624 results on '"P. Sarafidis"'
Search Results
2. Feel the rhythm of the beat: rhythmic components in ambulatory blood pressure monitoring for predicting cardiovascular risk in CKD patients
- Author
-
Karagiannidis, Artemios G., Iatridi, Fotini, and Sarafidis, Pantelis A.
- Published
- 2024
- Full Text
- View/download PDF
3. Commonly used medications for respiratory and cardiovascular support in neonates: Evidence, knowledge gaps, and future perspectives
- Author
-
Eleni Agakidou, Angeliki Kontou, Ilias Chatziioannidis, William Chotas, and Kosmas Sarafidis
- Subjects
Inotropes ,Neonatal hypotension ,Neonatology, Patent ductus arteriosus ,Pharmacology ,Respiratory distress syndrome ,Pediatrics ,RJ1-570 - Abstract
Critically ill neonates admitted to neonatal intensive care units require specialized pharmacological treatment due to various medical conditions. However, despite the decades of clinical use of some pharmacological agents, there are still significant knowledge gaps surrounding their everyday use. The wide variability of drugs used in neonates, and how they are used in different settings worldwide, precisely reflects this fact. A major factor contributing to this variability is the lack of adequate studies regarding the effectiveness and safety of medications administered to neonates, especially in those born preterm. This is mainly due to inherent difficulties in performing pharmacokinetic, pharmacodynamic, and clinical studies in this age group. In this review, we discuss the existing data on medications most commonly used in the respiratory and cardiovascular care of the sick neonate. Knowledge gaps and future perspectives are highlighted, as well.
- Published
- 2024
- Full Text
- View/download PDF
4. Beta-blockers in patients with intradialytic hypertension: are they potent anti-hypertensives?
- Author
-
Theodorakopoulou, Marieta, Iatridi, Fotini, and Sarafidis, Pantelis
- Published
- 2024
- Full Text
- View/download PDF
5. Finerenone and effects on mortality in chronic kidney disease and type 2 diabetes: a FIDELITY analysis.
- Author
-
Filippatos, Gerasimos, Anker, Stefan, August, Phyllis, Coats, Andrew, Januzzi, James, Mankovsky, Boris, Rossing, Peter, Ruilope, Luis, Pitt, Bertram, Sarafidis, Pantelis, Teerlink, John, Kapelios, Chris, Gebel, Martin, Brinker, Meike, Joseph, Amer, Lage, Andrea, Bakris, George, and Agarwal, Rajiv
- Subjects
All-cause mortality ,Cardiovascular mortality ,Chronic kidney disease ,Finerenone ,Non-steroidal MRA ,Type 2 diabetes ,Humans ,Middle Aged ,Diabetes Mellitus ,Type 2 ,Diabetic Nephropathies ,Double-Blind Method ,Mineralocorticoid Receptor Antagonists ,Renal Insufficiency ,Chronic ,Heart Failure ,Death ,Sudden ,Cardiac - Abstract
AIMS: Finerenone reduces the risk of cardiovascular events in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D). We investigated the causes of mortality in the FIDELITY population. METHODS AND RESULTS: The FIDELITY prespecified pooled data analysis from FIDELIO-DKD and FIGARO-DKD excluded patients with heart failure and reduced ejection fraction. Outcomes included intention-to-treat and prespecified on-treatment analyses of the risk of all-cause and cardiovascular mortality. Of 13 026 patients [mean age, 64.8 years; mean estimated glomerular filtration rate (eGFR), 57.6 mL/min/1.73 m2], 99.8% were on renin-angiotensin system inhibitors. Finerenone reduced the incidence of all-cause and cardiovascular mortality vs. placebo (8.5% vs. 9.4% and 4.9% vs. 5.6%, respectively) and demonstrated significant on-treatment reductions [hazard ratio (HR), 0.82; 95% confidence interval (CI), 0.70-0.96; P = 0.014 and HR, 0.82; 95% CI, 0.67-0.99; P = 0.040, respectively]. Cardiovascular-related mortality was most common, and finerenone lowered the incidence of sudden cardiac death vs. placebo [1.3% (incidence rate 0.44/100 patient-years) vs. 1.8% (0.58/100 patient-years), respectively; HR, 0.75; 95% CI, 0.57-0.996; P = 0.046]. The effects of finerenone on mortality were similar across all Kidney Disease: Improving Global Outcomes risk groups. Event probability with finerenone at 4 years was consistent irrespective of baseline urine albumin-to-creatinine ratio, but seemingly more pronounced in patients with higher baseline eGFR. CONCLUSION: In FIDELITY, finerenone significantly reduced the risk of all-cause and cardiovascular mortality vs. placebo in patients with T2D across a broad spectrum of CKD stages while on treatment, as well as sudden cardiac death in the intention-to-treat population. CLINICAL TRIALS REGISTRATION: FIDELIO-DKD and FIGARO-DKD are registered with ClinicalTrials.gov, numbers NCT02540993 and NCT02545049, respectively (funded by Bayer AG).
- Published
- 2023
6. Chronic cardiovascular–kidney disorder: a new conceptual framework
- Author
-
Zoccali, Carmine, Mallamaci, Francesca, Halimi, Jean-Michel, Rossignol, Patrick, Sarafidis, Pantelis, De Caterina, Raffaele, Giugliano, Robert, and Zannad, Faiez
- Published
- 2024
- Full Text
- View/download PDF
7. Circulating microvesicles across a population with various degree of cardiovascular burden are associated with systolic blood pressure
- Author
-
Gavriilaki, Eleni, Lazaridis, Antonios, Anyfanti, Panagiota, Yiannaki, Efthalia, Dolgyras, Panagiotis, Nikolaidou, Barbara, Vasileiadis, Ioannis, Alexandrou, Maria Eleni, Margouta, Anastasia, Markala, Dimitra, Zarifis, Ioannis, Sarafidis, Panteleimon, Doumas, Michail, and Gkaliagkousi, Eugenia
- Published
- 2023
- Full Text
- View/download PDF
8. New results on asymptotic properties of likelihood estimators with persistent data for small and large T
- Author
-
Juodis, Artūras and Sarafidis, Vasilis
- Published
- 2023
- Full Text
- View/download PDF
9. Diagnosis of cardiovascular disease in patients with chronic kidney disease
- Author
-
Zoccali, Carmine, Mark, Patrick B., Sarafidis, Pantelis, Agarwal, Rajiv, Adamczak, Marcin, Bueno de Oliveira, Rodrigo, Massy, Ziad A., Kotanko, Peter, Ferro, Charles J., Wanner, Christoph, Burnier, Michel, Vanholder, Raymond, Mallamaci, Francesca, and Wiecek, Andrzej
- Published
- 2023
- Full Text
- View/download PDF
10. Management of patients with hypertension and chronic kidney disease referred to Hypertension Excellence Centres among 27 countries. On behalf of the European Society of Hypertension Working Group on Hypertension and the Kidney
- Author
-
Jean-Michel Halimi, Pantelis Sarafidis, Michel Azizi, Grzegorz Bilo, Thilo Burkard, Michael Bursztyn, Miguel Camafort, Neil Chapman, Santina Cottone, Tine de Backer, Jaap Deinum, Philippe Delmotte, Maria Dorobantu, Michalis Doumas, Rainer Dusing, Béatrice Duly-Bouhanick, Jean-Pierre Fauvel, Pierre Fesler, Zbigniew Gaciong, Eugenia Gkaliagkousi, Daniel Gordin, Guido Grassi, Charalampos Grassos, Dominique Guerrot, Justine Huart, Raffaele Izzo, Fernando Jaén Águila, Zoltán Járai, Thomas Kahan, Ilkka Kantola, Eva Kociánová, FlorianP. Limbourg, Marilucy Lopez-Sublet, Francesca Mallamaci, Athanasios Manolis, Maria Marketou, Gert Mayer, Alberto Mazza, IainM. MacIntyre, Jean-Jacques Mourad, Maria Lorenza Muiesan, Edgar Nasr, Peter Nilsson, Anna Oliveras, Olivier Ormezzano, Vitor Paixão-Dias, Ioannis Papadakis, Dimitris Papadopoulos, Sabine Perl, Jorge Polónia, Roberto Pontremoli, Giacomo Pucci, Nicolás Roberto Robles, Sébastien Rubin, Luis Miguel Ruilope, Lars Christian Rump, Sahrai Saeed, Elias Sanidas, Riccardo Sarzani, Roland Schmieder, François Silhol, Sekib Sokolovic, Marit Solbu, Miroslav Soucek, George Stergiou, Isabella Sudano, Ramzi Tabbalat, Istemihan Tengiz, Helen Triantafyllidi, Konstontinos Tsioufis, Jan Václavík, Markus van der Giet, Patricia Van der Niepen, Franco Veglio, RetoM. Venzin, Margus Viigimaa, Thomas Weber, Jiri Widimsky, Gregoire Wuerzner, Parounak Zelveian, Pantelis Zebekakis, Stephan Lueders, Alexandre Persu, Reinhold Kreutz, and Liffert Vogt
- Subjects
Chronic kidney disease ,hypertension ,management ,RAS blockers ,hyperkalaemia ,SGLT2 inhibitors ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Objective Real-life management of patients with hypertension and chronic kidney disease (CKD) among European Society of Hypertension Excellence Centres (ESH-ECs) is unclear : we aimed to investigate it. Methods A survey was conducted in 2023. The questionnaire contained 64 questions asking ESH-ECs representatives to estimate how patients with CKD are managed. Results Overall, 88 ESH-ECS representatives from 27 countries participated. According to the responders, renin-angiotensin system (RAS) blockers, calcium-channel blockers and thiazides were often added when these medications were lacking in CKD patients, but physicians were more prone to initiate RAS blockers (90% [interquartile range: 70–95%]) than MRA (20% [10–30%]), SGLT2i (30% [20–50%]) or (GLP1-RA (10% [5–15%]). Despite treatment optimisation, 30% of responders indicated that hypertension remained uncontrolled (30% (15–40%) vs 18% [10%–25%]) in CKD and CKD patients, respectively). Hyperkalemia was the most frequent barrier to initiate RAS blockers, and dosage reduction was considered in 45% of responders when kalaemia was 5.5–5.9 mmol/L. Conclusions RAS blockers are initiated in most ESH-ECS in CKD patients, but MRA and SGLT2i initiations are less frequent. Hyperkalemia was the main barrier for initiation or adequate dosing of RAS blockade, and RAS blockers’ dosage reduction was the usual management.
