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Kakaletsis N, Ntaios G, Milionis H, Karagiannaki A, Chouvarda I, Dourliou V, Chytas A, Hatzitolios AI, Savopoulos C. Prognostic significance of 24-h blood pressure and variability indices in the outcome of acute ischaemic stroke. Intern Med J 2023; 53:1137-1146. [PMID: 35666577 DOI: 10.1111/imj.15834] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/29/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The association between blood pressure (BP) levels and BP variability (BPV) following acute ischaemic stroke (AIS) and outcome remains controversial. AIMS To investigate the predictive value of systolic BP (SBP) and diastolic BP (DBP) and BPV measured using 24-h ambulatory blood pressure monitoring (ABPM) methods during AIS regarding outcome. METHODS A total of 228 AIS patients (175 without prior disability) underwent ABPM every 20 min within 48 h from onset using an automated oscillometric device (TM 2430, A&D Company Ltd) during day time (7:00-22:59) and night time (23:00-6:59). Risk factors, stroke subtypes, clinical and laboratory findings were recorded. Mean BP parameters and several BPV indices were calculated. End-points were death and unfavourable functional outcome (disability/death) at 3 months. RESULTS A total of 61 (26.7%) patients eventually died. Multivariate logistic regression analysis revealed that only mean night-time DBP (hazard ratio (HR): 1.04; 95% confidence interval (CI): 1.00-1.07) was an independent prognostic factor of death. Of the 175 patients without prior disability, 79 (45.1%) finally met the end-point of unfavourable functional outcome. Mean 24-h SBP (HR: 1.03; 95% CI: 1.00-1.05), day-time SBP (HR: 1.02; 95% CI: 1.00-1.05) and night-time SBP (HR: 1.03; 95% CI: 1.01-1.05), SBP nocturnal decline (HR: 0.93; 95% CI: 0.88-0.99), mean 24-h DBP (HR: 1.08; 95% CI: 1.03-1.13), day-time DBP (HR: 1.07; 95% CI: 1.03-1.12) and night-time DBP (HR: 1.06; 95% CI: 1.02-1.10) were independent prognostic factors of an unfavourable functional outcome. CONCLUSIONS In contrast with BPV indices, ABPM-derived BP levels and lower or absence of BP nocturnal decline in the acute phase are prognostic factors of outcome in AIS patients.
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Affiliation(s)
- Nikolaos Kakaletsis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, Medical School, University of Ioannina, University Hospital of Ioannina, Ioannina, Greece
| | - Anastasia Karagiannaki
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Ioanna Chouvarda
- Laboratory of Medical Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasiliki Dourliou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Achileas Chytas
- Laboratory of Medical Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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Papagiannis A, Gkolfinopoulou C, Tziomalos K, Dedemadi AG, Polychronopoulos G, Milonas D, Savopoulos C, Hatzitolios AI, Chroni A. HDL cholesterol efflux capacity and phospholipid content are associated with the severity of acute ischemic stroke and predict its outcome. Clin Chim Acta 2023; 540:117229. [PMID: 36657609 DOI: 10.1016/j.cca.2023.117229] [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] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/08/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND/AIMS Impaired high-density lipoprotein (HDL) function and composition are more strongly related to cardiovascular morbidity than HDL concentration. However, it is unclear whether HDL function and composition predict ischemic stroke severity and outcome. We aimed to evaluate these associations. METHODS We prospectively studied 199 consecutive patients who were admitted with acute ischemic stroke. The severity of stroke was evaluated at admission with the National Institutes of Health Stroke Scale (NIHSS). Severe stroke was defined as NIHSS ≥ 5. The outcome was assessed with dependency at discharge (modified Rankin scale 2-5) and in-hospital mortality. Cholesterol efflux capacity (CEC), phospholipid levels, lecithin:cholesterol acyl transferase (LCAT)-phospholipase activity, paraoxonase-1 (PON1)-arylesterase activity and serum amyloid A1 (SAA1) content of HDL were measured. RESULTS CEC, phospholipid levels and LCAT-phospholipase activity of HDL were lower and SAA1 content of HDL was higher in patients with severe stroke. Patients who were dependent at discharge had lower CEC, PON1-arylesterase activity, phospholipid content and LCAT-phospholipase activity of HDL and higher HDL-SAA1 content. Independent predictors of dependency at discharge were the NIHSS at admission (RR 2.60, 95% CI 1.39-4.87), lipid-lowering treatment (RR 0.17, 95% CI 0.01-0.75), HDL-CEC (RR 0.21, 95% CI 0.05-0.87) and HDL-associated PON1-arylesterase activity (RR 0.95, 95% CI 0.91-0.99). In patients who died during hospitalization, phospholipids, LCAT-phospholipase and PON1-arylesterase activities of HDL were lower. CONCLUSIONS Changes in CEC and composition of HDL appear to be associated with the severity and outcome of acute ischemic stroke and could represent biomarkers that may inform risk stratification and management strategies in these patients.
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Affiliation(s)
- Achilleas Papagiannis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christina Gkolfinopoulou
- Institute of Biosciences and Applications, National Centre for Scientific Research "Demokritos", Agia Paraskevi, Athens, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
| | - Anastasia-Georgia Dedemadi
- Institute of Biosciences and Applications, National Centre for Scientific Research "Demokritos", Agia Paraskevi, Athens, Greece
| | - Georgios Polychronopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Dimitrios Milonas
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Angeliki Chroni
- Institute of Biosciences and Applications, National Centre for Scientific Research "Demokritos", Agia Paraskevi, Athens, Greece.
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Galanis P, Konstantakopoulou O, Karagkouni I, Gallos P, Tsampalas E, Lypiridou M, Gamvroula A, Mavraganis G, Manios E, Ntaios G, Karagkiozi E, Milionis H, Evangelou C, Tountopoulou A, Kouzi I, Vassilopoulou S, Protogerou A, Samara S, Karapiperi A, Savopoulos C, Hatzitolios AI, Myrou A, Kalliontzakis I, Kouridaki A, Papastefanatos S, Papastefanatos G, Vemmos K, Sourtzi P, Bellali T, Korompoki E, Kaitelidou D, Siskou O. Assessing Staff's and Stroke Patients' Experiences in 8 Hospitals in Greece: Results from a Prospective Multi-Center Study ("SUN4Patients"). Stud Health Technol Inform 2022; 289:392-396. [PMID: 35062174 DOI: 10.3233/shti210941] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED To assess stroke patient-reported experiences and hospital staff experiences, during hospital stay. METHODS Stroke patient-reported experiences (n=387) were recorded using the translated and culturally adapted NHS-Stroke Questionnaire into Greek and staff experiences (n=236) were investigated using the Compassion Satisfaction and Burnout subscales of the ProQOL questionnaire. RESULTS Staff's mean compassion satisfaction score was 39.2 (SD=6.3) and mean burnout score was 24.3 (SD=5.6). Only 38.5% of the staff stated that there is smooth cooperation with healthcare professionals of other specialties/disciplines. Personnel working in an NHS Hospital was more satisfied and less burned-out when compared to personnel working at a University Hospital (p=0.02 and p<0.001, respectively). Mean total patient-reported experiences score was 81.9 (SD=9.5). Bivariate analysis revealed statistically significant differences for total patient-reported experiences among the eight study hospitals (p>0.001). CONCLUSIONS Health policy planners and decision-makers must take into consideration the results of such self-reported measures to establish innovative techniques to accomplish goals such as staff-specialization, continuous training and applying formal frameworks for efficient cooperation amongst different disciplines.
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Affiliation(s)
- Petros Galanis
- Center for Health Services Management and Evaluation, Nursing Department, NKUA, Athens, Greece
| | | | - Iliana Karagkouni
- Center for Health Services Management and Evaluation, Nursing Department, NKUA, Athens, Greece
| | - Paris Gallos
- Center for Health Services Management and Evaluation, Nursing Department, NKUA, Athens, Greece
| | | | - Maria Lypiridou
- Department of Neurology, Panarkadikon General Hospital, Tripoli, Greece
| | | | - Georgios Mavraganis
- Department of Clinical Therapeutics, Alexandra Hospital, NKUA, Athens, Greece
| | - Efstathios Manios
- Department of Clinical Therapeutics, Alexandra Hospital, NKUA, Athens, Greece
| | - George Ntaios
- Hellenic Stroke Organization, Athens, Greece
- Department of Internal Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Efstathia Karagkiozi
- Department of Internal Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Greece
| | - Chara Evangelou
- Department of Internal Medicine, School of Medicine, University of Ioannina, Greece
| | | | - Ioanna Kouzi
- Department of Neurology, Eginition Hospital, NKUA, Athens, Greece
| | | | - Athanasios Protogerou
- Cardiovascular Prevention & Research Unit, Laiko General Hospital, Medical School NKUA, Athens, Greece
| | - Stamatina Samara
- Cardiovascular Prevention & Research Unit, Laiko General Hospital, Medical School NKUA, Athens, Greece
| | - Asteria Karapiperi
- Cardiovascular Prevention & Research Unit, Laiko General Hospital, Medical School NKUA, Athens, Greece
| | - Christos Savopoulos
- 1st Propaedeutic Internal Medicine Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- 1st Propaedeutic Internal Medicine Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Athina Myrou
- 1st Propaedeutic Internal Medicine Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | | | | | - Stefanos Papastefanatos
- Center for Health Services Management and Evaluation, Nursing Department, NKUA, Athens, Greece
| | | | | | - Panayiota Sourtzi
- Center for Health Services Management and Evaluation, Nursing Department, NKUA, Athens, Greece
| | - Thalia Bellali
- Department of Nursing, International Hellenic University, Thessaloniki, Greece
| | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital, NKUA, Athens, Greece
- Hellenic Stroke Organization, Athens, Greece
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Nursing Department, NKUA, Athens, Greece
| | - Olga Siskou
- Center for Health Services Management and Evaluation, Nursing Department, NKUA, Athens, Greece
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Siskou O, Korompoki E, Ntaios G, Tsampalas E, Alexopoulou H, Kalliontzakis I, Kouridaki A, Tountopoulou A, Kouzi I, Vasilopoulou S, Milionis H, Evaggelou H, Karagkiozi E, Hatzitolios AI, Savopoulos C, Myrou A, Manios E, Mavraganis G, Vemmou A, Kaitelidou D, Galanis P, Papastefanatos S, Konstantakopoulou O, Karagkouni I, Vemmos K. Access of Stroke Patients' to Optimal Healthcare Technology in Greece: Messages to Policy Makers. Stud Health Technol Inform 2020; 272:421-424. [PMID: 32604692 DOI: 10.3233/shti200585] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this study was to evaluate accessibility of stroke patients to optimal healthcare technology in Greece. Methods: The study population consisted of 313 first ever stroke patients derived from the "Stroke Units Necessity for Patients, SUN4P" registry. Descriptive statistics were used, to present patients' characteristics and resources utilization Results: The vast majority of patients (91.7%) conducted a CT scan during the acute phase (within the first 24hours). Almost, (65%) were admitted to wards of Internal Medicine Departments, whereas only 21% of patients were admitted to a Stroke Unit. Of note, a total of 6.9% of ischemic stroke patients received intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rtPA). Conclusions: Preliminary results from SUN4P underline the urgent necessity for the re-organization of acute stroke care in Greece, as rates of admissions to stroke units and rtPA treatment during the acute phase are currently below optimal.
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Affiliation(s)
- Olga Siskou
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Stroke Organization, Greece
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
- Hellenic Stroke Organization, Greece
| | | | - Helen Alexopoulou
- Department of Neurology, Panarkadikon General Hospital, Tripoli, Greece
| | | | | | - Argyro Tountopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Kouzi
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Vasilopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Hara Evaggelou
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Efstathia Karagkiozi
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Apostolos I Hatzitolios
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Athina Myrou
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Efstathios Manios
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Vemmou
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Galanis
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian University of Athens, Athens, Greece
| | - Stefanos Papastefanatos
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian University of Athens, Athens, Greece
| | - Olympia Konstantakopoulou
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian University of Athens, Athens, Greece
| | - Iliana Karagkouni
- Center for Health Services Management and Evaluation, Department of Nursing National and Kapodistrian University of Athens, Athens, Greece
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5
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Konstantakopoulou O, Galanis P, Kaitelidou D, Karagkouni I, Korompoki E, Ntaios G, Vemmos K, Papastefanatos S, Papastefanatos G, Tsampalas E, Alexopoulou H, Kalliontzakis I, Kouridaki A, Tountopoulou A, Kouzi I, Milionis H, Evaggelou C, Karagkiozi E, Hatzitolios AI, Savopoulos C, Myrou A, Mavraganis G, Vemmou A, Siskou O. Developing Patients' Experiences Database After Hospital Discharge: Another Step in Improving Stroke Care. Stud Health Technol Inform 2020; 272:441-444. [PMID: 32604697 DOI: 10.3233/shti200590] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to assess stroke patients' experiences in regards to hospital stay and during discharge. A cross-sectional study with retrospective data collection was conducted including patients (n=135) with first-ever acute stroke, who were admitted in seven Public Hospitals in Greece ("Stroke Units Necessity for Patients, SUN4P" registry). The translated version of the NHS-Stroke Questionnaire in the Greek was used. 48.2% of patients rated their overall experience from the care they received as very good/excellent. 66% of patients reported that they participated in decision making about their care and 21.5% reported not having received help from the hospital's social services regarding any benefits/aids, thus lowering their overall patient experience score (p=0.017). Decision and policymakers must consider factors affecting stroke patients 'experiences during their hospitalization. The development of a national stroke patients' experiences database can help prioritize relevant actions and draw up a commonly accepted management and services redesign framework for patients.
