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401. Apolipoprotein E ε4 Allele as a Genetic Risk Factor for Left Ventricular Failure in Homozygous β-Thalassemia

Author

Economou-Petersen, Effrosini, Aessopos, Athanassios, Kladi, Athina, Flevari, Panagiota, Karabatsos, Fotis, Fragodimitri, Christina, Nicolaidis, Peter, Vrettou, Helen, Vassilopoulos, Dimitris, Karagiorga-Lagana, Markissia, Kremastinos, Dimitrios Th., and Petersen, Michael B.

Abstract

In homozygous β-thalassemia, the organ damage is mainly attributed to excessive iron deposition through the formation of oxygen free radicals. Despite appropriate transfusion and chelation therapy and low ferritin levels, patients still develop organ failure, heart failure being the main cause of death. This study was designed to determine whether the decreased antioxidant activity of the apolipoprotein E (APOE) ε4 allele could represent a genetic risk factor for the development of left ventricular failure (LVF) in β-thalassemia homozygotes. A total of 251 Greek β-thalassemia homozygotes were studied. Patients were divided in three groups: group A (n = 151) with no cardiac impairment, group C (n = 47) with LVF, and 53 patients with LV dilatation and normal LV systolic function constituted the group B. DNA was obtained from all patients, and the polymerase chain reaction was used to analyze the polymorphism at the APOE locus. The APOE allele frequencies were compared with those of a Greek control sample of 216 healthy blood donors. Patients with no cardiac impairment had an APOE ε4 allele frequency (7.9%) not different from population controls (6.5%, P> .05), while patients with LVF had a significantly higher frequency of APOE ε4 (12.8%) than the controls (P< .05, odds ratio = 2.11, 95% confidence interval 1.03 to 4.32). The APOE ε4 allele may represent an important genetic risk factor for the development of organ damage in homozygous β-thalassemia.

Published
1998
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407. 37th International Symposium on Intensive Care and Emergency Medicine (part 2 of 3)