- Published
- 2024
- Full Text
- View/download PDF
11. Author Correction: Chronic cardiovascular–kidney disorder: a new conceptual framework
- Author
-
Zoccali, Carmine, Mallamaci, Francesca, Halimi, Jean-Michel, Rossignol, Patrick, Sarafidis, Pantelis, De Caterina, Raffaele, Giugliano, Robert, and Zannad, Faiez
- Published
- 2024
- Full Text
- View/download PDF
12. Antibiotics, Analgesic Sedatives, and Antiseizure Medications Frequently Used in Critically Ill Neonates: A Narrative Review
- Author
-
Angeliki Kontou, Eleni Agakidou, Ilias Chatziioannidis, William Chotas, Evanthia Thomaidou, and Kosmas Sarafidis
- Subjects
neonatal infections ,sepsis ,antibiotics ,antifungal ,analgesics ,sedatives ,Pediatrics ,RJ1-570 - Abstract
Antibiotic, analgesic sedative, and antiseizure medications are among the most commonly used medications in preterm/sick neonates, who are at high risk of nosocomial infections, central nervous system complications, and are exposed to numerous painful/stressful procedures. These severe and potentially life-threatening complications may have serious short- and long-term consequences and should be prevented and/or promptly treated. The reported variability in the medications used in neonates indicates the lack of adequate neonatal studies regarding their effectiveness and safety. Important obstacles contributing to inadequate studies in preterm/sick infants include difficulties in obtaining parental consent, physicians’ unwillingness to recruit preterm infants, the off-label use of many medications in neonates, and other scientific and ethical concerns. This review is an update on the use of antimicrobials (antifungals), analgesics (sedatives), and antiseizure medications in neonates, focusing on current evidence or knowledge gaps regarding their pharmacokinetics, indications, safety, dosage, and evidence-based guidelines for their optimal use in neonates. We also address the effects of early antibiotic use on the intestinal microbiome and its association with long-term immune-related diseases, obesity, and neurodevelopment (ND). Recommendations for empirical treatment and the emergence of pathogen resistance to antimicrobials and antifungals are also presented. Finally, future perspectives on the prevention, modification, or reversal of antibiotic resistance are discussed.
- Published
- 2024
- Full Text
- View/download PDF
13. Right Ventricular and Right Atrial Strain Are Associated with Kidney Dysfunction in Acute Heart Failure
- Author
-
Vasileios Anastasiou, Emmanouela Peteinidou, Christos Tountas, Stylianos Daios, Dimitrios V. Moysidis, Emmanouil Fardoulis, Christos Gogos, Marieta Theodorakopoulou, Fotini Iatridi, Pantelis Sarafidis, George Giannakoulas, Theodoros Karamitsos, Victoria Delgado, Antonios Ziakas, and Vasileios Kamperidis
- Subjects
acute heart failure ,renal impairment ,increased renal afterload ,right ventricular strain ,right atrial strain ,Medicine (General) ,R5-920 - Abstract
Background: In acute heart failure (HF), low cardiac output and venous congestion are pathophysiological mechanisms that contribute to renal function impairment. This study investigated the association between advanced echocardiographic measures of right ventricular and atrial function and renal impairment in patients with acute HF. Methods and Results: A total of 377 patients hospitalized for acute HF were prospectively evaluated. Estimated glomerular filtration rate (eGFR) on admission was measured using the 2021 Chronic Kidney Disease Epidemiology Collaboration creatinine equation. Advanced echocardiographic assessment was performed on admission. Patients with eGFR < 45 mL/min/1.73 m2 were more likely to have chronic heart failure, chronic atrial fibrillation, and type 2 diabetes mellitus compared to patients with eGFR ≥ 45 mL/min/1.73 m2. Patients with lower eGFR had lower cardiac output, higher mean E/e’ ratio, larger right ventricular (RV) size, worse RV free wall longitudinal strain, more impaired right atrial (RA) reservoir strain, and more frequent severe tricuspid regurgitation. RV free wall longitudinal strain and RA reservoir strain were the only independent echocardiographic associates of low eGFR, whereas cardiac output was not. Conclusions: Impaired RV and RA longitudinal strain were independently associated with eGFR < 45 mL/min/1.73 m2 in acute HF, while reduced cardiac output was not. This suggests that RV and RA dysfunction underlying venous congestion and increased renal afterload are more important pathophysiological determinants of renal impairment in acute HF than reduced cardiac output.
- Published
- 2024
- Full Text
- View/download PDF
14. Frequent hemodialysis versus standard hemodialysis for people with kidney failure: Systematic review and meta-analysis of randomized controlled trials.
- Author
-
Patrizia Natale, Suetonia C Green, Matthias Rose, Michiel L Bots, Peter J Blankestijn, Robin W M Vernooij, Karin Gerittsen, Mark Woodward, Carinna Hockham, Krister Cromm, Claudia Barth, Andrew Davenport, Jörgen Hegbrant, Pantelis Sarafidis, Partha Das, Christoph Wanner, Allan R Nissenson, Benedicte Sautenet, Marietta Török, and Giovanni Strippoli
- Subjects
Medicine ,Science - Abstract
BackgroundFrequent hemodialysis provided more than three times per week may lower mortality and improve health-related quality of life. Yet, the evidence is inconclusive. We evaluated the benefits and harms of frequent hemodialysis in people with kidney failure compared with standard hemodialysis.MethodsWe performed a systematic review of randomized controlled trials including adults on hemodialysis with highly sensitive searching in MEDLINE, Embase, CENTRAL, and Google Scholar on 3 January 2024. Data were pooled using random-effects meta-analysis. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. We adjudicated evidence certainty using GRADE.ResultsFrom 11,142 unique citations, only seven studies involving 518 participants proved eligible. The effects of frequent hemodialysis on physical and mental health were imprecise due to few data. Frequent hemodialysis probably had uncertain effect on death from all cause compared with standard hemodialysis (relative risk 0.79, 95% confidence interval 0.33-1.91, low certainty evidence). Data were not reported for death from cardiovascular causes, major cardiovascular events, fatigue or vascular access.ConclusionThe evidentiary basis for frequent hemodialysis is incomplete due to clinical trials with few or no events reported for mortality and cardiovascular outcome measures and few participants in which patient-reported outcomes including health-related quality of life and symptoms were reported.
