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Vogiatzis I.,National and Kapodistrian University of Athens | Vogiatzis I.,Evangelismos Hospital | Vogiatzis I.,Sotiria Hospital | Vogiatzis I.,University of West of Scotland | Zakynthinos S.,Evangelismos Hospital
Journal of Applied Physiology | Year: 2013

Cardiopulmonary rehabilitation is recognized as a core component of management of individuals with congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD) that is designed to improve their physical and psychosocial condition without impacting on the primary organ impairment. This has lead the scientific community increasingly to believe that the main effects of cardiopulmonary rehabilitative exercise training are focused on skeletal muscles that are regarded as dysfunctional in both CHF and COPD. Accordingly, following completion of a cardiopulmonary rehabilitative exercise training program there are important peripheral muscular adaptations in both disease entities, namely increased capillary density, blood flow, mitochondrial volume density, fiber size, distribution of slow twitch fibers, and decreased lactic acidosis and vascular resistance. Decreased lactic acidosis at a given level of submaximal exercise not only offsets the occurrence of peripheral muscle fatigue, leading to muscle task failure and muscle discomfort, but also concurrently mitigates the additional burden on the respiratory muscles caused by the increased respiratory drive, thereby reducing dyspnea sensations. Furthermore in patients with COPD, exercise training reduces the degree of dynamic lung hyperinflation leading to improved arterial oxygen content and central hemodynamic responses, thus increasing systemic muscle oxygen availability. In patients with CHF, exercise training has beneficial direct and reflex sympathoinhibitory effects and favorable effects on normalization of neurohumoral excitation. These physiological benefits apply to all COPD and CHF patients independently of the degree of disease severity and are associated with improved exercise tolerance, functional capacity, and quality of life. Copyright © 2013 the American Physiological Society.


Torres A.,University of Barcelona | Liapikou A.,Sotiria Hospital
Expert Opinion on Pharmacotherapy | Year: 2012

Introduction: Fluoroquinolone use has dramatically increased since the introduction of the first respiratory fluoroquinolone in the late 1990s. Levofloxacin, like other fluoquinolones, is a potent antibiotic, due to high levels of susceptibility among Gram-negative, Gram-positive (including penicillin-resistant strains of Streptococcus pneumonia) and atypical pathogens. Levofloxacin is recommended for the treatment of community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and in the management of acute exacerbations of chronic bronchitis (AECB). Levofloxacin demonstrates good safety, bioavailability and tissue penetration, thus maintaining adequate concentrations at the site of infection. High-dose (750 mg), short-course (5 days) therapy regimens may offer improved treatment, especially in HAP, due to higher drug concentrations, increased adherence and the potential to reduce the development of resistance. Areas covered: This article covers medical literature published in any language since 1990 until November 2011, on 'levofloxacin', identified using PubMed and MEDLINE. The search terms used were 'levofloxacin' and 'community acquired pneumonia', 'hospital pneumonia' or 'AECB'. Expert opinion: Levofloxacin is a valuable antimicrobial agent and an optimal treatment option for AECB, CAP (as a monotherapy) and HAP (as combination therapy at a high-dose regimen). Its improved bioavailability and safety profile makes the possibility of shorter hospital stays a reality. © 2012 Informa UK, Ltd.


Johnston A.,Queen Mary, University of London | Stafylas P.,University Hospital | Stergiou G.S.,Sotiria Hospital
British Journal of Clinical Pharmacology | Year: 2010

Cost-containment measures in healthcare provision include the implementation of therapeutic and generic drug substitution strategies in patients whose condition is already well controlled with pharmacotherapy. Treatment for hypertension is frequently targeted for such measures. However, drug acquisition costs are only part of the cost-effectiveness equation, and a variety of other factors need to be taken into account when assessing the impact of switching antihypertensives. From the clinical perspective, considerations include maintenance of an appropriate medication dose during the switching process; drug equivalence in terms of clinical effectiveness; and safety issues, including the diverse adverse-event profiles of available alternative drugs, differences in the 'inactive' components of drug formulations and the quality of generic formulations. Patients' adherence to and persistence with therapy may be negatively influenced by switching, which will also impact on treatment effectiveness. From the economic perspective, the costs that are likely to be incurred by switching antihypertensives include those for additional clinic visits and laboratory tests, and for hospitalization if required to address problems arising from adverse events or poorly controlled hypertension. Indirect costs and the impact on patients' quality of life also require assessment. Substitution strategies for antihypertensives have not been tested in large outcome trials and there is little available clinical or economic evidence on which to base decisions to switch drugs. Although the cost of treatment should always be considered, careful assessment of the human and economic costs and benefits of antihypertensive drug substitution is required before this practice is recommended. © 2010 The British Pharmacological Society.


