Piraeus, Greece
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PubMed | Korgialeneion Benakeion General Hospital, University of Thessaly, Aghios Dimitrios General Hospital, Ggennimatas General Hospital and 14 more.
Type: | Journal: Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases | Year: 2016

Sepsis-3 definitions generated controversies regarding their general applicability. The Sepsis-3 Task Force outscored the need of validation with emphasis on quick SOFA (qSOFA) score. This was done in a prospective cohort coming from a different health-care setting.Patients with infections and at least two signs of the systemic inflammatory response syndrome (SIRS) were analyzed. Sepsis was defined as total SOFA 2 outside the ICU or as increase of ICU admission SOFA 2. The primary endpoint was the sensitivity of qSOFA outside the ICU and sepsis definition both outside and in the ICU to predict mortality.3,346 infections outside the ICU and 1,058 infections in the ICU were analyzed. Outside the ICU, respective mortality with 2 SIRS and qSOFA 2 was 25.3% and 41.2% (p<0.0001); the sensitivities of qSOFA and of sepsis definition to predict death were 60.8% and 87.2% respectively. This was 95.9% for sepsis definition in the ICU. The sensitivity of qSOFA and of 3 SIRS criteria for organ dysfunction outside the ICU was 48.7% and 72.5% respectively (p< 0.0001). Misclassification outside the ICU with the 1991 and sepsis-3 definitions into stages of lower severity was 21.4% and 3.7% respectively (p< 0.0001) and 14.9% and 3.7% respectively in the ICU (p< 0.0001). Adding arterial pH7.30 to qSOFA increased sensitivity for death to 67.5% (p: 0.004).Our analysis positively validated the use of SOFA score to predict unfavorable outcome and to limit misclassification into lower severity. However, qSOFA score had inadequate sensitivity for early risk assessment.


Marinis A.,Tzaneion General Hospital | Gkiokas G.,National and Kapodistrian University of Athens | Argyra E.,National and Kapodistrian University of Athens | Fragulidis G.,National and Kapodistrian University of Athens | And 2 more authors.
Scandinavian Journal of Surgery | Year: 2013

The occurrence of an enteric fistula in the middle of an open abdomen is called an enteroatmospheric fistula, which is the most challenging and feared complication for a surgeon to deal with. It is in fact not a true fistula because it neither has a fistula tract nor is covered by a well-vascularized tissue. The mortality of enteroatmospheric fistulae was as high as 70% in past decades but is currently approximately 40% due to advanced modern intensive care and improved surgical techniques. Management of patients with an open abdomen and an enteroatmospheric fistula is very challenging. Intensive care support of organs and systems is vital in order to manage the severely septic patient and the associated multiple organ failure syndrome. Many of the principles applied to classic enterocutaneous fistulae are used as well. Control of enteric spillage, attempts to seal the fistula, and techniques of peritoneal access for excision of the involved loop are reviewed in this report. Additionally, we describe our recent proposal of a lateral surgical approach via the circumference of the open abdomen in order to avoid the hostile and granulated surface of the abdominal trauma, which is adhered to the intraperitoneal organs.


Tsakris A.,National and Kapodistrian University of Athens | Poulou A.,National and Kapodistrian University of Athens | Poulou A.,Serres General Hospital | Pournaras S.,University of Thessaly | And 5 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2010

Background: The increasing frequency of class A KPC enzymes and class B metallo-β-lactamases (MBLs) among Enterobacteriaceae as well as their possible co-production makes their early differentiation urgent. Methods: A simple phenotypic algorithm employing three combined-disc tests consisting of meropenem alone and with phenylboronic acid (PBA), EDTA, or both PBA and EDTA was designed for the differentiation of KPC and MBL enzymes. Augmentation of the zone of inhibition by ≥5 mm was considered a positive combined-disc test result. A total of 141 genotypically confirmed carbapenemase-positive Enterobacteriaceae clinical isolates (63 KPC producers, 47 MBL producers, and 31 KPC and MBL producers) with various carbapenem MICs were examined. For comparison, 84 genotypically confirmed carbapenemase-negative Enterobacteriaceae clinical isolates [39 extended-spectrum β-lactamase (ESBL) producers, 22 AmpC producers, and 23 ESBL and AmpC producers] were also tested. Results: The phenotypic algorithm was able to differentiate MBL from KPC producers as well as to detect the possible co-production of both carbapenemases (positive result only with the combined-disc test using meropenem alone and with both PBA and EDTA). The method detected all KPC or MBL producers (sensitivity 100%) as well as 30 of the KPC and MBL producers (sensitivity 96.8%). All three combined-disc tests were negative for non-carbapenemase-producing isolates, except two ESBL and AmpC producers that gave positive combineddisc tests using meropenem alone and with PBA and both PBA and EDTA (specificity for KPC detection 98.8%). Conclusions: This phenotypic method is very helpful to detect carbapenemase production and provides a simple algorithm for the differentiation of KPC and MBL enzymes, especially in regions where KPC- and MBL-possessing Enterobacteriaceae are highly prevalent. © The Author 2010.


