’s D) and calibration (3, 12 months). Internal validation was done with bootstrapping (100 samples). Three hundred and fifty-two patients (33.6%) died. All scores were significantly associated with overall mortality, when assessed by univariate Cox analysis. CP-creatinine score performed significantly better than all other scores [bootstrap C-index 0.672, 95% CI 0.642–0.703, bootstrap Somer’s D 0.344 (0.285–0.401)], apart from CP score, which showed similar performance. Inclusion in the multivariable Cox model of age together with CP-creatinine score improved the discriminative ability of the model [bootstrap C-index (95% CI) 0.700 (0.661–0.740)]. In terms of calibration, CP-creatinine score was the best for both 3- and 12-month survival in the total population. CP score and CP-creatinine score have better prognostic value compared to MELD score, MELD-Na score, and UKELD score for predicting short- and long-term mortality in patients with stable cirrhosis.
- Published
- 2017
40. Could the Quick Sequential Organ Failure Assessment Predictive Accuracy Be Affected by Site of Infection?
- Author
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Christos Davoulos, Christina-Panagiota Koutsouri, Charalambos Gogos, Vasiliki Niarou, Martha Kolosaka, Foteini Kosmopoulou, Dimitrios Ziazias, Anne-Lise deLastic, Karolina Akinosoglou, and Spyridoula Theodoraki
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Sequential organ failure assessment ,business.industry ,medicine ,Critical Care and Intensive Care Medicine ,Intensive care medicine ,business - Published
- 2020
41. Randomized, controlled, multicentre clinical trial of the antipyretic effect of intravenous paracetamol in patients admitted to hospital with infection
- Author
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Karolina Akinosoglou, Nikolaos Tsokos, Georgios‐Stefanos Soumelas, Thomas Tsaganos, Ioulia K. Tseti, Evangelos J. Giamarellos-Bourboulis, Nikolaos Tziolos, Athina Pyrpasopoulou, Styliani Sympardi, Marina Koupetori, Asterios Karagiannis, and Charalambos Gogos
- Subjects
Adult ,Male ,Antipyretics ,Time Factors ,paracetamol ,Infections ,Placebo ,law.invention ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Double-Blind Method ,Randomized controlled trial ,law ,medicine ,Clinical endpoint ,Humans ,Clinical Trials ,Pharmacology (medical) ,030212 general & internal medicine ,Antipyretic ,Adverse effect ,Acetaminophen ,Aged ,fever ,Pharmacology ,Creatinine ,hepatic metabolism ,business.industry ,digestive, oral, and skin physiology ,030208 emergency & critical care medicine ,Middle Aged ,Hospitalization ,Clinical trial ,Treatment Outcome ,chemistry ,Anesthesia ,Administration, Intravenous ,Female ,business ,Follow-Up Studies ,medicine.drug - Abstract
Aim No randomized study has been conducted to investigate the use of intravenous paracetamol (acetaminophen, APAP) for the management of fever due to infection. The present study evaluated a new ready-made infusion of paracetamol. Methods Eighty patients with a body temperature onset ≥38.5°C in the previous 24 h due to infection were randomized to a single administration of placebo (n = 39) or 1 g paracetamol (n = 41), and their temperature was recorded at standard intervals. Rescue medication with 1 g paracetamol was allowed. Serum samples were collected for the measurement of APAP and its metabolites. The primary endpoint was defervescence, defined as a core temperature ≤37.1°C. Results During the first 6 h, defervescence was achieved in 15 (38.5%) patients treated with placebo compared with 33 (80.5%) patients treated with paracetamol 1 g (P < 0.0001). The median time to defervescence with paracetamol 1 g was 3 h. Rescue medication was given to 15 (38.5%) and five (12.2%) patients allocated to placebo and paracetamol, respectively (P = 0.007); nine (60.0%) and two (40.0%) of these patients, respectively, experienced defervescence. No further antipyretic medication was needed for patients becoming afebrile with rescue medication. Serum glucuronide-APAP concentrations were significantly greater in the serum of patients who did not experience defervescence with paracetamol. The efficacy of paracetamol was not affected by serum creatinine. No drug-related adverse events were reported. Conclusions The 1 g paracetamol formulation has a rapid and sustainable antipyretic effect on fever due to infection. Its efficacy is dependent on hepatic metabolism.
