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Ymittos Athens, Greece

Kostikas K.,National and Kapodistrian University of Athens | Minas M.,University of Thessaly | Papaioannou A.I.,Sismanogleion General Hospital | Papiris S.,National and Kapodistrian University of Athens | Dweik R.A.,Cleveland Clinic
Current Medicinal Chemistry | Year: 2011

Approximately 20 years after the initial report of the measurement of exhaled nitric oxide (NO) in the exhaled air of humans, numerous publications have evaluated the possible applications of the fraction of exhaled NO (FeNO) in patients with asthma. The aim of the present review is to evaluate the technical issues and confounding factors related to FeNO measurements, as well as the role of FeNO in the diagnosis of asthma, the evaluation of asthmatic patients and the guidance of treatment. Several other issues, including the pursuit for "normal" and best personal values, the prediction of clinically relevant asthma outcomes and the identification of asthma phenotypes and future directions are discussed. FeNO represents the only exhaled biomarker that has reached clinical practice even in primary care settings and this review provides a critical view of the possible applications of this biomarker, both for the basic researcher and the clinician. © 2011 Bentham Science Publishers Ltd.

Giamarellos-Bourboulis E.,Cedars Sinai Medical Center | Tang J.,Cedars Sinai Medical Center | Pyleris E.,Cedars Sinai Medical Center | Pistiki A.,Cedars Sinai Medical Center | And 9 more authors.
Scandinavian Journal of Gastroenterology | Year: 2015

Objective. Breath testing and duodenal culture studies suggest that a significant proportion of irritable bowel syndrome (IBS) patients have small intestinal bacterial overgrowth. In this study, we extended these data through 16S rDNA amplicon sequencing and quantitative PCR (qPCR) analyses of duodenal aspirates from a large cohort of IBS, non-IBS and control subjects. Materials and methods. Consecutive subjects presenting for esophagogastroduodenoscopy only and healthy controls were recruited. Exclusion criteria included recent antibiotic or probiotic use. Following extensive medical work-up, patients were evaluated for symptoms of IBS. DNAs were isolated from duodenal aspirates obtained during endoscopy. Microbial populations in a subset of IBS subjects and controls were compared by 16S profiling. Duodenal microbes were then quantitated in the entire cohort by qPCR and the results compared with quantitative live culture data. Results. A total of 258 subjects were recruited (21 healthy, 163 non-healthy non-IBS, and 74 IBS). 16S profiling in five IBS and five control subjects revealed significantly lower microbial diversity in the duodenum in IBS, with significant alterations in 12 genera (false discovery rate < 0.15), including overrepresentation of Escherichia/Shigella (p = 0.005) and Aeromonas (p = 0.051) and underrepresentation of Acinetobacter (p = 0.024), Citrobacter (p = 0.031) and Microvirgula (p = 0.036). qPCR in all 258 subjects confirmed greater levels of Escherichia coli in IBS and also revealed increases in Klebsiella spp, which correlated strongly with quantitative culture data. Conclusions. 16S rDNA sequencing confirms microbial overgrowth in the small bowel in IBS, with a concomitant reduction in diversity. qPCR supports alterations in specific microbial populations in IBS. © Informa Healthcare.

Tzelepis G.E.,National and Kapodistrian University of Athens | Kokosi M.,National and Kapodistrian University of Athens | Tzioufas A.,National and Kapodistrian University of Athens | Toya S.P.,National and Kapodistrian University of Athens | And 3 more authors.
European Respiratory Journal | Year: 2010

