PubMed | Novartis, Laiko General Hospital, Polyclinic General Hospital, NIMTS Hospital and General Hospital of Thessaloniki Papageorgiou
Type: | Journal: International journal of endocrinology | Year: 2015
Objective. This study aimed to estimate the mean annual cost of treating type 2 diabetes mellitus patients (T2DM) including complications and comorbidities in Greece. Design. A noninterventional retrospective study was based on patient level data analysis (bottom-up approach) from medical records, with at least 10-year-follow-up data. Results. The total annual cost per patient for managing diabetes in Greece was estimated at 7,111 and was, statistically significantly, higher for patients with inadequate glycemic control (Hba1c > 7%) versus patients with adequate control (Hba1c = 7%) ( 7,783 versus 6,366, resp.; P = 0.017). This was mainly attributed to difference in CV hospitalizations between groups 14/111 versus 4/100, respectively, OR = 3.46 (95% CI: 1.10-10.9) for inadequately controlled patients. The largest component of cost was management of comorbidities, accounting for 48% of costs, and pharmaceutical treatment at 35.9% while only 14.9% was attributed to diabetes treatment per se. Obese men and patients with poor education are the groups with higher treatment costs. Conclusions. This is the first study to capture all cost components and the real burden of diabetes in Greece. Comorbidities were found to account for almost half of total cost, significantly higher in nonoptimally controlled diabetes patients.
Valotassiou V.,University Hospital of Larissa Mezourlo |
Leondi A.,National and Kapodistrian University of Athens |
Angelidis G.,NIMTS Hospital |
Psimadas D.,University Hospital of Larissa Mezourlo |
Georgoulias P.,University Hospital of Larissa Mezourlo
The Scientific World Journal | Year: 2012
Meningiomas arise from the meningothelial cells of the arachnoid membranes. They are the most common primary intracranial neoplasms and represent about 20 of all intracranial tumors. They are usually diagnosed after the third decade of life and they are more frequent in women than in men. According to the World Health Organization (WHO) criteria, meningiomas can be classified into grade I meningiomas, which are benign, grade II (atypical) and grade III (anaplastic) meningiomas, which have a much more aggressive clinical behaviour. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are routinely used in the diagnostic workup of patients with meningiomas. Molecular Nuclear Medicine Imaging with Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET) could provide complementary information to CT and MRI. Various SPECT and PET tracers may provide information about cellular processes and biological characteristics of meningiomas. Therefore, SPECT and PET imaging could be used for the preoperative noninvasive diagnosis and differential diagnosis of meningiomas, prediction of tumor grade and tumor recurrence, response to treatment, target volume delineation for radiation therapy planning, and distinction between residual or recurrent tumour from scar tissue. Copyright © 2012 Varvara Valotassiou et al.
Triantafyllou K.,Rimini Street |
Viazis N.,Evangelismos General Hospital |
Tsibouris P.,NIMTS Hospital |
Zacharakis G.,Evangelismos General Hospital |
And 3 more authors.
Gastrointestinal Endoscopy | Year: 2014
Background Colon capsule endoscopy (CCE) could be an option to examine the colon after incomplete colonoscopy. Objective To investigate the extent that CCE complements incomplete colonoscopy and guides further workup. Design Prospective, follow-up study. Setting Three tertiary-care centers. Patients Consecutive outpatients after colonoscopy failure; 1-year study period. Intervention Patients underwent CCE either immediately after colonoscopy or were rescheduled. Further investigations were guided by the results of CCE. Patients were followed as long as 2 years. Results We studied 75 outpatients; 39 had a screening colonoscopy. One third of the patients underwent CCE immediately after colonoscopy. Overall, CCE reached or went beyond the colon segment at which colonoscopy stopped in 68 patients (91%). CCE technically complemented difficult colonoscopy independently of whether same-day CCE was performed (24 [96%]) or was not performed (44 [88%]). CCE detected additional significant findings in 36% of the same-day CCE cases and in 48% of the rescheduled ones. Two patients in the same-day group and 13 in the rescheduled CCE group underwent further colon examination that revealed additional significant findings in 3 of them. Ten percent of the patients reported mild adverse events (AE). If needed, 63 participants (84%) were willing to repeat CCE. Follow-up has not identified symptomatic missed colon cancers. Limitations Selected patient population, first-generation colon capsule, old preparation scheme. Conclusion CCE performed immediately or at a scheduled date after colonoscopy failure is feasible and safe. CCE after incomplete colonoscopy appears to yield significant findings, guide further workup, and has high patient acceptance. © 2014 by the American Society for Gastrointestinal Endoscopy.