Gazouli M.,National and Kapodistrian University of Athens | Lyberopoulou A.,National and Kapodistrian University of Athens | Pericleous P.,Tzaneion General Hospital | Rizos S.,Tzaneion General Hospital | And 4 more authors.
World Journal of Gastroenterology | Year: 2012

AIM: To detect of colorectal cancer (CRC) circulating tumour cells (CTCs) surface antigens, we present an assay incorporating cadmium selenide quantum dots (QDs) in these paper. METHODS: The principle of the assay is the immunomagnetic separation of CTCs from body fluids in conjunction with QDs, using specific antibody biomarkers: epithelial cell adhesion molecule antibody, and monoclonal cytokeratin 19 antibody. The detection signal was acquired from the fluorescence signal of QDs. For the evaluation of the performance, the method under study was used to isolate the human colon adenocarcinoma cell line (DLD-1) and CTCs from CRC patients' peripheral blood. RESULTS: The minimum detection limit of the assay was defined to 10 DLD-1 CRC cells/mL as fluorescence was measured with a spectrofluorometer. Fluorescenceactivated cell sorting analysis and Real Time RT-PCR, they both have also been used to evaluate the performance of the described method. In conclusion, we developed a simple, sensitive, efficient and of lower cost (than the existing ones) method for the detection of CRC CTCs in human samples. We have accomplished these results by using magnetic bead isolation and subsequent QD fluorescence detection. CONCLUSION: The method described here can be easily adjusted for any other protein target of either the CTC or the host. © 2012 Baishideng.


Staikou C.,National and Kapodistrian University of Athens | Avramidou A.,Tzaneion General Hospital | Ayiomamitis G.D.,Tzaneion General Hospital | Vrakas S.,Tzaneion General Hospital | Argyra E.,National and Kapodistrian University of Athens
Journal of Gastrointestinal Surgery | Year: 2014

Methods: Between December 2011 and February 2013, 60 patients were randomly allocated to IVL, LEA, or control group. The IVL group received intraoperatively lidocaine 2 % intravenously (1.5 mg/kg bolus, 2 mg/kg/h infusion) and normal saline (NS) epidurally. The LEA group received lidocaine epidurally (1.5 mg/kg bolus, 2 mg/kg/h infusion) and NS intravenously. The control group received NS both intravenously and epidurally, as bolus and infusion. All NS volumes were calculated as if containing lidocaine 2 % at the aforementioned doses. We assessed pain intensity at rest/cough at 1, 2, 4, 12, 24, and 48 h postoperatively (numerical rating scale 0–10), 48-h analgesic consumption, and time to first flatus passage.Results: Data from 60 patients (20 per group) were analyzed. The IVL group had significantly lower pain scores at rest and cough compared to LEA or control group only at 1, 2, and 4 h postoperatively (P < 0.005 for all comparisons). The 48-h analgesic requirements and time to first flatus passage did not differ significantly between IVL group and LEA or control group (P > 0.05).Conclusions: Compared with LEA-lidocaine or placebo, intravenous lidocaine offered no clinically significant benefit in terms of analgesia and bowel function.Background: We compared the effects of intravenous lidocaine (IVL) with lumbar epidural lidocaine analgesia (LEA) on pain and ileus after open colonic surgery. © 2014, The Society for Surgery of the Alimentary Tract.