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Affiliation(s)
- Olympia Konstantakopoulou
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, Athens Greece
| | - Petros Galanis
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, Athens Greece
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, Athens Greece
| | - Iliana Karagkouni
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, Athens Greece
| | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens Greece.,Hellenic Stroke Organization, Greece
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa Greece.,Hellenic Stroke Organization, Greece
| | | | - Stefanos Papastefanatos
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, Athens Greece
| | | | | | - Helen Alexopoulou
- Department of Neurology, Panarkadikon General Hospital, Tripoli, Greece
| | | | | | - Argyro Tountopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Kouzi
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Chara Evaggelou
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Efstathia Karagkiozi
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa Greece
| | - Apostolos I Hatzitolios
- 1st Propaedeutic Internal Medicine Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- 1st Propaedeutic Internal Medicine Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Athina Myrou
- 1st Propaedeutic Internal Medicine Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens Greece
| | - Anastasia Vemmou
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens Greece
| | - Olga Siskou
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, Athens Greece
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6
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Willeit P, Tschiderer L, Allara E, Reuber K, Seekircher L, Gao L, Liao X, Lonn E, Gerstein HC, Yusuf S, Brouwers FP, Asselbergs FW, van Gilst W, Anderssen SA, Grobbee DE, Kastelein JJP, Visseren FLJ, Ntaios G, Hatzitolios AI, Savopoulos C, Nieuwkerk PT, Stroes E, Walters M, Higgins P, Dawson J, Gresele P, Guglielmini G, Migliacci R, Ezhov M, Safarova M, Balakhonova T, Sato E, Amaha M, Nakamura T, Kapellas K, Jamieson LM, Skilton M, Blumenthal JA, Hinderliter A, Sherwood A, Smith PJ, van Agtmael MA, Reiss P, van Vonderen MGA, Kiechl S, Klingenschmid G, Sitzer M, Stehouwer CDA, Uthoff H, Zou ZY, Cunha AR, Neves MF, Witham MD, Park HW, Lee MS, Bae JH, Bernal E, Wachtell K, Kjeldsen SE, Olsen MH, Preiss D, Sattar N, Beishuizen E, Huisman MV, Espeland MA, Schmidt C, Agewall S, Ok E, Aşçi G, de Groot E, Grooteman MPC, Blankestijn PJ, Bots ML, Sweeting MJ, Thompson SG, Lorenz MW. Carotid Intima-Media Thickness Progression as Surrogate Marker for Cardiovascular Risk: Meta-Analysis of 119 Clinical Trials Involving 100 667 Patients. Circulation 2020; 142:621-642. [PMID: 32546049 DOI: 10.1161/circulationaha.120.046361] [Citation(s) in RCA: 212] [Impact Index Per Article: 53.0] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND To quantify the association between effects of interventions on carotid intima-media thickness (cIMT) progression and their effects on cardiovascular disease (CVD) risk. METHODS We systematically collated data from randomized, controlled trials. cIMT was assessed as the mean value at the common-carotid-artery; if unavailable, the maximum value at the common-carotid-artery or other cIMT measures were used. The primary outcome was a combined CVD end point defined as myocardial infarction, stroke, revascularization procedures, or fatal CVD. We estimated intervention effects on cIMT progression and incident CVD for each trial, before relating the 2 using a Bayesian meta-regression approach. RESULTS We analyzed data of 119 randomized, controlled trials involving 100 667 patients (mean age 62 years, 42% female). Over an average follow-up of 3.7 years, 12 038 patients developed the combined CVD end point. Across all interventions, each 10 μm/y reduction of cIMT progression resulted in a relative risk for CVD of 0.91 (95% Credible Interval, 0.87-0.94), with an additional relative risk for CVD of 0.92 (0.87-0.97) being achieved independent of cIMT progression. Taken together, we estimated that interventions reducing cIMT progression by 10, 20, 30, or 40 μm/y would yield relative risks of 0.84 (0.75-0.93), 0.76 (0.67-0.85), 0.69 (0.59-0.79), or 0.63 (0.52-0.74), respectively. Results were similar when grouping trials by type of intervention, time of conduct, time to ultrasound follow-up, availability of individual-participant data, primary versus secondary prevention trials, type of cIMT measurement, and proportion of female patients. CONCLUSIONS The extent of intervention effects on cIMT progression predicted the degree of CVD risk reduction. This provides a missing link supporting the usefulness of cIMT progression as a surrogate marker for CVD risk in clinical trials.
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Affiliation(s)
- Peter Willeit
- Department of Neurology, Medical University of Innsbruck, Austria (P.W., L.T., L.S., S.K., G.K.)
| | - Lena Tschiderer
- Department of Neurology, Medical University of Innsbruck, Austria (P.W., L.T., L.S., S.K., G.K.)
| | - Elias Allara
- Department of Public Health and Primary Care, University of Cambridge, United Kingdom (P.W., E.A., M.J.S., S.G.T.)
| | - Kathrin Reuber
- Department of Neurology, Goethe University, Frankfurt am Main, Germany (K.R., X.L., M. Sitzer., M.W.L.)
| | - Lisa Seekircher
- Department of Neurology, Medical University of Innsbruck, Austria (P.W., L.T., L.S., S.K., G.K.)
| | - Lu Gao
- MRC Biostatistics Unit, University of Cambridge, United Kingdom (L.G.)
| | - Ximing Liao
- Department of Neurology, Goethe University, Frankfurt am Main, Germany (K.R., X.L., M. Sitzer., M.W.L.)
| | - Eva Lonn
- Department of Medicine and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (E.L., H.C.G., S.Y.)
| | | | - Salim Yusuf
- Hamilton General Hospital, Ontario, Canada (E.L., H.C.G., S.Y.)
| | - Frank P Brouwers
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (F.P.B.)
| | - Folkert W Asselbergs
- Department of Cardiology (F.W.A.), University Medical Center Utrecht, The Netherlands
| | - Wiek van Gilst
- Department of Experimental Cardiology, University Medical Center Groningen, The Netherlands (W.v.G.)
| | - Sigmund A Anderssen
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway (S.A.A.)
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care (D.E.G., M.L.B.), University Medical Center Utrecht, The Netherlands
| | - John J P Kastelein
- Department of Vascular Medicine (J.J.P.K., E.S.), Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine (F.L.J.V.), University Medical Center Utrecht, The Netherlands
| | - George Ntaios
- Department of Medicine, University of Thessaly, Larissa, Greece (G.N.)
| | - Apostolos I Hatzitolios
- 1st Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Greece (A.I.H., C.S.)
| | - Christos Savopoulos
- 1st Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Greece (A.I.H., C.S.)
| | - Pythia T Nieuwkerk
- Department of Neurology, Medical University of Innsbruck, Austria (P.W., L.T., L.S., S.K., G.K.)
| | - Erik Stroes
- Department of Vascular Medicine (J.J.P.K., E.S.), Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Matthew Walters
- School of Medicine, Dentistry and Nursing (M.W.), University of Glasgow, United Kingdom
| | - Peter Higgins
- Institute of Cardiovascular and Medical Sciences (P.H., J.D.), University of Glasgow, United Kingdom
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences (P.H., J.D.), University of Glasgow, United Kingdom
| | - Paolo Gresele
- Division of Internal and Cardiovascular Medicine, Department of Medicine, University of Perugia, Italy (P.G., G.G.)
| | - Giuseppe Guglielmini
- Division of Internal and Cardiovascular Medicine, Department of Medicine, University of Perugia, Italy (P.G., G.G.)
| | - Rino Migliacci
- Division of Internal Medicine, Cortona Hospital, Italy (R.M.)
| | - Marat Ezhov
- Laboratory of Lipid Disorders, National Medical Research Center of Cardiology, Moscow, Russia (M.E.), National Medical Research Center of Cardiology, Moscow, Russia
| | - Maya Safarova
- Atherosclerosis Department (M. Safarova), National Medical Research Center of Cardiology, Moscow, Russia
| | - Tatyana Balakhonova
- Ultrasound Vascular Laboratory (T.B.), National Medical Research Center of Cardiology, Moscow, Russia
| | - Eiichi Sato
- Division of Nephrology, Shinmatsudo Central General Hospital, Chiba, Japan (E.S., M.A., T.N.)
| | - Mayuko Amaha
- Division of Nephrology, Shinmatsudo Central General Hospital, Chiba, Japan (E.S., M.A., T.N.)
| | - Tsukasa Nakamura
- Division of Nephrology, Shinmatsudo Central General Hospital, Chiba, Japan (E.S., M.A., T.N.)
| | - Kostas Kapellas
- Australian Research Centre for Population Oral Health, University of Adelaide, SA, Australia (K.K., L.M.J.)
| | - Lisa M Jamieson
- Australian Research Centre for Population Oral Health, University of Adelaide, SA, Australia (K.K., L.M.J.)
| | - Michael Skilton
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, NSW, Australia (M.Skilton)
| | - James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, (J.A.B., A.S., P.J.S.)
| | - Alan Hinderliter
- Department of Medicine, University of North Carolina, Chapel Hill (A.H.)
| | - Andrew Sherwood
- Department of Neurology, Medical University of Innsbruck, Austria (P.W., L.T., L.S., S.K., G.K.)
| | - Patrick J Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, (J.A.B., A.S., P.J.S.)
| | - Michiel A van Agtmael
- Department of Internal Medicine (M.A.v.A.) Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Peter Reiss
- Amsterdam Institute for Global Health and Development, University of Amsterdam, The Netherlands (P.R.)
| | - Marit G A van Vonderen
- Department of Internal Medicine, Medical Center Leeuwarden, The Netherlands (M.G.A.v.V.)
| | - Stefan Kiechl
- VASCage GmbH, Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria (S.K.)
| | - Gerhard Klingenschmid
- Department of Neurology, Medical University of Innsbruck, Austria (P.W., L.T., L.S., S.K., G.K.)
| | - Matthias Sitzer
- Department of Neurology, Klinikum Herford, Herford, Germany (M. Sitzer)
| | - Coen D A Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, The Netherlands (C.D.A.S.)
| | - Heiko Uthoff
- Department of Angiology, University Hospital Basel, Switzerland (H.U.)
| | - Zhi-Yong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China (Z.-Y.Z.)
| | - Ana R Cunha
- Department of Clinical Medicine, State University of Rio de Janeiro, Brazil (A.R.C., M.F.N.)
| | - Mario F Neves
- Department of Clinical Medicine, State University of Rio de Janeiro, Brazil (A.R.C., M.F.N.)
| | - Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle-upon-Tyne Hospitals Trust, United Kingdom (M.D.W.)
| | - Hyun-Woong Park
- Department of Internal Medicine, Gyeongsang National University Hospital, Daejeon, South Korea (H.-W.P., M.-S.L.)
| | - Moo-Sik Lee
- Department of Preventive Medicine, Konyang University, Jinju, South Korea (M.-S.L.)
| | - Jang-Ho Bae
- Heart Center, Konyang University Hospital, Daejeon, South Korea (J.-H.B.)
| | - Enrique Bernal
- Infectious Diseases Unit, Reina Sofia Hospital, Murcia, Spain (E.B.)
| | - Kristian Wachtell
- Department of Cardiology, Oslo University Hospital, Norway (K.W., S.E.K.)
| | - Sverre E Kjeldsen
- Department of Cardiology, Oslo University Hospital, Norway (K.W., S.E.K.)
| | - Michael H Olsen
- Department of Internal Medicine, Holbaek Hospital, University of Southern Denmark, Odense (M.H.O.)
| | - David Preiss
- MRC Population Health Research Unit, Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (D.P.)
| | - Naveed Sattar
- BHF Glasgow Cardiovascular Research Centre (N.S.), University of Glasgow, United Kingdom
| | - Edith Beishuizen
- Infectious Diseases Unit, Reina Sofia Hospital, Murcia, Spain (E.B.)
| | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, The Netherlands (M.V.H.)
| | - Mark A Espeland
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (M.A.E.)
| | - Caroline Schmidt
- Wallenberg Laboratory for Cardiovascular Research, University of Gothenburg, Sweden (C.S.)
| | - Stefan Agewall
- Oslo University Hospital Ullevål and Institute of Clinical Sciences, University of Oslo, Norway (S.A.)
| | - Ercan Ok
- Nephrology Department, Ege University School of Medicine, Bornova-Izmir, Turkey (E.O, G.A.)
| | - Gülay Aşçi
- Nephrology Department, Ege University School of Medicine, Bornova-Izmir, Turkey (E.O, G.A.)
| | - Eric de Groot
- Imagelabonline & Cardiovascular, Eindhoven and Lunteren, the Netherlands (E.d.G.)
| | - Muriel P C Grooteman
- Department of Nephrology (M.P.C.G.), Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Peter J Blankestijn
- Department of Nephrology (P.J.B.), University Medical Center Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care (D.E.G., M.L.B.), University Medical Center Utrecht, The Netherlands
| | - Michael J Sweeting
- Department of Health Sciences, University of Leicester, United Kingdom (M.J.S.)
| | - Simon G Thompson
- Department of Public Health and Primary Care, University of Cambridge, United Kingdom (P.W., E.A., M.J.S., S.G.T.)
| | - Matthias W Lorenz
- Department of Neurology, Goethe University, Frankfurt am Main, Germany (K.R., X.L., M. Sitzer., M.W.L.)
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Petroglou D, Kanellos I, Savopoulos C, Kaiafa G, Chrysochoou A, Skantzis P, Daios S, Hatzitolios AI, Giannoglou G. The LDL-Receptor and its Molecular Properties: From Theory to Novel Biochemical and Pharmacological Approaches in Reducing LDL-cholesterol. Curr Med Chem 2020; 27:317-333. [PMID: 29865996 DOI: 10.2174/0929867325666180604114819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 02/25/2018] [Accepted: 05/31/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The Low-Density Lipoprotein (LDL) Receptor (LDL-R) is a transmembrane protein playing a crucial role in effective lipid homeostasis. Various therapeutic agents have been used in the management of dyslipidemias, however, the outcome of therapeutic target is debated. OBJECTIVE The aim of this review is to summarize and fully understand the current concept regarding LDL-R and its molecular properties, metabolic pathway, factors affecting LDL-R activity and all available pharmacological interventions. Additionally, non-lipid related properties of LDL-R are also referred. METHODS Literature from the PubMed database was extracted to identify papers between 1984 to 2017 regarding LDL-R and therapeutic agents on dyslipidemia management. RESULTS We analyzed basic data regarding agents associated with LDL-R (Sterol Regulating Element-Binding Proteins - SREBPs, Protein ARH, IDOL, Thyroid Hormones, Haematologic Disorders, Protein convertase subtilisin kexintype 9 - PCSK-9, ApoC-III) as well as non-lipid related properties of LDL-R, while all relevant (common and novel) pharmacological interventions (statins, fibrates, cholesterol absorption inhibitors, bile acid sequestrants and PCSK- 9) are also referred. CONCLUSION LDL-R and its molecular properties are involved in lipid homeostasis, so potentially sets the therapeutic goals in cardiovascular patients, which is usually debated. Further research is needed in order to fully understand its properties, as well as to find the potential pharmacological interventions that could be beneficial in cholesterol homeostasis and various morbidities in order to reach the most appropriate therapeutic goal.