- Published
- 2024
- Full Text
- View/download PDF
15. The Urinary Glycopeptide Profile Differentiates Early Cardiorenal Risk in Subjects Not Meeting Criteria for Chronic Kidney Disease
- Author
-
Aranzazu Santiago-Hernandez, Marta Martin-Lorenzo, María Gómez-Serrano, Juan Antonio Lopez, Ariadna Martin-Blazquez, Perceval Vellosillo, Pablo Minguez, Paula J. Martinez, Jesús Vázquez, Gema Ruiz-Hurtado, Maria G. Barderas, Pantelis Sarafidis, Julian Segura, Luis M. Ruilope, and Gloria Alvarez-Llamas
- Subjects
chronic kidney disease ,cardiorenal risk ,cardiovascular disease ,glycoproteins ,N-glycosylation ,proteomics ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Early diagnosis and treatment of chronic kidney disease (CKD) is a worldwide challenge. Subjects with albumin-to-creatinine ratio (ACR) ≥ 30 mg/g and preserved renal function are considered to be at no cardiorenal risk in clinical practice, but prospective clinical studies evidence increased risk, even at the high-normal (HN) ACR range (10–30 mg/g), supporting the need to identify other molecular indicators for early assessment of patients at higher risk. Following our previous studies, here we aim to stratify the normoalbuminuria range according to cardiorenal risk and identify the glycoproteins and N-glycosylation sites associated with kidney damage in subclinical CKD. Glycoproteins were analyzed in urine from hypertensive patients within the HN ACR range compared to control group (C; ACR < 10 mg/g) by mass spectrometry. A different cohort was analyzed for confirmation (ELISA) and sex perspective was evaluated. Patients’ follow-up for 8 years since basal urine collection revealed higher renal function decline and ACR progression for HN patients. Differential N-glycopeptides and their N -glycosylation sites were also identified, together with their pathogenicity. N-glycosylation may condition pathological protein deregulation, and a panel of 62 glycoproteins evidenced alteration in normoalbuminuric subjects within the HN range. Haptoglobin-related protein, haptoglobin, afamin, transferrin, and immunoglobulin heavy constant gamma 1 (IGHG1) and 2 (IGHG2) showed increased levels in HN patients, pointing to disturbed iron metabolism and tubular reabsorption and supporting the tubule as a target of interest in the early progression of CKD. When analyzed separately, haptoglobin, afamin, transferrin, and IGHG2 remained significant in HN, in both women and men. At the peptide level, 172 N-glycopeptides showed differential abundance in HN patients, and 26 showed high pathogenicity, 10 of them belonging to glycoproteins that do not show variation between HN and C groups. This study highlights the value of glycosylation in subjects not meeting KDIGO criteria for CKD. The identified N-glycopeptides and glycosylation sites showed novel targets, for both the early assessment of individual cardiorenal risk and for intervention aimed at anticipating CKD progression.
- Published
- 2024
- Full Text
- View/download PDF
16. Climate Change Risks for the Mediterranean Agri-Food Sector: The Case of Greece
- Author
-
Elena Georgopoulou, Nikos Gakis, Dimitris Kapetanakis, Dimitris Voloudakis, Maria Markaki, Yannis Sarafidis, Dimitris P. Lalas, George P. Laliotis, Konstantina Akamati, Iosif Bizelis, Markos Daskalakis, Sevastianos Mirasgedis, and Iordanis Tzamtzis
- Subjects
agriculture ,climate change ,impacts ,risks ,agri-food sector ,socio-economic ,Agriculture (General) ,S1-972 - Abstract
The study assesses the direct effects of climate change by 2060, including extreme events, on the productivity of regional crop farming and livestock in Greece, and the broader socio-economic effects on the agri-food and other sectors. Different approaches (i.e., agronomic models, statistical regression models, and equations linking thermal stress to livestock output) were combined to estimate the effects on productivity from changes in the average values of climatic parameters, and subsequently the direct economic effects from this long-term climate change. Recorded damages from extreme events together with climatic thresholds per event and crop were combined to estimate the direct economic effects of these extremes. The broader socio-economic effects were then estimated through input–output analysis. Under average levels of future extreme events, the total direct economic losses for Greek agriculture due to climate change will be significant, from EUR 437 million/year to EUR 1 billion/year. These losses approximately double when indirect effects on other sectors using agricultural products as inputs (e.g., food and beverage, hotels, and restaurants) are considered, and escalate further under a tenfold impact of extreme events. Losses in the GDP and employment are moderate at the national level, but significant in regions where the contribution of agriculture is high.
- Published
- 2024
- Full Text
- View/download PDF
17. Socioeconomic Impacts of Climate Mitigation Actions in Greece: Quantitative Assessment and Public Perception
- Author
-
Yannis Sarafidis, Nicolas Demertzis, Elena Georgopoulou, Lydia Avrami, Sevastianos Mirasgedis, and Othon Kaminiaris
- Subjects
climate mitigation ,socioeconomic impacts ,co-benefits ,trade-offs ,public perception ,climate action plans ,Meteorology. Climatology ,QC851-999 - Abstract
Appropriately designed and implemented climate mitigation actions have multiple co-benefits (yet some trade-offs cannot be excluded) that result in substantial social and economic value beyond their direct impact on reducing energy consumption and GHG emissions. Despite their wider acknowledgement by the research community, decision makers and the public have incomplete information on these multiple effects. This paper has a twofold objective: First, through analytical bottom-up approaches, it assesses, in quantitative terms, the macroeconomic effects and the public health benefits attributed to a variety of mitigation actions under consideration in the context of the Greek Energy and Climate Plan. Second, it investigates, through a social survey, how citizens perceive climate change and value these multiple impacts of mitigation actions, and to what extent they are willing to pay for them and support the adoption of policy measures aiming at the green transition of the Greek economy. We show that mitigation actions bring about significant health benefits, particularly in cities, and generate significant positive macroeconomic effects, particularly if mitigation actions focus on the decarbonization of the building sector and on the exploitation of local renewable sources. We also argue that most people do not realize that climate mitigation actions can have wider benefits for society, such as tackling energy poverty, improving public health, and creating new jobs. Unwillingness to pay tends to be the prominent attitude. People who are more reluctant to cover a part of the cost of environmental protection are less likely to perceive that climate change is one of the main challenges at global and national level and support the adoption of climate mitigation policies. In this context, the national strategy for climate change should focus on effectively informing and engaging the public in climate mitigation strategies, strengthening the public trust in government institutions, promoting mutually acceptable solutions with the local communities, and providing incentives for changing citizens’ behavior towards climate-related actions.
- Published
- 2024
- Full Text
- View/download PDF
18. Intertemporal Improvement in Physicians’ Perceptions of the Short-Term Adverse Outcomes of Neonatal Pain: Results of a Two-Time-Point National Survey
- Author
-
Eleni Agakidou, Angeliki Kontou, Theodora Stathopoulou, Maria Farini, Agathi Thomaidou, Konstantina Tsoni, William Chotas, and Kosmas Sarafidis
- Subjects
adverse effects ,analgesics ,cardiovascular ,central nervous system ,neonatology ,preterm infants ,Pediatrics ,RJ1-570 - Abstract
Pain in early life may seriously impact neonatal outcomes. This study aimed to evaluate whether the perceptions of physicians working in neonatal intensive care units (NICUs) of the short-term adverse outcomes associated with neonatal pain have changed over a 20-year period. Self-administered questionnaires were distributed to 117 and 145 neonatologists, pediatricians, and fellows working in level III NICUs in 2000 (T1) and 2019 (T2), respectively. The questionnaire consisted of four domains, including the central nervous, cardiovascular, and respiratory systems, as well as “other systems” (metabolic/endocrine system, growth, and general condition), with 21 total items overall. Although the proportion of positive (correct) responses to the total and system-specific domain scores was significantly higher at T2 than T1, the knowledge of certain short-term adverse outcomes was suboptimal even at T2. Adjustment for cofactors confirmed the independent association of the survey time-point with the total and system-specific domain scores. Moreover, NICU type was an independent significant factor associated with the adjusted total and central nervous system scores, while young doctors had a better knowledge of adverse cardiovascular effects. Conclusions: The perceptions of NICU physicians concerning the short-term outcomes associated with neonatal pain have significantly improved over the past 20 years, although remaining knowledge gaps mandate ongoing efforts to achieve an improvement in neonatal care.
- Published
- 2024
- Full Text
- View/download PDF
19. An Update on Pharmacologic Management of Neonatal Hypotension: When, Why, and Which Medication
- Author
-
Eleni Agakidou, Ilias Chatziioannidis, Angeliki Kontou, Theodora Stathopoulou, William Chotas, and Kosmas Sarafidis
- Subjects
blood pressure ,catecholamines ,inotropes ,neonatal hypotension ,neonates ,pharmacology ,Pediatrics ,RJ1-570 - Abstract
Anti-hypotensive treatment, which includes dopamine, dobutamine, epinephrine, norepinephrine, milrinone, vasopressin, terlipressin, levosimendan, and glucocorticoids, is a long-established intervention in neonates with arterial hypotension (AH). However, there are still gaps in knowledge and issues that need clarification. The main questions and challenges that neonatologists face relate to the reference ranges of arterial blood pressure in presumably healthy neonates in relation to gestational and postnatal age; the arterial blood pressure level that potentially affects perfusion of critical organs; the incorporation of targeted echocardiography and near-infrared spectroscopy for assessing heart function and cerebral perfusion in clinical practice; the indication, timing, and choice of medication for each individual patient; the limited randomized clinical trials in neonates with sometimes conflicting results; and the sparse data regarding the potential effect of early hypotension or anti-hypotensive medications on long-term neurodevelopment. In this review, after a short review of AH definitions used in neonates and existing data on pathophysiology of AH, we discuss currently available data on pharmacokinetic and hemodynamic effects, as well as the effectiveness and safety of anti-hypotensive medications in neonates. In addition, data on the comparisons between anti-hypotensive medications and current suggestions for the main indications of each medication are discussed.
