As diffuse alveolar hemorrhage is defined the clinical pathological syndrome characterized by hem... more As diffuse alveolar hemorrhage is defined the clinical pathological syndrome characterized by hemoptysis, diffuse alveolar infiltrates, acute respiratory failure and anemia. It is a life-threatening condition and a medical emergency. Causes are multiple and variable. A 75-year-old male, ex-smoker, with known coronary artery disease and paroxysmal atrial fibrillation treated with aspirin, presents due to low grade fever and bloody sputum. Hemodynamically stable, without respiratory failure, but with multiple alveolar infiltrates on chest imaging and anemia. Initially treated as lower respiratory tract infection with intravenous antibiotics while anticoagulant treatment was interrupted. Full laboratory testing for anemia, collagen vascular diseases and specific and nonspecific infections was performed. Anemia was normochromic, normocytic, without findings of hemolysis. Diffuse bilateral alveolar infiltrates were revealed on thorax computer tomography. Diagnostic bronchoscopy was performed with negative results for either infection or malignancy, while bronchoalveolar lavage analysis revealed siderophages 81% of alveolar macrophages. The patient underwent full pulmonary function testing, which revealed obstructive respiratory disease with a low diffusion capacity. Due to continuing life threatening anemia, despite blood transfusions, in combination with the results of the laboratory tests, the patient was started on high dose intravenous corticosteroids, followed by intravenous cyclophosphamide every 28 days for five cycles. Rapid improvement was achieved with elimination of chest CT infiltrates and normalization of blood tests and pulmonary function tests. At present peros treatment with azathioprine and low dose corticosteroids is given. Diffuse alveolar hemorrhage is a clinical pathological syndrome caused by different pathophysiological mechanisms, including capillary failure stress, diffuse alveolar damage and capillaritis. The most common cause is capillaritis associated with systemic autoimmune diseases, mostly ANCA-related vasculitides. The presence of diffuse alveolar hemorrhage, with pulmonary capillaritis without clinical or serological findings of a systemic autoimmune disease is known as isolated pauci-immune pulmonary capillaritis. The treatment is based on corticosteroids and cyclophosphamide.
Quarterly Journal of Nuclear Medicine and Molecular Imaging, Sep 1, 2004
The aim of this study was to determine if patients with lung cancer and metastatic bone pain due ... more The aim of this study was to determine if patients with lung cancer and metastatic bone pain due to disseminated secondary bone disease, can benefit from the treatment with (186)Re-HEDP and to discuss the criteria useful for selecting those patients. Twenty-four patients were included in this study and they received 1295 MBq (186)Re-HEDP. All patients underwent (99m)Tc-MDP bone scan before treatment from which the bone scan index (BSI) was determined (mean=18.7+/-17.1%). Most patients underwent CT scan of the painful areas from which the osteolytic element of their bone lesions as well as possible infiltration of the soft tissues was determined. Patients with predominantly osteolytic metastases at the sites considered to be the origin of pain in the CT scan, were excluded. All patients were under analgesic therapy, 22/24 were taking opiates. Pain was estimated by the visual analogue scale (VAS) before the application of (186)Re-HEDP and over the following 8 weeks. The possible myelotoxicity of (186)Re was assessed. The mean VAS score was 6.9+/-2.5 before the application and 3.2+/-2.6 after therapy. Pain relief was obtained in 23/24 patients. Sixty-two percent of the patients exhibited clinically significant pain relief of at least 3 VAS score. The dosage of opiates was decreased in 77% of the patients and could be discontinued in 4 of them. Myelotoxicity was observed in 1 patient. Ninety-one percent of our patients showed improvement in the parameters that assess the quality of life. The application of a standard dose of (186)Re-HEDP in patients with lung cancer and painful disseminated bone metastases has a satisfactory pain alleviating effect. The easy application and very low myelotoxicity are important factors in this group of patients. A better analgesic effect of the (186)Re-HEDP application can be expected if combined estimation of the (99m)Tc-MDP bone scan and the CT scan is used.