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Affiliation(s)
- Dimitrios Petroglou
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ilias Kanellos
- 1st Propedeutic Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Savopoulos
- 1st Propedeutic Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Kaiafa
- 1st Propedeutic Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Chrysochoou
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Skantzis
- 1st Propedeutic Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stylianos Daios
- 1st Propedeutic Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- 1st Propedeutic Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Giannoglou
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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8
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Savopoulos C, Pilalas D, Kaiafa GD, Panagiotou G, Grammenou MC, Kouskouras K, Tegos T, Psomas E, Papa A, Foroglou N, Hatzitolios AI. West Nile virus neuroinvasive disease. QJM 2020; 113:125-126. [PMID: 31593223 DOI: 10.1093/qjmed/hcz255] [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: 09/15/2019] [Revised: 09/25/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Savopoulos
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - D Pilalas
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - G D Kaiafa
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - G Panagiotou
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - M-C Grammenou
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | | | - T Tegos
- First Department of Neurology, AHEPA University Hospital, Medical School, Aristotle University, Thessaloniki, Greece
| | - E Psomas
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - A Papa
- Department of Microbiology, Medical School, Aristotle University, Thessaloniki, Greece
| | - N Foroglou
- First Department of Neurosurgery, AHEPA University Hospital, Medical School, Aristotle University, Thessaloniki, Greece
| | - A I Hatzitolios
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
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9
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Bahls M, Lorenz MW, Dörr M, Gao L, Kitagawa K, Tuomainen TP, Agewall S, Berenson G, Catapano AL, Norata GD, Bots ML, van Gilst W, Asselbergs FW, Brouwers FP, Uthoff H, Sander D, Poppert H, Hecht Olsen M, Empana JP, Schminke U, Baldassarre D, Veglia F, Franco OH, Kavousi M, de Groot E, Mathiesen EB, Grigore L, Polak JF, Rundek T, Stehouwer CDA, Skilton MR, Hatzitolios AI, Savopoulos C, Ntaios G, Plichart M, McLachlan S, Lind L, Willeit P, Steinmetz H, Desvarieux M, Ikram MA, Johnsen SH, Schmidt C, Willeit J, Ducimetiere P, Price JF, Bergström G, Kauhanen J, Kiechl S, Sitzer M, Bickel H, Sacco RL, Hofman A, Völzke H, Thompson SG. Progression of conventional cardiovascular risk factors and vascular disease risk in individuals: insights from the PROG-IMT consortium. Eur J Prev Cardiol 2020; 27:234-243. [PMID: 31619084 PMCID: PMC7008553 DOI: 10.1177/2047487319877078] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/29/2019] [Indexed: 12/23/2022]
Abstract
AIMS Averaged measurements, but not the progression based on multiple assessments of carotid intima-media thickness, (cIMT) are predictive of cardiovascular disease (CVD) events in individuals. Whether this is true for conventional risk factors is unclear. METHODS AND RESULTS An individual participant meta-analysis was used to associate the annualised progression of systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol with future cardiovascular disease risk in 13 prospective cohort studies of the PROG-IMT collaboration (n = 34,072). Follow-up data included information on a combined cardiovascular disease endpoint of myocardial infarction, stroke, or vascular death. In secondary analyses, annualised progression was replaced with average. Log hazard ratios per standard deviation difference were pooled across studies by a random effects meta-analysis. In primary analysis, the annualised progression of total cholesterol was marginally related to a higher cardiovascular disease risk (hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.00 to 1.07). The annualised progression of systolic blood pressure, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol was not associated with future cardiovascular disease risk. In secondary analysis, average systolic blood pressure (HR 1.20 95% CI 1.11 to 1.29) and low-density lipoprotein cholesterol (HR 1.09, 95% CI 1.02 to 1.16) were related to a greater, while high-density lipoprotein cholesterol (HR 0.92, 95% CI 0.88 to 0.97) was related to a lower risk of future cardiovascular disease events. CONCLUSION Averaged measurements of systolic blood pressure, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol displayed significant linear relationships with the risk of future cardiovascular disease events. However, there was no clear association between the annualised progression of these conventional risk factors in individuals with the risk of future clinical endpoints.
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Affiliation(s)
- Martin Bahls
- Department of Internal Medicine B, University Medicine Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Germany
| | - Matthias W Lorenz
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Germany
| | - Lu Gao
- MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, University of Cambridge, UK
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
| | - Stefan Agewall
- Institute of Clinical Sciences, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital Ullevål, Ullevål, Oslo, Norway
| | - Gerald Berenson
- Department of Medicine, Pediatrics, Biochemistry, Epidemiology, Tulane University School of Medicine and School of Public Health and Tropical Medicine, New Orleans, USA
| | - Alberico L Catapano
- IRCSS Multimedica, Milan, Italy
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Giuseppe D Norata
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- SISA Center for the Study of Atherosclerosis, Bassini Hospital, Italy
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wiek van Gilst
- Department of Experimental Cardiology, University Medical Center Groningen, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Institute of Cardiovascular Science, University College London, London, UK
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Frank P Brouwers
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Heiko Uthoff
- Department of Angiology, University Hospital Basel, Basel, Switzerland
| | - Dirk Sander
- Department of Neurology, Benedictus Hospital Tutzing, Tutzing, Germany
| | - Holger Poppert
- Department of Neurology, Technical University Munich, Munich, Germany
| | - Michael Hecht Olsen
- Department of Internal Medicine, Holbaek Hospital and Institute of Regional Health Research, University of Southern Denmark, Denmark
| | - Jean Philippe Empana
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Paris, France
| | - Ulf Schminke
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Damiano Baldassarre
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, Università di Milano, Milan, Italy
| | | | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eric de Groot
- Imagelabonline and Cardiovascular, Erichem, The Netherlands
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Liliana Grigore
- Centro Sisa per lo Studio della Aterosclerosi, Bassini Hospital, Cinisello Balsamo, Italy
| | - Joseph F Polak
- Tufts University School of Medicine, Tufts Medical Center, Boston, USA
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, USA
| | - Coen DA Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Michael R Skilton
- The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
| | - Apostolos I Hatzitolios
- Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki – AHEPA Hospital, Greece
| | - Christos Savopoulos
- Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki – AHEPA Hospital, Greece
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Matthieu Plichart
- Centro Sisa per lo Studio della Aterosclerosi, Bassini Hospital, Cinisello Balsamo, Italy
- Assistance Publique, Hôpitaux de Paris, Hôpital Broca, Paris, France
| | | | - Lars Lind
- Department of Medicine, Uppsala University, Uppsala, Sweden
| | - Peter Willeit
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Helmuth Steinmetz
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
| | - Moise Desvarieux
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
- METHODS Core, Centre de Recherche Epidémiologie et Statistique Paris Sorbonne Cité (CRESS), Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1153, Paris, France
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Stein Harald Johnsen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Caroline Schmidt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
| | - Johann Willeit
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | | | | | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Clinical Physiology, Gothenburg, Sweden
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
| | - Stefan Kiechl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Matthias Sitzer
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
- Department of Neurology, Klinikum Herford, Herford, Germany
| | - Horst Bickel
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, USA
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology | Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Henry Völzke
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Germany
- Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany
| | - Simon G Thompson
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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10
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Pilalas D, Chatzopoulos G, Kaiafa GD, Ztriva E, Spyridonakou S, Bisbinas V, Ioannidis P, Hatzitolios AI, Savopoulos C. Systemic lupus erythematosus in a patient with multiple system atrophy: A case report. Medicine (Baltimore) 2019; 98:e18005. [PMID: 31725670 PMCID: PMC6867731 DOI: 10.1097/md.0000000000018005] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Multiple system atrophy is a late-onset rare neurodegenerative movement disorder which results in debilitating disease. Fever frequently ensues in the context of infections which can be associated with significant morbidity and mortality, but among alternative diagnostic possibilities neoplasms and autoimmune disorders should be considered. PATIENT CONCERNS We describe a case of a prolonged febrile syndrome in a 55-year-old female patient with onset of multiple system atrophy two years before presentation. Patient history and symptoms were not contributive to guide the diagnostic work-up. DIAGNOSIS Initial evaluation provided no specific findings. Repeat testing of auto-antibodies revealed positive antinuclear and anti-ds DNA antibodies coupled with low complement which in conjunction with renal biopsy substantiated the diagnosis of systemic lupus erythematosus flare. INTERVENTION Pending the biopsy result, treatment with hydroxychloroquine and corticosteroids was initiated. Due to failure to achieve remission, azathioprine was added, but symptoms persisted. Following the diagnosis of lupus nephritis, azathioprine was discontinued and induction treatment with cyclophosphamide in accordance with the Euro-Lupus regimen was initiated and upon completion followed by maintenance therapy with mycophenolate mofetil. OUTCOMES The patient achieved remission after cyclophosphamide was added to treatment with corticosteroids and has not experienced new flares during the next two years. The neurological syndrome has remained stable during this period. LESSONS To our knowledge, we report the first case of concurrent systemic lupus erythematosus and multiple system atrophy. Prolonged fever presents unique challenges in patients with rare diseases.
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Affiliation(s)
| | | | | | | | | | | | - Panagiotis Ioannidis
- Second Department of Neurology, Medical School, Aristotle University, Thessaloniki, Greece
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11
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Tziomalos K, Katrini K, Papagianni M, Christou K, Gkolfinopoulou C, Angelopoulou SM, Sofogianni A, Savopoulos C, Hatzitolios AI, Chroni A. Impaired antioxidative activity of high-density lipoprotein is associated with more severe acute ischemic stroke. Metabolism 2019; 98:49-52. [PMID: 31202834 DOI: 10.1016/j.metabol.2019.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/11/2019] [Revised: 06/04/2019] [Accepted: 06/07/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND/AIMS High-density lipoprotein (HDL) has important anti-atherogenic functions, including antioxidant effects. However, it is unclear whether the antioxidative activity of HDL is associated with the severity and outcome of acute ischemic stroke. We aimed to evaluate this association. METHODS We prospectively studied 199 consecutive patients admitted with acute ischemic stroke and followed them up until discharge. We measured HDL antioxidant capacity, HDL-associated paraoxonase-1 (PON1) activity and HDL-associated myeloperoxidase (MPO) levels. Severe stroke was defined as National Institutes of Health Stroke Scale (NIHSS) at admission ≥5. Dependency was defined as modified Rankin scale at discharge between 2 and 5. RESULTS Patients with severe stroke had lower HDL antioxidant capacity, higher MPO levels and higher MPO/PON1 ratio. Independent risk factors for severe stroke were female gender (RR 2.80, 95% CI 1.37-5.70, p = 0.005), glucose levels (RR 1.01, 95% CI 1.0-1.02, p < 0.01) and HDL antioxidant capacity (RR 1.03, 95% CI 1.01-1.06, p < 0.05). Patients who were dependent at discharge had lower HDL antioxidant capacity, higher MPO levels and higher MPO/PON1 ratio. Independent predictors of dependency at discharge were lack of lipid-lowering treatment (RR 6.86, 95% CI 1.83-25.67, p < 0.005) and NIHSS (RR 1.56, 95% CI 1.29-1.88, p < 0.0001). The HDL antioxidant capacity did not differ between patients who died during hospitalization and those who were discharged. The only independent predictor of in-hospital mortality was NIHSS (RR 1.16, 95% CI 1.06-1.27, p < 0.005). CONCLUSIONS Impaired antioxidative activity of HDL is associated with more severe acute ischemic stroke and might also predict a worse functional outcome in these patients.
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Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University, Thessaloniki, Greece.
| | - Konstantina Katrini
- Institute of Biosciences and Applications, National Centre for Scientific Research "Demokritos", Agia Paraskevi, Athens, Greece
| | - Marianthi Papagianni
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University, Thessaloniki, Greece
| | - Konstantinos Christou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University, Thessaloniki, Greece
| | - Christina Gkolfinopoulou
- Institute of Biosciences and Applications, National Centre for Scientific Research "Demokritos", Agia Paraskevi, Athens, Greece
| | - Stella-Maria Angelopoulou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University, Thessaloniki, Greece
| | - Areti Sofogianni
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University, Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University, Thessaloniki, Greece
| | - Angeliki Chroni
- Institute of Biosciences and Applications, National Centre for Scientific Research "Demokritos", Agia Paraskevi, Athens, Greece.
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12
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Dimitriou P, Tziomalos K, Christou K, Kostaki S, Angelopoulou SM, Papagianni M, Ztriva E, Chatzopoulos G, Savopoulos C, Hatzitolios AI. Factors associated with delayed presentation at the emergency department in patients with acute ischemic stroke. Brain Inj 2019; 33:1257-1261. [PMID: 31293186 DOI: 10.1080/02699052.2019.1641226] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background and aims: Pre-hospital delay is a crucial factor that determines the eligibility for intravenous thrombolysis in patients with acute ischemic stroke. We aimed to evaluate the time to presentation at the emergency department (ED) and the factors that affect this time. Patients and methods: We prospectively studied 682 patients who were admitted with acute ischemic stroke (43.3% men, age 79.9 ± 6.6 years). Results: The median time to presentation at the ED was 2.1 h (range 0.15 to 168 h); 68.8% of the patients arrived within 4.5 h and 56.5% arrived within 3 h from the onset of symptoms. Independent predictors of presentation within 4.5 h were the use of emergency medical services (EMS) for transportation to the hospital (OR 2.61, 95% CI 1.38-4.94, p = .003), family history of cardiovascular disease (CVD)(OR 4.0 0,95%CI 1.61-12.23, p = .006) and the absence of history of smoking (OR 2.49, 95% CI 1.13-5.42, p = .021). Independent predictors of presentation within 3 h were the use of EMS for transportation to the hospital (OR 6.24, 95% CI 2.52-16.63, p = .0001), family history of CVD (OR 3.07, 95% CI 1.14-9.43, p = .03), and a moderately severe stroke at admission (OR vs. minor stroke 0.38, 95% CI 0.16-0.87, p = .02). Conclusions: A considerable proportion of patients with acute ischemic stroke arrives at the ED after the 4.5-h threshold for performing intravenous thrombolysis. Non-smokers, patients with a family history of CVD, with moderately severe stroke and those who use the EMS are more likely to arrive on time.
