Kourbeti I.S.,General Hospital of Chalkida |
Konstantopoulos K.,National and Kapodistrian University of Athens
Current Respiratory Medicine Reviews | Year: 2012
Biological agents such as monoclonal antibodies, soluble receptors and molecular mimetics, offer the potential to enhance or replace conventional therapies in the treatment of autoimmune diseases, multiple sclerosis, solid tumors and hematological diseases. As tumor necrosis factor (TNF) plays an essential role in host defense, anti-TNF therapies have increased the risk of serious infections, including mycobacterial and opportunistic infections. The increase in bacterial, fungal and parasitic or viral infections has been well-documented. Lung involvement is expected in 20% of the serious bacterial infections. Diagnosis of lung infections associated with biological agents can prove very difficult due to atypical clinical and pathological features. Patients and physicians should be alerted on the importance of early symptom recognition to avoid the delay in diagnosis. Pulmonary involvement presentation may often be dramatic with acute respiratory failure and bilateral infiltrates. Vigilance is needed for rapid diagnosis with the institution of computer assisted tomography and fiberoptic bronchoscopy. In this review we summarize epidemiology, offending pathogens, and diagnostics of pulmonary infections associated with the use of biological therapies. Measures that can be used for prophylaxis, such as vaccinations and latent infections therapy, will also be reviewed. © 2012 Bentham Science Publishers. Source
Association of post-cardioversion transcardiac concentration gradient of soluble tumor necrosis factor-related apoptosis-inducing ligand (sTRAIL) and inflammatory biomarkers to atrial fibrillation recurrence
Deftereos S.,Athens General Hospital G. Gennimatas |
Giannopoulos G.,Athens General Hospital G. Gennimatas |
Giannopoulos G.,Yale University |
Kossyvakis C.,Athens General Hospital G. Gennimatas |
And 12 more authors.
Clinical Biochemistry | Year: 2013
Objectives: Soluble tumor necrosis factor-related apoptosis-inducing ligand (sTRAIL) has been shown to have both pro- and anti-apoptotic activities and is associated to better prognosis in heart failure. The aim of this study was to determine the transcardiac concentration gradient of sTRAIL and inflammatory biomarkers after AF cardioversion and assess their relation to AF recurrence. Design and methods: We measured transcardiac gradients (coronary sinus concentration minus aortic root concentration) of sTRAIL, C-reactive protein (hsCRP) and interleukin-6 (IL-6) in patients with non-valvular AF after electrical cardioversion. Six-month AF recurrence was the study endpoint. Results: There were no differences in sTRAIL and hsCRP concentrations in peripheral venous blood between patients with and without AF recurrence (p. =. 0.066 and 0.149, respectively), while IL-6 was higher in patients with recurrence (p. =. 0.032). Only sTRAIL showed a significant transcardiac gradient [3. pg/mL (IQR 1-4. pg/mL); p. =. 0.01]. sTRAIL gradient was 4. pg/mL (IQR 3-5. pg/mL) in patients without recurrence versus -. 1. pg/mL (IQR -. 2-1. pg/mL) in those with recurrence (p. <. 0.001). IL-6 (p. =. 0.281) and hsCRP (p. =. 0.979) aortic concentrations were not significantly different from coronary sinus concentrations. In multivariate analysis, sTRAIL transcardiac gradient (beta -. 0.81, p. =. 0.004) remained a negative predictor of AF recurrence. Conclusion: This study demonstrates the existence of a significant transcardiac sTRAIL concentration gradient in patients with non-valvular AF, inversely associated to AF recurrence. These results suggest production of sTRAIL by the heart and a protective role against substrate-altering processes in AF-prone atria. This could have implications for TRAIL-targeting therapies currently under development. © 2013 The Canadian Society of Clinical Chemists. Source
Vrachnis N.,National and Kapodistrian University of Athens |
Belitsos P.,General Hospital of Chalkida |
Sifakis S.,University of Crete |
Dafopoulos K.,University of Thessaly |
And 3 more authors.