Liapikou A.,Sotiria Hospital | Torres A.,University of Barcelona
Expert Review of Respiratory Medicine | Year: 2016

The 2010 Global Burden of Disease Study reported that lower respiratory tract infections, including pneumonia, are the fourth most common cause of death globally. The etiology of acute bronchitis and asthma exacerbations is mostly viral and the therapy is symptomatic. Management decisions in community acquired pneumonia regarding site of care, extent of assessment, and level of treatment are based primarily on disease severity (outpatient, inpatient, ICU admission). Antibiotics are the main choice of treatment for patients with pneumonia, acute exacerbations (AE) of COPD (including increased sputum purulence and worsening shortness of breath) and AE of non-CF bronchiectasis. Inhaled antibiotics may represent a more optimal approach for the treatment and prevention of AE of non-CF bronchiectasis. Approved strategies for the prevention of exacerbations include smoking cessation and rehabilitation programs, drug therapy and vaccination. © 2016 Informa UK Limited, trading as Taylor & Francis Group.


Liapikou A.,Sotiria Hospital | Torres A.,University of Barcelona
Expert Opinion on Emerging Drugs | Year: 2013

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) has proven to be a prominent pathogen in hospitals and in the community, which is capable of causing a variety of severe infections. Until now, there has been a limited antimicrobial armamentarium for use against MRSA, of which glycopeptides and linezolid are the main agents used. Areas covered: This review assesses current treatment and the agents being developed for MRSA infections. A search was conducted in PubMed for English-language references published from 2000 to 2013, using combinations of the following terms: 'MRSA', 'MRSA therapy', 'gram (+) infections therapy', 'new antibiotics', 'vancomycin', 'staphylococcus resistance', 'oritavancin', 'ceftaroline', 'linezolid' and 'tigecycline'. The clinicalTrials website was also searched with keywords regarding the new antibiotic agents against MRSA infections. Expert opinion: There are a number of new agents, the place of which in therapeutic regimens is yet to emerge. New glycopeptides, such as dalbavancin and oritavancin, with long half-lives, enabling once-weekly dosing, and oral agents, such as iclaprim, may provide a treatment approach for outpatient therapy. A decision must be made regarding the most suitable agent for an individual patient, the site of infection and the place of therapy. © 2013 Informa UK, Ltd.


Adamantia L.,Sotiria Hospital | Torres A.,University of Barcelona
Expert Opinion on Pharmacotherapy | Year: 2014

Introduction: Bacterial infections play an important role as etiological agents in acute exacerbations of chronic obstructive pulmonary disease (AECOPD), and exacerbations of non-cystic fibrosis (CF) bronchiectasis. In acute bronchitis and asthma exacerbations their role is less well defined than with patients with COPD. The clinical features, causative pathogens and therapies of common acute respiratory tract infections are detailed in this review.Areas covered: This article covers medical literature published in any language from 2000 to 2014, on 'lower respiratory tract infections', identified using PubMed, MEDLINE and ClinicalTrial.gov. The search terms used were 'COPD exacerbations', 'bronchiectasis', 'macrolides' and 'inhaled antibiotics'.Expert opinion: Given that almost half of AECOPD are caused by bacteria, administration of antibacterial agents is recommended for patients with severe exacerbations or severe underlying COPD. Chronic prophylactic use of macrolides seems to be of benefit, particularly in patients with bronchiectasis and chronic mucous hypersecretion. In an effort to manage chronic airway infection non-CF bronchiectasis due to drug-resistant pathogens, aerosolized antibiotics may be of value, and the data from recent studies are examined to demonstrate the potential value of this therapy, which is often used as an adjunctive measure to systemic antimicrobial therapy. © 2014 Informa UK, Ltd.


