Introduction. Bacterial infections are common complications and the cause of death in patients wi... more Introduction. Bacterial infections are common complications and the cause of death in patients with cirrhosis and ascites. There is no standard method for a rapid and low-cost diagnosis, and its prognosis is poor. Objective. The aim of this study was to determine the etiology and frequency of bacterial infections in patients with liver cirrhosis of different etiology, and the influence of bacterial infections on the prognosis in patients with liver cirrhosis and ascites. Methods. Sixty-four patients with cirrhosis and ascites were included in the study. The diagnosis of spontaneous bacterial peritonitis was established based on the diagnostic abdominal paracentesis and the results of biochemical, cytological and microbiologic analysis of ascitic fluid. The diagnosis of urinary infection and pneumonia were made according to the standard criteria. Results. Spontaneous bacterial peritonitis was diagnosed in 23 (35.9%) patients, urinary infections in 16 (25%) and pneumonia in 11 (17.2%)...
Considering the increasing importance of immune checkpoints in tumor immunity we investigated the... more Considering the increasing importance of immune checkpoints in tumor immunity we investigated the clinical relevance of serum T-cell immunoglobulin and mucin domain-3 (TIM-3) in patients with hepatocellular carcinoma (HCC). Serum TIM-3 levels were measured and their association with HCC stage and the detection of serum programmed death ligand-1 (PD-L1) were assessed. In patients submitted to transarterial chemoembolization (TACE), pre- and 1-week post-treatment TIM-3 levels were also evaluated. We studied 53 HCC patients with BCLC stages: 0 (5.7%), A (34%), B (32.1%), C (22.6%), and D (5.7%). The patients with advanced HCC (BCLC C) had significantly higher TIM-3 levels than patients with BCLC A (p = 0.009) and BCLC B (p = 0.019). TIM-3 levels were not associated with HCC etiology (p = 0.183). PD-L1 detection (9/53 patients) correlated with TIM-3 levels (univariate analysis, p = 0.047). In 33 patients who underwent TACE, post-treatment TIM-3 levels (231 pg/mL, 132–452) were significa...
The International journal of artificial organs, 2018
Hepatitis C virus (HCV) infection is still common among dialysis patients, but the natural histor... more Hepatitis C virus (HCV) infection is still common among dialysis patients, but the natural history of HCV in this group is not completely understood. The KDIGO HCV guidelines of 2009 recommend that chronic haemodialysis patients be screened for HCV antibody upon admission to the dialysis clinic and every 6 months thereafter if susceptible to HCV infection. However, previous studies have shown the presence of HCV viraemia in anti-HCV-negative haemodialysis patients as up to 22%. To evaluate the presence of HCV viraemia, using HCV RNA detection, among anti-HCV-negative haemodialysis patients from a tertiary dialysis unit in Athens. We enrolled 41 anti-HCV-negative haemodialysis patients diagnosed with third-generation enzyme immunoassay. HCV viraemia was evaluated using a sensitive (cut-off: 12 IU/mL) reverse transcriptase polymerase chain reaction (COBAS AmpliPrep/TaqMan system) for HCV RNA. None of the 41 anti-HCV-negative haemodialysis patients were shown to be viraemic. Routine HC...
Hereditary bleeding disorders include a group of diseases with abnormalities of coagulation. Prio... more Hereditary bleeding disorders include a group of diseases with abnormalities of coagulation. Prior to 1990, infection with hepatitis C virus (HCV) was mainly transmitted via pooled plasma products as a treatment for hereditary bleeding disorders. Anti-HCV positivity in these patients may be as high as >70% in some areas, while some of them have also been coinfected with human immunodeficiency virus. Since about 20% of HCV-infected patients clear the infection naturally, chronic HCV infection represents a significant health problem in this group of patients. Mortality due to chronic HCV infection is estimated to be >10 times higher in patients with hemophilia than in the general population, and is mainly due to liver cirrhosis and hepatocellular carcinoma. The antiviral treatment of HCV in patients with hereditary bleeding disorders is not different from that of any other infected patients. Nevertheless, many patients with hereditary bleeding disorders have declined (Peg)interf...