- Published
- 2016
42. Survival benefit associated with clarithromycin in severe community-acquired pneumonia: A matched comparator study
- Author
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Dimitrios Sinapidis, Stamatios Halvatzis, Aggelos Stefos, Evdoxia Kyriazopoulou, Malvina Lada, Pantelis Koutoukas, Vasilios Kosmas, Nikolaos Alexiou, Anna Makina, Aikaterini Kyprianou, Michael S. Niederman, Anna Kyriakoudi, Maria Pavlaki, Charalambos Gogos, Evangelos J. Giamarellos-Bourboulis, Dimitrios Velissaris, Maria-Evangelia Adami, and Miltiades Kyprianou
- Subjects
0301 basic medicine ,Microbiology (medical) ,Male ,medicine.medical_specialty ,030106 microbiology ,Azithromycin ,beta-Lactams ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Community-acquired pneumonia ,Clarithromycin ,Internal medicine ,polycyclic compounds ,Clinical endpoint ,medicine ,Pneumonia, Bacterial ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Aged ,Aged, 80 and over ,business.industry ,Mortality rate ,Hazard ratio ,Retrospective cohort study ,General Medicine ,biochemical phenomena, metabolism, and nutrition ,Middle Aged ,bacterial infections and mycoses ,medicine.disease ,Anti-Bacterial Agents ,Community-Acquired Infections ,Pneumonia ,Infectious Diseases ,Treatment Outcome ,Female ,Macrolides ,business ,medicine.drug ,Fluoroquinolones - Abstract
Although analysis of retrospective studies has documented survival benefit from the addition of a macrolide to the treatment regimen for community-acquired pneumonia (CAP), no data are available to determine if there is differential efficacy between members of the macrolide family. In order to investigate this, an analysis was undertaken of data from 1174 patients with CAP who met the new Sepsis-3 definitions and were enrolled prospectively in the data registry of the Hellenic Sepsis Study Group. Four well-matched treatment groups were identified with 130 patients per group: clarithromycin and β-lactam; azithromycin and β-lactam; respiratory fluoroquinolone and β-lactam monotherapy. The primary endpoint was comparison of the effects of clarithromycin with β-lactam monotherapy on 28-day mortality. The secondary endpoint was resolution of CAP. Mortality rates for the clarithromycin, azithromycin, respiratory fluoroquinolone and β-lactam groups were 20.8%, 33.8% (P=0.026 vs clarithromycin), 32.3% (P=0.049 vs clarithromycin) and 36.2% (P=0.009 vs clarithromycin), respectively. After stepwise Cox regression analysis among all groups, clarithromycin was the only treatment modality associated with a favourable outcome (hazard ratio 0.61; P=0.021). CAP resolved in 73.1%, 65.9% (P=0.226 vs clarithromycin), 58.5% (P=0.009 vs clarithromycin) and 61.5% (P=0.046 vs clarithromycin) of patients, respectively. It is concluded that the addition of clarithromycin to the treatment regimen of patients with severe CAP leads to better survival rates.
- Published
- 2019
43. Long-term evolution of CD4+ cell count in patients under combined antiretroviral therapy
- Author
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Periklis Panagopoulos, Nikos Pantazis, Nikolaos V. Sipsas, Charalambos Gogos, Vasilios Paparizos, Giota Touloumi, Mina Psichogiou, Helen Sambatakou, Anastasia Antoniadou, Maria Giovanna Chini, Vasilios Papastamopoulos, Achilleas Gikas, Simeon Metallidis, Georgios Adamis, Georgios Chrysos, Olga Katsarou, and Amacs
- Subjects
0301 basic medicine ,Cart ,Adult ,Male ,medicine.medical_specialty ,Design data ,Immunology ,Viremia ,HIV Infections ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Antiretroviral Therapy, Highly Active ,medicine ,Antiretroviral treatment ,Immunology and Allergy ,Humans ,In patient ,030212 general & internal medicine ,Longitudinal Studies ,Cd4 cell count ,business.industry ,virus diseases ,Middle Aged ,Viral Load ,medicine.disease ,Antiretroviral therapy ,CD4 Lymphocyte Count ,030104 developmental biology ,Infectious Diseases ,Treatment Outcome ,Anti-Retroviral Agents ,Female ,business ,Viral load - Abstract
Objective Combined antiretroviral treatment (cART) results in profound immunologic improvement, but it is unclear whether CD4 cell counts return to levels similar to those of HIV-negative individuals. We explore long-term CD4 cell count evolution post-cART and its association with baseline levels, virologic suppression, pre-cART cumulative viremia and other factors. Design Data were derived from the AMACS. Included individuals were adults who started cART, at least 2003, while previously ART-naive. Methods Changes in CD4 cell counts were modeled through piecewise linear mixed models. Results A total of 3405 individuals were included. The majority was male (86.0%), homosexual (58.8%) with median (IQR) age at cART initiation 36 (31-44) years and a median (IQR) follow-up of 3.9 (2.0-6.9) years. Most persons (57%) starting cART with less than 200 cells/μl did not reach 600 cells/μl after 7 years of treatment. Those starting cART with 200-349 CD4 cells/μl could reach 600 cells/μl within less than 2 years of fully suppressive treatment. Probability of CD4 normalization (i.e. >800 cells/μl) after 7 years of suppressive treatment was 24 and 46% for those starting treatment with less than 200 or 200-349 CD4 cells/μl, respectively. Lower pre-cART cumulative viremia was associated with faster CD4 recovery. CD4 cell count increases after 4 years were either insignificant or very slow, irrespectively of baseline levels. Conclusion cART initiation before CD4 cell count drops below 350 cells/μl is crucial for achieving normal CD4 levels. These findings underline the importance of timely diagnosis and cART initiation as the risk of both AIDS and non-AIDS-related morbidity/mortality remains increased in patients with incomplete CD4 recovery.