Author

Rob, D., Špunda, R., Lindner, J., Šmalcová, J., Šmíd, O., Kovárník, T., Linhart, A., Bìlohlávek, J., Marinoni, M. M., Cianchi, G., Trapani, S., Migliaccio, M. L., Gucci, L., Bonizzoli, M., Cramaro, A., Cozzolino, M., Valente, S., Peris, A., Grins, E., Kort, E., Weiland, M., Shresta, N. Manandhar, Davidson, P., Algotsson, L., Fitch, S., Marco, G., Sturgill, J., Lee, S., Dickinson, M., Boeve, T., Khaghani, A., Wilton, P., Jovinge, S., Ahmad, A. N., Loveridge, R., Vlachos, S., Patel, S., Gelandt, E., Morgan, L., Butt, S., Whitehorne, M., Kakar, V., Park, C., Hayes, M., Willars, C., Hurst, T., Best, T., Vercueil, A., Auzinger, G., Adibelli, B., Akovali, N., Torgay, A., Zeyneloglu, P., Pirat, A., Kayhan, Z., Schmidbauer, S. S., Herlitz, J., Karlsson, T., Friberg, H., Knafelj, R., Radsel, P., Duprez, F., Bonus, T., Cuvelier, G., Mashayekhi, S., Maka, M., Ollieuz, S., Reychler, G., Mosaddegh, R., Abbasi, S., Talaee, S., Zotzmann, V. Z., Staudacher, D. S., Wengenmayer, T. W., Dürschmied, D. D., Bode, C. B., Nelskylä, A., Nurmi, J., Jousi, M., Schramko, A., Mervaala, E., Ristagno, G., Skrifvars, M., Ozsoy, G., Kendirli, T., Azapagasi, E., Perk, O., Gadirova, U., Ozcinar, E., Cakici, M., Baran, C., Durdu, S., Uysalel, A., Dogan, M., Ramoglu, M., Ucar, T., Tutar, E., Atalay, S., Akar, R., Kamps, M., Leeuwerink, G., Hofmeijer, J., Hoiting, O., Van der Hoeven, J., Hoedemaekers, C., Konkayev, A., Kuklin, V., Kondratyev, T., Konkayeva, M., Akhatov, N., Sovershaev, M., Tveita, T., Dahl, V., Wihersaari, L., Skrifvars, M. B., Bendel, S., Kaukonen, K. M., Vaahersalo, J., Romppanen, J., Pettilä, V., Reinikainen, M., Lybeck, A., Cronberg, T., Nielsen, N., Rauber, M., Steblovnik, K., Jazbec, A., Noc, M., Kalasbail, P., Garrett, F., Kulstad, E., Bergström, D. J., Olsson, H. R., Schmidbauer, S., Mandel, I., Mikheev, S., Podoxenov, Y., Suhodolo, I., Podoxenov, A., Svirko, J., Sementsov, A., Maslov, L., Shipulin, V., Vammen, L. V., Rahbek, S. R., Secher, N. S., Povlsen, J. P., Jessen, N. J., Løfgren, B. L., Granfeldt, A. G., Grossestreuer, A., Perman, S., Patel, P., Ganley, S., Portmann, J., Cocchi, M., Donnino, M., Nassar, Y., Fathy, S., Gaber, A., Mokhtar, S., Chia, Y. C., Lewis-Cuthbertson, R., Mustafa, K., Sabra, A., Evans, A., Bennett, P., Eertmans, W., Genbrugge, C., Boer, W., Dens, J., De Deyne, C., Jans, F., Skorko, A., Thomas, M., Casadio, M., Coppo, A., Vargiolu, A., Villa, J., Rota, M., Avalli, L., Citerio, G., Moon, J. B., Cho, J. H., Park, C. W., Ohk, T. G., Shin, M. C., Won, M. H., Papamichalis, P., Zisopoulou, V., Dardiotis, E., Karagiannis, S., Papadopoulos, D., Zafeiridis, T., Babalis, D., Skoura, A., Staikos, I., Komnos, A., Passos, S. Silva, Maeda, F., Souza, L. Silva, Filho, A. Amato, Granjeia, T. Araújo Guerra, Schweller, M., Franci, D., De Carvalho Filho, M., Santos, T. Martins, De Azevedo, P., Wall, R., Welters, I., Tansuwannarat, P., Sanguanwit, P., Langer, T., Carbonara, M., Caccioppola, A., Fusarini, C. Ferraris, Carlesso, E., Paradiso, E., Battistini, M., Cattaneo, E., Zadek, F., Maiavacca, R., Stocchetti, N., Pesenti, A., Ramos, A., Acharta, F., Toledo, J., Perezlindo, M., Lovesio, L., Dogliotti, A., Lovesio, C., Schroten, N., Van der Veen, B., De Vries, M. C., Veenstra, J., Abulhasan, Y. B., Rachel, S., Châtillon-Angle, M., Alabdulraheem, N., Schiller, I., Dendukuri, N., Angle, M., Frenette, C., Lahiri, S., Schlick, K., Mayer, S. A., Lyden, P., Akatsuka, M., Arakawa, J., Yamakage, M., Rubio, J., Mateo-Sidron, J. A. Rubio, Sierra, R., Celaya, M., Benitez, L., Alvarez-Ossorio, S., Fernandez, A., Gonzalez, O., Engquist, H., Rostami, E., Enblad, P., Canullo, L., Nallino, J., Perreault, M., Talic, J., Frenette, A. J., Burry, L., Bernard, F., Williamson, D. R., Adukauskiene, D., Cyziute, J., Adukauskaite, A., Malciene, L., Luca, L., Rogobete, A., Bedreag, O., Papurica, M., Sarandan, M., Cradigati, C., Popovici, S., Vernic, C., Sandesc, D., Avakov, V., Shakhova, I., Trimmel, H., Majdan, M., Herzer, G. H., Sokoloff, C. S., Albert, M., Williamson, D., Odier, C., Giguère, J., Charbonney, E., Husti, Z., Kaptás, T., Fülep, Z., Gaál, Z., Tusa, M., Donnelly, J., Aries, M., Czosnyka, M., Robba, C., Liu, M., Ercole, A., Menon, D., Hutchinson, P., Smielewski, P., López, R., Graf, J., Montes, J. M., Kenawi, M., Kandil, A., Husein, K., Samir, A., Heijneman, J., Huijben, J., Abid-Ali, F., Stolk, M., Van Bommel, J., Lingsma, H., Van der Jagt, M., Cihlar, R. C., Mancino, G., Bertini, P., Forfori, F., Guarracino, F., Pavelescu, D., Grintescu, I., Mirea, L., Alamri, S., Tharwat, M., Kono, N., Okamoto, H., Uchino, H., Ikegami, T., Fukuoka, T., Simoes, M., Trigo, E., Coutinho, P., Pimentel, J., Franci, A., Basagni, D., Boddi, M., Anichini, V., Cecchi, A., Markopoulou, D., Venetsanou, K., Papanikolaou, I., Barkouri, T., Chroni, D., Alamanos, I., Cingolani, E., Bocci, M. G., Pisapia, L., Tersali, A., Cutuli, S. L., Fiore, V., Palma, A., Nardi, G., Antonelli, M., Coke, R., Kwong, A., Dwivedi, D. J., Xu, M., McDonald, E., Marshall, J. C., Fox-Robichaud, A. E., Liaw, P. C., Kuchynska, I., Malysh, I. R., Zgrzheblovska, L. V., Mestdagh, L., Verhoeven, E. F., Hubloue, I., Ruel-laliberte, J., Zarychanski, R., Lauzier, F., Bonaventure, P. Lessard, Green, R., Griesdale, D., Fowler, R., Kramer, A., Zygun, D., Walsh, T., Stanworth, S., Léger, C., Turgeon, A. F., Baron, D. M., Baron-Stefaniak, J., Leitner, G. C., Ullrich, R., Tarabrin, O., Mazurenko, A., Potapchuk, Y., Sazhyn, D., Tarabrin, P., Pérez, A. González, Silva, J., Artemenko, V., Bugaev, A., Tokar, I., Konashevskaya, S., Kolesnikova, I. M., Roitman, E. V., Kiss, T. Rengeiné, Máthé, Z., Piros, L., Dinya, E., Tihanyi, E., Smudla, A., Fazakas, J., Ubbink, R., Boekhorst te, P., Mik, E., Caneva, L., Ticozzelli, G., Pirrelli, S., Passador, D., Riccardi, F., Ferrari, F., Roldi, E. M., Di Matteo, M., Bianchi, I., Iotti, G. A., Zurauskaite, G., Voegeli, A., Meier, M., Koch, D., Haubitz, S., Kutz, A., Bargetzi, M., Mueller, B., Schuetz, P., Von Meijenfeldt, G., Van der Laan, M., Zeebregts, C., Christopher, K. B., Vernikos, P., Melissopoulou, T., Kanellopoulou, G., Panoutsopoulou, M., Xanthis, D., Kolovou, K., Kypraiou, T., Floros, J., Broady, H., Pritchett, C., Marshman, M., Jannaway, N., Ralph, C., Lehane, C. L., Keyl, C. K., Zimmer, E. Z., Trenk, D. T., Ducloy-Bouthors, A. S., Jonard, M. J., Fourrier, F., Piza, F., Correa, T., Marra, A., Guerra, J., Rodrigues, R., Vilarinho, A., Aranda, V., Shiramizo, S., Lima, M. R., Kallas, E., Cavalcanti, A. B., Donoso, M., Vargas, P., McCartney, J., Ramsay, S., McDowall, K., Novitzky-Basso, I., Wright, C., Medic, M Grgic, Bielen, L, Radonic, V, Zlopasa, O, Vrdoljak, N Gubarev, Gasparovic, V, Radonic, R, Narváez, G., Cabestrero, D., Rey, L., Aroca, M., Gallego, S., Higuera, J., De Pablo, R., González, L. Rey, Chávez, G. Narváez, Lucas, J. Higuera, Alonso, D. Cabestrero, Ruiz, M. Aroca, Valarezo, L. Jaramillo, De Pablo Sánchez, R., Real, A. Quinza, Wigmore, T. W., Bendavid, I., Cohen, J., Avisar, I., Serov, I., Kagan, I., Singer, P., Hanison, J, Mirza, U, Conway, D, Takasu, A., Tanaka, H., Otani, N., Ohde, S., Ishimatsu, S., Coffey, F, Dissmann, P, Mirza, K, Lomax, M, Dissmann, P., Coffey, F., Mirza, K., Lomax, M., Miner, JR, Leto, R, Markota, AM, Gradišek, PG, Aleksejev, VA, Sinkovič, AS, Romagnoli, S., Chelazzi, C., Zagli, G., Benvenuti, F., Mancinelli, P., Boninsegni, P., Paparella, L., Bos, A. T., Thomas, O., Goslar, T., Martone, A., Sandu, P. R., Rosu, V. A., Capilnean, A., Murgoi, P., Lecavalier, A., Jayaraman, D., Rico, P., Bellemare, P., Gelinas, C., Nishida, T., Kinoshita, T., Iwata, N., Yamakawa, K., Fujimi, S., Maggi, L., Sposato, F., Citterio, G., Bonarrigo, C., Rocco, M., Zani, V., De Blasi, R. A., Alcorn, D, Barry, L, Riedijk, M. A., Milstein, D. M., Caldas, J., Panerai, R., Camara, L., Ferreira, G., Bor-Seng-Shu, E., Lima, M., Galas, F., Mian, N., Nogueira, R., de Oliveira, G. Queiroz, Almeida, J., Jardim, J., Robinson, T. G., Gaioto, F., Hajjar, L. A., Zabolotskikh, I., Musaeva, T., Saasouh, W., Freeman, J., Turan, A., Saseedharan, S., Pathrose, E., Poojary, S., Messika, J., Martin, Y., Maquigneau, N., Henry-Lagarrigue, M., Puechberty, C., Stoclin, A., Martin-Lefevre, L., Blot, F., Dreyfuss, D., Dechanet, A., Hajage, D., Ricard, J., Almeida, E., Landoni, G., Fukushima, J., Fominskiy, E., De Brito, C., Cavichio, L., Almeida, L., Ribeiro, U., Osawa, E., Boltes, R., Battistella, L., Hajjar, L., Fontela, P., Lisboa, T., Junior, L. Forgiarini, Friedman, G. F., Abruzzi, F., Primo, J. Azevedo Peixoto, Filho, P. Marques, de Andrade, J. Stormorvski, Brenner, K. Matos, boeira, M. Scorsato, Leães, C., Rodrigues, C., Vessozi, A., Machado, A. SantAnna, Weiler, M., Bryce, H., Hudson, A., Law, T., Reece-Anthony, R., Molokhia, A., Abtahinezhadmoghaddam, F., Cumber, E., Channon, L., Wong, A., Groome, R., Gearon, D., Varley, J., Wilson, A., Reading, J., Zampieri, F. G., Bozza, F. A., Ferez, M., Fernandes, H., Japiassú, A., Verdeal, J., Carvalho, A. C., Knibel, M., Salluh, J. I., Soares, M., Gao, J., Ahmadnia, E., Patel, B., MacKay, A., Binning, S., Pugh, R. J., Battle, C., Hancock, C., Harrison, W., Szakmany, T., Mulders, F., Vandenbrande, J., Dubois, J., Stessel, B., Siborgs, K., Ramaekers, D., Silva, U. V., Homena, W. S., Fernandes, G. C., Moraes, A. P., Brauer, L., Lima, M. F., De Marco, F., Maric, N., Mackovic, M., Udiljak, N., Bosso, CE, Caetano, RD, Cardoso, AP, Souza, OA, Pena, R, Mescolotte, MM, Souza, IA, Mescolotte, GM, Bangalore, H., Borrows, E., Barnes, D., Ferreira, V., Azevedo, L., Alencar, G., Andrade, A., Bierrenbach, A., Buoninsegni, L. Tadini, Cecci, L., Lindskog, J., Rowland, K., Sturgess, P., Ankuli, A., Rosa, R, Tonietto, T, Ascoli, A, Madeira, L, Rutzen, W, Falavigna, M, Robinson, C, Salluh, J, Cavalcanti, A, Azevedo, L, Cremonese, R, Da Silva, D, Dornelles, A, Skrobik, Y, Teles, J, Ribeiro, T, Eugênio, C, Teixeira, C, Zarei, M., Hashemizadeh, H., Eriksson, M., Strandberg, G., Lipcsey, M., Larsson, A., Lignos, M., Crissanthopoulou, E., Flevari, K., Dimopoulos, P., Armaganidis, A., Golub, JG, Stožer, AS, Rüddel, H., Ehrlich, C., Burghold, C. M., Hohenstein, C., Winning, J., Sellami, W., Hajjej, Z., Bousselmi, M., Gharsallah, H., Labbene, I., Ferjani, M., Sattler, J., Steinbrunner, D., Poppert, H., Schneider, G., Blobner, M., Kanz, K. G., Schaller, S. J., Apap, K., Xuereb, G., Massa, L., Delvau, N., Penaloza, A, Liistro, G, Thys, F, Delattre, I. K., Hantson, P., Roy, P. M., Gianello, P., Hadîrcă, L, Ghidirimschi, A, Catanoi, N, Scurtov, N, Bagrinovschi, M, Sohn, Y. S., Cho, Y. C., Golovin, B., Creciun, O., Ghidirimschi, A., Bagrinovschi, M., Tabbara, R., Whitgift, J. Z., Ishimaru, A., Yaguchi, A., Akiduki, N., Namiki, M., Takeda, M., Tamminen, J. N., Uusaro, A., Taylor, C. G., Mills, E. D., Mackay, A. D., Ponzoni, C., Rabello, R., Serpa, A., Assunção, M., Pardini, A., Shettino, G., Corrêa, T., Vidal-Cortés, P. V., Álvarez-Rocha, L., Fernández-Ugidos, P., Virgós-Pedreira, A., Pérez-Veloso, M. A., Suárez-Paul, I. M., Del Río-Carbajo, L., Fernández, S. Pita, Castro-Iglesias, A., Butt, A., Alghabban, A. A., Khurshid, S. K., Ali, Z. A., Nizami, I. N., Salahuddin, N. S., Alshahrani, M., Alsubaie, A. W., Alshamsy, A. S., Alkhiliwi, B. A., Alshammari, H. K., Alshammari, M. B., Telmesani, N. K., Alshammari, R. B., Asonto, L. P., Damiani, L. P., Bozza, F, El Khattate, A., Bizrane, M., Madani, N., Belayachi, J., Abouqal, R., Ramnarain, D., Gouw-Donders, B., Benstoem, C., Moza, A., Meybohm, P., Stoppe, C., Autschbach, R., Devane, D., Goetzenich, A., Taniguchi, L. U., Araujo, L., Salgado, G., Vieira, J. M., Viana, J., Ziviani, N., Pessach, I., Lipsky, A., Nimrod, A., O´Connor, M., Matot, I., Segal, E., Kluzik, A., Gradys, A., Smuszkiewicz, P., Trojanowska, I., Cybulski, M., De Jong, A., Sebbane, M., Chanques, G., Jaber, S., Rosa, R., Robinson, C., Bessel, M., Cavalheiro, L., Madeira, L., Rutzen, W., Oliveira, R., Maccari, J., Falavigna, M., Sanchez, E., Dutra, F., Dietrich, C., Balzano, P., Rezende, J., Teixeira, C., Sinha, S., Majhi, K., Gorlicki, J. G., Pousset, F. P., Kelly, J., Aron, J., Gilbert, A. Crerar, Urankar, N. Prevec, Irazabal, M., Bosque, M., Manciño, J., Kotsopoulos, A., Jansen, N., Abdo, W., Casey, Ú. M., O’Brien, B., Plant, R., and Doyle, B.

