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Viazis N, Drygiannakis I, Karmiris K, Theodoropoulou A, Zampeli E, Tzouvala M, Bamias G, Liatsos C, Theocharis G, Vrakas S, Tsironi E, Mathou N, Mantaka A, Christidou A, Koustenis K, Veretanos C, Papathanasiou E, Zacharopoulou E, Tribonias G, Kitsou V, Kartsoli S, Theodoulou A, Michopoulos S, Thomopoulos K, Koutroubakis IE, Mantzaris GJ. The natural history of COVID-19 in vaccinated inflammatory bowel disease patients. Dig Liver Dis 2023; 55:305-309. [PMID: 36658043 PMCID: PMC9843500 DOI: 10.1016/j.dld.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/07/2022] [Accepted: 12/15/2022] [Indexed: 01/18/2023]
Abstract
AIM Assess the characteristics of break through COVID-19 in Inflammatory Bowel Disease (IBD) patients, despite complete vaccination. METHODS Patients who reported a COVID-19 at least 3 weeks after complete vaccination were asked to answer an on-line anonymous questionnaire which included patient and disease characteristics, vaccination history, and the evolution of COVID-19. RESULTS Among 3240 IBD patients who reported complete vaccination between 1st May 2021 and 30thJune 2022, 402 (12.4%) were infected by SARS Cov-2 [223 male, 216 Crohn's disease (CD), 186 Ulcerative Colitis (UC), mean (SD) age 42.3 (14.9) years, mean (SD) IBD duration 10.1 (9.7) years]. Three hundred and sixty-nine patients (91.8%) were infected once and 33 (8.2%) twice. The mean (SD) time between last vaccination and infection was 4.1 (1.6) months. Overall, 351 (87.3%) patients reported mild constitutional and/or respiratory symptoms, 34 (8.4%) were asymptomatic and only 17 patients (4.2%) required hospitalization. Of hospitalized patients, 2 UC patients died of COVID-19 pneumonia. The remaining hospitalized patients did not need high flow oxygen supply or ICU admission. CONCLUSIONS A minority of completely vaccinated IBD patients developed COVID-19 which evolved with mild symptoms and a favorable outcome. These results reinforce the importance of vaccination especially in vulnerable populations.
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Affiliation(s)
- N Viazis
- Gastroenterology Department, Evangelismos-Polykliniki General Hospital, Athens, Greece.
| | - I Drygiannakis
- Gastroenterology Department, University Hospital of Heraklion, Crete, Greece
| | - K Karmiris
- Gastroenterology Department, Venizeleio General Hospital Heraklion, Crete, Greece
| | - A Theodoropoulou
- Gastroenterology Department, Venizeleio General Hospital Heraklion, Crete, Greece
| | - E Zampeli
- Gastroenterology Department, Alexandra General Hospital, Greece
| | - M Tzouvala
- Gastroenterology Department, General Hospital Nikaia Piraeus Agios Panteleimon-General Hospital Dytikis Attikis Agia Varvara, Greece
| | - G Bamias
- Gastroenterology Unit, 3rd Academic Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Greece
| | - C Liatsos
- Gastroenterology Department, 401 General Military Hospital of Athens, Greece
| | - G Theocharis
- Gastroenterology Department, University Hospital of Patras, Greece
| | - S Vrakas
- Gastroenterology Department, Tzaneio Hospital, Piraeus, Greece
| | - E Tsironi
- Gastroenterology Department, Metaxa Hospital, Piraeus, Greece
| | - N Mathou
- Gastroenterology Department, "Konstantopoulio-Patision" General District Hospital, Nea Ionia, Athens, Greece
| | - A Mantaka
- Gastroenterology Department, General Hospital of Chania, Crete, Greece
| | - A Christidou
- Gastroenterology Department, Evangelismos-Polykliniki General Hospital, Athens, Greece
| | - K Koustenis
- Gastroenterology Department, Evangelismos-Polykliniki General Hospital, Athens, Greece
| | - Ch Veretanos
- Gastroenterology Department, Evangelismos-Polykliniki General Hospital, Athens, Greece
| | - E Papathanasiou
- Gastroenterology Department, Alexandra General Hospital, Greece
| | - E Zacharopoulou
- Gastroenterology Department, General Hospital Nikaia Piraeus Agios Panteleimon-General Hospital Dytikis Attikis Agia Varvara, Greece
| | - G Tribonias
- Gastroenterology Department, General Hospital Nikaia Piraeus Agios Panteleimon-General Hospital Dytikis Attikis Agia Varvara, Greece
| | - V Kitsou
- Gastroenterology Unit, 3rd Academic Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Greece
| | - S Kartsoli
- Gastroenterology Department, Tzaneio Hospital, Piraeus, Greece
| | - A Theodoulou
- Gastroenterology Department, Metaxa Hospital, Piraeus, Greece
| | - S Michopoulos
- Gastroenterology Department, Alexandra General Hospital, Greece
| | - K Thomopoulos
- Gastroenterology Department, University Hospital of Patras, Greece
| | - I E Koutroubakis
- Gastroenterology Department, University Hospital of Heraklion, Crete, Greece
| | - G J Mantzaris
- Gastroenterology Department, Evangelismos-Polykliniki General Hospital, Athens, Greece
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Katsiadas N, Korkonikitas P, Theodoropoulou A, Tsipra E, Alousi M, Konstantinidis S, Fagkrezos D, Maniatis P, Patsilinakos S. Ivabradine Pretreatment In Patients Scheduled To Undergo Coronary Computed Tomography Angiography. J Cardiovasc Comput Tomogr 2023. [DOI: 10.1016/j.jcct.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Ellul P, Schembri J, Baldacchino VA, Molnar T, Resal T, Allocca MA, Furfaro F, Dal Buono, Theodoropoulou A, Fragaki M, Tsoukali E, Mantzaris GJ, Phillips F, Radford S, Moran G, Gonzalez HA, Sebastian S, Fousekis F, Christodoulou D, Snir Y, Lerner Z, Yanai H, Michalopoulos G, Tua J, Camilleri L, Papamichael K, Karmiris K, Katsanos K. Post-inflammatory polyps burden as a prognostic marker of disease-outcome in patients with inflammatory bowel disease. J Crohns Colitis 2022; 17:489-496. [PMID: 36322687 DOI: 10.1093/ecco-jcc/jjac169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION AND AIM Post-inflammatory polyps (PIPs) are considered as indicators of previous episodes of severe inflammation and mucosal ulceration. Inflammatory bowel disease (IBD), namely Crohn's disease (CD) and ulcerative colitis (UC), exhibit a perpetuating, relapsing, and remitting pattern and PIPs is a frequent sequela of chronicity. The aim of this study was to determine whether a high PIPs burden is associated with a more severe disease course in patients with IBD. METHODS This was a multinational, multicentre, retrospective study. IBD patients previously diagnosed with PIPs were retrieved from the endoscopic database of each centre. PIPs burden was evaluated and associated with demographic and clinical data as well as factors indicating a more unfavorable disease course. RESULTS A total of 504 IBD patients with PIPs were recruited (male: 61.9%). The mean age at IBD diagnosis was 36.9 (±16.8) years. Most patients (74.8%) were diagnosed with UC. A high PIPs burden was present in 53.4% of patients. On multivariable Cox regression analysis, high PIPs burden was independently associated with treatment escalation (HR 1.35, 95% CI 1.04-1.75; P=0.024), hospitalization (HR 1.90; 95% CI 1.24 - 2.90; P=0.003), need for surgery (HR 2.28; 95% CI 1.17-4.44, P=0.02) and younger age at diagnosis (HR 0.99, 95% CI 0.98-0,99; p=0.003). CONCLUSION PIPs burden was associated with a more severe outcome. Future prospective studies should focus on the characterisation of PIPs burden as to further risk stratify this patient cohort.
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Affiliation(s)
- P Ellul
- Division of Gastroenterology, Mater Dei hospital, Malta
| | - J Schembri
- Division of Gastroenterology, Mater Dei hospital, Malta
| | | | - T Molnar
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Hungary
| | - T Resal
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Hungary
| | - M A Allocca
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - F Furfaro
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Dal Buono
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - A Theodoropoulou
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | - M Fragaki
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | - E Tsoukali
- Department of Gastroenterology, GHA "Evangelismos-Polykliniki', Athens, Greece
| | - G J Mantzaris
- Department of Gastroenterology, GHA "Evangelismos-Polykliniki', Athens, Greece
| | - F Phillips
- Nottingham University Hospitals NHS Trust, Nottingham, England
| | - S Radford
- Nottingham University Hospitals NHS Trust, Nottingham, England
| | - G Moran
- Nottingham University Hospitals NHS Trust, Nottingham, England
| | | | - S Sebastian
- Hull University Teaching Hospitals, Hull, UK
| | - F Fousekis
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - D Christodoulou
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Y Snir
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Z Lerner
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - H Yanai
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - G Michalopoulos
- Gastroenterology department "Tzaneion" General Hospital of Piraeus, Greece
| | - J Tua
- Division of Gastroenterology, Mater Dei hospital, Malta
| | - L Camilleri
- Faculty of Science, University of Malta, Malta
| | - K Papamichael
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - K Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | - K Katsanos
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Giourou E, Theodoropoulou A, Yfantis S, Prodromaki O, Georgila E, Gourzis P. Affective disorder associated with post-traumatic epilepsy, misdiagnosis and under treatment: A case report. Eur Psychiatry 2022. [PMCID: PMC9567767 DOI: 10.1192/j.eurpsy.2022.1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction A history of traumatic brain injury (TBI) is often associated with acquired epilepsy, which is associated with psychiatric co-morbidity, that when undetected might lead to misdiagnosis and mistreatment. Objectives The objective is to present the case of a 47-years-old male with a history of TBI and undetected acquired epilepsy, with a subsequent treatment resident mood disorder that was lead to a full clinical remission once epileptic activity was controlled using anti-seizure monotherapy. Methods After compulsory admittion to our inpatient psychiatric unit because of suicidal ideation and persistent aggressive behavior with volatile mood swings, the patient was fully evaluated and his psychiatric and medical histories were recorded. A brain CT scan and EEG were performed. Laboratory tests excluded other medical co-morbidity. Results The patient had a previous history of TBI and subsequent multiple episodes of mood disorders that failed to reach full remission even if treated with antidepressives and antipsychotics for adequate time and dosage according to current quidelines. EEG was positive for epileptiform activity with sporadic slow theta waves and right frontotemporal epileptic-like features while the patient was free of clinical seizures. Carbamazepine was initiated and titrated up to 1200mg daily leading to the full remission of the initial clinical symptoms along with the EEG findings’ improvement. The patient remained stable with his functionality at its utmost recovery during the two-years follow-up evaluations. Conclusions TBI induced epilepsy might be under-diagnosed in the absence of clinical seizures leading to the mistreatment of the associated psychiatric disorders that could be the only clinical presentation of the underlying pathology. Disclosure No significant relationships.
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Giourou E, Theodoropoulou A, Batzikosta P, Prodromaki O, Georgila E, Gourzis P. A case report of eosinophilia associated with risperidone withdrawl in a patient with schizophrenia. Eur Psychiatry 2022. [PMCID: PMC9567693 DOI: 10.1192/j.eurpsy.2022.1837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Risperidone, a second generation antipsychotic, shows high affinity with serotoninergic and dopaminergic D2 receptors, but also adrenergic and H1 histaminergic receptors. Previous studies have shown an increase in eosinophile count associated with the second-generation antipsychotics through the histaminergic path. Objectives The presentation of a case in which eosinophilia was associated with risperidone withdrawl which has not been described so far. Methods A 46-year-old woman with schizophrenia diagnosed at the age of 22 was admitted in our inpatient psychiatric clinic with psychotic symptoms relapse after she voluntarily discontinued risperidone. The patient was fully evaluated with full laboratory tests, a brain CT scan, EEG and her medical and psychiatric histories were recorded. Results Risperidone was reinitiated but due to the persistence of symptoms it was switched to clozapine which lead to full remission. It was observed though, that while gradually decreasing risperidone dosage (Figure 1.), eosinophile count was raising and it was normalized after complete discontinuation. Eosinophilia was also present in other instances that the patient discontinued taking risperidone according to her personal history. Other causes of eosinophilia (allergic, inflammatory) were fully excluded. ![]()
Conclusions Risperidone discontinuation could lead to an elevated eosinophile count. There is limited research in this topic and it is yet to be clarified whether the elevation is due to stopping one antipsychotic or switching between two different antipsychotics. It is important to run laboratory tests regularly with every treatment modification. Disclosure No significant relationships.