Pericleous P.,Tzaneion General Hospital | Gazouli M.,National and Kapodistrian University of Athens | Lyberopoulou A.,National and Kapodistrian University of Athens | Rizos S.,Tzaneion General Hospital | And 2 more authors.
International Journal of Cancer | Year: 2012

Despite all major breakthroughs in recent years of research concerning the complex events that lead to cancer expression and metastasis, we are not yet able to effectively treat cancer that has spread to vital organs. The various clinical phases originating from cancer diagnosis through treatment and prognosis require a comprehensive understanding of these events, to utilise pre-symptomatic, minimally invasive and targeted cancer management techniques. Current imaging modalities such as ultrasound, computed tomography, magnetic resonance imaging and gamma scintigraphy facilitate the pre-operative study of tumours, but they have been rendered unable to visualise cancer in early stages, due to their intrinsic limitations. The semiconductor nanocrystal quantum dots (QDs) have excellent photo-physical properties, and the QDs-based probes have achieved encouraging developments in cellular (in vitro) and in vivo molecular imaging. However, the same unique physical and chemical properties which renowned QDs attractive may be associated with their potentially catastrophic effects on living cells and tissues. There are critical issues that need to be further examined to properly assess the risks associated with the manufacturing and use of QDs in cancer management. In this review, we aim to describe the current utilisation of QDs as well as their future prospective to decipher and confront cancer. Copyright © 2012 UICC.


Kristo I.,University of Thessaly | Pitiriga V.,National and Kapodistrian University of Athens | Poulou A.,National and Kapodistrian University of Athens | Poulou A.,Serres General Hospital | And 4 more authors.
International Journal of Antimicrobial Agents | Year: 2013

We examined the effect of applying the updated 2010 Clinical and Laboratory Standards Institute (CLSI) susceptibility breakpoints for extended-spectrum cephalosporins (ESCs) to detect extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. In total, 202 ESBL-producing, plasmidic AmpC- and carbapenemase-negative isolates derived from separate patients were collected from three Greek hospitals during 2007-2011, including 150 Escherichia coli, 43 Klebsiella pneumoniae and 9 Enterobacter cloacae clinical isolates. ESBLs were detected using the ESBL CLSI confirmatory test and PCR assays. Sequencing analysis showed that 91 (45.0%) of the ESBL-producers carried the blaCTX-M-3 gene, 66 (32.7%) carried the blaCTX-M-15 gene and the remaining 45 (22.3%) carried the blaSHV-5 gene. Minimum inhibitory concentrations for cefotaxime, ceftazidime and cefepime were determined by the agar dilution method. Based on the new CLSI breakpoints, 13 (6.4%) of the ESBL-producers were susceptible to cefotaxime, 90 (44.6%) to ceftazidime and 112 (55.4%) to cefepime; as many as 145 (71.8%) were susceptible to at least one ESC. Among the 150 E. coli, 12 (8.0%), 87 (58.0%) and 79 (52.7%) were susceptible to cefotaxime, ceftazidime and cefepime, respectively, whilst among the 43 K. pneumoniae, 1 (2.3%), 3 (7.0%) and 25 (58.1%) were susceptible to the above ESCs, respectively. None of the nine E. cloacae were susceptible to cefotaxime and ceftazidime, but all except one were susceptible to cefepime. By implementation of the new 2010 CLSI breakpoints, a considerable proportion of ESBL-possessing Enterobacteriaceae would be reported as susceptible, mostly to ceftazidime and cefepime, leading to possible infection control and therapeutic implications. © 2013 Elsevier B.V. and the International Society of Chemotherapy.


Voulgari E.,National and Kapodistrian University of Athens | Zarkotou O.,Tzaneion General Hospital | Ranellou K.,National and Kapodistrian University of Athens | Karageorgopoulos D.E.,U.S. Center for Disease Control and Prevention | And 4 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2013