Dietary and physical activity (PA) habits have been suggested as important factors for nonalcohol... more Dietary and physical activity (PA) habits have been suggested as important factors for nonalcoholic fatty liver disease (NAFLD). Published data are mainly focused on the effect of either diet or exercise, whereas data on other aspects like sleep remain sparse. The aim of this study was to explore potential associations between dietary intake, PA, and sleeping habits, and the presence of NAFLD. One hundred patients with ultrasound-proven NAFLD and 55 healthy controls matched for age, sex, and body mass index were included. Dietary habits were assessed through a semiquantitative validated food frequency questionnaire. PA level was assessed with a validated questionnaire. Total night sleep hours and duration of midday rest were also recorded. Optimal sleep duration was defined as sleep hours ≥7 and ≤9 hr/day. Patients compared to controls consumed less vegetables and nuts, more sweets, drank less coffee and alcohol (all P < 0.05), and exhibited a lower level of PA (P = 0.006). PA level [odds ratio (OR) per 100 metabolic equivalent of task-min/day = 0.74, 95% confidence interval (CI) 0.61-0.89, P = 0.002] was associated with lower probability of having NAFLD, whereas sweets consumption (OR = 2.13, 95% CI 1.22-3.71, P = 0.008) was associated with increased probability, after adjusting for several confounders, including body weight status. Optimal sleep duration was marginally and inversely associated with NAFLD presence (OR = 0.38, 95% CI 0.14-1.01, P = 0.05). Higher PA level and optimal sleep duration are associated with lower likelihood, whereas sweets consumption is associated with higher likelihood of having NAFLD. These associations are independent of body weight status and energy intake.
Applied Physiology, Nutrition, and Metabolism, 2016
Several lifestyle habits have been described as risk factors for nonalcoholic fatty liver disease... more Several lifestyle habits have been described as risk factors for nonalcoholic fatty liver disease (NAFLD). Given that both healthy and unhealthy habits tend to cluster, the aim of this study was to identify lifestyle patterns and explore their potential associations with clinical characteristics of individuals with NAFLD. One hundred and thirty-six consecutive patients with ultrasound-proven NAFLD were included. Diet and physical activity level were assessed through appropriate questionnaires. Habitual night sleep hours and duration of midday naps were recorded. Optimal sleep duration was defined as sleep hours ≥ 7 and ≤ 9 h/day. Lifestyle patterns were identified using principal component analysis. Eight components were derived explaining 67% of total variation of lifestyle characteristics. Lifestyle pattern 3, namely high consumption of low-fat dairy products, vegetables, fish, and optimal sleep duration was negatively associated with insulin resistance (β = −1.66, P = 0.008) and ...
European Journal of Gastroenterology Hepatology, Sep 1, 1999
Malignancies may uncommonly present as fulminant hepatic failure and, due to the rarity of such a... more Malignancies may uncommonly present as fulminant hepatic failure and, due to the rarity of such an occurrence, they may easily be overlooked as one of its possible causes. An unusual case of Hodgkin's disease presenting as a fulminant hepatic failure is reported. A 34-year-old man presented with an acute onset of liver failure characterized by jaundice, ascites, encephalopathy and bleeding diathesis. Chemotherapy was initiated, resulting in a dramatic improvement not only in the patient's level of consciousness, but also in prothrombin time. Unfortunately, he succumbed shortly after to disseminated candidiasis. A post-mortem needle liver sample revealed massive hepatocellular necrosis, but no liver infiltration by the neoplastic disease. We conclude that in Hodgkin's disease, involvement of the liver can be manifested as a syndrome of paraneoplastic fulminant hepatic failure. In such cases, liver transplantation is an absolute contraindication but urgent chemotherapy under antifungal surveillance can be life saving.