Subjects
Critical Care and Intensive Care Medicine, Meeting Abstracts
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408. Peripheral Neuropathy in Patients with Hepatitis C Infection—Reversibility after HCV Eradication: A Single Center Study.

Author

Androutsakos, Theodoros, Tsantzali, Ioanna, Karagiannakis, Dimitrios S., Flevari, Pagona, Iakovou, Despoina, Pouliakis, Abraham, Kykalos, Stylianos, Doris, Stylianos, and Xyla, Vasileia

Subjects
*PERIPHERAL neuropathy, *HEPATITIS C, *CHRONIC hepatitis C, *HEPATITIS C virus, *ULNAR nerve, *NERVE fibers
Abstract

Chronic hepatitis C virus (HCV) infection is characterized by a variety of extra-hepatic manifestations; peripheral neuropathy (PN) is one of the most common, especially when mixed cryoglobulinemia (MCG) is present. The prevalence and risk factors of HCV-related PN in the absence of MCG are largely unknown. We conducted a prospective, single-center study, examining the prevalence and reversibility of HCV-associated neuropathy in the absence of MCG. Nerve fiber density in the epidermis was evaluated through skin biopsy and electroneurography (ENG) before HCV-treatment initiation and 1 year post sustained virological remission (SVR). Forty HCV-infected individuals (nine HIV co-infected) with no other neuron-harming factors were included; four other HCV mono- and three HIV co-infected individuals were excluded due to presence of diabetes, B12 insufficiency, or neurotoxic drugs. Twelve consecutive controls with no neuron-harming conditions were also recruited; eight more were excluded due to meeting exclusion criteria. Four patients had ENG signs of polyneuropathy (two with HCV mono- and two with HIV co-infection), while seven more (five with HCV mono- and two with HIV co-infection) had signs of mono-neuropathy, leading to PN prevalences of 22.5% and 44% for mono- and co-infection, respectively (p value 0.179). The two patients with HCV mono-infection and polyneuropathy and the one with ulnar nerve damage showed ENG improvement 1 year post SVR. Regarding intraepidermal nerve density, HCV infection, irrespective of HIV co-infection, was correlated with a lower intraepidermal neuron density that improved 1 year post SVR (p value 0.0002 for HCV and 0.0326 for HCV/HIV co-infected patients). PN is common in HCV infection; successful eradication of HCV leads to PN improvement. [ABSTRACT FROM AUTHOR]

Published
2024
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410. Abstract 11623: Temporal Changes of Noninvasive Electrocardiographic Risk Factors for Sudden Cardiac Death in Post-Myocardial Infarction Patients With Preserved Ejection Fraction: Insights From The Preserve EF Study

Author

Xenogiannis, Iosif, Gatzoulis, Konstantinos, Flevari, Panayota, Ikonomidis, Ignatios, Iliodromitis, Eustathios, Trachanas, Konstantinos, Vlachos, Konstantinos, Arsenos, Petros, Tsiachris, Dimitris, Tousoulis, Dimitrios, Brilakis, Emmanouil, and Alexopoulos, Dimitrios