- Published
- 2024
- Full Text
- View/download PDF
20. Central and peripheral arterial diseases in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.
- Author
-
Johansen, Kirsten, Garimella, Pranav, Hicks, Caitlin, Kalra, Philip, Kelly, Dearbhla, Martens, Sven, Matsushita, Kunihiro, Sarafidis, Pantelis, Sood, Manish, Herzog, Charles, Cheung, Michael, Jadoul, Michel, Winkelmayer, Wolfgang, and Reinecke, Holger
- Subjects
abdominal aortic aneurysm ,acute kidney injury ,aortic dissection ,central aortic disease ,cerebrovascular disease ,chronic kidney disease ,peripheral artery disease ,renal artery stenosis ,renovascular ,stroke ,Humans ,Ireland ,Kidney ,Nephrology ,Peripheral Arterial Disease ,Renal Insufficiency ,Chronic - Abstract
Chronic kidney disease (CKD) affects about 10% of all populations worldwide, with about 2 million people requiring dialysis. Although patients with CKD are at high risk of cardiovascular disease and events, they are often underrepresented or excluded in clinical trials, leading to important knowledge gaps about how to treat these patients. KDIGO (Kidney Disease: Improving Global Outcomes) convened the fourth clinical Controversies Conference on the heart, kidney and vasculature in Dublin, Ireland, in February 2020, entitled Central and Peripheral Arterial Diseases in Chronic Kidney Disease. A global panel of multidisciplinary experts from the fields of nephrology, cardiology, neurology, surgery, radiology, vascular biology, epidemiology, and health economics attended. The objective was to identify key issues related to the optimal detection, management, and treatment of cerebrovascular diseases, central aortic disease, renovascular disease, and peripheral artery disease in the setting of CKD. This report outlines the common pathophysiology of these vascular processes in the setting of CKD, describes best practices for their diagnosis and management, summarizes areas of uncertainty, addresses ongoing controversial issues, and proposes a research agenda to address key gaps in knowledge that, when addressed, could improve patient care and outcomes.
- Published
- 2021
21. Peridialytic and intradialytic blood pressure metrics are not valid estimates of 44-h ambulatory blood pressure in patients with intradialytic hypertension
- Author
-
Theodorakopoulou, Marieta P., Alexandrou, Maria-Eleni, Iatridi, Fotini, Karpetas, Antonios, Geladari, Virginia, Pella, Eva, Alexiou, Sophia, Sidiropoulou, Maria, Ziaka, Stavroula, Papagianni, Aikaterini, and Sarafidis, Pantelis
- Published
- 2023
- Full Text
- View/download PDF
22. Kidney transplantation and kidney donation do not affect short-term blood pressure variability
- Author
-
Efstathios Xagas, Pantelis Sarafidis, Fotini Iatridi, Marieta P. Theodorakopoulou, Eva Pella, Maria Korogiannou, Antonis Argyris, Athanase Protogerou, Ioannis N. Boletis, and Smaragdi Marinaki
- Subjects
kidney transplantation ,blood pressure variability ,living kidney donors ,kidney transplant recipients ,ambulatory blood pressure monitoring ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Purpose Blood pressure variability (BPV) is an independent cardiovascular risk factor in CKD. Kidney transplantation (KTx) is associated with improved BP levels for kidney transplant recipient (KTRs), without evoking significant changes in donors. The aim of this study was to assess the short- and mid-time effects of KTx and donation on short-term BPV in KTRs and their respective living kidney donors. Materials and Methods Forty KTRs and their respective donors were evaluated with 24-h ABPM (Mobil-O-Graph-NG) at baseline (1 month before), 3-months and 12-months after KTx. Standard-deviation (SD), weighted-SD (wSD), coefficient-of-variation (CV), average-real-variability (ARV) and variability independent of mean (VIM) for SBP/DBP were calculated with validated formulas Results All 24-h systolic and diastolic BPV indexes studied did not change significantly from baseline to 3-month (SBP-wSD: 12.8 ± 3.0 vs 13.2 ± 3.4 mmHg, p = 0.608; SBP-ARV: 10.3 ± 2.4 vs 10.8 ± 2.6 mmHg, p = 0.463) and 12-month evaluation (SBP-wSD 12.8 ± 3.0 vs 12.1 ± 2.8; p = 0.424 and SBP-ARV: 10.3 ± 2.4 vs 10.2 ± 2.5; p = 0.615) after kidney transplantation in the KTRs.In kidney donors, all 24-h systolic BPV indices displayed a trend towards higher values at 3 months compared to baseline, but without reaching statistical significance (SBP-wSD: 12.2 ± 2.8 vs 13.6 ± 4.2 mmHg, p = 0.107 and SBP-ARV: 10.1 ± 2.1 vs 11.2 ± 3.1 mmHg, p = 0.099), the levels of 24-h systolic SBP indices at 12-months were almost identical to baseline values. 24-h diastolic BPV indices at 3-month and 12-month evaluation were similar to baseline. Conclusion Short-term BPV did not change significantly 3 and 12 months after kidney transplantation/donation neither in KTRs nor in living kidney donors. Longitudinal studies examining associations of BPV with adverse outcomes in these individuals are needed.
- Published
- 2023
- Full Text
- View/download PDF
23. Knowledge and attitudes of medical students about clinical aspects of congenital cytomegalovirus infection in newborns: A nationwide cross-sectional study in Greece
- Author
-
Sofia Benou, Eleftheria Hatzidaki, Anna Kalaintzi, Ioanna Grivea, Maria Baltogianni, Vasileios Giapros, Agathi Thomaidou, Kosmas Sarafidis, Sofia Tsichla, Xenophon Sinopidis, Eleni Papachatzi, Aggeliki Karatza, Maria Lagadinou, Theodore Dassios, Gabriel Dimitriou, Vassiliki Papaevangelou, and Despoina Gkentzi
- Subjects
congenital CMV ,medical students ,knowledge ,attitudes ,practices ,Medicine (General) ,R5-920 - Abstract
IntroductionCytomegalovirus (CMV) is the most frequent cause of congenital infection worldwide causing severe morbidity in newborns, infants, and children. Despite the clinical importance of congenital CMV (cCMV) infection, studies conducted so far indicate that there is limited awareness in the medical community in the field. The aim of this study was to assess Greek medical students’ knowledge on cCMV infection.MethodsWe performed a questionnaire-based nationwide cross-sectional study. A convenience sample of medical students from seven medical schools was enrolled.ResultsOf the 562 respondents, 54,8% considered themselves undereducated on cCMV infection. However, almost half of the participants could correctly recognize some basic principles of cCMV infection including ways of transmission, diagnosis and treatment, while there were aspects of cCMV infection with knowledge deficit. The year of study had a positive impact on the level of knowledge with students of higher years of study being of more sufficient education on the specific topic.ConclusionOverall, our study indicates a discrepancy between self-reported awareness and the level of knowledge among medical students in Greece. Further educational opportunities about cCMV should be offered, particularly in areas of the curriculum involving the care of women and children. Establishing medical students’ solid background on the disease burden and educating them about preventative strategies for at-risk populations, should be the main pillars of such efforts in order to promote confidence in managing these cases in their future professional careers.
- Published
- 2023
- Full Text
- View/download PDF
24. Intradialytic hypertension: epidemiology and pathophysiology of a silent killer
- Author
-
Iatridi, Fotini, Theodorakopoulou, Marieta P., Papagianni, Aikaterini, and Sarafidis, Pantelis
- Published
- 2022
- Full Text
- View/download PDF
25. Gastric Fluid Metabolomics Predicting the Need for Surfactant Replacement Therapy in Very Preterm Infants Results of a Case–Control Study
- Author
-
Konstantia Besiri, Olga Begou, Konstantinos Lallas, Angeliki Kontou, Eleni Agakidou, Olga Deda, Helen Gika, Eleni Verykouki, and Kosmas Sarafidis
- Subjects
gastric fluid ,RDS ,GC-MS ,prematurity ,surfactant ,prediction ,Microbiology ,QR1-502 - Abstract
Respiratory distress syndrome (RDS) is a major morbidity of prematurity. In this case–control study, we prospectively evaluated whether untargeted metabolomic analysis (gas chromatography–mass spectrometry) of the gastric fluid could predict the need for surfactant in very preterm neonates. 43 infants with RDS necessitating surfactant (cases) were compared with 30 infants who were not treated with surfactant (controls). Perinatal–neonatal characteristics were recorded. Significant differences in gastric fluid metabolites (L-proline, L-glycine, L-threonine, acetyl-L-serine) were observed between groups, but none could solely predict surfactant administration with high accuracy. Univariate analysis revealed significant predictors of surfactant administration involving gastric fluid metabolites (L-glycine, acetyl-L-serine) and clinical parameters (gestational age, Apgar scores, intubation in the delivery room). Multivariable models were constructed for significant clinical variables as well as for the combination of clinical variables and gastric fluid metabolites. The AUC value of the first model was 0.69 (95% CI 0.57–0.81) and of the second, 0.76 (95% CI 0.64–0.86), in which acetyl-L-serine and intubation in the delivery room were found to be significant predictors of surfactant therapy. This investigation adds to the current knowledge of biomarkers in preterm neonates with RDS, but further research is required to assess the predictive value of gastric fluid metabolomics in this field.