- Published
- 2019
44. Triple combination therapy with high-dose ampicillin/sulbactam, high-dose tigecycline and colistin in the treatment of ventilator-associated pneumonia caused by pan-drug resistant Acinetobacter baumannii: a case series study
- Author
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Stelios F, Assimakopoulos, Vassilis, Karamouzos, Aikaterini, Lefkaditi, Christina, Sklavou, Fevronia, Kolonitsiou, Mirto, Christofidou, Fotini, Fligou, Charalambos, Gogos, and Markos, Marangos
- Subjects
Acinetobacter baumannii ,Adult ,Aged, 80 and over ,Male ,Colistin ,Pneumonia, Ventilator-Associated ,Middle Aged ,Combined Modality Therapy ,Tigecycline ,Anti-Bacterial Agents ,Intensive Care Units ,Sulbactam ,Drug Resistance, Multiple, Bacterial ,Administration, Inhalation ,Injections, Intravenous ,Humans ,Ampicillin ,Female ,Aged ,Retrospective Studies - Abstract
Acinetobacter baumannii has evolved in recent decades as a major problem in carbapenem-resistant gram-negative nosocomial infections, associated with high mortality rates especially in intensive care units (ICUs). Recent reports highlight the increasing prevalence of resistance to colistin, a last resort therapeutic option for carbapenem-resistant A. baumannii. We retrospectively evaluated the potential efficacy, in terms of clinical and microbiological cure and mortality, of a combination of intravenous colistin and high-dose ampicillin/sulbactam and high-dose tigecycline, concurrently administered with inhaled colistin, in 10 ICU patients with ventilator-associated pneumonia (VAP) caused by carbapenem- and colistin-resistant A. baumannii strains, with high tigecycline MICs2μg/mL. Nine patients (90%) exhibited a successful clinical outcome, accompanied by microbiological eradication in seven of them. All clinically cured patients survived at 14 and 28 days. Acute kidney injury (AKI) was observed in one patient. In view of the increasing prevalence of pan-drug resistant A. baumannii infections in ICUs, its associated high rates of mortality and the lack of effective treatment options, we feel that there is an emerging need for our results to be further validated in larger prospective studies.