Niv Y.,Tel Aviv University |
Ilani S.,Tel Aviv University |
Levi Z.,Tel Aviv University |
Hershkowitz M.,Tel Aviv University |
And 10 more authors.
Endoscopy | Year: 2012
Background and study aims: The Capsule Endoscopy Crohns Disease Activity Index (CECDAI or Niv score) was devised to measure mucosal disease activity using video capsule endoscopy (VCE). The aim of the current study was to prospectively validate the use of the scoring system in daily practice. Methods: This was a multicenter, double-blind, prospective, controlled study of VCE videos from 62 consecutive patients with isolated small-bowel Crohns disease. The CECDAI was designed to evaluate three main parameters of Crohns disease: inflammation (A), extent of disease (B), and stricture (C), in both the proximal and distal segments of the small bowel. The final score was calculated by adding the two segmental scores: CECDAI =([A1B1] +C1) +([A2B2] +C2). Each examiner in every site interpreted 610 videos and calculated the CECDAI. The de-identified CD-ROMs were then coded and sent to the principal investigator for CECDAI calculation. Results: The cecum was reached in 72% and 86% of examinations, and proximal small-bowel involvement was found in 56% and 62% of the patients, according to the site investigators and principal investigator, respectively. Significant correlation was demonstrated between the calculation of the CECDAI by the individual site investigators and that performed by the principal investigator. Overall correlation between endoscopists from the different study centers was good, with r=0.767 (range 0.7170.985; Kappa 0.66; P<0.001). There was no correlation between the CECDAI and the Crohns Disease Activity Index or the Inflammatory Bowel Disease Quality of Life Questionnaire or any of their components. Conclusion: A new scoring system of mucosal injury in Crohns disease of the small intestine, the CECDAI, was validated. Its use in controlled trials and/or regular follow-up of these patients is advocated. © 2011 Georg Thieme Verlag KG Stuttgart New York.
Pitsilka D.A.,Hellenic Open University |
Pitsilka D.A.,NIMTS Hospital |
Kafetsios K.,Hellenic Open University |
Kafetsios K.,University of Crete |
Niakas D.,Hellenic Open University
Clinical and Experimental Rheumatology | Year: 2015
Objective: Previous research suggests that social support has beneficial effects for rheumatoid arthritis (RA) patients. Yet, recent studies suggest that sociocultural differences have implications for whether or not the individuals use social support to cope with stressful events. Given the stressful nature of a chronic disabling disease, the purpose of the present study was to investigate the association of structural and functional facets of social support with quality of life (QoL) in Greek RA patients. Methods: In a cross-sectional study, 127 Greek RA patients completed the Rheumatoid Arthritis Quality of Life questionnaire (RAQoL), the Patient Activity Scale-II (PAS-II), the Quality of Social Support Scale (QSSS), the Social Network Index (measuring social network size and number of social roles) and a visual analogue scale measuring reciprocity. Results: Patients' age, social network size and reciprocity had no significant correlation with QoL. Family income, education level and male gender were positively correlated with QoL. Number of social roles was positively correlated with QoL, but not significantly when disease activity and demographic factors were controlled. Quality of social support was positively correlated with QoL, and the correlation remained statistically significant after controlling for disease activity, demographic variables and number of social roles. Conclusion: In Greek RA patients, quality of social support predicts quality of life above and beyond disease activity, demographic factors and social integration. Structural aspects of social support were not significant predictors of QoL, in line with previous research on cultural differences in how people utilise their social networks. © Clinical and Experimental Rheumatology 2015.