- Published
- 2024
- Full Text
- View/download PDF
26. Climate Change Impacts on the Energy System of a Climate-Vulnerable Mediterranean Country (Greece)
- Author
-
Elena Georgopoulou, Sevastianos Mirasgedis, Yannis Sarafidis, Christos Giannakopoulos, Konstantinos V. Varotsos, and Nikos Gakis
- Subjects
climate change ,impacts ,energy ,power generation ,demand ,representative concentration pathways ,Meteorology. Climatology ,QC851-999 - Abstract
Climate change is expected to significantly affect countries in Southern Europe and the Mediterranean Basin, causing higher-than-average temperature increases, considerable reductions in rainfall and water runoff, and extreme events such as heatwaves. These pose severe threats to local energy systems, requiring a reliable and quantitative risk analysis. A methodological approach is thus proposed which covers both energy supply and demand, utilizing the latest climate projections under different greenhouse gas emissions scenarios and an appropriate scale for each energy form. For energy supply technologies, risks are assessed through statistical regression models and/or mathematical equations correlating climatic parameters with energy productivity. To analyze climate risks for energy demand, bottom–up models were developed, integrating both behavioral and policy aspects which are often considered in a very limited way. The results show that climate change will mainly affect electricity generation from hydroelectric and thermal power plants, with variations depending on the plants’ locations and uncertainties associated with precipitation and runoff changes. The climate risks for solar and wind energy were found to be low. Energy consumption will also be affected, but the range of risks depends on the ambition and the effectiveness of measures for upgrading the thermal performance of buildings and the intensity of climate change.
- Published
- 2024
- Full Text
- View/download PDF
27. Towards Production of Cost-Effective Modification of SmCo5-Type Alloys Suitable for Permanent Magnets
- Author
-
Margarit Gjoka, Charalampos Sarafidis, and Stefanos Giaremis
- Subjects
SmCo5 magnet ,intermetallic compounds ,structure and magnetic properties ,Technology ,Electrical engineering. Electronics. Nuclear engineering ,TK1-9971 ,Engineering (General). Civil engineering (General) ,TA1-2040 ,Microscopy ,QH201-278.5 ,Descriptive and experimental mechanics ,QC120-168.85 - Abstract
SmCo5 constitutes one of the strongest classes of permanent magnets, which exhibit magnetocrystalline anisotropy with uniaxial character and enormous energy and possess high Curie temperature. However, the performance of SmCo5 permanent magnets is hindered by a limited energy product and relatively high supply risk. Sm is a moderately expensive element within the lanthanide group, while Co is a more expensive material than Fe, making SmCo5-based permanent magnets among the most expensive materials in the group. Subsequently, the need for new materials with less content in critical and thus expensive resources is obvious. A promising path of producing new compounds that meet these requirements is the chemical modification of established materials used in PM towards the reduction of expensive resources, for example, reducing Co content with transition metals (like Fe, Ni) or using as substitutes raw rare earth materials with greater abundance than global demand, like Ce and La. Important instruments to achieve these goals are theoretical calculations, such as ab initio methods and especially DFT-based calculations, in predicting possible stable RE-TM intermetallic compounds and their magnetic properties. This review aims to present the progress of recent years in the production of improved SmCo5-type magnets.
- Published
- 2024
- Full Text
- View/download PDF
28. Mineralocorticoid receptor antagonists for cardioprotection in chronic kidney disease: a step into the future
- Author
-
Alexandrou, Maria-Eleni, Theodorakopoulou, Marieta P., Kanbay, Mehmet, and Sarafidis, Pantelis A.
- Published
- 2022
- Full Text
- View/download PDF
29. Magnetomechanical Stress-Induced Colon Cancer Cell Growth Inhibition
- Author
-
Katerina Spyridopoulou, Georgios Aindelis, Charalampos Sarafidis, Orestis Kalogirou, and Katerina Chlichlia
- Subjects
magneto-mechanical stress ,MNPs ,colon cancer ,growth inhibition ,cell cycle arrest ,lysosomes ,Medical technology ,R855-855.5 - Abstract
The application of magnetomechanical stress in cells using internalized magnetic nanoparticles (MNPs) actuated by low-frequency magnetic fields has been attracting considerable interest in the field of cancer research. Recent developments prove that magnetomechanical stress can inhibit cancer cells’ growth. However, the MNPs’ type and the magnetic field’s characteristics are crucial parameters. Their variability allows multiple combinations, which induce specific biological effects. We previously reported the antiproliferative effects induced in HT29 colon cancer cells by static-magnetic-field (200 mT)-actuated spherical MNPs (100 nm). Herein, we show that similar growth inhibitory effects are induced in other colon cancer cell lines. The effect of magnetomechanical stress was also examined in the growth rate of tumor spheroids. Moreover, we examined the biological mechanisms involved in the observed cell growth inhibition. Under the experimental conditions employed, no cell death was detected by PI (propidium iodide) staining analysis. Flow cytometry and Western blotting revealed that G2/M cell cycle arrest might mediate the antiproliferative effects. Furthermore, MNPs were found to locate in the lysosomes, and a decreased number of lysosomes was detected in cells that had undergone magnetomechanical stress, implying that the mechanical activation of the internalized MNPs could induce lysosome membrane disruption. Of note, the lysosomal acidic conditions were proven to affect the MNPs’ magnetic properties, evidenced by vibrating sample magnetometry (VSM) analysis. Further research on the combination of the described magnetomechanical stress with lysosome-targeting chemotherapeutic drugs could lay the groundwork for the development of novel anticancer combination treatment schemes.
- Published
- 2022
- Full Text
- View/download PDF
30. Ambulatory blood pressure trajectories and blood pressure variability in kidney transplant recipients: a comparative study against chronic kidney disease patients
- Author
-
Maria Korogiannou, Marieta Theodorakopoulou, Pantelis Sarafidis, Maria Eleni Alexandrou, Eva Pella, Efstathios Xagas, Antonis Argyris, Athanase Protogerou, Aikaterini Papagianni, Ioannis N. Boletis, and Smaragdi Marinaki
- Subjects
ambulatory blood pressure monitoring ,blood pressure variability ,chronic kidney diseases ,hypertension ,kidney transplantation ,Internal medicine ,RC31-1245 ,Specialties of internal medicine ,RC581-951 - Abstract
Background Hypertension is a major cardiovascular risk factor in both kidney transplant recipients (KTRs) and patients with chronic kidney disease (CKD). Ambulatory blood pressure monitoring (ABPM) is considered the gold-standard method for hypertension management in these subjects. This is the first study evaluating the full ambulatory blood pressure (BP) profile and short-term BP variability (BPV) in KTRs versus CKD patients without kidney replacement therapy. Methods Ninety-three KTRs were matched with 93 CKD patients for age, sex, and estimated glomerular filtration rate. All participants underwent 24-hour ABPM. Mean ambulatory BP levels, BP trajectories, and BPV indices (standard deviation [SD], weighted SD, and average real variability) were compared between the two groups. Results There were no significant between-group differences in 24-hour systolic BP (SBP)/diastolic BP (DBP) (KTRs: 126.9 ± 13.1/79.1 ± 7.9 mmHg vs. CKD: 128.1 ± 11.2/77.9 ± 8.1 mmHg, p = 0.52/0.29), daytime SBP/DBP and nighttime SBP; nighttime DBP was slightly higher in KTRs (KTRs: 76.5 ± 8.8 mmHg vs. CKD: 73.8 ± 8.8 mmHg, p = 0.04). Repeated measurements analysis of variance showed a significant effect of time on both ambulatory SBP and DBP (SBP: F = [19, 3002] = 11.735, p < 0.001, partial η2 = 0.069) but not of KTR/CKD status (SBP: F = [1, 158] = 0.668, p = 0.42, partial η2 = 0.004). Ambulatory systolic/diastolic BPV indices were not different between KTRs and CKD patients, except for 24-hour DBP SD that was slightly higher in the latter group (KTRs: 10.2 ± 2.2 mmHg vs. CKD: 10.9 ± 2.6 mmHg, p = 0.04). No differences were noted in dipping pattern between the two groups. Conclusion Mean ambulatory BP levels, BP trajectories, and short-term BPV indices are not significantly different between KTRs and CKD patients, suggesting that KTRs have a similar ambulatory BP profile compared to CKD patients without kidney replacement therapy.