Objectives: First detected in Enterobacteriaceae isolates in Turkey, the OXA-48 carbapenemase has gradually disseminated in the wider Mediterranean area and Europe. Despite reports from other European regions, until now no such isolates have been detected in Greece. We describe the characteristics of the first outbreak caused by OXA-48-producing Klebsiella pneumoniae in Greece. Methods: From December 2011 to March 2012, 13 ertapenem-resistant K. pneumoniae isolates, which were positive by the modified Hodge test while remaining negative by phenotypic screening for metallo-β-lactamase (MBL) and KPC production, were recovered from nine patients. Patient records were retrieved to access patterns of acquisition. Resistance genes were identified by PCR and sequencing. ompK35, ompK36 and the genetic environment of the blaOXA-48 gene were investigated. Plasmid profiling, conjugation experiments, PFGE and multilocus sequence typing (MLST) were performed. Results: All isolates harboured the blaOXA-48 gene along with the blaCTX-M-15 and blaOXA-1 genes. The blaOXA-48 gene was located on a self-transferable IncL/M-type plasmid of ~62 kb, which harboured no other resistance genes. IS1999 was located upstream of the blaOXA-48 gene. Genetic disruptions of the ompK35 and ompK36 genes were not detected. The isolates belonged to a unique PFGE clone and MLST assigned them to sequence type ST11. All cases were characterized as hospital acquired and none of them was linked to immigration or history of travel in endemic areas. Conclusions: Carbapenem resistance due to MBL and KPC carbapenemases is currently on an endemic scale in Greece and this report highlights the wider undetected dissemination of yet another carbapenemase in this region. © The Author 2012. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.


Tsakris A.,National and Kapodistrian University of Athens | Themeli-Digalaki K.,Tzaneion General Hospital | Poulou A.,National and Kapodistrian University of Athens | Poulou A.,Serres General Hospital | And 6 more authors.
Journal of Clinical Microbiology | Year: 2011

The accurate phenotypic detection of Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae is an increasing necessity worldwide. We evaluated the performance of boronic acid combined-disk tests using as substrate imipenem or meropenem and as inhibitor of KPC production 300 μg aminophenylboronic acid (APBA), 600 μg APBA, or 400 μg phenylboronic acid (PBA). Tests were considered positive when an increase in the growth-inhibitory zone around a carbapenem disk with KPC inhibitor was 5 mm or greater of the growth-inhibitory zone diameter around the disk containing carbapenem alone. The comparison of the combined-disk tests was performed with 112 genotypically confirmed KPC-possessing Enterobacteriaceae isolates. To measure the specificity of the tests, 127 genotypically confirmed KPC-negative Enterobacteriaceae isolates that were nonsusceptible to at least one carbapenem were chosen for testing. Using disks containing imipenem without and with 300 μg APBA, 600 μg APBA, or 400 μg PBA, 72, 92, and 112 of the KPC producers, respectively, gave positive results (sensitivities, 64.3%, 82.1%, and 100%, respectively). Using disks containing meropenem without and with 300 μg APBA, 600 μg APBA, or 400 μg PBA, 87, 108, and 112 of the KPC producers, respectively, gave positive results (sensitivities, 77.7%, 96.4%, and 100%, respectively). Among KPC producers, the disk potentiation tests using meropenem and PBA demonstrated the largest differences in inhibition zones (P < 0.001). All combined-disk tests correctly identified 124 of the 127 non-KPC producers (specificity, 97.6%). This comparative study showed that PBA is the most effective inhibitor of KPC enzymes, and its use in combined-disk tests with meropenem may give the most easily interpreted results. Copyright © 2011, American Society for Microbiology. All Rights Reserved.


Michalopoulos G.,Tzaneion General Hospital | Tzathas C.,Tzaneion General Hospital
Annals of Gastroenterology | Year: 2013

In recent years a lot of interest has been focused on a specific category of polyps, the so-called serrated polyps which until recently were categorized with the hyperplastic or mixed polyps and were thought to have no risk of malignant transformation. Recently though, the serrated pathway of carcinogenesis was discovered and destroyed this myth. It is believed that up to one third of all colorectal cancers arise through the serrated pathway; these cancers occur more often in the proximal colon and have specific molecular characteristics. Specific subtypes of serrated polyps (mainly the sessile serrated adenomas/polyps) are thought to be precursor lesions of these cancers. The prevention of these cancers is a challenge for gastroenterologists because their location and endoscopic characteristics renders them difficult to detect. Also, although there is a clear need for creating a specific post-polypectomy surveillance program for these lesions, to date there have been no guidelines for surveillance with a high level of evidence. In this article the main molecular, endoscopic, histological and epidemiologic characteristics of these lesions are presented, as well as recommendations for surveillance. © 2013 Hellenic Society of Gastroenterology.

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