- Published
- 2019
45. Diabetes on sepsis outcomes in non-ICU patients: A cohort study and review of the literature
- Author
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Maria Mouktaroudi, Charalambos Gogos, Karolina Akinosoglou, Georgia Kapsokosta, Evangelos J. Giamarellos-Bourboulis, Marina Kontogiorgi, Nikoletta Rovina, Vassileios Kaldis, and Aggelos Stefos
- Subjects
Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Type 2 diabetes ,030204 cardiovascular system & hematology ,Malignancy ,Cohort Studies ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Internal medicine ,Diabetes mellitus ,Internal Medicine ,medicine ,Humans ,Aged ,Cause of death ,Aged, 80 and over ,APACHE II ,business.industry ,Septic shock ,Prognosis ,medicine.disease ,Shock, Septic ,Intensive Care Units ,Diabetes Mellitus, Type 2 ,Female ,business ,Cohort study - Abstract
Aims We sought to determine whether primary outcomes differ between non-ICU septic patients with and without type 2 diabetes (T2D). Methods This study utilized the Hellenic Sepsis Study Group Registry, collecting nationwide data for sepsis patients since 2006, and classified patients upon presence or absence of T2D. Patients were perfectly matched for a) Sepsis 3 definition criteria (including septic shock) b) gender, c) age, d) APACHE II score and e) Charlson's comorbidity index (CCI). Independent sample t-test and chi-square t-test was used to compare prognostic indices and primary outcomes. Results Of 4320 initially included non-ICU sepsis patients, 812 were finally analysed, following match on criteria. Baseline characteristics were age 76 [±10.3] years, 46% male, APACHE II 15.5 [±6], CCI 5.1 [±1.8], 24% infection, 63.8% sepsis and 12.2% septic shock. No significant difference was noted between two groups in qSOFA, SOFA, or suPAR1 levels (p = 0.7, 0.1 & 0.3) respectively. Primary sepsis syndrome resolved in 70.9% of cases (p = 0.9), while mortality was 24% in 28-days time. Cause of death was similar between patients with and without T2D (sepsis 17.8% vs 15.8%, heart event 3.7% vs 3.2%, CNS event 0.5% vs 0.5%, malignancy 0.7% vs 2% respectively, p = 0.6). Conclusions DM does not appear to negatively affect outcomes in septic patients not requiring ICU.
- Published
- 2021
46. Complex Immune Dysregulation in COVID-19 Patients with Severe Respiratory Failure
- Author
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Vassiliki Panou, Antigone Kotsaki, Mihai G. Netea, Vasileios Lekakis, Nikolaos Koulouris, Theologia Gkavogianni, George Renieris, Panagiotis Koufargyris, Antonia Koutsoukou, Georgia Damoraki, Konstantina Katrini, Maria Evangelia Adami, Nikoletta Rovina, Mihaela Lupse, Maria Ntaganou, Dimitrios Velissaris, George Dimopoulos, Nikolaos Antonakos, Karolina Akinosoglou, Ioannis Koutsodimitropoulos, Evangelos J. Giamarellos-Bourboulis, Evangelia Koukaki, Charalambos Gogos, Magdalini Kyriakopoulou, Paraskevi Katsaounou, Danai Theodoulou, Anastasia Antoniadou, and Athanassios Karageorgos
- Subjects
Male ,medicine.medical_treatment ,Pneumonia, Viral ,lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4] ,Inflammation ,Antibodies, Monoclonal, Humanized ,medicine.disease_cause ,Microbiology ,Monocytes ,03 medical and health sciences ,chemistry.chemical_compound ,All institutes and research themes of the Radboud University Medical Center ,0302 clinical medicine ,Immune system ,Tocilizumab ,Lymphopenia ,Virology ,medicine ,Humans ,Interleukin 6 ,Pandemics ,Aged ,030304 developmental biology ,0303 health sciences ,biology ,Interleukin-6 ,COVID-19 ,HLA-DR Antigens ,Macrophage Activation ,Immune dysregulation ,medicine.disease ,3. Good health ,Killer Cells, Natural ,Cytokine ,chemistry ,Macrophage activation syndrome ,Immunology ,biology.protein ,Female ,Parasitology ,Tumor necrosis factor alpha ,medicine.symptom ,Coronavirus Infections ,Respiratory Insufficiency ,030217 neurology & neurosurgery - Abstract
Proper management of COVID-19 mandates better understanding of disease pathogenesis. The sudden clinical deterioration 7-8 days after initial symptom onset suggests that severe respiratory failure (SRF) in COVID-19 is driven by a unique pattern of immune dysfunction. We studied immune responses of 54 COVID-19 patients, 28 of whom had SRF. All patients with SRF displayed either macrophage activation syndrome (MAS) or very low human leukocyte antigen D related (HLA-DR) expression accompanied by profound depletion of CD4 lymphocytes, CD19 lymphocytes, and natural killer (NK) cells. Tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) production by circulating monocytes was sustained, a pattern distinct from bacterial sepsis or influenza. SARS-CoV-2 patient plasma inhibited HLA-DR expression, and this was partially restored by the IL-6 blocker Tocilizumab; off-label Tocilizumab treatment of patients was accompanied by increase in circulating lymphocytes. Thus, the unique pattern of immune dysregulation in severe COVID-19 is characterized by IL-6-mediated low HLA-DR expression and lymphopenia, associated with sustained cytokine production and hyper-inflammation.