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Andreadelis I, Kiriakidi S, Lamprakis C, Theodoropoulou A, Doerr S, Chatzigoulas A, Manchester J, Velez-Vega C, Duca JS, Cournia Z. Membrane Composition and Raf[CRD]-Membrane Attachment Are Driving Forces for K-Ras4B Dimer Stability. J Phys Chem B 2022; 126:1504-1519. [PMID: 35142524 DOI: 10.1021/acs.jpcb.1c01184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Ras proteins are membrane-anchored GTPases that regulate key cellular signaling networks. It has been recently shown that different anionic lipid types can affect the properties of Ras in terms of dimerization/clustering on the cell membrane. To understand the effects of anionic lipids on key spatiotemporal properties of dimeric K-Ras4B, we perform all-atom molecular dynamics simulations of the dimer K-Ras4B in the presence and absence of Raf[RBD/CRD] effectors on two model anionic lipid membranes: one containing 78% mol DOPC, 20% mol DOPS, and 2% mol PIP2 and another one with enhanced concentration of anionic lipids containing 50% mol DOPC, 40% mol DOPS, and 10% mol PIP2. Analysis of our results unveils the orientational space of dimeric K-Ras4B and shows that the stability of the dimer is enhanced on the membrane containing a high concentration of anionic lipids in the absence of Raf effectors. This enhanced stability is also observed in the presence of Raf[RBD/CRD] effectors although it is not influenced by the concentration of anionic lipids in the membrane, but rather on the ability of Raf[CRD] to anchor to the membrane. We generate dominant K-Ras4B conformations by Markov state modeling and yield the population of states according to the K-Ras4B orientation on the membrane. For the membrane containing anionic lipids, we observe correlations between the diffusion of K-Ras4B and PIP2 and anchoring of anionic lipids to the Raf[CRD] domain. We conclude that the presence of effectors with the Raf[CRD] domain anchoring on the membrane as well as the membrane composition both influence the conformational stability of the K-Ras4B dimer, enabling the preservation of crucial interface interactions.
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Affiliation(s)
- Ioannis Andreadelis
- Biomedical Research Foundation, Academy of Athens, 4 Soranou Ephessiou, 11527 Athens, Greece
| | - Sofia Kiriakidi
- Biomedical Research Foundation, Academy of Athens, 4 Soranou Ephessiou, 11527 Athens, Greece
| | - Christos Lamprakis
- Biomedical Research Foundation, Academy of Athens, 4 Soranou Ephessiou, 11527 Athens, Greece
| | | | - Stefan Doerr
- Biomedical Research Foundation, Academy of Athens, 4 Soranou Ephessiou, 11527 Athens, Greece
| | - Alexios Chatzigoulas
- Biomedical Research Foundation, Academy of Athens, 4 Soranou Ephessiou, 11527 Athens, Greece
| | - John Manchester
- Computer-Aided Drug Discovery, Global Discovery Chemistry, Novartis Institutes for BioMedical Research, 100 Technology Square, Cambridge, Massachusetts 02139, United States
| | - Camilo Velez-Vega
- Computer-Aided Drug Discovery, Global Discovery Chemistry, Novartis Institutes for BioMedical Research, 100 Technology Square, Cambridge, Massachusetts 02139, United States
| | - José S Duca
- Computer-Aided Drug Discovery, Global Discovery Chemistry, Novartis Institutes for BioMedical Research, 100 Technology Square, Cambridge, Massachusetts 02139, United States
| | - Zoe Cournia
- Biomedical Research Foundation, Academy of Athens, 4 Soranou Ephessiou, 11527 Athens, Greece
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Markantes GK, Karakioulaki M, Papanikolopoulou S, Theodoropoulou A, Markou KB, Vagenakis AG, Spyridonidis T, Goulis DG, Michalaki MA. Improving the prediction of persistent and recurrent differentiated thyroid cancer using the American Thyroid Association 2015 risk stratification system. Hormones (Athens) 2021; 20:761-768. [PMID: 34383288 DOI: 10.1007/s42000-021-00313-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/22/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The 2015 American Thyroid Association risk stratification system (ATA RSS) is used in patients with differentiated thyroid carcinoma (DTC) to assess their risk of persistent/recurrent disease. Our aims were to validate the 2015 ATA RSS in a registry of DTC patients and to examine whether the addition of factors not included in it, such as pre-radioactive iodine therapy stimulated thyroglobulin (pre-RAI sTg), gender, and age could increase its predictive ability. METHODS We studied 403 patients with DTC, treated at a tertiary center from 1990 to 2018 and subjected to total thyroidectomy. All patients had received RAI therapy, except those with low-risk papillary microcarcinoma. RESULTS Of our patients, 81.9% were women and 91.1% had papillary thyroid carcinoma. After a median follow-up of 5.0 years, 53 cases of persistent and 21 cases of recurrent disease were recorded. The proportion of variance explained (PVE) regarding the outcome (presence or absence of recurrent/persistent disease) using the 2015 ATA RSS alone was 18.3% (persistence) and 16.9% (recurrence), increasing to 74.4% and 52.0%, respectively, when pre-RAI sTg was added to the logistic regression model. Gender and age were not associated with the disease outcome. In ROC analysis, pre-RAI sTg had a high predictive value for persistent (AUC 0.983, 95% CI 0.962-1.000) and recurrent disease (AUC 0.856, 95% CI 0.715-0.997). The optimal cut-offs and sensitivity, specificity, and positive and negative predictive value for pre-RAI sTg were the following: for persistence 12.75 ng/ml, 100%, 90.5%, 64%, and 100%, and for recurrence 8.05 ng/ml, 77.8%, 85.5%, 36.8%, and 97%. CONCLUSIONS The 2015 ATA RSS displayed moderate performance in predicting recurrent/persistent disease in patients with DTC, which improved with the inclusion of pre-RAI sTg values; pre-RAI sTg was an independent predictor of the disease outcome, with high negative prognostic value.
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Affiliation(s)
- Georgios K Markantes
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece
| | - Meropi Karakioulaki
- 1st Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavroula Papanikolopoulou
- 1st Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Theodoropoulou
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece
| | - Kostas B Markou
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece
| | - Apostolos G Vagenakis
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece
| | - Trifon Spyridonidis
- Department of Nuclear Medicine, University Hospital of Patras, Patras, Greece
| | - Dimitrios G Goulis
- 1st Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marina A Michalaki
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece.
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Oikonomou E, Aznaouridis K, Barbetseas J, Charalambous G, Gastouniotis I, Fotopoulos V, Gkini KP, Katsivas A, Koudounis G, Koudounis P, Koutouzis M, Lamprinos D, Lazaris E, Lazaris E, Lazaros G, Marinos G, Platogiannis N, Platogiannis D, Siasos G, Terentes-Printzios D, Theodoropoulou A, Theofilis P, Toutouzas K, Tsalamandris S, Tsiafoutis I, Vavouranakis M, Vogiatzi G, Zografos T, Baka E, Tousoulis D, Vlachopoulos C. Hospital attendance and admission trends for cardiac diseases during the COVID-19 outbreak and lockdown in Greece. Public Health 2020; 187:115-119. [PMID: 32949881 PMCID: PMC7434308 DOI: 10.1016/j.puhe.2020.08.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/29/2020] [Accepted: 08/12/2020] [Indexed: 11/25/2022]
Abstract
Objectives The coronavirus disease 2019 (COVID-19) outbreak, along with implementation of lockdown and strict public movement restrictions, in Greece has affected hospital visits and admissions. We aimed to investigate trends of cardiac disease admissions during the outbreak of the pandemic and possible associations with the applied restrictive measures. Study design This is a retrospective observational study. Methods Data for 4970 patients admitted via the cardiology emergency department (ED) across 3 large-volume urban hospitals in Athens and 2 regional/rural hospitals from February 3, 2020, up to April 12 were recorded. Data from the equivalent (for the COVID-19 outbreak) time period of 2019 and from the postlockdown time period were also collected. Results A falling trend of cardiology ED visits and hospital admissions was observed starting from the week when the restrictive measures due to COVID-19 were implemented. Compared with the pre–COVID-19 outbreak time period, acute coronary syndrome (ACS) [145 (29/week) vs. 60 (12/week), −59%, P < 0.001], ST elevation myocardial infarction [46 (9.2/week) vs. 21 (4.2/week), −54%, P = 0.002], and non-ST elevation ACS [99 cases (19.8/week) vs. 39 (7.8/week), −60% P < 0.001] were reduced at the COVID-19 outbreak time period. Reductions were also noted for heart failure worsening and arrhythmias. The ED visits in the postlockdown period were significantly higher than in the COVID-19 outbreak time period (1511 vs 660; P < 0.05). Conclusion Our data show significant drops in cardiology visits and admissions during the COVID-19 outbreak time period. Whether this results from restrictive measures or depicts a true reduction of cardiac disease cases warrants further investigation. The coronavirus disease 2019 (COVID-19) outbreak has led to an unprecedented health system overload. The restrictive measures in Greece resulted in a low number of COVID-19 cases. Hospital visits and cardiovascular events have diminished after implementation of restrictive measures. Acute coronary syndromes reduced by approximately 55%, despite limited incidence of COVID-19. The multifactorial etiology of this finding should be thoroughly investigated.
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Affiliation(s)
- E Oikonomou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; Emergency Department, Hippokration' General Hospital, Athens, Greece.
| | - K Aznaouridis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - J Barbetseas
- Department of Cardiology, Laiko General Hospital, Athens, Greece
| | - G Charalambous
- Emergency Department, Hippokration' General Hospital, Athens, Greece
| | - I Gastouniotis
- Emergency Department, Hippokration' General Hospital, Athens, Greece
| | - V Fotopoulos
- Emergency Department, Laiko General Hospital, Athens, Greece
| | - K-P Gkini
- Athens Red Cross Hospital, 2nd Department of Cardiology, Athens, Greece
| | - A Katsivas
- Athens Red Cross Hospital, 1st Department of Cardiology, Athens, Greece
| | - G Koudounis
- General Hospital of Kalamata, Department of Cardiology, Kalamata, Greece
| | - P Koudounis
- General Hospital of Kalamata, Department of Cardiology, Kalamata, Greece
| | - M Koutouzis
- Athens Red Cross Hospital, 2nd Department of Cardiology, Athens, Greece
| | - D Lamprinos
- Emergency Department, Laiko General Hospital, Athens, Greece
| | - E Lazaris
- Athens Red Cross Hospital, 2nd Department of Cardiology, Athens, Greece
| | - E Lazaris
- Athens Red Cross Hospital, 2nd Department of Cardiology, Athens, Greece
| | - G Lazaros
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - G Marinos
- Emergency Department, Laiko General Hospital, Athens, Greece
| | - N Platogiannis
- General Hospital of Trikala, Department of Cardiology, Trikala, Greece
| | - D Platogiannis
- General Hospital of Trikala, Department of Cardiology, Trikala, Greece
| | - G Siasos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - D Terentes-Printzios
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - A Theodoropoulou
- Emergency Department, Hippokration' General Hospital, Athens, Greece
| | - P Theofilis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - K Toutouzas
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - S Tsalamandris
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - I Tsiafoutis
- Athens Red Cross Hospital, 1st Department of Cardiology, Athens, Greece
| | - M Vavouranakis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - G Vogiatzi
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; Emergency Department, Laiko General Hospital, Athens, Greece
| | - T Zografos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; Athens Red Cross Hospital, 1st Department of Cardiology, Athens, Greece
| | - E Baka
- Emergency Department, Hippokration' General Hospital, Athens, Greece
| | - D Tousoulis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - C Vlachopoulos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Kanakis GA, Chrisoulidou A, Bargiota A, Efstathiadou ZA, Papanastasiou L, Theodoropoulou A, Tigas SK, Vassiliadi DA, Tsagarakis S, Alevizaki M. The ongoing challenge of discrepant growth hormone and insulin-like growth factor I results in the evaluation of treated acromegalic patients: a systematic review and meta-analysis. Clin Endocrinol (Oxf) 2016; 85:681-688. [PMID: 27292418 DOI: 10.1111/cen.13129] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/05/2016] [Accepted: 06/09/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Growth hormone (GH) and insulin-like growth factor I (IGF-I) are the principal biomarkers used to assess disease activity in acromegaly, and any discrepancy between them renders interpretation of results inconclusive. Purpose of this study was to assess the frequency of this discrepancy and identify parameters that might affect its occurrence. DESIGN A systematic review of MEDLINE and Scopus was performed (1987-2013) followed by a meta-analysis to address the frequency of discrepant results between GH and IGF-I levels. Meta-regression and subgroup analyses were performed assessing the effects of the year of publication, the different types of GH testing and GH assays used, as well as the impact of treatment with somatostatin analogues (SSAs) on the occurrence of this discrepancy. RESULTS The analysis retrieved 39 eligible studies totalling 7071 patients. The pooled discordance rate between GH and IGF-I was 25·7% (95% CI: 22·3-29·4), and the predominant format was that of elevated IGF-I with normal GH levels (15·3%, 95% CI: 12·5-18·7). No significant correlation between the discordance rate and the year of publication was shown; whereas, the use of ultrasensitive GH assays resulted in higher discordance rates (30·7%, 95% CI: 25·9-35·9 vs 19·8%, 95% CI: 14·1-27·2, P = 0·04) as did treatment with SSAs (32·5%, 95% CI: 27·8-37·4) vs (21·6%, 95% CI: 17·8-25·6, P = 0·001). CONCLUSIONS Discrepancy between GH and IGF-I results is encountered in a quarter of treated patients with acromegaly, especially when using ultrasensitive GH assays or in patients receiving SSAs, a fact that the clinician should take into consideration when making clinical decisions.