- Published
- 2022
- Full Text
- View/download PDF
31. Patterns of antibiotic use, pathogens, and prediction of mortality in hospitalized neonates and young infants with sepsis: A global neonatal sepsis observational cohort study (NeoOBS).
- Author
-
Neal J Russell, Wolfgang Stöhr, Nishad Plakkal, Aislinn Cook, James A Berkley, Bethou Adhisivam, Ramesh Agarwal, Nawshad Uddin Ahmed, Manica Balasegaram, Daynia Ballot, Adrie Bekker, Eitan Naaman Berezin, Davide Bilardi, Suppawat Boonkasidecha, Cristina G Carvalheiro, Neema Chami, Suman Chaurasia, Sara Chiurchiu, Viviane Rinaldi Favarin Colas, Simon Cousens, Tim R Cressey, Ana Carolina Dantas de Assis, Tran Minh Dien, Yijun Ding, Nguyen Trong Dung, Han Dong, Angela Dramowski, Madhusudhan Ds, Ajay Dudeja, Jinxing Feng, Youri Glupczynski, Srishti Goel, Herman Goossens, Doan Thi Huong Hao, Mahmudul Islam Khan, Tatiana Munera Huertas, Mohammad Shahidul Islam, Daniel Jarovsky, Nathalie Khavessian, Meera Khorana, Angeliki Kontou, Tomislav Kostyanev, Premsak Laoyookhon, Sorasak Lochindarat, Mattias Larsson, Maia De Luca, Surbhi Malhotra-Kumar, Nivedita Mondal, Nitu Mundhra, Philippa Musoke, Marisa M Mussi-Pinhata, Ruchi Nanavati, Firdose Nakwa, Sushma Nangia, Jolly Nankunda, Alessandra Nardone, Borna Nyaoke, Christina W Obiero, Maxensia Owor, Wang Ping, Kanchana Preedisripipat, Shamim Qazi, Lifeng Qi, Tanusha Ramdin, Amy Riddell, Lorenza Romani, Praewpan Roysuwan, Robin Saggers, Emmanuel Roilides, Samir K Saha, Kosmas Sarafidis, Valerie Tusubira, Reenu Thomas, Sithembiso Velaphi, Tuba Vilken, Xiaojiao Wang, Yajuan Wang, Yonghong Yang, Liu Zunjie, Sally Ellis, Julia A Bielicki, A Sarah Walker, Paul T Heath, and Mike Sharland
- Subjects
Medicine - Abstract
BackgroundThere is limited data on antibiotic treatment in hospitalized neonates in low- and middle-income countries (LMICs). We aimed to describe patterns of antibiotic use, pathogens, and clinical outcomes, and to develop a severity score predicting mortality in neonatal sepsis to inform future clinical trial design.Methods and findingsHospitalized infants ConclusionAntibiotic regimens used in neonatal sepsis commonly diverge from WHO guidelines, and trials of novel empiric regimens are urgently needed in the context of increasing antimicrobial resistance (AMR). The baseline NeoSep Severity Score identifies high mortality risk criteria for trial entry, while the NeoSep Recovery Score can help guide decisions on regimen change. NeoOBS data informed the NeoSep1 antibiotic trial (ISRCTN48721236), which aims to identify novel first- and second-line empiric antibiotic regimens for neonatal sepsis.Trial registrationClinicalTrials.gov, (NCT03721302).
- Published
- 2023
- Full Text
- View/download PDF
32. Strong Association between Inotrope Administration and Intraventricular Hemorrhage, Gestational Age, and the Use of Fentanyl in Very Low Gestational Age Infants: A Retrospective Study
- Author
-
Theodora Stathopoulou, Eleni Agakidou, Christos Paschaloudis, Angeliki Kontou, Ilias Chatzioannidis, and Kosmas Sarafidis
- Subjects
neonates ,very low birth weight infants ,clinical pharmacology ,drug safety ,fentanyl ,inotrope ,Pediatrics ,RJ1-570 - Abstract
This was a single center, retrospective cohort study designed to evaluate the association between the administration of inotropes to hypotensive very low gestational age infants (VLGAI) and prenatal and neonatal risk factors. Inpatient medical records were reviewed to identify neonates treated with inotropes (treated group) and a control group for comparison. Two hundred and twenty two (222) VLGAI (less than 32 weeks’ gestation) were included in the final analysis and were stratified based on timing of treatment with 83 infants (37.4%) and 139 infants (62.6%) in the treated and control groups, respectively. A total of 56/83 (67%) received inotropes for arterial hypotension during the first 3 days (early treatment subgroup) and 27/83 (32.5%) after 3 days of life (late-treated subgroup). Fentanyl, severe intraventricular hemorrhage (IVH), and gestational age (GA) were the risk factors most significantly associated with the need for inotrope use both during the first 3 days of life and the whole NICU stay, before and after adjustment for confounders. In conclusion, fentanyl, severe IVH, and GA are the risk factors most strongly associated with the need for inotrope treatment in VLGAI. Measures to modify these risk factors may decrease the need for cardiovascular medications and improve outcomes.
- Published
- 2023
- Full Text
- View/download PDF
33. The Sympathetic Nervous System in Hypertensive Heart Failure with Preserved LVEF
- Author
-
Filippos Triposkiadis, Alexandros Briasoulis, Pantelis Sarafidis, Dimitrios Magouliotis, Thanos Athanasiou, Ioannis Paraskevaidis, John Skoularigis, and Andrew Xanthopoulos
- Subjects
hypertension ,heart failure ,sympathetic overactivity ,Medicine - Abstract
The neurohormonal model of heart failure (HF) pathogenesis states that a reduction in cardiac output caused by cardiac injury results in sympathetic nervous system (SNS) activation, that is adaptive in the short-term and maladaptive in the long-term. This model has proved extremely valid and has been applied in HF with a reduced left ventricular (LV) ejection fraction (LVEF). In contrast, it has been undermined in HF with preserved LVEF (HFpEF), which is due to hypertension (HTN) in the vast majority of the cases. Erroneously, HTN, which is the leading cause of cardiovascular disease and premature death worldwide and is present in more than 90% of HF patients, is tightly linked with SNS overactivity. In this paper we provide a contemporary overview of the contribution of SNS overactivity to the development and progression of hypertensive HF (HHF) as well as the clinical implications resulting from therapeutic interventions modifying SNS activity. Throughout the manuscript the terms HHF with preserved LVEF and HfpEF will be used interchangeably, considering that the findings in most HFpEF studies are driven by HTN.
- Published
- 2023
- Full Text
- View/download PDF
34. Early morning hemodynamic changes and left ventricular hypertrophy and mortality in hemodialysis patients
- Author
-
Mallamaci, Francesca, Tripepi, Rocco, Torino, Claudia, Tripepi, Giovanni, Sarafidis, Pantelis, and Zoccali, Carmine
- Published
- 2022
- Full Text
- View/download PDF
35. Opportunistic screening for hypertension: what does it say about the true epidemiology?
- Author
-
Menti, Ariadni, Kalpourtzi, Natasa, Gavana, Magda, Vantarakis, Apostolos, Voulgari, Paraskevi V., Hadjichristodoulou, Christos, Gkaliagkousi, Eugenia, Doumas, Michael, Kalaitzidis, Rigas G., Kallistratos, Manolis S., Karakosta, Argiro, Katsi, Vasiliki, Krokidis, Xenophon, Manios, Efstathios, Marketou, Maria, Ntineri, Angeliki, Papadakis, John A., Papadopoulos, Dimitrios, Sarafidis, Pantelis, Trypsianis, Grigoris, Chatzopoulos, Michail, Chlouverakis, Grigoris, Alamanos, Yannis, Zebekakis, Pantelis, Touloumi, Giota, and Stergiou, George S.
- Published
- 2022
- Full Text
- View/download PDF
36. Association of peridialytic, intradialytic, scheduled interdialytic and ambulatory BP recordings with cardiovascular events in hemodialysis patients
- Author
-
Iatridi, Fotini, Theodorakopoulou, Marieta P., Karpetas, Antonios, Bikos, Athanasios, Karagiannidis, Artemios G., Alexandrou, Maria-Eleni, Tsouchnikas, Ioannis, Mayer, Christopher C., Haidich, Anna-Bettina, Papagianni, Aikaterini, Parati, Gianfranco, and Sarafidis, Pantelis A.