Abstract

Introduction:Several noninvasive risk factors (NIRFs) have been proposed for predicting the risk for sudden cardiac death in post-myocardial infarction (post-MI) patients. However, it remains unknown if these factors remain unchanged over time.Methods:We measured seven electrocardiographic NIRFs ( [1] late potentials [LPs] on 45-minute electrocardiographic recording during resting; and [2] premature ventricular complexes [PVCs], [3] non-sustained tachycardia [NSVT], [4] standard deviation of normal RR intervals [SDNN], [5] QTc, [6] Heart rate turbulence/Deceleration capacity [HRT/DC] and [7] T-wave alternans on 24-hour electrocardiography) as they were described in the PRESERVE-EF trial (NCT02124018) in 80 post-MI patients with preserved-EF (?40%) and complete revascularization or non-remaining ischemia at least 40 days after the revascularization and one year later.Results:Mean patient age was 56?10 years and 88% were men. Most patients were NYHA class I (90%), had single-vessel disease (65%) and had presented with a STEMI vs. NSTEMI (61% vs. 49%). Between 40-days and one year the EF did not significantly change (50%?5 vs. 52%?6, p=0.169). The prevalence of the seven electrocardiographic NIRFs was similar at the two time points (mean 367 ? 31 days apart) (Figure), as was the prevalence of at least one positive NIRF (55% vs 54% p=0.874). However, 5 patients (6.3%) without NIRFs at baseline had at least one NIRF at one year and 6 patients (7.5%) with at least one NIRF at baseline had no positive NIRFs at one year.Conclusions:While the prevalence of the examined electrocardiographic NIRFs between the two examinations was similar on a population basis, some patients without NIRF at baseline developed NIRF at one year and vice versa, highlighting the need for risk factor reassessment during follow-up. The optimal timing for serial reevaluation remains unknown.

Published
2019
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411. Non Invasive Evaluation of Bone Marrow Activity in Patients with Sickle Cell Disease: Correlation with Disease Features, Genotype, Markers of Erythropoiesis, Iron Metabolism and Hydroxyurea Treatment

Author

Papassotiriou, Ioannis, Flevari, Pagona, Poziopoulos, Christos, Zaliou, Sofia, Tsaousis, Vasilis, Larissi, Katerina, Dimopoulou, Maria, Komninaka, Veroniki, Politou, Marianna, Terpos, Evangelos, and Voskaridou, Ersi

Abstract

Voskaridou: Genesis: Consultancy, Research Funding; Protagonist: Research Funding; Celgene Corporation: Consultancy, Research Funding; Acceleron: Consultancy, Research Funding; Addmedica: Membership on an entity's Board of Directors or advisory committees.

Published
2019
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412. Soluble P-Selectin Levels in Patients with Sickle Cell Disease Reflect Platelets' Activation Rather Than Endothelial Dysfunction

Author

Voskaridou, Ersi, Aimilia, Mantzou, Flevari, Pagona, Dimopoulou, Maria, Komninaka, Veroniki, Repa, Konstantina, and Papassotiriou, Ioannis

Abstract

Voskaridou: Genesis: Consultancy, Research Funding; Protagonist: Research Funding; Celgene Corporation: Consultancy, Research Funding; Acceleron: Consultancy, Research Funding; Addmedica: Membership on an entity's Board of Directors or advisory committees.

Published
2019
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413. Hematology Quiz - Case 40.

Author

Asimakopoulos, J. V., Papageorgiou, L., Flevari, P., Koutsi, E., Telonis, V., Zannou, A., Nikolaou, E., Arapaki, P.-M., Giannikos, T., Tsaftaridis, P., Plata, E., Vassilakopoulos, T. P., Angelopoulou, M. K., Konstantopoulos, K., and Meletis, J.

Subjects
HEMATOLOGY, ANEMIA, JAUNDICE
Abstract

A quiz concerning the hematological profile of a seven-year-old black patient from Nigeria admitted with severe anemia, fever and jaundice is presented.

Published
2015

414. Hematology Quiz - Case 39.

Author

Papageorgiou, L., Asimakopoulos, J., Petevi, K., Boutsikas, G., Gainarou, G., Flevari, P., Koutsi, E., Telonis, V., Zannou, A., Tsaftaridis, P., Plata, E., Vassilakopoulos, T. P., Angelopoulou, M. K., Konstantopoulos, K., and Meletis, J.

Subjects
AUTOIMMUNE thyroiditis, HYPERGAMMAGLOBULINEMIA, ANEMIA treatment
Abstract

The article presents a case study of a 42-year-old woman who was taken to the hospital because of severe anemia and persistent fever. She was previously diagnosed with Hashimoto's thyroiditis but was not given thyroid hormones substitution. She was diagnosed with polyclonal hypergammaglobulinemia and was given appropriate treatment and hematinics for her anemia.

Published
2015

415. Hematology Quiz - Case 38.

Author

Asimakopoulos, J., Papageorgiou, L., Petevi, K., Boutsikas, G., Gainarou, G., Flevari, P., Koutsi, E., Telonis, V., Zannou, A., Tsaftaridis, P., Plata, E., Vassilakopoulos, T. P., Angelopoulou, M. K., Konstantopoulos, K., and Meletis, J.

Subjects
HEARTBURN, CHEST pain, PALPITATION, PERIODIC health examinations, COMPUTED tomography, ARTHRITIS diagnosis
Abstract

The article presents the case study of an 80-year-old man presented to an outpatient clinic due to several conditions such as heartburn, chest pain and palpitations. The patient underwent physical examination, laboratory tests and computed tomography of the chest and the upper and lower abdomen. In 2005, the patients was diagnosed with a chronic, non-paramorphotic arthritis of the hands.

Published
2015

416. Hematology Quiz - Case 36.

Author

Asimakopoulos, J. V., Papageorgiou, L., Petevi, K., Boutsikas, G., Kanellopoulos, A., Gainarou, G., Flevari, P., Koutsi, E., Telonis, V., Zannou, A., Papakostas, A. E., Tsaftaridis, P., Plata, E., Vassilakopoulos, T. P., Angelopoulou, M. K., and Meletis, J.

Subjects
HEMATOLOGY, ABDOMINAL pain
Abstract

A hematology quiz concerning the diagnosis of a 34-year-old man with abdominal pain is presented.

Published
2013

417. Hematology Quiz - Case 34.

Author

Papageorgiou, L., Koutsi, E., Petevi, K., Boutsikas, G., Kanellopoulos, A., Gainarou, G., Flevari, P., Telonis, V., Bilalis, A., Zannou, A., Papakostas, A. E., Tsaftaridis, P., Plata, E., Vassilakopoulos, T. P., Angelopoulou, M. K., and Meletis, J.

Subjects
DIAGNOSIS of abdominal pain, HEMATOLOGY
Abstract

A quiz concerning the case of a 22-year-old shepherd who exhibited anemia and abdominal pain and has undergone hematological profiling is presented.

Published
2013

418. Hematology Quiz - Case 31.

Author

Gainarou, G., Vassilakopoulos, T. P., Koutsi, E., Papageorgiou, L., Petevi, K., Boutsikas, G., Kanellopoulos, A., Flevari, P., Telonis, V., Zannou, A., Bilalis, A., Sinni, E., Papakostas, E., Tsaftaridis, P., Angelopoulou, M. K., and Meletis, J.

Subjects
LYMPHOMAS, AXILLARY artery, HEMATOLOGY, PATIENTS
Abstract

A hematology quiz concerning the case of a 22-year-old Albanian woman with left axillary and supraclavicular lymphadenopathy (LDP) is presented.

Published
2012

419. Hematology Quiz - Case 30.

Author

Koutsi, E., Vassilakopoulos, T. P., Petevi, K., Gainarou, G., Boutsikas, G., Kanellopoulos, A., Papageorgiou, L., Flevari, P., Telonis, V., Zannou, A., Panou, M., Bilalis, A., Sinni, E., Tsaftaridis, P., Angelopoulou, M. K., and Meletis, J.