Objective: Psychological distress is not a new phenomenon in oncology. It has been considered a s... more Objective: Psychological distress is not a new phenomenon in oncology. It has been considered a serious subject for patients diagnosed with cancer. The main method of measurement of distress is the Distress Thermometer which consists of an analogical scale from 0-10 and of 5 groups of problems which cause concern to the patient: 1. Practical problems 2. Family problems 3. Emotional problems 4. Spiritual/religious uncertainties 5. Physical problems. Purpose: Is the presentation of Distress Thermometer in greek for taking measures promptly with the aim of ensuring a better quality of life for lung cancer patients. Method: The sample consisted of 88 males, 26 females, the average age of 64,95 +- 9,3, with lung cancer from the pulmonology clinics of “Swtiria” hospital. Results: Only 18,4% of the sample showed normal values (0-4) on the analogical scale while 37,3% showed serious distress (7-10). Regarding the practical problems 36% had difficulties in movement while 22% mentioned having economic, work or insurance problems. In reference to family problems 7,9% quoted problems with their spouses. As for the emotional side it was found that nervousness accounted for 71,9% of the sample and fear 60,5%. Furthermore 20,2% started to take an interest in spiritual/religious themes. In the field of physical problems, walking proved to be a difficulty for 70,2% of the patients. Conclusion: The distress thermometer may be used as a screening tool for detecting and promptly dealing with distress.
Snakes are integral components of ecosystems, being both predators and prey. They also provide va... more Snakes are integral components of ecosystems, being both predators and prey. They also provide valuable ecosystem services to people, such as rodent control, bushmeat, and leather goods. Although these positive services have been recognized, people are generally wary of snakes, because some species possess and release venom to immobilize prey. Therefore, understanding peoples' attitudes towards non-venomous and venomous snakes would be critical for their successful conservation. We carried out on-site face-to-face surveys with Greek residents (n = 897) to study their attitudes towards non-venomous and venomous snakes using a nine-statement attitudinal instrument. Survey participants had higher mutualism than domination wildlife value orientation and could more correctly identify the venomosity of venomous than non-venomous snake species. Factor analysis determined two general attitudes: tolerance and conservation. Participants were intolerant of snakes, while they generally supported their conservation, for both non-venomous and venomous species. However, their attitudes were more positive towards non-venomous than venomous snakes. Mutualism was a positive predictor of tolerance and conservation for non-venomous snakes, but only of conservation for venomous snakes. Domination was a negative predictor of conservation for both venomosity groups. Knowledge of snake venomosity was a positive predictor of tolerance and conservation for non-venomous snakes, and a negative predictor of tolerance for venomous snakes. Our findings not only indicated that the pubic differentiated attitudes towards snakes based on their venomosity but also, importantly, allowed for determining groups holding positive or negative attitudes towards snakes based on wildlife value orientations and the ability to evaluate snake venomosity. Such information further indicated that successful education and outreach plans should be venomosity and public group specific, aiming at increasing the pro-conservationist attitudes towards snakes, especially of those domination-oriented and unable to distinguish non-venomous from venomous snakes, thus promoting and ultimately securing the future survival of these controversial animals.
Aim: To retrospectively characterize real-world therapeutic strategies, clinical outcomes and att... more Aim: To retrospectively characterize real-world therapeutic strategies, clinical outcomes and attrition rates with EGFR tyrosine kinase inhibitors (TKIs), before first-line osimertinib approval, in EGFR-mutated advanced/metastatic non-small-cell lung cancer patients in Greece. Results: Among 160 patients, the discontinuation rate for first-line first- or second-generation EGFR-TKIs was 85%; among these patients, 43% did not receive any second-line therapy and 9.4% died during an 18.7-month follow-up period. Median progression-free and overall survival were 12.1 and 20.9 months, respectively. Osimertinib was offered as second- and third-line treatment in 69.6 and 21.7% of patients with the T790M mutation, respectively. Brain metastases were recorded in 10.6% of patients during treatment, with median overall survival of 4.9 months. Conclusion: Given the high attrition rates and the impact of CNS progression, offering the most appropriate first-line EGFR-TKI treatment with CNS penetrat...