- Published
- 2022
- Full Text
- View/download PDF
37. Systematic Review and Meta-Analysis of Cardiovascular Medications in Neonatal Hypotension
- Author
-
Kosmas Sarafidis, Eleni Verykouki, Stefanos Nikopoulos, Fani Apostolidou-Kiouti, Theodoros Diakonidis, Eleni Agakidou, Aggeliki Kontou, and Anna-Bettina Haidich
- Subjects
neonate ,arterial hypotension ,dopamine ,dobutamine ,Medicine (General) ,R5-920 - Abstract
Background: Comparative studies among the various cardiovascular medications used for the treatment of neonatal hypotension are lacking. Methods: This systematic review and pairwise meta-analysis of the anti-hypotensive treatments in preterm and term infants was conducted to evaluate efficacy and impact on outcome. Electronic databases were searched up to February 2021 for relevant articles. As an extension of the current approach for study selection, a machine learning technique was used. Only randomized controlled trials (RCTs) of inotropes, pressors, volume therapy, and corticosteroids were included. Response to treatment was the primary outcome while secondary outcomes included mortality and common morbidities. Results: Nineteen RCTs involving 758 preterm and term neonates were found, and 8 treatments were evaluated. Most studies involved subjects with early hypotension associated with prematurity. Pairwise meta-analysis among treatments showed that dopamine was more effective than dobutamine regarding the response to treatment (restoration of normotension or normalization of blood pressure) (7 trials, 286 neonates, odds ratio, 3.06 [95% CI = 1.06–8.87]; I2 = 49%, very low quality of the evidence per GRADE). Comparisons of other treatments were not significant. No differences were found among regimens regarding survival and other secondary outcomes. Conclusion: In this systematic review and pairwise meta-analysis, only the comparison of dopamine versus dobutamine provided evidence for efficacy of treatment and favored dopamine. No safe conclusions could be reached in regard to other treatments. Data regarding the management of arterial hypotension in conditions other than transition after birth in preterm newborns are sparse both in preterm and term infants.
- Published
- 2022
- Full Text
- View/download PDF
38. Meta-analysis addressing the impact of cardiovascular-acting medication on peak oxygen uptake of patients with HFpEF
- Author
-
Boulmpou, Aristi, Theodorakopoulou, Marieta P., Alexandrou, Maria-Eleni, Boutou, Afroditi K., Papadopoulos, Christodoulos E., Pella, Eva, Sarafidis, Pantelis, and Vassilikos, Vassilios
- Published
- 2022
- Full Text
- View/download PDF
39. Is Our Increasing Understanding of PCSK9 and Lp(a) Metabolism the Key to Unlocking the Paradox of Statins Ineffectiveness in Reducing Cardiovascular Events in Advanced CKD?
- Author
-
Loutradis, Charalampos, Sarafidis, Pantelis A., Ortiz, Alberto, and Ferro, Charles J.
- Published
- 2022
- Full Text
- View/download PDF
40. Effects of different exercise programs on the cardiorespiratory reserve in HFpEF patients: a systematic review and meta-analysis
- Author
-
Aristi Boulmpou, Marieta P. Theodorakopoulou, Afroditi K. Boutou, Maria-Eleni Alexandrou, Christodoulos E. Papadopoulos, Dimitra Rafailia Bakaloudi, Eva Pella, Pantelis Sarafidis, and Vassilios Vassilikos
- Subjects
HFpEF ,CPET ,exercise training ,peak VO2 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
HFpEF represents a heterogeneous syndrome with complex pathophysiological substrates and multiple clinical manifestations. Recently, much attention has been focused on cardiac rehabilitation programs for HFpEF patients, and several studies have examined the effects of exercise training on this specific population. This systematic review and meta-analysis included studies on adult patients with HFpEF and evaluated the impact of exercise on the cardiorespiratory fitness variables measured during CPET. The primary outcome was the difference in the change in the peak oxygen uptake (Δpeak VO2) between the groups. Literature search involved PubMed/MEDLINE, Cochrane/CENTRAL and Scopus databases. From an initial 5,143 literature records, we identified 18 studies fulfilling the inclusion criteria; 11 studies with 515 patients were finally included in the primary outcome analysis. Δpeak VO2 between baseline and study end was significantly higher in the groups of exercise training versus control (WMD 2.25 ml/kg/min, 95% CI 1.81–2.70). Exercise training resulted in greater change in the 6-minute walking test (6MWT) distance (WMD 2.25 m, 95% CI 1.81–2.70). Health-related quality of life (HRQoL) (WMD: −3.36, 95% CI −9.42 to 2.70, I2 = 14%, p = 0.33) and echocardiographic indices of diastolic function showed no differences between exercise and control groups at study end. In the subgroup analysis, no difference between resistance versus aerobic exercise was noted in Δpeak VO2, but high-intensity interval training showed a greater increase in peak VO2 versus aerobic exercise (WMD 1.62 ml/kg/min, 95% CI 0.96–2.29, I2 = 0%, p = 0.82). Exercise training in HFpEF results in significant improvements in peak VO2 and 6MWT distance as compared to those for controls. High-intensity interval training may offer greater enhancement of the exercise capacity of these patients than standard aerobic exercise.
- Published
- 2022
- Full Text
- View/download PDF
41. Lung ultrasound-guided dry-weight reduction and echocardiographic changes in clinically euvolemic hypertensive hemodialysis patients: 12-month results of a randomized controlled trial
- Author
-
Charalampos Loutradis, Christodoulos E. Papadopoulos, Vassilios Sachpekidis, Robert Ekart, Barbara Krunic, Dorothea Papadopoulou, Aikaterini Papagianni, Francesca Mallamaci, Carmine Zoccali, and Pantelis A. Sarafidis
- Subjects
echocardiography ,dry-weight reduction ,hemodialysis ,hypertension ,lung ultrasound ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Objective: Left ventricular hypertrophy (LVH) and dysfunction are highly prevalent in hemodialysis patients and are independently associated with adverse outcomes. This study examines the long-term effects of dry-weight reduction with a standardized lung ultrasound (LUS)-guided strategy on echocardiographic indexes of left ventricular (LV) mass and function in hemodialysis patients. Methods: Seventy-one clinically euvolemic hemodialysis patients with hypertension were randomized to dry-weight reduction guided by pre-hemodialysis LUS (n = 35) or standard-of-care treatment (n = 36) and were followed-up for 12 months. Two-dimensional and tissue-Doppler echocardiographies (TDI) were performed at the baseline and 12-month evaluations. Results: During follow-up, dry-weight reduction took place in more patients in the active arm than in the control arm of the trial (71.4% vs 22.2%; p
- Published
- 2022
- Full Text
- View/download PDF
42. De novo Minimal Change Disease in an Adolescent after Pfizer-BioNTech COVID-19 Vaccination: A Case Report
- Author
-
Eva Pella, Pantelis A. Sarafidis, Maria-Eleni Alexandrou, Maria Stangou, Christina Nikolaidou, Dimitrios Kosmidis, and Aikaterini Papagianni
- Subjects
nephrotic syndrome ,coronavirus disease 2019 ,minimal change disease ,mrna-based coronavirus disease 2019 vaccine ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
This is the first report in an adolescent of minimal change disease (MCD) after the first injection of the BNT162b2 COVID-19 vaccine (Pfizer-BioNTech) with complete remission following steroid treatment. An 18-year-old white male with no prior medical history complained of gastrointestinal symptoms 11 days after his vaccination. Ascites and lower extremity edema were observed a few days later. He was admitted to a hospital as laboratory testing revealed proteinuria of 10.5 g/24 h, normal creatinine levels, and serum albumin of 1.8 g/dL, confirming the presence of nephrotic syndrome. Immunology and serology tests were unremarkable. A diagnostic kidney biopsy showed no significant glomerular or tubular abnormalities in light microscopy with negative immunofluorescence. Treatment with methylprednisolone 48 mg daily was initiated. A week after discharge, proteinuria declined to 1.2 g/24 h, and edema had disappeared, and 6 weeks later, complete remission was evident. As COVID-19 vaccination has been associated with the development of de novo and relapsing MCD, and this case provides additional support for this possible correlation.
- Published
- 2022
- Full Text
- View/download PDF
43. Lung Ultrasound as a Tool to Evaluate Fluid Accumulation in Dialysis Patients
- Author
-
Maria-Eleni Alexandrou, Marieta P. Theodorakopoulou, and Pantelis A. Sarafidis
- Subjects
hemodialysis ,peritoneal dialysis ,lung ultrasound ,ultrasound b-lines ,Dermatology ,RL1-803 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Background: Volume overload is the main mechanism of BP elevation in end-stage kidney disease (ESKD) patients undergoing hemodialysis or peritoneal dialysis and has been linked to adverse outcomes and increased mortality in this population. Summary: This review discusses current knowledge on lung ultrasound as a tool for detection of extracellular volume overload through evaluation of extravascular lung water content. We describe the principles of lung US, the main protocols to apply it in clinical practice, and accumulated data evidence regarding its associations with cardiovascular events and mortality. We also summarize available evidence on the effect of lung ultrasound-guided volume management strategies on BP control, echocardiographic parameters, and major outcomes in patients undergoing dialysis. Key Messages: Among interventions attempting to reduce the burden of cardiovascular disease in ESKD, effective management of volume overload represents an unmet clinical need. Assessment of hydration status by lung ultrasound is a cheap, easy to employ, and real-time technique that can offer accurate dry weight assessment leading to several clinical benefits.