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Affiliation(s)
- G A Kanakis
- Department of Endocrinology, Athens Naval & VA Hospital, Athens, Greece.
| | - A Chrisoulidou
- Department of Endocrinology, Theagenio Cancer Hospital, Thessaloniki, Greece
| | - A Bargiota
- Department of Endocrinology and Metabolic Diseases, University of Thessaly, Larissa, Greece
| | - Z A Efstathiadou
- Department of Endocrinology, 'Hippokration' General Hospital of Thessaloniki, Thessaloniki, Greece
| | - L Papanastasiou
- Department of Endocrinology and Diabetes Center, Athens General Hospital 'G. Gennimatas', Athens, Greece
| | - A Theodoropoulou
- Division of Endocrinology, Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - S K Tigas
- Department of Endocrinology, University of Ioannina, Ioannina, Greece
| | - D A Vassiliadi
- Endocrine Unit, 2nd Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - S Tsagarakis
- Department of Endocrinology, Evangelismos Hospital, Athens, Greece
| | - M Alevizaki
- Endocrine Unit, Department of Medical Therapeutics, Medical School, University of Athens, Athens, Greece
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10
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Michalaki M, Bountouris P, Roupas ND, Theodoropoulou A, Agalianou N, Alexandrides T, Markou K. Low-risk papillary thyroid carcinoma patients who underwent near-total thyroidectomy without prophylactic central compartment lymph node dissection and were ablated with low-dose 50mCi RAI had excellent 10-year prognosis. Hormones (Athens) 2016; 15:511-517. [PMID: 28222412 DOI: 10.14310/horm.2002.1694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/06/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND The current trend in the management of low risk differentiated thyroid carcinoma is to follow less aggressive strategies. OBJECTIVE To assess the long-term morbidity and mortality outcomes of low-risk papillary thyroid carcinoma (PTC) patients undergoing minimal intervention. DESIGN We retrospectively analyzed 137 patients with low-risk PTC (stage I: n=77; stage II: n=60). Of these patients, 107 (Group 1) had macro-PTC and underwent near-total thyroidectomy and received postoperatively 50mCi RAI. The remaining 30 patients (Group 2) had micro-PTC (<1cm) and were treated only by means of near-total thyroidectomy. RESULTS The median follow-up for Group 1 patients was 10 years (range: 3-30). At 1-year evaluation, 8 patients of Group 1 had indeterminate or incomplete biochemical response, of whom 4 had also incomplete structural response to initial therapy. Only 1 of 4 patients with structural incomplete response underwent cervical lymph node dissection and then received an additional dose of 100mCi RAI. The remaining 7 patients received only an additional dose of 100mCi RAI. These patients have been continuously followed till the present time with no recurrences or deaths (median follow-up: 17.5 years; 3-30 years). At 15 years, 2 patients of Group 1 experienced biochemical recurrence and they received 100mCi RAI. Three patients of Group 2 experienced recurrence, with 2 receiving 50mCi RAI and 1 undergoing cervical lymph node dissection with 50mCi RAI. CONCLUSIONS Patients with low-risk macro-PTC treated by means of near-total thyroidectomy without PCCLND and receiving postoperatively a low dose of 50mCi RAI have excellent long-term prognosis.
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Affiliation(s)
- Marina Michalaki
- Endocrine Division, Internal Medicine Department, University of Patras, Medical School, Rion, Patras, Greece.
- University Hospital of Patras, Rion, Patras, 26500, Greece.
| | - Panagiotis Bountouris
- Endocrine Division, Internal Medicine Department, University of Patras, Medical School, Rion, Patras, Greece
| | - Nikolaos D Roupas
- Endocrine Division, Internal Medicine Department, University of Patras, Medical School, Rion, Patras, Greece
| | - Anastasia Theodoropoulou
- Endocrine Division, Internal Medicine Department, University of Patras, Medical School, Rion, Patras, Greece
| | - Niki Agalianou
- Endocrine Division, Internal Medicine Department, University of Patras, Medical School, Rion, Patras, Greece
| | - Theodoras Alexandrides
- Endocrine Division, Internal Medicine Department, University of Patras, Medical School, Rion, Patras, Greece
| | - Kostas Markou
- Endocrine Division, Internal Medicine Department, University of Patras, Medical School, Rion, Patras, Greece
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11
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Markantes GK, Theodoropoulou A, Armeni AK, Vasileiou V, Stratakis CA, Georgopoulos NA. Cyclopes and Giants: From Homer's Odyssey to contemporary genetic diagnosis. Hormones (Athens) 2016; 15:459-463. [PMID: 27394709 DOI: 10.14310/horm.2002.1687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 04/04/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Georgios K Markantes
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Patras Medical School, Rio, Patras, 26500, Greece
| | - Anastasia Theodoropoulou
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Patras Medical School, Rio, Patras, 26500, Greece
| | - Anastasia K Armeni
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Patras Medical School, Rio, Patras, 26500, Greece
| | - Vasiliki Vasileiou
- 1st Department of Endocrinology, Diabetes Centre, "Alexandra" Hospital, Athens, Greece
| | - Constantine A Stratakis
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, USA
| | - Neoklis A Georgopoulos
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Patras Medical School, Rio, Patras, 26500, Greece.
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12
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Efstathiadou ZA, Bargiota A, Chrisoulidou A, Kanakis G, Papanastasiou L, Theodoropoulou A, Tigas SK, Vassiliadi DA, Alevizaki M, Tsagarakis S. Impact of gsp mutations in somatotroph pituitary adenomas on growth hormone response to somatostatin analogs: a meta-analysis. Pituitary 2015; 18:861-7. [PMID: 26115707 DOI: 10.1007/s11102-015-0662-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Somatic mutations in the GNAS1 gene, which encodes the alpha-subunit of G stimulatory proteins (gsp), are frequently detected in somatotroph pituitary tumors and have been associated to specific clinical and histopathological characteristics. However, the question whether the presence of a somatic gsp mutation affects the response to somatostatin analog treatment remains unresolved. DESIGN Following a literature search, we performed a meta-analysis, including 8 eligible studies, in order to estimate the effect of gsp mutation on the percent reduction of growth hormone (GH) levels during an acute octreotide suppression test (OST). A total of 310 patients with acromegaly [126 gsp (+) and 184 gsp (-)] were included in the analysis. RESULTS The presence of the gsp mutation was related with a greater reduction in GH levels on OST [Weighted Mean Difference (WMD): 9.08 % (95 % CI, 2.73, 15.42); p = 0.005; random effects model]. There was significant heterogeneity for this effect estimate (I(2) = 58 %, p value for heterogeneity = 0.02). A sensitivity analysis after exclusion of a study with different methodology of OST provided similar estimates [WMD: 6.93 % (95 % CI, 1.40, 12.46); p = 0.01], albeit with no significant heterogeneity (I(2) = 35 %, p value for heterogeneity = 0.16). CONCLUSIONS The present meta-analysis suggests a role for gsp mutation as a prognostic factor of treatment response to somatostatin analogs.
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Affiliation(s)
- Z A Efstathiadou
- Department of Endocrinology, "Hippokration" General Hospital of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloníki, Greece.
| | - A Bargiota
- Department of Endocrinology, University of Thessaly, Larissa, Greece
| | - A Chrisoulidou
- Department of Endocrinology-Endocrine Oncology, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - G Kanakis
- Endocrine Unit, Athens Naval and VA General Hospital, Athens, Greece
| | - L Papanastasiou
- Department of Endocrinology and Diabetes Center, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - A Theodoropoulou
- Division of Endocrinology, Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - S K Tigas
- Department of Endocrinology, University of Ioannina, Ioannina, Greece
| | - D A Vassiliadi
- Endocrine Unit, Second Department of Internal Medicine, University of Athens, Medical School, "Attikon" Hospital, Athens, Greece
| | - M Alevizaki
- Endocrine Unit, Department of Medical Therapeutics, Athens University School of Medicine, Athens, Greece
| | - S Tsagarakis
- Department of Endocrinology, Evangelismos Hospital, Athens, Greece
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13
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Theodoropoulou A, Vardas E, Voudoukis E, Tavernaraki A, Tribonias G, Konstantinidis K, Paspatis GA. SpyGlass Direct Visualization System facilitated management of iatrogenic biliary stricture: a novel approach in difficult cannulation. Endoscopy 2013; 44 Suppl 2 UCTN:E433-4. [PMID: 23258490 DOI: 10.1055/s-0032-1325857] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- A Theodoropoulou
- Department of Gastroentrology, Benizelion General Hospital, Heraklion, Crete, Greece
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14
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Roupas ND, Mamali I, Armeni AK, Markantes GK, Theodoropoulou A, Alexandrides TK, Leglise M, Markou KB, Georgopoulos NA. The influence of intensive physical training on salivary adipokine levels in Elite Rhythmic Gymnasts. Horm Metab Res 2012; 44:980-6. [PMID: 22864904 DOI: 10.1055/s-0032-1321816] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Exercise challenges homeostasis and establishes a new dynamic equilibrium. Elite Rhythmic Gymnasts (RG's) begin exercise at an early age, undergo physical and psychological stress, and adopt negative energy balance to retain a lean physique. The aim of the present study was to evaluate the effect of negative energy balance, acute and chronic exercise on salivary adiponectin, resistin and visfatin levels and their interaction with salivary cortisol, and insulin levels in elite RG's. This study is unique in character, as all variables were assessed on the field of competition. The study included 51 elite RG's participating in "Kalamata 2010 World Cup" in Kalamata, Greece on April 2010. Twenty-seven healthy age-matched girls were used as controls. Anthropometric values were assessed; baseline and post exercise salivary cortisol, insulin, adiponectin, resistin, and visfatin levels were measured. Comparisons regarding hormonal features between RG's and controls were adjusted for BMI and body fat percentage. Salivary adiponectin levels were higher (p<0.05) and visfatin lower (p=0.094) in RG's compared with controls, while no significant changes were observed regarding salivary cortisol, insulin, and resistin levels. In elite RG's acute intensive anaerobic exercise led to increased salivary insulin levels (p<0.001), reduced salivary adiponectin (p<0.001) and visfatin levels (p<0.05), and no changes in salivary resistin levels. Moreover, diurnal variation of salivary cortisol was lost. In elite RG's salivary adiponectin is upregulated and salivary visfatin is downregulated after chronic intensive exercise and negative energy balance, while both salivary adiponectin and visfatin levels are suppressed after short term intensive anaerobic exercise.