Most patients infected with SARS-CoV-2 (COVID-19) experience mild, non-specific symptoms, but sev... more Most patients infected with SARS-CoV-2 (COVID-19) experience mild, non-specific symptoms, but several develop severe symptoms associated with an excessive inflammatory response. Elevated plasma concentrations of soluble urokinase plasminogen activator receptor (suPAR) provide early warning of progression to severe respiratory failure (SRF) or death, but access to suPAR testing may be limited. The Severe COvid Prediction Estimate (SCOPE) score, derived from C-reactive protein, D-dimers, interleukin-6, and ferritin circulating concentrations among patients not receiving non-invasive or invasive mechanical ventilation during the SAVE-MORE study, offers comparable predictive accuracy for progression to SRF or death within 14 days as suPAR ≥6 ng/ml (area under receiver operator characteristic curve, 0.81 for both). SCOPE score is validated in two similar independent cohorts. SCOPE score 6 or more is an alternative to suPAR for predicting progression to SRF or death within 14 days of hospital admission for pneumonia, and it can be used to guide treatment decisions.
Little is known on the key contributing factors towards progression into acute respiratory distre... more Little is known on the key contributing factors towards progression into acute respiratory distress syndrome (ARDS) necessitating mechanical ventilation (MV) in COVID-19. We determined serum levels, within 24 hours of diagnosis, of alarmins, as well as pro- and anti-inflammatory molecules in asymptomatic, moderate, severe and intubated patients compared to non-infected comparators. Levels of the pro-inflammatory interleukin (IL)-8, IL-18, matrix metalloproteinase-9, platelet-derived growth factor (PDGF)-B and calprotectin (S100A8/A9) were specific drivers of ARDS. Levels of the anti-inflammatory IL-1ra and IL-33r were increased; IL-38 was increased only in asymptomatic patients, but significantly decreased in the more severe COVID-19 cases. Multivariate ordinal regression showed that pathways of IL-6, IL-33 and calprotectin gave significant probability for worse outcome. These results indicate a dysfunctional response to the presence of alarmins that may be used for prognosis and de...
Introduction: Aim of the study was the evaluation of the QRS-T-angle, a novel marker of ventricul... more Introduction: Aim of the study was the evaluation of the QRS-T-angle, a novel marker of ventricular repolarization, in asymptomatic patients with sarcoidosis and investigation of the relationship between QRS-T-a and occurrence of ventricular arrhythmias. Methods: The ECG derived QRS-T-a of 112 sarcoidosis patients was calculated while cardiac involvement (CI) was assessed based on known criteria. Assessment of the ventricular arrhythmias was based on the Lown classification criteria. All patients were compared to 65 healthy controls. Results: 36/112 patients fulfilled the criteria of CI while 15 patients were classified as Lown 4A and 4B. The QRS-T-a of sarcoidosis patients was significantly increased compared to controls, while subgroup analysis showed that patients with CI and Lown >3 had significantly elevated QRS-T-a. Bivariate correlation showed that QRS-T-a is associated with the age and the Lown classification. Conclusion: The calculation of QRS-T-a may be useful in the ri...
Introduction: Five to 10% are the mortality rates reported in patients with sarcoidosis worldwide... more Introduction: Five to 10% are the mortality rates reported in patients with sarcoidosis worldwide. However, little are known about the factors affecting the survival. Methods: We conducted an observational study to examine factors affecting survival in patients with sarcoidosis. Totally 122 patients with biopsy-proven sarcoidosis enrolled, underwent pulmonary function tests, a 12-lead electrocardiogram, an echocardiogram and a 24-hour Holter monitoring. Cardiac sarcoidosis was detected based on known criteria. All-cause mortality and cardiac death were the primary and secondary endpoints. Results: During a median of 58.89±15.75 months follow-up, ten deaths (8.2%) were reported. The demographic characteristics of the survived patients and those who died are presented in table 1. Five patients (4.1%) died due to cardiac causes. Cardiac involvement was detected in 40 patients (32.8%). The multivariate analysis showed age, standard deviation of RR intervals Conclusion: The thorough eval...