Journal of Clinical Rheumatology Practical Reports on Rheumatic Musculoskeletal Diseases, Mar 1, 2010
Subacute thyroiditis is a painful, inflammatory disease of the thyroid gland, probably of viral o... more Subacute thyroiditis is a painful, inflammatory disease of the thyroid gland, probably of viral origin. It is an uncommon but important cause of fever of unknown origin (FUO). We report a case of a 72-year-old man who presented with a 1 month history of fever, headache and weakness, and in whom extensive evaluation only revealed subacute thyroiditis. He was treated with low-dose steroids and became asymptomatic after 2 weeks. In conclusion, when a patient presents with FUO, subacute thyroiditis should be considered as a possible cause even if classic features are absent.
Although non-alcoholic fatty liver disease (NAFLD) is associated with obesity and metabolic syndr... more Although non-alcoholic fatty liver disease (NAFLD) is associated with obesity and metabolic syndrome (MS), it may also be present in lean individuals. We evaluated the characteristics of NAFLD patients, focusing on those with normal body mass index (BMI). One hundred and sixty-two of 185 consecutive NAFLD patients were included (23 were excluded due to missing data). NAFLD diagnosis required elevated ALT and/or GGT, hepatic steatosis on ultrasonography and no other cause of liver disease. Demographic, clinical, somatometric and laboratory characteristics were recorded. BMI <25 kg/m2 was considered normal. Normal BMI was present in 12% of patients. Patients with normal compared to those with increased BMI had numerically but not significantly lower prevalence of diabetes mellitus (6% vs. 15%, p=0.472), arterial hypertension (17% vs. 29%, p=0.276) and MS (20% vs. 41%, p=0.160). Normal BMI NAFLD patients met no criterion of MS more frequently (43% vs. 2%, p<0.0001) and had smaller waist circumference (94±6 vs. 108±10 cm, p<0.001), higher median levels of ALT (92 vs. 62 IU/L, p=0.032) and AST (45 vs. 37 IU/L, p=0.036) and relatively lower fasting glucose levels (98±22 vs. 106±29 mg/dL, p=0.052), but similar levels of HDL, LDL and triglycerides. Approximately 1 of 8 NAFLD patients coming to the tertiary liver center has normal BMI. These patients do not necessarily have insulin resistance associated metabolic disorders, but they have higher levels of ALT/AST than the overweight or obese NAFLD patients.
Hyperbilirubinemia is an adverse reaction of simeprevir (SMV). The majority of these patients wer... more Hyperbilirubinemia is an adverse reaction of simeprevir (SMV). The majority of these patients were taking concurrent ribavirin presenting elevated unconjugated hyperbilirubinemia due to hemolysis. However, cases of hepatic failure with elevated bilirubin level have also been reported in patients with decompensated cirrhosis. We describe a 51-year-old female patient with HbS beta 0-thalassemia and recently diagnosed compensated cirrhosis due to chronic hepatitis C infection. Laboratory evaluation revealed total bilirubin: 2.7 mg/dL and serum HCV-RNA 137.204 IU/mL. HCV was genotyped as 4. A FibroScan revealed 35.3 kPa. She was considered as illegible for pegylated-interferon-free treatment with direct acting antivirals and a course with simeprevir and sofosbuvir (SOF) combination for twelve weeks was planned. Hyperbilirubinemia developed from the beginning with peak values during the 3rd month of treatment. However, no findings of liver decompensation were noticed. Hyperbilirubinemia ...
This report describes a cocaine user who presented with polymorphonuclear pleocytosis in cerebros... more This report describes a cocaine user who presented with polymorphonuclear pleocytosis in cerebrospinal fluid mimicking bacterial meningitis. Thorough investigation of the cerebrospinal fluid did not reveal evidence of bacteria or fungi. Clinical deterioration was observed in spite of empiric treatment with antibiotics. The patient had a favorable outcome after corticosteroid treatment.
