Patras Highest Institute of Education and Technology

Pátra, Greece

Patras Highest Institute of Education and Technology

Pátra, Greece

Time filter

Source Type

Kounis N.G.,Patras Highest Institute of Education and Technology
Clinical Therapeutics | Year: 2013

Background: When allergy or hypersensitivity and anaphylactic or anaphylactoid insults lead to cardiovascular symptoms and signs, including acute coronary events, the result might be the recently defined nosologic entity Kounis syndrome. Vasospastic allergic angina, allergic myocardial infarction, and stent thrombosis with occluding thrombus infiltrated by eosinophils and/or mast cells are the 3 reported variants of this syndrome. Objective: The purpose of this review was to highlight and consolidate the recent literature on allergic angina and allergic myocardial infarction and to propose new therapeutic modalities for stabilizing mast cells. Methods: A search for current literature on the pathophysiology, causality, clinical appearance, variance, prevention, and treatment of Kounis syndrome was conducted. Results: Kounis syndrome is caused by inflammatory mediators such as histamine; neutral proteases, including tryptase, chymase, and cathepsin-D; arachidonic acid products; platelet-activating factor; and a variety of cytokines and chemokines released during the mast-cell activation. Platelets with Fc γ receptor (FcγR) Ι, FcγRII, FcεRI, and FcεRII also have a role in the activation cascade. The same mediators released from the similar inflammatory cells are involved in acute coronary events of nonallergic etiology. These cells are not only present in the involved region before plaque erosion or rupture but also release their contents just before an acute coronary event. Pro-inflammatory mediators similar to those found in Kounis syndrome are found in some cases with nonallergic etiology, suggesting that this is a more general problem. The acute coronary and cerebrovascular events in Kounis syndrome may be prevented by the inhibition of mast-cell degranulation. Substances and natural molecules that protect the mast-cell surface and stabilize the mast-cell membrane are emerging as novel agents in the prevention of acute coronary and other arterial events. Conclusions: The 3 reported variants of Kounis syndrome-vasospastic allergic angina, allergic myocardial infarction, and stent thrombosis with occluding thrombus-are caused by inflammatory mediators. Agents that inhibit mast-cell degranulation may be efficacious in preventing the acute coronary and cerebrovascular events of Kounis syndrome. © 2013 Elsevier HS Journals, Inc.


Soufras G.D.,Saint Andrews State General Hospital | Kounis G.N.,Patras Highest Institute of Education and Technology | Kounis N.G.,Patras Highest Institute of Education and Technology
International Endodontic Journal | Year: 2014

Anaphylactic shock is a real and life threatening medical emergency which is encountered in every field of medicine. The coronary arteries seem to be the primary target of anaphylaxis resulting in the development of Kounis syndrome. Kounis syndrome is a pan-arterial anaphylaxis -associated syndrome affecting patients of any age, involving numerous and continuously increasing causes, with broadening clinical manifestations and covering a wide spectrum of mast cell activation disorders. Recently, Kounis-like syndrome affecting the cerebral arteries was found to be associated with mast cell activation disorders. In anaphylactic shock, the decrease of cerebral blood flow is more than what would be expected from severe arterial hypotension. This is attributed to the early and direct action of anaphylactic mediators on cerebral vessels. While adrenaline is a life saving agent in the treatment of anaphylactic shock, it contains sodium betabisulfite as preservative and should be avoided in sulfite allergic patients. Potential allergens encountered in endodotic practice include formocresol, zinc compounds thiurams, sodium dimethyldithiocarbamade, and mercaptobenzothiazole that might have synergistic action. All these agents together with analgesics, antibiotics, antiseptics, formaldehyde, latex, local anaesthetics and metals used in dental practice, in general, can induce anaphylactic shock. Practitioners should be aware of these consequences. A careful history of previous atopy and reactions is of paramount importance for safe and effective management. © 2013 International Endodontic Journal.


Nikolakopoulou N.M.,Patras Highest Institute of Education and Technology
International Journal of Adolescent Medicine and Health | Year: 2010

The aim of this study was to assess the acceptance of H1N1 vaccination among parents in Greece. A sample of 850 parents participated in the present study. Interviews were performed using a structured questionnaire. The overall percentage of participants reporting that they had been administered the H1N1 vaccine was 0.35%. Only 1.18% of the respondents who had not been administered the vaccine were willing to accept it A significant barrier to H1N1 vaccination is concern about vaccine safety. © Freund Publishing House Ltd.


Bakogianni G.D.,Patras Highest Institute of Education and Technology | Nikolakopoulos K.M.,Patras Highest Institute of Education and Technology | Nikolakopoulou N.M.,Patras Highest Institute of Education and Technology
International Journal of Adolescent Medicine and Health | Year: 2010

The human papillomavirus (HPV) vaccine protects against HPV-related disease. The aim of this study was to assess acceptance of HPV vaccination among female Greek students. A sample of 573 students aged 18-25 years participated in the present study. Interviews were performed using a structured questionnaire. Of the respondents, 3% were not aware of the HPV vaccine. Of the subjects, 10.47% had been administered the HPV vaccine. Of the respondents who had not been administered the vaccine, 43.86% were not willing to accept it because of the rumors of serious side effects. The results highlight the need for additional education and health promotion regarding HPV vaccination and cervical cancer prevention. © Freund Publishing House Ltd.