Most patients infected with SARS-CoV-2 (COVID-19) experience mild, non-specific symptoms, but sev... more Most patients infected with SARS-CoV-2 (COVID-19) experience mild, non-specific symptoms, but several develop severe symptoms associated with an excessive inflammatory response. Elevated plasma concentrations of soluble urokinase plasminogen activator receptor (suPAR) provide early warning of progression to severe respiratory failure (SRF) or death, but access to suPAR testing may be limited. The Severe COvid Prediction Estimate (SCOPE) score, derived from C-reactive protein, D-dimer, interleukin-6, and ferritin circulating concentrations at hospitalization during the SAVE-MORE study, offers comparable predictive accuracy for progression to SRF or death within 14 days as suPAR ≥6 ng/ml (area under receiver operator characteristic curve, 0.81 for both). SCOPE score was validated against an independent dataset from the SAVE study. The SCOPE score is an alternative to suPAR for predicting progression to SRF or death within 14 days of hospital admission for pneumonia, and it can be used to guide treatment decisions.<br><br>Funding: The study was funded in part by the Hellenic Institute for the Study of Sepsis and by Swedish Orphan Biovitrum. The Hellenic Institute for the Study of Sepsis is the Sponsor of the SAVE and SAVE-MORE studies.<br><br>Declaration of Interests:E. J. Giamarellos-Bourboulis has received honoraria from Abbott CH, bioMérieux, Brahms GmbH, GSK, InflaRx GmbH, Sobi and XBiotech Inc;independent educational grants from Abbott CH, AxisShield, bioMérieux Inc, InflaRx GmbH, Johnson & Johnson, MSD, Sobi and XBiotech Inc.;and funding from the Horizon2020 Marie-Curie Project European Sepsis Academy (granted to the National and Kapodistrian University of Athens), and the Horizon 2020 European Grants ImmunoSep and RISKinCOVID (granted to the Hellenic Institute for the Study of Sepsis). G. Poulakou has received independent educational grants from Pfizer, MSD, Angelini, and Biorad. H. Milionis reports receiving honoraria, consulting fees and non-financial support from healthcare companies, including Amgen, Angelini, Bayer, Mylan, MSD, Pfizer, and Servier. L. Dagna had received consultation honoraria from SOBI. M. Bassetti has received funds for research grants and/or advisor/consultant and/or speaker/chairman from Angelini, Astellas, Bayer, Biomerieux, Cidara, Cipla, Gilead, Menarini, MSD, Pfizer, Roche, Shionogi and Nabriva. P. Panagopoulos has received honoraria from GILEAD Sciences, Janssen, and MSD. G. N. Dalekos is an advisor or lecturer for Ipsen, Pfizer, Genkyotex, Novartis, Sobi, received research grants from Abbvie, Gilead and has served as PI in studies for Abbvie, Novartis, Gilead, Novo Nordisk, Genkyotex, Regulus Therapeutics Inc, Tiziana Life Sciences, Bayer, Astellas, Pfizer, Amyndas Pharmaceuticals, CymaBay Therapeutics Inc., Sobi and Intercept Pharmaceuticals. M. G. Netea is supported by an ERC Advanced Grant (#833247) and a Spinoza grant of the Netherlands Organization for Scientific Research. Hes is a scientific founder of TTxD and he has received independent educational grants from TTxD, GSK, Ono Pharma and ViiV HealthCare. The other authors do not have any competing interest to declare.<br><br>Ethics Approval Statement: The SAVE protocol was approved by the National Ethics Committee of Greece (approval 38/20) and National Organization for Medicines approval (ISO 28/20). The SAVE-MORE protocol was approved by the National Ethics Committee of Greece (approval 161/20) and by the Ethics Committee of the National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, in Rome (1 February 2021).<br><br>Trial Registration: The SAVE study was prospectively registered prior to enrolling the first patient (EudraCT number 2020-001466-11;ClinicalTrials.gov identifier NCT04357366). The SAVE-MORE study was prospectively registered (EudraCT no. 2020-005828-11;ClinicalTrials.gov identifier NCT04680949). Written informed consent was provided by all patients prior to enrollment.