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Affiliation(s)
- Panagiotis Dimitriou
- a First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Konstantinos Tziomalos
- a First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Konstantinos Christou
- a First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Stavroula Kostaki
- a First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Stella-Maria Angelopoulou
- a First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Marianthi Papagianni
- a First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Eleftheria Ztriva
- a First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Georgios Chatzopoulos
- a First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Christos Savopoulos
- a First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Apostolos I Hatzitolios
- a First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
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13
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Milonas D, Didangelos T, Hatzitolios AI, Tziomalos K. Incretin-Based Antihyperglycemic Agents for the Management of Acute Ischemic Stroke in Patients with Diabetes Mellitus: A Review. Diabetes Ther 2019; 10:429-435. [PMID: 30725400 PMCID: PMC6437305 DOI: 10.1007/s13300-019-0580-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Indexed: 12/18/2022] Open
Abstract
Diabetes mellitus (DM) is a major risk factor for ischemic stroke. Moreover, patients with DM suffer more severe strokes and have worse functional outcome following an acute stroke than patients without DM. In this context, data from animal studies and emerging evidence from clinical studies suggest that incretin-based antihyperglycemic agents might exert beneficial effects in patients with DM who suffer ischemic stroke. It appears that these agents exert neuroprotective actions that might both reduce infarct size and promote recovery. The present review summarizes the evidence on the potential role of incretin-based antihyperglycemic agents in the management of acute ischemic stroke.
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Affiliation(s)
- Dimitrios Milonas
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
| | - Triantafyllos Didangelos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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14
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Papagianni M, Tziomalos K, Kostaki S, Angelopoulou SM, Christou K, Bouziana SD, Vergou M, Didangelos T, Savopoulos C, Hatzitolios AI. Treatment with Mannitol is Associated with Increased Risk for In-Hospital Mortality in Patients with Acute Ischemic Stroke and Cerebral Edema. Am J Cardiovasc Drugs 2018; 18:397-403. [PMID: 29845546 DOI: 10.1007/s40256-018-0285-0] [Citation(s) in RCA: 7] [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] [Indexed: 11/28/2022]
Abstract
BACKGROUND Current guidelines state that osmotic therapy is reasonable in patients with clinical deterioration from cerebral infarction-related cerebral edema. However, there are limited data on the safety and efficacy of this therapy. We aimed to evaluate the effect of mannitol on the outcome of ischemic stroke-related cerebral edema. METHODS AND RESULTS We prospectively studied 922 consecutive patients admitted with acute ischemic stroke. Patients who showed space-occupying brain edema with tissue shifts compressing the midline structures received mannitol. The outcome was assessed with dependency rates at discharge (modified Rankin Scale grade 2-5) and in-hospital mortality. Rates of dependency were higher in patients treated with mannitol (n = 86) than in those who were not (97.7 and 58.5%, respectively; p < 0.001). Independent predictors of dependency were age, history of ischemic stroke and National Institutes of Health Stroke Scale (NIHSS) score at admission. Rates of mortality were higher in patients treated with mannitol than in those who were not (46.5 and 5.6%, respectively; p < 0.001). Independent predictors of in-hospital mortality were diastolic blood pressure [relative risk (RR) 1.05, 95% confidence interval (CI) 1.02-1.08, p < 0.001], NIHSS score at admission (RR 1.19, 95% CI 1.14-1.23, p < 0.001) and treatment with mannitol (RR 3.45, 95% CI 1.55-7.69, p < 0.005). CONCLUSIONS Administration of mannitol to patients with ischemic stroke-related cerebral edema does not appear to affect the functional outcome and might increase mortality, independently of stroke severity.
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Affiliation(s)
- Marianthi Papagianni
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloniki, Greece.
| | - Stavroula Kostaki
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Stella-Maria Angelopoulou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Konstantinos Christou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Stella D Bouziana
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Maria Vergou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Triantafyllos Didangelos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloniki, Greece
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15
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Poulter NR, Savopoulos C, Anjum A, Apostolopoulou M, Chapman N, Cross M, Falaschetti E, Fotiadis S, James RM, Kanellos I, Szigeti M, Thom S, Sever P, Thompson D, Hatzitolios AI. Randomized Crossover Trial of the Impact of Morning or Evening Dosing of Antihypertensive Agents on 24-Hour Ambulatory Blood Pressure. Hypertension 2018; 72:870-873. [DOI: 10.1161/hypertensionaha.118.11101] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Some data suggest that nocturnal dosing of antihypertensive agents may reduce cardiovascular outcomes more than daytime dosing. This trial was designed to evaluate whether ambulatory blood pressure monitoring levels differ by timing of drug dosing. Patients aged 18 to 80 years with reasonably controlled hypertension (≤150/≤90 mm Hg) on stable therapy of ≥1 antihypertensive agent were recruited from 2 centers in London and Thessaloniki. Patients were randomized to receive usual therapy either in the morning (6
am
–11
am
) or evening (6
pm
–11
pm
) for 12 weeks when participants crossed over to the alternative timing for a further 12 weeks. Clinic blood pressures and a 24-hour recording were taken at baseline, 12, and 24 weeks and routine blood tests were taken at baseline. The study had 80% power to detect 3 mm Hg difference in mean 24-hour systolic blood pressure (α=0.05) by time of dosing. A 2-level hierarchical regression model adjusted for center, period, and sequence was used. Of 103 recruited patients (mean age, 62; 44% female), 95 patients (92%) completed all three 24-hour recordings. Mean 24-hour systolic and diastolic blood pressures did not differ between daytime and evening dosing. Similarly, morning and evening dosing had no differential impact on mean daytime (7
am
–10
pm
) and nighttime (10
pm
–7
am
) blood pressure levels nor on clinic levels. Stratification by age (≤65/≥65 years) or sex did not affect results. In summary, among hypertensive patients with reasonably well-controlled blood pressure, the timing of antihypertensive drug administration (morning or evening) did not affect mean 24-hour or clinic blood pressure levels.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01669928.
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Affiliation(s)
- Neil R. Poulter
- From the Imperial Clinical Trials Unit (N.R.P, A.A, M.C, E.F, M.S.), Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece
| | - Christos Savopoulos
- Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece (C.S., M.A., S.F., I.K., A.I.H.)
| | - Aisha Anjum
- From the Imperial Clinical Trials Unit (N.R.P, A.A, M.C, E.F, M.S.), Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece
| | - Martha Apostolopoulou
- Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece (C.S., M.A., S.F., I.K., A.I.H.)
| | - Neil Chapman
- NHLI (P.S, D.T, N.C, S.T.), Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece
| | - Mary Cross
- From the Imperial Clinical Trials Unit (N.R.P, A.A, M.C, E.F, M.S.), Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece
| | - Emanuela Falaschetti
- From the Imperial Clinical Trials Unit (N.R.P, A.A, M.C, E.F, M.S.), Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece
| | - Spiros Fotiadis
- Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece (C.S., M.A., S.F., I.K., A.I.H.)
| | - Rebecca M. James
- William Harvey Clinical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (R.M.J.)
| | - Ilias Kanellos
- Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece (C.S., M.A., S.F., I.K., A.I.H.)
| | - Matyas Szigeti
- From the Imperial Clinical Trials Unit (N.R.P, A.A, M.C, E.F, M.S.), Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece
| | - Simon Thom
- NHLI (P.S, D.T, N.C, S.T.), Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece
| | - Peter Sever
- NHLI (P.S, D.T, N.C, S.T.), Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece
| | - David Thompson
- NHLI (P.S, D.T, N.C, S.T.), Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece
| | - Apostolos I. Hatzitolios
- Imperial College London, United Kingdom, 1st Medical Propaedeutic Department, Aristotle University, Thessaloniki, Greece (C.S., M.A., S.F., I.K., A.I.H.)
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16
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Mouslech Z, Somali M, Sarantis L, Christos D, Alexandra C, Maria P, Mastorakos G, Savopoulos C, Hatzitolios AI. Significant effect of group education in patients with diabetes type 1. Hormones (Athens) 2018; 17:397-403. [PMID: 30112705 DOI: 10.1007/s42000-018-0054-0] [Citation(s) in RCA: 6] [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: 02/16/2018] [Accepted: 06/18/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Type 1 diabetes mellitus (T1DM) constitutes a real challenge in everyday practice for both physicians and patients. Due to the complexity of the disease and its unpredictable nature, structured education and training programs are nowadays implemented that ensure active patient involvement and self-care behaviors to achieve adequate glycemic control, prevent diabetic complications, and improve the quality of life of patients. These programs provide patients with the necessary knowledge and skills to self-monitor and self-manage the disease and its associated metabolic conditions. The aim of the study was to evaluate the effect of a structured 12-month education program that motivated patients to follow a healthy Mediterranean diet and exercise regularly as well as to adjust carbohydrate intake and insulin dose according to their needs. DESIGN The education group (EG) was comprised of 62 patients (45 males) with type 1 DM, mean age 36 ± 4.2 years and BMI 24.2 ± 3.1 kg/m2. An age- and BMI-matched control group (CG, n = 25, mean age 41 ± 6.4 years, BMI 25.7 ± 4.2 kg/m2) was composed of patients referred but not enrolled in the project. RESULTS At the end of this program, HbA1C levels were significantly decreased (8.5 ± 2.1% vs. 7.08 ± 0.79%, p < 0.0001) as was also the incidence of hypoglycemic episodes (p < 0.05). Regarding daily glucose fluctuations, significant improvement (p < 0.05) was observed, as reflected in low, high, and daily median glucose values. On the other hand, the above parameters remained stable in the CG. CONCLUSIONS These results strongly support the need for long-lasting structured education group courses for adult diabetic patients keen to change their habits in order to achieve self-management of the disease.
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Affiliation(s)
- Zadalla Mouslech
- 1st Medical Propedeutic Dept. of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kiriakidi, 54621, Thessaloniki, Greece
| | - Maria Somali
- Endocrinology, Metabolism and Diabetes Unit, Euromedica General Clinic, 11 Marias Kallas & 2 Gravias Streets, 54645, Thessaloniki, Greece
| | - Livadas Sarantis
- Endocrine Unit, Metropolitan Hospital, 9 Ethnarchou Makariou, 18547, Athens, Greece.
| | - Daramilas Christos
- Endocrinology, Metabolism and Diabetes Unit, Euromedica General Clinic, 11 Marias Kallas & 2 Gravias Streets, 54645, Thessaloniki, Greece
| | - Chatzi Alexandra
- Endocrine Unit, 3rd Pediatric Department, Hippokration Hospital, Aristotle University, 49 Konstantinoupoleos, 54642, Thessaloniki, Greece
| | - Papagianni Maria
- Endocrine Unit, 3rd Pediatric Department, Hippokration Hospital, Aristotle University, 49 Konstantinoupoleos, 54642, Thessaloniki, Greece
| | - George Mastorakos
- Department of Endocrinology, Metabolism and Diabetes, Aretaeio Hospital, School of Medicine, National and Kapodistrian University Athens, 76 Vas. Sofias, 11528, Athens, Greece
| | - Christos Savopoulos
- 1st Medical Propedeutic Dept. of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kiriakidi, 54621, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- 1st Medical Propedeutic Dept. of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kiriakidi, 54621, Thessaloniki, Greece
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17
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Tziomalos K, Sofogianni A, Angelopoulou SM, Christou K, Kostaki S, Papagianni M, Satsoglou S, Spanou M, Savopoulos C, Hatzitolios AI. Left ventricular hypertrophy assessed by electrocardiogram is associated with more severe stroke and with higher in-hospital mortality in patients with acute ischemic stroke. Atherosclerosis 2018; 274:206-211. [DOI: 10.1016/j.atherosclerosis.2018.05.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 04/28/2018] [Accepted: 05/16/2018] [Indexed: 10/16/2022]
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18
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Papaliagkas V, Kaiafa G, Savopoulos C, Ztriva E, Rouskas P, Sofogianni A, Polychronopoulos G, Hatzitolios AI. Cardiac and neurological involvement in Antiphospholipid syndrome: a case of a 47-year-old woman with nonbacterial thrombotic endocarditis and cognitive impairment. Hellenic J Cardiol 2018; 60:387-390. [PMID: 29936322 DOI: 10.1016/j.hjc.2018.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/25/2018] [Accepted: 06/01/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Vasileios Papaliagkas
- Laboratory of Clinical Neurophysiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
| | - Georgia Kaiafa
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
| | - Christos Savopoulos
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece.
| | - Eleftheria Ztriva
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
| | - Pavlos Rouskas
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
| | - Areti Sofogianni
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
| | - Georgios Polychronopoulos
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
| | - Apostolos I Hatzitolios
- 1st Medical Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
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19
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Didangelos T, Koliakos G, Kouzi K, Arsos G, Kotzampassi K, Tziomalos K, Karamanos D, Hatzitolios AI. Accelerated healing of a diabetic foot ulcer using autologous stromal vascular fraction suspended in platelet-rich plasma. Regen Med 2018; 13:277-281. [DOI: 10.2217/rme-2017-0069] [Citation(s) in RCA: 6] [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: 12/17/2022] Open
Abstract
We describe the case of a Type I diabetic patient with a refractory foot ulcer that remained unhealed for 2 years despite conventional therapy. Autologous adipose-derived stromal vascular fraction suspended in autologous platelet-rich plasma was applied to the wound, which completely healed within 1 month. The wound remained closed with no complications for a 2-year follow-up. Reporting of this and similar cases may lead to larger clinical trials that will prove the efficacy of this therapy that may offer accelerated healing and lessen the financial burden of more expensive therapeutic modalities.