Cevik C.,Texas Tech University Health Sciences Center | Nugent K.,Texas Tech University Health Sciences Center | Shome G.P.,Texas Tech University Health Sciences Center | Kounis N.G.,Patras Highest Institute of Education and Technology
International Journal of Cardiology | Year: 2010

Kounis syndrome is potentially a life-threatening medical emergency with both a severe allergic reaction and acute coronary syndrome. Most of the information about this syndrome has come from the case reports. The management of these patients may be challenging for clinicians, and unfortunately guidelines have not been established yet. In this article, we review the current guidelines of acute coronary syndromes and anaphylaxis along with the published cases with Kounis syndrome secondary to beta-lactam antibiotics. We have summarized our recommendations for the work-up and treatment of Kounis syndrome from available data. Obviously, larger prospective studies are needed to establish definitive treatment guidelines for these patients. © 2010 Elsevier Ireland Ltd.


Kounis N.G.,Patras Highest Institute of Education and Technology | Giannopoulos S.,University of Ioannina | Tsigkas G.G.,University of Patras | Goudevenos J.,University of Ioannina
International Journal of Cardiology | Year: 2012

The use of drug eluting stents constitutes a major breakthrough in current interventional cardiology because it is more than halves the need of repeat interventions. It is incontrovertible that coronary stents, in general, have been beneficial for the vast majority of patients. A small increase in thrombosis, following DES implantation, is offset by a diminished risk of complications associated with repeat vascularization. However, late and, especially, very late stent thrombosis is a much feared complication because it is associated with myocardial infarction with increased mortality. Despite that stent thrombosis is thought to be multifactorial, so far clinical reports and reported pathology findings in patients died from coronary stent thrombosis as well as animal studies and experiments, point toward a hypersensitivity inflammation. The stented and thrombotic areas are infiltrated by interacting, via bidirectional stimuli inflammatory cells including eosinophils, macrophages, T-cells and mast cells. Stented regions constitute an ideal surrounding for endothelial damage and dysfunction, together with hemorheologic changes and turbulence as well as platelet dysfunction, coagulation and fibrinolytic disturbances. Drug eluting stent components include the metal strut which contains nickel, chromium, manganese, titanium, molybdenum, the polymer coating and the impregnated drugs which for the first generation stents are: the antimicrotubule antineoplastic agent paclitaxel and the anti-inflammatory, immunosuppressive and antiproliferative agent sirolimus. The newer stents which are called cobalt-chromiun stents and elute the sirolimus analogs everolimus and zotarolimus both contain nickel and other metals. All these components constitute an antigenic complex inside the coronary arteries which apply chronic, continuous, repetitive and persistent inflammatory action capable to induced Kounis syndrome and stent thrombosis. Allergic inflammation goes through three phases, the early phase, the late phase and the chronic phase and these three phases correspond temporally with early (acute and sub acute), late and very late stent thrombosis. Bioabsorbable allergy free poly lactic acid self expanding stents, nickel free stainless steel materials, stent coverage with nitric oxide donors and antibodies with endothelial progenitor cell capturing abilities as well as stents eluting anti-inflammatory and anti-allergic agents might be the solution of this so feared and devastating stent complication. © 2011 Elsevier Ireland Ltd.


Kounis N.G.,Patras Highest Institute of Education and Technology | Mazarakis A.,Agios Andreas State General Hospital | Tsigkas G.,University of Patras | Giannopoulos S.,University of Ioannina | Goudevenos J.,University of Ioannina
Future Cardiology | Year: 2011

Kounis syndrome is the concurrence of acute coronary syndromes with conditions associated with mast cell activation, such as allergies or hypersensitivity and anaphylactic or anaphylactoid insults that can involve other interrelated and interacting inflammatory cells behaving as a 'ball of thread'. It is caused by inflammatory mediators such as neutral proteases including tryptase and chymase, arachidonic acid products, histamine, platelet activating factor and a variety of cytokines and chemokines released during the activation process. Platelets with FCεRI and FCεRII receptors also participate in the above cascade. Vasospastic allergic angina, allergic myocardial infarction and stent thrombosis with occluding thrombus infiltrated by eosinophils and/or mast cells constitute the three reported variants of this syndrome. Kounis syndrome is a ubiquitus disease that represents a magnificent natural paradigm and nature's own experiment, in a final trigger pathway implicated in cases of coronary artery spasm and plaque rupture. Kounis syndrome can complicate anesthesia, vaccination, medical therapy and stent implantation and it seems to be associated with coronary allograft vasculopathy and takotsubo syndrome, it can often be confused with hypersensitivity myocarditis and can be the cause of unexplained sudden death. Kounis syndrome has revealed that the same mediators released from the same inflammatory cells are present in acute coronary events of nonallergic etiology. These cells are not only present in the culprit region before plaque erosion or rupture but they release their contents just before an actual coronary event. Therefore, does Kounis syndrome represent a magnificent natural paradigm and nature's own experiment in a final trigger pathway implicated in cases of coronary artery spasm and plaque rupture showing a novel way towards our effort to prevent acute coronary syndromes? Drugs, substances targeting the stem cell factor that is essential for mast cell development, proliferation, survival, adhesion and homing as well as monoclonal antibodies and natural molecules that protect mast cell surface and stabilize mast cell membrane could emerge as novel therapeutic ways capable to prevent acute coronary and acute cerebrovascular events. © 2011 Future Medicine Ltd.