As diffuse alveolar hemorrhage is defined the clinical pathological syndrome characterized by hem... more As diffuse alveolar hemorrhage is defined the clinical pathological syndrome characterized by hemoptysis, diffuse alveolar infiltrates, acute respiratory failure and anemia. It is a life-threatening condition and a medical emergency. Causes are multiple and variable. A 75-year-old male, ex-smoker, with known coronary artery disease and paroxysmal atrial fibrillation treated with aspirin, presents due to low grade fever and bloody sputum. Hemodynamically stable, without respiratory failure, but with multiple alveolar infiltrates on chest imaging and anemia. Initially treated as lower respiratory tract infection with intravenous antibiotics while anticoagulant treatment was interrupted. Full laboratory testing for anemia, collagen vascular diseases and specific and nonspecific infections was performed. Anemia was normochromic, normocytic, without findings of hemolysis. Diffuse bilateral alveolar infiltrates were revealed on thorax computer tomography. Diagnostic bronchoscopy was performed with negative results for either infection or malignancy, while bronchoalveolar lavage analysis revealed siderophages 81% of alveolar macrophages. The patient underwent full pulmonary function testing, which revealed obstructive respiratory disease with a low diffusion capacity. Due to continuing life threatening anemia, despite blood transfusions, in combination with the results of the laboratory tests, the patient was started on high dose intravenous corticosteroids, followed by intravenous cyclophosphamide every 28 days for five cycles. Rapid improvement was achieved with elimination of chest CT infiltrates and normalization of blood tests and pulmonary function tests. At present peros treatment with azathioprine and low dose corticosteroids is given. Diffuse alveolar hemorrhage is a clinical pathological syndrome caused by different pathophysiological mechanisms, including capillary failure stress, diffuse alveolar damage and capillaritis. The most common cause is capillaritis associated with systemic autoimmune diseases, mostly ANCA-related vasculitides. The presence of diffuse alveolar hemorrhage, with pulmonary capillaritis without clinical or serological findings of a systemic autoimmune disease is known as isolated pauci-immune pulmonary capillaritis. The treatment is based on corticosteroids and cyclophosphamide.
Quarterly Journal of Nuclear Medicine and Molecular Imaging, Sep 1, 2004
The aim of this study was to determine if patients with lung cancer and metastatic bone pain due ... more The aim of this study was to determine if patients with lung cancer and metastatic bone pain due to disseminated secondary bone disease, can benefit from the treatment with (186)Re-HEDP and to discuss the criteria useful for selecting those patients. Twenty-four patients were included in this study and they received 1295 MBq (186)Re-HEDP. All patients underwent (99m)Tc-MDP bone scan before treatment from which the bone scan index (BSI) was determined (mean=18.7+/-17.1%). Most patients underwent CT scan of the painful areas from which the osteolytic element of their bone lesions as well as possible infiltration of the soft tissues was determined. Patients with predominantly osteolytic metastases at the sites considered to be the origin of pain in the CT scan, were excluded. All patients were under analgesic therapy, 22/24 were taking opiates. Pain was estimated by the visual analogue scale (VAS) before the application of (186)Re-HEDP and over the following 8 weeks. The possible myelotoxicity of (186)Re was assessed. The mean VAS score was 6.9+/-2.5 before the application and 3.2+/-2.6 after therapy. Pain relief was obtained in 23/24 patients. Sixty-two percent of the patients exhibited clinically significant pain relief of at least 3 VAS score. The dosage of opiates was decreased in 77% of the patients and could be discontinued in 4 of them. Myelotoxicity was observed in 1 patient. Ninety-one percent of our patients showed improvement in the parameters that assess the quality of life. The application of a standard dose of (186)Re-HEDP in patients with lung cancer and painful disseminated bone metastases has a satisfactory pain alleviating effect. The easy application and very low myelotoxicity are important factors in this group of patients. A better analgesic effect of the (186)Re-HEDP application can be expected if combined estimation of the (99m)Tc-MDP bone scan and the CT scan is used.