- Published
- 2022
- Full Text
- View/download PDF
44. Heart Failure in Patients with Chronic Kidney Disease
- Author
-
Andrew Xanthopoulos, Adamantia Papamichail, Alexandros Briasoulis, Konstantinos Loritis, Angeliki Bourazana, Dimitrios E. Magouliotis, Pantelis Sarafidis, Ioannis Stefanidis, John Skoularigis, and Filippos Triposkiadis
- Subjects
chronic kidney disease ,heart failure ,β-blockers ,renin-angiotensin aldosterone system inhibitors ,angiotensin receptor/neprilysin inhibitor ,sodium glucose cotransporter 2 inhibitor ,Medicine - Abstract
The function of the kidney is tightly linked to the function of the heart. Dysfunction/disease of the kidney may initiate, accentuate, or precipitate of the cardiac dysfunction/disease and vice versa, contributing to a negative spiral. Further, the reciprocal association between the heart and the kidney may occur on top of other entities, usually diabetes, hypertension, and atherosclerosis, simultaneously affecting the two organs. Chronic kidney disease (CKD) can influence cardiac function through altered hemodynamics and salt and water retention, leading to venous congestion and therefore, not surprisingly, to heart failure (HF). Management of HF in CKD is challenging due to several factors, including complex interplays between these two conditions, the effect of kidney dysfunction on the metabolism of HF medications, the effect of HF medications on kidney function, and the high risk for anemia and hyperkalemia. As a result, in most HF trials, patients with severe renal impairment (i.e., eGFR 30 mL/min/1.73 m2 or less) are excluded. The present review discusses the epidemiology, pathophysiology, and current medical management in patients with HF developing in the context of CKD.
- Published
- 2023
- Full Text
- View/download PDF
45. Hypertensive Heart Failure
- Author
-
Filippos Triposkiadis, Pantelis Sarafidis, Alexandros Briasoulis, Dimitrios E. Magouliotis, Thanos Athanasiou, John Skoularigis, and Andrew Xanthopoulos
- Subjects
heart failure ,hypertension ,ejection fraction ,autonomic imbalance ,sympathetic nervous system ,Medicine - Abstract
Despite overwhelming epidemiological evidence, the contribution of hypertension (HTN) to heart failure (HF) development has been undermined in current clinical practice. This is because approximately half of HF patients have been labeled as suffering from HF with preserved left ventricular (LV) ejection fraction (EF) (HFpEF), with HTN, obesity, and diabetes mellitus (DM) being considered virtually equally responsible for its development. However, this suggestion is obviously inaccurate, since HTN is by far the most frequent and devastating morbidity present in HFpEF. Further, HF development in obesity or DM is rare in the absence of HTN or coronary artery disease (CAD), whereas HTN often causes HF per se. Finally, unlike HTN, for most major comorbidities present in HFpEF, including anemia, chronic kidney disease, pulmonary disease, DM, atrial fibrillation, sleep apnea, and depression, it is unknown whether they precede HF or result from it. The purpose of this paper is to provide a contemporary overview on hypertensive HF, with a special emphasis on its inflammatory nature and association with autonomic nervous system (ANS) imbalance, since both are of pathophysiologic and therapeutic interest.
- Published
- 2023
- Full Text
- View/download PDF
46. Role of hypertension in kidney transplant recipients
- Author
-
Loutradis, Charalampos, Sarafidis, Pantelis, Marinaki, Smaragdi, Berry, Miriam, Borrows, Richard, Sharif, Adnan, and Ferro, Charles J.
- Published
- 2021
- Full Text
- View/download PDF
47. Joint ESH excellence centers' national meeting on renal sympathetic denervation: A Greek experts’ survey
- Author
-
Michael Doumas, Emmanouil Andreadis, Markos Andronoglou, Periklis Davlouros, Kyriakos Dimitriadis, Eugene Gkaliagkousi, Harris Grassos, Apostolos Hatzitolios, Panagiotis Iliakis, Rigas Kalaitzidis, Emmanouil Kallistratos, Alexandros Kasiakogias, Dimitrios Konstantinidis, Vasilios Kotsis, Thomas Makris, Athanasios Manolis, Athanasios Moulias, Maria Marketou, Ioannis Papadakis, Dimitrios Papadopoulos, Leonidas Poulimenos, Elias Sanidas, Pantelis Sarafidis, Christos Savopoulos, George Stergiou, Fotis Tatakis, Konstantinos Thomopoulos, Helen Triantafyllidi, Areti Triantafyllou, Dimitrios Vlachakos, Pantelis Zebekakis, Antonios Ziakas, Vasilios Papademetriou, and Costas Tsioufis
- Subjects
renal denervation ,hypertension ,safety ,efficacy ,Greek hypertension experts ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Objective: The efficacy of renal sympathetic denervation (RDN) has been affirmed by a number of recent clinical studies, despite controversies in this field over the last five years. Therefore, it is of paramount importance that hypertension experts debate the merits of RDN by revealing and expressing their personal beliefs and perspectives regarding this procedure. Methods: A cross-sectional survey was conducted among Greek leaders of the Hypertension Excellence Centers with the use of a closed-type questionnaire specifically designed to elicit information and evaluate the respondent's views and perspectives about RDN efficacy, safety and ideal target patient population. Results: A total of 36 participants completed the survey. Based on the results, RDN was considered efficient (91.7%) and safe (94.5%), while the overwhelming majority of the participants felt confident in the long-term efficacy (88.9%) of the intervention and that it lacks reliable predictors of blood pressure response (94.5%). Patients with resistant (91.7%), ultra-resistant (94.4%), and uncontrolled hypertension (80.6%) were suggested as ideal candidates for RDN. Establishing a close co-operation between interventionalists and hypertension experts was considered essential to ensure the efficacy (97.2%) as well as the safety (97.3%) of the procedure. Conclusion: The vast majority of Greek hypertension experts surveyed were convinced of the efficacy and safety of RDN based on the preponderance of available scientific and clinical data. Identification of the ideal patient group remains controversial. Respondents generally agreed on the necessity of building close collaborative relationships between interventionalists and hypertension experts in order to improve RDN clinical outcome.
- Published
- 2021
- Full Text
- View/download PDF
48. Hyperkalemia in Chronic Kidney Disease in the New Era of Kidney Protection Therapies
- Author
-
Valdivielso, José M., Balafa, Olga, Ekart, Robert, Ferro, Charles J., Mallamaci, Francesca, Mark, Patrick B., Rossignol, Patrick, Sarafidis, Pantelis, Del Vecchio, Lucia, and Ortiz, Alberto
- Published
- 2021
- Full Text
- View/download PDF
49. Vertical Mergers in a Model of Upstream Monopoly and Incomplete Information
- Author
-
Moresi, Serge, Reitman, David, Salop, Steven C., and Sarafidis, Yianis
- Published
- 2021
- Full Text
- View/download PDF
50. Use of Newer and Repurposed Antibiotics against Gram-Negative Bacteria in Neonates
- Author
-
Angeliki Kontou, Maria Kourti, Elias Iosifidis, Kosmas Sarafidis, and Emmanuel Roilides
- Subjects
neonates ,ceftazidime–avibactam ,ceftolozane/tazobactam ,imipenem/cilastatin–relabactam ,meropenem–vaborbactam ,colistin ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Antimicrobial resistance has become a significant public health problem globally with multidrug resistant Gram negative (MDR-GN) bacteria being the main representatives. The emergence of these pathogens in neonatal settings threatens the well-being of the vulnerable neonatal population given the dearth of safe and effective therapeutic options. Evidence from studies mainly in adults is now available for several novel antimicrobial compounds, such as new β-lactam/β-lactamase inhibitors (e.g., ceftazidime–avibactam, meropenem–vaborbactam, imipenem/cilastatin–relebactam), although old antibiotics such as colistin, tigecycline, and fosfomycin are also encompassed in the fight against MDR-GN infections that remain challenging. Data in the neonatal population are scarce, with few clinical trials enrolling neonates for the evaluation of the efficacy, safety, and dosing of new antibiotics, while the majority of old antibiotics are used off-label. In this article we review data about some novel and old antibiotics that are active against MDR-GN bacteria causing sepsis and are of interest to be used in the neonatal population.
- Published
- 2023
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.