We sought to determine the type of pulmonary involvement in microscopic polyangiitis (MPA), primarily focusing on pulmonary fibrosis (PF), its prevalence, temporal relationship with other disease manifestations and outcome. 33 patients (16 males) with biopsy proven perinuclear anti-neutrophilic cytoplasmic antibody-positive MPA (age 63.5 yrs) participated in the study. Pulmonary involvement was assessed using standard methods, including radiographic imaging (chest radiographs and high-resolution computed tomography), pulmonary function testing, bronchoscopy and bronchoalveolar lavage, and, if indicated, lung biopsy. All-cause mortality was analysed by the Kaplan-Meier method and was compared between MPA patients with and without PF. At the time of diagnosis, renal involvement was detected in all patients, with renal biopsies being consistent with segmental necrotising glomerulonephritis in all patients. The most common respiratory symptom was haemoptysis, which was found in nine (27%) patients. PF was present in 12 (36%) patients at the time of diagnosis, whereas one patient developed PF while on therapy ∼10 yrs after disease diagnosis. In seven patients with PF, respiratory symptoms related to fibrosis preceded other disease manifestations by a median (range) period of 13 (5-120) months. Patients were followed up for a period of 38±30 months. Presence of PF was associated with increased mortality (p=0.02), with six deaths occurring in the fibrotic group and one in the nonfibrotic group. In the fibrotic group most deaths were related to PF. PF occurs frequently in MPA, may precede other disease manifestations by a variable length of time and has a poor prognosis. Copyright©ERS 2010.

Koussoulas V.,Sismanogleion General Hospital | Giamarellos-Bourboulis E.J.,National and Kapodistrian University of Athens | Barbatzas C.,Sismanogleion General Hospital | Pimentel M.,Cedars Sinai Medical Center
Digestive Diseases and Sciences | Year: 2011

Objective Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) is elevated in the gastric juice and in cultures of gastric mucosa of patients with peptic ulcer disease (PUD). Its application as a surrogate marker for the treatment of PUD was assessed. Methods From 138 eligible patients, 96 were enrolled; 50 with duodenal ulcer, 29 with gastric ulcer and 17 with chronic gastritis. Patients were endoscoped twice; once before treatment and once after treatment. Biopsy specimens were collected for histopathologic estimation of gastritis. Blood was sampled prior to each endoscopy. Serum was collected and sTREM-1 was measured by an enzyme immunoabsorbent assay (http://www. clinicaltrials.gov identifier NCT00534443). Results At the end of treatment sTREM-1 was either: (a) below the limit of detection (this occurred in 62 patients and it was accompanied by lacks signs of residual disease in 58 patients, 93.5%); or (b) above the limit of detection (this occurred in 17 patients and it was accompanied by residual disease in 14 patients, 82.3%) (p<0.0001). Odds ratio for complete healing of peptic ulcer with sTREM-1 below detection limit was 5.30 (95% CI: 1.89-14.83, p<0.001) compared to serum sTREM-1 above the limit of detection. Conclusions Serum sTREM-1 below detection limit may effectively distinguish patients who successfully completed therapy for PUD from those with residual disease and apply as a surrogate marker. © Springer Science+Business Media, LLC 2011.

Koutsounas I.,Sismanogleion General Hospital | Pyleris E.,Sismanogleion General Hospital
Arab Journal of Gastroenterology | Year: 2015

Invasive aspergillosis is a life-threatening, opportunistic fungal infection that mainly affects immunocompromised patients, particularly those receiving immunosuppressive therapy or high-dose corticosteroids. The most common portal of entry in aspergillosis is the lung, so the isolated occurrence of intestinal aspergillosis in the absence of pulmonary disease is an unusual pattern. Case report: We report a case of a lung cancer patient who did not receive chemotherapy, presenting to the emergency department with fever and chills. The patient also developed abdominal pain and bloody diarrhoea during his hospitalisation. Colonoscopy revealed diffuse epithelial and subepithelial oedema of the terminal ileum, linear ulcers, denudation of the mucosa, and necrosis. Histopathological examination of terminal ileum diffuse biopsies showed haemorrhagic infiltrations, while microscopy revealed Y-shaped, branching septate hyphae, diagnostic for Aspergillus fungi. Additionally, the culture of biopsy samples showed the growth of Aspergillus fumigatus. The patient was negative for Aspergillus antibodies in his blood, and bronchoscopy and sputum samples were negative as well. Conclusion: This is a rare case of isolated aspergillosis of the small intestine, as there is no pulmonary or other systemic participation, as it also happens in a patient not being in a severely immunocompromised state. © 2015 Arab Journal of Gastroenterology.

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