Objective: Psychological distress is not a new phenomenon in oncology. It has been considered a s... more Objective: Psychological distress is not a new phenomenon in oncology. It has been considered a serious subject for patients diagnosed with cancer. The main method of measurement of distress is the Distress Thermometer which consists of an analogical scale from 0-10 and of 5 groups of problems which cause concern to the patient: 1. Practical problems 2. Family problems 3. Emotional problems 4. Spiritual/religious uncertainties 5. Physical problems. Purpose: Is the presentation of Distress Thermometer in greek for taking measures promptly with the aim of ensuring a better quality of life for lung cancer patients. Method: The sample consisted of 88 males, 26 females, the average age of 64,95 +- 9,3, with lung cancer from the pulmonology clinics of “Swtiria” hospital. Results: Only 18,4% of the sample showed normal values (0-4) on the analogical scale while 37,3% showed serious distress (7-10). Regarding the practical problems 36% had difficulties in movement while 22% mentioned having economic, work or insurance problems. In reference to family problems 7,9% quoted problems with their spouses. As for the emotional side it was found that nervousness accounted for 71,9% of the sample and fear 60,5%. Furthermore 20,2% started to take an interest in spiritual/religious themes. In the field of physical problems, walking proved to be a difficulty for 70,2% of the patients. Conclusion: The distress thermometer may be used as a screening tool for detecting and promptly dealing with distress.
Snakes are integral components of ecosystems, being both predators and prey. They also provide va... more Snakes are integral components of ecosystems, being both predators and prey. They also provide valuable ecosystem services to people, such as rodent control, bushmeat, and leather goods. Although these positive services have been recognized, people are generally wary of snakes, because some species possess and release venom to immobilize prey. Therefore, understanding peoples' attitudes towards non-venomous and venomous snakes would be critical for their successful conservation. We carried out on-site face-to-face surveys with Greek residents (n = 897) to study their attitudes towards non-venomous and venomous snakes using a nine-statement attitudinal instrument. Survey participants had higher mutualism than domination wildlife value orientation and could more correctly identify the venomosity of venomous than non-venomous snake species. Factor analysis determined two general attitudes: tolerance and conservation. Participants were intolerant of snakes, while they generally supported their conservation, for both non-venomous and venomous species. However, their attitudes were more positive towards non-venomous than venomous snakes. Mutualism was a positive predictor of tolerance and conservation for non-venomous snakes, but only of conservation for venomous snakes. Domination was a negative predictor of conservation for both venomosity groups. Knowledge of snake venomosity was a positive predictor of tolerance and conservation for non-venomous snakes, and a negative predictor of tolerance for venomous snakes. Our findings not only indicated that the pubic differentiated attitudes towards snakes based on their venomosity but also, importantly, allowed for determining groups holding positive or negative attitudes towards snakes based on wildlife value orientations and the ability to evaluate snake venomosity. Such information further indicated that successful education and outreach plans should be venomosity and public group specific, aiming at increasing the pro-conservationist attitudes towards snakes, especially of those domination-oriented and unable to distinguish non-venomous from venomous snakes, thus promoting and ultimately securing the future survival of these controversial animals.
Aim: To retrospectively characterize real-world therapeutic strategies, clinical outcomes and att... more Aim: To retrospectively characterize real-world therapeutic strategies, clinical outcomes and attrition rates with EGFR tyrosine kinase inhibitors (TKIs), before first-line osimertinib approval, in EGFR-mutated advanced/metastatic non-small-cell lung cancer patients in Greece. Results: Among 160 patients, the discontinuation rate for first-line first- or second-generation EGFR-TKIs was 85%; among these patients, 43% did not receive any second-line therapy and 9.4% died during an 18.7-month follow-up period. Median progression-free and overall survival were 12.1 and 20.9 months, respectively. Osimertinib was offered as second- and third-line treatment in 69.6 and 21.7% of patients with the T790M mutation, respectively. Brain metastases were recorded in 10.6% of patients during treatment, with median overall survival of 4.9 months. Conclusion: Given the high attrition rates and the impact of CNS progression, offering the most appropriate first-line EGFR-TKI treatment with CNS penetrat...