Subjects
MYOCARDIAL infarction, HYPERPLASIA, OSTEOARTHRITIS, MULTIPLE myeloma, PLASMA cells, SERUM, BONE marrow
Abstract

The article presents a case study of an 88 year-old Greek male who was admitted with osseous pain at the outpatient of an institution. It says that an acute myocardial infarction, benign prostate hyperplasia, and osteoarthritis were included in his medical history. It adds that the patient was diagnosed with multiple myeloma (MM), which was based on the presence of the plasma cells and serum of bone marrow.

Published
2012

420. Hematology Quiz - Case 30.

Author

Kanellopoulos, A., Vassilakopoulos, T. P., Mikos, N., Petevi, K., Boutsikas, G., Papageorgiou, L., Gainarou, G., Flevari, P., Koutsi, E., Telonis, V., Zannou, A., Panou, M., Galani, Z., Bilalis, A., Sinni,, E., Angelopoulou, M.K., and Meletis, J.

Subjects
EOSINOPHILIA, COUGH, SINUSITIS
Abstract

A quiz concerning the diagnosis for a 37-year-old man who is suffering from prominent eosinophilia, persistent non productive cough, and recurrent sinusitis is presented.

Published
2012

421. Internal Medicine Quiz - Case 18.

Author

Ntalagiorgos, Th., Gainarou, G., Koutsi, E., Petevi, K., Boutsikas, G., Papageorgiou, L., Kanellopoulos, A., Flevari, P., Telonis, V., Galani, Z., Bilalis, A., Sinni, E., Georgiou, G., Angelopoulou, M. K., Vassilakopoulos, T. P., and Meletis, J.

Subjects
BRUISES, HEMATOLOGY, HOSPITAL emergency services
Abstract

A quiz concerning the case of a 42-year-old Egyptian immigrant male who was admitted with multiple bruises in the hematology department is presented.

Published
2012

422. Hematology Quiz - Case 28.

Author

Vassilakopoulos, T.P., Petevi, K., Boutsikas, G., Kanellopoulos, A., Bilalis, A., Sinni, E., Ntalagiorgos, Th., Gainarou, G., Koutsi, E., Papageorgiou, L., Flevari, P., Telonis, V., Georgiou, G., Galani, Z., Angelopoulou, M.K., and Meletis, J.

Subjects
BLOOD testing, ERYTHROCYTES, COMPUTED tomography, SEDIMENTATION analysis
Abstract

The article presents a case study of 32-year-old male patient who presented with an asymptomatic inguinofemoral mass in the medical department. It mentions that the complete blood counts, biochemical profile, and erythrocyte sedimentation rate of the patient is normal and there was no abnormal findings after the performance of whole body computed tomography. It adds that the presence of enlarged lymph nodes was the cause of the large inguinofemoral mass presented by the patient.

Published
2012

423. Hematology Quiz - Case 27.

Author

Papageorgiou, L., Karali, V., Kanellopoulos, A., Gainarou, G., Flevari, P., Boutsikas, G., Petevi, K., Dalagiorgos, T., Koutsi, E., Telonis, V., Galani, Z., Bilalis, A., Sinni, E., Georgiou, G., Angelopoulou, M. K., Vassilakopoulos, T. P., and Meletis, J.

Subjects
HEMATOLOGY, CONTINUING medical education
Abstract

A continuing medical education quiz concerning hematology is presented.

Published
2011

424. Hematology Quiz - Case 26.

Author

Vassilakopoulos, T. P., Zografos, E., Papageorgiou, L., Karali, V., Boutsikas, G., Petevi, K., Dalagiorgos, Th., Kanellopoulos, A., Gainarou, G., Flevari, P., Koutsi, E., Galani, Z., Bilalis, A., Georgiou, G., Angelopoulou, M. K., and Meletis, J.

Subjects
DISEASES in older people, SKIN inflammation, TUMORS, DENDRITIC cells
Abstract

The article presents a case study of an old man with one-month history of disseminated, painless skin lesions of the trunk and extremities. He has also complained of weakness, fatigue, and weight loss. A diffuse dermal blast cell infiltrate was noted on skin biopsies. A diagnosis of blastic plasmacytoid dendritic cell neoplasm (BPDCN) was made.

Published
2011

425. Hematology Quiz -- Case 24.

Author

Meletis, J., Asimakopoulos, J. V., Papageorgiou, L., Karali, V., Boutsikas, G., Petevi, K., Dalagiorgos, Th., Kanellopoulos, A., Gainarou, G., Flevari, P., Koutsi, E., and Terpos, E.

Subjects
HEMATOLOGY, INTERNAL medicine
Abstract

A quiz concerning hematology is presented.

Published
2011

426. Left atrial thrombus after biventricular pacemaker implantation.

Author

Ignatios Ikonomidis, Costas Papadopoulos, Panayota Flevari, Ioannis Paraskevaidis, John Lekakis, and Dimitrios T. Kremastinos

Abstract

We report the case of a patient with ischaemic cardiomyopathy who was admitted to our hospital for an echocardiographic follow-up a few days after the implantation of a biventricular pacemaker/defibrillator. Transthoracic echocardiographic examination revealed an immobile echogenic mass attached to the left atrial side of the fossa ovalis which was not present a month before the biventricular pacemaker implantation. Because the images of the pre-operative echocardiogram were not available at the time of the examination, the differential diagnosis included a tumour or a thrombus formed on the left side of intra-atrial septum. The use of low myocardial infarction contrast echocardiography and power Doppler clarified the lack of microcirculation and blood flow within the mass, respectively, and confirmed the diagnosis of thrombus. After an episode acute renal failure, the thrombus was absent at a follow-up echocardiogram presumably because of peripheral embolization. [ABSTRACT FROM AUTHOR]

Published
2009
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441. Difficulties in Diagnosing and Treating Disseminated Bacillus Calmette-Guérin (BCG) Infection After Intravesical BCG Therapy in a Patient with Liver Cirrhosis: A Case Report.

Author

Vallilas, Christos, Zachou, Maria, Dolkiras, Philippos, Sakellariou, Stratigoula, Constantinou, Costas A., Flevari, Pagona, Anastasopoulou, Amalia, and Androutsakos, Theodoros

Subjects
*BLADDER cancer, *DIAGNOSIS, *CIRRHOSIS of the liver, *PATHOLOGY, *SEIZURES (Medicine), *SYMPTOMS
Abstract

Objective: Rare coexistence of disease or pathology. Background: Bladder cancer (BC) is the second most common cancer involving the urinary system. In non-muscle-invading BC, transurethral resection of a bladder tumor followed by intravesical immunotherapy with Bacillus Calmette- Guérin (BCG) is the usual treatment. Disseminated (or systemic) BCG infection (BCGitis) represents the most severe adverse effect of intravesical BCG therapy, presenting with high-grade fever, with or without symptoms in the urinary tract, leading to severe sepsis and death if left untreated. The treatment of choice consists of isoniazid, rifampicin, and ethambutol (with or without corticosteroids) for 6 months, and the recovery rate is extremely high. Given the fact that these drugs are hepatotoxic, treating a patient with liver cirrhosis is challenging. Case Report: We present a patient with a medical history of BC treated with transurethral resection and intravesical BCG therapy, presenting with fever, transaminasemia, and generalized weakness. Liver and bone marrow biopsies revealed liver cirrhosis and granulomas in both organs. A diagnose of BCGitis was made and the patient was treated with isoniazid, rifampicin, and ethambutol; rifampicin was substituted with moxifloxacin after 1 month due to worsening of liver laboratory results, and moxifloxacin was substituted with levofloxacin later on due to tonic-clonic seizures. The patient was treated for 4 more months with levofloxacin and for 7 more months with isoniazid and ethambutol, with no other adverse effects, preserving liver function and achieving cure of BCGitis. Conclusions: We present the case of a cirrhotic patient presenting with fever and deterioration of liver laboratory results, found to have BCGitis, and discuss possible difficulties in diagnosing and treating such patients. [ABSTRACT FROM AUTHOR]

Published
2021
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442. Implantable Cardiac Monitoring in the Secondary Prevention of Cryptogenic Stroke.