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Affiliation(s)
- Triantafyllos Didangelos
- Diabetes Center, First Propedeutic Department of Internal Medicine, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Koliakos
- Biohellenika Biotechnology SA Georgikis Scholis 65 Thessaloniki, Thessaloniki, Greece
- Laboratory of Biochemistry, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kokkona Kouzi
- Biohellenika Biotechnology SA Georgikis Scholis 65 Thessaloniki, Thessaloniki, Greece
- Laboratory of Histology & Embryology, Medical School Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Arsos
- Laboratory of Nuclear Medicine, Papageorgiou Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Katerina Kotzampassi
- First Propaedeutic Department of Surgery, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- Diabetes Center, First Propedeutic Department of Internal Medicine, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Karamanos
- First Department of Surgery, Papageorgiou Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- Diabetes Center, First Propedeutic Department of Internal Medicine, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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20
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Fotiadou E, Kotzakioulafi E, Kiariaklidou E, Gounitsioti I, Savopoulos C, Hatzitolios AI. Dietary compliance to hypocaloric diet and weight reduction in obese men and women. Clin Nutr ESPEN 2018. [DOI: 10.1016/j.clnesp.2018.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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21
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Didangelos T, Moralidis E, Karlafti E, Tziomalos K, Margaritidis C, Kontoninas Z, Stergiou I, Boulbou M, Papagianni M, Papanastasiou E, Hatzitolios AI. A Comparative Assessment of Cardiovascular Autonomic Reflex Testing and Cardiac 123I-Metaiodobenzylguanidine Imaging in Patients with Type 1 Diabetes Mellitus without Complications or Cardiovascular Risk Factors. Int J Endocrinol 2018; 2018:5607208. [PMID: 29721015 PMCID: PMC5867537 DOI: 10.1155/2018/5607208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/31/2018] [Indexed: 02/08/2023] Open
Abstract
AIM To compare the cardiovascular autonomic reflex tests (CARTs) with cardiac sympathetic innervation imaging with 123I-metaiodobenzylguanidine (MIBG) in patients with type 1 diabetes mellitus (T1DM). PATIENTS AND METHODS Forty-nine patients (29 males, mean age 36 ± 10 years, mean T1DM duration 19 ± 6 years) without cardiovascular risk factors were prospectively enrolled. Participants were evaluated for autonomic dysfunction by assessing the mean circular resultant (MCR), Valsalva maneuver (Vals), postural index (PI), and orthostatic hypotension (OH). Within one month from the performance of these tests, patients underwent cardiac MIBG imaging and the ratio of the heart to upper mediastinum count density (H/M) at 4 hours postinjection was calculated (abnormal values, H/M < 1.80). RESULTS Twenty-nine patients (59%) had abnormal CARTs, and 37 (76%) patients had an H/M_4 < 1.80 (p = 0.456). MCR, PI, Vals, and OH were abnormal in 29 (59%), 8 (16%), 5 (10%), and 11 (22%) patients, respectively. When using H/M_4 < 1.80 as the reference standard, a cutoff point of ≥2 abnormal CARTs had a sensitivity of 100% but a specificity of only 33% for determining CAN. CONCLUSIONS CARTs are not closely associated with 123I-MIBG measurements, which can detect autonomic dysfunction more efficiently than the former. In comparison to semiquantitative cardiac MIBG assessment, the recommended threshold of ≥2 abnormal CARTs to define cardiovascular autonomic dysfunction is highly sensitive but of limited specificity and is independently determined by the duration of T1DM.
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Affiliation(s)
- Triantafyllos Didangelos
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Efstratios Moralidis
- Laboratory of Nuclear Medicine, Medical School, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Eleni Karlafti
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Charalambos Margaritidis
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Zisis Kontoninas
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Ioannis Stergiou
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Maria Boulbou
- Department of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Marianthi Papagianni
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | | | - Apostolos I. Hatzitolios
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Tziomalos K, Giampatzis V, Bouziana SD, Spanou M, Kostaki S, Papadopoulou M, Angelopoulou SM, Margariti E, Savopoulos C, Hatzitolios AI. Effect of antihypertensive treatment on the long-term outcome of patients discharged after acute ischemic stroke. Clin Exp Hypertens 2017; 39:246-250. [PMID: 28448189 DOI: 10.1080/10641963.2016.1246561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We aimed to evaluate the effects of the five main classes of antihypertensive agents on the long-term outcome of 313 consecutive patients discharged after acute ischemic stroke (36.4% males, age 78.5 ± 6.3 years). One year after discharge, the functional status [evaluated with the modified Rankin scale (mRS)], the occurrence of cardiovascular events, and vital status were recorded. Patients prescribed angiotensin receptor blockers (ARBs) had lower mRS than patients not prescribed ARBs (1.7 ± 2.0 vs. 2.9 ± 2.5, respectively; p = 0.006). The rates of adverse outcome (mRS 2-6) and cardiovascular events did not differ between patients prescribed each one of the major classes of antihypertensive agents and those not prescribed the respective class. Patients who were prescribed ARBs had lower risk of death during follow-up than patients who did not receive ARBs (9.4 and 26.9%, respectively; p < 0.05). In binary logistic regression analysis, the only independent predictor of all-cause mortality during follow-up was the mRS at discharge (relative risk 1.69, 95% confidence interval 1.25-2.28; p < 0.001). In conclusion, in patients discharged after acute ischemic stroke, administration of ARBs appears to have a more beneficial effect on long-term functional outcome and all-cause mortality than treatment with other classes of antihypertensive agents.
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Affiliation(s)
- Konstantinos Tziomalos
- a First Propaedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Vasilios Giampatzis
- a First Propaedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Stella D Bouziana
- a First Propaedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Marianna Spanou
- a First Propaedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Stavroula Kostaki
- a First Propaedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Maria Papadopoulou
- a First Propaedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Stella-Maria Angelopoulou
- a First Propaedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Eleni Margariti
- a First Propaedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Christos Savopoulos
- a First Propaedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Apostolos I Hatzitolios
- a First Propaedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
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Tziomalos K, Georgaraki M, Bouziana SD, Spanou M, Kostaki S, Angelopoulou SM, Papadopoulou M, Christou K, Savopoulos C, Hatzitolios AI. Impaired kidney function evaluated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is associated with more severe acute ischemic stroke. Vasc Med 2017; 22:432-434. [PMID: 28778138 DOI: 10.1177/1358863x17720865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Marina Georgaraki
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Stella D Bouziana
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Marianna Spanou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Stavroula Kostaki
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Stella-Maria Angelopoulou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Maria Papadopoulou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Konstantinos Christou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Savopoulos C, Kaiafa G, Kanellos I, Fountouki A, Theofanidis D, Hatzitolios AI. Is management of hyperglycaemia in acute phase stroke still a dilemma? J Endocrinol Invest 2017; 40:457-462. [PMID: 27873213 DOI: 10.1007/s40618-016-0584-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 06/14/2016] [Accepted: 11/09/2016] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Close monitoring of blood glucose levels during the immediate post-acute stroke phase is of great clinical value, as there is evidence that the risk of neurological deterioration is associated with both hyper- and hypoglycaemia. The aim of this review paper is to summarise the evidence on post-stroke blood glucose management and its impact on clinical outcomes, during the early post-acute stage. FINDINGS Post-stroke hyperglycaemia has been associated with increased cerebral oedema, haemorrhagic transformation, lower likelihood of recanalisation and deteriorating neurological state. Thus, hyperglycaemia during an acute stroke may result in poorer clinical outcomes, infarct progression, poor functional recovery and increased mortality rates. Although hypoglycaemia may also lead to poorer outcomes via further brain injury, it can be readily reversed by glucose administration. In most patients, the goal of regular treatment is euglycaemia and for acute-stroke patients, a reasonable approach is to target control of glucose level at 100-150 mg/dL. CONCLUSION Both hypoglycaemia and hyperglycaemia may lead to further brain injury and clinical deterioration; that is the reason these conditions should be avoided after stroke. Yet, when correcting hyperglycaemia, great care should be taken not to switch the patient into hypoglycaemia, and subsequently aggressive insulin administration treatment should be avoided. Early identification and prompt management of hyperglycaemia, especially in acute ischaemic stroke, is recommended. Although the appropriate level of blood glucose during acute stroke is still debated, a reasonable approach is to keep the patient in a mildly hyperglycaemic state, rather than risking hypoglycaemia, using continuous glucose monitoring.
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Affiliation(s)
- C Savopoulos
- 1st Propedeutic Department of Internal Medicine, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece.
| | - G Kaiafa
- 1st Propedeutic Department of Internal Medicine, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - I Kanellos
- 1st Propedeutic Department of Internal Medicine, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - A Fountouki
- Blood Donation Department, St Paul Hospital, Thessaloníki, Greece
| | | | - A I Hatzitolios
- 1st Propedeutic Department of Internal Medicine, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
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Tziomalos K, Giampatzis V, Bouziana SD, Spanou M, Kostaki S, Papadopoulou M, Angelopoulou SM, Tsopozidi M, Savopoulos C, Hatzitolios AI. Prognostic significance of major lipids in patients with acute ischemic stroke. Metab Brain Dis 2017; 32:395-400. [PMID: 27771869 DOI: 10.1007/s11011-016-9924-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 07/29/2016] [Accepted: 10/19/2016] [Indexed: 01/14/2023]
Abstract
Although dyslipidemia increases the risk for ischemic stroke, previous studies reported conflicting data regarding the association between lipid levels and stroke severity and outcome. To evaluate the predictive value of major lipids in patients with acute ischemic stroke. We prospectively studied 790 consecutive patients who were admitted with acute ischemic stroke (41.0 % males, age 79.4 ± 6.8 years). The severity of stroke was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). Moderate/severe stroke was defined as NIHSS ≥5. The outcome was assessed with dependency rates at discharge (modified Rankin scale between 2 and 5) and with in-hospital mortality. Independent predictors of moderate/severe stroke were age (relative risk (RR) 1.05, 95 % confidence interval (CI) 1.02-1.08, p < 0.001), atrial fibrillation (RR 1.71, 95 % CI 1.19-2.47, p < 0.005), heart rate (RR 1.02, 95 % CI 1.01-1.04, p < 0.001), log-triglyceride (TG) levels (RR 0.24, 95 % CI 0.08-0.68, p < 0.01) and high-density lipoprotein cholesterol (HDL-C) levels (RR 0.97, 95 % CI 0.95-0.98, p < 0.001). Major lipids did not predict dependency at discharge. Independent predictors of in-hospital mortality were atrial fibrillation (RR 2.35, 95 % CI 1.09-5.04, p < 0.05), diastolic blood pressure (RR 1.05, 95 % CI 1.02-1.08, p < 0.001), log-TG levels (RR 0.09, 95 % CI 0.01-0.87, p < 0.05) and NIHSS at admission (RR 1.19, 95 % CI 1.14-1.24, p < 0.001). Low-density lipoprotein cholesterol levels were not associated with stroke severity or outcome. Lower TG and HDL-C levels are associated with more severe stroke. Lower TG levels also appear to predict in-hospital mortality in patients with acute ischemic stroke.
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Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636, Thessaloniki, Greece.
| | - Vasilios Giampatzis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636, Thessaloniki, Greece
| | - Stella D Bouziana
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636, Thessaloniki, Greece
| | - Marianna Spanou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636, Thessaloniki, Greece
| | - Stavroula Kostaki
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636, Thessaloniki, Greece
| | - Maria Papadopoulou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636, Thessaloniki, Greece
| | - Stella-Maria Angelopoulou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636, Thessaloniki, Greece
| | - Maria Tsopozidi
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636, Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636, Thessaloniki, Greece
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Tziomalos K, Dimitriou P, Bouziana SD, Spanou M, Kostaki S, Angelopoulou SM, Papadopoulou M, Giampatzis V, Savopoulos C, Hatzitolios AI. Stress hyperglycemia and acute ischemic stroke in-hospital outcome. Metabolism 2017; 67:99-105. [PMID: 28081783 DOI: 10.1016/j.metabol.2016.11.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [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: 05/06/2016] [Revised: 10/15/2016] [Accepted: 11/22/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Stress hyperglycemia is frequent in patients with acute ischemic stroke. However, it is unclear whether stress hyperglycemia only reflects stroke severity or if it is directly associated with adverse outcome. We aimed to evaluate the prognostic significance of stress hyperglycemia in acute ischemic stroke. METHODS We prospectively studied 790 consecutive patients who were admitted with acute ischemic stroke (41.0% males, age 79.4±6.8years). The severity of stroke was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). Stress hyperglycemia was defined as fasting serum glucose levels at the second day after admission ≥126mg/dl in patients without type 2 diabetes mellitus (T2DM). The outcome was assessed with adverse outcome rates at discharge (modified Rankin scale between 2 and 6) and with in-hospital mortality. RESULTS In the total study population, 8.6% had stress hyperglycemia. Patients with stress hyperglycemia had more severe stroke. Independent predictors of adverse outcome at discharge were age, prior ischemic stroke and NIHSS at admission whereas treatment with statins prior to stroke was associated with favorable outcome. When the NIHSS was removed from the multivariate model, independent predictors of adverse outcome were age, heart rate at admission, prior ischemic stroke, log-triglyceride (TG) levels and stress hyperglycemia, whereas treatment with statins prior to stroke was associated with favorable outcome. Independent predictors of in-hospital mortality were atrial fibrillation (AF), diastolic blood pressure (DBP), serum log-TG levels and NIHSS at admission. When the NIHSS was removed from the multivariate model, independent predictors of in-hospital mortality were age, AF, DBP, log-TG levels and stress hyperglycemia. CONCLUSION Stress hyperglycemia does not appear to be directly associated with the outcome of acute ischemic stroke. However, given that patients with stress hyperglycemia had higher prevalence of cardiovascular risk factors than patients with normoglycemia and that glucose tolerance was not evaluated, more studies are needed to validate our findings.