Introduction. Bacterial infections are common complications and the cause of death in patients wi... more Introduction. Bacterial infections are common complications and the cause of death in patients with cirrhosis and ascites. There is no standard method for a rapid and low-cost diagnosis, and its prognosis is poor. Objective. The aim of this study was to determine the etiology and frequency of bacterial infections in patients with liver cirrhosis of different etiology, and the influence of bacterial infections on the prognosis in patients with liver cirrhosis and ascites. Methods. Sixty-four patients with cirrhosis and ascites were included in the study. The diagnosis of spontaneous bacterial peritonitis was established based on the diagnostic abdominal paracentesis and the results of biochemical, cytological and microbiologic analysis of ascitic fluid. The diagnosis of urinary infection and pneumonia were made according to the standard criteria. Results. Spontaneous bacterial peritonitis was diagnosed in 23 (35.9%) patients, urinary infections in 16 (25%) and pneumonia in 11 (17.2%)...
Considering the increasing importance of immune checkpoints in tumor immunity we investigated the... more Considering the increasing importance of immune checkpoints in tumor immunity we investigated the clinical relevance of serum T-cell immunoglobulin and mucin domain-3 (TIM-3) in patients with hepatocellular carcinoma (HCC). Serum TIM-3 levels were measured and their association with HCC stage and the detection of serum programmed death ligand-1 (PD-L1) were assessed. In patients submitted to transarterial chemoembolization (TACE), pre- and 1-week post-treatment TIM-3 levels were also evaluated. We studied 53 HCC patients with BCLC stages: 0 (5.7%), A (34%), B (32.1%), C (22.6%), and D (5.7%). The patients with advanced HCC (BCLC C) had significantly higher TIM-3 levels than patients with BCLC A (p = 0.009) and BCLC B (p = 0.019). TIM-3 levels were not associated with HCC etiology (p = 0.183). PD-L1 detection (9/53 patients) correlated with TIM-3 levels (univariate analysis, p = 0.047). In 33 patients who underwent TACE, post-treatment TIM-3 levels (231 pg/mL, 132–452) were significa...
The International journal of artificial organs, 2018
Hepatitis C virus (HCV) infection is still common among dialysis patients, but the natural histor... more Hepatitis C virus (HCV) infection is still common among dialysis patients, but the natural history of HCV in this group is not completely understood. The KDIGO HCV guidelines of 2009 recommend that chronic haemodialysis patients be screened for HCV antibody upon admission to the dialysis clinic and every 6 months thereafter if susceptible to HCV infection. However, previous studies have shown the presence of HCV viraemia in anti-HCV-negative haemodialysis patients as up to 22%. To evaluate the presence of HCV viraemia, using HCV RNA detection, among anti-HCV-negative haemodialysis patients from a tertiary dialysis unit in Athens. We enrolled 41 anti-HCV-negative haemodialysis patients diagnosed with third-generation enzyme immunoassay. HCV viraemia was evaluated using a sensitive (cut-off: 12 IU/mL) reverse transcriptase polymerase chain reaction (COBAS AmpliPrep/TaqMan system) for HCV RNA. None of the 41 anti-HCV-negative haemodialysis patients were shown to be viraemic. Routine HC...
Hereditary bleeding disorders include a group of diseases with abnormalities of coagulation. Prio... more Hereditary bleeding disorders include a group of diseases with abnormalities of coagulation. Prior to 1990, infection with hepatitis C virus (HCV) was mainly transmitted via pooled plasma products as a treatment for hereditary bleeding disorders. Anti-HCV positivity in these patients may be as high as >70% in some areas, while some of them have also been coinfected with human immunodeficiency virus. Since about 20% of HCV-infected patients clear the infection naturally, chronic HCV infection represents a significant health problem in this group of patients. Mortality due to chronic HCV infection is estimated to be >10 times higher in patients with hemophilia than in the general population, and is mainly due to liver cirrhosis and hepatocellular carcinoma. The antiviral treatment of HCV in patients with hereditary bleeding disorders is not different from that of any other infected patients. Nevertheless, many patients with hereditary bleeding disorders have declined (Peg)interf...