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Affiliation(s)
- N D Roupas
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, Patras, Greece
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15
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Theodoropoulou A, Metallinos IC, Psyrogiannis A, Vagenakis GA, Kyriazopoulou V. Ghrelin and leptin secretion in patients with moderate Alzheimer's disease. J Nutr Health Aging 2012; 16:472-7. [PMID: 22555794 DOI: 10.1007/s12603-012-0058-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Weight loss is a characteristic finding of patients with Alzheimer's disease (AD). It seems that precedes cognitive impairment by some years, but the underlying causes are not fully understood. Ghrelin and leptin are involved in energy homeostasis, and may be implicated in weight losing observed in these patients. OBJECTIVE To examine the potential relationship between ghrelin and leptin levels and weight loss in patients with AD. DESIGN The study included 27 patients (10 men and 17 women) with AD of moderate severity, and 23 controls (10 males and 13 females), matched for age and BMI. Body fat and lean mass content were assessed using a portable apparatus. Cognitive function was assessed with the Mini-Mental State Examination. Basal serum samples for the measurement of leptin, ghrelin, insulin and glucose were obtained, and serum ghrelin, insulin and glucose were measured after a 75-gr glucose load in both groups. RESULTS Patients with Alzheimer Disease (AD) have lower lean mass content compared to controls. Basal ghrelin and leptin is similar in patients with AD and controls. The area-under-the-curve for ghrelin (AUC) is lower in male patients with AD compared to control males, while no difference was observed between females AD and controls. CONCLUSION Male patients with AD, in contrast with female patients, fail to maintain a normal energy homeostasis even in the early stages of the disease, as shown by the decreased lean mass content in males AD compared to controls. Disruption of the normal compensatory modulation of ghrelin secretion might contribute to the metabolic changes observed in male patients with AD.
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Affiliation(s)
- A Theodoropoulou
- Department of Internal Medicine, Division of Endocrinology, University Hospital of Patras, Rio, Greece.
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16
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Markaki E, Ellul J, Kefalopoulou Z, Trachani E, Theodoropoulou A, Kyriazopoulou V, Constantoyannis C. The role of ghrelin, neuropeptide Y and leptin peptides in weight gain after deep brain stimulation for Parkinson's disease. Stereotact Funct Neurosurg 2012; 90:104-12. [PMID: 22398667 DOI: 10.1159/000335045] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 11/14/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND The exact mechanism of weight gain (WG) after deep brain stimulation (DBS) of the subthalamic nucleus (STN) in patients with idiopathic Parkinson's disease remains unknown. OBJECTIVES To investigate a possible involvement of ghrelin, neuropeptide Y (NPY) and leptin in WG after DBS. METHODS Twenty-three Parkinson patients were submitted for body composition measurements and blood sampling 3 days before, and 3 and 6 months after STN DBS. Peripheral concentrations of ghrelin, NPY, and leptin were determined, as well as the L-dopa equivalent daily dose. Patients were clinically evaluated using the Unified Parkinson's Disease Rating Scale. RESULTS Three months after surgery, a significant WG was observed (3.09 ± 5.00 kg; p = 0.007) with no further increase at 6 months. Three months postoperatively, NPY circulating levels increased significantly (p = 0.05), while the increase of ghrelin levels reached statistical significance at 6 months (p = 0.001). WG was significantly associated with changes of ghrelin and leptin levels at 3 and 6 months, respectively. CONCLUSIONS STN DBS seems to temporarily dysregulate the hypothalamic secretion of NPY and ghrelin. The variation of weight may be attributed to an increased production of ghrelin and leptin. A possible neuroprotective role of DBS, exerted through the increase of ghrelin levels, should be further studied.
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Affiliation(s)
- Elli Markaki
- Functional Neurosurgery Unit, Department of Neurosurgery, University of Patras, Rion, Greece
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17
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Georgopoulos NA, Theodoropoulou A, Roupas NA, Rottstein L, Tsekouras A, Mylonas P, Vagenakis GA, Koukkou E, Armeni AK, Sakellaropoulos G, Leglise M, Vagenakis AG, Markou KB. Growth velocity and final height in elite female rhythmic and artistic gymnasts. Hormones (Athens) 2012; 11:61-9. [PMID: 22450345 DOI: 10.1007/bf03401538] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of this study was to determine the impact of intensive training on adult final height in elite female rhythmic and artistic gymnasts. METHODS The study included 215 rhythmic gymnasts (RG) and 113 artistic gymnasts (AG). RESULTS AG were below the 50th percentile, while RG were taller than average. Final adult height was lower than target height in AG, while in RG, it exceeded target height. AG started training earlier than RG (p<0.001) and reported lower intensity of training (p<0.001). RG were taller than AG, with higher target height, greater Δ final height-target height and lower body fat and BMI (p<0.001). Using multiple regression analysis, the main factors influencing final height were weight SDS (p<0.001), target height SDS (p<0.001) and age of menarche (p<0.001) for RG, and weight SDS (p<0.001) and target height SDS (p<0.001) for AG. CONCLUSION In both elite female RG and AG, genetic predisposition to final height was not disrupted and remained the main force of growth. Although in elite RG genetic predisposition for growth was fully preserved, in elite female AG final adult height falls shorter than genetically determined target height, though within the standard error of prediction.
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Affiliation(s)
- Neoklis A Georgopoulos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, Patras, Greece.
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Abstract
OBJECTIVE Elite male artistic gymnasts (AG) are exposed to high levels of physical and psychological stress during adolescence and experience a significant late maturation in both linear growth and pubertal development. The aim of the present study was to determine the impact of intensive physical training on the adult final height in elite male AG. METHODS This study is unique in character, as all variables were measured on the field of competition. The study was prospective and longitudinal; however, the current analysis of data is cross-sectional. Data from 86 elite male AG were obtained during the gymnastics competitions of European and World Championships. Clinical evaluation included height and weight measurements, as well as assessment of pubic hair and genital development according to Tanner's stages of pubertal development. The laboratory investigation included determination of skeletal maturation. All athletes completed a questionnaire that included questions on personal (onset and intensity of training, number of competitions per year) and family data (paternal and maternal heights). RESULTS Male AG were below the 50th percentile for both final height and weight. Elite male AG had final height standard deviation score (SDS) lower than their genetic predisposition. Final height SDS was correlated positively with target height SDS (r = 0.430, p < 0.001) and weight SDS (r = 0.477, p < 0.001) and negatively to the intensity of training (r = -0.252, p = 0.022). The main factors influencing final height, by multiple regression analysis were weight SDS (p < 0.001) and target height SDS (p = 0.003). CONCLUSION In elite maleAG, final height falls short of genetic predisposition, still well within normal limits. Considering medical and psychological risks in general, and based on the results of this research project, the International Federation of Gymnastics has increased the age limit for participants in international gymnastics competitions by 1 year.
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Affiliation(s)
- Neoklis A Georgopoulos
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Patras Medical School, Patras, Greece.
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Mamali I, Roupas ND, Armeni AK, Theodoropoulou A, Markou KB, Georgopoulos NA. Measurement of salivary resistin, visfatin and adiponectin levels. Peptides 2012; 33:120-4. [PMID: 22108712 DOI: 10.1016/j.peptides.2011.11.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 11/06/2011] [Accepted: 11/06/2011] [Indexed: 12/23/2022]
Abstract
Hormonal determination in saliva offers several advantages. Peptides enter the salivary glands either by active transport mechanisms or are expressed and secreted by the salivary glands themselves. The collection of saliva is a noninvasive, easily repeatable and less stressful technique than blood withdrawal. The purpose of the present study was to introduce a method for measuring salivary resistin, visfatin and adiponectin levels and to evaluate their associations with serum levels. Resistin, visfatin and adiponectin levels were measured in serum and saliva of 50 healthy adult volunteers (17 male and 33 female) using commercial enzyme immunoassay kits for serum with minor modifications. The present study documented the determination of resistin and adiponectin levels in saliva and the significant correlation of salivary levels with serum levels (r=0.441, p<0.01 and r=0.347, p<0.05, respectively). Moreover, the identification of visfatin in saliva was achieved, but no significant correlation with serum visfatin levels was observed. To our knowledge, this is the first study to report the determination of resistin and visfatin in saliva and the significant correlation of salivary resistin with serum levels, while it confirmed the significant association between salivary and serum adiponectin. The introduction of salivary determinations of adipokines could contribute to the elucidation of the physiology and the role of the specific adipokines in various clinical conditions (obesity, insulin resistance, inflammation, reproduction, energy imbalance and stress response).
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Affiliation(s)
- Irene Mamali
- Division of Endocrinology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
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20
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Paspatis GA, Tribonias G, Konstantinidis K, Theodoropoulou A, Vardas E, Voudoukis E, Manolaraki MM, Chainaki I, Chlouverakis G. A prospective randomized comparison of cold vs hot snare polypectomy in the occurrence of postpolypectomy bleeding in small colonic polyps. Colorectal Dis 2011; 13:e345-8. [PMID: 21689363 DOI: 10.1111/j.1463-1318.2011.02696.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM Polypectomy techniques in the removal of polyps in the 3-8 mm size range are inconsistent. The aim of our study was to compare cold (CSP) with hot snare polypectomy (HSP) in the occurrence of postpolypectomy bleeding in small colonic polyps 3-8 mm in size. METHOD In all, 414 consecutive patients with small colorectal polyps 3-8 mm in size were prospectively randomized into the CSP group and the HSP group. RESULTS There was no early or late postpolypectomy bleeding in either group. Intraprocedural bleeding was significantly more frequent in the CSP group than the HSP group (CSP, 19/208; HSP, 2/206; P<0.001) but resolved spontaneously without any intervention in both groups. CONCLUSION The data show that the CSP technique is safe, effective and quicker than HSP for patients and it could be considered the ideal procedure for small polyp removal.
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Affiliation(s)
- G A Paspatis
- Department of Gastroenterology, Benizelion General Hospital, Heraklion, Crete.
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Castagna MG, Tala Jury HP, Cipri C, Belardini V, Fioravanti C, Pasqui L, Sestini F, Theodoropoulou A, Pacini F. The use of ultrasensitive thyroglobulin assays reduces but does not abolish the need for TSH stimulation in patients with differentiated thyroid carcinoma. J Endocrinol Invest 2011; 34:e219-23. [PMID: 21399390 DOI: 10.3275/7571] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Measurement of serum Tg using ultrasensitive assays is proposed to replace TSH-stimulated Tg measurement in the follow-up of differentiated thyroid cancer (DTC). Aim of our study was to verify this possibility using two ultrasensitive Tg assays. We selected 215 DTC patients with undetectable (<1 ng/ml) basal serum Tg at the time of a recombinant human TSH (rhTSH) stimulation. According to standard criteria, 173 (80.4%) patients were considered free of disease, 17 (7.9%) had documented disease and 25 (11.7%) had no evidence of disease but detectable serum rhTSH-stimulated Tg (biochemical disease). The sera of these patients were re-assayed with two commercial ultrasensitive assays and the results were compared with the clinical data. Basal Access and E-Iason Tg assays were able to distinguish patients with persistent disease or free of disease with a sensitivity of 82.3 and 82.3%, specificity of 85.5 and 86.1%, positive predictive value (PPV) of 35.8 and 36.8%, negative predictive value (NPV) of 98 and 98.6%, respectively. With both assays the addition of neck ultrasound to basal Tg increased the sensitivity and the NPV to 100% and decreased the false negative rate to 0%. In patients with detectable basal Tg without evidence of disease, serum Tg converted from detectable to undetectable in about 80% of the cases during 2-yr follow-up. Our study indicates that the combination of neck ultrasound and basal ultrasensitive Tg allows to identify all patients free of disease and can decrease the need for rhTSH stimulation in nearly 80% of the patients.