- Published
- 2020
47. Muscle fat infiltration assessed by total psoas density on computed tomography predicts mortality in cirrhosis
- Author
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Andreas Karatzas, Konstantinos Thomopoulos, Nikolaos Koukias, Paraskevi Tselekouni, Christos Triantos, Maria Kalafateli, Stelios F Assimakopoulos, Charalambos Gogos, Efstratios Koutroumpakis, Georgios I. Tsiaoussis, Christos Konstantakis, and Christina Kalogeropoulou
- Subjects
Sarcopenia ,medicine.medical_specialty ,Cirrhosis ,Gastroenterology ,03 medical and health sciences ,Liver disease ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,medicine ,Creatinine ,Proportional hazards model ,business.industry ,Hazard ratio ,medicine.disease ,Confidence interval ,nutrition ,analytic morphometry ,chemistry ,030220 oncology & carcinogenesis ,Original Article ,030211 gastroenterology & hepatology ,business ,Body mass index - Abstract
Background: Ongoing evidence suggests that sarcopenia adversely affects outcomes in cirrhosis. The aim of this study was to evaluate muscle fat infiltration as a component of sarcopenia and its prognostic value in this setting. Methods: In 98 consecutive patients with cirrhosis, muscle density was measured during a computed tomography scan at the level of the fourth to fifth lumbar (L4) vertebrae. Univariate and multivariate Cox regression analysis was used to determine predictors of survival. Results: Body mass index: median 26 (range 17-45.2); model for end-stage liver disease (MELD) score: median 11 (6-29); Child-Pugh (CP) score: median 7 (5-13), CP class: A=49 (50.5%), B=39 (40%), C=10 (9.5%); hepatocellular carcinoma: 14 (14.3%); follow up: median 45 (1-140) months. Median L4 total psoas area (TPA): 2022 (777-3806) mm2; L4 average total psoas density (ATPD): 42.52 (21.26-59.8) HU. ATPD was significantly correlated with age (r=-0.222, P=0.034), creatinine (r=-0.41, P
- Published
- 2018
48. Overexpression of CDT1 Is a Predictor of Poor Survival in Patients with Hepatocellular Carcinoma
- Author
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Ioannis Maroulis, Helen Papadaki, Dionissios Karavias, Charalambos Gogos, Vasiliki Bravou, Dimitrios Karavias, and Stavros K. Kakkos
- Subjects
Adult ,Male ,0301 basic medicine ,Genome instability ,Pathology ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,DNA damage ,medicine.medical_treatment ,Cell Cycle Proteins ,Cohort Studies ,DNA replication factor CDT1 ,03 medical and health sciences ,0302 clinical medicine ,Minichromosome maintenance ,Biomarkers, Tumor ,Humans ,Medicine ,Aged ,Aged, 80 and over ,biology ,business.industry ,Liver Neoplasms ,Gastroenterology ,Middle Aged ,Minichromosome Maintenance Complex Component 7 ,Prognosis ,medicine.disease ,Chromatin ,030104 developmental biology ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,embryonic structures ,Ataxia-telangiectasia ,biology.protein ,Cancer research ,Female ,Surgery ,Hepatectomy ,business - Abstract
Genomic instability is a common feature in hepatocellular carcinoma. Deregulation of replication licensing factors has been shown to trigger DNA damage response contributing to genomic instability. Overexpression of DNA replication licensing factors chromatin licensing and DNA replication factor 1 (CDT1) and minichromosome maintenance complex component 7 (MCM7) has been previously reported in several human cancers. The aim of the present study was to evaluate the expression and prognostic significance of CDT1 and MCM7 in association with DNA damage response markers and p53 in patients with hepatocellular carcinoma. Expression of CDT1, MCM7, p-H2A histone family member X (H2AX), phospho-ataxia telangiectasia-mutated (ATM)/ataxia telangiectasia rad3-related (ATR) substrate, and p53 was evaluated by immunohistochemistry on formalin-fixed paraffin-embedded surgical specimens from 111 patients who underwent hepatectomy for hepatocellular carcinoma. Statistical analysis was performed to evaluate associations between the studied proteins, clinicopathological parameters, and patient survival. CDT1 expression correlated with p-H2AX (p = 0.038), while MCM7 correlated with p-H2AX and phospho-ATM/ATR substrate (p
- Published
- 2015
49. Serum lipid profile, cytokine production, and clinical outcome in patients with severe sepsis
- Author
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Dimitrios Siagris, Alexandra Lekkou, Athanassia Mouzaki, Ifigenia Ravani, and Charalambos Gogos