Kounis N.G.,Patras Highest Institute of Education and Technology | Soufras G.D.,Saint Andrews State General Hospital | Hahalis G.,University of Patras
North American Journal of Medical Sciences | Year: 2013

Experiments have shown that anaphylaxis decreases cardiac output; increases left ventricular end diastolic pressure; induces severe early acute increase in respiratory resistance with pulmonary interstitial edema; and decreases splanchnic, cerebral, and myocardial blood flow more than what would be expected from severe arterial dilation and hypotension. This is attributed to the constrictive action of inflammatory mediators released during anaphylactic shock. Inflammatory mediators such as histamine, neutral proteases, arachidonic acid products, platelet-activating factor (PAF), and a variety of cytokines and chemokines constitute the pathophysiologic basis of Kounis hypersensitivityassociated acute coronary syndrome. Although the mechanisms of anaphylactic shock still remain to be elucidated, myocardial involvement due to vasospasm-induced coronary blood flow reduction manifesting as Kounis syndrome should be always considered. Searching current experimental and clinical literature on anaphylactic shock pathophysiology, causality, clinical appearance, and treatment via PubMed showed that differentiating global hypoperfusion from primary tissue suppression due to mast cell mediator constrictive action on systemic arterial vasculature is a challenging procedure. Combined tissue suppression from arterial involvement and peripheral vasodilatation, perhaps, occur simultaneously. In cases of anaphylactic shock treatment targeting the primary cause of anaphylaxis together with protection of coronary vasculature and subsequently the cardiac tissue seems to be of paramount importance.


Kounis N.G.,Patras Highest Institute of Education and Technology | Soufras G.D.,University of Patras | Tsigkas G.,University of Patras | Hahalis G.,University of Patras
Clinical and Applied Thrombosis/Hemostasis | Year: 2015

Inflammation is a key feature of atherosclerosis and its clinical manifestations. The leukocyte count has emerged as a marker of inflammation that is widely available in clinical practice. Since inflammation plays a key role in atherosclerosis and its end results, discovering new biomarkers of inflammation becomes important in order to help diagnostic accuracy and provide prognostic information about coronary cardiac disease. In acute coronary syndromes and percutaneous coronary intervention, elevated levels of almost all subtypes of white blood cell counts, including eosinophils, monocytes, neutrophils, and lymphocytes, and neutrophil-lymphocyte ratio and eosinophil-leukocyte ratio constitute independent predictors of adverse outcomes. Eosinophil count and eosinophil-leukocyte ratio, in particular, emerge as novel biomarkers for risk stratification in patients with coronary artery disease. Since the presence of eosinophils denotes hypersensitivity inflammation and hypersensitivity associated with Kounis syndrome, this reality is essential for elucidating the etiology of inflammation in order to consider predictive and preventive measures and to apply the appropriate therapeutic methods. © The Author(s) 2014


Bakogianni G.D.,Patras Highest Institute of Education and Technology
International journal of adolescent medicine and health | Year: 2012

Cervical cancer is a major cause of death in the developing world. The Papanicolaou (Pap) smear is a screening test that detects abnormal cells before they advance to cancer. The objective of this study was to assess the knowledge, attitude, and practice of cervical cancer screening among Greek students. A sample of 472 female students participated in the present study. Interviews were performed using a structured questionnaire. Of the participants, 94.07% were aware of the Pap test and 67.34% reported that the Pap test should be done yearly. The majority of them were informed about cervical cancer screening test by their parents. Of the participants, 44.82% had received Pap testing at least once in their life, whereas 36.2% had a Pap test yearly. The reported mean time of the respondents' first Pap test was 13.3±10.6 months after their first sexual intercourse. The reasons given by the participants for being noncompliant were lack of appreciation of the importance of the screening, embarrassment, fear, and high cost. Of the participants, 9.23% declared that those who had been administered the human papillomavirus vaccine do not need a Pap test. The results highlight the need for additional education and health promotion regarding cervical cancer screening.

Loading Patras Highest Institute of Education and Technology collaborators
Loading Patras Highest Institute of Education and Technology collaborators