Author

Triantafyllou, Sokratis, Katsanos, Aristeidis H., Dilaveris, Polychronis, Giannopoulos, Georgios, Kossyvakis, Charalampos, Adreanides, Elias, Liantinioti, Chrissoula, Tympas, Konstantinos, Zompola, Christina, Theodorou, Aikaterini, Palaiodimou, Lina, Flevari, Panagiota, Kosmidou, Maria, Voumvourakis, Konstantinos, Parissis, John, Deftereos, Spyridon, and Tsivgoulis, Georgios

Subjects
*TRANSIENT ischemic attack, *STROKE, *ATRIAL fibrillation
Abstract

Objective: In this study, we sought to evaluate the impact of implantable cardiac monitoring (ICM) in the prevention of stroke recurrence after a cryptogenic ischemic stroke or transient ischemic attack (TIA). Methods: We evaluated consecutive patients with cryptogenic ischemic stroke or TIA admitted in a comprehensive stroke center during an 8‐year period. We compared the baseline characteristics and outcomes between patients receiving conventional cardiac monitoring with repeated 24‐hour Holter‐monitoring during the first 5 years in the outpatient setting and those receiving continuous cardiac monitoring with ICM during the last 3 years. Associations on the outcomes of interest were further assessed in multivariable regression models adjusting for potential confounders. Results: We identified a total of 373 patients receiving conventional cardiac monitoring and 123 patients receiving ICM. Paroxysmal atrial fibrillation (PAF) detection was higher in the ICM cohort compared to the conventional cardiac monitoring cohort (21.1% vs 7.5%, p < 0.001). ICM was independently associated with an increased likelihood of PAF detection during follow‐up (hazard ratio [HR] = 1.94, 95% confidence interval [CI] = 1.16–3.24) in multivariable analyses. Patients receiving ICM were also found to have significantly higher rates of anticoagulation initiation (18.7% vs 6.4%, p < 0.001) and lower risk of stroke recurrence (4.1% vs 11.8%, p = 0.013). ICM was independently associated with a lower risk of stroke recurrence during follow‐up (HR = 0.32, 95% CI = 0.11–0.90) in multivariable analyses. Interpretation: ICM appears to be independently associated with a higher likelihood of PAF detection and anticoagulation initiation after a cryptogenic ischemic stroke or TIA. ICM was also independently related to lower risk of stroke recurrence in our cryptogenic stroke / TIA cohort. ANN NEUROL 2020;88:946–955 [ABSTRACT FROM AUTHOR]

Published
2020
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443. Prediction of mortality benefit based on periodic repolarisation dynamics in patients undergoing prophylactic implantation of a defibrillator: a prospective, controlled, multicentre cohort study.

Author

Bauer, Axel, Klemm, Mathias, Rizas, Konstantinos D, Hamm, Wolfgang, von Stülpnagel, Lukas, Dommasch, Michael, Steger, Alexander, Lubinski, Andrezej, Flevari, Panagiota, Harden, Markus, Friede, Tim, Kääb, Stefan, Merkely, Bela, Sticherling, Christian, Willems, Rik, Huikuri, Heikki, Malik, Marek, Schmidt, Georg, Zabel, Markus, and EU-CERT-ICD investigators

Subjects
*MORTALITY, *ELECTROCARDIOGRAPHY, *PROGNOSIS, *IMPLANTABLE cardioverter-defibrillators, *TREATMENT effectiveness, *CARDIOMYOPATHIES
Abstract

Background: A small proportion of patients undergoing primary prophylactic implantation of implantable cardioverter defibrillators (ICDs) experiences malignant arrhythmias. We postulated that periodic repolarisation dynamics, a novel marker of sympathetic-activity-associated repolarisation instability, could be used to identify electrically vulnerable patients who would benefit from prophylactic implantation of ICDs by way of a reduction in mortality.Methods: We did a prespecified substudy of EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU-CERT-ICD), a prospective, investigator-initiated, non-randomised, controlled cohort study done at 44 centres in 15 EU countries. Patients aged 18 years or older with ischaemic or non-ischaemic cardiomyopathy and reduced left ventricular ejection fraction (≤35%) were eligible for inclusion if they met guideline-based criteria for primary prophylactic implantation of ICDs. Periodic repolarisation dynamics from 24-h Holter recordings were assessed blindly in patients the day before ICD implantation or on the day of study enrolment in patients who were conservatively managed. The primary endpoint was all-cause mortality. Propensity scoring and multivariable models were used to assess the interaction between periodic repolarisation dynamics and the treatment effect of ICDs on mortality.Findings: Between May 12, 2014, and Sept 7, 2018, 1371 patients were enrolled in our study. 968 of these patients underwent ICD implantation, and 403 were treated conservatively. During follow-up (median 2·7 years [IQR 2·0-3·3] in the ICD group and 1·2 years [0·8-2·7] in the control group), 138 (14%) patients died in the ICD group and 64 (16%) patients died in the control group. We noted a 43% reduction in mortality in the ICD group compared with the control group (adjusted hazard ratio [HR] 0·57 [95% CI 0·41-0·79]; p=0·0008). Periodic repolarisation dynamics significantly predicted the treatment effect of ICDs on mortality (adjusted p=0·0307). The mortality benefits associated with ICD implantation were greater in patients with periodic repolarisation dynamics of 7·5 deg or higher (n=199; adjusted HR 0·25 [95% CI 0·13-0·47] for the ICD group vs the control group; p<0·0001) than in those with periodic repolarisation dynamics less than 7·5 deg (n=1166; adjusted HR 0·69 [95% CI 0·47-1·00]; p=0·0492; pinteraction=0·0056). The number needed to treat was 18·3 (95% CI 10·6-4895·3) in patients with periodic repolarisation dynamics less than 7·5 deg and 3·1 (2·6-4·8) in those with periodic repolarisation dynamics of 7·5 deg or higher.Interpretation: Periodic repolarisation dynamics predict mortality reductions associated with prophylactic implantation of ICDs in contemporarily treated patients with ischaemic or non-ischaemic cardiomyopathy. Periodic repolarisation dynamics could help to guide treatment decisions about prophylactic ICD implantation.Funding: The European Community's 7th Framework Programme. [ABSTRACT FROM AUTHOR]

Published
2019
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444. The Growth Differentiation Factor-15 (GDF-15) levels are increased in patients with compound heterozygous sickle cell and beta-thalassemia (HbS/βthal), correlate with markers of hemolysis, iron burden, coagulation, endothelial dysfunction and pulmonary hypertension

Author

Larissi, Katerina, Politou, Marianna, Margeli, Alexandra, Poziopoulos, Christos, Flevari, Pagona, Terpos, Evangelos, Papassotiriou, Ioannis, and Voskaridou, Ersi

Subjects
*FETAL hemoglobin, *ENDOTHELIUM diseases, *SICKLE cell anemia, *HEMOLYSIS & hemolysins, *VASCULAR smooth muscle, *BLOOD coagulation, *PULMONARY hypertension, *MUSCLE cells
Abstract