Most patients infected with SARS-CoV-2 (COVID-19) experience mild, non-specific symptoms, but sev... more Most patients infected with SARS-CoV-2 (COVID-19) experience mild, non-specific symptoms, but several develop severe symptoms associated with an excessive inflammatory response. Elevated plasma concentrations of soluble urokinase plasminogen activator receptor (suPAR) provide early warning of progression to severe respiratory failure (SRF) or death, but access to suPAR testing may be limited. The Severe COvid Prediction Estimate (SCOPE) score, derived from C-reactive protein, D-dimers, interleukin-6, and ferritin circulating concentrations among patients not receiving non-invasive or invasive mechanical ventilation during the SAVE-MORE study, offers comparable predictive accuracy for progression to SRF or death within 14 days as suPAR ≥6 ng/ml (area under receiver operator characteristic curve, 0.81 for both). SCOPE score is validated in two similar independent cohorts. SCOPE score 6 or more is an alternative to suPAR for predicting progression to SRF or death within 14 days of hospital admission for pneumonia, and it can be used to guide treatment decisions.
Little is known on the key contributing factors towards progression into acute respiratory distre... more Little is known on the key contributing factors towards progression into acute respiratory distress syndrome (ARDS) necessitating mechanical ventilation (MV) in COVID-19. We determined serum levels, within 24 hours of diagnosis, of alarmins, as well as pro- and anti-inflammatory molecules in asymptomatic, moderate, severe and intubated patients compared to non-infected comparators. Levels of the pro-inflammatory interleukin (IL)-8, IL-18, matrix metalloproteinase-9, platelet-derived growth factor (PDGF)-B and calprotectin (S100A8/A9) were specific drivers of ARDS. Levels of the anti-inflammatory IL-1ra and IL-33r were increased; IL-38 was increased only in asymptomatic patients, but significantly decreased in the more severe COVID-19 cases. Multivariate ordinal regression showed that pathways of IL-6, IL-33 and calprotectin gave significant probability for worse outcome. These results indicate a dysfunctional response to the presence of alarmins that may be used for prognosis and de...
Introduction: Aim of the study was the evaluation of the QRS-T-angle, a novel marker of ventricul... more Introduction: Aim of the study was the evaluation of the QRS-T-angle, a novel marker of ventricular repolarization, in asymptomatic patients with sarcoidosis and investigation of the relationship between QRS-T-a and occurrence of ventricular arrhythmias. Methods: The ECG derived QRS-T-a of 112 sarcoidosis patients was calculated while cardiac involvement (CI) was assessed based on known criteria. Assessment of the ventricular arrhythmias was based on the Lown classification criteria. All patients were compared to 65 healthy controls. Results: 36/112 patients fulfilled the criteria of CI while 15 patients were classified as Lown 4A and 4B. The QRS-T-a of sarcoidosis patients was significantly increased compared to controls, while subgroup analysis showed that patients with CI and Lown >3 had significantly elevated QRS-T-a. Bivariate correlation showed that QRS-T-a is associated with the age and the Lown classification. Conclusion: The calculation of QRS-T-a may be useful in the ri...
Introduction: Five to 10% are the mortality rates reported in patients with sarcoidosis worldwide... more Introduction: Five to 10% are the mortality rates reported in patients with sarcoidosis worldwide. However, little are known about the factors affecting the survival. Methods: We conducted an observational study to examine factors affecting survival in patients with sarcoidosis. Totally 122 patients with biopsy-proven sarcoidosis enrolled, underwent pulmonary function tests, a 12-lead electrocardiogram, an echocardiogram and a 24-hour Holter monitoring. Cardiac sarcoidosis was detected based on known criteria. All-cause mortality and cardiac death were the primary and secondary endpoints. Results: During a median of 58.89±15.75 months follow-up, ten deaths (8.2%) were reported. The demographic characteristics of the survived patients and those who died are presented in table 1. Five patients (4.1%) died due to cardiac causes. Cardiac involvement was detected in 40 patients (32.8%). The multivariate analysis showed age, standard deviation of RR intervals Conclusion: The thorough eval...