Dietary and physical activity (PA) habits have been suggested as important factors for nonalcohol... more Dietary and physical activity (PA) habits have been suggested as important factors for nonalcoholic fatty liver disease (NAFLD). Published data are mainly focused on the effect of either diet or exercise, whereas data on other aspects like sleep remain sparse. The aim of this study was to explore potential associations between dietary intake, PA, and sleeping habits, and the presence of NAFLD. One hundred patients with ultrasound-proven NAFLD and 55 healthy controls matched for age, sex, and body mass index were included. Dietary habits were assessed through a semiquantitative validated food frequency questionnaire. PA level was assessed with a validated questionnaire. Total night sleep hours and duration of midday rest were also recorded. Optimal sleep duration was defined as sleep hours ≥7 and ≤9 hr/day. Patients compared to controls consumed less vegetables and nuts, more sweets, drank less coffee and alcohol (all P < 0.05), and exhibited a lower level of PA (P = 0.006). PA level [odds ratio (OR) per 100 metabolic equivalent of task-min/day = 0.74, 95% confidence interval (CI) 0.61-0.89, P = 0.002] was associated with lower probability of having NAFLD, whereas sweets consumption (OR = 2.13, 95% CI 1.22-3.71, P = 0.008) was associated with increased probability, after adjusting for several confounders, including body weight status. Optimal sleep duration was marginally and inversely associated with NAFLD presence (OR = 0.38, 95% CI 0.14-1.01, P = 0.05). Higher PA level and optimal sleep duration are associated with lower likelihood, whereas sweets consumption is associated with higher likelihood of having NAFLD. These associations are independent of body weight status and energy intake.
Applied Physiology, Nutrition, and Metabolism, 2016
Several lifestyle habits have been described as risk factors for nonalcoholic fatty liver disease... more Several lifestyle habits have been described as risk factors for nonalcoholic fatty liver disease (NAFLD). Given that both healthy and unhealthy habits tend to cluster, the aim of this study was to identify lifestyle patterns and explore their potential associations with clinical characteristics of individuals with NAFLD. One hundred and thirty-six consecutive patients with ultrasound-proven NAFLD were included. Diet and physical activity level were assessed through appropriate questionnaires. Habitual night sleep hours and duration of midday naps were recorded. Optimal sleep duration was defined as sleep hours ≥ 7 and ≤ 9 h/day. Lifestyle patterns were identified using principal component analysis. Eight components were derived explaining 67% of total variation of lifestyle characteristics. Lifestyle pattern 3, namely high consumption of low-fat dairy products, vegetables, fish, and optimal sleep duration was negatively associated with insulin resistance (β = −1.66, P = 0.008) and ...
European Journal of Gastroenterology Hepatology, Sep 1, 1999
Malignancies may uncommonly present as fulminant hepatic failure and, due to the rarity of such a... more Malignancies may uncommonly present as fulminant hepatic failure and, due to the rarity of such an occurrence, they may easily be overlooked as one of its possible causes. An unusual case of Hodgkin's disease presenting as a fulminant hepatic failure is reported. A 34-year-old man presented with an acute onset of liver failure characterized by jaundice, ascites, encephalopathy and bleeding diathesis. Chemotherapy was initiated, resulting in a dramatic improvement not only in the patient's level of consciousness, but also in prothrombin time. Unfortunately, he succumbed shortly after to disseminated candidiasis. A post-mortem needle liver sample revealed massive hepatocellular necrosis, but no liver infiltration by the neoplastic disease. We conclude that in Hodgkin's disease, involvement of the liver can be manifested as a syndrome of paraneoplastic fulminant hepatic failure. In such cases, liver transplantation is an absolute contraindication but urgent chemotherapy under antifungal surveillance can be life saving.