The clinical manifestations of Sickle Cell Disease (SCD) include episodes of vascular occlusion, chronic hemolytic anemia and frequent infections. GDF-15, a multifactorial cytokine, is a member of the transforming growth factor- superfamily. Expression of the GDF-15 gene in cardiomyocytes, vascular smooth muscle cells, and endothelial cells is strongly upregulated in response to oxidative stress, inflammation and tissue injury, while high levels of serum GDF-15 associate with ineffective erythropoiesis and may reflect a certain type of bone marrow stress or erythroblast apoptosis. In this context we aimed to evaluate GDF-15 levels in 89 patients with HbS/βthal at steady phase and in 20 apparently healthy individuals, and correlate with clinical features of the disease and markers of hemolysis, iron burden, inflammation, coagulation and endothelial dysfunction. We found that: GDF-15 levels were elevated in patients with HbS/βthal compared to controls (1980.7 ± 159.8 vs 665.4 ± 50.9 pg/mL, p < 0.0001) and correlated significantly with LDH (p < 0.001), Hepcidin-25/Ferritin molar ratio (p = 0.002), vWF:antigen (p < 0.05), HbA% (p < 0.001) and Mean Pulmonary Artery Pressure (p < 0.001). These findings demonstrate for first time an important multifactorial role of GDF-15 in patients with HbS/βthal, however, prior to its clinical usefulness, this biomarker must undergo through rigorous validation in multiple cohorts. [ABSTRACT FROM AUTHOR]

Published
2019
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445. Differential multivariable risk prediction of appropriate shock versus competing mortality - A prospective cohort study to estimate benefits from ICD therapy.

Author

Bergau, Leonard, Willems, Rik, Sprenkeler, David J., Fischer, Thomas H., Flevari, Panayota, Hasenfuß, Gerd, Katsaras, Dimitrios, Kirova, Aleksandra, Lehnart, Stephan E., Lüthje, Lars, Röver, Christian, Seegers, Joachim, Sossalla, Samuel, Dunnink, Albert, Sritharan, Rajevaa, Tuinenburg, Anton E., Vandenberk, Bert, Vos, Marc A., Wijers, Sofieke C., and Friede, Tim

Subjects
*IMPLANTABLE cardioverter-defibrillators, *MORTALITY, *LEFT heart ventricle, *SHOCK therapy, *FOLLOW-up studies (Medicine), *ARRHYTHMIA, *DISEASE risk factors
Abstract

Abstract Background and objective We prospectively investigated combinations of risk stratifiers including multiple EP diagnostics in a cohort study of ICD patients. Methods For 672 enrolled patients, we collected history, LVEF, EP study and T-wave alternans testing, 24-h Holter, NT-proBNP, and the eGFR. All-cause mortality and first appropriate ICD shock were predefined endpoints. Results The 635 patients included in the final analyses were 63 ± 13 years old, 81% were male, LVEF averaged 40 ± 14%, 20% were inducible at EP study, 63% had a primary prophylactic ICD. During follow-up over 4.3 ± 1.5 years, 108 patients died (4.0% per year), and appropriate shock therapy occurred in n = 96 (3.9% per year). In multivariate regression, age (p < 0.001), LVEF (p < 0.001), NYHA functional class (p = 0.007), eGFR (p = 0.024), a history of atrial fibrillation (p = 0.011), and NT-pro-BNP (p = 0.002) were predictors of mortality. LVEF (p = 0.002), inducibility at EP study (p = 0.007), and secondary prophylaxis (p = 0.002) were identified as independent predictors of appropriate shocks. A high annualized risk of shocks of about 10% per year was prevalent in the upper quintile of the shock score. In contrast, a low annual risk of shocks (1.8% per year) was found in the lower two quintiles of the shock score. The lower two quintiles of the mortality score featured an annual mortality <0.6%. Conclusions In a prospective ICD patient cohort, a very good approximation of mortality versus arrhythmic risk was possible using a multivariable diagnostic strategy. EP stimulation is the best test to assess risk of arrhythmias resulting in ICD shocks. Highlights • We investigated combinations of risk stratifiers in a prospective ICD cohort study. • All-cause mortality and first appropriate ICD shock were predefined endpoints. • Age, LVEF, NYHA, eGFR, Afib, and NT-pro-BNP were excellent mortality predictors. • EP stimulation is the best test to assess risk of arrhythmias resulting in ICD shocks. • Excellent approximation of mortality versus arrhythmic risk was possible. [ABSTRACT FROM AUTHOR]

Published
2018
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446. Intrapulmonary pharmacokinetics of high doses of tigecycline in patients with ventilator-associated pneumonia.

Author

Dimopoulos, G., Almyroudi, M.P., Kapralos, I., Apostolopoulou, O., Flevari, A., Nicolau, D.P., and Dokoumetzidis, A.

Subjects
*VENTILATOR-associated pneumonia, *TIGECYCLINE, *PHARMACOKINETICS, *LIQUID chromatography, *BRONCHOALVEOLAR lavage
Abstract

Tigecycline is commonly used for infections by multidrug-resistant bacteria. However, it is not approved for ventilator-associated pneumonia (VAP) as increased mortality has been reported in VAP patients treated with conventional doses. The purpose of this study was to prospectively evaluate the intrapulmonary pharmacokinetics of off-label high-dose tigecycline in patients with VAP. Nine mechanically ventilated patients received tigecycline intravenously (loading dose 200 mg followed by 100 mg every 12 h). After ≥5 doses, two bronchoscopies were performed in each patient on consecutive days and eight blood samples were collected. Tigecycline concentrations in plasma and bronchoalveolar lavage fluid were determined by liquid chromatography. The urea dilution method was used to calculate epithelial lining fluid (ELF) concentrations. A two-compartmental pharmacokinetic (PK) model with linear elimination was used to estimate PK parameters. Mean patient age was 69 ± 11.86 years and mean APACHE II score was 21. The estimated population mean PK parameters (relative standard error) were: clearance, 11.64 L/h (54%); volume of distribution in central compartment, 79.01 L (37%); volume of distribution in peripheral compartment, 92.95 L (17%); intercompartmental clearance, 62.81 L/h (34%); and ELF penetration ratio, 2.41 (40%). C max , C min , plasma AUC 0–12 , plasma f AUC 0–12 and ELF AUC 0–12 were 1.99 ± 1.82 μg/mL, 0.81 ± 1.27 μg/mL, 12.89 ± 17.25 μg•h/mL, 3.24 ± 3.09 μg•h/mL and 7.13 ± 2.61 μg•h/mL, respectively. The increased plasma and ELF AUC 0–12 achieved with a 200 mg daily tigecycline dose, combined with high ELF penetration, support the effectiveness of off-label high-dose tigecycline in VAP. [ABSTRACT FROM AUTHOR]

Published
2022
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447. Αξιολόγηση της αποδοτικότητας της διαφημιστικής δαπάνης μάρκας (brand advertising efficiency)

Author

Γιαννίκος, Ιωάννης, Flevari, Fifi, Νεάρχου, Ανδρέας, and Θεοφανίδης, Φαίδων

Subjects
Advertising efficiency, Μέθοδος DEA, 659.1, Διαφημιστική αποδοτικότητα, DEA analysis
Abstract

Αφορμή για την πραγματοποίηση της παρούσας εργασίας στάθηκε το ιδιαίτερο ενδιαφέρον που παρουσιάζει ο τρόπος χάραξης διαφημιστικών στρατηγικών από τις διάφορες επιχειρήσεις ανά τον κόσμο και ιδιαίτερα σε μια χρονική συγκυρία σαν την παρούσα, όπου μετά την εμφάνιση της Παγκόσμιας κρίσης στα τέλη του 2008, ο ρόλος και ο τρόπος εμφάνισης της διαφήμισης έχει αλλάξει δραματικά. Στο παρελθόν αποτελούσαν συχνό φαινόμενο υπέρογκα ποσά που ξοδεύονταν για μεγάλες διαφημιστικές καμπάνιες, ειδικά σε κατηγορίες προϊόντων που χαρακτηρίζονταν ως πολυτελείας. Μας ενδιαφέρει, λοιπόν, σε ποιο βαθμό αυτή η πολιτική συνεχίζεται ακόμα και σήμερα που ο ανταγωνισμός σε όλα τα επίπεδα βρίσκεται στο ζενίθ και είναι ζωτικής σημασίας για τις σύγχρονες επιχειρήσεις να έχουν επιτυχημένες καμπάνιες, με όσο το δυνατόν μικρότερο προϋπολογισμό. Η υπευθυνότητα στη διαφήμιση, γίνεται πλέον ένα σημαντικό θέμα. Θα προσπαθήσουμε, λοιπόν, να εντοπίσουμε το βαθμό αποδοτικότητας των διαφημιστικών δαπανών μεγάλων αυτοκινητοβιομηχανιών της Ευρώπης, όπως αυτός αντικατοπτρίζεται στα έσοδα και το μερίδιο αγοράς τους με τη χρήση της Περιβάλλουσσας Ανάλυσης Δεδομένων DEA.