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Affiliation(s)
- M G Castagna
- Department of Internal Medicine, Endocrinology & Metabolism and Biochemistry, Section of Endocrinology & Metabolism, University of Siena, 53100 Siena, Italy
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Paspatis GA, Tribonias G, Manolaraki MM, Konstantinidis K, Chainaki I, Theodoropoulou A, Vardas E, Chlouverakis G. Deep sedation compared with moderate sedation in polyp detection during colonoscopy: a randomized controlled trial. Colorectal Dis 2011; 13:e137-44. [PMID: 21564466 DOI: 10.1111/j.1463-1318.2011.02555.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIM The detection rate of adenomas is one of the current quality indicators in high-quality colonoscopy. We compared the performance of colonoscopy for the detection of polyps in patients sedated with deep and moderate sedation. Secondary objectives included the patient's and the endoscopist's satisfaction, recovery time and the adverse events related to sedation between the two groups. METHOD Five hundred and twenty patients submitted for colonoscopy were prospectively randomized into a deep sedation group (DS group, n = 258) and a moderate sedation (MS group, n = 262) group. In both, sedation and analgesia were performed using midazolam with pethidine. RESULTS There were no differences between the two groups in the following three areas: (1) The overall detection of polyps (DS, 1 [0-20]; MS, 1 [0-15]; P = 0.67), (2): polyp size ≥ 10 mm (DS, 0.00 [0-7]; MS, 0.00 [0-6]; P = 0.30), and (3) polyp size < 10 mm (DS, 0.00 [0-20]; MS, 0.00 [0-13]; P = 0.83). There was no significant difference in the rate of adenoma detection (DS, 1 [0-10]; MS, 1 [0-9]; P = 0.99). CONCLUSION The study demonstrated no difference in the detection of polyps by colonoscopy using deep or moderate sedation.
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Affiliation(s)
- G A Paspatis
- Department of Gastroenterology Anesthesiology, Benizelion General Hospital, University of Crete, Heraklion-Crete, Greece.
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Georgopoulos NA, Rottstein L, Tsekouras A, Theodoropoulou A, Koukkou E, Mylonas P, Polykarpou G, Lampropoulou E, Iconomou G, Leglise M, Vagenakis AG, Markou KB. Abolished circadian rhythm of salivary cortisol in elite artistic gymnasts. Steroids 2011; 76:353-7. [PMID: 21073886 DOI: 10.1016/j.steroids.2010.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 10/24/2010] [Accepted: 10/29/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of intensive physical exercise and acute psychological stress during high level athletic competition as reflected on the levels of salivary cortisol in elite artistic gymnasts (AGs). DESIGN The study included 239 AGs (142 females-97 males) who participated in the European Championship of Gymnastics in 2006 and 81 adolescents (40 females-41 males), matched for age, as controls. All athletes participated voluntarily in all or parts of the study, providing samples or data for each of the variables measured. Height, weight, body fat, lean body mass (LBM), bone age and Tanner stage of puberty were assessed and data concerning the time of thelarche, adrenarche and menarche as well as, the onset and the intensity (hours per week) of training were obtained. METHODS Saliva samples were collected, the morning before training and in the afternoon shortly after the competition. From controls, the saliva samples were collected in the morning. Cortisol concentrations were measured using a chemiluminescence method. Acute stress was assessed using a questionnaire designed for the study. RESULTS No difference was found between morning and afternoon salivary cortisol levels in both male and female AGs (females: AM: 15.45±7.45nmol/l vs PM: 15.73±9.38nmol/l; males: AM: 10.21±5.52nmol/l vs PM: 9.93±13.8nmol/l, p>0.05). Female AGs presented higher levels of morning salivary cortisol than female controls (p<0.05). Both male and female AGs had higher degree of psychological stress in comparison with controls (p<0.001, p<0.013, respectively). Female AGs had higher morning and afternoon salivary cortisol levels (p<0.01, p<0.01, respectively) and higher degree of stress (p<0.003) than males. CONCLUSIONS In elite AGs the diurnal rhythm of salivary cortisol has been abolished, probably due to the strenuous training and competition conditions. Female AGs presented higher levels of morning salivary cortisol and psychological stress compared to both male AGs and female controls. The long term consequences of these modifications of the HPA axis remain to be elucidated.
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Affiliation(s)
- Neoklis A Georgopoulos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, University Hospital of Patras, Rio 26500, Patras, Achaia, Greece
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Milz P, Theodoropoulou A, Tei S, Faber P, Kochi K, Lehmann D. Common EEG spectral power characteristics during meditation in five meditation traditions. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)72648-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
IntroductionDifferent meditation practices reportedly affect brain electric activity.ObjectivesTo assess common characteristics in brain electric activity during the state of meditation across different meditation traditions.AimsDo meditation traditions share commonalities in EEG spectral power changes from task-free resting to meditation?MethodsData from 71 experienced meditators of five meditation traditions were analyzed (13 Tibetan Buddhists, 15 Qigong, 14 Shaja Yoga, 14 Ananda Marga Yoga, and 15 Zen). Power spectral results of multichannel EEG recordings (average reference) during meditation were compared with those during pre- and post-meditation task-free resting. Spectra were averaged across channels (19–58), and subject-wise normalized. Integrated power was computed for the eight independent frequency bands (delta through gamma).ResultsDuring meditation compared to the average of pre- and post-meditation resting, across the five traditions, there was a significant decrease of power in the alpha-2 band (10.5–12 Hz), and significant increases of power in the beta-3 (21.5–30 Hz) and gamma (35–44 Hz) bands; theta (6.5–8 Hz) band power showed an increase at p = 0.14.ConclusionsThe results indicate that EEG spectral power differences between task-free resting state EEG versus meditation state EEG show communalities that are shared by all five meditation traditions in spite of important differences in meditation techniques.
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Tribonias G, Theodoropoulou A, Konstantinidis K, Vardas E, Karmiris K, Chroniaris N, Chlouverakis G, Paspatis GA. Comparison of standard vs high-definition, wide-angle colonoscopy for polyp detection: a randomized controlled trial. Colorectal Dis 2010; 12:e260-6. [PMID: 19930146 DOI: 10.1111/j.1463-1318.2009.02145.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIM We sought to compare the performance of colonoscopy using a high-definition, wide-angle endoscope vs a standard colonoscope for the detection of polyps. METHOD A total of 390 patients were prospectively randomized into high-definition colonoscopy group (HD, n = 193) and standard colonoscopy group (SC, n = 197). RESULTS Analysis demonstrated that there were significant differences between the two groups, as far as the overall rate of polyps (SC, 1.31 ± 1.90; HD, 1.76 ± 2.31; P = 0.03) and the rate of small hyperplastic polyps (size < 5 mm; SC, 0.10 ± 0.36; HD, 0.25 ± 0.61; P = 0.003) were concerned. No significant differences between the two groups were observed, regarding large polyps (size ≥ 10 mm; SC, 0.39 ± 0.89; HD, 0.48 ± 0.80; P = 0.10), medium polyps (10 mm > size ≥ 5 mm; SC, 0.60 ± 1.46; HD, 0.58 ± 1.25; P = 0.31) and small polyps (size < 5 mm; SC, 0.32 ± 0.86; HD, 0.71 ± 1.65; P = 0.09). Similarly, no significant differences were demonstrated in the detection rate of adenomas and hyperplastic polyps, large adenomas, medium adenomas, small adenomas and large and medium hyperplastic polyps. CONCLUSION High-definition colonoscopy led to a significant increase in the polyp detection.
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Affiliation(s)
- G Tribonias
- Department of Gastroenterology, Benizelion General Hospital, Heraklion, Crete, Greece
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Abstract
Bone mass (BM) and skeletal size are similar in prepubertal girls and boys and double between the onset of puberty and early adult life. Sex steroids are responsible for the maturation in human skeleton, as well as for the sexual dimorphism, observed after the onset of puberty. Physical activity in childhood is critical for maximizing bone growth and thus for preventing osteoporosis during older age. Therefore, it constitutes the most effective prevention strategy available. In athletes, high-impact loading activities have been shown to improve BM, whereas in sports requiring a lean somatotype (therefore leading to a negative energy balance), the delay in skeletal maturation and pubertal development predisposes athletes to osteopenia and osteoporosis. Although the early onset of training, the continuous intensive exercise and its long duration attenuate bone acquisition, the excess mechanical load to which these athletes are exposed from a young age exerts beneficial effects on bone formation that lead to a positive net-effect on BM.
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Affiliation(s)
- Kostas B Markou
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, University Hospital, Patras, Greece.
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Georgopoulos NA, Roupas ND, Theodoropoulou A, Tsekouras A, Vagenakis AG, Markou KB. The influence of intensive physical training on growth and pubertal development in athletes. Ann N Y Acad Sci 2010; 1205:39-44. [PMID: 20840251 DOI: 10.1111/j.1749-6632.2010.05677.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Genetic potential for growth can be fully expressed only under favorable environmental conditions. Although moderate physical activity has beneficial effects on growth, excessive physical training may negatively affect it. Sports favoring restricted energy availability, in the presence of high energy expenditure, are of particular concern. In gymnastics, a different pattern in skeletal maturation and linear growth was observed, resulting in an attenuation of growth potential in artistic gymnasts (AG), more pronounced in males than in females. In female rhythmic gymnasts (RG), the genetic predisposition to growth was preserved owing to a late catchup growth phenomenon. In all other sports not requiring strict dietary restrictions, no deterioration of growth has been documented so far. Intensive physical training and negative energy balance alter the hypothalamic pituitary set point at puberty, prolong the prepubertal stage, and delay pubertal development and menarche in a variety of sports. In elite RG and AG, prepubertal stage is prolonged and pubertal development is entirely shifted to a later age, following the bone maturation rather than the chronological age.
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Affiliation(s)
- Neoklis A Georgopoulos
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Patras Medical School, University Hospital, Patras, Greece.
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Paspatis GA, Chainaki I, Manolaraki MM, Vardas E, Theodoropoulou A, Tribonias G, Konstantinidis K, Karmiris K, Chlouverakis G. Efficacy of bispectral index monitoring as an adjunct to propofol deep sedation for ERCP: a randomized controlled trial. Endoscopy 2009; 41:1046-51. [PMID: 19967620 DOI: 10.1055/s-0029-1215342] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS We sought to determine whether bispectral index (BIS) monitoring is a useful adjunct to the administration of propofol titrated to deep sedation, as measured by reductions of doses of propofol administered during endoscopic retrograde cholangiopancreatography (ERCP). PATIENTS AND METHODS 90 consecutive patients undergoing ERCP were randomized to receive propofol titrated to deep sedation, with the BIS value either visible (BIS group, n = 46) or invisible (control group, n = 44) to the anesthesiologist. In the BIS group, the anesthesiologist was instructed to use the BIS value as the primary end point for titration of sedation, and to target BIS values between 40 and 60. For the control group, the anesthesiologist was instructed to titrate propofol according to routine practice in the unit using the modified Observer's Assessment of Alertness/Sedation (MOAA/S) Scale (MOAA/S score 0). RESULTS The mean (SD) propofol doses (mg/min per kg weight) were 0.139 (0.02) and 0.193 (0.02) for the BIS and control groups, respectively (P < 0.001). Mean (SD) BIS values throughout the procedure were 61.68 (7.5) and 56.93 (4.77) for the BIS and control groups, respectively (P = 0.001). During the maintenance phase of sedation (MOAA/S score 0), the mean (SD) BIS values were 53.73 (8.67) and 45.65 (4.39) for the BIS and control groups, respectively (P < 0.001). CONCLUSIONS Our data suggest that BIS monitoring led to a reduction in the mean propofol dose when the BIS value was used as the primary target for sedation in ERCP procedures.
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Affiliation(s)
- G A Paspatis
- Department of Gastroenterology, Benizelion General Hospital, Crete, Greece.