Journal of Clinical Rheumatology Practical Reports on Rheumatic Musculoskeletal Diseases, Mar 1, 2010
Subacute thyroiditis is a painful, inflammatory disease of the thyroid gland, probably of viral o... more Subacute thyroiditis is a painful, inflammatory disease of the thyroid gland, probably of viral origin. It is an uncommon but important cause of fever of unknown origin (FUO). We report a case of a 72-year-old man who presented with a 1 month history of fever, headache and weakness, and in whom extensive evaluation only revealed subacute thyroiditis. He was treated with low-dose steroids and became asymptomatic after 2 weeks. In conclusion, when a patient presents with FUO, subacute thyroiditis should be considered as a possible cause even if classic features are absent.
Although non-alcoholic fatty liver disease (NAFLD) is associated with obesity and metabolic syndr... more Although non-alcoholic fatty liver disease (NAFLD) is associated with obesity and metabolic syndrome (MS), it may also be present in lean individuals. We evaluated the characteristics of NAFLD patients, focusing on those with normal body mass index (BMI). One hundred and sixty-two of 185 consecutive NAFLD patients were included (23 were excluded due to missing data). NAFLD diagnosis required elevated ALT and/or GGT, hepatic steatosis on ultrasonography and no other cause of liver disease. Demographic, clinical, somatometric and laboratory characteristics were recorded. BMI <25 kg/m2 was considered normal. Normal BMI was present in 12% of patients. Patients with normal compared to those with increased BMI had numerically but not significantly lower prevalence of diabetes mellitus (6% vs. 15%, p=0.472), arterial hypertension (17% vs. 29%, p=0.276) and MS (20% vs. 41%, p=0.160). Normal BMI NAFLD patients met no criterion of MS more frequently (43% vs. 2%, p<0.0001) and had smaller waist circumference (94±6 vs. 108±10 cm, p<0.001), higher median levels of ALT (92 vs. 62 IU/L, p=0.032) and AST (45 vs. 37 IU/L, p=0.036) and relatively lower fasting glucose levels (98±22 vs. 106±29 mg/dL, p=0.052), but similar levels of HDL, LDL and triglycerides. Approximately 1 of 8 NAFLD patients coming to the tertiary liver center has normal BMI. These patients do not necessarily have insulin resistance associated metabolic disorders, but they have higher levels of ALT/AST than the overweight or obese NAFLD patients.
Hyperbilirubinemia is an adverse reaction of simeprevir (SMV). The majority of these patients wer... more Hyperbilirubinemia is an adverse reaction of simeprevir (SMV). The majority of these patients were taking concurrent ribavirin presenting elevated unconjugated hyperbilirubinemia due to hemolysis. However, cases of hepatic failure with elevated bilirubin level have also been reported in patients with decompensated cirrhosis. We describe a 51-year-old female patient with HbS beta 0-thalassemia and recently diagnosed compensated cirrhosis due to chronic hepatitis C infection. Laboratory evaluation revealed total bilirubin: 2.7 mg/dL and serum HCV-RNA 137.204 IU/mL. HCV was genotyped as 4. A FibroScan revealed 35.3 kPa. She was considered as illegible for pegylated-interferon-free treatment with direct acting antivirals and a course with simeprevir and sofosbuvir (SOF) combination for twelve weeks was planned. Hyperbilirubinemia developed from the beginning with peak values during the 3rd month of treatment. However, no findings of liver decompensation were noticed. Hyperbilirubinemia ...
This report describes a cocaine user who presented with polymorphonuclear pleocytosis in cerebros... more This report describes a cocaine user who presented with polymorphonuclear pleocytosis in cerebrospinal fluid mimicking bacterial meningitis. Thorough investigation of the cerebrospinal fluid did not reveal evidence of bacteria or fungi. Clinical deterioration was observed in spite of empiric treatment with antibiotics. The patient had a favorable outcome after corticosteroid treatment.
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