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Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
| | - Panagiotis Dimitriou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Stella D Bouziana
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Marianna Spanou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Stavroula Kostaki
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Stella-Maria Angelopoulou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Maria Papadopoulou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Vasilios Giampatzis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Didangelos T, Tziomalos K, Margaritidis C, Kontoninas Z, Stergiou I, Tsotoulidis S, Karlafti E, Mourouglakis A, Hatzitolios AI. Efficacy of Administration of an Angiotensin Converting Enzyme Inhibitor for Two Years on Autonomic and Peripheral Neuropathy in Patients with Diabetes Mellitus. J Diabetes Res 2017; 2017:6719239. [PMID: 28373993 PMCID: PMC5360947 DOI: 10.1155/2017/6719239] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 02/21/2017] [Indexed: 01/06/2023] Open
Abstract
Aim. To evaluate the effect of quinapril on diabetic cardiovascular autonomic neuropathy (CAN) and peripheral neuropathy (DPN). Patients and Methods. Sixty-three consecutive patients with diabetes mellitus [43% males, 27 with type 1 DM, mean age 52 years (range 22-65)], definite DCAN [abnormal results in 2 cardiovascular autonomic reflex tests (CARTs)], and DPN were randomized to quinapril 20 mg/day (group A, n = 31) or placebo (group B, n = 32) for 2 years. Patients with hypertension or coronary heart disease were excluded. To detect DPN and DCAN, the Michigan Neuropathy Screening Instrument Questionnaire and Examination (MNSIQ and MNSIE), measurement of vibration perception threshold with biothesiometer (BIO), and CARTs [R-R variation during deep breathing [assessed by expiration/inspiration ratio (E/I), mean circular resultant (MCR), and standard deviation (SD)], Valsalva maneuver (Vals), 30 : 15 ratio, and orthostatic hypotension (OH)] were used. Results. In group A, E/I, MCR, and SD increased (p for all comparisons < 0.05). Other indices (Vals, 30 : 15, OH, MNSIQ, MNSIE, and BIO) did not change. In group B, all CART indices deteriorated, except Vals, which did not change. MNSIQ, MNSIE, and BIO did not change. Conclusions. Treatment with quinapril improves DCAN (mainly parasympathetic dysfunction). Improved autonomic balance may improve the long-term outcome of diabetic patients.
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Affiliation(s)
- Triantafyllos Didangelos
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
- *Triantafyllos Didangelos:
| | - Konstantinos Tziomalos
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Charalambos Margaritidis
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Zisis Kontoninas
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Ioannis Stergiou
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Stefanos Tsotoulidis
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Eleni Karlafti
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Alexandros Mourouglakis
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Apostolos I. Hatzitolios
- Diabetes Center, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Tziomalos K, Gkougkourelas I, Sarantopoulos A, Bekiari E, Makri E, Raptis N, Tselios K, Pantoura M, Hatzitolios AI, Boura P. Arterial stiffness and peripheral arterial disease in patients with systemic lupus erythematosus. Rheumatol Int 2016; 37:293-298. [PMID: 27873008 DOI: 10.1007/s00296-016-3610-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/17/2016] [Indexed: 12/24/2022]
Abstract
Systemic lupus erythematosus (SLE) is associated with increased cardiovascular risk. We aimed to evaluate arterial stiffness and the ankle brachial index (ABI), two markers of subclinical cardiovascular disease, in SLE. We studied 55 patients with SLE (12.7% males, age 53.3 ± 15.3 years) and 61 age- and gender-matched controls. Arterial stiffness was evaluated by measuring pulse wave velocity (PWV), augmentation index (AIx) and central systolic, diastolic, pulse and mean blood pressure (BP). Peripheral arterial disease was defined as ABI ≤ 0.90. Regarding markers of arterial stiffness, patients with SLE had lower PWV and AIx than controls (p < 0.01 and p < 0.05, respectively). However, after adjusting for differences in cardiovascular risk factors between patients with SLE and controls, PWV and AIx did not differ between the two groups. Central systolic, diastolic, pulse and mean BP also did not differ between the two groups. In patients with SLE, PWV correlated independently with systolic BP (B = 0.05, p < 0.001) and waist/hip ratio (B = 6.72, p < 0.05). Regarding ABI, the lowest ABI was lower in patients with SLE than in controls (p < 0.005). However, after adjusting for differences in cardiovascular risk factors between patients with SLE and controls, the lowest ABI did not differ between the two groups. The prevalence of PAD also did not differ between patients with SLE and controls (10.0 and 5.4%, respectively; p = NS). Markers of arterial stiffness and the ABI do not appear to differ between patients with SLE and age- and gender-matched controls. However, given the small sample size, larger studies are needed to clarify whether SLE promotes arterial stiffness and PAD.
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Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloníki, Greece.
| | - Ioannis Gkougkourelas
- Clinical Immunology Unit, Second Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloníki, Greece
| | - Alexandros Sarantopoulos
- Clinical Immunology Unit, Second Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloníki, Greece
| | - Eleni Bekiari
- Clinical Immunology Unit, Second Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloníki, Greece
| | - Evangelia Makri
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloníki, Greece
| | - Nikolaos Raptis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloníki, Greece
| | - Konstantinos Tselios
- Clinical Immunology Unit, Second Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloníki, Greece
| | - Marianna Pantoura
- Clinical Immunology Unit, Second Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloníki, Greece
| | - Apostolos I Hatzitolios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, 54636, Thessaloníki, Greece
| | - Panagiota Boura
- Clinical Immunology Unit, Second Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloníki, Greece
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Tziomalos K, Ntaios G, Miyakis S, Papanas N, Xanthis A, Agapakis D, Milionis H, Savopoulos C, Maltezos E, Hatzitolios AI. Prophylactic antibiotic treatment in severe acute ischemic stroke: the Antimicrobial chemopRrophylaxis for Ischemic STrokE In MaceDonIa-Thrace Study (ARISTEIDIS). Intern Emerg Med 2016; 11:953-8. [PMID: 27216796 DOI: 10.1007/s11739-016-1462-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 02/02/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
Abstract
Infections represent a leading cause of mortality in patients with acute ischemic stroke, but it is unclear whether prophylactic antibiotic treatment improves the outcome. We aimed to evaluate the effects of this treatment on infection incidence and short-term mortality. This was a pragmatic, prospective multicenter real-world analysis of previously independent consecutive patients with acute ischemic stroke who were >18 years, and who had at admission National Institutes of Health Stroke Scale (NIHSS) >11. Patients with infection at admission or during the preceding month, with axillary temperature at admission >37 °C, with chronic inflammatory diseases or under treatment with corticosteroids were excluded from the study. Among 110 patients (44.5 % males, 80.2 ± 6.8 years), 31 (28.2 %) received prophylactic antibiotic treatment, mostly cefuroxime (n = 21). Prophylactic antibiotic treatment was administered to 51.4 % of patients who developed infection, and to 16.4 % of patients who did not (p < 0.001). Independent predictors of infection were NIHSS at admission [relative risk (RR) 1.16, 95 % confidence interval (CI) 1.08-1.26, p < 0.001] and prophylactic antibiotic treatment (RR 5.84, 95 % CI 2.03-16.79, p < 0.001). The proportion of patients who received prophylactic antibiotic treatment did not differ between patients who died during hospitalization and those discharged, or between patients who died during hospitalization or during follow-up and those who were alive 3 months after discharge. Prophylactic administration of antibiotics in patients with severe acute ischemic stroke is associated with an increased risk of infection during hospitalization, and does not affect short-term mortality risk.
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Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Ntaios
- Department of Medicine, Larissa University Hospital, Medical School, University of Thessaly, Larissa, 41110, Greece.
| | - Spiros Miyakis
- Third Department of Internal Medicine, Papageorgiou Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Papanas
- Second Department of Internal Medicine, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Andreas Xanthis
- Department of Internal Medicine, General Hospital of Drama, Drama, Greece
| | - Dimitrios Agapakis
- Department of Internal Medicine, General Hospital of Goumenissa, Goumenissa, Greece
| | - Haralampos Milionis
- Department of Medicine, Ioannina University Hospital, Medical School, University of Ioannina, Ioannina, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efstratios Maltezos
- Second Department of Internal Medicine, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Apostolos I Hatzitolios
- First Propedeutic Department of Internal Medicine, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Tziomalos K, Giampatzis V, Bouziana SD, Spanou M, Kostaki S, Papadopoulou M, Angelopoulou SM, Tsopozidi M, Savopoulos C, Hatzitolios AI. No Association Observed Between Blood Pressure Variability During the Acute Phase of Ischemic Stroke and In-Hospital Outcomes. Am J Hypertens 2016; 29:841-6. [PMID: 26657891 DOI: 10.1093/ajh/hpv191] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 11/16/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Recent data suggest that blood pressure (BP) variability confers increased cardiovascular risk independently of BP. We aimed to evaluate the association between BP variability during the acute phase of ischemic stroke and the in-hospital outcome. METHODS We prospectively studied 608 consecutive patients admitted with acute ischemic stroke (39.5% males, age: 79.1±6.6 years). Variability in BP was assessed with the SD and with the coefficient of variation of systolic (SBP) and diastolic BP (DBP) during the first 2 and the first 3 days of hospitalization. The outcome was assessed with dependency rates at discharge and with in-hospital mortality. RESULTS Patients who were dependent at discharge did not differ from patients who were independent in any index of BP variability. Independent predictors of dependency at discharge were age (relative risk (RR) 1.17, 95% confidence interval (CI) 1.09-1.25, P < 0.001), history of prior ischemic stroke (RR 2.08, 95% CI 1.02-4.24, P = 0.04), and National Institutes of Health Stroke Scale (NIHSS) at admission (RR 1.64, 95% CI 1.44-1.86, P < 0.001). Patients who died during hospitalization did not differ in any index of BP variability from patients who were discharged. DBP at admission was independently and directly associated with in-hospital mortality (RR 1.06, 95% CI 1.03-1.09, P < 0.001). Other independent predictors of in-hospital mortality were history of atrial fibrillation (RR 3.30, 95% CI 1.46-7.49, P = 0.004) and NIHSS at admission (RR 1.18, 95% CI 1.13-1.23, P < 0.001). CONCLUSIONS Our data do not support the hypothesis of an association between BP variability and in-hospital outcomes among patients admitted for ischemic stroke.
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Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
| | - Vasilios Giampatzis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Stella D Bouziana
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Marianna Spanou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Stavroula Kostaki
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Maria Papadopoulou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Stella-Maria Angelopoulou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Maria Tsopozidi
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Fountoulakis KN, Savopoulos C, Zannis P, Apostolopoulou M, Fountoukidis I, Kakaletsis N, Kanellos I, Dimellis D, Hyphantis T, Tsikerdekis A, Pompili M, Hatzitolios AI. Climate change but not unemployment explains the changing suicidality in Thessaloniki Greece (2000-2012). J Affect Disord 2016; 193:331-8. [PMID: 26796233 DOI: 10.1016/j.jad.2016.01.008] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 12/26/2015] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Recently there was a debate concerning the etiology behind attempts and completed suicides. The aim of the current study was to search for possible correlations between the rates of attempted and completed suicide and climate variables and regional unemployment per year in the county of Thessaloniki, Macedonia, northern Greece, for the years 2000-12. MATERIAL AND METHODS The regional rates of suicide and attempted suicide as well as regional unemployment were available from previous publications of the authors. The climate variables were calculated from the daily E-OBS gridded dataset which is based on observational data RESULTS Only the male suicide rates correlate significantly with high mean annual temperature but not with unemployment. The multiple linear regression analysis results suggest that temperature is the only variable that determines male suicides and explains 51% of their variance. Unemployment fails to contribute significantly to the model. There seems to be a seasonal distribution for attempts with mean rates being higher for the period from May to October and the rates clearly correlate with temperature. The highest mean rates were observed during May and August and the lowest during December and February. Multiple linear regression analysis suggests that temperature also determines the female attempts rate although the explained variable is significant but very low (3-5%) CONCLUSION Climate variables and specifically high temperature correlate both with suicide and attempted suicide rates but with a different way between males and females. The climate effect was stronger than the effect of unemployment.
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Affiliation(s)
| | - Christos Savopoulos
- 1st Propedeutic Dept of Internal Medicine, School of Medicine, Aristotle University, AHEPA Hospital, Thessaloniki, Greece.
| | - Prodromos Zannis
- Department of Meteorology and Climatology, School of Geology, Aristotle University of Thessaloniki, Greece.
| | | | - Ilias Fountoukidis
- Internal Medicine Department, Agios Pavlos Hospital, Thessaloniki, Greece.
| | - Nikolaos Kakaletsis
- 1st Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece.
| | - Ilias Kanellos
- 1st Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece.
| | - Dimos Dimellis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Greece.
| | - Thomas Hyphantis
- Department of Psychiatry, Ioannina School of Medicine, Ioannina, Greece.
| | - Athanasios Tsikerdekis
- Department of Meteorology and Climatology, School of Geology, Aristotle University of Thessaloniki, Greece.
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Apostolos I Hatzitolios
- 1st Propedeutic Dept of Internal Medicine, School of Medicine, Aristotle University, AHEPA Hospital, Thessaloniki, Greece.