Koumi A.,Euroclinic of Athens |
Koumi A.,NIMTS Hospital |
Filippidis T.,Euroclinic of Athens |
Leontara V.,Euroclinic of Athens |
And 2 more authors.
World Journal of Gastroenterology | Year: 2011
AIM: To investigate whether differences in the rapidity of a positive result for Helicobacter pylori can save resources, by comparing two commercially available urease kits. METHODS: One hundred and eighty-five adults (130 outpatients, 55 inpatients) undergoing gastroscopy were entered prospectively. Patients were divided into two groups: Group 1 (if they were not on PPIs, antibiotics, H2A, bismuth or sucralfate for up to 14 d prior to the en-doscopy) and Group 2 (if they were on, or had been on, any of the above medication in the previous 14 d). At endoscopy two sets of biopsies, taken in random order, were placed in the wells of the Campylobacter-like organism (CLO) test (Kimberly-Clark, Utah, USA) and the Quick test (Biohit Plc, Helsinki, Finland). Five additional gastric biopsies were taken for histology/Giemsa and immunohistochemical study. The two urease test slides were read at 2 min, 30 min, 2 h and 24 h. Sensitivity and specificity at 24 h were determined. RESULTS: At 24 h, for all patients, there was no difference in sensitivity (100% vs 97.5%), specificity (99.3%), positive (97.5%) and negative predictive values (100% vs 99.3%) between the CLO and Quick tests, respectively. There was a positive result at 30 min in 17/41 (41.5%) CLO tests, and in 28/40 (70%) Quick tests, P = 0.05. Quick test enabled the prescription of eradication therapy before discharge in all 28/40 patients. Only 12 (30%) follow-up appointments were needed. If the CLO test had been used alone, only 17 (41.5%) prescriptions would have been possible prior to discharge and 24 (58%) follow-up appointments would be needed (P = 0.001). Of 2000 gastroscopies performed annually at our unit, a saving of 123 follow-up appointments (total: 8856 Euros or 11 808 USD) would be achieved if we switched to the Quick test. CONCLUSION: Direct comparison of locally available urease test kits is worthwhile, since the appropriate choice results in a significant saving of resources. Local costs and follow-up protocols will determine the magnitude of these savings. © 2011 Baishideng. All rights reserved.
Georgoulias P.,University Hospital of Larissa |
Tsougos I.,University Hospital of Larissa |
Valotassiou V.,University Hospital of Larissa |
Tzavara C.,University Hospital of Larissa |
And 2 more authors.
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2010
Purpose: The aim of this study was to determine the long-term prognostic value of early poststress lung/heart ratio (LHR) of 99mTc-tetrofosmin radioactivity. Methods: We studied 276 patients (aged 62.2±8.9 years, 168 men) with stress/rest 99mTc-tetrofosmin myocardial gated-SPECT and coronary angiography. To evaluate myocardial ischaemia, we calculated the summed stress score, summed rest score and summed difference score indices. For the eLHR calculation, an anterior image was acquired, 4-6 min after radiotracer injection at stress (eLHR was defined as mean counts per pixel in the lung region of interest divided by the mean counts per pixel in the myocardial region of interest). Cardiovascular death and nonfatal myocardial infarction were considered as hard cardiac events, and late revascularization procedures as soft cardiac events. The Cox proportional hazards model in a stepwise method was used to determine the independent predictors for hard and soft cardiac events. Results: During the follow-up period hard cardiac events occurred in 28 patients (10.1%) and soft cardiac events in 32 patients (11.6%). Implying multiple Cox regression analysis, eLHR was found to be a significant independent predictor for both soft and hard cardiac events. The hazard ratio (for a 0.1 unit increase) was 4.41 (95% CI 1.52-12.73, p=0.006) for soft cardiac events and 4.22 (95% CI 2.07-8.62, p<0.001) for hard cardiac events. The other significant prognostic factors were use of β-blockers, the summed stress score and the use of nitrates for soft events, and exercise duration and the summed stress score for hard cardiac events. Conclusion: Early poststress 99mTc- tetrofosmin LHR has an independent and powerful value in predicting hard and soft cardiac events. © 2009 Springer-Verlag.