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Paspatis GA, Manolaraki MM, Tribonias G, Theodoropoulou A, Vardas E, Konstantinidis K, Chlouverakis G, Karamanolis DG. Endoscopic sedation in Greece: results from a nationwide survey for the Hellenic Foundation of gastroenterology and nutrition. Dig Liver Dis 2009; 41:807-11. [PMID: 19410522 DOI: 10.1016/j.dld.2009.03.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 01/05/2009] [Accepted: 03/09/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND STUDY AIMS Recent surveys regarding practices in sedation during endoscopic procedures are limited, particularly in Greece where they are nonexistent. This survey was designed to provide national data on sedation practices in Greece. METHODS A 27-item survey regarding practices of endoscopy and sedation was mailed nationwide to 502 members of the Hellenic Society of Gastroenterology. RESULTS A total of 201 questionnaires were returned (40%). Survey respondents performed an average of 48 oesophagogastroduodenoscopies (EGD) and 35 colonoscopies per month. 50 of the respondents, who perform endoscopic retrograde cholangiopancreatography (ERCP), conducted an average of 10 ERCP per month. 15 of the respondents, who perform endoscopic ultrasound (EUS), conducted an average of 6 EUS per month. Respondents administered sedation intravenously in 64% of EGD, 78% of colonoscopies, 100% of ERCP and 100% of EUS. 125 of the respondents (62.1%) reported the use of synergistic sedation (benzodiazepines plus opioids), 71 of the respondents (35.3%) reported the use of benzodiazepines alone and 68 of the respondents (33.8%) reported the use of propofol based sedation in selected cases (more than one response was permitted). In most cases, propofol administration was directed by an anaesthesiologist. The majority of the respondents monitored vital signs and pulse oximetry (90% and 96%, respectively). CONCLUSION The use of sedation and physiologic monitoring in Greece is now standard practice during endoscopy. Benzodiazepines, either alone or combined with an opioid, are used by the majority of endoscopists, while propofol is used in selected cases, mainly in the presence of an anaesthesiologist.
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Affiliation(s)
- G A Paspatis
- Department of Gastroenterology, Benizelion General Hospital, L. Knossou, Heraklion, Crete 71409, Greece.
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Theodoropoulou A, Konstantinidis K, Kteniadakis S, Tribonias G, Tzanoudakis G, Vardas E, Karmiris K, Psillakis K, Zois E, Tzortzakakis E, Paspatis GA. Intussusception following enteroscopy and ileo-colonoscopy in an adult with acquired immune deficiency syndrome. Endoscopy 2009; 41 Suppl 2:E162-3. [PMID: 19544281 DOI: 10.1055/s-0029-1214688] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- A Theodoropoulou
- Department of Gastroentrology, Benizelion General Hospital, Crete, Greece
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Tarantini B, Ciuoli C, Checchi S, Montanaro A, Bonato V, Theodoropoulou A, Pasqui L, Pacini F. Serum ghrelin levels in growth hormone-sufficient and growth hormone-deficient patients during growth hormone-releasing hormone plus arginine test. J Endocrinol Invest 2009; 32:335-7. [PMID: 19636202 DOI: 10.1007/bf03345723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Ghrelin is an orexigenic hormone produced in the stomach and in other organs, exerting a wide range of metabolic functions, including stimulation of GH secretion. Ghrelin secretion is decreased by iv or oral glucose load as well as during euglycemic-hyperinsulinemic clamp and hypoglycemia. We evaluated the circulating ghrelin levels in GH-deficient (GHD) and in GH-sufficient (GHS) patients during GHRH plus arginine test. MATERIALS AND METHODS The study group comprised 35 patients, including 20 with pituitary tumors, 12 with empty sella, 2 with short stature, and 1 with post-traumatic isolated GH deficiency. According to the results of GHRH plus arginine test, 14 patients were defined as GHD and 21 as GHS. Patients with central hypothyroidism, hypocorticism, and hypogonadism had been on replacement therapy for at least 3 months at the moment of the study. Blood samples were collected every 20 min up to 60 min after GHRH and arginine administration. RESULTS By definition, GH response to GHRH plus arginine was higher in GHS than GHD group (p<0.0001). Basal serum ghrelin levels were not different in the two groups and did not correlate with body mass index, GH, IGFI and insulin concentrations. After GHRH plus arginine, serum ghrelin decreased significantly in both groups, with percent decreases ranging 13.3-66.6% in GHD patients (p=0.001) and 7.2-42.2% in GHS patients (p=0.004), with no significant difference in the two groups (p=0.12). CONCLUSION Our results show that ghrelin secretion is not modulated by acute GH increase observed in GHS subjects during GHRH plus arginine infusion. The similar decrease of serum ghrelin after GHRH plus arginine stimulation in both GHS and GHD subjects demonstrated that there is no negative feedback of GH on ghrelin secretion.
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Affiliation(s)
- B Tarantini
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of Siena, Via Bracci, 53100 Siena, Italy
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Theodoropoulou A, Psyrogiannis A, Metallinos IC, Habeos I, Vgenakis AG, Kyriazopoulou V. Ghrelin response to oral glucose load in hyperthyroidism, before and after treatment with antithyroid drugs. J Endocrinol Invest 2009; 32:94-7. [PMID: 19411802 DOI: 10.1007/bf03345693] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Hyperthyroidism is characterized by hyperphagia and increased basal metabolic rate. Ghrelin peptide is implicated in food intake through activation of the orexigenic neuropeptide Y/agouti related protein in the arcuate nucleus of hypothalamus. Also different studies suggested that ghrelin might play a role in states of energy insufficiency, controlling body weight. We therefore evaluate ghrelin levels in severe hyperthyroidism before and after medical treatment when euthyroidism was achieved, in order to evaluate its possible role in the increase of appetite and in the metabolic changes observed in hyperthyroidism. Serum ghrelin and insulin levels were measured after an oral glucose tolerance test (OGTT), in 7 severe hyperthyroid female patients, before and after medical treatment when euthyroidism was achieved. Body mass index (BMI), percentage of body fat and lean mass was also estimated in hyperthyroidism as well as in euthyroidism. Basal insulin levels were statistically higher in hyperthyroid patients with respect to euthyroid state after treatment (p=0.02, t=3.379), while homeostasis model assessment (HOMA) index for insulin sensitivity was statistically higher in hyperthyroidism (group 1) compared to euthyroidism (group 2) (1.64+/-0.69 vs 0.78+/-0.44, p=0.019, t=3.389). Fasting ghrelin concentrations were significantly reduced in group 1 compared to group 2 (938+/-578 pg/ml vs 1402+/-566 pg/ml, p<0.05, t=-2.489). Oral glucose loading induced suppression of ghrelin level in both groups, but the area under the curve for ghrelin during the OGTT in euthyroidism was greater compared to hyperthyroidism (p=0.05, t=-2.485). After medical treatment, a statistically significant increase in BMI (23.1+/-4.3 vs 25.9+/-5.1) (p=0.007, t=-4.399) was also observed. In hyperthyroidism, basal ghrelin levels showed a negative correlation with BMI (p=0.042, r=-0.829), insulin (p<0.001, r=-1.000), and HOMA index (p=0.019, r=-0.886). No correlation was found between ghrelin levels and thyroid hormone values. Ghrelin levels are decreased in hyperthyroidism and increase when euthyroidism is achieved. BMI and insulin are the main factors that influence ghrelin concentration in hyperthyroidism. T3 and T4 levels do not influence ghrelin levels. There is no evidence that ghrelin is responsible for the increase appetite seen in hyperthyroidism.
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Affiliation(s)
- A Theodoropoulou
- Department of Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece.
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Markou KB, Tsekouras A, Anastasiou E, Vlassopoulou B, Koukkou E, Vagenakis GA, Mylonas P, Vasilopoulos C, Theodoropoulou A, Rottstein L, Lampropoulou E, Apostolopoulos D, Jabarov R, Vagenakis AG, Georgopoulos NA. Treating iodine deficiency: long-term effects of iodine repletion on growth and pubertal development in school-age children. Thyroid 2008; 18:449-54. [PMID: 18399768 DOI: 10.1089/thy.2007.0277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Iodine deficiency (ID) is still a major universal health problem. Iodine deficiency disorders (IDDs) affect people of all ages, among whom the most vulnerable are children and adolescents. The aim of the present study was to assess the long-term effects on growth and pubertal development of correcting severe ID in areas of Azerbaijan between 1999 and 2000. METHODS Iodized oil was administered orally to 293,000 children, aged 6-16 years. Among those, 364 children were randomly selected and were examined 1 year before the administration of iodized oil (Group I-neg, iodine negative) and 295 children (Group I-Rx, iodine treated) were examined 4 years (Group I-R x 4, iodine treated 4 years later; n = 173) or 5 years (Group I-R x 5, iodine treated 5 years later; n = 122) after the last dose of iodide. RESULTS In Group I-neg the median urine iodine concentration (UIC) (mcg/L) was 36 (mean: 36.272 +/- 11.036) and increased significantly (p < 0.001) in Group I-R x 4: 188 (mean: 230.969 +/- 155.818) and in Group I-R x 5: 175 (mean: 201.176 +/- 130.369). The prevalence of goiter was 99% in Group I-neg and 2% in Group I-R x 4. Children in Group I-Rx had a greater standard deviation score (SDS) for height (-0.1364 +/- 1.279, n = 294) than children in Group I-neg (-0.5019 +/- 1.17, n = 363) (p < 0.001, t = -3.817), which was more significant for boys. SDS for weight was similar in both groups (Group I-neg: -0.17 +/- 0.78, n = 363; Group I-Rx: -0.115 +/- 0.917, n = 294). The rate of puberty development as judged by the development of breast and pubic hair was normalized in both sexes after the correction of ID. CONCLUSIONS Our results demonstrate that long-term correction of severe ID leads to sustained improvement of linear growth accompanied by a normalization of the time of onset of pubertal development for both sexes.
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Affiliation(s)
- Kostas B Markou
- Division of Endocrinology, Department of Internal Medicine, University of Patras Medical School, University Hospital, Patras, Greece
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Paspatis GA, Manolaraki MM, Vardas E, Theodoropoulou A, Chlouverakis G. Deep sedation for endoscopic retrograde cholangiopancreatography: intravenous propofol alone versus intravenous propofol with oral midazolam premedication. Endoscopy 2008; 40:308-13. [PMID: 18058653 DOI: 10.1055/s-2007-995346] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND STUDY AIMS The primary objective of the present study was to compare the dosage of intravenous propofol required in patients being sedated with propofol alone (group P) with the dosage of propofol required in patients who also received an oral dose of midazolam (group M + P) for endoscopic retrograde cholangiopancreatography (ERCP) procedures. The secondary objectives were to compare the two groups with regard to patient anxiety levels before the procedure, patient satisfaction, the recovery time, and the adverse events related to sedation. PATIENTS AND METHODS A total of 91 consecutive patients undergoing ERCP were randomly assigned to one of the two medication regimens. Patients in group P (n = 45) received only intravenous propofol, titrated to achieve deep sedation. Patients in group M + P (n = 46) received 7.5 mg of midazolam orally 30 minutes before being given intravenous propofol, which was similarly titrated to achieve deep sedation. RESULTS Patients receiving propofol alone required higher doses of propofol compared with those receiving synergistic sedation (512 +/- 238 mg vs. 330 +/- 223 mg respectively, P < 0.001). The patients' anxiety levels before the procedure were lower in group M + P patients than in group P patients (P < 0.001). The mean percentage decline in oxygen saturation during the procedure was significantly greater in group P patients than it was in group M + P patients. A significant drop in the oxygen saturation (to < 90 %) occurred in 11 group P patients and in three group M + P patients (P = 0.02). CONCLUSIONS Our data suggest that synergistic sedation with an oral dose of midazolam combined with intravenous propofol can provide a significant benefit, with a reduction in the dosage of propofol required and in patient anxiety levels before ERCP.
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Affiliation(s)
- G A Paspatis
- Department of Gastroenterology, Benizelion General Hospital, Heraklion-Crete, Greece.