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Tziomalos K, Giampatzis V, Bouziana SD, Spanou M, Kostaki S, Papadopoulou M, Angelopoulou SM, Tsopozidi M, Savopoulos C, Hatzitolios AI. Treatment with Clopidogrel Prior to Acute Non-Cardioembolic Ischemic Stroke Attenuates Stroke Severity. Cerebrovasc Dis 2016; 41:226-32. [PMID: 26795462 DOI: 10.1159/000443745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/30/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Clopidogrel reduces the risk of non-cardioembolic ischemic stroke, but it is unclear whether it affects the severity and outcome of stroke. We aimed at evaluating the effect of prior treatment with clopidogrel on acute non-cardioembolic ischemic stroke severity and in-hospital outcome. METHODS We prospectively studied 608 consecutive patients (39.5% males, age 79.1 ± 6.6 years) who were admitted with acute ischemic stroke. The severity of stroke was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). Severe stroke was defined as NIHSS ≥21. The outcome was assessed using the dependency rates that prevailed at the time of discharge (i.e. modified Rankin scale between 2 and 5) and with in-hospital mortality. RESULTS At admission, 397 patients did not have atrial fibrillation or heart valve disease. Among these 397 patients, 69 were receiving monotherapy with clopidogrel prior to stroke, 69 were receiving monotherapy with aspirin and 236 patients were not on any antiplatelet treatment. The prevalence of severe stroke was lower in patients who were receiving clopidogrel than in patients who were receiving aspirin and patients who were not on antiplatelets (1.4, 13.0 and 11.0%, respectively; p < 0.05). Independent predictors of severe stroke at admission were male gender (relative risk (RR) 0.31, 95% CI 0.12-0.78, p < 0.05) and treatment with clopidogrel prior to stroke compared with no antiplatelet treatment (RR 0.13, 95% CI 0.02-0.97, p < 0.05). Treatment with aspirin prior to stroke did not predict severe stroke compared with no antiplatelet treatment (RR 1.24, 95% CI 0.51-2.98, p = NS). The rate of dependency at discharge did not differ between patients who were receiving clopidogrel, patients who were receiving aspirin and those who were not on antiplatelets (57.9, 47.8 and 59.7%, respectively; p = NS). Independent predictors of dependency at discharge were age (RR 1.12, 95% CI 1.05-1.19, p < 0.001) and NIHSS at admission (RR 1.67, 95% CI 1.46-1.92, p < 0.001). In-hospital mortality rate also did not differ between patients who were receiving clopidogrel, patients who were receiving aspirin and those who were not on antiplatelets (4.3, 4.3 and 5.0%, respectively; p = NS). The only independent predictor of in-hospital mortality was NIHSS at admission (RR 1.22, 95% CI 1.14-1.30, p < 0.001). CONCLUSIONS Treatment with clopidogrel prior to acute non-cardioembolic ischemic stroke attenuates the severity of stroke at admission but does not appear to affect the functional outcome at discharge or the in-hospital mortality of these patients.
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Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Mouslech Z, Somali M, Sakali AK, Savopoulos C, Mastorakos G, Hatzitolios AI. TSH-secreting pituitary adenomas treated by gamma knife radiosurgery: our case experience and a review of the literature. Hormones 2016. [DOI: 10.1007/bf03401412] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Mouslech Z, Somali M, Sakali AK, Savopoulos C, Mastorakos G, Hatzitolios AI. TSH-secreting pituitary adenomas treated by gamma knife radiosurgery: our case experience and a review of the literature. Hormones (Athens) 2016; 15:122-8. [PMID: 26732165 DOI: 10.14310/horm.2002.1640] [Citation(s) in RCA: 6] [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] [Received: 08/12/2015] [Accepted: 11/19/2015] [Indexed: 11/20/2022]
Abstract
A 43-year-old woman, previously misdiagnosed as having primary hyperthyroidism and treated with antithyroid drugs, presented to us with overt hyperthyroidism, high levels of thyroid hormones and elevated thyroid-stimulating hormone (TSH). Μagnetic resonance imaging (MRI) revealed a pituitary microadenoma extending suprasellarly. The patient responded favorably to initial treatment with somatostatin analogs for 2 years but due to the escape phenomenon, TSH levels escalated and hyperthyroidism relapsed. Transsphenoidal adenomectomy was applied but recurrence was again observed due to incomplete tumor removal. Gamma knife radiosurgery was finally employed 5.5 years ago, resulting in complete disease remission without evidence of long-term complications to date. Thyrotropin-secreting adenomas (TSHomas) are rare with an estimated prevalence of about one case per million. We retrieved from the literature 14 cases of TSHomas treated by gamma knife radiosurgery and compared the outcomes. Our results demonstrate the efficacy and safety of gamma knife radiosurgery for achieving remission in most of the cases, suggesting validation of this technique as an effective treatment option for the management of recurrent TSHomas.
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Affiliation(s)
- Zadalla Mouslech
- 1st Medical Propedeutic Dept of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Somali
- Department of Endocrinology, Metabolism and Diabetes, Aretaieio Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Anastasia Konstantina Sakali
- Department of Endocrinology, Metabolism and Diabetes, Aretaieio Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Christos Savopoulos
- Department of Endocrinology, Metabolism and Diabetes, Aretaieio Hospital, School of Medicine, University of Athens, Athens, Greece
| | - George Mastorakos
- Department of Endocrinology, Metabolism and Diabetes, Aretaieio Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Apostolos I Hatzitolios
- 1st Medical Propedeutic Dept of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Tziomalos K, Bouziana SD, Spanou M, Kostaki S, Papadopoulou M, Giampatzis V, Dourliou V, Kostourou DT, Savopoulos C, Hatzitolios AI. Prior treatment with dipeptidyl peptidase 4 inhibitors is associated with better functional outcome and lower in-hospital mortality in patients with type 2 diabetes mellitus admitted with acute ischaemic stroke. Diab Vasc Dis Res 2015; 12:463-6. [PMID: 26297528 DOI: 10.1177/1479164115597867] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 12/14/2022] Open
Abstract
It is unclear whether prior antidiabetic treatment affects stroke severity and outcome. To evaluate this association, we prospectively studied all patients who were admitted in our Department with acute ischaemic stroke (n = 378, mean age = 78.8 ± 6.5 years). The severity of stroke was assessed at admission with the National Institutes of Health Stroke Scale. The outcome was assessed with the modified Rankin Scale at discharge and with in-hospital mortality. A total of 123 patients had type 2 diabetes mellitus. At admission, there was a trend for lower National Institutes of Health Stroke Scale in patients treated with dipeptidyl peptidase 4 inhibitors compared with patients treated with other antidiabetic agents (6.1 ± 7.5 vs 10.0 ± 9.2, respectively; p = 0.079). At discharge, patients treated with dipeptidyl peptidase 4 inhibitors had lower modified Rankin Scale than patients treated with other antidiabetic agents (2.1 ± 1.9 vs 3.2 ± 2.1, respectively; p < 0.05). Patients treated with dipeptidyl peptidase 4 inhibitors also had lower in-hospital mortality than patients treated with other antidiabetic agents (0.0% vs 15.1%, respectively; p < 0.05). In conclusion, prior treatment with dipeptidyl peptidase 4 inhibitors in patients with acute ischaemic stroke appears to be associated with better functional outcome and lower mortality risk.
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Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Stella D Bouziana
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Marianna Spanou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Stavroula Kostaki
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Maria Papadopoulou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Vasilios Giampatzis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Vasiliki Dourliou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Danai-Thomais Kostourou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Tziomalos K, Giampatzis V, Bouziana SD, Spanou M, Papadopoulou M, Kostaki S, Dourliou V, Papagianni M, Savopoulos C, Hatzitolios AI. Response to "Brachial Systolic Blood Pressure Fails to Predict Short-Term Outcome in Patients With Acute Ischemic Stroke: What About Central Systolic Pressure?". Am J Hypertens 2015; 28:1181. [PMID: 26135554 DOI: 10.1093/ajh/hpv105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 06/15/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
| | - Vasilios Giampatzis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Stella D Bouziana
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Marianna Spanou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Maria Papadopoulou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Stavroula Kostaki
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Vasiliki Dourliou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Marianthi Papagianni
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Kakaletsis N, Ntaios G, Milionis H, Haidich AB, Makaritsis K, Savopoulos C, Berge E, Hatzitolios AI. Prognostic Value of 24-H ABPM in Acute Ischemic Stroke for Short-, Medium-, and Long-Term Outcome: A Systematic Review and Meta-Analysis. Int J Stroke 2015; 10:1000-7. [DOI: 10.1111/ijs.12609] [Citation(s) in RCA: 19] [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] [Received: 03/07/2015] [Accepted: 06/01/2015] [Indexed: 11/26/2022]
Abstract
Background The association of blood pressure levels during the acute phase of ischemic stroke with outcome remains controversial. Aims The objective of this systematic review is to assess the predictive value for stroke outcome assessed by the modified Rankin scale score of systolic and diastolic blood pressure, measured by ambulatory blood pressure monitoring methods during the acute phase of ischemic stroke, compared with the values of casually derived blood pressure measurement on admission. Methods We searched for studies with patients admitted within 24 h of stroke onset, and who had ambulatory blood pressure monitoring during the first 24 h of admission. We identified studies that reported blood pressure in those with good outcome and in those with poor outcome at end of follow-up, and performed a meta-analysis of the effect of mean blood pressure on outcome. Results High systolic and diastolic blood pressure levels derived with ambulatory blood pressure monitoring were associated with poor short-, medium-, and long-term outcome, but the same was not found for casual blood pressure measurements. An increase in systolic blood pressure of 9·1 mmHg (95% confidence interval: 6·6–11·6, P < 0·001; I2 = 9%) and an increase in diastolic blood pressure of 2·3 mmHg (95% confidence interval: 0·8–3·7, P = 0·002; I2 = 0%) were associated with poor outcome. Conclusions Higher systolic and diastolic blood pressure levels derived with ambulatory blood pressure monitoring were associated with poor outcome. The same was not found for higher casual blood pressure measurements on admission, and it is possible that ambulatory blood pressure monitoring conveys better prognostic information.
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Affiliation(s)
- Nikolaos Kakaletsis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - George Ntaios
- Department of Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, Medical School, University of Ioannina, University Hospital of Ioannina, Ioannina, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene and Epidemiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Eivind Berge
- Department of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Apostolos I. Hatzitolios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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Tziomalos K, Giampatzis V, Bouziana SD, Spanou M, Papadopoulou M, Kostaki S, Dourliou V, Papagianni M, Savopoulos C, Hatzitolios AI. Elevated diastolic but not systolic blood pressure increases mortality risk in hypertensive but not normotensive patients with acute ischemic stroke. Am J Hypertens 2015; 28:765-71. [PMID: 25468807 DOI: 10.1093/ajh/hpu234] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 10/28/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The relationship between blood pressure (BP) at admission for acute ischemic stroke and outcome is controversial. We aimed to assess whether only systolic BP (SBP), only diastolic BP (DBP), both or neither predict outcome and whether these associations differ between patients with and without a history of hypertension. METHODS We prospectively studied all patients who were admitted with acute ischemic stroke (n = 415; 39.5% males, age 78.8 ± 6.6 years). The severity of stroke was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). The outcome was evaluated with dependency at discharge (modified Rankin scale between 2 and 5) and in-hospital mortality. RESULTS In the total study population, independent predictors of dependency at discharge were age, history of prior ischemic stroke, and NIHSS score at admission. Independent predictors of in-hospital mortality were DBP at admission and NIHSS score at admission. In patients with a history of hypertension (n = 343), independent predictors of dependency at discharge were age and NIHSS score at admission whereas independent predictors of in-hospital mortality were DBP at admission and NIHSS score at admission. In patients without a history of hypertension (n = 72), the only independent predictor of dependency at discharge and in-hospital mortality was the NIHSS score at admission. CONCLUSIONS Higher DBP at admission predict in-hospital mortality in patients with acute ischemic stroke whereas SBP in the acute phase is not associated with short-term outcome. The relationship between DBP at admission and outcome appears to be more prominent in hypertensive patients.
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Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
| | - Vasilios Giampatzis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Stella D Bouziana
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Marianna Spanou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Maria Papadopoulou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Stavroula Kostaki
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Vasiliki Dourliou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Marianthi Papagianni
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Dimas GG, Iliadis FS, Tegos TJ, Spiroglou SG, Karamouzis IM, Kanellos IE, Savopoulos CG, Hatzitolios AI, Grekas DM. FP310INCREASED SERUM LEVELS OF VASCULAR ENDOTHELIAL GROWTH FACTOR-A ARE REVERSELY CORRELATED WITH TIMP-1 IN ATHEROSCLEROSIS IN EARLY STAGES OF TYPE 2 DIABETIC NEPHROPATHY. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv174.45] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dimas GG, Iliadis FS, Tegos TJ, Spiroglou SG, Karamuzis IM, Kannellos IE, Savppoulos CG, Hatzitolios AI, Grekas DM. FP315CIRCULATING FGF-23 AS AN INDEPENDENT CORRELATE OF ATHEROSCLEROSIS IN EARLY STAGES OF CKD. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv174.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fountoulakis KN, Savopoulos C, Apostolopoulou M, Dampali R, Zaggelidou E, Karlafti E, Fountoukidis I, Kountis P, Limenopoulos V, Plomaritis E, Theodorakis P, Hatzitolios AI. Rate of suicide and suicide attempts and their relationship to unemployment in Thessaloniki Greece (2000-2012). J Affect Disord 2015; 174:131-6. [PMID: 25497469 DOI: 10.1016/j.jad.2014.11.047] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 06/21/2014] [Revised: 11/20/2014] [Accepted: 11/22/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Recently there was a debate concerning the relationship between the economic crisis and an increase in attempted and completed suicides in Europe and especially in Greece. The aim of the current study was to calculate the rates of attempted and completed suicide per year in the county of Thessaloniki, Macedonia, northern Greece, for the years 2000-12, and to investigate their relationship with unemployment. MATERIAL AND METHODS The archive of the Emergency Outpatient Units of three hospitals was investigated and the results were projected to the county population. Data from the Hellenic statistics authority concerning regional general population and suicides and unemployment were used. RESULTS The rate of attempted suicides was 16.69-40.34 per 10(5) inhabitants for males and 41.43-110.82 for females. Medication was the preferred method for 95.93%. The completed suicide rates varied from 3.62 to 5.47 for males and from 0.19 to 1.95 per 10(5) inhabitants for females. The male attempt rate correlated negatively with regional male unemployment (-0.63). For females the respected value was similar (-0.72). Concerning competed suicide rates, the respected values were 0.34 and 0.65. The attempt was repeated by 15.34%; almost half-repeated within the same year and 75% within two years. The female to male ratio varied significantly across years with 2:1 (more females) being the probable value for attempts and 1:3.6 (more males) for completed suicides. CONCLUSION This is the first study from Greece reporting rates on the basis of hospital archives. Attempt and suicide rates are low in Greece. Attempts are negatively and suicides are positively correlated with unemployment.