Mavrogiannaki A.N.,NIMTS Hospital |
Migdalis I.N.,NIMTS Hospital
International Journal of Endocrinology | Year: 2013
Nonalcoholic fatty liver disease (NAFLD) is the most common, chronic liver disease worldwide. Within this spectrum, steatosis alone is apparently benign, while nonalcoholic steatohepatitis may progress to cirrhosis and hepatocellular carcinoma. NAFLD is strongly associated with obesity, dyslipidemia, type 2 diabetes mellitus, and cardiovascular disease. The pathogenesis of hepatic steatosis is not clearly known, but its main characteristics are considered insulin resistance, mitochondrial dysfunction, increased free fatty acids reflux from adipose tissue to the liver, hepatocyte lipotoxicity, stimulation of chronic necroinflammation, and fibrogenic response. With recent advances in technology, advanced imaging techniques provide important information for diagnosis. There is a significant research effort in developing noninvasive monitoring of disease progression to fibrosis and response to therapy with potential novel biomarkers, in order to facilitate diagnosis for the detection of advanced cirrhosis and to minimize the need of liver biopsy. The identification of NAFLD should be sought as part of the routine assessment of type 2 diabetics, as sought the microvascular complications and cardiovascular disease, because it is essential for the early diagnosis and proper intervention. Diet, exercise training, and weight loss provide significant clinical benefits and must be considered of first line for treating NAFLD. © 2013 A. N. Mavrogiannaki and I. N. Migdalis.
Mavrogiannaki A.N.,NIMTS Hospital |
Migdalis I.N.,NIMTS Hospital
Therapeutic Advances in Chronic Disease | Year: 2012
All patients with type 1 diabetes mellitus need insulin treatment permanently, and many patients with type 2 diabetes will require insulin therapy. Basal insulin analogs are increasingly used in the treatment of diabetes, with the aim of offering a better replication of the pattern of basal endogenous secretion of insulin. Their flatter pharmacodynamic profile, with a much lower peak of action, their slow and continuous absorption into the systemic circulation, and prolonged duration, more closely duplicate the endogenous insulin secretion leading to physiological basal glycemic control and affording more flexible treatment with fewer hypoglycemia episodes. The basal analogs represent the most significant advances in 'basal insulin' supplementation, and can be used in different insulin regimens achieving the same clinical effectiveness over conventional insulins, with benefits in terms of hypoglycemia and less weight gain, and may be an option for patients with problematic hypoglycemia despite optimization of conventional insulin therapy. At present, there are no data on micro- or macrovascular endpoints, and indeed it is unlikely that these will become available, at least in the foreseeable future. The evidence for basal insulin analogs affecting the risk of cancer is limited, and overriding diabetes indications rather than putative cancer concerns should remain the principal consideration when selecting therapy in patients with diabetes. © The Author(s), 2012.
Migdalis I.N.,NIMTS Hospital
Diabetes Research and Clinical Practice | Year: 2011
Oral hypoglycaemic agents become less effective as beta cell function declines. Thus many patients with type 2 diabetes will ultimately require treatment with insulin. There are two main approaches to starting insulin: (a) as a basal supplement with an intermediate to long-acting preparation (NPH, glargine or detemir) plus oral agents; (b) as a premixed insulin regimen. Almost all the studies have shown similar glucose control with both NPH and the new insulin analogs. Further analyses between these insulins have documented significant reductions in hypoglycaemia especially at night with the insulin analogs. The weight gain is an important issue in patients with diabetes. It appears that insulin detemir studies have reported weight neutrality or less weigh gain or even weight loss. However, most insulin glargine studies have reported a weight gain. On the other hand insulin analogs have the important disadvantage of high cost. It is important to take in to account all the above factors such as cost, weight gain, number of insulin injections and hypoglycaemia while prescribing insulin. © 2011 Elsevier Ireland Ltd.