Published
2013

448. Siblings with coronavirus disease 2019 infection and opposite outcome-the hemodialysis's better outcome paradox: Two case reports.

Author

Bacharaki D, Chrysanthopoulou E, Grigoropoulou S, Giannakopoulos P, Simitsis P, Frantzeskaki F, Flevari A, Karagiannis M, Sardeli A, Kavatha D, Antoniadou A, and Vlahakos D

Abstract

Background: Coronavirus disease 2019 (COVID-19) is a highly contagious infection caused by the severe acute respiratory syndrome coronavirus 2 virus and has a unique underlying pathogenesis. Hemodialysis (HD) patients experience high risk of contamination with COVID-19 and are considered to have higher mortality rates than the general population by most but not all clinical series. We aim to highlight the peculiarities in the immune state of HD patients, who seem to have both immune-activation and immune-depression affecting their outcome in COVID-19 infection., Case Summary: We report the opposite clinical outcomes (nearly asymptomatic course vs death) of two diabetic elderly patients infected simultaneously by COVID-19, one being on chronic HD and the other with normal renal function. They were both admitted in our hospital with COVID-19 symptoms and received the same treatment by protocol. The non-HD sibling deteriorated rapidly and was intubated and transferred to the Intensive Care Unit, where he died despite all supportive care. The HD sibling, although considered more "high-risk" for adverse outcome, followed a benign course and left the hospital alive and well., Conclusion: These cases may shed light on aspects of the immune responses to COVID-19 between HD and non-HD patients and stimulate further research in pathophysiology and treatment of this dreadful disease., Competing Interests: Conflict-of-interest statement: No conflict of interest from none of the authors., (©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.)

Published
2021
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449. The haemostatic profile in critically ill COVID-19 patients receiving therapeutic anticoagulant therapy: An observational study.

Author

Tsantes AE, Frantzeskaki F, Tsantes AG, Rapti E, Rizos M, Kokoris SI, Paramythiotou E, Katsadiotis G, Karali V, Flevari A, Chrysanthopoulou E, Maratou E, Kyriakou E, Gialeraki A, Bonovas S, Dimopoulos G, Tsangaris I, and Armaganidis A

Subjects
Aged, Aged, 80 and over, Betacoronavirus, Blood Coagulation Tests, COVID-19, Case-Control Studies, Coronavirus Infections complications, Coronavirus Infections physiopathology, Critical Illness, Female, Humans, Intensive Care Units, Male, Middle Aged, Pandemics, Pneumonia, Viral complications, Pneumonia, Viral physiopathology, Prognosis, SARS-CoV-2, Severity of Illness Index, Thrombelastography, Thrombophilia blood, Thrombophilia virology, Thrombosis blood, Thrombosis virology, Treatment Outcome, Anticoagulants pharmacology, Coronavirus Infections blood, Hemostasis drug effects, Pneumonia, Viral blood, Thrombophilia drug therapy, Thrombosis drug therapy
Abstract

Hypercoagulability and thrombosis remain a challenge in severe coronavirus disease 2019 (COVID-19) infections. Our aim is to investigate the hemostatic profile of critically ill COVID-19 patients on therapeutic anticoagulant treatment.Forty one patients were enrolled into the study. We recruited 11 consecutive, COVID-19, patients who received therapeutic anticoagulant treatment on intensive care unit (ICU) admission. Disease severity indexes, biochemical, hematological and haemostatic parameters, endogenous thrombin potential (ETP), plasminogen activator inhibitor-1 (PAI-1) activity and extrinsically activated rotational thromboelastometry assay (EXTEM) were recorded on days 1, 3, 7. We also enrolled 9 ICU non-COVID-19, 21 non-ICU COVID-19 patients and 20 healthy blood donors as control populations.Critically ill COVID-19 patients demonstrated a more hypercoagulable and hypofibrinolytic profile related to those with COVID-19 mild illness, based on EXTEM amplitude at 10 min (A10), maximum clot firmness (MCF) and lysis index at 60 min (LI60) variables (p = 0.020, 0.046 and 0.001, respectively). Similarly, a more hypercoagulable state was detected in COVID-19 ICU patients related to non-COVID-19 ICU patients based on A10 and MCF parameters (p = 0.03 and 0.04, respectively). On the contrary, ETP and EXTEM (clotting time) CT values were similar between patients with severe and mild form of the COVID-19 infection, probably due to anticoagulant treatment given.Critically ill COVID-19 patients showed a hypercoagulable profile despite the therapeutic anticoagulant doses given. Due to the small sample size and the study design, the prognostic role of the hypercoagulability in this clinical setting remains unknown and further research is required in order to be assessed.

Published
2020
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450. Diaphragmatic ultrasonography as an adjunct predictor tool of weaning success in patients with difficult and prolonged weaning.

Author

Flevari A, Lignos M, Konstantonis D, and Armaganidis A

Subjects
Aged, Diaphragm physiology, Female, Humans, Male, Middle Aged, Prospective Studies, Ultrasonography, Diaphragm diagnostic imaging, Respiration, Ventilator Weaning methods
Abstract

Background: Diaphragmatic ultrasonography has been recently considered as a new weaning predictor method. Previous studies checked diaphragmatic excursion and thickness during quiet or deep breathing in unselected populations of critically ill patients. Our study aimed to investigate diaphragmatic excursion during quiet and unassisted breathing, in comparison to standard predictor tools, such as Rapid Shallow Breathing Index (RSBI) and Maximal Inspiratory Pressure (Pimax), in patients with difficult and/or prolonged weaning., Methods: Patients with difficult and/or prolonged weaning, who met the criteria for spontaneous breathing trial, were assessed. The excursion of each hemidiaphragm (DEx) was evaluated by B-mode and M-mode ultrasonography while patient was on quiet breathing and at supine position. RSBI and Pimax were simultaneously recorded and weaning outcome was recorded., Results: Thirteen male and fourteen female patients were included. DEx [median and interquartile range, mm] was 14 (8.5-22) for the right hemidiaphragm (RDEx) and 12 (7-23) for the left (LDEx). We found no difference in DEx between sexes. Among the four weaning predictor tools, LDEx at a cut-off 10 mm was the best index to predict weaning success (sensitivity 86%, specificity 85%, Negative Predictive Value 94%). The optimal cut-off values, as determined by the area under the receiver operating characteristic curve, were 10 mm for RDEx, 7 mm for LDEx, 57 breaths/min/L for RSBI and -20 cmH2O for Pimax., Conclusions: Our results suggest that DEx threshold of 10 mm and 7 mm for right and left hemidiaphragms respectively could be used as adjunct tool in the predictive algorithm of weaning in difficult to wean patients.

Published
2016

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