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,Sepsis ,chemistry.chemical_compound ,High-density lipoprotein ,Transforming Growth Factor beta ,Internal medicine ,medicine ,Humans ,Hospital Mortality ,Prospective Studies ,Prospective cohort study ,Triglycerides ,Aged ,Predictive marker ,medicine.diagnostic_test ,Triglyceride ,Interleukin-6 ,Tumor Necrosis Factor-alpha ,business.industry ,Interleukin-8 ,Middle Aged ,medicine.disease ,Lipids ,Interleukin-10 ,Community-Acquired Infections ,Cholesterol ,Cytokine ,Endocrinology ,chemistry ,Cytokines ,Female ,lipids (amino acids, peptides, and proteins) ,Lipoproteins, HDL ,Lipid profile ,business ,Biomarkers ,Lipoprotein - Abstract
Purpose The purpose of the study is to evaluate the prevalence and clinical significance of hypolipidemia and the relationship to cytokine concentrations and outcomes in septic patients. Materials and methods A prospective study was undertaken including 50 patients with severe sepsis due to community-acquired infections. Serum concentrations of total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein as well as tumor necrosis factor α (TNF- α ), interleukin (IL) 6, IL-8, IL-10, and transforming growth factor (TGF) β 1 were determined on admission and days 3 and 10 during hospitalization. Results Of the 50 patients enrolled, 28 survived, whereas 22 died during their hospital stay. Sepsis survivors had significantly higher HDL-C concentrations than nonsurvivors, whereas all patients with HDL-C values greater than 25 mg/dL survived. Baseline levels of TGF- β 1 were significantly higher in survivors. High-density lipoprotein levels correlated inversely with TNF- α , IL-6, and IL-10 concentrations and positively with baseline TGF- β 1 levels. Independent risk factors of mortality were IL-10 levels on day 3, whereas HDL-C concentration on admission was related to survival. Conclusions Low cholesterol and lipoprotein concentrations are detected in septic patients, especially in individuals with poor outcome. High-density lipoprotein cholesterol concentration seems to be an early independent predictive marker of survival in severe sepsis.
- Published
- 2014
50. How well does qSOFA correspond to underlying systemic inflammatory response?
- Author
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Aikaterini Pistiki, Karolina Akinosoglou, Evangelos J. Giamarellos-Bourboulis, Theologia Gkavogianni, Spyridoula Theodoraki, and Charalambos Gogos
- Subjects
Adult ,Male ,medicine.medical_specialty ,Critical Care ,Organ Dysfunction Scores ,Inflammatory response ,Critical Illness ,Immunology ,Biochemistry ,Severity of Illness Index ,law.invention ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,law ,Immunology and Allergy ,Medicine ,Humans ,Medical ward ,Hospital Mortality ,Prospective Studies ,Intensive care medicine ,Molecular Biology ,Aged ,Aged, 80 and over ,Inflammation ,business.industry ,Interleukin-6 ,Tumor Necrosis Factor-alpha ,030208 emergency & critical care medicine ,Hematology ,Middle Aged ,medicine.disease ,Prognosis ,Intensive care unit ,Systemic Inflammatory Response Syndrome ,Interleukin-10 ,Systemic inflammatory response syndrome ,030228 respiratory system ,Observational study ,Female ,business - Abstract
Need for prompt recognition and management of sepsis recently led to the introduction of qSOFA score. However, its association with underlying host inflammatory response remains unclear, while previous studies have challenged its performance in non - intensive care unit (ICU) patients comparing to previously used systemic inflammatory response syndrome (SIRS) criteria. Between June 2016 and April 2017, we performed a prospective observational study in the medical ward of a tertiary hospital to explore the relation of qSOFA ≥ 2 and2 to underlying inflammatory response, as this is mirrored in levels of serum pro- and anti-inflammatory mediators i.e. IL-6, IL-10 and TNF-α. A total of 100 consecutive patients were finally included in this study. Comparable levels [(pg/ml) median (IQR)] of IL-6 [200 (53-200) vs 65.1 (17.3-200)], IL-10 [ 7 (2.3-170.6) vs 2.3 (2.3-27.7)], and TNF-α [4 (4-46.1) vs 46.06 (4-227.2)] were noted between group of patients with qSOFA ≥ 2 or2. Nevertheless, prognosis was worse in patients with qSOFA ≥ 2 showing longer length of stay [10 (7-25) vs 5 (3-7) days, p = .03] and lower recovery rates (41 vs 93%, p .0001). Our results underline the need for prompt management of critically ill patients in presence of systemic inflammatory response regardless of qSOFA score, partly reflecting its low sensitivity comparing to previously used SIRS criteria.
- Published
- 2017
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