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Koutroubakis IE, Sfiridaki A, Tsiolakidou G, Theodoropoulou A, Livadiotaki A, Paspatis G, Kouroumalis EA. Genetic risk factors in patients with inflammatory bowel disease and vascular complications: case-control study. Inflamm Bowel Dis 2007; 13:410-5. [PMID: 17206678 DOI: 10.1002/ibd.20076] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Inherited risk factors have been suggested to play an important role in the pathogenesis of vascular complications of inflammatory bowel disease (IBD). The aim of the present study was to investigate the role of mutations associated with cardiovascular disease in IBD patients with or without vascular complications compared with thrombotic and healthy controls (HC). METHODS Twelve polymorphisms of thrombophilic and vasoactive genes were evaluated in a group of 30 IBD patients with vascular complications (IBD-VC) compared with 60 IBD patients without vascular complications, 30 thrombotic controls (TC), and 54 healthy controls, using a commercially available kit. RESULTS No significant differences between IBD-VC and TC concerning the carriage of these mutations were found. The frequencies of the factor V (FV) 506 RQ (Leiden) genotype and the 506Q allele were significantly higher in these groups than in HC (P < 0.05) but not IBD controls (P > 0.05). The allele frequency of the mutant 4G allele of the plasminogen activator inhibitor (PAI) polymorphism, similar in the IBD-VC and TC groups, was significantly higher in these groups compared with the IBD group (P = 0.03) and the HC (P = 0.001). It is noteworthy that there was a trend of association of FV R506Q polymorphism with venous thrombosis and PAI-1 gene polymorphism with arterial thrombosis. CONCLUSIONS Our results suggest that the investigated gene polymorphisms do not differ in patients with IBD-VC and TC. FV R506Q and PAI-1 gene polymorphisms might be associated with the increased risk of development of vascular complications in IBD.
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Affiliation(s)
- I E Koutroubakis
- Department of Gastroenterology University Hospital Heraklion, Crete, Greece.
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Theodoropoulou A, Vagenakis AG, Makri M, Markou KB. Thyroid hormone synthesis and secretion in humans after 80 milligrams of iodine for 15 days and subsequent withdrawal. J Clin Endocrinol Metab 2007; 92:212-4. [PMID: 17047024 DOI: 10.1210/jc.2006-1189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT In animals, acute iodine administration results in acute intrathyroidal inhibition of iodinations followed by escape of the inhibition if the excessive iodine intake continues. In humans, the intrathyroidal nonhormonal and hormonal iodine concentration after exposure to large doses of iodine for a relatively long period of time is not known. OBJECTIVE To determine whether, in human thyroid, administration of large doses of iodine for a relatively long time results in alterations of intrathyroidal hormonal (HI) T4 and T3 and total iodine (TI) content, as well as whether changes in serum concentration of thyroid hormones and TSH would occur after iodine administration or discontinuation. DESIGN In 33 euthyroid patients with single thyroid nodule or hyperparathyroidism, Lugol solution (80 mg iodine) was administered for 15 d before operation. Groups of six to eight patients underwent operation 0, 5, 10, and 15 d after iodine withdrawal. TI, HI in a sample of thyroid tissue, and serum concentration of T4, T3, and TSH were measured. In 21 normal euthyroid subjects who did not undergo operation, a similar protocol was used and serial blood measurements were taken. MAIN OUTCOME MEASURE Intrathyroidal TI, HI, and serum thyroid hormone and TSH measurements were the main outcome measure. RESULTS Intrathyroidal HI content and serum T4 and T3 were unchanged during and after iodine discontinuation. TI was increased during iodine administration and returned to control values 5 d after discontinuation of iodine. The ratio of HI/TI was decreased and returned to control values 15 d after the iodine was discontinued. Serum TSH was increased during iodine administration and returned to control values 10 d after iodine withdrawal. CONCLUSIONS In humans, administration of iodine for a relatively long period of time was accompanied by increased intrathyroidal TI, but no changes in HI or demonstrable increases of serum T4 and T3 were observed. It is hypothesized that the maintenance of normal intrathyroidal HI is the result of the combined inhibitory effect of iodine on thyroid hormone synthesis and on the release of T4 and T3 from the thyroid.
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Affiliation(s)
- Anastasia Theodoropoulou
- Department of Medicine, Division of Endocrinology, University of Patras Medical School, Patras 24500, Greece
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Theodoropoulou A, Metallinos IC, Elloul J, Taleli P, Lekka N, Vagenakis AG, Kyriazopoulou V. Prolactin, cortisol secretion and thyroid function in patients with stroke of mild severity. Horm Metab Res 2006; 38:587-91. [PMID: 16981141 DOI: 10.1055/s-2006-950505] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Different attempts were made to identify the variables that may be involved in the clinical course of cerebrovascular ischemia. In the case of stroke with mild severity (SMS), the clinical significance of neuroendocrine changes as well as of post-stroke depression (PSD) remains unknown. We therefore evaluated the presence of neuroendocrine changes in the acute and post-acute phase of SMS, and their potential role during convalescence. Serum cortisol, T4, T3, FT4, FT3, TSH and PRL levels were measured in 17 euthyroid patients with stroke on admission (day 1), following morning (day 2), 7 days and 3 months later. TSH and PRL secretion after TRH test were measured. Stroke severity on admission was determined by Scandinavian Stroke Scale (SSS). Montgomery-Asberg Depression Rating Scale (Madrs) was used for assessment of post-stroke depression. On admission, TSH and T3, were within normal limits and were greater compared to values on day 2. Lower basal TSH and decreased TSH response to TRH on day 2, were associated with stroke of greater severity. Delta-PRL after TRH on day 2 was higher in patients who develop PSD. Changes in serum thyroid hormones in SMS, reflects those of non-thyroidal illness. A mild stimulation of hypothalamic-pituitary-adrenal axis was detected. We provide evidence that PRL response to TRH, in the acute phase of stroke may be used as an index for early detection of PSD.
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Affiliation(s)
- A Theodoropoulou
- Division of Endocrinology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
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Mylonas PG, Makri M, Georgopoulos NA, Theodoropoulou A, Leglise M, Vagenakis AG, Markou KB. Adequacy of saliva 17-hydroxyprogesterone determination using various collection methods. Steroids 2006; 71:273-6. [PMID: 16430934 DOI: 10.1016/j.steroids.2005.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Revised: 11/07/2005] [Accepted: 11/16/2005] [Indexed: 11/17/2022]
Abstract
Steroids determination in saliva offers several advantages. The collection of saliva is a noninvasive, less stressful technique than blood withdrawal and reflects the circulating unbound fractions. The suitability of saliva for 17-hydroxyprogesterone and cortisol determinations has been documented in healthy subjects as well as in diseases like Congenital Adrenal Hyperplasia and Cushing syndrome. The aim of the study was to compare the influence of different collection methods on the results of 17-hydroxyprogesterone measurement in saliva collected by different ways, using commercially available RIAs developed for plasma. 17-hydroxyprogesterone was determined in 64 healthy adult volunteers (30 males, 34 females) in serum (Group SE) and in saliva collected before meals at 8-10 p.m. by directly spitting into a plastic tube (Group SP), using a cotton swab (Group SA) and using a polyester swab Salivette (Group SB). We used a commercially available direct radioimmunoassay without separation technique. The 17-hydroxyprogesterone mean values (ng/ml) were 1.16+/-1.3 (Group SE), 0.056+/-0.046 (Group SP), 0.089+/-0.048 (Group SA) and 0.058+/-0.049 (Group SB). The detection limit was 0.010 ng/ml. The correlations between the values in serum (Group SE) and in saliva were: r=0.77, p<0.05 (Group SP); r=0.62, p<0.05 (Group SA); r=0.70, p<0.05 (Group SB). The saliva values corresponding to the serum cut-off point of 3 ng/ml upper limit of normal values were in ng/ml 0.13 (Group SP), 0.16 (Group SA) and 0.11 (Group SB). In conclusion, 17-hydroxyprogesterone determinations in saliva using commercially available RIAs primarily developed for serum, is a reliable and easy to perform procedure. The three different methods of saliva collection showed 17-hydroxyprogesterone concentrations to have good agreement.
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Affiliation(s)
- Panagiotis G Mylonas
- Department of Internal Medicine, Division of Endocrinology, University Hospital of Patras Medical School, Patras, Greece
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Theodoropoulou A, Markou KB, Vagenakis GA, Benardot D, Leglise M, Kourounis G, Vagenakis AG, Georgopoulos NA. Delayed but normally progressed puberty is more pronounced in artistic compared with rhythmic elite gymnasts due to the intensity of training. J Clin Endocrinol Metab 2005; 90:6022-7. [PMID: 16118332 DOI: 10.1210/jc.2005-1762] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Elite gymnasts are subjected to intense training, which may alter pubertal development. OBJECTIVE The objective of the investigation was to study the impact of gymnastics on pubertal development in rhythmic (RGs) and artistic gymnasts (AGs). DESIGN Evaluation of somatometric parameters, pubertal stage, and intensity of training in the competition field were studied. SETTING The study was conducted at European and world championships of years 1997-2004. SUBJECTS Subjects included 433 elite RGs and 427 AGs, aged 11-23 yr. INTERVENTION There were no interventions. MAIN OUTCOME MEASURES Mean chronological and bone ages of each pubertal stage and their relation to the intensity of training were measured. RESULTS AGs and RGs showed a delay in skeletal maturation (Delta age-bone age, 2.13 and 1.28, respectively; P < 0.001). AGs were subjected to higher levels of physical training. Thelarche occurred at 12.9 yr for RGs and 13.2 yr for AGs (P = 0.003) and pubarche at 12.5 and 12.9 yr, respectively (P = 0.002). Puberty was delayed but normally progressed. AGs entered each pubertal stage later than RGs. The delay was influenced by the amount of energy output. Menarcheal age was 14.6 yr for RGs and 14.9 yr for AGs. Menarche was influenced in AGs by bone age (b = 0.333; t = 2.521; P = 0.020), pubarche (b = 0.322; t = 2.401; P = 0.026), and body fat (b = -0.458; t = -3.412; P = 0.003) and in RGs by bone age (b = 0.378; t = 3.689; P < 0.001) and pubarche (b = 0.525; t = 6.017; P < 0.001). CONCLUSION In RGs and AGs, pubertal development was shifted to a later age, maintaining a normal rate of progression, which followed the bone age. AGs, who were exposed to a greater and more sustained energy output than RGs, presented a more pronounced delay in both skeletal maturation and pubertal development.
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Affiliation(s)
- Anastasia Theodoropoulou
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, University Hospital, Rio-26500, Greece
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Habeos IG, Theodoropoulou A, Michalaki M, Kyriazopoulou V, Vagenakis AG, Psyrogiannis A. Insulin sensitivity and fibrinogen concentrations in normoglycaemic offspring of Type 2 diabetic parents. Diabet Med 2005; 22:1122-3. [PMID: 16026385 DOI: 10.1111/j.1464-5491.2005.01592.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Georgopoulos NA, Markou KB, Theodoropoulou A, Vagenakis GA, Mylonas P, Vagenakis AG. Growth, pubertal development, skeletal maturation and bone mass acquisition in athletes. Hormones (Athens) 2004; 3:233-43. [PMID: 16982598 DOI: 10.14310/horm.2002.11132] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The genetic potentials for growth can be fully expressed only under favourable environmental conditions. Excessive physical training may negatively affect growth, especially during puberty. Sports that require a strict control of energy input in the presence of a high energy output are of particular concern. In gymnastics, a different pattern in skeletal maturation was observed, leading to an attenuation of growth potential ins Artistic Gymnasts (AG), more pronounced in males than in females, whereas in female Rhythmic Gymnasts (RG) the genetic predisposition to growth was preserved because of a late catch-up growth phenomenon. In all other sports not requiring strict dietary restrictions, no deterioration of growth has been documented. Intensive physical training and negative energy balance modify the hypothalamic pituitary set point at puberty, prolong the prepubertal stage and delay pubertal development and menarche in a variety of sports. In elite RG and AG the prepubertal stage is prolonged and pubertal development is entirely shifted to a later age, paralleling the bone age rather than the chronological age. Bone formation, and, consequently, BMD are enhanced by physical activity. In athletes, high-impact loading activities have been shown to improve BMD, while in sports requiring a lean somatotype, the delay in skeletal maturation and pubertal development, resulting from hypoestrogenemia, predisposes athletes to osteopenia. In AG, an increase in bone density is observed using the bone age as denominator.