Mengreli C.,Aghia Sophia Childrens Hospital | Kanaka-Gantenbein C.,National and Kapodistrian University of Athens | Girginoudis P.,Aghia Sophia Childrens Hospital | Magiakou M.-A.,National and Kapodistrian University of Athens | And 4 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2010

Context: In our neonatal program, a number of infants with congenital hypothyroidism (CH) had escaped diagnosis,whena spot RIA-TSH value of 20 mU/liter whole blood was used as a cutoff point. Objective: The objective of the study was to find out prospectively the additional number of newborns with CH if the TSH cutoff point is lowered to 10 mU/liter. Population and Methods: The study included 311,390 screened newborns. The children with CH were followed up for a period of 3 yr. Results: Twenty-eight percent of infants diagnosed with CH had neonatal TSH values between 10 and 20 mU/liter (56 of 200). Forty of 47 infants, who were reevaluated later on (85.1%), suffered permanent CH. Athyroid scintiscan and/or echogram revealed that eight of 40 children (20.0%)had a structural defect, and the remaining (32 of 40) had a functional defect of the thyroid gland without anatomical abnormality; 14 of 32 cases were familial. Eighteen of the 47 reevaluated infants were prematurely born (38.3%) and 15 of these 18 had permanent CH (83.3%). The lowering of TSH cutoff point from 20 to 10 mU/liter resulted in a 10-fold increase of recall rate. Conclusions: A significant number of cases with permanent CH are missed when a TSH threshold of 20 mU/liter is applied. Almost 40% of the missed CH cases were premature. A mild increase of TSH at screening is not a predictor of transient CH. The increase in recall rate constitutes a serious drawback and should be balanced against the possible consequences of thyroid dysfunction at this important developmental stage. Copyright © 2010 by The Endocrine Society.


Sialer S.,Hospital Clinic of Barcelona | Liapikou A.,Sotiria Hospital | Torres A.,Hospital Clinic of Barcelona | Torres A.,University of Barcelona
Infectious Disease Clinics of North America | Year: 2013

Treatment failure in community-acquired pneumonia (CAP) is the failure to normalize the clinical features (eg, fever, cough, sputum production), or nonresolving image in chest radiograph, despite antimicrobial therapy. The incidence of treatment failure in CAP has not been clearly established; according to several studies it ranges between 6% and 15%. The rate of mortality increases significantly, especially in those patients with severe CAP. It is important to be able to identify what patients are at risk for progressive or treatment failure pneumonia that may make them candidates for a more careful monitoring. © 2013 Elsevier Inc.


Liapikou A.,Sotiria Hospital | Toumbis M.,Sotiria Hospital | Torres A.,University of Barcelona
Expert Opinion on Drug Safety | Year: 2015

Introduction: Inhaled corticosteroids (ICS) are known to increase the risk of pneumonia in patients with chronic obstructive pulmonary disease. To estimate the association between ICS and pneumonia among users of ICS relative to non-ICS users and to examine whether this risk is dose related, class related and what's its association with the pneumonia-mortality or overall mortality.Areas covered: Through a comprehensive literature search of MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov from inception to February 2015, we identified randomized controlled trials of ICS therapy lasting at least 6 months. We conducted meta-analyses to generate summary estimates comparing ICS with non-ICS treatment on the risk of pneumonia.Expert opinion: ICS alone or in combination with long-acting β-agonists are associated with an increased risk of pneumonia but have no effect on pneumonia related mortality. It is important to identify those patients to benefit the most from ICS, as those with frequent exacerbations, a severe airway obstruction, a positive bronchodilator test or a sputum eosinophilia despite treatment. © Informa UK, Ltd.


Liapikou A.,Sotiria Hospital | Torres A.,University of Barcelona
Expert Review of Respiratory Medicine | Year: 2014

Severe CAP (SCAP), accounting for 6% of admissions to intensive care units (ICUs) needs early diagnosis and aggressive interventions at the most proximal point of disease presentation. The prognostic scores as the ATS/IDSA rule, the systolic blood pressure, multilobar infiltrates, albumin, respiratory rate, tachycardia, confusion, oxygen and pH or SCAP system are appropriate in early identification of eligible patients requiring admission to ICU. Then the recommended initial resuscitation in SCAP in the ICU consists of fluid volume intake titrated to specific goals after a fluid challenge and hemodynamic optimization. The first selection of antimicrobial therapy should be started in the first hour and would be broad enough to cover all likely pathogens. Combination therapy may be useful in patients with non refractory septic shock and severe sepsis pneumococcal bacteremia as well. After 6 hours the patient would be reevaluated in terms of hemodynamic stability and antibiotic and therapy. Future developments will focus on sepsis biomarkers, molecular diagnostic techniques and the development of novel therapeutic immunomodulaty agents. © Informa Uk, Ltd.

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