Most patients infected with SARS-CoV-2 (COVID-19) experience mild, non-specific symptoms, but sev... more Most patients infected with SARS-CoV-2 (COVID-19) experience mild, non-specific symptoms, but several develop severe symptoms associated with an excessive inflammatory response. Elevated plasma concentrations of soluble urokinase plasminogen activator receptor (suPAR) provide early warning of progression to severe respiratory failure (SRF) or death, but access to suPAR testing may be limited. The Severe COvid Prediction Estimate (SCOPE) score, derived from C-reactive protein, D-dimer, interleukin-6, and ferritin circulating concentrations at hospitalization during the SAVE-MORE study, offers comparable predictive accuracy for progression to SRF or death within 14 days as suPAR ≥6 ng/ml (area under receiver operator characteristic curve, 0.81 for both). SCOPE score was validated against an independent dataset from the SAVE study. The SCOPE score is an alternative to suPAR for predicting progression to SRF or death within 14 days of hospital admission for pneumonia, and it can be used to guide treatment decisions.<br><br>Funding: The study was funded in part by the Hellenic Institute for the Study of Sepsis and by Swedish Orphan Biovitrum. The Hellenic Institute for the Study of Sepsis is the Sponsor of the SAVE and SAVE-MORE studies.<br><br>Declaration of Interests:E. J. Giamarellos-Bourboulis has received honoraria from Abbott CH, bioMérieux, Brahms GmbH, GSK, InflaRx GmbH, Sobi and XBiotech Inc;independent educational grants from Abbott CH, AxisShield, bioMérieux Inc, InflaRx GmbH, Johnson & Johnson, MSD, Sobi and XBiotech Inc.;and funding from the Horizon2020 Marie-Curie Project European Sepsis Academy (granted to the National and Kapodistrian University of Athens), and the Horizon 2020 European Grants ImmunoSep and RISKinCOVID (granted to the Hellenic Institute for the Study of Sepsis). G. Poulakou has received independent educational grants from Pfizer, MSD, Angelini, and Biorad. H. Milionis reports receiving honoraria, consulting fees and non-financial support from healthcare companies, including Amgen, Angelini, Bayer, Mylan, MSD, Pfizer, and Servier. L. Dagna had received consultation honoraria from SOBI. M. Bassetti has received funds for research grants and/or advisor/consultant and/or speaker/chairman from Angelini, Astellas, Bayer, Biomerieux, Cidara, Cipla, Gilead, Menarini, MSD, Pfizer, Roche, Shionogi and Nabriva. P. Panagopoulos has received honoraria from GILEAD Sciences, Janssen, and MSD. G. N. Dalekos is an advisor or lecturer for Ipsen, Pfizer, Genkyotex, Novartis, Sobi, received research grants from Abbvie, Gilead and has served as PI in studies for Abbvie, Novartis, Gilead, Novo Nordisk, Genkyotex, Regulus Therapeutics Inc, Tiziana Life Sciences, Bayer, Astellas, Pfizer, Amyndas Pharmaceuticals, CymaBay Therapeutics Inc., Sobi and Intercept Pharmaceuticals. M. G. Netea is supported by an ERC Advanced Grant (#833247) and a Spinoza grant of the Netherlands Organization for Scientific Research. Hes is a scientific founder of TTxD and he has received independent educational grants from TTxD, GSK, Ono Pharma and ViiV HealthCare. The other authors do not have any competing interest to declare.<br><br>Ethics Approval Statement: The SAVE protocol was approved by the National Ethics Committee of Greece (approval 38/20) and National Organization for Medicines approval (ISO 28/20). The SAVE-MORE protocol was approved by the National Ethics Committee of Greece (approval 161/20) and by the Ethics Committee of the National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, in Rome (1 February 2021).<br><br>Trial Registration: The SAVE study was prospectively registered prior to enrolling the first patient (EudraCT number 2020-001466-11;ClinicalTrials.gov identifier NCT04357366). The SAVE-MORE study was prospectively registered (EudraCT no. 2020-005828-11;ClinicalTrials.gov identifier NCT04680949). Written informed consent was provided by all patients prior to enrollment.
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