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Affiliation(s)
- Neoklis A Georgopoulos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, University Hospital, Patras, 26500, Greece
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Markou KB, Mylonas P, Theodoropoulou A, Kontogiannis A, Leglise M, Vagenakis AG, Georgopoulos NA. The influence of intensive physical exercise on bone acquisition in adolescent elite female and male artistic gymnasts. J Clin Endocrinol Metab 2004; 89:4383-7. [PMID: 15328065 DOI: 10.1210/jc.2003-031865] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2003] [Accepted: 03/28/2004] [Indexed: 02/12/2023]
Abstract
Physical exercise enhances bone acquisition during adolescence. The aim of the study was to evaluate the influence of intensive physical exercise on bone acquisition in adolescent elite artistic gymnasts. The study included 262 athletes (93 males and 169 females, aged 13-23 yr) participating in the 24th European Championship held in Greece. Bone age compared with chronological age was delayed by 2 yr for females (n = 120) and 1 yr for males (n = 68). For both sexes, the growth chart of bone mineral density (BMD) followed a normal pattern when estimated according to bone age rather than chronological age. For females, BMD was positively correlated with bone age, chronological age, height, body weight, body mass index, body fat, lean body mass, and with age of onset of training, and negatively with duration of exercise and intensity of training (P values range from <0.05 to <0.0001). Multiple regression analysis revealed that age of onset of training was the major parameter attenuating the effect of exercise on BMD (P < 0.001). The latter was related to the stage of puberty (P < 0.05). For males, BMD was correlated positively with bone age, height, body weight, and lean body mass (P values range from <0.01 to 0.0001). Multiple regression analysis revealed that the more powerful factor influencing BMD was weight (P < 0.01). In conclusion, bone acquisition in adolescents under intensive physical training follows the normal pattern only when estimated according to bone age. The age of onset, the duration, and the intensity of exercise attenuate the bone acquisition, at least in female artistic gymnasts.
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Affiliation(s)
- Kostas B Markou
- Division of Endocrinology, University of Patras Medical School, 26500 Patras, Greece
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Georgopoulos NA, Theodoropoulou A, Leglise M, Vagenakis AG, Markou KB. Growth and skeletal maturation in male and female artistic gymnasts. J Clin Endocrinol Metab 2004; 89:4377-82. [PMID: 15328064 DOI: 10.1210/jc.2003-031864] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2003] [Accepted: 03/29/2004] [Indexed: 11/19/2022]
Abstract
We studied 262 athletes who were 13-23 yr old. There were 93 male and 169 female artistic gymnasts (AG). This study is unique in character, because all variables were measured on the field of competition (24th European Championship). Male AG had a higher height SD score than female (P < 0.001), with a higher reported target height SD score (P < 0.001), a higher predicted final height (P = 0.007), a lower Delta height - target height (P < 0.001), a less delayed bone age (P < 0.001), a greater body mass index (BMI) (P < 0.001), a lower mean body fat (P<0.001), and an older age of onset of training (P < 0.001). In a subgroup of athletes who had reached final height, male AG had a higher weight SD score than female (t = 4.322, P < 0.001), with a higher reported target height SD score (t = 18.9, P<0.001), but a greater Delta final height-target height (t= 6.641, P < 0.001). Height SD score was positively correlated to reported target height SD score (P = 0.009 and P = 0.006, respectively) and to weight SD (P < 1 and P < 0.001, respectively) for both male and female AG, as well as to BMI for female AG (P<0.001), and negatively to Delta age - bone age (P < 0.001 and P = 0.003, respectively) and to predicted height SD score (P = 0.001 and P < 0.001, respectively). Using multiple regression analysis, height SD score was positively correlated to predicted height SD score for both male (P < 0.001) and female (P = 0.005) AG, as well as to weight SD score (P < 0.001) for female AG and negatively to BMI (P < 0.001) for female AG and to Delta age - bone age (P < 0.001) for male AG. In conclusion, a deterioration of growth in AG was observed. For both sexes, genetic predisposition to final height, although altered, was not disrupted.
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Affiliation(s)
- Neoklis A Georgopoulos
- Department of Obstetrics and Gynecology, University of Patras Medical School, University Hospital, 26500 Patras, Greece
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Georgopoulos NA, Markou KB, Theodoropoulou A, Benardot D, Leglise M, Vagenakis AG. Growth retardation in artistic compared with rhythmic elite female gymnasts. J Clin Endocrinol Metab 2002; 87:3169-73. [PMID: 12107219 DOI: 10.1210/jcem.87.7.8640] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We studied 129 female rhythmic gymnasts (RG) and 142 female artistic gymnasts (AG) who participated in the 1999 Gymnastics World Championship for RG in Osaka, Japan, and the 1999 and 2001 Gymnastics World Championships for AG in Tianjin, China (n = 48), and Ghent, Belgium (n = 94), respectively. RG were taller than average, with a mean height SD score above the 50th percentile, whereas AG were relatively short, with a mean height SD score below the 50th percentile. Both RG and AG followed their respective reported target height SD score, which was above the 50th percentile for the RG and below the 50th percentile for the AG. The RG followed a growth pattern that was higher than their reported target height, whereas AG exhibited a negative growth pattern. RG and AG weighed less than the population mean, with the mean weight for age below the 50th percentile for both groups. RG were taller than AG (t = 17.15; P < 0.001), with a higher reported target height SD score (t = 6.44; P < 0.001), a greater Delta height-reported target height (t = 2.74; P < 0.001), and a lower mean body fat (t = -11.83; P < 0.001) and body mass index (t = -10.73; P < 0.001) than AG. AG started their training at an earlier age than RG (t = 4.13; P < 0.001). Using multiple regression analysis, actual height SD score was independently influenced positively by weight SD score for both RG (b = 0.421; t = 4.317; P < 0.001) and AG (b = 1.404; t = 16.514; P = <0.001), and by reported target height only for RG (b = 0.299; t = 3.139; P = 0.002), and negatively by body mass index only for AG (b = -0.80; t = -9.88; P < 0.001). In conclusion, in elite female AG, a deterioration of growth potential was observed, whereas in RG the genetic predisposition to growth was preserved.
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Affiliation(s)
- Neoklis A Georgopoulos
- Department of Medicine, Division of Endocrinology, University of Patras Medical School, University Hospital, Patras, 26500 Greece
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Georgopoulos NA, Markou KB, Theodoropoulou A, Vagenakis GA, Benardot D, Leglise M, Dimopoulos JC, Vagenakis AG. Height velocity and skeletal maturation in elite female rhythmic gymnasts. J Clin Endocrinol Metab 2001; 86:5159-64. [PMID: 11701670 DOI: 10.1210/jcem.86.11.8041] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Rhythmic gymnasts performing under conditions of high intensity are exposed to particularly high levels of psychological stress and intense physical training, factors that can contribute to the observed delay in skeletal maturation and pubertal development, and alter optimal growth. The study was conducted in the field, during the International, European, and World Rhythmic Sports Gymnastics Championships of the years 1997-2000, and included 104 elite female rhythmic gymnasts, aged 12-23 yr. The study included height and weight measurements, estimation of body fat and skeletal maturation, and registration of parental height. Height, weight, target height, and predicted adult height were expressed as the SD score of the mean height and weight for age, according to Tanner's standards. Gymnasts were taller and thinner than average for age, with height velocity SD score for each age group above the 50th percentile for all age groups (n = 140, mean = 1.9 +/- 2.5). Interestingly, although height velocity in normal girls comes to an end by the age of 15, in our examined rhythmic gymnasts it continues up to the age of 18. There was a delay of skeletal maturation of 1.8 yr (n = 72, r = 0.730, P < 0.001), compensated by an acceleration of height velocity toward the end of puberty. The final adult height was identical to the estimated predicted height at first evaluation, and significantly higher than the genetically determined target height (n = 35, r = 0.58, P < 0.001), denoting that genetic predisposition to final height is not only achieved, but even exceeded. Using multiple regression analysis, target height was the only independent parameter that has been proven to influence positively the height velocity SD score (b = 0.233, t = 2.215, P = 0.029), denoting that genetic predisposition remains the main driving force for the observed efficient catch up growth. In conclusion, the elite rhythmic gymnasts compensate for their loss of pubertal growth spurt by a late acceleration of linear growth. Despite the delay in skeletal maturation, genetic predisposition of growth is not only preserved, but even exceeded.
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Affiliation(s)
- N A Georgopoulos
- Department of Medicine, Division of Endocrinology, University of Patras Medical School, University Hospital, Patras, 26500 Greece
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Koutroubakis IE, Sfiridaki A, Theodoropoulou A, Kouroumalis EA. Role of acquired and hereditary thrombotic risk factors in colon ischemia of ambulatory patients. Gastroenterology 2001; 121:561-5. [PMID: 11522740 DOI: 10.1053/gast.2001.27227] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS Hypercoagulable states may play an important role in the pathogenesis of colon ischemia. Aim of this study was to assess this hypothesis investigating the role of acquired and hereditary thrombotic risk factors in patients with definite diagnosis of colon ischemia. METHODS We compared the frequency of antiphospholipid antibodies, protein C, protein S, and antithrombin deficiencies, factor V Leiden, prothrombin gene mutation G20210GA, and methylenetetrahydrofolate reductase C677T in 36 patients (23 men, 13 women; mean age, 64.8 years) with colon ischemia, 18 patients with diverticulitis, and 52 healthy controls. RESULTS The prevalence of antiphospholipid antibodies was significantly higher in patients with colon ischemia compared with inflammatory and healthy controls (19.4% vs. 0% and 1.9%). Among genetic factors, only factor V Leiden was significantly associated with colon ischemia (22.2% vs. 0% and 3.8%). A combination of thrombophilic disorders was found in 25% of the cases. Overall, one or several prothrombotic abnormalities were present in 26 patients (72%). CONCLUSIONS A comprehensive thrombophilic screening in colon ischemia reveals a congenital or acquired thrombophilic state in 72% of patients. Hereditary and acquired thrombotic risk factors may play an important role in the disease pathogenesis.
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Affiliation(s)
- I E Koutroubakis
- Department of Gastroenterology, University Hospital Heraklion, Crete, Greece.
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Georgopoulos N, Markou K, Theodoropoulou A, Paraskevopoulou P, Varaki L, Kazantzi Z, Leglise M, Vagenakis AG. Growth and pubertal development in elite female rhythmic gymnasts. J Clin Endocrinol Metab 1999; 84:4525-30. [PMID: 10599712 DOI: 10.1210/jcem.84.12.6177] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Optimal growth depends upon both environmental and genetic factors. Among environmental factors that could alter growth and sexual maturation are stress and intensive physical training. The influence of these factors has been documented in a variety of sports, but there is limited information on rhythmic gymnasts, who have entirely different training and performance requirements. The study was conducted during the 13th European Championships in Patras, Greece, and included 255 female rhythmic gymnasts, aged 11-23 yr. The study included measurement of height and weight, assessment of breast and pubic hair development, estimation of body fat and skeletal maturation, and registration of menarcheal age and parental height. Gymnasts were taller than average height for age, with mean height above and mean weight below the 50th percentile. Actual height SD score was positively correlated to weight SD score (P < 0.001), number of competitions (P = 0.01), and body mass index (BMI; P < 0.001). Predicted adult height SD score was positively correlated to weight SD score (P < 0.001) and negatively to body fat (P = 0.004). There was a delay in skeletal maturation of 1.3 yr (P < 0.001). Pubertal development was following bone age rather than chronological age. The mean age of menarche was significantly delayed from that of their mothers and sisters (P = 0.008 and P = 0.05, respectively), was positively correlated to the intensity of training and to the difference between chronological age and bone age (P < 0.001 and P = 0.002, respectively), and was negatively correlated to body fat (P < 0.001). In the elite female rhythmic gymnasts, psychological and somatic efforts have profound effects on growth and sexual development. Despite these aberrations, adult height is not expected to be affected.
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Affiliation(s)
- N Georgopoulos
- Department of Medicine, University of Patras Medical School, University Hospital, Greece
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