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Affiliation(s)
| | - Christos Savopoulos
- 1st Propedeutic Department of Internal Medicine, School of Medicine, Aristotle University, AHEPA Hospital, Thessaloniki, Greece.
| | | | - Roxani Dampali
- Achladochori Prefectural Outpatient Clinic, Serres County, Greece.
| | - Eleni Zaggelidou
- Forensic Service of Thessaloniki, Ministry of Justice, Thessaloniki, Greece
| | - Eleni Karlafti
- 1st Propedeutic Department of Internal Medicine, AHEPA Hospital, Thessaloniki, Greece.
| | - Ilias Fountoukidis
- Internal Medicine Department, Agios Pavlos Hospital, Thessaloniki, Greece.
| | - Pavlos Kountis
- Internal Medicine Department, "G. Gennimatas" Hospital, Thessaloniki, Greece.
| | - Vasilis Limenopoulos
- Department of Internal Medicine, "G. Gennimatas" Hospital, Thessaloniki, Greece.
| | | | | | - Apostolos I Hatzitolios
- 1st Propedeutic Department of Internal Medicine, School of Medicine, Aristotle University, AHEPA Hospital, Thessaloniki, Greece.
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Tziomalos K, Giampatzis V, Bouziana SD, Spanou M, Papadopoulou M, Kazantzidou P, Kostaki S, Kouparanis A, Savopoulos C, Hatzitolios AI. Effects of different classes of antihypertensive agents on the outcome of acute ischemic stroke. J Clin Hypertens (Greenwich) 2015; 17:275-80. [PMID: 25765927 DOI: 10.1111/jch.12498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/23/2014] [Accepted: 11/25/2014] [Indexed: 11/29/2022]
Abstract
It is unclear whether antihypertensive treatment before stroke affects acute ischemic stroke severity and outcome. To evaluate this association, the authors studied 482 consecutive patients (age 78.8±6.7 years) admitted with acute ischemic stroke. Stroke severity was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). The outcome was assessed with rates of adverse outcome (modified Rankin scale at discharge ≥2). Independent predictors of severe stroke (NIHSS ≥16) were female sex and atrial fibrillation. Treatment with diuretics before stroke was associated with nonsevere stroke. At discharge, patients with adverse outcome were less likely to be treated before stroke with β-blockers or with diuretics. Independent predictors of adverse outcome were older age, higher NIHSS at admission, and history of ischemic stroke. Treatment with diuretics before stroke appears to be associated with less severe neurologic deficit in patients with acute ischemic stroke.
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Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Abstract
Riedel lobe of the liver is a simple anatomical variation, a downward tongue-like projection of the anterior edge of the right lobe of the liver to the right of the gallbladder with its typical case to be rare.We report the case of a 71-year-old woman with typical feature of a nonpalpable Riedel's lobe of the liver, as an incidental finding who was referred for reported hypergammaglobulinemia (22.7% [9%-19%]). Both features were attributed to a chronic inflammation because of an abscess in the right iliopsoas caused by infection due to bilateral hip replacement which underwent revision surgery. This was confirmed by her medical history, the imaging findings combined with elevated C-reactive protein, and by cross-reaction weak positive autoantibodies.Generally, knowledge or suspicion of Riedel's lobe of the liver is important, as it does not always remain clinically latent, as in our case, and it can be complicated by its torsion or hepatic tumors.
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Affiliation(s)
- Christos Savopoulos
- From the First Propedeutic Department of Internal Medicine (CS, NK, GK, FI, AIH), Medical School; and Department of Radiology (AK-F), Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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Kaiafa G, Perifanis V, Kakaletsis N, Chalvatzi K, Hatzitolios AI. Hypercalcemia and multiple osteolytic lesions in an adult patient with relapsed pre-B acute lymphoblastic leukemia: a case report. Hippokratia 2015; 19:78-81. [PMID: 26435654 PMCID: PMC4574594] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Hypercalcemia and severe osteolytic lesions are rare complications of acute lymphoblastic leukemia (ALL) in childhood, and those cases share similar clinical features. Similarly, hypercalcemia is a rare feature in adult ALL. Here, we report an uncommon case of an adult patient with relapsed precursor B ALL (pre-B ALL) who developed multiple osteolytic lesions and hypercalcemia. CASE DESCRIPTION A 24-year-old male patient, diagnosed with pre-B ALL, was admitted in our hospital due to severe lumbar pain. After reviewing laboratory, radiological and clinical findings, the patient was diagnosed as having relapse of a mixed phenotype acute leukemia, according to bone marrow aspiration (9% blasts) and cytogenetic analysis, with multiple osteolytic lesions in all lumbar vertebrae, sacrum and ilium and severe hypercalcemia (13.3 mg/dL). Thus, FLAG-IDA rescue therapy and hydration plus furosemide, corticoids and bisphosphonates were administered. Despite initial amelioration, his hematological condition deteriorated and he died due to severe sepsis as a result of severe immunosuppression. CONCLUSION Two possible mechanisms have been suggested for hypercalcemia in hematological malignancy, either the leukemic infiltration or the paraneoplastic production of a variety of humoral factors and proinflammatory cytokines. However, hypercalcemia and severe osteolytic lesions are rare features in ALL adult patients and their combination may be indicator of poor prognosis. Hippokratia 2015, 19 (1): 78-81.
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Affiliation(s)
- G Kaiafa
- First Propedeutic Department of Internal Medicine AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - V Perifanis
- First Propedeutic Department of Internal Medicine AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - N Kakaletsis
- First Propedeutic Department of Internal Medicine AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - K Chalvatzi
- Department of Immunology, Laboratory of Microbiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A I Hatzitolios
- First Propedeutic Department of Internal Medicine AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Tziomalos K, Spanou M, Bouziana SD, Papadopoulou M, Giampatzis V, Kostaki S, Dourliou V, Tsopozidi M, Savopoulos C, Hatzitolios AI. Type 2 diabetes is associated with a worse functional outcome of ischemic stroke. World J Diabetes 2014; 5:939-944. [PMID: 25512800 PMCID: PMC4265884 DOI: 10.4239/wjd.v5.i6.939] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 07/02/2014] [Accepted: 07/29/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To assess whether ischemic stroke severity and outcome is more adverse in patients with type 2 diabetes mellitus (T2DM).
METHODS: Consecutive patients hospitalized for acute ischemic stroke between September 2010 and June 2013 were studied prospectively (n = 482; 40.2% males, age 78.8 ± 6.7 years). T2DM was defined as self-reported T2DM or antidiabetic treatment. Stroke severity was evaluated with the National Institutes of Health Stroke Scale (NIHSS) score at admission. The outcome was assessed with the modified Rankin scale (mRS) score at discharge and with in-hospital mortality. Adverse outcome was defined as mRS score at discharge ≥ 2 or in-hospital death. The length of hospitalization was also recorded.
RESULTS: T2DM was present in 32.2% of the study population. Patients with T2DM had a larger waist circumference, higher serum triglyceride and glucose levels and lower serum high-density lipoprotein cholesterol levels as well as higher prevalence of hypertension, coronary heart disease and congestive heart failure than patients without T2DM. On the other hand, diabetic patients had lower low-density lipoprotein cholesterol levels and reported smaller consumption of alcohol than non-diabetic patients. At admission, the NIHSS score did not differ between patients with and without T2DM (8.7 ± 8.8 and 8.6 ± 9.2, respectively; P = NS). At discharge, the mRS score also did not differ between the two groups (2.7 ± 2.1 and 2.7 ± 2.2 in patients with and without T2DM, respectively; P = NS). Rates of adverse outcome were also similar in patients with and without T2DM (62.3% and 58.5%, respectively; P = NS). However, when we adjusted for the differences between patients with T2DM and those without T2DM in cardiovascular risk factors, T2DM was independently associated with adverse outcome [relative risk (RR) = 2.39; 95%CI: 1.21-4.72, P = 0.012]. In-hospital mortality rates did not differ between patients with T2DM and those without T2DM (9.0% and 9.8%, respectively; P = NS). In multivariate analysis adjusting for the difference in cardiovascular risk factors between the two groups, T2DM was again not associated with in-hospital death.
CONCLUSION: T2DM does not appear to affect ischemic stroke severity but is independently associated with a worse functional outcome at discharge.
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Tziomalos K, Bouziana SD, Spanou M, Giampatzis V, Papadopoulou M, Kazantzidou P, Kostaki S, Dourliou V, Savopoulos C, Hatzitolios AI. Increased augmentation index is paradoxically associated with lower in-hospital mortality in patients with acute ischemic stroke. Atherosclerosis 2014; 236:150-3. [DOI: 10.1016/j.atherosclerosis.2014.06.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/17/2014] [Accepted: 06/30/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
| | - Stella D Bouziana
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Marianna Spanou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Vasilios Giampatzis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Maria Papadopoulou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Pavlina Kazantzidou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Stavroula Kostaki
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Vasiliki Dourliou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Hatzitolios AI, Spanou M, Dambali R, Vraka K, Doumarapis E, Petratos K, Savopoulos C, Tziomalos K. Public Awareness of Stroke Symptoms and Risk Factors and Response to Acute Stroke in Northern Greece. Int J Stroke 2014; 9:E15. [DOI: 10.1111/ijs.12261] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Apostolos I. Hatzitolios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Marianna Spanou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Roxani Dambali
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Katerina Vraka
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Eugenios Doumarapis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Konstantinos Petratos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Tziomalos K, Giampatzis V, Bouziana SD, Spanou M, Pavlidis A, Papadopoulou M, Boutari C, Magkou D, Savopoulos C, Hatzitolios AI. Effect of prior treatment with different statins on stroke severity and functional outcome at discharge in patients with acute ischemic stroke. Int J Stroke 2014; 8:E49. [PMID: 24024925 DOI: 10.1111/ijs.12116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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Kakaletsis N, Kaiafa G, Savopoulos C, Iliadis F, Perifanis V, Tzalokostas V, Grekou A, Giannouli A, Hatzitolios AI. Initially lymphocytic Sweet's syndrome in male patients with myelodysplasia: a distinguished clinicopathological entity? Case report and systematic review of the literature. Acta Haematol 2014; 132:220-5. [PMID: 24714374 DOI: 10.1159/000357933] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 12/12/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sweet's syndrome (SS) is an acute febrile neutrophilic dermatosis. It can occur as an idiopathic, drug-induced or malignancy-associated entity. SS is also seen in patients with myelodysplastic syndrome (MDS) where it may present atypically, both clinically and histologically. In a few rare cases of MDS, lymphocytic infiltrates are the presenting feature of SS. METHODS MEDLINE and Scopus were the data sources for our review. RESULTS A clinicopathological subsetemerged of 12 male SS patients with MDS and a mean age of 67.3 years in which the initial SS lesions were lymphocytic infiltrates. However, from 0.5 to 8 years later, sequential biopsies revealed neutrophilic dermal infiltration typical of SS. CONCLUSION Initially lymphocytic infiltrates in this subset could be attributed either to an early timing of the biopsy concerning the age of the lesion or to the dysgranulopoiesis syndrome. A possible relationship between the dysfunction of the receptor of the granulocyte-macrophage colony stimulating factor, the gene of which is located on the pseudoautosomal X-Y region, may exist in MDS patients with initially lymphocytic SS. This could explain the male gender of this subset and might establish initially lymphocytic SS as a distinguished clinicopathological entity for predicting the occurrence and even the prognosis of MDS.
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MESH Headings
- Aged
- Anemia, Refractory, with Excess of Blasts/complications
- Anemia, Refractory, with Excess of Blasts/pathology
- Biopsy
- Chromosomes, Human, X/genetics
- Chromosomes, Human, Y/genetics
- Disease Progression
- Humans
- Lymphocytes/pathology
- Male
- Middle Aged
- Models, Immunological
- Myelodysplastic Syndromes/complications
- Myelodysplastic Syndromes/pathology
- Neutrophil Infiltration
- Receptors, Granulocyte-Macrophage Colony-Stimulating Factor/genetics
- Receptors, Granulocyte-Macrophage Colony-Stimulating Factor/physiology
- Sex Factors
- Skin/pathology
- Sweet Syndrome/etiology
- Sweet Syndrome/genetics
- Sweet Syndrome/immunology
- Sweet Syndrome/pathology
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Tziomalos K, Giampatzis V, Baltatzi M, Efthymiou E, Psianou K, Papastergiou N, Magkou D, Bougatsa V, Savopoulos C, Hatzitolios AI. Sex-specific differences in cardiovascular risk factors and blood pressure control in hypertensive patients. J Clin Hypertens (Greenwich) 2014; 16:309-12. [PMID: 24621371 DOI: 10.1111/jch.12289] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/06/2014] [Accepted: 01/16/2014] [Indexed: 11/30/2022]
Abstract
Cardiovascular disease (CVD) and cardiovascular risk factors are frequently undertreated in women. However, it is unclear whether the prevalence of additional cardiovascular risk factors and the total cardiovascular risk differ between hypertensive men and women. There are also limited data regarding rates of blood pressure control in the two sexes outside the United States. The authors aimed to compare the cardiovascular risk profile between sexes. A total of 1810 hypertensive patients (40.4% men, age 56.5±13.5 years) attending the hypertension outpatient clinic of our department were studied. Men were more frequently smokers than women and were more heavy smokers than the latter. Serum high-density lipoprotein cholesterol levels were lower and serum triglyceride levels were higher in men. On the other hand, abdominal obesity and chronic kidney disease were more prevalent in women. The estimated cardiovascular risk was higher in men than in women but the prevalence of established CVD did not differ between the sexes. The percentage of patients with controlled hypertension and the number of antihypertensive medications were similar in men and women. In conclusion, hypertensive men have more adverse cardiovascular risk factor profile and greater estimated cardiovascular risk than women. However, the prevalence of established CVD does not differ between sexes. These findings further reinforce current guidelines that recommend that management of hypertension and of other cardiovascular risk factors should be as aggressive in women as in men in order to prevent cardiovascular events.
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Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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