International Journal of Endocrinology | Year: 2012
Previous Gestational Diabetes Mellitus (pGDM) is a common condition and has been associated with future development of Type 2 Diabetes Mellitus (T2DM) and Metabolic Syndrome (MS) in women affected. The pathogenesis and risk factors implicated in the development of these conditions later in the lives of women with pGDM are not as yet fully understood. Research has recently focused on a group of substances produced mainly by adipose tissue called adipokines, this group including, among others, adiponectin, leptin, Retinol-Binding Protein-4 (RBP-4), and resistin. These substances as well as other inflammatory mediators (CRP, IL-6, PAI-1, TNF-) seem to play an important role in glucose tolerance and insulin sensitivity dysregulation in women with pGDM. We summarize the data available on the role of these molecules. Copyright © 2012 Nikolaos Vrachnis et al. Source
Tsioutis C.,University of Crete |
Chaliotis G.,General Hospital of Chalkida |
Kokkini S.,University of Crete |
Doukakis S.,General Hospital of Chania |
And 3 more authors.
Scandinavian Journal of Infectious Diseases | Year: 2014
Background: The characteristics of Rickettsia typhi infection in elderly patients have not been extensively described in the literature. Methods: We conducted a prospective study on murine typhus in patients > 65 years old in two endemic areas of Greece. Results: Forty-nine elderly patients were analyzed, including 30 (61.2%) males. The clinical triad of fever (100% of patients), headache (83.7%), and rash (73.5%), occurred in 63% of patients, whereas malaise (85.7%), anorexia (65.3%), and myalgia (59.2%) were also common. Frequent laboratory findings were transaminasemia (89.8%), lactate dehydrogenase elevation (65.3%), hematuria (55.1%), thrombocytopenia (53.1%), anemia (51%), leucopenia (40.8%), and mild hyponatremia (23.5%). Complications developed in 16 patients (32.7%); no deaths were recorded. Conclusions: The main clinical and laboratory characteristics of murine typhus are similar in elderly and younger adults. However, elderly patients have a more severe clinical picture, evidenced by a higher complication rate and longer duration of fever, even with appropriate treatment. To our knowledge, this is the first study to focus on murine typhus in a geriatric population. © 2014 Informa Healthcare. Source
Kourbeti I.S.,General Hospital of Chalkida |
Vakis A.F.,University Hospital of Heraklion |
Ziakas P.,Brown University |
Karabetsos D.,University Hospital of Heraklion |
And 3 more authors.
Journal of Neurosurgery | Year: 2015
Object The authors performed a prospective study to define the prevalence and microbiological characteristics of infections in patients undergoing craniotomy and to clarify the risk factors for post-craniotomy meningitis. Methods Patients older than 18 years who underwent nonstereotactic craniotomies between January 2006 and December 2008 were included. Demographic, clinical, laboratory, and microbiological data were systemically recorded. Patient characteristics, craniotomy type, and pre- and postoperative variables were evaluated as risk factors for meningitis Results Three hundred thirty-four procedures were analyzed (65.6% involving male patients). Traumatic brain injury was the most common reason for craniotomy. Almost 40% of the patients developed at least 1 infection. Ventilatorassociated pneumonia (VAP) was the most common infection recorded (22.5%) and Acinetobacter spp. were isolated in 44% of the cases. Meningitis was encountered in 16 procedures (4.8%), and CSF cultures were positive for microbial growth in 100% of these cases. Gram-negative pathogens (Acinetobacter spp., Klebsiella spp., Pseudomonas aeruginosa, Enterobacter cloaceae, Proteus mirabilis) represented 88% of the pathogens. Acinetobacter and Klebsiella spp. demonstrated a high percentage of resistance in several antibiotic classes. In multivariate analysis, the risk for meningitis was independently associated with perioperative steroid use (OR 11.55, p = 0.005), CSF leak (OR 48.03, p < 0.001), and ventricular drainage (OR 70.52, p < 0.001). Con clusion s Device-related postoperative communication between the CSF and the environment, CSF leak, and perioperative steroid use were defined as risk factors for meningitis in this study. Ventilator-associated pneumonia was the most common infection overall. The offending pathogens presented a high level of resistance to several antibiotics. © AANS, 2015. Source